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Thursday, 16 February 2012
Page: 1620

Dr SOUTHCOTT (Boothby) (12:17): I rise to speak on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. The coalition has always had a strong track record on investing and delivering in the e-health sphere. Under the coalition government, computerisation of general practice increased from 17 per cent in 1997 to 94 per cent in 2007. We achieved this through a $740 million investment throughout that decade. Significantly, this was an initiative of one of the previous health ministers, Michael Wooldridge, and his successors, Kay Patterson and the current Leader of the Opposition, and it was done through incentives for general practice. When we look to similar countries for comparison, we see that Australia does have a high rate of computerisation of general practice but also that computers are used in practice management and also patient records. For this reason, the coalition is supportive of the concept of a shared electronic health record. We think that it is a good idea in principle. In fact, it was the coalition government that originally started the focus on a shared electronic health record back in 2004. It is for this reason that we will not be opposing these bills before the House.

However, we do recognise that there are a number of concerns which have been raised over the way in which the PCEHR is being implemented by those opposite. Unfortunately, despite the direction established under the previous coalition government towards e-health, the previous Minister for Health and Ageing, and Labor's implementation of the PCEHR since taking government in 2007, has received enormous criticism from industry for the poor management of the program's development and progress.

In very simple terms, the government was presented with a national e-health strategy in 2008. The recommendation there was to go for incremental steps in the area of e-health, and that is an approach that the coalition would very much endorse. Instead, as we have seen in so many areas with this government, through pink batts and the NBN, the former Prime Minister, Mr Rudd, went for the big bang approach, and I will discuss why we now see some problems with that.

Before getting into the technicalities of the bills, I want to touch a bit on the timing of this debate. This legislation was introduced to parliament in the final sitting week of 2011. The opposition referred these bills to a Senate inquiry which is due to report on 29 February. In fact, the submissions to that inquiry have just closed this week. The Senate inquiry in its public hearing last Monday heard testimony highlighting a number of stakeholders' concerns with these bills. A better approach would have been for the Minister for Health and the government to defer debate on these bills until the Senate inquiry had reported on its findings. It is disappointing that, as with so many other bills, the Minister for Health and the government are trying to force through debate without proper scrutiny of the concerns being raised. This government is becoming known for rushing legislation through the parliament without the scrutiny that it needs.

This legislation provides the legislative framework required for the management of the personally controlled electronic health records system. The PCEHR is designed to be a secure electronic record of a patient's important health information. This electronic record is designed to be available anywhere there is internet access and at any time. The concept of a PCEHR is to allow for the important health information of a patient to be easily transferred between all of the patient's healthcare providers. For example, it would allow a patient's medical information to be shared between their general practitioner and their specialist, between a hospital and a community setting. Currently, this information sharing is not easily possible, with a patient being required to repeat their medical history and often to repeat results of pathology tests or radiology and diagnostic imaging, and other important information to each clinician they visit. This repetition of information can be hampered by a patient forgetting or confusing certain information, which results in poor information flow between practitioners, unnecessary or duplicated medical tests and potentially errors as well.

The proposed electronic health records will contain patient information that will include past and current medical conditions, medication history, a patient's allergies, hospital discharge summaries, Medicare information, as well as a section for any information that the consumer would like to add themselves. Importantly, the system is designed to be purely opt in. It is a voluntary system. It means a person will need to actively apply for a personal electronic health record. If a person does not apply, no record will be created. Once an individual has registered for a PCEHR, they can deactivate or reactivate that electronic health record at any point in time.

It is important to note that this opt-in system is enshrined in the legislation before the parliament, and this is a key concession to the privacy concerns which have been raised in this area. While many of the peak health groups have called for the system to be an opt-out system, it is a fundamental basis of the PCEHR design that a user be fully in control and should have a choice whether they have their record created or not.

The PCEHR will not be a centralised data collection. For security reasons the system has been designed to link up the data sources around the country that already exist. Information will be stored in a number of secure data repositories that conform with the required specifications. The PCEHR will be viewed through a portal which links up to these data repositories. Most of the information to populate a patient's PCEHR already exists within general practice, chemists, pathology groups and hospitals. Simply put, the current proposed electronic health record system links these data sources and displays them in a single online portal.

In touching on consumer control, the system has been designed so that any consumer who registers for an electronic health record should be fully able to choose the settings that control which practitioners can access their record and how much of their electronic health record the practitioner can access. For example, a patient may wish for their GP to view all information contained within their PCEHR but may want to restrict the amount of information available to their dentist or other clinician. The design of the PCEHR system, if implemented properly, should at all times allow the patient to be in full control of who sees what information and when they see it. A patient's data will be protected under both Commonwealth and state privacy legislation. The federal Information Commissioner will also be granted the power to investigate any complaints or potential breaches of privacy. However, I am going to touch on this point in a moment.

As I said earlier, it was the coalition that originally started the focus on an electronic shared health record. We have always been in favour of the concept. We are in favour of the concept because of the numerous benefits that this measure, if implemented properly, can achieve. However, we do have enormous concerns about the capacity of this government to implement large, complex projects. A properly implemented electronic health record system and in fact a broader e-health focus can improve patient care. At the heart of all health policy should be the desire to improve patient care.

Electronic health records have the capacity to reduce duplications, reduce prescribing errors and improve efficiencies, which will have a positive impact on overall patient care. There is anecdotal evidence that medical tests are often duplicated where previous tests are not available or not known to the current medical practitioner or where new tests are requested because they do not trust the original diagnostic source.

The government's own projections show that electronic health records alone will have a net economic benefit of $1.5 billion up to 2025. More importantly, electronic health records will also mean that patients will have their medical history available to them anywhere they travel. For example, a patient who becomes ill while travelling will have their full medical history available to them, their doctor or the emergency department that they visit. In addition, forecasts by Booz and Co. have shown that a comprehensive e-health platform, of which electronic records are a significant part, could save up to 5,000 deaths annually once fully operational. That same report goes on to say that a comprehensive e-health platform could also save up to two million primary care and outpatient visits, 500,000 emergency department visits and up to 310,000 hospital admissions annually. This clearly shows that the e-health record, if implemented properly, will make significant improvements to patient care and patient treatment right across the board.

However, like so many of this government's other programs—pink batts, school halls, GP superclinics—the implementation of the PCEHR has highlighted significant concerns. While the coalition is supportive of the concept of electronic health records, a flawed implementation and a lack of forward planning could see this project becoming the government's latest big white elephant. It could be pink batts on steroids.

You only need to look at the situation in the UK to see how poor planning and implementation can be financially disastrous. The UK have spent over £12 billion and over 10 years on the summary care record, which is their electronic health record equivalent. This is the equivalent of almost A$18 billion. Late last year the UK declared the program a failure, saying it was time consuming and challenging, with as yet discernible benefits for clinicians and no clear advantages for patients. While this is an extreme example, it highlights perfectly how the long-term costs of government programs can blow out exponentially without proper forward planning. Unfortunately, it seems that those opposite are yet to learn this lesson. Those opposite have been completely silent on the future and long-term expenditure required to promote and maintain the system. Indeed, the previous minister for health has been evasive when discussing the future funding of NEHTA, the National E-Health Transition Authority. NEHTA is funded on a joint Commonwealth-state partnership through COAG but their funding agreement expires on 30 June this year. That is the day before this electronic health record is meant to go live on 1 July. It is my understanding that the Standing Council on Health, a subset of COAG, has agreed to fund NEHTA post 30 June but the government refused to publicly release the Commonwealth contribution.

What may be more concerning is that the government have never mentioned their expected costs relating to ongoing maintenance and upgrades or the provision of a help desk or support staff. Like any computer network IT system, technology dates very quickly. Responses to questioning at Senate estimates have shown that this system includes almost $100 million in physical hardware and assets. This hardware will not last forever. At some point it will need repairing, it will need maintaining and it will need replacing. Again, there is no funding set aside for that in this bill post 30 June this year. Not once has the minister for health or anyone on the government benches publicly anticipated the future cost of this to the taxpayer.

We know that this is a government who cannot manage their money. It is not a scenario that we can afford to impose on the Australian taxpayer. The minister for health needs to tell this House and come clean with the Australian public and inform the taxpayers just how much the PCEHR is going cost. There is an expectation from the government that it will be a patient's GP who will create the shared health summaries, which make a vital part of any patient's electronic health record. The government expect that a GP will spend additional time and effort creating and maintaining the shared health summaries, with no incentive to do so. This is a complete contrast to the way in which the Howard government approached this issue through incentives for GPs, and that is what saw the revolution in computerisation of general practice.

The shared health summary is a collection of the patient's medical history. A frequently raised concern with the government's plan is the lack of any encouragement or incentives for general practitioners to create and maintain these summaries. It is widely anticipated that the driving force behind the successful uptake of the PCEHR will be from general practitioners, yet the government's plan presumes that they will do more work for no benefit. The minister needs to explain her plan again to the House to ensure that GPs will support the PCEHR and be willing to invest the extra time needed to make the PCEHR successful, without receiving any benefit for doing so.

A number of stakeholders and submissions to the Senate inquiry have raised the significant privacy concerns about these bills. While the bills provide for patient's data to be protected by the 1988 Privacy Act, an investigation by the Information Commissioner over breaches and complaints has raised concerns about governance and structure. The overlapping and confusing jurisdiction in the privacy arena based on the state-federal divide makes policing privacy within the PCEHR program somewhat difficult. The very large number of healthcare providers that are subject to state privacy laws in both the public and private sectors highlight this difficulty. It remains to be seen how effective the current privacy policing provisions will be and how these concerns will be rectified.

It is interesting to note that the Office of the Australian Information Commission, which has been charged with policing this program for privacy breaches, has made its own submission to the Senate inquiry. In fact, the Information Commission itself has called upon the government to strengthen the OAIC's powers under the Privacy Act to investigate breaches. It begs the question: how much did the government really liaise with their own body before deciding to give the task of policing these privacy concerns to the OAIC? More importantly, will the health minister be considering the OAIC submission and the other submissions which seek to strengthen the privacy protections embodied within the PCEHR legislation?

Almost all of the submissions to the Senate inquiry have raised concerns about the start date. The government set a start date for the electronic health records to go live from 1 July this year. The minister for health has repeatedly stated that we will be able to register for a PCEHR from 1 July this year. Unfortunately, just repeating it will not necessarily make it come true. There is a widespread belief from the majority of industry experts, peak health bodies and medical practitioners generally that 1 July will not bring the fanfare that we are expecting.

These concerns are compounded by the announcement made by NEHTA only a few weeks ago that development of their primary care desktop software at the lead implementation sites had been halted. This development work had been halted due to the discovery of technical incompatibilities across versions, which created a potential clinical risk if work continued. It is not clear how long this will take to be rectified. We are now a little over four months from the 1 July start date, yet the government is only just debating this legislation. Like so many other government initiatives, they have set an ambitious start date and are now struggling to meet their own self-imposed deadline.

We saw reports emerge late last year that key technical standards had not been finalised and that 'tiger teams' were being created to bypass the usual standard setting processes. It has been a repetitive comment that stakeholders consider that the minister's arbitrary 1 July deadline is unrealistic at best. The coalition want to see an effective electronic health record but we want to make sure that it is done right. It is counterproductive for this government to rush to meet this deadline for no other reason than to desperately try to get runs on an otherwise bare scoreboard. The bill and the comments I have made expose the underlying program of how this government operates. Those opposite seem to be working on the big bang theory of government: they make a huge, grandstand announcement for the media and then struggle to follow through to implement it on time, on budget or even at all. You only need to look at the former Prime Minister's historic health reforms, which were whittled down to a fraction of the original announcement. Then there was the home insulation saga, which has cost some people their lives and some their homes. Another example is the BER school hall program, which has seen enormous waste and the highest per square metre cost for halls ever seen in this country. You can look back over Labor's last two terms in government and identify countless announcements that have all ended the same way—looked good, sounded good, but just another Labor lemon. That is our deep concern with electronic health records: they sound good in principle, but look at the capacity of this government to manage complex large programs. It is not good.

While we do have concerns about the way in which the Gillard government has implemented the PCEHR, we remain committed to the concept of an electronic health record. We recognise the potential benefits a properly implemented PCEHR could bring to patients and practitioners alike. It is for this reason that we will not be opposing these bills in the House.

That said, we do remain sceptical about what capabilities will exist when the switch is flicked on 1 July, or even what money will be available for it. It remains to be seen whether this is another classic case of the Labor Party over-promising and under-delivering, a story we hear so much in health and across every avenue of government. This announcement sounds great, but there are problems with the implementation. For this reason, whilst not opposing these bills, we do reserve our right to move amendments, pending the outcome of the Senate inquiry, which is due to report on 29 February.