The bill provides for the database to be made available to the Ministry of Health for administrative purposes. These will presumably include cost control, clinical audit and other tasks related to the performance analysis of health providers and perhaps individual health service staff. There may also be public health missions. While many of these tasks are unobjectionable, and may be performed using a mechanism along the New Zealand lines, there appears to have been no public discussion of the issues (e.g., what sort of institutional arrangements will be necessary to prevent `function creep').
I understand that this will be the first time that medical records on Icelanders have been available centrally to administrators rather than being kept locally in health centres and clinics. It is prudent to see to it that there is an open and informed public debate on the issues; if Icelanders simply wake up one morning and realise that the Ministry of Health has a copy of the medical record which they believed to be kept safely in the local health centre, then the reaction could be disruptive and harmful.
In the UK, some health information systems were developed without consultation and then apparently adapted to unethical ends. For example, in 1996 the BMA became concerned that police access to prescription records, which had been granted in order to trace doctors and nurses who were stealing heroin, was being used to search for illegal immigrants. There were other problem systems too. The resulting public row led to the establishment of a commission to look into secondary uses of health records, and the development of health networking was held up for over a year as this commission deliberated.
I can assure all parties in Iceland that such an experience is to be avoided if at all possible. In order to maintain trust between doctors and patients, between administrators and public health professionals, and between politicians and the healthcare sector generally, it is much better to have the necessary debate before such systems are built rather than afterwards.