Jen's Posterous

Health Management Rx

Healthcare Innovation. It will be drastic. It will be painful.

Then a new technology emerges and creates the possibility for a radically different organizational architecture, using an entirely different combination of skills and relationships. The only way to get from one organizational architecture to the other is to make drastic, painful changes. The money and power that come from commitment to an existing organizational architecture actually place incumbents at a disadvantage, locking them in. It’s easier and more effective to start over, from scratch.
via michaelnielsen.org

Link via @ahier.

#myhealthdata Wednesday, July 1st. Mark your calendars.....

On Wednesday, July 1, 2009, Obama will be holding an online town hall meeting on health care reform to answer some common questions. People can submit questions via Facebook, YouTube, and Twitter (twitter hashtag: #WHHCQ)

President Obama will answer common questions. If enough of us ask, maybe we will get a verbal commitment from Obama to support our health data rights.

Here are a couple of twitter examples:

Obama, will #hcreform support my right to access and use #myhealthdata ? #WHHCQ

Hi Prez Obama! Will #hcreform support humans’ access to their own health data, kinda like how they access their pet’s data? #WHHCQ

via e-patients.net

Please RT. Wednesday July 1st on Twitter. #WHHCQ.

Participate in President Obama's online town hall meeting on healthcare reform. Let's storm the tweetstream folks.

Surely you can donate 140 characters?

Research 2.0: Social Networking and Direct-To-Consumer (DTC) Genomics - The American Journal of Bioethics

This target article discusses the need for new approaches to studying DTC genomics using social network analysis to identify the impact of obtaining, sharing, and using PGI.
via informaworld.com

Add another acronym to the pile: "PGI" = personal genomic information.

Interesting study published by 2 researchers from the Stanford Center for Biomedical Ethics, published in The American Journal of Bioethics, Vol. 9, Issue 6 & 7, June 2009, pages 35-44.

Music - the Universal Art? Fascinating Research on Autonomic Nervous System Responses

Cardiovascular and breathing rates consistently fall into step with musical crescendos and rhythms, according to a controlled clinical trial that may give impetus to new musical therapies.

Contrary to the conventional view of music as an intensely personal medium, researchers found that the same piece of music had similar cardiovascular effects on all subjects.

via medpagetoday.com

From "Medical News: Music Keeps Rhythm for Heart and Lungs - in Cardiovascular, Arrhythmias" - MedPage Today.

Fascinating. Note the music played that evoked a subconscious autonomic response was mostly of the classical bent.

The study is interesting for several reasons - first, it was a very small one (24 participants) with a young average age (25). Also, all the participants were white, and half were experienced choir singers.

Winning song? Puccini's "Nessun dorma," which showed "progressive arousal during crescendos." PS - guys. Download it on iTunes forthwith.

Even more fascinating: "Two Verdi arias have rhythmic "phrases" timed close to the circulatory oscillation frequency -- Mayer waves of blood pressure -- of six cycles per minute."

Those of us who select workout tracks based on our footfalls running, cycling pedal revolutions, or heart rates will find this research intuitive.

Nice to see someone started to look at the frequency/nervous system response in such detail.

Why I Didn't Sign the Declaration of Health Data Rights - Yet...

This is a very difficult decision for me. I have not joined in the large group of friends, peers, and mentors in the health and tech world endorsing the draft of Health Data Rights as they currently exist. 

Here's the current draft: http://www.healthdatarights.org/home

Why not? It's not a difficult question to answer, but the answer is difficult to share openly. 

This is my patienthood we're talking about here. That has been, historically, a huge compositional element of my personhood in total.

I can't take this one lightly and start throwing smoke bombs at store windows without thinking it through very carefully. 

When I saw the first draft, I immediately began looking at other Bills of Rights, including the US Constitution. 

I thought about what Bills of Rights are supposed to do, and what I'd like a Bill of Health Data Rights to accomplish.

Do I think this Bill accomplishes what I'd like to see a revolutionary piece of rousing advocacy achieve? No.

Is it an excellent start? Yes. 

Will I sign it as is? No.

Will I support the ongoing initiative with every fiber and dollar I can give? Yes.

Because this bill, and our choice and control over our personal health information, as well as establishing a view from within the system that acknowledges that choice and control, absolutely needs to evolve from this early composition. 

I am stepping out on a huge, bowing limb here, fully expecting it to break under the weight of my unreasonably high expectations. 

That being said, if I can't have high expectations about a Bill that is supposed to support my right to my health information, what the hell good are ascribing to principles of any kind?

Again. This is my patienthood we're talking about here. That has been, historically, a huge compositional element of my personhood in total. 

I have not endorsed the first draft of Health Data Rights, despite spending significant time with several composers whom I love and respect and utterly believe have people-who-are-patients best interests at heart. 

I must apologize now for the criticisms I am about to offer, which I also offered several times before the bill was made public. 

I know many of you who worked tirelessly on this - putting in weekend hours and pooling political, personal, and professional capital to get this done. 

I realize I am jeopardizing political, personal, and professional capital by NOT endorsing this draft. 

I recognize and applaud your efforts at this early stage. However...

While I wholeheartedly support this initiative, I cannot in good conscience endorse this product. 

I feel the results of the first round are problematic for several reasons, namely:

1. The language as is, opaque by necessity in order to get many important signatories (which I understand and accept), is largely not actionable. Terms are so loosely used that it will be very challenging to state with certainty when a 'right' to health data has been abused. Example: What does "minimal cost" mean to those who hold my health data in the bowels of their systems? 

2. How will we hold organizations (or individuals) accountable if they abuse our rights to health data? There are no suggestions given, in the preamble or media blitz materials. 

3. How will we build tools, systems, services, and conversations that help people who have been, will be, and are today patients, navigate these rights? Were they provided in any other language? Are they different for children and adults?

4. Where are the patient advocacy organizations? Where is NAMI and the like? Many employees and volunteers at organizations like this one would have plenty to say on the issue of composing a Bill of Health Data Rights, and useful or not, it would at least help refine the concepts displayed here with more specific and stirring language.  

Maybe I expect too much. Maybe I want the impossible. Maybe I would sacrifice several (or all) 'large' or 'famous' signatories of the Bill in the fight to have the language that I feel is life-saving included. 

Maybe I would also fight from within the system to encourage all of the parties who currently hold MY health data that it is, in fact, mine to choose to access (or not), to share (or not), and to control (or not). 

Maybe I have. Maybe I am still. 

But overall, there is one central tenet missing from the current Bill that, if included in explicit language, would result in me signing, and it is this:

My health data is my own. 

End of story. I don't have to reclaim it. It's already mine. 

Please note - It is a completely different issue for my health data to be tricky or dangerously expensive/time-consuming to obtain or inaccurately kept/updated/shared within the system. 

These issues, and these differences, are not even mentioned in the bill or accompanying language, and I fear that is a near fatal diagnosis that will prevent this effort from playing any lasting role in my pursuit of wellness beyond some extra blog hits and sound bytes. 

My health data rights already are being abused, and I will stand up against that abuse, personally and for others, and advocate for change. I am utterly committed to doing so.

Here's where I get myself into real trouble...

That also means I don't do things in half-measures. If it's not good enough, it doesn't go out. 

If a Bill of Health Data Rights doesn't acknowledge vital programs CURRENTLY IN PLACE in hospitals to help make people who are patients aware of our rights, like the JCAHO Speak UP! Program, it fails to connect patients with resources OUT THERE IN THE REAL WORLD more tangible than a Hallmark-card-esque Bill of Rights.

If a Bill of Health Data Rights doesn't direct me to SOMETHING, SOMEONE to call, or email, or txt, or tweet, or a senator to whom to write a letter or fax a protest, then it has failed me as a patient. 

It has failed me because now I've got my rights, but what the hell do I do with them? 

Perhaps worst of all is the last omission, which I find most aggregious - if a Bill of Health Data rights doesn't use terminology that ties the ABUSE of those rights to ACTIONABLE CONSEQUENCE then it has failed me. 

The failure (conscious or not) to include the term "personal health information" or PHI, that would 'link' these rights to actionable, legal consequences under current legislation is a failure of the worst kind. It is either a failure of ignorance or of fear, or of both. 

And revolutions, my friends, do not light a bonfire by being afraid of tyranny. Revolutionaries throw firebombs at the doorways. Yes, revolutionaries build barricades. Revolutionaries lay themselves down in protest in the line of fire.

This Bill of Rights does none of those things.

It is the equivalent, at best, of holding up a lighter in protest. Peaceable (not necessarily a bad thing). Lukewarm. Ineffectual. 

I must be a radical, and God help me, I'll probably never work in this town again. 

But apparently I'll have plenty of work to do lobbying for a Bill of Rights that has some sticking power. I hope to do it with those of you who are committed to holding the match, if I haven't just burned all my connections to cinders. 

Here's the accelerant I'd use to start:

BASIC HUMAN RIGHTS: Health. Life. Liberty. The Pursuit of Happiness.

PREAMBLE

We the people hold these truth(s) to be self-evident:

1. Our health data is our own. 
2. Our health data is an asset. It shall be legally described, and protected, as such.
3. Our health data is a part of who we are - it is not the sum and total of our identity. 

BILL OF RIGHTS

1. It is my right to know which people and organizations are writing, recording, sending, and receiving my health data.
2. It is my right to have included in my record a listing of who, what, when, where, why and how my information is stored and shared.
3. I have the right share my health data with whom I want, when I want, through any means of communication I choose.

I'd then take the above rights and reword them to demonstrate that people who are patients have the choice and control over personal health information (PHI) to release it only when and where and to whom we choose. 

This is my right - to have choice and control over my health data. These rights, more fully explained (but still in very blunt-force-trauma form) look a bit like this: 

5. I have the right to choose and control who sees my health information.
6. I have the right to choose and control who shares my health information.
7. I have the right to choose and control who profits from my health information.
8. I have the right to refuse access to my health information. 
9. I have the right to correct inaccuracies in my record. 
10. I have the right to protest data I view as inaccurate, and to have a record of that contestation included in the record. 
11. I have the right to report inaccuracies in my record(s), or abuses of my health data rights, to a HealthDataRights.org, the Better Business Bureau, and my elected representatives. 

If I still have a job tomorrow, I'll see you all 'online' then. Where I'll be working to protect health data rights I already own. 


Jen S. McCabe
@jensmccabe

CEO/Founder: Contagion Health 
CoFounder: NextHealth (NL)

Consulting/Chief Patient Advocate (social media): 
OrganizedWisdom Health

LinkedIn: Jen McCabe 
Skype: jenmccabe

iPhone: 301.904.5136 
Dutch Mobile:  +31655585351

jennifermccabegorman@yahoo.com

Shocker: ONC Goes Back to Drawing Board to Define "Meaningful Use"

After  a "lively discussion [on the criteria] and considerable input on meaningful use, we decided to send the workgroup back to work on another set," David Blumenthal, MD, national coordinator for health information technology, said during a media call.

The policy committee expects to receive a new set of recommendations from its workgroup at its July 16 meeting, Blumenthal told reporters on the conference call.

The policy committee still may  not be satisfied at the July 16 meeting, Blumenthal said.  He declined to say how long he thought it might take. He was not sure whether the committee would offer an additional comment period following the workgroup's proposed revision of meaningful use criteria.

The ONC policy committee recommendations on meaningful use will not be binding, Blumenthal said. The Centers for Medicare and Medicare Services will be the final word on meaningful use and how it applies to incentives for physicians and hospitals using healthcare IT under the Medicare and Medicaid program.

via healthcareitnews.com

PLEASE. Comment. http://hmrx.posterous.com/meaningful-use-initial-requirements-open-for

What do YOU think meaningful use entails?

Faith Healing: More Kids, Same Mania, Less Suicide?

“Religious Affiliation and Suicidal Behavior in Patients with Bipolar Disorder”
Dervic K, Carballo JJ, Baca-Garcia E, et al.
149 patients with bipolar disorder with a religious affiliation (BD-RA) were compared to 49 patients without religious affiliation (BD-WRA). Compared to BD-WRA, BD-RA were more likely to have children, fewer past suicide attempts, less comorbid substance abuse, and greater moral objections to suicide. Both groups, however, had similar levels of suicidal ideation, depression, hopelessness, and severity of manic symptoms. Poster NR2-110
via psychweekly.com

Psychiatry Weekly: Poster Highlights from the 162nd Annual Meeting of the American Psychiatric Association...fascinating.

Big Pharma Going All Warm and Gooey for Medicare Patients?

Pharma may have just given health reform a much-needed boost. The details are vague at this point, but the headline isn't: Drugmakers have agreed to foot the bill for $80 billion in Medicare drugs over the next decade
via fiercepharma.com

Lots of dough. The AARP will endorse the deal.

This is a quick reaction to President Obama's speech at the AMA (transcript: http://www.usatoday.com/news/washington/2009-06-15-obama-speech-text_N.htm).

And it's a quantitatively strategic one...Obama pegged pharma reforms to contribute + 30B to the "Health Reserve Fund" that will be used to pay for 'other (insert air quotes here)' health reforms.

By offering to contribute 80B, they're seeing Obama's 30B and raising it by 50B. Smart move? Probably. Here's exactly what the President said about pharma at the AMA meeting:

"Third, we need to introduce generic biologic drugs into the marketplace. These are drugs used to treat illnesses like anemia. But right now, there is no pathway at the FDA for approving generic versions of these drugs. Creating such a pathway will save us billions of dollars. And we can save another roughly $30 billion by getting a better deal for our poorer seniors while asking our well-off seniors to pay a little more for their drugs.

So, that's the bulk of what's in the Health Reserve Fund."

If this 80B plan isn't a checkmate for pharma, it's pretty damn close...