April 25, 2012
Worth Reading This Week
Zirui Song & Bruce Landon, Controlling Health Care Spending — The Massachusetts Experiment, NEJM
Tim Jost, Is Medicaid Constitutional? NEJM
Mark Hall, Supreme Court Arguments on the ACA — A Clash of Two World Views, NEJM
George Smith, Strategizing the End-Game: Palliative Medicine and the Law, SSRN
Publication Study of Faculty at Non-Top 50 Law Schools
As reported by the Tax Prof Blog:
Roger Williams University School of Law has updated its per capita publication study of the faculties at "'non-elite' law schools" -- those schools ranked outside the 2012 U.S. News Top 50. The study covers the 1993-2011 period and uses methodology developed by Brian Leiter, with one change: although Brian focused exclusively on the Top 20 journals, this study examines the Top 50 journals, defined as the general law reviews published by the 54 schools receiving the highest U.S. News peer assessment scores (2.8 or higher) in the 2008 U.S. News rankings, plus an additional 13 journals that appeared in the Top 50 of the Washington & Lee Law Journal Combined Rankings in 2007. (See here for an alphabetical listing of those journals).
Saying Goodbye to the Sunshine State
After several years of sun and fun, I am leaving Florida to move back to my home state of Ohio to join the talented faculty at the University of Akron School of Law as a tenured Professor of Law. I am blessed to have made many new friends in Florida and will miss my wonderful colleagues at St. Thomas University.
With my interest in public health and in the laws that regulate innovative biotechnologies, Akron is the perfect place for me. Biotechnology and life sciences are a top industry in Akron. Nationally known for its innovation in polymers, materials science and medical research, the city is home to a Biomedical Corridor, anchored by top health, education and research institutions, including the University of Akron’s nationally recognized engineering programs in polymers and advanced materials, biomaterials and medical devices, advanced energy, computational science and nanotechnology.
A particularly exciting group of researchers is working at the Austen BioInnovation Institute of Akron (ABIA) on, among many other projects, a new community-wide collaboration to reduce the impact of chronic disease through the creation of an Accountable Care Community initiative. ABIA, through its Center for Community Health Improvement, is leading this initiative with more than 60 public and private community partners. Based on the initial results, this Accountable Care Community model, which deals holistically with an entire community, may prove to have a greater positive impact on healthcare quality, access and cost than the Accountable Care Organization model which creates healthcare silos within communities.
I am also looking forward to working on law and science issues with the law school’s Center for Intellectual Property Law and Technology. Nationally respected, the Center administers one of the most comprehensive intellectual property programs in the country, offering over 20 courses in the field. The Center also administers the law school’s Master of Laws in Intellectual Property program and the joint J.D./LL.M. program in intellectual property law.
I look forward to sharing with you all the exciting developments at Akron Law School as we grow our programs in Public Health Law, as well as in Law and Science and as we collaborate on research efforts with the members of the Akron Biomedical Corridor and the Austen BioInnovation Institute of Akron.
With best wishes,
Katharine Van Tassel
April 23, 2012
Annual Southern Illinois Healthcare/Southern Illinois University Health Policy Institute - “EHRs, EMRs, and Health Information Technology: To Meaningful Use and Beyond"
On May 18, 2012, the Southern Illinois University School of Law’s Center for health Law and Policy will host the 14th annual Southern Illinois Healthcare/Southern Illinois University Health Policy Institute - “EHRs, EMRs, and Health Information Technology: To Meaningful Use and Beyond."
Featured speakers will include Nicolas Terry, Co-Director of the Hall Center for Law and Health at Indiana University; Eric Meslin, Director of the Indiana University Center for Bioethics at the Indiana University School of Medicine; Jodi Daniel, Director of the Office of the National Coordinator for Health Information Technology at HHS; and David Liebovitz, M.D. of Northwestern University’s Feinberg School of Medicine.
For more information and to register for the Institute go to: http://www.law.siu.edu/healthlaw/14hpi.php
April 22, 2012
Patient Safety, Automation, and the Aviation Model
If one jumbo jet crashed in the US each day for a week, we'd expect the FAA to shut down the industry until the problem was figured out. But in our health care system, roughly 250 people die each day due to preventable error. A vice president at a health care quality company says that "If we could focus our efforts on just four key areas - failure to rescue, bed sores, postoperative sepsis, and postoperative pulmonary embolism - and reduce these incidents by just 20 percent, we could save 39,000 people from dying every year." The aviation analogy has caught on in the system, as patient safety advocate Lucian Leape noted in his classic 1994 JAMA article, Error in Medicine. Leape notes that airlines have become far safer by adopting redundant system designs, standardized procedures, checklists, rigid and frequently reinforced certification and testing of pilots, and extensive reporting systems. Advocates like Leape and Peter Provonost have been advocating for adoption of similar methods in health care for some time, and have scored some remarkable successes.
But the aviation model has its critics. The very thoughtful finance blogger Ashwin Parameswaran argues that, "by protecting system performance against single faults, redundancies allow the latent buildup of multiple faults." While human expertise depends on an intuitive grasp, or mapping, of a situation, perhaps built up over decades of experience, technologized control systems privilege algorithms that are supposed to aggregate the best that has been thought and calculated. The technology is supposed to be the distilled essence of the insights of thousands, fixed in software. But the persons operating in the midst of it are denied the feedback that is cornerstone of intuitive learning. Parameswaram offers several passages from James Reason's book Human Error to document the resulting tension between our ability to accurately model systems and an intuitive understanding of them. Reason states:
[C]omplex, tightly-coupled and highly defended systems have become increasingly opaque to the people who manage, maintain and operate them. This opacity has two aspects: not knowing what is happening and not understanding what the system can do. As we have seen, automation has wrought a fundamental change in the roles people play within certain high-risk technologies. Instead of having ‘hands on’ contact with the process, people have been promoted “to higher-level supervisory tasks and to long-term maintenance and planning tasks." In all cases, these are far removed from the immediate processing. What direct information they have is filtered through the computer-based interface. And, as many accidents have demonstrated, they often cannot find what they need to know while, at the same time, being deluged with information they do not want nor know how to interpret.
A stark choice emerges. We can either double down on redundant, tech-driven systems, or we can try to restore smaller scale scenarios where human judgment actually stands a chance of comprehending the situation. For those who accept the inevitability of larger, more interconnected, and more technologized finance systems, the work of Kenneth Bamberger and Erik Gerding may provide a useful framework for eliminating the most troubling potential effects of automation. They have outlined commendable changes for the current regulatory framework. We will need to begin to recognize this regulatory apparatus as a "process of integrating human intelligence with artificial intelligence." (For more on that front, the recent "We, Robot" conference at U. Miami is also of great interest.) [FP]