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Personally Controlled Electronic Health Records Bill 2011, Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011

Speeches in Parliament
Richard Di Natale 24 Jul 2013


I am pleased to be able to rise today to continue my remarks on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records Bill (Consequential Amendments) Bill 2011. It is legislation that advances Australia down the road towards a much more modern, efficient and better connected health system. We know in this day and age, with the use of technology, that most Australians are familiar with communication technology. Kids and grandparents are all thoroughly familiar with the world of instant connectivity. My young 3½-year-old knows his way around an iPhone. Not my grandmother, but many grandmothers are now using the internet as part of their daily lives. It has become a part of the world we live in.

I think that people would be shocked at how technologically naive and how technologically primitive our health system is when we compare the role that technologies play in our daily lives. It would be natural to assume when you move between a GP, a specialist, your hospital, allied health professionals and so on that the health information collected in each of those places follows you around electronically. But I have to say that nothing could be further from the truth. If the information does follow you, it often goes in the post. It might sit on a fax machine somewhere or it might gather dust in medical archives. If you do get your hands on it, it is often incomplete and occasionally it is completely illegible.

In a former life, I have spent time as a medical professional and spent countless hours with some of my colleagues and other professionals trying to decipher notes from other medical colleagues. I do not have the best handwriting in the world, but some of my colleagues' handwriting more closely resembles Egyptian hieroglyphics than it does English. I have spent time contacting medical record departments and other doctors simply because I could not get access to up-to-date information, or the information was completely indecipherable. So it is important that we make change in this area.

There is also the situation where someone might present with a history of acute pain. I have been in that situation, where people present with acute pain and request analgesia, often opiate analgesia. One of the problems is that you cannot be sure whether the history is genuine or whether it is in fact somebody who is seeking opiates because they have a problem with dependence. It is a phenomenon known as 'doctor shopping'. For decades we have been talking about resolving this issue and getting up-to-date PBS information so that healthcare professionals can make these sorts of decisions with confidence. The electronic health record has the potential to realise that huge area where we can make those clinical decisions with confidence.

In short, the system we have in this country of health technology communication results in two enormous problems. It results in major inefficiencies within the health system, which of course impose an enormous cost. More importantly, it results in serious medical errors, some of which are life threatening and occasionally fatal. Every single day, because of inadequate information, people will get medication that they are allergic to and they will get drugs that interact negatively with other drugs that they are taking, causing major side effects. Tests will sometimes be ordered that are completely unnecessary because they have been done recently. With the full information at hand, the test would not have been ordered in the first place. Sometimes you will see a patient who has just had treatment from another healthcare professional or from hospital, and that information will make a huge difference in terms of the clinical decisions you make as a healthcare professional.

The savings estimated to be realised from the e-health implementation amount to about $11½ billion by 2025. That, I think, is a fairly conservative estimate. I have seen some people suggest that the figure may in fact be much, much higher, when you consider the duplication that occurs in medication, pathology and so on and savings in terms of primary care visits and a range of other potential benefits. As I said, cost is not the main reason that we need to take action in this area. The health system as it stands, because of the inadequate communication, results in damage to the health and wellbeing of Australian patients every day. Nearly 200,000 people are admitted to hospital every year because of medication errors. Many of those are avoidable and would have been avoided if we had access to up-to-date information. Lives are lost on a daily basis because of these sorts of errors, and it has to change. If you are wheeled into an emergency department, you want to know that the doctors treating you have access to all of the available information that will result in the best course of care for you. These issues are often a matter of life and death.

Times have changed. We have the technical know-how to fix this problem. We should see it in the same way as we see other health technologies. We accept that we would not deny cost-effective, life-saving medical technology in any other area of health care and we should not deny it in communication technologies either.

This legislation puts in place a crucial framework for e-health reform. In principle, the move towards e-health and the creation of the personally controlled electronic health record is not controversial. In fact, we heard recently that the coalition support the bill. I look forward to hearing from them about their comprehensive plan for e-health. It is very, very easy in this place to criticise; it is easy and it is cheap. What is more difficult is to be constructive and to provide solutions. So I am looking forward to hearing about the opposition's comprehensive plan for e-health.

The benefits that flow from the better use of communications technology in health care are obvious. As I said, they are potentially life saving. Everybody agrees that we need to make progress. While the government, doctors, consumer groups and even the opposition are in agreement on the principle of e-health, as with most reforms, the devil will be in the detail. The personally controlled electronic health record is the centrepiece of Australia's e-health agenda. Conceptually it is the central point of health information for every Australian. It brings together health information such as the medications that people take, the visits they have had to healthcare professionals—GPs and other allied health professionals—what was done at those visits, hospital information and important discharge information. All of this will be brought into the one place so that health professionals can monitor and update it. Once the system is operating, people will have confidence in it, knowing that their doctor, surgeon, allied health professional and so on are all coordinating their care and that they have the most up-to-date, most relevant information available. They will know what tests have been done recently, what pills people are taking and whether people have filled their scripts, and that is important because often a doctor issues a script but does not know whether in fact the script has been filled. That may be because you cannot afford it or because you are having a side effect and have been reluctant to tell your GP. All of those things are potential advantages through e-health. We will be able to see X-rays and other scans that have been done and monitor them against each other over time. That is important because small changes can mark important pathologies. It is going to be a comprehensive change.

Most importantly, it is a personally controlled record. It is not mandatory; individuals have the opportunity to decide for themselves whether they wish to take part. I am very confident that, over time, as the benefits become clear, more and more people will take up an electronic record and we will have a better health system as a result. People will have control over who can see their record. We know that personal details are private and must remain so, and I am confident that the provisions are in place to ensure that that happens.

It is a transformative technology as well. It has the potential to empower individuals in a way that often modern medicine does not. One of the criticisms of modern medicine is that it is a disempowering process. You hand over almost total control, in some instances, to the healthcare professional who is monitoring and treating your condition, but in this case individuals have the information at hand. They can access that information as they need to and they can become more informed, and they have an opportunity to have an interaction with their healthcare professional, which does not exist at the moment.

The details of access are controlled, such as that the defaults are left to the system operator to determine, and that is important, because I assume that most people will use the default access controls. I am pleased that the government has acknowledged just how important this is, that consultation will be a critical part of this process and that they will suggest amendments to this effect. If all goes well, millions of Australians will be entrusting the system with their most personal details. It could not be more crucial that consumers have faith that their privacy will be respected.

We hope that individuals will make an informed choice and get together with their nominated provider, which in most cases will be a GP, but not always, and that they will go through the steps to create and populate their health record in a shared health summary. They will be told how to control the information and who can see it. Of course, the more information you share the better the clinical decisions are likely to be, but it is always balanced against the patient's right to privacy, so we have to give clear advice to people that they must decide the most appropriate way to implement these sorts of decisions.

Shortly, Australians will be able to sign up for the patient-controlled electronic health record directly online, through Medicare, their GP or their nominated provider. They will prepare a shared health summary so that other clinicians can see at a glance the information they need to know about an individual's health. It is important to know that individuals will have control over what goes on the record and that they will be able to decide who gets to see it. You will be able to access the record online and make your own notes. At all times, control of the electronic health record is in the hands of the individual. If you do not want to participate, the choice remains yours.

Of course, there are some issues. I know that it is going to be some time before the health information systems used within doctors' surgeries are integrated with the PCEHR. Following that, hopefully we will see hospitals, radiologists, pathologists, pharmacists and so on included so that we get a much more integrated system. I for one would have liked to have seen this happen a little earlier. Obviously, since 1 July is the deadline, it would have been nice if the whole shebang were ready to go. It is not. It will be, as we have heard, a 'soft launch'. In fact, it is becoming softer by the day, but that is not of great concern to us. Ultimately a system that starts small and improves with frequent iterations is probably more likely to be successful.

It do not know of too many IT projects that go smoothly. I think that IT projects are a bit like construction projects. There are often unforeseen hiccups, so I think it will be most likely that we will need to iron out some bugs through this process. While the profession, the industry and other stakeholders continue work on these, I think it gives an opportunity for consumers to become accustomed to the idea of the electronic health record.

We do have some concerns with this legislation. As I said, the privacy controls are not fully specified by the bill but are to be developed by the system operator. We wanted to ensure that consultation around the default access controls would be conducted, and we are pleased that this will now happen. The record will also serve as an enormous repository of medical data, so, if there were a way the data could be used for research purposes that protects privacy and anonymity but also provides the opportunity to improve our health system and get valuable information, then I think we should go for it. I am really pleased that this is happening at a time when the Association of Australian Medical Research Institutes is currently looking very keenly at the McKeon review. One of the purposes of that review is to look at how we can improve integration between medical research and the health system.

The key roles of medical research as outlined by the Association of Australian Medical Research Institutes is to reduce the burden of disease by improving our understanding of the drivers of health—risky behaviours and so on—to improve the quality of health services, to improve the efficiency of health service delivery and so on. Medical research in this country plays a huge role—in fact, we are world leaders in that area—and the patient-controlled electronic health record has an opportunity to allow that to continue to grow and develop. We have heard some other concerns about the electronic health record. Some in the industry have been critical of the NEHTA, the National E-Health Transition Authority. We have heard criticisms of its governance structure and criticism of its approach to consultation. We have heard from industry stakeholders who feel that the development of technical specifications was poorly handled. We are aware of that. We have also heard that there were concerns around the governance of the PCEHR. We agree that there is the potential for a conflict of interest when the functions of the system operator are invested in the secretary of the department. It is an issue of accountability and we are sympathetic to suggestions that the system operator should exist independently. We are pleased that there will be a review after two years. As we have said, the devil is in the detail, so we will be watching very closely over the next two years.

I am also aware of some of the reservations that my former profession has around the issue of the liability of doctors who use the electronic record. Will they need to read the entire file of every patient at each consultation? If they do not, will they be held liable if there is a problem? There are some issues to resolve, but I am confident that the government, the medical establishment and other stakeholders will be able to work together to solve this dilemma.

The PCEHR also puts in place strict controls about who can see a record. It records who had access and when. We value the fact that consumers want their privacy to be respected, but that comes at a cost. The cost in this case is complexity. A small medical practice might have a single computer—one or two workstations—which makes this level of access control problematic. That is another issue that needs to be tackled.

There are bound to be delays, probably some mistakes, complaints and poor process encountered along the way. It is a big and expensive project with a lot of moving parts. It was not until we looked at this issue more closely that we began to get an appreciation of just how difficult and complex this issue is, but we do need to get it underway. We know that it is critical.

Modern medicine has made remarkable progress in a number of areas. We have had huge advances in medical technology. Life expectancy has increased, in part because of those advances. We have remarkable things, things that were previously the stuff of science fiction. Endoscopy, nuclear medicine, advances in genetics and so on are mainstream technologies today and they help us with the diagnosis and treatment of potentially fatal diseases. But there remains a glaring hole in the health system—that is, that in a 21st century health system we have what I consider to be in some instances 19th century communications practices. This bill provides the framework for improving that situation, for righting that wrong, and it is for those reasons that the Greens commend it to the Senate.


I rise to speak on the Personally Controlled Electronic Health Records Bill 2011. E-health is an integral part of the Australian government's agenda for health reform, an agenda that aims to create a continuously improving healthcare system for the 21st century, a system that is accountable, affordable and sustainable, with safety and quality at its centre.

The personally controlled e-health system is the next step in using e-health to enhance the health care system. This key infrastructure reform is of vital importance to the way in which our health professionals will provide their services in Australia in the future. It creates the capacity for a patient's shared health record to be available securely over the internet where and when it is needed at the point of care. The first release will deliver the core functionality required to establish a system that can grow over time. It will benefit both patients and providers through a secure opt-in system. A patient or their nominated representative will be able to register for an e-health record and control access to that record. Individuals can choose whether or not to have the personally controlled e-health record. If they choose to participate, they will be able to set their own access controls or allow default access settings to apply. With the individual's permission, key pieces of health information may be reviewed by participating healthcare providers across different locations and healthcare settings. This will remove the paper trail between health professionals, removing the need for pharmacists to squint when trying to make out the doctors' handwriting, as Senator Di Natale mentioned, importantly ensuring that the correct information is transferred between health providers. It will limit the need for patients to have to retell their story if they need to see a different specialist or GP, taking some of the burden out of seeing a new doctor. It will create synergies between a community mental health nurse who has assessed a patient at their home and the psychiatric unit of the local hospital.

It is a pleasure to be speaking to these bills only a few days after the Minister for Health, Tanya Plibersek, together with my federal Labor colleagues and I, announced a $325 million assistance package for the Tasmanian health system. A key aspect of this assistance package is to build on the tremendous work of the north-western health professionals and provide resources to speed up the rollout of e-health records to patients across the whole of Tasmania. A great example of how e-health can assist in isolated communities with limited health resources is evident in Smithton in the far north-west of Tasmania. Smithton is a small community of approximately 3,500 people that is serviced by a four-doctor general practice. The same GPs provide services at the local aged-care facility, Emmerton Park, and also at the local community hospital, which is located adjacent to Emmerton Park. As it is a small community, the majority of the residents of Emmerton Park and patients presenting to the community hospital are also patients of the local general practice.

Before the NBN connected the hospital, Emmerton Park and the general practice, doctors had not been able to access their existing patient notes when visiting Emmerton Park and the hospital because of variable and slow broadband, which meant that full patient histories, including test results, had not previously been available to them. This has provided the opportunity to implement technology using the NBN which will allow GPs to access their practice notes at both Emmerton Park and the community hospital, and print prescriptions on-site if required. The solution involves implementation of iPad 2 technology at Emmerton Park and the community hospital with virtual private network software to enable a quick remote connection to the practice system via the NBN. A wireless printer on-site will enable the printing of prescriptions, which the doctor can sign while in attendance. The iPad 2 technology will be duplicated at the practice so that doctors can use the camera features for consultation with their colleagues if required.

The Cradle Coast Electronic Health Information Exchange for north-west Tasmania has been a collaborative project of the UTAS Rural Clinical School, General Practice North West, the North West Area Health Service and the Cradle Coast Authority. The information exchange support team have had a very positive response from GPs, allied health professionals and specialists. Traditionally, the Tasmanian divisions of general practice have not worked with specialists and allied health professionals on collaborative IT initiatives. The north-west division engaged with the Cradle Coast Authority and with general practitioners, specialists and allied health professionals to install, train and support the uptake of a common, secure messaging platform, achieving the right balance between technology and the personal aspect of e-health initiatives for the support officers to increase the uptake of the new system.

The platform enables patient referral letters to be sent electronically, rather than using traditional paper based processes. Electronic referrals jumped from under 400 a month to 2½ thousand a month in just 12 months because of the hard work of the support officers, and the time they spent, with individual practitioners and their practices in adapting IT solutions to existing business processes. A specialist practice has reported time savings from eliminating printing, folding and putting letters into envelopes and a reduction of its monthly postal costs by $300. E-health teams are encouraged to focus on the personal side of IT and go over and above installing software and providing instructions. It does take time and effort, but the initiative has been embraced by healthcare providers, and the pilot will be used across the nation as this bill is enacted and the national e-health rollout continues.

During a recent spell of hospitalisation, I had a facial X-ray scan at a medical imaging facility. I was very surprised that there was no requirement for me to wait around for the slides to be processed and printed—no careful carrying of those slides between the imaging facility and the specialist. The e-health link between the medical imaging facility and the specialist's surgery was so comprehensive that, by the time I arrived for the appointment the next day, the specialist had already had time to study the images. He conveyed to me his enthusiasm for the arrival of the NBN and how this would enable more comprehensive e-health records. It will make it easier for him to communicate with other specialists in the community sector, in private practice and in hospitals.

The assistance package announced by Minister Plibersek last week in Tasmania will see an additional $36.8 million over four years used to roll out personally controlled e-health records in Tasmania's hospitals and enable allied health, pathology and diagnostic imaging services to connect to e-health. In consultations with Minister Plibersek, front-line health professionals—surgeons, psychiatrists, paediatricians, social workers and emergency department nurses—all emphasised how enhanced e-health records would reduce errors and duplication, and improve the efficiency of their work.

Together with the funding for e-health records, the package will deliver $31.2 million for an elective surgery blitz, providing about 2,600 additional surgeries, targeted at areas where there are large numbers of patients whose surgery is overdue, such as orthopaedic and cataract surgery. There is around $22 million to establish walk-in clinics in Hobart and Launceston to provide care for minor illnesses and injuries over extended hours and at no charge to patients, alleviating the pressures on emergency departments. There is $48.7 million over four years for Tasmania Medicare Local, to support better care in the community to prevent and manage chronic disease. Individual GPs will continue to have central responsibility for the clinical care of their patients, with Tasmania Medicare Local supporting allied and preventative health services and the coordination of care. Additional support will include providing strength development and fitness programs for frail older Tasmanians, and addressing smoking, excessive alcohol consumption, physical inactivity and poor diet.

There is $74.5 million to provide better care for patients when they are discharged from hospital and to provide better palliative care in the community. Tasmania Medicare Local will help build and support better links between hospitals and GPs by ensuring that appropriate follow-up care and services, such as rehabilitation, are available post hospitalisation. This is expected to reduce avoidable readmissions to hospital. Expanding access to community-based palliative care services will enable people to remain at home, if they wish, at the end of their life, with support for health professionals to improve their palliative care skills and for electronic advanced care planning, building on a model pioneered by the Cradle Coast Authority and North West Area Health Service.

There is $53.9 million to train more medical specialists in Tasmania and provide more scholarships for nurses and allied health professionals, with up to 132 undergraduate clinical placement scholarships per annum, up to 48 postgraduate scholarships per annum and up to 70 continuing professional development scholarships per annum.

There is $15.4 million that will target service gaps in mental health services and population groups who currently have poor access to mental health services.

There is $42 million to support innovation in clinical services that would 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's Faculty of Health Science, the Menzies Research Institute, the Clifford Craig Medical Research Trust and appropriate primary care providers.

This funding will provide both a short-term boost to elective surgery and increase the rollout of e-health records, as well as a plan for how we can manage the long-term issues Tasmania faces with its older population, higher rates of chronic disease and system constraints. The funding addresses concerns raised in conversations across Tasmania with health professionals. For example, in the north-west, 18 health professionals joined Minister Plibersek in a small workshop room in the North West Regional Hospital's medical school. Joining the hospital's director of surgery and North West Area Health Service CEO were front-line nurses, doctors, allied health professionals, public servants, private practice operators and those who worked in both. There were people interested in research, those keen to just get things rolling again and some who wanted to revolutionise the system. They were all united in a desire to rebuild Tasmania's health system both for their community and for their colleagues. Gone were the squabbles between doctors and nurses. This meeting presented a united front to the minister and demonstrated just why Tasmanians and Australians should be very proud of our health professionals.

I was very impressed by the constructive attitude on display, not about a hand-out to patch up the issues but a focus on targeting the areas that would give the greatest return for the Commonwealth dollar, if it were to be forthcoming, and of course seeking the greatest return for the health of people in Tasmania, specifically in my area, the north-west coast. There was no desire to seek undue credit for anything but a real sense that this was our time to explain to the minister what we really do well in north-west Tasmania and what we need help with. We heard that there is no point throwing a lot of money at elective surgery when there are also significant bottlenecks in preparing someone for surgery and in rehabilitating them afterwards, as well as the important facet of our health system of trying to keep people well and out of surgery to begin with. That is exactly why systems research and e-health infrastructure definitely need to be expanded. North-west Tasmania is leading the nation in the rollout of e-health infrastructure and capacity. E-health makes getting treatment simpler for patients and delivers treatment more easily for health professionals. This is another positive reform being brought about by a Labor government committed to improving the health outcomes of Tasmanians both now and in the long term. I commend the bills to the Senate.


Earlier this month I had the opportunity to travel to London for a Commonwealth Economic Forum and, as is obviously the case when leaving the country for foreign travel, the most important thing a person does is pass through immigration. I was very impressed by the fact that in our airports these days an electronic system looks at passports and confirms the identity of individuals. That is an example of IT being used in a very positive way. I think the introduction of electronic health records is a similar technological advance which will lead to greater efficiencies in the health industry, especially when a person away from their home base is struck by illness and their medical records can be available through the system of e-health records.

As has been said by other speakers, the coalition supports the concept of personally controlled electronic health records and the amendments to this bill. There is no doubt that the benefits of having an accessible electronic health record available around the country are great and have been referred to by many other speakers. This system is commonly referred to as e-health. It is certainly an exciting advancement, extending the scope of primary health care and protecting patients who are travelling. The efficiencies e-health can create are not new concepts to the coalition. Under the last coalition government, computerisation of general practice increased from 17 per cent in 1997 to about 94 per cent 10 years later. That meant that 94 per cent of general practices around the country had computers and patient records were kept much more systematically. The data within them was much more easily accessible to medical practitioners and to people doing research, for example, into the efficacy of drugs for the treatment of hypertension in which a general practice might have been participating. Accessing the records of the serial measurements of a patient's blood pressure is much easier with computers in general practice. Linking general practices to make up a huge pool of patients has been used widely in the United Kingdom to test new drugs, to record outcomes and to file those outcomes back to the university or wherever the trial was being facilitated, all linked by the internet.

The real value of this system is that when a patient who is away from their home becomes ill it is possible with an e-health record system that they can go to a hospital or perhaps to a medical practice anywhere in the country where their medical records will be accessible. This will mean that people can be treated much more quickly and effectively because the detail of their histories will be accessible. Very often people are not as aware of the details of their medical history as one might hope or imagine they would be. That is going to be one of the great benefits of electronic health records.

It has been forecast that by 2020 e-health capabilities could save up to $7.6 billion a year in health costs by reducing duplication and errors, by improving productivity and by providing better adherence to best practice principles. The government's own numbers suggest that the benefits of e-health records alone in Australia would be $11.5 billion saved by the year 2025. That is an incredibly large figure which in itself justifies completely the introduction of the system.

In addition, the same report suggests that a full e-health program can help avoid up to 5,000 deaths annually once the system is in full operation. That is a very important and practical consideration as well. It again shows how beneficial this program potentially will be to the Australian public.

The report further states that, annually, a fully implemented e-health system could avoid up to two million primary care and outpatients visits, 500,000 emergency department visits and 310,000 hospital admissions. They are amazing figures that testify to the efficiencies and cost savings that this system will introduce to our health system.

Importantly, it will also mean that patients have their entire medical history available to them anywhere they travel. A patient with a patient-controlled electronic health record who becomes ill while travelling has their full medical history available to the doctor or emergency department they visit. These are very important benefits.

The downside of the electronic health record system is the protection of patient privacy. There are very legitimate concerns about patient privacy in relation to the introduction of electronic health records. We all know that it is very easy to hack into computer systems. Persons' health records are often very important to their capability of getting a job or insurance. People are quite rightly concerned that the privacy of their health records should be protected, not only for those reasons but just for the general issue of privacy and confidentiality of a person's health records and for the protection of the privacy of the doctor-patient relationship. For this reason the issue of privacy is the biggest concern that people have in association with the idea of the introduction of electronic health records. I think it is very important that the government and those who are responsible for setting up this system make sure that the question of privacy is uppermost in their minds and that the absolute confidentiality of health records is protected. It is a very important consideration.

The idea of electronic health records, and having wide accessibility to them, is one that is under consideration around the world. When I was at the United Nations in 2010, I met a British doctor who was interested in an e-health system in which medical records could be accessible anywhere in the world. In my view it is very bold thinking of his to contemplate a system whereby wherever you were in the world your health records could be accessed through the internet by responsible individuals in a hospital. It would be very hard to set up such a system, but not impossible in this day and age.

Unfortunately, the British experiment with e-health was not a great success. After expending a great deal of money, unfortunately the United Kingdom's system was scrapped, in late 2011. The British had spent some $12 billion on their e-health equivalent of this proposal. So we do have to make sure that the system is efficiently managed and that the concerns for patient privacy are respected. But overall I think the benefits that this system will bring to Australia and to the Australian public are great, and the coalition endorses this system, as I do as a former medical practitioner. I can see great benefits in having access at your fingertips to a patient's records and to the records of an individual from some other part of the country who might come in to see you. It is certainly going to be an interesting exercise to see how this system develops. But I am sure that, with goodwill and concern, once this system is up and running we will have a very useful tool to ensure that the health of Australians is protected wherever they travel in this country.

Senator POLLEY

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.

Senator MASON

The coalition opposition supports the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. A personally controlled electronic health record system is, let us face it, a very good idea. Any improvement to mankind's armoury against the empire of disease is a very good thing as well. Senators in this debate this afternoon have spoken about the advantages of such a system, and indeed it does have advantages. I accept that this system will assist in effective, efficient and timely patient care. I accept that this system will save time and allow medical practitioners to rely on information noted by other doctors rather than forcing patients to relay their medical history. I accept that the system could dramatically reduce the number of hospital visits each year. I accept that the system could also help prevent thousands of deaths annually when the system is fully operational, another significant advantage provided by e-health.

We also should not forget about the dollars. It is very important in these times of fiscal stringency to save taxpayer dollars. This system may well save billions of dollars over the next 10 to 15 years, by reducing duplication and errors, improving productivity and encouraging stricter adherence to world's best practice. These are all good things. I know that coalition senators and members such as Senator Fierravanti-Wells, Dr Southcott in the other place and Senator Sue Boyce have done a lot of work on this particular issue, and I want to congratulate all of them.

But the opposition does have some reservations. Once again we encounter the standard problem with this government. They come up with some very good ideas now and then, but that is often marred by lack of attention to detail and poor implementation. You will recall that it was the coalition that initiated the focus on shared electronic health records. But again this is a program that the Labor government has not fully developed. I listened before to Senator Di Natale and I loved his use of the words 'soft launch'. We now know that even though the system is being launched on 1 July this year, it is being 'soft launched', which I think means it will be quite some time before the system is ubiquitous. I think that is probably right. But I liked the language—slightly Orwellian, but it never gets by the opposition. We are not quite sure about the costs. The government has not been too forthcoming about the long-term costs of this technology. We know it is expensive, but that does not mean it is not worth it. Already it has been raised in debate that the United Kingdom spent about $12 billion on e-health records and that money has now largely been scrapped. It would not be a good thing for this government to go the same way. I am hoping the Australian Labor Party is not like the British Labour Party in this context—I am in a generous mood and so I will not assume it is.

An opposition senator: You always are.

Senator MASON

Yes, I always am! Some of my colleagues have raised the issue of stakeholder use and how some will see it as a make-work scheme for medical practitioners with little incentive to create the shared health summaries. That is a potential problem and of course there is a reliance on general practitioners to drive the uptake. Some have already asked this afternoon why would they bother doing that. It will take time, and they will see little or no reward for their efforts. Over time, perhaps, that will change, but, initially, I think it is fair to say, it will be an issue. My colleagues have raised—Senator Fierravanti-Wells raised it well and eloquently—the lack of stakeholder consultation. Reports from a number of key stakeholders indicate there was not thorough consultation and they had difficulty communicating with the National E-Health Transition Authority.

They are all important points, and I know that the Senate has discussed them well this afternoon. I congratulate all my colleagues for their contributions in this debate. But I want to concentrate on one particular issue, if I might. As Senator Polley just recognised—and I agree with her—health records are among the most sensitive records citizens give to a doctor, but governments potentially have access too. They hold potentially the most personal, sensitive information. So, of course, there are significant privacy concerns about these e-health records—about access, about their security, about their veracity, about the control over contents, the use and the potential use of these e-health records. All those issues are legitimate and they are all live in this debate.

This is one of those absolutely classic Senate debates because this debate reflects that most fundamental tension in regulating a liberal democracy—that is, the quest for individual autonomy and individual privacy on the part of every citizen versus the impulse of a community and social responsibility. That tension between the two—it is not a dichotomy; it is a tension—is being played out in this debate. While the government does have a moral responsibility to look after their citizens—and e-health is a very good example of that—citizens do not want the state to intrude excessively upon their autonomy in extracting that information. Somewhere in that tension lies the answer and lies the balance. Exactly where those boundaries should be drawn will always be widely contested and hence the privacy concerns raised by citizens about these bills.

The government is quite right to suggest, as they have this afternoon, that the government's decision to have an opt-in scheme—I remember discussing an opt-in or opt-out scheme a long time ago, Acting Deputy President Boyce, with you and others. But the government having chosen that—that is, people have to choose to register to have a personally-controlled electronic health record—it does raise the question of privacy protections. Privacy remains a concern, but with an opt-in scheme they are strengthened, and I acknowledge that. In my view the government should be congratulated for that.

Last week I happened to watch the on the ABC—even though I am in the opposition, I do watch the ABC—with Professor Chris Puplick, the former New South Wales Privacy Commissioner, and he was asked about this legislation.

Senator Feeney

And former Liberal Party senator.

Senator MASON

Yes, and former Liberal Party senator and former President of the New South Wales Anti-Discrimination Board as well—appointed by a state Labor government. What he said was very interesting. He said that just like the internet, once the information is out there it will always be available to someone somewhere, regardless of restrictions and limitations. That, of course, is the problem. There is an oft-quoted saying among IT people that goes along these lines: information wants to be set free, but that does not mean that people necessarily want information to be free. Sometimes that is for good reasons—like patients wanting to protect their data—or sometimes for the wrong reasons, like authoritarian governments wanting to maintain their grip on power. It simply expresses the significant reality that once a genie is out of the bottle it is impossible to put it back in. When information is out, when it is set free, you cannot put it back in, because—guess what?—it is everywhere, particularly today with the promiscuous exchange of information, garnered by the internet, social media and other media enterprises. The fact is that these days information when leaked or when out is out forever. The information to be contained within this system is of an intensely personal and private nature, much of which may never leave the inner sanctum of a doctor's surgery. Given that the personal electronic health records system will, by its nature, exponentially increase the number of people with access to these details, it is not unreasonable for patients to fear that the risk of information being obtained by someone other than their doctor will also increase—and that is the concern. People are entitled to be concerned that their medical history could fall into hands in which it does not necessarily belong. Let us face it: in the profession many of us work in, the profession of politics, health records could devastate or potentially even destroy a political career. As examples take evidence of mental illness or evidence that someone is suffering from cancer or evidence that perhaps a woman at one stage even had an abortion or evidence that someone has contracted a sexually transmitted disease at some stage. All of these could be very embarrassing and would certainly be compromising and potentially they could destroy a political or a corporate or a legal or other career. That is why these records are so important and why their protection is absolutely and utterly vital. If they are released, even if they are released inadvertently, people would become subject to prejudice or subject potentially to blackmail. It could have detrimental impacts on their relationships, their work or their insurance and so on. There must be no unauthorised access.

It was not long ago, as you would recall, Madam Acting Deputy President, that we had the example of the stolen laptop in the United Kingdom, and this is not the only story of its kind. In about the middle of last year a laptop containing health information on over 8½ million patients and 18 million hospital visits, operations and procedures was stolen from a National Health Service building in London. The data did not contain names but it did include postcode, gender and age details. There were concerns at the time that the information could be used against the subjects by, for example, blackmail over sensitive medical issues and so forth. That is the sort of problem that is possible, hence the enormous concern as to privacy.

I note Senator Polley, when speaking before, mentioned the United States health system. The United States electronic health record system has been described as 'Wikileaks on steroids'. But while Australia's privacy laws generally do offer greater protection than do those in the United States, it is an interesting and concerning analogy for this kind of system. It is certainly a concerning analogy at least. Even with access to information by authorised users, so by those authorised to look at the information, there are still privacy concerns. Who owns the information? Can I change information that I deem to be wrong or inaccurate? Can I do that? Can I do that unilaterally? Can I restrict access by others to certain types of information? For example, I might not want my GP to know about my mental illness—

Senator Scullion

Or your drug addiction.

Senator MASON

Indeed, my drug addiction or some disease that I have contracted or whatever else. It could be embarrassing. Again, where do we draw the line? How does the regime in this bill interact with, in particular, the provisions of the Privacy Act, which, of course, is the ultimate protector of privacy in this country? All these issues are on the table. I accept what the government has said, that there will be at least a review of these issues in two years time, and again I say I think that is a very good thing because within that time of the next two years the true utility of this law can be addressed. I simply conclude by saying that for the good health of our nation I hope the government—for that matter any government of whatever political complexion—will address these privacy issues with very great discretion. Not to do so could lead to compromising of privacy and a shocking infringement of individual rights.


I also rise to make a brief contribution to debate on the legislation before us, the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. Currently we have the health records of patients scattered across a range of locations and attached to different clinics and hospitals, so we need to have a system that allows for a patient's whole health record to be easily accessible, no matter what medical facility they may present at. It is inefficient and potentially dangerous to a patient's health if they have to retell their medical history each time they visit a different healthcare provider. So that is why the Gillard Labor government has announced a $466 million investment over two years for the establishment of an electronic health records system. This funding is to establish the personally controlled electronic health records system national infrastructure. This will prove to be a vital piece of health technology as we continue to find more efficient and effective ways to treat patients.

The outdated approached of paper records or records that do not travel with a patient when they present at a new health facility can cause unnecessary delays and medical errors. In fact, medication errors cause about 190,000 hospital admissions each year, with eight per cent of those being because of inadequate consumer information. So that is why from 1 July 2012 we will begin to roll out the personally controlled electronic health records system. This is the next step in using e-health to enhance our healthcare system. It will create an individual electronic patient record that has the capability to be shared securely over the internet and it will be available to help treat a patient when and where it is needed. From 1 July 2012 individuals will have the option to register for a personally controlled electronic health record. The first stage of the e-health rollout will deliver the core functionality required to establish a system which can grow over time. Individuals can choose not to have a personally controlled the record and, if they choose to participate, they will be able to set their own access controls or enable default access settings. Once the individual has selected the permission level, key pieces of their health information may be viewed at participating healthcare providers across different locations and healthcare settings. Already, the federal government is making a significant investment in the nation's health system, and the personally controlled electronic health records are the next cog in this investment.

As part of our investment in health care, the federal government has signed with states and territories in a historic health reform agreement which will deliver a better deal for patients. This historic national health agreement ensures we can deliver the funding our public hospitals need, with unprecedented levels of transparency and accountability, less waste and significantly less waiting for patients. This new deal provides a much-needed funding boost to hospitals and ensures, through the provision of tough national standards, that the money goes straight to hospitals and, in turn, straight to patients. Together, the Commonwealth, the states and the territories will share in funding growth in an equal partnership. There will be a single national funding pool, activity based funding and national standards, including guarantees on emergency waiting times and elective surgery waiting lists, and it will improve front-line care through the afterhours GP helpline, Medicare Locals and GP superclinics. In effect, this funding deal ensures that our hospitals are able to invest in the infrastructure they need to provide the very best health care for all Australians.

As a Senator for Tasmania, I am particularly concerned about the Tasmanian health system and ensuring that the healthcare needs of Tasmanians are looked after. I am pleased to say that Tasmanians will benefit from the introduction of personally controlled e-health records. In fact, the whole Tasmanian health system is already benefitting from significant investment from the federal Labor government. The Tasmanian health system received a significant boost only last week when the Minister for Health, Tanya Plibersek, announced a $325 million package over four years for an emergency rescue of the Tasmanian health system. We know that the Tasmanian health system is facing significant pressures and has some unique challenges. For instance, we know that Tasmania has an older population and that the proportion of our older people is growing more quickly than in any other state or territory. Tasmania has a small and geographically dispersed population which suffers from a higher prevalence of chronic disease and has higher health risk factors. That is why I was pleased to see the Minister for Health come to Tasmania, after strong lobbying from the Tasmanian parliamentary Labor team, to conduct consultations with front-line health professionals, unions, Tasmanian Medicare Locals, Tasmanian Health Organisations, members of parliament and the Tasmanian state government.

The package announced by the Minister for Health, Tanya Plibersek, will include $31 million for an elective surgery blitz that will provide about 2,600 additional surgeries in areas where large numbers of patients are overdue for surgery, including cataract surgery, knee replacements, hip replacements, hernias and gall bladder surgery, and $22 million to establish walk-in clinics in Hobart and Launceston that will provide care for minor ailments and injuries, for extended hours and at no charge to patients. These centres will link to local general practices and Tasmanian Medicare Locals, to ensure continuity of care for patients. We will also deliver $48 million to better support care in the community to prevent and manage chronic disease through the Tasmanian Medicare Locals. GPs will still continue to have central responsibility for the clinical care of their patients, with Tasmanian Medicare Locals supporting allied and preventative health services and the coordination of care. There is $74 million to provide better care for patients when they are discharged from hospital and better palliative care in the community. There is $53 million to train more medical specialists and provide more scholarships for nurses and allied health professionals, which will deliver up to 34 additional specialist training places, up to 17 new clinical supervisor positions and up to 11 new training coordinators as well as funding for more scholarships for nursing and allied health professionals. There is $15 million to help address gaps in mental health services; $42 million to support innovation in clinical services which will enable care to be delivered more effectively and efficiently; and $36 million to roll personally controlled electronic health records into Tasmanian hospitals and enable allied health, pathology and diagnostic imaging services to connect to e-health.

This investment from the federal Labor government will ensure that the Tasmanian health system is put back on track and will allow us to deliver the very best health care to Tasmanian patients. We need to make structural changes that ensure that the Tasmanian health system is delivered as efficiently as possible to secure the long-term future of the Tasmanian health system. A key component of this is the rollout of the personally controlled electronic health records in Tasmania, which will support public hospitals, allied health, pathology and diagnostic imaging. As part of Minister Plibersek's consultations in Tasmania, it was repeatedly highlighted that e-health would help reduce errors and duplication and help improve the efficiency of care. The issue of e-health was raised at each roundtable that was held by Minister Plibersek in Launceston, Hobart and Burnie. Whilst this investment in Tasmanian health will have significant benefits, the e-health records rollout is very exciting. It stands to deliver significant assistance to help Tasmanian health professionals provide the very best care.

The rest of Australia also stands to benefit considerably from the rollout of the personally controlled electronic health records. E-health represents an important part of the future of health care in Australia for both consumers and healthcare providers. It will enhance the way health care is delivered and result in more efficient and effective health care. The federal Labor government has e-health as an integral part of its health reform agenda, an agenda that aims to continuously improve Australia's healthcare system to ensure that it is accountable, affordable and sustainable, whilst providing the very best of care. Personally controlled electronic health records represent the next exciting stage of our health reform agenda, and I commend the bills to the chamber.

Senator BOYCE

It is interesting that Senator Brown used the word 'rollout' in her contribution to this debate on the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011. In fact, there is no rollout. There is simply a system in which you can lodge your interest to be involved in what is happening on 1 July. It reminds us of this government's 'ability' to roll out the NBN in Tasmania. It leads us to the same sort of mismanagement, waste and inability to implement which we saw during that rollout and which is now happening with this rollout. I certainly share Senator Brown's hope that e-health will be useful to the people of Tasmania, but I do not have any certainty around that. I also hope that it will be useful to the people of Queensland, but again I do not have any certainty around that. I hope it will be useful to the people of Australia, but there cannot be any certainty around that either.

As numerous speakers have pointed out this afternoon, e-health is a noble aim. It is certainly something that we should do. Because of the work of successive governments in Australia—our current statistical collection and our work to date on definitions and standardisation of all manner of things within the health area—we are possibly in a better position to do it. We are in a better position than almost any other country in the world to do this well.

But today we are talking about the introduction of the personally controlled e-health records aspect of an e-health system. Once again, we are looking at fantastic rhetoric and zilch delivery, zilch implementation. The personally controlled e-health record system is supposed to start on 1 July. As Senator Di Natale said earlier, it will be a 'soft launch'. It will be a very soft launch. It will be an almost ghostly launch—a launch—because there is nothing in this ship to launch. It is simply a shell waiting to be populated. Fine. But this government should not go on with nonsense about what is going to happen.

Minister Roxon, the former health minister, talked about the e-health revolution that would be coming. It was in January 2011 when she started talking about the e-health revolution. She said:

After the outstanding success of the e-health conference in Melbourne earlier this month, there is strong momentum behind delivering the Government’s $466.7 million PCEHR system by July 2012.

It is fine for Senator Brown to try to suggest that this system is part of the national health and hospital reforms of this government, but it is in fact as meaningful as almost anything else they have done—which is almost nothing. There has been no real progress. Of course they now have to talk about a soft launch. Having gone from the big bang of 'Wow, we're going to have an e-health system that will be the envy of the world,' they are now saying, 'Well, people can just choose to let us know that they would like to be involved from 1 July.' There is at least some vague hope on that basis that the PCEHR legislation will achieve long term some of what it has set out to achieve.

But it is a complete nonsense for this government to try to claim that this legislation is some sort of a move, a reform, a revolution. They need to fess up to the fact that they could not work out how to do it. They could not work how to get it right and now they are going to take the easy option which was suggested to them all along. But of course this government loves to talk the rhetoric, fail to implement, waste money and mismanage as it goes.

As has been noted by other speakers, the coalition will not be opposing this legislation, because we think the idea of having personally controlled e-health records and a proper e-health system is an excellent idea. We are, however, like many stakeholders outside this place, concerned about this government's ability to implement a sensible system that will work. Despite all the promises made by NEHTA, the transitional authority for this program, and DOHA, the personally controlled e-health record system is simply nowhere near ready to launch. It is an idea still. This government needs to confess that it is still just an idea; it is just a ghost of an e-health system.

Key components of the PCEHR are not finished and are nowhere near being finished. Key issues identified during a number of inquiries—and I note one of them was by the Senate Community Affairs Legislation Committee, of which both you and I are members, Madam Acting Deputy President Moore—such as safety, liability and privacy have not been successfully resolved. The coalition, in its minority report to the PCEHR committee last year, suggested that it would be wise for the government to delay the launch until they knew that they had it right and that some of the systems they were intending to use had been trialled in real-life situations. We were concerned this would be a completely dysfunctional system that would cause more harm than good.

One of the key aspects for a functioning e-health system is the public's confidence in it. If it has serious errors or serious problems in its early days, it will take years to regain the trust of the public. I am told that the National E-Health Transition Authority was called to Minister Plibersek's office in recent weeks and was basically told: 'Stop the spin. It's not ready. It won't be ready. 'Let's wind back the rhetoric and the expectations. Let's start talking about soft launches and people choosing to get involved in registering, but let's stop the nonsense about the e-health revolution.' So we have a complete backtrack by this government.

One thing that has not been wound back is the spending. I am somewhat amused by Senator Carol Brown's view that more than $300 million for the hospital system in Tasmania would be sufficient to overcome the unique challenges of the Tasmanian health system. We have some unique challenges in my home state of Queensland in the health and hospitals system too, where over $1 million a day is being forced to be spent to pay the interest rate on the wages bill of the debacle of a health pay system that the former Bligh government implemented. I think perhaps the unique challenge faced by so many of these hospital systems is their Labor state governments which cannot, as this government cannot, properly implement and effectively discipline their own spending.

Let us look, for example, at the liability and risk issues associated with this legislation. Key medical indemnity insurers are warning GPs not to participate as they could be exposed to a new wave of litigation. Insurers are telling doctors not to use the e-health system and the PCEHRs until the issues are settled. The President of Medical Defence Australia, Julian Rait, said his organisation had serious concerns about the legal liabilities doctors would face if they used the PCEHRs and would 'advise members not to participate until these problems are properly addressed'.

As for safety, the fundamental issue of any medical system, one of the comments that came out of the estimates process was that NEHTA had just one document that it could show to the Senate committee demonstrating its interest and concern in the safety of the PCEHRs. It was called the . Thirty-three pages of that 34-page document detailed a huge number of safety risks that the PCEHR system was subject to. On page 32, the document says that 'the feedback to date on the clinical safety recommendations has not described to what degree they have been accepted into the design and if they will be included in future specifications'. So, in fact, none of these safety risks have been properly assessed for their level of danger and what needs to happen to get them properly out of the system. Clearly the question of who is going to be liable if things go wrong has been completely avoided. There is no answer to the question: 'Is the system safe?' There is no system, as I said before, so how are they going to know if it is safe? Yet $1.1 billion has been spent on this.

Just last Friday, we had the extraordinary situation of the CEO of NEHTA, Mr Paul Fleming, announcing that the NASH—the National Authentication Service for Health—was not going to be ready for 1 July. They gave the contract to IBM well over 18 months ago—again, to the distress of the local industry. Medical software providers in Australia were shocked when IBM got the job of providing the NASH. One of them even commented to me: 'They have just gone for the safe option. No-one ever got sacked for hiring IBM.' Apparently someone should get sacked for hiring IBM, because the NASH was due on 30 June and it will not be finished.

In the past, Paul Fleming has described the National Authentication Service for Health as:

… a key foundational component for eHealth in Australia. It is essential that the identity of people and organisations involved in each eHealth transaction can be assured, and this requires high quality digital credentials. The NASH, Australia’s first nationwide secure and authenticated service for healthcare delivery organisations and personnel to exchange sensitive eHealth information, will provide this.

That is the description of the NASH.

In March 2011, NEHTA gave the contract to IBM to design this key foundational component. Guess what? On 15 June, Mr Fleming quite happily said that the fact that the delivery of the NASH has been delayed to a date that no-one can tell us:

… will have no impact on the launch of the personally controlled eHealth records system in July, or the ability for consumers to register for an eHealth record.

Let us note that term 'register'. He went on to say:

Australians will be able to register for an eHealth record in July as intended.

That actually was not what was intended. They were supposed to be able to register and use the e-health system from 1 July. They will not be doing that. That is not what will be happening. And, when queried, Mr Fleming said they did not know when IBM were going to fix the problem and when we would have a NASH to go along with the system. Yet the most serious problems raised were around safety, security and privacy. That is what the NASH is designed to protect.

In the last Friday Karen Dearne said:

THE Gillard government's $1.1 billion e-health records program will launch without the key user verification system in place, with the National E-Health Transition Authority (NEHTA) conceding it has failed to deliver the project on time.

I just find it bizarre that this is what happened. But why should we find it bizarre that providing this and implementing it properly is way beyond the skills of this government or its appointees? As I said earlier, we support this legislation because we believe an e-health system is a national imperative. If it functions properly, it will save the public purse millions. But it has to be done properly, it has to be done intelligently and, far more to the point, it has to be done honestly and transparently. That has not happened to date with the way NEHTA has suggested that not having a key component of e-health ready in time for the so-called launch on 1 July is not a problem. I would love to know when someone is going to take responsibility for NEHTA and for the fact that this has gone from being an e-health revolution in early 2011 through to a 'soft launch' where people can put their names forward to say they would like to be involved if they want to, when and if it finally gets delivered.

I am pleased that the government are now slowing down the implementation of e-health, but I am completely displeased that they cannot simply be honest or transparent about the problems that they have encountered along the way. We are all aware of the problems that have come out of the UK, where over £6 billion was invested and wasted by the former Labour government. To everyone's shock and horror, it could not be reclaimed. It was simply wasted and closed down.

We are in a great position in Australia. We currently have 3.6 million people who are registered to receive primary care with their doctors. We are one of the few countries in the world that can actually tell you we have 3.6 million people registered for primary care by their doctors. So why wouldn't we look at using those people as the starting point—the people who have the chronic healthcare programs with their GPs? Why wouldn't we start with that group? These people would benefit from the fact that they will not have to cart X-rays around with them. They will not have to have test after test. They will not have to tell their story over and over. Why wouldn't we start there instead of creating some sort of money-eating machine that we have no hope of implementing successfully and nationally for so long?

There are so many issues that I think we need to work on with regard to these bills. We will be checking to make sure that the legislation does work as intended over time, that people do have sufficient confidence in the security and safety of the system to actually use it and that clinicians find the system functional for them.

I am disappointed at the approach that has been taken almost consistently by NEHTA, the lack of transparency, the lack of consultation with stakeholders until after the event and the lack of honesty here in suggesting, 'We don't need NASH, really.' Yes, they will get a system cobbled together to get them through, but to say that is as good as the one we have just paid $48 million to IBM for is just bizarre. So let us hope this is a good outcome for Australians.

Senator McLUCAS

I thank senators for their consideration of the Personally Controlled Electronic Health Records Bill 2011 and the Personally Controlled Electronic Health Records (Consequential Amendments) Bill 2011 and their contributions to the debate on these bills and the amendments. At present, consumer health records are scattered across a range of locations and clinics rather than being attached to the health consumer and easily available at the point of care. That means consumers need to retell their story each time they visit a different healthcare provider. This outdated approach can result in things like unnecessary retesting, delays and, unfortunately, medical errors. For example, we know that medication errors cause around 190,000 admissions to hospital each year, with eight per cent of those errors due to inadequate consumer information. The legislation in front of the chamber this afternoon will help to put an end to that.

The bills before the chamber today establish the essential IT and governance infrastructure that will allow consumers to set up their own personal electronic health records—computer based records that can be accessed anywhere where there is an internet connection. That means records can travel with a health consumer from clinic to clinic and doctor to doctor at the click of a button. 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 access a range of basic information on their own health care.

Just as you build a house, these bills help 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 the system carefully and systematically. We know this is a complex area of health reform. It is complex, and that is known by those sitting opposite. It is known that this desire for an electronic health record had part of its origin back in 2003, when the coalition embarked on implementing e-health reform and e-health records. The truth is that very little, if anything, was achieved in the period of government between 2003 and 2007. That is no reflection on the officers of the Department of Health and Ageing as seems to have been the case in some of the contributions we have heard today. The harsh language that we have heard from those opposite should, or could, be directed to the health minister of the former Howard government. It is a complex area of health reform.

A national e-health record system will continue to build over time as consumers and healthcare providers join the system. Since 2010 we have been working closely with consumers and healthcare providers to get this right, and will keep doing so. Establishing a national e-health record system is part of our government's e-health agenda, an agenda that builds on the work of GPs, hospitals and other health providers and that is integrating modern technology into 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 GPs for supporting this technology to become part of their practice, with all the benefits of improved efficiency and accuracy that it provides.

Throughout the development of this infrastructure there has been extensive consultation with clinicians, consumers and the health IT industry. We are looking to the health sector and technology experts to innovate and implement. Individuals can choose whether or not to have an e-health record. If they choose to participate they will be able to set up their own privacy and access controls. As the records evolve they will have the capacity to contain 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. We know that consumers and healthcare providers need to have confidence in the e-health record system and the information it contains, so it is critical to implement a legislative framework that provides robust and transparent governance and appropriate protections for participation in and use of the system. The bills and the amendments that are being debated here today will do just that.

Key elements of the bills 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 record 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.

This is a once-in-a-generation opportunity to deliver these important reforms. These bills are part of the government's bold health reform agenda, reforms that will make it easier for consumers to receive the right care when and where they need it. I commend the bills to the Senate.

Question agreed to.

Bills read a second time.

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