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Wednesday, 10 March 2010
Page: 2174


Dr SOUTHCOTT (6:29 PM) —The Healthcare Identifiers Bill 2010 and the Healthcare Identifiers (Consequential Amendments) Bill 2010 allow for the introduction of 16-digit identifiers for every Australian, every healthcare provider and every healthcare organisation in Australia. The introduction of these identifiers is a key foundation for the establishment of a national e-health system. In order for an effective national e-health system to be implemented it is critical that we put in place a solid foundation. This is the legislation which will establish that solid foundation. Healthcare identifiers are the first step in establishing a system that will ultimately ensure a more cohesive, coordinated healthcare system for Australian patients.

Since the last election, we have heard the Clayton’s promises of the Rudd Labor government. The Prime Minister promised to fix the hospitals by June 2009. We are still waiting for him to fix hospitals. He promised 31 GP superclinics and, according to a Senate estimates hearing, only two of those are currently fully operational and only five are expected to be operational by the time of the next election.

We have a healthcare system which is increasingly under pressure. Rates of chronic disease are increasing, coupled with an ageing population. This places a massive burden on the healthcare system, both from a health management point of view and in terms of cost. The Australian Institute of Health and Welfare estimated that just over seven million Australians had at least one chronic condition in 2004-05. As people age, the likelihood of their having more than one chronic condition increases. Australian hospital statistics for 2007-08 indicate that more than half of the potentially preventable hospitalisations are from selected chronic conditions. Better management of these conditions and a more coordinated approach between healthcare providers could have a significant impact in decreasing these hospitalisations.

E-health offers an opportunity to improve health care in Australia but it is critical that it is introduced right from the outset. In contrast to countries like Great Britain, Germany and Canada, we lag well behind in the implementation of e-health measures. The systems that have been introduced in those countries allow for the sharing of diagnostic imagery between providers, e-prescription services and the ability to facilitate communications between providers—reducing the silo method of treating patients.

The Howard government took e-health seriously, and we had a commitment to providing leadership in e-health. The computerisation of GPs, which now sees very high rates of prescriptions prepared by general practitioners, was part of an incentive payments scheme introduced by the previous government to increase the uptake of these technologies and the use of them in general practice.

A national system will provide for greater consistency of health care for Australians. We need to ensure that accurate information is conveyed and that patients are not undergoing unnecessary procedures or unnecessary diagnostic tests as a result of duplicated services. We need to ensure that our medical practitioners are being provided with the best possible information about their patients, enabling them to make accurate diagnoses. E-health has benefits for rural and regional services. Particularly in Indigenous health care, where there is a significantly higher rate of chronic disease, coordinated health management would have a significant impact.

Studies in the United States have shown that a failure to utilise health IT has resulted in higher costs, medical errors, administrative inefficiencies and poor coordination, amongst other issues. This information is taken from the 2008 Booz & Company report into e-health. The Institute of Medicine estimated that between 44,000 and 98,000 Americans die each year as a result of medical error, and as much as $300 billion is spent each year on health care that does not improve patient outcomes.

When we deal with this legislation there are still a number of concerns that have not been addressed and, once again, the government appears intent on rolling out legislation without having done the appropriate groundwork. The National Health and Hospitals Reform Commission recommended a person-controlled electronic health record. That recommendation has not been taken up. This will not be a patient-controlled electronic health record. It is also not an opt-in system for patients. Anyone who has a Medicare number or a DVA number will be given the 16-digit number. It will be compulsory for patients to have an individual healthcare identifier. A number of stakeholders have rased concerns around the privacy controls. The opposition believe it is critical to address any concerns before the implementation of these identifiers. The government is yet to provide details of the regulatory framework to ensure security of individuals’ health information. The government has not provided the regulations which will govern the operation of this legislation. The National E-Health Transition Authority has admitted that it is yet to decide how access control would work.

One of the most serious allegations in the area of e-health is in an article in the Australian on 2 March, where allegations were raised against Medicare Australia staff, with a report showing that one in six staff have apparently looked at confidential patient records, without authority, in the past financial year. That is an alarming figure and it is a concerning figure, given that we are talking about Medicare Australia. It is subject of course to the privacy principles. But the issue here is that this legislation intends to give responsibility for the implementation and oversight of healthcare identifiers to Medicare. Medicare will be the identifier service for this e-health system. So it is absolutely critical that the safeguarding of private patient information is assured and it is absolutely critical that the chief executive officer of Medicare Australia, who will be responsible for operating and maintaining the healthcare identifier service, addresses these issues, which show that Medicare staff are inappropriately accessing confidential patient records.

I recognise that there has been a long consultation period, with a discussion paper in July last year, and release of the draft legislation in December. However, there was very limited time for stakeholders to respond to the draft legislation, with the one-month window of opportunity spanning the Christmas break. This matter was raised by a number of stakeholders who felt they did not have sufficient opportunity to voice their concerns. As a result, while the opposition do not oppose this legislation, we think it is important that stakeholders be given a further opportunity through the Senate Standing Committee on Community Affairs to examine this legislation. That committee has received a number of submissions and conducted hearings, both yesterday and today, and will be reporting back to the Senate next week.

Another concern that has been raised follows on from the lack of consultation time available to stakeholders. This system is due to commence on 1 July 2010. It defies belief that the government has delayed in providing software manufacturers and developers the specifications to enable them to design an appropriate IT framework or to integrate healthcare identifiers into existing software packages.

In its submission, the Law Council proposed to include a legislative declaration to ensure that the healthcare identifier number could be used only for the purpose of health management. I thought that was a sensible recommendation but it was not picked up by the government in moving from the draft legislation to the legislation that we currently have before us. The Minister for Health and Ageing has not adopted that recommendation.

Concerns have also been raised about the breadth of this legislation. As it currently stands, privacy laws are able to be overridden if the action is legal under any other law—that is, giving out a healthcare identifier number is not subject to privacy laws if that action is legal under any other law. That very broad definition is contained in this legislation.

As I said earlier, the coalition are not opposing this legislation but we have referred it to the Senate Standing Committee on Community Affairs. We do reserve the right to make any amendments, depending on the findings of that Senate committee. The committee provides a greater opportunity for stakeholders to raise their concerns, and I recognise that many have done that. As I said before, with the draft legislation very little time was afforded for stakeholders to submit their views and, to date, not all of their concerns have been addressed. For legislation as important as this, which is set to play such a crucial role in sharing very sensitive, very confidential healthcare information in the future, it is absolutely vital that we get this right and the Senate committee will afford us that opportunity.