The HI Act flags that providers can adopt IHIs as the primary identifiers used in their health service. This would have advantages in reducing the maintenance effort associated with multiple identifiers and reducing issues with matching/searching for IHIs, which would support the broader e-Health objectives. However, it is the view of most health services that it is unlikely the IHI will ever become the only identifiers in local systems, because the Act states that a person can be given treatment without an IHI. Therefore if the IHI is not mandatory, health services must have the capacity to allocate local identifiers. Adoption as a primary identifier will also be impacted by issues relating to provisional and unverified IHIs if the processes relating to these do not support clinical practice.
A number of clinical stakeholders questioned the role of multiple provider identifiers. The use of HPI-Is, provider numbers, prescriber numbers and the maintenance of these for different purposes is introducing increasing complexity for providers. There were strong benefits to providers perceived if numbers allocated to providers could be rationalised and simplified, with potentially the HPI-I becoming the only identifiers for providers.
Legal advice was sought on the potential implications if the HPI-I was to be adopted as a sole provider number. Neither the Health Insurance Act nor the National Health Act expressly requires a healthcare provider to have a 'prescriber number'. However, as an operational matter the Chief Executive Medicare assigns a number to all persons who participate in the Pharmaceutical Benefits Scheme (PBS) and requires that number to be identified in connection with a PBS prescription. Other identifiers are used in the health sector, for example, chiropractors, osteopaths, physiotherapists and podiatrists can be assigned a 'requester number' under the Health Insurance Regulations 1975.
The following advice was provided in relation to this issue.23 While an HPI-I is treated as a Commonwealth identifier for the purposes of the Privacy Act, the prohibition against adopting government identifiers under NPP 7 arises in connection with organisations only and would not apply to the Chief Executive Medicare.
The legal obstacles to adopting the HPI-I as the sole identifier for providers will be different if the use of HPI-Is by Medicare in connection with the Medicare Benefit Scheme (MBS) and PBS business is consented to by healthcare providers under section 24A of the HI Act. This assumes that the use of an HPI-I for MBS and PBS purposes is "a purpose relating to the provision of healthcare".24
Where consent is provided by a healthcare provider, there would appear no legal prohibition under the HI Act against the HPI-I being adopted as a 'provider number' or 'prescriber number', nor published by the provider or used by Medicare.25 Neither the Health Insurance Act nor the National Health Act include provisions which would make the HPI-I unsuitable to be the number assigned by Chief Executive Medicare for the purpose of those Acts.
However, in the absence of consent being provided by a healthcare provider, the HI Act would need to be amended to give the Service Operator express authority to disclose the HPI-I to the Medicare service for the purpose of Chief Executive Medicare adopting the HPI-I as a 'provider number' or a 'prescriber number'.
It was also recommended that the HI Act be amended to specifically authorise the Chief Executive Medicare to adopt the HPI-I as an identifier for the purposes of transacting MBS and/or PBS business.
Other issues that would need to be addressed if the HPI-I were to be adopted as a sole provider number include:
- HPI-Is could not be adopted for the purposes of MBS and PBS unless the healthcare provider had first been assigned an HPI-I by the Service Operator, which will not necessarily be universal.
- The Chief Executive Medicare would always need to be in a position to assign a non-HPI-I identifiers for MBS and PBS purposes if a provider does not have an HPI-I.
- The HI Service and DHS would need to enhance their systems to enable a single number to be used while ensuring that the number was associated with different information in each business context.
Recommendation 13 – Consolidation of provider numbers
It is recommended that a feasibility assessment and Privacy Impact Assessment be conducted to evaluate the costs, benefits and risks that would be incurred if the HPI-I was adopted as the sole identifier for healthcare providers, replacing existing provider and prescriber numbers.
23 Minter Ellison Lawyers, Healthcare Identifiers Act and Service Review: Legal Advice on Specific Questions, Section 11
24 Section 24A of the HI Act
25 Section 24A of the HI Act provides the HI Service Operator with broad authority to disclose a healthcare provider's HPI-I if consent has been provided