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As health care providers determine how they will take advantage of the $19 billion allocated in the stimulus package to help jumpstart advances in health information technology (HIT), consumer appetite for electronic health records (EHRs), online tools and services is also growing, according to the results of the 2009 Deloitte Survey of Health Care Consumers (www.deloitte.com/us/2009consumersurvey). While only 9 percent of consumers surveyed have an electronic personal health record (PHR), 42 percent are interested in establishing PHRs connected online to their physicians. Fifty-five percent want the ability to communicate with their doctor via email to exchange health information and get answers to questions. Fifty-seven percent reported they'd be interested in scheduling appointments, buying prescriptions and completing other transactions online if their information is protected. Technologies that can facilitate consumer transactions with providers and health plans, like integrated billing systems that make bill payment faster and more convenient, are also appealing to nearly half (47 percent) of consumers surveyed. The survey of more than 4,000 U.S. consumers 18 and over was released today at the Healthcare Information and Management Systems Society (HIMSS) Annual Conference held in Chicago. It is the second annual study examining health care consumers' attitudes, behaviors and unmet needs conducted by the Deloitte Center for Health Solutions offering health care industry leaders and policymakers a timely look at how health care consumerism is evolving. "Consumers are increasingly embracing innovations that enhance self-care, convenience, personalization and control of personal health information," said Paul H. Keckley, Ph.D., executive director, Deloitte Center for Health Solutions. "Consumers want a bigger say in their health care decisions. Consumer demand for HIT and its potential impact on reforming the system has never been stronger." Despite strong con

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

Google never fails to surprise. It's the scope and scale of their ambitions that impresses me ranging as they do from relatively simple applications that are just way cool such as Sky Map, through their Chrome Web browser (which is now looking pretty stable), to the subject of this newsletter: Google Health. Google Health, which was launched as a beta (of course) in spring 2008, is a free repository for your personal health information. Using the service you can create online health profiles for yourself, family members or others you care for (these profiles can include health conditions, medications, allergies and lab results), you can import medical records from hospitals and pharmacies, share your health records with "your care network" (which may include family members, friends and doctors), and browse an online health services directory to find services that are integrated with Google Health. After you sign up you can import your medical records from Allscripts, Anvita Health, The Beth Israel Deaconess Medical Center, Blue Cross Blue Shield of Massachusetts, The Cleveland Clinic, CVS Caremark, Healthgrades, Longs Drugs, Medco Health Solutions, Quest Diagnostics, RxAmerica and Walgreens. What you'll wind up with if you update all of the sections is a pretty complete health profile, which means that privacy has to be a concern. Interestingly, because becoming a subscriber is voluntary it appears that the service is exempt from the provisions of the Health Insurance Portability and Accountability Act of 1996.

Wal-Mart Stores is striding into the market for electronic health records, seeking to bring the technology into the mainstream for physicians in small offices, where most of America's doctors practice medicine. Wal-Mart's move comes as the Obama administration is trying to jump-start the adoption of digital medical records with $19 billion of incentives in the economic stimulus package. The company plans to team its Sam's Club division with Dell for computers and eClinicalWorks, a fast-growing private company, for software. Wal-Mart says its package deal of hardware, software, installation, maintenance and training will make the technology more accessible and affordable, undercutting rival health information technology suppliers by as much as half. "We're a high-volume, low-cost company," said Marcus Osborne, senior director for health care business development at Wal-Mart. "And I would argue that mentality is sorely lacking in the health care industry." The Sam's Club offering, to be made available this spring, will be under $25,000 for the first physician in a practice, and about $10,000 for each additional doctor. After the installation and training, continuing annual costs for maintenance and support will be $4,000 to $6,500 a year, the company estimates. Wal-Mart says it had explored the opportunity in health information technology long before the presidential election. About 200,000 health care providers, mostly doctors, are among Sam Club's 47 million members. And the company's research showed the technology was becoming less costly and interest was rising among small physician practices, according to Todd Matherly, vice president for health and wellness at Sam's Club. The financial incentives in the administration plan - more than $40,000 per physician over a few years, to install and use electronic health records - could accelerate adoption. When used properly, most health experts agree, digital records can curb costs and i

Customers of CVS' pharmacy will be able to import their prescription records into a Google Health account as a result of an expanded deal between the two companies. The deal was announced Monday. An earlier deal already allowed workers whose company uses CVS Caremark to handle drug benefits to use Google Health to store their drug records. The new deal expands this to customers of CVS' network of retail pharmacies. "We now offer all of our consumers the ability to download their prescription and medication history into their Google Health Personal Health Record, whether they are CVS/pharmacy customers, CVS Caremark plan participants or visitors to our MinuteClinic locations," said CVS Caremark Executive Vice President Helena Foulkes in a statement. "By enabling patients to download their prescription information directly into their personal health record, we are helping to close the gap in today's fragmented health care system and provide a full view of a patient's health." To use the tool, the companies said, consumers need to sign up for the prescription management feature on CVS.com as well as be authenticated. With the latest deal, Google said it now believes more than 100 million Americans will have the option of viewing their drug history within Google Health. Microsoft, which is also trying to sign consumers up for its HealthVault service, announced a deal with New York-Presbyterian Hospital on Sunday which will allow patients of that hospital system to export their records to a HealthVault account.

URAC, the leading health care accreditation and education organization, announced today the recent Healthcare Information and Management Systems Society (HIMSS) annual conference raised important questions about consumer privacy and security around electronic health records (EHR). (Logo: http://www.newscom.com/cgi-bin/prnh/20030501/URACLOGO ) "There is no doubt that electronic health records are coming. The question is whether or not consumers' privacy is a key issue or an afterthought," said Alan P. Spielman, President and CEO of URAC. "A lot of forces are driving the push for EHR. However, it is important that standards go hand-in-hand with policy so that it doesn't become the Wild West with every vendor and health care provider using different terms." The rules set by the Health Insurance Portability and Accountability Act (HIPAA) are integral to the widespread adoption of EHR. However, the rules can be confusing for consumers and providers. URAC was the first organization to offer HIPAA Privacy Accreditation. The organization now offers comprehensive standards for both HIPAA Privacy and HIPAA Security accreditation. These standards are applicable to all personal health information storage formats and exchanges claims transactions and are designed for many different types of health care organizations including both Covered Entities (CE) and Business Associates (BA). They also require an ongoing compliance program that identifies, tracks and makes the necessary changes in response to a federal or state regulatory change.

The Senate and House appear headed for a clash over competing visions of how to protect the privacy of patients' electronic medical records, with the House favoring strict protections advocated by consumer groups while the Senate is poised to endorse more limited safeguards urged by business interests. President Obama has called creation of a nationwide system of electronic medical records fundamental to health-care reform, and both chambers of Congress have included about $20 billion to jump-start the initiative as part of their stimulus bills. But as with much in the stimulus package, it is not just the money but the accompanying provisions that groups are trying to influence. The effort to speed adoption of health information technology has become the focus of an intense lobbying battle fueled by health-care and drug-industry interests that have spent hundreds of millions of dollars on lobbying and tens of millions more on campaign contributions over the past two years, much of it shifting to the Democrats since they took control of Congress. At the heart of the debate is how to strike a balance between protecting patient privacy and expanding the health industry's access to vast and growing databases of information on the health status and medical care of every American. Insurers and providers say the House's proposed protections would hobble efforts to improve the quality and efficiency of health care, but privacy advocates fear that the industry would use the personal data to discriminate against patients in employment and health care as well as to market the information, often through third parties, to generate profits.

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."

U.S. lawmakers need to make sure privacy safeguards are in place before pushing electronic health records (EHR) on the public, senators and witnesses said at a Senate Judiciary Committee hearing today. Health IT improvements are needed to improve the quality and efficiency of health care in the U.S., but patients might be wary of electronic health records without strong privacy safeguards built in, Sen. Patrick Leahy (D-Vt.) said. "If you don't have adequate safeguards to protect privacy, many Americans aren't going to seek medical treatment," Leahy said. "Health care providers who think there's a privacy risk ... are going to see that as inconsistent with their professional obligations, and they won't want to participate." An $825 billion economic stimulus package, called the American Recovery and Reinvestment Act, includes $20 billion targeted toward health IT efforts. The bill, which could come before the full House for a vote this week, establishes an Office of the National Coordinator for Health Information Technology, which will be responsible for driving health IT standards.

Feds would spend $20 billion on health IT if Senate and House agree in coming weeks. The House-passed version of the economic stimulus bill includes about $20 billion in spending for health IT. The bill, known as H.R. 1 or the American Recovery and Reinvestment Act of 2009, would make Medicare and Medicaid providers and hospitals eligible for incentive payments for using certified e-health records technology. It also supports health information exchanges, standards development and conformance testing, a chief privacy officer for health IT and other aspects of health IT. The portion of the bill called the Health Information Technology for Economic and Clinical Health Act -- the Hitech Act, for short -- and health IT spending provisions passed largely unchanged from the bills introduced earlier this month. The Senate is expected to take up a similar bill in the first week of February. The Senate bill now calls for $23 billion in health IT spending. Once it is passed, a House-Senate conference will need to resolve differences between the bills. Congressional leaders aim to send President Barack Obama the bill by mid-February.

Electronic medical recordkeeping may not cut the overall cost of care, but by eliminating redundant procedures and reducing errors, quality may be improved. When physician Andrew Wiesenthal needs to work out a problem, he runs around Lake Merritt, across the street from his Oakland (Calif.) office at Kaiser Permanente. As one of the main drivers behind Kaiser's decades-long, multibillion-dollar effort to overhaul the way patient health records are kept, Wiesenthal has had a lot of laps to run. Doctors and other medical professionals across the country will be working through similar challenges in the coming years. President Barack Obama plans to spend $17.2 billion to induce care providers to maintain patient records electronically, scrapping the current paper-based system. The Obama Administration wants electronic health records for every American by 2014. Obama's predecessor also made a big push for electronic recordkeeping, and many doctors and hospital administrators see upgrading recordkeeping as a good way to improve care. Yet, fewer than 2% of acute care hospitals have a comprehensive electronic health record system in place, with another 8% to 12% using a basic system, according to a study published by The New England Journal of Medicine in March. Adoption isn't much better among physicians. Only 4% have a comprehensive system in place, with another 13% using basic systems, according to a study published in the journal in July. Kaiser Permanente is one of the few exceptions. Today, all of its medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by next year. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia.

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.

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.

The recent U.S. stimulus bill includes $18 billion to catapult the health industry toward the world of electronic health records. This is sure to light a fire under every hungry security vendor to position itself as the essential product or service necessary to achieve HIPAA compliance. It should also motivate healthcare IT professionals to learn where their sensitive data is located and how it flows. To be sure, with federal money allocated through 2014 for the task of modernizing the healthcare industry there will be many consultant and vendor businesses that will thrive on stimulus money. Healthcare is unique in that storage of electronic health records is highly distributed between primary care physicians, specialist doctors, hospitals, and insurance/HMO organizations. Information has to be efficiently shared among these entities with great sensitivity towards patient privacy and legitimate claims processing. Patients want to prevent over zealous employers from performing unauthorized background checks on medical history; claim processors want to prevent paying fraudulent claims arising from targeted patient identity theft. The bill has two provisions which turn this into a tremendously challenging plan, and a daunting task for securing patient data: * Citizens will have the right to monitor and control use of their own health data. This implies a large centralized identity and access control service, or perhaps a federated network of patient registration directories. Authenticated users will be able to reach into the network of health databases audit use of their data and payment history. * Health organizations suffering loss of more than 500 patient records must publicly disclose the breach, starting with postings on the government's Health and Human Services website. This allows related organizations to trace the impact of the breach throughout the healthcare network, but care must be taken not to disclose vulnerabilities in the system to intruders

Patients' advocates claimed victory in a battle over the privacy of health records as the U.S. Congress approved the economic stimulus bill, which contains $19 billion for health-care information. U.S. House and Senate negotiators' compromise reflects stricter standards that privacy advocates wanted for marketing, selling and disclosing health data. Both houses approved the $787 billion stimulus plan today and sent it to President Barack Obama for his signature. The legislation contains $2 billion in grants to create a national system of computerized health records and $17 billion in higher Medicare and Medicaid reimbursements for doctors and hospitals to adopt the technology. Electronic records will improve care and reduce costs, Obama said. The legislation also will boost the health-records industry, led by Allscripts-Misys Healthcare Solutions Inc., Quality Systems Inc. and Athenahealth Inc. "We've dramatically improved on the status-quo, wholly unregulated system where private patient data was bought and sold like any commodity," Caroline Fredrickson, director of the American Civil Liberties Union's Washington legislative office, said in an interview today.

The federal government would subsidize up to 65% of COBRA health insurance payments for many individuals who have lost their jobs since Sept. 1, 2008, under an $825 billion stimulus package unveiled by House Democrats. COBRA provisions are supported by health insurance groups, including America''s Health Insurance Plans and the National Business Group on Health. However, AHIP said other parts of the plan tying increased investment in health information technology to stricter scrutiny of how health IT records are handled would make it more difficult for plans to coordinate care and streamline administrative costs. Dubbed the American Recovery and Reinvestment Act, the House bill allocates $39 billion to aid individuals attempting to continue paying health insurance premiums through the 23-year-old Consolidated Omnibus Budget Reconciliation Act program. COBRA allows employees who are terminated or leave their jobs voluntarily to remain in their former employer''s group health plan for up to 18 months, which can be extended to 36 months for those with extenuating life circumstances. However, because COBRA enrollees can be charged up to 102% of the full cost of coverage, many find the plans prohibitively expensive and, according to Hewitt Associates Inc., only about 20% enroll. A recent report by the consumer group Families USA found monthly COBRA premiums for family coverage were $1,069, or 83.6% of the average monthly unemployment insurance benefit of $1,278. In nine states, average COBRA payments exceeded unemployment benefits, the group found. Health groups have been largely supportive of the proposal, with AHIP President Karen Ignagni writing in a letter to House Speaker Nancy Pelosi that the group believes the move would "help ensure continuity of coverage and serve as an important lifeline for many workers who do not qualify for Medicaid, but still need help paying their health insurance premiums."

It's often the security issue that dogs Google, Microsoft and other purveyors of personal health records (PHR): How will so much personal medical data be kept safe? A tangential question for Google, however -- one that has dogged the search giant since its Google Health offering was first made available in May 2008 -- is whether Google's search-based advertising platform creates a conflict with storing personal health data. Speaking at the Mastermind Session at Everything Channel's Healthcare Summit in San Diego in November,Google Vice President of Research and Special Initiatives Alfred Spector told health care CIOs, solution providers and other attendees that Google intended Google Health as an extension of the Google brand, and it was and would continue to be entirely separate from Google's main advertising platform. Watchdog organizations have taken Google to task over that claim, however, with one, Consumer Watchdog, even accusing Google of trying to lobby Congress to allow it to sell medical records by loosening regulatory language in the stimulus bill. "The medical technology portion of the economic stimulus bill does not sufficiently protect patient privacy, and recent amendments have made this situation worse," wrote Jerry Flanagan of Consumer Watchdog in a Jan. 27 open letter to Congress. "Medical privacy must be strengthened before the measure's final passage, rather than allowing corporate interests to take advantage of the larger bill's urgency." Flanagan in the letter states that, "Google is said to be lobbying hard ... to weaken the ban currently in the draft measure on the sale of our private medical records." While Consumer Watchdog did not cite specific evidence of Google pushing for softer restrictions, Google responded to the group's claims on its Public Policy Blog last week. "The claim -- based on no evidence whatsoever -- is 100 percent false and unfounded," wrote Pablo Chavez, Google's Senior Policy Counsel. "Google does not sell health

"If you live in Texas, your medical records are definitely up for sale by the state. If you live anywhere else in the United States, they probably are for sale there, too. Medical health records provide key information to researchers, who have lobbied hard to keep them accessible, despite government concerns about the privacy of patient data. The controversy dates back to 1996, when Congress passed the Health Insurance Portability and Accountability Act (HIPAA) to protect patients. "Researchers have very broad access rights to health care records under HIPAA," says Pam Dixon, director of a non-profit called the World Privacy Forum "The rules are pretty loose, and there are a lot of ways to get around them." That's especially true since the act wasn't designed to cover common scenarios today: records stored online in a vast, hackable cloud. In the rush to digitize all electronic health records, Dixon says not everyone is taking the proper steps to de-personalize the data and protect patients."

Even a booster of electronic systems like David Blumenthal, who just started his Washington post as the national coordinator of health IT, points to a myriad of challenges when it comes to digitizing the nation's medical records. Just take a look at his piece this month in the New England Journal of Medicine, in which he cites technical concerns and worries about patient privacy, among other things. In an interview with the WSJ, he said problems can crop up if the systems are installed too quickly and without enough technical support. There are plenty of potential advantages that electronic records can bring, from helping hospitals and doctors get information quickly on patients' medical histories to making catches when two drugs are being prescribed that may interact dangerously together. But there are also risks: Take a look at a study in Pediatrics that cites the case of Children's Hospital of Pittsburgh, which initially saw a rise in the death rate for certain patients after computerizing its order-entry system, perhaps because it took longer to begin their treatment. (The hospital told the WSJ the study was "flawed," adding the mortality rate had fallen since then.) The WSJ also cites the case of a patient who was initially given an incorrect diagnosis based on a mix-up involving electronic records and a test result for another patient. Health Blog Question of the Day: What's been your experience with electronic records? Do they prevent safety problems or create new risks?

U.S. lawmakers need to make sure privacy safeguards are in place before pushing electronic health records (EHR) on the public, senators and witnesses said at a Senate Judiciary Committee hearing today. Health IT improvements are needed to improve the quality and efficiency of health care in the U.S., but patients might be wary of electronic health records without strong privacy safeguards built in, Sen. Patrick Leahy (D-Vt.) said. "If you don't have adequate safeguards to protect privacy, many Americans aren't going to seek medical treatment," Leahy said. "Health care providers who think there's a privacy risk ... are going to see that as inconsistent with their professional obligations, and they won't want to participate."