Using Chapter 3 of Medical iPhone Photography, we show you how to put an ePUB file on your iPhone and continue learning great camera techniques.

Chapters 1 and 2 reminded us to use the camera "in your pocket" and make sure the pictures are recorded on a secure camera roll. Chapter 3 gets into posing or positioning the patient...so that clinical progress or deterioration can be professionally mapped.

As described in previous blogs, Medical iPhone Photography will be released in 2 formats, the .epub for iBooks, Nooks and all eBooks except for Kindles...and the .pdf for everything else. In order to bring up the .epub file as an iBook, please follow these instructions:

1. Open iTunes and drag the downloaded .epub file over to the Library section of iTunes with BOOKS selected. 

 2. Plug your iPhone or iPad into your computer and let it SYNC automatically.

3. Open your new "book" from your iPad's or iPhone's iBook shelves and enjoy learning.

After you open your iBook, touch the page and to choose print size, white or sepia background, and intensity of the lighting. You can view the book in either portrait or landscape mode. You can place bookmarks or do a search. Also you can highlight passages, you can enlarge pictures, you can ask for word definitions...all while sitting on the couch!

But the most fun of all is TURNING THE PAGES IN AN eBOOK!!! Slide from the right to the left to see the next page; slide in reverse to go back. And this is something that you cannot do with the PDF format! So take these extra steps.

When you have the whole Medical iPhone Photography book, there will be lots more interesting pages to turn.

• Note of an erudite presentation facilitated by telemedicine
• How access and collaboration lead to education at the highest level

Jagmohan S. Sidhu, MD is presenting a fascinating case of Cutaneous B cell lymphoma and has included Dr. Ronald Harris, oncologist, and ClickCare founder Dr. Lawrence Kerr as co-authors. The intricacies of the disease and management are likely beyond the interest of our readers, but the implicataions of the process are very interesting.

This presentation is on Friday, October 28, 2011 at the Society of Hematopathology and European Association of Haematopathology combined meeting in Los Angeles California.  FinalProgram 

The patient is elderly. Access to specialized is needed. Care coordination is important. The patient needs to be seen but not sent all around. So, three or four years ago, telemedicine collaboration allowed better diagnosis and to be followed by coordinated management. Moreover, because a store and forward technology was used, the case (no individual is no longer a patient, fortunately) is available for sharing again, this time with scientists who give a week of their time, meet and share in order to education themselves and improve care for all of us.

Special people who care for patients with store and forward telemedicine make a better future for all of us.

• What is clinical photography? Is it medical photography?
• What is the best camera for clinical photography.
• What makes a good clinical photograph.

Chapter 1 reminded us about the importance of the obvious: Take the picture. Hold the camera still. And archive the picture for easy retrieval!

In Chapter 2, we will get Permissions, HIPAA and HITECH carefully understood. You might subscribe to our blog so that you don't miss a chapter!

Throughout the course of 9 serial lessons we will show you how to maximize the remarkable capabilities of the iPhone, understand the principles of medical and clincal photography, and feel comfortable with documentation both descriptively and visually.

There is quite a history, but the value of good consistent clinical photographs is without change.

At this point in time, the quality from that small camera "in your pocket" is amazing because the picture is taken instead of missed. When coupled with the techniques in these chapters, the communication is only improved.

Medical iPhone Photography will be released one chapter a week until mid December...as both an iBook for the iPad or iPhone or a PDF for everything else. Then the book will become available in printed form for holiday giving to your favorite healthcare provider.

Harrison Ford isn’t one for small talk. And he hadn’t ever spoken in public about Star Wars… until last week. In commemoration of the 30th anniversary of Star Wars, and to raise money for St. Jude’s Children’s Hospital, Harrison Ford finally discussed the making of Star Wars.

Mobile Health, mHealth, 
coordinated and accountable care...are some of the buzz words currently in the media. It is possible to save billions of dollars if we act on these words (concepts) well. One of Mr. Ford's comments caught my imagination because of its connection to making ClickCare (equal measures collaboration, creativity, medical expertise, and art)… and to the process of making the “product” of fantastic medical care for our patients:

“[Making movies] is a collaborative process. And I think what it speaks to more than anything else is that when you have the opportunity to make something and you care about what it is you’re making, you try and you try and you try. You just don’t settle. You try because you care about the product.”

Here at ClickCare, we draw from wisdom in many fields, especially where we can learn something about collaboration. As you know, we are impassioned about collaboration in medicine.  This is inspiring, even if it is Hollywood.  Collaboration and creativity go together–in medicine, and in movies.

It’s Memorial Day, and a time to remember all who served our country.

There are millions who have done so over the years. A few have been singled out to receive a Congressional Medal of Honor because they stood out with some act of unbelievably unselfish heroism.

But there are so many who just did their duty, unknown and unnamed. They are honored fully as well, because each has served and each has contributed to our safety and freedom.

In healthcare, we are in the midst of a battle that in a way is even worse than one with tanks and guns, bombs and planes. The magnitude and confusion, the noise and the panic are the same. And, people are dying.

Just as in a war, each of us can make a difference. Some of us will become medal winners, some of us will not.

Sometimes instead of trying to analyze everything, it is better to examine an important slice. Our recent attendance and presentation at the New York Mid Atlantic Consortium, a collaborative of genetic programs, illustrated this clearly to us. During college and medical school we learned about Punnet Squares, polymorphism, and decreased penetrance. By 2011, genetics has exploded. We now have the human genome. Cancers can be analyzed and their own genome described. Personalized medicine is not only imminent, but it has started.

The problem is, however, that there are not enough people to do the work that is needed right now, needless to say, in the future. There is so much knowledge that no one person can know it all. These are big problems. These are problems, in part, because of funding. Those who are passionate about the field wonder where the funding can come from. Meanwhile, every other segment of society is asking the same questions. How can we do what we need to do without more funds? How come other interests get more funding? There is so much to do, so little time, so few personnel, and so little money. What can we do?

We at ClickCare have decided that each of us can make a difference. Maybe it won’t be a Congressional Medal of Honor difference, or maybe it will. But each of us, like each individual whom we remember this day, can make a difference. Each of us can push forward and improve our lot. Funding is important, but its value is negligible compared the richness of many who do their little part and collaborate with others. The rewards will come later, or doing your part better may be the reward in itself.

For our, part, I can put a stake in the ground and say: “If you don’t have the funds to buy a ClickCare subscription, call us and we’ll personally work with you to make it happen.”

ClickCare can bridge the gap between what can and should be and what is. We know that better collaboration brings better care, better access to that care, and better education of those who provide that care.

We applaud each of those we met at NYMAC and know that each of them are trying to make a difference. Many of them have, and many are still at it.

We at ClickCare will keep trying too because each of us deserves better, and each of us can make the world a better place.

Rite Aid to pay $1M to settle HIPAA privacy case

The regulators mean business. This is not the first enforcement of HIPAA by any means, but it is a significant one both in scope and in penalty.

We often hear busy doctors say I just use email. The patient says it is OK.

It may be OK with the patient, but it is not OK with regulators. In this case, both the Federal Trade Commission and the Office of Civil Rights of Health and Human Services have accused Rite Aid of improperly disposing of records in an unauthorized trash container.

Occasionally, it seems best to have the end justify the means – it more likely will not be the right thing to do. In matters such as HIPAA, it is a high risk maneuver. Since ClickCare can get to the same end in a legal way, why not use it? Further, all collaborations are saved and available for reference and teaching.

The HITECH act (which provides loans for EMR adoption) added teeth to the HIPAA regulations:

The Health Information Technology for Economic and Clinical Health (HITECH) Act provides a tiered system for assessing the level of each HIPAA privacy violation and, therefore, its penalty:
Tier A is for violations in which the offender didn’t realize he or she violated the Act and would have handled the matter differently if he or she had. This results in a $100 fine for each violation, and the total imposed for such violations cannot exceed $25,000 for the calendar year.
Tier B is for violations due to reasonable cause, but not “willful neglect.” The result is a $1,000 fine for each violation, and the fines cannot exceed $100,000 for the calendar year.
Tier C is for violations due to willful neglect that the organization ultimately corrected. The result is a $10,000 fine for each violation, and the fines cannot exceed $250,000 for the calendar year.
Tier D is for violations of willful neglect that the organization did not correct. The result is a $50,000 fine for each violation, and the fines cannot exceed $1,500,000 for the calendar year.
The HITECH Act also allows states’ attorneys general to levy fines and seek attorneys fees from covered entities on behalf of victims. Courts now have the ability to award costs, which they were previously unable to do.

Collaborate legally.

Comments based on http://www.healthcarefinancenews.com/news/rite-aid-pay-1m-settle-hipaa-privacy-case,  quoting Editor’s note: This is an excerpt from the April 2009 edition of the HCPro, Inc. newsletter, Briefings on HIPAA.

Harrison Ford isn’t one for small talk. And he hadn’t ever spoken in public about Star Wars… until last week.

In commemoration of the 30th anniversary of Star Wars, and to raise money for St. Jude’s Children’s Hopsital, Harrison Ford finally discussed the making of Star Wars.

One comment from Mr. Ford caught our imagination because of its connection to our methods of making ClickCare itself (equal measures collaboration, creativity, medical expertise, and art)… and to the process of making the “product” of fantastic medical care for our patients:

“[Making movies] is a collaborative process. And I think what it speaks to more than anything else is that when you have the opportunity to make something and you care about what it is you’re making, you try and you try and you try. You just don’t settle. You try because you care about the product.”

Here at ClickCare, we draw from wisdom in many fields, especially where we can learn something about collaboration. As you know, we are impassioned about collaboration in medicine.  This is inspiring, even if it is Hollywood.  Collaboration and creativity go together–in medicine, and in movies.

One of the joys of running ClickCareis being close to our customers’ hopes and fears. Sometimes we hear comments that inspire and invigorate. Other times, conversations are about:

“It would be nice, but…”
“I would like that, but there’s no budget for…”
“It is important, but I don’t know how I would implement it.”

They are words we might say about following a dream, or taking vacation, or sending a kid to college.  I hear the same words when I ask patients to stop smoking, lose weight, or exercise.

We know that budgets are cut, health care bills come and go, technology muddles, and there are always 101 items on the to-do list. Be that as it may, my take is this: We need to think bigger. Run around more. Dream big dreams, do big things. Take control back.

Benjamin Franklin sat in the hall during the Constitutional Convention for many days and there was one chair that caught his eye. The chair had a vibrant painting of a sun just above the horizon and Mr. Franklin kept staring at it. Finally, as the Declaration was signed, Franklin spoke. He said he had stared at that painting wondering about the half-sun and whether it was rising or setting. He concluded confidently: “Now at length I have the happiness to know that it is a rising and not a setting sun.”

Here at ClickCare, we too are confident the sun is rising. We are confident it’s rising because there is evidence for it. We are confident it’s rising because our experience tells us so. Mostly, we are confident it’s rising because that is the only useful way to move forward.

Join us.

We are now on at least the 60th version of one of the screens of the new software!  New technology gives us opportunity to make things clean, simple and easy.  It is a lot of work… and it is sending us to the book shelf.

We have been enjoying Paul Glen’s Leading Geeks: How to Manage and Lead the People Who Deliver Technology, which, for all of us who are intimately and constantly involved, is not so much about managing geeks, but about managing ourselves (there are a bunch of us).

While we’re not necessarily admitting to being geeks, this quote from one of our team members could be a clue:

I just put a zip on the FTP called “nathan_mockups_320x480.zip” — these are our latest iPhone mockups with the iPhone device part removed (they’re just the 320×480 part that shows on the screen itself).  I recommend that you sync these as photos to your phone and try them out under the Photos app.  I can explain how if necessary. They overall look pretty good but one of things you’ll notice is the fonts in the rows on the home_list view did get kind of small.

For the ultimate example of geeks (not that we are…) and their friends and comments… a little geekified viewing on Bill Gates and Steve Jobs, who were even said to go on double-dates together, back in the day. Geeks are people too, you know.

As medical professionals, we really don’t sit down much.  We walk from exam room to exam room, floor to floor, department to department, home to work, work to home, hospital to hospital, and even to our patients homes.

So the challenge, as a reconstructive surgeon building a software solution for collaboration among providers, was this: How can we make this solution organic, flexible, and easy-to-access? In other words, how can we make it reflect our lives, not the life of the average IBM worker?

The answer was to build a network not with concrete, paper, and disks, but with computer-to-computer connections that function like neurons in the brain. The answer? The cloud. And how do we access the cloud? Via Software as a Service (SaaS.)

Instead of requiring a concrete program on your individual computer, the cloud means that you subscribe to a service (SaaS again) that connects you with the “cloud” (a network of computers) to store and manage data, and to process that data as a partner with your computer.

To completely mix the metaphor, it’s like an apartment building where the furnace is shared by all of its tenants.  The apartment owner sets the thermostat in his apartment, while his neighbor sets a thermostat to a different setting.  Neither runs down to the basement and puts water in the boiler and coal on the fire.  Each of the multiple tenants has his own keys and locks.  But, the cost of the furnace and its maintenance is shared. Each tenant pays less for the heat than if each had bought his own furnace (needless to say a “green” use of our resources.)

Cloud services have five essential characteristics:

1. On-demand self-service: no IT guy needs to supply you with access or passwords. No disks; no servers; no installers. It’s there when you need it.
2. Broad network access: you can use the service from wherever you want, whenever you want. Your mother-in-law’s PC after dinner? Check. Your iPhone from a Hawaiian beach? Double-check.
3. Resource pooling: This is where the furnace example comes in. You don’t need a computing center or even a very good laptop. You just need to connect to computers that do these functions for you.
4. Rapid elasticity: It grows as you grow. No need to estimate usage 18 months later. Also, because changes can be made instantly, there is no “your computer is worthless now” obsolescence.
5. Measured service: Like the pay-per-pound buffet, you don’t have to pay for what you’re not going to use.

We use information continually, want updates, and want help. However, unlike office dwellers with their fingers glued to their keyboard, we flow, and we need our information to flow with us. The cloud does, and that’s why ClickCare is all about the cloud.