The panel combined both California and national health IT expertise and featured Jonah Frolich, California Deputy Secretary for Health Information Technology; Alex Kam, Acting Director of the California Office of Health Information Integrity (OHIII); David Lansky, President and CEO of the Pacific Business Group on Health; John Mattison, M.D., Chief Medical Information Officer of Kaiser Permanente; Deven McGraw, CDT’s Health Privacy Project Director; and Julie Murchinson, Managing Director of Manatt Health Solutions. Leslie Harris, President and CEO of CDT, moderated a discussion that quickly became an active one among both panelists and attendees.via cdt.org
The focus was initially on California and a recent paper released by CalOHIII largely raising concerns about “secondary” uses of health data (the paper will be available online shortly, check back here for a link). Such uses are often cited as raising greater privacy concerns. Yet the use of data for secondary (beyond individual treatment) purposes – such as for quality measurement and comparative effectiveness research – are key to achieving greater health system reform, raising the question of whether they should be relegated to secondary status.
The panel also spent some time discussing the appropriate role of individual consent in protecting privacy. The CalOHIII paper presents pro and con views on an “opt-in” approach to electronic health information exchange. CDT also has published papers raising doubts about the ability of privacy policy frameworks anchored by “notice and consent” to protect individual privacy.
"That dreaded day arrives. And no it is not just a bad dream. That police officer at your front door is not ringing the doorbell to warn you of a prowler in the neighborhood. He has come to serve you with papers notifying you of a complaint filed by a patient: a patient you may or may not remember seeing. Although anybody who serves you with papers is called a process server, in some jurisdictions, like mine, it is done by a sheriff ’s deputy. The feeling is akin to being hit on the head with a bat, stabbed in the back, and disemboweled, all at the same time. Thoughts run through your mind like, 'Will I lose my job?'; 'Is my money protected?'; 'Am I a bad doctor?'; and 'Is my career over?'
You are justifiably depressed, confused, frustrated, and angry. When you have had a few minutes, hours, or days to assimilate this experience that unfortunately has begun a new chapter in your life, you undoubtedly ask, 'Now what?'
When it happened to me, I called my father. Then again, not everyone has a medical malpractice defense trial attorney for a father. Most physicians do ot have an attorney who is readily available to give appropriate and timely advice to initiate damage control. Through this book I am going to suggest what to do and, equally important, what not to do...
Getting sued can damage your self-confidence. However, do not let fear consume you. Make every effort to continue practicing the good medicine you have been doing for years. It is possible that the lawsuit is a result of your unintentional negligence. If that is the case, realize you are human. We all make mistakes."
"There is a common misconception amongst physicians that if they explain things well, their intelligent responses will prove to the plaintiff’s attorney that the whole thing is a mistake. They may also think that they need to explain their defense clearly and completely to the plaintiff’s attorney. However, as will be detailed later on in the chapter, a general rule is, “the less you say the better.” Since there is the potential to do significant damage to your case, it is critically important that you perform well; otherwise you may be forced to settle an otherwise winnable case."There is an excellent review in Emergency Physicians Monthly by Louise B. Andrew, MD, JD. She points out the need to be careful about differing statutes between states, but overall gives a very positive review. Dr. Andrew basically breaks the book into tow sections. The first is a walk through the process of litigation, the second is a practical discussion n preventative measures and reducing risk.
“Congress has broken its promise to America’s seniors and military families. Today is the last day that Medicare can hold claims, and it is now 17 days past the Senate’s deadline to stop the cut. Tomorrow, physicians will start seeing a 21 percent cut in Medicare payments that will hurt seniors’ health care as physicians are forced to make difficult practice changes to keep their practice doors open.
“The Senate has been debating this issue for weeks and the latest proposal is a six-month delay of the cut. Delaying the problem is not a solution. Continued short-term actions are creating severe instability that harms seniors as physicians make decisions to protect their practices from Medicare’s volatility. Continuing down this path just slaps a Band-Aid on a problem that needs urgent surgery.
“This week congressional offices are rec eiving hundreds of signed white lab coats from AMA member physicians as a symbolic reminder of the need for quick resolution to the immediate Medicare crisis and the importance of solving the problem through repeal of the broken Medicare physician payment formula.”
Alnylum is a company that is focused on creating a whole new class of medicines with a new discovery based on a new discovery in biology called RNA interference or RNAi as it's abbreviated and it's a technology and an approach that we think can transform the treatment of many human diseases because we can silence disease causing genes and basically by turning those genes off temporarily, we can make a difference in people's lives by treating their disease in ways that can't be done with today's medicines.
And the other part of the company, which is quite exciting, is that with what we've been doing over the years now, our technology and innovation is now becoming increasingly a game changer in much of a biomedical discovery, both in industry and in academia. So we've got partnerships with companies like Roche and Novartis and Cicada amongst others, Medtronic as well, and we've also been able to work real closely with major academic institutions like MIT and Plank and Stanford and UT Southwestern and work together on our technology. So it's a company that's hopefully what we believe is going to make a big difference in the treatment of disease with the types of approaches that we're taking. And then at the same time we're finding that we're able to work real closely across the entire biomedical world to basically advance our technology.
Q: Tell us about your newest scientific advisory board
That's a group that's focused on are one of the applications of our technology focused on transforming biologics manufacturing. You know, there's a whole range of medicines that are used today that are collectively called the biologic system: includes recombinant proteins like the use of factor eight for hemophilia or monoclonal antibodies like the use of the drug Avastin for cancer. And then also vaccines, and we've recently started up an effort where we're using our technology to fundamentally transform how those types of products are made. And so the group you're referring to was a recent assembly of some world renowned scientists that are going to help advise us on, on our biotherapeutics effort. But Alnylum overall has had a very active scientific advisory board since 2002 with people like a Phil Sharp and Tom and Bob Langer amongst other people that had been advising or company.
One of the fun things and exciting things about what we've done, is that as we've developed our advanced technology, we've also realized that the role of RNA in general in human biology is far broader than we ever expected. And that allowed us to understand more about micro RNA; these are small RNA that are present in all of ourselves and then we figure out the technologies that allow us to either turn up or turn them down. And by what we've been able to learn is that by sometimes turning them down you can treat specific diseases and sometimes by turning them up you can treat other diseases.
And so a company that we've cofounder with Isis called Regulus. This is an exciting effort that's a focused on micro RNA therapeutics and we and Isis both own 50 percent of that company. So we have a high a retention of the ownership there. We're excited about where that's going and there's a lot of interest in the pharmaceutical industry for where that's going as well.
When first daughter Jenna Bush attended a Bay Area AIDS summit hosted by Google.org two years ago, some skeptics doubted it would amount to more than a photo op.
But they were wrong. In a conversation with a Google staffer and a Stanford AIDS activist at one session, she helped come up with a big idea: A plan to improve health care access in the poorest parts of the United States and the world. What may have seemed like a pie-in-the-sky plan has morphed into a nongovernmental organization with an impressive roster of donors and more than $1 million in funding. Few may have heard of the Global Health Corps, but as its influence grows, that is likely to change.
"So many ideas come up in group conversations that never get realized," said corps founding director Dave Ryan, who at the time was the executive director for Face AIDS, a nonprofit group that helps Rwandans living with HIV. "But when we all got together, we saw there was something special that could happen."
Having watched friends transition from college into careers through organizations like Teach for America, they wondered whether they could create a similar organization dedicated to health care.
"We felt like there should be a similar program for public health," said Charlie Hale, who works in Google's direct ad sales division and is one of the group's co-founders.
They enlisted an eager group of socially conscious friends and secured $250,000 in seed money from Google.org. Jenna's sister, Barbara Bush, became the president of the organization, after spending time working in Africa with UNICEF and the U.N. World Food Program
One of former President George W. Bush's daughters is aiming to change the face of global public health and she intends to use members of her generation to do it.
Former first daughter Barbara Bush's new non-profit, Global Health Corps, was inspired by a 2003 trip that she took with her parents to five African countries. The Bush family was in Africa at the time promoting the Bush administration's anti-AIDS initiative.
A visit to a health clinic for people battling HIV opened Barbara Bush's eyes to how she might make a difference in the health field.
"I think that was the first time that – I was not pre-med; I hadn't studied health – that was the first time that I thought well maybe, what am I doing? Maybe I should focus on this," the Bush daughter said in an interview Tuesday on CNN's American Morning. "And I can. You really can work in the health field even if you're not a doctor or a nurse."
Bush decided to take that premise and use it as the foundation of Global Health Corps, a non-profit that recruits young professionals who are age 30 or younger to work for a year in health organizations.
"They're not doctors or nurses. They're filling any needs that the organizations have. And what we've found is all of our partners want people with technology skills. They want program management skills. They want monitoring and evaluation support. They just want general program support – which are skills that tons of people have. They just don't know they can use them in the health field."
For example, Bush said one participant in the non-profit's first crop of fellows is a former Google employee with a background in product management who is now working on health management information systems in Tanzania.
SEC. 5. EHR CLARIFICATION.
(a) Qualification for Clinic-based Physicians-
(1) MEDICARE- Section 1848(o)(1)(C)(ii) of the Social Security Act (42 U.S.C. 1395w-4(o)(1)(C)(ii)) is amended by striking `setting (whether inpatient or outpatient)' and inserting `inpatient or emergency room setting'.
(2) MEDICAID- Section 1903(t)(3)(D) of the Social Security Act (42 U.S.C. 1396b(t)(3)(D)) is amended by striking `setting (whether inpatient or outpatient)' and inserting `inpatient or emergency room setting'.
(b) Effective Date- The amendments made by subsection (a) shall be effective as if included in the enactment of the HITECH Act (included in the American Recovery and Reinvestment Act of 2009 (Public Law 111-5)).
(c) Implementation- Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the amendments made by this section by program instruction or otherwise.
