ClickCare Café

Believe It or Not, There is a Human Behind Every Part of the Healthcare System

Posted by Lawrence Kerr on Fri, Oct 19, 2018 @ 06:00 AM

rawpixel-600792-unsplashMy daughter has a particular pet peeve. She’s noticed that in so many movies, when there is a doctor in the story line, he or she (usually he) tends to be arrogant, insensitive, and uncaring — in so many ways, inhuman.

As doctors ourselves, we tend to see our colleagues — whether doctors, nurses, or aides — as very much human because we know them and interact with them every day. But it’s easy to see insurance carriers or drug companies or other parts of the healthcare system as faceless monsters that make our patients’ lives difficult.

Which is why I was really interested to read a series of articles that turned all of that on its head, and definitely warmed my heart.

A couple of weeks ago, Gina Kolata wrote an article in the New York Times about the new class of drugs, PCSK9 inhibitors, that slash cholesterol levels for patients that aren’t seeing results on statins, or with diet or exercise, but have serious risk of early heart attack or stroke.

She told the story of the hyper-expensive drugs, the $14,000 price tag that the drug manufacturers have set, and the insurance carriers that create a byzantine maze for any patients trying to access the drug.

It’s a well-known story — evil drug companies and evil insurers make it impossible for patients to access the care they need. When I read it, I didn’t think much of it.

Then, about a week later, another story came out.  In this one, the New York times reporter tells a story that pretty much upends all of my assumptions about the players in the story.

The evening her story was published, the founders of Regeneron — the manufacturer of the PCSK9 inhibitors — emailed her.  Dr. George D. Yancopoulos and Dr. Leonard S. Schleifer wrote:

“If you can, please put Mackenzie and Rodney in touch with us, and we will try and help them get covered, or we can arrange to give them the drug for free… While we can’t give everyone free drugs, we can help Mackenzie and Rodney, especially as they had the courage to step forward and share their experiences.”

He then gave his personal phone number and asked the journalist to give it to the patients in the story, “explaining that he can be slow answering emails.” 

In her story detailing her conversations with Dr. Yancopoulos, Kolata told the story of Regeneron. It was founded by the two doctors in 1988. 20 years after that, Regeneron got its first drug approved. 5 years after that, they made a profit. 25 years of a business isn’t exactly a “get rich quick” scheme. The total cost to develop the drug was $1.6 billion and last year they made just $195 million (a tiny fraction of the total investment.) In reading the article, it's clear that Dr. Yancopoulos has battled for decades to create a drug that he truly believes will save lives -- and that his heart is very much invested in making sure people have access to it.

Certainly, it's great that these two patients got access to the drug -- although that doesn't change the challenges that most patients will encounter in obtaining it. That said, it's a fascinating article and shows that even the most "inhuman" elements of the healthcare system -- for instance, drug manufacturers -- may have real people behind them who are doing their best to chart a course forward in a challenging system. 

The truth is that none of us are as smart as all of us, working together, are. (We say that a lot.) And for us all to work together, we must continue to see everyone in the healthcare system as human. 

 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, healthcare collaboration

Why Overall Well-Being is as Important as Medical Intervention for Cost Savings

Posted by Lawrence Kerr on Tue, Oct 02, 2018 @ 06:00 AM

rawpixel-678092-unsplashHealthcare is such a potent combination of art, science, social work, and hard economics. And where these varying approaches touch each other, there can be friction.

So many healthcare providers view what they do as a combination of art, science, and social work — with hard economics never (or rarely) entering their mind.

But many times, healthcare economists come from a perspective that assumes something very different about how healthcare functions and how providers make decisions. Many times, healthcare economists use as a fundamental premise the idea that: providers are self-interested and will bill for as many services as they can; and it’s crucial to focus on hard outcomes of services, not on overall well-being of patients. Their perspective tends to be that hard economics reign and that these other approaches are dreamy intangibles.

A new study in JAMA challenges all of that.

JAMA published a study described as a “US national, population-based cross-sectional study [examining] the association between county well-being and Medicare fee-for-service (FFS) spending.”

In other words, researchers looked at whether Medicare spending was lower when people’s overall (non-medical) well-being was better. The results?  Medicare spent almost $1,000 less per patient for those in the 20% of well-being scores, compared to the bottom. And this is after adjusting for independent factors like income, urbanity, educational level, etc.

As the JAMA study explained, “Well-being is a positive state of being beyond the absence of disease, measured by not only physical health but also other dimensions, such as emotional, social, and economic health. Well-being may be modifiable by a broad range of interventions across different sectors.”  It’s all the stuff that we tend to see as “outside the scope” of a given medical intervention.

We think this is an incredibly important insight and study highlighting something not commonly spotlighted. Certainly, new models have gone up one level to reward fee-for-performance rather than fee-for-service. But the truth is that this measure of overall well-being is up several levels beyond that. And to capture the economic value of our patient's overall health and happiness is important. 

The whole goal of what we do as doctors is to support our patient’s well-being. But if you really needed another reason to pursue that measure, this is evidence that a broader view, a more holistic approach, is cost-effective too.

One of the challenges that we get into with iClickCare utilization is that it might be more efficient to just allow secure text-messaging, rather than having a fulsome, team-based, archivable healthcare collaboration system. The very reason we do what we do is because we believe that this kind of more holistic, team-based approach may not be the fastest way to get a simple, discrete answer — but it is the most efficient, effective, and cost-conscious way of approaching the whole patient. The "whole patient" includes all aspects of their medical condition as well as the other factors in their life that interrelate with that condition. 

The components of well-being in the study that decreased cost-per-patient so dramatically were largely non-medical. That means that any collaboration system that doesn’t allow non-medical caregivers and providers (social workers, teachers, caregivers, etc) to collaborate is misguided and ultimately wasteful in terms of ROI. 

We're glad that this kind of study is being done. And we continue to applaud the efforts of all of those healthcare providers who take the holistic view of their patient's well-being -- rather than simply addressing the malady in front of them. 

 

Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet

Posted by Lawrence Kerr on Thu, Sep 27, 2018 @ 06:00 AM

jordan-rowland-716475-unsplashMost healthcare providers let “innovations around reimbursement” come and go.

The majority of us — whether we’re aides, nurses, specialists, or generalists — try to provide the best care possible, in as reasonable a way as possible. And we let the reimbursement and payment fall however it does, after the fact.

That said, there are certainly big shifts that affect how we care for patients — and certainly how we’re paid to do so. And “bundled payments” are one of those shifts that are big enough to pay attention to.

A New York Times article did a thoughtful review recently of Medicare’s bundled payments programs. Currently, these programs are effectively pilots, with hospitals able to opt into the program, rather than making them mandatory.

As I’m sure you’re aware, bundled payment programs create a single payment for every health care service associated with an event. (Rather than paying for the healthcare services individually.) The idea, of course, is that this approach would decrease costs: “In theory, if doctors and hospitals get one payment encompassing all this, they will better coordinate their efforts to limit waste and keep costs down.”

Of course, anyone who has ever gotten a “meal deal” because it was a better value — even though they weren’t originally planing on buying chips or a drink — understands why this may not be the best idea.

That said, some data shows that at least for hip and knee replacements, overall costs are slightly lower than with fee-for-service models. But different types of healthcare are different. And data on hip and knee replacements may not relate at all to other areas of healthcare — especially when the data is coming entirely from hospitals who have opted into the program (rather than taking part in it mandatorily.

But we have some broader concerns about programs like bundled payments.

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet:

  • Most waste isn’t coming from doctors pursuing profit over smart care.
    One core concept in the formulation of this type of program is that providers are seeking profit first and safe, considerate care second. My honest take? This happens, but not very often. And so it's possible that one of the framing ideas is false.
  • Savings from bundled payments necessitate collaboration — and collaboration needs tools.
    Bundled payments benefit greatly from collaboration that can be empowered by healthcare collaboration tools like iClickCare. But simply changing how things are paid for may not provide the tools necessary to make that collaboration -- and thus the savings -- possible.
  • Savings from bundled payments necessitate care coordination — and care coordination demands support.
    This type of integrated payment depends on the interdependency of the providers. As with healthcare collaboration, however, providers are often attempting to coordinate care against all odds. And so it may make more sense to make care coordination more effortless than simply to change payment structures.
  • The “bundle” might not be the right combination of services.
    The bundling structure assumes that it is known what’s needed for a given healthcare event. The reality?  Healthcare “events” can be unpredictable and complex -- every patient is different.
  • Savings are good but rationing usually isn’t.
    The author of the Times article makes a point about steering patient access. While it certainly makes sense to guide patients towards the most appropriate treatments, I worry that this structure can raise the spectre of rationing -- which usually means that people with the least resources end up getting the worst care. Plus, in these programs, quality is generally not taken into account, at least not in very sophisticated ways — especially tracking quality across different groups.

 

All of the above isn’t to say that an overall shift to value-based care isn’t desirable (plus, it’s likely inevitable.) But we do think that it’s important to advocate for supports for shifts in care and reimbursement — not just change how doctors are paid.

 

Looking for ways to save costs in your hospital system? Hybrid Store-and-Forward may be the simplest way towards great ROI: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: care coordination, healthcare collaboration, value based care

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

Medical Education Fails to Prep Doctors to Care for Addiction

Posted by Lawrence Kerr on Tue, Sep 18, 2018 @ 07:00 AM

joshua-ness-225844-unsplashAs we’ve written about recently, the opioid epidemic is at staggering levels, and touching millions of lives every year in the US.

While these are complex cases, the truth is that treating addiction is not something that exists as distinct from treating any patient — since any patient can experience addiction. And a recent article in the New York Times put a spotlight on how our medical education may be failing to prepare doctors effectively to treat patients with addiction. 

The doctors, professors, and administrators in our medical education system are incredibly dedicated, and manage to adapt to a rapidly changing healthcare system. Some of the most satisfying work in my career has been my work with medical students and residents.

That said, there are always components of medical education that feel neglected, whether that's nutrition or alternative medicine. The care and treatment of addicted patients is no different, except for the staggering scale of the problem. In fact, addiction is contributing to 623,000 deaths each year in the US. And a new article explores whether our medical training is contributing to the shortcomings in how we care for these patients.

Realistically, the article documents what we're all aware of -- it's uncommon that there is sufficient training or support for doctors in caring for addicted patients. Most medical schools offer some training about opioids, but they rarely go very deep. New initiatives are aiming to create fellowships in addiction medicine -- but more trained fellows won't help the myriad of patients seeing providers in other fields who need solid training in how to care for them. But we also felt that some important perspectives were being left out of the conversation as represented in this article and the common ways of thinking about treating addicted patients.

5 things we know for sure about medical education and the treatment of addicted patients:

  • Medical education can’t stop at graduation.
    It concerns us that the conversation about education around caring for addicted patients is understood to be limited to medical school. In contrast, we've always had three core principles at ClickCare: access, collaboration, and education. We've baked education into every single aspect of how iClickCare works, since we believe that medical education should be a lifetime goal -- both as teachers and as students. The opioid epidemic is changing rapidly over time and so our medical education has to keep up -- it can't get stuck in decades-old coursework. Allowing teams to archive and search cases for education (using a tool like iClickCare) is crucial to this process.

  • "Problem patients" are everyone's problem. 
    All healthcare providers face different pressures. But we believe that when you decide to become a doctor, we believe that it's no longer ethical to see complex patients or cases as "not my problem." One of the suggested solutions to the training gap is to create "addiction medicine" specialists rather than increasing training around addiction for all doctors. Is specializing in addiction really the way to go?  Perhaps, all that does is let the rest of us off the hook for a very human dynamic that can happen to any patient and that we all need to be able to treat and recognize.

  • We must teach each other.
    We have different strengths and weaknesses. And in an increasingly complex medical setting, trusted collaboration and complementarity is crucial. The care and treatment of addicted patients is a great example of why healthcare collaboration -- whether supported by Hybrid Store-and-Forward telemedicine or through another means -- is so important.

  • Chronic diseases need special treatment.
    Addiction, like Diabetes, is a chronic disease. And patients suffering from chronic diseases need true care coordination, long-term collaboration within an integrated care team, and a truly team approach to their care. Addicted patients are no different, and we must find ways -- together -- of treating them as effectively as any other patient.

  • There must be space for ambiguity. 
    As the New York Times article says, “although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.” Addiction is a delicate, nuanced challenge that requires providers to be able to handle ambiguity at an emotional and an intellectual level. That said, out tools must also be able to support and handle ambiguity. Rather than a text message which demands a succinct answer, telemedicine-supported medical collaboration allows more space for ambiguity because there is more space for nuanced conversations. Photos, videos, complex conversations, and multidisciplinary teams are all components of supporting complex care for complex cases. 

We know that many of you are "on the frontlines" of caring for patients with addiction every day. And we certainly hope that you're able to find the tools you need to evolve as a healthcare provider within that -- teaching, learning, and caring for patients.

 

To learn more about Hybrid Store-and-Forward® telemedicine, download our white paper for free:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, healthcare collaboration, medical education

Is Medicine Today Shift Work, Team Work, or Solo Work?

Posted by Lawrence Kerr on Thu, Aug 23, 2018 @ 06:00 AM

john-price-380340-unsplashIt’s increasingly rare in everyday life to have someone take responsibility for caring for you or serving you.

If you sign up for a new account at a bank, the smiling salesman doesn’t end up being the person you interact with when you stop in to make a deposit. Most of us no longer have personal relationships with our grocers or butchers or farmers.

And the field where this change seems the most dramatic is medicine. As we’ve all experienced, the last few decades have shown a shift in medicine from everyone having a family doctor to… almost the opposite of that. Hour caps for residents, the rise of hospitalists, an emphasis on advanced practice nurses, and a change from medicine-as-a-calling to medicine-as-a-career-path have all contributed to a more fragmented, less personal relationship between patient and doctor.

So do these changes mean that medicine is now shift work?  And are the outcomes of these changes negative across the board?

As a surgeon, I always believed that the person who does the surgery is the person who checks on the patient after surgery. In my life, that sometimes meant my kids waiting in the hallway while I checked on a patient right on the way to a restaurant for Saturday night spaghetti. The generation before me might have done house calls and likely knew whole families, over generations.

A recent New York Times article looks at the shifts that have occurred recently.  These shifts have pushed medicine dramatically away from each person “having their doctor” to care being provided in a way that’s agnostic of who is giving the care and is more about who is responsible during any given hour, or for any given problem. The interaction described by the doctor and author of the article is emblematic of precisely these changes:

“Will you be my regular doctor?” a new patient seeing me in my primary care clinic asked.

“Sort of,” I honestly answered.

She looked back at me quizzically.

“Technically speaking I will be your doctor,” I explained. “But you may have trouble scheduling an appointment with me and may have to see another doctor here at our group clinic at times. And if you need to get admitted to this hospital, other doctors who work there will take care of you.”

 

Although I think that this change is positive in many ways -- and ultimately necessary -- I also worry about some of the "side effects" of the shift to shift work.

Specifically, I think that there are a few specific negative consequences of the change from medicine being a calling, with ultimate personal responsibility, to medicine being a career path, made up of people primarily doing a kind of shift work:

  • Lower satisfaction for healthcare providers. If you're handing off patients to a colleague once you complete your shift or role in care, you don't see the "welcome home party", hear about the happy return to a hobby, or see the relief in a daughter's eyes. Frequent handoffs in medicine often make it less satisfying to doctors because you don’t see the real life outcomes of your patients.
  • Less holistic care. The more we know about our patients' lives, families, circumstances, goals, and passions, the more we can make their care smart and holistic. The more fragmented care becomes, the less holistic it becomes -- the third provider in the handoff chain may have no idea about a key personal circumstance that could affect care or compliance.
  • More coordination mistakes. More handoffs mean more cracks for things to fall between. So often, signing out to a colleague is the crucial link in the chain to avoid problems -- but this step doesn't always or can't always happen.
  • Decreased trust in healthcare system. I've noticed that one reason patients trust medicine, and doctors specifically, less than they used to is that there isn't any one person to trust. 

So is good care possible within this fragmented system? I think it is -- but it involves a key shift in perspective. And I believe that the shift in perspective is this: 

We must evolve from shift work to team work. 

We can't go back to the old model of medicine as solo work. It looks like, for most of the population, we're not going back to house calls or family doctors. But even within the current medical framework, we can change from a handoff mentality, to a team mentality – we can evolve from shift work to team work. On a team, each of us is not always carrying the ball or responsible for the patient. But we're all always responsible for the outcome as a whole. That means that as medicine has changed, healthcare collaboration and care coordination has become not a "nice to have" but an absolute "must have" in order to provide adequate care to our patients. Ultimately, team work is about taking responsibility for the outcome of every single person we care for, even if we collaborate with colleagues on portions of that care.

It's not about handoffs, it's about collaboration. 

 

To try iClickCare for collaboration today, get it free here: 

Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

Why Limiting Access to the Medical System May Be a Good Thing

Posted by Lawrence Kerr on Wed, Aug 15, 2018 @ 07:00 AM

masaaki-komori-601781-unsplashI’ll be the first to say that our medical system, despite its flaws, is miraculous.

The care that healthcare providers give on a day-to-day basis, in terms of complexity and art and compassion is astounding, especially when we look at how far we’ve come in the last 100 years.

That said, the evidence is mounting that in many ways, the negative effects of contact with the healthcare system are significant. Are they usually are out weighed by the benefits of accessing healthcare? Certainly. But just as every drug has its side effects, the side effects of medical visits and hospital stays themselves are becoming more obvious and quantified.

So does healthcare really have a negative impact on health?

I think there is strong evidence that it does. For instance, this article on “post hospital syndrome” raises the point that hospital stays can be extremely damaging to the overall health of patients, especially the elderly. While the stays tend to treat the original illness, there is observed to be a significant impact on the patient's overall health, wellness, and independence.

In fact, post-hospital syndrome seems to be a cause of the very high readmission rates among older people. In 2016, about 18 percent of discharged Medicare beneficiaries returned to the hospital within 30 days, according to the federal Centers for Medicare and Medicaid Services.

Dr. Harlan Krumholz, a cardiologist at Yale University, has been looking at the reasons for this. When he looked at 30-day readmissions, he found that many causes of readmissions had nothing to do with the initial admission. “Patients came in with heart failure or pneumonia, were treated and discharged, then returned with internal bleeding or injuries from a fall. ‘Our general approach in a hospital is, all hands on deck to deal with the problem people come in with,’ Dr. Krumholz said. ‘All the other discomforts are seen as a minor inconvenience.’”

But the other discomforts can be incredibly serious when it comes to health and recovery after an illness. Dr. Krumholz is finding that simple things that keep patients’ lives as normal as possible even when hospitalized can have a big impact — walks down the corridor, wearing their clothes, eating normal foods, etc. These things can make it so that muscle loss, cognitive degradation, confusion, balance issues, and the like are all mitigated.

Solutions are mimicking regular life. But the only thing better than that is actual regular life -- keeping people out of the hospital, or even away from a doctor's office, as much as possible.

Similarly, outside of an inpatient context, we tend to refer and set appointments as if the transportation isn’t a relevant concern. But as this article explores, healthcare transportation can be a major impediment to care, a huge expense, and a important disruption to the patient’s life.

Each contact with the medical system comes at a cost. These costs can come in the form of money, transportation, and a negative impact on the things that keep people healthy and happy. And so many times, our patients don't need to be interacting with the healthcare system nearly as much as they do. A referral to a second provider, with its accompanying visit (and long drive, and a day off work or play), could easily be replaced by a quick consult with a tool like iClickCare. A hospital visit may be able to be shortened by 30% if the providers on the case had a quick way to touch base on the patient's status. Hopping between doctors for different diagnosis perspectives can be replaced by team-based medical collaboration (like hybrid store-and-forward® telemedicine.)

So what are providers to do? My opinion is that when healthcare providers work together more, patients need to interact with the healthcare system less. The truth is that when we are able to collaborate effectively, we dramatically cut down on length of stay, total number of medical visits, and time spent in a medical setting.

Evidence shows that home, and regular life, is where people heal. So let’s work together so our patients can spend more time there -- and less time in a hospital bed or in a doctor's office.

 

iClickCare is a simple way to cut length of stay and even visits. You can try it for free here: 

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Tags: healthcare collaboration, decrease readmissions, decrease length of stay

Why Telemedicine Can Help You Make Better Medical Decisions

Posted by Lawrence Kerr on Thu, Aug 02, 2018 @ 07:00 AM

michal-parzuchowski-43274-unsplashAnnie Duke is an author, consultant, and former professional poker player. In other words, she studies good decisions for a living.

Medicine, of course, is about far more than good decisions. It’s about compassion, leadership, science, and training. But excellent decisions — in both diagnosis and treatment plans — are absolutely crucial for providing excellent care. So I was intrigued to read an article recently, in my investment journal of all places, that made me think a lot about decisions and how we can make them better as healthcare providers.

The article, "Making Better and More Rational Decisions. An interview with Annie Duke," in the American Association of Individual Investors Journal, is a compelling piece with applications for life and investment, certainly. 

But what fascinated me were the implications for healthcare providers, trying to make the best possible decisions they can. Further, I noticed that many of Annie's points boiled down to getting better information or bringing others in on your decision -- both of which are deeply supported by hybrid store-and-forward telemedicine, when it comes to medical decisions. 

3 Fascinating Decision-Making Tips for Healthcare from Decision Expert and Pro Poker Player Annie Duke:

1. Remove emotion from the decision. 
We don't think about medical decisions as having an emotional component, but the truth is that they do. It's not unusual to get caught up in all of the details of a case, feel an emotional reaction to a patient, or otherwise let emotion creep into the decision-making process. Annie Duke says that predicting downsides is core to the decision-making process. And that predicting downsides is easier when you’re not emotionally involved -- which means that our colleagues' unbiased opinion is often crucial to a good decision. It's the reason that "bouncing an idea off" someone is such a common way to approach a decision -- but we have to have the tools in place to quickly and easily bounce ideas off colleagues, even when they're not just down the hall. That's what a consult via a telemedicine solution can do for you.


2. Bring in people with different experiences and views than you have.
That will lead to a better decision. “It’s especially important to seek out opinions that disagree with you. This is because we naturally notice things that do agree with us, and we already know why we think that way.”  Hybrid store-and-forward telemedicine is the most powerful way of truly engaging a team approach to telemedicine. Since you can quickly, easily, and asynchronously collaborate with people on the medical team across the continuum of care, it's not hard to bring in people with diverse experiences, views, and expertise than you have. These providers, who may not agree with your initial ideas, can help us make dramatically better decisions on behalf of our patients. 

3. Learn from past decisions. 
Learning from past decisions is crucial. It lets you take in new information, learn lessons from cases that didn't have the outcome you anticipated, as well as help our students or colleagues make better decisions by learning from our experiences. That's why every case in iClickCare is archived and searchable -- it's a realtime learning tool for making better medical decisions, now and in the future. 

 

Ultimately, good medical outcomes come from good medical decisions. These decisions may be large or small, but their sum contributes to the patient's outcome. So any tool that can help us make better decisions, may be critical to good care. That's one reason we're so passionate about our work with iClickCare -- and a reason to try it if you haven't already. 

 

Try the iClickCare 14-day evaluation

 

Tags: care coordination, healthcare collaboration, medical education

Migrant Children Highlight a Care Coordination Problem We All Have

Posted by Lawrence Kerr on Wed, Jul 25, 2018 @ 07:00 AM

chinh-le-duc-132753-unsplashOne truth that we don't acknowledge often enough is that the healthcare system often depends on caregivers to coordinate care. True, we have other members of the care team who do care coordination also, and we have tools that help us, but in many situations, it is the patient's caregiver that is doing the bulk of the caregiving. 

Healthcare depends on caregivers remembering care history, advocating for providers to collaborate, and reminding providers of key conditions when that information gets lost in the shuffle. This becomes exponentially more true, the more chronic, complex, or multidisciplinary a patient’s situation is.

The truth, of course, is that this isn’t always possible or feasible. Some patients don’t have an advocate or caregiver that is able to play this coordinating role. We do have team members like social workers and patient advocates, but sometimes the coordination of the care itself falls between the cracks.

I realized recently that there is an extreme case in which patients don't have a solid medical history and don't have a dependable caregiver able to coordinate care on their behalf. The situation is the medical care provided to the migrant children separated at the US border. It's interesting because it highlights the dangers inherent in the medical system for someone who might not have the same social supports and networks as many patients do.

A recent article in the New York Times looked at the situation in New York City, in which providers at public hospitals are seeing children who were detained at the border and separated from their parents. Brought in by foster parents, “The children who come in with medical issues such as asthma are without adult family members who can provide medical history.”  Further, therapists are endeavoring to provide emotional care for the children, along with the fact that they’re in the midst of an ongoing traumatic experience.

It's an obviously challenging situation and both foster families and healthcare providers are scrambling to help. But the broad strokes of the care don't different significantly from anyone without family to help, or caregivers to coordinate. These situations expose the cracks and weaknesses that affect all patients.

The truth is that to truly provide excellent care to all patients, we as healthcare providers need to be able to do care coordination and healthcare collaboration without the support of caregivers and family. We must identify and develop the tools we need to make this possible -- to allow us to communicate across the medical team, access key medical history, and consult with other providers efficiently and appropriately. The stakes are simply too high not to. 

 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, care coordination, healthcare collaboration

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: 

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Tags: good medicine, healthcare collaboration

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