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President-elect Barack Obama has promised to computerize all of America's medical records within five years. He made the pledge last week in a speech at George Mason University. "This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests," he said. "But it just won't save billions of dollars and thousands of jobs, it will save lives by reducing the deadly but preventable medical errors that pervade our health care system." But the road to digitized medical records will be a tough and expensive one, CNN Money reported. Today, only about 8% of the country's 5,000 hospitals and 17% of its 800,000 physicians use electronic medical records. There is also the issue of patient privacy. Numerous hospitals have faced security issues since moving to electronic medical records. The Industry Standard reported on a security breach at a Los Angeles hospital last month. And then there is the cost. Studies done by Harvard, RAND and the Commonwealth Fund peg the cost of the digitization plan between at least $75 billion to $100 billion, according to the CNN article. However, the health care industry spends $2 trillion dollars a year, so the $100 billion may be well worth the long-term savings.

Just days after President Obama signed a law giving billions of dollars to develop electronic health records, a university technology professor submitted a paper showing that he was able to uncover tens of thousands of medical files containing names, addresses and Social Security numbers for patients seeking treatment for conditions ranging from AIDS to mental health problems. Using peer-to-peer applications, which computer users download to share files, most commonly music and movies, M. Eric Johnson, director of the Center for Digital Strategies at Dartmouth College in Hanover, N.H., was able to access electronic medical records on computers that had the peer-to-peer programs stored on their hard drives. The medical files contained detailed personal data on physical and mental diagnoses, which a hacker could use to not only embarrass a patient but also to commit medical fraud. One of the largest stashes of medical data Johnson discovered during two weeks of research he conducted in January was a database containing two spreadsheets from a hospital he declined to identify. The files contained records on 20,000 patients, which included names, Social Security numbers, insurance carriers and codes for diagnoses. The codes identified by name four patients infected with AIDS, the mental illnesses that 201 others were diagnosed as having and cancer findings for 326 patients. Data also included links to four major hospitals and 355 insurance carriers that provided health coverage to 4,029 employers and 266 doctors.

Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill. Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true. The basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking. To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoi

In May 2008, the Office of the National Coordinator for Health Information Technology (ONC) awarded an approximately $450,000 contract to Booz Allen Hamilton to assess and evaluate the scope of the medical identity theft problem in the U.S. Medical Identity Theft Medical identity theft is a specific type of identity theft which occurs when a person uses someone else's personal health identifiable information, such as insurance information, Social Security Number, health care file, or medical records, without the individual's knowledge or consent to obtain medical goods or services, or to submit false claims for medical services. There is limited information available about the scope, depth, and breadth of medical identity theft. Dr. Robert Kolodner, National Coordinator for Health Information Technology, has noted that medical identity theft stories are being documented at an increasing rate, bringing to light serious financial, fraud, and patient care issues. ONC recognizes that health IT is an important tool to combat the threat of medical identity theft. We are seeking input from the public and other government agencies to better understand how health IT can be utilized to prevent and detect medical identity theft as well as build consumer trust in electronic health information exchange. ONC believes it is imperative to obtain a more comprehensive understanding of this issue from a variety of perspectives, and to create an open forum for dialogue to work proactively to address medical identity theft. Medical Identity Theft final report. The report summarizing health IT and medical identity theft issues raised at the town hall was completed January 15, 2009 and sets forth potential actions the Federal government and other stakeholders can undertake in working toward prevention, detection, and remediation of medical identify theft.

California regulators have fined Kaiser Permanente Bellflower (Calif.) Medical Center $250,000 for failing to keep workers from peeking at the electronic health records of Nadya Suleman, who gave birth to octuplets at the hospital in January. The fine is the first under a new state law, which took effect in January, aimed at protecting patient medical records at hospitals and carries the maximum penalty allowable. Twenty-three unauthorized staff and physicians accessed the medical records, including some at other Kaiser facilities. Seven people viewed the records more than once, according to the California Public Health Department, which licenses hospitals in the state. Kaiser fired one person who peeked at Suleman's records, 14 others resigned and eight were disciplined.

Both panels that advise the national coordinator for health IT plan to focus on privacy and security standards needed to support meaningful use of electronic health records when they meet later this month, according to notices in today's Federal Register. The Health IT Policy Committee, led by Dr. David Blumenthal, the national coordinator for health IT, will direct more of its discussion at its upcoming Sept. 18 meeting on health information privacy and security as it makes progress in defining meaningful use under the stimulus law, according to the notice. Likewise, the companion Health IT Standards Committee, which meets Sept. 15, will concentrate on refining standards recommendations made by its privacy and security work group. At the Standards Committee's previous meeting Aug. 20, its privacy and security workgroup presented standards for authentication, authorization, auditing and secure data transmission of health information in EHR products as well as the infrastructure that hosts them. The work of the panel includes protecting data inside an enterprise as well as data exchange between enterprises, "because security is an end to end process," noted Dr. John Halamka, the committee's chairman in a post on his blog, "Life as a Healthcare CIO."

Late last month, the House passed an economic recovery package containing $20 billion for health information technology, which would require the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically. The version of the recovery package passed by the Senate yesterday contains slightly less funding for health information technology ("health IT"). But as Congress moves to reconcile the two stimulus packages, conservatives have begun attacking the health IT provisions, falsely claiming that they would lead to the government "telling the doctors what they can't and cannot treat, and on whom they can and cannot treat." The conservative misinformation campaign began on Monday with a Bloomberg "commentary" by Hudson Institute fellow Betsy McCaughey, which claimed that the legislation will have the government "monitor treatments" in order to "'guide' your doctor's decisions." McCaughey's imaginative misreading was quickly trumpeted by Rush Limbaugh and the Drudge Report, eventually ending up on Fox News, where McCaughey's opinion column was described as "a report." In one of the many Fox segments focused on the column, hosts Megyn Kelly and Bill Hemmer blindsided Sens. Arlen Specter (R-PA) and Jon Tester (D-MT) with McCaughey's false interpretation, causing them to promise that they would "get this provision clarified." On his radio show yesterday, Limbaugh credited himself for injecting the false story into the stimulus debate, saying that he "detailed it and now it's all over mainstream media."

Last week, the government took another step toward closing a legal loophole in federal privacy and security rules for emerging Health 2.0 information technology applications by issuing proposed rules aimed at covering an estimated 900 companies and organizations offering personal health records and electronic systems connected to them. The Federal Trade Commission was careful to point out its new interim proposed rule on federal breach notification requirements for the developers of electronic PHR systems did not apply to covered organizations or their business associates as defined by the Health Insurance Portability and Accountability Act of 1996, heretofore the key federal privacy and security regulation. The FTC, operating under new authority given it by the American Recovery and Reinvestment Act of 2009, noted that its new rule seeks to cover previously unregulated entities that are part of a Health 2.0 product mix. FTC staff estimates that about 200 PHR vendors, another 500 related entities and 200 third-party service providers will be subject to the new breach notification rule. The staffers estimate that the 900 affected companies and organizations, on average, will experience 11 breaches each per year at a total cost of about $1 million per group, per year. Costs include investigating the breach, notifying consumers and establishing toll-free numbers for explaining the breaches and providing additional information to consumers. Pam Dixon, founder and executive director of the World Privacy Forum, said that this isn't the first involvement of the FTC in healthcare-related regulation, noting the consumer protection agency joined with the Food and Drug Administration in a joint statement on the marketing of direct-to-consumer genetic tests. The FTC also has worked in the field of healthcare competition. She noted the compliance deadline with the FTC's "red flag rules" on provider organizations that provide consumer credit to patients for installment payment

Don't underestimate the maddening complexity and considerable costs of digitizing health care records and processes. That was the overarching message from a dozen or so health care players, some of them doctors, following my recent column urging the industry to bring its IT practices into the 21st century. A few readers took issue with my labeling health care practitioners as "laggards." In fact, argues Dr. Daniel Essin, former director of medical informatics at Los Angeles County + USC Medical Center, "physicians are, and have always been, early adopters of technology." Essin, who's now chairman of an electronic medical records vendor, ChartWare, says many physicians have made multiple attempts to implement EMRs but failed. He cites six main reasons: * They can't articulate a set of requirements against which products can be judged. * EMR systems aren't flexible enough, requiring workarounds even before their implementation is complete. * There's a mismatch between the tasks products are expected to perform and the products' actual functionality. * Some systems are conceived as a "simple" add-on to the billing system. * System workflows consume way too much physician time and attention. * There isn't adequate integration between internal and external systems. Related to most of those obstacles is cost. One EMR kit at the entry level, offered by Wal-Mart's Sam's Club unit in partnership with Dell and eClinicalWorks, is priced at around $25,000 for the first physician and $10,000 for each additional one. After installation and training, annual maintenance and support costs are estimated at $4,000 to $6,500. That's still not chump change, especially for the smallest practices.

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In a study that is unlikely to find favor among privacy advocates, researchers from two academic institutions warned that increased efforts to protect the privacy of health data will hamper the adoption of electronic medical records systems. The study, conducted by researchers at MIT and the University of Virginia, said EMR adoption is often slowest in states with strong regulations for safeguarding the privacy of medical records. On average, the number of hospitals deploying EMR systems was up to 30% lower in states where health care providers are forced to comply with strong privacy laws than it was in states with less stringent privacy requirements. That's because privacy rules often made it harder and more expensive for hospitals to exchange and transfer patient information, thereby reducing the value of an EMR system, the study found.

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In New Jersey, and around the country, most doctors still rely on paper records for everything from writing prescriptions to keeping track of their patients' allergies. Only about 1.5 percent of U.S. hospitals have switched to an electronic records systems, and less than 8 percent have even a basic system, according to a recent study by the New England Journal of Medicine.

"Can personal medical data that has been stripped of its identifiers to protect privacy later be used to identify a specific person? That is the question that the Health and Human Services Department is hoping a research contractor can answer. HHS intends to hire a contractor to demonstrate either the "ability or inability" to re-identify data from a data set that has been de-identified under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, according to a Jan. 4 notice on the Federal Business Opportunities Web site. De-identification and re-identification of patient data have become hot issues in the discussion about how to protect patient privacy while advancing adoption of electronic health records. The Obama administration is distributing at least $17 billion in incentive payments to doctors and hospitals who buy and use digital systems for medical data."

"Although physicians support the use of electronic health records, concerns about potential privacy breaches remain an issue, according to two research articles published in the January 2010 issue of the Journal of the American Informatics Association (JAMIA), in its premiere issue as one of 30 specialty titles published by the BMJ (British Medical Journal) Group, UK. "

Do you know where your electronic health information is tonight? Here's a reader challenge: I'll pay $10 to the first adult who has had at least five encounters with the private-sector healthcare system in the past 10 years to come up with a complete map of where all his or her electronic health records have traveled, who has seen them and where they are now.

Privacy and civil liberties advocates are urging lawmakers working on the forthcoming economic stimulus package to ensure that any language to spur adoption of electronic medical records includes meaningful security safeguards. The American Civil Liberties Union, Consumer Action, the National Association of Social Workers, Patient Privacy Rights and others sent letters to House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid and President-elect Barack Obama Wednesday asking them to ensure individuals can control the use of their medical records and protect them from what they believe is a thriving industry of firms that share and sell medical data. "We all want to innovate and improve health care, but without privacy our system will crash as any system with a persistent and chronic virus will," Patient Privacy Rights executive director Ashley Katz said at a Capitol Hill briefing. Katz said her group has been pleased with progress that the House Energy and Commerce, and Ways and Means committees made last year.

Healthcare organizations are losing more than just names, addresses and Social Security numbers. When their data gets stolen, patients lose the privacy of their medical conditions, treatments and medications while at the same time falling prey to identity theft, medical billing fraud and other criminal schemes. Theft of electronic medical records is on the rise, and the implications are getting more serious. In a 2008 survey of identity theft victims, the Identity Theft Resource Center found that 67% had been charged for medical services they never received and 11% were denied health or life insurance due to unexplained reasons.

Ultimately, your first line of defense rests with your doctor, though, says Peel. To thwart breaches, pepper your doctor with questions. How will my data be transmitted? Will it be encrypted? For assistance, you can also download a question form at Patientprivacyrights.org.

This year was an interesting year in privacy and information security, and by looking back, we can clearly discern trends that will likely be a major part of the security management landscape in 2009. More and more states passed breach-notification laws and several enhanced or extended existing legislation. Software-as-a-Service (SaaS) and virtualization really took off, and compliance's looming presence grew with PCI DSS version 1.2 and some actual enforcement of HIPAA. Of particular note was Massachusetts' data breach law 201 CMR 17.00: Standards for The Protection of Personal Information of Residents of the Commonwealth. This is to date the most comprehensive law of its kind, setting a new standard for what breach-notification laws should look like; it covers both paper and electronic records, it mandates appropriate security awareness training as well as security and risk assessments and, most importantly, requires companies to make changes to their security programs in accordance with the findings of those risk assessments. Similarly, California enhanced the well-known CA-1386 to include not just traditional financial information, but also health care and health insurance data as well. With new mandates popping up all the time, it's no wonder compliance was one of the biggest focus areas for enterprise information security teams in the past year, and this trend will clearly continue in 2009; there will be more regulation on both the state and federal levels, and stronger enforcement of existing regulations. Fines and other penalties for violations of PCI DSS and HIPAA will continue to rise, along with the inevitable rise in discoveries of malfeasance. As a result, there will be an even larger focus on compliance by upper management, which also means decreased time and budget for necessary security controls that don't clearly fall under a compliance umbrella.

The statement did not indicate whether the information was paper-based or downloaded electronic information, and hospital officials were not immediately available for comment. The information likely was paper-based because "it appears the patients impacted by the incident were limited to individuals born between 1988 and 1992," according to the statement.