Dr. Phil’s “Blogajawea”

Well friends, fans and strangers, it’s time for another entry in the blogosphere finally.  There have been a number of things that have gone on since my last post.  Work at WebMD continues to be busy, the Personal Health Record area is starting to get a lot of attention, the house is gutted and being remodeled, and there’s this drum corps called the Oregon Crusaders which is getting all charged up and ready to rock the heartland.

Whew, so where do I start?  Well, since the Oregon Crusaders is on the verge of their first performance (dress rehearsal in 2.5 hrs), I’m going to start and end with OC.  We’ve had some ups and downs in membership, but the kids who are here are working their butts off and we’ve seen tremendous progress in the last few days (and it’s been 67-70 degrees and partly cloudy the entire time).  The show Inner Connections is such a rich piece of work that it’s difficult to put into words.  Every element of it has been written so that all sections contribute to a complex but engaging (and very demanding) show.  Our bus seat partners have been determined, we’ve got the bus company and the trucking company ready to go, and we’re looking forward to a great season. 

We were sorry to have to cut our first tour a show short.  Our financial campaign has come up short, so we had to make some tough choices.  But as hard as that decision was, it helped us to have complete confidence in the full eastern tour, where I’ll be “Back home again in Indiana.”

If you liked our show last year, just wait until you see this one!  Hope to see you soon!

I was flying from Dallas to Portland last Thursday afternoon.  I was seated against the window on the 2-seat side of a Super80, and sitting next to me was a 22 year-old US Army Private First Class who was headed home for an 18 day leave following his 8 month-long first tour of duty as an artillaryman/gunner in Baghdad.  The more than 3 hours we spent talking made the war that we’re fighting in Iraq get a lot more personal to me.  The conversation changed the way I look at things, and I would like to share the story with you.

When we think of the war, or we think of our soldiers, we can fall into the habit of thinking in soundbites, or in stereotypes.  For the war, we think either “it was a huge mistake and we need out” or “we can’t cut and run”, or when it comes to soldiers, we think ”grunts” or “because they didn’t have any other choice.”  These points of view are, of course, too simple and uneducated.  But without any better information (like, say, actual journalism and reporting), it’s easy to fall into the soundbite trap.  But in talking with the pfc on my flight, who I’ll call “Adam,” the reality of what’s happening on the ground, and the reality of our remarkable soldiers, has helped me to understand things a little more deeply.

Adam talked with me throughout the entire flight.  I thought I was being a burden, but he said he prefers to talk with someone because when his mind sits idle he gets paranoid and “jumpy”… effects of the war.  He commonly goes 72 hours with no sleep, and the sleep he does get is uneasy.  His state of unrest and his “get done what needs to be done, now” attitude was evident when we were 10 seconds from touching down and he got up from his seat to go to the bathroom.  I caught him just in time for him not to be yelled at by the flight attendants (or floored from the landing). 

Adam started by telling me how he got to Iraq.  He signed up for the Army after high school, and after having spent a little time working.  He has been trained as an artillaryman, and was shipped out to Iraq with his platoon 8 months ago to patrol a suburb of Baghdad.  Since we aren’t using much artillary, he sits atop a Humvee with a turret and large caliber machine gun, his hands still stained yellow from the residue off his gun. 

Adam provided remarkable, and terrifying, insight into the reality of this war.  If anyone thought that somehow this was not really a war zone, not really a dangerous place where people are dying in front of you, then think again.  His stories of his Lieutenant being killed, his stories of being shot at, and of shooting others, paint a very real, and very frightening picture.  But he was able to put it all in perspective in a way that I found heroic.  He was careful about not revealing anything confidential, but what he was able to share painted a picture of a strange mix of a 21st century tech-savvy soldier with the randomness and horror of medieval soldier. He was a remarkably balanced, professional, thoughtful and intelligent person.  He represents this country with strength and compassion, and he gave me insights into the war and the people of Iraq and our potential to do good that I found refreshing. 

Adam said that he, along with the army in general, believe that we should’ve “cleaned house” in Afghanistan following 9/11 before ever considering Iraq.  But at the same time, he said that he and his platoon have gotten to know many of the Iraqi people, and he feels good about the opportunity to create a better country than when Saddam Hussein ruled.  He’s proud of us being there, but at the same time believed that we have to start putting more pressure on the Iraqi government to provide their own security so we can begin withdrawing troops.  He thought Barack Obama’s plan of beginning to withdraw troops next year made sense and would put the appropriate pressure on their government.    But his positive attitude about the good that we are doing (or could do) for the Iraqi people made me feel better about us being there, and about supporting the effort - moreso than I had in the past.

Adam shared many things that made me concerned for him and his fellow soldiers beyond the risk of battle.  He shared that while the Army provides good medical care, he has experienced a lot of other soldiers having mental breaks due to the stress of war, but that there isn’t anything in place to handle those kinds of problems.  “Talk it over with your buddies” is the standard therapy whenever these kinds of problems present. 

Needless to say, Adam’s remarks have left an indelible mark on me.  He had the confidence and character to help me, a 40 year-old product guy who is trying to find his way in a fast-paced world and sometimes challenging corporate environment, to address my issues directly and strongly.  He spent just as much time providing me with advice as he did in answering my endless questions about his life as a soldier.  He has helped me to realize that this is war… yes, an actual “Saving Private Ryan” kind of war where real people are getting blown up, where real civilians are getting killed, where real bad guys are meeting their doom, and where our young people are doing the best they can to help another people.  I felt like crying in fear for his safety because he’ll be going back to the front lines in just a couple weeks, but I didn’t show it.  I just privately prayed for his safe return home to his young family. 

Should we be there in Iraq at all?  Maybe.  Maybe not.  But we should all be thankful that we have such remarkable men and women who are looking out for the interests of a people rather than their own interests.  We would be well-served to promote people like Adam to be our political leaders, and the sooner the better.

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When I came to the Northwest in 1994 from Indiana, I didn’t have any idea I’d be heading up a drum corps.  To run a drum corps is a fantasy that all drum corps fanatics have at one point or another (”Man, if only I could run a drum corps…”), and I’m livin’ the dream (although if you would’ve asked me in the middle of my first tour last year I might’ve not been so positive about it).  When I came into the Northwest, I was focused on my career mostly, and I was a fanatic for the Santa Clara Vanguard.  I didn’t really know much about NW drum corps, except of course for the Seattle Cascades.  The Oregon Crusaders, in whatever form they existed in 1994 if at all, wouldn’t be in Portland for another 6 years.  It was the Cascades that provided the consistency of a nationally touring NW drum corps, and in 2000 they won the Division III world championships.

There has been a lot of talk lately about NW drum corps.  At OC, we’ve been focused on growing our program, and it looks like it’s going to be a strong year for us as we dramatically increase our size, increase the complexity and artistry of our program, and tour nationally.  The Thunder has a number of new staff members and are looking to field a good group this year.  And the Cascades are taking a new and different approach in order to make sure their organization is fiscally sound as they look ahead to a strong future.

To make a decision to go in a new direction is really tough.  There are a lot of forces working against you.  We did it at the beginning of last year, creating a new program that is artistically very progressive and with a whole new staff.  The Cascades are doing it this year, and albeit with a limited tour, it sounds like a different and interesting kind of program.  We applaud what they’re doing this year and we hope the very best for them.  And it could serve as a real testament that in order to break free of some of the legacy constraints of providing a drum corps program - financial, recruitment or otherwise - you have to try new things. 

And so the more things change, the more we innovate in the Northwest, and the more we can provide something that is new and different, maybe things won’t stay the same.  Maybe they’ll be even better.  All we need to do is to have a little vision, put in a lot of hard work together, treat our young people with respect, and spread the word. 

All the best to all those in the Northwest for a productive and fulfilling 2008.

Dr. Phil 

Well, it’s time for another blog entry.  The Oregon Crusaders continue to make great progress (although sometimes housing is a stress… luckily I’ve got Ron Barnett helping me to manage that).  And our DCI directors meeting went well over the weekend - it was so good to hang out with friends like the Northwest directors, Rob Lowery, Rob Ripley, Jeff Pearson, Marc and Stefanie Hebert and so many others so committed to drum corps.  But instead of talking about drum corps I wanted to spend a little bit of time expanding on an issue that I brought up in my last health care blog.  (OK, so if you were looking for a drum corps post, like electronic guitars and how they aren’t approved for use in DCI shows, then I’m sorry to disappoint).  (Oh, second parenthetical point, if you’re looking for a blog every few days, you’ve got the wrong guy!). 

Now for the blog.  I had the great pleasure today of leading a discussion of health care connectivity in Washington DC at the World Health Care Congress with former US Surgeon General Jocelyn Elders and Dr. Paul Grundy of IBM.   Dr. Elders is as sweet at she could be, and still as eloquent as ever advocating for greater health care literacy among consumers.  Dr. Grundy has been on the “front lines” of providing personal health records to employees and advocating for a stronger relationship between patient and primary care provider.  Connectivity of all types is something that is getting a lot of play in health care.  Friends and colleagues Jamie and Ben Heywood at Patients Like Me, Adam Bosworth of Keas, WebMD with their drug insights and message boards and so many others are tapping into the power of technology to enable people to help other people to make better decisions and improve their care.  I hold to the belief that patients connected to each other, to physicians, and to the research community are what have the chance to transform our disconnected (and yet somehow overly techno-centric) health care system.  When it comes to patient-physician connectivity, we touched on something today that I believe is critically important.  We talked about the importance of the connection between patients and their doctors, but as part of a growing and meaningful relationship.  Not as part of the transient or distant relationship that most patients now have with their doctors.  It’s one of convenience, efficiency and significance.  It’s one that supports a continuity of care, a familiarity, between a doctor and his patients.  But it is one that meets the needs of doctors and patients.  Doctors choosing the health record and workflow systems that meet their needs, while patients choose the system that best meets their needs.  Connected, not tethered, but connected with all the doctors that provide him care.  We have held out hope that regional health information organizations and a national health information network might provide the connectivity we seek.  But two things have threatened these efforts: 1) There is no clear business model, and 2) The consumer is oftentimes nowhere to be found in these efforts. 
Why is it that the consumer cannot be the bridge across our health care system?  I believe, as we are beginning to show through WebMD, that patients can help to bridge our fragmented system.  They can use technology to support the doctor-patient relationship, supportive of their need for privacy and control, and supportive of the consumer-centric health care system for which we have all worked.  Imagine: A patient walks into their doctor’s office.  They provide unique information that is input into the doctor’s office system that automatically links the doctor’s system to the patient’s portal.  Secure messages, lab results, a full health history, monitoring and tracking, health improvement, clouds parting, angels singing.  You get the picture.  And doctors able to have a good quality of life managing urgent issues in-person while managing non-urgent issues more efficiently.  It’s not a future that has to be that far away.  In the words of one of the meeting’s attendees today: 2008 is the year.

Enjoy the pictures of me with the WebMD team and with Dr. Elders and Dr. Grundy.    

We had a great camp this weekend, learning up to probably 1/3 of the opener.  Everyone worked so hard, and we also had our first leadership session, doing an overview of this year’s (all new) curriculum, and getting to know each other just a bit more.  Thanks so much to the many volunteers (the Bess clan, Michelle Mohr and others), as well as to our staff for helping to make it a great success.  The level of maturity of our program, our training, and of our members is showing, and we’re all very excited about the up-coming year.  Have a great holiday season, and check back soon for pictures from camp.

Believe it or not, this blog will cover many topics, not just drum corps.  I’m a physician trained in surgery and public health and preventive medicine, and I head up strategy for a leading health care information and technology company.  I’ve been working hard over the past 10 years to develop technologies that bring “the right information to the right person at the right time.”  From a technical perspective, matching things to people who wouldn’t otherwise see them is a fun and worthy endeavor.  But as I’ve explored the needs of health care further, as I’ve interacted with those from Medicare and government, leading innovators from around the country, and leading corporations and health plans, I am evolving my perspective.  I have come to believe that enabling the matching of people to people could be the most important match of all in health care.  I’d like to talk about “People helping People”, and how this social model of people interacting, enabled through technology, is going to be just as important as any economic model in our evolution toward a more efficient and effective health care system.
I’d like to talk about this social model through three examples: Social networking, patient-physician communication, and patient-industry collaboration. 
Social networking over the web is personified by Facebook and MySpace, and is inevitably going to transform health care as consumers interact with each other to become healthier, compete with others over health improvement, and even decide what treatments are most likely to work based on how they worked for “patients like me”. (See patientslikeme.com for a great example for how this works).
More efficient and effective patient-physician and physician-physician connectivity will also become a cornerstone of our emerging health care system.  To be clear, calling what we have today a “system” is a stretch.  What we have today is individuals who do their best to guide people into the technologies or treatments that are most likely to have an impact, but there is no “system” which facilitates shared decision-making or information sharing.  If you’ve ever tried asking one doctor to share your health records with another, you know what I mean.  But we already have a platform in place that can provide the backbone to more efficient communication: the Internet.  Internet-based communications between patients and doctors can ensure that both have the information they need to make more informed decisions, and online messaging between patients and their doctors brings an efficiency and convenience to health care that benefits everyone.  And doctor-to-doctor communication using the Internet helps make a collaborative care environment possible, improving quality and lowering the risk of error.

But perhaps what excites me the most is patient-industry collaboration.  It may sound a little academic, but it’s a new idea that the Internet, and robust tools delivered through it, can help transform the way researchers and others in the pharmaceutical and medical device industries can collaborate with consumers directly to identify new therapies, and identify ways of targeting the therapies that are most likely to work for individuals.  By enabling researchers at institutions and industry to ask questions of large numbers of consumers, and by enabling consumers to utilize their own anonymous or private data to answer those questions without having to divulge their identity, we allow those answers to contribute to our knowledge and the development of new and exciting tests and therapies that can transform how we live.  You can see an idea for how this might work by going to www.genacy.com.
People helping People.  It draws upon our basic humanity.  It’s a social model that’s as important to the evolution of our health care system as any economic model.   As part of our national health care discussion I believe it can transform how we live.

Last Saturday, during our first camp and Orientation for the 08 season for the Oregon Crusaders, I asked our vets to stand.  About 40 students rose, and 35 of them had been rookies just a year ago.  They had gone through the drum corps experience.  They had learned so much, and they were ready to now enter a new year transformed.  Transformed as veterans. 

It would be easy to talk about the students.  All the experiences.  The friendships.  The competitions.  The gates.  But it has been more difficult to realize my own transformation.  Before this last season, I talked about drum corps from a first person perspective like I really knew about it.  I had been a long-time fan, and had even been fortunate enough to get to know the Santa Clara Vanguard as a member of their Board of Directors.  But I had never marched drum corps.  I had never even really volunteered for drum corps.  Whatever it was I had, it wasn’t exactly drum corps experience.  But at the end of 2006, when my local drum corps had lost its staff and was in danger of folding, I thought that I could help.  I became the executive director, with the plan of hiring a corps director to help manage the corps.  I wasn’t able to find that person last year, but was lucky enough to find other passionate and talented staff to help me to keep the corps going and to create a new foundation for the group.  I served as corps director as well, and during the process I had one of the most rewarding and gruelling years I could ever have imagined. 

Before 2007, I loved drum corps because I loved the artform.  The power. The sound.  And I had a vision for what the artform could achieve.  New and wonderful things.  I have never been emotionally moved like I am with a strong drum corps (or a hornline with a good melody and plenty of impact, at least).  But 2007 changed that.  By the time we had gone through the camps and all-days, the staff and students had become just as important a part of drum corps to me as the art.    And then there was tour.  It was a a blur.  A gruelling blur that is mostly blocked from my mind.  Housing was a nightmare, at least in California.  Getting the fleet where it needed to be was a major stress.  There were a number of issues.  I thought that I would have some emotional epiphany when we finally reached Finals in Pasadena, but I had been so emotionally and physically drained by the journey that I had nothing left.  No reserve.  I just wanted to get us back to Portland safe and sound.  

When we reached Portland, it took me a while to recover, and then a few weeks later we had our banquet.  Despite the stress, the pain, the strain of the tour, the kids had had a great experience and they were so thankful, and they were looking forward to next year.  Their spirit lifted me up, and I was more enthusiastic than ever that we could achieve something new, something great.  And what’s more, we were able to find fantastic staff members to add to our staff of 2007 - a program coordinator, and a corps director.

So with our new momentum, and with the experience of 2007 behind us, I knew a lot more about what to do and what not to do. Things were back into perspective.  And with that, we’ve kicked off the new season with a great camp, and I spent Thanksgiving being confident about our year ahead.

Confidence.  Perspective.  Drive.   A rookie no more.

Over 110 performers from around the Northwest joined us yesterday at Southridge High School in Beaverton for the OC Orientation for the 2008 season.  Not only did we have a great turnout, but we have already learned some of our 2008 show, Inner Connections!  See www.oregoncrusaders.org for a video scrapbook from the camp.  Jeff, Travis, Todd, Missy, Chris, Ron, Mike and the whole staff were excited by the level of commitment and enthusiasm of our students. 

In the morning we started with some opening remarks, and I had all the people who were veterans 1 year ago (i.e. had marched 2006 or earlier) and who came to our auditions exactly 1 year ago stand up.  About 5 people stood up.  The crowd applauded because these were the people who believed in us the most.  They invested their time and effort into helping the Oregon Crusaders survive, and become great in the 2007 season.  I then asked all of our veterans who were joining for 2008 to stand.  An additional 35 people stood up.  We’ve gone from having only a handful of veterans to over 40 returning! 

And in addition to all the people (vets and new members) who joined us yesterday, there is another 40 who have signed up to be a part of OC but had a conflict yesterday.  What a great start to the season! 

While we cannot predict the future, I bet that the students who were with us yesterday will tell their friends, and we will have a mighty powerful drum corps this season!

Some pictures from yesterday:

Welcome everyone to my new blog.  I felt like I was the only one left who didn’t have one, so here it is! 

Blogajawea! is where I’ll post information about my travels, my work toward helping Americans take better control of their helath care, the Oregon Crusaders Drum and Bugle Corps, and other aspects of my life.

The name Blogajawea! comes (of course) from blog + sacajawea, not because I live on Sauvie Island which was one of Lewis and Clark’s stops (with Sacajawea), but because last year while in Astoria for the drum corps camp I began adding “ajawea” to lots of words.  Thanks to Travisajawea for his encouragement and support for adding ajaewea to every wordajawea.

So Welcome!  I hope you enjoy the posts.