ClickCare Café

Why HIPAA Secure Healthcare Collaboration Is So Crucial to Providers' Survival

Posted by Lawrence Kerr on Wed, Sep 20, 2017 @ 06:00 AM

rawpixel-com-255080.jpgHealthcare providers tend to feel like they're being pulled in five directions at once.

We're supposed to improve patient satisfaction, use the new EMR/EHR more meaningfully (read: spend more time on the computer), connect deeply with each patient, and increase productivity.

No wonder most of us are burnt out.

Similarly, there are two dramatic trends that are pulling in opposite directions for healthcare -- and unless they use tools to reconcile them, providers are the ones who will feel, even more, torn apart.

I came across an article recently -- published by the consulting megalith McKinsey -- looking at how industries are beginning to change shape. The future, the article argues, will be made up of industries without borders, in which sectors and company lines become more fluid, and the organizations that collaborate best, win. 

I don't naturally apply learning from the business world directly to medicine because I believe medicine is unique. It's not an "industry" in the real sense of the word. It's an art, a calling, a science. 

But the business world is often the first to identify trends, as their profit motive drives them to identify changes before they are blindsided by them. And the changes predicted in the McKinsey piece seem to herald changes that are very much afoot in medicine as well. 

The general idea is that moving forward, organizations will need to collaborate more with each other, share data, and rethink how they draw the lines around what they do.

Current examples of this happening are like Amazon (sells consumer goods, providers digital content, and does logistics -- all in one company) or Apple. McKinsey argues that these blurry lines are just the beginning of what's to come. These shifts are in the works for a few reasons:

  • Technology makes it easier for communication to happen.
  • Customer (or patient) expectations have shifted. In the past, it was acceptable to tell a patient that you had no way to see their chart from another provider. In the future, this will become untenable.
  • Regulatory shifts demand it. In medicine, shifts away from fee-for-service models mean that we can no longer just provide our narrow service and expect to survive. We're expected to manage costs, readmissions, length of stay, and ultimate outcomes from the work we do.

McKinsey says, "As the approaching contest plays out, we believe an increasing number of industries will converge under newer, broader, and more dynamic alignments: digital ecosystems... This new environment will play out by new rules, require different capabilities, and rely to an extraordinary extent upon data."

I believe that we will see a similar dynamic in medicine moving forward. The lines among functions, sectors, and hospital systems are blurring. That's why we see this demand for coordination. We're no longer in a fee-for-service world. Instead, care coordination is explicitly our job, we're held responsible for outcomes and results, and the teams we work on are becoming broader and more complex.

But hospital systems and healthcare providers are not equipped to handle these dynamics. In fact, healthcare has spent the last 20 years moving in the exact opposite direction. We've seen huge consolidation, in which insurance companies become more powerful, hospital systems grow larger, and the siloes we work in become evermore separate. We're asked to become piecework laborers, keeping our head down and performing the task for which we are specialized.

It is more necessary than ever to collaborate and coordinate care but it is also harder than ever because we are separated in the work that we do. That's why healthcare providers feel so torn and overworked; they are being tugged by both of these forces simultaneously. 

We believe that the only resolution of this dynamic is to use tools, like iClickCare to collaborate and communicate within the current medical structure. The demands on you to do healthcare collaboration (HIPAA securely of course) are only going to increase as the lines, among organizations and sectors within medicine, blur. But you won't necessarily be given the tools to do those things. That's why iClickCare is available at the enterprise level or at the individual level -- we believe that in any given organization, it may be the administration or it may be the individual providers that truly chart the course forward amidst these competing demands. 

As Bill Gates is quoted as saying, "I’m a great believer that any tool that enhances communication has profound effects in terms of how people can learn from each other, and how they can achieve the kind of freedoms that they’re interested in.”

It's an exciting time, for sure -- but only if we're equipped with the proper tools. 

 

Try the iClickCare 14-day evaluation

Tags: telemedicine, HIPAA, regulatory issues

Why Healthcare May Be Due for an Arts and Crafts Revolution

Posted by Lawrence Kerr on Thu, Sep 14, 2017 @ 06:01 AM

farrel-nobel-108567.jpgMany people have noticed that healthcare has become more "industrialized." As healthcare has changed, with productivity and output being primary, the provider becomes a "factory worker" and the patient becomes a "product." As such, the provider and the patient become increasingly distanced from each other. 

Not enough doctors? Then make the doctor the foreman. Make the other providers, such as nurse practitioners and physician's assistants, part of their "line", under supervision. Of course, a manager and a coordinator are needed on top of that. And finally, don’t forget the chief financial officer (CFO) and the Utility Commission.

We doubt this will change, but just like in other industries (it hurts to describe a giving, healing profession as an "industry"), there are constant new movements and experiments. Many of these fail; some work. An analog would be during the late Victorian period when the Arts and Crafts movement developed. To quote Monica Obiniski:

"The Arts and Crafts movement did not promote a particular style, but it did advocate reform as part of its philosophy and instigated a critique of industrial labor; as modern machines replaced workers, Arts and Crafts proponents called for an end to the division of labor and advanced the designer as craftsman."

I liken this Arts and Crafts period to the period in medicine of my father's generation, when doctors might be paid with eggs from his chicken, the pace of medicine was slow, and patients and doctors had a lifelong relationship. There was a prioritization of human values over sheer productivity. And there was a respect for craft and quality rather than simply what cost the least to make.

The movement ultimately receded; it was largely gone by the 1920s and the acceptance of modernity in the machine age. In a parallel evolution, this "arts and crafts" period of medicine was largely gone by the middle of my career. 

Interestingly, the Arts and Crafts movement in American is experiencing a rebirth -- in large part, thanks to technology supporting it. For instance, Etsy, the worldwide online craft marketplace with millions of vendors making handmade goods and selling them online, started in 2008. Since then, I believe that we've seen a re-valuing of craftspeople -- whether makers of chocolate or furniture or leather goods -- and the valuing of thoughtful "industry," using new solutions, often supported by technology. 

So what does this have to do with healthcare collaboration and care coordination and the use of technology such as iClickCare in the current context of healthcare? I believe that healthcare is at the very beginning of a similar "craft"rebirth. For instance, direct care and concierge medicine are gaining in popularity. Neither are new; both harken back to the medical context of my father's generation and the early decades of my practice -- that slow, thoughtful, craft-focused practice of medicine. 

And I see healthcare providers around the country claiming and demonstrating that the principles of excellent, compassionate, and comforting care can be empowered by working together using technology to break down silos.

Of course, even if we say that the "healthcare factory" is inevitable, if it uses a collaboration based workflow, it can produce a better product (a healthy and peaceful patient) by using telehealth. (Needless to say, reduce burnout in the providers!) Medical collaboration and care coordination supported by technology can decrease waste and reduce "manufacturing errors."

It is our responsibility to remember the good of the past while embracing the promise of the present and future. It is our responsibility to design and craft our prescriptions and plans for our patients and advocate and promote the value of the individual, no matter if the individual is your patient or yourself. Technology in medicine is part of out future. But it's up to us as to whether that future also includes a return to our values.

We put together stories of medical collaboration from around the world. Download it for free:

ClickCare Quick Guide to Medical Collaboration

 

Tags: good medicine, care coordination, healthcare collaboration

Hospital Systems Look to Third Parties for EHR Interoperability & Care Coordination

Posted by Lawrence Kerr on Tue, Sep 12, 2017 @ 06:00 AM

daniel-wirtz-369020.jpgWhen it comes to housework, even though there are more time-saving tools than ever — dishwashers, washing machines, vacuum cleaners — families today spend about the same amount of time each week on housekeeping as they did in 1900. 

Similarly, I look at all the technological improvements we’ve made in medicine over the last 20 years and wonder whether care has improved or efficiencies have been made. And a recent article got me thinking about technology integration and interoperability challenges that hospital systems are facing -- that may need to be solved sooner rather than later.

At this point, EHR and EMR adoption is widespread. There are very few medical contexts in which technology isn’t a major component of our medical practice. But the ongoing problems (like interoperability and workflow issues) presented by many technologies may be more challenging to solve than the initial implementation was.

For instance, this article looks at several hospital systems that are struggling with interoperability. The University of Pittsburgh Medical Center uses three separate EHRs — one for oncology, one for ambulatory, and one for in-patient. Of course, up until recently, none of the systems talked to each other or were interoperable.

And as we move into a value-based era of medicine, the complications that present themselves in technology become even more challenging to manage.

The example of the University of Pittsburgh Medical Center using three different EHRs in a fee-for-service era may make sense. But when medicine is value-based, it simply won’t work. Chronic, complex conditions (those that tend to be most expensive for hospitals to deal with) are often the ones that bridge multiple areas of the hospital system. And having a separate EHR for each area, that doesn’t integrate or “talk to” the others, presents costs and care coordination problems that will be unmanageable, if they aren’t already.

That hospital’s solution was to develop interoperability software (developed in house) for one EHR to communicate with the others.

Ed Mcallister, CIO at University of Pittsburgh Medical Center says that “although EHRs took healthcare in the right direction by digitizing information that was once in a folder in a drawer, they are still lacking and not the right model for documenting patient information or for sharing it. More so than a vendor product that would tie [EHRs] together… [we need a technology that would] pull the information at the point of care into a layer that is more tied to patient care than what an EHR is today”

In other words — EHRs certainly do not meet hospital system needs for medical collaboration and care coordination. And interoperability problems aren’t just about transmitting information from one EHR to the other. The issue is facilitating care for patients, even in the complex context we find ourselves. What healthcare is seeking now is true care coordination, technological support for medical collaboration, and (certainly) interoperability, so that healthcare providers can access key information about their patients.

iClickCare plays a part in meeting the demands for a system that supports true medical collaboration -- but we can't do it alone.

If your hospital system struggles with Health IT interoperability or care coordination challenges, hybrid store-and-forward telemedicine may be one piece of the puzzle. Get our pictorial white paper report on it here:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Photo by Daniel Wirtz on Unsplash

Tags: medical collaboration, EMR, interoperability, healthcare IT,

What Your Netflix Recommendations and Telehealth Have in Common

Posted by Lawrence Kerr on Wed, Sep 06, 2017 @ 06:01 AM

samuel-zeller-360588.jpgAs you probably know, machine learning refers to the process through which a system can use a programmed process to "learn" and become more accurate over time. It's different from the way most of us think of a robot or a computer program because in this case, the programming changes based on the results it gets and new inputs available.

Experts say that the extensive use of machine learning in healthcare is inevitable. But how might that affect healthcare and what will the consequences of it be?

Machine learning is not a new field -- in fact, it was described by Arthur Samuel in 1959 as, “the field of study that gives computers the ability to learn without being explicitly programmed.” But exponential improvements in computing, plus innovations in AI and technology in general, have meant that the field has started burgeoning over the last few years.

Machine learning is used in applications from cyber security to healthcare to, well, the movies that Netflix suggests you watch after a long week. In medicine, we're seeing applications in everything from cancer prediction and prognosis, to diagnosis in medical imaging, to treatment suggestions.

For instance, when you search for, say, peach pie recipe on Google, you'll see search results based on what Google thinks matches those words. That's a regular computer algorithm. Machine learning comes into play, however, in that Google also "watches" (actually a computer collecting data) which search results you click on, and how much time you spend on the pages you visit, to re-rank and re-sort the search results it gives the next person searching for peach pie recipe.

There is a lot that is scary and even threatening about this new world of technology. It's disturbing to think that the best doctors are sometimes worse diagnosticians than computers. And it's true that, as this JAMA paper identifies, "comparative studies on the effectiveness of machine learning–based decision support systems (ML-DSS) in medicine are lacking, especially regarding the effects on health outcomes."

The JAMA paper looks at several potential unintended consequences of the use of machine learning in medicine, for instance:

  • Reducing the skills of physicians
    For instance, a study of 30 internal medicine residents showed that the residents exhibited a decrease in diagnostic accuracy (from 57% to 48%) when electrocardiograms were annotated with inaccurate computer-aided diagnoses."
  • Overreliance on text.
    The JAMA paper reports that machine learning "could lead to reduced interest in and decreased ability to perform holistic evaluations of patients, with loss of valuable and irreducible aspects of the human experience such as psychological, relational, social, and organizational issues."

Ultimately, machine learning is like any other technology in medicine -- the scalpel, anesthesia, or telehealth. These tools are powerful, and come with almost inalterable impacts on how we practice medicine. They're also in our control, we're supposed to wield responsibly and manage the negative consequences. 

In the field of telemedicine, we at ClickCare are determined advocates for healthcare providers to be thoughtful about what technology they use for telehealth, and how they use it.

We advocate for healthcare providers to do 2 key things when it comes to technology in telehealth and telemedicine:

  • Be open to new technology even as you're discerning about what to use.
    Of course, technology comes with unintended consequences and challenges. But it can also enrich and enhance the practice of medicine. We advocate for providers to be proactive in selecting technology that really works for them -- neither a "bury your head in the sand" approach, nor a "take whatever comes along" approach. You know what's best for you and your patients.

  • Be open to redefining some aspects of your role as a medical provider.
    As technology shifts, we have the opportunity and responsibility of shifting our roles as providers, too. Machine learning may create the ability for providers to focus less on the mechanics of medicine and more on the human art of it. Telemedicine based medical collaboration allows providers to step out of their silos and treat patients as a true team. We believe that the most successful, happiest providers are those that are willing to find new ways of working as our tools change.

 

We believe the same principles apply to our adoption and use of machine learning in medicine. And we look forward to being on that journey with you. 

 

Want to get all the information before making a telehealth or telemedicine decision? Get our free summary of hybrid store-and-forward telemedicine so you can be informed:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Photo by Samuel Zeller on Unsplash

Tags: telehealth, telemedicine technology, ACO

You Don't Need to Follow Those Annoying Password Rules -- And Telehealth Will Benefit

Posted by Lawrence Kerr on Thu, Aug 31, 2017 @ 06:00 AM

jeff-sheldon-264922-1.jpgWhether we're trying to buy a bath mat online or setting up a new bank account, we're all familiar with the prompts telling us the password we've selected isn't "complex" enough to be safe. For instance, you type in a long sentence, but you're told that it needs a number, an upper case letter, or a "special character." 

Well, those guidelines didn't come from nowhere -- they came from a man named Bill Burr, a former manager at the National Institute of Standards and Technology (NIST). And it turns out that Mr. Burr is very regretful for having wasted so much time with guidelines that don't really work. In 2003, Burr wrote a guide on secure passwords: the “NIST Special Publication 800-63. Appendix A.” That guide is where many of our standards around passwords came from. 

BUT, it turns out a longer password, with English words (much easier for most of us to remember) is actually harder for a computer to guess than a shorter password with arbitrary characters. And so all the complex password hijinks haven't really been keeping us safer.

We appreciated this article for the simple fact that getting a glimpse into the human side of the internet is always interesting. And Mr. Burr's honesty and humility are refreshing. 

But we also think there are two important takeaways from Mr. Burr's revelation:

  • What seems "high tech" is not always better or safer.
    For instance, we find that in medicine, there is a constant perception that more expensive hardware and technology are safer or more powerful. We've even had hospitals tell us that iClickCare is too inexpensive for them to buy. The truth is that iClickCare is as sophisticated, as HIPAA compliant, and as innovative as software can be. It just appears simple because it can be used from any computer, is relatively inexpensive to implement, and is very easy to use. Those are all great things, but not if you're looking for the most complicated-seeming solution on the market.

  • Just because something is repeated often, doesn't mean it's true. 
    With all of the complexity in medicine right now, it's common for an "echo chamber" effect to be created, in which things are repeated and seem true simply because we've heard them so often. Sometimes the EHR/EMR that is used a lot isn't the best one; and sometimes commonly understood causes of a situation aren't the correct causes. In the case with the passwords, it's clear that an incorrect approach became industry standard, just because it was used so often.

We encourage you to find the best solution for your situation. Just as it turns out that the "plain English" passwords actually work better, the simpler solution in telemedicine can work better as well. 

 

Get our guide on the simplest kind of telemedicine out there:

ClickCare Quick Guide to Hybrid Store-and-Forward

Photo by Jeff Sheldon on Unsplash

Tags: telehealth, telemedicine and hippa

Why The Only Way to Truly Solve Cost Issues is Medical Collaboration

Posted by Lawrence Kerr on Tue, Aug 29, 2017 @ 06:00 AM

pawel-chu-348970.jpgThere are few professional training trajectories that are quite as unique as that of medical training. 

In what other training are you expected to dissect human bodies? In what other training are you expected to simply not need to sleep? In what other training are you responsible for life and death? It's an almost impossibly rigorous path: physically, intellectually, and emotionally. It requires quite complete devotion.

For that reason, the medical path guides medical providers -- especially doctors -- to a very particular skillset and world-view. In myriad ways, that skillset and worldview are admirable, crucial, beautiful, and deeply helpful to society. But that skillset and worldview may also be the root cause of the skyrocketing costs in healthcare -- and here's why...

Dr. Thomas Lee argues in the Harvard Business Review that “the biggest driver of rising costs is medical progress: new drugs, new tests, new devices, and new ways of using them.” He says that this complexity causes workflow and team complications as well as creates a situation in which the providers involved in cases are frequently spread across multiple institutions.

Dr. Lee further asserts that medical providers aren't equipped with the viewpoint or skills to manage the complexity of this situation. He says, “The problem with health care is people like me -- doctors (mostly men) in our fifties and beyond, who learned medicine when it was more art and less finance. We were taught to go to the hospital before dawn, stay until our patients were stable, focus on the needs of each patient before us, and not worry about costs.”

He says that teamwork and collaboration are one of the antidotes to the complexity presented by modern medicine. "Improvements in performance require teamwork... At any organization that provides health care, superior coordination, information sharing, and teamwork across disciplines are required if value and outcomes are to improve."

Despite that acute need for collaboration, Dr. Jamie Stoller, Chair of the Education Institute at the Cleveland Clinic, shares with the New England Journal of Medicine Catalyst blog that the medical training and viewpoint actually make it very hard for medical providers to naturally collaborate.

He says there are 4 factors causing doctors to tend toward being poor collaborators: 

  • Training favors individual performance.
    "Each one of us as a doctor got into medical school on the strength of a strong academic record, succeeded in medical school, again on the strength of a strong academic record, found our way into hopefully fabulous residencies again on the strength of individual performance, [and] re-certifies and certifies with boards in a highly individual performance, so this cultivates deep-seated reflexes for individual performance."
  • Training is hierarchical.
    That training develops a certain reflex on arrival after finishing training that you’re kind of the king of the hill and can sometimes behave that way.
  • Extrapolated authority.
    In other words, applying the deep skill and authority in your area of medicine to all other areas of medicine and/or life.
  • Physicians are deficit-based thinkers.
    The skill involved in learning clinical medicine and differential diagnosis is oriented around finding the problems and connecting those dots -- rather than identifying opportunities and connecting those dots.

Dr. Lee illustrates the very real problems that can arise from poor collaboration in his article. “In my own organization, Partners HealthCare, a poignant example involves the widow of a young man who died of cancer. In the last days of his final six-week stay in the intensive care unit, she demanded that all his doctors have a meeting with the family. The family didn’t really need the meeting, she said—the doctors did. She wanted to be sure that the various physicians were actually talking to one another, because she so often received inconsistent or even contradictory messages from them. The confusion she described does more than distress families, of course. It leads to redundant care and errors that raise costs and threaten quality.”

Doctors aren't prepared well for medical collaboration. And medical costs could be staunched by better medical collaboration. So is there anything that medical providers can do to counter the trend? Well, we certainly think there is. 

3 Things That You Can Do to Cut Costs and Improve Your Approach to Medical Collaboration: 

  • Use tools that streamline workflow.
    Just as Dr. Lee explains, much of the increased costs in medicine come from the complex workflows that accompany innovation. That's one reason we think telemedicine that's accomplished through videoconferencing isn't ideal -- yes, it's a tool, but it also exacerbates workflow issues and coordination among providers. Use tools that allow you to consult with other providers on your schedule, with a workflow that works for you, using hardware, you already have.

  • Treat medical collaboration with the same seriousness as other parts of medical practice. 
    Likely because of the medical training that we receive, healthcare collaboration can be seen as a sort of "nice to have" (but not "must have") side activity to the real profession. The more we learn about costs, outcomes, and the more medicine changes, the more this becomes obviously false.

  • Identify where your training helps and hurts, and where your personality helps and hurts.
    Not all medical training is a negative for medical collaboration. For instance, my attendings were often nurturing leaders who took the time (even if just a few minutes) to work with and listen to me. I always applied this philosophy to my work with medical students. And, in fact, one of the most important aspects of iClickCare is its support of medical education. As the writers above point out, much of our medical training isn't helpful for healthcare collaboration, but some of what we've learned and experienced are things that we can lean into when it comes to medical collaboration -- especially the valuing you likely have for all members of the medical team.

Ultimately, we're optimistic about the potential medical providers have for being great collaborators. But it's important to acknowledge the challenges presented by our time and by the training we usually receive. That way we can build on our strengths while being aware of our weaknesses.

 

We've rounded up some of the most interesting stories in medical collaboration in our Quick Guide:

ClickCare Quick Guide to Medical Collaboration

 

Photo by Pawel Chu on Unsplash

 

Tags: medical collaboration, healthcare collaboration

New FDA Regulation Law Brings Changes for Telehealth

Posted by Lawrence Kerr on Thu, Aug 24, 2017 @ 06:01 AM

glen-alejandro-347236.jpgOn Friday, President Trump signed a bill reauthorizing the Food and Drug Administration’s user fee agreements for drugs and devices. 

The bill authorizes user fee agreements before they were set to expire in October. Interestingly, the bill also establishes several new approaches to the regulation of digital health and creates a digital health unit within the FDA’s Center for Devices and Radiological Health (CDRH).

Advocates of digital health, telehealth, and telemedicine might worry about whether this change is positive or negative for medicine and for progress in digital health. Here’s our take…

The Food and Drug Administration was created to regulate, make safe, and (perhaps), facilitate the development of food and drug products in the United States.

Of course, in 2017, digital technology is every bit as important as biochemistry in contributing to our health and wellness. So the Food and Drug Administration is working to keep up with the new forms that “food and drugs” take — and how data and technology can contribute to or potentially endanger the nation’s health.

As digital science becomes increasingly important, it will need to be regulated. But, at this point “watchful waiting” is more important than regulation to allow the development of creative technologies. These changes probably mean little to you using iClickCare but we wanted to keep you abreast of the changing regulations in the field.  On the other hand, here will more control of the hardware and medical device side of telemedicine.

ClickCare is proud to be a leader during an exciting and innovative time. And ultimately, we are advocates for technology that is safe because it is in service to providers caring for their patients — like telemedicine for medical collaboration — not a circumvention of the way providers care for patients.

Tools, technology, and drugs are only as safe as the professionals using them. So we see our job as simple: use technology but get out of the way so that you and your colleagues can care for your patients.

Learn more about the most innovative form of medical collaboration (that is also the simplest) here:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

 

 

 

 

Photo by Glen Alejandro on Unsplash

Tags: telehealth, hybrid store and forward medical collaboration, regulatory issues

A Shocking Solution From Jails That We Can Use in Medicine

Posted by Lawrence Kerr on Thu, Aug 17, 2017 @ 06:02 AM

the-end-of-the-line-free-license-cc0.jpgMustafa Willis was 24 in 2010. He was walking down the street, having a snack. He sees a police car coming down the street toward him. The police jump out and arrest him. Mustafa finds out eventually that they've arrested him for illegal possession of a firearm -- one found in a car.

The system is supposed to allow Mustafa to go home and start preparing his case. So we have the bail system in which the defendant can go home if they pay 10%, in this case $5,000, of the bail amount. But Mustafa, like so many other people, couldn't quickly come up with $5,000. And so he stayed in jail.The story, as told on Planet Money, continues. Mustafa stayed in jail for weeks, and then months. Finally, after three months, the judge lowered bail to $30K and his family was able to make bail.

Once he was home, Mustafa tracked down a video showing that the gun wasn't his at all and once he presented the evidence, the case was immediately dismissed.

However, the impact of the case on Mustafa is permanent. He owes the $3,000 regardless. He lost his job and missed his cousin's funeral. Roseanne Scotty, a lawyer, says, "one of the things that most people in jail have in common is that they're poor. So for these individuals, having $1,000 bail or $2,500 may as well be $1 million dollars."

The idea of bail is that it helps decide who is able to go free while awaiting trial and who needs to stay in jail until trial. Some people shouldn't be allowed to post bail -- for instance the king pin of a large mafia organization -- but these are the people that are most able to post bail.

In fact the average length of time that a defendant stays in jail awaiting trial is 314 days. And 40% of people in jail are there because they lack the nominal amount of bail (for instance, amounts under $5,000) needed to be released. Of course, innocent people being in jail for months costs the state huge amounts of money and can ruin lives.

In 2013, Scotty's organization put out a report about this. So many times, a report like that might be read and then ultimately ignored. But this time, that's not what happened. The Chief Justice of the New Jersey Supreme Court called defenders, prosecutors, and other people from across the system into chambers to discuss the report. He told them that something needed to change with the bail system. And they worked and worked until they came up with a plan to replace the bail system.

The plan they came up with uses "big data" to calculate a defendant's likelihood of committing another crime. It creates a 6-point scale (with 1 being least likely to commit another crime) and 6 being most likely. People ranked lower should be released, while people ranked higher wouldn't be. Mustafa rated a 1. 

Shockingly, the new system has now been incorporated across New Jersey and the bail system has completely been done away with. A fundamentally unjust part of the system has been changed, and it's because these people came together -- across partisan lines, to change it. 

The medical system is broken in some of the same ways as the US justice system. Well-meaning people are working within a largely miraculous, but hugely broken system -- and it's very difficult to make changes. 

So I thought the episode highlighted three really surprising things about this project that I think are crucial for a medical setting.

3 things that medicine can learn from New Jersey's bail project:

  1. Be willing to change approaches even if “we’ve always done it that way.”
    The bail system is literally the way that the justice system has always done things and it is enshrined in the state constitution. It would certainly be easy to believe that it could never change, or be improved, and yet it was. There are so many things in medicine that we do because we've always done them that way, even when there are better options. (This is one of the main objections to iClickCare that we hear, in fact: "I just don't think our staff will change how they do things.") But New Jersey's experience shows that real, substantial change can be made, quickly. And that the whole system is better for it.
  2. Look at — and use — the data.
    In New Jersey's case, Scotty lookd at the data to see whether the bail system was working at all, and what pre-trial jail stays looked like. The data brought the issue into relief and that was what caused the Chief Justice of the New Jersey Supreme Court to demand change. Further, it's big data that is fueling the new ranking system they're using. Decades ago, it's likely that neither set of data would have been available. But now that the data is available, I believe we have a responsibility to use it. The data shows that medical collaboration and telemedicine dramatically decrease costs, readmissions, length of stay, and improve outcomes. It's time for the medical community to start looking at the data and adapting our practice accordingly.
  3. Work together, collaboratively, even if not everyone on the team has exactly the same experience or motivations.
    It was facinating to me that in the bail changes, it was a group of people with all kinds of motivations who came together to change the system. They had all kinds of reasons to not work together, but they put those aside to work toward a common goal. This kind of collaboration is crucial in medicine. We don't have to agree on everything, but we do have to work together for the patient. 

We certainly applaud every single person who took part in this bail initiative. And we hope that the medical community can draw inspiration from their success. 

 

The data shows that hybrid store-and-forward telemedicine is a powerful tool to improve outcomes. Learn more about it here:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: medical collaboration

Why Medical Collaboration is the Real Hero of Value-Based Care

Posted by Lawrence Kerr on Tue, Aug 15, 2017 @ 06:01 AM

brooke-lark-229136.jpg

As a surgeon, I was certainly trained in a culture of respect for high-impact, high-sophistication interventions, like specialized surgeries.

That said, I was also taught that prepping your own patient for surgery, even down to preparing the surgical area with drapes, and checking on your patient frequently in the hours and days after surgery, are equally important. I was taught, too, that every single person on the care team is equally important — and each person on the team may mean the difference between life and death.

I think that the concept of specialized surgery being lauded above all, was winning for a couple of decades. It’s the concept of “only the best for my loved one” and “we took him to the Mayo Clinic” along with respect for research institutions (rather than community hospitals.) The fee-for-service approach certainly played into this swing. If hospitals are paid most for the most sophisticated, high-intervention care, it’s likely that the trend will be toward that approach.

A further consequence of this previous focus is that when specialized interventions are what matters, it’s the specialist who is valued above all. In that context, the team only exists to support the specialist.

Recently, however, the focus on outcomes-based or value-based care has meant that this high-intervention approach is being called into question.

For instance, two new programs spotlight simple, holistic approaches. This program created a teaching kitchen right next door to the pediatrician’s office, showing families how to improve their nutrition through cooking lessons. And this program reduced readmissions by 27%, cut hospital stays by two days, and saved $3800 per patient — all with a simple $36-per-person nutrition program. In a value-based, fee-for-performance, setting, these types of inexpensive, “unsophisticated” programs may have a bigger effect — and certainly a higher ROI — than the dramatic interventions.

In this context, and with programs like this, medical collaboration becomes the lynchpin. When we are looking at slightly “softer” interventions — like nutrition — everyone from the teacher to the aide to the specialist to the pediatrician to the nutritionist are equally important in the care plan. And those individuals must have the tools to collaborate or the interventions won’t be orchestrated among the providers.

iClickCare has always been oriented toward this kind of holistic, value-based approach. In fact, we started in a school-based health center setting, in which what mattered most was getting students healthy and back to class as efficiently as possible. We created the app to facilitate collaboration among specialists, a pediatrician, and the school-based nurses caring for students. It was holistic, it was team-based, and it was focused on outcomes. In other words -- we had the same values that the future of medicine will. 

If medical collaboration is part of your value-based care strategy, download our free medical collaboration quick guide:

ClickCare Quick Guide to Medical Collaboration

 

Photo by Brooke Lark on Unsplash

Tags: telemedicine, medical collaboration, value based care

Is Healthcare Collaboration a Process or an Attitude?

Posted by Lawrence Kerr on Wed, Aug 09, 2017 @ 06:01 AM

dane-deaner-334260.jpgOne of our roles here at ClickCare is educating healthcare providers. In particular, our passion is educating folks about the value and satisfaction of practicing medicine (nursing, physical therapy, etc) with the support of technology integrated into a centuries-old practice.

That does not seem such a leap for us, but it seems to be a challenge for many.  Information Technology is just part of our lives. The older colleagues in our audience can “remember when” there was little or no technology. The younger ones know no different.  Both groups drive safer technology-guided cars, nearly computers with a motor and wheels. Everyone glances up at a monitor while not touching the wrist for a pulse. But some seem to isolate their caregiving from technology. The prevailing attitude is that technology is something pushed down on them from above ("the EHR goes live in two weeks, be ready") rather than something that needs to incorporated from within.

A recent blog post brought these dynamics alive for me. The post, the Four Challenges of Launching a Telehealth Program, describes the launch of their telemedicine services a year ago.

They describe four challenges: 

  • Liability
  • Licensure
  • Reimbursement
  • Workflow

The first three are often discussed. We are pleased to see workflow added to the list. But, we have a different take on it. They note that decisions are made about basic operational matters such as registration and documentation. They developed “telehealth-specific care protocols”. Other broader issues are noted, “such as carving out specific time in existing schedules for clinicians to provide telehealth visits, or whether to expect them to be added on to the existing workload."

They give examples of their scheduling solution. We respect these efforts and their responses to other challenges as well as the good care provided by their system.

But, and it is a big but, we long ago learned that Time is as important an issue as Place in telemedicine programs. Telemedicine, telehealth, mHealth, and connected health have been all about shrinking geographic distance.  Essentially, this focus is one of single dimension. The question has been: What is the shortest distance between two points? Answer: electronic communication.

The more important question is: how can I do this task with the least time away from my patient and as efficiently as possible for me? And perhaps: How can I involve any or all members of the patient's team? And how can we include the patient as part of the solution rather than making the patient only the problem to be solved?

Ultimately, we chose the Hybrid Store-and-Forward® model for iClickCare because it means that providers can consult with each other asynchronously (on their schedules). Consulting on a patient is as simple as answering or sending a text message -- except it's 100% HIPAA safe and allows for photos, videos, and words.

That means that telemedicine isn't causing yet more scheduling challenges, and yet more visits on the schedule. We feel that Hybrid Store-and-Forward reminds us to use technology as appropriate for healthcare workflow.

The difference, to circle back, is that process should support attitude.  And the attitude should be: technology is part of our lives. Let’s make it serve us and, if possible, become invisible. If not invisible, then the least interruptive to the good patient care honed by the centuries of improvement.

 

If you want to learn more about hybrid store-and-forward telemedicine, you can get our guide here:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

 

 

 

 

 

Photo by Dane Deaner on Unsplash

 

Tags: medical collaboration, healthcare collaboration

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