I am always delighted to meet other physician bloggers, and such was the case with Bob Wachter, MD, who’s a physician that blogs, and from within academia. That’s rare, and welcomed, by me for sure.

He recently wrote this piece, Will Knols and Blogs Upend the Cozy World of Medical Publishing?, which echoes several ideas I have been having since I started blogging, especially around the idea of, as he calls it, “the democratization of peer review.” (I’m focusing on the comments about medical publishing - the world of Knols appears to be experiencing a rocky ride)

As I occasionally get requests to write for peer reviewed journals or books or I consider writing for them, I have been pausing to ask, “why?”

This is especially when the difference is between instant access and feedback to the people I serve, versus a smaller group of individuals with (potentially) limited experience in the ideas I’m writing about, and the medium I use to write them in. I say this without any predjudice to the publishing community - I am just not sure where physicians in my generation will fit in moving forward, unless the model is changed.

Bob refers to the difference between “Having an article peer reviewed by 3 experts is different than having 17 Joe Six-packs;” however, I’m not sure what the difference is, depending on the issue, between those two constituencies - what’s an expert in if she/he isn’t a person “just like me?” Also, what’s the value of a single (relatively speaking), private, review, that will be locked in time and space, forever? Robert Scoble speaks well to this in the post “Scoble Defends Blogging (Again), and He’s Right (Again).”

I do not work in academia, where people are incentivized/rewarded for the number of peer-reviewed publications with their names on them. I think a deeper question that should be asked, is, “What’s the best way, in this millennium, to produce portable knowledge that can be used by others?” I have talked with innovators in academia who have not shared their knowledge because of the effort required to publish to medical journals. That’s unfortunate.

How could the reward/incentive system in academia be reconfigured to respect the many different ways people can share knowledge, and put them to use to help people? I think it could be, and in turn a lot of great ideas could be unleashed.

Bob mentions in his post that he submitted his piece to two medical journals, who rejected it. However, we still get to read it thanks to Web 2.0.

I’m not even going to try with this one. And I sort of don’t have to.

JAY PARKINSON + MD + MPH

How long before HelloHealth comes to Washington, DC, with the most regional-serving walkable urban places per capita in the country?

Note: There’s been some buzz about walkability for other cities as well, also fine choices for those who love living in places that support walking.

Yesterday I had the privilege of speaking at the pre-course for Internal Medicine 2008, American College of Physicians annual conference, in Washington, DC. The topic of the pre-course was the focus on the individual practice, and was facilitated by the great team at the Center for Practice Innovation, including Michael Barr, MD, MBA, FACP, Paula Woodward, MPH, BSN, RN, and Maria Rudolph, MPH.

I really like working with this group first of all because Michael and Paula assemble entertaining and fun experts, like Gordon Moore, MD, Rodney Hornbake, MD, and Peter Basch, MD. All of these physicians, and fellow panelist, Maria Rudolph, are “current” in the field and honest and passionate about improving patient care, which includes being able to stage agreement and disagreement. It’s sort of East Coast, and I like it.

The second reason I like this group is because they represent the overwhelming majority of care environments for patients in the U.S. (over 90% get care from small practices). In terms of promoting patient-centered care for every patient in every system, these are the physicians who have both the ability to innovate and the fiduciary responsibility to make it work for their practice. Putting those two together makes for a perspective that is supportive of HIT and patient centered HIT (that’s what I observed) that succeeds for patients, and those who care for them. I think that’s what we want.

We were asked to provide some parting words for this group, and honestly, I feel a bit awkward being a teacher to this group of practitioners. In many ways they see a lot more of healthcare than I do. In any event, my parting words were that when it comes to HIT, they know more than they think they know, and are well suited to ask, “how will this work for my patient?” That and they should ask every patient if they access the Internet.

ACP enters the blogosphere this week with ACP Internist. A great move for this specialty society, in my opinion.

My visit was capped with a trip to see my colleague David Kauff, MD, from Group Health Cooperative. I have to say that I had to make my way through quite a bit of product placement (more than I would expect to see in 2008), and I wasn’t allowed to take pictures in the exhibit hall, but it was well worth the trip to meet up with one of my favorite internists.

I was interviewed by journalist Kyung Song from the Seattle Times for this article, which appeared in today’s paper:

Local News | Group Heath trolling cyberspace to learn what patients think | Seattle Times Newspaper

This was the first interview I have done representing both the organization I work for, and myself as a blogger at the same time. Usually, it’s one or the other, because the words on this blog are my own and not those of my employer (although obviously our approach to patient centered health care is well aligned). The worlds are starting to collide….

I definitely believe that there is content that’s traditionally outside of the physician-patient relationship that can and should be brought in via blogs and the like. We saw it with secure e-mail between patients and physicians to be sure. It changed our relationships, in a healthy, helpful way.

My personal belief about blogs and Web 2.0, though, needs to be coupled with an organization’s need to have a workflow and platform that brings in the right information at the right time. I definitely don’t expect a physician to review the 2,000 RSS feeds of their patients (and I don’t think the patients do, either).

That’s the fun intersection, and it is good pressure, to bring everything about a patient that matters to them into every clinical interaction.

See what you think…

I am in Oakland, California, today, participating in an discussion sponsored by Kaiser Permanente about Web 2.0 applications in health care. As part of the discussion I presented my story as a physician who wrote a blog internally for our medical group, and since October, 2007, on the public Internet (here).

From 2005-2007 I managed an internal blog that ended up having 748 posts total, so for 2 years, I posted something almost every business day, along with other physician informaticists on my team with me. That’s quite a commitment. This blog has 298 posts on it since October, 2007. I actually never thought I’d keep a blog, but I’m (a) glad I’m doing it and (b) glad I have a story to share about it as a Health Information Technology leader. I want people to know how I am serving them.

I also got to moderate/interact with two industry experts in the field, Tim Collins, SVP of Experiential Marketing for Wells Fargo Bank, and Lee Aase, Manager for Syndication and Social Media for the Mayo Clinic. It’s an honor to meet other industry leaders who are embracing this technology, and they are embracing it. I know this is the future (or the present…)

Given my experience, the idea of patients bringing their user generated content into the physician patient relationship really interests me. Could an electronic health record of the future subscribe to specially tagged RSS feeds from our patients? I don’t think physicians can or would be following 2,000 lives worth of lifestreams. However, if there’s something in a patient’s life that they want us to know about and can get it to us without double entry, I think that information would change the content of our relationship a lot. And in a good way.

March 18th through March 19th:

• The ‘World Wide Computer’?Another HAL? - Businessweek’s Review of “The Big Switch” - I used it for comparison
• NPR: Doctor Blogs Raise Concerns About Patient Privacy - I agree with points raised - a patient should never seek care and then discover that they have been written about on a blog. Instead, they should receive a copy of the medical record that has been created about them. At the same time, physician bloggers are doing something very important - they are testing the boundaries of transparency, to support a more accountable health care system. If anyone saw the 60 minutes story about Dennis Quaid and his family, the rationale for this become very clear.
• What Every Physician Should Know About the RUC - January 2008 - Family Practice Management - The information is useful. As primary care providers I think we need to be careful to include our specialty colleagues in the conversation, not distance themselves from it. As a member of a large multispecialty medical group, I know that there is interest across the physician community in supporting community health and the best experience for patients.
• MindBlizzard blog: Virtual Healthcare 2: Palomar Pomerado Health - All right - More news about the utility of Second Life - testing a hospital before it launches
• What is the ROI on employee suggestion systems? - A nice example from the toothpaste industry. But not necessarily one that supports the evidence, that far less toothpaste than people think is needed to protect teeth…..Maybe a customer suggestion system might be in order.

February 18th through February 19th:

• Graffletopia - Nice set of stencils for Mac users of diagramming software
• Lean Manufacturing Blog, Kaizen Articles and Advice | Gemba Panta Rei - Primer on Hoshin and SMART goals
• Life as a Healthcare CIO: Rapid Application Development with Facebook - Looking at innovative consumer technologies as an opportunity in the CIO role is a great thing. I’m a fan.
• Hooked: Ethics, Medicine, and Pharma: Institutional Conflicts of Interest Policies: Some Assembly Required - This tracks back to medical schools’ support of community health…
• Health Care Renewal: Medical Schools to Faculty: “Show Me the Money” - The contribution of medical education to fostering patient centered care is challenged by the current system.

February 4th through February 6th:

• DC Moves for Safer Sidewalks - Get There - Washington government takes a step toward promoting walkability. Sidewalks stay open for business.Walkers rejoice!
• Apple //c - a photoset on Flickr - The OOB experience of an unopened AppleIIc computer. Remember when technology was fun? It still is. And I never even learned to program in Pascal.
• Ryanair’s Changing Altitude - Efficient cost management and charging for everything keeps margins high at RyanAir - a great example of “copy how we think” in terms of being like Southwest
• Running a hospital: More on fetching and work-arounds - BIDMC launches an improvement methodology called SPIRIT. Looks like it’s at least partially based on LEAN?
• The Health Care Blog: Bad Medicine: How The AMA Undermined Primary Care in America - Brian Klepper - Analysis of RBRVS and impact on primary care.
• The ethics of CEO blogging - Nice discussion from Paul Levy about the approach that a CEO takes to blogging. I’m in support!
• Insurers Begin To Reimburse for Online Visits, Concerns Remain - Nice profile of Kaiser Permanente’s program.
• Marriot Rolls Out Web-Based PHR System to Employees Nationwide - iHealthBeat - An employer-sponsored PHR. Will the lack of connection to the health care team be an issue?
• KUOW: Program Archive: Patient Safety, January, 2008 - Dr. Matt Handley, from Group Health Cooperative, is featured
• Best Companies 2008 - FORTUNE Magazine’s Top 100 Employers to Work For - The 2008 list is out. From an HR/Leadership perspective, it is interesting to look at some of the most important qualifications for being on the list, such as support for diversity.

• Health IT Pioneer Calls for Changes in Federal Health IT Strategy - iHealthBeat - More changes requested in federal involvement around Health IT
• JAY PARKINSON + MD + MPH on Carol - Jay says it isn’t going to work. I’m not sure it will either as I think about what Apple had to do to create the iPhone. I found the CEO’s ideas compelling. We should start with what’s best for those we serve and figure out a way to make it work.
• ChangeThis Newsletter: 42.05 Ideaicide: How To Avoid It And Get What You Want by Alan Parr and Karen Ansbaugh - I would call this a nice primer on “Nemawashi” - or conversations around the office to get ideas off the ground.
• A Food Fight Over Calorie Counts - Interested more in the approach to sharing information than the issue of calorie counts (per se) - that “consumer confusion” is used as the reason to not provide information.
• Chapter 70.02 RCW: Medical records ? health care information access and disclosure - Background information; Transparency Law in Washington State
• Forrester?s Top Health-IT Predictions for 2008 ? Digital Healthcare and Productivity - Clinical analytics, EHRs gain a greater toehold, RHIOs will take a little longer. My experience in the field seems to resonate.
• The Health 2.0 Blog: Carol aims to disrupt the health care market by Matthew Holt - There’s that “d” word again, in reference to Carol.com. Can they do it? If we think about creating patient-centered HIT systems, why wouldn’t we include cost information as part of the Information part of HIT?

I received this insert in the mail recently. No better time like the present than to start blogging. It’s from The Department of Health Policy News, which is described as follows:

The Department of Health Policy at Jefferson Medical College is committed to conducting research and education programs that will contribute to the quality, safety, and cost-effectiveness of health care. The Department’s activities are meant to inform decisions made by government policy makers, providers, payers, and other health system stakeholders about how best to deliver and finance care in order to improve the health of the public.

I support blogging by health system leaders to support a conversation with the people we serve. Of course I subscribed to the RSS feed.