ClickCare Café

Dramatic Videoconferencing Screw-Up Brings Up Telemedicine Questions

Posted by Lawrence Kerr on Wed, Mar 13, 2019 @ 06:00 AM

glenn-carstens-peters-210782-unsplashWe'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. 


ClickCare Quick Guide to Hybrid Store-and-Forward



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

Believe It or Not, There is a Human Behind Every Part of the Healthcare System

Posted by Lawrence Kerr on Fri, Oct 19, 2018 @ 06:00 AM

rawpixel-600792-unsplashMy daughter has a particular pet peeve. She’s noticed that in so many movies, when there is a doctor in the story line, he or she (usually he) tends to be arrogant, insensitive, and uncaring — in so many ways, inhuman.

As doctors ourselves, we tend to see our colleagues — whether doctors, nurses, or aides — as very much human because we know them and interact with them every day. But it’s easy to see insurance carriers or drug companies or other parts of the healthcare system as faceless monsters that make our patients’ lives difficult.

Which is why I was really interested to read a series of articles that turned all of that on its head, and definitely warmed my heart.

A couple of weeks ago, Gina Kolata wrote an article in the New York Times about the new class of drugs, PCSK9 inhibitors, that slash cholesterol levels for patients that aren’t seeing results on statins, or with diet or exercise, but have serious risk of early heart attack or stroke.

She told the story of the hyper-expensive drugs, the $14,000 price tag that the drug manufacturers have set, and the insurance carriers that create a byzantine maze for any patients trying to access the drug.

It’s a well-known story — evil drug companies and evil insurers make it impossible for patients to access the care they need. When I read it, I didn’t think much of it.

Then, about a week later, another story came out.  In this one, the New York times reporter tells a story that pretty much upends all of my assumptions about the players in the story.

The evening her story was published, the founders of Regeneron — the manufacturer of the PCSK9 inhibitors — emailed her.  Dr. George D. Yancopoulos and Dr. Leonard S. Schleifer wrote:

“If you can, please put Mackenzie and Rodney in touch with us, and we will try and help them get covered, or we can arrange to give them the drug for free… While we can’t give everyone free drugs, we can help Mackenzie and Rodney, especially as they had the courage to step forward and share their experiences.”

He then gave his personal phone number and asked the journalist to give it to the patients in the story, “explaining that he can be slow answering emails.” 

In her story detailing her conversations with Dr. Yancopoulos, Kolata told the story of Regeneron. It was founded by the two doctors in 1988. 20 years after that, Regeneron got its first drug approved. 5 years after that, they made a profit. 25 years of a business isn’t exactly a “get rich quick” scheme. The total cost to develop the drug was $1.6 billion and last year they made just $195 million (a tiny fraction of the total investment.) In reading the article, it's clear that Dr. Yancopoulos has battled for decades to create a drug that he truly believes will save lives -- and that his heart is very much invested in making sure people have access to it.

Certainly, it's great that these two patients got access to the drug -- although that doesn't change the challenges that most patients will encounter in obtaining it. That said, it's a fascinating article and shows that even the most "inhuman" elements of the healthcare system -- for instance, drug manufacturers -- may have real people behind them who are doing their best to chart a course forward in a challenging system. 

The truth is that none of us are as smart as all of us, working together, are. (We say that a lot.) And for us all to work together, we must continue to see everyone in the healthcare system as human. 


ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, healthcare collaboration

Why Overall Well-Being is as Important as Medical Intervention for Cost Savings

Posted by Lawrence Kerr on Tue, Oct 02, 2018 @ 06:00 AM

rawpixel-678092-unsplashHealthcare is such a potent combination of art, science, social work, and hard economics. And where these varying approaches touch each other, there can be friction.

So many healthcare providers view what they do as a combination of art, science, and social work — with hard economics never (or rarely) entering their mind.

But many times, healthcare economists come from a perspective that assumes something very different about how healthcare functions and how providers make decisions. Many times, healthcare economists use as a fundamental premise the idea that: providers are self-interested and will bill for as many services as they can; and it’s crucial to focus on hard outcomes of services, not on overall well-being of patients. Their perspective tends to be that hard economics reign and that these other approaches are dreamy intangibles.

A new study in JAMA challenges all of that.

JAMA published a study described as a “US national, population-based cross-sectional study [examining] the association between county well-being and Medicare fee-for-service (FFS) spending.”

In other words, researchers looked at whether Medicare spending was lower when people’s overall (non-medical) well-being was better. The results?  Medicare spent almost $1,000 less per patient for those in the 20% of well-being scores, compared to the bottom. And this is after adjusting for independent factors like income, urbanity, educational level, etc.

As the JAMA study explained, “Well-being is a positive state of being beyond the absence of disease, measured by not only physical health but also other dimensions, such as emotional, social, and economic health. Well-being may be modifiable by a broad range of interventions across different sectors.”  It’s all the stuff that we tend to see as “outside the scope” of a given medical intervention.

We think this is an incredibly important insight and study highlighting something not commonly spotlighted. Certainly, new models have gone up one level to reward fee-for-performance rather than fee-for-service. But the truth is that this measure of overall well-being is up several levels beyond that. And to capture the economic value of our patient's overall health and happiness is important. 

The whole goal of what we do as doctors is to support our patient’s well-being. But if you really needed another reason to pursue that measure, this is evidence that a broader view, a more holistic approach, is cost-effective too.

One of the challenges that we get into with iClickCare utilization is that it might be more efficient to just allow secure text-messaging, rather than having a fulsome, team-based, archivable healthcare collaboration system. The very reason we do what we do is because we believe that this kind of more holistic, team-based approach may not be the fastest way to get a simple, discrete answer — but it is the most efficient, effective, and cost-conscious way of approaching the whole patient. The "whole patient" includes all aspects of their medical condition as well as the other factors in their life that interrelate with that condition. 

The components of well-being in the study that decreased cost-per-patient so dramatically were largely non-medical. That means that any collaboration system that doesn’t allow non-medical caregivers and providers (social workers, teachers, caregivers, etc) to collaborate is misguided and ultimately wasteful in terms of ROI. 

We're glad that this kind of study is being done. And we continue to applaud the efforts of all of those healthcare providers who take the holistic view of their patient's well-being -- rather than simply addressing the malady in front of them. 


Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

Surprising Study Shows Doctor’s Race Crucial in Health Outcomes

Posted by Lawrence Kerr on Wed, Sep 12, 2018 @ 07:00 AM


Black men have the lowest life expectancy of any ethnic group in the United States. Chronic disease — like diabetes and hypertension — play a big role. But the path to reducing rates of those maladies can seem unclear.

A new study by researchers in California showed a shocking finding in one parameter that could dramatically influence outcomes — the race of the doctor. 

The study itself was pretty simple and looked at the likelihood of patients to accept preventative measures, comparing the likelihood with a white doctor and with a black doctor. The study participants were 702 black men in Oakland, California, who came to a clinic for a free health screening. They were randomly assigned to a black male doctor or one who was white or Asian.

The results were pretty stark (as elucidated by The New York Times):

— 63 percent of the black men assigned to a black doctor agreed to a diabetes screening. Just 43 percent of those assigned to a doctor who was white or Asian consented to be screened.
— Some 62 percent of black men with a black doctor agreed to cholesterol tests, compared to 36 percent assigned to a doctor who was not black.

These rates might not sound world-changing, but the consequences of them are. If black patients were to agree to preventive care at these rates in the real world, researchers estimate that the gap in cardiovascular mortality between black men and the rest of the population could be reduced by 20 percent.

So was it the race of the provider itself that made the difference? Or was it something that black doctors were doing differently, or more effectively, than the white doctors?

There’s no hard evidence to answer that question, but one telling component of the findings are the comments written by both patients and doctors in the study. Black patients had equally positive comments of doctors, regardless of their race. But of black doctors, their comments skewed more emotional and effusive. Similarly, the notes on  the white doctors tended to be shorter and dryer. Black doctors’ notes were more detailed and more holistic, including comments on elements of the patient’s experience and overall life.

One of the black doctors in the study really affirmed that ultimately, it’s not about race — it’s about good care. “It’s something they don’t teach you in medical school — taking that extra step because you appreciate there have been barriers in the past,” Dr. ChaRandle Jordan said, saying that white doctors can reach out just as well and that a lot depends on how familiar a doctor is with black patients.

From our perspective, there are several key implications of this study for our work with medical collaboration and care coordination:

— A team approach is important. Sometimes the background of the provider can make a difference, and where that's true, having a diverse team working together closely, is a key asset. 

— Good care is about more than the facts. Simply offering the appropriate preventative screening isn't enough. In this study, it appears that the black doctors' efforts to build rapport and even to push back on patients' initial reticence were a big part of their good outcomes. Having the perspective and tools to work with a more holistic sense of the patient is key.

Obviously, we believe that great care can happen among providers and patients of any race. But looking at race and differences in engagement and interaction shouldn't be taboo. We often say that "no one of us is a smart as all of us."  And this is one more example of how our colleagues down the hall may have a lot to teach us — if we are open to learning. 

For stories of medical collaboration, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, care coordination

Is Medicine Today Shift Work, Team Work, or Solo Work?

Posted by Lawrence Kerr on Thu, Aug 23, 2018 @ 06:00 AM

john-price-380340-unsplashIt’s increasingly rare in everyday life to have someone take responsibility for caring for you or serving you.

If you sign up for a new account at a bank, the smiling salesman doesn’t end up being the person you interact with when you stop in to make a deposit. Most of us no longer have personal relationships with our grocers or butchers or farmers.

And the field where this change seems the most dramatic is medicine. As we’ve all experienced, the last few decades have shown a shift in medicine from everyone having a family doctor to… almost the opposite of that. Hour caps for residents, the rise of hospitalists, an emphasis on advanced practice nurses, and a change from medicine-as-a-calling to medicine-as-a-career-path have all contributed to a more fragmented, less personal relationship between patient and doctor.

So do these changes mean that medicine is now shift work?  And are the outcomes of these changes negative across the board?

As a surgeon, I always believed that the person who does the surgery is the person who checks on the patient after surgery. In my life, that sometimes meant my kids waiting in the hallway while I checked on a patient right on the way to a restaurant for Saturday night spaghetti. The generation before me might have done house calls and likely knew whole families, over generations.

A recent New York Times article looks at the shifts that have occurred recently.  These shifts have pushed medicine dramatically away from each person “having their doctor” to care being provided in a way that’s agnostic of who is giving the care and is more about who is responsible during any given hour, or for any given problem. The interaction described by the doctor and author of the article is emblematic of precisely these changes:

“Will you be my regular doctor?” a new patient seeing me in my primary care clinic asked.

“Sort of,” I honestly answered.

She looked back at me quizzically.

“Technically speaking I will be your doctor,” I explained. “But you may have trouble scheduling an appointment with me and may have to see another doctor here at our group clinic at times. And if you need to get admitted to this hospital, other doctors who work there will take care of you.”


Although I think that this change is positive in many ways -- and ultimately necessary -- I also worry about some of the "side effects" of the shift to shift work.

Specifically, I think that there are a few specific negative consequences of the change from medicine being a calling, with ultimate personal responsibility, to medicine being a career path, made up of people primarily doing a kind of shift work:

  • Lower satisfaction for healthcare providers. If you're handing off patients to a colleague once you complete your shift or role in care, you don't see the "welcome home party", hear about the happy return to a hobby, or see the relief in a daughter's eyes. Frequent handoffs in medicine often make it less satisfying to doctors because you don’t see the real life outcomes of your patients.
  • Less holistic care. The more we know about our patients' lives, families, circumstances, goals, and passions, the more we can make their care smart and holistic. The more fragmented care becomes, the less holistic it becomes -- the third provider in the handoff chain may have no idea about a key personal circumstance that could affect care or compliance.
  • More coordination mistakes. More handoffs mean more cracks for things to fall between. So often, signing out to a colleague is the crucial link in the chain to avoid problems -- but this step doesn't always or can't always happen.
  • Decreased trust in healthcare system. I've noticed that one reason patients trust medicine, and doctors specifically, less than they used to is that there isn't any one person to trust. 

So is good care possible within this fragmented system? I think it is -- but it involves a key shift in perspective. And I believe that the shift in perspective is this: 

We must evolve from shift work to team work. 

We can't go back to the old model of medicine as solo work. It looks like, for most of the population, we're not going back to house calls or family doctors. But even within the current medical framework, we can change from a handoff mentality, to a team mentality – we can evolve from shift work to team work. On a team, each of us is not always carrying the ball or responsible for the patient. But we're all always responsible for the outcome as a whole. That means that as medicine has changed, healthcare collaboration and care coordination has become not a "nice to have" but an absolute "must have" in order to provide adequate care to our patients. Ultimately, team work is about taking responsibility for the outcome of every single person we care for, even if we collaborate with colleagues on portions of that care.

It's not about handoffs, it's about collaboration. 


To try iClickCare for collaboration today, get it free here: 

Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

Migrant Children Highlight a Care Coordination Problem We All Have

Posted by Lawrence Kerr on Wed, Jul 25, 2018 @ 07:00 AM

chinh-le-duc-132753-unsplashOne truth that we don't acknowledge often enough is that the healthcare system often depends on caregivers to coordinate care. True, we have other members of the care team who do care coordination also, and we have tools that help us, but in many situations, it is the patient's caregiver that is doing the bulk of the caregiving. 

Healthcare depends on caregivers remembering care history, advocating for providers to collaborate, and reminding providers of key conditions when that information gets lost in the shuffle. This becomes exponentially more true, the more chronic, complex, or multidisciplinary a patient’s situation is.

The truth, of course, is that this isn’t always possible or feasible. Some patients don’t have an advocate or caregiver that is able to play this coordinating role. We do have team members like social workers and patient advocates, but sometimes the coordination of the care itself falls between the cracks.

I realized recently that there is an extreme case in which patients don't have a solid medical history and don't have a dependable caregiver able to coordinate care on their behalf. The situation is the medical care provided to the migrant children separated at the US border. It's interesting because it highlights the dangers inherent in the medical system for someone who might not have the same social supports and networks as many patients do.

A recent article in the New York Times looked at the situation in New York City, in which providers at public hospitals are seeing children who were detained at the border and separated from their parents. Brought in by foster parents, “The children who come in with medical issues such as asthma are without adult family members who can provide medical history.”  Further, therapists are endeavoring to provide emotional care for the children, along with the fact that they’re in the midst of an ongoing traumatic experience.

It's an obviously challenging situation and both foster families and healthcare providers are scrambling to help. But the broad strokes of the care don't different significantly from anyone without family to help, or caregivers to coordinate. These situations expose the cracks and weaknesses that affect all patients.

The truth is that to truly provide excellent care to all patients, we as healthcare providers need to be able to do care coordination and healthcare collaboration without the support of caregivers and family. We must identify and develop the tools we need to make this possible -- to allow us to communicate across the medical team, access key medical history, and consult with other providers efficiently and appropriately. The stakes are simply too high not to. 


ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, care coordination, healthcare collaboration

Is Medical Training About Rigor… or Bullying?

Posted by Lawrence Kerr on Wed, Jun 20, 2018 @ 06:00 AM

matteo-vistocco-424475-unsplashI played college football at a Division III school. That means there were no scholarships or cheerleaders, and high levels of academic work were requisite to playing on the team.

But the rigors of the team — sprints and pulling heavy objects up a dusty hill and doing two practices a day in the heat of late summer — were intense and real. Our coach was certainly not always polite, and part of the reason he was able to extract such hard work from us was that we were scared of him. There was a lot of shouting, quite a bit of belittlement, and frequent exertion past the point of exhaustion.

But I, like most of my fellow players, look back on that time with the fondest of feelings. It was a time when I knew I was getting the most out of myself, getting out of my own way, and contributing to something bigger than myself.

In a similar way, I look back on my medical training — as taxing and exhausting as it was — with fondness and respect. So I was interested to read an article in the New York Times characterizing much of medical training as bullying and harassing.

A recent New York Times article, by Dr. Mikkael A. Sekeres, M.D., looked at whether the US medical training system, especially for doctors, is marked by bullying, belittlement, and harassment. He cites a study that surveyed 1,387 American medical students in their final year of school finding that 42 percent reported having experienced harassment and 84 percent experienced belittlement during medical school. And he shares his experiences in medical school and residency, with doctors pulling rank, obsessing about his perceived faults, expecting inhuman work hours, and unattainable ideals of precision. In other words: he had normal training for a doctor.

Dr. Sekeres’s experience didn’t surprise me, of course, and indeed makes me remember many of my own teachers and experiences — things that these days might be called bullying or even harassment.

The recent tendency in medicine has been to soften the system a bit. The hours' cap has dramatically changed the face of residency and not always for the better. Along with more reasonable work hours, I’ve observed a lower level of felt personal responsibility — the resident's hours are up for the week, so he is signing out, whether or not that’s what’s best for the patient.

For that reason and others, I have to admit that when I read Dr. Sekeres’s article, my response wasn’t primarily agreement — it was concern. My concern is that as doctors, we have a duty to care for our patients at the highest levels of rigor. And the medical training — the long hours, the unreasonable standards, and the exacting mentors — supports that in many ways.

But the more I thought about it, there more I realized that while rigor is crucial, there is a difference between rigor and bullying. I even see it in my own medical teaching. While other surgeons were known for loud operating rooms — music and shouting and even throwing things — my OR was always quiet and calm. Similarly, my relationship with the medical students was always calm, precise, friendly, and even relaxed — we collaborated from a love of learning and a love of work done well. And they worked very hard. So even my own experience contradicts this idea that rigor goes hand-in-hand with bullying.

Especially in the medical landscape in which we find ourselves today, healthcare collaboration is deeply important, possibly the most important thing that can happen on any given case. The truth is that the time of the Lone Wolf Doctor is over, and so if the bully-them-until-they-shine approach was ever effective, it’s certainly not effective in an age when collaboration and coordination calls for teamwork, respect, and collegiality, all of which can be taught and modeled just like surgical techniques.

My takeaway? We benefit from rigor but we don’t benefit from our teachers pulling rank, creating an un-collaborative environment, or not valuing every member of the medical team. We don’t benefit from teaching new doctors that they are alone in their work, must solve every problem on their own, and can disrespect their colleagues when it suits them.

Yes, demanding high standards of care and work ethic alongside high standards of professionalism and collegiality is a very high bar. But our patients' lives require it, and I believe that each of us is up to the task.


For more stories of how doctors are doing healthcare collaboration, download our Quick Guide: 


ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, healthcare collaboration

The Biggest Mistake Doctors Make in Texting for Medical Collaboration

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

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

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

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

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

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

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

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

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

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

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

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

iClickCare IS BYOD Secure

Tags: medical collaboration, hippa secure healthcare collaboration, byod

As Medicine Changes, Our Collaborators Do, Too

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Try the iClickCare 14-day evaluation

Tags: medical collaboration, healthcare collaboration

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

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

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

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

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

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

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

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

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

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

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

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


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

Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

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