Wednesday, 14 October 2015
Health Legislation Amendment (eHealth) Bill 2015; Second Reading
I rise to speak on the Health Legislation Amendment (eHealth) Bill 2015. From the outset, I want to put on record Labor's strong support for eHealth and, in particular, the personally controlled electronic health record. To quote my colleague, the member the Sydney, when she was the Minister for Health, Labor:
… sees eHealth as a natural extension of our universal health system, Medicare.
Done properly, with the wholehearted support of state and federal governments, the health sector and patients, eHealth holds out the promise of great improvements in the quality of health care by reducing duplication, realising efficiencies and reducing medical errors. It has been estimated that as many as one in six of all medical errors are due to inadequate patient information, and almost one-third of unplanned hospital admissions in patients over 75 years of age are associated with medication mistakes. Electronic health records will not magically eliminate errors, but they do have the potential to dramatically reduce these often tragic mistakes and also save the health system billions of dollars.
As many as one in six pathology and diagnostic tests in hospitals are unnecessary duplicates. Even where there is no mistake or duplication, just the lack of information sharing and care management for chronic disease sufferers is estimated to costs the healthcare system up to $1.5 billion a year. A recent report published by Booz and Company on global e-health investment found that e-health programs could cut healthcare spending by three per cent annually, saving at least $7.6 billion in 2020 alone. Commitment to a full eHealth program now could help save an estimated 5,000 lives annually once the system is fully operational. The benefits that can flow from improving patients' understanding and appreciation of their own health cannot be underestimated, with the benefits from the Personally Controlled Electronic Health Records program forecast to reach $11.5 billion over the 15 years from 2010 to 2025.
The real question, therefore, about eHealth is not why we are doing this now but why it took so long—and why, once these benefits were fully appreciated, we had the coalition, when they were in opposition, remaining so openly hostile and so determined to stall its rollout. Frankly, like all of the great reforms in health, it took a Labor government to introduce electronic health in 2012, after many years of planning. I have been involved in health policy for a long time and I think we have been talking about an electronic health record in some form or another for well over 25 to 30 years in this country. Labor therefore welcomes much of what is being proposed in the legislation which, on the face of it, has the potential, after two years of neglect under this government, to finally advance the cause of electronic health records once more.
Be in no doubt that these are reforms that are very hard to implement. They are not easy. It is very easy to criticise from the sidelines. It is very easy to use something for a political headline, as those opposite did around electronic health when they were in opposition. It is very easy to do that. But these reforms are incredibly hard to implement. It took equivalent healthcare systems some 15 years to actually embed those reforms into their systems and to get it right. It is complex architecture that is made even more complicated here in this country because of the very nature of the way in which our health system has evolved and developed.
Whilst we are very pleased about the measures in this bill, I do have to say that this bill represents almost two years of wasted opportunities from a government that was, frankly, openly hostile in opposition to electronic health records. Until this point, the government had done very little in electronic health except commission a review. They cut some $215 million from the program in this year's budget. The review, led by the Executive Director of UnitingCare Health, Richard Royle, found that e-health records were a piece of critical national infrastructure and made a number of sensible recommendations that were delivered to the government in December 2013. In opposition, the coalition had been openly critical of eHealth and suggested it would scrap it. So this was clearly not the outcome the government was looking for, which might explain why it took some six months to make the findings of the electronic health record review public.
Now, more than a year after that review reported to government, I note this bill now represents, finally, the government's belated response to the review. I welcome the minister's acknowledgment in her second reading speech that the review found 'overwhelming support to continue implementing a national and consistent shared electronic health record system for all Australians'. It is critical architecture for health reform, and I am very proud that it was a Labor government that put that architecture in place. It is architecture that, as I said, is incredibly complex and it has taken some 15 years in other countries to get it right and embed it in their systems. Not having ever formally responded to this review, the bill the government has brought before the parliament is a pretty weak response, especially when one considers that the government has cut $215 million from the funds allocated for the operation of the Personally Controlled Electronic Health Record.
In terms of the specifics of the bill, it changes the name from Labor's Personally Controlled Electronic Health Record to the myHealth Record. This is a recommendation of the Royle Review that Labor is happy to support, picking up as it does our development of the MyHospitals and My School websites, which have been overwhelmingly welcomed by people across communities. According to the minister, the bill also includes a number of changes to improve the usability of the system and the clinical content available in the system for individuals and healthcare providers. On the face of it, these are sensible changes that Labor does not oppose, so long as they are made with proper rigour to ensure the protection of patients' personal information.
In addition to these changes, the bill makes a number of changes to the governance arrangements and the system's usability. The bill also increases the range of enforcement and penalty provisions available for intentional or deliberate misuse and introduces criminal penalties.
The most significant change is the move to increase the number of electronic health records by moving to an opt-out system where all Australians will be given electronic health records unless they specifically choose not to have one. Sensibly, the government has accepted the recommendation to commence this process through trials, and I welcome the minster's commitment that in areas where opt-out trials are being undertaken there will be extensive communication 'to allow individuals to make an informed decision about whether or not to opt out'. This is important not only to ensure that this move is successful; it is also an opportunity to better inform people generally about the value of eHealth records, what information they can hold and how they can best be utilised. Often our experience—and this is also the experience of other countries—is that it is consumers who drive reform. They are driving the reforms here because they are demanding that their health care be better integrated and they are demanding their healthcare providers have at their fingertips the information that they need to make sure they provide proper health care.
I note that the bill provides the ability for the government to, in consultation with the states and territories, extend opt-out arrangements nationally if the trials provide evidence that an opt-out system is a better approach for improving participation in the myHealth Record system. Beyond this consultation, the bill does not require the parliament to consider any change that would see a national opt-out system. To some extent this is academic because, from Labor's perspective, properly resourcing the myHealth Record system and providing the proper incentives for its take-up are more important than whether the system is opt in or opt out. At the end of the day, it is about embedding it within our healthcare system, embedding it within providers' practices and making it a natural extension of what they do and should be doing every single day. That is going to make the difference as to whether the myHealth Record and its very important architecture is successful or not.
I want to signal that Labor will not be making a detailed amendment to the bill to provide for a requirement that the parliament considers further extension of the opt-out system. We will take on good faith from the government that the outcomes of the trials will be properly communicated and that, if the evidence provides that a national opt-out system is a better approach, this evidence will be presented in a transparent way. It think it is in the interests of the entire health sector that that is done and shows what needs to be done and why. It would also be of value for the government, sooner rather than later, to announce the extent of these trials, what populations are being captured and which sites it has under consideration.
I understand the government has already commissioned the development of a training program. I understand that a date for the rollout of that is being pushed pretty hard. I suspect the government has some other announcements it wants to make in this space. I would warn, in that instance, there have been a couple of media releases out today—from doctors' groups and a few blogs that are going around—that, in this space, this is very difficult. I would not be rushing things just for the sake of making announcements or getting things done to be seen to be doing things. It is important you be a little careful in how you go about doing it.
In terms of Labor's record, more than a million Australians had a personally controlled electronic health record when Labor was last in government. A lot of that was being driven by really great work that Medicare Locals were doing in getting people to sign up and in promoting the electronic health record. They did undertake very substantial training for general practitioners. Unfortunately, with two years of it being in hiatus there is now the need for a new training program to be rolled out, in some way, across the country. I welcome the fact that this number continues to rise. This is principally because of Labor's work because, as we know, the government has done very little in that two-year period.
I note that since Labor introduced this important reform there are now more than 2.4 million Australians with a personally controlled electronic health record, with 3,261 specialist letters having been uploaded, 5,260 general practices having registered and more than 1.6 million prescriptions uploaded to the system. In 2010, Labor allocated $467 million over two years for the electronic health record, one of the key building blocks of Labor's National Health and Hospitals Network reforms.
The investment provided for the summaries of patients' health information, including medications and immunisations and medical test results; secure access for patients and health-care providers to their e-health records via the internet, regardless of their physical location; rigorous governance and oversight to maintain privacy; and funding to health-care providers to comply with the national standards, and for the planning and core national infrastructure required to use the national eHealth records system.
In addition to this, Labor introduced an eHealth Practice Incentive Payment to encourage the take up of the electronic health records. We knew at the time that being able to get doctors to embed this into their practices would be the critical part of it. I note that the government has released a discussion paper as part of a consultation process to revise the current practice-incentive payment e-health incentive. These changes have been criticised by the president of the Royal Australian College of General Practitioners, Professor Frank Jones, a man I have a great deal of respect for.
Labor will have a close look at the college's critique of the changes. I will say, however, that one of the challenges in getting meaningful information into electronic health records and increasing their take-up is getting GPs actively engaged in the program. It is important to look at the college's critique, but some of the proposals are ones that came to us, at the time, around larger practice-incentive payments, specialised incentive payments, MBS items.
It is simply not practical on the scale that we are talking about for that to occur, and I would be surprised if the government is able to do that. We really need doctors and others to be onboard. We are not, I suspect, as a country going to be in a position to pay for every single upload of every single piece of data required to do the work of an electronic health record. We will look at the college's critique but Labor, certainly, will not stand in the way of sensible changes the government is looking at to encourage more GPs to engage in the program.
The existing eHealth practice incentive payment was developed in consultation with the National eHealth Transition Authority and assists practices to improve administration processes and the quality of care provided to patients. Over the time Labor was in government, a number of other improvements were made to the system.
In 2013 the member for Sydney, when she was the Minister for Health, expanded what information the personally controlled electronic health record could hold. This was done to reduce duplication and improve the efficiency of Australia's health system by including a summary of the patient's important medical history; a list of medications prescribed and dispensed; allergy information; childhood immunisation records; child health and development information; hospital discharge reports; organ donor status; advanced care planning details; summaries of individual patient-health events; Medicare and PBS claims data; and private notes patients make about their own health. In 2013 Labor made an additional investment to ensure pathology and diagnostic imaging results could be included in a patient's e-health record. I know there are many allied health practitioners who are also very keen to participate, in their capacity, and to contribute to the e-health record.
In early June 2013 the member for Sydney also launched the child eHealth record mobile app or 'my child's eHealth record', which gives parents more options for keeping up-to-date information about their child's health, growth and development. This was the first app of its type and I am proud to say it was developed in Australia. In particular, it allows for parents to add all that crucial information in the blue book to the child development part of their child's eHealth record. These include height and weight, head circumference, reminders about immunisations and child-health checks as well as observations by parents about their child's personal growth and development and achievements.
I do want to put on record Labor's position that any changes in the future must ensure that patients can continue to choose to add health information to their eHealth record and retain some control over it. People must be able to add information like emergency contact details, the location of advance-care directions and other potentially life-saving information—like allergies and medication—to their personally controlled electronic health record. People must also be able to nominate a carer or family member to manage their eHealth record for them.
Being personally controlled allows people some control over what is in their record, including Medicare Benefits Schedule and Pharmaceutical Benefits Scheme data, and what a health-care provider can view or access. Again, Labor will not stand in the way of sensible changes based on independent advice and being informed by trials on how this system should best operate.
I also note that these bills make changes to the Copyright Act. Rather than continuing with provisions in existing legislation that allow existing providers to 'use, reproduce, copy, modify, adapt, publish and communicate' health records they upload for the purposes of providing health care and allow the system operator to sublicense other health-care provider organisations, the government is making changes to the Copyright Act that will specify that work will not be infringed when this is done.
Given the time, the Speaker probably wishes to interrupt the debate here. I obviously seek leave to continue my remarks at another time.