ClickCare Café

What Kindergarteners Know about Medical Collaboration

Posted by Lawrence Kerr on Tue, Jun 04, 2013 @ 05:34 AM

Recently, I came across something called the Marshmallow Challenge. It is an exercise that has been done with hundreds of people, ranging from CEOs to kindergarteners. A deceptively “silly” setup, it’s also an experience that can change the way people approach collaboration and innovation.

The task is simple: in 18 minutes, teams must build the tallest free-standing structure out of 20 sticks of spaghetti, one yard of tape, one yard of string, and one marshmallow. The marshmallow needs to be on top. And let me tell you -- I never thought I’d learn key lessons in medical collaboration from a marshmallow and a handful of spaghetti, but I did.

Tom Wujec shares learnings from the challenge in the video below. But in addition to his clever insights, I was really struck by the connections to medical collaboration and our daily work as providers. So, after the video are 3 takeaways you can steal for your practice of medical collaboration right away...

  1. Be more like a kindergartener. When teams in the Marshmallow Challenge are ranked, MBAs do the worst, with kindergarteners significantly out-performing them. One reason for this is that the kids start trying things from the very beginning, experimenting with different ways of assembling the spaghetti to hold up the marshmallow. As for the MBAs, they take almost the entire time to orient themselves, talk, and plan. So when they finally put their marshmallow on their structure near the time limit, the structure often falls down... and they don’t have time to try something else. I see this as a crucial finding for all of us doing the difficult, messy, fun work of medical collaboration. When all else fails, dive in and engage -- by working with your colleagues, you’ll find the best way to collaborate as you go. And when things start to wobble, you’ll still have plenty of time to try a different way to stack the marshmallow.
  2. You don’t need to be CEO of “Spaghetti, Inc.” As Tom points out, an “I lead, you follow” mentality can really slow down the collaborative process. In the Challenge, teams found that when MBAs took over from the beginning and started directing team members (making themselves CEO of Spaghetti, Inc.), the process stagnated. While it’s important to have leaders, it’s crucial that those leaders act in service of the group’s process, rather than directing things for the sake of it.
  3. If you think you only need specialists on your team, think again. It turns out that a team of specialists (CEOs or engineers) do pretty well in the challenge. But the teams that do best include specialists AND an administrator/assistant. Diverse teams do better every time because while specialist skills are great, it’s also paramount to have people who facilitate the process. Personally, I love the part of medical when we all -- nurses, aides, administrators, specialists, etc -- come together to collaborate around a single goal. You build a better marshmallow tower and, to be honest, it’s more fun.
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Tags: medical collaboration, collaboration, collaboration leadership, healthcare collaboration

A New View of Medical Collaboration. Inspiration from Strong Women

Posted by Cheryl Kerr on Thu, Apr 25, 2013 @ 01:05 PM

Which autobiographical account inspires you?

Lean In: Women, Work, and the Will to Lead, Facebook COO :Sheryl Sandberg (2013)
Until I Say Good-Bye: My Year of Living with Joy
:Susan Spencer-Wendel (2013)

To give you a tiny taste of Sheryl Sandberg's book, here are a few of the chapter titles:

     - Sit at the Table
     - Success and Likeability
     - Don't Leave Before You Leave
     - Make Your Partner a Real Partner
     - The Myth of Doing it All

Sheryl Sandberg is on Forbes' list of the most powerful people in the world. In her book, she encourages ambitious women to realize their own career goal, but also to make changes in their workplace so that other women can succeed, too. Sandberg tells women to have confidence in themselves and their knowledge, and to own their achievements.

I don't know if Susan Spencer-Wendell read or is trying to read Sheryl Sandberg's book. Susan is an award-winning journalist for the Palm Beach Post, who learned in June 2011 that she had amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). At that time, she was 44 years old, with a devoted husband and 3 young children. She was so determined to complete a book describing this experience for her children and the rest of us, that with her minimal strength, she typed the manuscript with one thumb on her iPhone. No longer able to walk or even lift her arms, she tapped it out letter by letter. USA Today on March 11, 2013 speaks of some of the fabulous lessons expressed in this memoir:

"Her "year of joy" included everything from traveling in hopes of witnessing the Northern Lights — she did not — to tracking down family roots on Cyprus — she did — to visiting Kleinfeld Bridal in New York with her teenage daughter, Marina, only because she knows she won't be around when the real pilgrimage will take place."Susan Spencer-Wendel

Her children Marin, 15, Aubrey, 11. and Wesley, 9, have been adapting to the situation. Their Aunt Stephanie says: "They rub her nose. They brush her hair out of her eyes. They have very normal routines with their mother. Nothing is strange."

This goes to show that there are a lot of heroes here. Reportedly, Susan didn't want to switch to another piece of high-tech equipment because she didn't want to lose the time needed to learn another system. With her laser focus, her habit of meeting deadlines, AND HER RIGHT THUMB, she wrote the 362-page book Until I Say Good-Bye. It's now available on Amazon, and movie rights have been sold to Universal.

This is definitely a new twist on Store-and-Forward. After reading this book, like the effect of all good medicine, I felt lighter and stronger and more accepting. Susan says: "don't force the world to be the one you dream; the reality is better." If she can say that, most all of us can say it more and do more.

Sheryl Sandberg's Lean In is also inspirational. "Sit at the Table" is up front and center; otherwise how can one hear or be heard. She says that opportunities are rarely offered; they are seized. That's an understatement!

There are many criticisms (jealousies?) of Lean In, but it is an important follow-on to Betty Friedan's The Feminine Mystique and Gloria Steinem's Revolution from Within. Sheryl is a 43-year-old former Google executive with two Harvard degrees, who is calling on other women, as she puts it, to "lean in" and embrace success. Even though Sheryl knew the business world was listening, she had the intestinal fortitude to include personal examples, that readers are dying for, which are definitely supportive and inspiring. Moreover, the cited research is impressive, for instance the data showing positive correlations between success and likeability for men, and negative correlations between success and likeability for women. Sheryl's bibliography and footnotes are lengthy, and the statistics support the thesis that even in 2013 — women simply aren't making it to the top. She says: "Ten years of no progress is no progress" (spoken like a real COO). 

Sheryl SandbergNPR relates: "Warren Buffet has very generously said that one of the reasons he was so successful is that he was only competing with half the population. Companies that use the full talents of everyone — those companies do better."

One of the HUFFPOST quotes from Sheryl's book is: "if we want a world with greater equality, we need to acknowledge that women are less likely to keep their hands up." Further a quote about working together: "As women must be more empowered at work, men must be more empowered at home."  Download "Caring for Baby" to help with that effort.

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We need all of the people in this country and the world striving to be better, helping each other, and sticking their neck out to do that. She says: "This revolution will happen one family at a time."

Where have you heard that before?  Give your patients access, collaborate with their other providers, and leave a legacy of education. Let's get on with step at a time; one thumb, one family, one patient, at a time.

Tags: good medicine, collaboration leadership, iPhone

California's Telehealth 2011 Law: Comments and References: 2

Posted by Lawrence Kerr on Tue, Dec 06, 2011 @ 06:54 PM

California Telehealth Law advances the opportunities for care coordination.

Last week, we discussed the vision of the California Telehealth Advancement 2011 Law.

The telehealth law does more.  We will discuss:

  • Do you know what the biggest challenge is for providers using telemedicine?
  • Have you considered why email is so valuable, but what its limitations are?
  • Why is California’s support of store and forward technologies is so important?

There is not enough time, and too much place. Telemedicine, traditionally videoconferencing and monitoring were designed to take care of the too-much-place problem.  But, neither videoconferencing nor monitoring do much about the not-enough-time problem.

Ask any provider about their biggest challenge. Invariably, the answer is not enough time. This is not a new problem, indeed.  Remember the doctor with the fancy car? He bought it because he could enjoy something while he drive from hospital to office, house-call-to-home over and over again.

Care coordination is limited by time. Photo: Huber/U Starke/CorbisStore and Forward telemedicine is the answer to this problem, but has not been pushed by vendors because it is a difficult sell: reimbursement has been offered only for video technologies, with the patient present. That has been described as "Face to Face."

That is why the foresight and vision of of the California Law is so exciting.

First, it is defined in Sec 4. 2290.5:

  1. “Asynchronous store and forward” means the the transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient.

Second, it requires payment to be made for store and forward services: 

(c) No healthcare service plan shall require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan, and between the health care service plan and its participating providers or provider groups.

  1. No healthcare service plan shall limit the type of setting where services are provided for the patient or by the healthcare provider before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the healthcare service plan, and between the healthcare service plan and its participating providers or provider groups.


iClickCare is developed specifically to free the provider to provide the right care at the right time. If it were emergent care, then it has to be now. If it were much more consultative and chronic, the appropriate time for research and management is preferred.

We are inspired by the creativity and the signing of the law. We trust that other states, and CMS itself, will follow soon. Until they do, reimbursement issues are greatly diminished by doing the right thing and sending the data and not the patient. It makes for a happier and more satisfying work day.

The next step is for providers to acknowledge their responsibility to do more than send data, but to discuss and change based on experience, protocol and conversation. That very process is why and EMR/EHR is not a coordinator of care. Artificial intelligence and hopeful advances aside, providers still need to collaborate. This Law makes it easier and more efficient. It is truly an advance in patient care. 

We have put together a concise guide and references to, guess what?, save you time:

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Tags: telehealth, collaboration leadership, care coordination, EMR

California's Telehealth 2011 Law: Comments and References.

Posted by Lawrence Kerr on Tue, Nov 29, 2011 @ 06:29 AM

It’s been six weeks since California passed Bill AB 415. The new law, California Telehealth Advancement Act of 2011 gives providers in California more choice in how to best collaborate on behalf of their patients.

This blog posting will highlight points about the California law and telemedicine:

  • The vision of the legislation and how it will make patient care better.
  • The limited interpretation of the true potential of the law by many commentators.
  • How the inclusion of store and forward technology in the law is important.

California leads with new telemedicine law

The Center of Connected Health Policy offers a focused review of what the law does and does not do.  This single page is remarkable for its clarity and brevity.

Obvious, but rarely stated, are three paragraphs expressing a strong vision about telemedicine and telehealth directly quoted from Section 2:

(e) Telehealth is a mode of delivering health care services and public health utilizing information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from health care providers.

(i) Consumers of health care will benefit from telehealth in many ways, including expanded access to providers, faster and more convenient treatment, better continuity of care, reduction of lost work time and travel costs, and the ability to remain with support networks.

(k) Without the assurance of payment and the resolution of legal and policy barriers, the full potential of telehealth will not be realized

Just as a toddler learns basic behaviors such as please and thank you, these three (of ten paragraphs) define the value (and that value will be manifest by ROI) that any health care provider, agency or institution should learn. It is a vision of better access, collaboration and education.

Portions of the law, and many of the commentators view the purpose of telemedicine as providing for the underserved and the rural.

(g) The use of information and telecommunication technologies to deliver health services has the potential to reduce costs, improve quality, change the conditions of practice, and improve access to health care, particularly in rural and other medically underserved areas.

Sometimes Telehealth wins.

But, a deeper, wider and more comprehensive vision must be developed. 

Why? It is never good to be sick. It is never convenient to be sick. It is even more inconvenient to maintain health. Everyone regardless of richness or poorness, high or low IQ, rural or urban deserves coordinated, collaborative care. Care management is equally the right of the CEO as the homeless child. The inner city tenant suffers the same as the rural migrant. The too busy entrepreneur faces the same constraints of place and time as the uninsured food service worker. Unfortunately, each faces the same challenge in receiving the right care, at the right time, from the right (and conferring) care giver. Each of us, all of us, should expect good care and encourage the use of telehealth and telemedicine to get it. When we have it, we have safe, efficient, cost effective and holistic care. That is what we used to have, it is what we need now, and with such good legislation, what we can expect in the future.

There are a lot of lessons in this law.  Next we look forward to discussing the immense value of Store and Forward technology.  iClickCare is a leading example of this.

Click meA focused review and set of references are here.  They are both a starting place and a quick review.

Tags: telemedicine, telehealth, store and forward, collaboration leadership, telemedicine law

How Pete Seeger and HHS Solve the Healthcare Crisis

Posted by Cheryl Kerr on Mon, Nov 07, 2011 @ 07:04 PM

What a weekend!  We attended an exciting conference one day, and stumbled on a living legend the next.  Read how a confluence of disparate backgrounds gives all of us hope for the future and suggests that we can change the world.


"Pete, what is the greatest change that you've seen in your time?"

"The Information Revolution...if we use it right, it may save the human race."

Seeger now talks on InnovationSaturday, we found Pete in a local art shop in Beacon NY.  Peter "Pete" Seeger (born May 3, 1919) is an American folk singer and an iconic figure in the mid-twentieth century American folk music revival. Some of his favorites are: Where Have All the Flowers Gone, If I had a Hammer; and Turn, Turn, Turn. Pete has led people in improving, reclaiming, and detoxifying the Hudson River Valley.

The day before, we had the honor of hearing Todd Park, the CTO of Health and Human Service speak at the Tech Garden in Syracuse, N.Y. on Unleashing the Power of Data, IT, and Innovations to Improve Health

Park of HHS on care coordination
  • decision support
  • care management tools
  • extended physician reach
  • consumer engagement tools
  • data mining

It was most inspiring that Todd said that we can innovate our way out of the healthcare crisis... care coordination, collaboration for improved health outcomes. Todd Park is a dynamic, charismatic speaker, and he was speaking to innovators of all ages saying that we have the greatest entrepreneurial opportunity since the birth of the internet. He talked about "a stitch in time," ACO's, meaningful use. CMS has $10 billion to use for reasearch and development to get value out of our recorded health data. He says that we shouldn't be paying for volume of service, but, instead, we should be paying for improved health and increased value.  This Land was Made for You and Me!  Certainly innovating our way out of the healthcare crisis would be a way of showing Pete that we are trying to use information in the right way.

To this end, Todd he moved his family and two very young children to Washington to liberate health data (Gov 2.0) and inspire the rest of us to improve the efficiencies of our country's healthcare. He said that he has never been so proud to be an American since he became the CTO of HHS. He wants to turn HHS into the NOAA of healthcare (NOAA is responsible for the data that spins The Weather Channel,, and nightly news weather, all in the interest of providing weather knowledge for our good). Think what this parallel could mean if applied consicentiously to healthcare delievery!

And feel free to check out the iClickCare innovation to make our medical days easier.

See a clip of the performance here.

Tags: health care, collaboration leadership, Pete Seeger, Todd Park

Collaboration Leadership: Our History and Our Future

Posted by Lawrence Kerr on Mon, Sep 26, 2011 @ 05:55 PM

Throughout history, small events have shaped the outcome. As Mohandas Ghandi said:

"You must be the change you wish to see in the world."collaboration leadership in healthcare

These small events often require a bit of sacrifice and determination, even though the actions don't appear overly great. However, even the smallest help can turn out to improve the bigger picture. This has been true since the time of Paul Revere, all the way up to modern medicine. Although there may not appear to be a direct connection between the two, there are some striking similarities.

During the unsure days approaching the American Revolution, British troops begin reinforcing their numbers in the Boston harbor. The American revolutionists knew the time was fast approaching to make their stand against the foreign leadership from which they so desperately wanted separation. One cold night, Paul Revere spotted the incoming British soldiers and set out to warn the countryside. He rode all night, informing towns, villages and individuals of the incoming British. This allowed the locals time to prepare themselves for the upcoming battle sure to take place. It was this seemingly small task that helped propel and prepare the Americans, and the collaborative leadership of Paul Revere and the other heads of the continental congress to eventually lead and form the United States of America.

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In the medical field, small additions and ideas of individuals help shape and form modern medicine. An idea to one individual may turn into an inspiration for another, and eventually, after time and hard work, a permanent solution. This collaboration leadership demonstrated between medical professionals is imperative to completing any task at hand.  The small idea that starts as the brain child of one, may eventually be passed off onto another party, in which the idea has time to grow, and with the help of others, become a complete medical theory.  Circling back to revolution from collaboration leadership is this interesting parallel between an idea and its spread.

Of course, it is often difficult to share ideas with similar professionals, as trained medical staff are in such high demand throughout the world. Thankfully, software services are beginning to exist that allow direct sharing of knowledge and help promote the world of collaboration leadership. Tools are available to providers who have medical questions and want collaborate with their colleagues, without sending the patient to venture out all over the country to see other professionals. With the help of modern technology, small steps by individuals are able to add to other ideas, and this collaboration leadership greatly improves the diagnosing and treating a problem.

Tags: telemedicine, collaboration, collaboration leadership

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