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PROLOGUEPatients’ Privacy And Data SecurityKey questions in the spread of health information technology (IT) include how much public support will be needed to make it happen—and how much "buy-in" will occur if people fear that their health information won’t be adequately protected. Knowingly or not, Americans have relaxed or even given up their privacy expectations in many spheres; hence the relative ease with which you can view someone’s home on Google or steal a person’s identity by gaining ready access to a Social Security number over the Internet. But health and health care are different, and many people still want and expect their health information to remain protected and private. The papers and Perspectives in this section grapple with a range of privacy issues and suggest various ways to get out of our current health information privacy morass. As Linda Dimitropoulos and Stephanie Rizk note, the privacy protections afforded health information are currently governed by a confusing, overlapping, and often contradictory patchwork of state and federal laws and regulations. Can any coherence be brought to this area—or does the United States need a new national privacy statute as a "floor"—or, alternatively, as a "ceiling"? This question lurks behind their paper as well as the others that follow. In the meantime, various efforts are under way to establish workable health information privacy frameworks at a local, regional, or multistate level. To this end, Deven McGraw and colleagues describe a proposed framework developed under the Markle Foundation’s Connecting for Health initiative that would incorporate key privacy principles, specific network design features, and oversight mechanisms to establish greater public trust in health IT. Dimitropoulos and Rizk derive lessons for privacy and security policy from a multistate effort to identify common practices in these areas and reduce variations among states. Finally, Micky Tripathi and colleagues relate the experience of the Massachusetts eHealth Collaborative, describing how patients have been engaged in developing policies through which they consent to having their health information shared. David Kendall, Clem McDonald, and Michael Greenberg and colleagues offer Perspectives, making arguments for and against a new national privacy standard.
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