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Wednesday, 29 February 2012
Page: 2250


Mr McCORMACK (Riverina) (10:14): The Personally Controlled Electronic Health Records Bill 2011 and Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 provide a legislative framework required for the management of the personally controlled electronic health records system. The personally controlled electronic health records system is designed to be a secure electronic record of a patient's important health information. This will allow for the health information of a patient to be easily transferred between a patient's health practitioners, such as between a patient's general practitioner and a medical specialist.

In the current health system, a patient is required to repeat their medical history and information each time they visit a different clinician. This can lead to poor information flows, extra or duplicated tests, delays and potential errors. As the electronic health records will contain patient information, including past and current medical conditions, medications, allergies, discharge summaries from hospitals, Medicare information, as well as any information the patient would like to add about themselves, health practitioners will be able to help overcome some of the current issues the current health system experiences in the transfer of information.

You could say at present that the system is mired in duplicity and, as with anything bogged down with procedure and red tape, it is the ones at the end of the line—in this case, patients—who are affected the most. In fact, it has been forecast by leading global consulting firm, analysts Booz & Co., that by 2020 e-health capabilities could save up to $7.6 billion each year by reducing duplications and errors, improving productivity and enabling better adherence to best practice. This is across all facets of e-health and not just electronic health records. It is also reported that a full e-health program could help avoid up to 5,000 deaths annually once the system is in full operation. That is a staggering statistic.

Significantly, this system will be entirely opt-in, meaning that people will need to actively apply for a personally controlled electronic health record. They will then be able to deactivate and reactive their record at any point in time. It is also important to realise that the personally controlled electronic health record is not a centralised data collection system. As most information already exists in GP practices, chemists, pathology groups and hospitals, this new system will link these existing data sources around Australia and will display them in a single online portal, confidentially.

Control of which practitioners can access a patient's record is left completely in the hands of the patient, as it should be. Patients can choose to allow only their general practitioner to access the information or they can allow all their health practitioners to have access. Importantly, this will also mean patients will have their entire medical history available to them anywhere they go. A patient with a personally controlled electronic health record who becomes ill while travelling will have access to their full medical history and will be able to make this available for the doctor or emergency department they visit. That is so important, particularly when people go on holidays and, as we all know, things sometimes happen on holidays. And for families with children who may fall ill that will be a great advantage if they are able to access that sort of information anywhere, at any time, on a personally controlled health record system.

All data which a patient uploads onto their personally controlled electronic health record will be protected by the provisions of the 1988 Privacy Act and the Information Commissioner will have the powers to investigate any complaints or potential breaches of privacy. Whilst the information will be protected by these provisions, there is some issue with overlapping and confusing jurisdictions in the privacy arena based on the federal/state control of privacy provisions. It is yet to be seen how these concerns will be rectified and addressed, yet they must be fixed to give assurance to patients that anything they upload will remain private. Anything that is uploaded on their behalf will remain private. Patient confidentiality and trust in the system are paramount. In discussions with my constituents in the Riverina, they have stressed to me just how important this particular point is—that patient confidentiality must be absolutely paramount.

The coalition will not be opposing either of these bills and has always supported the concept of a shared electronic health record. Under the coalition government, computerisation of general practice increased from 17 per cent in 1997 to 94 per cent in 2007. This was achieved through a $740 million investment during those years. Whilst the coalition does not oppose these bills, there are some concerns which have been raised over the way in which the system is to be implemented.

The government has repeatedly stated that the personally controlled electronic health records will be able to take user registration from 1 July this year. Despite this assurance, the majority of industry experts and peak health bodies hold grave doubts that 1 July will be achievable. In fact, the President of the Australian Medical Association, Dr Steve Hambleton, said:

We predict it will be many years before the PCEHR becomes ubiquitous in health care.

The Australian Medical Association is also concerned that the medical profession will be lumped with the administrative burden of implementing the PCEHR system. Further:

'Our concern is that the PCEHR may add to the 'information chaos' apparent in today's medical practices … this phenomenon is one in which problematic information arrives from many sources and can impair physician performance, increase workload, and reduce the safety and quality of care delivered,' according to Dr Hambleton.

This legislation was introduced to the House only on the last sitting day of 2011, and like so many other Labor announcements the government proposes a major reform and then plays catch-up to meet its own deadline. A Senate inquiry on these bills is due to report today. This government is guilty of rushing through legislation without proper scrutiny, and these bills are no different.

It was only on 24 January 20102 that the National E-Health Transition Authority announced that work on primary care desktop software development at its test sites had been halted due to the discovery of 'technical incompatibilities across versions' and that there was 'potential clinical risk' if work continued using the specifications supplied. There are also well-founded concerns about the future costs of the personally controlled electronic health records and the ongoing funding for the National E-Health Transition Authority.

The government needs to be transparent about the future long-term costs of managing and operating this program and the future funding contribution through the Council of Australian Governments, COAG, for the National E-Health Transition Authority. The current funding agreement for the National E-Health Transition Authority is due to expire on 30 June 2012, the day before the personally controlled electronic health records go live on 1 July 2012. The Standing Council on Health has agreed to fund the National E-Health Transition Authority after 30 June 2012, but no details have been released as to the agreed level of funding. The government has allocated just $35 million per year over the next three years for e-health implementation.

The Medical Software Industry Association is rightly perturbed 'that there are severe penalties in place for breaches of the Act from 1 July 2012 although the rules are not determined and there will be very short periods of time for the parties to understand and establish procedures for compliance with complex new obligations'. Fundamental to this is the problematic policy decision not to provide incentives or recompense to system participants who are nevertheless expected to contribute extensively to the PCEHR and, while doing so, assume significant risk in the event of breaches.

The Pharmacy Guild of Australia joined the chorus of condemnation against the rushing through by Labor of this legislation. Presently there is no ability for a pharmacy to add a patient's medication history to the PCEHR and there is no strategy or process in place at this time to enable this to occur. The electronic transfer of prescriptions is a reality in both pharmacies and surgeries now, and as it stands about 3.2 million records could be added to the PCEHR weekly through this system. The Pharmacy Guild has fears that the national infrastructure required to underpin the uptake and adoption of the PCEHR will not be ready within suitable time frames to enable adequate use of the system. But does this matter to Labor? The Leader of the House likes to spruik about the number of pieces of legislation which this minority government has passed; it is one thing to pass bills, but it is another for them to be implemented in the wider world.

As the PCEHR is a technology based system, it dates very quickly and there is a notable silence from the government on the future costs. There has been no comment or discussion about the long-term costs relating to ongoing maintenance of the system, upgrades to the system or the provision of a help desk or support staff for the system. The government needs to advise what these costs are going to be or potentially could be. We cannot afford to end up like the United Kingdom, where £12 billion has been spent on its e-health record equivalent, started in 2005 and canned in late 2011.

Personally controlled e-health records are a step in the right direction for the future leading to an easier flow of information between patients and health practitioners. Ultimately this system will save lives. However, it is important that the government is clear from the outset on the costs of this system to ensure that it does not become an undue burden on the taxpayer and instead works towards the goals it has been established to achieve.