By NextBestFitNational health record and patient ID
One national record that follows every patient.
Records follow patients.
To review: Privacy and security risks; paired with privacy law and redundancy.
Review ledgerHow this path connects
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Create a national health record and patient ID
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
- Records don't follow patients
A national record follows patients everywhere and reduces duplicate tests and medication errors.
- Low-value care and overtreatment
A national record that follows patients reduces duplicate tests.
- Medical errors and poor care coordination
A national record that follows patients reduces medication errors.
- Health privacy
A national patient record concentrates health information in a large database, creating privacy risks.
- Cyberattacks can halt payments and care
A national patient record places information in a large database with security risks.
- Requires new or changing information systems
Creating a national patient record is a large information technology project.
Who's affected
- People with ongoing or specialist care needs
- Records don't follow patients: Incompatible records lose information across providers and cause repeated tests.
- Low-value care and overtreatment: Low-benefit tests and treatments expose them to harm.
- Medical errors and poor care coordination: Delivery and coordination failures cause preventable harm.
- Health insurers, brokers, and their shareholders
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Taxpayers and public budgets
- Low-value care and overtreatment: They pay for tests and treatments with little benefit.
- Health data brokers
- Health privacy: They benefit from health information shared for marketing.
- Fraudulent operators and cybercriminals
- Cyberattacks can halt payments and care: Attackers profit from ransomware attacks on health systems.
- Health administration and software vendors
- Records don't follow patients: Record-system lock-in benefits vendors.
- Hospitals, clinics, and care organizations
- Records don't follow patients: Fragmented records help keep patients within their systems.
- Low-value care and overtreatment: Per-service payments reward additional low-value care.
- Medical errors and poor care coordination: Fee-for-service providers are paid for treating complications.
- Cyberattacks can halt payments and care: Cyberattacks disrupt claims and leave providers unpaid.
- Drug and device makers
- Low-value care and overtreatment: They sell devices and tests used in low-value care.
- People with ongoing or specialist care needs
- Health privacy: Widely shared sensitive health information can expose them to harm.
- People needing mental health care
- Health privacy: Widely shared sensitive health information can expose them to harm.
- Pregnant and postpartum people and infants
- Health privacy: Widely shared sensitive health information can expose them to harm.
- Immigrants and mixed-status families
- Health privacy: Widely shared sensitive health information can expose them to harm.
- People with employer coverage
- Cyberattacks can halt payments and care: Cyberattacks expose personal health data.
- Uninsured people
- Cyberattacks can halt payments and care: Cyberattacks expose personal health data.
- People with unaffordable deductibles or coinsurance
- Cyberattacks can halt payments and care: Cyberattacks expose personal health data.
- Retrain staff; keep vendors as contractors
Where it has been tried
- Taiwan, Estonia, Denmark: Every resident of Estonia has a nationwide digital health record; the system handles about 2.7 million patient queries a month, and 100% of prescriptions are digital.Sources: e-Estonia (2024)