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

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!

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.

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…

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.

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.”

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.

Twitter / carlosrizo: Would it be great that pat …

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

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:

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.

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 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.

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.

I didn’t catch the iPhone SDK launch right on March 6, but I did watch it a few days later, and it’s very impressive. It is worth a watch, especially with regard to the possibilities in verticals such as health care. I have met many physicians in the past 6 months who have told me, “I will get an iPhone when…” I think the “when” has been answered. Possibilities such as secure physician-patient communication and patient activity monitoring with direct connect to electronic health records are now possible.

It was interesting to see this right after the Health2.0 Conference, to be sure.

Not to mention that the iPhone is now enterprise-worthy….

Apple Developer Connection – iPhone Dev Center – iPhone Developer Program

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.

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.

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.