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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."

"Nearly every practicing doctor in the United States is being warned that their identities might have been stolen when the laptop of an employee of an insurance trade group was snagged from a car in Chicago. The laptop contained business and personal information such as Social Security numbers, addresses and certain identification numbers on the laptop of an employee from the Chicago-based Blue Cross and Blue Shield Association, a trade group for the nation's Blue Cross health insurance plans. The association confirmed that an employee "broke protocol and transferred to a personal laptop" information that was stolen in late August. No patient information was on the database, and so far, no doctor has reported a security breach. However, nearly 20 percent of the doctors listed in the database have their Social Security numbers as their medical-care provider identification, putting these health professionals at risk for identity theft, according to an article in the Chicago Tribune."

"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. "

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

"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."

"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.

Ultimately, your first line of defense rests with your doctor, though, says Peel. To thwart breaches, pepper your doctor with questions. How will my data be transmitted? Will it be encrypted? For assistance, you can also download a question form at Patientprivacyrights.org.

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

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.

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.

Two companies that collect, analyze and sell prescription information are mounting a Supreme Court challenge to New Hampshire's first-in-the-nation law making doctors' prescription writing habits confidential. In an appeal filed March 27, IMS Health Inc. of Norwalk, Conn., and Verispan LLC of Yardley, Pa., tell the high court that the law violates their First Amendment right to free speech in pursuit of their business. The law, aimed at thwarting hard-sell tactics by drug companies to doctors, makes it a crime for pharmacies and others to transfer information disclosing a doctor's prescribing history if the information could be used for marketing of prescription drugs in New Hampshire. Patients' names are not included in the data. The companies say that the ruling by the 1st U.S. Circuit Court of Appeals in Boston that upheld the law's constitutionality could be broadly applied to newspaper publication of stock market information and many other services that gather large amounts of information. The money made by selling the information to drug makers, the companies say, allows them to provide the same material to researchers and humanitarian organizations at little or no cost. The law first took effect in 2006. The following year, U.S. District Judge Paul Barbadoro in Concord ruled in the companies' favor and said the law violated the First Amendment. Another federal judge subsequently ruled against a similar law in Maine, relying heavily on the New Hampshire decision. But the 1st Circuit overruled Barbadoro, calling the law a valid step to promote the delivery of cost-effective health care. "Even if the Prescription Information Law amounts to a regulation of protected speech - a proposition with which we disagree - it passes constitutional muster," the court said. "In combating this novel threat to cost-effective delivery of health care, New Hampshire has acted with as much forethought and precision as the circumstances permit and the

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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"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?

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

NEW YORK With increasing amounts of personal information liable to float around in cyberspace, consumers are deciding whether their data is safe in the hands of some public- and private-sector entities. A BBC World News America/Harris Poll finds a mixed verdict, with social-networking sites faring especially badly. In polling conducted last month, adults were asked to say how much trust they have in various sectors "to handle your personally identified information (such as credit-card information, contact information and so forth) in a properly confidential and secure manner." The poll's best scores went to "health providers, such as doctors and hospitals," with 20 percent of respondents expressing "a great deal of trust" and 55 percent "some trust" in these. Nineteen percent voiced "not much trust" and 7 percent "no trust at all" in this sector. At the bottom of the rankings were "social-networking sites (like Facebook or MySpace)," with 5 percent expressing a great deal of trust and 18 percent some trust in these. Thirty-one percent said they had not much trust and 46 percent no trust at all in these sites to safeguard personal information. (Whether people should direct their distrust to themselves for posting such information there in the first place is a question the survey didn't address.) Respondents were also wary of "search and portal sites (like Google or Yahoo!)" when it comes to keeping personal information secure: Ten percent voiced a great deal of trust, 39 percent some, 29 percent not much and 22 percent no trust at all. Even the federal government fared (slightly) better, with 13 percent expressing a great deal of trust, 41 percent some, 28 percent not much and 18 percent none. The scores were more positive for "banks and brokerage companies": 15 percent a great deal of trust, 43 percent some, 28 percent not much and 13 percent none. That was roughly on a par with the ratings for "my e-mail provider": 14 percent a great deal, 48 percent some, 27 p

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."

Woonsocket-based CVS Caremark Corp., the largest U.S. drugstore chain, has agreed to pay $2.25 million to settle federal charges that company employees compromised customer privacy by throwing prescription records and drug bottles into open trash bins. The Federal Trade Commission said its investigation with the Health and Human Services Department followed media reports that trash bins behind CVS pharmacies contained pill bottles bearing patient names, credit-card and insurance information, and Social Security numbers. The company also did not have adequate policies for disposing of that information, and did not sufficiently train employees to dispose of the information properly, the agencies said. The items that were not properly discarded included pill bottles, medication instruction sheets, computer order forms, payroll information, job applications and credit-card and insurance information. Those labels and forms contained personal information including Social Security numbers and credit card and insurance information, and in some cases, driver's license numbers and account numbers. Names of the patients' doctors were also included. The settlement "will restore appropriate privacy protections to tens of millions of people across the country," FTC chairman William Kovacic said in a statement. "It also sends a strong message" that organizations "are required to secure consumers' private information," he said.