I run a technology company. So people are sometimes surprised when I choose decidedly low-tech solutions in my life or work. For instance, in my hobby of woodworking, I don’t use any electric tools — just hand saws, chisels, and the like.

I know that many people approach technology in their work and medical practice similarly. There may be a higher tech way of doing things, but many of us have either habits or very good reasons for doing things manually.

So when is technology the wise route? And when can that have hidden downsides that we’ll only realize once it’s too late?

A new report looks at the choices that Operations Executives make when it comes to technology and digitization. 

There are many automated tools for data visualizations and analysis that many COOs need. It would make sense for these executives to adopt the technologies — they limit mistakes and save time. The reality?  62% of operations executives say that their core systems make it hard to digitize processes. Often, the choose manual processes and manual workarounds instead — but the results are outstandingly negative: 

When processes are manual, operations execs report major risks to businesses: 

• 62% say it slows down performance
• 48% say it increases costs
• 38% say it increases compliance risks

Usually, these manual workarounds are desperate attempts after having tried other tech solutions and being backed into a corner. Many executives try "off the shelf" solutions but report other big business issues: 

• 36% said it couldn’t meet their mobile requirements
• 21% said it required additional professional services
• 31% said it couldn’t deliver the customization they needed

We've run into this over and over again with hospitals and medical practices. They think they "should" use technology for medical collaboration or telemedicine. They try some comprehensive, expensive, hardware-heavy solution. And the results are very similar to the above: the systems don't fit into their providers' workflows, they don't work across different hardware (e.g., mobile), and they're not adaptable in different situations and over time. 

As this author shares, "Operations executives need a software solution that enables them to easily build and modify applications that address their unique processes and systems. Furthermore, they need to be able to do so quickly, cost effectively, and without compromise." 

Honestly, that's precisely why we made iClickCare so low-cost, adaptable on any hardware, and endlessly flexible for different workflows. Ironically, some hospitals and executives have balked at iClickCare being so affordable and adaptable — perhaps looking for a "big splash" implementation. 

I believe that you should use the technology that's most appropriate for your situation and your goals. For my woodworking hobby, that means no electric tools — less injury, more craft, and a better experience. For many providers looking for telemedicine or medical collaboration technology, that means a flexible, low-overhead tool like iClickCare. Don't fall into the trap of reverting to old manual processes or tools that aren't really working — and don't fall into the trap of the "big splash" implementation. Be courageous enough to insist on technology that's appropriate for you, and for your patients. 

You can try iClickCare today, with a free download: 

In medicine, we tend to separate the “hard” skills of medicine from the “soft” things that simply don’t matter so much. For instance: surgical skill matters; the comfort of your waiting room chairs doesn’t.

Many providers have an ethos that is almost sports-like in its single-minded focus on executing the hard calls, crucial maneuvers, and life-saving techniques on behalf of the people we serve. Things like the tone we use with our colleagues, whether we sit down and listen to an aide with an idea, or even seeing a patient post surgery — these can all be dismissed as relatively inconsequential.

Well, it turns out this approach is wrong — and there’s data to back me up.

I’m not sure whether professionalism and teamwork are getting better or worse in healthcare, but there is certainly a lot of room for improvement. It used to be that there was a bit of a “gentleman’s club”  attitude, that, while exclusive to a very specific group of people and often excessively hierarchical, at least it had high standards for the work. Flash forward to current times, and (thankfully) medicine is less exclusive and more democratic… but many providers also treat it more like a job than a calling.

All of which is to say: not every provider has high standards for their personal conduct, professionalism, and team leadership. For so long, at ClickCare, we’ve been advocates of all of these things. Our own medical experience is that politeness, professionalism, respect, listening, collegiality, and leadership all are the foundation of good medicine. In fact, we've always believed that good patient care simply can't exist unless these "softer" elements are in place. 

This has not always been a popular viewpoint. Many doctors and healthcare providers have challenged us on the importance of these approaches, saying that they don't have time to concern themselves with that kind of thing. Certainly, we have the ROI of iClickCare to prove the validity of these approaches. But we've never had a more general confirmation of the importance of professionalism — until now. 

A recent study in JAMA found that “Patients whose surgeons had higher numbers of coworker reports about unprofessional behavior in the 36 months before the patient’s operation appeared to be at increased risk of surgical and medical complications."  Other studies also found links between the way healthcare providers treated their teams and the effect on their patients.  Why?  Well, as JAMA reminds us, “For surgical teams, high reliability and optimal performance depend on effective communication, mutual respect, and continuous situational awareness.”  Part of the core job of a surgeon is to be a team leader — and that means creating a team that displays and expects respect and professionalism. If that's not the case, the team doesn't function as well, and outcomes simply aren't as good.

I'll be blunt. Just as it is your responsibility to scrub before surgery, it is your responsibility to collaborate effectively with your team. Good patient outcomes depend on both; and both are within your control. Demand the tools to collaborate, certainly. But don't let yourself off the hook. 

Learn how other providers do medical collaboration quickly and easily here: 

Prenatal care in the United States is a bit of a crucible for issues related to rising health costs, telemedicine, and medical collaboration. 

Maternity and prenatal care are at the nexus of high-pressure healthcare, patients with often-routine but occasionally hyper-sophisticated care, and the high cost of care. For instance, OB-Gyn providers consistently have the highest rates of malpractice law suits in all of medicine. 

As the leading edge of healthcare, prenatal care is an interesting lens through which to see common dynamics in the rest of medicine. So two new articles are relevant to all of us, even though they're focused on prenatal medicine. 

First, UnitedHealthcare is launching bundled payments for maternity care. It will roll out the program to 20 provider groups by the end of the year. Under this program, providers will be paid a lump sum for prenatal, delivery and postpartum care. 

While a small percentage of all maternity care in this country, I believe that the impact of this program will be outsized. As a huge cost center within healthcare, insurers have a keen interest in shaving prenatal costs in any way they can. And a bundled payments system is, potentially, a way to do that. In a hypothetical kind of way, this program makes a lot of sense for everyone involved. In practice, the onus of doing the care coordination and medical collaboration that is demanded by a bundled payments system is huge. It requires that providers manage the diversity of providers across the continuum of care, and across the length and breadth of prenatal scenarios -- from the most simple to the most complex. 

I do think that eventually, this kind of integrated payment system is what we need for healthcare. But in the short and medium term, I think it's unwise to just pay in  a bundle without giving providers the appropriate tools to make sure the requisite care coordination happens. It's a "sink or swim" model, without giving providers the tools they need to swim.

Related to this is a study done to see whether a prenatal app could complement in-person visits effectively. Prenatal care has a notoriously intensive visit schedule -- which can be burdensome on both the patient and on the providers. But, as Fierce Healthcare reports, “providers say visits are hard to cut back on due to decreased patient satisfaction, the need for weight and blood pressure monitoring as well as the importance of providing educational information around pregnancy health.” So a new study looked at whether an app providing weight and blood pressure monitoring, as well as timed education for expectant moms, could be as effective as in-person visits for lower risk patients. The results? Patients were able to use the app to decrease their number of prenatal visits by about 20% without a decrease in patient or provider satisfaction. That said, it was a very small study size of less than 100 patients and perhaps more investigation is needed.

On one hand, I was excited to see the study of the use of the prenatal app -- as it's an example of actually providing a tool, rather than just changing how payments happen. On the other hand, I wonder whether it's the best tool we can come up with. I'd like to see more communication and coordination, and a more holistic approach -- rather than simply remote monitoring and one-size-fits-all education. 

I applaud any effort to improve healthcare and to use technology to evolve how we communicate and care for our patients. That said, I also think that it's important that we continue finding ways to care for our patients better -- not just less or more cheaply. 

When we became doctors, we did so because we wanted to help patients live longer, healthier lives. Not because we wanted to "provide healthcare."

That said, as days get more hectic, as visits with patients get shorter, and as demands on us get more intense, it's not easy to keep our sights on that vision of health. 

But a recent study reminded me of the very real difference between healthcare and true health -- and I bet it's a reminder that most of you need, too. 

A recent article in Fierce Healthcare looks at a study by The Stanford University School of Medicine's Clinical Excellence Research Center in California, which explored what role healthcare plays in avoiding premature death.

This question about the role of healthcare almost feels like a contradiction in terms -- our knee-jerk reaction is to say, "Of course healthcare plays the primary role in preventing premature death!"  But the results of the study contradicts that intuitive response. In fact, although healthcare plays a role in longevity, behavioral and social factors have much more influence on the longevity of people in the United States

Healthcare is estimated to prevent 5-15% of premature deaths. Behavioral and social factors, on the other hand, account for between 16% and 65% of premature deaths in the United States. As Robert Kaplan, research director of the Clinical Excellence Research Center (CERC) said, “in order to bring the U.S. health back in line with other rich countries, we need more than medicine.”

So what is that "more than medicine" that our patients need?

Dr. Steven Woolf, MD, Virginia Commonwealth University explains, “Healthcare systems need to do their part, such as paying attention to the social needs of their patients in order to help lower emergency department visits and hospital admissions.”  In other words, we need to: 

• Take a holistic view of our patients' health, including their social, environmental, financial, and behavioral realities. 
• Coordinate care and do medical collaboration so that we can actually attend to the full picture of our patients' health, rather than just "providing care."

That might mean realizing that a patient can't take time off work -- so using iClickCare to collaborate with a colleague on the case, rather than sending the patient for a consult. It might mean coordinating with a patient's care team across the continuum of care, including all of the aides and nurses that will care for that patient when they are discharged. It might mean doing medical collaboration with our young patient's teachers, social worker, pediatrician, and family -- rather than performing a procedure in isolation. 

We've said it before and we'll say it again: medical collaboration is not an optional flourish -- it's the foundation of caring for our patients in a truly effective way. 

Get our Quick Guide to Medical Collaboration for free, here: 

Some things in medicine come and go.

Many trends — demands on our time or our practice — start off as the trend du jour but eventually get abandoned for new trends on the horizon.

But there is one trend in medicine that appears to be here to stay— and it’s coming to your state and town, whether you are ready or not.

That trend that’s here to stay?  Value-based payment in medicine.

As Fierce Healthcare summarizes, in just 5 years, 700% more states have adopted value-based payment (VBP) systems. Currently, only 4 states have yet to launch a value-based model.

What does that mean for most healthcare providers?  It means that it's not enough to simply put our heads down and provide good care for the patient in front of us. In a value-based model, it becomes very much "our problem" whether care coordination happens, whether we need to do medical collaboration, and what "non-medical" things are affecting our patients.

For instance, in a value-based model, there are concrete consequences to referring a patient to a doctor 3 hours away and hoping the patient gets an appointment and that they actually go. The patient may not make it to the appointment, end up with a bad outcome, and ultimately — in addition to the subpar care — it becomes a financial hit for the doctor and her organization.  Far better?  Use a system like iClickCare to get a 2-minute consult from that provider, while the patient is in front of you. 

For a long time, healthcare providers felt that medical collaboration and care coordination were altruistic things they would do "when they had time."  In a VBP world, collaboration and coordination are the most practical, incentivized activities in healthcare. Coordinating a medical team means that followup care happens and readmissions drop. Medical collaboration means that you can efficiently pull in providers across the continuum of care to determine the best possible course of treatment — decreasing length of stay.

It's not always the case that the right thing to do and the selfish thing to do are the same. But in a VBP world, the right thing and the selfish thing are the same — use medical collaboration, telemedicine, and care coordination to care for our patients. 

You can try iClickCare for free. Get started in 5 minutes or less here: 

My daughter recently signed her new baby up as a patient at a pediatric practice and had to choose one of the doctors in the group. “Dr. Salno,” they said, “is great. But you have to wait at least an hour to see him, every time.” She ended up choosing another doctor in the practice.

Her experience isn’t uncommon — so many of the very best healthcare providers we know have long wait times in their offices or are frequently running behind. Is that a problem for healthcare, or is it simply part of the reality?

In our experiences as medical providers, there is sometimes a sense that long wait times, doctors who are hours behind, and extensive travel to get medical care are all just facts of life in medicine. And that makes sense — there is a shortage of providers, especially physicians, and every healthcare provider I know has far more work to do each day than time to do it in. For some of us, long wait times and long travel times are practically badges of honor, showing just how in demand our practice is. 

In fact, those travel and wait times are long, and aren't decreasing. A recent study by Altarum shows that “Despite significant investments in the United States [from 2006 to 2017] in improving access to health care through better insurance, the use of innovative delivery systems, and advances in digitizing health care records and automating administrative processes, travel and wait times show no discernable improvements.”  These dynamics haven't been improving in decades.

The place that I see travel times really come into play are for patients with complex, chronic, or even acute but serious conditions. According to the Altarum study, patients who reported their health as “poor”, spent an average 26.4 hours per month on healthcare. That time may be transiting from provider to provider, from appointment to appointment, in addition to actually accessing care. 

But is this time that patients spend a bad thing? Is it something that should be decreased? And further, are travel and wait times something that healthcare providers should concern themselves with, or is it someone else’s problem?

Long travel times may not seem like the healthcare provider's problem until we consider the health cost of that time. Of course, there is the element of lost productivity and wages. But even just focusing on health itself, I believe that spending so much time accessing healthcare, as well as transit and waiting, has a severe and negative impact on our patients' health. Time spent at home with loved ones, hours invested in hobbies, focus at work, and rest in our own beds are all crucial elements of healing from disease. Every hour that a patient spends in a waiting room or driving to yet another appointment detracts from this healing time. 

So what can healthcare providers do? Most importantly, we can try to understand our patients' lives, travel times, wait times, and recovery and see it as "our problem." We can use medical collaboration tools to loop in other providers' input without the patient needing to trek across the state to gain that input when a picture and a discussion is actually all that is required (and this is reimbursable). When tools like iClickCare exist, that use telemedicine to dramatically decrease transit and wait times, there is the opportunity for health to truly improve, because the patients are able to spend more time healing and less time transporting or waiting 

In a conversation with a young doctor recently, she sighed as she considered her future as a physician.

“I just don’t think my job is going to really exist in a decade or two,” she said. “It’s all going to be computers and nurse physician assistants.”

It’s a scary thought — that doctors as we know them — won’t have a role in providing medical care in the future. But is it true?

The applications to the U.S. Patent and Trademark Office are always illuminating as to what is on the horizon in the world of science and technology. Patents reflect those innovations that may or may not have a business plan or a market, but often reflect the direction that technology is headed more generally.

So I was interested to note that Google is developing an electronic health record (EHR) that uses machine learning to predict clinical outcomes.

As Fierce Healthcare reports, “Google appears to have plans to develop its own electronic health record (EHR) for clinicians that gathers patients’ medical records and then leverages machine learning to predict clinical outcomes, according to a patent application."

So is this patent application, backed by tech's behemoth, a harbinger of the inevitable phase-out of doctors?

I don't think so. True enough: it’s almost certain that the role of computers in our practice of medicine will continue to increase. But the truth is that doctors' core role is so much more essential and irreplaceable than any diagnosis, computer-assisted or otherwise. Ultimately, physicians are healers. And a computer can diagnose. A computer can perhaps even treat. But it takes a human being to truly heal another. 

That said, I believe that for medicine to be truly resilient -- for healthcare providers to continue to be relevant into the future, we need to lean into the art and humanity of medicine. The trend over the last couple of decades has been to reward providers who treat medicine like a complex factory -- the more efficiently and flawlessly you can move through the heap of patients, the more you are rewarded. But I believe that we are beginning to experience a shift. And into the future, simply being efficient and precise is not going to be our path forward. 

I believe that medical collaboration with our very human colleagues is a crucial part of leaning into that art and humanity. It's a tool that we can use to treat the whole patient, and do so with true thought. Our practice will likely be assisted by machine learning and artificial intelligence in the future. But if we're doing our jobs right, that assistance simply can't replace us. 

Recently, seven major hospital systems put out a bold call.

It is crucial, they contend, to improve data sharing and interoperability among EMRs and EHRs. As Fierce Healthcare reports, "In a 2017 AHA survey, 57% of respondents had experienced challenges sending the proper information to a different vendor platform. And 37% ran into challenges just matching patient identities between systems."

Any healthcare provider who works with Electronic Medical Records won't dispute that data sharing is lacking with these tools. But despite the importance of this report, I see 3 crucial blindspots that it has -- and that your hospital may have, too.

I agree that interoperability among EMRs and EHRs is something that we should all demand. The simple access to data about your patient is as fundamental as having a clean and private exam room to see that patient in... or as having the ability to record your own notes about that patient. 

So I was glad to see this hospital report come out. That said, I believe there are three crucial shortcomings to this report. And identifying them isn't so much to undermine the findings or importance of the report itself -- but to identify blindspots that your hospital may have as it begins to pursue interoperability of EMRs and EHRs.

3 crucial shortcomings to focusing on EMR interoperability:

• EMRs / EHRs will never be true healthcare collaboration tools.
  No matter how sophisticated interoperability among medical records becomes, the truth is that these systems will never be true healthcare collaboration tools. The records simply aren't made to easily facilitate multidirectional care coordination and medical collaboration among all members of a care team. And so it's a mistake to believe that by solving interoperability, we might have improved care coordination or collaboration. 
• Providers need better tools now. 
  The reality is that even if EMRs and EHRs become more interoperable, healthcare providers need better communication and collaboration in the meantime. The reality is that today, EMRs and EHRs consistently get in the way of sharing data and patient information. Until the day that EMRs/EHRs are interoperable, healthcare providers must take the burden on themselves of making sure that other members of the care team have HIPPA-secure access to patient information. 
• We need collaboration among people, not computers. 
  The AHA report emphasized that "there is an urgent need to coalesce around improved standards that overcome the significant gaps making communication difficult between systems." In other words: we need our computers to communicate better. But the harder truth is that allowing computer systems to share data is just Step One. What is really needed in medicine is the ability of providers to collaborate and coordinate care. The data-sharing is just the foundation -- it doesn't necessarily facilitate the profound collaboration that needs to occur for good care to happen. 

As always, these organization-level initiatives -- like those to improve interoperability -- are crucial. They are long-term projects that affect key foundational aspects of what we do as providers. But these projects are often uni-dimensional and may not affect our work in the holistic ways we need them to. So even as hospital-level and nation-level work occurs, we as providers must create and demand tools that are immediate and holistic enough to support excellent care for our patients. 

The United Hospital Fund is a nonprofit that is embarking on an important initiative. Their Difficult Decisions series explores the challenges that hospital staff personnel face in planning discharge.

The third in the series looks at the transition to post-acute care, usually to a Skilled Nursing Facility (SNF). And the study itself brought to light important insights for all providers, in understanding discharge planning, as well as patient transitions, more generally.

The most salient point in the study is, as Fierce Healthcare summarizes, that discharge planning presents profound obstacles for the hospital staff personnel who carry it out. Both administrators and staff very much have a goal of continuity of care. But the tools and structures that staff personnel encounter make the outcome of discharge planning fall short, many times. 

For any of us who work in hospitals every day, none of this comes as a surprise. That said, there were several nuances in the study that were enlightening in exploring when balls get dropped in discharge planning -- and how we might improve that process. 

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities: 

1. Discharge plans are made without real input from the people carrying them out. 
   One thing that I loved about this study is that it was carried out by talking directly to the people who are actually doing the work, in order to understand the real challenges and opportunities they face. For that reason, I think the insights carry more weight than a study solely based on administrators, or findings from a think tank or conference. Similarly, discharge plans are sometimes coordinated "at the top" rather than allowing them to be shaped and reshaped by the medical team, across the continuum of care.
2. Discharge plans are often static. 
   The status of a particular patient changes quickly and often without warning, which means that the discharge plan must change and evolve, too. A static plan won’t work. And one that’s created once and then executed by members of the care team, in their offices or even across institutions won’t work. That’s why a tool like iClickCare -- which uses telemedicine to support medical collaboration for care coordination -- is so crucial. As the patient's situation changes, the entire care team can continue to influence the discharge plan, communicate about status changes, and get multiple perspectives.
3. There is little communication across institutions. 
   Although, in theory, a nurse at a Skilled Nursing Facility, or a doctor at a hospital can always "pick up the phone,"  the pace of medicine and the realities of scheduling makes telephone tag nearly impossible to do successfully. For that reason, there is often little communicate across institutions -- for instance, from a hospital to a Skilled Nursing Facility, or vice versa. That means that information is often fractured and things can get missed, not to mention that crucial nuances of patient care fall by the wayside altogether. 
4. Patients are given information, not guidance. 
   In theory, patients are given the information they need (for instance, a list of skilled nursing facilities). But realistically, they’re not being given the guidance or support necessary to make high-quality decisions about "next steps" in their care. True guidance and support means their whole care team working with the patient collaboratively -- throughout the duration of their illness.

In exploring the findings of this study, it was so clear to me that "trying harder" is not the answer when it comes to healthcare providers doing care coordination and discharge planning effectively. Teams need excellent tools and strong processes to support them in actually creating the continuity of care they intend to. And telemedicine-based medical collaboration is one of those crucial tools. 

You can try iClickCare today to support your organization in doing care coordination as effectively as it intends:

In Sweden, 28% of women who give birth were born in another country.

These women may be Syrian refugees or arrivals from Africa, or France, or Spain. They speak countless languages and may not be familiar with the medical protocols and cultural norms of their new home. 

And this reality is not without its challenges. Sweden has good rates of maternal complications and mortality, but immigrants face outcomes six times worse than their native-born counterparts. 

That said, a simple new initiative has been changing that for immigrant women giving birth -- and the practice is rooted very much in medical collaboration and care coordination.

A recent article in the New York times explores Sweden's immigrant maternal health challenge -- in which foreign-born women face outcomes six times worse than Sweden-born women. Of course, these women may have significant linguistic and cultural barriers, keeping them from accessing the same standard of care.

Interestingly, the solution to this problem isn't intensive prenatal interventions or better technologies -- it's simply improving collaboration and communication.

This collaboration intervention comes in the form of "doula culture interpreters" -- trained women who assist a pregnant woman in her labor, supporting her in communicating with her midwife or doctor as well as helping her understand the norms and practices in the birthing process. These doulas translate from the immigrant’s home language and culture into their adopted language and culture. But they also translate the medical system, culture, and jargon. 

Sometimes the participation of the doula is as simple as literally translating from Swedish to, say, Arabic. Other times, the "translation" is from medical-speak to plain language. “Good communication is listed as one of the best ways to improve outcomes,” Dr. Esscher, a Swedish obstetrician, said in an interview. And, indeed, the doulas' support of good communication, has been having an effect on outcomes. 

I found this doula project inspiring in its simplicity. It's an intervention that doesn't involve displacing or dramatically changing any current practices or providers. It simply improves communication, collaboration, and coordination with the assistance of one of the doula interpreters. I also think that this kind of approach spotlights the importance of having collaboration tools that are flexible enough to involve multiple kinds of collaborators.

For instance, the old telemedicine paradigm of a one-to-one videoconference or text message thread between two doctors simply isn't enough to support this kind of approach. Rather, a truly team-based approach in which, perhaps, the doula interpreter, the obstetrician, and the midwife could all collaborate on postpartum or antenatal care, that is the approach that is truly necessary. Knowing this need generally, iClickCare has been structured to enable medical collaboration among multiple members of the care team, regardless of medical training, across the continuum of care. In an age when our care team includes a range of providers, offering a range of perspectives, this kind of tool is not only helpful, it's indispensable. 

To me, this program brings up questions that apply to all of us in medicine. First: We’re in a time where immigration and refugees are one of the challenges and opportunities that many countries face. How might we ensure that all people in our country experience the same quality of care and outcomes? And perhaps even more crucially: we're in a time when medical care is increasingly team-based, with a diversity of training levels and perspectives. How might we make sure that all members are engaged to provide the most coordinated, nuanced care possible?

Try iClickCare to support team-based telemedicine medical collaboration: