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Hundreds of medical records kept by a longtime Acton family doctor who abruptly closed his practice last year are about to be destroyed, leaving patients without crucial information and exposing a gap in state law about who owns abandoned medical records. On April 8, a Lynn storage company is scheduled to discard the records and auction the equipment left by Dr. Ronald T. Moody, who was evicted from his office last September as state regulators pursued him, saying he was practicing without a license. Many of Moody's former patients have no idea that their records are slated for destruction: None has been notified, nor does the law require such notice. "We throw people's lives away on a daily basis, and, believe me, we go out of our way to try and find someone" to salvage belongings, said Jim Appleyard, owner of the storage company that was hired by Moody's former landlord to clean out the office and store the items for six months, as required by law. But the idea of dumping hundreds of patients' files without them knowing about it bothered Appleyard. Unable to find Moody, he contacted the state Board of Registration in Medicine and pleaded to take the dozens of boxes of records. The board regulates doctors and administers rules governing medical records of physicians in private and group practices.

This week, the Government Accountability Office issued a report related to privacy and security issues at FDA and another report about the agency's plans to modernize its IT systems, Government Health IT reports. Privacy and Security Report On Monday, GAO released a report suggesting that FDA has not included sufficient privacy and security protections in its plans for a medical product safety monitoring system called the Sentinel Initiative. The system would use data from insurance companies, academic institutions, government agencies and health care providers to track the performance of medications and medical devices. According to the FDA Amendments Act of 2007, the initiative would have access to data from 25 million people by mid-2010 and 100 million people by mid-2012 (Foxhall, Government Health IT, 6/2). For the report, GAO conducted an audit of FDA's planning process for Sentinel from May 2008 to May 2009.

Names, credit card numbers, Social Security numbers: information Daron Breinholt did not go looking for, but found Thursday morning. He took out the trash from the shoe distribution center, where he works, in the warehouse section on Salt Lake's west side. "I was just throwing away some stuff (in a dumpster) , and it was chock full of medical records," said Breinholt. "There's everything in there from canceled checks to routing numbers. They could steal a lot identities. A lot of identities were in there." At least some of the records appeared to come from Mountain Medical Center, a chiropractic office that had been in the Murray area until some months ago. Dr. Randall Malin said through his lawyer that he did not throw away records. "It's news to him," said Attorney Robert Harrison. Salt Lake Police packed away perhaps twenty boxes of papers, and said they would protect the documents, as they dug into the matter. Surveillance video, which 2News has not been able to see, reportedly showed two people who drove up in a red pickup truck Wednesday afternoon, and unloaded the materials from a trailer.

Dr. Jay Holland of Little Rock and two former employees of St. Vincent Infirmary Medical Center pleaded guilty Monday to misdemeanor violations of the federal medical records privacy law, the U.S. Attorney's Office and the FBI in Little Rock announced. Holland, Sarah Elizabeth Miller of England and Candida Griffin of Little Rock admitted accessing "without any legitimate purpose" the medical records of Anne Pressly, the KATV-TV, Channel 7, reporter who was fatally attacked in her home in October. For the violations of the Health Insurance Portability and Accountability Act, each faces up to one year in prison, a fine of up to $50,000, or both. Sentencing has not been scheduled.

Privacy and civil liberties advocates are urging lawmakers working on the forthcoming economic stimulus package to ensure that any language to spur adoption of electronic medical records includes meaningful security safeguards. The American Civil Liberties Union, Consumer Action, the National Association of Social Workers, Patient Privacy Rights and others sent letters to House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid and President-elect Barack Obama Wednesday asking them to ensure individuals can control the use of their medical records and protect them from what they believe is a thriving industry of firms that share and sell medical data. "We all want to innovate and improve health care, but without privacy our system will crash as any system with a persistent and chronic virus will," Patient Privacy Rights executive director Ashley Katz said at a Capitol Hill briefing. Katz said her group has been pleased with progress that the House Energy and Commerce, and Ways and Means committees made last year.

"A Little Rock doctor was reprimanded and fined $500 by the Arkansas State Medical Board on Thursday for illegally accessing Anne Pressly's medical records as she lay unconscious in intensive care at St. Vincent Infirmary Medical Center before she died. Dr. Jay Douglas Holland, who has a family-practice clinic in the Hillcrest neighborhood, was also ordered to pay $265 to cover the cost of the board's investigation into the matter. Pressly, 26, was a news anchor for KATV-TV, Channel 7, when she was found raped and badly beaten in her Hillcrest home the morning of Oct. 20, 2008. She spent five days in intensive care before succumbing to her injuries."

"Doctor rapped over peeking at TV anchor's files Little Rock, Ark., doctor Jay Douglas Holland was reprimanded and fined $500 by the Arkansas State Medical Board for illegally accessing Anne Pressly's medical records as she lay unconscious in the intensive-care unit at St. Vincent Infirmary Medical Center before she died."

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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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.

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.

California regulators have fined Kaiser Permanente Bellflower (Calif.) Medical Center $250,000 for failing to keep workers from peeking at the electronic health records of Nadya Suleman, who gave birth to octuplets at the hospital in January. The fine is the first under a new state law, which took effect in January, aimed at protecting patient medical records at hospitals and carries the maximum penalty allowable. Twenty-three unauthorized staff and physicians accessed the medical records, including some at other Kaiser facilities. Seven people viewed the records more than once, according to the California Public Health Department, which licenses hospitals in the state. Kaiser fired one person who peeked at Suleman's records, 14 others resigned and eight were disciplined.

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."

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

For the third time in recent months, Tampa Bay citizens have found themselves the unwanted recipients of patients' private medical records. What's more, in two cases, the recipients' efforts to restore patients' privacy were rebuffed, suggesting the federal Health Insurance Portability and Accountability Act (HIPAA) is falling far short of its promise to protect and enforce patient privacy.

If the government won't enforce HIPAA, why bother having the law at all. Let patients know they are own their own.

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

Paperwork containing the personal medical information of at least 66 patients at Massachusetts General Hospital was lost this month when an employee apparently left it on an MBTA train. The hospital sent out letters last week to patients whose identities were included in the lost paperwork, telling them the information listed their names and dates of birth, and private medical information, including their diagnoses and the name of the provider with whom they met. The material constituted billing records for patients who attended the hospital's Infectious Disease Associates outpatient practice on Fruit Street on March 4. Deborah A. Adair, the hospital's privacy officer and director of health information services, said in a statement released yesterday that while the incident was regrettable, the hospital followed privacy laws by immediately alerting affected patients and authorities, including the state attorney general's office and the Department of Consumer Affairs and Business Regulation. "[Hospital] police and security are thoroughly investigating this matter not only with an eye toward recovering the missing information but also toward making sure that this will not happen again," Adair said. "Our information privacy and security policies and procedures are among the strongest in the healthcare industry, but incidents such as this remind us that we must continue to review and revise them, as well as continue to educate our staff on best practices to avoid incidents such as this." According to hospital security reports, a manager in the infectious disease center's billing unit told supervisors that she left the paperwork on a Red Line train the morning of March 9. The manager said she had brought the paperwork home with her to work over the weekend and left the material sometime between 7:30 and 9 a.m. The Transit Police were notified, but the paperwork was not found.

"Can personal medical data that has been stripped of its identifiers to protect privacy later be used to identify a specific person? That is the question that the Health and Human Services Department is hoping a research contractor can answer. HHS intends to hire a contractor to demonstrate either the "ability or inability" to re-identify data from a data set that has been de-identified under the Health Information Portability and Accountability Act (HIPAA) Privacy Rule, according to a Jan. 4 notice on the Federal Business Opportunities Web site. De-identification and re-identification of patient data have become hot issues in the discussion about how to protect patient privacy while advancing adoption of electronic health records. The Obama administration is distributing at least $17 billion in incentive payments to doctors and hospitals who buy and use digital systems for medical data."

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

A 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

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.