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"Kathy Silver, CEO of University Medical Center, learned three weeks ago that names, birth dates and Social Security numbers for at least 21 patients were leaked from the hospital - a crime being investigated by the FBI. But the hospital still has not disclosed the breach to the patients, Silver told a committee of legislators Wednesday. She spoke as if this was not a problem. The law allows 60 days from the time UMC learns of a security breach to inform patients, she said. One victim says that is too long to wait to tell patients they may be at risk of identity theft. The hospital should have disclosed the breach immediately, said a 40-year-old UMC patient whose personal information - the kind that can be used for identity theft - was leaked. The man, who went to the public hospital Nov. 1 after a motorcycle accident, learned his privacy had been breached only when a Las Vegas Sun reporter told him Wednesday afternoon. The man was stunned and angry to learn from someone other than hospital officials that his data had been leaked. Hospital officials should have notified him "way sooner," he said. "I would've given them two or three days after they initially found out. But this is a major thing - a priority thing!""

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

Johns Hopkins is alerting more than 10,000 of its hospital patients that they may have been victims of identity theft. An investigation suggests a former employee who worked in patient registration may have been linked to a scheme to create fake drivers' licenses in Virginia, according to this letter from Baltimore-based Hopkins to the Maryland attorney general's office. Most of the patients are at very low risk, the letter says - they're included because the former employee accessed their records in the course of her work. But a few dozen have already been identified as likely victims, and a few hundred who have Virginia mailing addresses and whose records were accessed by the former employee may also be at risk. Hopkins is offering those patients credit monitoring, fraud resolution and identity-theft reimbursement for certain expenses.

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?

Just days after President Obama signed a law giving billions of dollars to develop electronic health records, a university technology professor submitted a paper showing that he was able to uncover tens of thousands of medical files containing names, addresses and Social Security numbers for patients seeking treatment for conditions ranging from AIDS to mental health problems. Using peer-to-peer applications, which computer users download to share files, most commonly music and movies, M. Eric Johnson, director of the Center for Digital Strategies at Dartmouth College in Hanover, N.H., was able to access electronic medical records on computers that had the peer-to-peer programs stored on their hard drives. The medical files contained detailed personal data on physical and mental diagnoses, which a hacker could use to not only embarrass a patient but also to commit medical fraud. One of the largest stashes of medical data Johnson discovered during two weeks of research he conducted in January was a database containing two spreadsheets from a hospital he declined to identify. The files contained records on 20,000 patients, which included names, Social Security numbers, insurance carriers and codes for diagnoses. The codes identified by name four patients infected with AIDS, the mental illnesses that 201 others were diagnosed as having and cancer findings for 326 patients. Data also included links to four major hospitals and 355 insurance carriers that provided health coverage to 4,029 employers and 266 doctors.

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.

With identity theft on the upswing, Aram Langhans thought he was simply being prudent when he asked the Yakima Heart Center to remove his Social Security number from its files. "They had my insurance card and my driver's license. What else did they need?" said Langhans, a retired public school teacher insured by Group Health. Langhans said he was initially hooked up to a portable heart monitor that he was to wear for 24 hours, but the disagreement over his Social Security number prompted upper-level personnel to change their minds. He said moments after the device was attached, he was sent to a restroom to remove it and turned away. Shawnie Haas, administrator of the Heart Center, an independent outpatient group practice, declined to discuss the incident. But she said in an e-mail statement that the practice protects patients' privacy. "The Yakima Heart Center is careful to collect data pertinent to ensuring accuracy of our patient's medical record. Routine information collected for all patients includes name, address, date of birth, Social Security number, gender, and other specific information that helps us verify that individual's identity and insurance enrollment or coverage data. We are careful to maintain confidentiality of all patient information in our system." According to state and federal regulators, private insurance companies have moved away from using Social Security numbers for patient identification. But health-care providers in the Yakima Valley say they routinely collect them as "backup" in the event that patients' insurance doesn't pay the claim.

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.

Four HIV-positive patients whose records were left behind on an MBTA train by a Massachusetts General Hospital employee are suing the hospital, claiming their privacy has been breached. In March the hospital notified 66 patients who received care at its Infectious Disease Associates outpatient practice that billing records bearing their names, Social Security numbers, doctors, and diagnoses had been lost by a manager who was riding the Red Line. She had brought the paperwork home for the weekend, but left it on the train when she returned to work the morning of Monday, March 9, according to hospital security reports. Last week two patients who are HIV-positive filed a suit in Suffolk Superior Court against the hospital and the unidentified billing manager. The unnamed plaintiffs have been joined by two other HIV-positive people. The legal action was first reported in the weekly newspaper Bay Windows. Their lawyer, John Yasi of the Salem law firm Yasi and Yasi, said in an interview he has filed a motion to make the suit a class action that could cover all 66 patients, a significant number of whom are also HIV-positive. "The damages that jump out are the emotional distress surrounding the loss of obviously very sensitive medical information and secondarily the loss of personal security information," he said. "A Social Security number in reality may lead to identity theft, which we all know is a nightmare."

"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.

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

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.

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.

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

"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."

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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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.

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.

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

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.