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Patients' advocates claimed victory in a battle over the privacy of health records as the U.S. Congress approved the economic stimulus bill, which contains $19 billion for health-care information. U.S. House and Senate negotiators' compromise reflects stricter standards that privacy advocates wanted for marketing, selling and disclosing health data. Both houses approved the $787 billion stimulus plan today and sent it to President Barack Obama for his signature. The legislation contains $2 billion in grants to create a national system of computerized health records and $17 billion in higher Medicare and Medicaid reimbursements for doctors and hospitals to adopt the technology. Electronic records will improve care and reduce costs, Obama said. The legislation also will boost the health-records industry, led by Allscripts-Misys Healthcare Solutions Inc., Quality Systems Inc. and Athenahealth Inc. "We've dramatically improved on the status-quo, wholly unregulated system where private patient data was bought and sold like any commodity," Caroline Fredrickson, director of the American Civil Liberties Union's Washington legislative office, said in an interview today.

Beware of web sites offering free money Iain Thomson in San Francisco vnunet.com, 04 Mar 2009 The Federal Trade Commission (FTC) is warning of a rash of online scams offering payouts under the economic stimulus plan passed by Congress. Businesses and individuals are being targeted by the scammers using web sites and emails, the organisation warned. Recipients are typically offered 'grants' from the government, and must either surrender bank details to get the funds or make a small payment. Advertisement"Web sites may advertise that they can help you get money from the stimulus fund. Many use deceptive names or images of president Obama and vice president Biden to suggest that they are legitimate. They are not," said Eileen Harrington, acting director of the FTC's Bureau of Consumer Protection. "Don't fall for it. If you do, you'll get scammed." Several variants have also been discovered that use malware to steal important data. These include pages that purport to offer links to sites that show how to get the federal funds. The pages are loaded with malware that can penetrate an improperly patched browser. "Consumers who may already have fallen for these scams should carefully check their credit card bills for unauthorised charges, and report the scam to the FTC," said Harrington.

First quarter federal reports show Google lobbied on the electronic medical records provisions of the federal economic stimulus act, contradicting the Internet giant's earlier claims that Consumer Watchdog's report of its effort was "100 percent false." Google's report shows a total expenditure of $880,000 on lobbying during the period including on "online health-related initiatives; issues relating to online personal health records, including in connection with H.R. 1: American Recovery and Reinvestment Act of 2009." Google also contracted with an outside firm, the Podesta Group, which independently reported lobbying for Google on "health information technology" and "online privacy." King and Spalding LLP also independently reported lobbying for Google on "online health-related initiatives, including health information technology provisions in H.R. 1, The American Recovery and Reinvestment Act." After the nonprofit, nonpartisan Consumer Watchdog reported the "rumored" lobbying in January, Google contacted a charitable foundation about withdrawing Consumer Watchdog's funding. In a letter to Google CEO Eric Schmidt released today, Consumer Watchdog said the company owes the group an apology. Read Consumer Watchdog's letter here: http://www.consumerwatchdog.org/resources/LtrSchmidt042209.pdf. "It is now clear from public records that Google was lobbying Congress relating to online personal health records in connection with the economic stimulus act... What else could Google have been seeking except to be excluded from the Health Insurance Portability and Accountability Act (HIPAA) provisions on privacy and forbidding sale of records? Please tell us," wrote Jamie Court, Consumer Watchdog president and John M. Simpson, consumer advocate. "There is a simple way to resolve this," the letter said. "Publicly release all the substance of Google's lobbying efforts on H.R. 1. Google knows the drill: organize the information and make it universally accessible and useful."

Late last month, the House passed an economic recovery package containing $20 billion for health information technology, which would require the Department of Health and Human Services to develop standards by 2010 for a nationwide system to exchange health data electronically. The version of the recovery package passed by the Senate yesterday contains slightly less funding for health information technology ("health IT"). But as Congress moves to reconcile the two stimulus packages, conservatives have begun attacking the health IT provisions, falsely claiming that they would lead to the government "telling the doctors what they can't and cannot treat, and on whom they can and cannot treat." The conservative misinformation campaign began on Monday with a Bloomberg "commentary" by Hudson Institute fellow Betsy McCaughey, which claimed that the legislation will have the government "monitor treatments" in order to "'guide' your doctor's decisions." McCaughey's imaginative misreading was quickly trumpeted by Rush Limbaugh and the Drudge Report, eventually ending up on Fox News, where McCaughey's opinion column was described as "a report." In one of the many Fox segments focused on the column, hosts Megyn Kelly and Bill Hemmer blindsided Sens. Arlen Specter (R-PA) and Jon Tester (D-MT) with McCaughey's false interpretation, causing them to promise that they would "get this provision clarified." On his radio show yesterday, Limbaugh credited himself for injecting the false story into the stimulus debate, saying that he "detailed it and now it's all over mainstream media."

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.

A health care industry coalition on Monday released a prescriptive security framework that organizations can use to safeguard patient records as they increasingly move online. The framework, released by the Health Information Trust Alliance (HITRUST) -- which represents health care providers, pharmacies, insurers, biotech firms and medical device manufacturers -- is based on well-known standards such as COBIT, NIST and ISO 270001. But this is the first benchmark developed specifically for protecting health data. "It's tailored to protecting health information right out of the gate," Michael Wilson, vice president and chief information security officer of McKesson, the largest U.S. pharmaceutical distributor, told SCMagazineUS.com on Monday. "It's just a different sort of data. It's still structured [like other verticals], but there's a lot more of it in health care." The framework was created to improve adoption rates with regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and increase patient confidence in the security of their information. It also arrives on the heels of the new $787 billion economic stimulus bill, about $20 billion of which is earmarked to encourage health care organizations to adopt electronic health records as a way to reduce the number of medical errors and save money. The stimulus bill, in itself, contains srict privacy and security regulations for patient information. The standards took about 18 months to devise and can be implemented by organizations of any size, according to HITRUST. "2009 will be a turning point for information security in the health care industry, when organizations will begin implementing the framework...and create a cascading effect that will impact and benefit the entire health care ecosystem," Daniel Nutkis, CEO of HITRUST, said in news release. Wilson said the framework also will enable companies such as McKesson to show their customers and business partners that they are taki

The 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

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

Feds would spend $20 billion on health IT if Senate and House agree in coming weeks. The House-passed version of the economic stimulus bill includes about $20 billion in spending for health IT. The bill, known as H.R. 1 or the American Recovery and Reinvestment Act of 2009, would make Medicare and Medicaid providers and hospitals eligible for incentive payments for using certified e-health records technology. It also supports health information exchanges, standards development and conformance testing, a chief privacy officer for health IT and other aspects of health IT. The portion of the bill called the Health Information Technology for Economic and Clinical Health Act -- the Hitech Act, for short -- and health IT spending provisions passed largely unchanged from the bills introduced earlier this month. The Senate is expected to take up a similar bill in the first week of February. The Senate bill now calls for $23 billion in health IT spending. Once it is passed, a House-Senate conference will need to resolve differences between the bills. Congressional leaders aim to send President Barack Obama the bill by mid-February.

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.

Urging Privacy Protections with Health IT Privacy safeguards are needed if funds are to be provided for implementation of health IT systems in economic stimulus package. At today's news conference, the Coalition for Patient Privacy is releasing a letter sent to Congress advocating for the inclusion of privacy safeguards with any funding given to implement health IT systems in the proposed economic stimulus package. In the letter, the bipartisan coalition, representing over 30 organizations, individual experts and the Microsoft Corporation, welcomes the renewed commitment in Congress to protecting consumers over special interests, but makes clear that trust is essential to health IT adoption and participation, and only attainable with privacy protections. The coalition is calling on Congress to "A.C.T.", by providing: accountability for access to health records, control of personal information, and transparency to protect medical consumers from abuse. Consumer trust is essential to health IT adoption and participation, and only attainable with privacy safeguards. Through these three tenets, implementation of health IT is not only attainable, but would protect the right to privacy for consumers, employees, and providers.

Is the price to safeguard America's information systems and networks on a collision course with efforts to rescue the economy? One would hope not, but the $789 billion stimulus package that contains nearly $10 billions for IT-related projects offered very little for cybersecurity. Still, the president sees protecting government and private-sector information systems as crucial to the economic vitality of the country. So, when Acting Senior Director for Cyberspace Melissa Hathaway hands the President her recommendations on securing the nation's information infrastructure later this month, a sharper picture should emerge on how much money the government will need to spend to do just that. What Price Security? The government isn't a spendthrift in protecting its IT networks; it earmarked $6.8 billion a year on cybersecurity this fiscal year, up from $4.2 billion five years ago, according to the White House Office of Management and Budget. But is that enough? Appropriating money to find new and innovative ways to protect our critical information infrastructure doesn't seem to be a government priority, at least not yet. Of the $147 billion the government planned to spend on all types of research and development this fiscal year, only $300 million or 0.2 percent was slated for cybersecurity, according to the Securing Cyberspace in the 44th Presidency report issued by the Center for Strategic and International Studies. By comparison, the budget contained five times as much money $1.5 billion for nanotechnology R&D.

Two things to remember as you prepare to file your taxes: If you get an e-mail from the IRS, it's probably a scam. And don't forget the stamp. As the April 15 tax filing date nears, online tax-related scams tend to ratchet up, experts say. If you're not careful, you could lose a lot more than just the refund. "Filing your taxes online is extremely convenient, however if you want to maintain the privacy of your data, you need to ensure that you are connecting to the proper Web site, that the connection is using encryption, and that your computer is free from any malware. If any of these components are compromised then your data is not safe," Ryan Barnett, director of application security research for Breach Security, said on Friday. "This would be like going to an ATM machine to withdraw money and allowing everyone around you to see your PIN number as you punch it in," he added. Not only do people have to take precautions in storing and transmitting their data over the Internet, but they also have to be wary of social engineering-type ruses that scammers use to trick people into giving out their sensitive data. Probably the most common type of tax season scam is the fake IRS phishing e-mail. These e-mails will either claim to be a tax refund or an offer to help file for a refund, settle tax debt, or other aid. (Not long ago, scammers were offering economic stimulus payments, even before the plan was approved.) They will provide a link to a Web site where the visitor is prompted to type in personal data like a Social Security number. Don't trust it, experts say.

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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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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

Bits readers have a serious case of broadband envy. I've been writing about the debate about how the government might encourage more high-speed Internet use and you've complained loudly that people in other countries have faster, cheaper, more widely available broadband service. Even customer-service representatives of Internet service providers overseas are nicer too. I don't know about manners, but it's easy to find examples that American's broadband is second-rate: In Japan, broadband service running at 150 megabits per second (Mbps) costs $60 a month. The fastest service available now in the United States is 50 Mbps at a price of $90 to $150 a month. In London, $9 a month buys 8 Mbps service. In New York, broadband starts at $20 per month, for 1 Mbps. In Iceland, 83 percent of the households are connected to broadband. In the United States, the adoption rate is 59 percent. There's more than just envy at stake here. President Obama campaigned on a promise of fast broadband service for all. On the White House Web site, he writes "America should lead the world in broadband penetration and Internet access." And the recent stimulus bill requires the Federal Communications Commission to create a national broadband plan in order to make high-speed Internet service both more available and more affordable. I've spent the last week trolling through reports and talking to people who study broadband deployment around the world to see what explains the faster and cheaper service in many countries. We'll start with where the United States isn't doing quite so badly: the basic speed of broadband service. If you take out the countries that have made significant investment in fiber optic networks - Japan, Korea and Sweden - the United States is in the middle of the pack when it comes to network speed.

Congress has been dithering over the adoption of a federal data security breach notice law for the last several years without coming to an agreement on a national standard for reporting breaches in the security of personal and financial data, but on February 17, data breach notice provisions applicable to health information were signed into law as part of the HITECH Act provisions of the massive economic stimulus legislation, H.R. 1 (111th Cong., 1st Sess. Feb. 17, 2009). Beginning no later than September 16 of this year, "covered entities" under the Health Insurance Portability and Accountability Act (HIPAA) will be required to give notice of breaches in the security of protected health information, and "business associates" of HIPAA-covered entities will be required to report such breaches to the covered entities. §13402(a) & (b). Currently, California and Arkansas are the only states that require that notification be given in the case of a breach in the security of medical or health insurance information. The HIPAA Privacy Rule currently does not contain a requirement that individuals be notified in the event of such as breach. However, some covered entities interpret the existing HIPAA Privacy Rule requirement that covered entities mitigate harmful effects of uses or disclosures of health information in violation of either the Privacy Rule or the entity's policies and procedures as suggesting that such notice be given, and many covered entities currently provide such notification.

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

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.

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.