Thursday, May 31, 2007

The Flea Flicker: Risks of (anonymous) Medical Blogging

Kevin M.D. has the full roundup from the blogosphere of the unmasking of Flea (cached version) at his malpractice trial. Today's Boston Globe reports more of the details. More details courtesy of New York Personal Injury Law Blog.

I periodically ran across Flea's posts over the last year and was surprised a few months ago when I started to notice his posts discussed his ongoing malpractice case, including discussions with his defense counsel. My initial reaction -- does his defense counsel know about his blogging. The answer was no. At the time, like Eric Turkewitz I concluded that there was a high risk (if uncovered by the plaintiffs attorney) that his blogging publicly would potentially waive attorney client privilege. Eric also provides some great links of previous posts about Flea.

This situation highlights the potential risk faced by medical bloggers and a reason why lawyers need to better understand the blogosphere and the impact of online social networking on themselves and their clients. The fall out from this case will be interesting to watch.

UPDATE (6/4/07): More today from Eric Turkewitz and how plaintiff's counsel uncovered that Flea was Dr. Lindeman in his post, "Deconstructing the Trial - Part 1." A comment to the post raises the most important lessons for physicians or other bloggers who find themselves facing litigation. The comment reads:
This is a great example of why it's important to tell your lawyer about things like this. If Flea's lawyers had gone through all the posts on his blog, they would undoubtedly have prepared him for this question. These kinds of prior statements are neither unusual nor damning - you just have to know how to handle them.
In fact I'll say it again - TELL YOUR LAWYER ABOUT THINGS - whether you are the plaintiff or defendant. Usually its embarrassing or uncomfortable things that clients don't want to tell you and these things can significantly impact the outcome of litigation. It's these hidden facts or facts that weren't explored far enough (or understood) by defense counsel that can come back and bite. I suspect that defense counsel has a new appreciation for blog content.

Deconstructing the Trial of Flea - Part 2 is now also available where Mr. Turkewitz provides some insight into whether or not the existence of Flea's blog was a factor in settlement of the case.

Tip to Kevin M.D. for highlighting today's post by Mr. Turkewitz. Article: Google and Health Care

Today I noticed a little more traffic to my blog with much of it coming from As a result of a little searching I found an article (Google Aims to Extend Data Mantra into Health Care) quoting from one of my previous post (What Google Health Might Look Like).

My previous post on Google Health was a a reaction and response to a post at the Google Blog by Adam Bosworth, Google's VP, asking to hear from others about how you and I as patients know whether we are getting the best care. The post was not just about "concerns over what could be lost in the digitizing of medical information" (as quoted in the article) but rather an overall examination of what Google Health and some of the other Health 2.0 type companies may bring to bear on our traditional health information system and how this may ultimately impact the quality of health care we receive.

Friday, May 18, 2007

HealthDot Interview: Health Care Blogging and Social Media

Earlier this month I attended and spoke on a panel addressing some of the legal implications for health care bloggers at the 2007 Health Care Blogging Summit.

During one of the breaks I had the opportunity with a couple of my health blogging colleagues, Enoch Choi, M.D. who blogs at and medmusings and and Fard Johnmar of Envision Solutions blogging at Envision 2.0 and Healthcare Vox, to do an impromptu interview with Scribe Media who was capturing video content at the event.

We had some great discussion on the issues resulting from the growing use of blogging and social media by health care professionals and its potential impact on the health care industry.

Fishy FestivALL 2007

As a follow up to my recent post about Charleston being featured in Kiplinger's Best Cities At Every Stage of Your Life it reminds me to mention that FestivALL is on its way (June 21-24).

FestiVALL is just one example of why I think Charleston received a postive ranking in Kiplinger's bohemian factor. Here are posts (here and here) about last year's Charleston's premier arts event. For more background check out What is FestiVALL.

I got excited earlier this week after seeing the production photos of the 2007 FestiVALL Catfish over at friend and fellow blogger, Dale Morton's Costume Blog. (official FestiVALL catfish photo above).

Here is the quick overview of FestiVALL 2007 (For more info on 2007 FestiVALL check out the full schedule of events). Also, to stay up on FestiVALL check out the FestiVALL Blog by Adam Harris hosted via the Gazz Blogs.

This year our kick-off concert features the soulful sounds of The O’Jays at the beautiful Maier Foundation Performance Hall of The Clay Center on Thursday.

Friday night is party time on the river! Fund for the Arts’ Blues, Brews & BBQ will take place outdoors along the banks of the Kanawha at the University of Charleston with The Robert Cray Band and more. Phenomenal Australian guitarist Tommy Emmanuel will be in concert at The West Virginia State University Capitol Center Theater and A Gershwin Gala music and story tribute to the great George Gershwin will be at The Clay Center in a cabaret setting.

Saturday brings one of Charleston’s most popular events, Fund for the Arts’ Wine & All That Jazz, again outdoors on the U. of C. lawn. Smooth jazz sax man Eric Marienthal heads a bill that also includes the finest local and regional jazz artists and the fruits of local vineyards. Also on Saturday, The Capitol Street Art Fair fills two blocks with quality artists and crafts artists. They will be selling and, in some cases, demonstrating their work. On Saturday evening enjoy part one of The WV One Act Play Festival at The Clay Center. This year it will be topped off by a Late Night Cabaret performance. Also on Saturday night, at The WVSU Capitol Center Theater, you can hear the WV brother/sister duo of Tim and Mollie O’Brien in concert. Tim won a Grammy in 2005 for best traditional music recording and you may know Mollie as a long time regular on A Prairie Home Companion.

On Sunday, The Capitol Street Arts Fair returns and The One Act Theater Festival continues. On Sunday night, FestivALL 2007 ends with a very special edition of Charleston’s own internationally popular live music radio program, Mountain Stage.

On Wednesday, June 20, there will be a FestivALL West Virginia Day Celebration on the lawn of the Clay Center. It will feature popular local bands including the reunion of two of Charleston’s most popular 60’s and 70’s rock bands, The Mojos and Quiet. Later that evening, it’s the Gazz FestivALL Preview at Blues BBQ restaurant with more music and a discussion of FestivALL’s theme, “A City Becomes a Work of Art”, by city artists.

Check the Dance listings for performances by The Charleston Ballet, The River City Youth Ballet, West Virginia Dance Theatre, JADCO, Allegro and other companies. There will be 36 hours of free music on stages at Davis Park (blues, jazz), Haddad Riverfront Park (Charleston dance bands), Capitol Market (country and bluegrass), Charleston Town Center (eclectic mix) and at The Capitol Center FOOTMAD Stage (traditional Appalachian and folk). FOOTMAD will also be having a big Contra Dance Weekend.

Chalk artist Julian Beever will be coming in from Belgium to do one of his incredible “three dimensional” sidewalk drawings and the popular GO FISH catfish sculptures will be back in Brawley Walkway (Fife Street) and elsewhere. Street performers of all types will perform up and down Capitol Street. There will be family activities on The West Side and East End and, especially for the kids, The Kanawha Public Library’s Street Fair will take place on Saturday.

The City of Sistersville River Taxi will be ferrying folks across the Kanawha and last year’s extremely popular Location!Location!Location! “Ten Minute Play” contest winners, staged in the lobby of the Security Building, will be encored. Plus, a new contest, “A Streetcar Named…” will result in a twenty minute play that will be acted on a KRT Trolley as it makes its rounds.

In short, there will be plenty to keep the whole family entertained.

Tuesday, May 15, 2007

New WV Law Blog: West Virginia Business Litigation

Just a quick note to welcome another West Virginia lawyer, Jeff Mehalic, now blogging at West Virginia Business Litigation. It appears he started blogging in April. Looking at his past few posts looks like he will be generating some great content. Interesting reading, especially for West Virginia lawyers.

Welcome Jeff. I've added you to my blog roll list under the West Virginia Blog section. Be sure to check out some of the other West Virginia blogs. Your blog also now entitles you to attend the next meeting of CAB (reminds me that we need to schedule a get together).

Shhhh! . . . Charleston, West Virginia Is A Good Place To Live

Congratulation to Charleston, West Virginia for its ranking in Kiplinger's Best Citites for Every Stage of Your Life cover story. The ranking includes the top 25 places to launch a career, raise a family, retire in style, and more.

Charleston was ranked under the Best Cities for Empty-Nesters. Although my nest is still full its still a great place to live. Here is what Kiplinger had to say about Charleston in its online content (you can view this via the slide show feature linked in the article):


Population: 301,716
Cost-of-Living Index: 93 (100 being national average)
Percentage of Workforce in Creative Class: 27.9%
Bohemian Indicator: 69
Creative-Class Salary Growth (2000-2005): 9.8%

Charleston has an interesting combination of a low cost of living with a relatively strong creative class. The city is surprisingly cosmopolitan, with fine restaurants, art galleries, specialty shops and caf├ęs along its tree-lined downtown streets.

For those looking into Charleston don't miss local photo bloggers, ImageSmith (Tom Hindman) and Rick Lee, for some super shots of Charleston and West Virginia. Check out just one of the fantastic photos of downtown Charleston and the Kanawha River. The photos from the two local photo bloggers sure beat the photo Kiplinger used in its online content from the Charleston Visitors Bureau.

UPDATE: Skip Lineberg does a follow up post, Living In Charleston Rates High With Kiplinger, at his Marketing Genius from Maple Creative blog.

Sunday, May 06, 2007

Justia's RSS Federal Register

Do you have a need to monitor the federal rules, proposed rules and orders on a particular topic or particular agency? If so, Justia's Regulation Tracker to the rescue. A very useful tool for those of us in the highly regulated world of health care.

Thanks to Tom Mighell at inter alia I just learned about this new feature. I've added a couple of test RSS feeds on topics that I regularly try to monitor. You can also browse by government agency. I've been using Justia's federal court filings RSS feeds for a while to monitor cases filed in the Southern and Northern Districts of West Virginia but wasn't aware of this new federal rule tracker.

Pew Internet and American Life Survey On Technology Use

The AP reports on the findings of a new Pew Internet and American Life Project survey, "A Typology of Information and Communication Technology Users." The report doesn't really surprise me (like it does the AP writer) because the findings reflect what I see on a daily basis in our law firm.

As an "omnivore lawyer" (see my quiz results below) who serves as back up to our IT staff on "user problems" I think the survey is pretty accurate. I like the categories/classifications used in the survey -- especially the "lackluster veterans".

Take the Pew/Internet Quiz and see where you fit. I would be interested to give the quiz to various groups that I interact with and see where they fit. For example - lawyers in my firm? hospital CEOs? physicians? health information management professionals?

Check out the full survey results here. Here is a portion of the AP story:
A broad survey about the technology people have, how they use it, and what they think about it shatters assumptions and reveals where companies might be able to expand their audiences.

The Pew Internet and American Life Project found that adult Americans are broadly divided into three groups: 31 percent are elite technology users, 20 percent are moderate users and the remainder have little or no usage of the Internet or cell phones.

But Americans are divided within each group, according to a Pew analysis of 2006 data released Sunday.

The high-tech elites, for instance, are almost evenly split into:

• "Omnivores," who fully embrace technology and express themselves creatively through blogs and personal Web pages.

• "Connectors," who see the Internet and cell phones as communications tools.

• "Productivity enhancers," who consider technology as largely ways to better keep up with their jobs and daily lives.

• "Lackluster veterans," those who use technology frequently but aren't thrilled by it.
Here are my results from the quiz:

Based on your answers to the questionnaire, you most closely resemble survey respondents within the Omnivores typology group. This does not mean that you necessarily fit every group characteristic.

Omnivores make up 8% of the American public.

Basic Description
Members of this group use their extensive suite of technology tools to do an enormous range of things online, on the go, and with their cell phones. Omnivores are highly engaged with video online and digital content. Between blogging, maintaining their Web pages, remixing digital content, or posting their creations to their websites, they are creative participants in cyberspace.

Defining Characteristics
You might see them watching video on an iPod. They might talk about their video games or their participation in virtual worlds the way their parents talked about their favorite TV episode a generation ago. Much of this chatter will take place via instant messages, texting on a cell phone, or on personal blogs. Omnivores are particularly active in dealing with video content. Most have video or digital cameras, and most have tried watching TV on a non-television device, such as a laptop or a cell phone.

Omnivores embrace all this connectivity, feeling confident in how they manage information and their many devices. This puts information technology at the center of how they express themselves, do their jobs, and connect to their friends.

Who They Are
They are young, ethnically diverse, and mostly male (70%). The median age is 28; just more than half of them are under age 30, versus one in five in the general population. Over half are white (64%) and 11% are black (compared to 12% in the general population). English-speaking Hispanics make up 18% of this group. Perhaps unsurprisingly, many (42% versus the 13% average) of Omnivores are students.

Wednesday, May 02, 2007

CMS Proposed Rule Modifies PPS For Home Health Agencies

Last Friday, April 27, 2007, CMS issued a proposed rule (CMS-1541-P) modifying the prospective payment system (PPS) for home health agency reimbursement. The proposed rule will be officially published in the Federal Register on May 4, 2007. The details of how to comment on the proposed rule is included in the rule. According to the press release, the deadline for filing comments on the proposed rule June 26, 2007.

The summary from the proposed rule states:
This proposed rule would set forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health services, effective on January 1, 2008. As part of this proposed rule, we are also proposing to rebase and revise the home health market basket to ensure it continues to adequately reflect the price changes of efficiently providing home health services. This proposed rule also would set forth the refinements to the payment system. In addition, this proposed rule would establish new quality of care data collection requirements.
CMS issued a press release, CMS Proposes Payment Changes For Medicare Home Health Services providing an overview of the proposed changes. Also, CMS issued a Fact Sheet outlining some of the proposed PPS home health changes as compared to the current home health PPS payment system. For more information go to the CMS Home Health Agency Center.

I plan to take a closer look at the proposed rule and would welcome any comments on what impact these changes may have on existing home health providers.

UPDATE (6/18/07): Today CMS issued correction of technical errors in the proposed rule issued May 4, 2007. The corrections are entitled, "Medicare Program; Home Health Prospective Payment System Refinement and Rate Update for Calendar Year 2008; Correction" (72 FR 33425).

Also, one of the comments to this post mentions materials from Beacon Health providing analysis on the proposed Home Health PPS Reform and tips for submitting comments to CMS. Those interested in the changes might want to check out this information.