House debates

Thursday, 16 February 2012


Personally Controlled Electronic Health Records Bill 2011, Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011; Second Reading

12:17 pm

Photo of Andrew SouthcottAndrew Southcott (Boothby, Liberal Party, Shadow Parliamentary Secretary for Primary Healthcare) Share this | | Hansard source

I rise to speak on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. The coalition has always had a strong track record on investing and delivering in the e-health sphere. Under the coalition government, computerisation of general practice increased from 17 per cent in 1997 to 94 per cent in 2007. We achieved this through a $740 million investment throughout that decade. Significantly, this was an initiative of one of the previous health ministers, Michael Wooldridge, and his successors, Kay Patterson and the current Leader of the Opposition, and it was done through incentives for general practice. When we look to similar countries for comparison, we see that Australia does have a high rate of computerisation of general practice but also that computers are used in practice management and also patient records. For this reason, the coalition is supportive of the concept of a shared electronic health record. We think that it is a good idea in principle. In fact, it was the coalition government that originally started the focus on a shared electronic health record back in 2004. It is for this reason that we will not be opposing these bills before the House.

However, we do recognise that there are a number of concerns which have been raised over the way in which the PCEHR is being implemented by those opposite. Unfortunately, despite the direction established under the previous coalition government towards e-health, the previous Minister for Health and Ageing, and Labor's implementation of the PCEHR since taking government in 2007, has received enormous criticism from industry for the poor management of the program's development and progress.

In very simple terms, the government was presented with a national e-health strategy in 2008. The recommendation there was to go for incremental steps in the area of e-health, and that is an approach that the coalition would very much endorse. Instead, as we have seen in so many areas with this government, through pink batts and the NBN, the former Prime Minister, Mr Rudd, went for the big bang approach, and I will discuss why we now see some problems with that.

Before getting into the technicalities of the bills, I want to touch a bit on the timing of this debate. This legislation was introduced to parliament in the final sitting week of 2011. The opposition referred these bills to a Senate inquiry which is due to report on 29 February. In fact, the submissions to that inquiry have just closed this week. The Senate inquiry in its public hearing last Monday heard testimony highlighting a number of stakeholders' concerns with these bills. A better approach would have been for the Minister for Health and the government to defer debate on these bills until the Senate inquiry had reported on its findings. It is disappointing that, as with so many other bills, the Minister for Health and the government are trying to force through debate without proper scrutiny of the concerns being raised. This government is becoming known for rushing legislation through the parliament without the scrutiny that it needs.

This legislation provides the legislative framework required for the management of the personally controlled electronic health records system. The PCEHR is designed to be a secure electronic record of a patient's important health information. This electronic record is designed to be available anywhere there is internet access and at any time. The concept of a PCEHR is to allow for the important health information of a patient to be easily transferred between all of the patient's healthcare providers. For example, it would allow a patient's medical information to be shared between their general practitioner and their specialist, between a hospital and a community setting. Currently, this information sharing is not easily possible, with a patient being required to repeat their medical history and often to repeat results of pathology tests or radiology and diagnostic imaging, and other important information to each clinician they visit. This repetition of information can be hampered by a patient forgetting or confusing certain information, which results in poor information flow between practitioners, unnecessary or duplicated medical tests and potentially errors as well.

The proposed electronic health records will contain patient information that will include past and current medical conditions, medication history, a patient's allergies, hospital discharge summaries, Medicare information, as well as a section for any information that the consumer would like to add themselves. Importantly, the system is designed to be purely opt in. It is a voluntary system. It means a person will need to actively apply for a personal electronic health record. If a person does not apply, no record will be created. Once an individual has registered for a PCEHR, they can deactivate or reactivate that electronic health record at any point in time.

It is important to note that this opt-in system is enshrined in the legislation before the parliament, and this is a key concession to the privacy concerns which have been raised in this area. While many of the peak health groups have called for the system to be an opt-out system, it is a fundamental basis of the PCEHR design that a user be fully in control and should have a choice whether they have their record created or not.

The PCEHR will not be a centralised data collection. For security reasons the system has been designed to link up the data sources around the country that already exist. Information will be stored in a number of secure data repositories that conform with the required specifications. The PCEHR will be viewed through a portal which links up to these data repositories. Most of the information to populate a patient's PCEHR already exists within general practice, chemists, pathology groups and hospitals. Simply put, the current proposed electronic health record system links these data sources and displays them in a single online portal.

In touching on consumer control, the system has been designed so that any consumer who registers for an electronic health record should be fully able to choose the settings that control which practitioners can access their record and how much of their electronic health record the practitioner can access. For example, a patient may wish for their GP to view all information contained within their PCEHR but may want to restrict the amount of information available to their dentist or other clinician. The design of the PCEHR system, if implemented properly, should at all times allow the patient to be in full control of who sees what information and when they see it. A patient's data will be protected under both Commonwealth and state privacy legislation. The federal Information Commissioner will also be granted the power to investigate any complaints or potential breaches of privacy. However, I am going to touch on this point in a moment.

As I said earlier, it was the coalition that originally started the focus on an electronic shared health record. We have always been in favour of the concept. We are in favour of the concept because of the numerous benefits that this measure, if implemented properly, can achieve. However, we do have enormous concerns about the capacity of this government to implement large, complex projects. A properly implemented electronic health record system and in fact a broader e-health focus can improve patient care. At the heart of all health policy should be the desire to improve patient care.

Electronic health records have the capacity to reduce duplications, reduce prescribing errors and improve efficiencies, which will have a positive impact on overall patient care. There is anecdotal evidence that medical tests are often duplicated where previous tests are not available or not known to the current medical practitioner or where new tests are requested because they do not trust the original diagnostic source.

The government's own projections show that electronic health records alone will have a net economic benefit of $1.5 billion up to 2025. More importantly, electronic health records will also mean that patients will have their medical history available to them anywhere they travel. For example, a patient who becomes ill while travelling will have their full medical history available to them, their doctor or the emergency department that they visit. In addition, forecasts by Booz and Co. have shown that a comprehensive e-health platform, of which electronic records are a significant part, could save up to 5,000 deaths annually once fully operational. That same report goes on to say that a comprehensive e-health platform could also save up to two million primary care and outpatient visits, 500,000 emergency department visits and up to 310,000 hospital admissions annually. This clearly shows that the e-health record, if implemented properly, will make significant improvements to patient care and patient treatment right across the board.

However, like so many of this government's other programs—pink batts, school halls, GP superclinics—the implementation of the PCEHR has highlighted significant concerns. While the coalition is supportive of the concept of electronic health records, a flawed implementation and a lack of forward planning could see this project becoming the government's latest big white elephant. It could be pink batts on steroids.

You only need to look at the situation in the UK to see how poor planning and implementation can be financially disastrous. The UK have spent over £12 billion and over 10 years on the summary care record, which is their electronic health record equivalent. This is the equivalent of almost A$18 billion. Late last year the UK declared the program a failure, saying it was time consuming and challenging, with as yet discernible benefits for clinicians and no clear advantages for patients. While this is an extreme example, it highlights perfectly how the long-term costs of government programs can blow out exponentially without proper forward planning. Unfortunately, it seems that those opposite are yet to learn this lesson. Those opposite have been completely silent on the future and long-term expenditure required to promote and maintain the system. Indeed, the previous minister for health has been evasive when discussing the future funding of NEHTA, the National E-Health Transition Authority. NEHTA is funded on a joint Commonwealth-state partnership through COAG but their funding agreement expires on 30 June this year. That is the day before this electronic health record is meant to go live on 1 July. It is my understanding that the Standing Council on Health, a subset of COAG, has agreed to fund NEHTA post 30 June but the government refused to publicly release the Commonwealth contribution.

What may be more concerning is that the government have never mentioned their expected costs relating to ongoing maintenance and upgrades or the provision of a help desk or support staff. Like any computer network IT system, technology dates very quickly. Responses to questioning at Senate estimates have shown that this system includes almost $100 million in physical hardware and assets. This hardware will not last forever. At some point it will need repairing, it will need maintaining and it will need replacing. Again, there is no funding set aside for that in this bill post 30 June this year. Not once has the minister for health or anyone on the government benches publicly anticipated the future cost of this to the taxpayer.

We know that this is a government who cannot manage their money. It is not a scenario that we can afford to impose on the Australian taxpayer. The minister for health needs to tell this House and come clean with the Australian public and inform the taxpayers just how much the PCEHR is going cost. There is an expectation from the government that it will be a patient's GP who will create the shared health summaries, which make a vital part of any patient's electronic health record. The government expect that a GP will spend additional time and effort creating and maintaining the shared health summaries, with no incentive to do so. This is a complete contrast to the way in which the Howard government approached this issue through incentives for GPs, and that is what saw the revolution in computerisation of general practice.

The shared health summary is a collection of the patient's medical history. A frequently raised concern with the government's plan is the lack of any encouragement or incentives for general practitioners to create and maintain these summaries. It is widely anticipated that the driving force behind the successful uptake of the PCEHR will be from general practitioners, yet the government's plan presumes that they will do more work for no benefit. The minister needs to explain her plan again to the House to ensure that GPs will support the PCEHR and be willing to invest the extra time needed to make the PCEHR successful, without receiving any benefit for doing so.

A number of stakeholders and submissions to the Senate inquiry have raised the significant privacy concerns about these bills. While the bills provide for patient's data to be protected by the 1988 Privacy Act, an investigation by the Information Commissioner over breaches and complaints has raised concerns about governance and structure. The overlapping and confusing jurisdiction in the privacy arena based on the state-federal divide makes policing privacy within the PCEHR program somewhat difficult. The very large number of healthcare providers that are subject to state privacy laws in both the public and private sectors highlight this difficulty. It remains to be seen how effective the current privacy policing provisions will be and how these concerns will be rectified.

It is interesting to note that the Office of the Australian Information Commission, which has been charged with policing this program for privacy breaches, has made its own submission to the Senate inquiry. In fact, the Information Commission itself has called upon the government to strengthen the OAIC's powers under the Privacy Act to investigate breaches. It begs the question: how much did the government really liaise with their own body before deciding to give the task of policing these privacy concerns to the OAIC? More importantly, will the health minister be considering the OAIC submission and the other submissions which seek to strengthen the privacy protections embodied within the PCEHR legislation?

Almost all of the submissions to the Senate inquiry have raised concerns about the start date. The government set a start date for the electronic health records to go live from 1 July this year. The minister for health has repeatedly stated that we will be able to register for a PCEHR from 1 July this year. Unfortunately, just repeating it will not necessarily make it come true. There is a widespread belief from the majority of industry experts, peak health bodies and medical practitioners generally that 1 July will not bring the fanfare that we are expecting.

These concerns are compounded by the announcement made by NEHTA only a few weeks ago that development of their primary care desktop software at the lead implementation sites had been halted. This development work had been halted due to the discovery of technical incompatibilities across versions, which created a potential clinical risk if work continued. It is not clear how long this will take to be rectified. We are now a little over four months from the 1 July start date, yet the government is only just debating this legislation. Like so many other government initiatives, they have set an ambitious start date and are now struggling to meet their own self-imposed deadline.

We saw reports emerge late last year that key technical standards had not been finalised and that 'tiger teams' were being created to bypass the usual standard setting processes. It has been a repetitive comment that stakeholders consider that the minister's arbitrary 1 July deadline is unrealistic at best. The coalition want to see an effective electronic health record but we want to make sure that it is done right. It is counterproductive for this government to rush to meet this deadline for no other reason than to desperately try to get runs on an otherwise bare scoreboard. The bill and the comments I have made expose the underlying program of how this government operates. Those opposite seem to be working on the big bang theory of government: they make a huge, grandstand announcement for the media and then struggle to follow through to implement it on time, on budget or even at all. You only need to look at the former Prime Minister's historic health reforms, which were whittled down to a fraction of the original announcement. Then there was the home insulation saga, which has cost some people their lives and some their homes. Another example is the BER school hall program, which has seen enormous waste and the highest per square metre cost for halls ever seen in this country. You can look back over Labor's last two terms in government and identify countless announcements that have all ended the same way—looked good, sounded good, but just another Labor lemon. That is our deep concern with electronic health records: they sound good in principle, but look at the capacity of this government to manage complex large programs. It is not good.

While we do have concerns about the way in which the Gillard government has implemented the PCEHR, we remain committed to the concept of an electronic health record. We recognise the potential benefits a properly implemented PCEHR could bring to patients and practitioners alike. It is for this reason that we will not be opposing these bills in the House.

That said, we do remain sceptical about what capabilities will exist when the switch is flicked on 1 July, or even what money will be available for it. It remains to be seen whether this is another classic case of the Labor Party over-promising and under-delivering, a story we hear so much in health and across every avenue of government. This announcement sounds great, but there are problems with the implementation. For this reason, whilst not opposing these bills, we do reserve our right to move amendments, pending the outcome of the Senate inquiry, which is due to report on 29 February.

12:39 pm

Photo of Dick AdamsDick Adams (Lyons, Australian Labor Party) Share this | | Hansard source

What a dreadful contribution we have just heard—everything was doom and gloom and everybody is opposed to it, but they support the bill. I would have thought that everybody and every professional health worker in this country would be behind this legislation helping us to get it started because it will be in the interests of patients and the general welfare of the health system of Australia to have this system up and running. This bill gives us the opportunity to do that. So, I was very disappointed in that contribution from somebody from the health sector, even though those opposite are going to support the bill.

The object of the Personally Controlled Electronic Health Records Bill 2011 is to enable the establishment and operation of a voluntary national system for the provision of access to health information relating to consumers of health care. It will, firstly, help to overcome the fragmentation of health information, and we know what that is like. In hospitals in Tasmania we still see orderlies rolling files on big carts around the aisles. It is 1950s stuff, but it is still going on. The fact that we have not been able to upgrade to an electronic system is a real issue and people ought to be looking at why that has not occurred.

Secondly, it will improve the availability and quality of health information. When something is electronic much more information is available. How much could that help health care in this country? Thirdly, it will reduce the occurrence of adverse medical events and the duplication of treatment. When someone goes to a doctor and has tests but then a few days later sees another doctor elsewhere, the tests may have to be done again because no record can be transferred from the first treating doctor. These things will make a lot of difference to duplication and cost in the healthcare system. There are many such great things in this bill and they will help us go forward.

The personally controlled electronic health record system—the PCEHR system—will enable better access to important health information currently held in dispersed records around the country. It will mean that patients will no longer need to unnecessarily repeat their medical history every time they see a doctor or other health professional.

Australia's economic growth, productivity and long-term prosperity are underpinned by the health of its population. A healthy population is influenced by strong social and physical infrastructure and an accessible, safe, high-quality health system.

Recent health reform reports recognise that the health system is facing challenges, which are driving increased healthcare service demands and costs. The need to reform the healthcare system has been recognised by all governments. The Australian government is therefore implementing a range of health reforms that are underpinned by improvements to the operation of e-health in Australia. Some of the building blocks for e-health were established following health ministers endorsing the National E-Health Strategy in 2008.

One of the key building blocks that has been established is the Healthcare Identifiers Service—HI Service—which commenced operation on 1 July 2010 and allocates unique identifiers to healthcare consumers, healthcare providers and healthcare provider organisations. The use of healthcare identifiers to more accurately identify and match healthcare information is an integral part of the proposed PCEHR system.

The then Minister for Health and Ageing, the Hon. Nicola Roxon, released a paper early last year to promote discussion in the community to see what sort of reception such a scheme might have. It covered who was likely to participate: individuals, healthcare provider organisations, information service providers, the operator of the scheme, repository providers, trusted data sources and portal providers. The paper also covered who had access. Access is particularly geared to individuals, who will be able to access their own health information and to have choices about how access by healthcare providers can be managed. It also included privacy type legislation so that any information that is provided about patients is carefully secured and that no unauthorised use of it is made. This includes security of the information. Finally, the paper covered governance options in a framework that included strategic oversight, management and operation and independent regulatory oversight.

I can remember speaking about this concept four or five years ago and saying that we as a nation should be moving in this direction. This paper and the legislation have been a long time coming. These discussions have been going on in Australia for 10 years or more. I do not think that I would be wrong in saying that, if you go to an emergency section of any hospital in Australia, you will still see people pushing trolleys full of paper files around the place. That is pretty archaic. You hear of files being lost or filed in the wrong place or information being put in one file when it is supposed to be put in another. That addresses the issue that the last speaker spoke about: looking for some perfect process to replace the present system. The present system has a lot of holes in it. There are a lot of mistakes being made in the present system in the keeping of medical records. These areas are crowded and busy places and the filing systems sometimes do not keep up. I believe that this legislation is a way of removing all those problems by bringing in a faster and more efficient system that will use the modern technologies that we as a nation have available to us.

Individuals should be able to have some knowledge about what is in their health file. It is our health, after all. I am glad that we have overcome that argument. Politicians, celebrities and others who hit the press for one reason or another do not seem to have any privacy with their health issues and yet people worry about their health details being held electronically because someone might get unauthorised access. I understand that. However, I think that this will give us more privacy rather than less. It would also allow us to control what information is made public and not have to rely on bush whispers. If we are lying unconscious, at least all our information can be readily accessible wherever we are, with our local GP not having to be woken in the middle of the night in an emergency and asked what medication we are on.

There are a lot of good reasons why electronically controlled health records can help streamline the health system. They will allow us quicker access to informed help and give us back some feeling of control over our own health. That last point is important. We are asking people to take more control of and be more responsive to their own health and their own health needs. It is not going to be compulsory to have a PCEHR. People can nominate someone like their personal doctor or carer to have access to their electronic file. There is a choice. I for one would like to have my health information at my fingertips.

I note that the discussion paper had proposals to cover minors, those who are incapacitated and others who might find it difficult to access the information easily. The legislation is geared to cover those eventualities while still keeping the confidentiality of the record. There will be an opportunity to complain to a regulatory body if you are not satisfied with the use of your medical information or its privacy.

I think it makes a lot of sense to adopt this technology as part of the e-health agenda. It is expected to transform the way in which healthcare providers practise and consumers interact with the health system, and improve the safety and quality of healthcare and patient outcomes. I believe too that it will encourage us to take more responsibility for the state of our health. I am sure that we will seek more information about how our body works and how we can stay fitter and live longer by managing our own health. A lot of people now take more control over their chronic illnesses and we have programs to help them. These are good and positive things occurring throughout our health system. A lot of good people are working hard to achieve things.

I believe that this legislation is the start of a revolution in health information and it fits in well with this government's aim of moving our health system into the 21st century and beyond. This will add to the opportunities for health delivery in our nation that will be provided by the National Broadband Network. I support the bills.

12:50 pm

Photo of Ken WyattKen Wyatt (Hasluck, Liberal Party) Share this | | Hansard source

I rise today to support the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. I believe that this legislation will improve the level of connectivity between the points of access to health services and health care that people use. The Personally Controlled Electronic Health Records Bill 2011 will establish the framework for a national personally controlled electronic health record. It will establish the regulatory framework under which the system will operate and the privacy regime that will govern it. This system will operate in tandem with federal, state and territory privacy laws.

E-health is fundamentally the use of modern information and communication technologies to meet the needs of citizens, patients, healthcare professionals, healthcare providers and policy makers. The coalition will not be opposing either of the bills because it has always supported the concept of a shared electronic health record. The coalition has a strong record on investing and delivering in e-health. For example, under the coalition government computerisation of general practice increased from 17 per cent in 1997 to 94 per cent in 2007. This was achieved through a $740 million investment over those years. I am aware that the Howard coalition government in 1999 initiated steps towards the implementation of a national e-health policy with the establishment of the National Health Information Management Advisory Council. This body, in collaboration with government and relevant health stakeholders, conceived a plan for e-health. The Australian Health Ministers Council, in a media release and communiqué issued by Dr Wooldridge's office, stated:

Electronic medical records a boon for consumer safety—Health Ministers

Australian Health Ministers today considered and agreed to lend their support to a proposal to develop a system of electronic medication records.

Speaking at the Australian Health Ministers' Conference in Wellington, New Zealand, Federal Health Minister, Dr Michael Wooldridge, said today's show of support for the proposal in-principle could lead to significant and genuine improvements in health outcomes in a relatively short time.

"The Better Medication Management System (BMMS) is a way to bring together currently fragmented medication record systems by using information technology to link patients, doctors, pharmacists and hospitals," Dr Wooldridge said.

The new system would be entirely voluntary for all parties—consumers, prescribers and dispensers. The BMMS offers consumers access to their own medication record for the first time.

"This affords consumers the opportunity to become active participants in their medication management. It also enables doctors and pharmacists—with patient consent—to make prescribing and dispensing decisions based on knowledge of what has been prescribed for a patient before and what other current medications a patient is taking."

It is important to note that there have been two bills that have been discussed in this House which address both these issues. It continues:

"An area of potentially great gains will be at the interface with public hospitals, where quick access to a patient's medication record could be life saving."

In terms of the broader health IT agenda being discussed at the conference, Health Ministers agreed that the BMMS provides a unique opportunity to apply the principles for HealthConnect in a confined and manageable area of the wider health sector.

At that time I worked in health and it was interesting to read one of the reports that was commissioned for the health ministers at the time. Some salient points were made. Our healthcare system is one of Australia's largest and most complex industry sectors, with over 21 million customers, over 750,000 employees, tens of thousands of geographically dispersed and largely autonomous care providers and hundreds of millions of service transactions each year. We face a set of challenges in delivering that, including the increasing incidence of chronic disease, significant discrepancies between health outcomes for advantaged and disadvantaged Australians, an ageing population, increasing consumer demand for more costly and complex procedures and a shortage in the health sector workforce.

The information challenges that this bill addresses—and it has to be acknowledged that the sector has invested significantly less than other comparable sectors in information technology over a sustained period of time—include that health information management still being heavily reliant on pen, paper and human memory; the Australian health system containing many thousands of discrete islands of information; consumers not being to access their own health information; significant amounts of health system errors and inefficiencies occurring; and poor support for population health surveillance, service planning and operational-clinical decision making.

So there is widespread recognition within the Australian health sector of the importance of e-health in addressing healthcare challenges and that it requires a significant investment in e-health as well as a large and growing number of e-health projects being delivered in Australia across the health sector. There is an urgency to move forward in the way in which information is gathered, managed and is available to the consumer. I acknowledge that this has been an ongoing agenda, as mentioned by a previous speaker.

The Australian Health Ministers Advisory Council on 4 October 2007, following a discussion on e-health policy and strategic planning, agreed to the development of a national e-health strategy. All Australian jurisdictions undertook to work towards the establishment of a national integrated e-health system. Since the early 1990s governments have collaborated to develop national information management and technology governance arrangements and common standards to enable interoperability. More recently, they committed significant funding towards accelerating national efforts to identify and develop better ways to electronically collect and securely exchange health information.

It is interesting that within the tri-state regions of the Northern Territory, South Australia and Western Australia Aboriginal controlled health services some three or four years ago established an e-health records system so that the movement of Aboriginal people between communities and within those jurisdictions would not prevent access to information relevant to their health needs. That was at the forefront of some of the early work done in the private sector by non-government organisations.

The AHMAC e-health strategy said that all jurisdictions were committed to the establishment of the National Electronic Health Transition Authority to undertake work to establish and operate a unique health identifier service, and to work on a business case for a shared electronic health record. The council said it had identified a range of policy and operational issues that required examination and resolution by governments to ensure further development of e-health in accordance with government requirements but, more importantly, community aspirations and the needs of health consumers.

It was interesting that on 31 January 2008 at the Melbourne meeting the Australian Health Ministers Conference in their deliberations on this very issue noted the current context and progress towards the development of national e-health infrastructure and envisaged the contribution of e-health to improving health outcomes and health system efficiency, which is important if we are going to provide the quality of health care that is needed in this country. They noted that health ministers were expected to report back to COAG in 2008 on the next steps in the development of a national e-health records system and endorsed development of a national e-health strategy by the National E-Health and Information Principal Committee for consideration by AHMC and as an input to deliberations on health reform by the National Health and Hospital Reform Commission, the COAG Working Group on Health and Ageing and the Commonwealth, state and territory health agreement, which occurred at a time when there was a series of alignments occurring. In each of those I had the privilege of contributing to much of the debate. Again, it was about the consumer and the efficiency of health systems in the provision of services and connectivity, which meant that you did not have to continually repeat the story of your treatment and enabled people to get the type of treatment they had been having. So when they connected with the system there was that flow-through effect. They also noted progress in relation to a business case for a national shared electronic health records service for consideration by COAG.

I come to the new national entity to drive e-health. In a joint communiqué, Australian health ministers committed to looking forward to what was achievable, but that would require resources and all jurisdictions transcending their borders and looking at a system that would better serve all Australians. The ministers agreed to establish a new entity as a company limited by a guarantee, governed by a board of directors made up of CEOs from health departments across Australia. So NEHTA became, in effect, a body that drove work on the concept.

The ministers noted the need for further cooperation on significant national projects over the coming years. Those included clinical data standards and terminologies, and it is interesting to note the variations in those terminologies within the various sectors; patient, provider and product/services standards and directories/indexes; consent models; secure messaging and information transfer; and user authentication processes. One of the challenges there is the confidentiality of the information. In some of the submissions that were put forward during the work of the Senate committee, people expressed the view that they had not been engaged and that stakeholder engagement had not been comprehensive. As I said earlier, I know from having worked in this area that there was substantial consultation with some key stakeholders who were at the forefront of the delivery of these services and who also reflected their position, as an organisation or a representative body, on all matters that were being progressed within the bill.

I think the other serious element that highlights the commitment of government to this whole process was the allocation made in the 2010-11 budget of $466.7 million specifically for the purpose of creating a personally controlled electronic record for Australians who choose to opt into the system. In one sense it is a pity that it is an opt-in. I think that in this day and age records and access to information by medical providers and health providers will ensure that we do not have some of those adverse events that do occur within hospitals and clinics. The history and detailed records of a patient's treatment, regimes and types of investigations that have occurred tell a story. Nothing is worse than having only pieces of the information and all of us as human beings have incredibly selective memories as to what we recall about some of the treatments that we have had. Males in particular are probably worse than anybody else—and this would certainly serve males well.

I think the consumer perspective has been gleaned through the consultation processes, and I think we will see a tremendous take-up by Australians as the program is implemented. Certainly after their discussions with medical practitioners and health service providers, we will see more and more Australians setting aside their reservations about the way in which electronic records are kept, given the way in which they will be able to easily access their records regardless of their location. Hopefully, considering the increasing areas of chronic disease and some of those debilitating illnesses that people have, this system will enable them—and also grey nomads and many of us who travel in the course of our work—to move around Australia knowing that should anything happen then there will be different points at which the person treating them will have access to their medical records. I commend the bills to the House.

1:04 pm

Photo of Graham PerrettGraham Perrett (Moreton, Australian Labor Party) Share this | | Hansard source

I rise to voice my strong support for the Personally Controlled Electronic Health Records Bill 2011 and the cognate bill before the House. I especially thank the member for Hasluck for his wide-ranging contribution given his obvious expertise and experience in this area. I will say from the outset that, like him, I find it slightly bizarre that it has taken so long for the healthcare system to migrate to computer based records, although I was interested to hear of some of the initiatives in the northern part of Australia, across the Western Australian and Northern Territory regions.

Not far from where I live there are still hospitals and medical clinics that operate paper based files. Whilst I respect the great work that admin officers and clerical staff do in bringing order to the system, obviously as it is the time of the NBN it is also time for hospitals to make use of the digital revolution. We take for granted computerised systems in finance, transport and retail, but the health system as a whole has been very slow to move, although in a few parts of the health system there has been some innovation and initiative.

Clinicians tell us that one of the keys to better health care is sharing health records between clinicians. When patients move from one doctor to another, from one health service to another or from one hospital to another, it is difficult for medical professionals to know what has gone on before. It is difficult for a doctor to know what medications have previously been prescribed. Does the doctor have to reinvent the wheel? Obviously, this can lead to unnecessary or duplicate testing, delays and, sadly, in the worst cases, medical errors. I am advised that up to 17 per cent of tests are unnecessary duplication and up to 18 per cent of medical errors arise out of inadequate patient information. So, clearly, if you apply the common-sense test: it is a waste of money, and sadly it can be injurious for patients and people can die because of the medical errors that arise out of inadequate patient information.

By having access to a patient's medical history, healthcare professionals will be better equipped to provide appropriate care. La Trobe University's School of Public Health says medical records:

... should contain sufficient data to identify the patient or client, support the diagnosis or reason for the health care encounter, justify the treatment, and accurately document the results.

The university also says:

The medical record is vital to the care of the patient as it is a communication tool between all individuals involved in the patient's care, and provides a documented account of the episode to aid clinicians' memories.

If we can give caregivers immediate access to key medical information—such as a patients diagnoses, allergies, lab test results, and medications—we can improve the clinical decisions they make.

Of course, there are many benefits, including better records management and reporting capabilities, streamlined administration and better support for patients and doctors. So, one to keep the bean counters and accountants happy, but obviously under that bigger umbrella of saving lives and money—and, of course, no more nurses not being able to decipher a doctor's handwriting, if I can succumb to a stereotype. I say that as somebody who made my students endure my horrific blackboard writing for 11 years and also as the son of a nurse!

Most significantly, e-health records will ensure better quality of care. In fact, the Leader of the Opposition, when he was health minister, said in August 2005, 'Better use of IT is no panacea, but there's scarcely a problem in the health system it can't improve'—and he was right. Unfortunately, he never got around to turning those words into action, but he did recognise the problem and was no doubt taking steps to address it in that process of removing $1 billion from our healthcare system. By contrast, the Rudd and Gillard Labor governments embraced e-health as major part of our health reform agenda, bringing health care into the 21st century.

These bills establish a personally controlled electronic health record system. They authorise the Department of Health and Ageing to manage the system and authorise the collection, use and appropriate disclosure of information. They will enable consumers to have easy access to their healthcare information online and will enable them to share it with their authorised healthcare providers. Summary health information such as conditions,

medications, allergies and medical events created by healthcare providers will be included in the summary.

The online health records system is not some Orwellian attack on individual liberties. I know people are writing emails to my office about this as I speak. But they need to calm down. This is not about a person's right to privacy, it is not some Orwellian attack; instead, it is about delivering better patient care for all Australians. Consumers and healthcare providers will be able to choose whether or not to participate in the system. If they want to still have the coloured manila folders, that is fine—that is their choice. But consumers will also be able to personally set their privacy settings. I imagine that one of the reasons it has taken so long for health records to go digital is the need for that absolute privacy. These bills contain serious measures to ensure patient confidentiality is protected and maintained. The Australian Information Commissioner is empowered under the Privacy Act to investigate breaches of privacy. The bills also introduce civil penalties for breaches of privacy and criminal penalties for hacking. They also provide robust protection to ensure consumers and healthcare providers can have confidence using the system.

Obviously, this system requires sophisticated IT infrastructure to ensure a safe, secure and functional health records system. I understand this infrastructure is being developed and will be ready to go online from 1 July this year. Consumers and healthcare providers will be able to register for online health records from then. Online health records are long overdue, so I welcome the introduction of the personally controlled electronic health record system. And I thank the Minister for Health and her immediate predecessor for having the courage to take this vital reform out of the 'too hard basket'. As we realise the benefits to patient care in the years to come, and the savings, we will all wonder why this did not happen much sooner. I commend the bills to the House.

1:12 pm

Photo of Bob BaldwinBob Baldwin (Paterson, Liberal Party, Shadow Minister for Tourism) Share this | | Hansard source

I rise today to speak in favour of the measures outlined in the Personally Controlled Electronic Health Records Bill 2012 and related bill. Although I have certain reservations regarding this government's competence to efficiently administer the $467 million project, I welcome the rationalisation of the more-than 70 estimated Commonwealth, state and territory laws on securities in personal property and the move to put patients at the centre of their own health care.

This is an issue that is very important to my electorate of Paterson and in particular to the residents of Bulahdelah, with a population of just over 1,500. The town of Bulahdelah lies along the eastern and northern banks of the Myall River, far from a major urban centre, with Taree 75 kilometres away and Newcastle more than an hour away by car. The town's medical needs were met by a local hospital and by a GP, Dr Habashi, who has private rooms there and also provided on-call medical services to the hospital's emergency department. Unfortunately, in mid-2011 Dr Habashi fell ill, leaving Bulahdelah's residents without a GP to address their ailments and other needs. Patients also no longer have 24-hour access to the emergency department at Bulahdelah hospital. Dr Habashi's unforeseen illness meant that Dr Habashi had not had the time to put in place contingency arrangements. I say on behalf of the community of Bulahdelah: we wish Dr Habashi a speedy recovery. He is a great doctor and a good friend. Despite being in a beautiful part of the world, it is proving exceedingly difficult to attract replacement doctors to Bulahdelah, something that became even more urgent when it was clear that Dr Habashi would be on extended leave and may not be able to return at all.

What has this to do with this legislation? If the lack of a GP was not bad enough whilst he was on sick leave, his patients had no access to their medical records and there is no legislation that required this. This meant that when the Hunter New England Local Health Network was finally able to find three doctors to provide some relief to the community and to come once a week to review patients at the local aged-care facility in Bulahdelah, they had no access to the medical histories of those whom they came to see. Despite most medical records now being on computer, these badly needed doctors could not see what had been previously prescribed, what their patients had previously suffered from or even what allergies they might have. Their diagnosis had to rely on not-always-reliable recollections by patients or on starting from scratch.

Doctors need to have confidence when prescribing or treating, and this requires access to all relevant medical information. Therefore, this bill does not have implications just for the residents of Bulahdelah or even just for the people of Paterson; it has implications across our nation as a whole. The government's administration of this bill will therefore need to be watched extremely closely.

I have to say that the government's performance in the administration of the pink batts program, in which contractors were paid by taxpayers to install insulation in people's homes, only to put people's lives at risk, and then paid to remove such insulation, does not inspire much confidence in the Australian people. Neither did the government's administration of the Building the Education Revolution program. According to the government's own task force, taxpayers' money was wasted, with school halls' building costs inflated by an average of 12 per cent.

Now we have the costs of the NBN. When in opposition, the ALP promised a $4.7 billion government contribution towards the cost of high-speed broadband. When in government, they bungled a tender process and embarked on an ambitious $27.5 billion National Broadband Network and program instead, a program whose costs now seem likely to surpass $50 billion, if ever it is to be completed—a cost blow-out more than 10 times what was originally envisaged.

My point in relation to this is that we have a $467 million program to roll out electronic health records. It requires competency in the delivery to ensure that individuals' records are maintained with extreme privacy. Obviously this is a government that cannot be trusted with the nation's finances and should never be left alone to implement legislation—in particular, health legislation and the privacy surrounding those records.

By contrast, the coalition has a strong track record in investing in and delivering e-health. Under the coalition government, $740 million was invested in improving IT services for GPs, leading to 17 per cent of surgeries being computerised in 1997 and up to 94 per cent in 2007. The coalition have always supported the concept of shared electronic health records, but once the legislation is passed we will be monitoring this government closely to ensure that there are strong safeguards to protect private personal medical information from falling into the hands of a third party that was never designed to see the information.

This is a bill that needs to be implemented cautiously. Confidentiality concerns must be addressed and must be paramount. We do not want patients' safety and privacy compromised. It is therefore important that personally controlled electronic health records remain an opt-in system rather than an opt-out system. Let me restate that so that there can be no confusion: it is important that personally controlled electronic health records remain an opt-in rather than an opt-out system. Patients must have confidence that their privacy is protected and is sacrosanct. The system must be implemented to ensure that transgressions do not occur and, if they do, transgressors are dealt with seriously and the penalties are rigidly enforced.

While I am talking about the national implications of this bill: my electorate has some of the most outstanding countryside and stunning beaches in Australia and is a popular holiday destination, including Port Stephens, the Great Lakes and Dungog. This means that tourism sees those areas' populations increase quite significantly over the school holiday periods, when we host people from all over Australia. Unfortunately, their holidays are not always without medical incidents, and tourists often have to visit health providers such as Tomaree Community Hospital, whose doctors have to get on the phone to doctors in other parts of Australia to get a visiting patient's medical records. This is inefficient, unnecessary and a not insignificant impost on their valuable and very limited time.

The bill will also be of benefit to those of my constituents who visit their friends and relatives or go on holidays elsewhere in Australia, when they need to get their prescriptions or see a health provider. There are also local constituents of mine who have ongoing health concerns that have to be dealt with after hours. Often the doctor they see is not their personal GP, and the doctor therefore does not have their records immediately at hand. This bill will also allow for the health information of a patient to be easily transferred between a patient's GP and a specialist.

That is why I support the establishment and implementation of a national personally controlled electronic health record system, so that those patients who choose to opt in can have control over who can see their medical records, which documents they can view and the level of electronic records that can be accessed.

However, whether patients will be able to exercise such control is not exactly clear. Although the system has been designed to ensure this, it has not always been the case in either of the wave 1 or wave 2 trials currently underway. We will wait and see whether it eventuates after 1 July this year. The government has repeatedly committed to take user registrations from this date. It is more important, however, that the project is done right rather than quickly.

Many IT specialists on large-scale projects advise that such a system always takes years to become fully operable system wide. The coalition hopes that this is not yet another project that the government announces to great fanfare and then struggles to implement on time and on budget. After all, only last week, in a Senate public hearing, a number of stakeholders were raising profound concerns about these bills. Software vendors have their concerns about NEHTA's and their own legal liabilities under the legislation proposed. Stakeholders have also complained about the lack of proper and thorough consultation.

Would it not have been more sensible for the minister to wait for the Senate inquiry to publicly report on its findings, with a reasonable period for consideration before proceeding further? The coalition has some issues concerning how overlapping federal and state privacy provisions will come to work in practice.

However, Booz and Co. have predicted that measures that reduce duplication and errors, improve productivity and lead to greater use of best practice by doctors could see e-health capabilities result in annual savings of up to $7.6 billion by 2020. The ability for doctors to see a patient's existing medical conditions, including what they have suffered from in the past, past hospital stays and allergies, will play an important role in achieving these savings and benefits, which the coalition would like to see.

These benefits will come from the avoidance of unnecessary new tests, with significant savings to the taxpayers; an improvement in the availability and quality of health information by linking up the data sources around the country that already exist; the opportunity over time for patients to contribute and add their own information to the information stored in their medical records; safer coordination and quality of health care provided when patients see different healthcare providers; and, most importantly, a reduction in the occurrence of adverse medical events. The Booz and Co. report outlined that, fully implemented, these measures could see 5,000 annual deaths being avoided, two million fewer primary care and outpatient visits, 500,000 fewer emergency department visits and 310,000 fewer hospital annual admissions. Like everyone in this House I want to see these potential benefits come to pass. But the government needs to raise its game in terms of implementation and administration if they are to be achieved. This would be a huge task for a competent government. One only needs to look at the United Kingdom, which wasted £12 billion on its e-health record equivalent which was scrapped late last year, to understand this.

These benefits will only occur with the full commitment and cooperation of health care providers. They will have to spend additional time and effort creating and maintaining these shared health summaries and at the moment it is not clear they will have the incentives to do so. I look forward to hearing the Minister for Health explain what the government is doing to ensure a successful uptake of this program. For my fellow Australians, I hope that they do what ensures that. I do not want the success of this program to become a case of hope over experience.

Debate adjourned.