ClickCare Café

Is Care Coordination Sufficient for Good Healthcare?

Posted by Lawrence Kerr on Wed, Jun 18, 2014 @ 09:34 AM

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One of the concepts we see as crucial to healthcare is care coordination. We're proud of how iClickCare helps medical providers coordinate, allowing better care and fewer things getting "lost in the cracks."

So we were excited to notice a recent article on the "5 Pieces of the Care Coordination Puzzle." But upon reading it, we felt a level of disappointment. Just as medicine is an art, not just a science or a set of tasks, care coordination is not just about mechanics. Rather, when we think about care coordination, we think more along the lines of "care collaboration" in which multiple medical providers work together on behalf of the patient, in creative and caring ways. "Coordination" implies project management and the top down controller. While understandable from some institutional efficiency perspectives, it ignores the empowerment of the patient and the provider that results from old-fashioned conversations.

Ideas like the one the author quotes (from this article), "Physicians giving up their autonomy is not actually surrender but a noble act" completely miss the point. True care collaboration is not so much about the institution or the provider but rather about, and centered around, the patient. It is a responsive, creative team approach in which everyone leads or follows at the moment that either role is appropriate. So one need not give lip service to participation of, or working with, “pharmacists and other specialists”, but rather should ensure that all members of the team contribute, coordinate, care, and collaborate.

Whether it's the coordination of multiple providers, the integration of remote monitoring tools, engagement of the patient, or any other aspect of effective medicine, it works best when the following pieces are in place:

  • Medical providers are given the tools they need to communicate and collaborate. There are necessary medical collaboration tools like iClickCare, and there are the "soft" tools like having sufficient time. But neither coordination nor collaboration can happen without them.
  • There is trust. The institution needs to trust the providers; the providers must trust each other; the medical team must trust the patient as an "expert" in his own experience and his own disease.
  • Everyone is willing to do whatever it takes for good medicine to happen. Sometimes that means the most efficient choice, and sometimes it means spending an "unreasonable" amount of time on something. Sometimes it means collaboration and sometimes it means holding a patient's hand.

We believe that when providers work together for their patients, good things happen. It doesn't get more coordinated -- or more effective or efficient -- than that.

And we put together a "field guide" to medical collaboration. People are finding it inspiring and useful and you can get your free copy here:

ClickCare Quick Guide to Medical Collaboration

 

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

Tags: coordinated care, collaboration, care coordination, healthcare collaboration

What Does a Tattoo Artist Have to Do With Medical Collaboration?

Posted by Lawrence Kerr on Thu, Jun 12, 2014 @ 08:24 AM

Screen shot 2014 06 04 at 10.23.27 AM

When I saw a recent New York Times article and video about a tattoo artist that focuses on realistic nipple tattoos for women who have had cancer related breast reconstructions, I was skeptical. We certainly don't normally see a tattoo artist as part of the continuum of care or part of our community of medical providers, and I would have some hesitations about recommending this kind of post-surgery tattoo outside of the context of the surgeon's office.

I will say that while I have done nipple reconstruction, augmented by tattooing, since breast reconstruction started in the 70's, I have often wondered if the tattooing could not be done better by a tattoo artist. As a physician and surgeon, and student of anatomy, I have an appreciation of reconstruction, meaning restoration toward normal, its principles and indeed, its art (as is demonstrated in this tattoo artist's work). Nipple reconstruction is more than application of decoration. I also knew about the blood supply of the breast, where the implant may be working, and a surgeons commitment to sterility.

However, I also wondered, often, could more practiced hands and heavy duty equipment give a more long-lasting result, despite the fading all tattoos are subject to. I respect the commitment of this artist profiled in the article. Also, I have used medical tattooing as alternatives to things like eyebrow reconstructions.

So, what does this have to do with medical collaboration? Everything, actually. This tattoo artist may not be a traditional member of the medical team, and I might some recommending this to a patient, but in this case, he is certainly providing care related to the healing process. How much of a smoother process would it have been if he could have used iClickCare (as one example of a telemedicine-based medical collaboration platform) to communicate with the patient's surgeon? How much less would her wait time have been? How much more confidence would she have had that this was an appropriate course of action and would fit in with the rest of her treatment? How many potential medical issues could be avoided if the traditional medical providers were able to share their information with the folks supporting the patient with less traditional medical issues?

As medicine shifts, so does the team of medical providers. Our job is to make sure that we have the tools to collaborate with every member of the medical team, traditional or nontraditional.

Of course, it's crucial to have a medical collaboration tool that allows you to respect HIPAA and communicate in a way that honors the patient. We've found that this means you need to be able to have a virtual consult that may "pick and choose" what information, pictures, or history that particular collaborator has access to. So this kind of collaboration is certainly to be handled with care, but as medicine evolves, I believe it is absolutely crucial to involve all members of the team caring for the patient. In this case, the person in question is a tattoo artist, but in so many other cases, the continuum of care for a given patient could include people like:

  • Acupuncturists
  • Therapists
  • Teachers
  • Caregivers
  • Family
  • Lactation Consultants
  • Etc.


Have you found the need to do medical collaboration with any nontraditional parts of the team? How have you facilitated communication and collaboration with them? We'd love to hear, in the comments below.

And for our "field guide" to medical collaboration, click here:

ClickCare Quick Guide to Medical Collaboration

 

Tags: telemedicine, medical collaboration, collaboration, communication with patients, telemedicine solutions, telemedicine and hippa, collaboration leadership, care coordination, store and forward medical collaboration

Hearing Buzz About Medical Collaboration? Here's What It Means.

Posted by Lawrence Kerr on Tue, Mar 11, 2014 @ 08:27 AM

 

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Medical Collaboration

As you'll know from our other blog posts, we really believe in medical collaboration. This kind of interaction and problem-solving with our colleagues has been one of the most effective and rewarding parts of our careers as physicians.

So, we talk about medical collaboration a lot… but what does it mean?

Some of our other posts have more in-depth descriptions of medical collaboration, how telemedicine relates, HIPAA considerations, etc. But this post is about a few core pieces of medical collaboration that can help you figure out how to use it in your life.  

A definition

Wikipedia's definition of collaboration is: "working with each other to do a task and to achieve shared goals." Despite the fact that Wikipedia has only a single sentence on medical collaboration, the simple definition captures the way in which medical collaboration functions. We work together as medical providers to solve problems, share cases, or ease our workload, with the common goals of caring for patients, dealing with regulatory issues, and practicing in the ways we aspire to.

Over the decades of our practice, we've seen "medical collaboration" come in and out of favor. During some periods, and in some places, medical collaboration was status quo. During other decades, medical collaboration was all but condemned by the adminstration. Never used before 1880, it shows up increasingly in books as reflected in this chart that shows how frequently the word itself has been used over the decades. 

Even in WWII, "collaboration" was used in the negative sense of collaborators with the enemy. But in the last several years, we've seen real growth in how much our colleagues want to collaborate. We see our fellow healthcare providers wanting to share the joys and the struggles of caring for our patients.

Some examples

We've heard stories of medical collaboration from all corners of the globe, in all kinds of situations, for many different reasons. (And we put together this guide to explore these.) Examples of medical collaboration include:

  • Consults from the athletic training room to a surgeon or orthopedist
  • Questions to medical specialists from family doctors
  • Nurses getting opinions from other nurses
  • CNAs working with nurse practitioners on tricky cases
  • Nurse practitioners, PAs, and doctors ringing in on a patient's treatment
  • A whole team supporting a senior living or assisted living center in serving its patients
  • ... and everything in between.

Opportunities

When people think about beginning to collaborate, they're usually beginning for one of a few key opportunities:

  • They want to improve patient care and need to "loop in" the expertise or experience of other providers to do so
  • Patient satisfaction is important to them and medical collaboration will help them achieve it
  • They're concerned about one or more regulatory issues and want to use medical collaboration to help do things like decrease readmissions or drop length of stay.
  • HIPAA concerns are coming up and they want to create a HIPAA-safe way 

What are the advantages?
What are the opportunities for care, legal risk, marketing, customer satisfaction (family, patient), marketing?

We find this book by Stephan Willis on collaboration quite interesting, although not focused on medical collaboration specifically.


A medical collaboration resource

We were really inspired by the stories of collaboration from the medical world and beyond, so we put together a free resource with inspiring stories, key strategies, and easy ways for you to collaborate today:

 

ClickCare Quick Guide to Medical Collaboration

 

 

Image courtesy of StockMonkeys.com, used under Creative Commons rights.

 

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

How Hybrid Store and Forward Telemedicine Saved a Life

Posted by Cheryl Kerr on Fri, Feb 28, 2014 @ 06:08 AM

A guest post from Dr. Cheryl Kerr, pediatrician and co-founder of ClickCare...

A few years ago, I was in the middle of an afternoon of patients when a 18-year-old girl came in with trouble walking.

L's Mom had dragged her into my office despite L's protests that she had probably injured herself at swim practice. When I asked L to walk down the hallway, I got chills. It sure didn't look like a twisted ankle: a classic part of the neurologic exam (walk on your heels) showed her right foot did not dorsiflex. My first impulse was deep concern because I really needed a consult. But from whom? An orthopedist? A neurologist? A neurosurgeon? The usual wait times to get in to see any of those specialists can top 8 weeks. Who should be first? Which specialty was most appropriate?

Luckily, I was able to use an early version of iClickCare to send simultaneous consult requests to the orthopedist, neurologist, and neurosurgeon. Within hours, when they had a chance to take a look at the consult, the orthopedist felt that since it was not an injury, another speciality might offer more. The neurologist, 2 hours away by car, offered to see the patient, but absolutely could not fit her into the schedule for a few months.  

The next day, the neurosurgeon operated on L, removing a spinal cord tumor.

When people ask me why we chose a "Hybrid Store and Forward" model for iClickCare's telemedicine platform, I always think of L. We chose this kind of collaboration (instead of teleconferencing, secure text messaging or any other platform) because it is the only option that allows: 

  • Use of text, pictures, and video (crucial for sending a video of L's gait) 
  • When-you-get-a-chance consults that let colleagues respond on their schedule
  • No need to juggle time for video conference setup
  • Simultaneous consults to let you ask questions of multiple folks -- in this case, an orthopedist, neurologist, and neurosurgeon
  • Archiving of cases and media so that you can use them to teach and collaborate in the future

Curious how other providers use Hybrid Store and Forward telemedicine for medical collaboration and care coordination? We put together a free guide to pros and cons with a collection of case studies.

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

And for our overview of telemedicine options, advantages and disadvantages of different types, and a discussion of ROI: 

 

ClickCare Quick Guide to Telemedicine 

Tags: telemedicine, medical collaboration, collaboration, hybrid store and forward medical collaboration, telemedicine roi, Telemedicine and HIPAA, telemedicine solutions, care coordination

7 Ways Telemedicine Helps Compliance with Accountable Care

Posted by Lawrence Kerr on Wed, Feb 26, 2014 @ 08:52 AM

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Barely a day has gone by recently, that the Affordable Care Act (ACA), Accountable Care Organizations (ACO), or the Centers for Medicare & Medicaid Services (CMS) have not been in the news.

In the broadest strokes, the Accountable Care movement attempts to shift the health payment system from a pay-for-service (fee based) system, to a pay-for-performance (outcomes based) system. Of course, for hospitals that want to accept Medicare and Medicaid, these reforms are mandated. But the overall approach affects almost all practices, regardless of status or whether you are an ACO.

Part of the reason that these policies aren't going anywhere is that early data shows they're working. In 2012, ACOs established in the Medicare's Shared Savings Program generated nearly $400 million in savings, the Centers for Medicare & Medicaid Services said in a statement released last week. 

Despite the laws, it's not always clear how to use telemedicine to improve outcomes in a pay-for-performance system. Interestingly, telemedicine and telehealth has been identified as a key tool in compliance with Accountable Care. It is even written into CMS' final rule for the Medicare Shared Savings Program: accountable care organizations must "define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.

So here are 7 ways telemedicine can help you comply with Accountable Care: 

  1. Telemedicine makes care coordination possible and effective. Just changing incentives is not enough to improve outcomes. As the New England Journal of Medicine reports, "Merely aligning financial incentives will not improve quality and reduce costs for episodes of care... True coordination of care is required to ensure the best possible outcomes." Telemedicine makes this kind of care coordination possible and effective, particularly in a hybrid store-and-forward context that adapts to provider parameters.
  2. Telemedicine makes transportation less necessary. Whether home monitoring or distance consults, telemedicine can save costs of unnecessary visits and lengthy transportation. When payment is linked to outcomes, even saving a patient or provider a single trip can make a big difference over an organization.
  3. Telemedicine leverages provider time. In an age of provider shortages, telemedicine can make each provider's minutes count as much as possible. Through consults, collaboration, and even remote patient visits, provider time is leveraged. 
  4. Telemedicine can decrease readmissions. Because telemedicine can help the right at-home care to happen, clarify which provider is responsible, and make sure patients follow through, telemedicine has been shown to have a strong effect on decreasing readmissions.
  5. Telemedicine can drop length of stay. Data shows that care coordination, especially the kind of collaboration supported by telemedicine, is one of the strongest ways to drop length of stay. And length of stay is a key outcome in Accountable Care.
  6. Telemedicine improves access to care. Telemedicine can improve access for the underserved in rural, urban, or Veteran populations. Especially as provider shortages worsen in different parts of the country, and for different specialities, this kind of access to care is proving crucial in keeping costs down and meeting patient needs.
  7. Telemedicine supports good patient care, regardless of political climate and payment changes. Truth be told, many of our colleagues have been using telemedicine to improve the ways they care for patients -- regardless of whether it's rewarded by the current political context. We think that's good practice, in every election cycle.

 

Click here for our free guide on the pros, cons, and ROI of telemedicine options:

 

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of chelseastirlen on flickr.com, used under Creative Commons rights.


Tags: coordinated care, collaboration, accountable care, telemedicine roi, communication with patients, telemedicine solutions, decrease readmissions, decrease length of stay, ACO, affordable care act

4 Easy Ways to Try Telemedicine Before Lunchtime

Posted by Lawrence Kerr on Fri, Feb 07, 2014 @ 09:15 AM

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We've been hearing from a lot of people that they want to give telemedicine a try. Many providers have been noticing the overall thriving of the field. Others are drawn in by data showing collaboration (especially using telemedicine) can decrease length of stay, cut readmissions, and improve rates of healthcare provider burnout. 

But despite the interest in medical collaboration with telemedicine, many people aren't sure where to start. We're the first to admit that it can feel overwhelming to pick up a new tool or adopt a new habit!

So here are 4 easy ways you can try telemedicine before the day is over:

  • Start with someone you know and trust. Think of the last colleague -- it might be a nurse, doctor, or other provider -- that you had a great conversation with or who solved a problem with you. That's the person with whom to try telemedicine and collaboration. Start with people you already know and trust, and grow your collaborative circle from there. 
  • Keep it simple. Even chatting with a colleague about their day can open the door to problem-solving, so that is a great place to start. And when you are ready to collaborate using telemedicine, start with a simple case. You can always build up to consults on your most complex case, but getting a consult or two on more basic issues lets you build up confidence. That way, when you do reach out about a tricky patient, you're not worried about the telemedicine piece of it.
  • Organize a “cool case” breakfast or lunch. We used to take medical students out to egg sandwiches before work to discuss unusual cases and share stories. While this isn't technically telemedicine, it is definitely collaboration -- and that is the important part. 
  • Try iClickCare for free. You can start inviting colleagues, sharing cases, and connecting for a couple of weeks with no cost and no complicated set-up.


Plus, we put together a couple of "quick guides" to telemedicine and medical collaboration, and we're offering them for free -- so take your pick and get started.

 

ClickCare Quick Guide to Telemedicine

ClickCare Quick Guide to Medical Collaboration

 

 

Image courtesy of svoalex on flickr.com, used under Creative Commons rights.

Tags: collaboration, hybrid store and forward medical collaboration, medical collaboration software, healthcare provider burnout, telemedicine solutions, collaboration leadership, care coordination, healthcare collaboration, decrease readmissions, decrease length of stay

4 Tricks for Getting Reimbursed for Telemedicine

Posted by Lawrence Kerr on Fri, Jan 31, 2014 @ 07:49 AM

 

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Many people have been hearing telemedicine success stories and want to start using using technology to collaborate and connect with providers and patients.

Most folks use telemedicine to improve patient care and maybe make their lives as providers a little easier. However, those motives don't get around the fact that we all need to be paid for the work we do.

Reimbursement for telemedicine is a crucial part of making the practice sustainable. But it's not always easy to know how to make that possible when the political climate and reimbursement policies are constantly changing.

So here are 4 tips and resources to make sure you're paid for telemedicine:

  1. Just do it and worry about reimbursement later. Many of our colleagues have found that when they put collaboration and patient care first, the reimbursement ends up taking care of itself. So pay attention to reimbursement -- but if in doubt, just go ahead and care for the patient or collaborate with telemedicine and let the details sort themselves out later.
  2. Use the right codes. We've assembled a list of codes you can use to bill for telemedicine-related time. This is always changing, but keeping an eye on the right codes increases reimbursement significantly.
  3. Make sure you're billing for everything you can. Many providers don't know that in addition to patient-related time with telemedicine, you can also bill for time spent collaborating, and even charge a remote site facility fee. 
  4. Be smart about pre-authorizations. Always check if the patient’s insurance company needs a prior authorization. If so, text the pre-authorization information and patient insurance plan to the consultant.

 

Need guidance on telemedicine options? Get our guide for free:

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of 68751915@N05 on flickr.com, used under Creative Commons rights.

Tags: collaboration, accountable care, telemedicine roi, iPhone medical apps, compliance, telemedicine law

How to send patient files without HIPAA headaches

Posted by Lawrence Kerr on Wed, Jan 29, 2014 @ 08:38 AM

 

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A colleague of mine works in the Appalachian mountains. She's a committed practitioner who works with rolling green hills out the window, cultivates close relationships with every patient, and has a great breadth of skill.

What she does not have nearby is a Diabetes specialist. The closest Diabetologist is in Washington, DC, more than 3 hours away. And whenever a consult is needed, the specialist inevitably wants a long look at the patient files before offering advice. So when my friend in Applachia needs to get a consult and so needs to "share" the patient file with that specialist, she usually does it by driving the 200 miles to his office.

Recently, however, this provider asked me if there is any better way: "Can I upload and share patient files using telemedicine?" The answer is yes. There are certainly ways to use today's technology to safely and efficiently share patient files with colleagues, without running afoul of HIPAA -- or having to drive 3 hours. However, there are some key things to keep in mind so that patient data stays safe and the provider doesn't run into hassles.

How to send patient files without HIPAA headaches:

  • If it doesn't promise it is HIPAA-compliant, don't use it. We hear providers talking about using Google Docs, Dropbox, text messaging, email, and even Facebook to send patient information. The problem with every single service in that list? They're not HIPAA-compliant. Stay away from these platforms when it comes to patient data, and only use a medium that promises to keep you, and the patient, safe. 
  • Consider hybrid store-and-forward telemedicine. Because it is a hybrid store-and-forward model, when you upload a PDF of a patient file to ClickCare (or send questions, pictures, or video), the consulting provider doesn't have to be available on your timeframe. The data will sit there until they're ready to review -- safely -- and you can review their response on your own time as well. 
  • If you're texting, do it securely. Although regular text messages are not secure and can't be used for patient information, there are secure text messaging services available. So if you don't need to send a full patient file, don't need to include pictures, and don't need to review treatment or teach, secure text messaging can be a good way to go.
  • Be skeptical of the "easy way." The two most common ways that providers share patient information are either by driving patient files to other offices or talking about histories and conditions in the elevator. Driving, of course, is a huge time-waster and isn't scalable or sustainable. And it turns out that provider-to-provider conversations in the elevator are actually the most common HIPAA breach. So while we always encourage face-to-face conversations with colleagues -- in the elevator, or elsewhere -- we suggest using those conversations to connect as people... and use the technology available to send the actual patient information. 

 

Looking for more guidance on staying HIPAA-safe?


Download Quick Guide HIPAA Toolkit

 

 


Image courtesy of stephanieasher on flickr.com, used under Creative Commons rights.

Tags: collaboration, hybrid store and forward medical collaboration, medical collaboration software, HIPAA Collaboration, HIPAA secure images

Can Doctors Run Hospitals Better than CEOs?

Posted by Lawrence Kerr on Wed, Nov 13, 2013 @ 08:58 AM

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The medical collaboration that we champion with ClickCare is based on a simple concept: everyone in healthcare has different strengths, and we all do better when we work together. Every provider plays a role, whether that provider is a hospital administrator, nurse, doctor, or aide.

So we were intrigued by a recent New York Times article asking, "Should hospitals be run by doctors?" 

The article addresses whether hospital CEOs with a medical background have better results than hospital CEOs without a medical background. The answer is a bit ambiguous. Only 3.6% of hospitals are run by physician administrators. And new research by the Social Science & Medicine journal showed that hospital quality scores were about 25% higher when doctors ran the hospital. That said, that's not a proven causal relationship... and "quality scores" may not be the most precise measurement of success.

The tone of the article, and the implied competition between physicians and administrators, got us thinking. As pressure increases to drop costs and perform -- whether in terms of length of stay, readmissions, outcomes, or something else -- there is a temptation to play the blame game. We've all been guilty of it -- at some point, everyone has blamed everyone else. And there is something in the tone of this article that tries to single out hospital administrators as the scapegoat of the week. 

If there is anything that our work in telemedicine and medical collaboration has taught us, it's that blame and competition are never helpful. With every case we see, we notice that when medical providers just collaborate in service of the patient, everyone has a better outcome than they would have otherwise. We believe the question is not so much whether doctors can run hospitals better than CEOs, but rather how we can all run our hospitals and practices better -- together. 

 

Click below for our "field guide" to medical collaboration -- healthcare and beyond:

Download Quick Guide Medical Collaboration

 

 

Tags: medical collaboration, collaboration, telemedicine solutions, collaboration leadership

6 Ways the Affordable Care Act Makes Telemedicine Crucial

Posted by Lawrence Kerr on Tue, Oct 22, 2013 @ 09:19 AM

"Health-care reform, a ballooning and aging population and a shortage of available family physicians may be a perfect storm that could blow the doors open for telehealth to go mainstream."

-- Brian Heaton, GovTech 

Despite recent fiascos in our nation's capitol, the Affordable Care Act is taking root. And regardless of where you fall politically, there is one thing that is clear: the ACA may really boost telemedicine. We've been keeping our eye on the regulatory side of things, so here is our rundown... 

6 reasons the Affordable Care Act makes telemedicine (even more) crucial:

  1. High demand. It's estimated that the healthcare system will see an influx of more than 30 million newly insured patients. Those patients' needs may be best met with a combination of telemedicine and conventional solutions. 
  2. Provider shortage. The ACA's provisions increase demand while not addressing the provider shortage (particularly of primary care doctors), making telemedicine-based visits are care coordination crucial. 
  3. Better reimbursement and funding. The bill provides several explicit provisions increasing funding and easing reimbursements for telehealth.  
  4. Need for medical home and meaningful use. It's not enough to use EMRs, as we all know -- it has to be meaningful use.
  5. Shared cost and outcomes-driven models. A focus on outcomes (rather than treatments) and a shared cost model means that the care coordination, collaboration, and savings that telemedicine can provide will be crucial for hospital systems and providers. As Dr. Brian Rosenfeld, Chief Medical Officer at Philips Healthcare, said, "Telehealth offers the opportunity to provide the access, quality and cost that will be necessary to increase prevention and leverage our current workforce."
  6. Technology is less of a barrier. Although this factor isn't directly related to the ACA, it is a trend happening at the same time. Every year, technology -- broadband, collaboration platforms, cameras, computers -- get a little more widespread and a little easier to use. For instance, every doctor has the tools for using iClickCare in their office, and most have it in their pocket.
Want to give telemedicine a try without hassle or a big rollout?
Try the iClickCare 14-day evaluation

Tags: medical collaboration, coordinated care, collaboration, accountable care, telemedicine roi, affordable care act, telemedicine law

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