Just Read: Syllabus for “Transgender Care at Group Health” Continuing Medical Education Course – Feb. 2016

Thanks to colleague Rosemary Agostini, MD, for sending this on to me.

And this is why Group Health (@GroupHealth) is a magical health system of the future – being excellent for some is not good enough, and understanding that every health issue benefits from coordinated care:

About the Course
In recent years, the transgender community’s visibility has increased both locally and nationally. However, Group Health’s delivery of essential health care services to our transgen- der patients has been fragmented. Through this CME, we hope to begin formalizing transgender care within our care delivery system. is CME will focus on the transgen- der community and their unique health care needs; services available to help providers evaluate and treat transgender patients; the integral roles of mental health, medical, and case management strategies in transgender health care; and networking within Group Health to identify col- leagues who can help coordinate the care of this group of patients.

Equality Equals Health, and for this population, great health care promotes equality. We saw the future clearly during the KP Lantern project, which was that a prevention-oriented, coordinated care approach, would allow us to deliver great outcomes that are affordable for our members, but more importantly, life and health sustaining for the people we serve.

We’re excited for Group Health to experience this reality as well.

Any provider may register this program, as well as for the 2016 Kaiser Permanente first annual national LGBTQ Health Symposium, which will be held in Universal City, in May 2016. We’ll be featuring Harvey Makadon, MD, from the iconic Fenway Health, and Gail Knudson, MD, from the iconic Vancouver Coastal Health and WPATH, which she is currently President of.

Sharing imaging results online with patients: Data from Group Health Cooperative

This post is a tad bit belated (compared to when I received the information, not compared to health care having this experience, it’s way ahead of it’s time there), however I think the data is useful. Now that Group Health Cooperative (@GroupHealth) has been sharing imaging results online with patents for about 15 months now (See: What Group Health Physicians are saying about sharing imaging test results with patients – 1 year later | Ted Eytan, MD), the question came up:

What percent of the studies that are shared online with patients are actually read online by patients?

This question is asked because if physicians are anxious/concerned about receiving more communication (email/phone/in person) about these studies and they know that they are mostly being read by patients and phone calls/emails are not going up, this is reassuring beyond the reassurance that patients are active participants in their care.

And the answer is: for patients who are registered for access to MyGroupHealth (about 62% currently), 2/3rds of results are read by the patient.

		% potentially
		viewed % reviewed
	CT  		53% 	67%
	Fluoro* 	76% 	92%
	MRI 		65% 	76%
	Nuc Med 	93% 	54%
	U/S 		65% 	64%
	PET* 	100% 	75%
	Total: 		64% 	69%
	X-Ray 		67% 	67%
	Mammo 		67% 	65%
	Dexa 		75% 	80%
	Total: 		67% 	67%
	Overall: 	66% 	67%

* Not enough volume to accurately judge

So, 62% of the adult membership of Group Health Cooperative is signed up to use the MyGroupHealth portal, of those who are signed up and have an imaging study, about 2/3rds go online to review the result. That’s impressive. Theoretical focus group studies have shown that patients want to know (see: Now Reading: Patients want their radiology test results | Ted Eytan, MD). This experience shows that the studies aren’t theory.

Thanks to John Kaschko, MD, for providing this information and allowing me to share it.

Photo Friday: If you’re not at least nervous, it’s not courage

As the title of the post says. These signs were part of the innovative and colorful opening of the 3rd and last session of 2012’s Medicine and Management Course, for the first time in its history, hosted by Group Health Cooperative ( @GroupHealth ) , in Seattle, WA. (See: Does your physician know how to lead? A view into the Kaiser Permanente / Group Health Physicians Medicine and Management Program | Ted Eytan, MD)

This is a health system where people are nervous – about how to serve the greatest number of people with the best service and best quality. I have been here as part of the faculty for the course and I can say that they worry about things that our society expects physicians to worry about – supporting a healthy community and society. Their results show it – Group Health Medicare Coverage Ranked In Top 10 Nationally | Group Health Innovates.

The signs were a reminder to keep leading, on the challenging days and on the best days for this member-governed health system of the future. I still think it’s magical. And not just because they trained me :).

Here are some more signs from the journey and reasons to admire what’s being done here:

In his welcome, Executive Medical Director Michael Soman, MD, said to us, “In 1947, a few patients hired a few doctors, because they were fed up with ‘piecemeal’ medicine.”

Thanks for being nervous, courageous, and for being great hosts and teachers to those physicians and the generations that came after them.

Reaching people through the language of sports: shadowing Rosemary Agostini, MD, Group Health Cooperative

Rosemary Agostini, MD, Service Line Chief, Activity, Sports, and Exercise Medicine, Group Health Cooperative View on Flickr.com

Watching Rosemary Agostini, MD, the Service Line Chief of the Activity, Sports, and Exercise Medicine (ASEM) Department of Group Health Cooperative (@GroupHealth) reminded me of why I like shadowing so much. 

At some level, you can never really know someone until you observe them doing something they are passionate about. It would be kind of like knowing an elite athlete socially but never having seen them play their sport.

Yesterday I got the opportunity to watch Rosemary practice at the new Group Health Cooperative Bellevue Specialty Center in Bellevue, Washington. This facility was just a twinkle in the eye of Group Health when I left Seattle (well, it was like 50% built).

There’s a lot that’s new here, including the Activity, Sports, and Exercise Medicine Department, which Rosemary started. She explained to me that what’s unique about ASEM is that it is not part of another Department like it is in other health systems – it is own entity, set up to support the musculoskeletal health of a whole population. (See: Q&A With Dr. Rosemary Agostini)

Rosemary is Board Certified in both Family Medicine and Sports Medicine, and integrates the two specialties into her care, which also incorporates the latest health information technology to connect with patients (“When I email patients, I ask how they are doing as people as well as how their bodies are.”).

One of her hallmarks, she told me, is that she communicates with her patients in the language of their sports, from teens to seniors. She has learned to do this in the 30 years of her medical practice, often on the sidelines of a high school football field. “Everyone else looked at the cameras and scoreboard, I watched people move,” she said.

I had to ask why she developed this approach, and she told me it’s because she learned early in her practice that when she began to talk to athletes about their sport activities, she could connect in ways with them that she could not as a traditional physician. For her, this is a way to reach the sometimes unreachable, or to listen to people who sometimes aren’t heard. This reminds me a lot of the work of one of my other favorite physician innovators, Brigid McCaw, MD (@BrigidMcCaw) (See: Giving the voiceless a voice using social media, family violence prevention, and a walk with Brigid McCaw, MD | Ted Eytan, MD). Isn’t it interesting that some of the greatest innovation I see in medicine involves better listening to people, rather than doing more things to people…

Compassionate Concussion Care

Rosemary’s other passion is managing concussion, which is now recognized as a life threatening brain injury. She told me about Washington State’s Zackery Lystedt law, whose namesake, a 17 year-old nearly lost his life on the football field (See: Dr Stanley Herring – Zackery Lystedt – Lystedt Law). She sets up Statewide video conferences to teach Group Health Physicians how to manage concussions and creates tools in Group Health’s comprehensive Electronic Health Record to help physicians and patients (and their families) heal from concussion.

She showed me one of the tools she provides to patients and families as part of concussion evaluations, embedded in the Group Health EHR. There are lots of all caps words, including the sentence:

“Your BRAIN has been INJURED. Your BRAIN is essential to your whole life!”

If you read Zackery’s story or think about your own life experience, you know that there are so many forces pushing young adults and their families to forgo a healthy life (or even a life at all) in the hope of greater life success. The Lystedt law was passed to keep children alive, and from watching Rosemary practice, I can tell that it is an important role for a physician in practice (and in society) to be a force for prevention and health as part of this goal. She is definitely that force for prevention – while I was waiting to meet her in the morning, I noticed on the metrics on the wall that she provides after visit summaries for nearly 100 % of her patients. 

Musculoskeletal Health is part of Total Health

I came to see Rosemary because of my interest in walking and physicians walking with patients. I learned that this is a part of an overall commitment to musculoskeletal health. Rosemary’s patients, who are ultimately the teachers, (and who consented to me observing me their visits), showed the diversity of ways that musculoskeletal health is related to overall total health – everything from the minor to the heartbreaking. I got to see her listen to their stories in the language of their activity while gently and continuously promoting the safe pursuit of what she at one point said are the “zillion reasons that physical activity is good for you.”

Rosemary and Ginny Sugimoto, MD are setting up a program at Group Health Cooperative that involves physicians, members, and community leaders, including Seattle Police and Fire Departments. We share the same interest and passion for activity, and I think this is one of the most important things the medical profession will contribute to society in the next many years – promoting the activity of the human race. She shared the kit that participants are given as part of the Group Health “Walk and Talk” program. See the photos below (note the GHC / SPD partnership on the ball cap).

I am here this week as part of physician leadership history in the making – it is the first time Group Health Cooperative / Group Health Physicians are hosting the Permanente Medicine and Management Program. Twitter hashtag will be #GHMM12. In the meantime, thank you, Group Health members, staff, and Rosemary Agostini, MD for allowing me to spend time amongst the hailstorm of innovation happening here.

Does your physician know how to lead? A view into the Kaiser Permanente / Group Health Physicians Medicine and Management Program

Interviewing “Pat Permanente, MD” – will he succeed in our medical group? – a Kaiser Permanente Care Actor View on Flickr

It’s hard to become a Permanente physician. It’s difficult to stay a Permanente physician, if you are not prepared to be a healer, leader, and partner.

Fortunately, there are programs like Medicine and Management, designed to train 40-50 Permanente physicians from the Hawaii Permanente Medical Group, Northwest Permanente Medical Group, Group Health Physicians, Colorado Permanente Medical Group, Ohio Permanente Medical Group, and The Southeast Permanente Medical Group (@TSPMG) , in advanced topics in physician leadership.

The course is taught in 3 sessions. I just returned from the second session, hosted by the Colorado Permanente Medical Group. This session included a focus on recruiting and retaining the best physicians. In our health system, this is not a task that is taken lightly. Physicians are actively involved in deciding the fit of a physician candidate in our groups. Training in a top notch medical school and residency is not a guarantee of an offer being extended to take care of Kaiser Permanente members. In some cases, physicians will fly to observe surgeon candidates in the operating room.

To know how to recruit well, we have to be trained – this is not something that’s taught in medical school or residency. I loved the technique used this time – Kaiser Permanente care actors were brought in to adopt the roles of “Kim Kaiser, MD” and “Pat Permanente, MD,” both with top notch educational credentials, but with (very) different approaches to working as part of teams and being there for patients.

The care actors are part of the Kaiser Permanente Educational Theatre Program . I thought they were a brilliant use of this group. Following each interview session, the actors stepped out of their roles and critiqued the physician leaders about their approach and offered suggestions as well as compliments.

You can’t have a health system if you don’t have clinical leadership, and you can’t have clinical leadership unless you have training in its art and science. In this program, the training comes from the senior most leaders in each medical group, and Jack Cochran, MD (@JackHCochran), the Executive Director of The Permanente Federation (where I work).

I went through this program myself when I was a Group Health physician, and it was transformational. It allowed me to reach beyond knowing what the right things to do for/with patients were, to shaping a whole system to do those things every day, and not just for our patients, for every patient in every health system. Imagine that happening every year for 10+ years for 40-50 physicians and the impact adds up very quickly. And…the program is coming full circle for me, because in 2012, Group Health Physicians and Group Health Cooperative (@GroupHealth) are going to host session 3, for the very first time. See everyone in Seattle!

Photos below, including a birthday celebration for Jeffrey Grice, MD (@jeffreygrice) – Happy Birthday Jeffrey!

Presentation: 4 ½ Reasons WHY : Social Media for Physicians in Integrated Care Delivery – Ignite format

This is the second presentation I gave on social media last week. The first audience was interested in the “how,” this audience is interested in the “why”. (see: What does social media mean, in an integrated care system? A conversation at @KPGarfield | Ted Eytan, MD)

This audience is 42 physicians, in their leadership journey, from 6 Permanente Medical Groups (Hawaii Permanente Medical Group, Northwest Permanente Medical Group, Group Health Physicians, Colorado Permanente Medical Group, The Southeast Permanente Medical Group, and Ohio Permanente Medical Group). I’ll post on this leadership program separately.

And….I can’t believe it but I actually decided to do this in Ignite format. The disbelief is because I recall how challenging the Ignite format was for me when I first did it (see: Slides, Script, References, Photos, from my #ONCmeeting Ignite Talk – Acceleration and Tipping points – Consumer E-Health | Ted Eytan, MD). This time it was easier….and it was right for this discussion. Following the presentation I was asked more about the format, which none of the physicians had heard of. A little diffusion of innovation on top of diffusion of innovation.

My attempt to record a video of me giving the talk didn’t work out, so I’ve closed captioned the YouTube video of the slides above (just hit the “cc” button), and/or you can access the slideshare + the script as well as sources of the data (for an Ignite, you typically want the source information separate, to keep the slides clean). Let me know what you think.

The YouTube is timed at 5 seconds per slide instead of 15 seconds, to accommodate the attention-deficit web/mobile viewer of the content.


Washington, DC, is the most social city in the United States. It’s the most walkable city in the US, it’s compact, and it’s a place with shared challenges and leadership in society. We can’t vote like residents of other states; however, we’ve had marriage equality since 2010. It’s a great place to understand the “why” of social networking, with information that I’d like to share with you about why it’s important to us as physicians in an integrated, non-profit, care delivery system.

This is where my “why” started, in 2005, when I was helping to lead a statewide EHR/PHR project. I needed to use social media because it was the only way to communicate authentically, honestly, and frequently during a time of immense change.

Reason 1. We value communication. The ways people are communicating is changing.

Look at 2005: Just 7 years ago, very few people were using social networking sites, even among people aged less than 30 years old.

Now, look at the generation after Generation Y. If you ask teens how they communicate with their friends, they cite text as most common way they communicate with friends. Social networks are #2, in person is #3.

At the same time, their FAVORITE way of communication is in person, followed by text, followed by social networks. In person will always be valuable. Think about social networking as an ADDITIONAL method to all of the ways you will need to communicate as a colleague and as a physician with the people you serve.

This is what I hear from our patients today, like Mackenzie Marsh, who’s pictured here. She told me, “social networking does not replace the way I communicate. I talk with people in person, on the phone, in text, over facebook, all at the same time.”

This brings us to reason #2. We want to be there for our patients (and they want to be there for us).

If you look at the data from 2002 to 2011, health professionals are still the #1 place that people go to get health information. Notice, this percentage hasn’t gotten lower since 2002.

The data is even more significant for caregivers, 78% of them cite health professionals as the most common place they go to get health information.

Reason #3: We came here to change the world. I took this photograph at the AIDS Quilt display in Washington, DC, the first time the quilt has been shown there since 1992.

There are so many stories like this, during a time when the medical profession was not as compassionate as it could have been – causing people to ask “why?” about the death of their loved one.

Our ancestors, at Kaiser Permanente and Group Health Cooperative, wanted our organizations to demonstrate a replicable model, that gave people the choice to practice medicine in a higher quality, more compassionate way. We want to continue this tradition.

At Kaiser Permanente, this is not the case. We made an announcement in 2012 with the White House that we have eliminated disparities in care for HIV/AIDS patients. You don’t have to be white, Black, Latino, straight, gay, female or male, to achieve comparable outcomes at Kaiser Permanente. We have posted the HIV challenge online because other care providers and health systems should have this option (and really, a requirement) to eliminate disparities, too.

This is my blog post about that announcement. I blog because I want people to know that there is a voice for change, that we don’t have to do things the same way they have always been done. When I was in training, there was NO voice that I could turn to to understand that what was going on in my environment was not right, that the profession was not behaving professionally. I use social media to hopefully be that voice for others.

This is reason #4. Play at http://youtu.be/_vwxL59tWhc

Our ancestors led the way before anyone else did in thinking about environmental causes of good or poor health. Sidney Garfield recognized the benefit of sunlight for healing (the photograph on the right is called “sun bath”). Today, we are still thinking about the determinants of health beyond health care. We want physicians’ work to not be defeated by the environment, at Kaiser Permanente and beyond.

We have an amazing culture here, that allows us to innovate, and tell the world about it. People know that I’m passionate about walking meetings, and I can use social media to talk about the benefits and get feedback on what this means for others.

The ½ reason is that our leaders want us to. Bill Marsh, MD, is interested in exploring the lives of our patients beyond their health care through social media. We recently hosted the Permanente Executive Leadership Summit, with its own social network. This allowed 300 of leaders at Kaiser Permanente and the top health systems in the United States (and world) to engage in frequent, informal, small bits of communication + LISTENING, which is what social media ultimately is – listening.

With those why’s, it’s easy to see why you can find me here, here, here, here, here, and here. Glad you’re going to join me.

Sources of the data used above