• Clay Shirky at Web 2.0 Expo SF 2008 - “where do you find the time?” - Awesome answer to the "where do you find the time" question. If you've ever asked someone that question, think about why you really asked it……

I was speaking with Jane Sarasohn-Kahn today about some work she is doing for the California Healthcare Foundation and she asked me the question, “Do you think physicians would pay for their own continuing medical education (rather than being funded through industry support)?”

I immediately thought of this manifesto that I just read, whose conclusions I couldn’t agree more with, when I said, “yes we would.”

ChangeThis :: People Don’t Hate Change, They Hate How You’re Trying to Change Them

If you believe that people hate change and that it is your job to change them, they will hate it. If you believe that people thrive on change and that your job is to unleash it, you will tap into a limited source of ingenuity, energy and drive that will allow you to consistently take your ideas into big results.

This is exactly the theme we uncovered the Patient Centered Health Information Technology initiative, and what I have described many times on this blog and on the DailyKaizen blog (see: Let it Burn; a Wildfire of Respect), when I said, “in every part of every company there’s a monstrous capacity for creativity waiting to be unleashed.”

I sometimes hear about people in healthcare being “change averse.” I don’t think they are at all.

As we move toward Health 2.0, we have plenty of capacity to do things differently; nothing is static if it means doing things better for our patients. It’s what I see, again and again.

• Piracy | Look for the silver lining | Economist.com - I am not drawn to the idea of piracy as a source of innovation as much as the idea that providing knowledge to your competitors spurs innovation. If there's an approach to helping patients be healthy, I want to share it, and vice versa.

If you are interested in innovation, I think this is a good podcast worth listening to - and the actual audio is more useful than the printed version.

I listened to it the day before I attended the latest Patient Centered Primary Care Collaborative, in Washington, DC. At the meeting, I was fortunate to run into one of my role models, Susan Edgman-Levitan, PA, and we talked about the idea that the Medical Home is about improving the care of patients where they spend most of their time - where they live, work, and play. We can help patient-centered care flourish by including ideas from everyone involved in the care, including nurses, doctors, allied health practitioners, eye care, oral health care, behavioral health care, just to name a few.

I liked what Jack said in the podcast, that in a company, there has to be

a sense that in every soul of the company, the idea that everybody innovates.

Toward the end of the podcast, Jack gets quite fired up about the idea that innovation can’t be regulated to the chosen few. My experience reinforces this. In the area of health information technology, this is critical. When most people think about implementing HIT, they think about the implementation period. The most powerful part of HIT is what happens after implementation, and using a management system like the one developed by Toyota Motor Company (as we are) can allow an organization to turn HIT into an organization wide innovation engine - if they capture all of the ideas of everyone involved in providing care and put them to use. To not do so is to waste one of the most valuable raw materials for growth - ideas and time (and most importantly our patients’ time).

One other conversation that has come up in the last several days is about generational changes in approach. Many of the Generation X and Generation Y colleagues I have been talking with were raised in a professional environment where we were not going to have all the answers, and we are uncomfortable being accountable for them. We want to share the power of coming up with the answers with our provider colleagues and our patients. This is not to say that our baby boomer colleagues don’t have this desire, too. I think we are stimulating each other to do what they’ve always wanted to do, and involving patients, their families, and all practitioners, all specialties and roles, is really going to make a person’s medical home special.

Feel free to take a listen and let me know what you think:

Finding Innovation Where It Lives

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.

March 4th through March 6th:

• Steve Jobs speaks out - On his marathon Monday meetings (9) - FORTUNE - a weekly check and adjust at Apple
• S.F. equity firm launches health initiative with CalPERS, GE, others - San Francisco Business Times: - Maybe this will help California lead in Health IT.
• AMNews: March 10, 2008. Insurer finds EMRs won’t pay off for its doctors … American Medical News - Less health plans are requiring EHR adoption for P4P, and the AMA doesn’t have a policy requiring physicians to adopt them either.
• Virgin HealthMiles - As demonstrated at Health 2.0 - a pedometer program that includes a pedometer that uploads data to the Virgin HealthMiles website
• i2y - As featured at the Health 2.0 Conference. For the 68,000 GenX and GenY individuals who are diagnosed with cancer every year.

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.

February 20th through February 22nd:

• VA’s health IT gamble - Discussion of their efforts to centralize IT.
• Google your medical records? - Commentary in the Seattle-PI Health Blog. Innovation that helps health care be more patient-centered is goog. I mean good.
• Superfactory - Article: The Equally Important “Respect for People” Principle by Bob Emiliani - “A multi-lateral expression of the need for balanced, mutually respectful relationships, cooperation, and co-prosperity with these key stakeholders.” Thanks to mycolleague Lee for sending this on
• Cooking Light Best Cities: Washington, D.C. - Healthy Recipes and Menus - CookingLight.com - The description says it all. Great ways to eat healthy in this burgeoning food capital. Even for a non-foodie like me.

I missed the 60 Day mark due to travel, so this is the 79 day DCVersary. Still a green light, and greater appreciation for this environment by the day. In what other community do people respond to intolerance by staging a hug-in?

There’s a few stray links below about a recent report on RHIOs, and new “innovation” in ISPs accessing the code within Web pages for their customers - a new first.

Links for December 11th through December 12th:

• Wash. Leads Metro Areas in Walkability - people who know me well know that this is a make or break for a city. Another reason to love Washington.
• Underuse of colorectal cancer screening in a cohort of (Fee for Service) medicare beneficiaries - The study excluded managed care enrollees, so it’s really a study of fee for service Medicare, an important asterisk.
• DCist: Hug-In at Rite Aid: ‘It Feels Nice to Hug’ - What a great way to battle intolerance.
• The Shopkeeper Whose Sign Was ‘Open’ - washingtonpost.com - 14th Street Neighborhood leader Noi Chudnoff has passed away
• ZIPskinny demographic information for 20009 - WASHINGTON DC - Demographic Information about my neighborhood
• Dupont Circle Business Networking - Historic Dupont Circle Main Streets - 17th Street is getting a makeover. It looks like Plan B is more elaborate
• The State Of Regional Health Information Organizations: Current Activities And Financing — Adler-Milstein et al., 10.1377/hlthaff.27.1.w60 — Health Affairs - I admit, I have at times gotten in trouble for not being supportive of RHIOs.
• Lauren Weinstein’s Blog: Google Hijacked — Major ISP to Intercept and Modify Web Pages - ISP Content filtering now hits individual Web pages
• What Is Management’s Role in Innovation? ? HBS Working Knowledge - Nice discussion in the comments. I think there is a role, and some of the comments talk about what that role is.

November 14th through November 17th:

• ImproveHealthCare - Changing Physician Education - Improving medical students understanding of health policy.
• Life as a Healthcare CIO: Data, Information, Knowledge, and Wisdom - Interesting system to support accurate imaging ordering
• Jay Parkinson + MD + MPH » Blog Archive » The Cancer vaccine and me. - Interesting discussion of HPV vaccine. The $360 charge is 65% profit.
• Enterprise 2.0: Using Social Media in the Workplace - Don’t be scared of Web 2.0 in the workplace. Nice webinar for enterprise audiences.