Consumer Group Wants Full Access to National Practitioner Data Base

A consumer advocacy group is calling for full and unfettered public access to the National Practitioner Data Base to help patients identify problem doctors in their states.

The Consumers Union's Safe Patient Project said new restrictions imposed on the database last week by the Department of Health and Human Services would protect the identities of problem doctors at the expense of patients.

"When information held by the government is declared 'public' there should be no strings attached to the use of that data," Lisa McGiffert, director of the Safe Patient Project, said in a media release. "The elephant in the room during this whole controversy is that most of this information is public in other places and should be public at the NPDB. It's time to provide the public full access to this critical information, including the names of doctors who have been disciplined by state licensing boards or sued for failing to provide safe care."

The Safe Patient Project demand puts them at odds with the American Medical Association. In a September 23 letter to HHS, AMA CEO James L. Madara, MD, said the nation's largest physician organization has "long opposed public access to the NPDB" because it "was designed for a limited purpose and is not a reliable source of public information about the overall qualifications of physicians."

"Providing the public with unreliable or misleading information on physicians may cause patients to make ill-informed decisions about their healthcare," Madara said in the letter. "Further, we believe that the posting of the public use data file is statutorily prohibited. The NPDB statute explicitly provides that information reported to the NPDB is considered confidential and should not be disclosed except with respect to professional review activity."

Glen R. Stream, MD, president of the American Academy of Family Physicians, is ambivalent about access to the database.

"In general our academy is very patient-focused in our advocacy for how our healthcare system should be structured. Having informed patients making informed decisions about their physicians and other providers is important," Stream told HealthLeaders Media. "One of the concerns physicians have is that if you create a data repository for an original purpose and try to extend it for other purposes, then it may or may not meet that other need." Stream says the database was originally designed for the credentialing process for hospitals, health insurers, medical groups, and state licensing agencies. "To repurpose that information to be the transparent view for patients, I don't know how accessible things are."

"The same issues apply when we talk about patient access to their health information," Stream says. "We very much support that. Yet the structure and vocabulary and the meaning of some of that information is difficult for someone without a medical background."

The battle over public access to the database has see-sawed in recent weeks. In September, HHS removed the database from public view after it received complaints from a doctor whose malpractice history was detailed in a newspaper article. Then, last week, HHS restored the database to public scrutiny but included provisions that shield physicians' identities.

Stream says the lay public often doesn't have the experience or expertise to comprehend much of what is contained in the database. Taking an example from his own practice in Spokane, WA, Stream says a patient read about a physician in the Washington state database and raised concerns that the physician's medical license would soon expire. "The patient thought that was meaningful, when in fact your medical license is not unlike your driver's license. You need to renew it," Stream says. "She read into it that this person's ability to practice medicine was going to expire in the next few months."

Stream says that any physician database must include explanations for the public. "It needs to be created with a user-friendly interface and with some sort of key or dictionary or vocabulary guidance for how to interpret the data. To my knowledge, the National Practitioner Data Base does not contain that."