Monday, October 17, 2016

Weekly Australian Health IT Links – 17th October, 2016.

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

A really quiet week with the biggest news that the Senate has agreed to Telstra Health taking up the five year contract to run the National Cancer Screening Register.
Other than this we have material on health AI and a more fall out on data leaks and Government attempts on suppression etc.
Lots to browse this week.

Cancer register bill passes Senate with privacy fixes

By Allie Coyne on Oct 13, 2016 5:29PM

Telstra-run database given official approval.

The Senate has passed a bill enabling the federal government's planned national cancer screening register after the government agreed to fix privacy holes pointed out by the Information Commissioner.
Legislation backing the the register - which will be run by Telstra under a $220 million deal - went to parliamentary committee for scrutiny after Labor and the Greens raised issues with its drafting.
The Senate standing committee on community affairs this week tabled its report on the legislation, recommending the government "closely consider" amending the bill in line with the advice of Information Commissioner Timothy Pilgrim, who raised a number of privacy concerns.
Pilgrim pointed out the draft legislation authorised the use of personal information contained in the register for research purposes, bypassing a framework within the Privacy Act set up to grant exemptions for data access in the case of health research.

Senate backs Telstra-run Cancer Register — but calls for action on data breach bill

Data breach notification scheme should be legislated by end of 2016, Senate says
Rohan Pearce (Computerworld) 13 October, 2016 21:28
The Senate has passed government legislation to create the National Cancer Screening Register, which will be established and operated by Telstra under a $220 million contract announced earlier this year.
Although establishing the register has bipartisan support, the government has come under fire for the decision to outsource it to Telstra. In particular, the decision to award the contract to the telco before parliament passed enabling legislation has been criticised.
Telstra has argued it is “well placed” to establish the register, and has said that it will deliver a platform that meets the government’s privacy and security requirements.
The ALP and the Nick Xenophon Team passed amendments to the second reading motion for the National Cancer Screening Register Bill 2016 and National Cancer Screening Register (Consequential and Transitional Provisions) Bill 2016.
12 October, 2016

Green light for cancer registry bill

Posted by julie lambert
The creation of a national cancer screening registry is a step closer after a senate committee backed key enabling legislation with a call for tighter rules on privacy and data breaches.
The timing of the new register, scheduled to begin operating in May 2017, has been uncertain amid controversy over the choice of Telstra Health to build and operate a system to take over from the existing state and territory-based registers for bowel and cervical cancer.
The Community Affairs Legislation Committee recommended parliament pass the enabling legislation while calling on the government to closely consider amending the National Cancer Screening Register Bill 2016 to strengthen privacy provisions.
It said the bill should be revised in line with advice from the Office of the Australian Information Commission (OAIC) to strike out the use of patient information for “incidental” purposes.
7:08pm October 11, 2016

Labor fights against Telstra register

Federal Labor is trying to stop Telstra running a new national cancer screening register, upset sensitive health information will be handed to the private sector.
But the party has so far failed to amend legislation to restrict the management of the register to government agencies or not-for-profit organisations.
From May 1, the two-yearly Pap test will be replaced by an improved five-yearly cervical screening test administered by one national register, along with the bowel cancer screening program.
The bill to establish the register passed the House of Representatives on Tuesday.
October 4, 2016

Do Physicians in Ambulatory Care Spend More Time with the EMR Than with Patients?

Jamaluddin Moloo, MD, MPH reviewing Sinsky C et al. Ann Intern Med 2016 Sep 6. Hingle S. Ann Intern Med 2016 Sep 6.
For every hour of direct time with patients, physicians spent nearly 2 hours interacting with the electronic medical record system.
Outpatient practices have weathered substantial changes during the past decade, and these changes have placed new demands on physicians' time. In this study, researchers directly observed 57 physicians in 16 primary care or specialty outpatient practices (family medicine, internal medicine, cardiology, and orthopedics); time spent on various activities during the clinical day was documented. In addition, 21 physicians also kept after-hours diaries. Fifteen practices mandated use of electronic medical record (EMR) systems. Trained observers recorded the time each physician spent on various activities.
Physicians spent 33% of their total time on direct clinical interactions (27% with patients and 6% with clinical staff when patients were not present). Nearly half of physicians' time (49%) was spent on EHR or desk work (38% on documentation and review activities, 6% on test results, and 2% on medication orders).

Out with fax, in with secure messaging

Antony Scholefield | 11 October, 2016 | 
It’s 2019, and in line with RACGP instructions, you’ve finally thrown your fax machine out of the window. So now what do you do? 
The college’s recent announcement that it was a “national priority” for GPs and other doctors to go paperless has thrown a spotlight on the tech alternatives, especially secure messaging. 
The college wants GPs to embrace computer programs such as Argus, Medical-Objects, HMS or ReferralNet for communicating with other healthcare professionals. 
In total, 11 such programs are approved by the Australian Digital Health Agency (ADHA), including the four big ones mentioned above, as well as more niche options, such as MMEx, designed specifically for Indigenous health services. 

Senate introduces legislation criminalising re-identification of anonymised data

The amendment makes the re-identification and disclosure of de-identified data offences punishable by up to two years' imprisonment, while also forcing entities to notify agencies as soon as practicable.
By Corinne Reichert | October 12, 2016 -- 06:12 GMT (17:12 AEDT) | Topic: Telcos
Australian Attorney-General George Brandis has introduced into the Senate the legislation criminalising the re-identification of de-identified datasets that are collected and published by the Commonwealth.
"The publication of government datasets, including de-identified data, enables the government, policymakers, researchers, and other interested persons to take full advantage of the opportunities that new technology creates to improve research and policy outcomes," the explanatory memorandum [PDF] to the Privacy Act amendment says.
"However, with advances in technology, methods that were sufficient to de-identify data in the past may become susceptible to re-identification in the future. The Bill is intended to act as a deterrent against attempts to re-identify de-identified personal information in government datasets and introduces criminal and civil penalties for the prohibited conduct."

Brandis wants two-year jail sentence for re-identifying govt data

By Allie Coyne on Oct 12, 2016 5:07PM

Researchers not automatically exempt.

Individuals and businesses who re-identify government data that has been stripped of identifying details face up to two years jail under new laws proposed today by Attorney-General George Brandis.
Under the bill, security researchers will not automatically be exempt from new laws, in spite of a pledge from Brandis last week that they would be protected.
Under the Privacy Amendment (Re-identification Offence) Bill 2016, reversing the de-identification of published government data after September 29 this year will be a criminal offence that can incur up to two years in prison and 120 penalty units ($21,600), or a civil penalty of up to 600 penalty units ($108,000).

Up to two years’ prison for re-identifying govt datasets

New re-identification bill gives government power over research
Rohan Pearce (Computerworld) 12 October, 2016 16:34
A bill that will make it a crime to re-identify ostensibly de-identified government datasets will include provisions for exceptions to be made for security research. However, it will be up to the responsible minister to set out what individual organisations or classes of organisations will be exempt, and what conditions will be imposed on them.
Attorney-General George Brandis today introduced the Privacy Amendment (Re-identification Offence) Bill 2016 in the Senate. Brandis last month announced that the government would move to make it a crime to re-identify datasets released by the government.
The government was motivated by a health department privacy bungle, which saw the department release two datasets elements of which Melbourne University researchers were able to re-identify.
  • Oct 11 2016 at 6:30 PM
  • Updated Oct 11 2016 at 6:30 PM

Balancing people and technology in the health system

by Nicole Pierre
Holding her smartphone in the air, NSW Health Minister Jillian Skinner exclaimed, "This is the most important device".
For Skinner her mobile device allows her to access many applications, including a "Trauma app", which gives the location of the nearest hospital, and how to assist the patient before paramedics arrive.
Her comments at the recent Future of Healthcare roundtable co-hosted by The Australian Financial Review and Philips came as participants mulled over the merits of connected care and whether we can be sure the rise of technology infiltrating the health sector, from remote monitoring to virtual hospitals, will still position the human-centric exchange between the doctor and patient at the forefront of medical care.
  • Updated Oct 11 2016 at 6:30 PM

Emerging technologies a key to healthcare reform

by Kevin Barrow
This content is produced by The Australian Financial Review in commercial partnership with Philips.
At the recent Future of Healthcare round table, NSW Health Minister Jillian Skinner stated "the challenges that NSW, and health systems all over the world are now facing, are not simple tasks". She shared with attendees one of the ways the NSW government is working smarter through an investment in innovation and technology and integrated care.
Meeting the challenges that the minister outlined of an ageing population, the rise of chronic disease and a finite health budget will require a new approach to healthcare; one that facilitates technology to become "connected care" to address the integration of all parts of the health system, from patients and their carers, family and friends to doctors to hospitals, insurers and the government. It is based on real-time communication, enabled through emerging technologies that include secure networks, linking software and devices monitoring key health indicators.

Private companies accessed MBS data dump 1000 times

Antony Scholefield | 13 October, 2016 | 
Around 1000 private companies could potentially identify the MBS claiming histories of individual doctors following the Department of Health's botched data dump.
The department's release of one billion lines of supposedly anonymous MBS data in August was intended for research.
But the department was forced to remove the dataset two weeks ago after learning that provider numbers could be decrypted.
Minister for Health Sussan Ley (pictured) has attempted to reassure doctors, saying no "identifiable data had been compromised".

Is the computer about to replace your GP? Smart phones are becoming ‘mobile doctors’

October 14, 20164:30pm
Sue Dunlevy News Corp Australia Network
Computers are beating doctors at diagnosing melanoma, they can categorise your personality type and even tell if you are pregnant and now they are putting a doctor in your pocket.
Your smart phone is about to become a mobile doctor providing instant personalised health advice, reminding you about health screens, storing your medical records and helping you manage your illnesses.
It will make medical appointments for you when you need a pap smear or skin check, order your prescription medication when it is due to run out, allow you to attach blood test and x-ray results, and remind you when your kid’s vaccinations need updating.

‘Dr Google’-style programs wrong two times out of three

Doctors are more than twice as accurate at identifying diseases as popular “symptom-checker” programs and apps, Harvard researchers say.
  • The Australian
  • 7:00AM October 11, 2016

John Ross

 “Dr Google”-style programs are wrong two times out of three, ­according to what is being billed as the first direct comparison of personal and computerised diagnostics.
Harvard University researchers say doctors are more than twice as accurate at identifying diseases as popular “symptom-checker” programs and apps. The findings contradict years of claims that computer diagnostics have surpassed those of doctors.
In 2010 University of Sydney researchers developed a computer program that outperformed clinicians in identifying serious bacterial infections such as pneumonia published today in the Internal Medicine journal of the American Medical Association, the study found doctors were “vastly superior” to computer programs in terms of diagnostic accuracy.
In 2013 an artificial intelligence system designed at Indiana University proved more than 40 per cent more accurate at diagnosing clinical depression and ­accompanying illnesses, and prescribing effective treatments, than human doctors. And in August, IBM’s supercomputer Watson reportedly took just 10 minutes to diagnose a rare form of leukaemia that had stumped clinicians for months.

Trial of computers vs doctors shows there's no real contest

11 October 2016
IT LOOKS like virtual doctors won’t be taking over the jobs of GPs any time soon.
Harvard Medical School has conducted what it says is the first head-to-head comparison of computer versus real-life physician diagnostic accuracy, demonstrating there’s really no contest.
Evaluating clinical vignettes, the physicians hit on the correct diagnosis 72% of the time compared with 34% of the time for computer algorithms in symptom checker websites and apps.
The study involved 234 physicians (half of whom were fellows or residents) evaluating 45 clinical scenarios of varying complexity, and listing the most likely diagnosis followed by two differentials, using the Human Dx platform.

A viewer/editor for openEHR Operational Templates

2016-10-14 12:01 | By: Filed in:
openEHR has proven to be a sound methodology for detailed clinical modelling, particularly for underpinning electronic health records, but also for sharing clinical information between systems. Some of its key characteristics are:-
  • Two level modelling, underpinned by well-designed, stable and tested Reference Model.
  • Reference model designed specifically for EHR systems.
  • Comprehensive, clinician-authored building blocks – archetypes and templates.
  • Community-governed and tool-supported modelling process.
  • Version tracking of all specification artefacts.
  • Excellent support tools – for archetype editing and template designing, although mainly confined to Microsoft Windows environments.
  • Excellent design constructs to support non-English and multiple language implementations
  • Support for granular data querying via SQL-like query language – AQL

Ballarat Health Services in national My Health Record trial

Siobhan Calafiore
5 Oct 2016, 5 p.m.
A patient from Ballarat Health Services (BHS) was in Queensland when he suffered a heart attack. Despite being in another state, the hospital was able to access important medical information from his My Health Record and ensure the best possible treatment.
The electronic record stores health information, including medical history, medication lists, allergy information, reports and results, in a location that can be easily accessed by the patient and health professionals.
BHS project manager Pauline Basilio said rather than replace the doctor to patient dialogue, it supplements and supports it.

Important initiative to support pharmacists - Don't Rush to Crush to be integrated into AusDI

Media Release
10 October 2016
Don't Rush to Crush 2nd Edition will be fully integrated into AusDI during 2016 as the result of an agreement between AusDI and the Society of Hospital Pharmacists of Australia (SHPA)
SHPA CEO, Kristin Michaels said this initiative has taken place to ensure better access to Don't Rush to Crush since it has recently been included in the Pharmacy Board of Australia's list of essential references for pharmacists.
"This significant decision validates SHPA's long-standing commitment to developing and updating this important publication and means all pharmacists can have better access to this resource," she said.
"SHPA is keen to assist pharmacists comply with the new requirement and this has been accomplished through collaboration with AusDi," she said.

Medical devices: 3D pioneer Paul D’Urso calls for level field

  • The Australian
  • 12:00AM October 15, 2016

Sarah-Jane Tasker

Melbourne neurosurgeon Paul D’Urso has warned that Australian medical device manufacturers are locked out of the local market by big US multinationals feeding off a regulatory system that boosts their offshore profits.
Mr D’Urso, one of the first in the world to develop medical 3D printing, has argued that Australia’s regulatory system for the approval and pricing of medical devices is geared to American-based mass manufacturers.
He told The Weekend Australian that multinational companies should not be telling the Australian government what to do and how much to pay. “We can make these decisions ourselves. Let’s do it and make it happen now,” he said.
He said innovating medical devices in Australia was not the problem; it was whether the regulatory system included innovative devices on the pricing list.

Digital revolution underway at Cairns Hospital with eHealth system

October 9, 2016 6:30am
WHEN Cyclone Yasi loomed off the Far Northern coastline in February 2011, patients and staff were forced out of Cairns Hospital in the largest peacetime evacuation of a hospital in Queensland history.
There were scenes of patients being rushed from the hospital with their medical records literally strapped to their chests. It was the only way to ensure their bulky paperwork did not go astray.
It is chaotic scenes like this we are likely to never see again following Cairns Hospital’s changeover to electronic medical records.
In March this year, the 138-year-old hospital became the largest regional hospital in Australia to go “paperless” through its new Digital Hospital system.

Webstercare: remunerate the pharmacist

The designer of RxMedChart calls for accurate medication profiles and appropriate remuneration for pharmacists

Webstercare’s submission to the Review of Pharmacy Remuneration and Regulation says it hopes the outcome of the review will provide “every doctor, consumer, pharmacist and healthcare professional … access to an accurate current medication profile at every point of care.”
“Solutions already exist and are within the scope of the Community Pharmacy Agreement funding model,” writes Webstercare founder and managing director Gerard Stevens along with industry advisor Christine Veal.
They point out that financial pressures pose an imminent threat to pharmacy services, which they say “are a direct consequence of price disclosure and the reduction of prescription remuneration.”

Assessments on Guild myCPD site soar

The end of September saw the end of the CPD year for pharmacists and by the end of the month the Pharmacy Guild’s myCPD had completed more than 73,000 assessments on the site.

It was an extremely busy year for the site, the Guild says.
This represented an increase of more than 10,000 more assessments over the previous year and is testament to the demand that exists for quality education to meet the needs of pharmacists.
The myCPD has more than 30 courses available on the site that provide pharmacists with more than 70 CPD credits.
And with a long list of courses in the development phase there is more to come, the Guild says.

It's (not) elementary: How Watson works

The technology underlying IBM's AI has evolved considerably over the years
Katherine Noyes (IDG News Service) 07 October, 2016 23:33
What goes into making a computer understand the world through senses, learning and experience, as IBM says Watson does? First and foremost, tons and tons of data.
To build a body of knowledge for Watson to work with on Jeopardy, researchers put together 200 million pages of content, both structured and unstructured, including dictionaries and encyclopedias.
When asked a question, Watson initially analyzes it using more than 100 algorithms, identifying any names, dates, geographic locations or other entities.
It also examines the phrase structure and the grammar of the question to better gauge what's being asked. In all, it uses millions of logic rules to determine the best answers.

Attackers exploiting CBA health fund data breach

By Allie Coyne on Oct 11, 2016 10:00AM

CBHS warns customers to delete dodgy emails.

The not-for-profit health fund that services Commonwealth Bank staff is warning customers not to click on dodgy emails after attackers stole customer data from one of its third-party partners.
CBHS was established in 1951 by the Commonwealth Bank as a health fund for the bank's staff. It later separated from CBA and opened up its services to CBA family members and former staff.
CBHS last night emailed its customers to advise them that the systems of an unnamed third-party had been "subject to a data breach", with some of the data "accessed by an unauthorised party".
The affected data is "primarily corporate marketing information", CBHS said in the email, sighted by iTnews. It includes name, email address, suburb, state, postcode and date of birth records for "some" CBHS members.

I was wrong on NBN: It’s a turkey

The NBN could become costly.
  • The Australian
  • 12:00AM October 15, 2016

Alan Kohler

Unhappily, Australia’s national broadband network is a white elephant and, to mix metaphors, an albatross around the nation’s neck.
I say this by way of mea culpa: your correspondent was an enthusiastic supporter of it in the early days. I thought the fibre-to-the-home plan was a piece of courageous and visionary policymaking all too rare in Australia, and booed what I thought was the Coalition’s penny-pinching, politically motivated decision to cut it back to fibre-to-the-node.
It’s now clear that my colleague Stephen Bartholomeusz was right all along: the thing is a dud, a donkey, a pasty pachyderm, and it would have been much worse if the original FTTH plan had gone ahead.
Bevan Slattery, a serial builder of fibre networks (PIPE Networks, which he sold to TPG Telecom, and now Superloop) threw a metaphorical glass of water in my face recently, when he said the NBN was “like watching a car crash in slow motion”.

‘Two trillion galaxies’ in the universe: astronomers

  • AFP
  • 12:00AM October 15, 2016
There are a dizzying two trillion galaxies in the universe, up to 20 times more than previously thought, astronomers ­reported yesterday.
The find, based on 3D modelling of images collected over 20 years by the Hubble Space Telescope, is published in the ­Astronomical Journal.
Scientists have puzzled over how many galaxies the cosmos harbours at least since US astronomer Edwin Hubble showed in 1924 that Andromeda, a neighbouring galaxy, was not part of our own Milky Way.


Anonymous said...

So, despite all the kerfuffle Telstra's Cancer Registry is a done deal, or is it?

Anonymous said...

The digital health market is expected to reach 233.3 billion U.S. dollars by 2020 driven particularly by the mobile health market. The market from the Asia-Pacific region is expected to be a key region in the future. Telstra needs a national system to elevate its profile, of course it will get the gig, this is about profits, patients and professions are simply the source of revenue.

Bernard Robertson-Dunn said...

233.3 billion U.S. dollars by 2020

A thought.... Will all this "mobile health" technology improve an individual's health, or will health professionals end up fixing all the problems of bad decisions?

A second thought. Who's responsible for mobile technology going wrong or being improperly used?

john scott said...

Bernard, I agree with both of your comments and these questions are actually bad news for software vendors and investors.

The core issue is TRUST. Can you trust the information to act on it?

Absent a mechanism to create the necessary assurance healthcare will find it difficult to avail itself of even potentially valuable innovations--after all it is the clinicians who have the legal duty of care.

And, of course government and tax payers will ultimately face the bill for an unproductive market.

Bernard Robertson-Dunn said...


I agree - trust is the killer issue - potentially literally.
The Medical Republic:
"People are increasingly relying on fitness devices for a window into their daily heart health, despite mounting evidence these consumer products are imprecise."

"With cardiac patients increasingly relying on monitors to stay within physician-recommended, safe heart rate thresholds during rehabilitation and exercise, accuracy was important, the authors said."

Bernard Robertson-Dunn said...

Apart from the inaccuracies of health data, there's the issue of data security of IoT devices (and yes, I do know the difference between mobile devices and the IoT):

"On average, an IoT device is infected with malware and will launch an attack within six minutes of being exposed to the internet. IoT devices are probed for vulnerabilities 800 times per hour by attackers from across the globe. Every day there is an average of over 400 login attempts per device, an average of one attempt every five minutes and 66 per cent of them on average are successful, according to Nazario."

The Register
Sweet, vulnerable IoT devices compromised 6 min after going online