Let us help assure funding continuation by making it easier for your project to access care for patients, empower providers to collaborate and educate future providers. A common thread found in the many, many of the awardees, is care coordination and that is the mission of ClickCare as recently described in the NYTimes and in a shout out by Steve Wozniak at the American Telemedicine Association.

CMS says that the following is involved for the continuation of funding:

            Replicable innovation:
The Affordable Care Act (a.k.a. Obamacare) may or may not change things, but iClickCare replicates coordinated care.

            Rapid implementation, 6 months or sooner:
ClickCare stands ready, with its agility, compliance and quick implementation. Six months can pass alarmingly quickly, especially when a program is being launched. December 6 is predated by summer, Thanksgiving, and the holiday season. That is not much time to work. We invite you to piggyback on 16 years of experience and software development.

            Workforce development and deployment:
Their frequent references to using midlevel providers to provide care. This is certainly a topic of our times, but is it innovative?  What about collaborating with those who are really at the bedside, home and workplace?  And doing it in a simple and user friendly manner!

            Efficient and sustainable use of funds:
Implementing iClickCare involves a software subscription on the internet, iPad or phone for a very low price that is further discounted for volume customers

            Reporting and monitoring:
iClickCare can provide both consultation and service to allow each member of your team to not only transfer data, communicate, coordinate, but also collaborate. Everything is archive and pdf reports show usage.

We at ClickCare stand ready to help you meet your goals of improving healthcare in our country!

In Chapter 5, the control of focus and of lighting is discussed. 

Downlooad to learn how to use the iPhone for good and for evil.

In this blog post, 

• How to make an aged face look younger.
• How to erase wrinkles without creams, surgery, or exercise.
• How to hide ugly scars.

Images and Words create better communication together than each alone.

Collaboration is all about communicaton. Communication needs to be honest and collaboration requires the respect of each collaborator for one another.

Photography is all about light and how it is collected, used and interpreted.

It is the manipulation of light which like any tool can be used for good (consistency) and evil (misrepresentation).

Search for before and after photos after you download Chapter 5. Observe the before and after photographs and see where flash is used to over expose skin and fill dark areas. You can copy this, and  “erase”  wrinkles. Small changes in focus can also “soften the skin” and thus make skin treatments look better than they are.

DId you know that when HD TV was introduced a few years ago, it created quite a problem for the on-air personalities. Out-of-focus blemishes on the talent had no place to hide.

Want to make scars “disappear” in the same way as wrinkles?  Defocus the camera by choosing Macro and then moving out of its range. Or use the focus square to focus on something just a little off the target plane. The subject becomes blurred against a sharp background. Finally, want to get that “turkey gobbler” neck to go away? Easy, extend the neck forward, move the jaw forward, lift the chin, you can have a pretty good result.

We don’t condone these techniques, but you should be aware of them. As you collaborate with your trusted network, you can judge for yourself and decide who to trust. Figures lie, Liars figure.  Medical photographers can do both.

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.

It’s Memorial Day, and a time to remember all who served our country.

There are millions who have done so over the years. A few have been singled out to receive a Congressional Medal of Honor because they stood out with some act of unbelievably unselfish heroism.

But there are so many who just did their duty, unknown and unnamed. They are honored fully as well, because each has served and each has contributed to our safety and freedom.

In healthcare, we are in the midst of a battle that in a way is even worse than one with tanks and guns, bombs and planes. The magnitude and confusion, the noise and the panic are the same. And, people are dying.

Just as in a war, each of us can make a difference. Some of us will become medal winners, some of us will not.

Sometimes instead of trying to analyze everything, it is better to examine an important slice. Our recent attendance and presentation at the New York Mid Atlantic Consortium, a collaborative of genetic programs, illustrated this clearly to us. During college and medical school we learned about Punnet Squares, polymorphism, and decreased penetrance. By 2011, genetics has exploded. We now have the human genome. Cancers can be analyzed and their own genome described. Personalized medicine is not only imminent, but it has started.

The problem is, however, that there are not enough people to do the work that is needed right now, needless to say, in the future. There is so much knowledge that no one person can know it all. These are big problems. These are problems, in part, because of funding. Those who are passionate about the field wonder where the funding can come from. Meanwhile, every other segment of society is asking the same questions. How can we do what we need to do without more funds? How come other interests get more funding? There is so much to do, so little time, so few personnel, and so little money. What can we do?

We at ClickCare have decided that each of us can make a difference. Maybe it won’t be a Congressional Medal of Honor difference, or maybe it will. But each of us, like each individual whom we remember this day, can make a difference. Each of us can push forward and improve our lot. Funding is important, but its value is negligible compared the richness of many who do their little part and collaborate with others. The rewards will come later, or doing your part better may be the reward in itself.

For our, part, I can put a stake in the ground and say: “If you don’t have the funds to buy a ClickCare subscription, call us and we’ll personally work with you to make it happen.”

ClickCare can bridge the gap between what can and should be and what is. We know that better collaboration brings better care, better access to that care, and better education of those who provide that care.

We applaud each of those we met at NYMAC and know that each of them are trying to make a difference. Many of them have, and many are still at it.

We at ClickCare will keep trying too because each of us deserves better, and each of us can make the world a better place.

TNTC
Some of us will remember the old urinalysis report of Too Numerous To Count.

Certainly, the same report could be given for smart phone medical apps. We and our patients can track our blood sugar, exercise, blood pressure, weight, well being, stress and sleep. We have diet apps and women’s apps. We have medical references, and even physiologic monitoring.

Useful and concise reviews can be found at Medical iPhone. They reviewed ClickCare on Wednesday, April 20, 2011. A search in the Apple App store reveals nearly 6000 apps.

The buzz in the media, and the great majority of apps, center on those that are for the patient and consumer (B2C). There are many exciting (and some say futuristic) apps which help the owner of the smart phone to diagnose and care for herself. We do not demean these efforts, but have to ask the question: “What next?”

What does the provider do when the patient comes into the office hunched over, concerned, and holding a beautiful graphic display, delineating a consistently elevated blood sugar. She switches apps and the display shows blood pressure, high, as well. She has documented her intermittent headaches on her headache app. She brings in a Google search.

Google search for diabetes, hypertension, headache

She has not shown you an app for observation, but you observe acne and increased facial hair and think it unusual for a 43 year old.

So what next? Have you made the diagnosis? With which specialist should you confer? Do you call the renal person for her hypertension, a diabetologist, a neurologist? What studies would each like before seeing the patient? Since you know each of these as individuals in your community, and they are part of your natural network, who, indeed, could diagnose and comfort the patient best?

You have two choices:

1. You could pick up the phone or walk down the hall, wait until the CNA gets done with her break and ask her to dial. Or, you could wait on hold, ask the receptionist to ask the nurse to ask the doctor to “get him out of the room.”  Or, you could tell the patient that she might have a brain tumor, a lung tumor, an obesity problem, a new onset of diabetes, a normal expectation of hypertension, and to go see one of the specialists and tell him what you think. Maybe you want to dictate a letter, and wait for one to be returned. Expect the patient to wait for appointments for a long time because these folks are really busy.

2. You could take a picture with your iPhone, distill the history, and with three clicks of the mouse, ask each specialist for his thoughts, preferred tests, and concurrence with your presumed diagnosis. Did you make yours yet?  Each specialist gets back to you with a simple reply button, you call the patient, you share the diagnosis and the coordinated, collaborative treatment plan.

Someday, ClickCare will help each patient with her own care, but right now, today, it can help you, her trusted advisor, advocate, and experienced provider to care for her and yourself – quickly, securely, and with great satisfaction.

You just experienced (B2B). As the consumer wave rushes towards the medical professional’s office, help is available for those providers who care for them. Patients and consumers alike, still need help, and their providers need to help each other.

That’s what’s next.

Here is the Answer.

Or if you are really cool, take out your smartphone and read this bar code.

Use your barcode reader for the answer

We meet all kinds of people as we spread the word about how collaboration can help your patients.

Here is a recent post, and notable quote:
“The iPad could change things. If you think in terms of, ‘Is that a form factor that works better so a visiting nurse can go out to a patient’s home, and say, ‘Gee, this wound doesn’t look so good. Let me pop a picture and send it to the surgeon, who can then access it on his iPad or anything else,’ I think that’s possible.”
Thomas J. Handler M.D., a research director in Gartner’s Healthcare Provider analyst group, tells the News Alert. 1

A safe prediction I would say: iClickCare is already on the iPhone and compatible with iPad. As soon as we have time to stand in a long line, we will be putting the iPad 2 through its paces and see how the camera works. We are pretty sure that it does, but after all, we were talking about the future weren’t we?

That is so then, and we are so now.

And finally, this response from a rather large organization that runs nursing homes:
“Photographs are prohibited at our facilities” 2

What things can you share that you are doing and seem like the future?

Footnotes:
1. Telemedicine and eHealth Newsletter, March 11, 2011,Mary Ann Liebert, Inc.

2. Anonymous, we would not want to embarrass them in front of our extensive readership.

3. Full disclosure: a different Gartner analyst has interviewed us.

There is a lot to talk about. Year end is for reflection. Year beginning is for looking forward. We are reticent to predict (as in Doctor, “how long does she have to live?”), but it seems as if all the buzz of stimulus monies, of EMRs, of personal health, of debate over health care, some fundamentals have been forgotten. Forget fundamentals, disregard principles, abandon commitments, but if you do so, you will be reminded that you “Can’t Fool Mother Nature”.

So we want to look forward to where ClickCare will fit in.

Three diverse concepts relate to each other: EMRs, Twitter with information overload, and the Cloud.

Many of us have made large, very large, investments in licensing, infrastructure and workflow for EMR/EHRs. We have spent a lot of human capital to be sure that we get on the wagon with meaningful use. We have kept a very close eye on stimulus money. Why would we want to challenge ourselves even more? Why, then, are we unsure of ourselves?. Perhaps, we feel that the fable of the Emperor’s New Clothes might come true. Perhaps, we can see no end in sight.

The Emperor's New Clothes

First, we should feel satisfied and confident that the EMR is already advancing. Electronic subscribing and fewer scattered repositories of patient information are most valuable. So while we worry that the “truth might come out”, all is not lost. The team at ClickCare is very committed to being sure that the EMR becomes an even more valuable resource because ClickCare and iClickCare can magnify it and fill the gaps that most fear to mention. There are limits to the EMR. Dr. Alok A. Khorana eloquently and wisely describes them in his brief essay, Physician as Typist, in the Journal of Clinical Oncology.

One point is the lack of focus on communication–his EMR author with him as the typist:

“I stare at the primary care physician’s note in front of me. I have been concerned about our mutual patient’s hypertension. I believe it has been exacerbated by the use of bevacizumab, and I have referred her back for additional management. All I need is an acknowledgment of the problem and a treatment plan. The note that I have received is three pages long and is filled with unrelated laboratory values, scan results, and jumbled-up text.”

In contrast were other notes, generated “by hand”:

I get other notes, too, from providers that haven’t yet adopted an EMR system. I made a recent referral for a patient with hematuria to a urologist. In a day or two, I received a one-page summary of the problem, including a differential diagnosis, the findings on cystoscopy, and the plan for additional surveillance. It was, really, all I needed. Another oncologic surgeon with whom I share patients always mentions the patient’s profession in the first sentence of the letter. It tells me something about the care that a surgeon who cares to find out such details will provide. However, as our institution transforms from a hybrid to a completely EMR system, these unique styles are likely to disappear.

What is the reason there is a difference between man and machine? Dr. Khorana perceptively notes:

“Recall that there are two major narratives associated with the physician-patient encounter. The first is the narrative told by the patient to the physician. The starting point of this narrative is relatively uniform: the complaint that brought the patient in. From here onward, however, the narrative can be remarkably free flowing and often tangential. To make sense of this free-flowing story, we as providers resort to a second narrative. The physician’s narrative repackages the patient’s tale, but in a format that serves the scientific goal of the note, which is to reach a diagnosis and treatment plan. Of necessity, it requires the act of listening closely and mindfully to the patient first.”

This article is clearly and cogently written. Reading it is highly recommended.

The reaction

What we would add is that ClickCare takes that very “act of listening closely and mindfully to the patient first”, and allows the listener to act upon it subsequently and cooperatively with other colleagues. Not with every patient, not with every visit, but when necessary and appropriate, to do so easily and quickly. Indeed, ClickCare offers the patient an audience of more than just one.

Another way of looking at this, is that there is too much information, and that communication is not taking place. Here are excerpts from an interview on the blog GIGAOM.

Om Malik, the blogger is interviewing Evan Williams, the cofounder of Twitter:

Om Malik: Ev, when you look at the web of today, say compared to the days of Blogger, what do you see? You feel there is just too much stuff on the web these days?,

Evan Williams:I totally agree. There’s too much stuff. It seems to me that almost all tools we rely on to manage information weren’t designed for a world of infinite info. They were designed as if you could consume whatever was out there that you were interested in.

Om Malik:Do you think that the future of the Internet will involve machines thinking on our behalf?

Evan WIlliams: Yes, they’ll have to. But it’s a combination of machines and the crowd. Data collected from the crowd that is analyzed by machines. For us, at least, that’s the future. Facebook is already like that. YouTube is like that. Anything that has a lot of information has to be like that. People are obsessed with social but it’s not really “social.” It’s making better decisions because of decisions of other people. It’s algorithms based on other people to help direct your attention another way.

They also discuss immediacy and relevancy.

Om If you were starting Twitter today – same service, but in a world that is very mobile, very multi-touch driven and a very portable web – what would it look like?

Ev: I’d have to think about that for a while but i don’t think it looks that different than what we have today. Twitter is a natural fit for mobile – it has the immediacy. There is nothing significantly missing, but (we) need to really boost relevancy. If you can’t read everything, then (what is that) you really do need to know right now.

Immediacy creates a need for mobility. Mobility creates a need for immediacy. Again, ClickCare supports and enables the EMR by enabling both immediacy and mobility regardless of which EMR was purchased.

Which brings us to the Cloud, and our last prediction about where ClickCare fits in. Many will become comfortable with the Cloud, immediacy and access. There are some who already expect it. The last mile of internet access not with standing (ClickCare can use 3G and Edge), communication with pictures and words can be the norm. We will expand more on this in another post.

In the meantime our prediction is that the patients will begin to get better care this year. We just need to look ahead and beyond.

A lot of people seem to think so.  The most recent report, abstracted by research2guidance entitled “Global Mobile Health Market Report 2010-2015” was reported at mHealth Summit last week.  We also heard the same theme when we presented at mHealth in San Diego, last month.

The statistics are amazing, and all point to the same message:  we are all mobile creatures and would rather not be on a leash.  Research2guidance estimates that 500 million people will be using smartphones in various ways for health care.  These range from continuing medical education to unique monitoring devices.

We at ClickCare would caution, however, that the right tool, at the right time, at the right price should be used.  We could not be more enthusiastic about iClickCare and the iPhone, we also know that sitting quietly at a large, easy to read computer screen can be as valuable as taking and sending a secure message and photo/video with the iPhone.  That is why we have both available and included with each subscription.

Similarly, one can subscribe either via download from the App Store, or from our website ClickCare.com .  A free two week trial lets you start collaborating with your colleagues immediately–with an iPhone, with a desktop, with a laptop or iPad.

Use a needle to sew a laceration or a shirt.  Use a sledgehammer to crush a rock.

Use your ClickCare subscription in the way that is best for you at a particular time and in a particular place.

We look forward to your comments.