When I saw a recent New York Times article and video about a tattoo artist that focuses on realistic nipple tattoos for women who have had cancer related breast reconstructions, I was skeptical. We certainly don't normally see a tattoo artist as part of the continuum of care or part of our community of medical providers, and I would have some hesitations about recommending this kind of post-surgery tattoo outside of the context of the surgeon's office.

I will say that while I have done nipple reconstruction, augmented by tattooing, since breast reconstruction started in the 70's, I have often wondered if the tattooing could not be done better by a tattoo artist. As a physician and surgeon, and student of anatomy, I have an appreciation of reconstruction, meaning restoration toward normal, its principles and indeed, its art (as is demonstrated in this tattoo artist's work). Nipple reconstruction is more than application of decoration. I also knew about the blood supply of the breast, where the implant may be working, and a surgeons commitment to sterility.

However, I also wondered, often, could more practiced hands and heavy duty equipment give a more long-lasting result, despite the fading all tattoos are subject to. I respect the commitment of this artist profiled in the article. Also, I have used medical tattooing as alternatives to things like eyebrow reconstructions.

So, what does this have to do with medical collaboration? Everything, actually. This tattoo artist may not be a traditional member of the medical team, and I might some recommending this to a patient, but in this case, he is certainly providing care related to the healing process. How much of a smoother process would it have been if he could have used iClickCare (as one example of a telemedicine-based medical collaboration platform) to communicate with the patient's surgeon? How much less would her wait time have been? How much more confidence would she have had that this was an appropriate course of action and would fit in with the rest of her treatment? How many potential medical issues could be avoided if the traditional medical providers were able to share their information with the folks supporting the patient with less traditional medical issues?

As medicine shifts, so does the team of medical providers. Our job is to make sure that we have the tools to collaborate with every member of the medical team, traditional or nontraditional.

Of course, it's crucial to have a medical collaboration tool that allows you to respect HIPAA and communicate in a way that honors the patient. We've found that this means you need to be able to have a virtual consult that may "pick and choose" what information, pictures, or history that particular collaborator has access to. So this kind of collaboration is certainly to be handled with care, but as medicine evolves, I believe it is absolutely crucial to involve all members of the team caring for the patient. In this case, the person in question is a tattoo artist, but in so many other cases, the continuum of care for a given patient could include people like:

• Acupuncturists
• Therapists
• Teachers
• Caregivers
• Family
• Lactation Consultants
• Etc.

Have you found the need to do medical collaboration with any nontraditional parts of the team? How have you facilitated communication and collaboration with them? We'd love to hear, in the comments below.

And for our "field guide" to medical collaboration, click here:

As medical providers, we want all of our patients to stay healthy, have as few medical interventions as possible, and return to health quickly after sickness or injury.

For our patients who are athletes, the consequences of injury or illness are particularly great. When players -- whether amateurs or professionals -- get injured, they may be putting their careers on the line. Additionally, a single player's injury can endanger the viability of the entire team. Despite the consequences, injury remains a huge part of the experience of athletes who are performing at a high level. And athletic trainers are the primary line of defense against these injuries.

The Athletic Trainers that I know are concerned by trends like the ones acknowledged in a recent New York Times article about the epidemic of baseball players who are having the "Tommy John" ligament surgery:

• The volume of injured pitchers in MLB is huge and growing: "The year with the most documented Tommy John surgical procedures was 2012; there were 69 between the majors and the minors."
• Many pitchers are playing year-round to satisfy the level of performance required of them, which can increase injury rates.
• 1 in 5 professional players who have surgeries like this one never make it back to full strength.

Some Athletic Trainers, however, manage to flip the statistics and keep their players injury-free at greater-than-average rates and help their players recover faster than other athletes.

We've found that successful trainers focus on 3 specific things:

• Prevention. This is the real forté of Athletic Trainers. Through careful, consistent attention and thoughtful pre-injury measures, the best Athletic Trainers prevent dramatic injuries and interventions. The best way to solve the problem is to keep it from happening.
• Collaboration. The best Athletic Trainers know that they are not the only member of an athlete's medical team. They find ways to collaborate with other medical providers to shorten the length of time between diagnosis and treatment, drop transport and wait time, improve medical decisions, and make the best possible plan for that particular patient. We've seen Hybrid Store-and-Forward Telemedicine to have dramatic results in improving athletes' medical outcomes. 
• Rehabilitation. As all medical providers know, rehabilitation is a fundamental part of wellness. It's a piece of the puzzle that can get lost in the shuffle, especially when many providers are on the medical team. But with good medical collaboration and consistent engagement by the Athletic Trainer, rehablitation can happen with surprising speed. 

To learn how Hybrid Store-and-Forward Telemedicine can help you keep players and patients injury free:

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

Medical Collaboration

As you'll know from our other blog posts, we really believe in medical collaboration. This kind of interaction and problem-solving with our colleagues has been one of the most effective and rewarding parts of our careers as physicians.

So, we talk about medical collaboration a lot… but what does it mean?

Some of our other posts have more in-depth descriptions of medical collaboration, how telemedicine relates, HIPAA considerations, etc. But this post is about a few core pieces of medical collaboration that can help you figure out how to use it in your life.  

A definition

Wikipedia's definition of collaboration is: "working with each other to do a task and to achieve shared goals." Despite the fact that Wikipedia has only a single sentence on medical collaboration, the simple definition captures the way in which medical collaboration functions. We work together as medical providers to solve problems, share cases, or ease our workload, with the common goals of caring for patients, dealing with regulatory issues, and practicing in the ways we aspire to.

Over the decades of our practice, we've seen "medical collaboration" come in and out of favor. During some periods, and in some places, medical collaboration was status quo. During other decades, medical collaboration was all but condemned by the adminstration. Never used before 1880, it shows up increasingly in books as reflected in this chart that shows how frequently the word itself has been used over the decades. 

Even in WWII, "collaboration" was used in the negative sense of collaborators with the enemy. But in the last several years, we've seen real growth in how much our colleagues want to collaborate. We see our fellow healthcare providers wanting to share the joys and the struggles of caring for our patients.

Some examples

We've heard stories of medical collaboration from all corners of the globe, in all kinds of situations, for many different reasons. (And we put together this guide to explore these.) Examples of medical collaboration include:

• Consults from the athletic training room to a surgeon or orthopedist
• Questions to medical specialists from family doctors
• Nurses getting opinions from other nurses
• CNAs working with nurse practitioners on tricky cases
• Nurse practitioners, PAs, and doctors ringing in on a patient's treatment
• A whole team supporting a senior living or assisted living center in serving its patients
• ... and everything in between.

Opportunities

When people think about beginning to collaborate, they're usually beginning for one of a few key opportunities:

• They want to improve patient care and need to "loop in" the expertise or experience of other providers to do so
• Patient satisfaction is important to them and medical collaboration will help them achieve it
• They're concerned about one or more regulatory issues and want to use medical collaboration to help do things like decrease readmissions or drop length of stay.
• HIPAA concerns are coming up and they want to create a HIPAA-safe way 

What are the advantages?
What are the opportunities for care, legal risk, marketing, customer satisfaction (family, patient), marketing?

We find this book by Stephan Willis on collaboration quite interesting, although not focused on medical collaboration specifically.

A medical collaboration resource

We were really inspired by the stories of collaboration from the medical world and beyond, so we put together a free resource with inspiring stories, key strategies, and easy ways for you to collaborate today:

Image courtesy of StockMonkeys.com, used under Creative Commons rights.

"This is Dr Ryan Stone. Do you copy?
Anyone? Do you copy….
Anyone?
Do you copy? Please! Copy?"

Gravity, Warner Brothers, Director Alfonso Cuarón 2013

How often do we wish that we could have someone who we could talk to? Someone to take to  bounce our treatment plan off, someone to help with followup, someone with whom to share the responsibility and relieve the loneliness. Someone to lighten the load. Even if the response is: "That sounds ok."

Burnout is, in part, caused by stress and not being able to do anything about it. A long-ago stress model was used to study peptic ulcer in rats. The stressor was nothing more than wrapping the mouse in restraints. We providers have restraints galore. We have hierarchies to deal with as nurses and HIPAA regulations everywhere. Lack of time cascades into documentation demands. There are too many patients. We struggle against our restraints to do what we know is complete and right. Then, we settle for what we can do. It is never enough. Each restrains us from what we need and want to do: take care of patients.

Do you copy? Anyone? 

We went into healthcare because we wanted to help someone. We do, but not in the way we wish, the way we know we could. More stressors dangle in front of us as we struggle against restraints. Quality assurance, documentation, uninformed family, distrustful patients, guilt and incompletion. 

What to do? Get the satisfaction and comfort of working with colleagues. Collaborate with your colleagues, your associates, your coworkers, your floor-mates. Whatever way you choose, find a way to talk to your friends. We prefer hybrid store-and-forward telemedicine because can talk to our colleagues on their own time, not their time or ours. Another schedule is avoided.

Whatever way you want to do it, do it. Collaborate today.

Physician Assistant Week is October 6-12, 2013. We are reminded of a most remarkable case that originated with a Physician Assistant (PA), as so many remarkable stories do.

A retired man balanced carefully on a ladder. He was changing a garage door spring. The tensioned spring was one of those very strong springs that lift the door. He lifted his arms to position the spring. The spring snapped and dragged a large hook through his arm. The man lived 40 miles from the nearest hospital, a critical access hospital. The emergency room was staffed by a PA. We have worked with this PA over the years in many roles. He is a smart and dedicated man with good judgment. He was being supervised by local primary care physicians.

The consultation began as a phone call. Thanks to an Appalachian Regional Commission Grant, an early form of iClickCare® was installed in this emergency room. How quaint it seems now - not only not on a mobile device but there was no cell service. Yet, how effective this store-and-forward telemedicine was, even “back in the day.”  After a brief telephone conversation during which the indescribable was halfway described; pictures were taken, a brief history noted, a button clicked, and the hand surgeon was virtually in the emergency room within a few seconds at a hospital over one hour away. 

Care was begun.

• First, tell the patient an amputation was not necessary. It had been considered.
• Second, the Emergency Department was notified by a second click. The department was prepared for the patient's arrival. “Throughput”, not a term at the time, was 17 minutes.
• Third, a click, and the Operating Room was prepared. The anesthesiologist was informed. Equipment, tables, sutures, and personnel were assembled. 

Two hours of surgery (the case went well), another hour in recovery, and the patient went home. Hand therapy followed. Other PAs and students shared the case for learning, months and years later. A short video, securely stored in iClickCare, shows full function.

So who won here?

• The Patient received ACCESS to the proper care at the proper time. Moreover, he spent the entire trip in the ambulance during transfer, not looking at the roof and mourning the loss of his arm, but knowing the plan for repair. And he was back home in bed the same day. A video conference was not needed with the suffering patient holding his hemorrhaging arm up in front of a face-to-face video conference camera in a special room with expensive equipment.

• The Emergency Room COLLABORATED by anticipating and enabling the proper triage, orders and flow without making the patient wait for re-examination, wound observation and chasing down the specialist.

• The Operating Room spent the transfer time quietly preparing without stress of the unknown.

• The Anesthesiologist, who wishes only to relieve pain, did not have to inflict pain to examine the wound. 

• The surgical Specialist battened down the hatches, saved hours of visits, assessment, rounds the next day. He was not paid for the consultation. He would not have been anyway, but, he was paid for the surgery.

• The Originating Hospital provided good care, with good supervision, and allowed the Physician Assistant to practice medicine in a legally compliant, and even more importantly, a confident and comfortable way.

• The Accepting Hospital provided coordinated, cost effective care on a Saturday afternoon. If collaborative care is cost effective, which it is, the Hospital made out in spades!

• The Hand therapist also had benefit of an intra-operative photograph. She knew what was strong, what was weak, and her treatment plan was adjusted accordingly.

The Physician Assistant is the hero of this story.
He began, and eventually followed, the patient’s journey. Because he bothered to care, and not ship, because he took an extra minute or two for medical collaboration, because he was doing his everyday job with everyday excellence, he helped everyone. Since he then could follow the results, he could go home after his long shift, weeks later, satisfied and knowing, instead of worrying and wondering. EDUCATION.

ClickCare recognizes and congratulates all Physician Assistants. We hope that PAs will learn more about iClickCare so that they may, as the American Academy of Physician Assistants defines, be “health professionals licensed or, in the case of those by the federal government, credentialed, to practice medicine with physician supervision."

Access, Collaboration, and Education. We all need it.

Be sure to visit the ClickCare Homepage to find out about Healthcare Community Events you might want to attend, and to read the latest in telemedicine in this week's American Telemedicine Association (ATA) Newsbrief.

If you are a PA, and have your own story to tell, please let us know. If there are topics you would like to see us cover as a blog article, or have opinions about this blog article, please DO comment.

Some of us remember Mike Mulligan and His Steam Shovel, a child’s book by Virginia Lee Burton published in 1939. It is a story of change and adaptation. Mike's steam shovel is named Mary Anne. Both Mike and MaryAnne are being replaced by modern diesel-powered shovels. They go to a small town to look for work but find that they have literally dug themselves into a hole from which they cannot escape because they have not planned an exit. I won't spoil the story, but, I recommend that you read it. Captain Kangaroo read it, it became an HBO animated short and was posted by the National Education Association as one of the top 100 children’s books. Mike Mulligan was no longer a steam shovel operator, and Mary Anne, his steam shovel used her power for something else. Their pride, their skills, and their contributions became no less. They just changed.

Over 60 years later, dirt is still being moved, not by a steam shovel, but by the team work of two very skilled operators of a dozer and excavator. New names, same job. Move dirt. Same job, done better, needing more coordination. One pushes, the other lifts. Sometimes in sequence, sometimes at the same time. Each has a specialty. Each has an instant when one is “more important” than the other. By paying attention to each other, they finish the job elegantly and efficiently.

An Example of Working in Collaboration

These “tales” of moving dirt offer interesting lessons. Healthcare is different now than in the past. We still (should) help people heal or suffer less. Our tools are different. Yes, there are new innovations such as a computerized, recording, controlling IV pumps instead of a roller wheel on a tube. Similarly, the tools to provide true medical collaboration in healthcare are also different.

Hybrid store-and-forward is more efficient than videoconferencing. The diesel replaces the steam engine. Hybrid store-and-forward replaces videoconferencing. But, that change is merely a change of technology. As providers of healthcare (for all of you outside of the Washington beltway, “providers” means doctors, nurses, aides, therapists), our intent and purpose need to be changed as well. We need to develop a culture of medical collaboration, collegiality and coordination of care that emphasizes shifting roles and responsibilities, rising over hierarchy and accountability. We need to accept that healthcare as we know it is changing just as steam power changed to diesel power. While the foundation beneath our feet crumbles, we will move on and work with each other. We will regain a satisfying career and enjoy a productive life. As we move on, our patients will again have access to quality care, our satisfaction will increase as we collaborate, and we will have real experience to share as we educate those who come after us. Hybrid store-and-forward is the bridge to do so.

An Example of Working Without Collaboration.

We can dig ourselves into a hole, or we can plan to work in a better way.

Not so long ago, a resident of the old-fashioned “nursing home” might receive only palliative care from a nurse’s aide, RN and a general practitioner. A doctor would make rounds occasionally, prescribing treatments to ease the aging process. Nurses took care of patients on a healthcare island, separate from medical and public health communities.

A nurse’s aide would notice something with the patient and ask an RN or LPN for guidance. If the nurse could not resolve the problem, she would telephone the doctor’s office and wait for the physician to return her call – a process that arrests workflow for both busy environments. The nurse would describe the problem verbally. If the problem described seemed serious enough, staff members would trundle the frail resident off to the hospital where specialists could surround her bedside and collaborate about her condition. A family member was asked to leave work to accompany the patient and staff. Then, all together, they waited.

Residents in a skilled nursing facility are typically not robust, facing increased risk any time they are away from the facility. Elderly patients often become confused in the hospital, and they suffer an increased risk for falls and infections. Residents of skilled nursing facilities can introduce MRSA into hospital settings and vice versa. Collaboration would keep these individuals in their own beds, where the highly qualified CNAs and RNs they already know can deliver advanced skilled nursing techniques under the guidance of their trusted physician specialists.

Collaboration in today’s technically advanced skilled nursing facility
Today’s skilled nursing facility provides more than end-of-life care. Nurses and caretakers at these facilities provide special treatments, including enteral nutrition and intravenous injections.

The modern patient, especially one sick enough for placement at a skilled nursing facility, requires a team of specialists. Skilled nursing facilities now only provide palliative care. While a facility can grant privileges to multiple specialists, it is not feasible for all these physicians to maintain onsite offices or make rounds at the facility.

Caring for today’s skilled nursing facility resident requires a new approach to collaboration between everyone on the healthcare team, from the CNA to the oncologist. Collaboration provides feedback to the doctor regarding efficacy of treatment, and reassures the nurse’s aide that the physician was cognizant of her concerns regarding the patient’s health.

Medical collaboration is the communication and exchange of ideas between doctors, nurses, and other caregivers. Medical collaboration is an information superhighway connecting caretakers of all levels, from nurse’s aide to anesthesiologist.

The Association of American Medical Colleges says there are more than 200 types of physician specialists in the United States. Medical collaboration improves the likelihood a resident in a skilled nursing facility struggling with a specific condition will connect with a leading professional in that field. Before the advent of care coordination, chances of getting a nursing home patient into the hands of the right specialist were nearly infinitesimal.

Technology has driven medical collaboration. In 2010, the Apple iPhone led the way with the expanded adoption of smartphone apps. Today, clinicians use hybrid store and forward. This technology allows doctors to add personal health information for each patient at an intermediate, safe location and then send it to others on the collaborative team.

Collaboration keeps all caregivers in the loop without jostling the patient from office to office. A hospital radiology department can upload a chest x-ray, for example, to save the patient from repeating it for a consulting physician. A nurse’s aide can update pictures of a resident’s decubitis, or rash, or edema, frequently to the team of physicians and reduce the need for office visits.

Benefits of Medical Collaboration
Along with convenience, medical collaboration has many benefits to the patient and her healthcare team. 

Benefits to the resident include:

· Improved healthcare

· Increased access to specialists without travel

· Reduced risk for hospital-acquired problems like infection

· Coordinated healthcare

· Family stays at work and at home instead of going on office visits

Benefits to doctors and other caregivers:

· Fewer errors

· Less redundancy

· Greater efficiency and productivity

· More appropriate use of expertise and medications

· More confidence that comes with support 

Everyone benefits from medical collaboration; care coordination fully utilizes advancing technology to share patient information safely and effectively. This new approach to care brings together caregivers of all levels to provide superior care to patients in skilled nursing facilities. Nothing is needed except an iPhone, iPad or camera and computer. 

This comes to us via Emily Kerr, who works with amazing people to build brave and beautiful things. We would not have known, but she happened upon
this scene of courage, equipment and collaboration.

1700 miles away from the ClickCare corporate office, a cat was stuck in a tree. The story unfolded just as it does in so many children’s books. 

Why was the cat stuck in a tree? We are sure the fireman asked. As health professionals we ask as well. And like the brave fireman we know that as Alfred Tennyson in Charge of the Light Brigade tells:

Some one had blunder'd.

Theirs not to make reply,

Theirs not to reason why,

Theirs but to do and die.

Relate this story of the cat caught in a tree to the story of medical collaboration.

Cat caught in the tree:

• The problem: Cat in a Tree
• The requestor: The passerby who heard the meows for help.
• The collaborator (or consultant): The fireman.
• The device: The crane which connected the fireman to the cat.
• The result: A live cat. A brave hero fireman. An inspired passerby.

Patient caught in the tree of healthcare:

• The problem: A patient looking for health, and figuratively caught in the tree of heathcare
• The requestor: The first person who bothers to listen and try a little harder (the passerby could have ignored the cat)
• The collaborator (or consultant): A brave, responsive person who goes a little farther and gets out of his silo of the firehouse (his office, hospital, or routine)
• The device: iClickCare, as the crane, the hybrid store and forward tool, between patient, requestor and consultant
• The result: A healthy patient. A hero collaborator. A satisfied requestor/consultant.

Everyday, there are healthcare heros. They are unknown. They are un-lauded. They are sometimes next door and not 1700 miles away.

They are like the noble six hundred. And often feel the same.

References:

Photograph: Emily Kerr, "Seriously, Big Fat Cat on My Street"

Alfred Tennyson's recording of the Charge of the Light Brigade

Alfred Tennyson's handwritten poem.

The complete poem (do you feel the parallels as you work in healthcare?):

The Charge of the Light Brigade by Alfred Tennyson.

Half a league, half a league,

Half a league onward,

All in the valley of Death

Rode the six hundred.

"Forward the Light Brigade!

Charge for the guns!" he said.

Into the valley of Death

Rode the six hundred.

Forward, the Light Brigade!"

Was there a man dismay'd?

Not tho' the soldier knew

Some one had blunder'd.

Theirs not to make reply,

Theirs not to reason why,

Theirs but to do and die.

Into the valley of Death

Rode the six hundred.

Cannon to right of them,

Cannon to left of them,

Cannon in front of them

Volley'd and thunder'd;

Storm'd at with shot and shell,

Boldly they rode and well,

Into the jaws of Death,

Into the mouth of hell

Rode the six hundred.

Flash'd all their sabres bare,

Flash'd as they turn'd in air

Sabring the gunners there,

Charging an army, while

All the world wonder'd.

Plunged in the battery-smoke

Right thro' the line they broke;

Cossack and Russian

Reel'd from the sabre-stroke

Shatter'd and sunder'd.

Then they rode back, but not,

Not the six hundred.

Cannon to right of them,

Cannon to left of them,

Cannon behind them

Volley'd and thunder'd;

Storm'd at with shot and shell,

While horse and hero fell,

They that had fought so well

Came thro' the jaws of Death,

Back from the mouth of hell,

All that was left of them,

Left of six hundred.

When can their glory fade?

O the wild charge they made!

All the world wonder'd.

Honor the charge they made!

Honor the Light Brigade,

Noble six hundred!

ATA 2013 in Austin May 5-7

Remember last year, The Woz said... he’d move to Alaska for the collaborative care that iClickCare enables, but May 5-7 we’re at Booth 847 in Austin for YOU. He loved having access and collaboration, secure on the iPhone and web browser. This year, we have even more for you!

BOOK AN APPOINTMENT to see how you can save with ClickCare and improve the patient care and satisfaction (and yours)!

Register today for your free Expo Only pass at ATA 2013.

Stop by Booth 847, meet our leadership team and be the first to enjoy a brief demo of iClickCare for the new iPad and iPad mini subscription software. We're looking forward to putting a face to your name and joining with you to improve healthcare, one person at a time.

iClickCare is a hybrid Store-and-Forward of text messages, video, PDFs and still images. 

It is also a hybrid of platforms because as providers we are not always mobile nor sedentary. We need the right tool for the right job at the right time. Indeed, that is what medical collaboration and telemedicine is all about anyway — the right provider, at the right time and at the right place — for the patient.

We have had the web-based browser of iClickCare for years. Eighteen months ago, we added the mobility of the iPhone. As physicians, we also found a need for an in-between size and thus we started work on the iPad. The iPad mini came along as we developed our solution. So now we have an in between with an in-between. And as the image shows, we are putting our party hat on as well!

Fortunately, you don't have to learn something new. The same relationship you have with iClickCare on the web applies directly to the iPad, iPad/mini and the iPhone.

Meaningful Use and Meaningful Records:
We have added features to the iPhone as well, and now you can use Invite Patient to give true meaningful use to your care as you collaborate with your colleagues. The patient is, if you choose, part of the process.

Also added is the Compare Visits function. There is nothing quite so satisfying as seeing improvement over time, and nothing quite so educational as following decline over time. Visits can now be compared on both the iPhone/iPod and the iPad and mini, as well as the browser.

Security and Speed:
There are many, many improvements and tweaks to security and speed. Even though information about your patient is delivered to you faster, the security is solid. Our security systems surpassed stringent HIPAA requirements before, but, they are even more robust now. We would remind you to use strong passwords. Passwords can be changed by you as often as, and whenever, you wish from the top of the login page. 

Searches and the “serving up” of images, video and PDFs are faster because our developers really understand the tasks and demands on providers, and know how to make things work in very sophisticated ways.

Current pricing for version 2.0 will apply through May 20, 2013 if either a renewal or new subscription is confirmed. As an iClickCare customer, all you do is upgrade from the iTunes AppStore and contact your sales rep before May 20. New user subscription pricing is posted on www.clickcare.com, but, as a new customer you will receive a 2 week free trial to start. We want everyone to continue to see how incredible iClickCare can be with the ease and clarity of the new iPads and the iPad minis.

Learn one, you know them all... any browser, the iPhone, the iPad, or the Mini... all as Version 2.0 on the iPhone. You will also discover that the Search is faster, and the presentation of images is better than ever. And our Online Help is ready to serve YOU, as always.

You can use iClickCare on your browser, your iPhone and now your iPad all with one click.