Archive for April, 2009

“Do you have htn?” – Learning about home blood pressure monitoring first hand

April 29th, 2009 | Popularity: 15%
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The quote in the title of the post is the subject line (and the entire message actually) of an e-mail that was sent to me this morning from a colleague, after he saw this tweet:

Twitter - tedeytan- #homebp The WatchBP Home h ... (20090429).jpg

from this twitter stream of mine.

The answer is, I don’t have high blood pressure (“htn”) (that I know of), but I am learning about what it’s like to worry that I may have it.

To do this, I am trying out a new device, the WatchBP Home , that is novel in a specific way. Not the way people might think a blood pressure device might be, such as having bluetooth, wifi, or other technowizardry, but in a clinically important way – it has guidelines for checking blood pressure embedded in it such that it allows blood pressure checks at certain times of day, and produces meaningful results for patients and clinicians. Feel free to review the Web site yourself, or I’ll explain more about this in the future.

I’m going to keep tweeting about it after every measurement and will post thoughts about the experience when I am done. It’s been a great experience so far, not so much because of the device, but because of the experience.

As to the question of whether I have blood pressure or not – If you’ve been following my (many) posts on this blog about hypertension, it’s very likely that many people don’t know if they have high blood pressure either, because they have not gotten it checked (about 1/3 of people with high blood pressure are in this situation), or because they may be one of the 20 % of people who have been diagnosed with high blood pressure, but don’t really have it, because they were checked in a doctor’s office.

So this is why I am trying this out – what would the management of this condition be like if patients were in charge of the diagnosis, in partnership with a physician? I was fortunate to attend the medical school that has Andrew Weil, MD, on faculty, and I remember him telling us that we should try the therapies that we prescribe to patients (within reason) so they know what they are like. That’s what I’m doing here. Feel free to follow along on Twitter and I’ll post more here on the blog when I’m done.

Conflict of Interest Reminder: As it says on my “About” page, I do not have any financial interest or ties to, and have not received any honoraria from, pharmaceutical or device manufacturers.

Janet HealthConnect’s debut at Health 2.0 meets Information Therapy

April 28th, 2009 | Popularity: 22%
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Growth and Development of kp.org

I would like to start, rather than end this post, with huge thank you’s to:

Allan Rogers, MD, Kaiser Permanente’s National HealthConnect Team
Susan Campbell-Hartzell, Kaiser Permanente Internet Services Group

Without their help, Kaiser Permanente would not have been able to demonstrate kp.org, I’ll explain why.

We got the call (or rather, e-mail) a week before the Health 2.0 meets Information Therapy Conference in Boston, the premier event for the health care startup community (and which Kaiser Permanente is a Flagship Sponsor of): Would Kaiser Permanente be able to demonstrate KP HealthConnect and kp.org, connected to live servers, to this room of 450 health care patients, companies, and other leaders?

Piece of cake, we said. Except for the live server part. Even though this was the requirement of demonstrations at Health 2.0, we would not be able to do things this way, but it was still a lot of work, I’d like to assure everyone!

We only had a week to put together an integrated demonstration. A demonstration that was to last no longer than 3.5 minutes.

Now, I definitely believe that if you can demonstrate something in 10 minutes, you can do it in 3; the challenge is deciding what not to show in a health system that is so comprehensive in the way it does everything, not just health information technology. We also wanted to make this relevant next to really great work completed by Google Health and HelloHealth.

With several script revisions, test system password resets, and stocking of fictional patient records in a fictional system (i.e. one totally separate from the system patients, doctors, and nurses use every day), we created a few weeks in the life of Janet HealthConnect.

What we thought was best was to think about the things that Kaiser Permanente brings to Health Information Technology that complements Google, HelloHealth, and the entire Health 2.0 community. One of the biggest things that Kaiser Permanente brings is adoption – it’s good at this and it wants to share its expertise.

If Kaiser Permanente is demonstrating the future of health care in its medical centers, hospitals, and where its members live, work, and play today, this community is demonstrating the future of the future, and that’s why we need each other.

With that in mind, I asked Anna-Lisa Silvestre, VP of Online Services to serve as her letter turner. Kate Christensen, MD, the Medical Director of kp.org, was also close by as well. In the demonstration I prompted Anna-Lisa for several facts about the adoption of My Health Manager.

  • When Janet logged in to My Health Manager, Anna-Lisa told the audience that 47,348,917 other visitors had logged in in 2008
  • When Janet sent a secure e-mail to her personal physician, Dr. Rogers, Anna-Lisa told the audience that 6,078,838 other e-mails were also sent in 2008
  • When Janet reviewed her HbA1c result, Anna-Lisa told the audience that 16,773,273 other results had been reviewed by patients online in 2008
  • When Janet accessed the Health Encyclopedia to learn more about the HbA1c test, Anna-Lisa told the audience that 3,975,230 other visitors had in 2008
  • When Janet booked an appointment online with Dr. Rogers, Anna-Lisa told the audience that 1,403,870 other appointments were booked online in 2008, and that these appointments were more likely to be kept.

We then joined Janet HealthConnect’s physician, Allan Rogers, MD, opening Janet’s incoming e-mail. This was a great place to point out that Kaiser Permanente’s maturity with a comprehensive electronic health record has created a focus less on optimizing the acute care visit in the EHR, more on the In Basket as a central place for multispecialty care coordination.

Dr. Rogers then demontrated some of the efficiencies created by the KP HealthConnect team which allowed him to review the patient’s care snapshot right in the In Basket, and then to respond to Janet’s message with full decision support available.

In this portion of the demonstration we showed capabilities beyond sending messages – messaging is designed as an activity that promotes the personal physician-patient relationship with the right information in every encounter.

We quickly stepped through the in person visit, ending with the After Visit Summary, which we used to demonstrate the commitment to service quality, in that AVS use is measured and tracked to ensure a great experience with every encounter.

I closed the demonstration with a screen shot of a patient list, which showed that there may be many Janet HealthConnects, or populations of patients with chronic illness, that can be monitored as a group and cared for by teams, right within KP HealthConnect.

Our final slide is the one pictured above, where Anna-Lisa made the announcement to the audience that My Health Manager adoption has surpassed 3 million members.

So the the things we wanted to show that health information technology can and should do (and has done at Kaiser Permanente) are:

With special thanks to the Health2.0 meets Information Therapy team for their support and to the entire Health2.0 community for being supportive, and critical. This is where innovation comes from!

Photo Friday: ePatientDave from the Balcony

April 28th, 2009 | Popularity: 18%
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.ePatient Dave from the Balcony

Even though it’s not Friday, this photograph was taken on Friday. It is courtesy of Linda Davis, who responded to my tweet asking if anyone had documented the most impactful moment I experienced at Health 2.0 meets Information Therapy in Boston. In addition, there was a photo in this series of panelists Sean Khozin (HelloHealth), Roni Zieger (Google), and myself, listening to Dave from the balcony.

“We Will All be Patients Someday” – Health 2.0 meets Information Therapy, Boston, MA

April 27th, 2009 | Popularity: 27%
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I am back from the spring Health 2.0 Conference in Boston, MA, this time combined with Information Therapy, which in my opinion was both a great thing to do in terms of participants, and in terms of bridging the Health 1.0 and Health 2.0 worlds.

Photos below, click on any to enlarge

Some of my favorite health care leaders were in attendance of course, including Holly Potter, Kate Christensen, MD, Paulanne Balch, MD, Anna-Lisa Silvestre, Diane Gage Lofgren, James Hereford, ePatientDave, Trisha Torrey, Susannah Fox, Gilles Frydman, Dan Hoch, MD, Alan Greene, MD, Danny Sands, MD, Jay Parkinson, MD, Jane Sarashohn-Kahn, Lygeia Riccardi, as well was excellent co-hosts Matthew and Indu from Health 2.0, and Josh Seidman, from The Center for Information Therapy.

(Is this dangerous? Attempting to list all of your favorite people on a blog post? I suppose I could just link to my Twitter friends list – I hope everyone remembers what I said on stage about loving everyone and that you’ll add a comment if I’ve forgotten..)

My bias in coming to Health 2.0 is to look for connections and innovations for the established health care system, and I think the combination here supported that, beginning with a debate entitled, “Ix and Health 2.0 – Synergies and Tensions?” moderated by Jane Sarasohn-Kahn, probably one of the few humans alive who can moderate this many energetic people at once. Regardless of the outcome, though, the mere fact of the conversation is evidence that we all need each other, because when we are patients, we are going to need everything we can get to help us be successful.

The Patient Takes Center Stage, from the balcony

Twitter - SusannahFox- @epatientdave should be on ... (20090427)

The moment of most impact for me was when I was on stage, following a short demonstration of

kp.org (see tomorrow’s post), when the topic of ePatientDave’s work with Google Health and Beth Israel Deaconness (well represented by Roni Zieger, MD, and John Halamka, MD) was mentioned ( start here if you want to get up to speed on this great story ) .

Here’s what happened : When the topic was first brought up, and there were a few audio problems, we heard “Speak up!” coming from the balcony on the right. I turned to fellow panelist and said, “Voice of the patient!” Next, as the discussion was unfolding, with Roni and John describing what they had done in partnership with Dave, I noticed this tweet on the monitor in front of me: “@epatientdave should be on stage too #health2con“.

As Dave got up, in the balcony, to begin talking about his experience, I reflected on the tweet and motioned him to come down, but instead, a really interesting thing happened. Dave stayed up on the balcony, microphone in hand, and spoke to the entire audience below. It was a perfect moment at a perfect time for me (and I think for the rest of the room), when a room of health care leaders looked up to our patients, physically as well as emotionally. I don’t know if there’s a photograph out there of this scene, but it’s gotta be priceless. Even though I could not find one for this post, I like this description of things from Susan Carr.






ACP Internist, April 2009 – Twitter: a medical help, hindrance or hype?

April 27th, 2009 | Popularity: 13%
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A special report on health care and technology: Health 2.0 | The Economist

April 27th, 2009 | Popularity: 13%
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Three Million People Now Using Kaiser Permanente’s Personal Health Record | Kaiser Permanente News Center

April 27th, 2009 | Popularity: 14%
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Dr. Ted (he’s not me) | The Economist

April 27th, 2009 | Popularity: 15%
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  • Dr. Ted (he’s not me) | The Economist – Comment from a user of The Economist.com that refers to the Kaiser Permanente study showing a 21.5 % decrease in office visits in Hawaii. (see http://content.healthaffairs.org/cgi/content/abstract/28/2/323 ). I agree that the majority of care to Americans is provided in small practices, as well as the idea that physicians who want to perform virtual care find it difficult with today's reimbursement approach. (50% of the reason I’m posting this is to clarify that I’m not this Dr. Ted. I post comments on others’ blogs as “Ted Eytan.”

Social Technologies in Health Care – Part IV | SMUG – Social Media University, Global

April 27th, 2009 | Popularity: 11%
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Photo Friday: Dupont Circle Pillow Fight

April 17th, 2009 | Popularity: 20%
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There are no pillows in these bags!  

Pillow Fight!

This week’’s photograph is from the Washington, DC Pillow Fight, part of International Pillow Fight Day, which occurred on April 4, 2009. The DC version was staged twice, once at the national mall, and once in Dupont Circle. A good time was had by all.