ClickCare Café

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: telehealth, telemedicine technology, ACO

Are You Being "Tricked" into Ordering Extra Tests for Patients?

Posted by Lawrence Kerr on Wed, Apr 22, 2015 @ 07:30 AM

testsinmedicine

My teachers in medical school and residency did not take kindly to me ordering extra tests for patients.

You don't order tests that you don't need, they would tell me. Because when you're not following a logical path, but just poking around for what might come up, you can end up with bad conclusions, bad results, and wasted resources.

However, a recent article in the New York Times reminded me that medical providers are "tricked", guided, and incentivized to order extra tests at every turn. Dr. Zuger looks at how, these days: "Guidelines mandate tests, and patients expect them; abnormal tests mean medication, and medication means more tests."

No one is tricking us, and yet the system can influence us to make decisions we might not otherwise make-- no one's fault but everyone's problem. 

Why does this happen, when most medical providers know better? Dr. Zuger says that "As in education, our test-ordering behavior and our patients’ results increasingly define our achievements, and in the near future our remuneration is likely to follow." Plus, most of the technology we use doesn't help either. EMRs routinely spit out demands for tests that may not be necessary and this kind of poorly designed technology can skyrocket costs in the end.
In medicine, “true quality is extremely hard to measure,” Dr. Welch writes in a related article, “What is easy to measure is whether doctors do things.” And although pay-for-performance may not get at "true quality" completely, it certainly seems like an improvement from the current direct incentives for providers to shower patients with tests in a pay-for-services system that is not intrinsically bad, but is broken.
Ultimately, each of us can only guide our own behavior. When we choose to collaborate, use our EMRs in discerning ways, and let our good sense override the metric of the day, that's when we're contributing to a culture of extraordinary medicine. We see iClickCare as supporting those choices, but ultimately, you can do it with or without a tool to help you -- the important thing is following your own heart, training, and intellect.
For stories of how medical collaboration brings good choices back to medicine, get our free ebook here:
ClickCare Quick Guide to Medical Collaboration
Photo by tyfn on Flickr, used under Creative Commons rights

Tags: telemedicine, medical collaboration, good medicine, EHR, EMR, telemedicine technology

5 Tips for Using Technology with Medical Teams for care coordination

Posted by Lawrence Kerr on Tue, Apr 14, 2015 @ 07:30 AM

teams_and_technology

When I first started practicing, there certainly wasn't as much talk about technology. Now we're all thinking about BYOD, iPhones, EMRs, EHRs, and big data.

But there has always been discussion of how to use the tools available to us to make research stronger, care easier, and medicine better. And for decades, I've been experimenting with the best ways to use tools like telemedicine to support medical teams in caring for complex patients - facial deformities, handicapped children, spinal bifida and everyday care. Especially in the early years of computers in medicine, it was not always easy to get the team on board. There were a lot of long meetings, backtracking, and mistakes. So I learned some lessons the hard way about how to work on teams, integrate technology, and ensure great outcomes.

My 5 hardest earned lessons on using technology for medical teams, especially in managed care settings:

  1. Explain your technology choice and the reasons for your decision. Be open and honest with full disclosure of the pros and cons so teammates don't feel like they've been forced into a particular choice.
  2. Enlist the support of a champion. Find a person on the team with idealism and energy -- and show them how these new tools will help leverage everyone's efforts.
  3. Support the weakest link. After all, it is a team, and a team is only as strong as its weakest link. There are team members who preceded the information revolution. Often presenting themselves as proud of their computer illiteracy, they often strongly wish to be part ot the new age. So rather than leaving them behind, make them part of the solution.
  4. Make sure the technology helps solve the team's problem. We're all human, and it's hard to care about someone else's agenda. So if the technology solves the government's or joint commission's problem (as opposed to the team's or patient's problem), you'll struggle to get anywhere.
  5. Choose technology that is quick, on demand, detached from schedules, and delightful. Information overload has numbed minds, pained wrists, and strained eyes. The wrong technology for the wrong reasons (any reason that does not take care of the provider and patient first) will never work. Security is paramount, but when doubt, err on the side of simplicity.

 

 

Click here to get a rundown of telemedicine options and what to look for in a solution:

 

ClickCare Quick Guide to Telemedicine

Tags: medical collaboration, good medicine, telemedicine technology, managed care

How Bad Tech Can Skyrocket Managed Care Costs

Posted by Lawrence Kerr on Wed, Apr 08, 2015 @ 07:30 AM

tech

 

A sure way to form a bond with any medical provider is to share "war stories" of your EMR / EHR. Whether a specialist or a generalist, and across the spectrum of care, providers struggle with the heavy burden that this technology has created. 

EMRs with poor user interfaces, no collaboration mechanism, and formats that force counterintuitive thinking are hugely detrimental to providing good patient care. They contribute to the shrinking time we have with each patient and, as the article explores, can contribute to making mistakes. 

Things get even worse when you look at the performance of most EMRs / EHRs in managed care system. When the hospital system or ACO is responsible for the full scope of performance and efficiency for each patient, the losses that bad tech causes become compounded. There is an ever-worsening shortage of providers; how can we rationalize even a 20 minutes loss in their time each day due to bad tech? 

So what are providers and administrators to do? Well, we certainly don't have all the answers, and we know first-hand how frustrating technology can be. But here are 4 things that our colleagues have found to make technology in medicine a blessing, rather than a curse: 

  1. Invest in well-designed technology. Some products invest more in the design of the interface and functionality of the tool. Demand that the tool that helps you care for patients is elegant, easy to use, and helps you do your work in the ways you want to do it.
  2. Change how you work. As Robert Wachter said in the New York Times recently: "In health care, changes in the way we organize our work will most likely be the key to improvement... It means creating new ways to build teamwork once doctors and nurses are no longer yoked to the nurse’s station by a single paper record. It means federal policies that promote the seamless sharing of data between different systems in different settings."
  3. Figure out if there is just a lag time. The New York Times article above also mentioned what Erik Brynjolfsson, a management professor at M.I.T., described as “the productivity paradox” of information technology, in which there is a delay between adopting a new technology and experiencing the benefits from it. This is a reality to some extent, so patience can be helpful -- as long as you're not waiting for a gain that is never going to happen.
  4. As we shared in this post, you are not setting yourself up for success if you make huge investments in hardware. We recommend investing in software (which can be updated, and is generally the lowest portion of costs) rather than hardware which gets obsolete quickly. Use the equipment you already have, the spaces already available to you, and just start. 

 

One way to deal with poor technology at work is by bringing the tools that work for you, on your own phone / device: Bring Your Own Device (BYOD.) The challenge here is whether you'll run afoul of HIPAA. Click below to learn easy ways to stay secure. 

 

iClickCare IS BYOD Secure

Tags: telemedicine, telehealth, EHR, EMR, telemedicine technology, managed care

Innovation, like Telemedicine, Doesn't Have to be Fancy.

Posted by Lawrence Kerr on Tue, Jan 13, 2015 @ 07:30 AM

innovation
When we talk about innovation, what comes to mind?

For most people, "innovation" tends to be synonymous with the next new thing in technology. A designer drug, high-tech diagnostic equipment, or one of Apple's newest creations.

But what about the humbler kinds of innovation that are being advanced by medical providers day in and day out? For instance, a couple of years back, Dr. Sundari Periasamy identified 10-year-old Alaijah Borden's problem with her weight and did something both simple and progressive: she prescribed her fruits and vegetables in a program that made it easier to access and prepare the foods. Part of a pilot project, Alaijah and her family got nutritional education, recipes, and "health bucks" they could spend at farmers' markets.

After one year, Alaijah lost 5 pounds; a year after that, she lost an additional 8. Her mom started eating healthier too. Now, on the way to and from school, Alaijah munches on carrot sticks and fruit, rather than the cakes and cookies she used to stop off for. The Borden family is not alone. Of the 1200 families that participated, 97% of children ate more fruits and vegetables and after just 4 months, 40% of kids lowered their BMI.

So, no, the program is not the most sophisticated, the most complex, or the most newsworthy, probably. But it is innovative, in that it takes a complex problem and creates an effective solution.

So many times, we describe iClickCare to someone and, once they understand how telemedicine works and medical collaboration happens, it seems kind of obvious to them. They don't say "Wow! You must be a genius to think of that," they say "Huh. That makes a lot of sense.  People are probably doing that already." For us, iClickCare certainly is innovative, but so many other projects, big and small are, too. In fact, in so many ways, the most useful innovation means: 
  1. Solving a real problem. Kids, especially lower-income kids with weight issues. are not a flashy topic. But it is a real problem, affecting the lives and healths of millions. The problems we solve with medical collaboration and telemedicine are often similar. Perhaps it's a growth that could be cancerous, a gait that seems off, or the final stages of cleft palate surgery. None would make the news for uniqueness but all are crucial for the patient. 
  2. Using a solution that makes sense for the context. In the case of Alaijah, her weight solution had to take into account that finding and preparing fruits and vegetables is not an insignificant barrier. Had the doctor lectured the family about the problem, explained the issue at the molecular level, or even prescribed medication, it's very likely the little girl wouldn't have made any progress. But, like a simple software solution that can work on any hardware, Dr. Sundari's solution took the context into account.
  3. Working with people, not around them. Perhaps the most crucial element of an innovation is that it works with people to create solutions, instead of conceiving of a novelty and then trying to "get" people to adopt it. Just as in leadership, it's crucial for innovation to work with and for people, not trampling them for the sake of progress. 

 

For more stories of medical collaboration and medical innovation, click here: 

 

ClickCare Quick Guide to Medical Collaboration

Tags: telemedicine, medical collaboration software, telemedicine technology

How Telemedicine Can Help Your No-Show Rate

Posted by Lawrence Kerr on Thu, Nov 20, 2014 @ 07:30 AM

no-show_rate

 

My daughter works in a busy (hectic might be a better word) public-health clinic in New York State. It's a challenging patient base -- one with complex diseases and more complex life contexts for each patient. Even with those tricky conditions, these providers have had such extraordinary results that their practices are used as a model across the state.

That said, even her clinic struggles with no-shows. Providers will squeeze patients into an already overfull schedule, only to have that individual no-show the next day. Or a patient will be missing at their appointment time, but ask to be seen several hours later. It's difficult, but it's not surprising: the New York Times cites a no-show rate of up to 55% for most providers.

Non-compliance, of which patients not showing up for appointments, tests, or treatment is one variety, is always vexing for providers. It's not only frustrating, it can be dangerous. Plus, as the New York Times quotes American Medical News: “Medical liability experts say missed appointments and failures to follow up pose some of the greatest legal risks for physicians.”

Strangely, we've actually found this very human issue to be one solved by technology. Telemedicine has proven invaluable in helping with patient compliance issues, specifically this problem of making sure that the patient sees the providers she needs to, in a timely fashion.

So if no-shows are something you struggle with in your practice, here are a few ways that telemedicine can help make a difference:

  • Patients struggling to travel to a specialist can still be seen. For instance, veterans are increasingly accessing therapy appointments via telemedicine.
  • A telemedicine consult can mean fewer appointments. Rather than patients bouncing from provider to provider to "collect" perspectives, a store-and-forward telemedicine platform can allow providers to synch up without the patient having to make an extra appointment.
  • Followup is integrated. As the New York Times article points out, providers are often too squeezed for time to be able to follow up with patients to ensure they do what they're supposed to. Telemedicine can create a simple way for providers to check in with each other and make sure (in a matter of seconds) that the patient followed through.
  • Providers can communicate without hassle. When doctors aren't playing phone tag, it's less likely that things (like appointments or referrals) can fall between the cracks. Telemedicine can make it easier for providers to communicate how and when is most convenient for them.
Ultimately, no-shows may not be providers' fault, but it is sometimes their problem. And we're glad that there's a tool that can help, even if just a little bit.
Want to learn more about telemedicine? Get our QuickGuide:
ClickCare Quick Guide to Telemedicine

Tags: hybrid store and forward medical collaboration, telemedicine roi, telemedicine solutions, telemedicine technology

Can I Integrate My EMR or EHR with Telemedicine?

Posted by Lawrence Kerr on Wed, Feb 19, 2014 @ 09:01 AM

emrphoto resized 600

 

When our colleagues get excited about the possibilities of using telemedicine to streamline and improve the ways they care for patients, one of the first questions they ask is:

"Can I integrate an EMR with telemedicine?"


The short answer is yes.

It is 100% functional, 100% efficient, and 100% HIPAA-compliant to integrate any EMR with any telemedicine system simply by cross-referencing the EMR in the telemedicine system; or by cross-referencing the telemedicine consult in the EMR. We, and dozens of our ClickCare users, have found this to be a simple, low-tech way of effectively integrating the two platforms.

However, if a provider perceives that they must have an automatic, high-tech way of integrating the two platforms, then the answer becomes trickier. Here's why:

Medicine becomes more standardized, regulated, and homogenized every day. When I started practicing, I used to accept eggs from backyard chickens, or the promise of a refresh on my housepaint, as payment from folks without insurance.

As the years went on, it became disallowed for me to take payment in this way… and the expectation of all providers working in exactly the same way became status quo. Some standardization is good, and protects us in crucial ways, but I think we all have a sense that the baby (of creative and passionate medical care) often gets thrown out with the bathwater (of mistakes and inefficiency.) I see this kind of standardization is the way offices are laid out, "tips" on how to greet patients, and rule after rule about managing charts and records.

Another place I see this is in the ways that EMRs seem to be running healthcare providers, rather than the other way around. The EMR market is extremely competitive, with 4,800 different EMRs on the market in 2013. That competition means that EMR providers have an incentive to "edge out competitors" by advocating for extreme integration. It's like going to the salon, getting a great cut, and then hearing from the salon owner that in order to maintain the cut, you need shampoo, conditioner, and gel that cost $180 and all happen to be from their salon brand. EMRs have an incentive for telling you that all technology you use has to be provided by them. 

EMRs and EHRs are fantastic for storing patient information and making it available when we all need it. But telemedicine is not primarily for the storage of information. Telemedicine is for collaboration, problem-solving, teaching, and communication. So consider ignoring the EMR/EHR manufacturer when they say that absolutely everything has to come from them. Use a telemedicine tool that works for you, in the way that works for you, and cross-reference to the EMR/EHR.

We may not be able to "fix" medicine, but each of us can fix the way we interact with the tools available to us, making our lives as providers happier, and the care for our patients better.

Curious about telemedicine options? Get our quick guide: 

 

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of juhansonin on flickr.com, used under Creative Commons rights.

 

Tags: telemedicine, Telemedicine and HIPAA, telemedicine solutions, EHR, EMR, telemedicine technology, ehealth, telemedicine law

Review of iClickCare in Medical Office Today

Posted by Lawrence Kerr on Tue, Feb 07, 2012 @ 09:32 PM

We are pleased to have been reviewed by Medical Office Today and to be in such good company.

iClickCare in Medical Office Today

8 Popular Apps for Medical Practices by Daniel Casciato

http://www.medicalofficetoday.com/article/8-popular-apps-medical-practices?page=0,4

Our thanks to Mr. Casciato for his insightful curation and explanations. Taken all together with iClickCare they provide an interesting insight into making health care better.

  • Medscape
  • 5-Minute Clinical Consult
  • Jiffpad
  • Drchrono
  • GE Centricity Advance
  • Epocrates
  • ABEO Coder   
Click me

Tags: telemedicine, iclickcare, mhealth, telemedicine technology

Telemedicine Technology: 4 Things To Consider

Posted by Lawrence Kerr on Thu, Feb 02, 2012 @ 04:17 PM

Could this be the next telemedicine new thing? This review by Walt Mossberg describes an exciting device that let’s your HD TV become a whole room conferencing center.

telemedicine benefits from all technology

It is manufactured by a company called Tely Labs. It costs $250 and links through Skype. We are enthusiastic about such new developments, but we also remember that our 16 years of experience has shown us three things to think about:

  • Is what we are viewing easy to use, solid and usable on demand with the patient in front of you?
  • Is it secure?
  • Does it make a medical record for later teaching and documentation?
  • Does it allow a shift in time as well as place? In other words, do the requestor, the consultant, AND the patient all have to be present at the same time?

We also, in the past, have gone through the drill of purchasing a considerable amount of expensive equipment. Based on those purchases and experiences, we found that access to care is easier when scheduling is easier. Collaboration is best performed at a relaxed time for each provider individually, and that by having a database of each consultation, not only lawyers are served, but more importantly all those we educate -- the new hire, the graduate nurse, the medical student, the resident, or the nurse in training --  are served even better.

While we are very aware that Store and Forward technology provides all of these advantages, it is still not universally reimbursed. This is rapidly changing as noted in our previous post. In the mean time, creative products like this should be considered.

Please contact us if you would like to discuss further nuances of these types of decisions.

Tags: telehealth, store and forward, telemedicine technology

Subscribe By Email

Recent Posts

Posts by Topic

see all