In 2009, you can learn a lot about what’s going on in an environment (a conference, a person’s life), by looking at their status updates. Nice analysis by Chris Hogg.

I would like to start, rather than end this post, with huge thank you’s to:

Allan Rogers, MD, Kaiser Permanente’s National HealthConnect Team
Susan Campbell-Hartzell, Kaiser Permanente Internet Services Group

Without their help, Kaiser Permanente would not have been able to demonstrate kp.org, I’ll explain why.

We got the call (or rather, e-mail) a week before the Health 2.0 meets Information Therapy Conference in Boston, the premier event for the health care startup community (and which Kaiser Permanente is a Flagship Sponsor of): Would Kaiser Permanente be able to demonstrate KP HealthConnect and kp.org, connected to live servers, to this room of 450 health care patients, companies, and other leaders?

Piece of cake, we said. Except for the live server part. Even though this was the requirement of demonstrations at Health 2.0, we would not be able to do things this way, but it was still a lot of work, I’d like to assure everyone!

We only had a week to put together an integrated demonstration. A demonstration that was to last no longer than 3.5 minutes.

Now, I definitely believe that if you can demonstrate something in 10 minutes, you can do it in 3; the challenge is deciding what not to show in a health system that is so comprehensive in the way it does everything, not just health information technology. We also wanted to make this relevant next to really great work completed by Google Health and HelloHealth.

With several script revisions, test system password resets, and stocking of fictional patient records in a fictional system (i.e. one totally separate from the system patients, doctors, and nurses use every day), we created a few weeks in the life of Janet HealthConnect.

What we thought was best was to think about the things that Kaiser Permanente brings to Health Information Technology that complements Google, HelloHealth, and the entire Health 2.0 community. One of the biggest things that Kaiser Permanente brings is adoption – it’s good at this and it wants to share its expertise.

If Kaiser Permanente is demonstrating the future of health care in its medical centers, hospitals, and where its members live, work, and play today, this community is demonstrating the future of the future, and that’s why we need each other.

With that in mind, I asked Anna-Lisa Silvestre, VP of Online Services to serve as her letter turner. Kate Christensen, MD, the Medical Director of kp.org, was also close by as well. In the demonstration I prompted Anna-Lisa for several facts about the adoption of My Health Manager.

• When Janet logged in to My Health Manager, Anna-Lisa told the audience that 47,348,917 other visitors had logged in in 2008
• When Janet sent a secure e-mail to her personal physician, Dr. Rogers, Anna-Lisa told the audience that 6,078,838 other e-mails were also sent in 2008
• When Janet reviewed her HbA1c result, Anna-Lisa told the audience that 16,773,273 other results had been reviewed by patients online in 2008
• When Janet accessed the Health Encyclopedia to learn more about the HbA1c test, Anna-Lisa told the audience that 3,975,230 other visitors had in 2008
• When Janet booked an appointment online with Dr. Rogers, Anna-Lisa told the audience that 1,403,870 other appointments were booked online in 2008, and that these appointments were more likely to be kept.

We then joined Janet HealthConnect’s physician, Allan Rogers, MD, opening Janet’s incoming e-mail. This was a great place to point out that Kaiser Permanente’s maturity with a comprehensive electronic health record has created a focus less on optimizing the acute care visit in the EHR, more on the In Basket as a central place for multispecialty care coordination.

Dr. Rogers then demontrated some of the efficiencies created by the KP HealthConnect team which allowed him to review the patient’s care snapshot right in the In Basket, and then to respond to Janet’s message with full decision support available.

In this portion of the demonstration we showed capabilities beyond sending messages – messaging is designed as an activity that promotes the personal physician-patient relationship with the right information in every encounter.

We quickly stepped through the in person visit, ending with the After Visit Summary, which we used to demonstrate the commitment to service quality, in that AVS use is measured and tracked to ensure a great experience with every encounter.

I closed the demonstration with a screen shot of a patient list, which showed that there may be many Janet HealthConnects, or populations of patients with chronic illness, that can be monitored as a group and cared for by teams, right within KP HealthConnect.

Our final slide is the one pictured above, where Anna-Lisa made the announcement to the audience that My Health Manager adoption has surpassed 3 million members.

So the the things we wanted to show that health information technology can and should do (and has done at Kaiser Permanente) are:

• Keeping people and populations healthy
• Supporting the personal physician relationship
• Connecting the personal physician relationship with strong multispecialty/allied health relationships
• Adoption: showing that patients want and enjoy these services, regardless of age, income, or education level

With special thanks to the Health2.0 meets Information Therapy team for their support and to the entire Health2.0 community for being supportive, and critical. This is where innovation comes from!

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Even though it’s not Friday, this photograph was taken on Friday. It is courtesy of Linda Davis, who responded to my tweet asking if anyone had documented the most impactful moment I experienced at Health 2.0 meets Information Therapy in Boston. In addition, there was a photo in this series of panelists Sean Khozin (HelloHealth), Roni Zieger (Google), and myself, listening to Dave from the balcony.

I am back from the spring Health 2.0 Conference in Boston, MA, this time combined with Information Therapy, which in my opinion was both a great thing to do in terms of participants, and in terms of bridging the Health 1.0 and Health 2.0 worlds.

Photos below, click on any to enlarge

Some of my favorite health care leaders were in attendance of course, including Holly Potter, Kate Christensen, MD, Paulanne Balch, MD, Anna-Lisa Silvestre, Diane Gage Lofgren, James Hereford, ePatientDave, Trisha Torrey, Susannah Fox, Gilles Frydman, Dan Hoch, MD, Alan Greene, MD, Danny Sands, MD, Jay Parkinson, MD, Jane Sarashohn-Kahn, Lygeia Riccardi, as well was excellent co-hosts Matthew and Indu from Health 2.0, and Josh Seidman, from The Center for Information Therapy.

(Is this dangerous? Attempting to list all of your favorite people on a blog post? I suppose I could just link to my Twitter friends list – I hope everyone remembers what I said on stage about loving everyone and that you’ll add a comment if I’ve forgotten..)

My bias in coming to Health 2.0 is to look for connections and innovations for the established health care system, and I think the combination here supported that, beginning with a debate entitled, “Ix and Health 2.0 – Synergies and Tensions?” moderated by Jane Sarasohn-Kahn, probably one of the few humans alive who can moderate this many energetic people at once. Regardless of the outcome, though, the mere fact of the conversation is evidence that we all need each other, because when we are patients, we are going to need everything we can get to help us be successful.

The Patient Takes Center Stage, from the balcony

The moment of most impact for me was when I was on stage, following a short demonstration of

kp.org (see tomorrow’s post), when the topic of ePatientDave’s work with Google Health and Beth Israel Deaconness (well represented by Roni Zieger, MD, and John Halamka, MD) was mentioned ( start here if you want to get up to speed on this great story ) .

Here’s what happened : When the topic was first brought up, and there were a few audio problems, we heard “Speak up!” coming from the balcony on the right. I turned to fellow panelist and said, “Voice of the patient!” Next, as the discussion was unfolding, with Roni and John describing what they had done in partnership with Dave, I noticed this tweet on the monitor in front of me: “@epatientdave should be on stage too #health2con“.

As Dave got up, in the balcony, to begin talking about his experience, I reflected on the tweet and motioned him to come down, but instead, a really interesting thing happened. Dave stayed up on the balcony, microphone in hand, and spoke to the entire audience below. It was a perfect moment at a perfect time for me (and I think for the rest of the room), when a room of health care leaders looked up to our patients, physically as well as emotionally. I don’t know if there’s a photograph out there of this scene, but it’s gotta be priceless. Even though I could not find one for this post, I like this description of things from Susan Carr.

Janet HealthConnect’s non-live HTML based login screen

Janet HealthConnect is not a real person – she’s a manufactured patient that exists in a test version of Kaiser Permanente’s HealthConnect electronic health record. She’s coming with myself and Anna-Lisa Silvestre, Vice President of Online Services for Kaiser Permanente to demonstrate the integration between personal health record, electronic health record, and health care delivery at the “Health 2.0 Meets Ix” conference in Boston, next week.

Myself and colleagues at Kaiser Permanente are putting together a live demo of the systems with a twist – nothing is going to be live.

Janet’s My Health Manager on kp.org experience is going to be demonstrated using a series of HTML pages that have been saved from a running instance of a test version kp.org and manipulated by hand.

Janet’s doctor’s experience using the KP HealthConnect electronic health record is going to be demonstrated using a screen movie, filmed from a running instance of a test version of the electronic health record.

It used to be that “nothing substituted for live” in the area of information technology demonstrations; now, however we’ve come full circle.

Why?

• Protection of members’ information – Because KP HealthConnect is fully operational across the nation, no connections to the production system can be made outside of the places where they need to be made – to support delivery of care. This is the only reason to connect to the production system.
• Integrated care delivery is impressive, and complex – Kaiser Permanente’s strength as a system, its ability to coordinate health care across clinical specialties, time, and space, makes it nearly impossible to create a functional test “sandbox” that is working for every purpose, every time, the same way its production systems are tuned. Test systems may not be powered to function at the speed of production system, or may not be linked to a test copy of every system used to integrate care. There is never a question about where the power of systems should be directed – it is to taking care of members.
• The goal is to demonstrate what a functional system does for patients, not the speed of an internet connection in a conference room – We have all seen demonstrations where the message was lost on the audience due to unforseen technical problems. It’s inappropriate to use a hotel’s internet connection to simulate the approach to connectivity that exists in a modern medical office. Very different purposes.
• Live demo doesn’t differentiate “hype” from “reality” in this case – As I’ve shown on this blog and in 421 medical offices across the United States, live systems are supporting members every day. My Health Manager just surpassed 2.9 million active users across the United States, to boot.

It has taken even me some time to recognize (with the help of colleagues at KP – thank you!) that the benefit of doing things live for an external audience brings unacceptable costs.

All of this said, even a scripted demonstration based on live systems is going to have some plot holes, like why wasn’t a certain lab done for a certain indication on this patient? For those of you in attendance next week, feel free to let me know which ones you spot…

• Voxiva: The Power of the Internet, The Reach of the Phone – Demo'd at Health 2.0, impressive use of mobile to do things like HRA

I’ve selected a photograph of Matthew Holt (in the wig and skirt) and Indu Subaiya, MD, performing the lifecycle of a patient in a Heatlh 2.0 world, and the Health 2.0 conference this week, in San Francisco.

As you can see from the remaining photos below, Indu and Matthew had fun with this, and the approach was very effective as people removed themselves from themselves and focused on what these technologies will mean for people throughout life. Here are my remaining photos, click on any to see larger size, and my recap below:

The conference overall was really great and came together very nicely, as a sort of journey, from “what’s being worked on” to “what do we need to do as a society to move into the future.”

In the photos above, you can see Indu and Matthew doing a role play with the various technology companies at Health 2.0, covering everything from genetic science to virtual doctor visits (that’s Roy Schoenberg, MD, from American Well with Matthew on stage).

Josh Lemieux from the Markle Foundation led a panel on privacy issues followed by several technology demonstrations around supporting secure/private access to health information.

I met Joan Osborn and Sheila Subaiya, MD (pictured along with Brian Loew, CEO of Inspire.com) over an ice cream sandwich that I now regret not tasting.

I connected with three pioneers in health information technology to talk about the importance of place and telepresence (complimentary, not in opposition): Trenor Williams, MD, Danny Sands, MD, from Cisco, and Paulanne Balch, MD, from the Colorado Permanente Medical Group.

I got to watch as two pioneers connected, Adam Bosworth from Keas, and Paulanne Balch, MD.

I attended the closing, led by remarks from Alan Greene, MD, David Lansky, PhD, Robert Kolodner, MD , David Kibbe, MD , moderated by Brian Klepper.

A really great thing happened for me when I got to meet the faces and minds behind the Twitterstreams I have been following for the past several months. We’ve become a community; meeting in real life adds that extra layer of respect (Is it GenX of me to get this benefit or do GenY’s get this too?). I think a few really great people also became Twitterized this week…Jane, Patti, Paulanne, Ravi, welcome.

Finally, a curious and exciting thing happened at the very end, with the self-assortment of individuals from the Bos-Wash Megaregion to talk about how we would contribute to the Health 2.0 movement. We think we can and will, as DC realizes its present and future as the epicenter of health care transformation.

Come join us and thanks to Matthew, Indu, the Health 2.0 team, and all of the volunteers and organizations (including flagship sponsor Kaiser Permanente) for making us less afraid of the future.

Here are my photos, with a tiny bit of emphasis on the DC contingent (click any to see larger)

It’s hard to keep up with the energy here. In March, 2008, the motto (thanks to Susannah Fox), was “7 words.” This time, we seem to have become more efficient, and the motto is “4 letters,” and the driving 4 are “H-T-M-L” coined by Anna-Lisa Silvestre, VP of Online Services for Kaiser Permanente.

Why? Because during the consumer engagement demonstrations, Anna-Lisa’s team prepared the user experience based on static HTML to demonstrate the look and feel, rather than a dynamic demonstration. The others did not fare as well. But that’s okay with me – doing live demonstrations are never easy, and I trust that the organizations involved are going to do great work. I’ve had worse happen on stage – it happens. Perfection is not expected, just the ability to fix mistakes quickly.

I was asked yesterday about the energy level, and my answer is based on comparison to meetings which are of people working to help other people (clinicians, doctors, nurses). This gathering is of people who are working to help people just like them, and who are empowered enough to know what is needed. It’s very stimulating for me, and it should be stimulating for our health system. There is so much more we can do for patients that we aren’t doing, yet.

One more 4 letter word – Jane Sarasohn-Kahn (quoted in the New York Times today) mentioned to me that on our panel yesterday that the doctor, the patient, and the health economist did not disagree when it came to talking about Health 2.0, when it might be expected that we should. I have been saying that the killer app of Health 2.0 is “listening to people” but I like that Jane said:

In Health 2.0, “Love is the Killer App.”

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.

At Health 2.0:

Twitter / carlosrizo: Would it be great that pat …