Saturday, April 21, 2018

Weekly Overseas Health IT Links – 21st April, 2018

Here are a few I came across last week.
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.
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ECRI Institute launches tool to help EHR vendors track patient safety

The new Insight Culture of Safety Assessment for Health IT Companies was built to help vendors adhere to principles of safe design, development and use when creating products.
April 12, 2018 12:02 PM

ECRI Institute, through the multi-stakeholder Partnership for Health IT Patient Safety it convened in 2014, has announced a new tool to help electronic health record and other IT vendors assess how well they're keeping safety in mind when designing their products.
The new Insight Culture of Safety Assessment for Health IT Companies is built around a three-part safety vision, officials say: safe design and development, safe use, and safe implementation of IT for safer care.
"Ensuring a strong culture of safety can help avoid costly disruption of business and unwanted legal and regulatory actions," said Lorraine Possanza, program director for the partnership for Health IT Patient Safety, in a statement.
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HIT Think How to turn a doomed data project into a digital delight

Published April 13 2018, 6:12pm EDT
Savvy entrepreneurs know that a successful business starts with identifying a real problem in the market. Only then do you build a team, develop a prototype and create a company, moving gradually against clear objectives to minimize risk.
We should think about data initiatives in the same way. If you embark on a “data project” at your organization, you’re setting yourself up to fail. That’s because “data projects” almost by definition are ill-defined and unfocused. In fact, Gartner has estimated that 60 percent of big data projects are abandoned before they get past the pilot stage, citing a lack of clear objectives, over-investment in complex tools, and a failure to get buy-in from stakeholders.
I’d argue the real reason, however, is that we’ve come to believe data has inherent value. Ever since The Economist declared that data is “the world’s most valuable resource,” businesses have been scouring their organizations for every scrap of information that might be useful and throwing it in a massive data lake without thinking through how that data will actually drive the business forward.
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10 leading causes of death in the U.S.

Published April 13 2018, 5:33pm EDT
The 10 leading causes of death, according to the most recent figures from the Centers for Disease Control and Prevention, included cancer, respiratory disease and stroke. However, new health data initiatives promise to provide early interventions and better care, which could significantly reduce the impact of these killers. What follows is a list of the top 10 causes of death in America, according to the most recent annual CDC numbers, and a look at some of the technologies being deployed to help save Americans’ lives.
1. Condition: Heart disease
Deaths: 633,842 Americans
Health data initiative: A new technique developed at Cedars-Sinai Medical Center for conducting cardiac magnetic resonance imaging tests is offering a potential solution for solving a major problem associated with using conventional methods to perform MRI scans—how to get a still image when a beating heart and blood flow can blur the picture.
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Healthcare's $3 trillion question: Should the likes of Google and Facebook control this data?

How is data managed? Do users get to have consent over how their data is used? And do they get a cut out of the value generated by using that data? Let's take a walk on the wild side.
By for Big on Data |
April 7 is World Health Day, and the occasion warrants a closer look at the way healthcare-related data is managed. The challenges are laid out in the World Health Organization's bulletin on policy implications of big data in the health sector:
In the field of health-related big data, the public needs to be reassured that security measures are mandated and enforced. As new analytical models, data sources and stakeholders increasingly build into dynamic relationships, it may be helpful to think of health-related big data as an evolving ecosystem.
There are several challenges to the future development of this data ecosystem. Even basic health data can be misused and lead to discrimination, especially of vulnerable populations. The fair distribution of any new benefits that may arise from the collection and analysis of big data may also pose hard challenges.
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12 top HIT trends

Published April 12 2018, 11:59am EDT
Editors from Health Data Management spent several days at HIMSS18 in Las Vegas last month. After attending many educational sessions, meetings with vendors and other professional groups, and discussions with dozens of attendees, the following major trends emerged from the industry’s largest show, suggesting that they will impact the use of IT in healthcare. These common themes emerged as important trends at the conference.
1. AI/machine learning
Artificial intelligence and machine learning were the buzz again, with some providers beginning to demonstrate practical applications for specific uses of technology, particularly in radiology where AI is being in specific use cases, such as identifying cancer in breast tissue. However, most results are early, and the next phase appears to be the ability to deploy solutions so that they’re available at the point of care without creating additional workflow burden on clinicians.
2. APIs
There was more talk about using application programming interfaces to facilitate data exchange. For example, APIs will play a role as the federal government seeks to expand options for data sharing. The Centers for Medicare and Medicaid Services announced a next-generation version of the Blue Button program that enables Medicare beneficiaries to get and share claims data with family and friends and other entities. CMS is working with Human API, a vendor that markets a FHIR-based application that supports secure data sharing.
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Hackers claim they can breach a hospital in less than 5 hours: 10 report insights

Written by Julie Spitzer | April 11, 2018 | Print  |
Most hackers claim they are able to break into their victims' computer systems, determine their most valuable data and extract it within 15 hours, according to recent survey exploring the minds of hackers.
In its 2018 Black Report, cybersecurity, risk and compliance software company Nuix sought to explore the disconnect between organizations' presumed cyber defenses and real-world threats by talking to  hackers. 
Here are 10 things to know about hackers.
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U.S. FDA approves AI device to detect diabetic eye disease

 (Reuters) - U.S. health regulators said on Wednesday it will allow sale of the first medical device that uses artificial intelligence (AI) software to detect greater than a mild level of the most common cause of vision loss among more than 30 million Americans living with diabetes.
The device, called IDx-DR and produced by Iowa-based IDx LLC, is the first to receive Food and Drug Administration authorization that provides a screening decision without need for a clinician to also interpret the image or results. That makes it usable by health care providers not normally involved in eye care, such as primary care physicians who interact far more frequently with patients with diabetes.
It was reviewed under new FDA regulations designed to speed to market some devices seen as low- to moderate-risk and for which there is no prior legally marketed device, part of Commissioner Scott Gottlieb’s efforts to streamline approvals on a variety of fronts, including generic drugs and cheaper versions of costly biotech medicines.
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CVS pharmacists will have new tools to help patients save money on drugs

April 11
CVS Health is rolling out a tool to alert its 30,000 pharmacists to cheaper drug options when they fill patients' prescriptions.
For years, pharmacists have substituted generic drugs for identical brand-name versions. But CVS Pharmacy's Rx Savings Finder program will enable pharmacists and consumers to question doctors' prescription choices to save patients money.
If the software flags a less expensive therapeutic equivalent, the pharmacist will tell the patient and seek permission to ask their doctor to make the switch. It is also being made available directly to CVS Caremark consumers through an app.
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Survey: 50 percent of EHR-using docs unsatisfied with patient data access

April 11, 2018
A recent survey of 300 primary care physicians who use EHRs found that half of the respondents wanted better access to patient data.
The survey, which was commissioned by electronic prescribing and health information company SureScripts and administered online by ORC International during October of last year, also investigated physicians’ opinions on the availability of medication adherence and drug pricing information.
“Addressing physicians’ information needs and challenges is critical in an increasingly value-driven industry,” Dana Benini, vice president of Healthcare Practice at ORC International, said in a statement. “The Surescripts survey is an important inside look at physicians’ real-world information access and interoperability challenges and the opportunities to solve them.”
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HIT Think How technology can assist discharge planning and aid efficiency

Published April 12 2018, 5:32pm EDT
In today’s value-based environment, hospitals are under financial pressure to discharge patients sooner while ensuring patient safety and quality of care. This challenge comes with the clear risk that releasing patients too quickly can result in costly readmissions.
Discharge planning that requires care coordination is a complex process. Managing the transition from the hospital to a post-acute setting can be time consuming for discharge planners and care management staff. If prior arrangements with a particular facility are pending or have not been initiated, patient placement requires extensive communication and coordination among multiple care team members.
Considering the volume of patients released daily from a hospital, case managers often devote half their time to discharge planning. Statistics posted by the American Hospital Directory (AHD) show 31,787,121 annual discharges in the U.S. for 2017, an average of 87,088 discharges each day from U.S. hospitals. It’s no wonder the best efforts of case managers may not ensure the best post-acute option. Even with expanding EHR integration, many hospitals still rely on manual processes to manage patient care transitions.
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The emergence of personalised e-health care

CEO of Liva Healthcare, Kristoffer From explains the emergence of personalised e-health care and asks if e-health can close the gap between doctors and diabetic patients

Type 2 diabetes is a vast and growing, health problem for the UK. 3.7 million people in the UK are currently living with diabetes, 90% of which have Type 21. If the current trend persists, over five million people will have diabetes by 20251. The health consequences of Type 2 diabetes cannot be ignored. The condition is a major contributor to vision loss, kidney failure, heart attack, stroke and lower limb amputation.

Managing Type 2 diabetes

Traditional interventions for diabetes prevention have focused on counselling and medicine. However, these solutions alone are no longer enough to tackle the long-term health crisis the UK is facing. To reduce the number of people being diagnosed with Type 2 diabetes – we need to address the common root cause – unhealthy lifestyles.
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Patient Safety – Advisory Series, March 2018

By Claire Read – Digital Health
Many believe that technology has a crucial role to play in reducing avoidable harm and bolstering safety in the NHS. And while digital solutions are being designed to improve care, they will be properly effective only if they are efficient and reliably implemented. Claire Read reports.
About 15 years back, Suzette Woodward and her colleagues sat down to confront quite the complex challenge: how could the NHS build a system through which avoidable patient harm could be reported, analysed and, crucially, learnt from?
Woodward was patient safety director at the National Patient Safety Agency – the body then responsible for reducing avoidable harm across the NHS – and developing that system was one of its primary goals. And so, in 2003, the National Reporting and Learning System (NRLS) was born.
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AMA partners with Google on interoperability challenge

Apr 10, 2018 10:15am
The American Medical Association (AMA) has partnered with Google to launch a contest that challenges the startup community to come up with a solution that allows patients and clinicians to share patient-generated data.
The “Health Care Interoperability and Innovation Challenge,” sponsored by Google, calls on participants to transfer data captured by wearables or mobile apps “into one or more phases of clinical care” that can be “transformed into accessible and actionable information for the patient and physician to improve health outcomes,” according to an announcement.
Specifically, the AMA wants to see solutions that can help assess current conditions, develop treatment plans, record outcomes or prompt clinicians to intervene when necessary. Entrants are also asked to transfer data from the clinical care environment back to a mobile device or application.
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HHS issues new guidance on SamSam ransomware

Written by Jessica Kim Cohen | April 10, 2018 | Print  | Email
HHS' Healthcare Cybersecurity and Communications Integration Center released a report March 30 on SamSam, an ongoing ransomware campaign that has targeted the healthcare and government sectors since 2016.
There have already been at least eight SamSam attacks on healthcare and government organizations since the beginning of 2018, including attacks on two Indiana-based hospitals and EHR provider Allscripts, which faces a class-action lawsuit as a result of the attack, according to the report obtained by the American Hospital Association.
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Suggestions Offered to Reduce Physician Frustration With EHRs

Eight suggestions include providing individualized optimization training to personalize EHR settings
TUESDAY, April 10, 2018 (HealthDay News) -- Changes can be implemented to help reduce physician frustration with electronic health records (EHRs), according to an article published in Medical Economics.
In order to help physicians become more efficient and reduce their frustration with the EHR system, Martin Pricco, M.D., M.B.A., from the Gould Medical Group in Modesto, Calif., offers eight suggestions for changes that can be implemented.
The suggestions include improving the password process so that physicians do not need to spend time typing passwords into workstations. Practices should provide or allow physicians to attend individualized optimization training in order to personalize EHR settings; physicians need a minimum of six hours of training, some spent in the classroom and some spent with a trainer. EHR users should ascertain where time is being wasted; most systems can show where physician time is being spent in the software.
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Insider threats, human error, ransomware are healthcare's biggest risks, Verizon report says

Healthcare is the only industry where inside threats outnumber outside threat actors, according to Verizon’s most recent breach report.
April 10, 2018 04:48 PM
Ransomware is the most prevalent malicious software in all sectors, found in 39 percent of all malware-related breaches or twice as much as 2017, according to the latest Verizon Data Breach Investigations Report.
It moves from fourth place last year and up from 22nd place in 2014. Hackers are now leveraging the virus to disrupt critical systems instead of a single device to make more in ransoms.
But while ransomware is still a prevalent threat to the industry, healthcare has the most dubious title: The only industry where inside threats outnumber outside threat actors.
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HIT Think Why Facebook privacy concerns should impact HIT’s future

Published April 11 2018, 6:00pm EDT
The recent exposure of Cambridge Analytica’s deceptive and invasive use of Americans’ Facebook information during the 2016 election is causing widespread outrage, and more concern is emerging as the company’s top executive has testified before Congress the past two days.
However, government regulations for healthcare information also could be called into question, and many wonder if a similar incident could happen with data from Americans’ medical records. The Facebook situation provides important lessons around needed safeguards in healthcare IT regulation.
One lesson is that individuals’ consent is not always granted forever; they may someday regret allowing data access down the line, as was the case with Facebook. Current government regulations would still require patients to grant access to their health information, but the Facebook controvery shows the inadequacy of that protection alone.
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Coast Guard to implement same Cerner EHR as DoD

Published April 10 2018, 7:15am EDT
The U.S. Coast Guard will implement the same Cerner electronic health record system that the Department of Defense has so far installed at four military sites in the Pacific Northwest. The two agencies made the joint announcement on Monday.
A branch of the U.S. armed forces, the Coast Guard had been considering both government and commercial-off-the-shelf EHRs as possible solutions to replace its current paper-based records. But in the end, the agency decided to opt for DoD’s system—called MHS GENESIS—that leverages the Cerner Millennium platform.
“The Coast Guard plans to adopt the MHS GENESIS system to all its clinics and sick bays,” said Rear Admiral Michael Johnston, the Coast Guard’s director of acquisition programs and program executive officer. “Approximately 6,000 active duty Coast Guard members receive their medical care and dental care at DoD hospitals and facilities.”
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Specialty EHR Products Tied to Highest Physician Satisfaction

Integration, revenue cycle management, and other specialty EHR service providers continue to rank highest in physician satisfaction.

April 09, 2018 - Specialty EHR product categories were given the highest physician practice satisfaction scores, according to a recent Black Book survey.
Researchers interviewed 18,950 physician practices in client experience and satisfaction and gathered customer evaluations on 340 EHR products.
AdvancedMD, drchrono, Epic Systems, NextGen, NetSmart, Modernizing Medicine, and SIS Amkai received top ratings from Q3 2017 to Q1 2018, in areas such as addiction medicine, cardiology, endocrinology, and nephrology.
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25% of Patients Did Not Access Data Over Patient Privacy Concerns

A recent ONC study found that 25 percent of individuals offered access to their online medical records did not access that information because of patient privacy and security concerns.

April 09, 2018 - The HIPAA Privacy Rule guarantees patient data access as well as patient privacy.  
While both guarantees are important, they can sometimes be at odds. The goal of HHS under the HIPAA Privacy Rule is to ensure patient privacy is protected, while facilitating the flow of healthcare information to legitimate sources. 
That tension is reflected in a recent study by the Office of the National Coordinator for Health Information Technology (ONC) about individual use of online medical records and technology.
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HIT Think Why providers need a cost-conscious approach in buying IT

Published April 10 2018, 5:13pm EDT
Provider organizations have key needs for healthcare IT systems—they should be easy for clinicians to use, improve patient health and should not bankrupt their budgets.
And how is healthcare doing thus far?
The EHRs available today are developing rapidly. Vendors are making frequent and impactful improvements to improve system usability. Clinicians are getting better at maximizing the contribution healthcare IT makes to patient health and safety. It’s not hard to see how healthcare IT can meet the first two requirements and broadly contribute to improved healthcare.
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Health Information Exchange Connects Docs With EHRs During Disaster

Alexandra Wilson Pecci, April 10, 2018
HIE connectivity enabled care for evacuated patients when Hurricane Irma hit.
Hurricane Irma cut a devastating path through the Caribbean and the southeastern United States, leaving 144 people dead and nearly $65 billion in damage in its wake in September 2017.
The terror of such a storm is most certainly magnified for hospitals and health systems, which must continue to care for—and often evacuate—vulnerable patients.   
"During a disaster, chaos is the norm," Phillip L. Coule, MD, MBA, interim vice president and chief medical officer at Augusta University Health System and interim associate dean for clinical affairs at the Medical College of Georgia and Augusta University, told HealthLeaders Media via email.
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NIH completes Pan-Cancer Atlas based on massive genomic analysis

Published April 09 2018, 7:14am EDT
National Institutes of Health-funded researchers have developed an atlas that provides the scientific community with a comprehensive, in-depth and interconnected understanding of how, where and why tumors arise in humans.
The Pan-Cancer Atlas is based on a detailed genomic analysis of molecular and clinical data from more than 11,000 tumors, representing 33 different cancer types. NIH officials contend that the database will serve as an essential resource for precision medicine, enabling physicians to select treatments that are most likely to help patients based on a genetic understanding of their disease.
 “This project is the culmination of more than a decade of groundbreaking work,” said Francis Collins, MD, director of NIH. “This analysis provides cancer researchers with unprecedented understanding of how, where and why tumors arise in humans, enabling better informed clinical trials and future treatments.”
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Testing algorithms key to applying AI and machine learning in healthcare

A physician expert from Partners Connected Health and Harvard Medical School offers tips for healthcare organizations working with advanced technologies.
April 09, 2018 09:44 AM
Artificial intelligence and machine learning systems are gaining a lot of ground in healthcare, with everyone from tech giants like Google and Amazon to startup companies building systems for healthcare provider organizations.
Claims about algorithms beating physicians at their job are made every month. But are all algorithms made equal? Will invest in machine learning result in meaningful gains for an organization?
The Algorithm Science team at Partners Connected Health invests a great deal of time thinking about the right questions, working out potential pitfalls and developing best practices in evaluating machine learning based solutions. Sujay Kakarmath, MD, post-doctoral research fellow at Partners Connected Health/Harvard Medical School, offers advice to healthcare organization CIOs and other IT staff on working with algorithms.
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Millennials demand telehealth in a move away from traditional primary care model

April 04, 2018
It is no secret that millennials are a driving force in society today, and a new survey shows that their demands and behaviors differ from baby boomer and Gen Xers, and could reshape the healthcare industry especially when it comes to primary care and telehealth.
The 2017 Employee Benefit Research Institute/Greenwald & Associates Consumer Engagement in Health Care Survey was conducted online Aug. 10 to Sept. 1, 2017, with participation from roughly 3,560 adults ages 21 tp 64 who had health insurance provided through an employer, purchased directly from a carrier, or through a government exchange. Eighty-two percent of respondents receive coverage through an employer. The sample was weighted to reflect the actual proportions in the population ages 21 to 64 with private, health insurance coverage. 
Generational divides surface between millennials, Generation Xers and baby boomers in how they engage with healthcare providers. The survey results showed baby boomers are more likely than Gen Xers and millennials to have a primary care provider, with 85 percent of baby boomers saying they have a PCP, compared to 78 percent of Gen Xers and 67 percent of millennials.
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EHR-Integrated Tools Help Improve Chronic Kidney Disease Care

Treatment involving EHR-integrated tools and patient engagement strategies are effective in improving areas of chronic kidney disease care.

April 05, 2018 - A quality improvement program combining EHR-integrated tools and patient engagement strategies can significantly improve quality of care for patients with chronic kidney disease, according to new research published in the American Journal of Managed Care (AJMC).
Over a one-year period, Sequist et al. observed 153 primary care physicians treating 3,947 high-risk patients and 3,744 low-risk patients with stage III chronic kidney disease across 13 ambulatory health centers at Harvard Vanguard Medical Associates in Massachusetts. 
As part of the study, participating physicians received a set of EHR-integrated alerts through the practice’s Epic EHR system during office visits. These EHR alerts provided physicians with recommendations for risk-appropriate chronic kidney disease care.
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The cost of a data breach in healthcare averages $717k: 5 report findings

Written by Julie Spitzer | April 06, 2018 | Print  | Email
Healthcare cyber insurance claims comprised 18 percent of all cyber claims submitted in 2017, but they represented 28 percent of total breach costs, according to the annual NetDiligence Cyber Claims Study.
For the report, NetDiligence reviewed cyber liability insurance claims reported across multiple industries and from several insurers to help risk management professionals understand the importance of data security.
Here are five report findings.
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HIT Think Why cloud and connectivity apps are key for improving care

Published April 09 2018, 5:40pm EDT
In his HIMSS keynote address last month, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn't just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable ‘killer apps’ for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
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Enjoy!
David.

Looks Like The ADHA Board Needs A Bit Of A Push Along Again!

Dateline 21-April-2018.

Here is what we see....

Australian Digital Health Agency Board

Either they have nodded off or they have decided not to provide the usual pathetic level of transparency in a halfway timely fashion. Wonder which it is? Over 4.5 months since the last set of papers.

Wonder why? Surely they have done more than a few press releases and the usual swanning around in almost 5 months?

David.

Friday, April 20, 2018

This Is Really Worth A Close Read! I Hope The ADHA Takes Note As Their System Has Many Of The Same Issues!

This appeared a week or so ago.

Will the tech giants ever succeed at e-Health?

Posted on by wolandscat
Amazon, Apple, and Google are all having another go at e-Health. But we have been here before: remember Microsoft HealthVault? It’s still around, and still hasn’t taken off. Google Health went live in 2008, but was retired at end of 2011, due to ‘lack of adoption’.
Fast forward to 2018, and we see Apple, Amazon, Google and Uber making new e-Health plays. Initially each corporation will probably work from its strengths – retail delivery for Amazon, booking for Uber, data for Google, and devices for Apple. In the US at least, some of them will build their own healthcare providers for the workforce, and use the environment as a place to work on next-generation health IT solutions. Some challenges, particularly in the devices area, will undoubtedly see progress – there is no doubt that the tech giants do some things really well.
But I remain sceptical about overall success.
The reason is that big tech doesn’t understand the e-Health problem space. They appear to think it is a computing problem, like managing bank accounts or friend networks or SEO, and a question of just applying better technology. Things they don’t understand include:
  • privacy: the interests of consumers with respect to data in the healthcare space are complicated by the tension of needing open access to health data among current carers and data partners (e.g. pathology labs testing your blood), but strong privacy outside the care loop, including potentially from family, employers, and commercial data users. Not to mention national legislation generally banning the siting of patient data outside the country of residence. The big tech companies don’t have a terribly strong grip on this kind of privacy. Certainly Google would have its work cut out for it to convince healthcare professionals, and Alexa and Siri are enough to make many dubious of claims to data protection by Amazon and Apple.
  • patient records cross enterprise boundaries: the tech giants will no doubt realise that patient data crosses health provider enterprise boundaries, but in their efforts to each be the e-Health solution of the future, they will lock patient data into their own walled gardens, creating a new version of the same problem.
  • ethical data use: as the saying goes in tech, if you’re getting it free, then you are the product. Google is the best known for secondary use of data, although not many people really know exactly what they do with our data – but mining our every purchase, movement, and what we type in browsers is how they earn their vast wealth. Would we trust them to treat our health data differently?
  • semantics: all the tech companies think they can solve everything with corpus mining, machine learning, trained AI algorithms and other brute-force methods of extracting intelligence from noise. Because they are so addicted to brute force computing methods, they don’t think they need to understand the semantics of the any domain. Yet anyone who has used Google translate for 5 minutes will know how far these methods are from anything resembling intelligence or fidelity. Consequently, they don’t even employ the right kind of people to help them understand and construct the kinds of solutions that might help. I therefore doubt they’ll ever learn what an EHR really is, or even get to grips with the sheer scale of content semantics, terminologies or ontologies in the health domain.
  • clinical community: solving the semantics problem, and numerous other challenges in the e-Health space absolutely requires a close relationship with clinical professionals. It’s the only way to find out about clinical processes, information governance, and how exceptional situations are managed. Big tech is starting at ground zero here.
The problem in e-Health is that you have to create coherent, long-term, patient-centric information based on 10’s or 100’s of thousands of domain information elements, underpinned by terminologies and ontologies, and make the resulting records outlast all applications, OSs, DBs and other technology. This is hard to do, because the information is created during complex processes full of exceptions to rules, and routinely crossing enterprise boundaries.
Solving it requires design, and part of that design is to provide a way to formalise the semantics of the domain into artefacts that can be used at runtime in the workplace. But these artefacts can only be built by domain professionals who understand their information and workflow. And that requires advanced tools and model-based engineering.
Read what Tom thinks the outcome will be here:
To me Thomas Beale really nails it and recognises clearly just how complex the task of establishing a clinically useful secondary EHR (myHR) is!
Thanks Tom for dragging together so many of the issues that are vital to success. I really did save the best until Friday with this!
David.

Thursday, April 19, 2018

The Macro View – Health, Financial And Political News Relevant To E-Health And The Health Sector In General.

April 19, 2018 Edition.
The news of the week is the US, UK and France bombing Syrian chemical warfare facilities. It seems to have gone off reasonably well and all we now need to do is see if it puts an end to chemical weapons use. Time will tell as usual on how well it went and what effect it will have.
Trump also is seemingly changing his mind on trade etc. so who knows what is really going on! The TPP is off again for example!
 In OZ the NEG is being discussed and the undermining of Turnbull continues apace. The pollies continue to be self-obsessed and the public frustration continues to build! Who knows where and when it will all end? As for the Royal Commission it is just scary how many corrupt people seem to be out there! Just awful!
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Here are a few other things I have noticed.
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Major Issues.

Newspoll: a miserable Coalition mob with little hope of sunlight

  • The Australian
  • 12:00AM April 9, 2018

Simon Benson

The Coalition partyroom is a divided cabal torn between hope and despair and rendered immobile as it convulses over its future.
This is a condition that now crosses factional lines. The myth of a conservative mutiny has been broken. The Prime Minister’s broader support base among moderate MPs is also fracturing.
There are those who are still willing Turnbull to succeed, clinging to a cogent belief that Bill Shorten is disliked, distrusted and therefore beatable. But a larger number are now resigned to a ­defeat, having lost confidence in Turnbull’s ability to be the one to do it. No sensible Liberal will be doing cartwheels over a one-point gain in the two-party-preferred vote to 48/52 when the primary vote is stuck at 38 per cent.
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South African farmers: industrious, English-speaking migrants fit in best

  • The Australian
  • 12:00AM April 9, 2018

Adam Creighton

Forget South Africans, more ­Croatians please?
Home Affairs Minister Peter Dutton was spot on that South ­African farmers, terrorised by their own government and ­marauding compatriots, would likely make a strong economic contribution to Australia were they given refugee visas.
Of course, Australia can’t take all the world’s 23 million refugees, so why not prioritise those who are most likely to fit in economically? That saves taxpayers money in welfare, and minimises social discord.
It turns out skilled South African and English immigrants have unemployment rates of about 2 per cent, compared to a 5.6 per cent rate nationally, according to a 2014 study by the Immigration Department of arrivals between 2001 and 2011.
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Retirement savings loom as key battleground for next federal election

ROB HARRIS, National politics reporter, Herald Sun
April 4, 2018 6:06pm
RETIREMENT savings again loom as a key battleground for the next federal election as the Turnbull government attempts to win back the trust of millions of older Australians.
Revenue Minister Kelly O’Dwyer said the government wants to give certainty to workers planning for their retirement by ruling out any further tax changes to the superannuation.
The Coalition suffered a major backlash over its changes to super prior to the 2016 election from within its own ranks and was forced to adjusted some of its policy.
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Will the bank royal commission damage house prices?

By Elizabeth Knight
9 April 2018 — 3:42pm
Cutting through the various predictions of a slump in house prices, the facts are: yes, house prices in Sydney and Melbourne are still falling but the rate of decline is also falling; and at a national level prices have now steadied.
In the biggest market, Sydney dwelling values were falling at a monthly rate of 0.9 per cent in December and January, reducing to 0.6 per cent in February and now 0.3 per cent in March, according to CoreLogic.
Even before prices began to drop, the market was already losing steam. It was apparent a year before that growth rates started to ease.
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What's the value of the Commonwealth? Nearly $4 trillion in untapped trade

By Latika Bourke
10 April 2018 — 10:15am
London: Trade between the Commonwealth nations could explode to $3.86 trillion in value by the end of next decade a British inquiry committee has said.
The predicted boost in the value of trade depended on the 53 member countries of the Commonwealth signing up to a series of proposals to lower the cost of trading goods, particularly in African nations.
The committee said they would also need to harmonise regulations to facilitate the booming services sectors seen in countries such as Australia and Singapore.
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Changing tide: three big risks the global investor should watch out for

  • The Australian
  • 12:00AM April 10, 2018

Don Stammer

The prevailing sentiment in equity markets has swung from optimism to a mix of gloom and ­extreme uncertainty. In these market conditions, investors need to stand back from the crowd and recognise the shades of grey.
Over the 18 months to the end of January, shares delivered above-average returns, bond yields climbed only modestly and investment markets displayed ­remarkable calm. Concerns about stretched valuations and the many geopolitical worries were overridden by the stronger-than-expected global growth and by the comfort of accommodative monetary policies.
Then investment markets were hit by the wind change in early February. Initially, bond markets weakened sharply. Sharemarkets — in the US more than elsewhere — soon turned volatile and gloomy.
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Labor’s tax policy has retirees rethinking reasons to save

  • The Australian
  • 12:00AM April 10, 2018

Olivia Caisley

Adam Creighton

Labor’s push to slap a minimum 30  per cent tax on dividends hasn’t only enraged tax purists by tearing up an 18-year-old tax principle, it’s incensed the nation’s million-plus army of self-funded retirees who are increasingly asking “why did we even bother saving?’’
Opposition Leader Bill Shorten’s policy to cease cash refunds for dividend franking credits should Labor win the election has potentially left up to one million self-funded retirees out of pocket.
John Bolton, a 64-year-old ­retired lawyer from Caloundra, in southeast Queensland, said Labor’s plan to “defraud” him of his retirement savings had made him reconsider a lifetime of hard work, describing the proposed changes as “grossly unfair”.
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Liberals will struggle for as long as they remain the issue

  • The Australian
  • 12:00AM April 11, 2018

Paul Kelly

This is not just about personalities. The crisis within the Liberal Party is permanent and deep-seated. As an institution it is now incapable of unity around a common agenda. It is riven by disputes about the policies it needs to succeed and what the Liberal Party represents.
The lesson from the focus on the 30th Newspoll loss for Malcolm Turnbull is that the leadership story will run until the next election — and it will keep running beyond it. Julie Bishop and Peter Dutton are seen as banner-car­riers into the next political cycle of the ideological war between progressives and conservatives.
The brawl over energy policy has morphed into a dispute over core belief. With Tony Abbott calling for “strong-arming” and forcible acquisition of the AGL Liddell power station — after demanding the previous week the government build a new coal-fired power plant — the Prime Minister and Energy Minister Josh Frydenberg hit back by invoking RG Menzies and his crusade against nationalisation to chastise Abbott for breaching essential Liberal values.
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  • Apr 11 2018 at 11:54 AM

The fight about AGL's Liddell power station explained

AGL Energy's Liddell coal power plant has become a flashpoint for the debate around the future of the electricity system.
Amid the flurry of claims and counter-claims, The Australian Financial Review weighs up the arguments, leaving aside the political point-scoring.
Commissioned in 1973, the generator has a 50-year life and its original 2000 megawatts of baseload capacity is no longer able to be used in full.
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  • Apr 12 2018 at 7:45 AM

Volatility brings opportunities for long-term investors: Mohamed El Erian

by Mohamed El-Erian
The transition from liquidity-powered markets for risk assets to those influenced a lot more by fundamentals was never likely to be smooth, as it involved changes to drivers of investor behaviour and market flows. Yet, despite this year's unsettling spikes in high-frequency, two-way market moves, the right investment strategy is to "look through" the volatility.
Given the events in markets over the last few years, this approach has two main implications for long-term investors: On portfolio allocation, it calls for them to make either implicit or explicit calls on macroeconomic policies in the US, Europe and China; and, on specific exposures, it requires them to take a view on key emerging trends.
This year has been characterised by the kind of stock market movements that hadn't been seen for a while. As an example, Bloomberg Markets reported last week that there had already been three times as many moves of 1 per cent or more in the S&P 500 this year than there were for the whole of 2017.
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Business promise on tax cut 'a danger to economic freedom', warns leading conservatives

Eryk Bagshaw
Published: April 11 2018 - 3:45PM
A leading conservative think tank says an unprecedented pledge made to the Senate by the Business Council if company tax cuts were passed is “damaging to economic freedom,” as business chiefs prepare to face a grilling days before the May budget.
The pledge, made as part of a last-minute lobbying blitz in March by the nation's largest companies, including Qantas and BHP, committed them to reinvesting savings that resulted from tax cuts in the hope of eventually stimulating wage growth.
But conservative economists at the Centre for Independent Studies are incredulous the Business Council made such a promise, warning conditional cuts are “a step in towards central economic planning and corporatist economic management”.
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  • Updated Apr 11 2018 at 11:00 PM

Why do politicians think that there are votes in coal?

by Matthew Warren
The electricity grid that supplies power to Australia's populated east coast is one of the biggest machines on earth. It is troubling that in 2018 its future risks being determined by the vagaries of political ideology.
Apparently we have to save the coal-fired power industry by building new coal-fired power stations. Which is curious because the Australian Energy Council effectively represents this industry, and as far as we can see no one here has issued an SOS.
Coal-fired electricity generators have been the backbone of Australia's electricity supply for the past century. We still derive around 75 per cent of our power from them. Our members own them and run them. They will continue to supply electricity well into the 21st century.
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Upbeat outlook despite trade fears: report

2:26pm Apr 11, 2018
Economists expect Treasurer Scott Morrison can present a positive picture in next month's budget, despite fears of an escalating trade war between China and the US.
The stoush between the US and China has rattled financial markets and dented local confidence.
But in its quarterly economic outlook, KPMG Economics is forecasting growth of 2.9 per cent for this financial year, a marked pick-up from the modest two per cent expansion in the 2016/17 year.
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Next move is up, and it'll shock, says RBA

By Peter Martin
11 April 2018 — 6:36pm
The next move in official interest rates will almost certainly be up, it won’t come for a while, and it will “shock”, Reserve Bank Governor Philip Lowe has warned.
In what appears to be part of a campaign to prepare people for a rate hike, Governor Lowe told an audience in Perth that the last increase was more than seven years ago, meaning it would “come as a shock to some people”.
But it wouldn’t happen for some time.
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Malcolm Turnbull concedes there is 'tension' between Australia and China

By Fergus Hunter
12 April 2018 — 10:17am
Prime Minister Malcolm Turnbull concedes Australia's relationship with China is suffering from "some tension" amid fallout from the government's foreign interference laws and Beijing's growing influence in the Pacific.
Mr Turnbull blamed "misunderstandings and mischaracterisations" in Chinese media for the heightened tensions, and declined to confirm or deny a report that an angry Chinese government is denying Australian ministers visas to visit.
"There's clearly been some tension in the relationship following the introduction of our legislation about foreign interference but I'm very confident that any misunderstandings will be resolved," the Prime Minister told 3AW radio.
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Why the airport rail link barely stacks up and shouldn't happen yet

By Peter Martin
12 April 2018 — 10:12pm
Just months ago in December, Infrastructure Victoria published the most comprehensive analysis yet of Victoria’s infrastructure needs.
It examined 300 potential projects, many of them desperately needed, and pronounced the Melbourne Airport Rail Link only “supported in principle”.
And not for a long time.
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Reserve Bank still nervous about China debt risks

  • James Glynn
  • Dow Jones
  • 11:39AM April 13, 2018
Risks of a damaging housing crunch in Australia have eased as the property market cools following a crack down on loose mortgage lending in recent years, the Reserve Bank said today.
Still, in its latest report card on the stability of the financial system, the RBA said it remains fearful of a build up of risks around corporate and housing debt in China, by far Australia’s biggest trading partner.
China’s extensive shadow banking system makes measuring the extent of the financial-sector risk difficult, the RBA added.
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  • Apr 13 2018 at 12:06 PM

RBA flags dangers of $480b in interest-only loan resets over the next four years

The Reserve Bank of Australia estimates that as much as $480 billion in interest-only mortgages will convert to principle and interest loans over the next four years, ratcheting up the repayment burden on around 30 per cent of outstanding loans.
Warning that the resets are an "area of concern", the Reserve Bank expects repayments will jump by between 30 per cent and 40 per cent on those loans, even as it added that it didn't expect any increase in financial stress to be widespread.
"Most borrowers should be able to afford the step-up in mortgage repayments because many have accumulated substantial prepayments, and the serviceability assessments used to write IO loans incorporate a range of buffers," the Reserve Bank said on Friday. "Moreover, these buffers have increased in recent years.
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5 Rules to Help Avoid Investing Disaster

It's actually not that hard.
by Barry Ritholtz
February 9, 2018, 3:25 AM GMT+11 Corrected February 9, 2018, 7:20 AM GMT+11
Easy to avoid.
A basic rule of life is to avoid being a guinea pig in other people’s experiments. This is an inviolable rule of technology: consumers should always leave 1.0 of anything to the early adopters. All car fanatics know that any brand-new vehicle model will come with bugs, quirks and design issues that tend to get corrected in the second year of production. And anytime finance creates a new product -- from CDOs to ETNs to ICOs -- smart investors know to give these novel trading vehicles a wide berth until proven safe and effective in a variety of market and economic conditions.
Which brings us to the most recent shiny Wall Street toy to blow up: inverse volatility products. Consider the Credit Suisse Velocity Shares Inverse VIX ETN. The prospectus for this product has a so-called termination clause, and Credit Suisse has said it will redeem the ETN later this month. What was worth $1.5 billion last week has since declined by roughly 95 percent. The best explanation I have seen to date on the inverse volatility trade is here. See the chart below for what happened to those who played this bet:
Events such as this are opportunities to remind investors of some basic rules. So, without further delays, let’s delve into what lessons investors should have gleaned from the past week’s debacle.
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Is something more sinister at play in Australia’s low-wage story?

By Jessica Irvine
14 April 2018 — 12:05am
The annoying thing about economic turning points, is that it’s impossible to know – at the time – when one is occurring.
It is only with the benefit of hindsight, that we can declare with any confidence that a crucial turning point has been reached.
Policymakers at the most senior levels of Australian government and central banking are united in their hope that Australia’s record low wages are at a turning point.
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Scandals show ASX is sleeping at the wheel

  • The Australian
  • 12:00AM April 14, 2018

James Kirby

There’s a rotten development right at the heart of the Australian sharemarket as a string of scandals unfold: a motley selection of investor favourites that have been sold as “companies of the future” are instead being revealed as wealth destroyers.
“Pitched as innovative new era leaders, there is a distinct sense now that perhaps the outstanding feature of some of these companies is that they had a head start on local regulators.
For anyone in the sharemarket the delightful prospect of a bagging a big win on the ASX is always present. But the issue is whether you are gambling or investing when dealing with companies at this level?
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Housing OK but RBA warns on China, assets

  • The Australian
  • 12:00AM April 14, 2018

David Rogers

The risks of a damaging housing crunch had eased, with clear signs of a cooling property market following a crackdown on loose mortgage lending, the Reserve Bank said yesterday.
But in its latest report card on the stability of the financial system, the RBA warned that the accumulated risks to financial stability in the nation’s biggest trading partner — China — remain high.
It also cautioned that global markets were underpricing the risk of an economic shock.
While strong economic conditions had improved the health of the global banking system, “very low” yields on long-term government bonds were still causing “elevated asset valuations” and “search for yield activity”, so that compensation for risk was “low” for many assets, the RBA said.
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National Budget Issues.

A mongrel bunch of bastards': The small businesses being crushed by the tax office

Mark Freeman's bright business idea earned him a government grant. But the tax office disagreed and hit him with a huge bill. Seven years and $750,000 later, he is still fighting for justice.
By Adele Ferguson, Nassim Khadem & Lesley Robinson
8 April 2018
n dealing with the ATO, I’ve never come across such a mongrel bunch of bastards in my entire life.”
Mark Freeman’s troubles with the Australian Taxation Office began in mid-2011 with an audit of Blackwater Treatment Systems, a company he set up to develop technology that would turn waste into reusable water.
The company had won research and development grants from the government’s innovation arm, it was working in collaboration with the University of NSW and had third-party support from Standards Australia.
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Turnbull is wrong to give us tax cuts in the budget

By Jessica Irvine
9 April 2018 — 12:01am
There is just one month to go until the social highlight of every economics journalist’s calendar: the federal budget lock-up.
It’s the nerd equivalent of our Olympic games. Each year, on the second Tuesday in May, we gather in Canberra to be voluntarily imprisoned in a suite of committee rooms located deep in the heart of Parliament House, where – fuelled by little more than party pies and lollies – we attempt the Herculean task of combing through thousands of pages of statistics to figure out what exactly the government has done with your money.
Of course, the guessing game begins long before lock-up. In the weeks leading up to the budget, gallery journalists endure great hardship, as editors demand fresh budget leaks.
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Govts enjoy renewed mining profitability

3:31am Apr 11, 2018
The mining sector is enjoying its most profitable period since the industry's investment boom, providing a bigger tax coffer for Treasurer Scott Morrison as he puts his third budget together.
An analysis by Deloitte Access Economics for the Minerals Council of Australia found Australian mining companies paid $12.1 billion tax in 2016/17, almost four times as much as the previous financial year and the highest since the mining investment boom in 2011/12.
"This means that mining companies are estimated to have paid one in every five dollars of Australia's company tax take," the council's interim chief executive David Byers said in a statement on Wednesday.
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Extortion is no way to fix the budget

By Peter Martin
11 April 2018 — 10:07pm
In their rush to find money for next month's tax cuts, Turnbull and Morrison run the risk of making an awful mistake.
Like they did in 2016, and perhaps in 2017.
In 2016, needing to demonstrate that they could pay for their (modest) election promises, they unveiled a $2 billion fix days before the vote.
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It's time for sweetest tax of them all

By Peter Martin
Updated15 April 2018 — 1:13am first published at 12:05am
Time for a tax on sugar here?
Never before has a tax been such an instant success. I am talking about what happened in Britain last Friday. That’s when new so-called sugar tax sprung into life, with much of its work already done.
The whole idea was to cut the consumption of sugar, something we have just as much need to do here, given that our rates of obesity are on a par with those in Britain - an outrage that will prevent many of us living long lives.
Up to one third of us are obese, another third are overweight. Thirty years ago it was 10 per cent. If you don’t think that’s shortening lives, ask my colleague, Peter FitzSimons. He says everyone he sees aged over 75 is thin. Their heavier contemporaries are dead.
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Health Budget Issues.

Alcohol industry gets say on booze controls

  • The Australian
  • 12:00AM April 9, 2018

Ben Packham

Health Minister Greg Hunt has moved to reassert control over the development of a new ­national alcohol strategy, giving the industry a say on a plan that had threatened to raise the price of beer and wine for everyday drinkers.
The Ministerial Drug and ­Alcohol Forum was due to finalise the policy this month after a three-year process, but its final draft will now be pushed out to the second half of the year.
Mr Hunt wrote to his state counterparts last month calling for a forum with “selected stakeholders” to work “collaboratively and collectively on solutions to any residual issues”.
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The doctor who won't reveal fees - and other health cover hell tales

By Jenna Price
10 April 2018 — 12:05am
At dinner with friends, talk inevitably turns to the human condition. More
The dry eyeballs. The creaky hips. Our skin, yielded to those early decades of abuse. The pains and aches of ageing, even though, in the big scheme of things, we are not even two-thirds there.
I swore I would never be one of those people, yet here I am. And as we talk about our bodies falling apart, we also talk about money, how to pay for upkeep - those endless trips to the physio, the colonoscopies, multifocals, the fancy treatments to get rid of various skin cancers don't pay for themselves.
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Bill Shorten lashes AMA over Medicare levy rise for NDIS

  • The Australian
  • 2:04PM April 12, 2018

Greg Brown

Bill Shorten has accused the Australian Medical Association of being Malcolm Turnbull’s “pawn” after the peak doctors’ body urged Labor to support the government’s increase to the Medicare levy to pay for the $22 billion National Disability Insurance Scheme.
The Opposition Leader attacked the AMA, after The Australian revealed it had split with Labor on the issue and accused Mr Shorten of using the issue as a political football.
The AMA wants Labor to back the government’s 0.5 per cent increase to the Medicare levy for all taxpayers, rather than just workers earning over $87,000.
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How much booze can you drink before it starts killing you? Not much

By Liam Mannix
12 April 2018 — 6:26pm
Drinking more than six glasses of wine or cans of beer a week reduces your life expectancy, according to the one of the largest-ever studies on global alcohol consumption.
The more you drink, the higher your risk, the study says. Heavy drinkers shave years off their lifespan.
Australian health guidelines say 14 standard drinks a week – that’s about seven pints of beer, or about nine glasses of wine – is safe.
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Plan to tackle endometriosis top of list at COAG health ministers meeting

By Esther Han
12 April 2018 — 7:58pm

In numbers

·         Estimated number of Australian women with endometriosis 700,000
·         Federal Government's initial investment to address research priorities identified in the National Action Plan $2.5 million
·         Proper diagnosis can take many years 7 to 10 years
A plan is being drawn up by federal Health Minister Greg Hunt to tackle endometriosis, a chronic, painful condition suffered by 700,000 women nationally.
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AMA blasts Shorten for calling it a pawn

  • The Australian
  • 12:00AM April 13, 2018

Rick Morton

The Australian Medical Association has hit back at a jibe by Labor leader Bill Shorten that it is being used as a “pawn by the government” in advocating for a Medicare levy rise to fund the National Disability Insurance Scheme, declaring it is “furious” in its independence.
The doctors’ lobby, which yesterday called for the $22 billion disability scheme to be funded in full and prioritised across party lines, was joined by grassroots group Every Australian Counts that once stood with Mr Shorten at events campaigning for the NDIS.
“We stand together with the AMA demanding bipartisan support to fully fund the NDIS via a small increase to the Medicare levy,” Every Australian Counts campaign director Kirsten Deane said. “Full funding will guarantee the future of the NDIS and assure people with disability and their families that the scheme will be there for them when they need it.
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Turnbull closer to deal with states on health funding

  • The Australian
  • 12:00AM April 14, 2018

Joe Kelly

Malcolm Turnbull is closer to clinching a deal with the states and territories over his health funding package after South Australia and the ACT signed up to a new five-year agreement starting in 2020.
Health Minister Greg Hunt told The Weekend Australian the outcome of yesterday’s Council of Australian Governments meeting of health ministers in Sydney represented a “real breakthrough”.
“They’ll come on board and there’s very good progress with the other states,” he said. “This is a year earlier than expected ... That means we have two Labor and two Liberal states and territories.”
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International Issues.

Trump calls Assad 'animal', blames Putin after alleged chemical attack

By Mohammed Aly Sergie
8 April 2018 — 11:56pm
Dubai:  US President Donald Trump has condemned a "mindless chemical attack" in Syria that killed women and children, called Syrian President Bashar Assad an "animal" and delivered a rare personal criticism of Russian President Vladimir Putin for supporting the Damascus government.
As Washington worked to verify the claim by Syrian opposition activists and rescuers that poison gas was used, Trump said there would be a "big price to pay" for resorting to outlawed weapons of mass destruction. A top White House aide, asked about the possibility of a US missile strike in response, said, "I wouldn't take anything off the table."
The United Nations Security Council is holding an emergency meeting on Monday to discuss the attack.
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North Korea confirms it is willing to talk denuclearisation

By David Nakamura
9 April 2018 — 7:04am
Washington: North Korea has confirmed directly to the Trump administration that it is willing to negotiate with the United States over potential denuclearisation, administration officials said.
The confirmation on Sunday evening, US time, offers the administration greater assurances that North Korean leader Kim Jong-un is committed to a potential meeting with President Donald Trump by the end of next month.
"The US has confirmed that Kim Jong-un is willing to discuss the denuclearisation of the Korean Peninsula," an administration official said.
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In Syria, is Trump sowing the seeds for an Islamic State resurgence?

By Josh Rogin
9 April 2018 — 5:56am
Washington: There are a lot of good arguments for maintaining an American presence in Syria after the fall of the Islamic State, but US President Donald Trump doesn't seem persuaded by any of them.
Perhaps he would back off his urge to cut and run if he knew that the United States and its partners control almost all of the oil. And if the United States leaves, that oil will likely fall into the hands of Iran.
It's one feature of a larger US mission in Syria that is really about containing Iranian expansionism, preventing a new refugee crisis, fighting extremism and stopping Russia from exerting influence over the region. The United States has serious national security interests in making sure that Syrian President Bashar al-Assad, Russian President Vladimir Putin and Iran don't push America out of Syria and declare total victory.
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Trump has the right problem but the wrong solution

By Molly Kiniry
8 April 2018 — 10:00am
With all the grace and subtlety of a pay-per-view wrestling match, the Trump trade war has finally begun. In one corner, we have the president of the United States. In the other, we have president Xi Jinping and the Communist Party of the People's Republic of China, that newfound bastion of free trade. This isn't the show that most people signed up for, but it's the show we're going to get.
This is a dangerous game, and there has been no shortage of criticism of Donald Trump for imposing trade restrictions on China. But to his credit, the president's motives are not bad ones.
Be it a burglar stealing something from your home or a government deciding that your intellectual property no longer belongs to you or your shareholders, most people would call those activities "theft", and agree that some form of retaliation is acceptable. The Chinese have been bad actors in this area for a long time, and it's not unreasonable that the United States should respond. In fact, the US is probably the only country on Earth which can afford to challenge the Chinese government on some of its more egregious practices.
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China eyes Vanuatu military base in plan with global ramifications

By David Wroe
9 April 2018 — 8:14pm
China has approached Vanuatu about building a permanent military presence in the South Pacific in a globally significant move that could see the rising superpower sail warships on Australia’s doorstep.
Fairfax Media can reveal there have been preliminary discussions between the Chinese and Vanuatu governments about a military build-up in the island nation.
While no formal proposals have been put to Vanuatu's government, senior security officials believe Beijing’s plans could culminate in a full military base. The prospect of a Chinese military outpost so close to Australia has been discussed at the highest levels in Canberra and Washington.
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Canberra needs to get very serious, very quickly, to counter this move by a master strategist

By Peter Hartcher
10 April 2018 — 12:05am
On the global chessboard of power politics, the advent of a Chinese military base in the South Pacific would be the equivalent of Australia being placed in check.
If the government of Vanuatu were to agree to host a permanent base for an expanding Chinese military, "it would signal a pretty significant failure of Australia's long-term security policy," observes the head of ANU's National Security College, Rory Medcalf.
Ever since Japan's campaign in World War II, "it's been an unspoken objective of Australian defence and foreign policy for 70 years to ensure that no other power could project force against Australia from the South Pacific," he says.
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'Bite the bullet and get out': Trump has lost the confidence of investors

By Robert Burgess
10 April 2018 — 9:48am
President Donald Trump likes to equate the rally in stocks since the November 2016 elections with confidence in him and his policies. And yes, the S&P 500 Index has surged 22 per cent since then, but a deeper look at equities, bonds and the dollar reveals anything but trust in his stewardship.
Here's the executive summary: US companies are valued less now than before Trump was elected, despite the run-up in stocks, big corporate tax cuts, reductions in regulations and booming earnings. The cost to borrow for the US has soared relative to other governments, a sign investors are worried about America's creditworthiness. The dollar's share of global currency reserves has dropped by the most since 2002.
Investors are losing faith because Trump is turning into the type of president many always feared: unpredictable, volatile and tempestuous. Those characteristics were certainly present last year, but they were largely overlooked as his administration pushed through pro-growth, pro-business initiatives such as tax reform and regulatory cuts. Now, many highly-regarded White House staffers such as former Goldman Sachs President Gary Cohn and cabinet members such as former Exxon Mobil Chief Executive Rex Tillerson have exited and it's unclear who is left to keep Trump in check on his more radical policies such as those he is pushing through now on trade.
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  • Updated Apr 10 2018 at 12:22 PM

Canberra flounders as Beijing keeps calling the shots

by Geoff Raby
If anyone had been in doubt, the past few weeks have demonstrated once again how fundamentally Australia's geopolitical and strategic environment has changed and the extent to which this has been shaped by China. It has also highlighted Australia's strategic confusion over how to respond.
President Xi Jinping was at the height of his powers and unchallenged in the exercise of his authority in the recently concluded National People's Congress. Completing his appointments of trusted advisers and supporters to senior offices, which began at last year's 19th Party Congress, he appointed Wang Qishan as Vice-President. Over the past six years, Wang has led Xi's anti-corruption campaign, which has routed most political rivals.
In another unconventional move, Xi also appointed his chief economic adviser, Liu He, to the position of Vice-Premier. Together with Li Gang, appointed to head the People's Bank of China, the top echelons of economic policy advice are now occupied by English-speaking economists educated in the US. In the 1970s and '80s, diplomats in Beijing would rue the fact that China's economic policy elite were educated in the Soviet Union. A joke is now doing the rounds in Beijing: when the elite were educated in the Soviet Union, Beijing's relations with Moscow were terrible and now it's the same with the US when the elite have been educated there.
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Trump fumes over FBI raid in Stormy Daniels affair

By John Walcott
11 April 2018 — 9:32am
Washington: President Donald Trump was fuming on Tuesday over FBI raids of his lawyer's office and home in search of details about ties between Trump and two women who say they had sex with him, aides said.
The latest turn of events in a wide-ranging probe that Trump has called a "witch hunt" has moved investigators deeper into the president's inner circle of advisers and cast a pall of uncertainty over the White House.
The raids on attorney Michael Cohen represent a dramatic escalation of a federal inquiry led by Special Counsel Robert Mueller into alleged Russian meddling in the 2016 US election and possible collusion by Trump campaign aides.
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Lend unsustainably and move quickly: the China modus operandi

By Peter Martin
10 April 2018 — 6:48pm
From Vanuatu to Papua New Guinea, from Sri Lanka to Pakistan, from the Maldives to the tiny republic of Djibouti on the Horn of Africa, Chinese ‘assistance’ follows roughly the same pattern.
It comes in the form of loans, not much cheaper than, and sometimes more expensive than loans that could have been obtained from organisations set up for the purpose such as World Bank and International Monetary Fund. But their advantage is that they are approved quickly and are often for purposes more attractive to elites than to the countries themselves.
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On the ground in Vanuatu, monuments to China's growing influence are everywhere

By David Wroe
10 April 2018 — 7:04pm
Port Vila: Michael Jiang, the managing director of the Sino-Van fish processing factory in Vanuatu's capital, has a problem.
Right now, he has no fish and no workers. The initial burst of haste that led to the plant's construction a decade ago has stalled amid land disputes and other problems.
Port Vila's massive national convention centre - also Chinese-built - is even quieter. There is not a soul around.
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Russia as 'besieged fortress' storyline roars back as US tensions rise

By Anton Troianovski
11 April 2018 — 6:01am
Moscow: In the Kremlin's telling, this is a country under siege.
The United States is considering strikes on Russian ally Bashar Assad in Syria, prompting ominous speculation among people close to the Kremlin that such a move could touch off a wider conflict. One scholar who advises the Russian Defence Ministry even raised the specter of "World War III."
At the same time, US sanctions against top Russian business executives wiped billions of dollars off Russian stock market values this week, prompting fears the country's already stagnant economy could be thrown back into recession.
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Xi Jinping promises to lower tariffs, reduce investment restrictions

By Kirsty Needham
Updated10 April 2018 — 4:54pmfirst published at 1:40pm
Boao, China: Chinese President Xi Jinping has pledged to “considerably reduce” tariffs on foreign cars sold in China this year, meeting a key demand of Donald Trump.
The olive branch was offered in a keynote speech at the Boao Forum, considered by many the Davos economic forum of Asia, after days of escalating rhetoric between the US and China over trade.
Mr Xi said China would also reduce restrictions on foreign investment in automotive and aircraft manufacturing, among a raft of market opening measures, many of which have been previously flagged.
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  • Apr 11 2018 at 10:06 AM

Rivalry between the US and China will shape the 21st century

by Martin Wolf
China is an emerging superpower. The US is the incumbent. The potential for destructive clashes between the two giants seems potentially unbounded. Yet the two are also intimately intertwined. If they fail to maintain reasonably co-operative relationships they have the capacity to wreak havoc not only upon each other, but upon the entire world.
China is a rival of the US on two dimensions: power and ideology. This combination of attributes might remind one of the clash with the Axis powers during the second world war or the cold war against the Soviet Union. China is of course very different. But it is also potentially far more potent.
China's rising power, economic and political, is evident. According to the IMF, its gross domestic product per head in 2017 was 14 per cent of US levels at market prices and 28 per cent at purchasing power parity, up from 3 per cent and 8 per cent, respectively, in 2000.
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  • Updated Apr 9 2018 at 11:00 PM

The collapse of the 'Chinese collapse' theory

by Richard McGregor
In Japan, they call it "the collapse of the 'Chinese collapse' theory."
The line, which harks back to more than a decade of dire predictions about China, is a joking way to describe the state of the Middle Kingdom's economy.
Far from falling in debt-laden heap, the economy is looking robust in the medium term. Many of the perennial China bears are retreating into hibernation.
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  • Apr 12 2018 at 4:09 AM

Donald Trump v Vladimir Putin feud fires up in Syria

Donald Trump's warning for Russia to "get ready" for US missiles hailing on its Syrian ally and Moscow's threat to shoot them down shook financial markets and underlines sinking relations between Washington and Moscow.
The US President is usually reluctant to criticise the Russian leader by name, but the conflict in Syria has quickly morphed into a sideshow battle of Trump versus Vladimir Putin.
The resolve of the strongmen leaders will be tested, as geopolitical concerns deviate from US-China trade tensions and North Korea's nuclear weapons testing.
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  • Apr 12 2018 at 2:50 AM

Paul Ryan's unexpected retirement seen as a blow to Republicans

by Richard Cowan and Susan Cornwell
US House of Representatives Speaker Paul Ryan will not seek re-election and will leave his post at the start of 2019, further unsettling a Republican Party rocked by Donald Trump's tumultuous presidency ahead of November's pivotal congressional elections.
Ryan, who has had an often-strained relationship with Trump but helped the president achieve his biggest legislative victory in the form of major tax cuts in December, made the announcement on Wednesday (Thursday AEST), portraying it as a decision to spend more time with his family after serving two decades in the House.
He is the 41st Republican legislator to say he won't be contesting re-election in November, when the Democrats are expected to pick up new seats in the mid-term elections.
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  • Updated Apr 11 2018 at 11:00 PM

China's strength is also its weakness

by Daniel Moss
For the first time since the Opium Wars of the 19th century, China's borders and territory are unchallenged. No conflict frays the country's edges. This stability has allowed for rapid industrialisation, foreign investment and the rise of an urban Chinese middle class. Why would China jeopardise this in a trade spat with the US?
Hard-won political unity created the conditions in China for the reforms of the Deng Xiaoping era and the country's huge economic success. Those gains, in turn, make China confident and strengthen its hand in talks with the Trump administration that will ultimately come.
The advances are also the biggest thing China has to lose. The stronger China's position, the more it has the scope – and necessity – to offer concessions to stave off a conflict.
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Peter Costello laments ‘strained’ ties with China

Former treasurer Peter Costello has labelled Australia’s relationship with China as “strained”, using as evidence the lack of senior government officials at the annual Boao Forum for Asia conference.
Mr Costello said in the 10 years he had attended the forum Australia had always had high level ministerial representation, which has included prime ministers, foreign ministers, finance ministers and trade ministers.
“Australia has always taken the Chinese relationship very seriously and it still does but the lack of ministerial contact does show the relationship is strained at the moment,” he told The Australian on the sidelines of the conference.
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The Putin myth: why Russia is no economic superpower

By Ambrose Evans-Pritchard
12 April 2018 — 11:10am
Russia's GDP was smaller than that of Texas even before the latest and most lethal sanctions imposed by Washington.
It has diminished further to Benelux proportions after the rouble's 10 per cent crash this week, the steepest fall since the late Nineties.
Vladimir Putin has squandered Russia's advantages.
Upon this slender economic base, Vladimir Putin's Russia is posing as a world-class superpower, the new master of the Middle East, insisting on its "droit de regard" over the old Tsarist realms as if by natural right.
What is extraordinary is than anybody should believe in such posturing.
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Donald Trump untethered to truth, James Comey says in new book

13 April 2018 — 9:05am
Washington: Former FBI director James Comey blasts US President Donald Trump as unethical and "untethered to truth" in a forthcoming book and calls his leadership of the country "ego driven and about personal loyalty".
Comey reveals new details about his interactions with Trump and his own decision-making in handling the Hillary Clinton email investigation before the 2016 election.
He casts Trump as a Mafia boss-like figure who sought to blur the line between law enforcement and politics and tried to pressure him regarding his investigation into Russian election interference.
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China-Australia tension as biggest trading partner gives us the cold shoulder

By Kirsty Needham
12 April 2018 — 3:23pm
Hainan, China: The freeze in diplomatic relations between China and Australia is on, despite official denials – and business executives are clearly despondent about it.
That was the message from the sidelines and back-room meetings at the Boao Forum in China this week.
No Australian ministers attended. In fact, no Australian ministers have stepped foot in China this year, because the usual smooth process of invitations being issued and dates being confirmed by Beijing has ground to a halt.
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Billions of words later, the anti-Trump movement has failed

By David Brooks
10 April 2018 — 1:52pm
Over the past year, those of us in the anti-Trump camp have churned out billions of words critiquing the president. The point of this work is to expose the harm President Donald Trump is doing, weaken his support and prevent him from doing worse. And by that standard, the anti-Trump movement is a failure.
We have persuaded no one. Trump's approval rating is around 40 percent, which is basically unchanged from where it's been all along.
We have not hindered him. Trump has more power than he did a year ago, not less. With more mainstream figures like H.R. McMaster, Rex Tillerson and Gary Cohn gone, the administration is growing more nationalist, not less.
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  • Apr 13 2018 at 11:48 AM

Assad must go from Syria, and Iran with him

by Bret Stephens
On Saturday I took my family to have a closer look at Syria.
This was on the Golan Heights, from a roadside promontory overlooking the abandoned Syrian town of Quneitra. The border is very green at this time of year, a serene patchwork of orchards and grassland, and it was hard to impress on our kids that hell on earth was visible in the quiet distance.
But I wanted them to see it — to know that Syria is a place, not an abstraction; that the agonies of its people are near, not far; that we should not look away. Later that day, in a suburb of Damascus, Syrian forces apparently again gassed their own people.
It's fortunate for Israel that it did not bargain the Heights away during the ill-fated peace processes of the 1990s: Had it done so, ISIS, Hezbollah or Iran might in time have trained their guns on Israeli towns below. The strategy of withdrawal-for-peace has not been vindicated in recent years, whether in Iraq, Afghanistan or Gaza. It's a point Donald Trump obviously missed when he insisted last week on US withdrawal from Syria, likely encouraging the apparent chemical attack he now threatens to punish.
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  • Updated Apr 13 2018 at 11:00 PM

China, security, Vanuatu and the Pacific: Time for a chill pill

by Kerry Brown
The story of the Chinese government planning to open a base in the small Pacific island nation of Vanuatu has been dismissed as rumour mongering and idle speculation, particularly by the governments of the two nations directly involved. But the anxious response, even to something as speculative as this, seems real enough. In Australia, in the US and across the Asian region, if China did move ahead and establish a naval base similar to the one it has in Djibouti in Africa, plenty of those figuring we can at last see the tangible outlines of Chinese aggressive geopolitical attention would feel vindicated.
This anxiety is a problem for everyone. In particular, it is a problem for China. The bottom line is that as the world's second largest economy, with its ambitious Belt and Road Initiative, its burgeoning regional investments, its large naval fleet, and being the major trading partner of more than 120 countries, the People's Republic has interests and assets beyond its own borders that it has a legitimate right to attempt to protect. The problem is that so little is it trusted, and so deep are the suspicions harboured towards it by many policy-making communities and regional neighbours in particular, that the slightest move to do anything beyond its borders is met with huge interest and a deluge of interpretation. A good amount of that is negative. Here finally, many of the narratives go, is a sign we are seeing a China bent on global domination and aggressive intent.
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US launches missile strikes on Syria

Updated 14 April 2018 — 11:07am first published 12 April 2018 — 11:16am
Washington: President Donald Trump announced Friday that the US, France and Britain together launched military strikes in Syria to punish President Bashar Assad for his alleged use of chemical weapons against civilians and to deter him from doing it again.
Loud explosions lit up the skies over the Syrian capital, as Trump announced the airstrikes.
In an announcement from the White House, Trump said the US is prepared to "sustain" pressure on Assad until he ends what the president called a criminal pattern of killing his own people with international banned chemical weapons.
The decision to strike, after days of deliberations, marked Trump's second order to attack Syria; he authorised a barrage of Tomahawk cruise missiles to hit a single Syrian airfield in April 2017 in retaliation for Assad's use of sarin gas against civilians.
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Trump warns of more strikes if Syria uses chemical weapons again

By Nick O’Malley
14 April 2018 — 4:29pm
US President Donald Trump has left the door open to further strikes against targets in Syria after the United States in conjunction with France and Britain targeted chemical weapons sites and military installations with a barrage of missiles.
On Saturday, he praised Western air strikes against the Syrian government on Twitter as "perfectly executed", and added "Mission Accomplished".
The attack was launched in response to the alleged use of chemical weapons against civilians and rebels by Syrian forces in the city of Douma last Saturday, in which up to 75 people - including children - are thought to have been killed.
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I look forward to comments on all this!
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David.