Monday, October 30, 2006

Cost Of Living In Charleston, Martinsburg, Morgantown and Vienna

Does it cost more (or less) to live in West Virginia? Numerous times this question has either come up or been posed to me. The Charleston Daily Mail had a blurb today on a recent report issued by the WVU College of Business & Economics examining cost of living.

The report looks at 4 cities in West Virginia: Charleston, Morgantown, Martinsburg and Vienna. All come in below the national average for cost of living. Vienna (91.1%), Charleston (92.8%), Martinsburg (97.7%) and Morgantown (99.7%). The report also has a snapshot of prices for milk, new home, pizza, boy's jeans and a movie. Interesting info.

The West Virginia Business & Economic Review, Fall 2006 covers the topic in its report, "Cost of Living in West Virginia Cities: Second Quarter 2006."

Sunday, October 29, 2006

Go Mountaineers!


I have to agree with ESPN.com, "IF IT'S PANDEMONIUM YOU WANT . . . No. 3 USC lost. No. 5 Texas struggled. No. 7 Auburn struggled. This may have been the greatest Saturday in West Virginia history."

USC's loss sets up a great Thursday night game between the Mountaineers and the Cardinals. Let the hype begin for the "Battle in the Bluegrass."

Some inspiration for Mountaineer fans.


Friday, October 27, 2006

CAB 11.7: Election Day Event

The Charleston Area Bloggers (CAB) are planning to meet at Capitol Roasters on November 11 around 7am to 9am. Come early, late or anytime in between. Wi-fi is available.

If you can't make it the group is setting aside Wednesday, December 6 @ 7am for the December get-together. Mark your calendar and plan to attend.

Rick Lee and Oncee have posted about the upcoming event. As Rick says, everyone is welcome especially West Virginia bloggers.

Looking forward to seeing old and new bloggers.

HHS designates CCHIT as RCB

CCHIT is the first group to be designated by HHS as a RCB. How's that for health care acronyms!

The Certification Commission for Healthcare Information Technlogy's (CCHIT) designation as as a Recognized Certification Body (RCB) will allow for those marketing health IT products to move forward for approval as a certified interoperable product. The article indicates that CCHIT as a RCB will be able to evaluate health information technology products to ensure that they meet base-line requirements for functionality, interoperability and security.

The importance of RCB approval also plays into gaining the benefits of the new safe harbors for Anti-kickback and Stark law allowing electronic health information systems to be donated to physicians by hospitals, health plans and others.

A summary is also provided in the HHS Press Release.

UPDATE: Tax-exempt hospitals should be cautious and examine the tax implications of donating health information technology equipment to physicians and other for-profit health care providers. Non-profits have to examine whether the donation is a public vs. private benefit and I would think that most attorneys would recommended seeking a private letter ruling from the IRS prior to donating equipment.

Thursday, October 26, 2006

SCOTUS Trivia!

What current U.S. Supreme Court Justice has roots in West Virginia? Answer.

Tip to SW Virginia Law Blog.

Vonage Comes To West Virginia

The Charleston Daily Mail reports today that Vonage has finally entered the West Virginia market. I've been waiting for Vongage to come to West Virginia after having used the service in North Carolina at my brother in law's house. Based on my experience it's a great service.

Those of you who aren't famililar with Vonage and voice over internet service providers you can read this. Basically, it is phone service over your high speed internet service. One of the nice features is that your phone number is portable.

According to the article, Vonage prices will be $24.99 per month and a $14.99 per month basic residential service. There is a draw back if you live here in Charleston. You can't get a local Charleston number yet and instead have to sign up using a Wheeling, Huntington, Parkersburg or Beckley exchange number. This is a draw back for me -- since I would want local Charleston calls from my family and friends to not be charged a long distance call for calling me local via a landline.

Wondering when Vonage will get a Charleston exchange? Maybe someone from Vonage will see my post and provide a response.

UPDATE: A few weeks ago I checked in to see if Vonage was now available in Charleston. At that time it still wasn't available. However, today (2/4/07) I checked again after a conversation with my neighbor about the service and it now appears to be available in Charleston. Although I haven't switched yet -- I plan to switch our home phone the coming days, especially after a recent failure by Verizon to come out and check out lines after we had been having trouble with a garbling line. When we called Verizon they told us that we had to first go out and check the line ourself on the outside box by plugging in a phone and see if it still has problems. I guess this would help to diagnose whether the problem was an outside line problem or problem with the lines in our house.

The following areas are listed as available for West Virginia (area code 304).

304 is available
Available Towns:
BeckleyBridgeportCharleston Zone 1
ClarksburgFairmontGrafton
Huntington Zone 1HurricaneLogan
MartinsburgParkersburg Zone 1Philippi
PrincetonRavenswoodScott Depot
SpencerWheeling Zone 1


Welcome to West Virginia Vonage!

Health Care Blogging Summit 2006

The first Healthcare Blogging Summit will be held on December 11, 2006, at the Omni Shoreham Hotel in Washington, DC, co-located at Consumer Health World.

I've been invited by Dmitriy Kruglyak, the organizer of the summit to participate as a panel member of the session on Healthcare Blogging - Facts & Issues. The panel members include:
The focus of the panel will be on:
Whether or not you are ready to participate directly, there are some things about blogging you need to know. As you are reading these lines bloggers may be writing about your organization and shaping the public opinion! How do blogs work? How many are out there? What is the source of bloggers’ trust, credibility and influence? What options does an organization have for responding to the activities of independent bloggers? What about the legal and ethical considerations?
For more information about the conference or how to register visit the The Medical Blog Network.

120 Days then new National Coordinator for Health Information Technology?

Healtcare IT News reports that Robert Kolodner, Interim National Coordinator for Health Information Technology will only be in the position thru January 2007 and will then return to his position at the VA.

To maintain momentum the health care industry need a charismatic national leader on health information technology to help guide and coordinate a uniform and practical national policy on health information. The focus must remain on adopting technology that provides better, more efficient care and treatment.

Who that person should be (or will be) remains a mystery. If you've got any suggestions -- please post in the comments. I'd be interested to hear of potential candidates.

Wednesday, October 25, 2006

Hospital Patient Data Lost

A lesson on losing hospital patient data.

260,000 patient records were accidentally left in a new computer bag by a medical billing contractor who had copied the records onto CDs to work from home. The employee had decided the new recently purchased computer bag was too small and exchanged it at the store leaving the CDs inside. The person who later bought the bag three days later returned the CDs to the hospital system.

According to the article, the hospital system did not believe the data was improperly accessed, but as a precaution, notified patients urging them to monitor their credit.

Tuesday, October 24, 2006

HIPAA: All Bark, No Bite

The Red Tape Chronicles highlights HIPAA (un)enforcement in Health Care Privacy Law: All Bark, No Bite?

The post provides an update on the number of HIPAA complaints filed with OCR (22,664 since 2004) and the fact that no fines have been levied for violating the HIPAA Privacy Rule. The article also cites that 332 criminal cases have been referred to the DOJ resulting in three prosecutions.

The aricle provides some good back and forth discussion between privacy advocates, those responsible for implementing compliance/monitoring in the industry and officials at DHHR.

Thanks to my colleague, Dustin Dillard, for tipping me about the article.

Grand Rounds 3.5: A Visual Tour

Ohhhhh . . . Tuesday Morning . . . feels like a hangover. I'm finally coming down from the caffeine buzz of last weeks Grand Rounds hosted by Kim at Emergiblog. I'm in withdraw after a week of working on the incredible submissions for this week's edition of the best from the medical blogosphere. Actually, I'm looking more like Ground Round! I should have heded Kim's advice - but you know it's difficult for lawyers to take advice.

Lawyers are known for their written and verbal communication but any good defense trial lawyer knows that a photo is worth a thousand words. Hmmm . . . photos . . . theme? Photos tell a story. Photos enhance the story. Social interaction adds value to content. Social networking is content. Using Flickr within a theme? How will online social networking change the landscape of medicine and health? Just some thoughts.

It's a fascinating time to watch the evolution of online social interaction these days and discuss its impact on the health care industry. Not long ago we were all using the internet as a static place to obtain information. Listserves, bulletin boards and early individual blogs became the first generation of social networking. Soon came the growth of more blogs on specialized topics, more interaction, community blogs and carnivals, like Grand Rounds -- all mediums that allow sharing of information and knowledge in a decentralized process, providing a forum for feedback, comments, discussion and disagreement. Lately we are seeing the next generation develop. Two health care examples are Organized Wisdom, a collaborative health information resource, which allows patients and professionals to share health experiences in a learning environment, and Sermo, which allows physicians to consult with colleagues, share clinical observations, challenge or corroborate each other's opinions (for pay) and accelerate the emergence of trends and new insights on medications, devices and treatments, building open, collaborative health care. What next? It's Your World, Your Imagination. What about Second Life Medical? or Project Virtual Hospital?

Flickr , an online social photo sharing service was one of the early web 2.0 success stories. As an experiment to add value to content I've used "keyword" links for each submission. For example, check out alzheimers, new drug or insulin pump. I urge you to drill down and explore some the photo links, comments on the photos and consider how the photos change your impression of the written posts. On with the rounds . . .

First the Host's Favorites . . .

BREAD: From the don't always believe what you see department comes a post at Unbounded Medicine about a Thai student who bakes human being parts out of bread. Yum . . . .

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

FISH: A fishy topic is on the line at DiseaseProof. In Gone Fishing Again, Gerald Pugliese contemplates a recent article in The Los Angeles Times, pointing out that even the EPA acknowledges the confusion over fish consumption. Mr. Pugliese utilizes Dr. Fuhrman's past comments to add more to the fish tale. Dr. Emer at Parallel Universes is also fishing around this controversy with To Eat or Not To Eat Fish.

DEATH: From The Differential: Medscape Med Students, Ali Tabatabaey, an Iranian medical student, confronts death in The First Patient Death Leaves Its Mark. At why am i still here? a third year medical student confronts whether she would want extravagant measures taken if it were her 16-year-old daughter.

COMPETITION: Dmitriy Kruglyak, at the Medical Blog Network, takes a close look at what's left for hospitals in the current competitive environment in The Shifting Basis of Hospital Competition.

FOOD: I've got the rumblies in my tumblies. May I take your order please? Emergiblog covers the etiquette of ordering food in the ER in Here to Save Your Derrieere, Not Feed It.

The Best of the Rest . . .

FEET: From the foot bone is connected to the ankle bone comes The Foot Blog. A new community blog started this month covering everything for the podiatry community, a great example of a community blog modeling the long tail toe theory.

DIABETES: Amy Tenderich at Diabetes Mine announces the ultimate diabetic "extreme (medical) makeover" in her post Pimp Your Diabetes. A D-Dream Team has been put together and the progress of the individuals will be tracked at Diabetes Mine. Amy also provides a one blog mini-seminar on the thyroid in Hello, Mr. Thyroid and questions all the buzz on the new wireless monitoring devices for diabetes in Remote Control Diabetes? Not.

SPINE: The Science Creative Quarterly by Prashant Nair covers spinal injuries in Spinal Injuries: So many ways to strike a chord. The article made this lawyer confront the altered existence lived by victims of spinal injuries and their hopes for the future. But consider Mark Zupan and don't miss Murderball.

HIPAA: The HIPAA Blog covers the latest recommendations by the National Committee on Vital and Health Statistics . HIPAA may no longer just apply to "covered entities." All that hard work of creating business associate agreements might be for not.

CATHOLIC: Dr. Lei at Genetics Health interviews Catholic genetics blogger, Rebecca Taylor. Ms. Taylor, a clinical laboratory technologist in molecular biology at a Catholic hospital blogs at Mary Meet Dolly, where the world of genetics and genetic engineering (Dolly) meets the teachings of the Catholic Church on the sanctity of life (Mary). Mary Meets Dolly resonates with many people feeling alienated because most science and medicine bloggers are largely atheist or agnostic.

SHOPPING: Comparision shopping, Canada vs. Israel, comes your way via InsureBlog's post titled Isrameds. Canada isn't the only "foreign" country offering discount medications. If you've got a hankerin' for strictly kosher meds, Bob Vineyard has your source. The InsureBlog also has some surprising stats on "What Bothers People About Their Own Health Care" and a followup post poll.

INTUBATED: Homeschooledmedstudent confronts her own sadness and helplessness in Lingering, about an intubated, terminally ill patient.

POLICY: Matthew Holt covers the Six Dirty Little Health Care Secrets of health care.

AUTISM: Dr. Deborah Serani posts Gene Mutation Linked to Risk of Autism highlights further genetic underpinnings for Autism in a study coming out of Vanderbilt University that will be featured in the upcoming Proceedings of the National Academy of Sciences.

DIAGNOSIS: From the "What's Your Diagnosis?" category comes Failure to thrive in a 20-month-old from Rural Pediatrics. The case report involves a 20-month-old toddler with a one-year history of poor weight gain and large, mushy, smelly stools. Turns out the diagnosis was chronic Giardia infection due to likely becoming infected from playing in a mountain stream while his parents gold-panned. The full article can be obtained from Infectionus Disease in Children.

NEW DRUG: Straightfromthedoc discusses Duke University researchers' efforts to significantly prolong the effects of an anti-inflammatory drug by modifying a drug called interleukin-1 receptor antagonist. The engineered drug is potentially useful for providing longer-lasting treatment for osteoarthritis. Gloria Garnat also writes about the recently USFDA-approved drug, ARICEPT, for the treatment of Alzheimer's disease, at The Pharm Voice.

WELLNESS : Musing about the (un)balanced nature of Wellness is Dr. Rob Lamberts' post at Musings of a Distractible Mind. Dr. Lamberts asks the question "does wellness really exist?" and concludes that the physician's role is to "relate to our patients as they go through life and not treat them as a project to complete."

ALZHEIMERS: Mona Johnson at The Tangled Neuron highlights current studies of those diagnosed with mild cognitive impairment and the ongoing efforts to better understand the early stages of dementia and Alzheimers. Why be tested for Alzheimer's when there is no effective treatment? Contribution to research and ultimately finding a cure for the disease. Ms. Johnson, who went through testing at the Wisconsin Registry for Alzheimer's Prevention, recommends participating in testing at a memory clinic, university, or Alzeimer's Disease Research Center so that the results can be used in future studies. West Virginia's own Blanchette Rockefeller Neurosciences Center is leading a shift from laboratory tests to clinical trials.

WIKIPEDIA: Mnmonics Guy (MG) brings us CLMAA and a link to a Wikipedia page that includes volumes of medical acronyms and abbreviations. MG's post speculates that medical acronyms may be a dying art with the introduction of EHRs. MG also highlights the difference between acronyms and abbreviations. My favorite misspelled acronym is HIPPA.

HOSPITAL STORIES: Hospital Impact, authored by Tony Chen, shares the 2nd edition of Friday's Great Patient Stories with Great Patient Stories - Harry Potter, Hamburgers and Hemmorroids. Chen's initial post, along with my Pre-Rounds interview by Nick Genes,inspired me to start a new series of regular posts called The West Virginia Doctor.

STRETCHING: With advice on how not to over-stretch your back comes The Stretch You Need The Least from Dr. Jolie Bookspan at Healthline: The Fitness Fixer. Thanks, Doctor. Your submission was much needed advice after spending hours bent over my laptop working on Grand Rounds.

ODOR: A volunteer ER chaplain writes about wonderful ER odors in The Olfactory Tour at Rickety Contrivances of Doing Good.

BREAST CANCER AWARENESS: In recognition that October is National Breast Cancer Awareness Month, Dr. Emer at Parallel Universes posts about statistics on breast cancer in the Phillipines, catching breast cancer early, and the importance of regular breast self-examination.

PEG Tubes: This week, Dr. Marcucci at Inside Surgery covers the surgical facts and details of Percutaneous Endoscopic Gastrostomy Tubes.

FDA: From the California Medicine Man comes the "story" behind Lester Crawford's departure as the commissioner of the Food and Drug Administration (FDA) and the importance of the FDA maintaining integrity.

MEDICAL SCHOOL: Vitum Medicinus, who is journaling his experiences as he goes through medical school, reminds us of the excitement of practical learning and experience in the post Back in the Hospital: ER Shadowing.

CEO: At Running A Hospital the CEO asks, "How am I doing?" to which Kevin, M.D. responds pretty good job. Congratulations go out to the other blogging hospital CEO who details his trip to Northern Virginia to see Little Lucy for the first time.

VACCINES: Two posts on vaccines from PediatricsInfo . First, the FDA approved the rotavirus vaccine in Febuary 2006. Second, the MMR vaccine has been cleared from causing autistic disorders according to a trial published in the October 2006 issue of Pediatrics.

PERSONA: GruntDoc takes a look at his Work Persona.

BLOOD PRESSURE: South African medical student Karin Little, who blogs at Just Up The Dose, nostalgically remembers her first diagnosis in Thump-thump-thump as she winds down on her degree. Along the same vein comes Hypertension-Silent Killer with a hypertension quiz.

TUNNEL VISION: Wandering Vistor muses about viewing the tunnel from the outside in Are You Suffering from Tunnel Vision?

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

STINGRAY: Dr. Paul Auerbach, at Medicine for the Outdoors, blogs about Another Stingray Attack reported last week in Florida which follows the tragic death of the Crocidile Hunter, Steve Erwin, in a similar unlikely incident.

CALIFORNIA: Nancy L. Brown, PhD, at Teen Health 411, provides insight into the confidentiality laws related to reproductive health care in California for minors and points out the practical issues related to information leaking through the billing process when the minor seeks care covered under her parent's insurance.

POVETRY: Borneo Breezes recognizes the contributions of Mohammed Yunus, a Bangaladeshi economist and founder of Grameem Bank, who will be awarded the Nobel Peace Prize for his effort at ending poverty through providing credit to the poorest of the poor.

INSULIN PUMP: Kerrie Morrone, a twenty-something type 1 diabetic, contemplates incorporating her insulin pump into the tangles of daily dressing in Insulin Pumping, After a Fashion.

JEFF GOLDBLUM: A Caribbean medical student blogging at the rumors were true explores his own science role model. Jeff Goldblum?

HORMONES: A four-part post on Hormone Replacement Therapy at The Blog That Ate Manhattan.

FLU: In his post, Pediatric Flu Vaccine Supply Delayed, Not a Shortage, Dr. Choi at Tech Medicine helps this lawyer understand why his two-year-old can't get her flu shot -- there is only one FDA-approved flu vaccine for children under three.

NFL: The NFL's Punitive Substance Abuse Policy covers Brett Farve's standing up to the NFL and its substance abuse policy after the suspension of Packer's wide receiver Koren Robinson.

RANT: Citing one of my all time favorite movies, Terry Gilliam's "Brazil," Digital Doorway rants about healthcare bureaucracy in Bureaucracy Now! --- A Rant. Is it Buttle or Tuttle? Also, ranting about medblog ranting comes Pointing The Finger from Medblogopathy.

INFORMATION: David Williams at The Health Business Blog provides us a link to the original piece titled, "Information Is The Answer," used by ABC News in its week-long series, Prescription for Change.

HALLOWEEN: The Family Fork: Feeding the Kids and You provides timely advice for choosing healthly alternatives as you prepare to make the Grand Rounds with the kids next Tuesday Night.

The question remains whether Dr. Hebert's Medical Gumbo will be cooking up tricks or treats as the host of Grand Rounds 3.6.

As the first health care lawyer to host Grand Rounds, I just want to say thanks to Nick Genes for giving me the opportunity to host from the hills of West Virginia. Thanks to the contributors who make Grand Rounds what it is -- a wonderfully eclectic collaboration of individuals and health professionals who share a breadth and depth of knowledge unmatched anywhere.

Monday, October 23, 2006

Grand Rounds 3.5

Ohhhhh . . . Tuesday Morning . . . feels like a hangover. I'm finally coming down from the caffeine buzz of last weeks Grand Rounds hosted by Kim at Emergiblog. I'm in withdraw after a week of working on the incredible submissions for this week's edition of the best from the medical blogosphere. Actually, I'm looking more like Ground Round! I should have heded Kim's advice - but you know it's difficult for lawyers to take advice.

Lawyers are known for their written and verbal communication but any good defense trial lawyer knows that a photo is worth a thousand words. Hmmm . . . photos . . . theme? Photos tell a story. Photos enhance the story. Social interaction adds value to content. Social networking is content. Using Flickr within a theme? How will online social networking change the landscape of medicine and health? Just some thoughts.

It's a fascinating time to watch the evolution of online social interaction these days and discuss its impact on the health care industry. Not long ago we were all using the internet as a static place to obtain information. Listserves, bulletin boards and early individual blogs became the first generation of social networking. Soon came the growth of more blogs on specialized topics, more interaction, community blogs and carnivals, like Grand Rounds -- all mediums that allow sharing of information and knowledge in a decentralized process, providing a forum for feedback, comments, discussion and disagreement. Lately we are seeing the next generation develop. Two health care examples are Organized Wisdom, a collaborative health information resource, which allows patients and professionals to share health experiences in a learning environment, and Sermo, which allows physicians to consult with colleagues, share clinical observations, challenge or corroborate each other's opinions (for pay) and accelerate the emergence of trends and new insights on medications, devices and treatments, building open, collaborative health care. What next? It's Your World, Your Imagination. What about Second Life Medical? or Project Virtual Hospital?

Flickr , an online social photo sharing service was one of the early web 2.0 success stories. As an experiment to add value to content I've used "keyword" links for each submission. For example, check out alzheimers, new drug or insulin pump. I urge you to drill down and explore some the photo links, comments on the photos and consider how the photos change your impression of the written posts. On with the rounds . . .

First the Host's Favorites . . .

BREAD: From the don't always believe what you see department comes a post at Unbounded Medicine about a Thai student who bakes human being parts out of bread. Yum . . . .

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

FISH: A fishy topic is on the line at DiseaseProof. In Gone Fishing Again, Gerald Pugliese contemplates a recent article in The Los Angeles Times, pointing out that even the EPA acknowledges the confusion over fish consumption. Mr. Pugliese utilizes Dr. Fuhrman's past comments to add more to the fish tale. Dr. Emer at Parallel Universes is also fishing around this controversy with To Eat or Not To Eat Fish.

DEATH: From The Differential: Medscape Med Students, Ali Tabatabaey, an Iranian medical student, confronts death in The First Patient Death Leaves Its Mark. At why am i still here? a third year medical student confronts whether she would want extravagant measures taken if it were her 16-year-old daughter.

COMPETITION: Dmitriy Kruglyak, at the Medical Blog Network, takes a close look at what's left for hospitals in the current competitive environment in The Shifting Basis of Hospital Competition.

FOOD: I've got the rumblies in my tumblies. May I take your order please? Emergiblog covers the etiquette of ordering food in the ER in Here to Save Your Derrieere, Not Feed It.

The Best of the Rest . . .

FEET: From the foot bone is connected to the ankle bone comes The Foot Blog. A new community blog started this month covering everything for the podiatry community, a great example of a community blog modeling the long tail toe theory.

DIABETES: Amy Tenderich at Diabetes Mine announces the ultimate diabetic "extreme (medical) makeover" in her post Pimp Your Diabetes. A D-Dream Team has been put together and the progress of the individuals will be tracked at Diabetes Mine. Amy also provides a one blog mini-seminar on the thyroid in Hello, Mr. Thyroid and questions all the buzz on the new wireless monitoring devices for diabetes in Remote Control Diabetes? Not.

SPINE: The Science Creative Quarterly by Prashant Nair covers spinal injuries in Spinal Injuries: So many ways to strike a chord. The article made this lawyer confront the altered existence lived by victims of spinal injuries and their hopes for the future. But consider Mark Zupan and don't miss Murderball.

HIPAA: The HIPAA Blog covers the latest recommendations by the National Committee on Vital and Health Statistics . HIPAA may no longer just apply to "covered entities." All that hard work of creating business associate agreements might be for not.

CATHOLIC: Dr. Lei at Genetics Health interviews Catholic genetics blogger, Rebecca Taylor. Ms. Taylor, a clinical laboratory technologist in molecular biology at a Catholic hospital blogs at Mary Meet Dolly, where the world of genetics and genetic engineering (Dolly) meets the teachings of the Catholic Church on the sanctity of life (Mary). Mary Meets Dolly resonates with many people feeling alienated because most science and medicine bloggers are largely atheist or agnostic.

SHOPPING: Comparision shopping, Canada vs. Israel, comes your way via InsureBlog's post titled Isrameds. Canada isn't the only "foreign" country offering discount medications. If you've got a hankerin' for strictly kosher meds, Bob Vineyard has your source. The InsureBlog also has some surprising stats on "What Bothers People About Their Own Health Care" and a followup post poll.

INTUBATED: Homeschooledmedstudent confronts her own sadness and helplessness in Lingering, about an intubated, terminally ill patient.

POLICY: Matthew Holt covers the Six Dirty Little Health Care Secrets of health care.

AUTISM: Dr. Deborah Serani posts Gene Mutation Linked to Risk of Autism highlights further genetic underpinnings for Autism in a study coming out of Vanderbilt University that will be featured in the upcoming Proceedings of the National Academy of Sciences.

DIAGNOSIS: From the "What's Your Diagnosis?" category comes Failure to thrive in a 20-month-old from Rural Pediatrics. The case report involves a 20-month-old toddler with a one-year history of poor weight gain and large, mushy, smelly stools. Turns out the diagnosis was chronic Giardia infection due to likely becoming infected from playing in a mountain stream while his parents gold-panned. The full article can be obtained from Infectionus Disease in Children.

NEW DRUG: Straightfromthedoc discusses Duke University researchers' efforts to significantly prolong the effects of an anti-inflammatory drug by modifying a drug called interleukin-1 receptor antagonist. The engineered drug is potentially useful for providing longer-lasting treatment for osteoarthritis. Gloria Garnat also writes about the recently USFDA-approved drug, ARICEPT, for the treatment of Alzheimer's disease, at The Pharm Voice.

WELLNESS : Musing about the (un)balanced nature of Wellness is Dr. Rob Lamberts' post at Musings of a Distractible Mind. Dr. Lamberts asks the question "does wellness really exist?" and concludes that the physician's role is to "relate to our patients as they go through life and not treat them as a project to complete."

ALZHEIMERS: Mona Johnson at The Tangled Neuron highlights current studies of those diagnosed with mild cognitive impairment and the ongoing efforts to better understand the early stages of dementia and Alzheimers. Why be tested for Alzheimer's when there is no effective treatment? Contribution to research and ultimately finding a cure for the disease. Ms. Johnson, who went through testing at the Wisconsin Registry for Alzheimer's Prevention, recommends participating in testing at a memory clinic, university, or Alzeimer's Disease Research Center so that the results can be used in future studies. West Virginia's own Blanchette Rockefeller Neurosciences Center is leading a shift from laboratory tests to clinical trials.

WIKIPEDIA: Mnmonics Guy (MG) brings us CLMAA and a link to a Wikipedia page that includes volumes of medical acronyms and abbreviations. MG's post speculates that medical acronyms may be a dying art with the introduction of EHRs. MG also highlights the difference between acronyms and abbreviations. My favorite misspelled acronym is HIPPA.

HOSPITAL STORIES: Hospital Impact, authored by Tony Chen, shares the 2nd edition of Friday's Great Patient Stories with Great Patient Stories - Harry Potter, Hamburgers and Hemmorroids. Chen's initial post, along with my Pre-Rounds interview by Nick Genes,inspired me to start a new series of regular posts called The West Virginia Doctor.

STRETCHING: With advice on how not to over-stretch your back comes The Stretch You Need The Least from Dr. Jolie Bookspan at Healthline: The Fitness Fixer. Thanks, Doctor. Your submission was much needed advice after spending hours bent over my laptop working on Grand Rounds.

ODOR: A volunteer ER chaplain writes about wonderful ER odors in The Olfactory Tour at Rickety Contrivances of Doing Good.

BREAST CANCER AWARENESS: In recognition that October is National Breast Cancer Awareness Month, Dr. Emer at Parallel Universes posts about statistics on breast cancer in the Phillipines, catching breast cancer early, and the importance of regular breast self-examination.

PEG Tubes: This week, Dr. Marcucci at Inside Surgery covers the surgical facts and details of Percutaneous Endoscopic Gastrostomy Tubes.

FDA: From the California Medicine Man comes the "story" behind Lester Crawford's departure as the commissioner of the Food and Drug Administration (FDA) and the importance of the FDA maintaining integrity.

MEDICAL SCHOOL: Vitum Medicinus, who is journaling his experiences as he goes through medical school, reminds us of the excitement of practical learning and experience in the post Back in the Hospital: ER Shadowing.

CEO: At Running A Hospital the CEO asks, "How am I doing?" to which Kevin, M.D. responds pretty good job. Congratulations go out to the other blogging hospital CEO who details his trip to Northern Virginia to see Little Lucy for the first time.

VACCINES: Two posts on vaccines from PediatricsInfo . First, the FDA approved the rotavirus vaccine in Febuary 2006. Second, the MMR vaccine has been cleared from causing autistic disorders according to a trial published in the October 2006 issue of Pediatrics.

PERSONA: GruntDoc takes a look at his Work Persona.

BLOOD PRESSURE: South African medical student Karin Little, who blogs at Just Up The Dose, nostalgically remembers her first diagnosis in Thump-thump-thump as she winds down on her degree. Along the same vein comes Hypertension-Silent Killer with a hypertension quiz.

TUNNEL VISION: Wandering Vistor muses about viewing the tunnel from the outside in Are You Suffering from Tunnel Vision?

YUPIK: The TundraPA at Tundra Medicine Dreams shares with us the experience of death, funeral, family, and feast as a Yupik Eskimo village loses one of its members in a post called A Village Funeral.

STINGRAY: Dr. Paul Auerbach, at Medicine for the Outdoors, blogs about Another Stingray Attack reported last week in Florida which follows the tragic death of the Crocidile Hunter, Steve Erwin, in a similar unlikely incident.

CALIFORNIA: Nancy L. Brown, PhD, at Teen Health 411, provides insight into the confidentiality laws related to reproductive health care in California for minors and points out the practical issues related to information leaking through the billing process when the minor seeks care covered under her parent's insurance.

POVETRY: Borneo Breezes recognizes the contributions of Mohammed Yunus, a Bangaladeshi economist and founder of Grameem Bank, who will be awarded the Nobel Peace Prize for his effort at ending poverty through providing credit to the poorest of the poor.

INSULIN PUMP: Kerrie Morrone, a twenty-something type 1 diabetic, contemplates incorporating her insulin pump into the tangles of daily dressing in Insulin Pumping, After a Fashion.

JEFF GOLDBLUM: A Caribbean medical student blogging at the rumors were true explores his own science role model. Jeff Goldblum?

HORMONES: A four-part post on Hormone Replacement Therapy at The Blog That Ate Manhattan.

FLU: In his post, Pediatric Flu Vaccine Supply Delayed, Not a Shortage, Dr. Choi at Tech Medicine helps this lawyer understand why his two-year-old can't get her flu shot -- there is only one FDA-approved flu vaccine for children under three.

NFL: The NFL's Punitive Substance Abuse Policy covers Brett Farve's standing up to the NFL and its substance abuse policy after the suspension of Packer's wide receiver Koren Robinson.

RANT: Citing one of my all time favorite movies, Terry Gilliam's "Brazil," Digital Doorway rants about healthcare bureaucracy in Bureaucracy Now! --- A Rant. Is it Buttle or Tuttle? Also, ranting about medblog ranting comes Pointing The Finger from Medblogopathy.

INFORMATION: David Williams at The Health Business Blog provides us a link to the original piece titled, "Information Is The Answer," used by ABC News in its week-long series, Prescription for Change.

HALLOWEEN: The Family Fork: Feeding the Kids and You provides timely advice for choosing healthly alternatives as you prepare to make the Grand Rounds with the kids next Tuesday Night.

The question remains whether Dr. Hebert's Medical Gumbo will be cooking up tricks or treats as the host of Grand Rounds 3.6.

As the first health care lawyer to host Grand Rounds, I just want to say thanks to Nick Genes for giving me the opportunity to host from the hills of West Virginia. Thanks to the contributors who make Grand Rounds what it is -- a wonderfully eclectic collaboration of individuals and health professionals who share a breadth and depth of knowledge unmatched anywhere.

NOTE: I accidentally change the title of the Grand Rounds post which then automatically changed the permalink that was used in the Pre-Rounds Interview on Medscape. This created a dead link for all of these visitors coming from Medscape. To correct the problem I created a duplicate post of Grand Rounds here. You can read comments posted on the duplicate post here.

Saturday, October 21, 2006

Keep An Eye Out For Grand Rounds 3.5

The Unbounded Medicine byline reads, "Medicine as it must be: unlimited." A great perspective for those working in today's health care industry. Unbounded Medicine does a great job hosting this week's edition of Grand Rounds, the carnival of medical blogospere.

Next up, Kim at Emergiblog will be hosting the October 17th edition of Grand Rounds. After that, Grand Rounds 3.5 (October 24) will be hosted right here at Health Care Law Blog.

This will be my first go around at hosting the best of the medical blogs. I previously hosted Blawg Review, the lawyers carnival, and am excited about getting to host Grand Rounds. Week in and week out the content at Grand Rounds is excellent. If you've never read it -- make sure to take a look at some of the archive editions.

To submit a post for Grand Rounds 3.5, email me at bobcoffieldatgmail.com before October 22. Be sure to include the post's URL address, a short comment or summary about the post, your name and email address. You can also use Blog Carnival, which automates the process of submitting posts to various blogs. Just select Grand Rounds and complete the information requested.

Thursday, October 19, 2006

The West Virginia Doctor #1: Baptism

Over the last year I've toyed with the concept of a feature guest post or podcast recounting stories of West Virginia medicine reflected through the eyes of my dad, an 82 year old West Virgnia doctor. With help from my dad who has a knack for story telling the "West Virginia Doctor" Series is being born.

What prompted me to get this feature post started? By coincidence my dad sent me the story below at the same time I was thinking about the importance of Tony Chen's commentary at Hospital Impact seeking great patient stories. As the son of a small town doctor I've had the opportunity to experience and hear some great patient stories over the years. As I told Nick Genes, MD during his Pre-Rounds interview of me, these experiences from my childhood influence my approach to health care everyday.

Over the years I've heard wonderful medical stories told by my dad, LeMoyne Coffield, who practiced medicine from 1950 through 1993 in New Martinsville, West Virginia and his brother, Terrell Coffield, also a doctor who praticed alongside his brother in this same community. The stories run a full range -- some sad, some funny and some strange and unbelievable.

The story below was shared with me this past week and involves my grandfather, Albert Lee Coffield, who served this same small West Virginia community as a doctor from 1910 through 1936. The story takes place along the Ohio River at Duffy, Ohio which is just across the river from New Martinsville, West Virginia.

Back in the early 1930’s Dad had an old gentleman who lived in Duffy and had what he and the family thought was terminal lobar pneumonia. This was about 11 years before the discovery of penicillin. Lobar pneumonia ran a typical course; you had chills, high fever, cough with rusty sputum, shortness of breath and you would either die or it would resolve by lysis (slow resolution) or crisis (rapid resolution - with a sudden improvement and break of the fever).

During his illness the Ohio was flooded, ice cakes floating, and the ferry from New Martinsville not operating. Dad made a home call by rowboat and docked at the front porch. The old gentleman had never been baptized; the family were Disciples and wanted to carry this out by immersion. Water, water, everywhere but it was ice cold, and they knew he would die in their attempt to submerse him in the flooded river.

They solved the problem by pulling their row boat up on the front porch, filling it with partially warmed water, carrying the old man to the front porch, wrapped in blankets, and immersing him. They knew that such exposure in the bitter cold would be his death. They prayed over his chilled and shaking body but in a couple hours he rallied; fever subsided, got out of his deathbed and ate a hardy supper. He continued to improve and in a week or so miraculously back to good health.

Monday, October 09, 2006

GAO Report on Domestic & Offshore Outsourcing of Personal Information in Medicare, Medicaid and TRICARE

The Government Accounting Office (GAO) recently issued a privacy report on Domestic and Offshore Outsourcing of Personal Information in Medicare, Medicaid and TRICARE.

Following is the summary of the Report findings.
Federal contractors and state Medicaid agencies widely reported domestic outsourcing of services involving the use of personal health information but little direct offshore outsourcing. Among those that completed GAO’s survey, more than 90 percent of Medicare contractors and state Medicaid agencies and 63 percent of TRICARE contractors reported some domestic outsourcing in 2005. Typically, survey groups reported engaging from 3 to 20 U.S. vendors (commonly known as subcontractors). One federal contractor and one state Medicaid agency reported outsourcing services directly offshore. However, some federal contractors and state Medicaid agencies also knew that their domestic vendors had initiated offshore outsourcing. Thirty-three Medicare Advantage contractors, 2 Medicare fee-for-service (FFS) contractors, and 1 Medicaid agency indicated that their domestic vendors transfer personal health information offshore, although they did not provide information about the scope of personal information transferred offshore. Moreover, the reported extent of offshore outsourcing by vendors may be understated because many federal contractors and agencies did not know whether their domestic vendors transferred personal health information to other locations or vendors.

In responding to GAO’s survey, over 40 percent of the federal contractors and state Medicaid agencies reported that they experienced a recent privacy breach involving personal health information. (The frequency or severity of these breaches was not reported.) By survey group, 47 percent of Medicare Advantage contractors reported privacy breaches within the past 2 years, as did 44 percent of Medicaid agencies, 42 percent of Medicare FFS contractors, and 38 percent of TRICARE contractors. TMA and CMS differ in their requirements for notification of privacy breaches. TMA requires monthly reports on privacy breaches from its TRICARE contractors and follows up with contractors that report recurring lapses in privacy. While CMS requires Medicare FFS contractors to report privacy breaches within 30 days of discovery, such oversight is lacking for privacy breaches that may occur with personal health information held by state Medicaid agencies and Medicare Advantage contractors, as CMS does not require reports of privacy breaches from these entities.

New Hospital CEO Blog: Running A Hospital

Via a post from The Health Care Blog, I was alerted to a second hospital CEO blogger. Paul Levy is the Pres/CEO of Beth Israel Deaconess Medical Center in Boston and is blogging at Running A Hospital.

To my knowledge this is only the second hospital CEO blogger. Nick Jacobs, the CEO at Windber Medical Center, who blogs at Nick's Blog and periodically guest hosts at Hospital Impact gets credit for being the first hospital CEO blogger.

A warm welcome to Mr. Levy. I've added Running a Hospital to my blog roll and plan to monitor the RSS feed going forward. I've only had a chance to scan some of his past posts but the content looks promising. Based on the archives he started the blog in August 2006. Here is Mr. Levy's first post.