I like this. It demonstrates that our police department acknowledges that this a problem that is affecting a lot of people, and uses a creative way to get the information out.
And PS, if you are coming to visit Washington, DC, take this seriously. Do not use your smart device near a metro doorway or even in a public space, such as seated in a restaurant. You may find its presence in your life a distant memory….
Love wins: Gay marriage in Washington DC / The Christian Science Monitor – CSMonitor.com.
The State of Virginia’s decision to reinstate discrimination was immediately overshadowed by the District of Columbia’s decision to end it last week, creating lots of excitement in this territory-not-state part of the United States.
I really like the way the author of the article stated it:
When I picked up my paper (this morning), the images were joyful, depicting happy same-sex couples who were finally able to apply for marriage licenses in our nation’s capital. I went to the WaPo’s web site and discovered that it has a whole slide show of photos of happy couples.
I often tell my students that, in my humble opinion, one purpose of government is to help people be happy. The DC government did a good job on Wednesday.
Here are a few photographs of the happy couples, and a few humorous signs of celebrations (photo credits: (1) and (2) by Erin_M/Flickr.com, (3) Library of Congress (4) M.V. Jantzen (5) M.V. Jantzen ). Cupcakes were provided free of charge by Washington’s Hello Cupcake.
…and a few reminder photos of where we came from.
Okay, one more thing. The public statement made by Mildred Loving in 2007, on the 40th Anniversary of Loving vs. Virginia:
Loving for All
By Mildred Loving
Prepared for Delivery on June 12, 2007, The 40th Anniversary of the Loving vs. Virginia Announcement
When my late husband, Richard, and I got married in Washington, DC in 1958, it wasn’t to make a political statement or start a fight. We were in love, and we wanted to be married.
We didn’t get married in Washington because we wanted to marry there. We did it there because the government wouldn’t allow us to marry back home in Virginia where we grew up, where we met, where we fell in love, and where we wanted to be together and build our family. You see, I am a woman of color and Richard was white, and at that time people believed it was okay to keep us from marrying because of their ideas of who should marry whom.
When Richard and I came back to our home in Virginia, happily married, we had no intention of battling over the law. We made a commitment to each other in our love and lives, and now had the legal commitment, called marriage, to match. Isn’t that what marriage is?
Not long after our wedding, we were awakened in the middle of the night in our own bedroom by deputy sheriffs and actually arrested for the “crime” of marrying the wrong kind of person. Our marriage certificate was hanging on the wall above the bed.
The state prosecuted Richard and me, and after we were found guilty, the judge declared: “”Almighty God created the races white, black, yellow, malay and red, and he placed them on separate continents. And but for the interference with his arrangement there would be no cause for such marriages. The fact that he separated the races shows that he did not intend for the races to mix.” He sentenced us to a year in prison, but offered to suspend the sentence if we left our home in Virginia for 25 years exile.
We left, and got a lawyer. Richard and I had to fight, but still were not fighting for a cause. We were fighting for our love.
Though it turned out we had to fight, happily Richard and I didn’t have to fight alone. Thanks to groups like the ACLU and the NAACP Legal Defense & Education Fund, and so many good people around the country willing to speak up, we took our case for the freedom to marry all the way to the U.S. Supreme Court. And on June 12, 1967, the Supreme Court ruled unanimously that, “The freedom to marry has long been recognized as one of the vital personal rights essential to the orderly pursuit of happiness by free men,” a “basic civil right.”
My generation was bitterly divided over something that should have been so clear and right. The majority believed that what the judge said, that it was God’s plan to keep people apart, and that government should discriminate against people in love. But I have lived long enough now to see big changes. The older generation’s fears and prejudices have given way, and today’s young people realize that if someone loves someone they have a right to marry.
Surrounded as I am now by wonderful children and grandchildren, not a day goes by that I don’t think of Richard and our love, our right to marry, and how much it meant to me to have that freedom to marry the person precious to me, even if others thought he was the “wrong kind of person” for me to marry. I believe all Americans, no matter their race, no matter their sex, no matter their sexual orientation, should have that same freedom to marry. Government has no business imposing some people’s religious beliefs over others. Especially if it denies people’s civil rights.
I am still not a political person, but I am proud that Richard’s and my name is on a court case that can help reinforce the love, the commitment, the fairness, and the family that so many people, black or white, young or old, gay or straight seek in life. I support the freedom to marry for all. That’s what Loving, and loving, are all about.
* Together with her husband, Richard Loving, Mildred Loving was a plaintiff in the historic Supreme Court Loving v. Virginia, striking down race restrictions on the freedom to marry and advancing racial justice and marriage equality in America. (Mildred passed away ih 2008 at the age of 68. R.I.P.)
Love definitely won.
This week’s photograph was taken right after the snowpocalypse, and I am using it to add an image to the idea of “Total Health,” which is part of the presentation that Holly Potter and I are giving at HIMSS next week.
I like taking photographs like this because they show what the success of a health system looks like – people achieving their life goals through optimal health.
I learned to think this way because of the personal health record, which allows us to care about what our patients do when they are not in the medical office. From that perspective, the workplace of a health system that supports total health is where people live, work, and play.
I considered a few other images for the slide that this one is on (see below). They’re included here in the event you think they are a better fit than this one (let me know in the comments, please). I’ll post all the slides here after our presentation (and truth be told, when they are actually completed).
Among Large Cities, San Jose and D.C. Lead in Well-Being – The Gallup-Healthways Well-Being Index score measures for each city an average of six sub-indexes, which individually examine life evaluation, emotional health, work environment, physical health, healthy behaviors, and access to basic necessities. The overall composite score and each of the six sub-indexes' scores are calculated on a scale from 0 to 100, where 100 represents fully realized well-being. Gallup and Healthways initiated the Well-Being Index in January 2008.
DC Job Opening : Support the development of national health policy on behalf of the medical groups of Kaiser Permanente – I was asked to pass this on, which I am happy to do; it's an open position in the Washington, DC, office of The Permanente Federation. The job is Director, Public Policy and Government Relations, and as the title says, is for a talented individual with experience in the health policy arena and the desire to support the excellent care of Kaiser Permanente physicians in our nation's capital.
Click on the link for more details, and just in case, the job # is 012631. I am not the hiring authority; however I can pass questions on and/or feel free to post your resume at the site above for consideration.
Atul Gawande, MD and Jack Cochran, MD, NGA meeting, Washington, DC
A few weeks ago, Jack Cochran, CEO of The Permanente Federation (the company I work for) mentioned that he would be speaking alongside Atul Gawande, MD, in DC, and that I should try to come. I didn’t realize fully that he was speaking in front of the Governors of the United States of America, and definitely not that he was going right after The First Lady of the United States, Michelle Obama.
In any event, I got to go, so I’m going to share that experience here.
The First Lady
The First Lady was great. She talked about her family’s values with regard to exercise and eating. She’s leading an important conversation about why we need to treat childhood obesity as a societal issue, with multiple causes and solutions. (Disclosure: Kaiser Permanente is a founding partner in The First Lady’s Partnership for a Healthier America)
She spoke of food deserts, which are communities where families do not have convenient access to grocery stores and purchase processed and other less-healthy foods at convenience stores and corner markets.
I do not live in a food desert currently, but I did last week (this photograph explains it all), and I can definitely relate to the feeling of needing to pack high calorie, high sodium, non-perishable foods into the grocery bag, and how unsettling it feels. Great for The First Lady to work on making healthier food choices available to families in communities across the United States.
View from the TelePrompTer
Atul and Jack
Of all the things on our country’s governors agendas, it’s impressive to think that they made health care the lead issue of their winter meeting. And equally impressive that they asked to hear from physician leaders first.
The title of this post is from a comment made by Jack that started with, “Don’t say you can’t do this (high quality, patient-centered care) because you’re not KP. We didn’t know we could do it until we did it.“
As Dr. Gawande is very well known (understatement), so here’s a little bit about Jack: He’s a plastic surgeon who delivered care in the fee for service world and became curious about the Kaiser Permanente system in his community in Colorado (“If care was needed, physicians wrote me – ‘please deliver this care’), and became a plastic surgeon in that system. He eventually became the Executive Medical Director of the Colorado Permanente Medical Group where he fostered an environment of physician leadership (of the servant kind), innovation, and personal accountability and responsibility. And, Kaiser Permanente Colorado’s results speak for themselves.
In 2005, I had the good fortune/serendipity to be a student in the national Permanente Medicine and Management course led by Jack, where I and physician peers learned about what we could do to make health care (not just Kaiser Permanente) a better place, starting with us. A lot of the advice I give to others (and to myself) originates from the approach I learned here.
With my excessive interest in patient and family involvement – I picked up on a few significant things said by both leaders:
Blast from the Past – “You have the power”
At the event, I happened to sit behind Mary Selecky, The Secretary of Health for the State of Washington, and amazingly, we both remembered a moment, exactly 10 years ago, in a class at the University of Washington School of Public Health where we learned about making change.
My colleague, Abigail Halperin, MD, and I were students in the School of Public Health, working on ending the sale of tobacco products for profit by the University of Washington, and during the class, Abigail asked Secretary Selecky what she could do about ending this practice. Her answer, to us and the class was, “I don’t have the power as the Secretary, you have it as the student.”
It turned out she was right; the decision to end the practice was ultimately made by the Associated Students of the University of Washington, and we got there by working with the student body, not the Administration, who resisted the change.
The value of physician leadership (in addition to the leadership of every other stakeholder)
The not-so-subtle nudge from Secretary Selecky in 2000 made a difference, just like Atul and Jack will, by using their talents to help others lead.
I know that both physicians vastly understate what they know about how to create change in medicine and health care in a venue like this.
That’s okay, one of my tenets is “frequency is better than duration” – I think this experience will come out over time, and it’s going to be helpful to people who wonder if the impossible is possible, a great role for physicians.
I knew this had to be this week’s photograph the minute I saw it (and cross posted it in various places…). It is what it looks like, a beautifully created couch made out of snow, in Dupont Circle, Washington, DC. This is just the tip of the iceberg reminder of what comes from a community that embraces diversity and new ideas.
Not everyone lives in/works in a place that is brimming with or tolerates diversity (ahem, Virginia), so the creativity and new ideas may not be as apparent, but they are there. I think people should always stop to notice them – creativity, innovation, and diversity potentiate each other.
Here’s a view of the furniture from different angles. Enjoy.
Virginia: State Employees Lose Protections from Anti-LGBT Discrimination « HRC Back Story – I’m joining in the chorus of disappointment for Virginia’s residents with the decision of their governor to reinstate discrimination for lesbian, gay, bisexual, and transgender state employees. As I have written on this blog extensively, diversity is a health issue, and in this economy especially, it doesn’t serve purpose to promote a hostile workforce, or for citizens in need to receive services from employees that work in one.
Some time ago, I used to teach a class at the University of Washington School of Medicine on diversity in the health professionals, and I reminded students that in most parts of Washington State (at the time), it was still legal to fire someone from their job for no other reason than that they were lesbian, gay, bisexual, or transgender.
This is no longer true in Washington State, however, this is a reminder that such discrimination is still legal across most of the United States, in 2010. And this is just employment.
“Not a day goes by that I don’t think of Richard and our love, our right to marry, and how much it meant to me to have that freedom to marry the person precious to me, even if others thought he was the ‘wrong kind of person’ for me to marry. I believe all Americans, no matter their race, no matter their sex, no matter their sexual orientation, should have that same freedom to marry.”
Meanwhile, Washington, DC, is barelling toward the end of marriage discrimination, set to end in less than a month, in March, 2010, and many Virginia employers, including mine, respect the value of diversity. People are excited and happier to live in a place that supports equality. See for yourself:
Washington, DC is the #epicenter of equality, too. Come join us.
This week’s photograph shows a diverse group of people enjoying a recreational snowball fight in specially built snow-bunkers, at Malcolm X Park, in Washington, DC. In between them, is, I believe, the “black diamond” sled run, or at least it looked black diamond to me. Elsewhere in the park there is a green run and a blue run, formed from the snow covered steps of the park.
Despite the difficult week weather wise, there were a lot of smiles to be seen.
Here is another view from the top of the park, with the Washington Monument in the distant background. At one point in Washington, DC’s history, this was going to be the site of a “colossal presidential mansion to replace the White House.”
This post may seem off-topic for this blog; however,
And the information is this – Visa Enhancement Services, which exists to help card holders “Take advantage of the security, flexibility, and convenience that come with a Visa card,” including an auto-collision damage waiver, does not offer this security, flexibility or convenience for Zipcar drivers.
I have gone ahead and pasted in their letter of determination to me, again, in the interest of helping other customers understand what might happen in a situation where they attempt to use this benefit, now that my situation is concluded (click to see full size).
To quote (again, to help the search engines out there):
Zipcar Members entered into a “Vehicle sharing service subscription contract” with Zipcar and not a rental agreement. Zipcar Member’s relationship as a member of Zipcar, entitled you the use of an automobile but did not constitute a “rental transaction” as required under the terms and conditions of the Visa Auto Rental CDW Program.
Now, I did discuss this carefully with Visa Enhancement Services, including the explanation that DC charges Zipcar rentals with a Rental car tax. The individual I spoke with there said that it doesn’t matter if my locality considers this a rental car. Regarding the issue of Collision Damage Waiver, ZipCar does offer a buy down to zero deductible, and I did decline that.
The final person I spoke with at Visa Enhancement Services was professional and cordial, but ultimately unhelpful in creating understanding around Visa’s stance on this issue. He suggested that the Zipcar company initiate a written dialogue with the head of their Division, on behalf of Zipcar members. He stated that Visa doesn’t get that many claims from Zipcar members; I honestly find that hard to believe.
So, despite what the letter says (“we reserve the right to accept this claim later” – really, why put that language in there if there’s no intention of doing such a thing…), I don’t think Visa’s going to change their mind on this one.
Most importantly for me, I should state, the damage I experienced was not personal injury inducing to anyone or anything, which is infinitely more important than the financial impact, and there are options to mitigate that going forward (see below)
Compared to Visa, a different (and great) experience with Zipcar
I have to say, they’ve been terrific. I contacted them right away using their procedures and they were understanding that I am not the only one who has experienced this with Visa, and they managed the repair and restoration of my membership quickly and efficiently. After all was said and done, they even offered an unsolicited token of gratitude for my loyalty as a customer.
And that’s on top of the fact that every interaction that I have had with them has had an excellent level of customer service, from start to finish.
Which one do you like / trust more when this happens?
There’s a social media aspect to all of this…
For people in this situation, and from what I’ve seen online, there’s going to be a tendency in this situation to decide whether you “liked” dealing with Zipcar or Visa, and ultimately whether you “trust” Zipcar or Visa, or really any company who you approach about their assurances and ability to deliver on them.
I have read some commentary online about whether Zipcar’s policies are unclear or if their approach to a situation like this is confusing. At the same time, I’ve stopped owning a car since 2008, and I don’t miss it one bit, mostly because of Zipcar’s flawless customer service and approach to making cars available only when they are needed. That means a lot. And it’s worth putting it out there for others to appreciate.
From the perspective of my experience then, of the two, Zipcar is the organization that is doing more to support people like me in making the decision to keep 2-6,000 unnecessary pounds of aluminum, glass, and steel out of my community.
So there you have it, entered into the record of the Internet.
if anyone coming across this finds themselves in the middle of a seeming tug of war over this issue feel free to use my experience to innovate around a creative solution that supports yourself, your community, and a healthy environment.
What happens when you combine one of the most social cities in the United States, one of the most walkable cities in the United States, a blizzard, and great open spaces? Take a look.
Here’s a still photograph of the fun
Police: Robbers Targeting Pedestrians with iPhones « Borderstan (Washington, DC) – Washington, DC Metro Police are now advising people not to use iPhones of an increase in robberies with a specific target, the iPhone, that device specifically, in public. This is a big deal, in a previously-thought-of-as-safe part of the city.
People like me wish Apple would sell a version of its headphones that are not white. These appear to be setting us up as targets.
I was a recent victim of an iPhone snatcher in downtown Washington, DC, and in comparison to some of the crimes detailed in the blog post above, I consider myself very lucky.
It was going to happen eventually that wearing a $600 device would increase personal crime. I can’t help thinking that there’s a way to harness the wisdom of crowds and the very technology being sought after – maybe a "findmyiphone" aggregator that could help communiites and the police zero in on where these devices are ending up.
It’s worth noting that my stolen phone localized itself to the same location on multiple days, near a large Washington, DC, shopping mall, in Pentagon City, before I remotely secured it and wiped it clean (what a great feature – thank you Apple!).
To attest to the seriousness of this issue, even our local gym is passing on the warning:
Attention Members:There has been a report of an increase in robberies over the past week in the Golden Triangle/U Street area. Although not directly related to the club we thought it would be helpful to pass along the following alert from Metro P.D.
Golden Triangle Crime Alert
The Metropolitan Police Department has asked us to pass along the following information. As of late there has been an increase in street robberies around the DC Metro area. The Second District is not immune from these incidents. There is not a specific suspect lookout but there is a very specific target – the iPhone. To help combat this problem, MPD is asking the users of all phones and PDAs to use good street sense when carrying and using your mobile device.
Always be aware of your surroundings. It is a good idea to use your phone while stationary in a spot that will enable you to talk and observe your surroundings at the same time. Keep your mobile device close to your body and make sure it is out of sight when not in use. Please pass this along to reach as many people as possible.
Thank you,
MaryKay MoeOperations Coordinator
Golden Triangle Business Improvement District
As Washington, DC is the #epicenter of many innovations (and health care transformation), it is also a leader in many social issues, some not so enjoyable. Let our experience prevent others from having the same in this case.
I decided to post this photograph less for its celebrity content (see the next one to see who’s being photographed), and more for how it shows technology is changing. Compare this to a photograph of Martin Luther King, Jr. from 1963. I meet more and more people who’s only camera is their iPhone….
Patients demand: ‘Give us our damned data’ – CNN.com. Regina Holliday, Jen McCabe’s work highlighted on CNN, at DCA airport (people meet where they can in this web2.0 world…)
Always remember the feeling of excitement that comes with acceptance.
Council Votes to Legalize Gay Marriage – Political Hotsheet – CBS News
It makes a difference to live in a place where people think everything is possible, because it is.
– Thank you, Washington, DC.
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.
Washington in the ’60s | WETA – Finally, our own version of “Berkeley in the 60’s” – a great and moving show narrated by Connie Chung, about one of the most diverse cities in America.
As I’ve written here a few times, Washington, DC brings together my interests in empowerment, diversity, and innovation so well – it is still a city where people believe the possibilities are unlimited, because they are.
This is especially true on the eve of the end of marriage discrimination in the District of Columbia. I don’t think the DC local cable channel has ever been as popular among people living in my community, as the hearings for the bill, which is set to pass, occur. I thought it was worth juxtaposing two photographs, one from 1963 (credit: Library of Congress), and one from 2008 (credit: MV Jantzen)
I also want to point out Washington in the ’60s: Share Your Memories | WETA which in a way is Web 2.0 at its best – it is the voices of people who lived during that time, showing the power of sharing, and the use of this medium by the baby boomer generation, who by definition would be the population commenting here:
Living in the 60’s When JFK was President, I was at the State Dept. He’d hold his news conferences there. I would run down to the basement where he got out of the car into the elevator. The only time he shaked hands was when there were the nuns waiting for him, too. I protested in the Vietnam marches; brought people into my apt. (Glover Park) to shower and change during the Poor People’s Campaign….
Knew Washington was changing as I could see inter-racial couples walking down the street together without fear of being shot.
From the narrative above, and the photographs below (click to see full size), we have come a long way, and we have a ways more to go. If it was easy, this would already be fixed, but we are here because it’s not easy.
Enjoy the show.
Summit Overview – mHealth Summit – Didn't make it this year, but will look forward to November, 2010. In the meantime, there's http://mhs09.eventbrite.com/
This week’s photograph was taken in front of the west wing of the White House, which I was honored to tour. There are no pictures allowed on the inside of the tour, which includes a view of the Oval Office, and the door to the Situation Room. Below is a photo of the Executive Residence:
At the entrance to the West Wing, a collection of recent photographs of presidential activity is updated. One of the most interesting ones was of the President’s edits to his health care address to the Joint Session of Congress. I checked the White House flickr feed for that photograph, which is not there yet, but this one is similar enough (with many many less edits than the one we saw);
This week’s photograph (a panoramic shot) was taken at the National Equality March, in Washington, DC, and shows a packed McPherson Square with people waiting to walk to the United States Capitol.
I think every week in this city is exceptional; however, a few really stand out, including last week.
I’ve included a few more photographs below. Enjoy.
Zimmerman and Linton on innovation – Greater Greater Washington – Caught my eye with the title; instructive in health care with regard to innovation (and the sharing of it) as well – “Getting a customer on that pays a fare to fill a bus that’s not full could be worth a lot more to us, potentially.”
In other words, the tension between being proprietary vs sharing may be reduced by the idea that sharing brings more business.
Losing The Battle Of The Bulge: Portion Sizes In America – Better Health – Commentary posted by blogger and friend Dr. Val about an experience I recently had at a certain fast food restaurant.
This week’s photograph was taken on the sidewalk near 15th and P streets, in Washington, DC, also known as the Logan Circle Neighborhood.
The retail store Lululemon was putting on an impromptu show for neighborhood residents.I have written previously about Lululemon’s approach to growing their business by integrating into the communities by building showrooms staffed by community yoga instructors. It’s a great concept for health care too.
As I have been away from DC for the past week, it’s good to be back and be reminded of the diversity and philosophy of living (see the photo on the bottom right) that draws me to Washington or this part of any city I am fortunate to visit. It’s similar to the Suze Orman philosophy: People first, then money, then things. Enjoy.
This week’s photograph is of Senator Chuck Schumer, taking a (short) break from health reform, to address a group of local leaders in Washington, DC, in support of equality for gay, lesbian, bisexual, and transgender Americans, at an event hosted by the Victory Fund.
The District of Columbia is set to introduce and pass a bill supporting equality, entitled the “Religious Freedom and Civil Marriage Equality Act Amendment Act of 2009″ next week.
Here are some views from the event, hosted at the new W Hotel, Washington, DC. Enjoy.
Regina Holliday Paints Mural to Show Health Care Woes – October, 2009: Story on AOL news about the 73 Cents mural.
As I was quoted in the article, I believe this is a national monument to patient empowerment.
This week’s photograph was taken at the Pentagon Memorial, designed so that “the nation may remember and reflect on the events that occurred on September 11, 2001.” In the background, you can see The Air Force Memorial.
A short description of the memorial’s design, from cnn.com:
The focus of the memorial is 184 cantilevered benches built over a pool of lighted water. Each bench is engraved on the end with the name of one of the 184 people who died on board Flight 77 or in the Pentagon that day.
The benches are arranged by age, with the bench of the youngest victim, 3-year-old Dana Falkenberg, in the far southeast corner and the bench honoring 71-year-old John Yamnicky in the northwest corner.
The benches for the 59 victims on board the plane are arranged so that someone reading the name on the end of the bench will face the sky where the plane came from. The 125 benches for the victims inside the Pentagon face the opposite direction, so someone reading the name will look up and see the south facade of the Pentagon, where the jet hit that day.
This week’s photograph is a panoramic view (click to see larger size) that brings back memories of my time in Seattle, when I would get together with physician informaticists to share our experiences in health information technology across the organizations we served in the community.
Through the work of the Clinovations team, the same experience has been replicated here, with a diversity of professionals that reflects the diversity of work under way in our nation’s capital.
This month’s breakfast happened to be on the same day as the HIT Policy Committee, so we were visited by one of my favorite national health information technology leaders, Neil Calman, MD, from New York City, along with the usual group of my favorite health information technology leaders. That’s Phil Marshall, MD, from WebMD, in the center.
Attached below are the slides from the presentation I gave yesterday at the Agency for Healthcare Quality and Research Annual Conference, entitled “PHR’s What Are They Good For?“
An important thing I learned about yesterday’s session is that it was the first ever annual conference session in AHRQ’s history that was not moderated by an AHRQ staff member or grantee. This speaks to the openness with which AHRQ is approaching this content.
Slides (click on any to see full size and go backward and forward):
The room was full but not packed; however, some of the most important and influential people in my growth and development as a supporter of patient empowerment were present, including Pat Sodomka, from the Medical College of Georgia, Josh Seidman, from the Center for Information Therapy, and fellow panelists John Moore and James Hereford, from Chilmark Research and Group Health Cooperative, respectively. In addition, new influencers Regina Holliday and Christine Kraft were also present, taking time from their busy schedules to be there for patients everywhere. I was allowed to tell Regina Holliday’s story to this audience, a great honor.
In any event, the packed-ness of a room doesn’t matter to me anymore; the conversation and learning now happens socially after the event. So, any presentation I prepare is designed to start a conversation in the room and far beyond it.
If you’re read my writings, I think PHRs are good for a lot of things, and with great thanks to the following organizations, I was able to present actual data showing how personal health records change care for the better, reactively and proactively:
Also, the videos show in this presentation are available on demand, on the Kaiser Permanente YouTube channel. Feel free to view at your leisure.
To support the request to produce a 508-compliant presentation, I have uploaded one to slideshare (link below). Of course, all comments and questions are welcome.
This week’s photograph is of myself, at one of the most famous bowling alleys in the world. I had the opportunity to visit (and bowl) this week, interestingly at the same time that President Obama was addressing the nation about health care.
It’s a historic place, and also a nice reminder that ultimately, some of our most important public spaces are accessible to the public, in a free country. Enjoy.
What is everyone smiling at? Yesterday was a big day in Washington, DC, with the leash-cutting of a brand new dog park, and a companion human park across the street, in Dupont Circle.
Mayor Adrian Fenty was present to officially open the park, which has been eagerly anticipated for close to 9 months now.
Dogs are a big deal here. I am sure many residents would say the impact on their health of having the ability to run and play with your dog is as important as many health care interventions. People are drawn to all pursuits that help people achieve their life goals through optimal health.
Just ask Milo, my favorite dog in all of Washington (doesn’t he melt your heart?)
Here’s a few images of Mayor Fenty doing the official stuff…
This week’s photograph is actually a series, taken at Washington, DC’s Tech Cocktail 6, a gathering of the technology/startup community, in the Adams Morgan Neighborhood. From the top,Anita Samarth from DC’s Clinovations smiling, with AOL guy in the background, Cake, a panoramic view of the Adams Morgan neighborhood at night, and frozen yogurt from Caliyogurt.
As you can see, Washington’s startup and innovation community is growing and active. Recent data supports this – Patenting activity by Metropolitan Regions, 1976 to 2007, shows that Washington, DC is #3 in the nation in patenting activity, (far) behind San Jose-Sunnyvale-Santa Clara, and Austin-Round Rock, surpassing Rochester, NY and Seattle-Tacoma-Bellevue.
It’s no secret that Washington, DC, is home to monuments of great leaders, who, through their positions, helped our country grow and thrive.
A great discovery for me since living here is that Washington, DC, is also home to monuments built by its residents based on their experiences, often devastating, in the hope of creating a better society for everyone. It could be that our tight geography and extroversion as a region contribute to this, and it’s responsible for a lot of learning that happens just by walking down the street. (I’ve blogged about some of the ones I’ve seen here previously)
I just returned from visiting a new monument, entitled “73 Cents”:
Here is a panoramic view:
For the technologically adventurous, here’s a Quicktime Virtual Reality View:
“73 Cents” was painted by Regina Holliday, who I met in May, 2009, and refers to the cost-per-page, of her husband’s medical record, which she requested from the hospital where he was cared for, and received after a 21 day wait. There’s a photograph of it from my May blog post.
The images in the mural are stunning. They include health care professionals with hands tied behind their back, child’s play blocks with the acronyms known to people in the health information technology world, and a note written by Fred Holliday while dying that reads, “Go After Them Regina, Love Fred.” (What else do you see, and what does it make you think of?)
Many of these bring back memories of the failures of the health care system I observed, and it’s situation in a neighborhood relatively far from the medical establishment here is a reminder that any one of us could be a Fred Holliday one day.
Part of the theme of “73 cents” is to provide patients and families access and involvement in their care, so they can improve it for themselves and those who come after them.
Besides the monuments themselves, another great thing about DC is the number of colleagues, co-workers, and friends who come to visit this region’s exemplary health institutions, go to its national conferences, and speak with its national leaders. This monument is best seen in person, and I’ll recommend that people include a visit here as part of their other work to improve health care while in Washington, DC. It will help all of us reflect on what we are here for and how we hope to make things different for patients moving forward.
The great thing is the people who live here really believe that we can make things different, that’s why we’re the epicenter of health care transformation. Come join us.
By the way, Regina maintains a blog of her work that you can subscribe to here. In addition, you can download these photos from Flickr and use as you wish. There are additional photos of Regina completing this work here.
This week’s photograph is a pair of images from the Health Affairs Briefing in Washington, DC yesterday, entitled “Fact Versus Fiction: Key Issues in Health Reform” (link to twitterfeed is here, note this may not resolve in 7 days, so try to search on hashtag #haforumdc).
Each day my father descended deeper and deeper into paranoid confusion. He couldn’t rest, he was intermittently unsure of who I was. At first I could calm him with my voice, talking about the old days, reminding him of our fishing trips on the Chesapeake Bay when I was young. Then he needed the physical reassurance of my hand on his arm or shoulder at all times. Finally, so that he could get some rest, I got in the bed with him and held him, comforting him as he once—in a long-ago life—did for me.
As we try to figure out what we think is right for patients, we should know that our patients will tell us what is right for patients.
It really seems that Health Information Technology is becoming more about people. Organizations that implement it realize quickly that if the people receiving care do not feel the impact, then the benefits are fleeting, if they exist at all.
Two events last week demonstrated that even people who haven’t yet implemented Health Information Technology understand that just like social media, it should connect people to people, rather than people to technology.
The first event was the Social Media in Health Information Technology conference, which was very successful in my opinion, even with a brief writeup in The Washington Post. Most of the presentations are on the Web site. My slides are here:
In them, I did a brief reveal of the budding internal social network being deployed within Kaiser Permanente. I just learned today that the US Congress is also going to get a social network, which looks very similar. Great minds?
Beyond the presentations, the event captured the energy of Washington, DC, the nation’s most extroverted region. To prove this a little, I did some short video interviews of some of the principles, including Val (“Dr. Val”) Jones, from Betterhealth.com:
The second thing I did was sit in on the discussion of a new Objective for Healthy People 2020, which is about Americans having access to their own health information (e.g. via personal health records). I’ve been a huge fan of Healthy People ever since I entered the field of medicine – the defined objective for the health of our residents are respected nationally and internationally, and it would be great for personal health records access to be one of these measures.
The Healthy People process is an open one, so the public will be invited to participate to make these objectives the right ones for our country, later this fall. The other thing I learned (and very much enjoy) about the Objectives is that they all include measurements of equitable access, to the diversity of people who live here.
This week’s photograph is a video, reflecting the changing nature of social media, with the advent of iPhone Video and other devices, such as Flip HD.
This video is a brief interview of Trenor Williams, MD, one of the principles of Clinovations, a group of Washington, DC innovators in the Health Information Technology arena that I work with. Clinovations was a lead organizer, along with Ozmosis, and Amplify Public Affairs (of the well-regarded Disruptive Women in Health Care Blog), of the successful Social Media in Health Information Technology conference this week. I’ll be posting my slides and impressions here soon.
By the way, I am still learning how to integrate video into my repetoire, so feel free to provide tips or guidance if you (a) do this regularly (b) have suggestions for people/topics you’d like to see more of or (c) can provide constructive guidance on my technique – setting, questions, framing of the subject, etc. I always want to improve! I did several other interviews, which you can see on the YouTube channel I set up for my stuff.
This week’s photograph was taken at a regular gathering of some of Washington, DC’s most thoughtful health information technology professionals, known collectively as Clinovations. The group gets together to share cross-disciplinary expertise in implementation, policy, and local and national approaches to promoting a better health care system through technology. On this evening, we were briefed on the efforts of Chesapeake Regional Information Systems for our Patients , based in Maryland.
The venue in which the gathering was held, is unique to Washington, DC – it’s the Edward Marc Chocolatier sales office, which is opened to community organizations for events (a little chocolate was included…).
From left to right, top photograph: Joel Selz, Ike Brenner, John Kontor, Anita Samarth, Jeremy Wong, Luana Lewis, Jamie Marraccini, Steve Zlotkus, Gaurov Dayal, Brenda Wright
From left to right, bottom photograph: Jeremy Wong, Luana Lewis, Jamie Marraccini, Steve Zlotkus, Danny Rosenthal
Coco Kraft and the Village Elders: Medical Facts Mural #1 -
Regina Holliday has unveiled her work at Washington, DC’s Pumpernickels Deli. Image courtesy of Christine Kraft.
This week’’s photograph is from the Washington, DC Pillow Fight, part of International Pillow Fight Day, which occurred on April 4, 2009. The DC version was staged twice, once at the national mall, and once in Dupont Circle. A good time was had by all.
I snapped this photograph while walking from downtown Washington and noticing that the sun presented itself in an interesting way.
In New York City, they talk about “cupcake wars” (or as I like to say, “cupcake controversy”). In California, they discuss, “cupcake consciousness.” In Washington, DC, it’s definitely about “cupcake conspiracies.”
I couldn’t resist the opportunity to visit my favorite Smithsonian on this special day. I decided not to stick around for the de-installation at 5pm. Too many carbs at one sitting. Here’s a link to a more complete set of photos. Enjoy.
This week’s photograph, and a few additional ones below, are at dusk, where the inauguration stands are being taken down in front of the White House. You can see the smile on a fellow photographer in the image. There was a small crowd of visitors wishing our new president well.
This week’s photograph is of the Albert Einstein Memorial, in front of the National Academy of Sciences Building, in Washington, DC.
I had not known about this work before I was invited to go on a walking meeting with Claudia Williams, Director of Health Policy, for the Markle Foundation. The memorial is impressive both in its larger than life-ness, and its accessibility – you can literally sit next to Albert. Claudia pointed out that this memorial is an interesting juxtaposition to the Lincoln Memorial, just across the street, which I really wouldn’t have considered before she mentioned it.
Given my interest diversity in the workplace, in health care, and equal access for patients, I was especially uplifted by one of the three quotations engraved on the bench:
As long as I have any choice in the matter, I shall live only in a country where civil liberty, tolerance, and equality of all citizens before the law prevail.
Part of the fun (and magic) of walking meetings is learning more about one’s community through the perspective of another person. When a person schedules a walking meeting with me (using the excellent TimeDriver tool), I ask them in the scheduler to tell me where to meet them, so I can enjoy experiences like the one I had with Claudia and Albert.
This week’s photograph was taken at Washington, DC’s Loeb’s New York Deli , and has Anita Samarth and Trenor Williams, MD, assisting fellow customers with their breakfast meals. This kind of thing just happens in a city/state that’s the #3 most extroverted in the United States.
The occasion of our breakfast was a monthly dialogue of a group of mid-Atlantic health information technology professionals that get together regularly to learn from each other and and to believe that everything is possible, because it is. Here’s a photograph of the full smiling group (except for me, the photographer…).
As part of integration into Permanente medicine, I asked to go through Kaiser Permanente’s training for its electronic health record system, (KP HealthConnect™) with other Permanente clinicians joining the medical group, and was luckily able to do this here in the mid-Atlantic region.
As I normally do with my activities, I posted my status as a trainee on Twitter, starting with this tweet., and received interesting questions from a Twitter user in Switzerland. The conversation provided me interesting food for thought:
Reply to me: “and, what are you learning?”
My response (on Twitter): “Learning how new Permanente physicians experience the comprehensive electronic health record”
Their reply: “interesting. How do they experience it? elation? Resistance? Paradigm shift?”
My final response: “Well these are clinicians new to the medical group, so I would say, “glad to be at a place where this is already implemented.”
And we were. Here’s why.
The training was 2 days, a far cry from the 4-6 weeks required when I first trained on the same system in 2004.
A lot of things that were trained to me with certainty in 2008 were things that we didn’t know how to manage when I helped implement a system like this in 2003 – we have come a long way. This included things like developing, using, and sharing clinical content, and correctly routing information between members of care teams. I know from experience that a training curriculum is often the distillation of many thousands of people’s experience, and it showed. There were less guesses and more pieces of practical guidance. Questions posed about why the system was set up this way or that had pretty solid answers.
Within Kaiser Permanente, the Mid-Atlantic Region has been known for being among the most innovative in customizing the application (where possible – each region has the ability to innovate, and then share nationally) for a good user experience. These user-experience touches were visible throughout, with helpful (secure, based on the role of the user) 1-click access to relevant parts of the patient record set up where it made sense.
If there was uncertainty about things, I would say it is about the implicit knowledge that comes with joining a new practice – which features does this Department use regularly, for example? These are the things that come with experience next to other clinicians, and here again, the maturity of the training curriculum showed, because our trainer knew which things were system related and which required local interpretation.
For this type of interaction, the social part of using systems, Kaiser Permanente is piloting the use social networking applications within the organization. I hope to blog more on this work as it develops, and it’s a huge interest of mine, as part of the “what next?” part of maintaining and developing health information technology within health care.
It was overall impressive to see how the comprehensive electronic health record has settled in to this organization. As someone who has actively participated in implementations, I could appreciate the hundreds if not thousands of little decisions that have been made to support the best patient care experience into the system that I received training on. My trainer did a great job of representing the system as not the future, but the present, of medical care within this organization. A clinician new to the organization may not appreciate how much work it takes to get to this point, and I don’t think there’s a need that they should, but I definitely do!
This week’s photograph, of a mural depicting President Barack Obama and the word “Progress,” was taken on P Street, in Washington, just off of historic Logan Circle, which at one time was the “social, intellectual, and artistic center of Black Washington.”
The mural was produced by Obey Giant, and has a companion piece on 14th and U Street (see photographs below). There are some additional colorful murals just off of P street produced by Obey Giant as well.
The murals blend in well with these historic neighborhoods – there were several people in the alley enjoying art along with us – and serve as a reminder that everything is possible in this new year, and beyond.
Better Health » Did You Or Someone You Know Break the Health Care System?
As it says in the post linked to above from the Getting Better with Dr. Val blog, they didn’t want to hear about it. This was the Washington, DC version of the Obama-Biden Transition team-inspired community discussion about health care reform, and the instructions were to be prepared to come talk about an interaction with the health care system that was positive.
We were given copies of the participant guide, which is actually well referenced and backgrounded, although we didn’t follow it exactly per the directions we were given.
And, we had the discussion (not a debate!). In retrospect I think we covered a lot in a very short time, just through the lens of a few people’s experiences – everything from supporting vulnerable populations, to health information technology, to service oriented care, to dedication and commitment among health care professionals.
The interesting thing for me to notice was that it wasn’t the HIT-champions bringing up the benefit of HIT, the specialty care provider bringing up the benefit of good specialty care, or the member of the vulnerable population bringing up the value of supporting vulnerable populations.
The day after, this overall leaves me with the feeling that Americans know what good health care is, and we can trust them to tell us, if we listen. Part of the participant role was to answer three short questions in the participant guide, and since there are others blogging about last night’s event (I hope!), I’ll let them demonstrate how true this was in our responses to the questions…..
With thanks to Mr. Dr. Val (Steve Z) and Dr. Dr. Val for hosting the discussion in the zone where everything is possible, because it is.
On my lunch break from the NHIN forum this week, I stopped in to my favorite Smithsonian Museum to find a great exhibition, Women of Our Time. Photography isn’t allowed in special exhibitions, but some of the images are on the web. My three favorite ones (Lucille Ball, Virginia Apgar, and Rosalyn Yalow) are not there though.
An image of the photograph of Rosalyn Yalow is here on this web site – I like it because in her face is a look of confident accomplishment, without boundaries. Here is her story:
Rosalyn Yalow, born 1921. When physicist Rosalyn Yalow took a job in 1947 at the Bronx Veterans Administration Hospital to explore the potential of radioisotopes in diagnosing and treating illnesses, her first lab was a converted janitor’s closet, and she had to improvise some of her equipment. From that unpromising beginning came pathbreaking results. By the early 1950s she was working in partnership with Dr. Solomon Berson, and out of their investigations came RIA (radioimmunoassay), a procedure that proved invaluable in diagnosing and determining treatment for a wide range of diseases. In recognition of that achievement, Yalow becme the first woman to win the prestigious Albert Lasker Prize for Basic Medical Research in 1976, and a year later she was awarded the Nobel Prize in medicine.
Yalow’s portrait was part of a series of images by photographer Arthur Leipzig depicting Jewish women-both famous and anonymous-from around the world.
When I entered medical school, my class makeup marked the end of an era – it was the last medical school class that had more men than women in it. The stories of these amazing women reinforce how far we have come, thanks to their leadership.
One of the great advantages of living in Washington, DC, is access to lots of great (and affordable) learning opportunities, and this week’s National Health Information Network Forum was one of them.
The most important thing I learned is that there is one (a NHIN), and through the days’ demonstrations that progress is being made. I should qualify my comments with the fact that a good family practitioner knows what they don’t know, and this part of HIT is not central to my area of expertise, which is more focused on interactions closer to patients and providers in large heathcare systems.
In any event, I livetweeted my impressions on the fly, which you can read here, and will add some bullet points:
Overall, I am very thankful for the generosity of our Department of Health and Human Services for putting this public forum together. Many of the comments and thinking were well received by me, such as Secretary Mike Leavitt’s comment that the days of test results delivered at the convenience of the physician should end.
Photos at the top of this post, click on any to see larger.
This week’s photograph (published a little later, to support Engage With Grace) was taken on Thanksgiving day, at President’s Park, in front of the Andrew Jackson statue. You can see preparations for the inauguration happening behind it, on Pennsylvania Avenue.
I believed that 2008 would be an incredible year for this city, and my prediction was accurate just in thinking about this past month.
I thought about whether posting the images below would dilute the message of my blog, but I think they do not. The interest in empowering patients in health care is not far removed from an interest in empowering all members of society to achieve their true potential. This is an interest shared by the best organizations in the world, including my employer, and this community is a wonderful place to witness that commitment, which I did this month.
2009 is looking to be another incredible year in our nation’s capital for health care, diversity, and our world’s economy. Come join us!
The words in the title of the post were said by one of the staff at the newly re-opened National Museum of American History this morning to a young visitor. What she did, very effectively, for the visitor and myself (lunch counters in stores are even before my time) was relate yesterday’s inequalities to those of today, by explaining the importance of the lunch counter in the era before fast food. This is the Greensboro, North Carolina lunch counter, and it was donated to the Smithsonian by Woolworth’s in 1993.
I’m attaching a few more images that stirred some emotions in me, maybe they will for you, too. Overall, the last two weeks in Washington have really inspired the feeling that everything is possible. I’ll post some of those images next week. Feel free to share your comments on the NMAH opening in the meantime.
Today I gave the first official presentation in my new skin as a physician with The Permanente Federation. I was a little nervous leading up to this (as the tweet said) because this is earlier in the tenure of an organization than I would want someone to represent me.
I did this because it was National Partnership for Women and Families and the groups they work with. I am a huge fan of their work promoting friendly workplaces and blogged about this previously. I managed the newness to Kaiser Permanente by weaving in basic information about Kaiser Permanente’s onilne services (the slides in the middle) and including the names of the leaders involved and taking questions to provide more information later. I also planted a little seed at the end for the innovation potential of Washington, DC.
Today I also got to go on walking meetings with the famous (to me) Jacob Reider, MD , a family physician and health information technology innovator, and now Medical Director at Allscripts-Misys Healthcare Solutions., and soon to be famous (to me, but already to his fellow New Zealanders) Professor Jim Warren, Chair in Health Informatics and Chief Scientist for the National Institute for Health Innovation at the University of Auckland. Both Jacob and the Country of New Zealand have a lot of innovation up their sleeve, all involving patient centeredness in health care. Let’s cheer them on.
Click on any slide to see the images closer up. If you don’t know what the point of any image is, let me know in the comments.
Oh, last thing, the video I showed at the end is Kaiser Permanente’s latest TV commercial, launched in tandem with the 2008 Olympics. Kaiser Permanente now regularly uploads its media to YouTube. Sharing is healthy.
This week’s photograph is of The National Building Museum , in Downtown, Washington, DC, which became famous this year for an ending, to a historic presidential campaign. From the Museum’s about page:
The Museum is, however, much more than a repository of things, beautiful and intriguing though they may be. It is above all a forum for the development, exploration, and exchange of ideas. Created by an act of Congress in 1980, the National Building Museum has become one of the world’s most prominent and vital venues for informed, reasoned debate about the built environment and its impact on people’s lives
When I toured the interior, it was being set up to celebrate the beginning to a new relationship, in the gorgeous grand hall.
And for my ongoing curiosity about the city, the model for the City’s master plan used until the 1970’s was on display as well as an exhibit describing our transportation history. Washington, DC, like many cities, was slated to have interstate freeways coursing through it in the 1960’s, but thanks to the activism of its diverse residents, this never happened, for the benefit of all who enjoy its beauty today.
This article is actually called “Experiencing Physical Warmth Promotes Interpersonal Warmth” but when I read the writeup of it in the Los Angeles Times, I knew that it would have significance in thinking about the Walking Meeting.
I wrote a How-To on the Walking Meeting on this blog in Jaunary, 2008, and have been practicing them for almost 4 years now, and I’ve noticed a lot of differences between these and the standard sit down and talk meetings.
In this article, the authors test the hypothesis that stimulating the part of the brain that happens to process both physical and psychological warmth (the insular cortex) results in greater feelings of interpersonal trust and comfort. They tested this out two ways. First, by having subjects hold hot or cold fluids on their way up to a sham personality evaluation. The second way was even more interesting – they asked subjects to hold a hot or cold pad for a sham product evaluation and then offered them a “selfish” gift (bottle of Snapple) or a “community” gift, a $1 gift certificate to an ice cream shop presented as a “treat a friend” option. Half of the subjects were told the opposite, that the Snapple was the “treat a friend” gift and the gift certificate was the “treat yourself gift.”
In both cases, subjects perceived people as warmer (in the first case) with the warm exposure, and were more “community” oriented based on the framing of the gift they received.
Tying this back to what I’ve noticed after 4 years, it is that there seems to be an activation of some kind that happens in these meetings when I participate in them. Part of it is community orientation – I enjoy pointing out parts of our community as we walk, as a reminder of who we are serving. Part of it is the implied vulnerability of bringing someone to a less-controlled space. Maybe part of it is the occasional hot beverage.
In my How-To I actually caution against beverage purchasing during walking meetings because of the expense and caloric load, so I will slightly amend that with the added information provided here.
In terms of getting people to do these with me, I have had my share of blank stares and confusion from people, mostly ones who I am meeting for the first time, but I continue to ask for this as an option, and about 92.5 % of the people I ask are happy to do it.
Look at your calendar and see what meetings are coming up. Convert at least one to a walking meeting this week, and report on it here.
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.
support the health of everyone….
…are strong,
fun to live in….
…and beautiful.
From the top:
(support the health of everyone) AIDS Walk Washington 2008, sponsored by Whitman-Walker Clinic (that’s the US Treasury Department in the background of Pennsylvania Avenue). I supported the Kaiser Permanente Mid-Atlantic Region team.; (are strong) Fiesta DC 2008, Mount-Pleasant, Washington, DC (60,000 attendees); (are fun to live in) Adams-Morgan Day, Adams-Morgan Neighborhood, Washington, DC; (are beautiful) Fiesta DC 2008, Mount-Pleasant Neighborhood, Washington, DC.
A patient once said to me, “We don’t tolerate diversity where I work. We LIVE diversity.” This Photo Friday is a reminder to live diversity, wherever you are.
The statement in the title of the post was made in jest by Navigenics Co-Founder and Chief Scientific Officer Dietrich Stephan, Ph.D. to me recently. Dietrich was in DC, along with colleague Phil Marshall, MD sharing views on the future of medicine and health at the renown Lauriol Plaza in my neighborhood. In the context of our conversation, Dietrich was speaking to the current imbalance in our health system that prioritizes procedures and specialty care over primary care in our resource allocation.
The statement made an impact on me because it triggered visions of a different world, where medical students might choose primary care and community as the lucrative specialty instead of the ones they choose today with this idea in mind.
With that as a starting point (instead of “we want to make primary care less disenfranchised”) Dietrich laid out a vision for primary care providers as stewards of genetic science, leveraged to help patients stay healthy, whether by suggesting lifestyle modification, alternate therapies for common conditions, or mitigating risks later in life. Right now, our instruments are very blunt when it comes to predicting risk even for things where we have lots of data, like heart disease.
What would it be like for primary care providers to work with patients to plan a healthy life by wielding the best genetic science, and how would society value that relative to procedures? The path of primary care might change, from managing and directing goals and processes in the management of chronic illness to a new role of predictive science and planning, for a person, a family, a community.
I went to medical school hoping to become a family physician and left medical school hoping to become one, because I was most interested in what I would do as a physician. Even though I was a molecular biology major in college, I haven’t really considered how genetics would integrate into medical practice. Now I am. See what you think, comments welcome.
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 -
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?
Tomorrow is my one year anniversary of arrival to Washington, DC, from the “other” Washington’s City of Seattle.
It occurred to me that I could pick any 24 hours’ worth of events to describe why I heart DC, so I’ll just use the last 24 hours, which started off with me meeting Josh Seidman, President of the Center for Information Therapy, for a walking meeting in Dupont Circle, which was joined spontaneously by Susannah Fox, from the Pew Research Center and e-patients.net. We walked Susannah to her workplace, passing both Hello Cupcake, where we talked about the arrival of the cupcake wars in Washington, walking past the offices of Bisnow.com, where I reminded myself to introduce Curtis Raye from Medical Bisnow to both Josh and Susannah in his profile of local health influencers. Later on, I received a tweet from Jen McCabe-Gorman who met Curtis at the Disruptive Women in Healthcare meeting, and the reciprocal tweet from Curtis (you could just see their twitterstreams coming together) that he met Jen. And so the epicenter of health care transformation becomes a little more epicentric.
This is happening in place with the most walkable areas per capita in the United States and with incredible diversity of cultures and thought. The only thing the District is currently missing for me are an Apple Store. And a Cheesecake Factory. (Both are three metro stops away in Virginia, though).
Place matters. We all deserve to find the best one for ourselves. Who’s yours?
This week’s photograph comes from one of the hottest spots in most cities these days, the frozen yogurt shop. They’re popping up everywhere. As I ordered my green-tea mini with white chocolate chips, strawberries, and pineapple, I asked if this particular store was associated with the other hotspot just a few blocks away in lovely Dupont Circle, and the answer impressed me so much I tweeted it on the spot.
What if the mental model in health care was “co-investment,” just like in yogurt competition? It would go something like this – “we discovered a new workflow/process/patient safety issue in our care delivery. We’d like our peers/competitors to co-invest in it with us to make it even better/make it not happen again.” In this situation, the winners are the ones who can innovate and adapt others’ ideas as quickly as possible, not the ones who have the best firewalls.
Think about it what this would do for health care. It definitely makes for a tastier cup of 25-calories-per-ounce over time.
A quote from Trenor Williams, MD:
Our newest generation of care givers are incredibly tech savvy but nobody is equipping them with the skills to translate that knowledge so that it can be used to improve care delivery
We all agree: The Washington DC area is at the epicenter of the transformation of Healthcare.
Thanks, Mark Mark Scrimshire for planning a great event.
This week’s photograph is from HealthCampDC, which I have come to, to learn about UnConferences, and also to connect with Health 2.0 leaders in Washington, DC. Both are happening.
The agenda is set by the group and then we jump in. I want to do more of this. Take a look at the images below of us doing the agenda on the fly (click on any to see them larger). Would you like to try this in your city?
(I’m below the fold)
A dream realized: Made it into Bisnow on Business: Washington DC Local Medical News: WHAT DOCS
SHOULD READ. Now I’m really a Washingtonian, complete with driver’s license and taxpaying privileges.
I must say, in the background of the humorous sarcsasm of the corporate shackles comment in the article: Employed, Unemployed, what does that mean anymore in the context of ideas like the Results Only Work Environment, in a city where people work to improve the health of the nation in a diversity of ways, as part of a generation that challenges the importance of organizational affiliation?
I’ve been working this whole time and learned a ton, online and offline – and one of the things I’ve learned is that this is not dependent on being in a big company, or a company at all. It’s what you do for people and how you learn to be better at it every day.
Shackled or not (mostly not), this is a great community to be a part of and I am honored to support it along with all of the others profiled by Curtis and the Bisnow team. Keep up the great work!
Washington welcomed more of Roy Lichtenstein’s work recently, with the installation of Modern Head, at the Smithsonian American Art Museum. He’s one of my all time favorites, and I learned in writing this post that the largest repository of his work is located here, at the National Gallery of Art. I’m putting on my walking shoes again…
First Look: Hello Cupcake – We get a new cupcakery in Dupont Circle – a trend toward food dominance in DC over New York?
Opening Day
I spied bike sharing in Rome earlier this summer. Now DC is getting national attention as the first American city to start a program. Interesting comment/issue at the end in this movie about bike helmets. They are not provided, and they can’t be mandated
I admit, that maybe, once or twice in my past, I may have used convening and convener in less than flattering terms, much like I used to use “process” in unflattering terms. I learned through LEAN, though, that process isn’t bad, bad process is bad. And so I have learned the same thing about convening, now that I have done it a couple times this summer, with the California Healthcare Foundation.
The most recent time was yesterday, when Veenu Aulakh, MPH, and I brought together Safety Net health care organizations, and national experts in patient online access and social impact of the Internet to talk about (you can guess…) “Patient Online Access in the Safety Net.”
These being the first convenings I have co-led, rather than participated in, I have learned a ton, and have gotten a good understanding of doing this for a purpose, which both situations have had. In the event we hosted yesterday, in Oakland, I put together an A3 document before we invited anyone, which included the background, the goals, and most importantly, the “why?” we were doing this in the first place. It was really helpful to have created agreement around the “why?” – I referred to this many times in the planning.
At the event itself, I got a new perspective that I had not had as a participant previously. It was one of listener/observer – even when I was doing the talking, I was interested to see reactions and learn what people and organizations are capable of. It made me think that when I have been a participant in convenings in the past, this is what my hosts were doing – learning what myself or my organization was capable of doing to solve a problem, as much as they might have tapped me as an expert. Interesting to have this happening in my brain.
Sharing information happened, too, courtesy of some of the most innovative organizations in the U.S., including Cambridge Health Alliance, University of California, San Francisco’s Positive Health Program , New York’s Primary Care Information Project, Institute for Family Health, and Kaiser Permanente.
In addition to all of this, there were a few nice moments of recognition for people’s work, such as when Jim Kahn, MD, thanked Kate Christensen, MD, and her team at Kaiser Permanente for their support and assistance in the launch of the myHERO patient portal for HIV patients cared for at San Francisco General Hospital.
…and a little something for me, a follow-up conversation with Hilary Worthen, MD, from Cambridge Health Alliance, about his study and pathway to discover and implement LEAN in primary care at CHA. He told me that for him, this is a transition from thinking about exam rooms and staff to “work that you need to get done, defined by doctor and patient.” I love hearing about how people apply their creativity and copy the thinking of LEAN to do exceptional things for their patients.
This being the second time I have done this, I don’t know if it was perfect. We tried a lot of things I’ve not done in meetings before, and I am still working to integrate social media before, during, and after. I am definitely sold on my philosophy of supporting any and all technology use (“if you need or want to use your device, use it”) - I have not, in my conveningness, come around to the “turn your devices off” philosophy, as I have written about previously.
Oh, and I learned that a 60″ table seats 8 people.
Here are a few images from yesterday. I’ll follow up with my slides in a separate post. Click on any to see larger size.
This week’s photograph was taken on the National Mall, where the movie “The Apartment” was being shown as part of HBO’s Screen on the Green Series.
There was an interesting dialogue between Jack Lemmon (who works in a large insurance company) and Shirley McLaine (who’s an elevator operator in said company) in this 1960 film:
BUD
They got a great little band at El
Chico, in the Village — it’s
practically around the corner from
where you live.FRAN
Sounds good.
(a sudden thought)
How do you know where I live?BUD
Oh, I even know who you live
with — your sister and brother-in-
law — I know when you were born –
and where — I know all sorts of
things about you.FRAN
How come?BUD
A couple of months ago I looked up
your card in the group insurance
file.FRAN
Oh.BUD
I know your height, your weight and
your Social Security number — you
had mumps, you had measles, and you
had your appendix out.They have now reached the corner, and Fran stops.
FRAN
Well, don’t tell the fellows in the
office about the appendix. They may
get the wrong idea how you found
out.
(turning the corner)
‘Bye.
Many people in the audience were laughing during this part (and I assume many in this crowd probably are very engaged in these issues), and it made me think about how we got from there to here, and a thought provoking question: Did HIPAA solve a problem or is it a band-aid on a bigger, deeper one?
Lastly, on this gorgeous summer evening, I also encountered a curiosity of this series, the HBO Dance, which is choreographed to the opening theme many in my generation remember before the days of cable. It’s always good to dance, and laugh, every day – and that does happen in Washington!
Video posted below, along with a bonus image of the crowd.
This week’s photograph confirms Richard Florida’s research (just a little) about extroverted types being closer to the Atlantic than the Pacific Ocean.
Frozen yogurt is back. In a big way. As a Generation Y customer in line told me, “(large ice cream chain) is doomed.” I really enjoy a place where people are easy to engage, and they walk to get places. In this case it’s to one where the product sold is only 25 calories per ounce. Not bad! (More pictures of the atmosphere are here, this place is Web2.0 enabled)
click on the image to see it full size
As I walked by, I noticed the words written on the tire by Alice’s mother. They had an impact on me. They will on you too. Click on the image to see them for yourself.
The world is not flat; place matters.
I couldn’t agree more with the latest work by Richard Florida. This book looks at the importance of place not only in the global economy but in a person’s life. I personally had a good idea that this made a huge difference some time ago, despite living and working in a world where colleagues work for organizations for which home base is irrelevant.
On this, my 300-day DCVersary, I can confirm that my experience bears this out. Moving from one of the smaller “mega-regions” (Cascadia, Portland, Seattle, Vancouver, 9 million people, $260 billion light-based regional product) to the second largest one in the world (Bos-Wash, Boston-Washington, DC, 54 million people, $2.2 trillion LRP) has undeniably made a significant difference in everything I do, even in a technology-related occupation. As Florida describes, people cluster:
(There is) the tendency of creative people to seek out and thrive in like-minded groups, and (there is the) self-perpetuating economic edge that comes from doing so.
Florida does a good job of reviewing the evidence that place matters, and the idea that its impact on personal and professional happiness has been underemphasized. He combines original research as well as data currently available to create a compelling picture of both the importance of place and the factors about it that matter. One of the interesting explorations in the book is about the personality of cities – extroverted people and agreeable people tend to be localized east of the Mississippi, where “open to experience” people tend to be localized to the coasts, with dominance in California and Bos-Wash (okay, maybe the extroversion doesn’t stretch as far east as DC, and maybe the “open to experience” doesn’t stretch as far South, but I’m pretending they do – you always see the best in something you like).
Throughout, It’s nice to imagine where you might “fit” but also how your own experience stacks up, because an important criteria of a place its aesthetic.
I have been using a curious measure for the past few years to judge aesthetic, the “touch-down” measure. It is, “In what city do you say to yourself, ‘I’m home,’ when the plane touches down on the runway.” I think you can’t fake that. Alternately, it’s the city that when the plane touches down, you say to yourself, “I can’t believe I don’t live here.”
I give strong kudos to Florida for acknowledging the role of diversity and tolerance in a place, not just for minorities, but for all people. He says:
It’s not about tolerance for tolerance’s sake. As my previous research has shown, places that are intolerant simply do not grow. And, as the Place and Happiness Survey confirms, people in intolerant places are less happy and less fulfilled than those in tolerant an open-minded ones.
This finding is similar to research that shows the same thing about organizations. As a patient said to me a very long time ago, “We don’t tolerate diversity (within the organization I work for). We LIVE diversity.” That describes a place that has a better chance of thriving, and one that most people (including me) want to be involved with.
A book by an author that writes a blog is a better read
It is worth mentioning that as I read the book, the positive impact of Florida having experience writing a blog came across, because (a) he brought his personal experiences and those of his colleagues into the story and (b) he crowd sourced several of his ideas, bringing in commentary from blog entries. This made for a much more engaging read, and I can’t help thinking that without this experience, the work might feel less connected to the experience of real people. I think this is an interesting way that blogging is changing traditional publishing because those who blog are forced to become more personal in their communication to be successful. I like it. A lot.
And the winner is…
I have experience living in three mega-regions described in the book: Bos-Wash, Nor-Cal, Cascadia and it was interesting for me to compare the decisions I’ve made with the characteristics of each. All of them offer so much. My recent experience with Bos-Wash has been, well, fantastic, both in terms of livability, ability to be extroverted, and exposure to diverse populations and cultures. Nor-Cal scores high in my book as well as it shares many of the livability and diversity attributes, as well as strong dominance in technology and innovation. Cascadia was definitely enjoyable for the time I spent there.
Who’s Your City? Feel free to post your experiences…
How long before HelloHealth comes to Washington, DC, with the most regional-serving walkable urban places per capita in the country?
Note: There’s been some buzz about walkability for other cities as well, also fine choices for those who love living in places that support walking.
This week’s photograph is from my favorite museum in Washington, DC, that I was able to reconnect with this week, The Reynolds Center. The Reynolds has a brand new, beautiful, climate controlled atrium, with a Wi-Fi connection. On this evening, DC residents and visitors are enjoying a free jazz concert. Two bonus images are of the audience enjoying the show and an exterior of the museum just after a summer rain.
This week’s photograph is of the storefront of Go Mama Go!, a local and vital landmark, opened by Noi Chudnoff in 1999. I have never met Ms. Chudnoff, but I learned about her shortly after moving to Washington, when she died after a fall at a local hospital while awaiting surgery. She was weeks away from her 60th birthday. Ribbons tied by grieving members of the community in November, 2007 are still attached to the gate.
Members of the community marched in this year’s Capital Pride Parade (photograph here) to remember Noi, and it was a reminder of the impact a person can make in their community when they are present, and the greater impact that occurs when they are suddenly taken away.
What are the parades your patients will be a part of during their lives, and how can you make sure they are able participate in every one, in good health, with their family and community?
The following is an exchange with Kathleen Newbould, from One Economy Corporation, a global non-profit organization that works to maximize the potential of technology for low income people.
I was sent an informational piece about a new initiative in health care, DCHealthCare4U.org, was intrigued, and Kathleen kindly did some research on some questions I had, to fill in the “why” as well as the “what.”
My comment is that there’s a great potential for an organization involved in enabling technology use to expand their role into health care. I think it would be great in the future if DCHealthCare4U.org pointed out which health care providers did have secure patient access and could communicate with patients online. My work to date shows that this patient population is ready, willing, and able to do this, and maybe an organization like One Economy can help make it happen.
Take a look – What do you think?
Thanks to Kathleen and her team for entertaining my return query.
Ted,
Thank you for your response and your interest. I am glad to see that you have some good questions for us! I took some time to speak with one of the men heading up the DC Health Care for You project, Brian Reichart. With his help, I have these answers to your questions:Why did One Economy decide to get involved in health care?
One Economy’s mission is to maximize the potential of technology to help low-income people improve their lives and enter the economic mainstream. We know that low-income people have higher rates of many chronics diseases and believe that technology can play a role in helping to alleviate some of these disparities. From the start, One Economy has connected people to helpful information and resources in vital areas including health through our website, The Beehive (www.thebeehive.org). We are unique in that our content is always intentionally focused on low-income people who may not have the same literacy level as other audiences. With that in mind, our content is always at a 6th grade reading level or below and we utilize multimedia to the greatest extent possible. DC Health Care for You is way to connect DC residents to on-the-ground programs in their cities. In short, working to improve the ability of low-income people to health resources aligns with our mission.
Is DC Health Care a test site for other cities?
Health Care for You will be expanded to Atlanta and Chicago in the coming months.
How is this connected to our other IT initiatives?
DC Health Care for You links to The Beehive which has helpful, non local, information on disease management such as our diabetes coach. We have not taken formal positions on the ideas you described, but generally speaking we do encourage our audience to become more engaged in their own health care. Information is power.
Please let me know if you have any further questions! Thanks again,
Kathleen
Here’s the information about DCHealthCare4U.org:
Dear Dr. Eytan,
I am reaching out to you to inform you about One Economy’s new website called DC Health Care for You (www.DCHealthCare4U.org). We are now launching a campaign to spread the word about this new self-help website which focuses on health care in DC.
We would welcome any thoughts you may have on the website itself. In addition, we feel that since much of your readership consists of people in the DC health care field, you might be able to offer some assistance.
We are hoping to get the word out to DC residents concerned with health care in the area and believe that many of your readers fit this description. If it would not be too much trouble, we would like you to mention our website or include a link to www.DCHealthCare4U.org somewhere in your blog.
Please feel free to check us out online at www.one-economy.com and see the DC Health Care for You site at www.DCHealthCare4U.org.
We feel that this website could really help DC residents and would sincerely appreciate your cooperation. If you have any questions or comments please feel free to contact me. Thank you for your time.
My best, Kathleen
This is a photograph of 14th Street, in Washington, DC. The street is currently undergoing a rejuvination, and reflects some of the beautiful shades of spring that Washington reveals to passers-by.
I am in Besthesda, MD, attending the Institute’s intensive training seminar. The quote above is from Roslyn Marshall, RN, Nurse Manager for the Neurosciences Unit at Medical College of Georgia, who placed a sign with the words in the title near the place where nurses used to do their shift changes. They now do shift changes at the patient bedside. The other quote I liked was from Terry Griffin, who said:
No one more than parents wants to make sure their baby’s care is error free
In reference to including parents in hospital rounds and nursing rounds. I also learned to not call “Carts on Wheels” “COWs” – “WOWs” (“Workstation on Wheels”) is better.
May 15th through May 18th:
Presentation (PDF): 8 Years and 150,000 Patients
Today I was given the opportunity to return to the National Library of Medicine, to talk with Donald Lindberg, MD, and his team, about patient involvement in care and personal health records. The visit was facilitated by Aaron Navarro, Ph.D., the Assistant Director for Program Development in the Lister Hill National Center for Biomedical Communications, headed by Clement McDonald, MD.
The return part is based on the fact that I started my Informatics career here, as a fourth year medical student, in the NLM’s rotation in medical informatics in 1995. I even managed to find a slide from my informatics project during that time, which was a web front end on the Guide to Clinical Preventive Services (see the images above for that screenshot). It was a treat for me to reconnect with one of my mentors from that rotation, May Cheh.
Images: click on any to see larger size
Besides being able to show that a lot of the vision of preventive care from 1995 has now come true in systems like ours, I appreciate the way this group thinks. There were questions about our ability to generalize what we do to non-prepaid health care, and about the ability of a patient to take a copy of their record to another health care institution. Prior to starting my sabbatical, I really didn’t know the annswer to the question, “Can systems outside of Group Health implement patient centered health information technology?” Now, as the stories of this blog show, I know they can.
I was also delighted to see the server room where the magic of MEDLINE and PubMed are served up, and to get reacquainted with the Visible Human Project, led by Michael Ackerman, Ph.D. When I was a student, they not fit all of the data (18 GB worth) on any single hard drive. Those were the days.
I am grateful to the NLM for the inspiration I when I was a student and I respect the energy that they bring to advancing the field of Informatics. Thank you again to the leadership and staff at NLM for the warm re-welcome!
I’m not an atopic/allergic person by any stretch of the imagination, having never suffered from allergies. However, I got a good dose (pun intended) of what it feels like to be in Washington, DC recently, when I had an acute flare of environmental allergies. As a family physician I understand the toll that allergies can take; at the same time, it’s as impressive a condition as any that requires a person to stay indoors for fear of their eyes swelling shut.
Given that I’d never had anything to this degree before, I wanted to figure out the best approach to control things. I also found it challenging to explain to people that yes, this was my first time, and I truly didn’t know what to do about it in the most acute phase.
So I started looking.
A very well regarded medical database that I use started off with this description of the condition:
Allergic conjunctivitis is a relatively benign ocular disease that causes significant suffering and use of healthcare resources, although it does not threaten vision.
I’m not sure if this was supposed to be reassuring or comforting from the perspective of a patient. I would say on balance it was not. At the same time, this is a very factual statement made from the medical perspective, which is the audience this is for.
My next task was to figure out if taking supratheraputic doses of non-sedating antihistamines to control symptoms had any basis in experience or science. I was only able to find that a 400 % dose of loratidine is not associated with a fatal heart arrythmia. That was very important for me to know (I’ll leave the details out here). I also needed to know if it’s typical for patients to need this much to control symptoms. I came up empty, except in conversations with friends who said, yes, this can be the case.*
*Disclaimer: I do not recommend a supratherapeutic dose or off-label use of any medication. I am just illustrating the uncertainty that comes from an unexpected dose-response experience.
As things started to calm down, I wanted to find out if there’s something going on in my community that makes this a one-time event for me, or a prelude to more allergic challenges. I was able to find pollen counts, and a news story that allergies are flaring in Washington, DC. Otherwise, I depended on my short conversation with a staff member at the local Safeway who said that she, too, was having her very first allergy flare. Ok, so that means I’m not alone. Oh, and every allergy medication aisle in Dupont Circle was nearly empty.
What does that leave a patient like me with, though? With a few side conversations, rumor, gossip, luck, and an entire health care industry that can’t provide me with more information than the fact that the standard dose of loratidine and ceritrizine is 10 mg per 24 hours.
In my profession’s defense, I was able to get enough information to quickly change my topical ocular antihistamine to one that’s less likely to cause rebound (ketotifen), and better for long term control – but from my “special” medical sources. Nothing in the pharmacy said, “take this one if you’re really having problems.” If I had not switched, I would probably be sitting indoors still.
So I’m writing this post about my first time allergy flare in Washington, DC, so that it can be picked up by others in the blogosphere who wonder if they are alone (keywords: allergic, allergy, allergies, first-time, first, conjunctivitis, flare, DC, Washington). I am hopeful that Health 2.0 projects (like PatientsLikeMe.com) will help fill in the gaps that medical knowledge leaves us with: Am I the only first-timer in my community (bad sign for me, it may happen again)? How well does that drug work? How much do you really need to take to get relief? Are we getting better? This will work very well as a partnership, so patients and physicians can learn what happens between FDA approval and patient experience, the most crucial part of health.
It’s being said that pollen counts are going to massively increase in the next few weeks in DC. That’s okay, Washington – my like for you is still blind, even if you nearly made me go blind.
I have been intrigued by EMC’s work in managing an employee personal health record – it seems above and beyond (in a good way) how an human resources function and grow and support talent. Also, time to upgrade Office for Mac. It went OK. I’ll update “my own CIO” tools list in the near future.
I really like the visual display of the graphic here, depicting improvements in performance year over year for the Washington Capitals. I think this could be employed very effectively for physicians and/or health systems.
Without even needing a graphic designer, a medical office could just have a jar/receptacle for chips that are marked with satisfaction levels, or whether or not prevention was discussed in a visit.
This is a community where there are visible reminders everywhere to recommit yourself to what’s important.
The quote in the title is from Mark Snyder, MD, Associate Medical Director, Information Technology, Mid-Atlantic Permanente Medical Group, who once again, volunteered to demonstrate how Kaiser Permanente improves medical care for patients using the latest technology. This happened at Kaiser Permanente North Capitol Medical Center, which takes great care of a community that includes the United States Capitol.
Mark was demonstrating the After Visit Summary, in this case, to a group of leaders from the District of Columbia Primary Care Association, which is currently undertaking an impressive program to implement health information technology in safety net medical centers in Washington. Senior Project Specialist Lauren Mardirosian was in attendance, along with Tracy Knight, NW Social Services Director from Bread for the City, and Deborah Parris, Health Information Manager from Family and Medical Counseling Services.
I set up the visit, with Kaiser Permanente’s help, because I am excited by the fact that our members’ experience can help patients in every care system, locally and nationally. It’s a virtuous circle – sharing our experience brings other experience back that we can use to do even better, and the cycle continues. I have really learned the reinforcing power of sharing in this journey. It’s even more enjoyable when I get to work with colleagues like Mark and Medical Center Chief Doug VanZoeren, MD, who willingly give their time alongside me.
What about the After Visit Summary? Mark showed that by involving the patient in its development, he makes the creation as important as the delivery in achieving its goals – involving patients and families in their care. In an era where we talk about Web2.0, Health2.0, and focus on user generated content, I think this is a great example – we create the record of what happened today, together.
DCPCA is implementing a modern electronic health record system, manufactured by eClinicalWorks, that has this capability. A care system that I visited in Sonoma, California, is already generating these for patients. Sometimes a piece of paper (albeit one that is also available on the Web in real time, on Kaiser Permanente’s personal health record, kp.org) can be as revolutionary as the people who put it together.
Thanks again to DCPCA, Mark, Doug, and Kaiser Permanente North Capitol Medical Center members and staff for their interest in helping patients everywhere.
Pictures: Click on any to see larger. Note: The patient displayed is a test patient. No actual patient information was demonstrated during the visit.
This week’s photo is of the Columbia Heights Neighborhood in Washington, and its brand new big box tenant. As I pointed out in today’s deli.ico.us links, there are lots of feelings about what a big box retailer does for a community and a city. Several other retailers are about to open their doors as well, in this, one of the most diverse communities in America.
Note that spring has arrived. It’s gorgeous.
March 12th through March 13th:
Veterans Affairs Medical Center, Washington
Veterans Affairs Medical Center, Washington
I was fortunate to spend time with Hank Rappaport, MD, the principle PM for the Microsoft Azyxxi Team, to fill a few big gaps in my EHR knowledge recently. Hank is a critical care specialist and has extensive experience building and maintaining electronic health records within the Department of Veterans Affairs, and now will do the same as a leader at Microsoft.
I sought Hank out originally because I wanted to learn more about what the Department of Veteran’s Affairs is doing with patient access to their highly regarded electronic health record. The Washington, DC, VA Hospital was a pilot site for the MyHealthEVet program, which allows those served in this system access to their medical records online. What’s special about the pilot sites is that they allow patients access to the entire record, without any filtering. This includes progress notes. More on that later.
Hank simulated access to both systems for me to get a sense of each systems’ strengths. Azyxxi was actually born at Washington Hospital Center, where Hank showed it to me, and is an excellent aggregator of clinical and other data, in a very accessible way. It seems to fill a niche that some electronic health records lack, which is a population view of data. The heritage of Azyxxi was the emergency room; at the same time, the utility is very relevant to primary care. With Microsoft supporting its future development, it should continue to add to innovation in health information technology. Of course, wearing my patient-centered hat, I thought there could be very interesting applications of this tool for patient access.
Following the tour in Washington Hospital Center, we walked across the way to the VA Washington to look at a simulated view of CPRS. The system is of course very capable (it lives up to its stellar reputation), specifically in the areas of order entry and decision support. It’s able to capture structured and unstructured text data, for example in progress notes. Like Azyxxi, I think there are rich areas for expansion for the system. The capabilities of this development team are different, though, and there are some changes being made in the way that the VA manages its health information technology.
There is currently not much interaction between the physician / staff view of the medical record and the patient view. However, it’s remarkable that patients have full access to their entire medical record, and has Hank indicated to me, this has not been a problem. I understand that the production (non-pilot) versions of MyHealthEVet do not have full patient access in them. In the meantime, I think the experience here in Washington deserves further attention in terms of its innovation.
I appreciate the value of the experience of seeing these two very competent systems a little closer.
Now, on to California and Heatlh2.0 to see some other cool stuff up close!
I like how the advertising is different here, and I pay attention to advertising because it says something about the people who live here, and what can I say, I like to live in a place where people make things happen. In Seattle, advertising is more lifestyle oriented. Here it is more policy oriented, and I snapped a few shots of my favorite car company who are apparently doing a metro station “domination” (that’s the word the execs use) at Union Station, much as Kaiser Permanente did a very nice domination of Powell Street BART over the holidays (with a very cool nod to Kaiser Permanente’s excellence in supporting diversity).
The fun part is figuring out what’s behind this and what policy issue might be up for grabs that would make Toyota want to impress their commitment to the U.S. economy at this time. If anyone in the know knows, feel free to post a comment.
I’m adding one photo of the brand new Harris Teeter that’s about to open in my neighborhood. Apparently artsy photos are popular among the DC Flickr crowd. It’s a Web2.0 thing I guess.
February 20th through February 22nd:
February 4th through February 6th:
(Image, Sun on Prospect Street | Source: WebMuseum, Paris)
I was last “strongly encouraged” to visit the works of Edward Hopper by my high school English teacher, when they were on display at the Phoenix Art Museum, almost 20 years ago. Now I go of my own free will, even in the era of the iPhone. The way I go is different though – going from piece to piece is like traveling between hyperlinks for me.
Of course, the real thing is nothing like the image a Web page. Even with dozens of people present, the original makes you melt.
The Edward Hopper Exhibition is on display at the National Gallery of Art through January 21, 2008.
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