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!