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.

Predicting Flu Season With Google Flu Trends

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

According to Google.org 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 . . .

• Google To Track Flu Searches and Report Them to Feds? at Volokh Conspiracy
• Sick Surveillance: Google Reports Flu Searches, Locations to Feds at Drudge
• Google Flu Trends: A Glimpse into the future of Google Health at ReadWriteWeb
• Sick? Google Shares Health Searches with Government at CNET Technically Incorrect
• Google Introduces Flu Trends; Gets Red-Font Treatment on Drudge at U.S. Web

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:

ACTIVITY DURING WWII
INDUCTED INTO THE U.S. ARMY ON DECEMBER 18, 1942, PROCESSED AT FORT HAYES, COLUMBUS, OHIO AND REPORTED FOR DUTY AT WEST VIRGINIA UNIVERSITY ON DECEMBER 21, 1943. HE WAS LATER TRANSFERRED TO THE MEDICAL COLLEGE OF VIRGINIA TO COMPLETE HIS MEDICAL TRAINING. HE WAS IN THE ARMY SPECIALIZED TRAINING PROGRAM (ASTP) WHICH TRAINED PHYSICIANS FOR MILITARY SERVICE. A PRIVATE FIRST CLASS DURING THE WAR, HE WAS HONORABLY DISCHARGED ON MARCH 23, 1946.

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

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.

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.

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 (change.gov 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 (www.jrclifford.org).

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.

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.