Medicare numbers debatable identifiers in medical database scheme

Two years into legislative development there has been no resolution to the debate on the use of Medicare numbers as an identifier in the Federal Government's HealthConnect scheme.

The Government is due to start trials in September of HealthConnect, a national electronic database where health records for 19 million Australians will be collected.

Yet the Government's plans to use Medicare numbers as the unique patient identifier (UPI) faces strong opposition from IT health specialists, the Australian Medical Association (AMA) and privacy advocates.

Each Medicare number carries a unique identifier within the Health Insurance Commission (HIC).

However, Dr Tony Sara, deputy chair of the Health Informatics Society of Australia (HISA), told Computerworld: "Using the Medicare number as a unique identifier is technically and clinically inadequate."

He said Medicare numbers are not deterministic and therefore don't uniquely identify the individual.

For instance, in many cases family members are on the same Medicare card, Sara pointed out.

"There is no certainty that the person in front of you is the person you think it is," he said.

"The issue is one of data integrity. The system is not safe or robust. If legislation were changed to make it a prime identifier, we'd still not want to use it, because it won't be robust. It means a reissue of Medicare numbers across Australia and it simply will not work.

"Even internal UPI [linking it with HIC's PIN identifier] is not that robust when people are using Medicare cards in public hospitals and in private practices. Our experience is get a better system that is safer and which has a unique identifier other than the Medicare number," he said.

The AMA fears the use of Medicare numbers will result in on-selling of information to healthcare-related companies and mishandling of the data.

AMA spokesperson Frank Quinlan said a key concern is the potential for function creep of the Medicare number beyond its primary objective; for example, data matching the number in other databases.

Quinlan said the HealthConnect scheme could potentially link information in other databases under one number.

"Large databases collect and aggregate sensitive health information. As more and more information gets fed to Medicare, the potential for matching numbers across databases is greater."

Roger Clarke, principal of e-business consultancy Xamax and privacy advocate, also voiced his concern about HIC's involvement.

Clarke said he would be "horrified" if Medicare was connected to health information systems, adding HIC has a responsibility at the back-end of health care and it would be "obnoxious" if the insurers were to intrude into patient care.

He said the issue of the impracticality of the system is inseparable from the privacy issues surrounding it.

"It is a simplistic view [of one centralised system] that politicians and bureaucracy hold. The reality is there are many islands of healthcare information. The system needs to reflect these islands of information and information is to flow in controlled situations between those islands.

"HealthConnect should be an architecture not an information system. It should be a framework for establishing the ability to interconnect under controlled situations. This is the difference IT professionals understand, but politicians don't."

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