As Jay says, we’re speaking tomorrow, at SXSW – The panel is called Sick Clicks, the Evolution of Health Online. See you there.

Health Care Law Blog: AHLA Connections: Legal Implications of Health Care Social Media – A (dare I say) beautiful article / reference written by Bob Coffield about health care and social media.

A few things relevant to my situation that are worth repeating/thinking about in other organizations:

• The presence of an internal social network (at Kaiser Permanente, it’s called Ideabook – referenced in this presentation), helps to manage the stated concern about superiors and subordinates friending each other on public social networks. The internal social network creates a professional environment for colleagues to connect and share interests, and in the one that we use, there is no accepting or ignoring of requests – a colleague relationship is established on request automatically.
• The presence of a useful social media policy. Here’s a link to Kaiser Permanente’s social media policy. Several people have contacted me and asked if it may be copied / used by their organization. The answer is yes.

Thanks again to Bob and team for being interested in this topic and in keeping patients engaged and protected, two of the most important types of care we provide for patients.

This week’s photograph is of the “famous infamous @epatientdave” and Kate Christensen, MD, who’s the medical director of kp.org, Kaiser Permanente’s web site for members. They are giving a presentation at HIMSS10 about involving patients and families, not just in their health care, but in the design of the healthcare system itself.

I used this photograph to illustrate the part of the presentation that Holly Potter and I gave at HIMSS10 that touched on Health 2.0.

I wanted to find something in my collection that describes what Health 2.0 means, along the lines of the famous/infamous definition commissioned right here from this blog, and I needed to look no farther than the SD card in my digital camera from the day before.

I’d like to say that it doesn’t take having an EHR, a PHR, or even a lot of technology to participate with patients (these things can help a lot, though). It just takes a desire to want to.

As I said in my comments the next day, I don’t believe Kaiser Permanente is the national leader in patient participation in the design and operation of the health system. This is good news, because there are lots of leading edge organizations who doing this work (you can find many of them here), and in them, you will find scenes just like this.

I should say that due to an unfortunate coincidence, Dave and Kate’s presentation was at the same time as a discussion being led by Health 2.0’s Matthew Holt and my favorite economist Jane Sarasohn-Kahn, so even in the same meeting, you’ll find many scenes like this!

Several people asked for the slides after the event, so here they are in graphical form.

Lots of people prefer the slideshare.net experience when viewing slides, so if that’s what works for you, Holly has uploaded the slides here, with embedded YouTube videos.

If you’re interested in the sources/links from the presentation, they are beneath the slides, for your researching pleasure.

Comments/questions welcome, as always!

This week’s photograph was taken right after the snowpocalypse, and I am using it to add an image to the idea of “Total Health,” which is part of the presentation that Holly Potter and I are giving at HIMSS next week.

I like taking photographs like this because they show what the success of a health system looks like – people achieving their life goals through optimal health.

I learned to think this way because of the personal health record, which allows us to care about what our patients do when they are not in the medical office. From that perspective, the workplace of a health system that supports total health is where people live, work, and play.

I considered a few other images for the slide that this one is on (see below). They’re included here in the event you think they are a better fit than this one (let me know in the comments, please). I’ll post all the slides here after our presentation (and truth be told, when they are actually completed).

Click on the link for more details, and just in case, the job # is 012631. I am not the hiring authority; however I can pass questions on and/or feel free to post your resume at the site above for consideration.

Atul Gawande, MD and Jack Cochran, MD, NGA meeting, Washington, DC

A few weeks ago, Jack Cochran, CEO of The Permanente Federation (the company I work for) mentioned that he would be speaking alongside Atul Gawande, MD, in DC, and that I should try to come. I didn’t realize fully that he was speaking in front of the Governors of the United States of America, and definitely not that he was going right after The First Lady of the United States, Michelle Obama.

In any event, I got to go, so I’m going to share that experience here.

The First Lady

The First Lady was great. She talked about her family’s values with regard to exercise and eating. She’s leading an important conversation about why we need to treat childhood obesity as a societal issue, with multiple causes and solutions. (Disclosure: Kaiser Permanente is a founding partner in The First Lady’s Partnership for a Healthier America)

She spoke of food deserts, which are communities where families do not have convenient access to grocery stores and purchase processed and other less-healthy foods at convenience stores and corner markets.

I do not live in a food desert currently, but I did last week (this photograph explains it all), and I can definitely relate to the feeling of needing to pack high calorie, high sodium, non-perishable foods into the grocery bag, and how unsettling it feels. Great for The First Lady to work on making healthier food choices available to families in communities across the United States.

View from the TelePrompTer

Atul and Jack

Of all the things on our country’s governors agendas, it’s impressive to think that they made health care the lead issue of their winter meeting. And equally impressive that they asked to hear from physician leaders first.

The title of this post is from a comment made by Jack that started with, “Don’t say you can’t do this (high quality, patient-centered care) because you’re not KP. We didn’t know we could do it until we did it.“

As Dr. Gawande is very well known (understatement), so here’s a little bit about Jack: He’s a plastic surgeon who delivered care in the fee for service world and became curious about the Kaiser Permanente system in his community in Colorado (“If care was needed, physicians wrote me – ‘please deliver this care’), and became a plastic surgeon in that system. He eventually became the Executive Medical Director of the Colorado Permanente Medical Group where he fostered an environment of physician leadership (of the servant kind), innovation, and personal accountability and responsibility. And, Kaiser Permanente Colorado’s results speak for themselves.

In 2005, I had the good fortune/serendipity to be a student in the national Permanente Medicine and Management course led by Jack, where I and physician peers learned about what we could do to make health care (not just Kaiser Permanente) a better place, starting with us. A lot of the advice I give to others (and to myself) originates from the approach I learned here.

With my excessive interest in patient and family involvement – I picked up on a few significant things said by both leaders:

1. By Atul, who spoke about “how much faster things went” when the patients were in the room. (This is not a fluke, go with it)
2. By Jack, who started his remarks with “This is for the patients.” and later “This is about what this does for patients” (We enjoy leaders who never forget this)
3. By Jack, who, when talking about the deluge of medical information that physicians need to keep abreast of included, “and what our patients find online.” It’s not that he said this, it’s the way he said it – as important as anything else a physician needs to know. (A personal health record leaves an indelible and positive impact on a medical group)

Blast from the Past – “You have the power”

At the event, I happened to sit behind Mary Selecky, The Secretary of Health for the State of Washington, and amazingly, we both remembered a moment, exactly 10 years ago, in a class at the University of Washington School of Public Health where we learned about making change.

My colleague, Abigail Halperin, MD, and I were students in the School of Public Health, working on ending the sale of tobacco products for profit by the University of Washington, and during the class, Abigail asked Secretary Selecky what she could do about ending this practice. Her answer, to us and the class was, “I don’t have the power as the Secretary, you have it as the student.”

It turned out she was right; the decision to end the practice was ultimately made by the Associated Students of the University of Washington, and we got there by working with the student body, not the Administration, who resisted the change.

The value of physician leadership (in addition to the leadership of every other stakeholder)

The not-so-subtle nudge from Secretary Selecky in 2000 made a difference, just like Atul and Jack will, by using their talents to help others lead.

I know that both physicians vastly understate what they know about how to create change in medicine and health care in a venue like this.

That’s okay, one of my tenets is “frequency is better than duration” – I think this experience will come out over time, and it’s going to be helpful to people who wonder if the impossible is possible, a great role for physicians.

Thank you for being a loyal user of the Revolution Health Personal Health Record. Unfortunately we will be discontinuing this service as of the end of February 2010 and removing all records, information, and data from the Revolution Health Web site.

So that you don’t lose the information you’ve entered into the system, we strongly suggest that you download your personal records as a PDF to print and save for future reference. To do this, simply follow these instructions:

1. Log in to your Personal Health Record.
2. From any page of your record, click on the “printable version” link on the top right corner of any page. When you see a pop-up box asking you to “Select the following sections to include in your print out,” simply make sure that the sections you want to print and save are checked and then click the “Submit” button.
3. Once the PDF is created (this only takes a moment), you can print directly from it and/or save it to your computer. To print the PDF, click on the printer icon at the top left of the page. To save it, click on the disk icon to the right of the printer icon.

If you encounter a problem printing or saving your records, please e-mail our customer service department at CustomerCare@revolutionhealth.com for assistance. Even after the Personal Health Record is no longer available, Revolution Health and our partner sites will continue to offer you the same great health information and community pages as always. We hope you continue to visit Revolution Health often to take advantage of our offerings.

Thank you,
The Revolution Health Team

The irony is that this message comes on day #2 of the national meeting of physician and other Kaiser Permanente leaders involved in supporting My health manager at kp.org, Kaiser Permanente’s personal health record.

As I asked people here what they learned in day 1, it’s basically the opposite of what is expressed in the message above. This is a personal health record that is thriving, with demand from members/patients continually increasing, and an internet services group working as hard as ever to deliver next-generation services. If anything, they have not appreciated how successful this personal record has become, and this discussion allowed them to stop for a brief moment and appreciate.

Here’s a slide from a recent presentation showing the growth in use:

I hope that people receiving the quoted message do not see this as a sign that personal health records are not desired or wanted by patients. The opposite is very much true. The difference is that a personal health record that provides what people want is something that is wanted (I know, obvious). Such a thing exists. Ask for it where you deliver or receive care.

I specifically remember what Regina and the group said (in paraphrase) – “Show me the DNA of a high quality doctor.” and “Demonstrate that this/you are a doctor that I’m going to love.”

This is a very different need than “Tell me what I need to know about when to get a flu shot.” Not that patients don’t want this information also, of course.

In doing some more reading and experiencing, I thought about the outcome of social media in health care in creating engagement with the profession and health system compared to the outcome of providing information. Beth’s blog has a nice discussion about this (Engage, then Educate) in regard to the San Francisco Symphony. My hypothesis is that the principles are the same.

With that in mind, my colleague Rahul Parikh, MD, a practicing pediatrician and accomplished writer across many venues, worked on an experiment together and we’d like your feedback.

Click on any image to make it larger

This is his physician twitterfeed for patients:

This is him tweeting one way, let’s call it “standard” (more “education”):

This is him tweeting a different way, let’s call it “DNA – Enhanced” (more “engagement”):

Here’s the input we would like:

1. Do you notice the difference in the content/approach?
2. Which way would you want your own doctor. to tweet? (or a different way not shown here)
3. If you were looking to choose a doctor, does either approach draw you more to a potential physician?

Thanks for your comments in the comments, and thanks again to the patients, who continue to demonstrate that they are more than willing to help us perform well for them – all we have to do is ask.

You can also follow and tweet either Rahul (on his professional feed, different than the one above) or myself. Don’t worry, we’ll compare notes.

Kaiser Permanente // brand tags – Catching up on Jay Parksinson’s blog reminded me about this great little site. Although Jay uses the lookup of Mayo to illustrate a point about the health care industry focused on sickness, the lookup of Kaiser Permanente doesn’t follow on that theme….

…and the methodology anyway is more “fun” than accurate. However, the result for Kaiser Permanente does reflect the theme of a talk that Holly Potter and I are giving at HIMSS 2010 this year.

We’re calling it Driving Total Health with Health IT and Health 2.0, and we’re finishing it up now.

The title out of context is probably a little confusing. We were asked to talk about the impact of social media in what we do (surprise).

We are trying to make the point that getting engaged with patients/members where they live work and play using an electronic health record / personal health record, is naturally going to lead into engaging with them outside of the health care transaction. And this (HIT and Health 2.0) is a means, not the end, to helping people achieve their life goals through optimal health.

Holly and I gave a similar talk at Mayo Clinic Scottsdale, and we are retooling it a bit for this (HIMSS) audience, with some new patient stories and experience that we’ve had since then.

If you are going to HIMSS (or if you aren’t) and you have ideas for us about what would be useful to hear about, please feel free to post in the comments. This is my first HIMSS ever….

(PS, on a similar note about patient involvement, colleague Kate Christensen, MD, and e-Patient Dave, will also be speaking)

Kaiser Permanente is in the Top 50 U.S. places to work. It’s at #38, Apple Computer is #22. Not bad. Both Kaiser Permanente and Apple Computer also are on the list of employers that score a perfect 100% on the corporate equality index.

Washington, DC is joining the ranks of communities that provides equality to its residents, in the DC Council action yesterday to provide equality in marriage, expected to be signed by law by the Mayor, and not expected to be blocked by Congress.

In encouraging a colleague to blog the other day, I was asked, “How much of your personal life do you include in your blog?”

My answer to this is that I post things that are relevant to the three major things that are part of my professional existence:

• Health (as a means, not an end; of people, family, community)
• Diversity
• Washington, DC

So this information counts as bloggable. A great employer and a diverse community are good for health and happiness. Enjoy, and congratulations to Kaiser Permanente and the District of Columbia. I’m glad I know you.

I also would like to note that in these spaces, Kaiser Permanente purchases and displays art from local artists in the communities that it serves. Here’s a piece from the Colorado Springs Medical Office:

This week’s photograph is of one Kaiser Permanente’s newest medical offices, in Colorado Springs, Colorado. In addition to this photo, I’m posting two panormic views, of the Briargate Senior Center (above) with Memorial Hospital Across the street, and one of the scenic viewpoint from I-25. There are some views of the interior of the new facility below.

If you’ve been to the Sidney Garfield Center for Healthcare Innovation, you’ll recognize that the work done there in the health care environment is now real for patients, nurses, and doctors.

This medical office, as you might expect, does not have any space for paper charts or x-ray films – medical record and imaging information is captured digitally, allowing for more space for patient care.

My visit to Paulanne is part of a visit to innovative medical practices in the Kaiser Permanente, Colorado Region (now with it’s own Twitterfeed in 2009: @KPColorado). I happen to have come at at time full of pride for KP Colorado, as they have just been named the #1 Medicare Health Plan in the United States, which makes them the best for customer experience, prevention, and treatment, as measured by NCQA.

Actually, it’s top 1 ….

And…the practices that I have been visiting are demonstrating how KP Colorado got there. As I have written previously, it’s remarkable to watch clinicians in this system, who have been using a robust electronic health record linked to a robust personal health record (at kp.org) for over 2 years now. There is good understanding of the advantages of being electronically connected to patients and to each other, as well as a continuous drive to leverage these systems to their fullest potential (and maybe beyond what they can handle, even in 2009).

I was also able to shadow Kathy Mayer, MD and Michael Pate’s practice at Kaiser Permanente Southwest Medical Office in Denver. I have mentioned this practice previously, as one that is known inside and outside of Kaiser Permanente as one with a very well formed team approach to caring for patients. And, as the rankings reflect, they have great quality results. In a mature EHR environment like this, support of whole populations of patients is possible, no more hoping that a patient will come in and have their preventive care performed. In fact, as I was there, Dr. Mayer completed identifying the last few patients on her panel that did not have necessary preventive care performed so that they could be contacted to be up to date.

I plan to be here for a few more days, to see more practices in different parts of the region, and to learn about several innovations and potential innovations in care that are being developed here. I also did something new this time, by inviting colleague Jan Ground, a project manager from Colorado Permanente Medical Group, to shadow with me. We have been able to compare notes on what we see, and Jan has been able to contextualize what I have been seeing as someone aware of the operations here.

The most important thing, though, is that we are seeing things at the level of the patient, the highest level there is in health care.

Here are some more photos of our journey – Denver is enjoying the aftermath of a snowfall earlier this week….