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Wednesday, 29 February 2012
Page: 1270


Senator JACINTA COLLINS (VictoriaParliamentary Secretary for School Education and Workplace Relations) (17:15): I move:

That these bills be now read a second time.

I seek leave to have the second reading speeches incorporated in Hansard.

Leave granted.

The speeches read as follows—

PERSONALLY CONTROLLED ELECTRONIC HEALTH RECORDS BILL 2011

If you asked Australians if we should create a system where their health information can be easily transferred between their health practitioners- many would be surprised that such a system doesn't already exist.

The sad truth is that our medical information is not connected - despite how logical and possible it is to achieve.

In many ways, the absence of a system of electronic health records in Australia demonstrates the difficulties of health reform - the fragmentation, the vested interests and the balancing priorities.

But we clearly know the evidence of why we need to act.

Currently health information of individuals is fragmented across a range of locations rather than being attached to the patient. Consumers need to retell their story each time they visit a different clinician. This outdated approach can result in poor information flows, unnecessary re testing, delays and medical errors.

Studies in hospital environments have indicated that between 9% and 17% of tests are unnecessary duplicates.

Medication errors currently account for 190,000 admissions to hospitals each year. Up to 18% of medical errors are attributed to inadequate patient information.

There are situations demonstrating every day in Australia why the introduction of eHealth records will lead to improved care for patients.

A Victorian retiree on holiday away from his detailed medication history gets rushed by an ambulance to hospital.

A mother with two children who both suffer from asthma struggles to remember the different medications they have tried.

A carer tries to help their elderly mother with their healthcare who can't participate in her own health care.

Or a man with a chronic disease like diabetes who wants to better manage their disease - and ensure his doctors are all working off the same information.

These scenarios reflect the kinds of real-life situations that occur all around Australia every day.

EHealth records can change all these situations for the better.

That's why clinicians, health consumers and the health technology industry are all united in the call for electronic health records.

The National Health and Hospitals Reform Commission recommended to the Government in 2009 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 that person"

This is a proposition that had widespread support in the extensive health reform forums and consultations that the Government held throughout 2009 and 2010 around Australia.

Australians saw the value in preventing errors and misdiagnosis. They saw the benefits in managing their own health and the health of their family members. And they saw the benefits in creating a more efficient and effective health system.

Our analysis shows that the net economic benefits of eHealth records are estimated at $11.5 billion until 2025.

To put it bluntly - there is widespread support for dragging the management of health records into the 21st century.

That's why this Government committed $467 million in the 2010 Federal Budget to a two year program to build the national infrastructure for personally controlled eHealth records.

Records will have the capacity to contain summary health information such as conditions, medications, allergies and records of medical events created by healthcare providers. The records will also be able to include discharge summaries from hospitals, information from Medicare systems and some information entered by consumers.

Australians rightly do not want their privacy threatened. They do not want one single massive data repository for all their records. They also want the right to participate, but not be forced to do so.

That's why we are designing this project to take heed of privacy from the ground up.

We are building a truly personally controlled record.

We're establishing new consent settings for sensitive information and auditing that doesn't currently exist for any of our records.

It is how our system will strike the right balance between security and access. Many of these protections are about ensuring that patients have the same protections over the access to digital records that they do over paper based records.

The bias is placed upon linking data sources around the country - much of which exists already in various forms in general practices, at the pharmacy, with pathology groups or at hospitals. This also means that we won't be building every technology solution - but providing the national infrastructure that only the Commonwealth Government can do.

Already there have been significant achievements made in the past few years towards the implementation of eHealth.

This Parliament passed legislation last year to implement the Healthcare Identifiers Service which provides the backbone identification system for eHealth.

There's now 1.1 million of these identifiers downloaded - across jurisdictions and lead implementation sites.

Twelve lead implementation sites have been established and are working with clinicians and patients to deploy eHealth solutions.

Partners have been appointed and are busy working in the key areas of building the national infrastructure, change management and evaluating the success and effectiveness of the solutions.

The implementation approach is both swift and careful. We are developing infrastructure in a set period of time, but the rollout will happen in a staged manner.

All through the process there has been extensive consultation with clinicians, consumers and the health IT industry.

The finalised Concept of Operations released in September is the result of much of this consultation - but the engagement work now continues as the fine details are completed.

This consultation is important because establishing eHealth records is not an end in itself. It has to deliver for clinicians and patients. This is why we have embedded e-health within our health reform agenda.

We want to know what is going to work for the patients - as well as the doctors, nurses, allied health professionals and others who have to deliver care.

Now this legislation I am introducing today will deliver the legal basis for this new system from when it starts registrations from 1 July 2012.

To develop this legislation we have had two rounds of public consultations - both on the legal issues for the system, and then on an exposure draft version of this Bill.

The central theme of our system and this Bill is that any Australian will be able to register for an eHealth record, and they will be able to choose the settings for who can access their record and the extent of that access.

When registered, consumers may be represented by authorised and/or nominated representatives. This allows minors and persons with limited or no capacity to have an eHealth record which details their medical history. Patients can choose to have a carer, family member or friend assist them with their record.

Apart from consumers, the other participants who can choose to register include healthcare provider organisations and repository and portal operators.

A registration framework will ensure regulation of all these parties, verification of identity, assurance that minimum technical, security and administrative requirements are met, and system accountability.

The Bill prescribes the circumstances in which eHealth record information can be collected, used or disclosed and imposes civil penalties for knowing or reckless unauthorised collection, use or disclosure.

All registered consumers and organisations will be subject to the Privacy Act 1988 or state or territory privacy laws as prescribed. The Privacy Act will also apply to the System Operator including the ability of the Information Commissioner to investigate an interference with privacy and to penalise an offending party.

The Bill also sets out requirements which apply to protect the privacy and security of patient health information. This includes notification of data breaches and storing all information and in Australia. These requirements are also subject to civil penalties.

The System Operator will be responsible for the operation of the system. The Department of Health and Ageing will initially perform this role. The Bill allows for the System Operator to change in future to a statutory authority. This will be the subject of future discussions, both with states and territories and with stakeholders.

The System Operator will be responsible for establishing and maintaining the basic infrastructure of the system - including a register of participants, index service for documents and national repositories where appropriate.

There will also be important safeguards that the System Operator will deliver including audit logs for access to records, reports on the performance of the system and mechanisms for handling complaints.

An Independent Advisory Council will provide expert advice on the operation of the system and on clinical, privacy and security matters.

The membership will include consumers, health providers and people with experience in critical areas such as rural health, indigenous health, administration, technology and legal or privacy issues.

A Jurisdictional Advisory Committee will include representatives of the Commonwealth, states and territories and will provide advice regarding their perspectives of the system.

The Australian Information Commissioner will be the key regulator for the system and will have the capacity to conduct audits, commence investigations and impose a range of sanctions, accept enforceable undertakings and investigate complaints.

To ensure transparency of the system, the System Operator and the Information Commissioner will be required to provide annual reports on the practical operation of the system to the Minister and the Ministerial Council. The system is to be reviewed two years after the Bill commences.

This legislation being introduced is yet another sign that this Government is getting on with the job of rolling out eHealth records.

This stands in stark contrast to the record of the Opposition in this area, and particularly its current leader. When he was the Health Minister he committed to establishing eHealth records. This of course didn't occur.

He recalled in 2005 (and I quote):

"Failure to establish an electronic patient record within five years, I said, would be an indictment against everyone in the system, including the Government. I hope to be judged against that somewhat rashly declared standard; not because it is likely to be fully met but because it would mean that, come next year, I remain the Health Minister!"

Of course this was a standard that he failed, much to the detriment of patients and clinicians alike.

However he failed a second test when in the lead up to the 2010 election, he promised that a Government he led would cut every cent of the $467 million that this Government had committed to eHealth.

This legislation presents another test. Will he do what is the right thing for this country and support bringing our health system into the 21st Century, or will he continue his well trodden path of just saying no.

For the sake of the future health care of Australians I hope that the Opposition can finally come on board.

Many people may see this system and legislation as being about technology. That's a mistake. It is about health care. It is about helping patients and doctors to prevent, cure and treat.

It also builds upon the other advances that are happening because of this Government's investment - namely the National Broadband Network and telehealth. Investments that are rolling out now and helping to better the lives of Australians.

The use of technology to improve care will have a similar effect to the other great advances in health care technology - such as antibiotics or x-rays. This is a once in a generation opportunity to deliver these important reforms.

I encourage this Parliament to support this improved health care through the passage of this Bill.

PERSONALLY CONTROLLED ELECTRONIC HEALTH RECORDS (CONSEQUENTIAL AMENDMENTS) BILL 2011

This Bill makes a number of minor, consequential amendments to existing Acts to support the introduction of the Personally Controlled Electronic Health Records Bill 2011.

The system will enable patients who register to access their health information and make it available to participating healthcare providers, online, where and when it is needed.

To manage the information from different sources, a consumer's individual healthcare identifier number is used to ensure that only information relating to that consumer can be viewed through their eHealth record.

This Consequential Amendments Bill will ensure that the system is able to operate appropriately and effectively.

In order to enable the system to operate, a number of amendments to existing Acts are required, including to the Healthcare Identifiers Act 2010 to allow the system to take up and use healthcare identifiers. Using healthcare identifiers will allow more accurate matching of health information to the correct consumer record and allow more accurate identification of healthcare providers.

The amendments to the Healthcare Identifiers Act 2010 will authorise the System Operator, and other entities such as Medicare acting on behalf of the System Operator, to handle healthcare identifiers in various ways including the capacity to:

collect, use and disclose healthcare identifiers for the purpose of registering consumers in the system; and

use healthcare identifiers to verify the identity of individuals during the registration process;

Similarly, authorisations are also sought for repository providers to:

disclose healthcare identifiers for the purpose of indexing documents uploaded to a consumers electronic health record; and

adopt healthcare identifiers as the main identifiers in their repository for information that is to be used within the system.

There will also need to be amendments to the Health Insurance Act 1973 and the National Health Act 1953 to allow a range of health records stored by Medicare to be included in a consumer's eHealth record if the consumer so chooses.

The consequential amendments proposed in this Bill will allow a range of records created by Medicare to be included in a consumer's eHealth record. Consumers will be able to choose to have their Medical Benefits Scheme, Pharmaceutical Benefits Scheme, organ donor and childhood immunisation information included in their eHealth record. Both the Health Insurance Act 1973 and the National Health Act 1953 contain certain prohibitions regarding the linking of Medicare and Pharmaceutical Benefits Scheme information, and the amendments will displace those prohibitions only for eHealth records system purposes.

This Bill seeks to make these amendments so that consumers can have the health information they choose included in their eHealth record to support their better coordinated and better informed ongoing healthcare.

Debate adjourned.