Friday, June 22, 2012
Hansard From House of Representatives Where We Have Final Approval Of The NEHRS / PCEHR and Some Other Views.
Most of the Comments from the Minister - Made on 21 June, 2012 - cover the amendments. The Opposition takes a slightly broader view.
Here is the transcript.
Ms PLIBERSEK (Sydney—Minister for Health) (11:20): I move:
That the amendments be agreed to.
The amendments to this legislation, the PCEHR bills, reflect recommendations by the Senate Community Affairs Committee, address issues raised through consultation and make other small clarifications and corrections. Some of the key amendments will ensure the system operator can cancel or suspend a consumer's registration if continued registration poses a risk to the personally controlled e-health records system. The amendments strengthen consumer consent arrangements; clarify the extent of the Australian Information Commissioner's powers in respect of the PCEHR system; clarify the use of de-identified data for research and public health purposes and provide for requirements to be made for this function; support the use of participation agreements by the system operator; improve the transparency of the future review of the legislation; improve the consultation undertaken on the making of PCEHR rules; and they reflect the evolving design of the PCEHR system.
This is a once-in-a-generation opportunity to deliver these important reforms. The PCEHR bills and these amendments are part of the government's bold health reform agenda, reforms that will make it easier for consumers to receive the right care when and where they need it. I want to thank members opposite for their cooperation in relation to this legislation and I commend these amendments to the House.
Dr SOUTHCOTT (Boothby) (11:22): Time is of the essence here, because it is only 10 days until the personally controlled electronic health record launches on 1 July. The amendments under discussion arise out of the Senate inquiry, which the opposition moved for, into the PCEHR legislation. The amendments are sensible, and the opposition does not oppose them. I have a few brief points to make on the PCEHR and the government's implementation of it.
Right from the beginning—from the first grand announcement by the member for Griffith, the then Prime Minister, about the personally controlled electronic health record—the government has struggled to meet its own deadlines. We are now 10 days from the launch of the PCEHR, and the parliament is still considering the important issues around governance, security and privacy in the legislation which is needed for the system to operate. We now know that the National Authentication System for Health, NASH, will not be ready for the launch on 1 July and that Medicare will be required to provide an interim system until the NASH is ready.
I understand that there has been some dispute about how much has been spent on the e-health record and NEHTA. On my figuring, though I am very happy for the minister to correct me if I am wrong, since 2010, $846.7 million has been allocated by the Commonwealth to NEHTA and the personally controlled electronic health record. This sum is made up of $467 million for the e-health record in the 2010 budget, a $109 million contribution to NEHTA which was part of the COAG agreement in 2010, $233.7 million in the 2012 budget, and $37 million in the most recent Tasmania bailout . When the contribution from the states, which is another $109 million, is included, almost $1 billion—$955.7 million—has been spent on NEHTA and the e-health record. Since almost $1 billion has been spent, we would expect to see something on 1 July; instead, we hear that the electronic health record will not allow electronic or online registration when it launches. So there is the farcical situation of an electronic health record which cannot be signed up to electronically.
Senate estimates recently heard that the GP practice management software will not be ready to interface with the electronic health record until September this year—that is, three months after the launch of the electronic health record on 1 July. It remains to be seen what will be available on 1 July—that is, in 10 days’ time—after almost $1 billion has been spent by state and Commonwealth governments on NEHTA and, more specifically, the electronic health record project. The opposition believes that the government should have listened to its own national e-health strategy, which recommended a gradual and incremental approach focused on building quick wins—such as electronic prescriptions, discharge summaries and pathology results—which practitioners and health professionals would find useful. The coalition would have tackled it that way.
We do not oppose the amendments, and we did not oppose the original legislation; however, we will be keeping a close watch on the continued roll-out of this $846.7 million of Commonwealth money on NEHTA and the e-health record.
Question agreed to.
----- End Hansard.
So there you have it - done and dusted and awaiting Royal Assent.
It is clear that the Opposition simply does not agree with the strategy being adopted by the Government and I am sure all who read here will be aware I have a very similar view.
I am not the only one who thinks this is a mess: From the Drum on the ABC and written by two academics researching experience here and overseas with Shared E-Health Records.
On July 1, Australia is going to "change the world", "dive in the sand" and "realise the dream".
The date represents "our big chance to make a difference", and apparently we have to compare it to "putting a man on the moon". Exciting, isn't it? Surely we are finally going to Mars, initiate world peace or establish brotherhood amongst men? Or not, of course.
When Peter Fleming uttered these inspirational words last August, he was unfortunately not talking about finding a cure for cancer, but about the start of a national electronic health system in Australia.
It is understandable that the CEO of the National E-Health Transition Authority (NEHTA) is thrilled that E-Health is finally ready to go; in its embryonic phase the idea has been in existence since 1991, and 21 years is a long time in politics. The fact that it has survived is a major feat. The only question now is whether we are really ready for this brave new world?
The most important part of the government's E-Health package, and the element that goes online on July 1, is the Personally Controlled Electronic Health Record (PCEHR). From this date, Australians who 'opt into' the system will be given their own personal health-page, where their medical history, demographic details, allergies, medicines and clinical records will be stored.
If they choose to be involved, they have to nominate a provider, usually their GP, 'who', according to NEHTA, 'will supply basic verified data for a shared health summary'. Patients can limit who has access to specific data, but not to this shared health summary, and access restrictions 'can be overridden in case of an emergency'.
The idea behind this PCEHR is that all doctors who are engaged in treating a patient know all the information they need to do this and that they can share this information between them. The patient, in the mean time, is 'in control' and 'empowered', because he or she can access this information from any computer in Australia and decide who gets access to this information. This will, the government writes on its website, 'improve the quality and safety of our healthcare system'.
..... Lots omitted but needing to be read.
So why do it? Especially now, when even NEHTA says that most of the problems have not been solved yet? Maybe the language that talks about putting a man on the moon gives some idea. The promise of the internet is a powerfully seductive dream and politicians want to believe in technology as the solution for every complex problem. It is the lure of modernity, a type of utopian discourse, similar to the claims made during the advent of the telegraph. Then enthusiasts declared that this new technology would make war obsolete, because world leaders would be able to communicate more easily.
Unfortunately, this did not happen, and we think that launching a system without solving its problems first (and not during, as NEHTA wants to do) is about as safe as stepping into a car without knowing whether the engine will work or the tires are securely fastened. With or without the magic 'personal control', this is an accident waiting to happen.
The full article and a zillion comments are here:
The last 2 paragraphs say it all.
I wonder when it will be when we see the project plan covering all this for the next few years. Right now it is really a ‘pig in a poke’.
Posted by Dr David More MB PhD FACHI at Friday, June 22, 2012