10 Things Small Business Owner Should Do In 2009

A post on the Top 10 Things Every Small Business Owner Should Do in 2009 by Guy Kawasaki came across my screen this morning via @paulhelmick and caught my eye.

Great advice for any business person to consider and "do" in 2009. We can all do better at understanding how our customers view us and improving on the service or product we offer them.

ESPN World's Strongest Man Competition 2008 - Charleston WV

Everyone be sure sure to tune in to the ESPN World's Strongest Man Competition 2008 starting to air on ESPN2 on December 25 (7pm-1am) and ESPN on December 28 (1pm-7pm).

Charleston, West Virginia played host to the 2008 competition. I look forward to ESPN showing off the beauty and positive aspects of Charleston and West Virginia. Also, the hometown of the 2006 World's Strongest Man, Phil Pfister.

UPDATE: Today's Charleston Daily Mail  issues official announcement of the airing of 2008 World's Strongest Man Competition on ESPN.

ONCHIT Issues Nationwide Privacy and Security Framework for Electronic Exchange of Health Information

Today the Office of the National Coordinator for Health Information Technology (ONCHIT) issued The Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information. The summary states that the framework creates a set of consistent principles to:

". . .address the privacy and security challenges related to electronic health information exchange through a network for all persons, regardless of the legal framework that may apply to a particular organization. The goal of this effort is to establish a policy framework for electronic health information exchange that can help guide the Nation's adoption of health information technologies and help improve the availability of health information and health care quality. The principles have been designed to establish the roles of individuals and the responsibilities of those who hold and exchange electronic individually identifiable health information through a network."

Along with the Nationwide Privacy and Security Framework the Department of Health and Human Services (HHS) has issued The Health IT Privacy and Security Toolkit. The Toolkit includes new HIPAA Privacy Rule guidance documents developed by the ONCHIT and the Office for Civil Rights (OCR) to help facilitate the electronic exchange of health information.

Of particular interest to many interested in PHRs will be the OCR's guidance on Personal Health Records and the HIPAA Privacy Rule and the draft Draft Model Personal Health Record (PHR) Privacy Notice & Facts-At-A-Glance (the "Leavitt Label").

The Toolkit provides information and guidance focused around these key areas:

• Individual Access Principle - Individuals should be provided with a simple and timely means to access and obtain their individually identifiable health information in a readable form and format.
• Correction Principle - Individuals should be provided with a timely means to dispute the accuracy or integrity of their individually identifiable health information, and to have erroneous information corrected or to have a dispute documented if their requests are denied.
• Openness and Transparency Principle - There should be openness and transparency about policies, procedures, and technologies that directly affect individuals and/or their individually identifiable health information.
• Individual Choice Principle - Individuals should be provided a reasonable opportunity and capability to make informed decisions about the collection, use, and disclosure of their individually identifiable health information.
• Collection, Use, and Disclosure Limitation Principle - Individually identifiable health information should be collected, used, and/or disclosed only to the extent necessary to accomplish a specified purpose(s) and never to discriminate inappropriately.
• Data Quality and Integrity Principle - Persons and entities should take reasonable steps to ensure that individually identifiable health information is complete, accurate, and up-to-date to the extent necessary for the person's or entity's intended purposes and has not been altered or destroyed in an unauthorized manner.
• Safeguards Principle - Individually identifiable health information should be protected with reasonable administrative, technical, and physical safeguards to ensure its confidentiality, integrity, and availability and to prevent unauthorized or inappropriate access, use, or disclosure.
• Accountability Principle - These principles should be implemented, and adherence assured, through appropriate monitoring and other means and methods should be in place to report and mitigate non-adherence and breaches.

I have only made an initial pass though the information and guidance documents. There is a lot to read and digest over the holidays. Please post in the comments your thoughts on the new federal principles and guidelines.

Does the Certificate of Need Law Benefit West Virginia?

Joe Letnaunchyn, CEO of the West Virginia Hospital Association, responds to the continuing discussion on the pros and cons of certificate of need regulatory oversight in West Virginia. The commentary, Certificate of Need Program Benefits West Virginia, appears in the most recent edition of the State Journal.

Mr. Letnaunchyn responds to the commentary by Dashle Gunn Kelley, dated October 30 2008, State Doesn't Need Certificates of Need, asserting that West Virginia "doesn't need certificates of need" to deliver health care. Mr. Kelley is a doctoral student in economics at West Virginia University and is an associate fellow for the Public Policy Foundation of West Virginia.

Throughout the year the Select Committee D - Health (Subcommittee Certificate of Need) - Interim has been looking at the issues involving certificate of need in West Virginia. Highlights of the Interim Meetings can be found here. I suspect that the discussion and debate will continue at the upcoming West Virginia Legislative session.

UPDATE (12/19/08): The latest edition of the State Journal contains a follow up commentary on West Virginia's certificate of need program. The commentary, Who Really Benefits from the Certificate of Need Program? was written by Russell S. Sobel, Ph.D., is professor of economics, holder of the James Clark Coffman Distinguished Chair at West Virginia University and editor of the book "Unleashing Capitalism: Why Prosperity Stops at the West Virginia Border and How to Fix It."

Reengineering Health Information Technology to Wire The Medical Home

Over at The Health Care Blog Dr. Kibbee issues Part 2 of his Confessions of a Physician EMR Champion, subtitled "A Conversation with American Physicians About How to Save Medicine in the Age of Information." The Part 2 post, Empowering Health IT for the Connected Medical Home, is a must read for all interested in the world of changing world of health/technology.

Dr. Kibbe lays out 5 areas that health IT should focus on to be empowering and disruptive to the current models:

1. electronic data and information collection and access
2. communications among providers and patients
3. clinical decision support
4. population quality, performance, and cost reporting
5. consumer/patient education and self-management

He highlights the importance of stepping back and looking at the current EMR model (a bit of thinking outside the box):

There is nothing transformational or disruptive about EMRs because they have been designed to meet the functions and features of a status quo business model -- not the collaborative and participatory capabilities required of the business models of the future health system.

In this next installment of the conversation, I’d like to suggest some specific capabilities that health IT ought to empower doctors and health care teams to perform on behalf of, and in collaboration with, their patients.

I’m suggesting that we go back to the drawing board and design health IT that is truly a good fit for doctors and patients in a system that rewards quality, safety, and efficiency of care while working to keep people healthy, instead of simply adding up the charges when they’re sick.

I'm involved on a number of fronts looking at health information models for West Virginia that will improve the delivery of care and reduce the costs. Dr. Kibbee's comments and thoughts are valuable for others looking at these same issues.

Tip to Ted Eytan on the post.

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 www.engagewithgrace.org. 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.

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.