Healthcare Identifiers Act and Service Review - Final Report - June 2013

3.4.3 Expansion of the permitted uses of Healthcare Identifiers

Page last updated: 28 November 2013

Consultation for this Review highlighted a number of other uses relating to population health, clinical registries and clinical trials that offer the potential to deliver significant improvements in healthcare if data from different health services can be linked and outcomes and trends monitored. The Act currently limits use and disclosure for research to a “healthcare provider”. This restricts the use of Healthcare Identifiers for research conducted by DOHA or jurisdictions.

The absence of a means of uniquely identifying individuals has limited the opportunities in the past to effectively access data to assess the effectiveness of different treatments on health outcomes, antecedent conditions, population health status and risk factors and epidemiology that would provide information to better structure health programs, direct funding and inform evidence based policy. As demands on the health system escalate as the population ages this information will be even more critical to better target care and manage the health system. These purposes were one of the original drivers for the business case for a system of national Healthcare Identifiers.

Amendments to the HI Act to enable this type of use within healthcare services, subject to appropriate protections, could provide an invaluable mechanism to support this type of research to help deliver better targeted, more cost effective healthcare services and better health outcomes for the community.

Section 24(1) of the Act specifies that “A healthcare provider is authorised to use a Healthcare Identifier, or to disclose a Healthcare Identifier for....the conduct of research that has been approved by an ethics committee”. Consultation for this Review highlighted a number of other uses relating to population health and clinical registries that offer the potential to deliver significant improvements in healthcare if data from different health services can be linked and outcomes and trends monitored.

By limiting this use and disclosure for research to a “healthcare provider”, the Act precludes the use of Healthcare Identifiers for research conducted by DOHA or jurisdictions. The absence of a means of uniquely identifying individuals has limited the opportunities in the past to access data to assess the effectiveness of different treatments on health outcomes, antecedent conditions, population health status and risk factors and epidemiology.

The ability to do this would provide information to better structure health programs, direct funding and inform evidence based policy. As demands on the health system escalate as the population ages this information will be even more critical to better target care and manage health services. These purposes were one of the original drivers for the business case for a system of national Healthcare Identifiers. The implementation of the HI Service could provide an invaluable mechanism to support this type of research to help deliver better targeted, more cost effective healthcare services and better health outcomes for the community.

Section 135 of the National Health Act 1953 (National Health Act), section 130 of the Health Insurance Act 1973 (Health Insurance Act) and section 86 of the Aged Care Act 1997 (Aged Care Act) are consistent in the approach to release of data for secondary purposes if the disclosure is deemed to be in the public interest. It is recommended that section 24 of the HI Act is reviewed to align with the National Health Act, Health Insurance Act and Aged Care Act.

Legal advice was also sought on this issue. The following sections summarise this advice20. Section 24 of the Act identifies four secondary purposes for which Healthcare Identifiers can be used by a healthcare provider organisation or disclosed by a healthcare provider organisation to a third party entity. The Explanatory Memorandum to the Healthcare Identifiers Bill 2010 provides that “Healthcare identifiers are expected to be used broadly within the healthcare sector provided the uses and discloses [sic] fall under the activities described in subclause 24(1). Any activities that fall outside those activities described in subclause 24(1) are intended to be prohibited”.21

The activities or purposes identified in section 24 of the HI Act were designed to be “broad enough to cover a range of clinical, administrative and business activities that are regularly undertaken to support the delivery of healthcare. For example, management, funding, monitoring or evaluation of healthcare is intended to include activities such as quality assurance, quality improvement, policy development, planning, cost benefit analysis and the compilation of statistics in relation to those activities”.22

The broad interpretation of subparagraph 24(1)(a)(ii) suggests that the authority provided to healthcare provider organisations would not be limited to activities performed for or on behalf of the organisation. That is, so long as the activity for which the IHI was disclosed related to 'healthcare' there is no requirement that the activity be for the benefit of the organisation itself. This broad interpretation would support the proposition that Healthcare Identifiers could be disclosed by a healthcare provider to a third party and used by that third party to conduct its own monitoring or evaluation of healthcare.

However, because subparagraph 24(1)(a)(iv) expressly authorises the disclosure of an IHI in connection with the conduct of research which has been approved by a Human Research Ethics Committee, it indicates that section 24(1)(a)(ii) was not intended to create a 'catch-all' authority for research.

Because there is doubt about the scope of the authority granted to healthcare providers under section 17, it is recommended that the HI Act be amended to:

      • Clarify the purpose for which IHIs can be disclosed under subparagraph 24(1)(a)(ii); and
      • If necessary, introduce a specific authority to address the disclosure of IHIs by public healthcare provider organisations to government agencies and other relevant research organisations for the purposes of monitoring, evaluating and funding healthcare.

As potential uses for Healthcare Identifiers emerge it would be beneficial to develop and implement a governance process for consideration and endorsement of new uses so that this process is transparent, relevant interest groups are consulted and decisions are clearly communicated.

Top of page


20 Minter Ellison Lawyers, Healthcare Identifiers Act and Service Review: Legal Advice on Specific Questions, Section 16

21 Explanatory Memorandum, Healthcare Identifiers Bill 2010, p 19

22 Explanatory Memorandum, Healthcare Identifiers Bill 2010, p 18