International Journal of Healthcare Delivery Reform Initiatives, 2(3), 29-47, July-September 2010 29 Copyright © 2010, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited. Keywords: Electronic Health Records, Healthcare Information Systems, Patient Confdentiality, Probabilistic Record Linkage, Public Health Data, Record Linkage, Unique Patient Identifer InTroDucTIon As computerized databases have now become ubiquitous in many business and public sectors, the amount of data collected by these organiza- tions have multiplied exponentially during the past decade. However, these data collection efforts are often implemented by various and uncoordinated constituents. As a result, the information derived from these heterogeneous record Linkage in Healthcare: applications, opportunities, and challenges for Public Health Gulzar H. Shah, National Association of County and City Health Offcials, USA Kaveepan Lertwachara, California Polytechnic State University, USA Anteneh Ayanso, Brock University, Canada absTracT Recent years have witnessed the development of new record linkage technologies that are increasingly being used for data integration in various application settings. The authors’ objective in this article is to provide a review of recent developments in medical record linkage and their implications in healthcare research and public health policies. In particular, the authors assess the key advantages and possible limitations of record linkage techniques and technologies in various health care scenarios where different pieces of patient records are collected and managed by different agencies. First, the authors provide a brief overview of deterministic, probabilistic, and unsupervised record linkage techniques and their advantages and limitations. Then, the authors describe current probablistic record linkage software and their functionalities, and present specifc cases where probabilistic linkage has been successfully used to enhance decision-making in healthcare delivery as well as in healthcare-related public policy making. Finally, the authors outline some of the critical issues and challenges of integrating medical records across distributed databases, including technical considerations as well as concerns about patient privacy and confdentiality. databases tend to be fragmented and incom- plete. Thus, the ability to compare and match data records from multiple sources in order to determine which sets of records belong to the same person, object, or event has become a critical task for many organizations. However. the possibility of extensive analysis using these databases relies on the ability to integrate het- erogeneous databases across organizations and functional units. Such data integration requires the presence of an error-free unique identifier or key attribute common among the data sets be- DOI: 10.4018/jhdri.2010070104