ClickCare Café

Nurses Risk HIPAA Violations With BYOD Texting

Posted by Lawrence Kerr on Fri, May 30, 2014 @ 08:23 AM

pager resized 600

In many sectors, pagers are a technology that came and went with the '80s and '90s. With the advent of cellular phones, and then smartphones, the simple alarm-plus-message functionality became obsolete quickly.

In medicine, however, pagers are still ubiquitous. Most hospitals and medical settings use pagers as their main form of communication, primarily because they are viewed as low-risk communication tools. However, despite pagers being the more common choice, they're not necessarily the better choice. Pagers cost US hospitals $8.3 billion in 2013: $3.2 billion through lengthy discharge processes and $5.1 billion while clinicians wait for patient information.

The evidence shows that we may be reaching a crisis point regarding the viability of using pagers in medicine:

  • With so many providers at different parts of the continuum of care, and with so many handoffs within a given case, pagers can't keep up with care coordination.
  • In an age of increasing malpractice suits, having no record of communications or responses is riskier than ever. 
  • With pay-for-performance, rather than pay-for-service, being today's touchstone, it is no longer sustainable to be wasting time or money with an antiquated technology.

As usual, it is the providers themselves -- particularly the nurses -- who are taking matters into their own hands and finding efficient ways to communicate whether regulations or administrations support them in doing so. Hospitals are seeing a de facto Bring Your Own Device (BYOD) situation and 67% report nurses are using their smartphones to support clinical communications and workflow. According to research by Logicalis, the phenomenon is even more common in high-growth markets (like Brazil and India): almost 75% of users in these countries used their own devices at work, compared to 44% in places like the US. 

Why can't pagers support medical collaboration and coordination of care like smartphones can? Benjamin Kanter, chief medical informatics officer at Palomar Health, explains:

"The message is only one piece of the puzzle. You've got to provide context and you've got to be able to create action. Most secure texting systems don't take that into account."

When medical providers come to us for advice on how to coordinate care and collaborate without running afoul of hospital regulations or HIPAA, we acknowledge that it can be tricky. That's why we recommend the following: 

  1. Don't ignore HIPAA. While we do applaud the persistence of medical providers who just "get the job done" and use their own smartphones as necessary, we caution our colleagues to not use text messaging, email, or their regular camera roll as none of these are HIPAA-secure. The penalties are too great to risk it. 
  2. Be willing to go first. Sometimes a provider will be ready to use iClickCare for medical collaboration but hesitate because their institution doesn't already use it (even if it's allowed). If we're going to change medicine, we have to be willing to lead the charge -- first an individuals, and then as a community. 
  3. Be realistic about the complexity of your communication.  Popular messaging services don't incorporate the use of photos, videos, archiving, and consults with any provider. Communicating is great, and a great start, but the reality is that our medical collaboration demands more than a text message to really accomplish the communication and coordination we need. 

For our rundown of telemedicine options, pros, and cons, click here:

ClickCare Quick Guide to Telemedicine


Image courtesy of hades2k on Flickr, used under Creative Commons rights.

Tags: medical collaboration, coordinated care, medical collaboration software, HIPAA, accountable care, iPhone, iPad medical apps

A New View of Medical Collaboration. Inspiration from Strong Women

Posted by Cheryl Kerr on Thu, Apr 25, 2013 @ 01:05 PM

Which autobiographical account inspires you?

Lean In: Women, Work, and the Will to Lead, Facebook COO :Sheryl Sandberg (2013)
Until I Say Good-Bye: My Year of Living with Joy
:Susan Spencer-Wendel (2013)

To give you a tiny taste of Sheryl Sandberg's book, here are a few of the chapter titles:

     - Sit at the Table
     - Success and Likeability
     - Don't Leave Before You Leave
     - Make Your Partner a Real Partner
     - The Myth of Doing it All

Sheryl Sandberg is on Forbes' list of the most powerful people in the world. In her book, she encourages ambitious women to realize their own career goal, but also to make changes in their workplace so that other women can succeed, too. Sandberg tells women to have confidence in themselves and their knowledge, and to own their achievements.

I don't know if Susan Spencer-Wendell read or is trying to read Sheryl Sandberg's book. Susan is an award-winning journalist for the Palm Beach Post, who learned in June 2011 that she had amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease). At that time, she was 44 years old, with a devoted husband and 3 young children. She was so determined to complete a book describing this experience for her children and the rest of us, that with her minimal strength, she typed the manuscript with one thumb on her iPhone. No longer able to walk or even lift her arms, she tapped it out letter by letter. USA Today on March 11, 2013 speaks of some of the fabulous lessons expressed in this memoir:

"Her "year of joy" included everything from traveling in hopes of witnessing the Northern Lights — she did not — to tracking down family roots on Cyprus — she did — to visiting Kleinfeld Bridal in New York with her teenage daughter, Marina, only because she knows she won't be around when the real pilgrimage will take place."Susan Spencer-Wendel

Her children Marin, 15, Aubrey, 11. and Wesley, 9, have been adapting to the situation. Their Aunt Stephanie says: "They rub her nose. They brush her hair out of her eyes. They have very normal routines with their mother. Nothing is strange."

This goes to show that there are a lot of heroes here. Reportedly, Susan didn't want to switch to another piece of high-tech equipment because she didn't want to lose the time needed to learn another system. With her laser focus, her habit of meeting deadlines, AND HER RIGHT THUMB, she wrote the 362-page book Until I Say Good-Bye. It's now available on Amazon, and movie rights have been sold to Universal.

This is definitely a new twist on Store-and-Forward. After reading this book, like the effect of all good medicine, I felt lighter and stronger and more accepting. Susan says: "don't force the world to be the one you dream; the reality is better." If she can say that, most all of us can say it more and do more.

Sheryl Sandberg's Lean In is also inspirational. "Sit at the Table" is up front and center; otherwise how can one hear or be heard. She says that opportunities are rarely offered; they are seized. That's an understatement!

There are many criticisms (jealousies?) of Lean In, but it is an important follow-on to Betty Friedan's The Feminine Mystique and Gloria Steinem's Revolution from Within. Sheryl is a 43-year-old former Google executive with two Harvard degrees, who is calling on other women, as she puts it, to "lean in" and embrace success. Even though Sheryl knew the business world was listening, she had the intestinal fortitude to include personal examples, that readers are dying for, which are definitely supportive and inspiring. Moreover, the cited research is impressive, for instance the data showing positive correlations between success and likeability for men, and negative correlations between success and likeability for women. Sheryl's bibliography and footnotes are lengthy, and the statistics support the thesis that even in 2013 — women simply aren't making it to the top. She says: "Ten years of no progress is no progress" (spoken like a real COO). 

Sheryl SandbergNPR relates: "Warren Buffet has very generously said that one of the reasons he was so successful is that he was only competing with half the population. Companies that use the full talents of everyone — those companies do better."

One of the HUFFPOST quotes from Sheryl's book is: "if we want a world with greater equality, we need to acknowledge that women are less likely to keep their hands up." Further a quote about working together: "As women must be more empowered at work, men must be more empowered at home."  Download "Caring for Baby" to help with that effort.

Click me

We need all of the people in this country and the world striving to be better, helping each other, and sticking their neck out to do that. She says: "This revolution will happen one family at a time."

Where have you heard that before?  Give your patients access, collaborate with their other providers, and leave a legacy of education. Let's get on with step at a time; one thumb, one family, one patient, at a time.

Tags: good medicine, collaboration leadership, iPhone

Better Medical Collaboration: A Party for iClickCare on the iPad

Posted by Lawrence Kerr on Mon, Apr 22, 2013 @ 09:49 AM

iClickCare is a hybrid Store-and-Forward of text messages, video, PDFs and still images. 

iClickCare on iPad

It is also a hybrid of platforms because as providers we are not always mobile nor sedentary. We need the right tool for the right job at the right time. Indeed, that is what medical collaboration and telemedicine is all about anyway — the right provider, at the right time and at the right place — for the patient.

We have had the web-based browser of iClickCare for years. Eighteen months ago, we added the mobility of the iPhone. As physicians, we also found a need for an in-between size and thus we started work on the iPad. The iPad mini came along as we developed our solution. So now we have an in between with an in-between. And as the image shows, we are putting our party hat on as well!

Fortunately, you don't have to learn something new. The same relationship you have with iClickCare on the web applies directly to the iPad, iPad/mini and the iPhone.

Meaningful Use and Meaningful Records:
We have added features to the iPhone as well, and now you can use Invite Patient to give true meaningful use to your care as you collaborate with your colleagues. The patient is, if you choose, part of the process.

Also added is the Compare Visits function. There is nothing quite so satisfying as seeing improvement over time, and nothing quite so educational as following decline over time. Visits can now be compared on both the iPhone/iPod and the iPad and mini, as well as the browser.

Security and Speed:
There are many, many improvements and tweaks to security and speed. Even though information about your patient is delivered to you faster, the security is solid. Our security systems surpassed stringent HIPAA requirements before, but, they are even more robust now. We would remind you to use strong passwords. Passwords can be changed by you as often as, and whenever, you wish from the top of the login page. 

Searches and the “serving up” of images, video and PDFs are faster because our developers really understand the tasks and demands on providers, and know how to make things work in very sophisticated ways.

Current pricing for version 2.0 will apply through May 20, 2013 if either a renewal or new subscription is confirmed. As an iClickCare customer, all you do is upgrade from the iTunes AppStore and contact your sales rep before May 20. New user subscription pricing is posted on, but, as a new customer you will receive a 2 week free trial to start. We want everyone to continue to see how incredible iClickCare can be with the ease and clarity of the new iPads and the iPad minis.

Learn one, you know them all... any browser, the iPhone, the iPad, or the Mini... all as Version 2.0 on the iPhone. You will also discover that the Search is faster, and the presentation of images is better than ever. And our Online Help is ready to serve YOU, as always.

You can use iClickCare on your browser, your iPhone and now your iPad all with one click.

Click me

Tags: medical collaboration, medical collaboration software, store and forward medical collaboration, iPhone, iPad, iPad medical apps

We love our new medical iPad app & iPhone app, but they need attitude

Posted by Lawrence Kerr on Tue, Feb 19, 2013 @ 12:31 PM

We are excited about our brand new iClickCare® iPad app and updated iPhone app -- and how they can help you iPad and iPhone medical collaboration appwith healthcare collaboration. ClickCare® was formed for one reason: to help medical providers (17 years ago, we called them doctors, nurses and allied health professionals) help each other to help their patients. The iClickCare for the iPad app is about to ship to the Apple iTunes Store where it will join iClickCare for the iPhone. Both apps can be evaluated free for 14 days.

We use the guiding Mantra:

  • Access -- for the patient to the right care, at the right time, in the right place
  • Collaboration -- for those who care for patients on behalf of the patients and themselves
  • Education -- for those who join us anew or follow in our footsteps

We also have design goals of Simple, Secure and Spectacular.

With the hard work of our lead team, Marc Norman, Greg Born, and Nathan Uno, we are pleased to announce the new "iClickCare for the iPad" and upgraded "iClickCare for the iPhone" apps.

The new app features include even more:

  • Simple:
    • Easier to read.
    • A calming relaxing visual presentation.
    • A page design that mimics your workflow as a medical professional.
  • Secure
    • Backend enhanced security when images are served up.
    • A private, secure password-protected camera roll.
    • Continued high level SSL.
    • Firewall friendly.
  • Spectacular
    • Nothing really new to learn. iClickCare for the iPad is intuitive and integrated with our Web and iPhone apps.
    • Carefully chosen colors to highlight the patient and soften the intrusion of a form.
    • Maximum use of the Retina Display which supercedes our common encounters with imaging today.

We love this technology and are especially proud of iClickCare®. We need to make note, though, that for good patient care, efficient and cost effective healthcare, and a satisfying career, each of us needs to have the attitude that we want to collaborate. It takes effort on our part, no doubt, but the effort is worth the gain. To use iClickCare, we must do something different and take one step away from ourselves. The alternative is tedious telephone tag and reams of paper to be read and signed. The other alternative, “doing nothing”, is not acceptable.

We will be updating our book Medical iPhone Photography to INCLUDE being able to take pictures on the iPad as well as the iPhone. Stay tuned. In the meantime, to celebrate, we are offering an electronic copy of "Medical iPhone Photography" when you schedule an iClickCare demo.

Download Chapter 1 for your reading pleasure:

medical photography introductory chapter

Tags: Medical iPhone Photography, iPhone medical apps, iPhone, iPad, iPad medical apps

HIPAA Compliant Medical Collaboration: 5 Strategies

Posted by Lawrence Kerr on Sat, Jun 02, 2012 @ 10:13 PM

There must be something about the iPhone and healthcare. ClickCare has had very exciting time recently with our shout out from Steve Wozniak and the review of ClickCare in the NY Times.

We are also proud of our colleagues, Ms. Rebecca Kennis and Dr. Azful ur Rehman, and we want to highlight their presentation of their product iCare at HIMSS12. We are pleased to share the spotlight since we belong to the same tribe. We all work in the same vertically integrated hospital system. hipaa compliant medical collaborationTheir group, and ours, have been nurtured by Mr. Michael Rusnak, Director of Health Information Technologies at United Health Services (UHS). He has had a committed career dedicated to using computer technology to benefit the patient by enabling providers to do their job better.

Rebecca Kennis, CPHIMS and Afzal ur Rehman MD PhD, presented their view of security using smartphones at HIMSS12, Annual Conference and Exposition in February. While we are very aware of their groundbreaking work, the silos that we keep discussing, isolated us from their presentation, and we only found out about it in a more indirect manner. The presentation is entitled, Got Smartphones? Leveraging Physicians Smartphones Usage in HIT.

A well written summary by Don Fluckinger is available from SearchHealthIT. The article is entitled Ten iPad EHR Security Strategies for HIPAA Compliance.

We are happy to highlight (and agree with) five of their important points here.

  1. Store as little data as possible on mobile devices
  2. Make the device require a token as well as an ID and Password.
  3. Log off users after idle. They suggest 5 minutes.
  4. Limit views by users to only those that are needed.
  5. Use standard physical security as well as electronic security.

A PDF of their PowerPoint presentation is available here.

As they work to integrate information for providers, we continue to empower those same providers and many others to collaborate on behalf of the patient. Good data and good discussion can only lead to good healthcare outcomes.

Congratulations to Ms. Kennis and Dr. Rehman. They are two good people working hard at doing a good job. We are sure they appreciate Mr. Rusnak and his team as much as we do.


  Click me

Tags: HIMSS, HIPAA, HIPAA Collaboration, EHR, iPhone, iPad

Chapter 6 of Medical iPhone Photography on Turkey Day!

Posted by Cheryl Kerr on Thu, Nov 24, 2011 @ 07:51 AM

Collaboraton pardoned this turkey
  • How to get clear photographs,.

  • How to zoom and use macro.

  • Pardon me, but what about gloves?

Tricks for iPhone camera handling are discussed. It is also remembered that a blurry photograph is frustrating to see (unless it's a background) but it can be better than nothing. Whether you're a physician, a nurse practitioner, a therapist, an aide, or a specialist or anyone else who cares, this is just part of good communication.

Click me

While you are taking Thanksgiving pictures, REMEMBER TO HOLD THE CAMERA STILL. Clear photographs will even make Thanksgiving happier!

Tags: nurse practitioners, iPhone medical apps, clinical photography, medical photography, iPhone

Med Photography Ch5: Focus and Lighting for Communication

Posted by Lawrence Kerr on Thu, Nov 17, 2011 @ 06:01 AM

In Chapter 5, the control of focus and of lighting is discussed. 

Downlooad to learn how to use the iPhone for good and for evil.

Click me

In this blog post, 

  • How to make an aged face look younger.
  • How to erase wrinkles without creams, surgery, or exercise.
  • How to hide ugly scars.

Images and Words create better communication together than each alone.

Collaboration is all about communicaton. Communication needs to be honest and collaboration requires the respect of each collaborator for one another.

Photography is all about light and how it is collected, used and interpreted.

It is the manipulation of light which like any tool can be used for good (consistency) and evil (misrepresentation).

Communication? Kilmer Swamp Root, Credit Joe MabelSearch for before and after photos after you download Chapter 5. Observe the before and after photographs and see where flash is used to over expose skin and fill dark areas. You can copy this, and  “erase”  wrinkles. Small changes in focus can also “soften the skin” and thus make skin treatments look better than they are.

DId you know that when HD TV was introduced a few years ago, it created quite a problem for the on-air personalities. Out-of-focus blemishes on the talent had no place to hide.

Want to make scars “disappear” in the same way as wrinkles?  Defocus the camera by choosing Macro and then moving out of its range. Or use the focus square to focus on something just a little off the target plane. The subject becomes blurred against a sharp background. Finally, want to get that “turkey gobbler” neck to go away? Easy, extend the neck forward, move the jaw forward, lift the chin, you can have a pretty good result.


We don’t condone these techniques, but you should be aware of them. As you collaborate with your trusted network, you can judge for yourself and decide who to trust. Figures lie, Liars figure.  Medical photographers can do both.

Tags: telehealth, collaboration, clinical photography, iPhone, mobile health

How to Use ePUB to Read Medical iPhone Photography, Chapter 3

Posted by Cheryl Kerr on Tue, Nov 01, 2011 @ 03:17 PM

Using Chapter 3 of Medical iPhone Photography, we show you how to put an ePUB file on your iPhone and continue learning great camera techniques.

Chapters 1 and 2 reminded us to use the camera "in your pocket" and make sure the pictures are recorded on a secure camera roll. Chapter 3 gets into posing or positioning the that clinical progress or deterioration can be professionally mapped.

As described in previous blogs, Medical iPhone Photography will be released in 2 formats, the .epub for iBooks, Nooks and all eBooks except for Kindles...and the .pdf for everything else. In order to bring up the .epub file as an iBook, please follow these instructions:

1. Open iTunes and drag the downloaded .epub file over to the Library section of iTunes with BOOKS selected. 

ITunes for iBooks
 2. Plug your iPhone or iPad into your computer and let it SYNC automatically.



Click me  


3. Open your new "book" from your iPad's or iPhone's iBook shelves and enjoy learning.

After you open your iBook, touch the page and to choose print size, white or sepia background, and intensity of the lighting. You can view the book in either portrait or landscape mode. You can place bookmarks or do a search. Also you can highlight passages, you can enlarge pictures, you can ask for word definitions...all while sitting on the couch!

But the most fun of all is TURNING THE PAGES IN AN eBOOK!!! Slide from the right to the left to see the next page; slide in reverse to go back. And this is something that you cannot do with the PDF format! So take these extra steps.

When you have the whole Medical iPhone Photography book, there will be lots more interesting pages to turn.



Tags: ePUB, clinical photography, medical photography, iPhone

HIPAA Compliance and Medical iPhone Photography...Chapter 2

Posted by Cheryl Kerr on Thu, Oct 27, 2011 @ 08:16 PM

  • What is clinical photography? Is it medical photography?
  • What is the best camera for clinical photography.
  • What makes a good clinical photograph.

Chapter 1 reminded us about the importance of the obvious: Take the picture. Hold the camera still. And archive the picture for easy retrieval!

HIPAA important to photography

In Chapter 2, we will get Permissions, HIPAA and HITECH carefully understood. You might subscribe to our blog so that you don't miss a chapter!

Throughout the course of 9 serial lessons we will show you how to maximize the remarkable capabilities of the iPhone, understand the principles of medical and clincal photography, and feel comfortable with documentation both descriptively and visually.

There is quite a history, but the value of good consistent clinical photographs is without change.

At this point in time, the quality from that small camera "in your pocket" is amazing because the picture is taken instead of missed. When coupled with the techniques in these chapters, the communication is only improved.

Click me

Medical iPhone Photography will be released one chapter a week until mid both an iBook for the iPad or iPhone or a PDF for everything else. Then the book will become available in printed form for holiday giving to your favorite healthcare provider.

Tags: HIPAA, HITECH, clinical photography, medical photography, iPhone

Introducing a Unique Book, Medical iPhone Photography

Posted by Lawrence Kerr on Thu, Oct 20, 2011 @ 07:20 PM

  • What is clinical photography? Is it medical photography?
  • What is the best camera for clinical photography.
  • What makes a good clinical photograph.

historic digital cameraStarting today, we are excited to share decades of experience in medical and clincial photography using digital cameras. The paradigm shift from the time of the first Apple QuickTake is awe inspiring. Still, the value of good consistent clinical photographs is without change.

In 9 lessons we will show you how to maximize the remarkable capabilities of the iPhone, understand the principles of medical and clincal photography, feel comfortable in documentation both descriptively and visually.

clinical picture on iPhoneIt is true that the iPhone camera interface is intuitive, but while the one of the authors was writing the manuscript, the other was learning tips about flash settings and posing the patient while editing. When the tables were turned, the primary author learned new things about the automatic macro and video "righting." Originally the digital photography revolution was seen as a way to take and store before and after pictures easily; originally the resolution and the camera functioning was not ideal. At this point in time, the quality from that small camera "in your pocket" is amazing when coupled with these simple techniques.

medical photography introductory chapter

Medical iPhone Photography will be released one chapter a week until mid both an iBook for the iPad or iPhone or a PDF for everything else. Then the book will become available in printed form for holiday giving to your favorite healthcare provider.

Tags: telemedicine, iPhone medical apps, clinical photography, medical photography, iPhone

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