IT Support and Hardware for Clinics
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News, Information and Updates on Hardware and IT Tools to help improve your Medical practice
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Tips, Hacks, and Hope for a Better EHR System 

Tips, Hacks, and Hope for a Better EHR System  | IT Support and Hardware for Clinics |

All conversations about physician burnout eventually come around to the topic of EHR systems. The ongoing struggle with EHR systems is a chronic complaint, and physicians can feel that they are held hostage to their software. "If you're using a particular system, you have to go along with the flow," says Ron Sterling, president of Sterling Solutions, a healthcare information technology consulting firm in Silver Spring, Md., "even if that's not that way you would have done it yourself." However, there are ways to make the arrangement a little more comfortable. And there is reason to hope that things may soon improve.



"My system had the option of voice recognition software, and that saves a ton of time," says Peter Basch, MD, a general internal medicine physician in Washington, DC, and medical director of EHR and IT policy at Medstar Health. Even if voice recognition costs a little more at the outset, it generally saves money in the long run because it increases efficiency. If you've tried voice recognition before and weren't pleased, it may be worth a second look. "These programs have become much better, in the past few years" says Janis Orlowski, chief Health Care Officer for the Association of American Medical Colleges (AAMC).


You can also improve your relationship with your software by getting personal. "Medical language is a constricted vocabulary," says Basch. "Depending on your specialty or your practice, you tend to say the same things over and over." Basch recommends taking the time to personalize your software with macros and templates. "It takes a little time up front, but saves a huge amount of time in the long run," he says.


Power in Numbers

Of course, some of the problems must be addressed by vendors. "Many EHRs are put together without thinking of the user," says Basch. He describes such systems as being like a scalpel, but with the physician holding the blade end— "painful and not very efficient," he says. "EHRs are cluttered with redundant information," Orlowski points out. "Why are we including past surgeries, allergies, and so on every time? EHR's need to be smarter about displaying data," she says. You can no doubt add your own list of inefficiencies. But how to get software companies to listen?


"Vendors do listen to customer complaints," says Sterling. "But they wait for a general consensus before making changes." The best way to get the ear of your vendor is approach them as a group. If many doctors—particularly ones from the same specialty—have similar complaints, they're more likely to get results an individual grumbler here and there. Sterling also says that your chances of success are greater the more specific you can be. Rather than saying "I don't like the way this system handles orders," say something like, "I don't like that I have to cancel an order for a patient who is refusing care. I'd like to be able to leave the order as a recommended medication."


If your EHR is contributing to your burnout, it might be worth the time effort to try to improve your relationship with the software.

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How are college curriculums including telemedicine? 

How are college curriculums including telemedicine?  | IT Support and Hardware for Clinics |

As the use of telemedicine continues to increase in the health care workplace, it's important for medical schools to educate students on telehealth technologies before they are placed in the working world. Adding telemedicine to basic curriculum will give potential doctors, nurses and other health care professionals the skills and knowledge they need to make it in the every-changing industry.

Here are a few examples of universities that are staying ahead of the game, educating their students on telemedicine technologies and best practices:

NYIT College of Medicine

According to Becker's Hospital Review, the New York Institute of Technology College of Osteopathetic Medicine on the campus of Arkansas State University is adding telemedicine education to the first-year curriculum. Darren Sommer, DO, telemedicine assistant professor told Region 8 News that teaching students telehealth practices early on will prepare them properly for their future in the health care industry.

"If we continue to introduce medical students into the practice of medicine but don't include telemedicine, when they finally get into practice and they're acting as attending physicians they will not be prepared to deliver telemedicine services and they will be foreign to that," he said, according to Becker's Hospital Review.

College of Medicine at Chicago

Students who attend the College of Medicine at Chicago at the University of Illinois participate in the Telemedicine in Practice Curriculum, a five-module program that was designed to help students become more familiar with telehealth technologies. In this program, students will learn from multimedia lessons, interactive learning activities, simulated patient encounters and real-time patient care via telemedicine.

Texas Women's University and Old Dominion University

Both universities have introduced telemedicine programs into their curriculum to initiate delivering care in rural settings and underserved populations. By using AMD Global Telemedicine's clinical telemedicine programs, Texas Women's University and Old Dominion University are helping students prepare for the future of health care by teaching them how telemedicine provides efficient, coordinated care. Students are being trained on how to use the equipment, but they're also learning how the technology can leverage patient care and quality.

"AMD's clinical telemedicine system is the perfect complement to the curriculum we offer in the area of telehealth," said Dr. Mari Tietze, associate professor at Texas Woman's University. "Our telehealth electives are open to nursing, occupational health, physical therapy, nutrition, and health system management/business students. It is a great platform for them to understand how teams can collaborate and manage patients remotely."

Telehealth technology is the future of health care, so it's vital for universities to follow telemedicine curriculum practices. Learn more about some of the telemedicine systems AMD Global Telemedicine has to offer.

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9 Healthcare Cyber Security Tips to Help Protect Your Data

9 Healthcare Cyber Security Tips to Help Protect Your Data | IT Support and Hardware for Clinics |

As a forward-thinking individual who wants the most for your medical practice, you already have recognized the importance of using cloud-based healthcare software. The cloud uses multiple redundant facilities to store data to keep it safe in the event of a catastrophic breakdown in any one server center. Its information technology staff is focused on keeping the data safe and secure as well, and is devoted to making sure your patients’ records are available 24/7/365, even when cyber attacks plague institutions that are connected to the Internet.


Anyone who has been paying just cursory attention to the news will undoubtedly be aware that healthcare organizations are becoming a huge target for criminal computer hackers. You also know about the potential negative effects that a data breach will have on a practice, including loss of time and money and eroding the trust patients have placed in your organization.


Hospitals, doctor offices, and clinics have been exposed to cyber security threats that can cause grave repercussions. A common method of attack is to install ransomware. Once a medical organization’s system has been compromised, often because an employee clicked a link in a sketchy email, all the patient files are held hostage until ransom is paid. Computer viruses can arrive via email, text messages, and websites that are set up just for the purpose of attacking naive and unsophisticated end users.


So while the IT department of your cloud services provider will be handling security on their end, you still have to contend with potential security issues in your own office and make sure that your staff knows what to do to protect patient information.

With that in mind, here are 9 tips that will help improve healthcare cyber security in your organization and reduce the chance of attacks.

1. Ensure Staff is Properly Trained on Healthcare Cyber Security Protocols

In most situations, the weakest cyber security link in your medical practice will be the user. Ensuring that your staff knows all proper measures to take (and enforcing these measures) makes the organization as a whole more secure.

You may need to bring in a consultant who can first address the knowledge level of your team and then provide some training to get everyone caught up on the latest security protocols.

2. Don’t Put Off Software Updates

You are busy, and you do not like the idea of taking your computer system offline to conduct basic software updates. However, neglecting to get the latest version of your now outdated software leaves your devices much more vulnerable to attack. Any security patches that come with the update will be unavailable to you.

Criminal hackers take advantage of people’s complacency and can sneak into antiquated systems more easily than systems that have the latest protection.

3. Control Access to Protected Patient Data

You’ve undoubtedly seen news accounts of patients whose private information was stolen by hackers. These sensitive details are protected by the Health Insurance Portability and Accountability or HIPAA act. If you fail to keep this data secure, the results can be disastrous. Criminals hackers use confidential patient details to commit identity theft, take funds from bank accounts, and otherwise cause a great deal of havoc.

Have your security team carefully control access to patient records, only allowing authorized individuals to access the details. You can audit the system to verify who accessed what and when. It’s important to remove access from employees who have been terminated, to keep them from getting into the system and causing problems in their bid for revenge. Healthcare software like electronic health record applications make information access much easier to control.

4. Don’t Use the Same Password for Everything

Using easily guessed passwords or the same password for all platforms significantly increases vulnerabilities. Human nature will motivate your employees to use just one simple password to access their information, but this is a big mistake.

It can be tempting to set up one password to check your email, access your bank, and favorite online store as well as the see patient records, but convenience and ease of logging in instead of following patient security requirements have no place in a modern office’s computer systems.

All a criminal needs to do is discover one working password, and then apply it to all the other accounts that the victim uses. The convenience of one password leads to a catastrophic theft of data. Criminals can cause even more mischief if they get into the system and actually change information in patient files.

An easy solution is to force employees to generate new passwords on a periodic basis. That way, even if a criminal does manage to grab one particular login credential, access will soon be cut off as soon as you do the next update.

5. Store Passwords in a Secure Place

Instruct your team to never include passwords in a shared document or email. They should use a proven password storing system instead. Keep in mind that one common reason people have for skirting password security protocols has to do with their limited memory.

Instead of writing a password on a sticky note and hiding it in a desk drawer, it will be more effective if each user devises a password based on a phrase. For example, a member of your team could use a phrase such as “Every morning I check email while the coffee brews” and use the first letter of each word to make the password “emIcewtcb” with one uppercase letter. Including numbers and other characters helps make the password even more secure.

6. Perform Risk Assessments on a Regular Basis

Not knowing where your vulnerabilities are makes it much harder to protect yourself against attack. You won’t have a clear understanding of your organization’s security issues if you fail to conduct risk assessments on a regular basis.

Complacency is your enemy here. Your own IT team can perform the risk assessment, or you can work with more objective individuals by hiring an outside firm to take care of this task. 

7. Maintain a Layered Defense System

Have layered security protocols in place, so even if an attacker breaks through one layer, they still won’t be able to access the protected data, and your practice might be able to identify the attack before it’s too late. Just as you have multiple locking doors to protect your property, building and equipment, you should have many layers of defense against electronic intrusions. That way, even if a weakness appears in one aspect of your defense system, there will be redundant coverage.

So, in addition to using strong passwords and forcing workers to change them periodically, you can use physical security in the form of locked doors, security guards, and surveillance equipment. Antivirus software, a robust firewall, and whitelisting of approved applications all contribute to the overall security of your institution.

8. Have a Plan to Prevent (and Recover From) Data Breaches

In the unfortunate event of an attack, your practice needs to know what the next steps are. Having a plan in place will help you move forward after an attack. For example, your IT team should regularly review your healthcare cyber security protection to ensure you are always following the latest protocols.

This also means avoiding the practice of automatically allowing software updates before checking out any possible repercussions. And when you do assess an update, it’s best to try it out on a quarantined test computer to ensure a patch or update won’t negatively affect all the computers in your system.

To be ready for the aftermath of a successful intrusion, key members of your team should develop a plan for getting the system back up and running, confident that the cloud-based backup of your data will be clean and safe to use.

9. Install Better Software

Stress the importance of using software from a company that prioritizes cyber security in their software. They will update the software swiftly whenever a new threat has been identified. The surrounding applications used in your office must also be shored up.

High up on your to-do list, according to a report from Healthcare IT News, is to invest in a next-generation firewall to protect all data and your systems, and deploy the latest in anti-malware detection. Robust encryption is called for, and you might need to outsource some of your security information management.

Key Takeaway:

The fact that your healthcare organization has deployed a cloud-based solution for your medical software indicators that you already pay attention to emerging technology issues. Now it is time to take the necessary steps to shore up the sensitive information that you generate, store, and update for all of your patients.

  • Healthcare cyber security is one of the key issues that you and your staff must take great pains to address in order to stay in business.
  • News reports are filled with examples of criminal hackers that take over the computer systems of medical care providers, often locking information and demanding ransom to unlock the data.
  • Because you maintain patient data in the cloud, it’s essential that your organization follow industry best practices for cyber security.
  • Ongoing training of each of your staff members will help strengthen your cyber defenses.
  • Work with a healthcare software provider that has a demonstrated ability and commitment to updating its application on a regular basis.
  • Plan ahead about how your organization will react in the unfortunate event that your information does wind up getting breached.
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How telemedicine can help keep flu season under control 

How telemedicine can help keep flu season under control  | IT Support and Hardware for Clinics |

Flu season is upon us. It's a good time to remember the best protection is to stay ahead of it and keep it from spreading within our communities.

While the Centers for Disease Control and Prevention strongly recommends annual flu vaccination as the best way to protect against the contagious respiratory illness, many people will abstain from receiving the vaccine. This act has a major impact on those exposed to large populations, especially children in school.

When students with the flu or another virus attend classes, they put other kids and teachers in jeopardy for getting sick. By diagnosing these flu symptoms sooner and dismissing children from school at the right stage of the illness, facilities can prevent a flu outbreak early on. Telemedicine can be the tool to ensure this proactive stance happens successfully.

How does telemedicine impact flu season?

Telemedicine enables doctors to treat patients from afar, which can be incredibly beneficial for school systems during the flu season. Not only can facilities connected via telemedicine provide assistance and preventative care for students with early flu symptoms, but they can also treat students in the beginning stages of the virus and reduce exposing contagious students to a larger population, according to mHealth Intelligence.

Telehealth can enable protection for the healthy population and prevent the spread of the virus. This benefit can help schools dismiss children with the flu at the appropriate time and keep healthy students and teachers in class.

Success story: Sevier County Schools & Cherokee Health

For almost a decade, schools in Sevier County, Tennessee, have noticed improved overall health quality and reduced absences due to illness in students. Why? Because the school district has partnered with Cherokee Health Systems to integrate telemedicine health technology into their buildings.

"Sevier County has gone five years without closing a school down due to the flu."


By leveraging telemedicine technology, this partnership has completed over 11,000 telemedicine encounter visits that have enabled students to receive immediate diagnosis and treatment for strep throat, flu and other common illness. The telemedicine program with Cherokee Health Systems also helps students and teaching staff track and monitor ongoing issues, such as high blood pressure, diabetes and nutrition. As a result of the health and wellness initiatives with telemedicine, Sevier County has gone five years without closing a single school down due to seasonal flu outbreak. This is a big win for them, considering they previously had to shut down all the schools due to more than 20% of their population being infected by the flu.


By utilizing telemedicine solutions, more schools can detect flu symptoms during early stages of the virus by providing a full assessment and examination with the nurse. Telemedicine allows administrative staff to minimize distractions caused by sickness, such as missed school days, which can ensure education remains the top priority.

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How to do an effective Telemedicine Follow Up with Patients

How to do an effective Telemedicine Follow Up with Patients | IT Support and Hardware for Clinics |

When doctors consider doing a telemedicine follow up for their patients, they often do it in a haphazard way. There is a lot of confusion about the types of medical conditions that are suitable for a telemedicine follow up. Some doctors don’t even realize this is an option.

Most medical professionals are very used to being hands-on with patients. Indeed, some medical specialties demand it. But with a little forward planning, it can be easy to deliver an effective telemedicine follow up. This saves time and money for the patient. It also opens up another potential revenue stream for doctors.

Here are three important tips for an effective Telemedicine Follow Up:

1) Know what can be diagnosed at a distance

The first step in doing a Telemedicine Follow Up is to decide what can and can’t be done remotely. If a patient needs to be physically seen in the office, then this cannot be replaced with a telemedicine follow up. A full telemedicine diagnosis may require further information, but a follow up can be fairly simple.

In most cases, doctors are using a Telemedicine Follow Up for simple everyday monitor their progress, note any reported symptoms, talk through medications, review lab results, and generally check-in.

2) Decide on specific times for follow ups

One of the traps of telemedicine is that patients suddenly expect 24/7 access. A Telemedicine follow up should not become a burden for the doctor. Rather it is meant to streamline the process.

The best way to make sure this happens is to set specific days or times of day. Explain the process to patients and let them know to request a follow up rather than a consultation. Let them know the fee up front so there is no confusion about it being a free call.

3) Delegate all simple questions to the team

Very often doctors and medical teams will confuse a telemedicine follow up with answering questions. These are not the same things. Simple, repeated questions can typically be answered by the team.

To make your list of patient questions, think about what patients typically phone in about. Do they have quick questions to remedy small concerns? Are there side affects for some medications that may need to be checked? What other things do they call you about after hours?

These types of questions and concerns can often be handled with FAQ lists. Or your team can speak with the patient and answer them on your behalf. However if a patient is repeatedly using questions to avoid coming in, a telemedicine visit may be a better solution. It means the doctor is getting paid for the visit, and the patient is valuing the experience more.


Whether you’re working in outpatient or inpatient settings, offering Telemedicine Follow-Ups is a great way to care for patients. Telemedicine Follow up care can help ensure patients keep necessary routines. It can mean reduced readmissions, better care coordination and better overall patient outcomes.

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AI chatbots might be the money-savers hospitals are looking for

AI chatbots might be the money-savers hospitals are looking for | IT Support and Hardware for Clinics |

Healthcare provider organizations spend a lot of money on customer service representatives taking patient inquiries via phone, e-mail or live chat. But there’s a way technology can step in and save healthcare organizations time and money: automated chat-bots infused with artificial intelligence.


Among organizations in various industries, healthcare providers most of all will benefit from increased use of chatbots, which are becoming more adept at their work because of advances in AI, Juniper Research said. Chat-bots could save organizations $8 billion annually worldwide by 2022, up from $20 million this year, Juniper Research forecasted.


“We believe that healthcare and banking providers using bots can expect average time savings of just over four minutes per inquiry, equating to average cost savings in the range of $0.50-$0.70 per interaction,” said Lauren Foye, a Juniper Research analyst.

Most chatbots use multiple technologies: natural language processing, knowledge management and sentiment analysis. 

First, natural language processing tries to understand what a user is asking about. And second, a technological methodology provides conversational flow and responses, either direct or through guidance.


Typically, the natural language processing will identify the intent of a question with some level of confidence and then, based on the confidence level, the chatbot will either ask a follow-up or disambiguate the question for the user.

Once the confidence level is acceptable for the use-case, the chatbot will present the proper response based on an intent taxonomy that associates the intent of the question with the desired response. More advanced chatbots will try and anticipate the next question or guide the user to relevant resources or responses based on the previous intent.


“The technologies that support a chatbot need a common taxonomy in place that links the intent of a question to a contextual response,” said Jeff Cohen, co-founder and vice president of cognitive innovation services at Welltok, an AI-based healthcare software company. “And how do they interact to provide users with an answer to their question? There are many different ways to interact based on the sophistication and use-case for the chatbot.”


In addition to natural language processing technology, chatbots typically also rely on knowledge management systems.

“Knowledge management systems are absolutely essential in order to standardize the service experience,” said Khal Rai, an AI expert and senior vice president, product development and operations, at SRS Health, a healthcare software company. “Essentially, knowledge management systems are tools that allow you to document common questions and answers and problem-solving tips that are accumulated over the life of a product or a solution.”

It requires commitment and discipline by healthcare organizations to invest the necessary time and money to build knowledge libraries, Rai added.

Sentiment analysis is another technology that can be used by AI chatbots.


“How does the chatbot conjure up what is needed to be said?” asked Cohen. “Most AI chatbots need some content store or ‘traffic cop’ that knows, based on the intent of the question and the context of the user, where to obtain the proper response.”

AI chatbots have been used with varying levels of success in healthcare to date, addressing use-cases including helping consumers select a benefit plan, providing customer service responses, helping triage symptoms, and guiding consumers to resources. It still is early in the adoption of AI chatbots in healthcare, experts said, but early indicators of demand and satisfaction are promising.


“Chat-bots will continue to get more intelligent over time, thanks to AI and machine learning techniques that will make them very efficient technology, and of course, more timely than a human can ever be,” Rai said. “However, if you’re in the business of taking care of people, it’ll be a while before chatbots are fully adopted.”

Like other innovations, AI chatbots in healthcare will be a crawl-walk-run endeavor, where the easier tasks will move to chatbots while awaiting the technology to evolve enough to handle more complex tasks, Rai added.

“Research in the areas of emotional intelligence is happening,” he said. “But it is not advanced enough at this moment to put the satisfaction of customers on the line.”

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Ransomware and electronic records access, healthcare's biggest threats

Ransomware and electronic records access, healthcare's biggest threats | IT Support and Hardware for Clinics |

Of the varied threats facing healthcare provider organizations today, both external and internal, what rises to the top? Some cybersecurity experts have solid opinions on that.

When it comes to external threats, ransomware is the most urgent said Mike Fumai, COO at AppGuard, a cybersecurity software company.


“The longer term and newer threat with ransomware is medical devices,” he said. “Already hackable, but no real economic model yet for adversaries to focus on. That can change quickly. For example, they can simply extend the ransomware model by denying medical device use until a ransom is paid. The complexity of the medical device supply chain, however, poses even more exotic ransom possibilities.”


If a provider organization cannot treat patients because it doesn’t have access to medical equipment, records, billing processes, scheduling or vital third-party services, the impact is immediate, pervasive, urgent and even life-threatening – far worse than HIPAA fines and other typical data breach consequences.

“Healthcare providers are not prepared for ransomware attacks,” Fumai said.


So what should healthcare providers do to better prepare? Implement system back-ups and conduct realistic exercises to be sure they work is one tactic.


“Continuously conduct realistic, simulated attacks on your employees and track them individually, and on your organization two to four times per year to seek and fix human weaknesses,” Fumai said. “Form at least one peer group within 30 days with signed letters of intent to learn how to better fight ransomware and to field-test and hype-test cyber products and services before deploying them.”


When it comes to internal threats, access to patient records rises to the top, said George Brostoff, co-founder and CEO of SensibleVision, a cybersecurity technology company.

“Twenty-seven hospital employees in New Jersey were suspended after they improperly looked at the files of actor George Clooney, who was being treated after a motorcycle accident,” Brostoff said. “All of them had access to the files from inside the system. External hacks get all the press, but the real security issues that affect hospitals every day come from inside the building.”


When very private information is leaked, it is very embarrassing and damaging to a healthcare organization’s image and destroys the trust it has built with its patients. The specific data in patient records allows the source of the leaked information to be tied to the organization at fault.


“Most important, these leaks violate federal HIPAA rules and other regulations, which can put accreditation at risk and also open up the risk of lawsuits,” Brostoff said.

To combat problems associated with internal access to patient records, the first step is getting rid of passwords to protect any data, Brostoff said.


“They just don’t work, and everyone acknowledges that – even the guy who came up with the ‘Change your password every month’ approach to security,” he said. “Following industry best practices such as secure authentication, encryption and proper access policies is the only way to protect data.”

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Almost all large employers plan to offer telehealth in 2018, but will employees use it?

Almost all large employers plan to offer telehealth in 2018, but will employees use it? | IT Support and Hardware for Clinics |

Faced with another 5 percent increase in healthcare benefit costs, a growing number of large U.S. employers plan to focus more on how healthcare is delivered and paid for while still pursuing traditional methods of controlling expenses, such as cost-sharing and plan design changes, according to an annual survey by the National Business Group on Health.


As a result, more employees will have access to broader healthcare services including telemedicine, centers of excellence and onsite health centers during open enrollment while not experiencing major increases in their costs, the business group said.


The Large Employers’ 2018 Health Care Strategy and Plan Design Survey found virtually all employers (96 percent) will make telehealth services available in states where it is allowed next year. More than half (56 percent) plan to offer telehealth for behavioral health services, more than double the percentage this year. Telehealth utilization is on the rise, with nearly 20 percent of employers experiencing employee utilization rates of 8 percent or higher.


Employers are looking for ways to reduce healthcare costs while offering services and benefits their employees value, said Ralph C. Derrickson, CEO of Carena, a white-label telemedicine technology and services vendor.


“Carena has several health system partners who have established valuable partnerships with employers in their community by offering a competitive benefits package with virtual care,” Derrickson said health systems are increasingly partnering with vendors like Carena to offer competitive benefits packages that include virtual consults. 


Telemedicine can help lower costs associated with non-emergent emergency department utilization and reduce fragmentation by preserving and building on existing primary care relationships or establishing new ones, he added.


There are two prevailing factors that drive employers so widely into telehealth, said Roy Schoenberg, MD, CEO and co-founder of American Well, a white-label telemedicine technology and services company.


“The first are the return on investment numbers showing telehealth replacing higher-cost care settings, primarily urgent care and emergency rooms,” Schoenberg said. “These numbers are coming from payers but are applicable to self-insured employers just the same. Net cost savings around $200 per visit are quoted.”

The second reason is the growing appeal of telehealth as an employee perk, he said. At a time when health benefits are primarily cut, or their cost is shifted to the employee, adding modern and convenient healthcare benefits for employees can be a win for human resources leadership.


“There are many other factors that drive higher adoption, among them much better technologies, growing payer consensus, a regulatory requirement for reimbursement, and diversity of services that now go beyond urgent care, for example, behavioral health, child care, maternity, dermatology and more,” Schoenberg said. “But ROI and employee perk are the ones that move the needle the most.”


That said, while the Large Employers’ 2018 Health Care Strategy and Plan Design Survey found that 96 percent will make telehealth services available in states where it is allowed next year, employee utilization of telemedicine services today is only at 8 percent at only 20 percent of large employers. So what will it take to get many more employees to start turning to lower-cost, more efficient telehealth services?


“Telehealth is a behavioral change and as such has its own biology,” Schoenberg said. “It is inevitable that a good part of healthcare services will be rendered over technology, as we see in retail, finance, entertainment and everything else in our lives, but it will be a gradual process.”


Healthcare tends to be more sensitive to quality and trust concerns than, for example, the retail business. What that means is that adoption of the new ways of getting care potentially could be much faster when they come to patients under the traditional brands they trust today with in-person care. Schoenberg believes employer telehealth branded by providers will be the way to catch more employees.


“The growing trend of telehealth services that bring you – the employee, the consumer, the health plan member – not to a telehealth service but to Cleveland Clinic, Geisinger, New York Presbyterian, these will translate to a much easier adoption in the minds of Americans,” he said. “This trend is now happening and will become much more visible in the next 12 months.”

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What is Digital Imaging and Communication in Medicine (DICOM) and how does it work?

What is Digital Imaging and Communication in Medicine (DICOM) and how does it work? | IT Support and Hardware for Clinics |

When it comes to transferring digital images for telemedicine diagnostic purposes, it is important to adhere to the correct protocols. As the explosion of digital imaging technology has continued, so too has the improvement of standards and protocols.

A standard for communications among medical imaging devices has been set by the National Electronic Manufacturers Association (NEMA) in conjunction with the American College of Radiology since 1985.


The DICOM, which stands for Digital Imaging and Communications in Medicine, is the current standard for handling, storing, printing, and transmitting information in medical imaging. It includes a file format definition and a network communications protocol. It has been consistently upgraded under the acronym DICOM since 1993.

DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format. In this respect, it is the standard for todays medical imagining practices.

Within the DICOM standards are 4 key areas to understand and abide by:

1) DICOM Transfer Syntaxes

A Transfer Syntax is a set of encoding rules able to unambiguously represent one or more Abstract Syntaxes. In particular, it allows communicating Application Entities to negotiate common encoding techniques they both support (e.g., byte ordering, compression, etc.). A Transfer Syntax is an attribute of a Presentation Context, one or more of which are negotiated at the establishment of an Association between DICOM Application Entities.



A Service-Object Pair (SOP) Class is defined by the union of an Information Object Definition (IOD) and a DICOM Service Elements (DIMSE). The SOP Class definition contains the rules and semantics which may restrict the use of the services in the DIMSE Service Group or the Attributes of the IOD.


3) DICOM Modality

A DICOM data object consists of a number of attributes, including items such as name, ID, etc., and also one special attribute containing the image pixel data.  One of attributes – DICOM modality, that represents DICOM file type. In addition, each attribute also has a Value Multiplicity to indicate the number of data elements contained in the attribute.


4) DICOM Space Storage

Every DICOM file type made by different machines that generate data in different sizes. We present most common features that we are facing now.


For doctors wanting to transfer and share digital images as a part of their diagnostic process, it is important to be aware of following and adhering to the DICOM standards. However the current generations of telemedicine software do comply with these standards, making the role of the doctor an easier one.

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What are Real Time Interactive services in Telemedicine?

What are Real Time Interactive services in Telemedicine? | IT Support and Hardware for Clinics |

The best telemedicine and telehealth technology gives doctors a way to offer immediate advice to patients who require medical attention.

Today, thanks to advances in technology, there are several different mediums utilized for this purpose, including smart phone apps, desktop software, and electronically monitored home visits.

A medical history and consultation about presenting symptoms can be undertaken, followed by assessment similar to those usually conducted in face-to-face appointments.

Here are the key methods doctors and medical professional use Real Time Interactive Telemedicine services for:


Teleneuropsychology is an example of this type of telemedicine that includes neuropsychological consultation and assessment over video or phone with patients that have, or are suspected to have, a cognitive disorder.

Standard evaluation techniques are implemented to assess the patient via video technology. A 2014 study by the Journal of International Neuropsychology Society found that this method provides a feasible and reliable alternative to traditional in-person consultations, although it was noted that quality standards and administration must be upheld.


Telenursing refers to the utilization of communicative technology to provide remote nursing services. Consultations can be made over video or phone to reach a diagnosis and monitor health conditions and symptoms.

This is growing in favor due to the low cost and high accessibility of the services to patients, particularly for those in rural regions, or a Health Professional Shortage Area (HSPA). It also has the potential to lessen the burden of patients in hospitals because it is possible to address minor ailments earlier and patients can receive advice about whether hospital admission is required.


Telepharmacy allows pharmaceutical advice to patients when direct contact with a pharmacist is not possible. This allows medications to be monitored and patients can be offered advice over video conference or over the phone. Depending on regulations, refill authorization may be given to allow patients to receive regularly medications when required.


Telerehabilitation utilizes technology to communicate and perform clinical assessment and therapy for rehabilitation patients. This usually has a strong visual element with video conferences and webcams commonly used to assist in communicating symptoms and clinical progress.

These telemedicine services are a great step forward in improving accessibility of healthcare to all patients, particularly those living in areas with limited local health professionals.

Additionally, they offer a significant benefit of reduced cost in comparison to traditional in-person appointments.

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Top 6 Robotic Applications in Medicine

Top 6 Robotic Applications in Medicine | IT Support and Hardware for Clinics |

According to a recent report by Credence Research, the global medical robotics market was valued at $7.24 billion in 2015 and is expected to grow to $20 billion by 2023. A key driver for this growth is demand for using robots in minimally invasive surgeries, especially for neurologic, orthopedic, and laparoscopic procedures.

As a result, a wide range of robots is being developed to serve in a variety of roles within the medical environment. Robots specializing in human treatment include surgical robots and rehabilitation robots. The field of assistive and therapeutic robotic devices is also expanding rapidly. These include robots that help patients rehabilitate from serious conditions like strokes, empathic robots that assist in the care of older or physically/mentally challenged individuals, and industrial robots that take on a variety of routine tasks, such as sterilizing rooms and delivering medical supplies and equipment, including medications.

Below are six top uses for robots in the field of medicine today.


1. Telepresence
Physicians use robots to help them examine and treat patients in rural or remote locations, giving them a “telepresence” in the room. “Specialists can be on call, via the robot, to answer questions and guide therapy from remote locations,” writes Dr. Bernadette Keefe, a Chapel Hill, NC-based healthcare and medicine consultant.  “The key features of these robotic devices include navigation capability within the ER, and sophisticated cameras for the physical examination.”


2.Surgical Assistants
These remote-controlled robots assist surgeons with performing operations, typically minimally invasive procedures. “The ability to manipulate a highly sophisticated robotic arm by operating controls, seated at a workstation out of the operating room, is the hallmark of surgical robots,” says Keefe. Additional applications for these surgical-assistant robots are continually being developed, as more advanced 3DHD technology gives surgeons the spatial references needed for highly complex surgery, including more enhanced natural stereo visualization, combined with augmented reality.


3. Rehabilitation Robots
These play a crucial role in the recovery of people with disabilities, including improved mobility, strength, coordination, and quality of life. These robots can be programmed to adapt to the condition of each patient as they recover from strokes, traumatic brain or spinal cord injuries, or neurobehavioral or neuromuscular diseases such as multiple sclerosis. Virtual reality integrated with rehabilitation robots can also improve balance, walking, and other motor functions.  


4. Medical Transportation Robots
Supplies, medications, and meals are delivered to patients and staff by these robots, thereby optimizing communication between doctors, hospital staff members, and patients. “Most of these machines have highly dedicated capabilities for self-navigation throughout the facility,” states Manoj Sahi, a research analyst with Tractica, a market intelligence firm that specializes in technology. “There is, however, a need for highly advanced and cost-effective indoor navigation systems based on sensor fusion location technology in order to make the navigational capabilities of transportation robots more robust.”


5. Sanitation and Disinfection Robots
With the increase in antibiotic-resistant bacteria and outbreaks of deadly infections like Ebola, more healthcare facilities are using robots to clean and disinfect surfaces. “Currently, the primary methods used for disinfection are UV light and hydrogen peroxide vapors,” says Sahi. “These robots can disinfect a room of any bacteria and viruses within minutes.”


6. Robotic Prescription Dispensing Systems
The biggest advantages of robots are speed and accuracy, two features that are very important to pharmacies. “Automated dispensing systems have advanced to the point where robots can now handle powder, liquids, and highly viscous materials, with much higher speed and accuracy than before,” says Sahi.  


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4 Steps to Reducing Telemedicine Misdiagnosis

4 Steps to Reducing Telemedicine Misdiagnosis | IT Support and Hardware for Clinics |

Telemedicine misdiagnosis is a challenge for doctors who are looking to use the platform.

For over two centuries, the Doctors in society have been the source for explaining why we feel ill, and what can be done to change that. Yet with the explosion of online information in the past 20 years, it is impossible for any doctor to have the reach of the Internet when it comes to potential diagnosis.


Telemedicine adoption is on the rise and the growth is quite staggering. According to Bob Doherty from the American College of Physicians, “Doctors who ignore this latest competitive force do so at their peril, as it builds upon trends like pharmacy-based clinics that are providing increasing options for patients unable to fit their medical care into a 9-to-5 time frame.”

When a patient requests a telemedicine visit with their doctor, they assume that most conditions that can be diagnosed in person can be also diagnosed over a video consult.


For doctors, the role to becoming qualified to diagnose takes between 10-15 years. For this reason, it is reasonable to expect them to have a higher accuracy rate than most of their patients. However, for doctors when using a virtual format, there can be a risk of telemedicine misdiagnosis.

Telemedicine misdiagnosis can occur if proper steps are not taken before, during and after the consultation. To help, here are 4 steps to ensure doctors avoid telemedicine misdiagnosis when using the platform.


1) Prepare before the Appointment

It is advisable to educate patients about how the virtual visit will occur, and what is to be expected. If the booking is done virtually through an App, it is good to send some form of email confirmation as well.

You may have a list of potential conditions that can be diagnosed and medications that can be prescribed via the telemedicine platform.


2) Listen First during the Appointment

Consider the limited time you have with the patient on the screen, and the fact that the patient has likely self-diagnosed to some extent.

According to Dr David Troxel, ‘As a caregiver, it’s safe to assume that patients will come into the office already attached to a perceived diagnosis and possibly using medications improperly, based on their own online research.’

You might start with a quick understanding of what the patient already knows, and what symptoms they are reporting with. As explained by Dr Atul Gawande, it might help to keep questionnaire checklists for any conditions that may have similar symptoms. This will help to rule out misdiagnosis or missing multiple conditions.


3) Setting clear next steps

Once a telemedicine visit has been completed, there must be a clear course of action in the patients mind. Whether it is to take a course of medication, to rest, or to visit the practice for tests, this should be clearly explained by the doctor during the call.

For doctors, a lot of these next steps are typically explained by assistants. But on a telemedicine call, the doctor must take care of this themselves.


4) Consistent Follow Up

If a patient thinks that simply calling and reporting symptoms is the only step required, they are less likely to find telemedicine effective. This is my follow up is a good idea.

If the Telemedicine platform allows the doctor to message the patient this can be a great way to further follow up check in whether the symptoms have ceased.


At a minimum it can be a good idea to have a member of the team call or email to check in on how the patient is recovering. This will both increase patient trust and reduce telemedicine misdiagnosis.

A large reason why patients may avoid getting clinical confirmation is either the time constraint or the cost. This is where the adoption of Telemedicine by doctors potentially plays a role in bridging the gap.


Telemedicine is an amazing bridging technology. It enables offer patients a more reliable source of qualified diagnosis than simply searching online. It can assist a patient in confirming an initial self-diagnosis, by allowing the doctor to use their clinical expertise to the patients’ advantage. Doctors may advise patients to either seek a specific type of over the counter solution, or they may advise the patient to visit the office for further diagnosis.


To reduce the risk of telemedicine misdiagnosis, there need to be stringent protocols in place. Clear diagnosis criteria and knowing which types of consultations can be diagnosed remotely is important. Proper practices will help to decrease the risk of telemedicine misdiagnosis, and increase patients health and satisfaction.

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How to Launch a Telehealth Service in your Medical Clinic

How to Launch a Telehealth Service in your Medical Clinic | IT Support and Hardware for Clinics |

Many doctors are looking at how to launch a telehealth service. Doctors today are familiar with the telehealth virtual consultation model. Telehealth a few years ago was a new concept, but today it is becoming as common as using Uber, Airbnb and Venmo.

Doctors want to add the convenience and customization of telehealth services to their medical clinic. There is profit to be made and patients want the ease of remote visits.

The challenge is to know how to get started in a way that doesn’t interrupt your regular workday and can add value to both the patients and the office.

Here are 5 suggestions to help you launch a telehealth service in your medical clinic.

1) Choose a team member to lead

The success of launching a telemedicine service in your medical practice won’t happen by accident. You will need a dedicated team member who leads the project.

Think of it as a new section of your services that will take time, and need tweaking as you go. Choose a person on the team who has a good understanding of both technology and the patient relationship. Find someone who has an interest in moving the clinic forward and making a difference in the lives of patients. These values will be important as the launch will be challenging at first.

One tip is to plan a weekly meeting to review the progress with your telehealth team leader. Talk through the project and any challenges together. This will empower them and make them feel more focussed on main git a success.

2) Understand the rules and terminology

Telemedicine regulations will vary by state to state and insurance payer. It is important to know the specific rules such as your state’s law and the billing guidelines for all of your major insurance carriers. This A-Z Telehealth guide may help you guide your patients and help smooth over any confusion.

3) Decide on a platform

Perhaps the most difficult part of deciding on to launch a telehealth service is which platform to use. Each telemedicine provider will have their own benefits. Some are less expensive but offer little customization. Some offer more customization or better Telemedicine EHR integration than others.

It is important to know how much extra work a new technology will create, alongside any costs. Remember the time you spend working out the bugs is a key factor in the success or failure of your telemedicine implementation.

4) Start slow and test your process

Many offices will think launching telehealth means diving in the deep end and offering it to all patients immediately. All this will do is cause headaches. It is better to start slow, perhaps offering one or two telehealth visit slots per day, to begin with for the first 2-4 weeks. Then you can track the progress, refine the process and slowly and profitability of those telehealth visits.

5) Offer and Market to your best patients first

You probably have a pool of long term patients who are easy to deal with and have more common, easily remedied complaints. These are the ideal group to start with. This is because they are not likely to cause extra challenges above and beyond getting used to the technology. If you have an established relationship, this makes it easier as well, as they are more understanding that this is a new service.

This guide to launch a telehealth service in your medical clinic is just the start. There is no denying it will be a challenge but is well worth the effort. It will offer a new way to care for your patients and grow your profitability. If you think through the steps, and stay the course, teleahealth will become another successful, beneficial offering for your patients.

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4 conditions your clinic can tackle through telemedicine 

4 conditions your clinic can tackle through telemedicine  | IT Support and Hardware for Clinics |

Living with a debilitating disease can be overwhelming. Not only does it have an impact on overall wellness and longevity, but also the time, effort and money patients spend traveling to see specialists can limit the quality of care they receive. Still, these physician visits are critical to health outcomes, so patients could benefit from an easier way to keep their plan of care on track. That's where telemedicine comes in.


Technology is positively impacting the health care industry in various ways, and telehealth is an example of an effective tool for those living with chronic conditions. There is a direct correlation between access to care and quality of care, and telehealth closes the geographic gap to where and when people can get the care they need

4 chronic conditions supported with telemedicine

The ability to increase access to care via telemedicine has proven to be a convenient way to manage chronic disease. Here are four common conditions that telehealth can assist with:


  1. High blood pressure - According to Health IT News, someone living with hypertension can utilize telemedicine to connect with a specialist via video conferencing and discuss data from their wearable device

  2. Diabetes - Rural patients managing diabetes often lack access to a specialist. Telemedicine has proven a viable way to manage diabetes and when necessary, provide a high level interaction between patients in rural areas and diabetic specialist in larger urban centers.

  3. Depression - Discussing anxiety or other feelings related to depression with a psychologist can be done via telemedicine, as Mark Rood, MD, told the Cleveland Clinic. It's the same type of conversation that would happen in the office, so telehealth takes away the time and effort spent to meet in person.

  4. Arthritis - Determining one's range of motion doesn't have to happen face to face. With telemedicine, a patient living with arthritis can demonstrate how well he or she is healing and ask for additional recommendations if pain has worsened.


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Benefits of telemedicine during pregnancy 

Benefits of telemedicine during pregnancy  | IT Support and Hardware for Clinics |

Pregnancy is an amazing experience for mothers, but it can come with a number of challenges. Beyond the sometimes debilitating symptoms of pregnancy, mothers who are expecting must see their doctors multiple times throughout the gestation period. This requirement can be difficult for women who need to see numerous specialists, have busy schedules and have limited means of transportation. Still, expectant mothers are encouraged to attend all pre-term doctor's appointments to receive expert care and necessary monitoring of their unborn children.

To ensure all mothers are receiving the care they need throughout their pregnancies, pre-natal healthcare providers are implementing telemedicine solutions into their current offerings. Read on for some of the benefits of introducing telemedicine to expectant mothers.

Frequent check-ups without the need to travel

The technology already available today for pre-natal care is amazing!  Coupling in telemedicine with the existing practices just makes the reach even farther. Healthcare providers trying to deliver access to care for expectant mothers who might not be able to travel to an urban facility for care, can now easily perform examinations on patients using live ultrasound technology. This opens up a whole new way of doing pre-natal check-ups, by streaming ultrasound images directly to the remote provider at the time of the check up.

Instead of traveling from doctor to gynecologist to specialist to share information in regard to their pregnancies, mothers can also utilize telemedicine to transfer data among many medical professionals. Women who are expecting already have to attend doctor's appointments once a month up until the 28-week mark, when they then have to see their physicians twice a week up until the birth of the baby. If a mother has to see more than one doctor, she may not have the time or resources to make it to every extra appointment.

Offer services where specialists are rare

A mother who is experiencing a high-risk pregnancy will have to see doctors more often than the average pregnant woman. Again, this need can be difficult for someone who has limited access to care, such as a patient living in a rural location, or means of transportation to drive to the city where the specialist provides assistance. When more hospitals offer telemedicine solutions, mothers who need special treatment from a cardiologist or other medical professional during a high-risk pregnancy will have better access to those resources. Remote video conferencing allows for emergency consultations that can save the life of the baby and the mother who's carrying, ultimately improving the quality of care your hospital provides.

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4 Benefits of Telemedicine for Patients and Clinicians 

4 Benefits of Telemedicine for Patients and Clinicians  | IT Support and Hardware for Clinics |

Technology has improved every industry, but the medical industry has been impacted more than most.

Telemedicine allows doctors to provide quality care to their patients live via the web, rather than requiring in-person appointments.

There are countless benefits of telemedicine, which is why so many physicians and patients are starting to take advantage of it.

Below we’ll explore four of these benefits. Let’s take a look, so you can see if telemedicine is right for you.

The Four Main Benefits of Telemedicine

1. It’s Convenient for Both Patients and Clinicians

Without question, convenience is one of the biggest benefits of telemedicine for both patients and clinicians.

Think about it – a traditional, in-person appointment requires a patient to physically go to the office, fill out paperwork, and sit in the waiting room until called. Typically, they first see the nurse, then the doctor, and then the nurse again, and then they have to go back to the front desk to pay the bill. What should be a quick and routine check-up can take a whole morning!

Telemedicine allows for a quick and easy “face-to-face” appointment without requiring a patient to leave the comfort of home.

Doctors get the chance to see patients quickly without running from room to room, which makes this a win for both parties.

2. Doctors Get True One-On-One Time with Patients

During a telemedicine consultation, it’s literally just the patient and the doctor. There are no office distractions or go-betweens involved.

Because appointments must be scheduled without overlapping, doctors can be relaxed, focused, and thorough with each visit. Similarly, because of the convenience telemedicine offers, patients will be more relaxed as well, and more open in their questions (or answers to your questions).

This level of one-on-one time gives doctors the space to provide their best possible care.

3. Patients Can Get Prescriptions and Referrals Quickly

Imagine running out of your allergy inhaler the Saturday evening before leaving for your outdoor vacation, and your prescription is out of refills. This can be a huge predicament if you have to wait until normal business hours to get a doctor to order a refill for your prescription.

With telemedicine, patients can connect with a doctor who can review their medical records and quickly provide prescriptions or referrals as needed, even outside normal business hours.

Even better for practitioners, the ability of patients to have a quick check-in for prescription refills or referrals means you can devote more of your in-office appointments to patients with more complicated needs.

These quick telemedicine consultations provide the same level of HIPAA certified privacy, with the speed and convenience of an online transaction.

4. Telemedicine Is More Cost-Effective

For patients, access to telemedicine provides professional medical care at a cost that is lower than or equal to in-office visits. Because telemedicine decreases (or eliminates) the need to travel and miss work, patients can end up saving a significant amount of money versus traditional appointments.

With medical expenses through the roof today, patients are looking for new and different ways to save on their healthcare. This bodes well for the telemedicine industry since 74% of people surveyed said they would use it.

The great news is that telemedicine is cost-effective for clinicians as well!

A thriving telemedicine practice does not require extra space or extra staff, and telemedicine patients don’t require as many physical resources as in-office patients. Additionally, your practice will gain an increased reach when you are able to hold consultations with patients who cannot travel to your office.

The ability to see more patients, and the need for less physical space and fewer physical resources, means a more robust bottom line.

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Telehealth Essential Resource Addiction Treatment

Telehealth Essential Resource Addiction Treatment | IT Support and Hardware for Clinics |

In a recent article in The Atlantic, the former head of the National Institutes of Mental Health, psychiatrist Tom Insel, pinned the future progress of mental healthcare on one small but transformative piece of technology: the smartphone. Insel is reportedly convinced that “the smartphone can be a diagnostic instrument and, through the links it gives us to others, a life-saving mode of connection and treatment.”


Insel is on to something—and, as an addiction clinician, I am persuaded that telehealth initiatives (like smartphone apps) can also be an essential, life-saving resource for the substance abuse population. Proper legal and ethical training is key for therapists who plan to offer telehealth services, but that extra effort can have powerful results.


First, addiction’s chronic nature makes ongoing assessment and regular follow-up critical factors in effective care—for those in early recovery especially. Accumulated research has shown that like other chronic diseases, SUDs can be characterized by relapse, and rates of relapse tend to be highest during the first year following treatment. Yet outcomes are better among those who make regular and more frequent use of a supportive network in their recovery (such as ongoing individual therapy among others).

Inevitably, the ease and convenience with which these supports can be accessed are therefore crucial. Many of the clients who leave my care go back to full-time jobs, parenting roles and other responsibilities (including recovery commitments like weekly 12-step group attendance). Many clients return to areas of the country where therapists like myself are in overwhelmingly high demand but painfully short supply. Even in clinically well-resourced regions of the country, addiction therapists tend to carry heavy caseloads, and burnout remains a common feature of the SUD treatment landscape.


Such factors can often preclude regular, in-person follow-ups with a therapist—even when the long-term support and accountability these sessions provide may be critical to recovery (depending on the client and their treatment needs). The reality is that the necessary demands of life can dampen even the most dedicated commitment to follow-up therapy. There’s little utility to seeing a therapist weekly if it means you can’t hold down a job, after all (especially when job retention itself tends to support long-term recovery). On the other hand, virtual therapy apps like Talkspace make it easier and more convenient to keep in regular, even frequent touch with a therapist.


Telehealth also provides near-instant support for a disease that, unlike any other chronic disease, is distinguished by cravings. When left to their own devices (without immediate intervention), these compulsive desires to drink or use drugs can often drive and precede relapse. They also don’t always follow therapist work hours or take the same vacation days. A craving may strike in the middle of the night or on the weekend, at which point the more old-fashioned method—of leaving a voicemail for one’s therapist—proves useless.


That’s where videoconferencing and instant text messaging are part of the solution, as are innovative apps like the A-CHESS mobile app. The app provides users with a “panic button” for when cravings hit. Press it and presto: within a matter of minutes, users can access help and support that is individually customized to their needs.


But telehealth is probably most urgently needed as a bridge to treatment for the millions of Americans who would never darken the door of a therapist’s office because of the enduring stigma of substance abuse. That stigma is arguably worse in rural and underserved areas, where an in-person appointment with the only therapist in town likely means you’ll run into your next-door neighbor or a familiar business patron. Videoconferencing apps that allow clients to connect with a properly trained therapist in a secure, online meeting room from the privacy of their own home provide that assurance of anonymity. For many with SUDs, that’s a non-negotiable prerequisite to getting help and beginning the journey to recovery.


Candice Rasa, LCSW, is Clinical Director of Beach House Center for Recovery, a drug and alcohol addiction rehabilitation center in Juno Beach, FL. She has more than 10 years’ experience in the mental health and substance-abuse arena, and supports healing in the clients she serves from a solution-focused, strengths-based approach.

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8 Amazing Ways Telemedicine Is Changing Healthcare

8 Amazing Ways Telemedicine Is Changing Healthcare | IT Support and Hardware for Clinics |

Not everyone has access to good healthcare. Telemedicine increasingly serves as the bridge across the access gap, providing service solutions in a wide variety of specialties, and in unexpected ways.  Telehealth practitioners provide clinical services to patients by making use of electronic communications, specifically common voice and video technology. Services might occur via teleconferencing, image sharing, or remote patient monitoring. Here are 8 amazing ways telemedicine is changing healthcare:


According to research carried out in Georgia, stroke patients who went to a hospital that is part of a telestroke network received treatment 20 minutes faster than those in hospitals outside the network. Because a stroke victim has an increased rate of survival in proportion to the speed of diagnosis and treatment, early treatment is crucial. Fortunately, this is exactly what telemedicine makes possible.


Telemedicine provides great support within the ICU. It functions mainly to help physicians and nurses maintain their focus amid the myriad distractions that arise in a hospital. As a result, practitioners follow procedures for keeping proper track of a patient’s medication, monitoring blood pressure, and so on more consistently and effectively.


Telemedicine now helps with discharged patients as they undergo their rehabilitation at home. This is a great help considering how challenging it can be for rehabilitating patients to travel to healthcare facilities. The primary use of telemedicine in this context is allowing patients to participate in online education groups.


To buck the trend of deaths as a result of cardiovascular diseases, patients must work closely with doctors for help in the areas of losing weight, quitting smoking, and so on. Through telelemedicine, patients can eliminate the hassle of frequently going to a doctor’s office. Patients are happy to go online to send and receive information from their healthcare provider, and generally find it much more convenient and efficient than a typical office visit.


Diabetes patients benefit a great deal from telemedicine. It is easier to track a patient’s calorie intake, monitor medication and doses, and log workouts, among other things, with the help of mobile technology. Among groups of diabetic patients, older adults see the most advantage from the incorporation of telemedicine to their treatment and monitoring.


There are various long-term chronic conditions that can make good use of patient self-management, now possible through telemedicine. Hypertension and some varieties of digestive-related diseases are examples of such conditions. In cases like these, utilizing telemedicine for patient management reduces the number of inpatient visits the patients need to make and improves patient management.


Telemedicine improves dentistry access and services by allowing dentists to share information. As a result, specialists can recommend solutions before a condition worsens and results in excessive costs. This process is particularly helpful to those in rural areas.


Dermatology is another area of medicine that embraces telemedicine. Patients with skin problems now can send an image of their skin to a direct dermatologist, along with their health history, and receive a determination in two days. This saves patients the inconvenience of constant referrals from one specialist to another.

Telemedicine enhances healthcare in many ways, and has made navigating healthcare easier for practitioners and their patients. Give CIS a call to find out how telemedicine can improve and expand the services you provide!

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Why Are Telemedicine Doctors Important?

Why Are Telemedicine Doctors Important? | IT Support and Hardware for Clinics |

It’s no secret that healthcare costs continue to rise year after year. As a result, patients are having more difficulty accessing traditional physician’s services.

The American Hospital Association (AHA) recently reported some surprising healthcare statistics. Over 76 percent of patients place more value on access to health care than on having in-person interactions with their physicians.

The number of telemedicine patients in the United States is growing dramatically. In 2013, there were 350,000 patients who opted to consult with telemedicine doctors. By 2018, that number is predicted to be over 7 million.

It’s clear that this trend is changing healthcare in amazing ways. Telemedicine doctors are offering an incredibly important service.

This medical trend presents many significant advantages over traditional doctor-patient relationships.

Telemedicine Doctors Are Easily Accessible

Telemedicine offers a convenient solution for many patients. For example, it provides significant advantage to parents of children with chronic medical issues. Similarly, it also offers alternatives for patients with difficulty driving.

Physicians now can reach a much larger patient base. Patients have more options in choosing their preferred physicians and therapists. Physical location is no longer a barrier to quality medical treatment.

Telemedicine also serves as a viable alternative for follow-up visits. Because of its convenience, this results in a higher rate of patient compliance for after-care.

The Waiting-Room Experience Is Eliminated

The traditional waiting room experience can be difficult for many reasons:

– Patients generally do not like having to wait to be seen by their physicians.

– Being in a crowded room full of other sick people is stressful.

– The waiting room experience can exacerbate problems for patients with anxiety.

– Physicians feel guilty for taking breaks when they know there are people waiting.

Remote medical care reduces these pressures. The result is an experience that is better for all parties involved.

Results Are Overwhelmingly Positive

Communicating about medical issues through a teleconference may initially seem off-putting. However, the results have been overwhelmingly positive.  Most patients have been able to build rapport with their remote physicians easily.

Additionally, this treatment option is effective for addressing psychological issues including:

– Anxiety

– Depression

– Attention deficit disorder

– Obsessive compulsive disorder

Telemedicine Offers Cost Savings for Physicians and Patients

Physicians can introduce telemedicine into their practice with a very low initial cost. The ongoing monthly outlay is also nominal.

These savings generally pass on to patients. The typical cost for remote medical treatment can be as low as $25 to $50 per visit, depending on the doctor. Healthcare is now more accessible to people who previously may not have been able to afford it.

Telemedicine Is Now Legally Accepted in Most States

States are currently passing laws to legitimize the practice and protect patients. As of early 2017, over 30 states had enacted laws related to telemedicine.

These laws prevent state-regulated insurers from denying claims due to remote service. Telemedicine claims must be treated the same as claims for traditional services.

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Cybersecurity experts warn of ‘digital D-Day’ in healthcare 

Cybersecurity experts warn of ‘digital D-Day’ in healthcare  | IT Support and Hardware for Clinics |

After two global ransomware attacks highlighted the potential dangers of network disruptions in the healthcare environment, cybersecurity experts are warning that subsequent attacks could have a much more devastating impact on patient safety.


There is particular concern over the vulnerabilities of medical devices, nearly all of which are connected to the network in some way, where the potential for patient harm is enormous. Malware could weave its way through infusion pumps and disrupt medication dosages, or cyberterrorists could coordinate a physical attack with a shutdown of hospital EHRs across a city.


“We’re going to have our digital D-Day, our cyber D-Day, if you will, in medical, and there’s going to be patients that die,” Christian Dameff, M.D., an emergency room physician and clinical informatics fellow at the University of California San Diego Health, told McClatchy. “It’s going to be a big deal.”


Beyond the inherent risks in medical devices, widespread EHR disruptions mean patients will be diverted from emergency rooms and clinicians would be left to treat patients without critical patient information at their fingertips. After the UK’s hospital system was hit by the WannaCry attack in May, emergency physicians said the impact was “undeniably dramatic” and argued that digital security “simply hasn’t been an NHS priority.”


The same industry concerns exist in the U.S., according to a recent report by the Department of Health and Human Services Cybersecurity Task Force which called for a “unified effort” among public and private entities to address some of the industry’s most pressing concerns regarding staffing shortages and medical device insecurity.


“Some of these attacks are like ringing the dinner bell for adversaries,” Beau Woods, deputy director of the Cyber Statecraft Initiative at the Atlantic Council, told McClatchy. “Once they know they can and it’s that easy, at that point it becomes a race.”

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Why Healthcare Organizations Need to Leverage Enterprise Data Lakes

Why Healthcare Organizations Need to Leverage Enterprise Data Lakes | IT Support and Hardware for Clinics |

As the so-called “oil of the twenty-first century,” there is little doubt that data is the crown jewel of the digital economy. The Internet of Things is poised not only to shake up individual industries, but to bring them together like never before with the promise of hyper connected, ultra personalized experiences. And for consumers, one particular application of IoT is perhaps the most intriguing: the impact of connected devices on health and healthcare. Indeed, McKinsey has projected a $11.1 trillion market by 2025, nearly one-third of which will be comprised of healthcare-related devices.


Health-conscious wearables have rapidly gained popularity over the last few years, and are making strides when it comes to the complexity and accuracy of the data captured. These devices are monitoring everything from blood sugar to heart rate, tracking trends in medication, diet, and exercise, and communicating this information to providers to enhance and extend care beyond the doctor’s office. We can only imagine these applications growing and diversifying as technologies advance and become more affordable.


But like any conversation around data management, we know it’s not enough to simply collect massive amounts of data. Information must be captured in a way that makes it readily available and actionable for healthcare organizations and doctors, and in turn, their patients. Data volumes are exploding, the nature of data is changing, and the underlying technologies are being augmented or replaced by newer systems like Hadoop, MapReduce, and HIVE.

Beyond traditional healthcare data sources like EMR, PACS, transactional databases, CRM systems, and financial and prescription data, new unstructured and semi-structured data sources are rapidly emerging. The result is that the healthcare industry has become inundated by a myriad of data sources from multiple locations, all of which has the potential to make a real impact on people’s lives — but not as it exists currently.

The best way we can hope to unleash the power of big data for healthcare is to rethink how we capture, organize, and analyze it. Healthcare CIOs are already well-aware of the shifting landscape and focusing on refining and advancing internal systems, but they must also shift their focus to include integration and leveraging a system of insights.


Both providers and payers are in desperate need of a solution that can act as a common data platform and integrate data originating from multiple locations in a variety of formats, all while preserving all of the metadata associated with those data objects. In addition, media overrun and rising infrastructure costs pose a big problem as old data that is seldom used accumulates rapidly, reducing performance and even negatively impacting the accuracy of data analysis. This is where an enterprise data lake with archiving comes into play.


Think about it: medical professionals need immediate, direct and natural-language access to analysis of all patient data in its original format, as well as intelligent tools that can provide recommendations based on all of the available data. In the case of healthcare, this data consists not only of facts and figures about the patient, but highly pertinent free-form text such as physicians’ notes, radiology reports, medical journal articles, email correspondence, images such as CAT scans or MRIs, genome files, and of course, information collected directly from wearables, respirators, blood pressure monitors, and other connected devices.


Instead of attempting to pull this data from separate sources and manually integrating and maintaining it, all of the data from these disparate sources is fed into a single enterprise data lake that is capable of reaching across multiple internal as well as public cloud systems. Here, the data is highly organized and maintained, and any kind of external analysis tool can easily be integrated to more effectively transform the information into actionable insights for the provider and patient.


The beauty of this approach is that security levels can be individually maintained as appropriate to each separate database. This is critical to ensuring that patient data is managed sensitively, so organizations can adhere to the strict privacy and compliance regulations unique to healthcare. Entire patient records can be handled with complete and full control, to ensure that only the right patient data is shared with the right people. In addition, old and inactive data is automatically archived, thereby combating the high costs, potential problems, and inefficiencies of media overrun.


As the applications and capabilities of wearables continue to rise, we need a smarter, scalable way to collect, house, and manage the oceans of data that ensue. Organizations that leverage the enterprise data lake will be empowered to cut costs, streamline resources, and ultimately do more with their data. In the end, this will translate to higher satisfaction among providers and patients alike, and drive more effective outcomes in patient health and wellness.

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Healthcare environment: Achieving mobile security

Healthcare environment: Achieving mobile security | IT Support and Hardware for Clinics |

Using mobile devices in the healthcare world offers many benefits, but it also present major risks when it comes to security. In this guest post, Gene Fry, VP of technology and compliance officer at a company that streamlines paper-intensive processes, and protects sensitive and business-critical information, provides a guide healthcare organizations can use to develop a culture of mobile security.


Mobile devices are transforming the way professionals communicate, collaborate and coordinate care in the healthcare setting. In addition to improving operational efficiencies, mobile devices have been proven to help speed up health outcomes and reduce length-of-stay. In 2016, a study of approximately 11,500 patients at two hospitals found that patients whose care providers used secure text-messaging as a means of communication had shorter lengths-of stay, compared to patients whose providers used paging systems.

While there’s no denying the potential benefits of mobile devices, their use remains a significant risk if improperly managed. Of the 260 major healthcare breaches reported by the U.S. Department of Health and Human Services (HHS) in 2015, close to 10% involved a mobile device. Statistics such as this only go to strengthen the argument that IT leaders and CIOs need to look carefully at both sides of the coin when considering implementing a mobile strategy within an organization.

The following steps are intended to guide healthcare organizations through the process of developing a culture of mobile security in such a way that allows them to realize the benefits, while keeping risks to a minimum.

Conduct a risk assessment

The single greatest mobile-related risk to a healthcare organization is a breach of protected health information (PHI). A breach of this nature, which would fall under HIPAA, can carry significant fines, as well as both civil and criminal penalties.

To avoid such scenarios, it’s vital that healthcare organizations take necessary actions to thoroughly assess their technology infrastructure for potential vulnerabilities, and evaluate how best to protect against identified risks. Conducting a security risk assessment, which is a key requirement of the HIPAA security rule, should identify the following information:

  • every mobile device (both past and present) that has had any level of access to the organization’s internal systems, and
  • the type of information that has been accessed, stored or relayed via mobile devices.

Use the right tools for the job

Text messaging and email are inherently risky, due to a lack of encryption around the data being shared between and stored on devices. Should a device wind up lost or stolen, any data that resides on the device itself becomes under threat.

Therefore, organizations that access, store, send or receive PHI on mobile devices should only ever carry out such tasks within the secure environment of purpose-built, HIPAA-compliant applications that ensure data remains safeguarded at all times. These secure solutions can help mitigate risks by encrypting information while in transit and storage, enabling users to control and invigilate how this information is accessed.

Secure all mobile devices

Security measures such as password and PIN protection are often a device’s first line of defense when it comes to keeping sensitive information out the hands of bad actors. This considered, all devices that come in contact with PHI must be adequately protected, via the following security parameters:

  • multi-factor authentication
  • password and PIN protection
  • device encryption
  • firewalls, and
  • regularly updated software and applications.

This is particularly important within organizations that permit BYOD (Bring Your Own Device), where staff may be using the same devices for both professional and personal activities, increasing the likelihood of loss or theft.

Establish policies for mobile usage

Many security-related horror stories can be traced back to an internal source, such as an employee downloading an unauthorized mobile application, which in turn jeopardizes the security of all sensitive data stored on that device. More often than not, individuals don’t intend to cause harm by downloading non-secure applications or programs, but their seemingly innocent actions can introduce security vulnerabilities into the company’s IT infrastructure with potentially devastating consequences.

To avoid such scenarios, employers should establish clearly defined policies to encourage safe mobile usage, and ensure all staff are trained to comply with those policies, while also being made aware of any sanctions for violation.

Ideally, mobile policies should outline procedures for:

  • remote disabling and wiping
  • deletion of messages after a period of time
  • password protection and access authorization, and
  • downloading applications and files.

At the very least, healthcare organizations need to clearly define a list of acceptable and unacceptable actions, and formulate a response plan in case a device is lost, stolen or compromised.

Educate staff

Humans have always been, and will remain, the weakest link in the security chain, and the introduction of mobile devices into the healthcare workplace only accentuates this vulnerability. While the steps outlined above provide a good foundation for healthcare organizations to build upon, cracks will soon begin to show if staff aren’t adequately trained to identify and mitigate risks themselves.

The benefits of mobile technology should be embraced by the healthcare industry, not feared, but when the security risks remain so significant, that’s easier said than done.

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5 Things to Do Before Adding Telemedicine to your Medical Clinic

5 Things to Do Before Adding Telemedicine to your Medical Clinic | IT Support and Hardware for Clinics |

As a Doctor, you are paid to have answers.

Answers to uncertainty, answers to pain, answers to how the future will turn out.

However one area where uncertainty looms large for Doctors is how they can get started seeing patients via remote telemedicine services.

The next 5 years are expected to see explosive growth of telemedicine both in use and public awareness. Yet, questions of effectiveness, compliance, and logistics plague each doctors decision to start using a telemedicine service.

Like a wise investor, many physicians have been watching from the sidelines, tracking the ups and downs, do’s-and-don’t’s of colleagues and experts for several years to find the best practice for incorporating telemedicine into their clinics.

If you are on the verge of incorporating telemedicine into your practice, here are 5 Things to Do Before Adding Telemedicine to your Clinic that will help ensure a steadier introduction, and long term success.

1) Know WHY you want to use Telemedicine

Before getting started, spend some time contemplating the change. If you have a desire to increase cash payments in your practice, telemedicine can help. It can also help you with schedule flexibility. And it will also help you keep up with the latest technology and services for your patients.

Decide first about what you’d like to achieve from adding a telemedicine service into your practice. This will ensure that it becomes a part of the practice smoothly, and with a purpose, rather than something you try a few times, and then give up on. Well begun is half done.

2) Set up your Team for Success with Telemedicine

One of the dangers of suddenly offering a telemedicine option in your practice is that the team feel threatened by the change.

Hold a meeting and give them a say in how the process will work, ask for their feedback on what could be a good initial system and best practice. Get clear on the process of billing and setting appointments in the schedule before starting to offer appointments.

Doing this preparation will ensure the team back you up, as you move to the virtual consultation model.

3) Set up your patients for success with Telemedicine

For doctors, a virtual visit has a lot in common with a face-to-face visit. The location and time frame is the same, and the process of diagnosis is similar. It is familiar territory.

However, for patients, it is an entirely new experience. The majority of the population is reasonably comfortable with using video chat functionality. It is your role to give them a sense of comfort and understanding that the process is simple and effective.

Providing some form of how-to guide for your patients can be very valuable. Give patients an overview of what to expect on the call. Let them know what the fee will be, how long the call will be, when you will call, etc.

All these small details will make the process much more comfortable for your patients, and make them more willing to try a Telemedicine visit with you.

4) Have clear Guidelines for what you’ll offer via Telemedicine

Telemedicine offers doctors huge flexibility. But there must be guidelines. Let patients know what you will offer, and what you wont. Patients may have specific conditions that still need face-to-face time, and it is at your discretion which of these diagnoses you can do via virtual visits.

Telemedicine can reduce or replace 70% of routine visits can be replaced. However that doesn’t mean you should outsource your entire day to virtual visits.

5) Start slow and grow with Telemedicine

Remember that you have been practicing successfully without telemedicine for many years, and although there is a huge upside to adding it to your practice, there is no need to dive in the deep end.

You might want to offer the service initially only to your most familiar patients, those managing chronic conditions, or those at a remote location. Treat your initial interactions as a learning opportunity, and learn how you can create effective results.

Remember that technology exists to connect people. The lure of the new can sometimes cloud the focus that you are still simply speaking to your patients, just in a new, more efficient way.

For Doctors, Telemedicine is exciting and scary at the same time. Starting slow, with a clear purpose, a prepared team and informed patients can do a lot to make the transition a successful one.

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From Paper to Digital - How Mobile Technology is Changing Healthcare

From Paper to Digital - How Mobile Technology is Changing Healthcare | IT Support and Hardware for Clinics |

To say that mobile technology use is dramatically increasing in healthcare is a great understatement.  Today about half the adult population owns a smartphone.  By 2020, that number will increase to 80%.[1]  In fact, eMarketer found that smartphone users will number more than two billion in 2016.  With the proliferation of smartphones, mobile applications are also exploding.  Research2Guidance reports that there are already more than 100,000 health applications with over four million downloads per day.  The mobile healthcare market in general is expected to reach $58.8 billion by the end of 2020.[2]  As mobile technology and healthcare innovations combine, a new way of approaching healthcare will be established among patients, providers, and medical device manufacturers.


Mobile technology is fundamentally changing the way patients and doctors relate, and the way healthcare professionals perform their work, and how healthcare professionals and medical device representatives/service providers interact.  Healthcare has traditionally been a paper-centric industry with paperwork for patients to complete, charts for doctors to update, and medical device order and fulfillment done through forms and faxes.  With the use of tablets and smartphones, all of that paperwork is slowly being eliminated.  Patients are using mobile technology to track and monitor fitness and chronic conditions and then transmit the collected data to their healthcare providers.  Doctors use tablets to check patient records, take notes, and update charts during appointments.  They also communicate with other physicians, using their smartphones to share photos and questions.  Medical device reps manage sales and track inventory with sophisticated mobile apps.  This move from paper to mobile technology results in real-time visibility, increased productivity, greater efficiency, and enhanced accuracy – all of which leads to lower costs and better healthcare for patients.


Innovation and Risk Go Hand in Hand

Risk often follows innovation.  Some of the issues facing the advance of mobile technology in healthcare are data security, federal regulation of mobile apps and mobile healthcare devices, and software and platform compatibility. 

  • The Health Insurance Portability and Accountability Act of 1996 (HIPAA) poses challenges for providers using smartphones and tablets to store and share patient information.  Some of the data security concerns raised by HIPAA are: easy access to data through weak passwords, substandard encryption, lost or stolen devices, file sharing software that could lead to data leaks, and cloud storage of data without airtight controls.[3]  These problems compound as medical centers struggle with “bring your own device” initiatives.
  • In addition to HIPAA regulations, the Food and Drug Administration (FDA) is poised to review a record number of mobile health apps to ensure that apps work as intended and do not adversely affect the functionality or performance of traditional medical devices.  To date, the FDA, which has been regulating mobile apps for more than 10 years, has only approved about 100 products.[4]  FDA approval might slow down some app development and cause headaches for some that are already on the market, but, according to a recent PricewaterhouseCoopers report, regulatory approval may lend legitimacy to products and prove valuable for building successful and sustainable revenue models.[5]  The FDA stamp of approval might be just the ticket for a healthcare app.
  • Just as in any industry, the speed of innovation often sets a pace that is hard to match.  Healthcare stakeholders, from patients to doctors to medical device manufacturers, will find gaps between software and hardware technology that slow progress.  For example, many doctors and hospitals retain legacy systems that may not work with new mobile technology, and apps designed for use on the Apple platform may work differently on Android devices.  Compatibility from software to hardware as well as software to software may pose challenges as technology continues to evolve.


The Future of Mobile Technology in Healthcare

The question facing the medical device industry is: Where is mobile technology going?  The first point that must be reconciled is that the proliferation of mobile technology is going to continue, and, if computer technology is any precursor, mobile use will continue to accelerate.  That means the healthcare industry and medical technology industry will need to embrace this trend or risk being left on the sidelines. 


The second trend to expect is increased connectivity between devices.  Mobile devices will connect with hospital equipment and drive greater visibility and functionality for healthcare providers.  There will be clear traceability and accountability of actions and responses within the clinical environment and with that will come the opportunity to harness data at a far greater level of detail and accuracy than was previously available. 


Finally, mobile devices will connect systems across healthcare.  Mobile devices will connect with electronic medical records, hospital financial systems, and medical devices enterprise resource planning systems (ERP).  This will provide clarity to an otherwise opaque supply chain and reduce the cost of healthcare through improved efficiency.  Mobile technology has the opportunity to deliver improved clinical outcomes at a lower cost.                 

In summary, mobile device technology is radically altering the healthcare industry from the patient to the healthcare provider to the medical device sales rep to the manufacturer.  There are risks associated with the rapid adoption of mobile technology, but “the train has left the station” and healthcare industry stakeholders will be required to adapt or become obsolete.  The benefits of incorporating mobile technology are significant.  Advantages across the industry will include greater efficiency, cost savings, and increased productivity.  But, of course, the most important advancement will be vastly more effective medical treatment for patients.

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5 Healthy Reasons To Start Using Telemedicine in Your Practice

5 Healthy Reasons To Start Using Telemedicine in Your Practice | IT Support and Hardware for Clinics |

As a healthcare professional, it’s likely that you’ve heard of telemedicine. If not, it’s basically a way for doctors and patients to communicate using certain tech devices. You might ask why this is important, and that’s what we’re here to tell you. There are many reasons for you to begin using this special medical care in your practice; as telemedicine solution providers, we hope to give you all the information you need about it.

1. It’s Beneficial for Those in Rural Areas

As you may or may not know, medical care sometimes is hard to find in rural regions. Often, available healthcare in rural areas is not specialized for a patient’s needs, or it is simply too far away for a patient to go in for treatment. Rural patients often are referred to a doctor in a bigger town or city, which isn’t always a possibility. That’s where telemedicine solution providers come in; we can establish a system that allows a patient to get healthcare from far away places.

2. Patients Can Get Help from Home

Let’s say a patient doesn’t have a car or feels too ill to make a trip to the hospital. Telemedicine is a great way to give that patient the care they need from their home. Using things like voice chat and video technology, a doctor can take a look at what’s wrong right away. This means that even people stuck at their house can be properly diagnosed. It’s like a virtual house-call!

3. It Offers Immediate Help

This ties in with getting help from home. Instead of waiting until the last minute to get to a hospital, a person can call up a doctor or send photos that have to do with their illness. This gives the doctor a chance to examine what’s wrong, and keeps the ill person from having to wait several hours to reach a hospital. In severe cases, this could save a life!

4. Early Intervention

Sometimes, it’s necessary to catch something right away. Take heart attack symptoms; because they’re so subtle, many people choose not to go to a hospital. This results in the heart attack happening with no time for intervention, and can even increase the chance of death. Giving people a way to quickly and easily tell you their symptoms can keep this from happening and improve their chances of survival.

5. Good Communication

The main thing people look for in a healthcare provider is solid communication. One of the common factors that drives people away from a practice is a lack of real listening and understanding. Though it may seem unlikely, talking through live video can be one of the best ways to truly understand your patient. It allows one-to-one conversation, and gives you and your patient the chance to talk thoroughly. This way, questions, answers, and suggestions can be more fully dealt with.

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