Wordle: Health Care Law Blog

I noticed recent tweets about Wordle, an ultra cool "word count" generator. Here is an example pulled from the text of my Health Care Law Blog. Give it a try for your blog, tweets or next presentation.

Lifeline Television Program: Health Information Exchange and Health 2.0

Last month I had the opportunity to tape a television segment on Health Information Exchange and Health 2.0 for Lifeline, a weekly 30 minute public television program focusing on health and Medicare information for West Virginians. The segment started running this week and should run through the month of January. 

The show is produced by West Virginia Medical Institute to help educate West Virginians on a variety of health, Medicare and healthy living topics. Marc McCombs, WVMI's Director of Corporate Communications hosts the weekly shows. Many of Lifeline's topics are also covered in WVMI's companion print newsletter, also called Lifeline.

Lifeline airs on the West Virginia Library Television Network in over 200,000 households throughout the state. Lifeline airs every week in the Charleston area on Suddenlink Channel 17 at the following times:

• 11:00 AM Tuesday
• 5:00 PM Tuesday
• 11:00 PM Tuesday
• 5:00 AM Wednesday
• 2:00 PM Saturday 

You can find the channels for other cable systems airing the program around West Virginia by going to the Lifeline webpage. Also, the Lifeline page lists some of the archive shows. Below is a teaser clip from the show.

10 Things Small Business Owner Should Do In 2009

A post on the Top 10 Things Every Small Business Owner Should Do in 2009 by Guy Kawasaki came across my screen this morning via @paulhelmick and caught my eye.

Great advice for any business person to consider and "do" in 2009. We can all do better at understanding how our customers view us and improving on the service or product we offer them.

ESPN World's Strongest Man Competition 2008 - Charleston WV

Everyone be sure sure to tune in to the ESPN World's Strongest Man Competition 2008 starting to air on ESPN2 on December 25 (7pm-1am) and ESPN on December 28 (1pm-7pm).

Charleston, West Virginia played host to the 2008 competition. I look forward to ESPN showing off the beauty and positive aspects of Charleston and West Virginia. Also, the hometown of the 2006 World's Strongest Man, Phil Pfister.

UPDATE: Today's Charleston Daily Mail  issues official announcement of the airing of 2008 World's Strongest Man Competition on ESPN.

ONCHIT Issues Nationwide Privacy and Security Framework for Electronic Exchange of Health Information

Today the Office of the National Coordinator for Health Information Technology (ONCHIT) issued The Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information. The summary states that the framework creates a set of consistent principles to:

". . .address the privacy and security challenges related to electronic health information exchange through a network for all persons, regardless of the legal framework that may apply to a particular organization. The goal of this effort is to establish a policy framework for electronic health information exchange that can help guide the Nation's adoption of health information technologies and help improve the availability of health information and health care quality. The principles have been designed to establish the roles of individuals and the responsibilities of those who hold and exchange electronic individually identifiable health information through a network."

Along with the Nationwide Privacy and Security Framework the Department of Health and Human Services (HHS) has issued The Health IT Privacy and Security Toolkit. The Toolkit includes new HIPAA Privacy Rule guidance documents developed by the ONCHIT and the Office for Civil Rights (OCR) to help facilitate the electronic exchange of health information.

Of particular interest to many interested in PHRs will be the OCR's guidance on Personal Health Records and the HIPAA Privacy Rule and the draft Draft Model Personal Health Record (PHR) Privacy Notice & Facts-At-A-Glance (the "Leavitt Label").

The Toolkit provides information and guidance focused around these key areas:

• Individual Access Principle - Individuals should be provided with a simple and timely means to access and obtain their individually identifiable health information in a readable form and format.
• Correction Principle - Individuals should be provided with a timely means to dispute the accuracy or integrity of their individually identifiable health information, and to have erroneous information corrected or to have a dispute documented if their requests are denied.
• Openness and Transparency Principle - There should be openness and transparency about policies, procedures, and technologies that directly affect individuals and/or their individually identifiable health information.
• Individual Choice Principle - Individuals should be provided a reasonable opportunity and capability to make informed decisions about the collection, use, and disclosure of their individually identifiable health information.
• Collection, Use, and Disclosure Limitation Principle - Individually identifiable health information should be collected, used, and/or disclosed only to the extent necessary to accomplish a specified purpose(s) and never to discriminate inappropriately.
• Data Quality and Integrity Principle - Persons and entities should take reasonable steps to ensure that individually identifiable health information is complete, accurate, and up-to-date to the extent necessary for the person's or entity's intended purposes and has not been altered or destroyed in an unauthorized manner.
• Safeguards Principle - Individually identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure.
• Accountability Principle - These principles should be implemented, and adherence assured, through appropriate monitoring and other means and methods should be in place to report and mitigate non-adherence and breaches.

I have only made an initial pass though the information and guidance documents. There is a lot to read and digest over the holidays. Please post in the comments your thoughts on the new federal principles and guidelines.

Does the Certificate of Need Law Benefit West Virginia?

Joe Letnaunchyn, CEO of the West Virginia Hospital Association, responds to the continuing discussion on the pros and cons of certificate of need regulatory oversight in West Virginia. The commentary, Certificate of Need Program Benefits West Virginia, appears in the most recent edition of the State Journal.

Mr. Letnaunchyn responds to the commentary by Dashle Gunn Kelley, dated October 30 2008, State Doesn't Need Certificates of Need, asserting that West Virginia "doesn't need certificates of need" to deliver health care. Mr. Kelley is a doctoral student in economics at West Virginia University and is an associate fellow for the Public Policy Foundation of West Virginia.

Throughout the year the Select Committee D - Health (Subcommittee Certificate of Need) - Interim has been looking at the issues involving certificate of need in West Virginia. Highlights of the Interim Meetings can be found here. I suspect that the discussion and debate will continue at the upcoming West Virginia Legislative session.

UPDATE (12/19/08): The latest edition of the State Journal contains a follow up commentary on West Virginia's certificate of need program. The commentary, Who Really Benefits from the Certificate of Need Program? was written by Russell S. Sobel, Ph.D., is professor of economics, holder of the James Clark Coffman Distinguished Chair at West Virginia University and editor of the book "Unleashing Capitalism: Why Prosperity Stops at the West Virginia Border and How to Fix It."

Reengineering Health Information Technology to Wire The Medical Home

Over at The Health Care Blog Dr. Kibbee issues Part 2 of his Confessions of a Physician EMR Champion, subtitled "A Conversation with American Physicians About How to Save Medicine in the Age of Information." The Part 2 post, Empowering Health IT for the Connected Medical Home, is a must read for all interested in the world of changing world of health/technology.

Dr. Kibbe lays out 5 areas that health IT should focus on to be empowering and disruptive to the current models:

1. electronic data and information collection and access
2. communications among providers and patients
3. clinical decision support
4. population quality, performance, and cost reporting
5. consumer/patient education and self-management

He highlights the importance of stepping back and looking at the current EMR model (a bit of thinking outside the box):

There is nothing transformational or disruptive about EMRs because they have been designed to meet the functions and features of a status quo business model -- not the collaborative and participatory capabilities required of the business models of the future health system.

In this next installment of the conversation, I’d like to suggest some specific capabilities that health IT ought to empower doctors and health care teams to perform on behalf of, and in collaboration with, their patients.

I’m suggesting that we go back to the drawing board and design health IT that is truly a good fit for doctors and patients in a system that rewards quality, safety, and efficiency of care while working to keep people healthy, instead of simply adding up the charges when they’re sick.

I'm involved on a number of fronts looking at health information models for West Virginia that will improve the delivery of care and reduce the costs. Dr. Kibbee's comments and thoughts are valuable for others looking at these same issues.

Tip to Ted Eytan on the post.

Engage With Grace

Last month I had the opportunity to watch Alexandra Drane announce Engage With Grace: The One Slide Project at the Health 2.0 Conference in San Francisco. The idea behind the project is to get people to share just ONE slide that helps them and their loved ones talk about having a purposeful end-of-life experience.

Alexandra's talk personally touched me because my family went through a similar experience 30 years ago when I was 12 years old. My mother died at home with cancer in 1978. She had the opportunity to die at home surrounded by her 5 children because both my dad and uncle were her doctors. In the past and today, not all families are given this important choice. The memories I have of my mother's final days 30 years ago are still important to me today.

Last week, Matthew Holt who blogs at The Health Care Blog and Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston who blogs at Running A Hospital, spread the word to bloggers about a viral campaign (call it a blog rally) to raise awareness by encouraging families to discuss end of life care issues while gathering for the Thanksgiving holiday weekend.

For West Virginia readers who want to learn more about end of life care I recommend checking out the resources provided by the West Virginia Center for End of Life Care. There is also valuable information for health care professionals. Here individuals can find forms for the standard West Virginia Living Will and Medical Power of Attorney. The site also includes information, FAQs, list of West Virginia palliative/hospice providers and other resources.


Engage with Grace from Health 2.0 on Vimeo.

Below is a message being posted today and throughout the Thanksgiving holiday weekend at blogs around the country and the world:

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.This has real consequences.

73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences. But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started. Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)

UPDATE: Paul Levy provides a post-rally update thanking those engaging gracefully. There were well over 95 bloggers over the Thanksgiving holiday weekend helping to spread the word.

Blawg Review # 186: Blawgers Are All-A-Twitter

Res Ipsa Blog brings you this week's edition of Blawg Review -- Blawg Review #186. This edition begins with a summary of the raging Twitter Wars and includes a link to a post I did last week discussing some of the legal implications of live tweeting in health care.

Check out this week's edition for the latest law news from around the blogosphere.

Medicare PHR Pilot Project

HealthcareIT News reports on the announcement of a Medicare personal health record (PHR) pilot project that will be made available to Medicare beneficiaries in Arizona and Utah.

The four PHR companies selected out of almost 40 who applied to participate in the pilot are: Google Health, HealthTrio, NoMoreClipboard.com and PassportMD.

The Arizona Republic has more on the pilot project. More background information on CMS's PHR projects.

Tip to iHeathBeat on the article.

UPDATE: Today's iHealthBeat indicates that interoperable PHRs could result in$21B savings per study conducted by Center for Information Technology Leadership. Read the press release and full Value of Personal Health Records report.

The Implications for Live Tweeting Surgery

Yesterday Robert Hendrick, health care disruptor (I mean that in a positive way) and co-founder of change:healthcare, live tweeted his laser ablation surgery at the Surgical Clinic in Nashville. He also tweeted the first installment of his surgery to remove his varicose veins -- Live from the Operating Room.

Robert and his counterpart, Christopher Parks, are all about transparency in health care, especially as it relates to payment issues. This serves as just one more example of their efforts to engage health consumers and create transparency in health care.

Robert's live tweeting during surgery struck me as an interesting application of Twitter and other mobile social networking application. Here are just a few thoughts:

• A way to keep friends and family updated on your condition, surgery, etc.
• Useful for others who might be contemplating a particular procedure or surgery to get a real time look at what might be involved. I know someone who is contemplating undergoing the same procedure and plan to share Robert's posts with them.
• As more and more patients and providers start to document information via social networking avenues - what might this mean during future litigation and discovery? Certainly seeking tweets, historical Facebook updates, etc. might be valuable in either pursuing or defending litigation. What are the rules for lawyers in pursuing such evidence? What might this mean for the companies providing such services as they see more and more subpoenas for information?
  

For a real time look at surgery tweets check out Twitter Search for the term -- surgery. Interesting stuff. I welcome others thoughts on the topic.

Thanks Robert for making my day for awarding me "best tweet of the procedure." Follow Robert on Twitter at @Robert_Hendrick.

UPDATE (1/18/09): More discussion on live tweeting surgery. This time it is from the provider side and not just the patient tweeting away their surgery. Henry Ford Health System live tweeted a surgical procedure in Detroit to a group of medical professionals at a conference in Las Vegas.

Shel Israel at Global Neighborhood has a great summary/interview with background on the event that will be part of his upcoming book, Twitterville. Bertalan Mesko has provides coverage about the Live Tweeting Surgery at at ScienceRoll. To find all the tweets about the surgery search via Twitter Search for the tag: #twOR.


After seeing the post by Shel I reached out to him and told him this wasn't the first live tweeted surgery. However, it was the first tweeted "from the provider side" -- @HenryFordNews.@Robert_Hendrick still gets the 1st award from the patient side.

UPDATE (1/29/09): Noticed in my Twitter stream today that Rick Sanchez of CNN is live tweeting his knee/meniscus surgery. Another live tweeting patient. In this case, high profile reporter from CNN. Follow Mr. Sanchez's twitter stream at @ricksanchezcnn.

UPDATE (2/17/09): Elizabeth Cohen of CNN (@elizcohenCNN)covers the live tweeting of surgical procedures by hospitals in the article, Surgeons send 'tweets' from operating room. Included with the article is a video detailing the live twittering at Henry Ford Health Systems. You can also follow the tweet stream of the surgery tagged via Twitter as: #hfhor.

UPDATE (5/26/09): mobilehealthnews provides a historic timeline of the most notable examples of live tweeting surgery in a post, Twitter surgery timeline: 8 months of OR Tweets.

Why Is Healthcare So Expensive?

A simplified view of Why is Healthcare So Expensive? from Stay Smart Stay Healthy. Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry.

Our goal is simple: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.

Check out their other videos on health care.



Tip from KevinMD.

Predicting Flu Season With Google Flu Trends

Google Flu Trends uses search terms as an indicator of flu activity by state.

According to Google.org Flu Trends the aggregated search data can estimate flu activity in a state up to two weeks faster than traditional systems. The chart comparison with CDC data is impressive at showing the consistency between tracking search terms vs. using influenza surveillance data. Read about how it works and the FAQs. More background from the NYT in Google Uses Web Searches to Track Flu's Spread. 

What about privacy concerns? Has Google stepped beyond the boundary of the "trust question" by providing aggregated search information to the CDC? It might depend upon the level of data that is being release to the CDC. Already anyone using Google Trends can get a certain level of aggregated information on a particular topic - for example "Flu".

Privacy is one thing but expectation is another. My experience in dealing with clients on privacy breach matters has lead me to believe that it is often not about whether something should or should not be private -- but rather it is a question of expectation by the person who trusted information with another party. Did that party do something with the information that was unexpected or not agreed to by the parties.

The discussion on privacy has started . . .

• Google To Track Flu Searches and Report Them to Feds? at Volokh Conspiracy
• Sick Surveillance: Google Reports Flu Searches, Locations to Feds at Drudge
• Google Flu Trends: A Glimpse into the future of Google Health at ReadWriteWeb
• Sick? Google Shares Health Searches with Government at CNET Technically Incorrect
• Google Introduces Flu Trends; Gets Red-Font Treatment on Drudge at U.S. Web

Follow the current discussion using the search term: ("google flu trends" privacy) and related search results from Google Blogs.

UPDATE: Interesting follow up thoughts by Mark Hawker and the potential use of Facebook Lexicon as a similar approach to tracking flu and other health conditions.Wasn't aware of Facebook Lexicon feature - interesting tool.

The Health Cloud

Tim Sturgill, MD JD at symtym provides an explanation and insight into the potential shift from silo'ed EHRs controlled by multiple providers to a Health Cloud centralized around a single PHR.

The result of such a shift lessens the need for complex health information exchanges to process and communicate information among a variety of health information silos, matching patient records and trying to match multiple sources of health information that may or may not be identical.

This approach is similar to the discussion and perspective I outlined in a recent article on PHRs for Health Lawyer News.

Graphic image courtesy of Tim's post.

Purkinje: Another SaaS EHR

Justen Deal in his post, Purkinje: stealth fighter, introduced me to another SasS focused Electronic Health Record (EHR) and practice management service provider called Purkinje. Interesting read on the company and its history.

The principle owner of Purkinje is John Doerr, a partner in Kleiner, Perkins, Caufield and Byers, who provides venture capital funding for some of the largest technology companies in the world.

Like Athena Health, who I do know about, Purkinje appears headed in the same direction. I think this business model has a bright future in helping quickly ramp up the adoption of electronic health information systems in medium to small physicians practices. Justen's post provides his prospective on the cost/benefit analysis as compared to traditional EMR software vendors. Also, John Halamka, CIO of the CareGroup Health System and blogger at Life as a Healthcare CIO, lists these types of SaaS EMR providers as part of his Winners in 2009 list.

Sounds convincing from a $$$ standpoint and could be one of the solutions for West Virginia to expedite its efforts to bring low cost, flexible, electronic solutions to the provider community.

Thanks for the tip Justen.

World War II Honoree: LeMoyne Coffield

On this Veterans Day I give thanks to all military veterans who have served their county. Please take time today at the 11th hour of the 11th day of the 11th month to thank a family member, friend or colleague who served their county.

Thanks to my sister Becky who submitted information to the National WWII Memorial to honor my dad, LeMoyne Coffield, and his brother and my uncle, Terrell Coffield. They are my heroes in so many ways. The photo to the right is my dad and his honoree entry reads:

ACTIVITY DURING WWII
INDUCTED INTO THE U.S. ARMY ON DECEMBER 18, 1942, PROCESSED AT FORT HAYES, COLUMBUS, OHIO AND REPORTED FOR DUTY AT WEST VIRGINIA UNIVERSITY ON DECEMBER 21, 1943. HE WAS LATER TRANSFERRED TO THE MEDICAL COLLEGE OF VIRGINIA TO COMPLETE HIS MEDICAL TRAINING. HE WAS IN THE ARMY SPECIALIZED TRAINING PROGRAM (ASTP) WHICH TRAINED PHYSICIANS FOR MILITARY SERVICE. A PRIVATE FIRST CLASS DURING THE WAR, HE WAS HONORABLY DISCHARGED ON MARCH 23, 1946.

You can search the WWII registry or register an honoree here.

WV Lawyer Disciplinary Board Seeks Comments on Metadata and Wholly-Owned Subsidary Law Firms

The Lawyer Disciplinary Board of the West Virginia State Bar is seeking public comment by February 27,2009, on two draft Legal Ethics Opinions (LEO). The two LEO's were reviewed by the Board at the October 24, 2008 meeting.

Draft L.E.O. 2009-01 What Is Metadata and Why Should Lawyers Be Cautious?
The definition of metadata used in the draft LEO is broad to include all "data behind the data" including the "author's identity, the number of revisions made and comments and redlining." Citing Rule 1.1 and 1.6, N.Y. State Bar Association Committee Op. 782 and D.C. Bar Op. 341, the proposed LEO places a duty on a lawyer to take reasonable steps to protect metadata in transmitted documents. Citing Rule 8.4(C) and N.Y. State Bar Association Committee Op. 749, the proposed LEO also places a duty on the lawyer receiving inadvertently provided metadata to consult with the sender and abide by the sender's instructions before reviewing such metadata.

Draft L.E.O. 2009-02 Wholly-Owned Subsidiary Law Firms.
The draft opinion allows a law firm to form a wholly-owned subsidiary law firm while cautioning lawyers that, in order not to deceive clients and the public, full disclosure of the relationship between the two firms is essential.

Comments must be submitted by February 27, 2009, to the Office of Disciplinary Counsel, 2008 Kanawha Boulevard East, Charleston, West Virginia 25311.

Potential Data Breach and Extortion at Express Scripts

The WSJ Health Blogs reports about a potential data breach at Express Scripts, one of the largest pharmacy benefit management companies in North America. More from Express Scripts on the Facts, FAQs and Other Resources.

The potential data breach came to Express Scripts attention after having received an anonymous letter attempting to extort money from the company by threatening the expose millions of patient records. The threat letter included personal information on 75 members, including names, dates of birth, social security numbers and prescription information.

The article also mentions a similar extortion related data breach which occurred in March 2006 and involved Medical Excess LLC, a subsidiary of AIG. In that case the FBI investigated and arrested an individual who stole a computer server containing personal health information of more than 900,000 individuals. The individual tried to extort AIG for $208,000 after threatening to release the information on the Internet.

According to the FBI Press Release, the individual involved was the first person to be charged under the new federal criminal statute, Title 18 U.S.C. 1030(a)(7)(B) and (C). The new federal criminal statute makes it a federal crime to commit extortion relating to unauthorized access of, or damage to, a protected computer system and/or to impair the confidentiality of information obtained from a protected computer.

To learn more read Express Scripts' press release and related support site.

November 5, 2008 - Today Is A New Day!

Today is a new day. Andre Blackman shared the image below (courtesy of Patrick Moberg) with me this via Twitter. The image speaks volumes about the significance of yesterday. Congratulations to President Elect Barack Obama (change.gov blog)

Although West Virginia stayed in the red yesterday there was great support by West Virginians although not always reported that way by the national media. This morning I shared with friends some links to history about a West Virginia lawyer, J.R. Clifford, as a way to reflect on the significance of Obama's win.

Mr. Clifford (wikipedia entry) paved the way in 1898 as a result of his legal work on his most famous case, Williams v. Board of Education Tucker County. The case was the first in U.S. history to hold that discrimination in school terms and teacher pay is against the law. The case occurred 50 years before the landmark Brown v. Board of Education. In 1896, two years prior, Mr. Clifford brought the first legal challenge of the state's segregated school system to the court which he ultimately lost and was not overturned until Brown v. Board of Education. For more on Mr. Clifford check out the J.R. Clifford Project (www.jrclifford.org).

As a fellow West Virginian and lawyer I'm proud of Mr. Clifford and his willingness to create change and look forward to supporting President Elect Obama's efforts to create positive change for the United States at home and around the globe.

WVU College of Law: Entrepreneurship Law Clinic

Today the West Virginia State Bar announced a new project at the West Virginia University College of Law to provide legal assistance to technology start-ups, existing small business and nonprofits.

The Entrepreneurship Law Clinic will be directed by Professor Michael V. Risch and staffed by current law students. The Clinic will provide supervised legal counsel to small businesses and start-ups in a clinical setting by offering no cost or low cost assistance.

The Clinic will provide services to clients who are unable to find or afford legal representation. Initial services will include: preformation counseling; choosing and forming a business entity; financing and investing; drafting Articles of Incorporation and Bylaws, LLC Articles and Operating Agreements, etc.; filing for tax-exempt recognition; drafting and negotiating contracts; protecting and licensing intellectual property and forming employment policies.

Congratulations to Professor Risch for starting the new clinic program which will be valuable to the growing creative community looking to stay and invest in West Virginia. The program not only assists those with new ideas or businesses but also provide real life training to law students who will gain invaluable skills to help out lawyers like myself upon graduation.