In high-level sports teams (whether college or professional teams), there is a lot that is done for the athletes. Logistics are coordinated for them and tutors may be arranged when necessary. Food, travel, and training are all figured out on the athletes' behalf. Schedules are usually pretty tightly controlled, and everything is customized for the individual player.

Most of the time, this is a pretty fantastic arrangement. The athlete doesn't have to worry about the details outside of his or her athletic performance (and in the case of the college athlete, his or her academic performance.) And the team is able to use its perspective and knowledge to choose the best structures and support for the team.

Things start to get a little less clear, however, when there is a health issue or injury. Very quickly, "Plan A" becomes irrelevant, and the trainer, coach, player, and medical providers have to come up with a Plan B. All of which, of course, forces the question:

When athletes are sick or injured, where do their rights end and the team's rights begin? Do trainers and coaches have a right to share health information and take part in decisions?

Especially with more severe health issues, conflicts can emerge between the interests of the team and the interests of the athlete. For instance, if an athlete could continue playing with a knee issue for a few years, but would experience restricted mobility 5 years down the road, what should be done? Often, the athlete himself would choose to keep playing despite the long-term consequences, but what if he wishes not to while the team needs him to play? Interestingly, the National Athletic Trainers Association does not seem to address this conflict in their code of ethics. As we discussed recently: "there can sometimes be a contradiction between supporting a young athlete in reaching his full potential today and preparing him for his life after sports. Second, the athletic trainer and department must consider the needs of not just "this" athlete -- but of all the athletes on the team, present and future."

These are complex issues with no easy answer. However, as medical providers who have worked with athletes and teams from Little League to the Major Leagues, we have noticed some patterns. In short: the more that the athlete's medical providers collaborate and communicate, the fewer conflicts arise. When we've used iClickCare to facilitate communication among a surgeon, an athletic trainer, a physical therapist, and the family doctor, everyone seemed to quickly arrive at a good conclusion. However, when there is little collaboration or communication, that's when folks seem to dig in and see less alignment and more conflict.

How have you made sure that team and athlete interests are all respected when health issues occur? We'd love to learn from your experience in the comments below.

Read more about how medical collaboration changes things:

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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:

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In many sectors, pagers are a technology that came and went with the '80s and '90s. With the advent of cellular phones, and then smartphones, the simple alarm-plus-message functionality became obsolete quickly.

In medicine, however, pagers are still ubiquitous. Most hospitals and medical settings use pagers as their main form of communication, primarily because they are viewed as low-risk communication tools. However, despite pagers being the more common choice, they're not necessarily the better choice. Pagers cost US hospitals $8.3 billion in 2013: $3.2 billion through lengthy discharge processes and $5.1 billion while clinicians wait for patient information.

The evidence shows that we may be reaching a crisis point regarding the viability of using pagers in medicine:

• With so many providers at different parts of the continuum of care, and with so many handoffs within a given case, pagers can't keep up with care coordination.
• In an age of increasing malpractice suits, having no record of communications or responses is riskier than ever. 
• With pay-for-performance, rather than pay-for-service, being today's touchstone, it is no longer sustainable to be wasting time or money with an antiquated technology.

As usual, it is the providers themselves -- particularly the nurses -- who are taking matters into their own hands and finding efficient ways to communicate whether regulations or administrations support them in doing so. Hospitals are seeing a de facto Bring Your Own Device (BYOD) situation and 67% report nurses are using their smartphones to support clinical communications and workflow. According to research by Logicalis, the phenomenon is even more common in high-growth markets (like Brazil and India): almost 75% of users in these countries used their own devices at work, compared to 44% in places like the US. 

Why can't pagers support medical collaboration and coordination of care like smartphones can? Benjamin Kanter, chief medical informatics officer at Palomar Health, explains:

"The message is only one piece of the puzzle. You've got to provide context and you've got to be able to create action. Most secure texting systems don't take that into account."

When medical providers come to us for advice on how to coordinate care and collaborate without running afoul of hospital regulations or HIPAA, we acknowledge that it can be tricky. That's why we recommend the following: 

1. Don't ignore HIPAA. While we do applaud the persistence of medical providers who just "get the job done" and use their own smartphones as necessary, we caution our colleagues to not use text messaging, email, or their regular camera roll as none of these are HIPAA-secure. The penalties are too great to risk it. 
2. Be willing to go first. Sometimes a provider will be ready to use iClickCare for medical collaboration but hesitate because their institution doesn't already use it (even if it's allowed). If we're going to change medicine, we have to be willing to lead the charge -- first an individuals, and then as a community. 
3. Be realistic about the complexity of your communication.  Popular messaging services don't incorporate the use of photos, videos, archiving, and consults with any provider. Communicating is great, and a great start, but the reality is that our medical collaboration demands more than a text message to really accomplish the communication and coordination we need. 

For our rundown of telemedicine options, pros, and cons, click here:

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There may be specialties that have more fanfare or higher profiles. But Long Term Care is unique, fundamentally important, and complex for two reasons. First, it is the only speciality in medicine that affects every person -- both as a family member and as a care recipient -- at some point in their lives. Second, it invariably involves many collaborators, at all points in the continuum of care, and needs the focused collaboration of the family.

For instance, even in the simplest of long term care cases, all of the following people, and more, will likely need to be involved:

• Physician Assistant
• Nurse
• Home care aide or other caregiver
• Cardiologist
• Physician
• Therapists
• Wound Care Nurse
• Family

Managing, coordinating, and supporting these Interdisciplinary Teams can be time-consuming, risky, and difficult. Communication is great, but the more people that get involved, the more risk there is that something could fall through the cracks. Many teams actually choose to limit the number and type of people that collaborate on a given case. This is not an ideal solution, however.

Effective collaboration among every provider on the continuum of care is really the only way to ensure the best results for the patient.

Increasingly, the Long Term Care community is acknowledging this complexity and emphasizing the use of Interdisciplinary Teams (IDT) as a means to support the best patient centered care. And when it comes to Medicare reimbursement and submitting correct MDS data, an interdisciplinary approach is not just "nice to have" -- it is absolutely essential.

So how does a team providing Long Term Care coordinate and collaborate without letting any balls get dropped? We know it's not easy, so we recommend using tools to help make this kind of medical collaboration effortless. We know, we know -- technology can sometimes make our lives more difficult. But deciphering stacks of handwritten notes and playing phone tag is not effortless. That's why we created iClickCare -- we knew most teams need an effortless, easy-to-use way to collaborate that works with, not against, the flow of their lives and work.

In a long term care setting, using a telemedicine tool for medical collaboration can help you:

• Communicate efficiently and quickly to make better informed decisions
• Create, share, and implement care plans.
• Quickly send notes, photos and video clips to others and get efficient consults.
• Include the family in care decisions in meaningful ways.
• Avoid unnecessary doctor's visits and care delays.

If you'd like to hear stories of how people across the medical community and beyond are using medical collaboration, get our guide here:

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As of counts in the last couple of weeks, 9.5 million people are insured for the first time under the Affordable Care Act. These formerly uninsured patients tend to have clusters of medical issues, little or no treatment or care in the past, and tend to have concommitant socioeconomic challenges. 

For patients, coverage -- and the resulting medical care -- is a great thing. For providers, it is both an opportunity and a challenge. In the above New York Times video, Maria Catalano, a Nurse Practitioner at Family Health Centers, explains: "It seems like we're seeing a lot of newly eligible Medicaid patients who have not had established healthcare in many years. It's great that they're finally having access to insurance, but it can really expand the visit and try to do a lot in one visit."

This influx of patients creates a challenge in terms of the quantity of care that needs to be provided, as well as the pressure to comply with the regulatory issues related to the Affordable Care Act. Additionally, these patients present with medical issues that need collaboration and care from several different providers. All of this adds up to interconnected challenges that can be mitigated -- if not solved -- by medical collaboration through telemedicine solutions. 

The deluge of newly insured patients under the Affordable Care Act present challenges that can only be met through medical collaboration: 

• When time-per-patient is short, and patients are presenting with multiple interconnected issues, medical collaboration -- especially the kind of efficient collaboration that happens with hybrid store-and-forward telemedicine -- becomes a must-have. 

• Medicaid demands accountability for Length of Stay and Readmissions. Medical collaboration has been proven to improve both of these metrics.
  

• The ACA makes it easier than ever to be reimbursed for telemedicine. With this infux of patients, efficient reimubrsement is essential.
  
  
• Meaningful Use of medical records is even more important under the ACA, and telemedicine-supported medical collaboration can facilitate just that. 

Maria Catalano confirms both the ways that these new ACA patients present both difficulty and gift: "We're lucky in that a lot of our patients before now weren't getting Medicaid. So now we can start getting reimbursed for the care we weren't getting paid for before if they were a no-insurance patient. But I would say the most concerning thing is -- how can we accommodate so many new patients with so many different problems, and still function at the end of the day?"

For an medical collaboration inspiration and tools, get our free guide: 

Telemedicine is often associated with very remote areas, access to super-specialized providers, or cutting-edge technology. However, some of the most heart-wrenching and interesting uses of telemedicine have been with ordinary people in ordinary circumstances.

In particular, I've seen how telemedicine can make Assisted Living Communities more efficient and more resident or person-centered. 

Assisted Living is often part of a transition from full independence to full support: a person finds a midpoint between living at home and skilled nursing care. Of course, the lines are blurry -- home care, independent living, assisted living, and full support care like memory care or skilled nursing. What all of these care services have in common, though, is the prioritization of excellent care and the maintenance of a patient's lifestyle and independence.

Traditionally telemedicine has served Assisted Living by technological replacement of human visits and by home monitoring. Significant gains in health have been documented by monitoring weight, medication adherence, blood pressure and activity. Medical collaboration tools like iClickCare bring another level of support. Tools like these can have a significant impact on senior care by enabling simple, secure care coordination and collaboration with the family, the resident (often a senior), and their caregivers and providers. HIPAA compliance is a given.

The creativity and commitment of Assisted Living providers is astounding -- and for that reason, they are innovating evermore ways of using telemedicine in their practice.

Here are just a few of the ways that Assisted Living Communities use telemedicine to improve care and decrease costs and hassle:

• Measuring key patient indicators like weight or blood pressure without the resident having to leave their home
• Efficient, remote collaboration with team members, specialists or key providers from nearby hospitals or practices
• Aides and nurses, even family members, for more background history and also private pictures or video clips
  
• Decrease in ER and OR visits due to surgeons and other providers evaluating remotely whether a procedure is required
• Several kinds of provider "touch points" on a single case, since geriatric issues often involve more than one specialty 

Several days ago, a 26-year-old man was hit in the face with a baseball going close to 100 miles per hour. A traumatic and dangerous injury for anyone, this injury was compounded in its complexity and potential impact by the fact that the patient was Aroldis Chapman, famed Cincinnati Reds pitcher.

After the horrific line drive hitting him in the face, his team sprung into action. He was transferred from the stadium to the hospital and stayed overnight. Chapman and his medical team had a number of difficult decisions to make and a large team of providers and "stakeholders" to coordinate.

If he had an orbital fracture, he could be expected to lightly throw, 2 to 3 weeks after surgery, and play in 4 to 6 weeks. He's swollen and difficult to evaluate. Should his plastic surgeons save time on the schedule for him next week? Or see him next week and then schedule him? If they do that, then who will they bump from their already too full schedule? Does he need neurosurgery or ophthalmology or a dental consult? How might the OR, admitting nurse, and anesthesiologist be prepared? Then, what about followup? Can he travel with the team? What about the patient? How should his providers share the ramifications of what happened and what would be happening with Chapman and his family in Cuba?

Happily, Chapman was scheduled for surgery less than 24 hours after the injury, repairing fractures above his left eye and nose. He's expected to pitch again this season. It is clear that whatever medical collaboration tools were used, an incredible amount of medical collaboration did occur.

When medical collaboration occurs (whether with a tool like iClickCare or through other means), that's when good outcomes occur.

In fact, the rapidity and efficacy with which Chapman appears to be put on the road to recovery creates a bittersweet contrast with a similar injury from several decades ago. As baseball fans will remember, Herb Score, a pitcher for the Cleveland Indians was hit in the face by a batted ball in 1957. The injury and its ensuing treatment seem to have been career-ending: Score didn't play again until 1958 and retired completely just before turning 29.

Often, we don't think of sports teams or medical trainers as needing to do urgent medical collaboration at this level of complexity. The truth is, however, that for athletes, medical trainers are part of a large team of providers that are doing some of the most complex and high-pressure medical collaboration there is. These providers need to care for the patient-athlete (as for any other patient) but also weigh the impact of treatment, injury, and rehabilitation on careers that hang on a thread of health, timing, and performance. We applaud Chapman's team (both his sports team and his medical team) for their collaboration and success… and we wish Chapman a speedy recovery.

How are you using medical collaboration in sports medicine or team trainer situations? We'd love for you to share your stories from the front lines in the comments below...

For more medical collaboration stories and strategies, get our free quick guide:

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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:

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