Thursday, November 30, 2023

It Seems The Government Can’t Stop Fiddling With Its Near To Useless Toy! They Really Are Stubborn To Persist With It!

It looks like the Government has not thought its plans through again.

This appeared last week.

Should patients be able to immediately access results via MHR?

The DoH is looking to modernise My Health Record to include the default sharing of pathology and imaging reports, but the RACGP has concerns.

Matt Woodley

22 Nov 2023

The seven-day delay rule for uploading pathology and diagnostic imaging results to My Health Record (MHR) should remain in place, the RACGP has said.
 
The recommendation was included in
a recent submission to the Department of Health and Aged Care (DoH), which is planning to ensure all pathology and diagnostic imaging providers share their reports to MHR by default by the end of 2024.
 
According to the DoH, this change has emerged out of the Strengthening Medicare Taskforce to ‘empower’ patients and make it easier for healthcare providers to coordinate care and make clinical decisions.
 
However, while the college supports default sharing as it could reduce duplicate testing, lowering both Medicare and patient out-of-pocket costs, it also indicated there are risks associated with making those results immediately available to patients.
 
‘Maintaining the seven-day rule allows consumers to have access to their health information, albeit with a small delay that allows their GP or other clinician to discuss their results with them,’ the submission states.
 
‘We do not consider the benefit of real-time access to results outweighs the potential harm of consumers misinterpreting results or receiving unfortunate results with no immediate clinical support.
 
‘If the seven-day rule is to be removed, the RACGP recommends evaluation is undertaken to provide data that this change to the My Health Record has achieved the goal of supporting better patient health outcomes.’
 
In addition to opposing the immediate sharing of pathology and diagnostic imaging results, the college has also said any updates to MHR need to be supported by a ‘thorough and wide-reaching’ communication campaign, targeted at both consumers and healthcare providers.
 
‘Communication with healthcare providers should begin well in advance of any changes coming into place,’ it states.
 
‘Peak primary healthcare organisations should be engaged to deliver information to their members to raise awareness of these changes, discuss potential impacts and provide direction on where to obtain assistance if required.
 
‘[Public] messaging should include information reinforcing the My Health Record is a consumer-controlled record and consumers are able to manage the privacy controls of their record to restrict access to specific healthcare organisations.
 
‘GPs should not be expected to explain the changes to patients during consultations, so consumer resources available through practices, such as posters or flyers that GPs can refer their patients to, would be helpful.’
 
The submission goes on to point out that practical barriers need to be overcome ahead of the changes being adopted.
 
‘Some RACGP members have described the My Health Record interface for viewing test results within their clinical information systems as “clunky, hard to navigate, and slow”,’ the RACGP said.
 
‘It has also been noted it is particularly difficult to see each result where multiple test reports are available and that it is difficult to access images.
 
‘Results will need to be sent to My Health Record as atomic data to support the seamless integration of reports into general practice clinical systems.’
 
Once the mandatory uploading of pathology and diagnostic imaging is in place, the college says general practice systems will need to: 

  • efficiently search large volumes of data to ensure ease of access to relevant reports
  • be responsive to ensure there are no system delays when displaying data
  • display reports in a way that is easy to read and accessible
  • provide consistency in terminology and reporting to support safe quality care.

More here:

https://www1.racgp.org.au/newsgp/professional/should-patients-be-able-to-immediately-access-resu

You can view the full RACGP response here:

Modernising My Health Record:

Sharing pathology and diagnostic imaging reports by default and removing consumer access delays’ consultation

Response by the Royal Australian College of General Practitioners

October 2023

https://www.racgp.org.au/getmedia/08c0d736-a8f7-4340-8595-cda98f0f9461/FINAL-RACGP-response-Modernising-My-Health-Record-consultation.pdf.aspx

The RACGP makes some good points but really avoids the elephant in the room by not suggesting that the myHealthRecord is a useless pile of crock and really should be put out of its misery.

It is important also to note that the myHR modernisation is still to happen as best I can tell but that when it does upload of all results needs to be clinically tailored for the patient.

Some routine results are fine ASAP and others need to be controlled by the ordering clinician IMVHO!

Readers here will be aware that the Government has been trying to enthuse clinicians regarding the myHR since 2012 as I recall and if it is not a raging success by now one wonders how long they will persist with it? After my experience discussed in the blog before this it is clear the myHR is dead!

I reckon the bureaucrats are plain misleading the Minister on most aspects of the myHR and that he needs to take a close look for himself and take serious advice on what to do! My experience of my record was a total bust! Time to give up on it…..

David.

Tuesday, November 28, 2023

The myHealth Record Is Decaying And Dying As We Watch. Neglect is Obvious. Time To Switch It Off!

With all the talk of myHR updating etc. I thought I would log on and have a peek at all the new stuff!

What I found was amazing. Those who browse here will know I have had some health excitement in the last year with months in hospital, tests galore and consultations to fill weeks of fun and records! Most of this was at least 3-4 months ago, so it should be in the record!

So how much has made it to my record?

Latest entry I could find was dated 2018!!!!

Here are some highlights:

Snapshot taken 26/11/2023

https://myrecord.ehealth.gov.au/portal/home

Welcome to My Health Record

This page shows the records you can view.

Recent documents timeline

No recent documents to view

There are no recent documents added to this My Health Record. Documents uploaded within the past 12 months will appear in this list. You can still add personal health information including:

Select the record you want to view

·         David G More

74 years

Information on Discharge Summaries

Event Date

Author

Organisation

Author Role

Access Level

Action

23-Feb-2018

Ramirez, M

North Shore Private Hospital

General Medical Practitioner

General

Manage Access

08-Feb-2018

Napthali, A

North Shore Private Hospital

General Medical Practitioner

General

Manage Access

22-Apr-2017

Chen, Andy

NSW Department of Health

Medical Practitioners nfd

General

Manage Access

03-Apr-2017

Srivastava, Tarini

NSW Department of Health

Medical Practitioners nfd

General

Manage Access

08-Aug-2016

Davidson, Briony

NSW Department of Health

Hospital Pharmacist

General

Manage Access

Pathology Reports

Pathology reports provide the outcome of pathology tests performed. If you wish to know more about your pathology test results and tests performed, please see Lab Tests Online.

Space was empty!

---- End Extracts

Not a thing from any of the hospitals or doctors at all – so I am all good apparently.

What a joke and obscene waste of money. Questions in Parliament are sure needed!

David.

Sunday, November 26, 2023

I Am Amazed That This Truth Has Not Been More Remarked Upon Over The Ages!

This appeared a few days ago

NSW Customer Service says digital "cannot be the only answer"

By

Inclusivity and social cohesion drive decision-making.

The NSW Department of Customer Service has warned against over reliance of digital solutions to solve community issues, highlighting the importance of inclusion in the digital government service delivery age.

Deputy secretary for customer delivery and transformation Sarah Cruickshank told a Digital NSW 2023 showcase event in Sydney yesterday that the department is considering how customer-focused plans “reflect the public policy priorities of the government”.  

She said digital solutions aren't the sole solution to building harmonious communities.

“Digital cannot be the only answer for how we deliver government services, support and programs,” Cruickshank said.

“Over reliance on digital, whilst it will cater for the majority of people, actually runs the risk of creating and entrenching even further isolation for those that are already not feeling as connected to society as they should."

Cruickshank said the focus of government is around “social cohesion”, adding that NSW DCS has specific targets to ensure “that Aboriginal and Torres Strait Islander people have the equivalent access to digital services and general digital inclusion as the rest of the population by 2026.”

During the talk, Cruickshank said that social cohesion was also impacted by macro factors - outside of the government's control - notably "international security".

“Unfortunately, international security is something that has become more and more a space that governments are occupied with, and are investing heavily in. This obviously has cybersecurity implications as well," she said.

“But just generally, geopolitical security is causing a lot of angst within communities”.

Cruickshank said social and economic wellbeing is another aspect, with governments less focused on constant growth but rather ensuring basic community needs are meet.

“Australia has been largely immune until very recently from challenges with social cohesion," she said.

“Unfortunately, in recent months we've seen some fracturing of what has normally been a very harmonious society in Australia.

“There are other countries around the world that are in a much more difficult situation than we are. But we need to do everything as governments to ensure that we maintain and strengthen the cohesion within our society.”

Customer metrics

Cruickshank said when the first State of the Customer report, which measures nearly 40 service lines across NSW government, landed earlier this year “we were obviously incredibly pleased with the results”.

The report revealed 77 percent of people found NSW services easy to access, 75 percent were satisfied and 73 percent trusted the government to deliver its services.

However, Cruickshank pointed out the pandemic “taught us a lot about how we need to engage better as government with communities.”

“That was the first time that government realised we had to get much better at how we communicated information to communities that were impacted, but also how we worked with those communities to help us in the way we supported those communities.”

Lots more here:

https://www.itnews.com.au/news/nsw-customer-service-says-digital-cannot-be-the-only-answer-602669

Talk about the blooming obvious and the stupidity of the so called thought-leaders! So often all you see is denial that the digitally incognoscenti actually exist!

It is inevitable that there will always be a good 5-10% of people who, for whatever reason, just can’t or won’t engage with the digital world!

Because this is true, we need to accommodate the outliers with tools and access to services they can use and feel comfortable doing so. Any system design which does not accept this realty just stores up trouble and complexity for itself! This is especially true when providing services we are all expected to access - like Health Service!

Just a good idea to return to reality every once in a while!

David.

AusHealthIT Poll Number 724 – Results – 26 November, 2023.

Here are the results of the poll.

Are We Doing Enough To Track Down And Punish Cyber-Fraudsters?

Yes                                                                                14 (34%)

No                                                                                 27 (66%)

I Have no Idea                                                               0 (0%)

Total No. Of Votes: 41

A clear outcome with a majority feeling it is possible to do more.

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. But also a very clear outcome! 

0 of 41 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those very few who voted! 

David.

Friday, November 24, 2023

It Seems That As We Learn More We Realise We Know Less!

Here is a thoughtful read for the weekend.

The Astrophysicist Who Loves the Things We Cannot Know

A conversation with “rational mystic,” physicist Marcelo Gleiser.

By Anne Strainchamps

November 8, 2023

Marcelo Gleiser thinks we have the story of the universe all wrong. And that it’s time to restore Earth and humanity to the center of the cosmos. The Brazilian physicist, astronomer, and winner of the 2019 Templeton Prize thinks modern science has fallen prey to an increasingly bleak perspective—a view of Earth as an insignificant speck alone in a cold, dark universe.

Gleiser, a noted theoretical physicist who teaches at Dartmouth College, has published a string of books on high energy physics, cosmology, and the origins of the universe. In his latest, The Dawn of a Mindful Universe: A Manifesto for Humanity’s Future, he writes that ever since Copernicus, “the more we learn about the universe, the smaller and less important planet Earth seems.” It’s a toxic narrative, he thinks, that set the stage for reckless use and abuse of the planet’s resources. There aren’t that many writers who could make the story of the Big Bang, expansion of the universe, and galaxy formation relevant to fossil fuel consumption and the climate crisis. In Gleiser’s hands, the story of the universe becomes a call to action.

In a recent conversation, he seemed energized by the flood of new data raising questions about the current model of the universe—and by the very real possibility that humans will never truly understand the universe, a lesson he felt personally after a devastating loss in childhood.

You have argued that findings from the James Webb telescope are calling the story of our universe into question. What, specifically, makes you think cosmology may be due for a conceptual revolution?

We always thought stars were made when the universe was about 100 million years old. So the usual narrative is that first you have a bunch of big, big stars. They collect, they form black holes, they attract more stars, and then you have galaxies. And this takes a while. The idea was that it would take about a billion years for you to have big galaxies.

But in comes the James Webb, and we find that, nope—there were huge galaxies right around the same time that the first stars were being formed. So somehow we have to find a way of increasing the speed at which galaxies form.

So we’re surrounded by mystery.

Absolutely. I wrote a book called The Island of Knowledge a few years ago, where I said that the island of knowledge is surrounded by the ocean of the unknown. And as the island grows, so does its periphery, which is the boundary between the known and the unknown. So the paradox of knowledge is that the more you learn, the more you discover that you don’t know.

That sounds like a profoundly depressing realization for a scientist.

If you’re a card-carrying “reason will solve everything and science is truth,” person, then maybe. But in my case, I think it’s inspiring because it means there is no end to the quest; we humans will always have a limited grasp of what reality is. And what could be more fascinating than being surrounded by mystery?

If you’re someone who likes mystery. I think we humans tend to have a contentious relationship with the unknown.

Yeah, you know, in my other life, where I do all these extreme sports like endurance running, we have this saying—“you have to get comfortable with being uncomfortable.” I think that applies here too—you have to be comfortable with the fact that we will never know everything, that there are questions that have no answers, and that’s not a bad thing.

The paradox of knowledge is that the more you learn, the more you discover that you don’t know.

As a theoretical physicist, you’ve been working with big questions and mysteries for most of your career, but what drew you in that direction to begin with? I know your mother died when you were very young. Do you think that helped shape you as someone who was drawn to those questions?

Yes, absolutely, I have no doubt about that. I was 6 when my mother died, and it was a time of darkness in my life. There was just this void, the emotional void of not having a mom, you know? All your friends have moms, who come and pick them up from school and hold their hands. My dad sometimes came by, but he was a busy man. So what do you do with that kind of loss?

Did you have any kind of faith tradition to help explain it?

My family is Jewish—and I had a pretty traditional Jewish education—with traditions, but not so much belief in all of the details of the Old Testament. But there’s an element of the supernatural in all the big monotheistic religions, and I tried to connect with that. I was obsessed by supernatural stories and supernatural beings. When I was about 11 years old, vampires in particular were fascinating to me because they were both living and non-living, they had a foot in the world of the dead and a foot in the world of the living. So I said, “Hey, maybe if I became a vampire, I could go and connect with my mom!”

And you were growing up in Rio de Janeiro, which must have been filled with stories of the supernatural?

Oh, big time. There were spirits everywhere, according to my nannies. My dad was superstitious too. Every Monday was Souls’ Day, so people would go to the crossroads and light up candles and leave offerings for the spirits. Yeah, in Rio, you can’t avoid the other dimension.

Did you ever feel like you were able to be in touch with your mother?

Many times. In fact, if you had asked me when I was 9, I would have sworn that I could see her sometimes hovering in the big, long corridor of my house. I was desperate for that connection.

But then I started to transition from that to nature and to being in the natural world by myself. That’s when I began to fish. I was 12, and I would go all by myself to Copacabana Beach and spend hours alone fishing. I mean, what kid does that? I was surrounded by all these retired men, who were always like, “what is this kid doing here?” And I was just there, hanging out, looking at the horizon for 2 or 3 hours, you know, three or four times a week. For years, I did that. It was really trying to connect with, I don’t know what, the vagueness of the horizon? Because it is a weird place, the horizon, when you think about it—where the earth and the heavens join. The line of connection between one world—ours—and another world, which is up there.

I can see you feeling drawn to that—as though you yourself, in your life, were hovering there, stuck on the horizon in a way, because your mother’s death propelled you into this in-between place?

Exactly. And then I discovered Einstein. And that changed everything because I realized that some of these questions about space, about time, about duration, about the origins of everything, were actually also scientific questions.

How do you go from being a boy who thinks maybe he could see his mother’s ghost and who believes in spirits, to being a scientist working in the materialist paradigm?

Well you can see that I didn’t choose to work on superconductors or lasers or bacteria! I chose to work on the nature of space and time and the Big Bang and the origin of life. These are really boundary questions between scientific and philosophical or religious thinking. So I think I found a way to be what you could possibly call a rational mystic.

You have to be comfortable with the fact that we will never know everything.

Did that ever create problems for you in the scientific community, among other scientists?

No, simply because I never told them. Like—and I’m not comparing myself to Einstein—but I’m sure that Einstein also didn’t talk about his Spinoza notion that God is everywhere.

That’s what he thought?

He had a very wonderful—and I would say mystical—way of relating to this intelligence that he found embedded in nature, which was some sort of divine presence. He didn’t associate it with a Jewish God or anything like that, but there was something and he thought that science was a portal to connecting with this kind of intelligence.

That’s way more mystical than I thought Einstein was. I mean, there’s his famous remark, “God does not play dice with the universe.”

Yeah, but that was a joke. He had a much deeper connection, what I would call truly a mystic connection to the natural world, and to this kind of hidden intelligence in the depths of nature that we can never quite understand, but which is there. He has this famous quote that I love, which is: “the most beautiful experience we can have is the mysterious.” I mean, who would write that? Krishnamurti, yes—but that was Einstein!

So we’re circling around the subject of storytelling. Lately you’ve been saying that we need a new story of the universe, that ever since Copernicus, science has been telling the story of cosmological history wrong. That’s a pretty big rewrite.

I’m saying we have to rethink the story of who we are and how we relate to the planet. A little bit of deep time history here: Homo sapiens have been here on this planet 300,000 years, more or less. Of that time, about 95 percent, almost all of it, we were hunter gatherers moving about the planet. And we had a completely different relationship to the world than the agrarian civilizations did. For the hunter gatherers, the world was sacred. They understood that there were powers in nature that were beyond themselves, that they were not above nature.

But that was 10,000 years ago, so how do we know? Are you extrapolating from what current Indigenous cultures and traditions have to say?

No, we have anthropological evidence of how earlier hunter-gatherers congregated and how and what they ate. It’s amazing that we can tell that story. And of course, there is a dark side, and maybe overhunting was what caused the extinction of the mastodon and other mammals. But yes, I think current Indigenous cultures carry that tradition of coexisting with the natural world and respecting the sacredness of a place. Agrarian societies ushered in a complete phase transition: “look, we can actually control nature. We can tame the plants and animals to serve our purposes, and we can be the masters of the world.” No wonder the monotheistic religions say God created the world for humans.

And suddenly we get stories of paradise. Gardens of Eden given to us.

And most importantly, look what happened to the gods. Once, they were part of the trees, the rivers, the waterfalls, the winds, the volcanoes. Now, the gods are way up there, far away from the world. The world is not divine anymore. It becomes an object.

We carry the whole history of the universe in ourselves.

And this is the precursor to the revolutionary moment when Copernicus says Earth is also not the center of the universe?

Right. And then when Copernicus says, “Look, the Earth is not even the center of everything, the sun is,” then the Earth became not the center of creation, but just another world. Which further disrupted the vertical hierarchy of us here on Earth and the gods up in the skies. Now that Earth is revolving around the sun, it becomes less important. And we become less important too, because immediately after Copernicus, people started to speculate: “Wait a second. If there are other worlds, why should life only be here?”

Really, right afterward?

Very, very quickly. Copernicus published his book in 1543. In the 1580s, Giordano Bruno was saying, look, the stars are just like the sun, so they should also have planets moving around them, and those planets should have life, just like here. In the early 1600s, Johannes Kepler, who came up with the mathematical laws of planetary motion, wrote a fictional story about a trip to the moon.

So people were already beginning to think about escaping the Earth and heading to other planets.

It was all over the place. In 1686, one year before Newton published his famous book that changed the world, a French philosopher, Bernard le Bovier de Fontenelle, published a book called Conversations on the Plurality of Worlds. And then as science advanced, we learned more about stars and galaxies and the expansion of the universe. But within the framework of the Copernican narrative, the more we learned about the universe, the less important we and this planet became.

And today we talk about multiverses.

Yeah, that’s the final insult, right? “Hey, there’s not just our universe, there are countless universes! Ours is just one.”

There’s this thing people talk about in astronomy, the principle of mediocrity—meaning we are not important at all. I think this is just completely wrong. Because there is a fundamental element missing in this whole story: We have no clue what life is or how it emerged on this planet. I mean, we don’t even know how to define life very well. We have an operational definition: a biochemical network system that is capable of metabolism and of Darwinian evolution. But that’s what life does—it doesn’t tell me anything about what life is.

In the meantime, there’s a lot of money going into looking for exoplanets that might support life. Elon Musk thinks we can terraform Mars. There’s the whole narrative of “when we’ve wrecked this planet, we’ll head to another.” You’re pushing back on all that?

Okay, let’s qualify. Searching for other planets, and in particular searching for biosignatures, meaning the signs of life, is essential research right now. I work on this. But Elon Musk and terraforming Mars? That’s just silly stuff. Our problem right now is the next few decades on this planet—not if, in 500 years, we’re going to have a colony on Mars. I mean, that’s useless.

Then why even bother looking for exoplanets? Why not focus our attention on this one?

Because that’s how we advance knowledge, by asking profound questions about the universe and matter. Looking for life on other planets is essential because for now, as far as we know, Earth is the only planet that has life. The post-Copernican narrative decreased the value of our world, and we constructed a whole civilization based on the idea that we can use and abuse it. We built giant cities and industries by essentially consuming the entrails of our planet. Oil, gas, and coal—the insides of the planet—fed our technologies, and it all worked until it didn’t.

Without our voice, the universe itself would have no memory. 

At this point, it almost seems like the problems are too big to do anything about.

So what can we do? Well, we can tell a different story. First of all, when you look at the evolution of life, you realize that it’s completely dependent on the history of the planet. If you change or tweak something that happened here on our planet a long time ago, life would be different, which means we wouldn’t be here.

The most famous example is 66 million years ago, the big asteroid hits the Yucatan Peninsula. It wipes out the dinosaurs and a bunch of other creatures, with the exception, maybe, of the birds and some little mammals. It completely changed the evolution of life on the planet. And it was a cosmic accident.

So your point is, it’s not about counting up the number of planets that could possibly support life because they’ve got the right chemistry and the right mass. It’s that there were so many little contingencies without which you could never get this form of life again. Although, you might get a better one.

What I’m trying to say is that instead of thinking of the Earth as just another planet and life as ubiquitous in the universe, the truth is that Earth is not just another planet. The Earth is a very rare oasis that has supported life for at least three and a half billion years, which allowed for life to change and adapt to different environments that coincidentally and completely randomly evolved to generate a species that is able to reconstruct this entire story and to tell it. And without our voice, the universe itself would have no story, would have no memory. It would be a dead universe. So it’s not just that we are we are stardust, as Carl Sagan used to say—we are how the universe is telling its own story.

I think this is only possible because of this incredibly spectacular and rare planet that we live on. Look at Mars, a horrible frozen desert. Look at Venus, a boiling soup of sulfuric acid. Other planets, you can’t even stand on them because they’re gas giants. So this is not just another world; it’s a rare gem in the universe. And yes, there could be other planets with life on them, maybe. But probably very simple life—single celled organisms. Never or very rarely complex organisms.

More here:

https://nautil.us/the-astrophysicist-who-loves-the-things-we-cannot-know-436828/

I reckon there is a good deal of “food for thought” here!

I hope you read and ehjoy.

David.