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October 29th, 20115 questions about ClickCare: an interview by Eric Michaels
August 29th, 2011He called, we answered, and he asked us some interesting questions. We did our best to bring some insight about ClickCare and iClickCare.
Here is a link: Expert Interviews
For any of you who would like some more background about why we do what we do, we answered these questions:
- - After long careers as physicians, why did you start iClickCare?
- - Give me an example of how a patient would benefit?
- - If the internet is involved, how can privacy be assured?
- - Everything’s expensive in medicine, how does ClickCare save?
- - How does iClickCare fit into other healthcare IT initiatives?
- - How soon will I see this in my doctor’s office?
These questions are very commonly asked of us. Is there anything that we left out? Do you agree? We welcome your comments.
The Cry of Paul Revere
July 4th, 2011ClickCare’s founders spent their professional formative years in Philadelphia, working hard and seeing a lot. Not the least was exposure to wonderful mentors for Team and Collaborative Care of the patient. These mentors, Dr. Mary Ames, Dr. Peter Randall, and Dr Linton Whitaker had set up teams to care for the handicapped and facially disfigured. Some things are “copied” in iClickCare and some have been exceeded. They are continued influencers of how we believe and think.
Elfreth's Alley 1702 to present
Also, down the street and around the corner were Independence Hall, the Liberty Bell, Betsy Ross’s house, Elfreth’s Alley, the US Bank, Head House Square, and many other rich, idealistic reminders of the foundations of a free nation. No doubt, these influences are with us as well.
Now, we reference this article . You might not expect a technical reference in a blog related to collaborative care on behalf of the patient, securely, with pictures and words, over the Internet.
Always interesting, this technology site http://www.tidbits.com has had all things Apple for over 26 years. The article by Jeff Porten http://tidbits.com/author/Jeff%20Porten reports about the use, misuse, and misunderstanding of free communication among the populous of states involved in the Arab Spring. Much more than the Twitter revolution, he reports as the speakers talk about worldwide involvement, censorship, adaptation, and change. Individuals are making a difference.
Watch for vision of the same as we further understand ourselves on July 4, 2011. We remember how Paul Revere rode a horse and took initiative to make life better for his friends and family, and eventually, for us all. Healthcare needs a revolution, even a midnight ride, and each of us can get on a horse and gallop down the alley.
Tablets: a Syndrome, A Sequence, A Sign or A Symptom?
June 17th, 2011I read this report today from QuantiaMD research. They report the results of a survey of their online members.
Notable findings are:
- A high adoption rate of mobile technology, irrespective of years in practice or practice settings.
- A strong interest in tablet devices
- Use of both mobile phones and tablets
- A desire to use mobile devices to access EMRs
- Concerns about reimbursement.
Imagine this report as arising from a history and physical (patient assessment). The survey–the “examiner”,as a nurse or doctor, could be tempted to classify the report as a syndrome — a group of symptoms that consistently occur together, and be considered quite complete. We at ClickCare, however, find the report as a symptom —” what is told; or maybe a sign– what is seen or touched.”
Why? Because the “patient,” that group of doctors who were surveyed, feel unwell. That is their self-presented diagnosis. They think they feel unwell because they have the need to be the master of more knowledge, access more records, make their own diagnosis. Our survey “examiner” is told that they need more knowledge, is told that they need to look more things up, is told they need financial and institutional support. Probably all of this is just so, but they need so much more.
There are instead, other signs and symptoms that show they need more than they even knew: burnout, errors, early retirement, shortage of nurses. Intense attempts at control and regulation. They need the ability to collaborate and to share with their patients. They need to talk to each other between nursing shifts. They need to know that there is backup and help if they need it, when they need it. In other words, they need the strength that helping each other brings.
And thus, ClickCare sees the signs and symptoms: too much knowledge, too many demands, and no way to collaborate with each other. The diagnosis that this survey “patient” brings to the “examiner” is wrong. Yes, there are a lot of tablets and smartphones. Yes, we live in a mobile society. Yes, we need to make our lives made easier.
The syndrome: is a deficiency. We need access to knowledge and data, but we need more. We need even more ways to have better access for our patients, collaborate among ourselves, and educate those who follow us. ClickCare is the replacement therapy for the deficiency syndrome.
It is such a big problem, how can any one person make a difference?
May 30th, 2011It’s Memorial Day, and a time to remember all who served our country.
There are millions who have done so over the years. A few have been singled out to receive a Congressional Medal of Honor because they stood out with some act of unbelievably unselfish heroism.
But there are so many who just did their duty, unknown and unnamed. They are honored fully as well, because each has served and each has contributed to our safety and freedom.
In healthcare, we are in the midst of a battle that in a way is even worse than one with tanks and guns, bombs and planes. The magnitude and confusion, the noise and the panic are the same. And, people are dying.
Just as in a war, each of us can make a difference. Some of us will become medal winners, some of us will not.
Sometimes instead of trying to analyze everything, it is better to examine an important slice. Our recent attendance and presentation at the New York Mid Atlantic Consortium, a collaborative of genetic programs, illustrated this clearly to us. During college and medical school we learned about Punnet Squares, polymorphism, and decreased penetrance. By 2011, genetics has exploded. We now have the human genome. Cancers can be analyzed and their own genome described. Personalized medicine is not only imminent, but it has started.
The problem is, however, that there are not enough people to do the work that is needed right now, needless to say, in the future. There is so much knowledge that no one person can know it all. These are big problems. These are problems, in part, because of funding. Those who are passionate about the field wonder where the funding can come from. Meanwhile, every other segment of society is asking the same questions. How can we do what we need to do without more funds? How come other interests get more funding? There is so much to do, so little time, so few personnel, and so little money. What can we do?
We at ClickCare have decided that each of us can make a difference. Maybe it won’t be a Congressional Medal of Honor difference, or maybe it will. But each of us, like each individual whom we remember this day, can make a difference. Each of us can push forward and improve our lot. Funding is important, but its value is negligible compared the richness of many who do their little part and collaborate with others. The rewards will come later, or doing your part better may be the reward in itself.
For our, part, I can put a stake in the ground and say: “If you don’t have the funds to buy a ClickCare subscription, call us and we’ll personally work with you to make it happen.”
ClickCare can bridge the gap between what can and should be and what is. We know that better collaboration brings better care, better access to that care, and better education of those who provide that care.
We applaud each of those we met at NYMAC and know that each of them are trying to make a difference. Many of them have, and many are still at it.
We at ClickCare will keep trying too because each of us deserves better, and each of us can make the world a better place.
B2C and B2B: What’s Next?
April 28th, 2011
TNTC
Some of us will remember the old urinalysis report of Too Numerous To Count.
Certainly, the same report could be given for smart phone medical apps. We and our patients can track our blood sugar, exercise, blood pressure, weight, well being, stress and sleep. We have diet apps and women’s apps. We have medical references, and even physiologic monitoring.
Useful and concise reviews can be found at Medical iPhone. They reviewed ClickCare on Wednesday, April 20, 2011. A search in the Apple App store reveals nearly 6000 apps.
The buzz in the media, and the great majority of apps, center on those that are for the patient and consumer (B2C). There are many exciting (and some say futuristic) apps which help the owner of the smart phone to diagnose and care for herself. We do not demean these efforts, but have to ask the question: “What next?”
What does the provider do when the patient comes into the office hunched over, concerned, and holding a beautiful graphic display, delineating a consistently elevated blood sugar. She switches apps and the display shows blood pressure, high, as well. She has documented her intermittent headaches on her headache app. She brings in a Google search.
Google search for diabetes, hypertension, headache
She has not shown you an app for observation, but you observe acne and increased facial hair and think it unusual for a 43 year old.
So what next? Have you made the diagnosis? With which specialist should you confer? Do you call the renal person for her hypertension, a diabetologist, a neurologist? What studies would each like before seeing the patient? Since you know each of these as individuals in your community, and they are part of your natural network, who, indeed, could diagnose and comfort the patient best?
You have two choices:
1. You could pick up the phone or walk down the hall, wait until the CNA gets done with her break and ask her to dial. Or, you could wait on hold, ask the receptionist to ask the nurse to ask the doctor to “get him out of the room.” Or, you could tell the patient that she might have a brain tumor, a lung tumor, an obesity problem, a new onset of diabetes, a normal expectation of hypertension, and to go see one of the specialists and tell him what you think. Maybe you want to dictate a letter, and wait for one to be returned. Expect the patient to wait for appointments for a long time because these folks are really busy.
2. You could take a picture with your iPhone, distill the history, and with three clicks of the mouse, ask each specialist for his thoughts, preferred tests, and concurrence with your presumed diagnosis. Did you make yours yet? Each specialist gets back to you with a simple reply button, you call the patient, you share the diagnosis and the coordinated, collaborative treatment plan.
Someday, ClickCare will help each patient with her own care, but right now, today, it can help you, her trusted advisor, advocate, and experienced provider to care for her and yourself – quickly, securely, and with great satisfaction.
You just experienced (B2B). As the consumer wave rushes towards the medical professional’s office, help is available for those providers who care for them. Patients and consumers alike, still need help, and their providers need to help each other.
That’s what’s next.
Here is the Answer.
Or if you are really cool, take out your smartphone and read this bar code.
Use your barcode reader for the answer
Some people predict the future, some create the future, and some fear the future.
March 17th, 2011We meet all kinds of people as we spread the word about how collaboration can help your patients.
Here is a recent post, and notable quote:
“The iPad could change things. If you think in terms of, ‘Is that a form factor that works better so a visiting nurse can go out to a patient’s home, and say, ‘Gee, this wound doesn’t look so good. Let me pop a picture and send it to the surgeon, who can then access it on his iPad or anything else,’ I think that’s possible.”
Thomas J. Handler M.D., a research director in Gartner’s Healthcare Provider analyst group, tells the News Alert. 1
A safe prediction I would say: iClickCare is already on the iPhone and compatible with iPad. As soon as we have time to stand in a long line, we will be putting the iPad 2 through its paces and see how the camera works. We are pretty sure that it does, but after all, we were talking about the future weren’t we?
That is so then, and we are so now.
And finally, this response from a rather large organization that runs nursing homes:
“Photographs are prohibited at our facilities” 2
What things can you share that you are doing and seem like the future?
Footnotes:
1. Telemedicine and eHealth Newsletter, March 11, 2011,Mary Ann Liebert, Inc.
2. Anonymous, we would not want to embarrass them in front of our extensive readership.
3. Full disclosure: a different Gartner analyst has interviewed us.
EMRs, Twitter, 2011, and ClickCare: some thoughts for the New Year
January 5th, 2011There is a lot to talk about. Year end is for reflection. Year beginning is for looking forward. We are reticent to predict (as in Doctor, “how long does she have to live?”), but it seems as if all the buzz of stimulus monies, of EMRs, of personal health, of debate over health care, some fundamentals have been forgotten. Forget fundamentals, disregard principles, abandon commitments, but if you do so, you will be reminded that you “Can’t Fool Mother Nature”.
So we want to look forward to where ClickCare will fit in.
Three diverse concepts relate to each other: EMRs, Twitter with information overload, and the Cloud.
Many of us have made large, very large, investments in licensing, infrastructure and workflow for EMR/EHRs. We have spent a lot of human capital to be sure that we get on the wagon with meaningful use. We have kept a very close eye on stimulus money. Why would we want to challenge ourselves even more? Why, then, are we unsure of ourselves?. Perhaps, we feel that the fable of the Emperor’s New Clothes might come true. Perhaps, we can see no end in sight.
The Emperor's New Clothes
First, we should feel satisfied and confident that the EMR is already advancing. Electronic subscribing and fewer scattered repositories of patient information are most valuable. So while we worry that the “truth might come out”, all is not lost. The team at ClickCare is very committed to being sure that the EMR becomes an even more valuable resource because ClickCare and iClickCare can magnify it and fill the gaps that most fear to mention. There are limits to the EMR. Dr. Alok A. Khorana eloquently and wisely describes them in his brief essay, Physician as Typist, in the Journal of Clinical Oncology.
One point is the lack of focus on communication–his EMR author with him as the typist:
“I stare at the primary care physician’s note in front of me. I have been concerned about our mutual patient’s hypertension. I believe it has been exacerbated by the use of bevacizumab, and I have referred her back for additional management. All I need is an acknowledgment of the problem and a treatment plan. The note that I have received is three pages long and is filled with unrelated laboratory values, scan results, and jumbled-up text.”
In contrast were other notes, generated “by hand”:
I get other notes, too, from providers that haven’t yet adopted an EMR system. I made a recent referral for a patient with hematuria to a urologist. In a day or two, I received a one-page summary of the problem, including a differential diagnosis, the findings on cystoscopy, and the plan for additional surveillance. It was, really, all I needed. Another oncologic surgeon with whom I share patients always mentions the patient’s profession in the first sentence of the letter. It tells me something about the care that a surgeon who cares to find out such details will provide. However, as our institution transforms from a hybrid to a completely EMR system, these unique styles are likely to disappear.
What is the reason there is a difference between man and machine? Dr. Khorana perceptively notes:
“Recall that there are two major narratives associated with the physician-patient encounter. The first is the narrative told by the patient to the physician. The starting point of this narrative is relatively uniform: the complaint that brought the patient in. From here onward, however, the narrative can be remarkably free flowing and often tangential. To make sense of this free-flowing story, we as providers resort to a second narrative. The physician’s narrative repackages the patient’s tale, but in a format that serves the scientific goal of the note, which is to reach a diagnosis and treatment plan. Of necessity, it requires the act of listening closely and mindfully to the patient first.”
This article is clearly and cogently written. Reading it is highly recommended.
The reaction
What we would add is that ClickCare takes that very “act of listening closely and mindfully to the patient first”, and allows the listener to act upon it subsequently and cooperatively with other colleagues. Not with every patient, not with every visit, but when necessary and appropriate, to do so easily and quickly. Indeed, ClickCare offers the patient an audience of more than just one.
Another way of looking at this, is that there is too much information, and that communication is not taking place. Here are excerpts from an interview on the blog GIGAOM.
Om Malik, the blogger is interviewing Evan Williams, the cofounder of Twitter:
Om Malik: Ev, when you look at the web of today, say compared to the days of Blogger, what do you see? You feel there is just too much stuff on the web these days?,
Evan Williams: I totally agree. There’s too much stuff. It seems to me that almost all tools we rely on to manage information weren’t designed for a world of infinite info. They were designed as if you could consume whatever was out there that you were interested in.
Om Malik: Do you think that the future of the Internet will involve machines thinking on our behalf?
Evan WIlliams: Yes, they’ll have to. But it’s a combination of machines and the crowd. Data collected from the crowd that is analyzed by machines. For us, at least, that’s the future. Facebook is already like that. YouTube is like that. Anything that has a lot of information has to be like that. People are obsessed with social but it’s not really “social.” It’s making better decisions because of decisions of other people. It’s algorithms based on other people to help direct your attention another way.
They also discuss immediacy and relevancy.
Om If you were starting Twitter today – same service, but in a world that is very mobile, very multi-touch driven and a very portable web – what would it look like?
Ev: I’d have to think about that for a while but i don’t think it looks that different than what we have today. Twitter is a natural fit for mobile – it has the immediacy. There is nothing significantly missing, but (we) need to really boost relevancy. If you can’t read everything, then (what is that) you really do need to know right now.
Immediacy creates a need for mobility. Mobility creates a need for immediacy. Again, ClickCare supports and enables the EMR by enabling both immediacy and mobility regardless of which EMR was purchased.
Which brings us to the Cloud, and our last prediction about where ClickCare fits in. Many will become comfortable with the Cloud, immediacy and access. There are some who already expect it. The last mile of internet access not with standing (ClickCare can use 3G and Edge), communication with pictures and words can be the norm. We will expand more on this in another post.
In the meantime our prediction is that the patients will begin to get better care this year. We just need to look ahead and beyond.
mHealth–Is there a future?
November 15th, 2010A lot of people seem to think so. The most recent report, abstracted by research2guidance entitled “Global Mobile Health Market Report 2010-2015” was reported at mHealth Summit last week. We also heard the same theme when we presented at mHealth in San Diego, last month.
The statistics are amazing, and all point to the same message: we are all mobile creatures and would rather not be on a leash. Research2guidance estimates that 500 million people will be using smartphones in various ways for health care. These range from continuing medical education to unique monitoring devices.
We at ClickCare would caution, however, that the right tool, at the right time, at the right price should be used. We could not be more enthusiastic about iClickCare™ and the iPhone, we also know that sitting quietly at a large, easy to read computer screen can be as valuable as taking and sending a secure message and photo/video with the iPhone. That is why we have both available and included with each subscription.
Similarly, one can subscribe either via download from the App Store, or from our website ClickCare.com . A free two week trial lets you start collaborating with your colleagues immediately–with an iPhone, with a desktop, with a laptop or iPad.
Use a needle to sew a laceration or a shirt. Use a sledgehammer to crush a rock.
Use your ClickCare subscription in the way that is best for you at a particular time and in a particular place.
We look forward to your comments.
OnCall and Coverage: how many words?
October 8th, 2010We are sure you have heard that Eskimos have 100 words to describe snow.
Hawaiians similarly have many to describe the many emotions of the ocean. (full disclosure: some think that this is an urban myth,see: (http://en.wikipedia.org/wiki/Eskimo_words_for_snow).Hawaiians have many words to describe the many emotions of the ocean, These words describe their close relationship to their environment.
But have you thought about the fact that nurses and doctors have over 20 words for on call and coverage?
The new iClickCare™ for web and iPhone is about to be released. While working at this for over 15 years, we realized that on call and coverage are very important to all of us. So, we are building in a simple to use system that lets users to build there own coverage groups and on call notifications. Try to explain that to software engineers. We found that our everyday terms aren’t explicable to very smart people, and our developers are, indeed, very smart people! So, in order to help us clarify what we wanted to say, we started to place the very simple terms into a table. After a few minutes we had added row after row, and discovered nuance after nuance.
We even remembered, that in the modern day of medicine, there is yet another phrase: “Post Call”. A phrase that makes collaboration and ClickCare even more important.
Please look through the table below and add your own words about call and coverage in the comments. But remember,as difficult as it may be, this is a family oriented site, so don’t use the words that you really use when you have to cover and have to be on call! With great discipline and restraint we were very responsible and even controlled ourselves!
|
Root Word |
When used |
Root Phrase |
Modifying Phrase |
iClickCare |
|
Cover… |
Talking to someone who needs to know your schedule: |
I’m covering ___ |
the ER, at Hospital A, but not B, and I am on hand an plastic call |
Overview: on call list checked |
|
|
Talking to a patient who is another doctors patient and in the hospital, or talking over the phone |
I’m covering FOR |
Hello Ms Jones, I’m Dr Down, I am covering for Dr Salk this weekend. How are you doing… |
Overview: on call list checked |
|
|
Answering: Who is in you coverage group? |
I cover WITH |
these other doctors |
Coverage group |
|
|
|
I cover |
GI with Dr Wagenstein, but I cover pediatrics with Dr Down |
Two organizations |
|
|
ER |
Who is covering for |
Dr. X? |
|
|
|
|
Who is on call for… |
Plastics |
|
|
|
|
Who covers with |
the new doctor |
|
|
Privileges |
Administrator |
…privileges to cover… |
You are part of the ENT department, you do not have privileges to cover cardiac surgery |
Departmental control (credentialing) |
|
Department |
Academic |
…in the department of… |
I have a dual appointment in the surgery department, the vascular section and the radiology department |
I have been trained, certified and credentialed in two specialities. |
|
|
Administrator |
…in the department of… |
The disciplinary action will be reviewed by the surgery department and then referred to the medical executive committee |
Policy and procedure on done by department. Often historical and anatomically based. |
|
On Call |
Talking to someone who needs to know your schedule: |
I’m on call at__ |
the ER at Hospital A, but not B, and I am on hand an plastic call |
|
|
On Call and Coverage |
|
I’m covering ___ |
our practice, but I am not on call for the ER |
Call vs coverage |
|
Default |
Medical personnel, regulatory agencies, civil lawyers, criminal lawyers. |
Expectation is that all patients need availability at all times. To not provide it is abandonment both morally and legally. This is a long tradition. |
I did not know I was on call. I left a message I was out of town. |
Did you contact your coverage and document that in the chart? |
|
Slang |
in the barrel, in the box, |
|
|
|
|
|
On On for what |
|
|
|
|
Nurse |
my shift |
|
|
|
|
|
on duty |
|
|
|
|
|
off |
|
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