The military has always been on the front lines of technology, innovation, and medicine.

On the one hand, the demands are significant and the conditions are challenging. On the other hand, rewards for getting these things right can save lives and protect the country.

So when the military tests a brand new way of doing value-based care — I definitely pay attention.

Recently, the naval hospital in Jacksonville Florida launched an ambitious pilot project.

The goal, as Fierce Healthcare reports, was "to explore whether multidisciplinary care teams could improve the cost of care for active-duty personnel and their dependents."

The magnitude of the results of the pilot could be huge. As of 2019, the Navy spent $9.5 billion to deliver medical care to 2.8 million people (active duty personnel, retirees, and their dependents.)  And the initiative was ambitious -- pioneering a multidisciplinary way to take ultimate accountability for the results and the costs for complex conditions. 

The structure of the pilot was as follows: 

• Two project managers met weekly to guide the program.
• Medical conditions with high incidence and spending were chosen: back pain, osteoarthritis, diabetes, and high-risk pregnancy.
• Each condition had a physician and nurse co-champion with an interdisciplinary team working closely together to plan and execute care.

The results were very promising. Results showed that care was better, costs were lower, and active-duty personnel got back to work faster. 

Robert Kaplan, Harvard Business School co-author of the paper said that the results “demonstrated that no new medical advances or techniques are required to improve the health of these populations; just the need to better organize care around the patients’ conditions and treat them pro-actively with focused multi-disciplinary teams.”

What's fascinating to me about this project is that the military has an incentive to not only improve care and decrease costs -- but also to get personnel back to work as quickly as they can. In other words, it's a great demonstration truly considering all of the impacts of treatment -- care, costs, and the ultimate impact on the patient's life.

There were certainly challenges -- but the pilot showed the incredible value of working together, under an organized vision, and collaborating in multidisciplinary teams. These dramatic results could be transformative, certainly, for the military -- but it's possible they could be applied in many contexts with great results. “At a broader level, given the positive experience with this value-based health care pilot, the Navy’s implementation model could serve as a model for other organizations, including the Veterans Health Administration and those in the private sector, that are interested in new ways of organizing, measuring, and improving the care they deliver to patients,” the paper concluded.

To read more about the impact of medical collaboration, download our Quick Guide: 

Healthcare in the United States is struggling.

We need better care, more innovation, and to drastically cut the cost of care. We need everyone in the US to be insured, and we need to make sure that regardless of income, you have access to fantastic healthcare.

It is possible that small, incremental changes aren’t going to get us where we’re trying to go — it’s important for us to act boldly and to dare to rethink how we do medicine. But the reality is that our mindset tends to trap us into using even groundbreaking technologies in old fashioned ways. And a new VA program is no exception.

As Fierce Healthcare reports, the VA has gone in big with a new telehealth program. 

In a span of just 11 months from 2017 to 2018, veterans received care in 2.3 million episodes of telehealth. About half of these were video "visits" from veterans to providers; the other half was VA staff accessing or reviewing data sent via similar means.

It's inspiring to notice how much traction telemedicine has gained in the last several years. It has truly gone from something that very people understood or knew about — to something that many people will have contact with as a patient at some point soon. And I also applaud the willingness of the VA to adopt a new technology and implement it in an expedient manner. 

That said, I worry that the VA has found a more affordable way to provide care — having veterans have virtual visits with providers rather than in-person visits — but not a better way to provide care? In one way it is better: veterans don't have to leave home to be "seen" by a provider. But I worry that the quick telehealth virtual consult might lose the richness that an in-person visit can offer. For instance, perhaps the "doorknob" questions won't happen — those offhanded questions a patient asks once the doctor's hand is on the doorknob, on their way to another appointment... which often turn out to be the most important part of the visit. 

Beyond that, the expansion of these telehealth visits makes me think of another time in our history when we used a new technology in old fashioned ways. When the telephone was invented, no one could fathom wanting to have a conversation by phone — so the first phones were actually a tool to read telegrams aloud. We used our old fashioned telegram concept to shape how we used the new technology of the telephone. 

Similarly, we often use telemedicine as a "better version of the telephone" — and that's precisely what these VA telehealth visits are. Just as with the telephone, weak points of the system abound: no medical collaboration occurs because it is simply a 1:1 call; the case and information isn't archived or accessible to other team members or accessible for learning; schedules have to be coordinated for each visit to occur. It's using telemedicine as a fancier telephone — just as we initially used the telephone as a fancier telegraph.

I think it's important that we try to envision the highest and best use of the telemedicine technology we now have. To me, that means using it to facilitate asynchronous medical collaboration among medical teams. Because ultimately, that is the way to provide better care, not just cheaper care. 

When we became doctors, we did so because we wanted to help patients live longer, healthier lives. Not because we wanted to "provide healthcare."

That said, as days get more hectic, as visits with patients get shorter, and as demands on us get more intense, it's not easy to keep our sights on that vision of health. 

But a recent study reminded me of the very real difference between healthcare and true health -- and I bet it's a reminder that most of you need, too. 

A recent article in Fierce Healthcare looks at a study by The Stanford University School of Medicine's Clinical Excellence Research Center in California, which explored what role healthcare plays in avoiding premature death.

This question about the role of healthcare almost feels like a contradiction in terms -- our knee-jerk reaction is to say, "Of course healthcare plays the primary role in preventing premature death!"  But the results of the study contradicts that intuitive response. In fact, although healthcare plays a role in longevity, behavioral and social factors have much more influence on the longevity of people in the United States

Healthcare is estimated to prevent 5-15% of premature deaths. Behavioral and social factors, on the other hand, account for between 16% and 65% of premature deaths in the United States. As Robert Kaplan, research director of the Clinical Excellence Research Center (CERC) said, “in order to bring the U.S. health back in line with other rich countries, we need more than medicine.”

So what is that "more than medicine" that our patients need?

Dr. Steven Woolf, MD, Virginia Commonwealth University explains, “Healthcare systems need to do their part, such as paying attention to the social needs of their patients in order to help lower emergency department visits and hospital admissions.”  In other words, we need to: 

• Take a holistic view of our patients' health, including their social, environmental, financial, and behavioral realities. 
• Coordinate care and do medical collaboration so that we can actually attend to the full picture of our patients' health, rather than just "providing care."

That might mean realizing that a patient can't take time off work -- so using iClickCare to collaborate with a colleague on the case, rather than sending the patient for a consult. It might mean coordinating with a patient's care team across the continuum of care, including all of the aides and nurses that will care for that patient when they are discharged. It might mean doing medical collaboration with our young patient's teachers, social worker, pediatrician, and family -- rather than performing a procedure in isolation. 

We've said it before and we'll say it again: medical collaboration is not an optional flourish -- it's the foundation of caring for our patients in a truly effective way. 

Get our Quick Guide to Medical Collaboration for free, here: 

By the end of their career, nearly half of all doctors will be sued.

Any suit is gut-wrenching for a doctor. It means that not only was there an undesired patient outcome, but the relationship with the patient has broken down to such an extent, that a lawsuit has become the chosen path forward.

That said, medical malpractice lawsuits involving children are especially disturbing and concerning. No doctor wants a child to have less than perfect care — and the litigation process itself can be deeply painful for all involved. So I was really interested to notice a recent study that seems to point to a commonsense way of decreasing your risk of being involved in a malpractice suit involving a child.

A recent study, by The Doctors Company, looked at 1,215 malpractice claims filed on behalf of pediatric patients, from 2008 through 2017. These claims spanned 52 specialities and subspecialties.

What’s fascinating isn’t so much the claims themselves, but rather the root causes, allegations, and factors of the malpractice suits. Many of the most common factors in the lawsuits actually boil down to poor communication and poor medical collaboration among providers.

3 crucial highlights of the medical malpractice study that boil down to bad medical collaboration:

• Missed, failed, or wrong diagnoses were the main reason for lawsuits.
• Poor communication between the physician and the patient or family was a factor in up to 22% of claims, depending on the age of the child.
• System and collaboration failures, such as not notifying treating physicians of critical test results, was also a primary cause of patient injuries. 

No doctor wants to put their patients at risk. And no doctor wants to be sued. But the sad truth is that many doctors think they're "too busy" for medical collaboration -- even though in all three of the determinants of medical malpractice above, medical collaboration could have been preventative. 

It's easy to say "an ounce of prevention is worth a pound of cure" for our patients. But the ounce of prevention created by medical collaboration is worth far more than trying to "cure" a bad outcome or lawsuit once it has already occurred. 

Learn more about how easy and fast medical collaboration can be:

For many decades, we’ve thought about vaccines as a battle of science catching up with disease.

Conquering polio or measles was about finding the vaccine that would protect human bodies from those diseases, and then distributing those vaccines broadly enough to create immunity across the population.

However, there have been recent outbreaks of diseases that call into question this understanding. In places like the US and Europe, where the vaccines are established and the distribution is strong, we’ve seen a recent backsliding, with outbreaks of diseases like measles affecting communities. For instance, Washington State has had 71 cases of measles, just in the last few months.

So what are we to learn, as healthcare providers and leaders? And is there any way to win?

These outbreaks are of such concern, in fact, that there was a congressional hearing recently to explore the causes and potential fixes for these outbreaks.

Saad Omer, MBBS, MPH, PhD, from the Emory Vaccine Center, told the U.S. Senate Committee on Health, Education, Labor and Pensions that to battle new outbreaks, funding is needed not just for vaccines and research — but also for communication with the public about vaccines.

The biggest chink in the armor of our protection against these diseases is actually misinformation about vaccines, not limitations of the vaccines themselves. We all know about the concerns that boiled up in recent years about the supposed link between vaccines and autism. As Fierce Healthcare summarizes, “A paper published in The Lancet more than 20 years ago was long ago retracted after the author admitted to falsifying the information, but the concerns among many parents have persisted.”

This context shows clearly that in this case, protection against disease is about more than just science and treatment -- it's about the emotions, fears, and ideals of human beings. Whatever the science shows, if a mom believes the vaccine will cause autism, her child won't receive it. John Wiesman, DrPH, MPH, who is Washington's secretary of health said, “We need to be looking at how it is we get to the hearts and minds of people around vaccines and to not put science on the shelf."

Healthcare can't be distilled to a procedure, a recommendation, a scientific finding, or a single intervention. It's a messy, complex art that involves the hearts, minds, bodies, and social context. Which is exactly why healthcare collaboration can't just be secure text messages between two providers. It needs to allow the complex, long-term interactions of a whole medical team, across the continuum of care, and over time.

Hybrid store-and-forward telemedicine is a technology that supports this very human way of caring. And when the human context is respected -- it means that the science can succeed.

We've all been blindsided by technology taking the place of a human, when and where it shouldn't. 

It's the labyrinthine customer service switchboard when we just want to ask a simple question of a real person. It's the app that sends us in circles when we really just want to pay a bill. 

But a recent technology screw-up touched a serious nerve for one family -- and even called into question whether and how telemedicine should be used. 

Mr. Ernest Quintana was in the hospital for the third time in 15 days, as the New York Times recently recounted. His lung cancer was beginning to get the best of him and he was struggling. His family remained hopeful, though, and they were all with him throughout the hospital stay. 

One afternoon, though, Mr. Quintana was surprised to find a machine with a video screen on it being wheeled into his room. With his granddaughter by his bedside, Mr. Quintana listened as a doctor in an undisclosed location, and whom he had never met, began to discuss his care. His surprise turned to sadness and dismay when the doctor shared that Mr. Quintana was likely not going to survive this hospital stay and prepared him for end-of-life care.

A prognosis of death is never easy news for a person or a family. But hearing the news from a doctor you have a relationship with, who brings compassion, presence, and leadership, can decrease the suffering and ease the way forward. In Mr. Quintana's case, the terrible news and challenging decisions were worsened by the impersonal and jarring way that they were broached. No one wants to have a conversation about death with a stranger on a video screen. 

So is this a condemnation of telemedicine? Of technology?

I don't think so. I believe that this sad turn of events simply points to positive and negative uses of telemedicine and positive and negative uses of technology. 

So many people default to videoconferencing as the go-to (or even default) form for telemedicine to take. We believe videoconferencing has severe limitations because it requires expensive hardware and circuitous scheduling coordination. Those are some of the reasons that we believe hybrid Store-and-Forward telemedicine is significantly more powerful of a tool.

But this story brings into focus an even more important and powerful reason that we believe telemedicine should be about team-based collaboration -- not videoconferencing between a doctor and a patient. When telemedicine is used for healthcare providers to collaborate among each other, the patient can interact primarily or exclusively with the providers that they have a relationship with -- and the "other opinions" on the team can be shared among the medical team. That way, the providers can be leaders, healers, and human beings FIRST -- but use telemedicine to consult with other people on the team as necessary, and without disruption to the care for that patient.

For instance, in Mr. Quintana's case, perhaps an outside opinion was necessary regarding his end-of-life care. But rather than that opinion being piped in through a video screen, we believe it would have been far better for his provider, obviously, to consult with the outside doctor -- and then have a conversation with Mr. Quintana in person, within the context of their existing relationship. 

Don't risk this kind of technology screw-up. Prioritize human relationships and let technology -- and telemedicine -- serve them. 

My daughter recently signed her new baby up as a patient at a pediatric practice and had to choose one of the doctors in the group. “Dr. Salno,” they said, “is great. But you have to wait at least an hour to see him, every time.” She ended up choosing another doctor in the practice.

Her experience isn’t uncommon — so many of the very best healthcare providers we know have long wait times in their offices or are frequently running behind. Is that a problem for healthcare, or is it simply part of the reality?

In our experiences as medical providers, there is sometimes a sense that long wait times, doctors who are hours behind, and extensive travel to get medical care are all just facts of life in medicine. And that makes sense — there is a shortage of providers, especially physicians, and every healthcare provider I know has far more work to do each day than time to do it in. For some of us, long wait times and long travel times are practically badges of honor, showing just how in demand our practice is. 

In fact, those travel and wait times are long, and aren't decreasing. A recent study by Altarum shows that “Despite significant investments in the United States [from 2006 to 2017] in improving access to health care through better insurance, the use of innovative delivery systems, and advances in digitizing health care records and automating administrative processes, travel and wait times show no discernable improvements.”  These dynamics haven't been improving in decades.

The place that I see travel times really come into play are for patients with complex, chronic, or even acute but serious conditions. According to the Altarum study, patients who reported their health as “poor”, spent an average 26.4 hours per month on healthcare. That time may be transiting from provider to provider, from appointment to appointment, in addition to actually accessing care. 

But is this time that patients spend a bad thing? Is it something that should be decreased? And further, are travel and wait times something that healthcare providers should concern themselves with, or is it someone else’s problem?

Long travel times may not seem like the healthcare provider's problem until we consider the health cost of that time. Of course, there is the element of lost productivity and wages. But even just focusing on health itself, I believe that spending so much time accessing healthcare, as well as transit and waiting, has a severe and negative impact on our patients' health. Time spent at home with loved ones, hours invested in hobbies, focus at work, and rest in our own beds are all crucial elements of healing from disease. Every hour that a patient spends in a waiting room or driving to yet another appointment detracts from this healing time. 

So what can healthcare providers do? Most importantly, we can try to understand our patients' lives, travel times, wait times, and recovery and see it as "our problem." We can use medical collaboration tools to loop in other providers' input without the patient needing to trek across the state to gain that input when a picture and a discussion is actually all that is required (and this is reimbursable). When tools like iClickCare exist, that use telemedicine to dramatically decrease transit and wait times, there is the opportunity for health to truly improve, because the patients are able to spend more time healing and less time transporting or waiting 

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

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

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

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

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

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

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

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

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

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

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

Many healthcare providers don’t use the healthcare system often. In fact, I’m sure many of us have heard doctors say, “I don’t need to go to the DOCTOR!”

For that reason, sometimes I think we have a limited sense of what it’s like to be a patient.

As a patient in the hospital, we turn our days and nights over to a system that intends to get us to a certain level of recovery and intends to keep us alive. The hospital, per se of course, isn’t always structured to support overall wellness or healing — that’s the job of others in the healthcare system, and of the patients themselves.

But sometimes information will confront us about just how hard a hospital stay can be on the health of a patient -- and we're forced to reconsider our approach.

One common complaint in hospitals is that you can't sleep because of all of the interruptions throughout the night -- vital checks, light, noise, early rounds, blood draws, etc. For many of us, this may sound like a tiny price to play for the crucial monitoring that happens through those hours. And perhaps it is. 

But a recent article in the New York Times reconsiders whether the price truly is small. We all acknowledge the profound value of sleep in our basic functioning and healing: "Short sleep durations are associated with reduced immune function, delirium, hypertension and mood disorders. Hospital conditions, including sleep disruptions, may contribute to 'post-hospital syndrome' — the period of vulnerability to a host of health problems after hospitalization that are not related to the reason for that hospitalization."

There are so many demands in medicine that we’re forced to do things that may not make sense in terms of healing, but are the only way to proceed, working within the structure of the medical system. As the New York Times says, the hospital is "an environment that, all too often, seems set up for everyone else’s convenience but the patient’s.”

As providers who want to truly care for our patients, and in this time of value-based care, these are concerning truths. So what are we to do?

First, I believe that the sooner we can get people home, the better. This is a combination of the efficacy of care within the hospital PLUS an expectation of a high level of support once the patient leaves the hospital. The more we can depend on sophisticated monitoring and care from the home environment, the sooner the patient can get home. Many times, that means we need to be enabling healthcare collaboration across the continuum of care. That way, aides and wound care nurses can tend to patients from where they're most comfortable, but have a moment's access to other providers, as needed.

Second, the more humane, the more holistic, we can make our healing environments, the better. A clinical study showed that even small changes to disruptions to sleep in hospitals cut patients’ sedative use by half. Yes, hospitals are places where we achieve a bare minimum of functioning. But thinking more comprehensively about whether they're also supporting health may be a wise investment for us to make. 

Finally, it's crucial that we let providers make commonsense decisions. Our checklist culture has sometimes reduced errors, but it may have also reduced the commonsense nature of what many of us do. Any nurse has an impeccable gut sense of how she might combine vital checks and blood draws so that no monitoring sensitivity is lost, but the patient is disrupted less frequently. But if she's told she MUST do these things on a set schedule, she begins to override her own sense of what's best for the patient. 

Metrics like Length of Stay can seem challenging or even excessively profit-motivated to consider. But when you think about the patient's experience in the hospital and the intersection of Length of Stay and the patient's quality of healing, it gets clearer how the "right" thing to do is also the "smart" thing to do. 

To learn more about how telemedicine can support shorter Length of Stay and improve outcomes, download our Quick Guide: 

Our rallying cry at ClickCare is: access, collaboration, and education. 

Sometimes, people are surprised to hear that medical education is such a core part of what we do.

The reason?  We've always felt that no solution within the medical system can possibly be complete or effective unless it also addresses medical education. Ultimately, there is no separation between excellent medical care and excellent medical education. So the fact that across medicine today, medical education is lagging so far behind innovations in the care itself is deeply concerning. 

As Marc Triola, director of N.Y.U. Langone’s Institute for Innovations in Medical Education said in a recent New York Times article, "the gap between medical education and real-world care has 'become a chasm.'" 

I’ll admit that reading this is deeply frustrating. There has been no time in human history when the gap between real-world care and medical education should be smaller. The tools and technology are there. And the need for excellent, powerful, progressive medical education has never been greater. 

This article makes the further point that in many ways, we don’t need MORE healthcare providers (despite the realities of what’s effectively a shortage), we need providers in the right places, doing the right things.

I do agree with that. But where we deviate is the premise that technology should be like a more vivid version of book learning — in which students use virtual reality googles or 3-D simulations to learn.

As we move into a rapidly changing future, our job is not to use technology to make a “fancier” version of how we currently do medical education or medical practice. Our job is to use technology to reframe how we learn, how we teach, and how we care for patients.

It reminds me of a quote from Richard Buckminster Fuller:

“I am enthusiastic over humanity’s extraordinary and sometimes very timely ingenuity. If you are in a shipwreck and all the boats are gone, a piano top buoyant enough to keep you afloat that comes along makes a fortuitous life preserver. But this is not to say that the best way to design a life preserver is in the form of a piano top. I think that we are clinging to a great many piano tops in accepting yesterday’s fortuitous contrivings as constituting the only means for solving a given problem.”

So many of the ways we use technology in medicine are simply using piano tops to solve today's problems. We use telemedicine to replace in-person visits rather than changing how we interact and collaborate as medical providers. And then we use technology to make a more vivid version of the old medical training, rather than reconsidering what's needed today. 

To me, the most interesting and powerful applications of technology and medical education are those that demand that training meet the most challenging aspects of care today. For instance, an inclusion of a more holistic view of the patient’s experience and what it looks like to care for them effectively. One example of this is a program at the Penn State College of Medicine where students serve as “patient navigators” after discharge from the hospital — giving them a sense of the complexities of coordinating care for patients in thoughtful, holistic, and adequate ways. Did that involve any expensive hardware or fancy tech?  No. But it did potentially evolve our students' capacity for working effectively on behalf of our patients. 

Similarly, we're passionate about using iClickCare to treat patients (via telemedicine and healthcare collaboration) but we also deeply believe in iClickCare's ability to support education through collaboration across the continuum of care (learning via the collaboration in each case) as well as the archiving of the collaboration process for each case, so that providers and students learn from key cases, even if they weren't involved at the time. 

Each and every healthcare provider has the responsibility of caring for our patients. But we also have the responsibility of training and leading the next generation of providers -- without that, our efforts don't build upon themselves.

See how telemedicine can help improve medical education by trying iClickCare in your practice and teaching: