ClickCare Café

The Outcomes of Older Doctors and Female Doctors May Differ -- But Does It Matter?

Posted by Lawrence Kerr on Wed, Jun 07, 2017 @ 06:01 AM

olderphysicians.jpgOur least favorite type of research is the observational study. Think: eggs are good for you, eggs are bad for you; eat meat, don’t eat meat; statins cure everything, statins cause everything; and on and on.

However, observational studies can be a first step into deeper understanding. An example is Jenner’s observation that milkmaids who contracted cowpox did not get smallpox. In the current "publish or perish" environment, the necessary deeper inquiry (Jenner tested vaccination, albeit in a crude way as we look back) often does not happen. Public media grabs and grasps the story, disseminates the story, and the story disappears and is gone within less than 24 hours. Another publication is notched for institution and researcher. Big data is thanked. Rarely do we find someone who goes on to ask why.

Certainly, inquiry into what works and what doesn't is extremely valuable. That said, two recent studies also beg for a deeper answer. Both are by the same author. The first study by lead author Yusuke Tsugawa observes the female physicians have fewer patients die or be readmitted. They speak of adherence to clinical guidelines  and “patient centered communication." 

The second study concludes that younger physicians have fewer patients die while the readmission rate is the same. It pits older physicians against younger physicians. Medicare patients formed the sample. Policy implications concluded that medical education and its maintenance of certification is important.

There is no doubt that the younger physician is a better coder and understands the value of coding maybe even over outcome. Could this be the education that is required? 

But, let’s not quibble over reasons and explanations. Above all, what matters most is how we can improve medicine. 

Assume the conclusions are correct, and that there are indeed differences born of gender and age. Why not encourage, support, and demand collaboration and communication? Bring the old to share with the young, the young to teach the old. The style of the female to mesh with the style of the male.

Regardless of whether these studies are strong and solid and show true causality between these physician demographics and their outcomes... Why not work together, rather than focus on controlling the parts?

 

These stories of medical collaboration show that you can take outcomes into your own hands:

ClickCare Quick Guide to Medical Collaboration

Tags: collaboration, good medicine, collaboration leadership

4 Key Takeaways From Leaders on Medical Collaboration & Engagement

Posted by Lawrence Kerr on Wed, Apr 26, 2017 @ 06:01 AM

rope.jpgAs medical providers, we almost universally want to improve healthcare, increase our own sense of satisfaction, decrease burnout for ourselves and our colleagues, and improve the care we give our patients.

That's all good, but on a busy Thursday, these important goals have a way of taking a back seat to what feels most urgent in our practice.

So a recent web conference advancing these goals piqued our interest as being a great example of healthcare providers taking action.
You may not have had the time to attend the conference, so we put together the the most powerful takeaways, from insights via our friends at Fierce Healthcare as well as the conference content.

4 Takeaways from Thought Leaders on Medical Collaboration and Patient Engagement:

  • Medical collaboration isn't a "bleeding heart" idea -- it's key to our core goals as medical providers.
    The goal of the topics covered in the conference were to "improve patient outcomes and experiences, create stronger feedback loops, and inspire clinician performance." These are quite possibly the most important goals facing medicine today, so we see this work as fundamental. 

  • There are a lot of people crucial to care that aren't traditional medical providers. 
    We talk a lot about the importance of providers across the continuum of care, when it comes to medical teams. None of us is as smart as all of us; and every provider -- nurse, aide, specialist -- plays a key role with different perspectives. David A. Asch, M.D., executive director of the Penn Medicine Center for Health Care Innovation, and Michele E. Heisler, M.D., professor of internal medicine and health behavior at the University of Michigan, both emphasized an additional layer. Peer support and coaching programs can support better care management, since we tend to make better choices when our choices are visible.

  • Medical collaboration teams can change medicine -- but demand changes to how we work.
    Nirav Shah, M.D., senior vice president and chief operating officer for clinical operations at Kaiser Permanente Southern California, outlined something that can seem impossible: the "zero-day stay", in which the patient experience is integrated end-to-end, care is coordinated across the continuum of care, and every aspect is team-based. It paints a picture of cost savings, huge provider satisfaction, better regulatory compliance, and better outcomes. This is achievable. But it demands that we learn to work differently. It means that we need a medical collaboration tool that allows us to work asynchronously, since collaboration can't depend on coordinating schedules or it simply won't work. It demands "care teams that work together effectively and where all members are engaged in the process with patients, said Toyin Ayaji, M.D., chief medical officer of Commonwealth Care Alliance, an integrated delivery network. And, Dr. Ayaji clarified, "A program like this requires trust and confidence between each member of the care team to succeed."

  • Patients must be part of the team.
    Patients need to be a part of the team literally (patients need a way to collaborate with providers on their own care). And they need to be a part of the team in the sense that their full experience and context and "real life" have to be a part of the care plan. With value-based systems in full swing, this inclusion is no longer a "nice to have" -- it's core to what creates good outcomes. 

We applaud the team that put on the "Hardwiring Patient Engagement to Deliver Better Health" conference. We believe they're asking the right questions, and starting to make the path towards solutions. 

We're glad to be on that journey with them. 

 

Is iClickCare something you'd like to try, for medical collaboration? You can get it free here: 

Signup for an iClickCare Account

Tags: medical collaboration, good medicine, care coordination, healthcare collaboration

A Doctor Removed His Own Appendix and Here's What Happened.

Posted by Lawrence Kerr on Thu, Apr 20, 2017 @ 06:01 AM

Frozen-Snow.jpgThis American Life reports, "In 1961, a Russian doctor got appendicitis at a Soviet Antarctic station, and so he needed emergency surgery to remove his appendix or he would probably die. And he was the one doctor there, snowed in during a blizzard. And so he had to figure out what to do.

And so this Russian, a 27-year-old surgeon named Leonid Rogozov removed his own appendix and lived." In the end, he recovered fully and two weeks later, he was back on the job as a surgeon."

Ira Glass, from This American Life, interviewed Dr. Doug Smink, a surgeon and associate professor at Harvard Medical school, about the story.

Dr. Smink says, "Probably most impressive to me, though, is what is the mental aspect of this. And he obviously had the perfect personality to pull this off. And then to have the courage, but also the wherewithal to assemble a team and explain to them what they were going to do while he had appendicitis."

At one point, Glass asks Dr. Smink whether he could have done the surgery on himself.

He paused. It was clear that the interviewer was expecting an answer of "Likely not." But the surgeon ended up saying, "I'd like to think I could, if given no other option."

Like many healthcare providers, I have performed minor surgery in a cave and in a restaurant. I've given people turning purple the Heimlich maneuver on the airport tarmac.

So many of us work in adverse conditions every day. And because we take our oath so seriously, in some ways it's not anything special -- it's just what we do.

This really is an amazing story of discipline, courage and ingenuity. But to me, it is a story that highlights the everyday discipline, courage, and ingenuity of all medical providers -- demonstrated so strikingly by the doctor in Antarctica. As Doctor's Day passes, I'm taking a moment to applaud what healthcare providers do everyday. They're not lauded as heroes for it; but they are heroes, nonetheless.

 

For more stories of heroism and medical collaboration, get our Quick Guide:

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: good medicine, emergency medicine

Medicine: Part Art, Part Science, Part Rebellion and Now Healthcare Collaboration.

Posted by Lawrence Kerr on Tue, Feb 28, 2017 @ 06:20 AM

neurons.jpgSantiago worked as a kid. First, he apprenticed with a barber, then a cobbler.

But what he always wanted to be was an artist. He had a gift for drawing, and a love for art -- despite neither thing being much supported by his school or community. He was also rebellious and anti-authoritarian when it came to school. He even went to jail when he was 11, for something between a prank and a crime (he destroyed his neighbor's gate with a homemade cannon.) His father wanted him to be a doctor, though. And one day, trying to find a link between medicine and the arts for him, Santiago Ramón y Cajal's father took him to a cemetery, carrying home bones for him to sketch. (This might seem macabre now, but can be understood in the context of early anatomical studies, Ramón y Cajal's father being an anatomy professor.)

That day must have forged just enough of a connection between medicine and art, because Ramón y Cajal ended up going to medical school and, indeed, becoming a doctor. He became fascinated with understanding how neural impulses travel through the brain. He spent his days "hunched over a microscope" in his lab, making hyper-detailed, conceptually original drawings of neurons -- all of which added up to a transformation of how we understand the brain.  

Close to 100 years later, Ramón y Cajal is now known as the father of modern neuroscience and is a winner of the Nobel Prize. He used a combination of close observation, his own drawings, and deep insight to advocate for a theory of how the brain works that is precisely how we understand the fundamentals today.

We find Santiago Ramón y Cajal's story inspiring when it comes to our pursuit of telemedicine for a few reasons:

A picture really is worth a thousand words.
He demonstrates how our understanding often starts with the visual, especially of complex systems. He didn't start with theories or concepts. He started with drawings -- both to understand what was happening in the brain, as well as to communciate it. We see exactly the same dynamic with iClickCare. In Hybrid Store-and-Forward telemedicine you can use pictures and videos (not just words) -- these images enable understanding, as well as communication and then collaboration.

Working together is the only way to true significance.
As the New York Times said, Ramón y Cajal's theory for how neurons speak to each other "was made possible by Ramón y Cajal’s refinement of the Golgi stain and his persistence in sharing his ideas with others." The Golgi stain was a project that he didn't even start; he borrowed the stain technology, and then improved it in collaboration with Golgi. His sharing of these theories and drawings were what changed how we see the brain. This is a deeply held principle and why we are so passionate about telemedicine: even geniuses don't work in isolation. It's only by sharing our work that it gains significance.  Further, the mystery of connections elucidated by Cajal certainly feels the same now for healthcare collaboration 2017 as the neurons did at the turn of the last century.

Medicine is part art and part science.
Every moment with a patient is part art and part science. Every conversation with a colleague is part art and part science. And the same goes for telemedicine. For an iClickCare consultation to be effective, there is always a great photo and a thoughtful question. You don't have to be a great photographer, but there is a creative side to communicating well, especially through photos. 

 

We hope that this story inspires all of you to work at the intersection of art and science (with maybe just a little rebellion thrown in as well.) 

 

For a free guide to the basics of using your iPhone for medical photography and telemedicine, click here: 

 

Medical iPhone Photography

Resources: 

http://www.nobelprize.org/nobel_prizes/medicine/laureates/1906/cajal-bio.html

https://www.nytimes.com/2017/02/17/science/santiago-ramon-y-cajal-beautiful-brain.html

https://en.wikipedia.org/wiki/Santiago_Ram%C3%B3n_y_Cajal

Photo from 42600332@N08 on Flickr, used under Creative Commons rights.

Tags: telemedicine, good medicine

Money Can’t Stand in The Way of Better Healthcare

Posted by Lawrence Kerr on Wed, Aug 03, 2016 @ 07:30 AM

money.jpegAn interesting twist in what goes around, comes around.

Jason Helgerson, the Director of New York State Medicaid, wrote recently to offer encouragement and advice to Great Britain’s National Health System. Despite many of its laudable accomplishments, it turns out that the NHS is strapped for funds. We applaud Helgerson's attitude around creativity, innovation, and the merits of a positive attitude. We also hope to assist his New York State efforts by providing our iClickCare care coordination and telehealth system.

We have often argued for change over control. Contrast change which Helgerson suggests with that of the subtle rationing approach, which of course prioritizes control.

On the other hand, too much creativity can be problematic. When should profit be prioritized for good?

ClickCare is not a pharmaceutical company and respects that big pharma is providing value. The product iClickCare is a new technology with plenty of development and testing. Now all we have to do is to have innovative people step forward and do something different -- collaborate.

 

To learn more about how telemedicine can play a role in your organization, download our quick guide:

ClickCare Quick Guide to Telemedicine

Tags: telemedicine, good medicine, care coordination, regulatory issues

Our Jobs in Medicine Are Shifting -- Can Telemedicine Shift With Them?

Posted by Lawrence Kerr on Mon, May 02, 2016 @ 07:30 AM

jobdescription.jpg

 

Karen's job title is Registered Nurse.

Her job description includes (among many other things): 

  • Perform physical exams and health histories.
  • Provide health promotion, counseling and education.
  • Administer medications, wound care, and numerous other personalized interventions.

So when she comes in at 10pm on a Saturday night and she notices something -- a medication gap or a sobbing littler sister or a new way of wrapping a woung that promotes healing -- she could shrug and say, "That's not my job."

But for Karen to be truly satisfied, for medicine to change, and for her patients to receive the best care they can, she will look at her job differently. And she will choose a more holistic definition of what her job is all about.  

As the world gets more interconnected, and demands on performance increase, our job descriptions and titles are not our jobs. This isn't necessarily about doing more. We've all been doing more over the past years, and it doesn't really change anything -- it just burns us out. In fact, it's precisely this kind of burnout that leads us to get overwhelmed and push back the only way we know how, with "That's not my job." 

The alternative is to look at the purpose and intention behind our work and doing what it takes to accomplish that, even if the techniques and tactics are unfamiliar or unorthodox.

For instance, new programs are being spearheaded that teach police officers ways to deal with the mentally ill and "defuse potentially violent encounters before force becomes necessary." These programs have been successful. But one barrier has certainly been the minority of officers who take one look at this more holistic stance on policing, and say, "That's not my job." They see their job in a narrower way -- one that involves encountering a situation and using force if necessary. 

That's why Karen, the Registered Nurse, is certainly attentive to taking care of herself and not grinding herself into the ground. But she sees her job as caring for patients. And so she learns new technologies, is part of a pilot program that does home visits, she's constantly collaborating with providers across the continuum of care, and yes, she's there with a hug for the sobbing little sister. 

Our jobs are constatly shifting -- both what is in the job description, and what it really means to do our jobs well. We need the tools, space, and support to do our jobs, not just carry out our job description. And that's what we intend for iClickCare to be. 

 

If part of your job is doing healthcare collaboration in complex settings, we can help. Learn about how hybrid store-and-forward telemedicine can support you.

ClickCare Quick Guide to Hybrid Store-and-Forward





Tags: telemedicine, good medicine

Plastic Surgery "Guinea Pigs" Show Care Coordination at its Finest

Posted by Lawrence Kerr on Wed, Apr 13, 2016 @ 07:30 AM

newzealand.jpg


My field, of plastic surgery and reconstructive surgery, has always been one of innovation and even experimentation. So much of the innovation that has happened over the ages is innovation done with and for patients. Some people call these patients guinea pigs; some people call them pioneers; others simply call them valued patients.

Recently, an upcoming movie caught my attention. It's called “The Guinea Pig Club” and is the the story of Sir Archibald McIndoe, a New Zealander working in Britain in World War II who cared for the disfigured using classic plastic and reconstructive surgery techniques (read 4000 BC in India) as well as inventing and systematizing his own.

He worked at Queen Victoria Hospital in East Grinstead, England. He was the student and cousin of Sir Harold Gilles. Dr. Gilles' seminal work was related to World War I. (Interestingly Dr. McIndoe was a teacher of my Chief of Plastic Surgery, Dr Peter Randall. The techniques and the care have certainly been passed on.) The name of the film is the name of a group of patients. To belong to the club, born in a pub, was The Guinea Pig Club. The membership requirement: have had a number of procedures performed by Dr Mcindole. A look at the dramatic pictures demonstrates the fact that a “number of procedures” could easily be counted in scores and hundreds. The club's members supported each other both during and after the war.

Dr. McIndoe's work brought up a number of really interesting lessons and insights for me, both as a surgeon and as a founder of ClickCare. I find the principles of total patient care (now called care coordination, care across the continuum, and care management) fascinating, inspiring, and satisfying.

True medical care has always been about care coordination, not just interventions. 

Collaboration and care coordination extend beyond the institution’s walls -- whether that is long term care, the hospital, or the doctor's office.

For instance, a particularly amazing (but, on reflection, maybe not surprising) aspect of Dr. McIndoe's work was his effort to ensure that each patient also had the work he needed to make a life. (See this video, starting at 49:55.) To me, that is care coordination down to the roots and what we are passionate about making happen for everyone, everywhere.

Care involves more than the patient.

Dr McIndole worked with the local community to teach and help them look past the physical defects. Because of these efforts, East Grinstead became “the town that didn’t stare”.

Support and community is the foundation of health. 

A crucial part of these patients' success was related to their "pub club" through which they provided each other support and understanding. A condition that could have isolated and dominated these men ended up being connective and being the basis for their growth and flourishing after the war.

 

We're proud to be part of the legacy of Dr. McIndoe -- both in his valuing of innovation, and in his holistic way of pioneering health for his patients. We applaud his efforts as well as those of his patients -- just as we applaud all of the pioneers and "guinea pigs" who innovate with iClickCare every day. 

 

Click here to be a pioneer and try iClickCare for free for 14 days:

Try the iClickCare 14-day evaluation

 

 

 

Tags: long term care, good medicine, care coordination

The Greatest Healthcare Collaborations of All Time

Posted by Lawrence Kerr on Fri, Mar 25, 2016 @ 07:30 AM

two-friends

 

Our friends at Hubspot have a unique outlook on the world of business, and often have interesting insights for the medical world. Matthew Kane lists 7 creative collaborations, which are an interesting starting point for thinking about what it means to collaborate effectively with colleagues.

For instance, Kane identifies these classic collaborators:

  • Andy Warhol and Jean-Michel Basquiat
  • Paul McCartney and John Lennon
  • F. Scott Fitzgerald and Zelda Fitzgerald
  • Harry, Albert, Samuel, and Jack Warner
  • Ed Catmull, Steve Jobs, John Lassete
  • Steven Spielberg and John Williams
  • Helmut Krone, Julian Koenig, and William Bernbach


We love these as a starting point. Obviously, these folks are “creatives” and in a different field. But they solved problems in new ways, different ways, bold ways, and creative ways by being collaborative. And the truth is that we see medical teams acting equally collaborative and equally creative -- every day. For instance, just last week a major study looked at the way the "soft innovation" of full-time care teams for a given condition had blockbuster results.

In healthcare, some of the most important innovations of our history have been created by teams: 

  • Banting and Best (discoverers of insulin)
  • Watson and Crick (DNA)
  • Flexner and Flexner (memory)
  • The patient and the doctor
  • Marie and Pierre Curie (Curie said, “My husband and I were so closely united by our affection and our common work that we passed nearly all of our time together.”)
  • Blalock and Taussig (Blalock Taussig shunt for congental heart disease with the African American lab assistant who really did the work)
  • Debakey and Tarvik (artificial heart)

Of course, everone in medicine knows the thrill of teaming up a diagnostic problem, sharing woes or joys, or learning together. But these days, these exciting and illuminating moments of healthcare collaboration have become fewer and farther between. iClickCare is one way to bring them back to your practice -- without time or hassle -- but you can do it pretty simply, by walking down the hall or looking across your desk.

 

We looked for stores of medical collaboration around the world and here's what we found: 

 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, medical collaboration software, good medicine, healthcare collaboration, healthcare collaboration software

Telemedicine Improves Healthcare Efficiency -- But is That The Goal?

Posted by Lawrence Kerr on Thu, Jan 21, 2016 @ 07:30 AM

motionstudy

 

“In the past, the man has been first; in the future, the system must be first,”
- Frederick Winslow Taylor

 

Many of us have read the beloved children's book Cheaper by the Dozen, but few of us were aware that Frank Gilbreth, the famous and flashy author, also made forays into the hospital and operating room.

Two articles in the Perspective section of the New England Journal of Medicine Vol 374 (2) January 14, 2016 look at Frederick Winslow Taylor and Cheaper's Frank Gilbreth. Two industrial efficiency experts that looked at the operating room (and the hospital in general) as fertile ground for their work.

Gilbreth emphasized motion studies -- and I can certainly relate to that. I spent untold hours in training: observing, imitating, and refining what I saw. That has been followed by years of further attentiveness to myself and others, including my brilliant partners and colleagues. The one-handed knot, without a turn of the hand, and seemingly a mere crisiscross of motion, became a source of pride to me. Economy of motion was about how to organize and conduct the operation. It was a question of efficiency that went to the core of good surgery. My experience echoes that of the surgeons Gilbreth was working with. During that time, surgeons were accepting of these efficiency studies because they saw the potential to reduce their patients' expsure to ether, by reducing the total operating time.

Gilbreth's predecessor and colleague, Frederick Taylor, also addressed efficiency. His work lead to the concept of Taylorism, which has influenced how factories are run as well as practices like Toyota's Lean Manufacturing. While some specifics of his approach never became adopted in medicine, their essence became part of the language of healthcare. Six Sigma is the certainly the continuation and evolution of his work.

Hartzband and Groopman explain that Taylor's core premise is: "there is one best way to do every task and it is the manager's responsibility to ensure no worker deviates from it." But is that true? What of communicating efficiently and well? What are our goals? I am aware of the ER logging response times. But, that is not communication -- merely notification and response. When we do healthcare collaboration effectively, we're actually shaping outcomes in different ways, not just relaying messages. What is the current state of the art? The value of efficiency and the effectiveness are both appealing and undeniable, but we have a long way to go.  

iClickCare absolutely helps with efficiency -- at least as measured by the cost of care. Yes, but do we (ALL of us who care for patients) want only that? Apparently not. What we really want to do is work effectively, safely, and with satisfaction and be able to go home, more or less on time, knowing that we did the right thing.

By doing the right thing, and collaborating, we become the leaders of real change in healthcare.

 

Hybrid Store and Forward Telemedicine can help bridge the gap between the efficiency demanded of you, and the medicine you want to be practicing. You can download our free ebook about it here:

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine, good medicine, healthcare collaboration

It's Not About Great Doctors- It's About Great Healthcare Collaboration

Posted by Lawrence Kerr on Fri, Dec 04, 2015 @ 07:30 AM

emptytable


When relatives or friends are facing a medical issue, I'll often get a call. Sometimes it's to ask my advice. But more often than not, the issue is not in my field and so the question is: "Who is the best oncologist/gynecologist/fill-in-the-blank.

"The best."

So when I read this article in the New York Times by Dr. Emanuel, building off a similar experience -- I was curious. He looked at a study done in JAMA that looked at tens of thousands of hospital admissions, and concluded that when top-ranking cardiologists were out of town, patients back at their home hospitals had better results than when the famous and more experienced cardiologists were there to provide care.

In other words, the best cardiologists provided not-as-good care.

As someone who values experience, skill, and expertise, my first instinct was to be a little annoyed or dismissive of the article. Just one more thing to degrade the value of valuable professionals. But the more I thought about it, the more I realized that the point isn't so much that the experienced cardiologists aren't good. I'm sure they're exceptional.

To me, the point is that we overestimate the ability of a single provider to be extraordinary. When relatives ask for the "best oncologist" maybe they would be better off asking a more long-winded question like, "What do you think would be the best medical context and team for me to get treatment, heal, and thrive, within my life and parameters?"

Excellent medical care is an extraordinary thing. It involves deep caring, innovative medicine. It involves deep skill and experience. It also requires a team that is able to work together effectively. That requires more than just smart doctors -- it requires:

  • Treatment that disrupts the patient's life as little as possible and so is close to home and in a familiar setting.
  • A medical team that has the healthcare collaboration tools (and leeway / freedom) it needs to work together effectively. 
  • Communication tools (like telemedicine) that allow providers across the continuum of care to collaborate on cases from their unique perspectives and using their unique skills.
  • Administration that respects the contributions of each medical provider and allows the flexibility, time, and resources for them to do their work. 
  • A patient who is invested in the care plan and doing their part to make it successful. 

Good care requires good doctors -- but it requires a team of good doctors -- not a lone expert. 

 

Working on refining healthcare collaboration in your practice? Get our quick guide of tips and inspiration here: 

 

ClickCare Quick Guide to Medical Collaboration

Tags: telemedicine, good medicine, healthcare collaboration, medical provider burnout

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