By now, we've all heard the heart-breaking story of Thomas Eric Duncan, the Dallas patient who was seen in the ER for fever and vomiting and was sent home. Three days later, he tested positive for Ebola and subsequently died.

This is a tragic, unacceptable outcome. But sometimes doctors make mistakes: It's a new epidemic, as doctors we are routinely asked to see superhuman numbers of patients in small periods of time, and things can get past us.

However, in this case it appears that the issue is less about a single provider's mistake and more about the systemic issues that needed to be addressed. In recent days, news sources have reported that the ER doctors who cared for Mr. Duncan never saw a nurse's note in the EMR reporting that the patient had just come from Liberia. Apparently it was this issue with the EMR that caused a deadly gap in communication.

Unfortunately, this kind of problem is neither unexpected nor novel. In fact, although this example was particularly extreme in its consequences, this kind of communication failure is all too common in medicine. We see systemetic problems throughout the medical system:

• EMRs are often very difficult and counterintuitive to use, understand, or grasp the limitations of.
• Billing, paperwork, and controls take up most of the time we have with each patient.
• HIPAA keeps providers from talking with each other about patients in ways that can pass on crucial nuances (or facts about travel).
• Knowledge and data can overwhelm providers, making it hard to parse what is important
  
• Billing concerns demand a checklist focus and mentality or providers can't survive.

So, use iClickCare or not, but collaborate. None of us can afford the consequences otherwise.

Image courtesy of communityeyehealth on Flickr, used under Creative Commons rights.

Recently, a consultant from MIT visited a frustrated manager at a call center. The manager was experiencing something that many medical providers have experienced at different times. He was struggling to figure out "why some of his teams got excellent results, while other, seemingly similar, teams struggled?" It's that same frustration we wonder about as providers: we feel "flow" and pride in giving excellent care at one place where we work, while everything seems difficult at a different hospital or location.

After months of data analysis, the call center folks found that the teams that performed best were those that communicated best: "we’ve found patterns of communication to be the most important predictor of a team’s success. Not only that, but they are as significant as all the other factors—individual intelligence, personality, skill, and the substance of discussions—combined."

So how can you improve communications? Well, the hospital lounge is evidence that we've known the answer all along. The call center made one simple change to try to improve communication: they adjusted break schedules so everyone could take a break, make a coffee, and have a conversation at the same time. That change had huge consequences. Soon, they were seeing such increases in efficiency that they anticipate a savings of $15 million per year.

And while medical providers tend to measure success more in terms of patient outcomes than in terms of efficiency, we think there are some interesting patterns to inform our providers for medical collaboration. The coffee-break solution helped cultivate good teamwork, but what are the characteristics of what a good team actually looks like?

5 things that turn a good group of people into a great team for medical collaboration, via HBR:

• Everyone on the team talks and listens in roughly equal measure with short communications. That's why the entire continuum of care -- nurses, aides, doctors, and everyone in between -- must be included in the care conversation.
• With conference room encounters, members face each other and have energetic conversations and gestures. With communication technologies this means feedback, prompt responses, and a simple thanks. Video conferences take time and money. But store-and-forward telemedicine tools allow for this kind of energetic exchange of ideas.
• Members connect with each other not just the group leader. The typical "hub and spoke" consultation doesn't allow all team members to collaborate or share information. Face to face conversations and some telemedicine can support these kinds of "horizontal" conversations.
• Members can carry on back-channel and side conversation with the team. We feel everyone, no matter where in the hierarchy, should be talking to each other.
• Members periodically break, explore outside the team and bring information back. While there's a place for efficiency and 100-hour weeks, we certainly think that medical providers benefit from not being excessively overworked and overtaxed. One benefit (among many) is that team members that have a little wiggle room in their schedule can bring back new ideas and information. 

Some people may think medical providers join the profession for the pay, status, or job stability. My experience, however, has been that the work is challenging, the pay is dropping, and every provider I know is doing it because they care about people.

As the Dennis Rosen, MD, writing in the New York Times recently quoted the mother of a son with a genetic abnormality, "I like the people in health care. People in health care, they don’t stare at my son like he’s some kind of freak, you know? They see him for who he is." And the child's doctor affirmed the connection, saying, "I have yet to meet a child who fails to kindle my compassion or to bring out in me the most basic desire to try to help."

Caring about people in medicine becomes more difficult every day.

This basic desire to connect and help can easily be thwarted by the realities of the job, however. Nearly half of medical providers experience burnout and when they do, they can lose their sense of empathy for others and feel deeply isolated and emotionally exhausted.

The connection between this disconnection and the burdens providers face is clear: "A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer." (Article here.)

Of course, we often think technology makes this kind of isolation and burnout worse. We get the sense that if we could return to a world before EMRs, incessant messages, and endless paperwork, we could connect with our patients. But the truth is that technology isn't going anywhere and our only choice is how to use it in our service. 

For instance, we've found that by using Hybrid Store-and-Forward Telemedicine, we're able to deal with consults more quickly, leaving more time and energy for the patient sitting right in front of us. Our colleagues have also found that collaboration and communication with other providers and patients can (1) cut that sense of isolation and (2) decrease the unfinished issues, both of which are so damaging. Finally, we believe that when we take small steps to take ownership over our day and our work, we feel more able to survive, thrive, and connect. 

So it's not that it's impossible to connect in this modern day of medicine. It just takes a return to the collaboration, communication, and empathy that got us into this work in the first place. 

For more stories of medical collaboration, click here:

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Image courtesy of lencioni on Flickr, used under Creative Commons rights.

When it comes to using technology -- for medical collaboration, communication, meaningful use of medical records, or any other crucial function -- there are a lot of considerations that come into play.

In our relationships with current and prospective iClickCare users, we've seen decision parameters run the gamut from savvy to uninformed. And we were intrigued to see a recent report on key features that home health agencies look for in software, from Software Advice, a company that reviews medical software. In 385 interactions with home health software buyers, they found:

• 97% of buyers prefer a cloud-based system over an on-premise solution.
• Field support (mobile and remote access) was the most requested feature to better track care in the patient’s home.
• First-time buyers want the benefits of going digital, and top reasons for purchasing included improving efficiency (58%) and “going paperless” (35%).

We think that this orientation toward cloud-based, efficient, adaptable systems that allow remote access is right on.

This is a smart way for home health agencies -- any group, really -- to make the most of their technology dollars, comply with regulatory issues, and positively impact patient and provider satisfaction. That's one reason we had concerns about a report that Time Warner Cable and the Cleveland Clinic are collaborating on a pilot project installing video conferencing hardware in patient's homes to lower hospital readmissions. This kind of focus on expensive hardware installations can actually make outcomes for patients worse. By not using simple software, cloud-based systems that can be accessed from anywhere, and leveraging hardware that providers already have (like the smartphone in their pocket), a lot of resources tend to be wasted. For that reason, we recommend keeping the following things in mind in any big health IT investment: 

• Keep hardware investment to a minimum. Always see whether you can use existing hardware -- whether computers, smartphones, or other resources -- and invest your dollars in good software and systems. Hardware can easily go obsolete, while software can be updated.
• Make sure it's easy to use. Medical providers have enough on their plate without having to learn complicated systems or having to operate completely new hardware. Look for something that leverages what people already know... and demand a well-designed, easy-to-use interface.
• Prioritize flexibility and collaboration. Some systems can only be used or shared with providers that are "in the network." Look for a service that allows you to get consults and support from any provider, regardless of their status with your service.
• Invest in systems that can be used from anywhere. As the study above shows, savvy buyers are looking for cloud-based services (SaaS) that can be accessed from anywhere -- that kind of flexibility tends to pay off in the long run.

As of counts in the last couple of weeks, 9.5 million people are insured for the first time under the Affordable Care Act. These formerly uninsured patients tend to have clusters of medical issues, little or no treatment or care in the past, and tend to have concommitant socioeconomic challenges. 

For patients, coverage -- and the resulting medical care -- is a great thing. For providers, it is both an opportunity and a challenge. In the above New York Times video, Maria Catalano, a Nurse Practitioner at Family Health Centers, explains: "It seems like we're seeing a lot of newly eligible Medicaid patients who have not had established healthcare in many years. It's great that they're finally having access to insurance, but it can really expand the visit and try to do a lot in one visit."

This influx of patients creates a challenge in terms of the quantity of care that needs to be provided, as well as the pressure to comply with the regulatory issues related to the Affordable Care Act. Additionally, these patients present with medical issues that need collaboration and care from several different providers. All of this adds up to interconnected challenges that can be mitigated -- if not solved -- by medical collaboration through telemedicine solutions. 

The deluge of newly insured patients under the Affordable Care Act present challenges that can only be met through medical collaboration: 

• When time-per-patient is short, and patients are presenting with multiple interconnected issues, medical collaboration -- especially the kind of efficient collaboration that happens with hybrid store-and-forward telemedicine -- becomes a must-have. 

• Medicaid demands accountability for Length of Stay and Readmissions. Medical collaboration has been proven to improve both of these metrics.
  

• The ACA makes it easier than ever to be reimbursed for telemedicine. With this infux of patients, efficient reimubrsement is essential.
  
  
• Meaningful Use of medical records is even more important under the ACA, and telemedicine-supported medical collaboration can facilitate just that. 

Maria Catalano confirms both the ways that these new ACA patients present both difficulty and gift: "We're lucky in that a lot of our patients before now weren't getting Medicaid. So now we can start getting reimbursed for the care we weren't getting paid for before if they were a no-insurance patient. But I would say the most concerning thing is -- how can we accommodate so many new patients with so many different problems, and still function at the end of the day?"

For an medical collaboration inspiration and tools, get our free guide: 

With all the gift guides flying around the internet this time of year, our thoughts turned to the "gifts" that help us do our work better. Especially during the holiday season, handy tools like smartphone apps can contribute to decreasing provider burnout, a more easeful day, and better patient satisfaction.

As we quizzed our colleagues and dug into the research, we found some interesting trends when it comes to the best medical apps, especially in relation to making your day easier and helping to cut provider burnout:

• People still aren't paying attention to HIPAA. Many people continue to use email, text messaging, and the in-phone camera roll, despite the consequences. Our observation is that apps that aren't HIPAA-compliant actually increase burnout, with the extra worry and stress they cause.
• The humblest apps are the most used. We found that despite the hundreds of complicated apps that exist, the most commonly used are the simplest -- a finding that definitely resonates with our own experience. Sometimes you just need the easiest tool, not the most sophisticated one.

In thinking about the best medical apps to recommend, there are some surprising ones on the list. Here's our rundown, to help make your workday as healthcare providers a little saner -- or even more fun:

• Apps that help you care for patients. There are all kinds of complicated patient communication systems, but some of our favorite apps are simple tools that make it easier to communicate with patients, even when you're in the same room together. Often called "point of care education," these apps range from games to sophisticated modeling programs. Software Advice, a company that reviews medical software, recently put together a list of doctor-recommended education apps that make visits more effective.
• Evernote for studiers. Our medical students may be the most common studiers that use Evernote to keep their thoughts -- and notes -- together. But we all have times when we're "studying," whether for a new research project or to investigate something for our office. Evernote is our favorite study tool, easily syncing across devices and cutting the stress that comes from losing notes.
• Apps for collaborating. Call us biased, but we prefer the label "innovators." Our iClickCare app is still the best, easiest-to-use, medical collaboration app, hands-down. For other kinds of collaboration (document-based and not HIPAA-compliant), like intra-office collaboration on logistics, we look to 37 Signals.
• Oldies but goodies. Everyone knows Epocrates, and for good reason. The app has turned into our medical dictionary, calculator, and encyclopedia -- quickly becoming indespensable.
• Simple browsers. Mobile Safari ends up being the app we use the most. Why? It's adaptable to what we need. Whether it's easily finding a resource for a patient, looking up an address, or learning more about a certain condition, we find that having the "internet in our pocket" makes our lives flow more easily.
• Simple ways to connect with family. As our work lives get crazier, it seems even more important to stay in touch with our loved ones. We love FaceTime for virtual snacktime with a granddaughter, a chat with a spouse, or a check-in with a colleague. And never forget about the power of simply picking up the phone to connect with a friend, family member, or teammate at work! 

Let us know which apps make your life easier. And for our guide to the world of telemedicine (apps and beyond), click here: 

This month, we've been covering the direct care/payment model of medicine -- termed "concierge medicine" or "direct primary care." You can see our overview here and our discussion of models for middle and lower-income folks here.

One trend in this direct care movement is that new providers are among the most common providers advancing the model, particularly in the form of the more economical "direct primary care." As healthcare providers who have been practicing for decades, we certainly aren't in the ranks of new providers! But we're noticing some interesting folks from the next generation -- providers like:

• Sherpaa, a hybrid insurance / direct primary care model aimed at small companies.
• Bespoke Surgical, a general surgeon with a direct care and payment model.
• NeuCare, a Kansas family doctor using a direct primary care model and making use of many supportive modern technologies.

So, one question is, why are new providers the ones at the front lines of the concierge / direct primary care model? There are a number of explanations for the phenomenon, but we think that a few things are particularly interesting causes to notice:

• Technology. Even over the last few years, we've seen the cost and hassle of technologies plummet. New providers are in an ideal location to take advantage of that trend -- and may be more accustomed to these technologies being a part of their workday than other providers.
• Cultural context. The new generation across all industries is having to reinvent things -- whether it's publishing, finance, or medicine. Additionally, the alternatives are worse for new providers than they were several decades ago. Healthcare provider burnout is skyrocketing. New providers in the system know that -- and are taking the steps to avoid it. 
• Idealism. Our observation is that several decades ago, most new providers went into medicine for idealistic reasons. As incomes went up, some folks started entering for less altruistic motives. But in the last several years, perhaps as medicine has become more difficult of a field, we again notice the majority of new providers doing the work out of idealism. New providers want to spend their time with patients, not with insurance companies. And we notice that many direct primary care providers share this kind of do-the-right-thing ethic -- finding the model makes it easier to do medicine in the ways they want to.
• Networks. New providers, often in urban or progressive areas, seem to have patients that are willing to try something new. This means that as a doctor makes a change to a new model, they may be able to take their old patients with them. 

Concierge medicine and direct primary care are just two of the ways that providers are changing healthcare through their innovation. There is no one right answer, but we certainly support the many approaches that providers are experimenting with. And we think that all providers could learn a thing or two from our younger counterparts in this type of experimentation and the success it's having.

We also believe that medical collaboration is fundamental to these innovative models that are improving care, helping with healthcare provider burnout, upping patient satisfaction, and cutting costs.

Get our medical collaboration tips here:

Daniel Diaz was peeling an avocado recently and cut himself. Five stitches later, the hospital billed him $3,355.96.

Daniel's case is far from unique. Hospital charges are skyrocketing -- California Pacific Medical Center’s prices have doubled in the past 8 years. And although recent news has focused on insurance, costs and pricing models are proving to be one area of both concern and opportunity in the medical community.

High hospital costs are symptomatic of a system that isn't aligning care with costs. Finances are evermore opaque, bills don't seem to match the service provided, and patients -- not to mention providers -- seem frustrated and disillusioned. But true costs are not necessarily driving high prices. As the New York Times reports, "The main reason for high hospital costs in the United States, economists say, is fiscal, not medical." And it is hospital costs, not doctors' fees, that are the majority of the costs billed to patients.

So healthcare providers are often stuck in a system that doesn't make sense to patients, and doesn't prove rewarding (financially or medically) to the provider. It is in this context that some providers are exiting the system entirely, cutting ties to insurance and sometimes hospitals, and moving to a "concierge medicine" model. “When I decided to abandon insurance, I didn’t want to lose my patient base and make it unaffordable,” Dr. Stanford Owen, a physician who recently switched to the model, said. “I have everything from waitresses and shrimpers to international businessmen. It’s a concierge model, but it’s also the personal doctor model.” 

Concierge medicine is defined in this article as "a growing subset of medicine where patients pay doctors anywhere from $1,500 to $25,000 a year to receive personalized attention and care." It is a model that lets providers drive care, charges patients a truer cost for the care they receive, and may decrease costs overall. While concierge medicine is often associated with "white glove" treatment for the ultra-rich, the model is most basically a model in which doctors cultivate a direct care and payment relationship with patients, circumnavigating the insurance system.

In many ways, concierge medicine (especially in the humbler family doctor model) solves many of the problems we see in healthcare today. That said, it has its limitations, especially when it comes to specialists. “The vast majority of patients I see have very little money and are very, very sick,” Dr. Lahita, an autoimmune specialist, said. “It would be unconscionable for me to take cash. I’d limit my practice, and it wouldn’t be wise.”

We'll be exploring more about the concierge medicine model this month. It may not be the definitive answer to any of medicine's problems, but we certainly salute the brave physicians that are experimenting with a new model -- failures and successes included.

Concierge medicine makes medical collaboration crucial.  Get our guide: