The ethical imperative of child health population-based data a top-down/under-up analysis from the United Kingdom and Australia.
The policy move in both the United Kingdom and Australia to competitive primary care child health services (including preventive services and surveillance) has many advantages, but without secure and epidemiological information systems has the potential to put children at risk. More fundamentally, it produces the perverse effect of operating directly in opposition to the desirable policies of audit, outcomes studies, and evidence-based health care. Moreover, generations of children stand to be disadvantaged if environmental and ecological risk factors, as well as adverse clinical outcomes, cannot be identified quickly. Health informatics, linked to professional duties of clinical and fiduciary accountability, provide a way out of this conundrum. Standard clinical data sets, linked to invoicing procedures, would enable the development of summary records which could underpin integrated surveillance whilst also fuelling the new public health. Appropriate professional supervision, confidentiality and security measures, and agreement of data sets, would be necessary but not difficult in informatics terms. As health policy and delivery move forward, it is important not to lose the best aspects of previous systems and opportunities of future technologies.
Waters
E
E
Centre for Community Child Health & Ambulatory Paediatrics, University of Melbourne, Australia. waterse@cryptic.unimelb.edu.au
Rigby
M
M
D001315:Australia; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D002669:Child Welfare / Q000706:statistics & numerical data*; D016208:Databases, Factual; D004992:Ethics, Medical; D006801:Humans; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized; D011320:Primary Health Care / Q000458:organization & administration; D011785:Quality Assurance, Health Care; D006113:United Kingdom