• Sheraton Palace Picketing — Palace Hotel and Hall of Justice - As I sit here working to design a pilot for connecting Californians with chronic illness to their personal health information. It's incredible to walk these halls and think about what happened here 44 years ago. Now, we're doing the same work, in the digital sphere. Every patient deserves to have online access to their care system, insured or not.

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.

• Many Women Struggle With Uncontrolled Blood Pressure - Yahoo! News - American Heart Association is working to connect women to greater awareness of the impact of hypertension.

"Nickel and Dimed: On (Not) Getting By in America" (Barbara Ehrenreich)

Last week, I was walking with one of my patient-centered mentors, David Sobel, MD, through one of my favorite museums in Washington, DC., The National Portrait Gallery. As I brought him to one of my favorite pieces, I asked him if he read this book, and he told me it was one of the most influential books he’s read. “Have you gotten to the Wal-Mart section yet?” he asked. I have, and I have to say I agree with his assessment.

This book preceded a more modern version of living among the corporate natives which I reviewed previously, Punching In, by Alex Frankel. Unlike Alex Frankel’s adventure, Barbara Ehrenrich goes completely native, adopting the lifestyle of a minimum wage worker, down to eating, living, and surviving (or attempting to) in several different American cities. Her jobs include being a server in several restaurants, a house cleaner for a large national franchise, and a stint in retail.

We learn some realities of these jobs - it’s never really okay to not always be doing something, even if there’s nothing to do. One of her places of employment calls this “time theft.” So there’s a constant flow to the work, some of it useful, some of it not. The profiles of her coworkers describes the conditions that the working poor must accept - not having first month’s rent and deposit may mean spending $60 a night in a motel, an irrational yet necessary way to survive. The quality of life that Ms. Ehrenrich accepts for her assignment is concerning bordering on dangerous - a single woman in an efficiency with no screen on the window on the ground floor.

As I read this with an interest in employer-based health, I also learned a lot.

Read the rest of this entry »

• Aggressive medical care, conservative vs aggressive - Nice XPlane (xplane.com - one of my favorite design groups) produced images of regional differences in health care costs, from Consumer Reports. It's helpful to see this group champion appropriate care for patients.

This photograph was taken on the National Mall, at an event celebrating the 60th Anniversary of the birth of the State of Israel. The women in the picture are tracing the roots of their family across the globe, along with other attendees.

I learned at the event that I am here because of Operation “Ezra & Nehemiah” - a massive, emergency airlift of 125,000 Jews from their homes in Iraq in 1950-1951, to the only country that would accept them. My parents were a part of that airlift, and eventually emigrated to the United States, where I was born.

My life experience as a social/cultural minority has, in a great way, connected me to people and ideas that I think I wouldn’t have appreciated otherwise. I am always drawn to stories about people, of all backgrounds, finding their home and belonging, whether it’s in their health care, or where they live and work.

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

Just Looking: Consumer Use of the Internet to Manage Care - CHCF.org - Report from California Healthcare Foundation on consumer use of the internet. Note use by the uninsured, which tracks other data, showing that this population is online in respectable numbers. In addition, 54 % of those with high school education or less use the Internet to find information about specific medical conditions/prescription drugs. I think a nice proxy for Internet use is the use of online banking, since there’s a component of “convenience” and “confidence” in using these services. A recent analysis of online banking use shows similar results. As the CHCF report says:

These segments of the public likely have the greatest need for information that can help them manage their health, particularly in the case of the uninsured, who many not have regular access to health care.

In my work studying LEAN, I used to put “I see many correlations to clinical practice” on every blog post about another industry’s success in being customer centric in ways that we could learn from, kind of skipped-CD like. For this issue, I’d like to say, “the data demonstrates that every patient in every care system deserves to have this access.” To not provide patient access in HIT installations that serve these populations is the same as reducing access of 40 % of those patients to useful information for them (and their families) to be involved in their care.

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.

• Employers Find Benefits with PHRs - More info about EMC and its employee PHR
• News - - Gainesville.com: Dean admits student without backing - It’s interesting that this is posted in the entertainment section. That aside, this looks concerning. I don’t understand how a student is admitted to medical school on a personal recommendation, and without taking the MCAT. How will we have a diverse medi
• Event Calendar - A way to put upcoming events on a wordpress blog
• TimeDriver - Coming Soon! A revolutionary online personal appointment scheduler - A very high potential meeting scheduling package. Given that Timebridge only allows 5 slots to be determined, this looks very interesting.
• GE Healthcare-Press Release-NCHL and GE’s Institute for Transformational Leadership - I didn’t know about GE’s work in this area. It looks like they are doing work in LEAN as well as Six-Sigma, which they are known for.
• Report cites UA med school crisis | www.azstarnet.com ® - Sad news from my alma mater, related to the difficulties medical schools are having balancing revenue and their mission.
• D.C. Not-for-Profit Offers Model for IT Adoption - iHealthBeat - More progress in DCPCA’s EHR adoption efforts
• Burlington Free Press.com | Fletcher Allen’s new EHR - Fletcher Allen in Vermont gets approval to go ahead. I believe this is an Epic Systems install, bringing with it the possibility for excellent patient engagement with their health system as a result.
• Database Problem with Office 2008 for Mac - Office 2008 Install problems, just in case

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