Trust must be mutual for patient engagement to work

“A recent study in the Journal of the American Informatics Association reports that nearly one in eight patients has withheld information from their healthcare providers due to security concerns. Moreover, most of the respondents were very concerned about the security of their information when it was being shared electronically or by fax. Just last week, advocacy organization Patient Privacy Rights sent a letter to the U.S. Department of Health & Human Services urging the agency to improve privacy protections of patients’ electronic health records, particularly in the cloud and in HIEs.”

Read more: Trust must be mutual for patient engagement to work – FierceEMR http://www.fierceemr.com/story/trust-must-be-mutual-patient-engagement-work/2013-09-18#ixzz2fRtzIBsV
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Experts tout Blue Button as enabling information exchange between medical provider and patient

Blue Button Plus (BB+) and direct secure email technologies could put patients in control of all use and disclosure of their electronic health records. BB+ lets us ‘view, download, and transmit’ our own health data to physicians, researchers, or anyone we choose.

But state Health Information Exchanges (HIEs) don’t allow patients to control the disclosure of personal health data. Some state HIEs don’t even ask consent; the HIE collects and shares everyone’s health records and no one can opt-out. Most state HIEs ask patients to grant thousands of strangers—employees of hospitals, doctors, pharmacies, labs, data clearinghouses, and health insurers—complete access to their electronic health records.

When corporations, government, and HIEs prevent patients from controlling who sees personal health data– from prescriptions, to DNA, to diagnoses– millions of people every year avoid or delay treatment, or hide information.

HIEs that open the door to even more hidden uses of health data will drive even more patients to avoid treatment, rather than share information that won’t be private.

Health IT systems that harm millions/year must be fixed. Technology can put us in control of our data, achieve the benefits and innovations we expect, and prevent harms.  We have to change US law to require technologies that put patients in control of their electronic health records.

OCR Could Include Cloud Provision in Forthcoming Omnibus HIPAA Rule

The quotes below are from an article written by Alex Ruoff in the Bloomberg Health IT Law and Industry Report.

“Deborah Peel, founder of Patient Privacy Rights, said few providers understand how HIPAA rules apply to cloud computing. This is a growing concern among consumer groups, she said, as small health practices are turning to cloud computing to manage their electronic health information. Cloud computing solutions are seen as ideal for small health practices as they do not require additional staff to manage information systems, Peel said.
Cloud computing for health care requires the storage of protected health information in the cloud—a shared electronic environment—typically managed outside the health care organization accessing or generating the data (see previous article).
Little is known about the security of data managed by cloud service providers, Nicolas Terry, co-director of the Hall Center for Law and Health at Indiana University, said. Many privacy advocates are concerned that cloud storage, because it often stores information on the internet, is not properly secured, Terry said. He pointed to the April 17 agreement between Phoenix Cardiac Surgery and HHS in which the surgery practice agreed to pay $100,000 to settle allegations it violated HIPAA Security Rules (see previous article).
Phoenix was using a cloud-based application to maintain protected health information that was available on the internet and had no privacy and security controls.

Demands for Guidance

Peel’s group, in the Dec. 19 letter, called for guidance “that highlights the lessons learned from the Phoenix Cardiac Surgery case while making clear that HIPAA does not prevent providers from moving to the cloud.”

Peel’s letter asked for:
• technical safeguards for cloud computing solutions, such as risk assessments of and auditing controls for cloud-based health information technologies;
• security standards that establish the use and disclosure of individually identifiable information stored on clouds; and
• requirements for cloud solution providers and covered entities to enter into a business associate agreement outlining the terms of use for health information managed by the cloud provider.”

Patient privacy group (PPR) asks HHS for HIPAA cloud guidance

Government HealthIT recently wrote an article about Dr. Peel’s of Patient Privacy Rights’ letter to the HHS Office for Civil Rights pushing for security guidelines, standards, and enforcements for cloud technology being used in healthcare.

Here are a few key points highlighted in the article:

“Issuing guidance to strengthen and clarify cloud-based protections for data security and privacy will help assure patients (that) sensitive health data they share with their physicians and other health care professionals will be protected,” Peel said.

“Cloud-computing is proving to be valuable, Peel said, but the nation’s transition to electronic health records will be slowed ‘if patients do not have assurances that their personal medical information will always have comprehensive and meaningful security and privacy protections.’”

“Patient Privacy Rights, a group founded in 2006, is encouraging HHS to adopt guidelines that highlight ‘the lessons learned from the Phoenix Cardiac Surgery case while making it clear that HIPAA does not prevent providers from moving to the cloud as long as it is done responsibly and in compliance with the law.’”

“In general, Peel said, cloud providers and the healthcare industry at large could benefit from guidance and education on the application of federal privacy and security rules in the cloud. ‘HHS and HIPAA guidance in this area, to date, is limited,’ Peel said, recommending the National Institute of Standards and Technology’s cloud privacy guidelines as a baseline.”

Benefits of Online Medical Records Outweigh the Risks- Includes Opposing Quotes from Dr. Deborah Peel

An article written by Larry Magid in the Huffington Post quotes PPR when speaking about the issues surrounding electronic health records. You can view the full article here: Benefits of Online Medical Records Outweigh the Risks.

“There are also privacy concerns. In a 2010 Wall Street Journal op-ed, psychiatrist Deborah Peel, founder of Patient Privacy Rights, complained that ‘lab test results are disclosed to insurance companies before we even know the results.’ She added that data is being released to ‘insurers, drug companies, employers and others willing to pay for the information to use in making decisions about you, your job or your treatments, or for research.’ Her group is calling for tighter controls and recognition that “that patients own their health data.’”

Two University of Miami Hospital Employees May Have Stolen & Sold Patient Data

To view the full Miami Herald article, please visit: Two University of Miami Hospital Employees May Have Stolen & Sold Patient Data

Two hospital employees are accused of stealing thousands of “face-sheets” from the University of Miami Hospital over a 22-month period. These “face-sheets” included information such as name, address, reason for visiting, insurance policy number (note: Medicare and Medicaid use SSNs as insurance policy numbers), date of birth and the last four digits of the social security number. The employees have admitted to their improper conduct and were terminated immediately, but the lasting damage of the stolen information is still being addressed by the hospital and there is no information about how many of these sheets may have been taken. In a statement released released by the hospital, it was revealed that there is “no indication that medical records are at risk”.

Information Technology’s Failure to Disrupt Healthcare

Nicolas Terry wrote a very interesting and informative paper about the effects IT has had on healthcare today. It is available for download in its full text version here: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2118653. Below is his abstract.

Abstract: Information Technology (IT) surrounds us every day. IT products and services from smart phones and search engines to online banking and stock trading have been transformative. However, IT has made only modest and less than disruptive inroads into healthcare. This article explores the economic and technological relationships between healthcare and healthcare information technologies (HIT), asks (leveraging the work of Clayton Christensen) whether current conceptions of HIT are disruptive or merely sustaining, and canvasses various explanations for HIT’s failure to disrupt healthcare. The conclusion is that contemporary HIT is only a sustaining rather than disruptive technology. Notwithstanding that we live in a world of disruption, healthcare is more akin to the stubborn television domain, where similarly complex relationships and market concentrations have impeded the forces of disruption. There are three potential exceptions to this pessimistic conclusion. First, because advanced HIT is not a good fit for episodic healthcare delivery, we may be experiencing a holding pattern while healthcare rights itself with the introduction of process-centric care models. Second, the 2010 PCAST report was correct, the healthcare data model is broken. If Stage 3 of the MU subsidy program or some other initiative can funda

Your Health Information Isn’t Secure But Don’t Blame EHRs

There’s a lot of talk about the risks of storing health information in electronic medical records (EMRs). But, EMRs aren’t the problem. Those consent forms you sign at the doctor’s office… yeah, you should pay attention to the fine print. You may be giving permission to insurance companies, drug makers, and data aggregators to access your health information, regardless of how or where it’s stored. Sorry to get all sour grapes, but we just want to set the record straight. Here’s what you need to know about who can see your health information, how they can legally use it, and what you can do to protect yourself.

Your Doctor Isn’t the Only Person Who Knows Your Diagnosis

Have you heard of the Medical Information Bureau (MIB)? What about IntelliScript and MedPoint? These organizations, among others, build databases of Americans’ private medical information and sell it to other companies (MIB, a non-profit, only provides the information to its members). It’s perfectly legal. But, ethical? Well, you decide.

Data aggregators track down diagnoses codes, lab data, and prescriptions from databases such as those kept by pharmacy benefit managers. The data is later sold to health and life insurance companies to assess the risk of writing a policy. In other words, they can use it to determine rates, or possibly deny you service. However, we should point out that the MIB uses proprietary codes and only receives this information from member companies. The codes are “brief resumes” that act as “red flags” about a particular medical impairment or risk to a patient’s mortality or morbidity. MIB members aren’t supposed to make underwriting decisions based solely on a code.

Some of these organizations even perform analysis for insurance companies. For example, IntelliScript from Milliman provides insurers with drug profiles of patients. In each patient profile, they assign color codes to a drug – red, yellow, or green – in order to indicate its risk factor. Red means risk. It could be used to spotlight drugs for serious illnesses like cancer or AIDS.

Insecurities Plague Electronic Health Care

Information security and privacy in the healthcare sector is an issue of growing importance but much remains to be done to address the various issues raised by healthcare consumers regarding privacy and security and the providers’ perspective of regulatory compliance.

Writing in the International Journal of Internet and Enterprise Management, Ajit Appari and Eric Johnson of Dartmouth College, Hanover, New Hampshire, USA, explain that the adoption of digital patient records, increased regulation, provider consolidation and the increasing need for information exchange between patients, providers and payers, all point towards the need for better information security. Without it patient privacy could be seriously compromised at great cost to individuals and to the standing of the healthcare industry.

ONC IS MAKING HISTORY!

ATTEND THE FIRST EVER HEARING ON PRIVACY-ENHANCING TECHNOLOGIES IN THE NATION.

Register here.

The hearing, scheduled all day on June 29th, will showcase 7 innovative, existing privacy-enhancing Health IT products and systems, and future technologies. The technologies will be discussed by 4 experts and the Privacy and Security Tiger Team.

Early this year, Dr. Blumenthal met with the bipartisan Coalition for Patient Privacy. He told us our idea for this conference struck him as “very intriguing. Two principles should animate our policy development. Patients/consumers come first, and the process should be fair and open.” So he agreed to hold a hearing.

Register to attend the hearing at: http://www.blsmeetings.net/consumerchoicetechnologyhearing/
For agenda see: http://healthit.hhs.gov/portal/server.pt?open=512&mode=2&objID=2833&PageID=19423

This is the first hearing ONC has ever held that is focused solely on privacy rights and patients’ expectations to control sensitive health records, from prescriptions to DNA. It is VERY timely because billions in stimulus dollars are about to flow.

What kinds of systems do you want to get the stimulus billions??? Current HIT systems that facilitate the data mining, theft, and sale of personal health information or systems that put YOU in control of YOUR information?

Inside-the-beltway domination of policy and standards by major legacy health IT vendors, many major hospitals, the health data mining industries, and physicians’ organizations has made it very hard for consumer and privacy advocates to be heard, even though we represent the majority of the American public. The fear is if they have to ask first to see or use our health information, we might refuse. And we might. But it’s our right to do so.

Today’s HIT systems put our jobs and our kids’ futures at risk by exposing everything from our prescription records to our DNA to sale and theft. Once our health data is exposed, like Paris Hilton’s sex video, we can never make it private again.

Showcasing technology that empowers patients to actively share data for treatment, personal benefit, and for research, while empowering patients to protect personal information to prevent harms is critical—especially now as HHS prepares to spend billions on EHRs and models for data exchange that do not require meaningful and comprehensive privacy controls.

The video of the hearing will be a critical online resource for the public, the media, states, and the world. There is no other way to learn about robust privacy-enhancing technologies that meet patients’ expectations and rights to control use of PHI while enabling compliance with strong state and federal laws, medical ethics, and our Constitutional rights to privacy.

Latanya Sweeney’s testimony and slides show the need to choose the right HIT technologies and systems up front, rather than letting “100 weeds fester.” See her testimony at: http://patientprivacyrights.org/wp-content/uploads/2010/04/Sweeney-CongressTestimony-4-22-10.pdf
See her slides at: http://patientprivacyrights.org/wp-content/uploads/2010/06/Sweeney-TrustworthyNHINDesigns.pdf

If you cannot attend in person, PLEASE listen in and comment at the end during the comment period or submit comments online. The video link of the hearing will be posted the following day.

TAKE PART: Tell ONC to build privacy-enhancing health IT systems you can trust. Tell ONC to build privacy-enhancing EHRs and systems for data exchange, don’t blow the stimulus billions on systems that will never be trusted.

If we don’t fight for our rights to control sensitive personal health information, we will never GAIN the right to control the rest of our personal information online and in the Digital World.

Thanks for helping to save privacy!