Thanks for publishing my photo and wow, Migration to D.C. remains stable, but plummets for rest of region 

2016.03.21 DC People and Places 03-Edit-2
2016.03.21 DC People and Places 03-Edit-2 (View on

First, thanks for using my photo DC Policy Center (@DCPolicyCenter). This one was digitally enhanced by me, not to look like something it’s not, to look as the way I saw it with my eyes. It’s just how I see Washington, DC. Can’t help it. 🙂 .

Second, another great analysis that challenges recent conventional wisdom:

  • Nationally, people are moving FROM urban areas and TO suburbs, reversing commonly held wisdom about migration (except in Washington, DC)
  • Washington, DC is the exception, with net migration into the city, plus births and relocations and international migrations, the population grew by 10,800 in the last 12 months
  • Population in surrounding Virginia is plummeting, especially in Fairfax, County VA

I feel it’s reasonable to point out that this is another advantage of being the most inclusive city in the world, diversity not only allows the human species to survive, survey after survey shows that people are happier and more productive in diverse environments, which they migrate to. Washington, DC has the highest percentage of LGBTQ residents in the United States (10%), and the same for transgender residents (2.77%, 5 times greater than California or New York).

Coincidentally before reading this post, I took this photograph just a few days ago, in a part of Washington, DC undergoing tremendous growth. The visuals plus the data tell the story. I was a little off by the numbers (841/month, vs 1000/month), however it’s clear this is where the future is being born.

2017.07.02 DC People and Places, Washington, DC USA 7265
2017.07.02 DC People and Places, Washington, DC USA 7265 (View on

While more people continue to move into the District than move out, the opposite is true for much of the rest of the region.

Source: Migration to D.C. remains stable, but plummets for rest of region – D.C. Policy Center

Thanks for using my photo and for the fantastic visualization – Mapping D.C.’s nightlife boom – @DCPolicyCenter @DataLensDC

2017.04.11 Cherry Blossom Pop-up Bar, Washington, DC USA 02286
2017.04.11 Cherry Blossom Pop-up Bar, Washington, DC USA 02286 (View on

Sometimes I can’t stand how engaging @DCPolicyCenter’s work is. I definitely recommend clicking through to the piece and using the dynamic visualization of the changing pattern of nighttime entertainment in Washington, DC. This is especially relevant given the recent announcement that Town Danceboutique is closing. If you look at the map, you can see that in 2008, when it opened, it was a relative trailblazer, and probably shaped the growth of this part of Washington, DC.

Oh, and thanks for using my photograph to illustrate the piece 🙂 . Another publication I respect (@ggwash) recently used it, and I describe it a little in that post.

Liquor licenses for bars, clubs, and restaurants in D.C. have increased by over 50% since 2008 and expanded the footprint of the District’s nightlife.

Source: Mapping D.C.’s nightlife boom – D.C. Policy Center

Thanks for publishing my photos @DailyDot, in The Transgender Population in the U.S.: What We Know

2013 Rally for Transgender Equality 21175
2013 Rally for Transgender Equality 21175 (View on

Current research studies show that the percentage of transgender people in the U.S. is small, but it’s been growing over time.

Source: The Transgender Population in the U.S.: What We Know From Current Studies

Thanks for publishing my photos DailyDot (@DailyDot). It’s of a rally for transgender equality, in 2013 in Washington, DC, in a time and a place that much less of the world knew how to love better. Even much less of the LGBTQ community world.

DailyDot has been continuing to report on the transgender population and in this piece a remarkable statistic: 2.7% of the population of Washington, DC is transgender, that’s 600% greater than the percentages in California and New York. How did I miss this statistic. I did miss it, and it explains a lot – like why Washington, DC is the most inclusive city in the world, why the leaders here are the most transformational of our time, why our future 51st-state has the first transgender pride crosswalk in the United States.

Why I love this century 🙂 .

Daily Dot used this photo as well:

2017.02.22 ProtectTransKids Protest, Washington, DC USA 01133
2017.02.22 ProtectTransKids Protest, Washington, DC USA 01133 (View on

Which shows that these communities’ existence continues to be threatened. I am glad that the proportion of people in Washington, DC is large enough to compensate for the need for more of the world to learn to love better.

This generation has the power to change everything, especially when we know that love wins, 100% of the time.

Metro Hack Night with Transportation Techies : Controlling your city’s destiny through data

Metro Hack Night IV at WMATA HQ Washington DC USA 03119
Metro Hack Night IV at WMATA HQ Washington DC USA 03119 (View on

One of the other unnatural fascinations I have, as someone with Total Health in their job title, is the transformation of the transportation industry globally, from one designed to move heavy vehicles to one designed to promote health and well being.

There are 11 million people in the US working in transportation, 16 million in health care, 0.4 million in public transportation. There’s something there for all of us to think about (see: Transportation, Health, Food Systems : A Tour of the Future and comparing the stats)

And so, Transportation Techies (@TechiesDC) MetroHackNight IV, held at Washington Metropolitan Transit Authority Headquarters (@WMATA) is a sure bet to see the future.

Bravo DCTechies! Normally it's #whymetrowesnesday but not today 😀 #activetransportation
Bravo @TechiesDC! Normally it’s #whymetrowesnesday but not today 😀 #activetransportation (View on

Who would have thought, 50 years ago, when this system was conceived, that there would be a bunch of people in a room dissecting its Application Programming Interface so that they, on their spare time, could write software to empower and enable the citizens to know when and where each train is, down to the microsecond?

I read a really excellent book (which I’ll post on separately soon), “The Great Society Subway” in which it was described how the first iteration of the Washington Metro didn’t even have station names on the walls, to promote a unified aesthetic.

What the book revealed to me, by the way, is that all of the emotion and challenges around a transit system of this size were born 50 years ago, and they really haven’t changed.

It’s what happens when you take an innovation and turn it into a public works edifice. It’s a microcosm of the city. What was happening in the room was a proxy of citizens working to control their own destiny, including their health destiny. Open data is just the lever. And it’s a fine one in 2016, in my opinion.

The whole thing was delightful to watch. These events are among the most creative I have found in Washington, DC. I end up learning everything from how people plan to communities to fine tuning my javascript every time I go, thanks to our uber host with the most, Michael Schade (@mvs202).

Having it all unfold in the iconic WMATA headquarters, tucked between the Verizon Center and the National Building Museum was just icing.

This century is amazing.

Look What I Made
Look What I Made (View on

Visualization: Personal Healthmap, Capital Bikeshare, Washington, DC USA

CaBi Heat Map
CaBi Heat Map (View on

That didn’t take very long. No sooner did I learn about the possibility of creating a personal heat map (I’m just going to call it a health map, because I can) of just my Capital Bikeshare (@bikeshare) trips did I get one of my own.

This is in contrast from the population-based heatmaps that have already been generated: see A health map rather than a heat map – #CTHNext Bikeshare Station’s first two weeks.

Both were created by DC’s open transportation data diplomat, Michael Schade (@mvs202).

I’m not 100% sure why this is useful to a person. Well, here’s one way it is – engaging a person in data visualization that’s extremely relevant to them, can interest them in looking at the total health of the population, which is what the population heatmaps do currently.

If you have other ideas, let me know in the comments or via twitter. Capital Bikeshare currently doesn’t allow users to export their own data in batch or via API. It’s a screen scrape right now.

I’m more of a walker than a biker, but still, 90 trips in 2015 is more than I thought I’d taken. Plus the map demonstrates that indeed I did ride to Shirlington, the magical planned place of the future (writing about that in an upcoming post).

Just Read: In a health system where patient-physician email is actually used, how it impacts care

In an American health system, where, for the most part, patients *still* do not have access to their online medical records or access to their physicians (see: Patel V, Barker W, Siminerio E. Individuals’ access and use of their online medical record nationwide. Office of National Coordinator for Health Information Technology and Majority of Americans don’t use digital technology to access doctors | CAPP), this is a study conducted by the research team at Kaiser Permanente (@KPDOR) where patients mostly *do* have this access.

Of interest, they looked at how patients who had higher co-pays thought of using email as their first contact with providers, and how it may have shifted their use of services. This article on the @KPShare web site summarizes things nicely so I won’t repeat here: Patient-Initiated E-mails to Providers: Associations With Out-of-Pocket Visit Costs, and Impact on Care-Seeking and Health

I do want to clarify that the study is not asking about cost-sharing for email interactions. It asked what people would do if they didn’t have email at all. Totally different question. And no less interesting at this stage of adoption.

Speaking of adoption, the national numbers are 30% of people are offered their online medical record, and 46% viewed it at least once. That’s super low.

At Kaiser Permanente, 100% of people are offered their online medical record, 69% of the eligible population (as of 2Q2015) have signed up to use it, and 68% have viewed it at least once in the last quarter. 40% accessed it 5 or more times in the last quarter. By definition this is patient directed activity because there aren’t any organizational barriers to this access. These numbers are much better 🙂 .

Read the study to find out more what they do with it once they have it, which is a much more interesting question than, “when are they going to get it.”

Animation: The Center for Total Health Capital Bikeshare station No. 353 is alive

The animation goes from midnight to midnight, showing peak times of usage.

With tremendous gratitude to Michael Schade (@mvs202), the our nation’s capital’s digital transportation storyteller, and leader of Transportation Techies (@TechiesDC)

The animation is based on released Capital Bikeshare (@Bikeshare) data for 2nd Quarter, 2015, which means there is only about 2 weeks of function included in this dataset, because our station was installed on June 18, 2015 (but who’s counting? 🙂 ).

The station is located next to the busiest in the system (Union Station) and since it’s been “discovered” it is experiencing more frequent empty docks:

Capital Bikeshare Tracker for Center for Total Health Station Number 353 3
Capital Bikeshare Tracker for Center for Total Health Station Number 353 – Data is from opening of the station through to Thanksgiving (June 18-Nov 25) (View on

Capital Bikeshare Tracker for Center for Total Health Station Number 353 2
Capital Bikeshare Tracker for Center for Total Health Station Number 353 – Data is from the most recent operating month of the station (October 28 – November 25, 2015), showing more acute shortages of bikes, especially in the late morning time period (View on

These and other datasets show us that our city’s infrastructure is more alive than we think it is, and in this case, this infrastructure helps people be healthy.

For more on the station’s installation: Photo Friday: The Brand New #CTHNext Capital Bikeshare Station – Out-of-Box Experience

Using EHRs to eliminate rather than create health disparities for LGBTQ people: Landmark decision by U.S. DHHS

Via: Landmark Decision By Dept. of Health and Human Services Will Reduce Health Disparities Experienced By LGBT People | Fenway Focus (@FenwayHealth)

The finality in the way the rule is written reminds me of the R v North West Lancashire Health Authority Decision in 1999: “Appeals dismissed. Permission to to appeal to House of Lords Refused.”

That decision quashed forever the UK’s National Health Service policy of not covering transition-related care for its transgender or gender non-conforming residents.

When I visited Charing Cross, the world’s longest running gender identity clinic, in London in 2013, all of the medical records had to be managed on paper because their EHR systems were incapable of managing gender identity successfully and within policy.

This decision is pretty big one too, for the U.S. Health System, and one that might ultimately help our colleagues in the NHS as well.

The new rules released October 6 by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator of Health Information Technology (ONC) will require EHR systems certified under Stage 3 of Meaningful Use to allow users to record, change, and access structured data on sexual orientation and gender identity.

And here’s what the final rule says:

We thank commenters for their feedback. Given this feedback, the clinical relevance of capturing SO/GI, and the readiness of the values and vocabulary codes for representing this information in a structured way, we require that Health IT Modules enable a user to record, change, and access SO/GI to be certified to the 2015 Edition “demographics” certification criterion. By doing so, SO/GI is now included in the 2015 Edition Base EHR definition. The 2015 Edition Base EHR definition is part of the CEHRT definition under the EHR Incentive Programs. Therefore, providers participating in the EHR Incentive Programs will need to have certified health IT with the capability to capture SO/GI to meet the CEHRT definition in 2018 and subsequent years.

I was at the convening mentioned in the Fenway Article and wrote about it in this blog post: Sexual Orientation and Gender Identity Data in EHRs, convening at Fenway Health, it matters to all patients, where we took this lovely photograph:

Sexual Orientation and Gender Identity Collection in EHRs Convening at Fenway Health 57914
Sexual Orientation and Gender Identity Collection in EHRs Convening at Fenway Health 57914 (View on

Even though I was there, I am not responsible for making this happen. There’s the Do Ask, Do Tell Project Team, supported by the Robert Wood Johnson Foundation (@RWJF). I’m thinking Kellan Baker (@KellanEBaker), Harvey Makadon, MD (@HMakadon), Sean Cahill, PhD. And many others (please add their names in the comments) who deserve your thanks.

Even though I didn’t make this happen, I and millions of other people are the beneficiaries. This work will create a world where electronic health record systems work for us, to eliminate rather than create disparities. Thank you!

Buildings, Bikes, and Gardens with DesignDC

I love 10 minute meetings. Especially ones that involve active transportation.

DesignDC Bikes, Buildings, and Gardens 09286
DesignDC Bikes, Buildings, and Gardens 09286 (View on
Thanks Andrea Swiatocha, AIA, LEED AP and Nancy Skinkle, AIA, LEED AP (Architect of the Capitol) for coordinating this one, as part of 2015 Design DC organized by the Washington Chapter of the American Institute of Architects (@WashingtonDCAIA).

AIA|DC Design + Wellbeing Committee and the Committee on the Environment (COTE) present a biking tour that showcases DC projects and infrastructure that support an active, healthy, and sustainable community. District Department of Transportation (DDOT) will help facilitate the bike tour through historic and picturesque areas of downtown DC and highlight revitalized neighborhood amenities and infrastructure the supports active transportation. The tour will begin at Union Station and conclude at the AIA|DC District Architecture Center. Along the way, see how buildings, infrastructure, and a community garden have helped develop sustainable communities that support healthy and active choices.

The Kaiser Permanente Center for Total Health (@KPTotalHealth) was on the tour (hooray!), where we spoke about the determinants of health visible in our immediate environment. The street we are on is a very visible example of this (see: Photo Friday: Healing H Street, NE with Complete Streets, Washington, DC USA).

In addition the part of Washington, DC we exist in is a study in contrasts about where healthy infrastructure exists where it comes from. Here’s a map that you can play with from the most useful Community Commons (@communitycommon) database that shows stark differences in the immediate area surrounding us:

This raises the important question: Does healthy design precede a healthy community or does it create it?

Regardless of the answer, the architects and designers of the world play a huge role in our health, which is why we’re glad they’re including the health system in their discovery of health and wellness. 10 minutes now translates into a lifetime later. Let’s collaborate!

DesignDC Bikes, Buildings, and Gardens 09291
DesignDC Bikes, Buildings, and Gardens 09291 (View on
More photos of our session below, and one from the close of the meeting – they left the same way they came. All meetings should be like this 🙂 .

Just Read: Health Effects of the London Bicycle Sharing System (but does it improve health…)

Bikesharing is a great example of technology used in social innovation. It doesn’t require each individual to be technically inclined, but uses technology to make something basic available to a population, hopefully in a health promoting way.

This is a health impact modelling study, which uses computerized models + assumptions + data to understand the London bicycling sharing (they call it “cycle hire”) system’s impact on disability adjusted life years (DALYs). In my opinion this is a good measure and very “UK” – much more societally focused than what we typically examine in the United States.

They modeled through “medium term changes in physical activity, road traffic injuries, and exposure to air pollution.”

“The” conclusion: some health benefit for men, no evidence of benefit among women, more benefit for older people

“My” conclusion: this is a roadmap for engagement to make sure there is a health benefit

First, the data

  • 7.4 million cycle hire trips examined from April, 2011 to March, 2012 (Hooray for open data!)
  • 71% accounted for by men
  • 78% accounted for by people aged 15 – 44
  • Most trips didn’t replace car, van, taxi, motorcycle (6%)
  • Much higher proportion of cycle fatalities among women compared to men, involving heavy goods vehicles (15 women vs 7 men, despite women accounting for 30% of cycling time from 2005-2011)

As if to underscore the last point, the first cycle hire fatality occurred in 2013, after the analysis period. The second fatality occurred in February 2015. Both victims were women, and involved heavy goods vehicles.

Second, the analysis

Comparison of walking and bicycling in Washington DC 0976

Bike sharing needs to replace more car trips than walking to result in better health (View on

  • Cycle hire users are younger (97% under 60), and therefore the benefits of preventing physical activity-associated diseases are not going to be realized in the next 10-15 year period
  • Cycle hire users are slightly more physically active overall, but because they mostly replace walking and public transport, the effect isn’t as great as it could be. Still, a little bit more physical activity across a population results in important changes.
  • Cycle hire users are less likely to be exposed to pollution compared to being near cars or in the underground, but breathe more. Overall the impact is small.
  • Cycle hire recorded injury rates are less than for cycling as a whole, but reporting of injuries may not be accurate. The higher injury rate for women increases the harms relative to benefits if the “background cycling injury rate is used.”

Third, the conclusion, the opportunity for engagement

If you take this very well done analysis a different way – as a recipe, rather than analysis, a great platform for the health system presents itself:

  • Substitute more motor vehicle trips with bicycles
  • Support bicycling for older individuals and increase the average age of cyclists
  • Make streets safer

These are three things that physicians, nurses, and health professionals could absolutely champion as partners to bicycle sharing systems.

The substitution issue could be studied carefully, about whether it’s a person deciding on an individual trip to replace a car or whether they wholesale switch away from motorized vehicles.

An important piece of information embedded within: journey times via cycle hire are reduced by 20%.

Reducing the injury rate to that of the Netherlands, the analysis shows, would dramatically increase the health benefits. And what does the Netherlands do?

In the Netherlands, a comprehensive and well maintained system of cycle tracks, physically protected from fast motor traffic, have helped to make cycling widespread at all ages35 and reduce the risks of injury.

First Street NE Cycle Track Washington DC 0978

The beloved cycle track on 1st Street NE, Washington, DC USA (View on

Washington, DC is also starting to do this, as you can tell from our beloved 1st Street NE bicycle track.

In thinking about why I want bicycle sharing to succeed, it’s because it represents the changing of our cities to support a more sustainable lifestyle in a very visible way.

With that dream comes responsibility. My understanding is that bike sharing systems operate with very minimal staff and resources, and the amount of hope heaped upon them is probably disproportional to their ability to deliver. And why should they? This is what the health system is for, to leverage technology to improve health. The technology is here, on our streets. Now, let’s go leverage it 🙂 .