ClickCare Café

The Outcomes of Older Doctors and Female Doctors May Differ -- But Does It Matter?

Posted by Lawrence Kerr on Wed, Jun 07, 2017 @ 06:01 AM

olderphysicians.jpgOur least favorite type of research is the observational study. Think: eggs are good for you, eggs are bad for you; eat meat, don’t eat meat; statins cure everything, statins cause everything; and on and on.

However, observational studies can be a first step into deeper understanding. An example is Jenner’s observation that milkmaids who contracted cowpox did not get smallpox. In the current "publish or perish" environment, the necessary deeper inquiry (Jenner tested vaccination, albeit in a crude way as we look back) often does not happen. Public media grabs and grasps the story, disseminates the story, and the story disappears and is gone within less than 24 hours. Another publication is notched for institution and researcher. Big data is thanked. Rarely do we find someone who goes on to ask why.

Certainly, inquiry into what works and what doesn't is extremely valuable. That said, two recent studies also beg for a deeper answer. Both are by the same author. The first study by lead author Yusuke Tsugawa observes the female physicians have fewer patients die or be readmitted. They speak of adherence to clinical guidelines  and “patient centered communication." 

The second study concludes that younger physicians have fewer patients die while the readmission rate is the same. It pits older physicians against younger physicians. Medicare patients formed the sample. Policy implications concluded that medical education and its maintenance of certification is important.

There is no doubt that the younger physician is a better coder and understands the value of coding maybe even over outcome. Could this be the education that is required? 

But, let’s not quibble over reasons and explanations. Above all, what matters most is how we can improve medicine. 

Assume the conclusions are correct, and that there are indeed differences born of gender and age. Why not encourage, support, and demand collaboration and communication? Bring the old to share with the young, the young to teach the old. The style of the female to mesh with the style of the male.

Regardless of whether these studies are strong and solid and show true causality between these physician demographics and their outcomes... Why not work together, rather than focus on controlling the parts?

 

These stories of medical collaboration show that you can take outcomes into your own hands:

ClickCare Quick Guide to Medical Collaboration

Tags: good medicine, collaboration, collaboration leadership

Why I Think Telemedicine Only Works for Some Personality Types

Posted by Lawrence Kerr on Wed, Jul 29, 2015 @ 07:00 AM

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Doctors have different motivations for going into medicine. Some do it because they thrive on the intellectual and emotional challenge. Some because they have an altruistic desire to help people ease their medical problems. Some seek power. Others go into it because it seems stable, prestigious, and potentially well remunerated. Most, in my experience, do it because of a combination of the challenge and the altruism.

These different motivations create different actions and priorities in day-to-day care.

For instance, as Dr. Mikkael Sekeres describes, doctors who prioritize control or power can overreact when patients as for a second opinion. (I will say, though, that supporting second opinions is a nuanced thing -- from time to time, the inappropriate pursuit of multiple opinions will actually subvert, rather than support, the patient's health goals.)

We've frequently seen this with providers who use -- or don't use -- iClickCare. You can often predict the administrators and providers who embrace this collaboration tool.

Those who embrace telemedicine and collaboration are motivated by good care, not power or financial reward.

 

(Although, ironically, both power and financial reward seem to come from innovating and collaborating.) Those who embrace it are willing to take a risk (just the risk of having tried something.) Those who embrace it see their colleagues as friends and allies rather than as competitors.

In the same way that Dr. Sekeres believes that opening oneself to second opinions is part of being a good doctor, we believe that opening oneself to collaboration and technology is part of being a good doctor in 2015 and beyond.

No one of us is as good as all of us. And for those of us who want to be truly good at being a medical provider -- that means that collaboration is essential.

 

To learn how telemedicine and collaboration can help you give patients extraordinary care, click here: 

 

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Tags: telemedicine, collaboration, good medicine

Does This Approach to Health Insurance Go Too Far?

Posted by Lawrence Kerr on Fri, Jan 09, 2015 @ 07:30 AM

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We love bringing you news of innovators in healthcare, like this PA clinic or that project to encourage collaboration. Another story about an innovative initiative raised some questions for us, however.

The New York Times covered the trend of religiously oriented groups organizing health "networks" in which members contribute payments to cover each other's health expenses. As health insurance has become federally mandated, these groups are complying with federal law, but in a way that feels personal, affordable, and enables them to circumnavigate pieces of the law that don't align with their values. 

We get excited when we hear about projects like this. We firmly believe that when regular people get more involved in their healthcare, we all win. Plus, we leap for joy whenever a small group of people find a way for common sense to win out over healthcare madness. It's pretty fantastic that when Erica Beiler gave birth, her expenses were covered and members even sent extra money to help welcome the baby into the world. 

That said, we could never -- as people or as providers -- support the network since things like medical care to gay folks and treatment for STDs aren't covered. It's certainly not a system that aligns with our ethics. Plus, the networks are unregulated, often have a lifetime maximum payout, and there may not be enough money on hand in a given month to cover all eventualities.

Be that as it may, we still are happy to shine a spotlight on a small group of people doing something, taking action, to make the medical system work for them. You may not be a patient or provider that would take part in a network with these parameters, but it does raise the question: how are we taking action, today, to make the medical system work better? How might we take matters into our own hands?

 

We believe medical collaboration is one easy, fun way to change the healthcare system. Give it a try for free: 

 

Try the iClickCare 14-day evaluation

 

Image courtesy of holtsman on Flickr, used under Creative Commons rights.

Tags: telemedicine, collaboration, regulatory issues, insurance,

Medical Collaboration is Key to NFL Concussion Policy

Posted by Lawrence Kerr on Tue, Dec 02, 2014 @ 09:24 PM

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As a former college football player myself, I can understand the desire of athletes to play hard, hustle, and not let an injury keep them from the game. That get-it-done approach has served me well, on the sports field as well as in the operating room.

The NFL has long been a bastion of this kind of ethos. For many years, when NFL players got a concussion, they were tossed back into the game, told they got "dinged." And the players were often part of the problemas well; Ronnie Barnes, the Giants' SVP for medical services remembers locking players' helmets in a trunk to keep them from going straight back into a game.

But there is an increasing awareness of the negative short-term and long-term consequences of brain injuries, including disabling chronic traumatic encephalopathy. This is evidenced in part by the law suit for hundreds of millions of dollars brought by 5,000 former NFL players about NFL handling of hits to the head. For NFL players, and for the league, getting a hard hit is no longer something to be taken lightly.

Now, the NFL has created an exhaustive, and seemingly sincere, strategy to keep players safe and manage concussions when they do happen. The approach, chronicled in an inches-thick manual, includes specially trained head-injury spotters that patrol the game from high above the field. It necessitates that several providers ring in on a "go/no-go" decision for the player to return to a game after a hit to the head. And it requires waiting periods and a series of visits with a neurologist once a concussion is diagnosed.

What is fascinating about the protocol is that it leverages medical collaboration as a tool to make sure the best decision is made for the player. As the New York Times reports, "It features a broad cast: a head-injury spotter in the press box, athletic trainers on the bench, doctors and neuro-trauma specialists on the sideline, and experts in neuro-cognitive testing in the locker room." After a single bad hit, many people contribute their perspective on what they observed and whether the player is "acting like" he got a concusssion: referees, other players, the team doctor, athletic trainer, head-injury spotter, and a neuro-consultant may all have a voice in making the determination.

Some players or coaches may feel the protocol goes overboard in systematizing a medical decision that isn't that complex. Others may feel it doesn't go far enough. But one thing for sure is that the NFL's approach leverages the power of medical collaboration to keep players safe. When different providers are enabled to work together to share their perspectives -- whether from their speciality or from their vantage point on the field -- better decisions are made.

Here's to using your perspective to keep your patients happy, safe, and in the game as much as possible.

ClickCare can help you collaborate in a snap of the fingers. Get a free trial here:
Try the iClickCare 14-day evaluation

 

 

Image courtesy of yourdon on Flickr, used under Creative Commons rights.

Tags: telemedicine, medical collaboration, collaboration, healthcare collaboration

Is the Telemedicine Era Actually Finally Here? Why?

Posted by Lawrence Kerr on Tue, Nov 25, 2014 @ 10:17 AM

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Most people I talk to don't know what telemedicine is.

But they will in 2-3 years. A recent Economist article looked at the strong signs that telemedicine is gaining momentum at individual, hospital, and governmental levels.

The article traces the evolution of telemedicine, which we've experienced at ClickCare. You might be surprised to know that as early as 1924, Radio News documented a doctor seeing a patient via a television link. In the mid-90s, we ourselves were using bulky cameras and a network of enthusiastic nurse practitioners to connect pediatricians to in-school nurses' offices. And today, we've seen an exponential increase in the comfort, trust, and excitement around telemedicine.

So what are the forces that are pushing telemedicine to the fore? We see a few key pieces:

  1. Governments, often the slowest part of the system, are under pressure caused by budget constraints, chronic disease, an aging population, and regulatory issues. Telemedicine is now seen as a solution to these intersecting problems.
  2. There is increasing recognition that an approach to telemedicine and medical collaboration must address changing our practices as providers, not just changing our technology. “If you have a chaotic system and add technology, you get a chaotic system with technology,” says Peteris Zilgalvis, a health official at the European Commission. We've always insisted that it's better to invest in people and software, not expensive hardware -- and our behavior and workflow is key to this. Behavior and workflow are interrelated. An intrinsic and nourished desire to collaborate begins a constructive workflow. A workflow, dictated but not embraced, does not start the process. An empowered workflow can move the process along much more strongly. The provider with the right behavior, needs the right workflow to accomplish his goals.
  3. Reimbursement is no longer a barrier. 21 states mandate that telemedicine be reimbursed at the same rates as face-to-face care. This trend is one that's headed in a single direction: reimbursement for telemedicine is more widespread, more systematic, and more comprehensive every year.

So, like most "overnight successes", this one is taking decades. But the long-in-coming telemedicine era may actually be on its way.

Curious about telemedicine? Download our Quick Guide:

ClickCare Quick Guide to Telemedicine

Tags: telemedicine, collaboration, telemedicine roi, healthcare collaboration, telemedicine law

What Ebola Showed About Medical Collaboration and EMR Pitfalls

Posted by Lawrence Kerr on Thu, Oct 16, 2014 @ 08:46 AM

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By now, we've all heard the heart-breaking story of Thomas Eric Duncan, the Dallas patient who was seen in the ER for fever and vomiting and was sent home. Three days later, he tested positive for Ebola and subsequently died.

This is a tragic, unacceptable outcome. But sometimes doctors make mistakes: It's a new epidemic, as doctors we are routinely asked to see superhuman numbers of patients in small periods of time, and things can get past us.

However, in this case it appears that the issue is less about a single provider's mistake and more about the systemic issues that needed to be addressed. In recent days, news sources have reported that the ER doctors who cared for Mr. Duncan never saw a nurse's note in the EMR reporting that the patient had just come from Liberia. Apparently it was this issue with the EMR that caused a deadly gap in communication.

Unfortunately, this kind of problem is neither unexpected nor novel. In fact, although this example was particularly extreme in its consequences, this kind of communication failure is all too common in medicine. We see systemetic problems throughout the medical system:

  • EMRs are often very difficult and counterintuitive to use, understand, or grasp the limitations of.
  • Billing, paperwork, and controls take up most of the time we have with each patient.
  • HIPAA keeps providers from talking with each other about patients in ways that can pass on crucial nuances (or facts about travel).
  • Knowledge and data can overwhelm providers, making it hard to parse what is important
  • Billing concerns demand a checklist focus and mentality or providers can't survive.

So, use iClickCare or not, but collaborate. None of us can afford the consequences otherwise.

 

Image courtesy of communityeyehealth on Flickr, used under Creative Commons rights.

Tags: collaboration, EHR, care coordination, medical collaboration, HIPAA, provider burnout

Why Physicians Assistants Are Key to Medical Collaboration

Posted by Lawrence Kerr on Tue, Oct 14, 2014 @ 08:17 AM

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One of the fundamental values of ClickCare is that all parts of the medical team -- the patient, the family, and medical providers across the spectrum of care -- are crucial to healing and good care.

So as Physician Assistants Week wraps up, we wanted to take a moment to congratulate all physician assistants for the job that they do, day in and day out.

Physicians Assistants understand the need to collaborate as well as anyone. As they grow and expand from office to community and integrate and coordinate care, they are increasingly burdened with time wastage and hassle when medical providers don't communicate.

So thank a Physicians Assistant today. In doing so, remember that the medical team is a team made up of many kinds of providers. And we all need to work together for any of us to succeed.

 

Wondering whether you can use your smartphone in the medical setting? Get our free guide to secure "Bring Your Own Device (BYOD)" policies here:

iClickCare IS BYOD Secure

 

 

Image courtesy of marine_corps on Flickr, used under Creative Commons rights.

Tags: collaboration, telemedicine, care coordination, healthcare collaboration, store and forward medical collaboration, healthcare provider burnout, Physician Assistant

The Real Cost of a Rushed Doctor

Posted by Lawrence Kerr on Fri, Aug 29, 2014 @ 03:53 PM

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A recent article by Dr. Sandeep Jauhar intrigued us and challenged us. The author provokes a frank discussion of the real cost of doctors needing to work at increasingly frantic paces:

"There is no more wasteful entity in medicine than a rushed doctor."

In particular, the article pointed out that the mania for cutting payments to physicians actually does very little to address the real source of waste in the medical system: "Health care costs must be contained, but cutting payments to doctors is a self-defeating strategy. Policy makers need to focus on the drivers of waste." Spending that does not improve health outcomes -- waste -- accounts for $750 billion of the US healthcare costs. The author points to such sources of waste as unnecessary specialist consults, the costs of uncoordinated care, and primary doctors being left with confusion after a string of handoffs.

This perspective definitely resonates with us, especially since doctors are increasingly burnt out, expected to see double the patients in half the time, and still somehow have room in their heads and hearts for empathy. However, we would argue that the problem isn't simply calling in other doctors to help (as the author says at the end of the article), but the way in which they're called in.

So we propose that administrators and providers ask these questions as they bring in consults and specialists so that we can spend less on wasteful actions and more on providers' time with patients:

  • Is the patient shuttled from provider to provider without any coordination? 
  • Does any provider own the care for the patient? 
  • Is the consult actually a conversation between providers, or is it more like a chain of handoffs? 
In our experience, it's not the consult or the collaboration that causes the waste. It's the lack of coordination and effective collaboration.

 

Curious whether Hybrid Store-and-Forward Telemedicine can decrease waste and costs in medicine? Click here: 
ClickCare Quick Guide to Hybrid Store-and-Forward
Image courtesy of ztephen on Flickr, used under Creative Commons rights.

Tags: collaboration, medical collaboration software, coordinated care, care coordination, medical collaboration, provider burnout

How Medical Collaboration Can Make Us Feel Human Again

Posted by Lawrence Kerr on Fri, Aug 22, 2014 @ 11:44 AM

a warm gaze blunts provider burnout

Some people may think medical providers join the profession for the pay, status, or job stability. My experience, however, has been that the work is challenging, the pay is dropping, and every provider I know is doing it because they care about people.

As the Dennis Rosen, MD, writing in the New York Times recently quoted the mother of a son with a genetic abnormality, "I like the people in health care. People in health care, they don’t stare at my son like he’s some kind of freak, you know? They see him for who he is." And the child's doctor affirmed the connection, saying, "I have yet to meet a child who fails to kindle my compassion or to bring out in me the most basic desire to try to help."

Caring about people in medicine becomes more difficult every day.

This basic desire to connect and help can easily be thwarted by the realities of the job, however. Nearly half of medical providers experience burnout and when they do, they can lose their sense of empathy for others and feel deeply isolated and emotionally exhausted.

The connection between this disconnection and the burdens providers face is clear: "A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer." (Article here.)

Of course, we often think technology makes this kind of isolation and burnout worse. We get the sense that if we could return to a world before EMRs, incessant messages, and endless paperwork, we could connect with our patients. But the truth is that technology isn't going anywhere and our only choice is how to use it in our service. 

For instance, we've found that by using Hybrid Store-and-Forward Telemedicine, we're able to deal with consults more quickly, leaving more time and energy for the patient sitting right in front of us. Our colleagues have also found that collaboration and communication with other providers and patients can (1) cut that sense of isolation and (2) decrease the unfinished issues, both of which are so damaging. Finally, we believe that when we take small steps to take ownership over our day and our work, we feel more able to survive, thrive, and connect. 

So it's not that it's impossible to connect in this modern day of medicine. It just takes a return to the collaboration, communication, and empathy that got us into this work in the first place. 

 

For more stories of medical collaboration, click here:

 

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Image courtesy of lencioni on Flickr, used under Creative Commons rights.

Tags: collaboration, telemedicine, medical collaboration, nurse collaboration, communication with patients, provider burnout

Is the Sharing Economy the Next Step in Medical Collaboration?

Posted by Lawrence Kerr on Mon, Jul 14, 2014 @ 10:53 PM

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A few weeks ago, we ended up (virtually) attending a fascinating conference on the "Sharing Economy." The term wasn't familiar to us, although the participants were: Air BnB, Etsy, and Uber are just a few examples of this movement in peer-to-peer exchanges.

According to Jeremiah Owyang: "'The big trend here is that the crowd is empowered to get the physical world from each other rather than buying it from brands.' In other words, we used to trust brands, now we increasingly find trust in one another."

Since ClickCare's focus is bringing peers, providers, and patients together through medical collaboration, we see a lot of ourselves in the Sharing Economy community. That said, we also feel some skepticism:

Maybe peer-to-peer exchanges can work for dresses, cars, and couches, but can they work for the high-stakes and high-regulation environment of healthcare?

We may not have the hard-and-fast answers, but as larger economic trends bend toward sharing and collaboration, healthcare will eventually follow. So, we bring you 4 trends in how healthcare is becoming part of the Sharing Economy: 

  1. Providers and patients are taking matters into their own hands. For many years, patients and providers were increasingly distanced from each other, limiting the amount of control they had in interactions. However, that is changing: "people (consumers and caregivers) are taking on more responsibility in healthcare... adopting various patient engagement strategies, including, but not limited to, communicating via patient portals, enabling shared decision-making through communication aids and prescribing applications and tools for self-care." 
  2. The beginning of the sharing may start with hopsitals. Due to the unique attributes of healthcare, enterprise-level peer-to-peer sharing may be the first place we see this trend: maybe two hospitals share an MRI machine or infrastructure to increase capacity while limiting costs.
  3. Intention is key. Some collaborative initiatives seem to be more focused on regulating providers, rather than giving them the tools to do their best work, while others are more focused on the disease than the patient. Real progress will come when patients are at the center of care and providers have the tools to really serve them.
  4. Patients want to share. Patients are more willing than we might expect to anonymously -- and altruistically -- share their medical data for the good of all. 

What about you? How have you experienced the sharing economy in healthcare, either as a provider or as a patient? We'd love to hear about your experiences in the comments below.

As providers and patients take more control into their own hands, BYOD is increasingly common. Get our guide on how to avoid the pitfalls here:

 

iClickCare IS BYOD Secure

 

Image courtesy of clappstar on Flickr, used under Creative Commons rights.

Tags: collaboration, telemedicine, medical collaboration, communication with patients

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