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Medicine 2.0 in Toronto

Next week I’m heading up to one of my all-time favorite places, namely Toronto, for the Medicine 2.0 Congress, put together by Dr. Gunther Eysenbach of the University of Toronto‘s Centre for Global eHealth Innovation. I usually don’t advertise my travels ahead of time for competitive reasons (everyone in this business goes to HIMSS, so I’ll talk about that in advance), but I see so many familiar names on the agenda and on the list of planned attendees, that I feel compelled to do so.

If you’re going to be there, drop me a line and we can make plans to chat and/or grab some libations.

See you in T.O.

August 29, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More from Bellagio

Here’s one more story I wrote as a result of the Making the eHealth Connection conferences in Bellagio nearly a month ago. It’s about RAFT, the Réseau en Afrique francophone pour la télémédicine (Telemedicine Network in French-speaking Africa), which connects remote and underserved African communities in 15 countries to medical professionals worldwide. RAFT is a program of the Geneva University Hospitals and the cantonal government of Geneva, Switzerland.

The story appeared in E-Health Europe on Aug. 4, while I was still in Italy.

August 27, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Davies Public Health winners

I’ve just gotten the news that the Cherokee Indian Hospital Authority in Cherokee, N.C., and the New Jersey Department of Health and Senior Services have won the 2008 Nicholas E. Davies Public Health Awards of Excellence.

The Cherokee Indian Hospital Authority, part of the Indian Health Service, does not have its own Web site, but I did find one presentation that might shed some light on the IT work being done there.

For info on the Davies Awards, click here.

On an unrelated topic, check out the op-ed piece in Tuesday’s Christian Science Monitor by Sue Blevins of the Institute for Health Freedom, where she calls for Congress to scrap HIPAA and pass a new health privacy law.

I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Health Wonk Review

This week’s Health Wonk Review is up at the Workers’ Comp Insider blog. As the name implies, it does indeed cover a full spectrum of health and healthcare issues, but IT definitely is represented, and not just by me.

Thanks to Julie Ferguson for hosting and compiling this edition. Apparently, she did it from the beach.

August 21, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Privacy, please

A weekend trip to Maine for a family wedding turned into a business trip (and a tax deduction) when I was reminded that the 16th National HIPAA Summit and related Privacy Symposium were taking place at Harvard University this week. Since I was flying in and out of Boston, I hesitantly forked over the $150 extortion—er, change—fee to American Airlines and sprung for a hotel room, mostly so I could attend a heated debate—er, “roundtable discussion” (even though the table was not round)—about whether patient privacy rules were effective.

I’m pretty sure it was worth the money. Boston usually is. While in the area, I also got a tour of athenahealth’s Watertown headquarters. I learned that “chief athenista” and new daddy Todd Park is on paternity leave for the next several months, is relocating to the west coast and will come back as a board member only while he dedicates much of his time to some new ventures.

But I digress once again.

The roundtable featured a couple of heavy hitters in the privacy world, namely Dr. Deborah Peel and Dr. Bill Braithwaite, as well as Partners HealthCare System Chief Privacy Officer Karen Grant, Linda Sanches, representing the HHS Office of Civil Rights, and, via telephone, Jodi Daniel, from the Office of the National Coordinator. Given the expense I just incurred, I wrote a story Tuesday about the Peel-Braithwaite debate for someone who actually will pay me, Digital HealthCare & Productivity.

In the interest of getting the news out and getting picked up by this week’s Health Wonk Review, I’m going to give you for free some notes from other Tuesday sessions.

On Friday, HHS released some proposed dates for transitioning to the next generation of HIPAA transactional code sets—otherwise known as ANSI X12 version 5050—as well as to ICD-10 standards for E&M coding. The proposal also includes the the National Council for Prescription Drug Programs standard version D.0 for electronic pharmacy transactions.

The full language is at and will appear in this Friday’s Federal Register to trigger a 60-day comment period, closing Oct. 21.

“This is not a do-over of HIPAA,” said Workgroup for Electronic Data Interchange Chairman James Whicker, who also phoned in to the HIPAA Summit. Whicker, director of EDI and e-commerce at Intermountain Healthcare in Salt Lake City, said that changes are necessary because the current version 4010A1 is more than six years old already and has significant shortcomings.

Among the changes he highlighted:

  • The 835 transaction for remittance advice adds an embedded link to payer URLs for some payment adjustment and denial codes.
  • 834 will allow ICD-10 to report pre-existing conditions and address some privacy concerns
  • 270 and 271 eligibility transactions bring what Whicker called “a significant number of changes and improvements” from the provider perspective. For example, he said, the new code sets clarify instructions for sending inquiries based on whether the patient is the health plan’s primary enrollee or a dependent. If the eligibility date, plan name or benefit effective date for a particular encounter is different from that of the overall coverage, the health plan must report it as part of the transaction. Version 5010 also requires alternate search options for 270 and 271 transactions so a provider can search by member ID, last name only or date of birth to help eliminate false negatives and phone calls, Whicker said.
  • 276 and 277 transactions for healthcare claims status have minor changes addressing privacy concerns over sensitive patient information that is unnecessary for business purposes.
  • Implementation guides will no longer be free when 5010 takes effect.

I personally don’t know what to make of the 5010 news, but I know that there is significant opposition to the proposed Oct. 1, 2011, compliance date for ICD-10. As Whicker spoke, I was reading a press release from the Medical Group Management Association denouncing the idea, and would wager a large sum that the American Medical Association thinks three years and two months is not long enough.

And now back to the privacy debate.

In a separate session, Sanches vigorously defended OCR’s record on HIPAA privacy enforcement, despite the fact the office has not assessed a single civil monetary penalty in the five years the rules have been in effect. “Our enforcement has resulted in changes,” Sanches said, a sentiment also expressed by Michael Phillips, a health insurance specialist in the CMS Office of E-Health Standards and Services regarding enforcement of HIPAA security regulations.

Sanches said most privacy complaints have either been dismissed or resolved with corrective action, while some, as with Providence Health and Services last month, have been settled with with “resolution agreements,” usually resulting in a fine. Sanches described the resolution agreements as “forward-looking,” since they require corrective action even though there is no admission of liability. “We will be monitoring their compliance,” Sanches said of Providence, which agreed to pay $100,000 as part of the deal.

Suffice it to say, OCR still has plenty of critics. Deven McGraw, director of the Health Privacy Project at the Washington-based Center for Democracy & Technology, said that enforcement clearly is lacking. “When you haven’t imposed a single civil monetary penalty, you are not sending a message that you are going to hit people in the pocketbook,” McGraw said during a joint session with Peel.

Those who don’t know Peel well might think she would wholeheartedly agree with this sentiment, but she says the August 2002 HIPAA privacy amendments that created the “treatment, payment and healthcare operations” exemption effectively neutered the rule. “We believe there is nothing for OCR to enforce because there isn’t a privacy law anymore,” she said, arguing that lack of privacy is keeping people from seeking treatment for some conditions, including Iraq war veterans who might suffer from depression or post-traumatic stress disorder.

As for HIPAA security enforcement, Phillips said OCR gets many more privacy complaints per year than CMS does for the security rule, largely because so many violations involve paper PHI and the security rule only applies to electronic information. He said that CMS has received 350 security rule complaints, to date, but, surprisingly, given all the attention paid to laptop theft, only 10 percent have involved lost or stolen devices.

Of those 350 complaints, 248 have been resolved and 102 investigation remain open.
Phillips also discussed the CMS contract with PricewaterhouseCoopers to conduct 10 compliance reviews this year, saying that the audit firm has done six reviews, including the well-publicized critique of Piedmont Healthcare in Atlanta. Phillips said CMS will share information about one of the 10 cases when all the reports are done.

Another conference session focused on the Piedmont case, and I think I will do a story for one of my publication clients in the next week or two. Stay tuned.

And finally, since anything involving David Brailer tends to generate a lot of traffic to this site, I shall call your attention to the following from former U.S. Sen. Dave Durenberger (R-Minn.), who founded and chairs the National Institute of Health Policy and sits on the Medicare Payment Advisory Commission:

DAVID BRAILER a few short years ago was the No. 1 name in American healthcare according to the annual Modern Healthcare survey of important people in the field. His job then was to be President Bush’s “Health Information Czar” to get the medical system moving toward automation and electronic information interchange.

Today he runs Health Evolution Partners out of San Francisco. He says HEP was founded to accelerate the best in the inevitable change taking place in the healthcare market. It will focus on redefining quality, efficiency and accountability of healthcare services to consumers and payers. He has developed a “Purchaser Value Initiative” as well, and raised nearly a billion dollars from CALPERS and from an additional four or five state public employees retirement funds (including Minnesota).

Susan and I enjoyed lunch with David recently at the Buckeye Roadhouse just off CA Highway 101 near Sausalito. David’s no. 1 interest these days is in his family, especially his seven-year old son and year old daughter. I listened to much of a fascinating discussion over elementary education in San Francisco and the merits of various institutions before we got to passion no. 2. How health system entrepreneurs will use the cost-quality-access quandary we face in this country, to innovate our way to better health, medical care and health management services.

Listening to Brailer, you get the impression that there may have been a lot not to like in the Bush administration’s approach to “consumer driven healthcare.” On the other hand, it focused us on a critical reality. Everyone in America is a potential consumer of better health, more appropriate medical services and, someday, good judges of value in the healthcare system. Entrepreneur innovators are doing it right now, and Brailer’s EHP team will help make sure they succeed.

August 19, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

A healthcare blogger gets published

Nick Jacobs, CEO of Windber Medical Center in Windber, Pa., and author of Nick’s Blog, seems to be doing quite well with the writing thing.

He has just released a self-published book called “Taking the Hell out of Healthcare: A patient’s guide to getting the best care.” Jacobs describes it as “a book on how to get the same treatment as the CEO’s family in any hospital, a book on patient advocacy.” The project took four years.

But he is not stopping there. Jacobs is compiling two years of humor columns on childhood, parenthood and grandparenthood he wrote for two local newspapers into a yet-untitled book to be published in October. And he is working on a third book on healthcare administration, leadership and public health policy, which should be ready by next spring.

Jacobs qualifies as a Friend of This Blog for sitting down with me last year for a podcast.

August 13, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Podcast: Judith Rodin and Ariel Pablos-Méndez of the Rockefeller Foundation

As regular readers know, I was fortunate enough to be invited by the Rockefeller Foundation to Bellagio, Italy, last week for the third of four weeks in a series of conferences called Making the eHealth Connection. The goal was for a small group of technology and healthcare informatics leaders to come up with actionable ideas to use IT to improve the health of people in the developing world.

The week I was there focused on electronic health records and mobile health.

While I was in Bellagio, I interviewed Judith Rodin, Ph.D., president of the Rockefeller Foundation (and former president of the University of Pennsylvania), and Ariel Pablos-Méndez, M.D., managing director of the Rockefeller Foundation and the head of health programs. Unfortunately, there was an echo in the room that found its way onto the recording. And unfortunately the battery ran out of my recorder before I got done chatting with Dr. Pablos.

We also take a while getting into the discussion about IT, but I still think it’s an interesting interview.

Podcast details: Interview with Judith Rodin, Ph.D., and Ariel Pablos-Méndez, M.D., of the Rockefeller Foundation. Recorded July 29, 2008, in Bellagio, Italy. MP3, mono, 64 kbps, 14.5 MB, running time 31:41.

1:05 Rationale behind the conferences
1:55 Harnessing the beneficial aspects of globalization to fix the negative effects
2:50 Why e-health in the developing world?
5:00 Affordability, accessibility and quality of care
5:28 “Leapfrog” strategy for bringing technology to underserved areas
6:50 Market opportunities from public-private partnerships, even in poor countries
8:02 E-health as a remedy to globalization of diseases
10:30 Bold, actionable ideas
12:22 “Game-changing ideas” from previous Bellagio conferences
13:15 Welcome to Dr. Ariel Pablos-Méndez
14:05 The foundation’s current attempt to strengthen health systems and long history of creating global programs
15:15 Breaking down the silos of health programs in developing countries
16:05 Worldwide concerns go beyond HIV/AIDS
16:40 Problems with access to care, and the role of telemedicine
17:10 Problems with affordability and efficiency
18:20 Good health at low cost
19:15 Theory that the future will be about more health for the money rather than more money for health
19:45 Current Rockefeller Foundation health programs: access
20:35 Role of the private sector in health systems in developing countries
22:45 E-health in the developing world
23:50 Challenges and opportunities in e-health
24:55 Interoperability issues with legacy systems
26:20 Technology transfer from U.S. institutions to Africa before legacy systems become a problem
27:34 Why the timing is right for IT and for these conferences
28:10 Needs: collaboration, agenda setting, capacity building, evidence, applications
30:00 Bold ideas: British NHS and a system in Sao Paolo, Brazil, sharing code with South Africa and developing a framework strategy for e-health

August 8, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

‘Holy Grail’ in open source?

Open-source devotee Fred Trotter reports today that ClearHealth apparently has reached what he calls the “Holy Grail of open-source medical informatics”: a Web-based version of CPRS, the user interface for the Veterans Health Administration’s vaunted VistA system.

ClearHealth today has posted screen shots of the beta version of what it calls WebVista. I’m not a techie, I’m not well-versed in open source. Is this is a big deal? Someone please tell me.

Also, someone please tell ClearHealth that there has not been a “Veterans Administration” since 1989. It’s called the Department of Veterans Affairs.

August 7, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Scott Wallace resurfaces

I learned a few weeks ago, almost by accident, that former National Alliance for Health Information Technology CEO Scott Wallace had moved on to the University of Virginia‘s Darden Graduate School of Business as a Batten Fellow. Wallace co-authored a July 3 column in the Financial Times on value-based healthcare purchasing. (He collaborated with Darden professor Elizabeth Teisberg and Michael Porter of Harvard Business School.)

Today, NAHIT, which is going through a reorganization—its Web site is just a place-holder right now—decided to publicize Wallace’s fellowship with a press release. That suggests Wallace left on good terms and likely will stay involved in the promotion of health IT.

I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Still more health 2.0

I keep getting notices of new interactive healthcare sites. Here’s a list of some recent entries. It is by no means exhaustive.

Wellness Professionals has released version 2.0 of Health Gateway, its Web-based care management platform for providers.

A Massachusetts General Hospital resident has joined with Harvard and MIT graduate students to start MedicalPlexus, a forum for academic medical professionals and students.

checkMD, a site billing itself as “the first social networking site fully committed to healthcare and healthcare reform,” launched a couple of weeks ago. Of course, I pull this phrase from the same media advisory that informed me that “The Institution of Medicine [sic] estimates that nearly 100,000 patients die in hospitals each year due to medical errors.” It also asked me to “please RSVP,” so I assume it was produced by the Department of Redundancy Department.

August 6, 2008 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.