May 6th through May 7th:

• The Happy Hospitalist: This Deserves The Middle Finger - I guess it is controversial (the RUC report on Medical Home Reimbursement)
• AMA (RBRVS) RUC Medicare Medical Home Demonstration project recommendations - RUC and Medical Home. Might this be controversial?
• reportonbusiness.com: Asking ‘why’ again and again is harder than you think, but it works - Good description of the 5 Why's Exercise
• What is Hypertension? - WrongDiagnosis.com - Factoids about Hypertension, useful in planning a community intervension
• Cigna clients seek answers after expiration -
• Cigna ends pact with hospitals, leaves thousands in the lurch - This local story has not made the national news. I wonder why?

I recently pulled several articles to help leaders understand Web2.0 better. That’s what’s in the links below.

The image is one that I snapped while taking a flight recently. It reflects the accommodations an already troubled industry is having to make to support our health (or lack thereof).

• CDC trends in obesity 1985 2001 - CDC trends in obesity 1985 2001. Disturbing.
• A List Apart: Articles: Take Control of Your Maps - Useful article about integrating mapping visualization
• A List Apart: Articles: Accessible Data Visualization with Web Standards - Really nice article on simple data visualization using CSS
• VM — Being There, Mar 01 … Virtual Mentor - The use of telemedicine technology, while convenient, can at times be inadequate, as shown in the portrait painting entitled The Doctor, where the physician stays at the bedside of a gravely ill child and offers his presence as comfort to the family. Virt
• Notional Health Server | Economist.com - A flagship service adrift - problems with online booking at the National Health Service
• Health 2.0 | Economist.com - Technology and society: Is the outbreak of cancer videos, bulimia blogs and other forms of â??user generatedâ?? medical information a healthy trend?
• Social networking | Joined-up thinking | Economist.com - Social-networking sites are not just for teenagers. They have business uses too
• Sources and acknowledgements | Economist.com - Helpful links for Web2.0 research from the Economist
• What sort of revolution? | Economist.com - Both good and badâ??but it’s too early to say in what proportions
• The wiki principle | Economist.com - Are many minds better than a few?
• Compose yourself | Economist.com - Journalism too is becoming interactive, and maybe better
• It’s the links, stupid | Economist.com - Blogging is just another word for having conversations
• Among the audience | Economist.com - The era of mass media is giving way to one of personal and participatory media, says Andreas Kluth. That will profoundly change both the media industry and society as a whole

• Topics - e-Visits @ TransforMED - Transforming Medical Practices - Article on whether the tipping point has been reached for e-visits
• WordPress Plugin: SIMILE Timeline at freshlabs journal - Nice visualization tool
• Doctor-Patient ‘Web Visits’ Spur Privacy Concerns : NPR - Should the American Medical Association always present the contrarian view around patient access? I don’t agree with the implication that cell phone / telephone is “most secure.” Anyone who has been in an airport recently would probably agree.
• WSJ.com/Harris Interactive Study Asks: Are There Fair and Reliable Ways to Assess Healthcare Quality? - Patients are saying that having an EHR is a “fair” assessment of quality
• Expansion of CCHIT Certification for 2009 (PDF Presentation) - Overview of CCHIT’s work to date and future strategy. Disclaimer: I am on the Foundations Workgroup
• Meet the Press — Robert Scoble — The Blogosphere | Fast Company - How Tim Ferriss used the blogosphere to his advantage
• News - Diversity gap found among state’s doctors - sacbee.com - “Not just a civil rights issue, a public health issue”
• YouTube - Microsoft Surface Parody - Why not use the device the size of a small car? The peril and promise of on demand video in shaping your message.

I came across Susannah Fox’s recent blog entry: (e-patients: Flashback to 2001) where she uploaded a PDF of the American Medical Association’s Press Release of Resolutions for 2001 (you can link to it directly here), which included a resolution to “trust your doctor, not a chat room.”

She said she posted it by the popular demand (of one), but I also was glad she posted it (so increase the count to two, Susannah!), and followed the link to another blog post that was critical of her presentation at the Health 2.0 conference. In that post, the author said, “is Fox actually disagreeing with those who think it wiser to seek advice from physicians than to take seriously medical advice received from anonymous strangers in internet chat rooms?” and I wanted to comment on this as someone sitting in the audience (and who got to catch up with Susannah shortly before she went on stage - ok, so I am disclosing that I am a fan).

I think what Susannah was responding to, and somewhat verified in David Rothman’s post is the binary-ness of the argument, that it’s either your doctor or the Internet, not both. The first question I ask when I wonder about behavior is (in true LEAN tradition) “why?” Why would a patient access information outside of their physician relationship? We can guess at many reasons, including that they don’t have access to a doctor, or the doctor they do have access to has not given them the information they are looking for. At some level, there is a trust issue involved, and if we use the Edelman Trust Barometer as one piece of data, it is that patients are more likely to trust “someone like me” than their doctor. It’s impressive that we’ve come to this.

Rothman goes on to discuss the virtues of Medline Plus as a place to get authoritative information and “I do not believe that online resources collaboratively created by patients will solve the problems and dangers of healthcare misinformation online.” Again, I think it is the “it is or it isn’t” aspect that we have to be careful of. To Rothman’s comment, I would say, “Is that true 100% of the time?” And I thought about this a bit more as I pulled out a study I have been waiting to read for some time:

Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, et al. Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis: A Randomized Controlled Trial [Internet]. JAMA. 2007 Dec 5;298(21):2487-2496.[cited 2008 Mar 13 ]

The study is, I would say, on the incredible side. It challenges one of the most commonly held notions in primary care, that sinus symptoms should result in antibiotic treatment, and shows that prescribing amoxicillin for the most commonly used criteria to diagnose sinusitis was no better than a placebo (sugar pill). I imagine the signficance of this, considering that the average physician may see at least one case of these symptoms each week and the antibiotic cost yearly is $2.4 billion in the U.S. Not to mention that these antibiotics are now in our water supply.

So I next went to Medline Plus, to the Sinusitis topic, to look for the information that says that antibiotics have no effect on the condition in most cases, and that diagnosis itself is questionable.

Sinusitis [Internet]. [cited 2008 Mar 13 ]

No such mention. Is this surprising considering that the average piece of research takes 17 years to find its way into medical practice? I won’t go into why that is here; however, the point is that even the most infallible official resources can be fallible. All that this means is that we should always as “why?” and support our patients asking “why?” also. Of interest, I found out about this peer-reviewed study in the blogosphere, not on PubMed or Medline. We should leave the door open to the idea that patients may just help us reflect on better ways to treat them that are less costly and less harmful to themselves and the environment. It’s a continuous spectrum, not a binary switch.

What about American Medical Association 2001?

I also wanted to comment on Susannah’s use of the press release, which is very important and useful. We have to know where we came from so we can move ahead together. The same year that the press release came out, the American Medical Association also published another piece, “Geraghty K. Historical Postmortem, March 2001 (The Telephone). Jama 2001. (link fixed 03/13/08)” In that piece, my profession’s history with the telephone was discussed - it took 80 years for the telephone to become accepted in modern medicine. But it’s accepted now. And one day, the Internet will be, too. We’re really only 8 years into Internet-enabled health care (using my own organization as the example).

What Susannah presented was what it was: American Medical Association 2001. That’s not the same as American Medical Association 2008. Organizations grow and change. I’m confident that the medical profession will grow and change and use the best tools out there to help our patients. We came from barbers, after all. And I’ve never met a physician that wanted to provide bad health care to their patients.

February 4th through February 6th:

• DC Moves for Safer Sidewalks - Get There - Washington government takes a step toward promoting walkability. Sidewalks stay open for business.Walkers rejoice!
• Apple //c - a photoset on Flickr - The OOB experience of an unopened AppleIIc computer. Remember when technology was fun? It still is. And I never even learned to program in Pascal.
• Ryanair’s Changing Altitude - Efficient cost management and charging for everything keeps margins high at RyanAir - a great example of “copy how we think” in terms of being like Southwest
• Running a hospital: More on fetching and work-arounds - BIDMC launches an improvement methodology called SPIRIT. Looks like it’s at least partially based on LEAN?
• The Health Care Blog: Bad Medicine: How The AMA Undermined Primary Care in America - Brian Klepper - Analysis of RBRVS and impact on primary care.
• The ethics of CEO blogging - Nice discussion from Paul Levy about the approach that a CEO takes to blogging. I’m in support!
• Insurers Begin To Reimburse for Online Visits, Concerns Remain - Nice profile of Kaiser Permanente’s program.
• Marriot Rolls Out Web-Based PHR System to Employees Nationwide - iHealthBeat - An employer-sponsored PHR. Will the lack of connection to the health care team be an issue?
• KUOW: Program Archive: Patient Safety, January, 2008 - Dr. Matt Handley, from Group Health Cooperative, is featured
• Best Companies 2008 - FORTUNE Magazine’s Top 100 Employers to Work For - The 2008 list is out. From an HR/Leadership perspective, it is interesting to look at some of the most important qualifications for being on the list, such as support for diversity.