Some private hospitals are safer than others, but we don't know which

 Professor David Ben-Tovim, Flinders University

The recent jailing of British breast surgeon Ian Paterson after performing multiple unnecessary operations has highlighted the issue of hospital safety.

Paterson’s unnecessary surgeries included some performed in private hospitals, which prompted UK doctors to call for private hospitals to report similar patient safety data as public hospitals, including unexpected deaths and serious injuries.

This example shows how little we know about patient safety and quality in our private hospitals, not only in the UK, but also in Australia.

What do we know about hospital safety and quality?

In Australia, one of the best places to look for information on hospital safety and quality is the MyHospitals website, a commonwealth department site run by the Australian Institute of Health and Welfare.

The Australian Institute of Health and Welfare is provided with data about every patient treated in an Australian hospital, both public and private. Using that data, you can look up measures of safety and quality, as well as emergency department performances. You can compare public hospitals on all the performance measures, but private hospitals are excluded from the performance reports.

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Further reading: Which are better, public or private hospitals?

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Another good source is the New South Wales Bureau of Health Information, which allows you to compare information about the safety and quality of public hospitals in NSW. Private hospitals are not included.

Private hospitals are not all the same

Private health insurance allows you to choose your treating doctor and the hospital at which you’re treated. But how do you choose the right hospital, or the safest one? As our research shows, not all private hospitals in Australia are equal.

In 2009, the Australian Health Insurance Association (now called Private Healthcare Australia) asked me and my colleagues to look at the outcomes of care in private hospitals. We looked at death rates and the numbers of people who died during their stay in hospital, and a range of other safety and quality outcomes.

We were given access to three years of detailed data from a national sample of patients treated in 58 private hospitals. We did not know the names of the hospitals, nor patients’ names.

Our research showed some private hospitals were safer than others, but from the data we analysed we couldn’t tell which. from www.shutterstock.com

Many kinds of hospital outcomes, such as the likelihood of dying in hospital, or contracting a serious infection, are influenced by factors such as a patient’s age, and the range of conditions that brought them to hospital. We tried to take those factors into account and published our findings on the Private Healthcare Australia website.

We found a group of hospitals that, each year, seemed to have much lower death rates than average for all the private hospitals. Those, or other hospitals, also had lower than average rates of a variety of non-fatal incidents. There was also a group of hospitals that each year had higher than average death and adverse event rates. The greater than average death rate group included hospitals where death rates were consistently up to 90% higher than average.

If you are choosing a hospital, you’d want to know which hospital was which. But that information is not publicly available. You’d also want to know if there were more recent statistics, but there is no reported follow-up study. Without better public access to such facts and figures, we’re still in the dark.

What do other countries do?

Other countries do things differently. In the US, several groups provide extensive and detailed information on a range of hospital safety and quality outcomes for almost all US hospitals, including private hospitals. The groups, which do not always agree, include commercial (Healthgrades) and not-for-profit organisations (The Leapfrog Group), and public and government bodies (such as Medicare Hospital Compare).

And in England, it is easy to look up the Care Quality Commission’s detailed reports about public and private hospitals. The reports provide an easy to read, “blow-by-blow” account of their inspections of all types of hospitals, and make a variety of judgements on what they find. They are backed up by detailed statistical reports, but only for public hospitals.

Why don’t we do this in Australia?

A representative from the Office of the Australian Information Commissioner tells me that, provided individuals are not identified, there would be no breach of privacy if private hospital safety and quality data was made public. And no-one from a state health department has yet been able to say whether such a publication would be against any law.

Private Healthcare Australia, the peak body for health insurers, says it represents:

over 12.9 million Australians who choose better quality health care services and to put their health care needs first.

Private hospitals and private health insurers are in competition with each other for the 12 million or more Australians covered by some form of health insurance. So, it is in their commercial interests to avoid bad publicity.

Surely it is the role of both state and commonwealth governments to balance these commercial interests against the public’s right to know which hospital is providing safe, high-quality care.

David Ben-Tovim, Professor, Clinical Epidemiology & Process Redesign, Flinders University
This article was originally published on The Conversation. Read the original article.

Privacy law reform- in the fullness of time

Sure to be in someone's lifetime.

This recent speech by Australian Law Reform Commission President Professor Rosalind Croucher provides a useful summary of the history and current status of privacy law reform, including e-health issues. Reading the timelines reinforces the view that wheels just keep spinning on issues that in 2006 were important enough to refer to the ALRC, and on which the Commission reported in 2008.

A situation confirmed in these exchanges in the Senate Estimates hearing ( at 19:53) this week for the Department of Prime Minister and Cabinet:

Senator Rhiannon I wanted to move onto health privacy. Health privacy rules promised as part of the first tranche of the Privacy Act amendments are some of the issues that I want to cover. Why has the government proceeded with the introduction of individual health identifiers and electronic health records without ensuring that an appropriate health privacy framework was in place first; and also what stage has been reached in the government's consideration of health privacy rules?

Ms Leon (Deputy Secretary Governance) : The question is one that partly will be able to be answered here and partly will need to be addressed to the Department of Health and Ageing, which has carriage of the health issues that you have raised. In relation to where the privacy reforms are up to, as you would be aware the government has provided two exposure drafts on aspects of the privacy reforms to the relevant Senate committee, which has reported on both of those. Those drafts will now be subject to some amendments in response to the committee recommendations. In relation to health reform, it is likely that the health reforms will be drafted subsequent to the reforms that are currently the subject of committee consideration and redrafting in response to those committee reports.

Senator RHIANNON: Can you tell us when that will happen, please?

Ms Leon : We do not have an exact date for that yet.

Senator RHIANNON: When will you determine that date? As you know, these things so often fall by the wayside. Do you have some framework for it?

Ms Leon : It certainly is not falling by the wayside; it is receiving very active consideration. But exactly when it will be drafted will depend on the range of other legislative drafting priorities that are with the Office of Parliamentary Counsel.

Senator RHIANNON: When you say 'other legislative drafting priorities' you do not mean in this area; you mean—

Ms Leon : No, I mean legislation generally. Getting a slot in the parliamentary drafting program does depend on the legislative priorities across the whole—

Senator RHIANNON: Is that the only thing holding it up?

Ms Leon : Certainly getting it drafted will depend upon resources in the Office of Parliamentary Counsel.

Senator RHIANNON: Are there other matters holding it up, though? You have shifted it over to the drafting office, but are there other matters internal that are holding it up?

Ms Leon : There is work proceeding, as I indicated, on the response to the committee reports on the two exposure draft bills that have already been considered, and that is certainly taking the bulk of the attention of the relevant people.

More sunlight the best medicine for TGA

The Therapeutic Goods Administration has operated with a reputation for excessive secrecy so those who follow it closely would not have been surprised by reports that the US Food and Drug Administration publicised a list of deficiencies and inadequacies identified in audits of CSL at its Melbourne laboratory, leaving the TGA to admit belatedly that it also had sent the company letters detailing problems uncovered in its own audits but had not informed the public. Not mentioned in local reports of these developments was the Transparency Review commissioned by the government last November, chaired by former ombudsman and former chairman of the Australian Press Council Professor Dennis Pearce, and due to report on 30 June. Plenty of submissions and lively hearings around the country support the decision to establish the review because of "community concern about the lack of information made available by the TGA." The professor seems certain to prescribe more sunlight.

Ontario hospitals like Australian precedent for protecting health "quality of care" information

But just what is the "Australian approach"?

WikiMedia Commons-Stethoscopes

In Ontario a move to specifically exempt "quality of care" information from the province freedom of information act through an amendment tucked away in budget legislation has advocates and critics hard at it, with Australia featuring in the fine print as one of the precedents for such a provision. According to the Ontario Hospital Association:

Protecting quality of care information is a universally-recognized standard. The protection for a limited and well-defined class of information related to patient safety and quality of care is found in most other Canadian provinces, the United Kingdom and Australia.  In fact, what Ontario has proposed is less stringent than what is available in these other jurisdictions.

In its submission (pdf) to a parliamentary committee OHA states

"that other Canadian jurisdictions, as well as in the United Kingdom and Australia, exempt access to, and the disclosure of hospital quality of care information, either through their respective freedom of information legislation, or other related legislation."

Appendix D includes the research. It hardly amounts to a survey of Australian laws, focusing entirely on Victoria, with a passing reference to Western Australia.

The proposed amendment to the Ontario Freedom of Information and Protection of Privacy act would exempt

“information provided in confidence to, or records prepared with the expectation of confidentiality by, a hospital committee to assess or evaluate the quality of health care and directly related programs and services provided by a hospital, if the assessment or evaluation is for the purpose of improving that care and the programs and services.”

According to the OHA research, in Victoria  despite the existence of specific protections for this type of information in the Victorian Health Services Act 1988 

"hospitals generally rely on the exemptions contained in Sections 33 and 35 of the Victoria Freedom of Information Act 1982. Section 33 exempts information from disclosure affecting personal privacy, which is broadly defined. Section 35 exempts documents from disclosure if the material was obtained in confidence or "would divulge any information or matter communicated in confidence".
Hospitals in Victoria report that from an FOI risk management perspective they are very careful about what documentation they create relating to quality assurance activities (i.e., they ensure it is created in a manner that facilitates reliance on section 35). Consequently, in most instances, there is unlikely to be very much by way of difficult documentation to be requested under FOI even if Section 35 cannot be relied upon. Southern Health, the largest public health service in Victoria, reports that based on its reliance on sections 33 and 35 of its FOI legislation, it does not find that FOI legislation significantly impacts its comprehensive safety and quality review programs and accreditation programs for healthcare professionals."

Here is a rundown on the way in which the various Australian state access laws deal with this issue. I haven't looked at differences in the scope of the coverage. Or arguments that protections go too far.

Tribunal upholds decision on emergency department death reviews

The Courier Mail today reports detail from reviews of deaths in emergency departments at three hospitals in Queensland based on documents released after QCAT upheld (in a decision yet to be posted) the decision of the Right to Information Commissioner that the documents were not exempt from disclosure. (Update: the paper doesn't hold back in the editorial "When right to information is a sick joke."
(Further update-the QCAT decision.)

Review of deaths in emergency departments raise public interest issues

  Drop off rate of interest

An editorial  in The Courier Mail on 30 March (no link but extracts below) gives the paper's point of view about a decision by Right to Information Commissioner Smith against Queensland Health (QH) that the agency has now taken to QCAT, a review right available on error of law grounds. The decision, that documents that detail reviews of in-unit deaths in emergency departments at specified hospitals during a defined period (excluding identifying particulars of patients and medical staff), are not exempt from disclosure, will be of interest to those in the health sector in Queensland and beyond.

RTI Commissioner Smith found that QH's Death Review Process was a system or procedure for the protection of persons [26], but that "there is no reasonable basis to expect that disclosure of the Information in Issue could prejudice" that system or procedure, the grounds necessary for an exemption claim under Schedule 3 section10(1)(i) [ 42]; and disclosure on balance would not be contrary to the public interest [43-63]. On this point the Commissioner said disclosure could be expected to promote open discussion of public affairs and enhance the Government’s accountability:

• "to the extent that information reviewing the quality and safety of emergency care in Queensland public hospitals contributes to open discussion about QH’s service delivery, in accordance with proper professional standards and its timeliness, access to such information is important "[46]

• "disclosing the details of the reviews of specific emergency department incidents where a death occurred will enhance the accountability of QH. Disclosure will reveal actions taken and factors relevant when delivering emergency public health care, and the precise steps taken when evaluating those actions and factors following a death in an emergency department. Such disclosure enhances QH’s accountability because it demonstrates the practical operation of the Death Review Process and sheds light on critical issues arising in emergency departments and how those critical issues are managed"[47]

• "Disclosure of the Information in Issue will provide details of the type and scope of review of specific emergency department incidents. It will better inform the public about review practices when deaths occur in public hospitals and contribute to debate on the performance of QH emergency departments. In this regard I note that the word ‘positive’ is construed broadly in the context of access to information legislation and encompasses various effects that disclosure might have including enlivening public debate, generating criticism or leading to legal process" [48]

The Courier Mail made these observations about the long drawn out process:

Canberra keeps the lid on names of those who don't cut it on food hygiene

The ACT is the latest battleground regarding transparency and compliance with food hygiene standards.Markus Mannheim in The Canberra Times on 26 February (Let the public digest the truth:it's not always dangerous"-no link available) recounted:

I sought access, under freedom of information law, to ACT Health's food inspection reports, not because Canberrans are succumbing to an epidemic of poisoning but because I believe information produced for the public belongs to the public. This is more than simply a matter of principle: it's the law. The (Territory) FoI Act's object is to extend "as far as possible" the community's access to information held by the Government; a right "limited only by exceptions and exemptions necessary for the protection of essential public interests and the private and business affairs" of people to whom the information relates. It is a noble object that, sadly, bureaucrats rarely live up to in practice, whether in the ACT or elsewhere in Australia. ACT Health censored the names of the businesses that failed hygiene inspections, telling me it had no "legislative authority to publicise them". This is not strictly true; the FoI Act provides all of the authority that is required. Rather, the decision to suppress the names, which was made by health protection services director John Woollard, came down to a question of discretion: he cited his power to protect businesspeople from disclosures that would "unreasonably affect" their "lawful business or professional affairs". The Canberra Times disagrees with his conclusion and has begun the process of challenging it formally. Based on feedback this newspaper and Health Minister Katy Gallagher received, it's almost certain most Canberrans disagree with Woollard, too.

These issues have been raised and fought over in a number of jurisdictions. After what seemed a long battle in NSW where arguments against FOI disclosure included a claimed breach of privacy, that government set the Australian standard by publishing details online, getting closer to best practice such as the UK Scores on Doors scheme and similar in the US and Canada for example. Research in California where I was last week showed a 13 per cent reduction in hospitalisations for two years after the introduction of a restaurant hygiene grading system in Los Angeles in 1998.Impact of Restaurant Hygiene Grade Cards on Foodborne-Disease ... Restaurants there display the latest grading on the window in a notice that states a copy of the latest inspection report is available inside on request.

Mannheim was right to point out:

E-health pros, and privacy concerns

This article in the Sydney Morning Herald today has a close look at the Government's e-health plans, with $466 million on the table and enthusiastic support from some medical circles as well as privacy advocates' fear of "a stalking horse for another run at a national identity card. They also fear e-health records will mean Big Brother peeking through the keyhole of a very private place: the consulting room."(Update: Health Minister says safeguards are in place.)

ID card back on Opposition's agenda

So reports The Age, but just what's involved and how this fits with a decision to shelve e-health record plans until good economic times, who knows?

Transparency the order of the day for food hygiene

With the Sydney Morning Herald reporting that 140 food businesses have been added to the NSW register for breach of food hygiene standards in the last 30 days

"NSW Primary Industries Minister, Steve Whan said the name-and-shame list, maintained as a partnership between the state government and local councils, had proved an effective measure in raising hygiene standards. “The vast majority of Sydney and NSW businesses do the right thing and to protect these businesses and consumers we will continue to expose and prosecute those who flout the law,” he said. The NSW Food Authority recently began trials of a new ratings system, dubbed "scores on doors", which will give consumers a new level of clarity when choosing to patronise any of the state's 20,000 registered food outlets."

Hospitality magazine gives NSW a big tick for positive leadership in this field, queries why other states have been reluctant to out offenders (see Brisbane developments), and calls for a national approach.

A far cry in NSW from four years ago when attempts to force greater transparency about observance of standards were being staunchly resisted on privacy and other specious grounds.

E-health on, but not for the Opposition while the budget is in the red

The Coalition's proposed saving of $467 million from scrapping the  Government's e-health record plans mightn't be forever, according to this report by Karen Dearne in The Australian-just till the budget is back in surplus- but the Australian Medical Association said it should be an absolute priority,  and the Australian Privacy Foundation has a single, coherent and contextual e-health policy at the top of the election wishlist.

E-health-more money, some confusion

The Budget announcement of a $466.7 million investment over the next two years in the national e-Health records system saw a lot of emphasis on benefits to come, secure access, and rigorous governance and oversight to maintain privacy, .PDF printable version of Personally Controlled Electronic Health Records for All Australians (PDF 24 KB)

Dr David More at the Australian Health Information Technonogy blog raises  questions about how the money is to be spent, and by whom.  Answers to follow?

Scoring the local on food hygiene could make us all feel better

It's almost four years since the issue of transparency regarding hygiene standards in restaraunts was first mentioned here, and Matthew Moore of the Sydney Morning Herald began exposing excessive secrecy surrounding this issue, so terrific to see the NSW Government and local councils now preparing to introduce a score system that that moves things up a notch. Seems like only yesterday that some councils were arguing that release of fines imposed for breach of hygiene standards was personal information concerning the owner, among other howlers, until Blacktown and then Woollahra concils decided the public interest in disclosure trumped other considerations. The new emphasis on transparency as a spur to lift everyone's performance is a welcome shift from "name and shame" the laggards. And better public policy.

Health identifiers off to Senate Committee

The Senate yesterday referred the Government's Healthcare Identifiers Bill 2010  to the Community Affairs Legislation Committee for inquiry and report by 15 March 2010.

Reasons for referral/principal issues for consideration:

Privacy safeguards in the Bill

Operation of the Healthcare Identifier Service, including access to the Identifier

Relationship to national e-health agenda and electronic health records.

In introducing the bills Minister For Health Roxon referred to the strong emphasis on privacy considerations and to three Privacy Impact Statements. The Australian Privacy Foundation wasn't happy with the Exposure Draft. The Committee process will give the issue an, or another airing.

E-health privacy concerns suggest close scrutiny in the Senate.

The quietish run for the Federal Government's e-health plans seems to be coming to an end, with The Australian IT and Adelaide Now both reporting concerns about patient privacy and data security risks, and putting a different slant on things than Health Minister Roxon might have hoped after taking part in a demonstration of connectivity yesterday. 

From the Oz:

Ms Roxon insists the unique identifiers will be available on a secure system operated by Medicare Australia. The Australian Privacy Foundation  says the proposed legislation "fails to take account of significant concerns, despite these having repeatedly (being) drawn to the attention of senior health officials". "Information about consumers will be available to (around) 600,000 health workers, and the numbers will be stored in several thousand local health service information systems, regardless of their security arrangements," the privacy group said. "The bill should also mandate provision for consumer access to their own data."

The Australasian College of Health Informatics is concerned that the Council of Australian Governments "is yet to make a decision on a national e-health record implementation".

From Adelaide Now:

Software developer Peter West, who left NEHTA in September, says centralising the information will make it easier for hackers to access and increase the chance of abuse by medical staff. He says he is one of several people who have quit amid privacy concerns.

University of South Australia PhD candidate Steven Clark, whose doctorate is on the intersection of law and technology in privacy and security, said personal health information was valuable. Critical questions about "who, how, when and why" the information was to be accessed remained unanswered, he said. "In a place like Adelaide there's a lot of people you don't want knowing that your sister is on anti-psychotic medication, or your brother is going through counselling after a rape event," he said. "Who gets access to that?"

University of Adelaide Professor of Public Health Policy Christian Gericke said centralisation of data was a good idea as long as safeguards were preserved. "I have experiences with databases in Germany and the UK, and that's worked very well," he said. "Technically the difficulties are not that big to make them safe - but they were not internet-based, and that's one of the problems (with the Australian model)."

"People can do what they do with public information"

Tell it to the NSW Greens and the state Opposition who voted to make it a crime to play around with published data on school performance to produce "crude and simplistic league tables" if published in a newspaper but not elsewhere. And to the NSW Law Reform Commission which says in the report on a privacy cause of action referred to in the previous post [5.28], that publicly available information, say in a paper record buried away somewhere but theoretically available for public inspection, may in some ( they should have emphasised extremely rare) circumstances still retain a privacy character. But the NSW Food Authority has the right attitude to the arrival of an iPhone application, FoodWatch NSW, which brings the Food Authority's list of restaurants that have been issued an order in relation to food hygiene practices near your location to your fingertips.According to the Sydney Morning Herald:

A NSW Food Authority spokesman said it did not have a particular view of such applications, but would encourage the public to use the information wisely. "We don't endorse any of those products," he said. "We just provide the information for anyone to use. We just encourage people to be cautious because the information is frequently changed. They should check back to the original source before they make a decision. "People can do what they do with public information."

An improvement on Railcorp's threat to sue to protect intellectual property over something similar for train and ferry timetables. And the start of what should be a new era for the use and reuse of government information at a time, place and in a format to meet public needs. As to all those copyright and cost recovery policies that have dominated thinking in the past ???

E-health big picture thinking-action to follow?

The National Health and Hospitals Reform Commission Report on the future of the health system was released earlier in the week. The discussion of e-health is in Chapter 5 of the Report.

Generally positive reactions to the reform proposals overall, and although the Government has some runs on the board and plans to continue to move ahead on a number of fronts, disappointment about what is seen as more talk, not enough action on another big high priority. For example this editorial in the Sydney Morning Herald today says too much dithering, and the PM must have loved the George Bush comparison. Yesterday Ross Gittins said he wasn't optimistic about health reforms because "(i)n the short time he’s been in office, Rudd has established a record of over-promising and under-delivering." Although there is something to all this, with his ratings around 66% the PM continues to blog away on health and other topics and is probably not losing sleep at this stage.

On e-health the experts seem to see the general direction as the right way to go and want to see action and leadership from the Federal Government. But some cautionary flags for example from Dr David More about a Personal Electronic Health Record where everyone gets to choose their provider unless we can ensure "a secure, inaccessible, un-data-minable environment where the terms of service were such that the public would be entirely comfortable to have their information stored by whoever provided the service."

The e-health recommendations are:

115. We recommend that, by 2012, every Australian should be able to:
• have a personal electronic health record that will at all times be owned and controlled by
that person;
• approve designated health care providers and carers to have authorised access to some or
all of their personal electronic health record; and
• choose their personal electronic health record provider.

116. We recommend that the Commonwealth Government legislate to ensure the privacy of a
person’s electronic health data, while enabling secure access to the data by the person’s
authorised health providers.

117. We recommend that the Commonwealth Government introduce:
• unique personal identifiers for health care by 1 July 2010; unique health professional
identifiers (HPI-I), beginning with all nationally registered health professionals, by
1 July 2010;
• a system for verifying the authenticity of patients and professionals for this purpose – a
national authentication service and directory for health (NASH) – by 1 July 2010; and
• unique health professional organisation (facility and health service) identifiers (HPI-O)
by 1 July 2010.

118. We recommend that the Commonwealth Government develop and implement an appropriatenational social marketing strategy to inform consumers and health professionals about thesignificant benefits and safeguards of the proposed e-health approach.

119. Ensuring access to a national broadband network (or alternative technology, such as satellite) for all Australians, particularly for those living in isolated communities, will be critical to the uptake of person-controlled electronic health records as well as to realise potential access to electronic health information and medical advice.

120. We recommend that the Commonwealth Government mandate that the payment of public and private benefits for all health and aged care services depend upon the ability to accept and
provide data to patients, their authorised carers, and their authorised health providers, in a
format that can be integrated into a personal electronic health record, such that:
• hospitals must be able to accept and send key data, such as referral and discharge
information (‘clinical information transfer’), by 1 July 2012;
• pathology providers and diagnostic imaging providers must be able to provide key data,
such as reports of investigations and supplementary information, by 1 July 2012;
• other health service providers – including general practitioners, medical and non-medical
specialists, pharmacists and other health and aged care providers – must be able to
transmit key data, such as referral and discharge information (‘clinical information transfer’),
prescribed and dispensed medications and synopses of diagnosis and treatment, by
1 January 2013; and
• all health care providers must be able to accept and send data from other health care
providers by 2013.

121. We recommend that the Commonwealth Government takes responsibility for, and accelerates the development of a national policy and open technical standards framework for e-health, and that they secure national agreement to this framework for e-health by 2011-12. These standards should include key requirements such as interoperability, compliance and security. The standards should be developed with the participation and commitment of state governments, the IT vendor industry, health professionals, and consumers, and should guide the long-term convergence of local systems into an integrated but evolving national health information system.

122. We recommend that significant funding and resources be made available to extend e-health teaching, training, change management and support to health care practitioners and managers. In addition, initiatives to establish and encourage increased enrolment in nationally recognised tertiary qualifications in health informatics will be critical to successful implementation of the national e-health work program. The commitment to, and adoption of, standards-compliant e-health solutions by health care organisations and providers is key to the emergence of a national health information system and the success of person-controlled electronic health records.

123. With respect to the broader e-health agenda in Australia, we concur with and endorse the
directions of the National E-Health Strategy Summary (December 2008), and would add that:
• there is a critical need to strengthen the leadership, governance and level of resources
committed by governments to giving effect to the planned National E-Health Action Plan;
• this Action Plan must include provision of support to public health organisations and
incentives to private providers to augment uptake and successful implementation of compliant
e-health systems. It should not require government involvement with designing, buying or
operating IT systems;
• in accordance with the outcome of the 2020 Summit and our direction to encourage greater
patient involvement in their own health care, that governments collaborate to resource a
national health knowledge web portal (comprising e-tools for self-help) for the public as well
as for providers. The National Health Call Centre Network (healthdirect) may provide the
logical platform for delivery of this initiative; and
• electronic prescribing and medication management capability should be prioritised and
coordinated nationally, perhaps by development of existing applications (such as PBS online),
to reduce medication incidents and facilitate consumer amenity.

Only a glimpse of Victorian food hygiene standards

Mark Russell in The Sunday Age reports

"The veil of secrecy protecting Melbourne's restaurants and cafes caught dishing up contaminated food will be lifted next year. The State Government expects a "name and shame" food hygiene website to be up and running by July 1. The website will be similar to one in NSW that has attracted more than 2.3 million visitors since its launch a year ago."

The veil however won't be lifted as much as it should, or as much as it has in NSW, despite the claim by a spokeswoman for the Minister for Health that the Food Amendment (Regulation Reform) Bill currently before the Parliament will deliver the goods. The Bill ( Clause 27) will require the publication on a website of convictions for offences, which of course are court imposed, and while this would provide convenient access, only involves information that is already in the public domain. What is different about the NSW Register is that it also includes information about penalty infringement notices issued after council or Food Authority inspections. These are not convictions, but represent findings that may or may not be disputed. The Victorian Bill (Clause 39) provides for infringement notices to be issued but makes no provision for inclusion of notices issued on a publicly available register.

Last week the NSW Authority went a step further than the NSW Act requires in releasing in response to a Freedom of Information application, details of the number of inspections undertaken, providing for the first time a list of of those councils which don't appear to attach a priority to this aspect of regulatory responsibility.

On my reading, Victoria is following a Western Australian lead in only mandating publication of the register of convictions. A more serious effort to lift hygiene standards would involve opening up the inspection regime to public scrutiny by ensuring publication of results of all inspections (good as well as poor findings), any enforcable undertakings (Clause 34) entered into, and penalty infringement notices and convictions, with scope for the proprietor to add information about rectification of identified problems.

E-health on the move, with lively privacy debate to follow.

www.dietclipart.com. Not Federal Health Minister Nicola Roxon

Our wonderful system of federation adds a layer of complexity to an already complex problem when it comes to getting the balance right between access to health information, now in digital form, for those that need it for efficient and effective service to those in need, and the appropriate protection of privacy of the individual concerned.

In a somewhat low key fashion (not even a ministerial media release, perhaps reflecting the potential hot political potatoes at the heart of the matter), the Federal Government via the Department of Health and Ageing has released a Discussion paper on Healthcare Identifiers and National Health Privacy Arrangements.It seeks submissions by 14 August on legislative proposals, to be in place to allow a scheme for the issue of unique health identifiers by Medicare Australia, by mid 2010. A spokesperson for The Australian Privacy Foundation made the obvious point that any system poorly thought through and not properly managed poses dangers to the health of those involved. The Foundation had earlier laid down a few markers about the privacy concerns about e-health systems in letters to the Federal and NSW Health ministers. Expect considered comment on the details soon.

The Australian Law Reform Commission spent two years on research and consultation and delivered a report late last year running to over 2000 pages on the reform of Australia's privacy laws. The Government hasn't responded to any of it so far but as the Discussion Paper illustrates through examination of only some health issues, holding to the proposed consistent uniform approach will be a monumental task. Queensland's Information Privacy Act only commenced on 1 July; NSW and WA are looking at reforms and the Commonwealth will announce phase one of its response to the ALRC proposals before the end of the year. The Discussion Paper says consultations with the states about e-health (its been on the agenda of Australia's health ministers now for 9 years) will commence in the second half of the year. However existing laws and regulations-with some modifications to allow for national identifiers- are to get us by until the proposed uniform national system of regulation is in place.The mind aches at the thought of all those inter-departmental, inter-government meetings across the country..

Meanwhile before the Federal Government makes any public response to the ALRC proposals, the Paper (Part B, page 45) proposes ditching a number of those put forward by the Commission, including that one group of ministers (Attorneys- General) should be in the driver's seat on all this- Health ministers are preferred- and adding some new elements to the ALRC Uniform Principles proposals to reflect special features relating to health. Special pleading may have some justification, but I'm sure there has already been plenty of it behind closed doors from other sectors, and it's a contributing factor to the current legislative mess. No doubt the experts will give us plenty to think about over the next month on the e- health issues.

If we are still to get anything through the Federal Parliament on Freedom of Information Reform, 20 months on, what chance all this in place by mid 2010?

Back in touch.

I'm in Darwin catching up, courtesy of internet access, on developments of a week spent in very remote locations. For me, items of particular interest include:

James Massola in The Canberra Times, brought together the key elements of the open government reforms now moving on a number of fronts in Canberra, and included a well deserved wrap for what the four volunteers behind Open Australia have managed to do with parliamentary information. All very positive. Massola should have included a mention of the Australian Law Reform Commission review of secrecy provisions in Federal laws, due for final report later in the year, which is another plus piece in this picture. Meanwhile as Shadow Attorney General George Brandis pointed out, we still have zilch to show on Freedom of Information legislative reform, described by then responsible minister John Faulkner, as a "high priority" for the Rudd Government (elected 20 months ago).

Reality about accountability strikes when you read Warren Read's account in Online Opinion of the 15 year fight, now settled, between Defence and Russell Vance which has cost taxpayers $15 million, with limited parliamentary or media attention. And no-one's responsible. Ditto for security failings at Sydney Airport.

And reality double take to read on smh.com.au that the Therapeutic Goods Administration only has out-of-date and incomplete information about whether sunscreen approved for sale contains engineered material suspected of causing damage to human cells and DNA. It only cost Lee Rhiannon of The NSW Greens $2000 instead of $4000 to find this out however, after arguing for a public interest discount!

Matthew Moore in the Sydney Morning Herald finally obtained information from the NSW Food Authority about lax approaches to regulatory inspections of compliance with food safety standards by some NSW local councils, with the Authority somewhat belatedly recognising through disclosure, that it's more than "name and shame": there are major public health benefits in opening up the inspection system to public scrutiny. A tick for NSW but as to the rest of the country.....

The debate about publication of school performance information in NSW continues following the remarkable attempt by The Greens and the Opposition to put newspapers and magazines in the dock it they dare to play around with published data to create "simplistic league tables". I don't think this has occurred too often but I'm with former Treasurer Michael Costa, now writing for The Australian:

".. much union criticism of so-called league tables misses the central issue: parents and taxpayers have a right to know how their children and their schools are performing. The unions claim the league tables "are unfair and simplistic" and they could "stigmatise schools and lead to unfair comparisons". Any statistical data can be misused. That is not an argument against collection of the data or publication of the data."

This is the same Michael Costa who in the NSW Legislative Council for years made an art form of rude obfuscation and refusal to respond to legitimate questions from the other side of the chamber about aspects of government performance. Ah, you've gotta love 'em.

Good use by John Warhurst of ANU writing in The Canberra Times, of information dug out of the Federal Government on publicly funded travel by former parliamentarians by the Sydney Morning Herald, to give new life to the debate about the generosity of the Life Gold Pass scheme.

Fiona Hudson in the Herald Sun obtained some information about taxpayer-funded extras fitted to 126 vehicles supplied to Victorian members of parliament but I'd love to see the reasoning for the following knockbacks. Hope she challenges:

"(The) Department of Treasury and Finance staff ruled the cost of the extras was a "trade secret", and refused to release a breakdown of spending. The department also refused to identify which politicians had ordered which extras."

More as the week goes on.