I am in Oakland, California, today, participating in an discussion sponsored by Kaiser Permanente about Web 2.0 applications in health care. As part of the discussion I presented my story as a physician who wrote a blog internally for our medical group, and since October, 2007, on the public Internet (here).

From 2005-2007 I managed an internal blog that ended up having 748 posts total, so for 2 years, I posted something almost every business day, along with other physician informaticists on my team with me. That’s quite a commitment. This blog has 298 posts on it since October, 2007. I actually never thought I’d keep a blog, but I’m (a) glad I’m doing it and (b) glad I have a story to share about it as a Health Information Technology leader. I want people to know how I am serving them.

I also got to moderate/interact with two industry experts in the field, Tim Collins, SVP of Experiential Marketing for Wells Fargo Bank, and Lee Aase, Manager for Syndication and Social Media for the Mayo Clinic. It’s an honor to meet other industry leaders who are embracing this technology, and they are embracing it. I know this is the future (or the present…)

Given my experience, the idea of patients bringing their user generated content into the physician patient relationship really interests me. Could an electronic health record of the future subscribe to specially tagged RSS feeds from our patients? I don’t think physicians can or would be following 2,000 lives worth of lifestreams. However, if there’s something in a patient’s life that they want us to know about and can get it to us without double entry, I think that information would change the content of our relationship a lot. And in a good way.

• WMS Solution Components - SenseWear.com - A metabolic measurement system that doctors and patients can use to manage weight.
• National Health Information Network News - The Business Case | NHIN Watch - Running news service on NHIN status
• The Pill Phone - Verizon - Impressive - adherence is heating up as a Health2.0 app
• Social Media University, Global (SMUG) - Blog about social media and public relations professionals by Lee Aase
• Pharma Marketing Blog: Rejiggering the Marketing Mix a la Merck - How pharmaceuticals may be using Web2.0 in the future

I’m not an atopic/allergic person by any stretch of the imagination, having never suffered from allergies. However, I got a good dose (pun intended) of what it feels like to be in Washington, DC recently, when I had an acute flare of environmental allergies. As a family physician I understand the toll that allergies can take; at the same time, it’s as impressive a condition as any that requires a person to stay indoors for fear of their eyes swelling shut.

Given that I’d never had anything to this degree before, I wanted to figure out the best approach to control things. I also found it challenging to explain to people that yes, this was my first time, and I truly didn’t know what to do about it in the most acute phase.

So I started looking.

A very well regarded medical database that I use started off with this description of the condition:

Allergic conjunctivitis is a relatively benign ocular disease that causes significant suffering and use of healthcare resources, although it does not threaten vision.

I’m not sure if this was supposed to be reassuring or comforting from the perspective of a patient. I would say on balance it was not. At the same time, this is a very factual statement made from the medical perspective, which is the audience this is for.

My next task was to figure out if taking supratheraputic doses of non-sedating antihistamines to control symptoms had any basis in experience or science. I was only able to find that a 400 % dose of loratidine is not associated with a fatal heart arrythmia. That was very important for me to know (I’ll leave the details out here). I also needed to know if it’s typical for patients to need this much to control symptoms. I came up empty, except in conversations with friends who said, yes, this can be the case.*

*Disclaimer: I do not recommend a supratherapeutic dose or off-label use of any medication. I am just illustrating the uncertainty that comes from an unexpected dose-response experience.

As things started to calm down, I wanted to find out if there’s something going on in my community that makes this a one-time event for me, or a prelude to more allergic challenges. I was able to find pollen counts, and a news story that allergies are flaring in Washington, DC. Otherwise, I depended on my short conversation with a staff member at the local Safeway who said that she, too, was having her very first allergy flare. Ok, so that means I’m not alone. Oh, and every allergy medication aisle in Dupont Circle was nearly empty.

What does that leave a patient like me with, though? With a few side conversations, rumor, gossip, luck, and an entire health care industry that can’t provide me with more information than the fact that the standard dose of loratidine and ceritrizine is 10 mg per 24 hours.

In my profession’s defense, I was able to get enough information to quickly change my topical ocular antihistamine to one that’s less likely to cause rebound (ketotifen), and better for long term control - but from my “special” medical sources. Nothing in the pharmacy said, “take this one if you’re really having problems.” If I had not switched, I would probably be sitting indoors still.

So I’m writing this post about my first time allergy flare in Washington, DC, so that it can be picked up by others in the blogosphere who wonder if they are alone (keywords: allergic, allergy, allergies, first-time, first, conjunctivitis, flare, DC, Washington). I am hopeful that Health 2.0 projects (like PatientsLikeMe.com) will help fill in the gaps that medical knowledge leaves us with: Am I the only first-timer in my community (bad sign for me, it may happen again)? How well does that drug work? How much do you really need to take to get relief? Are we getting better? This will work very well as a partnership, so patients and physicians can learn what happens between FDA approval and patient experience, the most crucial part of health.

It’s being said that pollen counts are going to massively increase in the next few weeks in DC. That’s okay, Washington - my like for you is still blind, even if you nearly made me go blind.

I have been intrigued by EMC’s work in managing an employee personal health record - it seems above and beyond (in a good way) how an human resources function and grow and support talent. Also, time to upgrade Office for Mac. It went OK. I’ll update “my own CIO” tools list in the near future.

• Employers Find Benefits with PHRs - More info about EMC and its employee PHR
• News - - Gainesville.com: Dean admits student without backing - It’s interesting that this is posted in the entertainment section. That aside, this looks concerning. I don’t understand how a student is admitted to medical school on a personal recommendation, and without taking the MCAT. How will we have a diverse medi
• Event Calendar - A way to put upcoming events on a wordpress blog
• TimeDriver - Coming Soon! A revolutionary online personal appointment scheduler - A very high potential meeting scheduling package. Given that Timebridge only allows 5 slots to be determined, this looks very interesting.
• GE Healthcare-Press Release-NCHL and GE’s Institute for Transformational Leadership - I didn’t know about GE’s work in this area. It looks like they are doing work in LEAN as well as Six-Sigma, which they are known for.
• Report cites UA med school crisis | www.azstarnet.com ® - Sad news from my alma mater, related to the difficulties medical schools are having balancing revenue and their mission.
• D.C. Not-for-Profit Offers Model for IT Adoption - iHealthBeat - More progress in DCPCA’s EHR adoption efforts
• Burlington Free Press.com | Fletcher Allen’s new EHR - Fletcher Allen in Vermont gets approval to go ahead. I believe this is an Epic Systems install, bringing with it the possibility for excellent patient engagement with their health system as a result.
• Database Problem with Office 2008 for Mac - Office 2008 Install problems, just in case

I took this photograph recently while walking home. It’s very near the White House at 15th and G streets. Visitors have remarked to me that there are a lot of sirens in Washington, DC. I have sort of blocked this out, but I do recall when I first got here that I heard sirens a lot. Much more than one would expect.

Today I had the opportunity to participate with several national health plans demonstrating their innovations in health information technology and behavioral health at a Health Plan Innovations Event coordinated by America’s Health Insurance Plans. The event included remarks by Senator Pete Domenici from New Mexico.

Besides the company of my (great) boss, James Hereford, Executive Vice President of Strategic Services & Quality for Group Health Cooperative, and counterpart Mark Snyder, MD, Associate Medical Director of Information Technology, Mid-Atlantic Permanente Group, I got to touch base again with two great leaders from Kaiser Permanente, Anna-Lisa Silvestre, and Holly Potter, pictured here.

Anna-Lisa is the Vice President for Online Services for Kaiser Permanente, and Holly Potter is the Vice President, Public Relations, National Media and Stakeholder Management. Their leadership and promotion of patient-centered health care has helped Kaiser Permanente make a substantial impact in the deployment of patient personal health records nationally - 2 million members and counting.

Off the Record — Avoiding the Pitfalls of Going Electronic. 2008. [Accessed April 18, 2008].

Many of the readers of this blog have probably seen these articles in the New England Journal of Medicine this week:

1. Off the Record — Avoiding the Pitfalls of Going Electronic. 2008. [Accessed April 18, 2008].

2. Personally Controlled Online Health Data — The Next Big Thing in Medical Care? 2008. [Accessed April 18, 2008].

3. Tectonic Shifts in the Health Information Economy. 2008.

I was most interested in the Hartzband and Groopman article, which was concerned with “what does this mean for us?” The “us” referred to, though, is “us doctors.” What about “us, the people with a primary professional mission to serve the public.” (I still have this link on my mind, forwarded by Bob Moore from Group Health Cooperative). It’s possible that if patients had the same access to their electronic medical record that we do, that many of the problems expressed in the article would, as I like to say, be “self-healing.” If I know that the patient I am serving is going to read what I write, how will that impact my interest in making it accurate? (My guess: A lot)

See what you think, comments welcome of course.

I most enjoy photographs of people being people. The first is in the Gallery Place Neighborhood, of two women walking in front of the main DC Public Library. The second is of people awaiting our special guest this week. The third is of a reporter interviewing a young family in front of the White House.

Spring is really here.

Let me know what you think!

Ending Secrecy: Physician Makes Case for Full Disclosure of Health Records - iHealthBeat

If you are interested in innovation, I think this is a good podcast worth listening to - and the actual audio is more useful than the printed version.

I listened to it the day before I attended the latest Patient Centered Primary Care Collaborative, in Washington, DC. At the meeting, I was fortunate to run into one of my role models, Susan Edgman-Levitan, PA, and we talked about the idea that the Medical Home is about improving the care of patients where they spend most of their time - where they live, work, and play. We can help patient-centered care flourish by including ideas from everyone involved in the care, including nurses, doctors, allied health practitioners, eye care, oral health care, behavioral health care, just to name a few.

I liked what Jack said in the podcast, that in a company, there has to be

a sense that in every soul of the company, the idea that everybody innovates.

Toward the end of the podcast, Jack gets quite fired up about the idea that innovation can’t be regulated to the chosen few. My experience reinforces this. In the area of health information technology, this is critical. When most people think about implementing HIT, they think about the implementation period. The most powerful part of HIT is what happens after implementation, and using a management system like the one developed by Toyota Motor Company (as we are) can allow an organization to turn HIT into an organization wide innovation engine - if they capture all of the ideas of everyone involved in providing care and put them to use. To not do so is to waste one of the most valuable raw materials for growth - ideas and time (and most importantly our patients’ time).

One other conversation that has come up in the last several days is about generational changes in approach. Many of the Generation X and Generation Y colleagues I have been talking with were raised in a professional environment where we were not going to have all the answers, and we are uncomfortable being accountable for them. We want to share the power of coming up with the answers with our provider colleagues and our patients. This is not to say that our baby boomer colleagues don’t have this desire, too. I think we are stimulating each other to do what they’ve always wanted to do, and involving patients, their families, and all practitioners, all specialties and roles, is really going to make a person’s medical home special.

Feel free to take a listen and let me know what you think:

Finding Innovation Where It Lives