Posts Tagged ‘health2.0’

Patient-Physician Communication: My Video Interview on The Doctor’s Channel

January 7th, 2010 | Popularity: 5%
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I am relatively camera shy (which is why I take the photos), however, David Best, MD, asked if I would embed The Doctor’s Channel Video I did at Boston’s Health 2.0 in 2009, so here it is. I think David’s team did a nice job highlighting the most salient pieces of information. Also, this was my first time really speaking about Kaiser Permanente’s accomplishments (which were achieved by a lot of other terrific people) in my new role, I hope I did okay! See what you think.

HealthCamp SFBay – October 5, 2009 – Come Join Us!

August 5th, 2009 | Popularity: 11%
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Dear The Internet,

I wanted to give you the heads-up on a dynamic event in early October you may want to attend: The Accelerating Health Care Innovation “unconference” at the Kaiser Permanente Garfield Innovation Center near the Oakland airport.

Hosted by HealthCamp SFBay, Health 2.0 Accelerator and Kaiser Permanente, the event is 10 a.m. to 5 p.m. on Monday October 5, the day before the Health 2.0 Conference in San Francisco.

Accelerating Health Care Innovation is an “unconference” where peers in health care and technology introduce topics they want to present and discuss with the goal of advancing innovation of strategic, technical solutions in health care.

Among the participants and speakers are Dr. Kaveh Safavi, Cisco’s Vice President and Global Lead for Healthcare and Dr. Jack Cochran, Executive Director of The Permanente Federation.

Details & Background

HealthCamp SFBay is a gathering of software developers, technologists, doctors, nurses, innovators, designers and health care technology media who come together to talk about health care innovations.

Health 2.0 Accelerator is a consortium of Health 2.0 companies working together to advance consumer-centric health care by driving the integration of technology and the consumer experience.

The Kaiser Permanente Garfield Health Care Innovation Center (kp.org/innovationcenter) is the only setting of its kind where technologists, architects, nurses, doctors and patients collaborate to spawn innovation, brainstorm and test tools and programs for patient-centered care in mock hospital, clinic and home environments.

For a peek inside the Garfield Center, check out the audio and photographic slideshow CNET recently posted about it:

http://news.cnet.com/8301-11386_3-10265074-76.html?tag=newsEditorsPicksArea.0

Because the Accelerating Health Care Innovation event will sell-out due to limited tickets, early registration is recommended:

http://healthcampsfbay.eventbrite.com/

Free shuttles from BART are provided with details on the registration site.

Sidney R.Garfield Health Care Innovation Center
590 Whitney Street
San Leandro, CA 94577

I’ll see you there!

Best regards,

Ted

A special report on health care and technology: Health 2.0 | The Economist

April 27th, 2009 | Popularity: 13%
1 comment

Now Reading: Know Your Numbers, Outlive your Diabetes, by Richard Jackson, MD and Amy Tenderich

January 5th, 2009 | Popularity: 28%
3 comments

For the last several months, at least since Amy Tenderich, Jane Sarasohn-Kahn, and I served on a panel for the California Commonwealth Club, when people have suggested I read this book or that book, I have said, “Amy Tenderich’s book is at the top of my list, that’s what I’m reading next.”

And I stuck to that promise.

Why? The medical literature I read usually talks about patients (people) in the abstract/third person, which is great for focusing on the science (sort of, I’m not sure anymore), but maybe not the art. That and the fact that before Amy, Jane, and I went on stage, I noticed that Amy checked her blood glucose and had a protein bar ready to go in preparation for our hour-long discussion. There are things I am not going to understand about patients’ health experiences if I don’t listen to their experiences to start with.

I decided to combine the reading of this book with 2 experiments for myself. One, to use Twitter to write notes to myself about the book, two, to complete a board certification module for my specialty (Family Medicine) after reading the book. For the first experiment, there’s a good record of the first several chapters here. Part way through I thought that this was probably not as relevant to people following my Twitter feed as me, so I stopped. I would do it again, though, because the notes are helpful, maybe from a different account.

As you can tell from the linked notes on Twitter, I enjoyed the book and think it added a lot to my knowledge. Believe it or not, there are some details about some of the things we do as doctors that are not really explained to us except in the experiential part of doing what we do, such as how to organize the care of a condition, from the big picture. The authors laid that out extremely well using the diabetes health account concept. Diabetes was never taught to me that way – it was kind of a jumble of all the different diseases a patient can get and how to prevent them, not about how to organize and focus efforts. Leave it to a patient to do that because they don’t just have to tolerate having these conditions – they live with them.

I also noticed that a book written for and by patients doesn’t start with pharmaceutical therapy, it starts with knowledge, which may be the opposite way health care thinks about approaching condition management. I have to further celebrate Amy’s approach to thinking about diabetes in non-militaristic terms. The war analogy is pervasive in health care management (“front line staff,” “triage”) and I think it sets up the wrong type of relationship behavior with patients behind the scenes. It is great to see a patient confirm from their experience that it sets up the wrong type of relationship behavior with their condition:

People often refer to experience with a disease as a battle, such as “her battle with cancer..”…We think think this reference is wholly inappropriate for diabetes – one of the few chronic diseases with which patients have the power to both feel physically well day to day, and to live a long and healthy life….If you think of your diabetes as a battle, you’ll always be stuck in a miserable war. Make peace with your diabetes, and you’ll be at peace with yourself.

(let’s also stop using battlefield terms behind the scenes, we are not at war with patients, we are at peace with them)

As helpful as this book is, I think there’s great potential for a sequel (with Amy’s perspective). There’s new information about the value of home blood pressure monitoring, and new ways to check for retinopathy that don’t require a trip to the eye doctor. In addition, there’s now information about some of the newer drugs mentioned that may cause their harms to be underemphasized in the book. And I think Amy would be well suited to expand on some of the Web tools that are out there, including her very own, Diabetes Mine, and how they are helpful, from the patient perspective.

These are minor critiques, and actually not critiques of Amy, because it’s the job of doctors to have the most up-to-date information (and provide it to patients) in actual health care experiences. This brings me to a closing thought, which is that reading about the work of Amy and other leaders like her makes it clear that Health2.0 is not about shifting the power away from anyone, it is more about valuing the contribution of each role. As Amy and I discovered after our talk at the Commonwealth club (“you mean, you didn’t know the answer to that question either?”), neither of us is the true expert on everything, but we are both necessary, and I think it’s very valuable for a health professional to know how necessary the patient is by listening to their experiences.

Now that Amy has done a great job (truly!) in making it clear what someone with diabetes needs to focus on most, my follow-up is to look at some of the online tools available to help with that. Amy’s approach seems to lend itself well to a tool for health that’s as straightforward as mint.com is for finances. I will write on that in a future blog post.


Health 2.0 Through the Eyes of a Diabetic – One Year Later – ReadWriteWeb

November 30th, 2008 | Popularity: 17%
2 comments
  • Health 2.0 Through the Eyes of a Diabetic – One Year Later – ReadWriteWeb – A patient talks about his diabetes and what he did or didn't use Health2.0-wise. Are there good tools to consolidate information that patients with diabetes need to manage their health? I am especially interested this as I am reading Amy Tenderich’s book right now. Is there a place that is set up to manage the main pieces of data as Amy describes? I need to finish the book and not offer solutions….I’m interested, though, at this point.

Now Reading: Are You Listening…Are You Really Listening? (it’s the killer app for Health 2.0)

November 2nd, 2008 | Popularity: 26%
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This paper stands up really well on its own as a call to action around listening to patients and their families. It does a nice job of discussing the contribution of communication (or lack thereof) to a safe care experience, with some great quotes included, like this one, attributed to Julie Ann Morath, RN, MS, COO of Children’s Hospital and Clinics of Minnesota:

When you listen, it’s a demonstration of respect, and listening in itself is a healing practice.

The data presented are dramatic : in 77 % of patient/physician interviews, the patient’s true reason for visiting was never elicited. Patients are “redirected” by physicians on average, within 23 seconds.

This is also the hook for Web2.0/Health2.0 because what technology does is allow people to be heard, relative to their Web1.0/Health1.0 counterparts, and this is the action that the authors did not write about:

Actions that CMIO’s/CIO’s can take.

In that section, they would advise these leaders to consider carefully who the customer of their newly funded (maybe legally mandated) electronic health record is.

When they decide that the ultimate customer of the electronic health record is the patient, they would allow access to all of the information about that patient to themselves and those that care for them, privately, securely on line, inpatient or outpatient.

How does a personal health record promote listening?

When care providers open their electronic doors to questions about care, or questions about anything based on facts in their care that they can now access, listening becomes less of a choice – patients will ask questions about what they see and we’ll want to make sure they understand what we’re presenting to them in their electronic health records. This is what my colleague at Kaiser Permanente, Mark Snyder, MD, describes when he says the printed After Visit Summary “is a process, not a souvenir.” I wrote an example of this process here – I like that it gives you no option but to listen.

I found myself agreeing with a lot of the ideas written here, especially the one that the patient and their family are one of the most powerful barriers to harm in health care. The authors state it here:

“The hospital’s deepest resource of care information is patients and their families; this is because these people have the ability to share core root cause information, from symptom to outcome, that can drive the quality and safety of care in hospitals.”

And I said it almost exactly the same way in this month’s AHRQ Web M&M Spotlight Case.

Toward the end of the article, the authors write that this is not another paper that should collect dust on the shelve of a few “Safety Geeks.” Based on what I’ve been doing and what I saw most recently at the Health 2.0 conference, I can be reassuring that there are a whole lot of Geeks out there working to make listening happen. Come join us!

“Lots of General Stores, No Channels and Brands,” A Look at HealthShoppr.com

October 29th, 2008 | Popularity: 18%
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Part of the fun of the Health 2.0 Conference last week was meeting people who I have blogged or Twittered with, and one of those individuals is Vijay Goel, MD. The blog that Vijay runs is Consumer Focused Healthcare and he Twitters as vijaygoel. He told me at Health 2.0 that he agrees with some of the content on my blog, which only made me more interested. Vijay has a pretty extensive background in strategic health care consulting and I always want to learn more…

So Vijay gave me a tour of the alpha of HealthShoppr.com yesterday. It’s billed as the “Expedia of health services” and a limited launch is happening in a few weeks. Many of the concepts resonate with me after having read some of Clayton Christensen’s work, that there’s a role for supporting “long tail choice” – or specific kinds of health services, rather than going to a global solution provider in health care. The other significant feature of HealthShoppr is that it is disconnected from the traditional reimbursement system. HealthShoppr is starting with complementary health services like Massage, and will give consumers the opportunity to choose the type of service they want, book it, and pay for it, online.

It seems like starting with complimentary healing arts is a good choice, and it’s nice to see/know that physicians are engaged in changing the health system from all angles. In the future, there could be information flow along with the reimbursement flow in a system like this. It would be more natural for a provider to want to transfer clinical data to a referring or referral provider, to keep the satisfaction scores high. Take a look when it launches and see what you think….

.::. ISIS – Internet Sexuality Information Services .::.

October 27th, 2008 | Popularity: 11%
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“I’m Glad You Were Here….” at the Commonwealth Club

October 22nd, 2008 | Popularity: 26%
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On the day before the Health2.0 Conference began, I was delighted to sit on a panel about “Health 2.0″ with experts Jane Sarasohn-Kahn, who operates the Health Populi blog, and Amy Tenderich, who operates Diabetes Mine , a resource for patients, both thought leaders in Health 2.0. The panel was moderated by Sarah Varney, who is well known on her work for the California Report.

The quote in the title of the post was the comment that I made to Amy afterward, at which point she made the exact same comment back to me. I knew a little about The Commonwealth Club from their About page..

The Commonwealth Club of California is the nation’s oldest and largest public affairs forum, bringing together its more than 18,000 members for over 400 annual events on topics ranging across politics, culture, society and the economy.

Founded in 1903, The Commonwealth Club has played host to a diverse and distinctive array of speakers, from Teddy Roosevelt in 1911 to Erin Brockovich in 2001. Along the way, Martin Luther King, Ronald Reagan, Bill Clinton and Bill Gates have all given landmark speeches at The Club.

..and as I walked to the studio, I actually said to myself, “Jane and Amy will be there with me, they will make sure this goes smoothly – they’re the experts.” This is because of the scope of the audience (unknown, in person and on the radio) and the questions, based on Sarah’s experience and audience interests, could be anything. As I am still gaining comfort with the size of Kaiser Permanente’s reach in this area (this will be an ongoing theme for quite awhile), both aspects of the situation made me less uncomfortable because of Amy and Jane’s presence. And sure enough, their experience and knowledge in the industry and among patients is significant.

I was surprised to hear Amy and Jane echo the same sentiments to me that I had in my mind. My conclusion – we need each other, and isn’t that a metaphor for health care.

Thanks again to the sponsors of this event, the California Healthcare Foundation for bringing us together to learn this, live, in front of Californians.

The show is scheduled to be broadcast on KLIV on November 6. I’ll post a link when it’s available.

Revolution Health: Heralding the Demise of "Health 2.0"? | Trusted.MD Network

September 18th, 2008 | Popularity: 29%
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Revolution Health: Heralding the Demise of “Health 2.0″? | Trusted.MD Network

Is Health 2.0 in demise or not?

This is an opinion column followed by a lively discussion, including a comment from Matthew Holt.

My comment: I don’t think it is .

Why? Because Health 2.0 is not a company. It’s not a person. It’s a different way of thinking about health, and it’s a way that’s being thought of by many people who are disappointed in Health 1.0. As Susannah Fox said, “When over 80 % of people are online, the horse is out of the barn.”

People are interested in Health 2.0 (me included) because they want patients to win, where they are not winning in Health 1.0 (look at the data around hypertension management).

The challenge of commentary that is of the demise-prediction variety in the case of the Internet/Web2.0/Health2.0 is that it reads as anti-patient, and I don’t think our profession is anti-patient or wants to be perceived as anti-patient.

As I have mentioned previously, I think it’s a better place for us to listen to what people are actually doing, do it with them, and help them leverage it for their health. Companies will come and go; people’s desire to achieve their life goals will be a constant.

EKIVE – Thoughts and Ideas as Web 2.0 meets the Enterprise: HealthCampDc – looking back and looking forward

September 15th, 2008 | Popularity: 16%
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EKIVE – Thoughts and Ideas as Web 2.0 meets the Enterprise: HealthCampDc – looking back and looking forward

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.

Life as a Healthcare CIO: Cool Technology of the Week: iPod Touch, Underdog companion to iPhone

September 12th, 2008 | Popularity: 22%
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From John Halamka, MD’s blog:

Life as a Healthcare CIO: Cool Technology of the Week

I totally agree that the iPod Touch is the underdog device. I actually got the hint of this from several people at once, including ePatient Dave, that they could enjoy the goodness of the iPhone ecosystem without switching carriers. In addition, an organization could deploy these and “own” all the connections without dealing with a wireless carrier.

I was a little worried a few weeks ago when John talked about his Berry-philicity, but now I’m at ease knowing that the magic i-device of the future has a spot in his heart and in his innovation-leading mind.

Photo Friday: Whoever Comes are the Right People – HealthCampDC

September 12th, 2008 | Popularity: 17%
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HealthCampDC - 21

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?

Awesome. Advertising in health care that promotes participation.

August 14th, 2008 | Popularity: 16%
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  • “we gotta stay positive”

    From HelloHealth. No promises of perfection, fancy tests, or excessive procedures. It says, “we’ll listen.”

    I think it’s too bad that the MTA shut it down (MTA Bursts Thought-Bubble Subway Poster Campaign). People have a lot to say about their health – this shows that they aren’t being listened to. Why don’t we shut down ad campaigns for unecessary medical tests and procedures? Just something to think about.

Hello Health-Concierge Care for All | Nexthealth

June 23rd, 2008 | Popularity: 21%
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Top Health 2.0 Web Apps – ReadWriteWeb

June 17th, 2008 | Popularity: 10%
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Pew Internet : Participatory Medicine

June 17th, 2008 | Popularity: 12%
4 comments
  • Pew Internet : Participatory Medicine – The latest data from the Pew Internet & American Life Project about participation on the Internet. Participatory medicine may become a more common idea thanks to the Web2 revolution.

The Health 2.0 Definition : Not just the Latest, The Greatest!

June 13th, 2008 | Popularity: 59%
23 comments

Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.

Matthew Holt recognizes this as the latest definition out there. As I mentioned in my comments on previous posts about this , I started this process out of necessity. I needed to describe health 2.0 in a presentation to the Board of the California Healthcare Foundation. I did use the definition above, and what I was/am happiest about it is that it’s something I would not have come up with in my physician state of being (as patient focused as I am), and that it was finalized and approved by a patient.

We’re talking about a definition this time; isn’t this a metaphor for how any health system improvement should happen from now on?

Getting a Second Life—in an online health community: Consumer Reports Health Blog

June 10th, 2008 | Popularity: 12%
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Health 2.0 Definition, Version 2

June 6th, 2008 | Popularity: 48%
29 comments

Remember that I started the defining in anticipation of talk I am giving? That talk is happening next week, in collaboration with the California Healthcare Foundation, who are working to foster next generation ideas for health care.

Based on the comments I’ve read to date, here’s what I put together:

Health 2.0 is participatory health care. The combination of content and community enables the patient to be an active partner in their own health care and the citizen to be an equal partner in improving the health system.

Here’s a summary of the improvements suggested:

Dave: add “When patients meet Web 2.0″
Andre: add “Social Media”
Jen: “Content and Community” (commerce coming)
Deborah: “Strike transition, promote participation”
Lodewijk: “Not a transition; Health 2.0 defines the combination of health data and health information with (patient) experience through the use of ICT, enabling the citizen to become an active and responsible partner in his own health and care pathway”
Gilles: ” Add ‘and equal’, add ‘informed’”
Dave: “Lodewijk + is the combination of new Web tools, health information, and patient awareness, enabling the citizen”
Susannah (offline) : “Participatory medicine”
Matthew: “Good luck”

Here’s the original:

Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.

Better? Easy to discuss in an elevator, or on your way to a walking meeting?

BarCamp wiki / HealthCampMd

May 28th, 2008 | Popularity: 17%
1 comment
  • BarCamp wiki / HealthCampMd – June 14, I can't go, but I like the transparency of the setup, down to the finances, of this Health 2.0 get together

Bioethics Forum – Google Health: Organizing Your Medical Information

May 26th, 2008 | Popularity: 24%
2 comments
  • Bioethics Forum – Google Health: Organizing Your Medical Information – Comment on this blog about a method to display drug/device ads to physicians reviewing a patient's medical record. Is this sort of thing different than a physician reviewing a medical record while writing with a branded pen on branded paper that sits in their office in front of their computer, next to their drug sample cabinet (if they allow these things in their practice). Shouldn’t the conversation be about being an unbranded doctor instead of Google’s implementation?

Mobile applications for illness managment; Historical Scientific Misconduct; A Good LEAN Summary

May 21st, 2008 | Popularity: 65%
2 comments

May 10th through May 13th:

The Case for Hypertension and Health 2.0: California

May 15th, 2008 | Popularity: 33%
1 comment

This is simply a redrawing of yesterday’s graphic, based on California population data. This site has an excellent overview of the impact to California. It understates prevalence because it speaks of patients who have had hypertension diagnosed and does not include undiagnosed Californians.

I found a more recent article and updated proportions accordingly ( see, I did find something wrong with the previous diagram )

Click on the images to enlarge

I added a new source, #3 below, since yesterday. This paper has newer control data with a more optimistic point of view:

The prevalence of hypertension has not increased significantly since 1999. At the same time, there has been increasing control rate of hypertension, especially in Mexican American men, elderly, and obese people – Ong, et. al (see below)

(formatted for Zotero):

1. Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension Control at Physicians’ Offices in the United States. Am J Hypertens. 2008;21(2):136-142. Available at: http://dx.doi.org/10.1038/ajh.2007.35 [Accessed May 8, 2008].

2. Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics–2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146. Available at: http://circ.ahajournals.org [Accessed May 7, 2008].

3. Ong KL, Cheung BM, Man YB, Lau CP, Lam KS. Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999-2004. Hypertension. 2007;49(1):69-75. Available at: http://hyper.ahajournals.org/cgi/content/abstract/49/1/69 [Accessed May 15, 2008].

Tomorrow, a look at costs, direct and indirect, for the nation and California.

What’s Wrong With this Diagram? The Case for Hypertension and Health 2.0

May 14th, 2008 | Popularity: 31%
2 comments

In April of this year, I swtiched gears slightly, from spending time to discover the determinants of patient access / connectivity to their care system through personal health records, to examining the possibilities of creating connectivity with the California Healthcare Foundation.

We’ve been talking to several people and the Foundation is allowing me to present our ideas in sequence, here, for critique, improvement, and interest among potential partners. The goal is to launch a project that will connect multiple stakeholders in the health ecosystem, to improve chronic care management, in California. Timeline and details are going to be posted over time.

Let’s start with the case for hypertension as a chronic illness worthy of examination, though. Take a look at this graphic. What does it say to you about the state of high blood pressure care in the United States? What are the opportunities using HIT and Health 2.0? Are there corrections to be made?

Welcome to my PDCA cycle. Sources are underneath – feel free to ask questions about any of this data. I’ll begin posting regularly under this category.

Update: After finding an error in the image, I decided to leave it in, with this note that it’s incorrect, and a corrected version is in this post. PDCA is about iteration.

Quote: “…undiagnosed hypertension and treated but uncontrolled hypertension occur largely under the watchful eye of the healthcare system.” – Hyman and Pavlik

Sources (formatted for Zotero):

1. Fang J, Alderman MH, Keenan NL, Ayala C, Croft JB. Hypertension Control at Physicians’ Offices in the United States. Am J Hypertens. 2008;21(2):136-142. Available at: http://dx.doi.org/10.1038/ajh.2007.35 [Accessed May 8, 2008].

2. Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics–2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2008;117(4):e25-146. Available at: http://circ.ahajournals.org [Accessed May 7, 2008].

Tomorrow: Impact to Californians

A Conversation about Health 2.0 and community empowerment with the founders of Inspire.com

May 8th, 2008 | Popularity: 18%
6 comments

I had the opportunity to meet Brian Loew and Amir Lewkowicz, CEO and Vice President of Parnterships, respectively, for Inspire.com.

The company was created 3 years ago with this mission:

We believe no one should have to go it alone, we all need a safe place to talk, and we can help one another.”

Inspire is based here on the East Coast, which is good (Health 2.0 is happening all over the U.S.), and differentiates itself by not accepting advertising, and visibly partnering with nationally known health support organizations. As Brian and Amir explained to me, part of the drive was to improve access to clinical trials, which is handled in a privacy-appropropriate, opt-in, way.

I gave the analogy in our conversation of the patient that leaves an exam room in a medical center, not realizing that the patient going in after or before them might have similar experiences that they would want to share. Communities like this can fill that gap by bridging patient to patient and patient to community organizations like the partners on the Inspire site.

I think there’s a role for communities like this to partner with the greater health ecosystem, not just in the acute phase of a serious illness, but maybe in the acute phase of a manageable illness, like hypertension. Do readers agree? And do they know of Web2/Health2 communities for diagnoses like this?

e-patients: Participate in defining “Health 2.0″

May 7th, 2008 | Popularity: 29%
8 comments

Over at one of my favorite blogs, e-patients.net, e-Patient Dave is starting a dicussion about what Health 2.0 “is;”: e-patients: Participate in defining “Health 2.0″

I started things off with a definition based on one created by The Economist, which I’ll repeat here:

Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.

Feel free to suggest your improvements here, or there. I enjoy the idea that patients like Dave and readers of e-Patients will create improvements that can be incorporated.

If someone asked you, “What is Health 2.0?” Would you feel comfortable answering with the definition above? If not, how would you change it? Be sure if you would to tell a little bit about “why?” The story of how we get here is as important as the where we got to.

Giving a great presentation from Al Gore; Genie Industries LEAN approach; Wisdom of Patients Paper

May 7th, 2008 | Popularity: 55%
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The Genie Industries video is especially compelling because everything they discuss is applicable in health care. What if we substituted “patient care” for making scissor lifts – we would see huge strides in improvement. Also, just upgraded the software that powers this blog. Viva open source.

GenY Physicians in WSJ; Nice overviews of chronic illness burden; Twitter apps, Health2.0 Definitions

May 6th, 2008 | Popularity: 25%
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April 29th through May 4th:

My Definition of Health 2.0 : The Transition to Personal, Participatory Health Care

May 2nd, 2008 | Popularity: 55%
18 comments

Health 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.

When I went to medical school, a person’s ability to influence the health care system was linearly correlated with the length of their lab coat. Actually, in my medical school, medical students and attending physicians all wore the same length of lab coats, because I trained on the West Coast. I was exposed to the labcoat length protocol when I was a medical student and a new group of residents began training at our hospital. One of the residents was obviously from an East Coast medical school because she asked me permission to do something for a patient, and it took us both a few minutes to realize that she thought I was the “in charge” doctor because I wasn’t wearing a short lab coat. Neither of us wanted to relate in this way, and we transformed the relationship right there, in a beneficial way for our patients.

Flash forward to 2004, when my organization implemented an enterprise wide electronic medical record system for doctors, nurses, and staff. All of a sudden, we were on a common platform, and every member of the team had a contribution to make in each other’s learning of the new system. Once, when I was ordering an injectable medication, a nurse colleague came over to me and said, “here, let me show you how to do that, Ted.” Now, this new technology was creating an obvious platform for colleagues to teach each other, regardless of role. It was and is great.

In 2008, in organizations like ours where patients are regularly participating in the creation of their health record via secure e-mail and online health profiles, and participating in the creation of ideas and their health care stories inside and outside of our health care system, health care improvement is now more democratic than ever. When we combine that with management systems like LEAN (Toyota Management System) that support respect for our customers and our colleagues and use tools like visual systems and daily improvement methods, it is possible to see what the difference between Health 1.0 and Health 2.0 is. The technology has definitely stimulated this change by making it easier to participate, but the lasting intervention will be the participation of patients, their families, and every stakeholder (health care providers, businesses, philanthropies, non-profit associations, etc) in the improvement of our care system.

In 2006, The Economist referred to the transition from Web 1.0 to Web 2.0 as the transition from mass media to personal, participatory media. I think the same is true for Health 1.0 to Health 2.0.

I have spoken about the idea that physicians in my generation (Generation X) are a group that trained during an explosion of medical information. We are a group that is challenging the mental model of “omniscient physician” – we don’t want to hold all the answers for our patients because we’ll fail if we do. We want to learn something new from every patient, every colleague, and every industry, every day, so we can be good educators, too. Now we can, and we are.

Verizon Pill Phone for Adherence; A Place for NHIN News; Lee Aase’s Social Media University; Merck and Web 2.0

April 29th, 2008 | Popularity: 34%
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Why Health2.0 is a great idea: The Case for Allergies

April 28th, 2008 | Popularity: 23%
1 comment

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.

Background articles on Web2.0; Data Visualization; A USA-Obesity Slideshow from the CDC

April 14th, 2008 | Popularity: 63%
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Guide to a Second Seat Alaska AirlineI recently pulled several articles to help leaders understand Web2.0 better. That’s what’s in the links below.

The image is one that I snapped while taking a flight recently. It reflects the accommodations an already troubled industry is having to make to support our health (or lack thereof).


Photo: Bear Added Riches in Trust for Mankind

April 12th, 2008 | Popularity: 48%
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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.

Pomona College Pomona College Pomona College

“I’m not a doctor; I’m not a nurse; but I can tell what’s needed”

April 11th, 2008 | Popularity: 21%
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The quote in the title is from Susan Daniels, PhD, who I was fortunate to serve on a panel at the Consumer Health Informatics Symposium, on the topic of Consumer Health Informatics for Diverse Populations. Susan has extensive experience working with disabled individuals, and spoke eloquently about the needs of the disabled population, beyond managing health, to managing disability determinations, which are critical. I like the statement because it speaks the importance of patient, family, and community involvement in health care and health services.

The image displayed here is from another impressive demonstration, by David Williams from patientslikeme.com. I really liked the feature where patients can document the doses of drugs they are actually taking for various conditions.

There currently isn’t an area dealing with cardiovascular disease, but I would be really interested in an area focusing here, especially when it comes to anti-hypertensives. What if we could have a real sense, across a population, of how well certain drugs work and how long they take to take effect? It is one of those things in primary care where it’s a little unclear exactly when a blood pressure drug will have an impact for a specific patient.

Voicethread; Zotero; Nice Summary of Medical Home from Deloitte

April 3rd, 2008 | Popularity: 82%
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April 1st through April 2nd:

“Living, Breathing, Interaction with Data” – Demo of the Myca Patient-Provider EHR platform

April 2nd, 2008 | Popularity: 34%
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Health care disruptor Jay Parkinson, MD, just posted a nice demo of the Myca platform for patients and providers, that wowed so many at the Health2.0 conference in March.

The things I liked are the fact that they are demo-ing the platform in the first place – some vendors are reticent to show their user interface publicly. I liked that Jay starts out with the patient experience and flows to the provider experience, not the other way around. I like that the provider experience piece is equally capable of storing a video or IM interaction as much as the in person physician documentation.

The provider user interface looks very slick. I can’t say either way how I might practice with it. I would ask how the practice is able to keep prevention issues a part of every interaction (Jay started the demo by looking at the problem list). I would also be more interested in how flexible the product is over time to support a patient centered practice, as opposed to whether it is there today.

I was really impressed with what I see as the entre of basic tagging – providers being able to tag treatments for each patient. I’m not sure whether they can tag significant test results, too, but this would be very handy (e.g. which chest x-rays are the ones to remember moving forward).

All in all, more innovation is better, and let’s see what the patients think of the care, and let them guide us on what works best – it looks like HelloHealth is set up to do that, which is the most important thing in my mind.

See what you think of the demo yourself.

The Myca Platform

The Visible Body – A Health 2.0 Tool for Visualizing Human Anatomy

March 14th, 2008 | Popularity: 22%
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Andrew Soucy, from The Visible Body (note: incorrect URL fixed, 3/17/08), contacted me after the Health 2.0 Conference and asked if I wouldn’t mind looking at this anatomic visualization application. He said

stumbled across your blog this morning, and wanted to see if this might interest you, esp. given your coverage of Health 2.0.

After being at Health 2.0, I admit I have become more interested in new ideas and products, even if I am not endorsing any specific one (I am not). One thing that I really liked that is reflective of the Web2.0 world today is that the company posted a short video on YouTube, which I am pasting in here:

It’s a different way to experience something as opposed to going to the company’s web site – it’s kind of open source, publicly available, and other people can say what they thing of the product right there. I haven’t gotten a chance to use this yet because I am on a Mac running Windows Vista 64 Bit, but I am interested in the idea, and especially the idea that I wouldn’t have to reach for the anatomic atlas as I guide patients through a consultation about what’s going on their bodies.

Way back when, when I did a clerkship at the National Library of Medicine, I was exposed to the Visible Human Project, which you can read about on the National Library of Medicine’s Web Site. At the time, the images from that project comprised 18 Gigabytes of data (I remember this number, because it was so gargantuan). It’s interesting to see that we have come such a long way in being able to visualize our bodies like this.

American Medical Association 2001, Health 2.0, and Patients 2.0

March 13th, 2008 | Popularity: 39%
3 comments

I came across Susannah Fox’s recent blog entry: (e-patients: Flashback to 2001) where she uploaded a PDF of the American Medical Association’s Press Release of Resolutions for 2001 (you can link to it directly here), which included a resolution to “trust your doctor, not a chat room.”

She said she posted it by the popular demand (of one), but I also was glad she posted it (so increase the count to two, Susannah!), and followed the link to another blog post that was critical of her presentation at the Health 2.0 conference. In that post, the author said, “is Fox actually disagreeing with those who think it wiser to seek advice from physicians than to take seriously medical advice received from anonymous strangers in internet chat rooms?” and I wanted to comment on this as someone sitting in the audience (and who got to catch up with Susannah shortly before she went on stage – ok, so I am disclosing that I am a fan).

I think what Susannah was responding to, and somewhat verified in David Rothman’s post is the binary-ness of the argument, that it’s either your doctor or the Internet, not both. The first question I ask when I wonder about behavior is (in true LEAN tradition) “why?” Why would a patient access information outside of their physician relationship? We can guess at many reasons, including that they don’t have access to a doctor, or the doctor they do have access to has not given them the information they are looking for. At some level, there is a trust issue involved, and if we use the Edelman Trust Barometer as one piece of data, it is that patients are more likely to trust “someone like me” than their doctor. It’s impressive that we’ve come to this.

Rothman goes on to discuss the virtues of Medline Plus as a place to get authoritative information and “I do not believe that online resources collaboratively created by patients will solve the problems and dangers of healthcare misinformation online.” Again, I think it is the “it is or it isn’t” aspect that we have to be careful of. To Rothman’s comment, I would say, “Is that true 100% of the time?” And I thought about this a bit more as I pulled out a study I have been waiting to read for some time:

Williamson Et Al - 2007 - Antibiotics And Topical Nasal Steroid For Treatmen

Williamson IG, Rumsby K, Benge S, Moore M, Smith PW, Cross M, et al. Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis: A Randomized Controlled Trial [Internet]. JAMA. 2007 Dec 5;298(21):2487-2496.[cited 2008 Mar 13 ]

The study is, I would say, on the incredible side. It challenges one of the most commonly held notions in primary care, that sinus symptoms should result in antibiotic treatment, and shows that prescribing amoxicillin for the most commonly used criteria to diagnose sinusitis was no better than a placebo (sugar pill). I imagine the signficance of this, considering that the average physician may see at least one case of these symptoms each week and the antibiotic cost yearly is $2.4 billion in the U.S. Not to mention that these antibiotics are now in our water supply.

So I next went to Medline Plus, to the Sinusitis topic, to look for the information that says that antibiotics have no effect on the condition in most cases, and that diagnosis itself is questionable.

Sinusitis [Internet]. [cited 2008 Mar 13 ]

No such mention. Is this surprising considering that the average piece of research takes 17 years to find its way into medical practice? I won’t go into why that is here; however, the point is that even the most infallible official resources can be fallible. All that this means is that we should always as “why?” and support our patients asking “why?” also. Of interest, I found out about this peer-reviewed study in the blogosphere, not on PubMed or Medline. We should leave the door open to the idea that patients may just help us reflect on better ways to treat them that are less costly and less harmful to themselves and the environment. It’s a continuous spectrum, not a binary switch.

What about American Medical Association 2001?

I also wanted to comment on Susannah’s use of the press release, which is very important and useful. We have to know where we came from so we can move ahead together. The same year that the press release came out, the American Medical Association also published another piece, “Geraghty K. Historical Postmortem, March 2001 (The Telephone). Jama 2001. (link fixed 03/13/08)” In that piece, my profession’s history with the telephone was discussed – it took 80 years for the telephone to become accepted in modern medicine. But it’s accepted now. And one day, the Internet will be, too. We’re really only 8 years into Internet-enabled health care (using my own organization as the example).

What Susannah presented was what it was: American Medical Association 2001. That’s not the same as American Medical Association 2008. Organizations grow and change. I’m confident that the medical profession will grow and change and use the best tools out there to help our patients. We came from barbers, after all. And I’ve never met a physician that wanted to provide bad health care to their patients.

“I can ride a horse in here (Second Life)” – Great Patient Voice videos from Health 2.0

March 13th, 2008 | Popularity: 22%
1 comment

Scribemedia and the organizers of the Health 2.0 Conference have put the videos that they showed from the conference online. They’re terrific.

My favorites : A patient with reflex sympathetic dystrophy:, A patient with multiple sclerosis who can dance every night in Second Life

I think they’re moving from a patient, provider, and health system leader perspective. I especially enjoyed the one about chronic pain. We are taught in residency to support patients with pain by encouraging them to document their symptoms over time. Then we don’t give them tools to do it. Then we wonder why they didn’t document their symptoms. Then we ask them to document their symptoms. In the video I got the sense that bearing witness to one’s own symptoms is therapeutic in and of itself. Would I want this information brought into a consultation with a patient? Is it more important than asking if prescribed drugs were effective? Absolutely. See what you think.

Video will help the patient and consumer voice be heard in ways not thought possible before. Better health care will result.

Steve Jobs and Leadership Philosophy; Health Plans and AMA less EHR supportive?; Two Health2.0 Services

March 10th, 2008 | Popularity: 63%
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March 4th through March 6th:

Health 2.0: Interesting new EHR Platform, Microsoft and Google, Wrapup

March 5th, 2008 | Popularity: 42%
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Health 2.0 is now over, and it was a great experience. I am not the only person in the room that remarked that they felt less innovative than ever in this room of innovators. The patient experience was front and center. I / we need to see that, often.

The post-lunch surprise was a demo of Microsoft’s HealthVault, accompanied by a post-demo comparison of the HealthVault and Google Health product by Missy Krasner. Overall a great discussion. I’m happy that more, rather than less, is happening here.

From my perspective I thought a big splash was made by the new EHR platform that Jay Parkinson, MD, demonstrated, manufactured by Myca. It has a compelling patient portal aspect as well. Interesting to see what happens when people start from scratch and build things the way they want to use them.

Health 2.0: 7 words

March 4th, 2008 | Popularity: 17%
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Susannah Fox started something this morning by announcing her “7 words” around Health 2.0. It’s the meme of the conference.

Here are Holly Potter’s (National Director of Communications for Kaiser Permanente HealthConnect):

Build Continuity, Eliminate Fragmentation, Create Total Health

I need formulate mine. Feel free to post yours in the comments below.

Health 2.0: Jay Parkinson, MD, OnCall Medical Group, Enoch Choi, MD

March 4th, 2008 | Popularity: 32%
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A few more interesting ideas in Health 2.0: Jay Parkinson, MD, in a video about his practice, invoked the work of Toyota Motor Company (smiley face) as a company that works to remove errors from processes.

The On Call Medical Group, like Jay, go to where the patients are – home or work, their true Gemba. I liked the comment about the fact that going patients’ homes allows physicians to assess patients’ capabilities and work with them collaboratively.

The patient filmed was judged not to have a high likelihood of strep infection, yet a culture was still drawn and antibiotics prescribed.

Panel moderated by David Kibbe, MD, from the American Academy of Family Physicians. Overall, it is great to see physicians interested in the art of medicine and able to equip themselves to do something different.

Sitting at the Blogging Table at Health 2.0; I think I should blog

March 4th, 2008 | Popularity: 15%
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I figure that of all places in the world where it should be okay to blog live, the Health 2.0 Conference is it. So I’m going to try blogging as I go.

I’m in the morning session and I just saw Susannah Fox, from the Pew Internet and American Life Project, talk about the healthcare internet user.

She pointed out that there are few documented cases of harm that have come from consumers accessing the internet (and by the way, we had a conversation at this table about whether we should talk about people as “patients” or “consumers”).

Susannah closed with 7 words of advice:

Recruit doctors, let e-patients lead, go mobile

“What about one to many or many to many?” at Health 2.0

March 4th, 2008 | Popularity: 10%
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Josh and I are in San Diego this week for the Health 2.0 Conference, and to interact with innovative California health care organizations. I think we are two of the few people in the U.S. that did not attend HIMSS last week. However, we are two of the few people in the U.S. who are attending Health 2.0.

The quote in the title was from my table at the “Unconference” which was facilitated by Enoch Choi, MD, from the Palo Alto Medical Foundation. It refers to the difference between web services offered by physician groups and what could be offered.

In the kinds of conferences I go to, attended mostly by medical professionals (and in many parts of my medical group itself), I typically feel like “year ahead of my time guy.” (This post from my blog, using a cute Apple commercial, I think illustrates the dilemma well). In this group, though, I feel like “year behind everyone else guy (person)” and that’s pressure that I like. The current state of the art of patient access to their care team(s) is one to one, and in the next step should be many to many. I gave the example of a patient electing to have a surgical procedure. What might be one of the first questions they would ask. How about, “Can I talk to other patients who have had this procedure? And who have had it performed by you?”

We had a discussion about creating change and where that might happen – from within the (medical) profession or outside of it. Keith Schorsch, the CEO of Seattle-based Trusera offered the idea of the “enlightened” provider. I asked if there was a registry where we could all sign up. I was kidding though, because in my (our) travels so far, I find that all physicians/providers are enlightened, when we support them in being so. And that comes from thinking about the patient at the center.

The Kaiser Permanente Effect

Something I noticed that I need to watch out for, more carefully than I did on day 1, is the impact of being in a room of innovators as a representative of a large medical group / health plan. I say “Kaiser Permanente” effect even though I am not a Kaiser Permanante employee, but the thought/idea that permeates an audience sometimes when I/we represent ourselves and our work is the one that goes something like, “Only Kaiser Permanente/Group Health can do that kind of innovation.” That statement can be taken two ways – it can mean, “We aren’t going to do anything innovative because we aren’t structured like that.” I think in this audience, my concern is that it can be taken as, “We don’t have the ability to overcome inertia outside of a Kaiser Permanente/Group Health system.”

I think the statement in general is incorrect, and that’s good news. As I sometimes say, I am going to spend the day watching myself and listening 51 % of the time. There are a lot of smart people here working very hard to stimulate improvement in the health care system we all use; they are thinking of innovation 24/7 and I want to help make their ideas count. And pick up some new ones along the way.

Speaking of Innovation

One of the reasons we are here is to visit and shadow providers at Sharp Health Care. As you can tell from the image above, they are a leader in health care and interested in providing patient-centered health information technology. Josh and I presented our work to the group and it was well received. We’ll be shadowing in one of their medical facilities in the next two days.

Great RSS Readers are Now Free; Social Networking and Herbals; What We Can Learn from the Music Industry

January 12th, 2008 | Popularity: 26%
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iMedix allows patients to share treatment stories; Health Plans and Customer Experience; Handy Tip for Leopard Users; Handy Tip for DC Residents

December 27th, 2007 | Popularity: 42%
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December 24th through December 26th:

Baby Boomers and retirement; Case for Informed Optimism

December 3rd, 2007 | Popularity: 25%
2 comments

November 27th through December 2nd: