Even my 4-year-old granddaughter knows what a silo is: the iconic brick, wood, concrete, or metal structure that keeps one harvest from another on a farm. With all the change in agriculture, we would actually be hard pressed to find a farm with the iconic silo, but still. 

The silos in health care are infamous, rather than iconic. The physical barriers are reinforced with regulatory barriers, time constraints, virtual constraints, and -- most unfortunately -- attitudes.

Look around you and notice all of the physical constraints. Do you remember them being as pervasive even just a few years ago?

• Key cards
• Locked file rooms
• Locked drawers
• ID cards
• Files face-down
• Disconnected hallways
• Tree lined atrium replaced by cubicled offices
• Windows blocked by required notices
• Distances across town, across farmland, or just down the hall
• Diverse institutions. Long Term Care, Home Care and Hospitals

Of course, with technology so integrated with our days, there are also the virtual barriers we experience:

• Log ons and passwords
• Telephone tag
• Not enough integration
• Too much integration and too much data
• Packed email boxes

And, saddest of all, we have attitudes that separate us:

• Not my job.
• Competition. True story, overheard at a medical meeting in an urban center.... Older chairman of department to you surgeon: “Yes, I will grant you privileges, as long as you just do emergencies and never do cosmetic surgery. Welcome.”
• Outside of my scope of practice.
• I’m not allowed to do that.  
• I’m just doing what I am told.
• I’m not comfortable with that.
• I don’t do that often enough.
• That is too time consuming. 
• Medicine is a business. It needs to be run like Disney.

It is not enough to blog about it. It is not enough to complain. Each of us should do something, but where should we start? "We" meaning all of us; lab techs, aides, super-specialists, advanced practice nurses, doctors of what ever board certified -ology should get started!

We are not going to change HIPAA and the legions of other state and federal regulations, at least not right away. There are not enough of us to protest (maybe there are and we merely need the 17 year old Hong Kong activist to lead us). We will not get doors unlocked, IDs removed, logons discarded. So, the only thing left, and indeed the core of the problem, is our attitude. We need to regard the patient as our responsibility, not our institution's responsibility. We need more us and we, and less them and you in our language and in our thought. We need technology that promotes these good attitudes, not technology that blocks them. We need technology that empowers action based on these attitudes, not technology that dispirits them.

Hybrid Store-and-Forward Telemedicine Can Help Defeat Silos. Here's how:

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

A recent article in the New York Times told the story of several doctors' offices -- pediatricians and OB Gyns primarily -- who are finding out that while the traditional "baby wall" in the waiting room is cute, it's also, well, illegal.

Under HIPAA, "baby photos are a type of protected health information, no less than a medical chart, birth date or Social Security number, according to the Department of Health and Human Services. Even if a parent sends in the photo, it is considered private unless the parent also sends written authorization for its posting, which almost no one does" reported the Times. So doctors who have been displaying baby photos for generations are having to take them down, hide them, or keep them up but risk fines or jail time.

We are, of course, big proponents of HIPAA compliance -- our telemedicine medical collaboration software is designed around it -- but there is a part of this story that seems both ludicrous and sad. Patient privacy is crucial and can save lives and support important care. But sometimes the consequences -- like having to hide the faces and stories of a doctor's office -- seem untenable.

In terms of medical collaboration, we noticed a similar disappearance of collaborative conversations among healthcare providers. The elevator became an unsafe place to have a quick check-in about a patient; and no one seemed to have time for the lounge anymore as EHR and paperwork duties absorb every free minute.

ClickCare is our way of saying: we accept the changes, but we don't accept losing the reasons we got into medicine in the first place.

Comply with HIPAA. The penalties for not doing so -- for both providers and patients -- are too great not to. But keep looking for ways to keep medicine about people. Maybe you send parents a form to fill out that would allow you to post their baby's picture. Maybe you find HIPAA-safe telemedicine platforms to reinfuse connection and collaboration into your work. It's not easy, but it's part of building the future of medicine. And that means that baby pictures are far more important than just being "cute."

Curious how other providers are using telemedicine to collaborate? Get our QuickGuide here:

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

 
As a company passionate about making healthcare work better for patients and medical providers, we don't often talk about the "behind the scenes" of ClickCare itself.

This past week, however, we paused to reflect on how the success of our mission and the success of our company are deeply linked. We were fortunate enough to be chosen from hundreds of potential companies to be part of a business accelerator hosted at Binghamton University. Start-Up New York chooses businesses, particularly those developing key technologies that are ripe for expansion and that will develop jobs for New Yorkers. It's a coveted award, because it gives companies the depth of support and experience that they need. 

In being selected as one of these companies with the most potential to expand -- affecting our community and the lives of local folks in the process -- we realized that the award shows just as much about healthcare as it does about ClickCare. ClickCare is poised for expansion because of the medical need for accountable care, the huge demand for coordinated healthcare delivery, and the gap that exists in HIPAA secure communications. ClickCare's way of making telemedicine accessible is part of this bigger movement.

So as we move in to our new offices, we're conscious that this award puts a spotlight on not just us, but on everyone working to change healthcare. May we all take a little encouragement from the recognition that the state of New York gives to the importance of this work.

For more thoughts on telemedicine and how it can change healthcare, click here:

On Friday, Eric Shinseki, the Secretary of the Department of Veteran Affairs, arrived at the White House, and when he left 45 minutes later he was no longer employed.

This resignation comes after weeks of controversy and outrage around underperformance and coverups at the Veteran Health Administration. The New York Times has a good infographic on the panoply of issues which include data falsification, marathon wait times even for urgent medical issues, coverups, and manipulation of care to artificially improve indicators.

Shinseki's resignation may imply that the problems at the VA derive from this administration or even this individual. Unfortunately, that's far from the truth. As Jon Stewart insightfully detailed recently, these issues extend far past Shinseki's tenure, earlier than the Obama administration, and earlier in fact, than even the wars in Iraq and Afghanistan. 

There is no excuse for the negligence that we, as a country, have demonstrated in caring for our Veterans. But politics aside, the difficult truth is that there are a number of intersecting issues that are creating the VA wait times and care backlog. On the supply side, there is a nationwide shortage of primary care physicians. And the veterans' demand for medical services is simultaneously soaring. As vets are more likely to live from catastrophic injuries, and with vets from Vietnam to Iraq to Afghanistan needing care, the number of outpatient visits to the VA has grown by 26% in the last 5 years (with medical staff growing by only 18%). Primary-care appointments have grown by 50%, while the department’s staff of primary care doctors has grown by only 9%. And across departments, doctors are supposed to be responsible for 1200 patients but are caring for 2000. (See article here.)

Of course, as the New York Times reports, "Republicans say the problem is not a lack of money — the department’s $154 billion annual budget has more than doubled since 2006 — but rather inefficiencies in the delivery of care. Democrats say that the problem is a serious shortage of doctors and not enough hospitals." Either way, the problems for the VA delivering timely and quality healthcare is related to medical providers being asked to do too much with too little (whether that lack is of time, support, or money). Which is something that all medical providers can surely empathize with.

So what are the VA and its committed medical providers to do? If anything, pressure is increasing for quick fixes to a problem that is constrained in large part by numbers of patients, number of doctors, and severity of medical issues. One fix that we see is to use telemedicine to leverage the time and energy of the providers that the VA has. 

If the VA shortage of providers and resources resonates with you, these are some ways that telemedicine may be able to help: 

• Telemedicine can drop readmissions and length of stay. Surprisingly, medical collaboration -- like that facilitated by telemedicine -- can improve numbers on both readmissions and length of stay. 
• Telemedicine can save providers' time they're spent on care coordination. Most providers will tell you what this study proves: huge amounts of time are spent outside of patient care, coordinating care and waiting for patient data. Telemedicine, particularly hybrid store-and-forward telemedicine, can slash those wasted minutes and get you the data you need when you're ready to receive it.
• Telemedicine can loop in providers that are outside the system, but within a single patient visit. Of course, the most obvious use of telemedicine -- to enable consults with other providers even within a single visit -- is still a fantastic way to leverage provider time.
• Telemedicine can enable more providers to collaborate on complex cases, efficiently. Especially with the complexity of cases that the VA is seeing, multiple specialists and providers across the continuum of care are needed to care for a single patient. A medical collaboration platform will help you integrate all of these voices so that patients don't have to bounce from visit to visit with long wait times between each.

Looking for a telemedicine solution in your organization? We can help you sort through the options:

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

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:

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

Several days ago, a 26-year-old man was hit in the face with a baseball going close to 100 miles per hour. A traumatic and dangerous injury for anyone, this injury was compounded in its complexity and potential impact by the fact that the patient was Aroldis Chapman, famed Cincinnati Reds pitcher.

After the horrific line drive hitting him in the face, his team sprung into action. He was transferred from the stadium to the hospital and stayed overnight. Chapman and his medical team had a number of difficult decisions to make and a large team of providers and "stakeholders" to coordinate.

If he had an orbital fracture, he could be expected to lightly throw, 2 to 3 weeks after surgery, and play in 4 to 6 weeks. He's swollen and difficult to evaluate. Should his plastic surgeons save time on the schedule for him next week? Or see him next week and then schedule him? If they do that, then who will they bump from their already too full schedule? Does he need neurosurgery or ophthalmology or a dental consult? How might the OR, admitting nurse, and anesthesiologist be prepared? Then, what about followup? Can he travel with the team? What about the patient? How should his providers share the ramifications of what happened and what would be happening with Chapman and his family in Cuba?

Happily, Chapman was scheduled for surgery less than 24 hours after the injury, repairing fractures above his left eye and nose. He's expected to pitch again this season. It is clear that whatever medical collaboration tools were used, an incredible amount of medical collaboration did occur.

When medical collaboration occurs (whether with a tool like iClickCare or through other means), that's when good outcomes occur.

In fact, the rapidity and efficacy with which Chapman appears to be put on the road to recovery creates a bittersweet contrast with a similar injury from several decades ago. As baseball fans will remember, Herb Score, a pitcher for the Cleveland Indians was hit in the face by a batted ball in 1957. The injury and its ensuing treatment seem to have been career-ending: Score didn't play again until 1958 and retired completely just before turning 29.

Often, we don't think of sports teams or medical trainers as needing to do urgent medical collaboration at this level of complexity. The truth is, however, that for athletes, medical trainers are part of a large team of providers that are doing some of the most complex and high-pressure medical collaboration there is. These providers need to care for the patient-athlete (as for any other patient) but also weigh the impact of treatment, injury, and rehabilitation on careers that hang on a thread of health, timing, and performance. We applaud Chapman's team (both his sports team and his medical team) for their collaboration and success… and we wish Chapman a speedy recovery.

How are you using medical collaboration in sports medicine or team trainer situations? We'd love for you to share your stories from the front lines in the comments below...

For more medical collaboration stories and strategies, get our free quick guide:

Image courtesy of 20456447@N03 on Flickr, used under Creative Commons rights.