House of Representatives

Health Legislation Amendment (eHealth) Bill 2015

Second Reading Speech

Ms Ley (Minister for Health and Minister for Sport)

I move:

That this bill be now read a second time.

I am pleased to introduce the Health Legislation Amendment (eHealth) Bill 2015, which implements the government's recent $485 million budget announcement on eHealth. These changes are just one small aspect of the government's broader digital health agenda.

This bill takes the first important steps to reboot our national electronic health records system to deliver an effective system that will help improve the health of all Australians, as well as realising the benefits that instant access to and sharing of electronic health records can provide.

A review of the personally controlled electronic health record in 2013 found that there was overwhelming support to continue implementing a national and consistent shared electronic health record system for all Australians, but that a change in approach was needed to correct a number of early implementation issues, and a lack of confidence in the system from clinicians and consumers due to these issues.

The Healthcare Identifiers Service, a key foundation of the electronic health record system, was also the subject of a review in 2013. This review found that some adjustments are required to improve its operation to better support access to and sharing of information in the electronic health record system.

This bill implements the recommendations from both of these reviews which are aimed at facilitating increased participation in the system and improvements in the usability and clinical content available in the system for individuals and their healthcare providers.

Firstly, the personally controlled electronic health record will be renamed My Health Record-which is a simpler, more meaningful and clearer name for individuals to relate to.

The system is currently an opt-in system, where you have to actively apply to have your electronic health record created, and as it stands only around one in 10 Australians have an electronic health record set up. The review concluded that this is not a large enough population to make it an effective national system, nor is it worth the time for doctors to use it.

Healthcare providers have overwhelmingly indicated through the review process that, if the majority of their patients have a My Health Record, they would be much more willing to use it. This means more doctors would add their patients' health information to it, and this will improve the overall value of the system for both patients and the healthcare providers who care for them.

To increase uptake by individuals, the government will be conducting trials of different participation arrangements in 2016 to identify the optimal approaches for maximising participation in the system. This will include trials of opt-out participation arrangements.

Individuals in opt-out trials will automatically have a My Health Record created for them unless they opt out, which they will be able to do in a number of ways. Extensive communication will be undertaken in the trials before trials begin to allow individuals to make an informed decision about whether or not to opt out. The process and the criteria for selecting locations to conduct the trials will be made publicly available before the trial sites are selected, and this bill provides that I, as the responsible minister, in consultation with the states and territories, will be able to make rules under the act to apply opt-out participation arrangements to a particular geographic area, allowing these trials to occur.

Importantly, individuals will continue to be able to control access to their My Health Record through a range of existing access control settings in the system. This includes the ability to instruct healthcare providers not to upload certain information into their health record.

Outside the opt-out trials, the My Health Record system will continue to operate on an opt-in basis.

If the trials provide evidence that an opt-out system is a better approach for improving participation in the My Health Record system, the bill provides the ability for the government to extend opt-out arrangements nationally, in consultation with the states and territories.

Given the nature of information that may be contained in a My Health Record, the bill will increase the range of enforcement and penalty options available if someone intentionally or deliberately misuses the information or commits an act that may compromise the security or integrity of the system. This is an important protection for consumers who have their health information contained within their health record. Criminal penalties will now be available, in addition to the existing civil penalties and other sanctions, such as enforceable undertakings and injunctions. However, neither civil nor criminal penalties are triggered if someone simply makes a mistake.

Additionally, the enforcement and penalty options available for the Healthcare Identifiers Service will be aligned with those for the My Health Record system.

The bill also provides for a number of consequential amendments and additional clarifications. The scope of what is considered to be a health service and health information has long been subject to some ambiguity, and in 2008 the Australian Law Reform Commission recommended changes to the Commonwealth Privacy Act to remove uncertainty.

This bill implements those recommendations, amending the Privacy Act to make it clear that a health related disability, palliative care or aged-care service is considered to be a health service, and information about an illness or injury, and medical information about a genetic relative, is considered to be health information.

These clarifications reflect current practice in the health sector and will facilitate integration of health information and health related services to support improved continuity of care for patients.

The bill will make way for forthcoming changes to the governance of digital health in Australia.

The Australian Commission for eHealth will be established in coming months to oversee the operation and evolution of national e-health systems. Among other things this commission will become the system operator of the My Health Record. This commission is intended to remove the complexities associated with the current governance arrangements, strengthen accountability and improve transparency and stakeholder involvement, and it was another key recommendation of the PCEHR review.

An implementation task force is currently being established to design, establish and transition to the new governance arrangements. The task force will oversee the transition of functions from the Department of Health and the National E-Health Transition Authority to the new organisation. The National E-Health Transition Authority will be disbanded.

The Department of Health will continue to be responsible for the policy underlying national digital health programs, and for the supporting legislation.

In line with government's cutting red tape strategy, the bill will reduce burden by making amendments that will mean healthcare organisations will no longer need to enter into a participation agreement with the system operator. Entering into these agreements can be complex, and time consuming for organisations, and it is simply another barrier, and more paperwork that needs to be completed before organisations can participate in the My Health Record system.

We just do not know what kinds of new and innovative digital health services are just around the corner. The way in which services are provided and who provides them may become important to the efficient delivery of health care. If we do not anticipate innovation, our current processes and protections may prohibit new services and the providers of these services from becoming part of the My Health Record system.

Having said that, it is equally important that we continue to protect the integrity of the My Health Record system and the Healthcare Identifiers Service and exercise effective controls over who is able to become a service provider in the digital health system.

For these reasons, the bill will establish a mechanism that will allow the government to make regulations to authorise new entities to handle healthcare identifiers and other protected information. This power will be limited to circumstances that relate directly to providing or facilitating health care or assisting individuals who require support for health reasons.

As part of measures to simplify and streamline the My Health Record system, the bill will establish new copyright arrangements. At present, healthcare organisations participating in the My Health Record system, and the system operator, rely on copyright licences to use information in the system without infringing anyone's copyright.

In place of licences, the bill will establish new copyright exceptions in the Copyright Act. These will ensure that upload, download and use of works in the My Health Record system do not infringe copyright.

The bill will make a range of other amendments intended to clarify and improve the My Health Record system and Healthcare Identifiers Service.

The My Health Record system has the potential to change the nature of health care in Australia and become a widely accepted everyday part of good healthcare management. These improvements we are making get us closer to reaching that goal. I commend the bill to the House.