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Tuesday, 28 February 2012
Page: 2130


Mrs BRONWYN BISHOP (Mackellar) (20:57): In listening to some of the debate on the Personally Controlled Electronic Health Records Bill 2011 and cognate bill that comes from the government benches, one can only agree with the comment of Dr Ian Colclough in his submission to the Senate Community Affairs Legislation Committee when he said:

… it is easy to be seduced into believing the development of the PCEHR—

personally controlled electronic health record—

is readily achievable and for many advocates it is convenient to forget lessons from the past and hastily rush into this still uncharted territory.

He said the concept of the shared health record is 'relatively new' and so is the personally controlled electronic health record. He continued:

Consequently, available solutions are immature and the experience and understandings of health providers, agencies and consumers minimal. This accounts for why so few studies have been undertaken to validate their adoption.

He further said:

One recent major review stated that:

"Patients, policymakers, providers, payers, employers, and others have increasing interest in using personal health records to improve healthcare costs, quality, and efficiency. While organizations now invest millions of dollars in PHRs

personal health records—

the best PHR architectures, value propositions, and descriptions are not universally agreed upon. Despite widespread interest and activity, little research has been done to date, and targeted research investment in PHRs appears inadequate."

Whilst the idea of utilising electronic data collection can certainly be attractive to one in thinking, it is the examination by people who are involved in this sphere that puts up the sorts of worries that people have about a start date of 1 July 2012. I think this is a major sticking point for the opposition—that the whole process is being rushed. One of the things that seems to be driving that rush is the fact that the funding for it—an agreement under the COAG arrangements—runs out at that date, and there is no certainty about any further funding for it.

There are many issues that are of concern to people on this side of the House. We are a conservative party. We are conservative on this side and therefore we are cautious about the way in which we would go forward in order to bring about change. On the government side there is this overuse and indeed abuse of the word 'reform' when really what they are talking about is change, and sometimes it can be change for change's sake or rushed change without adequate work having been done to prepare for it and to look at what the consequences may be.

It was said in the course of the debate that one can have no confidence to date that the records to be accessed will be complete, that they will be up to date, that they will be reliable. Where are the questions being addressed as to who would be liable for damages for acting on records which are not complete, which are out of date, which have not been properly kept? We all know that in our hospital and health system there are many errors. Indeed, the second reading speech of the minister states:

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.

That presumes that electronically collected data is going to be accurate and reliable. Yet nowhere is there any evidence that proper risk assessment has been carried out. My colleague the member for Forrest outlined her concerns about the gathering of data in a central base which can be hacked into and abused. That well-known old adage 'information is power' certainly has great potential in the area of health records.

The way the system is meant to operate is that, rather than the patient repeating their medical history and information each time they visit a different clinician, there would be this huge database which could be tapped into. How much more sensible to look at things on a smaller scale, and these sorts of practices do exist—that is, where a patient who wishes to can have their medical data carried around with them on a USB stick, and when they go from a doctor to a specialist they take it with them. It can be utilised because the person owns it and controls it and hands it over because they wish to do so. There is that very personal connection between the GP and the patient because that is an ongoing relationship. It is vital that the system is an opt-in system, not an opt-out system. One can see that once such a huge infrastructure is established, and hundreds if not thousands of public servants are involved in it, the desire to go from an opt-in to an opt-out system is going to once again be one of those irresistible pursuits of those who want to control information.

The Deloitte study conducted in December 2008 and published by the department as a summary of the Deloitte national e-health strategy recommended that the building of long-term health capacity should be undertaken incrementally and that critical to driving the uptake of e-health and support by consumers and care providers will be the quality of the underlying e-health solutions and relationship between them, which involves a two-way data exchange. Deloitte went on to say that they advocated focusing initial investment in those areas that deliver the greatest immediate benefits for consumers, care providers and healthcare managers. They recommended a national e-prescription exchange service as the highest priority for e-health application solution, which should be developed immediately.

Dr Colclough said:

It makes good sense to move away from large scale, all encompassing national ehealth projects and focus on projects which are more modest in scope and geography. Subject to the architecture they can then be scaled up and rolled out nationally. This more ‘contained’ approach is easier to manage, less risky and less costly to 'prove'. It also makes it very much easier to quickly counter disruptive vested interests and overcome difficult political and technical hurdles as they arise.

In that regard it is a mystery why the Deloitte Recommendation to establish a National ePrescription Exchange Service has not been embraced by NEHTA and the Department.

…   …   …

The private sector has successfully deployed two Prescription Exchange Services serving medical practices and community pharmacies in every State and Territory of Australia. Yet this is not addressed.

Other submissions that were made point out other difficulties. Of course, much has been made of the fact that the development of such a system by the UK government has been wound back after repeated failures and growing criticism. According to the UK health minister, Simon Burns, 'this has been an expensive farce from the beginning'. In May 2011 the UK National Audit Office admitted that large sections of the National Health Service were withdrawing from the electronic record project, which is a key part of an £11.4 billion—A$17 billion—National Health Service project. Google, one of the world's largest vendors of online services, has abandoned its 'Google health' personal health record due to lack of patient interest in keeping personal medical records. The product was introduced in 2008 and it was withdrawn on 1 January 2012. Despite numerous conferences discussing the development of personally controlled electronic health records, foundational issues such as the definition of a health record and ownership of the health record have not been resolved. Dr Rhonda Jolly, of the Department of Parliamentary Services, says in an article headed 'The e health revolution—easier said than done':

… policy makers have discovered that there are many obstacles in developing e-health policies and programs. Some of these have been resolved, others persist, still others are beginning to emerge.

In other words, the picture that comes across is that this is being very hastily driven by the government, which once again has not done enough preparation or enough work. I for one have grave concerns about the privacy issues involved here. I think the involvement of bodies such as the Privacy Foundation is very important in this debate, and they too have concerns. Another point that has been made is that the emerging crime of identity theft utilising electronic data is changing public perceptions about the desirability in general of storing their most sensitive personal information on databases.

There are many uses for the new electronic access we have to so many things. People are being warned about the material that they put into the various forms of electronic media, because this material cannot be retrieved. Once installed, once it is there, there are secondary users who will be dying to get their hands on it. This rush to have this legislation implemented by 1 July 2012 is quite unseemly. The shibboleths from those on the other side, the insulting terms like living in the dark ages and back to the whatever, is the sort of language used when there is no real desire to debate what are the true issues—the legal ramifications of who owns what, who is liable for entering data and who will be liable if errors are made. Statistics I have indicate that in hospitals every year error, and malfeasance as well, kills 18,000 people a year and maims another 12,000, so we know there are many concerns.

I would simply say to the government that by any reasonable consideration this deadline of 1 July 2012 cannot be met and ought not be pursued. The government should listen to people who have greater wisdom and use the incremental approach. The big bang theory is not one wisely followed. When we debate this issue on this side we do so because we are concerned for the individual. We know that the philosophy divides us—we have individualism, where we make laws and consider the rights and implications for the individual, whereas on your side you have collectivism, where you always rule for the collective and the individual can be sacrificed for the collective outcome. So there is a philosophical divide, but there are important issues to be discussed. This unseemly haste does the government's reputation no good when it says it wants a better health system. There is a need for an incremental approach and a need for greater consideration.