After Tax Day Thought: Intuit CEO Returning To Speak In West Virginia

West Virginia claims its share of high profile thinkers leading and funding some of the most innovative companies and businesses in the world. Add to this list Brad Smith, President CEO of Intuit, Inc.

Last week I learned from Matt Ballard, President of the Charleston Area Alliance that Mr. Smith will be returning to West Virginia to serve as the keynote speaker for the Charleston Area Alliance's Annual Celebration on May 6 from 5:15pm to 8pm at the Clay Center.

Mr. Smith is a native of Kenova, West Virginia and graduated with a degree in business administration from Marshall University. According to his bio, Mr. Smith became Intuit's president and chief executive officer in January 2008, culminating a five-year rise through the company in which he successfully led each of its major businesses. Before being named CEO, Smith was senior vice president and general manager of Intuit's Small Business Division, including being responsible for the company's portfolio of QuickBooks, Quicken and Payroll products. Prior to this he ran the company's QuickBooks Group from May 2005 to May 2006.

I look forward to hearing Mr. Smith's keynote speech and hope to talk to him about Intuit's efforts to bring the Quicken approach to health care reimbursement/payment through its product, Quicken Health. Last year I attended the Health 2.0 conference and learn about Quicken Health from Mike Battaglia.

As a member of the board of the West Virginia Health Information Network I would like to brainstorm on how Quicken Health might be incorporated into West Virginia's efforts to provide better and more affordable health care for West Virginians.

The CAA Blog post on the upcoming event mentions that this ties in well with Governor Manchin's "Come Home to West Virginia" concept (listen to another native West Virginian's version). Recent story on the effort from the State Journal, Bringing Our Children Home.
Here is the except from the Governor's State of the State mentioning the concept:

However, we can’t continue down this path without help. As everyone knows, our best resource has always been our people – and not just those who are here today living and working in West Virginia, but those who were born or raised in West Virginia and have left the state because they felt they had no other choice in order to make a living. Unfortunately, we are all guilty of teaching an entire generation that they couldn’t find a good job in West Virginia, so don’t even bother trying. Well, that’s absolutely not true today, and now our challenge is to reverse these thoughts and show those who have left that this is the perfect time to come home.

Some of the most successful people in the country are native West Virginians – Sylvia
Matthews, chief operating officer of the Bill and Melinda Gates Foundation; Wes Bush, president of Northrop Grumman; Ralph Baxter of Orrick, Herrington & Sutcliffe who has come home to West Virginia to co‐chair our 21st Century Jobs Cabinet and, of course, as previously mentioned, John Chambers, CEO of Cisco Systems. And I know there are many, many more success stories out there, both large and small, that most of us aren’t even aware of – except for the proud mothers, fathers, brothers and sisters who deep‐down wish their loved ones were achieving success here in West Virginia.

Regardless of your field of expertise, we need you, and your intellectual capital, ingenuity and work ethic, now more than ever. We need those of you who have an entrepreneurial spirit, or those who have accomplished your goals and are looking for a place where you can teach others all that you have learned. You’ll recognize much of what you left behind, but you’ll also find a work force and a business community that have made tremendous advancements.

While your coming home will help us to make this an even better place to live and work, it will also be rewarding for you as well, because you’ll be able to give something back to this place that I know you’ve always carried with you in your heart and is such an important part of who you are.

So to get the word out, we are going to start a “Come Home to West Virginia” campaign this year through our Department of Commerce. This recruiting campaign will be aimed at bringing former West Virginia residents back home to either work in West Virginia’s growing industries or to expand in West Virginia the businesses they have started in other places.

These West Virginia born knowledge leaders bring a new direction that I hope West Virginia takes to transition itself into a state for the creative class to grow and thrive.

For more check out the blog posts at the CAA Blog and Skip Lineberg at Maple Creative.

Proposed Changes to the Hospital Inpatient Prospective Payment System Rule

CMS posted on its website yesterday (April 14, 2008) the Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 (CMS-1390-P).

The proposed rule includes changes to the Physician Self Referral law (Stark law) regulations and seeks comments on the Disclosure of Financial Relationship Report.

The description of the proposed rule reads:

Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2009 Rates; Proposed Changes to Disclosure of Physician Ownership in Hospitals and Physician Self-Referral Rules; Proposed Collection of Information Regarding Financial Relationships Between Hospitals and Physicians

Practical Advice on the Death Spiral

The Death Spiral, courtesy of the WSJ Health Blog.

Great graphic which highlights advice from my dad, a retired physician in West Virginia, who always warns us of such risks. He says, "eat better, eat less, take small bites, drive defensively with two hands on the wheel, don't climb ladders and be careful with guns." Looking at the graph if we listened to this advice we would take care of most of the larger circles.

Is Prevention Cheaper than Treatment?

David Williams over at the Health Business Blog looks at this question and surprisingly answers it saying that studies show it's often cheaper to let people get sick. This perspective comes from a Washington Post article, In the Balance, Some Candidates Disagree, but Studies Show It's Often Cheaper to Let People Get Sick.

I have assumed (apparently wrongly) that creating a model system in the United States focused on prevention would help halt rising health care costs. Although I've not read all the links in David's post I still have to believe that focusing prevention efforts on chronic disease will have a positive benefits. I'm also wondering whether the study took into account the difficulty (and related costs) of getting people to change their habits which in turn results in prevention.

David makes some valid points in his post including his comment that "consumerism, quality and patient safety initiatives will bear fruit." Like David I'm not sure that prevention will solve the cost crisis but I still have to believe that teaching good health habits and preventative efforts especially early on in childhood before bad habits are formed will ultimately lead to cost savings for our health system.

If you are interested in where the presidential candidates stand on a variety of health care issues -- check out the Washington Posts PoliGraph covering topics on healthcare reform, uninsured, drug prices, prevention, technology and stem cell. Interesting graph.

The Value of Wiki Collaboration

A great graphic from Wikinomics of why wiki collaboration beats email collaboration. A picture says a 1,000 words.

For me the graphic also demonstrates where we may be headed with cloud computing.

Tip to Doug Cornelius' post "Wikis and Happiness" at KM Space.

Dartmouth Atlas Health Care Stats on End of Life Care Costs

The WSJ Health Blog posts (WSJ article, More Choices Drive Cost of Health Care) interesting statistics on end of life care costs according to the latest Dartmouth Atlas of Health Care edition (due out today).

The report shows:

. . . that the cost of individual medical services isn’t the big driver of Medicare spending, at least for chronically ill patients in their last two years. It’s the intensity of care, such as the number of specialist visits and days in the ICU. . .

According to the map graphic West Virginia comes in low in the "below $37,500" category showing the average Medicare Spending during the last two years of life for chronically ill patients.

As the costs of our health care system increase over the coming years we will likely see an increased focus on looking at the end of life care issue vs. costs of health care in those remaining years. These bring to the front a variety of medical, ethical and legal questions.

Virtual Medical Dangers of Web 2.0

Thought provoking post by Bertalan Mesko at ScienceRoll on one of the dangers of web 2.0. Bertalan is a Hungarian medical student who plans to become a clinical geneticist and specialize in personalized genomics.

Bertalan highlights a danger of virtual medicine and gives us a glimpse at what might be the reality of the future as real and artificial life start to merge and blend. His post raises practical implications regarding the potential liability of a health care professional offering artificial (but real) advice online. The post also highlights to potential of the virtual world for training.

I've not spent anytime understanding what happens in Second Life and have only a superficial view of what it is and how it works. For those who know even less - it is a 3-D virtual world entirely created by its residents. There is a vibrant virtual community (including health care and medicine) growing that most don't even know about.

Thoughts on HIPAA and Privacy: NYT Article on PatientsLikeMe

First, an apology to my regular blog visitors for the lack of posts over the last month. Busy, busy, busy at work and home. No time to blog. The last couple of days I have been experimenting a bit with micro blogging via Twitter as a result of a conversation with my firm's IT director and blogger.

Quick post to this interesting NYT article, Practicing Patients, about PatientsLikeMe. The article covers some ground on some of the questions that periodically swirl in my brain regarding HIPAA, privacy rights, who is (should be) the steward of medical information, pro/cons of patients (consumers) self treatment, etc.

I particularly found interesting Alan Westin's taxonomy of Americans' attitudes toward privacy. The article states:

In 1990, Alan Westin, a political scientist at Columbia University and an expert in privacy issues, offered a useful taxonomy of Americans’ attitudes toward privacy. On one end of the spectrum were what he called privacy fundamentalists — the 25 percent of Americans who feel that their privacy is paramount and that no one, not the government or corporations or their family, should have access to their personal information without explicit permission. At the other end of the spectrum were the privacy-unconcerned — about 15 percent of Americans — who paid no mind to privacy issues and didn’t figure they had anything to hide. In the middle were the vast majority, the 60 percent whom Westin called privacy pragmatists: those who felt that they could give a company they trusted some information — birth date, ZIP code, telephone number — for particular benefits.

Google Sites: Collaboration from Google

Need to create a team site to centralize all types of data and information (think wiki)? Check out Google Sites a part of Google Apps. Here is Google's short summary of what it does:

Google Sites makes creating a team web site as easy as editing a document. You can quickly gather a variety of information in one place — including videos, calendars, presentations, attachments, and gadgets — and easily share it for viewing or editing with a small group, your entire organization, or the world.

I yet to try out the features -- but plan to test it for a couple of projects. I'm interested in thinking (and hearing from others) about how law firms and lawyers can use this technology service.

A review of Google Sites with more in depth discussion of the features. Business Week, VentureBeat and others cover the release of Google Sites.

Official Google Blog: Google Health, a first look

Official Google Blog: Google Health, a first look

HITCHtv: HIPAA Fun and HIStalk HISsies Awards 2008

Who says HIPAA law and health care technology (aka e-lectric-medical records) are boring topics. Health IT can be fun!



If you are missing HIMSS08, check out the HIStalk HISsies Awards 2008 (video) courtesy of the Healthcare IT Transition Group and HITCHtv. Great stuff for those interested in the best and worst of Health IT (or as Mr. HIStalk prefers HIS).

dCard: Health 2.0 Group Releases Standard for Physician Information

My health colleagues over at change:health (Christopher and Robert) and Organized Wisdom (Steve and Unity) along with Within3, the founding members, have worked together to release a new open standard dCard (doctor card) to establish basic e-standards for the collecting, storing and sharing of physician information. The dCard is also designed as a central location for the physician to maintain their core data and information.

The dCard concept is being initially supported by a group of nine health care technology companies. As the change:health press release indicates, joining them are eight other companies working together to develop the dCard:

• Within3 (Online professional network for health science professionals and organizations)
• OrganizedWisdom Health (First human-powered, physician-reviewed search service for health information, products and services on the web)
  
• VerusMed (Providers of clinical briefs for 150,000+ physicians and healthcare professionals)
• Peerclip (Online tool that enables physicians to organize, share, discuss and discover relevant medical information)
• Ozmosis (Online platform that unites physicians and healthcare organizations in a collaborative environment to improve patient care)
  
• Enurgi (Online healthcare services company that connects families and patients-in-need with 1 million+ local, clinical caregivers across the country)
  
• J. Parkinson, M.D. (Leading healthcare consumerism advocate and New York-based family practice physician)
• ReliefInsite (Secure, online pain management services)

I'm looking forward to learning more about the format and concept as the work to define the standard continues. Read more about the development of the dCard effort via VentureBeat and the press (change:health blog post). More from Unity Stokes at Organized Wisdom here.

Note: Not to be confused with this D-Card - but the entire industry could learn a lot from the Big D (see this post). Great step forward by this group. Christopher, you understand - I'm just returning from the land of Animal Kingdom and Magical Kingdoms and still not back in reality.

The Blogger Eye View of HIMSS Orlando

Jay Parkinson and Scott Shreeve give those of us not attending a glimpse into the happenings at HIMSS Orlando. I particularly enjoyed Dr. Parkinson's round soap theory of health care IT. For more from HIMSS check out HIStalk.

As I travel I aways wonder what happens to all the "once used" soaps. Do they just re-wrap them?

Google Health: Google Partners with Cleveland Clinic

The New York Times Technology Section reports on a pilot project between Gooogle and the Cleveland Clinic in an article, Google to Store Patients' Health Records.

The article indicates the pilot project will involve a volunteer patient group transferring their personal health records so that they are available via Google Health, a new health record product being developed by Google. The article quotes Pam Dixon of the World Privacy Forum concerning privacy issues under HIPAA (incorrectly referenced by the Times as HIPPA).

I don't necessarily agree with the scope of the comments regarding the applicability of HIPAA in this situation. Although I don't know the full details of the relationship for the proposed project but it would appear that Google in this situation might be serving as a business associate of the Cleveland Clinic for the project. As a business associate it is likely that Google would be held contractually to many of the HIPAA privacy standards.

Tip to Matthew Holt at Health 2.0 Blog for noticing the NYT article.

UPDATE (2/22/08): ZDNet's Larry Dignan at Between the Lines has more on the pilot project including the Cleveland Clinic's press release.

The comments to Dignan's post are interesting reading especially a couple with a legal perspective. The comment, two misconceptions, highlights the overall light enforcement efforts by OCR and lack of penalties, whether Google might fit the "healthcare clearinghouse" definition under the "covered entity" definition, entering into a contract with the health care provider (business associate requirement) and discusses the subpeona and marketing misconceptions.

Also, more from NYT's Steve Lohr, Google Health Begins Its Preseason at Cleveland Clinic which indicates that Google Health will be made available to the public following completion of the pilot project (appoximately 2 months). The article also has a quote from fellow health care blogger and CIO of Beth Israel Deaconess Medical Center in Boston, John Halamka, who indicates that the hospital is also interested in linking its EMR with Google Health. As a board member of the West Virginia Health Information Network I would like to explore the idea of utilizing and integrating Google Health into our statewide effort to bring about an integrated/interoperable health information system.

Jane Sarasohn-Kahn at HealthPopuli shares her thoughts and additional link commentary on the Google/Cleveland Clinic project. Jane highlights a recent report, Personal Health Records: Why Many PHRs Threaten Privacy, by the World Privacy Forum looking into privacy issues for PHRs.

Matthew Holt's follow up post taking a closer glimpse at the privacy questions, motives and opportunities both pro/con surrounding the Google Health project.

UPDATE (2/24/08): For the latest article covering the Google Health project check out Newsweek's article, Web Surfer, Health Thyself, out in the March 3 edition.

Also, MSNBC provides some additional insight on how Google Health will interact with the existing Cleveland Clinic EHR (or PHR) in Google Goes to the Doc's Office. The article describes the pilot project as follows:

. . . The Cleveland Clinic already keeps electronic records for all its patients. The system has built-in smarts, so that it will alert doctors about possible drug interactions or when it's time for, say, the next mammogram. In addition, 120,000 patients have signed up for a service called eCleveland Clinic MyChart, which lets patients access their own information on a secure Web site and electronically renew prescriptions and make appointments.

The system has dramatically cut the number of routine calls to the doctor and boosted productivity, though it has yet to effectively deal with information from an outside physician, Harris says. Those records are typically still on paper, and have to be laboriously added to the Cleveland Clinic system. It is a big problem, especially for the clinic's many patients who spend winters in Florida or Arizona, where they see other doctors.

Adding Google's technology lets patients jump from their MyChart page to a Google account. Once on Google, they'll see the relevant health plans and doctors that also keep electronic medical records. That means the patient can choose to share information between, say, the Arizona doctor and the Cleveland Clinic . . .

UPDATED 2/26/08: Scott Shreeve goes Giga over Google Health. Read his first impressions of the Google PHR after his test drive at HIMSS.

However, Dmitriy at TrustedMD makes some great points, including this quote:

Yet, even with free PHRs out there, consumers simply do not care for spending their time to learn and use them. Who would bother entering and checking their medical records if you are healthy and would rather go see a movie? And once you get sick, you do not want to enter them either. You just want your doctors and hospitals to hand your medical records to you. But you see, the providers have different priorities that a mere piece of software just cannot solve . . . PHRs' real problems are not technical, usability or even privacy. The real problem is consumer and provider motivation . . .

He ends his posts with some questions we should all be discussing. Until we see a reimbursement model that creates incentives for providers to look at more health information and consumers to care about and take an active part in their health -- I'm not sure the PHR/EHR initiatives will fully develop and mature.

Follow the latest news (blog posts) and the Techmeme reaction to the project.

David Harlow's Grand Rounds Gets To the Heart of the Matter

Congrats to fellow health law blogger, David Harlow at HealthBlawg who does a wonderful job weaving together a special Valentine's Day edition of Grand Rounds. David's edition gets to the heart of the matter and includes a wide range of posts - covering the love hormone, the Dead, death from Q-tips, Lupercalia and so much more. Thanks David for including my last minute submission.

AHLA Physicians and Hospital Law Institute

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

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

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

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

Web/Health 2.0 For Dummies

Blogs, wikis, social bookmarking and social networking for dummies courtesy of Pew Trusts' e-patients.net. Simple explanations and visual demonstrations to better understand the basic concepts.

I've watched a couple of these before -- but have not seen a post with them conveniently in one place. Again the power of social networking (e-social improvement courtesy of the grid crowd). Moreover, I didn't really know who produced these short explanatory videos -- check out Common Craft for more videos including on RSS in Plain English.



Hmm . . . I may contact them to help me produce a clip called: Stark Law in Plain English.

Tip to Matthew Holt over at the Health Care Law Blog.

CMS Releases New Physician Self Referral (Stark) FAQs

The Centers for Medicare & Medicaid Services (CMS) recently modified its website and included a new Frequently Asked Questions (FAQ) section under the Physician Self Referral (Stark) section. CMS added 12 new Stark FAQs on January 31, 2008. A number of these new FAQs relate to the new Stark III regulations.

Grand Rounds: Health 2.0 Explosion At Diabetes Mine

Amy Tenderich of Diabetes Mine explores the Health 2.0 Explosion in this week's edition of Grand Rounds, Vol. 4, No 20. If you are interested in health care social networking and health 2.0 topics don't miss reading this week's edition.

Great job Amy!

Hospitals and Anonymous Blogging: An Update of the Paris Regional Medical Center Lawsuit

Just pick up the latest news from Greg Piche of the Holland & Hart Healthcare Law Blog about the pending libel lawsuit against an anonymous blogger filed by Paris Regional Medical Center, a subsidiary of Essent. For some background on the case check out Jeff Drummond's past post Hospital Sues Blogger.

The libel lawsuit filed last year by Paris Regional Medical Center seeks the unmasking of an anonymous blogger and nine other anonymous contributors or commentators on his/her blog.

The hospital sought the identity of the anonymous bloggers from Suddenlink who balked at disclosing the identity of the anonymous blogger until he/she was given notice and an opportunity to object. As a result the anonymous blogger appeared through an attorney and objected which were rejected by the trial court.

However, on appeal to the Court of Appeals for the Sixth Appellate District of Texas at Texarkana, In re: Does 1-10, No. 06-07-00123-CV (Dec 12, 2007) followed the standard set out in Doe. V. Cahill, 884 A 2d 451 (De. 2005), granted the writ of mandamus and ordered the trial court to vacate its order requiring Suddenlink to disclose the name and address of the anonymous blogger. Basically, the court sustained the anonymous bloggers First Amendment rights of free speech until such time as the hopsital can show in a hearing at the trial court level that it has actually been damaged by the content of the blog.

The court analyzed the situation as follows:

The cases that have decided this issue range from placing an extremely light burden (indeed, virtually no burden at all) on the plaintiff, to requiring the plaintiff to tender proof of its allegations that would survive a summary judgment, or even more stringent requirements. At least one case has essentially concluded that the mere allegation of libel is sufficient. Alvis Coatings, Inc. v. John Does One Through Ten, No. 3:04CV374-H, 2004 U.S. Dist. LEXIS 30099 (W.D.N.C. Dec. 2, 2004). Other cases have articulated requirements that are so weak as to essentially require no more than allegations made in good faith (or not in bad faith), with some evidence to support the allegations. See Polito, 2004 Pa. Dist. & Cnty. Dec. LEXIS 340.

We cannot agree that either of these formulations is sufficient to survive any form of constitutional balancing. Thus, the question becomes the degree of actual proof that must be provided before the balance tips in favor of piercing the constitutional shield and disclosing the identity of the anonymous blogger.

We find ourselves more in alignment with the formulations set out in Cahill, 884 A.2d at 458-61. See extensive discussion about the application of this standard in Best W. Int'l, 2006 WL 2091695. The court in Cahill described the test as: "[B]efore a defamation plaintiff can obtain the identity of an anonymous defendant through the compulsory discovery process he must support his defamation claim with facts sufficient to defeat a summary judgment motion." Cahill, 884 A.2d at 460. This standard does not require a plaintiff to prove its case as a matter of undisputed fact, but instead to produce evidence sufficient to create issues that would preclude summary judgment.