A new platform developed by Cleveland-based Zivian Health aims to help nurse practitioners and physician assistants expand their scope of practice.
The HIPAA-compliant and HITRUST-secure platform is designed to help healthcare organizations broaden patient access and scale their operations while streamlining team-based care, say two of the founders.
Compliance conundrum
Those co-founders, Dr. Rafid Fadul, director of pulmonary medicine at Blanchard Valley Health System in Ohio, and Jesse Corn, Zivian’s chief product officer, say the technology was designed with states’ varying practice rules in mind.
Each state and territory has its own version of the Nursing Practice Act, which oversees licensing throughout the career of nurses.
If a nurse violates a state’s law or NPA rule, the state board of nursing can discipline that nurse — which could mean losing their license and any multistate licensing privileges they may have, according to a Overview of the law in the National Library of Medicine.
While 27 states and Guam grant nurses full practice authority, the rest are reducing or limiting their practice authority, according to NurseJournal’s state by state guide.
Many of these states are littered with healthcare deserts – places where NPs could be valuable in expanding much-needed access to patients, even if there is a shortage of physicians.
“By 2040, the number of NPs will have eclipsed the number of physicians,” Fadul said. Healthcare IT news.
But for certified NPs in states that limit their ability to assess patients’ conditions, order tests, diagnoses, prescribe medications, and order treatments, they need a licensed physician associate and must ensure that all comply with state and federal laws and regulations that apply to their licenses and those of their employees.
First, they must find a licensed physician associate that fits their practice area, and then securely share patient records. In the long run, they must oversee all federal and state regulations and licensing.
“If you’re in Texas, or if you’re in Georgia, or if you’re in Pennsylvania, it’s different,” Corn explained.
Since emerging from stealth in August, Zivian has steadily attracted individual practitioners and independent practices. The company now has such providers in every state, which currently represents 45% of its revenue, Fadul said.
From tired to powerful
First, the company matches nurses like Kathryn Anderson, APRN, FNP-C, of Cross Roads, Texas, with a physician associate licensed in their state, Fadul said.
Matches are made from Zivian’s selection of 4,000 physicians based on services, size and required licenses and practice areas.
As a board-certified family nurse practitioner with 12 years of experience, Anderson said she was looking for a better work-life balance, and so were many of her fellow nurses. So they founded Elite Healthcare, which opened in November 2021, to gain control over their patient volumes and the length of patient visits, she said.
They all questioned the “safety” of their licenses as they attempted to see more than 60 patients of varying acuity per day working under local physicians.
“We were just persistent and tired,” she said. “Patients were not receiving the best possible care.”
Now in their independent practice, which has four NPs, appointments with patients are scheduled in 30-minute blocks.
Although the lake community is located in densely populated Denton County, Anderson says physical medical services are in high demand.
Anderson said she met Fadul when the aspiring nurses left their previous employers and founded Elite. They were looking for a collaborating physician licensed in Texas, and he responded to the nurses’ only national ad — which Anderson said generated an unexpectedly overwhelming response.
If more nurses want to practice in the states that require physicians to collaborate, a collaboration and compliance platform is “the entrepreneurial opportunity (nurses) need,” Anderson said.
She noted that she also has telehealth patients in medically unserved areas outside of Texas, which require compact licensing in those states.
“This model works well with anything where supply and demand are mismatched, especially at the physician level,” Fadul said.
Removing administrative burden
Anderson explained that when Elite’s NP team met Fadul, he was already consulting with other nurses and they immediately knew he clearly met their needs.
However, that was before the Zivian technology had been developed – and there was a lot of extra administrative work, she said, including Fadul gaining access to the practice’s electronic medical records.
“Instead of requiring doctors to log in to multiple electronic medical records, Zivian has EPD-free overviews within the platform, so that collaboration is less burdensome and the chance of human error is reduced,” says Corn.
Because it is also secure and file independent, NPs can share images and other patient information.
“It’s SOC 2, supported in the cloud,” Fadul noted.
Anderson said the “seamless upload of card information” and secure chat functionality have streamlined the practice’s communications with Fadul, who remains the practice’s licensed associate.
Providers also get the feedback they need more quickly from their licensed employees on the platform, Corn said.
“As we’ve worked with more providers, it was important for us to create a way for a highly targeted feedback loop that is transparent to these providers and has it on the platform.”
The HIPAA-compliant chat feature allows NPs and PAs to “leave a message for their provider at any time,” he said.
“We wanted to create or open up communication tools to them in a way where they can feel protected and talk freely about what they need to talk about, share files, etc.”
Improving access to specialized care
The collaborative team approach is also useful for high-demand specialties such as behavioral medicine and infertility medicine, Fadul said.
Charisse Fullwood, a psychiatric nurse from Raleigh who was previously a labor and delivery nurse and now provides maternal and child health care, credits Zivian for making the launch of her practice, Mind & Body Renew, possible.
She said access to a physician associate licensed in her state has given the green light to a growing telehealth caseload without concerns about licensing compliance.
“It’s pretty seamless,” Fullwood said.
Fadul noted that since behavioral health “really lends itself to a virtual first,” the collaborative platform is an excellent channel to increase access and “really have some impact.”
“Moms are busy,” Fullwood said, so her ability to provide all forms of behavioral telehealth under her associate’s license is essential.
Covering legal bases
Because Zivian oversees physician licensing and licensing laws in the United States and all territories, if a red flag comes up, it will be reflected on the platform within a month, Corn explains.
“They’re going to prescribe,” so nurses need to be assured of compliance once their bespoke agreement is signed.
Physicians are also covered under nurse practitioner malpractice insurance.
“One of our key pieces of software is a rules engine through which we continually analyze the state rules and what happens is translated into actions for the providers,” he explained.
“Depending on your state and depending on the type of provider, every month there are certain actions you are asked to complete and then there is a test that you complete.”
Based on specific government regulations, the platform creates certificates and then checks whether employees stay informed and complete these tasks.
In addition, outside counsel is helping Zivian evaluate proposed rule changes, Fadul noted.
But with artificial intelligence on the back end “scrapping new rules and regulations” to enforce compliance, Anderson says nurses in her practice no longer have to do “a lot of extra work to keep up” and can focus their attention on patient care .
“Having that guarantee creates more confidence,” she said.
The company’s credentialing committee also discusses employees “who may not be a good fit for our platform,” Corn noted.
Meets the needs of physicians and businesses
Fadul and Corn said Zivian will roll out additional workforce management offerings in about six to nine months to help healthcare organizations outsourcing compliance and companies looking to scale.
“It’s a provider for the providers, it’s a home for them to manage everything throughout their career,” including licensing, payer credentials and more, Corn said.
Such data would also help improve Zivian’s compliance oversight, the founders said.
Shortening the learning curve “is also desirable for the companies,” Fadul said.
“Imagine a world where (clinicians) have the opportunity to upskill and get what we call ‘microbadges,’ and demonstrate the deeper training required within a specialty area,” he described.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.