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Thursday, 11 March 2010
Page: 2235

Dr WASHER (10:32 AM) —Before I start my speech, I would like to commend the member for Capricornia for her models on the increasing incidence of chronic disease. I support her in a lot of what she said.

The Healthcare Identifiers Bill 2010 and cognate bill aim to implement a national system for consistent identification of customers and healthcare providers, and set out purposes for which healthcare identifiers can be used.

In July 2004, health ministers endorsed the formation of the jointly funded National E-Health Transition Authority. The authority was to be responsible for establishing a national health information management and information and communication technology entity. One of its fundamental objectives was the development of a patient identification system, which, together with a product and medicines database and national provider index, was to contribute to a national shared e-health record. COAG agreed to accelerate the development of a national electronic health records system in 2006 with funding of $130 million to June 2009.

In 2007 COAG agreed to a further $218 million over three years and signed the National Partnership Agreement on E-Health. This signed agreement outlines a framework for cooperative jurisdictional arrangements and responsibilities for e-health. It sets out the objectives and scope for the Healthcare Identifiers Service, as well as relevant governance, legislative, administrative and financial arrangements. Once enacted, this bill will operate in conjunction with this agreement to support the operation of the service.

Implementation of a national healthcare identifiers system will: support messaging from one healthcare provider to another by providing a consistent identifier that can be used in communication; facilitate electronic communications between providers by establishing a way for healthcare providers to look up the contact details of other healthcare providers; and support the implementation of a security and access framework to ensure the appropriate authorisation and authentication of healthcare providers who access national e-health infrastructure.

The communication of health information and accurate identification of individuals is a critical part of effective health care. It is estimated that 10 per cent of hospital admissions are due to adverse drug events and up to 18 per cent of medical errors are a result of inadequate access to patient information. The use of individual healthcare identifiers will assist healthcare providers to accurately match the correct records to their patients and improve the accuracy when communicating information to other healthcare providers.

Greater accuracy of information available is not only critical to effective health care for the individual but it also enables greater efficiency and productivity. Other countries which have implemented e-health systems have demonstrated significant improvements in productivity. It is thought that the implementation of e-prescriptions in Sweden, Boston and Denmark has reduced providers’ costs and time, resulting in an improvement of productivity of over 50 per cent. E-referrals in Denmark have reduced the average time spent on referrals by 97 per cent; and in America and France test ordering and results management systems have reduced time spent by physicians chasing up test results by over 70 per cent.

By outlining solutions for e-prescriptions, e-referrals and electronic test ordering, it is estimated that Australia’s e-health strategy will reduce by 10 per cent the time currently spent by care providers in discovering information. This conservative figure may not sound significant, but in net present value terms this is in the order of $2.8 billion over 10 years. Around 25 per cent of a clinician’s time is spent seeking information about a patient, and 35 per cent of referrals are inappropriate as a result of insufficient direct access to specialists and insufficient information being passed from primary care to specialist. I can vouch for that problem.

Another concerning issue within our healthcare system is unnecessary or duplicated treatments. It is thought that unnecessary duplicate testing in hospital environments occurs at a rate of around nine per cent to 17 per cent—and I would suggest that that is a pretty conservative estimate. It is estimated that the implementation of e-health will result in a 15 per cent reduction in unnecessary tests. Based upon an average cost of $36 per test this would result in benefits of around $800 million in net present value over a 10-year period.

Although those healthcare providers who elect to participate may incur some costs associated with complying with required regulations, the system will result in efficiencies in a number of areas. The use of identifier numbers is likely to result in improved business practices and more efficient communication with other providers. Costs that may be incurred would include the upgrading of IT systems to incorporate appropriate minimum standards and security features to access the Healthcare Identifiers Service. However, the service draws heavily on the same IT infrastructure as Medicare Online. So for those providers that already have this in place that will be of no concern. The other cost will be the time required to educate and train staff; however, reference materials will be available to minimise this time outlay. A public awareness program via a range of methods will provide consumers with information about the service and its benefits. Those healthcare provider organisations that elect to participate in the service will also be provided with materials and appropriate sources of information to provide to patients.

An individual healthcare identifier will not be required for claiming healthcare benefits. So, if the healthcare provider is unable to obtain a person’s identifier for whatever reason, the patient may still undergo treatment. The implementation of the system will not affect anonymous healthcare services that are currently provided. Where lawful and practical, individuals may still seek healthcare treatments and services on an anonymous basis.

As Medicare Australia will be the operator of the Healthcare Identifiers Service, the bill confers functions upon the CEO of Medicare Australia. These functions include: assigning, collecting and maintaining identifiers for individuals, individual healthcare providers and organisations by using information already held by Medicare Australia for its existing functions; collecting information from individuals and other data sources; developing and maintaining mechanisms for users to access their own records and to correct or update details; using and disclosing healthcare identifiers and associated personal information for the purposes of operating the service; and disclosing healthcare identifiers for other purposes set out in the bill.

The bill outlines what permitted purposes for identifiers may be disclosed and the offences and relevant penalties for misuse or breach of the legislation. This clear framework supports the proper use and disclosure of healthcare identifiers. The Federal Privacy Commissioner will provide independent regulation of how healthcare identifiers are handled and of the operation of the service and will handle any complaints that are made. Where states have existing privacy arrangements, including an appropriate regulator, that regulator will be responsible for handling complaints which are made against a public sector organisation in their jurisdiction. For those states and territories that do not have such arrangements, these will also be handled by the Federal Privacy Commissioner.

The bill also establishes a ministerial council, whose key functions include development and review of regulations to support the operation of the service and the issuing of policy directions to the service operator, Medicare.

The service will be funded until 30 June 2012 as part of the $218 million allocated by COAG to the National E-Health Transition Authority. Of the $218 million, $52.02 million has been allocated to the operation of the service by Medicare. Funding beyond this date will need to be determined between the states and territories and the Commonwealth. In addition to this funding, $0.5 million has been allocated by the Commonwealth for the Office of the Federal Privacy Commissioner for regulatory oversight and advice on the introduction of the identifiers.

In summary, a national e-health system will improve safety and quality of healthcare in this country. It will improve access for healthcare providers to reliable healthcare information when and where it is needed. It will enhance shared care of complex medical problems and chronic disease. I would emphasise that as a major failure of Medicare currently, which is dysfunctional in the management of chronic disease. A national e-health system will reduce the burden on the health sector through better health management; improve healthcare planning to ensure resources are directed to where they are needed most; and, most importantly, save lives through better decision support, increased access to information and reduction of adverse events.

Obviously, there must be appropriate security measures and standards imposed throughout the health sector to ensure that privacy and confidentially of information are maintained and that there is the capacity for effective handling of complaints and review of the service. I would suggest, just light heartedly, that it is better to be alive and well than to have a little confidentiality breached and be dead. A bill which aims to introduce such a national e-health system is to be commended.