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."

Tuesday, April 02, 2024

The Scale And Severity Of The Autism Epidemic Seems To Have Gone Unnoticed By Many.

I found this article a bit of a wake-up call!

Thousand-fold increase: What is driving the rise of autism?


By Natassia Chrysanthos

March 31, 2024

In the late 1980s, when Professor Cheryl Dissanayake started researching autism, she estimated in her doctoral thesis that three or four babies out of 100,000 would be diagnosed with the condition.

“Now, I’m telling you it’s three in 100,” she says.

That thousand-fold increase isn’t because anything has changed in us, biologically. But our understanding of autism has changed. The evolution of the diagnosis is having a profound influence on Australian society, from our schools and workplaces to our popular culture and policy debates.

A massive expansion in the medical criteria means children who were diagnosed with Asperger’s syndrome in the late ′90s are considered part of the autism spectrum today. Evolutions in research mean children are identified younger, sometimes as early as 18 months. And as awareness has improved and the neurodiversity movement flourished, adults who weren’t seen in childhood have figured out they, too, are autistic.

Now, there are signs Australia has higher rates of autism than comparable countries. It’s raised thorny questions. Could the $42 billion National Disability Insurance Scheme have inflated diagnosis rates? On the other hand, rates of diagnosis for women and girls are on the rise, but remain significantly lower than for boys and men. Are true rates of autism higher than we think? And is “the autism spectrum” even a useful term, given it captures such a range of human experiences?

There aren’t definitive answers. But most people point to 2013 as the point things really shifted. In the same year that Australia started rolling out a world-first disability insurance scheme, the official diagnostic criteria for autism expanded significantly.

Ten years later, the way those two forces have converged is driving a complex debate about the NDIS – now one of the federal government’s biggest budget pressures – and how public funding should be delivered to support Australians with autism.
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Autism is a neurodevelopmental disability, which means that the brain develops differently to what we would typically expect. There is no single known cause, but researchers generally accept it’s a genetic condition that may also be influenced by someone’s environment.

But because there’s no genetic giveaway, autism is diagnosed based on behaviour. There are two core traits that autistic people display: they have difficulty with communication and social interaction, and have restricted interests or repetitive behaviours.

It’s a new condition in the scheme of things. The first paper to describe autism was written by Boston child psychiatrist Leo Kanner in 1943. He observed 11 children who were solitary, needed routine and had some language difficulty. This included the first person diagnosed with autism, Donald Triplett, who died last June. Austrian physician Hans Asperger was undertaking similar work at the same time.

But it wasn’t until 1980 that a diagnosis called “autism disorder” was added to the psychiatry bible: the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM. It was mainly children – and mainly boys – with intellectual disability and significant language impairments who were diagnosed, and they needed to have very significant difficulties to meet the threshold.

That stayed true until 1994. Researchers had realised there were some people who showed the core behaviours of autism – communication differences and repetitive interests – but did not have an intellectual or language impairment. Quite the contrary, they could be highly verbal or intelligent. And so several new diagnoses were introduced, reflecting those varying levels of ability.

There was Asperger’s syndrome for children who became hyper-fixated on certain interests and struggled to interact with others, but could also be highly intelligent. Classic autism was a diagnosis reserved for children who had more difficulty with language and communication. Childhood disintegrative disorder, or Heller’s syndrome, described those whose late onset developmental delays might have led to reversals in language, bladder control or motor skills. Children who did not meet the full criteria of those conditions were diagnosed with “pervasive developmental disorder not otherwise specified”. Australian children born in the ’90s and noughties were raised in this framework.

Then in 2013, “the spectrum” was born. The fifth and most recent edition of the DSM collapsed all those conditions under the umbrella term autism spectrum disorder, and marked the most significant change yet to how we understand autism.

Some autistic people are intellectually disabled, some are highly intelligent. One person could be non-speaking while another is highly verbal. Autism can present in hundreds of different ways, and no two people are the same. “That’s what we call the autism spectrum. We went from a unitary condition, where everyone had a similar and high level of impairment, to, actually: you can show all these behaviours. And so the numbers of children we diagnosed went from really small to large,” says Professor Andrew Whitehouse, head of the autism research team at Telethon Kids Institute.

But it’s not just children, any more. One of the fastest-growing categories of participant on the National Disability Insurance Scheme is now autistic adults. “Twenty years ago, adult diagnoses were extremely rare. Whereas in our contemporary world, adult diagnoses are almost as frequent as child diagnoses,” Whitehouse says.

“When these adults were children, we had a different conception of autism: that it was only for children who had very significant difficulty, like intellectual disability. As the diagnosis of autism has evolved, all of a sudden, the difficulties that [these adults] have been experiencing are seen in a new light and that they may actually meet criteria for autism.”

Still, there are two fundamental criteria for an autism spectrum disorder diagnosis: certain social and communication difficulties, and patterns of restrictive and repetitive behaviour. The DSM also describes three layers of severity, which are determined by how much support someone requires. These are referenced as level one, two and three autism, providing a shorthand for families to describe the level of disability their child experiences.
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Most people in the autistic community, however, don’t think of autism as a linear spectrum. Some talk about the condition as a constellation. Others describe a “spiky profile” that mixes incredible strengths and gifts in some areas – such as visual thinking, deep interests, an eye for detail, strong memory – with intense struggles in others.

Dr Melanie Heyworth, an autistic researcher who founded the organisation, Reframing Autism, describes being autistic as having a busy brain, which can affect everything from movement to sensory experiences, communication, emotion and empathy. “Every autistic person’s brain is different than the next, and the way those elements interact look different for every autistic person,” she says.

“The primary differences that most autistic people would talk about are in the way that we communicate. I use spoken language as my primary form of communication, but other autistic people don’t [and are non-speaking], or they are multi-modal communicators.”

Heyworth, for example, needs to see a person’s face in order to engage with them. “I would not be able to have this conversation with you effectively over the phone,” she says. Some autistic people struggle to understand sarcasm or small talk, or find spoken language takes longer to process altogether. For that reason, they might find public speaking easier than casual conversation because it doesn’t require them to digest what they’re hearing at the same time as they’re trying to talk.

Autistic people often empathise, process their emotions, or show their feelings differently. Some find it difficult to regulate their emotions, which can be intense; others withdraw, and this is a common response spotted in children. Eye contact is often uncomfortable, and for some people it even leads to nausea or dizziness.

Sensory overload is also common. Some people might be hyper-sensitive, “where everything you touch feels like pain”, while others are overwhelmed by bright lights. “That’s the reason you get the stereotype of the child in school with the big ear muffs. Or you get me rocking back-and-forth at the moment,” Heyworth says. Some of those repetitive movements, such as body-rocking and hand flapping, are known as “stimming”, and can help autistic people regulate their emotions or cope with anxiety.

Many autistic people “mask”, which means they try to hide their unique behaviours, perhaps because they were bullied at school. “Those things impact mental health and it’s exhausting, they experience burnout,” Dissanayake says. Studies suggest masking is more common in girls, which is why autism in females is identified less frequently.

Children are usually diagnosed with autism following a multidisciplinary assessment, where clinicians from different professions – such as paediatricians, speech pathologists, clinical psychologists – watch them in a range of settings to understand whether they show signs of autism. Dissanayake says the point of treatment is to help children develop ways to communicate and learn from people around them.

“We’re not focused on making the child less autistic. What we want to do is improve their cognition. If they don’t develop an ability to communicate, it lessens their ability to learn, and they end up with a learning disability.”

These days, more autistic children in Australia are getting the help they need much earlier in their lives.

But as more families receive that support by signing up to the NDIS, which offers automatic entry with a level two autism diagnosis, there have been uneasy questions about whether Australian children are being steered towards a clinical diagnosis for funding in an otherwise expensive and hard-to-access system. More than 9 per cent of five- to seven-year-old children are now on the scheme, mostly for autism or developmental delays.

A research paper published last year, by Australian National University scholar Maathu Ranjan, lit a fuse under that debate.

Ranjan, who is on study leave from her role as a senior actuary at the National Disability Insurance Agency, looked at dozens of studies estimating autism prevalence around the world. While diagnosis rates have gone up everywhere over the past 20 years, she found the Australian growth rate for children was higher than in similar countries.

Her paper, which is not peer-reviewed, quoted international studies that showed autism prevalence rates of one in 36 children in the United States, one in 50 in Canada, and one in 57 in the United Kingdom. In Australia, it was up to one in 25.

She said there was “considerable controversy” around the drivers of rising autism rates worldwide. But in Australia, she pointed to the NDIS. “It is plausible that the growth of prevalence rates above the global average in Australia can be attributed to the financial incentives created by government policy, specifically the implementation of the NDIS.”

Whitehouse agrees that the NDIS has led to more kids being diagnosed and distorted our understanding of true prevalence rates in Australia. “I think it’s without question that the use of an autism diagnosis level two shifted the focus, and the centre of gravity, towards that diagnosis. Clinicians, we all want the best for the kids that we are seeing. And if there are children who require support, there is a focus towards how can we get them that support.”

He says the levels of severity outlined in the DSM were intended for doctors to use, not for policymakers to allocate disability funding. But while the NDIS was rolling out quickly, it was an effective way of identifying people who needed significant support and signing them up to the scheme.

…..

This is part one of three in a series about how our understanding of autism has changed and what it means for Australia.

More here:

https://www.smh.com.au/politics/federal/thousand-fold-increase-what-is-driving-the-rise-of-autism-20240221-p5f6sa.html

I have to say I found this a useful review of the present state of play. Well worth a browse!

David.

Sunday, March 31, 2024

There Seems To Be Increasing Confidence AI Will Make A Positive Difference In Healthcare!

This appeared last week
AIs will make health care safer and better

It may even get cheaper, too, says Natasha Loder

Mar 27th 2024

When people set goals which are sky-high to the point of silliness, the sensible scoff. They are normally right to do so. Sometimes, though, it is worth entertaining the possibility that even the most startling aspiration might be achievable.

In 2015 Priscilla Chan, a paediatrician, and her husband Mark Zuckerberg, a founder of Facebook, set up the Chan Zuckerberg Initiative (CZI) with the aim of helping science bring about a world in which all disease could be prevented, cured or managed. Unsurprisingly there was a tech-centric feeling to the undertaking. But it was not until 2020 that the Chan-Zuckerberg’s annual updates started to talk about the potential of artificial intelligence (AI). Four years later it is hard to imagine anyone pursuing their goals not putting it front and centre.

The proportion of biomedical research papers which invoke artificial intelligence was climbing exponentially well before the field started dazzling the world with “foundation models” like OpenAI’s various GPTs (generative pre-trained transformers), Meta’s Llama and Gemini from Google (see chart). Given the vast amounts of data that biomedical research produces, AI’s early application there is hardly a surprise. That past progress and promise, though, is a mere prelude to what is now under way.

Artificial-intelligence systems of similar power to the foundation models and large language models that generate cogent text in all manner of styles, answer complex questions quite convincingly and helpfully, and create images that capture the ideas expressed in verbal prompts are becoming a part of health care. They have applications for almost every part of it. They can improve the choices researchers make about how exactly to edit genes; they are phenomenally good at making sense of big data from disparate sources; they can suggest new targets for drug development and help invent molecules large and small that might work as drugs against them. The CZI itself is now working on building an AI-powered “virtual cell” with which it hopes to revolutionise all manner of biomedical research.

The effects are not restricted to the lab. Various sorts of diagnosis in which AI is playing a role look ready to be transformed. Robot surgeons are taking on an expanding range of operations. The way that patients access health information and motivate themselves to follow treatment regimes looks ripe for reimagining as chatbots and wearable health monitors learn to work together. The productivity of health-care systems seems likely to be improved significantly.

Poorer countries may have the most to gain. An earlier generation of AI is already making itself felt in health care there. One advantage is that it can make quite modest equipment much more capable, allowing it to be used more widely and beyond the clinic. Smart stethoscopes can help users pick out salient details, phones can be turned into “tricorders” that measure heart rate, temperature, respiration and blood oxygen saturation all at once. Delivering reliable guidance for health-care workers over the world in their native language offers an advance both straightforward and game changing.

If such tools can become widespread, and if health-care systems are reshaped to get the most out of them, they should make it possible to deliver much better care. That represents an opportunity to improve the lives of hundreds of millions, even billions.

Some see not just a humanitarian breakthrough, but an epistemological one: a whole new sort of knowledge. Artificial intelligence can find associations and connections in bodies of disparate data too vast and knotted for humans to unpick without needing pre-existing models of what sorts of cause have what sorts of effect. Demis Hassabis, one of the founders of DeepMind, an AI powerhouse that is now part of Google, thinks that ability will change the way humans understand life itself.

Of the 1,500 vendors in health AI, over half were founded in the past seven years

There are caveats. The foundation models that power “generative” applications like ChatGPT have some serious drawbacks. Whether you call it hallucinating, as researchers used to, or confabulating, as they now prefer to, they make stuff up. As with most AI, if you train them on poor or patchy data the results will not be all they should be. If the data are biased, as health data frequently are (good data on minorities, low-income groups and marginalised populations is often harder to come by) the results will not serve the population as a whole as well as they should and may do harm in the underrepresented groups. The models’ “non-deterministic” nature (they will not always respond in the same way to the same stimulus) raises philosophical and practical problems for those who regulate medical devices. Blood-pressure cuffs and thermometers reflect reality more straightforwardly.

None of this is stopping the market for products and services in health-care AI from growing apace. Big AI companies have been keen on buying health-care specialists; health-care companies are buying AI. Research and Markets, a firm of analysts, estimates that in 2023 the health-care world spent about $13bn on AI-related hardware (such as specialised processing chips and devices that include them) and software providing diagnostics, image analysis, remote monitoring of patients and more. It sees that number reaching $47bn by 2028. Analysts at CB Insights reckon investors transferred a whopping $31.5bn in equity funding into health-care-related AI between 2019 and 2022. Of the 1,500 vendors in health AI over half were founded in the past seven years.

The digitisation of health care has seen its fair share of expensive disappointments. But there is a real possibility that AI will live up to some of the hope being placed in it. Simpler and more forgiving interfaces should make AI-based systems for handling data and helping with time-management more congenial to doctors, patients and health-care providers than those of yore. And health-care systems sorely need a productivity boost if they are to adapt and improve in a world of high costs and older populations. The shortage of health-care workers is predicted to reach nearly 10m by 2030—about 15% of today’s entire global health workforce. Artificial intelligence will not solve that problem on its own. But it may help.

More here:

https://www.economist.com/technology-quarterly/2024/03/27/ais-will-make-health-care-safer-and-better

A typically worthwhile overview from the Economist!

It seems fair to suggest that there is a lot of progress happening and that we are coning to see healthcare delivery incrementally improved and re-molded over time. There seems to be increasing little that is not possible and that the transformations over the next decade or two will be even more amazing that what we have seen to date.

These days it is getting much harder to distinguish our smartphones from a "tricorder"!

I have to say I just watch in awe as the previously impossible becomes the norm. We do indeed live in “interesting times”!

David.

AusHealthIT Poll Number 740 – Results – 31 March, 2024.

Here are the results of the recent poll.

Is Australia Doing Enough To Manage The Rising Epidemic Of Obesity?

Yes                                                                             9 (23%)

No                                                                             30 (77%)

I Have No Idea                                                           0 (0%)

Total No. Of Votes: 39

People seem to think that all of us are falling a bit short of useful ideas on how to best manage our rising obesity epidemic!

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

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

0 of 39 who answered the poll admitted to not being sure about the answer to the question!

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

David.

Friday, March 29, 2024

I Think This Is An Expert We Should Take A Little Notice Of

This appeared last week:

20 March 2024

The Emperor’s new clothes and digital mental health policy

By Associate Professor Louise Stone

Digital mental health services are not the “solutions” they claim to be. They lack data, GPs find them useful in only a few patients, and most patients don’t want them.


Hans Christian Anderson’s The Emperor’s New Clothes is a fairytale about two conmen who pretended to be weavers. They convinced the Emperor they have a magical fabric with which they could make him the finest suit in all the land. Only intelligent and brave people can see the fabric, they say, and anyone who can’t see it is stupid and incompetent.  

The Emperor is vain, and this is the crux of the con. He loves fine clothes, and he sees himself as intelligent. Like everyone else, he pretends to see the cloth the conmen pretend to weave, as he doesn’t want to be known as stupid and incompetent. Eventually, he wears the imaginary “clothing” the conmen create in a parade but the spectators fear looking stupid or incompetent, so they all comment on how magnificent he looks. 

Finally, a child yells out “the Emperor isn’t wearing any clothes” giving everyone permission to admit the Emperor is naked. The Emperor, of course, is forced to confront his own stupidity and ignorance.  

Speaking out when the emperor is naked: the problem of digital mental health 

The magic fabric in our world is evidence. Or the lack of it.  

One of the main problems we have in healthcare today is the lies we tell ourselves, as well as the lies that are told by others, so I thought I would take a moment to take a piece of what I believe to be poor policy and be the little kid in the crowd pointing out that the Emperor is not wearing any clothes.  

In this story, let’s look at the National Digital Mental Health Framework, which is not wearing much data.  

Data stories are usually made of three things: data, a narrative and good imagery. Over time, I’ve watched data stories rely on less and less data. Sometimes, like this policy, they make a token attempt at data, a little like putting a sticker on lollies and calling them “all natural” or labelling a sugar-dense food as “lite”.  

Without data, the framework tries to engage us without explaining why. 

The data story 

The National Digital Health Framework tries to tell us that:  

“Digital Health has the potential to help people overcome healthcare challenges such as equitable access, chronic disease management and prevention and the increasing costs of healthcare. By enhancing the use of digital technologies and data, it enables informed decision-making, providing people better access to their health information when and where they need it, improved quality of care, and personalised health outcomes.” 

Governments would love this to be true. More public services are moving to digital means of access. And yet it seems the digital divide is a new social determinant of health. The poorer you are, the less access you have to digital goods, and as more and more services are now delivered online, the greater your disadvantage becomes.  

Digital mental health services give the illusion of universal access, but let’s look at how they are used in practice.  

The first thing to say is that they are used rarely. Despite the massive investment in digital tools, the people are “voting with their feet” and avoiding them. Here’s the data from the National Study of Mental Health and Wellbeing, 2020-2022.  

Proportion of people aged 16-85 years with a history of mental health disorders (with and without symptoms) accessing digital technologies.  

In most environments, this would be interpreted as consumers making a choice. In this environment, it is cast as a problem of GP motivation. GPs, apparently, are the problem, because we don’t know how to use digital mental health tools, or we don’t know they exist. Apparently, this means we need nudging to overcome our “reluctance”.  

The digital health strategy tells us we need to be nudged to overcome our “reluctance”.  

“Investments into research, education and awareness promotion, evidence translation, resources and tools contribute to building trust in the efficacy and effectiveness of digital mental health services for stakeholders.” 

So maybe GPs just need to become familiar with the evidence and stop “stalling digital mental health”. The scoping review prior to the release of the National Digital Mental Health Framework has an explicit reference to this:  

“What are possible financial and non-financial incentives (professional standards, training, monetary incentives) to encourage health practitioners to adopt digital mental health services into ‘business as usual’?” 

In other words, make it compulsory.  

At the moment, the PHNs are required to use a common assessment tool, which despite over $34 million in investment, has no validity or reliability measures, to place people into five levels. At level one and two, digital mental health strategies are the preferred solution to their needs. If I were psychic, I would predict that when GPs are “required” to use the tool, no-one will get a level 1 or 2 classification.  

Examining the evidence in the National Digital Mental Health Strategy 

Despite the investment in digital mental health tool research, this document resorted to quoting one paper to support its claim of efficacy. The paper is by Gavin Andrews and his team, and is a meta-analysis from 2010 looking at the evidence from 1998-2009. I would have to say the world has moved on.  


To be fair, the framework also references the Australian Commission on Safety and Quality in Health Care’s (2020) National Safety and Quality Digital Mental Health Standards. This document also references one paper, a more modern one, but one with significant flaws. They use this paper to back their statement that: “There is growing evidence regarding the important role digital mental health services can play in the delivery of services to consumers, carers and families”.   

The paper, from 2016, examined the “Mindspot” online clinic. Let’s look at their evidence, or more specifically the cohort. Here’s the attrition of their convenience sample = see original article.  

So, of the people who ended up on the website (who I suspect are not representative of the broader population) 0.5% finished the study. It doesn’t matter what clever statistics are done on this tiny sample of a tiny sample. It can’t prove anything, except that 99.8% of people who visited the site left before completion.  

In any other setting, this would be considered a problem. However, the authors assert in their conclusion that “this model of service provision has considerable value as a complement to existing services, and is proving particularly important for improving access for people not using existing services”. 

This is the best paper (presumably) the Australian Commission on Safety and Quality in Health Care could find.  

The impact of digital mental health strategies on mental health policy 

The impact of this belief in digital mental health is significant. There has been substantial investment in digital health tools, including mandating the use of the Initial Assessment and Referral Tool to enable stepped care at the PHN level with digital health engagement.  

Here is the ongoing investment in digital mental health initiatives, excluding research and other grants: 

  • 2021-2022: $111.2 million to create a “world-class digital mental health service system”; 
  • 2022-2023: $77 million on digital mental health services; 

The scoping review in 2022 identified 29 digital mental health services funded by the Australian government. Here is the breakdown of budget announcements in the 2022-2023 budget. The budget for digital mental health would cover 308 fulltime GPs doing 40-minute consultations. That’s 887,000 consultations a year.  

GPs are a funny lot.  

John Snow knew the Broad Street pump in London was causing cholera, even though the reigning officials at the time did not. When governments refused to listen, John Snow worked around them, removing the pump handle himself. He was, of course, right.  

The second thing to know about John Snow was that his passionate opponent, William Farr, who was also a GP, changed his mind in the face of the evidence and supported John Snow in his quest to ensure Londoners had clean water. GPs do eventually follow the evidence. 

However, we are natural sceptics when it comes to innovation. We’ve seen “miracle” drugs come and go, and “miracle” devices like pelvic mesh cause harm. We can spot marketing and vested interests a mile away.  

The National Digital Mental Health Strategy is full of vested interests. Increasing uptake of digital mental health improves the bottom line of many digital entrepreneurs and gives the government the illusion of universal access to care, when in reality most patients miss out on therapy.  

It is our job as GPs to advocate for our patients. Digital mental health solutions may well work for some, but are also part of a trend towards “technological solutionism”, a common trend to “solving” complex problems by offering an app.  

Evidence-based medicine requires the whole triad of the best evidence, clinical opinion and patient preference. I’m going to be the small boy at the parade here and say digital mental health services are not the “solutions” they claim to be. They lack data, GPs find them useful in a small proportion of their patients, and most patients don’t want them.  

This does not make me a Luddite. It makes me an honest clinician fulfilling my ethical obligation to make clinical decisions on evaluating the efficacy of treatment for my practice population.  

In my view, the Emperor desperately needs a different tailor.  

Associate Professor Louise Stone

MBBS BA DipRACOG GDFamMed MPH MQHR MSHCT PhD FRACGP FACRRM FASPM

Associate Professor, Social Foundations of Medicine, Medical School

ANU College of Health and Medicine

E: louise.stone@anu.edu.au

More here:

https://www.medicalrepublic.com.au/the-emperors-new-clothes-and-digital-mental-health-policy/106072

Great perspective here and well worth a read!

David.

Thursday, March 28, 2024

Do You Think What Is Discussed Here Will Provide Any Real Worthwhile Outcome(s)?

This popped up a few days ago:

MEDIA STATEMENT

March 21 2024

In a significant stride towards advancing digital health leadership across the nation, the Australasian Institute of Digital Health (AIDH) and the Digital Health Cooperative Research Centre (DHCRC) proudly announce the release of the Clinical Informatics Fellowship Stakeholder Engagement Report. This pivotal document outlines the proposed framework for Australia’s Clinical Informatics Fellowship (CIF) Program, highlighting a collective commitment to develop a recognised clinical informatics fellowship pathway.

The report emphasises the critical need to establish a valued and accredited career path for clinicians and clinical informaticians, aiming to bolster the evolution of digital health leadership within Australia. This initiative stems from the collaborative efforts of the AIDH and DHCRC, who, with the support of DHCRC’s funding, embarked on a journey through 2022 and 2023 to conceive a Clinical Informatics Fellowship pathway. This endeavour involved research into international models and consultations with a diverse group of stakeholders, including healthcare leaders, educational institutions, and professional associations.

Feedback gathered over 18 months from a wide array of contributors has been instrumental in shaping the program.

The Report details the governance structure, analytical processes, stakeholder engagement, and consultation efforts, culminating in a summary of stakeholder feedback and adjustments made following these discussions. Additionally, it identifies critical areas requiring further exploration before the initiation of a pilot program for the new fellowship pathway.

Future Directions and Objectives

As we move into 2024 the AIDH and DHCRC are working collaboratively on planning the forthcoming stages of the fellowship program, including a pilot phase with a select group of candidates. This step is crucial for refining the program based on participant feedback, paving the way for its official launch to potential digital health community candidates.

Both organisations reiterate their commitment to continuous engagement with the digital health community, healthcare professionals, educational institutions, and other key stakeholders as they progress through this developmental phase.

About the Clinical Informatics Fellowship

The CIF Program is designed to recognise clinical informatics as a distinguished profession in Australia and internationally. It aims to cultivate a broad and diverse pool of skilled clinical informaticians, aligning with AIDH’s Australian Health Informatics Competency Framework (AHICF). The program will offer clinicians a path to achieve a nationally recognised Fellowship, highlighting their specialised knowledge, skills, and credentials in informatics.

Media contact: media@digitalhealth.org.au

Here is the link:

https://digitalhealth.org.au/career-building/clinical-informatics-fellowship/

Also we have the Media Statement

AIDH MEDIA STATEMENT

An engagement report informing the proposed model for a Clinical Informatics Fellowship (CIF) Program in Australia was released today, with a commitment to progress the build of a clinical informatics fellowship pathway through 2024.

The report emphasises the importance of establishing a recognised and valued professional trajectory for clinicians and clinical informaticians, fostering the growth of digital health leadership in Australia.

During 2022 and 2023, the Australasian Institute of Digital Health (AIDH) and the Digital Health Cooperative Research Centre (DHCRC) partnered on a project to build a Clinical Informatics Fellowship pathway. The project, funded by DHCRC, explored international models and engaged key stakeholders and experts in the design of a new fellowship pathway for Australia.

The Clinical Informatics Fellowship Stakeholder Engagement Report details the project’s governance, analysis undertaken, stakeholder involvement and consultation, which took place on the project during 2022 and 2023. Stakeholder input was received over 18 months from leadership of AIDH and DHCRC, clinicians, healthcare executives, universities, clinical colleges and associations.  AIDH and DHCRC would like to restate their gratitude for the comprehensive feedback that was contributed by the healthcare community.

The Report summarises stakeholder feedback, illustrating the refinements following consultation, and noting the outstanding matters to be worked through prior to commencement of a pilot of the new fellowship pathway.

“We are delighted to publish the Stakeholder Engagement Report in partnership with DHCRC and inform the broader health community on progress towards our goal of a widely recognised career pathway for emerging leaders in digital health”, said AIDH’s Interim CEO, Mark Nevin FAIDH.

Progressing Work through 2024

The DHCRC and the AIDH are discussing the next stages of the program of work to complete the build of the clinical informatics fellowship pathway and undertake a pilot. The pilot is intended to evaluate the new fellowship pathway and provide insights into further improvements. The pathway will then be officially launched to potential candidates within the digital health community.

Annette Schmiede, CEO of DHCRC said, “We are proud to collaborate with AIDH and support the progression of this ambitious program of work. A clinical informatics pathway, open to all health professions, would be a global first and support the digital transformation of our healthcare system”.

AIDH and DHCRC are committed to ongoing consultation with the digital health community, clinicians, healthcare leaders, universities, clinical colleges and other peak bodies as we advance through the next stage of development of the program.

Notes to Editors

The objectives of CIF Program are to:

  • Establish clinical informatics as an acknowledged and recognised profession in Australia, with international credibility and standing
  • Build and foster a large and diverse workforce of skilled and well-networked clinical informaticians who are included in leadership in the digital transformation of the health and social care sectors
  • Align with AIDH’s Australian Health Informatics Competency Framework (AHICF), which outlines essential domains of expertise and corresponding competencies required for proficiency in health informatics.

The Clinical Informatics Fellowship Stakeholder Engagement Report is available here
Further information about AIDH is available here
Further information about DHCRC is available here

Here is a link:

https://digitalhealth.org.au/blog/clinical-informatics-fellowship-stakeholder-engagement-report-released/

The rather sad thing about all this is the pursuit of status rather than just getting on with things and having clarity as to purpose and status come as a natural by-product!

Who knew that digital leadership needed to be "advanced"?

Come on team – show you are useful and worthwhile and you will get the recognition and status you seem to be obsessed by! I note the recognized experts from the US and the UK – and our own as well – don’t seem to need all this recognition etc. Those who matter know who they are and that is all that is needed!

David.

In passing I wonder is the plan to scrap all the present Fellows and Associate Fellows of the AIDH and start again? Might not be a bad idea? Can we also get rid of all those silly "badges" while we are at it?

See here:

https://digitalhealth.org.au/digital-badges/

What madness!

D.

Wednesday, March 27, 2024

Now It Has Become The Third Largest Company On The Planet We Need To Take Some Notice!

This appeared a few days ago:

Nvidia: what’s so good about the tech firm’s new AI superchip?

US firm hopes to lead in artificial intelligence and other sectors – and has built a model that could control humanoid robots

Alex Hern

Wed 20 Mar 2024 02.11 AEDTLast modified on Wed 20 Mar 2024 02.17 AEDT

The chipmaker Nvidia has extended its lead in artificial intelligence with the unveiling of a new “superchip”, a quantum computing service, and a new suite of tools to help develop the ultimate sci-fi dream: general purpose humanoid robotics. Here we look at what the company is doing and what it might mean.

What is Nvidia doing?

The main announcement of the company’s annual develop conference on Monday was the “Blackwell” series of AI chips, used to power the fantastically expensive datacentres that train frontier AI models such as the latest generations of GPT, Claude and Gemini.

One, the Blackwell B200, is a fairly straightforward upgrade over the company’s pre-existing H100 AI chip. Training a massive AI model, the size of GPT-4, would currently take about 8,000 H100 chips, and 15 megawatts of power, Nvidia said – enough to power about 30,000 typical British homes.

With the company’s new chips, the same training run would take just 2,000 B200s, and 4MW of power. That could lead to a reduction in electricity use by the AI industry, or it could lead to the same electricity being used to power much larger AI models in the near future.

What makes a chip ‘super’?

Alongside the B200, the company announced a second part of the Blackwell line – the GB200 “superchip”. It squeezes two B200 chips on a single board alongside the company’s Grace CPU, to build a system which, Nvidia says, offers “30x the performance” for the server farms that run, rather than train, chatbots such as Claude or ChatGPT. That system also promises to reduce energy consumption by up to 25 times, the company said.

Putting everything on the same board improves the efficiency by reducing the amount of time the chips spend communicating with each other, allowing them to devote more of their processing time to crunching the numbers that make chatbots sing – or, talk, at least.

What if I want bigger?

Nvidia, which has a market value of more than $2tn (£1.6tn), would be very happy to provide. Take the company’s GB200 NVL72: a single server rack with 72 B200 chips set up, connected by nearly two miles of cabling. That not enough? Why not look at the DGX Superpod, which combines eight of those racks into one, shipping-container-sized AI datacentre in a box. Pricing was not disclosed at the event, but it’s safe to say that if you have to ask, you can’t afford it. Even the last generation of chips came in at a hefty $100,000 or so a piece.

What about my robots?

Project GR00T – apparently named after, though not explicitly linked to, Marvel’s arboriform alien – is a new foundation model from Nvidia developed for controlling humanoid robots. A foundation model, such as GPT-4 for text or StableDiffusion for image generation, is the underlying AI model on which specific use cases can be built. They are the most expensive part of the whole sector to create, but are the engines of all further innovation, since they can be “fine-tuned” to specific use cases down the line.

Nvidia’s foundation model for robots will help them “understand natural language and emulate movements by observing human actions – quickly learning coordination, dexterity, and other skills in order to navigate, adapt, and interact with the real world”.

GR00T pairs with another piece of Nvidia tech (and another Marvel reference) in Jetson Thor, a system-on-a-chip designed specifically to be the brains of a robot. The ultimate goal is an autonomous machine that can be instructed using normal human speech to carry out general tasks, including ones it hasn’t been specifically trained for.

Quantum?

One of the few buzzy sectors that Nvidia doesn’t have its fingers in is quantum cloud computing. The technology, which remains at the cutting edge of research, has already been incorporated into offerings from Microsoft and Amazon, and now Nvidia’s getting into the game.

More here:

https://www.theguardian.com/business/2024/mar/19/nvidia-tech-ai-superchip-artificial-intelligence-humanoid-robots

There is little doubt this is a company we all have to keep a close eye on.

I fear they are seeking “global domination” of similar!!!

David.

Tuesday, March 26, 2024

Telstra Seems To Think It Is Leading The Digital Healthcare Transition.

19/03/2024

422 - Leading Digital Transformation in Healthcare: Elizabeth Koff, Telstra Health

In the wake of the digital age, the healthcare industry finds itself at the crossroads of opportunity and challenge, poised to enhance patient care and bridge gaps in the system through the power of technology. 

In this episode of Talking HealthTech, Elizabeth Koff, Managing Director of Telstra Health, shared invaluable insights into the critical focus areas and transformative potential of digital health. From safeguarding data security to leveraging AI, the conversation shed light on the pivotal role of digital health in revolutionising healthcare delivery.

The Ripple Effect of Connected Care

The vision for connected care has taken centre stage, with a strong emphasis on elevating patient and clinician experiences while steering towards improved health outcomes. There is a need for real-time information sharing among stakeholders to facilitate seamless care delivery. 

"Connected care makes for a better patient experience and a better clinician experience, ultimately leading to superior health outcomes."

The collaborative nature of healthcare highlights the critical importance of partnerships and ecosystems in fostering the connected care vision. No single provider can meet the full spectrum of connectivity, necessitating a cohesive ecosystem involving clinicians, healthcare providers, digital health solutions, and government bodies. This collaborative approach aims to bridge existing gaps in the healthcare system.

Navigating the Cybersecurity Terrain

The rising prominence of cybercrime in the digital healthcare landscape prompts a dedicated focus on safeguarding both solutions and data. This calls for a robust clinical governance framework, as seen with Telstra Health's commitment to upholding clinical safety across all aspects of digital health

The gravity of cybersecurity risks in healthcare stretches beyond mere breaches of personal information. The often-understated risks of denial of service, whereby digital solutions become ineffective, can pose clinical harm and compromise patient safety.

While acknowledging the omnipresence of cyber threats, there is an imperative to propel innovation responsibly, leveraging the transformative potential of data and AI in healthcare.

"The benefits far outweigh the risks, but we have to proceed responsibly and cautiously."

Unlocking the Potential of AI in Healthcare

The transformative power of AI in healthcare is at the forefront, with its far-reaching potential across the patient care continuum, from preventive measures and personalised medicine to clinical administrative tasks. AI's role in empowering patients to understand and manage their healthcare needs is highlighted as a pivotal advancement.

The burden of administrative tasks on clinicians forms a significant pain point within healthcare, further underscoring the potential of AI in streamlining clinical workflows. AI can be a catalyst in liberating the workforce to focus on what they do best: providing clinical care.

Digital Healthcare: Unveiling New Horizons

There is uncharted potential of digital health, and we need to continue to raise the bar on digital maturity within healthcare, echoing international benchmarks and paving the way for unparalleled advancements in healthcare connectivity.

The innate need for a patient-controlled health record resonates, reflecting a pivotal shift towards empowering consumers to engage with their health information. The dissemination of data across various healthcare settings, driven by an agnostic approach to digital solutions, is poised to strike a harmonious balance between access and security.

The era of superficial digital conversions gives way to the dawn of truly transformative digital health solutions. A future is possible where digital health forms the backbone of a connected, efficient, and patient-centred healthcare ecosystem.

Embracing Innovation: A Collaborative Voyage

The journey ahead for Telstra Health is illuminated by the focus towards platform-centric solutions, with the Telstra Health Cloud poised to harness the wealth of data and information aggregated within the business. This platform-centric approach aligns with the future outlook of connected care and transformative digital health solutions.

The landscape of healthcare is evolving at an exponential pace, fuelled by a myriad of players within the digital health arena. The promise of a healthcare landscape where platform solutions lay the groundwork for connected care initiatives is real, which will propel healthcare into uncharted territory.

Here is the link:

https://www.talkinghealthtech.com/podcast/422-leading-digital-transformation-in-healthcare-elizabeth-koff-telstra-health

I will leave it to others to assess what Ms Koff has to say and how Telstra Health fits into the Digital Health ecosystem.

Anyone with real world experience of their offerings or activities fell free to comment. I would have to say I have never really seen Telstra as a significant Digital Health player.

David.