As I was getting ready to board a flight to Boston this morning, the following appeared on my iPhone:

From: FlightInfo@delta.com
Date: December 20, 2007 8:40:26 AM EST

[8:40 EST] DL 5626 20Dec departs DCA now canceled

At the same time, the identical announcement came overhead, and we were instructed to get in line for further plans.

And then the most interesting thing happened. A community formed, instantly.

I have to insert here that one of the things I love about the east coast is that it feels very easy to engage people in conversation. Maybe it’s just a combination of things, but I perceive a difference here.

With that background, what happened was that each person consulted with someone or something close to them at the same moment - a cell phone call to a colleague, a text message or e-mail to a friend, a view of weather.com on an iPhone (that’s me), or the gate agent, for the person at the front. We then consulted our secondary sources - each other - comparing notes, piecing together what we had heard to create a picture to help us make decisions. I asked questions of others that I knew that they wouldn’t know definitively, but I wanted something. Clearly, the gate agent would have to choose between explaining all of the options to the group, or helping people one by one.

When the first person received their options and a new ticket, all of us asked for everything he knew, which he told us. We were looking for other experiences as others got their assignments. I said, “Within minutes we’ll probably have a panel of experts here that we can ask questions of.” We used each other to fill in the blanks.

When it was my turn, I sought information from the community again - to ask what their need was to make it to Boston, comparing it to the availability on the next flight. It turned out that several others had a critical need to make it, and the gate agent informed me that, yes, I could potentially bump one of them. I used this information to make the decision to support their journey, which they thanked me for.

As I walked out of security, it happened again, with individuals asking for any information I might have about flight X from Atlanta on Delta. I didn’t have the information. But I’m glad they asked - I had just felt the acute need for information myself.

When I compare this situation to health care, I realize that there are very few situations where patients are situated in a place where they all have an acute information need of the same variety. It is more dispersed and “moment of care” dependent.

One thing I said about blogs when I started doing them internally was, “About 10 % of the people I serve have an intense need for a piece of information I have 10 % of the time. I never know when that time will be, and blogs serve that purpose perfectly.”

I would say the same things for patients (which includes all of us) - that we will have acute information needs at various times of our lives, and when not near a primary source (such as a doctor, or nurse, our “gate agents”), we will seek out secondary sources instead of, or to compliment what our primary sources tell us. I think online communities and blogs are a great way to support those needs by concentrating them across the time and space continuum.

What I was reminded of today was the feeling that when we have acute information needs, we become very willing and supportive of those around us who have those needs too. We have a great opportunity with technology in medicine to leverage the spirit of our patients to help each other heal.

That’s a lot of learning for just a trip to the airport and back. I can’t wait to actually make it to Boston :). I do want to offer thanks to the team at Delta Airlines for really good service in spite of the weather challenge, and for helping me make the best decision for the community of travelers.

We are three months into the PCHIT initiative, and we would like to add additional sites that are local to the Center for Information Therapy, to establish a longitudinal relationship of proximity to care systems.

One such care system is the Baltimore Medical System, which I toured with Chief Medical Officer Kyu Rhee, MD yesterday. We went to the Belair-Edison site and the Middlesex site.

I have to say here that the day was a very interesting one for me, as I spent the morning at a Kaiser Permanente medical center in a nearby community, and the contrasts were very striking. Both organizations are working hard to improve their service in admirable ways, even if their service challenges are vastly different.

BMS is undergoing a significant transition, into the electronic age. It is also undergoing a leadership transition, with Kyu accepting a new position at the National Institutes of Health, where he will further pursue his interest in reducing disparities in health. Our tour was a little bittersweet because of this, as Kyu bonded with colleagues at the two medical centers we visited.

Kyu has been Chief Medical Officer of BMS for 2 years, with previous experience as a medical center Medical Director and internal medicine/pediatrics physician in a safety-net medical system in Washington, DC. BMS serves about 55,000 patients at 11 sites (as of 2006), and it funded acquisition of its EHR, manufactured by Misys, on its own, which is remarkable for an organization like this. As the data that Kyu pointed out, 8% of community health centers have EHRs. This puts BMS in the 92nd percentile. It also frames my work a bit, as I have been tending to visit the early adopters - having an EHR is far from being the norm.

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