Making Health Care Measurement Patient-Centered: Convening to Develop Principles and Strategies

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2016.09.30 Making Health Care Measurement Patient-Centered 08234 With @DrNic1 @kymlmartin @Lygeia (View on

As the title says, I attended this convening, “Making Health Care Measurement Patient-Centered: A Convening to Develop Principles and Strategies,” which you can review in more detail on Twitter (#PtCenteredMeasures) – one of the joys of this movement compared to others is the regular use of social media compared to others (*cough* environmental stewardship movement) – they’ll all get there with our help.

As I said in another post, many parts of these get togethers are really a proxy for respecting humans in health and health care. That’s good news because everything that’s being discussed by this group has applicability everywhere, from measures in health care to equity in health.

This is because equity comes from the ability to control one’s own destiny, and that means being able to participate and advocate in a group’s best interest. And what better group is there to advocate for than humans. As part of the walking gallery of health care 🙂 .

How to Build Health into Design – a day with Green Health Partnership

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2016.06.21 Heath and Design with Green Health Partnership 00649 (View on

Yesterday a bunch of friends (at this point) got together to explore solutions to bring health into the design of the built environment. You know, where we spend 90% of our lives.

As I said to a group recently, there may only be a single digit percent uptake of a fitness device, there’s 100% uptake of the street you’re walking on or the building you’re inside of.

The part about us being a bunch of friends – architects, public health experts, doctors, planners is both a good thing and a thing worth noting. Good thing is we all see a sustainable and health promoting future in the way our society is constructed. Thing worth noting is there is more to be done and more people needed to support it to make this the norm. Hence the workshop.

I continue to learn tons about the way our environment is built and all of the opportunities that exist to integrate health the way energy efficiency has been integrated successfully over the last 20 years. Doctors still love designers – they help us perform better for society. I hope many physicians and nurses get to work with designers in their lifetimes or while they’re training. Imagine all the health that will happen then.

Speaking of health, I mentioned a few projects of Kaiser Permanente’s that inspired me recently that I’ll link to from here:

Infused with the sights and sounds of the beach: the new Kaiser Permanente Santa Monica Medical Office


Photo Friday: Kaiser Permanente Antelope Valley, Lancaster, CA USA

Both of these projects, and the people within them (yes, including the people) are a glimpse into the future of all of the built environments we’re going to get to enjoy in our lifetimes. They’re congruent with the environment around them, open and inviting to the communities they exist in, and compassionate and sensitive to the people within them and the jobs they need to do. In this case, the jobs are to produce and promote health. Eventually every building will do some of that, even ones that aren’t in health care 🙂 .

More photos from the day, enjoy, and thank you to US Green Building Council (@USGBC), Robert Wood Johnson Foundation (@RWJF) and University of Virginia School of Medicine (@MedicineUVA). Thanks especially to our organizers Mira Panek (@miraisabel), Matt Trowbridge, MD (@MTrowbr), Kelly Worden, MPH (@K_worden). You can read more about this work at Green Health Partnership.

Just Read: My Connection Profile with Professor Sonya Grier, RWJF Leadership Network

Thanks to Meredith Wise and the team at the Robert Wood Johnson Foundation (@RWJF) Leadership Network, for putting together this story about a connection between myself and Professor Sonya Grier, from American University.

Of course I already blogged about that connection here: Dog Parks & Coffee Shops + Leadership Networks.

Because you have to be a member of the Leadership Network to read the piece, I’m reposting it here (with permission).

The thing we’re trying to show is that social media is not about mass communication, which I think is a mistake that new entrants make when engaging. The most important network connections are the single points outside of your normal network. They are the ones that help solve problems. Abstracting out a bit, this is why diversity is a good thing – it allows the human species to survive…

I illustrated the science behind that here if you’re interested: Less connected social networks solve complex problems better : Go ahead, have a dream – Here’s the data to go along with the story 🙂

Solving Complex Problems 29657
Solving Complex Problems 29657 (View on

Professor Sonya Grier, American University at Center for Total Health 09586
Professor Sonya Grier, American University at Center for Total Health 09586 (View on

Meredith Wise
November 10, 2015

You never know where a discussion thread on the RWJF Leadership Network will lead. Recently, a conversation about diversity, inclusion and health brought two Network members together. The topic is an area of interest for both Sonya Grier, professor of marketing at American University (AU), and Ted Eytan, medical director of the Kaiser Permanente Center for Total Health.

The pair were excited about each other’s work, and since they both work in Washington, D.C., they agreed to visit each other to learn more about how their work intersects.

“I was impressed that a health system had thought about integrating the social determinants of health,” said Sonya about Ted’s work at Kaiser Permanente.

Ted was equally intrigued by Sonya’s efforts. “Sonya is doing research around the changing diversity in our communities, and I’m interested in that from a Culture of Health perspective,” he said. “I found it interesting that a professor of marketing was doing this research and wanted to know more.”

Sonya’s research is focused on multiple aspects of marketing—for example, the impacts of food marketing on obesity and how social marketing can be used to design interventions. Specifically, she looks at target marketing—how marketing choices communicate messages and promote products to certain groups of people.

Ted was able to attend a screening of Sonya’s documentary “DogParks & CoffeeShops: Diversity Seeking in Changing Neighborhoods,” a film about three communities in Washington, D.C. that are undergoing urban revitalization. The piece also focuses on the role of gentrification in supporting (or not supporting) diverse communities.

While making DogParks & CoffeeShops, Sonya and her team interviewed residents in the three neighborhoods to understand what can be done to promote inclusivity in rapidly changing areas. (If you’re interested, check out the trailer.)

“In the documentary, we look at how you can keep diversity in neighborhoods. There are people who want to live in diversity, but there are also tensions that arise when you bring people together,” Sonya said. “We try to identify these tensions and what marketers and policy makers can do to create inclusivity.”

Ted said, “Sonya’s documentary was really eye opening. We’re content to live in diverse neighborhoods that aren’t really diverse—we only connect with those like us.” After watching the film, Ted posted some additional reflections to his LinkedIn page, which you can read here.

Later, Sonya reciprocated by visiting Ted at Kaiser Permanente, where he works to create total health around the world. In his office, there is a space dedicated to visualizing this goal. (Check out the “What Does Total Health Look Like” community inside the Kaiser Permanente Center for Total Health.)

“This is where Sonya’s work fits in,” said Ted. “You can’t have total health without diversity. We are always searching for the experts and information that fill in the picture so that others can work toward it together.”

Sonya said she also left Kaiser Permanente with a new point of view: “As a non-public health person, when I started looking into health I saw this real differentiation between health and health services and systems, with health being more in line with population health,” she said. “To see both of those come together at Ted’s place of work was enlightening.” (Check out Sonya’s full reflections about her visit, which inspired us to write this Connections Profile.)

“Ted is embedded in a health system with a community perspective, and it helped me think through what my next steps in research might be,” she said. Their conversation further sparked thoughts about new areas of research for Sonya, such as gentrification and health.

As for Ted, he’s glad that Sonya was able to gain some new insights from his world. “It was great to see her realize that health care could be a real partner for her,” he said.

Thanks to their connection, Kaiser Permanente and AU have started to discuss ways they might work together in different areas, including diversity. Recently, AU has been thinking about ways in which they can best serve their increasingly diverse student body. Many schools are seeing diversity as a trend, and are working to adjust services to better serve their students.

Through Ted, Sonya has made some connections between Kaiser and different departments on AU’s campus. She acknowledged that if it weren’t for meeting him through the Network, she probably wouldn’t have thought to include health systems in her referrals for these projects—to her it wasn’t initially a direct correlation.

“It’s important to be open to things that might seem tangential to you,” Sonya said. “I wouldn’t have thought about a doctor in a health system because it didn’t play into my idea of public health. Being open to that discussion let me learn about it and develop a potentially important partner, and increased my own knowledge.”

Ted also offers some advice for those looking to make a connection on the Network: “Take a chance and ask if someone wants to talk – assume that any new connection is potentially worthwhile,” he said. “Sometimes you’re busy, but it doesn’t hurt to take 20 minutes to chat – you never know what you’re going to learn.”

Have you made a connection on the RWJF Leadership Network? We’d love to talk to you! Send us an email at

Sexual Orientation and Gender Identity Data in EHRs, convening at Fenway Health, it matters to all patients

Sexual Orientation and Gender Identity Collection in EHRs Convening at Fenway Health 57912Sexual Orientation and Gender Identity Collection in EHRs Convening at Fenway Health 57912 (View on

We will ALL be patients one day.

When it’s our turn, when we are horizontal, in our most vulnerable state, will people:

  • Call us by our correct name?
  • Find out who we are and why we are important to ourselves, our families, our community, society?
  • Do the right things to our bodies, in the most gentle way possible?
  • Heal us?

There’s a far greater likelihood that they will do all of these things if they have the information needed to bring their compassion.

This is why I went to the convening on sexual orientation and gender identity collection in EHRs yesterday. It was held at the iconic Fenway Health (@FenwayHealth), led by the iconic Kellan Baker (@KellanEBaker) from the Center for American Progress and the iconic Harvey Makadon, MD (@FenwayHealth). Robert Wood Johnson Foundation (@RWJF) was the sponsor, and now I come to find out that Mike Painter, MD (@paintmd) was the part of RWJF that sponsored – they’re iconic, too 🙂 .

The reality is that health care is not collecting this information accurately and is therefore not doing the things above for every patient, and not just lesbian, gay, bisexual, transgender, queer patients. All patients. And  not just patients that are horizontal, but who are just as vulnerable. And, Kaiser Permanente has not figured this out either. Like everyone in the room, we are trying. We need help. And that’s why we were there.

Fenway, Harvey, Kellan, Sean Cahill, PhD have produced a whole web site, Do Ask, Do Tell, which is brand new, and saves a trip to multiple pages on web sites and journal articles that I’ve been sending around to people for two years. I wrote about some of these principles in a previous post (and this paper is very worth reading: Now Reading: Electronic medical records and the transgender patient – to eliminate, not create, disparities | Ted Eytan, MD).

Specifically on the Do Ask, Do Tell website is a comment letter for Meaningful Use Stage 3, which lays out a lot of the specifications and background on SOGI (“Sexual Orientation, Gender Identity”) data collection. Very valuable reference – go here and read all of the linked letters.

Things like, accurate name and pronoun, organ inventory, identity, are pieces of information relevant to all patients.

Many human beings do not leave this life with the organs they came with, LGBTQ or not. There has to be a conversation about decoupling “sex” designation in medicine and “what organs are inside your body.” This is what health care, the verb, not the noun, is for 🙂 .

To get there, we need to figure out what the right questions to ask are, how to ask them, who should ask them, and how to train them to ask them, in what settings to ask them. I did not appreciate any of these things very well before I came to Fenway yesterday. I definitely walked in with some eagerness about questions that I had, which got answered (learning to manage myself better every day), and at the same time, I got these questions that are new to me, and just as important, if not more.

And by the way, I’ve known about Fenway Health for a really, really, really long time and have been inspired by their nation-leading work on LGBTQ Health. I have always wanted to go there and see it. I felt as honored to be there as their patients are to get care there.

This group is not EXclusive, it is INclusive, because we all want to figure this out, and at the same time, this specific project doesn’t have staff currently, so that’s a hurdle. As Kellan says, there is much to do to get this off the ground. And, we’re going to do it, please join if you want to do it too, before it’s too late, for our patients, and ourselves. Tick tock!

There’s always a photoshoot in my world, especially when committed humans are involved. Enjoy, creative commons licensed, feel free to share. For my fellow attendees also from iconic places, if you have other observations, by all means, identify yourself, post in the comments, link to your blog or other resources, more is better, thanks for teaching and learning.

Hidden Strengths of Vulnerable Populations – Strength Beyond our Walls – Presentation

Yesterday (also on National Doctor’s Day), I was treated to a refresher dose of Keith McCandless’ (@KeithMcCandless) liberating structures, as part of the Robert Wood Johnson Foundation (@RWJF) Executive Nurse Fellows event called “Strength Beyond our Walls: Improving Transitions in Care and Empowering Patients Using Technology.”

RWJF Executive Nurse Fellows- Strength Beyond our Walls 53170RWJF Executive Nurse Fellows- Strength Beyond our Walls 53170 (View on Flickr)

Here’s the happy, savvy determined group, in action.

I was asked to participate by doing a 7 minute “shift and share” with the topic being the hidden strengths of a vulnerable population. That wasn’t hard to put together 🙂 .

My slides are below. The quote on the first slide is from Mother Teresa, whose organization ran an HIV care facility in Washington, DC, that was at one time protested by neighbors who believed that HIV could be transmitted through the air.

I started the 7 minutes with a 4 minute video produced by the World Bank (if the video doesn’t display on your mobile device, you can view it here):

video platformvideo managementvideo solutionsvideo player

…to illustrate the impact of isolation and social exclusion. In health and health care, people and groups suffer exclusion, sometimes purposefully with devastating consequences. History not remembered is bound to be repeated.

The hidden strength in this case is easy to find – transformational leadership, of the kind I rarely see in the medical profession.

I’m thinking of selflessness, humility, dedication, brilliance, and inclusion. This is both on the part of the people in the LGBTQ population as well as their care providers (doctors, nurses, social workers, attorneys). They are not just good clinicians/professionals, they are the best clinicians/professionals in the world.

They innovate every day with zero resources and an intrinsic drive to produce health. They are the people other humans want to be around, including me.

More photos from the day yesterday. Thanks for learning and leading!

Special thanks to Lisa Salazar (@lisanow) from the Vancouver School of Theology, for sharing early results of her data about the strengths of the transgender population.

Dog Parks & Coffee Shops + Leadership Networks

This week I got to go see a screening of DogParks & CoffeeShops: Diversity Seeking in Changing Neighborhoods on the invitation of Professor Sonya Grier, on the campus of American University, at the Metro Policy Center (@MPC_AU) which addressed a ton of interests of mine all in one.

First, the trailer:

DogParks & CoffeeShops: Diversity Seeking in Changing Neighborhoods (Trailer) from Sonya Grier on Vimeo.

In no particular order:

  • I love Washington, DC and have been posting about our changing cities and Washington as the ultimate laboratory
  • I am a fan of diversity and all that it does to support a healthy and resilient community
  • Storytelling and images are a big part of my existence. I’m more of a still photo person because video is challenging for me – so I watched with extra respect 🙂
  • The screening itself was in the American University School of International Service, a beautiful building which is famous for its LEED Gold Certification, and I got to meet its architect, Carl Elefante, FAIA, LEED AP O&M, in October (A bunch of doctors, an architect, and a bridge builder: Designing for Health)

So, of course I was going to go, and enjoyed every step that I took on my #activetransportation journey from downtown Washington, DC .

The film and discussion afterward, attended by Professor Grier and her collaborator Professor Vanessa Perry, from George Washington University further extended my interest:

  • “faux” diversity – when people are attracted to a diverse neighborhood but pick and choose the diversity they associate with, resulting in a divided community
  • Our changing cities – becoming more sustainable, with more amenities and health infrastructure, with tension around displacement
  • The work itself and what’s considered “scholarly” in academia. I didn’t anticipate this conversation at all.

Films and scholarship

Is a film, in this case peer reviewed (and Winner, “People’s Choice” Award, 13th Annual Association for Consumer Research (ACR) Film Festival) that generates portable knowledge and connects leaders and future leaders considered scholarly? Vanessa and Sonya mentioned that this would be a risky endeavor for a junior faculty, not tenured as they are.

I’m not surprised, but I am surprised in 2015 that this is still the case in academia. I thought things would have changed by now.

When I left academia (or should I say, I never joined it), I was producing “work” in my Robert Wood Johnson Foundation Clinical Scholars Program that included news stories and action to improve health on the campus we were learning on. I was allowed to present it at our annual meeting, but it was clearly different than everyone else’s project.

And here I am, now, in a non-profit health system that regularly engages in video ethnography. I am also embedded in a design consultancy right now to understand the health experience of some of the most special people we serve. This work is changing health. I know it.

I hope someday any body of work, no matter what the medium, is recognized for its value in (a) igniting the passion of its creator and (b) changing the thinking of the people who experience it with the result being a better society (as judged by the people in that society). As Vanessa mentioned, a recent screening to a group of economists probably generated more conversation than ever would have via a manuscript placed on their desks in front of them.

Leadership Networks

Sonya and I are part of the Robert Wood Johnson Foundation Leadership Network (@RWJF). There are a ton of people on it/in it, which reflects the size of the scholarship created and supported by the Foundation. She contacted me after seeing this post on the network, and we corresponded after that.

It reminds me of a concept that goes unrecognized when people learn that social networks are about having a lot of followers (they aren’t). That type of learning encourages people to think of these networks as one-way mass communication mediums, which disappoints. Instead, they are about meaningful connections with people who you might not say hello to while walking through the boulevards and picturesque circles of your communities.

My HHSIgnite teammate/lead Sabrina Matoff-Stepp, PhD (@SabrinaMatoffSt) asked me a question I haven’t heard in a long time which was about why I spend time doing these kinds of “things.” My response is that they save me time by discovering things sooner that I don’t know, and if someone knows how to do something better, I want to know about it (“Proudly discovered elsewhere”).

My suggestion, then, is post away, and then listen and engage afterward. You never know what you’ll learn. 1 to 2 great connections every 6 months is the goal of gaining followers and friendships, in social media and in life.

Our cities are changing

Today’s Photo Friday is about changing Washington, DC, which I’ve been reading and experiencing. Destroyed by riots in 1968, destroyed again by drugs that consumed people and communities, now just becoming a walkable, sustainable place, in some places.

Composite - 14th and T  Streets Then and Now - 2010 - 2014 49694

Thanks for the great networking experience and more knowledge that will help us create a place where everyone has what they need to be successful.

Photos from HIT Briefing – Reminder about Oral Health and Transgender Person Health

#HITBriefing dentists use EHR’s too #oralhealth

I didn’t know what I would learn at the HIT Briefing yesterday in Washington, DC  sponsored by the Robert Wood Johnson Foundation (@RWJF) and supported by the Office of the National Coordinator (@ONC_HealthIT) and it wasn’t what I thought, thanks to social media commentary on the photos I took/posted.

I maybe took a few photos (telephoto lens, lighting not optimal, I did my best) below, and here’s what I was reminded of:

  • Besides nurses (the number one clinical users of EHRs – patients are number one overall 🙂 ) and doctors, dentists use electronic health records as well.
  • When (not if) we remediate electronic health records to collect and respect sexual orientation and gender identity, we need to include all of the other health records too, such as oral health / dental care

Worth the trip / glad I asked/posted, especially since oral health care is delivered by Kaiser Permanente in some of its regions (Northwest, specifically), and we are working to remediate the EHR. More on that later.

I did some checking/review of what I have on the topic of collecting sexual orientation / gender identity information as part of meaningful use, and there’s this excellent public comment from The Fenway Instituteas well as another study performed of actually asking these questions in practice. There’s also a really good presentation from Kellan Baker, MPH, MA (@KellanEBakeron the topic here.

I’ve written about the issue of transgender person health and EHRs contributing to (or today, detracting from) health previously: Now Reading: Electronic medical records and the transgender patient – to eliminate, not create, disparities | Ted Eytan, MD 

I don’t want to try and repeat/summarize the briefing here – it has a hashtag: #HITBriefing , and there are a few papers published in HealthAffairs as well as the Jason report which was discussed.

Networks matter: Project ECHO at Permanente Executive Leadership Summit

Anyone who has ever learned about Project Echo (@ProjectEcho) is familiar with this iconic slide –  it shows the creation and support of knowledge networks among clinicians to build capacity for our health care system.

Thanks to the blog-wayback machine, I traced my first encounter with Sanjeev Arora, MD, and Project Echo to October, 2009 (!), in this blog post: HIStalk Interviews Sanjeev Arora (Project Echo – New Mexico) | HIStalk | Ted Eytan, MD

And here’s what I said back then:

I recently also had the chance to learn about Project ECHO from Sanjeev Arora. I liked the emphasis on skill-building among primary care clinicians caring for more complex conditions. It seems in this case that technology can recreate some of what was lost when primary care providers left hospital care and greater interaction with specialty care colleagues. See what you think.

So here we are, 5 years later, and through the magic of the networks we share, including the Robert Wood John Foundation Pioneer Portfolio and the RWJF Leadership Network, Sanjeev has now presented his work at the Permanente Executive Leadership Summit (PELS), which is an every 2-year dialogue about the future of care delivery at Kaiser Permanente.

And…. if you know of Sanjeev’s passion and how Project Echo works, you know this turned out, in a room full of health system leaders, technologists, physicians, and nurses passionate about producing health for people wherever they are. And, multispecialty medical groups working together to support member and community health is what we are all about 🙂

I’ve written multiple blog posts over the years about Project Echo (you know, adult learning, repetition…) including ones that link to his innovation’s very first discovery – you can see them all here.

People ask me how we got connected, and it was via social media of course, and the specific amazing aspect of social media which is that it allows to listen to ideas you have never heard about before. Because as I say often, I’m not that smart, my ideas are not that unique, and if someone is doing something better than me, I want to know about it. Sanjeev exudes that quality as a sub-sub specialist which is what allows him to be a patient, yet captivating teacher. When you think of the kind of consultative specialist that you want to work with, these are the things that come to mind.

Let’s see what happens from here, in the meantime, thanks Sanjeev, all of his boosters in the Robert Wood Johnson Foundation (@RWJF @PioneerRWJF) network, and now the ones in the Permanente Executive Leadership summit network.

Just a few more action shots – I know, this is a hotel conference room, but trust me, all of that melted away during this special moment…

CleanMed Europe LastDay: “Sustainable health system” definition : different here

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What does ‘sustainable’ mean. View on

  • One that meets the needs of the present generation without compromising the ability of future generations to meet their own needs.
  • Requires the reconciliation of economic, environmental and social demands – the ‘three pillars’ of sustainability of ‘the triple bottom line’

This is the best question – which is taken from the sustainability world more than the health world. I don’t think it’s the way Americans think about our health system. We seem more ‘health care system’ focused.

The people in the room when this slide was shown agreed across the board that their health system is not sustainable. 

I had an inkling there was a difference when I was doing research for this conference (I need to be a good @PioneerRWJF Advisor). When I talked to people here about sustainability, they included a lot more than carbon reduction or environmental stewardship in the definition. 

This approach is really simple – it’s “is the system we’re designing capable of supporting the next generation?” And this doesn’t mean the “next generation health system,” it means “the next generation of society,” which is what health care is for.

This is exactly what Andy Williamson, our patient, caused him to act, and what the next generation physician, Isobel “Izzy” Braithwaite (@izzybraithwaite) said to us from the stage.

Maybe it’s because European health systems are not struggling with the amount of GDP used by health care as it is in the United States that they can think this way.

I really enjoyed sharing space with everyone from architects, to chemists, to educators, to city planners, to legislators, all of whom want to amplify the work of health professionals.

It was worth coming here to experience this approach, it was quite novel for me.

At the same time, it brought healthy (continued) respect for the health system I work in. I became a Permanente physician because I wanted to be part of an aligned-for-society future-oriented model of care, with a 100% rating on the Corporate Equality Index (What it means to earn a perfect score on the Human Rights Campaign Corporate Equality Index | Ted Eytan, MD), Healthcare Equality Index (inclusion is very important to me, without inclusion, there can be no sustainability).

Nevirapine: life saving, as a drug, hazardous to manufacture. Chemists want to help us, too. See

It has turned out that I’ve also joined a health system that’s the only health insurer with a strong position on climate, with actions in support (Now Reading: Addressing Climate Change among Insurers, some are doing more than others | Ted Eytan, MD), and a place where patient/member involvement is encouraged (What “Patients included” looks like : 2012 Permanente Executive Leadership Summit | Ted Eytan, MD). These are things that make me think “sustainable”, which are in addition to excellent quality, service, access to health care.

What health professional wants all the hard work they do inside hospitals and medical offices destroyed by the operations of their own health care system or other forces outside their doors? None of them, they don’t have to, and we can be leaders rather than followers in preventing this (and yes, prevention is the new HIT).

I’m going to post about two papers that show the differences in approach (American/European) next. In the meantime feel free to write a comment or two about what sustainable means to you as a patient, community member, health professional…

Oh, and Google Glass (@GoogleGlass) continues to make friends. I love how the device makes people think positively about the future, their facial expressions show it. Enjoy.

CleanMed Europe Day2: Innovation, Technology, or Population Health, and PatientsIncluded

Day 2 was about changing models of care to support a more sustainable health care system, and the voice of the patient was heard, in the form of Andy Williamson (@BigBuzzard)

Innovation Conference, Technology Conference, or Population Health conference? Yes.

Today’s discussion was a lot less about carbon and more about new models of care, including ones that are technologically enabled, population centric, and innovative (of course).

I found myself wondering if I had wandered into a health information technology or quality conference, and then I realized I had not, because in order to reduce waste (and carbon emissions) the care models have to be changed. So, a conversation about advanced pulmonary rehabilitation programs, or texting mood status for the management of mental health is just as at home here as are a conversation about powdered versus gas-propelled inhalers.

In a way, this is as I predicted, a conference about the “H” in “Health Information Technology.”

I would even ask, what other type of get together would be as holistic to bring these things together (innovation, technology, population health) through a societal lens?

By definition, if health care emits carbon judiciously, it’s because it supports people in being healthy – too much carbon, too little, and people are less healthy. It’s simple. I like to say, “if the patients get sick, we go out of business.” It’s just as easy to say, “If the planet gets sick, then our patients get sick, and we go out of business.” This approach is more patient-centered, in my opinion, than a conference that focuses on EHR implementation or quality metrics.

Speaking of the Patient

This conference earns the PatientsIncluded badge, because of the contribution of Andy Williamson, who’s a renal transplant patient, and former student of Oxford University, as I found out.

From my very first presentation on environmental stewardship: the patients notice

I was delighted to meet Andy, who I quoted in my very first presentation on the topic of environmental stewardship, to illustrate that patients notice the waste that we in health care have gotten used to (see: My slides from presentation : #GreenHC – Healthy Environments, Healthy People | Ted Eytan, MD).

Patients Included

Andy took me on a tour of his Alma Mater, Merton College (what you’ll see in the photographs below) and told me about his patient journey and interest in improving the sustainability of health care. He wants to make sure that as a person with polycystic kidney disease, that the same kind of care he’s been given will be around for his daughter if it turns out she is similarly diagnosed. And, as he discussed on stage, sustainability is more than about carbon reduction, it’s about changing the model from “patient at doctor’s beck and call” to the other way around. I have to say I like the way Dr. Frances Mortimer put it, kind of powerfully:

Progress is being Made

The news was given by Sonia Roschnick of the Sustainable Development Unit (@SDUHealth) that the NHS is on track to reduce its carbon emissions by 10% by 2015.

Is sustainability this generation of physicians’ HIV?

My last observation here was something I was struck by in a session on physician leadership and medical education, co-led by fellow US physician Amy Collins, MD and Stefi Barna from the Centre for Sustainable Healthcare.

It was described that environmental stewardship gets very little attention in medical schools (worldwide) today, however when a lecture is given, the response has been, “Why didn’t anyone tell us about this, why isn’t anyone doing anything about this?”

This reminds me almost exactly of my generation of physicians’ experience with persons with HIV. When we discovered that our profession was dealing with its inability to understand the condition by deserting those who needed their help the most, and the physicians who did show leadership were persecuted by their colleagues for doing so, it left a permanent imprint. Let’s see what happens with this generation. If they became as determined from this experience as we did, we should see a lot of progress in the next 10 years :).

Thanks for the warm welcome

I’ve been warmly welcomed as a United States’ based physician and as a Permanente physician representing Kaiser Permanente, a health system with a visible position on climate, and where 100% of our patients can email their doctors  Hint, NHS, I know you can do it, too, you’ll be glad you did, trust us on this.