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Telemedicine

Help is Just a Couple of Clicks Away

A Look Inside of ClickCare, LLC

ClickCare, LLC was started in upstate New York in 1995 and is now supported throughout the world by multiple physicians and nurses, information services executives and developers, and innovative engineers and consultants. Archives have been expanding since 2001 with the availability of digital cameras. Medical students and pediatricians are enthusiastic about seeing each others multimedia teaching cases and about getting help from subspecialists. Interest in ClickCare continues to grow because of the need for the increase in collaboration -- designed by healthcare providers for healthcare providers.

Take It From the Beginning

Larry and Cheryl Kerr had been physicians for over 36 years when they began to feel that the field they loved was deteriorating. Cheryl, a pediatrician, and Larry, a specialist in reconstructive surgery, had devoted their working lives to ensuring a universal standard for care for all patients. They now observed a worsening medical environment that threatened their patients and brought collegiality, communication, and collaboration to near extinction. Excessive paperwork, regulation, and profit orientation created silos: doctors were becoming unconnected and unaware.

Around this time, both Larry and Cheryl had begun hearing from providers they worked with, “If only I could send you a picture!” Their interest was piqued. They began experimenting with sending and receiving digital pictures of their patients for consults. The other providers, ranging from nurses to specialist physicians, all seemed to appreciate how effective the system was. With a picture, it was easy for a plastic surgeon to decide whether a wound needed a new dressing. A nurse could get a consult almost instantly in the ER, without having to wait for the doctor to navigate snowy roads to the hospital. Soon, the cry from providers was, “This is incredible! A picture really is worth a thousand words.”

How It Works

ClickCare, the telemedicine business that these experiences grew into, is used for problem solving. It allows multiple providers to collaborate on a case using pictures, words, and video, regardless of where the providers are or when they are able to check the case. ClickCare essentially combines the ease of email, the collaboration of an Operating Room, the security of HIPAA, and the richness of pictures and graphics. The founders claim that no other product has been able to synthesize an insider’s understanding of complex collaboration, a highly developed technology, with a gentle and appealing interface in any language. Most importantly, it helps providers more easily effect great patient results, as in the example case of Mr. J:

Mr. J is a 33 year old patient in excellent health. While working as a bartender, he intervened in an altercation, a decision he now regrets. He sustained a fracture of his left tibia necessitating open repair, and a fasciotomy, because of the extreme swelling. The orthopedic surgeon, knowing that later closure would be necessary, took digital photographs and added the patient to ClickCare from the operating room, late at night. An automatic e-mail signaling the requested consultation was waiting for the plastic surgeon when he arrived early the next morning. The plastic surgeon was able to quickly review the presentation and pictures while in the operating room and determine that the patient would be best served by allowing the swelling to subside. The plastic surgeon in turn requested help over ClickCare from the hospital WOCN, and negative pressure therapy was begun. Updated photos were taken and integrated with the history, showing the patient’s progress.
The patient was discharged from the hospital, with a stay less than the DRG average. A referral was made to the local Home Care Agency and the archive of surgical wound photographs as well as the clinical notes and progress were available to the home health WOCN, making the hand-off seamless. After several days of home care, updated photos and clinical impressions were uploaded by the home care WOCN allowing the plastic surgeon to review and provide direction, which included a change of therapy, without any unscheduled office visits. The orthopedic surgeon was included in the update loop, and physical therapy and x-rays were coordinated with the scheduled office visit.
Based on continued collaboration, the appropriate time was identified for skin graft surgery leading to an excellent patient outcome. Although the plastic surgeon only saw the patient once, face-to-face, he was able to direct high quality care based on an accurate understanding of the clinical picture. It being winter in Upstate New York, Mr. J. needed to brave the snowy streets, on crutches, only once in order to meet with his surgeon before his reconstructive surgery, and his visits after surgery were cut in half as Home Care monitored his wounds post-operatively. He returned to work and was warned to stay behind the bar.

The Growth

ClickCare was quickly seized upon by people providing wound care. Home care nurses and WOCNs are out in the field and frequently need to consult with a doctor or specialist to guide their care of the patient. Sometimes this results in bringing patients into the hospital unnecessarily. In fact, three saved visits a week by the agency more than pays for subscription and training costs. ClickCare allows these consults to become seamless.

ClickCare and the network of providers and collaborators that developed it are leaders in the field of telemedicine. Telemedicine, from the Greek tele meaning distance, literally translates into practicing medicine at a distance. ClickCare is part of this wave but does not use the traditional means of videoconferencing, which necessitates scheduling and cannot be archived. HIPAA compliance is assured while keeping the program as easy to use as a typewriter. The full effects remain to be seen but for now, the hardest-working people in healthcare can breathe a little easier knowing that help and guidance are just a couple of clicks away.

About the Founders

Lawrence P. Kerr, MD is a highly respected plastic surgeon who has brought academic, medical-center reconstructive capability to the area of Upstate New York. He did residencies both in general surgery and plastic surgery at the University of Pennsylvania. He specializes in infants with congenital anomalies but is frequently involved with medical and surgical patients of all kinds. Cheryl B. Kerr, MD is committed to outstanding clinical care, innovation in medical teaching, and the initiation and development of technology. Dr. Kerr's dedication to improving the health care of all children led to the establishment in 1996 of a telemedicine pilot project, the nation’s first, at two school-based health centers in the Binghamton City school district. Since ClickCare started, its spread nationally has increased efficiencies in many areas of healthcare but, especially, in wound care.

For more information, please go to www.clickcare.com.

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