ClickCare Café

3 Simple Ways to Improve Healing in Hospitals (and Length of Stay)

Posted by Lawrence Kerr on Thu, Jan 10, 2019 @ 06:00 AM

luis-melendez-530478-unsplashMany 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: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: decrease length of stay, hybrid store and forward medical collaboration

Why Training New Healthcare Providers Depends on Healthcare Collaboration

Posted by Lawrence Kerr on Thu, Jan 03, 2019 @ 06:00 AM

rawpixel-660721-unsplashOur 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:

Get Started 

Tags: medical education, hybrid store and forward medical collaboration

What Factors Influence Telemedicine Adoption Across States?

Posted by Lawrence Kerr on Thu, Dec 13, 2018 @ 09:12 AM

rawpixel-586687-unsplashTelemedicine is not a new technology.

In fact, we’ve been doing telemedicine for almost 20 years at ClickCare. As you may know, we started by pioneering in a School-Based Health program at local underserved elementary schools. That program used newer technology — including some digital cameras — but really, the success of it was related to the approach and openness of the providers, patients, and families involved.

Because the school nurses and the pediatricians were so oriented towards caring for their young patients as well and as holistically as possible, they were open to trying new approaches. As participants saw the success of the program, it became broader and more organizationally supported. And honestly, at no point was there any conversation around reimbursement or policy — it was just one more way they cared for their patients.

All of the providers that use iClickCare today approach it similarly. While telemedicine is increasingly common, it’s certainly not the default. And so providers or hospitals that incorporate the tool do so as a conscious choice. Reimbursement improves; political and organizational support expands; but through it all, providers carry on with the tools and approaches they think will help their patients the most.

I was interested to read a report in JAMA, however, and extended in Fierce Healthcare, looking at how telemedicine use is expanding (or, in some cases, not), and how reimbursement laws relate to these adoption phenomena. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. These laws have been adopted in 64% of US states. In confluence with this, there was a significant uptick in telemedicine usage among primary care physicians between 2015 and 2017. For more rural areas, mental health services seemed to be higher usage than other specialities. While in urban areas, primary care telehealth was more common.

This is all in line with the expansion of both telemedicine and reimbursement that we’ve seen. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. That said, one interesting fact stood out: “the data showed a negative association with states that enacted comprehensive parity laws mandating reimbursement for the services.”  Perhaps that is because those states struggled the most with adoption in the first place — but either way, it’s clear that adoption “from the grassroots” may be more effective than approaches that aim to implement telemedicine starting at the policy level.

With any shift in practice, there is always a combination of technological, personal, psychological, and societal factors that need to come together for the technology to be incorporated into use.

For instance, simply inventing the telephone doesn’t create a culture that calls your friends. A combination of phone lines, social change, and early adopters combine with the new invention to lead to a society that talks on the phone.

On the one hand, telemedicine is becoming increasingly widespread, generally. There is increasing consensus that telemedicine can contain costs, increase access, and cut healthcare provider burnout. It’s not surprising that so many providers, patients, and payers are incorporating the technology into how they “do medicine.”  On the other hand, telemedicine implementation isn’t a matter of policy or a “snap of the fingers.”

Ultimately, telemedicine adoption must come from providers and patients. There is no way to legislate or demand creative ways of caring for our patients.

Learn more about how to implement telemedicine in your organization, economically and quickly, with our Quick Guide to Hybrid Store-and-Forward Telemedicine: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, regulatory issues, telehealth

Why Medical Collaboration Can Help Us Lead With Our Values

Posted by Lawrence Kerr on Wed, Dec 05, 2018 @ 09:41 AM

vidar-nordli-mathisen-537587-unsplashIn our community, there are two nonprofit community hospitals and one Catholic hospital. All are excellent. Each has slightly different founding values and ways of operating. All three have a strong heart and soul, which has been more or less apparent at different times depending on leadership.

So a recent article exploring the shift in how Catholic Hospitals have approached their values and leadership — and the effect that can have — certainly caught my eye.

Catholic Hospitals used to be run, of course, by nuns. Increasingly, however, as the Fierce Healthcare article describes, “Catholic hospitals are much more likely to be run by lay executives who don’t serve as a human embodiment of religious roots.”

There may be multiple positive aspects of this shift. Perhaps the hospitals are able to serve a broader base of people with a greater diversity of religious backgrounds or values. Perhaps the lay leadership is stronger in some technical aspects of running or managing the hospitals. But the author of this article points out that the shift away from hospitals’ original values “can actually hurt their bottom line, as Catholic hospitals lose the loyalty of community members who sense an erosion of the values that were long integrated into their care.”

In other words, although it may seem that the immediate effect is one of broadening and strengthening, there may be side effects — as of any strong medicine — that outweigh the positives. As the author concludes, we in medicine are in a unique place that is at the intersection of art, science, morality, and human caring. Indeed, “hospitals are seen as more than just a business – they are often seen a reflection of the overall health of a community.”

I don’t have a detailed understanding of the specifics of Catholic hospitals and how these shifts to lay leadership have affected them. That said, I have found on a personal, business, and medical level — that when you dilute or don’t lead with your values, it may seem practical but leads to negative consequences.

Collaboration is about declaring to ourselves and our colleagues that we have a unique perspective, unique skills, and unique values as individual providers. We’re not a generic “healthcare provider” that can be swapped in for any other provider. If that were the case, any provider could provide the same care as any other — and collaboration would be far from necessary.

Let there be no mistaking it: when we lead with our values, and care for patients from our unique set of strengths, weaknesses, and values — we are more interdependent with our colleagues and we end up with a more unique role in the process. For providers who want to see themselves as invincible, this can be uncomfortable. But, as with the example of the hospitals, there may be immediate, short term benefits to diluting our values and trying to be all things to all people — but ultimately, it results in weaker care.

In fact, I think that is one reason that iClickCare, and telemedicine-based medical collaboration in general, is so effective. When we are able to collaborate, to reflect on cases, and to lead (and treat patients) with our values, we get better results. As the article author emphasizes, “There’s benefit in continuing to cultivate the essence of local hospital’s unique personality and roots, even as the benefits of system affiliation are stressed.”

It takes courage to practice medicine from your own unique perspective and strengths, rather than from an imaginary “generic” place. But the rewards are great — and so is the care.

For more stories of courage, medicine, and medical collaboration, download our Quick Guide to Medical Collaboration:

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration software, hybrid store and forward medical collaboration, good medicine

New Medicare Proposed Rule to Expand Telehealth Benefits

Posted by Lawrence Kerr on Thu, Nov 15, 2018 @ 06:00 AM

rawpixel-487102-unsplashMedicare is a crucial part of our healthcare system. Although some providers feel themselves unwilling or unable to accept Medicare, the reality is that 44 million people are beneficiaries. It impacts those people, as well as our healthcare system as a whole. This is important because the whole healthcare system tends to lean towards Medicare's policies.

So a new proposed rule affecting telehealth is practical, crucial, and fascinating to explore. 

Just recently, Medicare announced a new proposed rule for public comment and review that would greatly expand payment for telehealth. 

The full proposed rule change can be found here, but the general shift leans heavily on Medicare Advantage plans and is summarized as follows: "Under this proposal, MA plans would be permitted to offer – as part of the basic benefit package – additional telehealth benefits beyond what is currently allowable under the original Medicare telehealth benefit. In addition, we propose to continue authority for MA plans to offer supplemental benefits (that is, benefits not covered by original Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for additional telehealth benefits."

The explanation and rationale for the shift includes this insight: "The healthcare industry has made significant advances in technology that enable secure, reliable, real-time, interactive communication and data transfer that were not possible in the past. Moreover, the use of telehealth as a care delivery option for MA enrollees may improve access and timeliness of needed care, increase convenience for patients, increase communication between providers and patients, enhance care coordination, improve quality, and reduce costs related to in-person care."

Not only is this a powerful positive development for medicare beneficiaries as well as healthcare providers who use telehealth -- we believe this represents an important philosophical shift. Telehealth is not an "an additional benefit" -- it's one of the many tools that healthcare providers have at their disposal to provide excellent care to all patients. This proposed rule is an important step away from that "special benefit" status of telehealth -- and towards it being just one more tool in our toolbox. 

Further, it is recognized that significant savings can come from the use of telehealth, as well as increased access by people who may be in rural, underserved, or hard-to-reach areas.  

The commonsense of telehealth seems to be slowly eroding the granite barrier of Medicare’s policy toward payment for telehealth.  As you know, there are significant restrictions about who, where and how a patient could benefit from technology applied to day-to-day care. Currently, live video conferencing from specific sites is the only reimbursable use of telehealth for Medicare recipients. We, of course, are strong believers in using technology to shift time as well as shift place. Hybrid Store-and-Forward Telemedicine®, for instance, uses asynchronous collaboration -- you respond on your own schedule -- so that both the patient and provider can solve problems without always using expensive hardware and having the interruption of scheduled appointments.

We understand CMS’s concerns about the potential for fraud and agree with the concerns. However, in our modern society with a fragmented health care system, collaborative and coordinated care has benefits that outweigh the risks.

For providers who care about good medicine and thoughtful healthcare, this new rule is an important development -- and likely shows the direction that reimbursement and medicine in general is headed. 

 

To learn more about Hybrid Store-and-Forward Telemedicine, including reimbursement issues, download our white paper: 

 ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, telemedicine reimbursement

Medical Collaboration has More Regulatory Flexibility than Direct-to-Patient Telehealth

Posted by Lawrence Kerr on Thu, Oct 18, 2018 @ 06:00 AM

victoria-heath-367303-unsplashAs the world changes, our regulations and laws often scramble to keep up.

Whether it’s Uber being challenged in individual cities or schools struggling to adapt to children owning cellphones, the legal side of life often lags behind our technology, our culture, and our needs.

So it shouldn’t be surprising that telehealth regulations face similar challenges across states — but the consequences are indeed challenging for those who do direct-to-patient telehealth.

A recent article in Fierce Healthcare looked at a few examples of recent telehealth challenges arising from state-to-state regulatory differences.

As they report, “Whether a medical professional can treat someone via telehealth—and if so, how—varies widely by jurisdiction, since medical practice is regulated at the state level.”

For instance, court cases involving doctors seeing patients via telehealth touched on:

  • The administration of medical abortions
  • Prescription of controlled substances
  • Etc.

Further, doctors and patients often run into challenges when the intended telehealth patient didn’t have access to the Broadband internet needed to access an electronic visit with a doctor (thus limiting care in the very places that telemedicine could be most useful.)

These challenges are real, and important to explore. That said, it's not necessarily the case that the challenges are inherent in using telemedicine across state borders.

The regulatory issues presented in the Fierce Healthcare article all boil down to the challenges inherent in a doctor seeing a patient electronically.  But “telehealth” is NOT synonymous with doctor-to-patient online visits. As we’ve written about extensively, the umbrella term "telehealth" includes the use of many different kinds of technology to care for patients. A doctor seeing a patient via an online platform is only one version of that.

In fact, the challenges of videoconferencing or electronic visits are the very reasons that we created iClickCare to revolve around medical collaboration among healthcare providers, NOT between a single medical provider and a patient. There are many reasons that a short, technology-supported visit between a healthcare provider and a patient via videoconferencing may not be adequate to provide strong, holistic care of that patient. There isn't a useful archive of the visit; other members of the care team can't be involved; there is often little longitudinal knowledge of the patient; and care is infrequently holistic. The regulatory issues inherent in a “visit” like that are only one aspect of the shortcomings involved.

As an alternative, telemedicine-based medical collaboration allows providers — regardless of location — to collaborate on a case. It also means that if a provider in California is consulting with a provider in New York about a patient in California, the provider in California remains responsible for that patient. And that is “responsible” in all senses, legally and otherwise. Telemedicine-supported medical collaboration allows the flexibility and location independence that telehealth promises. But it doesn’t put the sole responsibility for a patient in the hands of a provider who is 300 miles away and has interacted with them, once, on Skype.

As we step forward into this new age of telehealth, telemedicine, and technology, it's important that we don't simply replace our old system (one-on-one doctors' visits, for instance) with a technological version of that old system. Our patients deserve more imagination than that. And we deserve the ease that can come from a tool that really works to help us deliver great care. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, medical collaboration tool, telehealth and hipaa

Is an In-Person Visit Always Preferable to Telehealth Options?

Posted by Lawrence Kerr on Thu, Oct 11, 2018 @ 06:00 AM

rawpixel-743067-unsplashA new article in the New England Journal of Medicine takes a controversial stance on the topic of whether an in-person doctor's visit is always "Plan A."

Perhaps, the author argues, we are moving towards a time when patients will be better served by a model in which in-person visits are actually the "last resort" of care. 

Our take? Yes and no. Read on...

In "In-Person Health Care as Option B", Sean Duffy and Dr. Thomas H. Lee advocate for a new framework for healthcare visits. Rather than seeing telehealth visits or other virtual options as "in the meantime" approaches or ways to cut costs, they argue that perhaps patients can be cared for better when in-person visits become much rarer, only used when absolutely necessary.   

They describe the analogy of a tech support ticketing system, as might be used at your favorite software company. Perhaps a patient would submit a "ticket" with their concern or medical issue... it would be handled first via telehealth means (even automated or low level support at first)... only being "escalated" to an in-person visit if absolutely necessary. And the ticket wouldn't be closed out until or unless the initial complaint was resolved.

The technology is there, the authors contend. “Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.” And the reality is that in many ways, our medical system is already moving in this direction: "At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”

One important point that the authors make is that doctors are often approaching care this way currently -- but with improvised methods that aren't really meeting the provider's or the patient's needs. True enough: “Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome." Further, if doctors are simply using text messaging, email, or informal photos to replace a visit, that's not a safe or sustainable way to replace the richness and HIPAA-compliance of a real visit. Also, improvised approaches tend to be lesser replacements for in-person care, rather than innovative ways to save money AND get a better result.

Although we agree that there is a lot of potential to rethink how we approach clinical visits in healthcare, we also worry that the authors' approach isn't appreciating some of what can be lost if telehealth approaches aren't designed thoughtfully.

For instance, the example of the tech support "ticketing" analogy would fall severely short of our goals for any medical visit. Sure, the patient's complaint needs to be addressed. But medicine is more complex than software.

So any approach to increasing the use of telehealth solutions also must:

  • Support medical education.
    This means that simple videoconferencing or "e-visits" likely aren't sufficient, as they don't create an archivable, searchable, teachable record of the encounter.

  • Provide holistic care to the patient. 
    Support not just solving the immediate problem, but truly caring for the patient -- which doesn’t always just mean solving only the problem the patient presents with.

  • Enable providers to collaborate effectively.
    It would be a tragedy if telehealth caused a further silo-ing of providers across specialities and across the continuum of care.

Healthcare needs innovation, certainly. And technology will be a crucial part of any solution that stands a chance of survival moving forward. But we advocate for approaches that truly support access, education, and collaboration -- not just completing a ticket and checking off a box for a patient.

 

To learn more about alternative technologies for telehealth, download our Quick Guide to Hybrid Store and Forward Telemedicine®: 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

Tags: hybrid store and forward medical collaboration, telehealth and hipaa

Medical Education Fails to Prep Doctors to Care for Addiction

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

ClickCare Quick Guide to Hybrid Store-and-Forward

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

Can Telemedicine Change Rural Medicine’s Challenges?

Posted by Lawrence Kerr on Wed, Sep 05, 2018 @ 07:00 AM

jan-vernarec-290297-unsplashEveryone in medicine is under financial pressure these days.

For many rural clinics and hospitals, that has meant closing or consolidating. And for people in rural areas, that has meant limited access to care or extremely long drives to receive care. For instance, this article tells the story of a new mom in Missouri who was making regular 200-mile trips to be with her newborn twins in the NICU. Then she’d drive back home to be with her 2-year-old and go to work.

Rural medicine, whether in remote areas or in places like Native American reservations, has always come with its unique joys, gifts, and challenges. But the more medicine evolves, the greater the pressure on these rural providers and hospitals seems to be.

The New York Times reports, “At least 85 rural hospitals — about 5 percent of the country’s total — have closed since 2010.”

One doctor commenting on the article describes the situation from his viewpoint: “The main issue I’ve seen working in health care is consolidation of smaller systems into larger collectives. Smaller rural hospitals are bought by the larger systems, which in turn buy out practices, and end up owning everything in a three to five county radius — sometimes more. The system shunts patients to their main facilities and either closes or cuts back on services offered at the smaller hospitals. It’s not surprising, because it is a balancing of limited resources in a for-profit system, but it does leave the most vulnerable without access to care.”

Certainly, these pressures are a reality. And many providers and patients are dealing with that reality on a daily basis. But these articles also led us to wonder whether there are other solutions to these challenges, beyond the 200-mile drive to care for a newborn.

We’ve worked with many providers, clinics, and hospitals in remote areas who find that by using telemedicine, they’re able to dramatically expand their offerings and capabilities, while decreasing costs.

For instance, with hybrid store-and-forward telemedicine, even a more bare-bones staff is able to get consults on cases that they’d normally have to send to a much larger care center, many hours away. Furthermore, the staff is able to coordinate care for patients so that they may be able to avoid unnecessary visits to distant centers.

So although telemedicine can't fix everything  a woman in labor still usually needs a maternity ward that's closer than 100 miles from her home  there are creative ways of working within these new constraints. And telemedicine, care coordination, and medical collaboration are three tools that may help. 

To learn more about hybrid store-and-forward telemedicine and how it can help in rural settings, download our free guide:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: rural medicine, telemedicine solutions, hybrid store and forward medical collaboration

Hospital Consolidation May Not Improve Data Sharing or Interoperability

Posted by Lawrence Kerr on Thu, Jul 26, 2018 @ 07:00 AM

helloquence-61189-unsplashThere has been an increasing trend towards consolidation in the healthcare field. Hospital systems buy other hospital systems, with the promise of cost-savings, improved results, and better data-sharing and interoperability.

In many ways, this is common sense. If we’re all part of the same organization, or even under the same roof, it stands to reason that we will be able to share data and collaborate more effectively.

Unfortunately, though, this doesn’t appear to be the case.

Using data from the 2014 American Hospital Association (AHA) annual survey and the 2015 IT supplement that included more than 2,000 hospitals, researchers found that consolidation enough wasn’t enough to improve interoperability.

In fact, it took several additional circumstances for interoperability to improve: centralized organizational governance, a specific business model, and an integrated insurance offering. 

Of course, achieving interoperability and data sharing is a hugely complex endeavor that can take time to come to fruition. It's not a race, and there are many precautions and complications that arise.

That said, I find it fascinating that even merging with another organization doesn't necessarily make it more streamlined for healthcare providers to collaborate, for data sharing to happen, or for interoperability to be a reality. 

My take on why? I believe that true data sharing and healthcare collaboration only come about through intention and through workflow changes on the part of healthcare providers. Yes, the organizational structure affects it. Yes, EHR interoperability plays a role. Yes, being under the same roof can make collaboration simpler than being in separate buildings. But ultimately, healthcare collaboration comes down to the choices that individual healthcare providers make. It's the choice to ask a question of a colleague, regardless of how that question gets asked. 

That's why we're so passionate about hybrid store-and-forward telemedicine® (like iClickCare) as a tool for healthcare collaboration. It doesn't require being under the same roof, or in the same organization, or even using the same EMR/EHR to collaborate, share information, and coordinate. It doesn't require that everyone in your organization use it or that everyone is "on board."  It just requires a 30-second download and then as-you-have-time consults with colleagues. Everything is archived so you can find it later -- and it won't conflict with your EHR. 

The above study certainly demonstrates that we can't wait for large structural shifts to practice medicine in ways that we think are right, and useful. We have access to the tools and structures we need now -- it's just a matter of acting on that.

 

Try the iClickCare 14-day evaluation

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

Subscribe By Email

Recent Posts

Posts by Topic

see all