Collaborative care and case management can be assisted by telemedicine. 

http:cloudtimes.org

 Anyone beginning a telehealth or telemedicine program should consider:

• What hardware and software to buy.
• Who is going to collaborate with whom.
• Will it be a hub and spoke system or a network system.

A report by KLAS describes the dynamic changes that have brought better choices for healthcare providers. It describes the hosting relationships of the hosting providers and the relationships of  serveral legacy systems. It all reads like a complicated Russian novel.

Thankfully, the study is reviewed and nicely clarified by Ken Terry, and editor at Fierce Markets. Ken cogently headlines his report "Cloud computing in healthcare: the question is not if, but when".  

He notes that Meaningful Use is a motivator to change. There is less expense and with deadlines looming, shorter implementation times.

Concerns about security and reliability are counter currents to this change.

We at ClickCare feel that this is beyond discussion. Cloud computing is here to stay. In fact, we have had a cloud based system (know as SaaS or Software as a Service) for years now.

Despite this, early in our telemedicine career, the leading vendor at the time, and our vendor as well, refused to consider what we had asked for then--a Web-based system.

The advantages are clear and simple:

• No installation.
• Hosting in secure, controlled facilities, larger than any single institution can afford.
• Automatic, unattended backup.
• Markedly decreased costs: overhead is shared, while privacy is maintained.
• Updates instant, invisible, and independent.
• Collaboration enhanced because technologic barriers are broken down. A single practitioner at any distance has the same ability to participate as a major institution.

Because of the Cloud or Software as a Service, you can quickly collaboratel

Start your free trial now or simply learn more.

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.

As medical professionals, we really don’t sit down much.  We walk from exam room to exam room, floor to floor, department to department, home to work, work to home, hospital to hospital, and even to our patients homes.

So the challenge, as a reconstructive surgeon building a software solution for collaboration among providers, was this: How can we make this solution organic, flexible, and easy-to-access? In other words, how can we make it reflect our lives, not the life of the average IBM worker?

The answer was to build a network not with concrete, paper, and disks, but with computer-to-computer connections that function like neurons in the brain. The answer? The cloud. And how do we access the cloud? Via Software as a Service (SaaS.)

Instead of requiring a concrete program on your individual computer, the cloud means that you subscribe to a service (SaaS again) that connects you with the “cloud” (a network of computers) to store and manage data, and to process that data as a partner with your computer.

To completely mix the metaphor, it’s like an apartment building where the furnace is shared by all of its tenants.  The apartment owner sets the thermostat in his apartment, while his neighbor sets a thermostat to a different setting.  Neither runs down to the basement and puts water in the boiler and coal on the fire.  Each of the multiple tenants has his own keys and locks.  But, the cost of the furnace and its maintenance is shared. Each tenant pays less for the heat than if each had bought his own furnace (needless to say a “green” use of our resources.)

Cloud services have five essential characteristics:

1. On-demand self-service: no IT guy needs to supply you with access or passwords. No disks; no servers; no installers. It’s there when you need it.
2. Broad network access: you can use the service from wherever you want, whenever you want. Your mother-in-law’s PC after dinner? Check. Your iPhone from a Hawaiian beach? Double-check.
3. Resource pooling: This is where the furnace example comes in. You don’t need a computing center or even a very good laptop. You just need to connect to computers that do these functions for you.
4. Rapid elasticity: It grows as you grow. No need to estimate usage 18 months later. Also, because changes can be made instantly, there is no “your computer is worthless now” obsolescence.
5. Measured service: Like the pay-per-pound buffet, you don’t have to pay for what you’re not going to use.

We use information continually, want updates, and want help. However, unlike office dwellers with their fingers glued to their keyboard, we flow, and we need our information to flow with us. The cloud does, and that’s why ClickCare is all about the cloud.