ClickCare Café

House Calls & Home Care Are Lonely But Medical Collaboration Helps

Posted by Lawrence Kerr on Thu, Mar 30, 2017 @ 06:04 AM

winterroad.jpgHouse calls are not a core part of my practice as a specialist, although I have made many.

In doing a house call, I think of driving up a snowy road to a decaying-but-loved farmhouse and moving next to a window's light to look at what might be cancer. I am always struck by contrasting feelings of attachment with the patient and family and isolation from the medical environment. Without doubt, seeing my patients in their home amplifies understanding of their challenges. Deeper understanding of their cultural and personal roots is placed front and center. (And, of course, that understanding is a great help, even if it sometimes makes clinical detachment difficult.)

For a doctor, it's unusual to have this level of immersion in patients' contexts on a routine basis. But for people who deliver care in the home -- the caregiver, the aide, sometimes the family -- it is their "normal." They see a developing stroke manifest by a slow degradation in clarity of speech, although it's hard to describe and hard to communicate. They see subtle changes in the nature of a wound that portend massive sepsis. But they are not given the tools or the structure to communicate these observations, hunches, and context effectively.

Medical hierarchy is both very deep, very entrenched, and often with caregivers and home care aides, seen as being at the "bottom." Because of the hierarchy, providers like aides, who primarily give care at home, are expected to carry out orders, not influence the course of care. So they're left with checkboxes and protocols, not tools to share their insight. Often checkboxes and protocols are designed to avoid mistakes, but instead have the unanticipated consequence of communicating nothing because there are not enough boxes to check.

The hierarchy has value in that a chain of command makes orders clear and accountability strong. However, complex situations demand a more complex flow of information. Not just orders from top to bottom, but information "uphill," too. And when information needs to flow uphill, the orderliness of hierarchy makes a strong barrier to responsive and personal adjustment and modification as a vital response to changing condition.

Beyond communication, we need to rely on collaboration where we take the best of everyone in the hierarchy and build a team and a plan. Teams change. Plans change. We need to accommodate, embrace, and adjust to the change.

So, to return to the title of this post, probably the loneliest and most solated work in healthcare is home health care. Changes are observed but it can be an almost impossible job to communicate those changes in the context of the hierarchy. When home monitoring sends a signal of weight change to a central station, that is lauded as a great breakthrough and it is. Then what? The caregiver in the home probably saw a change first and even knows the intervention that is needed. We need to recognize this and empower the change while keeping the entire team involved.

One more reason for doing what we are working so hard to do: getting access for the patient, collaboration for the providers, and use the interactions to teach those who follow us.

Help us help you. Try building true collaboration into your workflow.

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Tags: medical collaboration, healthcare collaboration, homecare, home care

What that Fearless Girl Can Teach Us About Telemedicine

Posted by Lawrence Kerr on Wed, Mar 29, 2017 @ 07:36 PM

fearlessgirl.jpg

The other day was International Women's Day. We certainly paused as the day came and went, since so many of the healthcare providers most crucial to the healthcare system are women -- across the continuum of care.

As I closed my computer for the day, though, an image caught my eye. It was a statue of a young girl, facing one of the most famous sculptures in the country -- the Wall Street bull. The statue itself was striking -- the little girl had the strength and quiet joy that remind me of my granddaughter. The location, of course, is also incredible -- to be facing down the iconic bull on the busiest corner on Wall Street.

It's not until I dug into the story behind the statue, though, that I really appreciated what I was seeing. The sculpture was created by artist Kristen Visbal, but it turns out that the statue wasn't placed there by a rogue artist. It was commissioned by the world's third-largest asset manager, State Street Global Advisors. State Street manages some $2.5 trillion in assets and is trying to pressure more companies into adding women to their boards. Not only that, as Business Insider reports, their "money manager said it would vote against boards if a company failed to take steps to increase its number of members who are women. State Street plans to send a letter to 3,500 companies on Tuesday asking the companies to act."

Those at the top have to risk their capital for the larger good.

We need diverse teams. As Ron O’Hanley, CEO of State Street Global Advisors, said, "creating diverse boards results in better governance."

 

Photo of the Fearless Girl statue by dnorton on Flickr, used under Creative Commons rights. Statue by Kristen Visbal.

Why You Can't Afford to Ignore Art as a Healthcare Provider

Posted by Lawrence Kerr on Tue, Mar 28, 2017 @ 06:01 AM

Rembrandt-Anatomy-Lesson-Dr.-Tulp-1024x775.jpegWe've always been obsessed with art, medicine, and the art of medicine. These are our passions, and the foundation of ClickCare.

Our co-founder, Cheryl, did a dual major at Smith College in Art History and Biochemistry. I've always loved the beauty and art in photography, video, woodworking, and in reconstructive surgery itself. And the entire iClickCare app is based on a profound appreciation of simplicity in design, and the nuanced art of medicine.

But, so many people ask -- with healthcare providers under such pressure, is it really practical to think about art in the context of medicine?We recently came across a New York times piece looking at new educational initiatives training medical providers and medical students to use art as a way of being better doctors.

Their goal was to help the new provider to become a more "thoughtful and meticulous observer." It may sound esoteric but the results are significant and hard-hitting. In fact, students of an art-and-medicine class at Yale were 10% more likely to pick up on important details on their patients, than did their peers. And students in a visual skills class made 38% more observations on a visual physical exam of their patients than did their peers.

When these educators speak of "training the eye" through art, that is precisely what we aim for in the iClickCare environment. Early on in iClickCare's history, people were surprised that we included photos in our collaboration tool. Originally, photos were deemed too high tech, and cameras too hard to operate. These days, so many people think secure texting is the way to go. But secure texting simply transmits a question, it doesn't improve our practice as doctors, teams, or as observers. When we use pictures, videos, and multidisciplinary conversations to care for our patients, we're not just doing medical collaboration for that individual patient, we're profoundly improving our capacity as healthcare providers and as healthcare teams.

The reality is that with iClickCare, we advance many of the same goals that are identified in these art and medicine classes. With the goal being to help healthcare providers:

  • Think broadly
  • Consider multiple interpretations
  • Observe closely
  • Empathize with the whole patient
  • Understand the context for your patient's condition.

As Harvard's Dr. Joel Katz (professor of Training the Eye: Improving the Art of Physical Diagnosis) shared, "We’re trying to teach them to trust their vision, to look carefully before making judgments.”

We're amazed that so many in the medical field see medical collaboration and medical photography as "optional" or as a "nice to have". If the third leading cause of death is medical errors, then these skills are far from optional -- they're life or death. 


If you want to work on medical photography, do healthcare collaboration, and see your patients differently, get the first chapter of our book on iPhone medical photography here:

Medical iPhone Photography

Tags: medical collaboration, best medical apps, healthcare collaboration

Can Collaborative Care Reduce the 3rd Leading Cause of Death in the U.S.?

Posted by Lawrence Kerr on Tue, Mar 21, 2017 @ 06:20 AM

collaborativecarecauses.jpgThe 3rd leading cause of death in the US is medical errors. 

No medical provider wants to make a mistake. And every hospital administrator wants to create the conditions for an error-free hospital. 

But the reality is that these errors happen on our watch. And we believe that the key to addressing them is something that few providers or administrators are addressing sufficiently: collaborative care and medical collaboration.

The first step in beginning to address medical errors is understanding their causes. The Joint Commission Center for Transforming Healthcare notes that 80% of medical errors are communication driven. The sad part of this note is that it was published in 2012, and now, 5 years later, very little has changed!

Communication errors, usually problematic handoffs, can result in misinformation to the attending physician, the consulting physician, the resident physician, the nurse or technician, or the patient and family. Results are delays in treatment, inappropriate treatment, “adverse events”, omission of care, increased cost, inefficiency from rework.

The Joint Commission's response to these issues --their TST tool -- is a set of protocols that describe what should happen and analyzes where mistakes occur. We think this tool is a tremendous contribution to the space. It's so important to look at where mistakes happen and identify the ideal flow to avoid them. 

That said, a set of protocols doesn't give providers a tool for what should happen, or make it any more likely to occur. We generally start with the understanding that medical providers are trying just about as hard as they possibly can -- so it's not a better understanding of what they should be doing that they need, it's help to do it.

Of course, our current tools don't support us as medical providers in addressing any of these issues. EMRs / EHRs are for recording what happened, not doing things better. 

That's why we believe that it's so crucial to use Hybrid Store-and-Forward® telemedicine as a tool to do medical collaboration and improve handoffs and communication. It's one of the few things not just telling you what you should do -- but actually making it faster and easier to do it. Medical collaboration is challenging because it involves transmitting complex information to a multidisciplinary team, in a way that works with people's hectic days. This kind of tool supports that, never missing a beat.

We try very hard not to promote iClickCare here, and really want to discuss the environment in which we live and work. But, we very much want you to have the tools you need to work how you want to work. 

Try the iClickCare 14-day evaluation

Tags: medical collaboration, healthcare collaboration

Your Hospital's Design Could Kill Your Patients

Posted by Lawrence Kerr on Wed, Mar 15, 2017 @ 09:15 PM

hospitalsdesign.jpgWhen it comes to HIPAA, we are vigilant to keep doors locked, technology hyper-secure, and even watch what we say to colleagues in elevators.

These things are important, of course, and they're also the way to avoid big fines and sanctions when as we protect patient privacy.

All of that goes out the window, however, when we're sitting with a patient in a curtained hospital room with a handful of people within earshot. We collect personal information, talk about diagnoses, and discuss sensitive history. It's not a lack of sensitivity on the part of the provider -- it's just a reality of how hospitals are designed.
Of course, this little quirk of how hospitals are designed is just one of the myriad ways we get used to suboptimal design. Not only do we get used to it, but we begin to think that the status quo is probably the best way.

As the New York Times writes, "Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we’ve been building them all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us."

The way we design hospitals also trickles down to other technologies and tools we use. The idea that "design flaws may be killing us" resonates with me as a description of EMRs/EHRs as well. Whether it is inefficient workflow, frustrating experiences for providers and patients, or realities about fatalities that we can prevent, poor design can cost us. We get used to hospitals, and this comfort with the status quo affects how we design tools like EMRs/EHRs, which in turn, affects how we work with each other on teams.

We designed iClickCare to support true medical collaboration of teams. The design supports the behavior. The truth is that many people get used to a way of working that fits with the status quo -- and it takes a person who is willing to think differently to try something new.

So is it a lost cause? "Hospitals can be dangerous and unpleasant,” Roger Ulrich, a professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden says, “But there’s a lot we can do to keep patients safe and help them recover.”

Hospitals are increasingly questioned as to the ideal way to provide care. So much is being decentralized now -- technology supports us in providing and receiving care far from the "center" (which always used to be the hospital). In fact, one way that the article highlights hospital improvement is to decentralize nurse's stations to increase speed to the patient. Whether it is rural care, at-home care, or concierge medicine, hospitals are coming into question across the board.

Of course, our buildings and tools aren't going to change overnight. But we can start looking at our behavior, and questioning whether the tools are serving us -- or whether we've shaped our behavior to an inadequate tool. 

If you want to try a different way of working, using a tool to do medical collaboration, try iClickCare for free:

Signup for an iClickCare Account

Tags: telemedicine, medical collaboration, medical collaboration software

Medicine: Part Art, Part Science, Part Rebellion and Now Healthcare Collaboration.

Posted by Lawrence Kerr on Tue, Feb 28, 2017 @ 06:20 AM

neurons.jpgSantiago worked as a kid. First, he apprenticed with a barber, then a cobbler.

But what he always wanted to be was an artist. He had a gift for drawing, and a love for art -- despite neither thing being much supported by his school or community. He was also rebellious and anti-authoritarian when it came to school. He even went to jail when he was 11, for something between a prank and a crime (he destroyed his neighbor's gate with a homemade cannon.) His father wanted him to be a doctor, though. And one day, trying to find a link between medicine and the arts for him, Santiago Ramón y Cajal's father took him to a cemetery, carrying home bones for him to sketch. (This might seem macabre now, but can be understood in the context of early anatomical studies, Ramón y Cajal's father being an anatomy professor.)

That day must have forged just enough of a connection between medicine and art, because Ramón y Cajal ended up going to medical school and, indeed, becoming a doctor. He became fascinated with understanding how neural impulses travel through the brain. He spent his days "hunched over a microscope" in his lab, making hyper-detailed, conceptually original drawings of neurons -- all of which added up to a transformation of how we understand the brain.  

Close to 100 years later, Ramón y Cajal is now known as the father of modern neuroscience and is a winner of the Nobel Prize. He used a combination of close observation, his own drawings, and deep insight to advocate for a theory of how the brain works that is precisely how we understand the fundamentals today.

We find Santiago Ramón y Cajal's story inspiring when it comes to our pursuit of telemedicine for a few reasons:

A picture really is worth a thousand words.
He demonstrates how our understanding often starts with the visual, especially of complex systems. He didn't start with theories or concepts. He started with drawings -- both to understand what was happening in the brain, as well as to communciate it. We see exactly the same dynamic with iClickCare. In Hybrid Store-and-Forward telemedicine you can use pictures and videos (not just words) -- these images enable understanding, as well as communication and then collaboration.

Working together is the only way to true significance.
As the New York Times said, Ramón y Cajal's theory for how neurons speak to each other "was made possible by Ramón y Cajal’s refinement of the Golgi stain and his persistence in sharing his ideas with others." The Golgi stain was a project that he didn't even start; he borrowed the stain technology, and then improved it in collaboration with Golgi. His sharing of these theories and drawings were what changed how we see the brain. This is a deeply held principle and why we are so passionate about telemedicine: even geniuses don't work in isolation. It's only by sharing our work that it gains significance.  Further, the mystery of connections elucidated by Cajal certainly feels the same now for healthcare collaboration 2017 as the neurons did at the turn of the last century.

Medicine is part art and part science.
Every moment with a patient is part art and part science. Every conversation with a colleague is part art and part science. And the same goes for telemedicine. For an iClickCare consultation to be effective, there is always a great photo and a thoughtful question. You don't have to be a great photographer, but there is a creative side to communicating well, especially through photos. 

 

We hope that this story inspires all of you to work at the intersection of art and science (with maybe just a little rebellion thrown in as well.) 

 

For a free guide to the basics of using your iPhone for medical photography and telemedicine, click here: 

 

Medical iPhone Photography

Resources: 

http://www.nobelprize.org/nobel_prizes/medicine/laureates/1906/cajal-bio.html

https://www.nytimes.com/2017/02/17/science/santiago-ramon-y-cajal-beautiful-brain.html

https://en.wikipedia.org/wiki/Santiago_Ram%C3%B3n_y_Cajal

Photo from 42600332@N08 on Flickr, used under Creative Commons rights.

Tags: telemedicine, good medicine

Don't Choose the Worse Treatment Just Because It's Complicated

Posted by Lawrence Kerr on Wed, Feb 22, 2017 @ 06:18 AM

complexity.jpgLast year, I was sitting at a conference room table with high-level administrators at a major hospital. They were looking for ways to use telemedicine to improve care coordination, decrease readmissions, and bring down length of stay. They were thrilled about iClickCare because, as they said, "This is something our providers would actually enjoy using."

Their main concern before moving forward with iClickCare? "It's too inexpensive."

At first we were concerned -- did they mean the solution wasn't complete enough? "No," they confirmed, "It's actually much more complete and adaptable than other solutions. It's just that our board is expecting a much more expensive purchase, with a large hardware outlay."

As counterintuitive as that experience was, the sentiment is not uncommon. So many times, we think that expensive hardware is the "right" way to approach a problem.

Similarly, recent studies are showing that time, physical activity, and over-the-counter ibuprofen is the best possible treatment for back pain. Not surgery, not an MRI, not opioids. And as healthcare providers, we know that prescribing "go for a run, take some Advil, and don't call me for a few months" may well be a harder pill for a patient to swallow than, well, a bottle of pills. 

Telemedicine does not depend on expensive hardware and high-end cameras, just as most treatment for back pain doesn't depend on surgery or medication. The unglamorous truth is that telemedicine success comes from people working together effectively -- and the medical collaboration tool has to be simple and effective enough to allow that to happen. 

Just as a great healthcare provider uses the least invasive treatment that will be effective, we believe the simplest telemedicine solution is usually the best one. And we know that for a lot of healthcare providers, that's a pretty big relief.

If you're ready for a simpler solution for telemedicine and healthcare collaboration, try iClickCare for free:

Signup for an iClickCare Account

Tags: hybrid store and forward medical collaboration, medical collaboration software, telemedicine solutions, healthcare collaboration

Does Ego Make Doctors Better or Worse?

Posted by Lawrence Kerr on Mon, Feb 20, 2017 @ 06:33 AM

ego.jpgAs a specialist surgeon, the stereotype is that we have big egos.

The caricature of a surgeon is that we drive up to the hospital in a late model BMW (now Tesla?), running late but without a call to the OR, perform the surgery like a prima donna, and without pre- or post-operative care, float away to other "fancy" work, leaving the rest of the team to clean up the pieces.

It's behavior that typifies a "big ego job" as defined in this article. But do surgeons -- or healthcare providers in general -- have big egos? It's fascinating to note that the biggest ego jobs are found to be cooks, chief executives, and art directors, with medical doctors not even ranking in the top ten. Our culture so often thinks of doctors as having big egos, when really most healthcare providers are all too aware of their own shortcomings.

So what's the truth? Well, I think that surgeons do tend to have a lot of confidence -- enough to slice into people on a daily basis, trusting we'll do less damage than good. And we do tend to associate our self worth with our ability as professionals, which creates a kind of drive to improve that is often associated with big egos. 

But I don't think that having a lot of confidence in your own abilities translates necessarily to the "lone wolf", interventionist, hyper-non-holistic caricature I just described. It doesn't translate into having a big ego in the negative sense.

In fact, I see the best medical collaboration happening among medical providers that take a lot of pride and confidence in their own abilities.

BUT -- they know that they can provide the best care when they work together with other extraordinary medical providers.

My greatest professional satisfaction has always been collaborating with the best in the business. There is a thrill to sitting at a table with a social worker, nurse, speech pathologist, and oral surgeon and mapping out the best conceivable care for a 3-month-old with a cleft palate. And every time one of our colleagues uses iClickCare to request a consult on a case, they get that satisfaction of connecting with an excellent colleague, the knowledge of providing the best care for the patient, and all without picking up a phone or scheduling anything.

So does a big ego make you a better or worse healthcare provider? I think the answer is that it makes you a better healthcare provider -- as long as you look at the whole picture.

"None of us is as smart as all of us," is attributed to Einstein. Each provider has a different perspective, experience, and expertise. Each is going to care for the patient in a different way. So medical collaboration isn't optional if we want to be the best in our field -- it is the only way.

ClickCare Quick Guide to Medical Collaboration

Tags: telemedicine, medical collaboration, healthcare collaboration

The VA's New Approach to Healthcare IT is Surprising -- But Useful

Posted by Lawrence Kerr on Tue, Feb 14, 2017 @ 06:04 AM

vaapproachtoit.jpgThe VA's operational, managerial, and technological struggles have made nationwide news in recent months and years.

But the Department of Veteran Affairs is working on a new approach to scheduling, EHR interoperability, and billing.

Since the VA is an extreme case in terms of the problems they're facing, resources available, and unique constraints given their governmental status, their approach to these changes is surprising -- and potentially a good model for other hospital systems.As Fierce Healthcare reports, "Lawmakers continued to criticize VA officials for using decades-old legacy systems, drawing comparisons to the overwhelming costs required to maintain an old car."

We tend to trust that despite all of the VA's challenges, the vast majority of administrators and healthcare providers are doing their absolute best to improve care at VA hospitals, within the constraints they have. A recent article reports that they are making a fairly dramatic shift in how they approach their IT and their purchasing. As Fierce Healthcare reports, the VA is "considering commercial products and moving data to the cloud instead of spending money building customized in-house systems."

So does that shift have anything to teach the rest of us who are also trying to improve our systems, while cutting costs, and improving performance? We think so.

There are three great ways to improve performance and adaptability while not increasing costs, as the VA is beginning to find:

Don't build everything custom.
As David Powner, director of IT management issues at the Government Accountability Office said, "Buying instead of building is the way to go." There is a growing community of products available for the healthcare system, iClickCare being just one of them. Are they all perfect? Of course not. But if you keep a shrewd eye on HIPAA compliance and a high prioritization on ease of use, you often more easily find an off-the-shelf product that will meet your needs than building from scratch.

Use the cloud.
The VA says they're looking more to cloud-based software, and that certainly makes sense to us. iClickCare has always been cloud-based because it allows us to be constantly updating the software as needs change, technology improves, and our offerings evolves. It means that with a single subscription, you get cutting edge technology -- without your team needing to use time or resources to update it yourselves.

Don't over-invest in hardware.
The Government Accountability Office has estimated that a large portion of the VA's budget has been going to maintain systems that are more than 50 years old. Wasteful? Definitely? Dumb? Probably not. This type of expenditure often comes from having a lot of hardware that would be impossible to update but expensive to replace. This isn't just the VA's problem, though, it's every hospital system's challenge when they've overinvested in hardware, rather than investing in software, systems, and people. As we've shared in other posts, hardware is often the least cost-effective, least innovative way to pursue telemedicine -- and this concept applies to other Healthcare IT as well.

 

We look forward to seeing the VA evolve and grow in coming years, and we hope that this shift toward modernizing their approach to IT is the sign of more great things to come. 

 

If you're curious how iClickCare works to limit your hardware expenditures and keep you HIPAA safe, click here to learn more:

Tell Me More About iClickCare

Tags: telemedicine, healthcare collaboration software

Talking to Your Patients May Be The Most Effective Part of Their Treatment

Posted by Lawrence Kerr on Wed, Feb 08, 2017 @ 06:30 AM

coversationbag.jpgMany healthcare providers fell in love with science first, and medicine second.

Innovation, scientific advancements, academic rigor, and medical sophistication are in our blood.

That said, the more we advance our understanding of medicine, the more we see that medicine is about more than just hard science and concrete treatment interventions.

Our medical training has always shown us that: 

  • More "specialized" and "advanced" providers are not more important that other providers on the continuum of care.
  • Medicine is about wellness, not just the absence of disease.
  • Healing is more complex than just implementing surgical or medicine-based interventions.
  • Medical care is most effective in a context of care, not considered in isolation.
  • We can only provide effective care to patients through medical collaboration.

Two recent articles reminded me of these currents in medicine and struck me in terms of their importance.

First, The Conversation Placebo looks at a study in which several physical therapy treatments for back pain were compared: electrical stimulation only; placebo, electrical stimulation with in-depth provider-to-patient conversation; placebo with in-depth provider-to-patient conversation.

While electrical stimulation outperformed placebo alone, conversation with placebo outperformed electrical stimulation alone. The best performer of all of the treatments was electrical stimulation with in-depth provider-to-patient communication. 

In other words, the conversations we have with our patients may well be the most important part of their treatment plan -- more important, even, than the medicine we give them. 

The second article looks at the huge "workforce" of unpaid caregivers (like family members) who are providing care in this country. This article argues that these caregiver providers are an indispensable part of healthcare, and yet they are poorly supported and integrated into the care plans of patients. The author says, "health systems, under pressure to reduce costs, increasingly rely on [unpaid caregivers like family members] to manage illness at home."

"There’s more we medical professionals can do to improve the way we engage, support and educate them. Family caregivers aren’t always clearly listed in the medical record, and even when they are, we often fail to include them in important decisions about a patient’s treatment plan — despite expecting them to carry out that plan at home."

Both of these articles point to a valuing of the elements of healthcare that may not be highly paid, traditionally valued, or empirically proven. But both caregivers and doctor-patient conversation are some of the most important backbones of real medical care.

But we need tools that will help us approach medicine in this kind of holistic, inclusive, collaborative way  we need tools to do medicine right. In fact, most medical providers have no HIPAA compliant way to include caregivers in any conversation about care  or to inform them of the care plan in any formal way. That's why iClickCare allows medical providers to collaborate on cases and enable free-form conversation between the medical providers and the patients. To that end, we have an "invite patient" feature, which can be used for patients or caregivers. 

As you evolve your medical practice, you're not alone. There have been tools built to help you  every step of the way. 

Tell Me More About iClickCare

Tags: telemedicine, medical collaboration, long term care

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