Senate Estimates - June 2015 - E-Health - The Details - Obfuscation Central Again!

We has Senate Estimates on E-Health a week ago.

Interestingly - other than for a very, very confused and pretty ignorant Senator who wanted to discuss e-cigarettes in the e-Health section (she was looking for the TGA discussion) we had only two Labor Senators asking questions - and they were keen to defend their Labor legacy of the initial PCEHR fiasco.

Interestingly Mr Madden fielded most of the questions with Mr Fleming being very quiet indeed.

I have tried to italicise the more interesting bits.

[11:20am] June 2, 2015

Senator RUSTON: My questions are around e-cigarettes or e-vaporisers, or whatever they are supposedly called. This is probably for the TGA, is it?

CHAIR: I was told it was e-health.

Senator RUSTON: Is that not the right place?

Mr Bowles: I think that would be in population health.

Senator RUSTON: So which one is this one under?

CHAIR: This is e-health. There are other aspects but—

Mr Bowles: E-cigarettes is a mix of TGA and population health, so you will only get part of the story.

Senator RUSTON: So it would be better to come back to it.

Mr Bowles: In population health.

Senator RUSTON: Brilliant. That was quick.

CHAIR: Thank you, Senator Ruston.

Senator McLUCAS: While we have e-health, we may as well do those questions now.

CHAIR: Sure. Senator Moore?

Senator MOORE: I just have a few questions on e-health. Welcome, NEHTA.

Mr Madden: Thank you very much.

Senator MOORE: I want to know how many e-health records have now been created. What is the current state of play?

Mr Madden: To date, as of midnight last night, for individuals registered, we have 2,242,823.

Senator MOORE: Has there been any kind of goal set, say, that you wanted to reach a certain number by a certain time?

Mr Madden: The last goal would have been in June 2013, when we had a target of 1.5 million.

Senator MOORE: Did you meet it?

Mr Madden: We achieved that target before the June mark. Probably around April, from memory, we reached 1.5 million, but it has been growing naturally ever since.

Senator MOORE: Now it is just growing and there is no particular target that you have in mind.

Mr Madden: Yes.

Senator MOORE: How many new records have been created since we met last in estimates?

Mr Madden: I do not have that with me; I am sorry.

Senator MOORE: Just take that on notice. We want to see the growth trajectory as it goes through.

Mr Madden: I can say that the average growth rate on the natural growth of individual registrations is running at about an average of 2,000 per business day, so around about 10,000 per week is what is happening.

Senator MOORE: Is that a pretty solid average?

Mr Madden: Yes.

Senator MOORE: What has the government done to promote the take-up of e-health records in this period; what has been the promotion strategy?

Mr Madden: Up until recently we were still waiting for the outcome of the review into the PCHR. We had done little, other than to have people asking for information or particular communication material to provide to their local individuals or health care providers—again, in awaiting the outcome of the review. I guess with the announcement of funding post review, which gives us three years of operational funding, we can now commit to a communication, education and stakeholder management strategy, which we are working on at the moment. We will be doing that in consultation with our key stakeholders.

Senator MOORE: So the review has now been completed and announced?

Mr Madden: Yes. The review was completed in late 2013 and released in May 2014 and the outcomes announced as part of the budget decisions just in the last couple of weeks, in mid-May.

Senator MOORE: So that is the budget that has set aside $485 million over the next four years; is that right?

Mr Madden: Yes.

Senator MOORE: In terms of the activity over the last two years to pursue the e-health record, what activities have taken place to do that? What actions have been taken over the last two years to ensure that e-health records continue to be monitored?

Mr Madden: To be monitored?

Senator MOORE: To be put into the system and then maintained.

Mr Madden: Sure. Since 2012, when the system was implemented, we have had a strict regime of operational maintenance of the system, which includes monitoring of all activities, monitoring of the clinical safety of the records involved, monitoring for errors and particular issues, such as complaints reported by individuals, including privacy breaches. Those staff and resources have continued to be there and to be funded through until 30 June 2015, the last budget outcome—sorry, the budget from 2014.

Senator MOORE: That was the year—

Mr Madden: That is right.

Senator MOORE: keeping you going.

Mr Madden: Yes. So we had one year to keep going while we went through the consultation and further work on the implementation plans for recommendations of the review. We employ a workforce which monitors progress, activity and security and all of those things around the system. They have continued to do that, and will continue to do so now for another three years through the optional funding for the system as well.

Senator MOORE: What consultation has been had with the medical profession regarding the decision to shift to the opt-out system?

Mr Madden: The recommendations from the review were to increase participation in the system. The health community had said, 'If we had the majority of our patients in the system, we would be more compelled and likely to take this on and use it.' That came through in the form of submissions from the AMA, RACGP, Consumers Health Forum and others—

Senator MOORE: That was prior to 2014.

Mr Madden: That was in 2014, in the report. We did do some consultation directly with health care providers and the community between July and September 2014 just to confirm views about how that would work. The point I need to make is that opt-out, in the current budgetary decision, is to trial opt-out in at least two geographical locations to understand the issues and make sure that we have continued to maintain the consumer's or individual's confidence in the system and to understand the issues that might come with that. So we have not taken a decision to move completely to a national—

Senator MOORE: But you have made a decision to go to the trial of two opt-outs, which is a distinct change from the other process. This committee did an inquiry into the original legislation and the opt-in/opt-out model was a great point of contention at that time. So now, as a result of the review, we have gone with a trialling of opt-out.

Mr Madden: Yes.

Senator MOORE: What form are the trials going to take; has that been determined?

Mr Madden: We are looking at least at two trial sites. We are working with states and territories through the Australian Health Ministers Advisory Committee on the possible selection of sites. We need to find sites which are discernible so that people who are in the sites in the trials know that they are in the trials and people who are outside know that they are clearly not. So we will be doing consultation on the location of the trials. We will be trialling our communication processes and also working through education, communication and training for GPs and other health care providers in the trial sites. While the population and the individuals in those areas might have a registration, we want to make sure that the health care providers are engaged with that system as well. That is why it is important to work with the states, so that we have a connection through the public hospital system.

Senator McLUCAS: Are you proposing to use a PHN boundary for those trial sites?

Mr Madden: Not necessarily. The trial population that we are looking for across, again, a minimum of two and a maximum of five, would be about a million people. So it would probably be an amalgam of some PHNs and it could be based on postcodes that join a couple of PHNs together. We want to get a spread that includes lots of people or individuals and lots of GPs and specialists, allied and private, and public hospitals to get the whole connected community of health care providers for that community involved.

Senator MOORE: Have the terms of the trial been determined yet?

Mr Madden: No. Where we have got to at the moment is to describe the criteria that would pick out what those trial areas might be. We will be looking to appoint an independent person to create the evaluation criteria for that, certainly well before the trials begin.

Senator MOORE: Is all that covered in the $485 million?

Mr Madden: Yes.

Senator MOORE: So that whole process of trialling is involved in that as well as the ongoing operations of the existing processes?

Mr Madden: That is right.

Senator MOORE: In e-health—

CHAIR: Senator Moore, I am sorry to cut you off. I am going to have to be very sharp with the time of 12.25 and I know that Senator McLucas has some housekeeping she wants to do. So can I get this to be the last question for now? We can come back afterwards, if you would like, and then I will go very briefly to Senator McLucas before the lunch break.

Senator MOORE: Okay. We will go to Senator McLucas.

CHAIR: Thank you, Senator Moore.

Senator McLUCAS: And then I will come back to e-health after lunch.

CHAIR: Yes; that is fine.

Senator McLUCAS: There are a couple of things that I want to fix up from yesterday. Mr Bowles, you took on notice for me yesterday a question that was around costings for coalition policy on hospital funding. I asked a question and you said that you would investigate and come back to us.

Mr Bowles: Yes. I still do not have an answer yet. Was this the 50 per cent issue?

Senator McLUCAS: The 50 per cent growth fund, yes.

Mr Bowles: I do not have an answer. I will follow that up over lunch and see what I can find out.

Senator McLUCAS: Thank you. The other question that I have goes to some clarification around the Tax and Superannuation Laws Amendment (Medicare Levy and Medicare Levy Surcharge) Bill explanatory memorandum. That is not your bill, but you, I hope, have been consulted on it. On page 7 of the EM for the bill there is a table about which we would like to get some understanding at a later point in the estimates, if that is possible.

Mr Bowles: What was the bill?

Senator McLUCAS: It is the Medicare levy and Medicare levy surcharge bill. It is a Treasury bill, but if affects us. If I could have a conversation with someone about that at an appropriate point some time today, that would be great.

Mr Bowles: We will see what we can do but if it is a Treasury bill I may not be able to shed too much light on it other than what involvement we have had.

Senator McLUCAS: Okay; thank you.

CHAIR: Thank you. We will suspend proceedings now.

Proceedings suspended from 12:24 to 13:28

CHAIR: We will recommence and I will go to Senator Moore.

Senator MOORE: I was just talking with you, Mr Madden, and also with NEHTA about the opt-out trials and in terms of the process you said you were going to look at two sites. Is that right?

Mr Madden: Yes. We are looking for a minimum of two sites. We do not want to go any larger than five. Again, we have criteria that would describe what would make for the best sites or not for the best sites. Did you want to know about the logistics of the opt-out?

Senator MOORE: Yes, I do, because of the process.

Mr Madden: By September we are looking to have the sites selected. In the funding for the opt-out trials or what we have called the participation trials, we have funding for education, communication and training for healthcare providers and certainly a heavy dose of communication for individuals in the areas so they are aware of what this means to them, what they get as a benefit, what their rights are and what they do if they choose to opt out. We would be looking to do that from early 2016 with the training starting around about the same time for the healthcare providers.

We then have a period for two months where we have a system available for the communities to inquire and get information about staying in the system or opting out of the system. They will have a system where they can indicate their expectation or their option to opt out of the system and after that two months we will create skeleton eHealth records for all of those people who did not choose to opt out. We will then give them six weeks or so for them to log into and take control of their records, if that is what they choose to do, because the eHealth system will still have the patient or the personally control aspects. They can still determine who can operate their eHealth record on their behalf, healthcare providers that might be allowed to or not allowed to upload records to their record and who can or cannot see particular records. They will have five weeks to take control of those and to put all of those controls in place if that is what they choose to do. Then about two weeks after that we will create the records. We are looking to target that for having records in the hands of healthcare providers and individuals after the controls have been set some time during July 2016.

Senator MOORE: So it is just over the year?

Mr Madden: Yes.

Senator MOORE: For the option to opt out you have to have them all in first. Are you going to have to put trial sites where there are a lot of records already in the system?

Mr Madden: Part of the criteria—and this is something that has been suggested by our colleagues at the states and territories—is it would be best to go into areas where there is a degree of innovation. Whether that is involving people with a high level already registered in the system, I think it is one of those things that if you went into an area that was quite publicly saying, 'We don't want to use the system', that would give you a different view.

We have said we would look at places where there is innovation and use of technology from both the community and the healthcare providers' perspective as well as innovation in terms of using sharing and communicating across the health community in those areas. Again, we are looking for the states and territories to come back with some suggestions on where those areas might be.

Senator MOORE: So, you would be signing up new people. In my mind, when it was opt out I was thinking it was people already in that were opting out, but this is signing up new participants who can choose to be in and out?

Mr Madden: That is right. The average is running at about 10 per cent of the community who have already registered into the system themselves. If they are in the opt-out trial area they will be in the system already. It will only be those people who have not previously registered that will go through that opt-out process. If somebody does opt out and they choose later on to come back into the system they will be able to do that and if somebody fails to opt out because they either did not understand or they did not know that that was their decision at the time they will still be able to delete that eHealth record, as they can today, if they are registered.

Senator MOORE: So, at the moment everybody is either in the opt-out system or the opt-in system?

Mr Madden: That is right. The current system is an opt-in system.

Senator MOORE: That is what I thought.

Mr Madden: Everybody who wants to be in it needs to go in and consent by registering into that system.

Senator MOORE: So, that is the standard.

Mr Madden: Under the opt-out system everybody will be a member of that system unless they choose to opt out.

Senator MOORE: That is where I am having trouble with my thinking on the process. I can understand people opting in, but if you are not in there already. We can get the format of that. Do you have the guidelines of that public about how the trial will work?

Mr Madden: No. We have one more round of consultation with the states and territories later on this month.

Senator MOORE: When is that due?

Mr Madden: This is on 11 or 12 June.

Senator MOORE: That is a standard representatives from the states that will get together?

Mr Madden: Yes.

Senator MOORE: So, this should be all up and running. You went through the timetable before, but it should be early in the new year. I am just wanting to check the funding.

Mr Madden: All of those will be in place in the system in use from July 2016.

Senator MOORE: I was thinking the implementation process would be starting in the new financial year.

Mr Madden: That is right. It will be after people come back from holidays.

Senator MOORE: I would like to check on the money in terms of the process. Is the $485 million the full funding for eHealth for the next four years?

Mr Madden: We have three years funding for the operation and redevelopment or enhancement of the current system.

Senator MOORE: Is that separate funding?

Mr Madden: I am sorry?

Senator MOORE: I would like to know exactly how much funding you have. You had one year carryover from 2014-15. How much was the funding for the 2014-15 year?

Mr Madden: It was about $140 million.

Senator MOORE: So, that was standard operations for one year?

Mr Madden: Standard operation plus some consultation on the key recommendations from the review to formulate a package.

Senator MOORE: So, now for 2015-16 through until 2017-18 you have $485 million in total?

Mr Madden: We have $485 million, which will take us through to 2018-19.

Senator MOORE: And that is based on?

Mr Madden: We have three years of that for the operation of the system. So, $426 million of that is for the operation and redevelopment of the system to work on useability, clinical content and clinical workflow. We have four years funding for the other aspects of the package, which is the opt-out trials and the changes to the governance arrangements. That is the four years. We will be coming back to government during 2017 with some recommendations on the basis and on the outcomes of the trials to recommend a way forward either in continued opt in or move to opt out.

Senator MOORE: So, at this stage you have no money beyond 2018-19?

Mr Madden: That is right.

Senator MOORE: And the expectation is you would come back to government for that?

Mr Madden: Yes.

Senator MOORE: In terms of the process you have just given me. I have not written that down as neatly as I had hoped, but in terms of that how does it compare with your previous funding proposals?

Mr Madden: As in previous years' funding that we have been given?

Senator MOORE: Yes.

Mr Madden: One of the headlines on this one is we have actually got three years of operational funding, which is the longest period of operational funding we have ever had. The annual cost of that operational funding is incrementally greater than the operational funding for the current year and for previous years because the size and scale of the system continues to grow. There is a minor incremental growth in the operational costs in there, but there is also some money in there in the operations to do some of the enhancements to the system. We need to continue to make it more useable for clinicians and continue to make it more useable and the information more accessible, particularly in the eyes of an opt-out trial where we need people to be able to regularly understand what this system can mean for them so the questions that they would need to be answered will in fact be answered by our information.

Senator MOORE: You think there is a marginal increase on previous estimates?

Mr Madden: Yes.

Senator MOORE: The advantage for you is having three full years of funding?

Mr Madden: Yes. That three years of funding is certainly a strong sign to the health community. In trying to get other software vendors to join up and connect to the system the question was, 'So, what happens after 30 June?' So, it is three years continued. As I said, that is the longest period this program has been funded for in an operational sense.

Senator MOORE: When we spoke last you were saying that state hospitals were now signed up. Is that all state hospitals now signed up? The last time I spoke with you Queensland had just signed up.

Mr Madden: We have hospitals in every state signed up.

Mr Fleming: At this stage we have 399 hospitals from the public sector signed up. That comprises 152 in New South Wales; eight in South Australia; one in ACT as there is only one public hospital in the ACT; 219 in Queensland; four in Tasmania, which is all of their public hospitals; eight in Victoria, two in Western Australia; and five, which is their total, in the Northern Territory. We are working with the states that are not fully functional at the moment and with those hospitals of course, as you would expect, it is a hospital-by-hospital process, but those 399 are linked through. You can expect to see the public hospital numbers grow. In addition to that, we recently issued an invitation to the private sector.

Senator MOORE: That was my next question.

Mr Fleming: Seven contracts have now been signed with members of the private sector where we are working with their companies to link them through. That is another group that we are negotiating with at the moment.

Senator MOORE: That is your first access to private hospitals?

Mr Fleming: Private hospitals, absolutely. The intention there is they will link into the identifier systems but also into, obviously, the PCEHR to view it and to send a discharge and over a period of time some additional functionality will be added.

Senator McLUCAS: When the Senate select committee was in the Northern Territory recently we had evidence from clinicians and Aboriginal controlled health services in the Territory—and my recollection is NT Health but that may not be correct—saying that their eHealth system in their hospital system was brilliant and there was not the take-up of PCEHR because they were ahead of the game. What is your view of that assertion?

Mr Madden: If we go back in time in the Northern Territory, the My eHealth record system has been running successfully for a number of years. A key difference between their system and the personally controlled eHealth record system is that the person controlled it and the individual's ability to see their record. Northern Territory have been undergoing a transition from their My eHealth to the national personally controlled eHealth record and they are probably 90 per cent of the way through in transitioning across to the PCEHR. They are running through the process at the moment in registering people into the PCEHR. I think the last number I heard was 20,000-plus out of the 56,000 that were registered before, but the target is across the next six to nine months to get the remainder of that population through as they visit, on an opportunity basis, to the various clinics or hospitals in the Northern Territory.

The intention is that after a period of time they will keep access to the historical records in the My eHealth record, but it will be the case that all of the clinicians in the hospitals and the government funded primary care services will all be accessing their patient records through the PCEHR chart or into the future into the My eHealth record.

Senator McLUCAS: The other issue that they raised with us is connectivity and how difficult it is in particularly more remote areas to download. We were at an art show in Katherine that is a bit out of town and sometimes it takes them 20 minutes to download a record, which means that clinicians will not be entering as we are going through and then the inevitable delay. Maybe the record is not even entered. That is not your problem.

Mr Madden: Collectively, it is one of those things that has to improve otherwise the records will be ignored.

Senator McLUCAS: They did say to us that their NT record could not 'talk to' the PCEHR. Is that true?

Mr Madden: Probably the best way of describing that is that the people who are registered in the Northern Territory's My eHealth record system are in there as a consent into that particular system. The consent model for the personally controlled eHealth record is different so we actually need the patient's consent to be there. The movement of the patients, the movement of the records at a technical level in being able to read them through the various software is all there as capacity at the moment. As I said, they are moving that functionality across with the view into the longer term to actually shut down their own local services and rely solely on their clinical software. There is two main GP software variants used generally in the Northern Territory or the top end of Australia. They are all capable of connecting to, to both upload documents and read documents from the PCEHR.

At the moment they are able to run in both modes, to talk to the My eHealth record as well as the PCEHR but into the future they will just be talking to the national system.

Senator McLUCAS: Thank you.

Senator MOORE: What is the take-up amongst GP services at the moment? Do you keep data on that? What are the obstacles? Are they still the same as they were in the past?

Mr Madden: They continue to grow gradually. The questions we were getting from some of the consultations with the GP community or the healthcare providers at large were, 'Should we get involved in this? Will you still be here in 12 months, nine years, six months and now three months?' I think the expectation would be that that will start to grow. The commitment to the system being there is one of the factors. Having the majority of the patients registered in the system so that more than two out of 23 of their patients walking through the door will have one is something that will bring them in there, too.

We have a situation where some of the training which was delivered to GPs two or three years ago, if they have not accessed and used the system since they were trained they will need a refresher because things have changed a lot since then. We had a lot of useability problems. Our colleagues from NEHTA have worked closely with clinicians to work through the useability issues through the software that GPs actually use so that has improved.

In the operational funding we also have a review of the GP incentives. The incentives will be paid as an entitlement to those who use the system to upload records on behalf of what I would call their most in need patients. They will be the ones who have care plans. We would be looking for a shared health summary for a small proportion of their total patient base. That will be the set of what is the entitlement for the incentive as opposed to the past where it has been access to a system, registered to use a system and able to use it, but not necessarily use it. I think we are moving to that next phase now.

In order to deal with the gap between those who are prepared to use the system with confidence and those who are not, we will have training available. We will have the online self-directed resources for GPs to work through at their pace in their own timeframe all the way through to training systems so they can actually create patient records which are not for real patients and they can practise with creating those, changing them and getting familiar with the system all the way through to face-to-face training if that is what it takes. We have that factored into our work with that training commencing from later on this calendar year, from October, with those new incentives looking to be in place in early 2016 for all GPs across the country.

Senator MOORE: Does it cost them to be on it?

Mr Madden: Does it cost them to be on it?

Senator MOORE: Yes. Some claim that it does.

Mr Madden: I think there would be a perceived cost in needing to learn and become familiar with the system because it might take a little more time. The question is: what is the value in the investment of the time? I think there is an acceptance that, 'There is a business case for doing that, but if I am the only one doing it what's the point?' I think the bigger the population we get the better. In filling up the gaps of, 'Do I have the capacity? Do I have the knowledge? Do I have the confidence to use it?', we need to make sure they do and can use this confidently in front of their patients. We need to work through that process to get them across the line.

Senator MOORE: Do you have any figures of percentages of GPs? You keep the public hospitals but do you have any data that can tell us the percentage? You can take that on notice.

Mr Madden: We have numbers of practitioners registered in the system at the moment.

Senator MOORE: Are they practitioners or practices?

Mr Madden: Practices.

Senator MOORE: So, it is based on the practice?

Mr Madden: Based on the practice. So, 5,189 practices. Mr Fleming has already told you about the hospitals. There is over 1,100 retail pharmacies, 144 aged care residents services and another 1,099 other categories of healthcare provided.

Senator MOORE: So, is it growing?

Mr Madden: It seems to be growing at around about 34 or 35 per month.

Senator MOORE: Is it still mostly in New South Wales?

Mr Madden: New South Wales is certainly a high scorer. New South Wales is still running at 31 per cent. Victoria is at 23 per cent and then it scales down from there.

Senator MOORE: Queensland is quite low?

Mr Madden: Yes. Queensland is running at 20; South Australia is at nine; Western Australia is at 10; Tasmania is now running at about 10; ACT is running at about 10, as well as the Northern Territory.

Senator MOORE: Thank you very much.

Senator McLUCAS: I would like to ask a follow-up question around take-up. When we made the investment in 2013 to encourage people to enrol what were the daily numbers of people who were enrolling with the PCEHR? We actually invested money to get capacity into the system; is that what is holding us back?

Mr Madden: Yes.

Senator McLUCAS: We have more people in the system demanding of their doctor that they want to be using their record electronically.

Mr Madden: We will try to find the numbers back in the days when we were doing the assisted registration. The key point made in many of the submissions to the review was about getting the majority of patients registered into the system. The two ways you can do that is to invest in getting people to register in a system or a system then to register in the system and pay the cost for that. The alternative is to take away the burden for people who need to spend potentially up to an hour to learn about the system, register in the system and then get on with it.

Those two are really what we are looking to test through the process of the opt-out trials. There is a burden there for people to register. There is also the data in the matching pieces; if it is done at an assisted level where the keyboard work or the data input work is done when the person is not there anymore we get a high level of errors as well.

Senator McLUCAS: Has there been any consideration of investing in assisted enrolment?

Mr Madden: We have that as one of the options. The costings for that and the timing to do that are the two things would be compared against what the opt-out process would give as a possible alternative. The known costs are somewhere between $30 and $38 per person to do the assisted registration. If you scale that up into the whole community you are into hundreds of millions of dollars.

Senator McLUCAS: I am not suggesting the whole community but perhaps setting another target would be something reasonable to do. You are not saying that we will trial the opt-out model and not bother about any assisted enrolling or will you do both?

Mr Madden: We will be running some trials in the opt-in mode. We will call them opt-in trials. Noting that the rest of the country is in opt-in we will be inviting primary healthcare networks to come to us with some innovative ideas on how they might energise their community to join up, both from an individual's perspective and from a healthcare provider's perspective to compare that against the opt-out trials. We need to look at those innovative ways of driving that up. It is not necessarily just clipboards and people walking around with assisted registration but looking at other ways of getting their communities to work this through.

Senator McLUCAS: Thank you.

Senator MOORE: I am just playing with my figures, which is always nasty. You had $140 million last year as the full allocation and you have $485 million across four years into the future. That is not $140 million a year?

Mr Madden: We have funding for the trials and the governance arrangements for a four-year period, but we have funding for the operation of the system for three years.

Senator MOORE: We went through that before. What is the total?

Mr Madden: The total for the three years operation is $426 million.

Senator MOORE: Which is closer to the $140 million, but that is for three years?

Mr Madden: Yes, but the $140 million had more than operations. It actually had the consultation process.

Senator MOORE: Yes. You talked about consultations and different things. I am wanting to find out exactly how the core funding is going with the operational needs that you have. So, you have the operational needs to keep going in just your standard program of putting the system out into the area and signing up and then you have got an overlay of the specialist commitment for the trials for the opt-out. I am trying to see exactly what the financial processes are there. Can you give that to me in a document?

Mr Madden: We will take that on notice. The clarification is the $426 million is an amalgam of the operation of the system, the enhancement of the system to increase the useability, to increase the clinical content and the clinical workflows at the practitioner level, as well as the education and training for the GPs in order to meet their incentive entitlements.

Senator MOORE: So, that is operational plus two special projects?

Mr Madden: Yes.

Senator MOORE: That is the $426 million?

Mr Madden: On top of that, we then have the trials, which is about $50 million and about—

Senator MOORE: It would be really useful if you could give that to me in a document that I can understand.

Mr Madden: We will give you a nice table.

CHAIR: That is all on eHealth. I am in your hands.

Senator McLUCAS: Can we have Organ and Tissue donation.

Mr Bowles: I can just respond to a question. Senator McLucas asked me before lunch around that Medicare Levy Surcharge. It is a question best asked of Treasury, because the comparison page that you referred to, I think it was page 7, just changes the income. We do not have anything to do with that. That will be a Treasury issue.

Senator McLUCAS: So, you were not consulted around that at all?

Mr Fleming: We would not necessarily be consulted about changing income thresholds. That is a Treasury related issue.

Senator McLUCAS: We will do that through Treasury. I thought we may be able to get a quick answer so we do not have to write you a letter.

[13:55]

So there you are - an hour or two we won't get back!

Note we got:

1. No clarification as to how useability will be improved.

2. No clarification on other changes and incentives.

3. $50M to be spent on trials and no evaluation of how things have run to date.

4. No actual information on information usage of what is held in the system.

5. Apparently forced replacement of a working system by one that is yet to prove itself.

We really have some clever people running all this don’t we?

David.