WV Chamber of Commerce President Calls for EHRs

In yesterday's Charleston Daily Mail, Steve Roberts, president of the West Virginia Chamber of Commerce, was quoted as calling for a statewide electronic health record system to reduce health care costs and increase the value of care.

The full article, Chamber of Commerce promotes electronic record-keeping, can be read via the Charleston Daily Mail.

For more information on the State Chamber's position check out the Chamber's 2008 Policy Paper on Health Information Technology.

Lights, Camera, Action . . . Health 2.0

Matthew Holt of The Health Care Blog sent me a message that they are close to announcing the agenda for the March 2008 Health 2.0 Spring Fling in San Diego. In preparation for the conference the planners are out seeking real life examples of Health 2.0 technologies in action.

Below is Matthew's summary of the panel format and information on how you can participate or help to locate someone using health 2.0 type technology to improve the every day care of their patients.

I plan to submit some suggestions of a couple of West Virginia providers for the Health 2.0 team to check out. If you know of someone who might fit the mold for connecting consumers to providers -- please leave a comment or send an email directly to John at the email listed below.

We are excited to announce a new panel format at our Spring Health 2.0 conference, "Connecting Consumers and Providers" in San Diego on March 3-4, 2008. In addition to spotlighting demos and reactions from industry experts, we will be capturing the user-experience of people living with health conditions as they use Health 2.0 technologies in their everyday lives.

Has the web changed your life? Does it help you deal with the isolation of a condition or improve your quality of life in some other way? We are looking for a few good consumers/patients to feature live on stage or in a video segment. Our roving video crew will be traveling the country to document interesting real-life stories showing how Health 2.0 impacts both people and the health care system.

And for those of you budding videographers, we are also accepting user-generated video clips that show how you are using Health 2.0 technologies in your daily life. Maybe it's an active online community where you've found support, a portable medical device, an online tracking tool, a blog, a video game, a virtual world, or some combination of the above. If you have something to say, we'd love to hear about it so we can help you share your stories with your peers and other members of the Health 2.0 community. We welcome you to join the conversation with some of the most progressive minds in health care including consumers, health providers, technologists and entrepreneurs. If you are a physician using health 2.0 technologies to connect with your patients or if you know of patients for whom technology has made a real difference, please drop us a line.

Email John our resident Health 2.0 web guru/talent scout at john@health2con.com.

Health Wonk Review - December 13

Check out the final 2007 edition of Health Wonk Review, a round up of the best health policy blog posts, hosted by fellow health law blogger, David Harlow at HealthBlawg.

Check out the Health Wonk Review blog for more information on how to be a host.

Physician Liability: Was Accident Foreseeable By Treating Physician?

A colleague pointed out this WSJ Law Blog post via the WSJ Health Blog reporting on a ruling made by the Massachusetts's Supreme Judicial Court. The ruling found a physician liable for failing to warn his patient about the side effects of the medications and the potential danger of driving while taking them.

The Boston Globe reports on the case and a copy of the slip opinion in the decision of Lyn-Ann Coombes, administratix v. Roland J. Florio, SJC-09869 December 10, 2007 can be found on the Supreme Judicial Court of Massachusetts decision website.

Although I have not had a chance to read the full opinion, the legal question that comes to mind (and which depends upon the facts in each case) is whether it was foreseeable by the physician that the patient (tortfeasor driver) was likely to have an accident? Remember Palsgraff? Was a duty owed and how broad should that duty be?

The blog post indicates that Justice Cordy's dissent states that the ruling "introduces a new audience to which the physician must attend -- everyone who might come in contact with the patient."

HealthBlog by Bill Crounse, MD

HealthBlog by Bill Crounse, MD, a new (at least to me) health care IT blog to follow. Dr. Crounse is the Worldwide Health Director for Microsoft. I've added HealthBlog to my RSS reader and look forward to the great green content being generated by Dr. Crounse.

I picked up a reference to HealthBlog via a post by Jay Parkinson, MD giving his impression of the opening keynote address and morning session at the World Healthcare Innovation and IT Congress in Washington, D.C. (Dr. Crounse's comments include a summary of Kevin Kelly's keynote on mega trends: Global, You, Do and Open).

Kibbee/Markle: Exploration of Consumer Access to Networked Health Information

Dr. David Kibbee provides great insight on the meeting by the Markle Foundation and what it might mean for Health 2.0, consumer driven health care and how health data is managed by traditional health care providers and payors. Well worth the read for anyone interested in where health information might be headed.

I look forward to reading the public policy document cited in his post, Consumer Access Practices for Networked Health Information." Dr. Kibbee hits on a point that I continue to explore from a legal perspective. He makes the statement:

Markle has lifted the discussion onto another level, and this time it's about health data, its ownership and rules of access, and its uses in our nation to promote health and wellness.

We are in the midst of a wave of change in the ownership rights of health information and data. Traditionally (and legally) we have viewed health data as owned/controlled by one group or another (what Dr. Kibbee refers to as the institutional custodians). For example, physician/hospital who owns the patient's paper medical record or insurer who own beneficiaries payment/claims information.

Typical state law support such ownership notions. Most state laws provide you and I as patients the right to copy our records. Some states go as far as providing you and I a right of access. However, to my knowledge no state law takes the alternative approach of the patient owning the records and providing access rights. Most state laws, if not all, base the ownership right on the originator or creator of the medical record. Even the HIPAA privacy rule that evolved to its present state in the late 1990s and early 2000s speaks in terms of a patient's "right to copy" and "right access to records". At no point does it speak of patient's ownership of the records.

Our legal system have very strong views on "ownership" rights. In fact ownership is a basis legal premise build into the fabric of everything we do. With ownership comes notions of control, propriety nature, privacy, competition and power (financially and otherwise). I subscribe that this foundation has largely been the reason we have yet to see integration, standardization and openness of health data exchange. Dr. Kibbee gets at this question in his post when he discusses the spirited debate during the Markle conference surrounding the question of how to "liberate" personal health information.

Dr. Kibbee also gets into the difficult questions that I am constantly struggling with regarding privacy (how much is too much and how much is not enough) and introduces the concept of "fair information practices". Balance between a patient/consumers right to control access to health information, need for access by health care professionals, reasonable protections to prohibit the breach of data, rights of governments to access/use data for particular purposes, etc.

In reacting to Dr. Kibbee's worries that physicians are not embracing the change -- I suspect this is largely due to the current reimbursement system that we have created to pay for health care. My view is that until this reimbursement model changes to create financial incentives for wellness and management of chronic disease it will be difficult to bring about change via the physicians.

These are my initial reactions (stream of consciousness) after having read Dr. Kibbee's very insightful and thought provoking post. I hope to have a chance to come back and think some more about his post and my reaction.

Business Blogging Features in Sunday Gazette-Mail

Last week's Sunday Gazette-Mail featured an article, Blogging for Dollars: talky web journals keep customers in the loop, providing insight into some local business bloggers. I want to thank the reporter, Sarah Winn, for contacting me and allowing me the opportunity to be interviewed for the article.

The article featured my Health Care Law Blog along with these other West Virginia based business blogs:

Just A Modern Guy by Chuck Hamsher of The Purple Moon Marketing Genius from Maple Creative Direct Online Marketing Jason Keeling and A Better West Virginia

It was nice to be featured along with these great blogs. The draw back of such an article is that you can't cover all the great West Virginia blogs that are available. For more check out the follow up comments by Skip Lineberg at Maple Creative and Paul at Direct Online Marketing.

As a result of Justin Seibert's comment to this post I thought I would share a link to a resource over at This is not my blog that includes a good comprehensive list of West Virginia blogs (over 200). He also cites the blog roll at Lincoln Walks at Midnight as also having a comprehensive list of West Virginia blogs.

Photo: Marketing and public-relations professionals Skip Lineberg of Maple Creative LLC and Jason Keeling of Keeling Strategic Communications LLC discuss blogging at the recent Create WV conference at Stonewall Resort. Each writes a blog and says his online journal has become a business tool.

Governor Manchin Rejects New Certificate of Need CT Standards

Eric Eyre reports in today's Sunday Gazette-Mail that Governor Manchin has rejected the proposed new Certificate of Need CT Standards approved by the West Virginia Health Care Authority last month.

The article indicates Governor Manchin sent a letter to the Authority's Board on Friday, December 7, asking that they re-examine the imaging equipment proposal and submit a revised plan. The article also indicates that Governor Manchin rejected the proposed new standards on the basis that the standards did not require physicians to accept low income patients.

For more background on the proposed new standards see my previous posts - here and here.

UPDATE (12/10/07): Governor Manchin's December 7, 2007 letter to the WVHCA.

UPDATE (1/26/08): On January 18, 2008, Governor Manchin approved the Authority's revisions to the Certificate of Need Computed Tomography Services Standards.

WVHCA Reconsiders HCR Manor Care CON

The State Journal provides background on the pending reconsideration hearing set for December 14, 2007 (9am), before the the West Virginia Health Care Authority regarding the Authority's granting of a certificate of need for the $6.3 billion buyout of HCR Manor Care by The Carlyle Group, a private global investment firm.

The Authority granted HCR Manor Care a certificate of need on October 19, 2007, however, on November 15 the Service Employees International Union Local 1199 filed a Request for Reconsideration with the Authority along with an Appeal to the Office of Judges.

On November 20, the Authority issued its Decision on Request for Reconsideration granting the reconsideration and ordering a stay of its October 19, 2007 decision pending resolution of the request for reconsideration.

UPDATE (12/10/07): Jeff Mehalic at the West Virginia Business Litigation blog picks up on my post and includes uploaded links of some of the CON pleadings in the matter, including the:

• Authority's October 19, 2007 CON Decision approving the merger between Manor Care and Carlyle Group
  
• SEIU District 1199's Request for Reconsideration
• the Authority's Decision on Request for Reconsideration granting reconsideration, a hearing on the reconsideration and a stay of its October 19 Decision and
  
• the Amended Notice of Administrative Hearing set for December 14.

Thanks to Jeff for the link and for uploading some of the key public documents in this pending certificate of need matter.

Revolution Health Expanding . . .

iHealthBeat reports via the Washington Post that Revolution Health is expanding its online health business by acquiring HealthTalk, a site focused on chronic conditions, and an investment in SparklePeople, a web site offering diet/exercise advice and ideas.

Case says in the Washington Post article:

. . . We are building a platform that reaches the largest possible audience, and in the process want to build the largest health brand from a consumer standpoint," said Revolution founder Steve Case. "Consumerism is going to become a driver in health care, which represents $2 trillion, or one-sixth of the economy. That segment is ripe for disruption, and the key disrupting force is consumers . . .

The article indicates that:

Based on October data compiled by comScore, an Internet market research firm, Revolution Health drew 105 million page views, while SparkPeople had 84 million and HealthTalk had 8 million, for a total of 197 million, Revolution Health spokesperson Brad Burns said.

Give One Get One: Tech It Forward . . .

I like the concept behind the movie, Pay It Forward. Why not "Tech It Forward."

Looking for a unique holiday gift? Why not buy and give an XO Laptop through the Give One Get One program. Take a moment and think about how much you use your computer and the power it gives you to work, learn, think, communicate and so on . . .

The computer and concept of getting compters in the hands of children around the world is the brainchild of Professor Nicholas Negroponte of MIT. You have options: giving one or more ($200 each one tax-deductible), give 1 and get 1 (still get the tax deduction for 1/2 the price) or give many and designate where they go in the world.

For more information about the program and a review of the XO Laptop check out this NYT article, Laptop With a Mission Widens Its Audience.

UPDATE: Denise Howell has similar holiday thoughts for a tech stocking stuffer with a link to the tech uproar on This Week in Tech.

Health 2.0 In Action . . .

While catching up on my RSS feeds this evening a ran across a couple of interesting posts showing Health 2.0 in action.

The first takes you on a tour through the eyes of a new diabetic from Richard MacManus at Read/WriteWeb.

The second, I would suggest you bring at least fifty bucks, from Page Thompson over at change:healthcare takes a look into the dark and humorous world of the costs for strep tests.

The third example comes from Dr. Parkinson's new (old) approach to providing care through technology and house calls. A while ago he mentioned in a post (Food Photography) his approach to helping a patient with weight and obesity problems. This recent Chicago Tribune article again mentions his simple but effective approach to monitoring his patients food intake using Flickr. In the Q/A Dr. Parkinson explains his approach:

Q. How do you treat obesity?
A. I use the Internet as much as possible. I use Web sites like sparkpeople.com or weightwatchers.com to help patients understand how much they eat. I encourage them to start a flickr account to post photos of what and how much they eat. I can comment on portion size, fat content, etc. Having a visual record of all of the food you eat is quite powerful. I calculate how many calories they should take in to lose weight by a certain date. I do frequent follow-ups via IM or e-mail to see how they are doing and to let them know that there is one other person in the world who cares and supports them. My role is that of informative coach.

(Note: This approach to fighting and changing his patient's eating/weight problems reminded me of a modern version of what I saw my dad, a West Virginia country doctor, did on a regular basis when we went out to dinner. We would inevitably run across one or more of his patients and their families. His patients (especially those who I suspect he had advised they needed to lose weight and exercise more) would sheepishly look at their plates piled high and offer excuses of why they were eating so much or didn't have more greens and vegetables on their plate. I've got to believe this daily monitoring by the physician will help to change the patient's approach to eating -- the patient become accountable every day.)

As Health 2.0 matures we are seeing health consumers and those involved in the process (and business) of changing health care through technology and social health networking giving us concrete example of what might be possible. This wasn't around a year ago when I started down the path of trying to understand, grasp and apply health 2.0 thinking to the industry. Examples like these are moving us from concept to reality.

The Health 2.0 Spring Fling follow up conference set for March 3-4, 2008 in San Diego should bring us more concrete examples of how real people are using Health 2.0 technologies to drive change. Matthew Holt summarizes the approach to the conference as follows:

In the annual Health 2.0 event last September we heard from leading edge companies. The Spring Fling will be smaller and more intimate, and it will be themed around the experience of actual users. It will also explore a specific topic in more depth. This Spring, we will focus on consumers & providers connecting using Health2.0 tools and technologies.

Here is just a peek at what you can expect at Health 2.0 Connecting Consumers & Providers

In the months preceding the event, we will send camera crews out to follow real-life patients and providers using Health 2.0 technologies. With input from industrial designers and experts in ethnographic research, we will bring you experiences from the front-line delivered over video at the event.

On stage, interspersed with the videos, we’ll have real patients and physicians discussing their experiences using Health2.0 technologies. We’ll also be hearing from health care luminaries and technology companies pushing the limits of communities, tools, and search.

While you are at change: healthcare don't miss Christopher Parks current post adding his own perspective on meeting Bill Frist and follow up on Adam Bosworth's thoughts on the Aspen Institute health conference. Christopher is at the heart of the change going on and has insight on the practical realities where others may not. The statistics on the costs of health care if we continue the current path are unfathomable. Without real change focused on preventative care, chronic disease management and simple things like getting Americans to eat less (and better) the system will break.

A Lesson For All West Virginia Expatriates: Country Road Less Traveled

Rodriquez is running to Michigan for the $$$ and prestige. Sad ending to his career here in West Virginia. The Detroit Free Press writes:

Rodriguez had a 10-minute meeting with his team early this afternoon, told the 11th-ranked Mountaineers that he was leaving for Michigan and went back to his office, according to West Virginia media reports.

His players had little comment but looked downtrodden.

Nice story about Coach Rodriquez decision from Dan Wetzel, Yahoo Sports. A story that all West Virginia expatriates should read. A story of recognizing the benefits of staying home (or coming home) and making great things happen here.

Congratulations to Coach Rodriquez, Coach Stewart (a native of my hometown of New Martinsville), Coach Casteel (a native of Paden City just down the road from New Martinsville), the rest of the coaching staff and all the Mountaineer players on a great win Saturday over Connecticut.

Good luck the West Virginia Mountaineers this coming week against Pitt in the Backyard Brawl. Here is hoping that Pat White and the rest of the Mountaineers take the growl out of the Panthers and head toward New Orleans. My favorite Pat White video from the 2007 edition of the Backyard Brawl in Pittsburgh. BEAT PITT!



Note: Wondering whether Dan Wetzel is from West Virginia and related to the namesake of the county where I grew up, Wetzel County, made famous by the great Indian fighter, Lewis Wetzel. My Coffield family actually traveled to West Virginia (then Virginia) in the mid 1700s with the Wetzel family who settled in what is now Marshall County. One of my distant relatives married Martin Wetzel, Lewis' older brother.

Thanksgiving Traditions: Turkey, Black Friday, Diet . . .

Clinical Cases and Images looks at the predictability of humans courtesy of Google Trends. Below is an example of the traditions of turkey (blue), Black Friday (red) and diet (orange). Advice for the holidays from my dad, a retired family physician from Wetzel County, "everything in moderation." Please remember to think about and share with each other why you are thankful. Happy Thanksgiving!

Should Hospitals Blog?

Practical advice from Tony at Hospital Impact on the question of "should hospitals blog?" Good advice for anyone thinking about starting a health related or business blog.

I regularly follow both Nick Jacobs at Nick's Blog and Paul Levy at Running a Hospital cited in Tony's post. Both are examples of extremely successful blogging hospital CEOs who understand the Live Web medium. Take for example the fact that Paul commented on Tony's post four hours after it was published (see the post comments).

I agree with Tony's perspective and warning when he says:

It's a lot of work and there is no hard-core ROI, but for the right type of person, it pays off in other ways. Both of these CEOs can probably point to examples where their blog put out a PR fire before it could start. They've built trust and credibility through the blog. They've humanized the hospital through the blog. So when fires do come (and of course, they will), they're well positioned to engage authentically. We are entering an age where proactive transparency is rewarded and reactive transparency is lame.

One word of warning. Don't blog if your organization:
* Doesn't trust their employees.
* Doesn't want to hear bad news.
* Wants absolute control over their message and reputation (this isn't happening anymore anyways)
* (the kicker) Doesn't have someone who's really wired to do it.

Music From The Mountains: Who was Johnnie B. Good?

West Virginia has always had a rich music history and is still creating a rich musical history through Mountain Stage (and Newsong), Vandalia, Appalachian String Band Music Festival, All Good Music Festival, and from every nook, cranny, hill and holler.

Last week the first annual West Virginia Music Hall of Fame inductions occurred in Charleston. It was a all star night event and all the living inductees made it to the event. In attendance were For more on the inductees check out the Virtual Hall of Fame. Also read the insight from The West Virginia Music Hall of Fame at LA Woman by emcee for the evening and West Virginia native, Ann Magnuson.

Included in the class was pianist, Johnnie Johnson (wikipedia entry)who is considered by many to be the father of rock 'n' roll piano. He played with Chuck Berry and was the inspiration for the classic, "Johnny B. Goode."

Create WV Conference Wrap Up

Due to prior commitments and client demands I wasn't able to attend the Create West Virginia Conference held this week at Stonewall Resort.

Over the past two days I received a number of emails and facebook comments from friends and colleagues about the quality of the content and expressing excitement about the event. If you didn't attend and want to get a flavor for the sessions be sure to check out some of the presentations on the Create WV website and wrap up comments and photos on the Create WV Blog. For more read what other are saying about the conference.

I was particular interested in the presentation by Anthony Salcito, General Manager U.S. Education for Microsoft, after reading the live blogging notes by Lee Kraus who blogs about learning and technology issues out of central West Virginia. Read through Mr. Salcito's presentation for some eye opening facts about what we all face as a result of the growing global community. His slides remind me a bit of the video, Shift Happens - Globalization.

Photo courtesy of one of West Virginia's most creative artists, Charleston Jupiter Hamilton.

WVHCA Issues Proposed Amendments to Cardiac CatheterizationStandards

The West Virginia Health Care Authority issued and approved on November 14, 2007, proposed amendments to the Cardiac Catheterization Standards.

The Notice of Public Comment Period indicates that comments must be submitted to the Authority by December 14, 2007.

WVHCA Approves New Certificate of Need CT Standards

Eric Eyre of the Charleston Gazette reports on the board decision by the West Virginia Health Care Authority approving new Computerized Tomography (CT) Standards under West Virginia's Certificate of Need Program. The proposed standards will now be sent to Governor Manchin for final approval.

Eyre reports:

A state agency cleared the way Wednesday for doctors across West Virginia to put diagnostic imaging equipment in their offices, a move hospital executives predict will drive up health costs and force them to raise rates.

West Virginia Health Care Authority members voted unanimously to approve standards that doctors’ offices must meet before the state allows them to buy and use computed tomography machines, also known as CT scanners.

The authority wrestled with the standards for nearly a year. “We tried to strike a balance between all of the competing interests,” said board chairwoman Sonia Chambers. “We tried to keep the best interests of the citizens of West Virginia in mind.”

The authority plans to send the standards to Gov. Joe Manchin, who has 30 days to give them final approval. . .

For more background information check out my previous post. Additional background information, including comments by various groups on the proposed standards, can be found on the the Authority's CT Services Workgroup Meeting site.

Spread The Word: World Diabetes Day

Fellow health care blogger, Amy Tenderich of Diabetes Mine asked that I help spread the word about National Diabetes Month (November) and World Diabetes Day on November 14. Here is her post, Diabetes Mine: World Diabetes Day Agenda Grows, and Grows...

On November 14 landmarks around the world (including the Empire State Building) will be lighting up using the color of the World Diabetes Day logo.
Why don't we light up something in West Virginia to show support? Why not the WV Capitol?

Why should West Virginians care about this? West Virginia ranks #1 in Adult's with Diabetes in the United States at 11.1% (U.S. Average is 7.4%). For more information check out the WV Diabetes Prevention and Control Program (note: the summary info indicates WV rate in 2006 at 12.1%).