title: Secondary uses of clinical data in primary care.
abstract: This paper, presented as a panel at the American Medical Informatics Association (AMIA) Fall Symposium 2006, explores a number of secondary uses of primary care clinical data derived from point-of-care systems, and the issues arising from those uses. The authors (from the USA and the UK) describe, compare and contrast some secondary uses: pay-for-performance, public disclosure, clinical audit, health resource planning, and clinical system usage; in various environments: national health system, network of small family practice offices, and university teaching centres. In the UK, such data are now being used in pay-for-performance for GPs, and approximately 35% of their salary has been put at risk, which has resulted in close scrutiny. In the USA, pay-for-performance is at an earlier stage but is increasingly prevalent and continues to be hotly debated. Some of the issues that arise from these uses of clinical data - data quality including accuracy, comparability, perverse incentives, effect of secondary uses on care provision, and security and confidentiality among others - were discussed. Finally, options and opportunities for improving secondary uses of data in the light of the issues covered earlier were considered.
authors.affiliation: University of Nottingham, Nottingham, UK. sheila.teasdale@gmail.com
authors.forename: Sheila
authors.initials: S
authors.lastname: Teasdale
authors.forename: David
authors.initials: D
authors.lastname: Bates
authors.forename: Karen
authors.initials: K
authors.lastname: Kmetik
authors.forename: Jeff
authors.initials: J
authors.lastname: Suzewits
authors.forename: Mike
authors.initials: M
authors.lastname: Bainbridge
mesh_terms: D003133:Commission on Professional and Hospital Activities; D004470:Economics, Medical; D006304:Health Status; D006801:Humans; D020407:Internet; D008490:Medical Informatics; D011320:Primary Health Care; D014481:United States