2011 AHLA Annual Meeting: How to Use Social Media with @BobCoffield

Welcome How to Use Social Media session students and others.

I hope you enjoyed my presentation during the afternoon health care social media sessions at the 2011 American Health Lawyers Association Annual Meeting in Boston. The health care social media sessions this afternoon were a great introduction to a variety of practical and legal issues surrounding the world of social media and its impact on the health care industry.

Now it is time for you to do your "out of the classroom" social media assignment using the SOCIAL MEDIA bucket list. Click on the linked Google Doc and get started. Good luck!

Below is a copy of the written materials from today's session which were posted here using Scribd. If you want to review my Prezi slides from my presentation watch it below and then go explore Prezi. 

If you have any questions send me a Tweet at @BobCoffield. Follow along with the tweets from the AHLA Annual Meeting at #AHLABoston. David Harlow (@HealthBlawg) also set up a Cover It Live Twitter feed for the Annual Meeting tweets. Thanks for attending the session.

How to Use Social by @BobCoffield (AHLA Annual Mtg 2011) on Prezi

How to Use Social Media (AHLA Annual Mtg - Coffield)

AHLA Boston "TWEETup"

Plans are set for a "TWEETup" during the American Health Lawyers Association 2011 Annual Meeting next week in Boston. All registered health lawyers are welcome along with other Boston area Twitter friends, Boston's Health 2.0 community, health care social media aficionados, and anyone else interested in the intersection of social media and the law.

Come join us at the #AHLABoston TWEETup on Tuesday, June 28 starting around 5:30pm at the BrasserieJO bar located across from the Prudential Center at The Colonnade Hotel, 120 Huntington Avenue. The BrasserieJO is located down Huntington Avenue near the Boston Marriott Copley Place, the location of the annual meeting.

Check out the TwtVite set up by David Harlow at HealthBlawg and RSVP that you will be attending. Help us spread the word.

The TWEETup follows an afternoon of health care social media and the law sessions held as a part of the AHLA Annual Meeting. For full details of the sessions and registration information check out the AHLA Annual Meeting schedule here (PDF version).The sessions run from 2pm - 5:30pm and will include:

A Legal Ethics Safety Line for Health Lawyers Online: How to Practice Safe Social Networking
Alan S. Goldberg (@GoldbergLawyer), Annie Hsu

E-Discovery Litigation
Gary L. Kaplan (@Gary_L_Kaplan), Joshua P. Kubicki (@JKubicki)

Cutting the PowerPoint Clutter: Using Zen-Like Visuals for more Compelling and Memorable Presentations
Susan Peterson

Should Health Lawyers Use Social Media?
David Harlow (@HealthBlawg)

HIPAA Privacy Issues in Social Media
Jodi Goldstein Daniel (@JodiDaniel), Daniel S. Goldman (@danielg280)

How to Use Social Media
Robert L. Coffield (@BobCoffield), David Harlow (@HealthBlawg), Gary L. Kaplan (@Gary_L_Kaplan)

Triaging Social Media in the Healthcare Workplace: Assessment, Analysis and Action
Mark W. Peters

A special thanks to @HealthBlawg for helping find the location for the TWEETup. Thanks to all the AHLA health lawyer and others spreading the word about the tweetup. Be sure to follow @HealthLawyers and use the AHLA Annual Meeting hashtag: #AHLABoston.

AHLA Teleconference: The Intersection of Social Media and Human Subjects Research

On May 4, 2010, I will be participating in a teleconference on The Intersection of Social Media and Human Subjects Research. The teleconference is co-sponsored by the American Health Lawyers Association Health Information Technology, Life Sciences and Teaching Hospitals and Academic Medical Centers Practice Groups.

The moderator for the teleconference will be Karl A. Thallner, Jr., Esquire, Partner, Reed Smith LLP, in Philadelphia, PA. The other panel presenters will be:

Naomi Halpern, Esquire
Partner
Frommer Lawrence & Haug, Washington, DC

Laura Odwazny, Esquire
Senior Attorney, Public Health Division
Office for Human Research Protections
Office of the General Counsel
U.S. Department of Health and Human Services, Rockville, MD

More information, including a description of the program and how to register, is available through the AHLA website.

AHLA Connections: Legal Implications of Health Care Social Media

The current issue of the American Health Lawyers Association's Connections magazine features an article I co-authored with fellow AHLA health lawyer, Jody Joiner, on the impact of social media use in health care.

The article, Risky Business: Treating Tweeting the Symptoms of Social Media (PDF version), is featured in the March 2010 issue of AHLA Connections (Vol.14, No. 3, March 2010), a health lawyer magazine for the health and life sciences law community.

We provide background context on the use of social media tools by health care providers, address why we think health lawyers need to understand social media, and explore some of the legal implications as social media and the law intersect. The article ends with practical guidance to health care providers and organizations on implementing policies emphasizing the appropriate use of social media.

You can peruse the complete digital edition of the March 2010 AHLA Connections (Vol. 14, No. 3, March 2010). AHLA members should also check out the article in this issue on the recently launch Health Law Wiki. Great to see AHLA adding a wiki resource for members to share their expertise and experience in the complex and ever changing health care legal and regulatory world.

Special thanks to the AHLA Connections staff for allowing Jody and I the opportunity to write the article and for their great editorial assistance.

AHLA Hospital's Friend or Foe: The Age of Social Media and Health 2.0

Today Jody Joiner and I presented at the AHLA Hospitals and Health Systems Institute on the use of social media by hospitals and health care providers. We provided an overview of social media use by hospitals and health care providers, discussed the pros/cons of using social media in the health care environment, presented case studies of the risks and legal implications and did a short role play involving tweets in the context of a medical negligence case. We also provided those attending with recommendations on developing social media guidelines and policies.

To show the speed and ease of using social media tools to spread information, news and photos we we did some live shots during the presentations using an iPhone that were then loaded up to my blog, Twitter and Facebook. We then pulled up the posts and tweets at the end of our hour presentation.

Great audience with great follow up questions. Thanks go out to Mark Browne (@ConsultDoc) and Peter Leibold (@HealthLawyers) for live tweeting during the session.

2010 AHLA Hospitals and Health Systems Law Institute: Hot 2010 Health Law Legal Topics

Although it is cold today in West Virginia - I'm hoping it will be hot in Florida in February.

I thought I would take a moment on this cold wintry day to write about the hot health topics that will be discussed at the American Health Lawyers Association (AHLA) Hospitals and Health Systems Law Institute scheduled for February 25-26, 2010 at the Doral Golf Resort & Spa in Miami, Florida (Conference Brochure PDF).

I will be speaking at the Hospitals Law Institute along with my colleague, Jody Joiner, Assistant Operations Counsel at Sisters of Charity of Leavenworth Health System. Our topic scheduled for Friday, February 26 is Hospital’s Friend or Foe: The Age of Social Media and Health 2.0 where we plan to cover:

• The social media technology tools used by health care providers and hospitals
• Pros/cons and legal implications of social media and health 2.0 services such as blogs, wikis, social networking, podcasting, video sharing, etc.
• Best practices and development of policies and procedures which address staff and employees using social media

In addition to our session there will be variety of "hot" health law legal topic covered at the conference that will interest hospital administrators and their legal counsel, including sessions on government data mining to identify hospital compliance, understanding the recent ARRA HITECH developments impacting HIPAA and EHR, hospital/physician collaboration and relationships, best practices in hospital practitioner credentialing, peer review and privileging, voluntary disclosure strategies, hospital clinical research issues, and much more.

The AHLA Hospital and Health System Law Institute overlaps with the AHLA Physicians and Physician Organizations Law Insitute which will be held on February 24-25.The Physician Law Insitute will include "hot" physician topics on on call payments, Accountability Care Organizations, HITECH, disruptive physician behavior intervention, Stark issues for physicians, hospital/physician mergers, FMV for physician compensation and much more.

You can register for one or both. As an AHLA Member I regularly attend the Physician/Hospital Law Institutes every year or so because of quality and breadth of health law related materials for those who work in the health care industry. More information, along with how to register, can be found at the AHLA website:
Hospitals and Health Systems Law Institute
Physicians and Physician Organizations Law Insitute

AHLA Public Interest Committee Publishes Stark Law White Paper

The American Health Lawyers Association's Public Interest Committee recently published a new white paper on on the federal self-referral law also known as the "Stark Law" which looks at and considers what, if any, changes to the Stark Law might be beneficial under the current health care system and the proposed reform efforts.

The white paper is entitled, A Public Policy Discussion: Taking the Measure of the Stark Law. The white paper was written as a result of the Committee's Convener on Stark Law, held in Washington, DC on April 24 and June 30, 2009.

AHLA Teleconference: HIPAA Privacy Fundamentals

Next month I will be co-presenting on an American Health Lawyer Association Teleconference on the topic of HIPAA Privacy Regulation Fundamentals - An Introductory Course.

The teleconference is scheduled for May 13, 2009, 1:00 - 2:30 pm EST. My co-presenter is Rebecca L. Williams of Davis Wright Tremaine LLP and the moderator will be Phyllis Granade of Adorn & Yoss.

This teleconference is geared toward a gaining a basic understanding of HIPAA privacy law for health lawyers (think, HIPAA 101). We will also be discussing the impact of the changes unde rthe HITECH Act of 2009. Although geared toward health lawyers this teleconference would also be valuable for health care professionals and others in the industry interested in learning more about HIPAA.

You can find out more about the teleconference and how to register via the AHLA website.

The Rise of the Personal Health Record

The October edition of the Health Lawyers News, a publication of the American Health Lawyers Association (AHLA), contains an article I co-authored with Jud DeLoss, a principal in the law firm of Gray Plant Mooty, who blogs at Minnesota Health IT. On the eve of the Health 2.0 Conference next week the article provides a look at some of the legal issues around PHRs.

The article, The Rise of the Personal Health Record: Panacea or Pitfall for Health Information (pdf version), provides an introductory background on the changing world of PHRs, highlights Health 2.0 and covers some of the legal implications and compliance issues for PHRs. We are working on a longer and more detailed analysis that will be turned into a Member Briefing for the Health Information and Technology Practice Group. I would appreciate your posting a comment on topics or legal implications that we might consider covering in the full Member Briefing.

If you are a health lawyer, law student interested in health law or otherwise interested in the the legal aspects of the health care industry and not already a member of AHLA -- think about joining. The AHLA is at the top of my professional associations for written resource material, member briefings, in person programs, listserves and collaboration with health lawyer colleagues.

The Rise of the Personal Health Record: Panacea or Pitfall for Health Information

I. Introduction
Giant bytes have been taken out of the personal health record (PHR) market by technology companies like Google, Microsoft, Dossia, and others on a mission to connect consumers with their health information. If successful, the efforts by these and other Health 2.0 technology companies could transform the health care industry. It is too early to say whether the PHR will be the catalyst for health care reform; however, we can explore what may lie in the wake if a consumer-focused PHR revolution occurs.

Technological changes in health information management are altering the way in which patients and health care providers maintain, use, control, and disclose health information. We are experiencing a paradigm shift from the current decentralized system of records maintained by multiple entities at multiple locations – often with conflicting and duplicative information – to a centralized system relying on personal health information networks (PHINs), regional health information networks (RHIOs) or national health information exchanges (HIEs).

In the 21st Century, our health care system has become more fragmented and specialized. Patients seek the services from a variety of providers – from family care providers to specialists. Moreover, as individuals move from city to city and state to state, they leave a trail of partial medical records with various providers, insurers, and others.

The rise of electronic medical records (EMRs), electronic health records (EHRs), RHIOs, and HIEs reflects a need to address the increasing complexity of maintaining and sharing health information. PHRs may be the disruptive technology providing an alternative to a complex system of interconnected interoperable health information systems, often among health care stakeholders who have conflicting and competitive interests.

A. PHRs Defined
The Office of the National Coordinator for Health Information Technology (ONC) defines a PHR as “an electronic record of health related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual.”[2]

The ONC report highlights the growing importance of PHRs to facilitate the participation of individuals in their own care and wellness activities. Encouraging individuals to become engaged in their health care, and providing the means to document, track, and evaluate their health conditions, a PHR can lead to more informed health care decisions, improved health status, and ultimately, reduced costs and improved quality of health care. The PHR is broader than a medical record and contains any information relevant to an individual’s health, including diet and exercise logs, a list of over-the-counter medications, and personal information.

PHRs are distinguishable from EMRs and EHRs. A key distinction is that a PHR is under the patient’s control. The individual patient is the ultimate guardian of information within a PHR. Portability is another distinguishing characteristic of the PHR. The goal of a PHR is to be a lifelong source of health information for an individual.

B. History of PHRs
According to Wikipedia, the earliest article mentioning PHRs is dated June 1978. Wikipedia also mentions that most articles written about PHRs have been published since 2000. In its November 2001 report, the National Committee on Vital & Health Statistics (NCVHS) mentions PHRs and the growing consumer use of Internet-based health information services.[3]

Early on, PHRs were used in a rudimentary fashion as a way for individuals to track their own specific health care information. First generation PHRs can be categorized as either stand-alone PHRs, requiring patients to gather and enter their own information, or tethered PHRs, provided by a health plan, provider, or employer sponsor who populated the PHR with information.

The past twelve months mark a new era of increased activity. Call it a second generation of PHRs or PHR 2.0. The advancement is led by the entrance of large technology companies, such as Google with Google Health and Microsoft with HealthVault, into the PHR marketplace. PHR
2.0 is not merely a data collection application, but rather a platform for the electronic aggregation and storage of health information as well as the foundation for various applications.

At the federal level, ONC also is focusing on patient-centered health care. Released in June 2008, the ONC - Coordinated Federal Health Information Technology Strategic Plan: 2008-2012 serves as the guide to coordinate the federal government’s health information technology (HIT) efforts to achieve a nationwide implementation of an interoperability health information system.[4] A critical goal is to create “patient-focused health care” through the promotion of the deployment of EHRs and PHRs and other consumer HIT tools.

C. Social Networking and Health 2.0
The transformation to a PHR-based health information system is fueled by the intensifying interest in web-based social networking and the Health 2.0 movement. The increasing adoption of social networking and lightweight web-based tools among the general public may create a willingness to have and utilize PHRs. There are various technology players positioning themselves to create the “killer PHR application” to become the default standard for industry and the personal portal for each patient’s personal health information.

The definition of the Health 2.0 movement is still being refined.[5] Jane Sarasohn-Kahn, of THINK- health, defines Health 2.0 as “the use of social software and its ability to promote collaboration between patients, their caregivers, medical professionals and other stakeholders in health.”[6] Early use of the Internet for health care was limited to the distribution and search for health information. The read-only World Wide Web has been transformed into the World “Live” Web. Today, user-generated content is being created by businesses, professionals, and ordinary people at lightening speed through social media tools such as blogs, wikis, collaborative websites, and a variety of web based products.

Online health social networking and software as service models harness the positives of networking and collective intelligence to generate a new level of collective knowledge. Whether it is patients sharing observations on chronic conditions,[7] physicians globally exchanging clinical information and insights,[8] human powered health service searching,[9] online consulting,[10] or promoting transparency through tools for organizing, managing, and comparing health care paperwork[11] -- the Health 2.0 movement is creating business models and becoming a catalyst for improving efficiency, quality, and safety of health care.

D. The Common Framework for Networked Personal Health Information
Recently the Markle Foundation announced the Common Framework for Networked Personal Health Information,[12] which has been endorsed by a collaborative group of providers, health insurers, consumer groups, and privacy groups. The framework outlines a set of practices to encourage appropriate handling of personal health information as it flows to and from PHRs.

The framework uses the term “consumer access services,” which it defines as an emerging set of services designed to help individuals make secure connections with health data sources in an electronic environment. Consumer access services are likely to provide functions such as authentication as well as data hosting and management. The framework also provides analysis of the application of HIPAA to consumer access services.

II. Ownership of Health Information
The shift to a patient-centric PHR from a provider based record raises traditional property law issues. As health information becomes networked and technology allows for health information to be transferred more easily, the lines of ownership of health information become further blurred.

Health information is often viewed under the traditional notion of property as a “bundle of rights,” including the right to use, dispose, and exclude others from using it.[13] This legal application of historic property law may not be well suited to today’s health information where patient information is shared via a variety of formats, copied, duplicated, merged, and combined with other patient records into large scale databases of valuable information.

Who owns health information? The physician? The insurer? The patient? Under the traditional rule, providers own the medical records they maintain, subject to the patient’s rights in the information contained in the record.[14] This tradition stems from the era of paper records, where physical control meant ownership. Provider ownership of the record is not absolute, however. HIPAA and most state laws provide patients with some right to access and receive a copy of the record, along with amendment and accounting of disclosures.[15]

The PHR model, where all records are located and maintained by the patient, flips and realigns the current provider-based model of managing health information. Instead of provider-based control, where the provider furnishes access to and/or copies of the record and is required to seek patient authorization to release medical information, the PHR model puts the patient in control of his medical information.

III. Legal Liability and Compliance Issues Associated with PHRs
PHRs open the door to a wide-range of new and modified legal claims. PHR stakeholders should recognize and address the negative implications to avoid long-term problems. These, of course must be balanced against the liability risks of not adopting an available technology designed to improve the quality of health care.

A. Medical Malpractice
Medical malpractice cases address whether: a patient-physician relationship was created; the treatment provided was within the standard of care; a breach of the standard of care was causally related to the injury; and the patient was injured.[16]

Seeking to prove or disprove these elements raises the issue of whether the PHR would be relevant as evidence against a provider. Generally speaking, if the data within the PHR was provided to or accessible by the provider then the evidence is admissible.[17]

Many providers have expressed concerns over the accuracy and completeness of PHRs if controlled by patients. Whether the information is credible is a legitimate question. On one hand, a patient would not want to jeopardize his or her health by including inaccurate information. On the other hand, it is well known that patients often withhold sensitive and possibly embarrassing information.

Moreover, with the advent of electronic discovery under Federal and States Rules, the production of PHRs in their electronic form could impact evidentiary issues. Health 2.0 and other social networking sites suddenly become fair game for defense lawyers seeking to discredit patients’ claims. Patients may attempt to refer to those same records and other portions of their PHR as examples of treatment modalities approved by other medical providers. Plaintiffs’ lawyers may also investigate the potential for utilizing the collective knowledge of the types of treatments suggested online within the patient networking sites as evidence of the standard of care. In essence, the possibility exists to use PHRs as the “expert” to support or reject claims of malpractice.

B. Defamation and Invasion of Privacy
Generally, a claim of defamation requires the publication of a false statement that harms the plaintiff’s reputation or esteem in the community.[18] Accordingly, PHRs which are solely accessible by the individual or upon the invitation of the individual may not create a cause of action for defamation. However, those PHRs that include communication with other individuals or providers may provide the publication necessary to satisfy that element.

Defamation based upon online communication is fairly new. Typically, such claims have involved false celebrity information posted on the Internet.[19] Arguably, where an individual uses a PHR to publish false information, an analogous claim could be pled.[20]

Generally, the tort of “invasion of privacy” encompasses four claims: (1) intrusion upon the plaintiff’s seclusion; (2) appropriation of the plaintiff’s name or likeness; (3) publicity of the plaintiff’s private life; and (4) publicity placing the plaintiff in a false light.[21] The improper disclosure of health information contained within the PHR may form the basis for one or more of these claims. Each of these claims involves the use or disclosure of private information – such as health information – concerning a person. If wrongfully used or disclosed, those responsible for the use or disclosure, as well as those responsible for protecting the PHR, may face potential liability.

C. Discrimination and Improper Disclosure
HIPAA prohibits impermissible uses and disclosures of protected health information. Although individuals are free to use and disclose their own information as they see fit, appropriate firewalls need to be constructed where, for example, employer-sponsored health plans are providing PHRs. Information in the PHR should not flow from the plan to the plan sponsor nor should it be used for employment purposes.

In addition to HIPAA, employers – and possibly insurers – must consider the implications of the Americans with Disabilities Act, the Family and Medical Leave Act, and similar State laws. The laws offer protection to employees from access to employee health information and discrimination based upon that information.

D. Breach of Contract
Despite the disclaimers and protections set forth in user agreements, it may be possible for an individual to argue that some protections arise through the agreement itself. While user agreements tend to be drafted almost entirely in favor of the PHR vendor or provider/plan, these documents may contain limited rights in favor of the individual. The individual could bring an action for breach of those rights in the event of a violation.

E. HIPAA Compliance
Most PHR vendors have taken the position that HIPAA does not apply to them. PHR vendors generally do not qualify as covered entities. Such vendors take the position that they are not business associates because they are not providing services on behalf of covered entities but rather have a relationship with the patients. Moreover, the patient releases information to or creates information in the PHR, and HIPAA does not regulate individuals’ use and disclosure of their own information.

The contrary position is that many of the PHRs are now linked directly with covered entities to allow the health information to be transferred. Several high profile relationships have been announced relating to collaborations between PHRs and medical facilities to provide PHRs for patients.[22] The collaborations should be reviewed to determine whether a business associate relationship has been created.There has been recent activity to expand the reach of HIPAA to encompass PHRs. Federal and State proposals also may address privacy and security concerns separately. In the interim, private initiatives, by the Markle Foundation and others, propose a voluntary framework to protect health information.

F. State Laws
Many States have enacted breach notification requirements and other consumer protections, which raise new issues with respect to PHRs. Some states, e.g., California, have expanded the breach notification rules to specifically cover health information. These regulations must be addressed with respect to PHRs.Finally, many states have promulgated regulations addressing the movement towards health information exchange. Many recognize “record locator services” or other similar entities that may contain health information or act as an intermediary for locating such information.[23] These State laws may be implicated by PHRs.

G. Stark and Fraud and Abuse
The Federal Stark Law prohibits certain referrals for Designated Health Services (“DHS”) by a physician to an entity with which he/she has a financial relationship.[24] In addition, the Anti-Kickback Statute prohibits remuneration in exchange for the referral of a patient for services covered by a Federal health program.[25] The violation of these laws may provide the basis for a claim under the Federal False Claims Act.[26] State laws may provide additional restrictions and prohibitions.

Recently, a number of health plans and systems have begun to offer PHRs to patients and providers. Currently, the Stark exception and Anti-Kickback Statute safe harbor expressly allow only for EHR and electronic prescribing to be donated. PHR donation may not be protected.

In addition to the practical issues associated with the donation and use of PHRs, new avenues of identifying fraud and abuse are being opened with discovery involving PHRs. Federal investigators and qui tam litigators may turn to PHRs to prove treatment that was billed for may not have been provided. In addition, the compilation of information via Health 2.0 raises the specter of data aggregation to establish fraud over a large population of patients.

Conclusion
PHRs bring a new dimension to the debate over how to create an interoperable health information network. The shift of power into the hands of patients could bring about a sustainable model. Before proceeding with the expansion of PHRs, the legal implications that go along with such an adoption should be addressed.

Bob Coffield is a member of Flaherty, Sensabaugh & Bonasso, PLLC in Charleston, West Virginia. Bob is also a Co-Chair of the Privacy and Security Compliance and Enforcement Affinity Group, a part of AHLA’s Health Information and Technology Practice Group.

Jud DeLoss is a principal with the law firm of Gray Plant Mooty in Minneapolis, Minnesota. Jud is also a Vice Chair of the AHLA’s Health Information and Technology Practice Group.

[1] Mr. DeLoss thanks Bryan M. Seiler, a Summer Associate at the firm, for his assistance in this article. Mr. Seiler is a third year student at the University of Minnesota Law School.
[2] National Alliance for Health Information Technology, Defining Key Health Information Technology Terms, April 2008. http://www.hhs.gov/healthit/documents/m20080603/10.1_bell_viles/testonly/index.html.
[3] Report and Recommendations From the National Committee on Vital and Health Statistics, Information for Health, A Strategy for Building the National Health Information Infrastructure, November 15, 2001. http://aspe.hhs.gov/sp/NHII/Documents/NHIIReport2001/default.htm.
[4] ONC-Coordinated Federal Health IT Strategic Plan: 2008-2012 (June 3, 2008), http://www.hhs.gov/healthit/resources/reports.html.
[5] Health 2.0 Wiki, http://health20.org/wiki/Main_Page.
[6] California Healthcare Foundation, The Wisdom of Patients: Health Care Meets Online Social Media, Jane Sarasohn-Kahn, M.A., H.H.S.A., THINK-Health, April 2008, http://www.chcf.org/documents/chronicdisease/HealthCareSocialMedia.pdf.
[7] E.g., Patients Like Me, http://www.patientslikeme.com/; TuDiabetes.com, http://tudiabetes.com/; Daily Strength, http://dailystrength.org/; SugarStats, http://www.sugarstats.com/; Revolution Health, http://www.revolutionhealth.com/.
[8] Sermo, http://www.sermo.com/.
[9] Organized Wisdom, http://organizedwisdom.com.
[10] American Well, http://www.americanwell.com.
[11] change:healthcare, http://company.changehealthcare.com/; Quicken Health, http://quickenhealth.intuit.com/.
[12] Markle Foundation, Connecting for Health, Connecting Consumers Common Framework for Networked Personal Health Information, June 2008; http://www.connectingforhealth.org/phti/.
[13] Christiansen, John R., Why Health Care Information Isn’t Property – And Why That Is to Everyone’s Benefit, American Health Lawyers Association, Health Law Digest, 1999.
[14] Alcantara, Oscar L. and Waller, Adelle, Ownership of Health Information in the Information Age, originally published in Jounal of the AHIMA, March 30, 1998; http://www.goldbergkohn.com/news-publications-57.html.
[15] E.g., 45 C.F.R § 164.524.
[16] See, e.g., Nogowski v. Alemo-Hammad, 691 A.2d 950, 956 (Pa. Super 1997).
[17] See, e.g., Breeden v. Anesthesia West, P.C., 656 N.W.2d 913 (Neb. 2003) (nurse’s electronic note on patient condition which would have prevented administration of anesthesia should have been reviewed by anesthesiologist despite no verbal or handwritten report by nurse).
[18] See, e.g., Mahoney & Hagberg v. Newgard, 729 N.W.2d 302 (Minn. 2007).
[19] See, e.g., Carl S. Kaplan, Celebrities Have Trouble Protecting Their Names Online, Cyber Law Journal (July 30, 1999).
[20] See, e.g., Churchey v. Adolph Coors Co., 759 P.2d 1336 (Colo. 1988). See also Restatement (Second) of Torts § 577, cmt. k (1977).
[21] See, e.g., Werner v. Kliewer, 238 Kan. 289, 710 P.2d 1250 (1985); Humphers v. First Interstate Bank, 298 Or. 706, 696 P.2d 527 (1985). See also Restatement (Second) of Torts § 652 (1977).
[22] E.g., Google Health with Cleveland Clinic and Microsoft HealthVault with Mayo Clinic.
[23] See, e.g., Minn. Stat. § 144.291, Subd. (i).
[24] 42 U.S.C. § 1395nn(a).[25] 42 U.S.C. § 1320a-7b(b).[26] 31 U.S.C. § 3729.

AHLA Physicians and Hospital Law Institute

Tomorrow I'm off to attend the American Health Lawyers Association's Physicians and Hospitals Law Institute in Orlando tomorrow. Looking forward to the Florida warmth as the temperature here in West Virginia dips into the single digits tonight.

If your interested in the law of health care the AHLA is the group to join. I highly recommend any of their programs. Good venues, great speakers, good networking and all around first class.

Later in the week my family will be joining me and we plan on enjoying Walt Disney World for a few days. Both my wife and I haven't visited since we were young kids in the 1970s and first visit for our two kids. Everyone is excited.

If any regular readers are attending the AHLA Conference and want to get together send me an email or post a comment.

Healthcare Blogging and Web 2.0

Today and tomorrow I am attending the American Health Lawyer Association's Hospitals and Health Systems Law Institute in Las Vegas where I am speaking on Healthcare Blogging and Web 2.0. The session is designed to introduce health lawyers to the world of health care bloggers, RSS, web 2.0, health 2.0 and the impact on the health care industry.

While planning my presentation I decided to post the outline of my materials so the attendees and others could access the information after the conference. By posting the information it will allow a wider audience to read, provide feedback and comment on the materials.

Healthcare Blogging and Web 2.0: Understanding the Basics and Explore the Impact on the Healthcare Industry

Note: The handout for this session contains live links to online resources that are only accessible through the electronic version of the session materials. You can access these links by using the electronic copy of the materials contained on the Health Lawyers program material CD or by accessing a copy of the materials that will be posted on the Health Care Law Blog after the conference at the post link, Healthcare Blogging and Web 2.0.

· Blogging - What is it?

· A blog or "web log" is a user generated website where entries are made in journal style and displayed in a reverse chronological order. A typical blog contains text, images and links to other blogs, web pages and websites. The first blogs were started as online journals where people kept a running account of their personal lives. As the tools for blogging became more sophisticated and more people joined in on the blogging phenomenon there was creative growth in the ways and type of content that was delivered or written. Different topic areas or genre of blogs were created -- politics, technology, travel, fashion, legal and health care. News and political blogs were the first group of blogs to become popular and reach the mainstream public. Since 2001, blogs have had an increasing impact and role in breaking, shaping and spinning news stories.

· The modern blog evolved from users who went online in the 1990s to participate in digital communities. The history of blogs goes back to usenets, bulletin board systems and email listserves. The origin of blogs goes back to 1994 with Justin Hall being recognized as one of the first bloggers. The December 2004 New York Times Magazine referred to him as "the founding father of personal blogging." On December 17, 1997, Jorn Barger was credited with coining the term "weblog" to describe the process of "logging the web" as he surfed the Internet. The shorter form of "blog" was created by Peter Merholz, who broke the word weblog into the phrase "we blog" in the sidebar of his blog called peterme.com. Blogging gained momentum in the late 1990s with the launching of hosted blog tools that allowed for the mass creation of thousands of new blogs -- including Open Diary, LiveJournal and Blogger. This set the stage for the phenomenal growth in blogs and other social networking technology tools that has been expanding since 2001.

· Technorati defines a blog as a regularly updated journal published on the web. Some blogs are written to reach a small audience and others vie for readership equal with national newspapers. Blogs are powerful because they allow millions of people to easily (and quickly) publish and share content and ideas, and allow millions more to read, respond and interact with the content. They allow writer and reader to have an open interactive conversation by sharing comments and links.

· Blogs are really just an extension of websites but allow individuals (especially non-technical persons) to manually update the content rather than requiring a webmaster who knows HTML. Blogs can be hosted on their own dedicated hosting server or can be run using remote blog software such as WordPress, Blogger, Typepad, Windows Live Spaces, LiveJournal, Vox and others. The Online Journalism Review has a good blog software comparison chart of some of the more popular blogging software.

· Blog technology capitalizes on and is suited for the desire and need of individuals to share information on narrowly focused topic areas or areas of interest. People like and need to collaborate. The success of the AHLA listserves is a perfect example of the need for and benefits from a digital community focused on specialty areas. It allows me, an attorney practicing in Charleston, West Virginia, to share experiences, seek guidance and information and collaborate with other health lawyers from around the country. My participation in the AHLA listserves and in the health and law blogging community has developed into what I refer to as my "virtual law firm." Blogs and Web 2.0 social networking initiatives are only expanding on what can be done, shared and learned in these virtual collaborative communities.

· Blogging and Web 2.0 are the vehicles allowing the transformation of the traditional concept of the World Wide Web, where a majority of the information is static or periodically updated, into what is fast becoming a living breathing Live Web. As evidence of the "live-ness" of the web, Technorati indicates that bloggers update their blogs regularly to the tune of 1.6 million posts per day or over 18 updates a second. Below are additional statistics showing the incredible growth of blogs and user created content over the last couple of years. Steve Rubel recently indicated at the first Healthcare Blogging Summit that he thinks that blog post volume has peaked. However, the full evidence is not in yet and I can’t believe that the volume of blogging won’t continue to rise based on my experience on knowing how many people are still just beginning to learn about the value of blogging. The current trends will be closely watched in 2007 to see whether or not the flattening out of blog post volume over the last quarter of 2006 is actually a trend.

· Blogging Terms: Like any hobby or specialty area blogging has developed its own specialized vocabulary -- posting, tagging, blawg, carnival, blogroll, Instalanche, link or permalink, commenting, trackback, splogs, vlog, etc.

· Technorati is recognized as one of the authorities on what is happening on the "Live Web". Currently Technorati is tracking 63.2 million blogs (January 6, 2007). Technorati founder Dave Sifry often looks at the state of the blogosphere on the Technorati Blog and Sifry's Alerts. In Sifry's October 2006 State of the Blogosphere, Technorati was tracking 57 million blogs. The post indicates that 100,000 blogs are created every day, and the blogosphere (total blogs tracked) has been doubling every 5-7 months. The post also compares blogs to mainstream media and charts the global breakdown of language of blogs (English 39%, Japanese 33%, Chinese 10%). For more information see State of the Blogosphere April 2006 which contains links for a historical perspective on blogs.

· Additional Statistics and Examples:

· In 2004, the Pew Internet & American Life Project found that 44% Internet users were creating content for the online world. The November 2005 Pew Internet Report, "Teen Content Creators and Consumers," found that 57% of teens now create content for the Internet. The trends indicate that the younger generations will want to create and control content, including health information, which will influence all of us. I speculate that this group will demand from the health care industry the ability to create, manipulate and easily access their own health information online.

· One statistic that blogged about earlier this year (courtesy of Denise Howell) was that "Among 21 year olds, 61% of web content was created by someone they know." This statistic shows that the public is not only creating content but using and relying on content by those who they personally know. Along these same lines, Steve Rubel of Edelman who spoke at the Healthcare Blogging Summit commented that research has shown that 68% of the public agreed that the people we trust are "a person like me." Indicating that people tend to trust those "like themselves" more than larger organizations. The statistics are not really surprising and the results mirror what is mostly human nature. If we need help with a critical issue or problem -- we seek the help of a person like us who we know.

· Riding the Waves of Web 2.0, another Pew Internet Project article, highlights the online activities that demonstrate Web 2.0 characteristics. One example discussed in detail is the growing use and traffic to Wikipedia, the online encyclopedia whose content is shaped by the wisdom and, at times, the stupidity, of its users and has an amazing growth rate as compared to the downward growth of its corporate cousin, Encarta. Think for a minute – when was the last time you used the electronic encyclopedia that resides on your hard drive as part of the software bundle that came with your computers? My suspicion – not much, if at all. Your response is probably similar to the amount you pull off the shelf a hard bound volume of Encyclopedia Britannica.

· Blogs: A Guide to Health Care Bloggers

· Following are some representative health care related blogs. While this is not an exhaustive list of health care blogs, it serves to demonstrate the breadth and scope of the types of health care blogs that are available online. Most bloggers include on their blog a “blogroll” that lists other bloggers that they find interesting or regularly follow. An excellent way to explore other blogs of interest is by accessing the links of the other blogs referenced in the blogroll.

· Searching for blog posts can be done though dedicated search engines that are designed to track and search blog related materials. Most known in this area is Technorati, which is dedicated to indexing, organizing and making blogs and other user generated content available through search. Google has also developed its own blog search, Google Blog Search. Google Blog Search contains content published through Blogger, Google's blog publishing technology, and other blogs that publish a site feed (either RSS or Atom).

· Health Law Blogs

o Garlo Ward, P.C. Blog - Focused on legal issues for long term care, retirement, home health care, assisted living providers, physicians and other health care providers.

o HIPAA Blog - A discussion of medical privacy buried in political arcana.

o Holland and Hart's Health Care Law Blog - Focused on health care issues affecting the Rocky Mountain West and the states in which we practice which include Montanan, Idaho, Wyoming, Utah, Colorado and New Mexico.

o HealthBlawg - David Harlow's health care law blog.

o Physician Law - Current news, updated and useful tips relating to legal issues affecting physicians and non-institutional providers in their personal and professional lives.

o Health Care Law Blog - Thoughts and comments on the health care industry, privacy, security, technology and other odds and ends.

o Tennessee Med Mal Blog – A firm sponsored blog focusing on medical malpractice.

· Hospital CEO/Administration Blogs

o Nick's Blog - Nick Jacob, President of Windber Medical Center and the Windber Research Institute, Winber, PA. Recognized as the first hospital CEO blogger. More on Nick and Windber via YouTube, including Why are Hospitals the Way They Are?

o Running a Hospital - Paul Levy, President and CEO of Beth Israel Deaconess Medical Center, Boston, MA.

o Hospital Impact - Collaborative blog on hospital related topics.

o The Candid CIO - Will Weider, CIO of Ministry Health Care and Affinity Health System.

· Physician/PA/Nurse/Med Student Blogs

o Kevin, M.D. - A practicing primary care physician tells it like it is.

o A Chance to Cut is a Chance to Cure - A perspective on medical and other issues from a general surgeon.

o GruntDoc - Ramblings of an Emergency Physician in Texas.

o Tundra Medicine Dreams - Bush medicine, dog mushing and tundra life from a physician assistant in Southwest Alaska.

o KidneyNotes.com - Notes on Medicine, Science & Technology from a Nephrologist in New York City.

o Emergiblog - The Life and Times of an ER Nurse.

o The Examining Room of Dr. Charles - A young family physician's attempt to say something pithy.

o blogborygmi - Nick Genes, founder of Grand Rounds - a digest of developments in the life of an emergency medicine resident.

o Dose of Reality: Med Students' Blog - University of Michigan Medical School sponsored student blogs. The blog project allows 12 current University of Michigan medical students to share their thoughts and feelings about being in medical school. The blogs feature students from each level of the program. The project also involves audio blogs via podcasts. The online edition of the AMA's American Medical News covered this unique blog experiment in an April 2006 article, Med Schools Web Site Adds Student Blogs.

o Graham Walker's Over My Dead Body is an example of the next generation of physicians bloggers. Mr. Walker was featured in USNews in a feature on Blogging Their Way Through Academe. His recent post, Meet The GMR, An EMR That Doesn't Suck, highlighting his development of a user focused web 2.0 based EMR (or as he refers to GMR) and is an example of the bottom up approach that bloggers and Web 2.0 aficionados are taking to change institutions and traditional business methods and models.

· Other Health Care Blogs

o MSSPNexusBlog - Rita Schwab, CPCS, CPMSM - focusing on issues for medical staff service professionals.

o The Health Care IT Guy - Shahid Shah, CEO of Netspective - focusing on health care information technology issues.

o The Health Care Blog - Matthew Holt - focusing on health care policy. Blog byline: "Everything you always wanted to know about the Health Care System. But were afraid to ask."

o Healthcare Vox - Fard Johnmar - focusing on healthcare communications and marketing news.

o Health Business Blog - David E. Williams of MedPharma Partners - focusing on business issues in health care.

· Patient and Health Topic Blogs

o Patient Blogs which allow them to share their experiences with others. The blogs are sponsored by High Point Regional Health System in North Carolina.

o Diabetes Mine - A gold mine of straight talk and encouragement for people living with diabetes.

o Mighty Max Update - Mother of child with CHARGE Syndrome blogs about his diagnosis, surgeries, development and spirit to get well.

· Legal Blogs:

o Legal blogs are often referred to as "blawgs," a term coined by one of the early law bloggers, Denise Howell of Bag and Baggage. A blawg is a blog whose content is devoted in to legal topics, opinions or issues.

o Legal Blawg resources:

§ Blawg: A blawg directory and source for legal blogs and podcasts. Blawg was started in December 2002 by Bill Gratsch.

§ MyHq Blawgs: A blogroll listing an extensive list of the available law related blogs.

§ Justia's Blawg Search: A legal blog directory and search tool which also ranks the popularity of legal blogs. The site also provides good basic information for lawyers exploring the idea of starting a legal blog.

§ 3L Epiphany Taxonomy of Legal Blogs: A law blog list and law blog information organized by Ian Best a recent Ohio State law grad as a part of an independent study project on law blogs. In addition to his taxonomy of legal blogs he has compiled some interesting information about the citation of blogs in legal decisions (including the first time the U.S. Supreme Court opinion cited to a blog) and interviews with judges on the current impact blogs are having on the judiciary.

o Blog Carnivals:

§ Grand Rounds - The weekly rotating carnival of the best of the medical blogosphere.

§ Health Wonk Review - A biweekly compendium of the best of the health policy blogs. More than two dozen health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant's blog. For participants, it's a way to network and share ideas, and for those readers who don't live in this space every day, it's a way to sample some of the latest thinking and the "best of the best."

§ Pediatric Grand Rounds - A bi-weekly collection of the best posts pertaining to the health of children.

§ Radiology Grand Rounds – A carnival focused on radiology and medical imaging for physicians, patients, nurses, medical students, radiographers and imaging technicians.

§ Patient Consumer Parade (no longer active) – A carnival of patient-consumer posts.

§ Change of Shift - A place for nurses and other members of the health care team, including students and patients to send their nurse related stories and ideas.

§ Blawg Review – A weekly roundup of legal issues by law bloggers.

· Web 2.0: What is it?

· Web 2.0 is a perceived or proposed second generation of Internet based services -- such as social networking sites, wikis, folksonomies, podcasts, RSS feeds and other person to person communication tools that emphasize online collaboration and sharing among users. The 2.0 moniker hints at the idea of an improved or new version of the "World Wide Web." Web 2.0 is also a social phenomenon centered around generating and distributing content that is characterized by open communication, decentralization of authority, freedom to share and reuse and a market of conversation.

· The phrase was coined in 2004 by Tim O'Reilly of O'Reilly Media in his opening talk at the first Web 2.0 Conference. O'Reilly summarized the key principles of Web 2.0 applications as:

o the web as a platform

o data as the driving force

o network effects created by an architecture of participation

o innovation in assembly of systems and sites composed by pulling together features from distributed, independent developers (a kind of "open source" development)

o lightweight business models enabled by content and service syndication

o the end of the software adoption cycle ("the perpetual beta")

o software above the level of a single device, leveraging the power of The Long Tail.

o easy to pick up by early adopters

· Paul Graham's Web 2.0 post from November 2005 provides the historical perspective and origin of the term, Web 2.0. Graham's blog post provides a useful definition as we explore and try to understand the Web 2.0 phenomenon. Graham's suggests a two part definition of Web 2.0 -- web-based applications and democracy. He indicates that the first vision of Web 2.0 was centered around "using the web as a platform" or utilizing web-based applications. This description was used in the promotion of the first Web 2.0 conference in June 2004: "While the first wave of the Web was closely tied to the browser, the second wave extends applications across the web and enables a new generation of services and business opportunities." According to Paul Graham, the definition of Web 2.0 came to mean something else -- democracy -- by the second Web 2.0 Conference. Graham described this as the ability of amateurs to surpass professionals. He cited Wikipedia as an example. He also described the democratic power of Web 2.0 to displace traditional media outlets dictating and "deciding what counts as news." Digg (user powered news and content) and del.icio.us (collaborative bookmarking and tagging) are examples cited. The third point Graham makes in his definition of Web 2.0 in an attempt to distinguish it from the initial Internet bubble has to with how you and I are treated as "users." Generally, his idea focuses on not mistreating the user and allowing the user more control.

· Why is Web 2.0 possible? Ajax. No not the stuff under your sink. Ajax is shorthand for Asynchronous JavaScript or XML and is responsible for allowing the creation of interactive web applications. In simple terms -- Ajax lets web pages feel alive and responsive by exchanging small amounts of data behind the scenes so that the entire web page doesn't have to be reloaded each time the user requests new information. Ajax is what makes web-based applications look and act like desktop applications. Ajax has been the fuel allowing a paradigm shift -- desktop applications to web-based applications. Example, Microsoft Word and Excel vs. Google Docs & Spreadsheets.

· Jesse James Garrett of Adaptive Path was the first to use the term Ajax in public. For a more detailed description of how Ajax works read Garrett's, Ajax: A New Approach to Web Applications. The article describes classic web application as working like this: "Most user actions in the interface trigger an HTTP request back to a web server. The server does some processing — retrieving data, crunching numbers, talking to various legacy systems — and then returns an HTML page to the client. It’s a model adapted from the Web’s original use as a hypertext medium, but . . . what makes the Web good for hypertext doesn't necessarily make it good for software applications." The article goes on to describe the benefits of Ajax, "[a]n Ajax application eliminates the start-stop-start-stop nature of interaction on the Web by introducing an intermediary — an Ajax engine — between the user and the server. It seems like adding a layer to the application would make it less responsive, but the opposite is true. Instead of loading a web page, at the start of the session, the browser loads an Ajax engine — written in JavaScript and usually tucked away in a hidden frame. This engine is responsible for both rendering the interface the user sees and communicating with the server on the user’s behalf. The Ajax engine allows the user’s interaction with the application to happen asynchronously — independent of communication with the server. So the user is never staring at a blank browser window and an hourglass icon, waiting around for the server to do something."

· Google was one of the first companies to capitalize on and has invested heavily in Ajax development. Most of Google's products are Ajax based applications -- including, Gmail, Google Suggest and Google Maps. Google Suggest provides one of the clearest examples of Ajax. As you type in your search term the suggested terms automatically update as you type. Most new Web 2.0 applications include some Ajax based features and many traditional software and Internet companies have now moved toward implementing Ajax based applications.

· Recently, Time Magazine recognized the power of those who now create, control and collaborate with content online and the incredible influence that it is having around the world. In doing so, Time honored "you" and "me" as Time's Person of the Year. In describing Web 2.0, Time stated, "Web 2.0 harnesses the stupidity of crowds as well as its wisdom. Some of the comments on YouTube make you weep for the future of humanity . . . But what makes all this interesting. Web 2.0 is a massive social experiment, and like any experiment worth trying, it could fail. There's no road map for how an organism that's not a bacterium lives and works together on this planet in numbers in excess of 6 billion. But 2006 gave us some ideas. This is an opportunity to build a new kind of international understanding, not politician to politician, great man to great man, but citizen to citizen, person to person."

· For a perspective on Web 2.0 and what it may mean for lawyers and law practices, read Bruce McEwan's blog post, Web 2.0 In The Legal Blogosphere at Adam Smith, Esq. McEwan produces a chart showing the evolution from Web 1.0 to Web 2.0 and offers some comments on legal sites targeting micro-communities. McEwan suggests the theory that any new media/medium begins by imitating its closest analogous predecessor and then experiments and evolves. McEwan outlines that the web began imitating print and has evolved roughly as follows:

o Web 1.0

§ revolution = hyperlinks

§ static content ("brochure-ware")

§ activity = surfing

o Web 1.5

§ revolution = self-contained portals

§ dynamic content (Salon, Nerve, Slashdot)

§ activity = search

o Web 2.0

§ revolution = collaboration

§ user-generated content

§ activity = share

· RSS: What is it?

· RSS (Web Feed) is a term used to publish frequently updated digital content, such as blogs, news feeds, podcasts or videocasts. RSS stands for "Really Simple Syndication". Using a program called a "feed reader" or "news aggregator" a user subscribes to an RSS feed. Programs known as feed readers or aggregators can check a select list of RSS feeds on behalf of a user and display any updated articles or information found. Many websites and most blogs now have some form of RSS of Atom capability.

· Dave Winer, the father of RSS, describes RSS with a three-word answer: automated web surfing. It allows you to spend more time reading content rather than searching for content. I've often referred to it as "push technology" where you select the information you want and have it pushed to you rather than you having to constantly go to the information using bookmarks or favorites.

· Have you ever wondered what that little orange box is? A website has RSS capabilities and can be subscribed to if it has any of the following terms or icons: RSS, Atom, XML, Subscribe, , or . In addition, many of the news aggregators have developed their own distinct icons or subscriptions buttons to notify a user of an available RSS feed. For example, MyYahoo, Feedburner, NewsGator and MyMSN have all created their own distinct subscription buttons.

· What do I need to get started? You will need to choose a "news reader" to subscribed to RSS feeds. There are two basic types: desktop software application and online readers. I prefer the online reader because I like to be able to access my feeds from multiple locations, including my Blackberry. I currently use Bloglines as my primary reader, although I have also been experimenting with the new Google Reader. I also use MyYahoo, which now has RSS capabilities built into the custom start up page allowing you to select any RSS enabled content. News reader functionality is now being integrated into the latest version of browsers, including Internet Explorer 7 and Firefox.

· If you have not incorporated RSS technology into your online research and monitoring process, you are missing out on an amazingly powerful resource. RSS allows you to monitor (in real time) any new web related content or news article about your most important client, updates on a particular area of law, new regulatory materials, new state/federal court decisions and the list goes on. If there is one thing you take away from this session it should be how to implement RSS technology into your everyday practice.

· The ABA published a good "how to" article on RSS called, RSS Resources You Can Use: Automatic Websurfing for Lawyers. The article written by Tom Mighell and Dennis Kennedy provides an overview of RSS and practical guidance on using RSS technology. Instead of referring to RSS as "really simple syndication" they use the Oprah Way, "I'm Ready for Some Stories!" The article also links to the RSS Tutorials for Law Librarians, three online video/audio online tutorials that walks you through the basics of RSS, using an aggregator and advanced RSS techniques.

· Still not convinced of the value of RSS? Check out Robert Ambrogi's article What RSS Can Do For Lawyers, Steve Matthews' article Top Ten Uses for RSS in Law Firms, Tim Yang's Things You Can Do with RSS and How To Explain RSS the Oprah Way.

o Examples of legal and law related RSS feeds you can use:

§ State Legislative RSS Feeds via Stateline.org

§ U.S. Supreme Court RSS Feeds for "Daily Decisions" and "Recent Decisions" via Cornell's Legal Information Institute

§ U.S. Government RSS Library, including the following White House RSS feeds, Federal Court RSS feed (7th Circuit), FDA Recalls RSS Feed, Health Care and Medicare/Medicaid related RSS feeds, U.S. Copyright Office RSS Feeds and others.

§ RSS in Government, a blog providing news about how RSS is being used by international, federal, state and local government including a variety of RSS links (see right hand column of links)

§ Google search using the terms hospital and RSS provide some sample hospital RSS feeds

· Health Care Blogging and Web 2.0 Health 2.0 Trends:

· Health care blogging is still in its infancy and we will continue to see more individuals and businesses take up blogging on a variety of health care topic areas. Physicians were the early blogging adopters, writing about their experiences and sharing observations on the health care system. An April 28, 2003, article from AMA American Medical News, Welcome to the Blogosphere: A brave new world of web dialogue, provides insight into some of the early physician bloggers. This core group of health care bloggers has now grown in diversity as shown by the blogs mentioned above. Discussing health care is popular -- whether its a patient recommending advice to another patient, a physician offering preventative care tips or a health policy expert offering solutions to the national debate over health care. This popularity creates a perfect environment for blogging and Web 2.0 Health 2.0 type companies. As a result, the number and diversity of health care focused blogs will grow and entrepreneurial type ventures will be explored. Over the next couple of years health care blogging and Web 2.0 Health 2.0 will mature. It is likely we will see more coordinated efforts to utilize blogging as a media and public relations communication tool. There will be a growing number of corporate coordinated and collaborative (multi-author) blogs.

· There is a growing community of health care bloggers which was recognized by the first Healthcare Blogging Summit held on December 11, 2006, in Washington, D.C. The conference brought together a diverse group of bloggers, public relations representatives, physicians, policy expert, media consultants, health care opinion leaders and others interested in the health care blogging trends. Additional conference events are planned for 2007.

· In July 2006, an online survey of health care bloggers, "Taking The Pulse Of The Healthcare Blogosphere: A global online survey of healthcare bloggers," (free download) was conducted by Envision Solutions and The Medical Blog Network (now TrustedMD.com). The results of the survey were released as a part of the Healthcare Blogging Summit in December 2006. Fard Johnmar of Envision Solutions summarized the poll results in this December 11, 2006 blog post. Following is an overview of key statistics and findings from the survey:

o Bloggers devoting at least 30% of blog posts to health care related topics were eligible to take the survey. 214 healthcare bloggers took at least a portion of the poll, which was fielded between July 31 and September 29, 2006.

o 76% percent of survey respondents are from the United States. Between 3% and 5% hail from Canada, the United Kingdom, Australia and the Netherlands. The survey population was evenly split between men (54%) and women (46%). The age distribution was older than expected -- Age category: 18-25 (9.3%); 26-29 (9.9%); 30-39 (35.5%); 40-49 (20.3%); 50-59 (22.1%) and 60 or above (2.9%).

o Nearly 40% of bloggers report that the most important reason they decided to start their blog was to "share their opinions" or "educate others." 12.4% of bloggers responded to "market myself." 8.5% of bloggers responded to "advocate for cause." 8.5% of bloggers responded to "cope with medical condition." 2.3% of bloggers responded to "employed to write."

o A combined 72% of those taking the survey said that their primary audience is either healthcare providers, the general public or patients. 6.5% said that their primary audience was "healthcare executives" and 1.2% said their primary audience was "journalists."

o In response to a question about primary topics they blog about, 60.9% of respondents write about their personal experiences. 55.7% blog about health news, 54.6% blog about health business, 51% blog about health policy, 44.8% about medical treatment, 47.1% about disease information and 23.6% about health law.

o 38.7% of those surveyed hide their identity to protect their privacy. Of this group, the reason they hid their identity: 85.5% to protect myself, 42.1% to protect patient privacy and 36.8% to enable me to freely comment about my job/employer.

o 93% of those responding have been blogging about health care less than three years. Of this group, 52% have been blogging about health care less than one year.

o 47% of those taking the survey spend between one and two hours maintaining their blogs daily. However, nearly as many (43%) devote less than one hour a day to their blog.

o The survey also included interesting statistics on trust and credibility the survey participants gave to other blogs. The results indicated that 77% of respondents have either a low or moderate level of trust in their blogging colleagues.

· The Healthcare Blogosphere survey speculates on ways that blogs have the potential to improve health care, including speeding the adoption of best practices, aiding the critique and analysis of clinical trials, fostering the exchange of information about treating new illnesses and educating patients on preventative health care issues.

· A January 10, 2007 iHealthBeat article, Consumers Read, Post Info on Health Blogs, reported that about 8.9 million U.S. adults reported reading health related blogs online. The study, conducted by Manhattan Research, also found that 9.9 million consumers regularly post health information online. The study results were based on a telephone survey of 4,000 U.S. adults conducted between September and November 2006.

· The HealthTrain: The Open Healthcare Manifesto (full Report Version 0.1) released by The Medical Blog Network (now TrustMD.com) was discussed at the Healthcare Blogging Summit and provides some interesting material on the future impact open published health media might have on the health care industry. The Manifesto presents the idea that the "new wave of open publishing technology now enables any individual, with or without professional training, to communicate with global audiences to share health related information and opinions." The Manifesto recognizes the change occurring from "traditional command and control" forms of communication. The goals of the Manifesto are to develop a shared vision of how open media can have a positive impact on health care. There is diversity/opposing views on health care issues, including health care policy, politics, finance, liability, scope of practice and moral values among others. The principal of the Manifesto is not to take sides but to focus on a shared understanding that an open exchange of information and opinion can create positive change. The principles of the Manifesto are organized around the following key concepts: openness, empowerment, conversation, empathy, trust, critical thinking, guidance, control, credentials, transparency, privacy, anonymity, scientific validity, conflict of interest, sponsorship, promotion, controversy and civility and respect.

· Examples of Health 2.0 focused companies:

o Organized Wisdom was launched in beta in August 2006. Organized Wisdom is a health focused, social networking site that enables consumers, physicians, health care professionals and health organizations to collaborate on health topics. The mission of the company is to make it easier for people everywhere to get access to better health wisdom. The company has developed what they call "WisdomWizard" application that allows people to easily share their knowledge and recommendations on any health-related experiences with diseases, conditions, medications or health procedures. The goal of the company is that the result will be human indexes of user-generated health content that will help people make better health decisions. The Health Wisdom Blog has more information about Organized Wisdom.

o Launched in September 2006, Sermo is an online community, created by physicians for physicians. It is a medium for physicians to aggregate observations from daily practice then -- rapidly and in large numbers -- challenge or corroborate each other's opinions, accelerating the discovery of emerging trends and new insights on medications, devices, and treatments. Through Sermo, physicians exchange knowledge with each other the minute it is learned, and gain insights from colleagues as they happen instead of waiting to read about them in conventional media sources. Sermo harnesses the power of collective wisdom and enables physicians to discuss new clinical findings, report unusual events, and work together to impact patient care.

o Revolution Health, launched in preview in December 2006 and scheduled for a mid January 2007 public launch. Revolution Health is the brainchild of founder, Steve Case, co-founder and former CEO of America Online. Revolution Health's website says that its objective is to give consumers more choice and control over their health care. The health portal allow the user to do a variety of things: create your own personal health portfolio, learn about health topics, rating doctors and hospitals, complete online health risk assessment surveys, join community groups on health specific topics, read and comment on health related stories, create your own health care blog and utilize (free trial) a health expense manager. The health content is divided in sections on Healthy Living and Conditions & Treatments. The content is from resources such as: The Mayo Clinic, Harvard University and The Cleveland Clinic. It allows users to rate the content they think is best and even submit your own resources from around the web. The Personal Health Portfolio feature allows you to save information about your conditions and treatments for future reference, store basic contact information for all your doctors and health care providers and automatically generate a form to take with you to your next office visit. The Tracking feature allows you to track a variety of areas: blood pressure, blood glucose, health weight/BMI, weight loss/gain, pregnancy weight gain, exercise routine, etc. There will also be a membership section which includes other services such as: personal health counselor, claims advocate and health expense manager. Revolution Health may have the best chance of success in the Health 2.0 space if it focuses on what it does well and can gain critical mass and participation by consumers. This type of consumer "revolution" will likely force change in traditional models of health care delivery and payment.

o Tony Chen at Hospital Impact provides commentary and comparison of what Revolution Health offer versus what U.S. Preventative Medicine offers. Chen provides a link to U.S. Preventative Medicine's letter to the American public announcing its efforts and reasons for focusing on preventative medicine. Based on information from U.S. Preventative Medicine's website, the company wants to create a "comprehensive prevention ecosystem" and believes "that proactive, preventive health management is a necessary and imminent revolution in medical care. Economic necessity and medical evidence are driving the transformation of health care from a legacy of treatment to a culture of prevention." The mission of the company is, "to provide consistent services and methodologies, strong brand recognition, and a turnkey business model that will make the "prevention experience" a winning proposition for health care providers and consumers." Chen indicates that U.S. Preventative Medicine may be Revolution Health's biggest competitor in the preventative medicine space. I'm in agreement with Chen's closing comment that someone is going to figure a way to monetize prevention and make billions. Maybe it will be the next company listed below . . .

o Google Health (aka Google Scrapbook). At this stage Google has not made any formal announcement of its strategic plans toward the health care industry. However, it is evident that Google is actively developing ideas in the health care space. Adam Bosworth, VP at Google, provides some insight in a November 2006 post, Health Care Information Matters, on the Google Blog. His post looks at the use of Google Co-op in the health arena along with discussing Google's ideas on the ability of patients to have easy access to their medical information. Also, Bosworth was the keynote speaker at a national conference sponsored by The Markle Foundation on December 7, 2006. His keynote address was titled, Connecting Americans to Their Health Care: Empowered Consumers, Personal Health Records and Emerging Technologies, which looked at putting patients in charge of their health information and creating a "Health URL". Bosworth envisions the Health URL as follows, "every ill person needs a “health URL,” an online meeting place where their caregivers — with express permission from the ill person — can come together, pass on notes to each other, review each other’s notes, look at the medical data, and suggest courses of action. This isn’t rocket science. It is online web applications 101." For an interesting response read, Where Google Veep Adam Bosworth is Wrong. For more details on what Google Scrapbook might include read, The Upcoming Google Scrapbook.

· The Health Care Blog does some health care forecasting for 2007, including a discussion of Health 2.0. The author, Matthew Holt, indicates that he thinks Health 2.0 is not all "hype" and that by the end of 2007 there will be a larger category of health care consumers starting to use the new web-based health care software tools. I agree with his prediction and believe that these tools will start the process of fundamentally changing the way that patient/consumers interact with insurers and providers. The key to success will depend on which companies tap into the real needs of health care consumers, successfully execute a business model to entice health care consumers who are looking for a solution to the ever growing health care problems (including health coverage and cost) in our country and ultimately gain the confidence of those patients/consumers.

· Additional Health 2.0 Resources and Creative Uses of Technology:

· Health 2.0 Wiki is a new health 2.0 focused wiki. This resource was created in late 2006 and the users and public authors will continue to add content and resources. What's a wiki? A website that allows visitors to add, remove, edit and change content. It is a very effective tool for mass collaborative authoring (example: Wikipedia). Imagine the possibilities of using this type of technology in a variety of ways in the health care and legal industry? For example, physicians or patients collaborating around conditions, treatments or drugs or health lawyers collaborating around health law topics or regulations.

· Ask Dr. Wiki is a medical wiki devoted to creating a free source of medical information allowing individual to store handouts, pearl book, teaching EKGs, X-ray Images, and Coronary Angiograms and Venograms online so they can have access to them from anywhere at anytime.

· YouTube Health Films: A GPs' surgery in mid Wales has launched a series of health education films on YouTube. Advice about flu vaccination and cervical screening are two of the topics covered by Builth and Llanwrtyd Medical Practice in Powys.

· The Clinical Cases and Images Blog in Echocardiograms and Cases on YouTube provides another example of the use of YouTube as an educational device.

· YouTube and Whistleblowers. This August 2006, Washington Post article, On YouTube, Charges of Security Flaws, highlights what might be in store for those prosecuting or defending health care whistleblower cases. The article highlights the YouTube video clip (and video updates) by a Lockheed Martin engineer who had complained to no avail to his boss, the government and his congressman about security flaws in a fleet of refurbished Coast Guard patrol boats. What about hospital whistleblowers?

· Legal Implications of Blogging:

· The Electronic Frontier Foundation's Legal Guide for Bloggers provides a good basic resource for understanding the legal implications of blogging. The guide covers intellectual property rights, defamation, freedom of speech, Section 230, privacy, bloggers rights as journalists and labor law. There are FAQ sections on each topic area. Like any new technology development we are still in a learning phase of understanding the legal impact and the court's interpretation regarding bloggers and blogging.

· Workplace issues involving the rights and restrictions on employee blogs has received the most attention from labor lawyers. Employment law blogging issues take on added complexity when dealing with health care employee bloggers due to the added privacy and confidentiality overlay. For example, we will see employment litigation involving the release of protected health information via an employee blog. Further, to date no guidance or interpretation has been issued on whether HIPAA places any specific requirements on a health care employer to limit or restrict employee blogs.

· Following are a number of corporate blogging resources and sample blogging policies that provide some insight into those employers who have chosen to allow some amount of employee blogging.

o Your Guide to Corporate Blogging provides in a June 2005 post, Policies compared: Today's corporation blogging policies, that looks at the core principles in most blogging policies by comparing eight well known blogging policies. The result is four simple rules: (1) you are personally responsible; (2) abide by existing rules; (3) keep secrets; and (4) be nice. The post also goes into some common rules (that appear in at least half of the policies examined) and also looks at unusual rules contained in some of the policies.

o A post, Sample Corporate Blogging Policies, by Kevin O'Keefe of Real Lawyers Have Blogs (citing Yourden Report) highlights links to blogging policies at some major corporations, including:

§ IBM’s Blogging Policy and Guidelines

§ Sun Microsystems’ Blogging Policy

§ Yahoo Employee Blog Guidelines

§ Groove’s Blogging Guidelines (discussion by Ray Ozzie's discussion from 2002)

o Other examples of corporate blogging policies from the NewPR Wiki and other blogs:

§ Exony Blogging Policy, James Snape, November 4, 2004

§ Corporate Blogging Policy, March 7, 2005

§ Weblogs At Harvard Law - Terms of Use

§ Blogging policies and guidelines, Niall Cook, Marketing Technology, May 19, 2005

o A podcast on corporate blogging with Denise Howell, Steve Rubel, George Lenard and Jeff Seul at IT Conversation.

o Practical advice from Random Acts of Reality written by Tom Reynolds (a London, England EMT) called How To Blog And Not Lose Your Job.

o The Thomas Nelson Publisher's Blogging Guidelines (revised) and commentary by Thomas Nelson's CEO, Michael Hyatt.

o Plaxo's Public Internet Communication Policy, and much reader commentary.

o Robert Scoble's Corporate Weblog Manifesto and Scoble's update.

o Dennis Kennedy's Corporate Blogging Policies and Deja Vu and Kennedy's Seminar Materials on Blogging and Technology Use Policies.

TaTags: AHLA, health care, law, health 2.0, web 2.0