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This has been a fantastic conference, and I’m so appreciative of the efforts put forth by ASLME and PHLA in pulling it all together. There were so many outstanding sessions and great speakers. An example of the sort of “cutting edge” information that was available at the conference was the “standing room only” session on health reform (Impact of National Health Reform on Public Health Laws and Policy.)
I was of course elated at the opportunity to launch our new Public Health Law Network. RWJF’s Jim Marks introduced the Network in fine style with his “Lawyers, Guns, and Money” talk at lunch, and I was thrilled at the opportunity to introduce our incredible Regional Centers and other critical partners at the evening reception.
The “buzz” arising from the reception included a comment from a very enthused new Network member about the “Dream Team” of regional center leaders that has been assembled by RWJF. Starting with the “Dream Team”, and with the involvement of public health lawyers, officials, practitioners, advocates, policymakers, and academicians throughout the country, we have the opportunity to build the seamless Public Health Law Network envisioned by the Foundation. Onward and upward!
Director, National Coordinating Center of the Public Health Law Network
Sessions have ended, so this wraps up our coverage of the public health law conference. Wish you were there? The conference organizers have posted many session summaries and public health law resources at www.aslme.org/PHLConference2010.
And,watch our twitter feed and this space tomorrow for links to the public health network website, as well as links to podcasts and videos about the Network. The Network opens for business on September 20th.
Have a thought, comment or question? Post them here on our Tumblr site.
Editor, Robert Wood Johnson Foundation Public Health Page
Hear from public health and legal experts speaking at national conference in Atlanta. Today we have podcasts from James Hodge, J.D., L.L.M., president of the Public Health Law Association, and Ted Hutchinson, executive director of the American Society of Law, Medicine and Ethics.
Should local health agencies band together to provide a greater range and quality of services? According to Subha Chandar of NACCHO, they are studying the pros and cons of regional health department arrangements. Will the move to accredit public health agencies spur these arrangements? If so, there will be significant legal issues to consider.
Edie Snethen of the Kansas Association of Public Health talked about a new paradigm of horizontal governance — working through partnerships across government boundaries. Kansas is being funded by the Kansas Health Foundation to examine and transform these collaborations via network governance.
Kansas did not pursue formal consolidation, but has moved to sharing functions. They took a “form follows function” approach, doing needs assessment, and identifying common strengths and gaps. Community health assessments and improvement plans identified regional and local functions. They next considered factors required for accreditation, and grouped functions as local, regional or multi-jurisdiction. The next step is to report recommendations back to the Public Health Accreditation Board.
—Nancy Kaufman, RWJF Public Health Team Consultant
Of these, lawyers may be the most important avenue for improving public health, said Jim Marks, Robert Wood Johnson Foundation Sr. VP and Health Group director who riffed on the Warren Zevon lyrics in a keynote lunch speech before hundreds at this week’s public health law conference.
Why lawyers? Well, says Marks, “building a healthier nation will require harnessing the power of policy and law.” Examples abound — tobacco taxes that drive down youth smoking, housing policies to reduce lead and mold, transportation policies that either encourage or inhibit people being physically active. Marks cited an example in Charlotte, NC, where a light rail system helped people who used it to lose weight — from walking to and from the light rail station. Sometimes good health outcomes come from policies in ways not originally intended.
And riffing on the words of Bill Foege — a public health rock star in his own right, who once said that every public health resource decision is really a political decision — Marks said that nearly every political decision is really a public health decision. Health Reform-the Affordable Care Act, comes to mind. Marks’ take: =”Other countries are getting healthier, faster than we are…and are performing better on standard measures of good health such as life expectancy and infant mortality…despite our rapid increase in dollars spent on medical care. What we need isn’t more expensive treatment; what we really need is less disease….as a nation we need to look to public health for the answers…making the places where we live, learn, work and play healthier.”
Which brings us back to law and lawyers. In his keynote, Marks announced the launch of a new Public Health Law Network — a $12.5 million three-year initiative funded by the Foundation to “jump start” the use of public health laws broadly to protect, promote and improve people’s health. The Network will have 5 regional centers staffed by legal experts and strategists who are dedicated to applying law to solve our nation’s most pressing health problems. Marks noted that this efforts is “built on the shoulders” of those at the conference and many who aren’t here in Atlanta — experts in law and policy in their own right. Marks is hopeful that they will join and actively contribute to the Network. Other RWJF programs such as the National Policy & Legal Analysis Network to Prevent Childhood Obesity (NPLAN), the Tobacco Control Legal Consortium and the Public Health Law Research program at Temple University will form connections with the Public Health Law Network as well. Learn more at www.publichealthlawnetwork.org.
Marks concluded: “Warren Zevon may have had a pretty good list of levers to make social change in ‘lawyers, guns and money.’” But he implored the audience — “the one most important for the public’s health is law.”
Senior Communications Officer
Federal regulation of cigarettes and other tobacco products now falls within the jurisdiction of the Food and Drug Administration (FDA). But can states and cities also regulate tobacco, beyond what the FDA does?
That question was answered at a session today — Federal Regulation of Tobacco Products. Experts from the Tobacco Control Legal Consortium and Public Health Law & Policy told attendees what states and cities can do to regulate tobacco, what they cannot do, and what is still open to legal debate in the courts.
States can clearly develop new regulations on retailer licensing, so that stores found guilty of selling tobacco products to minors could face a suspension of their license to sell cigarettes and smokeless products. Cities and towns can also develop zoning laws that can regulate the density of stores selling cigarettes in a neighborhood. They can also prevent cigarette sales near schools and near playgrounds.
States and cities cannot, however, regulate product standards in terms of the nicotine content of cigarettes. They also cannot develop new warning labels or come up with warning labels in other languages.
Some cities and states are trying new ways of educating the public about the hazards of tobacco smoking. New York City, for example, has developed public health warnings that can be displayed in retail stores. But the tobacco industry has challenged that in court. States may also ban tobacco sales in pharmacies, as in San Francisco. And that too is being decided by the courts. States may also set minimum price laws for cigarettes, so that the tobacco companies cannot drop the price of cigarettes in spite of increases in cigarette taxes. Increases in cigarette prices is associated with reductions in cigarette use.
Consultant, Robert Wood Johnson Foundation
Sharona Hoffman, Case Western
David Kaelber, MetroHealth Hospital, Cleveland
Andy Podgurski, Case Western
Sharona Hoffman presented first. There are a host of technological concerns that come with implementation of electronic health records (EHR). The ability to cut and paste, while handy, can lead to confusion in medical records if large chunks are data are pasted incorrectly. Decision support is difficult to design precisely, so there’s concern that the feature may be so unhelpful in some situations that practitioners will turn off the feature entirely. And as with all technologies, software defects and computer shutdowns are always a worry.
Some interesting issues arise with EHRs. For instance, with the ability to communicate electronically with patients, some patients may have unrealistic expectations about a physician’s ability to communicate quickly.
Andy Podgurski took the stage next to go over the regulatory framework of EHRs; it’s a system that can provide large financial incentives for “meaningful users of certified EHR systems;” by “large,” in this case, we mean a national total of $27 billion.
He proceeded to break down the terms “meaningful use” and “certified.” For an EHR to be meaningfully used, it must meet 15 core objectives — basic things like being able to enter patient data — and five out of a list of ten “other” objectives, such as decision/diagnostic support and the electronic transmission of drug orders.
Certification is a bit more complicated. There’s a temporary certification program in place, using authorized testing and certification bodies (ATCB) using test tools and procedures approved by ONC.
Podgurski continued with a critique of this system. There’s no clinical safety testing nor continuing review of systems after certification. He questioned how closely the ATCBs will be monitored for concerns like conflicts of interest or general competency of members. Further, if a system is destined to change through software updates or the application of the system towards new uses, there’s no procedure in place to deal with this. He noted that EHRs are not classified as medical devices, so the FDA has no jurisdiction over them.
A huge promise of this technology, he says, is in research. The data collection will allow large scale observation, promote evidence-based medicine, and will allow de-identified data to be stored in research databases. Further, the research wouldn’t just be restricted to organizations — the physicians themselves could perform targeted research during diagnosis. As an example, they could compile a cohort of data comprised of folks clinically similar to you, who had been treated for your condition. Then, they could examine the best treatments for that clinical profile, rather than success rates for treatment on a general population.
David Kaelber presented next, giving the audience some on-the-ground data about the effects of EHRs in practice. He profiled Electronic Support for Public Health, or ESP, an open-source system designed to communicate between EHRs and public health departments. ESP has shown much higher degrees of accuracy in reporting over manual reporting, as well as massive savings in time (he estimates that for reporting of the two most commonly reported communicable diseases, gonorrhea and chlamydia, on a nation-wide scale would be $7 million).
Communications Coordinator, Public Law Health Center
How many states have mandatory school immunization statutes with no exemptions? According to Ann Goldberg, counsel for West Virginia’s Bureau of Public Health, only two — and West Virginia is one of them. Following failure of legislation, in 2008 West Virginia turned to administrative code to mandate childhood immunizations. Using an interpretive rule based on existing public health code, the rule has yet to be challenged. The agency is now looking to add adolescent vaccines to its rule.
Geoff Wilkinson, from Massachusetts’ public health agency, reported that they have used administrative rules to expand the types of providers that can give immunizations during emergencies, such as pandemic flu. Regulations also are being used to fight obesity — mandating menu labeling and requiring BMI measurements in schools. Broadly reaching, Massachusetts also uses regulations to require changes in the health care delivery system. Geoff encouraged use of administrative rules as a more expeditious tool than legislation. A down-side to this approach? The lack of budget to implement new administrative rules.
—Nancy Kaufman, RWJF Public Health Team Consultant