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In May 2008, the Office of the National Coordinator for Health Information Technology (ONC) awarded an approximately $450,000 contract to Booz Allen Hamilton to assess and evaluate the scope of the medical identity theft problem in the U.S. Medical Identity Theft Medical identity theft is a specific type of identity theft which occurs when a person uses someone else's personal health identifiable information, such as insurance information, Social Security Number, health care file, or medical records, without the individual's knowledge or consent to obtain medical goods or services, or to submit false claims for medical services. There is limited information available about the scope, depth, and breadth of medical identity theft. Dr. Robert Kolodner, National Coordinator for Health Information Technology, has noted that medical identity theft stories are being documented at an increasing rate, bringing to light serious financial, fraud, and patient care issues. ONC recognizes that health IT is an important tool to combat the threat of medical identity theft. We are seeking input from the public and other government agencies to better understand how health IT can be utilized to prevent and detect medical identity theft as well as build consumer trust in electronic health information exchange. ONC believes it is imperative to obtain a more comprehensive understanding of this issue from a variety of perspectives, and to create an open forum for dialogue to work proactively to address medical identity theft. Medical Identity Theft final report. The report summarizing health IT and medical identity theft issues raised at the town hall was completed January 15, 2009 and sets forth potential actions the Federal government and other stakeholders can undertake in working toward prevention, detection, and remediation of medical identify theft.

The federal government has a key role to play in researching and organizing a national response to the problem of medical identity theft, authors of a government-funded study have concluded. Patients, providers, payers and other members of the healthcare community also must join in the effort to combat a problem that is serious, although as yet its scope is not fully known, the report stated. Contractor Booz Allen Hamilton released the report last week. It represents the final phase of the $450,000 study funded last year by the Office of the National Coordinator at HHS. The study consisted of three parts, the first being to review existing knowledge about medical identity theft as well as policies and practices to prevent it. Those findings were included in a research paper on the subject released last October. The second phase involved a public meeting Oct. 15, 2008, the same day the paper was released, to "open a dialogue about medical identity theft within the healthcare industry. The final phase, the 26-page report, includes 31 "potential actions," which are recommendations that could form a national policy on medical identity theft. While medical identity theft "may be categorized as healthcare fraud," according to the report, "there are unique and important distinctions of medical identity theft that need to become more commonly understood to address this issue effectively." One difference, the report authors noted, is that the primary motive behind healthcare fraud "is most often monetary gain, such as when fraudulent providers bill for more expensive services than those rendered. However, medical identity theft tends to be focused on the use of someone else's information to gain goods, services and healthcare." IT could hurt, help Therefore, undetected medical identity theft poses medical risks to its victims, since their medical records may contain inaccurate and potentially harmful information that may cause them not to be con

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.

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 Kaiser Permanente hospital in Bellflower has been hit with a $187,500 fine for failing for a second time to prevent unauthorized access to confidential patient information, state pubic health officials said today. [Updated at 3 p.m.: A spokesman for the hospital said the fine was part of the ongoing investigation into employees improperly accessing the medical records of Nadya Suleman and her children. Disciplinary action has been taken against the employees, said Jim Anderson, a hospital spokesman. All the incidents occurred in January; a previous post said they had occurred in April and May.] State officials said Kaiser Permanente Bellflower Medical Center compromised the privacy of four patients when eight employees improperly accessed records. This is the second penalty against the hospital, officials said. The hospital was fined $250,000 in May for failing to keep employees from snooping in the medical records of Nadya Suleman, the woman who set off a media frenzy after giving birth to octuplets in January. The fine was the first penalty imposed and largest allowed under a new state law enacted last year after the widely publicized violations of privacy at UCLA Medical Center involving Farrah Fawcett, Britney Spears, California First Lady Maria Shriver and other celebrities. "We are very concerned with violations of patient confidentiality and their potential harm to the residents of California," said Dr. Mark Horton, director of the California Department of Public Health. "Medical privacy is a fundamental right and a critical component of quality medical care in California."

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

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

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.

"For five days as her husband lay in his hospital bed suffering from kidney cancer, Regina Holliday begged doctors and nurses for his medical records, and for five days she never received them. On the sixth day, her husband needed to be transferred to another hospital -- without his complete medical records. "When Fred arrived at the second hospital, they couldn't give him any pain medication because they didn't know what drugs he already had in his system, and they didn't want to overdose him," says Holliday, who lives in Washington. "For six hours he was in pain, panicking, while I ran back to the first hospital and got the rest of the records." Despite a federal law requiring hospitals and doctors to release medical records to patients who ask for them, patients are reporting they have a hard time accessing them leading to complications like the ones the Holliday family experienced. 'What part of "Give us our damn data" do you not understand?'"

Privacy law matters in ways not readily apparant until they hit home.

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

Healthcare organizations are losing more than just names, addresses and Social Security numbers. When their data gets stolen, patients lose the privacy of their medical conditions, treatments and medications while at the same time falling prey to identity theft, medical billing fraud and other criminal schemes. Theft of electronic medical records is on the rise, and the implications are getting more serious. In a 2008 survey of identity theft victims, the Identity Theft Resource Center found that 67% had been charged for medical services they never received and 11% were denied health or life insurance due to unexplained reasons.

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.

Personal profiles on Facebook and other social-networking sites are a trove of inappropriate and embarrassing photographs and discomfiting breaches of confidentiality. You might expect that from your friends and even some colleagues - but what about your doctor? A new survey of medical-school deans finds that unprofessional conduct on blogs and social-networking sites is common among medical students. Although med students fully understand patient-confidentiality laws and are indoctrinated in the high ethical standards to which their white-coated profession is held, many of them still use Facebook, YouTube, Twitter, Flickr and other sites to depict and discuss lewd behavior and sexual misconduct, make discriminatory statements and discuss patient cases in violation of confidentiality laws, according to the survey, which was published this week in the Journal of the American Medical Association. Of the 80 medical-school deans questioned, 60% reported incidents involving unprofessional postings and 13% admitted to incidents that violated patient privacy. Some offenses led to expulsion from school.

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

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

Eight years ago, a woman we'll call Sarah discovered that she was not biologically related to the father she had known all her life. Sarah, her mother revealed, was "donor-conceived." Her parents, after trying without success for a pregnancy of their own in the late 1970s, turned to a fertility center, where Sarah's mother was artificially inseminated with sperm from an anonymous donor. At the time sperm banks did not offer detailed donor profiles. Upon discovering the truth, Sarah was told what her parents had been told about her biological father: He was a medical student, possibly of Scandinavian ancestry. Sarah, who describes her family as "loving and stable," was shocked. Today she is also sick. A year before finding out about her conception, she began to experience severe, unexplained bladder problems. She has been seeing doctors at Johns Hopkins; so far they haven't figured out the cause. Recently married, Sarah worries that she may pass the illness on to future children. The medical history of her biological father could provide a crucial piece of the diagnostic puzzle. But in the early days of artificial insemination, clinics often shredded or burned files to ensure donor anonymity and client privacy. Sarah's father's identity may be locked away in storage somewhere, or it may have been destroyed. Although aware of the likely futility of her search, Sarah still continues-writing the clinic, nurses, her doctor-in the hope that someone can help. Faced with stories like this, the fertility industry and a few state governments are trying to come up with a way to ensure that future donor-conceived children will have access to their fathers' medical files. A national registry, for example, could allow banks to monitor how many times a man donates semen and how many children are born from his seed, to share updates about medical issues and to facilitate long-term research on health outcomes. But any such registry poses a threat to the p

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.

In a study that is unlikely to find favor among privacy advocates, researchers from two academic institutions warned that increased efforts to protect the privacy of health data will hamper the adoption of electronic medical records systems. The study, conducted by researchers at MIT and the University of Virginia, said EMR adoption is often slowest in states with strong regulations for safeguarding the privacy of medical records. On average, the number of hospitals deploying EMR systems was up to 30% lower in states where health care providers are forced to comply with strong privacy laws than it was in states with less stringent privacy requirements. That's because privacy rules often made it harder and more expensive for hospitals to exchange and transfer patient information, thereby reducing the value of an EMR system, the study found.

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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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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.

Traditionally, we trust doctors with confidential information about our health in the knowledge that it�s in our own interests. Similarly, few patients object to the idea that such information may be used in some form for medical research. But what happens when this process is subject to scrutiny?How explicit does our consent have to be? Since the introduction of the Data Protection Act 1998 medical researchers have raised concerns over the increasing barriers they face to accessing patient data.These concerns have heightened amongst some researchers since the passing of the Human Tissue Act 2004 introduced in the wake of the Alder Hey and Bristol Royal Infirmary scandals. When scientific advances are unraveling the secrets of DNA and the decoding of the human genome has opened up substantial new research opportunities.Clinical scientists and epidemiologists argue that the requirements being placed upon them are disproportionate to the use they are making of either datasets or tissues samples and, besides, their work is in the public interest.At the heart of the debate lie key questions over trust and consent and how these can best be resolved.To complicate things, it is no longer just medical researchers, but also public health bureaucrats who are keen to have access to our data.Quasi-official bodies have been charged with persuading individuals to change their behaviour and lifestyles in connection with all manner of issues such as diet, exercise, smoking and alcohol consumption.Social Marketing � the borrowing of commercial marketing techniques in the pursuit of 'public goods' � is in vogue amongst public health officials. Empowered by advanced data collection and computing techniques, armed with the latest epidemiological research, and emboldened by a mission to change unhealthy behaviour, public health officials are keen to target their messages to specific 'market segments' in most need of advice.Are government researchers abusing patients' trust? Can an