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Wednesday, 29 February 2012
Page: 2247


Ms GAMBARO (Brisbane) (10:00): I rise today to make a contribution to the debate on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. The coalition will not be opposing either of the bills. The coalition has had a strong record on investing and delivering on e-health. For example, under the coalition government's computerisation of general practice it increased from 17 per cent in 1997 to 94 per cent in 2007. This was achieved through an investment of $740 million over those years.

The coalition have always supported the concept of shared electronic health records and the benefits are very obvious. However, the problem is the way and the manner in which the system is implemented. The coalition do recognise that some concerns have been raised in the way in which this particular bill and system are going to be implemented. We will look at reserving the right to amend the bill if we feel so at the later stages of its passage. But, true to form and true to prediction, we see another example of Labor mismanagement, this time in relation to the private electronic health record system, the particular subject of this bill. In an article in the Australian on 28 February, yesterday, by Karen Dee she revealed that spending on the personally controlled electronic health record system had blown out to $760 million, almost $300 million more than budget. This reinforces our concerns about the ability of this government to implement this very important aspect of electronic health.

The bills before the House provide a legislative framework required for the management of the personally controlled electronic health reform system and the PCEHR is designed to be a secure electronic record of a patient's important health information. This will allow for health information of a patient to be easily transferred between the patient's health practitioners. A good example of this is the sharing of a patient's medical records between a GP and a specialist. Currently a patient will need to repeat their medical history and information every time they visited a different clinician. This results in very poor information flow and in extra or duplicating testing, delays and potential errors. We see that quite often when medical tests are ordered.

The other major beneficiary of a shared electronic health record are people on holidays. As we know, occasionally accidents will happen, particularly when you are away and children get sick, so circumstances do change. Holidays are not always the happy and joyous occasions that they are meant to be, but when you have an electronic health record, it means that when you are away from home you can present to an emergency department or to a local GP clinic and you do not have to spend all that extra time explaining the medical history to the particular health professionals concerned.

The health records provide patient information including past and current medical conditions, medications, allergies, discharge summaries from hospitals and Medicare information, as well as any information the consumer might want to add themselves. This system is purely an opt-in system, which means that a person will need to apply for a PCEHR. They can then deactivate and reactivate their electronic record at any time in the future. Most of the information that will be required for the PCEHR already exists in GP practices, in pharmacies, in pathology groups and in hospitals. The currently proposed system merely links these different data sources and displays them in a single online portal, which is a good thing. Consumers who register for a PCEHR will be fully able to choose the settings for which practitioners will be able to access their record and how much of their electronic record will be accessible.

I would like to flag a concern at this stage of the need to ensure that the staff of health providers have the training and professional skills to manage this system. A number of speakers have raised privacy concerns around this issue and I also raise those privacy concerns. The PCEHR will be subject to the privacy acts of the federal and different state governments, so it is really very important that staff, doctors and health professionals are familiarised with the basic aspects of those privacy provisions.

The PCEHR system has been designed to at all times allow the patient to be in full control of who sees that information. Patients' data will be protected by the provisions of the 1988 Privacy Act and the Information Commissioner will have the powers to investigate any complaints or potential breaches of privacy. While this is the case, there are always overlapping and very confusing jurisdictions across a number of states in Australia and the privacy area is based on federal-state control of privacy provisions, but it remains to be seen how these concerns will be rectified. I really urge the minister to address this point when she is considering this bill.

As I stated before, there are a number of perceived benefits of an electronic health record system. There are some amazing cost savings to be had. If we look at an analysis by Booz & Company, we see that by 2020 e-health capabilities could save up to $7.6 billion each year by reducing duplications and errors, and of course there will be a large aspect of improved productivity and better adherence to what is best practice. However, these are all facets of e-health and not just the electronic health records we are talking about here today.

The government's own numbers suggest that the benefit to Australia from e-health records alone would amount to $11.5 billion over the years up to 2025. In addition, the same report suggests that a full e-health program could help to avoid up to 5,000 deaths annually once the system is fully operational. That report goes on to state that the fully implemented e-health system could avoid up to two million primary care and outpatient visits, 500,000 emergency department visits and 310,000 hospital admissions annually. Importantly, it would mean that patients would have their entire medical history available to them regardless of where they travelled in Australia. A patient with a PCEHR who became ill whilst travelling would have their full medical history available to any health practitioner—including any emergency department—they visited.

It was the coalition that originally started the focus on shared electronic health records. Unfortunately, despite the focus and direction established under the Howard government towards e-health, implementation of the PCEHR by Labor since taking government in 2007 has received much criticism from industry for poor management of the development of the program. This is not coming just from this side of the House; it is coming from key stakeholders and it is coming from submissions put forward to the Senate Community Affairs Legislation Committee on these bills. Running through these criticisms is that very familiar thread—the one we see with this government's implementation of any program.

The coalition does recognise that a number of concerns have been raised by different stakeholders about the current government's implementation of the PCEHR rollout. The government has repeatedly stated that the PCEHR will be able to take user registrations from 1 July this year. That is a very ambitious starting point. Despite the government's assurance, the majority of industry experts—and they are industry experts—beg to differ. A number of peak bodies have also expressed very grave concerns about the ability of the system to be up and running on 1 July. We really need to make sure that this government does not, once again, rush in and put a system in place without having the right quality framework behind it. As with so many Labor promises, they announce a major project and then struggle to meet their own deadline—and, in the process, what do you see? You see waste and you see increased mayhem everywhere.

The legislation was only introduced to the House on the last sitting day of 2011. The government has now brought it on for debate. There is a Senate inquiry into these bills and the committee is due to report today, 29 February. The Senate inquiry, in its public hearing on 6 February 2012, heard testimony highlighting a number of stakeholder concerns about this legislation. It would be very prudent for the Minister for Health and for the government to defer debate on these bills until the Senate inquiry has publicly reported its findings. The government has form, has considerable form, on rushing legislation through without proper scrutiny—and this bill is no different.

The government also needs to come clean on the future long-term costs of managing and operating the PCEHR program and on the future funding contribution through COAG. This is so vitally important—that they come clean on the contribution of COAG to the NEHTA. While the previous Minister for Health and Ageing, Nicola Roxon, was reluctant to commit to the future funding of the NEHTA, now is the time for the government to come clean—to tell taxpayers what the long-term costs of implementing this system are going to be. A number of concerns were also raised in the Senate committee about the definition of a health provider. This needs to be clarified by the government. We need to have this clarification to allay the concerns of stakeholders.

The government has only allocated $35 million per year over the next three years for e-health implementation. As with any computer, network or IT system, technology changes very rapidly, yet there is a notable silence from the other side on the future costs arising from these issues. There has been no comment, there has been no discussion, on the long-term costs relating to the ongoing maintenance of the system, any upgrades to the system or the provision of a so-called help desk for the system. This is a phenomenal change to the way health records are to be stored and maintained. One only needs to look at the situation in the United Kingdom. They spent ₤12 billion on their entire e-health record equivalent—and then they scrapped it in 2011.

I also add as an example the payroll debacle in my own home state of Queensland. The cost of the Queensland Health payroll system blew out to over $209 million. Why? Because they did not have a backup system. They rushed the implementation. They bungled the implementation. We saw the scenario—thousands of nursing professionals across Queensland not receiving their pay. Some of them had to go to the Red Cross or other organisations for assistance. There were tragic stories of nurses not being able to pay the rent and not being able to afford food or basic supplies. This is what happens when you do not get a system correct. These people were the innocent victims of incompetence and the inability to get it right.

The other concern I have is that the software and systems that hospitals and practices will require to support the PCEHR will obviously cost money. I am therefore interested in the government's response to that issue—whether they have any plan to support the obvious parties and stakeholders in this. If this is indeed the case, there is the potential for it to lead to higher health costs for consumers. So we really need to know what is happening in that area of support.

In conclusion, the personally controlled electronic health record is a great concept, however the devil is in the detail and the implementation. The government must get it right. We cannot afford to have another situation where the implementation is bungled and it costs taxpayers many millions of dollars to fix. It would have been much more sensible to await the outcome of the Senate inquiry. However, we do support this bill. We think that it is a good thing, but we want to make sure that the government gets all of the details right in its implementation.