Stephen Jones (Throsby, Australian Labor Party, Shadow Parliamentary Secretary for Regional Development and Infrastructure) Share this | Hansard source

Thank you to the member for McMahon, who I know has a passion about personally controlled electronic health records which would have enlightened the debate and the House had he been given more time to speak upon it. Perhaps at the conclusion of my address, the member for McMahon will share his thoughts on this issue.

The subject matter of the Health Legislation Amendment (eHealth) Bill 2015 is electronic health records. It has a long history. The idea of e-health and maximising the capacity of online systems to extend the benefits of modern health care to hard to reach populations and make the existing delivery of health care more efficient and effective dates back to the 1990s. Successive governments have endorsed strategies; they have not always taken a consistent position from government into opposition, and the history of electronic health records is an example of that. It might surprise many to know that the Howard government was actually quite enthusiastic about the idea. As then Minister for Health and Ageing, Tony Abbott, the former Prime Minister, invested a fair bit of money into the idea but, when going into opposition, threatened to turn the tap off and said there would be no further support for the idea. I welcome the fact that, on review and reflection, the current Minister for Health sees the obvious benefit in continuing the initiative, legislated by Labor in July 2012, to move the paper based health system to a digital system and to improve the level of health care for all Australians.

What are the benefits? Quite simply, to ensure that we have a more secure system of keeping an individual's medical records. Some people worry about the privacy associated with electronic health records. There are actually a lot of advantages to an electronic health record which are not there for a paper based record. When you have an electronic health record, you have a digital footprint—or thumbprint might be a better way to describe it—for everyone who accesses or attaches themselves to that health record, something that cannot be said about a paper based file. So there are two sides to the privacy concerns that have often been raised by well-meaning and influential advocacy groups, many of whose concerns I share. There are two sides to these arguments. Other benefits include cutting down on duplication, stopping people falling between the cracks and having a more effective and efficient means of not only delivering face-to-face healthcare services but ensuring that people are using the right pharmaceuticals and that pharmaceutical products are distributed and administered properly as well. It is especially important for people with complex and chronic health conditions.

The bill that we are debating today forms the government's response to the 2013 review into the personally controlled electronic health record—I will just refer to it as PCEHR from here on in—as well as the 2013 review into the health identifiers service. It implements a number of those reviews' recommendations specifically. It enables opt-out trials to be undertaken but with the same patient controls contained in the PCEHR and allows that opt-out to be adopted nationally if the trials are proven to be successful. The existing opt-in system will continue to operate in the meantime. It is a system that I have availed myself of and I certainly hope, without wanting to reflect upon the chair, Mr Deputy Speaker, that you have availed yourself of as well. It will allow the government to make regulations to authorise new entities to handle healthcare identifiers and other protected information. The bill also changes the name of the PCEHR, perhaps pleasantly, to the My Health Record system—perhaps a much more user-friendly name. In addition to this, it increases the range of enforcement and penalty options available for intentional or deliberate use, introduces criminal penalties and amends the privacy framework.

The PCEHR is, of course, a proud Labor reform. When Labor were in office, we managed to get more than one million Australians signed up, on a voluntary basis, for a personally controlled electronic health record. That number has continued to rise up to almost 2.4 million Australians today and I anticipate that it will continue to rise while we are trialling the opt-out system. It is also very good to know that, since Labor introduced its reform, over 3,000 specialist letters have been uploaded, over 5,000 general practices have registered for the PCEHR and over 1½ million prescription documents have been uploaded. As the member for Sydney said when she was the Minister for Health, Labor sees eHealth as a 'natural extension of our universal health system, Medicare'.

Of course, after more than a decade of talking about the need for an electronic health record, it took Labor to actually put it into place. In 2010 the then minister for health, Nicola Roxon, announced that Labor would invest over $450 million over two years, as a key building block in the National Health and Hospitals Network. Specifically, Labor allocated funding to provide summaries of patients' health information—including medications, immunisations and medical test results—in addition to secure access for patients and healthcare providers to their e-Health records via the internet, regardless of their physical location, but also to provide rigorous governance and oversight to maintain privacy.

E-health records are a critical piece of infrastructure for any modern health system, and their potential in reducing duplication and allowing a more efficient health system cannot be underestimated. Following changes made by the member for Sydney when she was Minister for Health, Labor's system can hold a summary of the patient's important medical history, a list of medications prescribed and dispensed, allergy information, childhood immunisation records, child health and development information, hospital discharge reports, organ donor status and advance care planning details, amongst many other issues, including Medicare and PBS claims data and private notes patients make about their own health records.

In 2013, Labor made an additional investment to ensure pathology and diagnostic imaging results could be included in a patient's e-health record—an important initiative. We know that this is an area where savings can be made, because of a duplication of the provision of services, and we know that, with a better collection of that data and information, there is significant capacity for an enhancement of services and a reduction of the cost to the funders, including the Commonwealth.

The government has just not done enough when it comes to e-health. It is disappointing, because we know what benefits a well-functioning electronic health record can deliver. We know there are significant benefits. When then minister Nicola Roxon introduced the reform, she said, 'About two to three per cent of hospital admissions in Australia are linked to medical errors, which equates to 190,000 admissions each year and costs the health system well in excess of $650 million per annum.' More than that, she noted that about eight per cent of medical errors are because of inadequate patient information. So the potential that an electronic health record has for improving the care patients receive, as well as delivering efficiencies, simply cannot be underestimated. Indeed, it has been estimated that the benefits from an electronic health record program will reach $11.5 billion over the 15 years from 2010 to 2025.

It is disappointing, against this background and with this data within our grasp, that the government have done nothing for the last two years. This is probably a product of the fact that they did very little on the issue when in opposition. The then shadow health minister could not have been less interested in this important initiative; they went to war on it. On coming into office, and perhaps, after two years, succumbing to the best advice available to them, they have decided that this is an important issue, and we are now revisiting it.

But, in fact, the government has done significant damage not only through its inaction but by cutting $215 million from the program. Last year, there was $700 million allocated for the redevelopment of the Personally Controlled eHealth Record System. In launching its so-called rescue package, the government has in fact cut $215 million from this important program. But, more important than that, it has lost the capacity to yield the savings that would have been available to it, had it kept the momentum that was put in place by Labor. Let us not forget, the savings that we are talking about are in excess of half a billion dollars per annum—savings that can then be reinvested into the health system.

With these sorts of savings available, the government would not have had to contemplate the ridiculous propositions around the GP taxes mark 1, 2 and 3. The government would not have had to contemplate some of the proposals around increasing the price of medicines to some of our most vulnerable within the community. Through investing in the healthcare system and through investing in electronic health records, the savings that would have been available to the government over these lost two years could have been yielded, and they would have avoided the terrible decisions they have made in the area of health policy.

The issue of privacy concerns, which I have alluded to, is something that needs to be taken seriously. Nothing could elicit more concern than the belief that some of the most intimate conversations that occur between you and your doctor about the conditions of your health, both mental and physical, may somehow become available to other third parties, thereby breaching your privacy and the important responsibility and duty that the doctor owes to their patient. This bill introduces criminal penalties, including imprisonment, for unauthorised collection, use or disclosure of information from the My Health Record system and the holding or handling of information outside of Australia. It achieves this by amending the Healthcare Identifiers Act 2010, the Privacy Act, the Copyright Act, the Health Insurance Act and the National Health Act 1953.

Labor accepts that a number of the changes are very sensible indeed—for example, allowing that service providers that might not meet the definition of a healthcare provider under the existing act, such as a palliative care or aged-care service provider, be included. These are sensible propositions.

However, it is of the utmost importance that patients' privacy be given the highest regard possible, and it is for this reason that Labor believes these provisions do require further scrutiny. Whilst we will not be opposing the bill in this House, we would like to see more scrutiny of this particular aspect of this bill. When the bill reaches the other place, we will be calling upon our colleagues in the Senate to have it referred to an inquiry so that some of these issues can be further adumbrated.

In conclusion, Labor does not oppose the majority of changes that the government proposed to make to the bill. In fact, we warmly receive the government's rediscovery of this important area of health policy. However, we do have concerns and, for that reason, we will be calling upon our colleagues in the other house to facilitate the parliament as a whole to ensure that we have greater knowledge of those identified issues and greater input from all stakeholders into those identified issues.

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