This photograph is from a session using Tapulous’ Twinkle software, which is a location-aware version of Twitter. This exchange is evidence that the iPhone’s most powerful innovation is not 3G, it’s GPS, which Apple, Inc., has now seeded into the mainstream, just as it did with a host of other technologies, like Wi-Fi.

What is shown here is community being created with complete strangers based on location - this exchange happened when my tweet was broadcast to everyone within a 1 mile radius of the San Francisco airport.

Some of you out there have been expressing your reservations about Twitter, Friendfeed, and the like. Here’s a nice article about both. Don’t be reserved, these are important technologies that will have applications in healthcare. Get your Twitter accounts now. Post your ideas in the comments, as well, please!

And San Francisco, thanks for being nice. You never disappoint.

I admit, that maybe, once or twice in my past, I may have used convening and convener in less than flattering terms, much like I used to use “process” in unflattering terms. I learned through LEAN, though, that process isn’t bad, bad process is bad. And so I have learned the same thing about convening, now that I have done it a couple times this summer, with the California Healthcare Foundation.

The most recent time was yesterday, when Veenu Aulakh, MPH, and I brought together Safety Net health care organizations, and national experts in patient online access and social impact of the Internet to talk about (you can guess…) “Patient Online Access in the Safety Net.”

These being the first convenings I have co-led, rather than participated in, I have learned a ton, and have gotten a good understanding of doing this for a purpose, which both situations have had. In the event we hosted yesterday, in Oakland, I put together an A3 document before we invited anyone, which included the background, the goals, and most importantly, the “why?” we were doing this in the first place. It was really helpful to have created agreement around the “why?” - I referred to this many times in the planning.

At the event itself, I got a new perspective that I had not had as a participant previously. It was one of listener/observer - even when I was doing the talking, I was interested to see reactions and learn what people and organizations are capable of. It made me think that when I have been a participant in convenings in the past, this is what my hosts were doing - learning what myself or my organization was capable of doing to solve a problem, as much as they might have tapped me as an expert. Interesting to have this happening in my brain.

Sharing information happened, too, courtesy of some of the most innovative organizations in the U.S., including Cambridge Health Alliance, University of California, San Francisco’s Positive Health Program , New York’s Primary Care Information Project, Institute for Family Health, and Kaiser Permanente.

In addition to all of this, there were a few nice moments of recognition for people’s work, such as when Jim Kahn, MD, thanked Kate Christensen, MD, and her team at Kaiser Permanente for their support and assistance in the launch of the myHERO patient portal for HIV patients cared for at San Francisco General Hospital.

…and a little something for me, a follow-up conversation with Hilary Worthen, MD, from Cambridge Health Alliance, about his study and pathway to discover and implement LEAN in primary care at CHA. He told me that for him, this is a transition from thinking about exam rooms and staff to “work that you need to get done, defined by doctor and patient.” I love hearing about how people apply their creativity and copy the thinking of LEAN to do exceptional things for their patients.

This being the second time I have done this, I don’t know if it was perfect. We tried a lot of things I’ve not done in meetings before, and I am still working to integrate social media before, during, and after. I am definitely sold on my philosophy of supporting any and all technology use (”if you need or want to use your device, use it”) - I have not, in my conveningness, come around to the “turn your devices off” philosophy, as I have written about previously.

Oh, and I learned that a 60″ table seats 8 people.

Here are a few images from yesterday. I’ll follow up with my slides in a separate post. Click on any to see larger size.

This week’s photograph is a special West Coast edition, about a city and neighborhood going through an enormous transition. This is Capitol Hill in Seattle, where a significant number of businesses have been relocated in preparation for a light rail station (see the photograph below), and to the north, condominums are going in (cranes in the background there).

The building of public transit can be difficult times for neighborhoods (think, Mission District, San Francisco, U Street, Washington, DC). I wish Seattle the best.

Publishing has been a bit delayed on this blog (but not on my TwitterFeed, I am starting to get how each thing fits together depending on what one is doing), due to the distraction of the beauty of the Seattle summer.

As part of reconnecting with friends who are also iPhone users, I ended up participating in an application-downloading binge. “What does that application with the funny name do? I don’t know, let’s just install it and find out.” I did have the sense to stop and create e-mail aliases for some of them before signing up, but it’s otherwise interesting to reflect on the mob mentality’s ability to modulate concerns about identity exchange. That in itself is interesting - the agility of Apple’s application distribution scheme is going to change a lot about the viral use of software.

What happened next was even more interesting. I have been using Tapulous’ software’s Twinkle for a while now. It’s a Twitter-based application that publishes location information along with lifestreaming events. So, depending on where you are at any given time, it will show you your friend’s tweets, and with the press of a button, anyone who is tweeting around you. The interesting part is that if no one has tweeted recently, it will go back in time, to the location where you are.

While driving across the WA-520, pushing the button revealed the tweets of the people who had been stuck in traffic on this notoriously congested floating bridge hours and days prior. As we crossed effortlessly in the evening, I saw the frustrations of many a driver in the past few days while in the same place. It was a sort of a “kilroy was here” - a twitter signature of a place with meaning to Seattleites (this is the bridge that connects many Seattle residents to work for a very large software company in Redmond, Washington) that would persist.

Of course there’s a tie in to healthcare. Think about all of the places with meaning in the healthcare temple - the operating theatre, the waiting room, the intravenous infusion center, the intensive care unit. If a person had used the Twinkle application in one of those places, any future visitor could pick up the tweets/feelings/emotions of that space. Kind of like an emotional geiger counter. If we did a sweep now in these places, what would we find about these environments? Would it be good news or bad? Will America’s hospitals and health care settings create “no tweet” policies for staff within their facilities? Or would they do the opposite….

What if a health care organization used this feature with intention, and asked patients to tweet their feelings during these meaningful times in the lives of themselves and their families while physically located in these places. The tweets would remain fixed to the GPS location and would be retreivable forever in the future. It’s interesting to think how this could potentially connect patients and families to each other across time and place. Imagine if you could ask, “what were the triumphs and the sorrow that happened in this room before I came into it?”

In the meantime, the next time I am in a health care environment, I will have my location aware device “on” and listening…

If anyone else here has used Twinkle or any other location aware lifestreaming application, feel free to post your experiences here.

This week’s photograph was taken on the National Mall, where the movie “The Apartment” was being shown as part of HBO’s Screen on the Green Series.

There was an interesting dialogue between Jack Lemmon (who works in a large insurance company) and Shirley McLaine (who’s an elevator operator in said company) in this 1960 film:

BUD
They got a great little band at El
Chico, in the Village — it’s
practically around the corner from
where you live.

FRAN
Sounds good.
(a sudden thought)
How do you know where I live?

BUD
Oh, I even know who you live
with — your sister and brother-in-
law — I know when you were born –
and where — I know all sorts of
things about you.

FRAN
How come?

BUD
A couple of months ago I looked up
your card in the group insurance
file.

FRAN
Oh.

BUD
I know your height, your weight and
your Social Security number — you
had mumps, you had measles, and you
had your appendix out.

They have now reached the corner, and Fran stops.

FRAN
Well, don’t tell the fellows in the
office about the appendix. They may
get the wrong idea how you found
out.
(turning the corner)
‘Bye.

Many people in the audience were laughing during this part (and I assume many in this crowd probably are very engaged in these issues), and it made me think about how we got from there to here, and a thought provoking question: Did HIPAA solve a problem or is it a band-aid on a bigger, deeper one?

Lastly, on this gorgeous summer evening, I also encountered a curiosity of this series, the HBO Dance, which is choreographed to the opening theme many in my generation remember before the days of cable. It’s always good to dance, and laugh, every day - and that does happen in Washington!

Video posted below, along with a bonus image of the crowd.

Free Movie, originally uploaded by M.V. Jantzen.

Everything in moderation, including moderation…

This week’s photograph confirms Richard Florida’s research (just a little) about extroverted types being closer to the Atlantic than the Pacific Ocean.

Frozen yogurt is back. In a big way. As a Generation Y customer in line told me, “(large ice cream chain) is doomed.” I really enjoy a place where people are easy to engage, and they walk to get places. In this case it’s to one where the product sold is only 25 calories per ounce. Not bad! (More pictures of the atmosphere are here, this place is Web2.0 enabled)

click on the image to see it full size

I took this photograph as I was walking to Georgetown and noticed the Ghost Bike placed in Dupont Circle by the Washington Area Bicycling Association. The ghost bike was placed in a ceremony on July 10 (more information here) following the death of 22-year old Alice Swanson, who was killed by a garbage truck while riding her bike to work on July 9, 2008, in Dupont Circle.

As I walked by, I noticed the words written on the tire by Alice’s mother. They had an impact on me. They will on you too. Click on the image to see them for yourself.

This week’s photograph is from my favorite museum in Washington, DC, that I was able to reconnect with this week, The Reynolds Center. The Reynolds has a brand new, beautiful, climate controlled atrium, with a Wi-Fi connection. On this evening, DC residents and visitors are enjoying a free jazz concert. Two bonus images are of the audience enjoying the show and an exterior of the museum just after a summer rain.

The lunch time session at today’s Patient Centered Primary Care Collaborative Stakeholder’s Meeting included the voice of the patient, in this case a person who is a school principal. The quote in the title of the post is just an example of how the conversation changes when the patient voice is included. We stop thinking about health care as an end and more about life goals, with health care as a means.

Kudos to the meeting organizers for explicitly including the patient voice.