Senate Estimates - Community Affairs Legislation Committee - February 28, 2018. ADHA - Questions And Responses. Worth A Close Read!

Here is a transcript of what went on very late last Wednesday evening in Canberra.

Community Affairs Legislation Committee
28/02/2018
Estimates
HEALTH PORTFOLIO
Australian Digital Health Agency

[22:50]

Senator GRIFF: When is the universal automatic enrolment of the My Health Record expected to go live?

Mr Kelsey : The timing of the opt-out is a matter for government. Ministers are considering it at the moment. The legislative instrument that the budget measure determines that the opt-out has to have occurred before the end of 2018.

Senator GRIFF: You don't actually have a nominal go-live date at this point?

Mr Kelsey : Not at the moment.

Senator GRIFF: Are there still issues that need to be resolved within the system?

Mr Kelsey : No, the program is tracking green, so it's purely a matter for ministerial decision.

Senator GRIFF: So you are ready to go now, if the minister decides you are able to go now?

Mr Kelsey : That's correct.

Senator GRIFF: In answer to a question I put on notice, which is SQ17-001360, the department said that there would be a national opt-out period in mid-2018. When the opt-out portal is actually going to happen is again a government decision; is that what you're saying?

Mr Kelsey : That's correct.

Senator GRIFF: So you are ready to go now, but there is still no firm date from government nor a date for the opt-out system?

Mr Kelsey : That's correct.

Senator GRIFF: When the universal rollout happens, will it happen in stages or will it occur on a particular date?

Mr Kelsey : The opt-out period, or the period during which Australian citizens will be able to register for opt-out, will last for three months. There will then be a month during which opt-out registrations that were made by post—in mail—will be reconciled. At that point, records will be created for all Australians who have chosen not to opt out of the My Health record.

Senator GRIFF: The opt-out portal will actually cease at the time that the records are automatically created?

Mr Kelsey : That's correct. Thereafter, people will be able to cancel their record should they choose to.

Senator GRIFF: According to a November story by News Corp health reporter Sue Dunlevy, the opt-out period will be promoted through, and I quote:

There will be no paid TV … it'll be a PR-based approach also using social media, community engagement and the Primary Health Networks.

What, specifically, will be done to promote the opt-out portal to all Australians?

Mr Kelsey : News Corp corrected that story after its publication because it was inaccurate in a number of respects, particularly in relation to things like the fact that at local level where it's appropriate we will be promoting awareness through paid media channels. Could I take a second to brief you on this. The agency will implement an evidence based public communications approach to inform every Australian about My Health Record and how to opt out if they would like. This program of comprehensive communication and engagement will be undertaken in collaboration with clinical and consumer leaders, including the Royal Australian College of General Practitioners, the Australian Medical Association, the Pharmacy Guild, the Pharmaceutical Society of Australia and the Consumer Health Forum, as well as all Primary Health Networks and state and territory health services, among others. Evidence from the opt-out trials, conducted in late 2016, is that messaging is complex and consumers want to receive information from trusted sources such as Health, GPs and pharmacists. This is why the agency has contracted nationally all primary health networks to deliver training and education to all GPs and pharmacists nationally by the end of 2018. Additionally the agency has partnered with key health peak bodies to support education adoption. The campaign itself will be multilayered through health and non-health channels. The objective of course is to ensure that all Australians are made aware of their right to opt out should they choose to do so.

Senator GRIFF: Is there concern that, if the opt-out portal becomes more widely known, too many people will use it?

Mr Kelsey : The legislation is quite clear that people have an absolute right to make an informed decision about whether they choose to opt out. We are agnostic about the level of opt-out.

Senator GRIFF: You referred to evidence-based promotion. How are you determining that it's evidence based?

Mr Kelsey : As you'll know, the government conducted two opt-out trials last year, in which a million people were given a My Health Record unless they chose not to have one. In that instance 1.9 per cent chose to opt out of the opportunity. We've learned an awful lot from those trials, the evidence for which is in the public domain. Subsequent to those trials, we have also conducted, as you'd expect, I hope, rigorous marketing research in order to assess just how best we can reach different communities in Australia, particularly, of course, remote rural Australians, but the whole community as well.

Senator GRIFF: Will there be different log-in procedures for medical staff using My Health Record in a hospital setting compared to a GP surgery, for instance?

Mr Kelsey : Essentially any registered health practitioner who has an appropriate identifier is able to access My Health Record. The software they use in their different contexts will determine the way in which they log into it. But in all cases they will have to have an individual identifier, and that individual identifier has to be linked to an organisational identifier for them to gain access to My Health Record.

Senator GRIFF: In Ms Dunlevy's story there were concerns of security experts about My Health Records being vulnerable to hacking because it's a centralised database with so many access points. Do you have a view on that. What work has been done in that regard?

Mr Kelsey : I had the opportunity of explaining that to a Senate inquiry recently on Medicare. The way My Health Record works and the way in which it maintains the safety and privacy of people's sensitive medical information is by requiring all the registered health practitioners who wish to use it to have, as I've mentioned, a personal identifier which is linked to an organisational identifier. The way in which those identities are confirmed is through their access to what's called conformant software. They have to essentially be present in the consulting room in front of the software which is delivering the My Health Record to them for them to have access to it. So, unlike Medicare, it is not possible for a clinician to browse the My Health Record. The way the system has been set up is to ensure that they are identified through the physical software in that practice or in that hospital.

Senator GRIFF: How are medical professionals incentivised to put people on the system?

Mr Kelsey : The peak bodies I mentioned before, for example the College of General Practitioners, have long supported the case for a My Health Record and are incentivised principally by the desire to improve the quality of the health outcomes of their patients. Imagine for a minute that a GP has access to a full history of a person's medications when they are registering for the first time, or an emergency doctor has similar access to their medications. This will, we know from the evidence, significantly improve the outcomes of their patients. So the principal motive is that these are caring professionals who want to do the best job they can for their patients. That is the principal driver of clinical interest in this service.

Senator GRIFF: No financial incentive?

Mr Kelsey : There is a federal incentive, which I am sure my colleagues from the Department of Health can discuss in relation to the ePIP, but the reason My Health Record is generally supported by the clinical representative bodies is that it does represent an opportunity to increase the quality of clinical practice. I don't know whether the department has anything to add

Senator GRIFF: That's fine. I'll put more on notice.

CHAIR: We will need to move on. Thank you very sincerely. I understand from Senator Griff that you have been called late at night before, so I do thank you for your patience.

[22:59]

CHAIR: We've got a very short series of questions for program 1.2. Senator Singh assures me it will only take a couple of minutes.

Senator SINGH: I have questions about the My Health Record. Is it still government policy that every Australian will have a My Health Record by the end of the year?

Mr Kelsey : Yes.

Senator SINGH: Unless they choose to opt out?

Mr Kelsey : Unless they choose to opt out, yes.

Senator SINGH: Is the opt-out period still proposed to be for three months?

Mr Kelsey : Yes.

Senator SINGH: When will the opt-out period commence?

Mr Kelsey : Referencing the answer I gave before to your senatorial colleague, that's a ministerial decision which is yet to be made.

Senator SINGH: We are at February at the moment—actually, it's March tomorrow—and you can't confirm when the opt out will start?

Ms Edwards : Senator, it might be worthwhile to point out that the rule which is set in relation to the opt out allows the minister to set the date on which it commences, which is what Mr Kelsey is talking about. But it does have a date of no later than 1 September, so if no decision is made in the meantime, it would commence on 2 September—I forget what day it is today, but 2 September. We are expecting it in the middle of the year, but the rule provides that it commences on that day if not before.

Senator SINGH: Thank you.

CHAIR: Again I thank the minister and I sincerely thank all officers who appeared today. Ms Beauchamp and Professor Murphy, it's been a long day in the chair. Thank you very much. Thanks to Hansard, Broadcasting and our secretariat. Senators are reminded that written questions on notice should be provided to the secretariat by Friday, 9 March 2018. That concludes today's examination of the Health portfolio. We are adjourned.

Committee adjourned at 23 : 01

Here is the link:

http://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;db=COMMITTEES;id=committees%2Festimate%2F402b1fde-1d4d-4458-bc70-e11d59c2c288%2F0007;query=Id%3A%22committees%2Festimate%2F402b1fde-1d4d-4458-bc70-e11d59c2c288%2F0000%22

Note that Senator Stirling Griff represents the Nick Xenophon Team and Senator the Hon. Lisa Marie Singh represents the ALP.

This transcript is worth a very careful read as there are some interesting points that are worth noting – such as the initiation of the opt-out period is the subject to Ministerial Discretion until September when it just happens.

For all the ducking and weaving there is clearly not going to be any public advertising as one would usually see (think 200 Billion Dollar defence spending etc) in such matters.

Additionally just what is “evidence based promotion”?

Note also the claim that financial incentives are not important and that GPs are using the system because it is the right thing to do. That is not what we saw in the Share Health Summary Upload Stats!

As for the advocacy organisations being behind the myHR I would hardly say the support is rapturous and enthusiastic!

You can form your own view on just how transparently the questions were answered.

David.