September 8 Edition.
The big issue for this week will be just what a mess politics seems to have become. One week back and already the 45th Parliament is seeming rather like a childlike rabble. Heavens knows just how we can get sane government from all this.
Globally things seem to be rather fragile with no one quite sure what is going to rock the boat.
If you really want to be depressed try this from Alan Kohler.
“Here is a fantastic presentation by Richard Koo, the chief economist of Nomura Research Institute, about what’s wrong with monetary policy – “Surviving in the Intellectually Bankrupt Monetary Policy Environment”. It’s an hour and a half long, but worth it!”
Here is the link.
I have watched it through and have the deep sense we might all be living in a fool’s paradise. Time will tell I guess.
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Not good news from Australia also.
- August 30 2016 - 11:09AM
Australia's growing debt a 'ticking time bomb', says TD Securities
Jens Meyer
Australia's fiscal position is becoming increasingly untenable, even if current debt and deficit metrics remain low by global standards, TD Securities has warned in a strongly worded note to clients.
"The government is borrowing record amounts to consume, not invest - a ticking fiscal time bomb," the investment firm's chief Asia-Pacific macro strategist Annette Beacher said on Tuesday.
Treasurer Scott Morrison welcomes Moody's decision to maintain Australia's credit rating at AAA. Courtesy ABC News 24.
TD Securities expects $100 billion of new bonds to be issued every year over the next three years at least, as the inability to fix the budget due to populist stonewalling sparks an "explosion" of government bonds.
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Here are a few other things I have noticed.
General Budget Issues.
- August 29 2016 - 12:00AM
Turnbull leaves the door ajar on super changes as Shorten steps up banks, same-sex pressure
James Massola
Prime Minster Malcolm Turnbull appears to have left the door open to dropping the most controversial element of his government's $6 billion superannuation package, while pointing out the "vast bulk" of it had been accepted.
Liberal MPs are expected to raise their concerns about the proposed $500,000 non-concessional lifetime cap on contributions, which is the most controversial element of the package, during a party room meeting on Monday that comes after a wipe-out result for the Country Liberal Party in the Northern Territory.
Mr Turnbull said the super package had, overall, been "very well received" and criticised Mr Shorten's decision to hold back details of Labor's alternate proposal – which also includes blocking three other measures in the package and lowering the income threshold at which point a 30 per cent tax on a person's super would apply – until after the election.
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- Opinion
- Updated Aug 29 2016 at 12:15 AM
Fiscal repair is not about banks and Medicare
by The Australian Financial Review
Add the eight-week federal election campaign to the eight weeks since the the July 2 poll and Bill Shorten has been running a four-month Mediscare and anti-big business campaign. That's a full third of the year spending peddling the political lie that the Turnbull government has had some plan to "privatise", dismantle or cut Medicare. Now Mr Shorten has sought to elevate the non-existent privatisation of Medicare to the top of the nation's parliamentary priorities. While the opposition would work on "fair" budget repair, this was not the chief concern for the new parliament. "If you ask me," Mr Shorten says, "this week in Parliament, Medicare remains the number one issue." Forget about about the budget deficit, the rising public debt, the creaking tax system and falling national income. Fighting a make-believe policy designed to scare sick voters is Mr Shorten's No.1 priority. As our political correspondent, Phillip Coorey, quoted a Labor source in summarising the party's basic approach as Parliament sets to resume this week: "Banks and Medicare mate."
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- August 29 2016 - 9:06PM
Malcolm Turnbull echoes Kevin Rudd on 'massive moral challenge' over budget
James Massola
Prime Minister Malcolm Turnbull has declared budget repair the "massive moral challenge" of the new Parliament, challenging Labor, the Greens and the crossbench to tackle the nation's ballooning debt "head-on" while echoing Kevin Rudd's stark warning about climate change a decade ago.
And Fairfax Media has obtained a leaked copy of a "backbenchers brief" that sets out the details of the so-called omnibus savings bill, which largely contains measures that Labor agreed to, or indicated it could agree to, during the election campaign.
The leaked document reveals the omnibus bill is designed to save $6.1 billion over four years and includes 24 measures - up from the 21 that had initially been foreshadowed.
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Shades of Dr Evil in Morrison
- on August 29, 2016, 6:31 am
Austin Powers fans will understand.
Dr Evil stared at the camera and told the world that he was holding it to ransom — for one million dollars.
To his left, a lackey pointed out that one million dollars wasn’t exactly a lot of money.
So Dr Evil ramped up his demand to one hundred billion dollars.
Scott Morrison is no Dr Evil but his speech last week warning of Australia facing gross debt of $1 trillion if nothing was done to fix the Budget was straight from The Spy Who Shagged Me.
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Nasty Budget measures resurrected in omnibus Bill
August 30, 201612:35pm
Turnbull outlines new parliament battle plan
THE door to the Budget crypt has been wrenched open and measures you might have thought dead and buried two years ago have emerged as live legislation.
They are among 24 items in an omnibus Bill of spending cuts worth $6.1 billion — most backed by both the government and Labor.
They will cut a range of payments from the dole to pensions to student loan concessions, which are wrapped in a 600-page document now being studied by the Opposition.
Manager of Opposition business Tony Burke today warned there was no guarantee all elements of the government Bill would be accepted.
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We must prepare for economic shocks: GG
August 30, 20164:11pm
Governor-General Sir Peter Cosgrove has warned the new parliament that failure to prepare against any shocks in the global economy will leave the Australian economy and living standards vulnerable.
Opening the 45th parliament on Tuesday, Sir Peter said it was prudent for the government to strengthen the economy's resilience while committing to maintaining strong fiscal discipline and supporting policies to encourage jobs, growth and investment.
"My government will continue to bring the budget back into balance, by controlling expenditure growth and by strengthening economic growth," he said in an address prepared by the prime minister's office to a joint sitting of MPs and senators.
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- September 1 2016 - 7:18AM
Australia has an underemployment problem
· Michael Heath
The strength of Australia's jobs market is being overstated by a surge in casual positions and an inability by workers to secure more hours.
While the unemployment rate fell to 5.7 per cent in July from 6.3 per cent a year earlier, 87 per cent of the jobs created in that period were part-time: a definition that covers anything from 1 hour a week to 35 hours. At the same time, the underemployment rate is stuck near a record high of 8.5 per cent.
The changing labour market reflects more jobs generated in services industries -- which rely less on full-time employees -- amid the waning of a mining-investment boom. The resulting lift in part-time jobs, along with a rise in underemployment, has seen a sharp slowdown in wage growth. The flow-on effect: weak inflation that spurred the Reserve Bank of Australia to cut rates to a record-low 1.5 per cent last month.
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Parliament given first budget repair task
Australian Associated Press
August 31, 2016 7:00pm
The federal government has launched into its "moral challenge" to repair the budget, introducing a $6.1 billion savings bill as parliament finally got down to business after a near four-month absence.
Prime Minister Malcolm Turnbull chose the new parliament's first question time on Wednesday to remind every MP and senator of their responsibility to support the task of budget repair.
"Failing to do so betrays our children and grandchildren," he said.
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COMMENT
- September 1 2016 - 8:26PM
Scott Morrison's $6 billion 'omnibus' savings bill: the devil in the detail
Jessica Irvine
I don't expect you've had time to read the 260 pages of legislation, plus 403 -age explanatory memorandum, detailing the government's $6 billion "omnibus" savings bill.
Much has been made of Treasury's $100 million calculation error. But ignore that. That's the sideshow.
The substance of the 24 individual measures that comprise the bill is far more concerning in the way it targets some of the most vulnerable groups in society.
So here's the fine print. Read it and weep if you are someone, or love someone, who falls into one or more of the following groups:
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- September 2 2016 - 2:05PM
Apartment correction to cause Australia-wide recession: report warns
Simon Johanson
A "correction" in the apartment market could see sharp falls in all Australian home prices and a nationwide recession, a gloomy bank analyst report on the housing market warns.
The report by analysts CLSA paints a "base case" scenario which says Australia's housing cycle has "peaked," with household debt now extending the country's property bubble.
The shift by big banks to tighten lending standards is likely to cause a "correction" and "crisis" in cheap apartments which will spread, leading to defaults among smaller developers and a sharp contraction in construction, CLSA says.
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Government debt: Turnbull, Morrison can’t delay budget repair
- The Australian
- 12:00AM September 3, 2016
Judith Sloan
It’s a big call by Malcolm Turnbull to say “one way or another, at the end of the 45th parliament, I want Australians to be able to say that this parliament has come to terms with the budgetary challenges we face”.
One of the problems he faces is that there is no consensus that we do have budgetary challenges, even though Scott Morrison has outlined the basic, incontestable facts in a recent speech.
“As a government we inherited $240 billion in accumulated deficits and a debt of $317bn, projected to increase to $667bn within the next 10 years,” the Treasurer says. “We have so far acted to reduce that projected debt by $55bn. However, we are still a long way from where we need to be, and time is running out to get there.
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Health Budget Issues.
Bill Shorten’s Medi-scare campaign undermined by new figures
SAMANTHA MAIDEN, National political editor, The Sunday Telegraph
August 28, 2016 12:00am
OPPOSITION Leader Bill Shorten’s Medi-scare campaign has been undermined by new figures that reveal there were 17 million more bulk-billed GP visits last year than under Labor.
During the bitter election campaign, Labor advertisements and text messages warned voters: “Time is running out to Save Medicare.”
Labor accused Malcolm Turnbull of introducing a GP tax by stealth because he maintained a freeze to GP payments that is forcing more doctors to abandon bulk billing.
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- August 29 2016 - 7:10AM
Lack of competition allows specialist doctors to charge according to patient income
Harriet Alexander
Rally car driver Bruce Garland was happy with the results of his prostate surgery but was left with a feeling he had been ripped off.
The costs associated with the surgery were listed to show the fees for the equipment and the surgeon, but a disclaimer said there may be other fees for assistance.
"We looked at it and said, 'Maybe at worst it's $12,000'," Mr Garland said. "It ended up being $18,000 after everyone else charged their fees as well.
"There was nothing wrong with the job, but it was just the cost of it, and we had to pay upfront."
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More than 100k patients waiting for dental care in Sydney
9NEWS
The list of those needing dental treatment in NSW has blown out, with residents in Sydney's western suburbs suffering the most.
More than 100,000 adults and children are waiting to receive general dental care in Sydney, new figures have revealed.
The latest figures from NSW Health show around 100,000 adults and more than 13,000 children are waiting for general dental care.
The biggest queue is in Sydney's south-west, with more than 20,000 people waiting for treatment, followed by the western suburbs, with about 12,000 on the list.
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- September 1 2016 - 8:17PM
Drug companies paying doctors millions for 'educational' events, consultancies
Daniel Burdon
Drug companies have paid Australian doctors and nurses more than $64 million since April 2015 to attend "educational events", advisory group meetings and to act as consultants to the industry.
Thousands of doctors and nurses shared in about $8.5 million in payments from 35 drug companies between October 2015 and April this year, new data from Medicines Australia has revealed.
Drug companies paid doctors and nurses more than $8 million in the six months to April this year, new data shows.
The $8.5 million for the six months to April this year comes on top of about $56 million the companies paid health professionals between April 2015 and October 2015, including travel and accommodation and hospitality to attend events, speaking and consultancy fees.
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SkyGen, CosMediTour and others offer cheap surgery in Asia
- The Australian
- 12:00AM September 2, 2016
Sean Parnell
The best way to explain what Daniel Donner and his colleagues offer is by using one of their earliest clients as an example.
Ra Herangi is a fly-in, fly-out worker who provides for his family and is proud of his Polynesian roots. At 59, Herangi is out working in remote Western Australia while his wife Lee keeps home base in Perth. Yet two years ago, his osteoporosis had him wondering how long he could keep it up. Hauling his heavy frame up 300 stairs each day at the mine site was taking a toll on his hip, and the doctors and specialists, partly funded by his health insurer, agreed a hip replacement was needed.
Herangi took long service leave to have the operation in a Perth private hospital, and do the necessary rehabilitation to allow him to keep working. Astonishingly, only 12 hours before he was due to be admitted, his insurer notified him he was not covered.
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Cheaper prescription drugs to slash bills for chronically ill
Exclusive, Samantha Maiden, Herald Sun
September 4, 2016 5:00am
CHRONICALLY ill patients will save up to $400 a year when the costs of prescription medicines are slashed from next month.
The federal government has predicted one-in-three medicines will drop in price as a result of better bargaining with drug companies.
Sufferers of common ailments including diabetes, anxiety, high blood pressure and high cholesterol are the big winners, saving up to $20 a script.
As the government moves to blunt Labor’s attacks over Medicare, some of the biggest price cuts the Pharmaceutical Benefits Scheme (PBS) has ever delivered to patients will come into force on October 1.
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Scott Morrison's car-crash logic and the real story behind the 'taxed-nots'
There is a new divide in treasurers – those who simplistically view the world through ill-thought out binary oppositions, and those who don’t
Monday 29 August 2016 10.45 AEST Last modified on Monday 29 August 2016 11.39 AEST
Last week, in the lead up to the new parliament, the treasurer Scott Morrison sought to outline his economic vision. Unfortunately, rather than provide any clear ideas of where he sees the nation’s economy heading, the speech was a mishmash of internal inconsistencies, statistical misreadings, and statements which made less sense the more you paid attention to them.
The big take away from the speech was Morrison’s desire to ape Joe Hockey’s outlook of the world as being divided into two types. Where Joe Hockey talked of “lifters and leaners” Scott Morrison has decided that “there is a new divide – the taxed and the taxed nots”.
Sigh.
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COMMENT
- August 30 2016 - 10:14PM
Scott Morrison is attacking the old when he puts down the 'taxed-nots'
Ross Gittins
It's a sad day when economic commentators like me have to spend so much time explaining what's wrong or misleading about the things the federal Treasurer says, rather than backing up his efforts to educate the public on economic realities and helping him fight for sensible though unpopular policies.
To be fair, Scott Morrison did have useful points to make in his big speech last week, his first major contribution since the election.
But then he veered off onto reinforcing the mythology of the greedy well-off, who resent being taxed to help those less fortunate than themselves.
He announced there was a new divide in the community – "the taxed and the taxed-nots".
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Health Insurance Issues.
Ramsay slams health insurers on reform
- The Australian
- 4:36PM August 30, 2016
Sarah-Jane Tasker
The head of private hospital group Ramsay Health Care, Chris Rex, has warned state governments could be forced to pay more for medical devices if the federal government looks after “its friends” the health insurers with new reforms.
Mr Rex, saying he has doubts there will be reform of the Prostheses List, has argued that private health insurers “made a lot of noise” and came up with some “infantile arguments” around the issue.
Health Minister Sussan Ley has promised private health insurers that she will look to reform the Prostheses List, which the government uses to regulate how much health funds pay for prosthetics, human tissues and device implants.
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iSelect, Ley to discuss ‘worrying trend’
- The Australian
- 3:20PM August 30, 2016
Sarah-Jane Tasker
The head of comparator website iSelect, Scott Wilson, will head to Canberra tomorrow to meet Health Minister Sussan Ley, to discuss health insurance reform as he warns of a “worrying trend” of younger people not buying insurance.
Mr Wilson, who today delivered a strong second half result including a 34 per cent jump in annual net profit after tax to $12.9 million, said he would meet Ms Ley and her advisers because the company was keen to take an active role in reform discussions.
“This is something iSelect has not done well in the past,” he said.
“There are more than 1.3 million Australians that come and compare health insurance with us each year.
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Private health exodus: Premium rises lead to membership decline
September 2, 20169:54pm
THE proportion of the population in a health fund has fallen for the first time in 15 years as premiums rises three times the inflation rate threaten to send the industry into a death spiral.
Exclusive IPSOS research obtained by News Corp Australia shows if no action is taken to control premium rises, one in five fund members will downgrade or drop their cover within six years.
Health funds say Health Minister Sussan Ley could save the day and cut premiums by between $150 and $300 a year if she changes to the way the government sets the price for prostheses like hip and knee replacements.
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Pharmacy Issues.
31 August, 2016
Posted by Felicity Nelson
Public submissions to the King Review into pharmacy remuneration and regulation have criticised “shonky” practices and “rampant capitalism” in the industry
The Federal Government created the review, chaired by economist Professor Stephen King, in 2015 to recommend changes to the industry.
The review panel is currently consulting stakeholders through an online questionnaire, public forums and submissions. The panel will provide a final report to Federal Health Minister Sussan Ley by March next year.
Five out of seven submissions from doctors and pharmacists have been published online so far.
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Superannuation Issues.
How much superannuation do you really need?
- The Australian
- 8:13PM August 29, 2016
Tony Negline
The government has proclaimed that $1.6 million is enough to provide sufficient income in retirement.
Is it right? This is a good question but before we can answer it, we need to consider some numbers.
One of the good policies in the 2006 Better Super regime introduced by the Howard/Costello government was the removal of Reasonable Benefit Limits or RBLs. Back then we had two RBLs — a lump sum and pension RBLs.
Each July 1 these RBLs were indexed by movements in average weekly earnings. The 2006-07 lump sum RBL was about $680,000 and the pension RBL was $1.35m. If these had been indexed to the 2015-16 financial year then they would have had been worth about $930,000 and $1.87m.
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Scott Morrison needs to rethink public sector superannuation
- The Australian
- 12:00AM August 30, 2016
Judith Sloan
It was always going to come out that the real rorts and costs in the superannuation system are the public sector defined benefit superannuation schemes.
Just ignore Scott Morrison’s assurances that “commensurate measures” will ensure the privileged ones on defined benefit schemes will be treated like everyone else; it’s complete twaddle and he knows it.
Or he should know it, unless he has been hoodwinked by his bureaucratic advisers who are, almost to a man and a woman, beneficiaries of these gold-plated schemes.
Let us first consider constitutionally protected employees. They include judges, tribunal members and senior state public servants. As their titles suggest, they won’t be affected at all by the changes to the taxation and regulation of superannuation announced in the budget.
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Tony Abbott’s grenade for superannuation reforms
- The Australian
- 12:00AM September 3, 2016
Sarah Martin
Tony Abbott has clashed with Scott Morrison over his superannuation changes, labelling them “deeply unpopular” with the Coalition’s base, as support builds for the Treasurer to increase the cap on after-tax contributions to $1 million.
In a “tetchy” private meeting with a group of Liberal and Nationals MPs in Parliament House on Thursday, Mr Abbott confronted Mr Morrison and Minister for Revenue Kelly O’Dwyer about their proposed $6 billion super package. He argued the government was wrong to offer super concessions to low-income earners.
He also argued for the government to abandon its proposed cap on post-tax contributions.
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- September 2 2016
Defined benefit fund members still in the dark over changes
Daryl Dixon
While public attention focuses on whether the $500,000 lifetime non-concessional super cap will be legislated, defined benefit fund members are yet to learn precisely how the budget changes will affect them. The greatest area of uncertainty is how the proposed $1.6 million cap on pension fund accounts will be applied to defined benefit pensions.
The proposed arrangements for taxing defined benefit pension income were set out clearly in the budget. The 10 per cent tax offset for unfunded pensions after age 60 will be capped at a maximum annual income of $100,000 increasing the income tax payable on pensions in excess of this amount. Recipients of tax-free funded pensions will be subject to income tax on 50 per cent of their annual pension in excess of $100,000.
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I look forward to comments on all this!
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David.
7 comments:
In his speech at the Opening of Parliament why didn't the Governor-General make any mention of eHealth Reforms, of the Australian Digital Health Agency (ADHA), and of My Medical Record being made available for all Australians? Accidental omission maybe?
In some of his first public remarks upon taking up the high-profile role, Mr Kelsey told the Committee for the Economic Development of Australia (CEDA) in Brisbane recently that the modernisation of healthcare through the implementation of digital technology was now the single most important public policy agenda.
David, it's such a pity the Governor-General's speech made no reference to that fact. Left hand right hand stuff I guess.
Bonfire of the faxes, Kesley if you want to be taken seriously and through you the ADHA,
1. Leave the slogans at the door, understand there is a lot of work yet to done
2. If you choose to use naff slogans use your own not a rehash of an NHS phrase from a few years ago
3. Get over the UK, this is Aus, a blend of NHS structural thinking hashed together based on US systems might not work
4. Let us know when you are ready to get down from the power point engagements and Twitter and start talking in open public forums where debate can take place and everyone's views can be heard
5. If you have so much faith in MyHR and it potential to support your information dreams, invite the ACS to look it over for you.
I do hope the ADHA reads the Royle Report. There's a long list of things wrong with eHealth in this country.
For a start they could look at fixing Secure Messaging. This is what the Royle report said:
23. Implement a standardised Secure Messaging platform for the medical industry, prioritising support for standards compliant platforms.
24. Expand the Secure Messaging strategy to include exchange of secure communication between the medical industry and consumers to facilitate improved communications and workflow efficiencies.
At the moment the MyHR is being used to get discharge summaries from hospitals to GPs. It's a side effect that these summaries are held in MyHR so that they can be read by all and sundry.
BTW, the The Health Minister keeps telling us the MyHR is a "summary of your health information". In one respect she's right. It can potentially contain four types of summary
Shared Health Summary
Personal Health Summary
(Multiple) Event Summaries
(Multiple) Discharge Summaries
A system that can contain lots of summaries can soon stop being a summary system.
IMHO, the biggest hurdles ADHA/Mr Kelsey is going to face are:
1. Convincing us that there is value to patients that justifies the billions in cost
2. That it's not just an underhand way of the government getting at huge amounts of health data that it couldn't get at before and which it can link to other data bases.
23. Implement a standardised Secure Messaging platform for the medical industry, prioritising support for standards compliant platforms.
What does that mean in reality?
I have said this so many times that it feels like an endless loop, but to get secure messaging working requires a few basic things to be fixed.
1. We need to have message inter-operability through standards compliance testing of both senders and receivers because without that turning on a stream of messages that doesn't work or crashes systems is a recipe for disaster and a threat to patient safety. There is no way that systems are robust in this way at the moment and they are not agile enough to fix problems in anything under a few months time frame. Currently there are a host of "fixes" that must be applied for things to work and every new release of PMS software introduces new issues because of the lack of compliance testing. Messaging vendors do a lot more than transfer a message.
2. There is a lack of infrastructure. The PIP program only targeted GPs and most clinical data does not flow from GP to GP. What about specialists, hospitals, allied health etc etc
3. The PKI infrastructure is inadequate with many non GP providers not registered and certificate expiry and renewal remains a manual process which is not scaleable. The process of getting certificates remains burdensome and people can't use the one certificate for everything.
4. The directory services are woefully inadequate
5. The provider identifiers are not location specific and location identifiers are optional and often obtained for an entire organisation rather than every location. This combination makes reliable addressing impossible and reliable addressing is vital for privacy.
Yes most of these issues can be solved by going outside the national infrastructure and being present at both ends of the transaction, and we do solve them, but the demand that messaging just happen freely ignores the reality. I have wasted significant time and effort trying to bring these issues to the attention of NEHTA with some vague promise that they would do something but they never have and I doubt that the management level of these organisations has the the ability to understand the real technical issues. Instead its all about "Change Management", which is true, but its organisations such as NEHTA, DOHA and now ADHA that need to change, or else we will stay stuck in this endless loop of wanting inter-operable secure messaging, but not knowing that if we had it tomorrow it would be an unmitigated disaster, which would be a significant threat to patient safety and would overwhelm the support desks of every Health IT entity in the country. We do need to be able to transfer any compliant message securely to any health care entity with a high level of confidence that it will be understood correctly at the other end. The transport is the easy part, and is not difficult if the real issues were addressed. I doubt they will be.
For those wondering how to vote in this week's poll and adding to the issues Andrew has identified, this is something else the Royle report says:
Medications / Prescriptions
* The lack of a universally accepted and utilised identifier for medications continues to result in unnecessary risks being experienced in drug matching between systems particularly in regards to combined drugs. Further investment is required in the development and implementation of a universally accepted medications terminology or in a program that makes the Australian Medications Terminology (AMT) implementable.
* A medication repository is vital to enabling a more collaborative health care environment. The PCEHR medication data (NPDR) currently available is sourced through Medicare (PBS data), it is administrative and therefore not meaningful or useful in an electronic health record setting as its design and the terminology used was never intended or created for this purpose (it does not provide fundamental information such as dosage and instructions, for example). This results in the data being mostly meaningless and incomplete for both the patient and health care practitioner.
* The benefits from a national medication repository will only be totally realised when all medications for all patients are always available.
* It is unclear the extent to which the Australian Medicines Terminology has been installed into clinical systems in GP clinics, or hospitals. Without a common clinical terminology, it is not possible to achieve the basic, accurate medication list required.
* Medicines management is a significant area of value that is not sufficiently supported within current PCEHR design
* Encouraging the ongoing uptake of electronic transfer of prescriptions would also improve the quality of data available in an integrated Medications Profile.
The bit about the PCEHR design is interesting. A Patient Health Record is not the place to put prescription data to be used for real-time medication/prescription monitoring.
And a patient controlled, opt-out system will never satisfy this requirement
"all medications for all patients are always available."
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