Unique health record stuck in government


24 Jun 2003

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The holy grail of a new health service – the single patient identifier (SPI) – is tied up in government bureaucracy, according to health service insiders, and badly needs someone in the Department of Health to make it a priority.

The promise of an SPI is that an individual’s unique health records would be instantly accessible anywhere at any time, regardless of whether it’s a hospital, agency or primary healthcare facility. Someone involved in a car accident in a different part of the country to where they live, for example, would be admitted to a hospital that could instantly access information that might save their life.

“We regard it as essential and strongly advocate its adoption and not just as a health service identifier,” says Dennis Doherty of the Health Board Executive. “We see advantages in having one identifier for all public services. The Personal Public Service Number [PPSN] seems the obvious way to go.”

The problem with the PPSN is that it was introduced in the 1998 Social Welfare Act and is uniquely deigned to be an identifier between state and citizen. This is acknowledged in the National Health Information Strategy document, which is still waiting for government approval before publication. The document outlines the need for a SPI but says there is a legal question mark over the use of the PPSN. Private practitioners would need access to it when engaged in work with a patient and this contravenes its terms of use as outlined in the Social Welfare Act. The Data Commissioner’s office has already expressed its concerns and a spokesman confirmed that it would require a change in legislation to make the PPSN workable.

“It’s one of those areas where a decision is required,” says Dennis Doherty. “It’s about achieving the balance between data protection and the freedom of information, but it’s also about being committed to the advantage of it and dealing with the fallout and satisfying data protection. It’s not about someone making the decision, it’s about it being prioritised.”

The SPI is a first step in creating an electronic health record that offers a single and comprehensive view of a patient that can be accessed from multiple locations.

“The reality is that health services are extraordinarily information intensive,” explains Seamus Mulconry of Accenture. “You go to a doctor and then a consultant and they ask precisely the same questions. It would save everybody a lot of time and money if the questions were asked once and the information was shared.”

Taking this a stage further, it would be possible for the health service to aggregate all of the electronic records to take a unique reading of the nation’s health. It would enable real-time access to patient ailments and the medication; it would make it possible to identify anomalies and clusters of a particular disease in that might otherwise take years to identify.

“The benefits are serious,” says Seamus Mulconry, who shares Doherty’s concern that something needs to be done. “There is a legislative issue that needs to be tackled and it’s well worth tackling. Undoubtedly it would save money.”

By Ian Campbell