Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"


H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, July 31, 2014

Review Of The Ongoing Post - Budget Controversy 31st July 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
It is amazing how the discussion on the GP Co-Payment just runs and runs.
Here are some of the more interesting articles I have spotted this ninth  week since it was released.
Parliament has now got up for the Winter Recess we can take a breath and see where we are.
The AMA has been out recently suggesting ideas and worrying about just what the Government’s health agenda actually is. Prof Owler does not seem happy with the apparent directions.
We sure do live in interesting times!
The first article is a huge relief to all of us - no emergency and all is well according to our Treasurer.


Australian economy is not in trouble, Joe Hockey tells NZ

Date:  July 26, 2014 - 2:37PM
Joe Hockey has told New Zealand that there is no crisis in the Australian economy, nor is it in trouble.
The treasurer also made no mention of the "budget emergency" he and his government referred to when justifying their unpopular budget to Australians.
Instead, Mr Hockey reassured Kiwis that their second biggest trading partner is benefiting from 23 years of consecutive economic growth.
"The Australian economy is not in trouble," he told New Zealand political current affairs show The Nation on Saturday.
Mr Hockey also denied drastic reforms to Australian healthcare, education and taxes were about ideological change.

Push for G20 cuts to health, pensions

David Crowe

Political Correspondent
TREASURY has called for structural savings in areas such as health and education with a warning that “complacency can be disastrous”, amid a deepening political row over the government’s attempts to sell an ­unpopular budget.
As Joe Hockey hits back at critics of his budget sales job, the federal government’s top economic official has warned of the growing weight of spending on pensions as the population ages in Australia and other countries.
The speech by Treasury secre­tary Martin Parkinson sharpens debate on the nation’s finances as the government struggles to explain controversial changes.
The Treasurer sought yesterday to step up the case for spending cuts, as he helped launch a new biography that has fuelled frustrations within the Coalition over the budget and leadership.

Joe Hockey opens the book on a misfiring government

Death and tragedy reset the national political conversation. Whether, in recent times, it was the brief lull in hostilities after the death of Julia Gillard’s father or the national shock after the downing of MH17, all that has gone before seems trivial.
Politicians stop attacking each other in three-word slogans and instead speak as the leaders they should be, however briefly.
There is a restraint in what issues journalists ask questions about. A sudden observance of appropriateness rules.
Context is everything in politics and things that might have seemed sort of OK one week are just so wrong in another week. So whatever else is said about MH17, it stopped the noise generated by the Senate and Clive Palmer in its tracks.

AMA warns against push by private health insurers into 'US-style care'

Brian Owler, Australian Medical Association president, fears medical profession at risk of being undermined
Daniel Hurst, Guardian Australia political correspondent
The Australian Medical Association has issued a pre-emptive warning to the government against a major expansion of the role of private health insurers, arguing the public did not want a US-style “managed care” system in primary care and hospitals.
The AMA president, Brian Owler, said the government would need to change the law if it wanted to allow private health insurers to insure for the “gap” payment for GP consultations, but warned that this would lead to “all sorts of problems”, including straining the traditional doctor-patient relationship.
Owler told the National Press Club in Canberra on Wednesday that he feared private health insurers were leading a concerted effort “to undermine and control the medical profession” and that the government was “looking towards” a system in which insurers dictated the care that patients received and which medical professionals they visited.

Stage set for US-style health system: AMA

The Australian government is setting the stage for a United States-style health system with a lower level of care for the uninsured, according to new ­Australian Medical Association president Brian Owler.
Dr Owler, a paediatric neurosurgeon, used his first appearance at the National Press Club in Canberra to criticise the government for “threatening the very foundations of the health system” because of its budget.
He said the $7 GP co-payment, cuts to hospital funding agreements and changes to general practice training programs as the worst aspects.

We'll resist GP push from insurers: AMA

Date July 23, 2014 - 12:38PM
Doctors fear private health insurers are making a concerted effort to undermine their profession.
They warn a push by insurers to cover primary care is a step towards a US-style health system.
The insurers are lobbying the federal government to allow them to enter the lucrative primary care market - services which are now covered by Medicare.
Health Minister Peter Dutton has said he is prepared to consider such a change because insurers could deliver savings to the government.

Medibank pen-pushers overruling doctors – AMA

THE nation’s largest health fund is refusing to fund plastic surgery for burns and skin cancer victims under a new policy which doctors claim amounts to the introduction of United States-style managed care.
The government-owned health fund Medibank has also refused to pay for women to have both breast implants removed after one of them burst under the controversial new policy, Sydney media report.
The Australian Society of Plastic Surgeons says Medibank’s new policy means a health fund clerk who may have no medical qualifications is overruling a doctor without ever seeing the patient.

GPs still being told to stop claiming nurses’ time

21st Jul 2014
GPs have been alarmed in the past week to find confusion persists within the government over Medicare’s policy on the role of nurses in health assessments.
Doctors calling Medicare’s item interpretation hotline have had the bad news spelled out in the clearest possible terms, complete with examples, that they could not bill for practice nurses’ time spent on health assessments.  
The AMA received assurances from the health department nearly two weeks ago that a clear statement would be drawn up “within days” that would endorse practice nurses’ contributions to timed health assessments under Medicare items 701–707.

No end in sight for Wagga's prostate pain

By Alex McConachie

July 20, 2014, 5:45 p.m.
AFTER 12 months of lobbying, Wagga remains no closer to securing a prostate care nurse than when the campaign first began.
And in a blow for advocates, who have been tirelessly campaigning for the city to secure one of the federally funded nurses, Wagga may never receive one with the prostate care nurse program's future up in the air.
In a meeting with Health Minister Peter Dutton on Tuesday, member for Riverina Michael McCormack was told the minister was "uncertain" if there would be another round of nurses deployed to hospitals following this year's allocations.

GP Co-Payments.

Health spending is not out of control: Owler

23rd Jul 2014
AMA president Associate Professor Brian Owler has rejected a fundamental premise of the government's budget health reforms, saying health spending is not out of control.
Speaking today at the National Press Club in Canberra, Professor Owler also called for national discussion on what Australians want from their health system. 
"Is it such a bad thing that Australia spends more of its wealth on healthcare? As a nation becomes prosperous, its total expenditure on healthcare should increase just as it should on education," he said, before echoing the remarks of his predecessor Dr Steve Hambleton in describing the government as "bean counters".

Abbott asks AMA for alternative co-pay plan

23 July, 2014 Paul Smith
A revamp of the GP co-payment plan is now on the cards after Prime Minister Tony Abbott asked the AMA to draw up an alternative.
AMA president Associate Professor Brian Owler (pictured) has stressed that his organisation supported co-payments but not the details of the scheme announced in this year's budget, saying it risked putting some general practices out of business.
"The proposal threatens the viability of some medical practices — not just in general practice, but in radiology and pathology — particularly those in disadvantaged areas in which bulk-billing rates are high, such as those in Western Sydney," Professor Owler told the National Press Club on Wednesday.
The AMA's alternative model, requested by Mr Abbott two weeks ago, is under wraps.
Professor Owler claimed it would "provide protections for vulnerable patients and it will value general practice".

GP co-pay: can the Govt ignore Clive Palmer?

22 July, 2014 Paul Smith
Australian parliamentary democracy, if judged by the ugly verbal spats witnessed during the average Question Time, is a difficult concept to love when rendered in living, political flesh.
But when your executive pushes on with flawed, half-baked, semi-rational policies that look like they were thought up by someone who thinks Yes Minister is a documentary on good government, then even cynics can see its virtues.
Unless, as Treasurer Joe Hockey has been suggesting recently, that same executive can finds ways to act without the meddling of parliamentary democracy.

Most will ask for $7 waiver

25th Jul 2014
SIX in 10 Australians will ask GPs to waive the $7 co-payment if the government’s plan becomes law, shifting the cost of a $5 MBS rebate reduction back onto doctors, according to research commissioned by the RACGP.
The figure climbed to almost eight in 10 for full-time students and the unemployed.
And, more than three-quarters of respondents said people would visit their GP less if the co-payment became a reality.
RACGP president Dr Liz Marles said the survey made clear that the co-payment would increase, rather than decrease, pressure on the health system.

Health insurers push into GP clinics

A co-ordinated move into GP clinics would provide lucrative new growth opportunities for the private health insurance industry.
Joanna Heath
The private health insurance industry is planning a large-scale push into GP clinics, which it says will result in better health for its members and lower costs in the hospital system.
But it faces resistance from the peak doctors’ lobby, which says the move could lead to commercial interests dictating health outcomes for patients.
A controversial Queensland trial run by Medibank Private that guarantees its customers fast GP appointments at no cost will be expanded to include the creation of recommended care plans for customers deemed at risk of chronic illness.

Medicare Locals.

AMA explains vision for Medicare Locals’ replacement

24 July, 2014 Amanda Davey
The AMA says it intends to work closely with the government to make Primary Health Networks (PHNs) more effective than the “under-achieving” Medicare locals they are replacing.
Its president, Associate Professor Brian Owler (pictured) says he wants PHNs to be better targeted and driven by family doctors at the local level.
“While some Medicare locals have clearly done a good job in improving access to care, the overall Medicare local experiment has clearly failed – largely due to deliberate policy decisions to marginalise the involvement of GPs,” he says.
“We can’t afford to get it wrong a second time.”

Pharmacy, PBS and Medicine Issues.

Health Minister Peter Dutton removes comments from parents of sick kids from his Facebook site

  • July 26, 2014 12:00AM

Cystic fibrosis sufferer's dream professional debut

HEALTH Minister Peter Dutton has enraged parents of sick children by removing their posts from his Facebook account and accusing them of working for a drug company.
The parents are pleading for a subsidy for a breakthrough $300,000 per person per year medication that treats the deadly cystic fibrosis disease whose sufferers have a life expectancy of just 38 years.
On Saturday, July 12 those managing the minister’s Facebook account deleted all posts relating to the medicine Kalydeco after one parent used a swear word and said the subsidy delay was “killing” sufferers.
For more than a week afterwards parents who wanted to post on the website using the word Kalydeco claim subsequent posts were blocked from public view.
It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out, with the AMA suggesting alternatives, in secret, to Mr Abbott. I wonder why not to Mr Dutton
The crucial New Senate has now really shown itself to be rather an extreme rabble and just where we will all wind up is rather in the lap of the gods!
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:

Wednesday, July 30, 2014

Can You Believe Something This Crazy Seems To Be Happening? I Really Can’t

This appeared a few days ago:

Campaign for single eHealth record, says Young

By Natasha Egan on July 23, 2014 in In-depth, Industry, Technology
AUDIO: Aged Care Industry Information Technology Council representative Rod Young has called on the sector to campaign for a single eHealth and aged care record at the council’s annual technology conference currently underway in Hobart.
Mr Young, Associate Professor Kate Swanton from Feros Care and Dr George Margelis took part in a panel discussion on the government’s eHealth record at the Information Technology in Aged Care (ITAC) conference on Tuesday.
All three speakers agreed that, when it began doing assessments in July 2015, the My Aged Care record would add another unnecessary layer to an already complex system.
After the panel discussion, AAA’s Natasha Egan spoke with Mr Young, a former peak body CEO and now an advocacy and policy consultant with service provider IRT, about the problems an additional record posed for the sector:
Here is the link and the audio is at the bottom and summarises things in a couple of minutes
That there needs to be a campaign to have what is needed in an Aged Care Record optimally integrated into whatever other patient records are held by Government would seem blindingly obvious - recognising that there will be commonality in some aspects - while there may be administrative differences.
Just where all this might fit with the PCEHR and how the details might workout needs to be watched - especially given the obscurity of just what is happening with the PCEHR.
A very useful web site to keep an eye on regarding Aged Care Health IT is found here:

Tuesday, July 29, 2014

It Looks Like South Australia Has Caught The Very Problematic Hospital IT Roll Out Disease. What A Disappointment.

This appeared a few days ago:

Minister puts future of $422m SA eHealth system in doubt

Paris Cowan

EPAS still on hold.

South Australian Health Minister Jack Snelling has refused to commit to the continuation of the state’s $422 million electronic patient administration system (EPAS) rollout, which is currently on hold as the government works through funding and performance issues.
“We are having a look at it at the moment,” Snelling said, when challenged by opposition MP Duncan McFetridge to guarantee the rollout during an estimates hearing late last week.
“We have obviously put a pause on the rollout, which has partly been driven as a result of the federal cuts."
The SA Government paused a cluster of capital works programs within the health portfolio in response to a fall in revenue from the Commonwealth Budget.
But the halt on EPAS work has also come as the result of user headaches plaguing the implementation.
“It was sensible also, for the moment, to pause on EPAS while we have a bit of a rethink about it,” Snelling said.
The opposition raised anecdotal evidence of ambulance service dashboards displaying no data for months, and of doctors who have to click through up to 40 screens to admit a patient.
McFetridge claimed 300 medication errors in one hospital were made by the system in its first few weeks, with staff forced to return to paper until the system was able to operate safely.
“There is no arguing that we have had difficulties with the patient administration side, in particular with the billing module. They are things that are being rectified by Allscripts, which is the provider of the software,” Snelling said.
More here:
In September last year all seemed to be going OK.
See here:
However there had been some rumbles earlier in the same year:
But the SA Health CIO had come out, again in September last year, saying all was OK:
See here:
It seems now that wheels are looking a little rickety!
The oldie of a US Billing system not working in Australia seems to have also popped up. Those of us who have been around for a while have seen all this before - as we have also seen the other issues raised.
Sadly SA seems to be joining Victoria, Queensland and WA in having Hospital IT problems. I wonder is NSW going as well as its brochures and web-sites claim?

Monday, July 28, 2014

Weekly Australian Health IT Links – 28th July, 2014.

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

Some interesting items this week - especially the apparent problems with the South Australian e-Health roll out - that until recently was seen as going pretty well. Given there has not been a change of Government in SA, who have driven the project for a good number of years, it seems there is really a problem. After the problems in Qld, Victoria and WA this is all getting a bit frustrating!

Minister puts future of $422m SA eHealth system in doubt

EPAS still on hold.

South Australian Health Minister Jack Snelling has refused to commit to the continuation of the state’s $422 million electronic patient administration system (EPAS) rollout, which is currently on hold as the government works through funding and performance issues.
“We are having a look at it at the moment,” Snelling said, when challenged by opposition MP Duncan McFetridge to guarantee the rollout during an estimates hearing late last week.
“We have obviously put a pause on the rollout, which has partly been driven as a result of the federal cuts."

Andrew Knight: e-Health revolution

Andrew Knight
Monday, 21 July, 2014
THE benefits of having an effective electronic health record seem obvious. Rapid sharing of information, reduction of duplication and greater ownership by patients of their health information offer hope of reduced harm and savings in time and money.
The review of the personally controlled electronic health record (PCEHR) commissioned late last year by the federal government certainly thinks so.
The reviewers point to modelling which suggests that e-health changes could lead to savings of $7 billion a year by 2020. The modelling estimates implementing e-health would avoid 5000 deaths, two million outpatient visits, 390 000 hospital admissions and 10 million laboratory and imaging tests by 2020.
The overwhelming majority of those making submissions to the review were also supportive. According to the review, more than 1.2 million Australians have demonstrated support by registering for an e-health record, exceeding the 2013 target.

Campaign for single eHealth record, says Young

By Natasha Egan on July 23, 2014 in In-depth, Industry, Technology
AUDIO: Aged Care Industry Information Technology Council representative Rod Young has called on the sector to campaign for a single eHealth and aged care record at the council’s annual technology conference currently underway in Hobart.
Mr Young, Associate Professor Kate Swanton from Feros Care and Dr George Margelis took part in a panel discussion on the government’s eHealth record at the Information Technology in Aged Care (ITAC) conference on Tuesday.
All three speakers agreed that, when it began doing assessments in July 2015, the My Aged Care record would add another unnecessary layer to an already complex system.

Providers get update on sector’s ‘ICT vision’

By Natasha Egan on July 25, 2014 in Industry, Technology
 AUDIO: Work is underway to achieve aged care’s ICT vision, the ITAC conference heard in Hobart this week, but the sector will remain vigilant on key issues including the client eHealth record.
Aged Care Industry IT Council (ACIITC) chair Suri Ramanathan gave a report on progress since the council, which is a joint initiative of Aged & Community Services Australia (ACSA) and Leading Age Services Australia (LASA), launched the IT roadmap in March.
Mr Ramanathan said fact sheets developed two years ago as part of the Pathfinder project to help providers roll out the eHealth record system would soon be available on ACIITC’s website.

My eHealth Record

My eHealth Record is a way of securely storing and sharing important healthcare information with your consent, so that it is easily and quickly available when needed for your ongoing care. Click on a category below to find out more...

eHealthNT Happenings 

The new eHealthNT Happenings will be a regular publication, which over time will provide updates on all eHealth initiatives in the Northern Territory. The first issue (to be published soon) will provide information on the project to transition registered consumers and healthcare providers from the My eHealth Record service to the National eHealth Record System (also known as the personally controlled electronic health record or PCEHR system).

Tasmania – tapping scripts into the PCEHR

Tasmania is set to become the first state to connect and upload information to the National Prescribe and Dispense Repository. The move comes after extensive development work, including the digitisation of discharge prescription summaries, along with outpatient prescribing.
“We’re doing things a little bit backwards,” says Tom Simpson, executive director, statewide hospital pharmacy in Tasmania. “We implemented the last thing first, and we’ll do what would traditionally have been the first thing towards the end.”
The backwards implementation was a positive move for Tasmanian hospitals, because it meant getting the doctors and other clinical staff on board. This might not have happened if the highly complex move to in-patient prescribing had been the first task out of the blocks.

System issues being fixed (for providers)

This page lists current issues which may impact Healthcare Providers using the PCEHR system.
It includes what is being done to resolve the issue and ways you can work around them in the National Provider Portal and in clinical information systems.
Need help? Select one of the following options if you have a question or require assistance with any of our products or services.

Help Centre

Any personal information you provide to NEHTA will be used by NEHTA to assist us with responding to your enquiry. If we cannot resolve your enquiry, we may need to pass your information on to the Department of Human Services or Department of Health.  If you do not wish your enquiry to be transferred to another entity, please let us know. 
For more information on the ways NEHTA handle your personal information, how you can access and seek correction of the information, how privacy complaints can be made and how NEHTA deals with such complaints, please see the NEHTA Privacy Policy.

Technology One Assists Epworth Hospital

Epworth HealthCare has opened two new hospitals in Camberwell and Hawthorn with the help of TechnologyOne’s OneHealth Software.

Healthdirect Australia looks through the 'software lens'

Summary: Healthdirect Australia has transformed its entire back-end architecture on the basis that software applications will play a crucial role in how it delivers clinical information to the public.
By Aimee Chanthadavong | July 22, 2014 -- 07:32 GMT (17:32 AEST)
Healthdirect Australia started out as an initiative set up by the Council of Australian Governments for procurement in 2006. But five years down the track as the world began to move online for advice, it forced Healthdirect to change its strategy from being a telephony based contact centre to a multichannel information service provider.
Speaking at the Gartner Application Architecture, Development and Integration Summit in Sydney on Tuesday, Bruce Haefele, Healthdirect Australia chief architect, said it was important for the organisation to move into offering digital services across all of its brands, including Pregnancy Birth and Baby, after hours GP helpline, mindhealthconnect, and National Health Services Directory.

Question: NEHTA CDA & GP referrals

Posted on July 22, 2014 by Grahame Grieve
Is there any example of NEHTA compliant CDA document that I can look at from a perspective of a GP referral form ( http://nhv.org.au/uploads/cms/files/VIC%20-%20GP%20Referral%20(March%202013).rtf )? Is there a tool that can be used to navigate and generate the CDA from a HL7 v2 message?
There’s been a lot of discussion over the last decade or so about creating a CDA document for these kind of referral forms. I saw a pretty near complete set of functional requirements at one point. But for various reasons, the project to build this has got any funding, either as a NEHTA project, or a standards Australia project (it’s actually been on the IT-14-6-6 project list for a number of years, mostly with my name on it).

Robots fail to impress in surgery

  • Joseph Walker
  • The Wall Street Journal
  • July 24, 2014 9:49AM
A new study finds treating bladder cancer with a surgical robot made by Intuitive Surgical is no better at reducing procedural complications than performing the procedure with traditional surgery, a result that surprised researchers, who had expected the robotic technology to be superior to human hands alone.
The small study may cast further doubt on the benefits of Intuitive Surgical’s da Vinci robot, which allows surgeons to perform minimally invasive procedures from computer consoles that control the robot’s arms and surgical tools.
A study last year questioned the cost benefit of the da Vinci for hysterectomies, or uterus removal, compared with minimally invasive laparoscopic procedures done by hand.

Robot enhances human dexterity

24 July, 2014 Rachel Worsley
Researchers have developed a robot that enhances the grasping motion of people with limited dexterity.
The robot, which is worn on the wrist, features two extra fingers worn around the one’s wrist and would that help the user achieve routine tasks that generally require two hands, such as removing a bottle cap or lifting a heavy object.
The Massachusetts Institute of Technology (MIT) researchers hope their work will lead to a model that can be scaled down an integrated with a watch or a bracelet.
23 July 2014, 11.50pm AEST

Evidence based medicine is broken. Why we need data and technology to fix it

David Glance
A recent paper in the British Medical Journal suggests that evidence based medicine is in crisis. Evidence based medicine is based on the practice of employing treatments that have scientific research that backs up their effectiveness. It is usually set against medical practice that is based on anecdotal experience or simply doing things because that is the way they always have been done.

The ways evidence based medicine is broken

The authors of the paper point out however that there are a number of problems with evidence based medicine that together, significantly compromise its effectiveness. The first problem is that evidence based medicine plays right into the hands of companies and organisations with a vested interest in seeing a treatment recommended. Of particular concern are drugs that are recommended for treating pre-diseases. The classic example of this is the use of [statins]9http://en.wikipedia.org/wiki/Statin) to lower cholesterol in the attempt of reducing cardiovascular disease.

Easy GPeasy - checks at the touch of a button

Jamie Morton is science reporter at the NZ Herald.
5:00 AM Monday Jul 21, 2014
Digital innovations expected to change face of system in next 20 years.
A future where a health check-up could take just a few taps of your smartphone has moved a step closer.
AUT University has launched its Centre for eHealth, bringing together researchers with health sector partners to share developments in innovation.
The centre will build on work by the Ministry of Health's IT Health Board, which has overseen a project that will give patients of nearly all GP practices access to their records through portals.
Dozens of researchers at AUT, including experts in IT, engineering, business, design and infomatics, will work together on projects using technology to improve the health system.

General practitioners order more imaging in Australia

July 22, 2014 -- General practitioners (GPs) in Australia are placing more orders for medical imaging exams, with total orders for imaging growing 45% from 2005 to 2012, according to a survey released this week by researchers from the University of Sydney. The numbers also indicate a shift away from general radiography and toward more advanced modalities such as ultrasound, CT, and MRI.
The figures were released on July 22 as part of the Bettering the Evaluation and Care of Health (BEACH) program, a national study of clinical activity by general practitioners in Australia. The report compares imaging use over two time periods: from 2002 to 2005 and from 2009 to 2012. The BEACH data represent physician orders for imaging exams, as opposed to exams that were eventually performed and billed to the federal Medicare system.
In general, the report found that while Australian general practitioners mostly comply with appropriateness guidelines, there is some room for improvement in several areas. The lead author on the study was Helena Britt from the University of Sydney.

National broadband network: Coalition spends $10m on cost-benefit analyses

THE Abbott Government has spent more than $10 million in taxpayers’ money to work out whether the national broadband network is good value.
As superfast broadband continues to be rolled out across the country, consultants have been the biggest winners, pocketing millions of dollars from numerous reviews and cost-benefit analyses.
A Question on Notice tabled in Federal Parliament revealed the external consulting cost for the NBN was $10.1 million. The cost of implementing the recommendations was not included.

Six Clicks: The best Linux desktop environments

Summary: Unlike Windows or Mac OS X, Linux offers a wide variety of desktop environments. Here are my picks of the most important of these PC interfaces.