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Lawrence Kerr

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Dramatic Videoconferencing Screw-Up Brings Up Telemedicine Questions

Posted by Lawrence Kerr on Wed, Mar 13, 2019 @ 06:00 AM

glenn-carstens-peters-210782-unsplashWe've all been blindsided by technology taking the place of a human, when and where it shouldn't. 

It's the labyrinthine customer service switchboard when we just want to ask a simple question of a real person. It's the app that sends us in circles when we really just want to pay a bill. 

But a recent technology screw-up touched a serious nerve for one family -- and even called into question whether and how telemedicine should be used. 

Mr. Ernest Quintana was in the hospital for the third time in 15 days, as the New York Times recently recounted. His lung cancer was beginning to get the best of him and he was struggling. His family remained hopeful, though, and they were all with him throughout the hospital stay. 

One afternoon, though, Mr. Quintana was surprised to find a machine with a video screen on it being wheeled into his room. With his granddaughter by his bedside, Mr. Quintana listened as a doctor in an undisclosed location, and whom he had never met, began to discuss his care. His surprise turned to sadness and dismay when the doctor shared that Mr. Quintana was likely not going to survive this hospital stay and prepared him for end-of-life care.

A prognosis of death is never easy news for a person or a family. But hearing the news from a doctor you have a relationship with, who brings compassion, presence, and leadership, can decrease the suffering and ease the way forward. In Mr. Quintana's case, the terrible news and challenging decisions were worsened by the impersonal and jarring way that they were broached. No one wants to have a conversation about death with a stranger on a video screen. 

So is this a condemnation of telemedicine? Of technology?

I don't think so. I believe that this sad turn of events simply points to positive and negative uses of telemedicine and positive and negative uses of technology. 

So many people default to videoconferencing as the go-to (or even default) form for telemedicine to take. We believe videoconferencing has severe limitations because it requires expensive hardware and circuitous scheduling coordination. Those are some of the reasons that we believe hybrid Store-and-Forward telemedicine is significantly more powerful of a tool.

But this story brings into focus an even more important and powerful reason that we believe telemedicine should be about team-based collaboration -- not videoconferencing between a doctor and a patient. When telemedicine is used for healthcare providers to collaborate among each other, the patient can interact primarily or exclusively with the providers that they have a relationship with -- and the "other opinions" on the team can be shared among the medical team. That way, the providers can be leaders, healers, and human beings FIRST -- but use telemedicine to consult with other people on the team as necessary, and without disruption to the care for that patient.

For instance, in Mr. Quintana's case, perhaps an outside opinion was necessary regarding his end-of-life care. But rather than that opinion being piped in through a video screen, we believe it would have been far better for his provider, obviously, to consult with the outside doctor -- and then have a conversation with Mr. Quintana in person, within the context of their existing relationship. 

Don't risk this kind of technology screw-up. Prioritize human relationships and let technology -- and telemedicine -- serve them. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

Tags: medical collaboration, hybrid store and forward medical collaboration, healthcare collaboration

Healthcare Travel and Wait Times Are Bad - But is That Our Problem?

Posted by Lawrence Kerr on Wed, Mar 06, 2019 @ 06:00 AM

andrik-langfield-266832-unsplashMy daughter recently signed her new baby up as a patient at a pediatric practice and had to choose one of the doctors in the group. “Dr. Salno,” they said, “is great. But you have to wait at least an hour to see him, every time.” She ended up choosing another doctor in the practice.

Her experience isn’t uncommon — so many of the very best healthcare providers we know have long wait times in their offices or are frequently running behind. Is that a problem for healthcare, or is it simply part of the reality?

 

In our experiences as medical providers, there is sometimes a sense that long wait times, doctors who are hours behind, and extensive travel to get medical care are all just facts of life in medicine. And that makes sense — there is a shortage of providers, especially physicians, and every healthcare provider I know has far more work to do each day than time to do it in. For some of us, long wait times and long travel times are practically badges of honor, showing just how in demand our practice is. 

In fact, those travel and wait times are long, and aren't decreasing. A recent study by Altarum shows that “Despite significant investments in the United States [from 2006 to 2017] in improving access to health care through better insurance, the use of innovative delivery systems, and advances in digitizing health care records and automating administrative processes, travel and wait times show no discernable improvements.”  These dynamics haven't been improving in decades.

The place that I see travel times really come into play are for patients with complex, chronic, or even acute but serious conditions. According to the Altarum study, patients who reported their health as “poor”, spent an average 26.4 hours per month on healthcare. That time may be transiting from provider to provider, from appointment to appointment, in addition to actually accessing care. 

But is this time that patients spend a bad thing? Is it something that should be decreased? And further, are travel and wait times something that healthcare providers should concern themselves with, or is it someone else’s problem?

Long travel times may not seem like the healthcare provider's problem until we consider the health cost of that time. Of course, there is the element of lost productivity and wages. But even just focusing on health itself, I believe that spending so much time accessing healthcare, as well as transit and waiting, has a severe and negative impact on our patients' health. Time spent at home with loved ones, hours invested in hobbies, focus at work, and rest in our own beds are all crucial elements of healing from disease. Every hour that a patient spends in a waiting room or driving to yet another appointment detracts from this healing time. 

So what can healthcare providers do? Most importantly, we can try to understand our patients' lives, travel times, wait times, and recovery and see it as "our problem." We can use medical collaboration tools to loop in other providers' input without the patient needing to trek across the state to gain that input when a picture and a discussion is actually all that is required (and this is reimbursable). When tools like iClickCare exist, that use telemedicine to dramatically decrease transit and wait times, there is the opportunity for health to truly improve, because the patients are able to spend more time healing and less time transporting or waiting 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Tags: hybrid store and forward medical collaboration, healthcare collaboration, medical collaboration tool

Why $5 of Supplies Can Prevent Thousands of Deaths

Posted by Lawrence Kerr on Thu, Feb 28, 2019 @ 06:00 AM

phuong-tran-1248347-unsplashIf there is one thing we all agree on, it’s that healthcare is complex.

The health of any individual is, of course, complex — with thousands of variables in the matrix of health, illness, and healing. Further, healthcare itself is complex, with so many challenges and opportunities that it’s easy to lose hope that things can change or improve.

So it’s deeply heartening when we stumble across a healthcare initiative that is outrageously simple, but with profound results.

Recently, I stumbled across two healthcare interventions that are deeply effective but very, very simple.

First, a group of California hospitals implemented a simple post-hospital educational initiative to reduce MRSA infections. 2000 patients were given either education on preventing infections via hygiene or that education plus antiseptic for bathing, antiseptic mouthwash, and antibiotic nasal ointment. The results? MRSA infections came down by 30%, with the education-plus-supplies group showing the most improvement. No new technologies were pioneered; nothing expensive was implemented. Just a simple “care package” to send home with patients from the hospital.

Second, a Virginia VA hospital had its nurses spend extra minutes with patients plus spend $5 on a toothbrush and toothpaste to encourage patients to brush their teeth. The results? Non-ventilator cases of hospital-acquired pneumonia have decreased by 90%. So far, they estimate that they’ve saved 21 lives and reduced costs by $4.69 million. Pretty phenomenal results for something as simple as a toothbrush and a helping hand.

So is there anything that we can conclude from these two studies, other than celebrate the ingenuity of their pioneers? I think there is. 

2 Key Learnings From These Pioneering (But Simple!) Studies: 

  • Simple and inexpensive can be best. 
    One thing that we love about iClickCare is that it's a simple, inexpensive way to do telemedicine -- no expensive new hardware or computers or huge software implementations required. Sadly, some in healthcare believe that complexity is always better -- so they'd almost prefer a more expensive, more difficult product. But these studies are yet another proof point of how misguided that approach is. 
  • Real life trumps theory. 
    In both of these studies, the initiatives were thoughtful about the reality that patients would face as people receiving care (one in the hospital, and one after the hospital stay.) It's easy for us in healthcare to focus on the glamorous treatment -- like a sophisticated surgery -- and forget that something as simple as nasal ointment or tooth-brushing can save lives. Similarly, we believe it's crucial to collaborate across the continuum of care -- not just between specialists -- since often, aides or nurses or others on the team will have a more "real life" perspective that can help.

The bottom line? Don't be afraid to do what is right for your patients, even if it doesn't sound fancy. It's possible that the deeply un-fancy is what's going to save healthcare -- and save lives. 

 

For more stories of smart collaboration, download our Quick Guide:

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: telehealth, healthcare collaboration

Why Robots May Not Steal Your Job as a Medical Provider

Posted by Lawrence Kerr on Tue, Feb 26, 2019 @ 06:00 AM

franck-v-740555-unsplashIn a conversation with a young doctor recently, she sighed as she considered her future as a physician.

“I just don’t think my job is going to really exist in a decade or two,” she said. “It’s all going to be computers and nurse physician assistants.”

It’s a scary thought — that doctors as we know them  won’t have a role in providing medical care in the future. But is it true?

 

The applications to the U.S. Patent and Trademark Office are always illuminating as to what is on the horizon in the world of science and technology. Patents reflect those innovations that may or may not have a business plan or a market, but often reflect the direction that technology is headed more generally.

So I was interested to note that Google is developing an electronic health record (EHR) that uses machine learning to predict clinical outcomes.

As Fierce Healthcare reports, “Google appears to have plans to develop its own electronic health record (EHR) for clinicians that gathers patients’ medical records and then leverages machine learning to predict clinical outcomes, according to a patent application."

So is this patent application, backed by tech's behemoth, a harbinger of the inevitable phase-out of doctors?

I don't think so. True enough: it’s almost certain that the role of computers in our practice of medicine will continue to increase. But the truth is that doctors' core role is so much more essential and irreplaceable than any diagnosis, computer-assisted or otherwise. Ultimately, physicians are healers. And a computer can diagnose. A computer can perhaps even treat. But it takes a human being to truly heal another. 

That said, I believe that for medicine to be truly resilient -- for healthcare providers to continue to be relevant into the future, we need to lean into the art and humanity of medicine. The trend over the last couple of decades has been to reward providers who treat medicine like a complex factory -- the more efficiently and flawlessly you can move through the heap of patients, the more you are rewarded. But I believe that we are beginning to experience a shift. And into the future, simply being efficient and precise is not going to be our path forward. 

I believe that medical collaboration with our very human colleagues is a crucial part of leaning into that art and humanity. It's a tool that we can use to treat the whole patient, and do so with true thought. Our practice will likely be assisted by machine learning and artificial intelligence in the future. But if we're doing our jobs right, that assistance simply can't replace us. 

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Tags: telehealth, medical collaboration tool

Why Opioid Overdoses Spotlight Care Coordination Failures

Posted by Lawrence Kerr on Thu, Feb 21, 2019 @ 06:00 AM

tom-parsons-426898-unsplashThe US opioid epidemic is reaching unprecedented levels. Almost 48,000 people died of an overdose in 2017 and millions of people are affected by opioid abuse. 

One challenge in the treatment of opioid abuse and overdose is that they lie at the intersection of multiple disciplines, providers, and dynamics. Mental health, public policy, law enforcement, social work, housing, emergency care, and medication all play a role. But too often, only the immediate problem is addressed -- and care coordination fails -- which means that patients end up experiencing chronic repetition of that problem. 

A recent study looks at why opioid overdoses reveal the significant cracks in the care coordination that exist -- and endanger all patients.

You could say that West Virginia is Ground Zero for the opioid epidemic. The state has an opioid overdose rate more than three times the national average and the highest death rate from drug overdoses in the country. So the challenges that patients and providers face there are instructive for providers in states with less severely affected populations but who face similar dynamics.

In an effort to understand the trajectory of care for these patients, Fierce HealthCare looked at a recent West Virginia study of Medicaid claims. Researchers followed the treatment of patients after the overdose code to see whether follow-up care was billed. For instance, checking to see whether mental health visits, opioid counseling visits or prescriptions for psychiatric and substance abuse medications were billed after the initial Emergency Room care. 

Following ER care for an overdose, less than 10% of patients received a substance abuse drug and fewer than 15% received mental health counseling. Of course, it’s possible that the rate of referrals was higher and that many patients didn’t access the counseling. But realistically, follow-up may be as crucial a part of the care as the initial care itself. As one patient who was treated for an overdoes in the ER said, “There were a lot of times I could have gone down a better path, and I fell through the cracks."

I noticed several key insights from this study that I think are meaningful for any provider, regardless of how relevant opioid abuse in particular feels to them. 

4 key learnings from opioid overdose and care coordination failures:

  • The more complex the disease, the greater the risks for coordination.
    But "complexity" doesn't just come from the details of the disease itself. In opioid abuse, multiple parties, including healthcare providers and social services all need to come together to care for the patient effectively. And these providers must collaborate across institutional lines, across the continuum of care, and across a long time horizon. This complexity is where we start to see care coordination fall apart -- but really it just reveals the weakness in care coordination that exists for all patients.
  • Some diseases are associated with less sympathy than others. 
    The reality is that with drug overdoses, there may be an aspect of moral condemnation in the ways that healthcare approaches the problem. As healthcare providers, we know that opioid abuse is really a complex disease. But it's very possible that bias sneaks in and the complex coordination of providers, services, and care falls short because providers may feel less sympathetic about the particular aspects of this disease. Some of our most vulnerable populations may have healthcare challenges that are frustrating or overwhelming to providers -- and it's important that providers are able to collaborate with social services and colleagues that can support these patients in ensuring appropriate care.
  • All good care goes beyond acute care. 
    It’s never enough to simply treat the acute illness that is right in front of us. But as providers, we need the tools and collaboration to care for patients more broadly than that. Most emergencies require more than simply treating the situation in front of us. A baby's stitches in the ER require follow-up with the pediatrician. An overdose necessitates counseling and substance abuse drugs.

Our EHRs and systems simply don't support this more broad understanding of what it means to provide care in complex situations. And that means our patients are receiving subpar care, due to the limitations of our tools and workflows. Each healthcare provider is doing his or her job to the best of his or her ability. But the demands of caring for our patients mean that sometimes just "doing our job" isn't good enough -- we must also look at the big picture of that care. And we must demand tools to help us act well and care appropriately within that big picture. 

 

You can try iClickCare for free, and get started in one day. Sign up for free here:

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Tags: care coordination, healthcare collaboration

The 3 EMR Interoperability Blindspots Your Hospital Has

Posted by Lawrence Kerr on Thu, Feb 14, 2019 @ 06:00 AM

rawpixel-782046-unsplashRecently, seven major hospital systems put out a bold call.

It is crucial, they contend, to improve data sharing and interoperability among EMRs and EHRs. As Fierce Healthcare reports, "In a 2017 AHA survey, 57% of respondents had experienced challenges sending the proper information to a different vendor platform. And 37% ran into challenges just matching patient identities between systems."

Any healthcare provider who works with Electronic Medical Records won't dispute that data sharing is lacking with these tools. But despite the importance of this report, I see 3 crucial blindspots that it has -- and that your hospital may have, too.

I agree that interoperability among EMRs and EHRs is something that we should all demand. The simple access to data about your patient is as fundamental as having a clean and private exam room to see that patient in... or as having the ability to record your own notes about that patient. 

So I was glad to see this hospital report come out. That said, I believe there are three crucial shortcomings to this report. And identifying them isn't so much to undermine the findings or importance of the report itself -- but to identify blindspots that your hospital may have as it begins to pursue interoperability of EMRs and EHRs.

 

3 crucial shortcomings to focusing on EMR interoperability:

  • EMRs / EHRs will never be true healthcare collaboration tools.
    No matter how sophisticated interoperability among medical records becomes, the truth is that these systems will never be true healthcare collaboration tools. The records simply aren't made to easily facilitate multidirectional care coordination and medical collaboration among all members of a care team. And so it's a mistake to believe that by solving interoperability, we might have improved care coordination or collaboration. 
  • Providers need better tools now. 
    The reality is that even if EMRs and EHRs become more interoperable, healthcare providers need better communication and collaboration in the meantime. The reality is that today, EMRs and EHRs consistently get in the way of sharing data and patient information. Until the day that EMRs/EHRs are interoperable, healthcare providers must take the burden on themselves of making sure that other members of the care team have HIPPA-secure access to patient information. 
  • We need collaboration among people, not computers. 
    The AHA report emphasized that "there is an urgent need to coalesce around improved standards that overcome the significant gaps making communication difficult between systems." In other words: we need our computers to communicate better. But the harder truth is that allowing computer systems to share data is just Step One. What is really needed in medicine is the ability of providers to collaborate and coordinate care. The data-sharing is just the foundation -- it doesn't necessarily facilitate the profound collaboration that needs to occur for good care to happen. 

As always, these organization-level initiatives -- like those to improve interoperability -- are crucial. They are long-term projects that affect key foundational aspects of what we do as providers. But these projects are often uni-dimensional and may not affect our work in the holistic ways we need them to. So even as hospital-level and nation-level work occurs, we as providers must create and demand tools that are immediate and holistic enough to support excellent care for our patients. 

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: care coordination, EHR, EMR, medical collaboration tool

The Healthcare Collaborators It's a Mistake to Overlook

Posted by Lawrence Kerr on Tue, Feb 12, 2019 @ 06:00 AM

ben-white-998822-unsplashMost healthcare providers struggle to collaborate with even the most essential of their colleagues. Many of us are stuck in the "dark ages" of phone tag or hoping that the EMR/EHR manages to coordinate different provider visits and perspectives. (I'll give you a hint: it doesn't.) 

While iClickCare is commonly used in hospital settings, private practices, or home healthcare, you might be surprised to know that iClickCare actually originated in elementary schools, with a school-based healthcare program. Our Founder is a pediatrician and she created the tool to collaborate with nurse practitioners at local low-income elementary schools. The goal was to use telemedicine to collaborate, coordinate care, and keep young students in class by resolving health problems more efficiently.

So when I heard about a recent program with similar goals, I was glad to know it is succeeding -- even as there are key aspects of it that fall short.

 

In 2012, Children's Hospital Colorado started a program with school and corporate collaborators -- it works with school nurses to train students to manage their asthma more effectively. 

The question asked in the article, "Are schools part of the healthcare system?” is an important one -- and I would answer with a resounding Yes. As Dr. Deterding said, “Even though schools may not want to be a medical healthcare delivery system, they are. ”In fact, I believe that “the healthcare system” includes far more collaborators than one would think. It’s not just doctors, nurses, and hospitals. Our collaborators in medicine include social workers, teachers, parents, kids, school nurses, home health aides… the list goes on and on and is unique for each patient.

According to Fierce Healthcare’s summary, participants in the Colorado program "experienced a 22% drop in school absenteeism and an 80% decline in hospitalizations and urgent care visits among pediatric asthma patients.”

While this is an exciting program, with strong results, I do think that we can do even better. Ultimately, this program doesn't create a foundation to improve the way we care for young patients overall -- it simply resolves one aspect of a complex care scenario. While results were excellent, I worry that the intervention isn't holistic enough or sustainable because it's not involving the full picture of these young patients' care. That said, I think there are several crucial learnings from this project that we can all take away. 

3 Key Care Coordination Learnings from a School-Based Health Program:

  • The people closest (geographically or emotionally) to our patients may have the strongest ability to support them.
    In this case, the people consistently close to these young patients are school nurses. School nurses are close in terms of physical access, are embedded in the students' community and cultural context, and likely know the students personally. Similarly, it's crucial to recognize the similar closeness of wound care nurses, home health aides, teachers, social workers, and others. Medicine can become very hierarchical, in which specialists are hyper-valued. But the reality is that for the best care to happen, we need to collaborate with the people closest to our patients as well. 
  • Working across the continuum of care can be a powerful way of achieving new results.
    The new world of healthcare requires that we expand our understanding of who is part of the care team. But I believe that it's not enough to simply engage school nurses to execute a program. We must truly collaborate across the continuum of care. We have seen over and over again that this approach yields a strong ROI and best-in-class patient care.
  • Tools used to bridge different aspects of the healthcare system must be robust and flexible. 
    What does that mean specifically? It means that our tools must do more than support us in treating a single disease, as with this asthma program. Rather, we need tools like telemedicine-based healthcare collaboration that help manage asthma today, a cancer scare tomorrow, and a complex broken leg next year. Healthcare is too complex, and our patients are too valuable, to settle for single-use tools.

With the inspiration of both the strengths and shortcomings of this program, I encourage you to look more broadly in your practice today. More broadly in terms of who you see as part of the care team... and more broadly in terms of what you expect from the tools you use in your practice of medicine. Our patients deserve more and better care coordination and healthcare collaboration -- and we deserve more and better satisfaction from the work we do.

 

Learn more about hybrid store-and-forward telemedicine and how it can help you do care coordination across the continuum of care:

ClickCare Quick Guide to Hybrid Store-and-Forward 

 

Tags: hybrid store and forward medical collaboration, nurse practitioners, nurse collaboration, healthcare collaboration software

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities

Posted by Lawrence Kerr on Wed, Feb 06, 2019 @ 06:00 AM

 

hush-naidoo-1170845-unsplashThe United Hospital Fund is a nonprofit that is embarking on an important initiative. Their Difficult Decisions series explores the challenges that hospital staff personnel face in planning discharge.

The third in the series looks at the transition to post-acute care, usually to a Skilled Nursing Facility (SNF). And the study itself brought to light important insights for all providers, in understanding discharge planning, as well as patient transitions, more generally.

The most salient point in the study is, as Fierce Healthcare summarizes, that discharge planning presents profound obstacles for the hospital staff personnel who carry it out. Both administrators and staff very much have a goal of continuity of care. But the tools and structures that staff personnel encounter make the outcome of discharge planning fall short, many times. 

For any of us who work in hospitals every day, none of this comes as a surprise. That said, there were several nuances in the study that were enlightening in exploring when balls get dropped in discharge planning -- and how we might improve that process. 

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities: 

  1. Discharge plans are made without real input from the people carrying them out. 
    One thing that I loved about this study is that it was carried out by talking directly to the people who are actually doing the work, in order to understand the real challenges and opportunities they face. For that reason, I think the insights carry more weight than a study solely based on administrators, or findings from a think tank or conference. Similarly, discharge plans are sometimes coordinated "at the top" rather than allowing them to be shaped and reshaped by the medical team, across the continuum of care.
  2. Discharge plans are often static. 
    The status of a particular patient changes quickly and often without warning, which means that the discharge plan must change and evolve, too. A static plan won’t work. And one that’s created once and then executed by members of the care team, in their offices or even across institutions won’t work. That’s why a tool like iClickCare -- which uses telemedicine to support medical collaboration for care coordination -- is so crucial. As the patient's situation changes, the entire care team can continue to influence the discharge plan, communicate about status changes, and get multiple perspectives.
  3. There is little communication across institutions. 
    Although, in theory, a nurse at a Skilled Nursing Facility, or a doctor at a hospital can always "pick up the phone,"  the pace of medicine and the realities of scheduling makes telephone tag nearly impossible to do successfully. For that reason, there is often little communicate across institutions -- for instance, from a hospital to a Skilled Nursing Facility, or vice versa. That means that information is often fractured and things can get missed, not to mention that crucial nuances of patient care fall by the wayside altogether. 
  4. Patients are given information, not guidance. 
    In theory, patients are given the information they need (for instance, a list of skilled nursing facilities). But realistically, they’re not being given the guidance or support necessary to make high-quality decisions about "next steps" in their care. True guidance and support means their whole care team working with the patient collaboratively -- throughout the duration of their illness.

In exploring the findings of this study, it was so clear to me that "trying harder" is not the answer when it comes to healthcare providers doing care coordination and discharge planning effectively. Teams need excellent tools and strong processes to support them in actually creating the continuity of care they intend to. And telemedicine-based medical collaboration is one of those crucial tools. 

 

You can try iClickCare today to support your organization in doing care coordination as effectively as it intends:

 

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Tags: care coordination, medical collaboration tool, skilled nursing facility, telehealth in skilled nursing facilities

A Surprisingly Simple Way to Improve Birth Outcomes

Posted by Lawrence Kerr on Tue, Jan 29, 2019 @ 06:00 AM

julie-johnson-692218-unsplashIn Sweden, 28% of women who give birth were born in another country.

These women may be Syrian refugees or arrivals from Africa, or France, or Spain. They speak countless languages and may not be familiar with the medical protocols and cultural norms of their new home. 

And this reality is not without its challenges. Sweden has good rates of maternal complications and mortality, but immigrants face outcomes six times worse than their native-born counterparts. 

That said, a simple new initiative has been changing that for immigrant women giving birth -- and the practice is rooted very much in medical collaboration and care coordination.

A recent article in the New York times explores Sweden's immigrant maternal health challenge -- in which foreign-born women face outcomes six times worse than Sweden-born women. Of course, these women may have significant linguistic and cultural barriers, keeping them from accessing the same standard of care.

Interestingly, the solution to this problem isn't intensive prenatal interventions or better technologies -- it's simply improving collaboration and communication.

This collaboration intervention comes in the form of "doula culture interpreters" -- trained women who assist a pregnant woman in her labor, supporting her in communicating with her midwife or doctor as well as helping her understand the norms and practices in the birthing process. These doulas translate from the immigrant’s home language and culture into their adopted language and culture. But they also translate the medical system, culture, and jargon. 

Sometimes the participation of the doula is as simple as literally translating from Swedish to, say, Arabic. Other times, the "translation" is from medical-speak to plain language. “Good communication is listed as one of the best ways to improve outcomes,” Dr. Esscher, a Swedish obstetrician, said in an interview. And, indeed, the doulas' support of good communication, has been having an effect on outcomes. 

I found this doula project inspiring in its simplicity. It's an intervention that doesn't involve displacing or dramatically changing any current practices or providers. It simply improves communication, collaboration, and coordination with the assistance of one of the doula interpreters. I also think that this kind of approach spotlights the importance of having collaboration tools that are flexible enough to involve multiple kinds of collaborators.

For instance, the old telemedicine paradigm of a one-to-one videoconference or text message thread between two doctors simply isn't enough to support this kind of approach. Rather, a truly team-based approach in which, perhaps, the doula interpreter, the obstetrician, and the midwife could all collaborate on postpartum or antenatal care, that is the approach that is truly necessary. Knowing this need generally, iClickCare has been structured to enable medical collaboration among multiple members of the care team, regardless of medical training, across the continuum of care. In an age when our care team includes a range of providers, offering a range of perspectives, this kind of tool is not only helpful, it's indispensable. 

To me, this program brings up questions that apply to all of us in medicine. First: We’re in a time where immigration and refugees are one of the challenges and opportunities that many countries face. How might we ensure that all people in our country experience the same quality of care and outcomes? And perhaps even more crucially: we're in a time when medical care is increasingly team-based, with a diversity of training levels and perspectives. How might we make sure that all members are engaged to provide the most coordinated, nuanced care possible?

 

Try iClickCare to support team-based telemedicine medical collaboration: 

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Tags: telemedicine solutions, care coordination, medical collaboration tool

Holistic Medical Approaches Can Have Measurable Outcomes

Posted by Lawrence Kerr on Thu, Jan 24, 2019 @ 10:54 AM

rawpixel-659503-unsplashMy mentors in surgery never allowed us to view surgery as solely the surgical event.

Truly knowing the patient, preparing the patient mentally and physically, and working with other providers to ensure excellent post-operative care were all inherent parts of the job — not “extras.”

The truth is that the structure of the medical system has made this approach increasingly difficult to carry out. Ironically, though, many of our most pressing health issues demand this kind of approach. So I was inspired recently to hear about a new program using just this kind of holistic approach -- achieving tremendous success, in a major hospital system. 

As we know, recovering from surgery can be slow and complex, even in the best of times. In the midst of an opioid epidemic, however, there are even more reasons that surgical recovery can touch off opioid addiction. On the face of it, it doesn't sound like a problem you could do much about -- but Geisinger Health System, a major Pennsylvania-based hospital system, decided they could do something about it. 

Rather than trying to address opioid problems directly and after-the-fact, Geisinger's program uses a holistic model to prevent issues before they start.

As Fierce Healthcare explains, “Pennsylvania-based Geisinger Health System is launching a program to "redesign" the surgical experience aimed at improving the healing process following surgery while ultimately tackling one of the major sources of opioid addiction: postsurgical care. Officials said their Proven Recovery program rethinks the surgical experience by pushing patients to be healthier before surgery, which leads to fewer complications.”

Since June 2017, when the program began, opioid usage across the system has dropped 18%. Perhaps even more astounding, hospital stays for neurosurgery and colon surgery went down by a full 50%.

The program focused on pre-surgery and post-surgery approaches, like making it easy for patients to achieve proper nutrition, a focus on non-opioid and targeted pain approaches, as well as focusing on mobility after surgery.

In many ways, this program isn’t cutting-edge medicine. It’s appropriate pre- and post-surgical care. “Appropriate” care is always holistic in these ways — and at other points in the history of healthcare, this kind of approach wouldn’t be out of the ordinary.

That said, the frustrating truth is that this kind of holistic program is so rare that the results Geisinger is getting are truly exceptional. The way the medical system is structured, a program like this — which is preventative, collaborative, and holistic — simply isn’t easy to create or get support for.

We hope that models like this pave the way for more programs that tackle challenging problems in smart, holistic, collaborative ways. And we will continue to make sure that courageous healthcare providers like these have the tools they need to overcome silos and work in medical collaboration, together. 

 

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Tags: good medicine, medical collaboration tool

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