Physician Incentives Under HITECH Act

Fellow health care lawyer colleague, AHLA HIT member and friend, Jud DeLoss, provides an excellent overview of the Physician Incentives under the HITECH ACT.

The incentives focus on providing direct payment for the adoption, implementation and maintenance of electronic health records (EHRs) to "eligible professional" who establishes the "meaninful use" of an EHR.

Check out this post and others at Jud's Minnesota Health IT Blog.

Health Care Law Blog Makes Avvo's Top Legal Blogs

I noticed some traffic coming from the Avvo Blog and realized that they compiled a list of top legal blogs based on Alexa traffic rankings. Currently my Health Care Law Blog comes in at #98 on the list.

If you are new to legal blogs this is a great list to see the variety of law related blogs available. Thanks to Avvo for compiling and sharing the list.

HIPAA Settlement: Dumping of PHI Results In $2.25M Settlement

This week's settlement by CVS, the nations largest retail pharmacy chain, to pay the U.S. government a $2.25 million settlement and take corrective action highlights the need for providers and other covered entities to focus on the simple privacy protections such as appropriately disposing of patient information in a secure manner.

The first known joint investigation and settlement by the U.S. Department of Health and Human Services (HHS) and the Federal Trade Commission (FTC) with CVS was the result of CVS failing to guard patients PHI when disposing of patient information such as identifying information on pill bottle labels. .

The review and settlement under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule by OCR and the FTC indicated that:

• CVS failed to implement adequate policies and procedures to appropriately safeguard patient information during the disposal process
• CVS failed to adequately train employees on how to dispose of such information properly
  

The investigation started after various news media reported fiding prescription drug and other PHI had been dumped into unsecured trash containers at CVS pharmacies. As a result CVS not only violated the HIPAA Privacy Rule but also was brought under the FTC's deceptive business practice guidelines by claiming that CVS represents to consumers that maintaining customer privacy was central to their operations.
For more read the OCR Press Release (related OCR information/summary) FTC Press ReleaseComplaint and Consent Order) and the Resolution Agreement. Also, OCR has posted new FAQs that address the HIPAA Privacy Rule requirements for disposal of PHI. (related FTC

West Virginia's Health Information Technology Efforts

Yesterday the Charleston Gazette ran an op-ed piece, West Virginia A Leader In Health Information, written by Kenneth Kizer and Peter Groen.

The article provides an overview of the various efforts in West Virginia to become a national leader in health information technology. The op-ed piece states:

As Congress deliberates the economic stimulus package aimed at, among other things, accelerating use and adoption of health information technology, leaders would be well served to look to West Virginia's example as a guide for how to accomplish this objective in a cost-effective fashion.
West Virginia has quietly become a national leader in the use of health information technology, particularly in the area of "open-source" electronic health record solutions that are used by the U.S. Department of Veterans Affairs and Indian Health Service. These high-value systems, developed with a substantial investment of federal funds over the past 30 years, have been adapted and are being used in a number of innovative ways to improve the health of West Virginians:

• The state Department of Health and Human Resources has just completed rolling out Bar Code Medication Administration in all eight state hospitals. This technology, developed by the VA in the late 1990s, has been shown to reduce the overwhelming majority of medication errors among hospitalized patients.

• DHHR completed implementation of OpenVista, the commercial version of the internationally known electronic health records used by the VA last fall. This means that all federal and state hospitals in West Virginia now use essentially the same system. No other state has done this.

• West Virginia University Hospitals recently launched the second phase of implementing a proprietary electronic health records system.

• The Community Health Network of West Virginia finished installing MedLynksTM RPMS, a cousin of OpenVista, in 30 clinic locations located across the state last year, and continues to implement MedLynk RPMS at additional sites. (RPMS is currently used by the Indian Health Service at almost 200 of its facilities.)

A recent survey conducted by the Shepherd University Research Corp. found that 76 percent of state hospitals have at least begun implementing an electronic health records system; this is among the highest rates, if not the highest, in the nation. These are important developments that will result in higher quality and safer health care, reduced costs and saved lives. The people of West Virginia should take pride in these accomplishments - and look forward to completion of additional efforts underway.
Gov. Manchin's strategic plan for improving health care in West Virginia envisions important improvements, including installing electronic medical records in all hospitals and clinics in the state; implementing the West Virginia Health Information Network - a statewide network to improve information flow between different types of healthcare facilities; implementing a new web-based Medicaid claims management system to more efficiently process claims and better detect fraud and abuse; expanding use of personal health records; and continuing to increase e-prescribing.
Under the leadership of DHHR Secretary Martha Walker and Medicaid Commissioner Marsha Morris, the department has launched a Medicaid transformation initiative aimed at creating "medical homes" for Medicaid patients. Medical homes use "health information exchange" technology to connect different types of electronic medical records so that they are integrated to provide more complete information so that doctors can better treat chronic diseases like diabetes and heart disease and more effectively work to keep people healthy.
The Medicaid program has established the West Virginia Health Improvement Institute and an Innovation Community to teach caregivers how to integrate health information technology and medical home concepts to support patient education and self-management. Pilot programs to show the effectiveness of these efforts are underway. The West Virginia Medicaid program competed for funding from the federal Centers for Medicare & Medicaid Services to support these efforts.
Further, the West Virginia Telehealth Alliance is one of 69 programs across the country that has been funded to enhance broadband capacity for nearly 300 participating facilities supporting telehealth and HIT applications in West Virginia.
Clearly, West Virginia has taken the initiative and is aggressively moving forward to improve health care using a blend of open source and commercial health-care IT systems. There is much the rest of the nation can learn from West Virginia's experience.
Kizer, a doctor and public health specialist, is a former undersecretary in the U.S. Department of Health Services. Groen is with the Computer & Information Science Department at the Shepherd University Research Corp.

World Health Care Congress Consumer Connectivity: Overcoming Legal and Policy Barriers for Health IT Adoption

Next week I will be speaking at the World Health Care Congress 2nd Annual Leadership Summit on Consumer Connectivity in Carlsbad, CA on February 23-24. I will be co-presenting a session on Overcoming Legal and Policy Barriers for Health IT Adoption with Rod Piechowski, Senior Associate Director for Policy, American Hospital Association and Director, National Assocation of Health Information Technology.

Our session will examine the following areas:

• Addressing the need to reform the overall payment system to spur system-wide IT adoption
• Managing the shift in traditional practice models to meet cross-generational needs – Strategies to change traditional behaviors
• Evaluating the current legal barriers to utilizing web-based applications and today's PHRs
• Responding to the shift in medical information ownership – moving from provider-based to patient-centered records
• Overcoming current concerns of defamation and invasion of personal privacy
• HIPAA Compliance – Expanding regulations to cover PHRs and other web-based health IT applications
• Discussing the merger of traditional healthcare with the next generation/Health 2.0 community

Rainmaking 101

Friend and West Virginia lawyer colleague, Pat Kelly, told me today about the release of his new book on client development and rainmaking. Although I have yet to read the book -- I know Pat well and look forward to his valuable insight on the topic.

Rainmaking 101: How to Grow Your Client Base & Maximize Your Income, is being distributed through Authorhouse, Amazon and Target. The price at Authorhouse is $14.95.

The summary from the back cover:

Each year, millions of talented men and women embark on professional careers, convinced that technical proficiency and hard work alone will propel them to the top, only to find themselves competing with an army of equally ambitious newcomers. Which individuals will beat the odds? THE RAINMAKERS. Young entrepreneurial professionals who excel at the most important skill of all — client development.

Mere months after graduation from law school, Pat Kelly realized that his legal education had failed to cover one very important component to being successful — how to attract and maintain clients. Mr. Kelly discovered that it wasn’t enough to be smart, diligent, and motivated. He had to gain a competitive edge and make business RAIN DOWN on himself and the fi rm that hired him. On the pages of this easy-to-read book, he spells out the essential skills, attitudes, and strategies that can help you do the same.

Learn how to:

• Stand out from a crowd of talented professionals.
• Create a memorable first impression.
• Bridge communication gaps that separate you from older generations.
• Make the most of social and professional events.
• Follow the “Platinum Rule” to build client trust and loyalty.
• Develop quality relationships with colleagues and clients.
• Hone vital social and conversational skills.
• Deliver presentations with lasting impact.

DECIDE NOW to be a RAINMAKER. With a little practice, a little imagination, and a little creativity, the only thing that won’t be “little” will be the results.

U.S. Hospitals: Using Facebook, YouTube and Twitter

Great post listing the U.S. Hospitals using social networking tools like YouTube, Facebook and Twitter. Check out the complete list of 150 hospitals and a related FAQ about the Hospital Social Networking List at Found In Cache: Notes from a Hospital Web Manager authored by Ed Bennett.

Thanks to @schwen for pointing out the list.

Medical Uses of Twitter: Twitter Consult

Two case studies pointing out additional medical uses for Twitter from Jennifer Texada at How to Go Web 2.0.

Her post, Health 2.0 Makes it to Twitter, discusses two separate cases. The first involved the use of Twitter by medical professionals seeking real time advice with a diagnosis. Call it a "Twitter Consult." The second involved a researcher looking for exercise study participants who were endometrial cancer survivors.

West Virginia: The Roadmap to Health Project

Last week Kenneth E. Thorpe, PhD of Emory University released the Roadmap to Health Project report to the West Virginia Legislature's Select Committee D on Health. The Roadmap to Health Project is an initiative by Select Committee D. The full report is titled, "West Virginia Health Care Reform - Roadmap to Health Project: Final Recocommendations to Select Committee D."

Lessons For PowerPoint Users

Yesterday I did a presentation for the West Virginia Healthcare Financial Management Association on Social Media, Consumer Driven Health Care, Health 2.0 and the Legal Implications. Today I see friend and creative guru, Jeff James' post on Begin With PowerPoint in Mind which highlights how NOT to use PowerPoint and links to a Top 10 Best Presentations Ever.

The how NOT to use PowerPoint is a must see for anyone who uses PowerPoint. I have yet to watch the Top 10 but plan to go back and check them out to see how I can improve my skills. Thought others might be interested in checking out this top 10 list.

American Well: e-House Calls by the Hawaiian Doctor

Today Hawaii Medical Service Association along with American Well roll out American Well's technology that redesigns the house call -- call it "e-House Call." More about the joint effort and how to log in can be found at HMSA's Online Care For Consumers.

American Well's technology allows live, face-to-face consultations between physicians and patients. The technology matches up the patient with the physician. Hawaii hope that the project will provide convenient, affordable and better access to health care in a state (not unlike West Virginia) that has remote areas/islands.

I plan to invite American Well to West Virginia to see whether we might roll out a similar effort in conjunction with the West Virginia Health Information Network or as a part of the innovation community under the Medicaid Transformation Grant program that I am working on through the West Virginia Health Improvement Institute.

More background information in the AP News article, "The Hawaii doctor is in - online." Also, David Harlow over at HealthBlawg recently examined whether American Well might be the disruptive innovation to unseat retail based health clinics.

Tip to @jenmccabegorman.

WVHFMA: Consumer Driven Health Care

Tomorrow I will be speaking on consumer driven health care at the West Virginia Chapter Healthcare Financial Management Association's Winter Education Conference in Charleston, West Virginia.

I thought I would post my slides for the presentation titled, Consumer Driven Health Care: The Impact of Social Media and Health 2.0. The presentation is an introduction to the concepts of social media, health 2.0, consumer driven health care and some of the legal implications.

This past week I ask my social media network on Facebook and Twitter to help develop a list of words and phrases that represent Consumer Driven Health Care. The results are included in the presentation.

WVHFMA CDHC And Health 2.0 (1 15 09)

View SlideShare presentation or Upload your own. (tags: driven consumer)

My Family Health Portrait: A Family PHR

The Surgeon General has launched a new online tool allowing a user to create an electronic family health tree to track your family health history. The site is called "My Family Health Portrait." The Surgeon General press release.

The tool draws on the value of creating a family health genealogy and marries it with the concepts of PHRs. The tool states, "using My Family Health Portrait you can:

• Enter your family health history.
• Create drawings of your family health history to share with family or health care worker.
• Use the health history of your family to create your own.

The new site lets users create and download their health information into their own computers and e-mail a tree-in-progress to family members to fill in missing health history information. The site also allows a user to "reindex" the tree to include any person in the tree as the center of information. For example I can create a health tree for my family but by sending it to one of my sisters or cousins who adds to the health information tree that person can then reindex the site to look at their health history and potential health risks.

According to the details on the website the tool will be interoperable and EHR-ready (i.e., developed using HL7 Family History Model, LOINC, SNOMED-CT and HL7 Vocabulary) . Information included in the My Family Health Portrait can then be transferred and embedded in EHRs or PHRs. The details on the website indicate that the tool is open source, free and can by "adopted" by other organizations.

Coinciding with the release of My Family Health Portrait, the Office for Civil Rights (OCR) has published new HIPAA Privacy Rule FAQs related to family medical history. The new FAQs support the roll out of the Surgeon General's family health history portal.

The FAQs address the following questions:

1. Does the HIPAA Privacy Rule limit an individual’s ability to gather and share family medical history information?

2. Does the HIPAA Privacy Rule limit what a doctor can do with a family medical history?

3. Under the HIPAA Privacy Rule, may a health care provider disclose protected health information about an individual to another provider, when such information is requested for the treatment of a family member of the individual?

More from the Washington Post. Tip from iHealthBeat.

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.