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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.

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?

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

This tip is part of SearchSecurity.com's Data Protection School lesson, E-discovery and security in the enterprise. Visit the E-discovery and security in the enterprise lesson page for additional learning resources. Most information security pros have a handle on the major data types found in their environments, but they also know that there is a whole lot more data lurking around the edges. These unknown data types can include documents used by individuals, or whole applications owned by departments that have quietly become essential to the business. Most of the time, focusing on the squeaky wheels is an acceptable strategy; if there's no "squeak" then there's no need to worry. But when it comes to litigation, and especially managing the electronic discovery process, what you don't know can hurt you. There are four major types of data in use today: paper documents; structured data sets, like databases; semi-structured applications, like email and image stores; and unstructured repositories, like file servers. Comprehending the vast volume of these varied records can be a challenge for everyone involved, which includes information technology, records management, legal staff, and even the data owners themselves. But since almost all business information is stored in digital formats today, electronic storage systems are the most popular target for the discovery motions filed as part of legal proceedings. It is most efficient for a litigator to head straight for your email, spreadsheets and applications, looking for what they term electronically stored information (ESI). Making matters worse for IT administrators, new rules for civil litigation enacted at the end of 2006 (called the Federal Rules of Civil Procedure, or FRCP) have pushed up the timetable of electronic discovery. What was once a delayed and informal process has become much more structured, with lawyers meeting to discuss available ESI, typically just a few weeks after legal action commences. When l

The US government has now adopted a policy of fostering the adoption of electronic medical records (EMR). The policy is intended to increase the efficiency of the US healthcare system, thereby lowering costs and reducing the incidence of preventable errors. At the same time, through its The Health Insurance Portability and Accountability Act (HIPAA) privacy rules, the government has set minimum standards for the security of those records. These two goals-privacy and security of these records, along with their free interchange among medical providers-can easily wind up at odds with each other. A recent study that looked at the role of state privacy laws in EMR adoption suggests that the problem is very real, as state privacy laws seem to inhibit the use of EMR by hospitals located there. The authors, based at MIT and the University of Virginia, line up a variety of data that validate their suggestion that privacy and the use of EMR may require a careful balance. So, for example, they cite some highly publicized lapses when it comes to the maintenance of patient privacy: someone once offered the records of 200,000 patients for sale on Craigslist, while hospitals have seen their own employees attempt to get at the electronic files of famous patients. Perhaps more significantly, the authors suggest that the public, as represented by their legislators, has concerns about the privacy of EMR. They found that states that have passed their own privacy laws to supplement the HIPAA rules tend to have a higher percentage of their populace signed up for the Do Not Call Registry, indicating a corresponding individual-level interest in maintaining privacy. So, they looked at whether these laws had any impact on the adoption of EMR by hospitals located in each state.

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Rarely is the response to a new government initiative a unanimous round of "thumbs up," but so far that seems to be the case regarding yesterday's (April 9) announcement that The Defense Department and the Department of Veterans Affairs will collaborate on building an electronic database of administrative and medical information for U.S. servicemen and women. Since developing a broad electronic health records (EHRs) initiative is a prominent feature of the Obama Administration's economic stimulus plan, it makes sense to start (or at least focus) on a defined segment of the population -- current and past military personnel. But, apart from the specific technology, architecture and technical administration aspects of this program, there will be other challenges in pursuing the goal of EHRs for the military -- challenges that insurance technology executives know only too well. These include collaboration among different and sometimes competing interests (in this case, the Department of Defense (DOD) and the Department of Veterans Affairs (VA), which historically have not worked together as closely as one might imagine); and concerns about privacy and security. In fact, the ways in which the military EHRs initiative addresses the privacy issue could provide some interesting best practices (or actions to avoid) for private-sector players. "Currently, there is no comprehensive system in place that allows for a streamlined transition of health records between DOD and the VA," President Barack Obama said at yesterday's announcement, "and that results in extraordinary hardship for an awful lot of veterans who end up finding their records lost, unable to get their benefits processed in a timely fashion. And that's why I'm asking both departments to work together to define and build a seamless system of integration with a simple goal: When a member of the Armed Forces separates from the military, he or she will no longer have to walk paperwork from a DOD

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Travelers arriving at U.S. borders may soon be confronted with their laptops, PDAs, and other digital devices being searched , copied and even held by customs agents -- all without need to show suspicion for cause. Notices are being proposed by the Privacy Office at the U.S. Department of Homeland Security (DHS), which last week released a report approving the suspicionless searches of electronic devices at U.S. borders. The 51-page Privacy Impact Assessment also supported the right of U.S. Immigration and Customs Enforcement agents to copy, download, retain or seize any content from these devices, or the devices themselves, without assigning any specific reason for doing so. Also, while in many cases searches would be done with the knowledge of the traveler in some situations, the report says, "it is not practicable for law enforcement reasons to inform the traveler that his electronic device has been searched." In arriving at the assessment, the Privacy Office argued that such searches of electronic devices were really no different from searches of briefcases and backpacks. They are needed to interdict and investigate violations of federal law at U.S. borders and have been supported by courts in the past, the assessment said.

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 Federal Trade Commission today announced that it has approved a Federal Register notice seeking public comment on a proposed rule that would require entities to notify consumers when the security of their electronic health information is breached. The American Recovery and Reinvestment Act of 2009 (the Recovery Act) includes provisions to advance the use of health information technology and, at the same time, strengthen privacy and security protections for health information. Among other things, the Recovery Act recognizes that there are new types of Web-based entities that collect or handle consumers' sensitive health information. Some of these entities offer personal health records, which consumers can use as an electronic, individually controlled repository for their medical information. Others provide online applications through which consumers can track and manage different kinds of information in their personal health records. For example, consumers can connect a device such as a pedometer to their computers and upload miles traveled, heart rate, and other data into their personal health records. These innovations have the potential to provide numerous benefits for consumers, which can only be realized if they have confidence that the security and confidentiality of their health information will be maintained. To address these issues, the Recovery Act requires the Department of Health and Human Services to conduct a study and report, in consultation with the FTC, on potential privacy, security, and breach notification requirements for vendors of personal health records and related entities. This study and report must be completed by February 2010. In the interim, the Act requires the Commission to issue a temporary rule requiring these entities to notify consumers if the security of their health information is breached. The proposed rule the Commission is announcing today is the first step in implementing this requirement. In keeping with the Recover

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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

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.

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

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

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."

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.

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.

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

"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. "

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

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