ClickCare Café

Why HIPAA Waivers Don't Happen + How to Stay Safe Without Them

Posted by Lawrence Kerr on Fri, Jul 08, 2016 @ 07:00 AM



Irrespective of ROI, irrespective of jail time, irrespective of public shaming, irrespective of patient rights and privacy, we often hear from our colleagues: “I am emailing and texting patient stuff. I asked the patient! After all, I am a medical professional and acting on their behalf."

When I hear this, I feel real fear for my colleagues -- and dismay. The HIPAA rules are clear and the law is being enforced. The fines are big, and a year in jail is not appealing.

That is why we were confused about reports surrounding the recent tragedy in Orlando. Orlando Mayor Buddy Dyer told television reporters that he had asked the White House to waive HIPAA.

We certainly applaud the motivation in terms of caring for people -- but the reality is that even a tragedy of that magnitude, and likely even a White House clearance, would not keep providers safe. We all know that the law has real teeth, not the least being that anyone in a chain of events is liable (the administrator for the doctor, the doctor for the administrator). So how could a waiver be granted? The law becomes both complex and obtuse about the release of patient information to family members and the media. We are very aware of cases where grown children with an admission for psychiatric disease are isolated and essentially jailed while the parents with whom they live are not allowed to learn and intervene. In a chaotic situation, the difficulties compound.

As the dust settled, we found out that indeed, there was no waiver. None have been granted since the Katrina disaster -- and that includes the 9/11 attacks. None was actually needed, as the U.S. Department of Health and Human Services Office of Civil Rights (OCR) outlines that professional discretion is allowed for 72 hours when there is an emergency situation.

Ultimately, it's appropriate that patients' privacy is protected, even in times of uncertainty and emergency -- as so much of medicine exists in.

HIPAA waivers can't -- and likely shouldn't ever -- be granted. Especially when there are legal ways to communicate and collaborate that are easy and fast. It can be simple to stay HIPAA compliant.

The waiver asked for was not necessary. However, it is clear that texting a consult, emailing a picture, and talking about a case in the elevator are all violations.

We understand the problem, we created a solution, and we are doing our best to make it available to everyone because that is truly “care on behalf of the patient”.

Learn more about your HIPAA rights and risks here: 

ClickCare Quick Guide to HIPAA Checklist and Toolkit


Tags: medical collaboration, HIPAA, HIPAA Collaboration, Telemedicine and HIPAA, healthcare collaboration, regulatory issues

Huge Legislative Changes for Store-and-Forward Telemedicine

Posted by Lawrence Kerr on Tue, Jun 07, 2016 @ 07:00 AM



The American Telemedicine Association reports an amazing change in regulations: 49 of 50 states now have Medicaid programs that cover telemedicine for low income beneficiaries. (The single outlier? Hint: the smallest state in the nation.)

This report also notes that Missouri is a new member of an exclusive but growing group of states on the cusp of expanding coverage to store and forward Technologies. Store and Forward means non-videoconferencing, but instead communication with pictures and words in an email-timeframe. At this time, Missouri joins New York by specifically including -- and covering -- providers of all types and across the continuum of care.  

These legislative trends are at the convergence of several trends that are obliterating the barriers to telemedicine. Modern technology that assists in the everyday care of patients -- telemedicine and telehealth -- is no longer an experimental, conceptual idea. It is no longer about pilots, trials, and demonstration projects. In fact, telemedicine isn't even that cool or new anymore -- it is a mainstream, valuable, everyday tool.

With this change in telemedicine's place in society comes a change in providers, and a change in supporters. No longer is the only telemedicine model that of a central expert "helping" dispersed or lesser-resourced/educated/connected outposts. Now, and especially with store and forward telemedicine, these tools can help all providers support, challenge, educate, and collaborate with each other. And it's a good thing, too. Sometimes the most influential provider in the room is the one with the least number of degrees, but the closest contact with the patient. Sometimes, it is the patients themselves.

Missouri and New York, while pioneers, are enabling what we at ClickCare have been espousing and creating since our early grant days in the 1990s. They are enabling patients' access to care. They are ensuring that everyone, including the patient, should be involved in care at the right time and the right place. And most importantly, they are allowing collaboration to happen -- which means better care for each patient. 

So we call for more pioneers to join Missouri and New York in cultivating and enabling access, collaboration, and (don’t forget) education.


Still learning the basics of Hybrid Store-and-Forward® telemedicine? This guide can help:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine, telehealth, store and forward, hybrid store and forward medical collaboration, healthcare collaboration, store and forward medical collaboration, regulatory issues

Hospitals Look Like Factories But Medical Collaboration Still Possible

Posted by Lawrence Kerr on Thu, Jan 14, 2016 @ 07:30 AM


When doctors at Sacred Heart Hospital in Oregon heard that the hospital would be outsourcing their hospitalist care to an outside company (rehiring the existing hospitalists), many were not happy, to say the least. They expected that they'd be pushed to see more patients per day -- and were not willing to make that change without a fight.

Eventually, some of the hospitalists left for other jobs -- and the rest formed what became the first single-speciality doctor's union in the country.

We really identified with one line from the recent New York Times article about the unionization: "you get the distinct feeling it is not just their jobs that hang in the balance, but the loss of something much less tangible — the ability of doctors everywhere to exercise their professional judgment."

One big driver of Sacred Heart's push with the hospitalists was that the hospitalists be forced to have some "skin in the game" -- their way of referring to performance-based incentives. One of the hospitalists, Dr. Schwarz, really bristled at this concept.  “It really took all of my self-control to not say, ‘What the hell do you mean skin in the game?’” he said. “We have our licenses, our livelihoods, our professions. Every single time we walk up to a patient, everything is on the line.” 

As decisions become more centralized, as administrators and doctors take up opposite sides of the table, and as the pressure to cut costs, slash readmissions and length of stay, and increase profits and medicine increase at every turn -- yes, the hospital begins to ressemble a factory. And it's not any one person's fault. It's a system that has so much pressure on every aspect of it that it is hard to retain dignity and humanity in the day to day. 

What are the consequences? Well, provider burnout for one. As the American Medical Association found not too long ago, the main pieces of medical providers avoiding burnout are enough one-on-one time with patients, and the sense that they've provided good care. This fits with what is being found in other industries about the need for people having autonomy, mastery, and purpose in their work.

As Dr. Brittany Ellison put it: “We’re trained to be leaders, but they treat us like assembly line workers,”

So what is any individual provider to do?

We think you do what you can, with the hospital, doctors, and administration you have. Administrators and doctors are both doing the best they can, with the constraints they have -- we all would do well to focus on what we can do for the patient in front of us.

iClickCare saves hospital systems money. It improves care. But beyond all of that, it also puts the power of treating patents back in the hands of doctors. Sometimes a whole hospital system comes to us and decides that they want to use telemedicine to meet their goals. Sometimes, though, it is a single doctor who starts using iClickCare for medical collaboration with their colleagues.

That's the beauty of this kind of simple telemedicine -- you don't need everyone to do it, in order for one person to do it.

You can do a great job, for this patient, right here and now.


You don't have to wait for permission or incentives to do medical collaboration with telemedicine. You can try iClickCare today, on your own smartphone, for free:


Try the iClickCare 14-day evaluation

Tags: telemedicine, medical collaboration, provider burnout, regulatory issues, medical provider burnout

Telemedicine Study in California Shows ROI of 200%

Posted by Lawrence Kerr on Tue, Jun 09, 2015 @ 07:30 AM



Many states are wisely removing barriers to telemedicine. You can see in the American Telemedicine Association's ranking of states' friendliness to telemedicine technologies that places like Virginia and New Mexico are making it easier for reimbursement and care to happen using telehealth.

Of course, some states (and some organizations) are battling these changes. For instance, the Texas state medical board recently challenged the use of telemedicine in the state (it appears the challenge may have been overturned.) All of which seems a little misguided when you hear stories of just how impactful telemedicine programs can be. Stories and data abound about their impact, excellent care, and cost savings.

Among the many (just as one example), we recently came across a great study of a pediatric telemedicine impact and savings. The University of California Davis Children's Hospital did research on the costs of implementing and maintaining a telemedicine program and compared them to 8 rural emergency medicine departments over the course of 6 years.

The researchers found that the telemedicine program improved quality, safety and patient satisfaction. In terms of costs, they found a $1.96 return on investment (ROI) for each dollar spent on telemedicine.

So it's not tough for us to see that telemedicine is worth it, especially when it's implemented in thoughtful ways. And we laud all of those pioneers who are "making the path by walking" as the data emerges to support their work.


If you're looking into telemedicine ROI at your organization, get your free guide to the options here:
ClickCare Quick Guide to Telemedicine






Photo used under Creative Commons rights from lowercolumbiacollege on Flickr

Tags: telemedicine, telemedicine roi, regulatory issues, emergency medicine, rural medicine

4 Barriers to Telemedicine Are Starting to Crumble

Posted by Lawrence Kerr on Wed, Jan 28, 2015 @ 07:30 AM

It can be easy to feel that things are getting worse and worse in medicine. EMRs/EHRs that seem possessed by a demon, ever-shorter visit windows, and climbing stacks of paperwork all contribute to an atmosphere of "I thought things couldn't get worse. And then they did." 

But when it comes to telemedicine and medical collaboration, the trend is assuredly positive. Especially in the last few months, one obstacle to telemedicine after another is crumbling. Likely driven by incentives to cut costs while improving care, the government, insurance companies, and providers -- all of which are starting to move in the same direction and making choices to support telemedicine.

We believe medical providers need to pioneer their own telemedicine and medical collaboration practices, even without widespread support. But it certainly can't hurt if some of the obstacles are removed.

Here are our top favorites:

  1. Smartphones and tablets make adoption effortless (or close to it). 
    When clunky, expensive hardware was the only option, it was hard for medical providers to adopt telemedicine. Not only was it a pain to interrupt your day to go to the "videoconferencing room," these options also meant that providers had to wait for large budgets to act. “We’ve moved to a belief that you have to deliver this to a phone or tablet in order to get the adoption you want,” says Margaret Laws, the Innovations for the Underserved program director at the California Healthcare Foundation. And since using telemedicine or collaborating on a smartphone or tablet is easier than ever, there is good news for the spread of the practice.
  2. Regulations are starting to get smarter.
    In one example, a new bill would remove health software and clinical software from the FDA's jurisdiction. Is it possible that common sense might just be winning out?
  3. Reimbursements are finally coming together.
    As of last week, there are now 22 states that require telehealth visits to be reimbursed at the same rate as in-person visits. New York State's Governor Cuomo just signed a law that allows NY providers to bill for live video/audio, store-and-forward, and remote patient monitoring from private insurers and Medicaid. And other efforts continue to move forward, as well: a Colorado bill has just moved to the House that would prohibit health insurance plans from requiring in-person care. 
  4. New tools make workflow a snap.
    We've always believed that telemedicine is less about technology than it is about people and good workflow. When a telemedicine solution is easy to use and works with the schedule of the provider, then the technology can really be adopted. For instance, we've found that a Hybrid Store-and-Forward® solution removes the need for providers to play telephone tag, schedule video conferences, or wait for consults. 

So let this post be one vote for the "glass being half-full" -- and getting fuller every day. 


To learn more about Hybrid Store-and-Forward Telemedicine, get our free guide:


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine, medical collaboration, hybrid store and forward medical collaboration, telemedicine solutions, regulations, hippa,, regulatory issues, workflow

3 Secrets Prisons Know About Telemedicine

Posted by Lawrence Kerr on Mon, Jan 26, 2015 @ 07:30 AM


Often, telemedicine is seen as the domain of the advanced, the technologically savvy, and the well-to-do. People assume that something so "sophisticated" as e-health, remote visits, or telemedicine-supported medical collaboration couldn't work for their clinic, their context, or their patients. 

In fact, we've had the experience that, as with many disruptive technologies, telemedicine has first benefitted the under-resourced, the underserved, and the marginalized. Our journey with telemedicine started in the late 90s, at one of the poorest elementary schools in our county. Originally, we were just looking for a simple way for kids -- whose parents couldn't miss hours of work and still pay the bills -- to get specialized medical care. We ended up using early digital cameras and distance learning lines to piece together a telemedicine program, in what would eventually become an early version of iClickCare.

All of which is to say that in our experience, telemedicine can be a simple thing. It can be a human thing. And it can certainly work in under-resourced environments.

So when we saw a recent article over at Fierce Health IT about how prisons are increasingly adopting telemedicine, it made perfect sense to us. Prisons, of course, have different parameters than most care settings. And they may even have different goals in the care of their patients. While they manage their lives, in a sense they are also providing managed care. But we all share common challenges in providing good, safe, efficient care for our patients -- and telemedicine is a great tool for many of us.

So here are 3 reasons that prisons use telemedicine and that you might want to consider it, too:

  • Telemedicine removes downsides of travel. For prisoners, the ride to the hospital or to a specialist can be an expensive endeavor and present risk of escape. And while most patients don't have the escape-avoidance challenge, travel to faraway specialists and providers can be costly, mean missed work and school, and be highly disruptive of the healing process.
  • Telemedicine saves money. We've repeatedly seen high ROIs (both financially and in terms of quality of care) for organizations and providers that adopt telemedicine practices. As Dr. Michael Moore experienced: "During a 3 month period, 70 patients were treated solely using iClickCare with an overall healing rate of 93% and an estimated savings of $24,000 in transportation costs alone." The prisons are seeing the same impacts, which is why these programs are increasingly common across the country.
  • Telemedicine can make both the patient's and the provider's lives easier. Beyond just cost savings, the trauma and "run around" of caring for a chronic condition -- managing schedules, managed care, coordinating appointments, waiting for consults, and sharing information -- can be exhausting for both patient and provider. Telemedicine, especially a hybrid store-and-forward model that doesn't demand everyone be available at once, can make everyone's lives easier.


If you're wondering if Hybrid Store-and-Forward Telemedicine is right for you, get our free Quick Guide:


ClickCare Quick Guide to Hybrid Store-and-Forward



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



Tags: hybrid store and forward medical collaboration, medical collaboration software, telemedicine roi, telemedicine solutions, regulatory issues, managed care

Does This Approach to Health Insurance Go Too Far?

Posted by Lawrence Kerr on Fri, Jan 09, 2015 @ 07:30 AM


We love bringing you news of innovators in healthcare, like this PA clinic or that project to encourage collaboration. Another story about an innovative initiative raised some questions for us, however.

The New York Times covered the trend of religiously oriented groups organizing health "networks" in which members contribute payments to cover each other's health expenses. As health insurance has become federally mandated, these groups are complying with federal law, but in a way that feels personal, affordable, and enables them to circumnavigate pieces of the law that don't align with their values. 

We get excited when we hear about projects like this. We firmly believe that when regular people get more involved in their healthcare, we all win. Plus, we leap for joy whenever a small group of people find a way for common sense to win out over healthcare madness. It's pretty fantastic that when Erica Beiler gave birth, her expenses were covered and members even sent extra money to help welcome the baby into the world. 

That said, we could never -- as people or as providers -- support the network since things like medical care to gay folks and treatment for STDs aren't covered. It's certainly not a system that aligns with our ethics. Plus, the networks are unregulated, often have a lifetime maximum payout, and there may not be enough money on hand in a given month to cover all eventualities.

Be that as it may, we still are happy to shine a spotlight on a small group of people doing something, taking action, to make the medical system work for them. You may not be a patient or provider that would take part in a network with these parameters, but it does raise the question: how are we taking action, today, to make the medical system work better? How might we take matters into our own hands?


We believe medical collaboration is one easy, fun way to change the healthcare system. Give it a try for free: 


Try the iClickCare 14-day evaluation


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

Tags: telemedicine, collaboration, regulatory issues, insurance,

Expanded Telemedicine Reimbursements in New York State!

Posted by Lawrence Kerr on Wed, Jan 07, 2015 @ 09:34 AM

Good news for supporters of telemedicine, innovators in medicine, and providers concerned with good and efficient care: New York State... new legislation is putting forth strong reimbursement and regulatory support for telemedicine and telehealth in the state.

New York State's Governor Cuomo just signed a new law that allows NY providers to bill for live video/audio, store-and-forward, and remote patient monitoring from private insurers and Medicaid. The new rules go into effect on January 1, 2016.

Since we wouldn't expect anything else from formal legislation, well, there are some grey areas and confusing parts. That said, the bill represents strong and unequivocal progress for telemedicine. The key points include:

  • The main thing is that multiple categories of telemedicine and telehealth must be covered by private insurers and Medicaid:
    • Types of telemedicine and telehealth include (but aren't limited to): 2-way real-time audio/video, store-and-forward telemedicine (this would include iClickCare, which is a Hybrid Store-and-Forward® telemedicine platform), monitoring of patients' conditions, education, medication management, etc. 
    • Eligible providers include hospitals, home care and hospice agencies, licensed physicians, PAs, dentists, nursing, midwives, podiatrists, optometrists, ophthalmic dispensers, psychologists, social workers, or speech language pathology and audiologists.
  • There are no restrictions on the patient or the origination of the telemedicine consult.

As a New York State based telemedicine company, we're thrilled!  In particular, we're pleased that the law, as it does in so many other states, explicitly supports Hybrid Store-and-Forward telemedicine, which is what iClickCare is so passionate about.

If you're not sure what Hybrid Store-and-Forward® telemedicine is, though, or are comparing your options with other telemedicine tools, get our Quick Guide: 


ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: telemedicine law, regulatory issues, telemedice reimbursement,

A Medical Blind Spot You May Not Know You Have

Posted by Lawrence Kerr on Fri, Dec 19, 2014 @ 07:30 AM


These days, medical providers have to tend to a lot of moving pieces, just to ensure they're keeping pace with the expectations of their institution, insurance companies, and the government -- not to mention providing good care. For instance, these are just a few of the things we providers are held to: 

  • Length of stay in the hospital
  • Readmissions
  • ROI
  • Cost effectiveness of the care
  • The "triple aim:" patient experience of care, health of populations, and per-capita cost.

In all of these metrics and objectives, there is someone conspicuously absent: the medical provider. 

Whether you are a nurse, WOCN, specialist, or general physician, it would seem from this common list of priorities that you are, well, not a priority. A great recent article on Fierce Practice Management challenged this omission. The article cites a recent study by Bodenheimer, MD and Sinsky, MD that suggests healthcare provider burnout is severe, widespread, and significantly influences the quality of medical care: "The industry can't achieve the Triple Aim's core ideals--providing better care, improving population health, and lowering costs--without first improving the work life of healthcare providers."

Of course, healthcare provider burnout affects one of every two providers, and we've written extensively about how medical collaboration and telemedicine can help to ameliorate it. But this study is one of the the first times that we've heard incisive commentary on why improving burnout for providers is crucial to our overall goals for healthcare. In other words, how happy and healthy medical providers are is crucial to whether their patients will get good care. As the study authors confirm:

"Healthcare is a relationship between those who provide care and those who seek care, a relationship that can only thrive if it is symbiotic, benefiting both parties."

We've always known that the patient can't thrive when the provider is suffering and that the provider can't thrive unless her patients are healthy and successful. Now, we're starting to see the evidence for it. 

Want a 1-minute break? Watch our video on iClickCare to learn how it can help improve outcomes:
Watch the iClickCare One Minute Video


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

Tags: telemedicine roi, healthcare provider burnout, provider burnout, good medicine, regulatory issues, medical provider burnout

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