Healthcare in the United States is struggling.

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

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

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

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

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

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

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

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

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

In 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:

Stories are sewn into every part of medicine. 

The way we are trained to talk to patients is about drawing their story out of them. The way we share cases with colleagues is about describing the narrative of a patient. 

But modern medicine, especially in this age of EHRs and silos, tends to reduce patients to treatments and boils stories down to a series of interventions. And this weakness might feel more "efficient" at first but does tend to erode the quality of care our patients receive -- as well as the results they may experience from that care. 

That said, there are programs and tools that intend to reintegrate patient stories into our work. A recent article in the New York Times told of a program at Weill Cornell Medicine in New York. To combat ageist biases and practices, the program brings in older people to speak to medical students about their experience. Like all people, older patients have a diversity of experiences, strengths, and challenges. And for doctors to care for them well, they need to be able to understand this diversity, and create a care plan within that knowledge. 

As Dr. Adelman, the coordinator of the program, says, "Unfortunately, most education takes place within the hospital. If you’re only seeing the hospitalized elderly, you’re seeing the debilitated, the physically deteriorating, the demented. It’s easy to pick up ageist stereotypes.”  This program aims to complement this more hospital-based perspective with the other facets of patients' experiences. 

Unfortunately, this type of program is still rare. And rarer still are tools that support the full, holistic story of patients as the center of care -- especially once healthcare providers are outside of an academic setting and in the flow of practice. 

Electronic Medical Records, text messaging, and other intervention-focused tools only serve to create a further lack of "story" in patient care. But when you don't have the full story of a patient -- including their dreams, goals, daily habits, health goals and other "ancillary" aspects -- you don't necessarily have the full picture of how best to treat them. 

Certainly, many aspects of medicine pull us, as providers, away from stories and towards interventions. But when we use a telemedicine-based medical collaboration tool -- like iClickCare -- to have fulsome conversations with other providers about patients and share the holistic picture of whom the patient is, we provide better care and experience more satisfaction. So whatever our medical education provided or did not provide in this way, we always have the choice to use tools to practice medicine in the way that best fits our values. And for me, that has meant a tool that helps me do medical collaboration and see patients as full people. 

Medicine is an altruistic career path for most of the people who undertake it.

Certainly, there are those who pursue it for the perceived salary benefits, but most health care providers pursue medicine as a means to help people, and to achieve a level of professional excellence.

Sometimes I wonder if this is why many doctors are very resistant to “anything extra.”  We feel so overtaxed by the altruistic work we do every day that we simply can’t comprehend adding anything else to an already full plate — both practically and emotionally.

Although there are altruistic reasons to do healthcare collaboration and use telemedicine, I also believe that there are selfish reasons as well. And perhaps the best professional practices are those that sit at the intersection of both.

Yes, telemedicine is altruistic in the sense that it improves outcomes for our patients.

But the reality is that, as medical providers, we benefit as much as the people we are treating, do. So I thought back to the benefits that my colleagues who use iClickCare have experienced and realized that the benefits to the individual provider are meaningful and concrete.

5 Concrete Ways that Telemedicine-Supported Healthcare Collaboration is Good for Medical Providers:

• It gets you home to your kids faster. The reality is that working with colleagues on a diagnosis but not having to play phone tag to do so will save time -- those minutes grabbed during "lunch" (obviously just a sandwich while you do notes) or at the end of the day. And that means that you are delivering the care you know is appropriate, but you're home for dinner faster.
  
  
• It can improve data and sophistication of care. I was really interested to see this article describing the healthcare collaboration among several competing health systems to share data to support precision medicine. Many of our newest technologies, including precision medicine, require resources and knowledge that we just don't have on our own. Just as sharing the burden of a specialized diagnosis can increase what we know, sharing data can increase our capabilities. 
  
  
• It will decrease burnout. Healthcare provider burnout is exacerbated by providers' feeling of inefficacy in their work, overload in work quantity, and a feeling of disconnection from their patients. Healthcare collaboration can support improvements around all three things. Especially when supported by a telemedicine tool, healthcare collaboration can increase your feelings of connection and efficacy but not increase your workload or time burden. 
  
  
• It makes your day more manageable. Playing phone tag might be done in stolen minutes throughout the day, but those minutes add up. Videoconferencing can further grab hours and attention. But healthcare collaboration that's asynchronous doesn't need to be a burden at all. It can actually streamline diagnoses, care plans, and your appointment schedule. 
  
  
• It can keep you HIPAA safe. The reality is that whether you have the tools or not, you're going to ask colleagues for their input. But if you're texting, emailing, or using an other HIPAA-insecure tool, an innocent question can turn into a huge fine. If you have a HIPAA-safe telemedicine tool available to you, on the other hand, it's there when you need an answer, and you don't have to worry about staying compliant.
  

Ultimately, we know that you'll decide what tools you'll use based on what's best for you and what's best for your patients. But it's certainly helpful to know that a tool, and workflow that improves outcomes, together, are a route to positive things in your day and your life. 

When people consider becoming healthcare providers, it’s sometimes the “big things” that they think of. Saving a child’s life. Groundbreaking research. Dramatic diagnoses.

But the truth is that for many of us, the part of medicine that is most satisfying is actually the “little things.” A patient’s shy smile when she learns she can play in Friday’s game. A new mom’s growing confidence. Getting a a referral for a patient fast, with just the right combination of phone calls and sweet-talking.

In this age of patient satisfaction surveys, relentless metrics, and widespread provider burnout, we can forget that for patients, it’s actually the little, human things that matter most to them, too.

I read a beautifully written narrative recently that brought this dynamic to life for me. 

The author, Lisa Rubisch, a mom with a year-old baby, had a benign cyst in her uterus that she needed removed with surgery.

A person who was generally nervous with medical procedures, Rubisch felt especially vulnerable, since she had given birth to her young son not too long beforehand.

Once wheeled into the OR, Rubisch found that the team was playing Led Zeppelin on the overhead speakers. It was harsh, heavy music to her ears and unnerved her further.

“You don’t like Zeppelin?” a nurse asked, in his thick Queens accent. “Who do you like?”

I heard myself muttering the first band that came to mind: “The Beatles?”

Someone actually left the room in search of a Beatles CD but returned empty-handed.

“Well, I guess we should just call the whole thing off,”  I said, laughing nervously.

They stood around me in awkward silence. I could see in their faces how much they wanted to soothe me; they were all trying so hard to be cheerful and upbeat, but the truth was, the show must go on.

Then, from somewhere behind me, outside my peripheral vision, a lone male voice started to sing. “In the town, where I was born… lived a ma-a-an who sailed to sea…”

He was slowly joined in chorus by the other surgeons, nurses, assistants and anesthesiologists, in what was possibly the strangest, sweetest, most tuneless version of Yellow Submarine ever to be sung. “…and he told us of his life in the la-a-and of submarines…”

The whole surgical team singing an off-key Beatles song was a “little thing.” A medically unimportant, human moment that struck Rubisch in a profound way. As she put it, “When placing your life in someone’s hands, you want to know that they are particularly skilled hands. You want the best surgeon that exists in the universe. But beyond skill, beyond technology, medicine and state-of-the-art equipment, the thing that you remember long after you’ve healed is human compassion.”

So ultimately, the “little things” aren’t so little.

Knowing your patient as a person and understanding the social and economic and personal context of their life allows you to create these moments of human compassion. We talk a lot about telemedicine-based healthcare collaboration as a tool that does big things: cuts costs, saves lives, and creates a new way of doing medicine. But the truth is that doing healthcare collaboration with telemedicine allows us to do the little things too: to care for patients in ways that are meaningful to them — and satisfying to us.

When it comes to HIPAA, we are vigilant to keep doors locked, technology hyper-secure, and even watch what we say to colleagues in elevators.

These things are important, of course, and they're also the way to avoid big fines and sanctions when as we protect patient privacy.

All of that goes out the window, however, when we're sitting with a patient in a curtained hospital room with a handful of people within earshot. We collect personal information, talk about diagnoses, and discuss sensitive history. It's not a lack of sensitivity on the part of the provider -- it's just a reality of how hospitals are designed.
Of course, this little quirk of how hospitals are designed is just one of the myriad ways we get used to suboptimal design. Not only do we get used to it, but we begin to think that the status quo is probably the best way.

As the New York Times writes, "Hospitals are among the most expensive facilities to build, with complex infrastructures, technologies, regulations and safety codes. But evidence suggests we’ve been building them all wrong — and that the deficiencies aren’t simply unaesthetic or inconvenient. All those design flaws may be killing us."

The way we design hospitals also trickles down to other technologies and tools we use. The idea that "design flaws may be killing us" resonates with me as a description of EMRs/EHRs as well. Whether it is inefficient workflow, frustrating experiences for providers and patients, or realities about fatalities that we can prevent, poor design can cost us. We get used to hospitals, and this comfort with the status quo affects how we design tools like EMRs/EHRs, which in turn, affects how we work with each other on teams.

We designed iClickCare to support true medical collaboration of teams. The design supports the behavior. The truth is that many people get used to a way of working that fits with the status quo -- and it takes a person who is willing to think differently to try something new.

So is it a lost cause? "Hospitals can be dangerous and unpleasant,” Roger Ulrich, a professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden says, “But there’s a lot we can do to keep patients safe and help them recover.”

Hospitals are increasingly questioned as to the ideal way to provide care. So much is being decentralized now -- technology supports us in providing and receiving care far from the "center" (which always used to be the hospital). In fact, one way that the article highlights hospital improvement is to decentralize nurse's stations to increase speed to the patient. Whether it is rural care, at-home care, or concierge medicine, hospitals are coming into question across the board.

Of course, our buildings and tools aren't going to change overnight. But we can start looking at our behavior, and questioning whether the tools are serving us -- or whether we've shaped our behavior to an inadequate tool. 

If you want to try a different way of working, using a tool to do medical collaboration, try iClickCare for free:

Last year, I was sitting at a conference room table with high-level administrators at a major hospital. They were looking for ways to use telemedicine to improve care coordination, decrease readmissions, and bring down length of stay. They were thrilled about iClickCare because, as they said, "This is something our providers would actually enjoy using."

Their main concern before moving forward with iClickCare? "It's too inexpensive."

At first we were concerned -- did they mean the solution wasn't complete enough? "No," they confirmed, "It's actually much more complete and adaptable than other solutions. It's just that our board is expecting a much more expensive purchase, with a large hardware outlay."

As counterintuitive as that experience was, the sentiment is not uncommon. So many times, we think that expensive hardware is the "right" way to approach a problem.

Similarly, recent studies are showing that time, physical activity, and over-the-counter ibuprofen is the best possible treatment for back pain. Not surgery, not an MRI, not opioids. And as healthcare providers, we know that prescribing "go for a run, take some Advil, and don't call me for a few months" may well be a harder pill for a patient to swallow than, well, a bottle of pills. 

Telemedicine does not depend on expensive hardware and high-end cameras, just as most treatment for back pain doesn't depend on surgery or medication. The unglamorous truth is that telemedicine success comes from people working together effectively -- and the medical collaboration tool has to be simple and effective enough to allow that to happen. 

Just as a great healthcare provider uses the least invasive treatment that will be effective, we believe the simplest telemedicine solution is usually the best one. And we know that for a lot of healthcare providers, that's a pretty big relief.

If you're ready for a simpler solution for telemedicine and healthcare collaboration, try iClickCare for free:

Our friends at Hubspot have a unique outlook on the world of business, and often have interesting insights for the medical world. Matthew Kane lists 7 creative collaborations, which are an interesting starting point for thinking about what it means to collaborate effectively with colleagues.

For instance, Kane identifies these classic collaborators:

• Andy Warhol and Jean-Michel Basquiat
• Paul McCartney and John Lennon
• F. Scott Fitzgerald and Zelda Fitzgerald
• Harry, Albert, Samuel, and Jack Warner
• Ed Catmull, Steve Jobs, John Lassete
• Steven Spielberg and John Williams
• Helmut Krone, Julian Koenig, and William Bernbach

We love these as a starting point. Obviously, these folks are “creatives” and in a different field. But they solved problems in new ways, different ways, bold ways, and creative ways by being collaborative. And the truth is that we see medical teams acting equally collaborative and equally creative -- every day. For instance, just last week a major study looked at the way the "soft innovation" of full-time care teams for a given condition had blockbuster results.

In healthcare, some of the most important innovations of our history have been created by teams: 

• Banting and Best (discoverers of insulin)
• Watson and Crick (DNA)
• Flexner and Flexner (memory)
• The patient and the doctor
• Marie and Pierre Curie (Curie said, “My husband and I were so closely united by our affection and our common work that we passed nearly all of our time together.”)
• Blalock and Taussig (Blalock Taussig shunt for congental heart disease with the African American lab assistant who really did the work)
• Debakey and Tarvik (artificial heart)
  
  

Of course, everone in medicine knows the thrill of teaming up a diagnostic problem, sharing woes or joys, or learning together. But these days, these exciting and illuminating moments of healthcare collaboration have become fewer and farther between. iClickCare is one way to bring them back to your practice -- without time or hassle -- but you can do it pretty simply, by walking down the hall or looking across your desk.

We looked for stores of medical collaboration around the world and here's what we found: 

I believe that almost every single healthcare provider has gone into medicine because they deeply want to help people. Whether they want to help as a nurse or a surgeon or an administrator- the desire the care and contribute is the same.

It's pretty easy to forget, though. As we've shared in the past, more than 50% of healthcare providers show signs of burnout. And, to be honest, I'm almost surprised the stats are that low, when I hear the experience and cynicism of so many of my colleagues.

The wear and drain and stress of daily work in medicine is enough to make anyone forget the original impetus of the work. It's easy enough to think that the goal is some incremental improvement. A little bigger productivity bonus. A slightly shorter wait time in the waiting room. A bit higher patient satisfaction numbers.

But then something comes along and reminds us that incremental improvements are not the only option that exists.

Just last week, scientists found the molecular process in the brain that helps trigger schizophrenia. This isn't a small shift in the disease -- it changes everything. Steven Hyman, director of the Stanley Center for Psychiatric Research at the Broad Institute at MIT, called it "the most significant mechanistic study about schizophrenia ever." He said, "I’m a crusty, old, curmudgeonly skeptic. But I’m almost giddy about these findings."

And that's exactly what healthcare collaboration and telemedicine can be -- something that healthcare providers get giddy over. These are not small process improvements -- they're fundamental shifts in the way medicine can happen. It's not a little bit better treatment for a patient -- it's a radically different outcome. It's not a tiny bit more satisfaction or a minute of saved time for a doctor -- it's a return to the reason you went to medical school.

Our colleagues in telemedicine and who are collaborating are creating a new era of medicine. An era in which the old puzzles and conundrums may indeed become obsolete as radical changes make something new possible. And we believe that this finding on schizophrenia, telemedicine platforms, and courageous providers are all part of that process.

To hear about the kinds of huge changes that can come with medical collaboration, get our free ebook: 

"It is only with the heart that one can see rightly; what is essential is invisible to the eye."
Antoine de Saint-Exupery

As a small business trying to take on the medical system, we certainly gravitate towards things that help us be more productive. When we find a more efficient way to do something, we usually seize it.

The medical system seems to have the same impulse. If three minutes can get stripped off a visit, those three minutes get eliminated. If a step can be removed from a process, administrators are thrilled to advocate that providers do so.

Sometimes, these "efficiencies" in medicine lead to significant losses and unintended consequences.

For example, one thing we've noticed being eliminated from medicine -- because it's not efficient -- is everyday collaboration, information sharing, and human interaction. A highlight of my schedule as a surgeon has always been sitting in the doctors' lounge in the spare 10 minutes before an operation. I'd chat with other doctors who also had a free minute about new medical findings, our kids' sports, a shared patient, or a treatment conundrum. Those simple interactions would be satisfying in all kinds of ways, but with very few tangible, "efficient" outcomes. Over the course of a week, though, I always gained powerful insights, identified care opportunities, and collaborated in ways that saved time and improved quality of care.

Recently, we came across a couple of articles that show how the efficient, streamlined approach can actually strip out huge positives in other contexts. For instance:

• Everything from asthma to obesity is affected by the microbial balance in our gut. As this informal article describes, some research is now showing that it is integrated, indirect consequences or combinations of healthy habits that seem to improve our intestines' microbial makeup and protect us from disease. For instance, the negative effects of a McDonald's breakfast on inflammation can be nullified by drinking a glass of orange juice with the meal. Researchers haven't yet been able to strip out the "active" component of the orange juice in the dynamic system and are concluding that it is actually the combination of things like flavinoids, antioxidants, vitamins and soluble fiber that create the effect. 
• It turns out that "Ground-up artemisia plants, from which the anti-malaria drug artemisinin is derived, appear to work much better than the refined drug does by itself, according to research at the University of Massachusetts," reports the New York Times. Why? The plant goes beyond just the active ingredient that we extract to create the anti-malaria drug. Much like with the orange juice (or the doctors' lounge), it is a combination of multiple factors that create the positive effects -- and a shortcut won't get you all the way there.

That's why, when we are asked for advice on telemedicine and medical collaboration, we always suggest using common sense and not necessarily doing the most efficient, stripped down, basic thing. For instance, secure text messaging services can be effective in some situations, but often lose the richness of real interactions. Sometimes, a face to face conversation is still the best way to determine a course of treatment. And when that's not possible, we believe that a telemedicine solution that incorporates informal discussion, video, photos, and perspectives from multiple providers (like iClickCare) is the way to go.

In the same way that the plants are more effective than the malaria drug itself, we advocate for "leaving in" some of the still-inexplicable positives that come from doing the traditional thing that works. Have the conversation, even if it's not 100% obvious what came of it. Use the richer store-and-forward solution. Do what works, even if we don't yet understand all the reasons why it works so well.

To learn more about why Hybrid Store and Forward Telemedicine is often the best option, get our free guide: