My favorite Italian restaurant in our town is a little place called Nick's. Like most good eateries, this one is always packed with a wide swath of folks from our community. And among the families sharing platters of pasta is usually a patient or two.

I'm always grateful for this kind of informal communication with patients. I get to ask after their nose or thumb or hip… and usually inquire about that trip they were about to take when I saw them, or their son that played quietly in the corner of the exam room. I never thought much about these interactions until my daughter commented on it.

"Dad," she said, "How can you possibly remember all of those details when you see so many patients?" I shrugged. Being familiar with the details of my patients' lives is as much a part of my job as being able to do a flap effectively.

I take my ability to remember these things for granted, for the most part. I expect myself to remember a patient's name, condition, family, job struggles, and point of view. I expect myself to recall details of decades-old cases in my communication with patients. And I expect myself to remember an interesting case to share with young students.

Or, at least, I thought I did until I heard this TED Radio Hour on Memory. One quote from Scott Fraser, a forensic psychologist and expert on memory, stood out to me in particular:

"We all have to be very careful. All our memories are reconstructed memories. They are the product of what we originally experienced and everything that's happened afterwards. They're dynamic. They're malleable. They're volatile, and as a result, we all need to remember to be cautious, that the accuracy of our memories is not measured in how vivid they are nor how certain you are that they're correct."

There are reams of research (not all of it useful) on the best methods for communication with patients, like this piece on whether patients actually prefer a patient-centered style. But no matter what your approach, it's crucial to be able to remember the details of what happened as you communicate. I have not found EMRs to be useful aids, as they're not searchable and the information is organized in such a way that I can't seem to pull out the story of the patient.

I do think it's likely that my memory for patients is trained, and thus better than average in this context, but I also know that it can be immensely valuable to have tools that help me remember a patient's full story accurately. Although I hadn't realized it, I have been using ClickCare as a tool, not just for collaboration, but for remembering full cases. That better "remembering" has also led to better communication with patients (as well as with other colleagues and with students.)

So while I can usually remember my patients when I see them in Nick's, I'm incredibly grateful to have ClickCare on my iPhone to help me out when I need to remember a nuance about a case -- wherever I happen to be when I need that information. 

A look back at the past, can help us with the Now. Right now, the "Future of Healthcare" is a big conversation. The Supreme Court is about to hand down a decision on healthcare, but the train has left the station. Years before the internet, at the birth of computing, there was considerable controversy about the control of computing. Large companies were designing large computers for large jobs. Steve Wozniak and his colleagues changed all of that. Now we have small, powerful and even smaller, computers for everyone, everywhere. Control of the internet was next. Like telephone, radio, and TV before it, large companies and government tried unsuccessfully to control and centralize development. The discussion about healthcare is very similar. Dave Chase, our colleague in the NY Times report, discusses this in TechCrunch, entitled "Supreme Court Decision On Obamacare Has Little Relevance To Healthcare Disrupters."

At the ATA 2012, some special Woz quotes were caught on iPhone VIDEO even though they were omitted from the ATA Highlights. You can hear again his wonderful encouragement for the entrepreneur, his talk about hard work and passion, his recommendation to do what one cares about and feels is important, not just do business.

Steve further said…”I love all the little devices that hook up to my iPhone. I’m a gadget guy. You know, I probably wouldn’t get a blood pressure thing at home and take readings and write them down. But heck, when I take a reading and it’s automatically on my iPhone, I can show it off, I love it.”

When Dr. Harris asked him specifically about telemedicine and mHealth, his shout out for iClickCare was a thrill because he mentioned iClickCare, and iClickCare alone, on the stage at the ATA 2012 in front of 5000 of our closest friends! He even volunteered a move to Alaska to reap some of these benefits of telemedicine. 

In total, Steve Wozniak is a generous and appreciative individual whose life has made, and is making, the world a better place.

ClickCare believes that, especially in light of the pending Supreme Court decision on healthcare, real change occurs through innovation and collaboration. What are your thoughts?

Accountable Care Organization, Care Coordination, Pay for Performance, Patient Centric Care, Coordination of Care, and so much more. It is all ready here. See the difference.

 A missed opportunity for homecare? A prevailing attitude? A broken system?

Which, or all?  Why did medical collaboration not happen?  We have our opinions, but, we want to know yours. We know what we would do differently. What would you do?

A near transcription of a true event this past weekend (names changed)...

Scene:  Saturday, 1:07 pm, Physician hears: "Beep, Beep, Beep"

      Physician reads beeper: "Melissa - Homecare at Home. Plz call ASAP. 555-555-5555. Dr. Pollard's patient. Wound pink."

      Physician calls: This is Dr. Specialist calling back.

      Nurse: Thanks for calling. Dr Pollards's patient had surgery and it looks pink around the wound.

      Physician: Pink?

      Nurse: Yes, pink.

      Physician: When was the surgery?

      Nurse: I am not sure, I was not here last week, but I think it was a week or two ago. Maybe 9 days.

      Physician: OK, where is it pink? Is there a temperature?

      Nurse: She didn't tell me the temperature, just said that the wound area was pink.

      Physician: How pink? Is it red? What part of the wound?

      Nurse: I don't know, I am the office nurse. This was called into me by the nurse in the field.

      Physician: Did it change? Is it worse? Is the nurse availaible? I can see the patient in the Emergency Room.

      Nurse: No, she has left for the day, and said she would see the patient in the morning. We just wanted to inform you. FYI.

      Physician: FYI?

      Nurse: Just wanted to inform you.

      Physician: FYI or CYA?

      Nurse: Unfortunately, we all have to do it.

Let us know your thoughts. 

Innovation in telemedicine, collaboration and coordinated care is finally getting its due.

All of us at ClickCare are excited to have Eilene Zimmerman of the New York Times identify us as innovative and disruptive. We appreciate the great and careful effort that this journalist made to get the story right with her constraints of space.

We have known for many years how we can best help our patients. We also know, while technology is at play here, good medical principles never change. The greatest of these is: The Patient is First.

The article in The New York Times was widely reviewed and tweeted. The well-respected online newsletter written by editor Sara Jackson of Fiercemobilehealthcare.com succinctly summarizes and reviews this again.

Over a month ago, Daniel Casciato in  Medical Office Today selected iClickCare as one of 8 Popular Apps for Medical Practices.

Because ClickCare was reviewed as business news, the measurement focused on making money. That is important to ClickCare. One major reason ClickCare was chartered as a separate company was the beseeching of a bright and forward thinking federal leader who felt ClickCare had a chance to become self-supporting and, therefore, not dependent on grants. Grantors become frustrated because invariably after the grant runs out, the massively expensive equipment is relegated to a pile in the back closet.

iClickCare by design is inexpensive, simple, and independent of complex equipment needs. This approach alone is innovative. It also is disruptive since it goes against current profit-oriented teleconferencing approaches. The disruption, however, is firmly grounded in good principles of caring for patients. So, there is much more to measure than financial success.

We care strongly about social impact. Thus we also measure and focus on the number of patients who have been helped, the number of physicians who go home and come back to work less stressed, happier, more satisfied and enthusiastic, and the number of learners who have seen what they would have otherwise missed.

Caring about social impact can sometimes be too big to deal with. When you use iClickCare, irrespective of your role in the health care hierarchy, you will notice the immense satisfaction of helping a single patient, time and again. That help comes in different forms — access to care that would not have been available, faster and easier diagnoses, less pain with wound care, and “Great Case Cures.”

As the healthcare debate intensifies, and ACO, accountable care, coordination of care, and the medical home, all come more and more to the fore, it will be more important than ever to count things other than dollars saved.

Join us in counting providers (from bedside aide and family to super-specialist) who are relieved of fear and isolation. And in counting how many patients are helped, by how much, with less missed time from work and less delay in diagnosis. These numbers stand in stark contrast to the cost per covered lives per day, and the like, but they are the important measures because after Patients First, come Providers — both current and future.

We are growing as a profitable company. We are doing so by measuring success as well as savings. It is a business adage that if one provides a service to one's fellow man, it will be rewarded. 

We are working very hard to provide that service. We will continue to count in many different ways.

Ask for a second opinion?  I will look stupid!

Patients perceive of their providers as smarter rather than stupid when they look for collaboration. Often the response is that "two heads are better than one."  There are multiple studies over the last decade attesting to increased satisfaction. There have been a couple of articles which legitimately criticize methodology, particularly because surveys from investigator to investigator are self made and inconsistent.

It is our experience over the past two decades, that a telemedicine collaboration is not only appreciated, it is expected.  Anything less is perceived of as disinterest.

Why? We are all aware of the explosion of knowledge. For instance. how many of you have read the entire Encyclopedia Brittanica? That is a lot of information. but look at this graphic. Wikipedia, alone, is equal to 1624 volumes of the Encyclopedia Britannica.

 Representation of how many volumes placed in library stacks would equal Wikipedia.

There is more to this discussion than voluminous knowledge, though.  SEARCH can substitute for memorization. Collaboration allows interpretation, interchange, and uses human creativity to build upon data alone.

Take this trivia question:  What fruit has the most vitamin C?  Simple right? Orange or Lemon? With our shrinking world there is another whole set of choices that as North Americans we did not grow up with. (To our international readers... please don't tell the answer!).

How about Guava?  That anwer can still be searched. But we find there is more to the question. What did boiling do to the Vitamin C?  How much of it is bioavailable. What assay should be used. Now the answer is more than data, it really should have some expert opinion. You should have a chance to question and examine the answer. You need to collaborate.

The answer: Guava has 183mg VitaminC/100 gm. At least that is one answer. Did we consider the source, preparation, acceptance. What would you feed the well know sailor with scurvy?  By the way: an Orange has 53mg and a Lemon only 46mg/100 grams.

You might want to examine the source and ask an expert. It's OK, none of us can know everything or even enough! We just have to try to do the right thing.

That right thing gives health care providers the same satisfaction.

The Contest:  How I will fix healthcare delivery?

 And the winner is...

 But first some comments.

• about the contest
• why discussions about healthcare are vital to us all
• why medical collaboration is necessary

The contest as a whole documents the frustration, malaise, and institutionalization of medical care. Ironically, health is one of the most personal relationship.

The Contest:

We thank you all for your entries. The word map shows quite nicely the range of answers.  Frankly, we were a bit disappointed by the contest. In part, this was caused by our inexperience since this was our first Facebook contest. We had no idea that there was a community of professional contesters with multiple names, lists of operatives who help each other win, and a certain amount of vitriol.

Naively, we had hoped to stimulate a grassroots discussion among all of us. In a busy world, and with a complex subject, there were no newly creative answers. The question was answered largely with an approach oriented toward the  “them” -- insurance, government, doctors and drug companies -- and not us.  This was countered by preventive care.

The sum of the comments showed the problem to be expense and the solution to bypass insurance companies, and have everyone save money in very basic ways. Suggestions included turning off lights and closing rooms, and contributing to a national fund which would be nonprofit. A plan suggested $5 to $10 per person per week or $260 to $520 per year. Currently about $7500 is spent per person. Prevention and taxing of risky behavior, as well as government run, universal healthcare another. The disappointment is that, despite the question "What will I do," the answers were expected to be supplied by someone other than an individual.

As you review the world map, consider other alternatives.

Importance of collaboration:

Each of us needs to use our expertise and our view of fairness to others to reach a solution that benefits us all. Discussion is needed, not devoid of self interest, but respectful of all ideas. Discussion is the life blood of collaboration.

Medical Collaboration is necessary:

Our own view, not expressed except but by one contestant, is that collaboration is not the end of our healthcare problems, but rather an important piece of a very high tech, high demand field where no one of us is as smart as all of us. Telehealth and telemedicine are part of this!

Thanks for participating, all.  Please continue to do so with your comments.

And the winner is: Amada Acevedo, of Texas. Congratulations Amada. This is her entry:

If one person were to save $5-10 a month and put it towards our healthcare system, then we could be able to provide for our less fortunate and also to put more efforts and monetary help towards PREVENTION, then the healthcare crisis would change drastically. Most of the lower income people do not have access to health care, and therefore only go to the Emergency Room when illnesses and injuries have gotten past the point of being cured or treated. If one person could sacrifice that small amount of money, then many others will follow the good example!

We disagree with your math, but endorse prevention and leading by example.  We look forward to learning more about you and your passion for fixing healthcare.

What a weekend!  We attended an exciting conference one day, and stumbled on a living legend the next.  Read how a confluence of disparate backgrounds gives all of us hope for the future and suggests that we can change the world.

"Pete, what is the greatest change that you've seen in your time?"

"The Information Revolution...if we use it right, it may save the human race."

Saturday, we found Pete in a local art shop in Beacon NY.  Peter "Pete" Seeger (born May 3, 1919) is an American folk singer and an iconic figure in the mid-twentieth century American folk music revival. Some of his favorites are: Where Have All the Flowers Gone, If I had a Hammer; and Turn, Turn, Turn. Pete has led people in improving, reclaiming, and detoxifying the Hudson River Valley.

The day before, we had the honor of hearing Todd Park, the CTO of Health and Human Service speak at the Tech Garden in Syracuse, N.Y. on Unleashing the Power of Data, IT, and Innovations to Improve Health

• decision support
• care management tools
• extended physician reach
• consumer engagement tools
• data mining

It was most inspiring that Todd said that we can innovate our way out of the healthcare crisis... care coordination, collaboration for improved health outcomes. Todd Park is a dynamic, charismatic speaker, and he was speaking to innovators of all ages saying that we have the greatest entrepreneurial opportunity since the birth of the internet. He talked about "a stitch in time," ACO's, meaningful use. CMS has $10 billion to use for reasearch and development to get value out of our recorded health data. He says that we shouldn't be paying for volume of service, but, instead, we should be paying for improved health and increased value.  This Land was Made for You and Me!  Certainly innovating our way out of the healthcare crisis would be a way of showing Pete that we are trying to use information in the right way.

To this end, Todd he moved his family and two very young children to Washington to liberate health data (Gov 2.0) and inspire the rest of us to improve the efficiencies of our country's healthcare. He said that he has never been so proud to be an American since he became the CTO of HHS. He wants to turn HHS into the NOAA of healthcare (NOAA is responsible for the data that spins The Weather Channel, weather.com, and nightly news weather, all in the interest of providing weather knowledge for our good). Think what this parallel could mean if applied consicentiously to healthcare delievery!

And feel free to check out the iClickCare innovation to make our medical days easier.

See a clip of the performance here.

He called, we answered, and he asked us some interesting questions. We did our best to bring some insight about ClickCare and iClickCare. Here is a link: Expert Interviews, For any of you who would like some more background about why we do what we do, we answered these questions:

• After long careers as physicians, why did you start?
• Give me an example of how a patient would benefit?
• If the internet is involved, how can privacy be assured?
• Everything’s expensive in medicine, how does ClickCare save?
• How does iClickCare fit into other healthcare IT initiatives?
• How soon will I see this in my doctor’s office?

These questions are very commonly asked of us. Is there anything that we left out? Do you agree? We welcome your comments.