Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Friday, January 10, 2014

Another Type Of Risk With Clinical Software That Does Not Often Get Discussed.

This article appeared a little while ago.

Birmingham to offer PICS licence-free

11 November 2013   Lis Evenstad
University Hospitals Birmingham NHS Foundation Trust will offer its Prescribing Information and Communication System to the NHS on a licence-free basis instead of “open-sourcing” it.
EHI reported last week that NHS England is working with four different organisations, one of which is Birmingham, to put their products on a new open source electronic patient record systems framework.
The trust’s medical director, Dr Dave Rosser, told EHI that Birmingham would not be offering its PICS e-prescribing system open source because it is too risky.
“We think open sourcing PICS would be dangerous. It’s too complicated a programme with very complicated code,” said Dr Rosser.
“It would be risky to say the least. It has 600,000 lines of code and it is all interactive. It’s very easy to make a change in one part that changes something in another part that not even the programmers can predict.”
Speaking at EHI Live last week, Beverley Bryant, director of strategic systems and technology at NHS England, said that up to £20m of the £250m first round of the Safer Hospitals, Safer Wards Technology Fund will go towards developing the open source option.
Twenty trusts have expressed an interest in using open source systems. IMS Maxims, HP and the US Veterans Association system, VistA, are also expected to be on the framework that trusts will be able to call-off against.
Lots more here:
Continuing on from other software safety risks we have discussed on the blog, a really interesting issue raised here with the complexity of an application being such that there are real concerns with having others modify it, as would be possible with open-source, because there is a serious risk of breaking the software.
This is interesting given that going open source has often been associated with improvement in software quality and reliability. Clearly the authors think the learning curve with their software is such that only those who are very involved can cope with.
Do you think the authors are right, or are they underestimating the smarts out there in ‘geek land’?
David.

Thursday, January 09, 2014

Here Is A Useful Contribution To Consideration of Issues Around Health IT Safety. Worth A Download.

This appeared a little while ago.

A Guide: How to Identify and Address Unsafe Conditions Associated with Health IT

December 5, 2013, 8:46 am
Kathy Kenyon, JD / Senior Policy Analyst , and Steven Posnack / Director Federal Policy Division, ONC
When front line clinicians confront a clinical mishap or unsafe condition in EHR-enabled healthcare settings (such as a medication error or a missed diagnosis) they may not connect the clinical event with how EHR use could have helped prevent it, how misuse or failure to use EHR functionality as intended contributed to the problem, or how weaknesses in EHR configuration, interfaces, or usability contributed.

To help clinicians and other EHR users address health IT-related safety issues, we have posted a guide and slide deck [PDF - 2.7 MB] [PPTX – 3.0 MB] called How to Identify and Address Unsafe Conditions Associated with Health IT, developed by ECRI Institute under an ONC contract.  The guide aims to help healthcare organizations and Patient Safety Organizations (and perhaps health IT technology developers, industry professional associations, and risk management and liability insurance companies) improve reporting of unsafe conditions associated with health IT, EHRs in particular.
This guide is one of a series of tools developed to addresses the potential unintended consequences of health IT as part of our commitment to improving health IT safety based on the Health IT Patient Safety Action and Surveillance Plan (Health IT Safety Plan).
Both the Health IT Safety Plan and the ONC-sponsored Institute of Medicine report on Health IT and Patient Safety: Building Safer Systems for Better Care recognized the need for more reporting of health IT safety events and unsafe conditions, and urged a larger role for Patient Safety Organizations (PSOs), listed by AHRQ, in reporting and follow-up of errors and health IT related events.
Lots more here:
This is a really useful presentation which provides a framework for how to consider risks and better still how to make sure problems are being monitored and responded to.
Well worth a download.
David.

Wednesday, January 08, 2014

It Seems Large Scale EHealth Failures are Happening All Over. I Wonder Why We Imagine The Outcome Here Will Be Any Different?

These appeared in the last few days:

Editorial: The eHealth money pit

By Ottawa Citizen Editorial, Ottawa Citizen January 3, 2014
Ontarians are likely to groan at the news, reported by the Toronto Star, that more than 700 employees at eHealth Ontario are getting a little extra in their paycheques this month, as they share $2.3 million in performance bonuses.
This is the agency tasked with creating a system of electronic health records in Ontario. In 2009, the province’s auditor general found that a lack of oversight and planning meant that Ontario was “near the back of the pack compared to most other provinces,” and found disturbing evidence of favouritism, sole-sourcing, inefficiencies and overspending. One consultant, paid $2,700 a day, famously billed for expenses right down to a few dollars for Choco Bites. But the real scandal is that despite all the money paid to develop electronic health records — more than $1 billion from 2002 to 2009 — the province still does not have an integrated, universal electronic health system.
There has been progress made in several elements of the patchwork: in the records systems in doctors’ offices and hospitals, for example. And there has been some stitching together of the pieces. Many things that used to happen on paper now happen digitally, allowing for quicker transfer between institutions. But the services available lag the technology and the culture. We are now where we should have been a decade ago.
That is not the fault of the employees, who filed and won a class-action lawsuit to restore performance bonuses after the Liberal government cancelled them in a panic.
The full editorial is here:
We also have - in French - bad news from there as well.

Dossier médical partagé : un coût excessif pour un succès mitigé

Le Monde.fr avec AFP | 04.01.2014 à 08h50 • Mis à jour le 04.01.2014 à 13h56

Selon des informations du Parisien publiées samedi 4 janvier, la mise en place du dossier médical personnel (DMP) a coûté 500 millions d'euros pour seulement 418 011 ouvertures sur les cinq millions prévus. « Selon un document interne du Conseil national de la qualité et de la coordination des soins, chargé d'arbitrer les financements destinés à l'amélioration de la médecine de ville, 500 millions d'euros ont été versés depuis 2004 », indique le quotidien qui a pu consulter le document.

Le Parisien souligne que c'est la première fois qu'un document officiel mentionne le chiffre exact du financement du DMP. Ces fonds proviennent en grande partie de l'assurance maladie, précise le journal.
The full article is here:
Google does a great job of translation:
Shared medical record: an excessive cost for a mixed success
The Monde.fr with AFP | 04.01.2014 at 8:50 Updated 04.01.2014 at 1:56 p.m.
According to information from Parisien published Saturday, January 4, the introduction of personal health record (DMP) cost € 500 million to only 418,011 of the five million openings planned. "According to an internal document of the National Council of the quality and coordination of care, to arbitrate the funding for the improvement of general practice, 500 million euros have been paid since 2004," the paper says who could view the document.
Le Parisien points out that this is the first time an official document mentions the exact amount of funding DMP. These funds come largely from health insurance, the newspaper said.
Here is the link:
It is hard to think of much to add - other than to be amazed at just how much better Google is than my schoolboy French and how history just keeps repeating.
David.

Tuesday, January 07, 2014

NSW Moves To Update Its E-Health Plan. How Is It Looking For The Future?

The following popped up just before we all entered the Christmas Coma.

eHealth

A Blueprint for eHealth in NSW

A Blueprint for eHealth in NSW sets out the NSW Government’s principles and directions for using information and communication technology (ICT) to drive improvements in health and medical care in NSW over the next five years.
The Minister for Health released the Blueprint on 18 December 2013.

eHealth NSW

The Blueprint officially formalises the establishment of eHealth NSW. The core responsibility for eHealth NSW will be to provide high level governance for NSW Health’s information strategy, forward planning and delivery. A Chief Executive will be appointed to lead eHealth NSW by April 2014.
The NSW Government is investing $1.5 billion in eHealth NSW over the next ten years, including almost $400 million for ICT programs such as electronic medications management and community health and outpatients care.

Using eHealth to improve patient care

  • Patient information will be available to clinicians across the state, which means clinicians in metropolitan areas can also support services in regional and rural centres.
  • Clinicians and other LHD staff will be engaged to implement statewide systems at the local level.
  • eHealth NSW will set performance standards to ensure systems meet the needs of clinicians and patients.
eHealth NSW encompasses a number of innovative programs already underway across the state that support new models of care. These include telehealth, electronic medications management, statewide access to digital imaging and the use of voice recognition software as part of the second phase of the electronic medical records program.
The page is found here:
Here is the direct link to the blueprint.
At the highest level this seems to be a useful document. The ideas of having a focussed organisation, a clear e-Health leader and a senior clinician in place as a CCIO are all good and sensible - if not overdue.
The broad direction is also sensible and I do like the balance of central vs local control that is implied.
The key issue is that this is really just a plan to do at real plan.
Page 14 (top left) makes this clear.
“Refreshing our eHealth vision
While the NSW eHealth Strategic Plan 2006-2011 has served us well, it is time to set new strategic directions. A new five-year eHealth Strategic Plan will be developed to guide our future investment. Our new plan will:
·         articulate the benefits of eHealth to patients, clinicians and the community
·         consolidate the expansion of existing state-wide eHealth applications
·         demonstrate the transparency of the eHealth infrastructure to ensure reliability and security of patient information
·         support new eHealth solutions – including mobile and innovative “disruptive” technologies, and locally driven solutions – to meet changing needs and deliver new models of care, including outside the hospital setting
·         build eHealth capacity across the whole NSW Health network, as well as developing key partnerships and collaborations that will enable and support connectivity across providers and treatment settings 
·         measure and report the benefits of our investment in eHealth.
I note the plan is going to be a year or two after the end of the old plan in 2011 and it seems to me in all this the devil will be in the detail.
I look forward to the real plan - but this is a worthwhile first step with some good initial actions.
I note a reticence to lock in too hard to the NeHR until what happens later this year becomes clear.
Time will tell how it all works out.
David.

Monday, January 06, 2014

Weekly Australian Health IT Links – 6th January, 2014.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Welcome back - a few interesting things happening both in e-Health and slightly more broadly.
As you will note during the week we are all being softened up for major funding changes and drops in health sector funding from the Federal Government. I suspect e-Health is squarely on the hit list.
Watch this space!
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What Doctors Really Think Of The Billion Dollar Portal

in Blog
on 27 November, 2013
Since the change in government a few months ago, there have been a number of media releases around the failure of the Personally Controlled Electronic Health Records or the PCEHR.
The main point of discussion has been the lack of patient data uploaded to the portal. Only 5000 patient summaries uploaded to the billion-­dollar portal. 5000 patient records from a population of over 23 million is without a doubt a justifiable reason for calling the project outcome a failure.
The main reason for failure, which has been touted around the media by many prominent health personalities, has been the difficulty for the doctors to use the system and access the data.
I agree that this is one of the reasons BUT it turns out it’s not the main reason for the low usage of this platform. The main reason is much simpler and obvious, turns out that the high majority of doctors have never had exposure to the platform and as such, have never been able to understand how it could help them or their patients.
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FHIR DSTU Candidate Posted & Version Question

Posted on December 31, 2013 by Grahame Grieve
So today, to mark the end of the year, we’ve posted the final DSTU candidate version of FHIR.
This is not the DSTU itself: it’s the editors draft, which is now undergoing several weeks of QA review for ballot completion, technical errors, layout issues, and spelling mistakes etc.
Our intent is that we won’t be making substantiative changes to the DSTU any more, but if there’s changes that really are justified, we’ll still make them – we have one last connectathon to test everything out. Btw, early registration for that connectathon closes today.
Today’s version of FHIR is the product of 100′s of hours of review, argument, and work., and many people have contributed to the process. We (the FHIR project team – myself, Lloyd, and Ewout) would like to thank all of the contributers (they are named in the specification). We decided to turn FHIR into a real standard very nearly 2 years ago. We originally targeted the end of this year, but earlier this year we reset to the end of January, to give us one more meeting to work on it. I’m pretty pleased that we’ve pretty much stuck to the schedule, though it’s certainly been a grind.
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24 December 2013, 8.14am AEST

2013, the year that was: Health + Medicine

TThe first election year since the launch of The Conversation didn’t have a massive impact on the Health + Medicine page. Sure, we ran quite a few stories on the subject and some of them were avidly read…

Author

The first election year since the launch of The Conversation didn’t have a massive impact on the Health + Medicine page. Sure, we ran quite a few stories on the subject and some of them were avidly read but, for the most part, it was a steady diet of general pieces and articles linked to the news cycle.
But election year it was and it’s ending with a new government in office. We haven’t heard much from minister Peter Dutton yet, but combining the health and sport portfolios could mean good things for both.
Perhaps we’ll see less linking of sport with alcohol, gambling, and junk food. This triumvirate of sins undermines any health messages transmitted through professional sports. And it means bad things for the nation’s well-being.
Perhaps we’ll even see some “sin taxes” to help health funding, an area in which I expect much activity next year.
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Google chairman Eric Schmidt's tech predictions for 2014

Date December 31, 2013

Seth Fiegerman

This post was originally published on Mashable.
It's that time again when everyone makes a few bold predictions for the year to come. This year, Google's executive chairman Eric Schmidt is joining in on the fun.
In an interview with Bloomberg TV about 2014 trends, Schmidt highlighted the growing importance of big data for businesses and the rise of personal genetics. But the key trend, according to Schmidt, boils down to one word: mobile.
"The trend has been that mobile was winning. It's now won," he said. "There are more tablets and phones being sold than personal computers. People are moving to this new architecture very fast." For that reason, he believes we will see a "new generation of applications" emerge to fill changing needs for entertainment, social networking and more.
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Bendigo makes the most of eHealth records

By Hannah Knight

Dec. 28, 2013, 3:40 p.m.
BENDIGO health professionals are embracing the eHealth record initiative.
The federal government initiative is a secure online summary of your health information designed to enable doctors, hospitals and other healthcare providers to view and share your health information to provide patients with the best possible care.
Loddon Mallee Murray Medicare Local has teamed up with St John of God Hospital Bendigo to help people register their eHealth records.
LMMML trained 11 of the hospital’s volunteers to help staff, patients and visitors register for an eHealth record.
LMMML eHealth co-ordinator Katrina Law commended St John of God Hospital Bendigo for embracing the eHealth initiative.
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How to make hospital wards smarter

Jessica Gardner
Rob Ferguson was lunching with some mates at Centennial Vineyards in Bowral when he first met Matt Darling.
“He approached us nervously,” Ferguson says. “He wasn’t brazen about it. He sort of said his piece in about two sentences.”
For an introverted suburban Dad, Darling’s approach to a table of strangers in winter 2010 was out of character but he was feeling equally anxious and downtrodden. The founder of health software start-up SmartWard had just been knocked back by some Sydney venture capitalists. Travelling with his wife and two children, Darling had stopped in Bowral on the drive back to Canberra. Darling told the group he was developing software for hospitals but wasn’t sure what to do next. “Would any of you be prepared to give me some advice?” he asked.
Ferguson, the chairman of Australia’s largest medical centre operator, Primary Health Care, offered his notepad for Darling to write down his details and said he would call on Monday.
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Computer failure adds to ambulance patients' pain

Date January 4, 2014

Louise Hall

Court Reporter

The Ambulance Service of NSW was forced to seek a cash bailout from the government after its new electronic billing system malfunctioned, meaning $7.5 million in invoices could not be sent out.
The new billing system was designed to allow paramedics to enter patient details into an electronic medical record that would automatically generate and track invoices. However it was suspended in July 2013, nine months after it was introduced.
Imagine getting a bill three months after a loved one has died 
The NSW Ministry of Health has had to subsidise the ambulance service's cash flow while the system was offline for three months and has continued to plug the revenue hole created by the delay in creating 105,000 invoices worth $7.5 million.
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Device implants will push the boundaries of what it means to be human

Date December 27, 2013 - 8:09AM

Steve Johnson

It's likely the world in the not-so-distant future will be increasingly populated by computerised people like Amal Graafstra.
The 37-year-old doesn't need a key or password to get into his car, home or computer. He's programmed them to unlock at the mere wave of his hands, which are implanted with radio frequency identification tags.
The rice-size gadgets work so well, he says, he's sold similar ones to more than 500 customers through his company Dangerous Things.
The move to outfit people with electronic devices that can be swallowed, implanted in their bodies or attached to their skin via "smart tattoos" could revolutionise health care and change the way people interact with devices and one another.
Critics call the trend intrusive, even sacrilegious. But others say it ultimately will make life better for everybody. Some researchers and executives envision a day when devices placed in people will enable them to control computers, prosthetic devices and many other things solely with their thoughts.
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Government puts key talks on health reform on hold for six months

FEDERAL, state and territory health ministers earlier this year resolved to have a high-level advisory committee explore "possible future directions for future reform of Australia's health system".
The committee was to look at how this could be done through a closer working relationship between GPs and hospitals, better e-health solutions and improved co-ordination of care for people with chronic and complex conditions, including cancer.
The NSW government was then tasked with reporting on the progress of the existing National Health Reform Agreement, including the performance of various bodies established by the Rudd and Gillard governments, and with developing a framework and timeline for further reform work.
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NSA researching quantum computer that could crack most types of encryption

Date  January 3, 2014 - 11:17AM

Steven Rich, Barton Gellman

In room-size metal boxes, secure against electromagnetic leaks, the US National Security Agency (NSA) is racing to build a computer that could break nearly every kind of encryption used to protect banking, medical, business and government records around the world.
According to documents provided by former NSA contractor Edward Snowden, the effort to build "a cryptologically useful quantum computer" – a machine exponentially faster than classical computers – is part of a $US79.7 million ($89.5 million) research program called "Penetrating Hard Targets". Much of the work is hosted under classified contracts at a laboratory in College Park, Maryland, in the United States.
The development of a quantum computer has long been a goal of many in the scientific community, with revolutionary implications for fields such as medicine as well as for the NSA's code-breaking mission. With such technology, all forms of public key encryption would be broken, including those used on many secure websites as well as the type used to protect state secrets.
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SA Health defends omission of $95m worth of late bills from annual report

30 December, 2013
SA Health says there is nothing suspicious about the omission of millions of dollars worth of late bills from its annual report.
The department paid $95 million worth of bills more than 30 days after the due date in the 2012-13 financial year, but that figure was left out of the report.
A spokeswoman says it was a "complete and accidental oversight" and the department has improved its account payments since the introduction of new software in May.
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Your Australian broadband results may vary

Summary: Two days out from Christmas, the Australian government has released the summary of its broadband availability and quality report, but the detail and methodology will wait until 2014.
By Josh Taylor for Gen Why? | December 23, 2013 -- 05:28 GMT (16:28 AEST)
It is part and parcel of the IT journalism industry that several times a week, we'll be handed the results of some "amazing" new survey commissioned by a vendor seeking to push a product that just happens to answer all of the desires of the survey respondents.
When the methodology is there, you can usually see whether the results can be relied upon and reported, but even then, we're often hesitant to report on them, because the company that commissioned the report clearly wants you to buy its new product.
These sorts of surveys usually rise in frequency around quiet times in the year, so it is not surprising to see one land on our desks today, two days out from Christmas. What is unusual is that this time, the vendor happens to be the Australian government.
Communications Minister Malcolm Turnbull today delivered the Department of Communications' Broadband Availability and Quality report, as expected, but the presents were a little light, with just the summary of the report being released.
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Australian broadband speeds inconsistent, patchy: study

Date January 2, 2014 - 11:46AM

Lucy Battersby

More than a third of the Australian premises with access to fixed broadband never get more than moderate speeds of 9 megabits per second (Mbps), according to a summary of broadband availability and quality released by the government.
However, about 65 per cent of 9.9 million premises with access to DSL technology could theoretically get up to 21 Mbps, and about 28 per cent of Australian premises already have access to high speeds of more than 25 Mbps, including those connected to the national broadband network (NBN).
The study was one of four promised by Communications Minister Malcolm Turnbull into broadband and the NBN during the election. A five-page summary was released on December 23 to meet the minister’s 90-day deadline, but the full report will not be available for some weeks.
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10% of desktop PCs now run Windows 8

Date January 3, 2014 - 2:28PM

Pete Pachal

This post was originally published on Mashable.
Microsoft's bold attempt to redefine the PC as a touch-enabled, cloud connected machine – otherwise known as Windows 8 – is slowly but steadily spreading to more of the world's PCs. However, its predecessor, Windows 7, is still the version of choice for most Windows users.
PCs running Windows 8 and 8.1 now compose 10.49 per cent of the PC market, according to data from Net Applications. The two versions of Windows gained a combined 1.19 per cent in the month of December.
Those gains weren't at the expense of Windows 7, though, which rose by 0.88 per cent, or even Windows Vista, which rose 0.04 per cent. Windows XP was the big loser, dropping 2.24 per cent, sliding on the news that Microsoft would sunset the 13-year-old operating system in 2014.
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Enjoy!
David.

Sunday, January 05, 2014

Be Alert And Alarmed! - The Federal Government Is Testing The Response To Healthcare Funding Cuts.

As often happens in the period before any hard federal budget leaks on the planned nasties come out early. In this case, with the Commission of Audit off and running, we are getting even earlier warning.
Here is one of the first mentions:

$5 to see the GP is healthy

  • Editorial
  • Sunday Herald Sun
  • December 29, 2013 12:00AM
ENDING free visits to the doctor is a long overdue reform to reduce unnecessary appointments and ease the growing burden of public health spending on taxpayers.
Prime Minister Tony Abbott’s Commission of Audit is considering the value of a small $5 co-payment for bulk-billed GP visits to send a “price signal” to patients to avoid unwarranted visits to the doctor.
Supporters of the change say a co-payment of “less than (the price of) a Big Mac and fries” would ensure the sick can get an appointment with a doctor when they need to.
Some will argue that such a change would undermine the universality of Medicare, or even stop people going to the doctor when they need to.
But unfettered access to free doctor visits has encouraged many to visit their doctor at the first sign of a sniffle, and led some doctors to rort the system through over-service.
Amid warnings that the current system is driving GPs at big clinics to encourage patients to book multiple visits to resolve complaints while families with sick children struggle to find an appointment, Health Minister Peter Dutton says his priority is to make sure our “most sick” have access to GPs.
More here:
Despite the timing the reports were really noticed and we got this.

Statement from Minister for Health

Speculation in the media regarding Commission of Audit recommendations in relation to health.

Page last updated: 29 December 2013
29 December 2013
There has been widespread speculation in the media today about what recommendations the whole of government Commission of Audit may make in relation to health.
The Coalition Government is committed to maintaining and improving our world-class health system.
Labor spent a lot of money on creating huge health bureaucracies. The Coalition Government is committed to getting more of that money back to deliver and improve front line services for patients.
The Government has committed to funding in health and to making sure our health system is sustainable and accessible into the future. We stand by that commitment.
We won't be commenting on speculation around what the Commission of Audit may or may not recommend.
The Commission’s work is still being compiled and will be provided to the Government in 2014.
The Government will be able to consider any recommendations and respond after that time.
The release is here:
We then had all sorts of opinions emerge:
See here:

GP visits should cost $30: former health boss Andrew Podger

  • ADAM CREIGHTON and STEFANIE BALOGH
  • The Australian
  • January 03, 2014 12:00AM
PATIENTS should be charged as much as $30 to visit a general practitioner or the emergency department to reduce demand on medical services, a former Health Department chief has urged.
And here:

Healthcare: 'Doctor obsession' to lead to cost blowout

Date January 2, 2014

Jonathan Swan

Decisions made by Tony Abbott when he was health minister will soon cause a blowout in healthcare costs dwarfing the money saved by introducing a $6 fee for GP visits, a health workforce expert says.
And here:

The side effects of GP co-payments

Date January 1, 2014

Jennifer Doggett

We should contribute to our healthcare costs. But this is not the best way.
A co-payment for GP visits might seem like a cure for Australia's rising healthcare costs but its introduction could cause serious side effects.
And here:

Abbott urged to reinstate GP fee

TONY Abbott is facing mounting calls to whack patients with a new $5 fee for GP visits, as doctors warn any move to introduce "co-payments" risks escalating pressure on the strained public health system.
And last here:

Medicare co-payments have a lesson in their history

Date December 30, 2013

Anne Davies

The announcement of a $3.50 co-payment for people who were bulk-billed under Medicare in the August 1991 budget arguably cost prime minister Bob Hawke the Labor leadership.
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Comment: All in all what we have here is a situation where the PCEHR and Medicare Locals have / are being reviewed and broader cuts are being floated.
So as the title of the blog says - Be Alert and Alarmed. Major cuts have to be coming and for sure the PCEHR and Medicare Locals will suffer some form of hit. The only question is how big and damaging the cuts will be and where else the axe will fall!
David.

AusHealthIT Poll Number 199 – Results – 5th January, 2014.

How Much Progress Do You Think Will Be Made In E-Health In 2014?


A Very Great Deal 0% (0)

A Fair Bit 8% (3)

Not Much 30% (12)

None 23% (9)

We Will Go Backwards 40% (16)

I Have No Idea 0% (0)

Total votes: 40

90%+ think minimal to no progress in the year ahead - seems the e-Health leadership needs to lift their game.

Again, many, many thanks to those that voted!

David.

Wednesday, January 01, 2014

Saw This From A Day Or So Ago - Works For Me! HNY!

These sure are the values I like (not sure about 9 and 10 - Top 8 are great)!

What do you think?

"If I was to take a crack at an alternative ten commandments it'd go something like this:

1. Be kind (that takes care of not killing, stealing, lying, etc).
2. Be brave.
3. Be curious. Seek the truth. Question everything.
4. Don't waste.
5. Love as much as you can and never hate.
6. Respect, protect and guide - particularly the very old and young. 
7. Respect your body.
8. Respect nature.
9. Be a great shag.
10. Never wear sandals."

Would it not be great if Government actually behaved like this?

Have a great 2014!

I hope it is all you hope for.

David.

(Back to e-health next week!)

D.