ClickCare Café

Why Nurses are Uniquely Suited for Medical Collaboration.

ClickCare knows that the need to collaborate is more important than ever. Electronic Medical Records, Med Reconciliation Lists, and standard orders don’t hack it.

Medical collaboration, nurse management, coordinated care, care coordination and many more terms have been word smithed when just the words “good nurse” would do fine. 

It is the nurse who is on the floor and intimately sees changes in condition. It is the nurse who discusses with one specialist after another the many ideas of a particular patient’s care. It is the nurse who makes the many ideas understandable to that patient. It is the nurse who juggles meds with tests and therapy visits. It is the nurse who talks to the family and plans for home care. Sometimes, it is the nurse who finds the patient failing or dead. Finally, it is the nurse who smiles, pats, reassures and advocates. It is the nurse who is caring for the patient.

It is the ICU nurse who waits in the doctors' parking lot to accost the specialist who was too busy to call back!

Imagine how much easier your day as a nurse would be if you could supplement your documentation with clear and easy-to-use communication. Imagine less time spent hanging on the phone while grouchy office staff (could it be an overworked nurse?) “gets the doctor out of the room.” Imagine how much happier you would be to be able to show your colleague that you did your best irrespective of how things look the next morning.

We congratulate our nurses that we work with everyday, and those around our country. We are impressed with the care they manage to give to their patients despite heavy demands on documentation.

We are also following carefully how they are running a pilot on how to best use iClickCare to collaborate with each other from shift to shift and day to day.

IV sites, wounds, loss of skin integrity, cellulitis and edema can all be documented and shared without ambiguity.

Having spent a summer between medical school years working as a substitute pseudo-nurse during the last nursing shortage, I know well the feeling of the attending physician telling me that it could not have happened and could not have looked that way! Incredulously, the fact that I was there at the bedside the entire shift or more, seemed to have no importance.

Oh, how I wish I had been able to use iClicCare then.

That being said, ClickCare respects your role in healthcare and is working hard to empower you to do what you do best — care for the patient in so many ways.

 

                                                                                                                                 

Steve Wozniak Promotes iClickCare as Example of mHealth, Telemedicine

To quote Brandon Glenn in MedCityNews:

“And at least credit Woz with giving a special shout-out to one lucky telemedicine company: ClickCare, a New York company that’s developed an app that lets physicians collaborate on care with pictures and video on iPhones and iPads.”  

Steve Wozniak is an engineer who designs circuits to work in the most efficient and inexpensive manner. As Laura Montini quotes in Health 2.0, he said: “I got better and better at making things smaller and smaller and smaller...The number of chips it took for a design had to be the minimum. And it turns out that led me to some good life philosophies about trying to make everything the fewest steps possible.” Mr. Wozniak is beyond legendary and his contribution to mankind is so large, it even goes beyond those of others such as the Wright Brothers and Thomas Edison. 

We did not get a opportunity to ask him, but we wonder if, after hearing about iClickCare, those values are why he singled out ClickCare and iClickCare as the lone identified company in the ATA 2012 Keynote Speech. We freely admit to following the same principles as we design, improve and sell iClickCare and future products. We are committed to having a ubiquitously available, cost effective, simple, secure and spectacular service to allow providers to collaborate over the internet.

We did, however, get to see how personable, generous, and caring he is. We are honored. We are proud. We are humbled. We are also challenged to further grow into his standards and will continue to keep his principles of engineering in mind as we keep the timeless principles of medicine — access for the patient, collaboration for the provider, and education for the student — at the fore.

We recommend his book iWoz, available (as is our book iPhone Medical Photography) at these retailers:

Apple ITunes Store:

Amazon:

Barnes and Noble:

Google:

Medical Collaboration, ClickCare and 5 P's

Care coordination and telemedicine are coming to the fore.  The last two weeks have made 5 P's worth discussing.

• Publicity
• Pinterest
• Pigeon Holes 
• Principles
• Patients

Medical Collaboration and ClickCare in the News

Innovation in telemedicine, collaboration and coordinated care is finally getting its due.

All of us at ClickCare are excited to have Eilene Zimmerman of the New York Times identify us as innovative and disruptive. We appreciate the great and careful effort that this journalist made to get the story right with her constraints of space.

We have known for many years how we can best help our patients. We also know, while technology is at play here, good medical principles never change. The greatest of these is: The Patient is First.

The article in The New York Times was widely reviewed and tweeted. The well-respected online newsletter written by editor Sara Jackson of Fiercemobilehealthcare.com succinctly summarizes and reviews this again.

Over a month ago, Daniel Casciato in  Medical Office Today selected iClickCare as one of 8 Popular Apps for Medical Practices.

Because ClickCare was reviewed as business news, the measurement focused on making money. That is important to ClickCare. One major reason ClickCare was chartered as a separate company was the beseeching of a bright and forward thinking federal leader who felt ClickCare had a chance to become self-supporting and, therefore, not dependent on grants. Grantors become frustrated because invariably after the grant runs out, the massively expensive equipment is relegated to a pile in the back closet.

iClickCare by design is inexpensive, simple, and independent of complex equipment needs. This approach alone is innovative. It also is disruptive since it goes against current profit-oriented teleconferencing approaches. The disruption, however, is firmly grounded in good principles of caring for patients. So, there is much more to measure than financial success.

We care strongly about social impact. Thus we also measure and focus on the number of patients who have been helped, the number of physicians who go home and come back to work less stressed, happier, more satisfied and enthusiastic, and the number of learners who have seen what they would have otherwise missed.

Caring about social impact can sometimes be too big to deal with. When you use iClickCare, irrespective of your role in the health care hierarchy, you will notice the immense satisfaction of helping a single patient, time and again. That help comes in different forms — access to care that would not have been available, faster and easier diagnoses, less pain with wound care, and “Great Case Cures.”

As the healthcare debate intensifies, and ACO, accountable care, coordination of care, and the medical home, all come more and more to the fore, it will be more important than ever to count things other than dollars saved.

Join us in counting providers (from bedside aide and family to super-specialist) who are relieved of fear and isolation. And in counting how many patients are helped, by how much, with less missed time from work and less delay in diagnosis. These numbers stand in stark contrast to the cost per covered lives per day, and the like, but they are the important measures because after Patients First, come Providers — both current and future.

We are growing as a profitable company. We are doing so by measuring success as well as savings. It is a business adage that if one provides a service to one's fellow man, it will be rewarded. 

We are working very hard to provide that service. We will continue to count in many different ways.

WOC Nurse Week 2012: Models of Medical Collaboration

This week is WOCN week. 

We wish to honor these three special people. They are three dedicated nurses with whom we work everyday as we carry on with our clinical practices. They are nurses at United Health Services Hospitals.

• Janet Brhel, RN, BS, CWOCN.
• Christine Oliver, RN, BS, CWOCN.
• Ann Semo, RN, BS, CWOCN.

Telemedicine Security and HIPAA: What if you lose your iPhone?

You’ve followed HIPAA, now you’ve lost your phone. Now what?

It happens more than you would think. In 2011, statistically, each owner lost his phone at least once.

The most common places to lose your phone are:

1. Coffee Shop
   
2. Bar
3. Office   
   
4. Restaurants
5. Apartment & Condo
6. Grocery Store
7. Gas Station
8. Residential
9. Pharmacy or Drug Store
10. Park                                                   Source: Lookout Mobile Security March 22, 2012. Image: Wikihow.com

Since for many of us, the “office” is the floor, the ER or the Operating room, and we rarely get to the park, the grocery store, or bar, the list shrinks considerably. 

Here are some suggestions for not losing your phone:

• Keep it in the same pocket all the time, pants, shirt or pocketbook.
• Pat that pocket as you do your wallet.
• Don’t hold it, put it away.
• When at home keep it attached to the charger. Don’t let children play with it. It is a good substitute babysitter, but easier to lose, believe it or not.
• In the operating room, check your scrubs before they go into the laundry. If placed on a table or shelf, keep it away from the rest of the equipment and supplies.
• When using Medical iPhone Photography, take the picture, put the phone away, and then do your procedure. For instance, laying it down on the bed while changing a dressing has two problems:  (1) The patient lies on it and gets another pressure sore or (2) you lose it and the picture you just took.

This brings us to why we at ClickCare are making note of this study. First, replacing an iPhone is expensive. But, paying the HIPAA and HITECH fine is worse. A $500 loss could quickly become a $50,000 loss if the phone compromised patient privacy.

Second, if the picture is lost, and as the saying goes—you may have had only one shot at it--collaboration is that much more difficult.

iClickCare was specifically designed to solve these problems. 

First, even if your phone is lost, the pictures which were taken are hidden within a secure log-on barrier. Second, when an iClickCare visit or consultation is created, the data is sent, stored and available on the secure server. You may have wasted $500, but you have not lost your patient's information.

If you have lost your cell phone, just call or text it. Maybe someone can answer it.  Let it ring long enough for them to pick up. Provide contact information in the text.

The iPhone has the Find My iPhone feature. You can also kill the iPhone remotely. Here is a helpful article from PCMag about different phones and different choices. Another good article is in www.wikihow.com/

If you are lucky, like us, the nice people at the Roscoe Diner will put it behind the cash register for safe keeping!

 

                            

                                       

Source: www.liveintentionally.com

References:

Lookout Projects Lost and Stolen Phones Could Cost U.S. Consumers Over $30 Billion in 2012

Lost cellphones added up fast in 2011 – USATODAY.com

10 Ways NOT To Lose Your Cell Phone! | Schmoozins

Americans Lost $30 Billion Worth Of Cellphones In 2011, Study Finds

http://www.pcmag.com/article2/0,2817,2363526,00.asp

http://www.wikihow.com/Find-a-Lost-Cell-Phone

http://www.liveintentionally.org/2011/03/30/things-you-dont-have-time-not-to-do-13-make-a-place-for-everything/

 

 

Accountable Care and Provider Shortages

As accountable care expands, and ACO becomes as familiar an acronym as HMO, the delivery of care will change.

In a way, it seems as if this mega-industry reflects the same stresses as the disintegration of the nucleur family: two jobs, job sharing, a parent on the day shift, and one on the night shift, soccer, music lessons, friends. No wonder the calendar on the refrigerator door is so important.

A shortage of providers will be met by, as CMS describes it, by expanding the workforce. This brings up an interesting discussion of collaborative care and telemedicine.

Donald W. Fisher, Ph.D., CAE, is AMGA president and chief executive officer. AMGA is the American Medical Group Association. His organization reports a study about manpower needs on March 12, 2012.

"Collaboration and teamwork are significantly more important to medical groups and health systems because care models and performance measures require it. The ability to work effectively as a member of an accountable care team becomes a valued skill for physicians and advanced practitioners who increasingly will partner with colleagues in primary care, hospital medicine, a wide range of specialties and subspecialties and allied health."

Accountable Care Organizations (ACOs) and the medical home model are growing concepts in modern health care delivery. This survey by the American Medical Group Association (AMGA) and Cejka Search 2011 Physician Retention Survey is most interesting as it describes physician, nurse practitioner, and physician assistant staffing needs and turnover. Many shocking facts are brought to light. These facts add up to a roiling environment of instablility. Medicine, now consolidated as a "medical industry," if nothing else, was once considered stable. Now the core -- providers -- shows itself to be unstable and changing.

Thus, there are shocking facts:

• 67% of respondants reported "somewhat or significantly" increased involvement of advanced practitioners (non-physicians) in the past 5 years.
• Turnover rate of nurse practitioners and physicians' assistants is 12.6%.
• Three fourths will hire more in the next 12 months than the previous 12 months.
• Turnover can cost as much as $1 million per physician in recruitment, startup costs and lost revenue

Four more interesting facts from the survey:

• There is increased turnover. Turnover is nearly 6% in 2011.
• There is more part-time work. 22% of male physicians and 44% of female physicians as compared to 7% and 29% in 2005.
• More work is is being done by advanced (mid-level) practitioners.
• There is a huge shortage of providers developing.                                                                                 

Incentives to address these issues have been:

• Reduce hours
• Flexible scheduling
• Performance incentives.

There is a strong motivation to develop teams since they are the core of accountable care and of the medical home. With incentives, efficiency becomes important. 

Our interpretation of this data is both more specific and more broad: that there is a strong need to provide a way to build teams. These teams cannot just be items on a work schedule, but strongly need to have communicating, sharing, handing off, following up and educating -- people.

Moreover, the concept of centralization is no longer necessary, advantageous, or even possible. Just as the internet has decentralized commerce, the same forces will decentralize health care.

Our passion is to support and connect each individual to all the others in the team. We want to ensure that the patient does not continue to fall through the cracks, as a "disconnect" from care delivered from silos. We need to enable sign-outs, on- and off-call, continuity and creativity. With turnover, more education, and more collaboratoin is paramount.

 

                                                                             

                                                                             

 

 

 

Sources:

American Group Medical Association

Fierce Practice Management 

Cejka Search 

Calendar: www.bmscentral.com 

iClickCare: is it a distraction?

Could iClickCare be a distraction?

On December 14, 2011 Mr. Matt Richtel in the NY Times wrote about electronic devices when placed (forced?) into the hands of medical providers resulted in unintended distractions.

Many, many comments followed. Some fearful, some indignant, but all observing use and misuse of computers and smartphones. A dramatic mention of a neurosurgeon who was involved in a malpractice suit after using a wireless headset during surgery... clearly typifies abuse. It is sad to see colleagues who have much training but little judgment. A humorous advertisement shows the absurdity of such practice.

Any tool can be used for creation or for destruction. The ball-peen hammer is a necessary part of a tool box, and an oft used prop in murder mysteries. The EMR/EHR is cited in the comments. The electronic medical record should be a help, but judging by the comments in Mr Richter’s piece which we agree with, it has become more than a distraction, it has become a liability.

That is ironic since the EMR/EHR was in part designed to “document” in an litiginous environment where appearance trumps reality. Could it be that this misapplication of technology is worsened by a subtle, but well advertised, push to document so billing can be justified (or maybe enhanced)?

We at ClickCare are heavily invested in using technology to make things better for both patient and provider. We also remember the student who is left totally behind by expensive costs of EMR/EHR “seats.”  We are aware of distraction, and we are dismayed by anything that interferes with the provider/patient relationship.

                                                               

Our design principles follow this rule: that technology be assistive, simple and delightful. So when you see your doctor, your nurse, or yourself pull out an iPhone or stare at a screen and see iClickCare, be confident that you are involved in medical management that is supportive and exciting. Beeps, clicks, fields and page flips are minimized and distraction changes to problem solving.

iPhone Security, iClickCare and HIPAA

The New York Times reported this week that some iPhone apps were collecting users' address books and later, photos from users' camera rolls. Later, the same security risk was described in Android phones.

This risk does not apply to iClickCare. While the camera roll looks the same and works the same, it is placed within iClickCare itself, and thus is not accessible.

                                                               

When using iClickCare we recommend that you use the general device password. Of course, to use iClickCare a second layer of protection is provided since admission to the app is only by user name and password. iClickCare’s browser interface also needs the same login information. Parenthetically, users and usage are monitored by the secure server.

  

While any device can be hacked, it would take evil intent, and considerable skill, to breach iClickCare. We encourage use of the iPhone rather than a routine digital camera (which works with your desktop) in this very secure two-password schema, in that their is not a digital storage card which can be removed. Loss of the iPhone can also corrected by tracing and wiping the iPhone remotely. Of course, because iClickCare is software as a service, in the cloud, and instantly synced, your pictures and comments are not lost to you. They are unaccessible, however, to the iPhone thief if your lost phone was actually stolen.

More detail is available here:  The iPhone Camera Roll is described in greater detail in our book Medical iPhone Photography.

HIPAA Violations, Audits, and Medical Collaboration

There are both moral and regulatory reasons to protect our patients' privacy.

 
HIPAA and HITECH, at times, seem to be over the top. The regulations have certainly been interpreted, reinterpreted, over implemented, and a plethora of “saviors” has created an entire industry around them. I doubt some of the extreme responses to fear of enforcement and fear of technology are intentional, but never-the-less, we live with the unintended consequences that make our day difficult at best, impossible at worst.

That said, there seems to be 3 active responses by providers:

• Ignoring the rules.
• Never confronting the problem by never coming out of one's silo.
• Begrudgingly, following the rules, but hurting the patient.

How many times have you heard (or said): 

• “I just send an email.”
• “I just send an email, but I asked the patient.”
• “I am the doctor (nurse, therapist), I do what is right, the rules are stupid and don’t matter.” 

These are dangerous (to self and patient) responses to an impossible situation. There will be continuing enforcement, and there are easier solutions. We offer a good one.

Review this graphic from OnLine Tech. First, HIPAA audits are funded. $9.2 million to KPMG for 150 audits and $182,000 to Booz Allen Hamilton for Audit Candidate Identification. The funds come from the Office of CIvil Rights. Completion date is 12/31/2012.  

 

The most common types of covered entities that have been required to take corrective action to achieve voluntary compliance are, in order of frequency:

1. Private Practices;
2. General Hospitals;
3. Outpatient Facilities;
4. Health Plans (group health plans and health insurance issuers); and,
5. Pharmacies.

Most of these are easily solved. If one removes the simple Physical causes (77%), then the risk of violation is now left to Hacking (6%) and Unauthorized access/disclosure  (16%) and unknown at !%. No one is immune from hacking, although ClickCare works hard to protect against that. No one has to use email and risk enforcement, and as you see above, it is the small guys who top the list.   

 The message here:                                   

• This is real.                    
• This is significant.
• This is avoidable.

We owe our patients more than protecting ourselves by opting out.  There is an inexpensive and easy solution.

Sources:

HIPAA Audits Are Coming: KPMG Contracted to Perform 150 Audits Through 2012

2011 HIPAA Violations and Audits

HSS Office of Civil Rights (OCR)

Award Notice