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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.

Maryland is poised to jump ahead of the rest of the nation in health information technology on Tuesday when Gov. Martin O'Malley signs a bill intended to coax doctors into using electronic medical records. The computerized files are seen as the foundation of a national health information network that proponents say will improve care, advance medical knowledge and save the country tens of billions of dollars annually. But with the startup costs to individual doctors in the tens of thousands of dollars, many smaller practices have been slow to move from clipboard to computer screen. With today's bill signing, Maryland will become the first state requiring private insurance companies to offer doctors financial incentives to adopt the technology, state officials say. Doctors who do not bring an electronic medical records system on line by 2015 could face penalties. "This is where government and private health care providers can come together to really improve not only the quality of care but also, hopefully, create some costs savings as well," O'Malley said. "Health IT is the future of health care in our country, and we want Maryland to lead the way."

The problem with securing data and insuring its safety is that there is simply so much more stored electronically these days that opportunities for outside hackers or insiders to steal valuable, confidential information off a company's computer systems are growing exponentially, according to those in the insurance industry who make it their business to cover this expanding exposure. Indeed, "you can take out more data in a thumb drive now than people could take out in a super-computer 10 years ago," according to Kevin Kalinich, co-national managing director for Professional Risk Solutions at Aon. The risk of a data breach is very real for companies large and small across almost any industry, noted Mr. Kalinich. He cited a report from the University of California, Berkeley, that more data has been aggregated and stored in the last three years than in the entire history of mankind. He also noted that between 75 and 85 percent of Fortune 2000 companies have suffered a "material data breach," meaning there is a growing market for those selling insurance coverage for liability and repair costs, as well as loss control services. Companies that take an "it won't happen to me" approach to securing data need only look at news headlines to see that organizations are often hit by breaches, and as more data is being stored electronically, the potential for, and impact of possible breaches increase. Princeton, N.J.-based credit and debit processing company Heartland Payment Systems reported that it had been compromised in 2008 in a breach that involved up to 100 million records, which would be tops for number of records accessed in a breach. The Heartland incident would displace the 2007 breach of TJX, in which over 45.6 million credit and debit card numbers were stolen. The TJX breach, in turn, took the record set by a breach of CardSystems Solutions in 2005.

Bring up the subject of digitizing medical records and you're likely to get a paradox of a discussion. Everyone thinks it will help save money and improve health care, and everyone has grave reservations. Get ready to hear more as a massive economic stimulus bill works its way through Congress, which includes IT health care spending measures. Although lawmakers are close to pulling the trigger. ensuring the privacy of patients' electronic health records (EHR) remains a top concern. "I very firmly believe that the Achilles heel of health IT is privacy," said Sen. Jim Whitehouse, a Rhode Island Democrat who chaired a hearing this morning examining the appropriate safeguards government should insist on before it doles out billions of dollars to help providers computerize patients' records. Champions of health IT argue that EHRs and interoperable systems to integrate data among providers would drive down healthcare costs while greatly reducing medical errors. Just 17 percent of physicians currently have even basic EHRs. The Center for Disease Control has estimated that as many as 98,000 preventable deaths occur in U.S. hospitals each year, many of which could presumably been avoided with more accessible patient data. "If 100,000 Americans were being killed by anything else, we'd be at war," Whitehouse said.

More electronic records were exposed in 2008 than in the previous four years combined and most of those breaches -- nine out of 10 -- could have been easily avoided with basic preventative controls consistently applied. In its 2009 Verizon (NYSE: VZ) Business Data Breach Investigations Report, Verizon Business Security Solutions analyzed 90 confirmed breaches that occurred in 2008, affecting 285 million compromised records. The company's previous data breach report covered from 2004 through 2007, a period that saw 230 million compromised records. About a third of the breaches in Verizon Business' caseload have been publicly disclosed, and additional disclosures are expected before the end of the year. But many breaches will remain unreported because of the absence of any applicable disclosure requirement. Among the report's findings: 91% of all compromised records were linked to organized criminal groups; customized malware attacks doubled; and the most common attack vectors were default credentials and SQL injection. In a statement, Peter Tippett, VP of research and intelligence for Verizon Business Security Solutions, described the report as a wake-up call. Businesses need strong security and a proactive approach, he said, particularly because the economic crisis is likely to spur even greater criminal activity.

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The state's highest court told Bergen County yesterday to release 8 million pages of real estate documents -- including mortgage information -- to fulfill a request filed under the state's public records law, but that Social Security numbers included in them must be kept private. The justices also said the company requesting the information should pay the $460,000 it will cost the county to remove the Social Security numbers from records spanning more than two decades. The court unanimously agreed that the documents, requested by a business that wants to sell electronic access to this information, are public records under the state's Open Public Records Act. But it stressed some of the personal information, if released, would hurt residents. "The request was made on behalf of a commercial business planning to catalogue and sell the information by way of an easy-to-search computerized database. Were that to occur, an untold number of citizens would face an increased risk of identity theft," Chief Justice Stuart Rabner wrote for the court. Bergen County officials called the decision a victory for all New Jersey residents concerned about identity theft.

A consumer group accused Google of seeking provisions in the economic stimulus package that would allow it to sell patient medical data to Google Health advertisers. Perhaps patients' biggest worry about electronic medical records is that their private health data will get into the wrong hands. To get a feel for some folks' anxiety, just take a look at this from a group called Patient Privacy Rights: "CHILLING NEWS ABOUT HEALTH PRIVACY: You Have None." (Or look at one of our many posts about health data breaches.) So it's probably not a surprise that Google, which last year launched Google Health, a personal online repository, was quick to refute a charge by a different consumer group, called Consumer Watchdog, of "a rumored [Google] lobbying effort aimed at allowing the sale of electronic medical records." The group further claimed that Google is "reportedly" pushing for items in the economic stimulus bill that would allow the company to "sell patient medical information" to advertisers. Google shot back, posting an item in its public policy blog calling the claims "100 percent false and unfounded." The company added: Google does not sell health data. In fact, one of our most steadfast privacy principles is that we don't sell our users' personal data, whether it's stored in Google Health, Gmail, or in any of our products. And from a policy perspective, we oppose the sale of medical information in the health care industry. Google's ear is likely fine tuned to this issue, considering some folks in the medical community have already pointed out the company is not a type required to follow a federal patient-privacy law called HIPAA.

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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"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.

"Medical records for about 15,500 Northern California Kaiser patients - about 9,000 of them in the Bay Area - were compromised after thieves stole an external drive from a Kaiser employee's car last month, Kaiser officials said Tuesday." Kaiser officials said the electronic device contained patients' names, medical record numbers and possibly ages, genders, telephone numbers, addresses and general information related to their care and treatment. No Social Security numbers or financial information was contained on the drive, and Kaiser officials said there's no evidence that the information has been used inappropriately. The device was not encrypted, but some of the information was password protected. Kaiser has sent letters to the 15,500 members and the employee, who Kaiser would not identify, has been fired.

Another hospital employee fired for inappropraite access of medical records. More damage to a medical group reputation because someone failed to get the message.

Legislation aimed at protecting the privacy rights of car owners is drawing objections from auto manufacturers and Progressive Insurance, which hopes to introduce a program in Washington state that charges drivers based partly on how and when they drive.\n\nThe American Civil Liberties Union of Washington is pushing for the legislation, which would require automakers and other companies to inform car owners of the presence of devices that record information about their driving habits.\n\nThat includes event data recorders, or black boxes, installed on most newer cars, as well as electronic equipment such as GPS devices and OnStar, the wireless subscription service from General Motors.\n\nIn addition to requiring notification, a bill sponsored by state Sen. Claudia Kauffman, D-Kent, would clarify that vehicle owners are the owners of the data. With a few exceptions, a court order or the owner's permission would be required in order for a third party to obtain it.\n\nCarrie Tellefson, a lobbyist for Progressive Insurance, testified last week at a House Transportation Committee hearing that Substitute Senate Bill 5574 would prevent the insurance company from introducing its pioneering MyRate insurance program into Washington.\n\nProgressive Insurance first tested the idea of usage-based insurance in 1999. The company introduced the current plan, called MyRate, in 2004 and now offers it in nine states, including Oregon.\n\nCustomers who agree to opt into the program plug a device into their car's onboard diagnostic system, usually somewhere under the dashboard near the steering column. The device records information about how, when, and how much the car is driven, and wirelessly transmits the data back to Progressive's servers.\n\nCustomers are either rewarded with a discount or penalized with a higher rate depending on the information collected.\n\nThe discount can be as much as 30 percent, and the surcharge up to 9 percent.\n\nCustomers can go online and look at perso

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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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.

Jan 15, 2009 There may be only a handful of days left in the Bush administration, but the brouhaha over White House e-mail retention policies promises to continue right up to the last day. A federal court yesterday extended a preservation order to ensure that the outgoing administration does everything it can to recover any missing White House e-mails. The White House IT staff now has five days to scour workstations for missing e-mail before administration data records are archived on Jan. 20. The ruling, by U.S. District Judge Henry Kennedy Jr., also orders staff of the Executive Office of the President (EOP) to relinquish any digital media that may contain e-mails from March 2003 and October 2005. The legal action is the latest resulting from a lawsuit filed in September 2007 by the National Security Archive against the EOP, seeking to preserve and restore White House e-mails it alleged were missing. "There is nothing like a deadline to clarify the issues," Tom Blanton, the National Security Archive's director, said in a statement. "The White House will complain about the last-minute challenge, but this is a records crisis of its own making." The Archive, an independent nongovernmental research institute based at George Washington University, is a repository of government records and does not receive U.S. government funding. The Citizens for Responsibility and Ethics in Washington (CREW), a left-wing public advocacy group, also filed suit, but its legal action was subsequently consolidated with the Archive's legal action, which is taking place in the U.S. District Court for the District of Columbia. Last May, the White House's top tech staffer acknowledged that three months of data were missing from backup tapes. In earlier testimony before a congressional committee, White House technical staff said millions of e-mails from the past eight years could potentially have been erased. Also yesterday, Magistrate Judge John M. Facciola held an emergency status con

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

"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."

A health care industry coalition on Monday released a prescriptive security framework that organizations can use to safeguard patient records as they increasingly move online. The framework, released by the Health Information Trust Alliance (HITRUST) -- which represents health care providers, pharmacies, insurers, biotech firms and medical device manufacturers -- is based on well-known standards such as COBIT, NIST and ISO 270001. But this is the first benchmark developed specifically for protecting health data. "It's tailored to protecting health information right out of the gate," Michael Wilson, vice president and chief information security officer of McKesson, the largest U.S. pharmaceutical distributor, told SCMagazineUS.com on Monday. "It's just a different sort of data. It's still structured [like other verticals], but there's a lot more of it in health care." The framework was created to improve adoption rates with regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and increase patient confidence in the security of their information. It also arrives on the heels of the new $787 billion economic stimulus bill, about $20 billion of which is earmarked to encourage health care organizations to adopt electronic health records as a way to reduce the number of medical errors and save money. The stimulus bill, in itself, contains srict privacy and security regulations for patient information. The standards took about 18 months to devise and can be implemented by organizations of any size, according to HITRUST. "2009 will be a turning point for information security in the health care industry, when organizations will begin implementing the framework...and create a cascading effect that will impact and benefit the entire health care ecosystem," Daniel Nutkis, CEO of HITRUST, said in news release. Wilson said the framework also will enable companies such as McKesson to show their customers and business partners that they are taki

Bruce Schneier is the chief security technology officer at BT and a celebrated writer and speaker on privacy, cryptography and security issues. Welcome to the future, where everything about you is saved. A future where your actions are recorded, your movements are tracked, and your conversations are no longer ephemeral. A future brought to you not by some 1984-like dystopia, but by the natural tendencies of computers to produce data. Data is the pollution of the information age. It's a natural byproduct of every computer-mediated interaction. It stays around forever, unless it's disposed of. It is valuable when reused, but it must be done carefully. Otherwise, its after effects are toxic. And just as 100 years ago people ignored pollution in our rush to build the Industrial Age, today we're ignoring data in our rush to build the Information Age. Increasingly, you leave a trail of digital footprints throughout your day. Once you walked into a bookstore and bought a book with cash. Now you visit Amazon, and all of your browsing and purchases are recorded. You used to buy a train ticket with coins; now your electronic fare card is tied to your bank account. Your store affinity cards give you discounts; merchants use the data on them to reveal detailed purchasing patterns.

Federal authorities are investigating the loss of a computer hard drive containing a huge quantity of personal information from Bill Clinton's presidency in an apparent security breach at a National Archives record center, government officials said Tuesday. Government officials briefed on the matter said the breach, which was confirmed in April, involved the loss of a drive containing a terabyte of computerized data, which could include millions of individual pieces of information, including personal information about one of then Vice President Al Gore's three daughters. The missing information included Social Security numbers and home addresses of numerous people who visited or worked at the White House, along with other material related to security procedures used by the Secret Service at the White House in the Clinton years. The National Archives and Records Administration said Tuesday in a statement that the agency "takes very seriously the loss of an external hard drive that contained copies of electronic storage tapes from the executive office of the president of the Clinton administration."