Increasingly, taking photos is a part of our lives. We snap photos when we're out at dinner or on a trip. And we certainly want to take a picture when we see an interesting case or need to remember or share something about a patient.

With the significant fines and punishments for HIPAA violations, however, medical photography on your iphone or smartphone brings up a several HIPAA compliance and security issues:

• If your phone gets lost, all photos on your camera roll are insecure
• Once a photo is on your phone, it is tempting to email or text it, both of which are in conflict with HIPAA.
• Photos on your camera roll may be susceptible to access by apps that are not HIPAA compliant.

So what is a person to do? It seems ridiculous to choose not to use technology in service of patient care. Here is the good news: you can and should use your iPhone or other smartphone for medical photography. In fact, we think that medical photography is a simple, powerful way to improve how we care for patients and make our lives as providers a little easier.

So here is a checklist to make sure that your medical photos are secure and useful:

• Understand HIPAA. You don't need to drive yourself crazy, but a little understanding of the fines and penalties goes a long way 
• Never put patient photos into your regular camera roll. Sometimes smartphone apps (with the exception of iClickCare) pull from your camera roll-- even sharing pictures without your knowledge. And even if that doesn't happen, your camera roll only has one layer of security -- the login password on your smartphone. So when dealing with patient photos, we recommend using a secure app like iClickCare that doesn't ever save photos to your camera roll. You'll know your pictures are safe, and used only for your purposes. 
• Use some overall security strategies so you don't have to worry. When your technology is more secure overall, your photos are more secure, too. 
• Don't email photos. Email is never a secure way to collaborate. 
• Use apps that are explicitly HIPAA-secure. When you do collaborate, only use collaboration platforms that explicitly promise HIPAA security.

Security issues aside, we all want our medical photos to be a little bit better. Get the first chapter of our book on iphone photography for free:

This post was originally published on July 24th. Since this piece of our website was not working for all viewers, we're republishing some selected posts this week. 

Protecting patient privacy is a good thing. If a patient's medical information gets into the wrong hands, it can make it hard to get a job, complicate relationships, and have financial consequences -- so privacy and HIPAA are important and serious.

But the truth is that HIPAA is causing healthcare provider burnout. As we've talked about in other posts, up to half of physicians are burned out, which has real ramifications: physicians experiencing burnout are more prone to errors, less empathetic, and more likely to quit practicing altogether

And HIPAA is one factor contributing to this burnout, by:

• Disconnecting you from patients. HIPAA-induced wariness about sharing information with patients or patients' families can start to create barriers to interacting.  With so many rules about what is allowed to be shared, to whom, and when, some providers shut down.
• Wasting time with extra forms and EMRs. Most providers report that paperwork (even if it's electronic "paperwork") is at an all-time high, and HIPAA is a strong driver.
• Causing anxiety about getting in trouble. These days, even a simple conversation, phone call, or (gasp!) text message can start to feel hugely risky. That stress contributes to the overall stress of providing healthcare and accelerates burnout. 

So what is to be done? Well, there's a lot you can do, actually. First of all, when you acknowledge the ways HIPAA creates challenges in your practice, it makes you less likely to blame the people around you. Second, when you notice ways that HIPAA is making connection difficult, you can address it in your workflow. For instance, many of ClickCare's users tell us that ClickCare saved them a lot of stress -- as well as time -- because they didn't have to "reinvent the wheel" around HIPAA-safe collaboration. And finally, when you accept that HIPAA rules and constraints might be creating a feeling of disconnection with patients, you can get creative about ways to connect with them even within those constraints.

As with most things, the first step is recognizing the dynamic. Like William James said, "Acceptance of what has happened is the first step to overcoming the consequences of any misfortune." HIPAA is no exception. 

For an overview of the HIPAA/HITECH Omnibus Rule 2013, click the button:

Let us know your comments about the blog article, and tell us which topics you would like us to write about in future blog articles.

This post was originally published on July 24th. Since this piece of our website was not working for all viewers, we're republishing some selected posts this week.  

Working with the doctors and nurses I see every day is one of my favorite things about this work. I also observe a lot of folks working together, and the frustrations and successes I have been seeing made me want to look in the literature for other perspectives on medical collaboration. I found many articles, but two of them really struck me. 

The first was about teamwork on inpatient medical units and the second discussed barriers to nurse-physician collaboration. They made some pretty stark observations about the ways healthcare providers are failing to work together effectively -- and why. 

Sure, we're working in teams and we're trying hard. But working in a team is not the same as working together in a team.

These studies found 4 key barriers to medical collaboration:

1. People aren't in the same place at the same time. This may sound obvious, but the fact that medical teams are working in different buildings, across organizations, and over different shifts creates a unique communications challenge. Communications systems that ignore this challenge (like video conferencing systems or pages in hospital hallways) ultimately fail. 
2. Common systems don't work. Healthcare providers report that the communications systems they're expected to use don't facilitate collaboration or coordination of care. Whether it's an EMR, a paging system, or telephone calls, providers are frustrated with the current options. They're old technologies that don't match the pace, aspirations, or reality of healthcare today. 
3. Coordination of care is basic, and not happening. You would think that the question, "who is taking care of this patient?" would be pretty basic. But providers report that coordination of care is taking up increasing amounts of their time and happening poorly. So poorly, in fact, that knowing who is taking care of a given patient is becoming a daily challenge.
4. The "cockpit approach" doesn't work. Well, to be more specific, it does work -- 10% of the time. In a few specific situations, like in ERs and NICUs, applying learnings from airplane cockpits works (e.g., using checklists). But as Zwarenstien and Reeves point out, 90% of medicine takes place outside of this type of setting. The rest of medicine involves fluid teams, long-term and complex problems, and takes place in different locations and different times. That means that the cockpit construct doesn't help much, and these teams are left without a solution.

These barriers are familiar to me, both in our own hospital setting, and in the experience of many ClickCare users. The good news is that time and time again, I've seen creative, courageous nurses, aides, and physicians overcome these barriers, creating better patient care and a better provider experience.

What ClickCare's users taught me about breaking through to medical collaboration: 

1. Accept that this is your problem, even if it's not your fault. We may not have caused these difficulties in collaboration and communication, but we're suffering from them. The good news is that we've noticed ClickCare users getting a lot of satisfaction and stress-relief from collaboration. It wasn't their fault that it wasn't happening in the first place, but it did benefit them to make it happen.  
2. Experiment. There isn't a one-size-fits-all solution for collaboration, and so we have to experiment with figuring out what can work for us. The thing about experimentation, though, is that new efforts may not work right away. In the words of Seth Godin, "Anyone who says failure is not an option has also ruled out innovation." 
3. Choose a communications technology that works for you, even if not everyone is using it. As human beings, we have a tendency to wait for permission, to wait for standardization, to wait until we find out what everyone else is doing. But given the slow rate of change in the medical world, we have to take change into our own hands. Even if not everyone has adopted a new technology, it could easily be the right thing for us, for our organization, and for our patients. 

He called, we answered, and he asked us some interesting questions. We did our best to bring some insight about ClickCare and iClickCare. Here is a link: Expert Interviews, For any of you who would like some more background about why we do what we do, we answered these questions:

• After long careers as physicians, why did you start?
• Give me an example of how a patient would benefit?
• If the internet is involved, how can privacy be assured?
• Everything’s expensive in medicine, how does ClickCare save?
• How does iClickCare fit into other healthcare IT initiatives?
• How soon will I see this in my doctor’s office?

These questions are very commonly asked of us. Is there anything that we left out? Do you agree? We welcome your comments.

TNTC
Some of us will remember the old urinalysis report of Too Numerous To Count.

Certainly, the same report could be given for smart phone medical apps. We and our patients can track our blood sugar, exercise, blood pressure, weight, well being, stress and sleep. We have diet apps and women’s apps. We have medical references, and even physiologic monitoring.

Useful and concise reviews can be found at Medical iPhone. They reviewed ClickCare on Wednesday, April 20, 2011. A search in the Apple App store reveals nearly 6000 apps.

The buzz in the media, and the great majority of apps, center on those that are for the patient and consumer (B2C). There are many exciting (and some say futuristic) apps which help the owner of the smart phone to diagnose and care for herself. We do not demean these efforts, but have to ask the question: “What next?”

What does the provider do when the patient comes into the office hunched over, concerned, and holding a beautiful graphic display, delineating a consistently elevated blood sugar. She switches apps and the display shows blood pressure, high, as well. She has documented her intermittent headaches on her headache app. She brings in a Google search.

Google search for diabetes, hypertension, headache

She has not shown you an app for observation, but you observe acne and increased facial hair and think it unusual for a 43 year old.

So what next? Have you made the diagnosis? With which specialist should you confer? Do you call the renal person for her hypertension, a diabetologist, a neurologist? What studies would each like before seeing the patient? Since you know each of these as individuals in your community, and they are part of your natural network, who, indeed, could diagnose and comfort the patient best?

You have two choices:

1. You could pick up the phone or walk down the hall, wait until the CNA gets done with her break and ask her to dial. Or, you could wait on hold, ask the receptionist to ask the nurse to ask the doctor to “get him out of the room.”  Or, you could tell the patient that she might have a brain tumor, a lung tumor, an obesity problem, a new onset of diabetes, a normal expectation of hypertension, and to go see one of the specialists and tell him what you think. Maybe you want to dictate a letter, and wait for one to be returned. Expect the patient to wait for appointments for a long time because these folks are really busy.

2. You could take a picture with your iPhone, distill the history, and with three clicks of the mouse, ask each specialist for his thoughts, preferred tests, and concurrence with your presumed diagnosis. Did you make yours yet?  Each specialist gets back to you with a simple reply button, you call the patient, you share the diagnosis and the coordinated, collaborative treatment plan.

Someday, ClickCare will help each patient with her own care, but right now, today, it can help you, her trusted advisor, advocate, and experienced provider to care for her and yourself – quickly, securely, and with great satisfaction.

You just experienced (B2B). As the consumer wave rushes towards the medical professional’s office, help is available for those providers who care for them. Patients and consumers alike, still need help, and their providers need to help each other.

That’s what’s next.

Here is the Answer.

Or if you are really cool, take out your smartphone and read this bar code.

Use your barcode reader for the answer

A lot of people seem to think so.  The most recent report, abstracted by research2guidance entitled “Global Mobile Health Market Report 2010-2015” was reported at mHealth Summit last week.  We also heard the same theme when we presented at mHealth in San Diego, last month.

The statistics are amazing, and all point to the same message:  we are all mobile creatures and would rather not be on a leash.  Research2guidance estimates that 500 million people will be using smartphones in various ways for health care.  These range from continuing medical education to unique monitoring devices.

We at ClickCare would caution, however, that the right tool, at the right time, at the right price should be used.  We could not be more enthusiastic about iClickCare and the iPhone, we also know that sitting quietly at a large, easy to read computer screen can be as valuable as taking and sending a secure message and photo/video with the iPhone.  That is why we have both available and included with each subscription.

Similarly, one can subscribe either via download from the App Store, or from our website ClickCare.com .  A free two week trial lets you start collaborating with your colleagues immediately–with an iPhone, with a desktop, with a laptop or iPad.

Use a needle to sew a laceration or a shirt.  Use a sledgehammer to crush a rock.

Use your ClickCare subscription in the way that is best for you at a particular time and in a particular place.

We look forward to your comments.