A Start to Securing PHI?

Sometimes press releases for new products tell us far more about the risk of identity theft in electronic health systems than the mainstream press or trade journals.

Check out this zinger quote: “Most organizations don’t even know where their PHI is.” Why doesn’t the mainstream press tell the public that the health care organizations (like hospitals) have no idea where all their sensitive personal health data resides?

How about this: “The software (Identity Finder) automatically finds PHI such as social security numbers, medical record numbers, dates of birth, driver licenses, personal addresses, and other private data within files, e-mails, databases, websites, and system areas. Once found, the software makes it simple for users or administrators to permanently shred, scrub, or secure the information.” Emails? Who sends drivers license numbers, SS#s, and Dates of Birth in emails? Clearly lots of healthcare organizations do.

We can only hope products like this sell.

See full article at:

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/05-05-2009/0005019328&EDATE

Reducing Cost or Care? Orszag on HIT

Fascinating ‘insider’ article on the budget process and the Orzag/Obama plan to reduce healthcare costs by building a health IT system ‘wired’ for data mining:
“At the core of both the stimulus bill and the Obama budget is Orszag’s belief that a government empowered with research on the most effective medical treatments can, using the proper incentives, persuade doctors to become more efficient health-care providers, thus saving billions of dollars. Obama is in effect betting his Presidency on Orszag’s thesis.” (See Article)

“Orszag seems more right than wrong about how to bring down health-care costs, but the truth is that, while there is obviously a great deal of waste in the American medical system, nobody knows for certain whether Orszag’s plan—which is now Obama’s plan—will work.”

The plan relies on building HIT infrastructure to obtain the data for “comparative effectiveness” research. Republicans question whether this research approach can reign in healthcare spending enough and also fear it will lead to “vast government intrusion into the doctor-patient relationship”. And the plan relies on building an HIT system to data mine ALL data without informed consent.

Our problems with the plan:

1) Orzag/Obama want ALL health data without informed consent for research, which is unethical, illegal, and destroys patient trust in doctors.
2) Orzag/Obama do not seem to realize that compelling the use of all health data will INCREASE the number of Americans who avoid treatment altogether (already in the millions). Many Americans know that avoiding care is the only way to keep health data private.
3) Millions avoiding treatment means millions delay care or never get care, increasing bad outcomes, deaths, and costs.
4) But worst of all for proponents of research: they won’t get the data needed to learn what works best unless they restore privacy and patient control over data. Researchers cannot get the results all of us want with missing and inaccurate data!
5) To find out what the most effective treatments are for many costly conditions we have to actually have all the data in our systems. Today millions of people with Depression and Addiction have NO data in the system because they pay for private care or attend AA or NA so NO data is ever generated.
6) It will be a tragedy never to find out what treatments are most effective—and a HUGE waste of the billions of stimulus dollars to build an HIT system without privacy.

Key Quotes from the article:

• The deficit spectre has loomed over every major debate. The most contentious issue has been health care.
• Orszag came to the debate with a third option, which combined Summers’s concern about deficits and Daschle’s insistence that Obama tackle health care this year. He argued that health-care reform is deficit reduction.
• At the core of both the stimulus bill and the Obama budget is Orszag’s belief that a government empowered with research on the most effective medical treatments can, using the proper incentives, persuade doctors to become more efficient health-care providers, thus saving billions of dollars. Obama is in effect betting his Presidency on Orszag’s thesis.
• Orszag, despite his image as a number-crunching technocrat, considers himself an activist.
• At Princeton, he wrote his senior thesis on the relationship between the Federal Reserve and Congress. One of his conclusions was that “it is clear that Congress suffers from a lack of understanding of even the most rudimentary economics.” Orszag’s paper won an award for the best thesis that year in international economics or politics.
• At the Congressional Budget Office, Orszag hired specialists in health-care economics and turned the institution into a clearinghouse of information about rising health-care costs. When I asked him whether he was an advocate for policies at a place that was supposed to be nonpartisan, he replied, “I would say I was activist.”
• Kent Conrad, the chairman of the Senate Budget Committee, has made eradicating the federal budget deficit his life’s work. He told me that he picked Orszag to run the C.B.O. in 2007, and repeatedly asked him to testify before his committee, because they shared a concern about long-term spending trends.
• If there was one aspect of the President’s budget that demonstrated Obama’s European sympathies, Ryan said, it was health care. More specifically, it was Orszag’s approach to curbing health-care costs. “He believes you need to set up this über-bureaucracy—the institute of comparative effectiveness—which we’ll put smart people in, and they will design the metrics and the processes on how medicine is to be practiced,” Ryan said. “And then the federal government will impose and enforce those processes. . . . It is precisely what they employ in England. It’s precisely what they employ in Canada.” Rather than celebrate Orszag’s attempt to rein in health-care spending, Ryan seemed horrified by it.
• Obama will spend the rest of this year fighting a war on two fronts. On one are Democrats protecting old-line economic interests: oil, gas, and coal companies; agribusiness; student-loan companies; and pharmaceutical companies and medical providers who fear that Orszag’s ideas for cutting health-care costs will hit them hard. On the other are institutional interests. Obama will be battling committee chairmen who oppose his Pell-grant reforms, and placating senators who resent his willingness to use a feature of the budget process known as “reconciliation,” which limits debate and prevents the use of a filibuster, to pass his health-care plan.
• Orszag’s job is to defend Obama’s budget on all fronts, but he will be most deeply engaged in health care. I asked him how he could be so sure that his ideas about how to reduce health-care costs would work, mentioning that I had been surprised to learn that Paul Ryan and other Republicans had seized on health-care cost controls as the issue they believed would bring down Obama’s health-care plan and, with it, they surely hoped, his Presidency. Specifically, they believed that Orszag’s obsession with “comparative effectiveness,” research about which treatment options work best for a given ailment, will lead to vast government intrusion into the doctor-patient relationship. The research, which received major funding in the stimulus legislation and which was also included in Obama’s budget, had assumed a sinister meaning on the right.
• Orszag dismissed the criticism as a caricature. “I don’t see how it interferes with the doctor-patient relationship to suggest that it would be better if your doctor had more information about what would work for you,” he said. “The best way of putting it is that your doctor shouldn’t have disincentives to give you the higher-quality care, which often happens now.” Far from a huge government bureaucracy, he proposes a simple adjustment of incentives: “You get paid more if the treatment has been shown to be effective and a little less if not.”
• Orszag seems more right than wrong about how to bring down health-care costs, but the truth is that, while there is obviously a great deal of waste in the American medical system, nobody knows for certain whether Orszag’s plan—which is now Obama’s plan—will work.
• As Orszag explained his ideas, I couldn’t help remembering an encounter I had with him one day in the hallway at O.M.B. I told him that I had read his Princeton undergraduate thesis. He looked at me and smiled a little sheepishly. He said that at some point after his arrival at graduate school, in London, he had had a sudden realization: that he had made a mistake, and the crucial formula that he had used in his thesis, the one that had won him the prize, was incorrect. “It was so innovative,” he said, “that it was wrong.”

Can Peter Orszag keep the President’s political goals economically viable?

Orszag can match Lawrence Summers in policy expertise, and has proved to be a subtle and persistent political player.

…The deficit spectre has loomed over every major debate. The most contentious issue has been health care. The Administration was divided into three camps. According to White House officials, a group including Vice-President Biden and David Axelrod, a senior adviser, and led by Summers was hesitant to make a major push on health care this year, especially given the fact that a full plan would cost roughly a trillion dollars over ten years. Then, there was Tom Daschle, the former South Dakota senator who was Obama’s original choice to lead the health-care-reform team, and his staff at the White House and at the Department of Health and Human Services. In January, Daschle became alarmed that health care would be either absent from the Obama budget or not given the emphasis that Obama had promised. (When Daschle went to see Rahm Emanuel to register these concerns, the President, who had been quiet during the early health-care meetings, stopped by and reassured Daschle of his commitment.) Orszag came to the debate with a third option, which combined Summers’s concern about deficits and Daschle’s insistence that Obama tackle health care this year. He argued that health-care reform is deficit reduction.

Orszag is convinced that rising federal health-care costs are the most important cause of long-term deficits. As a fellow at the Brookings Institution, he became obsessed with the findings of a research team at Dartmouth showing that some regions of the country spend far more money on health care than others but that patients in those high-spending areas don’t have better outcomes than those in regions that spend less money. If spending more on health care has no correlation with making people healthier, then there must be enormous savings that a smart government, by determining precisely which medical procedures are worth financing and which are not, could wring out of the system. “I spent several months in very intense study,” Orszag told me. “The reason that I wanted to go to C.B.O. was I thought that was one of the key bodies that could really delve into what we could do about it.”

More than just google

In response to the Consumer Watch article: “U.S. Senate Records Reveal Google Inc. Lobbying Campaign On Personal Medical Records Law Despite Internet Giant’s Denials

This story is of interest because the public has no idea which corporations lobbied against their privacy rights in the stimulus bill or how much was spent overall to try to eliminate health privacy.

The focus on Google alone is misleading and actually distracts from the real work of informing the public about the major health-related industries that have long opposed Americans’ privacy rights. The real question is which other industry giants that are not household names lobbied against privacy?

The total lobbying money spent by the massive secret health data mining industry, insurers, hospitals, and big Pharma to oppose Americans’ rights to privacy far exceeds Google’s lobbying expenses.

If we don’t know who all the culprits are, we can’t stop them and restore privacy.

The most dangerous enemies of privacy are the ones we don’t know about.

U.S. Senate Records Reveal Google Inc. Lobbying Campaign On Personal Medical Records Law Despite Internet Giant’s Denials

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.”

Is not just celebs who need strong security and privacy for PHI

‘Smart’ EHR software designed for security, privacy, and compliance with the law and ethics, would allow only those who have your informed consent to access your records. Staff and employees who carry out the orders of your attending physician could access your records under the informed consent you give your physician, by electronically affirming they are part of your treatment team. Instead of primitive, legacy EHR systems that allow 10,000 hospital staffers or employees access to your records, in a ‘smart’ EHR system only the 100 or so directly involved in your treatment could get into your PHI, preventing 9,900 snoopers’ eyes from seeing anything.

Is not just celebs who need strong security and privacy for PHI–what about women whose abusers work for hospitals? What about all the minor local celebs? Do you want your nosy neighbor who is a clerk to be able to read your records?

Stepping up employee snooping via retroactive audits is EXTREMELY expensive (major hospitals have to have large technical staffs to be able to audits millions of accesses looking for those that should not have occurred). ‘Smart’ consent technologies exist. Retroactive audits for improper access are like looking for needles in a haystack UNLESS you are Nadya Suleman or some other celebrity whose EHR is being actively watched. Why not keep the horses from getting out of the barn in the first place?

Refer to COMPUTERWORLD story: “Kaiser fires 15 workers for snooping in octuplet mom’s medical records“.

Kaiser fires 15 workers for snooping in octuplet mom’s medical records

Another eight hospital employees disciplined for improperly accessing Nadya Suleman’s files

A Kaiser Permanente hospital located in a Los Angeles suburb has fired 15 employees and reprimanded eight others for improperly accessing the personal medical records of Nadya Suleman, the California woman who gave birth to octuplets in January.

The unauthorized accessing of Suleman’s electronic records at the medical center in Bellflower, Calif., violated a California law designed to safeguard the privacy of health care data, according to Kaiser spokesman Jim Anderson, who said the snooping incidents have been reported to the California Department of Public Health.

RealAge sets new low…

RealAge sets a new low for unscrupulous behavioral targeting to sell drugs.

Is the RealAge quiz an unfair and deceptive trade practice? Where is informed consent?

Do the 27 million who took the test to find out if they are younger or older than their “biological age” really know that they are giving detailed information so RealAge can market drugs to them?

RealAge illustrates a critical problem with almost all health-related websites: people are actually going there for help – they appear to offer services, so people expect that health websites follow medical ethics and protect their privacy. But they don’t. Health websites are not altruistic and don’t adhere to medical ethics or privacy rights. Health-related websites offering rating scales, searchers, or information about diseases and treatments are typically just as deceptive: they also are designed primarily to collect personal information for personally-targeted marketing or worse.

View the New York Times article Online Age Quiz Is a Window for Drug Makers.

Online Age Quiz Is a Window for Drug Makers

Americans yearn to be young. So it is little wonder that RealAge, which promises to help shave years off your age, has become one of the most popular tests on the Internet.
According to RealAge, more than 27 million people have taken the test, which asks 150 or so questions about lifestyle and family history to assign a “biological age,” how young or old your habits make you. Then, RealAge makes recommendations on how to get “younger,” like taking multivitamins, eating breakfast and flossing your teeth. Nine million of those people have signed up to become RealAge members.
But while RealAge promotes better living through nonmedical solutions, the site makes its money by selling better living through drugs.

Data Mining Case Heads to the Supreme Court

Two major publishers of health care data filed a petition Friday at the Supreme Court, raising cutting-edge questions about whether increasingly widespread data mining that is used for commercial purposes is protected by the First Amendment.

Two major publishers of health care data filed a petition Friday at the Supreme Court, raising cutting-edge questions about whether increasingly widespread data mining that is used for commercial purposes is protected by the First Amendment.

The petition, titled IMS Health, Inc. and Verispan LLC v. Ayotte, is an appeal of a controversial ruling last November by the 1st U.S. Circuit Court of Appeals. The appeals panel ruled that the data about drug prescriptions gathered by the companies is outside the protection of the First Amendment, in part because it has “scant societal value,” in the same way that obscenity is not protected speech. The ruling written by Judge Bruce Selya said the pharmaceutical data at issue in the case was to be viewed, not as speech, but as a commodity like “beef jerky” that can be regulated without running afoul of the First Amendment.