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:

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

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

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

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

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

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

An important deadline is coming up. By 9/23/13, healthcare providers need to come into compliance with the final HIPAA rule. Because our iClickCare hybrid store and forward collaboration system was developed with HIPAA in mind, we want to share some time-saving experience with you. This week, we're covering 3 aspects of the deadline. Monday was overall background; Wednesday was about steps to get in compliance; Today we're discussing HIPAA and telemedicine.

As we wrap up our week of posts addressing the final HIPAA rule deadline, we wanted help you understand how telemedicine fits in with the world of HIPAA.

So, a roundup of our most popoular posts on telemedicine and HIPAA: 

• HIPAA violations and penalties. Your colleagues may be emailing about patients, but they're not doing it without risk. Just because you're ignoring the rules, doesn't mean they don't exist. 
• What if you lose your phone? Telemedicine security and HIPAA for the forgetful folks.
• 3 ways to keep patient communication safe from HIPAA. It can be equally easy to communicate with patients in ways that are HIPAA-safe -- it just takes a little knowledge and planning.
• A review of the HIPAA Omnibus Rule. Some key points to keep in mind, whether in relation to telemedicine, or just as you come into compliance this week. 
• Repeat after us: email is not HIPAA-secure. That's why we invented ClickCare, after all. But if you're going to be emailing, use this guide to work out the settings. 

Now, what: 
We've created a tool that reduces the 492 official HIPAA compliance questions to only 32, while still meeting the HIPAA standards. You will eventually need more work in this area, but this is a start. Of course, be aware that we are not lawyers, you shouldn't take action on information in this post alone, and we do not represent the government.

Click below for a quick-and-easy version of an assessment to help you come into HIPAA compliance. 

An important deadline is coming up. By 9/23/13, healthcare providers need to come into compliance with the final HIPAA rule. Because our iClickCare hybrid store and forward collaboration system was developed with HIPAA in mind, we want to share some time-saving experience with you. This week, we're covering 3 aspects of the deadline. Monday was overall background; Today we're talking about steps to get in compliance; Friday we're discussing HIPAA and telemedicine.

Why should you care and comply with HIPAA, HITECH and the Omnibus Reconciliation 2013 bill? 

1. You are a health care professional.
2. It’s the law (read: you'll pay if you don't "care.") 

The Office of Civil Rights of the Department of Health and Human Services summarized the 500+ pages of the Omnibus Rule as including the following final modifications:

• Make Business Associates of Covered Entities directly liable for compliance with certain of the HIPAA Privacy and Security Rules' requirements.
• Strengthen the limitations on the use and disclosure of protected health information for marketing and fundraising purposes, and prohibit the sale of protected health information without individual authorization.
• Expand individuals' rights to receive electronic copies of their health information and to restrict disclosures to a health plan concerning treatment for which the individual has paid out of pocket in full.
• Require modifications to, and redistribution of, a Covered Entity's notice of privacy practices.
• Modify the individual authorization and other requirements to facilitate research and disclosure of child immunization proof to schools, and to enable access to information by family members or others.
• Increased and tiered civil money penalty structure provided by the HITECH Act.
• Replacement of the breach notification rule's "harm" threshold with a more objective standard. [Our note: Previously, a breach had to reported if there was a “risk of harm." The Omnibus Rule requires any breach to be reported.]
• Prohibition of most health plans using or disclosing genetic information for underwriting purposes.

In service of becoming compliant, a risk assessment of your practice is required. There are five safeguards that need to be assessed:

• Administrative
• Physical
• Technical
• Organizational
• Policy and Procedures and Documentation Requirements

Now, what: 
This assessment can be done by you but the findings of the assessment and the plan of action must be documented and the assessments need to be ongoing. We've created a tool that reduces the 492 compliance questions to only 32, while still meeting the HIPAA standards. You will eventually need more work in this area, but this is a start. Of course, be aware that we are not lawyers, you shouldn't take action on information in this post alone, and we do not represent the government.

Click below for a quick-and-easy version of the assessment and come into HIPAA compliance. 

An important deadline is coming up. By 9/23/13, healthcare providers need to come into compliance with the final HIPAA rule. Because our iClickCare hybrid store and forward collaboration system was developed with HIPAA in mind, we want to share some time-saving experience with you. This week, we're covering 3 aspects of the deadline. Today is overall background; Wednesday we're talking about steps to get in compliance; Friday we're discussing HIPAA and telemedicine.

Healthcare providers have a way of focusing on the "now." There's always another patient to see -- and future deadlines can slip. Plus, truth be told, we get tired of the endless regulatory hoops to jump through.

That said, it's crucial to understand our regulatory context, and the time to avoid expensive and difficult violations penalties is now. After the background below, jump to the button at the end of the post to start the assessment process immediately and quickly, without expensive consultants. 

Some background on this September 23rd HIPAA deadline: 

HIPAA
In the mid-90s, the internet bubble was expanding and the world wide web was born. Amid all that connection, concerns about privacy and insurance arose, and in 1996, HIPAA was passed: the Health Information Portability and Accountability Act. In exchange for the ability to transfer, access to continuing health insurance, and healthcare fraud monitoring, the act mandates processes to protect health information. It controls more than digital electronic information, however: it controls paper charts, locks on doors and conversations as well.

HITECH
HITECH is the acronym for Health Information Technology of Economic and Clinical Health Act. It is part of the American Recovery and Reinvestment Act of 2009 and stipulates that healthcare providers be offered financial incentives for demonstrating meaningful use of electronic health records. It also provides for penalties for not using them and increases fines and jail terms for disclosure of health information.

The 9/23 Deadline
Since the passing of HIPAA in 1996, rules and revisions have been added to clarify and add to the regulations. Most recently, in January of this year, the HIPAA "final rule" -- the 2013 Omnibus -- was released. Part of that release was a mandate that all healthcare providers covered under HIPAA must come into compliance -- typically involving an assessment. There are 492 questions that comprise the rule's components, though-- a daunting asessment for any practice.

The quick and easy way
We've created a tool that reduces the 492 compliance questions to only 32, while still meeting the HIPAA standards. You will eventually need more work in this area, but this is a start. Of course, be aware that we are not lawyers, you shouldn't take action on information in this post alone, and we do not represent the government.

Click below for a quick-and-easy version of the assessment and come into HIPAA compliance.