Access card The AMA Perspective

1. Access cardThe AMA Perspective Dr Peter Garcia-Webb Chair AMA Expert Advisory Committee on Information Technology

2. History • AMA is the peak medical organisation in Australia • AMA is an opinion leader in e-health in Australia • AMA has been closely involved with the Australian Government on e-health initiatives for over 10 years • AMA opened discussion re eftpos claiming 4 to 5 yrs ago • So, naturally, AMA has an interest in the Access Card

3. Outline Privacy • Embedded identifier • Function creep • Card content Use by the young • Apply versus general availability Types of information on card • Tier 1 • Tier 2

4. Privacy – Embedded Consumer Identifier History • DoHA – planned to use Medicare number in MediConnect • AMA - maintained this was a breach of Privacy Act • DoHA – considered legislation to allow its usage • AMA – wrote to federal Privacy Commissioner NEHTA • Charged with developing a national identifier Embedded identifier • Will be a registration number • AMA suggests use of a national identifier when available

5. Privacy – Function Creep A major danger in all of e-health May relate to • Use or purpose of card • Use of data accessible through embedded identifier • Potential problems lie in policy not technology Governance and management policy • Change to other security and privacy acts may embrace card Card legislation should specifically prevent this

6. Potential for Data LinkingSection 135AA of National Health Act • Prevents linking of PBS and MBS databases • Progress in technology could enable such linkage • Privacy Act allows collateral use of information if • Consumer aware of such use when providing information • Many government forms now contain an IPP2 clause Will consent for possible collateral use be part of application for Access Card?

7. AMA View on Collateral Use • Legislative protection of information held on or accessible by Access Card • Such protection not to be overridden by other legislation • May be waived by absolutely voluntary consent • Defined clear limits of possible collateral use • Access by Freedom of Information only to individual whose information is on Access Card

8. Card governance and administration Legislation • Minister policy statement will define administration • Such policy statements are independent of parliament • Process to identify an individual in guidelines • Register to contain “reasonably necessary” information • Process for individual to correct “errors” not defined • Not planned to use access card as identity card

9. AMA views on legislation content • Administration should be built into act • Major admin changes to be discussed in parliament • Identification of individual to be in legislation • Function creep to be specifically excluded • Specifically state card cannot be used as national identity card • Process to enable error correction to be simple and defined

10. Use of Access Card by the YoungThe problem • Current legislation states that Access card is not available to those < 18 yrs • Government state that their intention people to apply for age exemption if 15 to 18 • If so, why word legislation to say that it is not available • AMA is concerned that act introduces this limitation

11. Use of access card by the youngAMA position If community is serious about • Managing chronic illness • Preventative health • Creating health positive patterns of behaviour • Ensuring patients are able and willing to take individual responsibility for their health Then: • We must remove any and all barriers introduced by rule changes that affect independent access to health by the young

12. Use of access card by the youngIdentification process • Registration for an Access Card will require careful identification if the individual • For example, the 100 point system used elsewhere • The young may not have passport or driving licence • AMA view is that an application for a card by those 15 to 18 may require different identification data • Identification may then be re-confirmed once individual becomes 18

13. Information Access Card Could Contain Tier 1 • Verified medical information • Can be absolutely relied on in a medical emergency Tier 2 • Voluntary non verified data • Stored on card at consumer’s discretion • May contain health information • Cannot be relied on in an emergency

14. Verified Medical Information Some medical information is useful in an emergency • Subject has diabetes, asthma, proven allergy, pace maker If subject is unable to communicate in emergency • If doctor is going to rely on such information • Information must be correct • Incorrect or out of date information may be dangerous From which if follows • Process of information entry must be reliable • Process of information verification must be reliable

15. Tier 2 Information may Include Medical Information • This type of medical information may well be correct • May be useful in a medical emergency • But cannot be relied upon in a medical emergency • Analogy is data to be found in a hand bag or wallet • May be useful if subject sees a new doctor • Record of filled prescription • Tablets were dispensed • But were tablets taken correctly or at all? • Results of pathology test • Were data accidentally altered at entry?

16. Data Entry for MedicAlert Bracelets • Application form signed by approved medical practitioner (GP) • Application required subjects consent • Managed by Australia MedicAlert Foundation • Confidential national Registry • Only treating doctor plus subject can verify or edit information AMA view is that Tier 1 data be entered using an appropriate well controlled process