Archive for November, 2009

Now Reading: Meaningful Use for Food – Impact of calorie labeling in New York City

November 30th, 2009 | Popularity: 3%
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I’m a obsessed with fascinated by transparency because of my heritage working in an industry with built-in information asymmetry.

I feel, as colleague Jane Sarasohn-Kahn does, that “transparency is the new black.” I also have liked Senator Patrick Leahy’s comment: transparency promotes competition. In this case, transparency could promote competition with less optimal food choices.

Beyond the science of changing consumer behavior, I learned that transparency is also promoting competition with old ideas of trust within the consumer….read on.

Several papers/studies have recently come out about the impact of menu-labeling. I posted a news article about a preliminary report, then learned that there was conflicting data, so I decided to take a more thorough look, and there is more to look at.

In Calorie Labeling and Food Choices: A First Look at the Effects On Low-Income People in New York City, a case-control design (comparing New York to nearby Newark) showed that people in New York City definitely noticed calorie labeling after regulations went into effect in 2008, from less than 20 % to 54 %. People also were more likely to report having their choices influenced by menu-labeling. Their actual purchases did not show a change in the calorie counts purchased, so a little dampening of the enthusiasm with which I posted last is in order.

In New York City’s Fight Over Calorie Labeling, a different dimension of this discussion is presented: Trust. The importance of trust is growing, accelerated because of social media.

I almost felt the pages in my hand heat up as I read the account of New York City’s Health Department’s work to implement requirements for menu-labeling, and its contest with the New York State Restaurant Association. NYSRA filed multiple lawsuits to block required provision of the information based on constitutional (First-Amendment and federal preemption) principles. At the time this was happening, I recalled that the NYSRA’s arguments seemed eerily similar to those used to keep patients in the dark about their health information – the customer would be “confused”. A perception of lack of trust seems to strengthen the argument for regulation to provide truthful information.

In Report Suggests New York City Menu Labeling Law is Effective at Promoting Health Changes (data presented at Obesity 2009 Conference), the data is more supportive of actual food choice-changes, with a larger sample size, albeit with study authors being the New York City Department of Health team. It will be interesting to see that study in print.

And the answer is….

There isn’t a definitive answer about consumer food choices yet. That’s one impact. What about this one:

Requiring restaurants to provide calorie information to customers could also have a larger benefit. Restaurants, recognizing that some customers might be alarmed at the high calorie amounts of some items or seeing actual reductions in sales of those items, might reformulate their products to contain fewer calories or include more low-calorie items on their menus, in which case all customers would benefit. (Farley, et. al)

This is in fact what Le Pain Quotidien did, and what Hillstone Restaurant Group (owners of Houston’s) probably won’t do, because it’s refusing to comply.

Which restaurant are consumers going to trust? And therefore, which one will be more competitive?

As usual, I see a lot of analogies to health care.

Three more things

1. A concise and provocative way of saying what I say above can be found here, on the comments section of The Economist.

2. Why this is important, from The Biggest Loser. With information and support, people really can take control of their lives.

3. Let’s not forget about all the data our groceries have and have yet to fully unleash. It’s time for a food PHR.

Links to articles in this post


Social Media ROI: Socialnomics (Video)

November 29th, 2009 | Popularity: 3%
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YouTube - Social Media ROI: Socialnomics. Also, see this presentation as a reminder that “return on investment” means that “investment” is required.

Some conversations are easier than others

November 24th, 2009 | Popularity: 3%
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Last Thanksgiving weekend, many of us bloggers participated in the first documented “blog rally” to promote Engage With Grace – a movement aimed at having all of us understand and communicate our end-of-life wishes.

It was a great success, with over 100 bloggers in the healthcare space and beyond participating and spreading the word. Plus, it was timed to coincide with a weekend when most of us are with the very people with whom we should be having these tough conversations – our closest friends and family.

Our original mission – to get more and more people talking about their end of life wishes – hasn’t changed. But it’s been quite a year – so we thought this holiday, we’d try something different.

A bit of levity.

At the heart of Engage With Grace are five questions designed to get the conversation started. We’ve included them at the end of this post. They’re not easy questions, but they are important.

To help ease us into these tough questions, and in the spirit of the season, we thought we’d start with five parallel questions that ARE pretty easy to answer:

blogrally2009-1.jpg
Silly? Maybe. But it underscores how having a template like this – just five questions in plain, simple language – can deflate some of the complexity, formality and even misnomers that have sometimes surrounded the end-of-life discussion.
So with that, we’ve included the five questions from Engage With Grace below. Think about them, document them, share them.
Over the past year there’s been a lot of discussion around end of life. And we’ve been fortunate to hear a lot of the more uplifting stories, as folks have used these five questions to initiate the conversation.
One man shared how surprised he was to learn that his wife’s preferences were not what he expected. Befitting this holiday, The One Slide now stands sentry on their fridge.
Wishing you and yours a holiday that’s fulfilling in all the right ways.

blogrally2009-2.jpg

(To learn more please go to www.engagewithgrace.org . This post was written by Alexandra Drane and the Engage With Grace team. )

Photo Friday: Kaiser Permanente Colorado Springs

November 22nd, 2009 | Popularity: 5%
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Kaiser Permanente Colorado Springs

This week’s photograph is of one Kaiser Permanente’s newest medical offices, in Colorado Springs, Colorado. In addition to this photo, I’m posting two panormic views, of the Briargate Senior Center (above) with Memorial Hospital Across the street, and one of the scenic viewpoint from I-25. There are some views of the interior of the new facility below.

If you’ve been to the Sidney Garfield Center for Healthcare Innovation, you’ll recognize that the work done there in the health care environment is now real for patients, nurses, and doctors.

This medical office, as you might expect, does not have any space for paper charts or x-ray films – medical record and imaging information is captured digitally, allowing for more space for patient care.

Colorado Springs Panoram

Colorado Springs Panoram

Gemba Walk: Kaiser Permanente Colorado

November 17th, 2009 | Popularity: 5%
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Finally, the opportunity to shadow one of my favorite physicians, Paulanne Balch, MD! This is her in her practice environment, at Kaiser Permanente Hidden Lake Medical Office, near Denver, Colorado. I’ve known Paulanne for at least 6 years, but have never seen her practice. I think this fills out the knowledge of who a doctor is – seeing how they care for patients. And as expected, I was impressed.


Paulanne Balch, MD

My visit to Paulanne is part of a visit to innovative medical practices in the Kaiser Permanente, Colorado Region (now with it’s own Twitterfeed in 2009: @KPColorado). I happen to have come at at time full of pride for KP Colorado, as they have just been named the #1 Medicare Health Plan in the United States, which makes them the best for customer experience, prevention, and treatment, as measured by NCQA.

We're in the top 10

Actually, it’s top 1 ….

And…the practices that I have been visiting are demonstrating how KP Colorado got there. As I have written previously, it’s remarkable to watch clinicians in this system, who have been using a robust electronic health record linked to a robust personal health record (at kp.org) for over 2 years now. There is good understanding of the advantages of being electronically connected to patients and to each other, as well as a continuous drive to leverage these systems to their fullest potential (and maybe beyond what they can handle, even in 2009).

I was also able to shadow Kathy Mayer, MD and Michael Pate’s practice at Kaiser Permanente Southwest Medical Office in Denver. I have mentioned this practice previously, as one that is known inside and outside of Kaiser Permanente as one with a very well formed team approach to caring for patients. And, as the rankings reflect, they have great quality results. In a mature EHR environment like this, support of whole populations of patients is possible, no more hoping that a patient will come in and have their preventive care performed. In fact, as I was there, Dr. Mayer completed identifying the last few patients on her panel that did not have necessary preventive care performed so that they could be contacted to be up to date.

I plan to be here for a few more days, to see more practices in different parts of the region, and to learn about several innovations and potential innovations in care that are being developed here. I also did something new this time, by inviting colleague Jan Ground, a project manager from Colorado Permanente Medical Group, to shadow with me. We have been able to compare notes on what we see, and Jan has been able to contextualize what I have been seeing as someone aware of the operations here.

The most important thing, though, is that we are seeing things at the level of the patient, the highest level there is in health care.

Here are some more photos of our journey – Denver is enjoying the aftermath of a snowfall earlier this week….

eValue8 Health Plan Innovation Awards: 2009

November 17th, 2009 | Popularity: 4%
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eValue8 Health Plan Innovation Awards: 2009 – Group Health Cooperative and UnitedHealthcare Recognized by NBCH for Programs that Improve Health and Health Care 2009 – Based in Seattle, Group Health Cooperative is a consumer-governed, nonprofit health care system that coordinates care and coverage that was selected for creating a comprehensive health risk assessment, called the Health Profile, which is integrated into care delivery.

Photo Friday: National Capitol Columns

November 14th, 2009 | Popularity: 4%
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US Capitol Columns

This week’s photograph is of the National Capitol Columns, At the United States National Arboretum, in Washington, DC. I didn’t know these existed until I visited the Arboretum last weekend. It was a great find. Here’s the interesting history (from the USNA web site, linked above):

The columns began their life on the East Portico of the Capitol in 1828. They were quarried from sandstone near Aquia Creek in Virginia and were barged to Washington in the early days of our country, before the familiar Capitol dome was completed. Their stay at the Capitol was to be limited by an oversight. The dome of the Capitol, completed in 1864, appeared as if it was not adequately supported by the columns because the iron dome that was ultimately built was significantly larger than the dome that the designer envisioned. An addition to the east side of the Capitol was proposed to eliminate this unsettling illusion, but it was not constructed until 1958. More time would pass before the columns would come to their final resting place. It was not until the 1980s that Arboretum benefactor Ethel Garrett took up the cause of establishing a permanent home for them. Russell Page, a close friend of Garrett’s, and landscape designer visited the Arboretum in September 1984, only months before his death. He found the perfect site for them on the east side of the Ellipse where the grandeur of the columns would be in scale with the more than 20 acres of open meadow, a rarity in a built up city like Washington. The columns are set on a foundation of stones from the steps that were on the east side of the Capitol. Old identification marks from the quarry are still visible on some of the stones.

The columns are a great place to find Washingtonians and visitors exploring, which makes for great photographs to use in presentations when I talk about what it means to be able to achieve life goals through optimal health. Here are some more photos, enjoy.

Now Reading: Patients actually want their entire medical record

November 13th, 2009 | Popularity: 6%
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Ok, this article isn’t titled that either, it’s titled Insights for Internists: “I Want the Computer to Know Who I Am” and it continues to complement the stream of information from peer reviewed literature that is more or less confirming what people who use robust personal health records already know. I discussed the issue of imaging test results earlier, as you may have read. That article was published in the radiology literature, which is significant, this one is published in the internal medicine literature, which is also significant. When the producers of the content themselves (internists, radiologists) convey what their patients want from them, it’s a powerful adjunct to the patients doing this themselves (and frankly, they’ve been doing it for a really long time…).

This paper was written by a team at Beth Israel Deaconness Hospital, and encompasses data from patient and physician focus groups conducted in multiple cities in 2006-2007. They asked them about how they manage their health information and how they would ideally manage health information. Some of the more important points:

  • They mostly do it – keep their own records – except for the college student group
  • They want full access to all the information. They know about their legal right to see their record, and understand that as currently constructed, this legal right doesn’t grant them functional access (think “73 cents”).
  • Privacy: “worries that appeared to fade rapidly in the face of the desire to have records fully available in emergency settings and with multiple and new providers.”
  • “Strikingly, the health professionals professed far more concern about maintaining privacy than patients.”
  • They understand that their clinicians are busy/stressed, they want the information to supplement and make their (clinicians) work more efficient, not less

I both enjoy and get discouraged by reading this information because it should be more universalized than it is. But it will be. I’ll continue to invite the patient voice wherever I can, and continue to work with leading edge care systems (there are many) who take this information and innovate for patients.

With great thanks to the team at BIDMC and lots of nurses and physicians who are now asking the “why?” question about keeping things from patients. It reminds me of a letter I once composed to send to USA Today, that I never did, and through the magic of Mac OS X spotlight, I found it (and very quickly – amazing). Here’s what I wrote in 2005. Hmm..the passion didn’t fade.

In the USA Today article (“Prescription for Patients: E-mail”), the author felt from her experience that “patients could not be trusted not to abuse doctors time.” What we have known from the beginning is that patients can be trusted – they could always be trusted. And that’s the difference. We are supporting our patients’ trust in us, that we do not waste their time. Isn’t that what matters most?


Bots for Seniors: iRobot Creates New Division to Serve Eldercare Market – Innovation Economy – Boston.com

November 12th, 2009 | Popularity: 3%
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Bots for Seniors: iRobot Creates New Division to Serve Eldercare Market – Innovation Economy – Boston.com

Strategies for Prevention: Holly Potter’s blog

November 12th, 2009 | Popularity: 4%
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Strategies for Prevention: Holly Potter’s blog – Yes, she has one. And you can link to it here.