Quote Of The Year

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

Sunday, December 08, 2019

What Do You Reckon Could Be Coming For The ADHA In Coming Weeks?

As reported in the last few days there has been a huge shake-out and purge of the Australian Public Service (APS) in the last few days.
Here is the start of the Australian’s reporting:

Get lean: Scott Morrison wields the axe on bureaucracy

Five Mandarins have been axed in a move to implement a "lean and mean" bureaucracy.
December 6, 2019

Scott Morrison has ordered the biggest shake-up of the public ­service in more than 30 years, axing four departments and five mandarins in a move to ­implement a “lean and mean”­­ ­bureaucracy.

Delivering on a pledge to cut red tape and streamline government services, the Prime Minister will cut the number of departments from 18 to 14 as of February 1 to “bust bureaucratic congestion”.

Mr Morrison, who is also Minister for the Public Service, said Australians should be able to ­access “simple and reliable ser­vices, designed around their needs”.

The creation of four super departments is the most significant restructure of the public service since Bob Hawke reduced the number of departments from 28 to 18 and abolished the public service board soon after the 1987 election.

Ahead of Mr Morrison releasing his response to David Thodey’s review of the public service next week, The Australian understands government agencies and boards, estimated to number more than 180, will be next in the firing line.

There is a great deal more here:

It seems pretty clear that plans for this have been underway for a while and that there is much more in the works!
This from the OZ daily email says it all.

“The next step is the agencies … there are more government agencies than there are countries in the UN.”

SENIOR GOVERNMENT SOURCE”
So what might this mean for the Agency that brought all that political pain to Minister Hunt with the mess that became the ‘opt-out’ transition which was repeatedly delayed due to public outrage and has left more than 2.5million annoyed voters?
Is there a clue that Renee Leon – Secretary for Services Australia (the old DHS) was one of the casualties?
What follows has to be pure speculation but given the new Department already operates the #myHealthRecord all that would need to remain of the ADHA would be a small policy advisory unit in the new Department Of Social Services for Digital Health. I guess it is also possible that they could otherwise be merged into the Department of Health.
It is hard to see how this would not be very cost effective and suitable payback for the ‘opt-out’ stuff up. These pollies seem to have long memories and seem to play a pretty vengeful calculated game.
What do you think?
David.

AusHealthIT Poll Number 504 – Results – 8th December, 2019.

Here are the results of the poll.

Do You Believe The ADHA Is On Top Of, And Properly Managing, The Shared Cyber-Security Risks Associated With The #myHealthRecord, As Identified By The ANAO Recently?

Yes 4% (4)

No 94% (95)

I Have No Idea 2% (2)

Total votes: 101

Well that was pretty clear. A huge majority thinks that the ADHA is not fully across the #myHealthRecord security risks.

Any insights on the poll welcome as a comment, as usual.

A very reasonable turn out of votes.

It must have been a relatively easy question as only 2/101 readers were not sure how to respond.

Again, many, many thanks to all those that voted!

David.

Saturday, December 07, 2019

Weekly Overseas Health IT Links – 07 December, 2019.

Here are a few I came across last week.
Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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Is the third sector the solution to 24/7 mental health care?

In the last few years there has been significant progress in advocating against social stigma of mental health but could the third sector be the key to providing more convenient access to services? Ian Jackson, Medical Director and Clinical Safety Officer at Refero, explains how teaming telecommunications tech with third-sector services could enable joined-up, personalised mental healthcare.
DHI News Team – 26 November, 2019
Jeremy Corbyn has vowed to give every child access to mental health support by spending £845 million if Labour succeeds in December’s general election.
And the Conservatives have announced that new models of personalised care will be rolled out to tackle the serious issue of adult mental illness, as part of a “huge boost to community mental health services for adults which will see an extra £975 million going into these services every year.”
Team these announcements with events such as World Mental Health Day, and most recently, the Movember male suicide campaign, we can say that significant progress in advocating against social stigma, raising awareness, and offering crucial support to those in need, is being made. But there is still much work to be done when it comes to delivering effective, consistent, joined-up care through the NHS.
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A Roadmap To Welcoming Health Care Innovation

10.1377/hblog20191119.155490
Health care systems are being flooded with a slew of digital innovations, both internally and externally sourced. The promise of remote sensors, machine learning, artificial intelligence, and personal health records, together with investment from the National Institutes of Health and private investors, has resulted in a tsunami of interest in these solutions. Yet, health care systems across the country are struggling with their approach to innovation, which has resulted in a tremendous proliferation of pilot studies but little adoption of solutions at scale. The mismatch between the promise of the technology and current organizational strategy requires further examination. 

Why Is This So Hard? 

The first challenge is that executing on innovation that impacts value (cost and quality) requires both technology and business model transformation. While we have had significant focus on the technology aspects of the digital revolution, the business model transformation aspect has received much less attention. Business transformation requires significant investment of time by senior leadership, resources, the development of new business models, and the retirement of legacy business models. Most organizations will not undertake this level of investment in a novel concept without significant justification. 
Another dilemma stems in part from leadership’s inability to evaluate novel technologies and pilot studies appropriately from an investment perspective. Rather than being seen as a point solution, digital innovations should be viewed as a starting point for investment in novel business processes, novel business designs, and potentially, novel organizational structures. Senior leadership, which must assess whether the digital innovation has reached a level of maturation appropriate to this level of investment, is often the bottleneck in these decision-making processes. Leaders at lower levels of decision making are often not empowered to make decisions regarding business transformation, and few health systems have an alternative “strategic” decision-making pathway that includes alternative perspectives, leaders, and metrics. 
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Amazon rolls out new Alexa feature to let consumers refill prescriptions

Nov 26, 2019 12:17pm
Amazon is rolling out medication reminders as a new feature of its Alexa device in partnership with pharmacy chain Giant Eagle.
The new feature, announced Tuesday, could be the first step in the tech giant's broader effort to use the voice assistant to help consumers manage their medications.
The new voice-enabled medication reminder feature represents "day one" for Amazon and healthcare, Rachel Jiang, who leads the Alexa health and wellness team, wrote in a blog post Tuesday.
But Amazon expects to learn from the initial launch and plans to expand the feature to more pharmacies next year, Jiang wrote.
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Vanderbilt Researchers Test mHealth Platform to Improve ED Hand-Offs

The project equipped EMS personnel with wearable mHealth sensors to create a log of procedures done during transport, so that ED and trauma care providers have a better idea of what happened on the way to the hospital.

November 27, 2019 - Researchers at Vanderbilt University Medical Center are piloting an mHealth wearable platform that aims to improve emergency care – by tracking how EMS providers move.
The researchers, working with the Nashville Fire Department, are using the connected health platform to track what paramedics and other care providers do in the ambulance prior to handing off a patient to the hospital’s Emergency Department. In doing so, they’re creating a digital log of in-transit procedures, including cardio-pulmonary resuscitation and intubation, that will help ED personnel better plan their course of treatment.
“The resulting documentation will be extremely valuable for emergency room physicians and trauma surgeons who want to know what care has been provided,” Daniel Fabbri, PhD, an assistant professor of Biomedical Informatics and Computer Science at Vanderbilt, told the university’s news service.
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Heart Attack or Not? Apple Watch Might Give the Answer

By Dennis Thompson
HealthDay Reporter
MONDAY, Nov. 25, 2019 (HealthDay News) -- A doctor armed with your Apple Watch might be able to tell if you're suffering from a heart attack, researchers report.
A physician should be able to gather enough heart rhythm data by placing the watch's sensors on different parts of your body, to judge whether a person is in the middle of a heart attack, the study found.
"Any Apple Watch series 4 and 5 can be used," said report author Dr. Miguel Angel Cobos Gil, a cardiologist with the Hospital Clinico San Carlos in Madrid, Spain. "You don't need any modification or accessory."
However, you do need to be able to interpret an electrocardiogram (ECG), so this is a trick that Apple Watch owners won't be able to do on their own, Cobos Gill added.
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The 2020 state of cybersecurity: 2 ways enterprises need to prepare

November 27, 2019, 3:30 a.m. EST
Securing all forms of data is, and will continue to be, an ongoing challenge for individuals, organizations and enterprises as we head into 2020. Just look at the past year—one of the most notable cybersecurity threats that plagued cities, individuals and other organizations (especially healthcare) was ransomware.
And when you look at the numbers, they’re staggering. As of this past August, 140 ransomware attacks have targeted public state and local governments as well as healthcare providers this year, with two-thirds of publicly known attacks targeting the former. The point is that malicious actors are tenacious, creative, and will keep finding new ways to get what they want: your data.
And, as with every new year, comes new—and often unforeseen or even unfathomable—threats to cybersecurity and the data, apps and technology that we’ve all come to rely on every day. As someone who’s worked in cybersecurity throughout my entire career, there are two things I believe we’ll see make headlines next year that every enterprise should be aware of and prepare for.
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EHR ‘nudges’ increase clinician ordering of cancer screenings

November 27, 2019, 12:42 a.m. EST
The University of Pennsylvania Health System programmed a best-practice alert into its electronic health record to automatically prompt medical assistants to either accept or decline a cancer screening order.
The EHR “nudge” implemented at three different Penn primary care practices resulted in a 22 percent increase in screening order rates for breast cancer, compared with practices without the alert. In addition, the colorectal cancer order rate rose by almost 14 percent vs. the other practices.
“An active choice intervention in the electronic health record directed to medical assistants was associated with a significant increase in clinician ordering of breast and colorectal cancer screening tests,” finds a Penn Medicine study published in JAMA Network Open.
Because the intervention was directed only to medical assistants, the study’s authors contend that the EHR nudges reduced the burden on physicians to respond to the alerts, giving them more time to have discussions with their patients about screenings.
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Healthcare Companies Struggle With Implementing Digital Transformation

November 27, 2019
New research has found that healthcare organizations around the world have big plans for digital transformation but often stumble when it comes to implementing this process.
Global marketing strategy and marketing consulting firm Simon-Kucher & Partners surveyed more than 120 managers from the pharma and medtech industries in August and September of this year to get a sense of where these companies were headed within digital health activity.
Researchers found that 70% of respondents said that their companies were working to introduce digital add-on services and 38% standalone digital offers. In addition, half of those surveyed were working to collect customer data.
When examining their efforts, the firm found that in 56% of cases, respondents created a dedicated digital team to define the strategy, while in another 42% a new or existing commercial team carried on these efforts.
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Major Misconceptions About Machine Learning In Healthcare

November 27, 2019
Over the past few years, as some standout use cases began to emerge, enthusiasm for AI has grown among health leaders, to the point where you’ll hear little but positive thoughts about AI’s potential benefits.
Now that interest in AI has moved almost entirely into the mainstream, it’s probably time to look at areas in which the industry has gotten perhaps carried away with itself and lost sight of potential challenges to its use.
This is why I was pleased to stumble across an article in Harvard Business Review which names what it sees as some bothersome myths about machine learning in healthcare which have already begun to take hold in the industry.
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Patient Safety Still Problematic 20 Years After 'To Err Is Human' Report

By Christopher Cheney  |   November 27, 2019

There have been leaps forward in patient safety over the past 20 years but harm remains far too common, two experts say.


KEY TAKEAWAYS

·         In 1999, the landmark report To Err Is Human estimated that as many as 98,000 patients died annually from medical errors.
·         Despite publication of To Err Is Human, estimates of deaths from medical errors have increased. In 2013, an article published in the Journal of Patient Safety estimated annual patient deaths from medical errors were as high as 440,000.
·         High reliability in the commercial aviation industry provides guideposts for the healthcare industry to follow to achieve zero harm.
Progress has been made in patient safety improvements but many more advances are needed, a pair of experts say regarding the 20-year anniversary of the landmark report To Err Is Human: Building a Safer Health System.
The 1999 report included the alarming statistic that as many as 98,000 Americans were dying annually due to medical errors. Yet despite two decades of attention, estimates of annual patient deaths due to medical errors have since risen steadily to as many as 440,000 lives, a figure that was reported in the Journal of Patient Safety in 2013.
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Digital alert helps speeds sepsis treatment in test at London system

November 26, 2019, 3:38 p.m. EST
A London healthcare delivery system is using a digital alert to help remind physicians to look for signs of sepsis in the emergency department.
The technology-based reminder system speeds the time it takes for doctors to check for signs of sepsis early in an emergency department visit, which quickens the administration of antibiotics.
Sepsis is a common health issue in the U.K.; the nation has reported 123,000 cases and 46,000 deaths annually. Consequently, UK hospitals have a goal of administering antibiotics intravenously to suspected sepsis patients within one hour.
Embedding sepsis tools into the electronic health record enables use of digital alerts to physicians, based on current and past clinical measurements. For example, Cerner has developed a digital sepsis alert that has a silent running mode. Silent alerts are not visible to doctors at the front end of the system, but once an alert is turned on, nurses are notified of patients who have triggered the alert via a pop-up warning on the EHR.
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AMIA: FHIR is not suitable for research, needs NIH R&D funding

November 26, 2019, 12:07 a.m. EST
The American Medical Informatics Association wants the National Institutes of Health to fund research and development to advance HL7’s Fast Healthcare Interoperability Resources standard.
AMIA submitted comments to NIH in response to the agency’s request for information seeking input from stakeholders on how FHIR could be used to capture and share clinical data for biomedical research purposes.
According to AMIA, it is critical that NIH assume a leadership position to coordinate a research and development strategy for using FHIR for research and that the agency devote “substantial resources” to the effort.
Specifically, AMIA recommended that NIH directly fund FHIR research and development through grants; indirectly fund FHIR through special emphasis notices and project requirements that prioritize projects that will use FHIR; and educate the research community and help represent it in activities supported by HL7, the Office of the National Coordinator for Health IT and other standards developing organizations that have an interest in FHIR.
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Virtual Clinical Trial Aims for HF Drug Indication

ISCHEMIA's John Spertus, MD, MPH, calls it a dream come true

·         by Crystal Phend, Senior Editor, MedPage Today November 25, 2019
Could a drug get a new indication without ever having study participants step in a medical office?
CHIEF-HF will push the bounds on indication-seeking trial design. This "digital trial" is expected to launch early in 2020, accrue 1,900 heart failure patients with preserved or reduced ejection fraction, and potentially report results after 18 months.
MedPage Today spoke with the trial's primary investigator John Spertus, MD, MPH, of the University of Missouri Kansas City and St. Luke's Mid America Heart Institute there.
Tell us about the trial ...
Spertus: This is a trial of the impact of Invokana [canagliflozin], an SGLT2 inhibitor, on heart failure. The recent DAPA-HF study in heart failure with reduced ejection fraction had very compelling data.
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EHR Training Improves Physician Satisfaction & Physicians Don’t Want to Make Time for EHR Training

November 26, 2019
While at the CHIME 2019 Fall Forum conference in Phoenix, AZ, I had a great chance to sit in on one of the CIO focus groups at the event hosted by Optimum Healthcare IT. The session discussed a wide variety of topics including EHR optimization, EHR training, and other related topics. While listening to these discussions, I was struck be a certain irony that seemed to be experienced by almost every CIO I met at the CHIME Fall Forum and this focus group in particular. The irony is illustrated in these two statements.
EHR Training Improves EHR Satisfaction
and
Physicians Don’t Want to Make Time for EHR Training
These are pretty broad generalizations, but the beauty of a generalization is that it’s generally true. For the first statement, this has really been proven out by the great EHR Satisfaction research that KLAS’s Arch Collaborative has done along with Heather Haugen’s research in the book Beyond Implementation. If you’re not doing enough EHR training, then fixing it will help with physician satisfaction. If you don’t have great EHR trainers, getting better trainers will help with EHR satisfaction.
Given this is the case, it’s amazing how much push back CIOs get when it comes to EHR training from physicians. The stories I’ve heard are wide and varied. Everything from physician’s refusing to do EHR training and hospitals hiring a scribe to do all the EHR work for them through physician’s leaving organizations because they don’t want to train on the EHR. While those are the extremes, the most common request I’ve seen is doctor’s asking for as little EHR training as possible.
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Can Google “Restore the Joy of Caregiving”?

November 26, 2019
That’s quite an ambitious question. It’s a sentiment I’ve heard over and over from people who think that Google or Apple could enter healthcare and finally make the software a joy. However, what prompted the title of this article was Alvin Rajkomar, MD, Product Manager at Google Health who shared this as Google’s ambition in healthcare.
Alvin shared Google’s goal to “restore the joy of caregiving” in a video which showed the first demo of a Google Health product. Check it out below:
I have to admit that this is the closest I’ve seen to a big tech company putting together something that’s starting to look like an EHR. Props to Google for having this ambition. However, this demo falls flat on so many levels that it’s still hard to take serious. Plus, it doesn’t address the real underlying challenges that make clinician burnout a reality today.
The most glaring thing for me with the above demo is that it largely focuses on viewing EHR data as opposed to data entry. While there are certainly challenging nuances to viewing EHR data today, most of the “joy” is sucked out of healthcare thanks to data entry, not viewing data. Certainly, Google’s demo asserts that they can more effectively access and display data across multiple organizations which we all know would be great. However, it doesn’t share a compelling case for how they’ve really solved the healthcare interoperability problem. Remember that the problem is not a technical one, but a business one. Does a slicker interface do anything to solve the business problem here? Not even close.
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Google demos its EHR-like clinical documentation tool

News of the tool, currently in clinical pilots, comes a week after reports circulated that Google was working with healthcare system Ascension on a controversial project involving patient data.
November 21, 2019
Google Health has offered a peek at what it's planning for its next set of clinical digital tools. It includes a more integrated charting system that aims to make it easier for doctors to search for a variety of metrics and notes. 
“With a single login, doctors can access a unified view of data normally spread across multiple systems. All the types of information clinicians need are assembled together such as the vitals, labs, medications and notes,” Dr. Alvin Rajkomar, product manager and practicing physician, said in a demo video
“Clicking on any value will start a deeper exploration showing recent and historical trends both graphically and with tables," he explained. "Doctors can query the entire chart with their own words and typos. Results are not strict keyword matches. A variety of Google technologies are used to identify related concepts.”
The new tool, which is still in the pilot phase, lets clinicians use shorthand to search and will bring up results that may have typos. Users can also jump to different parts of the chart, such as vitals or notes, by using the search feature. Doctors will also be able to search through scanned documents and faxes, both with handwritten and typed notes, for information.
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11/22/2019
04:40 PM

Researchers Explore How Mental Health Is Tracked Online

An analysis of popular mental health-related websites revealed a vast number of trackers, many of which are used for targeted advertising.
Researchers who analyzed a collection of mental health-related websites found a vast majority embed "an impressive number" of trackers mostly used for marketing purposes. More than a quarter embed third parties engaged in programmatic advertising and Real Time Bidding (RTB).
Eliot Bendinelli, a technologist with UK non-profit Privacy International, says the organization wanted data protection agencies to take action because it believed there was a fundamental problem with the tracking industry. Its project began with an investigation into sales in the field of ad tech companies, credit rating agencies, ad blockers, and related organizations, he says.
"We were building a case, and basically we think what they're doing is unlawful," Bendinelli continues. While waiting for agencies to act, the research team wanted to find an example of how tracking is taking place on Web pages where people go to read and share sensitive data.
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Nov 24, 2019, 12:47pm

10 Predictions How AI Will Improve Cybersecurity In 2020

Louis Columbus
Cybersecurity is at an inflection point entering 2020. Advances in AI and machine learning are accelerating its technological progress. Real-time data and analytics are making it possible to build stronger business cases, driving higher adoption. Cybersecurity spending has rarely been linked to increasing revenues or reducing costs, but that’s about to change in 2020. 
What Leading Cybersecurity Experts Are Predicting For 2020
Interested in what the leading cybersecurity experts are thinking will happen in 2020, I contacted five of them. Experts I spoke with include Nicko van Someren, Ph.D. and Chief Technology Officer at Absolute Software; Dr. Torsten George, Cybersecurity Evangelist at Centrify; Craig Sanderson, Vice President of Security Products at Infoblox; Josh Johnston, Director of AI, Kount; and Brian Foster, Senior Vice President Product Management at MobileIron. Each of them brings a knowledgeable, insightful, and unique perspective to how AI and machine learning will improve cybersecurity in 2020. The following are their ten predictions:
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Nov 23, 2019, 07:00pm

Concrete Problems: Experts Caution on Construction of Digital Health Superhighway

Michael Millenson
I write critically about U.S. health care
If you’re used to health tech meetings filled with go-go entrepreneurs and the investors who love them, a conference of academic technology experts can be jarring.
Speakers repeatedly pointed to portions of the digital health superhighway that sorely need more concrete – in this case, concrete knowledge. One researcher even used the word “humility.”
The gathering was the annual symposium of the American Medical Informatics Association (AMIA). AMIA’s founders were pioneers. Witness the physician featured in a Wall Street Journal story detailing his use of “advanced machines [in] helping diagnose illness” – way back in 1959.
That history should provide a sobering perspective on the distinction between inevitable and imminent (a difference at least as important to investors as intellectuals), even on hot-button topics such as new data uses involving the electronic health record (EHR). 
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Breaches in 2018 exceed previous year; affected patient records soar

November 25, 2019, 3:12 p.m. EST
The healthcare sector continues to be a highly valued target for hackers and other malicious attackers at the rate of one breach per day, according to a new report.
The research, published by Protenus, a healthcare compliance analytics company, and DataBreaches.net, a web site devoted to reporting on data security breaches, found that, out of all breaches reported last year, 353 (or 70 percent) involved healthcare providers, 62 (or 12 percent) involved health plans, and 39 (or 8 percent) involved some other type of entity.
The latest Breach Barometer report was based on an analysis of 503 health data breaches reported to the Department of Health and Human Services, the media or some other source during 2018. The number of breaches was up slightly from the 477 breaches reported in 2017. Protenus and DataBreaches.net have information on the majority of the breaches in 2018, which affected more than 15 million patient records, the companies said.
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New fed guidance helps providers, stakeholders avoid phishing attacks

November 25, 2019, 3:26 p.m. EST
A report from CISA, a cybersecurity and Infrastructure Security Agency within the Department of Homeland Security, offers a number of tips to beat phishing attacks.
The agency is aiming the report to share ways that healthcare providers, business associates, consultancies and other stakeholders can avoid social engineering and the phishing attacks that likely would occur.
In a social engineering attack, the offender employs human interaction social skills to get information on the organization or its information systems. Acting unassuming and respectable and passing off as a new employee, repair person or researcher, the offender may even offer credentials to support the identity deception.
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VA reports 235% increase in video telehealth visits in FY19

November 24, 2019, 10:57 p.m. EST
The Department of Veterans Affairs, which already has the country’s largest telemedicine program, delivered more than 2.6 million episodes of telehealth care in Fiscal Year 2019.
The milestone—reached between October 2018 and September 2019—represents a 17 percent increase in overall telehealth visits over the previous fiscal year, according to new data released by the VA.
Over the past fiscal year, more than 900,000 veterans availed themselves of the agency’s telemedicine services in a clinic or at home, enabling real-time interaction with VA care teams.
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VA sees a surge in veterans' use of telehealth services

More than 900,000 veterans used the agency's virtual care in 2019, with their use of the VA's Video Connect app up 235% in the same period.
November 25, 2019 12:53 PM
The U.S. Department of Veterans Affairs has announced a 17 percent jump in telehealth visits compared with the previous fiscal year, and says the VA delivered more than 2.6 million episodes of telehealth care in FY 2019.
WHY IT MATTERS
The VA report revealed more than 900,000 veterans used the agency's telehealth services in 2019, with their use of the VA Video Connect app, which connects Veterans to their care teams through a secure video session, jumping 235% in the same period.
"More than 200,000 or approximately two-thirds of the 294,000 VA Video Connect appointments in FY 2019 were for tele-mental health visits," said VA officials.
The agency noted that more than 99,000 Veterans used the app, which connects Vets with their health care team using encryption to ensure a secure and private session, at home, thereby saving a trip to a medical facility.
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Providers Increasing Adoption of AI-Fuelled Clinical Documentation Technology

November 25, 2019
The use of computer-assistant coding has been percolating along for a while now but hasn’t taken over the healthcare industry. However, it could find a much more extensive place in the industry in coming years as AI becomes more widely accepted within healthcare organizations, a new survey suggests.
According to Black Book Research, which conducted the survey, the clinical documentation tech market should hit $5.2 billion by 2022, up from $3.2 billion at the end of fiscal 2018. That represents a 10.2% compound annual growth rate.
The survey, which connected with 3,300 coding and health records professionals, found that 44% of respondents already use AI in some form and that 88% of C-suite officers surveyed expected to see wide AI implementation within the next five years.  Black Book also found that 93% of healthcare professionals were optimistic that AI technology will be able to streamline document creation.
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Weekly News Recap

  • The American Medical Association calls for EHRs to be fully inclusive for transgender patients and expresses its support for government funding to improve public health technology, including EHR integration.
  • Government officials in Bahamas scramble to dodge blame for signing an $18 million contract with Allscripts in 2016 that was supposed to transform healthcare, but has yet to result in any installed software.
  • HHS expands its price transparency plans by proposing that both hospitals and insurers be required to publicly post their negotiated contract prices.
  • The Spokane VA hospital hires more than 100 new employees to cover its expected productivity losses during its Cerner go-live in March.
  • Kareo sells its revenue cycle management business.
  • Stanford Hospital opens its $2.1 billion, 368-bed hospital that incorporates extensive technology.
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Doctors give electronic health records an 'F'

Date: November 14, 2019
Source: Yale University
Summary: The transition to electronic health records (EHRs) was supposed to improve the quality and efficiency of healthcare for doctors and patients alike -- but these technologies get an 'F' rating for usability from health care professionals, and may be contributing to high rates of professional burnout, according to a new study.

Full Story

The transition to electronic health records (EHRs) was supposed to improve the quality and efficiency of healthcare for doctors and patients alike -- but these technologies get an "F" rating for usability from health care professionals, and may be contributing to high rates of professional burnout, according to a new Yale-led study.
By contrast, Google's search engine earned an "A" and ATMs a "B" in similar but separate studies. Like EHRs, the spreadsheet software Excel got an "F."
"A Google search is easy," said lead author Edward R. Melnick, assistant professor of emergency medicine and director of the Clinical Informatics Fellowship at Yale. "There's not a lot of learning or memorization; it's not very error-prone. Excel, on the other hand, is a super-powerful platform, but you really have to study how to use it. EHRs mimic that."
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Enjoy!
David.

It's Hard Not To Be Proud Of Such A Collection Of Secretive, Obfuscating, Excessively Paid Board Members.

The ADHA have finally done it.

A whole year of radio silence at Board Level while the Agency spews misleading exaggerated spin at every turn!

Captured just now from their site - Dec 7, 2019 12.00am.

Download the latest Board Meeting 6 December 2018 - Board Papers

https://www.digitalhealth.gov.au/about-the-agency/australian-digital-health-agency-board

Can you really believe they are genuinely working in the interests of the Australian Digital Health with this sort of behaviour? You can read all about them from the link above!

David.

Friday, December 06, 2019

There Seems To Be Some Problems With The Security / Privacy Controls Of The iEMR in Queensland.

This yarn appeared a few days ago.

How two British shark victims posed a challenge for Queensland patient confidentiality

By Lucy Stone
November 24, 2019 — 9.33pm
Confidentiality "flags" were placed on the private medical records of two British shark attack victims treated at Mackay Hospital, warning curious staff they should only access the records for valid medical reasons.
The incident was one of several case studies presented to the Crime and Corruption Commission’s public hearings for Operation Impala, investigating the misuse of private data in public organisations.
Mackay Hospital and Health Service’s executive director of people, Rod Francisco, gave evidence to the hearings last week, detailing his concerns about the broad level of access to patient medical data in the integrated electronic medical record (ieMR).
The ieMR enables clinicians to view a patient's medical record from any of the 14 Queensland public hospitals in which the software has been installed.
Questioned by counsel assisting the CCC Julie Fotheringham, Mr Francisco said the broad access of data was a risk that Mackay HHS had not fully understood in the lead-up to the software’s rollout there about two years ago.

"The greatest risk from my perspective is that staff can do things that they shouldn't be doing," Mr Francisco told the hearing on Tuesday, November 12.
"In some systems that we have, a person can look at everything. And I think that's the greatest risk, that they can look at everything, whether they need to or not."
Queensland Health director-general John Wakefield also gave evidence at the CCC hearings, saying the end of paper-based records had been a "revolution" saving thousands of hours of administration and patient time and frustration.
Dr Wakefield said privacy breaches on the ieMR were "thankfully rare", but when they do occur, they "undermine our public trust and our reputation for being custodians of probably the most precious information that citizens hold".
He said the ieMR had "dramatically improved our ability to deliver the sort of healthcare outcomes that our community and our patients tell us they want and, indeed, expect".
"I think it is not hyperbole to suggest that lives depend upon access to this information in a very timely way for the people who need to have it to help those people, particularly where time criticality matters in emergencies," he said.
One option to reduce the number of potential breaches could be to remove the access of administration staff to the ieMR, Mr Francisco suggested.
"You physically can’t lock some information down. So you can lock a specific record down, but generally, the people can access any data they choose to look at," he said.
Lots more here:
With a little research it becomes clear this is a known issue.
See here:

'Flawed' privacy in Queensland Health's electronic medical record, expert says

By Lucy Stone
February 1, 2019 — 11.08am
A "very strange model" allows all Queensland Health clinicians to edit the medical data of all patients in public hospitals that have the integrated electronic medical record installed, a leading health law expert says.
Queensland University of Technology innovation law professor Matthew Rimmer said it appeared the $600 million electronic medical record project had a “whole host of issues”.
Dr Rimmer, who specialises in intellectual property and public health, questioned why clinicians working in any of the state's digital hospitals could view any patient's record and edit all aspects, including medication prescriptions.
“That seems a terrible approach, surely one would want to engage in data minimisation,” he said.

An Australian Medical Association Queensland letter to Queensland Health director-general Michael Walsh, dated September 2018 and seen by Brisbane Times, warned that clinicians were seriously concerned about the statewide access.
"Clinicians are concerned that write access to medication charts outside their immediate hospital can result in adverse events," the letter reads.
"For example, a doctor from Princess Alexandra Hospital had prescribed heparin on a patient in Mackay ICU who was also on other blood thinning agents, resulting in the patient bleeding and coming to harm."
The letter says the Mackay Hospital's medication safety committee had been "inundated with incidents" due to difficulties prescribing medications such as insulin and heparin, a blood thinner, through the integrated electronic medical record (ieMR), and other medications have gone missing from the system.
In one instance a clinician calling the ieMR helpline because oxytocin "went missing from the system" was told to prescribe an alternative drug, when there was none available.
"System wide 'upgrades' have also resulted in alerts to all ieMR sites about patient safety risks on the medication module and an order to revert to using paper with little notice," the AMAQ letter says.
The letter cites an alert issued on April 11, 2018, which warned of urgent patient risk.
Vastly more is found here:
Surely it can’t be too hard to have both ways of flagging patients who need enhanced privacy and to prevent staff from browsing patients other than those they have some genuine role in delivering care for. Patient data should be able to be accessed by their care team and those the care team gives access to for consultation as well as those involved in handling of test results and so on. Equally nursing staff the ward need access but surely not from the whole hospital or other hospitals.
I sense this is the outcome of a rushed implementation – and it really is not good enough on any score, allowing that the fine details of what changes are made need to mix practicality and protection of privacy. The system also needs to very fully track and control who can alter and add to records.
What do others think?
David.

Thursday, December 05, 2019

The Macro View – Health, Economics, and Politics and the Big Picture. What I Am Watching Here And Abroad.

December 05, 2019 Edition.
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Trump has been rolling on with false news and hysterical claims as far as I can tell. Right now his total focus is not governing but getting re-elected – and it is showing!
Only a week or two to go until the Brexit election
Australian politics seems to have descended into chaos with all sorts of unexpected outcomes as we see the economy continuing to go backwards. The Morrison gloss is fading quickly it would seem.
The country is still sadly seeming to be ablaze and summer has just started.
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Major Issues.

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Life insurers hit hard by Hayne fallout, mental health claims

Nov 22, 2019 — 4.53pm
Rising mental health claims and the fallout from the Hayne royal commission have contributed to a net loss of $86 million across all Australian life insurers in the first six months of 2019, a new report by KPMG has found.
That continued a stark downward trajectory from 2017, when life risk products generated a profit of $1.5 billion. In 2018, that fell to just $33 million.
The report's authors said there was no relief in sight, with the extension of the "unfair contracts" provisions to cover insurers and a continued rise in mental health claims further squeezing or obliterating margins.
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International security expert slams Australia's 'abysmal' fire strategy

By Anthony Galloway and Rob Harris
November 24, 2019 — 12.00am
An international security expert has described Australia’s fire strategy as ‘‘abysmal’’, warning that the nation needs to ramp up investment in fire-fighting equipment and be prepared for the possibility of terrorists starting bushfires to try and cause mass casualties.
Allan Orr, a counter-terrorism and insurgency specialist, also said a new national fire-fighting force should be established – either within the Department of Defence or preferably as a stand-alone body partially modelled on the United States National Guard.
The call comes after Defence Minister Linda Reynolds earlier this month gave approval to send hundreds of navy, army and air force reservists to join the fight against the catastrophic bushfires across NSW and Queensland.
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COAG clears the air on electricity

In the often messy and turbulent world of energy and climate policy, we end 2019 in a far better place than we began.
Tony Wood Contributor
Nov 25, 2019 — 12.00am
Federal Energy Minister Angus Taylor emerged from Friday’s long-delayed meeting of the COAG Energy Council with an unexpectedly upbeat perspective. It was at least partly justified: the apparent absence of vitriol and a positive, if underwhelming, Communique held some good news.
The last meeting of the Council in December 2018 featured verbal warfare between key states and the Commonwealth, particularly on climate policy, given it came so soon after the demise of the National Energy Guarantee. It took almost 12 months, accompanied by an ongoing war of words, for another meeting to be called.
There were three substantial outcomes. The first, and most substantial, covered reliability.
The Australian Energy Market Operator (AEMO) advised the ministers that there are enough arrangements in place to minimise supply risks over the coming summer. Yet some ministers, notably those from Victoria, NSW and the Commonwealth, have become increasingly concerned that the existing reliability standard needs to be enhanced to reflect the broad expectations of consumers. This standard is the trigger that determines how much capacity, either as more supply or less demand, should be in place ahead of time.
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Don't bet on markets rising as risks to growth escalate

There is a disconnect between rising equity values and the fundamental threats to the global economy.
Nouriel Roubini Contributor
Nov 25, 2019 — 12.00am
This past May and August, escalations in the trade and technology conflict between the United States and China rattled stockmarkets and pushed bond yields to historic lows. Since then, financial markets have once again become giddy. US and other equities are trending towards new highs, and there is even talk of a potential “melt-up” in equity values.
The financial market buzz has seized on the possibility of a “reflation trade”, in the hope that the recent global slowdown will be followed in 2020 by accelerating growth and firmer inflation (which helps profits and risky assets).
The sudden shift from risk off to risk on reflects four positive developments. First, the US and China are likely to reach a “phase one” deal that would at least temporarily halt any further escalation of their trade and technology war.
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Welcome China's rise but defend Australia's sovereignty

Striking the right balance between protecting national security and promoting a strong economy requires a strategic approach to managing the relationship with both China and the US.
Nov 25, 2019 — 12.00am
Ever since Richard Nixon’s historic 1972 visit ended China’s decades of international isolation, Sino-Western relations have dispensed with cold war strategising in favour of constructive engagement. The West has calculated that respecting the sovereign rule of the Chinese Communist Party would help contain the threat of the spread of Chinese Communism posed to the sovereignty of other nations in China’s sphere of influence.
This approach has succeeded beyond expectations. Overall, Western engagement has helped create a China that has been far easier for the West to live alongside in peaceful and interdependent coexistence.
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Coalition's attempt at rewriting history unfolding before our eyes

Eryk Bagshaw
Economics correspondent
November 24, 2019 — 11.30pm
There is a good dose of historical revisionism in our midst.
Coalition MPs, still emboldened by their unlikely election victory, are increasingly unpicking one of the few significant legacies of the former Labor government: Australia’s response to the global financial crisis.
Never mind that Australia was only one of three developed economies to avoid recession when the global economy tanked a decade ago (the others being Poland and Israel, plus the emerging economy of South Korea).
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The political classes are stuck and the consequences could be catastrophic

Sean Kelly
Columnist and former adviser to Labor prime ministers Kevin Rudd and Julia Gillard.
November 25, 2019 — 12.10am
In the odd hours following Donald Trump’s election victory, many of us traced our shock to the obvious fact the world had just changed. But soon enough we realised that this obvious fact was wrong. The world had changed some time ago. It was just that we had missed it, caught in old ways of seeing, old ways of being. We often take a while to catch up to the present.
Those memories have come back to me over the past couple of weeks, as heavy grey-smoke skies have pressed down on Sydney, and the scent of bushfire has made its way inside. Yes, there have been fires before, just as there had been election upsets before – but to many of us this year feels different. You strike up conversations with people you don’t know about the fact this is the way it’s going to be from now on. And you know, too, that really we’ve been heading this way for some time, it’s just that we are now beginning to comprehend the scale.
And yet debate in this country, as conducted by politicians and the media, remains stuck, unproductively nostalgic for what debate once was, unwilling to concede the change that many citizens feel instinctively.
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Spike in climate concerns highlights challenge for government

By David Crowe
November 26, 2019 — 12.00am
Australians' concern about climate change has almost doubled over the past year, highlighting a challenge for the Morrison government in acting on voter demands.
The annual survey of community sentiment conducted by Monash University also found a distrust of China and deep anxiety about "overcrowding" and house prices, despite strong support for immigration and multiculturalism.
Report author Andrew Markus said 19 per cent of respondents named climate as the biggest issue, up from 10 per cent last year, one of the largest increases since the surveys began, while 28 per cent nominated the economy and 8 per cent named social issues.
"I think it has emerged almost daily as an issue of significance, not only in Australia but globally," Professor Markus said of climate change. "The sense that things are getting worse, and more quickly than even the more pessimistic assessment of climate scientists – I think that also is having an impact on people's understandings."
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Hartzer's departure a necessary firebreak

Brian Hartzer's resignation was a belated recognition by the Westpac board that the rules of accountability have permanently changed.
Jennifer Hewett Columnist
Nov 26, 2019 — 9.31am
The pressure was just too great. From politicians, from investors, from public opinion.
It took chairman Lindsay Maxsted and the Westpac board several days to realise that promising action to “get to the bottom of things” and fix the problem was never going to be enough to satisfy the urge for an immediate, dramatic response.
Media revelations about Brian Hartzer’s attempt to calm his team by telling senior executives that mainstream Australia was not overly concerned about the Westpac case only compounded the sense of grievance about the bank’s tin ear. From the top down.
Allegations of child abuse and sexual exploitation will always register in the public consciousness in a way that overwhelms any detail of systemic failures of technology. In an era of all-media, all-the-time that hype-sensitivity only becomes more intense.
The politicians and big institutional investors the Westpac chairman had been seeking to reassure this week clearly understood that reality well ahead of the shell-shocked Westpac board.
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Australia’s strategic risks are changing and so must our defence thinking

Australia’s strategic outlook is deteriorating. For the first time since World War II, we face an increased prospect of threat from high-level military capabilities being introduced into our region.
This means we need to make a major change to the management of strategic risk. Strategic risk is a grey area in which governments need to make critical assessments of capability and intent. Since the 1976 defence white paper, judgments in this area have relied heavily on the conclusion that the capabilities required for a serious assault on Australia simply did not exist in our region.
In contrast, in the years ahead, the level of capability able to be brought to bear against Australia will increase. So, judgments relating to warning time will need to rely less on evidence of capability and more on assessments of motive and intent. Such judgments are inherently ambiguous and uncertain.
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No QE until interest rates hit 0.25pc

Matthew Cranston Economics correspondent
Nov 26, 2019 — 8.05pm
Reserve Bank of Australia governor Philip Lowe has hosed down the prospect of quantitative easing and asserted that the central bank would not move to such a tool until the official interest rate dropped to 0.25 per cent which was still a "fair way" off.
In a speech to the Australian Business Economists on Tuesday night Dr Lowe gave the market his strongest guidance yet on how the central bank would implement QE, saying that it would favour buying government bonds over corporate ones.
"Our current thinking is that QE becomes an option to be considered at a cash rate of 0.25 per cent, but not before that," Dr Lowe said.
Before Dr Lowe's speech markets were pricing in a 22 per cent chance of another 0.25 per cent interest rate cut in December to 0.5 per cent – the point at which some economists thought the RBA would begin some form of unconventional monetary policy.
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It's the cover-up that's killed the prince and the banker

Updated Nov 27, 2019 — 6.03am, first published at 12.00am
Westpac has, as Prince Andrew might say, acted in a “manner unbecoming”. And even more unbecomingly, it at first sought to scratch sand over the stinking little heap and sidle away.
As any communications professional will tell you, it’s not the crisis that kills you: it’s the response.
The time it took the Westpac chief executive and board to recognise that their problem could not be solved with cosmetic PR invites parallels to the tin-eared Duke of York, who could not see that it wasn’t the optics but the substance of his situation that left the world aghast.
Among other things, it seemed normal to the prince to say that he ended his friendship with Jeffrey Epstein because “it would not do” for a royal to be seen in the company of the convicted child sex abuser.
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Ratings' agency warns government against missing surplus

By Shane Wright
November 27, 2019 — 10.23am
The Morrison government has been urged to stick with its focus on strong budget surpluses with credit ratings' agency S&P Global warning too much spending could put at risk the country's triple A rating.
The agency on Wednesday said "strong fiscal outcomes" were key to Australia retaining its current rating, adding that calls for governments to spend more on infrastructure would prove difficult because of capacity constraints.
Australia is one of 11 nations that has S&P's top credit rating. It was upgraded to a stable rating from negative in September last year.
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Philip Lowe speech: two rate cuts left in Reserve Bank arsenal

Reserve Bank governor Philip Lowe has insisted that monetary policy remains effective, declaring the bank is still two rate cuts away from implementing more unorthodox ­monetary policies.
In what will be seen as a landmark speech, Dr Lowe offered the clearest outline yet on what action the RBA was prepared to take should rate cuts alone fail to set the economy on the path to reaching its 2-3 per cent inflation target over time.
“Conventional monetary policy is still working in Australia and we see the evidence of this in the exchange rate, in asset prices and in the boost to aggregate ­household disposable income,” Dr Lowe said in a speech in Sydney on Tuesday night.
But Dr Lowe identified 0.25 per cent as the “effective lower bound” for its policy rate.
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China's coal mania is alarming, yet there's a big twist

Despite Beijing ramping up plans for new coal-fired electricity plants, they will be outpriced by cheap wind and solar, says Ambrose Evans-Pritchard.
Ambrose Evans-Pritchard
Updated Nov 28, 2019 — 9.17am, first published at 9.09am
No further coal plants should be built anywhere in the world ever again. The great majority of existing plants should be phased out within 15 years.
That is the message of the Intergovernmental Panel on Climate Change (IPCC) as delegates descend on Madrid for next week's COP25. There is no chance of keeping CO2 emissions below critical thresholds and preventing runaway climate change if this does not happen.
So one might justifiably be aggrieved by news that China is engaged in a massive - if surreptitious - expansion of its coal power fleet in breach of earlier pledges, taking advantage of climate denialism in the White House to raid the global commons. Xi Jinping's industrial machine accounts for half the world's coal consumption. He is now adding a large coal plant every two weeks.
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What the government wants from business

Jennifer Hewett Columnist
Nov 27, 2019 — 8.04pm
Westpac may have just received a capital F for regulatory failure but it's not about to derail the government’s commitment to reducing the cost and impact of regulation on the business community more broadly.
Scott Morrison calls it regulation “congestion busting” and has put Ben Morton, his close ally and assistant minister, in charge of delivering it. Morton acknowledges the promise to reduce regulation has been a constant commitment from all governments – as well as a constant disappointment to businesses.
Indeed in key sectors, such as energy and banking, the Morrison government has radically increased the scope of regulation. Morton shows little patience for the criticism, saying the PM takes a long-term view of deregulation with an expectation of continuing improvement.
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Planet Earth ‘cascades’ towards a hothouse, say scientists

A “hothouse” Earth caused by the domino-style collapse of natural systems due to climate change could already be under way, according to a new call for action by scientists.
An editorial in the journal Nature, co-written by Australian National University professor Will Steffen, says more than half of the tipping points that could push the planet towards a hothouse and threaten civilisation are now “active”.
“As soon as one or two clim­ate dominoes are knocked over, they push Earth towards others,” Professor Steffen says.
 “We fear that it may become impossible to stop the whole row of dominoes from tumbling over, forming a cascade that could threaten the existence of human civilisations.”
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Australia to fight Europe on climate demands in free-trade deal

By Anthony Galloway
November 29, 2019 — 12.00am
Trade Minister Simon Birmingham has described France's push to force Australia to adopt climate change targets in a planned trade deal with European Union as "unprecedented", declaring he will only accept terms that are in the best interests of the nation.
Senator Birmingham wants to clinch a free-trade agreement (FTA) with the EU by the end of next year, followed by Britain in early 2021, after Parliament this week ticked off on deals with Indonesia, Hong Kong and Peru.
In a week when Australia-China relations soured over allegations of a plot to install a Chinese agent in federal Parliament, Senator Birmingham stressed the benefits of diversifying Australia's trading interests around the world through the new FTAs, but said China would remain a major trading partner with Australia for years to come.
He also declared he wouldn't "capitulate" to Europe's claim for exclusive use of key food names including feta, Parmesan and Gorgonzola cheeses.
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Crossbench defeat suggests trouble for Scott Morrison on other fronts

By David Crowe
November 28, 2019 — 7.43pm
Scott Morrison and his ministers have just been clobbered by the crossbench in a Senate tussle that is about much more than a single law.
The frustration with the government among crossbenchers like Pauline Hanson and Jacqui Lambie suggests there will be trouble for Morrison on other fronts before too long.
The government's Ensuring Integrity Bill is defeated in the Senate with a 34 - 34 tied vote.
The defeat of the Ensuring Integrity Bill is not just a momentary problem for the industrial relations changes, which the government badly wanted to pass this year to prove it was going ahead with economic reform.
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How ANZ has avoided an AUSTRAC disaster so far

Learning from past mistakes, a paranoid attitude towards financial crime, and wide experience in money transfers have helped it stay on the right track.
Nov 30, 2019 — 12.00am
On the same day that Westpac chief executive Brian Hartzer resigned to take responsibility for the money-laundering scandal, the Australian Federal Police in Perth praised ANZ Banking Group for helping freeze the assets of a suspected Chinese criminal.
Thanks to ANZ’s rapid-fire response to requests made by the AFP Criminal Assets Confiscation Taskforce, a total of $2.24 million in deposits suspected of being the proceeds of crime were seized.
The taskforce is a joint effort of the AFP, Australian Criminal Intelligence Commission, the Tax Office and AUSTRAC.
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As Morrison slams Westpac, anti-money laundering laws lag behind

Nov 30, 2019 — 12.00am
The Morrison government's failure to tighten anti-money laundering laws has allowed billions of dollars each year handled by lawyers, accountants and real estate agents to potentially fund terrorism, drug trafficking and child exploitation.
Prime Minister Scott Morrision and his senior ministers have spent the week excoriating Westpac for its breaches of anti-money laundering laws, criticism labelled hypocritical as the government drags its feet on implementing tougher rules.
Australia is ranked alongside Haiti and Madagascar for its lax anti-money laundering rules, a performance which led a global taskforce to suspend a review of Canberra’s performance last month
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Our fear of China is not loathing

Peter Hartcher
Political and international editor for The Sydney Morning Herald
November 30, 2019 — 12.00am
I knew Australia was worried about the Chinese Communist Party's grip on the country, but until now I didn't realise the extent of the fear. The worry shows up very clearly in opinion polls. Fear is harder for a poll to detect.
First, the worry. A year ago, most Australians trusted China to act responsibly. No longer. The proportion of people trusting in China fell from 52 per cent to 32 in a year, according to the annual Lowy survey.
More specifically, seven in 10 people say there is too much Chinese investment in Australia. That Australia is too dependent economically on China. That Australia should do more to restrict China's military activities in the region – even if it comes at an economic cost. Six in 10 say they favour Australia's navy conducting freedom-of-navigation exercises in the South China Sea.
Almost half say China will become a military threat to Australia in the next 20 years. And 49 per cent say that foreign interference in Australian politics is a "critical threat" to Australia's vital interests. And that was before this week's news.
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The left’s belief in inequality doesn’t stand up to scrutiny

Inequality is on the rise, or not, depending on who you listen to.
Even in a world of polarisation, fake news and social media, some beliefs remain universal, and central to today’s politics. None is more influential than the idea that inequality has risen in the rich world. People read about it in newspapers, hear about it from their politicians and feel it in their daily lives.
This belief motivates populists, who say selfish metropolitan elites have pulled the ladder of opportunity away from ordinary people. It has given succour to the left, who propose ever more radical ways to redistribute wealth. And it has caused alarm among businesspeople, many of whom now claim to pursue a higher social purpose lest they be seen to subscribe to a model of capitalism that everyone knows has failed.
In many ways the failure is real. Opportunities are restricted. The cost of university education in the US has spiralled beyond the reach of many families. Across the rich world, as rents and house prices have soared, it has become harder to afford to live in the successful cities that contain the most jobs.
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Morrison government wipes $500 million in dodgy debt from students

By Farrah Tomazin
December 1, 2019 — 12.00am
The Morrison government has this year wiped about $500 million in dodgy debt accumulated by unsuspecting students as part of the most disastrous education rort in Australia’s history.
Three years after the government scrapped the botched vocational loan scheme known as VET FEE-HELP, the defunct program is continuing to have an enduring impact as more people discover they were duped by shonky private providers.
The Age and The Sydney Morning Herald can reveal that between January and October 31 this year, Canberra approved the removal of more than $493 million worth of “inappropriate debt” for about 38,000 students, most of whom had loans issued without their consent when they were signed up to substandard courses.
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Fuel security woes amp up tensions around Caltex bid

Nov 30, 2019 — 12.00am
Caltex Australia's Canadian suitor, Alimentation Couche-Tard, looks set to face mounting pressure to guarantee the future of the target's Brisbane oil refinery as the Labor Opposition, strategic risk and transportation experts underscore the importance of the plant to fuel security.
While Couche-Tard - French-Canadian slang for "night owl" - has yet to secure any agreement from Caltex on its proposed $8.6 billion cash takeover offer, the refinery's fate is shaping up to be a potential key factor in regulatory approval for a deal.
"Australia’s fuel security is an extremely important issue, especially at a time of heightened security risks," said Labor's energy spokesman, Mark Butler, accusing the federal government of being "asleep at the wheel" on the issue for six years.
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The price of banks becoming crime fighters

The genesis behind the latest AUSTRAC scandal can be traced back to the decision to transform banks into de facto law enforcement and counter-terrorism agencies.
Christopher Joye Columnist
Nov 29, 2019 — 3.39pm
After dismissing quantitative easing as “very unlikely” for most of 2019, Reserve Bank of Australia governor Phil Lowe this week revealed we are just two rate cuts away from the government bond-based QE anticipated by this column back in May.
Indeed, Lowe painted an astonishingly detailed picture of the decision-making rules his board will apply when navigating down this path.
While Lowe slammed Westpac’s anti-money laundering (AML) failures as “appalling” and “completely unacceptable”, they could end up defining how quickly the RBA embarks on QE through their non-trivial impact on bank funding costs.
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Religious discrimination bill due for 2020

Prime Minister Scott Morrison says his government is issuing revised draft religious discrimination laws before the end of the year.
Colin Brinsden
Australian Associated Press November 30, 20198:21pm
Religious freedom laws will not be introduced to federal parliament until 2020 after hundreds of submissions were made to the draft bill.
The government will also be issuing a revised draft of the Religious Discrimination Act before the end the year to take into account issues that have been raised during the consultation process.
Prime Minister Scott Morrison said the decision was made earlier this week and will allow further engagement opportunities for concerned parties.
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Capital capers, bonus bonanzas and more: How banks and debt are changing society

A friend’s mother is in a quilting group of women of a certain age who meet every few weeks, and on Monday she reported that all her friends were exhausted. That’s ­because all of them are constantly minding grandchildren for working daughters who can’t afford full-time childcare.
In a speech on Tuesday, the deputy governor of the Reserve Bank, Guy Debelle, fleshed out that little slice of suburban reality with some data: “Over recent decades, the participation rate of mothers with dependent children has trended higher, rising by 10 percentage points since the early 2000s to 73 per cent. Over the past decade, the rise in participation has been most pronounced for mothers with children aged between 0 and 4.”
This is a huge, quiet change in our society. Why is it happening? Because of debt, says Debelle. “The rise in debt levels has broadly coincided with the increase in the participation rate of females.”
He rather spoils the clarity of the moment by wondering which way the causality goes. Are debt levels higher because more households have two incomes and can afford to borrow more? Or is it (as I suspect) that more women with young kids are working because of the amount of debt the family has had to take on to buy a house?
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Migrant drain on economy a myth

The “pervasive myth” that mig­rants are a drain on the economy has been busted by new Australian Bureau of Statistics data showing migrant employees’ median income is no different than for other taxpayers.
The ABS data, which reveals the nation’s 1.9 million migrant taxpayers generated more than $112bn in total personal income in 2016-17, prompted Migration Council Australia to call for a fresh look at increasing Australia’s permanent migration program, after the annual intake was reduced from 190,000 to 160,000 during the term of the last Coalition government.
The median employee income of all migrant taxpayers in 2016-17 was $49,438, the data reveals, slightly higher than the median employee income for all Australian taxpayers at $49,412.
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Royal Commissions And The Like.

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'Pretty confronting': Up to a third of aged care services may be substandard

By Judith Ireland
November 23, 2019 — 12.00am
Aged Care Services Minister Richard Colbeck has revealed up to a third of aged care services may not be "up to scratch" as he warned government spending alone won't fix the quality issues plaguing the sector.
With the aged care royal commission planning to confirm the level of substandard aged care in its final report next year, Senator Colbeck said initial indications from commissioner Lynelle Briggs were that at least 12 to 15 per cent of services were below par and the figure could be as high as 20 to 30 per cent.
"That's going to be pretty confronting for us all, if that's what comes back in 12 months' time," Senator Colbeck told an aged care conference this week.
As the Morrison government prepares to respond to the royal commission's initial findings, Senator Colbeck put the sector on notice that the quality of aged care would not simply be fixed through higher government spending.
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National Budget Issues.

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Why Boomer retirement time bomb could trigger youth backlash

John Kehoe Senior Writer
Nov 24, 2019 — 12.15pm
The federal government’s retirement income review is investigating whether an unfair tax burden will fall on younger workers to pay for superannuation tax breaks and the age pension.
The review, commissioned by Treasurer Josh Frydenberg, is looking at the budget sustainability of the retirement income system, as the large Baby Boomer generation retire and there are fewer working-age people to support the elderly.
The inquiry is exploring the sustainability of super tax concessions worth $37 billion a year that is "expected to continue to grow" and $48 billion in age pension payments.
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'The new normal': RBA tells people to get used to low wages growth

By Shane Wright
November 26, 2019 — 10.50am
Lower wage rises are "the new normal" with most workers likely to see increases of between 2 and 3 per cent for the foreseeable future, the Reserve Bank has conceded even as it tries to get them growing faster.
Deputy governor Guy Debelle, in a speech to the Australian Council of Social Service in Canberra on Tuesday, said the bank's business liaison program suggested 80 per cent of all businesses expect "stable" wages growth in the coming year. Just ten per cent are tipping stronger growth while the remaining ten per cent believe it may slow.
The bank has taken official interest rates down to 0.75 per cent in a bid to tighten the jobs market and lift wages. Wages growth has slowed to a 15 month low of 2.2 per cent over the past year.
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New sub fleet blows out to $225 billion

Australian taxpayers will fork out $225 billion over the lifetime of the nation's new submarine fleet, an estimates committee was told.
Finbar O'Mallon
Australian Associated Press November 29, 20194:13pm
Australia's new 12-strong submarine fleet will cost taxpayers $225 billion, an estimates committee has been told.
Rear Admiral Greg Sammut said there was an $80 billion build cost, which was originally touted by defence to be $50 billion.
There would also be an $145 billion support and maintenance cost over the lifetime of the attack subs until 2080.
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Health Issues.

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Health insurers hit back after minister rejects premium rise

By Dana McCauley
November 24, 2019 — 3.18pm
Health insurers are appealing to federal Health Minister Greg Hunt to fast-track reforms aimed at helping lower their costs.
Mr Hunt has written to insurers demanding they resubmit their applications for premium increases for next year, which are understood to be an average 3.5 per cent, more than double the rate of inflation and higher than this year's 3.25 per cent rise.
Private Healthcare Australia chief executive Rachel David said the industry was battling rising costs that were squeezing profit margins - with some funds in "negative territory" - making the minister's request for a 3 per cent rise "incredibly challenging".
Dr David said for-profit health funds were battling rising costs on several fronts, with ageing members putting in more claims, hospital costs increasing and suppliers of medical devices using sales tactics to drive up overall expenditure.
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Public dental treatment waiting list grows to almost 90,000

By Rachel Clun
November 25, 2019 — 12.00am
The waiting list for public dental treatment has grown to almost 90,000 adults, prompting dentists to plead for more funding.
President of the Australian Dental Association NSW Kathleen Matthews said the demand for public dentistry was there "but the funds aren't".
"It's a health service that, for the majority of Australians, doesn't receive any governmental funding," she said.
The number of adults waiting for public treatment in NSW has risen to a high of 88,433, data from NSW Health shows. The previous high was 87,542 in late 2016.
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Codeine poisonings halve at Brisbane hospital

By Lucy Stone
November 25, 2019 — 1.01am
Codeine-related overdoses have more than halved at one of Brisbane's busiest hospitals since the drug was made prescription-only in February last year.
Before then, drugs containing less than 30 milligrams of codeine did not require a prescription, but responding to a spike in the number of poisonings, the Therapeutic Goods Administration added all codeine-containing drugs to the prescription-only register.
New research by the Princess Alexandra Hospital in Brisbane's southside on the number of poisonings presented there shows that in the 12 months before the ban, the hospital's toxicology unit saw 163 presentations for codeine poisoning. This compared with just 77 in the 12 months after the ban – a 53 per cent decrease.
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Greedy doctors blamed for spiralling health costs

Nov 25, 2019 — 9.00pm
Greedy doctors, rocketing hospital bills and overpriced prosthetic devices have been blamed for the "death spiral" facing the private health insurance industry, in a damning new report by the Grattan Institute.
The report, which comes seven months after the think tank ignited a fierce debate when it declared the industry to be in "death spiral", calls for sweeping changes to the healthcare industry to counter rising premium costs.
The Grattan Institute laid very little of the blame for these cost increases – which have seen many younger people abandon private insurance – at the door of the health funds themselves.
Instead, it blamed a mixture of poor government policy and overcharging by doctors and hospitals, and recommended strict controls to keep costs down.
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'Bubble' in biotech stocks troubles investors

Luke Housego Reporter
Nov 25, 2019 — 11.59pm
The search for the next CSL and excessive valuations in local tech stocks have seen investors pouring into biotech, but elevated prices may be putting capital at risk.
Last week Regal Funds Management co-founder Phil King called the biotech sector "the biggest bubble in the Australian stock market" at the Sohn Hearts and Minds investor conference in Sydney, driven partly by a lack of expertise with biotech.
"We don't have the big pharmaceutical companies that North America and Europe have, and as a result Australians aren't that good at valuing drug companies," Mr King said.
Tribeca Investment Partners portfolio manager Jun Bei Liu has also cautioned investors about valuations in the sector
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'Hospital-in-the-home revolution': Hunt's plan to shake up private health insurance

By Dana McCauley
November 26, 2019 — 12.00am
Health Minister Greg Hunt has outlined his plan for a major shake-up of rules governing private health insurance in a bid to arrest an exodus of customers as premiums rise.
Mr Hunt is working on changes that would enable health funds to cover specialist treatment delivered outside hospitals at a lower cost, starting with mental health and orthopaedics. He hopes to roll out the proposed regime by mid-2020 so insurers can factor in cost savings and keep a lid on premium increases in 2021.
Currently, Australians can only claim on their hospital cover for treatment received in hospital, a rule Mr Hunt said created "perverse outcomes and perverse incentives".
"These are old rules [that] were put in place 20 years ago for a different medical system and a different time," Mr Hunt told The Sydney Morning Herald and The Age.
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‘Wasteful’ hospital spending a $2bn burden on private health

Costs to health insurers could be cut by $2bn every year if “wasteful” spending on long hospital stays and high specialist fees were reined in, reducing premiums paid by consumers by up to 10 per cent.
They are the findings of a ­report by the Grattan Institute, which recommends an overhaul of the way patients are billed for private hospital costs and doctors’ fees. “Private health ­insurance will continue its death spiral unless excessive private hospital costs and specialist bills are reined in,” the report says.
Grattan’s health program ­director, Stephen Duckett, analysed differences in the length of stay by patients in public and private hospitals, and found that for a host of procedures those having operations in the private system spent longer in hospital.
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'New normal': Deaths by acute conditions dropping in public hospitals

By Rachel Clun
November 27, 2019 — 12.00am
The chance of dying within a month of presenting to emergency with a stroke, heart attack or pneumonia is shrinking, but that risk can vary widely between Sydney hospitals.
A report published on Wednesday by the Bureau of Health Information (BHI) looked at mortality rates 30 days after patients were admitted to a NSW public hospital for heart attack, ischaemic stroke, haemorrhagic stroke, congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD) and hip fracture surgery.
These seven life-threatening conditions make up 11 per cent of acute emergency hospitalisations (about 180,000 patients), but account for 28 per cent (almost 18,000) of all hospital deaths.
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Air pollution particles responsible for spike in UTIs, sepsis hospitalisations

By Kate Aubusson
November 28, 2019 — 10.30am
Tiny air pollution particles - like the very ones in bushfire smoke swathing NSW - are doing more than aggravating the lungs of asthmatics. Even short term exposure to the particulate PM2.5 is sending people to hospital for a multitude of newly identified reasons including sepsis and urinary tract infections.
Every 0.001 part-per-million of PM2.5 in the air is linked to 2050 extra hospital admissions, 12,216 days in hospital and almost $46 million in healthcare costs for conditions including lung diseases, diabetes, parkison's disease and diabetes, a US study published on Thursday in the BMJ found.
PM2.5 was also linked to rises in hospitalisations for illnesses not previously associated with the particulate, such as septicaemia, kidney failure, UTIs and skin and subcutaneous tissue infections.
These newly identified PM2.5-linked diseases accounted for roughly one-third of all hospitalisations associated with the particulate (31 to 38 per cent), suggesting we may be considerably underestimating its health burden, an accompanying editorial warned.
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Young, healthy and bled dry: look who gets the rawest deal from private health insurance

Jessica Irvine
Economics writer
November 28, 2019 — 12.00am
In the Spielberg epic Saving Private Ryan, a crack team sets out on a mission to retrieve a young lost soldier from the blood-drenched fields of Normandy during World War II. It’s a daring mission, one beset with danger and examples of tragic waste.
As narrative arcs go, it’s not entirely dissimilar to the one detailed in Saving Private Health, a report released this week by the Grattan Institute.
In it, the institute’s health program director, Stephen Duckett, details the daunting task confronting the federal government as it seeks to pull the nation’s private health insurers out of their self-described “death spiral” of rising costs and declining membership among young Australians.
In the first of two reports – the next is due next week – Duckett sensationally describes how a minority of “greedy” medical specialists charge inflated fees to private patients in hospital.
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Suicide rates among ex-servicemen 18pc higher

The suicide rate for ex-servicemen is 18 per cent higher than for all Australian men since 2002, new Australian Institute of Health and Welfare data shows.
The difference is mainly caused by suicide of ex-servicemen under the age of 30, who in recent years have died at rates up to twice that of all men their age. Overall, there were 419 suicides among serving, reserve and ex-serving ADF personnel since 2001, the report reveals.
Commissioned by the Department of Veterans’ Affairs to ­collate data on suicide among serving and ex-serving ADF ­personnel to inform prevention measures, the institute found that between 2002 and 2017, after adjusting for age, the suicide rate was 18 per cent higher for ex-serving men compared with the civilian male population. But for current serving men and men in the ­reserves it was 48 per cent lower.
Since 2007 the institute has made a study that enables a comparison of suicide rates specifically by age.
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Are men struggling through a feminised health system?

Whether or not men are being let down in their interactions with GPs is proving to be a point of contention among health experts.
Jill Margo Health Editor
Nov 30, 2019 — 12.15am
Novel research that goes beyond conventional thinking has put forward a new reason why men in Australia have poorer health than women. It suggests the health system is feminised.
This is not about the number of female doctors at work. Rather, it is about how the standard model of interaction between doctor and patient favours the female form of communication.
In gender-sensitive Australia, this is a bold suggestion, but Professor Gary Wittert, director of the Freemasons Foundation Centre for Men's Health at the University of Adelaide, says his research supports this notion.
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Private health system in a 'death spiral', says expert, but what can be done to save it?

By Patrick Hatch and Dana McCauley
November 30, 2019 — 12.00am
George Savvides, who ran Medibank for 14 years until 2016, describes the exodus of young people from private health insurance as akin to “a climate change event in the health system".
The Grattan Institute health economist Stephen Duckett is more blunt, saying the trend has put the private system into a "death spiral" and that urgent surgery is required to save it.
Whatever the turn of phrase, the symptoms are clear: the rising cost of hospital treatments is leading to higher health insurance premiums which people - particularly young ones facing anemic wage growth - can't afford to pay.
As they cancel their membership (the number of people aged 20 to 34 with cover is down 11 per cent over the past five years) they take the premiums that subsidise older and sicker members with them, which Duckett says forces premiums higher again.
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Alcohol lobby says new pregnancy warning labels 'too expensive'

By Dana McCauley
November 29, 2019 — 7.45pm
The alcohol lobby has launched a fresh offensive against the regulator's mandatory pregnancy warning labels, claiming it will cost manufacturers $600 million to redesign their products.
Food Standards Australia and New Zealand (FSANZ) has proposed a new warning for alcohol bottles, supported by public health advocates, with a graphic showing a silhouette of a pregnant woman drinking and red text that says: "Health warning: any amount of alcohol can harm your baby."
Alcohol Beverages Australia (ABA) chief executive Andrew Wilsmore said the new label had "all the hallmarks of looking for a fix to a problem that's not really there" and the cost of changing the labels would have to be passed on to drinkers through higher prices.
He said manufacturers should be able to keep using the DrinkWise label, which has the silhouette but no written warning, instead directing consumers to a website funded by the alcohol industry.
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Measles cases spike around the world as anti-vax campaigns take hold

By Abdi Latif Dahir
November 28, 2019 — 3.11pm
New York: There has been a rapid increase in the global measles outbreak, with reported cases jumping 300 per cent in the first three months of 2019 compared with the same period last year, according to the World Health Organisation.
As reasons for the increase, the organisation has cited a deep mistrust of vaccines, gaps in immunisation coverage and lack of access to healthcare facilities or routine check-ups.
WHO said multiple large outbreaks are being reported across Africa, Europe, Latin America and the Middle East.
As of November 5, there were more than 440,200 measles cases worldwide reported to WHO.
The highly contagious disease is caused by a virus and typically begins with a high fever and rash that can lead to complications of deafness, pneumonia, diarrhoea and encephalitis, according to the Centres for Disease Control and Prevention in the US. And although measles can be prevented with two doses of vaccine administered during childhood, the WHO estimated that 110,000 people, most of them children younger than 5 and living in developing countries in Africa and Asia, succumbed to it in 2017.
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Australia a 'treasure island' for medical device giants: ex-hospital boss

By Patrick Hatch and Dana McCauley
November 30, 2019 — 1.00am
The former chief executive of Australia's second largest private hospital operator has backed health insurers' claims they are being gouged by medical device manufacturers, saying the country is referred to as a "treasure island" for the industry.
Robert Cooke, who has 40 years of experience in the health industry including six as chief executive of hospital group Healthscope, said it was clear Australia "pays too much" for prostheses, which range from replacement hips through to medical sponges.
Australia's private health insurers have been pushing federal Health Minister Greg Hunt to overhaul the government's "prostheses list", which mandates how much they pay for more than 10,000 prosthetic and implanted medical devices.
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A hospital at home would help us all. It certainly helped my dying husband

Helen Pitt
December 1, 2019 — 12.00am
Federal Health Minister Greg Hunt has outlined his plan for a major shake-up of rules governing private health insurance which would include a "hospital in the home" option.
The Royal Australian College of General Practitioners seconded his idea to treat patients at home, especially those with mental health issues, recovering from orthopaedic or heart issues, or undergoing cancer treatment.
Labor health spokesman Chris Bowen, however, opposed the plan. And he was "implacably opposed" to health funds being able to cover GP services.
"Universal healthcare is a fundamental pillar of Medicare and we will not stand for the Americanisation of the Australian health system, which that would amount to," Bowen said.
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International Issues.

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Give Beijing an inch, it will take a mile: Obama's former UN envoy

Australia must draw a line in the sand when it comes to what is acceptable behaviour by President Xi's China, Obama-era diplomat Samantha Powell says. But Donald Trump is not helping.
Jacob Greber United States Correspondent
Nov 24, 2019 — 2.53pm
Washington | One of America's most senior former diplomats has warned Australia against succumbing to Chinese bullying and intimidation but admitted Canberra's ability to raise its voice against Beijing would be stronger if the West's democratic alliances "weren't so fractured by President Trump's behaviour".
Samantha Power, who frequently tangled with China as the Obama administration's ambassador to the UN Security Council during the rise of President Xi Jinping's assertive foreign policy pivot, says she has seen first-hand how American interests can be hurt by Beijing.
"If you give China an inch, they will take a mile," she told The Australian Financial Review in Washington ahead of what will be her first visit to Australia this week.
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China will overtake the US by 2030

Andrew Clark Senior Writer
Nov 25, 2019 — 12.00am
Australia should prepare for China to overtake the US as the world’s biggest economy by 2030, according to a group of influential Australian foreign policy figures.
Former foreign minister Gareth Evans said he agreed with forecasts that China will have a bigger economy than the US by 2030, although “not in per capita terms”.
However, he said the number one status wouldn't mean that China had dominant world power.
Mr Evans, foreign minister in the Hawke and Keating governments, said becoming a dominant world power “is a function of many factors like reserve currency status, dominance across multiple technological sectors, number of allies and partners, total military firepower, soft power, and general; global – as distinct from regional – reach and influence”.
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Hong Kong voters deliver pro-democracy message in 'de facto referendum'

By Kirsty Needham
November 25, 2019 — 6.46am
Hong Kong: A record voter turnout for district council elections has delivered a strong message to chief executive Carrie Lam as young democracy activists won a swathe of seats while the most combative pro-Beijing figure, Junius Ho, lost in early results.
Almost 3 million people in a city of 7 million queued to vote in the election held every four years, or 71.2 per cent of registered voters.
By 3am, 177 pro-democracy candidates had picked up seats, out of a total 452 seats, compared to 17 pro-establishment candidates.
Jimmy Sham, the organiser of June's million-strong peaceful marches, who was later attacked by thugs and hospitalised, won the seat of Lek Yuen in Shatin. Sham is still walking with crutches, the wounds to his head still visible, after being beaten with hammers by a group of men in a laneway.
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Billionaire businessman Bloomberg joins the race for the White House

November 25, 2019 — 2.56am
Washington: Billionaire Michael Bloomberg has jumped into the US presidential race, ending months of speculation over whether he would join the Democratic contenders looking to unseat Republican President Donald Trump in the November 2020 election.
Billionaire businessman Michael Bloomberg, the former mayor of New York City, jumped into the US presidential race, becoming the 18th candidate to join a crowded field of Democratic contenders seeking to face Republican President Donald Trump in the
"I'm running for president to defeat Donald Trump and rebuild America," the former mayor of New York said on Sunday. "We cannot afford four more years of President Trump's reckless and unethical actions."
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What happens when the language of democracy is hijacked?

Chris Zappone
Digital Foreign Editor
Updated November 25, 2019 — 5.51amfirst published November 24, 2019 — 11.47pm
When Twitter said it would no longer accept political ads on its platform this month, two voices loudly complained. Donald Trump's campaign manager said it was “yet another attempt by the left to silence Trump and conservatives”. Kremlin-funded RT said Twitter had "caved in" to "election-meddling fearmongers".
It was a telling duo of critics – but not a surprising one. Casting the issue of political disinformation as one of an assault on free speech is a common error. A figure no less than Facebook chief Mark Zuckerberg has conflated the issue of political lying with free expression. Yet the threat posed to democracy by an organised war on facts is clear to most critically minded journalists.
The invocation of the language of liberalism to damage our precious democracies is not new. But four years after Trump began his run for office, the use of “freedom” as a wrecking ball for democracy is approaching critical mass.
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HK democrats score big local elections win

Pro-democracy candidates in Hong Kong have romped to a landslide and symbolic majority in district council elections after residents turned out in record numbers to vote following six months of anti-government protests in the embattled city.
In a rare weekend lull in the unrest that has embroiled the financial hub, democratic candidates across the city of 7.4 million secured more than half the 452 district council seats for the first time against a strongly resourced and mobilised pro-establishment opposition.
Hong Kong's district councils control some spending and decide a range of local livelihood issues such as transport and they also serve as an important grassroots platform to radiate political influence in the city ruled by communist China.
Some winning candidates said the result was akin to a vote of support for the protest movement and could raise the pressure on Hong Kong's pro-Beijing chief executive, Carrie Lam, amid the city's worst political crisis in decades.
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Gold is looking more and more attractive

You have to really believe the sky is falling in order to hoard physical gold bars in a digital age. So, it’s rather worrying that some investors and central bankers are talking up gold, says the FT's Rana Foroohar.
Rana Foroohar Columnist
Nov 25, 2019 — 10.16am
Gold bugs have always struck me as paranoid. You have to really believe the sky is falling in order to hoard physical bars in a digital age. So, it’s rather worrying that some investors and central bankers are talking up gold.
The Dutch Central Bank recently argued in an article that if there were to be a major monetary reset, “gold stock can serve as a basis” to rebuild the global monetary system. “Gold bolsters confidence in the stability of the central bank’s balance sheet and creates a sense of security.”
Talk of gold, however, does not. Investor Ray Dalio recently spooked attendees at the Institute for International Finance conference when he mentioned the possibility of a flight to gold because of his concerns about America’s fiscal position.
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Scepticism or not, the Chinese threat is real

It's high time certain people stopped worrying so much about hurting Beijing's feelings.  
Phillip Coorey Political Editor
Nov 25, 2019 — 6.06pm
The case of Wang Liqiang, the Chinese man seeking asylum on the basis he is a former spy wishing to defect, poses yet another diplomatic challenge for the Morrison government. Potentially.
Prima facie, his case is compelling enough for many, including Liberal MP Andrew Hastie, to urge the government to grant him protection. Internally, the mood is more sceptical.
Why? Because as a rule of thumb, a defector does not try to force the hand of a desired protector by defecting through a media interview.
ASIO and the Department of Home Affairs will consider the protection claims seriously but will also "attempt to separate fact from fiction'', The Australian Financial Review has been told.
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China's overreach is testing Australia in four key ways

Peter Hartcher
Political and international editor for The Sydney Morning Herald
November 26, 2019 — 12.00am
The emphatic weekend verdict by the people of Hong Kong is a pronouncement much bigger than that city. It is a vote of "no confidence" in Beijing from some of the people who know it best. Twice as many people turned out to vote in the local district elections than at the last ones four years ago.
And it wasn't the weightiness of local district affairs – rubbish collection and public parks, for instance – that brought more than 71 per cent of eligible voters to the ballot box, compared with the previous record high turnout of under 50 per cent.
The people of Hong Kong voted to at least treble the number of pro-democracy district councillors, pending final results. While they won 100 seats last time around, this time it'll be at least 333 of the 452 seats contested, according to local media estimates. On Saturday, pro-government and pro-Beijing parties controlled all 18 of the city's district councils. By Monday morning they had just one.
Amid angry calls for greater democracy, record numbers have voted in district elections in Hong Kong with some suggesting the high turnout will likely boost those aligned with the city's protest movement.
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Carrie Lam will make no concessions after local election landslide

By John Ruwitch
November 26, 2019 — 3.55pm
Hong Kong: Hong Kong's embattled leader Carrie Lam has refused to offer any concessions to anti-government protesters despite a local election setback.
The chief executive says she will accelerate dialogue and plans to set up a committee to review deep-seated social issues that contributed to grievances.
Hong Kong's most unpopular post-colonial leader acknowledged voters wanted to express their views on many issues, including "deficiencies in governance", but also wanted an end to the six-month-old unrest gripping the city.
"Everybody wants to go back to their normal life and this requires the concerted efforts of every one of us," Lam said.
"So, as I have said repeatedly, resorting to violence will not give us that way forward. So please, please help us to maintain the relative calm and peace ... and provide a good basis for Hong Kong to move forward."
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Unsettling precedents for today’s world

Events evoke not the 1930s but the period before the first world war
Martin Wolf
History does not repeat itself, but it often rhymes. This remark is often incorrectly attributed to Mark Twain. But it is a good one. History is the most powerful guide to the present, because it speaks to what is permanent in our humanity, especially the forces that drive us towards conflict. Since the biggest current geopolitical event, by far, is the burgeoning friction between the US and China, it is illuminating to look back to similar events in the past. In a thought-provoking book, Destined for War, Harvard’s Graham Allison started with the account of the Peloponnesian war by Thucydides, the great Athenian historian of the 5th century BC. However, I will focus on the three eras of conflict of the past 120 years. From them much is to be learnt.
The most recent conflict was the cold war (1948-1989) between a liberal democratic west, led by the US, and the communist Soviet Union, a transformed version of the pre-first world war Russian empire. This was a great power conflict between the chief victors of the second world war. But it was also an ideological conflict over the nature of modernity. The west ultimately won. It did so because the scale of western economies and the speed of western technological advances vastly outmatched those of the Soviet Union. The subjects of the Soviet empire also became disenchanted with their corrupt and despotic rulers and the Soviet leadership itself concluded its system had failed. Despite moments of danger, notably the Cuban missile crisis of 1962, the cold war also ended peacefully.
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China overtakes US as no 1 in diplomatic posts

China has overtaken the US to ­establish the world’s largest diplomatic network, as Xi Jinping ­pushes to expand his country’s economic footprint through the Belt and Road Initiative.
New Lowy Institute analysis reveals China now has 276 diplomatic posts, surpassing the network of the US by three posts.
While Beijing and Washington have almost the same number of embassies, China is unmatched in the number of consulates, with 96 compared to 88 for the US.
As Donald Trump pursues his “America First” agenda, the institute’s Global Diplomacy Index finds US diplomacy “has entered a period of limbo”.
“With a hollowed-out State Department — only 73 per cent of key positions are filled — and ­attempts to cut the State Department’s budget by 23 per cent, American diplomacy is looking rudderless,” Lowy Institute ­research fellow Bonnie Bley said.
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How the Navy chief's firing illustrates Trump's most corrupt impulses

By Paul Waldman
November 26, 2019 — 12.30pm
Washington: One key reason Donald Trump's presidency has been so damaging is that he has a way of corrupting all the people and institutions he comes in contact with, infecting them with his virus. No one remains untouched.
As the sudden firing of Navy Secretary Richard Spencer shows, that includes the military. Spencer's story also bears a remarkable resemblance to the Ukraine scandal, in the way people with their own agendas played on Trump's most repugnant impulses to manipulate him.
Spencer's firing has its roots in the case of Edward Gallagher, a Navy SEAL who became a Fox News hero. Gallagher's long and complicated case began when members of his own unit accused him of a series of war crimes, including firing on civilians and murdering a wounded teenage Islamic State fighter receiving medical treatment from his unit.
Gallagher allegedly stabbed the wounded fighter multiple times, then took a picture with the corpse and texted it to friends, with the caption "Got him with my hunting knife." He was also charged with covering up his crime by threatening to kill members of his platoon if they reported it. They did anyway.
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'We're with them': Trump signs into law support for Hong Kong's pro-democracy protesters

By Anne Gearan and David J. Lynch
Updated November 28, 2019 — 4.18pmfirst published at 11.17am
Washington: China has reacted furiously to US President Donald Trump's signing of laws on Hong Kong human rights and says the US will bear the unspecified consequences.
A Foreign Ministry statement on Thursday repeated heated condemnations of the laws and said China would counteract. It said all the people of Hong Kong and China opposed the move.
Trump signed legislation designed to support pro-democracy protesters in Hong Kong after previously suggesting he might veto the measure to pave the way for a trade deal with China.
The legislation, with near-unanimous support in the House and Senate, authorises sanctions on Chinese and Hong Kong officials involved in human rights abuses and requires the State Department to perform a new annual review of the special trade status that Washington grants Hong Kong.
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Why I cannot vote for Jeremy Corbyn’s Labour Party

It's hugely expansionary and revolutionary program is likely to trigger capital flight and a currency collapse.
Martin Wolf Columnist
Nov 29, 2019 — 10.29am
At the age of 16, I joined the young socialists, the youth branch of the Labour Party. I was a supporter of the leader, Hugh Gaitskell, who opposed the party’s “Clause IV”commitment to nationalisation.
I then encountered the hard left or, as we called them, “Trots”, after Leon Trotsky, an architect of the Soviet revolution, assassinated by Joseph Stalin. I disliked them then. I dislike them now. I doubt their commitment to freedom and democracy.
With Jeremy Corbyn’s leadership, the hard left took over the Labour Party. It was a change of enormous, and probably enduring, importance. Labour remains the UK’s main opposition party. At some point, it is likely to gain power. I wish I could want it to do so. I do not.
The Tories have provided dreadful government, from post-crisis fiscal austerity at the expense of the vulnerable, to the idiocy of Brexit. The economy’s performance has been dire, above all, on productivity.
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Corporate debt nears a record $10 trillion, and borrowing binge poses new risks

November 30, 2019 at 4:27 a.m. GMT+11
Little more than a decade after consumers binged on inexpensive mortgages that helped bring on a global financial crisis, a new debt surge — this time by major corporations — threatens to unleash fresh turmoil.
A decade of historically low interest rates has allowed companies to sell record amounts of bonds to investors, sending total U.S. corporate debt to nearly $10 trillion, or a record 47 percent of the overall economy.
In recent weeks, the Federal Reserve, the International Monetary Fund and major institutional investors such as BlackRock and American Funds all have sounded the alarm about the mounting corporate obligations.
The danger isn’t immediate. But some regulators and investors say the borrowing has gone on too long and could send financial markets plunging when the next recession hits, dealing the real economy a blow at a time when it already would be wobbling.
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Disillusioned Chinese officials closely watching Wang case: analyst

By David Crowe
December 1, 2019 — 12.00am
Disaffected Chinese officials are closely watching how Australia deals with defector Wang Liqiang, with others weighing up whether to follow his path, an analyst says.
Questions are swirling about Mr Wang’s account of his life as a Chinese spy, and the federal government’s response to his plea for asylum could influence others who might bring their secrets to Australia, said Australian Strategic Policy Institute researcher Alex Joske.
"He has indirect value to Australia because the way Australia handles this case will be closely watched by others within the Chinese government who may have an interest in defecting," he said.
Security agencies have confirmed they are examining Mr Wang’s background and his request for asylum after The Age and The Sydney Morning Herald revealed his story last weekend in an investigation with 60 Minutes.
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North Korea locked and loaded with ‘super-large’ rocket launcher

North Korea has said the latest test-firing of its “super-large” multiple rocket launcher was a final review of the weapon’s combat readiness, a suggestion Pyongyang is preparing to deploy the weapon soon.
South Korea’s military had earlier said North Korea fired two projectiles, likely from the same “super-large” rocket launcher, on Thursday. It expressed “strong regret” over the launches and urged North Korea to stop escalating tensions.
On Friday, the North’s ­Korean Central News Agency confirmed the launches were made in the presence of leader Kim Jong-un — nicknamed “little rocket man” by Donald Trump. “The volley test-fire aimed to ­finally examine the combat ­application of the super-large multiple launch rocket system proved the military and technical superiority of the weapon system and its firm ­reliability,” KCNA said.
It said Kim expressed “great satisfaction” over the results.
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I look forward to comments on all this!
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David.