Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Monday, April 30, 2018

Weekly Australian Health IT Links – 30th April, 2018.

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

Lots of bits and pieces week with a lot on the security / privacy theme. As well the ADHA seems to be increasing promotional activities and we see lots of digital start-up activity!
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With one click, GPs accidentally agree to share their patients' data

Did you pay attention when installing the latest edition of Medical Director?
27th April 2018
Medical Director says it's being as “open as possible” about its plan to share GPs' de-identified patient data, after some doctors complained they had signed up without realising.
The company, which provides practice software to 45% of Australia's GPs, is asking for permission to extract information — including prescriptions and immunisation records of all their patients — as part of its latest program update.
Dubbed MD Heart, the scheme will allow GPs who agree to the handover to compare their activity with other doctors.
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Australia, your privacy has been breached — we reveal the biggest health data leaks

Sue Dunlevy, National Health Reporter, News Corp Australia Network
April 23, 2018 12:00am
EXCLUSIVE
THE sensitive health data of Australians is subject to a data breach every two days and the organisations and governments that fail to protect it are facing no financial penalties.
As outrage builds over Facebook’s failure to protect privacy, a News Corp investigation has uncovered health data that shows if Australians have a sexually transmitted disease, mental illness, HIV or an abortion, even whether they’ve used a prostitute, is not properly protected.
A new mandatory notification scheme that requires businesses to report to the Office of the Australian Information Commissioner when there is a data breach shows in the first 37 days of the new regime a data breach occurred every two days in the health sector.
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“Creaking in the rigging”: The ADHA is warned to look beyond data warehousing to prioritise the people making sense of it all

Richard Lawrance | 23 Apr 2018
As Australian governments at state, territory and federal levels grapple with dramatically escalating healthcare costs, a bow wave innovation opportunity has arisen to provide a solution that will save billions at the same time as actually improving the quality of care: eHealth. 
The digitisation of health information in particular will enable the provision of medical records and other diagnostic and decision support data for health practitioners to point of patient care at any time, in any place with the right connectivity. 
Financial savings from reduced duplication of tests and endless repetition of patient history, along with the reduction of adverse patient events due to increase in information accuracy and integrity will transform the cost effectiveness as well as the service efficiency of care delivery. 
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Risk of failure points to budget fix for Medicare payment systems

  • The Australian
  • 12:00AM April 24, 2018

Sean Parnell

The future of the Medicare payment systems — an issue that dogged the Coalition during the last election campaign — may have to be decided in the budget amid evidence there has been a “critically high risk of system failure”.
The payment systems are massive, responsible for up to 600 million health, aged-care and veterans’ affairs transactions each year, totalling about $50 billion. Several years ago, bureaucrats warned the existing systems were “old, overly complicated, expensive to operate and change and ... in need of redevelopment”. They have also stifled reforms in key portfolio areas.
Last term, a secretive systems-replacement project fuelled Labor claims the Coalition wanted to privatise Medicare. At the election, Prime Minister Malcolm Turnbull was forced to promise a new payments system would be owned, operated and controlled by the government, and work on a replacement continued last year.
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Data debacle earns health department a slap on the wrist

One of the odder privacy sagas seems have run its course
24th April 2018
It had all the hallmarks of a major blunder.
It was 2016 and the Federal Department of Health had just made public the MBS and PBS claims of some 2.5 million Australians, dating back 30 years.
The ostensibly de-identified dataset was supposed to be used for academic research.
But it wasn't long before three University of Melbourne boffins reported a potential flaw: using a few simple computer tricks, it was possible not only to identify the Medicare services provided by every GP in the data set, but also to identify patients and a significant amount of their medical history.
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ANDREW RYAN
April 26, 2018

Consent and ID after Cambridge

The Cambridge Analytica scandal, where the Facebook histories and personal records of more than 87 million people were extracted and used potentially for political influence, underscores a critical concept when it comes to digital identity: What rights do users have when it comes to giving consent?
According to Helaine Leggat, Principle Lawyer at Sladen Legal, Australian law does not distinguish digital identity from other forms or formats of personally identifiable information (PII).
“Global privacy and data protection laws includes information that identifies an individual, or has the potential to identify an individual,” she said.
“In relation to Facebook and Cambridge Analytica, both PII that indirectly identified individuals and inferential PII, was scraped and processed without consent,” she added.
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Patients demanding more tech in GP practices but the AMA says digital transformation comes at a cost

Lynne Minion | 26 Apr 2018
Consumer pressure is set to transform tech uptake in general practice, with new research claiming patients are increasingly demanding access to their medical records and SMS alerts to cut down on the time they spend in doctors’ waiting rooms.
But the AMA has said technologies are expensive to implement and doctors continue to have privacy and cybersecurity concerns about data sharing.
Tech-savvy patients are increasingly demanding technologies that provide improved choice and control, but there is a “clear divide” between expectations and availability, according to the GP Insights Report by the Commonwealth Bank.
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27 April 2018

My Health Record: It’s not all terrible, is it?

Posted by Felicity Nelson
I still haven’t decided whether I want to opt out from getting a My Health Record later this year. 
For more than half a decade, My Health Record (MHR) has received a hammering in the media for failing to make itself useful to patients or doctors. 
E-health experts have called for a reboot of the $2-billion project, but the people behind the venture seem to have fallen prey to the sunk-cost fallacy, rendering any attempt to restructure the project near impossible because of because of the weight of the accumulated emotional investment in it. 
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ACEM welcomes next phase of My Health Record

The peak body for emergency medicine in Australia and New Zealand has welcomed the next phase of the My Health Record.
According to the Australian Digital Health Agency, which is responsible for the My Health Record, records will be created for all Australians by the end of 2018, unless they choose not to have one.

The Australasian College for Emergency Medicine (ACEM) supports every Australian having a My Health Record.

“Providing quality care in a modern health system relies on accessible and accurate clinical and patient information,” ACEM President Dr Simon Judkins said.
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Media release - Digital health leaders meet in United States to forge global plans

27-April, 2018
Digital health leaders from 17 countries and the World Health Organization (WHO) are participating in the Global Digital Health Partnership (GDHP), which has held its second Summit hosted in Washington DC on April 24-25. Participants discussed approaches to global collaboration in a range of topics related to the delivery of digital health services and associated policy priorities.
The GDHP is a collaborative of governments, territories, government agencies and the World Health Organisation to support effective implementation of digital health services. It was initiated in February 2018 in Canberra, Australia.
Australia, Argentina, Austria, Republic of Belarus, Canada, Hong Kong SAR, Republic of Indonesia, India, Italy, Kingdom of Saudi Arabia, New Zealand, Singapore, Republic of Korea, Sweden, the United States, the United Kingdom, the Ukraine, and the World Health Organization (WHO) are participating in the GDHP.
The GDHP is a platform for international healthcare leaders to share best practice in the use of data and technology to advance health and care, said Tim Kelsey, CEO of the Australian Digital Health Agency, which hosts the GDHP secretariat.
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My Health Record – the connection to accessible information at any time

Hospital pharmacist Leonie Abbott discusses the benefits of My Health Record.
This article originally appeared on Australian Association of Practice Management (AAPM).
By the end of this year, every Australian will have a My Health Record unless they decide they do not want one – and all healthcare providers need to be prepared, wherever they are.
Already 5.5 million Australians – more than 20% of the population – have a My Health Record.
Almost 1,000 public and private hospitals around Australia have connected to the My Health Record system via their electronic medical record systems. Across Australia, 72% of public hospitals are connected to My Health Record – covering approximately 81% of available beds nationally.
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Framework for Action – invitation for contributions

24 April 2018
Have your say about the implementation of Australia’s National Digital Health Strategy – Safe, Seamless and Secure.
Australia’s National Digital Health Strategy – Safe, Seamless and Secure was published in August last year after an extensive national consultation. As we move towards the implementation of this overarching vision, we are once again seeking input from interested parties about this next phase of development.
This implementation plan is called the Framework for Action. The realisation of this strategic vision is expected to result in
  • Hospital admissions avoided
  • Fewer adverse drug events
  • Reduced duplication of medical tests
  • Better coordination of care for people with chronic and complex conditions, and
  • Better informed treatment decisions.
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Have your say on the Health Information Workforce Census

Your participation will assist in Australia’s digital health workforce planning.
24 April 2018
Are you part of Australia’s health information workforce? Do you work in, or are actively seeking work in, a role related to developing or managing health information? Hint: If you’re reading #Share, you almost certainly are!
If so, you should consider participating in the Health Information Workforce Census, which is being conducted by the University of Tasmania, the University of Melbourne, the Australian Digital Health Agency, and a host of other organisations. The purpose of this census is to count and delineate the current health information workforce in Australia, and to identify career pathways and future training and support needs for the sector.
As with any census, maximum levels of participation will lead to better quality data and more reliable forecasts. As a #Share reader, we encourage you to participate, and also to help promote the census in your workplace with the promotional materials available on site.
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International recognition for Australia’s my Health Memory app

Sydney Children’s Hospitals Network app wins at 2018 Health Innovation Awards.
“Make it easier for me to do what I want to do when I want to do it, and make sure I don’t miss anything that’s really important. Because I’m frightened ¬ especially if I’m looking after a young child ¬ that I’m going to miss something that’s critical for them.”
When the Sydney Children’s Hospitals Network (SCHN) embarked on an extensive consultation with patients about their needs, these are the key themes that emerged, Cheryl McCullagh, Director of Clinical Integration at the SCHN, tells us.
This consultation process shaped the design and development priorities of the My Health Memory app, which is being developed by Oneview Healthcare in collaboration with the SCHN. The ultimate goal of the app is to create a “shared health memory for life” which empowers patients to actively participate in their care. The functions of the My Health Memory app are therefore directly reflective of patients’ expressed needs.
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GDPR data breach notification letter

Originally Published: Apr 2018
Once the GDPR becomes enforceable on May 25, 2018, organizations everywhere will be subject to stiff fines and penalties for noncompliance. This download includes an overview of the information required for a basic data breach notification as well as a sample letter to help your organization create an appropriate response.

From the download:

In the current business environment, it is almost inevitable that an organization will experience a security breach that exposes collected personal data to unauthorized access. Under the provisions of the GDPR, regardless of the severity of the security breach, organizations must inform their EU customers and stakeholders of the incident in a timely manner.

GDPR compliance requires that all data subjects be notified that a security breach has occurred within 72 hours of first discovering it. Regardless of whether the notification is in the form of a public announcement, email, or text message, it should contain several key pieces of information:
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Reported breaches not painting complete picture of Australian security landscape

Although 63 data breaches were reported to the Office of the Australian Information Commissioner in less than six weeks, FireEye's Mandiant has warned the figure is higher, but organisations are unsure if their breach fits the brief.
By Asha McLean | April 23, 2018 -- 05:08 GMT (15:08 AEST) | Topic: Security
The Office of the Australian Information Commissioner (OAIC) reported earlier this month it had received 63 notifications since Australia's Notifiable Data Breaches (NDB) scheme came into effect on February 22, 2018.
While 63 breach notifications may appear quite high for the period spanning just shy of six weeks, Charles Carmakal, vice president at FireEye's Mandiant, said the number is likely to be even higher.
"In general, any time a data breach disclosure law comes into effect, there are a lot of organisations that actually do experience a breach, but they're still trying to figure out if the law applies to them and whether or not they're dealing with a reportable incident," he told ZDNet.
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DHS begins search for Sterrenberg’s replacement

Human Services CIO role up for grabs
Rohan Pearce (Computerworld) 23 April, 2018 09:06
The Department of Human Services has officially begun the hunt for a new chief information officer to replace Gary Sterrenberg.
Sterrenberg held the Human Services CIO role for half a dozen years before tendering his resignation last year in order to complete his PhD on ‘Measuring public value created through the introduction of a disruptive, digital platform-servicing model in the disability sector in Australia’. Prior to joining the department Sterrenberg was CIO at ANZ.
From January, Charles McHardie — general manager at Human Services’ CIO Group — has been acting CIO at the department.
The department’s recruitment documents state the CIO position is “arguably the most significant role of its kind in Australia”.
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ACT govt steals Health IT exec as next digital chief

By Justin Hendry on Apr 24, 2018 5:00PM

To drive transformation.

The ACT government has poached Department of Health IT executive Bettina Konti as its new chief digital officer, iTnews can reveal.
Konti, who has worked at the department for more than ten years, will assume the whole-of-government role on May 31.
She replaces inaugural CDO Jon Cumming, who departed the position in January to move to the UK.
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DHS used up child support system project budget two years ago

By Justin Hendry on Apr 27, 2018 6:53AM

Forced to rely on BAU funds.

The Department of Human Services spent all $102 million budgeted for the development of its new child support IT system almost two years ago and has "absorbed" extra funding demands ever since.
The department has been trying to replace its legacy ‘Cuba’ child support system since 2009, when it determined the system was incompatible with new initiatives and policy directions, and would soon reach the end of its usable life.
It was given $102.3 million over five years in the 2013 budget to replace Cuba with an “agile and responsive” system based on SAP commercial off-the-shelf technology.
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Orangeworm menaces healthcare computers

By Juha Saarinen on Apr 24, 2018 10:42AM

Plants Kwampirs backdoors.

Security vendor Symantec believes it has identified a hacking group that is planting remote access software on medical computers in order to steal information.
Dubbed Orangeworm by Symantec, the attackers have conducted supply chain attacks on healthcare providers, pharma companies, as well as IT solution providers and equipment makers for the medical sector, since January 2015.
Targets are chosen carefully, Symantec said, with attackers planting the Kwampirs backdoor that was first discovered in August 2016 on computers.
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Orangeworm group takes aim at healthcare sector

An attack group named Orangeworm is using a backdoor known as Kwampirs to target Windows machines in the healthcare sector and related industries in the US, Europe and Asia.
Security firm Symantec said the use of legacy versions of Windows like XP in these sectors was one reason why they were being targeted.
There was some confusion in the company's blog post about Orangeworm with claims that it was both "a previously unknown group" and also that it was "first identified in January 2015". Obviously both these statements could not be true.
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Submitting a health provider related tip-off

Page last updated: 22 December 2017

About this form

You can confidentially report suspected fraud or suspicious activity by health providers against health related programmes. It doesn’t matter how much or little information you have, every detail is valuable.
Health providers are:
  • professionals (e.g. doctors, pharmacists, dentists and allied health professionals)
  • organisations (e.g. medical practices, hospitals and administrative staff).
Health related programmes include:
  • Medicare
  • Pharmaceutical Benefits Scheme (PBS)
  • Child Dental Benefits Schedule (CDBS)
  • Health Provider incentive programmes.

Security

This is a secure online form to protect your privacy.

Completing this form

Please supply as much information as possible in the following sections to enable us to assess your concerns.
You do not need to provide your personal details on the form. You can remain anonymous, but it may be helpful if we can contact you to ask for more information.
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  • Apr 23 2018 at 4:00 PM
  • Updated Apr 23 2018 at 4:00 PM

Garvan Institute uses Microsoft Azure grant to build genetic index to hunt disease cures

Sydney-based biomedical researchers at the Garvan Institute will kickstart an ambitious plan to create a genetic index including summary data of 5000 aggregated human genomes to help the global hunt for cures to diseases, after receiving a grant from Microsoft to crunch the data on its Azure cloud infrastructure.
The index will require enormous amounts of computing power, and the Garvan Institute hopes it will make a major contribution to ongoing international efforts, such as the hunt for cancer treatments, by making the resource accessible to the worldwide genomics community.
Chief of informatics at the Garvan Institute Warren Kaplan said there had been extraordinary advances in the technology of DNA sequencing during the past 10 years, meaning the different genomes could now be split into groups, in order to run hugely complex queries to try to pinpoint the causes of different abnormalities or diseases.
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Alcidion announces acquisition of MKM Health and Patientrack to create international specialist health informatics company

 Posted April 24, 2018
Highlights
  • Transformative acquisition creating a market leading, international specialist health informatics company focused on decision intelligence and analytics technology for improved health care
  • The combined Alcidion Group will have:
    • Specialised IT capabilities and a diversified product platform with lead products including: Miya and Smartpage products (Alcidion) and Patientrack (MKM Health)
    • Extensive capabilities in IT implementation, integration and data management in healthcare, supporting the product platforms
    • Proven sales and go-to market capabilities
    • Large diversified customer base including 20 UK National Health Service (NHS) hospitals, over 50 Australian public and private hospitals, and Health Departments and 11 District Health Boards covering more than 30 New Zealand hospitals
    • Combined revenue of approximately A$13 million in FY17 (on a pro forma basis)
  • Patientrack is highly complementary with Alcidion’s existing products and has an established customer base in the United Kingdom, New Zealand and Australia
  • UK market represents a new international market for Alcidion, with immediate cross selling opportunities
  • Initial Acquisition consideration of A$12 million with A$10 million to be satisfied by the issue of 198 million Alcidion shares and A$2 million payable in cash, subject to completion adjustments, and funded from existing cash reserves. A further contingent consideration of up to A$4 million payable in 12 months in Alcidion shares, subject to the revenue and EBITDA performance of MKM Health and Patientrack in that 12 month period
  • Highly experienced Board and management team to be led by Ray Blight as Executive Chairman, with Ms Kate Quirke – currently CEO of MKM Health – to be appointed as CEO of the enlarged Alcidion Group
  • Investor conference call scheduled for Tuesday 24th April, 11.00am AEST (registration and dial in details provided at the bottom of this announcement).
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PainChek takes strides toward commercialisation for e-health tool

08:26 26 Apr 2018
Pain often goes undetected and untreated in people with dementia.
A carer can use the app, PainChek™, to check if a patient is experiencing pain
PainChek Ltd (ASX:PCK) had a busy March quarter working towards commercialisation in Australia for its pain assessment tools.
PainChek™ is the world’s first smartphone pain assessment and monitoring device that detects pain through facial recognition technology using a smartphone or tablet.

Targeting people with dementia

Clinical studies conducted in Australian residential aged care centres, have been published in the Journal of Alzheimer’s Disease.
The published article indicates that PainChek™ is a valid and reliable pain assessment tool for people with moderate to severe dementia, who can no longer self-report their pain.
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Sponsored

How genomics can lead doctors to 'knowing ahead of time'

Oracle Australia

By Rob Preston, Oracle
Wednesday, 04 April, 2018
A relative handful of patient success stories show the promise of genomic medicine in treating previously confounding health disorders, but the big challenge now is to expand that patient universe from hundreds of people to hundreds of millions.
During a presentation at Oracle Industry Connect on 20 March, Dr Robert B Darnell, senior physician at The Rockefeller University and a founding director of the New York Genome Center, laid out how far we’ve come and how far we still need to go in customising medical care to individuals’ unique genetic makeups.
In setting up the enormity and complexity of the data challenge alone, Darnell offered this nugget: If you were to take the genomic data on just 400 or so people and represent it on a board, it would stretch from Earth to Mars.
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Citadel Group acquires medical SaaS provider Anaesthetic Private Practice for $2 million

The Citadel Group has acquired Queensland-based medical software-as-a-service provider Anaesthetic Private Practice (APP) in a $2 million all-cash deal.
APP was founded in 2010 and provides cloud-based practice management and billing solutions to anaesthetists in private practice, with close to 300 customers mostly in Queensland.
According to Citadel, 89 percent of APP's revenue is recurring, with approximately $500,000 in annual earnings.
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NBN boss says mixed technology build behind network complaints

  • The Australian
  • 9:50AM April 27, 2018

Supratim Adhikari

Outgoing NBN Co chief executive Bill Morrow has blamed poor customer experiences with the network on the Turnbull government’s multi-technology approach to building the $49 billion project.
In a new position paper, Mr Morrow acknowledges that NBN Co’s task of rolling out a national network while looking to make a profit had led to the high wholesale prices charged to the retail telcos.
Mr Morrow says that although the multi-technology mix has allowed NBN Co to roll out the network at a much faster rate, it has introduced a host of complexities and led to customer confusion.
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NBN Co to create a class war on its network

By Ry Crozier on Apr 24, 2018 6:55AM

Exclusive: How its new price construct really works.

NBN Co is set to divide its customer base into two classes in October: those who can afford to pay for a higher minimum standard of service, and those who can’t.
The company’s retail service providers - particularly those that have a lot of 12Mbps users - face being caught in the middle and are already bracing for a backlash.
The situation came to light in part because NBN Co finally released technical details [pdf] of a new permanent price construct it announced late last year.
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NBN Co accused of using Sky Muster as 'dumping ground'

By Ry Crozier on Apr 23, 2018 7:20AM

For hard-to-serve metro premises.

NBN Co has been accused of using its Sky Muster satellite service as a “dumping ground” for premises on metropolitan fringes that are otherwise too hard or expensive to serve.
In a submission to the joint parliamentary inquiry into the NBN, BIRRR (Better Internet for Rural, Regional and Remote Australia) expressed disappointment that more underserved areas of Australia were only being offered Sky Muster services.
It said that “despite extensive research” it was often unclear why NBN Co made choices about the access technology a particular town or community would get.
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Alien spacecraft speculation after WA telescope captures 'cigar-shaped' object

By Franziska Rimrod
10 April 2018 — 10:33am
When astronomers using WA's giant Murchison telescope first detected a mysterious cigar-shaped object in our solar system they thought it must be a comet or asteroid.
But after further study they realised it came from another solar system, prompting speculation it could be an alien spacecraft,  International Centre for Radio Astronomy Research reveals.
Researchers using the Murchison telescope, which is about 800 kilometres north of Perth, had been searching for radio transmissions coming from the object since late last year but did not find any signs of intelligent life.
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Enjoy!
David.

Sunday, April 29, 2018

The Harvard Business Review Explains Why The myHR Is A Flawed Digital Health Initiative!

This article appeared a few days ago:

How to Accelerate the Adoption of Digital Health Technology

April 26, 2018
In 1997, health information technology and digitial health pioneer Warner Slack wrote his bold and prophetic book, Cybermedicine: How Computing Empowers Doctors and Patients for Better Care.  Slack argued that “the electronic digital computer, with its capacity to hold large amounts of data and to execute multiple complex instructions and accuracy would…find an important clinical role in both diagnosis and treatment.”
While the digitization of health information has solved many problems in American medicine — particularly, helping to reduce medical errors by enhancing clinical decision support — it has inevitably created many new ones. Clinician-oriented solutions such as electronic health records (EHRs) are contributing to physician burnout instead of facilitating patient care. Many anticipated that health information technology would reduce costs by limiting the duplication of tests and studies, but there is little evidence that it has accomplished this. And while patient-oriented digital solutions have proliferated in number, their clinical impact has been limited. Slack anticipated a world in which patient access to records would enhance “patient power” — yet many patient-oriented solutions have little relevance in the clinical exam room.
Yet there are rays of light, each of which shares a common denominator: a rigorous focus on the specific needs of the end user, be it patient or clinician. When creative health systems consider and engage the end user of the digital technology as the “customer” of that technology, adoption levels are high and so, too, is the impact. Two CareMore Health initiatives serve as examples: One provides patients with non-emergency transportation, and the other is a new secure platform for clinical team communication and collaboration.
Patient-oriented solutions.
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Clinician-oriented solutions. As a physician-led organization, CareMore’s approach to health IT implementation fully embraces the end user at the outset. Clinicians identify the problems to be solved and collaborate during the testing of solutions to help the information technology team refine the app. Once fully implemented, continual refinement and oversight of the solution is managed collaboratively by physicians and members of a digital implementation team to ensure that the technology is being embraced and effectively utilized so its benefits are fully realized.
An example is TigerText, CareMore’s new secure platform for clinical team communication and collaboration. Inpatient, hospital-based physicians were accustomed to using phone calls, text messages, faxes, and e-mails to communicate with various outpatient physicians such as primary care doctors and specialists, and information was delivered to the members of the clinical team in question in a fragmented and inconsistent way. The new platform required clinicians to move to a single platform for communication.
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When the end user identifies the problem, participates in building in the solution, and continues to engage during its refinement, adoption is inevitable.
***
The American health care system is in constant need of innovation and digital health has the ability to provide solutions to some of its biggest challenges. As simple as it is, the industry has often failed to engage the end user in building solutions. By placing greater emphasis on the problems of the end user — and less emphasis on the systems themselves — health care systems  will perhaps succeed in creating the cybermedicine revolution prophetically envisioned by Dr. Slack.
The full article is here:
This sentence says it all:
“Yet there are rays of light, each of which shares a common denominator: a rigorous focus on the specific needs of the end user, be it patient or clinician.”
I have been making this point since the days of the PCEHR. You can’t have a system that at the same time is optimised for the clinician to use and at the same time for the patient. It just does not work and HBR agrees!
Why can’t the ADHA just stop this nonsense before we are all both clinically and technically frazzled. One application simply cannot be optimised for both clinicians and patients!
David.