Monday, January 23, 2017

Weekly Australian Health IT Links – 23rd January, 2017.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

It seems the silly season has shrunk a little – with quite a lot seemingly happening.
A new minister, Telstra Health out spruiking its wares and all sorts of steps in medication management – both public and private.
Enjoy the browse.
-----

Govt proposing automation for health dept

The Australian Government is proposing to extend the use of automation based on big data, to the health department, even though its efforts to do the same with Centrelink have not exactly been a success.
An amendment proposed to the National Health Act of 1953 would, "enable the minister, the secretary or the Chief Executive Medicare to arrange for the use of computer programs to make decisions and determinations, exercise powers or comply with obligations and do anything else related to those actions".
It would also "enable approved pharmacists whose premises have been affected by disaster or exceptional circumstances to supply pharmaceutical benefits at alternative premises in the same locality for a limited period and be paid for claims at the full rate; and ensure that entitlements for concessional beneficiaries and their dependants will apply for pharmaceutical benefits until midnight on the day of a person’s death".
-----

A quick guide to Greg Hunt, the new health minister

18 January 2017
Former lawyer and long-time Liberal politician Greg Hunt has officially been named Health Minister in the wake of Sussan Ley’s implosion amid an expenses scandal.
Here are 10 things to know about him:
·         He was born into a political family in Melbourne in 1965. His father, Alan, was a member of the Victorian parliament for more than 30 years.
·         He attended Melbourne Law School, where he captained the Australian Universities Debating Team while working casually as a steelworker, fruit picker, waiter and storeman and packer. He became an associate to the Chief Justice of the Australian Federal Court in 1992.
·         He subsequently attended Yale University as a Fulbright Scholar, obtaining a Master of Arts in International Relations.
----

Arthur Sinodinos claims innovation as Turnbull reshuffles cabinet again

Cabinet secretary Arthur Sinodinos has been announced as the country's new minister for Industry, Innovation and Science.
By Asha McLean | January 17, 2017 -- 23:51 GMT (10:51 AEDT) | Topic: Innovation
Australian Prime Minister Malcolm Turnbull has announced new changes to his ministry, following the resignation of Health Minister Sussan Ley last week, amid concerns over her travel expenses.
Former Minister for Industry, Innovation and Science Greg Hunt has now moved into the health minister role, with Arthur Sinodinos taking on the vacated innovation portfolio.
Sinodinos is currently a senator representing New South Wales, and was previously former prime minister John Howard's senior economic adviser and chief of staff. Sinodinos was acting in the health minister role immediately following Ley's resignation.
-----
18 January, 2017

My Health Record ‘threat to public trust’

Posted by Julie Lambert
The Australian government is endangering trust in the My Health Record system by failing to reveal its full list of objectives and obtaining patients’ consent.
This is the conclusion of Professor Danuta Mendelson, Deakin University’s Chair of Law (research) and law lecturer Gabrielle Wolf, writing in the Journal of Law and Medicine last month.
In their analysis, the MrHR system falls short of its statutory objectives such as overcoming the fragmentation of healthcare, but the intentions of successive governments in advancing eHealth records have gone far beyond the reasons set out in the statutes.
-----

Qld health service expects to save millions with telehealth

By Paris Cowan on Jan 17, 2017 6:31AM

Aussie-first deployment targets most frequent visitors.

For someone who suffers from a chronic disease, the local hospital can become an unwanted second home.
The burden of regular visits to doctors and specialists can easily compound an already debilitating medical condition.
For hospital operators, the cost of treating frequent visitors outstrips the price of all other patients combined.
This is why Queensland’s West Moreton Health and Hospital Service decided chronic disease sufferers should top its priority list for a personalised telehealth push, which it has dubbed MeCare.
-----
  • Updated Jan 19 2017 at 11:00 PM

Telstra aims to turn e-health into a healthy earner

Telstra is aiming to make e-health a material contributor to earnings in the long-term and is taking its health business into the next stage of development, group executive of new business Cynthia Whelan said.
After a launch nearly two years ago, there has been little noise from the division and Ms Whelan admitted there has not been a lot of clarity around Telstra Health's progress and what the plans for the division are.
"We've completed that acquisition phase of the business, now we're moving into the integration phase," Ms Whelan told The Australian Financial Review.
"We've now amassed a portfolio of foundational companies."
-----

The pitfalls of taking clinical photos on your phone

16 January 2017
Technology often evolves faster than the law — and this is as true in healthcare as it is in many other industries.
One example is the in-built camera in your smartphone. Phone cameras, with increasingly high resolution, are taking off as a clinical tool, allowing doctors to photograph symptoms without waiting for professional clinical photography units, according to a recent article in the Medical Journal of Australia.
GPs can photograph skin lesions, for example, and send the photos to a dermatologist for their opinion.
But without a clear medicolegal framework, doctors who do this could be asking for trouble, say the researchers from Australia and Qatar.
-----

National Medicines Safety Program Established

Created on Thursday, 19 January 2017
The Australian Digital Health Agency is pleased to announce the establishment of a new national Medicines Safety Program.
The Agency’s Executive General Manager Clinical and Consumer Engagement and Clinical Governance, and Chief Clinical Information Officer Dr Monica Trujillo said the program will work with consumers and healthcare providers to explore how digital health can improve the safety and quality of medicines usage in Australia.
Dr Steve Hambleton, former president of the Australian Medical Association and one of Australia’s most respected authorities in digital health has been joined by Mr Steven Renouf, former rugby league star and dedicated advocate for Aboriginal health as Program Co-Sponsors.  Mr Neville Board will represent the Australian Commission on Safety and Quality on Health Care (ACSQHC).
-----

Establishment of Medicines Safety Program January 2017

The Australian Digital Health Agency is pleased to announce the establishment of a new Medicines Safety Program.
Good medicines management can help to reduce the likelihood of medication errors and hence patient harm. The Program is designed to improve the access and quality of medicines information through the use of digital health, enabling consumers and healthcare providers to make safe, informed decisions and achieve better health outcomes.
The Program’s Executive Sponsor is Dr Monica Trujillo, the Agency’s Executive General Manager Clinical and Consumer Engagement and Clinical Governance, and Chief Clinical Information Officer.  The Agency welcomes the Programme Co-Sponsors Dr Steve Hambleton and Mr Steven Renouf who will advocate the interests of clinicians and consumers, and Mr Neville Board representing the Australian Commission on Safety and Quality in Health Care (ACSQHC).  
-----

Let’s kill the Australian identity card zombie once and for all

January 17, 2017 11.33am AEDT

Author Bruce Baer Arnold

Assistant Professor, School of Law, University of Canberra
Some policies are like zombies – toxic, frightening, defiantly unkillable. They reappear, even though they aren’t useful and aren’t pretty. Pauline Hanson’s call for a national identity card is one of those zombies.
The One Nation leader has been calling for a networked biometric card for people who interact with the national government. Put simply, that is most citizens. The card will supposedly significantly reduce fraud by non-citizens who are resident in Australia.
Statements about the card are confusing. Presumably it is meant also to reduce entitlement fraud by citizens – a focus of the current Centrelink debacle – and provide definitive proof of identity in dealing with state or local government and the private sector.
Past enthusiasts for a national identity card, claiming “if you have done nothing wrong you have nothing to fear”, have suggested a “must carry” regime. People would be expected to take the card with them when they use public transport, walk the dog, visit granny, go shopping or otherwise step outside. The card would be the default proof of identity in private sector transactions, stronger than the easily forged driver licence photo cards that are the standard ID for most adults.
-----

Landmark Australian ruling on what counts as 'personal information'

By Paris Cowan on Jan 19, 2017 12:06PM

Privacy Commissioner knocked back in metadata case.

A full bench of the Federal Court has today handed down a hotly awaited judgment on its interpretation of Australian privacy law, and what qualifies as personal information.
It has served a rebuff to Australian Privacy Commissioner Timothy Pilgrim, who has been fighting to secure a broad definition of personal information in the courts, to ensure that everything that could reasonably be used to identify an individual will fall under the protection of the Privacy Act.
But federal court judges today dismissed the commissioner's appeal, siding with Telstra and the Administrative Appeals Tribunal over whether the telco needs to hand a full suite of telecommunications metadata over to Telstra customer and former Fairfax journalist Ben Grubb, under the personal information access provisions of the Act.
-----

Pharmacy must be integral in Health Care Homes

Pharmacy needs to be a key part of Health Care Homes if the initiative is to succeed

The Pharmacy Guild said today that it strongly supports the Federal Government’s Health Care Homes primary care reforms, but pharmacists must play a strong role.
Guild National President George Tambassis says the HCHs provide the opportunity to move towards a more integrated and coordinated approach to meeting the primary care needs of patients with complex, chronic health conditions.
But “in order for the HCHs to succeed in delivering better, more cost-effective health outcomes for patients with complex needs, it is imperative that their community pharmacy is an integral part of the primary care team,” Mr Tambassis said.
“More than any other healthcare professional, the community pharmacist is responsible for ensuring that patients are adherent with their medicines and that their medication-related needs are being met. 
-----

Successful openEHR EHR implementation featured in WHO eHealth report

January 07, 2017  |  from: Heather Leslie
In Australia, the Northern Territory's My eHealth Record service has been featured as the only example of a successful electronic health record (EHR) implementation in a newly published WHO report on eHealth - a great win for the openEHR community as the EHR is underpinned by an openEHR platform.
The whole of  the report, 'Global diffusion of eHealth: making universal health coverage achievable - Report of the third global survey on eHealth' makes interesting reading, but focus on page 106 for the openEHR-related case study.
This  follows a very positive evaluation report, commissioned by NEHTA (now the Australian Digital Health Agency' and completed in August 2015, about the same My eHealth Record service. Importantly, the report stated:
"For the first time in Australia, we have strong evidence of the benefits of eHealth records in bridging the gaps in information that occur as patients move between different healthcare providers in the public and private sectors."
-----

Case Studies

OceanEHR platform - NT Health, Australia

Published: 16 August 2016

Demonstrates: a secure way of sharing an individual’s healthcare information between care providers

Project:
My eHealth Record - a territory-wide shared electronic health record
Background:
The Northern Territory Department of Health provides health care to all territorians across the vast, remote geographical area of the northern Australia, including servicing the health needs of the indigenous community.
Goals:
  1. To store structured atomic clinical data in a shared Electronic Health Record;
  2. To enable decision support;
  3. To enable advanced care planning;
  4. To consolidate health information using a common data structure; and
  5. To address identified inadequacies in security, access control and privacy management.
-----

AMA defends its pharmacy trial

13 January, 2017 
AMA Victoria has defended its role in a controversial trial allowing pharmacists to change medication doses, issue repeat scripts and perform point-of-care tests.
The Victorian Government has opened applications for an 18-month pilot where pharmacists will monitor and refine the medication regimen of patients with asthma, hypertension and hypercholesterolaemia, as well as those on anticoagulation medications.
Before the trial begins, the government will train the pharmacists involved to perform blood pressure, spirometry, INR and lipid panel tests.
It is being stressed that the pharmacists will work according to a shared care plan drawn up by the patient’s GP who will also take an active role in the pilot.
-----

Meet Qld Health's five new technology execs

By Allie Coyne on Jan 18, 2017 10:38AM

Still no fill for long-vacant CIO role.

Queensland's Health department has recruited five new executives into its eHealth Queensland technology arm to turn around the agency's IT fortunes and drive "digital transformation" into healthcare in the state.
The department has welcomed a new chief technology officer, chief digital strategy officer, chief customer experience officer, chief solution delivery officer, and executive director of corporate services.
All report into interim eHealth Queensland CEO and departmental CIO Mal Thatcher. The agency has been searching to recruit permanently into the position since July last year, following the departure of Colin McCririck to IBM in the US. It today was unable to give an indication of when that role will be filled.
-----

Reducing medication errors in hospital discharge summaries: a randomised controlled trial

Erica Y Tong, Cristina P Roman, Biswadev Mitra, Gary S Yip, Harry Gibbs, Harvey H Newnham, De Villiers Smit, Kirsten Galbraith and Michael J Dooley
Med J Aust 2017; 206 (1): 36-39.
doi: 10.5694/mja16.00628
Abstract
Objectives: To evaluate whether pharmacists completing the medication management plan in the medical discharge summary reduced the rate of medication errors in these summaries.
Design: Unblinded, cluster randomised, controlled investigation of medication management plans for patients discharged after an inpatient stay in a general medical unit.
Setting: The Alfred Hospital, an adult major referral hospital in metropolitan Melbourne, with an annual emergency department attendance of about 60000 patients.
Participants: The evaluation included patients’ discharge summaries for the period 16 March 2015 – 27 July 2015.
-----

‘Precision medicine’ promises new hope for cancer sufferers

  • The Australian
  • 3:00AM January 17, 2017

John Ross

A shift from mass to personalised medicine promises new hope for cancer sufferers and health authorities, improving patients’ quality of life and saving health budgets billions of dollars by averting perilous and ultimately pointless operations.
A proof of concept study has given the tick of approval to “precision medicine”, which harnesses genomic “knowledge banks” to tailor individualised treatments based on the experiences of thousands of earlier patients.
Scientists reanalysed genetic data from more than 1500 leukaemia sufferers confronted with a harrowing choice: reduce the risk of relapse with a dangerous stem cell transplant or stick to safer but less effective chemotherapy.
It found a precision medicine approach would have changed treatment of about one-third of the patients, slightly boosting survival rates and cutting the number of transplants, while leaving survivors with fewer side-effects.
-----

Christian Porter, Chris Bowen, Cory Bernardi are among victims of internet security breach

January 17, 201712:26pm
Staff writers News Corp Australia Network
PRIME Minister Malcolm Turnbull has ordered a report from his top cyber security adviser on a Yahoo data breach amid claims more than 3000 Australian government officials — including a federal minister — had private data stolen.
The Prime Minister confirmed he had not been a victim of the massive 2013 Yahoo data breach that has reportedly involved Australian diplomats, Defence officials and high-profile politicians.
Mr Turnbull said, based on what he had seen in news reports, it was unlikely there would be security issues with the politicians whose emails had been hacked.
Social Services Minister Christian Porter, Shadow Treasurer Chris Bowen, Victorian Premier Daniel Andrews, Liberal MP Andrew Hastie, Shadow Health Minister Catherine King and Liberal senator Cory Bernardi were among the victims of the hacking, ABC reports.
-----

Malcolm Turnbull orders inquiry into theft of ministers’ data

  • The Australian
  • 12:00AM January 18, 2017

Kylar Loussikian

Malcolm Turnbull has ordered a review into data stolen from senior MPs and thousands of public servants as part of a wider leak ­revealed last month by Yahoo.
But the Prime Minister said the hacked accounts related to a time before the Coalition was elected and it was “very unlikely” there would be security issues.
“It begs the question as to ... what was in those accounts and clearly in terms of classified ­government information can only be transmitted or used on approved government communication ­systems,” Mr Turnbull said. “We don’t take any of this stuff lightly or complacently and I’ll be getting a report on this from my cyber adviser, Alastair MacGibbon.”
-----

2017 should be the year of privacy – healthy paranoia obligatory

If one issue dominated the headlines last year it was Internet privacy – specifically the lack thereof. It was not just the tech giants collecting masses of information via telemetry, search, email, calendars, and document snooping but the massive data breaches of Yahoo! and others that shook our faith in using the Internet, trusting email, and trusting household technology names.
I don’t intend to go into the details – there are 851 million search articles that cover that all too well but I would like to help iTWire readers “walk softly and leave a smaller digital footprint".
The first thing to remember is that there is no inherent, inalienable concept of online privacy – the ability to separate and control sensitive information about yourself (privately identifiable information or PII). There are certain protections about what you do in the privacy of your home, but almost all countries have laws that limit online privacy. It seems that the overlap between privacy and secrecy (concealing information that others might use to their advantage) has led to a one-size-fits-all approach. So it's all up to you!
-----
ASX ANNOUNCEMENT
16 January 2017

Medadvisor - Quarterly Activities Report and Appendix 4C        

Highlights
-       Record operating cash receipts for the quarter, totalling $1.32 million, an increase of 77% on the September quarter ($0.75 million)
-       Strong operational performance across all key metrics
o   Over 600,000 users on the MedAdvisor platform as at 31 December 2016, an increase of over 160% since September 2016
o   Over 45% of Australian pharmacies connected to the platform (30% in September quarter 2016)
o   Patient Engagement Programs (PEPs) experienced rapid traction, closing the quarter with 18 medications using the platform across 9 of Australia’s largest pharmaceutical companies including Pfizer, GSK, AstraZeneca, Novartis & Bristol-Myers Squibb
o   Increased the number of General Practitioners (GPs) benefiting from the platform to nearly 4,000 GPs
o   Tap-to-Refill script ordering function processing an average of $2.5 million in script refill value per week
-       Completion of $8 million oversubscribed capital raising receiving strong  participation from leading Australian financial institutions and pharmacy groups
-       Completion of Healthnotes acquisition, significantly enhancing the MedAdvisor offering and expanding market share
-       Key partnership agreements with Asthma Australia and Osteoporosis Australia, plus extended existing relationship with Bupa into certain Healthscope Hospitals
------

Pensioners and disabled next in line in Centrelink robo-debt campaign

Noel Towell
Published: January 17, 2017 - 10:10AM
The Coalition government is going to target more than 3 million of elderly and disabled Australians with its controversial Centrelink "robo-debt" campaign, Parliamentary documents show.
The mid-year economic forecast tables published last week shows the government has booked savings of $1.1 billion from data-matching the aged pension and another $400 million from the disability support pension.
The move will bring more than 3 million more Australians into the sights of the data-matching program, which uses an automated system to match information held by Centrelink and the Australian Taxation Office and calculate overpayments.
-----
Enjoy!
David.

Sunday, January 22, 2017

Draft Strategy Submission for Comment - 22 January, 2017

National Digital Health Strategy - Submission - DG More - January 2017

Introduction

The following submission has been prepared to offer some commentary and input to the Strategy process, now underway, and to assist in the ongoing development of the National Digital Health Strategy.
With experience of over a decade of preparing such submissions I have to say the submission is provided in hope rather than based on past experience of making any difference!

Author Of Document

This document is authored by Dr David G More MBBS BSc(Med) PhD FANZCA FCICM FACHI.
I have had over 20 years involvement, in one form or another, in the area of Health Information Technology (e-Health) and been a contributor to many projects in the area including a role in the development of the 2008 National E-Health Strategy and discussions on the 2014 Update.
I am reasonably well known in Health IT circles as the author of a blog on Health IT (www.aushealthit.blogspot.com) which has now been in operation continuously since 2006 and I have been widely quoted in the professional clinical press, the national press and in reports published by the Parliamentary Library.
I have no direct financial interests in any entities involved in Australian Health IT and receive no payments from the work I undertake with respect to the blog.
Over the last 4-5 years I have made submissions in the Health IT domain when requests for such submissions have been made by Government and these are available on the DoH website (www.health.gov.au).

Purpose Of This Document

I wish to provide comments on three aspects of the current consultation.
First I wish to point out that the process is deeply flawed for a number of reasons. Among these are:
1. There has not been an appropriate detailed knowledge base provided to those being consulted to permit informed decision making. At the very least those consulted should have been provided with:
a. A comprehensive review of what is happening in the Digital Health Domain overseas with a review of what has been shown to make a positive difference in terms of either cost, quality, safety or patient satisfaction.
b. A comprehensive review of the current status of the Digital Health Domain in Australia and what has been shown to work (or not) in Australia.
c. A review of the current Digital Health Capabilities and Workforce with deficiencies clearly identified.
d. An economic review of expenditure at a State and Federal level on Digital Health over the last decade and the benefits received for that expenditure.
2. An implicit assumption that seems to be built into virtually all documentation that Digital Health is ‘good’ and we just need to improve to make all right. I conducted a poll on this assumption a little while ago and the outcome was interesting.
AusHealthIT Poll Number 352  – Results – 16th January, 2017.
Here are the results of the poll.

Is The ADHA Correct In Assuming That 'National Digital Health' Is A 'Good Thing' And All We Need To Do Is Work Out How To Do It Correctly And Get On With It?

Yes 21% (22)
No 58% (62)
ADHA Does Not Assume Digital Health Is A Good Thing 0% (0)
I Have No Idea 21% (22)
Total votes: 106
 3. Despite the enormous cost and almost non-existent clinical utilisation of the myHR, there appears to be an implicit assumption that this program is vital and central the Health Care Service Delivery (which it is clearly not).
In summary, the consultation is being conducted based on a combination of relative ignorance, feel good assertions and an absence of evidence of real impact or utility.
Second I believe there is no credible plan being put forward by ADHA and the bureaucracy as to just what needs to be done to move from the present myHR dominated environment to a future state that addresses the real needs of patients and clinicians as a priority, rather than serving the bureaucratic needs to gather detailed personal health information in a centralised database for purposes that are barely disclosed.
As I commented very recently on the call for input:
-----
In that vein it the second paragraph that stands out.
“ (Quoting ADHA) There’s nothing more important than our health and the health of those we care about. Putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them can help Australians live healthier, happier and more productive lives.”
I am sure all who read here will be well aware of the risk of making ‘sweeping generalisations’, and that somehow glossing over detail a false impression can be created. When this impression leads to government expenditure on a grand scale then we all have a problem.
So stepping back, obviously, appropriately used data and information is crucial for the proper operation of the health system in most aspects from research to patient care etc. Think everything from research management systems to patient management and scheduling systems. Trying to do without these systems would clearly be a waste of time and money – if not impossible – think the management of major clinical trials to the optimisation of patient flow in a major hospital – all basic stuff that, if it did not work, no one would pay for and use it!
Equally there are a zillion technologies that are vital from MRI Scanners and drug discovery to the various monitoring systems that track our patient’s progress. The evidence that these technologies do / have make a positive difference is well documented.
But the ADHA is not interested, as far as I know, with all this. Their interest is in patient specific information and how it is shared and communicated by digital systems and this is where we hit a problem with evidence as well as all the other issues of safety, privacy and so on.
There is no doubt that a well-designed GP System can improve the quality and safety of what the GP does with and individual patient and make it easier to follow a patient’s clinical journey and treatment. There is good evidence to this as well as much evidence that current systems are by no means perfect and still need more work.
-----
Equally there is decent evidence supporting the deployment of clinical systems in Hospitals and specialist and allied health practices and well as linking them with information providing systems (pathology, radiology etc.).
Where evidence is lacking and history is littered with failures are large national, all things to all men (and women) health system initiatives that centralise information at national scale.
Third, and rather bringing the above two threads together there was a valuable contribution from ACHI to the earlier call for input – in April 2016. I quote a recent blog:
-----
In response to a draft National Digital Health Strategy made available in April, 2016 ACHI produced some excellent suggestion that are well worth discussion.
This was in the form of some specific and actionable recommendations to Government. These were:
“Recommendation 1: That the strategy reference and benchmark Australian activity with international comparisons.
Recommendation 2: That the strategy properly outline existing activity and lessons learned from outputs from the 2008 strategy and other initiatives.
Recommendation 3: That the strategy outline clearly and unambiguously the problems that it is trying to solve, with specific objectives and indicators for success.
Recommendation 4: That the strategy be properly supported by an evidenced business case for its recommendations.
Recommendation 5: That the strategy outline an informative and comprehensive approach to clinical governance, data and information governance, quality and safety.
Recommendation 6: That the strategy define an approach to development of a strong and highly competent informatics workforce.”
Just wandering around asking people what they want and what their aspirations are is really not the way. What is needed is a defined process of research, information gathering from the front line and a hard-nosed look at what works, what is safe, what is reasonable and what has measurable benefits.
The issue is to then define an idea ‘future state’ and work out how to get there from here!
-----

Recommendation.

Overall I believe the consultation process to date has been the ‘soft / easy’ part! What is needed now is the ‘hard’ rigour of an evidence based planning process, conducted by real experts, that wins broad patient and clinician acceptance. My take is that ADHA is not even 1/3 of the way there so far and needs to seriously expand the scope, range and depth of what they are doing, if anything useful is going to be delivered. Overall much more detailed evidence-based work and consultation is needed if the whole effort is not to be both flawed and wasted.
Note: I believe this view is confirmed by the recent summary of the findings to date in the Strategy Process which was  published last week:
A Final Crucial Point.
A last and crucial comment is to point out that the Australian Health System is, at an extreme simplification, a public hospital system run by the States and a private clinical delivery system which operates to a large extent separately from Government – except to charge what it chooses – for the services provided. Clinical services are actually delivered – outside Public Hospitals – by a large number of private (usually) small businesses.
A core issue for the Strategy development process is therefore to work out just where a Commonwealth National Digital Health Entity actually fits and just what it should be doing – and more importantly what it should NOT be doing. Sorting this out will be fundamental to the success of any proposed Strategy. At present the raison d'ĂȘtre of the ADHA is not at all clear.
In summary, we need to know just where ADHA fits and just what it should be doing with the enormous resources it seems to have available to actually deliver health improvement for the Australian population, at a level beyond the feel-good motherhood statements so typically trotted out.
22/01/2017

AusHealthIT Poll Number 354 – Results – 22th January, 2017.


Here are the results of the poll.

How Confident Are You Greg Hunt Will Make A Good Health Minister - Especially Regarding The myHR?

Very Confident 2% (1)

Confident 4% (2)

Neutral 51% (23)

Not Really Confident 27% (12)

He Is A Bad Choice 13% (6)

I Have No Idea 2% (1)

Total votes: 45

It seems readers are taking a ‘wait and see’ approach to the new Federal Health Minister.

A good turnout of votes for just a few days.

Again, many, many thanks to all those that voted!

David.

Saturday, January 21, 2017

Weekly Overseas Health IT Links – 21st January, 2017.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
-----

NIST updates outline first-ever cybersecurity measurements

Jan 13, 2017 11:10am
NIST's updated cybersecurity framework includes new metrics to quantify the impact of cybersecurity efforts.
For the first time, organizations seeking an objective way to quantify cybersecurity performance can use updated federal guidelines aimed at measuring the impact of cybersecurity interventions and business objectives.
The updated draft guidelines (PDF) released this week by the National Institute for Standards and Technology (NIST) include specific updates regarding cybersecurity metrics, considerations supply chain risk management and common terminology used to communicate with outside partners and vendors.
-----

EarlySense, ResMed share promising data on digital health sleep monitoring

January 12, 2017
Two digital health companies focused on sleep published data this week that highlighted the efficacy of their respective platforms, bringing continued attention to the space after a CES week where sleep was a major focus. A whitepaper by Pricewaterhouse Cooper showed that ResMed’s myAir improved CPAP adherence while a paper in the Journal of Clinical Sleep Medicine found that EarlySense’s new consumer system EarlySense Live performed comparably to polysomnography.
ResMed’s myAir is an app that launched last year allowing CPAP users to track their treatment via an app and giving them access to their daily sleep patterns and coaching tips. The new whitepaper looked at data from over 23,000 patients in Germany and the United Kingdom, 1,800 of whom used myAir. 
-----

ONC Announces Phase 2 Winners of Consumer, Provider App Challenges

January 12, 2017
by Rajiv Leventhal
The Office of the National Coordinator for Health Information Technology (ONC) today announced the Phase 2 winners for the Consumer Health Data Aggregator Challenge and the Provider User Experience Challenge. 
ONC designed these challenges last year to "spur the development of market-ready applications that would enable consumers and providers to aggregate health data from different sources into one secure, user-friendly product."
Challenge submissions were required to use Fast Healthcare Interoperability Resources (FHIR) and open application programming interfaces (APIs), which are both strongly supported by ONC. Phase 1 winners of the challenges were announced last summer; applicants were required to submit a series of plans for their proposed apps, including designs or screenshots, technical specifications, business/sustainability plans, and proposed provider and/or electronic health record (EHR) vendor partners to test their work. Both challenges then moved Phase 2, where the apps themselves were evaluated.
-----

The policy implications of using big data in healthcare

01/12/2017 05:52 pm ET
Adi Gaskell A London-based innovation scout
The growing importance of big data in healthcare is something I’ve touched on a lot in the last few months. It should perhaps come as no surprise therefore, that the European Commission have recently released a paper that examines the issue in depth, including the key areas it is being used, and some of the policy implications involved.
The paper looked at a number of solutions in key policy areas, including:
  • supporting the sustainability of health systems
  • improving the quality and effectiveness of treatment
  • combating chronic disease
  • supporting healthy lifestyles.
One of the more well known examples analyzed by the researchers was the E-Estonia national identity scheme, which includes within its remit a digital patient record.
-----

Health information exchange: E pluribus unum?

Can one model for health data exchange emerge from the diverse HIE ecosystem that exists?
January 11, 2017 03:17 PM 
The state of health information exchange (noun and verb) is complex, to say the least. The past decade-plus has given rise to a patchwork of approaches: public and private exchanges; statewide, regional and local networks; national vendor-based interoperability groups such as CommonWell and Carequality. And more.
If it's a bit of hodgepodge – and far from the seamlessly interconnected "learning health system" aspired for in ONC's Shared Nationwide Interoperability Roadmap – this cobbled-together system is a whole lot better than the shelves of dusty manila folders that represented the health data ecosystem in the not-too-distant past.
But there's always room for improvement. John Kansky, president and CEO of the Indiana Health Information Exchange, said there's a better way forward from the existing conflicting and confusing state of HIE in the U.S. 
-----

Digital Health at CES 2017, Las Vegas

Digital Health News' US correspondent Lindsey Birnsteel, provides a hands on report on the very latest digital health trends from the Consumer Electronics Show, 2017, Las Vegas.
Lindsey Birnsteel
9 January 2017
If you are into the very latest consumer technology and gadgets, then CES is the big one. The 2017 show boasted more than 177,000 attendees and nearly 4,000 exhibitors.  And once again technologies, apps and sensors to support health and fitness were a key trend.
Digital health technologies have grown dramatically at CES as wearables and smart health technologies have taken centre stage in the consumer market. Digital Health News combed through the crowds to find what’s trending in digital health and which companies are leading in their field.
From a quick glance digital health companies from the US, France and not surprisingly Asia (Korea, Singapore and China) dominate the floor.
-----

May announces £67.7 million for digital mental health

Laura Stevens and Ben Heather
9 January 2017
Prime minister Theresa May has announced £67.7 million of funding for digital mental health services.
May made the announcement in a speech at the annual Charity Commission lecture in London on Monday, which outlined a broader package of funding and policy aimed at improving support for people suffering from mental health problems.
This would include new mental health support within secondary schools, in the community and within the workplace.
-----

mHealth roundup: Health apps to cut costs, improve care

by Judy Mottl 
Jan 12, 2017 9:05am
Mobile apps are ubiquitous in wellness and healthcare, driven by consumers eager for healthcare information at their fingertips. Hospitals, health systems and health insurance companies have embraced them as a way to provide better, faster and more cost-effective care and treatment.
A top focal point for app makers has been management of chronic illness, such as diabetes, as the population of patients diagnosed with Type 2 diabetes swells. Health and fitness are also a prime focus for payers and providers and are popular with consumers.
But app makers are working to expand beyond those entry-level functions to tackle everything from patient care and management to back-end operations and streamlined business processes.
-----

Why healthcare organizations and vendors need to embrace APIs

Published January 12 2017, 2:51pm EST
Application programming interfaces give access to data created by others, enabling a computer programmer or someone working on a computer to call up another program and get it to do a particular task, explains Brian Murphy, an industry analyst at Chilmark Research.
It is a technology the healthcare industry desperately needs and is slowly moving toward, he contends.
APIs are not new, having been invented in the 1950s. But Google, Facebook and other social media put them on the map in recent years. Most notably, APIs power all the apps on your smartphone.
-----

What providers can learn from 2016’s security incidents

Published January 12 2017, 3:03pm EST
Cue the year-end articles saying that this was the worst year to date for data breaches. Follow that with more dire predictions for 2017. Layer in one-size-fits-all recommendations to mitigate these risks. And finish with technology solutions that you must have.
If you read all of this you might come away thinking that if your company is not using AI and machine learning, buying threat intelligence, building a threat-hunting team, installing a next-generation antivirus solution, deploying an endpoint product and reducing your attack surface, all of those bears people talk about outrunning may already be in your network.
-----

Use of mobile EHR apps can boost productivity

January 12, 2017
Many primary care physicians mainly rely on desktop computers, taking time during or between patients to sit at their desks to enter data, according to healthcare IT consultant Rick Shepardson.
Mobile, however, could help physicians boost their productivity, he and other experts said.
“It can help make better use of a physician’s time,” said Amelia Coleman, M.Ed., director of the practice management consulting group at MBA HealthGroup, who added a growing number of physicians are interested in using mobile devices at their practices.
-----

Proof-of-concept for VA’s Digital Health Platform leverages analytics

Published January 10 2017, 6:52am EST
Healthcare analytics vendor Apervita is participating in a proof-of-concept to demonstrate the viability of a Department of Veterans Affairs Digital Health Platform (DHP), designed to integrate veteran data from VA, military and commercial electronic health records—as well as apps, devices, and wearables— so that the information is available to providers in real time.
Managed by Georgia Tech, the VA proof-of-concept seeks to demonstrate the power of real-time analytics to deliver higher quality, more efficient and flexible care as part of the envisioned DHP architecture. The cloud-based platform is meant to create a new paradigm for the delivery of healthcare services with a modern, integrated system that incorporates best-in-class technologies and standards.
-----

HHS Sec. Burwell's advice to Dr. Tom Price: Prioritize cybersecurity

Written by Tamara Rosin (Twitter | Google+)  | January 10, 2017 | Print | Email
In her farewell remarks at the National Press Club Monday, HHS Secretary Sylvia Mathews Burwell warned Republican lawmakers that repealing the ACA could be "a step backwards" for the U.S. healthcare system. She had more pointed advice for nominated HHS Secretary Rep. Tom Price, MD, R-Ga., regarding the issue of cybersecurity.
"This is very important and I would tell my successor it has to be prioritized," she said in response to a question on how to address cyberattacks in the healthcare industry. "People don't want to spend money on it. They don't want to spend time on it. It is extremely important that you put in place the protections as much as you can."
-----

IBM Watson, FDA to explore blockchain for secure patient data exchange

The initial focus for blockchain will be oncology-related data exchange

Senior Writer, Computerworld | Jan 11, 2017 5:01 AM PT
IBM's Watson Health artificial intelligence unit has signed a two-year joint-development agreement with the U.S. Food and Drug Administration (FDA) to explore using blockchain technology to securely share patient data for medical research and other purposes.
IBM Watson Health and the FDA will explore the exchange of patient-level data from several sources, including electronic medical records (EMRs), clinical trials, genomic data, and health data from mobile devices, wearables and the "Internet of Things." The initial focus will be on oncology-related information.
"The healthcare industry is undergoing significant changes due to the vast amounts of disparate data being generated. Blockchain technology provides a highly secure,
-----

Patient advocate: caregiver's viewpoint as critical as the doctor's

Kristina Sheridan is among the growing legion of caregivers who have come to believe that involving input from patients and their families can be a game-changer when it comes to diagnosis and treatment. 
January 10, 2017 07:02 AM
When it comes to managing chronic conditions, healthcare providers are often missing incisive input from two very important sources — the patient and caregiver.
“It’s interesting what perspective we’ve gained — it is realizing that patients and caregivers are the true experts in managing chronic conditions,” said Kristina Sheridan, who left her engineering job in the aeronautics industry to become a healthcare advisor and today is a department head for McLean, Va.-based MITRE Corp. “My 12-year-old daughter Kate (now 21) was the only one who could explain what she was going through.”
When Kate was 12, in fact, the situation became complicated such that even repeated visits to doctors did not get them any closer to finding the root cause of what was bothering her. 
-----

Hospital Impact: Trump policies could escalate EHR privacy fears, threaten quality and patient safety

Jan 11, 2017 11:41am
When patients are afraid to share information, it creates inaccurate and incomplete data, affecting care quality or even causing harm.
One of the biggest EHR-related issues of 2016 has been cybersecurity. The industry has been plagued with ransomware attacks, hacked EHR systems, threats to networked medical devices and sloppy internet use that leaves patient records vulnerable and exposed to the public. 
All of which has made patients leery of the ability of EHR-using providers to keep their records confidential, and understandably so. While even the most careful of entities can be hit with a security breach, all too many of them have been careless, not taking even some of the most basic safeguards. 
-----

Detailed EHRs offer opportunity for personalized care

Jan 11, 2017 10:50am
Kaiser Permanente and Geisinger Health System are in the early stages of incorporating and utilizing detailed patient information that can inform future treatments.
Health systems around the country are incorporating new patient information into electronic health records in an effort to provide more customized patient care as the healthcare industry attempts to keep pace with a constant stream of potentially useful health data.  
Kaiser Permanente and Geisinger Health System are in the early stages of incorporating and utilizing detailed patient information that can inform future treatments, according to NPR. Kaiser is working toward a system in which physicians can pull up information about a disease based on specific factors such as age. Although currently operating as a prototype, the system is looking to incorporate patient reported information that can offer a more complete perspective of different treatment options.
-----

Secondary commercial market for patient data rife with privacy concerns

Jan 11, 2017 11:02am
Data “re-identification” is a growing threat as cybersecurity concerns continue to plague the healthcare industry.
By signing a privacy form at their doctor’s office, patients often assume their medical data is protected. In fact, it’s often redirected into a commercial market where data miners resell that information for marketing purposes.
The influx of computerized patient data has fueled this “health data bazaar” over the last decade, allowing wholesalers to buy and sell information collected from various medical sources, according to a report released by The Century Foundation. The practice is legal because patient data is stripped of any identifying information, which meets the privacy requirements outlined under the Health Insurance Portability and Accountability Act (HIPAA).
-----

Privacy, security issues cause consumers to distrust HIT

Published January 09 2017, 7:25am EST
A new survey of more than 12,000 Americans has found that 57 percent of consumers are skeptical of the overall benefits of health IT such as electronic health records, mobile apps and patient portals, in light of recent high-profile data breaches and a perceived lack of privacy protections by providers.
The national survey, conducted from September to December by market research firm Black Book, also revealed that 70 percent of Americans distrust health technology. That’s significantly lower than a 2014 survey by the Office of the National Coordinator for Health Information Technology, in which only 10 percent by respondents said they distrusted HIT.
“We saw that distrust number in particular with consumers and mental health records and pharmacies,” says Doug Brown, managing partner at Black Book. “They feel that there’s some kind of leakage of information, even if it’s not cybersecurity-related.”
------

C-suiters: Keep an eye on these technologies in 2017

Jan 10, 2017 1:44pm
From Pepper, the emotional interactive robot, to the new da Vinci Xi Integrated Table Motion to pipeline vaccines, ECRI Institute highlights 10 healthcare technologies C-suiters should keep an eye on in 2017.
The organization's annual watch list outlines technologies that hospital leaders should bring into their hospitals—and which ones to keep out. But separating the facts from the hype isn't easy, they note.
Pepper, for example, might be a pass thanks to its hefty price tag. But other emerging technologies, such as vaccines for chronic conditions such as diabetes, hold promise.  
-----

DirectTrust outlines health IT uncertainties in 2017

Jan 10, 2017 7:01am
Uncertainty is the only given that 2017 will bring for health information technology, according to a new report from DirectTrust.
The organization, an alliance of participants in the Direct Exchange network for health information exchange, pointed to five health IT trends to watch in 2017, with a focus on the possible repeal of the Affordable Care Act.
Republican promises to repeal ACA will fuel that uncertainty, especially if months of debate and controversy ensue without a replacement plan, writes president and CEO David C. Kibbe, MD.
-----
Mon Jan 9, 2017 | 6:35pm EST

St. Jude releases cyber updates for heart devices after U.S. probe

Abbott Laboratories (ABT.N) moved to protect patients with its St. Jude heart implants against possible cyber attacks, releasing a software patch on Monday that the firm said will reduce the "extremely low" chance of them being hacked.
The company disclosed the moves some five months after the U.S. government launched a probe into claims the devices were vulnerable to potentially life-threatening hacks that could cause implanted devices to pace at potentially dangerous rates or cause them to fail by draining their batteries..
The Food and Drug Administration and the Department of Homeland Security said that St. Jude's software update addresses some, but not all, known cyber security problems in its heart devices.
-----

How best to include patients in clinical communications

Published January 10 2017, 4:04pm EST
Maintaining effective communication across the spectrum of care is crucial to the quality and efficiency of care delivery, yet communication disconnects plague the healthcare industry.
Poor clinical communication has been a prime cause of medical errors as detailed in successive Institute of Medicine reports. The problem may be far worse—a report by Johns Hopkins School of Medicine lists medical errors as the third leading cause of death in the U.S.
Medical communications are a generation behind any other mature industry. It is a crippling industry-wide flaw that has consequences for workflow, duplication and waste. It is a leading contributor to medical errors, care mis-coordination, and provider and patient frustration. It consumes scarce capital. And it is preventable.
-----

How to mitigate middleware security vulnerabilities

Published January 06 2017, 3:40pm EST
Middleware has great potential for mitigating healthcare IT interoperability issues. However, because it mediates network services to applications, middleware can also create major security issues—possibly enough to offset any benefits.
A need for healthcare providers to have easy access to patient data fueled the push for the widespread adoption of electronic health records (EHR) systems. In the days of paper records, patients would often show up at doctors’ offices or, worse yet, hospital emergency rooms with no paper trail; if they had never been to that facility before, their medical records were not available, leaving their new providers scrambling to treat them with an incomplete or non-existent medical history.
The goals of EHR systems were to increase the quality of patient care and reduce medical errors and costs by making patient medical data accessible to all healthcare providers they saw, regardless of where they were located or whether the patient had seen them before.
-----

IBM names 5 game-changing innovations

Big Blue casts the annual crop of 5 in 5 promising tech’s as breakthroughs expected to change the world as we know it.
January 05, 2017 02:13 PM
IBM revealed its roster of emerging technologies poised to have considerable impact on the world within five years. And three of them are healthcare-related.
The tech stalwart said it bases the 5 in 5 market and societal trends as well as technologies from IBM’s Research labs around the world that can make these transformations possible.
1. With AI, our words will be a window into our mental health. In five years, what we say and write will be used as indicators of our mental health and physical wellbeing. Patterns in our speech and writing analyzed by new cognitive systems will provide tell-tale signs of early-stage developmental disorders, mental illness and degenerative neurological diseases that can help doctors and patients better predict, monitor and track these conditions.
-----

HL7 CTO: How to set healthcare on FHIR

Wayne Kubick addresses the need for healthcare industry leaders to think differently and create a defense mentality to support FHIR’s power. And the biopharma industry just might be the best place to start.
January 06, 2017 07:25 AM 
HL7’s CTO Wayne Kubick said that the challenges FHIR faces are more cultural than technological. 
The current state of healthcare and the way clinical studies are conducted exists in separate systems and paper-based processes. And the datasets compiled from older systems are difficult to read or gather any tangible information.
FHIR can eliminate many of these issues, but the industry is reluctant to embrace change, according to HL7’s Chief Technology Officer Wayne Kubick.
“The FHIR platform is robust and I don’t think we’ve seen limitations to what FHIR can do," Kubick said. "The real challenge is to identify what it can do and what will give the industry the greatest benefits."
-----

Obama disappointed in medical data-sharing progress

Jan 9, 2017 10:37am
In a video interview, President Barack Obama says sharing data from electronic medical records is an area that hasn’t improved as much as he would have liked.
President Barack Obama says interoperability and data-sharing efforts haven’t gone as well as he had hoped they would under his signature healthcare reform law.
In a video interview with Vox, Obama said efforts to cut healthcare costs by reducing readmissions have been a success, fueled by financial incentives, common-sense, low-tech interventions such as follow-up phone calls and bipartisan support for value-based care efforts.
We’ve started to see “some real movement” when we pay for outcomes, he said. 
-----

What an interoperability leader predicts for 2017

Published January 09 2017, 3:15pm EST
David Kibbe, MD, CEO at DirectTrust, which offers the Direct Project secure messaging software, believes five overarching trends will influence the health information technology industry during 2017. His opinions are personal and do not reflect those of member organizations within DirectTrust.
Policymaking: Efforts to repeal the Affordable Care Act and move Medicare toward fixed contributions could lead to months of inaction, during which investments in health IT and new innovations may lag.
IT momentum remains: While uncertainty discourages change, Kibbe doesn’t see major shocks to the health IT economy. “The themes of using health IT to improve care coordination, to manage patient populations through better collection and data use, and the value of advances in telemedicine will continue to be heard and supported by both the private sector and the federal government in a bipartisan fashion,” he says. Further, the newly enacted 21st Century Act will increase the transparency of health IT vendors and their products, while also discouraging the blocking of health information.
-----

How to make sure a telehealth program pays off

Published January 09 2017, 3:27pm EST
As the cost of healthcare increases and access decreases, hospitals and healthcare providers are searching for alternative methods of care delivery to supplement the existing care pathways. Over the last decade, telehealth technologies have emerged as a means to solve many of the concerns around access and cost.
Despite various barriers to growth – from reimbursement and regulatory barriers, to concerns around adoption, or lack of evidence to support the effectiveness of telehealth programs—data indicates that telehealth adoption is on the rise and shows no signs of slowing down.
As investors continue to fund the development of telehealth technologies, the number of hospitals using telemedicine is also increasing. According to the 2016 HIMSS Analytics Telemedicine study, about 45 percent of existing hospitals use some form of telehealth, which is expected to increase to about 53 percent by 2020. Still, many healthcare providers across the country are struggling to demonstrate both the financial and clinical value these programs bring to their hospitals and patients.
-----

EHR usage still too slow

Long-term care providers are feeling pressure to implement an EHR, despite facing hurdles like costs and resources. Many complain about a lack of options allowing interoperability with hospitals and o
Nursing homes and their counterparts in assisted living and other senior living settings may be sluggishly dipping their toes into the waters of electronic health records. 
But that hasn't stopped a highly motivated and, arguably, savant-level vendor community from building what many see as a linchpin of the new caregiving world.
Despite the bells, whistles and some amazing new features and efficiencies, however, adoption is not going fast enough for many.
-----

US IoT Working Group: IoT personalizes care, reduces cost in healthcare

Written by Jessica Kim Cohen | January 06, 2017 | Print | Email
The Internet of Things Working Group, co-chaired by U.S. Representative Bob Latta (R-Ohio) and U.S. Representative Peter Welch (D-Vt.), has released its year-end report.
The working group was established to identify benefits and challenges facing IoT consumers and stakeholders, issues affecting deployment of IoT technologies and the potential role of the federal government in advancing IoT technology. In off-the-record roundtables, the working group determined IoT can personalize patient care, increase healthcare access and reduce overall costs.
-----

Physicians, patients at odds over value of health data

Jan 6, 2017 9:51am
Physicians and patients are at odds over the value of personal health data.
It’s a big disconnect: The vast majority of physicians say healthcare data is overwhelming, redundant and doesn’t make a difference in care quality. But most patients say their primary care physician's office should store any personal health data they ask them to.  
That’s according to a new Black Book research survey in which 94% of physicians said they’re deluged with what they think is useless data, while 91% of their tech-savvy patients want them to have more of it.
The survey also found that patients don't completely trust the privacy and security of health information technology such as electronic health records and patient portals.
-----

2017 emerges as pivotal year for FHIR interoperability standard

Published January 05 2017, 7:09am EST
Health Level Seven International’s Fast Healthcare Interoperability Resources (FHIR) application programming interface is moving closer to becoming a mature standard, with the “normative” version slated for release sometime in 2017.
Standards are widely perceived as providing the greatest potential for achieving national health IT interoperability in the near future. In particular, FHIR is seen by industry stakeholders as a promising solution to the complex interoperability challenges that are confronting healthcare organizations.
Standard for Trial Use (STU) 3 is the next release of the FHIR specification before it reaches a normative level, which is defined by HL7 as content that has been subject to review/production implementation in a wide variety of environments, has been “frozen” and is considered to be stable.
-----

Patients don't trust health information technology

Jan 5, 2017 11:03am
A whopping 96% of consumers worry about the security of their financial information as data passes from providers to payers.
More than 50% of consumers are skeptical about the benefits of healthcare information technologies, including patient portals, mobile apps and electronic health records. And fully 70% of Americans distrust health technology, up sharply from just 10% in 2014.
High-profile cybersecurity incidents were part of the reason patient respondents don’t think providers are keeping their information private and secure, the Black Book research survey of more than 12,000 adults found.
----

Global telemedicine market to hit $113B+ by 2025: 4 trends to note

Written by Anuja Vaidya (Twitter | Google+)  | January 03, 2017 | Print | Email
The global telemedicine market is anticipated to grow rapidly through 2025, according to a Grand View Research report.
Here are four market trends to note:
1. The global telemedicine market is expected to reach $113.1 billion by 2025.
2. Increasing incidences of chronic conditions and the rising demand for self-care are boosting market growth.
-----

The global state of eHealth: emerging trends and regulatory developments

What developments are shaping the interactions between technology and health? A look at how the rapidly growing E-Health space is advancing human welfare

Health and medicine specifically, have always been a domain at the forefront of human technological advancement, as motivated by the need to survive and adapt to infirmity.
The field is then understandably flourishing more than ever upon exposure to the new levels of innovation that the digital age brings, as evidenced by the rapid emergence of eHealth as a definitive startup category in its own right with an industry valuation of just over $85 billion in 2014.
-----

Enjoy!
David.