ClickCare Café

Long Term Care Staffing Woes Demand Care Coordination

Posted by Lawrence Kerr on Tue, Jul 17, 2018 @ 07:00 AM

eberhard-grossgasteiger-255502-unsplashLong Term Care is complex — and it’s no secret that providers have long been doing a lot with a little — providing the best care they possibly can, with limited resources.

The nurses, aides, and other healthcare providers are generally committed, savvy, deeply caring people who provide sophisticated care to people with chronic conditions. And, usually, they receive less support than they should from the broader medical community. Our Long Term Care colleagues report feeling more isolated than they'd like to. 

So, a new report by the New York Times felt a bit blindsiding for our colleagues in the community. 

According to the piece, “Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data.” A spotlight was put on facilities that could possibly be "gaming" the Medicare system by over-reporting staffing. And a serious look was given to facilities that have provider shortages on nights and weekends  a serious potential cause of issues like falls.

These issues are serious. And the reality is that skilled nursing facilities need oversight, especially because of the population they serve. These issues certainly shouldn't be downplayed or minimized. As David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine commented, “Volatility means there are gaps in care. It’s not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day.”

That said, this New York Times article is written like an exposé. It's written as if the nursing facilities are trying to “pull one over” on Medicare and the public. And, surely — some facilities probably are being dishonest in how they run. But most are trying to do the best possible work they can in an era when there is a shortage for great providers.

For instance, the New York Times references David Camerota, Chief Operating Officer of Upstate Services Group, who said that many nursing homes are in "a constant battle to recruit and retain employees even as it has increased pay to be more competitive."

In our opinion, Long Term Care and skilled nursing facilities would improve more by being offered better tools and more support  rather than more oversight or more scrutiny. We've found that hybrid store-and-forward telemedicine can be transformative in supporting providers in connecting with collaborators outside the walls of their institution  effectively amplifying the manpower of their healthcare providers. When there is a dearth of healthcare providers, care coordination becomes essential. For someone who may be caring for more patients than they should, the ability to ask a question of a specialist or an RN, regardless of the time of day, can mean the difference between a great outcome and a sad one.

Further, in addition to the substantive impacts on patient care, a tool like iClickCare can be powerful for lessening the sense of isolation and alienation that overworked Long Term Care providers can feel. And ultimately, that sense of connection is what we all need  the providers and the patients, alike.

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: long term care, care coordination, healthcare collaboration, skilled nursing facility

The Opioid Epidemic Can't Be Solved Without Healthcare Collaboration

Posted by Lawrence Kerr on Thu, Jul 12, 2018 @ 09:15 AM

freestocks-org-126848-unsplashWe're all aware of the opioid epidemic in the United States.

We've seen the tragic photos of lives ripped apart. We've scanned the news describing the huge dollar amounts committed to resolving the problem. And we've experienced the complexities of treating an opioid abuser as healthcare providers.

But the truth is that our approach to care, treatment, and policy around this disease is lagging behind the realities of the epidemic. And as healthcare providers, we play one of the most important roles in preventing and treating the disease -- and caring for its sufferers.

Certainly, there are bright spots when it comes to the opioid epidemic. As Fierce Healthcare reports“Data from the Medicare Part D program show fewer beneficiaries are receiving high amounts of opioids, but a watchdog agency says usage 'remains concerning,' while urging insurers to further restrict at-risk patients with lock-in programs. However, 1 in 3 Part D beneficiaries still received at least one prescription opioid, and the overall level of opioid use 'continues to raise concerns.'"

Chemical dependency is not solved by other chemicals.  In the long term, many changes are needed and extensive, ongoing support is vital.  This includes the extreme burden placed on the providers themselves. Dependency is not an inpatient disease. It is not an outpatient disease. It is not family therapy. It is not joblessness, nor hopelessness. It is pervasive and knows no time schedule. It is difficult to treat for the provider, and a lifelong challenge for the patient.

If there was ever a time and need for universal healthcare collaboration across the entire spectrum of providers, patients and families, it is now, with this disease.

A single episode of failed access, of telephone tag, or of failure to educate –– results in the crashing down of years of rehabilitation. But who has the time or resources or skills to be available everywhere, for everyone, all the time?

A dramatic, gripping, thoughtful, and open Perspective piece in the New England Journal of Medicine by Audrey M. Provenzano, M.D., M.P.H., once read, becomes nearly haunting. She describes her feelings about caring for a patient with addiction:

“Already overwhelmed, I did not want to take on patients with needs that I did not know how to meet.”  She finishes the essay with a sentiment common to all who practice medicine: “I wish that I’d listened more closely. I wish that I had not been afraid.”

Dr. Provenzano articulates beautifully the loneliness and isolation a healthcare provider can feel in treating such a complex, multifaceted disease. Yes, a tool like iClickCare can smooth and facilitate the healthcare collaboration that bring many types of services and providers into one case. But perhaps equally importantly, a tool like iClickCare can alleviate the loneliness and isolation that the providers themselves feel. And that's not just a "nicety." That's a core part of ensuring sustainable care for the patients they are treating. 

As a company, we're finding ways of contributing to the opioid epidemic, using hybrid strore-and-forward telemedicine to facilitate the complex care needed. And as fellow healthcare providers, we certainly stand with the providers on the front lines of navigating this care every day.

If you're facing complex patients or opioid abuse in your practice, try iClickCare as one of your tools: 

Try the iClickCare 14-day evaluation

 

 

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

5 (More) Reasons Healthcare Collaboration Helps Medical Providers

Posted by Lawrence Kerr on Thu, Jun 28, 2018 @ 06:00 AM

adam-jang-260876-unsplashMedicine is an altruistic career path for most of the people who undertake it.

Certainly, there are those who pursue it for the perceived salary benefits, but most health care providers pursue medicine as a means to help people, and to achieve a level of professional excellence.

Sometimes I wonder if this is why many doctors are very resistant to “anything extra.”  We feel so overtaxed by the altruistic work we do every day that we simply can’t comprehend adding anything else to an already full plate — both practically and emotionally.

Although there are altruistic reasons to do healthcare collaboration and use telemedicine, I also believe that there are selfish reasons as well. And perhaps the best professional practices are those that sit at the intersection of both.

Yes, telemedicine is altruistic in the sense that it improves outcomes for our patients.

But the reality is that, as medical providers, we benefit as much as the people we are treating, do. So I thought back to the benefits that my colleagues who use iClickCare have experienced and realized that the benefits to the individual provider are meaningful and concrete.

5 Concrete Ways that Telemedicine-Supported Healthcare Collaboration is Good for Medical Providers:

  • It gets you home to your kids faster. The reality is that working with colleagues on a diagnosis but not having to play phone tag to do so will save time -- those minutes grabbed during "lunch" (obviously just a sandwich while you do notes) or at the end of the day. And that means that you are delivering the care you know is appropriate, but you're home for dinner faster.

  • It can improve data and sophistication of care. I was really interested to see this article describing the healthcare collaboration among several competing health systems to share data to support precision medicine. Many of our newest technologies, including precision medicine, require resources and knowledge that we just don't have on our own. Just as sharing the burden of a specialized diagnosis can increase what we know, sharing data can increase our capabilities. 

  • It will decrease burnout. Healthcare provider burnout is exacerbated by providers' feeling of inefficacy in their work, overload in work quantity, and a feeling of disconnection from their patients. Healthcare collaboration can support improvements around all three things. Especially when supported by a telemedicine tool, healthcare collaboration can increase your feelings of connection and efficacy but not increase your workload or time burden. 

  • It makes your day more manageable. Playing phone tag might be done in stolen minutes throughout the day, but those minutes add up. Videoconferencing can further grab hours and attention. But healthcare collaboration that's asynchronous doesn't need to be a burden at all. It can actually streamline diagnoses, care plans, and your appointment schedule. 

  • It can keep you HIPAA safe. The reality is that whether you have the tools or not, you're going to ask colleagues for their input. But if you're texting, emailing, or using an other HIPAA-insecure tool, an innocent question can turn into a huge fine. If you have a HIPAA-safe telemedicine tool available to you, on the other hand, it's there when you need an answer, and you don't have to worry about staying compliant.

Ultimately, we know that you'll decide what tools you'll use based on what's best for you and what's best for your patients. But it's certainly helpful to know that a tool, and workflow that improves outcomes, together, are a route to positive things in your day and your life. 

 

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Tags: medical collaboration software, telemedicine solutions, healthcare collaboration

Is Medical Training About Rigor… or Bullying?

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, healthcare collaboration

Two Studies Show Care Coordination Can Be Simple

Posted by Lawrence Kerr on Wed, Jun 13, 2018 @ 06:00 AM

kara-michelle-544960-unsplashThere are certain transition points in medicine that are short in time, but outsized in importance. For instance, the moment of discharge, the moment of intake, the moment the patient arrives home after a hospital stay -- these are all brief periods within the scope of care but all have a big impact on outcomes.

And frequently, these moments of transition are attended by providers on the continuum of care that aren’t doctors and certainly aren’t super-specialists. It’s the aides, the nurses, the pharmacists, and the WOCNs that are there during these crucial moments.

Two recent studies put a spotlight on this truth for us… demonstrating just how important this dynamic is.
As Fierce Healthcare explores, “A nurse is typically the first person a patient interacts with, and he or she can set the tone for the entire visit.”  Because of that frontline position, a nurse can play a critical role in establishing a strong patient-provider, family-organization, relationship and even affecting the chances of a patient embarking on the indicated care plan. Nurses can also become a bridge among care modalities, connecting aspects of care, like behavioral care and physical care. A study they explored found that nurses were the crucial provider in a program that aimed to unify and streamline these two care approaches.

Similarly, Fierce Healthcare looked at an issue at Virginia Commonwealth University, in which pharmacists, a key part of the discharge process, weren’t being communicated with effectively: “Even though they are a key part of the discharge process, they had limited information on which patients were closest to being sent home.”

So Kelley Barry, senior clinical applications analyst at VCU Health, built a new system to indicate whether a pharmacist needs to rush to fill a prescription, whether a prescription is being waited for or delayed, or whether it’s been filled. Of course, “Discharge is a critical time for patients, particularly the elderly, and research shows that a more efficient, coordinated approach can ease the transition from hospital to home.”  VCU’s program lead said that the key step was breaking down the silos between the people involved in discharge.

"If you're not all working toward the same goal, you'll never meet it," Barry said. "If we all join in the conversation in real time, it makes things more efficient. That's what everybody really wants. How do we respect everyone's time and give the most updated information that everyone can act on?" 

In both cases — that of the study of the nurses and that of the pharmacist-oriented program, the solutions used:

  • Were simple and inexpensive.
  • Involved providers across the continuum of care.
  • Prioritized sharing information and bringing more people into the conversation.
  • Allowed participants to engage on their schedule, rather than a rigid way.
  • Didn't wait for change across the system -- they made improvements within an arena they could impact.

These are inspiring examples of people using care coordination, technology, and team-based healthcare collaboration in innovative ways. Did that innovation involve an expensive or technologically-advanced tool?  No. And that's just what makes these solutions so ingenious.

 

For more on simple ways of doing healthcare collaboration, get our Quick Guide for free: 

ClickCare Quick Guide to Medical Collaboration

Tags: care coordination, healthcare collaboration, nurse collaboration

Where Healthcare Collaboration, Telemedicine, and Patient Navigation Intersect

Posted by Lawrence Kerr on Thu, Jun 07, 2018 @ 06:00 AM

rawpixel-603653-unsplashOncology care is one area where care coordination, access to good care, and healthcare collaboration come to the fore.

The stakes are very high, the treatments are long-term and complex, care teams are interdisciplinary and cross the continuum of care, and there are often outcome disparities related to socioeconomic status. 

So I was really interested to review the proceedings of a workshop looking at Establishing Effective Patient Navigation Programs in Oncology, published by the National Academy of Sciences. The work raised some important questions about when patient navigation is effective, what problems it solves -- and what its crucial shortcomings are.

The context for the publishing of the proceedings of this workshop: The National Academy of Sciences, who published it, was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. In itself, it is a fascinating example of interdisciplinary collaboration.

The question explored in this workshop is whether, how, and under what circumstances, patient navigation can be a key tool for improving oncology outcomes. Of course, delivering high-quality cancer care to all patients presents numerous challenges, including difficulties with care coordination and access. The supposition is that "patient navigation" can be an important tool for meeting these challenges.

Patient navigation is defined in the paper as, "a community-based service delivery intervention designed to promote access to timely diagnosis and treatment of cancer and other chronic diseases by eliminating barriers to care.” (Freeman and Rodriguez, 2011). Navigation can improve early detection and screening, increase clinical trial enrollment, and remove barriers to care, etc.

How does that relate to healthcare collaboration?  In one way it is the same. The goals are the same, and the impetus for the development of the practice is the same. On the other hand, there are a few key differences. Patient navigation: 

  • It is disease-specific. Instead of looking at the whole patient across the continuum of care they need, the program focuses on cancer care.
  • It is centralized. Ultimately, patient navigation is a centralized hub approach. There is a central patient navigator, not team collaboration among all the parts of the team.
  • It doesn't change the fundamental care and collaboration patterns. Patient navigation is a bit of a stop-gap for a medical system that's working in sub-par ways, rather than a more fundamental transformative tool in how we do medicine in the first place.

Key unresolved questions of patient navigation are described: 

"Unresolved questions include where patient navigation programs should be deployed, and which patients should be prioritized to receive navigation services when resources are limited. Patient navigation systems are often implemented as an attempt to address socioeconomic disparities in care delivery. Therefore, many interventions have been clustered in pre-dominantly minority and economically underserved areas, often in urban cancer centers. However, navigation programs often go beyond poor and underserved patients, to aid all patients. Experts also continue to debate whether patient navigation should be proactive or reactive, and who benefits most from using navigation programs, particularly with regard to ongoing concerns about the cost and value of care."

The description of these unresolved questions brought to the fore one of my key concerns about the patient navigation model. Everyone, everywhere, deserves and should receive collaborative, connected care. In order for that to be a reality, however, that would mean that our workflows would be supportive of collaboration throughout medicine, not that we create workarounds to treat the consequences of care when it's not collaborative. Patient navigation requires an assigned navigator -- which is an expense -- rather than enabling more efficient and time-proven workflows that are enhanced by technology such as Hybrid Store-and-Forward Telemedicine.

On one hand, this kind of patient navigation initiative is deeply impressive. Healthcare is facing so many challenges that if we don't have some "stop gap" programs patients will certainly be suffering needlessly. But so many parts of this feel like band-aids. The patient navigation itself is a bit of a band-aid for a system that isn't enabling its healthcare providers to collaborate. And then even the tools that patient navigation programs are encouraged to employ -- like videoconferencing -- to oversee navigation, are not as helpful as transforming workflows and enable true team collaboration. 

Ultimately, I'm firmly in support of this kind of program. I'm also in support of programs that seek to shift the structures, workflows, and systems whose limitations create the need for this kind of program in the first place. 

 

For more on Hybrid Store-and-Forward telemedicine, download our free guide here:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, care coordination, healthcare collaboration

The Royal Wedding and Healthcare Collaboration

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

 

 

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Tags: good medicine, healthcare collaboration

Healthcare Collaboration May Be World-Changing But It Can Be Very Personal Too

Posted by Lawrence Kerr on Tue, Apr 17, 2018 @ 06:00 AM

aditya-romansa-117344-unsplashWhen people consider becoming healthcare providers, it’s sometimes the “big things” that they think of. Saving a child’s life. Groundbreaking research. Dramatic diagnoses.

But the truth is that for many of us, the part of medicine that is most satisfying is actually the “little things.” A patient’s shy smile when she learns she can play in Friday’s game. A new mom’s growing confidence. Getting a a referral for a patient fast, with just the right combination of phone calls and sweet-talking.

In this age of patient satisfaction surveys, relentless metrics, and widespread provider burnout, we can forget that for patients, it’s actually the little, human things that matter most to them, too.

I read a beautifully written narrative recently that brought this dynamic to life for me. 

The author, Lisa Rubisch, a mom with a year-old baby, had a benign cyst in her uterus that she needed removed with surgery.

A person who was generally nervous with medical procedures, Rubisch felt especially vulnerable, since she had given birth to her young son not too long beforehand.

Once wheeled into the OR, Rubisch found that the team was playing Led Zeppelin on the overhead speakers. It was harsh, heavy music to her ears and unnerved her further.

“You don’t like Zeppelin?” a nurse asked, in his thick Queens accent. “Who do you like?”

I heard myself muttering the first band that came to mind: “The Beatles?”

Someone actually left the room in search of a Beatles CD but returned empty-handed.

“Well, I guess we should just call the whole thing off,”  I said, laughing nervously.

They stood around me in awkward silence. I could see in their faces how much they wanted to soothe me; they were all trying so hard to be cheerful and upbeat, but the truth was, the show must go on.

Then, from somewhere behind me, outside my peripheral vision, a lone male voice started to sing. “In the town, where I was born… lived a ma-a-an who sailed to sea…”

He was slowly joined in chorus by the other surgeons, nurses, assistants and anesthesiologists, in what was possibly the strangest, sweetest, most tuneless version of Yellow Submarine ever to be sung. “…and he told us of his life in the la-a-and of submarines…”

The whole surgical team singing an off-key Beatles song was a “little thing.” A medically unimportant, human moment that struck Rubisch in a profound way. As she put it, “When placing your life in someone’s hands, you want to know that they are particularly skilled hands. You want the best surgeon that exists in the universe. But beyond skill, beyond technology, medicine and state-of-the-art equipment, the thing that you remember long after you’ve healed is human compassion.”

So ultimately, the “little things” aren’t so little.

Knowing your patient as a person and understanding the social and economic and personal context of their life allows you to create these moments of human compassion. We talk a lot about telemedicine-based healthcare collaboration as a tool that does big things: cuts costs, saves lives, and creates a new way of doing medicine. But the truth is that doing healthcare collaboration with telemedicine allows us to do the little things too: to care for patients in ways that are meaningful to them — and satisfying to us.

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration software, healthcare collaboration

How Aboriginal Healers Do Healthcare Collaboration for Complementary Medicine

Posted by Lawrence Kerr on Thu, Apr 05, 2018 @ 06:00 AM

joey-csunyo-512460-unsplashLyn Ackerman has had 9 heart attacks and an infection she contracted from surgical tools. But she says that one of her biggest challenges has been being far from her community. 

She's also indigenous and is similarly distanced from her culture every time she goes into the hospital. Even waiting for an appointment has felt alienating and treatment has often felt irrelevant, far from the healers that she says many indigenous people are more familiar with. She said, "The healers' power for Indigenous people lay with their ability to reconnect them to culture, the lifeblood of their spiritual being."

This sense of alienation, as well as poor health outcomes, has continued until a new program was implemented in a local hospital. And for Lyn, everything started to turn around.

This new program is bringing aboriginal healers (Ngankari healers) -- whose tradition goes back 60,000 years -- into hospitals across Australia.

The healers work separately but in collaboration with conventional healthcare providers, in the hospital or clinic setting. As ABC reports, Ngangkari healers use their hands to, as they describe it, move energy and spirit. It's been shown to alleviate pain symptoms. 

One indigenous woman said, "I'd rather go to the Aboriginal clinic where you sit back, can have a yarn, catch up with family and friends." In other words: I prefer medical care when there is a connective, socially embedded component. And one of the biggest impacts of the program has been improved attendance rates. People comply with medical treatment when they feel it is appropriate to their lives and working in the ways they want it to.

It's an example of both complementary medicine and healthcare collaboration. Healers certainly don't replace conventional medicine in the hospital setting. And the doctors and the hospital aren't excluding the healers. Instead, each modality is respected as an important part of the whole picture for patients who may struggle with the way conventional medicine intersects with their beliefs and experience. And the program is in place to support appropriate elements of the team in providing and coordinating care. Of the Ngangkari healer program, Jon Wardle, a senior lecturer in public health at the University of Technology Sydney says: “Including healers in a hospital setting could also reduce the risks alternative medicine could have, such as physical trauma caused by under-qualified therapists, or interactions with prescriptions drugs if a patient was offered herbal medicine.”

This setup might seem a world away for many of us, with little experience of traditional healers. But the importance of having a holistic social/cultural/emotional view of care as well as a more expansive understanding of the medical team, is crucial for many patients. It's a dynamic that comes up for the high school athlete who has to miss games to travel to a specialist appointment three counties away -- and who would do better with compliance if his doctors were collaborating. Or the older gentleman who needs a change to his medication and may not come in if he feels like the doctor hasn’t understood the full scope of his challenges and can't get the social worker and doctor on the phone together.

Of course, the most commonly thought about forms of complementary medicine are things like acupuncture. Many of these "complementary" treatments are sidelined, and healthcare collaboration with doctors or the conventional medical team doesn't happen. Because of this shortcoming, treatment or medication conflicts can occur, and patients may be less compliant. Because of our limited idea of the "medical team" and our limited tools to do healthcare collaboration, care suffers.

When more people are part of the medical team, more modalities can be used to care for the patient. And that's always a good thing. The more integrated the team is, the more divergent but complementary the viewpoints, the more progress can be made. I think we can all learn from the Ngangkari healers and their doctor colleagues -- and I believe that we can all find ways to work together, whatever our context.

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Tags: care coordination, healthcare collaboration

Why School-Based Health Centers Are the Front Lines for Healthcare Collaboration

Posted by Lawrence Kerr on Wed, Feb 28, 2018 @ 06:42 AM

eye-for-ebony-402230-unsplash.jpgThis February weather has us reflecting a bit about the origins and core purpose of what we do at ClickCare. 

We are passionate about the big picture of collaboration in medicine. We're intrigued by the evolution of technology that allows us to build and refine our software. We're fascinated by medical advancements and new ways of doing medicine. 

But ultimately, the thing we're most passionate about is people. Specifically, the real and meaningful difference that thoughtful, effective, healthcare can make in a person's life. And the place we've seen that play out in the most interesting, powerful, subtle ways are in School-Based Health Centers -- which also happens to be where ClickCare started.

ClickCare wasn't started in a brainstorming session or at the keyboard of a programmer's computer. ClickCare was started in a school nurse's office.

Cheryl, our co-founder is a pediatrician in the Binghamton area, has focused her practice on the underserved in our community. Over time, she became connected with the school-based health centers near her office. There were several elementary schools that weren't especially wealthy in resources but were wealthy in caring teachers and caring nurse practitioners in their health centers -- the "nurse's office."

ClickCare was started -- with much more basic technology of course -- so the nurse practitioners at the school could collaborate with Cheryl on cases. It let the NPs use their insight in combination with Cheryl's perspective to keep students in class and get them healthy as fast as possible. We found quickly that the dynamics and reasons that iClickCare was so important and effective in that context made it particularly well suited to other care contexts as well. 

What few people realize is what a complex care context a school-based health center is. To give you a sense, we wanted to tell you the story of Shawn, an 8-year-old, just finishing first grade. He struggles a little bit with reading but is great at math. When asked his career goals, he says he'd like to be President one day, but would settle for being a scientist.

One Tuesday at 10:30am, Shawn raises his hand in class and tells Ms. Kapison, his teacher, that he doesn't feel well. He says he's having stomach pains and dizziness. She sends him to the health center within the school, which is where the care story continues:

  1. Kate, the nurse practitioner in the care center receives Shawn. She notices that beyond the flu or a cold, he may have psychosocial concerns as well. She remembers a few issues he had recently with other kids and also thinks about some of his challenges at home. 
  2. Kate makes an assessment, but with limited tools. Mostly, she is doing a thoughtful history and physical.
  3. Under significant pressure and great responsibility, Kate decides what happens next. Can she keep Shawn in school and coordinate care? It might sound like a small decision, but the ramifications are extensive. Shawn could get worse and there could be a delay in treatment if appropriate transfer is not made. On the other hand, his parents will be forced to take unnecessary time off from work if the child is sent out for no good reason except "to be safe."  Further, the referral may be to the wrong specialist.
  4. The child’s pediatrician can take over, but faces very sparse data. The process is prone to the same management challenges.
  5. Should the child need treatment, then the school’s role in post care management becomes important. When to return to gym? Is a rest period needed? Are there factors that interfere with learning?

Pediatricians often say: "A child is not a small adult."

For a child, the onset of illness is often quicker. And chronic disease needs to be managed as a growth project as opposed to a "holding" or "maintenance" project. Psychological overlay can be set up as a lifelong problem rather than as a compensation, as it would be for an adult. Like an athlete or soldier with the emphasis on keeping in play, the child needs to be kept in school in order to learn, and of course needs to be healthy to learn.

Children's problems tend to be a mix of simple and complex. And because the child is dependent, a caregiver is needed more often. A sick child means missed work for a working parent. Thus, a speedy, accurate, and specific diagnosis and treatment plan is important. Because specialty care is more likely to be needed, good communication and collaboration is even more necessary. 

This is why we developed iClickCare -- to allow all of these complex issues to be navigated, with telemedicine that involves multiple providers, across the continuum of care, to collaborate without interrupting their busy schedules, on complex cases. Children in schools need care coordination and healthcare collaboration on their behalf -- but, it turns out, those dynamics -- economic, psychological, social, personal as well as medical -- are present in every case. Children are not small adults; similarly, no person is simply "just another case."

Particularly today, this last day of African American History month, we want to pause to recognize the value of healthcare in caring for everyone in our country -- black and white, young and old, wealthy and not. We pause to recognize the complexity and intricacy that each person's life presents, and the importance of tending to these issues with respect, if we are to provide truly excellent healthcare.

Store-and-Forward healthcare collaboration keeps children healthy and in school while keeping Mom and Dad at work and siblings focused. And this means that all of us can be healthy enough to reach our potential.

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: care coordination, healthcare collaboration

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