Where the magic happens

I had the opportunity to talk about participation (of patients, families, and communities) in health care and the design of the health system today at the Agency for Healthcare Research and Quality (AHRQ) headquarters in Rockville, Maryland, at the invitation of AHRQ’s Director, Carolyn Clancy, MD, with attendance of experts including Jon White, MD, Director of the Health Information Technology Portfolio for AHRQ.

What can I say except it was a great experience at a place I and many people who do what I do have thought highly of for a very long time.

The slides I presented are below. I want to thank the students in the University of Washington eMHA program for doing a run-through with me. One of the suggestions I was given was to know what I “wanted” in giving this presentation to AHRQ. I told the group that I thought about this, and it was - to inspire them. I think that’s both enough to want, and a lot to want.

The session is/was a reminder to me that in 2008, people who are studying health information technology (a) have a good grasp of the idea that it’s a tool to improve health and health care and (b) the importance of involving patients and families in their care. That, and we should look outside our borders, to places like Africa, to think about innovation in IT beyond the computer.

Inspiration is a 2-way street. Thanks again Bill, Carolyn, Jon and AHRQ for the warm welcome.

I am attaching the opening remarks that I made, alongside Veenu Aulakh, at the Patient Online Access in the Safety Net discussion, hosted by the California Healthcare Foundation. It describes the “why?” in the context of my journey of discovery. Click on any image to see full size, and comments are welcome.

Update: Incidentally, depending on the reviewer, I am either congratulated or questioned about my presentation style. I just ran across this very nice slideshare : Death by Powerpoint . See if the slides below are more similar to that ideal (I hope they are)

I started off a presentation-in-the-works to students in the University of Washington Executive MHA program, led by David Masuda, MD (who, sadly, doesn’t have a blog, just a Twitterfeed, it’s a journey…), with the words, “This is a beta test,” and I’m glad I did.

The beta test part is true, since I was asked by Carolyn Clancy, MD, from Agency for Healthcare Research and Quality to reprise and elaborate on a talk I gave at the American Board of Internal Medicine Forum in July for a seminar at AHRQ later this month. That was a 10 minute presentation, the one coming up is a little more full. The way I like to do these when the presentation is in evolution is practice to myself, of course, but also to test with a smart audience to read the feelings/emotions that are created (which is what I think a presentation is for - read more about this here) and see what ideas resonate well and which ones don’t. I usually tell the test audience that I’m testing, and it really helps, because it engages the discussion beyond the content, to how to make the content help other people after this group. Synergy.

Luckily, Dave and his co-students gave me the opportunity to do this.

Before it was my turn, I got to see Rick Rubin, President of Washington’s OneHealthPort in action, talking about community collaboration in the health information technology space. In my travels, I have seen that OneHealthPort is really a gem in the area of health information technology (when people find out about it). It’s company that supports collaboration among potential competitors who jointly have a business need for this collaboration. Whenever I mention that it exists on the East Coast, I have always gotten a good amount of interest in it (which I in turn forward on to the OneHealthPort folks).

I didn’t know before this day that Rick is from Boston, which probably accounts for some of my draw to his style. I think OneHealthPort should get more exposure nationally as a functional model for community collaboration and I reflected on the fact that doing business behind the Cascade Mountains in the Pacific Northwest sometimes shields the nation from some really good ideas. Place matters.

My turn - I worked to combine my work at Group Health with my work at California Healthcare Foundation, and beyond, with Participation as a theme, which is really where I have come to in terms of what I am about professionally. I think it went okay as a first run. I got great feedback from the students (all accomplished health professionals in their own right). I included some information about the 60 Minutes piece about Cedars Sinai and heparin. Luckily someone in the audience had first hand experience with this situation, and I need to adjust the presentation about this - it’s a reminder to be careful about telling other people’s stories, they know their stories better than I do (and vice versa).

One of the physicians in the class, who’s an Infectious Disease specialist, let me know that this approach to health care resonated with him as a physician supporting HIV patients, and how it was when his cohort of specialists began practicing a new way based on the needs of his patient population. I thought this was great to hear - I tell people that my cohort of physicians (Generation X) went through medical school during this time, and as a result we (I) graduated with the idea that I would work with patients who would know more than I would about their condition (which I embraced).

As far as the presentation I need to tighten it up more, and link every section to the concept of participation, and maybe a little leading on what should be done to foster it (study it in the leadership context among health providers? study it in the leadership context among patients guiding health systems? Going beyond studying participation of patients in their care). One of the parting commenters said to me, “It was very entertaining, it needs more substance,” and then, “you asked for feedback, so I wanted to give it to you.” I’ll take it, and since I’m now an East Coaster, directness really works.

I’ll wait to post the slides at the end of the month, so I can work up these ideas a little more.

Thanks again, Dave and University of Washington eMHA students for allowing me to continuously improve my continuous improvement!

I think word has gotten out that I am something of an urban dweller; Susan Edgman-Levitan was nice enough to ask me, “Ted, are you hanging in there?” as we spent several days in Yountville, California at the American Board of Internal Medicine Foundation forum on Achieving Patient-Centered care.

I ended up doing just fine - it’s about the content, not the place, and a scenic jog through the vineyards of Yountville can’t be argued with.

And the content was right up my alley, with thanks to the ABIM Foundation for hosting this discussion. The discussions at the Forum are being compiled by the ABIM Foundation, so I will let them report on that rather than me, but I can share my perceptions of the event here.

First of all, patients and families were involved throughout, as faculty and equal participants. This continues an important precedent in helping health care leaders achieve comfort with this idea.

One of the most powerful moments was Margaret Murphy sharing the story of her son Kevin’s death (You can read more about it here) within the Irish health system. I really appreciated Mrs. Murphy’s use of images in her storytelling - in the future, a presentation without at least 50 % images and a video or two is going to be minimum bar to go in front of an audience. There was discussion about Kevin’s death being the result of diagnostic error. I think that’s true, and I also think that if the family had access to all of his medical information from the beginning, it might have changed the diagnostic approach or caught the fatal series of errors before they happened.

For my part, I presented the following slides in the 10 minutes I had alotted, around the topic of the use of health information technology to put patients, families, and communities in the center of care.

Enjoy (I hope) and thanks to the ABIM Foundation for hosting this discussion and follow-up.

Click on any image to see them larger

I am posting this presentation that I created, commissioned by the California Healthcare Foundation, and supported by the Center for Information Therapy and indirectly, Group Health Cooperative.

It is the presentation that created the need for me to define Health 2.0. It is also the last presentation I will give as as a Group Health employee, and the only time I will be able to give it, due to my my career change.

It’s in slide show format, so feel free to click on any of the images and page through. I had a lot of fun putting it together because it allowed me to reflect on what I learned and how much I have changed in my thinking in just the past year. May the same trend continue.

I would like to extend special thanks to Crosskeys Media, producers of the excellent show “Remaking of American Medicine,” for allowing me to use portions of the content in the interest of supporting patient centered care. I encourage anyone interested in this topic to view or purchase the show. There is an educational license available that allows for use in teaching (as a whole piece, not intended for editing by users). It’s worth it.

Feedback and comments welcomed.

Application of the Toyota Management System across the Group Health Cooperative System Webcast (2/26/08)

I come from a leadership heritage that says, “help others be successful,” so I jumped at the chance to bring two great business partners (Karl Hoover, Executive Director of Quality&Informatics, and Lee Fried, Senior LEAN Consultant) together to conduct a national event on Group Health Cooperative’s work implementing the Toyota Management System across the enterprise. It was fun, and Lee and Karl are always great to listen to (as well to work with).

I attached two slides to the right which are around my contribution to the work, which dramatically changed the way we develop and maintain a statewide electronic health record with linked personal health record. The work was a lot of fun and very challenging at times (which is normal for a LEAN transformation, many peaks and valleys). I like challenges like this in what you learn about yourself in the process. One thing I learned about myself is that I am not afraid to work with people who are smarter than me (Karl and Lee as an example). It’s an attribute I have always looked for in other leaders, and I am happy I developed it, too.

Enjoy.

PCHIT links for January 11th through January 13th:

• Racial Disparities in cancer therapy among (FFS) Medicare Beneficiaries - I think this is really “Racial Disparities …among Fee For Service Medicare Beneficiaries,” since HMO enrollment was excluded from the study. The data are concerning regardless, and raise the question of PCHIT in enhancing access to information in making

AHRQ-Funded Projects: Using an Electronic Personal Health Record to Empower Patients with Hypertension - Innovative grant to Medical College of Georgia to develop a PHR on the Cerner Platform

• The Big Opt Out » About the campaign - A campaign led by patients to opt out of NHS data sharing (UK)
• Kaiser Permanente EHR System Facts - KP HealthConnect Electronic Health Record Project - As the title says, a handy public status update of the KP HealthConnect Project
• Medical Care - Abstract: Volume 45(12) December 2007 p 1205-1209 Behind-the-Scenes of Patient-Centered Care: Content Analysis of Electronic Messaging Among Primary Care Clinic Providers and Staff. - Impressive: 47.8% of all messages between providers and staff dealt with the act of communicating and informing staff of attempts or achievements of acts of communication.
• SpringerLink - Journal Article - See the review on the pchit.org blog
• The Diabetes Patient Portal: Patient Perspectives on Structure and Delivery — Hess et al. 19 (2): 106 — Diabetes Spectrum - Early focus group testing from UPMC’s patient portal. Patients understand efficiency gains to the system and wonder why they should pay more, therefore.

PDF: Web 2.0 for Planning, Communication and Change Management, Ted Eytan, MD

Given at California Healthcare Foundation’s new headquarters, Oakland, CA

It was a busy week in California, starting with a visit to the California Healthcare Foundation’s new headquarters in Oakland, California. I was honored to lead a discussion on the use of “Web 2.0″ (mostly focusing on blogs) in health care. This blog itself is an experiment, partially funded by the Foundation. I think the basic message is “If you don’t, they will,” and “being transparent and accountable as a health system can inspire confidence.”

I first gave this presentation with Andy Wiesenthal, MD, who leads the Kaiser Permanente HealthConnect project, at a User Group meeting for Epic Systems clients, later within my own health system, Group Health Cooperative, and now this public version.

I am a bit of an evangelist now of using Web 2.0 in Healthcare, and consider myself “very available” when it comes to the opportunity to give this presentation to other audiences. It’s been a great journey, as you can see in the slides.

We had a nice discussion about the value of blogging and transparency in different environments. The presentation is meant to be informational, without any particular recommendation for the philanthrophy community. Of interest, though, was a question posed about how to move to Web 2.0 in a large organization. My answer was, “Slowly” and “not to shock the system.”

What was really great was that Holly Potter, the Director of Communication for the HealthConnect project was in attendance, and her response was, “It would be nice to have the luxury of being that deliberate. We don’t have that option anymore.” Holly’s team supports a project that touches millions of lives. She related her experience as the person accountable for ensuring that the communities that are touched by this project have the most accurate information about it, all the time. It was very powerful to have Holly present in the discussion, in my opinion.

Council of Accountable Physician Practices (CAPP)

Speaking of accountability, I was also fortunate to meet Nancy Taylor, the Executive Director of CAPP, which is an affiliate of the American Medical Group Association. The medical group I belong to, Group Health Permanente, is a member of CAPP, and these are the medical groups that are working to promote a health care system that is “more accountable to patients, consumers, and purchasers.”

I actually didn’t know about CAPP before I started this work, but as I look at the roster, it’s a who’s who of innovators in the personal health record / patient-centered care world.

This is not to say, though, that CAPP groups are the only ones innovating. As I discussed previously on this blog, there is a lot going on in smaller practices supported by the American College of Physicians and the American Academy of Family Physicians. At the same time, this consortium represents another nice touchpoint for those who ask, “Who can I talk to about implementing patient centered health information technology?”

Of course, in the shadow of the talk I had just given, I thought about which of these medical groups have blogs where they are communicating their work to the public. I don’t know the answer to that question (and if any of them are reading this, please post your comments here about that). I hope at some point to interact more with the Council and maybe discuss the opportunity to be even more transparent using Web 2.0 technology

I am wrapping up my time in California, with just a few more posts to go, and I wanted to again thank the California Healthcare Foundation and The Council of Accountable Physician Practices for their support of patient centered health information technology.