You're going to need a bigger binder.


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This presentation is a mash-up of film, social media and HIT policy.

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You're going to need a bigger binder.

  1. 1. “You’re going to need abigger binder:”What one late great film professorcan teach us about care transitions.a presentation by @Regina Holliday
  2. 2. "Thats part of your problem,you havent seen enough movies.All of lifes riddles are answered in the movies."—Davis (Steve Martin), Grand Canyon,from Frederick Hollidays PhD e-mail signature
  3. 3. What does 70s TVhave to do with medicine?
  4. 4. Fredmet Regina on stage in a scenic painting class at Oklahoma State University. Theywould talk of Stephen King’s Dark Tower and fall in love.
  5. 5. The reality of patient engagement
  6. 6. Playing Doctor: Fall 2008
  7. 7. During the months ofJanuary, February andMarch of 2009,Status Lines…
  8. 8. On Friday March 13th, We went to the ER because Fred was in so much pain .We waited three hours before being sent home.
  9. 9. Fred was hospitalized on March 25th 2009for the administration of tests. On March 27th, he was told while alone that he had ―tumors and growths.‖
  10. 10. What was the diagnosis? What were the treatment options? Would he get a pain consult?
  11. 11. This is my husband’smedical record.I was told it would cost73 Cents per pageAnd we would have towait 21 days to get a copy.
  12. 12. ―She must not have tried very hard to get the record….‖Comparing access to an unpublished book byStephen Kingto accessing theElectronic Medical Recordwhile hospitalized.
  13. 13. ―Go After Them, Regina.‖ April 18, 2009
  14. 14. "This is your last chance.After this, there is no turning back.You take the blue pill -- the storyends, you wake up in your bed andbelieve whatever you want to believe.You take the red pill -- you stay inWonderland and I show you howdeep the rabbit-hole goes.‖-The Matrix
  15. 15. 5After waiting for days for a transfer, we weresent with an out of date and incomplete medicalrecord and transfer summary.The new staff spent 6 hours trying to cobbletogether a record using a phone and a fax machine.
  16. 16. This is thevital clinical informationfrom Fred’s electronic medical record.Painted on the wall ofPumpernickel’s Deli inWashington, DC.
  17. 17. I am trying to talk with Christine Kraft and epatient Dave. Why did we get more help and answers from Social Media than from our local hospital ?
  18. 18. Going to Hospice.
  19. 19. Terminal Restlessness.
  20. 20. This is the painting 73 cents.This is the vital patient story, the social history , the sacred heart of Fred’sELECTRONIC MEDICAL RECORD.
  21. 21. On Tuesday, October 20th 2009 we dedicated the mural,―Where do we go from here?‖
  22. 22. What can we do by next Tuesday?What will defeatthe Big Bad?The Final Boss?
  23. 23. Meaningful Usein adiner
  24. 24. The Cake is a Lie.
  25. 25. Doctor Strangelove&Value Based Purchasing
  26. 26. MIBMedicalInformationBureau
  27. 27. My Halloween Decorations:Portals are coming!
  28. 28. What does data and device accessadvocate Dr. Eric Topolhave in common withthe movie Alien?
  29. 29. All over the world, patientsare demanding their data.
  30. 30. 2 year study at Primary care settings of Beth IsraelDeaconess Medical Center, Geisinger and Harborview90% patients responded they understood what they had read& were not bothered by it.87% of those patients enrolled in this study did check thenotes.80% Patients claimed greater adherenceto medication protocols due to access to the notes.
  31. 31. What if data donation improved organ donation?
  32. 32. The Learning Health System and Chaordic Organization
  33. 33. Blue Button: More than app for veterans.
  34. 34. Who taught you how to be a patient?
  35. 35. Involving Patients as a Path to Achieving the Triple AimHow would pop-culture define the IHI Triple Aim?Not as just another pyramid….Not as just another failed pictograph.What does it make you think of ?How about…
  36. 36. The Temple of Gozer from Ghostbusters?
  37. 37. I have a radical idea. The door swings both ways, we could reverse the particle flow through the gate. How?[hesitates] Well cross the streams. Scuse me Egon? You said crossing the streams was bad! Cross the streams... Youre gonna endanger us, youre gonna endanger our client - the nice lady, who paid us in advance, before she became a dog...Not necessarily. Theres definitely a *very slim* chance well survive.[pause while they consider this] [slaps Ray] I love this plan! Im excited to be a part of it! LETS DO IT!
  38. 38. IHI Triple Aim is not a triangle. It is a focusing beam.
  39. 39. HAI!The artists and designers are coming
  40. 40. What happens to user experience when designers likeMichael Graves design wheelchairs?
  41. 41. Why can’t we ask Hallmarkto make hospice cards?Would that help us talkabout end of life?
  42. 42. You can take a negative and turn it into a POSITVE.Welcome to the Walking Gallery. Telling the patient story one jacket at a time.
  43. 43. 206 unique Walkers have joinedwearing 227 jackets.The Walking Gallery is promoted heavilyusing the free tools ofsocial media.
  44. 44. Fred’s last request is to remember him by watching a film on his birthday. March 31,1970 – June 17, 2009 Thank You.