ClickCare Café

The Best Way to Help Young Patients? Get Them Back to Playing Faster

Posted by Lawrence Kerr on Thu, Sep 20, 2018 @ 06:00 AM

jelleke-vanooteghem-578746-unsplashAs you probably know, our cofounder is a pediatrician.

As someone who has treated children across socioeconomic groups for decades, she found that having a playhouse in the waiting room created a sense of normalcy, fun, and respect for the children she saw. She found that patients looked forward to their visits, since they could play in the playhouse -- and parents had a few unexpected moments of respite.

Of course, that was just one detail out of thousands as to how she cares for children in ways that are deeply effective and respectful of who they are as children -- but it highlights the ways that play are important in medicine.

Perhaps it’s eye-rollingly obvious, then, that the American Academy of Pediatrics would release a statement affirming the role of play in children’s lives. Perhaps their suggestion that doctors need to write a “prescription for play” is a good one.

But I also wonder whether, as healthcare providers, we should think less about prescribing play to parents who are already likely doing the best they can. And we should think more about how we, and the medical system, can get out of the way so that our patients can get back to play and learning.

Children have important work to do — learning and playing being two big parts of it. And one part of the tragedy of sickness — and the hospital stays, doctors' visits and long car rides that accompany it — is that children are removed from that important work of play. If play is so important, it’s crucial for our pediatric patients that we limit time in the hospital so they can spend more time “doing the work of childhood”

Sometimes the simplest solution is the most effective. In fact, I was reminded of this story of a terminally ill 2-year-old who loves Christmas. Realizing that he wasn't going to live until December 25th, his parents decided to recreate Christmas early that year. His neighbors, hearing the idea, decided to join suit. So the little boy's neighborhood became filled with lights, decorations, good cheer, gifts, and even a Christmas parade, even though it's only September. 

To me, allowing children to get back to play means different things in different situations -- sometimes a playhouse; sometimes a neighborhood teaming up for Christmas. But most of the time, in a medical setting, it means that we are doing care coordination and healthcare collaboration effectively enough that our young patients are spending less time in the doctor's office, waiting room, car-ride, and hospital. That means coordinating care so they can be released from the hospital 6 hours sooner. It means a team approach to care so that they're not bouncing from doctor's visit to doctor's visit with no resolution. It means using telemedicine to get a consult so that the child doesn't need to leave school to see yet another specialist. It means school-based health centers (linked to specialists by telemedicine) so that kids can get healthcare during the school day. 

Our view as providers must be broad enough to include an understanding of care that isn't simply about curing disease -- but about cultivating health in our patients (young and old). And that starts with getting patients back to their lives as quickly as possible. 

For stories of how medical collaboration can work in the real world, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: good medicine, care coordination, healthcare collaboration

Surprising Study Shows Doctor’s Race Crucial in Health Outcomes

Posted by Lawrence Kerr on Wed, Sep 12, 2018 @ 07:00 AM


Black men have the lowest life expectancy of any ethnic group in the United States. Chronic disease — like diabetes and hypertension — play a big role. But the path to reducing rates of those maladies can seem unclear.

A new study by researchers in California showed a shocking finding in one parameter that could dramatically influence outcomes — the race of the doctor. 

The study itself was pretty simple and looked at the likelihood of patients to accept preventative measures, comparing the likelihood with a white doctor and with a black doctor. The study participants were 702 black men in Oakland, California, who came to a clinic for a free health screening. They were randomly assigned to a black male doctor or one who was white or Asian.

The results were pretty stark (as elucidated by The New York Times):

— 63 percent of the black men assigned to a black doctor agreed to a diabetes screening. Just 43 percent of those assigned to a doctor who was white or Asian consented to be screened.
— Some 62 percent of black men with a black doctor agreed to cholesterol tests, compared to 36 percent assigned to a doctor who was not black.

These rates might not sound world-changing, but the consequences of them are. If black patients were to agree to preventive care at these rates in the real world, researchers estimate that the gap in cardiovascular mortality between black men and the rest of the population could be reduced by 20 percent.

So was it the race of the provider itself that made the difference? Or was it something that black doctors were doing differently, or more effectively, than the white doctors?

There’s no hard evidence to answer that question, but one telling component of the findings are the comments written by both patients and doctors in the study. Black patients had equally positive comments of doctors, regardless of their race. But of black doctors, their comments skewed more emotional and effusive. Similarly, the notes on  the white doctors tended to be shorter and dryer. Black doctors’ notes were more detailed and more holistic, including comments on elements of the patient’s experience and overall life.

One of the black doctors in the study really affirmed that ultimately, it’s not about race — it’s about good care. “It’s something they don’t teach you in medical school — taking that extra step because you appreciate there have been barriers in the past,” Dr. ChaRandle Jordan said, saying that white doctors can reach out just as well and that a lot depends on how familiar a doctor is with black patients.

From our perspective, there are several key implications of this study for our work with medical collaboration and care coordination:

— A team approach is important. Sometimes the background of the provider can make a difference, and where that's true, having a diverse team working together closely, is a key asset. 

— Good care is about more than the facts. Simply offering the appropriate preventative screening isn't enough. In this study, it appears that the black doctors' efforts to build rapport and even to push back on patients' initial reticence were a big part of their good outcomes. Having the perspective and tools to work with a more holistic sense of the patient is key.

Obviously, we believe that great care can happen among providers and patients of any race. But looking at race and differences in engagement and interaction shouldn't be taboo. We often say that "no one of us is a smart as all of us."  And this is one more example of how our colleagues down the hall may have a lot to teach us — if we are open to learning. 

For stories of medical collaboration, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, care coordination

New Pay Structures May Make It Harder to Care for Poor Patients

Posted by Lawrence Kerr on Thu, Jul 19, 2018 @ 07:00 AM

matt-collamer-555626-unsplashCaring for everyone has always been a core part of our practice of medicine.

Whether or not you can pay, and the complexity of your condition (medical or social) has never been a factor in whether we are willing to treat you, or in the quality of care you receive. 

In both of our community medical practices — Cheryl as a pediatrician and Larry as a reconstructive surgeon — this is just how we’ve done medicine, and it’s been a core part of what we did from the beginning. It’s not that we make money during our regular practice and then volunteer for the “disadvantaged” a few weeks per year — rather, we know that no one gets truly great care if a doctor is picking and choosing who to care for. The slope of that line of thinking is simply too slippery.

The truth, though, is that caring for people in this way used to be easier.

It’s certainly not impossible now. But taking payment from a patient in the form of chicken eggs (if that’s what they had to pay with) is almost impossible given the insurance and regulatory context we’re currently in. And that used to be somewhat frequent in my practice. Furthermore, the tools and workflow structures that orchestrate our day generally work against thoughtful, deep, individualized work with patients — driving us towards testing and diffusion of responsibility and fast, solo decisions.

So I do think that an article that came out in the New York Times recently is an important one.

Overall, the author, Dr. Dhruv Khullar, makes the point that “Doctors who care for disadvantaged populations need more resources to produce comparable health outcomes, but they’re less likely to have them.”  Further, that the current drive toward a fee-for-performance system is going to deeply dis-incentivize care of patients who have especially complex social, emotional, or economic needs. In a fee-for-service system, there are many inappropriate incentives — but at least doctors are compensated fairly for patients who have external circumstances demanding more time.

I think this perspective, in which we consider how new structures will affect all of our patients, is important. It’s not discussed enough, though. That said, I also worry that the framework of the discussion has some flaws. First, the framing of some patients as "poor / disadvantaged / complex" and others as "wealthy / straight forward" neglects to acknowledge that on any given day, even the wealthiest among us may experience complex social or economic constraints that make them the complex patient. Further, the truth is that the richness of our healthcare practice comes from treating all patients to a single standard  not to dividing up and choosing our standard of care (or who we treat) in any way.

Second, I believe that medical providers should view the imperatives of good medicine as outside of  and above  any fluctuations in payment or even workflow tools. We are each responsible for the hippocratic oath we took; we are each responsible to the human being sitting in front of us. It is up to us to find or create the tools and structures we need to do medicine in the ways that our conscience demands. 

That's why we believe so strongly in our work with iClickCare. The healthcare providers who use iClickCare to do healthcare collaboration, to improve medicine, to make their workday more satisfying do so because it's important to them  and they need wait for no one to start using it. It's affordable enough, and the ROI is so extreme, that it is a choice we can each make, on behalf of our patients  without anything else structural changing at all. 

You can try iClickCare today, for free, here: 

Try the iClickCare 14-day evaluation

Tags: good medicine, healthcare collaboration

Is Medical Training About Rigor… or Bullying?

Posted by Lawrence Kerr on Wed, Jun 20, 2018 @ 06:00 AM

matteo-vistocco-424475-unsplashI played college football at a Division III school. That means there were no scholarships or cheerleaders, and high levels of academic work were requisite to playing on the team.

But the rigors of the team — sprints and pulling heavy objects up a dusty hill and doing two practices a day in the heat of late summer — were intense and real. Our coach was certainly not always polite, and part of the reason he was able to extract such hard work from us was that we were scared of him. There was a lot of shouting, quite a bit of belittlement, and frequent exertion past the point of exhaustion.

But I, like most of my fellow players, look back on that time with the fondest of feelings. It was a time when I knew I was getting the most out of myself, getting out of my own way, and contributing to something bigger than myself.

In a similar way, I look back on my medical training — as taxing and exhausting as it was — with fondness and respect. So I was interested to read an article in the New York Times characterizing much of medical training as bullying and harassing.

A recent New York Times article, by Dr. Mikkael A. Sekeres, M.D., looked at whether the US medical training system, especially for doctors, is marked by bullying, belittlement, and harassment. He cites a study that surveyed 1,387 American medical students in their final year of school finding that 42 percent reported having experienced harassment and 84 percent experienced belittlement during medical school. And he shares his experiences in medical school and residency, with doctors pulling rank, obsessing about his perceived faults, expecting inhuman work hours, and unattainable ideals of precision. In other words: he had normal training for a doctor.

Dr. Sekeres’s experience didn’t surprise me, of course, and indeed makes me remember many of my own teachers and experiences — things that these days might be called bullying or even harassment.

The recent tendency in medicine has been to soften the system a bit. The hours' cap has dramatically changed the face of residency and not always for the better. Along with more reasonable work hours, I’ve observed a lower level of felt personal responsibility — the resident's hours are up for the week, so he is signing out, whether or not that’s what’s best for the patient.

For that reason and others, I have to admit that when I read Dr. Sekeres’s article, my response wasn’t primarily agreement — it was concern. My concern is that as doctors, we have a duty to care for our patients at the highest levels of rigor. And the medical training — the long hours, the unreasonable standards, and the exacting mentors — supports that in many ways.

But the more I thought about it, there more I realized that while rigor is crucial, there is a difference between rigor and bullying. I even see it in my own medical teaching. While other surgeons were known for loud operating rooms — music and shouting and even throwing things — my OR was always quiet and calm. Similarly, my relationship with the medical students was always calm, precise, friendly, and even relaxed — we collaborated from a love of learning and a love of work done well. And they worked very hard. So even my own experience contradicts this idea that rigor goes hand-in-hand with bullying.

Especially in the medical landscape in which we find ourselves today, healthcare collaboration is deeply important, possibly the most important thing that can happen on any given case. The truth is that the time of the Lone Wolf Doctor is over, and so if the bully-them-until-they-shine approach was ever effective, it’s certainly not effective in an age when collaboration and coordination calls for teamwork, respect, and collegiality, all of which can be taught and modeled just like surgical techniques.

My takeaway? We benefit from rigor but we don’t benefit from our teachers pulling rank, creating an un-collaborative environment, or not valuing every member of the medical team. We don’t benefit from teaching new doctors that they are alone in their work, must solve every problem on their own, and can disrespect their colleagues when it suits them.

Yes, demanding high standards of care and work ethic alongside high standards of professionalism and collegiality is a very high bar. But our patients' lives require it, and I believe that each of us is up to the task.


For more stories of how doctors are doing healthcare collaboration, download our Quick Guide: 


ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, healthcare collaboration

The Royal Wedding and Healthcare Collaboration

Posted by Lawrence Kerr on Tue, May 22, 2018 @ 06:00 AM

marko-pekic-145777-unsplashOne of challenges, and frankly, frustrations, of what we do at ClickCare is communicating the value of collaboration. The rewards (both emotional and tangible) to providers, patients, and institutions, are profound and meaningful. But to the uninitiated, healthcare collaboration can seem idealistic and impractical.

Collaboration is given lip service (Chronic Care Management CPT code XXXXX) but not truly cultivated or supported. It is not taught in medical schools, as there is such a competition for time in a curriculum. It seems to be taught better in nursing schools, but the experienced nurses are known for “eating their own”.  Pharmacy schools rarely produce graduates with a true intent on fitting into a team, and when they do, it's despite their training, not because of it.

Because of this conventional bias against healthcare collaboration, it takes true leaders (whether those leaders are aides or specialists or nurses or patients) to foment it. True leadership doesn't have to be sanctioned by an institution or lauded in a newspaper -- sometimes it's just simple acts of asking a question of a colleague or taking a moment to try something new. But true leadership does tend to take courage -- and it can give us courage to see other leaders, acting bravely.

So, when I find an example of leadership, I feel it should be acknowledged, celebrated, and learned from -- even if from an unlikely source.

I'll be honest -- I wasn't planning to wake up early to watch the royal wedding. Like many Americans, I often feel conflicted about the Royals -- and (not being very interested in fashion) wouldn't expect to find much of significance in such a seemingly frivolous event. 

But I ended up watching it from start to finish, finding myself drawn into the tradition, the ceremony, and the powerful lessons of both collaboration and leadership that made themselves known in subtle, but deeply significant, ways. 

A few leadership and healthcare collaboration lessons I learned from watching the royal wedding:

  1. Lead by inclusion and by example. 
    The bride and groom chose to include an American Episcopalian pastor in the African American tradition to give a sermon, something that had never been done before. They included an African American choir singing Stand By Me and Amen, Amen alongside the traditional songs. Instead of demurely hiding Meghan's African American heritage, they wove it artfully into the ceremony. And although surely not all of the tradition-bound attendees were fully supportive, the bride and groom were grounded and joyful throughout the event, not scurrying around for approval, but standing firm in the choices they made to honor tradition, honor both of their heritages, and perhaps bring the monarchy into a new age. This seemed to me an example of the best kind of leadership by example, not by rhetoric or coercion.

  2. Don't be afraid of the big issues.
    By acknowledging Meghan's heritage and country of origin throughout the event, the royal couple certainly took on the "elephant in the room," which could be an element of contention for such a tradition-bound event and context. Similarly, the beautiful sermon by Bishop Michael Curry made unflinching reference to the history of race relations in the US, including the Civil Rights Movement and slavery. Throughout, there was a willingness to take on what might be considered "difficult" or fraught topics, but to do so in elevated, inclusive ways.

  3. Remember that nothing big happens without collaboration.
    Yes, Saturday's event was a wedding. But it was also a massive event involving thousands of people, viewed by millions, and costing close to $50 million. It's staggering to imagine the massive collaboration that must have been needed -- to have each person contribute and be truly honored as important, but also have their contribution blended to become the whole. From the Kensington gardener who nurtured the flowers that Harry chose for Meghan's bouquet, to each musician that shared their song, to the members of their families, to the bride and groom themselves. Just the existence of such a scale of event is testament to the power of collaboration.

  4. Love is all you need.
    It seems sentimental and perhaps even unprofessional to speak of love in a blog post for a telemedicine company. But Bishop Curry's sermon reminded us of the transformative power of love in the creation or recreation of a culture, society, and world. He reminded us, as the royal wedding did, that love can be a catalyst for profound change and the driver of things that would be unimaginable without love's transformative power. Maybe in medicine we should talk more about love. And leave the medical jargon behind.


Will this event actually be remembered and change something, as the new couple wishes? Maybe or maybe not. But I do believe that in its example, this event gave us a shining example of a way forward. We need to respect each other; we need to find a greater cause in our duty; we need to compromise; and we need to be steadfast in our choices.

Many felt joy in watching the royal wedding on Saturday. And I believe that joy is something each of us can access daily (even hourly) in our everyday choices about leadership and about collaboration.



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Tags: good medicine, healthcare collaboration

Healthcare Collaboration Is No Replacement for Everyday Heroism

Posted by Lawrence Kerr on Thu, Apr 26, 2018 @ 06:00 AM

jessica-podraza-524601-unsplashAs healthcare providers, we have an almost unimaginable level of responsibility. Every day, we use our depth of knowledge, caring, compassion, and skill to cut people open, make life-or-death decisions, and execute sophisticated care plans in endlessly complex contexts. 

For that reason, I think that many healthcare providers start their career with a healthy level of pride about their personal skill and end up having a fair amount of confidence in their own abilities. 

That can mean that when the topic of healthcare collaboration comes up, there is a sense of skepticism. There's a subtle feeling of resistance, coming from the idea that, "If I have to ask for collaboration, it's because I wasn't able to do it on my own." Being passionate about collaboration, at ClickCare, we talk about working together as a team a lot. But does that mean that there isn't any place for individual achievement or even heroism in the work?

Recently, I was reminded that in addition to the deep rewards for teamwork, sometimes the skill and courage of a single individual really does "save the day."

On April 21st, James Shaw, a 29-year-old electrician, and his best friend Brennan McMurry went to a Nashville Waffle House for early-morning waffles. Minutes into their visit, a gunman opened fire. People were running and glass was shattering. But suddenly there was a pause in the shooting and Shaw realized that the shooter was reloading. That's when he leaped on the shooter, grabbed the rifle, and threw it over the counter. Although 4 people died in the attack, we know that the shooter had pockets bulging with ammunition and that Shaw likely saved dozens of lives in that courageous moment.

The week before, on April 17th, Southwest Airlines Flight 1380 was en route to Dallas when an engine exploded and shrapnel hit the fuselage, blowing a hole in one of the windows and partly sucking out one of the passengers (who eventually died.) Captain Tammie Jo Shults was calm and decisive in the cockpit, however. She radioed control without a hint of alarm in her voice. “Southwest 1380 has an engine fire. Descending.”

Guiding the plane towards Philadelphia with one engine out, she arranged for medics to meet the plane on the runway and then guided it to a smooth landing. There were 149 people on board and most thought the plane was not going to make it. But Shults was unfailingly collected and clear and skilled. As the New York Times reports, Captain Shults's reflexes and professionalism were hard-earned. "Captain Shults was well trained to handle stress in the cockpit. She had flown supersonic F/A-18 Hornets as one of the Navy’s first female pilots at a time when women were still barred from combat duty, before leaving active service in 1993." The story of the obstacles she had to overcome to pursue her passion and career are astounding and showed courage, grit, and heroism throughout. As a woman, she wasn't allowed to fly in the Air Force, and was denied combat positions as a pilot in the Navy -- but she flew in increasingly rarified and groundbreaking roles, including Operation Desert Storm.

Of course, in both of these cases, there was actually powerful teamwork behind the scenes as well. In the case of the Nashville Waffle House, Shaw's friend McMurry ushered people to safety and law enforcement hunted down the shooter in just 24 hours. Not to mention the doctors who treated the patients and other first responders. And on Flight 1380, flight attendants, the first officer, passengers, medics, and air traffic control all played a role in the successful outcome. 

And, in neither case was there an unmitigated success. Four people died at the Waffle House and one person died on Captain Shults's flight. Heroes don't always have perfect outcomes.

All of that said, both Shaw and Shults saved lives, showed exemplary action and courage, and gave us examples of what a hero can be, and do -- and what a difference one person can make.

As you find opportunities for healthcare collaboration, don't forget that you're also, so often, a lone hero. Both ways of working are necessary. And you owe it to yourself and your patients to do the right one at the right time. 


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Tags: good medicine, healthcare collaboration software

3 Must-Dos From Nurses Creating Healthcare Innovations. Why We Like Healthcare Collaboration.

Posted by Lawrence Kerr on Wed, Dec 20, 2017 @ 10:03 AM

aditya-romansa-117344.jpgAbout a year ago, Maggie McLaughlin, a Registered Nurse, was caring for a baby in the NICU and his IV tube came unhooked. The baby started bleeding unexpectedly and, while he was alright in the end, Maggie was frustrated.

Doing some research, McLaughlin found that there is no accepted, effective way to keep IVs hooked to an infant's body. And that's when she started prototyping her own.

McLaughlin ended up developing an IV connection that lies flatter on a baby's skin and so holds more effectively than alternatives. She has partnered with a former nurse to create and market the device under the name IV Safe T. 

That a nurse may become an entrepreneur may sound unusual to some, but as the Boston Globe reports, "research has shown that nurses spend a significant portion of each shift using workarounds and making impromptu fixes to ineffective processes or equipment... Such adaptations take up time that could otherwise be devoted to patient care, but they also demonstrate creativity that can be channeled into developing new tools and procedures to improve the delivery of medicine."

This finding certainly resonates with our experience with ClickCare. From the very beginnings of the company, we've found that nurses have been the most courageous, principled, spirited, persistent collaborators of them all. From our beginnings in school-based healthcare programs, to today, nurses are a core part of what we do at ClickCare.

In fact, these nurses' entrepreneurship puts a spotlight on three things we think are crucial in healthcare:

  • Take matters into your own hands. These nurses found a problem... and instead of waiting for "someone else" to create a solution, they created their own solution. Whether it's pioneering a telemedicine program at your hospital or doing medical collaboration with colleagues, this is key.
  • Use your own experience as a guide. McLaughlin used her own experience with infants to identify the problem that she would solve with her product. We believe that whether it's with patient care or with entrepreneurship, your experience is your best guide.
  • Don't be constrained by hierarchy. Many people think doctors would be more likely to create healthcare innovations than nurses, because of their place in the medical hierarchy. In fact, we've found that providers across the continuum of care are indispensable for both innovation and healthcare collaboration. 

We hope you find these nurses' stories as inspiring as we do -- and that you find ways to take their approach into your own day. 


For more stories of innovation and collaboration, download our free medical collaboration quick guide:

ClickCare Quick Guide to Medical Collaboration


Tags: good medicine, healthcare collaboration, nurse collaboration

3 Things We Learned About Telemedicine from the Hippocratic Oath

Posted by Lawrence Kerr on Tue, Nov 07, 2017 @ 06:00 AM

helloquence-51716-1.jpgThe pace at which medicine is changing makes your head spin.

When you consider that the first surgery under anesthesia was performed only 150 years ago, it’s shocking what competencies we have developed as a profession over that time.

But the truth is that the core nature of what we do has remained the same for thousands of years. The specifics, and technology, and lived reality has evolved dramatically, but the ethos, heart, soul, and discipline of the work is continuing.

I was especially struck by the reality of this “through line” of the continuity of medicine as I began to dig into the history of the Hippocratic Oath.

As you undoubtedly know, The Hippocratic Oath was written in the fourth or fifth century BC.  As Wikipedia says, “The Oath is the earliest expression of medical ethics in the Western world, establishing several principles of medical ethics which remain of paramount significance today. These include the principles of medical confidentiality and non-maleficence. Although the ancient text is only of historic and symbolic value, swearing a modified form of the Oath remains a rite of passage for medical graduates in many countries.”

I’m fascinated both by the lasting nature of the Oath as well as by how it has evolved. It’s amazing that such an old document and set of concepts has stood the test of time for so long. (Although perhaps it could be said that many of our most foundational principles and books have lasted as long or longer.) 

The oath has evolved, as well. The version that is in use at many medical schools today was a version rewritten by Dr. Louis Lasagna, Academic Dean of the School of Medicine at Tufts University. The wording is different, but the spirit and even the content is ultimately almost identical.

Dr. Lasagna’s oath highlighted for us three aspects of the vow that really underlie what we do at ClickCare, and, interestingly, are the core of what telemedicine and healthcare collaboration are all about:

  • Collaborating with our colleagues and admitting when there are limits to our knowledge.
    “I will not be ashamed to say 'I know not,' nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.” The foundation of everything we do at ClickCare comes from the understanding that none of us is as smart as all of us. 
  • Respecting privacy.
    “I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know." This value is why iClickCare far exceeds the demands and standards of HIPAA compliance, though they are onerous. And it's why we've created a HIPAA-safe way for medical providers to collaborate with each other, that's as easy as a text message, but safe for our patients.
  • Learn and teach.
    “I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.” All cases in iClickCare are archived for future teaching cases. In a way never supported by video teleconferencing, Hybrid Store-and-Forward® telemedicine lets you nurture the next generation.

We're proud to be part of the lineage of doctors from Hippocrates to today. And we honor the continuation of that legacy, with the insights and tools that our contemporaries, like Dr. Lasagna, are contributing. 


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: good medicine, healthcare collaboration

Why Healthcare May Be Due for an Arts and Crafts Revolution

Posted by Lawrence Kerr on Thu, Sep 14, 2017 @ 06:01 AM

farrel-nobel-108567.jpgMany people have noticed that healthcare has become more "industrialized." As healthcare has changed, with productivity and output being primary, the provider becomes a "factory worker" and the patient becomes a "product." As such, the provider and the patient become increasingly distanced from each other. 

Not enough doctors? Then make the doctor the foreman. Make the other providers, such as nurse practitioners and physician's assistants, part of their "line", under supervision. Of course, a manager and a coordinator are needed on top of that. And finally, don’t forget the chief financial officer (CFO) and the Utility Commission.

We doubt this will change, but just like in other industries (it hurts to describe a giving, healing profession as an "industry"), there are constant new movements and experiments. Many of these fail; some work. An analog would be during the late Victorian period when the Arts and Crafts movement developed. To quote Monica Obiniski:

"The Arts and Crafts movement did not promote a particular style, but it did advocate reform as part of its philosophy and instigated a critique of industrial labor; as modern machines replaced workers, Arts and Crafts proponents called for an end to the division of labor and advanced the designer as craftsman."

I liken this Arts and Crafts period to the period in medicine of my father's generation, when doctors might be paid with eggs from his chicken, the pace of medicine was slow, and patients and doctors had a lifelong relationship. There was a prioritization of human values over sheer productivity. And there was a respect for craft and quality rather than simply what cost the least to make.

The movement ultimately receded; it was largely gone by the 1920s and the acceptance of modernity in the machine age. In a parallel evolution, this "arts and crafts" period of medicine was largely gone by the middle of my career. 

Interestingly, the Arts and Crafts movement in American is experiencing a rebirth -- in large part, thanks to technology supporting it. For instance, Etsy, the worldwide online craft marketplace with millions of vendors making handmade goods and selling them online, started in 2008. Since then, I believe that we've seen a re-valuing of craftspeople -- whether makers of chocolate or furniture or leather goods -- and the valuing of thoughtful "industry," using new solutions, often supported by technology. 

So what does this have to do with healthcare collaboration and care coordination and the use of technology such as iClickCare in the current context of healthcare? I believe that healthcare is at the very beginning of a similar "craft"rebirth. For instance, direct care and concierge medicine are gaining in popularity. Neither are new; both harken back to the medical context of my father's generation and the early decades of my practice -- that slow, thoughtful, craft-focused practice of medicine. 

And I see healthcare providers around the country claiming and demonstrating that the principles of excellent, compassionate, and comforting care can be empowered by working together using technology to break down silos.

Of course, even if we say that the "healthcare factory" is inevitable, if it uses a collaboration based workflow, it can produce a better product (a healthy and peaceful patient) by using telehealth. (Needless to say, reduce burnout in the providers!) Medical collaboration and care coordination supported by technology can decrease waste and reduce "manufacturing errors."

It is our responsibility to remember the good of the past while embracing the promise of the present and future. It is our responsibility to design and craft our prescriptions and plans for our patients and advocate and promote the value of the individual, no matter if the individual is your patient or yourself. Technology in medicine is part of out future. But it's up to us as to whether that future also includes a return to our values.

We put together stories of medical collaboration from around the world. Download it for free:

ClickCare Quick Guide to Medical Collaboration


Tags: good medicine, care coordination, healthcare collaboration

Sweet Potatoes Help with Care Coordination

Posted by Lawrence Kerr on Wed, Jul 05, 2017 @ 06:01 AM

Medical Collaboration depends on different communication.jpgSometimes medical providers have a tendency to focus on the seriousness and sophistication of care. 

When we're about to give a shot, we emphasize that it might hurt. When we prescribe a medicine, we don't always explain the pathway simply -- sometimes we use jargon that makes sense to only the other providers in the room. 

We get most excited about care plans that are cutting edge. 

But a recent study caught my eye as evidence that we might be better off focusing on the simplicity, ease, and fun of a care plan, rather than the more rigorous or medically important aspects.

A recent article in JAMA Internal Medicine looked at the trend of emphasizing the health merits of foods. We see things advertised as high protein, high fiber, or farm-fresh -- and we assume that these descriptors are attractive to people.

As the study reports, "Ironically however, health-focused labeling of food may be counter-effective, as people rate foods that they perceive to be healthier as less tasty."

So the researchers created a study to see whether health-focused labeling is better or worse than just a neutral label -- and better or worse than how junk food is described.

Researchers watched 27,933 students (with some staff) in a dining hall over 46 days. Each day, the researchers offered the same vegetables, but named them differently. For instance, the sweet potatoes might be described as "zesty ginger-turmeric sweet potatoes” instead of just “sweet potatoes." That change, in fact, resulted in 25 percent more people choosing the vegetable. And, as the New York Times summarizes, "35 percent more customers chose the zesty label than the health-positive 'wholesome sweet potato superfood,' and 41 percent more chose it than the scolding 'cholesterol-free sweet potatoes.'"

Across all of the vegetables, the study concludes that vegetables were most likely to be chosen when they had "flavorful, exciting, and indulgent descriptors" rather than neutral ones, or (even worse), descriptors touting their health benefits.

It's a simple study, with results that may seem obvious. But the implications for how you talk about care plans could be significant. It's human nature to want to choose fun things over healthy things -- and there's no reason we can't frame care the same way we frame sweet potatoes. Care coordination is more than assuring appointments are kept; it is about ensuring a good attitude and thus good compliance for improving health. If the patient buys into your recommendations, you are making value, and you will get paid (telehealth with value based care and MACRA).

For instance, your heart patient might need to lose weight so he'll add years to his life. But is it possible that losing weight could also make his August vacation more fun and active? That might be the component to focus on. The shift also makes us reflect on the continuum of care, as different people on the team should be collaborating on things as seemingly mundane as the verbal phrasing of a care plan -- and that requires strong medical collaboration and care coordination -- and a medical collaboration tool. 

Care is far more than how we describe it, of course -- but if subtle changes in verbiage can benefit your patient's outcomes, it could be worth experimenting with.

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Image: Carol Mitchell

Tags: good medicine, care coordination, value based care, medical collaboration tool

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