The government may seek savings in the cost of operating My Health Record by shifting to cloud infrastructure.
Paul Madden, special adviser, Strategic Health Systems and Information Management, at the Department of Health, said that the cost forecasts for operating the system in 2019-20 and 2020-21 are still being finalised.
"We have some variables in the cost of the system, which we will work through in the next 12 to 18 months," he told a Senate Estimates hearing earlier this week after being asked by Senator Lisa Singh why the federal budget showed no funding past June 2019 for My Health Record.
"Our commitment is to come back to the budget in 2019 to paint out those costs for the four years," Madden said.
Variables include "the re-platforming of the system to an open source environment, using cloud technology" which Madden said "is expected to net some significant dividends" in terms of operating the system.
The federal budget set aside $374.2 million over two years for the expansion of the e-health record system as it moves to an opt-out participation model.
At the hearing the department also revealed that if a My Health Record is created for an individual, it will not be deleted on request - instead it will be made "unavailable" in the system. An individual can opt out of the system before a record is created, but once it is created it will not be deleted.
"On the basis that it existed for you, it will continue to exist as a record for while you were in the system, but it will not be available to any healthcare providers," Madden said.
"What that allows you to do is, at some time in the future you, if you say, 'I didn't want it then, but I think I want now,' you can have it reinstated."
"You do not actually have a record until we get past a period where you have had an option to opt out," Madden said. "If you flag that you wish to opt out, we just will not create one for you."
A national opt-out approach to the system will be implemented before the end of 2018.
A department-commissioned evaluation of opt-out trials staged in Queensland and New South Wales concluded that an "opt-out approach to increase both individual and healthcare provider participation and use is the preferred option," with opt-in approaches "unsustainable".
A 2013 government-commissioned review of the My Health Record system - then named the Personally Controlled Electronic Health Record (PCEHR) - recommended the system shift to an opt-out approach.
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