Photo Friday: Thank you Liz Taylor in Watercolor, Shaw Neighborhood, Washington, DC USA



This week’s photograph is of the (now) iconic 50-foot tall mural of Elizabeth Taylor in watercolor. From Dacha Beer Garden Glams up Shaw With Gigantic Elizabeth Taylor Mural | InTheCapital:

Although Taylor is no doubt a alluring figure to look at, there is a deeper meaning behind the mural. The mural is meant to pay respects to the late actress for her foundation’s generous support of the Whitman-Walker Health Center, which helped to prevent the spread of AIDS and provided treatment to those affected by HIV/AIDS.

The mural exists in a neighborhood experiencing a renaissance following its destruction after the assasination of Martin Luther King, Jr. (see: Photo Friday: Progression Place, Washington, DC | Ted Eytan, MD for photos of 7th Street in 1968)

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Latest adoption data for kp.org



Yesterday on a tour of the Kaiser Permanente Center for Total Health (@KPTotalHealth), one of my esteemed guests, Larry Wolf, Health IT Strategist at Kindred Healthcare and Co-Chair, Certification and Adoption Workgroup, Health IT Policy Committee asked about the adoption curves I showed for Kaiser Permanente’s personal health record, kp.org.

Because of that and since I’m giving a guest lecture as part of my colleague Carol Cain, PhD’s (@ccain) course: “Digital Medicine: Designing IT Innovations that Improve Healthcare Stanford University Biomedical Informatics 207” later this month, I needed to update them anyway, so here they are. 

The totals are out of a member population of 9.3 million members, with the average practice having 67% of the eligible members (Internet users over 18 years of age) registered to use the portal. Enjoy, and remember, it is possible to engage patients.

Kp org data update 44882

Kp org data update 44883

Kp org data update 44884

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Just Read: Medicare bids farewell to the 20th Century in covering transgender person care, and maybe pokes fun at itself, too…



even assuming the NCD’s exclusion of coverage at the time the NCD was adopted was reasonable, that coverage exclusion is no longer reasonable.

In english, this means that Medicare’s former determination in 1981, 33 years ago, that gender confirmation surgery should not be covered, is now history. Medicare entered the 21st century only 14 years too late. With glass-half-full, that’s 3 years faster than the length of time it takes for science to make it into practice :)

Definitively stated: Gender confirmation surgery is safe, effective, backed by science

There is an excellent review of the literature within which puts to rest any notion that gender confirmation surgery is experimental (it isn’t), that there isn’t evidence to support its use (there is, plenty), that it isn’t safe (it is).

The experts cited note that the surgical procedures used in gender confirmation have been validated (and are covered) in other medical conditions, such as Mayer-Rokitansky-Kuster-Hauser syndrome, or MRKH, in which women are born with a complete or partial absence of a vagina, cervix and uterus.

With regard to safety, 1985 appears to be the turning point year, where surgical technique improved to the point that compliation rates and hostpital stay requirements went down significantly.

The decision also points out something that wasn’t called out in 1981, which is the lack of safety in a situation where treatment is not offered:

…(Gender Dysphoria) ..if left untreated, can result in clinically significant psychological distress, dysfunction, debilitating depression and, for some people without access to appropriate medical care and treatment, suicidality and death”

By the way, all of these symptoms of no treatment, leading up to and including death, are covered in health insurance plans even if the medically necessary care is not. In other words, as stated by the American Medical Association, coverage for this care is probably preventive.

Laughter is good medicine – do I detect a little humor in here?

I assume there are many ways to wipe away a 33 year legacy. You can do it with solemnity but you don’t want to appear too solemn because then the legacy won’t be sufficiently wiped. I suppose you can inject some humor into it as well, and that’s what I spy in this paragraph on page 18:

the 1981 report (and the NCD) cited an alleged “lack of well controlled, long term studies of the safety and effectiveness of the surgical procedures and attendant therapies for transsexualism” as a ground for finding the procedures “experimental.”

…and then goes on to say that the same report cited studies that ran in length from 3 months to 13 years and

If these studies do not qualify as acceptable long-term studies, the basis for such a conclusion is not adequately explained in the NCD record.

This is unmistakeable medical speak for “you have got to be kidding.”

What else can I say except, I enjoyed it :). In reality though, a subtle poke at the past helps a new generation of medical professionals tease apart data and bias, which are clearly and transparently wrapped up together in the previous coverage decision. Which is now vaporized.

Health plans are changing their coverage decisions in response

A careful review performed by my digital librarian (Google) shows the impact. Check out the difference in this coverage decision from a large commercial health plan in California, from 2012 to 2014. You can see the edits that move this medically necessary care into the same domain as all other medically necessary care. Check it out.

“Use this page to view details for national coverage determination (ncd) for transsexual surgery (140.3)” – this is the “heritage” coverage determination, which was invalidated on May 25, 2014. (see original)

Fit for the museums of the future…

In addition to saving the coverage decisions above, I’ve also clipped the 1981 National Coverage Decision for posterity. One day it will hang on a museum wall (Perhaps this one? @LGBTMuseum ) where people will stare at it in disbelief.

This saga reminds me of a quote I will never forget by one of my medical school professors, Andrew Weil, MD (yes, that Andrew Weil), who once said, “We’ll look back at what we did to people with cancer in 20 years and be aghast.” Maybe that’s the quote that will be printed on the wall above these heritage pieces as well, and I am so happy to be in medicine on the other side of those 20 years. I only wish we didn’t have to wait so long.

seattle gay marriage 5

Congrats, sorry it took so long

Welcome to the present, Medicare, we’re glad to have you!

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Mentioned in the HuffPo: Trans-inclusive, trans-supportive and culturally competent



A Senate Campaign Interlude With Friends, Family and the President | Dana Beyer

A Senate Campaign Interlude With Friends, Family and the President | Dana Beyer.

This is the first time seeing the work I’ve been doing described publicly, and she’s right, it is what I’m doing. Thanks Dana Beyer (@DanaBeyerMD) and Huffington Post (@HuffPostDC)

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Networks matter: Project ECHO at Permanente Executive Leadership Summit



Anyone who has ever learned about Project Echo (@ProjectEcho) is familiar with this iconic slide –  it shows the creation and support of knowledge networks among clinicians to build capacity for our health care system.

Thanks to the blog-wayback machine, I traced my first encounter with Sanjeev Arora, MD, and Project Echo to October, 2009 (!), in this blog post: HIStalk Interviews Sanjeev Arora (Project Echo – New Mexico) | HIStalk | Ted Eytan, MD

And here’s what I said back then:

I recently also had the chance to learn about Project ECHO from Sanjeev Arora. I liked the emphasis on skill-building among primary care clinicians caring for more complex conditions. It seems in this case that technology can recreate some of what was lost when primary care providers left hospital care and greater interaction with specialty care colleagues. See what you think.

So here we are, 5 years later, and through the magic of the networks we share, including the Robert Wood John Foundation Pioneer Portfolio and the RWJF Leadership Network, Sanjeev has now presented his work at the Permanente Executive Leadership Summit (PELS), which is an every 2-year dialogue about the future of care delivery at Kaiser Permanente.

And…. if you know of Sanjeev’s passion and how Project Echo works, you know this turned out, in a room full of health system leaders, technologists, physicians, and nurses passionate about producing health for people wherever they are. And, multispecialty medical groups working together to support member and community health is what we are all about :)

I’ve written multiple blog posts over the years about Project Echo (you know, adult learning, repetition…) including ones that link to his innovation’s very first discovery – you can see them all here.

People ask me how we got connected, and it was via social media of course, and the specific amazing aspect of social media which is that it allows to listen to ideas you have never heard about before. Because as I say often, I’m not that smart, my ideas are not that unique, and if someone is doing something better than me, I want to know about it. Sanjeev exudes that quality as a sub-sub specialist which is what allows him to be a patient, yet captivating teacher. When you think of the kind of consultative specialist that you want to work with, these are the things that come to mind.

Let’s see what happens from here, in the meantime, thanks Sanjeev, all of his boosters in the Robert Wood Johnson Foundation (@RWJF @PioneerRWJF) network, and now the ones in the Permanente Executive Leadership summit network.

Just a few more action shots – I know, this is a hotel conference room, but trust me, all of that melted away during this special moment…


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Photo Friday: Change Reality, Talk about Magic, Learn Javascript. MakerDocs DC



This week’s photograph is of an almost electric (see the full set of photos below) ignite talk given by Kevin Maloy, MD (@maloykr) , Emergency Room physician and innovator at Medstar Institute for Innovation (@MI2Innovation), where he shows an audience how a simple web page, like, say the one for the Center for Total Health (@KPTotalHealth) can gently be edited to become a place to talk about magic.

A place to talk about magic? Maybe. View MakerDocs in DC 42798 on Flickr.com

MakerDocs is the super secret meeting of physicians that none of us wants anyone to know about(™), and includes doctors from across institutions who talk about the magic of innovation and are changing reality.

This is the second major meeting, the first was in San Francisco earlier this year (see: MakerMDs: Physician Intra/Entrepreneurs driven to innovate | Ted Eytan, MD)

Thanks again to Rebecca Coelius, MD (@RebeccaCoelius) and Connie Chen, MD (@ConnieChenMD) for organizing and our other igniter, Jacob Reider, MD (@jacobr), who’s also the Chief Medical Officer of the Office of the National Coordinator, AND Sandeep Pulim, MD (@Spulim) for being our DC facilitator.

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Unify and Go: Designed to Move – Active Cities – North America Webinar – with Nike



Also on Tuesday, I had the opportunity to represent Kaiser Permanente as part of this North America Webinar, a continuation of the global work of Designed to Move, which is being coordinated by Nike’s Access to Sport team.

The part that I briefly covered was about Active Cities, and our believe as health system leaders, that cities designed for activity are healthier and allow us to help our members/patients achieve their life goals. Put another way, a city designed with movement engineered out of it is not one that’s going to be competitive.

I was surrounded by physical activity rock stars including experts from the world famous Aspen Institute (doing work on youth and sports), Let’s Move! Active Schools, and American College of Sports Medicine. We were joined later by champions of the built environment from US Green Building Council (@USGBC).

Since this blog is about what I learn, I have to say I am impressed that physicians and health systems can be part of the solution to make health the default wherever we are. Now that I have had the chance to interact with real estate developers, highway engineers, and architects, teachers and school administrators, I realize that a lot of our health destiny is created for us, whether we know it or not. These professions are coming together, and they’re including us, and we need each other.

I personally care about this because I know the limits of technology, and I live in an amazing city, where all the design filters for activity are in place, and it’s transforming every day to make health integral to life.

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