Tuesday, September 30, 2008

PHR Certification Criteria: Public Comments Being Accepted

Josh Seidman, president of Center for Information Therapy, of provides an update of the status of Certification Commission for Healthcare Information Technology's (CCHIT) process for certification of personal health records (PHRs) over at The Health Care Blog.

CCHIT has published the first draft of the 2009 certification criteria for Personal Health Records (PHR) 09 Introduction and Personal Health Record (PHR) 09 Criteria (Draft 01).

CCHIT is currently taking public comments on the drafts through October 28, 2008.

NY Times Health: Articles On Changing World of Online Health Information

The New York Times Health section in the article, "Logging On for a Second (or Third) Opinion," examines the changing world of online health information search.

As the article points out we are moving from a "search and read" web to a "search, share and interact" web. As Dr. Ted Eytan indicates, we are seeing the "democratization of health care." Patients as consumers are becoming more engaged and knowledgeable through the use of online search and collaboration before and after they visit with a health care professional. Likewise, physicians and other providers are utilizing technology and the evolving social networked web in the same fashion. I agree with the comments of Clay Shirky who indicates patients (aka health consumers) are becoming empowered actors in the health system. The article gives a good overview with links to some of the health care business models evolving in this sector.

Matthew Holt, co-founder of the Health 2.0 Conference, ends the article by stating "the marketplace in information can correct itself over time." He indicates that "the more people you have in the conversation, the better information drives out the worse information." I think there are risks with a socially networked and driven health system but I hope the rewards of improved information, treatment, outcomes and reduced costs outweigh such risks. Time will tell.

A companion article, "You're Sick. Now What? Knowledge is Power," also examines the rise of the empowered health consumer and offers some sage advice on how much information is good, how much is bad and some best practices on using web based health information. The article hits on these key points:
  • The goal is to find an M.D., to become one.
  • Keep statistics in perspective.
  • Don't limit yourself to the web.
  • Tell your doctor about your research.
Much of what is discussed in these two articles will the topic de jour at the Health 2.0 Conference next month in San Francisco. I look forward to attending and participating in the ongoing conversation about how technology is changing the health care industry.

Monday, September 29, 2008

Critical Condition: A Look at America's Health Care System

Critical Condition, a look at the American health care system and crisis, begins airing tomorrow on PBS. Locally it will air on WVPBS beginning Tuesday, September 30 at 9pm with follow up broadcasts on October 1, October 6, October 8, October 13.

View the film trailer and learn more. Below is a synopsis of the film:

Roger Weisberg's Critical Condition is a powerful, eye-opening look at the health care crisis in America. In an election season when health care reform has become one of the nation's most hotly debated issues, Critical Condition lays out the human consequences of an increasingly expensive and inaccessible system. Using the same cinema verite style he employed with Waging a Living (P.O.V., 2006), Weisberg allows ordinary hard-working Americans to tell their harrowing stories of battling critical illnesses without health insurance.

The four people profiled in Critical Condition live in places as diverse as Los Angeles; Austin, Texas; and Bethlehem, Penn., but they face distressingly similar obstacles to surviving without health insurance. It is through their eyes and words that we are taken through the gaping holes in the health care system, where care is often delayed or denied. Ultimately, the unforgettable subjects of Critical Condition discover that being uninsured can cost them their jobs, health, homes, savings, and even their lives.

Critical Condition dramatizes how health care is rationed based on ability to pay. "It's your money or your life," says one of the film's subjects, who courageously lays bare the uncounted cost in pain and suffering that is borne by millions of uninsured Americans

As the film illustrates, the country spends over $2 trillion a year — over $6,000 per person — on health care, yet is the only major industrial nation without universal coverage. Forty-seven million Americans live without health insurance, and 80 percent of them are from working families who either cannot afford insurance premiums or lose their insurance exactly when they need it most: when they fall ill and can no longer work.

Despite spending 50 percent more on health care than any other country in the world, America ranks 15th in preventable death, 24th in life expectancy, and 28th in infant mortality. The struggles of the four families profiled in Critical Condition put a human face on just what these statistics really mean for ordinary Americans.

Friday, September 26, 2008

WV Creative Communities Project: New Martinsville and Bethany

West Virginia's Creative Communities Under Construction project is underway to promote the Create West Virginia Conference set for October 20-22 at Snowshoe Mountain Resort. The viral campaign is being spread by West Virginia bloggers. If you are creatively curious, attend the conference and check out the Create WV Blog.

I'm promoting the conference because the future of West Virginia lies in creating a "new" intellectually-based economy using the creative skills of our people. Focusing our efforts on this type of economy creates a "wonderful" environment to live in where "wild" ideas can thrive. I want to attract similarly minded people to West Virginia who believe intelligence, creativity, technology, innovation, arts and culture are the foundation for our future.

The viral campaign asked that we each highlight an element of the new economy in our hometown or county. Since others will cover Charleston, I thought I would share information about my hometown, New Martinsville, and Wetzel County. New Martinsville is a community where a kid named Greg Babe (related story from Wheeling Intelligencer) can grow up "out Doolin" to become the first American to lead a German-based global chemical and pharmaceutical company, where a girl named Sandra Block, who ran around the local newspaper with her mom, can grow up and write about Money for USA Today, where a kid named Ralph Baxter can grow up to lead a global law firm, and where a boy named Bill Stewart, who played high school football, can realize his dream of leading the Mountaineers.

Although New Martinsville, like many West Virginia communities, has struggled economically, one bright example of entrepreneurship is Baristas Cafe & Pub on Main Street where you can drink locally and think globally. Baristas is a great place to hang out any time of the day or night and get a coffee, have some brick oven pizza or sip a Guiness.

How many baristas can claim a feature article in the New York Times written by Rebecca Skloot who sometimes escapes to the hills of Wetzel County to write (and blog)? Skloot's article captures the early essence of Baristas' opening in New Martinsville, and although probably an over simplified view of my howetown, gives a glimpse at the comparison between the old and new economy existing in West Virginia.

Another shining example of creative entrepreneurship in Wetzel County is Thistle Dew Farms and Mountain Craft Shop located "out Proctor." Thistle Dew is owned by Ellie and Steve Conlon who left Philadelphia with two bee hives in 1974.
Today they operate an environmentally friendly beekeeping business with over 700 bee hives and produce some of the sweetest stuff that West Virginia offers. In 2002, they acquired the Mountain Craft Shop, a business founded in 1963 by folk toy master Dick Schnacke. Thanks to the Conlons', the amazing vision, creativity and tradition of Mr. Schnacke continues -- employing local woodworking artisans and giving children around the globe (including my own) the experience of a whimmydittle or flipper dinger.

Below is a guest commentary by the President of Bethany College, Dr. Scott D. Miller, highlighting the new economy opportunities being developed at Bethany College in Bethany, West Virginia.

I approached President Miller with this project because I thought it important to highlight what I think is the best kept educational and community experience in West Virginia -- the Bethany Community. My undergraduate years (1984-88) were spent at Bethany and provided me with education and experience to become a successful health care and technology lawyer. President Miller's latest editorial in the West Virginia State Journal, "It's Time to Get Serious About Global Awareness," is the type of innovative and progressive thinking that goes on at Bethany. The editorial is timely in light of the topics to be discussed at the Create WV Conference.

Below is guest commentary provided to me by Dr. Miller:

"West Virginia in the 21st Century: A World Without Borders - A Future Without Limits."

At Bethany College, we are preparing students to participate in a new world defined far more by intellectual limitations than geographic boundaries. The majestic mountains and raging rivers that created West Virginia’s borders stood as barriers to progress in the past. But as our state moves forward into the 21st Century, technology has given us the opportunity to play a major role in a world without borders and a future without limits.

I devoted my September Higher Education column in the State Journal to exploring how our state’s colleges and universities could best groom our students to compete in a marketplace where Beijing is a mere mouse click away from Buckhannon. The success of three alumni illustrates the unlimited potential that awaits individuals who are willing to embrace the concept of global awareness with innovation and creativity. Thomas Buergenthal is the only American Judge on the International Court of Justice in The Hague, Netherlands. Gregory Jordan, Chairman of our College’s Board of Trustees, is Global Managing Partner for Reed Smith, LLP, one of the largest law firms on the planet. George “Ken” Bado helps shape how we view the world – literally – he serves as Executive Vice President of Sales and Service for Autodesk, a company whose computer technology helps build the largest dam in the world in China, and provides special effects for most of the movies you view.

We believe it’s important to be on the cutting edge of providing new and challenging opportunities for students to expand their academic horizons. John Osborne, our Director of Career Counseling and Placement, has a “been there, done that” style. After graduating from Bethany, he spent 16 years in a variety of senior management positions with Apple Computer and another decade in management at IBM. There’s no substitute for a counselor with personal experience when your son or daughter is trying to chart out the next 40 years of his life.

We’ve put these ideas into practice outside our classrooms, as well, with the Camp Canyon youngsters who visit our campus each summer. Our unique staffing arrangement, which utilizes local college-level coaches and instructors along with American and international “skill-specific” professionals, gives us the flexibility to create multiple specialty camp experiences in a traditional “summer camp” setting.

The 21st Century offers opportunities and challenges for West Virginia and West Virginians. It’s time for us to realize that borders are nothing more than lines on a map in this increasingly global economy.

Dr. Scott D. Miller
Bethany College

Thursday, September 25, 2008

Work In Progress: West Virginia Creativity

Check back tomorrow for more on the Creative Communities Under Construction Project. I'll be posting tomorrow on elements of the new economy in my hometown of New Martinsville.

Signs around Charleston have started to appear . . .

WVHCA Examining Current CON Standards

The West Virginia Health Care Authority has scheduled various public meetings over the coming months to discuss and examine the current certificate of need standards for a variety of service areas.

As states on the Authority's website these meetings are being held as a part of the legislature's review of West Virginia's certificate of need statute.

The dates of the meetings scheduled to be held at the Authority's Charleston office are as follows. Most of the meetings are set for 1pm. Those interested can also participate by phone. Call-in information: 1.800.244.2500, Code #9271804.

September 25 - Renal Dialysis
October 7 - Hospice & Home Health
October 14 – Medical Rehabilitation
October 15 – Lithotripsy (2nd meeting)
October 22 – Long Term Care
October 23 – Ambulatory Surgical Care
October 28 - Ambulatory Care Centers
November 5 - Radiation Therapy
November 12 - Imaging
November 13 - Behavioral Health
November 19 - In Home Personal Care
November 20 – Private Office Practices

Tuesday, September 23, 2008

Grand Rounds 5th Anniversary Edition

The 5th Anniversary edition of Grand Rounds hosted by Dr. Val is up at two locations -- KevinMD and Emergiblog. If you want to know what is happening around the health care blogosphere Grand Rounds is required weekly reading.

Great to see Dr. Val carrying on the tradition of Grand Rounds started by Dr. Nick Genes by becoming the co-leader. Check out the upcoming Grand Rounds host schedule at Medskool link.

Monday, September 22, 2008

Michael Gerrard: National Environmental Lawyer and West Virginia Native

Dave Yaussy over at the WV Environmental Law blog beat me to the post. The Sunday Charleston Gazette featured another nationally recognized lawyer with West Virginia roots.

Featured in the article was Michael Gerrard, a nationally known environmental lawyer and current managing partner of the New York office of Arnold & Porter, LLP. Mr. Gerrard grew up in Charleston, West Virginia not far from where I currently live in South Ruffner near the University of Charleston.

While looking over his profile and publications I noticed a timely article as we head down the home stretch to the election. The article looks at environmental policy positions of McCain vs. Obama. The article, McCain vs. Obama on Environment, Energy and Resources was published in Natural Resources & Environment, ABA, Fall 2008.

Mr. Gerrard follows on a list of well known West Virginia lawyers who are heading up some of the largest law firms around the globe, including Ralph Baxter and Greg Jordan.

Great to see successful fellow West Virginians who help to project a positive stereotype of of West Virginia.

Sunday, September 21, 2008

Follow The Top Lawyer Twits

Last week I noticed that I made JDScoop's list of 145 lawyers and legal professionals to follow on Twitter. I came in at #137 (@bobcoffield). Also making the list is my firm's IT Director, Bill Gardner, coming in at #69 (@oncee).

The list is a great resource to find some of the leading lawyers experienced in adopting new social media tools into their practice of law. I've already started following a couple of colleagues who I didn't know were twittering.

Thanks JDScoop for including me on the list of influential legal twitters (aka litters). Thanks to Steve Mathews at stem for pointing out the post.

100 Best Health Care Policy Blogs and Top 50 Best Health 2.0 Blogs

Thanks to the folks at RNCentral.com for naming the Health Care Law Blog to its list of the 100 Best Health Care Policy Blogs (see #21 under Politics, Legislation and Law category) and the Top 50 Health 2.0 Blogs (#49 under the Health Care Policy and Law category).

Looking over both lists of blogs its a privilege to be listed alongside some of the best health care industry thinkers and writers. If you are new to health blogs or health 2.0 this is a excellent resource.

Tuesday, September 16, 2008

HIPAA: Can you release medical information to family and friends?

My favorite fellow HIPAA blogger, Jeff Drummond, over at the HIPAA Blog points out the Office for Civil Rights has issued new guidance for providers to follow when assessing whether or not they should provide protected health information (PHI) to the friends or family of a patient under HIPAA Privacy Rule 164.510(b).

The guidance is titled "Guidance on Communications with Family, Friends, or Others Involved in a Patient's Care" and includes a patient and provider guide:
  • Patient Guide: When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved in Your Care
  • Provider Guide: Communicating with a Patient's Family, Friends, or Others Involved in a Patient's Care
Thanks Jeff for the tip on the new guidance information.

BeBetter: Charleston Based Health Company Is 15th on Inc.'s 5000 Fastest Growing Private Companies

Today's Daily Mail covers Charleston based beBetter Networks, Inc. selection as the 15th fastest growing private company in the U.S. BeBetter was selected and is highlighted in Inc. Magazine's September edition featuring the 5,000 fastest growing companies.

BeBetter's three year growth rate was 6,675% and Inc. Magazine names beBetter as the industry leader in the health care sector ranking. See the full list of 5000 fastest growing.

The Daily Mail article points out that the company has developed several Web sites, including one mentioned that caught my eye called the Portion Plate. The website includes information to better understand the importance of portion control and help individuals visualize the correct portion size. The site is focuses on fighting the growing obesity problems in U.S. and West Virginia.

Congratulations to beBetter Network. Great to see a West Virginia based company in the top 20. Keep up the great work.

Monday, September 15, 2008

Friday, September 12, 2008

Doc Searls: The Patient as the Platform

Doc Searls on The Patient as the Platform.

I missed this post and am glad it was pointed out via Twitter. The title caught my eye because it captures in a phrase what I think may be happening to our health care information system - a shift from provider-centric records to patient-centric records.

Thanks to Jen McCabe-Gorman for the twitter tip.

Obama vs. McCain: A look at the differences in health care reform policies

For those interested (and we all should be) in the differences between the health care policies of Obama and McCain I a sharing a recent article appearing in the August 21 issue of The New England Journal of Medicine.

The article is by Jonathan Oberlander, professor of health policy at the University of North Carolina at Chapel Hill titled, "The Partisan Divide: The McCain and Obama Plans for U.S. Health Care Reform." It takes a look beneath the campaigns' rhetoric to discuss the substantive differences in the candidates' approaches to health care delivery as well as the relative costs and benefits of their two proposals.

Thanks to the AHLA physcian organization practice group for pointing out the article.

The Facebooking of Medical Records

Bob Wachter on the Facebooking of medical records over at The Health Care Blog. Great thought provoking read for those in the health care world and who understand the powers of online social networking tools for communication.

Recently I just completed co-authoring with Jud DeLoss the feature article for the next AHLA Health Lawyers News on PHRs where we discuss what may be a major shift in health information gathering from provider-centric to patient-centric. Basically the rise of the PHR and what may be on the horizon for health lawyers with such change. Bob's example and analogy of the Facebook culture is a valuable one as we look at the pros/cons of such a shift. His thoughts on leveraging the value of collaborative social networking tools to reinvent the medical record system are valuable and should be considered as we look at ways to improve the bedrock of good medical care -- the patient history and record of care.

I'd take the ideas a bit further and provide another analogy. Think about the use of Twitter (or recently discussed and TC50 winner Yammer - Twitter for businesses) like solutions to allow access to a real time updates of the patient's condition in timeline fashion among those caregivers providing care to the patient. The providers would be the followers. If able, the patient could also participate in this stream of information. Sounds a bit like Dr. Wachter's synopsis program.

Just some Friday morning thoughts. Would be interested to hear from others in the comments.

Wednesday, September 10, 2008

California Proposes New Privacy Breach Protections: Will Other States Follow The Trend?

Last month The LA Times reported on a new law (AB 211 and SB 541) moving through the California Legislature to increase protections around confidential medical and health information and create a new state Office of Health Information Integrity to oversee compliance, investigate breaches and assess fines.

The article cites the high profile celebrity snooping cases into the records of Britney Spears, Farrah Fawcett and California First Lady Maria Shriver as recent examples highlighting the need for more protection. Governor Schwarzenegger has a personal interest in signing this bill if it gets through the legislature. The Health Law Prof Blog provides some additional insight and information on the bills.

As is often the case California is a leader in new legislative initiatives and I suspect we will see other states following the lead this coming legislative session looking at implementing or revising current breach notification and privacy of health information laws.

For more information on the bills check out the following additional information.

AB 211 (August 22, 2008 amendment) currently appears to be in the final stages of being passed by the California State Assembly. The bill creates a new Office of Health Information Integrity and gives the office powers to levy administrative fines and penalties. The bill also authorize the office to forward on the potential violation to the appropriate licensure bodies.

Following is the Legislative Counsel's Digest summary version of AB 211 (amended August 22, 2008):
AB 211, as amended, Jones. Public health. 
Existing law permits the establishment of the position of county
health officer for the performance of various duties and powers
relating to public health.

This bill would authorize the local health officer to provide
assistance to cities and counties with regard to public health issues
as they relate to local land use planning and transportation
planning processes.

Existing law prohibits a health care provider, health care service
plan, or contractor from disclosing medical information regarding a
patient of the provider or an enrollee or subscriber of the health
care service plan without authorization, except as specified.
Existing law makes it a misdemeanor to violate these provisions
resulting in economic loss or personal injury to a patient, as
specified. In addition, existing law authorizes administrative fines
and civil penalties against any person or entity that negligently
discloses, or knowingly and willfully obtains, discloses, or uses
medical information in violation of these provisions, as specified.
Existing law specifies the entities that may bring a civil action to
recover civil penalties.
This bill would require every provider of health care ,
as defined, to prevent the unlawful access, use, or
implement appropriate specified safeguards
to protect the privacy
of a patient's medical information. The
bill would require every provider of health care to monitor
employees who have access to patient medical information, as
specified, to ensure compliance. The bill would also require a
provider to establish and maintain appropriate safeguards and
policies to ensure the confidentiality and security of medical
information, as specified
reasonably safeguard
confidential medical information from unauthorized or unlawful
access, use, or disclosure
. The bill would establish within
the California Health and Human Services Agency the Office of Health
Information Integrity to assess and impose administrative fines for a
violation of these provisions, as provided. The director would be
appointed by the Secretary of California Health and Human Services.
The bill would establish the Internal Health Information Integrity
Quality Improvement Account for the deposit of funds derived from
these penalties. Upon appropriation by the Legislature, the bill
would authorize money in the account to be used to support quality
improvement activities. The bill would also authorize the director to
make send a recommendation to
the licensing authority of a health care provider
investigation of, or discipline of
the licensee, as specified, and to recommend that a civil action to
collect penalties be commenced
for, a potential
violation to the licensee's relevant licensing authority

This bill would provide that any costs created pursuant to this
act associated with the implementation and operation of the Office of
Health Information Integrity shall be funded through non-General
Fund sources.

Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.

SB 541 passed the Senate on August 29, 2008 and is now in enrolled status. The bill creates specific penalties for the unlawful or unauthorized access to patient medical information and sets the fines at $25,000 per patient with a $250,000 cap per reorted event. It also sets a per day fine for failing to notify patients impacted by a breach after 5 days.

Following is the Legislative Counsel's Digest summary version of SB 541:
 SB 541, Alquist. Clinics, health facilities, home health agencies,
and hospices: administrative penalties and patient information.
Existing law provides for the licensure and regulation of clinics,
health facilities, home health agencies, and hospices by the State
Department of Public Health. A violation of these provisions is a
Existing law authorizes the department to assess a licensee of a
general acute care hospital, an acute psychiatric hospital, or a
special hospital an administrative penalty not to exceed $25,000 if
the licensee receives a notice of deficiency constituting an
immediate jeopardy to the health or safety of a patient and is
required to submit a plan of correction. Existing law makes these
provisions applicable to incidents occurring on or after January 1,
This bill would increase this administrative penalty to be up to
$100,000 for incidents occurring on and after January 1, 2009. This
bill would set the administrative penalties, for incidents on and
after January 1, 2009, at up to $50,000 for the first administrative
penalty, up to $75,000 for the 2nd subsequent administrative penalty,
and up to $100,000 for the 3rd and every subsequent violation.
Existing law also provides that, upon the adoption of specified
regulations, the administrative penalty for an immediate jeopardy
violation may be up to $50,000. If the violation does not constitute
an immediate jeopardy violation, the penalty may be up to $17,500,
except that no penalty shall be assessed for a minor violation.
Under existing law, moneys collected by the department as a result
of the imposition of the above penalties are required to be
deposited into the Licensing and Certification Program Fund, to be
expended, upon appropriation by the Legislature, to support internal
departmental quality improvement activities.
This bill would increase the administrative penalties for an
immediate jeopardy deficiency from $50,000 to a graduated scale of a
maximum of $75,000 for a first penalty, a maximum of $100,000 for the
2nd penalty, and a maximum of $125,000 for the 3rd and subsequent
penalties, and would increase the penalty for deficiencies not
causing immediate jeopardy from $17,500 to $25,000. The bill would
apply the penalty provisions only to incidents occurring on or after
January 1, 2009.
The bill would specify that, for any of the above administrative
penalties, a penalty issued after 3 years from the date of the last
issued immediate jeopardy violation be considered a first
administrative penalty so long as the facility has not received
additional immediate jeopardy violations and is found by the
department to be in substantial compliance with all state and federal
licensing laws and regulations. The bill would give the department
full discretion to consider all factors when determining the amount
of an administrative penalty.
This bill would require health facilities, clinics, hospices, and
home health agencies to prevent unlawful or unauthorized access to,
or use or disclosure of, a patient's medical information, as defined.
The bill would authorize the department to assess an administrative
penalty of up to $25,000 per patient for a violation of these
provisions, and up to $17,500 for each subsequent accessing, use, or
disclosure of that information.
The bill would require all of the administrative penalties to be
deposited into the Internal Departmental Quality Improvement Account,
which would be created within the existing Special Deposit Fund, and
would delete the requirement that certain of the penalties be
deposited into the Licensing and Certification Program Fund. The bill
would require moneys in the account to be used for internal quality
improvement activities in the Licensing and Certification Program.
This bill would impose specified reporting requirements on a
health facility or agency with respect to unlawful or unauthorized
access to, or use or disclosure of, a patient's medical information,
and would authorize the department to assess a penalty for the
failure to report, in the amount of $100 for each day that the
unlawful or unauthorized access, use, or disclosure is not reported,
up to a maximum of $250,000. The bill would authorize a licensee to
dispute a determination of the department regarding a failure to make
a report required by the bill, as provided.
By expanding the definition of an existing crime, this bill would
impose a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.

Tuesday, September 09, 2008

5 blogs & 5 blawgers

David Harlow blogging on health care law at HealthBlawg tagged me via his version of 5 blogs & 5 blawgs. A new law meme started by the editor of Blawg Review in honor of Blog Day.

The basic rule is to post links to five great blogs (other than law blogs) and tag five of your favorite law bloggers (otherwise known as blawgers) to do the same under the post title "5 Blogs & 5 Blawgers".

5 blogs that I enjoy reading and recommend to others:
5 blawgers who I am tagging to spread "5 Blogs & 5 Blawgers" on to other blawgers:

Is Your Health Care Killing You?

Check out and download for free the EBook, "My Health Care Is Killing Me: a survival guide for the american healthcare consumer."

The book was written by a couple of colleagues, Christopher Parks and Robert Hedricks, health care technology innovators and disruption mavericks who started change:healthcare based in Nashville.

A short interview covering the who, what why about the book. The basic reason for writing the book is summarized by Robert as:
It really began as a way to help our employees – some of whom hadn’t worked in healthcare before – better understand key aspects of the industry and our role in helping consumers regain control over their own healthcare. I began writing by covering some of the basics – providers, bills, insurance, industry terminology – and things just cascaded from there.
Congratulations on completing the book and love the cover photo of the two of you running down the hall. Very appropriate.

UPDATE: Notice the tagged "book cover outtake" photos on Facebook of Christopher and Robert. Fun stuff. I especially the shot to the right for volume 2 - How Our Health Care Is Killing Primary Care Physicians.