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, June 28, 2018

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

June 28, 2018 Edition.
It has been a big week in the US with Immigration Policy causing much grief for President Trump. It is now only 5 months till the mid-term elections and the divides are deepening it seems. Amazingly he seems now to want to visit with President Putin and is making arrangments – I wonder how badly that might go!
The news in OZ is that the personal tax cuts being phased in over 7 years have been passed and are law. Now for company tax cuts they are saying - but they have not got support for it and Shorten is in repeal mode so nothing will happen until spring.
In other news Albo seems to be going after Shorten’s job.  If he succeeds I suspect the Liberals would face an electoral wipe out as he is way more authentic and likeable.
Oh and by the time you read this the Financial Services RC will be in full flight again with more horror stories! RaboBank, ANZ and Bankwest have all had a pounding, to say the least, so far.
Here are a few other things I have noticed.

Major Issues.

There’s an ugly side but it does not diminish Western civilisation

  • Peter Craven
  • The Australian
  • 12:00AM June 16, 2018
It’s hard to imagine the heat of the Western civilisation/Ramsay Cen­tre debate being generated in the way it has been anywhere but in this country. Someone wants to leave a lot of money to establish courses at the Australian National University that trace the glories of what we have inherited from, say, Homer and Herodotus, Plato and the Psalms to wherever you want to stop: Wittgenstein and Proust, perhaps. The Ramsay Centre ­appointed a board that included John Howard and Kim Beazley.
Yes, but it also includes Tony Abbott, who writes an article in Quadrant suggesting the course must be for Western civilisation and the people who teach it should be selected to further this bias. And, lo and behold, this scares the horses, or rather the academics who are fearful of being Eurocentric, who want to interrogate the horrors of postcolonialism and generally back away from cultural triumphalism.
This, in turn, affects the Nobel prize-winning vice-chancellor of ANU, Brian Schmidt, the physicist, and he has to back off, so the pot of gold falls from the hands of the university. Sydney University is also chary but no doubt there will be negotiations with others.
  • Jun 17 2018 at 4:40 PM

For Labor, Liberals are making the next scare campaign as easy as ABC

Malcolm Turnbull's main message to the Liberal Party on Saturday was to never, ever let Labor get away again with a campaign such as Mediscare.
The Liberal government never intended to privatise Medicare. It did, however, want to outsource some back-office elements and this, combined with budget cuts and the party's historic hostility toward universal health care, formed the basis of Labor's Mediscare campaign which was so effective in the run-up to the last election.
With Labor road testing similar themes ahead of the July 28 byelections, Turnbull used his keynote speech to the Liberal Party Federal Council as a call to arms.

'Targeting trust': How Russia, and soon China, will undermine us

By Nick Miller
15 June 2018 — 12:31pm
Riga, Latvia: Bob Posner’s name is perfect for who he is: a mild, middle-aged British public servant, not given to grand statements or dramatic claims.
He comes across as the sort of chap who’d say things like “anything for a quiet life”.
But suddenly it’s not that quiet.
Posner is the director of the UK Electoral Commission’s finance and regulation section. His job is to make sure, using the principle of “follow the money”, that elections and referendums are run lawfully.

Energy retailers commit to change as Frydenberg puts them on notice

By Cole Latimer
17 June 2018 — 5:13pm
Electricity retailers have acknowledged the industry must change to restore trust with the community as Environment and Energy Minister Josh Frydenberg warned the government could introduce tougher laws to protect consumers.
A report released by the Australian Energy Market Commission on Friday found consumer trust in the sector fell from 50 per cent in 2017 to 39 per cent in 2018. This level is lower than for the banking and telecommunications industries.
Energy retailers told Fairfax Media they understood why consumer confidence in the sector had waned amid confusing discounting practices and high prices.

Academic freedom is at heart of Ramsay Centre furore

By Tanya Plibersek
18 June 2018 — 12:53am
Following the hysteria surrounding the Ramsay Centre for Western Civilisation – and the decision by the Australian National University to reject its offer that would have funded a new course – I think it’s time for everyone to take a deep breath.
There’s not enough philanthropy in Australia. If someone offers to donate millions of dollars, I completely understand why universities would want to say “yes please”.  Unless, of course, that donation could compromise academic freedom.
The Ramsay Centre is still looking for a tertiary home for its donation, that is linked to the running of a course on Western civilisation.

Our democracy is more important than Facebook's profits

By Lucy Battersby
18 June 2018 — 12:00am
No one realised it at the time, but in 2004 a poison was created that is now spreading through and threatening the stability of democratic countries around the world.
The poison isn’t attacking government’s directly. Instead it infects the information flowing through society to the point that citizens are confused and misled away from making proper decisions.
At its worst, this poison, this disinformation, prompts people to hunt down and hurt perceived enemies.

Extreme pressure is not stopping the National Energy Guarantee

By David Crowe
17 June 2018 — 5:14pm
Another dispute on energy policy is brewing as federal parliament resumes and Liberals and Nationals meet for the final two weeks before the winter break.
One of the most outspoken Liberals on energy and climate, backbencher Craig Kelly, says he expects the Coalition party room to discuss the issue on Tuesday to hear the latest on plans for the National Energy Guarantee.
An update on the NEG last Friday offered new details to keep MPs on edge, setting up another chance for conservatives to push back against Energy Minister Josh Frydenberg on the ambition to reduce carbon emissions.

Australia could be sorry if China relationship isn't mended: Brumby

By Fergus Hunter
17 June 2018 — 6:21pm
Former Victorian premier John Brumby says diplomatic tensions between Canberra and Beijing need to be resolved or the Australian economy could face long-term damage, warning there is a particular danger of isolation if the United States and China ultimately settle their own economic and strategic differences.
As a trade war beckons between the US and China after President Donald Trump announced new tariffs on $50 billion worth of Chinese imports, Mr Brumby, the national president of the Australia China Business Council, said companies were nevertheless predicting the world's top two economies will come to an accommodation that would present a bonanza for American businesses and hurt Australian rivals.
"I think there's a prevailing view that, one way or another, the US and China will come to some agreement. They have to come to some agreement. They are the two biggest economies in the world and I think both their leaders understand that, for the world economy to do well, those two economies need to co-exist," Mr Brumby told Fairfax Media.

Unfair takeover tactics

  • The Australian
  • 12:00AM June 16, 2018

Alan Kohler

The modern habit of all takeover offers starting out as “indicative and non-binding” proposals, designed to persuade boards to let the bidder into a data room to see non-public information, has got ridiculous, and should be stopped.
These are public companies, not private, about which everything is supposed to be continuously disclosed and equality of information is meant to be enforced — that is, no insider trading. Two examples of the genre landed on Wednesday this week: indicative, non-binding offers — or rather “proposals” — for APA Group and Gateway Lifestyles.
Will they turn into firm bids? Who knows?
  • Jun 18 2018 at 1:16 PM

A worldwide financial storm is brewing as central banks pick their poison

Trump woos a dictator
by Ambrose Evans-Pritchard
Central banks are on the warpath. The flow of monetary stimulus to the international financial system is drying up.
The US Federal Reserve has given an unequivocal warning that it will not be deflected by currency mayhem in emerging markets. Chairman Jerome Powell might as well have told the world to drop dead.
The combined policy of the Fed, the European Central Bank, the Bank of Japan, and the Bank of England (G4 bloc) will be contractionary within months, perhaps dangerously so if the monetarists are right.

PIMCO: Financial markets poised for new era of change

By Joachim Fels, Andrew Balls, Daniel Ivascyn, PIMCO
June 2018
Major shifts underway and here is what’s driving them.
Ten years after the global financial crisis, the world economy and financial markets could be entering a new era of potentially radical change that will make the next decade look very different from the last.
Investors who assume the future will resemble the post-crisis past could be in for a series of rude awakenings. They need to be prepared for the challenges ahead and be able to be offensive.
The post-GFC environment has been characterised by financial repression through regulation and dominant central banks. There have been mostly passive or restrictive fiscal policies, weak growth in productivity and real wages, subdued inflation, largely uninhibited trade and capital flows, and low macro and market volatility.

ANZ tips 10% decline in Sydney, Melbourne house prices

By Melanie Beeby
19 June 2018 — 10:28am
ANZ Banking Group is tipping falls in Sydney and Melbourne housing prices of about 10 per cent from peak to trough, driven by tighter credit and higher interest rates next year.
ANZ senior economists Daniel Gradwell and Joanne Masters said the housing market had slowed further than they expected and, as a result, they had "materially downgraded" their price outlook.
"We now expect to see peak-to-trough price declines of around 10 per cent in Sydney and Melbourne, with smaller declines elsewhere," they said in ANZ's June housing update.

Why this house price slump is different from the last one

By Clancy Yeates
19 June 2018 — 11:00am
Amid all the gloom engulfing the housing market, here's a sliver of more positive news you may have missed.
The Westpac Melbourne Institute index of consumer sentiment recently suggested home buyer demand is gradually recovering from  its recent low, with the number of consumers who think now is a good time to buy a home lifting substantially in the past year.
Over the decades this survey has been running, a change like this would normally suggest prices might stabilise within about six months.

Six pathways to Australia’s ‘economic armageddon’

THINGS are about to get very bad for Australia, an expert says. Here are six ways we’ll usher in “economic armageddon”.
Frank Chung @franks_chung  news.com.au June 19, 201811:46am
THE future is going to be very bad.
It’s not a question of if or even when, but how. That’s the view of Australian economist John Adams, who says “economic armageddon” awaits us — we just don’t know what particular version it will take.
For the past two years, the former Coalition adviser has been sounding increasingly dire warnings about a looming global economic crisis in the face of record public and private debt, near-zero interest rates, excessive public spending and a massive housing bubble.

Housing crash unlikely, based on real debt levels

  • The Australian
  • 12:00AM June 19, 2018

Don Stammer

Predictions abound that Australian house prices will collapse, causing a banking crisis and economy-wide recession. And it’s mainly because of the mountain of household debt.
Of course, forecasts of an impending calamity in Australian housing are nothing new. One example was when gloom was widespread in 1989, when housing interest rates reached 17 per cent. Another example was in 2010 when one of the world’s best-known economic commentators, Jeremy Grantham, the founder and head of a large US investment group, warned us that Australian house prices were a “time bomb … (it’s) only a matter of time before they crash … prices would need to come down by 42 per cent to return to the long-term trend”. To be fair, Grantham later forecast that our house prices would fall slowly rather than plunge. Nonetheless, the median house price climbed more than 40 per cent in the seven years that followed.
  • Updated Jun 19 2018 at 11:00 PM

Labor throws down the China challenge to Coalition

Management of the Australia-China relationship is shaping up as an important issue in the lead up to the next election as the Labor Party, which has been quietly nailing down its position in recent months, steps up criticism of the government.
Labor's foreign affairs spokeswoman Penny Wong took the opportunity at a speech in Canberra on Tuesday to take a swipe at the Turnbull government for its "disjointed megaphone diplomacy" and argue for "a more sophisticated approach".
Wong is targeting a weak spot for the government amid increasing tensions in the bilateral relationship, which have affected ministerial visits and may be behind some customs difficulties for wine companies at Chinese ports.

Next step for China's Belt and Road could be northern Australia

By Richard McGregor
19 June 2018 — 11:26pm
When Chinese officials began pondering an idea to harness continental Asia’s economy to their own, they would often question their Western interlocutors about the Marshall Plan.
On the face of it, it was a strange question. The Marshall Plan was a US initiative to rebuild a Europe ravaged by war to prevent it from falling under the control of the Soviet Union.
China’s plan, announced by President Xi Jinping in 2013 and called in its latest incarnation the Belt and Road Initiative, has nothing to do with restoring countries laid waste by armed conflict.

Australia tipped to buy British naval frigates in $35 billion deal with old partner

By David Wroe
19 June 2018 — 6:17pm
Britain is strongly tipped to win the hard-fought contest to design and build Australia’s new $35 billion fleet of naval frigates in a move that would firm up the partnership with a key ally at a time of international political uncertainty.
Sources in Canberra and defence industry circles said it was all but certain that Britain’s BAE Systems would be chosen as the international partner to design and help build what will form the backbone of the Royal Australian Navy’s surface fleet for the coming decades.
The national security committee of cabinet is expected to discuss the decision soon, with an announcement possible by the end of next week.

'Very brittle' world economy is not ready for a slump, economist warns

20 June 2018 — 6:10am
Lawrence Summers and Paul Krugman are casting gloom on the global economy.
Former US Treasury Secretary Summers said developed nations are ill-equipped for another recession while Krugman, the Nobel Prize-winning economist, warned of market complacency as Donald Trump and Xi Jinping ratchet up a tit-for-tat trade war between the world's two largest economies.
"The issue that's preoccupied monetary policy for the generation before the financial crisis -- the avoidance of inflation -- is no longer the top issue," Summers said in a Bloomberg Television interview with Stephanie Flanders on Tuesday. It's the "maintenance of sound growth and getting to full employment."
  • Jun 21 2018 at 9:27 AM

Flat yield curve sends a grim message to investors in 2019

by Robin Wigglesworth
Of all the fashionable alarm bells that market-watchers keep an eye on, the yield curve is the most timeless. It is Coco Chanel's proverbial "little black dress" of economic indicators.
The slope made up of bond yields of various maturities has a record of predicting recessions that would make even the savviest econometrician turn pea-green with envy. It is not perfect, but the curve has become flat and inverted — when short-term bond yields are actually higher than long-term ones — ahead of most economic downturns in most major countries since the second world war.
This is why some analysts and investors are worryingly eyeing the US yield curve, where the difference between the two- and 10-year Treasury yields has narrowed to just 37 basis points. That is the slimmest spread since September 2007. But interestingly, and worryingly, the global yield curve has now already inverted.

Middle-income Australians losing share of welfare, new data shows

By Eryk Bagshaw
20 June 2018 — 6:37pm
Average workers are being cut out of the welfare pie, losing 17 per cent in government benefits on top of their incomes since 2010, according to new figures that are likely to bolster arguments for urgent income tax relief for middle-Australia.
Bureau of Statistics data released on Wednesday show the majority of taxpayers with average incomes have had their government benefit boost reduced from $91 a week to $76 a week since 2010, while the proportion of government benefits flowing to the poorest and wealthiest 20 per cent has remained the same.
The new figures come as the Turnbull government and Labor opposition sharpen their arguments ahead of a looming federal election by targeting middle-income voters with the competing taxation philosophies of "aspiration" and "fairness".

Want advice on the government's reverse mortgage? Tough

By John Collett
19 June 2018 — 12:41pm
Retirees seeking access to the expanded Pension Loans Scheme – a reverse mortgage managed by the government – will likely be hard-pressed finding someone who can give advice on how the scheme stacks up against private-sector reverse mortgages.
The government scheme has advantages over private-sector reverse mortgages, such as a lower interest rate and no fees.
From the middle of next year, providing legislation is passed by Parliament, access to the scheme will be open to anyone who is of pension age.
  • Jun 21 2018 at 2:45 PM

Why does RBA governor Philip Lowe sound so defensive?

Sharing a conference stage overnight in the Portuguese resort town of Sintra with the three most powerful central bankers in the world, Philip Lowe looked the "odd man out" - as he himself quipped.
But it's not - as he suggested - just because Australia's economy is small compared to the US, Europe and Japan.
It's because his presence alongside Jerome Powell, Mario Draghi and Haruhiko Kuroda drives home how much the governor sounds increasingly out of step with his bigger counterparts.

Rate rise still some way off: RBA

  • David Winning
  • Dow Jones
  • 11:38AM June 19, 2018
The Reserve Bank of Australia signalled that interest rates will remain at record lows for a while yet, even as other central banks dial back stimulus that has underpinned the global economy for a decade.
The tone of the RBA’s minutes of its June 5 meeting was not unexpected, given Governor Philip Lowe last week said potential catalysts for an interest rate rise — higher wages and a return of inflation to around the midpoint of the RBA’s 2-3 per cent target band — were still some way off.
Interest rates in Australia have been held at a record low 1.5 per cent since mid-2016, helping to support an economy that is on the world’s largest ongoing expansionary streak.

Abbott's comments on Ramsay Centre 'frightened a lot of people': CEO

By Jordan Baker
22 June 2018 — 8:11pm
The chief executive of the Ramsay Centre says Tony Abbott made mistaken and mistimed comments about the centre's western civilisation degree that "frightened a lot of people".
His comments come as Sydney University vice-chancellor Michael Spence described public debate about the centre as silly, saying the right wanted the proposal to fail as much as the left. "It's a really tragic situation, where in the puerile culture wars, the truth is being lost," he said.
Sydney University is in early talks with the Ramsay Centre about a degree in western civilisation, but there is deep resistance from many of its staff and students.

Young and out: Australia's hidden scourge of youth unemployment

By Jessica Irvine
23 June 2018 — 12:01am
The political calculus of an ageing population means that the national debate is increasingly dominated by issues that concern older Australians, like retirement and superannuation policies.
Meanwhile, younger Australians are derided as avocado-gobbling whingers, too lazy or entitled to get a proper job and save hard.
But a new Reserve Bank paper has lifted the lid on what it's like for young people entering the workforce today.

Supermarket plastic bag ban ‘like religion’

  • The Australian
  • 12:00AM June 23, 2018

Adam Creighton

The author of a landmark study into plastic bags has likened to “religion” their impending removal from supermarkets, suggesting ­arguments against them are “complete furphies you can demolish in a few minutes of analysis”.
Phillip Weickhardt, lead ­author of a 2006 Productivity Commission inquiry into waste management, said raising fines for littering made more sense.
“This is largely religion, deeply felt,” he told The Weekend Australian. “Plastic bags are useful: ­hygienic, water proof. They have multiple uses and functions,” he added.

A new approach to defending democratic discussion

By Chris Zappone & Matthew Sussex
23 June 2018 — 2:17pm
Democracies are up in arms about immigration. Yet talk around immigration is so heated, it's hard to be sure what is fact and what is highly emotional fiction.
One need only look abroad to other democracies to see how information overload has enabled factually wrong but emotionally resounding stories about immigration to flourish.
And it's not just about the subject of immigration. Anti-gun protesters in the US have erroneously been dismissed as “crisis actors”. Falsehoods about Brexit motivated voters.

Just what the doctor ordered: Huge gains for share investors

A WIDELY-ignored stock has delivered Australians rivers of gold across the past 10 years, and if global trends stack up, their growth will continue to boom.
Anthony Keane
News Corp Australia Network June 22, 201810:00pm
IF you’re hoping for healthy gains on the stock market, here’s an investment that’s almost guaranteed to grow.
Health care companies are booming, and one reason why Australia’s market is at 10-year highs despite weak performances from household names such as Telstra, AMP and the banks.
Almost three-quarters of our biggest health stocks have more than doubled their share price in a decade and several have jumped more than four times in value.

How Telstra became a cash machine for the nation’s retirees

  • The Australian
  • 12:00AM June 23, 2018

Alan Kohler

What Telstra announced this week should have been done years ago.
That’s evidenced by the fact that the company, in 2018, still has 8000 unnecessary staff, 1780 unnecessary mobile phone plans and $2 billion in unnecessary assets.
‘Telstra2022’ is simply a long overdue tidy-up and shrink. In fact, Telstra has known for years what had to be done and has not acted, just talked, and this week’s effort was another talkfest. In any case, it’s too late; the train has left the station.
And the worst of it is that Telstra is not an outlier — too many of Australia’s supposed corporate champions have known that transformation has been required, but haven’t done it. The banks and AMP spring to mind of course, but there are others, and in fact it’s easier to list the exception: CSL.

Financial Royal Commission Issues.

AMP may face charges: ASIC

  • The Australian
  • 12:00AM June 23, 2018

Michael Roddan

The corporate watchdog has revealed it is working with the Director of Public Prosecutions over wealth management group AMP after the financial scandal sparked by the royal commission.
Appearing before the House of Representatives economics committee yesterday, Australian Securities & Investments Com­mission head of enforcement Tim Mullaly said the regulator was “consulting with the DPP” on its AMP investigation as it combed through more than 600,000 documents it obtained from the group over the past month.
ASIC conducts some prosecutions of minor criminal matters but refers more serious matters to the DPP, which conducts those prosecutions in court if it believes wrongdoing has taken place. Mr Mullaly said ASIC would be in a position to finalise its investigation into AMP by September.

National Budget Issues.

Dangerous territory as households feel sting

By Jessica Irvine
17 June 2018 — 7:33pm
If you’ve been watching closely, you can begin to see the contours of the coming federal election take shape.
The most important battlelines - over duelling tax cuts - are still being drawn. As parliament resumes on Monday for its final fortnight before the winter break, Labor is yet to outline whether it will agree to the final stages of the Coalition’s seven-year income tax cut package, outlined in the May budget. It has agreed to the first three years – and doubled them.
Many commentators have dismissed the size of the savings being offered by both sides – targeted firmly initially at low- and middle-income earners – as little more than loose change.

Australian businesses must change their tune on wage rises

Shane Wright The West Australian
Monday, 18 June 2018 10:06AM
Trying to make sense of the musings of a central banker is up there with understanding early Michael Stipe. For those not into the independent music scene of the 1980s, Stipe was the lead singer and lyricist for R.E.M.
Famously, on some early songs he just made up words or sounds and let the listener try to work out the meaning. And the hit It’s the End of the World as We Know It (And I Feel Fine) features such a quick array of words that it defies easy comprehension.
Central bankers are the Michael Stipes of the finance world. But last week Australia’s lead “singer”, the RBA’s Philip Lowe, was particularly clear.

Why you should keep paying the 'tampon tax'

By Jessica Irvine
18 June 2018 — 5:06pm
From John Howard to Tony Abbott, generations of conservative male politicians have stifled a deep desire to simply scream “Dear lord, please stop them saying tampon!”, to argue in favour of subjecting feminine hygiene products to the goods and services tax.
Only one – former treasurer Joe Hockey – lacked the intestinal fortitude when, in 2015, he caved in to support calls for the axing of the so-called “tampon tax”.
Despite young feminists now strapping red-stained sanitary napkins to their heads in protest, Coalition lower house MPs are expected to hold the conservative line and vote down a Greens-initiated bill to exclude sanitary items from the GST, which passed the Senate on Monday.
  • Updated Jun 19 2018 at 6:48 PM

Immigration supports ageing population, RBA says

Despite enjoying longer lives, older Australians will have more younger taxpayers to fund their housing and welfare thanks to skilled immigration compared to most other advanced economies, according to findings presented to Reserve Bank of Australia board members this month.
In a challenge to growing anti-immigration sentiment, policy members debated the fact that surging population growth was "in large part" driven by overseas migration of younger people.
This has not only driven demand for house prices and stoked the need for ongoing infrastructure investment, but has also ensured the economy remains dynamic and means it will have the resources of younger workers to carry the burden of older people.

Never mind the tax, it's wage growth that's making us glum

By Peter Martin
20 June 2018 — 8:05pm
Why do they keep going on and on about tax when they must know it’s not our real concern? Because the sudden dive in wage growth – the thing that is really worrying us – is beyond their control.
As recently as 2012, just six years ago, wages were growing like they usually had, at a touch under 4 per cent per year. The rapid dive meant that by June 2014, two years later, they were growing at 2.4 per cent, the lowest rate since the last recession, and a good deal less than the lows plumbed during the global financial crisis.
Another two years later they were growing at just 2 per cent; even less than in the early 1990s recession, and on the face of it, the least since the Great Depression in the 1930s.

When Pauline Hanson backs your tax code, alarm bells should ring

By Jessica Irvine
21 June 2018 — 5:38pm
These are the tax cuts we don’t deserve and can’t afford. They are not part of a wider tax reform package, leave the budget too vulnerable to future economic shocks, and they’re unfair, to boot.
Upper income earners will be the biggest winners over the seven year horizon of the tax cuts that passed the Senate on Thursday, with the support of One Nation.
Senator Pauline Hanson said her decision to support the government's tax bills in the Senate is based on her support for lower income earners who deserve tax cuts.

Health Budget Issues.

Senior doctors ‘must shield juniors’

  • The Australian
  • 12:00AM June 18, 2018

Sean Parnell

Senior doctors need to do more to protect their younger colleagues from becoming overworked and at greater risk of clinical errors or suicide, according to an article in the Medical Journal of Australia.
The pressure put on mostly junior doctors through unsafe working hours has long been an issue in Australia, reiterated in ­recent industry debates over bullying and high suicide rates.
An article in The Lancet this month detailed how a junior doctor working a 36-hour shift would make 460 per cent more diagnostic mistakes than when well rested.

British visa change opens door for Australian medics

  • The Australian
  • 12:00AM June 18, 2018

Charlie Peel

Australian doctors and nurses seeking to work in Britain have been given a boost following a relaxation of the number of visas given to medical practitioners.
The British Home Office announced the exclusion of doctors and nurses from the cap on Tier 2 skilled migrant visas on Friday, clearing the way for thousands of applicants.
An annual cap of 20,700 visas across all industries will no longer apply to those within the medical profession from outside Europe.

Healthcare at critical point, says Medibank

  • The Australian
  • 12:00AM June 20, 2018

Sarah-Jane Tasker

Medibank boss Craig Drummond warns the healthcare sector is at a critical point as he calls for competitors across the industry to increase collaboration to combat rising costs and improve patient outcomes.
Mr Drummond said with more Australians going to hospital more frequently, patients needed to be provided with more information to help them make better choices about their healthcare.
“The Australian healthcare sector is at a critical point and we as an industry have the opportunity to work together to ensure its long-term viability,” he said.
20 Jun 2018

Growing pains in the health sector

Richard Grayson
Head of Health, Business and Private Banking, ANZ
Median hourly rates for medical specialists are slowing down relative to wage growth in the broader economy. However Australia’s medical specialists are covering an increasing volume of services, including those bulk billed.
These key findings are drawn from the annual ANZ-Melbourne Institute Health Sector Trends Report, commissioned by ANZ and led by University of Melbourne Professor Anthony Scott, drawing on the latest health care sector data to analyse trends and challenges facing the medical specialist industry.
"The sector remains strong, supported by robust drivers of growth such as demographics, demand and funding.” 

Govt wants to avoid US-style opioid crisis

4:36pm Jun 23, 2018
The federal government wants to stop Australia facing a US-style opioid crisis as health authorities work to rein in doctors who are handing out tens of thousands of doses.
Health Minister Greg Hunt confirmed on Saturday one country doctor has handed out 68,000 doses in less than a year and a city doctor has handed out 56,000.
"We don't want to end up in the place that the United States is in where opioids are a national crisis," he told reporters in Victoria on Saturday.
Mr Hunt said some doctors may have "inadvertently become over-prescribers" but the vast majority do the right thing, and are among the world's best.

Australia's health 2018

20 Jun 2018
Australia’s health 2018 marks the 16th biennial flagship report on health that the Australian Institute of Health and Welfare (AIHW) has released since it was established in 1987.
This latest national report card continues the trend of providing independent, trusted and timely information to the wide range of Australians who use it—the community, policymakers, service providers and researchers. Australia’s health 2018 examines health using a person-centred approach—this takes the view that a person’s health is part of a broader social context and encompasses the ideas that health:
  • is an important part of how people feel and function
  • contributes to, and is influenced by, social and economic wellbeing
  • can exist in degrees of good, as well as poor, health and varies over time.
  • Updated Jun 22 2018 at 11:00 PM

Medibank Private sees 20 per cent drop in private births

Medibank Private has seen a 20 per cent drop in members having babies over the past four years and chief executive Craig Drummond blames an increase in out-of-pocket expenses charged by obstetricians and new public maternity hospitals in cities for the drift away from private births.
"I think the broader industry needs to come together to address out-of-pocket costs because we do see that some of our customers are experiencing bill shock," Mr Drummond told AFR Weekend. Out-of-pocket charges cover non-hospital services and are not insurable. 
The drop in private births is an extreme example of pressures on private health from cash-strapped households giving up their memberships because costs have been increasing at more than twice the rate of incomes, which are barely keeping abreast with inflation. 

Health Minister Greg Hunt announces $160 million funding boost for mental health

AN extra $160 million in funding will help Australians with mental illness and psychosocial disability who aren’t otherwise covered by the NDIS, the Health Minister has announced.
Jodie Stephens, AAP
News Corp Australia Network June 23, 201810:12am
A NATIONAL funding boost will help address service gaps for Australians with mental illness and psychosocial disability who aren’t covered by the National Disability Insurance Scheme, according to a peak mental health body.
Health Minister Greg Hunt on Saturday announced $160 million for a new national psychosocial measure for people with severe mental illness following an agreement between the federal and state and territory governments.
The federal government will provide $80 million over four years, beginning in July, with state and territory governments matching the commitment.

Doctors hit back over opioid crackdown

A move to monitor Australia's top opioid-prescribing doctors has been met with resentment from GPs, who say the move is heavy-handed.
Australian Associated Press June 23, 20183:31am
A move by the federal government to crack down on the over-prescribing of opioids has upset GPs who say it risks unfairly targeting some doctors.
Earlier this month, Australia's Chief Medical Officer Brendan Murphy sent a letter to almost 5000 GPs who prescribe the most opioids, warning them of the risks of dependence on the drugs.
"Seventy per cent of all fatal opioid overdoses in Australia involve prescription opioids and pharmaceutical opioid deaths now exceed heroin deaths by a significant margin," the letter states.

International Issues.

  • Jun 17 2018 at 3:05 PM

Beijing strikes back against Donald Trump as trade war escalates

Donald Trump's tit-for-tat trade war with China is expected to escalate this week after Beijing responded to the US president's latest tariff hike with retaliatory import duty increases on $US50 billion ($67 billion) of American goods, including soybeans, cars and seafood.
China also declared earlier agreements to buy more American agricultural products and natural gas were now "invalid" following the breakdown in goodwill between the world's two largest economies, which had been showing signs of progress in resolving their commercial differences.
The move came after Mr Trump, who has also antagonised traditional allies such as Canada and the European Union, said over the weekend he would slap 25 per cent tariffs on more than 800 Chinese imports from July 6.

Donald Trump’s trade tariff madness

  • The Australian
  • 6:38AM June 18, 2018

Alan Kohler

Is Australia at risk if a global trade war breaks out? Well yes of course, if someone blocks our exports or there’s a world recession.
But the language around trade can be misleading — for example “trade war” isn’t a war, and calling it that is confusing and unhelpful.
War is a conflict between two countries that can rope in allies like Australia but that’s not what happens in a “trade war” at all, nothing like that, even though President Donald Trump’s rhetoric about tariffs, as well as most people’s intuitive understanding of them, implies that tariffs are shots fired at the exporting country, aka “the enemy”.
  • Jun 19 2018 at 10:24 AM

Donald Trump targets another $US200b in China imports as trade war escalates

Donald Trump has escalated a trade and technology fight with China by ordering US officials to prepare a list of an additional $US200 billion of imports from China to be hit with a 10 per cent tariff, intensifying a tit-for-tat showdown.
The US President is also threatening to double this to $US400 billion of goods if China again retaliates, after Beijing last week confirmed it would match US import duties of 25 per cent on a separate $US50 billion of goods from July 6.
The ratcheting-up of economic tensions puts the world's two largest economies on the brink of a full-blown trade war.

Trump is trashing the American dream

By Nicole Hemmer
18 June 2018 — 7:54pm
If you want to understand the crisis unfolding on the U.S.-Mexican border, one photograph, featured on the front page of the New York Times last week, captures it in its stark inhumanity.
A two-year-old Honduran girl sobs as her mother is frisked by a gloved officer. The girl wears a long-sleeved pink shirt, dark jeans, and pink sneakers – without shoelaces. Her mother was forced to remove them, along with her own, before the two were separated. The girl would be taken to a shelter, the mother to prison. Their shoelaces were removed to prevent them from attempting suicide.
The AP toured a holding facility in South Texas that's holding hundreds of immigrant children. While reporters were not allowed to record the tour, video released by border patrol shows them waiting in a series of cages created by metal fencing.

China says Pacific debt claims 'ridiculous' after Julie Bishop raises concerns

By David Wroe
19 June 2018 — 11:55am
China’s ambassador has branded “ridiculous” the idea that Beijing is threatening the sovereignty of small Pacific nations by building infrastructure that saddles them with unsustainable debt.
His comments followed remarks by Foreign Minister Julie Bishop that the Australian government was concerned some Chinese financing arrangements in Pacific would damage the island nations' sovereignty and that Australia would offer alternatives to Chinese infrastructure development.
Speaking in Canberra, ambassador Cheng Jingye indicated he was not aware of Ms Bishop’s remarks but said the proposition China was creating so-called debt-traps for small nations was “ridiculous”.

Beijing uses infrastructure as friendly forerunner of political power

By Peter Hartcher
18 June 2018 — 7:51pm
Do you see a pattern here?
The Chinese Communist Party built a road into Tibet and the Tibetans were excited - it was their first highway: "We were promised peace and prosperity with the highway, and our parents and grandparents joined in building the road," as the president of Tibet's government in exile, Lobsang Sangay, tells the story.
"In fact, they were paid silver coins to help them build the road. So there was a popular song during those days, it goes like this: Chinese are like our parents; when they come, they shower you with silver coins," the Harvard-educated lawyer recounted at the National Press Club in Canberra last year.
The Chinese soldiers were patient with the local kids and bore their taunts with smiles, he said.

What China really thinks

China's ambassador to Australia has provided some answers to questions posed about his country's ambitions and aims.
Pat Griffiths
Australian Associated PressJune 19, 201811:48am
Chinese ambassador Cheng Jingye made a speech at an Australia China Business Council event in Canberra on Tuesday, and gave an interview on the run afterwards.
Here is what he had to say...
  • Updated Jun 20 2018 at 7:59 AM

US withdraws from the UN Human Rights Council, denouncing 'hypocrisy'

US pulls out of UN Human Rights Council
by Lesley Wroughton
The United States withdrew from the UN Human Rights Council on Tuesday after no other countries "had the courage to join our fight" to reform the "hypocritical and self-serving" body, said US Ambassador to the United Nations Nikki Haley.
Her statements came as Republican senators tried to defuse a political crisis and secure passage of legislation to end President Donald Trump's practice of separating children from their parents on the Mexican border with thousands of children locked into detention centres away from their parents, the New York Times reported. Trump warned more than a year ago that he was ready to separate mothers from their children.
Speaking about the move to withdraw from the UN council, Haley said: "In doing so, I want to make it crystal clear that this step is not a retreat from our human rights commitments".

The city where a trillion-dollar plan to dominate global trade began

Welcome to Chongqing, the heart of China’s dream to reshape the world. Next stop, Europe.
By Kirsty Needham
19 June 2018
At a quarter past midnight in Chongqing’s biggest container terminal, milk powder for infants is the hottest new product to come off a freight train that has just rolled in from Germany.
Now, in the humid night, the train is being reloaded for its journey back to Europe.
The high-value cargo – mobile phones, LCD monitors, mechanical parts and clothing – is packed in insulated containers to protect it from Central Asia’s extreme temperatures, which can plummet to minus 30 degrees along parts of the 10,000-kilometre journey.

Trump's lack of strategic wisdom may spark an all-out economic war

By Ambrose Evans-Pritchard
21 June 2018 — 10:51am
The urgent question for investors and diplomats alike is whether Donald Trump wants a trade deal with China, or whether his undeclared objective is geostrategic victory.
The dark view is that Trump is trying to provoke Beijing into tit-for-tat escalation in order to justify a pre-emptive assault on the Chinese technology-military complex before it is too late.
The struggle is over control of artificial intelligence and the cutting-edge industries of the 21st century. As Trumpian ideologue Steve Bannon put it last year: "We're at economic war with China. One of us is going to be a hegemon in 25 or 30 years."

Uncertainty about America’s role in region is bad news for our security

  • The Australian
  • 12:00AM June 21, 2018

Greg Sheridan

Outside of war, Australia is living through the most unpredictable and challenging international environment we have known. Unlike the Cold War, there is no immediate danger of nuclear devastation, but it is more unpredictable and its long-term dangers are immense.
That is the view at the top of our national security establishment, and it’s right.
A whole swag of factors that fundamentally influence our security are changing substantially and unpredictably. The public does not yet understand how radical each of these changes is and the complex way they interact with, and magnify, each other.

Time magazine cover puts immigration crisis at Trump's feet

By Rachel Olding
22 June 2018 — 5:13am
New York: A powerful cover of Time magazine has struck a chord in the US, capturing national anguish over immigration policy by placing a crying immigrant girl at the feet of US President Donald Trump.
"Welcome to America," the headline on the poignant cover says.
The crying two-year-old girl is a cut out from a now-iconic photograph by Getty photographer John Moore that went viral in the US and became a symbol of the Trump administration's new "zero tolerance" border policy.

Madness: Trump is treating the world economy like it's a reality show

By Matt O'Brien
President Donald Trump is starting a trade war against China at the same that he's starting one against the countries we'd need to help us against China. And he's doing this while also trying to undo sanctions on a Chinese company that bipartisan majorities in Congress think might be a real national security threat.
If any of that makes sense to you, odds are your last name is Trump.
For everyone else, though, it's difficult to discern any method to the madness that is Trump's trade policy. Indeed, he's alternated between announcing that he's instituting new tariffs and that he's putting them on hold, like a reality-TV show host trying to gin up ratings by keeping people guessing about what's going to happen next. Which, when you put it that way, actually makes more sense than anything else. Even then, however, we're still left with the question of why, other than maybe force of habit, Trump seems to be trying to run the global economy as if it were just a slightly more involved episode of "The Apprentice."

How to trade a trade war

  • James Mackintosh
  • The Wall Street Journal
  • 12:00AM June 23, 2018
Markets follow a well-worn pattern after US President Donald Trump’s pronouncements, a pattern followed by tax, North Korea and trade.
There is a sharp reaction — up or down — on the first news, fading as doubts that the President is willing to follow through set in.
Then there is another panic on the realisation that he is serious, and finally the market prices in the details of whatever compromise he settles on.
The Trump trade war briefly reached the realisation phase on Tuesday, but markets are still waking up to the idea that trade battles are more than a sideshow.
  • Updated Jun 22 2018 at 11:32 AM

President Donald Trump pushes for meeting with President Vladimir Putin

by Andrew E. Kramer and Peter Baker
President Donald Trump hopes to meet with Russian President Vladimir Putin in the next few weeks even as the American leader increasingly clashes with European allies over how to counter Moscow's assertive actions in Europe and the Middle East.
Mr Trump is sending his national security adviser, John Bolton, to Moscow next week to discuss a possible meeting. Mr Trump is already scheduled to attend a NATO summit in Brussels next month, followed by a long-delayed visit to Britain. He could presumably add a stop in another country like Austria to see Mr Putin.
Mr Trump has been eager to get together with Mr Putin for months despite increasing tension in the relationship between Russia and the West. Just two weeks ago, Mr Trump urged the rest of the Group of 7 major industrial powers to readmit Russia, which was expelled in 2014 after its armed seizure of Crimea from Ukraine. But the other members rejected the idea, deeming it inappropriate.
I look forward to comments on all this!


Anonymous said...

The real reason pharmacists want a piece of the myhr action. Like most other parties, it's got nothing to do with patient health.

Chemists beware: Amazon's attack on pharmacies has just begun


Amazon isn't the only threat, supermarkets have been trying it on for years.

tygrus said...

Are they going to let the pharmacies use the MyHR data to target advertising OTC products to patients? They'll claim it's for improving clinical care of their patients but really it's to improve sales&profits. Another option will be a message to "click here to get your repeat prescription sent", ePrescription on file and 30days later you get the reminder for them to send you the next pack (usual price charged to your recorded credit card).

This will then be a goldmine for SPAM fraud with criminals sending out similar looking messages and then asks for your credit card details. Aaarrgghh!

Anonymous said...

To be fair of the pharmacist he or she is not at fault here they are simply pawns being used by greed and misplaced but well intended brain farts and visions of little substance. I hope the age old and earned trust between patient and those who take up the challenge to care for us is not damaged

Bernard Robertson-Dunn said...

I agree with "To be fair of the pharmacist he or she is not at fault here ..."

I think what is happening is that non-medical organisations are trying to monetise an individual's health data. Apps developers like HealthEngine, Tyde, and Meditracker, etc have little or no interest in health care. They are interested in using health data in its most general sense, and that includes things like appointments and the taking of medicines and looking for opportunities to sell service to patients (as in selling sales leads to lawyers).

Amazon is trying to develop "better" delivery of pharmaceuticals to customers who want the added convenience and lower prices.

The health care system is being disrupted by modern technology, however not much is disrupting clinical medicine, apart from potentially having a negative impact in that it is increasing the cost of doing clinical medicine in satisfying the need for more data - which is an activity often being lumped on GPs.

IBM got displaced as the primary supplier of IT systems, not by someone coming along and doing IT better but by changing the nature of IT systems.

The Health Care System is being radically changed in many ways by modern technology, not by automating existing practices (like Health Record document management) but by new entrants offering new services. Dr Google, DNA analysis, and smartphone apps are just the start.

The government is so far behind the wave it isn't funny, but it is a fact of life.

One of the original purposes of myhr was to reduce data fragmentation. That is now a forlorn fantasy - health data is exploding and myhr as a summary system can never catch up.

The other touted benefit of myhr - that it could provide health data in times of emergency - is being undermined by a plethora of new apps and a reliance on patients creating and keeping up-to-date a clunky government owned system in which the important information (allergies, immunisations, medicines) in a Shared Health Summary can only be updated by a GP. The availability of these systems also means that emergency workers will not know where to go to find useful health data - it could be in one of many places - or nowhere. What are they likely to do? Not waste time looking for data that may not exist, which may be unreliable and incomplete, or carry on with the old methods and treat the patient in front of them.

That is an example of Digital Health making clinical medicine harder, not more effective or efficient. What option does the government have - make myhr mandatory and the only source of health data? Good luck with that.

The move to opt-out and the campaign to prevent people from doing so will be at best a Pyrrhic victory, at worst a Canute gesture - pick your metaphor.

Anonymous said...

Passed without comment - https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/interoperability-find-out-what-it-means-to-me?

Anonymous said...

4:44 PM : How entertaining! With the following classic quotes from https://www.digitalhealth.gov.au/about-the-agency/digital-health-space/interoperability-find-out-what-it-means-to-me? :

“In the main, however, the most useful repository for information about patients is their My Health Record.”
- Truly? I thought it might be whatever is on the other end of the fax machines.

“Within My Health Record, it’s impossible to know, in advance, what laboratory, or doctor, or imaging provider (etcetera) the information might be coming from. Therefore it’s equally impossible to know what “dialect” is in use.”
- Que? I believe that each document uploaded includes metadata about which coding schemes (or ‘dialects’) are used within, together with identifiers of the health provider organisation/health provider that is submitting the document. And is it not true that providers need to ‘register’ to participate in the My Health Record system, so we do know in advance where documents will be coming from?

“So what’s the answer? Ultimately, we need to agree to implement a consistent language for clinical concepts at the interface. We already have large and well-defined national terminologies, but these have not yet been consistently implemented, and there are a broad range of reasons for this. One of these reasons is that there has never been a mandate for a standard terminology.”
- And would it not be a great example nationally if the My Health Record system itself used a well-defined national terminology. Let’s hope that future designs will include this very important requirement for interoperability.

“Returning to our question: how do we move forward? The answer, as always, is “Together”.”
- So sweet. Who cares about practical steps. Much better to have a good laugh “together”. I can feel a song coming on…

Anonymous said...

A single terminology? Terminology of wha, clinical, medicine, ingrediates, administration, billing???

MyHlR is exposing how little ADHA knows about the system

This is not about interoperability, it is about singularity.

Bernard Robertson-Dunn said...

Further to my rant on apps, above - June 29 2018 3:48 pm

A bit of history:

In the late 1980s, OSI was the great white hope of the IT world. “The Open Systems Interconnection (OSI) Model is a conceptual and logical layout that defines network communication used by systems open to interconnection and communication with other systems.”


In the early 1990s, the Federal government saw OSI as a means to ensure that its systems could easily talk to each other. They had a variation of OSI called GOSIP, based on one developed by the US government.

For a number of years I was the Australian Information Industry Association representative on the government's Open Systems Committee, mainly because I had worked as an architect on a large project run by a consulting company (DMR group) that looked at the problems to be solved and appropriate strategies and architectures that could deliver the benefits of an Open Systems approach.

GOSIP failed miserably. The strategy everyone adopted was TCP/IP, a set of standards which is the basis of the Internet as we know it today.

Briefly, OSI was over engineered and did not have a strategy that allowed a gradual implementation – all the old interfaces had to be replaced. TCP/IP was based upon a strategy of “just do it”. Simple solutions were developed that advanced technology incrementally, provided immediate benefits that people wanted and did it in an open manner. Evolution, not revolution.

OSI took a purist technology view, TCP/IP looked at ways to solve real problems and delivered real and immediate benefits. Enterprises, businesses and vendors flocked to it, there were no sticks or even carrots, just a recognition that there were good reasons for adopting the approach and the solutions offered solved real problems.

OSI/GOSIP used the term “standard” in the sense of formal, internationally agree standards. TCP/IP used the term in a way that ensured that the protocols were agreed and used in a common manner. Both were open to a greater or lesser extent.

Having lived through all that and seen what won and why, I now see exactly the same pattern with health data. On one side is the HL/7 SNOMED, FHIR etc technology camp.

On the other side are apps developers and big corporations with no medical agenda delivering useful functionality (sometimes getting it wrong but they are called out quickly and rapidly back off – just look at the Health Engine fiasco)

The Federal government is the biggest single purchaser of IT in Australia and even they couldn’t influence the market to go down the GOSIP track. IMHO, the same will happen with health data. As GOSIP became irrelevant, so will My Health Record. The only difference is that GOSIP wasn’t an embarrassment to the government, very few people understood or even knew what was happening. My Health Record will come to the attention of most Australians and may have significant unintended political consequences.

I have no expectation that anyone will listen to me; that is one of the lessons I have learned. All I am doing is expressing my opinion. History can make its own judgement using the luxury of 20/20 hindsight.

Anonymous said...

The ADHA interoperability article seems to me to have been compiled by someone with minimal understanding copy and pasting a few sentences from multiple sources, stitched them together, passed to someone with less understanding how waved the magic spin wand and then passed to a comma person with no understanding to construct what they posted.

I guess to copy one is plagiarism to copy many is evidence based research

Grahame Grieve said...

@Bernard, I enjoyed the rant. But TCP/IP is a standard too, so you've mischaracterised what happened. We pay attention to how standards are developed, and which ones won... and we're trying to replicate the approaches that have worked, and not replicate the ones that didn't. It's a game of standards...

Regarding the ADHA interoperability document - that's an attempt to reduce out all the technical complexity and produce a description that makes sense to someone who doesn't understand informatics. Criticising it because the informatics details are weak is completely missing the point. In general, I've never seen that approach work, but feedback to the agency about interoperability is all over the place because the feedback spans such a broad range of knowledge and perspectives. This document is trying to draw a minimal line. Did it work? I don't know.... Bernard, perhaps rather then being critical, you could draft your own effort...

Bernard Robertson-Dunn said...

Grahame, you missed my point. I was drawing a distinction between a purist, standards driven approach (OSI/GOSIP) and a highly pragmatic, benefits driven approach which used a far simpler, minimalistic approach to standards (and yes I know TCOP/IP is a standard).

Health apps are being created and sold with minimal attention to standards. This may cause many problems in the future but so did TCP/IP, which lacks many of the security features of OSI.

But we now have the Internet along with all its weaknesses, something that would be difficult to live without, now we have it and use it.

In this context (and I've made no particular mention of interoperability) I was suggesting that the market place is producing many different solutions to the challenge of how to gather, use and benefit from health data. These solutions are undermining the claimed benefits of myhr, do not involve giving your data to the government, offer more than myhr and vendors are not waiting for standards to be further developed. It's the same Nike approach, Just Do It, that was adopted by the developers of TCP/IP.

Real Digital Health is a disrupter and it's disrupting the government's strategy.

IMHO, the biggest question is "what is the point of integration of a patient's health data?"

In the past it has been the GP. You saw a GP, they collected your health data. You had tests, saw a specialist. The data would flow back to the GP. It was done in clunky, poor ways, but it happened.

The government wants it to be myhr. Unfortunately, myhr has too many costs, risks and disadvantages.

Will it continue to be the GP? Maybe. What else could it be? The patient's smartphone or tablet? Quite possibly. There are likely to be multiple points, depending on the patient's circumstances. But those points will be based upon the patient's interaction with the health care system i.e. the patient, the GP or shared.

In which case there will be an interoperability problem in the interaction between patient and GP. The best people to solve this would be the suppliers of GP clinical medicine systems. Because they are in control of both ends, they can deliver quickly and without reference to others. Inter-system interoperability is important, but not as important as the GP/Patient relationship.

The consequence of this is that changing to a GP with a different clinical system would come at a cost. To the patient, not the GP. Is this a problem? Only to patients who want to or have to change GPs.

The dynamics of health care are about to change and will be driven by the interests and priorities of GPs and their support for their patients. Freezing medicare payments, increasing the bar for ePIP payments, using nudge techniques, accessing myhr data to monitor GP/practice decision making could well end up costing the government dearly.

Anonymous said...

With the greatest respect, with or without the “informatics” aspect I struggle with who the audience is suppose to be? Is it a policy setter? Is it a collection of business owners? Is it for health CIO’s?

The ADHA must do better, they cannot remove components simply because it is complex.