View ’2012 Health Foo Day 3 12442′ on Flickr.com

This post is patterned on a similar post penned by Susannah Fox ( @SusannahFox ) after the first HealthFoo in 2011. She lays out the origin of the event and the meaning of its name so I won’t repeat that here. I’m going to be honest and say that I was intrigued when I read the post then. A year later when I had the chance to actually attend, in Cambridge, MA, I was still intrigued.

And here’s what I learned.

All the photographs below are creative commons licensed, you can access the collection on Flickr at this link.

We all have “imposter syndrome”

Don’t know what that means? There’s an extreme definition on Wikipedia that you can reference. In the medical profession though, it’s a commonly discussed concept. Am I good enough to be here? Do I deserve the trust I’ve been given? Do I know all that I need to know for this case?

I walked in knowing a few people and maybe a little uncomfortable, and eventually discussed having imposter syndrome with several colleagues. The way to deal with imposter syndrome is to recognize that you have it, that everyone around you has it, and use it to provide humility and open leadership. No one deserves to be in that room, and everyone deserves to be in that room. Whoever are there are the right people. This event is not about a moment in time, I think it is about learning to learn, and preparing for the next experience, to include more people who will embrace imposter syndrome with you.

Hot topics for me: Less Tech, more people, more Food, more Quantified Self (“Prevention is the new HIT’)

In comparing my experience to Susannah’s last year, it is interesting that my experience was one of a shift away from health information technology and into prevention, social determinants, and behavior change.  This could be my selective attention based on what interests me.

This year brought experts in food systems, where I learned about an industry outside of health care that is struggling with transparency. There is no GTFS standard for food like there is for transit.  The food databases in our mobile apps can be incomplete or inaccurate, which has downstream effects on our behavior. The manufacturing processes of food, which affects the sustainability of our cities and rural areas, are also opaque, which disproportionately impacts people across the social spectrum. Note the USDA publication: “Are Healthy Foods Really More Expensive? It Depends on How You Measure the Price.”

I also received some insight into my obsession, I mean interest in, the data locked away in grocery club card databases. As I blogged previously (See: “R.I.P. Safeway FoodFlex“) , Safeway had previously made this information transparent, and then made it opaque again in 2011 (why, Safeway?). There is a company, Gojee, that has established a connection to a grocery’s consumer’s database for the purpose of providing information about recipes. Would they like to work with the health system?

I had a great conversation with Alan Greene ( @DrGreene ) and others about the first 33 months of an infant’s life, and what it can mean for obesity prevention. What a pregnant woman eats in her last 2 trimester is what her baby eats, and it has a profound impact on what they see as tasty throughout their lives. I’m bringing my intrigue to the Obesity Prevention Code-a-Thon on June 2-3, 2012 that’s part of DC Health Data and Innovation Week ( @DCHealthWeek )

This was very timely in the era of “Weight of the Nation,” which aired just last week.

Quantified Self  ( @QuantifiedSelf ) was also a topic of discussion. At this point, I am learning just what quantified self is – how does it fit with population health, communities, and systems of behavior change. It is more than just having a device, more than just tracking for health. Alex Carmichael ( @accarmichael ) exposed me to the three prime questions:

1. What did you do?
2. How did you do it?
3. What did you learn?

That really changes things for me. Instead of wondering about which device has what data that connects to what care experience, it makes me think that our care system could just ask people/patients/members to ask these questions and provide the answer, that’s it.

On the topic of people, the role of pathologists came up from two different perspectives: first, from Regina Holiday, who is concerned about the rate of autopsies in the United States, and the profession’s ability to stay competent in this procedure. Second, from Mark Boguski, MD, who cleverly titled his topic “The fallacy of $1000 genome sequencing in cancer,” and described another view of the pathology specialty, which is one working to adapt to the future of tumor treatment by DNA.

Going all in, hacking with The Regina, Cambridge

One thing I liked about the atmosphere was that there was the open agenda which was timed, and then a flow into the evening. There was an immersive component to the experience – you wanted to hang around and meet one more person, and maybe write a blog post or paint late into the night. There is something to having a 24/7 environment available.

On the last evening there were a series of Ignite presentations. Regina Holliday ( @ReginaHolliday ) and I had talked about signing up for one before we went, but we decided that we wouldn’t have time to put one together. Well, as the first presentation of the night started, we decided to go ahead and create one on the spot. I thought the patient story was a great cap on the meeting, and brought me new resolve about what and who we are doing things for.

I have to make one note about Cambridge. I haven’t been there in a long time, but as I walk through the town, it feels like nothing less than the re-engineering of the human species is happening in the labs and tech hubs of this place.

In conclusion..

As I review the above, I realize the feeling I took away is very similar to Susannah’s from last year, we are learning to learn differently, which means in environments of greater diversity, humility, and embracing our vulnerabilities. There are many opportunities in cities all across the country to interact with new people in meet ups, health camps, code-a-thons. Many of these events don’t last  as long as this one, so I hope this post provides ideas about the possibilities that can come from these alternate learning environments, and what you can bring to them. It’s worth it.

Thanks a ton to Tim O’Reilly and the team at O’Reilly Media, The Robert Wood Johnson Foundation, and Microsoft for being courageous, open hosts.

Similar Posts:

• Night of Service at #SatNightSips Washington DC
• My second encounter with Fred Holliday’s Medical Record, Regina Holliday at Medstar’s CMIO Bootcamp, Columbia Maryland
• “Think of the current treatment of hypertension as a really bad game” Innovation Learning Network #iln11 day 1
• Tackling the spread of innovation, in the fishbowl, at AHRQ Innovations Exchange @AHRQIX
• Photo Friday: Bert, at 81, is the oldest Lindy Hopper in the world. He told me to learn the Lindy on YouTube.

View ’2012 Health Foo Day 2 12411′ on Flickr.com

My letter – text is below

Almost 3 years to the day (May 28, 2009), I wrote a blog post entitled “Is it meaningful if patients can’t use it?”, that detailed my first meeting of Regina Holliday ( @ReginaHolliday , blog ). In it, I wondered if the then-unannounced Meaningful Use standards would recognize the important role of patients and families in the health system.

3 years later, I am writing a letter of nomination to the General Accounting Office of the United States of America, nominating Regina Holliday to become a member of the Committee that sets direction for Meaningful Use. In 2012, it appears that a lot of other people think that electronic health records aren’t meaningful unless patients can use them – great to see that this is a statement rather than a question .

I’m posting my letter below, so that you may copy, improve, and nominate Regina or the patient advocate of your choice. You can read the Federal Register announcement for this vacancy here. Letters are due in just 5 days, May 25, 2012, so be sure to do this as soon as you can.

I just spent 3 days with Regina at HealthFoo (post on that coming later), and I took the photograph on the right during our daily #walkwithadoc-and-an-artist. I noticed a person who’s able to enjoy her life and the people around her. She brings optimism, energy, and compassion to literally every conversation we have. At the same time she tells me she is on a mission – she will do whatever it takes to change the role of patients and families in health information technology and health care.

Comments, as well as a link or paste of your letter, are welcome below. Just make sure you send a copy to General Accounting Office like I did.

May 20, 2012

General Accounting Office
441 G Street NW Washington, DC 20548
Also via email: HITCommittee@gao.gov

RE: Nomintation: Regina Holliday, Health Information Technology Policy Committee

Dear Gentlepersons,

I am writing to nominate Ms. Regina Holliday to fill the current vacancy for a patient advocate on the Health Information Technology Policy Committee.

I have known Ms. Holliday for 3 years, when she began her work advocating on behalf of patients and families impacted by the lack of access to information in their health care. Since that time, she has become a national expert in Meaningful Use, patient and family engagement in the health care system, and communicating the benefits and challenges of health information technology.

Ms. Holliday brings value and diversity in her voice in that she represents the interests of patients and families based on her own personal experience, rather than as an employee or an affiliate of a consumer advocacy organization. In my opinion, her unaffiliated state will make her representation accessible and responsive to the public who she will serve. She has already demonstrated the ability to successfully collect, synthesize, and communi- cate the most vital information necessary for an informed policy conversation. I have per- sonally observed Ms. Holliday in dialogue with health professionals, health IT leaders, health system leaders, patients, families, and consumer advocates and feel she is able to engage in detailed conversations about use of Health IT in medicine to improve patient care and overall health.

I believe Ms. Holliday will make the best contribution to the Health Information Tech- nololgy Policy Committee, with lasting impacts for Americans seeking to acheive optimal health through a health care system enabled by the technology.

I am disclosing, with Ms. Holliday’s consent, that I am an employee of the organization where Ms. Holliday receives her health care. I am not involved in the provision of her health care and this letter is written on behalf of myself.

Feel free to contact me with questions about this nomination.

Kind regards,

Ted Eytan, MD MS MPH
Washington, DC, USA

HTTP://WWW.TEDEYTAN.COM • TWITTER: TEDEYTAN

Similar Posts:

• Meaningful Meaningful Use
• My second encounter with Fred Holliday’s Medical Record, Regina Holliday at Medstar’s CMIO Bootcamp, Columbia Maryland
• Please provide advance input to Meaningful Use Workgroup on Patient Family Engagement – Hearing on April 20 on …. their blog
• Now Reading: Proof that it IS Meaningful if Patients can Use it
• Join us for e-Patient Ephemera, an evening of health, art, and technology, in the #epicenter

View Seizing the moment on Flickr.com

I took this photograph right at the moment that my colleague Kristin ( @krisitnjuel ) realized that she had arrived. Soon after, I realized I had arrived, too. What an amazing lesson in innovation there is at the Motown museum ( @motown_museum ).

What happened was that we had just returned from a tour of the Ford Rouge Plant, in Dearborn, Michigan. This plant is a multibillion modern marvel, complete with green room, LEAN production techniques, showcasing the best in American ingenuity on a grand scale.

On our way back to the host venue, after passing the museum multiple times, I agreed to take a quick detour to the Motown Museum. It showed me so much about how incredible innovation, much more than I expected. We learned about how a 30 year-old Berry Gordy connected with the social network of people in their early teens and 20′s, who packed into a small room known as the snake pit, with no air conditioning (it created too much noise), lots of cigarette smoke, and a two track recorder, meaning that each take had to be executed perfectly. Detroit was put on the world map in an era where it shouldn’t have been. When he learned that a DJ would only play 3 songs from a single record label in an hour, he just created new record labels, and moved songs between artists for maximum exposure.

We were standing in the room with photographs like this, where Diana Ross and Smokey Robinson created the greatest hits of their time (and I’ll say of all time). If you know Kristin, you know how much music is a part of her life, and that it’s no surprise she had a tear in her eye as we walked through the space. I may have had a little one, too. Innovation and creativity in a time and place of constraint is emotionally powerful – it’s the triumph of the human spirit.

So that’s the story behind the photograph. My photos of the Ford plant are below. Unfortunately neither Ford nor the Motown museum allow taking pictures inside their production areas. 

I wanted to share what we experienced because it will shape dialogues I have about innovation for a long time to come. All of this is available in a little house a block away from the Henry Ford Health System in Detroit, Michigan, USA.

Oh, PS, see that green line in the parking lot at Ford? We were told that workers that drive Ford vehicles to work are allowed to park their cars on the side of the line that is closer to the plant so they don’t have to walk as far. It made me think, what if the drivers of the Ford vehicles were rewarded with parking farther away from the plant instead .

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• Photo Friday: Why fight traffic, fight discrimination instead, The Rosa Parks Bus @thehenryford
• detnews.com | Webvideo | Ford's most advanced assembly plant operates in rural Brazil
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• Photo Friday: National Building Museum, A Place for Beginnings and Endings
• Gathering with the Innovation Learning Network in Grand Rapids

The 5th International Conference on Patient- and Family-Centered Care – Event Summary

From the place where I learned that it wasn’t just “patient centered care” ( @ipfcc )….

Wherever I go in health care, I have gotten in the habit of asking these questions:

1. Do you have ‘visiting hours’ or can family be present 24/7 in this hospital?
2. Does this hospital/health care system have member/patient/family advisory councils?

In fact, I asked these very questions earlier this week at the beautiful Henry Ford West Bloomfield Hospital ( @HenryFordWBH ) (pictures coming soon).

The answers are not always “yes” and getting to “yes” is both (a) possible and (b) dependent on learning about the experiences of others who have done this. If you can make it to Washington, DC (and why wouldn’t you want to), you’ll get to touch base with the who’s who of health care systems who have done this. 

That’s one important piece of knowledge to gain.

The other important piece of knowledge to gain is “what happens when an organization committed to patient and family involvement also walks the walk when it comes to planning its meetings?” I blogged about previously when I noticed that every abstract submission required proof of patient/family involvement (See: Promoting patient and family involvement – image from abstract submission form, Institute for Patient and Family Centered Care @IPFCC | Ted Eytan, MD.

And…one more thing…the conference is not just the conference, it includes an opportunity to learn where health care is delivered. The Institute for Patient and Family Centered Care has also set up hospital tours, of Fort Belvoir Community Hospital and Children’s National Medical Center:

Fort Belvoir Community Hospital, the newest military hospital in the nation, serves as a model for military hospitals around the world. Patient and family advisors participated in the planning for this new facility that opened in 2011. The guiding principles to achieve the hospital’s mission, pursue its vision, and maintain the highest level of quality and service are the Culture of Excellence, Patient- and Family-Centered Care, and Evidence Based Design.

This is also an interest of mine – that when you go somewhere to learn about health care being delivered, that you leave the conference room and learn about it where it is being delivered.

The sad part for me is that I cannot go, only because I have assigned duties at DC Health Data and Innovation Week – however I have no qualms about encouraging people to come to Washington, DC to attend this conference. I will be at Health Data and Innovation Week bringing the lessons that I’ve learned from IPFCC, and in the end, innovation and health data are insignificant without the involvement of patients, people, and their families. There’s going to be crossover, specifically with The Walking Gallery, so it’s possible to do both. See you in Washington!

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• Promoting patient and family involvement – image from abstract submission form, Institute for Patient and Family Centered Care @IPFCC
• Slides for Closing Keynote: Consumer Health Care Congress 2010, Washington, DC
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• Remembering Pat Sodomka, F.A.C.H.E.
• A few minutes with Microsoft’s Amalga (formerly Azyxxi) and the VA’s CPRS

With that in mind, and with the series Weight of the Nation on last night, I did some exploration, partly based on this, and partly based on a question my colleague Jan Ground ( @janground ) asked, which was, “Is obesity correlated with poverty?”

Because our friends at Community Commons have set up a special Weight of the Nation page with information , data kits, and the like, I ran some queries on Washington, DC:

View DC Obesity and Poverty 12218 on Flickr.com

View DC Obesity and Poverty 12217 on Flickr.com

As I’ve pointed out on this blog before (See: Do national numbers inaccurately represent Washington, DC’s obesity condition? ), any state or county-wide obesity % for Washington, DC, is going to be wrong, because we have wards with the lowest obesity rates in the United States ( 12 percent! ) and the highest, higher than Mississippi ( 42 percent! ). I’ve just pointed those out rather than putting the data on the maps.

You tell me if there’s a correlation.

Since I’m in Detroit right now for the Innovation Learning Network ( @HealthcareILN ) in person meeting, I decided to look at similar data for the Detroit area. I added the obesity % layer to the map because I believe that this region doesn’t have the same issue as DC (but I just did it this morning, you tell me).

View Detroit Obesity and Poverty 12219 on Flickr.com

We thought the first two segments of the show are important and educational for the American population. And now, in the era of open data, we don’t have to stop at admiring (or being afraid of) the pictures on the screen. One thing that came up was the image of the man with the “ARMY” T-shirt during the segment. We take for granted that this logo is commonly worn by people who have served, however, two of our colleagues watching the show with us serve as leaders in our military and spoke to us about how it made them feel to see that. How would it make me feel to see our health system logo being worn by a person who is struggling to stay healthy in their environment?

Because the viewing party was for this show, I made sure to pick up healthy snacks. Notice what I noticed – those bags of carrots and celery are resealable, which allows for portion control and re-use. Potato chip bags are typically not. Food for thought.

View 2012 ILN12 Day 1 12213 on Flickr.com

The 3rd and 4th parts are on tonight, with a reminder that this is “open signal,” no HBO subscription is required to watch. The shows are also available on YouTube, to keep them accessible to all Americans and their loved ones.

Similar Posts:

• Quantified Community: Visualizing the health and illness of Washington, DC through open data and art
• Do national numbers inaccurately represent Washington, DC’s obesity condition? what electronic and personal health records can do to help
• Data visualization, obesity and hunger rates
• Community Commons – A learning utility to create healthy, equitable, and sustainable communities
• Photo Friday: Whole Foods college eating advice takes some interesting turns…

This groundbreaking series begins tonight. Note that it is being broadcast as an open signal, which means that an HBO subscription is not required to watch.

You can learn more about Kaiser Permanente’s involvement in this project here: Kaiser Permanente and Weight of the Nation.

I’ll be watching with colleagues from the Innovation Learning Network ( @HealthcareILN ) and will post some thoughts on the first film tomorrow.

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• Now Reading: Harvard Business Review, Kaiser Permanente’s Innovation on the Front Lines
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• DC Job Opening : Support the development of national health policy on behalf of the medical groups of Kaiser Permanente

An interesting debate had over twitter by our city’s Mayor ( @mayorvincegray ) about the utility and funding of the wildly successful Capital Bikeshare ( @bikeshare ) bicycle sharing program.

I actually found this because my photograph of the Mayor is used in the piece ( thank you! ). It directly relates to this recent post about the visualization of Capital Bikeshare data (see: “Quantified Community“).

I think the art piece in the blog post referred to above settles the question visually about whether Capital Bikeshare is being used by commuters or not. Another great use of art + open data to help people and communities make the best decisions.

@MrTinDC @turnageb @DDOTDC @tomselliott @Bikeshare Watching the many visualisations of hr-by-hr usage quite clearly shows commuting patterns

— ♭oſsi (@thisisbossi) May 8, 2012

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• Riding DC’s @bikeshare to give @ReginaHolliday the jacket I will wear at #TheWalkingGallery – quintessential #epicenter
• Checking out at the D.C. Public Library
• Photo Friday: Watch the Audience (New Dog and Human Parks in Washington, DC)

View 2012 American Hospital Association Meeting and Jacket Presentation 11909 on Flickr.com

I chose this photograph of Isaac Holliday, wearing his jacket entitled “Feelings,” which he designed himself, with a little help from a famous local artist and also his mother, Regina Holliday ( @ReginaHolliday ).

In the photo, Isaac is playing with the bubble machine that Regina Holliday brought to the corner of Connecticut and T Street, Northwest, this past Sunday. I came to officially present the blank canvas of my next gallery piece and request Regina’s talent in turning it into a piece in The Walking Gallery. She said yes!

Oh, and she was also there to bring awareness to the American Hospital Association’s stance on providing patients and families with their medical record information.

I brought my favorite dog in Washington, DC, Milo, and Isaac really took to him (and why wouldn’t he, who doesn’t love Milo) – they are both 6 years old, I found out. What the heck, let’s include a photo of Milo today as well:

View 2012 American Hospital Association Meeting and Jacket Presentation 11923 on Flickr.com

Milo looks a little pensive. He’s in a strange surrounding (a little farther away from his normal dog park), and he’s also a very attached kind of dog. He gets very nervous when his dad or his dogfather (that’s me) are not close by. If I were to put a thought bubble over his head, it wouldn’t be that he’s angry or upset or sad or disapproving of what the humans around him are fussing over. It would just be, “I hope everyone here is working together to make sure that my dad is around for a long time.”

Isn’t it interesting how the most complex things are really simple from the perspective of our children and our dogs. It was great to see Isaac enjoying life again – he asked about Milo last night at Regina’s birthday party – I am glad he remembered him!

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• Photo Friday: Milo knows what love is
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• Photo Friday: My first cover of a medical journal, it’s of #TheWalkingGallery

Not walking, our brains have quit working. View ‘Ted Eytan MD and Janet Wright MD’ on Flickr.com

(click here to download directly into iTunes)

I’ll try anything if it involves walking (my first walking podcast!), and luckily so will Janet Wright, MD, FACC, who’s the Executive Director of Million Hearts ( @MillionHeartsUS ):

a U.S. Department of Health and Human Services initiative with the explicit goal to prevent a million heart attacks and strokes in five years.

Maybe I have more than a passing interest in hypertension (if you read all the linked posts about it on this blog, you’ll see), and that’s what brought myself and Janet together, on foot.

The podcast shows that DC can be a noisy (and stunningly beautiful) place – I did my best to shape the audio to be more understandable, but in reality I think more than 5 minutes with this background wouldn’t be as fun, so I edited accordingly.

As Janet points out, DNA is not destiny, and it is the science of creating systems and teams that are going to allow us to manage a condition that affects 1/3 of the United States population.

You’re also get a peek inside the relationship between the primary care (family practice) and specialist (cardiology) point of view. Janet reminds me, correctly, that blood pressure is not easy to treat in every person, which is another reminder that we’re all necessary.

In our talk, she refers to an event in Washington, DC, that brought four innovative programs together to talk about their scale and spread across health care. In 2012, there are many more programs that harness the science of systems. Our friends at the AHRQ Innovations Exchange ( @AHRQIX ) have a whole resource of the people, methods, victories and challenges of each. From my work with AHRQIX, I believe that just about any idea to innovate in health care should start with a search on that resource. Here are the links to the four programs featured recently just as a (great) example.

Since we were walking and talking I needed to ask about walking meetings at the end and…Janet’s a fan! Keep this in mind if you are fortunate to work with her during this effort. She added yet another important reason to walk, talk, and think at the very end of our conversation – our brains quit working when we stand still. And you know, she’s right.

Similar Posts:

• Health Business Blog Podcast, Dr. Ted Eytan of Kaiser on health IT, walking meetings, innovation
• Fast Forward Health Film Festival @FastFwdHealth , Washington, DC
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• Riding DC’s @bikeshare to give @ReginaHolliday the jacket I will wear at #TheWalkingGallery – quintessential #epicenter
• 73 Cents, 2 years on

Galea S, Tracy M, Hoggatt KJ, Dimaggio C, Karpati A. Estimated deaths attributable to social factors in the United States. American journal of public health. 2011;101(8):1456-65

I referred to this paper in a previous blog post but decided to give it its own, based on recent interest.

A lot of people are familiar with the often-cited breakthrough analysis, “Actual Causes of Death in the United States,” by McGinnis and Foege in 1993, which was followed by another, impactful analysis in 2002. Both changed ideas about what could be done to promote health and wellness, from looking at “heart disease,” to instead looking at “smoking,” (1993), to instead looking at “behavioral patterns,” (2002).

In the 2002 analysis, “social circumstances,” is listed as being responsible for 15 percent of deaths, with an accompanying editorial that said:

the data are still not crisp enough to quantify the contributions [of social circumstances] in the same fashion as many other factors. (reference)

Well, it’s almost 10 years later, and there is more crisp data, and greater awareness of the “causes of the causes” of poor health. I created a pie chart from that data:

View SDOH Studies Eytan 7661 on Flickr.com

And below are the three studies laid out the same way, 1993, 2002, 2011. We have come a long way in understanding what we can do to improve health. What do we believe the balance is now compared to 2002, and where should we act, and in what proportion, at the level of the individual, family, community, society? Quantified self and/or quantified community? An app for improved social health or one for individual behavior change?

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• Now Reading: Understanding the science of life expectancy #SDOH

My answer, of course, is “Absolutely.”

And while there is commentary on this post that employers insist that employees spend all of their time in front of computer screens, I have found that a proportion of that is self-inflicted. Depending on your occupation, sometimes the “we need to discuss this looking at a computer,” is actually better done as, “we need to walk and organize our thoughts for 15 minutes, and then look at a computer.” And again, this is for meetings, that involve more than 1 person .

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View 2012 DC Zeitgeist III 11782 on Flickr.com

My good friend MV Jantzen ( @mvs202 ) is not a physician or in public health. He doesn’t study social determinants of health. The first thing he said to me when I went to go see this unique visualization of Capital Bikeshare ( @bikeshare ) trips in Washington, DC, on its busiest day, March, 23, 2012, was “I was able to do this because of open data.”

Compare this piece with another piece on the other side of the room:

On the left is a visualization of crime in Washington, DC, with the biggest cutouts being homicide, the smallest assault. The right, the visualization of bike trips. There are bike stations throughout the city. Do you notice how one image is the mirror of the other? The part of the city with reduced bike trips and higher violence (Wards 7 and 8 ) also has the highest obesity rate, higher than the most obese state in the United States – 42 %. If you want to familiarize yourself with that map, see “Do national numbers inaccurately represent Washington, DC’s obesity condition? what electronic and personal health records can do to help“

Think about it – every part of Washington, DC has access to this technology (cell service, bikeshare stations), and yet there is a dramatic and visible difference in health. These images teach that community wellness is more complex than creating the right app, even more complex than individual behavior change.

Art + data teaches valuable lessons (hmm…where I have learned that before ).

Thanks, MV, and the DC Arts Center for making this real. The show that this is part of, “Zeitgeist III” runs through June 10. More photos below, as well as the video of the Capital Bikeshare visualization. You can learn more about that piece on MV’s blog.

How to interpret the above: Blue ripples are bike trips among regular riders (with memberships), green ripples are bike rips among casual riders (one time users). Notice what happens in the early morning (commuting), versus later in the day (riding for pleasure). More ripples equals more bike trips. This was the busiest day in the Bikeshare system to date, March 23, 2012. The data is made available for people to analyze.

“Rise up with me against the organisation of misery,” – For more information on social determinants of health, see my post on the Marmot review (“Now Reading: Why a focus on lifestyle behavior change may not improve health: The Marmot Review“)

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View ’2012 Kaiser Permanente Innovation Retreat 11757′ on Flickr.com

The title of the post is real quote by Lynda Applegate, who is the Sarofim-Rock Professor of Business Administration at Harvard Business School and serves as the Head of the Entrepreneurial Management Unit. She said it to us while sharing this famous quote

Everything that can be invented has been invented.(Charles Duell, 1899, the Commissioner of the US Patent Office)

She’s been spending time with innovators at Kaiser Permanente, and so have I. This post is not just about the annual Kaiser Permanente Innovation Retreat, it is also about another signature program, Medicine and Management, that brings together 43 physicians from across Kaiser Permanente to learn how to be better leaders.

These two programs are related because they demonstrate what I learned at both:

Innovation in the post-EHR health system

What’s it like to be in a health system that has had a fully functioning EHR for 2 years? This year for the first time, Innovation Fund awards were incorporated into the learning program, and the completed projects give a great glimpse of the future of health care. 

In the post-EHR health system, the focus is not on what the EHR will do, it’s on the people who will use it (including patients). For example: the innovations developed place EHR data/access in ambulances so sick children being transferred across distances are warmly received, they combine EHR data with evidence based guidelines and rules engines that watch over patients with kidney stones or osteoporosis (no hitting the refresh button on your desktop computer needed), they create electronic mashup dashboards that take EHR data and provide guidance on how to build facilities or operate them in real time.

The innovations also come from all parts of the health system – physicians, primary care and specialist, nurses, information technologists, health educators, you name it. The thing that I see is not just the search for the idea, but the search for the cost-effective idea that helps the most people.

In this environment, an idea that allows people to have the right amount of health care, sometimes more, sometimes less, the right amount for total health (mind, body, spirit, individual, family, community, society), the most respectful of our members’ time, are the best ones. 

People don’t want to innovate, they need to innovate

Both the physicians in the Medicine and Management Program and the Innovation Fund winners have far reaching visions for health and health care. This quote from Urologist Ron Loo, MD, shows that the drive is unstoppable, and also that it’s not about the innovator, it’s about the group that they collaborate with to execute the good idea. Here’s the workflow he suggested to me on our internal social network:

1. When you have an idea, find some friends who are much smarter than you.
2. Convince them that your idea will change the world.
3. If they agree with you, make a plan.
4. Money will follow, especially if your friends are rich; if not, they will help you secure funding because they are smarter than you and they believe in your idea.
5. Execute the plan (“Vision without execution is hallucination” T Edison)
6. Repeat steps 1-5 as many times as you can before you die. It gets easier each time especially if you can complete step 5 more times than not. An added benefit is that your smart friends won’t consider you so dumb after a while.
7. Embrace the risk, and feel really good about what you do.

These programs are a non-trivial investment. Even in a health system with aligned incentives, innovators need a helping hand, which is the point of this post.

If people say things to me like (which they really never do ), “you could do that because you are Kaiser Permanente,” I might say back, “we could do that because we invested in the people who power Kaiser Permanente, and you have talented people who power your health system, too.”

What about health systems where incentives are not aligned? There are just as many people who need to innovate in all of health care, there’s no monopoly on that at Kaiser Permanente. Are they given the opportunity to do it? In many places, absolutely, and please post in the comments about your experiences having these opportunities.

It is all of ours/society’s responsibility to give health professionals (and the people they serve) the ability to innovate. This post is therefore intended to create the drive in all health systems to invest formally in innovation at all levels of organizations, with patients included, of course. Always with patients included.

There are places to learn about this such as The Innovation Learning Network ( @healthcareILN ). More innovation in more places means less, “we couldn’t do it,” and more like this quote from Jack Cochran, MD:

DON’T say you can’t do it because you’re not KP. We didn’t know we could do it until we did it.#NGAKP

— Ted Eytan, MD (@tedeytan) February 20, 2010

Special thanks to the team at Kaiser Permanente Information Technology, led by Phil Fasano, Kaiser Permanente CIO, and the Hawaii, Northwest, Group Health, Colorado, Southeast, and Ohio Permanente Medical Groups for their time and attention to the future.

Similar Posts:

• Accepting the challenge to go tablet at Kaiser Permanente, what I learned at our Innovation Retreat 5.0
• Kaiser Permanente Care Stories | Patients teaching about Integrated care through their stories
• “What about one to many or many to many?” at Health 2.0
• Another 21st Century Vision of Primary Care: Kaiser Permanente Ohio
• Two Million People Using Kaiser Permanente’s Personal Health Record

Thanks to ABC 7 News ( @ABC7News ) and reporter Pamela Brown ( @ABC7Pamela ) for looking into the science behind walking and producing a story about walking meetings that aired in in the Washington, DC, area today.

My physician colleague at Kaiser Permanente, Amy Banulis, MD, an OB/Gyn was also featured in the story, and she integrates walking support and education into her medical practice. I really feel this is not a unique obsession of mine anymore, with Kaiser Permanente having an entire campaign around walking ( @everybodywalk ). You’ve seen the West Wing Reunion video, right?

The discovery for me is simple – whether your workplace is a television news station or a health system, it’s possible to combine exercise and thinking, and the combination (muscles, mind, and most importantly, heart) create a very cool synergy. Just try it. And tweet me with your results. Here’s the guide to making it happen: http://bit.ly/walkingmeetings . Let’s keep the revolution going, so others can discover it, too.

Covering this story was eye opening & a life-changer “@tedeytan: Thx @ABC7News @ABC7Pamela- gr8 #walkingmeetings story wj.la/IMRNnb“

— Pamela Brown (@ABC7Pamela) May 3, 2012

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• Health Business Blog Podcast, Dr. Ted Eytan of Kaiser on health IT, walking meetings, innovation
• More support for walking – Behind the scenes at the launch of Every Body Walk! (@everybodywalk)
• Riding DC’s @bikeshare to give @ReginaHolliday the jacket I will wear at #TheWalkingGallery – quintessential #epicenter
• Walking Meetings Energize Body and Mind
• Starting a walking meeting revolution – Photos and story of a homemade walkstation.

and…22% of Americans still do not access the internet. Check out the data below.

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• Now Reading: Mobile Access 2010 (Pew Internet and American Life Project)
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• Now Reading: Pew Hispanic Center’s Hispanics and Health Care in the United States

Posting a few interesting pieces of data I have come across recently. I thought this one is interesting because it describes the use of the Toyota Management System in a sort of novel way. And, as I would normally wonder if this private equity approach is using “real” LEAN or a variant, I think it’s impressive that they have accomplished Toyota alumni involved. This makes me think that there is a lot more going on beyond daily kaizen and stopwatch tracking. See what you think.Similar Posts:

• LEAN Hospital and Public Comments; The Unconference Concept; The State of Agile (LEAN Software Development)
• Now Reading: Toyota Management System meets Innovation: Lean Startup, by Eric Ries
• Promising Reimbursement Methodology; More on Music and Real Estate Industries; Another Blog Post Goodbye to an Employer
• Facts are what you see on the ground; Being in your 20′s in the 2000′s; RHIO closure
• Toyota misunderstood by Businessweek; Enterprise 2.0 from Google

In this Harvard Business Review article on happiness (“The Science Behind the Smile“):

Much of the research confirms things we’ve always suspected. … Healthy people are happier than sick people. People who participate in their churches are happier than those who don’t. Rich people are happier than poor people. And so on.

That said, there have been some surprises. For example, while all these things do make people happier, it’s astonishing how little any one of them matters. Yes, a new house or a new spouse will make you happier, but not much and not for long. As it turns out, people are not very good at predicting what will make them happy and how long that happiness will last. They expect positive events to make them much happier than those events actually do, and they expect negative events to make them unhappier than they actually do… A recent study showed that very few experiences affect us for more than three months. When good things happen, we celebrate for a while and then sober up. When bad things happen, we weep and whine for a while and then pick ourselves up and get on with it.

Christine is now walking (view on Flickr.com)

This is Christine today. Her injury is resolving – she’s now walking! This is after 12 weeks of no ability to ambulate. I had a reunion with her and asked her what she was thinking and feeling.

In contrast to our visit last time, when she was energized about improvements to the health system, she’s now focused on her experience and that of others. She says that she’s approached by a lot of people in public who give her advice or tell her their stories.

I asked her about this and she wondered if these experiences (being the involuntary patient) are so defining in their lives that they are driven to tell others about them.

Christine doesn’t want that though – in fact, when she talks to me she refers to her injury as “not that serious compared to other people” – which is amazing for me to see – a testament to the resilience of people.

It’s possible that she may even forget about a lot of it as she focuses on her career, her family, her relationships. 

She told me about this note that I sent to her from my awesome colleague Kayt Havens, MD who read the first post in Christine’s blog:

“can’t tell you the number of patients I see at the VA for whom this article will give solace…thanks yet again”

Christine said this feedback was meaningful (her exact words were ‘it almost made me cry’). She told me that sustaining an injury like she did, with such a long recovery, requires daily thoughts about the future, the next day, and a reliance on a support network that a lot of people don’t have, or if they do have, can’t be there all the time. Christine would like to see a world where people in her situation can reach out to other people to get this support. In an easier way than random Google searches. And she says, physicians not required, this is not about getting medical questions answered.

She has fleshed out many more lessons learned in her blog, which she said has been therapeutic to write – she looks back at in a little bit of amazement about where she was.

What did I learn? 

This is the first time I have ever followed a patient as a person who writes a blog and who happens to be a doctor. I didn’t expect that Christine would be this patient, and neither did she. She said it so well:

If I could just get a redo on those 3 seconds…..3 seconds….sigh.

Three seconds can change your life. Besides being reminded to cherish every second we do have,  I learned that every patient, involuntary or not, will make choices about where to fit their health care experiences into their lives.

Some patients might become health activists as a result of their experience. Some may not, and they don’t have to, they’ve chosen to live their lives and reach their goals through optimal health.

On the one hand, the resilience of the human body and the ability of people to move on works against health care improvement, because people forget. Therefore, its our job, the people who work in health care, to remember on their behalf, and carry their stories with us. It also means that the patients who do become health activists and leaders in health care improvement (the Regina’s, the Kait’s, the Dave’s) are carrying the flag for a lot of people – we are fortunate to have them.

Before concluding part III, I want to show Christine’s progression as captured in photographs, from injury (and disempowerment), to information (and empowerment), to resolution (and resilience). All of us know or will know patients in all phases. Keep this in mind when you see someone in any phase – it’s a journey, and they may not see themselves defined by their health condition, even if, to the observer, it seems that they are.

The people you see may not be as open with you as Christine has been here. However, like Christine, they will always be awesome.

“We grow strong in the broken places.”

Thanks for reading.

Pain and the compassion quotient – sent home, little information  View on Flickr.com

Information and empowerment – iPad + printed medical record – View on Flickr.com

Resolution and Resilience – healing, focused on life – View on Flickr.com

Similar Posts:

• The involuntary patient wants to redesign the health care system. We should let them. Christine, Part 2.
• Being a patient is involuntary – Christine’s story and what the compassion quotient feels like
• Photo Friday: Love always Wins
• Photo Friday: The patient in the room changes everything. Everything.
• Photo Friday: @kaitbr walking in DC after the #73cents salon

View Sully Sullenberger and Leroy Jones (wearing his jacket) on Flickr.com

I know the photo’s a little fuzzy (there’s a clearer one of Sully below), it shows my view of things at the National Press Club – Captain Chesley “Sully” Sullenberger on the stage, Leroy Jones, Jr. ( @technicaljones ) in the audience, wearing his Walking Gallery Jacket, entitled “Supermom 1976″.

I went back and watched the story behind Leroy’s jacket, because I remembered it from last year – his mother, diagnosed with sarcoidosis, given 6 months to live, in 1976, survived to 1996, hospitalized every year, with what he said was an “amazing spirit.” You can watch the story and see a clearer photograph of the jacket here.

My view made me answer the question with, “they all are,” and that’s what brings me to these things, because of what’s on stage, and because of what’s off stage.

Because of what’s off stage, too

Imagine what the world would be like if everyone wore their story on the back of their jacket. And, actually, you can, on June 4, 2012. See you there – don’t forget to register!

More photos below, Enjoy

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• Photo Friday Special: Regina, Regina, and Donna Shalala #TheWalkingGallery
• Photo Friday: Isaac Holliday, Bubbles….and Milo
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dwellSense

Check out the photo to the right. The patient did not do well. First, they stopped taking medicine on time, then they stopped taking medicine. The patient fell, and then died. The patient was seen by his oncologist well into the period of the chart showing his steep decline, without benefit of this data. Would would have happened if this data was available at the time of the visit?

I am in Nashville, TN, at the Vanderbilt Center for Better Health, the über cool innovation center at Vanderbilt University (everyone has one these days), where Project HealthDesign teams do much of their work. Five teams are examining the integration of patient generated data, which they refer to as “observations of daily living” or ODL’s into clinical care and health decision making. This includes more than just medication adherence data – anything from moods to peak flow to ability to make coffee in the morning (through the use of clever sensors).

I am always grateful when an innovative project like this has a well stocked web site so I don’t to explain how amazing it is here -feel free to explore - instead I am posting my impressions from the review of the 5 teams’ work. 

And here they are - 

• ODL are a form of the patient voice, and a codified version of it that can be analyzed – it appeals to the science and the art of medicine
• Their integration into care could change the conversation from what doctors think they need to know from patients to what is actually helpful to know about their patients. For example, a patient that fits the physician profile of being non-adherent but in fact has an excellent adherence record may not need to be counseled about medications relative to other health issues at a visit.
• ODL could serve as an early warning system as in the example above, or a recognition system for the times when patients are able to demonstrate achievement of their health goals. Both could be motivating for care provider and patient (and family) at critical times.
• ODL, ironically, could promote the health system’s understanding of social determinants of health – when asthma controller medicines are shown not to be used, we saw evidence of a search for the “causes of the causes” of poor adherence, such as housing conditions that created reactive airways
• This work will help health care understand which people and in what states are successful tracking ODL (of various types, active, passive, hybrid). I was cautioned, though, that the teams have not arrived at demographic segmentation of which people are most likely to capture and use ODL for their conditions.
• I think a lot of people believe that understanding the patient experience around an illness or wellness  and the community conditions around those may be more important than understanding therapeutic treatment options. This work brings us closer to making the gathering of that data possible. 

And…I’m not sure how algorithmic it has to be, or how much computing needs to be done. I can imagine the image at the top of this post being presented to patients’ primary care physician and them knowing immediately that something is wrong. The human brain coupled with a strong patient-physician relationship is an amazing piece of computational hardware.

Because this work is still in progress and will eventually be submitted for publication, I am not able to share any preliminary results here. LIke my other favorite Robert Wood Johsnon Foundation Projects (repeat after me: @myopennotes , @AF4Q ), stay tuned to the literature, it’s worth the wait.

More photos from the day below, including the crazy hats ….

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• Project Health Design : Bringing Patients Along with Teams to Washington, DC
• Project HealthDesign Expo Washington, DC – It’s not the record, it’s what you do with it
• Innovation Learning Network Fall 2011 – co designing the future of connected healing
• ONC Consumer Health IT Summit
• Innovating for our Veterans online at Portland VA Medical Center