Ted’s passion portfolio. Innovation Learning Network InPerson Meeting, Boston, MA, USA View on Flickr.com

Either the Innovation Learning Network (@healthcareILN) meetings have gotten so good or I have learned to leverage them extremely well. I think it’s the former rather the latter based on what happened on the last day.

After getting to go on innovation safaris that were customized to our interests (mine, social determinants of health, expressed through the food insecurity program at Boston University Medical Center), the last day we were given the opportunity to create a pitchable, potentially fundable plan based on our interests. Attendees were assembled at the front of the room and told to address all the other attendees with a general topic and a table number. Whoever went to that table, went to that table to work on it.

Usually I stay on the sidelines because I like to see and support others, but this time I decided to be totally selfish and announce my topic as “non-IT innovation” and then proceeded to list my current portfolio of passions. I figured if no one came to my table I could at least write my ILN blog post. But alas people came to my table, and so the “ILN Carbon Green Room” was born.

The ILN Carbon Green Room

I originally called it the ILN Carbon War Room (based on this organization in Washington, DC), but changed it after consultation to be something less militaristic. The idea, with my collaborators Paul Tarini (@PaulTarini) and Marilyn Chow (@InnovationChow) was to look at the overall carbon impact of the 32 organizations in the Innovation Learning Network and work to (a) reduce it and (b) tie it to the other innovations that are being created within them.

I took the handwritten pitch and game plan and made them easier to read. Click to enlarge.

Basically, there are still very few health care organizations that understand the connection between the way they operate and health. Kaiser Permanente is one that does (see Now Reading: Addressing Climate Change among Insurers, some are doing more than others | Ted Eytan, MD ), as is the National Health Service. That’s one issue. The second issue is understanding that it is a myth that environmental stewardship only reaps long term savings. Instead, it yields short term and long term savings, that are noticeable by our patients (don’t believe me? check out slides 27-28 of this presentation I gave at/to Emory University). Also, for the data, check out: Now Reading: Little things add up to $15 billion in environmental stewardship by hospitals | Ted Eytan, MD

As it says above, the work is to collect the carbon footprint of the Innovation Learning Network organizations and tie them to the Healthier Hospital Initiative (@HHIorg) which supports organizations in stepwise improvements. I have already been funded to go to CleanMed Europe (@CleanMedEurope), where I will go to study the best practices in environmental stewardship around the world, as well as shadow in sustainable medical practices and communities. And also find Paul a nice pair of socks somewhere – Marks and Spencer perhaps? The goal is to connect the work of the Innovation Learning Network to a sustainable health system and communities in which they operate. Sounds innovative to me.

So that’s the pitch. The ME part of AwesoME is that even though my pitch wasn’t funded, I’m going to do it anyway, of course. And I think so is everyone else for their pitches. Everyone wins, even ultimately, when Paul and Marilyn snuck an IT-type innovation onto my table

Here’s the scene from the day, with lots of oversampling of my table. Having a passion portfolio means that you’re passionate about the things in it.

Similar Posts:

• Presentation: #GreenHC – Environmental Stewardship in Health Care
• In Front of the Counter with the Innovation Learning Network
• Innovation Learning Network 2009 In Person Meeting – Learning Innovation in Healthcare
• Community Health Needs Assessment includes the Environment, and Green Health Care Resources
• Gathering with the Innovation Learning Network in Grand Rapids

Gender Neutral – Capital TransPride (View on Flickr.com)

My medical ancestors sat (and stood ) on the side of patients, in rooms big and small, determined to help the patients take control of their own health destiny. When they were ostracized and oppressed by their medical colleagues, they fought back, they won, and they changed health care for everyone.

35 years ago in our nation’s capital, pride (which is actually an acronym: “Personal Rights in Defense and Education“) was a lot different. The press wasn’t allowed because people were afraid of being photographed. Gay-owned businesses were targeted and people feared for their jobs and their lives. And yet, they created it anyway.

Transgender Pride (Capital TransPride) is a lot like that today.

As it was explained by the organizers, the day is a celebration, a day when the media may tell stories of trans people living well than of their murders.

I had a great time representing myself as a citizen, a Washington, DC resident, a member of the medical profession, and as a physician in the Kaiser Permanente non-profit health system, a proud sponsor this year. I was joined by another Permanente physician, EW Emanuel, MD, and Melanie Hiller and Bianca Rey, our President and Treasurer of the KP Pride Lesbian Gay Bisexual Transgender Intersex Employee Resource Group for Mid-Atlantic States.

I took the photos below knowing that we’ll eventually be joined by physicians and nurses in every health system in this room, and then the room won’t be big enough. It’s just a matter of time.

Health, Employment, and Total Health

Many in this community have difficulty finding employment, even though it is illegal to discriminate on the basis of gender identity. Needless to say, access to the necessary care for a healthy transition is challenging, much less ongoing preventive care.

Some are gainfully employed in fortune x00 companies who tell me their companies refuse to cover medically necessary care for their trans employees.

These companies are easy to find on the Human Rights Corporate Equality Index – they typically are stuck at 90 % in the ratings, because coverage for medically necessary care for trans employees is the difference between a 90 % and a 100 %. The brand names in this category will surprise you. The brand names in the 100% category will impress you.

Codie Leone, our keynote speaker and award winning stylist for Patricia Feld, Sex and the City and the Devil Wears Prada, illustrated the connection when someone asked her about traveling through Europe. She told us after her transition she has been able to travel without worry. She also talked about her ability to command respect for who she is (“but not with a baseball bat” she said).

In 2013, we know that it’s a myth that sex affirmation surgery is “cosmetic or experimental” (it isn’t), or that medically supervised transitions are unsuccessful (they are).

The goal of care is not so that a person “passes” as a man or a woman, as Codie mentioned, it’s allowing a person to be who they are.

It’s exciting that in this group of people, health care can have such a profound effect – allowing people to labor, live, love, learn, play, and pray as a productive member of society. That’s total health.

More allies every year

If current societal trends to become more inclusive and love people better continue, next year there will be more of us from our health system and other health systems in the room. Eventually, the room will be filled with doctors and nurses and other professional and community allies. And then there won’t be enough room in this room for all the allies. Just watch. This is history being made.

In the meantime, supporters of trans person (and all LGBTI) health, are invited to walk with us (Kaiser Permanente doctors, nurses, staff, members, and supporters) in this year’s Capital Pride parade on June 8, 2013. We’ll be waving transgender and rainbow pride flags. Sign up here for that.

We are also hosting a transgender health care dialogue at the Kaiser Permanente Center for Total Health (@kptotalhealth), on June 20, 2013. Sign up here for that, too. (Interestingly, two days prior we’ll be hosting a meetup for Google Glass, imagine the applications of that technology for culturally humble care…)

This community is getting stronger and taking control of its destiny. The District of Columbia is ahead of every State in the Union (and tied with Washington State) in protecting its LGBT residents, in large part due to the people in the room with me. Here are the comments of one of them, Ruby Corado, Founder of Casa Ruby (@CasaRubyDC) and 2013 DC Sheroes Awardee.

“Trans Pride DC 2013″
As a Trans woman from DC,
I have seen this city do a 360; degree turn for the better since 1995.
We now enjoy a city that although not perfect has a mayor that is not afraid to speak for Trans injustice, politicians that legislate on our behalf not against us, an LGB community that stands next to us when we fight for our dignity and rights, we now have lgbt media that promotes our success stories not just covers our murders, we now have a city where Trans people can be themselves 24/7.
We even have a day to come together as a big family and celebrate our gender identity and expression.
Please join me tomorrow as I open our Trans Pride celebration remarks with the estate of the Trans movement in DC address.(i made that up lol)
See you tomorrow at 10am at the national christian church 5 thomas circle nw DC

Love
Ruby Corado

Ruby said something remarkable to us as well: “If I am not in the room, it is okay to represent me.” This is a level of trust that few others would have in a community this challenged on a daily basis.

I came to Washington, DC to live diversity and equality and create a world of zero disparities. I found people here who believe that it’s possible to achieve, because it is .

See you on June 8, if not sooner. Enjoy celebrating pride wherever you are!

Similar Posts:

• 2013 HRC Corporate Equality Index Awards for LGBT employment – New York City
• Philadelphia Passes Historic LGBT Health Equality Bill! | Transgender Law Center
• March’s Community Tour of @kptotalhealth: Focus on Diversity, for LGBT Health Awareness Week
• Clinicians from the future practice the medicine of inclusion – Kaiser Permanente LGBT Health Symposium
• Photo Friday: Love always Wins

#SDOH Walking Meeting, photograph by Nirav Shah, MD, MPH View Forum for Healthy Behavior Change – healthy walking meeting through Washington, DC on Flickr.com

He said “You’re taking all the photos, there isn’t one of you.” So now there is. Here’s the one I took of the group:

View Forum for Healthy Behavior Change 24622 on Flickr.com

We were on the morning walk with several-docs-and-business-and-clinical-leaders through Washington, DC, observing the history and the social determinants of health around us, from health in every policy to active transportation to crime, and irreplaceable loss. All in 30 minutes. That’s how awesome this city is as a lab for learning about health .

Total Health. View on Flickr.com

I actually didn’t take that many photographs at the Forum because we had an expert photographer colleague in our midst.

The ones I took show the diversity of conversations this week, from Brenda Suits at Bank of America Foundation (@BofA_Community) talking about the Bank’s work to reduce hunger and support affordable housing (many attendees didn’t know about this), to Ideas42 (@ideas42) talking about behavior design and behavior audits in the workplace and beyond.

One of my favorites, Opower (@Opower) was also there showing off the seductive, addicting, and successful reduction of energy use in households across the United States using behavior change science. Can’t forget about the Monday Campaigns (@HealthyMonday), in the form of Peggy Neu, whose work seamlessly meshes with BJ Fogg’s (@BJfogg) work on the periodicity of behavior modification. More, much more happened, including the voice of the patient and some pretty impressive commitments for the health system to collaborate with the rest of society to design for better health.

At the conclusion of the event someone asked me what I thought of it – my response was/is “I got everything I wanted,” which is really a commitment to listen, learn, and act in a way that supports the causes of the causes and the causes of the production of health to support achievement of every human being’s life goals. That’s what the health system is here for, right? Right.

Enjoy the photos, click to enlarge.

Similar Posts:

• A visit to Opower, a company that uses behavior change science to enable energy savings
• Photo Friday/Follow Friday: AT&T Innovation Center, Washington, DC
• Meet the Member: Kaiser Permanente Care Management Institute Annual Meeting, Behavior Change track
• “My son is more important than the gossip going around the neighborhood” – Jeanne Manford
• Quantified Community: Visualizing the health and illness of Washington, DC through open data and art

Open Doors, by @ReginaHolliday

Short answer: because I and my fellow physicians went into medicine to support the ability of every human being to achieve their life goals.*

*see my note at the bottom of this post about the physician role

Capital Transpride is May 18, 2013, in Washington, DC.

Kaiser Permanente is a Gold Sponsor for the first time, this year. As of 2013, Kaiser Permanente covers and provides medically necessary care for its employees who are trans, earning it a 100% rating on the Human Rights Campaign Corporate Equality Index.  Every member is covered for hormone treatment and behavioral health services. Not every member is covered yet for surgery, however, because not every employer purchases a supplemental insurance rider for this coverage.

There are also clinical facts about this care, and an increasing trend of coverage across the United States, which I have written about in several posts on this blog, since November, 2012.

Since then, I have been having dialogues with others in this area, some friendly, some extremely hostile.

I’ll answer some of the questions I have actually been asked, here. I have reworded a few and not answered a few because they were asked too insensitively to post in their original format – it’s okay, we’re on a learning journey .

Q: This is a small population of people, why should they be advocated for?

That’s what people asked in 1993 about persons with HIV/AIDS.

Today, we look back in horror at the way the medical profession carried itself during that era.

To learn more about that, check out Regina Holliday (@ReginaHolliday) and my TEDx Talk, Embracing Failure.

I’m relatively certain the medical profession will be horrified by its treatment of trans people when it looks back as well. I’m going to TransPride to help shorten and end the horror.

Q: Isn’t this care way too expensive? Why should I have to pay for it? 

That’s what people asked in 1993 about persons with HIV/AIDS.

A few additional points:

• Trans persons who are insured and have so-called “exclusion clauses” for their care are paying for everyone else’s care, including care that has been deemed unnecessary and wasteful. Hormones, sex affirmation surgery, and behavioral health, when medically supervised are necessary and effective. Treating this rare condition (the way I refer to it with medical colleagues, understanding that every person doesn’t see it as a “condition”, it is an identity) using established guidelines promotes other positive health outcomes, and supports the achievement of life goals, which is what the health care system is for.
• Most insurance plans that won’t cover surgery or hormones cover the complications of surgery or hormones. In other words, if a trans person obtains surgery and has an infection or other complications, or complications from non-prescribed hormones (heart attacks, clots, strokes) you will pay for their care. This doesn’t even touch on lost productivity, behavioral health issues, and suicide. Gender dysphoria is not a mental illness – much of the mental illness that is associated with gender dysphoria is caused by bias in society that the health care system promotes. Medically supervised care is likely to be less costly in the long run.

Q: Isn’t sex affirmation surgery cosmetic? 

No, it is not. I’ll state it again for the search engines out there: Sex affirmation surgery is not cosmetic.

The below is from American Medical Association Resolution 122 (A-08), 2008

Whereas, Health experts in GID, including WPATH, have rejected the myth that such treatments are “cosmetic” or “experimental” and have recognized that these treatments can provide safe and effective treatment for a serious health condition; and

Whereas, The denial of these otherwise covered benefits for patients suffering from GID represents discrimination based solely on a patient’s gender identity; and

Whereas, Delaying treatment for GID can cause and/or aggravate additional serious and expensive health problems, such as stress-related physical illnesses, depression, and substance abuse problems, which further endanger patients’ health and strain the health care system; therefore be it

RESOLVED, That the AMA support public and private health insurance coverage for treatment of gender identity disorder (Directive to Take Action); and be it further

RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician (Directive to Take Action). Fiscal Note: No significant fiscal impact.

If hormones and behavioral health are covered and performed, but not surgery, is this discrimination?

Yes. Medically necessary care includes all three components, appropriately prescribed in consultation between a patient and physician. Not every patient needs all three components. Disallowing any of the components represents discrimination based on a person’s gender identity.

See above.

Weren’t you attacked recently on the Yale Daily News website when you commented about their decision to cover sex affirmation surgery?

I was. By 3 or 4 people.

By the way, Yale University is in the group of 37 universities who now cover this care for their students.

Once the attacks became ad hominem in nature, I went away. I just checked back in, an lo and behold, and comments like this  popped up:

 I admire Dr. Eytan’s remarkable patience and forbearance in responding to the comments on this thread. Even when respondents have turned to devaluation and ad hominem attacks, he has maintained a respectful stance toward all.

And then an email like this arrived in my box, from 15-year Yale Alumnus, Rachel See, JD:

Just wanted to drop you a note to thank you for your accurate and even-handed comments to the Yale Daily News story on Yale’s extension of health benefits (including surgery) to transgender students. This trans Yale alumna who graduated some 15+ years ago from Yale College was deeply gratified to see an accurate, and compassionate voice of reason in the comments.

In many trans*-related discussions in the popular media, I often see a tagline of, “…and as always, don’t read the comments.” I routinely ignore that advice, but its presence reflects an unwelcome reality that there can be a lot of rancor (and plain old fashioned ugliness) in online comments.

In a totally different context (blogging about ichthyosis), my wife and I have asserted that a calm, rational and respectful voice can act as a humanizing buffer against the propagation of some of the uglier trolls. But we’ve also noticed that those (lone) voices often go unrecognized.

So — thanks.

These messages cancel out 10,000 attempts at devaluing other human beings, because they show that the world is learning to love better.

If more attacks come in any venue I’ll just get one or two more of these messages that will cancel out 10,000 more.

The lesson is the same here – un-love can’t win – so great to see that affirmed, again.

Ted, are you transgender?

Feel free to select the answer that will allow you to have the greatest empathy.

The truth is:

• I am not transgender

I am also not

• a person who fears for my safety every time I use a public bathroom
• a patient who has been humiliated, harassed, or physically abused in a clinical setting because of my gender identity
• a person who was forced to spend my own money on a medically necessary procedure, present to an emergency room after an infection complication and then asked, “are you a man, woman or what.”
• a person who was denied emergency care after a car accident and left to die in an emergency room because of my gender status
• a person who was left to die in a university hospital ward in 1993 because of my sexual orientation

But I have met or seen the stories of people who are/were.

We didn’t go into medicine to un-care for people, and in 2013, we don’t have to. More and more clinicians are practicing the medicine of inclusion every day, and we’re going to change everything.

If I missed any questions above, feel free to ask more in the comments.

See you there. Oh yes, and love always wins .

*A note about the physician role. There are a lot more people than physicians working in this area, and they have been doing it for a very long time. Our role is to bring the patient story into every conversation, and help the people and communities we serve take control of their destiny. With that in mind, I acknowledge many dedicated people and organizations, including Casa Ruby , @casarubyDC , the DC Center @TheDCCenter and those who I have not met or worked with, yet. See you tomorrow as well.

Similar Posts:

• Asking about sex affirmation surgery – a review of the numbers
• Photo Friday: Nico Quintana , his story
• Celebrating Transgender Pride, our nation’s capital, and our community health, May 18 2013
• Photo Friday: Love Always Wins
• Now Reading: Care of Transsexual Persons — NEJM, in the era of inclusion

@medialab – photos by @veenu_a (View on Flickr.com)

This Innovation Learning Network (@healthcareILN) I tried something new – I brought a second camera and gave it to a colleague, to allow me to be in two places at once.

While I was learning about food insecurity and demonstration kitchens at Boston University School of Medicine (the social determinants of health thing), my colleague Veenu Aulakh (@veenu_a) was learning about the future of the future at the MIT Media Lab (@medialab). Here are her photographs, enjoy.

(She has a good eye!)

Similar Posts:

• Innovation Learning Network 2013 Day 1-2 , Boston University and CIMIT
• Now Writing: Seven Visual Insights of Social Determinants and Behavior Change – ILN INSIGHTS 2013
• Innovation Learning Network in Person in Wichita #iln10 day 1
• What does social media mean, in an integrated care system? A conversation at @KPGarfield
• ILN11/ Changing the Game – How to have fun while learning – Day 3

Overdue because I was supposed to write a half-way summary of my co-mentorship relationship with Katie Rovere (@katierovere) , who’s on the board of GenKP, the Generation Y Employee Resource Group of Kaiser Permanente.

Right on Time because we’re almost at the conclusion of our one year co-mentorship relationship. It’s concluding in the most awesome way, with Katie front of room, leading a workshop at our annual innovation retreat.

First, on the subject of the post – handing over the keys:

I see and hear so much commentary, including this article, around the concept of “get out of the way of Generation Y,” and I think it’s misguided. The articles seem to focus excessively on GenY’s ability to leverage technology:

What’s more, Gen Y workers raised on social media have special skills in pulling together solutions, and they know how to mobilize their networks. In today’s world, this ability to quickly collect and make sense of information and respond in real time often trumps experience.

To that I say, don’t be dazzled by something just because you don’t understand it. If you understand technology, you understand its limitations.

In many articles, I see Generation Y referred to as something of an invading force coming to take over with their different values. Are the values that different?

If you read an article about Generation X written 10 years ago, a lot of the themes are the same – self sufficiency, leveraging new communication, etc.

The suggestions people make about managing Generation Y to my eyes are about being more human and respectful in the workplace.

GenX wanted that too when we were starting our careers. Same goes for transparency.  I witnessed the most amazing devastation at the hands of a medical profession obsessed with paternalism and secrecy (as laid out in my TEDx talk with Regina Holliday) which makes me as interested in transparency as any GenY person might be. A lot of the desires of this generation are felt by other generations, too.

My year-long mentorship relationship – collaboration is the key, not handing keys over

When I encourage people to mentor, they sometimes say to me (I’m paraphrasing), “I should mentor a Generation Y staff member because they know a lot more than I do.”

To that I say, (1) yes you should and (2) that’s a fallacy.

My assessment above comes after a wonderful year co-mentoring Katie. We’ve been in the same space physically just twice in the last 12 months, and have been having regular semi-structured interactions by phone otherwise. Kaiser Permanente has a really nice matchmaking site for mentoring; that’s how we found each other. The joke between us is that we are always on the hunt for a mobile phone / land line combination that allows us to hear each other clearly . That’s a good sign for both of us, we are intensely interested in what the other person is saying.

In our time together, Katie has brought real, tangible insights about what it’s like to be starting a career in a large organization. None of them have struck me as the rant of the spoiled or the entitled. They highlight important limitations that I don’t see in my every day life. I don’t see them because I am farther along, I am a physician ( It doesn’t matter that I tell people to call me by my first name, there is a difference ) , and part of me has stopped noticing the every day hurdles. 

We need to validate, empower, reflect, and support Katie and her colleagues to connect their desires to the mission and values of the organization. We learn a lot during this process, of course!

It’s a great thing to provide the support that I was offered when I was in her shoes. It seems only natural that I want her to benefit from whatever I got, x 10.

A good mentor in my opinion does not intervene or choose the path for a mentee. As Lao Tsu said:

“The Sage is self-effacing and scanty of words. When his task is accomplished and things have been completed, all the people say, ‘We ourselves have achieved it!

From spreadsheets to cathedrals: Left to Right: David Nwangwu, Jessica Johnson, Bernard Tyson, Incoming Chairman and Chief Executive Officer, Kaiser Permanente,Katie Rovere, (GenKP Board)

A good mentor does do things like mention to Katie that her name was on a spreadsheet connected to planning an event (like the national Diversity Conference), and it was her decision to decide to follow-up on that. When life throws your name on a cell in a spreadsheet…

In the case of the National Diversity Conference, Katie did follow up, and literally showed attendees the difference between laying bricks and building cathedrals, on site. She herself and her colleagues achieved it.

So now Katie has ended up on another spreadsheet, and she and I will both spend some time on stage at our innovation retreat. I’ll be doing what I love, bringing the member voice forward (in a multigenerational panel – Gen B, X, Y, and Z!) She’ll be doing what she loves, bringing the voice of her generation forward.

We’re collaborating, because we love what we do and we want each other to succeed.

Utilize rather than surrender

The founders of my specialty, family medicine, said this about the relationship that family doctors should have with specialists:

Her/His aim is to broaden her/his concern, to widen her/his skill; s/he seeks to accept responsibility; not merely to pass it along. S/He utilizes specialists, rather than surrendering to them

I think this is a good analogy. Our patients don’t want anyone to surrender to anyone, they want us to leverage each other’s talents to create a much more beautiful cathedral (i.e. the achievement of their life goals through optimal health) for them. No one is laying bricks around here.

Here’s a video of the imaginarium that the GenKP group were a part of last year. Tomorrow I’ll post about Katie’s commentary on a few articles I asked her to read.

Similar Posts:

• Walking with Generation Y – From Bricklayers to Cathedral Builders
• Now Reading: Access to a PHR constitutes highly meaningful use – published data on member retention from Kaiser Permanente
• Kaiser Permanente Care Stories | Patients teaching about Integrated care through their stories
• A mentor around every corner
• What “Patients included” looks like : 2012 Permanente Executive Leadership Summit

Thanks to Kayt Havens, MD, for sending this to me. As she mentioned to me, it is a sweet article, about the transition of a dad to a mom.

It makes me think, changing the medical profession is at times nothing but grief, too. People should try it more often. We are.

Similar Posts:

• Now Reading: Care of Transsexual Persons — NEJM, in the era of inclusion
• Photo Friday: AIDS Quilt in DC – A journey through loss
• Don’t Ask Don’t Tell repeal is a big deal for the medical profession : The end of “if”
• World AIDS Day 2012: We’ll see the last one
• Being human and HIV care – Our generation does have the power to change it

View ILN13 24051 on Flickr.com

This Innovation Learning Network (@healthcareILN) was one of the ones where we spent most of the time doing open space networking so I’m not going to be able to create a summary that will reflect anyone’s experience but my own, which is fine because this is my RSS Feed .

I like the ILN. It’s a combination of exposure to people like me who need each other for various reasons, because life is not always dancing with prince charming at the ball (see my Teds2ndJacket story for more), a little bit of rebooting of the brain, and a few nuances and tidbits to help my passions become a little more refined and organized.

There’s also a component built in of “it feels good to be bad” 

Guest photographers with firefighters (View on Flickr.com)

Only to a point, until Chris reels you back in. Until then, though, there’s nothing wrong with celebrating the protectors of your community, or taking a moment to remember those who were not protected enough.

I innovated a little myself this time, by bringing a second camera, and inviting guest photographers to use it to take great photos. This time, they were Margaret Laws (@margaretlaws) and Veenu Aulakh (@veenu_a). As a result there are a lot of photos, so I’ll let the pictures do the talking.

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• ILN13: MIT Media Lab Safari
• #iln11 Day 2 – Prototyping life
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• Photo Friday: Hillary Clinton and Run of Show with Colleagues

Dys4ia – a game

From the author:

dys4ia is an autobiographical game about the period in my life when i started hormone replacement therapy. it’s a story about me, and is certainly not meant to represent the experience of every trans person.

When people talk about games for health they often talk about games to impact the health of an individual person. This is a game about the health of a health care system, that sometimes isn’t caring:

A recent non-peer reviewed report on transgender discrimination showed some 28% of respondents had experienced harassment in a clinic setting and that 2% had been subject to physical abuse.

The game is flash based, use the arrow keys to play, and see things from the perspective of a person as they interact with the health system. Go through all the four levels. You’ll see that just a little more listening and caring, which sadly is not the norm for this population, can go a really long way.

When I posted this on Facebook, Robin Deane said:

Anything that engages someone in a more open-minded format helps! …and, for me, highlighting the challenge of the psych gatekeepers and a supposedly like-minded community stood out! In the end, my trauma was ‘relieved’ through my association with similarly situated individuals…they really get the credit for launching me like a rocket!! )

That’s the job of physicians in this generation, to launch rockets. Holding people back is the domain of 20th Century medicine.

Make sure you get to the ending, there’s something valuable and worthwhile in helping people become who they are; everyone deserves the opportunity.

Similar Posts:

• “Think of the current treatment of hypertension as a really bad game” Innovation Learning Network #iln11 day 1
• Roundtable on Innovations in Games – Better Health and Health Care – White House, Washington, DC
• Trying out SCVNGR – a game about doing challenges at places
• Photo: Creating Community at VirginAmerica
• Innovation Learning Network – Final Day – Via Christi’s new hospital

This paper includes tidbits including a description of the first mention of the term “patient-centered care”:

Balint introduced the term in 1969, referring to the need for physicians to build a physician-patient relationship by seeing each patient as having a unique experience of illness.

Isn’t it interesting that 1969 is also the birth year of the specialty of family medicine – a lot of innovation was going on in the 1969.

I digress, though. Tony and I think very much the same way when it comes to involving patients and families in the design of the health system. This paper takes that passion and applies it to requirements of the Accountable Care Act and vice versa, connecting what should be done to what needs to be done. Easy!

Actually, the easy part is that Tony’s methodology doesn’t take a lot of resources, just the ability and interest in listening and observing. He discusses the limitations of data (I am also in agreement, when I talk about data versus facts – Getting the Facts about patient and family experience: Shadowing (presentation) | Ted Eytan, MD).

When patient satisfaction benchmarks are exceeded, we tout the results; when they are not, we variously (1) attribute the results to comparing “apples to oranges”; (2) are frustrated by the fact that the data is necessarily dated because of the time it takes to distribute, collect, collate, and disseminate it; (3) are frustrated by the difficulty of identifying root causes for both positive and negative patient satisfaction data, and (4) redouble and reprioritize our efforts to achieve better outcomes and scores despite the inevitable shortcomings of the data.

One great aspect of the PFCC methodology is that Tony’s view of what the care team is is much broader – innovation and caring comes from everyone on the team:

The PFCC M/P defines caregivers broadly, as any person within the health care setting whose work touches a patient’s or family’s experience (eg, doctors, nurses, therapists, technicians, appointment schedulers, parking attendants, medical records clerks, etc).

He involves all of them in the process to produce a healthy, cost-effective, high quality care experience. Want to practice how it’s done and you’re close to Washington, DC? Come to VisionQuest on May 10, 2013 at The Center for Total Health (@kptotalhealth). We’re hosting this with Tony because we want to build a base in Washington, DC for this approach as a norm rather than an exception in health care here. There are a limited number of scholarships available – contact me in the comments or tweet me @tedeytan and we’ll set you up. If every health system did this there would be a lot less unnecessary un-health.

Similar Posts:

• PFCC VisionQuest: Patient and Family Centered Care as the New Operating System for Health Care – May 10, 2013
• Wearing the story of fellow family physician Regina Benjamin, MD at #TheWalkingGallery on June 7, 2011, Washington, DC
• Also in DC June 4-6, 2012: International Conference on Patient- and Family-Centered Care
• Now Reading: Pursuing the Triple Aim Book (Launch Event in a separate post)
• Pursuing The Triple Aim Book Launch Event, at Kaiser Permanente Center for Total Health

ILNdc (View on Flickr.com for names and affiliations)

The Center for Total Health hosted the following organizations who are (relatively) local to Washington, DC and (mostly) part of the Innovation Learning Network (@healthcareILN) in a conversation we titled #ILNdc:

• Kaiser Permanente (@kptotalhealth)
• Medstar Health (@mi2innovation)
• VA Innovation (@vainnovation)
• Military Health System (@healthdotmil)
• Henry Ford Health System (@henryfordideas)
• Robert Wood Johnson Foundation Pioneer Portfolio (@pioneerrwjf)

Of course a walking meeting was involved

We were working to see sparks and touch points for the more east coast (United States) ILN organizations that are at most a train ride away, often walkable. We found some, which you can see in the photographs below. We also found that the answer to every discussion is not to start a new organization, it’s to celebrate the organization we are already a part of. And for me, to find new friends to attend meetups with, in Washington, DC. 

Thanks a ton Chris McCarthy (@McCarthyChris) for being with us as a leader and helping us discover ourselves as part of a leading region in the world in health innovation. So leading in fact, that we’re hoping to host THE Innovation Learning Network in person meeting in 2014. 

In the meantime, the ILN in person meeting in 2013 starts tomorrow, in Boston. Look for the #ILN13 tweets from there.

Presentations from the day are below.

Similar Posts:

• Henry Ford West Bloomfield Hospital: Where the hospital meets hospitality
• Photo Friday: Why fight traffic, fight discrimination instead, The Rosa Parks Bus @thehenryford
• He is a magician | Innovation Institute at Henry Ford
• Being atypical, the TEDx rules, and Regina Holliday, at #TEDxAlvaPark – November 8, 2012
• Exploring the Weight of the Nation, and Washington, DC, and Detroit

View Google Glass at 1776dc 23301 on Flickr.com

Easy choice this week.

Google Glass (@ProjectGlass) (Google Glass) made its first public appearance (that I know of…) at the hip new innovation space 1776 DC (@1776dc) at a meet up aptly titled “Anticipating Google Glass.” In the photograph, Antonio Zugaldia (@zugaldia) of Silica Labs (@silicalabs) is showing the audience the basics of how the device works.

The audience included people from all over the world to take a look for the first time. It was really akin to seeing the iPhone unveiled – everything to understanding how to use it, to how to program for it.

Later that evening, Mayor Vince Gray (@mayorvincegray) even tried on the pair.

Even the mayor of DC, @mayorvincegray loves Google Glass. @silicalabs @zugaldia @ammori #dctech @projectglass twitter.com/nguyenist/stat…

— Stephanie Nguyen (@nguyenist) May 2, 2013

The Kaiser Permanente Center for Total Health (@KPtotalhealth) and the Garfield Center (@KPGarfield) are both in the glass explorers program. As soon as we get ours (if not sooner), we’ll be hosting a meetup to talk about glass in health. Please come innovate with us. And yes, I have already thought of an app to support culturally humble health care .

Here are the rest of my photos from 1776 dc.

Similar Posts:

• Walk With a Doc – Washington, DC , August 10, 2012
• Proclaimed! 2012 DC Health Data and Innovation Week – Washington, DC USA
• Sign up for December’s Community/Entrepreneur Tour of the Center for Total Health – 12/7/12
• Photo Friday: Born to be a Leader (beginning with being baby in a drawer)
• Sign up for the next Community/Entrepreneur Tour – Center for Total Health – December 21, 2012

Walking the walk, not through an airport (View on Flickr.com)

Thanks to Howard Chiou (@medxanthro) at Emory University, I had the awesome opportunity to talk about Kaiser Permanente’s environmental stewardship work ( everything you need to know is here: http://kp.org/green ) at the Rollins School of Public Health (See: First, Do Earth No Harm).

Also thanks to Howard Chiou and his information technology partners, I had the awesome opportunity to give the talk after walking to work rather than walking onto a jet plane.

The Rollins School has a good setup, and it went really smoothly. I was excited to learn from the other presenters (see Facebook link above for more info) that ours is not the only health system with experts interested in environmental stewardship – and that includes physician and nursing leaders. I was excited overall to learn that curricula are developing in medical and nursing schools around environmental stewardship. As I mention in the slides below,

Not here to hug trees, here to hug these (View on Flickr.com)

• our patients see the waste in health care and want to know that we are not harming the world around them while we are healing them (quoting that @Jess_jacobs again!)
• environmental stewardship is not cost saving in the long run – it is cost saving in the short run AND the long run – exploding one of the biggest myths (see this report for more info)
• There’s a way to do this work with help – Healthier Hospitals Initiative. It’s all laid out in easy to accomplish steps.
• we’re not here to hug trees, we’re here to hug these, and that’s why we’re doing this work

Did I say thanks to Howard yet for putting all of this together? I think I did but I’ll say it again – a thoughtful and dedicated (in this case, MD/PhD, but it could be nursing, pharmacy, college, high school) student can have a lot of impact, all it takes are a few tweets to people who are curious and some determination – no need to wait for graduation .

• Community Health Needs Assessment includes the Environment, and Green Health Care Resources
• Kaiser Permanente 2009 Greenhouse Gas Emissions Report
• Getting the Facts about patient and family experience: Shadowing (presentation)
• Sign up for January’s Community Tour of Center for Total Health : Focus on Labor Management Partnership
• Photo Friday: A focus on pharmacists, at Howard University, Washington, DC, USA

I am excited to in the doc contingent part of this, but of course I will also be walking for road safety and to yoga (will I participate in that? we’ll see). May 5, 10:00 am, Stanton Park, Washington, DC, USA

Thanks Bella Dinh-Zarrr (@dinhzarr) , Sharon Bauer, and fellow doc-teammate Robert Zarr (@DocZarr) for paving, I mean walking the way…

Here is what Jane’s Walk is about:

Jane’s Walk celebrates the ideas and legacy of urbanist Jane Jacobs by getting people out exploring their neighbourhoods and meeting their neighbours. Free walking tours held on the first weekend of May each year are led by locals who want to create a space for residents to talk about what matters to them in the places they live and work. Since its inception in Toronto in 2007, Jane’s Walk has expanded rapidly. In May of 2011, 511 walks were held in 75 cities in 15 countries worldwide.

This walk, on the day before UN Global Road Safety Week, will take us from historic Capitol Hill (Stanton Park, 4th & Massachusetts NE – meet at the statue!) to Constitution Gardens (Constitution Avenue and 17th Street, NW, along the northern edge of the National Mall) for free Yoga on the Mall!  All are welcome – bikes, dogs, strollers, everyone!Similar Posts:

• Walk With a Doc – Washington, DC, December 19, 2012 – To learn about rating and prescribing parks
• “This park is nearly ideal” – A walk to rate, celebrate, and prescribe parks, in Washington, DC, USA
• Time for Walk with a Doc: Long Short version , for Road Safety (UPDATE: Surgeon General/Time Change)
• Celebrate Telework Week: Go for a Walk (while working)!
• Physicians Rating and Prescribing Parks : The DC Park Prescription Podcast

WPATH recommends1—in concert with policy statements from the American Medical Association,2 the American Psychiatric Association,3 the American Psychological Association,4 the American College of Obstetricians and Gynecologists,5 and the Center of Excellence for Transgender Health at the University of California, San Francisco6—that the healthcare needs of transgender people should be openly and properly addressed, at the same level of quality and thoroughness as is afforded to any other person.

This just published paper (unfortunately behind a paywall, but you can access a summarized version at the transhealth.ucsf.edu website) explodes an inaccurate tenet within electronic health record systems – that a person’s sex and gender are tied together, and in turn fully inform a person’s medical destiny. This is not the case for a small percentage of patients.

It is recognized that the overwhelming majority of patients are not transgender, which has led to implementation of a binary male/female oriented system across multiple platforms such as EHR systems, billing and coding systems, and laboratory systems; however, this structure inhibits the collection of accurate medical information, and therefore such systems should be modified.

The paper describes a recommended two-step process to collect two pieces of information, gender identity and sex assigned at birth, that is already in use at the CDC. In addition, there are recommendations for recording preferred pronouns, common treatments and procedures, and status of a person’s transition and anatomy. In 2010 The Institute of Medicine recommended that gender identity be accurately collected in electronic health records and be part of meaningful use.

The Working Group producing the recommendations is EHR experienced and the ideas make sense in terms of what is doable in an electronic health record. The alternative today is not very healthful for this population – having to change the “sex” field back and forth to order necessary preventive exams, or to not have ready access to transition history or preferred pronouns in establishing a relationship.

As WPATH guidelines become followed more regularly and medically necessary services are covered and performed across health care (37 Universities and counting), the health of trans people will be more and more about ongoing preventive care, just like the population at large.

Why do this?

A recent non-peer reviewed report on transgender discrimination showed some 28% of respondents had experienced harassment in a clinic setting and that 2% had been subject to physical abuse.12

Electronic Health Records are for health, and should not codify or indirectly create misunderstanding in the clinical setting. The results can be devastating. Fortunately, health information technology can be used to eliminate disparities in health instead of creating them.

I love hearing about great things HIT “does” for people rather than what HIT “is,” don’t you? Similar Posts:

• dys4ia – A game for the health system, to heal itself
• MedEdPortal – Call for Submissions – to improve LGBT / DSD curricula in Medical Schools
• Now Reading: Health information technology: fallacies and sober realities ( so why not involve patients )
• Now Reading: Choosing Wisely : Standards of Care for the Health of Trans People
• Photo Friday: Nico Quintana , his story

Register for online (streamed in HD) or in person attendance here.

Technology Focus is a monthly hosted series created in partnership with the Kaiser Permanente Innovation and Advanced Technology Group.

We will interact with technology and people that have the potential to produce health in medical care and beyond, where people live, work, learn, pray, and play.

The series includes person and online participation, with high definition streaming capability from the Center for Total Health, in the heart of Washington, DC.

Technology focus is open to Kaiser Permanente physicians, nurses, staff, members, and the communities we serve, locally and nationally.

May: Vital Connect

Vital Connec’t‘s VitalPatch(tm) is a wearable biometric sensor capable of

• continuous monitoring combining multiple, simultaneous, advanced, biometric measures to generate meaningful data
• full configurability to filter data streams and enable thresholds to generate notifications
• with a comfortable, unobtrusive, disposable form factor

The Technology Focus for May will include a live demonstration of Vital Connect’s biosensor platform, including measurement, transmission, and interpretation of data, as well as discussion of use cases to promote healing in the home, workplace, and after discharge from the hospital.

Follow us on an journey through the prototype workplace, hospital, and home.

We will be joined by

• Nersi Nazari, PhD, Chairman and CEO, Vital Connect
• Justin Heindel, Vice President of Business Development, Vital Connect
• your hosts Ted Eytan, MD, Physician Director • Keith Montgomery, Executive Director Kaiser Permanente Center for Total Health Roger Lam, Kaiser Permanente Innovation and Advanced Technology

and YOU! The amazing live audience

This event will be live streamed in HD and will support two-way interaction with the audience

Similar Posts:

• “Everyone feels that their work is important” – learning about leading primary care at Kaiser Permanente and affiliates
• Presentation: Technology to Achieve Total health – Office of Health Information Technology and Quality, HRSA
• Presentation: Meaningful mobile technology use … to achieve Total Health
• March’s Community Tour of @kptotalhealth: Focus on Diversity, for LGBT Health Awareness Week
• February’s Community/Entrepreneur Tour of the Center for Total Health : Focus on #HCSM

Tweeting Regina Tweeting

When I was studying and passionate about implementing the Toyota Management System to improve efficiency in health information technology, someone said to me, “You’re going to LEAN yourself out of a job at this rate.” My response was, “I hope so.” I fired myself about 18 months later….

On Friday I was on stage with fellow crazy life rider Regina Holliday (@ReginaHolliday) at the 6th Annual Mid-Atlantic Healthcare Informatics Symposium, put on by Childrens Hospital of Philadelphia Center for Biomedical Informatics (@CHOP_CBMI), and I noticed….I can’t give a talk anymore without bringing in environmental stewardship (hashtag: #GreenHC), and I was this close to adding in a slide about transgender health issues.

I asked Regina if if would be inappropriate to include that information in the presentation, and she told me that it would be fine, since hers included references to toy stores. I probably could have weaved it all in…

Something tells me though, that these are not the topics an audience interested in healthcare informatics comes to the Philadelphia Sheraton to hear about (or do they?).

On the one hand, I was told this audience wants to hear about guidelines and code sets. On the other hand, I walked into the room overjoyed that the day before Philadelphia’s city council had just passed a landmark piece of legislation supporting the health of its LGBT residents. Which is more important for health?

And yet, on the other hand, about 30-40 % of the people in the audience raised their hand when I asked if they had ever e-mailed their doctor / looked at their medical record online.

And on the other other hand, about 1 % of the people in the audience raised their hand when I asked if they had gone on a walking meeting.

And, in 2013, it is an impressive accomplishment to get 300 people at an event, so there’s much respect there – and we’re there to serve the audience, not me.

I don’t know the answer or even the question, which is why the title of this post ended up being a hedge. These are the images I presented in the end -

I think the work in informatics to include patients and families is definitely not done, even if it is on the launch pad, so it was most prescient and supportive for CBMI to invite me (and for me to ask them to invite Regina too, which they readily did).

I’m using the hashtags #PreventionisthenewHIT and #GreenHC and #transgender #health a lot more than I’m using #HIT. 

One thing I learned is that people who are working in HIT are actually trying to speak at non-informatics conferences, to broaden the conversation about HIT into the greater health care community. Maybe for me, then, speaking at informatics meetings will be my foray into my non-world world. How strange.

Subject matter aside, my role and the role of all physicians is always in creating environments for patients to have a voice co-lead the health system until the day they don’t have to anymore. That may include downloading Regina’s slideshare onto my laptop while 300 people look on, it’s part of the service.

In a nutshell: Crazy life ride, now with refreshed ripples on my walking jacket! And, I’m open to others thoughts who are working in HIT or not, about what the audience like this can and want to learn. Thanks a ton, CBMI, for thinking outside the toy box.

Similar Posts:

• Shattered ceilings, doors, and computer screens – Speaker of the United States House Nancy Pelosi and Regina Holliday
• Photo Friday: Love always Wins
• Every Movement includes Art – an introduction for The United States Surgeon General
• Campaign for Better Care Forum : Patient Voices, my Interview
• Clinicians from the future practice the medicine of inclusion – Kaiser Permanente LGBT Health Symposium

View Love Sculpture and Philadelphia 23118 on Flickr.com

This week’s photograph wasn’t taken in Washington, DC, because I haven’t been there a lot lately

However, Philadelphia definitely deserves the honor this week, for what it has done, in passing a national landmark LGBT Health bill, which includes support for transgender health.

The photograph was taken in Love Park, which includes the so-named sculpture. More photos of the sculpture below, along with a few shots in the neighborhood where the future is being celebrated.

Love continues to win.

Similar Posts:

• Photo Friday: Ready, Set…
• Photo Friday: Comparing two monuments – Gay Liberation Monument (NYC) and Boy Scout Memorial (DC)
• Photo Friday: Life’s better here – It’s True, DC is diverse
• Photo Friday: Cadillac Hotel and the Green Book for African American Travelers, Logan Circle, Washington, DC, USA
• Philadelphia Passes Historic LGBT Health Equality Bill! | Transgender Law Center

The transgender health provision would make Philly the largest city to remove trans health care coverage exclusions for city employees. It also institutes the first of its kind “transgender health tax credit” which would urge willing businesses to choose transgender inclusive health plans.

via @translawcenter

Similar Posts:

• 2013 HRC Corporate Equality Index Awards for LGBT employment – New York City
• Virginia: State Employees Lose Protections from Anti-LGBT Discrimination
• Photo Friday: Nico Quintana , his story
• Now Reading: Healthcare Equality Index 2011 – @HRC delivers good news and the news that we have a ways to go
• March’s Community Tour of @kptotalhealth: Focus on Diversity, for LGBT Health Awareness Week