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Wednesday, 29 February 2012
Page: 2238


Mrs MOYLAN (Pearce) (09:22): As I outlined last night, there have been concerns expressed about the national eHealth transition policy by the National eHealth Transition Authority, and those concerns give rise to the capacity of the government to finalise the design and to deliver the electronic health records without—and I quote here from the National eHealth Transition Authority—'potential clinical risks'. That being said, notwithstanding some of the difficulties, the intent of the Personally Controlled Electronic Health Records Bill 2011 and related bill is sound because, as I was saying last night, in an increasingly mobile world one of the most frustrating experiences for patients across Australia is having to continually recite their medical history to each doctor, specialist and allied health professional that they come into contact with. The process is necessary at the moment as it is an unfortunate reality that an individual's medical record often gets lost, is not updated or critical information is not effectively passed between an individual's treating professionals.

In an increasingly mobile society people often overlook the need to transfer records from their previous medical practitioners. The process is equally frustrating to the medical community and, more importantly, treating professionals are acutely aware that not having a comprehensive understanding of a person's medical history is a danger in itself to the patients that they are treating. The Personally Controlled Electronic Health Records Bill 2011 seeks to address the situation by establishing the framework for individuals to have an electronic medical record. The record is intended to be an online system, which will include past and current medical conditions, medications taken, allergies, Medicare information and summaries of discharge information from hospital, as well as any information the person wishes to add themselves.

Unlike systems such as those in the tax office and other government departments, this system is not intended to be a centralised collection of information held on government computers. Instead, the system is designed to link the data sources around the country that already exist. For instance, many individuals already have an electronic record at their local GP clinic, chemist and hospital, and, rather than duplicate this or create a master record, the system is intended to allow each of these individual medical practitioners and health professionals to access those records through a single online portal.

Understandably, a person may not want all of the information shared. Through the system, participants will be able to choose who has access to what information. The system is also an opt-in system, allowing participants to activate and deactivate their records at their choosing. The scale of such a project is immense. The national State of our public hospitals report notes that in the financial year 2006-07 alone there were 16 million outpatient contacts with a further 24 million allied health services, including pharmacy, pathology and imaging services. Creating a system that can allow efficient access to such an enormous amount of information across a multitude of different systems requires significant research, testing and continual monitoring.

Ensuring that the proposed system is secure and workable is vital given its potential to save lives. Analysis by Booz & Co. suggest that up to 5,000 lives a year could be saved by having correct and timely information available through electronic records. But such a significant step forward is only part of the value that electronic records can provide. With proper planning, treatment can move from being responsive to being proactive. As the chair of the Parliamentary Diabetes Support Group, I and my colleagues who are involved in that group know all too well the importance of diabetics having records available to their treating clinicians. Diabetes Australia has developed a database of over a million Australians as part of their administration of the National Diabetes Services Scheme. Not only does it track the Pharmaceutical Benefits Scheme's subsidised medicines used; it can also be used to send reminders and advise of new products and services. This is important because it can tell the National Diabetes Service Scheme whether people are in fact taking the medication that is prescribed. We saw the tragic case of a young Western Australian girl who, in her teenage years, did not always take her prescribed medication, and she is now facing life having had a limb amputated and having serious kidney disease. So this can be a great benefit to preventing these kinds of situations from occurring.

Such initiatives in the private sector are commendable and provide a sound template which government can follow. Allowing this information to be combined as part of the electronic health system would also mean that a patient's normal GP could be alerted to considerations that might otherwise go unchecked, like patients not taking their prescribed medication. This could happen via a pop-up reminder to check the lower limbs, for example, of a diabetes sufferer—to check the feet—because we are all too aware that neglected problems with the feet can lead to limb amputation and other complications.

With proper development of this system medical treatment can shift from being responsive to preventative practices with patients confidently and proactively contributing to the management of their own treatment regimes. But it would appear that more development is required before this potential can become a reality. For instance, what assistance will be given to older Australians, the infirm and those from lower socioeconomic backgrounds to create and add to their e-records? These groups are often overrepresented within our hospital system and allied programs and could benefit the most from such a system, yet they are more likely to not have the resources or the knowledge to create an online health record. To brush such concerns aside and roll on with the project would seem counterproductive as the government would be creating a system that provides little benefit to those who need it most.

Another issue of concern in the transition authority submission is the privacy safeguards. On page 5 of that submission is the example of Christine Lee, who chooses the basic access controls which are meant to authorise only those providers involved in her care to view her records; but it appears that the basic setting—presumably the setting most people will choose—does not block other practitioners from accessing her details. In fact, in the example an interstate doctor accesses this young woman's information. Worse still, the only way that unauthorised access is discovered is by the patient themselves trawling through the computer log and picking it up. A strong analogy can be drawn here with unauthorised transactions on credit cards. While it is expected that everyone checks their statement, it is a common reality that most do not. To ensure unauthorised transactions do not take place, the bank's system highlights suspicious transactions based on a number of criteria. I would think that a similar system could be adopted with electronic records, with patients indicating the health providers who are authorised to view their records or with unusual transactions being flagged, highlighted or otherwise brought to the attention of patients.

The integration with other systems designed to assist the public should be considered as well. The submission of the National E-Health Transition Authority to the current Senate inquiry into this bill notes one benefit of online records is their availability when Australians travel overseas—but if the patient is incapacitated how can they access their records to give to foreign medical practitioners? Perhaps consideration should be given to linking the SmartTraveller website of the Department of Foreign Affairs with a tick box authorisation to allow the department to access those records in the event of an emergency when the person is travelling overseas.

Finally, it would seem prudent for the government to heed the warnings of the opposition. I note the member for Shortland was critical last night of the opposition, but one of the important functions of this chamber is to debate this legislation with a view to ironing out the bumps, to sorting out some of the problems, to make sure we get the best public outcomes we can for policy and the delivery of programs. It would therefore seem prudent for the government to heed the warnings of the opposition and the stakeholders and delay the system's full implementation until these critical issues are resolved.