Allergy & Immunology Practice Software

Allergy and immunology practices run a unique operational model: a large volume of injection patients cycling through on individualized schedules, combined with clinic visits for diagnosis and management.

The injection volume:

A busy allergy practice might manage 500-1,000 patients on allergen immunotherapy. Each has an individual schedule — weekly during build-up, monthly during maintenance. Each has an individual vial set. Each gets 30 minutes of post-injection observation.

Coordinating this volume without systematic tracking leads to: - Missed escalation points - Patients staying on incorrect doses - Vials expiring before use - Observation time errors - Reaction documentation gaps

The biologic opportunity:

Severe asthma, chronic urticaria, eosinophilic esophagitis, and food allergy prevention (peanut OIT) now have biologic therapies. These require prior authorization, patient monitoring, and ongoing management.

The RTM opportunity:

Allergic patients track symptoms between visits — asthma symptoms, rhinitis severity, hive episodes, food reactions. This monitoring is billable as RTM.

Allergen immunotherapy is the core operational challenge of allergy practice.

The escalation protocol:

Immunotheray follows a build-up phase (weekly injections, increasing doses) followed by maintenance (monthly injections at maximum dose). Each patient progresses at their own rate based on reactions.

What clinIQ does:

Patient injection record: Current dose, vial set, last injection date, next scheduled, escalation status.

Dose verification: Before injection, system confirms: correct patient, correct vial, correct dose per protocol.

Reaction documentation: Any local or systemic reaction documented with dose, timing, and outcome. Reactions influence next dose.

Escalation tracking: Which patients are in build-up vs maintenance? Which are due for dose increase?

Missed injection management: Patient missed 4 weeks — protocol requires dose reduction. Automatic flag with recommended adjustment.

The observation workflow:

Patients wait 20-30 minutes post-injection for reaction observation. Who's waiting? Since when? Who's cleared?

clinIQ tracks observation start and elapsed time. Staff see who needs to be checked and when they're ready for discharge.

The reaction protocol:

Systemic reaction → epinephrine → observation extension → dose hold → physician review. Every step documented.

Each immunotherapy patient has their own vial set — typically 2-4 vials at different concentrations, mixed specifically for their allergen sensitivities.

Vial lifecycle:

- Mixing: Vial mixed with patient-specific allergen concentrations - Expiration: Most vials expire within 3-6 months - Doses remaining: Track doses used, doses remaining - Replacement: Order replacement vials before current set runs out

What clinIQ does:

Vial inventory: Every patient's vial set, mix date, expiration, doses remaining.

Expiration alerts: Vial expires in 14 days, still 8 doses remaining — alert to patient and staff to schedule more frequent visits or order new mix.

Replacement scheduling: When doses run low, trigger for new vial order.

Lot documentation: Vial lot numbers documented for each injection (required for adverse event reporting).

The expiration problem:

Expired vials are a patient safety issue and a waste issue. A vial set for a non-compliant patient might expire with many doses remaining — that's allergen extract cost wasted and a billing opportunity lost.

Allergy biologics require prior authorization with specific documentation requirements.

Severe asthma biologics:

- Nucala (mepolizumab): Eosinophilic asthma, eosinophil count required - Fasenra (benralizumab): Eosinophilic asthma - Dupixent (dupilumab): Type 2 asthma, also approved for other conditions - Tezspire (tezepelumab): Severe asthma regardless of phenotype - Xolair (omalizumab): Allergic asthma, IgE levels required

Chronic urticaria:

- Xolair (omalizumab): Chronic idiopathic urticaria — requires documented failure of antihistamines

What clinIQ does:

Auth status per patient per drug: Current authorization, start date, expiration, doses/injections remaining.

Expiration alerts: 'Xolair auth expires in 21 days. Next injection scheduled next week.'

Phenotype documentation: Eosinophil counts, IgE levels, pulmonary function — labs tracked for authorization support.

Step therapy documentation: Prior medication trials (antihistamines, ICS, LABA) documented with dates and outcomes.

In-office vs home administration: Some biologics are given in-office (Nucala, Fasenra, Xolair). Others can be home-administered (Dupixent). Tracking differs.

The in-office injection workflow:

For in-office biologic injections: Auth verified → patient arrived → injection given → observation → discharge. Separate from immunotherapy injection workflow but same observation requirement.

Allergic patients monitor symptoms between visits — and that monitoring is now billable.

What allergy patients track:

Asthma: - Symptom days per week - Nighttime awakenings - Rescue inhaler use - Activity limitation - Controller medication compliance

Allergic rhinitis: - Daily symptom severity (sneezing, congestion, itching) - Medication use - Trigger exposure - Impact on sleep and daily function

Chronic urticaria: - Hive frequency and severity - Angioedema episodes - UAS7 (Urticaria Activity Score) tracking - Medication use and compliance

Food allergy: - Accidental exposure incidents - Symptom tracking - Avoidance compliance

The CPT codes:

98975: RTM setup — one-time. ~$20-25. 98977: RTM device supply. ~$50-60/month. 98980: RTM treatment management — first 20 minutes. ~$50-70/month. 98981: Additional 20-minute increments.

Typical: $120-150/patient/month.

What clinIQ does for allergy RTM:

Condition-specific templates: Asthma patients get asthma questions. Urticaria patients get UAS7 tracking.

Flare detection: Symptom frequency increasing? Rescue inhaler use up? Urticaria activity score rising? Alerts trigger.

Pre-visit data: Symptom trends available when patient arrives for allergy visit.

Automatic time tracking: Every data review documented toward 20-minute threshold.

Allergy practices have a unique patient flow challenge: injection patients and clinic visit patients sharing the same space.

The two patient streams:

Injection patients: Check in, get injection, observe 30 minutes, leave. No physician needed unless reaction.

Clinic patients: New consultations, follow-ups, challenge procedures. Physician required.

What clinIQ does:

Separate queues: Injection patients and clinic patients managed separately. Nurses see injection queue. Physicians see clinic queue.

Observation room visibility: Who's in observation, how long, when ready for discharge.

Challenge procedure tracking: Oral food challenges and drug challenges require extended observation with specific protocols.

Challenge procedures:

Oral food challenges (OFC) and drug challenges are half-day or full-day procedures. Multiple staff, multiple doses, extended observation. clinIQ tracks challenge protocol steps and dose timing.

Allergy implementation covers injection program, vial tracking, and RTM.

Week 1: Configuration

Injection program configured: escalation protocols, observation requirements, reaction documentation.

Vial tracking configured: current patient vials loaded, expiration tracking active.

RTM templates: asthma, rhinitis, urticaria condition templates.

Week 2: Training

Injection nurses learn patient queue, dose verification, observation tracking. Front desk learns patient flow. Providers learn biologic auth and RTM dashboard.

Week 3: Go-Live

Injection tracking active. Vial expiration alerts running. RTM enrollment starting.

ROI Timeline:

Month 1: Injection compliance immediate. Vial expiration alerts preventing waste.

Month 3: RTM billing building. Biologic auth organized.

Month 6: Full RTM revenue. Injection program fully optimized.

ROI Math:

RTM revenue: 60 patients × $130/month = $7,800/month = $93,600/year

Vial waste prevention: Expired vials typically cost $200-500 each. Systematic tracking prevents significant waste.

Injection efficiency: Systematic dose management prevents errors and adverse events.

Investment:

Professional: $499/month

Implementation: $750 one-time