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Why Developing Countries Beat the US in Medical Technology

Posted by Lawrence Kerr on Tue, Apr 23, 2019 @ 06:00 AM

annie-spratt-210845-unsplashThose of us who live in the US tend to think of our medical system as the most cutting-edge in the world.

And there is a lot of truth to that — medical innovation is certainly an area of strength for us and we can be proud of our contributions. 

That said, a recent New York Times article put a spotlight on the ways developing countries can show a special kind of rapid innovation with technology that sometimes leapfrogs our slow, deeply challenged adoption patterns.

Any new technology presented to the US medical community has to beat a gauntlet of obstacles to be adopted. Between regulatory issues, compatibility troubles, concerns about compensation, and political drama, the adoption of any new technology is a minefield.

Sometimes the needs of developing countries make technological adoption quicker and more focused than it would ever be in the US. For instance, a new ultrasound scanner has been invented that can do ultrasounds anywhere in the world, with a device the size of an electric shaver, connected to an iPhone.

As the New York times reports, “Two-thirds of the world’s population gets no imaging at all,” so the allure of an ultrasound wand that can provide even rudimentary imaging is compelling for medical providers and NGOs in developing countries. Many times, the stance is one of finding innovative ways to use technology, rather than having the immediate reaction be one of resistance. Further, experimentation seems to come at less of a perceived cost, as downsides of failures may not be as dramatic in terms of repercussions.

So within a short period of time, providers in Uganda used their new ultrasound wand to scan everyone from babies to nonagenarians. And their approach to using it in service of diagnoses was deeply creative.


My challenge as the founder of a medical technology company is to support US medical providers in approaching innovation in this same way — but of course in combination with all of the advantages that we have in our medical system. How is that possible?  I believe that when providers in the US make an effort to try new technologies as quickly and cheaply as possible, it lends us the type of speed and innovation sometimes only found in a country like Uganda when experimenting with an ultrasound wand. The smaller and faster our experiments are, the less investment we have in every single one succeeding. That's what I'm so passionate about iClickCare as a medical collaboration tool  it doesn't require expensive hardware, even one doctor can start using it on his/her own, and it's so intuitive to use that you can do your first consult within minutes. That means that it's inexpensive and fast for medical providers to experiment with its optimal usage in their unique medical setting  making innovation much faster and more expansive than it is with huge, expensive, and years-to-implement videoconferencing hardware. 


We can certainly learn something from the resilience and creativity of other countries  and innovation around medical technology may be one place to start. 

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Tags: telemedicine technology, healthcare collaboration software

The Healthcare Collaborators It's a Mistake to Overlook

Posted by Lawrence Kerr on Tue, Feb 12, 2019 @ 06:00 AM

ben-white-998822-unsplashMost healthcare providers struggle to collaborate with even the most essential of their colleagues. Many of us are stuck in the "dark ages" of phone tag or hoping that the EMR/EHR manages to coordinate different provider visits and perspectives. (I'll give you a hint: it doesn't.) 

While iClickCare is commonly used in hospital settings, private practices, or home healthcare, you might be surprised to know that iClickCare actually originated in elementary schools, with a school-based healthcare program. Our Founder is a pediatrician and she created the tool to collaborate with nurse practitioners at local low-income elementary schools. The goal was to use telemedicine to collaborate, coordinate care, and keep young students in class by resolving health problems more efficiently.

So when I heard about a recent program with similar goals, I was glad to know it is succeeding -- even as there are key aspects of it that fall short.


In 2012, Children's Hospital Colorado started a program with school and corporate collaborators -- it works with school nurses to train students to manage their asthma more effectively. 

The question asked in the article, "Are schools part of the healthcare system?” is an important one -- and I would answer with a resounding Yes. As Dr. Deterding said, “Even though schools may not want to be a medical healthcare delivery system, they are. ”In fact, I believe that “the healthcare system” includes far more collaborators than one would think. It’s not just doctors, nurses, and hospitals. Our collaborators in medicine include social workers, teachers, parents, kids, school nurses, home health aides… the list goes on and on and is unique for each patient.

According to Fierce Healthcare’s summary, participants in the Colorado program "experienced a 22% drop in school absenteeism and an 80% decline in hospitalizations and urgent care visits among pediatric asthma patients.”

While this is an exciting program, with strong results, I do think that we can do even better. Ultimately, this program doesn't create a foundation to improve the way we care for young patients overall -- it simply resolves one aspect of a complex care scenario. While results were excellent, I worry that the intervention isn't holistic enough or sustainable because it's not involving the full picture of these young patients' care. That said, I think there are several crucial learnings from this project that we can all take away. 

3 Key Care Coordination Learnings from a School-Based Health Program:

  • The people closest (geographically or emotionally) to our patients may have the strongest ability to support them.
    In this case, the people consistently close to these young patients are school nurses. School nurses are close in terms of physical access, are embedded in the students' community and cultural context, and likely know the students personally. Similarly, it's crucial to recognize the similar closeness of wound care nurses, home health aides, teachers, social workers, and others. Medicine can become very hierarchical, in which specialists are hyper-valued. But the reality is that for the best care to happen, we need to collaborate with the people closest to our patients as well. 
  • Working across the continuum of care can be a powerful way of achieving new results.
    The new world of healthcare requires that we expand our understanding of who is part of the care team. But I believe that it's not enough to simply engage school nurses to execute a program. We must truly collaborate across the continuum of care. We have seen over and over again that this approach yields a strong ROI and best-in-class patient care.
  • Tools used to bridge different aspects of the healthcare system must be robust and flexible. 
    What does that mean specifically? It means that our tools must do more than support us in treating a single disease, as with this asthma program. Rather, we need tools like telemedicine-based healthcare collaboration that help manage asthma today, a cancer scare tomorrow, and a complex broken leg next year. Healthcare is too complex, and our patients are too valuable, to settle for single-use tools.

With the inspiration of both the strengths and shortcomings of this program, I encourage you to look more broadly in your practice today. More broadly in terms of who you see as part of the care team... and more broadly in terms of what you expect from the tools you use in your practice of medicine. Our patients deserve more and better care coordination and healthcare collaboration -- and we deserve more and better satisfaction from the work we do.


Learn more about hybrid store-and-forward telemedicine and how it can help you do care coordination across the continuum of care:

ClickCare Quick Guide to Hybrid Store-and-Forward  


Tags: hybrid store and forward medical collaboration, nurse practitioners, nurse collaboration, healthcare collaboration software

The Simple Truth about Collaboration in Medicine

Posted by Lawrence Kerr on Thu, Aug 16, 2018 @ 07:00 AM

rawpixel-703123-unsplashMany people love science and medicine for the exciting stuff: the cutting-edge research, the dramatic diagnoses, the high-tech equipment.

The truth, though, is that medicine actually happens in a much subtler, more incremental way. It’s quiet moments with a patient or busy weeks when we see hundreds of patients but without any "big cases." Real medicine is simpler and less outwardly impressive than people may think. 

Similarly, healthcare collaboration is more steak than sizzle. And a recent article about a collaborative institution in Europe reminded me of these fundamentals. 

Robert Klaber, MD is a pediatrician who works at the Imperial College Health Care NHS Trust. The organization serves 2 million patients in Northwest London, with a staff of 11,000. He wrote a phenomenal article sharing his experience of collaboration in London -- bold work that is both more commonsensical, simpler, and more impactful than so much of what we read about healthcare collaboration. 

As he explains, “If you talk to patients, they will often tell you they receive poor care or their needs aren’t met when they fall between different providers. Support for patients often isn’t joined up, so it’s crucial that we collaborate much more thoughtfully. Unfortunately, the levers in the system still point away from that.”

He sees collaboration as even more than just provider-to-provider conversations. It's also about collaboration with the community they serve. "As we start to move [away] from a model of fixing illness toward one focused on health and wellbeing, our old methods just don’t stack up. We need to learn from the people and parts of society that have been doing more of this than health care."

The common way to think about healthcare collaboration is unidimensional (one specialist speaking to another on videoconferencing) but also tech-heavy and expensive. What I love about this article is that Dr. Klaber is thinking about collaboration in ways that are both more simple and more expansive than people normally do. 

Dr. Klaber sees collaboration as creative, dynamic connection that might not need special tools. Just as in our town of Binghamton NY, we did cutting-edge multidisciplinary cranio-facial team meetings (which involved no more complicated technology than a round table and some donuts), Dr. Klaber is doing multidisciplinary team meetings to talk holistically about pediatric cases -- with great and measurable results. 

So to me, the question is simply -- what can we envision for creative, multidirectional collaboration? And what are the simplest tools we can use to make that vision become real?

We're so passionate about iClickCare because it's a very affordable and easy-to-use tool that facilitates multidirectional and multidisciplinary collaboration. But other collaboration tools can include a simple conversation, a box of donuts, or a smile. 

As Dr. Klaber emphasizes, metrics are important but "It’s more important that we sustainably develop a workforce who has a sense of meaning and purpose, and the skills to do what our patients need us to do... [And] How do we start to deliver outcomes that really matter to patients, and aren’t just a traditional, often hospital-based process that we’ve had in place since Victorian times? Better collaboration could help with all these priorities."

Get inspired with more stores of medical collaboration here: 

ClickCare Quick Guide to Medical Collaboration

Tags: healthcare collaboration software, medical collaboration tool

Do Women Doctors Experience Gender Bias or Is It a Thing of The Past?

Posted by Lawrence Kerr on Wed, Aug 08, 2018 @ 10:58 AM

rawpixel-675359-unsplashAs you may know, our cofounder was one of five women in her medical school class.

She’s a tremendous doctor, bringing compassion, strong instincts, and impeccable skill to the challenging field of pediatrics.

But she didn't have it easy along the way. She certainly experienced gender bias (to put it lightly) over the span of years. She thrived despite challenging conditions around her, and became a leader in medicine.

So as I flipped through the New England Journal of Medicine recently, a chart caught my eye. It showed women as a percentage of matriculants in US medical schools -- from 10% in 1955 to about 50% in 2017. Which had me wondering -- is gender bias a thing of the past for women in medicine? And what does it mean for our teams that the percentages of male and female doctors are changing so dramatically?

In "Recognizing Blind Spots - A Remedy for Gender Bias in Medicine?" Loren Rabinowitz, MD looks at the question of how gender bias functions in medicine. She cites data, both personal and quantitative, demonstrating that despite the changing numbers, gender bias and even sexual harassment are common in the medical workplace for women. And, women are underrepresented in leadership positions in medical schools and hospitals.

That said, she also points to data showing the richness that women bring to the medical field. One study, for instance, shows that patients treated by female doctors have better outcomes than those treated by male doctors. 

In some ways, I notice that this changing landscape starts to make it feel like a competition for scarce resources among male providers and female providers. Does the growth of women in medicine -- past, present, and future -- come at a cost for men in medicine? It's a divisive question to ask, but I believe that it underlies many people's actions and is worth bringing to the surface.

My take? It’s in our interest to make sure that we don’t have a “zero sum” mindset. Women having a safe and respectful workplace for their practice of medicine doesn’t detract from men’s experience. In fact, strong medical teams depend on a diversity of opinions, experiences, and skill sets. And the truth is that our personal background (including race, gender, nationality, etc.) is big part of the experience and opinions that we bring to the table. When we create an environment that values these differences, rather than seeking to minimize them, our practice of medicine becomes richer and more nuanced.

Beyond just ensuring gender equity in medicine, I believe that it's important to look at the issue more broadly. Effective healthcare collaboration demands that we are respectful of all of the voices on our medical team. But this requires more than good intentions -- it requires that we have the appropriate tools to enable teams to truly collaborate, not just fit in with the hierarchy. If you don't use telemedicine for healthcare collaboration, I encourage you to think about what tools you do have to encourage the team to collaborate in all its diversity -- and in all its strength.


ClickCare Quick Guide to Medical Collaboration


Tags: coordinated care, healthcare collaboration software

Your Medical Team is Changing, Whether You Like It or Not

Posted by Lawrence Kerr on Tue, Jul 31, 2018 @ 07:00 AM

rawpixel-577480-unsplashOne of my favorite parts of medicine is the experience of working across the continuum of care, with providers from a variety of backgrounds. Certainly, colleagues like nurse practitioners and RNs are deeply valued but people like orderlies and administrators are also passionate parts of the healthcare system that form key parts of the team. 

In my practice, one of the most successful parts of the what we did was to demonstrate in word and action that every single person, who is part of the medical team, is deeply valued and has a unique contribution that only he/she can bring. This approach was brought into our lauded Cranio-facial Team, as well, through which providers from social workers to plastic surgeons to oral surgeons, each of whom collaborated on complex cases like cleft palate and cleft lip care. In short: much of the richness I find in medicine comes from the diversity in our medical teams. 

That said, it can feel unmooring or even alarming to notice the ways that our medical teams are changing, especially when it comes to a relative decrease in the importance of physicians and the boom in numbers of providers like nurse practitioners. 

A recent article in the New England Journal of Medicine, Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce, looks at the boom in advanced practice registered nurses (APRNs), relative to the almost imperceptible growth of physicians in the US.

To start, one simple fact stood out to me: “Throughout the history of modern medicine, physicians have made up the vast majority of professionals to diagnose, treat, and prescribe medication to patients.”  This, of course is changing. An increasing part of healthcare is done by advanced practice registered nurses (APRNs), including nurse practitioners and physician assistants. Even with the current numbers, 41% of physicians work with nurse practitioners.

While the number of physicians in the US is growing very slowly (projected at 0.5% per year 2016-2030), the number of APRNs is growing quickly. Training times for these providers are shorter and there are fewer institutional constraints. The article authors did a rigorous projection of expected physician growth alongside expected APRN growth, based on census data, growth rates, and other key data. The result is that comparing 2001 to 2030, the percentage of APRNs relative to the pool of providers and APRNs together will go from 13% to 35%.

As doctors, we can bemoan these changes. We are all too familiar with the depth and rigor of the training we’ve received and it’s hard to fathom how an APRN can provide care that is as good as training that is less sophisticated.

But the reality is that, as the study authors assert, "These dynamics will have lasting effects on the composition of the health care workforce and working relationships among health professionals.”  Our medical team is changing -- our choice is how we adapt our work so that our medical teams can be as effective and satisfying to us as possible. 

The authors state unequivocally that “The changing composition of the workforce will have implications for provider teams.”  They point out that primary care providers are tending to work in larger groups with varying backgrounds and types of training. But this doesn't always go smoothly. Alarmingly, a recent study of NPs and physicians working on primary care teams “found that physicians, other staff, and patients often confused the roles and skills of various providers and that these misunderstandings often led to practices undermining the productivity and efficiency of NPs.”

This is where I believe my colleagues who are innovating in the field of care coordination, medical collaboration, and hybrid store-and-forward telemedicine have some crucial insights to share. By using telemedicine-supported healthcare collaboration, we fundamentally change the orientation of medicine from a sole provider giving the best care she can to a team of providers offering the best care they can. If we are individual providers working on our own, APRNs are a threat to physicians, and vice versa. Further, their very existence muddles things, creating confusion in care plans and complicating care coordination. In many instances, this is how things are right now.

On the other hand, if we have a consistent system to use telemedicine-based healthcare collaboration to work as a team -- like iClickCare -- then APRNs and physicians can work together smoothly, each contributing his/her unique perspectives in a way that doesn't detract from the work of the other. 

And ultimately, that's a more satisfying, effective, easeful way to work, regardless of what the healthcare landscape looks like now, or in the future.

You can try iClickCare without cost or implementation challenges. Get it free here:

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Tags: nurse practitioners, care coordination, telemedicine technology, Physician Assistant, healthcare collaboration software

Can Telemedicine Yield Results of High Intensity Without the High Cost?

Posted by Lawrence Kerr on Thu, Jun 14, 2018 @ 06:00 AM

hush-naidoo-535092-unsplashIt's a simple but troublesome truth that, as The New York Times puts it, “How much you spend on medical care depends on what you get, but also where you get it.”

And in an age when the whole medical community is pushed to increase efficiency, this reality is challenging to providers and to hospital systems. How are we to cut costs and provide high-value and high-efficiency care when costs vary not only by the care provided, but by where it’s provided, and who pays for it?

Costs of the same operation or care can vary dramatically in different places. This is due to different prices (and costs), of course, but it also has to do with the "intensity" of care. 

If you deliver a baby in a teaching hospital, it costs $2,000 more (on average) than delivering at a community hospital. Part of that is because of the difference in prices, but part of it is because the "intensity" of care (number of providers, specialization of providers, services provided) is greater at the teaching hospital. 

As the healthcare system struggles to provide care that is high-value for patients and efficient for providers and hospital systems, it's hard to know whether and when high-intensity care is worthwhile and when it's just, well, expensive.

So a recent study of Medicare hospitalizations -- led by Laura Burke and Ashish Jha at Harvard -- is interesting. It analyzed about 11 million Medicare hospitalizations and found that almost all patients had lower mortality rates at teaching hospitals.

But, as the New York Time synthesizes, "Among patients admitted for operations like hip replacements, the patients with the most health problems over all were the ones likeliest to benefit from a teaching hospital. On the other hand, among people admitted with conditions like pneumonia or heart failure, though all groups did better at the teaching hospitals, the difference was greatest for the relatively healthy patients."  So, interestingly, the high intensity care lead to better outcomes overall, but there are situations in which the difference is not significant. 

This led us to wonder whether there are ways that community hospitals or individual providers could provide the advantages of teaching hospitals, but at a lower cost, and in their care setting. As the study shows, "The more advanced technologies available at teaching hospitals explained some, but not all, of the difference. Other factors like subspecialty expertise, more clinicians involved in care, and greater availability of ancillary services may also be playing a role.”

The importance of subspecialty expertise and the inclusion of more providers in care points to the potential of healthcare collaboration, especially where supported by a tool or technology like iClickCare. If a community hospital can loop in sub-specialists that are not based at that hospital (but on their schedule, asynchronously)... and if the tool supports team collaboration in a meaningful way... it raises the question whether telemedicine-based healthcare collaboration could provide the benefits of the intense care at teaching hospitals, but at a much lower cost. 

Of course, this will need to be studied on a large scale for conclusive results -- but anecdotal results from our colleagues indicate this does work. You can get the benefits of high-intensity care, but from a community hospital, at a lower cost.


Looking for a low-cost way to implement a telemedicine program? Download our Quick Guide to explore hybrid store-and-forward telemedicine:

ClickCare Quick Guide to Hybrid Store-and-Forward


Tags: care coordination, healthcare collaboration software, cost effectiveness

3 Surprising Healthcare Collaboration Insights From a Very Big Airplane

Posted by Lawrence Kerr on Wed, May 02, 2018 @ 06:00 AM

jakob-owens-209005-unsplashWe often think of fields like engineering as being quite collaborative.

We know that no one professional has all of the knowledge to build a car, so many people need to offer their expertise when, say, a Ford is built.

But the creation of the new 787 Airliner from Boeing demonstrates going far beyond what we even thought was possible when it comes to collaboration — inspiring me for what may be possible in healthcare collaboration.

In building the new 787 Dreamliner, Boeing is using 3 suppliers and 40 global partners to build the airplane, “sharing the risk and the design burden.”  It's a feat of global coordination and collaboration  and certainly seems to demonstrate that more is possible than we often think when it comes to collaborating on a complex project. 

So we pulled out the most surprising  and helpful  aspects of the project and looked at what the Boeing project has to teach us in the medical field about healthcare collaboration. 

3 Surprising Insights from the Boeing Collaborative Design Project:

1. Even in a collaborative environment, it's still important to have someone who is responsible. 
This was not a completely equal collaboration in which 40 partners participated. Ultimately, Boeing was the owner and guide of the project. Similarly, with any iClickCare consult, there is always a "requesting provider" who remains the responsible owner and guide of the collaborative effort. This clarity helps, especially when collaboration is happening across geographies or in quite complex conditions.

2. Good collaboration is good business (and good medicine).
Some people think of collaboration as positive, but time-consuming, inefficient, and costly. Boeing’s example shows that this complex collaboration was actually the most efficient of all the possible alternatives. The 787 project has costs that are about 20% lower than they would have been and shaved a year off their production schedule. That said, it did involve some behavior change, on the part of the collaborators, and new ways of doing things.

3. To do collaboration effectively, you need a tool to help you. 
In Boeing’s case, they describe the lynchpin of the project as having a common “development environment” (a proprietary software) and set of design processes. This allowed the partners to have a single place to share and store information as well as a single system for moving through the design process. That’s one key challenge with telemedicine solutions that are based entirely on texting or videoconferencing — it does not create a single place or single system where all of the collaboration can happen. And this central location can be key to supporting collaborative efforts becoming effective.


It's certainly courageous to not just effect "business as usual" in building yet another airplane. And Boeing's example is an inspiring way to highlight the truth that healthcare collaboration does involve change, but it leads to better outcomes and lower costs. Even in a very big, or very complicated, project.


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Tags: healthcare collaboration software, telehealth and hipaa, hippa secure 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. 


Try the iClickCare 14-day evaluation


Tags: good medicine, healthcare collaboration software

Are Primary Care Doctors Being Replaced By Urgent Care?

Posted by Lawrence Kerr on Wed, Apr 11, 2018 @ 06:01 AM

filip-mroz-172352-unsplashThe time when each family had a family doctor isn’t long behind us.

When my parents were growing up, it was common for the family doctor to know your parents, kids, cousins, and neighbors; to make house calls; and to take your full situation (social, economic, cultural, familial) into consideration in treatment. Of course, payment might be made in dollars, insurance, or chicken eggs.

That time in medicine, of course, is gone. While some elements of this system are having a rebirth (like the dawn of the concierge family doctor), the structures that supported it have crumbled.

Until recently, though, primary care doctors have been a core part of the healthcare system, and the foundation of most people's experience as patients. Primary care doctors, of course: 

  • Give continuity of care, remembering your last visit and your overall life situation, embedding their perspective in these elements 
  • Coordinate care, playing the role as the key intersection point among specialists and family and patient.
  • Tend to have long-term incentives, meaning their motivation is usually providing the right care over the long term, not necessarily providing a quick fix. 

Recently, as the New York Times investigates, urgent care and "minute clinics" have begun to supersede primary care doctors as the first place people go when they need medical care. There are 12,000 across the country and as visits increase, visits to primary care doctors have dropped. There are multiple factors that contribute to this, including the key advantages of urgent care or retail clinics: 

  • Expanded office hours, which often coincide with hours that busy working people are available.
  • Affordable, clear fees.
  • Perception of faster results and more streamlined treatment. 

There certainly is no replacement for a caring doctor who can truly care for you and understand the context of what you’re going through. Many in the healthcare field worry that outcomes will be worse from urgent care approaches, that antibiotics may be prescribed unnecessarily, and that key conditions or issues may be missed. Plus, fast isn’t always better — or cheaper. “None of the research has shown any of these approaches to delivering care has meaningfully addressed cost,” Dr. Werner said in the New York Times.

That said, even the best primary care doctor doesn’t eliminate the need for excellent care coordination and healthcare collaboration. For many years, the primary care doctor seemed like the panacea for coordinated, thoughtful care. But in reality, so much has fallen through the cracks for so long. And overloaded providers struggle to do healthcare collaboration and care coordination in the right ways. 

So much is lost when we transition from primary care doctors to urgent care clinics. But something might be gained as well. Perhaps, as the traditional structures of healthcare change, doctors and patients may begin to be more open to new solutions. Demands for speed and efficiency are exposing the weaknesses of the old system, certainly -- it's up to us whether we rise to the occasion and create better things to replace what's no longer possible to depend on. 


For more stories of how people are using telemedicine to move forward in healthcare, download our quick guide: 

ClickCare Quick Guide to Telemedicine


Tags: direct primary care, care coordination, emergency medicine, healthcare collaboration software

The Surprising Result of a Study on EMR-Related Medical Errors

Posted by Lawrence Kerr on Wed, Apr 04, 2018 @ 06:00 AM

andrew-pons-6488-unsplashElectronic Medical Records are one of the most frustrating parts of every healthcare provider's day. 

EMRs are notorious for being difficult to use and to make do what you want, and they impinge on our ability to be present with patients. 

I think most healthcare providers instinctively feel that the EMR is, overall, a net negative in the way they care for their patients. But a new study has some surprising results that may shock any provider who uses an EMR intensively. 

The sense that Electronic Medical Records are taking a toll on medicine is one thing. But a team of researchers who published their results in JAMA recently decided to quantify that toll. The researchers looked at 1.7 million patient safety incidents reported to the Pennsylvania Patient Safety Authority and from a large multi-hospital academic medical center between 2013 and 2016. They were trying to codify whether the safety reports were linked directly to an issue of EMR usability. 

The results are surprising. As Fierce Healthcare summarizes, "The authors found just 0.11% of events explicitly mentioned an EHR vendor or product and just over 500 events (0.03%) includes language explicitly referencing EHR usability."

In other words -- barely any of the incident reports related to the EMRs being hard to use. 

When I read this, I furrowed my brow, not quite believing the results. The data was surprising, given my and my colleagues' felt experience with EMRs. We'd expected that many incidents would arise in one way or another from the EMRs' lack of usability.

The JAMA study defines Electronic Health Record (EHR) usability as "the extent that EHRs support clinicians in achieving their goals in a satisfying, effective, and efficient manner." Even reading that sentence puts a spotlight on current shortcomings. Few providers feel their EHR lives up to that standard. 

Sure, the study design may have created far too conservative a standard for linking the patient safety issues and EHRs. (The standard was that the vendor or product be mentioned by name, which may well be unlikely even if the EHR's usability contributed to a safety incident.) But what I found even more interesting was simply my reaction to the study. I was very surprised that there weren't more related safety incidents; in fact, even the study's authors seem incredulous at the results, trying to explain why they were so low: "Broadly, patient safety incidents are notoriously underreported, and the likelihood that a clinician would include the name of the EHR vendor tightens those parameters even farther."

Our tools are so difficult to use that we think they are putting our patients in danger -- this is sobering to realize. in contrast, we made iClickCare so intuitive, so visual, and so simple that anyone understands it easily, within seconds of opening the program. And that's not because we're better funded than the entrenched EMR vendors -- it's because we care and because we have a medical and a software background. 

It's time for us to demand more from the tools we use. And if your telemedicine platform or electronic health record isn't fully useable and supportive of your practice, it's time that you start demanding changes. 


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Tags: telemedicine solutions, healthcare collaboration software

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