Friday, October 16, 2015

See The Amazing Quality Of Our Parliamentary Debate On E-Health. It Is Just So Deep And Well Informed - NOT!

The debate is found here:
Here is what they said early on October 15, 2015 in the House of Reps.
Health Legislation Amendment (eHealth) Bill  2015
Ms KING (Ballarat) (09:53): As I was saying last night, the government in this bill is making changes to the Copyright Act that will specify that work will not be infringed where it is done for the following purposes: where the collection, use or disclosure of information is required or authorised under the My Health Records Act; where it is unreasonable or impracticable to obtain the individual's consent to the collection, use or disclosure, and the entity reasonably believes that the collection, use or disclosure is necessary to lessen or prevent a serious threat to the life, health or safety of any individual, or to public health or safety; where a permitted health situation exists in relation to the collection of health information about an individual; and where prescribed by the regulations, provided the purpose relates to health care, or the communication or management of health information.
The bill also makes a number of changes to the Health Identifiers Act, many of which are technical in nature. Others include allowing healthcare providers that are not registered under the national law—that is the 14 professions covered by the Australian Health Practitioner Regulation Agency—to access personally controlled electronic health records. This could include, for example, paramedics or social workers.
The new division clarifies when the recipient of a health service's healthcare identifier or other information can be collected, used or disclosed to another party. Division 2 provides that it can be collected, used or disclosed to another party for: assigning a healthcare identifier to a healthcare patient; keeping a record of healthcare identifiers and related information; providing healthcare to a healthcare recipient; for the purposes of the My Health record system; aged-care purposes; adopting a healthcare recipient's healthcare identifier; disclosing a healthcare recipient's healthcare identifier; disclosing information about a healthcare recipient's healthcare identifier; and additional purposes that will be specified in the regulations. Further changes to the Healthcare Identifiers Act allow the Healthcare Identifier Service Operator to disclose to a healthcare provider information about a healthcare recipient for the purpose of determining the recipient's healthcare identifier.
The new section 20 broadens the power to allow for future regulations to be made allowing prescribed entities to collect, use, disclose and adopt identifying information and healthcare identifiers. According to the explanatory memorandum, this is only for very limited purposes that relate to the provision of healthcare or to assist people who, because of health issues, require support. I appreciate that this could include entities such as the National Disability Insurance Agency and cancer registers, and these changes certainly make sense to the opposition. It is clear, as the explanatory memorandum states, that entities and individuals may benefit from the entity being able to associate disability or health related records with an individual's healthcare identifier.
The bill also allows for the viewing of certain disability or cancer registry records as part of an individual's MyHealth Record. This differs from the current situation where entities such as National Disability Insurance Agency and cancer registers are not authorised to handle healthcare identifiers or identifying information as they are not healthcare providers within the meaning of the Healthcare Identifiers Act. This will certainly allow for the collection of information by entities such as the NDIA and cancer registers, according to the explanatory memorandum, 'within tight limits related to providing healthcare and assisting individuals who require support because of health issues, without having to amend the act each time a new entity needs to be authorised'.
Because this is a somewhat significant change, as I said, whilst Labor does not oppose these measures—in fact, we think they are sensible measures—we think the change requires some scrutiny in the other place to ensure that people's privacy is protected. As I stated well at the outset, Labor does not oppose the intent of this bill. However, we do believe there are elements—especially those that relate to changing the way information can be collected and shared—that do require further scrutiny. As I said, it is not that Labor opposes the principles—many of them do at face value appear to be very common-sense and necessary changes to meet the policy intent—but, given the extent of the changes, stakeholders with direct experience and responsibility in delivering health care and working with personally controlled electronic health records should have an opportunity to provide feedback on the bill.
More generally, however, I again want to put on record Labor's strong support for an electronic health records system. It is, after all, our initiative. The reason we are here having this debate is that Labor, as part of its health and hospitals reform agenda, drove this change and built the architecture for an electronic health records system. Again, I add some words of caution to the government: it is an incredibly complex area and it will take time to get it right. It is important to not rush decisions just for the sake of being seen to be doing something in this space, particularly after the government has done very little for the last two years. It requires an approach that makes sure it has the effect intended. In particular, you want to make sure that you address the very issue that we are trying to grapple with: how to get health professionals engaged in uploading data and then utilising that data in an integrated system. How do you embed it in the everyday practice of general practitioners, specialists, our hospital system, our residential aged care, disability support, and, eventually, allied health professionals? How do you embed it as a normal tool of their trade. That is a really challenging prospect, and it takes time and effort to do that. It is not something, unfortunately, that there is any magic bullet to or any easy or swift answer to. It is a difficult area. So, I reiterate, don't rush to a solution in that area, because you are going to find yourself in a bit of strife if you do.
It was the Labor that introduced this reform, and we continue to see it as a vital component of Australia's health system. It is vital when it comes to improving the quality of care patients receive. It has enormous potential to improve the efficiency of the health system, especially in terms of reducing duplication, and it will ensure that a patient's medical record stays with them throughout their whole life. These reforms, once embedded as normal practice within our health system, will provide a platform for future technologies, many of which we will not even have thought of today, that have applications well beyond our imagination.
I will now move the second reading amendment that appears in my name. I move:
That all the words after "That" be omitted with a view to substituting the following words:
"while not declining to give the Bill a second reading, the House notes the Government's inaction on eHealth over more than two years and the inadequacy of this Bill in making real improvements to a national electronic health record system".
The DEPUTY SPEAKER ( Mr Goodenough ): Is the amendment seconded?
Mr Bowen: I second the amendment and reserve my right to speak.
The DEPUTY SPEAKER: The question now is that the amendment be agreed to.
Mrs PRENTICE (Ryan) (10:01): I rise to make a contribution to debate on the Health Legislation Amendment (eHealth) Bill 2015. There is a bipartisan commitment in this House to support greater adoption of electronic health records in Australia. Electronic health records in the Australian healthcare context are known as Personally Controlled Electronic Health Records, or PCEHRs.
The benefits of electronic health records are obvious to anyone who has ever had to navigate the health system. Health delivery in any country as large as Australia is complex and unwieldy. In Australia, it is further complicated by the at times opaque delineation of services between state and Commonwealth governments, and between public and private providers. What this means is that the average patient and their family are often moving between providers and between systems in the course of receiving treatment. These systems have different patient management systems and different records management practices. Sharing of information between providers and between systems is piecemeal and incomplete. Consequently, the effectiveness of medical treatment relies on patients being able to provide their treating clinicians with all medical information relevant to their condition. This may range from information as basic as age and blood type, to known allergies and, in some cases, details of chronic conditions that may impact on their treatment.
In the real world, this process frequently breaks down, especially with vulnerable patients. Details can be forgotten, or patients can present for treatment in a condition that renders them unable to provide details of their medical history. This has consequences for patient safety, and results in delays, inefficient practices and considerable frustration for medical professionals. It is estimated that 2.5 per cent of all hospital admissions are due to adverse drug events, many of which could be avoided if a complete medications history were available.
An estimated one in ten laboratory tests are duplicated or unnecessary—a percentage that would be slashed with widespread adoption of electronic health records. And 36 per cent of medical visits involve the clinician spending at least five minutes locating information—again, a delay that could be significantly reduced with better coordination of patient information.
When one considers that healthcare provision costs the Commonwealth government—indeed, the taxpayer—$27 billion a year, a figure that will increase to $250 billion a year by 2050, there is a clear imperative for government to ensure that wastage is minimized and patient outcomes are improved. Electronic health records offer substantial promise, but it is fair to say that in Australia that promise has yet to be delivered. Members will know that Personally Controlled Electronic Health Records were first implemented in 2012, following on from the commencement of the Healthcare Identifiers Service, in 2010. Since then, adoption of PCEHRs by patients has been slow. The minister noted in her remarks that to date only about one in 10 Australians have an electronic health record set up.
Electronic health records are a network economy—that is, the marginal benefits to users, be they patients or professionals, increases with greater adoption. Unfortunately, an adoption rate of 10 per cent by patients is not sufficient to encourage doctors to spend the time to familiarize themselves with the system and use it routinely. At the current rate of adoption, it is estimated that it could take a further fifteen years for a critical mass of the population to set up a PCEHR.
Despite the inertia in adopting electronic health records, a review of the system reveals continuing widespread support among the medical profession and patients for the concept. A key recommendation of the review was for PCEHRs to transition from an opt-in to an opt-out basis. This bill allows for the trial of an opt-out system on a region by region basis. I am advised that the move to trial opt-out arrangements is not opposed by members opposite, and I thank them for their bipartisanship in this important matter of public health policy.
The bill will change the name given to electronic health records in Australia from PCEHRs to the more easily understood My Health Record. A range of additional safeguards will also be introduced to ensure it that patients have ample opportunity to opt out, as well as increased penalties for misuse of personal information contained within electronic health records. Geographic areas chosen as trial locations will be determined based on publicly available criteria and will be made in consultation with states and territories. The trial will be accompanied by an education and communications strategy that will seek to mitigate any community concern. Following the trials, it is anticipated that the government will be in a position to make a final decision on whether to transition to a full opt-out system by late 2017.
This bill continues the efforts of successive governments to ensure that Australia has a widely respected and widely adopted electronic health records system. While uptake to date has been lower than anticipated, the concept remains sound and the potential benefits to patients and the government are substantial. I am confident that the measures contained in this bill will be a step in the right direction—a step towards Australia finally having a world-class electronic health record to go with the world-class health care provided by the hardworking doctors, nurses and other health professionals who comprise our health system. I commend this bill to the House.
Mr BOWEN (McMahon) (10:08): As the member for Ryan has said, the opposition is supportive of the thrust of the Health Legislation Amendment (eHealth) Bill 2015. I know that the relevant shadow minister has a considerable amount to say about it, and I am sure the House will benefit from his contribution.
Mr STEPHEN JONES (Throsby) (10:08): Thank you to the member for McMahon, who I know has a passion about personally controlled electronic health records which would have enlightened the debate and the House had he been given more time to speak upon it. Perhaps at the conclusion of my address, the member for McMahon will share his thoughts on this issue.
The subject matter of the Health Legislation Amendment (eHealth) Bill 2015 is electronic health records. It has a long history. The idea of e-health and maximising the capacity of online systems to extend the benefits of modern health care to hard to reach populations and make the existing delivery of health care more efficient and effective dates back to the 1990s. Successive governments have endorsed strategies; they have not always taken a consistent position from government into opposition, and the history of electronic health records is an example of that. It might surprise many to know that the Howard government was actually quite enthusiastic about the idea. As then Minister for Health and Ageing, Tony Abbott, the former Prime Minister, invested a fair bit of money into the idea but, when going into opposition, threatened to turn the tap off and said there would be no further support for the idea. I welcome the fact that, on review and reflection, the current Minister for Health sees the obvious benefit in continuing the initiative, legislated by Labor in July 2012, to move the paper based health system to a digital system and to improve the level of health care for all Australians.
What are the benefits? Quite simply, to ensure that we have a more secure system of keeping an individual's medical records. Some people worry about the privacy associated with electronic health records. There are actually a lot of advantages to an electronic health record which are not there for a paper based record. When you have an electronic health record, you have a digital footprint—or thumbprint might be a better way to describe it—for everyone who accesses or attaches themselves to that health record, something that cannot be said about a paper based file. So there are two sides to the privacy concerns that have often been raised by well-meaning and influential advocacy groups, many of whose concerns I share. There are two sides to these arguments. Other benefits include cutting down on duplication, stopping people falling between the cracks and having a more effective and efficient means of not only delivering face-to-face healthcare services but ensuring that people are using the right pharmaceuticals and that pharmaceutical products are distributed and administered properly as well. It is especially important for people with complex and chronic health conditions.
The bill that we are debating today forms the government's response to the 2013 review into the personally controlled electronic health record—I will just refer to it as PCEHR from here on in—as well as the 2013 review into the health identifiers service. It implements a number of those reviews' recommendations specifically. It enables opt-out trials to be undertaken but with the same patient controls contained in the PCEHR and allows that opt-out to be adopted nationally if the trials are proven to be successful. The existing opt-in system will continue to operate in the meantime. It is a system that I have availed myself of and I certainly hope, without wanting to reflect upon the chair, Mr Deputy Speaker, that you have availed yourself of as well. It will allow the government to make regulations to authorise new entities to handle healthcare identifiers and other protected information. The bill also changes the name of the PCEHR, perhaps pleasantly, to the My Health Record system—perhaps a much more user-friendly name. In addition to this, it increases the range of enforcement and penalty options available for intentional or deliberate use, introduces criminal penalties and amends the privacy framework.
The PCEHR is, of course, a proud Labor reform. When Labor were in office, we managed to get more than one million Australians signed up, on a voluntary basis, for a personally controlled electronic health record. That number has continued to rise up to almost 2.4 million Australians today and I anticipate that it will continue to rise while we are trialling the opt-out system. It is also very good to know that, since Labor introduced its reform, over 3,000 specialist letters have been uploaded, over 5,000 general practices have registered for the PCEHR and over 1½ million prescription documents have been uploaded. As the member for Sydney said when she was the Minister for Health, Labor sees eHealth as a 'natural extension of our universal health system, Medicare'.
Of course, after more than a decade of talking about the need for an electronic health record, it took Labor to actually put it into place. In 2010 the then minister for health, Nicola Roxon, announced that Labor would invest over $450 million over two years, as a key building block in the National Health and Hospitals Network. Specifically, Labor allocated funding to provide summaries of patients' health information—including medications, immunisations and medical test results—in addition to secure access for patients and healthcare providers to their e-Health records via the internet, regardless of their physical location, but also to provide rigorous governance and oversight to maintain privacy.
E-health records are a critical piece of infrastructure for any modern health system, and their potential in reducing duplication and allowing a more efficient health system cannot be underestimated. Following changes made by the member for Sydney when she was Minister for Health, Labor's system can hold a summary of the patient's important medical history, a list of medications prescribed and dispensed, allergy information, childhood immunisation records, child health and development information, hospital discharge reports, organ donor status and advance care planning details, amongst many other issues, including Medicare and PBS claims data and private notes patients make about their own health records.
In 2013, Labor made an additional investment to ensure pathology and diagnostic imaging results could be included in a patient's e-health record—an important initiative. We know that this is an area where savings can be made, because of a duplication of the provision of services, and we know that, with a better collection of that data and information, there is significant capacity for an enhancement of services and a reduction of the cost to the funders, including the Commonwealth.
The government has just not done enough when it comes to e-health. It is disappointing, because we know what benefits a well-functioning electronic health record can deliver. We know there are significant benefits. When then minister Nicola Roxon introduced the reform, she said, 'About two to three per cent of hospital admissions in Australia are linked to medical errors, which equates to 190,000 admissions each year and costs the health system well in excess of $650 million per annum.' More than that, she noted that about eight per cent of medical errors are because of inadequate patient information. So the potential that an electronic health record has for improving the care patients receive, as well as delivering efficiencies, simply cannot be underestimated. Indeed, it has been estimated that the benefits from an electronic health record program will reach $11.5 billion over the 15 years from 2010 to 2025.
It is disappointing, against this background and with this data within our grasp, that the government have done nothing for the last two years. This is probably a product of the fact that they did very little on the issue when in opposition. The then shadow health minister could not have been less interested in this important initiative; they went to war on it. On coming into office, and perhaps, after two years, succumbing to the best advice available to them, they have decided that this is an important issue, and we are now revisiting it.
But, in fact, the government has done significant damage not only through its inaction but by cutting $215 million from the program. Last year, there was $700 million allocated for the redevelopment of the Personally Controlled eHealth Record System. In launching its so-called rescue package, the government has in fact cut $215 million from this important program. But, more important than that, it has lost the capacity to yield the savings that would have been available to it, had it kept the momentum that was put in place by Labor. Let us not forget, the savings that we are talking about are in excess of half a billion dollars per annum—savings that can then be reinvested into the health system.
With these sorts of savings available, the government would not have had to contemplate the ridiculous propositions around the GP taxes mark 1, 2 and 3. The government would not have had to contemplate some of the proposals around increasing the price of medicines to some of our most vulnerable within the community. Through investing in the healthcare system and through investing in electronic health records, the savings that would have been available to the government over these lost two years could have been yielded, and they would have avoided the terrible decisions they have made in the area of health policy.
The issue of privacy concerns, which I have alluded to, is something that needs to be taken seriously. Nothing could elicit more concern than the belief that some of the most intimate conversations that occur between you and your doctor about the conditions of your health, both mental and physical, may somehow become available to other third parties, thereby breaching your privacy and the important responsibility and duty that the doctor owes to their patient. This bill introduces criminal penalties, including imprisonment, for unauthorised collection, use or disclosure of information from the My Health Record system and the holding or handling of information outside of Australia. It achieves this by amending the Healthcare Identifiers Act 2010, the Privacy Act, the Copyright Act, the Health Insurance Act and the National Health Act 1953.
Labor accepts that a number of the changes are very sensible indeed—for example, allowing that service providers that might not meet the definition of a healthcare provider under the existing act, such as a palliative care or aged-care service provider, be included. These are sensible propositions.
However, it is of the utmost importance that patients' privacy be given the highest regard possible, and it is for this reason that Labor believes these provisions do require further scrutiny. Whilst we will not be opposing the bill in this House, we would like to see more scrutiny of this particular aspect of this bill. When the bill reaches the other place, we will be calling upon our colleagues in the Senate to have it referred to an inquiry so that some of these issues can be further adumbrated.
In conclusion, Labor does not oppose the majority of changes that the government proposed to make to the bill. In fact, we warmly receive the government's rediscovery of this important area of health policy. However, we do have concerns and, for that reason, we will be calling upon our colleagues in the other house to facilitate the parliament as a whole to ensure that we have greater knowledge of those identified issues and greater input from all stakeholders into those identified issues.
Mr WHITELEY (BraddonGovernment Whip) (10:23): I rise to speak on the Health Legislation Amendment (eHealth) Bill 2015. This bill is a part of the coalition government's responsible and effective approach to the health system in this country. I do want to just say that I come to this debate today in this place having been the shadow minister for health and human services in the state of Tasmania for four years. As a previous contributor said, this issue has been part of public policy discussion for many years and, in my view, for far too long.
Our health system is an extremely important part of the fabric of our society. It consumes enormous amounts of financial resources, as taxpayers would expect it to, but there are ways in which we can now use technology to ensure that efficiencies are in place and that double dipping, duplication and doctor shopping are not issues. We need to be looking at all of these issues to ensure that the hardworking taxpayer money that is invested into the area of health in this country is working at its best and we are extracting every opportunity from every dollar spent.
This government acknowledges the difficulties facing Australians today in seeking medical assistance from multiple doctors, sometimes in different cities, areas and even states. The e-health system will greatly improve patient health outcomes as doctors are able to access patient records quickly. This government is cognisant of the need to make our comprehensive healthcare system more efficient and more effective. This bill is part of that process and specifically seeks to amend the Personally Controlled Electronic Health Records Act 2012—the PCEHR Act—in order to better facilitate positive outcomes for all Australian systems when it comes to health.
Under the previous government, the Healthcare Identifiers Service came into being, which is the foundational service of the PCEHR. The Healthcare Identifiers Service is a national system for consistently identifying individuals, individual healthcare providers and healthcare provider organisations for healthcare communication purposes. Both the HI service and the PCEHR are helping to facilitate a more efficient and effective healthcare system. This government is seeking to build on and improve the current service in a number of significant ways.
First, however, I believe it is important to understand the reforms that this government is enacting within the context of this electronic framework. This national electronic system commenced in July 2010 and was the result of a joint initiative of all Australian governments as part of accelerating work on a national electronic health record system to improve patient safety, to support safe and efficient sharing and storage of person health information and to increase efficiency for healthcare providers. It is jointly funded by the Commonwealth, state and territory governments.
Under the previous government, a review in 2012-13 found that the core functionality of the HI service was operating effectively; but given the PCEHR system is now impacting directly on clinical workflows, there are emerging issues that needed to be addressed. The HI review made 24 recommendations to improve the HI service. In response to some of those recommendations, the PCEHR system was implemented in July 2012. Its aim was to overcome significant issues facing health care that were arising from the fragmentation of health information across a vast number of different locations and different systems. In many situations, quick access to key health information about an individual is not always possible but is often necessary for the patient.
A review of the PCEHR system was undertaken in 2013. It found that there was overwhelming support for continuing implementation of a consistent electronic health record system for all Australians, but that a change in approach was needed to correct early implementation issues. The PCEHR review made 38 recommendations aimed at making the system more useable and able to deliver the expected benefits in a shorter period of time. The recommendations include establishing new governance arrangements, moving to an opt-out system for individual participation and improving system usability and the clinical content of records.
The government strongly believes in the benefits of an effective and efficient electronic record system. Such a system rectifies many issues facing our healthcare practitioners and delivers better results for our citizens. The coalition government's response to the recommendations of the PCEHR review was announced in the 2015-16 budget. We committed to strengthening e-health governance and operations by establishing an Australian commission for e-health to manage governance operation and the ongoing delivery of e-health. We also are committed to trialling new participation arrangements, including an opt-out system; we are committed to improving system usability and the clinical content of records; we are revising incentives; and we are delivering education and training to all healthcare providers.
The government is also renaming PCEHR—thank goodness for that—to My Health Record. What do you think? Do you agree? Whilst this government is committed to lower, simpler taxes, we are also committed to simpler and more efficient language. As I said, thank goodness for that. We have made significant commitment in the eHealth space and are today delivering on those commitments.
As a sideline, you do often wonder how on earth some of these acronyms ever get into operation. Sometimes you read one and you go, 'Didn't someone put those letters in a row to see what they actually spell?' But, obviously, some do not. Either that, or they have a very good sense of humour.
To get back to the main point, whilst we are delivering on recommendations made through extensive reviews, we are also staying very proactive in this space. Trials of participation arrangements—including the important opt-out trials—are intended to inform future strategies for increasing uptake and meaningful use of the myHealth Record.
This government appreciates that limited access to health information at the point of care can result in a greater risk to patient safety, can deliver less than optimal health outcomes and assist in the avoidance of adverse events of treatment. We remain committed to decreasing costs of care and time wasted, and we know that this can be delivered through providing a more effective mechanism for collecting or finding information.
This bill will deliver on our commitment to making health care more efficient through avoiding unnecessary or duplicated investigations; reducing additional pressure on the health workforce; and increasing participation by individuals in their own healthcare management. Our obligation to provide a comprehensive healthcare system is a priority of the government but we are also vigilant in ensuring our healthcare system is as efficient as it can be, thus maintaining our commitment to the taxpayer by ensuring the long-term sustainability of what is a very under-pressure health system.
The coalition government will continue to lead the national rollout of eHealth technology and services, and work with the states positively to support eHealth foundations and to finalise a national eHealth strategy, which will identify the priorities for future Commonwealth and jurisdictional investment in eHealth.
Productivity improvements such as those that can be delivered by eHealth are needed—they are really needed—to help counter the expected increase in the unit costs associated with the delivery of health care. Leveraging eHealth is one of the few strategies available to drive microeconomic reform to reduce Commonwealth health outlays.
I remind this chamber that the annual Commonwealth costs of health care are forecast to increase by $27 billion to $86 billion by 2025 and over $250 billion by 2050.This is an enormous cost burden and is the consequence of maintaining a comprehensive, world-class healthcare system. Yet whilst our broad healthcare system is important and integral in delivering quality of life to all our citizens, it is now what we would commonly call a very sacred cow.
We should not be afraid to reform our healthcare system and ensure its efficiency into the future, and to ensure that hardworking taxpayers' money—for a service that they obviously expect for them and their families—is actually sustainable into the future, and, as I said earlier, that we are getting the best bang for the hard-earned buck. Rather than being uncompassionate, it is irresponsible to maintain a view that our healthcare system is beyond reform. Any scare language around the fact that any reform is bad for the health system is not helping the public policy debate in any way, shape or form. It is irresponsible to refuse to make our tax dollars work harder in our expansive healthcare system. That is why reforms enacted under this government are so essential.
It is only a coalition government which can deliver an effective, efficient and economically sustainable healthcare system today and for future generations. Whilst the previous government implemented the PCEHR system as a first step, today this government is making, I believe, meaningful progress in overcoming serious issues facing health care arising from the fragmentation of health information. We understand the opportunities that technology provides us with, and that is why we have embraced eHealth and are developing a more efficient system.
We acknowledge that health information is spread across a vast number of different locations and systems, especially as more Australians are constantly moving between various state and territory health systems. It is estimated that 2.5 per cent of hospital admissions are due to adverse drug events due to incomplete medication histories. This is not an acceptable state of affairs in any first world country—it is not acceptable anywhere. I know that my state of Tasmania and the electorate of Braddon are not the only state and constituency facing hospital shortages. That is why this government is making every effort and taking every opportunity to leverage better healthcare outcomes for all.
Thirty-six per cent of visits involve the clinician spending at least five minutes or more locating information. Just think about that: 36 per cent, in over a third of all visits to any clinician five minutes of it is spent just locating information. In any language, whether it concerns the health system or the education system, time is money. In year 2009-2010, 83 per cent of Australians visited a GP with a total of 116.8 million general practice services paid for by the taxpayer through Medicare. The collective waste of time and energy over these huge volumes of patients is staggering, and that is only looking at the opportunity costs associated with GP visits. When you take into account that this waste of time is constant among all healthcare practitioners it is astounding and it is a significant cost to the taxpayer.
Currently, 10 per cent of laboratory tests are avoidable through electronic health records—that is right: one in ten very expensive laboratory tests are unnecessary. Due to duplicated investigations, these tests occur not only wasting time but taking up time and resources that could be directed to more necessary testing. We do not have to have an ideological debate in this place about the left, the centre-right or the right view of health. This just makes sense. If we can improve the circumstances of all Australians and get a better return on hard-earned taxpayers' money, it has to be a good result irrespective of what side of politics we may be on. Currently, when a person attends a new provider and their previous test results are not available, this leads to huge, unnecessary duplication—especially as Australian citizens are more fluid, as I said, in their living arrangements.
These are just some of the areas this bill seeks to address. This bill will change the name, as I said, and will enable opt-out trials to be undertaken for individuals in a manner that retains the same patient controls as were provided. But while these trials are operating in defined areas, the existing opt-in system will continue to operate everywhere else in Australia. If the trials are successful, and I suspect they will be, the government will decide to implement opt-out nationally. This bill enables that to occur if and when that is the case.
To make way for new governance arrangements that will be established, this bill will abolish the existing PCEHR Jurisdictional Advisory Committee.
In order to better protect the sensitive information that can be contained in a myHealth record and to provide a more graduated framework for responding to inappropriate behaviour that is proportional to the severity of a breach of either the HI or myHealth system, the bill will introduce new civil and criminal penalties and provide that enforceable undertaking. This government is delivering a more comprehensive and effective system and it also strongly believes in the consequences of breaching the integrity of that system.
In the short time that I have left, I just make a plea to all members of parliament that, as one, we should all be committed to efficiencies within our health system. We should not be scared of that technology that is now available to us. Every man, woman and child now knows that, with all online purchases and online records, much of our lives is exposed basically to the world. I would encourage everyone to understand that it is very much in the best interests of the health system of this country to move to a fully implemented myHealth Record system. I thank the House.
Mrs ELLIOT (Richmond) (10:38): I rise to speak on the Health Legislation Amendment (eHealth) Bill 2015, which is aimed at streamlining the eHealth system within Australia. As the previous speaker said in summing up, it is important that we embrace the technology available to us, particularly to improve, in this instance, our health systems. There are major opportunities for the expansion of e-health to improve so many health outcomes. So I certainly agree with many of the points that he did make, particularly in terms of embracing the benefits of such technological advances as we do have. Indeed, we have said on this side of the House that we certainly support the intent of this bill.
We have mentioned how we would like to see some further scrutiny, but we certainly do support the intent because, of course, eHealth was a Labor initiative and it does have great potential to enhance our health system. The primary purpose of the bill is to modify the Personally Controlled Electronic Health Records system. This system contains an electronic summary of a person's health records, which allows individuals and healthcare providers to access all that vital health information all in one place. The information is available online, so it is fantastic that it can be accessed where and when it is actually needed. Under health situations which at many times may be urgent that information can be accessed. So the opportunities available with e-health are tremendous. Under the bill, the personally controlled electronic health record will be renamed the myHealth record.
These changes are proposed in response to recommendations made by the review in December 2013. The bill will additionally implement recommendations of the 2013 review of the Healthcare Identifiers Service, which is a foundation for these e-health measures. Further to this, it will make several amendments to the legislation in order to improve the operation and cohesiveness of these very important health systems. This bill will also change the governance arrangements and the system's usability.
What is important about this bill is that it will enable opt-out trials to be undertaken but with the same patient controls as contained in the Personally Controlled Electronic Health Record system, and it importantly allows opt-out to be adopted nationally if the trials are proven to be successful. In the meantime, the existing opt-in system will remain in place when these trials start. The bill will allow the government to make regulations to authorise new entities to handle healthcare identifiers and other protected information. It also increases the range of enforcement and penalty options available for intentional or deliberate misuse, introduces criminal penalties and amends the privacy framework. The government has stated that individuals in opt-out trials will automatically have a myHealth record created for them unless they opt out, and I understand they will have a number of ways to do that.
I was pleased to see that the government has undertaken that extensive communication will be undertaken in the trials before the trials actually begin to allow individuals to make informed decisions about whether or not to opt out. It is especially important, I think, for everyone to be aware of the benefits of e-health, particularly for our older Australians, obviously, who often have more complex and complicated health needs and who, I think, would be perhaps some of the greatest beneficiaries of the eHealth record. So it is important that extensive communication occur so that they can fully understand the benefits of such changes to the system.
I understand that the trials are expected to commence in 2016, and it is understood that they will take place in three locations. One location is most likely to be in northern New South Wales. I think my electorate of Richmond would certainly welcome a trial such as this, particularly, as I say, with the higher number of older Australians there. Another location, I understand, is metropolitan Queensland, and a further, third, site is yet to be determined at this stage.
This eHealth system has been so successful—and, of course, it is a Labor reform that was brought in by us in government. It was initially brought in through an opt-in-model. Labor introduced the Personally Controlled Electronic Health Record system in July 2012 to move the paper based health system to a far more efficient digital system. The main reason was to improve the level of health care for all Australians, especially those with complex and chronic health conditions. There are so many benefits for them. This change was needed due to the complex and often inefficient paper based system. Having such paper based systems can ultimately lead to poorer health systems and poorer health outcomes as well. There is so much potential with e-health.
This change, initiated by Labor, represents an ongoing commitment to improving our health systems which, of course, began with the introduction of the Medicare system of universal health care, and so distinguishes us on this side of the House. Labor is always looking for ways to improve the health system for all Australians and is very committed to making sure those improvements are in place.
When last in office, Labor achieved substantial milestones in the progress of e-health. We encouraged over a million Australians to sign up for the online system, and this growth has continued to expand to almost 2.5 million Australians today. That is a huge increase. Since Labor introduced these reforms, I understand over 3,000 specialists' letters have been uploaded, over 5,000 general practices have registered for e-health and a massive amount of more than 1.6 million prescription documents have been uploaded. So there certainly has been a lot of interest and involvement in e-health so far.
When we look at some of the history and evolution of e-health, there was more than a decade of debate in which, really, little action did happen. It took the Labor party to actually create the change to e-health. As stated by the member for Sydney when she was the health minister, eHealth is merely an extension of Labor's universal healthcare system, Medicare. I think it reinforces Labor's commitment to the principles of a universal national healthcare system, which is the basis of a strong Medicare system. A system which has, of course, been under threat generally from this current government. We have seen a number of versions of their GP tax, which would potentially have devastating results across the country, especially in rural areas, as well as $50 billion in cuts to hospitals. The impact of that has been very harmful, particularly in regional and rural areas such as my electorate of Richmond. Australians are gravely concerned about the extent of this government's harsh cuts, and some of those harmful health outcomes.
When we are talking about the history and the evolution of eHealth, having undertaken such significant health changes in the past, designing and implementing such an e-health system proved to be a challenge that only a Labor government would truly commit to and undertake. In 2010, the then minister for health, Nicola Roxon, announced Labor's two-year $467 million investment in developing the National Health and Hospital System. This funding was directed in several key areas to serve, essentially, as a building block for the growth of our health system. Specifically, funding was allocated to a range of areas relating to e-health, including providing summaries of patients' health information, including medications, immunisations and medical test results. A key area of funding was also the establishment of secure access for patients and healthcare providers to the online records. An investment priority was to also provide rigorous governance and oversight in order to maintain privacy and to ensure that healthcare providers had access to national standards, planning and core national infrastructure required to use the e-health system. Labor understand the health needs of a modern Australia, and we do see eHealth as a critical piece of infrastructure in any healthcare system, which is why we have said we certainly support the intent of this bill.
The potential for e-health records to reduce duplications and allow for a more efficient healthcare system cannot ever be underestimated. If we look to the extensive record in terms of what e-health can hold, there can be a summary of the patient's important medical history, the lists of medications prescribed and dispensed, allergy information, childhood immunisation records, child health and development information, hospital discharge reports, organ donor status, advanced care planning details, summaries of individual patient health events, Medicare and PBS claims data, and even private notes made by patients about their own health. All of that is vitally important to have there. In 2013 Labor made an additional investment, which enabled even pathology and diagnostic imaging results to be included in a patient's e-health record. So it is absolutely wonderful to have that all contained in one particular area and easily accessed, often urgently, so that all of that information is available to a healthcare provider, which is very important.
Unfortunately, the inaction of the Liberal-National government in their two years of government has certainly been disappointing when it comes to the lack of progress with e-health so far. We certainly saw last year that there may have been $700 million allocated for investment into the development of eHealth, but the government's so-called rescue package only served to cut this essential program back by $215 million. Compounding this situation is the fact that the government has not allocated a single dollar to the program for the entire 2018-19 financial year. That is disappointing because it has already been established that this system is vital in improving the efficiency and effectiveness of the healthcare program, and it means that this program will become increasingly cost-effective for the health system over time, so it is vitally important that it is implemented properly and funded effectively and efficiently. The government's lack of action raises serious concerns about their long-term commitment to reform and, more importantly, the health care of this nation.
These reforms are very important, and there is very strong proof as to why they are important. When Labor first introduced these measures about two per cent to three per cent of hospital admissions in Australia were linked to medication errors, which equates to 190,000 admissions each year and costs the health system $660 million, and about eight per cent of medical errors are because of inadequate patient information. When we look at those figures, there is a huge potential under this system to make sure there are major improvements in healthcare outcomes and also major savings due to all of those errors that did occur with ineffective and inefficient patient information.
In an electorate like mine, Richmond, on the New South Wales North Coast, where there is an ageing population, e-health measures are vitally important. The potential that an e-health record has in improving patients' care, especially the elderly, can never ever be underestimated—as I said, because of the often complex health concerns that older Australians do have. When we look overall at some of the benefits of e-health, it has been estimated that the benefits from this program will reach $11.5 billion over the 15 years from 2010 to 2025. That is a major achievement.
Labor supports the majority of changes the government proposes to make through this bill. Our concerns do lie with the length of time the government has taken to do anything in relation to e-health and to act on it. We do accept that a number of the changes they have made are very sensible, such as allowing service providers that might not meet the definition of a healthcare provider under the existing act, such as a palliative care or aged-care service provider, to now have access to it. So it is very good, and I certainly commend the government in terms of those changes. It is also of the utmost importance that patients' privacy be given the highest regard possible, and it is for that reason that Labor believes some of these provisions do require further scrutiny. We have stated that we believe that further scrutiny should occur when it is in the other house, in the Senate. We would like to see some more detail and get some greater reassurances around those privacy provisions that are contained. We do think that is vitally important.
In conclusion, we certainly do support the intent of this bill. We know the benefits of e-health as we initiated it, and we would certainly like to see it expanded properly. These new systems do seem to be very effective, and we look forward to the further expansion of e-health to improve the health outcomes for all Australians.
Ms LEY (FarrerMinister for Health, Minister for Sport and Minister for Aged Care) (10:51): I am pleased to sum up the Health Legislation Amendment (eHealth) Bill 2015. The My Health Record system has the potential to change the nature of health care in Australia and become a widely accepted, everyday part of good healthcare management. This bill gets us closer to that goal. I thank the members for their contributions to the debate on this bill. I thank members of the opposition for, in the main, approving the direction we are taking and for understanding the vital importance of this e-health record coming to fruition as soon as possible.
The bill will reboot the national electronic health record system. It will also rename it as My Health Record, which is simpler, more meaningful and ultimately for the individual to whom it relates. The bill also implements the recommendations of the 2013 reviews of the national electronic health record and the Healthcare Identifiers Service, which facilitates increased participation in the system and improvements in usability and clinical content for individuals and healthcare providers.
At present about one in 10 Australians has an electronic health record. That is not enough to make it an effective national system, and doctors do not see enough value as yet to use it. If the majority of people have a My Health Record, more healthcare providers will use it and include their patients' health information on it, and this will improve the overall value of the system. In order to identify the optimum approaches for maximising participation in the system and increase uptake, the government will conduct trials of different participation arrangements in 2016. These will include trials of an opt-out model.
The bill enables me, as the responsible minister, to make rules to apply the opt-out arrangements to a community. I will consult with the states and territories before making any such rules. The process for choosing trial sites has been made public, and trial sites are expected to be selected shortly. Individuals in an opt-out trial would automatically have a My Health Record created for them unless they opt out, which they will be able to do in a number of ways. Individuals who do not opt out will be able to exercise the same access controls over their My Health Record that are available today so that they can manage who can access their My Health Record and what information it contains. Extensive communication will be undertaken in the trial communities before trials begin. This will allow individuals to make an informed decision about whether or not to opt out. Outside the opt-out trials, the My Health Record system will continue to operate on an opt-in basis.
To ensure that we implement the best systems for Australians, an independent evaluation of the trials will be undertaken in 2016. If the trials provide evidence that an opt-out system is a better approach for improving participation in the My Health Record system, the government may decide to implement the opt-out model nationally. The bill also makes a range of other amendments as part of improving the operation of the My Health Record system and Healthcare Identifiers Service. Key changes will broaden the penalties available for deliberate misuse of certain information; clarify what is considered to be a health service and health information; establish copyright arrangements to ensure that the permitted use of health information obtained from a My Health Record does not infringe copyright; provide for regulations to specify new entities that may handle healthcare identifiers for health related purposes; and align the legislative frameworks for both the My Health Record system and the Healthcare Identifiers Service. These changes take us closer to delivering a My Health Record system that can help improve the health and wellbeing of all Australians.
The DEPUTY SPEAKER ( Mr Mitchell ): The original question was that this bill be now read a second time. To this the honourable member for Ballarat has moved as an amendment that all the words after 'That' be omitted with a view to substituting other words. The immediate question is that the amendment be agreed to.
Question negatived.
The DEPUTY SPEAKER: The question now is that this bill be now read a second time.
Question agreed to.
Bill read a second time.
Third Reading
Ms LEY (FarrerMinister for Health, Minister for Sport and Minister for Aged Care) (10:56): by leave—I move:
That this bill be now read a third time.
Question agreed to.
Bill read a third time.
----- End Extract.
A load of pathetic attempts at political point scoring and utter superficiality and magical thinking. Labor seems to think they did a great job and the Libs think they can fix it!
Just hopeless!


Anonymous said...

When you head your article "It is just so deep and well informed" I and anyone else would breathe a sigh of relief that at long last you finally approve. The heading can be reproduced everywhere and used to demonstrate how supportive you have finally become. Also, because of the reassuring stance you have taken many would not necessarily read further because clearly the debate in Parliament is all goodness.

ON THE OTHER HAND - some of your readers know the heading simply reflects your style of 'cynicism / sarcasm'. Some of us will read the heading and interpret it as saying:

"See how little is understood in our parliamentary debate on eHealth. It is just so shallow and ill informed"

There is no ambiguity here; the message is clear. You would do well to remove the cynicism if you want your messages to be taken seriously and eliminate any possibility they can me reinterpreted (misinterpreted) to achieve an outcome which you had never intended. Sorry to be so blunt but you do good work and you should take care not to unwittingly undermine it in this way. Keep up the good work.

Dr David More MB PhD FACHI said...

I think my comment at the end of the Hansard extract is pretty clear!



Anonymous said...

No issue with your comment at the end - quite valid. Have another think about what I said.

Dr David More MB PhD FACHI said...

Given it is Friday I took the view I would startle regular readers - until they get to the end!! My view have not changed and I am as sick of all this stupidity and nonsense we are being fed by our 'leaders'.

All the press commentary today makes it just possible something might change!

I doubt it however.


Anonymous said...

Now that both major parties clearly want to 'own' the PCEHR and its revamped child, I suspect it will be a many years before there is any hope of an evidence-based review of this system and its contribution, dollar for dollar, to health outcomes. The only way thins might change earlier would be if there were a big stink about technical glitches, cost over-runs, malfeasance, or patient harm.

Anonymous said...

Whoever commissioned the worst IT project of all time

Politicians - Federal & State should all take note:

Back in the Blair era, someone had the bright idea that the entire NHS should use the same computer system, so that patient records could be shared. So began one of the most wasteful sagas in British government history. It was delayed and delayed and delayed, and was never rolled out nationally. By the time the Conservative/Liberal Democrat coalition came to power in 2010, ministers decided that it would be more cost-effective to cancel the project than to continue. The cost of this procurement failure came to over £10 billion, £2 billion more than the current Conservative government agreed to boost investment in the NHS by over the course of an entire parliament. Richard Bacon, a member of the House of Commons Public Accounts Committee, described it as “one of the worst and most expensive contracting fiascos in the history of the public sector.” Just think what £10 billion could have achieved had it been spent on patient care.