Keep data bank access limited

Rep. Thomas Bliley's ill-considered campaign to open the National Practitioner Data Bank to public access is a bad idea that would deliver little useful information to consumers.

Editorial. April 3, 2000.

Ever hear the one about the statistician who drowned in a river with an average depth of six inches? Apparently Rep. Thomas Bliley (R, Va.) hasn't.

If he had, he might realize that often a narrow piece of data is one thing and that reality is another. It's a distinction particularly relevant to Bliley's ill-considered campaign to open the National Practitioner Data Bank to access by the public.

Despite Bliley's rhetoric that such a move will "empower" patients to be better informed when choosing a physician, evidence strongly points to a conclusion that opening the data bank is a bad idea that would deliver little useful information to consumers. The AMA and others underscored that point in testimony at a hearing before a subcommittee of Bliley's House Commerce Committee.

Contents of the data bank, a listing of malpractice payments and disciplinary actions against physicians and dentists, were never intended to be open to the public. The data are meant for hospitals, state licensing boards and others, to be viewed in context with other information, when making credentialing decisions.

As the AMA's testimony noted, knowledgeable investigators -- most recently in the Institute of Medicine's landmark report on patient safety, as well the members of President Clinton's Health Care Quality Commission -- have considered and rejected public release of data bank information. The Joint Commission, the American Health Quality Assn. and other groups also oppose it. And in a letter to Bliley on a data bank-related issue, Health and Human Services also reminded the congressman about the importance of keeping data bank information confidential.

A major problem is that approximately three-quarters of the data bank information is about malpractice payments, which is an unreliable standard for separating good doctors from bad ones. It could be that a physician is in a high-risk specialty, or is willing to take on high-risk patients. A settlement might be made to get rid of a nuisance suit, or may even been entered into by an insurer against the doctor's objections. On the other side of the equation, data bank entries do not contain valuable information about education, training, board certification and accomplishments of physicians.

The AMA testimony pointed to the process that works best for the release of physician information -- programs run by state medical boards (and even by some private-sector organizations). It is on the state medical board level that licensure and most professional discipline occurs anyway. They are in the best position to collect and report that information in a balanced and useful way.

Invariably there will be controversies and dust-ups over exactly how to handle the release of information. In that regard there is good news. The Federation of State Medical Boards soon will issue a wide-ranging report on the release of physician information, including models for how states should release the information.

While medicine awaits that step forward, there is an unfortunate step backward to report. The AMA's American Medical Accreditation Program -- AMAP -- has officially folded. AMAP would have been an excellent resource for patients, a seal of approval backed by high standards. Unfortunately AMAP faced insurmountable business hurdles and other problems. It is a loss to both patients and physicians alike.

But organized medicine continues to move forward in advocating for a patient safety movement, one that focuses on examining and reducing errors across the entire medical system. The release of the data base information, however, would work against a new openness by putting even greater pressure on covering up mistakes instead of learning from them.

Fortunately, Bliley's campaign appears to be finding relatively little support. This likely will remain true as long as better, more credible and complete approaches to informing patients and keeping them safe are pursued. But legitimate patient concerns about making informed choices will not go away. If the medical and licensure communities falter in their commitment, the data bank will always be there, and there inevitably will be someone to raise the issue of opening it up for public view.