Susannah Fox started something this morning by announcing her “7 words” around Health 2.0. It’s the meme of the conference.

Here are Holly Potter’s (National Director of Communications for Kaiser Permanente HealthConnect):

Build Continuity, Eliminate Fragmentation, Create Total Health

I need formulate mine. Feel free to post yours in the comments below.

A few more interesting ideas in Health 2.0: Jay Parkinson, MD, in a video about his practice, invoked the work of Toyota Motor Company (smiley face) as a company that works to remove errors from processes.

The On Call Medical Group, like Jay, go to where the patients are - home or work, their true Gemba. I liked the comment about the fact that going patients’ homes allows physicians to assess patients’ capabilities and work with them collaboratively.

The patient filmed was judged not to have a high likelihood of strep infection, yet a culture was still drawn and antibiotics prescribed.

Panel moderated by David Kibbe, MD, from the American Academy of Family Physicians. Overall, it is great to see physicians interested in the art of medicine and able to equip themselves to do something different.

I figure that of all places in the world where it should be okay to blog live, the Health 2.0 Conference is it. So I’m going to try blogging as I go.

I’m in the morning session and I just saw Susannah Fox, from the Pew Internet and American Life Project, talk about the healthcare internet user.

She pointed out that there are few documented cases of harm that have come from consumers accessing the internet (and by the way, we had a conversation at this table about whether we should talk about people as “patients” or “consumers”).

Susannah closed with 7 words of advice:

Recruit doctors, let e-patients lead, go mobile

We were just introduced to a few interesting web services during a very moving video about patients’ experience with significant conditions.

http://www.i2y.org/
http://www.reliefinsite.com/

There was also an impressive story about the use of SecondLife for a patient living with Multiple Sclerosis. She is able to go dancing every night in this community.

(Who is Melissa Peterman?)

http://www.trusera.com - launching today

David Sobel, MD - “Doctors will be flooded” with this material (potentially). “These sites can help people learn that they are more than about their disease.”

I was asked this very good question last evening about my sabbatical. It was well timed because if I were asked it even a few days ago, I would have responded that I haven’t been doing this long enough. According to my Mac Dashboard Widget, I’ve now been on sabbatical for 159 days, and interestingly, I had begun to form an answer, which began to crystallize.

So, here are my top 3:

• There are a lot more ideas and interesting and smart people with them in health care than even I believed.
• Energy around the safety net: every patient deserves to have the benefits of great health care supported by technology, including patient access to their care teams and online health information. The data shows that they want it, and they can access it. We need to provide it to them.
• Supporting diversity and reducing disparities among minority populations always energizes me.

Oh, and at the Health 2.0 Unconference yesterday, I was asked to introduce myself in 3 words. I chose “change the profession.”

Josh and I are in San Diego this week for the Health 2.0 Conference, and to interact with innovative California health care organizations. I think we are two of the few people in the U.S. that did not attend HIMSS last week. However, we are two of the few people in the U.S. who are attending Health 2.0.

The quote in the title was from my table at the “Unconference” which was facilitated by Enoch Choi, MD, from the Palo Alto Medical Foundation. It refers to the difference between web services offered by physician groups and what could be offered.

In the kinds of conferences I go to, attended mostly by medical professionals (and in many parts of my medical group itself), I typically feel like “year ahead of my time guy.” (This post from my blog, using a cute Apple commercial, I think illustrates the dilemma well). In this group, though, I feel like “year behind everyone else guy (person)” and that’s pressure that I like. The current state of the art of patient access to their care team(s) is one to one, and in the next step should be many to many. I gave the example of a patient electing to have a surgical procedure. What might be one of the first questions they would ask. How about, “Can I talk to other patients who have had this procedure? And who have had it performed by you?”

We had a discussion about creating change and where that might happen - from within the (medical) profession or outside of it. Keith Schorsch, the CEO of Seattle-based Trusera offered the idea of the “enlightened” provider. I asked if there was a registry where we could all sign up. I was kidding though, because in my (our) travels so far, I find that all physicians/providers are enlightened, when we support them in being so. And that comes from thinking about the patient at the center.

The Kaiser Permanente Effect

Something I noticed that I need to watch out for, more carefully than I did on day 1, is the impact of being in a room of innovators as a representative of a large medical group / health plan. I say “Kaiser Permanente” effect even though I am not a Kaiser Permanante employee, but the thought/idea that permeates an audience sometimes when I/we represent ourselves and our work is the one that goes something like, “Only Kaiser Permanente/Group Health can do that kind of innovation.” That statement can be taken two ways - it can mean, “We aren’t going to do anything innovative because we aren’t structured like that.” I think in this audience, my concern is that it can be taken as, “We don’t have the ability to overcome inertia outside of a Kaiser Permanente/Group Health system.”

I think the statement in general is incorrect, and that’s good news. As I sometimes say, I am going to spend the day watching myself and listening 51 % of the time. There are a lot of smart people here working very hard to stimulate improvement in the health care system we all use; they are thinking of innovation 24/7 and I want to help make their ideas count. And pick up some new ones along the way.

Speaking of Innovation

One of the reasons we are here is to visit and shadow providers at Sharp Health Care. As you can tell from the image above, they are a leader in health care and interested in providing patient-centered health information technology. Josh and I presented our work to the group and it was well received. We’ll be shadowing in one of their medical facilities in the next two days.

Veterans Affairs Medical Center, Washington

Veterans Affairs Medical Center, Washington

I was fortunate to spend time with Hank Rappaport, MD, the principle PM for the Microsoft Azyxxi Team, to fill a few big gaps in my EHR knowledge recently. Hank is a critical care specialist and has extensive experience building and maintaining electronic health records within the Department of Veterans Affairs, and now will do the same as a leader at Microsoft.

I sought Hank out originally because I wanted to learn more about what the Department of Veteran’s Affairs is doing with patient access to their highly regarded electronic health record. The Washington, DC, VA Hospital was a pilot site for the MyHealthEVet program, which allows those served in this system access to their medical records online. What’s special about the pilot sites is that they allow patients access to the entire record, without any filtering. This includes progress notes. More on that later.

Hank simulated access to both systems for me to get a sense of each systems’ strengths. Azyxxi was actually born at Washington Hospital Center, where Hank showed it to me, and is an excellent aggregator of clinical and other data, in a very accessible way. It seems to fill a niche that some electronic health records lack, which is a population view of data. The heritage of Azyxxi was the emergency room; at the same time, the utility is very relevant to primary care. With Microsoft supporting its future development, it should continue to add to innovation in health information technology. Of course, wearing my patient-centered hat, I thought there could be very interesting applications of this tool for patient access.

Following the tour in Washington Hospital Center, we walked across the way to the VA Washington to look at a simulated view of CPRS. The system is of course very capable (it lives up to its stellar reputation), specifically in the areas of order entry and decision support. It’s able to capture structured and unstructured text data, for example in progress notes. Like Azyxxi, I think there are rich areas for expansion for the system. The capabilities of this development team are different, though, and there are some changes being made in the way that the VA manages its health information technology.

There is currently not much interaction between the physician / staff view of the medical record and the patient view. However, it’s remarkable that patients have full access to their entire medical record, and has Hank indicated to me, this has not been a problem. I understand that the production (non-pilot) versions of MyHealthEVet do not have full patient access in them. In the meantime, I think the experience here in Washington deserves further attention in terms of its innovation.

I appreciate the value of the experience of seeing these two very competent systems a little closer.

Now, on to California and Heatlh2.0 to see some other cool stuff up close!

Legal and Policy Analysis: Personal Health Records: Why Many PHRs Threaten Privacy, World Privacy Forum

2008 Survey of Health Care Consumers, Deloitte Center for Health Solutions

Actually we do want access to our own health information. The title is a reference to three things:

1. Personal Health Records, why PHRs May Threaten Privacy, published by the World Privacy Forum.

I think this is less about not using a Personal Health Record (PHR) and more about understanding HIPAA, and its useful. The paper states clearly that the discussion is a different one for HIPAA-covered entities (such as Kaiser Permanente and Group Health). I would recommend that people review the information or at least the summary document to be familiar with what an organization can or can’t legally do with personal health information. I think that’s the key - even if an organization states it is not going to do something, there may be no legal protection if they change their mind.

So could a personal health record threaten privacy? Sure. Is it a reason not to use one? That’s a personal decision of benefits vs risks. I think it would be a challenging statement to say that these concerns should keep all Americans from having access to their own health information, and certainly the situation is different for HIPAA-covered entities, where there is both access and legal protections. I also think that we should not rely on information technology to create trust for us using software, or the system we have long been waiting for will never arrive.

2. Deloitte’s 2008 Survey of Health Care Consumers, published by the Deloitte Center for Health Solutions

This is a very well done representative survey sample of Americans with regard to health care with a focus on online access an alternative treatments. The conclusion is very clear: consumers want access to information created by themselves with their physicians, hospitals and health plans. And only 6 percent have this access. So, a huge discrepancy between what people want and what they are getting.

I keyed in on some very important statements, that buttress a fact from my travels, that “uninsured does not mean uninformed”:

The attitudes and preferences of the uninsured mirror those of the insured

Interest in online appointment scheduling, e-mail access, and online access to medical records and test results is equally high in the uninsured and insured groups.

There was a similar attempt at creating “personas” of the various consumer groups in this paper, much as we did here, for the stakeholders we are working with. I would say that the technique is less effective in this report because the personas aren’t based on standard terms and are likely to be forgotten. In the health system world, it seems easier to segment by known groups, like Gen X, Gen Y, baby boomer, or by insurance status or by care system.

One other item of note is that 60% of respondents state that they are on medications. That’s an impressive number, especially when I think about the power of the compounds that we prescribe today. Having access to one’s information is more than a convenience. I wrote about a real-life example that I encountered recently, on my blog.

3. Google. See for yourself. I think this ties together a lot of the ideas above. John Halamka makes some comments about HIPAA and the Google product based on his experience being on the Google Health Advisory board. I think patient-centeredness may become mainstream. Comments are welcome of course.