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Current conversations about health information policy often tend to be based on three broad assumptions. First, many perceive a tension between regulation and innovation. We often hear that privacy regulations are keeping researchers, companies, and providers from aggregating the data they need to promote innovation. Second, aggregation of fragmented data is seen as a threat to its proper regulation, creating the risk of breaches and other misuse. Third, a prime directive for technicians and policymakers is to give patients ever more granular methods of control over data. This article questions and complicates those assumptions, which I deem (respectively) the Privacy Threat to Research, the Aggregation Threat to Privacy, and the Control Solution.

This article is also intended to enrich our concepts of “fragmentation” and “integration” in health care. There is a good deal of sloganeering around “firewalls” and “vertical integration” as idealized implementations of “fragmentation” and “integration” (respective). The problem, though, is that terms like these (as well as “disruption”) are insufficiently normative to guide large-scale health system change. They describe, but they do not adequately prescribe.

By examining those instances where: a) regulation promotes innovation, and b) increasing (some kinds of) availability of data actually enhances security, confidentiality, and privacy protections, this article attempts to give a richer account of the ethics of fragmentation and integration in the U.S. health care system. But, it also has a darker side, highlighting the inevitable conflicts of values created in a “reputation society” driven by stigmatizing social sorting systems. Personal data control may exacerbate social inequalities. Data aggregation may increase both our powers of research and our vulnerability to breach. The health data policymaking landscape of the next decade will feature a series of intractable conflicts between these important social values.

Publication Citation

14 Houston Journal of Health Law & Policy 95 (2014).


Health Law and Policy