Jane Anderson

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement (pdf) between MassGen and the U.S. Health and Human Services Department over "potential violations" of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients’ rights by failing to provide them with access to their own medical records.

Photo credit: Cybrain/Fotolia.com

Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood, said the two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming.

"Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message," he said in an interview. "I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts."

To safeguard themselves, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

"The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information," he said. "The terrifying thing about computers, smartphones and electronic medical records is that [they make it] amazingly easy to store, access, and share information.

"Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing. These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance," Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement. "We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement. It is a covered entity’s responsibility to protect its patients’ health information," Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital’s Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS. The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the information on a subway while commuting to work, and it was never recovered. One of the patients involved filed a complaint with HHS, which investigated and found that MassGen had "failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General’s premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule."

MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital’s property for work purposes. The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

"After these policies and procedures are issued, we will be providing mandatory training on them," the hospital said. "All members of our workforce must participate in the training and certify that they have completed it."

It’s very unusual for an employee to intentionally violate HIPAA, but it’s the inadvertent violations that potentially can cause trouble, said Dr. Whelan. "It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access," he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said. But "with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats. With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy."

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said. "How many people have patient information stored or accessible through these omnipresent devices? Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone. Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS."

In order to better safeguard protected data, hospitals need to have enterprise-wide programs in data information management, but also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, Dr. Whelan said.

"Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation," he added.

Major Finding: A study that included 29 meta-analyses of pharmaceutical treatment trials found that only 7% reported funding sources for the trials, and none of them reported ties between trial authors and the pharmaceutical industry.

Data Source: Analysis of meta-analyses reported in 'high impact' medical journals.

Disclosures: Dr. Joel Lexchin reported being a consultant to a law firm representing Apotex in 2007, the Canadian federal government in a lawsuit challenging the Canadian ban on direct-to-consumer advertising of prescription drugs in 2007–2008, and a law firm representing a plaintiff in a case against Allergan in 2010. The other authors reported no disclosures.

Most meta-analyses of pharmaceutical treatments published in major medical journals fail to include information on conflicts of interest in the original trials, even when the trials were funded by the pharmaceutical industry or include authors employed by drug manufacturers, a study showed.

The omission of those data from meta-analyses represents “a major gap in the reporting of conflicts of interest, and suggest[s] that, without a formal reporting policy, [conflicts of interest] from [randomized, controlled trials] are unlikely to be reported when results are synthesized in meta-analyses,” reported Michelle Roseman of the department of psychiatry at McGill University, Montreal, and her colleagues.

The authors recommended that the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, which most researchers follow when reporting data for meta-analyses, be updated to require authors of meta-analyses to report funding sources of included randomized controlled trials.

Authors of meta-analyses also should include information on trials' funding sources and authors' financial ties to industry when evaluating the risk of trial bias, the study authors recommended.

The researchers investigated whether meta-analyses of pharmacological treatments published in “high-impact” biomedical journals included information on the conflicts of interest reported in the original studies. They selected 29 meta-analyses of patented pharmacological treatments, all of which were published in major medical journals in 2009. The journals included JAMA, the Lancet, Annals of Internal Medicine, and BMJ.

The 29 meta-analyses reviewed included 509 randomized clinical trials. Of those, only two meta-analyses, or 7%, reported randomized, controlled trial funding sources, and none reported author-industry ties or employment by the pharmaceutical industry, the investigators found (JAMA 2011;305:1008-17).

However, when the study authors evaluated the individual randomized controlled trials included in the meta-analyses, they found that more than 62% included information on the trial's funding source. Of those, nearly 69% were funded in part or entirely by the pharmaceutical industry, about 30% were funded by nonindustry sources, and fewer than 1% reported that the trial received no funding.

Only about 26% of the randomized, controlled trials included in the 29 meta-analyses reported author financial disclosures, according to the study. Of those, nearly 69% reported one or more authors having financial ties to the pharmaceutical industry. Almost all of the randomized, controlled trials included in the 29 meta-analyses examined in the JAMA study – 95% – reported author affiliations, and more than 26% of the trials included at least one author employed by the pharmaceutical industry.

Of the two meta-analyses that reported funding sources of the included randomized, controlled trials, one listed funding sources in a table footnote and the other in a table that followed the main document and references, according to the researchers. “Neither mentioned [randomized, controlled trial] funding sources in the column of a core table, in the text, or in an assessment of potential bias,” they noted.

None of the 29 meta-analyses analyzed reported author-industry financial ties or employment associated with the included clinical trials.

The study's authors said that “consumers of research, including patients and physicians,” want to see disclosures of researchers' financial ties to industry.

“Authors of meta-analyses are expected to transparently assess and interpret potential sources of bias from included studies that could influence outcomes,” the authors wrote. “Meta-analysis authors should document that they have evaluated all potentially relevant sources of bias.”

Major Finding: A study that included 29 meta-analyses of pharmaceutical treatment trials found that only 7% reported funding sources for the trials, and none of them reported ties between trial authors and the pharmaceutical industry.

Data Source: Analysis of meta-analyses reported in 'high impact' medical journals.

Disclosures: Dr. Joel Lexchin reported being a consultant to a law firm representing Apotex in 2007, the Canadian federal government in a lawsuit challenging the Canadian ban on direct-to-consumer advertising of prescription drugs in 2007–2008, and a law firm representing a plaintiff in a case against Allergan in 2010. The other authors reported no disclosures.

Most meta-analyses of pharmaceutical treatments published in major medical journals fail to include information on conflicts of interest in the original trials, even when the trials were funded by the pharmaceutical industry or include authors employed by drug manufacturers, a study showed.

The omission of those data from meta-analyses represents “a major gap in the reporting of conflicts of interest, and suggest[s] that, without a formal reporting policy, [conflicts of interest] from [randomized, controlled trials] are unlikely to be reported when results are synthesized in meta-analyses,” reported Michelle Roseman of the department of psychiatry at McGill University, Montreal, and her colleagues.

The authors recommended that the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, which most researchers follow when reporting data for meta-analyses, be updated to require authors of meta-analyses to report funding sources of included randomized controlled trials.

Authors of meta-analyses also should include information on trials' funding sources and authors' financial ties to industry when evaluating the risk of trial bias, the study authors recommended.

The researchers investigated whether meta-analyses of pharmacological treatments published in “high-impact” biomedical journals included information on the conflicts of interest reported in the original studies. They selected 29 meta-analyses of patented pharmacological treatments, all of which were published in major medical journals in 2009. The journals included JAMA, the Lancet, Annals of Internal Medicine, and BMJ.

The 29 meta-analyses reviewed included 509 randomized clinical trials. Of those, only two meta-analyses, or 7%, reported randomized, controlled trial funding sources, and none reported author-industry ties or employment by the pharmaceutical industry, the investigators found (JAMA 2011;305:1008-17).

However, when the study authors evaluated the individual randomized controlled trials included in the meta-analyses, they found that more than 62% included information on the trial's funding source. Of those, nearly 69% were funded in part or entirely by the pharmaceutical industry, about 30% were funded by nonindustry sources, and fewer than 1% reported that the trial received no funding.

Only about 26% of the randomized, controlled trials included in the 29 meta-analyses reported author financial disclosures, according to the study. Of those, nearly 69% reported one or more authors having financial ties to the pharmaceutical industry. Almost all of the randomized, controlled trials included in the 29 meta-analyses examined in the JAMA study – 95% – reported author affiliations, and more than 26% of the trials included at least one author employed by the pharmaceutical industry.

Of the two meta-analyses that reported funding sources of the included randomized, controlled trials, one listed funding sources in a table footnote and the other in a table that followed the main document and references, according to the researchers. “Neither mentioned [randomized, controlled trial] funding sources in the column of a core table, in the text, or in an assessment of potential bias,” they noted.

None of the 29 meta-analyses analyzed reported author-industry financial ties or employment associated with the included clinical trials.

The study's authors said that “consumers of research, including patients and physicians,” want to see disclosures of researchers' financial ties to industry.

“Authors of meta-analyses are expected to transparently assess and interpret potential sources of bias from included studies that could influence outcomes,” the authors wrote. “Meta-analysis authors should document that they have evaluated all potentially relevant sources of bias.”

Major Finding: A study that included 29 meta-analyses of pharmaceutical treatment trials found that only 7% reported funding sources for the trials, and none of them reported ties between trial authors and the pharmaceutical industry.

Data Source: Analysis of meta-analyses reported in 'high impact' medical journals.

Disclosures: Dr. Joel Lexchin reported being a consultant to a law firm representing Apotex in 2007, the Canadian federal government in a lawsuit challenging the Canadian ban on direct-to-consumer advertising of prescription drugs in 2007–2008, and a law firm representing a plaintiff in a case against Allergan in 2010. The other authors reported no disclosures.

Most meta-analyses of pharmaceutical treatments published in major medical journals fail to include information on conflicts of interest in the original trials, even when the trials were funded by the pharmaceutical industry or include authors employed by drug manufacturers, a study showed.

The omission of those data from meta-analyses represents “a major gap in the reporting of conflicts of interest, and suggest[s] that, without a formal reporting policy, [conflicts of interest] from [randomized, controlled trials] are unlikely to be reported when results are synthesized in meta-analyses,” reported Michelle Roseman of the department of psychiatry at McGill University, Montreal, and her colleagues.

The authors recommended that the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, which most researchers follow when reporting data for meta-analyses, be updated to require authors of meta-analyses to report funding sources of included randomized controlled trials.

Authors of meta-analyses also should include information on trials' funding sources and authors' financial ties to industry when evaluating the risk of trial bias, the study authors recommended.

The researchers investigated whether meta-analyses of pharmacological treatments published in “high-impact” biomedical journals included information on the conflicts of interest reported in the original studies. They selected 29 meta-analyses of patented pharmacological treatments, all of which were published in major medical journals in 2009. The journals included JAMA, the Lancet, Annals of Internal Medicine, and BMJ.

The 29 meta-analyses reviewed included 509 randomized clinical trials. Of those, only two meta-analyses, or 7%, reported randomized, controlled trial funding sources, and none reported author-industry ties or employment by the pharmaceutical industry, the investigators found (JAMA 2011;305:1008-17).

However, when the study authors evaluated the individual randomized controlled trials included in the meta-analyses, they found that more than 62% included information on the trial's funding source. Of those, nearly 69% were funded in part or entirely by the pharmaceutical industry, about 30% were funded by nonindustry sources, and fewer than 1% reported that the trial received no funding.

Only about 26% of the randomized, controlled trials included in the 29 meta-analyses reported author financial disclosures, according to the study. Of those, nearly 69% reported one or more authors having financial ties to the pharmaceutical industry. Almost all of the randomized, controlled trials included in the 29 meta-analyses examined in the JAMA study – 95% – reported author affiliations, and more than 26% of the trials included at least one author employed by the pharmaceutical industry.

Of the two meta-analyses that reported funding sources of the included randomized, controlled trials, one listed funding sources in a table footnote and the other in a table that followed the main document and references, according to the researchers. “Neither mentioned [randomized, controlled trial] funding sources in the column of a core table, in the text, or in an assessment of potential bias,” they noted.

None of the 29 meta-analyses analyzed reported author-industry financial ties or employment associated with the included clinical trials.

The study's authors said that “consumers of research, including patients and physicians,” want to see disclosures of researchers' financial ties to industry.

“Authors of meta-analyses are expected to transparently assess and interpret potential sources of bias from included studies that could influence outcomes,” the authors wrote. “Meta-analysis authors should document that they have evaluated all potentially relevant sources of bias.”

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients' rights by failing to provide them with access to their own medical records.

The two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming, according to Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood.

“Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”

To safeguard themselves from violating HIPAA, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information,” he said.

“The terrifying thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information. Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing.

“These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement.

“We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement.

“It is a covered entity's responsibility to protect its patients' health information,” Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital's Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS.

The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the documents containing the information on a subway while commuting to work, and the documents were never recovered. One of the patients involved filed a complaint with HHS.

The agency conducted an investigation and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General's premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule.”

In response, MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital's property for work purposes.

The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

“After these policies and procedures are issued, we will be providing mandatory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It's very unusual for an employee to intentionally violate HIPAA, but it's the inadvertent violations that potentially can cause trouble, according to Dr. Whelan.

“It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said.

But “with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats.

With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said.

“How many people have patient information stored or accessible through these omnipresent devices?

Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone.

Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS.”

In order to better safeguard protected data concerning patints' medical records and other health-related matters covered by HIPAA, hospitals need to have enterprise-wide programs in data information management.

But hospitals need to take HIPAA compliance a step farther. Hospitals also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, according to Dr. Whelan.

“Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation,” he added.

The benefits of electronic data storage should not be lost while trying to reduce risk of HIPAA violation.

Source DR. WHELAN

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients' rights by failing to provide them with access to their own medical records.

The two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming, according to Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood.

“Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”

To safeguard themselves from violating HIPAA, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information,” he said.

“The terrifying thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information. Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing.

“These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement.

“We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement.

“It is a covered entity's responsibility to protect its patients' health information,” Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital's Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS.

The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the documents containing the information on a subway while commuting to work, and the documents were never recovered. One of the patients involved filed a complaint with HHS.

The agency conducted an investigation and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General's premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule.”

In response, MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital's property for work purposes.

The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

“After these policies and procedures are issued, we will be providing mandatory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It's very unusual for an employee to intentionally violate HIPAA, but it's the inadvertent violations that potentially can cause trouble, according to Dr. Whelan.

“It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said.

But “with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats.

With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said.

“How many people have patient information stored or accessible through these omnipresent devices?

Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone.

Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS.”

In order to better safeguard protected data concerning patints' medical records and other health-related matters covered by HIPAA, hospitals need to have enterprise-wide programs in data information management.

But hospitals need to take HIPAA compliance a step farther. Hospitals also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, according to Dr. Whelan.

“Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation,” he added.

The benefits of electronic data storage should not be lost while trying to reduce risk of HIPAA violation.

Source DR. WHELAN

Hospitals and hospitalists should expect more aggressive enforcement of protected health information regulations following a $1 million settlement paid by Massachusetts General Physicians Organization Inc. over documents on 192 patients left on the subway by a MassGen employee, a top hospitalist says.

The payment – part of an agreement between MassGen and the U.S. Health and Human Services Department over “potential violations” of HIPAA rules – came at the same time as HHS issued its first civil money penalty for violations of the privacy act. The $4.3 million civil money penalty involved Cignet Health Care, a Maryland-based clinic, which HHS found had violated 41 patients' rights by failing to provide them with access to their own medical records.

The two high-dollar enforcement moves by HHS indicate more aggressive enforcement of HIPAA is coming, according to Dr. Chad Whelan, director of the division of hospital medicine at Loyola University Chicago, Maywood.

“Given the large fines and the high-profile institution [MassGen] affected, it sure seems like they are sending a message,” he said in an interview. “I would fully expect more stringent enforcement in the coming years, and we will likely see more payouts.”

To safeguard themselves from violating HIPAA, physicians and hospitals need to take a hard look at their policies regarding electronic storage and transmission of protected health information across multiple electronic devices, especially smartphones and tablet-style electronic devices, Dr. Whelan said.

“The beautiful thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information,” he said.

“The terrifying thing about computers, smartphones, and electronic medical records is that [they make it] amazingly easy to store, access, and share information. Medical centers and hospitalists must be aware of this tension between improving care through information access and sharing and the risk to confidentiality through easier information access and sharing.

“These settlements are the first shot across the bow to all of us that HHS is certainly taking a long, hard look at this balance,” Dr. Whelan said.

Office of Civil Rights director Georgina Verdugo said as much in a statement involving the MassGen settlement.

“We hope the health care industry will take a close look at this agreement and recognize that the OCR is serious about HIPAA enforcement.

“It is a covered entity's responsibility to protect its patients' health information,” Ms. Verdugo said.

The MassGen incident involved hard copies of protected health information from the hospital's Infectious Disease Associates outpatient practice, and included patients with HIV and AIDS, according to HHS.

The documents involved included a patient schedule with names for all of the patients, plus billing encounter forms with identifying information such as name, date of birth, health insurer, and policy number for 66 of the same patients.

A MassGen employee left the documents containing the information on a subway while commuting to work, and the documents were never recovered. One of the patients involved filed a complaint with HHS.

The agency conducted an investigation and found that MassGen had “failed to implement reasonable, appropriate safeguards to protect the privacy of [protected health information] when removed from Mass General's premises and impermissibly disclosed PHI potentially violating provisions of the HIPAA Privacy Rule.”

In response, MassGen said in a statement that it will implement a corrective action plan over the next 3 years designed to enhance protection of protected health information when it is physically removed from the hospital's property for work purposes.

The organization also said it will issue new or revised policies and procedures dealing with laptop encryption and USB drive encryption.

“After these policies and procedures are issued, we will be providing mandatory training on them,” the hospital said. “All members of our workforce must participate in the training and certify that they have completed it.”

It's very unusual for an employee to intentionally violate HIPAA, but it's the inadvertent violations that potentially can cause trouble, according to Dr. Whelan.

“It is far more likely that a well-meaning employee simply forgets the basics of patient protection on a device and then accidentally misplaces the device, leaving it open for anyone with basic computer skills to access,” he said.

Traditional concern has been focused on data stored on portable computer hardware, such as hard drives, CDs, and laptops, he said.

But “with the increased availability of electronic medical records, it will only become easier to have information about patients in portable formats.

With paper, it was difficult to carry records of hundreds of patients around. Now, it is remarkably easy.”

The explosion of extremely portable devices such as smart phones and iPads poses new risks, Dr. Whelan said.

“How many people have patient information stored or accessible through these omnipresent devices?

Certainly, patient information that has been sent through e-mail is easily accessed through a smartphone.

Hospitals need to develop policies around encryption and support end users in encrypting the multiple devices they may use to levels that are acceptable to HHS.”

In order to better safeguard protected data concerning patints' medical records and other health-related matters covered by HIPAA, hospitals need to have enterprise-wide programs in data information management.

But hospitals need to take HIPAA compliance a step farther. Hospitals also need to help employees make certain any data-storage or transmission devices they use are HIPAA-compliant, according to Dr. Whelan.

“Hospitalists should be involved in both policy development and process implementation to assure that the benefits of electronic data storage are not lost in order to reduce the risk of HIPAA violation,” he added.

The benefits of electronic data storage should not be lost while trying to reduce risk of HIPAA violation.

Source DR. WHELAN

Major Finding: Only about 26% of the randomized controlled trials reported author financial disclosures.

Data Source: Analysis of 29 meta-analyses of pharmaceutical treatment trials reported in 'high-impact' medical journals in 2009.

Disclosures: Dr. Joel Lexchin reported being a consultant to a law firm representing Apotex in 2007, the Canadian federal government in a lawsuit challenging the Canadian ban on direct-to-consumer advertising of prescription drugs in 2007-2008, and a law firm representing a plaintiff in a case against Allergan in 2010. The other authors reported no disclosures.

Most meta-analyses of pharmaceutical treatments published in major medical journals fail to include information on financial conflicts of interest in the original trials, even when the trials were funded by the pharmaceutical industry or include authors employed by drug manufacturers, a study showed.

The omission of those data from meta-analyses represents “a major gap in the reporting of conflicts of interest, and suggest[s] that, without a formal reporting policy, [conflicts of interest] from [randomized, controlled trials] are unlikely to be reported when results are synthesized in meta-analyses,” wrote Michelle Roseman of the psychiatry department at McGill University, Montreal, and her colleagues.

The authors recommended that the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, which most researchers follow when reporting data for meta-analyses, be updated to require authors of meta-analyses to report funding sources of included randomized controlled trials.

Authors of meta-analyses also should include information on trials' funding sources and authors' financial ties to industry when evaluating the risk of trial bias, the study authors wrote.

The researchers investigated whether meta-analyses of pharmacological treatments published in “high-impact” biomedical journals included information on the conflicts of interest reported in the original studies. They selected 29 meta-analyses of patented pharmacological treatments, all of which were published in 2009 in major medical journals, including JAMA, the Lancet, Annals of Internal Medicine, and BMJ.

The 29 meta-analyses included 509 randomized clinical trials. Only two meta-analyses reported randomized controlled trial funding sources, and none reported author-industry ties or employment by the pharmaceutical industry (JAMA 2011;305:1008-17).

However, when the study authors evaluated the individual randomized controlled trials included in the meta-analyses, they found that more than 62% included information on the trial's funding source.

Of those, nearly 69% were funded in part or entirely by the pharmaceutical industry, about 30% were funded by nonindustry sources, and fewer than 1% received no funding.

Only about 26% of the randomized controlled trials included in the 29 meta-analyses reported author financial disclosures. Of those, nearly 69% reported one or more authors having financial ties to the pharmaceutical industry.

Almost all of the randomized controlled trials included in the 29 meta-analyses – 95% – reported author affiliations, and more than 26% of the trials included at least one author employed by the pharmaceutical industry.

None of the 29 meta-analyses analyzed reported author-industry financial ties or employment associated with the included clinical trials.

Major Finding: Only about 26% of the randomized controlled trials reported author financial disclosures.

Data Source: Analysis of 29 meta-analyses of pharmaceutical treatment trials reported in 'high-impact' medical journals in 2009.

Disclosures: Dr. Joel Lexchin reported being a consultant to a law firm representing Apotex in 2007, the Canadian federal government in a lawsuit challenging the Canadian ban on direct-to-consumer advertising of prescription drugs in 2007-2008, and a law firm representing a plaintiff in a case against Allergan in 2010. The other authors reported no disclosures.

Most meta-analyses of pharmaceutical treatments published in major medical journals fail to include information on financial conflicts of interest in the original trials, even when the trials were funded by the pharmaceutical industry or include authors employed by drug manufacturers, a study showed.

The omission of those data from meta-analyses represents “a major gap in the reporting of conflicts of interest, and suggest[s] that, without a formal reporting policy, [conflicts of interest] from [randomized, controlled trials] are unlikely to be reported when results are synthesized in meta-analyses,” wrote Michelle Roseman of the psychiatry department at McGill University, Montreal, and her colleagues.

The authors recommended that the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, which most researchers follow when reporting data for meta-analyses, be updated to require authors of meta-analyses to report funding sources of included randomized controlled trials.

Authors of meta-analyses also should include information on trials' funding sources and authors' financial ties to industry when evaluating the risk of trial bias, the study authors wrote.

The researchers investigated whether meta-analyses of pharmacological treatments published in “high-impact” biomedical journals included information on the conflicts of interest reported in the original studies. They selected 29 meta-analyses of patented pharmacological treatments, all of which were published in 2009 in major medical journals, including JAMA, the Lancet, Annals of Internal Medicine, and BMJ.

The 29 meta-analyses included 509 randomized clinical trials. Only two meta-analyses reported randomized controlled trial funding sources, and none reported author-industry ties or employment by the pharmaceutical industry (JAMA 2011;305:1008-17).

However, when the study authors evaluated the individual randomized controlled trials included in the meta-analyses, they found that more than 62% included information on the trial's funding source.

Of those, nearly 69% were funded in part or entirely by the pharmaceutical industry, about 30% were funded by nonindustry sources, and fewer than 1% received no funding.

Only about 26% of the randomized controlled trials included in the 29 meta-analyses reported author financial disclosures. Of those, nearly 69% reported one or more authors having financial ties to the pharmaceutical industry.

Almost all of the randomized controlled trials included in the 29 meta-analyses – 95% – reported author affiliations, and more than 26% of the trials included at least one author employed by the pharmaceutical industry.

None of the 29 meta-analyses analyzed reported author-industry financial ties or employment associated with the included clinical trials.

Major Finding: Only about 26% of the randomized controlled trials reported author financial disclosures.

Data Source: Analysis of 29 meta-analyses of pharmaceutical treatment trials reported in 'high-impact' medical journals in 2009.

Disclosures: Dr. Joel Lexchin reported being a consultant to a law firm representing Apotex in 2007, the Canadian federal government in a lawsuit challenging the Canadian ban on direct-to-consumer advertising of prescription drugs in 2007-2008, and a law firm representing a plaintiff in a case against Allergan in 2010. The other authors reported no disclosures.

Most meta-analyses of pharmaceutical treatments published in major medical journals fail to include information on financial conflicts of interest in the original trials, even when the trials were funded by the pharmaceutical industry or include authors employed by drug manufacturers, a study showed.

The omission of those data from meta-analyses represents “a major gap in the reporting of conflicts of interest, and suggest[s] that, without a formal reporting policy, [conflicts of interest] from [randomized, controlled trials] are unlikely to be reported when results are synthesized in meta-analyses,” wrote Michelle Roseman of the psychiatry department at McGill University, Montreal, and her colleagues.

The authors recommended that the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, which most researchers follow when reporting data for meta-analyses, be updated to require authors of meta-analyses to report funding sources of included randomized controlled trials.

Authors of meta-analyses also should include information on trials' funding sources and authors' financial ties to industry when evaluating the risk of trial bias, the study authors wrote.

The researchers investigated whether meta-analyses of pharmacological treatments published in “high-impact” biomedical journals included information on the conflicts of interest reported in the original studies. They selected 29 meta-analyses of patented pharmacological treatments, all of which were published in 2009 in major medical journals, including JAMA, the Lancet, Annals of Internal Medicine, and BMJ.

The 29 meta-analyses included 509 randomized clinical trials. Only two meta-analyses reported randomized controlled trial funding sources, and none reported author-industry ties or employment by the pharmaceutical industry (JAMA 2011;305:1008-17).

However, when the study authors evaluated the individual randomized controlled trials included in the meta-analyses, they found that more than 62% included information on the trial's funding source.

Of those, nearly 69% were funded in part or entirely by the pharmaceutical industry, about 30% were funded by nonindustry sources, and fewer than 1% received no funding.

Only about 26% of the randomized controlled trials included in the 29 meta-analyses reported author financial disclosures. Of those, nearly 69% reported one or more authors having financial ties to the pharmaceutical industry.

Almost all of the randomized controlled trials included in the 29 meta-analyses – 95% – reported author affiliations, and more than 26% of the trials included at least one author employed by the pharmaceutical industry.

None of the 29 meta-analyses analyzed reported author-industry financial ties or employment associated with the included clinical trials.

Social Media Warrant Watching

Pediatricians should add social media to their list of topics on which to counsel parents and children during visits, the American Academy of Pediatrics said in a new statement. Social media sites such as Facebook and Twitter can enhance communication and help teens develop socially and technically, according to the statement.

However, tweens and teens also can find themselves in situations online that aren't age appropriate and that may lead to “cyberbullying,” depression from feelings that their lives aren't as good as those of their friends, sexting, and exposure to inappropriate content, the AAP said.

Pediatricians should help families understand the risks and benefits involved and should guide patients and parents to healthy uses of social media, the AAP said in its statement.

Kids Characterize Good Taste

The presence of a popular-media character on a cereal box can directly affect a child's taste preference, according to a report in the March issue of Archives of Pediatrics & Adolescent Medicine. In the study, 80 children aged 4–6 years rated the flavor of a cereal going by the name “Healthy Bits” or “Sugar Bits” in the experiment. On average, children preferred cereal from a box showing baby penguins from the movie “Happy Feet” versus the same cereal from a character-free box. Children also preferred cereal labeled Healthy Bits versus Sugar Bits, but the characters were a more powerful influence on the children.

The researchers concluded that messages of healthy eating may be resonating with children, but media characters override that influence.

Fresh-Produce Program Grows

The Department of Agriculture will expand a program that provides fresh fruits and vegetables to low-income children at their schools. In 2011, the effort will provide $158 million to state agencies, up from $101 million in 2010, according to the department. The states select schools to participate, and there each student receives $50-$75 worth of fresh produce during the school year. The agency said the expanded assistance could serve an additional 600,000 to 950,000 students this year.

Group Warns on Gun Bills

Legislation under consideration in Florida would hinder the efforts of pediatricians to protect children from gun-related injuries, the AAP warned. As of mid-April, both houses of the Florida legislature were considering bills that would prohibit physicians from asking patients and families about gun ownership and from adding information on household guns to a patient's medical records. Physicians who inquired about guns anyway could be subject to fines and state medical board sanctions. The AAP noted in a statement that pediatricians often are first to spot children, teens, and young adults at risk for suicide and that firearms in the home increase suicide risk.

“If the government begins to restrict the trust and confidentiality between a physician, a patient, and – for children – a patient's parents, then the health and well-being of patients is placed in jeopardy,” said AAP president O. Marion Burton in the statement. “Tragedies that could have been prevented by a simple conversation will, instead, occur.”

Insurer Pays for Terminations

BlueCross BlueShield of Illinois has agreed to pay the federal government $9.5 million and the state of Illinois $14.25 million to settle charges that the insurer wrongfully terminated coverage of private duty skilled nursing care for medically fragile, technologically dependent children in order to shift costs to the state's Medicaid program. According to the settlement, the Illinois Blues denied patient claims based on secret internal guidelines.

In addition, the insurer improperly told policyholders that children were not covered for private duty nursing during reviews of denied claims, the U.S. Department of Justice had charged. Under the agreement, the insurer will pay an additional $1.25 million to Illinois to settle allegations under the state consumer fraud statute.

Social Media Warrant Watching

Pediatricians should add social media to their list of topics on which to counsel parents and children during visits, the American Academy of Pediatrics said in a new statement. Social media sites such as Facebook and Twitter can enhance communication and help teens develop socially and technically, according to the statement.

However, tweens and teens also can find themselves in situations online that aren't age appropriate and that may lead to “cyberbullying,” depression from feelings that their lives aren't as good as those of their friends, sexting, and exposure to inappropriate content, the AAP said.

Pediatricians should help families understand the risks and benefits involved and should guide patients and parents to healthy uses of social media, the AAP said in its statement.

Kids Characterize Good Taste

The presence of a popular-media character on a cereal box can directly affect a child's taste preference, according to a report in the March issue of Archives of Pediatrics & Adolescent Medicine. In the study, 80 children aged 4–6 years rated the flavor of a cereal going by the name “Healthy Bits” or “Sugar Bits” in the experiment. On average, children preferred cereal from a box showing baby penguins from the movie “Happy Feet” versus the same cereal from a character-free box. Children also preferred cereal labeled Healthy Bits versus Sugar Bits, but the characters were a more powerful influence on the children.

The researchers concluded that messages of healthy eating may be resonating with children, but media characters override that influence.

Fresh-Produce Program Grows

The Department of Agriculture will expand a program that provides fresh fruits and vegetables to low-income children at their schools. In 2011, the effort will provide $158 million to state agencies, up from $101 million in 2010, according to the department. The states select schools to participate, and there each student receives $50-$75 worth of fresh produce during the school year. The agency said the expanded assistance could serve an additional 600,000 to 950,000 students this year.

Group Warns on Gun Bills

Legislation under consideration in Florida would hinder the efforts of pediatricians to protect children from gun-related injuries, the AAP warned. As of mid-April, both houses of the Florida legislature were considering bills that would prohibit physicians from asking patients and families about gun ownership and from adding information on household guns to a patient's medical records. Physicians who inquired about guns anyway could be subject to fines and state medical board sanctions. The AAP noted in a statement that pediatricians often are first to spot children, teens, and young adults at risk for suicide and that firearms in the home increase suicide risk.

“If the government begins to restrict the trust and confidentiality between a physician, a patient, and – for children – a patient's parents, then the health and well-being of patients is placed in jeopardy,” said AAP president O. Marion Burton in the statement. “Tragedies that could have been prevented by a simple conversation will, instead, occur.”

Insurer Pays for Terminations

BlueCross BlueShield of Illinois has agreed to pay the federal government $9.5 million and the state of Illinois $14.25 million to settle charges that the insurer wrongfully terminated coverage of private duty skilled nursing care for medically fragile, technologically dependent children in order to shift costs to the state's Medicaid program. According to the settlement, the Illinois Blues denied patient claims based on secret internal guidelines.

In addition, the insurer improperly told policyholders that children were not covered for private duty nursing during reviews of denied claims, the U.S. Department of Justice had charged. Under the agreement, the insurer will pay an additional $1.25 million to Illinois to settle allegations under the state consumer fraud statute.

Social Media Warrant Watching

Pediatricians should add social media to their list of topics on which to counsel parents and children during visits, the American Academy of Pediatrics said in a new statement. Social media sites such as Facebook and Twitter can enhance communication and help teens develop socially and technically, according to the statement.

However, tweens and teens also can find themselves in situations online that aren't age appropriate and that may lead to “cyberbullying,” depression from feelings that their lives aren't as good as those of their friends, sexting, and exposure to inappropriate content, the AAP said.

Pediatricians should help families understand the risks and benefits involved and should guide patients and parents to healthy uses of social media, the AAP said in its statement.

Kids Characterize Good Taste

The presence of a popular-media character on a cereal box can directly affect a child's taste preference, according to a report in the March issue of Archives of Pediatrics & Adolescent Medicine. In the study, 80 children aged 4–6 years rated the flavor of a cereal going by the name “Healthy Bits” or “Sugar Bits” in the experiment. On average, children preferred cereal from a box showing baby penguins from the movie “Happy Feet” versus the same cereal from a character-free box. Children also preferred cereal labeled Healthy Bits versus Sugar Bits, but the characters were a more powerful influence on the children.

The researchers concluded that messages of healthy eating may be resonating with children, but media characters override that influence.

Fresh-Produce Program Grows

The Department of Agriculture will expand a program that provides fresh fruits and vegetables to low-income children at their schools. In 2011, the effort will provide $158 million to state agencies, up from $101 million in 2010, according to the department. The states select schools to participate, and there each student receives $50-$75 worth of fresh produce during the school year. The agency said the expanded assistance could serve an additional 600,000 to 950,000 students this year.

Group Warns on Gun Bills

Legislation under consideration in Florida would hinder the efforts of pediatricians to protect children from gun-related injuries, the AAP warned. As of mid-April, both houses of the Florida legislature were considering bills that would prohibit physicians from asking patients and families about gun ownership and from adding information on household guns to a patient's medical records. Physicians who inquired about guns anyway could be subject to fines and state medical board sanctions. The AAP noted in a statement that pediatricians often are first to spot children, teens, and young adults at risk for suicide and that firearms in the home increase suicide risk.

“If the government begins to restrict the trust and confidentiality between a physician, a patient, and – for children – a patient's parents, then the health and well-being of patients is placed in jeopardy,” said AAP president O. Marion Burton in the statement. “Tragedies that could have been prevented by a simple conversation will, instead, occur.”

Insurer Pays for Terminations

BlueCross BlueShield of Illinois has agreed to pay the federal government $9.5 million and the state of Illinois $14.25 million to settle charges that the insurer wrongfully terminated coverage of private duty skilled nursing care for medically fragile, technologically dependent children in order to shift costs to the state's Medicaid program. According to the settlement, the Illinois Blues denied patient claims based on secret internal guidelines.

In addition, the insurer improperly told policyholders that children were not covered for private duty nursing during reviews of denied claims, the U.S. Department of Justice had charged. Under the agreement, the insurer will pay an additional $1.25 million to Illinois to settle allegations under the state consumer fraud statute.

The American Academy of Pediatrics, citing a substantial increase in scientific evidence backing best practices for child passenger safety, is recommending changes in child car seat use that include keeping most infants and toddlers in rear-facing safety seats until they reach age 2 years, according to a new policy statement released March 21.

The new guidelines also recommend forward-facing car safety seats for most children until they outgrow the weight or height limits on those seats; belt-positioning booster seats for most children through age 8 years or well beyond; and lap-and-shoulder belts for all those children who have outgrown booster seats. In addition, the policy statement recommends that all children ride in the back seat of vehicles through age 12 years (Pediatrics 2011;127:788-93).

Although the AAP policy recommendations are not binding, states use them in crafting and revising child safety seat laws, said Dr. Benjamin Hoffman, an expert in child passenger safety and associate professor of pediatrics at the University of New Mexico, Albuquerque. Previous academy recommendations regarding the use of booster seats prompted many states to enact laws requiring booster seats for older children, which has improved safety dramatically, he said.

"The best way to get people to use child safety seats appropriately is to have state laws requiring their use," Dr. Hoffman said in an interview. "Our job is to help consumer organizations and states understand what the best practice is."

The new AAP guidelines represent big changes in the way car safety seat use has been viewed, said Dr. Hoffman, a new member of the AAP’s committee on injury, violence, and poison prevention, which crafted the recommendations. Now, there’s much more emphasis on the transitions between different types of seats – rear-facing seats to forward-facing seats, forward-facing seats to booster seats, and booster seats to seat belts.

"In these transitions, you lose protection every step of the way," he noted. "Therefore, you need to delay these transitions for as long as possible."

However, many parents and even older children themselves view the transitions as milestones, which encourages them to make the transition as quickly as they legally can, he said. "Parents are really viewing these transitions as graduations. There’s a perception that this graduation is a positive thing. It’s not."

Instead of making the switch to a lower level of protection as soon as they’re legally able, parents should keep their children in safety seats until they outgrow the weight and height limits, Dr. Hoffman said. For example, many rear-facing seats can handle children up to 35 pounds, and parents should use these seats in their rear-facing configuration until their children no longer can fit in them.

Likewise, parents should keep their children in forward-facing car seats until they have outgrown the weight or height limits on those seats, and should use a belt-positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when children have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.

According to the technical report by committee member Dr. Dennis R. Durbin, professor of pediatrics and epidemiology at The Children’s Hospital of Philadelphia, research in Sweden shows that rear-facing child safety seats reduce the risk of significant injuries by 90% relative to unrestrained children. Many infants and children in Sweden remain in rear-facing seats until age 4 years, when they transition directly to booster seats, according to the report (Pediatrics 2011;127:e1050-66).

"There’s a 500% increased risk of injury" for toddlers between the ages of 1 and 2 years when seated in a forward-facing seat, compared with a rear-facing seat, Dr. Hoffman said.

Analysis of the data also indicates substantial benefits for children aged 2 years and older seated in forward-facing car seats, compared with just booster seats or seat belts, and for children seated in booster seats who have outgrown car seats but who have not yet reached 4 feet, 9 inches, according to the report.

Some forward-facing seats can accommodate children up to 65 or 80 pounds, and should be used until that weight limit, according to the report.

Pediatricians should counsel their patients on these new recommendations at every well-child visit, the guidelines say.

"Pediatricians don’t have to know how to install car seats, but they have to know what the best recommendations are," said Dr. Hoffman. "They should know what the resources are in their communities [for car seat installation help], and it would be even better for them to make contact with those resources" in order to facilitate assistance for patients who might need it.

In addition, pediatricians should counsel parents to follow the AAP recommendations for the utmost car seat safety rather than simply follow state laws, which may allow "graduation" to the next level before the child is large enough, Dr. Hoffman said.

"The laws of physics will always trump the laws of the state," he concluded.

All authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the AAP Board of Directors, according to a statement in the journal.

A list of formal car seat inspection stations is available at http://www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org).

The American Academy of Pediatrics, citing a substantial increase in scientific evidence backing best practices for child passenger safety, is recommending changes in child car seat use that include keeping most infants and toddlers in rear-facing safety seats until they reach age 2 years, according to a new policy statement released March 21.

The new guidelines also recommend forward-facing car safety seats for most children until they outgrow the weight or height limits on those seats; belt-positioning booster seats for most children through age 8 years or well beyond; and lap-and-shoulder belts for all those children who have outgrown booster seats. In addition, the policy statement recommends that all children ride in the back seat of vehicles through age 12 years (Pediatrics 2011;127:788-93).

Although the AAP policy recommendations are not binding, states use them in crafting and revising child safety seat laws, said Dr. Benjamin Hoffman, an expert in child passenger safety and associate professor of pediatrics at the University of New Mexico, Albuquerque. Previous academy recommendations regarding the use of booster seats prompted many states to enact laws requiring booster seats for older children, which has improved safety dramatically, he said.

"The best way to get people to use child safety seats appropriately is to have state laws requiring their use," Dr. Hoffman said in an interview. "Our job is to help consumer organizations and states understand what the best practice is."

The new AAP guidelines represent big changes in the way car safety seat use has been viewed, said Dr. Hoffman, a new member of the AAP’s committee on injury, violence, and poison prevention, which crafted the recommendations. Now, there’s much more emphasis on the transitions between different types of seats – rear-facing seats to forward-facing seats, forward-facing seats to booster seats, and booster seats to seat belts.

"In these transitions, you lose protection every step of the way," he noted. "Therefore, you need to delay these transitions for as long as possible."

However, many parents and even older children themselves view the transitions as milestones, which encourages them to make the transition as quickly as they legally can, he said. "Parents are really viewing these transitions as graduations. There’s a perception that this graduation is a positive thing. It’s not."

Instead of making the switch to a lower level of protection as soon as they’re legally able, parents should keep their children in safety seats until they outgrow the weight and height limits, Dr. Hoffman said. For example, many rear-facing seats can handle children up to 35 pounds, and parents should use these seats in their rear-facing configuration until their children no longer can fit in them.

Likewise, parents should keep their children in forward-facing car seats until they have outgrown the weight or height limits on those seats, and should use a belt-positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when children have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.

According to the technical report by committee member Dr. Dennis R. Durbin, professor of pediatrics and epidemiology at The Children’s Hospital of Philadelphia, research in Sweden shows that rear-facing child safety seats reduce the risk of significant injuries by 90% relative to unrestrained children. Many infants and children in Sweden remain in rear-facing seats until age 4 years, when they transition directly to booster seats, according to the report (Pediatrics 2011;127:e1050-66).

"There’s a 500% increased risk of injury" for toddlers between the ages of 1 and 2 years when seated in a forward-facing seat, compared with a rear-facing seat, Dr. Hoffman said.

Analysis of the data also indicates substantial benefits for children aged 2 years and older seated in forward-facing car seats, compared with just booster seats or seat belts, and for children seated in booster seats who have outgrown car seats but who have not yet reached 4 feet, 9 inches, according to the report.

Some forward-facing seats can accommodate children up to 65 or 80 pounds, and should be used until that weight limit, according to the report.

Pediatricians should counsel their patients on these new recommendations at every well-child visit, the guidelines say.

"Pediatricians don’t have to know how to install car seats, but they have to know what the best recommendations are," said Dr. Hoffman. "They should know what the resources are in their communities [for car seat installation help], and it would be even better for them to make contact with those resources" in order to facilitate assistance for patients who might need it.

In addition, pediatricians should counsel parents to follow the AAP recommendations for the utmost car seat safety rather than simply follow state laws, which may allow "graduation" to the next level before the child is large enough, Dr. Hoffman said.

"The laws of physics will always trump the laws of the state," he concluded.

All authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the AAP Board of Directors, according to a statement in the journal.

A list of formal car seat inspection stations is available at http://www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org).

The American Academy of Pediatrics, citing a substantial increase in scientific evidence backing best practices for child passenger safety, is recommending changes in child car seat use that include keeping most infants and toddlers in rear-facing safety seats until they reach age 2 years, according to a new policy statement released March 21.

The new guidelines also recommend forward-facing car safety seats for most children until they outgrow the weight or height limits on those seats; belt-positioning booster seats for most children through age 8 years or well beyond; and lap-and-shoulder belts for all those children who have outgrown booster seats. In addition, the policy statement recommends that all children ride in the back seat of vehicles through age 12 years (Pediatrics 2011;127:788-93).

Although the AAP policy recommendations are not binding, states use them in crafting and revising child safety seat laws, said Dr. Benjamin Hoffman, an expert in child passenger safety and associate professor of pediatrics at the University of New Mexico, Albuquerque. Previous academy recommendations regarding the use of booster seats prompted many states to enact laws requiring booster seats for older children, which has improved safety dramatically, he said.

"The best way to get people to use child safety seats appropriately is to have state laws requiring their use," Dr. Hoffman said in an interview. "Our job is to help consumer organizations and states understand what the best practice is."

The new AAP guidelines represent big changes in the way car safety seat use has been viewed, said Dr. Hoffman, a new member of the AAP’s committee on injury, violence, and poison prevention, which crafted the recommendations. Now, there’s much more emphasis on the transitions between different types of seats – rear-facing seats to forward-facing seats, forward-facing seats to booster seats, and booster seats to seat belts.

"In these transitions, you lose protection every step of the way," he noted. "Therefore, you need to delay these transitions for as long as possible."

However, many parents and even older children themselves view the transitions as milestones, which encourages them to make the transition as quickly as they legally can, he said. "Parents are really viewing these transitions as graduations. There’s a perception that this graduation is a positive thing. It’s not."

Instead of making the switch to a lower level of protection as soon as they’re legally able, parents should keep their children in safety seats until they outgrow the weight and height limits, Dr. Hoffman said. For example, many rear-facing seats can handle children up to 35 pounds, and parents should use these seats in their rear-facing configuration until their children no longer can fit in them.

Likewise, parents should keep their children in forward-facing car seats until they have outgrown the weight or height limits on those seats, and should use a belt-positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when children have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.

According to the technical report by committee member Dr. Dennis R. Durbin, professor of pediatrics and epidemiology at The Children’s Hospital of Philadelphia, research in Sweden shows that rear-facing child safety seats reduce the risk of significant injuries by 90% relative to unrestrained children. Many infants and children in Sweden remain in rear-facing seats until age 4 years, when they transition directly to booster seats, according to the report (Pediatrics 2011;127:e1050-66).

"There’s a 500% increased risk of injury" for toddlers between the ages of 1 and 2 years when seated in a forward-facing seat, compared with a rear-facing seat, Dr. Hoffman said.

Analysis of the data also indicates substantial benefits for children aged 2 years and older seated in forward-facing car seats, compared with just booster seats or seat belts, and for children seated in booster seats who have outgrown car seats but who have not yet reached 4 feet, 9 inches, according to the report.

Some forward-facing seats can accommodate children up to 65 or 80 pounds, and should be used until that weight limit, according to the report.

Pediatricians should counsel their patients on these new recommendations at every well-child visit, the guidelines say.

"Pediatricians don’t have to know how to install car seats, but they have to know what the best recommendations are," said Dr. Hoffman. "They should know what the resources are in their communities [for car seat installation help], and it would be even better for them to make contact with those resources" in order to facilitate assistance for patients who might need it.

In addition, pediatricians should counsel parents to follow the AAP recommendations for the utmost car seat safety rather than simply follow state laws, which may allow "graduation" to the next level before the child is large enough, Dr. Hoffman said.

"The laws of physics will always trump the laws of the state," he concluded.

All authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the AAP Board of Directors, according to a statement in the journal.

A list of formal car seat inspection stations is available at http://www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org).

The American Academy of Pediatrics, citing a substantial increase in scientific evidence backing best practices for child passenger safety, is recommending changes in child car seat use that include keeping most infants and toddlers in rear-facing safety seats until they reach age 2 years, according to a new policy statement released March 21.

The new guidelines also recommend forward-facing car safety seats for most children until they outgrow the weight or height limits on those seats; belt-positioning booster seats for most children through age 8 years or well beyond; and lap-and-shoulder belts for all those children who have outgrown booster seats. In addition, the policy statement recommends that all children ride in the back seat of vehicles through age 12 years (Pediatrics 2011;127:788-93).

Although the AAP policy recommendations are not binding, states use them in crafting and revising child safety seat laws, said Dr. Benjamin Hoffman, an expert in child passenger safety and associate professor of pediatrics at the University of New Mexico, Albuquerque. Previous academy recommendations regarding the use of booster seats prompted many states to enact laws requiring booster seats for older children, which has improved safety dramatically, he said.

"The best way to get people to use child safety seats appropriately is to have state laws requiring their use," Dr. Hoffman said in an interview. "Our job is to help consumer organizations and states understand what the best practice is."

The new AAP guidelines represent big changes in the way car safety seat use has been viewed, said Dr. Hoffman, a new member of the AAP’s committee on injury, violence, and poison prevention, which crafted the recommendations. Now, there’s much more emphasis on the transitions between different types of seats – rear-facing seats to forward-facing seats, forward-facing seats to booster seats, and booster seats to seat belts.

"In these transitions, you lose protection every step of the way," he noted. "Therefore, you need to delay these transitions for as long as possible."

However, many parents and even older children themselves view the transitions as milestones, which encourages them to make the transition as quickly as they legally can, he said. "Parents are really viewing these transitions as graduations. There’s a perception that this graduation is a positive thing. It’s not."

Instead of making the switch to a lower level of protection as soon as they’re legally able, parents should keep their children in safety seats until they outgrow the weight and height limits, Dr. Hoffman said. For example, many rear-facing seats can handle children up to 35 pounds, and parents should use these seats in their rear-facing configuration until their children no longer can fit in them.

Likewise, parents should keep their children in forward-facing car seats until they have outgrown the weight or height limits on those seats, and should use a belt-positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when children have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.

According to the technical report by committee member Dr. Dennis R. Durbin, professor of pediatrics and epidemiology at The Children’s Hospital of Philadelphia, research in Sweden shows that rear-facing child safety seats reduce the risk of significant injuries by 90% relative to unrestrained children. Many infants and children in Sweden remain in rear-facing seats until age 4 years, when they transition directly to booster seats, according to the report (Pediatrics 2011;127:e1050-66).

"There’s a 500% increased risk of injury" for toddlers between the ages of 1 and 2 years when seated in a forward-facing seat, compared with a rear-facing seat, Dr. Hoffman said.

Analysis of the data also indicates substantial benefits for children aged 2 years and older seated in forward-facing car seats, compared with just booster seats or seat belts, and for children seated in booster seats who have outgrown car seats but who have not yet reached 4 feet, 9 inches, according to the report.

Some forward-facing seats can accommodate children up to 65 or 80 pounds, and should be used until that weight limit, according to the report.

Pediatricians should counsel their patients on these new recommendations at every well-child visit, the guidelines say.

"Pediatricians don’t have to know how to install car seats, but they have to know what the best recommendations are," said Dr. Hoffman. "They should know what the resources are in their communities [for car seat installation help], and it would be even better for them to make contact with those resources" in order to facilitate assistance for patients who might need it.

In addition, pediatricians should counsel parents to follow the AAP recommendations for the utmost car seat safety rather than simply follow state laws, which may allow "graduation" to the next level before the child is large enough, Dr. Hoffman said.

"The laws of physics will always trump the laws of the state," he concluded.

All authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the AAP Board of Directors, according to a statement in the journal.

A list of formal car seat inspection stations is available at http://www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org).

The American Academy of Pediatrics, citing a substantial increase in scientific evidence backing best practices for child passenger safety, is recommending changes in child car seat use that include keeping most infants and toddlers in rear-facing safety seats until they reach age 2 years, according to a new policy statement released March 21.

The new guidelines also recommend forward-facing car safety seats for most children until they outgrow the weight or height limits on those seats; belt-positioning booster seats for most children through age 8 years or well beyond; and lap-and-shoulder belts for all those children who have outgrown booster seats. In addition, the policy statement recommends that all children ride in the back seat of vehicles through age 12 years (Pediatrics 2011;127:788-93).

Although the AAP policy recommendations are not binding, states use them in crafting and revising child safety seat laws, said Dr. Benjamin Hoffman, an expert in child passenger safety and associate professor of pediatrics at the University of New Mexico, Albuquerque. Previous academy recommendations regarding the use of booster seats prompted many states to enact laws requiring booster seats for older children, which has improved safety dramatically, he said.

"The best way to get people to use child safety seats appropriately is to have state laws requiring their use," Dr. Hoffman said in an interview. "Our job is to help consumer organizations and states understand what the best practice is."

The new AAP guidelines represent big changes in the way car safety seat use has been viewed, said Dr. Hoffman, a new member of the AAP’s committee on injury, violence, and poison prevention, which crafted the recommendations. Now, there’s much more emphasis on the transitions between different types of seats – rear-facing seats to forward-facing seats, forward-facing seats to booster seats, and booster seats to seat belts.

"In these transitions, you lose protection every step of the way," he noted. "Therefore, you need to delay these transitions for as long as possible."

However, many parents and even older children themselves view the transitions as milestones, which encourages them to make the transition as quickly as they legally can, he said. "Parents are really viewing these transitions as graduations. There’s a perception that this graduation is a positive thing. It’s not."

Instead of making the switch to a lower level of protection as soon as they’re legally able, parents should keep their children in safety seats until they outgrow the weight and height limits, Dr. Hoffman said. For example, many rear-facing seats can handle children up to 35 pounds, and parents should use these seats in their rear-facing configuration until their children no longer can fit in them.

Likewise, parents should keep their children in forward-facing car seats until they have outgrown the weight or height limits on those seats, and should use a belt-positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when children have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.

According to the technical report by committee member Dr. Dennis R. Durbin, professor of pediatrics and epidemiology at The Children’s Hospital of Philadelphia, research in Sweden shows that rear-facing child safety seats reduce the risk of significant injuries by 90% relative to unrestrained children. Many infants and children in Sweden remain in rear-facing seats until age 4 years, when they transition directly to booster seats, according to the report (Pediatrics 2011;127:e1050-66).

"There’s a 500% increased risk of injury" for toddlers between the ages of 1 and 2 years when seated in a forward-facing seat, compared with a rear-facing seat, Dr. Hoffman said.

Analysis of the data also indicates substantial benefits for children aged 2 years and older seated in forward-facing car seats, compared with just booster seats or seat belts, and for children seated in booster seats who have outgrown car seats but who have not yet reached 4 feet, 9 inches, according to the report.

Some forward-facing seats can accommodate children up to 65 or 80 pounds, and should be used until that weight limit, according to the report.

Pediatricians should counsel their patients on these new recommendations at every well-child visit, the guidelines say.

"Pediatricians don’t have to know how to install car seats, but they have to know what the best recommendations are," said Dr. Hoffman. "They should know what the resources are in their communities [for car seat installation help], and it would be even better for them to make contact with those resources" in order to facilitate assistance for patients who might need it.

In addition, pediatricians should counsel parents to follow the AAP recommendations for the utmost car seat safety rather than simply follow state laws, which may allow "graduation" to the next level before the child is large enough, Dr. Hoffman said.

"The laws of physics will always trump the laws of the state," he concluded.

All authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the AAP Board of Directors, according to a statement in the journal.

A list of formal car seat inspection stations is available at http://www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org).

The American Academy of Pediatrics, citing a substantial increase in scientific evidence backing best practices for child passenger safety, is recommending changes in child car seat use that include keeping most infants and toddlers in rear-facing safety seats until they reach age 2 years, according to a new policy statement released March 21.

The new guidelines also recommend forward-facing car safety seats for most children until they outgrow the weight or height limits on those seats; belt-positioning booster seats for most children through age 8 years or well beyond; and lap-and-shoulder belts for all those children who have outgrown booster seats. In addition, the policy statement recommends that all children ride in the back seat of vehicles through age 12 years (Pediatrics 2011;127:788-93).

Although the AAP policy recommendations are not binding, states use them in crafting and revising child safety seat laws, said Dr. Benjamin Hoffman, an expert in child passenger safety and associate professor of pediatrics at the University of New Mexico, Albuquerque. Previous academy recommendations regarding the use of booster seats prompted many states to enact laws requiring booster seats for older children, which has improved safety dramatically, he said.

"The best way to get people to use child safety seats appropriately is to have state laws requiring their use," Dr. Hoffman said in an interview. "Our job is to help consumer organizations and states understand what the best practice is."

The new AAP guidelines represent big changes in the way car safety seat use has been viewed, said Dr. Hoffman, a new member of the AAP’s committee on injury, violence, and poison prevention, which crafted the recommendations. Now, there’s much more emphasis on the transitions between different types of seats – rear-facing seats to forward-facing seats, forward-facing seats to booster seats, and booster seats to seat belts.

"In these transitions, you lose protection every step of the way," he noted. "Therefore, you need to delay these transitions for as long as possible."

However, many parents and even older children themselves view the transitions as milestones, which encourages them to make the transition as quickly as they legally can, he said. "Parents are really viewing these transitions as graduations. There’s a perception that this graduation is a positive thing. It’s not."

Instead of making the switch to a lower level of protection as soon as they’re legally able, parents should keep their children in safety seats until they outgrow the weight and height limits, Dr. Hoffman said. For example, many rear-facing seats can handle children up to 35 pounds, and parents should use these seats in their rear-facing configuration until their children no longer can fit in them.

Likewise, parents should keep their children in forward-facing car seats until they have outgrown the weight or height limits on those seats, and should use a belt-positioning booster seat until the vehicle lap-and-shoulder belt fits properly, typically when children have reached 4 feet, 9 inches in height and are between 8 and 12 years of age.

According to the technical report by committee member Dr. Dennis R. Durbin, professor of pediatrics and epidemiology at The Children’s Hospital of Philadelphia, research in Sweden shows that rear-facing child safety seats reduce the risk of significant injuries by 90% relative to unrestrained children. Many infants and children in Sweden remain in rear-facing seats until age 4 years, when they transition directly to booster seats, according to the report (Pediatrics 2011;127:e1050-66).

"There’s a 500% increased risk of injury" for toddlers between the ages of 1 and 2 years when seated in a forward-facing seat, compared with a rear-facing seat, Dr. Hoffman said.

Analysis of the data also indicates substantial benefits for children aged 2 years and older seated in forward-facing car seats, compared with just booster seats or seat belts, and for children seated in booster seats who have outgrown car seats but who have not yet reached 4 feet, 9 inches, according to the report.

Some forward-facing seats can accommodate children up to 65 or 80 pounds, and should be used until that weight limit, according to the report.

Pediatricians should counsel their patients on these new recommendations at every well-child visit, the guidelines say.

"Pediatricians don’t have to know how to install car seats, but they have to know what the best recommendations are," said Dr. Hoffman. "They should know what the resources are in their communities [for car seat installation help], and it would be even better for them to make contact with those resources" in order to facilitate assistance for patients who might need it.

In addition, pediatricians should counsel parents to follow the AAP recommendations for the utmost car seat safety rather than simply follow state laws, which may allow "graduation" to the next level before the child is large enough, Dr. Hoffman said.

"The laws of physics will always trump the laws of the state," he concluded.

All authors filed conflict of interest statements with the AAP, and any conflicts have been resolved through a process approved by the AAP Board of Directors, according to a statement in the journal.

A list of formal car seat inspection stations is available at http://www.seatcheck.org. If your community does not have an inspection station, you can find a child passenger safety technician in your area on the National Child Passenger Safety Certification Web site (http://cert.safekids.org).