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David St. Clair on privacy

It’s a few weeks old and you may have seen it elsewhere, but I see no harm posting this commentary from David St. Clair, founder and CEO of care management software company MEDecision. You’ll note that the CNN video he references also appeared on my blog last month.

Consumers Need All of the Facts in the Privacy Debate

By David St.Clair

The economic stimulus package that President Obama has signed contains upwards of $20 billion to create electronic health records for most Americans within five years. The president has been very outspoken in his belief that EHRs are essential to health care reform and that the subsequent savings they’ll generate will help to strengthen the larger overall economy.

Whenever the subject of proliferating EHRs catches the national spotlight, you can bet that debates about privacy aren’t far behind. Indeed the privacy issue has already started to gain some traction in the media. In this video clip, CNN’s Campbell Brown and Elizabeth Cohen examine how easy it is for someone to obtain private medical information online by simply using someone’s Social Security number and date of birth.

While this assessment may be accurate, it’s a bit light on the fairness scale. Brown and Cohen only make a very brief mention of facts like President Obama’s plan to appoint a chief privacy officer and to implement unprecedented privacy controls to safeguard the EHR transformation. Instead they emphasize the more sensational angle implying that electronic health information just isn’t safe. They also seem to downplay the fact that a simple thing like creating a password can protect one’s private information.

I suspect the privacy issue is going to reach a crescendo in the coming months, and it’s very important that Americans have all of the facts. There are unfortunately people in the world who are going to try to illegally obtain and misuse private health information. But that doesn’t mean we should just write off EHRs as a bad idea. We simply need to be vigilant and proactive in incorporating the highest security measures into the planning process — which the president has done. To borrow an analogy from a close colleague: we don’t stop building roads because some people drive drunk. We punish the drunk drivers and continue building roads because of the tremendous benefits they bring to the rest of our law-abiding society. There is too much at stake for the health care system and the nation’s economy to allow over-dramatized and misperceived weaknesses in EHR security to thwart progress.

Additionally, to make the privacy debate a fair one we must ask what’s more dangerous: the potential misuse of information or simply not using information at all? Should we put the privacy of an overwhelming minority of people ahead of safer, more efficient, more affordable and potentially life-saving health care for the overwhelming majority? In reality, the only people who stand to be harmed by an unlikely EMR privacy breach are celebrities and other high profile individuals. Even if someone were to gain access to the average person’s health information, there isn’t much they could do with it, other than cause that person some personal embarrassment. In a very real sense, the question then becomes whether we value the privacy of information more than its potential to help us lead healthier lives.

Without question we must make ensuring privacy a top priority in any plans to implement EHRs. I’m confident that the Obama plan does so and, in fact, I think we’ll see even stronger controls than we may have previously imagined. No EHR is going to come with guaranteed safety, but I would argue that the risk level is the same or less than that associated with online retail and banking transactions. The public needs to understand this. It is up to those of us in the industry to ensure that the facts are clear and readily available. Hopefully the media will choose to report all of them so that Americans can form opinions based on complete information.

March 15, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

EMRs at Sam’s Club

I have to say I’m bemused but somehow not surprised about the news that Wal-Mart Stores will sell EMRs at Sam’s Club warehouse locations.

Yes, the Bentonville, Ark., retail giant is joining with ambulatory EMR vendor eClinicalWorks and computer-maker Dell to sell systems at deeply discounted prices, reportedly less than $25,000 for the first physician and around $10,000 for each additional doctor in a practice. Maintenance and support will run about $4,000 to $6,500 a year, the New York Times reports.

Snicker, perhaps, but remember that the warehouse clubs offer a bit of everything. Sam’s Club rival Costco Wholesale sells caskets, after all. (Just don’t bundle those with EMRs. It might send the wrong message.) And remember that Wal-Mart has been talking about improving the quality of care and reducing healthcare costs with IT for several years and is one of the founding sponsors of the Dossia PHR project. I posted a podcast with Wal-Mart executive Linda Dillman in October 2006.

Wal-Mart already has a strong business in retail clinics and eClinicalWorks has a history of making creative business deals, such as with the Massachusetts eHealth Collaborative and the New York City Department of Health and Mental Hygiene. So yeah, it makes sense. Whether doctors will shop for EMRs while picking up 5-pound jars of pickles and jumbo packs of toilet paper, we’ll have to see.

March 12, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Seriously, why Twitter?

I’m not a user of Twitter and might only become one if I thought it might be a good way of reporting breaking news during, say, a speech at a conference or something like that. Any other uses seriously seem pointless, particularly in healthcare.

I’m particularly disturbed by the news last month that the chief resident at Henry Ford Hospital in Detroit provided live tweets of a surgery to remove a cancerous tumor from a kidney. Then, last week, another Henry Ford resident Twittered a robotic hysterectomy.

I know the Twitterers weren’t the actual surgeons doing the cutting, but seriously, didn’t they have anything better to do? And unless they were close friends or family of the patients, didn’t the people following the updates have anything better to do with their time?

As I watched so many news outlets breathlessly report on the popularity of Twitter in recent weeks, I couldn’t help thinking that once the mainstream media and non-techies started using this decidedly geeky application, Twitter may already be jumping the shark. A day or so after I first had this thought, I heard someone on WGN Radio in Chicago say Twitter had jumped the shark. And then, last week, The Daily Show had this great satire of Twitter.

.cc_box a:hover .cc_home{background:url(‘http://www.comedycentral.com/comedycentral/video/assets/syndicated-logo-over.png’) !important;}.cc_links a{color:#b9b9b9;text-decoration:none;}.cc_show a{color:#707070;text-decoration:none;}.cc_title a{color:#868686;text-decoration:none;}.cc_links a:hover{color:#67bee2;text-decoration:underline;}

Still, I think this person offers the best commentary on Twitter I’ve seen to date.

March 11, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

OK haters, here’s your chance

Those of you who have been critical of the EHR certification process and other aspects of national health IT policy have a chance to make some of that policy. Here’s a solicitation that just went out from the Office of the National Coordinator for Health Information Technology:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the National Coordinator for Health Information Technology

HIT Standards Committee and HIT Policy Committee Nomination Letters

ACTION: Notice on letters of nomination.

SUMMARY: The American Recovery and Reinvestment Act of 2009 (Act), Pub. L. 111-5 amends the Public Health Service Act (PHSA) to add new sections 3002 and 3003. The new section 3003 of the PHSA establishes the HIT Standards Committee to make recommendations to the National Coordinator for Health Information Technology on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information for purposes of health information technology adoption. The HIT Standards Committee members are to be appointed by the Secretary of the Department of Health and Human Services with the National Coordinator taking a leading role. Membership of the HIT Standards Committee should at least reflect the following categories of stakeholders and will include other individuals: providers, ancillary healthcare workers, consumers, purchasers, health plans, technology vendors, researchers, relevant Federal agencies, and individuals with technical expertise on health care quality, privacy and security, and on the electronic exchange and use of health information.

In addition, we also seek nominations to the HIT Policy Committee (established by the new section 3002 of the PHSA), which makes recommendations to the National Coordinator on the implementation of a nationwide health information technology infrastructure. The HIT Policy Committee will consist of at least 20 members. Three of these members will be appointed by the Secretary of the Department of Health and Human Services. Of the three members, one must be a representative of the Department of Health and Human Services and one must be a public health official. If, 45 days after the enactment of the Act, an official authorized under the Act to make appointments to the HIT Policy Committee has failed to make an appointment(s), the Act authorizes the Secretary of HHS to make such appointments. The Department of Health and Human Services is consequently accepting nominations for the HIT Policy Committee.

New section 3008 of the PHSA allows the Secretary to recognize the NeHC (if modified to be consistent with the requirements of section 3002 and 3003 of the Act and other federal laws) as either the HIT Policy Committee or the HIT Standards Committee. At this time, the Department of Health and Human Services is evaluating options regarding the National eHealth Collaborative and its role in relation to those Committees.

For appointments to either the HIT Standards Committee or the HIT Policy Committee, I am announcing the following: Letters of nomination and resumes should be submitted by March 16, 2009 to ensure adequate opportunity for review and consideration of nominees prior to appointment of members.

ADDRESS: Office of the National Coordinator, Department of Health and Human Services, 200 Independence Avenue, NW, Washington, DC 20201, Attention: Judith Sparrow, Room 729D. Email address: HIT_FACA_nominations@hhs.gov. Please indicate in your letter or email to which Committee your nomination belongs.

FOR FURTHER INFORMATION CONTACT: ONC/HHS, Judith Sparrow, (202) 205-4528.

Authority: The American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5), section 13101.

Dated: March 9, 2009

So if you’re feeling left out, go ahead and nominate yourself.

March 10, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Online support groups

Here’s another story I had published not too long ago: The January cover story in Oncology Net Guide about online support groups for cancer patients and their effect on the practice of oncology.

Those of you who attended either the Health 2.0 Conference in San Francisco or the more academic Medicine 2.0 Congress in Toronto last fall will recognize some of the names in the story. My family might recognize another name, Dr. Michael Nissenblatt, a cousin on my dad’s side. Hey, if you’ve got a good source, you’d might as well use it.

Among the other familiar names in the story are Dr. Geoffrey Rutledge, whose Wellsphere otherwise a useful consumer information site, had not yet been widely exposed as a marketing scam when I wrote the story, and Dr. Stephen T. Colbert, D.F.A., who offers the Best Commentary Ever about Wikipedia:

Stand up and say it with me: The revolution will not be verified!

I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Kaiser, NorthShore hospitals reach HIMSS Stage 7

The first-ever list of “Stage 7” hospitals is out, and it includes 15 facilities, but just organizations: Kaiser Permanente and NorthShore University HealthSystem, formerly known as Evanston Northwestern Healthcare.

HIMSS Analytics said that 12 Kaiser hospitals in California and all three NorthShore acute care facilities in the suburbs of Chicago reached the top level of EMR implementation on the HIMSS Analytics EMR Adoption Model. That means they are effectively paperless, can share patient data with other organizations by sending standardized electronic transactions and are able to mine their clinical databases for quality improvement.

The Kaiser Stage 7 hospitals are:

  • South San Francisco Medical Center (127 Beds)
  • South Sacramento Medical Center (228 Beds)
  • Sacramento Medical Center (331 Beds)
  • Roseville Medical Center (166 Beds)
  • Modesto Medical Center (220 Beds)
  • Manteca Hospital (77 Beds)
  • Walnut Creek Medical Center (229 Beds)
  • Antioch Medical Center (130 Beds)
  • Hayward Medical Center (200 Beds)
  • Fremont Medical Center (106 Beds)
  • Santa Rosa Medical Center (112 Beds)
  • Irvine Medical Center (150 Beds)

NorthShore University HealthSystem includes:

  • Evanston Hospital (389 Beds)
  • Glenbrook Hospital (143 Beds)
  • Highland Park Hospital (211 Beds)

A cousin of mine is expecting to give birth at Evanston Hospital in late April. I’m happy to know she’ll be in good hands.

March 9, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Up to speed on CCHIT controversy

We may have a definitive account on the recent controversy about the Certification Commission for Healthcare Information Technology and its relationship with the Healthcare Information and Management Systems Society. I sure hope it’s definitive, because it’s a story I wrote for Healthcare IT News—my first byline in that publication after several years of working for a competing publication that’s no longer around.

Having to hew to actual journalistic standards rather than the lawless nature of the blogosphere, I did not name “Calvin Jablonski,” “Rocky Ostrand” or “Maggiemae Ph.D.” in the article because I was unable to confirm those identities. In fact, the Jablonski and Maggiemae comments were so similar in language and tone that I suspect they might be from the same person. I also wonder if “Rocky Ostrand” wasn’t somehow a play on the name of Racquel Orenick, corporate counsel of HIMSS, whom I quoted in the story.

I also left out of the story some of the more incendiary comments from the pseudononymous critic or critic, but included the critiques of those willing to go on the record with their real names.

I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Deborah Peel on Fox Business

Privacy hawk Deborah C. Peel, M.D., appeared Thursday on the Fox Business Channel to talk about the new privacy protections for EHRs contained in the economic stimulus bill.

The segment is about three minutes long:

March 6, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Does HITECH have teeth? Google may not think so

I was astounded today to read in Modern Healthcare (the fact that I apparently was blacklisted from writing there for reasons never explained to me makes me reluctant to link to the story) that Google says the new privacy and security rules won’t change its PHR plans.

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted last month as Title XIII of the American Recovery and Reinvestment Act of 2009, strengthens much of the privacy and security language of HIPAA. Some of the language effectively gives business associates the same responsibilities as covered entities when it comes to protecting patient data. Section 13408 specifically includes personal health records.

Reporter Joe Conn, my former boss and an all-round good guy (rare at MHC these days), quotes Google Health Product Manager Roni Zeiger, M.D., as saying the new legislation has no effect on the company’s offering. Zeiger actually said that Google Health, as a service offered directly to consumers, is neither a covered entity nor a business associate under the new law.

Excuse me? I’ve been struck since Day 1 with the arrogance Google seems to be exhibiting with its entry into healthcare (actually, since before Day 1, since Google says CEO Eric Schmidt’s speech to the 2008 HIMSS conference was not technically a product introduction), but it seems to me Zeiger is intimating that the law doesn’t apply to Google.

This is almost as ludicrous as former Vice President Dick Cheney suggesting in 2007 that he was a fourth branch of government.

March 4, 2009 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

More on e-prescribing

I recently had a long feature story published in MDNG about e-prescribing. It’s pretty basic, but fairly comprehensive.

Check it out here. I’m not sure what happened with the paragraph breaks to make so much of the text run together in the online version.

In the same issue, Alberto Borges, M.D., writes in his “The HIT Realist” column that physicians should be wary of vendors, insurers and government agencies pushing them to adopt e-prescribing and other health IT.

I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.