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Mac OS X Viruses: Rare but they happen

Thanks to the MacAttorney, Randy B. Singer.  Randy emailed to his mailing list about a recent virus making the rounds for Mac users.  This “Mac Flashback Trojan” has apparently infected some Mac computers.  Here is an article on how to check if your computer is infected, and how to go about resolving the issue.

For many Mac OS X users, you should have already received a Java update from Apple that will patch this problem.  If not, you can check for operating system updates by clicking on Apple icon in the upper left corner of your desktop and going to Software Update.  If a patch for Java is listed, be sure to install it promptly to protect your computer from viruses like these.

The “Hon” Controversy

If you are from Bawlmer, you probably say “hon.”  It is a local tradition.  The word is a part of our local vernacular.  However, Denise Whiting, owner of a restaurant named “Cafe Hon” registered the word “hon” as a trademark with the federal patent and trademark office.  The registrations online (which Whiting has subsequently abandoned after a public outcry) include these uses: (a) retail gift shops (see: Hon Trademark Reg) (IC 035), (b) paper goods, namely, bumper stickers, napkins, note cards, gift cards, greeting cards, stationery, wrapping paper, gift bags, note pads, note paper, calendars, pens (see: Hon Trademark Reg 2) (IC 016), and (c) restaurant services (see: Hon Trademark Reg 3) (IC 043).  Ms. Whiting’s use with her restaurant was not controversial, as Cafe Hon has been around for quite some time in Baltimore.  The public outcry was over her registrations for various goods with the “Hon” logo.

Trademarks, whether registered or not, are intended to identify the source of goods of a product or service.  Trademarks, in one way or another, have been in use by craftsmen and traders for thousands of years.  Trademarks serve an important purpose in commerce today, in that brand names distinguish a particular maker’s goods from competitors.  Businesses may invest millions of dollars over time in building up brand name recognition with the public.  Brands, with time, become associated with a particular product’s quality or attributes (the taste of Coke is strongly associated with its mark, and distinguishes it from Pepsi and other soft drink products).

In the “Hon” controversy, the public outrage was over Whiting’s claim of exclusivity for gift shop goods. Interestingly, even though the baseball team, the Orioles, evokes strong public response and is strongly identified with Baltimore, there is not much controversy over their trademarks or their exclusive right to use those marks on t-shirts and baseball hats (and a whole lot of other merchandise based on their trademark registration: O’s Trademark Reg).  I suppose the public doesn’t claim to own the “O’s” (that’s Peter Angelos, hon), but is there that much of a difference?  I haven’t seen any bumper stickers inviting the Orioles to sue to challenge the “O’s” trademark registration.

Property rights, whether the right is to a physical thing or an intangible, are limited by certain public interests.  For a piece of real property, you have to pay your property taxes or risk the loss of title to your property.  The public may also have certain limited rights to enter your property (like the sidewalk that runs through the front yards of many homes in Maryland).  And the air roughly 100 feet above your home is not yours, either.  The exclusive rights in intellectual property are also limited by certain public interests.  For example, there is the concept of the “public domain” in copyright law.  Original works of authorship can be dedicated to the public domain, or end up there after a certain period of time from when the work was originally created (a work today doesn’t end up in the public domain for quite some time, but older works created before the 1920’s are generally in the public domain).

The Lanham Act provides the statutory basis for trademark registrations in the U.S.  Section 1052 identifies certain exceptions to the right to register a particular mark.  Unlike the U.S. Copyright Act, which provides for a “public domain” of works that otherwise would be entitled to protection, the Lanham Act has a much more limited set of circumstances that would prevent registration of a mark.  For example, immoral or deceptive marks can’t be registered.  The coat or flag of a state can’t be registered as a mark.  A living person’s name, portrait or signature can’t be registered without that person’s consent.  The mark cannot be confusingly similar to another registered mark.  The mark cannot be merely descriptive of the product (e.g., “Table” brand tables won’t work).  But, words in the public vernacular are not necessarily protected by these exceptions.  As subsection (f) notes, a mark that has become distinctive over time as to that person’s goods can be registered.

Irregardless of the Lanham Act, Whiting abandoned her marks after local outcry about “Hon.”  There was a strong sense among some in the public that “you just can’t do that” with the word “Hon.”  Some invited Whiting to sue them so that they could challenge her marks in court.  The Baltimore Sun ran a number of articles on the controversy.  Public opinion was against the registration of the word “Hon.”  Ultimately, Whiting abandoned or “Hon” marks in response to it all.  Tempest in a teapot?  Maybe.  But don’t mess with our “Hons.”

101 Shortcuts You Wish You Knew

Ok, the title to this blog post is a wee bit ambitious.  But here are a number of shortcuts that may well be so old (in the world of computers) that they represent the grandparents of all that stuff kids do these days tweeting, texting, and generally misspelling:

Control – C, Control – X, and Control – V: Copy, Cut, and Paste

It takes way too long to highlight text, go up to wherever it is in the menu (and in the new version of MS Word – 2011 for Mac – Microsoft, in its infinite wisdom, has moved absolutely every thing that used to be somewhere obvious to somewhere less-than-obvious), and then Copy, Cut or Paste text.  So that is why back in 1982, some guy assigned these basic but essential functions to keyboard combinations.  For Windows, you use the Control key.  For OS X users, you generally use the Command key.

Control – B, Control – I, and Control – U: Bold, Italicize, and Underline, Baby!

I feel exactly the same way when you ask me to make some header bold, or underline a table heading.  I do not, I repeat, I do not want to spend time with your cutesy point-and-click menu to figure out how to format my font.  That’s what Control – B, I, and U are all about!  Do not leave home without them!

Control – Z: Undo.

Ever do something stupid and then want to undo it?  Like in life when you are talking to someone you really like and something incredibly stupid comes out of your mouth and the person you are talking to stops and looks at you like you should be institutionalized?  Control – Z.  Control – Z undoes all sorts of really dumb things that we accidentally, or intentionally, do when we are busy, not quite awake, bored, or freaking out.  Control – Z.  If only you could do that with the rest of your life.  I would have Control – Z’ed at least a half a dozen things that happened today if I could.

Control – Y: Redo.

Control – Y is Control – Z’s misunderstood cousin.  But there are days when I really do want to redo something.  Most commonly, I use this to apply styles in Word documents to various sections of text that need some reformatting.  I totally could Control – Y all day some stuff that comes across my desk.  Well, not all day.  And not everything.  There are, actually, a lot more things I would prefer to Control – Z than Control – Y, but I don’t want Control – Y to get an inferiority complex.  And you should use it.

Control – A: Select It All

Now, I share this one with you with some hesitation, because sometimes when you use Control – A, you then promptly do something you wish you didn’t do.  However, Control – Z, your new BFF, is already above this entry.  So, you should be ok with Control – A.  This function selects everything in the active window of the computer program you are using.  Just keep in mind that everything is selected.  Ah, the force is strong with you.

Here is a link to an article with a few other gems.  Now, if you are really good, I will tell you how to make Indexes, Tables of Contents, and how to Mark Citations (for all of you Appellate writing nerds out there that have to build tables of Cases, Statutes, Rules and so on).  Which, by the by, has a lot to do with properly using Styles in your Microsoft Word documents.

Meaningful Use Overview for Maryland MGMA

On March 13, 2012, I presented to the membership of the Maryland MGMA on the topic of “Meaningful Use,” in light of the recent publication of the Stage 2 interim regulations by CMS.  Below, please find a link to the presentation file.

Meaningful Use Overview

Members had questions related to meaningful use, which I will make an effort to respond to under separate cover.

Baltimore Bead Society – Intellectual Property Presentation

On March 13, 2012, I presented a primer on intellectual property to the membership of the Baltimore Bead Society.  Below you will find the presentation file embedded as a quick time movie.

IP Overview (for online) medium

The membership had a number of questions about intellectual property issues, particularly the controversial “Hon” trademark dispute.  Look for additional postings later on some of those questions and issues.

Comparing Meaningful Use Stage 1 and Stage 2

The following two tables compare the Stage 1 and Stage 2 meaningful use criteria under the Meaningful Use proposed/interim regulations that were issued last month.  These tables illustrate some of the changes to the existing criteria, and also the changes in the metrics for the measures (generally increasing the compliance rate required to continue to qualify for the incentive payments).

Table 1 – Core Criteria Under Stage 1 and Stage 2 Meaningful Use Comparison

Eligible Providers must meet all of the Core Criteria to Qualify for the Incentives.  Stage 1 had 15; Stage 2 has 17.  Stage 1 meaningful use Core Criteria are found in section 495.6(d) for eligible providers.  Stage 2 meaningful use Core Criteria are found in section 495.6(j) for eligible providers.

Core Criteria for EPSubsections (d), (j) Stage 1 Metric Stage 2 Metric
§ 495.6(j)(1) – provider use of CPOE for medication, lab, and radiology orders [§ 495.6(d)(1)] 30% of orders 60% of orders
§ 495.6(d)(2) – drug-drug and drug-allergy checking Enabled during period N/A
§ 495.6(d)(3) – maintain up to date problem list 80% of patients N/A
§ 495.6(j)(2) electronic prescriptions [§ 495.6(d)(4)] 40% of Rx 65% of Rx
§ 495.6(d)(5) – active medication list 80% of patients N/A
§ 495.6(d)(6) – active allergy list 80% of patients N/A
§ 495.6 (j)(3) demographics [§ 495.6(d)(7)]50% of patients with encounters 80% of patients with encounters
§ 495.6 (j)(4) vital signs [§ 495.6(d)(8)]50% of patients with encounters 80% of patients with encounters
§ 495.6 (j)(5) smoking status [§ 495.6(d)(9)]50% of patients with encounters 80% of patients with encounters
§ 495.6(d)(10) – reporting clinical measures to CMS or State Successful testing N/A
§ 495.6 (j)(6) decision support [§ 495.6(d)(11)] Implement 1 decision support intervention Implement 5 decision support interventions
§ 495.6 (j)(7) lab results as structured data [§ 495.6(e)(2)] Was Menu in Stage 1; 40% of all lab results 55% of all lab results
§ 495.6 (j)(8) patient lists by specific condition for QI [§ 495.6(e)(3)] Was Menu in Stage 1; at least 1 list At least 1 list
§ 495.6 (j)(9) patient reminders [§ 495.6(e)(4)] Was Menu in Stage 1; 20% of patients sent during period 10% of patients seen in last 2 years receive a reminder
§ 495.6 (j)(10) patient electronic access of health information [§ 495.6(e)(5)] Was Menu in Stage 1; 10% of patients receive timely access 50% of patients receive timely access
§ 495.6 (j)(11) clinical summaries at patient visit [§ 495.6(d)(13)] 50% receive summary from office visit 50% receive summary from office visit
§ 495.6 (j)(12) patient education resources [§ 495.6(e)(6)] Was Menu in Stage 1; 10% of patients receive ed. resources 10% of all office visits
§ 495.6 (j)(13) medication reconciliation for transition of care [§ 495.6(e)(7)] Was Menu in Stage 1; 50% of transitions have recon 65% of transitions of care have medication recon
§ 495.6 (j)(14) patients transitioned to another provider’s care have care summary prepared by provider [§ 495.6(e)(8)] Was Menu in Stage 1; 50% of transitions have recon 65% of transitions of care have patient summary
§ 495.6 (j)(15) capability to submit electronic data to immunization registry [§ 495.6(e)(9)] Was Menu in Stage 1; perform 1 test to registry Ongoing submission of data to registry during CY
§ 495.6 (j)(16) security risk assessments under HIPAA security regulations [§ 495.6(d)(15)] Conduct security assessment Conduct security assessment
§ 495.6 (j)(17) use electronic messaging to communicate with patients N/A 10% of patients seen during period received secure message from provider
[§ 495.6(d)(14)] – capability to exchange key clinical information among care providers and patients One test of exchange N/A
[§ 495.6(d)(12)] 50% of patients receive timely access 50% in 3 days on patient request N/A

 

Table 2 – Menu Criteria Under Stage 1 and Stage 2 Meaningful Use Comparison

In Stage 1, EP had to meet 5 out of 10 Menu Criteria to qualify.  In Stage 2, EP must meet 3 out of the 5 Menu Criteria to qualify.  Stage 1 meaningful use Menu Criteria are found in section 495.6(e) for eligible providers.  Stage 2 meaningful use Menu Criteria are found in section 495.6(k) for eligible providers.

Menu Criteria for EPSubjections (e), (k) Stage 1 Metric Stage 2 Metric
§ 495.6(k)(1) – access to imaging results in EHR N/A 40% of imaging results in HER
§ 495.6(k) (2) patient family health history in structured data N/A 20% of all patients seen
§ 495.6(k) (3) capability to submit syndromic surveillance data to public health agency [§ 495.6(e)(10)] Was Menu in Stage 1; perform 1 test to registry Successful ongoing submission of data for period
§ 495.6(k) (4) capability to identify and report cancer cases to State cancer registry N/A Successful ongoing submission of data for period
§ 495.6(k) (5) capability to report other specialized registry (other than cancer) to specialized registry N/A Successful ongoing submission of data for period
[§ 495.6(e)(1)] – implement drug formulary checking Enable functionality N/A
[§ 495.6(e)(2)] – lab results as structured data 40% of lab results are structured data Moved to Core
[§ 495.6(e)(3)] – generate lists by specific conditions 1 reporting list Moved to Core
[§ 495.6(e)(4)] – send reminders to patients for follow-up care 20% of patients Moved to Core
[§ 495.6(e)(5)] – Provide patients with timely access to health information 10% of patients have electronic access Moved to Core
[§ 495.6(e)(6)] – Use EHR for patient education 10% of patients Moved to Core
[§ 495.6(e)(7)] – Incoming transition of care to EP medication reconciliation 50% of patients have medication recon Moved to Core
[§ 495.6(e)(8)] – Outgoing transition of care from EP care record summary 50% of patients have care summary Moved to Core
[§ 495.6(e)(9)] – immunization registry 1 certified test Moved to Core

Maryland EHR Incentives

I’m willing to bet you didn’t know about Maryland’s best kept EHR incentives secret: namely, six private insurers will pay up to $15,000 each to each Maryland practice that implements an EHR before 2014.  Here are some details about the program and where you can find further information about it.

There are six insurers that participate in this incentives program: Aetna, CareFirst, Cigna, Coventry, Kaiser Permanente, and United Healthcare.  Each insurer will pay up to $15,000 in two parts to participating providers.  Half the incentive is calculated based on the total number of Maryland patients either assigned to the practice as a PCP, or at $8 per member for each Maryland insured seen by the practice in the last 24 months.  So, if in two years, you treat 938 members of one of the six insurers, you can maximize the first part of the incentive payment.  The other half of the incentive is based on your ability to meet one of the following three criteria: (a) sign up with a state MSO, (b) demonstrate advanced use of your EHR, or (c) participate in a quality improvement initiative with the insurer.

To obtain the incentive payments, you first file an Incentive Application with the appropriate private insurer prior to December 21, 2014.  The insurer will then acknowledge your application.  Then, six months after the application, you submit a Payment Application to the insurer, who will adjudicate the claim in 60 days and make your incentive payment.  These incentives are per practice (rather than by individual physician or provider), however, these are in addition to any federal incentive payments your practice may qualify to receive from CMS under the Medicare or Medicaid programs through the HiTech Meaningful Use incentives.

You can read more about this on the MHCC web site here.