West Virginia E-Prescribing Regulations

On January 4, 2008, the West Virginia Board of Pharmacy filed a Notice of Emergency Rule amending CSR 15-1, Licensure and Practice of Pharmacy, implementing the requirements of SB 1001 (See SB 69 and HB 2289) passed during the 2007 Legislative Session permitting electronic prescribing (e-prescribing) of legend drugs in West Virginia, including through the use of electronic data intermediaries.

The Board also filed on January 4, 2008, the Notice of a Comment Period on a Proposed Rule amending CSR 15-1, Licensure and Practice of Pharmacy. Comments on the Proposed Rule must be submitted before February 8, 2008.

The summary and statement of circumstances included in the notice reads:

SB 1001, passed during the First Special Session, 2007, and duly enacted into law, permits electronic prescribing (e-prescribing) of legend drugs in this State, including through the use of electronic data intermediaries as defined therein. SB 1001 contains the following directive to the West Virginia Board of Pharmacy as set forth in West Virginia Code Section 30-5-12C(d): "The board shall promulgate emergency rules pursuant to the provisions of article three, chapter twenty-nine-a of this code to implement and enforce the provisions of this section." E-prescribing is already being done by prescribers around the state, with the amount and frequency of electronic prescriptions being received by pharmacies increasing each day as the technology becomes more accepted and available in the industry. While the current rules allowed for electronic transmission of prescriptions, SB 1001 states that e-prescribing may not be done in this State until emergency rules are promulgated, and further sets additional parameters defining this growing area. As such, the e-prescribing currently being done in this State is being done without appropriate legislative rules in place to protect the integrity, privacy, security and confidentiality of the prescription orders. In addition, prescription drug diversion is an ongoing problem in this State and nation; e-prescribing done correctly is one method to combat the problem often perpetrated through passing fraudulent written prescriptions. Finally, e-prescribing aids in the accuracy of prescriptions by more timely presenting them electronically from the prescriber's office to the pharmacy in a clearly legible format, thus reducing fill-errors and facilitating patient compliance with the prescribed treatment.

Given these factors, the Legislature, through its deliberative process, has determined that an emergency exists requiring the need for emergency rules to govern the use of e-prescribing and electronic data intermediaries in this State for patients to access prescription medications in a safe and efficient manner. Therefore, in accordance with that directive, the purpose of this emergency rule is to revise existing rules governing issuance of prescription orders to set specific standards to govern e-prescribing in West Virginia, thereby protecting the public health, safety, and welfare with regard to restricted drugs which may only be obtained by patients with a proper prescription.

Results of Tech President Primary

Want to know where the presidential hopefuls stand on technology?

Check ou the result of the TechCrunch Tech President Primaries. You can see where the candidates stand on 10 key tech issues. Based on the results the TechCrunch endorsements goes to Barack Obama and John McCain.

Great information if you are concerned about the level of knowledge our leaders must have regarding the importance of technology on the economy and our culture.

Grand Rounds . . . Revolution

Grand Rounds Volume 4, No. 19 is up over at my favorite nurse blog, Emergiblog. Kim has wonderful vision into the world of health care and is a creative writer to boot.

I've gotten out of the habit of submitting posts to Grand Rounds. Never enough time in the day. However, I wish I would have submitted my Guitar Hero Health Care post from this week -- it would have fit well in her Beatles theme. Find the Beatles link in my post.

Maybe I'll email Kim as see if she will give me a Grand Rounds postscript note.

West Virginia Educational Social Network

The State Journal reports that West Virginia University with the backing of a grant from Verizon will create a social network for middle and high school students focused around education (with emphasis on the energy sector) to get a head start on career decisions.

Partners in the project include WVU's College of Engineering and Mineral Resources, College of Human Resources and Education and The EdVenture Group.

A description of the project from the WVU press release:

Unlike Facebook.com and other social networking sites, the new site, once developed, will not be open to the general public. Rather, a network of representatives from participating companies and schools will serve as experts and mentors for students who join the site.

Along with Web-based interaction within groups, the site will host discussion groups, chats and blogs on relevant topics and an “Ask the Counselor” section where students can ask questions concerning academic or career issues. Other activities may include contests based on career knowledge, virtual career fairs and group visits to employer or educational facilities.

Interesting concept and I'm excited to learn more about the project. Based on my experience with social networking and the use of blogs in the legal industry I think the application of these technologies in education can be powerful. The added plus is that the platform will be familiar and attractive to the way that middle and high school students communicate. Anyone aware of similar projects like this happening around the country?

I will be interested to hear what Lee Kraus, the guru on education focused social networking, has to say about the pilot project. This reminds me of a concept that I previously discussed with Lee.

WVU press release has more details.

Newsweek Features Amy Tenderich of DiabetesMine

Great to see Newsweek run a story on Amy Tenderich and the success of her blog, DiabetesMine. Amy's efforts are a great example of how blogs can be used to creatively share valuable information with a patient community.

Here is a taste of the article and how Amy got started,

I've been writing my Web site for three years now, and some amazing things have happened. First, I learned all sorts of facts about my own health that doctors never told me. I learned that thousands of other people out there have been diagnosed with type 1 diabetes later in life, like me—a condition called LADA (latent autoimmune diabetes in adults). From other patients I also learned essential basics about related conditions, like gluten intolerance (celiac disease), and Raynaud's syndrome, a circulation disorder in the hands—both of which I suffer from, along with the diabetes.

Second, a whole community of "patient bloggers" has grown up around me—hundreds of other people sharing their health challenges on the Web. We exchange treatment and insurance tips, hold online chats, link to each other's sites, and even manage to meet in person sometimes.

Congrats Amy on a great article.

Get Your Google Health . . . Soon

Various reports out about the coming of Google Health. As Matthew Holt indicates, the Google purists found a log in page (screen shot).

The log in page has since been pulled down but Matthew and Tech Crunch provide a list of what the log in page said Google Health will do for you, including:

With Google Health, you can:

• Build online health profiles that belong to you
• Download medical records from doctors and pharmacies
• Get personalized health guidance and relevant news
• Find qualified doctors and connect to time-saving services
• Share selected information with family or caregivers

I'm particularly interested to check out the "Google Health Privacy Policy" which is referenced on the log in screen shot.

Stay tuned . . .

HealthBlawg Cover Northeast Health 2.0 Event

Fellow health law blogger, David Harlow, hangs with the Health 2.0 crowd at the Northeast Corridor Health 2.0 shindig in Cambridge. David provides his thoughts on where Health 2.0 might be headed. Looking forward to attending a future NE Health 2.0 event.

Mark Modzelewski, organizer of the event and author of Hub 2.0 - Boston Herald Blogs, served as moderator for the panel discussion and provides some additional commentary.

More Predictions on The Future of Health Care

Great post, "Everybody's Talking about the Future of Health Care," by Fred Fortin over at the World Health Care Blog. The post focusing our attention on what may occur in 2008.

The other day I was in a meeting related to West Virginia's efforts to create a state wide health information network. We were looking at project time lines that ran into 2010. Although only two years away I thought how long a time that is as technology, health care, political landscape, etc. move around at light speed. Similar to Mr. Fortin's thoughts and "humble appreciation and respect for the role of high impact, improbably events in social affairs."

Mr. Fortin points out in his post the key concept of "unsustainability". Which in my mind leads to major disruption in the industry. The question is when and how hard. What will be the key drivers? We have to push forward on developing models but in doing so we always have to remain aware and vigilant of what is happening around us.

Tip to Tony for pointing out the post.

Guitar Hero Health Care

Guitar Hero (Rock Band) Health Care. The current (next) generation expects to be on the stage performing and not just sitting passively in the audience.

Check out Why Consumer - Directed Medicine, Health 2.0 Will Flourish by Jen McCabe Gorman at Health Management RX.

What the coming generation will expect from providers - read Jen's questions and formulate your answer. The task we all have in front of us is how to harness these mentoring powers to focus on preventative care, disease management and wellness.

She ends with:

Work on mentoring the 'me' generations - the next wave of healthcare delivery will depend on carefully mentoring 'me' thinkers to manage personal responsibility and maintain individual health. Wellness maintenance programs are just one part of the solution . . .

. . . Give us a solo - we've been taught for most of our lives to tell people what we want. You've been taught for most of your lives to tell people what we need to be well. Your answers about how to work with us in the new system are waiting.

The Return of Flea . . .

An interview with Dr. Flea (Robert Lindeman, MD) from Eric Turkewitz at the New York Personal Injury Law Blog.

Thanks to Mr. Turkewitz for taking the time and effort to approach Dr. Lindeman and for Dr. Lindeman for agreeing to be interviewed. A great series of questions and answers. There is a lesson in this for all of us -- lawyers (plaintiff and defense), physician, hospital CEOs, etc.

Mr. Turkewitz followed up with Dr. Lindeman after seeing that he was interviewed for an article on Canadian doctor blogs, Check my blog and call me in the morning, by the National Review of Medicine. More on the behind the scenes interview for the article at the Canadian Medicine blog.

For more information check out my past post, "The Flea Flicker" and a follow up post highlighting an article I assisted Fard Johnmar, including some basic legal tips for physician bloggers.

Thanks to KevinMD courtesy of Althouse for the tip.

Advocating The Need For A Federal Data Breach Disclosure Law

Information Week's Security Blog advocates for a federal data breach disclosure law in this post, The Time Is Now (Better Yet, Yesterday) For A Federal Data Breach Disclosure Law.

Thanks to the HIPAA Blog for point out the article. I agree with Jeff Drummond's conclusion. After having analyzed overlapping and different state disclosure requirements as a part of assisting clients with data breach issue a federal approach is the direction we should go. (caveat: it should require total preemption - not partial preemption like HIPAA privacy).

A federal approach would help set a national industry standard that can be clearly understood, implemented and followed by those who regularly deal in data, health care or otherwise. The state-by-state patchwork of different laws that currently exist create a complexity that is not needed.

For more on the ongoing complexity issue check out California's recently revised law (AB1298) that recently took effect. AB1298 effective January 1, 2008, expands the coverage and protections to medical information and health insurance information under California's State Information Practices Act.

A clear and concise national approach would simplify compliance for those required to maintain and protect data, including health care providers maintaining health information. Customers and patients who expect their data to be maintained would also benefit by a simplified approach and uniform law that provides for a consistent level of breach notification and protection.

For more on state security breach notification legislation/laws check out the National Conference of State Legislatures website page "Breach of Information". Last updated in April 2007, it states "thirty-five states have enacted legislation requiring companies and/or state agencies to disclosure security breaches involving personal information." I suspect this number will increase after the 2008 legislative sessions around the country.

Also, NCSL provides a summary of data breach notification legislation introduced by year. For 2007, they list three bills introduced (but not passed) before the West Virginia Legislature:

WEST VIRGINIA

WV H 2175	Sponsor: Marshall (D) Title: Acquisition of Security Compromising Data Introduced: 01/16/2007 Location: House Judiciary Committee Summary: Relates to the unauthorized acquisition of data that compromises the security, confidentiality, or integrity of personal information maintained by the data collector. Status: 01/16/2007 INTRODUCED. 01/16/2007 To HOUSE Committee on JUDICIARY.

WV H 2263	Sponsor: Brown (D) Title: Clean Credit Information and Identity Theft Protection Introduced: 01/16/2007 Location: House Judiciary Committee Summary: Ensures clean credit information and identity theft protection (FN). Status: 01/16/2007 INTRODUCED. 01/16/2007 To HOUSE Committee on JUDICIARY.

WV H 2705

Sponsor: Marshall (D) Title: Consumer Right to Impose Freeze on Credit Reports Introduced: 01/30/2007 Location: House Judiciary Committee Summary: Establishes a procedure whereby a consumer may implement a security freeze to prohibit a consumer reporting agency from releasing all or any part of the consumer's credit report. Status: 01/30/2007 INTRODUCED. 01/30/2007 To HOUSE Committee on JUDICIA

As a result of high profile cases like this one that occurred in West Virginia, we will again see activity this year in West Virginia.

WVHCA: Update on the Proposed Cardiac Catheterization Standards

I previously posted about the proposed amendments to the Certificate of Need Cardiac Catheterization Standards issued by the West Virginia Health Care Authority for public comment.

Today, Charleston Gazette reporter, Eric Eyre, reports on the current debate over the standards. To learn more you can read the comments submitted regarding the proposed standards.

2008 WV Legislature: Modification to WV Mental Health Confidentiality Provisions

iHealthBeat (courtesy of Daily Mail) reports on proposed House Bill 4020 introduced last week before the West Virginia Legislature to modify W.Va. Code 27-3-1 authorizing the disclosure of certain mental health records to the National Instant Criminal Background Check System.

According to the article, West Virginia is one of about 24 states that do not allow the release of records to the database. Some states have declined to participate in the federal database because of privacy concerns.

Blawg Review #142: Letter To A New Lawyer

Be sure to check out this week's Blawg Review #142 over at Build A Solo Practice by Susan Cartier Liebel.

This week's edition is creatively formatted as a letter to a new lawyer. Enjoy the read, click on a few of the links and discover interesting posts from around the legal blogosphere.

Dr. Crounse Interviews Dr. Parkinson: A Look Into A New Generation of Physicians and Patients

Bill Crounse, MD of HealthBlog posts about his interview courtesy of ScribeMedia) with Jay Parkinson, MD about his unique business model for today and tomorrows health care delivery - part concierge medicine, part old-time house call infused with modern technology.

Dr Crounse on Dr. Parkinson:

. . . someone who I believe is setting the bar for a new generation of healthcare professionals and the patients they care for. Someone who isn't afraid to buck the system. Someone who says, "why not?" instead of "why?". Someone who just plain understands how to leverage the power of the Net in healthcare . . . he is doing exactly what needs to be done to better serve his patients. He is leading by example, and I have nothing but admiration for what he is doing.

What Do You Get For $2 Trillion?

What do you get for $2 Trillion?
Answer

More from Maggie Mahar at Health Beat Blog with a series of posts on this topic. Great stuff. Tip to KevinMD for the link.

History of HIPAA Standard Patient Health Identifiers

John Halamka at Life as a Healthcare CIO has a nice summary and discussion of the history of the decision not to adopt a HIPAA national standard unique health identifier for each individual patient.

I often talk about this topic when presenting my standard presentation on the various component regulations under HIPAA. Over the years I have asked my audiences whether they think having a standard unique identifier would be a good idea. I saw an upswing in the percentage voting yes after the events of Sept 11. However, over the last couple of year I've again seen that number drop -- not really sure why -- but suspect it has something to do with the increased awareness of the vulnerability of health data as wemove more and more toward a completely electronic system. Maybe the high profile data breach reports also have something to do with the reluctance of individuals to have their health records tied to a single number? Maybe concern over state and federal governments or others using the unique number to more easily access, track information or otherwise use the information?

I agree with John's conclusions that I don't see the federal government adopting a compulsory national health identifier any time soon and that health care technology companies in conjunction with providers will move in the direction of working toward a voluntary standard.

The goal of having a standardized identifier structure is something that those of us in the Health 2.0 community should discuss and work toward. Dr Kibbe shared some great thoughts on these issues and points out that this is one of the pieces of the puzzle that we need to consider as an "accelerator" for Health 2.0.

President-Elect of American Medical Association

Congratulations to Elkins, West Virginia native, Nancy J. Nielsen, M.D., Ph.D., president-elect of the American Medical Association. Dr. Nielsen will only be the second female to hold the position. Another example of a West Virginian making great strides in health care and medicine.

More of the story from today's Charleston Daily Mail. AMA press release dated June 23, 2006.

Health IT Predictions for 2008 by Jane Sarasohn-Kahn

Jane Sarasohn-Kahn has a nice round up of health IT predictions for 2008 over at iHealthBeat. Be sure to check out Get Out the Crystal Ball: Predicting What's Next for Health IT - iHealthBeat.

One correction that I just pointed out to Jane is that Nick Jacobs IMHO is the grandfather of hospital CEO bloggers (started in May 2005) and that Paul Levy comes in a close 2nd. Both are great blogs providing wonderful insight into a variety of topics.