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: 

In a fee-for-performance world, we are all under huge amounts of pressure to improve our metrics. 

We are expected to cut costs, drop readmissions, decrease length of stay, and even improve healthcare provider burnout.

As you probably know, we believe that telemedicine-based healthcare collaboration can dramatically improve almost every one of these metrics. But a recent study had us asking -- is there a down side?

A recent JAMA study looked at 115,245 fee-for-service Medicare beneficiaries hospitalized with heart failure at 416 sites across the United States. Then, they looked into the consequences of a Hospital Readmissions Reduction program implemented at the sites. 

Happily, and as expected, implementation of the Hospital Readmissions Reduction Program was associated with a subsequent decrease in 30-day and 1-year risk-adjusted readmissions. The shocking part, however, is that implementation of the program was also associated with an increase in 30-day and 1-year risk-adjusted mortality.

In other words, people were coming back to the hospital less, but they were dying more. 

This type of story -- in which we see unexpected consequences of well-guided programs in healthcare -- comes up frequently. And it's easy to adopt a kind of nihilism in the face of a study like this: nothing will actually improve the situation so why bother. 

But we believe that that is the wrong conclusion. Rather, it's crucial to pioneer new initiatives to both improve care and improve our performance against metrics. But initiatives must be holistic. It's not enough to create a program that aims to improve readmissions but worsens care overall. That's why we are such advocates for telemedicine and healthcare collaboration. Initiatives like these are holistic enough that results across multiple dimensions of care are improved. On the flip side, it means that the "sell" to hospitals that have to improve in one dimension in 6 months is more difficult.

But ultimately, the only sustainable improvements are those that take care, metrics, and the whole picture into account. 

If you're ready to try iClickCare, you can download it for free here: 

It's easy to feel like better handoffs and better communication is a "nice to have" or something that we can resolve, as providers, once we have more time. 

We hear about tools to facilitate medical collaboration and we tend to think, "Well, that's so nice. Maybe once I get the big stuff resolved, I can move on to refining things like that."

We know from our work with iClickCare that medical collaboration IS one of the big things in medicine, very much not a "nice to have." But a recent study that looked at handoffs and communication from hospitals to Skilled Nursing Facilities (SNFs) really brought this point into relief and made the negative consequences of poor communication at discharge incredibly clear. 

More than 5 million people transition from hospitals to Skilled Nursing Facilities (SNFs) annually. The investigators in this study did detailed focus groups and interviews with SNF nurses, looking at that transition and the communication and medical collaboration that happens -- or doesn't -- and what the consequences are.

It's interesting and smart that the study looks at nurses rather than physicians. There is a lot of investigation around handoffs to physicians, but the handoffs to nurses have been looked at less. And nurses in SNFs play the primary role in managing handoffs and discharge to SNFs. 

The conclusions in this study are fascinating and are also crucial to both SNFs and to hospitals. As the study reports, “Discharge to a SNF is one of the strongest predictors of experiencing rehospitalization within 30 days.” And the study concludes, "High-quality, complete discharge communication is vital to safe and effective hospital-SNF transitions.”

The investigators interviewed 27 registered nurses from 5 SNFs in Wisconsin. Facilities ranged from urban to rural, and from 42 to 184 beds. They spoke with the nurses about handoffs and discharge. And poor quality discharge communication was the major barrier they identified to safe and effective transitions. “From the perspective of SNF nurses, difficult hospital-to-SNF transitions were the norm, and when asked to recall the details of a good transition, none were able to do so.”

The issues they identified are crucial, both because they are significant, specific, and also because they can be easily addressed by existing telemedicine medical collaboration technology. 

Discharge communication issues in Skilled Nursing Facilities (SNFs) that nurses identified:

• The information they get from the hospital is inadequate, incomplete, and incorrect.
  SNFs need specific, up-to-date information about the patient including “remarkable hospital events; written orders for medications, treatments, activity level, and diet; recent and pending laboratory test results; accurate descriptions of functional and cognitive status; and pertinent social information, such as preferences and unique needs.”  Both the medical and the social plan of care are important. And they found that when they do intake for a patient, much of this information was missing or conflicting.
• Information is coming from multiple sources, but they are often conflicting.
  Transition information came from three sources -- the patient, the family, and the hospital -- and they had to synthesize it and try to fill in the gaps.
• There is no good means of communication or collaboration with hospital staff.
  It is very difficult to contact hospital staff for any clarifications or to reconcile discrepancies. They don’t have contact information and don’t have the right contacts.
• Inadequate information, presented in challenging ways, creates care delays.
  At a patient’s arrival, SNF nurses often receive “reams” of paper, sometimes exceeding 80 pages, most of which isn’t relevant to the plan of care. They spend hours navigating records and often have to go through the entire printed electronic health record to figure out an accurate history. Discrepancies are often not reconciled for several days. Nurses often end up going in circles to try to get information, where no one provider actually has all of the information. SNF nurses said, “The primary states… ‘I didn’t know what happened at the hospital so I can’t give you any orders…You need to call the hospitalist or whoever worked with them.’”
• Getting information from families is usually not a good solution.
  Nurses sometimes try to get additional information by asking individuals and families but there are three problems with this approach:
• They often aren’t informed enough to offer quality information.
• Asking them creates a poor impression of the SNF.
• Medical orders are legally binding so they need to reconcile what they hear with the orders.

With all of these issues, nurses say they are mostly “working blindly" when they receive a patient. And that's not a matter of inconvenience, it can be a matter of life and death. The study reports, “Missing or incomplete information resulted in care delays, which threatened individual safety and produced individual and family dissatisfaction with the transition process... In one example, an individual who had bilateral lower extremity casts was left in bed for 1 week as the SNF nurses repeatedly requested and waited for clarification of physical activity orders and cast care.”

Also, these communication issues can be a major problem for the reputation and trust in SNFs. “Care delays and implementation of an inappropriate plan of care resulting from inaccurate information produced significant individual and family dissatisfaction and made the SNF facility appear unorganized and ill equipped to care for individuals. This experience produced substantial stress and frustration in SNF nurses.”

Our frustration in hearing about this kind of problem is huge. Not because it's a concerning public health problem, both in terms of medical provider burnout, and in terms of providing adequate care for our patients... but because we have the tools to fix this. 

Ultimately, this blog is not about advocating for iClickCare as a tool. And if you can find a better telemedicine tool for medical collaboration and communication around handoffs, you should use it. But we see several key reasons why iClickCare a crucial tool to support communication with SNFs, essentially fixing all of the above problems in a simple and cost-effective way: 

• Multiple voices, in one place. 
  One of the primary issues that SNFs face is that there is information coming from multiple providers and sources in multiple institutions and they can conflict with each other. iClickCare keeps all of these voices in one simple patient record, which means that when there are conflicts, they can be resolved quickly. Also, it allows communication across the continuum of care, so that whether it is a physician, generalist, hospitalist, aide, or nurse, all of their experiences about the patient's status can be integrated and incorporated. This also helps ensure that both the medical and social and personal context for care plans can be communicated -- rather than the picture being stripped down to just "orders", leaving nurses to guess about things like cognitive condition or personal context.
• Simple communication for busy people. 
  Nurses in SNFs identified contacting hospital staff -- and even knowing who to contact as a key barrier to effective discharge with adequate communication. With iClickCare, you don't need to play phone tag, hunting down the provider who last saw your patient. You request a consult and the other providers can answer your questions quickly, but on a schedule that works for them, and without needing to track down contact information. Further, words, pictures, video clips, and PDFs can be used to clarify issues and make sure that everyone is on the same page. 
• More efficient development of care plans. 
  It's downright dangerous to delay care for hours or even days because there is inadequate information at discharge and it takes days to resolve the issues. With iClickCare, the process is more efficient because you're using the power of telemedicine to navigate care, asking key questions of the right people.

If you're experiencing communication or discharge challenges in a Skilled Nursing Facility, we urge you to use a telemedicine tool to resolve them. You can try iClickCare for free, for 14 days. Download it 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: 

Anyone who has recently been sick knows that the cost of healthcare is high. In fact, healthcare spending in the United States is twice as much as it is in any other developed countries. And, as medical providers, we know that we're in no way benefitting from these high costs to consumers and the system. In fact, as overall costs rise, we as providers are simply increasingly squeezed to do more with less, faster.

So it is puzzling (and maybe hopeful) to read reports that health spending is actually slowing down significantly. The New York Times has been reporting that health spending in 2013 grew at the lowest rate since government officials started tracking it — back in 1960. The slowdown in health spending growth began over ten years ago, and has been especially pronounced in the last four years.

Some studies attribute this decrease in health spending to the overall recession, but many analysts say that it's not just about the economy. In fact, the New York Times, identifies several key components of this decrease, all of which are elements we see as strongly supported by medical collaboration and the use of telemedicine:

• Decrease in hospital spending. It seems that instead of going straight to the hospital, people may be getting care in their doctor's office or other lower-cost settings. We've seen telemedicine support this kind of patient behavior, as providers can get consults from specialists or other providers without the patient having to make additional appointments.
• Reduction in readmissions. Readmissions have long been singled out as a major opportunity for cost savings. And as we've looked at in other posts, medical collaboration (especially as supported by telemedicine) can be fundamental to managing readmissions.
• Drop in errors. The final potential cause for the decrease in medical spending is a decrease in errors. Over and over again, we've seen errors decrease when providers can support each other in making good decisions, doing follow up care, and getting the help they need.

Of course, none of these reasons are proven or conclusive. But we do breathe a small sigh of relief that the efforts of so many in changing medicine may be starting to show results.

See how telemedicine can affect your ROI by giving it a try today: 

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