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Wednesday, 29 February 2012
Page: 2240


Ms LIVERMORE (Capricornia) (09:33): I am pleased to be able to contribute to this debate on the Personally Controlled Electronic Health Records Bill and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill. As I have said in many debates on bills in this House already, the government when elected in 2007 promised a major program of reform in our health system and here today we are debating yet another step along the reform path.

This bill puts in place the framework for personally controlled electronic health records that we want to see as a feature of a modern, efficient and patient centred healthcare system. I have said that we want to see this framework, but the reality is that we have to do this. Efficiency and quality patient care demand that the health system of the future runs on better managed information than it does now. The starting point has to be patients. Right now, patients do not own their health records or play any active role in the management of them. Information about an individual patient is generally scattered all over the place. Some will be held at their GP clinic, their pharmacist may have additional information and there will be more at the local hospital. Usually, the only way that information is shared across healthcare providers is when the patient physically carts a piece of it from one health service to another. More often, the information is shared by the patient repeating their medical history and current treatments to the healthcare professional sitting in front of them—and then the next one and then the next one. Those healthcare professionals have to hope that the patient remembers to disclose all relevant information so that they can treat them appropriately.

Mr Speaker, I had that exact experience myself over the Christmas break. I was fortunate enough to be holidaying on the Sunshine Coast, which I know is very close to your heart. I went to see a doctor there and, right at the end of the consultation, I remembered that I was taking some antibiotics at that time and told him. It was really just a fluke that that popped into my memory. In that circumstance it was not really important, but you can imagine how difficult it is for doctors. That situation gets harder and harder for patients suffering from multiple health problems or as they age and their health care becomes more complex.

Moving towards an electronic platform for recording, assessing and sharing patient data is not some kind of nice add-on our health system. It is not an optional extra or a novelty that might be picked up as a passing fad. This is a fundamental part of making our health system work better, with better health outcomes for patients and better use of our health dollars. That is clear when you look at what is happening in our current system of information management. 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. These are mistakes that do not need to happen and they have serious repercussions for patients and health professionals. On top of that is the waste and inefficiency inherent in our current system. Studies in hospital environments have indicated that between nine and 17 per cent of tests are unnecessary duplicates. When you think of the pressures on our health professionals and the pressures on our health budgets the thought of that kind of waste of scarce time and scarce money is outrageous. There has to be a better way.

One of the first things we did when we came to government was to establish the National Health and Hospitals Reform Commission. The commission was tasked with presenting the government with a blueprint for a health system that would meet the needs of a growing and ageing population in a way that could be sustained financially into the future. The commission recognised the importance of e-health or telehealth more broadly but specifically identified that electronic health records will be a key element in progressing its reform themes of putting patients at the centre of the healthcare system and driving efficiencies to maximise the care delivered for every health dollar spent. A key recommendation of the commission therefore was 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 the person'.

We have already put one building block in place with legislation for healthcare identifiers passing the parliament in 2010. Virtually all Australians now have an individual healthcare identifier automatically created by virtue of their connection with the Medicare or veterans' affairs systems. That identifier is their unique personal passport into the electronic health record system that is being established. The information about an individual patient attaches to that identifier and provides the basis for accessing and controlling that information.

Work is well underway towards the design and implementation of the electronic health records system led by the National e-Health Transition Authority. We are now approaching the 1 July 2012 date by which we want people to be able to register for an electronic health record and experience the benefits of the system. The personally controlled electronic health record will enable consumers to have easy access to their key healthcare information online and—very importantly—enable them to share it with their authorised healthcare providers where and when it is needed anywhere in Australia. It creates the capability for a patient's record to be available securely over the internet. That means that the information can be truly shared between all healthcare providers involved in the patient's care.

The beauty of the personally controlled electronic health record is that it has the capacity to bring together crucial information about a person's health and their medical history in the one place such that it will be immediately accessible to health providers in a way that is not possible now. Information now is fragmented and largely carried around in the patient's head, meaning doctors are often doing their job based on incomplete information.

Once in place a person's electronic health record can display clinical information in summary form, such as health conditions, allergies, medications and records of medical events created and added by healthcare providers. The record can also contain discharge summaries from hospitals and information from Medicare, including childhood immunisations and organ donor status. Individuals can also add their own information, such as any over-the-counter medications that they are taking and, if it is relevant, key particulars of an advanced care directive.

These bills provide a regulatory framework to complement the work that is happening at the infrastructure and operational level ahead of the 1 July start date. To start with it establishes the Department of Health and Ageing as the interim electronic health record system operator and sets out its functions and responsibilities and the advisory bodies to the system operator. One of those is jurisdictional and another is an independent body comprising consumer, clinical, privacy and IT expertise.

The most significant parts of these bills go to the questions of how a person creates an electronic health record and the conditions they attach to it, as well as the privacy and security protections that surround it. The bills provide for the registration regime which will act as people's entry into the system. There is also a registration process for healthcare providers and other service providers essential to the functioning of the system—for example, portal and repository providers.

It is important to note that registration is completely a matter of choice for consumers. There is no compulsion on people to opt for an electronic health record and the government has been very explicit in saying that in no circumstances will health care be dependent on having an electronic health record. A consumer who chooses to register for an electronic health record can set their own access controls to determine which healthcare organisations are permitted to access their personally controlled electronically health record. There are different levels of access controls available, so consumers can make access open to all providers involved in their healthcare or they can set the controls for much more limited access. In emergency situations it will be possible for healthcare providers to override the chosen control settings to access vital information but only in narrowly prescribed circumstances and with a range of safeguards attaching to that access, which would otherwise be unauthorised.

Another important point to make about registration for an electronic health record is that it is possible for an individual to participate in the system through an authorised representative. This recognises that many people accessing healthcare services do so with the assistance and support of a carer or family member. I note that this has been particularly welcomed by the Consumer Health Forum. The registration process will be an easy and streamlined exercise that can be completed by people online or through their local Medicare office or shopfront.

The part of the bills that underpins the whole transition to electronic health records is that dealing with protection of privacy and the security of information. The Information Commissioner has said:

Ensuring that privacy is adequately addressed is fundamental to achieving community trust in e-health information systems, and gaining consumer acceptance and take-up of the new systems.

That is a very important and obvious warning and for that reason the bar is set very high in this legislation.

The bills prescribe very clearly the circumstances in which registered consumers and organisations can collect, use or disclose electronic health record information. There are penalties in the bills for unauthorised use of the information, and the Privacy Act also applies to further protect users of the system. That means that the Australian Information Commissioner has authority to investigate breaches and interferences with privacy. Those legislative safeguards have to be in place, but the design of the system has its own security features that should give people confidence that their information is being accessed properly. Anyone accessing an electronic health record will leave an audit trail, so that the person who the EHR belongs to can go into their record and see every organisation which has viewed that record. It is their record; the individual sets the controls on who gets access to what information and they can see any interaction with that information. Of course, that is not something that is currently possible with paper records. As I am giving this speech I know that there are paper records of mine sitting in a file at the base hospital in Rockhampton, and I have no idea right now who could be looking at them or what they are doing with them. That is something that just will not be possible through the EHR system, where that audit trail is very evident to each person who has an EHR.

There are already 12 lead e-health implementation sites across Australia putting e-health innovations into practice. Already the benefits of electronic health records are evident. For example, Dr Raymond Seidler, a GP from Sydney, spoke earlier this year at an e-health launch for health professionals in Canberra. As an early adopter of electronic health records whose practice is connected to nearby hospitals, he has seen what is possible. He told the launch:

The hospital receives up-to-the-minute information including pathology tests performed by the GP and has all the demographic information required clearly legible.

He goes on to say:

Previously GPs have received handwritten letters which are often indecipherable from overworked hospital doctors. Some patients forgot to bring their letter to the GP and so much information was lost.

I think that all speakers in the debate have agreed that the benefits of the electronic health records system are self-evident and it is clear that we need to continue the progress towards putting in place this system. This was highlighted even further last week when I travelled with the regional Australia committee to, among other places, Moranbah, a mining town in my electorate of Capricornia. We were looking at the practice and experience of fly-in fly-out work arrangements in Queensland and, obviously, across Australia. One of the groups who appeared before the committee were representatives from Moranbah Medical, which is one of the GP practices in Moranbah. They spoke to us about their experiences of practice in a town where anywhere between 30 and 40 per cent of the population are non-resident in Moranbah—they are people who travel to Moranbah week-on, week-off according to their rosters, to work in the mining industry. They told us of the difficulties that presents to doctors. For example, in their practice they have a snapshot from June 2011 showing that 23 per cent of patients at that practice are non-resident in Moranbah and in many cases are presenting at that practice for the first time. These are not patients who necessarily belong to that practice, even though they are seeking the services of those doctors. It is not hard to work out the difficulties that presents to doctors, but I will quote from their submission:

Without a prior relationship with a patient, a lack of medical history or other information in an emergency can be very difficult to manage and carries dangers such as drug interactions/allergy risks.

That just highlights further the importance of having those electronic health records, particularly for people working in those fly-in fly-out situations. It is much better for the patient and much better for the doctors.

I understand that with this bill today we are still at the foundational stage of getting the personally controlled electronic health records system in place, but I would call on the government to ensure that, at the appropriate time, we have a very focused campaign in places like Central Queensland, targeting both consumers and health professionals, to promote the take-up of electronic health records in recognition of the highly mobile workforce in our region.

This is a bill that continues the government's proud record of health reform, and I commend it to the House.