One advantage of hybrid store and forward telemedicine is that each and every medical collaboration becomes a teaching case. And store-and-forward, recorded video clips can be very exciting! This report of using Google Glass to allow students to see a surgeons view even from miles away is intriguing and wonderful. While only 1000 devices have been released for "Google Explorers", the concept fits one of our design philosophies: 'Use what is available.' This event was reported 16 September 2013, and not in the medical literature, but rather in the audio visual literature. 

A student was quoted:

“To have the opportunity to be a medical student and share in this technology is really exciting,” said Ryan Blackwell, a second-year medical student who watched the surgery remotely. “This could have huge implications, not only from the medical education perspective, but because a doctor can use this technology remotely, it could spread patient care all over the world in places that we don’t have it already.” 

We imagine that a student of Vesalius, Morgani or Fallopio, on 16 January 1594 would have been similarly excited. Consider he's standing in the Fabrici d'Aquapendente, standing, because it is to crowded to sit, with 200 people crowded over a dissecting table, he shares the fascination with future colleagues. We imagine William Harvey standing in the third and fourth row, first conceiving of the idea of circulation. We, ourselves, as newlyweds and medical students just finished with anatomy, had the privilege of visiting and stood in that same amphitheater and wondered...to this day.

The disseccting table was unique. It flipped the body at a moments notice, dropping it into a boat floating below in a secret canal. With the table turned an animal showed up on the other side. Dissection was implicitly, if not explicity, illegal. We wonder, also if, Dr. Christopher Kaeding, should have had something similar for HIPAA, HITECH and the Omnibus 2013 Reconciliaiton Law!

Try doing medical education (and collaboration!) for free on the iPad...

References:

Anatomic theater image: http://www.chimica.unipd.it/ispe12/Teatro%20Anatomico.jpg

http://www.c2meworld.com/consumption/ohio-state-doctor-shows-promise-of-google-glass-in-live-surgery/

http://www.unipd.it/esterni/visiteweb/english/pagine/teatro.htm

Winds tore down houses. Good people tore down silos.

While a storm raged and lives were threatened, good people did the right thing. They worked together -- call it medical collaboration -- to save lives.

For those who wish a short read rather than a short video, here is the story. It starts with flooding of one of the United States’ respected institutions. NYU is in Manhattan, next to the East River. Despite precautions and advanced architecture, it experienced flooding. Backup generators were at the top of the building, but the pumps that supplied fuel to them failed at the bottom. 

This accompanying screen shot from the TV report shows six or seven people working together to care for one 8-hour old baby. They worked together in a simple way. One held the baby and endotracheal tube, another mechanically ventilated the child, another worked with the monitor, and another with the IV bag and central line. They walked down many flights of stairs as a single unit. They were guided by medical students holding flashlights, and a unit clerk counting and reporting stairs. The father also is seen to be a participant. The nurse talks about the healthcare collaboration starting at about 55 seconds into the video.

This was an exceptional circumstance. One that was not scripted nor regulated... instead, only a collection of individuals who functioned as one collaborating team. The group might have looked like a disorganized centipede, but they got the job done. Imagine similar care for obesity, diabetes, back pain, or deformity...imagine getting the job done in a simple, straight forward way.

We should expect the same exceptional medical collaboration of (from and for) ourselves to be routine, everyday. Each of us has a role, each can hold something, count something, light the way. We need both the intentional encouragement and the tools to do this. ClickCare is tool, now we need the intent. 

When silo-made attitude, lassitude, regulation, hierarchy, and skills are broken down, we can all carry our patients to safety and will be proud to do so.

We congratulate Ms. Condon and the thousands of medical collaborators like her. As she said

“It was a beautiful thing.” 

Learn how iClickCare can make this happen everyday for you.

Telemedicine sometimes seems as though it makes more stress, rather than less. This is particularly true for staff who have technologic fatigue. Collaboration might be different. 

As reported by Health Day, nearly 50% of physicians report one of the signs of burnout. This is not a new phenomenon and has been reported before. A study by Tait Shanaflet in the August 20, 2012 Archives of Internal Medicine reported on physicians who had experienced at least one of several significant symptoms: emotional exhaustion, cynicism, low professional esteem, depression, suicidal tendency, enthusiasm dissipation, and negative views about balance between work and life.

What happened to the bushy-tailed, bright-eyed high school students who really wanted to be a doctor?  That discussion should wait. More important, what can we, each of us, do about it, now?

Get a friend.

There is both old and new research, as well as popular advice to endorse this idea. A brief, quick read with a few starting references is available at this blog. 

We used to be able to find a friend in the hallway, the doctor's lounge, or the ER at night. We used to get subtle emotional support while we asked for help with a problem patient. No more! HIPAA, hospitalist practice, outpatient practice, surgi-centers, and an atmosphere of regulation and sometimes mandatory reporting of behavior, have all formed an invincible, unbeatable team of isolation implementers. When we were residents, a nurse became both confidant and mentor. As we mature in practice, these relationships are even more important, but ever more difficult to nurture. Each contributor to healthcare, whether administrator, support staff, high-level or low-level should help each other. However, there is no system to do so, and worse, such relationships are discouraged. 

iClickCare is the medical collaboration app from the company ClickCare. Even before the app was born, before there was a company, two physicians struggled to solve their own problems in medicine. Their mantra was (and continues to be) "Access, Collaboration, Education."

The very features and coding of iClickCare are designed to be a legal/modern substitute for the hallway, lounge and ER. iClickCare fosters those same interactions that are so difficult to experience now, and the network encourages all providers to take part. 

By Medical Collaboration, patients get the best of their providers' knowledge. The providers get the best of each other's advice, perspective, support and respect. The weight of each decision can be shared. The joy of friends can be experienced again.

You can go to your home feeling satisfied and not alone.

Join us, build your network. None of us should suffer what this study uncovered. Each of us can do something about it!

You can be collaborating and working with friends immediately. Full functionality for 14 days; and then read and comment after that for Free.

Could iClickCare be a distraction?

On December 14, 2011 Mr. Matt Richtel in the NY Times wrote about electronic devices when placed (forced?) into the hands of medical providers resulted in unintended distractions.

Many, many comments followed. Some fearful, some indignant, but all observing use and misuse of computers and smartphones. A dramatic mention of a neurosurgeon who was involved in a malpractice suit after using a wireless headset during surgery... clearly typifies abuse. It is sad to see colleagues who have much training but little judgment. A humorous advertisement shows the absurdity of such practice.

Any tool can be used for creation or for destruction. The ball-peen hammer is a necessary part of a tool box, and an oft used prop in murder mysteries. The EMR/EHR is cited in the comments. The electronic medical record should be a help, but judging by the comments in Mr Richter’s piece which we agree with, it has become more than a distraction, it has become a liability.

That is ironic since the EMR/EHR was in part designed to “document” in an litiginous environment where appearance trumps reality. Could it be that this misapplication of technology is worsened by a subtle, but well advertised, push to document so billing can be justified (or maybe enhanced)?

We at ClickCare are heavily invested in using technology to make things better for both patient and provider. We also remember the student who is left totally behind by expensive costs of EMR/EHR “seats.”  We are aware of distraction, and we are dismayed by anything that interferes with the provider/patient relationship.

Our design principles follow this rule: that technology be assistive, simple and delightful. So when you see your doctor, your nurse, or yourself pull out an iPhone or stare at a screen and see iClickCare, be confident that you are involved in medical management that is supportive and exciting. Beeps, clicks, fields and page flips are minimized and distraction changes to problem solving.

• More than clinical photography? Can you photograph the xray viewer?
• Can you send ECG's or gastroscopy findings?
• What are some traps that need judgement?

We continue to be excited sharing decades of experience in use of photographs for better collaboration. In this chapter, you wil feel even more comfortable in documentation both descriptively and visually. Medical students, therapists, aides, all can send each other those unique pictures which will enhance care coordination and make healthcare immensely better.

For the past couple of months, our readers have seen how to enhance quality from that small camera "in your pocket." Together we are amazed at the results of imagination coupled with these simple techniques. We also marvel how simple and "good enough" combine with good judgement and good intent to greatly benefit the patient, but also give satisfaction and peacefulness to the provider.

This is the next to last chapter in Medical iPhone Photography until the book is complete...as both an iBook for the iPad or iPhone or a PDF for everything else. Then the book will become available in printed form for holiday giving to your favorite healthcare provider.