Heatlh 2.0 DC

This Health 2.0 was a milestone for me – the first time that I (a) sat on a panel with a patient as a peer and (b) did media with a patient as a peer. The last Health 2.0 I was at had me sitting on a panel on stage with the patient “encouraging” us from the balcony. A small step toward last week…

The patient is @ReginaHolliday , who ultimately took a significant chunk amount of time from her schedule to sit on a panel with me, do multiple and honest interviews about her experience as a Kaiser Permanente member, and lead a “Patient 2.0” session later in the day.

This feels as right, as natural, as I thought it would, and the converse, not having a patient involved feels as unnatural, as uncomfortable as I thought it would.

Their presence virtually also helps –  a disclosure, I am the “friend” that Regina refers to in this blog post – surrogate blogging is something we can do with each other to mix our perspectives for complicated issues.

Behind the scenes at Health 2.0

Matthew Holt ( @boltyboy ) and Indu Subaiya ( @bluetopaz ) were, as usual, terrific hosts, and one memory I will have from the day is of Indu beginning the round of applause that greeted the news that Kaiser Permanente is the first health and hospital system in the United States to receive a perfect 100 % on the Healthcare Equality Index. This relates very much to a passage in Charlene Li’s new book, Open Leadership (review coming soon) where she refers to the skill of Open Leaders “Knowing when and what to “check at the door” – something that many women and minorities innately understand.” Matthew, Indu, and the Health 2.0 community always create an environment that doesn’t require people to check anything at the door.

The panel I was on, by the way, included some of my favorite people in health information technology, Josh Seidman, Ph.D., from the Office of the National Coordinator ( @jjseidman ) and Jon White, MD, from AHRA (Jon, are you on Twitter??). All have been interested in making health information technology happen for a really long time and can bring a good sense of optimism as its time comes….

Ragan Health Care Communicators Summit

In part 2 of a whirlwind week, I joined health care communicators from across the nation at Kaiser Permanente’s Sidney Garfield Health Care Innovation Center ( @KPGarfield ) to share and discuss the application of new media in health care communication.

A low fidelity backdrop to impressive accomplishments in communication

The positioning of the Summit ( you can see the Tweetstream here ), by the way, is/was a nod to the work that Holly Potter, Vice President of Public Relations and National Stakeholder Management ( @htpotter ) and Diane Gage-Lofgren, Senior Vice President for Brand/Communications/Public Relations ( @dianelofgren ) have been doing to transform relationships with their stakeholders. And look at the results to date (photograph).

Two things worth mentioning are that I was not the only physician there (hooray!) – Wendy Sue Swanson, MD ( @SeattleMamaDoc ) from Seattle Children’s Hospital did a wonderful job conveying the benefits she has discovered in being open in her physician leadership through her work on the Seattle Mama Doc blog, and really just from being present, because I think that’s all physicians have to be at this point. I was energized for sure!

The second thing is the progress of my former employer (but happy affiliate to my current employer), Group Health Cooperative ( @Group_Health) as shared by Katie McCarthy ( @kamseattle ). I think it’s okay to say 3 years later that we used to go on walking meetings in Seattle to talk about how the organization we enjoyed being part of so much could share more with its stakeholders using new media. And, they are doing it.

What Katie and Wendy Sue did that was especially “in the spirit of” in my eyes was relay with authenticity the challenges they have faced in learning and teaching about social media. I captured one of Wendy Sue’s experiences in this tweet and one of Katie’s in this tweet. In particular, the observation about “the network is for patient care, not social media” is an observation that I think will change – because social media is not social media, social media is communication, and communication is at the core of patient care. Right? Right.

We were also treated to a wonderful closing day keynote by Matthew Holt ( @boltyboy ) (he’s everywhere!). I don’t think I have actually seen him out of his conductor of the orchestra hat, so it was a treat to see him create a nice sense of urgency and engagement in an audience that is not as familiar with his incredible-ness as I.

Speaking of communication, the Summit was a glimpse into the state of communication between health care and stakeholders.

It seems to me that parts of health care may not know what is expected of them in terms of their communication with their communities, and maybe this comes from not feeling the impact of not communicating with their stakeholders, relative to peers in other, less GDP-hungry industries. From that perspective, it was great to meet the professionals in this group, which ranged from the extremely adept and model leaders/organizations to the really interested and getting started leaders/organizations.

We, the medical profession, need to be there with them, as partners, listening and learning. When we live up to the image that they have of us, it’s a sure thing that we will do great things for the people we serve.

Thanks again to the teams at Ragan Media, Health 2.0, and leaders that participate in teaching each other about what this is really about (listening).

Speaking of giving patients access to their medical records, this week’s photograph is both a little grainy, and not taken in Washington, DC. This one comes from an iPhone and San Francisco, California, and is of an advertisement for Virgin America airlines, on Market Street.

I sort of follow (and fly) Virgin America because they have done a great job of meeting the expectations of customers in ways that other airlines have seemed unable/resistant to. Any customer would have expected or desired a power outlet at every seat 5 or 10 years ago.

As usual, there are a lot of analogies to health care. Patients and their families are a force of nature. They have high expectations of us, just as we do of them. Let’s make sure we meet theirs, because we can.

Harley Davidson dealership, Oakland, California

I am back in Oakland, California, at the Sidney Garfield Center Health Care Innovation Center, this time supporting the Permanente Medical Group’s course “Medicine and Management,” which brings physician leaders from across the nation to learn about leadership in all of its facets. This includes providing great care experiences for members, recruiting and mentoring other physicians, and today’s installation of the course, techniques used in innovation.

In this morning’s session, there was a surprise trip to the Bob Dron Harley Davidson dealership in Oakland, California to learn about leadership in a context other than health care. By the way, I misspoke in my twitter feed that we were going to the Harley-Davidson factory – this is where we went, and it was no less impressive. One thing I really enjoy is learning about different ways of doing things from outside of health care.

The question in the title of the post was something we were asked by several of our tour guides – they would ask, “Does anyone here ride?” as a way to identify enthusiasts up front. Despite the fact that most patients wouldn’t call themselves enthusiasts of health care, there are (as with everything I see), parallels to health care. Although not enthusiastic about health care, I’d say most patients are enthusiastic about a great patient-physician relationship.

I was impressed by the level of interest in collaborating to create a good customer experience in all facets of the relationship – from the decision to purchase, to buying add-ons, to service. Because service is such an important part of the relationship, the service area is as clean and welcoming as the sales floor is (and service involves sales, too).

This part of the day was an introduction to observation, in the process of innovation. We were coached in asking useful, open-ended questions, and then went back to the Garfield Center to convert the observations into storytelling. We also did exercises in brainstorming (see photograph below) to acquire as many ideas as possible and sort through them.

Tomorrow, the group will continue to learn about the skills of innovation, or design thinking, led by the Innovation Consultancy group at Kaiser Permanente. The skills being taught to this group of physician leaders are the same ones used to develop the breakthrough MedRite program, which has changed the way people think about (and do) medication administration in hospitals so that it is safer. If you look at the tools used in MedRite, they are not new computers – using design thinking, the tools are simple, effective, and can be spread easily.

I am, of course, a big fan of continuous learning, and think it’s differentiating for medical groups to teach the skills of innovation. Through the work of the innovation consultancy, and more broadly, the Innovation Learning Network, Kaiser Permanente participates in sharing knowledge across organizations, just like our members expect.

More photographs, click on any to see larger size

While speaking at the Institute for the Future’s Health Horizons’ Spring 2009 Conference (LiveTweets here and more organized here) about Combinatorial Innovation, with William Ruh, Vice President, Cisco Systems, Larry Tessler, from 23andMe, and Mike Liebhold, Senior Researcher from IFTF, I had a great opportunity to have my words documented graphically, by a very talented visual recording artist.

You could look at the product and get a sense of what I was speaking about on behalf of Kaiser Permanente – member/patient as the hub of health care, engaged doctors with their patients, moving ahead together in the interest of those they serve.

Seeing the documentation is also a great check on accuracy – and in fact, it showed an error in my discussion – the “$5 billion Project” attributed to Kaiser Permanente HealthConnect is actually $4.2 billion, which is a big difference in discussing the investment of a non-profit health system in leading edge technology.

I think (and thought) this was a great opportunity. How can a person tell what the audience feels after they tell a story about something like patient empowerment using technology? Extrapolating to the patient-physician encounter, how does a patient know if their physician understood the significance of their story? Seeing the documentation is very powerful, and a visual check on creating the right impression of the work is very innovative, in my opinion.

Thanks a ton to Institute for the Future for hosting a great discussion, and for allowing me to touch base again wtih two of my favorite leaders in the universe, Karl Hoover and Diana Elser, both from Group Health Cooperative, and as of the date of this discussion, now on Twitter (Follow them here: @kmhoover @dlelser and please encourage them to share their experience in this medium…) Welcome aboard!

This week’s photograph was taken at California Healthcare Foundation offices in Oakland, California, where patient advisor Bryan Bush is part of an advisory group was assembled to discuss the “Clinic of the Future” Initiative, described as

The goal of this initiative is to stimulate large scale, substantial, sustainable and scalable improvement for patients and providers in the way safety net clinics provide high quality care to the underserved.

Bryan is a patient of Sebastopol Family Health Center, which I have profiled (and cheerleaded here) previously, and as I have observed in other environments, helped center the conversation. Bryan told the group that in his former primary care environment that “It’s hard when you start to care (about your health) to not be able to see your doctor.” He also told the group that Sebastopol’s patient portal will be one of the sites he bookmarks (“it will be one of my favorites”) when it goes live – “It will be lifesaving.”

That’s Mary Szecsey to Bryan’s left, and Jason Cunningham, MD, to Bryan’s right. Together they are innovating in Bryan’s patient experience by providing him with the primary care he needs when he needs it, and by bringing him into the conversation about how their primary care is designed for patients and families.

It was posed by e-Patient Dave in a comment on this post illustrating the challenge of test result sharing with patients today.

He’s referring to California Health and Safety Code Section 123148 , which makes it illegal to share certain kinds of test results with patients online. It also says:

In the event that a health care professional arranges for the provision of test results by Internet posting or other electronic manner, the results shall be delivered to a patient in a reasonable time period, but only after the results have been reviewed by the health care professional.

Knowing what we know about health care, reasonable time period and “only after the results have been reviewed” may be in conflict.

I understand this law was passed in 2002, so in 2009, I’d like to ask patients and those who care for them what they know of the rationale here? If you do not live in California, is there any such legislation in your state? If this law no longer existed, can people envision what the harms (and benefits) would be?

See how many different aspects of this experience could be improved (security, privacy, confidence, accuracy) if the patient had online access to their results, linked to explanatory health information and interaction with their care team at their convenience.

While the situation is obviously a parody, it seems to have enough elements of truth in it that I wonder if the writer experienced receiving test results recently. Without overanalyzing, I would say that the piece does a great job of showing the impact of disempowerment. Thanks to the 30 Rock team for the great example.

In California, a patient wouldn’t have a choice except to receive the results via telephone or in person, because it’s been illegal since 2002 to share pathology results with patients over the Internet, even if the patient and/or the doctor wish them to be communicated that way.

Just as with the presentation, I was a little nervous about the demonstration. Unlike the previous health information technology environment I was a part of, this one is between 10 and 100 times as vast, and I wanted to respect the work of the experts who were involved in making it happen.

And, the experts have done great work – I looked at a specific aspect of Kaiser Permanente’s care, highlighted in this television advertisement, that has resulted in a 30% lower death rate from cardiovascular disease among Kaiser Permanente members relative to other Californians. Kaiser Permanente, by the way, has funded expansion of this program to patients outside of Kaiser Permanente through its Community Benefit work.

The demonstration was attended by other Kaiser Permanente experts and members of the national media, to see “today” and “tomorrow.” And there’s lots of tomorrow happening here, because the reality is that there are still very few organizations that are at this maturity level of electronic health record use.

I’m including some photographs below, and I am supported in sharing them here, just as the innovation will be shared. There’s a fully simulated hospital ward, ambulatory medical center, and even a patient’s home (because that’s where the hub of good health should be). A lot of what is being developed here will find its way to patient care inside of, and outside of Kaiser Permanente. A lot of it already has. From reading Sidney Garfield’s writings, this is by design. Enjoy and feel free to let me/us know what you think.

This week’s photograph was taken in a well known coffee store, where customer evaluations were posted in a conspicuous place. What would it be like for a medical office to do the same?

“Our patients don’t expect us to be perfect, they expect us to recognize our mistakes quickly.” (that’s not on the sign, it’s my quote)

I had a few great photographs to choose from for this week’s Photo Friday, they were of colleagues and friends from this week’s California Chronic Care Conference. Those are posted below. I chose this one to be “the” photograph though – the one of the conference attendees.

Why? Because when I downloaded this one it was different than a typical picture of people at a conference. Look at their faces – they are smiling. They are smiling because they are attending a panel of patients talking about their experiences in and out of health care managing their conditions. The panel was moderated by Alan Glaseroff, MD, and it demonstrated how much energy people get from knowing how their work impacts others. It’s a Toyota Motor principle that I mention often (do I need to stop?) – “Seeing the impact of what you do.”

Thanks to the California Healthcare Foundation for hosting the conference with this idea in mind, and for doing things differently, including no powerpoint slides. Some of the other photographs from this week are below. Enjoy.

Left to right: ePatients and Doctors: Ted, Susannah (Fox), Dave, Sal Volpe, MD; Patient Panel, California Chronic Care Conference; Jay Parkinson, MD, and Susannah Fox.

To recap the data that I linked to in this mini-photo essay:

• People in intolerant places are less happy and less fulfilled than those in tolerant and open-minded ones.
• Business organizations that embrace diversity have more customers and greater profitability (even after controlling for size and region of the U.S.).
• Health and health care is improved when we embrace the differences of the people we are serving and serving with.

All three organizations agree (here, here, and here) that their positions are based on their interest in supporting diverse communities that can compete locally and globally. The best organizations and communities in the world see diversity as an asset, which is why I work for one, and why I live in one. Respect creates the most powerful stickiness there is.

I’ve selected a photograph of Matthew Holt (in the wig and skirt) and Indu Subaiya, MD, performing the lifecycle of a patient in a Heatlh 2.0 world, and the Health 2.0 conference this week, in San Francisco.

As you can see from the remaining photos below, Indu and Matthew had fun with this, and the approach was very effective as people removed themselves from themselves and focused on what these technologies will mean for people throughout life. Here are my remaining photos, click on any to see larger size, and my recap below:

The conference overall was really great and came together very nicely, as a sort of journey, from “what’s being worked on” to “what do we need to do as a society to move into the future.”

In the photos above, you can see Indu and Matthew doing a role play with the various technology companies at Health 2.0, covering everything from genetic science to virtual doctor visits (that’s Roy Schoenberg, MD, from American Well with Matthew on stage).

Josh Lemieux from the Markle Foundation led a panel on privacy issues followed by several technology demonstrations around supporting secure/private access to health information.

I met Joan Osborn and Sheila Subaiya, MD (pictured along with Brian Loew, CEO of Inspire.com) over an ice cream sandwich that I now regret not tasting.

I connected with three pioneers in health information technology to talk about the importance of place and telepresence (complimentary, not in opposition): Trenor Williams, MD, Danny Sands, MD, from Cisco, and Paulanne Balch, MD, from the Colorado Permanente Medical Group.

I got to watch as two pioneers connected, Adam Bosworth from Keas, and Paulanne Balch, MD.

I attended the closing, led by remarks from Alan Greene, MD, David Lansky, PhD, Robert Kolodner, MD , David Kibbe, MD , moderated by Brian Klepper.

A really great thing happened for me when I got to meet the faces and minds behind the Twitterstreams I have been following for the past several months. We’ve become a community; meeting in real life adds that extra layer of respect (Is it GenX of me to get this benefit or do GenY’s get this too?). I think a few really great people also became Twitterized this week…Jane, Patti, Paulanne, Ravi, welcome.

Finally, a curious and exciting thing happened at the very end, with the self-assortment of individuals from the Bos-Wash Megaregion to talk about how we would contribute to the Health 2.0 movement. We think we can and will, as DC realizes its present and future as the epicenter of health care transformation.

Come join us and thanks to Matthew, Indu, the Health 2.0 team, and all of the volunteers and organizations (including flagship sponsor Kaiser Permanente) for making us less afraid of the future.

It’s hard to keep up with the energy here. In March, 2008, the motto (thanks to Susannah Fox), was “7 words.” This time, we seem to have become more efficient, and the motto is “4 letters,” and the driving 4 are “H-T-M-L” coined by Anna-Lisa Silvestre, VP of Online Services for Kaiser Permanente.

Why? Because during the consumer engagement demonstrations, Anna-Lisa’s team prepared the user experience based on static HTML to demonstrate the look and feel, rather than a dynamic demonstration. The others did not fare as well. But that’s okay with me – doing live demonstrations are never easy, and I trust that the organizations involved are going to do great work. I’ve had worse happen on stage – it happens. Perfection is not expected, just the ability to fix mistakes quickly.

I was asked yesterday about the energy level, and my answer is based on comparison to meetings which are of people working to help other people (clinicians, doctors, nurses). This gathering is of people who are working to help people just like them, and who are empowered enough to know what is needed. It’s very stimulating for me, and it should be stimulating for our health system. There is so much more we can do for patients that we aren’t doing, yet.

One more 4 letter word – Jane Sarasohn-Kahn (quoted in the New York Times today) mentioned to me that on our panel yesterday that the doctor, the patient, and the health economist did not disagree when it came to talking about Health 2.0, when it might be expected that we should. I have been saying that the killer app of Health 2.0 is “listening to people” but I like that Jane said:

In Health 2.0, “Love is the Killer App.”

The United States of Mind, Wall Street Journal

Rentfrow P, Gosling S, Poter, Jeff. A Theory of the Emergence, Persistence, and Expression of Geographic Variation in Psychological Characteristics [Internet]. Perspectives on Psychological Science. 3(5)

If you’re following this blog it’s pretty clear that I have been examining the impact of location for awhile now, partially for personal reasons, (“Why did you move to Washington, DC, Ted?”) and partially for professional reasons – geographic diversity may emerge to be as important as any other diversity awareness we rely on to keep our nation healthy, physically and emotionally.

This is why I was excited to read the attached article, which is the description of a model for personality characteristics, geographic expression, coupled with an extensive survey of our population and correlation to health and social characteristics. In a nutshell – what’s the personality of each State and how does it manifest?

If you want to get right to the conclusions, the Wall Street Journal has prepared an interactive map of the differences, and you can test yourself on the Big Five Inventory of personality here. In the event you’ve done the Myers-Briggs before, I encourage you to read this article about that tool by Malcolm Gladwell, which casts a fairly large amount of doubt on the usefulness of the Myers-Briggs tool.

A short primer on the dimensions of the BFI:

The central aspect of E (Extraversion) that emerged from the results seemed to emphasize social orientation; that is, state-level E seems to reflect the extent to which people in a region socialize with others. The state-level correlates of A (Agreeableness) allude to friendliness, trust, and helpfulness, which is very similar to conceptualizations of social capital. The defining features of C (Conscientiousness) that emerged seem to denote restraint, order, and dutifulness; that is, individuals in high-C states seem to place more value on rules and obedience than do people in low-C states. State-level N (Neuroticism) reflects social, psychological, and physical well-being. Indeed, the patterns of correlations converged, suggesting that individuals in high-N states are socially isolated and generally unhealthy. State-level O (Openness) seems to capture the degree of creativity, unconventionality, and tolerance in a region.

The kinds of differences described in the article hit me in the face all the time – when I step off a plane in California I can feel the difference – the inventory points to an open, tolerant, place but one that is less social. The contrast between the two Washingtons is especially impressive – Washington State, among the least extroverted (#48 out of 51), District of Columbia, among the most (#3), and also the highest in the nation on the Openness scale (we’re #1. Not so much of a surprise after visiting Tech Cocktail DC 3 recently and interacting with the people here for the past year).

The Ted Angle

When I did my BFI, I scored a perfect 5 the Extraversion scale, middle on Neuroticism, high on Openness, high on Conscientiousness and high on Agreeableness. I think the feeling is best encapsulated by something a physician colleague said to me the other day about where he lives. He said, “I like where I live a lot. Now, if I could move to Manhattan, I’d do it in a heart beat.”

This review for me is about the place that gives a person the most energy to achieve their life goals rather than whether the place we are in is enjoyable or not, as encapsulated by that comment.

Interestingly enough, when I ran one of my blog posts through another BFI engine that looks at writing, the results were similar, off the charts Extraversion, but less Agreeableness and off the charts Openness to experience.

The next time someone asks me why I moved to Washington, DC, my answer will be, “Have you seen my BFI scores?”

The Everyone Else Angle

After reviewing this piece and several other pieces on this topic, (additional link cloud here and here) some interesting questions are raised -

1. What’s the personality inventory of someone interested in patient empowerment/engagement/transforming the health care system. Are we alike?
2. What’s the personality inventory of the geography that are the epicenters of this transformation? Where does DC Stand?

Take a look, post your BFI and State correlation in the comments if you’d like. What does this mean for supporting a nation’s health?

The nice thing about the blogosphere is that when you get behind in your blogging, someone else will help you out. Thanks to Susannah Fox for writing about her experience with us in Oakland, California, around the sharing of Pew Research Data with safety net health care organizations.

The comments on the post are especially heartening, in that they support that involving the audience in the presentation of information is meaningful. In this case, they presented just as much information back, which is as it should be.

If I can have one claim to fame in the convening world, besides audience involvement, it is that internet access, checking e-mail, using the Web is allowed at the discretion of attendees. At the last two meetings where I suggested this, people seemed a little caught off guard that this is okay. I want to change that. Just as in the Results-Only Work Environment, in the Results-Only Meeting Environment, respect for people deciding what is most important to them creates the pressure I like, that I/we need to be more interesting than an e-mail inbox.