Linking data to improve health outcomes

To the Editor: Olver raises important issues concerning data linkage and the future of public health research in Australia.1 We agree, but want to highlight several other impediments to research opportunities in Australia.

First, ethics applications to link multiple health databases are complex and inefficient. Each state has a different process — some require only a letter, others require full applications to ethics committees and data custodians. Multiple applications to multiple states should be unnecessary when a centralised data source is being used. Further, some ethics committees only meet quarterly, and meetings do not align between states. The process can take up to 2 years before approval is achieved. While the introduction of the National Ethics Application Form in 2006 heralded the streamlining of applications, this has not occurred, as the uptake of the form has been uneven across states.2

As a nation, we should learn from other models. Scandinavian countries lead the way in health linkage research3,4 owing to their well thought out systems of unique health identifiers and administrative processes, which are not held up by bureaucracy. In Australia, linkage is conducted using probabilistic matching. This requires thorough understanding of the component databases and expertise in statistics and programming. This process is arduous and prone to errors and could be simplified by the use of unique health identifiers. Despite years of lobbying from researchers and some parliamentary members, we do not seem any closer to this becoming a reality.

Data linkage projects are where future public health research is headed. We need to minimise administration and long lag times between project approval and receiving data and to upskill staff in management and linkage of large datasets. This will facilitate productive research in Australia with more competitive outputs and, ultimately, better health outcomes for all Australians.