----- Part 2 Follows.
Thursday, March 01, 2012
Hansard Of Debate On PCEHR Bills. Only Some Seem To Get The Complexity or the Details. Part 1.
Here is the debate that happened yesterday and the day before from Hansard.
I have divided it into two parts for posting as I think it is important we know what pollies are saying. It is clear some have put some time in that not all the concerns are fully addressed. Anyway the legislation now goes to the Senate where we will see a good deal more discussion I suspect.
Tuesday, 28 February 2012
Second Reading Speeches
Ms MARINO (Forrest—Opposition Whip) (20:03): As I have said previously, I have concerns about security of patients' information, firstly, through unauthorised access, secondly, through the broader cybersecurity risk and, thirdly, because of the critical importance in this environment of patients' medical records and the issue of trust between the doctor and patient.
In Australia health is a multibillion dollar industry with multibillion dollar rewards for companies and individuals who are best prepared for health trends. I am aware that e-health is a voluntary sign-up, but there is no doubt that the information contained in people's health files is and will be of considerable value, especially if it can be collated to identify either local, regional or national health trends. For practical purposes there will be a central electronic government repository full of people's private details and information.
I also believe that the government is ignoring the broader cyber risk. Cyberattacks cause direct financial losses to consumers and businesses from the theft of information or through extortion. The information in electronic health records has to be protected. It has to protect the rights and privacy of the patient. We know that hackers have been able to breach some of the world's most secure internet sites. I was a member of the House of Representatives Standing Committee on Communications when it reported on cybercrime. The evidence we took was a very graphic but very chilling reality check. As we said in our report, cybercrime is now a sophisticated transnational threat that operates on an industrial scale. The cybercriminal is no longer the nuisance hacker and is more likely to be part of a network of hackers, middlemen and organised criminals who combine to commit large-scale online crimes for significant profit.
Cybercrime is highly prevalent and directly affects a significant number of Australians. In fact, the manager of the Australian Computer Emergency Response Team, AusCERT, said:
Cybercrime in Australia is getting out of control and we are losing. And I think that, with the pressures coming on us over that next few years, if nothing is done to change the current direction we will lose faster.
Given the collective and individual value of health records, how will the government ensure that the private health records of Australian citizens remain totally secure. What responsibility will the government accept when an inevitable breach occurs? This bill appears to impose all of this responsibility on health organisations and none of it on the government itself.
Breaches will be possible at all stages, both directly through unauthorised access and through sophisticated hacking. The government's NBN will facilitate internet access and internet crime at speeds we have never before experienced in this country. A report by the Kokoda Foundation, entitled Optimising Australia's response to thecyberchallenge, released on 4 February last year at the National Press Club, said that 'cybersecurity has become the fundamental weakness in Australia's national security' and that 'the threat is poorly understood by politicians, business people and the general public'. The report was co-authored by former Deputy Chief of Air Force John Blackburn and identified that Australia has reached the point where our ability to respond to internet attack is being rapidly outpaced by advances in cyberattack and cyberterrorism. The foundation also stated:
A case in point is the mooted National Broadband Network (NBN). The report notes that once the network is built, taking high-speed broadband services through fibre-optic cable to an estimated 93 per cent of households, responsibility for maintaining cyber-security will rest with retail service providers rather than NBN Co.
I believe that this unprecedented growth in cyberthreat should be considered very seriously as a risk and as something that needs to be managed with the e-health system. The generation of these electronic records will require the goodwill of medical practitioners inputting the data into the system.
Given the size of the medical workforce across Australia and the workload they have, it will require an enormous effort and cost to transfer medical records to a new database. Most medical practices today have electronic databases and so have copies of records in digital form. Indeed, the computerisation of general practice increased from 17 per cent in 1997 to 94 per cent in 2007, achieved through a $740 million investment under the coalition government. But will medical practices be able to transfer the desired information directly to the government's e-health records database with the push of a button? I presume not, especially given that a wide range of medical software is in use in practices across Australia. Many may well not be compatible, not only with each other but with the new system.
I am aware that in my electorate alone there are so many different forms of software currently in use. Thus considerable time will have to be committed to transferring information to the new database. There will be issues with costs, training, support and assistance. But at this point there does not appear to be any government acknowledgment or support for that function, so we are left to assume that the individual medical practice will have to absorb the cost and the work. Without some streamlining and rationalisation of electronic medical record keeping, this problem of double data entry will not go away and could continue into the future. There will always be someone putting the data in to the practice's database and then repeating the process, perhaps for the government database. Having single-entry data storage is obviously the ideal outcome for efficiency, but will the government acknowledge the needs related to software in non-compatible medical computer systems? Or will the government assume that doctors or their staff will enter the information twice into different databases?
I want those who use digital technology in the medical field to be able to do so with absolute confidence. As I said previously, the relationship between doctor and patient in this nation underpins our whole medical system and is, in my view, sacred. A number of reports indicate that using digital medical records and instructions can save lives. As a member from a rural and regional electorate I well understand, as I said earlier, the benefits this can bring to electorates like my own.
The Howard government initiated steps in 1999 toward the implementation of a national e-health policy through a national health information advisory council. As I said, I do want the public to have absolute faith in their electronic health records, but the government and this legislation need to be able to deliver a secure, accountable, reliable and transparent system.
I saw something in the newspapers today that concerned me. I am concerned about the government's incapacity to deliver projects and programs on time and on budget. A report today shows that spending on Labor's personally controlled health records system has already blown out by $300 million.
Ms Plibersek: Mr Deputy Speaker, I rise on a point of order. I was wondering whether I can take a point of order about misrepresentation when a newspaper article is wrong and includes double-counted figures. The newspaper article the member is referring to has some glaring inaccuracies in it. I am seeking your guidance about whether it would be possible to make a personal explanation with regard to that.
The DEPUTY SPEAKER ( Hon. DGH Adams ): The minister is quite entitled to take the matter up in another way. It is not a point of order.
Ms MARINO: I see that the figure used there was a blow-out of $300 million. Given the previous efforts of this government in so many of its programs and project delivery in which we have seen continual waste and spending of taxpayers' funds, I and a number of my colleagues would not have confidence that that will not be the case with these electronic records. I place on record my very serious concerns about the cybersafety matters I have raised, the issue of the integrity of the information that is contained in patients' records and my very genuine concerns, which have been demonstrated historically by this government's inability to deliver projects on time and on budget.
Mrs ELLIOT (Richmond—Parliamentary Secretary for Trade) (20:13): I am very pleased to be speaking on the Personally Controlled Electronic Health Records Bill 2011, because I know what a very positive impact it will have for people within my electorate and indeed all Australians. Having e-health records is such a vital part of improving access to health services for all Australians. It will improve the way health information is shared. In fact, many people are often surprised to learn that their medical records are not at the moment easily transferrable between health practitioners and associated health entities, particularly as we live in such an electronic age. When I talk to people in the community about the benefits of e-health they are often quite surprised—and very enthusiastic—about what this government is doing to improve access to health, particularly through these wonderful e-health initiatives. Electronic health records really are a central part and a very important element of this government's very vital health reforms, some of which I will run through later on. It has been the health reforms of this government that have made such a major improvement to the lives of so many Australians. Let us look at the issue of electronic health records. There is very widespread community support for this. This has been called for by many people within the health sector for many years, with much support from clinicians and the health technology industry. Indeed, many patients and health consumers right across the community are providing a lot of support. They are very united in the call for electronic health records. In fact, I find bizarre any opposition to it because it really is such a great initiative by this government.
Let us have a look at the healthcare system at the moment when it comes to the reason why we need to have e-health records. When we look at our current system, what we see is a fragmentation of the healthcare system. That means patients often have to retell their story when they visit different health providers, so you literally have a situation where they are often carrying copies of their own health records and they are going around to see different health providers. We know that this situation causes so many problems and the result of those can often be poor communication as to symptoms and medications while remembering that it is a very stressful time for people travelling around and seeing different specialists. So it can cause a lot of problems and that can then result sometimes in unnecessary tests—tests that may have been performed previously. That can really add to the very distressing situation for those patients, particularly elderly ones.
What we also know when we look at some of the facts is that hospital statistics already dictate that at least 17 per cent of tests are necessary duplications. We know that medication errors account for 190,000 hospital admissions each year and 18 per cent of medical errors are attributed to poor patient information. So when we look at that fragmentation of our system and the current reality of it we can see the very real need to have e-health records.
E-health records will have the capacity to contain summary health information such as conditions, medications, allergies and records of medical events created by healthcare providers. The records will also be able to include discharge summaries from hospitals, information from Medicare systems and some information entered by the consumers themselves. So we are looking at a very widespread amount of information.
Looking at all of that we can really see the need to have e-health records right throughout our community. This is given the very widespread support for this initiative and it being part of the Gillard government's commitment to major health reforms. This government committed $467 million in the 2010 federal budget to a two-year program to build the infrastructure for personally controlled electronic health records. That really is a reflection of our major commitment when it comes to providing e-health, because we understand how necessary it is.
I noted before that the previous speaker raised some concerns that have been reported, so I would like to make the situation very clear as to some of the allegations that have been made in relation to the funding for e-health. Some of the suggestions that she put forward are certainly very wrong. There are two main sources of funding for the e-health agenda: (1) the personally controlled electronic health records allocation and (2) the COAG approved funding. Both the Personally Controlled Electronic Health Records Program and the COAG funded e-health program are within budget. The personally controlled electronic health records allocation is $467 million over two years. This allocation goes towards the National E-Health Transition Authority, Medicare support, the 12 e-health pilot sites and the national infrastructure partner. The National E-Health Transition Authority also receives funding from COAG of currently $218 million over three years. The Commonwealth contributes 50 per cent of this funding, which is around $109 million. The Commonwealth's portion of this funding is used for e-health related activities other than the personally controlled electronic health records system, such as healthcare identifiers, e-prescribing, standards and specifications, and the National Authentication Service for Health. That certainly clears up some of the very false allegations that have been raised by opposition members, some of which have been reported previously, when it comes to the specific funding of it.
Whilst there will be major benefits—in fact, great benefits—Australia-wide from e-health records, it is in regional areas like mine, the electorate of Richmond, that it will be particularly important in the benefits it will bring, especially when we look at the rollout of telehealth and also the National Broadband Network, all part of the major reforms of this government. In my electorate there is widespread support in the community for e-health records, particularly as Richmond has one of the highest proportions of elderly Australians. For example, an elderly person having to visit numerous specialists—often due to the very complex nature of elderly Australians' health issues—will be greatly assisted by having e-health records. Many elderly people in my electorate have noted that, because, as I have said previously, it is a very distressing time for them having to go around to see many health professionals. I have another example, a totally different one. A person comes to my electorate for a holiday and requires medical attention. They might be rushed to hospital but their detailed patient history is unavailable under the current system. This could lead to very poor patient outcomes. Under the system of e-health records they will be able to access that. So you can see the benefits at all ends of the spectrum in utilising e-health records. As I said, all this is part of this government's commitment to improving Australia's health and hospital system.
I would also like to add that in my electorate we have seen so many commitments from the government to providing better healthcare services. There is one that I would be particularly pleased to report on. Prior to the last election we made a commitment, if the Gillard government was re-elected, that there would be $7 million towards a GP superclinic at Tweed Heads. I am really happy to be able to tell the House that this is certainly underway. It is a wonderful initiative. In fact, we turned the sod for the clinic in September. The tender went to a fantastic group of local GPs. Ausjendia is the company that they run. These are GPs with about 30 or 40 years of local experience and I know they are very keen on e-health initiatives as well—and having a GP superclinic there will make such a big difference to the people of Tweed Heads and the surrounding region. So that is just part of this government's commitment when I look at my electorate and the impacts of our health reforms.
I would also like to touch on some of the concerns that have been raised in relation to privacy and e-health records. I understand that there have been a number of concerns and that these have been addressed and the safeguards have been identified. These records will be truly personally controlled records with new consent settings for sensitive information and auditing that is not currently in existence for paper based records. The central theme of our system in the bill is that any Australian can register for an e-health record and they alone will choose the security settings as to who can access the records and to what extent they can be accessed. The bill provides very clear privacy protections, prescribing the circumstances in which registered consumers and organisations can collect, use or disclose information, and it imposes civil penalties for any unauthorised collection, use or disclosure. Of course all registered consumers and organisations will be subject to the Privacy Act as well. Those privacy concerns have been addressed because that is vitally important in what is, yes, a very complex and major initiative. All these areas have been canvassed and looked at.
This government continues to deliver better health and hospital services for all communities, and e-health builds on some of those great initiatives. It is the federal Labor government that is delivering jobs, growth and fairness in health care and public hospitals. I want to run through some of our record in relation to that. Let us look at jobs. There is training for an extra 1,000 nurses every year.
Mr Fletcher: Mr Deputy Speaker, I rise on a point of order. It is not relevant to the bill, which concerns personally controlled electronic health records, to be running through the Labor government's record.
Ms Plibersek: Mr Deputy Speaker, on the point of order: the previous speaker ventured very far off track when talking about cybersafety and I did not take a point of order on that because at 8:30 at night we usually show each other a little bit of latitude on these things.
Mrs Bronwyn Bishop: Mr Deputy Speaker, clearly the question of cyberrisk that was raised was very relevant to the bill. It was quite apparent that the member for Bradfield was drawing attention to the fact that the Parliamentary Secretary for Trade had run out of material and was just going back to an old litany of things that the government chant out when there is nothing to say.
The DEPUTY SPEAKER ( Hon. DGH Adams ): I will listen to the Parliamentary Secretary for Trade. If she goes off the bill I will bring her back to the bill.
Mrs ELLIOT: Mr Deputy Speaker, I am happy to provide more detailed information as to how all facets of the health system will have greater usage of the e-health systems and to what it needs. Yes, it does relate to the bill because we are providing more services to people who will be using e-health services. Certainly the extra 1,000 nurses we have trained and the extra 5½ thousand doctors we have trained will all be able to provide better services because of the e-health records that exist right throughout our health system, and we are making sure we have more people trained to use them. Our extra 44 specialist breast cancer nurses will be accessing e-health records for their patient care, whether it be in a community health setting or in GP clinics. Those people will be using e-health services in our hospitals as well. We have increased hospital funding by 50 per cent, and it will be in those hospitals that they will be accessing e-health services. Some of the people in the extra 1,300 federally funded hospital beds will be accessing e-health services as well, and people in the extra 13,000 residential aged-care beds that the federal Labor government has provided can access e-health services as well. These e-health services relate to all the things this federal Labor government has done to improve health and hospital services.
Right across the country we have been improving services, whether they be in hospital settings or in community health settings. Of course this is all very different to what the opposition did when they were in government. What did the Leader of the Opposition do when he was health minister? He cut $1 billion from our healthcare system. That is how he views, and how much he values, health care—he cut $1 billion from it.
Mrs Bronwyn Bishop: Rubbish!
Mrs ELLIOT: It is a fact that he did. But it is this government that has committed major funding to it. The opposition has said that in government they will slash the $467 million that this government has committed to e-health. We know that is how they feel about it. They will slash it because they do not have the commitment that we do. They do not have a commitment to providing the services we have said we will provide because we know how important they are. We know how long people have been calling for e-health initiatives like this. The opposition have said they will cut them.
It is only Labor that has this commitment to providing access to world-class health care for all Australians and it is only Labor that can be trusted to keep our health and hospital system strong. I see that all the time in my own electorate. I see it with the extra funding for the hospitals. I see it through the GP superclinic that is going to be built in Tweed Heads. I see it through funding for GP infrastructure. I speak to people every day who see the benefits of a federal Labor government and what the Gillard government is providing on the ground in health and hospital services.
I can tell you, Mr Deputy Speaker, there is a lot of enthusiasm around the fact that e-health is so desperately needed in the community, and people are responding very positively to the fact that it is a federal Labor government that is providing it. I commend the bill to the House.
Mr FLETCHER (Bradfield) (20:27): I am pleased to rise to speak on the Personally Controlled Electronic Health Records Bill 2011. In principle, having a system of electronic health records is of course a very good idea. According to the national e-health strategy paper issued in 2008:
... E-health is the means of ensuring that the right health information is provided to the right person at the right place and time in a secure electronic form for the purpose of optimising the quality and efficiency of health care delivery.
Of course this sounds like an extremely attractive vision. The question before the House this evening is not whether in principle this is a good thing. The question before the House this evening is whether the method being used by the government to deliver on this vision, as embodied in the provisions of the bill before the House, is appropriate and makes sense—particularly in light of the fact that, while this government may be strong on vision and aspiration, as we know, implementation is very far from being their strong suit. In that regard, I want to focus on three issues in the brief time available to me to comment on the provisions of this bill.
The first question is: how do you get take-up of the electronic health records system? Secondly, is the timing proposed for the implementation of these arrangements realistic and is there a risk that this government is falling for one of the most obvious and repeated errors in information technology policy, which is: go for the big bang, the big system that is going to change everything and solve every problem?
The third issue I want to speak about is whether the business model underpinning this system is a realistic one or whether it is a wholly unrealistic one and, therefore, there is a huge gap between the funding which is required and the funding which has been allocated.
Let me turn firstly to the question of how to achieve take-up of this new system, this new application. I think it is an uncontentious proposition that, unless there is a high rate of take-up of this application—particularly by doctors and other health professionals in choosing to use it—this policy will have failed and the money spent to deliver this system will have been wasted. Against that backdrop, I would argue that there are several critical problems with the approach that is being adopted.
The first problem, in my view, is the approach of opt-in rather than opt-out. There is a privacy question which has informed the particular approach which has been taken. I do not want to deal with that issue. I want to deal with another issue, which is a corollary, a consequence, of the approach which has been taken, and that is: how many people are likely to use this system? How many people are likely to agree to their records being incorporated within this system? It is absolutely and plainly obvious that, unless as many as people as possible have their records contained within the system, the prospects of the system being a success are not high. Unfortunately, because of the decision to make the system opt-in, the power of inertia will work against most people having their records included within it. The power of inertia will cause people to keep their personal health records out of the system, and that is not good news if you want to maximise take-up of the system.
The second issue, which is a critical problem, is that the approach which has been taken permits patients to view and then to modify their own records. That is a decision with a critical consequence, and that consequence is that doctors and health professionals cannot have confidence that the record of the patient which they access electronically is in fact comprehensive, complete and accurate. If doctors and other health professionals do not have that confidence, if they fear that the record which they are looking at might have material and relevant information omitted from it because an individual has chosen to have that information excised then they are very unlikely to use that record in the way that the architects of this system would hope that they do.
The related point that I think can be made here is that the approach in designing this system makes an absolutely classic error in the field of information technology, and that error is to assume that all you need to do is implement a new system and then behaviour will change; that once you put the new system in the hands of users, users will automatically take it up. That is a deeply flawed assumption because what you actually need to do is achieve behavioural change on the part of users.
Who are the key stakeholders who are going to determine whether or not this system is used and whether or not this system is a success. The key stakeholders are doctors and other health professionals. If they are uncertain, if they are unpersuaded, if they are unconvinced about the merits of this system, then you can spout all the rhetoric you like about the potential of electronic health records but you will not achieve anything meaningful. Against that backdrop it is surely relevant to mention that the peak bodies representing health professionals, particularly the Australian Medical Association, have raised, amongst other things, serious concerns about the medico legal risk to which doctors may be exposed if they rely on electronic records which are subsequently discovered to have key information missing from them. It is a reality that doctors in particular and, to a lesser extent, other health professionals are key in the health system. They are the gateway to significant decisions and significant behaviours. Unless there is buy-in by doctors and other health professionals, this system will not achieve its objectives, and we will have simply wasted a substantial amount of public money.
There are similarities between the error this government is making with this particular IT system and another major IT system that it is implementing—the National Broadband Network. There is a failure on the part of this government to think about the marketing issues involved. How do we sell people on the use of this system? How do we persuade, in this case, doctors and other health professionals that it is in their interests to use this system? You cannot simply assume that, if you make the system available, you can force people to use it. That assumption is a grave misreading of the organisational behaviour of key groups of people within the health system, particularly doctors and other health professionals.
Let me turn to the second serious concern I want to identify, which is that this government is seeking to make a big bang change in information technology applicable to the health system and to do so in a huge rush. The near universal view in the sector is that the timetable for implementing these reforms is absurdly and unbelievably tight. The date which has been specified, 1 July 2012, is widely considered to be ludicrous. We have seen this government make this error in area after area. They impose a deadline so that they can announce it in a media release, without thinking through the complex implementation issues. We have every reason to suspect that the same error is going to be made again. I note, for example, that the Medical Software Industry Association, whose members include Cisco, Microsoft and iSOFT, made a very critical submission to the Senate inquiry, noting that the government's approach on this issue has not followed normal business practices in the IT industry and that the documents issued by the National E-Health Transition Authority to software developers were manifestly inadequate.
So if one issue is the unrealistic timeframe, a second issue which compounds that is the naive belief that we can create here a brand new system which will completely transform everything: 'This is going to be year zero. This new system will solve every problem.' That error has been made time after time when it comes to the application of information technology in both the public sector and the private sector. We are well on the way under the approach embodied in this bill to making the same error again.
Why is it that when the government's consultants, Deloitte—commissioned by the Australian Health Ministers' Advisory Council in 2008 to develop a plan to guide the national approach to e-health—recommended 'an incremental and staged approach', they proposed seeking a specific application which was manageable and achievable and which would deliver early benefits. The one they proposed was an electronic prescriptions transfer service between health carers and pharmacies. In their view, a quick win could be delivered at relatively low risk.
They argued that the first step was to connect the care providers, the next was to enable key information flows and only then to go to the third step of building repositories to accumulate the information contained in those information flows. Unfortunately, this government has chosen to reject that very sound advice. On this point, a witness to the Senate Community Affairs Legislation Committee, Dr Ian Colclough, had this to say:
It makes good sense to move away from large scale, all encompassing national ehealth projects and focus on projects which are more modest in scope and geography.
He went on to say:
In that regard it is a mystery why the Deloitte Recommendation to establish a National ePrescription Exchange Service has not been embraced by NEHTA and the Department.
And I can only agree with him.
The third point I would like to make in the brief time available to me is to ask: what is the business model under which it is envisaged that the personally controlled electronic health records system will operate? If you ask any large private sector organisation—it could be Qantas, Telstra, National Australia Bank, or any one of a host of large private sector corporates—about how they run their IT systems, they will say to you that they assume a cost per customer per year, which is often in the range of several hundred dollars, to encompass all of the costs involved in managing, maintaining and, where necessary, upgrading that IT system. There is no way around the fact that the ongoing costs of running a large IT system are enormous.
A one-time allocation of $467 million for a system that is designed to meet the electronic health record needs of all Australians is manifestly inadequate. We do not know the answer of where the ongoing spending is going to be sourced from. Where will the money come from to keep this system operating over successive years? The amount of money being proposed here has been described, for example, by Sydney University surgery professor Mohamed Khadra as 'a drop in the ocean'. It is well known that the UK spent some £12 billion on their equivalent scheme to introduce e-health records before the program was scrapped late last year as unsuccessful. That should be a warning to all of us.
I regret to say this is yet another example of the Gillard government espousing a worthy objective, rushing out a media release, setting an unrealistic timeframe and showing that it has manifestly failed to deliver a credible and implementable robust plan to deliver and execute on its aspirations. For that reason, we on this side of the House have very grave concerns about this bill.
Mr NEUMANN (Blair) (20:42): I rise to speak on the Personally Controlled Electronic Health Records Bill 2011 and a related bill. The economic growth, productivity and prosperity of our country is underpinned by the health of the people. It is absolutely critical that we get right the social and physical infrastructure of our public health and hospital system, our primary health care and also our e-health. The coalition has had every position possible in this regard. In fact, it is incredible that they are standing here today, spokesperson after spokesperson, criticising us on this area.
Before the 2010 election the AMA sought a commitment from the coalition on e-health. We know that because the then President of the AMA, Dr Andrew Pesce, said in a statement:
We also note that there is no commitment from the Coalition yet on e-health.
This is a major concern because, without e-health, we cannot make the best use of existing health care services and avoid errors, duplication and waste.
I can tell you, the AMA is not an affiliated union to the Australian Labor Party. The coalition also took a policy to the last election that criticised us. They intended to scrap the proposed $466.7 million investment in e-health in our budget. They vowed to scale it back. The strange thing about that was that the shadow minister for health, the Hon. Peter Dutton, said that the coalition was absolutely committed to e-health. He said that before the last election and I have seen performances on Q&A where he said similar things about health reform. But there is no money on the table and when it comes to the crunch, it is all about cuts. He said:
We are committed to e-health into the future. We do strongly support a roll-out of e-health and the funding is there until 2012.
Where is their commitment now?
Another body not necessarily affiliated to the Australian Labor Party, the Business Council of Australia, wrote to Peter Dutton, the member for Dickson, on 4 February 2010, well before the last election. Katie Lahey, the chief executive, said in the letter:
I am writing on behalf of the Business Council of Australia (BCA) which represents the CEOs of Australia's top 100 companies to advise you of our support for early commitment by COAG and the Commonwealth government to implementation of the national e-health strategy.
And the coalition has the gall to come in here and say that they are opponents of this. This was the position of the AMA and the Business Council of Australia. Katie Lahey went on to say:
As you are aware, the BCA has been promoting the need for reform of the health system and for sustained improvement in Australia's health status as an integral part of the productivity and workforce participation improvement strategies necessary to underpin Australia's future economic prosperity. We have become convinced that acceleration of a nationally integrated e-health system is fundamental to achieving these reforms.
And the coalition come into this place and say, 'We'll all be ruined if we bring it in.' The coalition's e-health spokesperson, Andrew Southcott, has said:
… $5 billion has been spent on e-health over the past 10 years and the experience is that a lot of money can be wasted.
That is what he claimed: wasted. Well, it actually happened to be the case that the now Leader of the Opposition was the health minister at the time. He presided over much of that expenditure. In 2005 the Leader of the Opposition pulled the plug on the coalition's former HealthConnect shareable e-health records program and created the National E-Health Transition Authority, and money has been spent on that ever since. The coalition say to the public, 'We're in favour of e-health,' and then criticise us about the e-health program and then criticise their own former health minister, now the Leader of the Opposition, about the policy. They do not know whether they are Arthur or Martha on this issue. It is an extraordinary performance by the coalition in relation to this.
The genesis of this was a long time ago. In 1999 the then Howard coalition government took the first steps towards implementation of a national e-health policy. I cannot recall coalition spokespersons at the time getting up and criticising John Howard and his government in relation to that. But now they say, 'We'll all be ruined,' and they say that it is all too rushed. We are developing the foundations of this system. We are doing it carefully, systematically and in consultation with healthcare providers and consumers. We want to get it right and we want to keep going, because we think it is important. This is a complex area of reform. We know that, and we know that it will build over time, as consumers and healthcare providers join the system. That is why we are rolling out e-health pilot sites to trial software and e-health capabilities across the country. We want to make sure that we get the software and the clinical settings right and that there is no risk to patients.
I am pleased that, in my area of Ipswich, the West Moreton-Oxley Medicare Local have been chosen as one of the sites. They have delivered e-health innovations, including adoption of the personally controlled electronic health record, as a wave 2 lead implementation site. I have been in touch with Vicki Poxon, who is in charge of the Medicare Local in relation to this. This is fantastic news for the whole region.
E-health records will provide faster diagnosis, cut down on medication errors, give patients peace of mind and let doctors see a patient's complete history. There are security and privacy protections provided in this legislation. We think e-health sites such as we are going to have in Ipswich and the western corridor are particularly important. Patients will be able to log on to the purpose-built stations at the GP superclinic located at the Ipswich campus of the University of Queensland—another great initiative of this federal Labor government, opposed by those opposite. E-health records will be contained of course—there will be privacy protections—and we are committed to investing $55 million in the lead implementation sites as part of our $467 million. We are committed to a national rollout of the e-health initiative from 1 July 2012.
This is particularly important for my constituents. The West Moreton-Oxley Medicare Local undertake the Ipswich after-hours clinic. A patient who sees a doctor after hours may not see their regular GP and may be referred to a hospital, and it is important to make sure that their medical records are available to all doctors and health professionals they see. The Medicare Local do a great job. Another great initiative they undertake is the Ipswich psychology clinic, again located at the Ipswich campus of the University of Queensland. It is critical to patients. We want to make sure they do not fall through the cracks. We want to make sure that these records are accessible to anyone who touches a patient, effectively, including allied health professionals ultimately and, I think, even people in schools. The West Moreton-Oxley Medicare Local are aiming to have about 100 practices using these records. We think it is key. Vicki Poxon and the whole Medicare Local are particularly excited about this initiative.
But those opposite want to live in the dark ages. They must think that you deliver post by carrier pigeon. They really are living in the Dark Ages in this regard. I am a bit of a digital immigrant, to be honest with you. I have had to learn to use a computer and a BlackBerry and all those things. We all do, as politicians. I see Deputy Speaker Scott nodding his head sagaciously. He is probably in the same situation as me, although I must confess I am just a few years younger than him. But it is important that we have medical records in this way. It is far more likely that you will get things wrong with the outdated approaches that can result in poor information flows, unnecessary duplication of testing, delays and medical errors. Some studies have shown that, in hospital environments, between nine and 17 per cent of tests are unnecessary duplicates and up to 18 per cent of medical errors can be attributed to poor patient information. As I say, the West Moreton-Oxley area—which covers the west and south-west parts of Brisbane, through Ipswich into the Lockyer Valley, the Scenic Rim and up into the Brisbane Valley—will be one of the sites. When the Leader of the Opposition was the Minister for Health and Ageing, he promised e-health. He never delivered it. It is a real tragedy. Somewhere along the line, he must have had a Damascus Road conversion experience, but not a positive one—not like St Paul. He must have had a negative one because, having supported e-health when he was health minister, he decided to cut it at the last election. From comments by those opposite tonight, it looks to me like they have no intention at any stage, notwithstanding what the member for Dickson has said, of ever supporting e-health. But why would they? They opposed the GP superclinics. They opposed GP after-hours hotlines. They opposed the Medicare Locals. They opposed health reform. They opposed the BER in my area. They opposed every road infrastructure and community infrastructure project that this government has ever done.
I think this is a particularly important reform. It will make such a difference to people across the areas of my electorate. I think it is going to be important in terms of peace of mind for patients—they will know that, when they go and see a doctor, that doctor will have access to all their medical records. One of the frustrating things that constituents in Blair have told me is that, when they go to a doctor—and if they get referred to a specialist, another specialist and another specialist, which often is the case—they have to recount, again and again, their medical history. Some of those medical histories can be quite complex. Just imagine if you were, say, a woman who had had a liver transplant. Just say you had also had hepatitis. And you might have needed a knee reconstruction or you might have diabetes. People have, as they get older, lots of chronic ailments, illnesses and indeed injuries. To recount all those things, to remember all those medications as you are getting older, to remember every single thing, is not always easy. But e-health will provide that. For all those opposite who say this is a waste, I think they are really denying something that is in the best interests of their constituents.
We on this side are committed to e-health because we think it is integral to the kinds of reforms that we want to undertake in rural and regional Australia: the cancer clinics we are seeing across the country, the telehealth and the greater numbers of GPs and nurses trained—and they are going into regional and rural areas after many years of neglect and cutbacks in this area. As we have said on many occasions in this place, taking a billion dollars out of the health system was the Leader of the Opposition's legacy as health minister.
I think that those opposite do not quite get how important this particular benefit will be to rural and regional Australians in seats like mine and in seats like so many of theirs—to disadvantaged Australians, to Australians who do not necessarily have English as their first language, to the elderly, to Indigenous people, to families and to the hard-pressed mums who are looking after little kids and have little kids running around a doctor's surgery. Just to say no to this and say no to so much other health reform shows what negativity those opposite have in their hearts and in their minds on health reform.
This legislation before us will enable us in many ways to resolve the tyranny of distance. It will reduce costs associated with caring for an ageing population. It will assist people to be independent for longer. It will minimise, as I said, the potential for errors in patient treatment. It is an ambitious undertaking. We know that, but we think it is important for the 21st century. We think that paper records can be stored incorrectly. They can be read by the wrong person. They can be left unsecured. They can be dumped in a rubbish bin accidentally. Moving to an electronic system reduces those risks, protects patients' medical records and improves privacy. We are about consultation, as we in this government always are. We are going to make sure that we take advantage of high-speed, high-capacity broadband through the National Broadband Network to dramatically change our health services that are delivered to regional and rural Australia.
The CEO of the National E-Health Transition Authority, Peter Fleming, in August last year likened the creation of the personalised e-health records system to the task of putting a man on the moon, a task once thought impossible but a task which was delivered successfully. Those opposite are like the naysayers, basically, who, when President John F Kennedy challenged the US congress in 1961 to commit itself to 'landing a man on the moon and returning him safely to the earth', scoffed. He said he could do it within a decade.
In many ways, I really think e-health is our moon landing. I think it is revolutionary. I think it is visionary. I think it is courageous. I commend the government for it. I commend the former health minister and I commend the current health minister for their personal commitment to this vital reform in this country.
Mrs BRONWYN BISHOP (Mackellar) (20:57): In listening to some of the debate on the Personally Controlled Electronic Health Records Bill 2011 and cognate bill that comes from the government benches, one can only agree with the comment of Dr Ian Colclough in his submission to the Senate Community Affairs Legislation Committee when he said:
… it is easy to be seduced into believing the development of the PCEHR—
personally controlled electronic health record—
is readily achievable and for many advocates it is convenient to forget lessons from the past and hastily rush into this still uncharted territory.
He said the concept of the shared health record is 'relatively new' and so is the personally controlled electronic health record. He continued:
Consequently, available solutions are immature and the experience and understandings of health providers, agencies and consumers minimal. This accounts for why so few studies have been undertaken to validate their adoption.
He further said:
One recent major review stated that:
"Patients, policymakers, providers, payers, employers, and others have increasing interest in using personal health records … to improve healthcare costs, quality, and efficiency. While organizations now invest millions of dollars in PHRs —
personal health records—
the best PHR architectures, value propositions, and descriptions are not universally agreed upon. Despite widespread interest and activity, little … research has been done to date, and targeted research investment in PHRs appears inadequate."
Whilst the idea of utilising electronic data collection can certainly be attractive to one in thinking, it is the examination by people who are involved in this sphere that puts up the sorts of worries that people have about a start date of 1 July 2012. I think this is a major sticking point for the opposition—that the whole process is being rushed. One of the things that seems to be driving that rush is the fact that the funding for it—an agreement under the COAG arrangements—runs out at that date, and there is no certainty about any further funding for it.
There are many issues that are of concern to people on this side of the House. We are a conservative party. We are conservative on this side and therefore we are cautious about the way in which we would go forward in order to bring about change. On the government side there is this overuse and indeed abuse of the word 'reform' when really what they are talking about is change, and sometimes it can be change for change's sake or rushed change without adequate work having been done to prepare for it and to look at what the consequences may be.
It was said in the course of the debate that one can have no confidence to date that the records to be accessed will be complete, that they will be up to date, that they will be reliable. Where are the questions being addressed as to who would be liable for damages for acting on records which are not complete, which are out of date, which have not been properly kept? We all know that in our hospital and health system there are many errors. Indeed, the second reading speech of the minister states:
Medication errors currently account for 190,000 admissions to hospitals each year. Up to 18 per cent of medical errors are attributed to inadequate patient information.
That presumes that electronically collected data is going to be accurate and reliable. Yet nowhere is there any evidence that proper risk assessment has been carried out. My colleague the member for Forrest outlined her concerns about the gathering of data in a central base which can be hacked into and abused. That well-known old adage 'information is power' certainly has great potential in the area of health records.
The way the system is meant to operate is that, rather than the patient repeating their medical history and information each time they visit a different clinician, there would be this huge database which could be tapped into. How much more sensible to look at things on a smaller scale, and these sorts of practices do exist—that is, where a patient who wishes to can have their medical data carried around with them on a USB stick, and when they go from a doctor to a specialist they take it with them. It can be utilised because the person owns it and controls it and hands it over because they wish to do so. There is that very personal connection between the GP and the patient because that is an ongoing relationship. It is vital that the system is an opt-in system, not an opt-out system. One can see that once such a huge infrastructure is established, and hundreds if not thousands of public servants are involved in it, the desire to go from an opt-in to an opt-out system is going to once again be one of those irresistible pursuits of those who want to control information.
The Deloitte study conducted in December 2008 and published by the department as a summary of the Deloitte national e-health strategy recommended that the building of long-term health capacity should be undertaken incrementally and that critical to driving the uptake of e-health and support by consumers and care providers will be the quality of the underlying e-health solutions and relationship between them, which involves a two-way data exchange. Deloitte went on to say that they advocated focusing initial investment in those areas that deliver the greatest immediate benefits for consumers, care providers and healthcare managers. They recommended a national e-prescription exchange service as the highest priority for e-health application solution, which should be developed immediately.
Dr Colclough said:
It makes good sense to move away from large scale, all encompassing national ehealth projects and focus on projects which are more modest in scope and geography. Subject to the architecture they can then be scaled up and rolled out nationally. This more ‘contained’ approach is easier to manage, less risky and less costly to 'prove'. It also makes it very much easier to quickly counter disruptive vested interests and overcome difficult political and technical hurdles as they arise.
In that regard it is a mystery why the Deloitte Recommendation to establish a National ePrescription Exchange Service has not been embraced by NEHTA and the Department.
The private sector has successfully deployed two Prescription Exchange Services serving medical practices and community pharmacies in every State and Territory of Australia. Yet this is not addressed.
Other submissions that were made point out other difficulties. Of course, much has been made of the fact that the development of such a system by the UK government has been wound back after repeated failures and growing criticism. According to the UK health minister, Simon Burns, 'this has been an expensive farce from the beginning'. In May 2011 the UK National Audit Office admitted that large sections of the National Health Service were withdrawing from the electronic record project, which is a key part of an £11.4 billion—A$17 billion—National Health Service project. Google, one of the world's largest vendors of online services, has abandoned its 'Google health' personal health record due to lack of patient interest in keeping personal medical records. The product was introduced in 2008 and it was withdrawn on 1 January 2012. Despite numerous conferences discussing the development of personally controlled electronic health records, foundational issues such as the definition of a health record and ownership of the health record have not been resolved. Dr Rhonda Jolly, of the Department of Parliamentary Services, says in an article headed 'The e health revolution—easier said than done':
... policy makers have discovered that there are many obstacles in developing e-health policies and programs. Some of these have been resolved, others persist, still others are beginning to emerge.
In other words, the picture that comes across is that this is being very hastily driven by the government, which once again has not done enough preparation or enough work. I for one have grave concerns about the privacy issues involved here. I think the involvement of bodies such as the Privacy Foundation is very important in this debate, and they too have concerns. Another point that has been made is that the emerging crime of identity theft utilising electronic data is changing public perceptions about the desirability in general of storing their most sensitive personal information on databases.
There are many uses for the new electronic access we have to so many things. People are being warned about the material that they put into the various forms of electronic media, because this material cannot be retrieved. Once installed, once it is there, there are secondary users who will be dying to get their hands on it. This rush to have this legislation implemented by 1 July 2012 is quite unseemly. The shibboleths from those on the other side, the insulting terms like living in the dark ages and back to the whatever, is the sort of language used when there is no real desire to debate what are the true issues—the legal ramifications of who owns what, who is liable for entering data and who will be liable if errors are made. Statistics I have indicate that in hospitals every year error, and malfeasance as well, kills 18,000 people a year and maims another 12,000, so we know there are many concerns.
I would simply say to the government that by any reasonable consideration this deadline of 1 July 2012 cannot be met and ought not be pursued. The government should listen to people who have greater wisdom and use the incremental approach. The big bang theory is not one wisely followed. When we debate this issue on this side we do so because we are concerned for the individual. We know that the philosophy divides us—we have individualism, where we make laws and consider the rights and implications for the individual, whereas on your side you have collectivism, where you always rule for the collective and the individual can be sacrificed for the collective outcome. So there is a philosophical divide, but there are important issues to be discussed. This unseemly haste does the government's reputation no good when it says it wants a better health system. There is a need for an incremental approach and a need for greater consideration.
Ms HALL (Shortland—Government Whip) (21:11): I support the personally controlled electronic health records legislation simply because I care for each and every individual Australian. This is about the safety and protection of individual Australians. As a government and as a parliament I think we can best ensure that individual Australians—all Australians—are protected by introducing these bills.
When I researched the information I needed for my speech and looked at the history of this legislation it was amusing to discover that electronic health records were the child of the Howard government. It was the Howard government that was promoting electronic health cards. The Howard government were early enthusiasts of e-health—they were promoting e-health as a cost-saving device and they could see it streamlining healthcare records. They believed it would provide better health care for all Australians. Now the opposition seem to have changed their mind, viewing e-health now as some sort of sinister piece of legislation that is going to be detrimental, when every bit of information I have read convinces me that electronic health records are good for the patient, good for our health system and good for everybody involved.
The opposition argues against e-health records and the legislation before us but it puts up no alternative. Those opposite lack any viable alternative. When they speak to constituents and address people working within the health system they do not put forward any alternate ideas. I find that really disappointing. It shows to me that only one side of this parliament takes health seriously and is interested in ensuring that those people living in rural and remote areas have the best access to health information—this side of parliament.
One of the bibles that I use when I am talking about health care is the Blame Game report that was released in 2006. I will refer to a section in the report, entitled 'Better use of patient information'. The report highlights that all governments have recognised the benefits of electronic storage and transmission of health records and have made significant investments in information technology. The report says that the previous Howard government saw the benefits, invested in it and thought that more investment should be made in it in the future. It highlights that hospitals and other organisations, such as divisions of general practice, were also involved in information technology systems. The national approach to health records was being promoted through HealthConnect. That occurred not under the Rudd or Gillard governments but under the Howard government. The Howard government was totally committed to e-health and to electronic records. Now the coalition are sitting on the opposition side of this parliament. When they were in government they could see the benefits that e-health records would provide to Australians. They could see that legislation like that before us, on personally controlled electronic health records, would be good for the country, good for Australians and good for those administering the health system.
This legislation, despite what previous speakers have said, is not being rushed through the parliament. It has not just appeared out of nowhere. This legislation has had a long lead-in period. There has been an enormous amount of consultation. This has been considered in every possible way. I know that a lot has been said about privacy issues. Privacy protection and security has been paramount in the development of this legislation. To make it a little bit easier, I will use the acronyms. The PCEHR bills provide clear privacy protections and prescribe the circumstances in which consumers and organisations can collect and have access to this information. The legislation puts in place significant penalties for any breaches. All government records are protected. There are a number of firewalls in place. The highest level of protection available for electronic records will be put in place when this new technology comes in.
What will electronic health records mean for Australians? They will enable Australians to have easy access to their healthcare information online and enable them to share that with those authorised healthcare providers that they choose. And those providers can be anywhere in Australia. If someone goes away on holidays and leaves their prescription behind and they need to provide information about their medical condition they will be able to do that. They will be able to have their GP and any other GP connect and electronically access their records. This will save a lot of time and trouble. This will deliver good health outcomes.
Digressing just a little, I noticed that the previous speaker made a lot of noise about the number of deaths that occur because of hospital error—18,000 people a year. The legislation that we have before us today is designed to address just that. It is not about promoting more errors; this will cut down on the number of errors that occur within the health system. I find it difficult to listen to speakers on the other side of the House who turn the positives of this legislation into negatives. I can only come to the conclusion that they are objecting for the sake of objecting.
I sit here in this parliament day after day and I hear a constant mantra of, 'We oppose; no; no; no.' Sometimes both sides of this parliament need to come together to look at and consider things from a national perspective and from the perspective of whether it is going to deliver good health outcomes for the Australians we represent in this parliament. We need to ask: 'Should we accept the latest technology? Should we put in place the proper systems that are going to ensure that that technology will deliver the desired outcomes and make health care more accessible and safer for all Australians?'
I have come to the conclusion that that is exactly what this legislation does. I think that wider reading by those in the opposition would show that this is a really good change. I notice the member for Mackellar was conservative. She did not like change but sometimes we have to change. If we did not change we would be coming to work in a horse and buggy. I think change is good—not all change but change that is well researched, and this change has had enormous public consultation. Change is a key element of health reform in this country. This change will remove the fragmentation of healthcare information across a wide range of locations. It is change that was identified in the report The Blame Gameas a positive and something that would deliver to Australians. I might add that this was a unanimous report. Both sides of the parliament and all members on the committee at that time could see that this is beneficial. It will get rid of the outdated approach which allows for poor flows of information, unnecessary duplicating tests and delays and medical errors. I have already touched on the medical errors.
I constantly have constituents come to see me with the complaint that they have been to one doctor, who sent them to another doctor, who sent them back to another doctor, who then sent them off to somebody else. They find themselves back where they started but all the way along there has been a duplication within the system. I have spoken to friends who are health professionals and they can see the benefits of this legislation. They believe that this legislation is a positive change, a well-researched change and something that will deliver to Australians.
This is legislation where consumers and health provider organisations will be able to choose whether or not to register or participate in. It is not something people are going to be forced to become involved in. For the record, I can say that it is a system I will choose to become involved in because I believe it is the way of the future. I believe it will ensure my safety and I am convinced that the mechanism and the privacy surrounding it are adequate. I believe this is legislation for the future which will improve our health system. I have great pleasure in supporting this legislation and I congratulate the health minister on bringing it to the House. I know she will ensure it is implemented in a timely fashion.
Mrs MOYLAN (Pearce) (21:26): I note we will only get a couple of minutes but I would like to respond to some of the criticisms by the member for Shortland, because although it is true the coalition government has been critical of the way in which this proposed measure will be implemented by the government, the process was started under the former coalition government. So it is not that we are against the principles of this bill—far from it. It is just as with many of this government's policy initiatives they fall flat when they try to put them into practice. The difficulty of this particular challenge has been exposed recently with the E-Health Transition Authority announcing in January that the work on primary care desktop software development at their test sites has been halted due to the discovery of technical incompatibilities across versions and that there was 'potential clinical risk if work continued using the specification supplied'.
One of the major problems the coalition has is the way in which this bill has been introduced before. Some of the bugs have been ironed out of the system. We do not want to see a repeat of the pink batts fiasco, which cost this country billions of dollars to rectify. It has that potential for this to be implemented in a way that does not do the job it is intended to do. Back in November 2004, the then health minister and now opposition leader, Mr Abbott, made a pertinent point in answer to a question put by my colleague the member for Moore, which this government should have listened to. Speaking about the work of the National E-Health Transition Authority, he noted that just about all the computers on the health professionals' desks right around our country are already linked by the internet. The challenge though is to try to create a secure database with secure transmission. That is the task at hand. I do not think at this stage that the government has demonstrated that it is taking that challenge into consideration in this bill.
As I said, millions of dollars have been spent on ensuring this initiative is workable. The government is really rushing the system into operation simply to meet some arbitrary deadline it set for itself. While we all recognise it is good to have targets and deadlines, it is also very important to get such a measure right and not to put the health of people in this nation at risk because we have not ironed out the bugs in the system. I look forward to continuing my comments at a later hour. I note that we are shortly due to move into the adjournment debate. I am sure that in a very mobile society, on the positive side of this bill— (Time expired)
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Posted by Dr David More MB PhD FACHI at Thursday, March 01, 2012