RWJF Comments on Meaningful Use Stage 2 NPRM

Libby Dowdall, Communications Coordinator, Project HealthDesign National Program Office

Today, Robert Wood Johnson Foundation (RWJF) formally commented on the Electronic Health Record (EHR) Incentive Program’s Stage 2 proposed rule, issued by the Centers for Medicare & Medicaid Services (CMS). As a national program of RWJF’s Pioneer Portfolio, we, too, recognize health IT’s role as an important tool for improving health and health care in the U.S., and we applaud this effort toward the truly meaningful use of EHRs.

We encourage you to read a selection from RWJF’s general comments on patient engagement:

We are encouraged by efforts in the proposed rule regarding patient and consumer engagement, especially regarding secure messaging; direct, downloadable access to patient data; patient reminders; inclusion of family health history; and provision of patient education. Nevertheless, we would like to see the required percentages higher than proposed in some cases. In addition, as our Project HealthDesign makes clear, patients now expect to engage with their personal health data in apps and on mobile devices of their choosing. We expect this trend to increase significantly. Further, patients will almost certainly expect that the flow of information be in two directions. In other words, patients will reasonably expect they will have both access to personal health data but also the ability to provide personal data to their health professionals. Work by both Project HealthDesign and by RWJF’s OpenNotes project shows that health data is becoming essentially a platform for conversation between patient and health professional. Project HealthDesign uses patient-generated data to spark conversations about the course of treatment. OpenNotes enables patients to see their data and have a discussion with their health professional about that information. A recent study about OpenNotes (Ann Intern Med, 2011;155:811-819) indicates that patients feel very strongly about gaining access to actual information in their medical record. The patients in this study did not share concerns noted by physicians in the study that patients would not understand or would worry about aspects of this information.

Native apps on smartphones and tablets may currently provide the most engaging experiences with health data for the public. Unfortunately importing data about care, such as lab test results, remains a significant barrier to adoption and use for both patients and app developers alike. Ideally, efforts to liberate this data for things like these apps, other personal health information tools as well as a platform for conversations between patients and their health professionals will become a policy reality in future versions of this rule.

Read RWJF’s full comment.

The comment period for the proposed rule closes tonight at 11:59 p.m. EST. Submit a comment at regulations.gov.

Meaningful Use on the iPad and Beyond

Nikolai Kirienko, Chronology.MD Co-Project Director, UC, Berkeley

Tablet computing at the point of care is poised to touch virtually every corner of care delivery in medicine. Yet, the currently proposed criteria for Meaningful Use Stage 2 have yet to embrace the post-PC world of medicine that’s just over the horizon. Someday sooner than we think, those large, immobile boxes chained to a desk will seem as quaint a notion as the endless stacks of paper charts they replaced.

Thankfully, Project HealthDesign offers a practical glimpse of our rapidly emerging future in action today.

By equipping patients and providers with an array of cutting-edge consumer technologies-- from iPads to WiFi biometric devices-- and putting them through their paces in clinical practice, we are able to learn a vast amount about the promise and pitfalls we're likely to encounter at scale in just a few short years.

With respect to Meaningful Use, and through Project HealthDesign, Robert Wood Johnson Foundation is characteristically ahead of the game, pioneering a scenario that, at first glance, may look ridiculous to folks steeped in the world as it is today. iPads? SMS messaging? WiFi? I can't even get my patients to show up! (Note the Estrellita team's most popular app feature: appointment tracking.)

As a member of ONC’s newly minted Consumer/Patient Engagement Power Team, it's been a privilege to work with ONC's senior adviser for Consumer E-Health, Lygeia Riccardi and MaryJo Deering, acting director of the Office of Communications, to examine the long view in the context of Meaningful Use.

They recently asked fellow patient advocates Hugo Campos, Heidi Sitcov and me to work alongside industry leaders as co-chairs of a remarkable group assembled to combine a rare blend of on-the-ground experience implementing health IT. Our task: to bring the patient voice, via direct item by item comments, before the Policy and Standards Committees overseeing the development of the Meaningful Use Stage 2 criteria.

Thanks to Project HealthDesign, I have no shortage of vivid patient experiences involving the challenges of working with electronic health data, which I hope to more explicitly detail along with our specific comments in an upcoming post.

In short, Project HealthDesign makes abundantly clear that patients today-- and in rapidly growing numbers into the future-- will expect to easily engage with their personal health data in apps and on mobile devices of their choosing. Native apps on smartphones and tablets may provide the most engaging experiences available, but importing data, such as lab test results, remains a significant barrier to adoption-- for patients and developers alike.

The SMART Platform within ONC’s Strategic Health IT Advanced Research Projects (SHARP) is working hard to reduce many of these barriers.In conjunction with existing standards, it will facilitate the role outlined early on by the Project HealthDesign Common Platform and through complementary third party services like Microsoft HealthVault.

My highest hope is that data liberation for apps, as advanced in these and similar projects, will become a policy and standards reality in Meaningful Use Stage 3 and beyond.

It will be a beautiful day when sharing components of my longitudinal health record, such as medication adherence or lab test results, with an iPad app is as simple and easy as installing an app on Facebook.

Chronology.MD, in conjunction with other interactive health history timelines such as SMART app challenge winner MyNote, or @KatieMcCurdy's inspiring medical life history will require this data for greater accuracy and to spare patients from hand transcription.

The details of my experience directing and using our app have made me a vocal advocate for the robust inclusion of patient engagement as more than just a theme in a spreadsheet. To make a transformational difference, truly liberated data will need to be hard coded into the policies and standards driving value in our rapidly evolving electronic health care economy.

Granting static electronic views of data will be a welcome improvement, as written in the current Meaningful Use criteria. But if patients can't engage with their data in order to create meaningful change in their daily lives-- via apps they might actually enjoy-- then it’s but one more health information silo that used to be on paper.  When it’s all said and done, Meaningful Use must be meaningful for patients for it to be truly meaningful at all. Thankfully, this is only the beginning.

How would you enhance Meaningful Use to aid dynamic patient engagement? Sound off in the comments so I can share your input with the Power Team.

 

Proposed Stage 2 Meaningful Use Rule Strong on Patient Engagement

Robert Belfort, Project HealthDesign Regulatory and Assurance Advisory Group, Manatt, Phelps & Phillips, LLP

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) released the proposed rule governing Meaningful Use Stage 2 under the Medicare and Medicaid Electronic Health Record Incentive Program last week. In a move that is likely to promote patient engagement, the agencies took the advice of the Health IT Policy Committee and beefed up the requirements on eligible professionals and hospitals for sharing data electronically with patients.

The patient engagement requirements in Meaningful Use Stage 1 are important but limited. For example, in Meaningful Use Stage 1:

• Eligible professionals and hospitals must provide patients electronic copies of their health information upon request and within three business days
• Hospitals must provide electronic copies of discharge instructions to patients upon request.
• Eligible professionals must provide clinical summaries of each office visit to patients upon request, but these do not have to be in electronic format.
• Eligible professionals have the option of providing at least 10 percent of their patients electronic access to their health information within four days of the information becoming available to the eligible professional. 

In the proposed rule for Stage 2, CMS and ONC are proposing to require eligible professionals and hospitals to provide patients with direct electronic access to their information. Patients will no longer have to request an electronic copy of their health information; instead they will have to be provided with a mechanism to electronically view — and securely download on demand — relevant portions of their health information.

Specifically, CMS and ONC are proposing the following patient-engagement-related objectives for Stage 2 of Meaningful Use:

For eligible professionals: 

• Provide patients the ability to view online, download, and transmit their health information within 4 business days of the information being available to the eligible professional.
• Provide clinical summaries for patients for each office visit.
• Use secure electronic messaging to communicate with patients on relevant health information.

For hospitals: 

• Provide patients the ability to view online, download, and transmit information about a hospital admission.

For both:

• Use certified EHR technology to identify patient-specific education resources and provide those resources to the patient.

Although these new objectives and their attendant measures do not hew exactly to those proposed by the Health IT Policy Committee, they are very close and represent CMS and ONC’s commitment to ensuring that health care providers use EHRs to improve not only their own access to health information but their patients’ access as well.

Further, beginning in 2014, CMS and ONC are proposing to replace the Stage 1 objectives requiring eligible professionals and hospitals to provide patients with an electronic copy of their health information/discharge instructions and with timely electronic access to their health information with the new view, download and transmit objectives proposed for Stage 2.

We think the patient engagement provisions in the proposed rule are good news for patients and that they could increase the demand for personal health records and applications that help individuals securely store, share and make use of their personal health information. We’d also like to give kudos to the Project HealthDesign team for providing the Health IT Policy Committee with valuable comments about extending the effect of meaningful use of EHRs beyond clinicians and to patients and their family members.

Of course, there is more work to be done. CMS and ONC will take public comments on the proposed rule before finalizing it. The comment period will last 60 days and we can expect a final rule sometime this summer. At that point, we’ll set our sights on Stage 3, which is scheduled to begin in 2015 and where we might see requirements that deal with accepting electronic data from patients.

The proposed rule will be published in the Federal Register on March 7, 2012. In the meantime, it is available for display or as a fact sheet.

Let us know your reaction to the new patient engagement requirements in Meaningful Use Stage 2 below.

Read more posts about legal and policy issues.

Latest Health IT Policy Developments

Deven McGraw, Proje­ct HealthDesign Regulatory and Assurance Advisory Group, Center for Democracy & Technology

A new year has started — year two of the incentive program to encourage the meaningful use of certified electronic health record technology to improve individual and population health. It’s a good time to get caught up on policy developments from the end of a very busy 2011 and provide an update on expected developments in early 2012.

On November 7, the Institute of Medicine issued a report and recommendations intended to assure the safety of EHRs. The report identifies some safety risks associated with EHRs and acknowledges the potential for safety benefits. The report also recommends the establishment of a new entity to investigate EHR safety risks and urges HHS to establish a mechanism for vendors and others to report safety-related incidents. In response to the report, ONC noted it is already in the process of developing an EHR safety and surveillance plan.

In December, the Department of Health & Human Services (HHS) announced that providers who started participating in the  meaningful use incentive program in the first year (2011) will have an additional year (until 2014) before being required to meet the more robust meaningful use Stage 2 requirements. This change, which was initially recommended by the Health IT Policy Committee, is intended to give providers a longer period of time to adjust to and implement the earliest stage of meaningful use before being required to demonstrate more robust use and exchange of health information in Stage 2.

Speaking of meaningful use, the proposed meaningful use requirements for Stage 2 are still expected to be released early in 2012. In addition, the Health IT Policy Committee has begun discussions about requirements for Stage 3, and incorporation of patient-generated data into EHRs continues to be a priority.

ONC unveiled its consumer engagement program in September, and the office is continuing to roll out initiatives to promote consumers’ use of e-health tools to improve their health:

• Earlier this month, ONC announced the Healthy New Year video challenge intended to collect short (up to two minutes) videos from consumers sharing their new year’s resolutions for the use of e-health tools to improve their health or the health of their families. The deadline to submit a video is February 16, at 5 p.m. EST. Cash prizes will be awarded to the top videos.

• On December 6, the Office of the Surgeon General and ONC launched a Healthy Apps Challenge to encourage the development and submission of technology apps that tailor health information to the needs of the consumer user and empower the public to regularly engage in and enjoy health-promoting behaviors. The deadline for entry was December 31, 2011. Winners will be announced on January 31, 2012 and finalist apps will be featured on an HHS website.

ONC also has launched efforts to gather more information about consumer concerns about e-health privacy and security. Specifically, ONC is surveying consumers (and conducting focus groups) about attitudes and preferences regarding the communication of personal health information using mobile devices. In addition, ONC will conduct annual, nationwide surveys to assess the percentage of individuals who are concerned about the privacy and security of EHRs, who report having kept any part of their medical history from their doctors due to privacy concerns, and who are concerned that an unauthorized person would see their medical information if it is sent electronically, among other key measures. ONC will assess trends in consumer privacy and security views between 2012 and 2016 and intends to compile the results into a final report.

Stay tuned for further updates.

Read more posts about legal and policy issues.

Good News for Patients Hidden in Health IT Policy Committee’s Meaningful Use Stage 2 Recommendations

Deven McGraw, Project HealthDesign Regulatory and Assurance Advisory Group, Center for Democracy & Technology

Recently, the federal Health Information Technology Policy Committee sent its official recommendations on Meaningful Use Stage 2 to the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare and Medicaid Services (CMS). In a bit of good news for patients and their advocates, these recommendations significantly increase requirements on providers and hospitals for sharing data electronically with patients.

For example, in Meaningful Use Stage 1:

• Providers and hospitals must provide patients electronic copies of their health information upon request and within three business days.*
• Hospitals must provide electronic copies of discharge instructions to patients upon request.*
• Providers must provide clinical summaries of each office visit to patients upon request, but these do not have to be in electronic format.*
• Providers have the option of providing at least 10% of their patients electronic access to their health information within four days of the information becoming available to the provider.  

For Stage 2, the Policy Committee’s recommendations place greater emphasis on providers and hospitals providing patients direct electronic access to their information. If the recommendations are accepted, patients will not have to request an electronic copy of their health information; they will instead have the capability to electronically view — and securely download on demand — relevant portions of their health information. This could significantly increase the demand for personal health records (PHRs) and applications that help individuals securely store, share and make use of their personal health information.

Specifically, in Meaningful Use Stage 2:

• Providers will be required to provide their patients access to view and download longitudinal health information within 24 hours of an encounter, or within four days of the provider having received the information from a lab or other external clinical site.**  
• Hospitals will be required to provide patients access to view and download information about a hospital admission within 36 hours of the encounter.**

Providers will still be required to provide patients clinical summaries of office visits, and hospitals will still be required to provide patients electronic copies of discharge instructions, but both will be able to use the view and download functionality described above to meet those objectives in Stage 2.

The Policy Committee also recommended that providers offer secure messaging to patients in Stage 2; at least 25 patients must be using this service in order for the provider to qualify for the Stage 2 payment. This is one of several instances in which the threshold is deliberately low in order to give providers time for implementation and to get patients accustomed to using the service.

The Policy Committee also adopted recommendations to deal with the privacy and security issues raised by the view and download functionality in Stage 2. For example, patients must be able to download information securely, and the information must include information on data provenance so that any subsequent users, including other providers, can know the data’s origin and the date it was created. Providers and hospitals also must establish processes to properly identify and authenticate patients who use view and download functionalities.

Additionally, in a move that’s sure to interest patients, the Policy Committee once again signaled its intent to include in Stage 3, which is scheduled to begin in 2015, requirements that deal with accepting electronic data from patients.

The Policy Committee’s Meaningful Use Stage 2 recommendations are not the final word on Stage 2. The final Meaningful Use criteria are set by CMS, and CMS’ proposed rule for Stage 2 likely will not be released until the end of the year. However, CMS relied significantly on the Policy Committee’s recommendations for Stage 1, so these recommendations are a strong signal of what’s to come in the very near future.

Do you see these recommendations as good news for patients and patient advocates? Tell us what you think by leaving a comment.

Read more posts about legal and policy issues.

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* Providers and/or hospitals must successfully execute these processes in response to at least 50% of patient requests in order to qualify for the Meaningful Use Stage 1 payment.

** Providers must provide this functionality to at least 10% of their patients in order to qualify for Meaningful Use Stage 2 payment.

More Patient Engagement in Meaningful Use

Bob Belfort, Manatt, Phelps & Phillips, LLP

As National Program Director Patricia Flatley Brennan and Deven McGraw of the Center for Democracy & Technology have discussed in recent blog posts, Stage 2 of Meaningful Use may set higher standards for health care providers’ engagement with patients. For example, in Stage 1, providers need only provide patients with an electronic copy of their health information upon request 50 percent of the time. But under Stage 2, providers may be required to use online secure patient messaging to communicate with patients via e-mail.

This move toward more patient engagement in Meaningful Use leads to an important question, which PricewaterhouseCoopers (PWC) explored in a recent research paper titled “Putting Patients into Meaningful Use”: How can health care providers use health IT tools, such as personal health records (PHRs), to effectively expand the care team to include patients?

A recent study suggests that less than half of all physicians are willing to use patients’ PHRs as part of their clinical work. Mistrust of patient-generated data, time constraints, lack of financial incentives and liability concerns are several issues that could contribute to this sentiment. To truly exploit the transformative potential of health IT tools, health care providers will have to become comfortable with engaging patients as more active partners in managing their own care. This is why Project HealthDesign is so important to ensuring that the government’s larger health IT adoption efforts succeed.

We are looking forward to talking about the issue of provider liability for reliance on patient-generated data and other related issues at an upcoming meeting with our five current project teams. In the meantime, we encourage you to let us know what you think about the steps PWC outlined for using PHRs to effectively expand the care team to include patients and consumers:

• Make providers (doctors, nurse practitioners) the face of the PHR.
• Define expectations for active participation by patients.
• Keep family members in the loop.
• Work side-by-side with patients as they use their PHRs.

They seem like good baseline recommendations to us. How would you build on them to be more specific?

Related resource:

• Read the full PWC report.

Evaluating Meaningful Use of Health Information Systems

Kathy Johnson, R.N., M.S., Project HealthDesign Ph.D. Candidate in Nursing, University of Wisconsin-Madison

Right now, we are witnessing the birth of a health information technology system architecture. Because of the complexity of this integrated structure, the evaluation of this process requires a great deal of thought.

The Health Information Technology Policy Committee (HITPC) recently solicited public comments on proposed meaningful use Stage 2 criteria [pdf]. May and colleagues’ Normalization Process Model provides theoretical guidance for this type of evaluation (May, et al., 2007). This model proposes that the evaluation of complex intervention implementations requires more than the measurement of outcomes and effectiveness; it holds that the social relations and processes related to the work that leads to those outcomes must also be considered. It emphasizes the processes by which complex interventions are made workable and integrated into everyday practice.

I argue that there is an implicit normativity, or reliance on common perceptions, in the emerging structures of the health information technology system. The proposed criteria for clinician meaningful use reflect only the clinical side of a system that is meant to be used by everyone. This approach to meaningful use is clinician-centric; the opportunity for patients to contribute health information in a format that is meaningful to them has not been addressed. Furthermore, efforts to evaluate the effectiveness of these systems have only been in terms of percentages of information bins filled; the only “meaning” in this rubric is the completion of a task.

Others may assert that there is nothing wrong with an implicit normativity by arguing that the professional is “in charge” of the patient and that the root purpose of the system is the provision of patient-centered care. If that is the case, then we are not moving toward a system that invites patients to participate in their care. Instead we are merely moving from paper to electronic documentation. Before us is a stellar and unprecedented opportunity to create a system that is meaningful for all.

Related resource:

• May, C., Finch, T., Mair, F., Ballini, L., Dowrick, C., Eccles, M., . . . Heaven, B. (2007). Understanding the implementation of complex interventions in health care: The normalization process model. BMC Health Services Research, 7, 148. doi:10.1186/1472-6963-7-148

Can Meaningful Use Become More Meaningful for Patients?

Patricia Flatley Brennan, R.N., Ph.D., Project HealthDesign Director

Because so many of the Stage 1 meaningful use criteria apply primarily to professionals’ uses of health information technology (HIT) in clinical care settings, Project HealthDesign is pleased to see criteria proposed in Stage 2 that would allow patients to become beneficiaries of meaningful use of HIT.

Meaningful use shouldn’t focus exclusively on electronic health records (EHRs) and clinical care settings. It’s time to ensure that the benefits of HIT meaningful use extend to the everyday lives of patients and families.

We call for accelerating the criteria for meaningful use Stage 2 that would lead HIT to:

1. Exchange health data back and forth between EHRs, which house clinically originated data, and PHRs, which house patient-originated data. Health data arise from a variety of sources. Our work on Project HealthDesign has shown that patients value health data that they themselves define and generate. These types of health data, or observations of daily living (ODLs), can include data related to mood, pain levels and even sleep quality.
   
   
2. Allow patients to invite trusted others, including family members, friends and surrogate decision-makers, to access selected health data. The coordination of patient care would benefit from this type of shared access, which engages patients, clinicians and other individuals designated by the patient while also allowing each patient to maintain the level of privacy he or she desires.

Now is the time for a broader, bolder approach to meaningful use. Patients are relying on HIT professionals to ensure that the bilateral exchange of health data between EHRs and PHRs is meaningful for both patients and clinicians. For more information, please read the full Project HealthDesign Stage 2 meaningful use comments.

Related resources:

• View the full draft of proposed Stage 2 meaningful use criteria [pdf].
• Read Project HealthDesign national advisory committee member John Halamka’s comments.

Stakeholders Weigh in on PCAST Report

Deven McGraw, Health Privacy Project Director, Center for Democracy & Technology

Project HealthDesign Director Patti Brennan recently blogged about the report issued by the President’s Council of Advisors on Science and Technology (PCAST), which set forth recommendations to facilitate more effective use of technology for health information exchange. In the post, she praised the more expansive vision of exchange promoted by PCAST and noted the absence of a robust discussion on the need to include patient-generated data as part of this broad vision.

Efforts to analyze the PCAST report and determine how its vision of greater health data liquidity can be achieved have begun in earnest. The Health IT Policy Committee (HITPC) has established a PCAST Report Workgroup, which held a day-long public hearing on Feb. 15.

Stakeholder groups testifying included consumers and patients, providers, technology experts, and health information exchanges. Nearly all agreed with the goal of facilitating more widespread electronic exchange of health data for treatment and secondary data uses like public health and research. But stakeholders also raised a number of concerns about some of the recommendations in the report, including:

• fears that exchange of information at an “atomic data element” level would rob the information of the context necessary for providers and researchers to understand it;
• concerns that providing patients with very granular choices about how their data is shared could be difficult for patients and providers to manage;
• uncertainty about whether the PCAST recommendation for a “universal exchange language” would disrupt (or build on) existing data standardization efforts; and
• questions about whether the designated approach to protecting privacy – tagging data elements with meta data about privacy preferences and other applicable data sharing constraints – would be workable and effective.

The key task for the PCAST Workgroup, the federal advisory committees, and ultimately HHS will be to find a path forward to promote the PCAST vision in a way that builds on work that has been done in the past and effectively responds to implementation concerns raised by stakeholders. Here are a few possibilities:

• Ramp up the requirements for health information exchange in Stages 2 and 3 of meaningful use, including active exchange of data with patients.
• Adopt and implement standards that will allow patients and providers to exchange computable data with one another no matter which EHR, PHR or software application is being used.
• Develop the infrastructure for a query-response model of health data exchange that is based on the needs of the patient.
• Pilot privacy-enhancing technologies (including but not limited to the meta data tagging approach recommended by PCAST) and research both their efficacy and impact on care.

This first year of the meaningful use program provides us with an opportunity to test the efficacy of current strategies for effective use of health IT to improve health and health care. The PCAST Report provides yet another opportunity to consider whether these efforts are headed in the right direction and how we can accelerate progress toward the goals we share.

This week, those interested in HIT have another opportunity to influence future public policy in this arena: HITPC is soliciting public comments on proposed Meaningful Use Stage 2 objectives through Friday, Feb. 25.

Could 2011 Be a Big Year for Consumer Privacy?

Deven McGraw, Health Privacy Project Director, Center for Democracy & Technology

A number of developments at the end of 2010 suggest that 2011 could be an important year in the advancement of consumer personal information protections, which would include health information protections.

• The Department of Health and Human Services (HHS) Office of the National Coordinator (ONC) hosted a day-long roundtable, “Personal Health Records – Understanding the Evolving Landscape,” on December 3, 2010. The roundtable explored the current state and evolving nature of personal health records (PHRs), the value of PHRs to consumers, and privacy and security protections for PHRs.
  
  Three Project HealthDesign principal investigators submitted to the ONC comments demonstrating that a lack of comprehensive protections on PHR data, uncertain application of the law and failure of current law to keep up with technological innovation all hinder progress toward innovative care approaches that leverage innovations in information technology. This testimony will inform a congressionally mandated report on privacy and security protections for entities not covered by HIPAA (which includes many PHRs); this HHS PHR report is expected to be issued in 2011.

• Two days before the PHR Roundtable, the Federal Trade Commission (FTC) issued a comprehensive report on consumer privacy, “Protecting Consumer Privacy in an Era of Rapid Change.” The report was based in part on a series of public roundtables the FTC hosted in 2009 and 2010. In the report, the FTC notes the growing collection of consumer personal data (particularly on the Internet), consumers’ limited understanding of data collection practices and inability to make meaningful choices about them, the importance of privacy to consumers, the significant benefits that result from the increased flow of consumer data, and the blurring distinction online between personally identifiable information and information purported to be “anonymous” or de-identified.
  
  In response, they proposed a new framework for addressing the use of consumer data, both online and offline. This framework has three main components:
  1. Businesses should embrace a full complement of fair information practices and build consumer privacy protections into their everyday business practices (also known as “privacy by design”).
  2. Consumers should have more simplified, streamlined choices about how their data is accessed, used and disclosed.
  3. Businesses should increase the transparency of their data practices.

          The FTC is accepting comments on this report until February 18, 2011.

• Two weeks after the FTC released its consumer privacy report, the U.S. Department of Commerce (DoC) released its own report, “Commercial Data Privacy and Innovation in the Internet Economy: A Dynamic Policy Framework.” This report calls for the U.S. to improve its privacy protection framework and better align itself with global data protection initiatives. DoC also calls for a framework based on a full set of fair information practice principles. Those principles would then be used to create industry-specific codes of conduct that would be developed through negotiations with multiple stakeholders.
  
  The report recommends that any new commercial data privacy framework not conflict with existing laws that provide important protections, such as laws governing the health industry and the financial sector. The report also called for “nationally consistent” security breach notification laws.
  
  DoC is accepting comments on this report until January 28, 2011. Submit comments via e-mail.

At a minimum, these reports indicate a renewed federal focus on privacy protections for consumer data. The reports also suggest that privacy initiatives could garner congressional attention, and that the private sector could also become more engaged in developing strong, voluntary codes of conduct. All of this activity is occurring just as the HITECH meaningful use incentive program begins in earnest, ensuring that a focus on the use and protection of personal health data will remain front and center in 2011.