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Thursday, 16 February 2012
Page: 1633


Mr BALDWIN (Paterson) (13:12): I rise today to speak in favour of the measures outlined in the Personally Controlled Electronic Health Records Bill 2012 and related bill. Although I have certain reservations regarding this government's competence to efficiently administer the $467 million project, I welcome the rationalisation of the more-than 70 estimated Commonwealth, state and territory laws on securities in personal property and the move to put patients at the centre of their own health care.

This is an issue that is very important to my electorate of Paterson and in particular to the residents of Bulahdelah, with a population of just over 1,500. The town of Bulahdelah lies along the eastern and northern banks of the Myall River, far from a major urban centre, with Taree 75 kilometres away and Newcastle more than an hour away by car. The town's medical needs were met by a local hospital and by a GP, Dr Habashi, who has private rooms there and also provided on-call medical services to the hospital's emergency department. Unfortunately, in mid-2011 Dr Habashi fell ill, leaving Bulahdelah's residents without a GP to address their ailments and other needs. Patients also no longer have 24-hour access to the emergency department at Bulahdelah hospital. Dr Habashi's unforeseen illness meant that Dr Habashi had not had the time to put in place contingency arrangements. I say on behalf of the community of Bulahdelah: we wish Dr Habashi a speedy recovery. He is a great doctor and a good friend. Despite being in a beautiful part of the world, it is proving exceedingly difficult to attract replacement doctors to Bulahdelah, something that became even more urgent when it was clear that Dr Habashi would be on extended leave and may not be able to return at all.

What has this to do with this legislation? If the lack of a GP was not bad enough whilst he was on sick leave, his patients had no access to their medical records and there is no legislation that required this. This meant that when the Hunter New England Local Health Network was finally able to find three doctors to provide some relief to the community and to come once a week to review patients at the local aged-care facility in Bulahdelah, they had no access to the medical histories of those whom they came to see. Despite most medical records now being on computer, these badly needed doctors could not see what had been previously prescribed, what their patients had previously suffered from or even what allergies they might have. Their diagnosis had to rely on not-always-reliable recollections by patients or on starting from scratch.

Doctors need to have confidence when prescribing or treating, and this requires access to all relevant medical information. Therefore, this bill does not have implications just for the residents of Bulahdelah or even just for the people of Paterson; it has implications across our nation as a whole. The government's administration of this bill will therefore need to be watched extremely closely.

I have to say that the government's performance in the administration of the pink batts program, in which contractors were paid by taxpayers to install insulation in people's homes, only to put people's lives at risk, and then paid to remove such insulation, does not inspire much confidence in the Australian people. Neither did the government's administration of the Building the Education Revolution program. According to the government's own task force, taxpayers' money was wasted, with school halls' building costs inflated by an average of 12 per cent.

Now we have the costs of the NBN. When in opposition, the ALP promised a $4.7 billion government contribution towards the cost of high-speed broadband. When in government, they bungled a tender process and embarked on an ambitious $27.5 billion National Broadband Network and program instead, a program whose costs now seem likely to surpass $50 billion, if ever it is to be completed—a cost blow-out more than 10 times what was originally envisaged.

My point in relation to this is that we have a $467 million program to roll out electronic health records. It requires competency in the delivery to ensure that individuals' records are maintained with extreme privacy. Obviously this is a government that cannot be trusted with the nation's finances and should never be left alone to implement legislation—in particular, health legislation and the privacy surrounding those records.

By contrast, the coalition has a strong track record in investing in and delivering e-health. Under the coalition government, $740 million was invested in improving IT services for GPs, leading to 17 per cent of surgeries being computerised in 1997 and up to 94 per cent in 2007. The coalition have always supported the concept of shared electronic health records, but once the legislation is passed we will be monitoring this government closely to ensure that there are strong safeguards to protect private personal medical information from falling into the hands of a third party that was never designed to see the information.

This is a bill that needs to be implemented cautiously. Confidentiality concerns must be addressed and must be paramount. We do not want patients' safety and privacy compromised. It is therefore important that personally controlled electronic health records remain an opt-in system rather than an opt-out system. Let me restate that so that there can be no confusion: it is important that personally controlled electronic health records remain an opt-in rather than an opt-out system. Patients must have confidence that their privacy is protected and is sacrosanct. The system must be implemented to ensure that transgressions do not occur and, if they do, transgressors are dealt with seriously and the penalties are rigidly enforced.

While I am talking about the national implications of this bill: my electorate has some of the most outstanding countryside and stunning beaches in Australia and is a popular holiday destination, including Port Stephens, the Great Lakes and Dungog. This means that tourism sees those areas' populations increase quite significantly over the school holiday periods, when we host people from all over Australia. Unfortunately, their holidays are not always without medical incidents, and tourists often have to visit health providers such as Tomaree Community Hospital, whose doctors have to get on the phone to doctors in other parts of Australia to get a visiting patient's medical records. This is inefficient, unnecessary and a not insignificant impost on their valuable and very limited time.

The bill will also be of benefit to those of my constituents who visit their friends and relatives or go on holidays elsewhere in Australia, when they need to get their prescriptions or see a health provider. There are also local constituents of mine who have ongoing health concerns that have to be dealt with after hours. Often the doctor they see is not their personal GP, and the doctor therefore does not have their records immediately at hand. This bill will also allow for the health information of a patient to be easily transferred between a patient's GP and a specialist.

That is why I support the establishment and implementation of a national personally controlled electronic health record system, so that those patients who choose to opt in can have control over who can see their medical records, which documents they can view and the level of electronic records that can be accessed.

However, whether patients will be able to exercise such control is not exactly clear. Although the system has been designed to ensure this, it has not always been the case in either of the wave 1 or wave 2 trials currently underway. We will wait and see whether it eventuates after 1 July this year. The government has repeatedly committed to take user registrations from this date. It is more important, however, that the project is done right rather than quickly.

Many IT specialists on large-scale projects advise that such a system always takes years to become fully operable system wide. The coalition hopes that this is not yet another project that the government announces to great fanfare and then struggles to implement on time and on budget. After all, only last week, in a Senate public hearing, a number of stakeholders were raising profound concerns about these bills. Software vendors have their concerns about NEHTA's and their own legal liabilities under the legislation proposed. Stakeholders have also complained about the lack of proper and thorough consultation.

Would it not have been more sensible for the minister to wait for the Senate inquiry to publicly report on its findings, with a reasonable period for consideration before proceeding further? The coalition has some issues concerning how overlapping federal and state privacy provisions will come to work in practice.

However, Booz and Co. have predicted that measures that reduce duplication and errors, improve productivity and lead to greater use of best practice by doctors could see e-health capabilities result in annual savings of up to $7.6 billion by 2020. The ability for doctors to see a patient's existing medical conditions, including what they have suffered from in the past, past hospital stays and allergies, will play an important role in achieving these savings and benefits, which the coalition would like to see.

These benefits will come from the avoidance of unnecessary new tests, with significant savings to the taxpayers; an improvement in the availability and quality of health information by linking up the data sources around the country that already exist; the opportunity over time for patients to contribute and add their own information to the information stored in their medical records; safer coordination and quality of health care provided when patients see different healthcare providers; and, most importantly, a reduction in the occurrence of adverse medical events. The Booz and Co. report outlined that, fully implemented, these measures could see 5,000 annual deaths being avoided, two million fewer primary care and outpatient visits, 500,000 fewer emergency department visits and 310,000 fewer hospital annual admissions. Like everyone in this House I want to see these potential benefits come to pass. But the government needs to raise its game in terms of implementation and administration if they are to be achieved. This would be a huge task for a competent government. One only needs to look at the United Kingdom, which wasted £12 billion on its e-health record equivalent which was scrapped late last year, to understand this.

These benefits will only occur with the full commitment and cooperation of health care providers. They will have to spend additional time and effort creating and maintaining these shared health summaries and at the moment it is not clear they will have the incentives to do so. I look forward to hearing the Minister for Health explain what the government is doing to ensure a successful uptake of this program. For my fellow Australians, I hope that they do what ensures that. I do not want the success of this program to become a case of hope over experience.

Debate adjourned.