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Wednesday, 23 November 2011
Page: 13576

Ms ROXON (GellibrandMinister for Health and Ageing) (12:12): I move:

That this bill be now read a second time.

If you asked Australians if we should create a system where their health information could be easily transferred between their health practitioners, many would be surprised that such a system does not already exist.

The sad truth is that our medical information is not connected—despite how logical and possible it is to achieve.

In many ways, the absence of a system of electronic health records in Australia demonstrates the difficulties of health reform—the fragmentation, the vested interests and the balancing priorities.

But we clearly know the evidence of why we need to act.

Currently health information of individuals is fragmented across a range of locations rather than being attached to the patient. Consumers need to retell their story each time they visit a different clinician. This outdated approach can result in poor information flows, unnecessary retesting, delays and medical errors.

Studies in hospital environments have indicated that between nine per cent and 17 per cent of tests are unnecessary duplicates.

Medication errors currently account for 190,000 admissions to hospitals each year. Up to 18 per cent of medical errors are attributed to inadequate patient information.

There are situations demonstrating every day in Australia why the introduction of e-health records will lead to improved care for patients. Take these situations as examples:

A Victorian retiree on holiday away from his detailed medication history gets rushed by an ambulance to hospital.

A mother with two children who both suffer from asthma struggles to remember the different medications they have tried.

A carer tries to help their elderly mother with their health care who cannot participate in her own health care.

Or a man with a chronic disease like diabetes who wants to better manage their disease—and ensure his doctors are all working off the same information. These scenarios reflect the kinds of real-life situations that occur all around Australia every day.

E-health records can change all these situations for the better.

That is why clinicians, health consumers and the health technology industry are all united in the call for electronic health records.

The National Health and Hospitals Reform Commission recommended to the government in 2009 that 'by 2012 every Australian should be able to have a personal electronic health record that will at all times be owned and controlled by that person'.

This is a proposition that had widespread support in the extensive health reform forums and consultations that the government held throughout 2009 and 2010 around Australia.

Australians saw the value in preventing errors and misdiagnosis. They saw the benefits in managing their own health and the health of their family members. And they saw the benefits in creating a more efficient and effective health system.

Our analysis shows that the net economic benefits of e-health records are estimated at $11.5 billion until 2025.

To put it bluntly—there is widespread support for dragging the management of health records into the 21st century.

That is why this government committed $467 million in the 2010 federal budget to a two-year program to build the national infrastructure for personally controlled e-health records.

Records will have the capacity to contain summary health information such as conditions, medications, allergies and records of medical events created by healthcare providers. The records will also be able to include discharge summaries from hospitals, information from Medicare systems and some information entered by consumers themselves.

Australians rightly do not want their privacy threatened. They do not want one single massive data repository for all their records. They also want the right to participate, but not be forced to do so.

That is why we are designing this project to take heed of privacy from the ground up.

We are building a truly personally controlled record.

We are establishing new consent settings for sensitive information and auditing that does not currently exist for any individual's record.

It is how our system will strike the right balance between security and access. Many of these protections are about ensuring that patients have the same protections over the access to digital records that they do over paper based records.

The bias is placed upon linking data sources around the country—much of which exists already in various forms in general practices, at the pharmacy, with pathology groups or at hospitals. This also means that we will not be building every technology solution—but providing the national infrastructure that only the Commonwealth government can do.

Already there have been significant achievements made in the past few years towards the implementation of e-health.

This parliament passed legislation last year to implement the Healthcare Identifiers Service which provides the backbone identification system for e-health.

There are now 1.1 million of these identifiers downloaded—across jurisdictions and lead implementation sites.

Twelve lead implementation sites have been established and are working with clinicians and patients to deploy e-health solutions.

Partners have been appointed and are busy working in the key areas of building the national infrastructure, change management and evaluating the success and effectiveness of the solutions.

The implementation approach is both swift and careful. We are developing infrastructure in a set period of time, but the rollout will happen in a staged manner.

All through the process there has been extensive consultation with clinicians, consumers and the health IT industry.

The finalised concept of operations released in September is the result of much of this consultation—but the engagement work now continues as the fine details are completed.

This consultation is important because establishing e-health records is not an end in itself. It has to deliver for clinicians and patients. This is why we have embedded e-health within our health reform agenda.

We want to know what is going to work for the patients—as well as the doctors, nurses, allied health professionals and others who have to deliver care.

This legislation I am introducing today will deliver the legal basis for this new system from when it starts registrations from 1 July 2012.

To develop this legislation we have had two rounds of public consultations—both on the legal issues for the system, and then on an exposure draft version of this bill.

The central theme of our system and this bill is that any Australian will be able to register for an e-health record, and they will be able to choose the settings for who can access their record and the extent of that access.

When registered, consumers may be represented by authorised and/or nominated representatives. This allows minors and persons with limited or no capacity to have an e-health record which details their medical history. Patients can choose to have a carer, family member or friend assist them with their record.

Apart from consumers, the other participants who can choose to register include healthcare provider organisations and repository and portal operators.

A registration framework will ensure regulation of all these parties, verification of identity, assurance that minimum technical, security and administrative requirements are met, and system accountability.

The bill prescribes the circumstances in which e-health record information can be collected, used or disclosed and imposes civil penalties for knowing or reckless unauthorised collection, use or disclosure.

All registered consumers and organisations will be subject to the Privacy Act 1988 or state or territory privacy laws as prescribed. The Privacy Act will also apply to the system operator including the ability of the Information Commissioner to investigate an interference with privacy and to penalise an offending party.

The bill also sets out requirements which apply to protect the privacy and security of patient health information. This includes notification of data breaches and storing all information in Australia. These requirements are also subject to civil penalties.

The system operator will be responsible for the operation of the system. The Department of Health and Ageing will initially perform this role. The bill allows for the system operator to change in future to a statutory authority. This will be the subject of future discussions, both with states and territories and with stakeholders.

The system operator will be responsible for establishing and maintaining the basic infrastructure of the system—including a register of participants, index service for documents and national repositories where appropriate.

There will also be important safeguards that the system operator will deliver including audit logs for access to records, reports on the performance of the system and mechanisms for handling complaints.

An independent advisory council will provide expert advice on the operation of the system and on clinical, privacy and security matters.

The membership will include consumers, health providers and people with experience in critical areas such as rural health, Indigenous health, administration, technology and legal or privacy issues.

A jurisdictional advisory committee will include representatives of the Commonwealth, states and territories and will provide advice regarding their perspectives of the system.

The Australian Information Commissioner will be the key regulator for the system and will have the capacity to conduct audits, commence investigations and impose a range of sanctions, accept enforceable undertakings and investigate complaints.

To ensure transparency of the system, the system operator and the Information Commissioner will be required to provide annual reports on the practical operation of the system to the minister and the ministerial council. The system is to be reviewed two years after the bill commences. To ensure transparency of the system, the System Operator and the Information Commissioner will be required to provide annual reports on the practical operation of the system to the minister and the ministerial council. The system is to be reviewed two years after the bill commences.

This legislation being introduced is yet another sign that this government is getting on with the job of rolling out e-health records.

This stands in stark contrast to the record of the opposition in this area, and particularly the current Leader of the Opposition. When he was the health minister he committed to establishing e-health records. This of course did not occur.

He recalled in 2005, and I quote:

Failure to establish an electronic patient record within five years—

that would take us to 2010—

I said, would be an indictment against everyone in the system, including the Government. I hope to be judged against that somewhat rashly declared standard; not because it is likely to be fully met but because it would mean that, come next year, I remain the Health Minister!

Of course that did not eventuate, that was a standard that he failed. The previous government did not deliver on this change, much to the detriment of patients and clinicians alike.

However he also failed a second test when, in the lead-up to the 2010 election, the Liberal Party promised that if they formed government they would cut every cent of the $467 million that this government had committed to e-health.

This legislation presents another test. What will the opposition do? Will it do the right thing for this country and support bringing our health system into the 21st century, or will the Leader of the Opposition continue down this well-trodden path of just saying no?

For the sake of the future health care of Australians I hope that the opposition will come on board.

Many people may see this system and legislation as being about technology. That is a mistake. It is about health care. It is about helping patients and doctors to prevent, cure and treat, and it uses technology to do that.

It also builds upon the other advances that are happening because of this government's investments—namely the National Broadband Network and telehealth, investments that are rolling out right now and helping to better the lives of Australians.

The use of technology to improve care will have a similar effect to the other great advances in healthcare technology, whether it be antibiotics or X-rays. This is a once in a generation opportunity to deliver these important reforms.

I encourage this parliament to support this improved health care through the passage of this bill, which I commend to the House.

Debate adjourned.