My mentors in surgery never allowed us to view surgery as solely the surgical event.

Truly knowing the patient, preparing the patient mentally and physically, and working with other providers to ensure excellent post-operative care were all inherent parts of the job — not “extras.”

The truth is that the structure of the medical system has made this approach increasingly difficult to carry out. Ironically, though, many of our most pressing health issues demand this kind of approach. So I was inspired recently to hear about a new program using just this kind of holistic approach -- achieving tremendous success, in a major hospital system. 

As we know, recovering from surgery can be slow and complex, even in the best of times. In the midst of an opioid epidemic, however, there are even more reasons that surgical recovery can touch off opioid addiction. On the face of it, it doesn't sound like a problem you could do much about -- but Geisinger Health System, a major Pennsylvania-based hospital system, decided they could do something about it. 

Rather than trying to address opioid problems directly and after-the-fact, Geisinger's program uses a holistic model to prevent issues before they start.

As Fierce Healthcare explains, “Pennsylvania-based Geisinger Health System is launching a program to "redesign" the surgical experience aimed at improving the healing process following surgery while ultimately tackling one of the major sources of opioid addiction: postsurgical care. Officials said their Proven Recovery program rethinks the surgical experience by pushing patients to be healthier before surgery, which leads to fewer complications.”

Since June 2017, when the program began, opioid usage across the system has dropped 18%. Perhaps even more astounding, hospital stays for neurosurgery and colon surgery went down by a full 50%.

The program focused on pre-surgery and post-surgery approaches, like making it easy for patients to achieve proper nutrition, a focus on non-opioid and targeted pain approaches, as well as focusing on mobility after surgery.

In many ways, this program isn’t cutting-edge medicine. It’s appropriate pre- and post-surgical care. “Appropriate” care is always holistic in these ways — and at other points in the history of healthcare, this kind of approach wouldn’t be out of the ordinary.

That said, the frustrating truth is that this kind of holistic program is so rare that the results Geisinger is getting are truly exceptional. The way the medical system is structured, a program like this — which is preventative, collaborative, and holistic — simply isn’t easy to create or get support for.

We hope that models like this pave the way for more programs that tackle challenging problems in smart, holistic, collaborative ways. And we will continue to make sure that courageous healthcare providers like these have the tools they need to overcome silos and work in medical collaboration, together. 

After declining steadily through the early 2010s, gun violence has been rising in the US. Mass shootings, while a very small percentage of total gun deaths, have also risen significantly in the past few years — thus the reason that it feels like we hear about a new shooting every week. Of course, the overall numerical significance of gun deaths may not be as sizable as other causes of death -- but gun deaths remain a killer in our country.

For these reasons, gun violence is sometimes seen as a public health issue. Although not an “unpreventable biological disease,” it is a killer and a factor in the well-being of our citizens. Similar to the opioid epidemic, gun deaths have social, public health, political, and behavioral dimensions. So it makes sense that doctors may have perspectives and concerns about gun violence, especially trauma or ER doctors who are literally on the front lines of battling to save patients who have suffered from a gunshot wound. (That said, the overall deaths from gun violence each year are tiny compared to many other public health problems.)

But a recent kerfuffle highlighted how difficult this topic can be to broach.

As is highlighted in a recent New York Times article, Bronx doctor, Dr. Marianne Haughey was outraged when the National Rifle Associated tweeted: "Someone should tell self-important anti-gun doctors to stay in their lane.”

She replied, "I have cared for victims of gun violence for the past 25 years. THAT must be MY lane." 

The politics and practicalities of gun control and mitigation of gun violence are beyond my sphere of expertise. And the analysis of the relative significance of gun deaths relative to other causes of death is a matter of real research to understand -- not something to address flippantly or scandalize.

But regardless of those more specific questions, for me, the conversation brought up an important question -- what does it mean for a doctor to "stay in their lane"?

What is our lane as doctors, generally, and as individual doctors?

Does our “lane”…

• End after the last stitch is sewn, as surgeons, or does it extend to stopping by to check on the patient post-surgery?
• End after we refer a patient to a specialist, or does it extend to following up on their care?
• Include the societal, social, behavioral, and economic determinants of health?
• Necessitate medical collaboration, or is seeing a patient during the visit the only job we have?
• End at the end of our shift?

The answers to these questions have evolved for physicians and healthcare providers over time. And the truth is that there are no right answers. There do have to be boundaries to our sphere of influence as doctors -- both to remain within our expertise and to maintain sanity and efficiency. 

But I think that as a healthcare culture, we've drawn our "lane lines" too narrowly. I do believe that doctors have an important voice when it comes to questions of gun violence. I do believe that surgeons have a responsibility to care for patients long after the surgery is complete. And I believe that medical collaboration is a bare minimum requirement for adequate care. 

In a recent New York Times article, Dr. Peskin tells the story of one of her patients — Shirley.

The first time that Dr. Peskin saw Shirley, she had been taking shots on a daily basis to deal with her diagnosis of Multiple Sclerosis.

5 months later, Dr. Peskin saw her again because she had now suffered anaphylaxis from the shots. In the process of treating the anaphylaxis, another doctor ended up reviewing Shirley’s history and concluded that she didn’t have MS at all — indicating that the decades-long course of daily shots were actually unnecessary.

In other words, Shirley’s first doctor made an incorrect diagnosis; that diagnosis was confirmed by a second doctor; and a it wasn’t until a third doctor was involved that the mistake was revealed.

This story certainly isn’t unique. In fact, mistakes are often revealed at the junction point between two doctors — whether it’s during a handoff or because care has been taken up with a new doctor for a different reason.

To me, there are three important findings that relate to this story:

• Mistakes must be part of our medical experience.
  The entire structure of our medical system and practice treats mistakes as an unpardonable, inexcusable part of care. That means that, as Dr. Peskin explains, doctors are left to deal with the intellectual and emotional aftermath of making a mistake on their own. And, I think, learnings from mistakes are limited. Far better would be to incorporate a thoughtful exploration of our mistakes into our practice — in a way that doesn’t necessarily make anyone “wrong” for having made the mistake in the first place. This is one crucial reason that all ClickCare cases are automatically archived and searchable for teaching and reflection.
• The more we collaborate, the better we do.
  If you collaborate, you don’t need to wait until a mistake is found “after the fact” — another set of eyes (or two or six) can help us make better decisions and diagnoses in the moment.
• Handoffs are not collaboration.
  It’s important to note that Shirley would likely have received more thoughtful, appropriate care if her three doctors had been able to work together, sharing perspectives. This type of collaboration creates far better, more sophisticated care than simply bouncing the patient between providers. It’s possible that her original doctor had important insights about her that informed the diagnosis of MS — and rather than reversing the original diagnosis, perhaps the final doctor would effect the change by integration or interpolation, while engaging together about the care.

Shirley's case didn't end badly, and all of her doctors had been working hard to provide the best care possible. But we believe that a better way is possible, easy, and doable -- if doctors have the right tools and the right mental framework. Doctors don't have to "go it alone" and be infallible -- they can collaborate and they can learn from their mistakes. 

Frequently, “power users” of healthcare are seen negatively.

Whether because they are seen as more “demanding” patients or because of their relatively larger “burden” on the healthcare system, there is often a bias against these patients.

But a recent study — a collaboration among the New York Times, The Commonwealth Fund, and the Harvard TH Chan School of Public Health — looked in depth at these patients, both putting a spotlight on their behavior and experience, as well as sharing the wisdom they have about how to interact effectively with the healthcare system. Interestingly, much of what they shared advocated for a more collaborative, connective way of doing medicine.

In this study, “power users” of healthcare are defined as “people who have been hospitalized multiple times and are seeing multiple physicians, related to a serious illness, medical condition, injury, or disability.”

Of course, their perspective holds a lot of important insights for healthcare providers, for a few reasons. They: 

• Have experienced more facets of the healthcare system. 
• Necessarily developed skills and habits to deal with the shortcomings and strengths of the system. 
• Are sicker and so may tax the system more, revealing faults that go less noticed otherwise. 

So this study of their experience, problems, and advice is enlightening. Among the findings: 

• 30% say they were sent for duplicate tests by different healthcare providers.
• 23% have had to wait too long for appointments, treatments, and tests.
• Overall, they offer the following advice for navigating the medical system:
  • Show your doctor a list of medications you are taking (78%)
  • Bring a list of things to discuss with your doctor (70%)
  • Bring a family member, friend or someone else to all of your medical appointments to serve as a coordinator (55%)
  • Seek advice or help from a family member or friend who is a doctor, nurse or other health professional (34%)
  • Seek advice or help from a former patient who had a similar health condition (23%)

Our take on these results? People who use the medical system a lot experience the delays, confusion, and duplication caused by healthcare providers that aren't able to coordinate care or do healthcare collaboration. For that reason, the advice these patients offer tends to revolve around creating their own solutions to ensure care coordination on their behalf.  

Instead of patients trusting doctors and other providers to coordinate care, they do it themselves or involve friends or relatives to support them in doing it. This behavior certainly makes sense. And it's a wise way to approach a well-intentioned system that doesn't always work. But it does concern us, since patients have only a limited ability to truly coordinate care on their own behalf. For instance, a patient can bring a list of medications they are taking, but they can't bring a list of providers who should collaborate on a case. They can ask a friend to offer advice, but they can't necessarily facilitate meaningful conversations among all of the members of their care team. 

That's why we believe it's necessary for healthcare providers to have the tools they need to truly effect care coordination and healthcare collaboration. Sure, patients may fill in the gaps. But their ability to identify all of the possible gaps and truly fill them effectively is limited.

As the world changes, our regulations and laws often scramble to keep up.

Whether it’s Uber being challenged in individual cities or schools struggling to adapt to children owning cellphones, the legal side of life often lags behind our technology, our culture, and our needs.

So it shouldn’t be surprising that telehealth regulations face similar challenges across states — but the consequences are indeed challenging for those who do direct-to-patient telehealth.

A recent article in Fierce Healthcare looked at a few examples of recent telehealth challenges arising from state-to-state regulatory differences.

As they report, “Whether a medical professional can treat someone via telehealth—and if so, how—varies widely by jurisdiction, since medical practice is regulated at the state level.”

For instance, court cases involving doctors seeing patients via telehealth touched on:

• The administration of medical abortions
• Prescription of controlled substances
• Etc.

Further, doctors and patients often run into challenges when the intended telehealth patient didn’t have access to the Broadband internet needed to access an electronic visit with a doctor (thus limiting care in the very places that telemedicine could be most useful.)

These challenges are real, and important to explore. That said, it's not necessarily the case that the challenges are inherent in using telemedicine across state borders.

The regulatory issues presented in the Fierce Healthcare article all boil down to the challenges inherent in a doctor seeing a patient electronically.  But “telehealth” is NOT synonymous with doctor-to-patient online visits. As we’ve written about extensively, the umbrella term "telehealth" includes the use of many different kinds of technology to care for patients. A doctor seeing a patient via an online platform is only one version of that.

In fact, the challenges of videoconferencing or electronic visits are the very reasons that we created iClickCare to revolve around medical collaboration among healthcare providers, NOT between a single medical provider and a patient. There are many reasons that a short, technology-supported visit between a healthcare provider and a patient via videoconferencing may not be adequate to provide strong, holistic care of that patient. There isn't a useful archive of the visit; other members of the care team can't be involved; there is often little longitudinal knowledge of the patient; and care is infrequently holistic. The regulatory issues inherent in a “visit” like that are only one aspect of the shortcomings involved.

As an alternative, telemedicine-based medical collaboration allows providers — regardless of location — to collaborate on a case. It also means that if a provider in California is consulting with a provider in New York about a patient in California, the provider in California remains responsible for that patient. And that is “responsible” in all senses, legally and otherwise. Telemedicine-supported medical collaboration allows the flexibility and location independence that telehealth promises. But it doesn’t put the sole responsibility for a patient in the hands of a provider who is 300 miles away and has interacted with them, once, on Skype.

As we step forward into this new age of telehealth, telemedicine, and technology, it's important that we don't simply replace our old system (one-on-one doctors' visits, for instance) with a technological version of that old system. Our patients deserve more imagination than that. And we deserve the ease that can come from a tool that really works to help us deliver great care. 

Many people love science and medicine for the exciting stuff: the cutting-edge research, the dramatic diagnoses, the high-tech equipment.

The truth, though, is that medicine actually happens in a much subtler, more incremental way. It’s quiet moments with a patient or busy weeks when we see hundreds of patients but without any "big cases." Real medicine is simpler and less outwardly impressive than people may think. 

Similarly, healthcare collaboration is more steak than sizzle. And a recent article about a collaborative institution in Europe reminded me of these fundamentals. 

Robert Klaber, MD is a pediatrician who works at the Imperial College Health Care NHS Trust. The organization serves 2 million patients in Northwest London, with a staff of 11,000. He wrote a phenomenal article sharing his experience of collaboration in London -- bold work that is both more commonsensical, simpler, and more impactful than so much of what we read about healthcare collaboration. 

As he explains, “If you talk to patients, they will often tell you they receive poor care or their needs aren’t met when they fall between different providers. Support for patients often isn’t joined up, so it’s crucial that we collaborate much more thoughtfully. Unfortunately, the levers in the system still point away from that.”

He sees collaboration as even more than just provider-to-provider conversations. It's also about collaboration with the community they serve. "As we start to move [away] from a model of fixing illness toward one focused on health and wellbeing, our old methods just don’t stack up. We need to learn from the people and parts of society that have been doing more of this than health care."

The common way to think about healthcare collaboration is unidimensional (one specialist speaking to another on videoconferencing) but also tech-heavy and expensive. What I love about this article is that Dr. Klaber is thinking about collaboration in ways that are both more simple and more expansive than people normally do. 

Dr. Klaber sees collaboration as creative, dynamic connection that might not need special tools. Just as in our town of Binghamton NY, we did cutting-edge multidisciplinary cranio-facial team meetings (which involved no more complicated technology than a round table and some donuts), Dr. Klaber is doing multidisciplinary team meetings to talk holistically about pediatric cases -- with great and measurable results. 

So to me, the question is simply -- what can we envision for creative, multidirectional collaboration? And what are the simplest tools we can use to make that vision become real?

We're so passionate about iClickCare because it's a very affordable and easy-to-use tool that facilitates multidirectional and multidisciplinary collaboration. But other collaboration tools can include a simple conversation, a box of donuts, or a smile. 

As Dr. Klaber emphasizes, metrics are important but "It’s more important that we sustainably develop a workforce who has a sense of meaning and purpose, and the skills to do what our patients need us to do... [And] How do we start to deliver outcomes that really matter to patients, and aren’t just a traditional, often hospital-based process that we’ve had in place since Victorian times? Better collaboration could help with all these priorities."

Get inspired with more stores of medical collaboration here: 

We're all aware of the opioid epidemic in the United States.

We've seen the tragic photos of lives ripped apart. We've scanned the news describing the huge dollar amounts committed to resolving the problem. And we've experienced the complexities of treating an opioid abuser as healthcare providers.

But the truth is that our approach to care, treatment, and policy around this disease is lagging behind the realities of the epidemic. And as healthcare providers, we play one of the most important roles in preventing and treating the disease -- and caring for its sufferers.

Certainly, there are bright spots when it comes to the opioid epidemic. As Fierce Healthcare reports, “Data from the Medicare Part D program show fewer beneficiaries are receiving high amounts of opioids, but a watchdog agency says usage 'remains concerning,' while urging insurers to further restrict at-risk patients with lock-in programs. However, 1 in 3 Part D beneficiaries still received at least one prescription opioid, and the overall level of opioid use 'continues to raise concerns.'"

Chemical dependency is not solved by other chemicals.  In the long term, many changes are needed and extensive, ongoing support is vital.  This includes the extreme burden placed on the providers themselves. Dependency is not an inpatient disease. It is not an outpatient disease. It is not family therapy. It is not joblessness, nor hopelessness. It is pervasive and knows no time schedule. It is difficult to treat for the provider, and a lifelong challenge for the patient.

If there was ever a time and need for universal healthcare collaboration across the entire spectrum of providers, patients and families, it is now, with this disease.

A single episode of failed access, of telephone tag, or of failure to educate –– results in the crashing down of years of rehabilitation. But who has the time or resources or skills to be available everywhere, for everyone, all the time?

A dramatic, gripping, thoughtful, and open Perspective piece in the New England Journal of Medicine by Audrey M. Provenzano, M.D., M.P.H., once read, becomes nearly haunting. She describes her feelings about caring for a patient with addiction:

“Already overwhelmed, I did not want to take on patients with needs that I did not know how to meet.”  She finishes the essay with a sentiment common to all who practice medicine: “I wish that I’d listened more closely. I wish that I had not been afraid.”

Dr. Provenzano articulates beautifully the loneliness and isolation a healthcare provider can feel in treating such a complex, multifaceted disease. Yes, a tool like iClickCare can smooth and facilitate the healthcare collaboration that bring many types of services and providers into one case. But perhaps equally importantly, a tool like iClickCare can alleviate the loneliness and isolation that the providers themselves feel. And that's not just a "nicety." That's a core part of ensuring sustainable care for the patients they are treating. 

As a company, we're finding ways of contributing to the opioid epidemic, using hybrid strore-and-forward telemedicine to facilitate the complex care needed. And as fellow healthcare providers, we certainly stand with the providers on the front lines of navigating this care every day.

If you're facing complex patients or opioid abuse in your practice, try iClickCare as one of your tools: 

Introduction to this Review:

They say that the more things change, the more things stay the same. And in medicine, that's especially true.

Recent years have brought pay-for-performance systems, focus on metrics like length of stay and readmissions, and demands of care coordination and meaningful use. In turn, all of these pressures mean that healthcare collaboration is critical to surviving in today's medical landscape But, of course, the more things change, they more they stay the same. Healthcare collaboration has always been the best way to provide excellent care to our patients. So it's one of those times when the "practical thing" is also the right thing to do.

As two doctors who founded a telemedicine-based healthcare collaboration platform, we're deeply passionate about healthcare collaboration. In fact, it might just be our life's work. So this page is meant to be your "cheat sheet" to healthcare collaboration. Use it as you wish: as a review, as a checklist, as an introduction. No matter how you use it, remember that beyond technology, beyond telemedicine -- the main thing is treating our patients in the ways we would want to be cared for. And it turns out that's good medicine, good business, and good work.

Table of Contents: 

What is Healthcare Collaboration?

The classic principles of good medical care have always involved a team approach to complex diagnosis and treatment, as well as complex psychosocial overlays to physiologic and anatomic problems. This is not foreign to us as medical providers.

In school, we used study groups to help us learn. In labs, we had partners. If you were a medical doctor, you had rounds, grand rounds and morning report. If you were a surgeon, you had morbidity and mortality conferences. If you were a Physician's Assistant or Nurse Practitioner or Aide or nurse, you certainly had the same structure and hopefully were invited to be part of the above. With the changes in medicine, the need for these supports has increase, but most of the supports themselves have disappeared.

Currently, information technology is the lens through which this simple principle is seen. That has not always been the case. The concept and assumptions are timeless. Current or historical, they use the same classic principles.  One professional has a question for another. Sometimes a simple answer is all that is needed. At other times, a discussion is needed to add judgment and experience. And still at other times, discussion is needed over time.

However, the concept has been warped by technology and by the lens through which we view the technology. We have become more “connected” but in fact we are more isolated.  A text message has room for only data or for feelings, but not both. The phrase, “I am worried about” wastes 16 characters of message space. By its elimination, it also eliminates offers of support and enhances isolation.

Many, almost too numerous to count, words are used to label the use of technology in healthcare.  For example, this thorough analysis from Ziegler,  a speciality investment bank report.  

Many descriptors are used: telemedicine, mHealth, eHealth, telehealth, synchronous, asynchronous, video store and forward, secure text, secure email, telephone call, care management, personalized health, home monitoring, telecardiology, teleneurology, telestroke, teleER, telepsychiatry, telenursing and more. They overlap.

Why is Healthcare Collaboration Necessary?

Certainly, collaboration is not always necessary. It should not just be another healthcare product but rather an assist when an extra hand is needed. But when it is necessary, it is necessary for a variety of reasons:

1. As much expertise as each of us has, we need to realize that “No one of us is as smart as all of us."

2. The amount of knowledge has exploded. No one of us can master all of it. 

3. Healthcare is complex with ambiguity, uncertainty, and a blend of too much data and incomplete data. 

4. In serving the patient, often called providing healthcare, the provider, can be lonely. Burnout, job changes and suicide rates attest to that. 

5. The patient needs access to the right care, at the right time, in the right place, as close to home as possible. 

6. Those who follow behind need education. Medical education is the least effective that it has ever been from the time of the Flexnor report of the early 20th century. 

7. Data alone is useless without interpretation. Can you interpret high normal on lab and anatomic normal on an X-Ray, always? Weeding through an EMR is both exhausting and time consuming, only allows review of data, and can be supported by extensive reading. Our expertise is needed -- and, often, the expertise of multiple people is what's needed.

What Attitude is Necessary?

Artificial intelligence will become an aide. Emotional intelligence will become a necessity.

The demands of today's medical systems mean that we work in our own silo and rarely collaborate. We have academic specialties (stroke, cardiology, neurology, etc.) and relate to only one part of the body, not to the patient as a holistic being.

So medical providers who do healthcare collaboration tend to have a unique attitude. In our work with thousands of providers in telemedicine and collaboration, we've found the following attitudes to be crucial:

1.  Yearning to do better and belief that we can do more.

2.  Sense of responsibility beyond “the job."

3.  Respect for all colleagues regardless of role, from support to ultra-specialist.

4.  Enjoyment of interaction and of being a vibrant part of a community.

5.  Recognition of the whole, rather than fixation on the part.

6.  Acceptance of the limitations of one’s self or of one’s colleagues.

7.  Attitude towards technology as a friend not an as enemy.

8.  Understanding that the patient is the boss, not the administration nor the government.

9.  Recognition that the patient is a person, not a widget to move down the assembly line.

10.  Sense of satisfaction from being part of the whole that is bigger than oneself.

11.  Desire and ability to abstract, prioritize, and communicate a question and an answer.

12. Respect for the value of coordination and at times, for compromise.

Who Benefits from Healthcare Collaboration?

Healthcare collaboration, even when done on a limited scale, has so many benefits that it's almost difficult to enumerate them.

Some of the benefits of healthcare collaboration include:

1.  The patient by receiving the best care, at the best time, in the best place.

2. The healthcare system by benefiting from efficient and coordinated care.

3.  The taxpayer who is not the victim of waste from an inefficient system.

4.  The more healthy society by having more healthy members.

5.  The payor by paying for care that is less wasteful, more accurate and more preventative.

6.  The provider by having a satisfying and supportive work environment.

7.  The family who understands, who supports, and who is free of needless burden.

8.  The student who is healthy enough to learn well and to stay in school as much as possible.

9.   The educator who gains a rich experience for review to share with others.

Who DOES NOT Benefit From Healthcare Collaboration

Of course, we all resist change sometimes. And we're all busy and selfish at other times. But we find that the benefits of healthcare collaboration tend to be so significant and so immediate, that very few providers don't benefit. 

Ultimately, only the following people tend to resist healthcare collaboration so much that they never benefit:

1.  The egotist who is no longer the narcissistic center of attention

2.  The medical center wanting to survive because of control of the catchment area

3.  The entrenched regulator who resists change (within government or within a system)

4.  The adherent to a zero sum game where one wins only at the expense of another’s loss

What Equipment Is Necessary?

Little equipment or special technology is necessary to be collaborative. That said, there are a few technological tools that can make healthcare collaboration much simpler and more practical in today's medical system.

A secure system that ensures patient privacy.

In the United States, this is described as HIPAA compliant. In Europe, it's European Union General Data Protection Regulation; in Mexico, the Federal Data Protection Act; in Canada, it's PIPEDA. Countries throughout the world have similar examples.

Software is needed to make the devices, mobile or stationary, protect patient privacy and ensure that the entire system is compliant.

The ability to share images and videos.

Rich information allows good evaluation, so text is usually insufficient. A photo of a rash, a video of gait, or an audio clip of speech can be crucial to good collaboration and diagnosis.

At times, live video conferencing is important, especially when a consultation is direct from provider to consumer, but this is not really an example of collaboration. Further, when relationships need to be developed or when voice and face are easier than typing, the live video is important.

Limited peripherals.

When equipment (often called peripherals) is needed to obtain data such as an endoscopy, then specialized equipment is important. Realize though, that once the data obtained, it can be shared by a healthcare collaboration system.

Internet Connection.

An internet connection, slow or fast, is necessary if modern technology is going to be leveraged. However, stopping a colleague in the hall or on a telephone call is also healthcare collaboration. But one might not be in the hall at the right time or able to take on the phenomenal burden of telephone tag -- which is why it can be helpful to have a technology tool to help with the coordination and communication.

Specifically, the components of the needed equipment include:

1.  The desire and need to collaborate

2.  Connectivity

3.  Secure, comprehensive software platform (asynchronous, store-and-forward)

4.  Secure video-conferencing system (on occasion)

5.  Policy and procedures

6.  A system that is easy to use, always on, always available (for instance, a smartphone)

What About Policy And Procedures?

Seven main components need to be in place. They need not be complex, but should be tended to to ensure compliance:

1.  Reimbursement policy and procedures.

2.  Privacy procedures consistent with HIPAA.

3.  Bring Your Own Device (BYOD) policy.

4.  Patient permission policy.

5.  Policy about access to records with change in employment.

6.  Electronic orders.

7.  Delineation of responsibility.

What Is Needed From Leadership?

Of course, there are many leaders in every healthcare community. Aides, family members, nurses, doctors, administrators, and specialists are all leaders at different times and in different ways. But many times, medical providers get stuck in their efforts to collaborate because they don't have the support they need from "official" leaders -- department heads, hospital administrators, and the like. Medical providers can also be buoyed and championed by forward-thinking hospital administrators (of which there are many), something we've certainly seen and experienced over and over again. 

Medical leadership can offer the following to support healthcare collaboration efforts:

1.  Acceptance of something new and willingness to change

2.  Commitment to making healthcare collaboration work

3.  Encouragement and enforcement of use

4.  Strong support of implementation

5.  An empowering attitude

6.  High level understanding of workflow and its challenges

7.  Broad view of ROI and the changing reimbursement landscape.

8. Pride in accomplishing improvement over operational status quo.

9. Trust in downstream integrity

10. Willingness to make a decision (take a risk) before others in the industry

What are Examples Of Good Healthcare Collaboration?

Despite what skeptics may say, there is excellent healthcare collaboration happening all around the country, every single day. We see so many examples of incredible collaboration, including:

1.  School-based healthcare.

2.  Connected health.

3.  Cleft and Craniofacial Teams.

4.  Rehabilitation teams.

5.  Developmental teams.

6.  Clinical-pathological conferences.

7.  Tumor Boards where clinicians, researchers and lab colleagues discuss cancer care.

8.  Burn centers where intensity varies from ultra-acute to chronic care.

9.  Space medicine where many need to tackle the unknown at the limits of mankind’s habit.

10.  Transplant medicine where molecular biology works with surgical skill and pharmacology.

11.  WWII Valley Forge Hand Center where multiple specialists came freely and shared in care.

12.  WWI Harold Gillies Facial Reconstruction team where devastating facial injuries met artist and surgeon.

What are Examples of Poor Healthcare Collaboration?

There have also been some false starts and failures along the way as medical providers have tried to do healthcare collaboration and failed, or as people have willfully ignore the opportunity to work together altogether. For instance: 

1.  Development of anesthesia where fight over ownership slowed adoption.

2.  Semmelweis’s prevention of puerperal fever which was demeaned by the establishment.

3.  Banning of reconstructive breast implants because of a single approach to the complex.

4.  Patenting of medical advances such as cataract procedures.

5.  Various centers based on self promotion, look to the billboards and TV for the list.

How Do I Implement A Healthcare Collaboration Program?

If you're a medical provider or a healthcare administrator and you're interested in starting a healthcare collaboration program, then we are thrilled to help in any way we can. We've seen thousands of programs implemented and found some key steps to help you along the way. 

Keep in mind:

1.  Consider starting at a hotspot with fewer than 30-50 people involved.

2.  Plan and purchase for build out within 45 to 90 days to enable the network effect.

3.  Build collaborative networks based on already trusted colleagues.

4.  Continue support after introduction.

5.  Use train-the-trainer approaches so that there may always be local expertise.

6.  Budget less than one hour exposure for each participant to keep things simple.

7.  Allow self study and for medical providers to work at their own location and timing (as with hybrid store-and-forward technology.)

Key Outcomes of Healthcare Collaboration

There are many reasons to prioritize healthcare collaboration in your practice, hospital, or workday. Chief among them is the satisfaction, decreased burnout symptoms, and overall joy that providers tend to get from working together on cases.

But you'll notice a lot of other benefits as well, and the following overview of the key benefits may be a helpful outline for you as you share the potential of healthcare collaboration with colleagues... or even to be used as a checklist for assessing progress and results.

I. Cost

A.  Avoid duplication

1. Tests

2. Procedures

3. Sorting out of complications (i.e. reddened IV sites

4. Order and ranking of testing done with expert guidance

5. Avoid referral to wrong place

B.  Efficiency

1. Throughput in Emergency Department

2. Throughput in Operating Room

3. Shorter Length of Stay

4. Faster communication among unit or team members

5. Shorter work time (store-and-forward)

6. Change of diagnosis and testing from “shotgun” to precision

7. Imaging and Lab results easily placed into appropriate clinical history 

C.  Income

1. Larger catchment area can be served

2. Increasingly billable services

3. Value-based care

II.  Quality

A.  Safety

1.  Handoff errors reduced or eliminated

2. Reference and saving of more informal communication

3. Inappropriate, but still dangerous, testing, reduced

4. Rapid secure communication of environmental or infectious events

5. The potential for understanding trends with AI analysis of conversations

B.  Provider employee support and satisfaction

1.  Decrease burnout of isolation

2. Increase educational opportunities

3. Remove nagging doubt

4. Increase satisfaction of job well done by short and long term follow-up

5. More rapid on-boarding based on case review and store-and-forward methods

C.  Public health

1.  Increase communication across entire community of providers

2. Allow on-site care of patients by first responders

3. Better triage in disasters

4. Population health analysis

III.  Patient

A.  Patient understands thought process behind advice

B. Patient appreciates effort on their behalf

C. Patient can be part of the process (part of the solution, not the problem)

D. Patient avoids time off from work or school for self for some follow-up

E. Patient avoids time off from work or school while caring for child or parent

F. Patient avoids repeated history as thread of conversation unfolds

As things settle down from the holiday season, many of us are in full-on planning modes for our work. 

In the change-averse medical field, I think that many of us hope that nothing will change, so that we know what to count on. 

But the reality is that change is happening at a powerful rate in medicine these days -- and the changes in the works are impacting every part of the healthcare system. So it's in our interest to understand what's just around the corner, so we can adapt and thrive in these new contexts.

Dr. Jerry Penso leads the American Medical Group Association, a trade group which represents multispecialty medical groups and integrated systems of care. The 175,000 physicians that are part of that group treat 1 out of every 3 Americans -- so Dr. Penso gets a pretty broad sense of the trends that are afoot for us in the American medical system. In a recent Fierce Heatlhcare article, Dr. Penso predicts the top 5 trends in healthcare that will shape our experience in 2018. He lists: 

1. Efficiency will become a top priority. Costs rise and revenues remain the same, so providers, groups, and hospitals are all searching for ways to become more efficient. 
2. Physician burnout will be a strategic imperative. Providers shortages and concern about the stability of the workforce means that burnout has changed from a concern to an immediate priority for administrators.
3. Competition for convenience will heat up. Patients have decreasing patience for long waits, long drives, or unnecessarily complex care scenarios.
4. Scope-of-practice issues will become more acute. Across the continuum of care, we'll continue to find ways for providers like pharmacists, aides, and PAs to expand the scope of their care.
5. Practices will form more community partnerships. As value-based pay becomes the norm, working together becomes a financial imperative.

Dr. Penso's predictions certainly resonate with us as strong forces in healthcare this year. And in many cases, we see care coordination, medical collaboration, and what Dr. Penso calls "enabling technology" like iClickCare as being key pieces of the puzzle. 

Realistically, as these trends catch up with us, we won't be able to respond in kind unless we find new tools, new workflows, new collaborators, and new ways of thinking about what's in our job description, that may not have been, even a few years ago. 

And the good news is that we do see our colleagues starting to adapt to these new realities in medicine. Sure, not all providers relish the chance to make a change. But many providers are starting to experiment with new tools and new ways of collaborating -- even if their institution is not leading the way. 

If you're reading to start 2018 with a tool that will support you in all of the ups and downs of these trends, try iClickCare: 

Sometimes medical providers have a tendency to focus on the seriousness and sophistication of care. 

When we're about to give a shot, we emphasize that it might hurt. When we prescribe a medicine, we don't always explain the pathway simply -- sometimes we use jargon that makes sense to only the other providers in the room. 

We get most excited about care plans that are cutting edge. 

But a recent study caught my eye as evidence that we might be better off focusing on the simplicity, ease, and fun of a care plan, rather than the more rigorous or medically important aspects.

A recent article in JAMA Internal Medicine looked at the trend of emphasizing the health merits of foods. We see things advertised as high protein, high fiber, or farm-fresh -- and we assume that these descriptors are attractive to people.

As the study reports, "Ironically however, health-focused labeling of food may be counter-effective, as people rate foods that they perceive to be healthier as less tasty."

So the researchers created a study to see whether health-focused labeling is better or worse than just a neutral label -- and better or worse than how junk food is described.

Researchers watched 27,933 students (with some staff) in a dining hall over 46 days. Each day, the researchers offered the same vegetables, but named them differently. For instance, the sweet potatoes might be described as "zesty ginger-turmeric sweet potatoes” instead of just “sweet potatoes." That change, in fact, resulted in 25 percent more people choosing the vegetable. And, as the New York Times summarizes, "35 percent more customers chose the zesty label than the health-positive 'wholesome sweet potato superfood,' and 41 percent more chose it than the scolding 'cholesterol-free sweet potatoes.'"

Across all of the vegetables, the study concludes that vegetables were most likely to be chosen when they had "flavorful, exciting, and indulgent descriptors" rather than neutral ones, or (even worse), descriptors touting their health benefits.

It's a simple study, with results that may seem obvious. But the implications for how you talk about care plans could be significant. It's human nature to want to choose fun things over healthy things -- and there's no reason we can't frame care the same way we frame sweet potatoes. Care coordination is more than assuring appointments are kept; it is about ensuring a good attitude and thus good compliance for improving health. If the patient buys into your recommendations, you are making value, and you will get paid (telehealth with value based care and MACRA).

For instance, your heart patient might need to lose weight so he'll add years to his life. But is it possible that losing weight could also make his August vacation more fun and active? That might be the component to focus on. The shift also makes us reflect on the continuum of care, as different people on the team should be collaborating on things as seemingly mundane as the verbal phrasing of a care plan -- and that requires strong medical collaboration and care coordination -- and a medical collaboration tool. 

Care is far more than how we describe it, of course -- but if subtle changes in verbiage can benefit your patient's outcomes, it could be worth experimenting with.

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Image: Carol Mitchell