I was suddenly seized with a desire not to go to the gym today, and so I decided to do an “urban hike” - a walk around DC. In today’s heat, I definitely sweat a lot, but I can’t say it’s really aerobic exercise. Maybe 5-6 miles, total loop, but I don’t walk fast enough to do the powerwalking aerobic thing. Still, I felt like being outside even though it is summer in DC, which is to say, horrible. Why can’t I be in California, preferably the Eastern Sierra Nevada? Jean-Marie and Renee were at Renee’s swim meet at St Alban’s - they are out the door pretty much every Saturday by 6:30 am, which is a precise and accurate explanation of why I gave up on attending swim meets. So I hiked from our house at American University down to Dupont Circle, then cut over on M Street and recrossed Rock Creek Park into Georgetown. I’m currently sitting and posting from Saxby’s coffee house next to Georgetown University. I like the place - student place, friendly, airconditioned, free wifi - I used to come here Sunday mornings while Renee was in religion class at the church up the block. Listening to my ipod - I broke with all the Marianne Faithfull oldies I had been just slightly obsessed with (Renee asked me What On Earth I Had Been Humming For Three Days Straight?!? - Ans: Faithfull’s cover of the 1930s Boulevard of Broken Dreams. I finally got it out of my head by playing the melody on my cello - it works well in D minor in either of two octaves. It would sound good with two cellos, one on the melody and one on an arpeggiated background, or two cellos with a vocalist singing in Faithfull’s “nicotine-stained” contralto.) So: not Marianne Faithfull, but Antonio Caldara’s trio sonatas and cello sonatas, from the 17th century Italian Baroque. Urban hiking in DC on a warm Saturday
As I have stressed repeatedly before (most recently here), the US Sentencing Commission has said officially, repeatedly and emphatically that the current crack guidelines are too harsh and thus "significantly undermine[] the various congressional objectives set forth in the Sentencing Reform Act." (And, as detailed here and this archive, the USSC has this year put its long-held expert opinion into action by amending the guidelines, effective November 1, to lower all crack guideline ranges across the board.)
In Rita (opinion here), Justice Breyer’s opinion for the Court speaks approvingly of arguments from counsel that "the Guidelines sentence itself fails properly to reflect ?3553(a) considerations" and/or that "the Guidelines reflect an unsound judgment." The Rita opinion for the Court further explains that "where judge and Commission both determine that the Guidelines sentences is an appropriate sentence for the case at hand, that sentence likely reflects the ?3553(a) factors (including its ‘not greater than necessary’ requirement)."
Adding all this up ? and again keeping in mind the USSC’s own official, repeated and emphatic assertions that the crack guidelines are "greater than necessary" to achieve serve ?3553(a) ? shouldn’t a circuit court view a within-guideline crack sentences as presumptively unreasonable? Of course, after Rita, a district judge surely would have discretion, in the course of "exercising his own legal decisionmaking authority" to explain why he or she believes that, on the facts of a particular case, a defendant’s sentence should be within or even above the current crack range. But, unless and until a district judge explains why it is imposing a sentence that the Commission has officially, repeatedly and emphatically deemed inappropriate, I think that sentence logically ought to be reversed as greater than necessary.
Are within-guideline crack sentences now presumptively unreasonable after Rita?
The New York Times Technology Section reports on a pilot project between Gooogle and the Cleveland Clinic in an article, Google to Store Patients’ Health Records.
The article indicates the pilot project will involve a volunteer patient group transferring their personal health records so that they are available via Google Health, a new health record product being developed by Google. The article quotes Pam Dixon of the World Privacy Forum concerning privacy issues under HIPAA (incorrectly referenced by the Times as HIPPA).
I don’t necessarily agree with the scope of the comments regarding the applicability of HIPAA in this situation. Although I don’t know the full details of the relationship for the proposed project but it would appear that Google in this situation might be serving as a business associate of the Cleveland Clinic for the project. As a business associate it is likely that Google would be held contractually to many of the HIPAA privacy standards.
Tip to Matthew Holt at Health 2.0 Blog for noticing the NYT article.
UPDATE (2/22/08): ZDNet’s Larry Dignan at Between the Lines has more on the pilot project including the Cleveland Clinic’s press release.
The comments to Dignan’s post are interesting reading especially a couple with a legal perspective. The comment, two misconceptions, highlights the overall light enforcement efforts by OCR and lack of penalties, whether Google might fit the “healthcare clearinghouse” definition under the “covered entity” definition, entering into a contract with the health care provider (business associate requirement) and discusses the subpeona and marketing misconceptions.
Also, more from NYT’s Steve Lohr, Google Health Begins Its Preseason at Cleveland Clinic which indicates that Google Health will be made available to the public following completion of the pilot project (appoximately 2 months). The article also has a quote from fellow health care blogger and CIO of Beth Israel Deaconess Medical Center in Boston, John Halamka, who indicates that the hospital is also interested in linking its EMR with Google Health. As a board member of the West Virginia Health Information Network I would like to explore the idea of utilizing and integrating Google Health into our statewide effort to bring about an integrated/interoperable health information system.
Jane Sarasohn-Kahn at HealthPopuli shares her thoughts and additional link commentary on the Google/Cleveland Clinic project. Jane highlights a recent report, Personal Health Records: Why Many PHRs Threaten Privacy, by the World Privacy Forum looking into privacy issues for PHRs.
Matthew Holt’s follow up post taking a closer glimpse at the privacy questions, motives and opportunities both pro/con surrounding the Google Health project.
UPDATE (2/24/08): For the latest article covering the Google Health project check out Newsweek’s article, Web Surfer, Health Thyself, out in the March 3 edition.
Also, MSNBC provides some additional insight on how Google Health will interact with the existing Cleveland Clinic EHR (or PHR) in Google Goes to the Doc’s Office. The article describes the pilot project as follows:
. . . The Cleveland Clinic already keeps electronic records for all its patients. The system has built-in smarts, so that it will alert doctors about possible drug interactions or when it’s time for, say, the next mammogram. In addition, 120,000 patients have signed up for a service called eCleveland Clinic MyChart, which lets patients access their own information on a secure Web site and electronically renew prescriptions and make appointments.
The system has dramatically cut the number of routine calls to the doctor and boosted productivity, though it has yet to effectively deal with information from an outside physician, Harris says. Those records are typically still on paper, and have to be laboriously added to the Cleveland Clinic system. It is a big problem, especially for the clinic’s many patients who spend winters in Florida or Arizona, where they see other doctors.
Adding Google’s technology lets patients jump from their MyChart page to a Google account. Once on Google, they’ll see the relevant health plans and doctors that also keep electronic medical records. That means the patient can choose to share information between, say, the Arizona doctor and the Cleveland Clinic . . .
UPDATED 2/26/08: Scott Shreeve goes Giga over Google Health. Read his first impressions of the Google PHR after his test drive at HIMSS.
However, Dmitriy at TrustedMD makes some great points, including this quote:
Yet, even with free PHRs out there, consumers simply do not care for spending their time to learn and use them. Who would bother entering and checking their medical records if you are healthy and would rather go see a movie? And once you get sick, you do not want to enter them either. You just want your doctors and hospitals to hand your medical records to you. But you see, the providers have different priorities that a mere piece of software just cannot solve . . . PHRs’ real problems are not technical, usability or even privacy. The real problem is consumer and provider motivation . . .
He ends his posts with some questions we should all be discussing. Until we see a reimbursement model that creates incentives for providers to look at more health information and consumers to care about and take an active part in their health — I’m not sure the PHR/EHR initiatives will fully develop and mature.
Follow the latest news (blog posts) and the Techmeme reaction to the project. Google Health: Google Partners with Cleveland Clinic
Law #38 Order Criminal Intent#34 2001Law & Order: Criminal Intent" is one of only a few crime dramas that contains all of these elements. I will always set aside one hour every week to watch . The third “Law and Order” series involves the criminal justice system from the criminal . Law & Order". "Law & Order: Special Victims Unit". Midnight Court. Behind . Criminal Intent.". Vincent D’Onofrio, Kathryn Erbe, Jamey Sheridan, and .
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FOX has ordered the script for a new comedic drama from Josh Berman, creator of previous FOX series Vanished and Killer Instinct, a story editor on Bones and a consulting producer for CSI.
Short but good 
