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While the recession injured many industries in 2008, health care was one of the few bright spots in the employment picture, growing by 372,000 jobs last year, according to the U.S. Bureau of Labor Statistics' January 2009 Employment Situation Summary. The large aging population has health care employers in need of qualified workers: stat. Therefore, despite the current economic conditions, health care employers will continue to increase staff in 2009, according to CareerBuilder.com's annual health care hiring forecast, conducted online within the U.S. by Harris Interactive. Close to one-in-five (17 percent) of large health care employers (50 or more employees) plan to increase the number of full-time, permanent employees in 2009, while 67 percent foresee either making no change in the number of employees or are unsure. Sixteen percent plan to decrease the number of employees. "The health care industry continues to boast high demand for qualified workers. Employers are reacting to this need by continuing strong recruiting efforts this year," says Jason Ferrara, vice president of corporate marketing for CareerBuilder.com. "Half of health care employers, the highest among industries we surveyed, have open positions for which they can't find qualified candidates. In response, health care employers will have to adjust their recruitment and retention strategies to find and keep top talent."

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

Industry Insiders Discuss HIT and HIPAA Issues March 30, 2009 by Astrid Fiano, Writer A significant part of President Obama's health care reform agenda is the push for implementing more health care technology. In the health care field privacy is always a major concern, and was the impetus of the Health Insurance Portability and Accountability Act of 1996--protecting the privacy of individually identifiable health information in all formats, and the confidentiality provisions of the Patient Safety Act--protecting identifiable information being used to analyze patient safety events. So those in the health care industry now wonder will the Administration's focus on health IT (HIT) present more challenges to privacy concerns? As part of a continuing focus on HIT issues, DOTmed interviewed industry expert Kirk J. Nahra, a partner in the Washington D.C. legal firm of Wiley Rein LLP, specializing in privacy and information security for the health care and insurance industries, and named an expert practitioner by the Guide to the Leading U.S. Healthcare Lawyers. DOTmed also interviewed Lise Rauzi, Vice President, Training Development, for Health Care Compliance Strategies (HCCS). HCCS provides online training compliance for employees. Nahra notes that regardless of the rising concern over privacy and the new HIT legislation, there have already been formal HIPAA security rules on electronic information in place for several years--the health care industry compliance has just been inconsistent. The problem -- to the extent there is one -- is that HIPAA rules are process-oriented, Nahra explained. The rules don't tell an entity what to do, but rather what to evaluate--a standard set of questions, but without a standard set of answers. For example, a covered entity has to have an internal audit, but the rules do not tell the entity how best to carry out that internal audit. Not surprisingly, different businesses have different ideas on how to implement their HIPAA evaluations

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

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.

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

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."

"A federal law designed to prevent employers and health insurers from discriminating against an individual based on their genetic predisposition to disease took effect late last month, signaling a new era where intermingling genetic advances and privacy concerns create new challenges in health care. But left out of the federal Genetic Information Nondiscrimination Act, commonly known as GINA, were privacy protections for individuals seeking long-term care, disability and life insurance coverage. Each of those areas was left up to the individual states. At least 10 states regulate the use of genetic information in long-term care insurance. But in California, privacy protections were left to expire by lawmakers in January 2008. Mark Billingsley, spokesman for state insurance commissioner Steve Poizner, said in an e-mail that there "appears to be a giant loophole" in California's insurance code regarding long-term care insurance and genetic privacy protections. He said he couldn't identify a single provision in the state code that would preclude a private insurer from requesting such a test for underwriting purposes. "

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.

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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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.

Physician groups press FTC for exemption from Red Flag Rules With a May 1 deadline for compliance looming, the American Medical Association (AMA) has asked the Federal Trade Commission (FTC) to suspend the application of the Red Flag Rules to physicians and publish a new rule so that physicians have an opportunity to provide comments. In a March 9 letter to the FTC, AMA Executive Vice President Michael D. Maves wrote that the AMA "strongly believes that the FTC did not provide physicians with an opportunity to review and comment on this Rule." Controversy. Under the Red Flag Rules, which were finalized in October 2007 under the Fair and Accurate Credit Transactions Act (FACTA), financial institutions and creditors must develop and implement written identity theft prevention programs. FACTA provides a broad definition of "creditor" as "any entity that regularly extends, renews or continues credit." The FTC has interpreted this definition to include health care providers and physicians. The AMA and several other medical trade associations have taken the position that physicians were not intended to be subject to the Red Flag Rules, but the FTC has held firm in its interpretation, in spite of the objections. In a Feb. 4 letter to the AMA, the FTC reiterated its position that "the plain language and purpose of the Rule dictate that health care professionals are covered by the Rule when they regularly defer payment for goods or services." The FTC also has taken the position that application of the Red Flag Rules to physicians will reduce the incidence of medical identity theft and will not impose a heavy burden on health care professionals. Rulemaking process. In addition to its claim that health care providers should not be classified as creditors, the AMA also has argued that the physician community was not informed that it would be subject to the Red Flag Rules.

One of my predictions for last year was that privacy would be a growing concern among mainstream users. I didn't repeat that prediction this year, but perhaps I should have. The reason? Apparently, younger web users seem to care more about privacy controls. Or at least, they use them more. According to Facebook chief privacy officer Chris Kelly, more teenagers than adults use privacy controls on the social network, at a rate of 60% to about 25-30%. That's surprising given the conventional wisdom that younger Internet users tend not to care about the privacy of their data. A recent study from Computer Associates confirms that many teens are at least somewhat concerned with online privacy. That study showed that 79% of teens aged 13-17 who are members of a social networking site like MySpace or Facebook protect their profiles from the general Internet in some way (i.e., only allow friends or friends of friends to view their information). Profiles on Facebook, of course, are automatically protected from viewing by the Internet at large, but protecting them from the rest of your network requires additional steps. That teens are more likely to utilize Facebook's granular privacy controls points to one of two things that lead to the same conclusion: 1. Teens care more about online privacy than adults, or, 2. Teens are simply more aware of social networking privacy controls than adults.

Current government rules do too little to protect the privacy of people's personal health information and also hinder the use of health data in medical research, a panel of experts reported on Wednesday. A committee of the Institute of Medicine, which provides advice to U.S. policymakers, urged Congress to take an entirely new approach to protecting personal health data in research. Federal standards for protecting privacy of personal health data under the Health Insurance Portability and Accountability Act of 1996, or HIPAA, are not doing the job, the panel said. Congress and the Obama administration are planning major changes this year to the U.S. health care system. Regarding the privacy rules, Congress should either start from scratch or thoroughly overall HIPAA's privacy provisions, the panel said. Better data security is needed, with greater use of encryption and other security techniques, the panel said. Encryption should be required for laptops, flash drives and other devices containing such data, it said. "Both privacy and health research are important. And we feel that we can strengthen privacy protections for people who participate in research while also allowing important research to proceed without unnecessary impediments," Dr. Bernard Lo of the University of California San Francisco, a member of the panel, told reporters. HIPAA governs how personally identifiable health information can be used and disclosed by health plans, health care providers and others. The intention is to protect personal health information while permitting the flow of information for health-related research and medical care. Lo said HIPAA has burdensome and confusing procedures for people to consent to have their health data used in medical research, dissuading people from taking part in such research.

With identity theft on the upswing, Aram Langhans thought he was simply being prudent when he asked the Yakima Heart Center to remove his Social Security number from its files. "They had my insurance card and my driver's license. What else did they need?" said Langhans, a retired public school teacher insured by Group Health. Langhans said he was initially hooked up to a portable heart monitor that he was to wear for 24 hours, but the disagreement over his Social Security number prompted upper-level personnel to change their minds. He said moments after the device was attached, he was sent to a restroom to remove it and turned away. Shawnie Haas, administrator of the Heart Center, an independent outpatient group practice, declined to discuss the incident. But she said in an e-mail statement that the practice protects patients' privacy. "The Yakima Heart Center is careful to collect data pertinent to ensuring accuracy of our patient's medical record. Routine information collected for all patients includes name, address, date of birth, Social Security number, gender, and other specific information that helps us verify that individual's identity and insurance enrollment or coverage data. We are careful to maintain confidentiality of all patient information in our system." According to state and federal regulators, private insurance companies have moved away from using Social Security numbers for patient identification. But health-care providers in the Yakima Valley say they routinely collect them as "backup" in the event that patients' insurance doesn't pay the claim.

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

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."

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.

LOS ANGELES-Fifteen hospital workers have been fired and another eight disciplined for looking at medical records of octuplet mother Nadya Suleman without permission, hospital officials said Monday. Kaiser Permanente reported the violations of health care privacy laws to the state and has warned employees at its Bellflower facility to keep away from Suleman's records unless they have a medical purpose, said hospital spokesman Jim Anderson. "Despite the notoriety of this case, to us this person is a patient who deserves the privacy that all our patients get," Anderson told The Associated Press. Anderson would not elaborate on how the other eight employees were reprimanded, saying only that the punishments were significant. A similar privacy breach at UCLA hospitals led to celebrities' medical information getting leaked to tabloids in recent years, including details of Farrah Fawcett's cancer treatment showing up in the National Enquirer. Anderson said Kaiser does not believe any of Suleman's information was shared with the media, based on the results of their inquiry. The 33-year-old single mother of 14 gave birth to her octuplets on Jan. 26 at Kaiser's hospital in Bellflower, about 17 miles southeast of Los Angeles. Her attorney Jeff Czech said Suleman does not plan to file a lawsuit, though he suspects Kaiser employees were looking for medical information on Suleman's sperm donor. He said the name is not listed on the Advertisement medical records. "She trusts Kaiser and they said they'd look into it," Czech said. "We feel that they're on top of it and are taking care of it." Anderson could not provide details about when Suleman's medical records were accessed and by what kind of hospital employee. He said Kaiser had warned its employees about patient confidentiality rules before Suleman checked into the hospital in December. "Even though no one knew she was there, they knew she was going to have a lot of babies," Anderson said. "The extra monitoring he

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.