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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.

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

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.

"UC San Francisco said late Tuesday it has alerted 600 patients and others that an external hacker may have obtained "temporary access to emails containing their personal information" as a result of a late September phishing scam. The breach occurred about three months ago, and was investigated in mid-October, but wasn't disclosed to the public until Dec. 15. Corinna Kaarlela, UCSF's news director, told the San Francisco Business Times late Tuesday that individuals whose data may have been compromised were notified between Oct. 21, when an in-depth investigation began, and Dec. 11, when it was completed. UCSF said Tuesday that an unnamed faculty physician in the School of Medicine was victimized in late September by the alleged scam. The physician provided a user name and password in response to an email message fabricated by a hacker, that appeared as if it came from those responsible for upgrading security on UCSF internal computer servers. UCSF's Enterprise Information Security unit subsequently identified the breach and disabled the compromised password. UCSF says it conducted an investigation and in mid-October determined that emails in the physician's account ─ including some containing demographic and clinical information and, in a few cases, Social Security numbers ─ may have been exposed."

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

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

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

"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. "

"Reporting from Washington - When your doctor writes you a prescription, that's just between you, your doctor and maybe your health insurance company -- right? Wrong. As things stand now, the pharmaceutical companies that make those prescription drugs are looking over the doctor's shoulder to keep track of how many prescriptions for each drug the physician is writing. By obtaining data from pharmacies and health insurers, the drug companies learn the prescribing habits of thousands of doctors. That information has become not just a powerful sales and marketing tool for the pharmaceutical industry but also a source of growing concern among some elected officials, healthcare advocates and legal authorities. "

"Drug store chain Walgreens now enables its pharmacy patients to download their prescription history from the Walgreens.com Web site to a personal health record on the Microsoft HealthVault platform. The Deerfield, Ill.-based chain announced last June it would link to HealthVault. Patients registered on Walgreens' site already can access their complete prescription history. Now, that history can also reside in a HealthVault PHR and be automatically updated. Patients can enroll with HealthVault directly from the Walgreens site. The partnership will promote stronger collaboration among patients, pharmacists, physicians and other providers, says Don Huonker, senior vice president of health care innovation at Walgreens. More information is available at walgreens.com/pharmacy and healthvault.com. "

Think twice before giving MicroSoft your personal health care information.

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 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

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.

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.

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.

Hackers, possibly from Asia, have stolen about a decade's worth of personal information on current and former UC-Berkeley students, the university announced Friday. The breaches involved records dating to 1999 at the school's health center that included Social Security numbers, health insurance information, immunization history and the names of treating physicians. No other treatment-related records were stolen, the university said, although self-reported medical histories of students who studied abroad were hacked. The school on Friday sent e-mails and letters to 160,000 people, including about 3,400 Mills College students who used or were eligible for University of California-Berkeley medical services. About 97,000 people are most at risk because their names and Social Security numbers could be connected by the hackers, said Steve Lustig, the university's associate vice chancellor for health and human services. "What's been taken is bits of data that the thief might put together into an identity," he said. The university traced the hackers back to Asia, possibly China, but the exact origin could not be pinpointed. UC and FBI investigators are probing the breaches, which apparently occurred over several months. An FBI spokesman said the agency was informed of the hacking immediately, but declined to provide more information. The thefts were discovered about a month ago, but system administrators did Advertisement not realize the breadth of the attack until April 21. The hackers disguised their work as routine operations and then left taunting messages for UC-Berkeley employees, said Shelton Waggener, the university's associate vice chancellor for information technology. The thieves accessed the information through the university Web site, he said. "You should think of it as a public building," Waggener said. "They got into the building properly, but then they broke into secure areas." Administrators at Mills College, which contracts with UC-Berkeley for

Another test of who owns what data, what can be done with it and the power of State's Rights.

IMS Health (RX) has built a lucrative niche collecting data on which drugs physicians prescribe, then selling the information to pharmaceutical companies. But legislators in more than 20 states have questioned whether the company has a constitutional right to do so. The Supreme Court could shine a spotlight on this topic in the next few weeks if it decides to hear a closely watched case IMS has been fighting in New Hampshire. The court's ruling would quickly reverberate beyond the pharmaceutical industry, affecting virtually any business that uses information about consumer buying behavior to guide its sales strategies.

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.