Wednesday, November 26, 2008

Engage With Grace

Last month I had the opportunity to watch Alexandra Drane announce Engage With Grace: The One Slide Project at the Health 2.0 Conference in San Francisco. The idea behind the project is to get people to share just ONE slide that helps them and their loved ones talk about having a purposeful end-of-life experience.

Alexandra's talk personally touched me because my family went through a similar experience 30 years ago when I was 12 years old. My mother died at home with cancer in 1978. She had the opportunity to die at home surrounded by her 5 children because both my dad and uncle were her doctors. In the past and today, not all families are given this important choice. The memories I have of my mother's final days 30 years ago are still important to me today.

Last week, Matthew Holt who blogs at The Health Care Blog and Paul Levy, CEO of Beth Israel Deaconess Medical Center in Boston who blogs at Running A Hospital, spread the word to bloggers about a viral campaign (call it a blog rally) to raise awareness by encouraging families to discuss end of life care issues while gathering for the Thanksgiving holiday weekend.

For West Virginia readers who want to learn more about end of life care I recommend checking out the resources provided by the West Virginia Center for End of Life Care. There is also valuable information for health care professionals. Here individuals can find forms for the standard West Virginia Living Will and Medical Power of Attorney. The site also includes information, FAQs, list of West Virginia palliative/hospice providers and other resources.

Engage with Grace from Health 2.0 on Vimeo.

Below is a message being posted today and throughout the Thanksgiving holiday weekend at blogs around the country and the world:
We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.This has real consequences.

73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences. But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions. Lets start a global discussion that, until now, most of us haven’t had.
Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started. Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them. Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to This post was written by Alexandra Drane and the Engage With Grace team)

UPDATE: Paul Levy provides a post-rally update thanking those engaging gracefully. There were well over 95 bloggers over the Thanksgiving holiday weekend helping to spread the word.

Monday, November 17, 2008

Blawg Review # 186: Blawgers Are All-A-Twitter

Res Ipsa Blog brings you this week's edition of Blawg Review -- Blawg Review #186. This edition begins with a summary of the raging Twitter Wars and includes a link to a post I did last week discussing some of the legal implications of live tweeting in health care.

Check out this week's edition for the latest law news from around the blogosphere.

Thursday, November 13, 2008

Medicare PHR Pilot Project

HealthcareIT News reports on the announcement of a Medicare personal health record (PHR) pilot project that will be made available to Medicare beneficiaries in Arizona and Utah.

The four PHR companies selected out of almost 40 who applied to participate in the pilot are: Google Health, HealthTrio, and PassportMD.

The Arizona Republic has more on the pilot project. More background information on CMS's PHR projects.

Tip to iHeathBeat on the article.

UPDATE: Today's iHealthBeat indicates that interoperable PHRs could result in$21B savings per study conducted by Center for Information Technology Leadership. Read the press release and full Value of Personal Health Records report.

The Implications for Live Tweeting Surgery

Yesterday Robert Hendrick, health care disruptor (I mean that in a positive way) and co-founder of change:healthcare, live tweeted his laser ablation surgery at the Surgical Clinic in Nashville. He also tweeted the first installment of his surgery to remove his varicose veins -- Live from the Operating Room.

Robert and his counterpart, Christopher Parks, are all about transparency in health care, especially as it relates to payment issues. This serves as just one more example of their efforts to engage health consumers and create transparency in health care.

Robert's live tweeting during surgery struck me as an interesting application of Twitter and other mobile social networking application. Here are just a few thoughts:
  • A way to keep friends and family updated on your condition, surgery, etc.
  • Useful for others who might be contemplating a particular procedure or surgery to get a real time look at what might be involved. I know someone who is contemplating undergoing the same procedure and plan to share Robert's posts with them.
  • As more and more patients and providers start to document information via social networking avenues - what might this mean during future litigation and discovery? Certainly seeking tweets, historical Facebook updates, etc. might be valuable in either pursuing or defending litigation. What are the rules for lawyers in pursuing such evidence? What might this mean for the companies providing such services as they see more and more subpoenas for information?
For a real time look at surgery tweets check out Twitter Search for the term -- surgery. Interesting stuff. I welcome others thoughts on the topic.

Thanks Robert for making my day for awarding me "best tweet of the procedure." Follow Robert on Twitter at @Robert_Hendrick.

UPDATE (1/18/09): More discussion on live tweeting surgery. This time it is from the provider side and not just the patient tweeting away their surgery. Henry Ford Health System live tweeted a surgical procedure in Detroit to a group of medical professionals at a conference in Las Vegas.

Shel Israel at Global Neighborhood has a great summary/interview with background on the event that will be part of his upcoming book, Twitterville. Bertalan Mesko has provides coverage about the Live Tweeting Surgery at at ScienceRoll. To find all the tweets about the surgery search via Twitter Search for the tag: #twOR.

After seeing the post by Shel I reached out to him and told him this wasn't the first live tweeted surgery. However, it was the first tweeted "from the provider side" -- @HenryFordNews.@Robert_Hendrick still gets the 1st award from the patient side.

UPDATE (1/29/09): Noticed in my Twitter stream today that Rick Sanchez of CNN is live tweeting his knee/meniscus surgery. Another live tweeting patient. In this case, high profile reporter from CNN. Follow Mr. Sanchez's twitter stream at @ricksanchezcnn.

UPDATE (2/17/09): Elizabeth Cohen of CNN (@elizcohenCNN)covers the live tweeting of surgical procedures by hospitals in the article, Surgeons send 'tweets' from operating room. Included with the article is a video detailing the live twittering at Henry Ford Health Systems. You can also follow the tweet stream of the surgery tagged via Twitter as: #hfhor.

UPDATE (5/26/09): mobilehealthnews provides a historic timeline of the most notable examples of live tweeting surgery in a post, Twitter surgery timeline: 8 months of OR Tweets.

Wednesday, November 12, 2008

Why Is Healthcare So Expensive?

A simplified view of Why is Healthcare So Expensive? from Stay Smart Stay Healthy. Stay Smart Stay Healthy is a Humana new-media venture designed to deliver guidance, and to support awareness and understanding of the healthcare industry.

Our goal is simple: to educate consumers on the healthcare system by removing the usual complexities and replacing them with an informative and engaging series of videos.

Check out their other videos on health care.

Tip from KevinMD.

Tuesday, November 11, 2008

Predicting Flu Season With Google Flu Trends

Google Flu Trends uses search terms as an indicator of flu activity by state.

According to Flu Trends the aggregated search data can estimate flu activity in a state up to two weeks faster than traditional systems. The chart comparison with CDC data is impressive at showing the consistency between tracking search terms vs. using influenza surveillance data. Read about how it works and the FAQs. More background from the NYT in Google Uses Web Searches to Track Flu's Spread

What about privacy concerns? Has Google stepped beyond the boundary of the "trust question" by providing aggregated search information to the CDC? It might depend upon the level of data that is being release to the CDC. Already anyone using Google Trends can get a certain level of aggregated information on a particular topic - for example "Flu".

Privacy is one thing but expectation is another. My experience in dealing with clients on privacy breach matters has lead me to believe that it is often not about whether something should or should not be private -- but rather it is a question of expectation by the person who trusted information with another party. Did that party do something with the information that was unexpected or not agreed to by the parties.

The discussion on privacy has started . . .
Follow the current discussion using the search term: ("google flu trends" privacy) and related search results from Google Blogs.

UPDATE: Interesting follow up thoughts by Mark Hawker and the potential use of Facebook Lexicon as a similar approach to tracking flu and other health conditions.Wasn't aware of Facebook Lexicon feature - interesting tool.

The Health Cloud

Tim Sturgill, MD JD at symtym provides an explanation and insight into the potential shift from silo'ed EHRs controlled by multiple providers to a Health Cloud centralized around a single PHR.

The result of such a shift lessens the need for complex health information exchanges to process and communicate information among a variety of health information silos, matching patient records and trying to match multiple sources of health information that may or may not be identical.

This approach is similar to the discussion and perspective I outlined in a recent article on PHRs for Health Lawyer News.

Graphic image courtesy of Tim's post.

Purkinje: Another SaaS EHR

Justen Deal in his post, Purkinje: stealth fighter, introduced me to another SasS focused Electronic Health Record (EHR) and practice management service provider called Purkinje. Interesting read on the company and its history.

The principle owner of Purkinje is John Doerr, a partner in Kleiner, Perkins, Caufield and Byers, who provides venture capital funding for some of the largest technology companies in the world.

Like Athena Health, who I do know about, Purkinje appears headed in the same direction. I think this business model has a bright future in helping quickly ramp up the adoption of electronic health information systems in medium to small physicians practices. Justen's post provides his prospective on the cost/benefit analysis as compared to traditional EMR software vendors. Also, John Halamka, CIO of the CareGroup Health System and blogger at Life as a Healthcare CIO, lists these types of SaaS EMR providers as part of his Winners in 2009 list.

Sounds convincing from a $$$ standpoint and could be one of the solutions for West Virginia to expedite its efforts to bring low cost, flexible, electronic solutions to the provider community.

Thanks for the tip Justen.

World War II Honoree: LeMoyne Coffield

On this Veterans Day I give thanks to all military veterans who have served their county. Please take time today at the 11th hour of the 11th day of the 11th month to thank a family member, friend or colleague who served their county.

Thanks to my sister Becky who submitted information to the National WWII Memorial to honor my dad, LeMoyne Coffield, and his brother and my uncle, Terrell Coffield. They are my heroes in so many ways. The photo to the right is my dad and his honoree entry reads:


You can search the WWII registry or register an honoree here.

Monday, November 10, 2008

WV Lawyer Disciplinary Board Seeks Comments on Metadata and Wholly-Owned Subsidary Law Firms

The Lawyer Disciplinary Board of the West Virginia State Bar is seeking public comment by February 27,2009, on two draft Legal Ethics Opinions (LEO). The two LEO's were reviewed by the Board at the October 24, 2008 meeting.
Draft L.E.O. 2009-01 What Is Metadata and Why Should Lawyers Be Cautious?
The definition of metadata used in the draft LEO is broad to include all "data behind the data" including the "author's identity, the number of revisions made and comments and redlining." Citing Rule 1.1 and 1.6, N.Y. State Bar Association Committee Op. 782 and D.C. Bar Op. 341, the proposed LEO places a duty on a lawyer to take reasonable steps to protect metadata in transmitted documents. Citing Rule 8.4(C) and N.Y. State Bar Association Committee Op. 749, the proposed LEO also places a duty on the lawyer receiving inadvertently provided metadata to consult with the sender and abide by the sender's instructions before reviewing such metadata.

Draft L.E.O. 2009-02 Wholly-Owned Subsidiary Law Firms.
The draft opinion allows a law firm to form a wholly-owned subsidiary law firm while cautioning lawyers that, in order not to deceive clients and the public, full disclosure of the relationship between the two firms is essential.

Comments must be submitted by February 27, 2009, to the Office of Disciplinary Counsel, 2008 Kanawha Boulevard East, Charleston, West Virginia 25311.

Friday, November 07, 2008

Potential Data Breach and Extortion at Express Scripts

The WSJ Health Blogs reports about a potential data breach at Express Scripts, one of the largest pharmacy benefit management companies in North America. More from Express Scripts on the Facts, FAQs and Other Resources.

The potential data breach came to Express Scripts attention after having received an anonymous letter attempting to extort money from the company by threatening the expose millions of patient records. The threat letter included personal information on 75 members, including names, dates of birth, social security numbers and prescription information.

The article also mentions a similar extortion related data breach which occurred in March 2006 and involved Medical Excess LLC, a subsidiary of AIG. In that case the FBI investigated and arrested an individual who stole a computer server containing personal health information of more than 900,000 individuals. The individual tried to extort AIG for $208,000 after threatening to release the information on the Internet.

According to the FBI Press Release, the individual involved was the first person to be charged under the new federal criminal statute, Title 18 U.S.C. 1030(a)(7)(B) and (C). The new federal criminal statute makes it a federal crime to commit extortion relating to unauthorized access of, or damage to, a protected computer system and/or to impair the confidentiality of information obtained from a protected computer.

To learn more read Express Scripts' press release and related support site.

Wednesday, November 05, 2008

November 5, 2008 - Today Is A New Day!

Today is a new day. Andre Blackman shared the image below (courtesy of Patrick Moberg) with me this via Twitter. The image speaks volumes about the significance of yesterday. Congratulations to President Elect Barack Obama ( blog)

Although West Virginia stayed in the red yesterday there was great support by West Virginians although not always reported that way by the national media. This morning I shared with friends some links to history about a West Virginia lawyer, J.R. Clifford, as a way to reflect on the significance of Obama's win.

Mr. Clifford (wikipedia entry) paved the way in 1898 as a result of his legal work on his most famous case, Williams v. Board of Education Tucker County. The case was the first in U.S. history to hold that discrimination in school terms and teacher pay is against the law. The case occurred 50 years before the landmark Brown v. Board of Education. In 1896, two years prior, Mr. Clifford brought the first legal challenge of the state's segregated school system to the court which he ultimately lost and was not overturned until Brown v. Board of Education. For more on Mr. Clifford check out the J.R. Clifford Project (

As a fellow West Virginian and lawyer I'm proud of Mr. Clifford and his willingness to create change and look forward to supporting President Elect Obama's efforts to create positive change for the United States at home and around the globe.

Monday, November 03, 2008

WVU College of Law: Entrepreneurship Law Clinic

Today the West Virginia State Bar announced a new project at the West Virginia University College of Law to provide legal assistance to technology start-ups, existing small business and nonprofits.

The Entrepreneurship Law Clinic will be directed by Professor Michael V. Risch and staffed by current law students. The Clinic will provide supervised legal counsel to small businesses and start-ups in a clinical setting by offering no cost or low cost assistance.

The Clinic will provide services to clients who are unable to find or afford legal representation. Initial services will include: preformation counseling; choosing and forming a business entity; financing and investing; drafting Articles of Incorporation and Bylaws, LLC Articles and Operating Agreements, etc.; filing for tax-exempt recognition; drafting and negotiating contracts; protecting and licensing intellectual property and forming employment policies.

Congratulations to Professor Risch for starting the new clinic program which will be valuable to the growing creative community looking to stay and invest in West Virginia. The program not only assists those with new ideas or businesses but also provide real life training to law students who will gain invaluable skills to help out lawyers like myself upon graduation.