Friday, August 25, 2006

West Virgina Medicaid Initiative: Policy Meets Practicalities

David Harlow's HealthBlawg provides very interesting commentary on West Virginia's Medicaid Redesign efforts to implement change to the West Virginia Medicaid program, including pointing out a New England Journal of Medicine article, Personal Responsibility and Physician Responsibility - West Virginia's Medicaid Plan.

The article examines the practical realities of implementing a Medicaid plan that includes implementing consumer driven and patient responsibility components into a program that serves the most vulnerable sector of the West Virginia health care population -- the poor, uneducated, young/aged health consumer. West Virginacategory. The article also raises interesting questions about the role physicians play in the redesigned program and the fact that physicians will be faced with policy and ethical issues under the program changes.

Thursday, August 24, 2006

A little Nick: I'm a liberal and a conservative, that I am as complex as the universe and as simple as a newborn child's cry . . .

Don't miss reading this post by my favorite hospital blogging CEO, Nick Jacobs over at Nick's Blog. Much of what Nick has to say strikes a chord with me and this post is a great example of his creative, optomistic and insightful look at health care and life.

Nick's statement of "everything in moderation" is something that I have heard forever (prize to the first Coffield reader who can cite the originator of this quote) and believe in. It's applicable to everything from diet to politics to work to play.

Just a taste. Enjoy the post:
This week a person called me to criticize me, accuse me of misdeeds because we were supportive of Mr. Murtha, and then he said, "Let me guess, you're a liberal?" The label was placed. (There's a lot of labeling going on in this country right now.) It is my belief that everything is relative. It is my belief that I am a liberal and a conservative, that I am as complex as the universe and as simple as a newborn child's cry.

When I asked my critic why he was convinced that the truths that he espoused were accurate, he proudly boasted into the telephone. "I listen to Rush." Let me assure you that "I don't listen to Rush, EVER." Mom always said, "Everything in moderation." Not too Republican. Not too Democrat. Not to fatalistic. Not too utopian.

During an exchange at a board meeting this week, I started a string of comments directed toward my board that went something like this, "We have $750,000 coming from grants, right?" My Foundation Director said, "Yes, maybe," and my Chief Financial Officer said, "It's not here yet." To which our board chairman replied, "Perfect, the Optimist, the Realist and the ACCOUNTANT." The next day we received the first $350,00 of the $750,000. Hah.

Executive Order Impacts Health Care

President Bush signed an Executive Order on August 22 requiring federal agencies to do more to inform public health care consumers about the cost and quality of health care services.

The Executive Order: Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs directly impacts the Defense Department (military health care system), DHHS (Medicare and Medicaid), Office of personnel Management (Federal Employees Health Benefits Program) and Departmetn of Beterans Affairs (VA Health System).

For more information be sure to read the Fact Sheet: Health Care Transparency Empowering Consumers to Save on Quality Care which is linked with the Executive Order. Also, check out the most current discussion via Google News.

Monday, August 14, 2006

The important lesson from sandcastle building

As I return to West Virginia after a week spent at the beach -- this post by Jim Carrol, Futurist, Trends & Innovation Expert, caught my attention. Much of my week on the sand was spent enjoying building sandcastles with my son, daughter and our friend's two children. All ranged in age from 2 to 6. I love the creative side of sandcastle building -- more so than most adults, I think. Jim's post titled, Why innovation thrives in sandcastle building," hit the mark for me.

I was also intrigued by Jim's recent comments on the 10 major health care and pharmaceutical trends. I'm not a regular reader of Jim's blog but have now added it to my RSS reader.

Thanks to Denise Howell for pointing me to this post. Don't move on until you click on the "sandcastle link" above highlighting some amazing sandcastle construction courtesy of Flickr.

Sunday, August 13, 2006

Topsail Beach and Web 2.0

I've been off the grid for most of the week while spending time with my family and good friends at Topsail Beach, NC. Our family's first time at Topsail -- what a great beach community. The web access was limited but luckily I had my new Blackberry 8700c (I finally broke down and got a blackberry to give it a try) which allowed us to get to the grid to look up vital information like "how to skimboard."

On our way back to WV we are spending a few days in Chapel Hill with family and I'm now catching up with some backlogged grid reading. Coincidently one of the posts I read was by Matt Ballard, another West Virginia blogger who specializes in economic development for the Charleston Area Alliance. His post, "Trip to North Carolina Leads to Flickr Encounter," highlights and my finding it (and commenting) while in Chapel Hill further highlight in simple terms the powers of the new web 2.0 interaction and communication.

In conversation I often talk about the new people focused technology and what it means over the coming years. This new technology has been referred to as Web 2.0.

As a good starting point, Mike Arrington at TechCrunch has put together a 24 minute documentary on "What is Web 2.0?"

Tuesday, August 01, 2006

Interesting Statistic: Online Social Networking and the Health Care Industry

"Among 21 year olds, 61% of web content created by someone they know."

Interesting stat courtesy of Denise Howell's attendance at Always On 2006. Interesting because I find myself more and more attracted to websites, blogs and other online content created by individuals I know or have met. This stat supports discussions with my nieces and nephews (all 20 somethings) who have grown up with and are more comfortable with online social networking including, text messaging, facebook, MySpace, Flickr, YouTube, etc. Interestingly, my 83 year old dad, a retired physician and resident historian of New Martinsville where I grew up, has become a regular on classmates.com sharing old high school stories and family information. This trend will only continue as they move into the workplace and beyond.

I'm interested in watching thie impact that online social networking will have on the delivery of health care in the United States. This is made all the more interesting by the aging baby boomers who are quickly moving into the largest users of health care (aka pig in python concept). For example:
  • More doctors and patients blogging
  • Online direct communication between patient and provider
  • Network aggregation of treatment information
  • Online support and communities of patients with specific diseases and the providers who treat them
  • Podcasting health information and medical advice
  • Videocasting health education or training for health care professionals
Scoble is on the same track with his recent comment that it's humans who optimize the web. He comments:

When I search on “Office Furniture” why is the first thing I see stores? I don’t wanna see freaking corporate info. I wanna know what HUMANS like to use in their offices. . . None of the big search companies have figured out that it’s the humans who “optimize” the Web. . . I’ll be looking for who lets me get to the other humans the fastest.
The younger generation and others who get it are trending in this direction and the web companies who answer will be the leaders. For another example of the shift in the younger (actually youngest) generation of web users take my 5 year old who yesterday wanted to order a costume for Halloween. Can't be too early for Halloween. He's been driving us crazy this week with an obsession for a particular costume. My wife and I finally collapsed and she asked him whether or not he wanted to call in the order or do it over the web. His response with a slight look of why are you even asking that was, "the internet . . . I want to see the costume." Then he said, "we can just Google it." His selection of web visual content vs. static telepphone audio struck me as interesting. This is the same 5 year old who who earlier this year we watch pull a Peter Pan video down and type in the words P-E-T-E-R-P-A-N from the cover into Google. He knew what he wanted even though he couldn't yet spell it out.

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Healthcare Blogging Summit 2006

For those readers who are health care bloggers or interested in becoming a health care blogger or better understanding the impact of blogging on the health care industy you may want to plan to attend the Healthcare Blogging Summit 2006 scheduled for December 11th in D.C. The event is being held in conjunction with the Consumer Health World conference.

The event is the brainchild of Dmitriy Kruglyak of The Medical Blog Network. The summit looks like it will be a great event based on the speakers lined up for various panel discussions. I plan to try to attend and meet in person some of the health bloggers I've communicated with.

If you blog on health care industry related topics take time and complete a survey being conducted by The Medical Blog Network and Envision Solutions called Taking The Pulse Of The Healthcare Blogosphere. The results will be released and discussed at the Healthcare Blogging Summit and should provide the first organized look at the state of the healthcare blogging community.

HITSpere: A Network of Healtcare IT Blogs

If you are interested in the latest on health care, medical and clinical information technology be sure to check out HITSphere, a network of healthcare IT blogs including my Health Care Law Blog.

HITSphere was founded and is managed by Shahid Shah who blogs at as The Healthcare IT Guy. Shahid describes the HITSphere as a healthcare IT blogoshpere launching pad where health IT blogs are aggregated and the HITSphere community that he is putting together can help bring out in the open the myriad problems in healthcare IT in a way that transcends technology.

Grand Rounds 2.45: Inside Surgery

Grand Rounds 2.45 is up at Inside Surgery.

I especially enjoyed reading long summer night by About a Nurse which provides a glimpse into the therapeutic nature and use of blogs by health care professionals. As a health lawyer I was struck by the implications posting about health care situations and how these conversations might ultimately make their way to court. I've yet to see a professional negligence case or a breach of privacy claim involving a health care practitioner who blogs about the event and then is either sued or called to testify -- but I am sure that day is coming.

Monday, July 31, 2006

Blawg Review #68: Jeremy Blachman

Blawg Review #68 is up at Jeremy Blachman's Brand New Weblog (aaka* Anonymous Lawyer and aka Jeremy's Weblog). Enjoy the week's best posts from the legal blawg world.

I'm nominating Jeremy for the Guinness World Record blawg category of "most law blogs owned and maintained by one person".

* aaka "also anonymously known as"

HR 4157: Health Information Technology Promotion Act of 2006

HR 4157, the Health Information Technology Promotion Act of 2006, was passed by the House on July 27, 2006. The bill promotes the use of health information technology to improve the safety and quality of the nation’s healthcare system.

Important to those groups, including West Virginia, looking at the barriers to health information technology adoption under the RTI funded Health Information Security & Privacy Collaborative (HISPC) is language requiring DHHS to study the impact of variation between state security and confidentiality laws and federal security andconfidentiality standards.

The legislation requires DHHS to report back to Congress within eighteen months whether “there is a need for greater commonality of the requirements of State security and confidentiality laws and current Federal security and confidentiality standards to better protect, strengthen, or otherwise improve the secure, confidential, and timely exchange of health information among States, the Federal government, and public and private entities.”

Also, the legislation calls for statutory exceptions in the Stark law (federal physician self-referral) and safe harbors to the Anti-Kickback Statute that would allow hospitals to supply physicians with HIT software and hardware used for the electronic exchange of clinical health information. Also, the bill requires adoption of International Classification Diseases (ICD)-10 codes sets by October 1, 2010.

The summary (as introduced) reads as follows:

SUMMARY AS OF:
10/27/2005--Introduced.

Health Information Technology Promotion Act of 2005 - Amends the Public Health Service Act to add a new title II part D (Health Information Technology).

Establishes within the Department of Health and Human Services an Office of the National Coordinator for Health Information Technology.

Directs the National Coordinator to: (1) maintain, direct, and oversee the continuous improvement of a strategic plan to guide the nationwide implementation of interoperable health information in both the public and private health care sectors; and (2) serve as the coordinator of federal government activities relating to health information technology.

Prescribes conditions under which any nonmonetary remuneration (in the form of health information technology and related training services) made by a hospital or a critical access hospital to a physician shall not be considered a prohibited payment (subject to civil and criminal penalties) made as an inducement to reduce or limit services to certain individuals.

Directs the Secretary of Health and Human Services to study and report to Congress on whether pertinent state laws and current federal standards should be conformed to create a single set of national standards to preserve and protect the security and confidentality of patient health information.

Amends SSA title XI to provide for establishment of uniform confidentality and security standards with respect to individually identifiiable patient health information.

Directs the Secretary to: (1) promulgate a final rule for upgrading specified Accredited Standards Committee X12 (ASC X12) and National Council For Prescription Drug Programs (NCPDP) Telecommunications standards and International Statistical Classification of Diseases and Related Health Problems, 9th revision, Clinical Modification (ICD-9-CM) codes; and (2) develop a strategic plan related to the need for coordination in the area of health information technology.

Wednesday, July 26, 2006

2005 Statistics on Physician Use of EHRs



Statistics on the use of electronic health record systems by office based physicians courtesy of iHealthBeat and a report by the National Center for Health Statistics.

The chart shows an increase in usage from approximately 18% in 2001 to 24% in 2005. Interestingly, the use varies among regions with the Northeast at 14.4% as compared to the West at 33.4%.

A recent report issued by the Healthcare Financial Management Association, "Overcoming Barriers to Electronic Health Record Adoption," provides more statistics on the adoption and barriers faced by the health care industry.

E-prescribing: privacy & security vs. lower cost & reduced errors

A tale of e-prescribing data breach courtesy of Instapundit. More on the e-prescribing breach and the suspension of the program at Georgetown University Hospital from iHealthBeat.

Alternatively, see this iHealthBeat report on a commitment by the auto manufacturers (Ford, Chrysler and GM) to continue support for an e-prescribing systemby pledging $1M.

Thursday, July 20, 2006

West Virginia E-Health Initiative Update

The West Virginia State Journal online edition provides an update of West Virginia's efforts to implement a statewide electronic medical records system.

The 2006 Legislature passed legislation creating the West Virginia Health Information Network responsible for guiding and overseeing West Virginia's efforts to coordinate and implement a private/public interoperable health information system. Governor Manchin has named Dr. Julian Bailes, chairman of WVU's Department of Neurosurgery as chairman of the Network.

Wednesday, July 19, 2006

Pew Study: Blog Stats

While on the topic of stats -- check out these interesting stats on the state of blogs from a recent Pew Survey. Courtesy of Yahoo News and Reuters.

Denise Howell, Reed Smith and the Blawg Effect

Robert Ambrogi at Inside Opinions: Legal Blogs raises many of the questions I've been thinking about over the last few days after learning about the separation of Denise Howell from Reed Smith. I first learned about the separation after reading the Aussie version of Blawg Review #66 (evidence that news travels quickly these days).

Prompted by Craig William's post, "Neo, Did you see that ripple in the Internet?," and other posts about the departure of Denise Howell from Reed Smith, I thought it would be interesting to provide some statistics (see below). Kevin O'Keefe at LexBlog reports that Reed Smith internet discussion is up 50%. Time will tell as to the overall impact (positive or negative) of the decisions made by Reed Smith and Denise. Do the stats below tell us anything? The stats reflect the first wave of interest in the news. It doesn't show us the lasting effect or the overall impact. It's also interesting to look at the stats over a longer period -- the Technorati charts below only show 30 days. Looking at the stats over a longer period of time makes this incident appear as more of a "blip."

My followup post from last week to Adam Smith Esq. post, "Are you making your times, or are they making you?" is more relevant now as we look at the decisions made by the parties. I would place Denise in the same category. She is a person who "makes the time" rather than being created by the time. Having a feeling of connection to both Denise and Greg Jordan I wish both Denise and Reed Smith success in the future.

Like no time ever before, the blogosphere (blawgoshere or bobbersphere) and electronic social networking allow for the quick sharing and discussion of opinions on a global scale. It simply amazes me everyday. The action taken by both parties and the resulting online dialogue in this case is but one example.

Update: A followup post by Kevin O'Keefe at LexBlog mentioning an article from the UK's Lawyer, "Reed Smith launches women's career forum and sacks female blogger."


Technorati stats:

Posts that contain "Reed Smith" per day for the last 30 days.
Technorati Chart
Get your own chart!

Posts that contain "Denise Howell" per day for the last 30 days.
Technorati Chart
Get your own chart!

Posts that contain "Denise Howell" And "Reed Smith" per day for the last 30 days.
Technorati Chart
Get your own chart!

Posts that contain "Denise Howell" Fired "Reed Smith" per day for the last 30 days.
Technorati Chart
Get your own chart!


Google statistics as of 7/19/2006:

Search of "Reed Smith" law 1,220,00 hits.

Search of "Denise Howell" 490,000 hits.

Search of "Denise Howell" and "Reed Smith" 690 hits.

Search of "Denise Howell" fired "Reed Smith" 154 hits.

Tags: Howell, Bag and Baggage, Reed Smith, blawg

Tuesday, July 18, 2006

New Medical Blog By Senator Frist

Senator Bill Frist has announced a new medical blog called MedicalMatters.org: a 21st Century Discussion of Health Care Issues.

According to the inaugural post:

MedicalMatters.org is a blog about health care and the politics of health care. In the coming days and weeks we will discuss stem cells, avian flu, electronic medical records, Health Savings Accounts, and much more. We will take a long term look at some of the health care challenges facing the country and start an online discussion encouraging different points of view. I will blog regularly as will 10-12 regular bloggers from a variety of health care-related fields. We will also encourage high profile, guest bloggers to join the discussion.

I'll be interested to watch the posts on this new health/medical blog. Based on the volume of comments already being submitted to the blog -- it should provide a lively debate on health care in the U.S.

I did leave a comment that the blog needs to incorporate RSS.

Tip to Instapundit.

Friday, July 14, 2006

Update on West Virginia's Participation in Health Information Security & Privacy Collaborative Project

Over the past few months I have had the opportunity to participate in the Legal Working Group of the Health Information Security & Privacy Collaborative (HISPC) being co-managed by the West Virginia Health Care Authority and West Virginia Medical Institute.

Following is an AP press release on the current status of the grant project in West Virginia which involves looking at the current barriers in West Virginia (legal, practical and otherwise) faced by health care providers as they work to move toward an interoperable health information system. Similar projects are occuring in various states and all of the information will then be combined to get a national perspective on the barriers.

The following article has appeared in Modern Healthcare and the local newspapers. It is my understanding that a more detailed article will appear in the State Journal in the coming weeks. For more information on the project you can check out WVMI HISPC website.
W.Va. agencies seek to protect privacy on state network
Being able to access personal medical information electronically might sound a little scary to some patients and healthcare providers. That's why the West Virginia Health Care Authority and the West Virginia Medical Institute are being asked to review existing privacy and security policies and regulations and business practices within the healthcare industry.

The agencies will be consulting with members of the medical community and consumers, trying to figure out how to protect patient confidentiality as they prepare to launch a statewide network containing medical histories, test results and other medical information.

With a patient's consent, that information would be electronically available to any medical provider in the state. In addition to creating the public-private network, a new state law passed earlier this year would allow secure electronic consultations between doctors and patients.

The West Virginia authority will be appointing a board of directors later this summer to plan and implement the statewide network.

Last month, West Virginia University Hospital and University Health Associates signed a contract for a $40 million information technology system that streamlines record-keeping and record-sharing at the Physicians Office Center, WVU Cheat Lake Physicians office and the WVU Harpers Ferry Family Medicine Center. It also consolidates several systems at Ruby Memorial Hospital, WVU Children's Hospital and Chestnut Ridge Hospital.

Thursday, July 13, 2006

West Virginia Hospital For Sale

Today's Charleston Daily Mail is reporting that St. Francis Hospital in Charleston and St. Joseph's Hospital in Parkersburg are again up for sale and according to the Daily Mail's sources the hospitals bids for the facilities are due on Friday. The article cites a recent article in Modern Healthcare about the sale of the four hospitals by HCA to Lifepoint.

In the June 30, 2006, new release by Lifepoint Hopsitals it was announced that St. Francis and St. Joseph's Hospital were classified as assets held for sale.

Google Health Portal

I've notice word circulating about a Google Health portal referred to as Google Health Scrapbook or M Scrapbook. Although I've expected Google's involvment in the health care industry sector, it will be interesting to watch Google approach on providing service to patients/customers, providers and others in the health care industry.

Thanks to the Wired General Counsel for the tip.