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Wednesday, 29 February 2012
Page: 2259

Ms PLIBERSEK (SydneyMinister for Health) (10:49): It is a great pleasure to sum up on this legislation today, the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. I thank members for their consideration of this legislation and their contributions to the debate on these bills.

At present, consumer health records are scattered over a range of locations and clinics rather than being attached to the consumer and easily available at the point of care. This means that consumers need to retell their story every time they visit a different healthcare provider. This outdated approach can result in things like unnecessary retesting, delays and medical errors. For example, we know that medication errors cause about 190,000 admissions to hospital each year, with eight per cent of those errors being due to inadequate consumer information.

I can tell you a story that was told to me by a doctor married to another doctor—a two-doctor household. The father of one of them was living with them and he collapsed in a shopping centre one day because his GP, his heart doctor and another specialist had all changed his medication independently without talking to each other. When they discovered this change, it was completely predictable that this combination of medicines would have had an adverse effect on the patient, but because the doctors were not able to check each other's prescribing an adverse effect occurred. That is just one example of the 190,000 people admitted to hospital each year because of things like medical errors and medication errors.

The Personally Controlled Electronic Health Records Bill 2011 before the House today establishes the essential IT and governance infrastructure that allows consumers to set up their own personal electronic health records—computer based records that can be accessed anywhere there is an internet connection. That means that records can travel with consumers clinic to clinic and doctor to doctor at the click of a button.

We had some criticisms from the member for Bradfield yesterday saying that this should be an opt-out system rather than an opt-in system. He was strongly contested by the member for Mackellar. The reason that we have made this an opt-in situation is that it is important that people feel ownership of their records and feel confident that this is something that they want and want to participate in. Once this essential infrastructure is in place later this year, consumers will be able to opt in and begin registering for personal electronic health records and accessing a range of basic information on their own health care.

Over time, as people register and we work with both consumers and healthcare providers to build on this infrastructure, more detailed and sophisticated features will be available as part of an electronic health record. A number of speakers are worried that this is the big bang—that it is the whole rollout all at once. It is important to emphasise that this is a gradual process starting in the lead sites and allowing individual patients to register, at a time of their own choosing, in a system that will build over time. Just as you would build a house, this legislation helps to lay the foundations for e-health today—strong foundations that will underpin the development of the sector as it expands into the future. This is about developing the foundations of that system carefully and systematically. We are very aware that this is a complex area of reform and a that a national e-health records system will have to be built over time as both consumers and healthcare providers join the system. But since 2010 we have been working closely with consumers and with healthcare providers. To get this right we will continue to keep talking and working with these groups.

Establishing a national e-health records system is part of the government's e-health agenda. It is an agenda that builds on the work of GPs, hospitals and other healthcare providers and that is integrating modern technology into day-to-day health care. Already, 97 per cent of GPs have access to computers and 96 per cent have access to the internet in their consulting rooms. I congratulate doctors for supporting this technology becoming part of their practice, with all of the benefits of improved efficiency and accuracy it provides.

I was in a fantastic GP superclinic a couple of days ago down at Shell Cove family practice, and I was looking at the computer technology they use. That technology allows them not only to access individual patient records but to search within their patient database for people who have a particular condition. If, for example, they get new information about a better way to treat diabetes they can look for every patient who has got diabetes and systematically contact those patients and say: 'We have got new information for you. Would you like to come in and talk about this new information?' They can search for young women who are smokers and contact them and say, 'Did you know about this new measure that might help you?' This government has put lower strength nicotine patches on to the PBS. They can contact people who are smokers and say, 'Have you considered this treatment for you?'

The potential is not just in transferring old paper based records into electronic records but in the tools that it gives practitioners to better serve their patients—the people that they have regular contact with. We are providing significant support for GPs and other front-line healthcare providers to take up new technology, including, from the middle of this year, the e-health records system. For example, the Practice Incentives Program provides up to $50,000 per practice to over 4,000 general practices to support the adoption of e-health initiatives. The government is also supporting Medicare Locals to provide general practices with on-the-ground assistance to improve their readiness for e-health, including help with improving the quality of their data and records. We are keen to make processes as easy as possible for GPs so that they will be able to use existing Medicare rebate items in the preparation of clinical notes if they are viewing or adding information to a consumer's e-health record during a consultation. In 2010 this government committed $467 million to a two-year program to build national personal electronic health records infrastructure, and this legislation is part of delivering on that commitment.

A number of opposition members have mentioned an article in the Australian written by Karen Dearne on 28 February—yesterday—about e-health blow-outs. Despite the fact that I corrected the record yesterday during this debate, members opposite continue to use this inaccurate reporting. I am very disappointed that the opposition continue to be prepared to ignore fact. The two main sources of funding for the e-health agenda are the personally controlled electronic health records allocation and the COAG approved funding. Both of these sources of funding are within budget. The personally controlled electronic health records allocation is $467 million over two years. This allocation goes towards the National E-Health Transition Authority, Medicare support, the 12 e-health pilot sites and the national infrastructure partner—that is, not the National E-Health Transition Authority alone.

The National E-Health Transition Authority also receives funding announced by COAG. Currently, that funding is $218 million over three years. The Commonwealth contributes 50 per cent of this funding, which is around $109 million. The Commonwealth's portion of this funding is used for e-health related activities other than the personally controlled electronic health records system, such as healthcare identifiers, e-prescribing, standards and specifications, and the National Authentication Service for Health. The $760 million figure cited in the Australian cannot be reconciled with either the personally controlled electronic health records system or the COAG funding allocations. It seems to have been reached by making significant errors in calculation, including the double counting of funds. The majority of the figures that are added together to reach $760 million are actually part of the $467 million budgeted investment, including the quoted $21 million, $89 million and $38½ million funding announced for the National E-Health Transition Authority. In addition, the $136 million figure used in the media includes $109 million allocated by COAG and a carryover from the previous COAG funding period from 2009 to 2012. They seem to have been simply added together and, in many cases, double counted. It is very important that the opposition acknowledge that this inaccuracy, which they continue to repeat, does not reflect the budget position of the e-health rollout that we are talking about. Throughout the development of this infrastructure there have been extensive consultations with clinicians, with consumers and with health IT industry individuals and bodies. We are looking to the health sector and technology experts to innovate and to implement the rollout of e-health. The national e-health records system will place the individual at the centre of their own health care by enabling access to important health information by individuals, and their healthcare providers, when and where it is needed. Individuals can choose whether or not to have an e-health record and, if they choose to participate, they will be able to set their own privacy and access controls. Yesterday, the member for Mackellar suggested they could carry a USB stick with their private health information on it. Mr Deputy Speaker Leigh, I think you would understand—as certainly the member for Boothby would—the danger of leaving your USB stick lying around is very significant indeed.

As the records created by healthcare providers evolve over time they will have the capacity to contain health information such as conditions, medications, allergies and records of medical events. The records will also be able to include discharge summaries from hospitals, information from Medicare and some information entered by consumers. Some have expressed concern that patients will not enter some information or that they will try to take information away. It is important to realise that patients do not always tell their doctors everything that the doctor would like to know and, when patients visit a variety of different doctors, the clinician often gets only part of the story. E-health increases the likelihood of having full information from the patient.

We know that consumers and healthcare providers need to have confidence in the e-health records system and the information it contains, so it is critical to implement a legislative framework that provides for robust, transparent governance and appropriate protections for participation in, and use of, the system. The Personally Controlled Electronic Health Records Bill 2011 will do just that. Key elements of the bill will establish the system operator and its advisory bodies, a registration regime for consumers, a privacy and security framework and associated penalty mechanisms, and the circumstances in which information in the national e-health records system can be collected, used or disclosed by particular parties. The bill also provides for the legislation to be reviewed after it has been operating for two years.

Much has been made in this debate of cybersecurity and privacy matters and I want to take a moment to address those in a little more detail. Strict operational rules, along with existing provisions in the Criminal Code and criminal offences for related matters such as cybercrime, will work together with the civil penalties in this bill to protect consumers and the national e-health records system. The civil penalties in the bill are significant, including possible fines of several million dollars. The bill will apply across Australia in all states and territories, so it has been developed to work with existing Australian laws wherever possible. The consequential bill will make amendments to the Healthcare Identifiers Act 2010, the Health Insurance Act 1973 and the National Health Act 1953 to enable the use of healthcare identifiers in the operation of the national e-health records system, and allow access to certain Medicare information for inclusion in an individual's e-health record. This is a once-in-a-generation opportunity to deliver important reforms starting with the foundation and infrastructure. These bills are part of the government's bold health reform agenda: reform that will make it easier for consumers to receive the right care when they need it, where they need it. I commend the bills to the House.

Question agreed to.

Bill read a second time.