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7 posts from December 2012

December 19, 2012

HealthCare SocialMedia Review No. 19 - Festivals of Lights Edition

Welcome to the final edition of HealthCare SocialMedia Review for 2012. HCSM Review is a biweekly compendium of the best of the #HCSM blogosphere.

Given the plethora of holidays with themes of light that fall around this time of year -- Diwali, Eid al-Adha, Christmas, Kwanzaa and Hanukkah (well, some of them are on different calendars, so they sometimes fall around this time of year), this edition of the Review will attempt to incorporate the theme of lights into the roundup.

2012-12-10 17.10.39

(I had occasion to celebrate Hanukkah at the Massachusetts State House -- the photo to the left shows the Senate President, Chabad rabbi, Speaker of the House and Governor Patrick on a scissors lift, lighting the giant menorah.)

Fard Johnmar sheds some light into dark corners, debunking some common myths about online and social media health content at digihealth pulse.

2012-12-02 17.02.16Kathy Nieder is getting ready to flip the switch and turn on an online physician community for herself and fellow docs at her system. As they begin using this system, they will be in good company; a new survey coauthored by (among others) fellow tweeps and bloggers Brian McGowan and Bryan Vartabedian finds that one in four docs uses social media daily.  

(I captured the unusual set of lights shown here to the right after a friend of mine flipped the switch on his bid for a more ecumenical approach to holiday lights in his neighborhood.)  

Looking back on 2012 and peering into the future, Kevin Campbell offers some illuminating thoughts about social media, mHealth and medicine. He tips his hat to Doc Tom and the e-patient movement, medblogger Westby Fisher and others, but notes that health care providers are using social media in basic ways, just scratching the surface. It's important to match the tool to the job at hand. (Everyone's darling these days seems to be Pinterest, so here's the latest Pinterest post from the HL7 Standards blog.) And let's not forget: it's important to measure the value of your social media efforts.

I recently spoke with Barbara Ficarra about clinicians lighting up online; check out her post on the subject.

The story about physicians on twitter has jumped the shark -- it's not on a blog; it's in the LA Times, but it contains a boatload of references back to the blogerati and twitterati of health care, so I suppose it merits a link. Physicians who have not yet caught on to the many uses of social media should at least remember Dan Hinmon's advice on The One Thing You Should Not Do if a Patient Posts Negative Online Reviews. And a ll health care providers should remember not to fear patient negativity on social media.

Hospital use of social media is the subject of a Hospital Impact post, which draws in part on Reed Smith's study of Facebook use by thirteen hospital systems (check out the infographic at the link).

These days, when we think about hospitals and physicians, we often think of Accountable Care Organizations. Gregg Masters blogged about the role of social media in ACO development after hosting the #HITsm tweetchat where the issue came up.  

Patient communities on twitter are the subject of a series of posts on the Symplur blog, including this one on network centrality analysis, focusing on Kelly Young (aka @rawarrior) and other key nodes (or points of light) in the RA network. 

To balance this last post, here is a more basic primer on social media as a means to patient empowerment.

Health care brands active online understand the need to engage with patients. Exhibit A: a post on the NPR Shots blog, Social Media Help Diabetes Patients (And Drugmakers) Connect. (Shout out to Kerri Sparling.)  A key element of using social media to reach people and have a positive effect on their health is the need to meet people where they are.  This point comes through loud and clear in a post by Ruchi Dass about fighting malnutrition in rural India. And it is emphasized further by Susannah Fox, a reliable source of illumination and clarity, in her post on SMS messaging for health, and the cavalcade of comments that her posts always elicit.

Thanks to Dan Dunlop for highlighting "The Germinator" -- a homegrown, soon-to-be-viral video focusing on hospital acquired conditions (HACs) coming to you from Crouse Hospital in Syracuse, NY.  

With any luck, this meta-blog-carnival link will not create an irreparable tear in the fabric of the universe: Hold onto your hats while I commend to your attention the Festival of Lights edition of the Health Wonk Review recently hosted by Hank Stern at InsureBlog.

Candle_2A jumble of greetings to everyone, some late and some early: Shubh Deepavali, Eid Mubarak, Merry Christmas, Habari Gani, Hanukkah Sameach, and a Happy New Year. Here's to balance, and to a step back from burning the candle at both ends.

HealthCare SocialMedia Review has information about the next edition’s host and instructions on how to submit your posts for review in future editions.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

December 16, 2012

Leon Rodriguez, Director, HHS OCR, discusses HIPAA / HITECH Enforcement Last Week

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

December 14, 2012

Call for Submissions - Health Care Social Media Review No. 19

Next Wednesday your humble HealthBlawger will be hosting Health Care Social Media Review No. 19.

From the HCSMReview blog carnival homepage:

HealthCare SocialMedia Review is the blog carnival for everyone interested in health care social media.  It is a peer-reviewed blog carnival; the host of each edition decides which of the posts submitted for consideration are suitable for inclusion.

Our mission is to serve as a hub for posts from the best and the brightest health care social media writers, thinkers, users and proponents worldwide, to contribute to better understanding and adoption of social media in health care.  This carnival is intended to showcase posts about health care social media use, best practices, guides, resources, case studies, experiences, new techniques and technologies and new social media communities and tools.  We seek to spread the word that the use of social media in health care is becoming unavoidable and is of critical importance to both patients and providers worldwide.

Check out Nos. 1-18, linked to at the bottom of the HCSM Review carnival homepage.

Please send in any and all blog posts from the past two weeks that touch on health care social media. Given the season, please feel free to demonstrate how the posts you suggest are tied to Diwali, Hanukkah, Christmas or Kwanzaa -- or even the relatively recent Eid al-Adha (which this year falls almost in this season of festivals of lights, but has a somewhat different theme). This thematic touch would be appreciated, but is not required, by any means. 

The HealthBlawger awaits your submissions -- please send them in via this form by 8 p.m. Monday.

If the form is not working for you, email your submission david AT harlowgroup DOT net


See you back here next Wednesday.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

December 12, 2012

Can Patient-Centered Care Reduce Hospital Readmissions?

A new Press Ganey white paper highlights an association between HCAHPS performance -- patient experience scores -- and lower rates of readmission. (Performance Insights - The Relationship Between HCAHPS Performance and Readmission Penalties.)

With Medicare payment penalties for excess readmissions now in effect, reducing readmissions has become a top priority for hospitals and other stakeholders. The Centers for Medicare and Medicaid Services (CMS) publicly reports risk-adjusted readmission rates for heart attack, heart failure and pneumonia. The data show significant variation in performance across hospitals, indicating that some hospitals are more successful than others at addressing the causes of readmissions. A new study by Press Ganey suggests that performance on readmission metrics is associated with performance on patient experience of care measures.

This study is an interesting look at the relationship between two value-based purchasing programs used by CMS to calculate Medicare payments to hospitals -- the Hospital Value-Based Purchasing Program and the Readmissions Reduction Program.

The key learning from this study is this:  

Effective communications is fundamental to ensuring that patients become engaged in their care and, consequently, better equipped to follow discharge instructions and self-monitor after leaving the acute care setting.

Coupled with patient-centered practices supported by past studies which have shown that "the single most effective strategy for improving patient satisfaction is purposeful hourly rounding by nursing staff," a "sustainable discharge" strategy is highlighted as a key predictor of avoided readmissions.

A sustainable discharge strategy comprises identifying and addressing patient-specific factors that could lead to readmission, strategic patient education, developing a patient-focused after-care plan and ensuring a smooth transition to a post-acute setting. Tactics that drive success in achieving sustainable discharges include: dedicated patient transition coaches, proactive planning for non-medical barrier to treatment adherence, post-discharge phone calls, scheduled follow-up care, and use of cross-setting discharge planning tools and teams.

In other words, a patient-centered discharge planning process, built on clear communications with the patient, is likely to reduce readmissions.

With more than 20% of Medicare beneficiaries discharged from an acute care hospital being readmitted within 30 days, at a cost of over $15 billion a year, and with over 2000 hospitals looking at readmissions reduction program Medicare payment penalties in FFY 2013 totaling $280 million, this is a significant issue -- but one where a potential solution is clearly at hand.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

December 07, 2012

Data Breach Analysis 2009-2012 - HITECH Experience Reviewed by HITRUST

In the first three years that the HITECH data breach notification rules have been in effect (September 2009 - September 2012), almost 500 breaches affecting more than 500 individuals have been reported.  As of this spring, over 57,000 data breaches affecting fewer than 500 individuals have been reported.

Courtesy of HITRUST (Health IT Trust Alliance)

The key takeaways:

  • Most data breaches are accounted for by theft or loss (2/3 of breaches, over 4/5 of breached records); the balance are accounted for by unauthorized access or disclosure, incorrect mailing, hacking and improper disposal 
  • Hacks are on the rise, and given the likely underreporting of all breaches and the ease with which theft and loss of devices and records are detected, chances are that security improvement efforts are not being targeted appropriately
  • The weak link for most data breaches are laptops, paper records and mobile media (3/4 of breaches, 2/3 of records); the balance are from desktop computers, network servers and system applications
  • The trend in number of data breaches over time is encouraging, but there have been upticks in late 2011 and early 2012 
  • Hospitals, health plans and business associates are getting better at securing their data over time; physician practices are getting a little worse, particularly in smaller practice which, since they are often linked to community hospital EHRs, expose the hospitals as well
  • Government sector breaches account for a large percentage of the whole (check out the OIG report on CMS data breaches under HITECH for a glimpse of one sliver of this problem)

The full report is worth reading.  Also: see more from HealthBlawg on HIPAA, HITECH and data breaches.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting

December 05, 2012

David Harlow featured in Becker's ASC Review: 6 Steps for ASCs to Participate in New Payment Models

Here's an excerpt from a piece in Becker's ASC Review quoting me on the effect ACO development and other health reform environmental changes are likely to have on ambulatory surgery centers, and how ASCs can position themsleves for future success

Here are six steps for surgery centers to participate in new payment models.

1. Figure out how to participate in ACOs productively. ACOs are becoming more common in different healthcare markets across the country and ambulatory surgery centers need to figure out how they can most productively participate. First and foremost, they should leverage the relationships they have with hospitals and physician groups for a seat at the table during the ACO formation.

"There is clearly a place for physician led ACOs because we are talking about developing systems to control costs that are ultimately directed by physician order," says David Harlow, principal at The Harlow Group, a healthcare law and consulting firm. "There is an opportunity for physician-led ASCs to participate in ACOs and benefit from the payment incentives that are included in the program simply because of the ability to improve quality and reduce costs over a baseline period, and that could fall to the ASC's bottom line."

Integration will be easier if the ACO is physician-led. Hospital-led ACOs may focus on filling hospital ORs; however, surgery centers also have partnership options if the ACO is hospital-led.

Follow the link to read about the other five.

For related information, check out the 2013 Medicare rate regulation for ASCs and my recent post on accountable care organizations and health reform after the election.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting


December 03, 2012

Gimme My Damn Data - The ICD Edition

The latest news story to examine the issue of patient access to implantable cardiac defibrillator data (a variation on the theme of “gimme my damn data”) is an in-depth, Page One Wall Street Journal story featuring Society for Participatory Medicine members Amanda Hubbard and Hugo Campos. They have garnered attention in the past – one example is another piece on Hugo on the NPR Shots blog about six months back. The question posed by these individuals is simple — May I have access to the data collected and/or generated by the medical device implanted in my body? — but the responses to the question have been anything but. It is important to note that not every patient in Amanda’s or Hugo’s shoes would want the data in as detailed a format as they are seeking to obtain, and we should not impose the values of a data-hungry Quantified Self devotee on every similarly-situated patient. Different strokes for different folks.

The point is that if a patient wants access to this data he or she should be able to get it. What can a patient do with this data? For one thing: correlate activities with effects (one example given by Hugo is his correlation of having a drink of scotch with the onset of an arrhythmia — correlated through manual recordkeeping — which led him to give up scotch) and thereby have the ability to manage one’s condition more proactively.

We can get copies of our medical records from health care professionals and facilities within 30 days under HIPAA — and within a just a few days if our providers are meaningful users of certified electronic health records (it ought to be quicker than that … some day). In some states now, and in all states sometime soon (we hope), we can get copies of our lab results as soon as they are available to our clinicians.

Data from implantable medical devices is not covered by HIPAA until it is sent to the patient’s physician (on a periodic basis and usually in edited form — other data is typically retained by the device manufacturer) and entered into the patient’s medical record. It is, rather, governed by FDA rules, and the recent attention to this issue has prompted an FDA spokesperson to say that it would review a plan to give data directly to patients, but that data should be directed to physicians who can interpret it for patients. This is where the action will be in the future: the FDA could develop a framework to allow sharing of this data directly with patients. (The data is collected wirelessly in patients’ homes from the implantable devices.)

Not surprisingly, earlier this year, a Medtronic exec referred to the data in question here as “the currency of the future.” There is clearly a market for the secondary use of patient data — on a de-identified, or anonymized basis — for a variety of purposes, and this is the “big data” we are all hearing about so much lately. (The HIPAA enforcers at HHS recently released guidance on the de-identification of patient data for secondary use — i.e., use for research purposes.) There is value to be extracted from big data, and the question is: Who owns the value? Who owns the data? Suffering as I do from the professional disability of being a lawyer, I am reminded of Moore v. Regents of the University of California, the 1990 California Supreme Court case that found that Mr. Moore, a cancer patient who sought to share in the profits for the commercial cell line developed from cancer cells in a tumor removed from his body, had no property rights in his discarded body parts. Moore could perhaps be read to support the device manufacturers’ perspective that there is no value in the data coming from the implantable device until it is processed by the manufacturer.

Another perspective would be that each patient has a property right in the data generated by his or her body or implants. There have been a couple of discussions on and elsewhere about the notion of a “green button” or a “rainbow button” that would serve as a mechanism for patients to decide how to share their own data (in those cases, the discussion was focused on EHR data, but the principles ought to be the same here). If I want to share my EHR or device data with all, so that it may be aggregated with other patient data and used in research and the development of evidence-based medicine protocols, then I should be able to do so.  If I want to donate that data gratis, or if I want to see a small license payment collected by an intermediary (a la the Copyright Clearance Center), if I want to permit it to be used with full identifiers, or as a de-identified record, I should be able to do that.

The quest of patients with implanted devices to gain rights to data should not have to be so quixotic. The information in question is subject to a different regulatory scheme than EHR data, but that is an accident of history, technology and politics.  There is no fundamental distinction between a series of MRI images, or a blood test result, and a set of data downloaded from an implantable medical device.

It is possible that we have turned a corner on this issue. It is far from resolved, but the FDA is addressing it — or at least acknowledging it — publicly.

How close are we to resolving this issue? What obstacles do you see ahead? What other sorts of data have remained inaccessible to patients? Where is the next battlefield?

This post first appeared on, the blog of the Society for Participatory Medicine. I chair the Society's public policy committee.

David Harlow
The Harlow Group LLC
Health Care Law and Consulting