ClickCare Café

What Intergenerational Housing Has to do With Healthcare Collaboration

Posted by Lawrence Kerr on Wed, Feb 21, 2018 @ 06:02 AM

nick-karvounis-381270.jpgA friend of my daughter’s just bought her first house. It’s a cute little bungalow with room for a garden out front and a chef’s kitchen. Just the right size for a young professional starting out.

It also has an apartment with its own entrance. When pressed, that apartment was actually the selling point for our friend. Her parents are a beloved part of her life and she wanted room for them to be a part of her household, if that made sense for all of them, either because of new babies, needs to share care, or for other reasons.

The New York Times reports that her approach is becoming increasingly common -- but for years, the trend has been in the opposite direction. In 1940, most families had a parent living with them, by 1990, only 20% did. There is good evidence to suggest that the shift has less to do with preferences and more to do with economics -- the advent of Social Security led many older people to choose to live independently, once they were able to afford it. 

But now, between 2007 and 2010, the number of shared households has risen more than 11%. Multigenerational households, in particular, are climbing. Many people point out that, although not the norm, these kinds of arrangements are often much better solutions than nuclear families living alone, paying for childcare -- while older relatives struggle to live alone. These solutions often save money for everyone, while allowing people to care for each other in creative ways.

Fascinating, and hopeful-seeming, somehow -- but what does it have to do with medicine?

Well, the connection jumped out at me immediately, actually. Just as our country's families have, in many ways, become isolated, our healthcare providers have also become increasingly isolated over the last several decades, facing the demands of the practice alone. The support of the surgeon's lounge, or a relaxed conversation with a colleauge, are missing from most of our days. Just as many families feel pressure to face the demands of parenting and living alone, healthcare providers become burnt out as they face the productivity demands that ratchet up with each day. 

This multigenerational household trend is an initial sign that a new approach may be percolating, as to how we live. Similarly, I believe that there are exciting signs of new approaches in medicine, as well. Telemedicine, especially healthcare collaboration using store-and-forward telemedicine, allows for healthcare providers to begin to connect in the "old ways" but using new tools. These are signs of people connecting in the ways they have always needed to, but using new tools to make it easy and effective.

What's crucial, though, is that we don't use telemedicine to further isolate ourselves. One-on-one videoconferencing and secure text messaging, only serve to isolate medical care to a one-dimensional consult between two parties. 

Hybrid Store-and-Forward® telemedicine allows connected, shared healthcare collaboration by: 

  • Allowing all members of the medical team to take part in the collaboration.
  • Making the case available for further collaboration over time, as well as available for education. 
  • Supporting consults and conversations among different members of the team -- rather than a unidirectional question-and-answer.
  • Valuing the contributions of even non-traditional members of the medical team (like family and teachers and social workers) as well as valuing the contributions of people "lower down" in the medical hierarchy.

We have the opportunity now to broaden our understanding of who is part of the solution. We have the tools to support dynamic, multilayered conversations and collaboration among many members of the continuum of care. As with multigenerational households, there may be some newness or discomfort as these new ways of doing things come to be -- but ultimately, if we embrace it, we'll all be better off. 


Learn more about this kind of telemedicine-supported healthcare collaboration here: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: care coordination, healthcare collaboration

Interruption is Not Collaboration (But Healthcare Thinks It Is)

Posted by Lawrence Kerr on Wed, Feb 14, 2018 @ 06:01 AM

freestocks-org-229658.jpgI love listening to a podcast called Rework. They talk about work and business in interesting ways -- and although they're certainly not in the medical field, many of the insights apply. 

Last week's episode really stuck with me as important and made me realize just how far behind the healthcare field is. The episode, Interruption is Not Collaboration, looked at the cost of interruptions in the workplace.

If you're like most healthcare providers, the thought of even talking about "interruptions" seems ridiculous. In a medical setting, the day is one long interruption. There's so many things scheduled and happening simultaneously, that we become used to the situation, not noticing the cost. 

In fact, as is cited in Rework's episode, when we are interrupted, it takes about 23 minutes to recover from that interruption, in terms of productivity and the quality of your focus. In other industries, business leaders have started putting in place systems and tools that limit interruptions. Not for emotional reasons, but because the interruptions are "expensive" in their impact on work, in productivity, quality of insight, and errors made. But in the world of healthcare, we accept interruptions as normal and do little to try to minimize them.

I believe that many of my colleagues have little interest in medical collaboration because when they hear "collaboration" they think of interruptions in the form of: 

  • Text messages
  • Phone calls (or calls they have to return) 
  • Videoconferencing appointments
  • More meetings to attend. 

Of course this is what providers envision when they think of collaboration -- because these are the common forms that collaboration ends up taking. But these forms of collaboration come at such a high cost in terms of the provider having to interrupt or step away from the rest of their work -- that the collaboration becomes very much not worth the trouble. The other challenge with collaboration taking this form is that because the medium is so ephemeral, the conversation is not archived or accessible over time. Once the question is answered (like so much in our virtual world), it ceases to exist.

This is why we believe so firmly that healthcare collaboration needs to take the shape of Hybrid Store-and-Forward® telemedicine. It's absolutely crucial that care coordination and healthcare collaboration be sustainable, and supportive of the rest of the provider's workflow. Providers need to be able to ask and answer questions on their schedule, in their own time. With this form of collaboration, questions and answers don't interrupt the rest of your work, you can answer in a way that works with the rest of your schedule, and the case is archived for future review. That means that all of your patients get the most focus you can provide, and that you get the satisfaction of finishing one thing before starting another.

Your work matters too much to allow interruption to be the way things happen. Demand more for yourself -- and demand more for your patients.


To learn more about Hybrid Store-and-Forward telemedicine, download our free quick guide: 

ClickCare Quick Guide to Hybrid Store-and-Forward

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

Why Excessive Focus on Specialists Hurts Care Coordination

Posted by Lawrence Kerr on Tue, Feb 06, 2018 @ 06:01 AM

helloquence-61189-2.jpgClickCare was founded by a specialist (reconstructive surgery) and a generalist (pediatrics). 

Because of that, we've always valued the unique perspectives that different kinds of providers bring. As a reconstructive surgeon, I have a unique perspective on what's possible in certain types of surgeries, and have sophisticated takes on wound healing. As a pediatrician, Cheryl's diagnoses of childhood disease has always seemed like a sixth sense and her synthesis of complex variables in treatment verges on the miraculous. 

But the medical team is made up of far more than just specialist doctors and generalist doctors. It's made up of a team that includes aides, nurses, home care providers, nurse practitioners, PAs, and all of the other providers who "do medicine" on a daily basis. 

In a post we published a few weeks ago, we talked about the possibilities and challenges of leadership and teams in healthcare. We looked at how to develop leaders and leadership within care teams. We discussed an article in the New England Journal that pinpointed how crucial this is and explored some of the factors in effective healthcare leadership. 

And although we mentioned that leadership comes from across the continuum of care, I've noticed that when we say "consult", people hear "specialist." When we say "leadership", people hear "doctors." And when we say "collaboration," people think "between two providers."

Realistically, healthcare simply cannot withstand more years in which we focus on specialists (to the exclusion of the rest of the continuum of care); look at consultations as being only FROM the aide or nurse, the generalist TO the specialist; and regard the tertiary care center as inherently stronger.

That's why we wanted to highlight a few things that we think are crucial to healthcare moving forward in today's context:

  • The tertiary center has expertise, but also the local originator has complementary expertise.
  • Collaboration and care coordination MUST use technology that allows collaboration among all members of the team, not just text messages between two members -- that answers a question but doesn't ultimately support the whole team in moving forward.
  • Not just licensed professionals, but everyone who cares for the patient, has a contribution. To focus on researchers and clinicians is to only touch the tip of the iceberg of those who care for the patient. 

We can all act on the knowledge that care coordination depends on the whole team -- not just the "top of the pyramid" of the hierarchy. It starts with us. It starts with our valuing the perspectives of each person caring for the patient. And it starts with using tools that allow us to do healthcare collaboration and care coordination in team-oriented ways.


Try iClickCare for free -- and share it with the rest of your team:

Try the iClickCare 14-day evaluation

Tags: care coordination, healthcare collaboration

Why Healthcare Collaboration Matters More to the Burnout Crisis than Work Hours

Posted by Lawrence Kerr on Thu, Feb 01, 2018 @ 06:00 AM

remi-walle-86579.jpgA common critique of healthcare collaboration in general — and iClickCare in particular — is that it will never become widespread because doctors are too rational and self-centered to do something “altruistic.”

We’ve even seen hospital administrators make widespread strategy decisions with the assumption that doctors care most about money and status and “what’s in it for me.”

That perspective never resonated with us. And we’ve seen hundreds of people thrive with iClickCare, both because it saves them time, has a great ROI, and for the “altruistic” reason that it is better for their patients. But it wasn’t until today that our hunch was truly confirmed by a medical journal.

The New England Journal of Medicine published two articles recently that dig into the phenomenon of burnout and debunk a lot of myths we have about it  ultimately getting at what motivates doctors.

In “To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis,”  Dzau et al. look at the causes and manifestations of burnout.

Of course, the consequences of allowing burnout to persist are serious:

  • Physician suicide.
  • Patient safety. “Some studies have revealed links between clinician burnout and increased rates of medical errors, malpractice suits, and health care–associated infections.”
  • Costs to productivity. “In one longitudinal study, the investigators calculated that annual productivity loss in the United States that is attributable to burnout may be equivalent to eliminating the graduating classes of seven medical schools.”

It's a critical problem that demands real solutions. As for what those solutions should be, common wisdom is that doctors need more time, money, or efficiency.

But as Dzau et al. share, in many cases, what doctors really need more of is connection to the meaning and fulfillment in their work. “The ethical principles that guide clinical care — a commitment to benefiting the patient, avoiding harm, respecting patient autonomy, and striving for justice in health care — affirm the moral foundation and deep meaning underlying many clinicians’ views of their profession as a worthy and gratifying calling… Clinicians are human, and it takes a personal toll on them when circumstances make it difficult to fulfill their ethical commitments and deliver the best possible care.”

So although people sometimes challenge iClickCare on the grounds that doctors are too rational or self-centered to use it, iClickCare allows doctors to connect with colleagues, do healthcare collaboration and care coordination, and make better diagnoses and fewer mistakes. In other words, iClickCare connects directly to doctors' sense of fulfilling their ethical commitments and delivering the best possible care. And in doing so, iClickCare relates directly to easing burnout.

In “Beyond Burnout — Redesigning Care to Restore Meaning and Sanity for Physicians,” Wright and Katz quote Dr. Christine Sinsky as saying, “We’re spending our days doing the wrong work. At the highest level, we are disconnected from our purpose and have lost touch with the things that give joy and meaning to our work.” Doctors spend 1-2 hours doing the clerical or administrative work for every hour they see patients. (Patients who are often double-booked, back to back.) As high achievers, they fit this work into spaces in their day that don’t exist. Administrators, facing their own severe pressures, aren’t compensating doctors for this "around the edges" time and they are not giving them the tools they need to feel, and be, supported in the work.

The demands on doctors increase, but with decreasing access to the parts of the job that fulfill them  decreasing access to the parts of the job that keep a doctor from burning out. 

David Whyte, the poet, says: "The antidote to exhaustion may not be rest. It may be wholeheartedness." And ultimately, when we think about iClickCare, we're motivated to help doctors find that wholeheartedness in their work. You don't need your hospital's support and you don't need all of your colleagues to take it on. All you need to do is to make the tiny choice to act on your own behalf. 

Downloading iClickCare takes 10 seconds and is free. Try it today:

Try iClickCare Today!

Tags: healthcare provider burnout, provider burnout, healthcare collaboration

One Common Thing Providers Do That Fails Their Patients

Posted by Lawrence Kerr on Tue, Jan 23, 2018 @ 06:00 AM

evan-mcdougall-371935.jpgIn a ten-minute span, the average healthcare provider might return a phone call, make an incisive diagnosis, listen deeply to a patient, check a chart, fill out the EMR, and check the labs on this morning's patient.

The focus, ability to perform under pressure, caring, and excellence of medical providers is pretty astounding, I have to say. 

But there is one way in which we might be failing our patients without knowing it.

In our intensity, speed, productivity, and care for our patients, there is one thing that is easy to forget: they heal best outside of a medical setting, ultimately. Of course, a doctor, a visit, and a hospital are all critical to a patient becoming healthy -- but too much time in these contexts comes at a cost for them.

Each of our patients is a person outside of our 4 walls. They have work, hobbies, families, and pets. They have things that make them relaxed and things that make them stressed. And for the most part, good providers remember this and even tailor the care plan to be optimal for all of these elements of "real life."

But a recent article in the New York Times reminded me that things as subtle as fresh air, light, and plants can have a dramatic impact on our health. Being indoors too much affects our circadian rhythm, which is intimately related to healing. Levels of cortisol are higher in indoor spacesPoor ventilation and higher levels of carbon dioxide can affect both mood and cognitive performance. And of course, we remember that a study has shown that "patients whose windows looked out on views of nature needed less pain medication and were released from the hospital on average about a day earlier than those whose rooms faced a bare brick wall." 

So what does this have to do with how we care for our patients? 

It's a reminder that every hour in the hospital is an hour that the patient can't be puttering in their garden or going to the park, healing with fresh air and sunlight. It's a reminder that care delays, waiting in the waiting room, and waiting to be discharged all keep the patient from being in his/her ideal space, healing. 

We talk about how iClickCare improves care coordination and medical collaboration. And of course, collaborating more efficiently saves providers time and supports better care plans. But it also means that our patients can be back into a natural, healing place that is supportive to them getting healthy -- faster. When our patients aren't bouncing from appointment to appointment... aren't waiting hours, days, and months for care... aren't sitting in a waiting room, waiting for a referral -- they can be back in the spaces and people that are most healthy for them. 

Want to see if iClickCare can help you with care coordination? Try it for free: 

Signup for an iClickCare Account

Tags: care coordination, healthcare collaboration

What Do New Long Term Care Models Demand of Medical Collaboration?

Posted by Lawrence Kerr on Tue, Jan 16, 2018 @ 06:01 AM

brian-babb-256298.jpgJust as the field of medicine is in a process of re-imagining, transition, and disruption  long term care is too.

Long Term Care is one of the most challenging settings to work in for a healthcare provider, and our colleagues who do, are caring, sophisticated, and innovative.

But the reality remains that the typical nursing home model — of which there are 15,000 in the US — isn’t serving its residents to the degree that they, their families, and their providers would like. So, the Green House Project is aiming to disrupt that model, creating something completely new — and a study was just done about whether it is working or not.

The Green House Project has several principles they work from. But the most crucial seem to be: a home-like environment with just 10-12 residents and private rooms and baths; consistent assignment of aides so that relationships and understanding can develop; more control over your own routines, space, and choices as a resident.

There are 242 Green Houses with 150 in the works.

The challenge with models like this is often that, while they sound great, it’s not always known if the results (holistically determined) will be strong. So we were intrigued to hear The New York Times report that the Robert Wood Johnson Foundation gave $2 million to fund research assessing the model.

The studies covered 9 years of data and overall, showed positive indicators. While not all of the promise and change of the Green House Project was evident, many key indicators of the value of the model were. “The researchers found that Green House residents were 16 percent less likely to be bedridden, 38 percent less likely to have pressure ulcers and 45 percent less likely to have catheters. Avoidable hospitalizations and readmissions were also lower.”

In our vision for what healthcare can be, we’re deeply inspired by models like this that prove the way we’ve been doing things doesn’t have to be the way we keep doing things. Specifically, we believe that we should be moving towards models in which care is decentralized and structured around the needs of our patients. For instance, we've written about Community Paramedics, Aging in Place, and other new models that allow medicine to be more responsive to the people it's serving (and likely create a more humane work environment for providers in the process.) 

Of course, for models like this to work, we need tools that will allow us to do care coordination and medical collaboration effectively and efficiently. The more decentralized the model, the more important it is that providers are able to consult with other colleagues, across the continuum of care.

For us, Hybrid Store-and-Forward® telemedicine like iClickCare is a crucial piece of that puzzle. Because decentralization can easily mean isolation and that's not good for providers or for patients. 

Get our White Paper ebook on long term care and how telemedicine performs in that context here:

Transforming Long Term Care Through Telemedicine

Tags: long term care, care coordination, healthcare collaboration

As Medicine Changes, Our Collaborators Do, Too

Posted by Lawrence Kerr on Tue, Jan 09, 2018 @ 06:01 AM

joshua-ness-225844.jpgLet me share with you three things that happened in the field of medicine recently, none of which seem to have any relationship or connection to the others.

  1. A black-and-white cat named Oscar lived in a nursing home floor in Florida. Over 2 years, he would occasionally curl up next to an individual patient. Every single time he did, with over 50 patients, the person would die shortly thereafter. The case was written up in the New England Journal of Medicine.

  2. JR McLain, a former Navy mechanic and truck driver, became a nurse.

  3. A computer became better than most doctors at predicting death on behalf of a palliative care unit.

All three situations are surprising and interesting, for sure. At face value, though, the three things seem to have nothing in common, and they seem to be little more than novelties in the seriousness and rush of our days.

The commonality is clear to me, however. These are small harbingers of the changes that are coming (well, already arrived) in medicine.

As medicine changes, who we work with and how we work with them changes. 

100 years ago, all doctors were men, all nurses were women, there were no computers that aided (or hindered) our practice, and medicine was quite narrowly defined. 

Today, wise providers know that the scope of collaborators we have in medicine, as well as the gender and other identity markers of those collaborators, is changing. Home health aides are a crucial part of the team, despite their "lower" place in the medical hierarchy. We expect surgeons to be men or women. In my Craniofacial Team -- an interdisciplinary group which collaborated on complex cases like cleft palate -- teachers are as important a part of the medical team as the surgeon, since both impact and are impacted by the surgeries. “Alternative” health providers, like acupuncturists and herbalists are key to many patients' care. Artificial intelligence and the role of computers in diagnosis, prognosis, and even treatment are here to stay. We've come to rely upon a variety of technologies to support our medical practice -- from iClickCare to EMRs to computer-assisted radiology. 

To state the obvious, I’m not saying that computers, cats, and male nurses all belong in the same category. But I am saying that as things change, medicine will benefit from changing our ideas as to who our collaborators are. In fact, the future of medicine depends on us redefining who is important and in what roles. 

As these changes happen, we will benefit from creating workflows and systems and using technologies that will support changes, rather than butt up against them. That's why we think it's so crucial to use a medical collaboration tool that allows the flexibliity of collaborators of all kinds, that allows asynchronous collaboration, and that isn't entirely dependent on a specific platform or EMR. 

Today, maybe we can be just a little bit more open to the ways the faces of our collaborators are changing -- and maybe we can be a little bit more active in welcoming these collaborators and hearing their voices and appreciating their roles. 

If you're ready to collaborate in new ways, try iClickCare for free:

Try the iClickCare 14-day evaluation

Tags: medical collaboration, healthcare collaboration

Who is Allowed to be a Healthcare Leader & Do Medical Collaboration?

Posted by Lawrence Kerr on Thu, Jan 04, 2018 @ 06:01 AM

brooke-lark-194253.jpgThis week, we’re looking at what’s most needed in healthcare in 2018. Our take?  Leadership.  There are certainly a lot of needs in medicine, but we believe that without better leadership, none of our other aspirations can be made real.

“Leadership” is something that’s easy to talk about but hard to pin down… and even rarer to practice. We are honored to work with extraordinary leaders every day at ClickCare. And we’re always looking for ways to support leaders in medicine. So we were thrilled to come across a series in the New England Journal of Medicine Catalyst called Lessons in Leadership. Two pieces stood out to us as especially important, and we are looking at them in a two-article series this week. (You can find Part I here.)

In Building a New Kind of Leader for an Era of Cooperation, Rebecca Graham explores an consortium that endeavors to facilitate collaboration between the academic and the clinical. “UCLPartners, in London, England, is one of the largest academic health science partnerships in the world, encompassing more than 40 health care providers and universities that together serve a population of 6 million people in London and surrounding areas.”

The article goes on to explore the unique competencies that excellent leaders need when collaboration and team-based coordination is central to their work. They found that in cross-disciplinary collaboration, far more than just technical skill or expertise was needed. This kind of project, “as a collaborative partnership of equals, needs leaders to leverage change in the system through influence, without the hierarchical positioning; leaders must appeal to a greater concept and idea of achievement through a collective strength across the partnership.”

We certainly agree that 2018’s teams and 2018’s medicine need a different kind of leader than a healthcare provider who acts as a solo technician. Our addition to this exploration, however, would be to question who we see as leaders.

Who is allowed to be a leader, in medicine? And with whom is that leader allowed to work and collaborate?

Indeed, even in UCLPartners’ project meant to cultivate collaboration, I believe that there are some blind spots. In defining the two parties needed to collaborate as “clinicians” and “academics”, and endeavoring to get them under one roof as a requisite for collaboration, I believe we’re defining collaboration too narrowly. As you know, we believe that we need tools to help us collaborate across silos, national boundaries, state boundaries, and institutional boundaries. 

Further, their focus is on the leaders in the “C Suite” (for instance, their CMO.) Our experience has shown that the most influential leaders in medicine come from the places you might least expect it. It’s the orderly, the aide, the social worker, the teacher from the school down the street. Leaders in medicine come from across the continuum of care, offering crucia and unique perspectives  if we allow it and if we value them.

We believe that in today’s medicine, it’s not a sufficient solution to get the “C Suite” in the same room with their counterparts in other institutions. Rather, each and every person who cares for a patient should have the tools to collaborate with the people — in any institution and at any level — on behalf of the patient.

And the good news is that we can start that work, today, in whatever office, hospital, or home we find ourselves.


If you’re ready to start leading, in your setting, you can download iClickCare for free:

Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

Can Leadership Benefit Healthcare Collaboration?

Posted by Lawrence Kerr on Wed, Jan 03, 2018 @ 06:01 AM


The new year is always a time of reflection and taking stock. For us at ClickCare, we’ve taken the opportunity to step back and look at what is most needed in healthcare.

In 2018, we believe one of the things that is most crucially needed in healthcare is: leadership.  As healthcare becomes increasingly volatile, politicized, and competitive, leaders within medicine are needed more now than ever. And in 2018, we look to leadership to advance the cause of collaborative health care.

So we were intrigued to come across a series in the New England Journal of Medicine Catalyst called Lessons in Leadership. Two pieces stood out to us as especially important, and we’re going to look at them in a two-article series this week.

In Transformative Collaboration Across the Care Continuum, Dr. Slocum looks at the profound importance of teams in healthcare (as well as challenges they face). Of course, the role of teams and collaboration in healthcare is increasingly recognized as crucial to improving both care and metrics.

But there are a myriad of challenges to effective collaboration and team-based healthcare. In fact, Dr. Slocum identifies challenges like, “bridg[ing] the divides of geography and discipline” and “making cross-disciplinary collaboration between clinicians and researchers a day-to-day endeavor.” In summary, she said, “Collaborative relationships across settings are critical to optimizing care, yet they are very difficult to achieve.”

While there is a lot of truth to the challenges that exist for teams, we know for sure that it’s certainly not impossible, or even “very difficult” to achieve collaboration and strong teams across settings. Before we started ClickCare, I worked with the Craniofacial Team — an interdisciplinary group of providers, truly across the continuum of care — to collaborate on very complex cases. We got together once a month to discuss our cases and used whatever communication tools we could to collaborate outside of our meetings. The collaboration took a bit of work, sure, but it was easeful and effective.

And now, with iClickCare, we watch our colleagues create strong, agile, effective teams using the simple app to collaborate. It's work that regular providers do, every day. It's true leadership, shown by everyone from aides to super-specialists.

The truth is: we have the technology to collaborate and support our teams.  The next challenge is to develop leaders who are willing and able to:

  • Assert themselves and their ideas without fear of reprisal
  • Create an environment that empowers others to do so as well.
  • Do so in the current hostile environment of 
    Payment distrust (insurance companies, CMS and fraud - real and imagined)

Yes, the technology and innovations (like new programs) are important. We wouldn't have created iClickCare if we didn't think the technology and tools were crucial. But more important than tools are the leaders who use them. And every healthcare provider regardless of your title or training  can be a leader this year, starting today. 


For more stories of everyday leaders and healthcare collaboration, download or free Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, collaboration leadership, healthcare collaboration

Is Your Readmission Reduction Program Causing Deaths?

Posted by Lawrence Kerr on Wed, Dec 27, 2017 @ 09:36 AM

ken-treloar-411651.jpgIn a fee-for-performance world, we are all under huge amounts of pressure to improve our metrics. 

We are expected to cut costs, drop readmissions, decrease length of stay, and even improve healthcare provider burnout.

As you probably know, we believe that telemedicine-based healthcare collaboration can dramatically improve almost every one of these metrics. But a recent study had us asking -- is there a down side?

A recent JAMA study looked at 115,245 fee-for-service Medicare beneficiaries hospitalized with heart failure at 416 sites across the United States. Then, they looked into the consequences of a Hospital Readmissions Reduction program implemented at the sites. 

Happily, and as expected, implementation of the Hospital Readmissions Reduction Program was associated with a subsequent decrease in 30-day and 1-year risk-adjusted readmissions. The shocking part, however, is that implementation of the program was also associated with an increase in 30-day and 1-year risk-adjusted mortality.

In other words, people were coming back to the hospital less, but they were dying more. 

This type of story -- in which we see unexpected consequences of well-guided programs in healthcare -- comes up frequently. And it's easy to adopt a kind of nihilism in the face of a study like this: nothing will actually improve the situation so why bother. 

But we believe that that is the wrong conclusion. Rather, it's crucial to pioneer new initiatives to both improve care and improve our performance against metrics. But initiatives must be holistic. It's not enough to create a program that aims to improve readmissions but worsens care overall. That's why we are such advocates for telemedicine and healthcare collaboration. Initiatives like these are holistic enough that results across multiple dimensions of care are improved. On the flip side, it means that the "sell" to hospitals that have to improve in one dimension in 6 months is more difficult.

But ultimately, the only sustainable improvements are those that take care, metrics, and the whole picture into account. 

If you're ready to try iClickCare, you can download it for free here: 

Try the iClickCare 14-day evaluation

Tags: healthcare collaboration, decrease readmissions, regulatory issues

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