ClickCare Café

4 Surprising Reasons Telemedicine Is Thriving

Posted by Lawrence Kerr on Tue, Jan 14, 2014 @ 09:07 AM

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Telemedicine practitioners can feel isolated. They are often among a handful of people in their immediate practice or hospital who are using telemedicine to perfect care, improve outcomes, and make their lives easier. 

The truth, however, is that healthcare providers using telemedicine are part of a large, growing, and thriving community. When we started working in this field almost two decades ago, telemedicine was rare. Now, however, the most committed, innovative healthcare providers all use telemedicine in one form or another. 

Telemedicine is actually thriving. Here are 5 reasons why: 

  • Politics are catching up. As this article details, parity laws are going into effect in several states. Also, the Telehealth Modernizaion Act -- to establish a clear definition of telehealth -- is on its way to going through. "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio)
  • Telemedicine is reaching critical mass. Research and Markets is predicting 18.5 % growth in global telemedicine in the next 4 years. 
  • New providers are more familiar with technology. For some of the same reasons as we highlighted in our discussion of concierge medicine, and as this article discusses, new providers are adopting practices like telemedicine at higher rates.
  • Providers are using smartphones in their practice. According to Verizon, "38% of physicians with smartphones use medical apps on a daily basis, and that number is expected to increase to 50% this year. Two-thirds of healthcare providers said that implementing or improving their use of mobile technologies is a high or mid-level priority during the next 12 months."

We're thrilled to know that providers are connecting better, people are collaborating, and patient care is improving as telemedicine becomes more widespread.


If you're looking into the options, get our Quick Guide to Telemedicine here:

ClickCare Quick Guide to Telemedicine


Image courtesy of thomaslevinson on, used under Creative Commons rights. 

Tags: telemedicine, medical collaboration software, accountable care, telemedicine roi, patient satisfaction, telemedicine solutions, ACO, affordable care act, concierge medicine, telemedicine law

Care Coordination, Accountable Care and Behavior

Posted by Lawrence Kerr on Sun, Jul 15, 2012 @ 08:44 PM

Accountable Care is a payment and delivery model that relates quality and cost. It is conceptually very similar to the HMO models of the 1970s. Interestingly, the same players have rejoined the game.

Tallies are made on three items:

  • Appropriateness
  • Efficiency
  • Quality

At first reading, these are undeniable truths, but further thought brings untenable falsehoods.

Accountable care ACO image

They are significant, and both the process and the products arehighly questionable. 

  • Where are the Carl Bernstein’s, Jacob Riis’s, and Robin Cook’s of the world? Why does the Affordable Care Act (Obamacare) feel as complicated as the disease of the system itself?
  • Why have thousands of lobbyists participated in a process that leaves the individual citizen/patient overwhelmed and under-informed.
  • Why must discussion be brought down to sound bites?

Instead of sound bites, let’s focus the fundamentals of health care. Let’s focus on patients and those who care for them. When it comes to paying and payors, it all becomes too impersonal, too murky, and frankly, too suspicious. Maybe the healthcare system has become so complex, and so inter-twinned, and so self-interested, than no one Bernstein, Riis or Cook can take on the investigation that is needed. Still, fortunately, questions are being raised.

All of that said, and all of that needed, we each can do our part. Our warning is about quality. Not quality itself, but about defining quality. Our concern is that to measure quality one needs numbers. To get numbers one needs definitions. To get definitions on needs language. To get language one needs ideas. And that is where the problem lies. Ideas can be new or old; accepted or controversial; hackneyed or original; common or cultural. 

It is naive to think that judging data will “incentivize” quality. What is measured, indeed, is what is changed, but when an institution (government or corporate) measures things, its citizens and employees fill out whatever form is offered to get the reward, and most often do not accept the penalty to reach a higher good. Can complete, comprehensive empathetic care be measured by ICD-9 or ICD-10?

Medical professionals as workersFor instance, is "incentivize hospitals, physicians, post-acute care facilities, and other providers involved to form linkages and facilitate coordination of care delivery" really collaboration? Who benefits? Is the patient or the ACO at risk? Is doing nothing good or bad? Does compromise of treatment, because of a compromised patient, acceptable.

This is not a new debate. Thus the reminder is that the patient must be the final beneficiary of quality improvement. It is the patient who sits before you, places trust in you, and ultimately lives or dies because of you. True quality is getting the best data available (yes even from an EMR/EHR) and then doing your very best, as an individual with an individual to get he best answer. This requires true medical collaboration on behalf of the patient. Collaboration requires exchanging data, experience and judgment. It is an extra effort. It takes work—in the past telephone tag, long and inaccurate descriptions, and long meaningless “reports and consults” from  “incentivized” consultants were bad enough. Not to be out done, primary care providers now send a 12 page EMR referral with every single checkbox filled in. Nobody thinks, they just generate data, devoid of interpretation, and without understanding.

Now, iClickCare makes it much better and easier. We must not jump over the bar that is given to us, but instead consider what is needed for the patient in front of us, and raise the bar for ourselves. iClickCare empowers the part of ACOs that matter for the patient -- patient centered collaboration.

Download our 10 stepsto simply collabora


(1) McClellan, Mark, et al. A National Strategy to put Accountable Care into Practice. Health Affairs. 29(5). 2010. 982-990.


Tags: telemedicine, medical responsibilities, coordinated care, accountable care, ACO

Accountable Care and Provider Shortages

Posted by Lawrence Kerr on Thu, Mar 22, 2012 @ 07:39 PM

As accountable care expands, and ACO becomes as familiar an acronym as HMO, the delivery of care will change.

In a way, it seems as if this mega-industry reflects the same stresses as the disintegration of the nucleur family: two jobs, job sharing, a parent on the day shift, and one on the night shift, soccer, music lessons, friends. No wonder the calendar on the refrigerator door is so important.

A shortage of providers will be met by, as CMS describes it, by expanding the workforce. This brings up an interesting discussion of collaborative care and telemedicine.

Donald W. Fisher, Ph.D., CAE, is AMGA president and chief executive officer. AMGA is the American Medical Group Association. His organization reports a study about manpower needs on March 12, 2012.

"Collaboration and teamwork are significantly more important to medical groups and health systems because care models and performance measures require it. The ability to work effectively as a member of an accountable care team becomes a valued skill for physicians and advanced practitioners who increasingly will partner with colleagues in primary care, hospital medicine, a wide range of specialties and subspecialties and allied health."

Accountable Care Organizations (ACOs) and the medical home model are growing concepts in modern health care delivery. This survey by the American Medical Group Association (AMGA) and Cejka Search 2011 Physician Retention Survey is most interesting as it describes physician, nurse practitioner, and physician assistant staffing needs and turnover. Many shocking facts are brought to light. These facts add up to a roiling environment of instablility. Medicine, now consolidated as a "medical industry," if nothing else, was once considered stable. Now the core -- providers -- shows itself to be unstable and changing.

Thus, there are shocking facts:

  • 67% of respondants reported "somewhat or significantly" increased involvement of advanced practitioners (non-physicians) in the past 5 years.
  • Turnover rate of nurse practitioners and physicians' assistants is 12.6%.
  • Three fourths will hire more in the next 12 months than the previous 12 months.
  • Turnover can cost as much as $1 million per physician in recruitment, startup costs and lost revenue

Four more interesting facts from the survey:

  • There is increased turnover. Turnover is nearly 6% in 2011.
  • There is more part-time work. 22% of male physicians and 44% of female physicians as compared to 7% and 29% in 2005.
  • More work is is being done by advanced (mid-level) practitioners.
  • There is a huge shortage of providers developing.                                                                                 

Incentives to address these issues have been:

  • Reduce hours
  • Flexible scheduling
  • Performance incentives.

There is a strong motivation to develop teams since they are the core of accountable care and of the medical home. With incentives, efficiency becomes important. 

Our interpretation of this data is both more specific and more broad: that there is a strong need to provide a way to build teams. These teams cannot just be items on a work schedule, but strongly need to have communicating, sharing, handing off, following up and educating -- people.

Moreover, the concept of centralization is no longer necessary, advantageous, or even possible. Just as the internet has decentralized commerce, the same forces will decentralize health care.

Our passion is to support and connect each individual to all the others in the team. We want to ensure that the patient does not continue to fall through the cracks, as a "disconnect" from care delivered from silos. We need to enable sign-outs, on- and off-call, continuity and creativity. With turnover, more education, and more collaboratoin is paramount.


                                                                             Click me

                                                                             Click me





American Group Medical Association

Fierce Practice Management 

Cejka Search 


Tags: collaboration, accountable care, ACO

Medical iPhone Photography, Call and Accountable Care

Posted by Lawrence Kerr on Wed, Dec 21, 2011 @ 02:12 PM

  • Improve your skills.
  • Be sure you have time off.
  • Consider Accountable Care.

Improve your Skills:  Medical Photography with the iPhone

medical iPhone photographyIt is now complete! We are announcing Medical iPhone Photography. This book is designed to be put in your pocket. Indeed, it is the exact size of the iPhone itself. Brief and concise, it shares over 30 years experience in medical photography from practicing physicians.

It falls into the long tradition of Harriet Lane's handbooks, American Heart Associations color-coded cards or even, your dog-eared crib notes.

Learn as your “earn.” In no time you will have a new skill that will benefit your patients and make your iClickCare collaborations even more valuable.

Buy the Kindle version

Buy the Nook version



It is the Holiday Season. Do You Know How to be Off Call?


You can be off call and still check on your patients when you get back. You can chooseclickcare collaboration on call someone to cover (with their permission, of course). When you get back, you can see their responses go into the Everything Else part of your List.



Upcoming in the New Year...

Last year’s strange word is next year’s buzzword. What do you know about ACOs, accountable care, and care coordination? How are payments made? Who participates? Why is this occurring?

We will be discussing this in the next few months and try our best to simplify the confusion and government speak.

Please help us plan by answering these three short questions. 



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Tags: iPhone photography, accountable care, ACO, medical photography

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