Many healthcare providers don’t use the healthcare system often. In fact, I’m sure many of us have heard doctors say, “I don’t need to go to the DOCTOR!”

For that reason, sometimes I think we have a limited sense of what it’s like to be a patient.

As a patient in the hospital, we turn our days and nights over to a system that intends to get us to a certain level of recovery and intends to keep us alive. The hospital, per se of course, isn’t always structured to support overall wellness or healing — that’s the job of others in the healthcare system, and of the patients themselves.

But sometimes information will confront us about just how hard a hospital stay can be on the health of a patient -- and we're forced to reconsider our approach.

One common complaint in hospitals is that you can't sleep because of all of the interruptions throughout the night -- vital checks, light, noise, early rounds, blood draws, etc. For many of us, this may sound like a tiny price to play for the crucial monitoring that happens through those hours. And perhaps it is. 

But a recent article in the New York Times reconsiders whether the price truly is small. We all acknowledge the profound value of sleep in our basic functioning and healing: "Short sleep durations are associated with reduced immune function, delirium, hypertension and mood disorders. Hospital conditions, including sleep disruptions, may contribute to 'post-hospital syndrome' — the period of vulnerability to a host of health problems after hospitalization that are not related to the reason for that hospitalization."

There are so many demands in medicine that we’re forced to do things that may not make sense in terms of healing, but are the only way to proceed, working within the structure of the medical system. As the New York Times says, the hospital is "an environment that, all too often, seems set up for everyone else’s convenience but the patient’s.”

As providers who want to truly care for our patients, and in this time of value-based care, these are concerning truths. So what are we to do?

First, I believe that the sooner we can get people home, the better. This is a combination of the efficacy of care within the hospital PLUS an expectation of a high level of support once the patient leaves the hospital. The more we can depend on sophisticated monitoring and care from the home environment, the sooner the patient can get home. Many times, that means we need to be enabling healthcare collaboration across the continuum of care. That way, aides and wound care nurses can tend to patients from where they're most comfortable, but have a moment's access to other providers, as needed.

Second, the more humane, the more holistic, we can make our healing environments, the better. A clinical study showed that even small changes to disruptions to sleep in hospitals cut patients’ sedative use by half. Yes, hospitals are places where we achieve a bare minimum of functioning. But thinking more comprehensively about whether they're also supporting health may be a wise investment for us to make. 

Finally, it's crucial that we let providers make commonsense decisions. Our checklist culture has sometimes reduced errors, but it may have also reduced the commonsense nature of what many of us do. Any nurse has an impeccable gut sense of how she might combine vital checks and blood draws so that no monitoring sensitivity is lost, but the patient is disrupted less frequently. But if she's told she MUST do these things on a set schedule, she begins to override her own sense of what's best for the patient. 

Metrics like Length of Stay can seem challenging or even excessively profit-motivated to consider. But when you think about the patient's experience in the hospital and the intersection of Length of Stay and the patient's quality of healing, it gets clearer how the "right" thing to do is also the "smart" thing to do. 

To learn more about how telemedicine can support shorter Length of Stay and improve outcomes, download our Quick Guide: 

I’ll be the first to say that our medical system, despite its flaws, is miraculous.

The care that healthcare providers give on a day-to-day basis, in terms of complexity and art and compassion is astounding, especially when we look at how far we’ve come in the last 100 years.

That said, the evidence is mounting that in many ways, the negative effects of contact with the healthcare system are significant. Are they usually are out weighed by the benefits of accessing healthcare? Certainly. But just as every drug has its side effects, the side effects of medical visits and hospital stays themselves are becoming more obvious and quantified.

I think there is strong evidence that it does. For instance, this article on “post hospital syndrome” raises the point that hospital stays can be extremely damaging to the overall health of patients, especially the elderly. While the stays tend to treat the original illness, there is observed to be a significant impact on the patient's overall health, wellness, and independence.

In fact, post-hospital syndrome seems to be a cause of the very high readmission rates among older people. In 2016, about 18 percent of discharged Medicare beneficiaries returned to the hospital within 30 days, according to the federal Centers for Medicare and Medicaid Services.

Dr. Harlan Krumholz, a cardiologist at Yale University, has been looking at the reasons for this. When he looked at 30-day readmissions, he found that many causes of readmissions had nothing to do with the initial admission. “Patients came in with heart failure or pneumonia, were treated and discharged, then returned with internal bleeding or injuries from a fall. ‘Our general approach in a hospital is, all hands on deck to deal with the problem people come in with,’ Dr. Krumholz said. ‘All the other discomforts are seen as a minor inconvenience.’”

But the other discomforts can be incredibly serious when it comes to health and recovery after an illness. Dr. Krumholz is finding that simple things that keep patients’ lives as normal as possible even when hospitalized can have a big impact — walks down the corridor, wearing their clothes, eating normal foods, etc. These things can make it so that muscle loss, cognitive degradation, confusion, balance issues, and the like are all mitigated.

Solutions are mimicking regular life. But the only thing better than that is actual regular life -- keeping people out of the hospital, or even away from a doctor's office, as much as possible.

Similarly, outside of an inpatient context, we tend to refer and set appointments as if the transportation isn’t a relevant concern. But as this article explores, healthcare transportation can be a major impediment to care, a huge expense, and a important disruption to the patient’s life.

Each contact with the medical system comes at a cost. These costs can come in the form of money, transportation, and a negative impact on the things that keep people healthy and happy. And so many times, our patients don't need to be interacting with the healthcare system nearly as much as they do. A referral to a second provider, with its accompanying visit (and long drive, and a day off work or play), could easily be replaced by a quick consult with a tool like iClickCare. A hospital visit may be able to be shortened by 30% if the providers on the case had a quick way to touch base on the patient's status. Hopping between doctors for different diagnosis perspectives can be replaced by team-based medical collaboration (like hybrid store-and-forward® telemedicine.)

So what are providers to do? My opinion is that when healthcare providers work together more, patients need to interact with the healthcare system less. The truth is that when we are able to collaborate effectively, we dramatically cut down on length of stay, total number of medical visits, and time spent in a medical setting.

Evidence shows that home, and regular life, is where people heal. So let’s work together so our patients can spend more time there -- and less time in a hospital bed or in a doctor's office.

iClickCare is a simple way to cut length of stay and even visits. You can try it for free here: 

As healthcare providers, we believe we're doing everything we can for our patients. 

We're providing the standard of care, always looking for better medicines, better protocols, better surgical techniques, better ways of caring. 

But I recently stumbled upon one factor in patient outcomes that very few providers are aware of -- and the effects of it can be staggering. Even if this finding doesn't apply to your practice directly, I think there are important lessons to be learned for all healthcare providers, across contexts.

A recent article in the American Journal of Health Economics, looked at the effect of the health or sickness of a patient's roommate on that patient's health. They found that there is significant "spillover" of health from healthier roommates to less healthy roommates. In fact, patients with healthier roommates needed less care during hospitalization, lower rates of readmission, better condition at discharge, shorter length of hospital stay, and lower hospitalization costs.

As the New York Times reports, "a patient who rooms with the healthiest roommate has a hospital stay that is about eight hours shorter, requiring 27 percent less medical attention, and costing about $840 less."

Crucially, the study controlled for the factors that nurses used to assign patients to rooms, including diagnosis and specific room assignment. Even looking at one room, patients with healthier roommates had better outcomes than those with sicker roommates. 

In terms of appropriate action based on the findings, it’s not 100% obvious what might be implied. For patients, it could be worthwhile to advocate for themselves, requesting a different roommate if they find themselves with a sicker one. 

But for providers, the findings are much more applicable. With Length of Stay such a crucial metric for providers, these findings are astounding. A stay that's shorter by 8 hours and almost one-third less medical attention is powerful -- and hard to beat. 

There may be specific ways to approach the assignment of patients to rooms that will optimize around this dynamic. But more interesting to me are the higher-level takeaways that the study points at. 

Two takeaways from the findings that patients have better results if they have healthier roommates:

1. Peer influence is crucial.

The study seems to point to the influence that peers can have on patient progress. In fact Peer Support is a burgeoning part of the field, with significant positive consequences for health outcomes. This is one reason that we made iClickCare so accessible and powerful for collaborations among people across the continuum of care, including providers not traditionally included in many care decisions, like occupational therapists, teachers, family members, social workers, and aides. If peers are on one side of the continuum and super-specialists are on the other side, then we advocate for including as wide of a spectrum of care as possible, in the acknowledgement that -- as in the case of roommates -- the rewards can be significant.

2. Care is more than just medical intervention, and there are rewards for addressing the full picture.

When we look at Length of Stay metrics, we are trained to look at "hard" factors, like the disease, intervention, skill level of the practitioner, etc. What surprised me about this study is that it almost takes on the issue from "peripheral vision" -- it's looking at a soft, often ignored, almost irrelevant-seeming factor in outcomes. iClickCare is made to facilitate inclusion of precisely this kind of variable, and to keep all the factors in one place. Whether it's a patient's hobby, where he/she lives, his/her interests or fears, or details of behavior or presentation that only the aide would notice -- you should choose a medical collaboration tool that captures the whole picture. 

Certainly, the factors influencing the roommate phenomenon haven't been completely explored yet. And there certainly aren't easy answers for room assignments based on the results. But we're grateful to the researchers for their creativity in exploring the issue. And we encourage you to use the same kind of creativity in applying the findings.

Use a healthcare collaboration tool that takes all the factors into account. Get iClickCare free for 2 weeks:

It's so expected as to be mundane at this point, but healthcare costs are indeed rising.

As the New York Times reports, health plans nationwide are reporting rate increases for 2017. And many are very large -- Blue Cross Blue Shielf of Texas is seeking an increase of nearly 60%.

These rising costs are, of course, felt by individuals and families buying health insurance. They're perhaps felt by insurance companies. And they are felt acutely by hospital systems and healthcare providers -- who are often left with the burden of picking up the slack when the insurance, the individual, and the payment doesn't quite cover the true costs of care.

We believe that there is such a swell of support for telemedicine right now because of the context of rising costs in which we find ourselves. Telemedicine is a way for healthcare collaboration to happen, for care coordination to happen, and for key metrics to come into line -- all without huge investments of time or money in implementation.

10 simple ways that we see telemedicine playing a key role in cutting costs in the medical context in which we find ourselves:

• Telemedicine can influence key indicators directly. Key indicators, like length of stay, can be very directly influenced by telemedicine. That means that you can use telemedicine systems to create interventions in the areas your system is struggling in. 
• Telemedicine can make it easier to factor in the "intangibles." Being a healthcare provider is almost insurmountably complex. Telemedicine makes it easier for all "voices" and all aspects of a patient's life to be heard and factored in -- something that improves outcomes and decreases costs through fewer treatments and less noncompliance.
• Gaps in EMRs and EHRs can be patched and addressed.
• Improvements in care coordination don't have to be complex. In fact, we found that the simpler care coordination tools actually had better outcomes than the higher-cost implementations.
• Long term care, a key cost center, is a particularly high-leverage place to use telemedicine.
• Hardware should be cheap and readily available. We always balk when providers say they need fancy or expensive equipment to do telemedicine-based healthcare collaboration. In fact, the best camera is the one already in your pocket. 
• All of the key components in health costs decreasing can be influenced by telemedicine. 
• Telemedicine-supported care coordination can help with super-utilizers. When patients fall between the cracks, it costs them their health, and it costs everyone money. Telemedicine-based care coordination can be the missing link. 
• Care coordination works better than incentives for decreasing length of stay.
• Telemedicine has played some key roles in affecting costs already.
  
  

Not all telemedicine is created equal. Some telemedicine solutions are so intensive to implement, that returns may not be reaped -- ever. So it's certainly not one-size-fits all, but telemedicine -- especially hybrid store-and-forward solutions that don't require expensive hardware -- can play a large role in getting healthcare costs down.

For more on how telemedicine can help your organization address rising costs, explore our free quick guide to telemedicine: 

The great podcast Freakonomics has been doing some powerful episodes recently, as part of their "self improvement month."

One episode seemed particularly relevant to the ways that the ClickCare community does healthcare collaboration and why it makes such a dramatic difference in healthcare as a whole.

First, let me back up.

K. Anders Ericsson is a professor of psychology at Florida State University. He has studies how people become world-class at anything from surgery to music to sports.

And it turns out that, for the most part, human beings are getting better and better at learning how to learn. For instance, in order to qualify to run the Boston Marathon today, a male in the 18- to 34-year-old group has to have a time of 3 hours and 5 minutes. That time is only 6 minutes slower than the WINNER of the marathon in the 1896 olympics.

Ericsson says that "we’ve gotten so much better primarily because we’ve learned how to learn." And he links this ability to learn things to something he calls "deliberate practice." Not just logging hours, but practice involving "well-defined, specific goals, and [it] often involves improving some aspect of the target performance. It is not aimed at some vague, overall improvement.”

Interestingly, Ericsson cites studies that show that for doctors, their ability to diagnose heart sounds actually decreases the longer they are in practice. He says that this is because most physicians are in a fairly isolated environment, and that because they don't have coaching, input, challenge, support, or feedback during the diagnosis process -- they don't get better. In other words, doctors practice, but it's not deliberate practice, so they don't improve.

“Once a person reaches that level of “acceptable performance and automaticity,” Ericcson writes, "the additional years of 'practice' don’t lead to improvement.”

This data resonates with us because we see such significant gains in patient results, decrease in readmissions, decrease in length of stay, and even a drop in provider burnout when healthcare providers use a telemedicine tool for healthcare collaboration.

A few reasons why telemedicine-based healthcare collaboration can have such dramatic results:

• Providers get immediate feedback, to support improvement. 
  When I get the relief of asking another provider for her consult on a case, I'm not just helping make my day easier and improving care for that patient -- I'm also getting what amounts to targeted coaching and feedback on my diagnosis and care overall -- a key component of "deliberate practic." 
• Cases are saved for teaching. 
  One key difference between videoconferencing and hybrid store-and-forward telemedicine is that with something like iClickCare, all cases are saved and searchable so that you can use them to learn from and teach with in the future. That means immediate gains for you and your patients, plus effortless long-term building for the future.
• This kind of collaboration adapts to providers' real lives and real tools. 
  We always tell people that they can do healthcare collaboration however they want, but never to invest in huge hardware infrastructure that is going to go obsolete fast, as well as be a huge learning curve and workflow conundrum for the people using it. For practice to be significant in terms of improving results, it needs to integrate flawlessly into providers' lives and use tools they already have.
• Healthcare collaboration and care coordination go hand in hand. 
  Healthcare collaboration is usually seen as the one-off "conversation" about the patient. But when you can have mutliple providers -- across the continuum of care -- collaborating on cases, that means it's not just collaboration that's happening -- it's meaningful care coordination. 

The one thing that differentiates people who use iClickCare from those who don't isn't tech savvy or background. It is simply the sincere desire to have more fun while they do medicine, and to care for each patient as well as they possibly can.

When deliberate practice is part of the equation, using simple tools, it's not hard to see why they succeed so well at those goals.

Learn more about what makes hybrid store-and-forward telemedicine different here: 

We've written pretty extensively about how healthcare collaboration can cut readmissions and decrease length of stay. We see really consistent, measurable, and immediate return on investment from our customers that use iClickCare for medical collaboration. Forget "the right thing" -- the kind of healthcare collaboration that iClickCare facilitates pays in terms of care, in terms of results, and in terms of cost savings. 

So a recent comment that we heard from someone in the field was shocking to us: "Communication," she said, "Has no role in reducing readmissions." 

The comment was frustrating because it seemed to undermine so much of what we, and our colleagues, stand for. Assuredly, the investment in a tool like iClickCare is simple and obvious to us, both in terms of a pay-for-performance context and in the simple terms of caring for patients.

The more we thought about it though, the more the comment actually made sense. Communication, in itself (as with secure texting) can't really influence anything. 

Move the process up a step step and make turn communication into a conversation. That is a start. At least two providers will think about the problem. Maybe even they will come to a conclusion. Often though, this is based on hierarchy and answers the needs of the system and not the needs of the patient.

What about collaboration, the process of communicating, conversing, and working together to create a solution that is as close to ideal as possible. The dictionary definition is “the process of working with someone to produce or create something." That is where real care can happen and providers can become less burned out and lives can be saved.

"Collaboration" has a pretty extensive entry in Wikipedia, and gives examples from many human endeavors. But there is just one short line about Medicine: “In medicine the physician assistant - physician relationship involves a collaborative plan to be on file with each state board of medicine where the PA works. This plan formally delineates the scope of practice approved by the physician." It's not really about a multi-directional working relationship -- it's about approval and simple transmission of information. Note that the patient is left out. The regulations are left in.

Providers, payors and systems need to realize “that working with someone to produce or create something” -- healthcare collaboration -- is more than communication and more than conversation.

It is the essence of our evolution and the satisfaction in our daily lives.

Download our free ebook about hybrid store-and-forward telemedicine and how it can, yes, decrease readmissions in your hospital:

As healthcare providers, we know there is pressure to decrease readmissions and length of stay -- but we don't always have insight into the mechanics of how and why. Our patients have even less grasp of why and how discharge decisions get made, a situation which can erode both trust and outcomes.

One thing is for sure: the average hospital stay is decreasing. As the New York Times reports, today's average stay is 4.5 days -- compared to 7.3 in 1980.

There are many potential reasons for these shifts, but data suggests that financial incentive is the main determinant. Recent changes affect who is admitted, how frequently, and how quickly they are discharged. For instance, Medicare's prospective payment system, which paid a predetermined rate and so shifted risk to the hospital is shown to have decreased length of stay.

Of course, slashing Length of Stay has consequences. In fact, many people point to the increase in readmissions that can accompany drops in length of stay. Or as Mr. Frakt shares, "A physician who practices at a Boston-area teaching hospital told me that hospital administrators exert social pressure on doctors by informing them that their patients’ stays are longer than that of their peers. "

This kind of social pressure or hard financial cutoffs to push numbers are like medical shortcuts. They seek to quickly drive "expensive" numbers down -- without significant investigation into the consequences. Of course, logic and experience tells us one simple truth: the only way to improve care, decrease readmissions, and decrease length of stay is through medical collaboration and coordination of care.

This isn't something tbat you can simply put in a memo. And there is no shortcut, but it is certainly possible. As we've shared before: 

• Telemedicine supports overall health spending decreases without pushing other indicators out of alignment.
• Medical collaboration tends to decrease readmissions as well as decreasing length of stay -- by improving the care coordination that happens -- all without worsening overall outcomes.

It is hard enough to provide excellent medical care -- but short term fixes and social pressure definitely make it harder. 

See how hybrid store-and-forward telemedicine can support you in better care coordination here: