p o s t: G P O B o x 1 1 9 6 
S y d n e y N S W 2 0 0 1
e m a i l: m a i l @ p r i v a c y . o r g . a u
w e b : w w w . p r i v a c y . o r g . a u
6 March 2009

APF response to the interim report of the National Health
and Hospitals Reform Commission

I am writing in my capacity as Chair of the Health Sub Committee of the Australian Privacy Foundation (APF). 
Unfortunately as an all volunteer organisation, currently facing a number of consultations, we have not been able to resource a detailed response to the interim report of the National Health and Hospitals Reform Commission (NHHRC). Nonetheless, the report is of significance and so some brief comments follow. 
1.	Areas of Agreement and Support 
1.1	The APF agrees with those aspects of the interim report stating that health information management, when done well, is a vital component of effective and efficient health care. 
1.2	We are pleased to note that the NHHRC interim report emphasises the importance of healthy communities and is committed to the value of universal entitlement to adequate healthcare. 
1.3	It is also heartening to see 10 year health goals articulated as well as encouraging ways to facilitate patient access to evidence-based, consumer-friendly information.
1.4	The interim report also acknowledges the utility of personal health records for many and the need for patient consent with regard to a national electronic health record system. 
These are all very positive report outcomes. 
2	Areas of Serious Inadequacy 
However, several APF comments to the committee in May last year have not been addressed in the interim report. These include the following: 
2.1	The report is permeated by inherent assumptions about a centralised database, which unlike federated systems, require only a single point of failure to facilitate data breaches and the growing problem of identity fraud. 
2.2	As borne out by research and clinician feedback to the APF, health care professionals distrust most data, including e-data, because it is generally dated, unreliable, and 'wrong' (at least for the context in which they are operating) (1-3). 
2.3	Complete data is not available to clinicians when using e-health. Rather, patient records are drawn from various information systems, printed on a single sheet of paper and then circulated to all clinicians on a shift for use during patient rounds. Updated records are later transcribed back into the e-health systems from which they were drawn. E-Health ensures neither the quality nor availability of reliable health information at the point of patient care [4-5].
2.4	Dis-economies of scale and scope is a key feature of technological resources available to health care. While the use of e-health technologies may equate to effective spending on healthcare, it is expensive to implement.
2.5	The report recommends the need to improve public participation in health reform efforts. The APF is the main non-governmental organisation dedicated to protecting the privacy rights of Australians, yet it was not called upon for a formal consultation with the NHHRC. 
3.	Lack of Detail on Technological Enablement of the Recommendations 
Finally, the interim report treats e-health as an enabler for many suggested reforms. It also argues that telehealth and telemedicine are not being used to their full potential (NHHRC report p.16). Yet the interim report overlooks basic and relevant details, such as outlining ways that information and communication technology might support the range of recommendations that the NHHRC is considering.
4.	Support for Local Control, Including by Patients 
In terms of "who should run the system", the APF supports Option A: Continued shared responsibility between governments, with clearer accountability and more direct Commonwealth involvement. Option A ensures accountability and patient control at the local level. However, the APF was surprised to note discussion of the pros and cons of this approach overlooked patient concerns entirely in the interim report, although ‘people’ are discussed in Options B and C. The APF is concerned that conversations with bureaucrats, hospital authorities and head office accountants about the future of the Australian health system cannot continue to exclude patients and their advocates if reform efforts are to succeed.
Please do not hesitate to contact me for further information or clarification of any point raised herein.

Yours sincerely

Dr. Juanita Fernando
Chair
Sub-Committee
Australian Privacy Foundation
REFERENCES
1.	Callen JL, Braithwaite J, Westbrook JI. Contextual implementation model: A framework for assisting clinical information system implementations. J Am Med Inform Assoc. 2008(15):255-62.
2.	Staroselsky M, Volk LA, Tsurikova R, Newmark LP, Lippincott M, Litvak et al. An effort to improve electronic health record medication list accuracy between visits: Patients' and physicians' response. International Journal of Medical Informatics. 2008;77(3):153-60.
3.	Avison T, Young T. Time to rethink healthcare and ICT? Communications of the ACM. 2007 June;50(6):pp69-74.
4.	Timmons S. Nurses resisting information technology. Nursing Inquiry. 2003;10(4):257-69.
5.	 Fernando, J. The protocols of privileged information handling: Are our fears warranted? Keynote address presented at 18th Annual Medico Legal Congress, 26th & 27th February 2009 Sydney Harbour Marriott at Circular Quay