For remote monitoring and care management companies
The home record your care managers work from.Minutes, contacts and checks, ready for the billing team's review.
Families already keep the patient's day in ExpressAgain: the readings, the doses, the symptoms and the team feed. Your nurses join that record, log their time and contacts on it, and the practice's billing team reviews the month from it.
In the browser on any phone, tablet or computer. Nothing to install.
- Care management programs run for practices: CCM, PCM and APCM
- Transitional care teams calling after a discharge (TCM)
- Remote monitoring companies whose devices send readings on their own
- Nurse care-coordination services working for physician practices
Where you stand
Your nurses work the phone. The patient's day happens at home.
Every month has to be written down
Every minute, every call, the consent, the care plan and the discharge date, written down where the practice's billing team can review it before anything is submitted.
The family is the one at home
The readings, the doses and the fall happen between your calls. In ExpressAgain the family writes them down, with the professionals who help in the home.
Typed is not transmitted
A number the family types is useful to your nurses. It is not a device transmission, and ExpressAgain never presents it as remote patient monitoring.
Built for fewer months that end with a missing consent or a call nobody wrote down, and for nurses who start each call knowing what changed at home. A pilot measures these with you, on your own patients.
The month, documented
The minutes, the contacts and the checks your billing team reviews.
Your nurses log their time and their contacts on the patient's record. The Billing support report under Reports gathers the month for the practice: who logged what, which checks the records meet, and the files the billing team opens.
ExpressAgain keeps the minutes, contacts and documentation your billing team reviews. It never sends a claim, never picks a code and never decides what may be billed.
Log time, in minutes and activities
Your nurse logs the minutes, the activity and a note, under Clinical on the care-team dashboard.
Billing support →How it works
Log time takes 1 to 480 minutes, one of seven activities (reviewed readings or records, a call with the patient or family, coordinating with other providers, teaching, the care plan, documentation or other) and a note. An entry can be dated back for late charting but never into the future. It documents time; it never names a code.
Log contact: calls, visits and a typed discharge
Calls, video, office and home visits, and the hospital discharge with its date, on one log.
Log time and contacts →How it works
Log contact records a phone call with the patient or family, an on-call nurse call, a video, office or home visit, a care-coordination call with another provider, and encounters such as an emergency room visit or a hospital discharge, with the day, the time, the minutes and who was involved. A clinician's timed contact is also saved as a time entry, so the two never disagree.
Documentation checks, per program
For CCM, PCM and APCM: each requirement the records can show, met or not yet, with where to fix it.
What the month documents →How it works
The Billing support report runs plain checks for chronic, principal and advanced primary care management: the conditions on file, the consent, the care plan and the clinical time logged. Each row reads met or not yet with a link to the place that fixes it; what the records cannot show is left for the billing practitioner to attest. The heading says what they are: documentation checks, not code determinations.
The transitional care rules, from the discharge
The discharge on record, the contact within 2 business days and the visit within 7 or 14 days.
Transitional care on the report →How it works
When a discharge is on record, from a facility feed or typed with the name of who typed it, the report checks the interactive contact within 2 business days (weekends skipped, holidays not) and the visit within 7 or 14 days. A pharmacy call or a call with another provider is not counted as the contact with the patient or family.
Consent, recorded per program
CCM, PCM and APCM consent with the date, verbal or written, and who recorded it.
Consent on the report →How it works
A clinical login records the patient's consent for a program with the date, whether it was verbal or written, and an optional note. The row keeps who recorded it and their organization, and a revoked consent stays on file, marked revoked. Until a consent is on file, the program's check reads not yet.
The flagged-alert trail and the necessity draft
Each flagged reading with who acknowledged it, and a draft the billing practitioner reviews and signs.
The flagged-alert trail →How it works
Under the checks: each flagged alert with its date and time, the reading and the target, who logged it, who acknowledged it and when, and the follow-up within 24 hours. Then a medical necessity draft built only from the month's records, with no model writing it; the clinician edits and saves it with their name, and the billing practitioner reviews and signs.
Two CSVs for the billing team
One row per time entry, headed by the practice's billing details, and a monthly summary.
The billing CSVs →How it works
Print the month, or download two files: one row per time entry with the date, the clinician, the discipline, their organization, the activity, the minutes and the patient's payer, headed by the practice's billing details when the practice has entered them; and the monthly summary of the month's facts and checks. The billing team reviews them in the tools it already uses.
We walk through one sample patient's month with you.
Between your calls
Your nurse starts each call knowing what changed at home.
The family, the home professionals and the clinicians log on the same record, and the family names the patient, so the app says Sam's Day and Sam's care. Every card below is in the app today and links the Help Center article that describes it.
Since your last visit, for a nurse
Vitals and glucose with their ranges, doses given, missed and refused, symptoms and flagged alerts.
Since your last visit →How it works
The dashboard opens to what was logged since your nurse's last logged visit, or since they last opened the record: vitals and glucose with their ranges and how many were outside the targets, doses given, missed and refused from the dose log, symptoms, and flagged alerts. Every line is a count, a range or what changed, never a diagnosis.
Care alerts on the targets the clinicians set
Every reading becomes a plain line; one outside the targets goes out at once.
Targets and care alerts →How it works
Every glucose, vitals or symptom entry becomes one line, such as Glucose, breakfast before, 312, above target, for every active clinical login. A clinician on the team can update the targets on the Care targets tab, stamped with who changed it. Each nurse picks instant, a daily digest or off; a text says only that an alert needs a look. A line says above or below target and never what it means.
Feed and alerts across your patients
One stream for every patient you may see, with Acknowledge and an escalation window.
Feed and alerts, and escalation →How it works
Feed and alerts is one stream of alert lines, team posts and activity for every patient in your scope, filtered by patient, by type or unacknowledged only. Acknowledge records it on your side and never changes the family's settings. When a flagged alert waits past the escalation window you set, the primary and covering providers are emailed.
The organization panel
Every patient you follow on one view: last reading, open alerts, unread feed and enrollment.
The organization panel →How it works
A stat strip (patients, open alerts, unread feed, readings today, enrollments pending), then a row for each patient with the primary provider, the last reading, open alerts and how old, unread feed and the enrollment status. Open takes your nurse into that patient's whole care-team dashboard; Back to panel returns.
Health reports, with Print and CSV
Vitals and glucose, medications, symptoms and alerts, and the weekly home summary.
Health reports →How it works
The same five reports the family reads: vitals and glucose, medications, symptoms and alerts, the weekly home summary and the visit flow sheet, for 7, 30 or 90 days or a range you pick. Each prints with the patient's name and the range and downloads as a CSV. Everything is counts, ranges and the words that were logged, never a judgment of a number.
The team feed, with the family and the clinicians
One conversation with the family, the practice and the professionals in the home.
The IDC Team feed →How it works
The care team's own conversation, where the family, the practice's clinicians, your nurses and the home professionals post, with an @ to ask one person. A reading, a dose or a ticked step of the day shows there as an activity line with the initials of who logged it.
Devices and monitoring
What a device sent, and what someone typed, are kept apart.
A reading someone types into ExpressAgain is never remote patient monitoring. Only blood pressure and glucose readings that a device vendor's key pushes in through the Partner API carry the Device transmitted tag, and only those days count as device days on the Billing support report.
Devices on file, and who provided them
Each home monitor, who provided it, since when, and whether it reaches the practice on its own.
Insurance & Devices →How it works
Devices on file lists the glucose meter, the blood pressure cuff, the scale and the pulse oximeter, who provided each one (the practice, a device vendor or monitoring program, or the family), the vendor or program name, since when, and whether its readings reach the practice on their own: yes, no or we do not know. The Billing support report prints each device on that line.
Device readings, pushed in through the Partner API
A device vendor's key pushes blood pressure and glucose readings in, tagged Device transmitted.
Devices that transmit →How it works
A device vendor set up with a Partner API key pushes blood pressure and glucose readings straight onto the patient's record, where Health Tracking shows them tagged Device transmitted and the care alerts treat them like any reading. Only those days are counted as device days on the Billing support report.
Typed and device numbers, side by side
When the family checks a reading against the meter, both numbers are kept and only the difference is shown.
Typed and device readings →How it works
Many families still type the reading and check it against the meter. Health Tracking keeps both numbers and shows only the difference, for example device said 132, typed 128, differs by 4, and never interprets it.
Bring the device programs you run to the demo.
How you connect
Five ways in, each set up with our team.
Which one fits depends on the practices you work for and on how your nurses document today. We decide it together before the first patient.
Your company as an organization, in preview
Set up with our team, starting with a few patients and a few people, enrolled with the family's yes.
Preview and signed organizations →How it works
ExpressAgain sets your company up as an organization in preview: a small number of patients and people to start, the number agreed with you. Enroll a patient by the family's email or mobile number; the message names your organization and its location, never the patient, and the family accepts, creating a free account first if they need one.
Inside the practice's organization
The practice invites your nurses on its Team and adds them to its patients as care coordinators.
Roles, and how people are added →How it works
When the practice you work for is on ExpressAgain, its administrators can invite your nurses to its own organization, and a provider adds a care coordinator to their own patients. Minutes count toward a practice when the login that logged them belongs to that practice's organization.
As the practice's partner, by referral
The practice lists your company under Partners and refers a patient to your caseload.
Partners and referrals →How it works
A practice keeps the companies it contracts with under Partners. Once your company is on ExpressAgain as its own organization, the practice can refer one patient at a time with a short reason; that patient appears on your caseload with who referred them, the family is told on the care-team feed, and either organization or the family can end the referral.
A care-team login per discipline
A family that already uses the app gives your nurse the Nurse code.
Join with a code →How it works
A family generates a code for one discipline, such as Nurse, on the Care Team page. Your nurse enters it at the IDC Team sign-in with their name, credentials and practice or company, and from then on signs in with an email and password and sees the shared record and the nurse's tools.
The Partner API, for your own platform
Read what families shared with you, push readings and PDFs back, and get webhooks.
Share with an organization →How it works
Your platform reads the readings, medications and care plan of the patients whose families shared with your organization by its six-character share code, writes readings and PDF documents back, and receives signed webhooks when a reading arrives or falls outside the targets. Every call is logged, the family can revoke at any time, and keys are issued only after a signed BAA.
An HL7 v2 feed for admits, discharges and results is built and pending activation. Ask us if the practices you serve send HL7. Partners and integrations.
The endpoints, scopes and webhooks are on the Partner API reference.
How a company starts
Three steps, starting with a few patients.
Book the 30-minute demo
We walk through one sample patient's month with you: the minutes, the contacts, the checks, the devices on file and the two CSVs.
Choose how your nurses sign in
With the practice you work for and with our team: your own organization in preview, inside the practice's organization, as its partner, or the Partner API for your own platform.
Enroll your first patients
The family accepts the enrollment. Your nurses log time and contacts from the dashboard, and the practice's billing team reviews the month.
Questions
What care management companies ask us.
Start with a few patients and one practice's month.
Book the 30-minute demo, or tell us about your program and a real person replies within one business day.
Request a demo
Talk to us about your program.
Which programs you run, for how many practices, and how your nurses document the month today. A real person replies within one business day.
Rather pick a time now? Book a 30-minute demo.
One team, one plan
Built for the interdisciplinary care team
An interdisciplinary care team is a group of different health professionals who work together closely with the patient and family to create a single, shared treatment plan. ExpressAgain is the platform where all of those parties care for one patient together: the same day, the same medications, the same notes, and the same record of who did what and when.
Family
the daughter, the siblings, the friends who show up
Home care
aides hired directly or sent by an agency
Clinicians
nurses, therapists, hospice, palliative, paramedics
Agencies
the office that staffs, schedules and bills