Intended for healthcare professionals


Big health data: the need to earn public trust

BMJ 2016; 354 doi: (Published 14 July 2016) Cite this as: BMJ 2016;354:i3636
  1. Tjeerd-Pieter van Staa, professor of health e-research1 2,
  2. Ben Goldacre, senior clinical research fellow3 4,
  3. Iain Buchan, professor of health informatics1,
  4. Liam Smeeth, professor of clinical epidemiology3
  1. 1Farr Institute, University of Manchester, Manchester, UK
  2. 2Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, Netherlands
  3. 3London School of Hygiene and Tropical Medicine, London, UK
  4. 4Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
  5. Correspondence to: T-P van Staa

Failures in implementation of data sharing projects have eroded public trust. In the wake of NHS England’s decision to close down its programme, Tjeerd-Pieter van Staa and colleagues examine how we can do better

Better use of large scale health data has the potential to benefit patient care, public health, and research. The handling of such data, however, raises concerns about patient privacy, even when the risks of disclosure are extremely small.

The problems are illustrated by recent English initiatives trying to aggregate and improve the accessibility of routinely collected healthcare and related records, sometimes loosely referred to as “big data.” One such initiative,, was set to link and provide access to health and social care information from different settings, including primary care, to facilitate the planning and provision of healthcare and to advance health science.1 Data were to be extracted from all primary care practices in England. A related initiative, the Clinical Practice Research Datalink (CPRD), evolved from the General Practice Research Database (GPRD). CPRD was intended to build on GPRD by linking patients’ primary care records to hospital data, around 50 disease registries and clinical audits, genetic information from UK Biobank, and even the loyalty cards of a large supermarket chain, creating an integrated data repository and linked services for all of England that could be sold to universities, drug companies, and non-healthcare industries. has now been abandoned and CPRD has stalled. The flawed implementation of plus earlier examples of data mismanagement have made privacy issues a mainstream public concern. We look at what went wrong and how future initiatives might gain public support.

Why have English big data initiatives not worked?

Key elements for success of big health data projects include public confidence that records are held securely and anonymised appropriately (information security)2; public awareness of and engagement …

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