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New Englanders have a reputation for being taciturn, but when it comes to data Massachusetts takes the cake. No state loves its privacy more than the Bay State, which last year passed the nation's most exacting data privacy law, requiring companies to check off a honey-do list of steps designed to protect personal data belonging to commonwealth residents. Connecticut and Rhode Island preceded Massachusetts in joining the minority of states that have enacted proactive data privacy laws, requiring businesses to protect information like Social Security and credit card numbers. Maine, Vermont and New Hampshire, like nearly all states, have only reactive data laws, requiring companies to take certain steps - like reporting a breach to authorities - after data has been compromised. Rhode Island's law, passed in 2006, requires businesses that own or license Rhode Islanders' personal information to "provide reasonable security" for that data. Connecticut's law, passed shortly before Massachusetts enacted data privacy legislation last summer, requires businesses to create and publicly display a data protection policy, but does not specify what that policy should entail. The Connecticut and Rhode Island laws stop far short of the controversial requirements in Massachusetts, where new regulations are scheduled to take effect by January 2010. "They're not technically one-liners, but they're very general," Goodwin Procter LLP partner David Goldstone said of the Connecticut and Rhode Island statutes, which are similar to laws passed in Texas and California. "Essentially they say companies have to have reasonable protections in place."

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Marcia Angell MD is a well-known, respected physician, long-time editor of NEJM. So it was a bit of a shock today when Amy Romano, blogger for Lamaze International, sent me this quote: "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine".

Interesting quote by former editor of the New England Journal of Medicine

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.

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?

A federal judge said he will decide in the next few days whether supermarket giant Hannaford Bros. is potentially liable for damages because of a data breach that exposed more than 4 million credit and debit card numbers to computer hackers. Judge D. Brock Hornby heard arguments on Wednesday at U.S. District Court. Attorneys for Hannaford asked the judge to dismiss the lawsuit, which was filed against the Scarborough-based company last year. Attorneys for the plaintiffs said Hornby should certify the case as a class-action suit and let it proceed toward trial. The upcoming ruling will determine whether parts or all of the suit will go forward. The case boils down to a couple of central questions: To what extent are merchants responsible for securing the electronic data that gets processed with every noncash purchase, and what should the consequences be when that data is stolen? "These are fascinating and difficult issues," Hornby said after hearing the arguments Wednesday. "I'll get a written decision out to you as soon as I can." Between Dec. 7, 2007, and March 10, 2008, hackers stole credit and debit card numbers, expiration dates and PIN numbers from people shopping at Hannaford supermarkets. The grocery chain operates more than 200 stores under various names in New England, New York and Florida. More than 4 million card numbers were exposed, and by the time Hannaford publicly announced the breach, on March 17, 2008, about 1,800 fraudulent charges had been made.

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.

On January 7, backers of California's Proposition 8 filed a federal lawsuit, asking that they be exempted from complying with California election laws that require disclosure of the names of people who give as much as $100 to a campaign for or against an initiative. The case is ProtectMarriage.com v Bowen, no. 2:09-cv-00058 (Sacramento). It was assigned to U.S. District Court Judge Morrison England, who was appointed in 2002. The case depends on the 1982 U.S. Supreme Court precedent Brown v Socialist Workers '74 Campaign Committee, which said that disclosure is not compelled if there is a reasonable possibility that campaign contributors, if identified, will be subject to harassment. Besides the Socialist Workers Party, other groups that have won freedom from disclosure include the Freedom Socialist Party, Socialist Action, and the Communist Party.