Moderator: Some people are calling for greater integration of government databases for easy access and cross-checking by public agencies, especially for public health and law enforcement. What are the benefits and risks of doing this? What safeguards need to be applied?

Debra Cohn: We all come to this with a presumption that there is a great benefit in integrating government databases that serve similar functions, such as law enforcement databases. For example, I did some health care fraud enforcement and literally the investigators could not look electronically at whether providers were double billing in terms of Medicaid and Medicare because the systems weren't compatible. We had to do that manually and that was a terrible impediment to enforcement.

There are a lot of challenges here. Databases are usually created from the ground up and have different demands for the data entered into the system and the quality of the data. Even within law enforcement, data is obtained using different tools and those tools may only provide us with data for certain purposes. There are lots of different limitations by which government obtains data and they all affect and limit how that data can be integrated.

Another issue is privacy. I'm originally from Australia. They have fewer problems with health care fraud enforcement because they have a single-payer system. They have every single patient and every provider in one database. Well, that story usually makes people sit up -- "You mean someone could know exactly the prescription drugs I'm taking and what doctor I've seen for what purpose?" It may have certain benefits but it raises some serious challenges as to whether we want government to have all that kind of information.