A new study on uses of healthcare information is recommending that data bases regularly publish provider-specific evaluations of cost and effectiveness.
The Institute of Medicine study also recommends a "fairness doctrine" that should be followed to minimize the potential for harm to providers because of data inaccuracy or flawed methods.
The institute began the study two years ago to advise federal policymakers how to foster the cost-control and quality-improvement potential of emerging data bases while preventing the misuse of sensitive data that computerization makes more accessible.
The report, issued last week, reinforces concerns about privacy and confidentiality raised by the recent releases of a congressional Office of Technology Assessment study and a Louis Harris and Associates poll (Nov. 22, 1993, p. 24).
But the new study provides more specific advice on regulating release of data, identifying patients in a data base and authorizing permission to use patient-identifiable data in reports.
The institute, part of the not-for-profit National Academy of Sciences, is chartered by Congress, and its studies often become the starting point for legislation and regulatory decisions.
The institute focused on "secondary" data bases generated subsequent to the primary records of patient encounters. These secondary sites aren't intended to be the major source of specific information about individuals for the treating physician. Examples would include insurers or business coalitions that accumulate information to rate providers on cost or quality.
The report strongly favored taking advantage of these comprehensive data bases to develop comparative studies on costs and performance of specific providers in a region.
To minimize the risk of "unintended" harm to identified providers, the institute recommended that data bases make available to the providers all data required to do an independent analysis before public release of results. Also, reports using such data bases should be accompanied by notice of challenges or alternative analyses.
The institute said the advance "fairness" procedure could turn up problems with data quality and study methods.
The report also:
|Called on Congress to enact a uniform federal law assuring confidentiality of patient-identifiable health data, with civil penalties for violations.
|Recommended that employers not be allowed to require reports on individuals from a healthcare data base as a condition of employment or benefits.
|Found serious problems with the use of a Social Security number as a uniform patient identifier, noting that "it is not characterized by law as confidential," and organizations "are under no legal requirement to protect it|.|.|.|"-John Morrissey