Tomorrow I will be in Oakland, California, along with health care leaders from the California Heatlhcare Foundation, California Safety Net Organizations, National Leaders in Patient Online Access in the Safety Net, and other national leaders in the social aspect of the Internet for Americans to talk about patient online access in the health safety net. It promises to be a very interesting day, which I’ll post about here.

The referenced report is one of two recent studies on the impact of the Internet among Latinos in the United States, and among all Californians (next post). They are both timely and useful as we answer the question that I was asked many times while visiting Safety Net medical centers: “Are our patients online?”

Pew Hispanic Center Report: Hispanics and Health Care in the United States: Access, Information and Knowledge

This report describes research performed jointly by the Pew Hispanic Center and Robert Wood Johnson Foundation, and consisted of a bilingual telephone survey of a nationally represented samle of 4,013 Hispanic adults conducted from July - September, 2007.

Highlights from my review

• 27 % of Latinos report having no usual care provider, the rate is 42 % for those without insurance.According to the CDC, the proportion among Hispanics is more than double that of non-Hispanic whites and non-Hispanic blacks.
• Language differences are significant: 24 % are English dominant, 35 % are bilingual, 41 % are Spanish-dominant. This has significance with regard to the Internet….only 17% of Spanish-dominant Latinos receive health information from the Internet, compared to 53 % of their English-dominant peers. Interestingly, those of South American descent report a 51 % figure, higher than the figure for Puerto Rican (49%) and Mexico (31%).
• Fleshing the language issue a bit more: 40 percent of those who get health information from the television get it from Spanish-language stations. For those getting information from radio, 47 % rely on Spanish language radio stations
• Youth is a factor: 42 % of those aged 18-29 get health information from the Internet.
• Overall, 35% of Hispanics get their health information from the Internet, far behind television (68%), radio (40%), or a doctor (72%)
• Also of interest to me is in the demographics of this population, younger than their non-Hispanic cohorts, and with lower rates of chronic disease today (20 % with high blood pressure, compared to 22.4 % Non-Hispanic White, 31.6 % Non-Hispanic Black)
• And….in terms of health seeking, 41% said the reason they did not have a regular health provider was because they are seldom sick. The impact? Only 62 % of these individuals have had their blood pressure checked in the last 2 years.

What impressed me overall was the impact of language - it reinforces what I saw from my observations way back in November 2007:

Key health care leaders are saying the time for PHRs are now. Based on the Boston visit, I am saying the time for multilingual and culturally relevant PHRs is now.

Obviously, I still believe that, and this is why I am especially excited that one of the organizations presenting to us today is Cambridge Health Alliance (see information about my visits with CHA here), who have launched their personal health record to a population that is predominanly portuguese-speaking.

Without parity in access to quality health information, the concern is that the dependence on the in-person interaction with the health provider is greater for Spanish-dominant individuals than for English-dominant, and therefore the risk is greater that needed preventive care will not happen if they do not have a usual health care provider. The data appear to bear this out. It is worth thinking - if you did not have your blood pressure checked in the last 2 years, how would you be able to reassure your family about your ability to provide for them with a healthy heart? Should these individuals wait for their organs to be damaged, or should they have an equal chance at providing for themselves and their families with healthy hearts, brains, and kidneys? Thank you to the Pew Hispanic Center and Robert Wood Johnson Foundation for informing these questions.

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…

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?

• Building on a tradition of inclusion. Kaiser Permanente leader tapped for diversity award. - The combination of leadership in information technology, diversity, and member-centeredness is ideal for a health care professional (I’m projecting - it’s the ideal career for me :)); it's a powerful combination for an organization, as well. Congratulations, Kaiser Permanente.

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

I walked past this sign, welcoming people to Pomona College, in Claremont, California. As our profession thinks about broadening consumer health informatics to help more people (from diverse backgrounds and parts of our society), we should remember to share the added riches of our learning, experience, and ideas for improving health care in trust for mankind. More innovation happens when more is shared, not less. This includes what we did well with, and what mistakes we made.

• 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.

This is a community where there are visible reminders everywhere to recommit yourself to what’s important.

I just read that at the exit of the headquarters of the business maverick ING Direct National Bank, employees see a sign that says, “Did Today Really Matter?”

This is a nice analysis of solutions from the Family and Community Medicine Team at University of California, San Francisco, to support diversity in the health professions, which unfortunately have not yet reached levels comparable to the general population, especially in allopathic medicine.

There are two concepts that reinforce that this is not just an issue for health care, it is an issue for society, and the people and businesses that depend on a strong health care system:

The business case highlights the customer service and competitive advantages to the health industry of having a workforce that is culturally and linguistically attuned to the increasing diversity of the nation’s health care consumers.

and

A wide group of organizations—including the AAMC and other health professions educational organizations, higher education institutions, consumer groups, and Fortune 500 companies—contributed amicus briefs and other documents in support of the University of Michigan in Grutter v. Bolinger, signifying a more concerted effort to identify and organize stakeholders interested in supporting diversity efforts.

Many physicians, myself included, work in the most downstream parts of this ecosystem, and it’s therefore helpful to consider that there are places we can be to create a more effective care system for everyone. From my travels to date, it’s clear to me that these are worthy investments of my physician colleagues’ expertise. None of us enjoy waking up to a world where the quality of health care is dependent on things other than the fact that you are a human being.

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.