New York State plans country's largest health information network

 Via Democrat and Chronicle (Rochester):

The New York state Department of Health and a public-private partnership called New York eHealth Collaborative, or NYeC (pronounced "nice"), recently announced plans to spend $129 million in state and federal money to create a statewide network for electronic medical records, to be complete in 2014. Like the highways, they envision the network as a public utility that will allow medical providers anywhere in the state to view — with your permission — a list of your medications, any allergies and any recent X-rays or other tests that could help guide your care. The e-records network would be the largest in the country, dwarfing networks of other states and the Veterans Administration.

The planned statewide network, called Statewide Health Information Network for New York or SHIN-NY, is intended to serve more than 200 hospitals, thousands of medical practitioners and up to 20 million patients a year.

You can read more about NYeC here.
 

FTC Issues Final Breach Notification Rule for Electronic Health Information

Pursuant to the American Recovery and Reinvestment Act of 2009 (ARRA), the Federal Trade Commission (FTC) issued the final rule regarding notification requirements for breaches of electronic health information by vendors of personal health records and certain affiliated entities:

The rule applies to both vendors of personal health records – which provide online repositories that people can use to keep track of their health information – and entities that offer third-party applications for personal health records. These applications could include, for example, devices such as blood pressure cuffs or pedometers whose readings consumers can upload into their personal health records. Consumers may benefit by using these innovations, but only if they are confident that their health information is secure and confidential.

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The Final Rule requires vendors of personal health records and related entities to notify consumers following a breach involving unsecured information. In addition, if a service provider to one of these entities has a breach, it must notify the entity, which in turn must notify consumers. The Final Rule also specifies the timing, method, and content of notification, and in the case of certain breaches involving 500 or more people, requires notice to the media. Entities covered by the rule must notify the FTC, and they may use a standard form, which can be found along with additional information about the rule at www.ftc.gov/healthbreach.

You can find the full text of the rule here.

"FTC Issues Final Breach Notification Rule for Electronic Health Information," FTC Press Release (August 17, 2009).

New York Times reports on privacy concerns about use of de-identified health information

The New York Times reported on Americans' growing concern regarding commercial use of their personal health information, especially the use of re-identified prescription drugs information for marketing purposes.  

The article points out correctly that the Recovery Act of 2009 (ARRA) included a few key changes to the present privacy regime, which would make it more difficult for pharmacies and data mining companies to use patient information for marketing or fundraising purposes.  While the new law (and the upcoming applicable HHS regulations sanctioned by ARRA) will close a few loopholes in the current medical privacy regime, data mining companies like IMS Health and Verispan do not seem to be overly worried about these new developments:

The law won’t shut down the medical data mining industry, but there will be more restrictions on using private information without patients’ consent and penalties for civil violations will be increased. Government agencies are still writing new regulations called for in the law.  <...>

IMS Health reported operating revenue of $1.05 billion in the first half of 2009, down 10.6 percent from the period a year earlier. [An IMS representative] said he did not expect growing awareness of privacy issues to affect the business.

The Times article also touches on a few other important areas of concern for privacy advocates:  the effect of widespread adoption and use of electronic health records (EHR's) and personal health records (PHR's) on privacy and security of patients' protected health information.  

Interestingly, the article notes that while "Microsoft and WebMD acknowledge that the privacy rules in the stimulus law apply to them," "Google says the law’s prohibitions do not apply to it, except for its duty to report any breaches of medical privacy."  According to a Google spokeswoman, "Google is bound by the privacy policy that people agree to when they sign up."  Right after the enactment of the Recovery Act, Google claimed that the additional privacy rules included in the ARRA did not apply to its PHR products.  However, Google acknowledged the applicability of ARRA's data breach notification requirements a few months thereafter.  This quote in the Times may reintroduce, if not underscore, Google's ambiguous attitude toward applicability of the new privacy and security rules.

"And You Thought a Prescription Was Private," The New York Times (August 9, 2009).

 

 

In the news: Personal Health Records edition

  • The Federal Trade Commission (FTC) issued interim regulations regarding breach notification requirements for PHR vendors, as mandated by the American Recovery and Reinvestment Act of 2009.  According to the FTC press release, aside from breach notification, the proposed rule also:

stipulates that if a service provider to one of these [PHR vendor] entities experiences a breach, it must notify the entity, which in turn must notify consumers of the breach. The proposed rule contains additional requirements governing the standard for what triggers the notice, as well as the timing, method, and content of notice. It also requires entities covered by the proposed rule to notify the FTC of any breaches. The FTC can then post information about the breaches on its Web site, and notify the Secretary of Health and Human Services.

             The full notice can be found here.

  • Mayo Clinic, in collaboration with Microsoft, launched its new personal health record (PHR) site on Tuesday April 21, 2009.  The Mayo Clinic Health Manager uses Microsoft's HealthVault system to store medical histories, test results, immunization files and other records from doctors' offices and hospital visits, along with data from home devices like heart rate monitors.  Anyone, not just Mayo Clinic patients, can open an account online; users can grant limited access to doctors, family members, and others to view the information contained in their PHR.  It would be very interesting to learn if the Mayo Clinic required Microsoft to sign a Business Associate Agreement, or if Microsoft would publicly acknowledge that their PHR product is subject to certain privacy and security rules under HIPAA.  ("Mayo Clinic backs new personal health record site", USA Today, April 21, 2009.)

 

  • Meanwhile, the Boston Globe raised serious doubts regarding the accuracy of patient information contained in Google Health's PHRs because "Google takes some information from insurance billing records that use broad and imprecise codes to describe patient treatment."  According to Dr. David Kibbe, a senior technology adviser to the American Academy of Family Physicians, "[claims] data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has."   However, as Bob Evans of Global CIO Blog points out in an entry on this subject, is it better to have some information regarding a patient contained in a PHR, even if there is a good chance that such information can be wrong, or no information at all? ("Electronic Health Records Raise Doubt", The Boston Globe, April 13, 2009; "Google Health Records Reveal Grossly Inaccurate Info", Global CIO Blog (Bob Evans), April 13, 2009.)

 

Steve Fox on the new PHR privacy rules

Bob Brewin of NextGov interviewed Steve Fox regarding the new privacy rules for vendors of personal health records (PHRs), and the applicability of such rules not only to PHR vendors such as Google and Microsoft, but also to the less obvious "related entities", a group so broad it may include an iPhone app:

Steven Fox, a lawyer with Post & Schell in Washington who co-chairs the firm's data protection group, agreed that the rules cover Google and Microsoft but said he wished FTC had specifically identified the two companies in the proposed rules.

The rules cover about 200 vendors of personal health record systems and 500 "related entities, which include online medication or weight tracking programs, and 200 third-party providers that offer billing and data services.

The related entities category could include low-cost iPhone applications that would have to comply with the potentially costly breach notification process, Dixon said. An online guide lists "100 Fabulous iPhone Apps for Your Health and Fitness," and Fox said these applications would be covered by the breach notification rules if they exchange information with personal health records.

("Proposed breach notification rule would affect more health vendors", NextGov, April 16, 2009.)

 

Deloitte Publishes Healthcare Consumer Survey Findings

Deloitte published the results of its 2009 survey of more than 4,000 healthcare consumers, and the findings included some good news for the healthcare IT industry:

  • 9% of consumers have an electronic personal health record (PHR), but 42% are interested in creating one connected online to their physicians.  This leaves much room for growth for companies like Microsoft and Google which offer a PHR product.
     
  • 55% want the ability to communicate with their doctor via email to exchange health information and get answers to questions, and 57% would be interested in scheduling appointments, buying prescriptions and completing other transactions online if their information is protected.
  • 4 in 10 favor increasing government funding and incentives to support adoption of electronic medical records by doctors, hospitals and health plans.

However, consumers remain worried about the privacy and security of their personal health information, with 38% of those surveyed being "very concerned" as opposed to 24% of those who are not concerned at all.  Sixty percent support government establishing standards "for how medical for how medical information is collected, stored, exchanged and protected." 

The full survey findings can be downloaded here.

"Deloitte Survey Finds Healthy Consumer Demand For Electronic Health Records, Online Tools and Services", PRNewswire.com, April 6, 2009.

"2009 Survey of Health Care Consumers: Key Findings, Strategic Implications", Deloitte Center for Health Solutions, released April 2009.

In the news: CVS and Google; Connect Open Source Software; and more

  • CVS pharmacy customers now have the ability to download their prescription and medication histories to Google Health accounts after CVS and Google expanded their partnership.  Patients at CVS' walk-in MinuteClinics are also able to add summaries of their visits to their Google Health accounts.  It would be interesting to find out if CVS and Google ever executed a Business Associate Agreement.  After the enactment of the HITECH Act, Google famously maintained that its personal health records product is not a subject to the new legislation and certain privacy and security provisions under HIPAA.  ("CVS-Google Health pact now includes drugstores", AP, April 6, 2009.)
  • The federal government released Connect, and open source software which allows public and private entities to share health information via the National Health Information Network.  The source code is free to download (the code and its documentation are available here), but organizations choosing to acquire and use this product will be responsible for costs associated with the installation and maintenance of Connect.  The Social Security Administration, Department of Defense, Veterans Affairs, and the CDC are among the many government agencies using this software for health information exchange already.  ("NHIN software released to open-source community", Government Health IT, April 7, 2009.)

     

 

  • This Business Week article analyzes the various data privacy and security concerns facing health care providers and patients alike.  ("Putting Patient Privacy in Peril?", Business Week, April 6, 2009.)
  • The New York Times reports that New York-Presbyterian Hospital became "the first large institution to move beyond the pilot stage this week as it begins to offer consumer-controlled health records for patients... New York-Presbyterian has been working with Microsoft for more than a year, not only on technical matters but also ease-of-use concerns with patients. The introduction will be gradual, beginning with heart patients, who will be told of the potential benefits of personal health records when they visit a New York-Presbyterian hospital or outpatient clinics."  Once again, it would be very interesting to find out if NYB and Microsoft signed a Business Associate Agreement, or if Microsoft acknowledged whether it is now subject to certain privacy and security provisions under HIPAA.  ("A Hospital Is Offering Digital Records", New York Times, April 5, 2009.)

 

Update: Healthcare Informatics Interviews Steve Fox and Ed Shay about the HITECH Act, Parts III and IV

Healthcare Informatics Editor-in-Chief Anthony Guerra recently talked with our own Steve Fox and fellow Post & Schell partner Edward Shay about the substance of the HITECH Act and what this new legislation means for healthcare providers. The interview appears under the "Online Exclusives" section of the Healthcare Informatics Web site.

Healthcare Informatics recently published Part III and Part IV of the interview on its Web site.