Just So You Know What Was Actually Said By The Minister on the HI Service. A Real Worry!

Note: The commentary that follows the Hansard I see as very important indeed – please browse! Be alarmed, very alarmed indeed!

----- Begin Hansard.

Wednesday, 10 February 2010

Healthcare Identifiers Bill 2010

Second Reading

9:04 am

The Hansard Reads as follows.

Nicola Roxon (Gellibrand, Australian Labor Party, Minister for Health and Ageing)

I move:

That this bill be now read a second time.

This bill seeks to establish a single national healthcare identifier system for patients, healthcare providers and healthcare provider organisations.

This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.

As noted recently by the third Intergenerational report and the final report of the National Health and Hospitals Reform Commission, we need to prepare the health system to meet the needs of the coming decades.

An ageing population, technological change, a rise in the prevalence of chronic disease and increasing consumer expectations mean we cannot continue with a ‘business as usual’ approach.

The government is currently undertaking the most important overhaul of our health system since the introduction of Medicare 25 years ago. An important part of this work will be ensuring that as a nation, we are well positioned to take full advantage of the opportunities presented by information and communication technology. The reform commission was clear in identifying the importance of e-health in driving and enabling reform to healthcare delivery. Among the 123 recommendations of the final report is a recommendation to introduce healthcare identifiers by July 2010 and individual electronic health records by 2012.

This bill establishes the healthcare identifiers, without which there cannot be an integrated, consistent, e-health system in Australia.

One of the major barriers currently limiting the progress of national e-health initiatives is the lack of a single process to accurately and consistently identify patients and healthcare providers.

For example, when a patient visits their GP for a check-up, the identifying number on their health record is different to the number at the pharmacy where they have their prescription filled or the pathology laboratory where they have their blood tests done.

Healthcare providers face a similar problem with professional or registration bodies, Medicare Australia, and their employers all identifying them through a variety of different methods.

This fragmented approach to identification does not provide the accuracy or consistency needed to confidently share health information in an electronic environment. Nor does it adequately support the safe delivery of health care with providers regularly required to match patients and patient information to their records, increasing the risk of mismatching records and tests needing to be re-ordered.

Studies in hospital environments have indicated that between nine per cent and 17 per cent of tests are unnecessary duplicates. Up to 18 per cent of medical errors are attributed to inadequate availability of patient information, which indicate the scope of the potential efficiency and productivity benefits possible when we have accurate patient information. Healthcare identifiers help progress our goal to utilise health resources in a smarter, more targeted and sustainable way.

In 2006 the Council of Australian Governments (COAG) agreed to a national approach to identification for patients and providers as part of accelerating work on the national e-health records system. This decision was re-affirmed in November 2008 when COAG agreed to universally allocate healthcare identifiers to all healthcare recipients in Australia.

A national approach to establishing healthcare identifiers has been adopted to avoid duplicating development costs and efforts and in recognition that identifiers are part of the core infrastructure needed to support secure electronic communication across the various elements of Australia’s healthcare system.

In consultation with the healthcare sector and the Australian community over the past three years NEHTA, in conjunction with Medicare Australia, has designed and developed an identifiers system for patients, healthcare providers and healthcare provider organisations.

The Healthcare Identifiers Service has been designed to include appropriate safeguards to ensure that:

• minimal demographic information will be required to assign and obtain healthcare identifiers;
• no clinical information will be held by the service operator;
• only authorised healthcare providers will be able to access the Healthcare Identifiers Service and obtain healthcare identifiers for their existing patients; and
• the Medicare card and Department of Veterans’ Affairs treatment card are used as a token to obtain an individual’s healthcare identifier.

The service has been designed to ensure that mechanisms currently available through Medicare Australia to protect the identities of vulnerable individuals (such as those in the witness protection program) will continue to be catered for.

An individual healthcare identifier will not alter the way in which anonymous healthcare services are currently provided. Where it is lawful and practical, individuals can seek treatment and services on an anonymous basis. In these instances, an individual healthcare identifier would not be used by the healthcare service.

The design of the service has been subject to three independent privacy impact assessments to ensure significant privacy impacts were identified and where necessary, addressed. This ensures the design of the service appropriately protects the privacy of those participating in it.

The design of the Healthcare Identifiers Service, combined with a national authentication system, an appropriate governance framework and the regulatory support this bill seeks to establish, healthcare identifiers will deliver the access and identity requirements critical to ensuring confidence in the way a patient’s health information is handled in an electronic environment.

While attention is often given to the potential benefits of the eventual adoption of electronic health records, there are immediate benefits associated with the implementation of a national healthcare identifiers system. These benefits will improve the safety and quality of healthcare in Australia and include:

• Minimising the likelihood of information being sent to the wrong healthcare provider or being assigned to the wrong patient;
• Reducing the likelihood of adverse events and inefficiencies associated with mismatching of patient information;
• Establishing a Provider Directory Service to enable, for example, GPs to locate specialists in a timely manner and to provide a greater confidence in electronic communications; and
• Improving productivity for healthcare providers and increasing patient convenience by helping to automate some of the more routine interactions between providers such as referrals, prescriptions and image processing.

For example, when eight-year-old Amy injures her arm rollerskating, her mum takes her to the emergency room at the local hospital. Using their family Medicare card as a token, the hospital collects Amy’s healthcare identifier from the Healthcare Identifier Service and adopts it as an identifier in its own system.

Using Amy’s healthcare identifier the treating doctor at the hospital orders an X-ray, the results of which are sent electronically from the radiology department to the doctor. This allows the doctor to quickly diagnose Amy’s fracture, treat her and prescribe any medication to assist with the management of her pain.

When Amy is discharged from the hospital, the doctor sends an electronic discharge summary to her regular GP with information about her condition, treatment and the medication prescribed. From this information, Amy’s GP knows when follow-up treatment is needed, reducing the likelihood of needing to go back to hospital for further care.

At each step in this scenario, Amy’s healthcare identifier is used to uniquely identify her in a variety of different healthcare settings and support the electronic communication of information relevant to her healthcare provision.

The scenario I have described can only become a reality if there is widespread use of a healthcare identifiers system by both patients and healthcare providers. To achieve this, the system must be easy to use, provide benefits to clinical care and be one that people can trust.

The bill seeks to establish appropriate limitations and protections for healthcare identifiers, including a robust complaints handling framework which will be managed by independent regulators. This will give patients and healthcare providers the necessary confidence in the safety of the system to encourage widespread participation.

The protections will be achieved by:

• Limiting the use of healthcare identifiers to:
• health information management and communications activities undertaken as part of delivering health-care; and
• other related purposes including health service management, research and emergency situations.
• Working to develop uniform health information regulation and privacy arrangements, for both the public and private healthcare sectors;
• Supporting appropriate authorisation and authentication processes for access to the healthcare identifiers system;
• Establishing strong inquiry and complaint handling arrangements with oversight conducted by the Federal Privacy Commissioner and penalties for misuse; and
• Providing for a review of the role of Medicare Australia as the service operator after a two-year period.

While all individuals receiving health care in Australia will be issued with an identifier, the bill does not impose a requirement that healthcare providers use healthcare identifiers when providing healthcare services, nor will identifiers be required by patients for claiming healthcare benefits.

On 7 December 2009, COAG signed a national partnership agreement setting out its commitment to implementing the governance, legislative and administrative arrangements necessary to implement e-health, starting with this healthcare identifiers system.

This agreement recognises the need for strong collaborative governance arrangements between jurisdictions, allocating responsibility for oversight of the Healthcare Identifiers Service, including the consideration of any proposed legislative changes and decisions regarding ongoing funding of the service to a ministerial council made up of representatives from each jurisdiction.

Two rounds of public consultation on the legislative proposals to support the Healthcare Identifiers Service have been undertaken. While there is strong support for the implementation of healthcare identifiers as a foundation for the development of e-health, patient and healthcare provider confidence in the regulatory support outlined in the bill is only one part of the story when it comes to ensuring widespread participation.

Getting a broad range of healthcare providers to actively participate in the system is going to be critical to achieving widespread use of healthcare identifiers in the healthcare system.

It is our aim to get as close to full participation in the healthcare identifier system as possible.

Engaging with and educating healthcare providers is the best way of ensuring widespread uptake of the identifiers. While most of the benefits associated with improving safety and quality and increasing patient convenience and productivity are obvious, the government will be strongly encouraging healthcare providers to participate in this system.

This is an exciting time for health reform and specifically for e-health development. Every Australian has a stake in our health system and e-health provides us with great opportunities to improve the way in which healthcare is delivered.

The implementation of a healthcare identifiers system for patients and healthcare providers is an important step towards building an effective national e-health system.

I commend the bill to the House.

Debate (on motion by Mrs Gash) adjourned.

----- End Hansard

The Hansard Record is found here:

http://www.openaustralia.org/debates/?id=2010-02-10.7.1

The holes in this speech one can drive a truck through are:

1. “This new identifier system will facilitate reliable healthcare related communications, support the management of patient information in an electronic environment and provide the foundations necessary to support the development of a national e-health record system.

The development of a national e-health system will improve safety and quality and patient convenience by ensuring that the right people have access to the right information at the right time.”

The point is remade here:

“The reform commission was clear in identifying the importance of e-health in driving and enabling reform to healthcare delivery. Among the 123 recommendations of the final report is a recommendation to introduce healthcare identifiers by July 2010 and individual electronic health records by 2012.

This bill establishes the healthcare identifiers, without which there cannot be an integrated, consistent, e-health system in Australia.”

So we are doing this HI Service to create a national e-Health record system. And what is this to look like, do and cost. Blowed if any of us know. We haven’t been asked. What is more it is not funded and there has been no serious consultation on how it might work that have seriously involved the Health Informatics community.

This is a very serious development in my mind. With the lack of governance and leadership NEHTA has provided in the HI Service program I would estimate that without a dramatic change in the delivery approach any national e-Health record system is doomed to catastrophic failure.

This is a classic example of NEHTA ‘not knowing what it does not know’ and to have NEHTA funded to deliver this sort of program makes me feel weak at the knees. I really don’t think they actually know what they want or what they are doing.

There is so much preparatory and structural work that needs to be done before a project of this type should be even considered it is staggering. It will be a reflection of ignorant hubris if the first step of a detailed feasibility and practicality study is not conducted and made public before this moves any further. The last decade of messing about in this domain has left us without the skills and the numbers to contemplate such exercises without some very serious capacity building first.

2. “Engaging with and educating healthcare providers is the best way of ensuring widespread uptake of the identifiers. While most of the benefits associated with improving safety and quality and increasing patient convenience and productivity are obvious, the government will be strongly encouraging healthcare providers to participate in this system.”

Tell me about the major change in the health system that has come about through Government ‘encouragement’ when the change involves extra time and cost – but does not come with some financial incentive.

3. “One of the major barriers currently limiting the progress of national e-health initiatives is the lack of a single process to accurately and consistently identify patients and healthcare providers.”

This is not true and NEHTA knows it. There are ways forward that do not involve what is being proposed here.

4. “On 7 December 2009, COAG signed a national partnership agreement setting out its commitment to implementing the governance, legislative and administrative arrangements necessary to implement e-health, starting with this healthcare identifiers system.

This agreement recognises the need for strong collaborative governance arrangements between jurisdictions, allocating responsibility for oversight of the Healthcare Identifiers Service, including the consideration of any proposed legislative changes and decisions regarding ongoing funding of the service to a ministerial council made up of representatives from each jurisdiction.”

See my commentary here:

http://aushealthit.blogspot.com/2009/12/details-of-new-national-partnership-on.html

and here:

http://aushealthit.blogspot.com/2009/12/coag-again-does-not-endorse-nehta-iehr.html

This is in no way what is needed. Note the absence of mentions of leadership and funding beyond the present NEHTA funding! Note also it all end in June 2012 unless re-done!

The full document is here:

http://www.coag.gov.au/coag_meeting_outcomes/2009-12-07/docs/npa_e-health_signature.pdf

Overall, this really is just not the way to go about things.

5. I won’t go on about the confusion about what flows from having identifiers and what flows from having EHRs. They have just jumbled and confused that totally.

There are now rumblings that a new COAG submission on some form of S/P/I/EHR might be approved – or at least considered – in the rush to try and cover up the lack of progress in the health sector as the election looms.

There really needs to be a great deal more openness about all this before something goes to COAG or I can assure you it will be doomed and DOA – after a waste of even more money. As I say earlier it would be helpful to know exactly what they are actually planning!

It seems to me there is an ‘e-health deathwish’ loose in the land with Medicare and NEHTA as its sponsors.

David.