Happy Holidays!

Happy Holidays to all my regular readers! Wishing you, your family and friends the best over the holidays.

A Coffield family tradition is painting Christmas cookies each year. It all started with an incredible women and family neighbor, Mrs. Martin, who lived into her 100s. Mrs. Martin collected cookie cutters (and I mean collected). Most draws in her kitchen were full of cookie cutters from around the world. Each year she would invite all the neighbor kids into her house to paint cookies with brushes and decorate them with what now seems like hundreds of toppings. A wonderful childhood experience. Watching it now with my own children and others who happen to stumble into the event is the way it brings out the creativity of people. Below are a few photos of this years artwork.

WVHCA Grants Motion to Dissolve Stay in Manor Care CON

Yesterday the West Virginia Health Care Authority issued an Order Dissolving Stay. The Order granted MCHCR's (Carlyle Group) Motion to Dissolve Stay but denied the Motion to Affirm the Initial CON Decision.

The Authority set January 7 as the date for initial briefs to be submitted by both parties as a result of the Reconsideration Hearing held on December 14.

Support The Mountaineers!

The last week has been tough for all West Virginians with the untimely departure of Rich Rodriguez for what he believes is greener grass in Michigan.

Today I got the email below from my partner and friend, Chris Brumley, loyal Mountaineer Fan and all around good guy.

He is heading up a grassroots effort to allow all Mountaineer Fans to show their support for the players and the program and do something great for kids in the Glendale, Arizona area. UPDATE: Chris has made arrangements with the Boys & Girls Clubs of Metropolitan Phoenix who are planning a field trip to the game. The WVU Athletic Department has agreed to allow a purchase of block seats so the kids can sit together. Also, in the works are gold t-shirts to be donated.

Think back to the first time you got to go to (old or new) Mountaineer Stadium and watch the Mountaineers. Think about giving that experience away to a kid in Arizona. Photo to the right is my son's first trip to watch the Mountaineers in 2003.

Good luck to the Mountaineer players and remaining coaches (Bill Stewart, who hails from my hometown of New Martinsville has admirably stepped in to lead the Mountaineers).

After reading the message below if you are interested in supporting the effort by buying a ticket please notify me at RCoffield@fsblaw.com or Chris via email at CBrumley@fsblaw.com. Send your check written to: Chris Brumley, 200 Capitol Street, Charleston, WV 25338. Deadline to notify via email is December 27. Chris has arranged with Boys & Girls Club to get an acknowledgment letter and will do a follow up donor letter to each donor to acknowledge their donation for tax purposes.

I will periodically update the number of ticket sponsored here - so check back:
12/21 @ 7:30am: 55
12/21 @ 12 noon: 65
12/22 @ 12 noon: 92
12/26 @ 12 noon: 98

12/27 @ 12 noon (final count): 128 tickets have been donated to the Phoenix Metropolitan Boys and Girls Club, with Gold T-Shirts to match. The donation is equivalent to a cash donation of more than $17,500.00. Way to go WVU fans!

Hello Everyone:

This email is an invitation. It is inspired by a friend of mine, Paul White, who every year at this time takes the opportunity, and dedicates his time, to benefiting others during the holiday season by coordinating a donation effort to the less fortunate. This is also a solicitation and it is not intended to distract from Paul’s charitable efforts whatsoever, and if you are not interested please do not rely as I sent this out to most every email address I have!!!!

As I have watched the last week unfold, and our football program and State take a severe hit with the Rich Rod/WVU debacle, I almost forgot about the players and the program that are most affected by all the turmoil. Obviously, these negative events have taken away from the successes of this season, the program, and the enjoyment of a BCS bowl game. With that said, it is not too late. While I doubt anyone is going to travel to the Fiesta Bowl that was not planning to before these events, we can still provide the support that WVU fans have become so renown for, and do something good for the less fortunate.

I am willing to coordinate and propose the following:

1. I propose that everyone that can email me back and pledge to buy One ticket to the bowl game through the university. ( I think they are $135 per tix, feel free to buy more if you like, I will also accept ½ tix donations and match them up, that’s $67.50 for the math impaired)

2. I will fund the purchase and collect the $ from each person individually.

3. We will donate the tickets we purchase to boy/girls clubs or other worthy charities in the area so they can attend the game. (I have family there that can identify charities, but anyone that knows of a worthy charitable group please suggest).

4. I will follow up with a letter to each person noting their purchase and subsequent donation to the charity by letter.

This is the best way I can think of to support this team, WVU, and the less fortunate during the Holiday Season, all in one act. So if you choose to, email me back and I will out the coordination into this effort. Please do not reply to this unless you are in since I sent it to most everyone on my email list and my blackberry cannot take the traffic. Also, feel free to fw this to anyone you think may be interested.

Lets Bring on the Mountaineers!!!!!!

Thanks to my fellow WV bloggers for the linking to the post and spreading the word:

• This Is Not My Blog
• Marketing Genius from Maple Creative

WV Chamber of Commerce President Calls for EHRs

In yesterday's Charleston Daily Mail, Steve Roberts, president of the West Virginia Chamber of Commerce, was quoted as calling for a statewide electronic health record system to reduce health care costs and increase the value of care.

The full article, Chamber of Commerce promotes electronic record-keeping, can be read via the Charleston Daily Mail.

For more information on the State Chamber's position check out the Chamber's 2008 Policy Paper on Health Information Technology.

Lights, Camera, Action . . . Health 2.0

Matthew Holt of The Health Care Blog sent me a message that they are close to announcing the agenda for the March 2008 Health 2.0 Spring Fling in San Diego. In preparation for the conference the planners are out seeking real life examples of Health 2.0 technologies in action.

Below is Matthew's summary of the panel format and information on how you can participate or help to locate someone using health 2.0 type technology to improve the every day care of their patients.

I plan to submit some suggestions of a couple of West Virginia providers for the Health 2.0 team to check out. If you know of someone who might fit the mold for connecting consumers to providers -- please leave a comment or send an email directly to John at the email listed below.

We are excited to announce a new panel format at our Spring Health 2.0 conference, "Connecting Consumers and Providers" in San Diego on March 3-4, 2008. In addition to spotlighting demos and reactions from industry experts, we will be capturing the user-experience of people living with health conditions as they use Health 2.0 technologies in their everyday lives.

Has the web changed your life? Does it help you deal with the isolation of a condition or improve your quality of life in some other way? We are looking for a few good consumers/patients to feature live on stage or in a video segment. Our roving video crew will be traveling the country to document interesting real-life stories showing how Health 2.0 impacts both people and the health care system.

And for those of you budding videographers, we are also accepting user-generated video clips that show how you are using Health 2.0 technologies in your daily life. Maybe it's an active online community where you've found support, a portable medical device, an online tracking tool, a blog, a video game, a virtual world, or some combination of the above. If you have something to say, we'd love to hear about it so we can help you share your stories with your peers and other members of the Health 2.0 community. We welcome you to join the conversation with some of the most progressive minds in health care including consumers, health providers, technologists and entrepreneurs. If you are a physician using health 2.0 technologies to connect with your patients or if you know of patients for whom technology has made a real difference, please drop us a line.

Email John our resident Health 2.0 web guru/talent scout at john@health2con.com.

Health Wonk Review - December 13

Check out the final 2007 edition of Health Wonk Review, a round up of the best health policy blog posts, hosted by fellow health law blogger, David Harlow at HealthBlawg.

Check out the Health Wonk Review blog for more information on how to be a host.

Physician Liability: Was Accident Foreseeable By Treating Physician?

A colleague pointed out this WSJ Law Blog post via the WSJ Health Blog reporting on a ruling made by the Massachusetts's Supreme Judicial Court. The ruling found a physician liable for failing to warn his patient about the side effects of the medications and the potential danger of driving while taking them.

The Boston Globe reports on the case and a copy of the slip opinion in the decision of Lyn-Ann Coombes, administratix v. Roland J. Florio, SJC-09869 December 10, 2007 can be found on the Supreme Judicial Court of Massachusetts decision website.

Although I have not had a chance to read the full opinion, the legal question that comes to mind (and which depends upon the facts in each case) is whether it was foreseeable by the physician that the patient (tortfeasor driver) was likely to have an accident? Remember Palsgraff? Was a duty owed and how broad should that duty be?

The blog post indicates that Justice Cordy's dissent states that the ruling "introduces a new audience to which the physician must attend -- everyone who might come in contact with the patient."

HealthBlog by Bill Crounse, MD

HealthBlog by Bill Crounse, MD, a new (at least to me) health care IT blog to follow. Dr. Crounse is the Worldwide Health Director for Microsoft. I've added HealthBlog to my RSS reader and look forward to the great green content being generated by Dr. Crounse.

I picked up a reference to HealthBlog via a post by Jay Parkinson, MD giving his impression of the opening keynote address and morning session at the World Healthcare Innovation and IT Congress in Washington, D.C. (Dr. Crounse's comments include a summary of Kevin Kelly's keynote on mega trends: Global, You, Do and Open).

Kibbee/Markle: Exploration of Consumer Access to Networked Health Information

Dr. David Kibbee provides great insight on the meeting by the Markle Foundation and what it might mean for Health 2.0, consumer driven health care and how health data is managed by traditional health care providers and payors. Well worth the read for anyone interested in where health information might be headed.

I look forward to reading the public policy document cited in his post, Consumer Access Practices for Networked Health Information." Dr. Kibbee hits on a point that I continue to explore from a legal perspective. He makes the statement:

Markle has lifted the discussion onto another level, and this time it's about health data, its ownership and rules of access, and its uses in our nation to promote health and wellness.

We are in the midst of a wave of change in the ownership rights of health information and data. Traditionally (and legally) we have viewed health data as owned/controlled by one group or another (what Dr. Kibbee refers to as the institutional custodians). For example, physician/hospital who owns the patient's paper medical record or insurer who own beneficiaries payment/claims information.

Typical state law support such ownership notions. Most state laws provide you and I as patients the right to copy our records. Some states go as far as providing you and I a right of access. However, to my knowledge no state law takes the alternative approach of the patient owning the records and providing access rights. Most state laws, if not all, base the ownership right on the originator or creator of the medical record. Even the HIPAA privacy rule that evolved to its present state in the late 1990s and early 2000s speaks in terms of a patient's "right to copy" and "right access to records". At no point does it speak of patient's ownership of the records.

Our legal system have very strong views on "ownership" rights. In fact ownership is a basis legal premise build into the fabric of everything we do. With ownership comes notions of control, propriety nature, privacy, competition and power (financially and otherwise). I subscribe that this foundation has largely been the reason we have yet to see integration, standardization and openness of health data exchange. Dr. Kibbee gets at this question in his post when he discusses the spirited debate during the Markle conference surrounding the question of how to "liberate" personal health information.

Dr. Kibbee also gets into the difficult questions that I am constantly struggling with regarding privacy (how much is too much and how much is not enough) and introduces the concept of "fair information practices". Balance between a patient/consumers right to control access to health information, need for access by health care professionals, reasonable protections to prohibit the breach of data, rights of governments to access/use data for particular purposes, etc.

In reacting to Dr. Kibbee's worries that physicians are not embracing the change -- I suspect this is largely due to the current reimbursement system that we have created to pay for health care. My view is that until this reimbursement model changes to create financial incentives for wellness and management of chronic disease it will be difficult to bring about change via the physicians.

These are my initial reactions (stream of consciousness) after having read Dr. Kibbee's very insightful and thought provoking post. I hope to have a chance to come back and think some more about his post and my reaction.

Business Blogging Features in Sunday Gazette-Mail

Last week's Sunday Gazette-Mail featured an article, Blogging for Dollars: talky web journals keep customers in the loop, providing insight into some local business bloggers. I want to thank the reporter, Sarah Winn, for contacting me and allowing me the opportunity to be interviewed for the article.

The article featured my Health Care Law Blog along with these other West Virginia based business blogs:

Just A Modern Guy by Chuck Hamsher of The Purple Moon Marketing Genius from Maple Creative Direct Online Marketing Jason Keeling and A Better West Virginia

It was nice to be featured along with these great blogs. The draw back of such an article is that you can't cover all the great West Virginia blogs that are available. For more check out the follow up comments by Skip Lineberg at Maple Creative and Paul at Direct Online Marketing.

As a result of Justin Seibert's comment to this post I thought I would share a link to a resource over at This is not my blog that includes a good comprehensive list of West Virginia blogs (over 200). He also cites the blog roll at Lincoln Walks at Midnight as also having a comprehensive list of West Virginia blogs.

Photo: Marketing and public-relations professionals Skip Lineberg of Maple Creative LLC and Jason Keeling of Keeling Strategic Communications LLC discuss blogging at the recent Create WV conference at Stonewall Resort. Each writes a blog and says his online journal has become a business tool.

Governor Manchin Rejects New Certificate of Need CT Standards

Eric Eyre reports in today's Sunday Gazette-Mail that Governor Manchin has rejected the proposed new Certificate of Need CT Standards approved by the West Virginia Health Care Authority last month.

The article indicates Governor Manchin sent a letter to the Authority's Board on Friday, December 7, asking that they re-examine the imaging equipment proposal and submit a revised plan. The article also indicates that Governor Manchin rejected the proposed new standards on the basis that the standards did not require physicians to accept low income patients.

For more background on the proposed new standards see my previous posts - here and here.

UPDATE (12/10/07): Governor Manchin's December 7, 2007 letter to the WVHCA.

UPDATE (1/26/08): On January 18, 2008, Governor Manchin approved the Authority's revisions to the Certificate of Need Computed Tomography Services Standards.

WVHCA Reconsiders HCR Manor Care CON

The State Journal provides background on the pending reconsideration hearing set for December 14, 2007 (9am), before the the West Virginia Health Care Authority regarding the Authority's granting of a certificate of need for the $6.3 billion buyout of HCR Manor Care by The Carlyle Group, a private global investment firm.

The Authority granted HCR Manor Care a certificate of need on October 19, 2007, however, on November 15 the Service Employees International Union Local 1199 filed a Request for Reconsideration with the Authority along with an Appeal to the Office of Judges.

On November 20, the Authority issued its Decision on Request for Reconsideration granting the reconsideration and ordering a stay of its October 19, 2007 decision pending resolution of the request for reconsideration.

UPDATE (12/10/07): Jeff Mehalic at the West Virginia Business Litigation blog picks up on my post and includes uploaded links of some of the CON pleadings in the matter, including the:

• Authority's October 19, 2007 CON Decision approving the merger between Manor Care and Carlyle Group
  
• SEIU District 1199's Request for Reconsideration
• the Authority's Decision on Request for Reconsideration granting reconsideration, a hearing on the reconsideration and a stay of its October 19 Decision and
  
• the Amended Notice of Administrative Hearing set for December 14.

Thanks to Jeff for the link and for uploading some of the key public documents in this pending certificate of need matter.

Revolution Health Expanding . . .

iHealthBeat reports via the Washington Post that Revolution Health is expanding its online health business by acquiring HealthTalk, a site focused on chronic conditions, and an investment in SparklePeople, a web site offering diet/exercise advice and ideas.

Case says in the Washington Post article:

. . . We are building a platform that reaches the largest possible audience, and in the process want to build the largest health brand from a consumer standpoint," said Revolution founder Steve Case. "Consumerism is going to become a driver in health care, which represents $2 trillion, or one-sixth of the economy. That segment is ripe for disruption, and the key disrupting force is consumers . . .

The article indicates that:

Based on October data compiled by comScore, an Internet market research firm, Revolution Health drew 105 million page views, while SparkPeople had 84 million and HealthTalk had 8 million, for a total of 197 million, Revolution Health spokesperson Brad Burns said.

Give One Get One: Tech It Forward . . .

I like the concept behind the movie, Pay It Forward. Why not "Tech It Forward."

Looking for a unique holiday gift? Why not buy and give an XO Laptop through the Give One Get One program. Take a moment and think about how much you use your computer and the power it gives you to work, learn, think, communicate and so on . . .

The computer and concept of getting compters in the hands of children around the world is the brainchild of Professor Nicholas Negroponte of MIT. You have options: giving one or more ($200 each one tax-deductible), give 1 and get 1 (still get the tax deduction for 1/2 the price) or give many and designate where they go in the world.

For more information about the program and a review of the XO Laptop check out this NYT article, Laptop With a Mission Widens Its Audience.

UPDATE: Denise Howell has similar holiday thoughts for a tech stocking stuffer with a link to the tech uproar on This Week in Tech.

Health 2.0 In Action . . .

While catching up on my RSS feeds this evening a ran across a couple of interesting posts showing Health 2.0 in action.

The first takes you on a tour through the eyes of a new diabetic from Richard MacManus at Read/WriteWeb.

The second, I would suggest you bring at least fifty bucks, from Page Thompson over at change:healthcare takes a look into the dark and humorous world of the costs for strep tests.

The third example comes from Dr. Parkinson's new (old) approach to providing care through technology and house calls. A while ago he mentioned in a post (Food Photography) his approach to helping a patient with weight and obesity problems. This recent Chicago Tribune article again mentions his simple but effective approach to monitoring his patients food intake using Flickr. In the Q/A Dr. Parkinson explains his approach:

Q. How do you treat obesity?
A. I use the Internet as much as possible. I use Web sites like sparkpeople.com or weightwatchers.com to help patients understand how much they eat. I encourage them to start a flickr account to post photos of what and how much they eat. I can comment on portion size, fat content, etc. Having a visual record of all of the food you eat is quite powerful. I calculate how many calories they should take in to lose weight by a certain date. I do frequent follow-ups via IM or e-mail to see how they are doing and to let them know that there is one other person in the world who cares and supports them. My role is that of informative coach.

(Note: This approach to fighting and changing his patient's eating/weight problems reminded me of a modern version of what I saw my dad, a West Virginia country doctor, did on a regular basis when we went out to dinner. We would inevitably run across one or more of his patients and their families. His patients (especially those who I suspect he had advised they needed to lose weight and exercise more) would sheepishly look at their plates piled high and offer excuses of why they were eating so much or didn't have more greens and vegetables on their plate. I've got to believe this daily monitoring by the physician will help to change the patient's approach to eating -- the patient become accountable every day.)

As Health 2.0 matures we are seeing health consumers and those involved in the process (and business) of changing health care through technology and social health networking giving us concrete example of what might be possible. This wasn't around a year ago when I started down the path of trying to understand, grasp and apply health 2.0 thinking to the industry. Examples like these are moving us from concept to reality.

The Health 2.0 Spring Fling follow up conference set for March 3-4, 2008 in San Diego should bring us more concrete examples of how real people are using Health 2.0 technologies to drive change. Matthew Holt summarizes the approach to the conference as follows:

In the annual Health 2.0 event last September we heard from leading edge companies. The Spring Fling will be smaller and more intimate, and it will be themed around the experience of actual users. It will also explore a specific topic in more depth. This Spring, we will focus on consumers & providers connecting using Health2.0 tools and technologies.

Here is just a peek at what you can expect at Health 2.0 Connecting Consumers & Providers

In the months preceding the event, we will send camera crews out to follow real-life patients and providers using Health 2.0 technologies. With input from industrial designers and experts in ethnographic research, we will bring you experiences from the front-line delivered over video at the event.

On stage, interspersed with the videos, we’ll have real patients and physicians discussing their experiences using Health2.0 technologies. We’ll also be hearing from health care luminaries and technology companies pushing the limits of communities, tools, and search.

While you are at change: healthcare don't miss Christopher Parks current post adding his own perspective on meeting Bill Frist and follow up on Adam Bosworth's thoughts on the Aspen Institute health conference. Christopher is at the heart of the change going on and has insight on the practical realities where others may not. The statistics on the costs of health care if we continue the current path are unfathomable. Without real change focused on preventative care, chronic disease management and simple things like getting Americans to eat less (and better) the system will break.

A Lesson For All West Virginia Expatriates: Country Road Less Traveled

Rodriquez is running to Michigan for the $$$ and prestige. Sad ending to his career here in West Virginia. The Detroit Free Press writes:

Rodriguez had a 10-minute meeting with his team early this afternoon, told the 11th-ranked Mountaineers that he was leaving for Michigan and went back to his office, according to West Virginia media reports.

His players had little comment but looked downtrodden.

Nice story about Coach Rodriquez decision from Dan Wetzel, Yahoo Sports. A story that all West Virginia expatriates should read. A story of recognizing the benefits of staying home (or coming home) and making great things happen here.

Congratulations to Coach Rodriquez, Coach Stewart (a native of my hometown of New Martinsville), Coach Casteel (a native of Paden City just down the road from New Martinsville), the rest of the coaching staff and all the Mountaineer players on a great win Saturday over Connecticut.

Good luck the West Virginia Mountaineers this coming week against Pitt in the Backyard Brawl. Here is hoping that Pat White and the rest of the Mountaineers take the growl out of the Panthers and head toward New Orleans. My favorite Pat White video from the 2007 edition of the Backyard Brawl in Pittsburgh. BEAT PITT!



Note: Wondering whether Dan Wetzel is from West Virginia and related to the namesake of the county where I grew up, Wetzel County, made famous by the great Indian fighter, Lewis Wetzel. My Coffield family actually traveled to West Virginia (then Virginia) in the mid 1700s with the Wetzel family who settled in what is now Marshall County. One of my distant relatives married Martin Wetzel, Lewis' older brother.

Thanksgiving Traditions: Turkey, Black Friday, Diet . . .

Clinical Cases and Images looks at the predictability of humans courtesy of Google Trends. Below is an example of the traditions of turkey (blue), Black Friday (red) and diet (orange). Advice for the holidays from my dad, a retired family physician from Wetzel County, "everything in moderation." Please remember to think about and share with each other why you are thankful. Happy Thanksgiving!

Should Hospitals Blog?

Practical advice from Tony at Hospital Impact on the question of "should hospitals blog?" Good advice for anyone thinking about starting a health related or business blog.

I regularly follow both Nick Jacobs at Nick's Blog and Paul Levy at Running a Hospital cited in Tony's post. Both are examples of extremely successful blogging hospital CEOs who understand the Live Web medium. Take for example the fact that Paul commented on Tony's post four hours after it was published (see the post comments).

I agree with Tony's perspective and warning when he says:

It's a lot of work and there is no hard-core ROI, but for the right type of person, it pays off in other ways. Both of these CEOs can probably point to examples where their blog put out a PR fire before it could start. They've built trust and credibility through the blog. They've humanized the hospital through the blog. So when fires do come (and of course, they will), they're well positioned to engage authentically. We are entering an age where proactive transparency is rewarded and reactive transparency is lame.

One word of warning. Don't blog if your organization:
* Doesn't trust their employees.
* Doesn't want to hear bad news.
* Wants absolute control over their message and reputation (this isn't happening anymore anyways)
* (the kicker) Doesn't have someone who's really wired to do it.

Music From The Mountains: Who was Johnnie B. Good?

West Virginia has always had a rich music history and is still creating a rich musical history through Mountain Stage (and Newsong), Vandalia, Appalachian String Band Music Festival, All Good Music Festival, and from every nook, cranny, hill and holler.

Last week the first annual West Virginia Music Hall of Fame inductions occurred in Charleston. It was a all star night event and all the living inductees made it to the event. In attendance were For more on the inductees check out the Virtual Hall of Fame. Also read the insight from The West Virginia Music Hall of Fame at LA Woman by emcee for the evening and West Virginia native, Ann Magnuson.

Included in the class was pianist, Johnnie Johnson (wikipedia entry)who is considered by many to be the father of rock 'n' roll piano. He played with Chuck Berry and was the inspiration for the classic, "Johnny B. Goode."

Create WV Conference Wrap Up

Due to prior commitments and client demands I wasn't able to attend the Create West Virginia Conference held this week at Stonewall Resort.

Over the past two days I received a number of emails and facebook comments from friends and colleagues about the quality of the content and expressing excitement about the event. If you didn't attend and want to get a flavor for the sessions be sure to check out some of the presentations on the Create WV website and wrap up comments and photos on the Create WV Blog. For more read what other are saying about the conference.

I was particular interested in the presentation by Anthony Salcito, General Manager U.S. Education for Microsoft, after reading the live blogging notes by Lee Kraus who blogs about learning and technology issues out of central West Virginia. Read through Mr. Salcito's presentation for some eye opening facts about what we all face as a result of the growing global community. His slides remind me a bit of the video, Shift Happens - Globalization.

Photo courtesy of one of West Virginia's most creative artists, Charleston Jupiter Hamilton.

WVHCA Issues Proposed Amendments to Cardiac CatheterizationStandards

The West Virginia Health Care Authority issued and approved on November 14, 2007, proposed amendments to the Cardiac Catheterization Standards.

The Notice of Public Comment Period indicates that comments must be submitted to the Authority by December 14, 2007.

WVHCA Approves New Certificate of Need CT Standards

Eric Eyre of the Charleston Gazette reports on the board decision by the West Virginia Health Care Authority approving new Computerized Tomography (CT) Standards under West Virginia's Certificate of Need Program. The proposed standards will now be sent to Governor Manchin for final approval.

Eyre reports:

A state agency cleared the way Wednesday for doctors across West Virginia to put diagnostic imaging equipment in their offices, a move hospital executives predict will drive up health costs and force them to raise rates.

West Virginia Health Care Authority members voted unanimously to approve standards that doctors’ offices must meet before the state allows them to buy and use computed tomography machines, also known as CT scanners.

The authority wrestled with the standards for nearly a year. “We tried to strike a balance between all of the competing interests,” said board chairwoman Sonia Chambers. “We tried to keep the best interests of the citizens of West Virginia in mind.”

The authority plans to send the standards to Gov. Joe Manchin, who has 30 days to give them final approval. . .

For more background information check out my previous post. Additional background information, including comments by various groups on the proposed standards, can be found on the the Authority's CT Services Workgroup Meeting site.

Spread The Word: World Diabetes Day

Fellow health care blogger, Amy Tenderich of Diabetes Mine asked that I help spread the word about National Diabetes Month (November) and World Diabetes Day on November 14. Here is her post, Diabetes Mine: World Diabetes Day Agenda Grows, and Grows...

On November 14 landmarks around the world (including the Empire State Building) will be lighting up using the color of the World Diabetes Day logo.
Why don't we light up something in West Virginia to show support? Why not the WV Capitol?

Why should West Virginians care about this? West Virginia ranks #1 in Adult's with Diabetes in the United States at 11.1% (U.S. Average is 7.4%). For more information check out the WV Diabetes Prevention and Control Program (note: the summary info indicates WV rate in 2006 at 12.1%).

HHS Announces Physician EHR Demo Project

Yesterday HHS announced that CMS will involve physicians in a five year demonstration project encouraging small and medium physician practices to adopt electronic health records.

Excerpt from Secretary Leavitt's announcement:

“This demonstration is designed to show that streamlining health care management with electronic health records will reduce medical errors and improve quality of care for 3.6 million Americans. By linking higher payment to use of EHRs to meet quality measures, we will encourage adoption of health information technology at the community level, where 60 percent of patients receive care,” Secretary Leavitt said. “We also anticipate that EHRs will produce significant savings for Medicare over time by improving quality of care. This is another step in our ongoing effort to become a smart purchaser of health care -- paying for better, rather than simply paying for more.”

Conducted by the Centers for Medicare & Medicaid Services (CMS), the demonstration would be open to participation by up to 1,200 physician practices beginning in the spring. Over a five-year period, the program will provide financial incentives to physician groups using certified EHRs to meet certain clinical quality measures. A bonus will be provided each year based on a physician group’s score on a standardized survey that assesses the specific EHR functions a group employs to support the delivery of care.

The CMS demonstration also will help advance Secretary Leavitt’s efforts to shift health care in the U.S. toward a system based on value. The Department is working to effect change through its Value-Driven Health Care initiative, which is based on Four Cornerstones: interoperable electronic health records, public reporting of provider quality information, public reporting of cost information, and incentives for value comparison.

For more info check out the HHS Press Release.

Thanks to the Medicare Update blog for a tip on this new project.

WV Rolls Out BMI Wheel Project

West Virginia and Unicare rolls out a simple solution to fighting the obesity problem in West Virginia (WV ranks as the #3 heaviest state). The project involves giving West Virginia physicians a small body mass index (BMI) calculator wheel and training in how to use the wheel to recognize obesity earlier, especially in children.

Thanks to Jane Sarasohn-Kahn at Health Populi for the tip on the project.

Grand Stories at Grand Rounds

Don't miss this week's Grand Rounds hosted by Paul Levy of Running a Hospital. Paul's edition focuses on personal experiences by health care bloggers and how it caused them to change their behavior and beliefs.

Take some time today out of your busy schedule and read a couple of the linked stories.

While on the topic of blog carnivals - also check out the latest edition of Medicine 2.0 hosted this week at The Health Wisdom Blog.

Wild and Wonderful West Virginia

First big lions in West Virginia, now bigfoot sightings (more details) in Pennsylvania. The "big lion" sights in West Virginia certainly give new meaning to the motto of "Wild and Wonderful." Here's hoping that it wins the election.



UPDATE (10/31/07):

The votes have been tabulated and West Virginians have overwhelmingly chosen a return to our motto of "Wild, Wonderful." The Governor's Office just released the following press release:

CHARLESTON -- Tabulation of the results from the final round of voting for West Virginia’s official roadway welcome sign was completed this morning and 57.5 percent of the nearly 49,000 West Virginians who voted said they want the state to be known as “Wild, Wonderful,” the governor announced today.

“Wild, Wonderful,” which was on West Virginia’s Interstate highway welcome signs from 1975 until 1991, is the clear winner with 28,046 votes, followed by “Almost Heaven,” with 17,591 votes and “The Mountain State” with 3,120.

Residents cast 41,284 votes using the state’s online voting system, while 7,473 voted by telephone. In total, since the slogan contest was announced Sept. 5, more than 110,000 votes were cast by West Virginians.

“I’m delighted we had such a large number of West Virginians who took the opportunity to choose their favorite slogan,” Manchin said. “I truly want to thank everyone for their participation and for the creative suggestions many provided during the first round of voting. We had a lot of worthy entries, but it is clear that West Virginians love to call this state ‘Wild, Wonderful.’”

The governor now will take the results to the Legislature in January and ask that the members codify the people’s selection so that they can be assured their wishes will be consistently followed. “I look forward to working with the Legislature to make this slogan our official welcome,” he said.

Method of Voting	Wild, Wonderful	Almost Heaven	The Mountain State
Web site	23,653	15,015	2,616
Telephone	4,393	2,576	504
TOTAL VOTES	28,046	17,591	3,120
Grand Total Votes	48,757

New (Old) Physician Models: Dr. Parkinson and Doctokr

If you are interested in Dr. Parkinson's business model check out doctokr (doc-talker) based in Vienna, Virginia. For more what doctokr is and how Alan Dappen, MD. provides his unique service check out about/services.

Thanks to Dr. Val for the referral. I particularly like this quote from her post:

"The physical exam is a straw man for reimbursement. Doctors require people to appear in person at their offices so that they can bill for the time spent caring for them. But for longstanding adult patients, the physical exam rarely changes medical management of their condition. It simply allows physicians to be reimbursed for their time. Cutting the middle man (health insurance) out of the equation allows me to give patients what they need without wasting their time in unnecessary in-person visits."

An Early Look At How Iowan Voters Feel About Health Care

Jane Sarasohn-Kahn at Health Populi looks at some early statistics of how Iowans feel about the state of our health care system. The survey was sponsored by CodeBlueNow, a consumer-led health advocacy group.

I found it particularly interesting that Iowans believe "health care services should stress disease prevention over high-technology cures." I wonder if a poll in West Virginia would show a similar statistic.

Contrast this statistic with some data coming out of the Leadership West Virginia Conference saying that West Virginia's health care system is dysfunctional and in peril. Dave Campbell, CEO of Community Health Network said that "$10 billion a year is spent on health care in [West Virginia], but only 3 percent of that is spent on preventative measures." Chronic disease is a huge problem in West Virginia.

Citing respiratory disease and diabetes as two treatable problems that are causing health care rates to rise in West Virginia, Campbell goes on to say that of the "$4 billion a year spent in hospitals, we know that $1 out of every $10 is avoidable. Over $400 million would be avoidable if people had earlier access to prevention and primary care."

Guy V., this post is for you after our weekend discussion.

Hatfields & McCoys, Book Banning and The World Is Flat

Larry Messina beat me to the post. I agree - quote of the day from award winning author, Pat Conroy in a letter to the editor appearing in today's Charleston Gazette.

"Because you banned my books, every kid in that county will read them, every single one of them. Because book banners are invariably idiots, they don’t know how the world works — but writers and English teachers do."

More on the the story involving the suspension of two of his books, Beach Music and The Prince of Tides, from high school English class at Nitro High School.

The emailed letter to the editor was in response to an effort lead by Makenzie Hatfield, a George Washington High School senior who the article indicates is working to for form a coalition against censorship. Hatfield emailed the author about the situation and received the response.

Just another example of how the ease of modern communication (email, internet, blogging, etc.) can put anyone (student) in contact with anyone else (author). The world is flat.

Conroy also weaves in the Hatfields & McCoys and ends with my other favorite quote from the letter.

"I salute the English teachers of Charleston, West Virginia, and send my affection to their students. West Virginians, you’ve just done what history warned you against — you’ve riled a Hatfield."

New Health Care CIO Blog

A welcome to John Halamka, MD and CIO of CareGroup Health System and the Chief Information Officer and Dean for Technology at Harvard Medical School who has launched a new blog, Life as a Healthcare CIO. Dr. Halamka is also the Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.

His tag line says:

Every day I experience life in the world of healthcare IT, supporting 3000 doctors, 18000 faculty, and 3 million patients. In this blog I record my experiences with infrastructure, applications, policies, management, and governance as well as muse on such topics such as reducing our carbon footprint, standardizing data in healthcare, and living life to its fullest.

Check out the great content in these recent posts, Top 10 Things a CIO Can Do to Enhance Security and the pro/cons of Flexible Work Arrangements. Looking forward to reading more of his posts. Tip to David Williams at Health Business Blog for pointing out this new health care CIO blog.

Data Missing on 200,000 West Virginia PEIA Members

WSAZ News, the State Journal and Charleston Gazette are reporting that data on approximately 200,000 past and current members of West Virginia Public Employees Insurance Agency (PEIA) is missing. According to the articles, the data was contained on a computer tape being mailed to a data analyst in Pennsylvania and was reported missing on October 18.

The data tape included names and maiden names, addresses, social security numbers, telephone numbers, and marital status of program participants and their covered dependents. The article indicates that the data tape did not contain medical or prescription claims information.

According to the article, letters will be mailed to impacted members and a hotline will be set up to answer questions about the lost data.

UPDATE: For more information check out the PEIA Data Loss Press Release and the Letter to Affected Policyholders about PEIA's Recent Data Loss.

Putting WV Mountaintop Removal In Perspective

How big are West Virginia's mountaintop removal sites? Check out the post "How Big is MTR Mining?" over at the Charlestonian Blog to better understand the scale.

AHIMA Report on State Level Health Information Exchange

The Foundation of Research and Education arm of the American Health Information Management Association (AHIMA) released a report titled "State Level Health Information Exchange: Roles in Ensuring Governance and Advancing Interoperability." The report was funded by ONCHIT.

I've just scanned the report but it appears to give a nice overview of the current status of state level initiatives to create an interoperable health information system.

Tip from iHealthBeat.

George Clooney and HIPAA Minimum Necessary Rule

An attorney I work with sent me a link to the following Fox News article, Doctors, Hospital Workers Suspended for Viewing George Clooney's Medical Records. For more news check out Google News search.

The article indicates that 40 employees at Palisades Medical Center in North Bergen, NJ were suspended for violating the hospital's HIPAA policies and procedures.

Based on the information in the article I suspect that the employees were found to have violated the minimum necessary provisions under the HIPAA Privacy Rule. This section of the rule provides:

For uses of protected health information, the covered entity’s policies and procedures must identify the persons or classes of persons within the covered entity who need access to the information to carry out their job duties, the categories or types of protected health information needed, and conditions appropriate to such access.

As more news comes out about this I suspect this might serve as a good example of application of the minimum necessary requirements under HIPAA. If the employees further disclosed the information to third parties outside the hospital (including the media) other provisions of HIPAA might also come into play.

Now Playing . . . The Digital Health Revolution

Friend and fellow health care blogger, Fard Johnmar, today officially announced the launch of The Digital Health Revolution. A project he has been working on with the folks at Scribe Media since meeting them at the fHealthcare Blogging Summit in Las Vegas.

Fard has great insight into the health care industry and I look forward to great content coming out of DHR. Check out the show here, including a very interesting interview with Susannah Fox, Associate Director with the Pew Internet and American Life Project on the topic of empowerment/revolution of the e-patient.

Enoch Choi, MD and I were lucky enough to be Fard's guinea pigs in his first (impromtu) interview for Scribe Media.

HealthVault: Adding Structure (Interoperability) to the Health Information Ecosystem

Last week (October 4) Microsoft rolled out a brand new vehicle that should help accelerate the growing consumer driven health care movement and creation of a national interoperable health information system. HealthVault is a new personal health record (PHR) platform that allows the user to gather, store and share health information online.

There has been a lot written about the roll out of HealthVault over the last week. I've read numerous articles and blog posts to try to get a better grasp of what it is (and what it is not). Over the weekend I ran across Vince Kuraitis' post at his e-CareManagement Blog which I found to have provided some good insight. Not until reading Kuraitis' post did I actually understand that HealthVault is not a PHR but a PHR platform.

In particular I like this quote by Kuraitis and his comparison of the pre-fax world:

" . . . this really isn’t about Microsoft vs. Google . . . It’s about creating a new business ecosystem based on the appropriate (honoring privacy and security) free flow of interoperable and transportable personal health information (PHI) — something that doesn’t exist today."

I'll throw out another comparison that I thought about as I read his post -- the natural gas transportation and storage industry. West Virginia is home to some large underground gas storage facilities. Basically, natural gas is pumped during off season to West Virginia from the Gulf Coast via large transmission lines or is gathered from small wells through gathering facilities and lines. The gas is then pumped and stored in previously depleted underground wells. In doing so, the natural gas can be stored safely and moved quickly to market in the northeast during the cold months.

HealthVault is setting out the same architecture, transportation and storage device for health information. The natural gas (health information) is very valuable and the system of moving it around is incredibly complex with multiple players and competitors. You have individuals and companies constantly adding natural gas (health information) to the system and end users who need natual gas (health information) at the opposite end. To date the health care industry does not have such a structured, standardized system of pipelines to protect and transport health information. We are largely still living in a paper world with systems that don't have the capability to talk to each other.

As I step back and take a look -- I see an industry in the midst of a tidal shift regarding the control of personal health information and maybe the bigger question of who wants (and can safely) control health information. Microsoft's HealthVault appears to be laying down more planks to create the platform for an interoperable system that will allow for health information to become more transportable, transparent and standardized. Ultimately, the question in my mind remains whether this will help to improve care and help each of us become better stewards of our own health?

Stay tune . . .

HealthBlawg Explores This Weeks Best Law Posts At Blawg Review #129

David Harlow of HealthBlawg takes to the keyboard like Columbus took to the seas and explores the world of law in Blawg Review #129. Don't miss this edition by one of my fellow health law bloggers.

Check out the upcoming editions at Blawg Review. If you are a new law blogger -- sign up to host or submit your favorite law related post.

PeerClip: physician social bookmarking and collaboration

I got the opportunity at Health 2.0 to learn about peerclip, a new social bookmarking tool, information rating and peer collaboration tool exclusively for physicians. I've not personally used the tool but saw this recent review by Shahid Shah, the Healthcare IT Guy. Here is ConnectivHealth's official press release on the new product.

Read the "about us" section for more about peerclip and how you might use the tool if you are an MD, DO, physician assistant or nurse practitioner. I plan to pass along some information about peerclip to my physician clients to gain further insight into the tool and its value. I'd be interested to hear from anyone out there using the tool - feel free to post your thoughts in the comments.

Hospital Mashup: Google and HHS Hospital Data

NetDoc now as a mashup of Google Maps and HHS hospital data. As Shahid Shah says, these types of tools takes mountains of data and makes it more accessible and easier to digest by the average public health consumer. Here is the view/data of hospitals that are 100 miles from Charleston, West Virginia.

Here is the summary of what the tool provides:

When it comes to treating heart attacks, pneumonia, surgery and other emergencies, you want to find the best medical care available.

To help you make these decisions, visit the NetDoc.com Hospital Rankings tool and enter your ZIP code to see how hospitals in your neighborhood rank on benchmarks set out by the U.S. Department of Health and Human Services in four categories: Heart Attack, Heart Failure, Pneumonia and Surgical Care Improvement/Surgical Infection Prevention.

Thanks to Shahid for the tip on this new tool.

Health 2.0 Physician Model: House Calls and FICO

Just back from Health 2.0 and was reading about Dr. Parkinson who demonstrates his new (disruptive) model changing the way health care is provided. Don't miss the great discussion in the comments. Check out Dr. Parkinson's website Jay Parkinson, MD + MPH (and his blog).

Dr. Parkinson's approach also highlights something of value that I think has been missing from health care for years -- house calls. I had the chance to watch and go on house calls with my dad, a retired rural physician. There is incredible value in seeing the patient in his/her own environment.

Dr. Parkinson's response in the comments is a concrete example of Scott Shreeve's FICO concept discussed at Health 2.0. Dr. Parkinson comment:

"I’m also toying with the possibility of lowering the following year’s fee for each individual who utilizes my services less often than average. We’ll see."

Update: Catch an interview with Dr. Parkinson who explains his business mode on ABC News.

Health 2.0: User-Generated Healthcare Conference 2007

The Health 2.0: User-Generated Healthcare Conference officially gets underway today but the pre-conference gathering was a great time last evening. We started out at the Hilton San Francisco lobby bar and then moved down to Johnny Foley's Irish Pub just down O'Farrell Street.

I had the opportunity to talk with Chris Sparks and Robert Hendrick of MedBillManager, Michael Markus with Within3, Daerick Lanakila with SugarStats, Joel Selzer with Ozmosis, Ash Damle with MEDgle, Daniel Kogan with Health WorldWeb, Laird Kelly with RSi Focal Search, Fred Eberlein with ReliefInsite and others.

Clear to me was that there was an incredible amount of excitement and enthusiasm around what is happening as this group tries to figure out how best to position themselves and their companies in this new non-traditional health sector. I was also struck by the fact that many of those who have jumped in with new ventures have done so as a result of a personal family health story or a frustration with how they were treated by the current health care system.

Some thoughts by others covering the Health 2.0 Conference and some of the afterglow:

• Brian Klepper blogged the days sessions over at The Health Care Blog while Matthew was busy playing host for the event. Brian has his initial thoughts on the conference over at The Doctor Weighs In. Brian does a great job capturing the day's sessions (Introductions, Opening Panel - Consumer Aggregators, David Brailer, Search Panel, Social Media for Patients Panel, Reactor Panel - Payor, Provider, Pharma, Closing Reactor Panel.
  
• Scott Shreeve is blogging over at Scott Shreeve, MD. Here is his take on the opening session.
• Jane Sarasohn-Kahn provides the quotable "gems" from the conference at Health Populi.
  
• Rock'n Roll perspective from the HealthcareITBlog, including the central theme of "you need to have a community, and you need to have a business model."
• Esther Dyson summarized her experience and perspective as a part of the reactor panel, including her discussion of how Health 2.0 can become a catalyst for real(age) change at The Huffington Post. Engaging the public in their own health care has to be at the heart of real change for the industry and the only way that the future costs of health care can truly be controlled.
  
• PointClear Blog highlights one of the practical issues (and problems) with health search - whether the everyday user can interpret the complex and specialized search results. The demos by the search panel using the term "diabetes" were overwhelming to me and probably to most average health consumers. This is is something that the health search engines are going to have to address. PointClear also discussed data liquidity, another theme of the day.
  
• Arizona Health Futures captures the essence of what we all have to strive to change with the Health 2.0 movement and does a nice job of summarizing the closing panel's discussion. Also, an interesting post on what came out of the unconference group covering liquidity of data vs. privacy (wish I could have participated in the discussion - I totally agree that traditional providers view their control of the health data as incredibly powerful. We are going to continue to see the struggle as individual patients try to wrestle away the control of this data).
• Podcast with Dr. Brailer at Neil Versel's Healthcare IT Blog.
  
• Check out the video interviews from the conference being produced and posted by ICYou including a short interview that I was privileged to get to do with ICYou.

I'm going to attempt to do some live blogging during todays sessions depending on availability of wireless access and available time. Below is speaker panel agenda for the day which I will use to post comments and questions on during the day.

Conference Agenda (live blogging notes are in italics)

Cool opening video on Health 2.0 called "A Brief History of Medicine . . ." created by guys at Scribe Media and inspired by the Web 2.0 . . . The Machine is Us/ing Us, video that I've posted about before.

8:00-8:30 INTRO Health2.0: User-Generated Healthcare
Matthew Holt/Indu Subaiya

Covered some background for the crowd on "what the hell is Web 2.0/Health2.0?" Used the O'Reilly definition including lightweight business models.

What is Health 2.0 (personalized search that finds the right answer for the long tail, better presentation of integrated data, communities, etc.) Consumerism is a great force - how will it impact health care? Transparency and consumerism.

Search is the largest area with social network and tools linked in. Good graphic with interlinking circles and content --- transaction. Also put up a slide graphic of Scott Shreeve's definition of Health 2.0 a much broader definition.

Matthew's continuum of Health 2.0?
User generated health care -- user connect to providers -- partnership to reform delivery -- data drives discovery.

8:30-9:30 OPENING PANEL: The Role of the Consumer Aggregators

Missy Krasner, Product Marketing Manager, Google

Question of whether consumers/patients are really ready to put all their personal information online. Search needs to continue to be refined in the health search field.

Wayne T. Gattinella, CEO, WebMD

The number of people searching for information online has doubled recently. People/patients now go online first for health information then to family and health care providers. This same trend is occurring with new doctors coming out of med school - they are going online instead of looking at text books.

Peter Neupert, VP Health Solutions Group, Microsoft

The challenge for those in the room that want to disrupt the health care industry is finding the business model that works. Cited stats on the revenue generated by health search -- big number and will continue to trend upward.

Bonnie Becker, Director, Health Category, Yahoo!

Yahoo groups on health are happening organically. Talked about the emotional side of online health communication by patients for patients. Individuals want to get information from other individuals -- not necessarily from their health care provider.

Moderator: Jane Sarasohn-Kahn, THINK-Health

Q/A from the crowd:

• Trust lies in the individual user. Google's experiment with "passionate experts" who go out and label good/trustworthy content on the web. People want a trusted coach to help them weed through the data.
• How do we mesh search and ads (revenue)? Good discussion on the topic from the panel.
  
• Will search marginalize the need for physicians? Doctors are feeling alienated by some of what search brings to the table. Will the patient arrive in the office better prepared to discuss their health condition. One problem is that the traditional model of care (read: payment/reimbursement model) requires doctors to quickly move patients through the office - patients who arrive better prepared to discuss their health condition take more time (not less). Can we empower physicians and other care providers with information rather than alienate them from the process.
  
• Question on what is your business model Google, Yahoo and Microsoft? Google response - we are not a health care company, trying to get better at health care, taking it slowly, very small team making quick decisions working bottom up, team is small, business model - free service for health user/put out a product that will help people/ads that help with discovery of information. Microsoft response - sell enterprise software to hospitals, working on consumer ideas (MedStory), fragmentation in the industy is a big problem in the hospital space - no work flow of data, wants to help guide in a connected way to improve connection of data. Yahoo response - goal of creating a good user experience, Yahoo health groups, search and answers, model is search advertising.
  
• Data liquidity. How do health care data standards get in the way? "health care is a hairball" - Wayne at WebMD. Discussed the behavioral changes that have to occur - the technology has been out there for use in the industry.
  
• How do we help users ask smarter health questions?
  
• How do we pull folks into the Health 2.0 revolution for their own benefit, as well as society's? Great question - this is the one I have thought a lot about. How does all this actually improve patient behavior? What will drive people to care about their health? Patients with chronic disease have a direct stake in taking care of themselves. The more difficult question is how do we engage the masses to take care of preventable disease - obesity, cardic, etc.
  

Special Perspective from: David J. Brailer Former National Health IT Coordinator & Founder, Health Evolution Partners

Will web/health 2.0 become a catalyst to accelerate traditional models of health care to change. The future health of the health care industry needs health 2.0 . Many of the traditional models of communication and collaboration among providers, patient to provider, insurer to provider, etc. will be changed by health 2.0. Relationships in health care can be redefined by the health 2.0 movement. Need to bring/create sustainable business models - you can't just drop technology in (not passive role - must actively change the culture/process).

9.30-9.40 STRETCH BREAK, Bio Break & Coffee refill

9.40-10.40 DEMO PANEL & Discussion: Search in Healthcare

Each of the panel members did a quick demo of their individual search product focused on diabetes information. Interesting to see the various search engines search results for the same topic. I was overwhelmed by the information and can't imagine an ordinary consumer of health care (especially one who is poor, uneducated and otherwise unsophisticated) being able to grasp this much information.

Alain Rappaport, CEO, Medstory/Microsoft

Very good graphic showing a long tail like list of content sources in the "Information that Matters" section. Here is the search for diabetes.

Venky Harinarayan, Co-Founder, Kosmix

Tom Eng, President & Founder, Healia/Meredith

Working to refine health search. Recently released a new clinical study search feature.

Dean Stephens, President & COO, Healthline Networks

Praxeon/CurbsideMD

Somewhat unique in that it uses natural language search.

Moderator: Jack Barrette, CEO WeGoHealth (ex-Yahoo)

10.40-11.15 NETWORKING Break with Demonstrations

11.15- 12.15 DEMO PANEL & Discussion: Social Media for Patients

Ben Heywood, CEO, Patients Like Me

Doug Hirsch, CEO, Daily Strength

Steve Krein, CEO, OrganizedWisdom

Karen Herzog, Founder, Sophia's Garden

John de Souza, CEO, MedHelp International

Brian Loew, CEO, Inspire

Moderator: Amy Tenderich, Blogger/Journalist DiabetesMine

Like my discussion last night, this panel again brought out the personal side of Health 2.0. Most of the panel members had a personal experience that lead to their passion to want to create something new to address or supplement something that the traditional health care system was failing to provide them or their family members. For example, Patients Like Me grew out of a desire to Ben Heywood to want to create something to help his brother who was diagnosed with ALS.

Steven Krein stood out on the panel and suggested that Organized Wisdom was positioning itself to be the aggregator of consumer created health information from the likes of those on the panel. He talked a bit about Organized Wisdom's new roll out as a people driven search engine and coined the phrase, "people are the new algorithm."

12:15-1:00 REACTOR PANEL Payers, Providers, & Pharma….and Health2.0

Paul Wallace, Senior Advisor & Medical Director, Kaiser Permanente

Joe Gifford, Chief Medical Officer, Regence BCBS

Jeff Rideout, Managing Partner, Ziegler HealthVest Fund

Bruce Grant, SVP, Digitas Health

Ted von Glahn, Director, Performance Information and Consumer Engagement, PBGH
Moderator: Doug Goldstein, eFuturist

1:00-2:00 LUNCH with "Unconference" issue tables & more demonstrations

During the unconference I hosted a group on law/privacy issues and Health 2.0. We had some really great discussion including a brainstorming session on what changes to HIPAA privacy law need to occur to better accommodate the Health 2.0 companies. We also discussed most of the companies participating in the conference are likely not required to comply with HIPAA (although many do because they want to move toward the industry standard) because they don't fall into definition of a covered entity under HIPAA (a health care provider, health care plans or health care clearinghouse). The knee jerk reaction from those who don't understand HIPAA is to overreact by ratcheting down on privacy. We also got into the "flip side of the rock" on data aggregation. Most of the talk all morning focused on the positive aspects of health data aggregation. However, there are downsides to data aggregation including those who might want to use the data improperly for financial gain.

2:00-3:00 DEMO PANEL & Discussion: Tools for Consumer Health

Mike Battaglia, VP Healthcare Strategy, Intuit - Quicken Health

Marlene Beggelman, CEO, Enhanced Medical Decisions

Dave Hall, VP of Innovations, HealthEquity

Joseph Villa, COO Employer Division, Revolution Health

Ryan Phelan, CEO, DNADirect

Moderator: Scott Shreeve, CrossOver Healthcare (founder Medsphere)

3:00-3:30 NETWORKING Break with Demonstrations

3:30-4:30 DEMO PANEL & Discussion: Providers and social networks

Daniel Palestrant, CEO, Sermo

Effective presentation by Daniel who used the "saw blade" example as a way to show the value and positive impact of sharing/collaborating among physicians. Creative suggestion by a physician to use a straw to help remove a saw tooth blade from a patient presenting in the ER with a saw blade through the finger. Money is not a motivator of physicians. They have found that the physicians on Sermo are motivated more by the need to collaborate.

Lance Hill, CEO, Within3

Chini Krishnan, CEO, Vimo

Gale Wilson Steele, Founder/CEO, Careseek

Patricia Ball, VP Product Development Consumer Aware/BCBS Minnesota

Doug Goldstein, eFuturist & President, Medical Alliances

Moderator - Enoch Choi MD, MedHelp/PAMF

Q/A from the crowd:

• How do the companies moderate the comments made by consumers about providers and what are the legal ramifications?
• What are the panel members doing to protect/address protecting privacy within their business model? Will they make the data anonymous before reporting that out to other groups? Sermo will be making the aggregated data available to track trends and be analyzed by others.
• What is your business model? Most rely on value of the data aggregated and advertising. Daniel at Sermo indicated that Sermo does not rely on advertising but instead talked about value in information arbitrage (taking advantage of the information created through the system).
  

4:30- 5:30 CLOSING REACTOR PANEL: Health2.0 - Looking Ahead

Marty lead off with setting the stage by asking the panel to look back and reflect on the day and then give some perspective on where they see this headed in the future. The discussion and thinking by this group was superb. There was recognition of fragmentation but also reflection that similar fragmentation existed in the early days of the technology/online revolution. Great concept of the calcified ball at the center of current health care model and that this group was working to eat away at the fringes.

Lee Shapiro, President, Allscripts

Referred to the use of EMR as subsituted service from paper records. The new feature is connectivity. This connectivity is what will really change the way the data collected in the EMR is used -- sharing information with practitioners to add greater value.

David Kibbe, American Academy of Family Physicians

Bob Katter, Senior VP, Relay Health (McKesson subsidiary)

Pioneered the idea of reimbursed e-visits.

Jay Silverstein, Chief Imagineer, Revolution Health

He recognized the creativity in the room on ideas to create better community in health care. Also intrigued by the idea of improving practice patterns across the county. Downsides he sees from the day is still the fragmentation of health business. Very insightful thoughts.

Steve Brown, Founder Health Hero Network, Entrepreneur in Residence, Mohr Davidow Ventures

Esther Dyson, EDventure

Moderator: Marty Tenenbaum, Commercenet

5:30- 5:45 Wrap-up - Matthew Holt/Indu Subaiya