(Reviewed and updated May 18, 2016)

Recently, we've shared our suggestions on how to share patient files securely and the best ways to take medical photos. From those posts, an additional question came up from our readers who are using technology but still trying to stay HIPAA secure...

How do I send medical photos securely over the internet?

Good question! Many of the tactics for staying HIPAA-safe while sending medical photos over the internet came up in our recent posts, but there are a couple of specific things to keep in mind.

When sending medical photos on the internet, don't make these HIPAA mistakes:

• Texting from your phone. As with texting patient information, you can't text photos unless you use a secure service. Merely texting from your smartphone definitely won't do the trick when it comes to HIPAA, even if it's just a patient photo (without their record.) 
• Saving photos on your camera roll. Few people realize that the camera roll on your smartphone is not HIPAA-secure. ClickCare uses a HIPAA-secure camera roll for that very reason.
• Sending photos via email. Email isn't HIPAA-secure, even "secure" email. If you're looking for the kind of sharing that email and photos can give you, consider doing medical collaboration with a hybrid store-and-forward telemedicine platform, which can let you share photos while not running afoul of HIPAA. 
• Leaving them on your data card. A final thing to be careful of is the data card in your digital camera. If you store your data card in a place where people can get to it, or you're sharing your camera with other people, that data card is not HIPAA secure. The system we recommend is to erase the data card as soon as you've uploaded your photo to the secure sharing platform you're using. 
• Saving them on your hard drive. As safe as it may seem, in most contexts it is not HIPAA-compliant to leave patient photos on your computer's hard drive. So use the same protocol as with a data card -- erase the photos as soon as they're uploaded to your telemedicine platform. Did you know your copier also has a hard drive - the old way may not be so safe either!

For an in-depth look at HIPAA mistakes you might not know about, get our guide:

Image courtesy of ben_grey on flickr.com, used under Creative Commons rights.

After Percy Harvin's father left, his Mom started a daycare out of the home to make ends meet. Percy, always wanting to contribute to his family, would help with the little ones when he got out of school.

Percy wasn't just conscientious or a hard worker, though: Percy had a spark. His athletic talent grew through his high school and college years. And then, he won the sports lottery -- Percy was drafted to the NFL.

After his rookie year, things changed. Percy suffered a string of illnesses and injuries that made him miss game after game. Finally, just last year, Percy was traded to the Seahawks. A new franchise that had never won a Super Bowl, the team's motto was "why not us." Unfortunately, though, Percy was suffering from serious injuries. Over the course of the '13-'14 season, he only played a couple of minutes.

As Percy navigated hip surgery, inflammation, pain, and finally a concussion, the Seahawks made their way steadily toward the Super Bowl. Just 10 days before the big game, Percy was still on the injured list.

Percy's doctors, physical therapists, and other providers were obviously doing effective care coordination, though, because suddenly, just 7 days before the Super Bowl, Percy was cleared for play. Once Percy made it onto the field, he mage a significant contribution. His kick-off runback seemed to break the spirit of the Denver Broncos, eventually leading to his new team and beaming coach winning their first-ever championship.

Had Percy's recovery taken just a week longer, he would have missed the Super Bowl and maybe led to a loss -- an event potentially hugely damaging to his career. Those seven days of speedier recovery, likely due to care coordination and thoughtful medical care, were profoundly valuable to Percy, his team, and his family. When we save patients days, weeks, or months of injury and sickness -- whether the issue is cancer, hip issues, colitis, or congestive heart failure -- we don't always see the benefits so starkly. But Percy Harvin's story shows that care coordination with telemedicine not only saves lives -- it can save careers, whether you're an NFL player, a mom, or a mid-level manager.

So the next time you're wondering whether care coordination could help your patient, even if you don't have a system in place, ask yourself, "why not us?" And give coordination, collaboration, and telemedicine a shot. It will definitely contribute to a life, and might even save a career.

Get our guide to medical collaboration and care coordination here:

Image courtesy of ifindkarma on flickr.com, used under Creative Commons rights. Percy Harvin's story and facts from his wikipedia page. 

 The need for medical collaboration is astounding. Care coordination is most important. 

Why think like a Neanderthal? Or more accurately, like this Cro-Magnon Man. 

As knowledge expands no one of us can know enough, and we must become more narrow and specialized.  

The concept of collaboration is not new. As a matter of fact, it is old, very old.

History (discussed here with some significant over-simplification) shows that the issue is an integral part of our species development. For instance, as soon as Neanderthals and Cro-Magnons transformed society from hunter/gathers, they had a problem. 

Their problem was the same as ours. Let two long standing and highly honored Stanford Professors, Paul and Anne Ehrlich, explain their problem. The professors recognize that there are complex cultural decisions that we, in a modern society, need to make. A “culture gap” makes these societal decisions difficult and misguided. They have a website dedicated to closing this culture gap: The Dominant Animal. Human Evolution and the Environment. The website is an extension of a Stanford course. They make this note:

"After the evolution of language and the great leap forward, the most important event in cultural evolution was the agricultural revolution some 10,000 to 7,000 years ago, leading to great increases in stores of cultural information and a transformation of social organization as some people began to specialize in occupations other than farming, becoming, for example, priests, warriors, traders, carpenters, and teachers. Social hierarchies soon developed as well, with kings, governing officials, and peasants. No longer were individuals able to know virtually the entire content of their culture as hunter-gatherers could."

Think like a Neanderthal. The Neanderthal was coping and settling into his agricultural revolution. 

We are trying to cope and trying to settle in to our own information revolution. Medical information has become the wooly mammoth of 2012. 

The Neanderthal ponders --

• How do you eat a wooly mammoth? One bite at a…?
• How do you catch a wooly mammoth?
• No one man, Neanderthal or not, could catch a wooly mammoth. Thus collaboration was necessary. They hunted cooperatively together. They specialized and shared expertise.

We ponder --

• How do we “eat” all of the knowledge we are supposed to know.
• How do we catch that mammoth knowledge?
• No one of us can ingest it all. We, instead, need to share our expertise.

While we doubt that prehistoric man worried about HIPAA and HITECH, we know that they used pictures and presumably words -- more likely spoken -- to communicate. The best tools they had was a rock wall inside a cave, natural pigments such as magnesium oxide mixed in animal fat or “air brushed” by blowing through a hollow reed. It worked, and the drawings are still here for us 12,000 years later. Here is an anatomic study called Venus and Sorcerer from the Salle de Fond, Chauvet Cave.

We designed iClickCare to meet the same need that our ancestors and ancestors had. The need to collaborate. The need to be clear. The need to educate later generations. While we all are frustrated, overwhelmed, and technologically fatigued, we can still cope—

One collaboration bite (byte) at at time.

References:

Cave Drawings

http://www.bradshawfoundation.com

Anthropology:

http://www.modernhumanorigins.com/human-evolution-cro-magnon

http://www.casos.cs.cmu.edu/education/phd/classpapers/Gumerman_TheEvolution.pdf

http://dominantanimal.org/students/chapter-5-cultural-evolution-how-we-relate-to-one-another

A short vacation with mobile devices challenged us to keep up with our exploding business. The problem was that we couldn't successfully send emails. Recipients did not get them! Confirmatory blind copies were received by us. But none of the recipients received them.

• We looked at and compared settings. We checked our original emails.
• We uninstalled and reinstalled passwords.
• We visited the Apple store three times (but just the Genius Bar once). 
• We gave up and went to bed and a few minutes later popped out of bed and asked questions to ourselves such as: How can I possibly receive an email, but not send one? What are all those settings?

As with every modern software, there are many supporting layers. Each layer in isolation can work, perfectly, according to the customer service representative who owns that layer, so fault must lie elsewhere. One wonders—“Not my job, Man…”

After a little rest and the resulting infusion of patience, we started over. Tediously and carefully we went to websites and forums. We learned a lot and want to share it with you. Hopefully, we can Pay Forward this time for you.

First, a warning: email cannot be used for medical collaboration. Review of Accountable Care Plans has shown recognition, but is not a plan for resolution of this problem. iClickCare can resolve the issue immediately, but it is something new, so why can regular email not be used?

Think of email as a postcard. Turn it over, and the message and address can be read. Even if it incorporates SSL (secure email), it has three points of failure.

1. It is unencrypted and not password protected on the originator's desktop (or phone).
2. Transmission is encrypted, but all the intermediate relays store the email in its pure form.
3. The recipient has it stored in plain view, not password protected, on his/her desktop (or phone).

As they say, we have an app for that, iClickCare, (actually a complete system), but we use email all of the time, so let us share what we found. Looking at email settings is scary and unfamiliar to most of us. To ease this, we will list some definitions and note some principles for thinking. They might not please computer scientists, but they will help you get the job done.

There are three settings that need to be addressed.

1. Basic identifiers. 
2. Incoming settings.
3. Outgoing settings.

Basic:  The purpose of the basic settings is obvious: who are you anyway? Use your complete email address -- include everything both before and after the "@" sign. Did we mention spelling? We should have.

Incoming:  The purpose of the incoming settings is to give a software protocol (list of agreed upon terms) with which to work. The protocols have two versions: POP and IMAP. References are below. POP is Post Office Protocol and IMAP is Internet Mail Protocol. POP is older and simpler. IMAP is newer and more complex. Both retrieve the message from the server and manage mailboxes; POP deletes the original message and IMAP keeps a copy of the message on the server.

Outgoing:  SMTP is Simple Mail Transfer Protocol. It is a delivery protocol only and yet a third area for settings. An advanced setting is the Port. This is the entry door (Portal) that the host server has left open to allow the SMTP-based message through which to enter.

Email is not so easy after all. But now you know the only terms and principles to allow you to set it up for any message that does not need HIPAA compliance and security for medical collaboration.

These are references and instructions specific to many common servers or ISPs.

A more complete description and list is available with this PDF. 

This reference is the Rosetta Stone for many, many settings.
http://www.att.com/esupport/article.jsp?sid=KB5892#fbid=vVhlq-6w-cA

Apple
General:
http://www.apple.com/support/iphone/assistant/mail/#section_1
Cheat sheet (more general settings):
http://support.apple.com/kb/HT1277

ATT
http://www.att.com/esupport/article.jsp?sid=KB412068#fbid=vVhlq-6w-cA

Comcast
For exchange:
http://businesshelp.comcast.com/help-and-support/email/connecting-iphone-to-email-account/
Forum showing a problem and an unannounced fix:
http://forums.comcast.com/t5/Comcast-ID-and-Sign-In/iPhone-Mail-no-longer-working-for-Comcast-email/td-p/1246817

Google
http://support.google.com/mail/bin/answer.py?hl=en&answer=77702

Network Solutions
iOS5:
http://www.networksolutions.com/support/assets/Email-Support/Mobile-Setup/ios5setup.pdf
3g (previous iOS):
http://www.networksolutions.com/support/assets/Email-Support/Mobile-Setup/iphonesetup.pdf

Time Warner Roadrunner
http://help.rr.com/hmsfaqs/e_rrmail_emailSettings_iphone.aspx

Verizon
https://www22.verizon.com/ForYourHome/VZRepair/vziha/Service.aspx?ihaweb=EmailAccountsAndSettings

Yahoo
http://mobile.yahoo.com/mail/iphone

More indepth information about protocols from Wikipedia (also the source for the diagram)
POP3 Post Office Protocol:
http://en.wikipedia.org/wiki/Post_Office_Protocol

IMAP Internet Message Protocol:
http://en.wikipedia.org/wiki/Internet_Message_Access_Protocol

SMTP Secure Mail Transfer Protocol:
http://en.wikipedia.org/wiki/Simple_Mail_Transfer_Protocol

Thus, incoming emails are set with a POP or IMAP protocol and outbound ones are set with SMTP.  After understanding that, it is a matter of just filling in the blanks. If you would like to learn more about iClickCare and how it makes secure medical collaboration delightful and easy, then start with the ClickCare home page.

The Near and Far Future:

• What does Steve Wozniak see in the future?
• Can Machines replace doctors?
• Where do machines fit into the care we receive as patients?

If man and machine merge, what is now for medical collaboration, and what is next?

Steve Wozniak gave the keynote address at the American Telemedicine Association 2012 Annual Meeting. In answering a question about telemedicine in general, he singled out iClickCare as an example of what can be done now and in the future. As we have said, we were honored by the analysis and attention.

He also described the Facebook IPO as a stock he would buy because Mark Zuckerberg reminds him of Steve Jobs and himself combined into one, in a way.

As we read about his thoughts, we see commonality in his dreams about empowering the individual, and his thoughts about ClickCare and Facebook. We see respect for the individual, for innovation and for sound engineering in all of his writings and speeches, and most importantly, that every individual be empowered to do more. His discussions of both Facebook and ClickCare's iClickCare validates a lot of what we are trying to do at ClickCare. We want each and every patient to receive the best care possible because collaboration among providers has been empowered and enhanced.

During the ATA 2012 keynote, and springing from discussion of iClckCare, Mr. Wozniak shared his vision of the future: Apple's Siri and IBM's Watson merge and morph and give birth to a new mobile device/"person"  which/"who" would know him better than any friend because of its sensors, communication, and vast knowledge.

This is an exciting vision, and a question arose about where do doctors fit in. Where does man meet machine, be replaced by machine, or expanded by machine?  Mr. Wozmiak has proven himself as a visionary, and speaks of the future. But how do we view him and ourselves now?

His thoughts are, brilliantly, a comprehensive synthesis of ideas. They go against a flow where those in the field struggle to deal with large concepts by trying to categorize mhealth, telehealth, telemedcine, remote monitoring, and a myriad of other terms into narrow, pigeon-hole definitions.

Right now, in 2012, telemedicine (and all other categorizations) could be described as the embryonic development (or even evolutionary development) of joining man and machine. A good review was written by Aasha Bodhani in E & T, Engineering and Technology Magazine, entitled M2M in healthcare: wellness connected. This quote highlights one point “The potential to automate healthcare procedures - freeing up staff and only involving doctors when they are actually required - is compelling for a healthcare sector looking to make best use of its available resources.”

While we look to ”free up” providers, we also have the unexpected consequence of creating too much data. Do you remember the promise of the paperless office?  Machines (software and hardware) can filter data, but until Mr. Wozniak’s vision can come to fruition, we need humans to help interpret, balance, synthesize, and interpret data. Because of the explosion of knowledge, that can only be done in a collaborative environment, an environment that makes work easier and not more cumbersome.

As SIRI becomes the voice of Watson, as the world shrinks, as knowledge expands and as brilliant providers become rare, the concepts of ClickCare become even more important. As man joined machine to fly through the air, Air Traffic Control was needed to manage and coordinate the flights.

When telemonitors stream data, glucometers send levels, weights are recorded, massive amounts of data are recorded. An individual provider who receives that data wants help and relief. The provider must have relief from the loneliness of the massive information burden, and relief when treatment plans conflict. That relief can only come from medical collabroation with trusted colleagues. iClickCare is here, right now, to fill the gaps. The bridges will be built and the patient will safely cross the bay of the unforgiving sea of information.

We greatly appreciate the foresight of the journalists as they share our vision.  See our News.

Innovation in telemedicine, collaboration and coordinated care is finally getting its due.

All of us at ClickCare are excited to have Eilene Zimmerman of the New York Times identify us as innovative and disruptive. We appreciate the great and careful effort that this journalist made to get the story right with her constraints of space.

We have known for many years how we can best help our patients. We also know, while technology is at play here, good medical principles never change. The greatest of these is: The Patient is First.

The article in The New York Times was widely reviewed and tweeted. The well-respected online newsletter written by editor Sara Jackson of Fiercemobilehealthcare.com succinctly summarizes and reviews this again.

Over a month ago, Daniel Casciato in  Medical Office Today selected iClickCare as one of 8 Popular Apps for Medical Practices.

Because ClickCare was reviewed as business news, the measurement focused on making money. That is important to ClickCare. One major reason ClickCare was chartered as a separate company was the beseeching of a bright and forward thinking federal leader who felt ClickCare had a chance to become self-supporting and, therefore, not dependent on grants. Grantors become frustrated because invariably after the grant runs out, the massively expensive equipment is relegated to a pile in the back closet.

iClickCare by design is inexpensive, simple, and independent of complex equipment needs. This approach alone is innovative. It also is disruptive since it goes against current profit-oriented teleconferencing approaches. The disruption, however, is firmly grounded in good principles of caring for patients. So, there is much more to measure than financial success.

We care strongly about social impact. Thus we also measure and focus on the number of patients who have been helped, the number of physicians who go home and come back to work less stressed, happier, more satisfied and enthusiastic, and the number of learners who have seen what they would have otherwise missed.

Caring about social impact can sometimes be too big to deal with. When you use iClickCare, irrespective of your role in the health care hierarchy, you will notice the immense satisfaction of helping a single patient, time and again. That help comes in different forms — access to care that would not have been available, faster and easier diagnoses, less pain with wound care, and “Great Case Cures.”

As the healthcare debate intensifies, and ACO, accountable care, coordination of care, and the medical home, all come more and more to the fore, it will be more important than ever to count things other than dollars saved.

Join us in counting providers (from bedside aide and family to super-specialist) who are relieved of fear and isolation. And in counting how many patients are helped, by how much, with less missed time from work and less delay in diagnosis. These numbers stand in stark contrast to the cost per covered lives per day, and the like, but they are the important measures because after Patients First, come Providers — both current and future.

We are growing as a profitable company. We are doing so by measuring success as well as savings. It is a business adage that if one provides a service to one's fellow man, it will be rewarded. 

We are working very hard to provide that service. We will continue to count in many different ways.

We are pleased to have been reviewed by Medical Office Today and to be in such good company.

8 Popular Apps for Medical Practices by Daniel Casciato

http://www.medicalofficetoday.com/article/8-popular-apps-medical-practices?page=0,4

Our thanks to Mr. Casciato for his insightful curation and explanations. Taken all together with iClickCare they provide an interesting insight into making health care better.

• Medscape
• 5-Minute Clinical Consult
• Jiffpad
• Drchrono
• GE Centricity Advance
• Epocrates
• ABEO Coder   

Telemedicine, particularly Store and Forward Telemedicine, is extremely valuable for taking care of patients with wounds.

We are pleased and proud to announce and support the Dallas Wound Care Symposium 2012. Presentations will be done by true leaders in wound care, research and teaching:

• 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.

Harrison Ford isn’t one for small talk. And he hadn’t ever spoken in public about Star Wars… until last week. In commemoration of the 30th anniversary of Star Wars, and to raise money for St. Jude’s Children’s Hospital, Harrison Ford finally discussed the making of Star Wars.

Mobile Health, mHealth, 
coordinated and accountable care...are some of the buzz words currently in the media. It is possible to save billions of dollars if we act on these words (concepts) well. One of Mr. Ford's comments caught my imagination because of its connection to making ClickCare (equal measures collaboration, creativity, medical expertise, and art)… and to the process of making the “product” of fantastic medical care for our patients:

“[Making movies] is a collaborative process. And I think what it speaks to more than anything else is that when you have the opportunity to make something and you care about what it is you’re making, you try and you try and you try. You just don’t settle. You try because you care about the product.”

Here at ClickCare, we draw from wisdom in many fields, especially where we can learn something about collaboration. As you know, we are impassioned about collaboration in medicine.  This is inspiring, even if it is Hollywood.  Collaboration and creativity go together–in medicine, and in movies.