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Care Coordination Failures Cause Long Term Care Transfer Issues

Posted by Lawrence Kerr on Thu, Apr 11, 2019 @ 06:00 AM

martha-dominguez-de-gouveia-572638-unsplashFor the older people at Long Term Care facilities, nursing homes, and assisted living facilities, even small issues — like a simple fall — end up with a transfer to the emergency room. Those visits to the ER can often mean a hospital stay as well. And of course, hospital stays can cause backtracking for overall strength, wellness, dementia, and disease. The best case scenario  a visit to a doctor instead of a visit to an ER  can still mean bouncing from provider to provider, with a lot of stress and physical challenges along the way. 

But aren't these ER visits, hospital stays, and doctors' visits simply the necessary realities of life. New insights and ways of working point to innovative solutions to this Business As Usual problem. 

There are 30,000 assisted living facilities in the US. As the New York Times reports, “most assisted living facilities have no doctors on site or on call; only about half have nurses on staff or on call.”

That means that if an event happens  a virus, a fall, a concern about a worsening condition  it results in a transfer, doctor's appointment, or ER visit, the vast majority of the time. Of course, coordination of medical transfers, tests, appointments, and the like can be a huge challenge for any person — but throw in significant physical challenges and perhaps cognitive impairment and the challenges compound.

“The assisted living industry has to recognize that the model of residents going out to see their own doctors hasn’t worked for a long time,” said Christopher Laxton, executive director of The Society for Post-Acute and Long-Term Care Medicine. “It’s an expensive, disruptive response to problems that often could be handled in the building, if health care professionals were more available to assess residents and provide treatment when needed.”

It's a way of caring for people that hurts the patient, the provider, the Long Term Care facility, and even the hospitals. Hospitals will stay away from sending their patients back to the community if they are afraid they’ll be readmitted within 30 days of discharge. And Long Term Care organizations may shy away from getting the right care for their residents if it often results in backsliding in their care. 

So what is the solution?

One solution has been to have a geriatrician on staff. But realistically, that doesn’t solve the problem. There will be myriad medical problems that fall outside of the expertise or time of that provider. 

There are two key things that need to happen:

  • Hospitals should partner with assisted living and nursing home facilities that have the means to do medical collaboration and prevent readmissions.
  • Long Term Care facilities must find ways to get the medical consults they need without putting their residents through the stress and danger of ER visits and bouncing among doctors’ appointments.

To facilitate those goals, though, hospitals, doctors, nurses, aides, and care providers at Long Term Care facilities need a platform to collaborate. The ideal scenario is that if a resident has a fall that isn't actually worrisome but could use "an extra pair of eyes,"  an aide can take a photo or video, consult with a trusted provider at a practice or hospital in the community, and keep the patient at home base until or unless a transfer is needed. It's good care in every way: it saves money, decreases readmissions, and ultimately supports the best possible health, wellness, and quality of life for the patient. It's a classic example, too, of why email or text messaging  in addition to not being HIPAA compliant  aren't nearly sufficient. In cases like this, whole teams are involved and cases need to by asynchronously collaborated on, over the span of time. A one-off question won't fit the bill. 

Care coordination and healthcare collaboration aren't a panacea. But I do believe that when it comes to Long Term Care, the impact of collaboration and coordination can be dramatic. 


If you're involved in Long Term Care, get our ebook on using telemedicine to improve care and make workflows more efficient:


Transforming Long Term Care Through Telemedicine

Tags: medical collaboration, long term care, healthcare collaboration, hippa secure healthcare collaboration

Collaboration and Stories Might Be What Makes Humans Unique

Posted by Lawrence Kerr on Tue, May 15, 2018 @ 06:00 AM

bernard-hermant-665070-unsplashI’ve been meaning to read the book Sapiens for a while now. Billed as a “brief history of mankind,” the book looks at 70,000 years of history and science to explore what makes us human.

Recently, though, a friend summarized the book's main conclusion and theme — and his summary stopped me in my tracks.

There are a lot of learning from the book, he said, but “Overall, the most important is that it is collaboration and stories that make humans different from animals — collaboration and stories.”  Collaboration and stories -- two things that seem so optional, so subtle -- could these really be the things that make us unique, make us powerful, and make us tick?

The book’s author, Yuval Noah Harari, was interviewed by Smithsonian recently, and elaborated on each topic as follows…

On how humans use stories:

“The truly unique trait of Sapiens is our ability to create and believe fiction. All other animals use their communication system to describe reality. We use our communication system to create new realities.”

On how humans cooperate and collaborate:

“The Sapiens secret of success is large-scale flexible cooperation. This has made us masters of the world. But at the same time it has made us dependent for our very survival on vast networks of cooperation.”


These insights are important for medicine, as well. It’s so easy for all of our institutions, technology, and systems to strip away what is most human about us. It’s easy for our medical practice to become very literally “dehumanized and dehumanizing” in our pursuit of efficiency -- we literally cut out collaboration and stories in order to save time and money.

When we are forced to rush through visits, we miss the stories that make the patient who she is. When the only collaboration tool we have is uni-directional text messaging, our ability to collaborate and cooperate in complex ways is limited.

That’s why I believe that initiatives that re-embed medical care back into our personal contexts, that allow us to connect with each other in rich ways, are those that end up being most effective and most powerful. Ironically, sometimes these initiatives are almost laughably simple. For instance, Cleveland Clinic is creating a "groundbreaking initiative" affecting 50,000 providers -- which amounts to little more than a reminder to remember patients' stories and to have empathy. Certainly this is backed up by the Sapiens author, but not very surprising for most good healthcare providers. (Of course, trying to systematize something like empathy can backfire in unintended ways, but here I'm just highlighting the interesting nature of the initiative existing at all.)

It's certainly why iClickCare is intuitive to use, allows rich and complex sharing (pictures, long form narrative, and videos) in consultations, and supports multi-directional, complex collaboration. 

In some ways, what's most groundbreaking in medicine is actually that which brings us back to our core as people -- and that's always been pretty simple. 

Learn more about how hybrid store-and-forward allows for rich, simple collaboration: 

ClickCare Quick Guide to Hybrid Store-and-Forward

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

3 Surprising Healthcare Collaboration Insights From a Very Big Airplane

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

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

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

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

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

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

3 Surprising Insights from the Boeing Collaborative Design Project:

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

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

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


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


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

Why The Pay Gap for Women Doctors Hurts More Than Women

Posted by Lawrence Kerr on Wed, Mar 21, 2018 @ 06:00 AM

rawpixel-com-267082-unsplash.jpgWhen our founder, Cheryl, went to medical school, there were only 5 women in her medical school class. (Actually our medical school class since both of us were in the same medical school class and shared a cadaver.)

Things have certainly changed since then, in some ways for better and in some ways, for worse.

Although Cheryl’s medical school class only had 5 women in it, in 2017’s incoming medical school classes, women made up just over 50% of students. As this is Women’s History Month, that seems a milestone worth noting. 

Surely, allowing the makeup of our doctors’ demographics to reflect the demographics of the talented people in our country is good for everyone. So the equity in representation of the genders in medical school classes is likely a step forward.

That said, I was, quite honestly, saddened and surprised to hear that female doctors earn 27.7% less than their male counterparts (an average of $105,000 less.) This number actually has increased since 2016.

The pay gap, of course, is a serious issue across all industries and physician pay aligns with the pay gap that is seen in other professions. And truthfully, the pay gap for lower-waged workers is probably more significant of a problem for those experiencing it.

But my concern about this pay gap in medicine goes beyond gender equity or salaries. My concern is greater because I believe this persistent — and growing — pay gap is representative of our tendency in medicine to devalue the contributions of some medical providers relative to others.

This instance is especially stark because the job being performed is exactly the same. So we're very obviously undervaluing the contributions of female doctors relative to male doctors.

But we do this across the medical team. We each have such unique contributions to a patient's case. When we refuse to use existing tools to do medical collaboration, we are effectively saying, "my opinion on this case is the only one that is relevant."  When we refuse to ask colleagues to collaborate, when we disregard the perspectives and input of others on the team, or when we neglect to consult on a case, we're devaluing those perspectives and the patient suffers. 

Stark data is always a chance to see where we find the same dynamics in our life or practice. So as Women's History Month comes to a close, I hope we can use it as a moment to reflect on how we might value, reward, and listen to all of the voices on the medical team, regardless of gender or title. 


ClickCare Quick Guide to Medical Collaboration

Tags: store and forward medical collaboration, hippa secure healthcare collaboration

A Definitive Guide to Healthcare Collaboration

Posted by Lawrence Kerr on Wed, Mar 14, 2018 @ 07:40 AM

HC 3.png


Introduction to this Review:

They say that the more things change, the more things stay the same. And in medicine, that's especially true.

Recent years have brought pay-for-performance systems, focus on metrics like length of stay and readmissions, and demands of care coordination and meaningful use. In turn, all of these pressures mean that healthcare collaboration is critical to surviving in today's medical landscape But, of course, the more things change, they more they stay the same. Healthcare collaboration has always been the best way to provide excellent care to our patients. So it's one of those times when the "practical thing" is also the right thing to do.

As two doctors who founded a telemedicine-based healthcare collaboration platform, we're deeply passionate about healthcare collaboration. In fact, it might just be our life's work. So this page is meant to be your "cheat sheet" to healthcare collaboration. Use it as you wish: as a review, as a checklist, as an introduction. No matter how you use it, remember that beyond technology, beyond telemedicine -- the main thing is treating our patients in the ways we would want to be cared for. And it turns out that's good medicine, good business, and good work.


Table of Contents: 


“What we have here is a failure to communicate”
1967 Cool Hand Luke, Strother Martin, Captain and Paul Newman, Luke.

What is Healthcare Collaboration?

Healthcare collaboration is simply a team, working together, as professionals, on behalf of a patient. The goal is rapid, simple, documented, interactive presentation and discourse of information pertinent to a particular health need. When appropriate, the patient is part of the team. 
Of course, healthcare collaboration is not dependent on any one kind of technology. Providers doing healthcare collaboration may use technology but it's a tool, not the purpose. It's not dependent on any one kind of expertise, either. Providers doing healthcare collaboration can bring multiple kinds of experience and expertise, from across the continuum of care. It is the sharing of expertise that brings out the best medical care, irrespective how it was done. 

The classic principles of good medical care have always involved a team approach to complex diagnosis and treatment, as well as complex psychosocial overlays to physiologic and anatomic problems. This is not foreign to us as medical providers.

In school, we used study groups to help us learn. In labs, we had partners. If you were a medical doctor, you had rounds, grand rounds and morning report. If you were a surgeon, you had morbidity and mortality conferences. If you were a Physician's Assistant or Nurse Practitioner or Aide or nurse, you certainly had the same structure and hopefully were invited to be part of the above. With the changes in medicine, the need for these supports has increase, but most of the supports themselves have disappeared.

Currently, information technology is the lens through which this simple principle is seen. That has not always been the case. The concept and assumptions are timeless. Current or historical, they use the same classic principles.  One professional has a question for another. Sometimes a simple answer is all that is needed. At other times, a discussion is needed to add judgment and experience. And still at other times, discussion is needed over time.

However, the concept has been warped by technology and by the lens through which we view the technology. We have become more “connected” but in fact we are more isolated.  A text message has room for only data or for feelings, but not both. The phrase, “I am worried about” wastes 16 characters of message space. By its elimination, it also eliminates offers of support and enhances isolation.

Many, almost too numerous to count, words are used to label the use of technology in healthcare.  For example, this thorough analysis from Ziegler,  a speciality investment bank report.  

Many descriptors are used: telemedicine, mHealth, eHealth, telehealth, synchronous, asynchronous, video store and forward, secure text, secure email, telephone call, care management, personalized health, home monitoring, telecardiology, teleneurology, telestroke, teleER, telepsychiatry, telenursing and more. They overlap.


Why is Healthcare Collaboration Necessary?

Certainly, collaboration is not always necessary. It should not just be another healthcare product but rather an assist when an extra hand is needed. But when it is necessary, it is necessary for a variety of reasons:

1. As much expertise as each of us has, we need to realize that “No one of us is as smart as all of us."

2. The amount of knowledge has exploded. No one of us can master all of it. 

3. Healthcare is complex with ambiguity, uncertainty, and a blend of too much data and incomplete data. 

4. In serving the patient, often called providing healthcare, the provider, can be lonely. Burnout, job changes and suicide rates attest to that. 

5. The patient needs access to the right care, at the right time, in the right place, as close to home as possible. 

6. Those who follow behind need education. Medical education is the least effective that it has ever been from the time of the Flexnor report of the early 20th century. 

7. Data alone is useless without interpretation. Can you interpret high normal on lab and anatomic normal on an X-Ray, always? Weeding through an EMR is both exhausting and time consuming, only allows review of data, and can be supported by extensive reading. Our expertise is needed -- and, often, the expertise of multiple people is what's needed.


What Attitude is Necessary?

Artificial intelligence will become an aide. Emotional intelligence will become a necessity.

The demands of today's medical systems mean that we work in our own silo and rarely collaborate. We have academic specialties (stroke, cardiology, neurology, etc.) and relate to only one part of the body, not to the patient as a holistic being.

So medical providers who do healthcare collaboration tend to have a unique attitude. In our work with thousands of providers in telemedicine and collaboration, we've found the following attitudes to be crucial:

1.  Yearning to do better and belief that we can do more.

2.  Sense of responsibility beyond “the job."

3.  Respect for all colleagues regardless of role, from support to ultra-specialist.

4.  Enjoyment of interaction and of being a vibrant part of a community.

5.  Recognition of the whole, rather than fixation on the part.

6.  Acceptance of the limitations of one’s self or of one’s colleagues.

7.  Attitude towards technology as a friend not an as enemy.

8.  Understanding that the patient is the boss, not the administration nor the government.

9.  Recognition that the patient is a person, not a widget to move down the assembly line.

10.  Sense of satisfaction from being part of the whole that is bigger than oneself.

11.  Desire and ability to abstract, prioritize, and communicate a question and an answer.

12. Respect for the value of coordination and at times, for compromise.


Who Benefits from Healthcare Collaboration?

Healthcare collaboration, even when done on a limited scale, has so many benefits that it's almost difficult to enumerate them.

Some of the benefits of healthcare collaboration include:

1.  The patient by receiving the best care, at the best time, in the best place.

2. The healthcare system by benefiting from efficient and coordinated care.

3.  The taxpayer who is not the victim of waste from an inefficient system.

4.  The more healthy society by having more healthy members.

5.  The payor by paying for care that is less wasteful, more accurate and more preventative.

6.  The provider by having a satisfying and supportive work environment.

7.  The family who understands, who supports, and who is free of needless burden.

8.  The student who is healthy enough to learn well and to stay in school as much as possible.

9.   The educator who gains a rich experience for review to share with others.


Who DOES NOT Benefit From Healthcare Collaboration

Of course, we all resist change sometimes. And we're all busy and selfish at other times. But we find that the benefits of healthcare collaboration tend to be so significant and so immediate, that very few providers don't benefit. 

Ultimately, only the following people tend to resist healthcare collaboration so much that they never benefit:

1.  The egotist who is no longer the narcissistic center of attention

2.  The medical center wanting to survive because of control of the catchment area

3.  The entrenched regulator who resists change (within government or within a system)

4.  The adherent to a zero sum game where one wins only at the expense of another’s loss


What Equipment Is Necessary?

Little equipment or special technology is necessary to be collaborative. That said, there are a few technological tools that can make healthcare collaboration much simpler and more practical in today's medical system.

A secure system that ensures patient privacy.

In the United States, this is described as HIPAA compliant. In Europe, it's European Union General Data Protection Regulation; in Mexico, the Federal Data Protection Act; in Canada, it's PIPEDA. Countries throughout the world have similar examples.

Software is needed to make the devices, mobile or stationary, protect patient privacy and ensure that the entire system is compliant.

The ability to share images and videos.

Rich information allows good evaluation, so text is usually insufficient. A photo of a rash, a video of gait, or an audio clip of speech can be crucial to good collaboration and diagnosis.

At times, live video conferencing is important, especially when a consultation is direct from provider to consumer, but this is not really an example of collaboration. Further, when relationships need to be developed or when voice and face are easier than typing, the live video is important.

Limited peripherals.

When equipment (often called peripherals) is needed to obtain data such as an endoscopy, then specialized equipment is important. Realize though, that once the data obtained, it can be shared by a healthcare collaboration system.

Internet Connection.

An internet connection, slow or fast, is necessary if modern technology is going to be leveraged. However, stopping a colleague in the hall or on a telephone call is also healthcare collaboration. But one might not be in the hall at the right time or able to take on the phenomenal burden of telephone tag -- which is why it can be helpful to have a technology tool to help with the coordination and communication.

Specifically, the components of the needed equipment include:

1.  The desire and need to collaborate

2.  Connectivity

3.  Secure, comprehensive software platform (asynchronous, store-and-forward)

4.  Secure video-conferencing system (on occasion)

5.  Policy and procedures

6.  A system that is easy to use, always on, always available (for instance, a smartphone)


What About Policy And Procedures?

Seven main components need to be in place. They need not be complex, but should be tended to to ensure compliance:

1.  Reimbursement policy and procedures.

2.  Privacy procedures consistent with HIPAA.

3.  Bring Your Own Device (BYOD) policy.

4.  Patient permission policy.

5.  Policy about access to records with change in employment.

6.  Electronic orders.

7.  Delineation of responsibility.


What Is Needed From Leadership?

Of course, there are many leaders in every healthcare community. Aides, family members, nurses, doctors, administrators, and specialists are all leaders at different times and in different ways. But many times, medical providers get stuck in their efforts to collaborate because they don't have the support they need from "official" leaders -- department heads, hospital administrators, and the like. Medical providers can also be buoyed and championed by forward-thinking hospital administrators (of which there are many), something we've certainly seen and experienced over and over again. 

Medical leadership can offer the following to support healthcare collaboration efforts:

1.  Acceptance of something new and willingness to change

2.  Commitment to making healthcare collaboration work

3.  Encouragement and enforcement of use

4.  Strong support of implementation

5.  An empowering attitude

6.  High level understanding of workflow and its challenges

7.  Broad view of ROI and the changing reimbursement landscape.

8. Pride in accomplishing improvement over operational status quo.

9. Trust in downstream integrity

10. Willingness to make a decision (take a risk) before others in the industry


What are Examples Of Good Healthcare Collaboration?

Despite what skeptics may say, there is excellent healthcare collaboration happening all around the country, every single day. We see so many examples of incredible collaboration, including:

1.  School-based healthcare.

2.  Connected health.

3.  Cleft and Craniofacial Teams.

4.  Rehabilitation teams.

5.  Developmental teams.

6.  Clinical-pathological conferences.

7.  Tumor Boards where clinicians, researchers and lab colleagues discuss cancer care.

8.  Burn centers where intensity varies from ultra-acute to chronic care.

9.  Space medicine where many need to tackle the unknown at the limits of mankind’s habit.

10.  Transplant medicine where molecular biology works with surgical skill and pharmacology.

11.  WWII Valley Forge Hand Center where multiple specialists came freely and shared in care.

12.  WWI Harold Gillies Facial Reconstruction team where devastating facial injuries met artist and surgeon.


What are Examples of Poor Healthcare Collaboration?

There have also been some false starts and failures along the way as medical providers have tried to do healthcare collaboration and failed, or as people have willfully ignore the opportunity to work together altogether. For instance: 

1.  Development of anesthesia where fight over ownership slowed adoption.

2.  Semmelweis’s prevention of puerperal fever which was demeaned by the establishment.

3.  Banning of reconstructive breast implants because of a single approach to the complex.

4.  Patenting of medical advances such as cataract procedures.

5.  Various centers based on self promotion, look to the billboards and TV for the list.


How Do I Implement A Healthcare Collaboration Program?

If you're a medical provider or a healthcare administrator and you're interested in starting a healthcare collaboration program, then we are thrilled to help in any way we can. We've seen thousands of programs implemented and found some key steps to help you along the way. 

Keep in mind:

1.  Consider starting at a hotspot with fewer than 30-50 people involved.

2.  Plan and purchase for build out within 45 to 90 days to enable the network effect.

3.  Build collaborative networks based on already trusted colleagues.

4.  Continue support after introduction.

5.  Use train-the-trainer approaches so that there may always be local expertise.

6.  Budget less than one hour exposure for each participant to keep things simple.

7.  Allow self study and for medical providers to work at their own location and timing (as with hybrid store-and-forward technology.)


Key Outcomes of Healthcare Collaboration

There are many reasons to prioritize healthcare collaboration in your practice, hospital, or workday. Chief among them is the satisfaction, decreased burnout symptoms, and overall joy that providers tend to get from working together on cases.

But you'll notice a lot of other benefits as well, and the following overview of the key benefits may be a helpful outline for you as you share the potential of healthcare collaboration with colleagues... or even to be used as a checklist for assessing progress and results.

I. Cost

A.  Avoid duplication

1. Tests

2. Procedures

3. Sorting out of complications (i.e. reddened IV sites

4. Order and ranking of testing done with expert guidance

5. Avoid referral to wrong place

B.  Efficiency

1. Throughput in Emergency Department

2. Throughput in Operating Room

3. Shorter Length of Stay

4. Faster communication among unit or team members

5. Shorter work time (store-and-forward)

6. Change of diagnosis and testing from “shotgun” to precision

7. Imaging and Lab results easily placed into appropriate clinical history 

C.  Income

1. Larger catchment area can be served

2. Increasingly billable services

3. Value-based care

II.  Quality

A.  Safety

1.  Handoff errors reduced or eliminated

2. Reference and saving of more informal communication

3. Inappropriate, but still dangerous, testing, reduced

4. Rapid secure communication of environmental or infectious events

5. The potential for understanding trends with AI analysis of conversations

B.  Provider employee support and satisfaction

1.  Decrease burnout of isolation

2. Increase educational opportunities

3. Remove nagging doubt

4. Increase satisfaction of job well done by short and long term follow-up

5. More rapid on-boarding based on case review and store-and-forward methods

C.  Public health

1.  Increase communication across entire community of providers

2. Allow on-site care of patients by first responders

3. Better triage in disasters

4. Population health analysis

III.  Patient

A.  Patient understands thought process behind advice

B. Patient appreciates effort on their behalf

C. Patient can be part of the process (part of the solution, not the problem)

D. Patient avoids time off from work or school for self for some follow-up

E. Patient avoids time off from work or school while caring for child or parent

F. Patient avoids repeated history as thread of conversation unfolds




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Tags: healthcare collaboration software, medical collaboration tool, hippa secure healthcare collaboration

The Biggest Mistake Doctors Make in Texting for Medical Collaboration

Posted by Lawrence Kerr on Tue, Jan 30, 2018 @ 06:55 AM

nordwood-themes-469906.jpgI text a lot. Sure, sometimes a phone conversation is the only way to go, like with a serious topic or close friend. But otherwise, texting is often easier than email and faster than phone for coordinating plans, updating the status of work events, or even touching base with family.

So I certainly understand when colleagues say that they often text about, or to, patients. I know that my colleagues are more burnt out, hurried, and frustrated than ever before in the history of medicine in the US. And I know that anything that seems like a shortcut is tempting. In fact, it’s more than tempting — it may feel like an imperative.

We’ve spoken pretty extensively about the penalties and punishments for texting about or with patients. Texting patient’s information is very rarely, and only in certain circumstances, compliant with HIPAA. But the more I've observed texting in action in medical contexts, and for use in healthcare collaboration, the more I've realized that the biggest problem with texting isn't even HIPAA...

Yes, despite the huge penalties for texting in ways that aren't HIPAA compliant, I believe that the biggest problem with texting is actually that it's failing our patients and putting us at risk for malpractice lawsuits. Let me explain...

Texting had its 25th anniversary this past December. Over those 25 years, we've become used to communicating via text, such that in some social circles, it's more polite to text than to call. So as healthcare providers, we naturally tend to want to text in a medical context, especially when we have a quick question for a colleague. More recently, like over the past 5 years, there's even been a shift from emails to texts, as it better fits our hyper-fast lifestyle. 

The problem is that texting on behalf of, or to, our patients gives the illusion of adequate care coordination and collaboration, but simply does not deliver. So the biggest mistake you may be making when you text in a medical context is that you are shortchanging yourself and your patients. 

Texting in a medical context, or for healthcare collaboration, is: 

  • Enmeshed with all of your personal communication.
    When you text a colleague, those messages are in the same place as texts about your daughter's recital. The truth is that it becomes very difficult to be responsive and responsible when there is no separation between personal texts and medical texts. 
  • Not archived. 
    If you text a colleague about a patient, you may get a quick answer now, but what happens in a day, week, year or decade when you need to refer to that message, either to inform care or to share the case with a colleague? 
  • Not organized. 
    We feel that organization, structure and amplification are important components of true collaboration. It is not enough to yell “fire” in an movie theater. One most also show and help theater goers to the exits and prevent panic. Ultimately, texting doesn't allow messages about a case to be sequenced, organized, and accessible so busy providers can use the information well. 
  • Not collaborative among multiple people on a team. 
    Texting is between two people, not among multiple members of a team. 
  • Words only. 
    Secure texting is almost always just text -- not voice or videos -- because it becomes very difficult to keep that information secure in a text message. 
  • Usually not HIPAA compliant.
    In order to text in HIPAA compliant ways, you need to have the permission of the patient (if you are texting them), not using any PHI, not using the patient's first and last name in the text thread, etc. In other words -- if you're texting, you're probably not HIPAA compliant. 

So what is a person to do, when texting is so convenient, but doesn't truly meet our needs as medical providers? You may have interesting ways of collaborating you'd like to share, but we're certainly passionate about iClickCare as a solution. iClickCare allows all of the ease and speed of texting, but in a way that allows the entire team to collaborate using chat-like messages, videos, and photos -- and that collaboration is organized, archived, and HIPAA secure. 

What you do is too important to use tools that don't meet your needs. Demand more for yourself, and more for your patients.

If you're looking for ways to use your smartphone to do medical collaboration, but without all of the downsides of texting, download our free white paper on BYOD (Bring Your Own Device) Policies here: 

iClickCare IS BYOD Secure

Tags: medical collaboration, hippa secure healthcare collaboration, byod

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