ClickCare Café

Independently, a contest shows a collaboration solution

Posted by Lawrence Kerr on Tue, Nov 08, 2011 @ 11:12 PM

The Contest:  How I will fix healthcare delivery?

 And the winner is...

 But first some comments.

  • about the contest
  • why discussions about healthcare are vital to us all
  • why medical collaboration is necessary


The contest as a whole documents the frustration, malaise, and institutionalization of medical care. Ironically, health is one of the most personal relationship.

The Contest:

We thank you all for your entries. The word map shows quite nicely the range of answers.  Frankly, we were a bit disappointed by the contest. In part, this was caused by our inexperience since this was our first Facebook contest. We had no idea that there was a community of professional contesters with multiple names, lists of operatives who help each other win, and a certain amount of vitriol.

Naively, we had hoped to stimulate a grassroots discussion among all of us. In a busy world, and with a complex subject, there were no newly creative answers. The question was answered largely with an approach oriented toward the  “them” -- insurance, government, doctors and drug companies -- and not us.  This was countered by preventive care.

The sum of the comments showed the problem to be expense and the solution to bypass insurance companies, and have everyone save money in very basic ways. Suggestions included turning off lights and closing rooms, and contributing to a national fund which would be nonprofit. A plan suggested $5 to $10 per person per week or $260 to $520 per year. Currently about $7500 is spent per person. Prevention and taxing of risky behavior, as well as government run, universal healthcare another. The disappointment is that, despite the question "What will I do," the answers were expected to be supplied by someone other than an individual.

As you review the world map, consider other alternatives.ContestWordCloud redsize


Importance of collaboration:

Each of us needs to use our expertise and our view of fairness to others to reach a solution that benefits us all. Discussion is needed, not devoid of self interest, but respectful of all ideas. Discussion is the life blood of collaboration.

Medical Collaboration is necessary:

Our own view, not expressed except but by one contestant, is that collaboration is not the end of our healthcare problems, but rather an important piece of a very high tech, high demand field where no one of us is as smart as all of us. Telehealth and telemedicine are part of this!

Thanks for participating, all.  Please continue to do so with your comments.

And the winner is: Amada Acevedo, of Texas. Congratulations Amada. This is her entry:

If one person were to save $5-10 a month and put it towards our healthcare system, then we could be able to provide for our less fortunate and also to put more efforts and monetary help towards PREVENTION, then the healthcare crisis would change drastically. Most of the lower income people do not have access to health care, and therefore only go to the Emergency Room when illnesses and injuries have gotten past the point of being cured or treated. If one person could sacrifice that small amount of money, then many others will follow the good example!

We disagree with your math, but endorse prevention and leading by example.  We look forward to learning more about you and your passion for fixing healthcare.


Tags: health care, medical responsibilities, coordinated care

Coordinated Care: De-Skilling of Physicians: Is There a Solution?

Posted by Lawrence Kerr on Mon, Sep 26, 2011 @ 05:57 PM

Standardization is Nirvana to many, particularly regulators and payors. But, there are unintended consequences, one of which is called de-skilling. De-skilling is a process driven by a need to extract maximum value from labor. It occurs primarily by separating planning from execution and using technology to create efficient workflows.

lotsofworkers 200x150

In a paper titled, "De-skilling and adaptation among primary care physicians using two work innovations" Timothy Hoff, PhD, thoroughly analyzes primary care physician behaviors as they adapt to clinical guidelines, pay for performance, and EMR/EHRs.

There are at least 3 unexpected consequences:

  1. Less patient-specific information from specialists
  2. Visits become "checklist visits"
  3. Record completion dominates "over all else"

The implications of these unexpected consequences are huge. Providers talk to their laptops. Drugs are administered at the bedside with a scan of the wrist bracelet and without an explanation. Conversations are thrwarted. Medical providers at all levels have both implicit and explicit, ethical and moral, commitments to put the patient first.  That the patient should always come first is undeniable, but what is one to do?

Click me

We incessantly seek an answer. We are not naive enough to suppose that all of this de-skilling will go away.  We do know a couple of things that help:

  1. Slow down to speed up. Collaborate with your colleagues and supervisors.
  2. Find other ways to collaborate and coordinate care.
  3. Don't even try telephone tag and tardy written report.
  4. Collaborate: provide better care and enjoy satisfaction and peace.

We thank Kevin Pho, MD and Stephan Wilkens, MPH  for bringing this to our attention.

Tags: medical responsibilities, coordinated care, EMR

OnCall and Coverage: how many words?

Posted by Lawrence Kerr on Fri, Oct 08, 2010 @ 12:49 PM

We are sure you have heard that Eskimos have 100 words to describe snow.

Hawaiians similarly have many to describe the many emotions of the ocean. (full disclosure: some think that  this is an urban myth,see:  ( have many words to describe the many emotions of the ocean, These words describe their close relationship to their environment.

But have you thought about the fact that nurses and doctors have over 20 words for on call and coverage?

The new iClickCare for web and iPhone is about to be released. While working at this for over 15 years, we realized that on call and coverage are very important to all of us. So, we are building in a simple to use system that lets users to build there own coverage groups and on call notifications. Try to explain that to software engineers. We found that our everyday terms aren’t explicable to very smart people, and our developers are, indeed, very smart people!  So, in order to help us clarify what we wanted to say, we started to place the very simple terms into a table. After a few minutes we had added row after row, and discovered nuance after nuance.

We even remembered, that in the modern day of medicine, there is yet another phrase: “Post Call”. A phrase that makes collaboration and ClickCare even more important.

Please look through the table below and add your own words about call and coverage in the comments. But remember,as difficult as it may be, this is a family oriented site, so don’t use the words that you really use when you have to cover and have to be on call!  With great discipline and restraint we were very responsible and even controlled ourselves!

I’m covering FORHello Ms Jones, I’m Dr Down, I am covering for Dr Salk this weekend.  How are you doing…Overview: on call list checked

Root Word When used Root Phrase Modifying Phrase iClickCare
Cover… Talking to someone who needs to know your schedule: I’m covering ___ the ER, at Hospital A, but not B, and I am on hand an plastic call Overview: on call list checked
  Talking to a patient who is another doctors patient and in the hospital, or talking over the phone I’m covering FOR Hello Ms Jones, I’m Dr Down, I am covering for Dr Salk this weekend. How are you doing… Overview: on call list checked
  Answering: Who is in you coverage group? I cover WITH these other doctors Coverage group
    I cover GI with Dr Wagenstein, but I cover pediatrics with Dr Down Two organizations
  ER Who is covering for Dr. X?  
    Who is on call for… Plastics  
    Who covers with the new doctor  
Privileges Administrator …privileges to cover… You are part of the ENT department, you do not have privileges to cover cardiac surgery Departmental control (credentialing)
Department Academic …in the department of… I have a dual appointment in the surgery department, the vascular section and the radiology department I have been trained, certified and credentialed in two specialities.
  Administrator …in the department of… The disciplinary action will be reviewed by the surgery department and then referred to the medical executive committee Policy and procedure on done by department.  Often historical and anatomically based.
On Call Talking to someone who needs to know your schedule: I’m on call at__ the ER at Hospital A, but not B, and I am on hand an plastic call  
On Call and Coverage   I’m covering
our practice, but I am not on call for the ER Call vs coverage
Default Medical personnel,
regulatory agencies,
civil lawyers, criminal lawyers.
Expectation is that all patients need availability at all times.  To not provide it is abandonment both morally and legally. This is a long tradition. I did not know I was on call.  I left a message I was out of town. Did you contact your coverage and document that in the chart?
Slang in the barrel, in the box,      
  On On for what      
Nurse my shift      
  on duty      

Tags: medical responsibilities, collaboration, on call

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