ClickCare Café

Is the 2019 Outlook for Nonprofit Hospitals as Bleak as it Appears?

Posted by Lawrence Kerr on Thu, Jan 03, 2019 @ 06:00 AM

brooke-lark-194254-unsplashMoody’s Investors Service came out with their 2019 projections and predictions for nonprofit hospitals.

And unfortunately the summary is: things don’t look great.

Although I don’t put tons of confidence or stock in this type of projection, I do think that the report captures many of the challenges that nonprofit hospitals face.

Fierce Healthcare does a good job summarizing Moody’s report: Moody’s says that nonprofit hospitals are on an “unsustainable path” because of “soft revenue growth, weak inpatient volumes and single-digit reimbursement increases in the coming year.”

Other challenges in 2019 may include lower cashflow, an increase in bad debt, lower inpatient admissions, and pressures like nursing shortages and increasing wages.

So much of healthcare is conservative. We don’t change until we need to. And for many nonprofit hospitals, there has been a consistent tendency to maintain the status quo in an almost superstitious fashion — if I don’t change, then nothing will change around me.

Reports like this demonstrate that things are surely changing around us. Our only choice as healthcare providers, as hospital administrators, and as citizens is whether and how to act proactively so that the things that matter to our organizations and to ourselves can be supported and pursued.

Healthcare is changing around us -- for better and for worse. 2019 will bring new technologies, shifts in reimbursement, demographic changes, and developments in our own practice as healthcare providers. Our goal can't be to not change within that. Our goal has to be to change towards what we envision for ourselves and for our patients. And with the new year here already, I encourage all of us to take the opportunity to reflect on what that might look like this year.

 

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Tags: telehealth, good medicine, telemedicine reimbursement

What Factors Influence Telemedicine Adoption Across States?

Posted by Lawrence Kerr on Thu, Dec 13, 2018 @ 09:12 AM

rawpixel-586687-unsplashTelemedicine is not a new technology.

In fact, we’ve been doing telemedicine for almost 20 years at ClickCare. As you may know, we started by pioneering in a School-Based Health program at local underserved elementary schools. That program used newer technology — including some digital cameras — but really, the success of it was related to the approach and openness of the providers, patients, and families involved.

Because the school nurses and the pediatricians were so oriented towards caring for their young patients as well and as holistically as possible, they were open to trying new approaches. As participants saw the success of the program, it became broader and more organizationally supported. And honestly, at no point was there any conversation around reimbursement or policy — it was just one more way they cared for their patients.

All of the providers that use iClickCare today approach it similarly. While telemedicine is increasingly common, it’s certainly not the default. And so providers or hospitals that incorporate the tool do so as a conscious choice. Reimbursement improves; political and organizational support expands; but through it all, providers carry on with the tools and approaches they think will help their patients the most.

I was interested to read a report in JAMA, however, and extended in Fierce Healthcare, looking at how telemedicine use is expanding (or, in some cases, not), and how reimbursement laws relate to these adoption phenomena. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. These laws have been adopted in 64% of US states. In confluence with this, there was a significant uptick in telemedicine usage among primary care physicians between 2015 and 2017. For more rural areas, mental health services seemed to be higher usage than other specialities. While in urban areas, primary care telehealth was more common.

This is all in line with the expansion of both telemedicine and reimbursement that we’ve seen. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. That said, one interesting fact stood out: “the data showed a negative association with states that enacted comprehensive parity laws mandating reimbursement for the services.”  Perhaps that is because those states struggled the most with adoption in the first place — but either way, it’s clear that adoption “from the grassroots” may be more effective than approaches that aim to implement telemedicine starting at the policy level.

With any shift in practice, there is always a combination of technological, personal, psychological, and societal factors that need to come together for the technology to be incorporated into use.

For instance, simply inventing the telephone doesn’t create a culture that calls your friends. A combination of phone lines, social change, and early adopters combine with the new invention to lead to a society that talks on the phone.

On the one hand, telemedicine is becoming increasingly widespread, generally. There is increasing consensus that telemedicine can contain costs, increase access, and cut healthcare provider burnout. It’s not surprising that so many providers, patients, and payers are incorporating the technology into how they “do medicine.”  On the other hand, telemedicine implementation isn’t a matter of policy or a “snap of the fingers.”

Ultimately, telemedicine adoption must come from providers and patients. There is no way to legislate or demand creative ways of caring for our patients.

Learn more about how to implement telemedicine in your organization, economically and quickly, with our Quick Guide to Hybrid Store-and-Forward Telemedicine: 

ClickCare Quick Guide to Hybrid Store-and-Forward

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

Joint Commission Permanently (for now) Cancels Telehealth Standards

Posted by Lawrence Kerr on Mon, Oct 23, 2017 @ 06:01 AM

trent-erwin-338084.jpgLast week, Fierce Healthcare reported that the Joint Commission has decided to table the Telehealth standards that, in May, they had originally announced were in the works.

The primary focus of the standards was the portion of telehealth where care is provided direct from, and to, the patient. As The Center for Telehealth and e-Health Law reports, attorney Nathaniel Lacktman of Foley & Lardner said the standards would have "forced Joint Commission-accredited hospitals to obtain informed consent from patients prior to delivering care via telehealth. In addition, providers would have had to discuss with patients the 'type of modality that will be used' before providing care."As readers of this blog well know, iClickCare is all about using technology to help providers collaborate. This collaboration results in the best care for the patient, and the patient can be invited to join when desired and necessary. See our answer from our FAQs “Can I include my patient of family members in iClickCare?"

We're largely appreciative of the Joint Commission's dropping the standards. It's not that telehealth standards of any kind are out of the question. But the Joint Commission's proposed standards were troublesome because they were simultaneously narrow and too restrictive.

We believe that the portion of telehealth that is direct-to-patient is over emphasized in the telemedicine landscape. It's a tool with specific applications and potential because it doesn't allow a team of thoughtful providers to partner with a patient in asking the right questions about their own care. Instead, a "fix" is sought, and via technology, seemingly obtained.

As an architect friend of ours said recently, “Sometimes we come to a conclusion before we have defined the problem”.  We all know that the patients who often get the worst care are physicians and nurses.  Why?  Because they make the diagnosis, and seek the treatment from an ultra-specialist, before the big picture is analyzed. They seek the tree and miss the forest. Similarly, direct-to-patient telehealth can risk the same challenges. 

None of this has been addressed fully. Narrow standards applied to a isolated topic will do little to advance a broader view of technology and health and worse, stifle innovation and adoption.

 

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Tags: telehealth, regulatory issues, medical collaboration

When Telehealth Monitoring Takes the Place of Medical Collaboration

Posted by Lawrence Kerr on Wed, Oct 11, 2017 @ 06:01 AM

tim-bish-171738.jpgOne of ClickCare’s founders is a pediatrician.

And as a pediatrician, she’s no stranger to the obsession that new parents have over their babies.

Sometimes in her practice, it seemed that the more educated or well-off a parent, the more bizarre their parenting approach would be. Now called “helicopter parenting,” the excessive hovering and worrying that many parents show is nothing new.

A recent article showed that technology can certainly exacerbate a natural tendency, however. The New York Times looks at extreme baby monitoring gadgets. Whether it’s a sock that measures oxygen levels or a temperature indicator to tell you if your baby’s blanket has slipped, there are more gadgets than ever to allow parents to track babies continuously, night and day.

These devices are likely unnecessary and even potentially harmful in terms of the family dynamic. Dr. Michael Yaker of Westside Pediatrics in Manhattan and the Icahn School of Medicine at Mount Sinai says, “In general, do the vital signs of healthy babies need to be monitored regularly? Absolutely not… If your baby needs to be on a monitor regularly tracking vital signs, your baby is likely not ready to be discharged from the hospital.”

The article asks the valuable question: can this information be applied in a meaningful way, or is it noise? Is the information gathered from these monitors a) accurate and b) actionable? 

Similarly, the telehealth monitoring boom has meant that the most publicized and well-funded projects in the telehealth space are those that gather a lot of information using hardware devices. The allure of 24/7 data gathering and always-accessible videoconferencing is seemingly hard to resist.

In either, the case of excessive focus on telehealth monitoring or the case of the extreme baby monitoring, I believe that there is a dynamic in which fear is being capitalized on to sell quick fixes. Rather than asking what is truly good for the baby and the family, the monitoring is providing a few moments of salve for panic and worry. Similarly, expensive telehealth monitoring programs sound impressive but may not ultimately improve outcomes significantly or take the whole patient into account. Telehealth monitoring in conjunction with videoconferencing isn't really taking the whole system into account, either. If they were, they would be thoughtful about allowing asynchronous consults. They would enable medical collaboration. They would facilitate real human medical providers talking with each other about patients. They would engage providers in considering the whole picture, rather than just a few data points.

Ultimately, we believe that medical collaboration, enabled by an inexpensive and asynchronous tool like Hybrid Store-and-Forward® telemedicine, is the best tool available to truly improve medicine. We believe it's good medicine to be skeptical about whether gathering more data is always best: is it accurate? is it actionable? is it meaningful?

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Tags: medical collaboration, telehealth

Telehealth Brings Providers Closer Together — So How Will You Use It?

Posted by Lawrence Kerr on Thu, Oct 05, 2017 @ 06:47 AM

nasa-53884.jpgLast week Elon Musk announced a new plan for getting people to Mars — and a clearer idea of how SpaceX would make money at it.

As the New York Times reports, “The key is a new rocket — smaller than the one he described at a conference in Mexico last year but still bigger than anything ever launched — and a new spaceship.”

But it was a specific aspect of his vision that reminded me of the potential, promise, and reality of telehealth…

Mr. Musk’s Mars vision is interesting and almost unbelievable. (And, indeed, may not be practical, but time will tell.) “For Mars colonists, the rocket would lift a spaceship with 40 cabins, and with two to three people per cabin, it would carry about 100 people per flight. After launching, the B.F.R. booster would return to the launching pad; the spaceship would continue to orbit, where it would refill its tanks of methane and oxygen propellant before embarking on the monthslong journey to Mars.”

What is even more fascinating to me, however, is Mr. Musk’s vision for using the reusable rocket here on earth.

Because the rockets are reusable and because they travel up to 18,000 miles per hour, the rockets could take off to the atmosphere, and then come down in, say, Shanghai. Any two points on earth would be less than an hour apart. And, in fact, he says that the cost of a ticket would be cheaper than an economy ticket on a plane today. (He didn’t mention the leg room, but I’ll assume it’s better!)

When you watch the BFR “Earth to Earth” video, imagining the idea that you could get to Shanghai in 39 minutes, or from New York to Paris in 30, you start to wonder how our world would change if we could connect to each other so easily, so quickly. You think about how our understanding and empathy of other cultures might grow. You think about how new ways of practicing business, medicine, and art might emerge. How we might work and live differently, better. And you wonder -- if I could go to any country in the world before lunchtime, what would I do with that ability to connect? If I had the power to connect across the world, how would I use it?

The truth, of course, is that you have that power now.

Mr. Musk’s vision is big, and it’s encouraging to know that entrepreneurs with big visions are working towards new futures. But the truth is that in the palm of our hands, we have tiny computers that let us collaborate with medical colleagues in any corner of the world, even in a HIPAA-safe way, for a cost that is tiny. The reality is that telehealth now allows us to connect with patients and people across the spectrum of care in ways we couldn’t, even 20 years ago.

What will you do with that power?

 

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Photo by NASA on Unsplash

Tags: telehealth, telehealth and hipaa, Telemedicine and HIPAA, hybrid store and forward medical collaboration

Bring-Your-Own-Device Policy in Healthcare Is Key to Providers Using Health IT

Posted by Lawrence Kerr on Tue, Sep 26, 2017 @ 06:00 AM

mia-baker-330625.jpgHealthcare providers -- especially doctors -- are not known as the most receptive, malleable folks. In fact, in the world of private pilots, it's commonly accepted that doctors are the most dangerous pilots because they have too much confidence in their own abilities. 

So it's no surprise that providers almost universally hate that they've been forced to use EMRs/EHRs. The widespread frustration with the technology would be practically a galvanizing force in the medical world, were it not for the complete impotence we have to actually reject EMRs.

That said, I've always struggled to understand why so many healthcare providers resist the implementation of tools like telemedicine or other telehealth advances. Many of these tools are beautifully designed, save huge amounts of time, and greatly advance care. And yet many providers resist them with a vehemence I find hard to fathom.

But some recent research brought these reasons clearly into focus for me...

Two recent studies look at the adoption of EMRs/EHRs and dig into the true reasons that healthcare providers resist the usage of technology in many contexts.

This study looks at why healthcare providers are so resistant to EMRs/EHRs. The researchers look at the institutional beliefs in the institution of medicine -- the profession, they say, is "based upon main values such as professional autonomy, status role and expertise." These are values that butt directly against the coercive implementation of difficult-to-use EMRs/EHRs in so many settings.

This piece, in turn, surveyed 199 physicians practicing at a large US hospital. They found that -- consistent with our life experience -- healthcare providers largely deeply dislike EMRs/EHRs and see them as infringing on their time with patients and inhibiting of their ability to practice as they wish. No surprises there. However, the researchers go on to summarize, "when faced with a decision between alternate IT systems [for instance, choosing between an EMR and paper records], individual users tend to select and make use of the technology or system that is most readily accessible."

In other words, the physicians were simply trying to navigate their overloaded days by choosing the system that felt most accessible or "easy" to them. The researchers found two dimensions to this perceived accessibility: logical and physical. The physical accessibility had to do with the placement of the computer in the office or exam room, how many computers the practice had, etc. The local accessibility had to do with how difficult it was to log into and use the EMR system. The study concludes, "Both dimensions of accessibility act as barriers to EMR use intentions through their indirect effect on physicians' perceptions of EMR usefulness and ease of use."

I found this particularly fascinating because these two dimensions are the two foundations that we built iClickCare on: 

  • Physical accessibility: iClickCare works in a HIPAA compliant way on any iPhone, Android, or web browser. Which means that you can use it on the computer in your office, on your phone in the exam room, on your home computer, or on a floor down from your office in the hospital. This is huge for physician's perceptions of accessibility. (Not to mention making it practical to use in home-based or long term care settings.) 
  • Logical accessibility: iClickCare is technology for people who hate technology. Getting a consult on iClickCare is as simple as posting a Facebook update. And the workflow integrates with any other technology or Health IT systems you may be using. 

So if you're exploring implementation of a Health IT system -- whether telemedicine for medical collaboration or something else -- we recommend considering these same dimensions:

  • Physical accessiblity: will the system work on multiple hardware pieces (e.g., the "hardware" in everyone's pocket)? Does it require a hardware investment? 
  • Logical accessibility: does the system work with providers' existing workflow? Does it make sense with providers' days? How well-designed is the user interface and how hard is it to use? Do providers need to change their schedules to use the system? Will they need to use hardware they are unfamiliar with?

A Bring Your Own Device (BYOD) policy, especially in combination with smart software, can open up the possibilities for technology implementation that providers will really use and really benefit from. We always recommend investing in software, not hardware and using that software on as many devices as providers use already. 

The determinants of technology adoption aren't complicated, but working in harmony with them can be transformative.

 

Download our full white paper on Bring-Your-Own-Device (BYOD) policies here:

iClickCare IS BYOD Secure

Photo by Mia Baker on Unsplash

Tags: telehealth, HIPAA, byod, bring your own device

What Your Netflix Recommendations and Telehealth Have in Common

Posted by Lawrence Kerr on Wed, Sep 06, 2017 @ 06:01 AM

samuel-zeller-360588.jpgAs you probably know, machine learning refers to the process through which a system can use a programmed process to "learn" and become more accurate over time. It's different from the way most of us think of a robot or a computer program because in this case, the programming changes based on the results it gets and new inputs available.

Experts say that the extensive use of machine learning in healthcare is inevitable. But how might that affect healthcare and what will the consequences of it be?

Machine learning is not a new field -- in fact, it was described by Arthur Samuel in 1959 as, “the field of study that gives computers the ability to learn without being explicitly programmed.” But exponential improvements in computing, plus innovations in AI and technology in general, have meant that the field has started burgeoning over the last few years.

Machine learning is used in applications from cyber security to healthcare to, well, the movies that Netflix suggests you watch after a long week. In medicine, we're seeing applications in everything from cancer prediction and prognosis, to diagnosis in medical imaging, to treatment suggestions.

For instance, when you search for, say, peach pie recipe on Google, you'll see search results based on what Google thinks matches those words. That's a regular computer algorithm. Machine learning comes into play, however, in that Google also "watches" (actually a computer collecting data) which search results you click on, and how much time you spend on the pages you visit, to re-rank and re-sort the search results it gives the next person searching for peach pie recipe.

There is a lot that is scary and even threatening about this new world of technology. It's disturbing to think that the best doctors are sometimes worse diagnosticians than computers. And it's true that, as this JAMA paper identifies, "comparative studies on the effectiveness of machine learning–based decision support systems (ML-DSS) in medicine are lacking, especially regarding the effects on health outcomes."

The JAMA paper looks at several potential unintended consequences of the use of machine learning in medicine, for instance:

  • Reducing the skills of physicians
    For instance, a study of 30 internal medicine residents showed that the residents exhibited a decrease in diagnostic accuracy (from 57% to 48%) when electrocardiograms were annotated with inaccurate computer-aided diagnoses."
  • Overreliance on text.
    The JAMA paper reports that machine learning "could lead to reduced interest in and decreased ability to perform holistic evaluations of patients, with loss of valuable and irreducible aspects of the human experience such as psychological, relational, social, and organizational issues."

Ultimately, machine learning is like any other technology in medicine -- the scalpel, anesthesia, or telehealth. These tools are powerful, and come with almost inalterable impacts on how we practice medicine. They're also in our control, we're supposed to wield responsibly and manage the negative consequences. 

In the field of telemedicine, we at ClickCare are determined advocates for healthcare providers to be thoughtful about what technology they use for telehealth, and how they use it.

We advocate for healthcare providers to do 2 key things when it comes to technology in telehealth and telemedicine:

  • Be open to new technology even as you're discerning about what to use.
    Of course, technology comes with unintended consequences and challenges. But it can also enrich and enhance the practice of medicine. We advocate for providers to be proactive in selecting technology that really works for them -- neither a "bury your head in the sand" approach, nor a "take whatever comes along" approach. You know what's best for you and your patients.

  • Be open to redefining some aspects of your role as a medical provider.
    As technology shifts, we have the opportunity and responsibility of shifting our roles as providers, too. Machine learning may create the ability for providers to focus less on the mechanics of medicine and more on the human art of it. Telemedicine based medical collaboration allows providers to step out of their silos and treat patients as a true team. We believe that the most successful, happiest providers are those that are willing to find new ways of working as our tools change.

 

We believe the same principles apply to our adoption and use of machine learning in medicine. And we look forward to being on that journey with you. 

 

Want to get all the information before making a telehealth or telemedicine decision? Get our free summary of hybrid store-and-forward telemedicine so you can be informed:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Photo by Samuel Zeller on Unsplash

Tags: telemedicine technology, telehealth, ACO

You Don't Need to Follow Those Annoying Password Rules -- And Telehealth Will Benefit

Posted by Lawrence Kerr on Thu, Aug 31, 2017 @ 06:00 AM

jeff-sheldon-264922-1.jpgWhether we're trying to buy a bath mat online or setting up a new bank account, we're all familiar with the prompts telling us the password we've selected isn't "complex" enough to be safe. For instance, you type in a long sentence, but you're told that it needs a number, an upper case letter, or a "special character." 

Well, those guidelines didn't come from nowhere -- they came from a man named Bill Burr, a former manager at the National Institute of Standards and Technology (NIST). And it turns out that Mr. Burr is very regretful for having wasted so much time with guidelines that don't really work. In 2003, Burr wrote a guide on secure passwords: the “NIST Special Publication 800-63. Appendix A.” That guide is where many of our standards around passwords came from. 

BUT, it turns out a longer password, with English words (much easier for most of us to remember) is actually harder for a computer to guess than a shorter password with arbitrary characters. And so all the complex password hijinks haven't really been keeping us safer.

We appreciated this article for the simple fact that getting a glimpse into the human side of the internet is always interesting. And Mr. Burr's honesty and humility are refreshing. 

But we also think there are two important takeaways from Mr. Burr's revelation:

  • What seems "high tech" is not always better or safer.
    For instance, we find that in medicine, there is a constant perception that more expensive hardware and technology are safer or more powerful. We've even had hospitals tell us that iClickCare is too inexpensive for them to buy. The truth is that iClickCare is as sophisticated, as HIPAA compliant, and as innovative as software can be. It just appears simple because it can be used from any computer, is relatively inexpensive to implement, and is very easy to use. Those are all great things, but not if you're looking for the most complicated-seeming solution on the market.

  • Just because something is repeated often, doesn't mean it's true. 
    With all of the complexity in medicine right now, it's common for an "echo chamber" effect to be created, in which things are repeated and seem true simply because we've heard them so often. Sometimes the EHR/EMR that is used a lot isn't the best one; and sometimes commonly understood causes of a situation aren't the correct causes. In the case with the passwords, it's clear that an incorrect approach became industry standard, just because it was used so often.

We encourage you to find the best solution for your situation. Just as it turns out that the "plain English" passwords actually work better, the simpler solution in telemedicine can work better as well. 

 

Get our guide on the simplest kind of telemedicine out there:

ClickCare Quick Guide to Hybrid Store-and-Forward

Photo by Jeff Sheldon on Unsplash

Tags: telemedicine and hippa, telehealth

New FDA Regulation Law Brings Changes for Telehealth

Posted by Lawrence Kerr on Thu, Aug 24, 2017 @ 06:01 AM

glen-alejandro-347236.jpgOn Friday, President Trump signed a bill reauthorizing the Food and Drug Administration’s user fee agreements for drugs and devices. 

The bill authorizes user fee agreements before they were set to expire in October. Interestingly, the bill also establishes several new approaches to the regulation of digital health and creates a digital health unit within the FDA’s Center for Devices and Radiological Health (CDRH).

Advocates of digital health, telehealth, and telemedicine might worry about whether this change is positive or negative for medicine and for progress in digital health. Here’s our take…

The Food and Drug Administration was created to regulate, make safe, and (perhaps), facilitate the development of food and drug products in the United States.

Of course, in 2017, digital technology is every bit as important as biochemistry in contributing to our health and wellness. So the Food and Drug Administration is working to keep up with the new forms that “food and drugs” take — and how data and technology can contribute to or potentially endanger the nation’s health.

As digital science becomes increasingly important, it will need to be regulated. But, at this point “watchful waiting” is more important than regulation to allow the development of creative technologies. These changes probably mean little to you using iClickCare but we wanted to keep you abreast of the changing regulations in the field.  On the other hand, here will more control of the hardware and medical device side of telemedicine.

ClickCare is proud to be a leader during an exciting and innovative time. And ultimately, we are advocates for technology that is safe because it is in service to providers caring for their patients — like telemedicine for medical collaboration — not a circumvention of the way providers care for patients.

Tools, technology, and drugs are only as safe as the professionals using them. So we see our job as simple: use technology but get out of the way so that you and your colleagues can care for your patients.

Learn more about the most innovative form of medical collaboration (that is also the simplest) here:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

 

 

 

 

Photo by Glen Alejandro on Unsplash

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

A Step-by-Step for Specialists Using Telehealth for Care Coordination

Posted by Lawrence Kerr on Tue, Oct 25, 2016 @ 07:30 AM

Last consultsmall.jpgweek, we talked about how primary care providers can use telemedicine for care coordination -- and looked at a simple workflow for getting a consult or asking a question.

Today, we want to look at how "specialists" can organize their workflow to ensure ease and efficiency in answering questions.

Whether you are a primary care provider or a specialist, you will sometimes be requesting a consult, and sometimes be providing a consult. The advantage of a platform that supports true healthcare collaboration is that the "help" can go two ways, or multiple ways, in a single case.

The workflow is always up to you, but here are some guidelines for when you respond, consult, or answer.

A step-by-step workflow for providing a consult via telemedicine:

  • Make sure you understand the question.
    If you are not sure what the question is, then ask a question back. Ask for clarification. Mostly, being a specialist means knowing what to ask and letting the patient provide the answer. Do so with respect. What is obvious and easy for you in your field is probably not obvious and easy for someone in another field. Indeed, you yourself may soon be off your turf and need help.
  • Add your own data, be concise, be focused.
    While we have become used to the four page referral letter -- because we bill based on how many elements or how many domains we provide -- most data is not pertinent and too much information decreases precision.
  • Help the requestor be the judge and jury.
    The requestor knows the whole picture more than you. Ask the requestor to get other specialty help. For example: an open fracture with marginal skin loss, or a case of white-coat hypertension shockingly found by you the night before the patient's surgery. If you did not receive follow-up, ask for it. Otherwise, skeletons in the closet are there when they don’t need to be.
  • Consult with the team to get a consensus.
    Before you bring tablets down from your lofty mountain, make sure there aren't other opinions you should gather. As a specialist, I have to remind myself that my opinion is not final and there might be some other aspect to the problem that I might not see. By engaging in discussion, my opinion becomes more valuable. We need to move on from the four page referral letter and its unidirectional pronouncements.
    Sometimes, you just have to see the patient. 
  • Don’t be afraid to ask, but don’t ask just ask to avoid thinking. There is a human and financial cost to seeing you.

Medical collaboration doesn't only happen in hospitals. Read our Quick Guide for collaboration tips from across industries:

ClickCare Quick Guide to Medical Collaboration

Tags: telemedicine, telehealth, care coordination, medical collaboration

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