ClickCare Café

Do Women Doctors Experience Gender Bias or Is It a Thing of The Past?

Posted by Lawrence Kerr on Wed, Aug 08, 2018 @ 10:58 AM

rawpixel-675359-unsplashAs you may know, our cofounder was one of five women in her medical school class.

She’s a tremendous doctor, bringing compassion, strong instincts, and impeccable skill to the challenging field of pediatrics.

But she didn't have it easy along the way. She certainly experienced gender bias (to put it lightly) over the span of years. She thrived despite challenging conditions around her, and became a leader in medicine.

So as I flipped through the New England Journal of Medicine recently, a chart caught my eye. It showed women as a percentage of matriculants in US medical schools -- from 10% in 1955 to about 50% in 2017. Which had me wondering -- is gender bias a thing of the past for women in medicine? And what does it mean for our teams that the percentages of male and female doctors are changing so dramatically?

In "Recognizing Blind Spots - A Remedy for Gender Bias in Medicine?" Loren Rabinowitz, MD looks at the question of how gender bias functions in medicine. She cites data, both personal and quantitative, demonstrating that despite the changing numbers, gender bias and even sexual harassment are common in the medical workplace for women. And, women are underrepresented in leadership positions in medical schools and hospitals.

That said, she also points to data showing the richness that women bring to the medical field. One study, for instance, shows that patients treated by female doctors have better outcomes than those treated by male doctors. 

In some ways, I notice that this changing landscape starts to make it feel like a competition for scarce resources among male providers and female providers. Does the growth of women in medicine -- past, present, and future -- come at a cost for men in medicine? It's a divisive question to ask, but I believe that it underlies many people's actions and is worth bringing to the surface.

My take? It’s in our interest to make sure that we don’t have a “zero sum” mindset. Women having a safe and respectful workplace for their practice of medicine doesn’t detract from men’s experience. In fact, strong medical teams depend on a diversity of opinions, experiences, and skill sets. And the truth is that our personal background (including race, gender, nationality, etc.) is big part of the experience and opinions that we bring to the table. When we create an environment that values these differences, rather than seeking to minimize them, our practice of medicine becomes richer and more nuanced.

Beyond just ensuring gender equity in medicine, I believe that it's important to look at the issue more broadly. Effective healthcare collaboration demands that we are respectful of all of the voices on our medical team. But this requires more than good intentions -- it requires that we have the appropriate tools to enable teams to truly collaborate, not just fit in with the hierarchy. If you don't use telemedicine for healthcare collaboration, I encourage you to think about what tools you do have to encourage the team to collaborate in all its diversity -- and in all its strength.

 

ClickCare Quick Guide to Medical Collaboration

 

Tags: healthcare collaboration software, coordinated care

Population Health aids Coordinated Care Initiatives

Posted by Lawrence Kerr on Wed, Jul 12, 2017 @ 06:19 AM

samuel-schneider-222889.jpgPopulation health initiatives are nothing new -- but I'll be the first to admit that I was floored by the results that some projects are getting, and this may aid our efforts toward coordinated care. 

As you likely know, population health initiatives are projects that look at the health of a group -- for instance the health of everyone in a state -- including the distribution of those outcomes.

CareOregon is one example -- a nonprofit that increases access to healthcare services for patients on Oregon’s Medicaid programs. As their CEO tells it, their goal is to make hospitals all but unnecessary by limiting the need for that kind of care.

The surprising results? Since it launched in 2011, CareOregon has seen a statewide 23% drop in unnecessary emergency department visits and admissions have decreased as well.

As providers, we may not be population health practitioners in name, but it's our responsibility to look at these determinants of health as well. And we've identified three crucial takeaways from population health that any provider can use.

CareOregon is a great example to look at when it comes to population health. It's broad-based enough to carry takeaways for all kinds of health initiatives. Its results have been substantial in a short period of time. And they've generously shared their initiatives and results so others can learn. 

4 Takeaways from Population Health That Every Provider Can Use:

  • Focus on health, not just healthcare.
    For instance, with CareOregon, a child with severe asthma might be cared for with air conditioners or air filters -- not just medication or even emergency care. This full picture of the "social determinants of health" is something we're passionate about at ClickCare -- and a big reason that the case method of iClickCare is flexible, holistic, multimedia, and includes providers across the continuum of care.

  • Value people -- including the patient and the family -- across the continuum of care.
    CareOregon focus on teams, not events. So whether that means a specialist, an aide, or even a professional outside of medicine, if it will help the patient's overall healthcare, it's part of the picture. As they say, "Sometimes protecting your health means we’ll help you find other agencies that can help you access non-medical support." They also prioritize improving teamwork and communication over advancing specific tactics to improve care. If the team is working well, the results will be good. Finally, they use a “bottom up, top-enabled” approach -- so that the folks who are in most contact with the patient are driving the care (the day-to-day providers), in ways that are enabled at the top (administrators). Valuing people strongly supports our belief that healthcare collaboration and coordinated care are also crucial initiatives -- and telemedicine is one way to make them practical, efficient, and easy.

  • Use simple, inexpensive solutions. 
    This approach is about using technology to work smarter, not harder. Sure, videoconferencing telemedicine systems are fancy (and expensive) -- but we believe that the best medical camera is the one in your pocket already and that the technology should be deeply intuitive. Sophisticated technology doesn't need to be expensive -- and that usually means investing in software, not hardware that is rapidly outdated. 

  • Look at holistic data.
    Fierce Healthcare quotes Karen DeSalvo, M.D., former national coordinator for health information technology at the the Department of Health of Human Services, as saying that we need to break down data "silos that prevent providers from seeing the full picture of a patient's, or community’s, health. Having the full picture allows for a 'system that wraps around people and supports them."  Electronic health records (EMRs and EHRs) are just one piece of the puzzle. All of the other parts of patient data -- that anecdote from a nurse, the self-reported weight changes, etc -- need to be taken into account in systematic ways. Sure, the data in EMRs and EHRs can be codified, but we think that a big reason that CareOregon has seen such dramatic results is because they use the data that helps, even if it's not able to be put into a spreadsheet.

We applaud the pioneers of CareOregon, and the work of every provider who has been courageous enough to try something new as part of it. 

Maybe your medical context is not one where these principles are being used -- but that doesn't mean that you can't apply them, even in small ways, today. 

And if you want a medical collaboration tool like iClickCare as part of that effort, try it for free:

Download iClickCare from the Apple App Store

 

 

Tags: healthcare collaboration, big data, medical collaboration, care coordination, coordinated care

People Love Their Doctors -- But Hate Healthcare

Posted by Lawrence Kerr on Tue, Mar 01, 2016 @ 07:00 AM

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There is a poll that came out recently, done by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. The poll looks at Americans' perceptions of their healthcare, doctors, insurance, and health. And the findings are surprising.

Two things, in particular, struck us about patient perceptions -- and they may indicate an important reframing of where the problems and opportunities in medicine lie.

1. Doctors are great, but the medical system is not working because of the gaps between doctors.

About 80 percent of Americans say they get good or excellent care. But 42 percent rate the health care system in their state as fair or poor. 

How to reconcile those dramatically different numbers? Our take is that patients recognize that the doctor that is caring for them is doing a great job. It is the system itself that people are struggling to navigate -- and the ways doctors collaborate and communicate with each other. NPR comments that difficulty in navigating the system, repeat visits, and the process of getting help is what patients dislike. 

2. Patients probably don't have a single provider who coordinates all their care.

Nationally, a quarter of adults say they do not have a regular doctor or health care professional who provides most of their health care when they are sick or have a health concern. 

When people do not have a medical home, providers have to be sharing that they know about patients with each other. Healthcare collaboration and active coordination of care becomes crucial in providing even basic levels of care.


To us, these findings point more than ever to care coordination as a huge part of what it will mean to improve medicine. Each provider may be caring for his or her patient in excellent ways -- but if we're not talking to each other, then patients can get lost in the cracks. 

 

Get our take on using telemedicine for care coordination and healthcare collaboration:

 

ClickCare Quick Guide to Telemedicine

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

Burn Down Capitated, Managed, and Accountable Care?

Posted by Lawrence Kerr on Mon, Mar 09, 2015 @ 07:00 AM

contributionship

Last weekend, I visited Philadelphia to see my daughter. As I walked along one cobblestone street, I noticed a metal plaque with four interlinking hands on some of the oldest homes. It was familiar to me, and in reminding myself of the history of these placards, I realized something fundamental about the changes in medicine.

But let me back up. In fact, let me back up to Benjamin Franklin in 1752. In response to the horrific fires in the young city of Philadelphia, Benjamin Franklin put together a “contibutionship” to take care of rebuilding after the fires. Modeled after a London firm, policyholders of this contributionship formed a mutual insurance company to share burdens in the case of fire. A contributionship member placed a medallion or plaque on the house. When a fire occurred, the paid firemen raced to the scene and put the fire out. If there was no medallion, they watched the property burn. Of course, risk was managed: there could be no trees on the property of the houses with medallions.

Capitated care, managed care, accountable care are all built on the same principle. Benefits (care) are given, but risk is shared by everyone involved. The only difference is that there are a lot more middlemen and statisticians in the healthcare system. And rather than each member paying directly, the member pays taxes or a premium to the government or insurance company.

Management of that care involves finding a better way to decrease costs. Instead of requiring no trees on the property, healthcare management focuses on efficiencies and expensive outcomes. iClickCare focuses on both the quality and savings of coordinated and collaborative care. Everyone “at risk” -- institutions, providers and patients themselves -- can contribute to the outcome by safe handoffs, time saved, and decreasing waste.

The nearly unspoken caveat is that everyone must behave differently. Not only the providers need to change, the patients need to do so as well. An excellent commentary on that piece by Christensen, Flier and Vijayaraghavan is here.

So as these concepts become even more crucial for us all to move towards sharing the burden of disease, managing risk, decreasing costs, and providing good care, these are the definitions that will be crucial:

  • Capitated care:  By the head. The payment for insurance to care for a member for a fixed fee per year.
  • Managed Care:  Adding tools such as approvals for procedures, a panel of physicians, and occasionally rationing of services. Remember the rule about trees in the contributionship? HMOs have those kinds of provisions.
  • Accountable Care Organization:  An organization which pays by capitation or fee for service, but adds penalties and rewards based on quality measures from the Centers for Medicare and Medicaid Services.
  • Managed Medicaid:  A healthcare payment system by states which enrolls the poverty stricken in a capitated plan. Payments to providers can be fee for service or capitated.
  • Prepaid Health Plans:  Same as above. Prepaid group practices developed from 1930 through 1960.
  • HMO (Health Maintenance Organization):  A prepaid health plan but based on the Health Maintenance Organization Act of 1973. Payment for services is only made within the network of the plan after referral from a primary care provider.
  • PPO (Preferred Provider Organization):  A prepaid heath plan in which the patient is able to make self referral within and without of the network of the plan.
  • EPO (Exclusive Provider Organization):  A hybrid of HMO and PPO. The patient selects the provider without a primary care referral, but the care must be exclusively within the network of the plan.
  • BPCI (Bundled Payments for Care Improvement):  Not prepaid, but retroactively paid services to groups of providers to force alignment of incentives. A managed care program with retroactive payments instead of prospective payments. 

When all is said and done, though, medicine should come down to a partnership with the provider and the patient. The doctor, the nurse, the aide and the therapist are a team with the patient and for the patient. Any system will only work when it is also really bought into by the patient. For as Benjamin Franklin said when referencing fighting fires: “an ounce of prevention is worth a pound of cure."

 

Tools like iClickCare can support a Managed Care system by improving the way that coordination and collaboration happen. See how iClickCare can work for your organization with a free 2-week trial:

Try the iClickCare 14-day evaluation

Tags: coordinated care, accountable care, managed care, capitated care

Why Telehealth Is Not Always Good for Managed Care

Posted by Lawrence Kerr on Mon, Feb 23, 2015 @ 08:00 AM

telehealth


There have been a lot of exciting articles recently about the advantages of replacing some in-person visits with telehealth visits.  

For instance, these stories on using telehealth services to cut costs and improve care have stood out to us as models: 

These are fantastic and crucial findings. For so many years, there was such skepticism about telehealth "visits" that hospital systems have been throwing money away when they could be routing large numbers of patients to this kind of remote visit. One figure in the article above ("Assessment of the Feasibility and Cost of Replacing In-Person Care with Acute Care Telehealth Services, Dale H Yamamoto, December 2014") stuck out at us though. While 83% of the patients' issues were able to be resolved in that telehealth visit, 17% of the issues were not resolved.

That means that patients likely needed to repeat the original visit in person, and then proceed to a number of providers to ultimately resolve their medical problem.

Because "telehealth services" are often defined as video conferencing, there is a gaping hole in the process. When the initial visit fails to get the expected results, it can actually end up less efficient for all parties.

That's why we are such strong proponents of both medical collaboration and hybrid store and forward telemedicine (like iClickCare) as tools for coordinated care and managed care. These services enable providers to share pictures, videos, and questions easily and securely, without having to be available at the same time. Many people are finding that this kind of telemedicine can decrease length of stay, drop readmissions, and keep the number of overall visits down.
Video conferencing can be a great component of the overall plan. But unless there is a system for providers to communicate with each other about the case, asynchronously, there will be unnecessary waste that occurs-- costing your Accountable Care Organization money.


To learn what Hybrid Store and Forward telemedicine looks like and why ACOs are using it to coordinate care, get our free guide here:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine, medical collaboration, telehealth, coordinated care, care coordination, ACO, managed care

Barriers to Medical Collaboration Are Barriers to Good Care

Posted by Lawrence Kerr on Fri, Oct 24, 2014 @ 11:12 AM

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Even my 4-year-old granddaughter knows what a silo is: the iconic brick, wood, concrete, or metal structure that keeps one harvest from another on a farm. With all the change in agriculture, we would actually be hard pressed to find a farm with the iconic silo, but still. 

The silos in health care are infamous, rather than iconic. The physical barriers are reinforced with regulatory barriers, time constraints, virtual constraints, and -- most unfortunately -- attitudes.

Look around you and notice all of the physical constraints. Do you remember them being as pervasive even just a few years ago?

  • Key cards
  • Locked file rooms
  • Locked drawers
  • ID cards
  • Files face-down
  • Disconnected hallways
  • Tree lined atrium replaced by cubicled offices
  • Windows blocked by required notices
  • Distances across town, across farmland, or just down the hall
  • Diverse institutions. Long Term Care, Home Care and Hospitals

Of course, with technology so integrated with our days, there are also the virtual barriers we experience:

  • Log ons and passwords
  • Telephone tag
  • Not enough integration
  • Too much integration and too much data
  • Packed email boxes

And, saddest of all, we have attitudes that separate us:

  • Not my job.
  • Competition. True story, overheard at a medical meeting in an urban center.... Older chairman of department to you surgeon: “Yes, I will grant you privileges, as long as you just do emergencies and never do cosmetic surgery. Welcome.”
  • Outside of my scope of practice.
  • I’m not allowed to do that.  
  • I’m just doing what I am told.
  • I’m not comfortable with that.
  • I don’t do that often enough.
  • That is too time consuming. 
  • Medicine is a business. It needs to be run like Disney.

It is not enough to blog about it. It is not enough to complain. Each of us should do something, but where should we start? "We" meaning all of us; lab techs, aides, super-specialists, advanced practice nurses, doctors of what ever board certified -ology should get started!

We are not going to change HIPAA and the legions of other state and federal regulations, at least not right away. There are not enough of us to protest (maybe there are and we merely need the 17 year old Hong Kong activist to lead us). We will not get doors unlocked, IDs removed, logons discarded. So, the only thing left, and indeed the core of the problem, is our attitude. We need to regard the patient as our responsibility, not our institution's responsibility. We need more us and we, and less them and you in our language and in our thought. We need technology that promotes these good attitudes, not technology that blocks them. We need technology that empowers action based on these attitudes, not technology that dispirits them.

 

Hybrid Store-and-Forward Telemedicine Can Help Defeat Silos. Here's how:


ClickCare Quick Guide to Hybrid Store-and-Forward


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

Tags: HIPAA Collaboration, medical collaboration software, coordinated care, care coordination, medical collaboration, communication with patients, healthcare provider burnout

Why Afternoon Tea is Crucial to Medical Collaboration Teams

Posted by Lawrence Kerr on Mon, Sep 29, 2014 @ 08:32 AM

afternoon tea, medical collaboration is aided by social interaction

Last week we shared 5 things that make a medical collaboration team great. And today we look at the the 6th thing:

Afternoon tea.

As our last post discussed, social interaction is critical to collaboration. A study from MIT showed that when social interaction happens, productivity increases. A call center made the simple change of scheduling all their coffee breaks at the same time, and call response time - an easy to measure statistic - decreased markedly. Which leads us to Anna of Bedford, whose birthday just passed on September 3rd. As the industrialized society grew, and dinner was served late, people began to have a light snack at 4 or 5 pm. Anna took it one step farther: she served tea. These tea times were gathering places for gossip and moments to discuss the affairs of the day. Anna's friend, Queen Victoria, followed suit. The practice became fashionable, spreading, and becoming what we now know as the British Afternoon Tea.

We do not know if call response times decreased then, but we do know that it was the time of the peak of the British Empire.

In medicine, we used to do a lot of versions of afternoon tea, to keep relationships strong and the lines of communication open. In fact, modern residents won’t believe this, but we used to have “GI rounds” of beer, wine, and cheese in the pathology lab conference room. The surgeons actually talked to the pathologists too!

The truth is that these times for afternoon tea in the medical profession are dwindling. But the need for social interaction and conversation hasn't decreased. It's crucial when we do any collaborative venture whether it is in person, by phone, with paper, or ideally with Hybrid Store and Forward telemedicine.

So as you collaborate, remember that we are collaborating with another professional with skills and knowledge different from ours. That person can be anyone with any title, HIPAA compliant of course. And in that collaboration, I've found it useful to keep the following in mind:

  • Talk and listen. “Yes sir, no sir” doesn’t hack it any more than “My way or the highway”
  • Engage in energetic conversation. Healthcare can be depressing. We don’t have to add to the depression. Bad outcomes taken seriously, but bad administrative and regulatory environments, not.
  • Connect with all of us, not the boss. Hybrid Store and Forward allows connections and conversations to take place both anywhere and any time.
  • Carry on inside and outside of the meeting. Continue the conversation, as in “I just had another thought”.
  • Be individuals and explore, but return and share. It’s the patient who should win roundsmandship, not the last man standing.
  • Take time to make one more entry. “Thanks”; “We came to a good plan”; or “Keep in touch”.

And most of all remember to take time for tea.

 

Want more stories from the front lines of collaboration?

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: coordinated care, care coordination, medical collaboration, store and forward medical collaboration

The Real Cost of a Rushed Doctor

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

rushed resized 600

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

New York State Recognizes ClickCare -- and Telemedicine

Posted by Lawrence Kerr on Tue, Aug 05, 2014 @ 08:00 AM

New York Award to ClickCare

 
As a company passionate about making healthcare work better for patients and medical providers, we don't often talk about the "behind the scenes" of ClickCare itself.

This past week, however, we paused to reflect on how the success of our mission and the success of our company are deeply linked. We were fortunate enough to be chosen from hundreds of potential companies to be part of a business accelerator hosted at Binghamton University. Start-Up New York chooses businesses, particularly those developing key technologies that are ripe for expansion and that will develop jobs for New Yorkers. It's a coveted award, because it gives companies the depth of support and experience that they need. 

In being selected as one of these companies with the most potential to expand -- affecting our community and the lives of local folks in the process -- we realized that the award shows just as much about healthcare as it does about ClickCare. ClickCare is poised for expansion because of the medical need for accountable care, the huge demand for coordinated healthcare delivery, and the gap that exists in HIPAA secure communications. ClickCare's way of making telemedicine accessible is part of this bigger movement.

So as we move in to our new offices, we're conscious that this award puts a spotlight on not just us, but on everyone working to change healthcare. May we all take a little encouragement from the recognition that the state of New York gives to the importance of this work.

For more thoughts on telemedicine and how it can change healthcare, click here:

ClickCare Quick Guide to Telemedicine 

Tags: telemedicine, medical collaboration software, coordinated care, medical collaboration, Telemedicine and HIPAA, healthcare collaboration, store and forward medical collaboration

Independence, Interdependence, and Medical Collaboration

Posted by Lawrence Kerr on Thu, Jul 03, 2014 @ 08:51 AM

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As our week tapers down toward the holiday weekend, we want to wish you all a happy and healthy Independence Day.

We often think of our country as a country of individualists: our national holiday is "Independence Day;" cowboys are national heros; and our constitution is about protecting individual freedoms. And that may seem contradictory to the focus of our company, which is about people working together in medical collaboration. 

The fact that ClickCare is an American company is no coincidence or mistake, however. The truth is that independence and freedom are closely related to collaboration. We cannot thrive as individuals -- individual providers, patients, or people -- if we don't work together. 

These days, more and more healthcare professionals are asserting their independence and freedom by bringing their own devices to use in the care of their patients -- what has become known as the BYOD movement. The trick is to actively support BYOD, guarantee the security of patient confidentiality and still be able to collaborate effectively in the diagnosis and treatment of the patient. 

To find out more about BYOD in healthcare, its advantages and concerns, as well as a real HIPAA secure solution to supporting BYOD, we invite you to download our whitepaper titled Healthcare BYOD and HIPAA Security: The Issues and a Solution.

                                           iClickCare IS BYOD Secure

There is evidence from psychological research, the "sharing economy," and throughout history, that when we work together, we all do better. And our experience confirms this. As providers, we've always felt freer, stronger, and more effective when we collaborate. We don't feel so isolated; we're better able to provide a high level of care; and we can count on the support of the people around us.

So, as we celebrate on July 4th, let's celebrate our interdependence as well as our independence -- because you can't have one without the other.

Let the fireworks begin!

If you have your own comments or stories to tell about independence and interdependence, or how BYOD is affecting you, please add your comments.

Tags: coordinated care, medical collaboration, good medicine, telemedicine solutions

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