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Tuesday, 19 June 2012
Page: 3665


Senator POLLEY (TasmaniaDeputy Government Whip in the Senate) (16:42): I rise to fully endorse and support the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. This is another plank in building our health system in this country. Earlier in this debate a member of the opposition made reference to former minister for health Tony Abbott and the contribution he made. I just thought we should correct the record. I would not be proud of having been part of a government where the minister for health ripped $1 billion out of the health system.

Before talking about this legislation I want to refer to the very positive developments that took place last week in Tasmania, when the Minister for Health, the Hon. Tanya Plibersek, announced a much needed injection of funds into the Tasmanian health system. I would like to commend not only the current minister, the Hon. Tanya Plibersek, but also the former Minister for Health and Ageing, the Hon. Nicola Roxon, because they have listened to the Tasmanian people over a long period of time and have now invested in health where the Tasmanian community best needs that money spent at this point in time. Some $31.2 million over four years will be provided for an elective surgery blitz, providing about 2,600 additional surgeries targeted at areas of need; about $22 million to establish walk-in clinics in Hobart and Launceston that will provide care for minor illnesses and injuries, for extended hours and at no cost to patients, thus removing pressure on our departments of emergency medicine; and $48.7 million over four years to support Better Care in the Community to prevent and manage chronic disease through the Tasmanian Medicare Local. Individual GPs will continue to have central responsibility for the clinical care of their patients, with the Tasmanian Medicare Local supporting allied and preventive health services and the coordination of care. Given the disease profile of health in Tasmania, this is an very important consideration.

Further, there will be $74.5 million over four years to provide better care for patients when they are discharged from hospital and, most importantly—and something I have been lobbying for for a long period of time—better palliative care in the community; and $53.9 million over four years to train more medical specialists in Tasmania and provide more scholarships for nurses and allied health professionals. The very limited training of allied health professionals has had a significant effect on service provision in my state of Tasmania. There will be $15.4 million over four years to address gaps in mental health services; $36.8 million over four years to roll out the personally controlled electronic health record in Tasmania's hospitals and enable allied health, pathology and diagnostic imaging services to connect to e-health; and $42.0 million over four years to support innovation in clinical services that will enable care to be delivered more effectively and efficiently. This will include $1 million in seed funding to establish a virtual health sciences precinct, bringing together Tasmanian hospitals, the University of Tasmania Faculty of Health Science, the Menzies Research Institute, the Clifford Craig Medical Research Trust and appropriate primary care providers

The reasons I raise this are manifold. Firstly, this came as a consequence of the efforts of Tasmanian politicians, both in this chamber and in the other place, over quite a considerable period of time. This is not a spur-of-the-moment decision but a considered response to the unique situation in Tasmania. Community and, particularly, clinician consultation with Minister Plibersek contributed to the development of this package. This was gathering information at the grassroots level. As the minister has said on many occasions, her Labor colleagues in the House of Representatives and the Senate have camped out in her office. If I recall correctly, last Friday she said she was possibly looking at an extension to her ministerial office to accommodate her Tasmanian colleagues!

This reflects the concern of this government to act in the best interests of the Australian community. This is in stark contrast to the Howard government's overt operations to downgrade a public health system, upon which much of our community relies, and drive people into a private system, which was often beyond their resources. We only have to look at the US to see the effect of reliance on private health care: 15 per cent of population have no access to health care—some 47 million people. I could outline a number of things that have been brought to my attention in relation to the lack of access for Americans to their health system, because it is quite frankly unaffordable and not available to most Americans.

But to get back to the health forums that were held in Launceston, at the one held at Launceston General Hospital all the health professionals were represented, and it was a very vigorous and engaging exchange of views and ideas. And it was suggested very strongly, at all the forums around Tasmania, that there was a desire—a need, in fact—for electronic health records, and that the e-health in this legislation was a step in the right direction.

Clearly, this is a major indicator of the $36.8 million over four years to roll out the personally controlled electronic health records. The Personally Controlled Electronic Health Records Bill 2011, the PCEHR Bill, will establish the national personally controlled electronic health record, PCEHR, system. The PCEHR system and its regulatory framework will include an entity that will be responsible for the operation of the PCEHR system.

These bills will also implement a privacy regime specific to the PCEHR system which will generally operate concurrently with Commonwealth, state and territory privacy laws. The national e-health strategy, endorsed by health ministers in 2008, recognised that a 21st century healthcare system requires 21st century health information infrastructure in order to achieve its vision, which is to enable a safer, higher quality, more equitable and sustainable health system for all Australians by transforming the way information is used to plan, manage and deliver healthcare services. And that is obviously underpinned by the rollout of the National Broadband Network.

Underpinning this vision is a recognition that significant improvements in the way that health information is accessed and shared is required if Australia is to maintain a world-class health system in the face of rapidly increasing demand and costs. The purpose of the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 is to ensure that the PCEHR Bill, once enacted, operates appropriately and effectively. This will be achieved by making a number of amendments to the Healthcare Identifiers Act 2010 and other legislation to allow participants in the PCEHR system to take up and use healthcare identifiers to support the secure and accurate sharing of records within the PCEHR system.

The Healthcare Identifiers Service, the HI Service, was created by the HI Act as a foundation element for electronic transmission of health records. By assigning a unique identifier to each consumer, individual healthcare provider and healthcare provider organisations, the HI Service provides a solid basis for ensuring that a health record is attached to the PCEHR of the right consumer, restricting the ability to author a clinical record for the PCEHR system to qualified healthcare providers and making sure that connection to the PCEHR system is only available to those healthcare provider organisations that meet technical and security requirements. As a result, a health record entering the PCEHR system will typically contain all three kinds of healthcare identifiers. The healthcare provider organisation's identifier will be used to identify the provider organisation to the system, the individual healthcare provider's identifier will be used to identify the author of a record uploaded to the system, and the consumer's identifier will be used to identify the PCEHR to which the record should be attached.

The consequential bill amends the HI Act to allow healthcare identifiers to play a central role in the integrity, security and safety of the PCEHR system. The consequential bill will also make amendments to the Health Insurance Act 1973 and the National Health Act 1953 to allow a range of health records created by Medicare to be included in an consumer's PCEHR where a consumer wants that information to be included.

The Senate Community Affairs Legislation Committee clearly reported the following:

Submitters to the inquiry have been in favour of the benefits that will result from the implementation of the PCEHR system, many recognising that it is time that such a system were implemented.

The AMA commented as follows:

... most members are enthusiastic about using a shared electronic health record. They know that with the right system they can improve the patient's healthcare experience. The right sort of shared record system will help doctors deliver better care. They will have important information about their patients to help them to make good clinical decisions.

The Royal Australian College of General Practitioners stated that they continue to strongly support the PCEHR and the foundations of electronic communications.

Support for the bills came not only from medical organisations. The Aboriginal Health Council of Western Australia was similarly supportive of the system and also identified that its introduction will see benefits delivered to patients, particularly those in remote and rural Australia. They said:

We also very much see that the proposed legislation has great potential to enhance better patient outcomes in Aboriginal communities. Our sector also sees that this has a role to play in terms of Closing the Gap. It is also very clear from what the government is saying they are trying to do that this particular legislation and the proposal would support people who are in remote and regional centres.

Submissions to the Senate committee raised some concerns about the system operator. These were addressed by the Department of Health and Ageing, who stated that they believed the compromise between a private organisation and an interdisciplinary statutory authority was a sensible middle position. They said that the membership of the advisory committee should be as diverse as possible. The committee felt that both of these issues should be reviewed in two years but should not delay the development of this important improvement to health care.

Debate about the opt-in or opt-out issue raised arguments on both sides. This issue should be revisited in the two-year review. But it must be remembered that this is the beginning of a system and, as long as we accept that review and even change can occur, we need to get on with this, as with many of the other health reforms that are being implemented. Safety is critical to the operation of the system. We need clear definitions, privacy and access. The time line for introduction has also been raised. But no good reason has been raised to not proceed with the introduction of personally controlled electronic health records.

The Greens have raised recommendations about additional privacy controls, community consultation and data aggregation. The coalition, who as usual see everything in a negative light, wish to delay it for another year. But, as I said earlier, we need to implement what is necessary. The commentary at the health forum in Launceston last week confirmed to me that moving ahead with these two pieces of legislation is what is needed. We should stop procrastinating and do what needs to be done. From what I can see, these pieces of legislation and the investment that the federal government has made in Tasmanian healthcare services relating to them are steps in the right direction and will provide a good foundation for us to build on as we continue making and dealing with revolutionary changes not only in our economy and in health but in the way that we provide services to the members of our communities.