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."

Thursday, February 18, 2016

The Macro View - General And Health News Relevant To E-Health And Health In General.

February 18 Edition
Clearly the big news in the last few weeks has been macroeconomic.
The crisis in the energy industry seems to be moving to the banking sector which is a very worrying trend and needs to be closely watched over the next few weeks. The European Banks are apparently in some considerable trouble according to the Economist - so there are clearly some issues.
Also, out of the blue, in Australia, we now see a continuing bun-fight on health insurance costs. Will be fun to watch.
Also out of the blue the Left Wing Think Tank the Australia Institute is on about Death Duties - after trying their luck earlier with Superannuation and Negative Gearing.
Parliament is now off until 22nd February.

Thursday Update: Mr Morrison gave a pretty uninteresting speech on the economy yesterday and the markets seem to be having a few good days - will it last?
Here is a summary of interesting things up until the end of last week:
-----

General Budget Issues.

Prime Minister Malcolm Turnbull should bring back 2014 Budget

February 8, 2016 1:00am
Rowan Dean The Courier-Mail

Turnbull remains unconvinced by GST move

MALCOLM Turnbull is a salesman looking for a good economic message to sell.
The 2014 Budget was a good economic message desperately in need of a decent salesman. Maybe it’s time they got together.
The perceived wisdom among most of the chattering classes (of both Left and Right persuasion) who adorn our TV studio chat shows and newspaper columns is that the Abbott and Hockey 2014 Budget was an economic disaster.
This is simply incorrect – it was a political disaster, which is different.
Most serious commentators now broadly agree with what I wrote in The Spectator Australia only a few days after the infamous cigars-on-the-lawn Budget night, which I was fortunate enough to attend (the dinner, not the cigar smoking).
-----
  • Feb 8 2016 at 10:13 AM
  • Updated Feb 8 2016 at 2:14 PM

Scott Morrison says 'we are having to go the long road' on tax reform

Treasurer Scott Morrison has indicated there will only be small tax cuts in the May budget because increasing the GST rate was the only opportunity to fund large deductions.
All but confirming that the GST option was dead, he said "we are having to go the long road" on tax reform.
Last week, the government starting backing away from the GST option. As the week wore on, the government started defining criteria that must be met and on Sunday, Prime Minister Malcolm Turnbull all but abandoned it, saying he was yet to be convinced that case had been made that tax cuts funded by a GST increase would drive growth. 
As well as the difficult politics involved, the government has been turned off by the size of the compensation that would need to be paid to low and middle-income earners.
-----
  • Feb 8 2016 at 7:13 PM
  • Updated Feb 9 2016 at 7:26 AM

Morrison could save $16b by restricting super contributions

Treasurer Scott Morrison could save $16 billion over four years by drastically limiting the amount of pretax earnings Australians can pump into superannuation every year.
By reducing the annual contributions limit to $15,000, the Treasurer could save more than $10 billion over the forward estimates. The $16 billion saving would require the annual contributions cap to be lowered to $11,000 from the current $30,000 that applies to most Australians, according to modelling by think tank The Grattan Institute. Restricting annual pretax contributions to $20,000 a year would result in $6 billion of savings over four years.
Under pressure to narrow the deficit and fund tax cuts, and with the GST apparently off the table, the federal government is analysing a range of savings measures ahead of the May budget. Restricting the amount that savers can inject into super would deliver a substantial resource.
-----

Deutsche Bank has a radical proposal for fixing Australia's budget problems

Paul Colgan Feb 10, 2016, 5:15 AM
There’s never been a more exciting time to be an Australian federal treasurer.
This would particularly be the case if you were to follow the advice of Deutsche Bank’s chief economist in Australia, Adam Boyton, who believes the federal government could embark on a radical path of deploying fiscal tightening – most likely through cutting spending – when the economic circumstances permit, rather than waiting for the annual budget.
It raises the prospect of the government announcing significant spending cuts – or, conversely, tax increases – in response to improved economic data, dramatically speeding up the fiscal policy cycle.
-----

Parties need money, business supplies it

Date February 9, 2016 - 9:00PM

Ross Gittins

The Sydney Morning Herald's Economics Editor

According to the Labor Party's rising star, Senator Sam Dastyari, 10 big companies control our political process. They are the four big banks, three big mining companies, the two big grocery chains and the one big telco, Telstra.
The only surprise in that list was his third miner, not the foreign-owned Glencore Xstrata – to go with the foreign-owned BHP Billiton and Rio Tinto – but the largely Australian-owned Fortescue Metals.
I doubt it's quite that simple but, on the other hand, I doubt many people would believe me if I claimed that big business had no great influence on our politicians.
-----

Treasurer Scott Morrison welcomes Greens' input on tax debate

By political reporter Matthew Doran
Federal Treasurer Scott Morrison has welcomed the input of the Greens in the nation's tax debate, after the party offered to negotiate with the Government on changes to superannuation concessions and negative gearing.
Greens MP Adam Bandt wrote to Mr Morrison on Tuesday, asking the Government to consider a "Plan B" for tax changes, based on his party's longstanding policies.
Key to "Plan B" is scaling back superannuation tax concessions for high income earners.
"If we had a progressive tax system where those who are earning more than $100,000 start paying a bit more than they are now, we could save $3 billion a year," Mr Bandt said.
-----

State governments are about to hike up taxes

Date February 11, 2016 - 12:00AM

Peter Martin

Economics Editor, The Age

Victoria, NSW, and every other Australian state have been mugged.
Here's how it happened. The Coalition came to office in 2013 promising to continue to properly fund state hospitals and schools. It left the impression the commitment had no expiry date. Then in its first budget it abandoned funding some state programs (encouraging the states to continue them "at their expense") and announced that from 2017-18 it would lift hospital and school funding only in line with population growth and inflation.
Think about that. Population growth is 1.7 per cent in Victoria and 1.4 per cent in NSW. Inflation is 1.7 per cent. Combined, they are about 3 per cent. But the costs of running hospitals are soaring. In the past decade they've jumped 7.2 per cent a year.
-----

Scott Morrison's tax change would have taken from the poor and given to the rich

Date February 12, 2016 - 7:56AM

Peter Martin

Economics Editor, The Age

GST would hit poor hardest

Treasury modelling on the GST reveals the most vulnerable could be hit the hardest Fairfax's Peter Martin explains why.
The most shocking thing in the Treasury analysis delivered to Scott Morrison on January 25 isn't the finding that a cut in income tax funded by a lift in the goods and services tax wouldn't boost the economy at all.
Morrison had asked the treasury to model a change that enriched middle and high earners at the expense of the least-well off. 
It's what Morrison asked the Treasury to model.
-----

The unexpected benefit of slugging the rich

February 11, 20162:49pm
A death tax on the rich could the way to reduce the deficit.
Charis Chang and AAP news.com.au
AS DEBATE moves away from the GST, other options are being explored to raise money, and some could have interesting impacts.
Today, the non-profit sector has called on federal Treasurer Scott Morrison to introduce a death tax, saying it could raise billions in new revenue as well as increase charitable donations.
A death tax would only be applied to estates over a certain value.
Community Council for Australia (CCA) chairman Tim Costello said it would be the fairest way to address budget repair.
The tax is estimated to raise more than $5 billion if applied to estates with a net wealth over $5 million.
-----

Malcolm Turnbull thinks small after large ambitions go bust

  • The Australian
  • February 12, 2016 12:00AM

Dennis Shanahan

The GST increases have been cleared off the table. We are waiting only for the scraps to be declared dead, buried and cremated. So too are personal income tax cuts of $30 billion, and any immediate and sizeable cut in the company tax rate.
Big-bang, once-off attempts to boost economic growth, which is the prime aim, are gone as well. Malcolm Turnbull and Scott Morrison, after months of speculation about immediate, big, growth-inducing reform based on heroic GST changes to the rate or base, have shifted ground to politically safer and economically less risky incremental change over years and years.
Politically, the Turnbull government is back where it started before the Prime Minister put the prospect of a GST rise “on the table”.
-----

Government’s ‘big-bang’ tax reform gone

  • The Australian
  • February 12, 2016 12:00AM

David Crowe

Malcolm Turnbull and Scott ­Morrison have rejected mammoth tax reform that could deliver personal income tax cuts worth $30 billion a year, in favour of “modest” change that delays relief for workers and companies, ruling that the economic gains are too small to justify the risk of a package that lifts the GST.
Mr Morrison admitted that future­ tax changes would have to be delivered “far more modestly”, as the government retreated from proposals that would have cut income­ taxes by increasing the GST from 10 to 15 per cent.
In a pivotal decision to scale back their plans, the Prime Minister and Treasurer are now focusing on spending restraint and smaller revenue measures as ways to pay for income tax relief at the coming election.
-----
  • Feb 12 2016 at 11:45 PM
  • Updated Feb 12 2016 at 11:45 PM

Labor pledges limits on negative gearing and CGT as tax wars heat up

Future property investors are in the sights of both major parties with Labor to limit negative gearing to new homes only and to halve the Capital Gains Tax discount to 25 per cent.
The policy, to be unveiled by Labor leader Bill Shorten on Saturday at the NSW state Labor conference, will give the Turnbull government political cover if it also chooses to target negative gearing now that its GST plans have collapsed.
Labor's measures will apply only to properties purchased after July 1, 2017, and are budgeted to raise $32.1 billion over 10 years and $565 million over the next four.
Following the collapse this week of plans to fund income tax cuts with a 15 per cent GST, the government, too, is now looking at changes to negative gearing, superannuation tax concessions and trading away tax deductions for lower tax rates. It is not looking at touching CGT concessions at this stage.
-----

Scott Morrison: ‘Labor’s higher taxes are not about delivering tax relief for Australians’

February 14, 2016 12:00am
SCOTT MORRISON Federal Treasurer The Sunday Telegraph
LIKE their famous mining tax, Labor’s proposed change to negative gearing promises big, but raises very little revenue. It could also have some very nasty consequences for everyday mum and dad investors just trying to get ahead.
If Labor want to strengthen the budget they need to support savings rather than just keep pushing for higher taxes.
In our midyear budget update we identified billions in additional savings to strengthen the budget. This comes on top of more than $80 billion in savings already put forward by the government.
-----

Health Budget Issues.

  • Feb 9 2016 at 9:24 AM
  • Updated 8 mins ago

Pathology Australia to launch campaign against $650m funding cut

Pathology Australia will attempt to kill $650 million in cuts for diagnostic tests such as blood tests and X-rays with a consumer campaign to run in 5000 pathology collection centres across the nation.
The pathologists' lobby group, which represents big corporates such as Sonic Healthcare, said on Tuesday that it was "about to launch a consumer campaign" opposing cuts to the bulk-billing incentive for diagnostic imaging and pathology announced by Treasurer Scott Morrison in the Mid-Year Economic and Fiscal Outlook.
"We don't want people facing situations where they are unable to get their pap smears and their life-savings blood test," said Pathology Australia chief executive Liesel Wett.
-----

Premier Jay Weatherill says government could still close hospitals if health funding gap cannot be filled

February 8, 2016 9:53pm
LAUREN NOVAKPOLITICAL REPORTER The Advertiser
MORE hospitals could be closed and state taxes increased unless South Australia secures additional revenue to fund the health system, Premier Jay Weatherill has warned.
Mr Weatherill made the claim as federal Treasurer Scott Morrison on Tuesday said the federal Government would never have used revenue from a higher GST to boost funding for the states.
The Premier said it was “absolutely” still an option to consider closing more hospitals if a health funding solution could not be found.
He has conceded that an increase to the GST rate is looking increasingly unlikely but he has refused to resort to increasing state taxes.
-----

‘Enough is enough’: Pathology Australia puts government on notice

  • The Australian
  • February 9, 2016 11:16AM

Sarah-Jane Tasker

Pathology Australia has told the federal government “enough is enough” as it kicks off an election year with a country-wide campaign to inform consumers about proposed cuts.
The industry body has used its pre-budget submission to warn that patients could miss out on lifesaving blood tests and pap smears if the proposed $650 million cuts to pathology and diagnostic imagining are not reversed.
Health Minister Sussan Ley had outlined late last year cuts to bulk-billing subsidies for pathology and diagnostic imaging services.
-----
10 Feb 2016 - 10:22am

We're not privatising Medicare: Ley

Health Minister Sussan Ley says outsourcing Medicare payments means less money spent on backroom bureaucracy and more for patients.
Source: AAP
10 Feb 2016 - 7:10 AM  UPDATED 42 MINS AGO
Health Minister Sussan Ley insists the federal government has no plans to privatise Medicare even though it's looking at outsourcing the payment of benefits.
"We need to move it on, and we need to make it work for everyone," she told ABC radio on Wednesday of a payment system that was designed in 1984.
Ms Ley said she wanted less money spent on backroom bureaucracy and more dollars for the frontline and patients.
"We're not privatising Medicare."
-----

More fed health cuts to hit Victoria

February 11, 20169:01am
AAP
More fed health cuts to hit Victoria
Victoria will lose another $73 million in federal health funding after an accounting change.
Health Minister Jill Hennessy says a change in how the National Health Funding Pool is calculated and allocated will leave the state worse off.
-----

Trimming the fat: how we could save billions in the health system

Date February 12, 2016 - 11:45PM

Jessica Irvine

Australia's health care system is captured by providers and their lobby groups.
Cervixes are the surprise new battleground in the fight to curb rising health costs.
Just before Christmas, the federal government unveiled a plan to save public coffers $650 million a year by scrapping a bulk-billing incentive for pathologists and diagnostic service providers.
They just close ranks, because if one part of the system's fiscal rorts gets addressed, God knows where it will end. 
Jeremy Sammut, Centre for Independent Studies
The incentive paid providers between $1.40 and $3.40 a service and had done little to achieve its stated aim of boosting bulk-billing rates.
-----

States bypass efficiency to prop up ailing public hospital systems

  • The Australian
  • February 13, 2016 12:00AM

Sean Parnell

Services in some public hospitals cost twice as much as the same services elsewhere
Inefficient public hospitals are being propped up by state and territo­ry governments, despite chan­g­es to the underlying funding formula intended to significantly slow growth in health spending.
As the states lose hope of a GST increase, having ­already lost $50 billion in future hospital funding in the federal ­Coalition’s first budget, there are questions over their commitment to make best use of existing resources.
In its original form, the formula known as activity-based funding was expected to save between $500 million and $1.3bn each year. But new data suggests its benefits have yet to be fully realised as some states, and many hospitals, remain grossly inefficient.
-----

What will it take to have a healthy Budget 2016-17?

Editor: Marie McInerney Author: Marie McInerney on: February 11, 2016In: Elections and budgets, Federal Budget 2016-17, public health
How will Health fare in the May Federal Budget this year after some pretty disastrous outings in the past two years?
The signs are not good, with continued focus by Ministers on cutting “spending” rather than seeing health as an investment and news that the government is (once again) considering the possibility of privatising the payment services associated with Medicare – see the Minister’s statement. (What DID happen to those expressions of interest?)
The deadline for submissions to the 2016-17 Federal Budget closed last Friday. Treasury doesn’t publish them, but this post compiles links to submissions from key players in the public health space. Croakey will add to these if organisations can provide them in the coming weeks.
-----

Health Insurance Issues.

HBF caves to lower health insurance rise

Andrew Tillett, Canberra
February 11, 2016, 12:55 am
HBF has become the first major health fund to publicly opt to reduce its planned insurance premium rise after the Federal Government blocked insurers’ initial requests for increases.
WA’s dominant fund will ask for a lower increase than the 5.96 per cent rise members were slugged last year, saying the Government’s pledge to overhaul pricing for prostheses will ease pressure on its bottom line.
HBF had been critical of Health Minister Sussan Ley’s decision to order every fund to resubmit their applications for an annual premium rise, warning it could see members hit with higher out-of-pocket costs.
-----

HBF scales back plea on health insurance premium hike

  • The Australian
  • February 11, 2016 12:00AM

Sarah-Jane Tasker

Private health insurer HBF has applied for a lower premium ­increase for 2016 in response to federal Health Minister Sussan Ley’s promise of major reform to the Prostheses List.
HBF is the first fund to publicly announce it has lowered its figure for this year’s premium increase. It follows Ms Ley’s directive that insurers review their 2016 submissions. The not-for-profit fund cannot disclose the increase it has applied for but it said it was lower than the previous year and lower than its original application for 2016. HBF’s increase last year was 5.96 per cent, while the industry average was 6.18 per cent.
Rob Bransby, managing director of HBF, said the insurer had ­reviewed its original increase ­application in the wake of the minister’s promise to curb the cost insurers pay for prostheses.
-----

Health Minister Sussan Ley warns families are on the brink of abandoning private health

February 13, 2016 12:30am
John Rolfe Cost of Living Editor News Corp Australia Network
SECRET findings from Federal Government research reveal a quarter of households are thinking about dumping their health cover, fed up with being ripped off.
A survey of more than 40,000 consumers commissioned by Health Minister Sussan Ley shows 70 per cent of people contemplating some sort of action to cut the soaring cost of private insurance.
News Corp Australia has seen results from a draft report on the survey which show 39 per cent of respondents saying they had considered leaving their fund, while 25 per cent were looking to drop their cover entirely. More than two-thirds of respondents said they didn’t believe health insurance offered value for money anymore.
-----

Health premiums could be cheaper if the Australian government changes costs of medical devices

February 14, 2016 12:00am
Sue Dunlevy National health writer News Corp Australia Network
EXCLUSIVE
HEALTH fund premium rises could be more than halved saving members $150 from next year if the government changes the way it prices medical devices like hip and knee replacements.
Health insurers have calculated Australians using private hospitals are paying $900 million a year too much for medical devices under an outdated government pricing system.
News Corp Australia revealed last year private hospitals have to charge health funds the government set price for medical devices even though they can buy them for more than 30 per cent less.
-----

Pharmacy.

Many pharmacies not choosing to discount $1: Quilty

While the second half of 2015 was positive for pharmacies, 2016 will be challenging with the further PBS reforms reducing wholesaler and generic trading terms, says Guild executive director David Quilty.

Quilty writes in this week’s edition of Forefront that pharmacies need to prepare for these further reforms, which include price reductions for combination medicines, the 5% price cut on brand medicines; and the exclusion of the originator from price disclosure calculations.
“Members should make use of the 6CPA Forecaster and the Guild is also committed to updating Script Map for the 6CPA,” he says.
“Two significant changes took effect on 1 January, namely the commencement of the optional co-payment discount up to $1 and the de-listing of certain medicines from the PBS that are available over-the-counter.”
-----
Health is also clearly still under review as far as its budget is concerned with still a few reviews underway and some changes in key strategic directions. Lots to keep up with here with all the various pre-budget kites being flown! Enjoy.
David.

Wednesday, February 17, 2016

This Could Be One Of The Biggest Health Related IT Projects Ever In OZ!

This appeared late last week:

Medicare outsourcing skunkworks explodes into confusion

By Julian Bajkowski on February 11, 2016 in Federal, Health & Social Services, ICT, Jobs, Law
A revived Coalition plan to outsource archaic in-house payments processing technology at Medicare – and potentially claims processing too – has exploded during heated Senate Estimates hearings after the Department of Health admitted it has been working on a stealth payments outsourcing project now in the market.
Both the Health Department and its Minister Sussan Ley this week confirmed the active scoping of a new, commercially provided payments facility for Medicare, a move that had initially been put to the market in 2014 but then appeared to stall.
Specifics surrounding exactly what kind of payments service or outsourced infrastructure Health is shopping for remain somewhat unclear; but what is now known is that a Request for Quotation was quietly issued to eight consultancies including KPMG, Boston Consulting Group, PWC, Ernst & Young and McKinsey.
The quotes are due on Friday 12th February and a decision is expected by the end of the same month.
It is understood that a number of respondents to the initial EoI have been taken by surprise by the revelations of a restricted approach to market as they are still waiting on a response or feedback from the government.
The use of a ‘Request for Quotation’ mechanism also suggests that the government has settled on at least a basic set of technical specifications rather than the more open-ended EoI process.
Concurrently, Health has now created a so-called digital payments taskforce headed by John Cahill, who took the reins in January and has been allocated $5 million and around 20 departmental staff to get the ball rolling.
The raw political sensitivity surrounding the nascent project being linked to the idea of privatising Medicare is acute. Health Minister Sussan Ley on Tuesday raced out a statement declaring that the Turnbull government “remains committed to Medicare” and was only “investigating ways to digitise its transaction technology for payments to a more consumer-friendly and faster format”.
There is understood to be considerable anger within parts of the Coalition over how the issue has been handled by Health, with one adviser saying it was not the first time a health minister had been “thrown under a bus” and that the Opposition had been handed a gift.
Labor has immediately seized on the revelations as proof the Turnbull government is secretly plotting to privatise the universal public health scheme.
The thrust of the Opposition’s attack centres on why Health has been keeping its digital payments efforts under wraps, going so far as to keep its approach to market out of the normally open publication stream of the Department of Finance’s AusTender system – which would have alerted potentially interested parties to the business opportunity – along with Labor and the unions.
Lots more here:
There has been a lot of coverage on all this. Here are 2 examples:

Govt eyes massive Medicare, health privatisation

EXCLUSIVE Andrew Probyn Federal Politics Editor
February 9, 2016, 1:20 am
Medicare, pharmaceutical and aged-care benefits would be delivered by the private sector under an extraordinary transformation of health services being secretly considered by the Federal Government.
The West Australian has learnt that planning for the ambitious but politically risky outsourcing of government payments is well-advanced, with a view to making it a key feature of Treasurer Scott Morrison’s first Budget in May.
To be put to the market a few weeks later, the $50 billion-plus outsourcing would be the first time the private sector has delivered a national service subsidised by the government.
It would replace back-office operations done by bureaucrats.
They would administer claims and payments while overseeing eligibility criteria, meaning they would require access to people’s sensitive private information.
Doctors would also have to open their books to the provider, , which would be subject to regulatory oversight.
More here:
and here:

Massive health services shake-up: report

February 9, 2016
AAP
Federal Labor has taken the government to task over reports Medicare, pharmaceutical and aged-care benefits could be delivered by the private sector.
The $50 billion-plus outsourcing would be the first time the private sector has delivered a national service subsidised by the government, The West Australian reported on Tuesday.
"When the Liberals start dabbling with Medicare it means the cost of medicine gets more expensive for sick people," Opposition Leader Bill Shorten told reporters in Canberra.
The West Australian says planning is well advanced, with a view to making it a key feature of Treasurer Scott Morrison's first Budget in May.
The plan involves replacing back-office operations done by bureaucrats.
The private sector would administer claims and payments while overseeing eligibility criteria.
Australia Post, eftpos providers, Telstra and the big banks are showing interest, given they have online payment and supply structures.
Opposition human services spokesman Doug Cameron fears the private health information of Australians could be kept by multinational companies overseas without the required security.
More here:
Obviously there is a long way to go on this but, given the billions of dollars processed through these systems it is going to be crucial to get the systems right and to continue with the levels of security, privacy and efficiency we have all become used to with the PBS and MBS.
This will be a project, if it happens, to keep a very close eye on. Given the huge costs that the Commonwealth incurred with the PCEHR for not very much value for money will be a really important issue!
The risks with all this are huge and should not be underestimated!
David.

Tuesday, February 16, 2016

Here Is What Can Happen When You Allow Your Personal Information To Be Held On Government Databases.

This appeared last week:

Nurse allegedly assaulted after watchdog employee used database to find her

Exclusive: Breach at Australia’s health practitioner regulator reveals flaws in handling of personal data and ‘shakes confidence’ in medical complaints system
Medical professionals are raising concerns after a series of data breaches at the Australian Health Practitioner Regulation Agency. Photograph: Andres Rodriguez/Alamy
A nurse was allegedly assaulted by an employee of Australia’s health practitioner regulator, who used his credentials to access the agency’s database and track down her home address and phone number.
The security breach is one of several Guardian Australia has uncovered at the Australian Health Practitioner Regulation Agency (Ahpra), the body responsible for protecting the public by investigating complaints against healthcare practitioners.
The investigation has uncovered serious flaws that could be placing medical practitioners at risk of further assaults, fraud and unauthorised access to their personal data. The agency is set to face scrutiny from a Senate inquiry into medical complaints handling initiated by the independent senators Nick Xenophon and John Madigan.
Xenophon told Guardian Australia the allegations were “extraordinary” and called on Ahpra to provide a full explanation.
“This calls into question the very foundation of our medical complaint system in this country,” he said. “These allegations have shaken my confidence in Ahpra. If this has happened what else is going wrong that compromises our system of medical complaints? Ahpra has a very heavy obligation to make a full and prompt response to these most serious allegations.”
The Ahpra employee allegedly accessed the nurse’s personal records in September 2015 in order to track her down over a personal matter.
Ahpra, which regulates 14 health professions, including doctors and nurses, became aware of the alleged assault and the unauthorised access of its database only when the nurse lodged a complaint with the organisation. The nurse contacted New South Wales police following her assault, and the employee was suspended by Ahpra.
In a separate incident, an Ahpra employee who was also a midwife used her access to medical records to look up details of a complaint that had been made against her in July 2014. The complainant had separately launched civil proceedings against the woman in Victoria.
The Ahpra employee then used the information as evidence in her own civil court case. It is not known whether the incident was ever disclosed to the woman who made the complaint.
The incidents are just two of a number of serious data breaches that have occurred within the organisation, but have never before been disclosed.
Lots more here:
There is nothing to be said about all this other than to suggest that everyone thinks very carefully before making personal information available for storage in any (private or public) database unless you have no choice.
A pretty bad look.
David.

Monday, February 15, 2016

Weekly Australian Health IT Links – 15th February, 2016.

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

An interesting week with the biggie probably being plans to privatise the operations of the Medicare Payments System. This will be a huge and very risky project to say the least.
-----

Evidence-based health informatics

February 11, 2016

Have we reached peak e-health yet?

Anyone who works in the e-health space lives in two contradictory universes.
The first universe is that of our exciting digital health future. This shiny gadget-laden paradise sees technology in harmony with the health system, which has become adaptive, personal, and effective. Diseases tumble under the onslaught of big data and miracle smart watches. Government, industry, clinicians and people off the street hold hands around the bonfire of innovation. Teeth are unfeasibly white wherever you look.
The second universe is Dickensian. It is the doomy world in which clinicians hide in shadows, forced to use clearly dysfunctional IT systems. Electronic health records take forever to use, and don’t fit clinical work practice. Health providers hide behind burning barricades when the clinicians revolt. Government bureaucrats in crisp suits dissemble in velvet-lined rooms, softly explaining the latest cost overrun, delay, or security breach. Our personal health files get passed by street urchins hand-to-hand on dirty thumbnail drives, until they end up in the clutches of Fagin like characters.
Both of these universes are real. We live in them every day. One is all upside, the other mostly down. We will have reached peak e-health the day that the downside exceeds the upside and stays there. Depending on who you are and what you read, for many clinicians, we have arrived at that point.
-----

Govt eyes massive Medicare, health privatisation

EXCLUSIVE Andrew Probyn Federal Politics Editor
February 9, 2016, 1:20 am
Medicare, pharmaceutical and aged-care benefits would be delivered by the private sector under an extraordinary transformation of health services being secretly considered by the Federal Government.
The West Australian has learnt that planning for the ambitious but politically risky outsourcing of government payments is well-advanced, with a view to making it a key feature of Treasurer Scott Morrison’s first Budget in May.
To be put to the market a few weeks later, the $50 billion-plus outsourcing would be the first time the private sector has delivered a national service subsidised by the government.
-----

Labor questions the tech upgrade of payments system as government considers outsourcing

February 10, 20168:27pm
Malcolm Farr news.com.au
IT WAS a terrific system when put together in 1984, but the Turnbull Government believes the way it disperses billions in Medicare and other payments now should be brought firmly into the digital age.
This could cost as much as $1.5 billion, but the savings would be much greater.
And this could mean moving from what the Australian Medical Association has called “a sort of clunky exchange of cheques” to zapping money around on our mobile phones.
Most people would accept that. The problem is that the government is considering letting contracts to private companies to do this zapping.
-----

Privatising Medicare's payment system gathers political momentum

Date February 13, 2016 - 12:15AM

Jane Lee

If there was ever any doubt about whether Australians still valued universal healthcare, Labor swiftly removed it in its successful campaign against the Abbott government's plan to introduce a $7 GP co-payment in 2014.
The plan, borne of a deeply unpopular Commission of Audit, was designed to help pay for Medicare, which then-health minister Peter Dutton insisted was financially unsustainable.
Voters so detested the idea that two years, a prime minister, Treasurer and Health Minister later, current Minister Sussan Ley still finds herself required to back-pedal from the co-payment and reassure voters the Coalition has learned its lesson, frequently telling reporters the co-payment is "dead, buried and cremated."
Privatising Medicare's payment system was another, less prominent brainchild of the Commission of Audit. After the dust had settled on the dumped co-payment, former health minister Peter Dutton asked his department to put out expressions of interest in a bid to test the market for providers in late 2014. Since then, a number of companies are understood to have been hovering in wait for a contract potentially worth billions of dollars.
-----

Text messaging doubles medication adherence

5 February, 2016 
Text reminders double the odds of medication adherence among middle-aged patients with chronic diseases, report Australian researchers.
They reviewed 16 randomised controlled trials (involving 2742 patients) that used SMS reminders for chronic diseases including coronary artery disease, asthma, allergic rhinitis and epilepsy.
Five studies provided personalised messages, eight involved two-way communication, and eight sent daily reminders.
The pooled analysis shows text messaging increases the likelihood of adherence compared with usual care.
-----
InterSystems, a global leader in health information technology, today announced that Bendigo Health is implementing the InterSystems TrakCare® unified healthcare information system as the electronic medical record (EMR) and clinical information system for the new Bendigo Hospital, set to open in early 2017.  TrakCare is scheduled to go live in late 2017. The Bendigo Hospital Project is the largest regional hospital development in the state of Victoria. Its aim is to create a world class digital hospital incorporating the latest design and technology solutions with InterSystems TrakCare chosen to support effective, efficient and consistent healthcare delivery. “The project will see a transition from mainly paper-based processes and records to a paper light, digital healthcare environment, said Rob McCathie, Program Manager Electronic Medical Records/Information Services at Bendigo Health. The system also needs to be flexible and enable leverage across the Loddon Mallee region if required.” TrakCare will provide comprehensive clinical functionality, including advanced clinical decision support, for almost all of the hospitals clinical departments. InterSystems will initially integrate Bendigo Healths existing pathology, radiology, pharmacy and maternity systems with TrakCare, with pharmacy and maternity scheduled to be phased out and replaced with TrakCare. TrakCare will also integrate Bendigo Healths existing patient administration system, with an option to replace it with TrakCare.
-----

A brief guide to the health informatics research literature

February 8, 2016
Every year the body of research evidence in health informatics grows. To stay on top of that research, you need to know where to look for research findings, and what the best quality sources of it are. If you are new to informatics, or don’t have research training, then you may not know where or how to look. This page is for you.
There are a large number of journals that publish only informatics research. Many mainstream health journals will also have an occasional (and important) informatics paper in them. Rather than collecting a long list of all of these possible sources, I’d like to offer the following set of resources as a ‘core’ to start with.
(There are many other very good health informatics journals, and their omission here is not meant to imply they are not also worthwhile. We just have to start somewhere. If you have suggestions for this page I really would welcome them, and I will do my best to update the list).
-----

Inside BloodNet: Australia's real-time blood database

One national system tracks the country's critical blood stores.

By Allie Coyne
Feb 11 2016 10:07AM
Australia's National Blood Authority has created a single interface linking up information systems used in hospitals and pathology labs across the country to provide a real-time view of the nation's blood stores, which has seen it cut blood wastage by $10 million annually.
The project has been two years in the making. It surfaced from a drive to enable better management and visibility of the national blood supply and therefore reduce wastage, which is currently estimated to cost the country $30 million each year.
The authority also hoped the platform would allow the NBA and labs to better respond to emergencies - like the 2008 blood shortage that caused elective surgery in Australia to shut down for a week.
To get such a significant undertaking up and running, the authority first needed to develop a system that could handle the automated receipt and processing of real-time feeds from each laboratory's information system.
-----

How 'mind-controlled' bionic devices could help quadriplegics walk

10 February 2016
The development of “mind-controlled” bionic devices moved another step closer today with the publication of a Nature Biotechnology paper describing how a tiny, 3cm-long stent containing 12 electrodes could one day help people living with spinal cord injury to walk with the power of thought.
The device, called the “stentrode”, is inserted into the jugular vein in the neck and pushed up the vein until it reaches the brain’s motor cortex, which is responsible for muscle activity.
I’ve been part of the 39-person team developing and testing the device, and we’re now planning a clinical trial next year in Victoria.
-----

'Bionic spinal cord' trial for humans

February 9, 20163:13am
By Margaret Scheikowski AAP
'Bionic spinal cord' trial for humans
A "revolutionary" device implanted in a brain blood vessel may one day enable people with spinal cord injuries to walk again, say Melbourne researchers.
Their limbs won't be reactivated, but the person's direct thought may be able to control equipment that can move the limbs.
The device is a minimally invasive brain machine interface - a bionic implant that translates thought into action.
It consists of a stent-based electrode, stentrode, which is implanted within a blood vessel in the brain.
-----

Slow internet stymies support for rural GPs

10 February 2016
A VALUABLE web tool to help rural GPs cope with work-related stress is being held back by sluggish internet.
Nearly half of rural GPs report work-related distress, but support groups can be difficult to attend because of distance constraints.
To help bridge this gap, Australian researchers tested the effectiveness of running support sessions online.
They ran Balint groups, in which doctors meet to discuss challenging patient scenarios, for 13 GPs and eight general registrars via an online videoconferencing platform over eight fortnightly sessions.
-----

This app puts orthopaedic guidelines in a GP's hand

11 February 2016
THE American Academy of Orthopaedic Surgeons (AAOS) has developed a number of apps, and their newest provides access to the AAOS clinical practice guidelines.
The development of the Ortho­Guidelines app received funding from the Agency for Healthcare Research and Quality in the US and subsequently has been made available free for download.
The home page accesses a menu on the guidelines grouped by topic, strength of recommendation, or stage of care, as well as searched by keyword.
Although these guidelines are aimed at orthopaedic surgeons, much of the information contained on each of the topics is also of use in general practice.
-----

Artificial intelligence and the future of hospitals

February 10, 2016 | By Zack Budryk
Healthcare already has its hands full with rapid shifts in the status quo, but an even more dramatic change could be on the way: robotic doctors powered by artificial intelligence or AI.
What sounds like science fiction is already poised to take other industries by storm in the form of innovations such as self-driving cars, according to The Conversation. Patients will likely be apprehensive; after all, even advanced technology is far from foolproof. But like self-driving cars, medical robots don't have to be 100 percent reliable--they just need to be more reliable than humans, the article notes.
-----

Nurse allegedly assaulted after watchdog employee used database to find her

Exclusive: Breach at Australia’s health practitioner regulator reveals flaws in handling of personal data and ‘shakes confidence’ in medical complaints system
Medical professionals are raising concerns after a series of data breaches at the Australian Health Practitioner Regulation Agency. Photograph: Andres Rodriguez/Alamy
A nurse was allegedly assaulted by an employee of Australia’s health practitioner regulator, who used his credentials to access the agency’s database and track down her home address and phone number.
The security breach is one of several Guardian Australia has uncovered at the Australian Health Practitioner Regulation Agency (Ahpra), the body responsible for protecting the public by investigating complaints against healthcare practitioners.
-----

Biomed fund set to turn a buck

  • The Australian
  • February 8, 2016 12:00AM

Sarah-Jane Tasker

Malcolm Turnbull’s innovation push will be cemented this year with the $500 million biomedical translation to market fund set to make its first investments through a scheme designed to return a profit to the government.
Innovation and Science Australia chairman Bill Ferris will today outline the fine details of the fund at briefings in Sydney and Melbourne.
Mr Ferris said bio and medical technology would be one of the highest growth and profitable investment opportunities Australia had in the next couple of decades.
“The yellow to green light is now flickering on for professional investors to get involved,” he said.
-----

NSW govt hires consultants to help stop IT project blowouts

Follows ongoing LMBR headache.

By Juha Saarinen
Feb 8 2016 9:05AM
The NSW Baird government has hired consultants to develop a best-practice framework for handling ICT projects following the long-running fiasco of the Education LMBR overhaul.
The Australian arm of Boston Consulting Group was recently awarded the contract, which has an estimated value of $863,500 for just over three months to March 30.
It has been asked to develop a "strategic, whole-of-government framework for best practice ICT project delivery" for the NSW government.
This will provide clear guidance for ICT investments focusing on state priorities, and will improve the identification of benefits as well as the management and reporting of funded projects, the state said.
-----

Day 2: eHealth

Utilising Technology to Reduce Risk for better health

State and federal governments driven by decreases in funding, massive cost blowouts, extreme overtime, adverse media coverage, legal challenges, a push to deliver efficiency and many more issues are looking to technology to overcome the challenges of overloaded system.
Technology and the implementation of better systems is able to deliver massive cost savings.
eHealth records are expected to deliver improvements to health budgets in reducing medical errors, prescription errors, medicine conflicts, doctor shopping, and more. The benefits from these systems are not simply tied to hospital systems, but also through to local doctors, pharmacies, PBS and more.
-----

Ovum ‘encouraged’ by NBN progress

Research analyst firm Ovum says the growth in the number of  ‘premises ready for service’ from the nbn is encouraging, with figures released by NBN Co on Friday showing the number of premises has more than doubled in 2015 to 1.67 million, with growth accelerating in 2H15.
Commenting on the release of nbn's half yearly results by CEO Bill Morrow, Ovum Australia senior telecoms consultant, Craig Skinner, said, "This growth rate is encouraging, especially considering the fibre-to-the-node service has only just come on line, and the HFC based service is yet to launch commercially.”
“NBN also announced today (Friday) that it has contracted 10 network partners to build its fibre network. These build agreements with contractors are vital to the NBN keeping its network build on track.
-----
Enjoy!
David.

Sunday, February 14, 2016

Enrico Coiera Demands We Stop It Before We All Go Blind! And Proposes A Fix!

In a fantastic intervention into E-Health Prof. Enrico Coiera of Macquarie University points out that Australian (and much of Global) E-Health lacks an evidence base and is being made up as we are all unwillingly dragged along.
Here is his blog (republished with permission):

Evidence-based health informatics

February 11, 2016

Have we reached peak e-health yet?

Anyone who works in the e-health space lives in two contradictory universes.
The first universe is that of our exciting digital health future. This shiny gadget-laden paradise sees technology in harmony with the health system, which has become adaptive, personal, and effective. Diseases tumble under the onslaught of big data and miracle smart watches. Government, industry, clinicians and people off the street hold hands around the bonfire of innovation. Teeth are unfeasibly white wherever you look.
The second universe is Dickensian. It is the doomy world in which clinicians hide in shadows, forced to use clearly dysfunctional IT systems. Electronic health records take forever to use, and don’t fit clinical work practice. Health providers hide behind burning barricades when the clinicians revolt. Government bureaucrats in crisp suits dissemble in velvet-lined rooms, softly explaining the latest cost overrun, delay, or security breach. Our personal health files get passed by street urchins hand-to-hand on dirty thumbnail drives, until they end up in the clutches of Fagin like characters.
Both of these universes are real. We live in them every day. One is all upside, the other mostly down. We will have reached peak e-health the day that the downside exceeds the upside and stays there. Depending on who you are and what you read, for many clinicians, we have arrived at that point.

The laws of informatics

To understand why e-health often disappoints requires some perspective and distance. Informed observers again and again see the same pattern of large technology driven projects sucking up all the e-health oxygen and resources, and then failing to deliver. Clinicians see that the technology they can buy as a consumer is more beautiful and more useful that anything they encounter at work.
I remember a meeting I attended with Branko Cesnik. After a long presentation about a proposed new national e-health system, focusing entirely on technical standards and information architectures, Branko piped up: “Excuse me, but you’ve broken the first law of informatics”. What he meant was that the most basic premise for any clinical information system is that it exists to solve a clinical problem. If you start with the technology, and ignore the problem, you will fail.
There are many corollary informatics laws and principles. Never build a clinical system to solve a policy or administrative problem unless it is also solving a clinical problem. Technology is just one component of the socio-technical system, and building technology in isolation from that system just builds an isolated technology [3].

Breaking the laws of informatics

So, no e-health project starts in a vacuum of memory. Rarely do we need to design a system from first principles. We have many decades of experience to tell us what the right thing to do is. Many decades of what not to do sits on the shelf next to it. Next to these sits the discipline of health informatics itself. Whilst it borrows heavily from other disciplines, it has its own central reason to exist – the study of the health system, and of how to design ways of changing it for the better, supported by technology. Informatics has produced research in volume.
Yet today it would be fair to say that most people who work in the e-health space don’t know that this evidence exists, and if they know it does exist, they probably discount it. You might hear “N of 1” excuse making, which is the argument that the evidence “does not apply here because we are different” or “we will get it right where others have failed because we are smarter”. Sometimes system builders say that the only evidence that matters is their personal experience. We are engineers after all, and not scientists. What we need are tools, resources, a target and a deadline, not research.
Well, you are not different. You are building a complex intervention in a complex system, where causality is hard to understand, let alone control. While the details of your system might differ, from a complexity science perspective, each large e-health project ends up confronting the same class of nasty problem.
The results of ignoring evidence from the past are clear to see. If many of the clinical information systems I have seen were designed according to basic principles of human factors engineering, I would like to know what those principles are. If most of today’s clinical information systems are designed to minimize technology-induced harm and error, I will hold a party and retire, my life’s work done.
The basic laws of informatics exist, but they are rarely applied. Case histories are left in boxes under desks, rather than taught to practitioners. The great work of the informatics research community sits gathering digital dust in journals and conference proceedings, and does not inform much of what is built and used daily.
None of this story is new. Many other disciplines have faced identical challenges. The very name Evidence-based Medicine (EBM), for example, is a call to arms to move from anecdote and personal experience, towards research and data driven decision-making. I remember in the late ‘90s, as the EBM movement started (and it was as much a social movement as anything else), just how hard the push back was from the medical profession. The very name was an insult! EBM was devaluing the practical, rich daily experience of every doctor, who knew their patients ‘best’, and every patient was ‘different’ to those in the research trials. So, the evidence did not apply.
EBM remains a work in progress. All you need to do today is to see a map of clinical variation to understand that much of what is done remains without an evidence base to support it. Why is one kind of prosthetic hip joint used in one hospital, but a different one in another, especially given the differences in cost, hip failure and infection? Why does one developed country have high caesarian section rates when a comparable one does not? These are the result of pragmatic ‘engineering’ decisions by clinicians – to attack the solution to a clinical problem one way, and not another.  I don’t think healthcare delivery is so different to informatics in that respect.

Is it time for evidence-based health informatics?

It is time we made the praxis of informatics evidence-based.
That means we should strive to see that every decision that is made about the selection, design, implementation and use of an informatics intervention is based on rigorously collected and analyzed data. We should choose the option that is most likely to succeed based on the very best evidence we have.
For this to happen, much needs to change in the way that research is conducted and communicated, and much needs to happen in the way that informatics is practiced as well:
  • We will need to develop a rich understanding of the kinds of questions that informatics professionals ask every day;
  • Where the evidence to answer a question exists, we need robust processes to synthesize and summarize that evidence it into practitioner actionable form;
  • Where the evidence does not exist and the question is important, then it is up to researchers to conduct the research that can provide the answer.
In EBM, there is a lovely notion that we need problem oriented evidence that matters (POEM) [1] (covered in some detail in Chapter 6 of The Guide to Health Informatics). It is easy enough to imagine the questions that can be answered with informatics POEMs:
  • What is the safe limit to the number of medications I can show a clinician in a drop-down menu?
  • I want to improve medication adherence in my Type 2 Diabetic patients. Is a text message reminder the most cost-effective solution?
  • I want to reduce the time my docs spend documenting in clinic. What is the evidence that an EHR can reduce clinician documentation time?
  • How gradually should I roll out the implementation of the new EHR in my hospital?
  • What changes will I need to make to the workflow of my nursing staff if I implement this new medication management system?
EBM also emphasises that the answer to any question is never an absolute one based on the science, because the final decision is also shaped by patient preferences. A patient with cancer may choose a treatment that is less likely to cure them, because it is also less likely to have major side-effects, which is important given their other goals. The same obviously holds in evidence-based health informatics (EBHI).

The Challenges of EBHI

Making this vision come true would see some significant long term changes to the business of health informatics research and praxis:
  • Questions: Practitioners will need develop a culture of seeking evidence to answer questions, and not simply do what they have always done, or their colleagues do. They will need to be clear about their own information needs, and to be trained to ask clear and answerable questions. There will need to be a concerted partnership between practitioners and researchers to understand what an answerable question looks like. EBM has a rich taxonomy of question types and the questions in informatics will be different, emphasizing engineering, organizational, and human factors issues amongst others. There will always be questions with no answer, and that is the time experience and judgment come to the fore. Even here though, analytic tools can help informaticians explore historical data to find the best historical evidence to support choices.
  • Answers: The Cochrane Collaboration helped pioneer the development of robust processes of meta-analysis and systematic review, and the translation of these into knowledge products for clinicians. We will need to develop a new informatics knowledge translational profession that is responsible for understanding informatics questions, and finding methods to extract the most robust answers to them from the research literature and historical data. As much of this evidence does not typically come from randomised controlled trials, other methods than meta-analysis will be needed. Case libraries, which no doubt exist today, will be enhanced and shaped to support the EBHI enterprise. Because we are informaticians, we will clearly favor automated over manual ways of searching for, and summarizing, the research evidence [2]. We will also hopefully excel at developing the tools that practitioners use to frame their questions and get the answers they need. There are surely both public good and commercial drivers to support the creation of the knowledge products we need.
  • Bringing implementation science to informatics: We know that informatics interventions are complex interventions in complex systems, and that the effect of these interventions vary depending on the organisational context. So, the practice of EBHI will of necessity see answers to questions being modified because of local context. I suspect that this will mean that one of the major research challenges to emerge from embracing EBHI is to develop robust and evidence-based methods to support localization or contextualisation of knowledge. While every context is no doubt unique, we should be able to draw upon the emerging lessons of implementation science to understand how to support local variation in a way that is most likely to see successful outcomes.
  • Professionalization: Along with culture change would come changes to the way informatics professionals are accredited, and reaccredited. Continuing professional education is a foundation of the reaccreditation process, and provides a powerful opportunity for professionals to catch up with the major changes in science, and how those changes change the way they should approach their work.

Conclusion

There comes a moment when surely it is time to declare that enough is enough. There is an unspoken crisis in e-health right now. The rhetoric of innovation, renewal, modernization and digitization make us all want to believers. The long and growing list of failed large-scale e-health projects, the uncomfortable silence that hangs when good people talk about the safety risks of technology, make some think that e-health is an ill-conceived if well intentioned moment in the evolution of modern health care. This does not have to be.
To avoid peak e-health we need to not just minimize the downside of what we do by avoiding mistakes. We also have to maximize the upside, and seize the transformative opportunities technology brings.
Everything I have seen in medicine’s journey to become evidence-based tells me that this will not be at all easy to accomplish, and that it will take decades. But until we do, the same mistakes will likely be rediscovered and remade.
We have the tools to create a different universe. What is needed is evidence, will, a culture of learning, and hard work. Less Dickens and dystopia, more Star Trek and utopia.

  1. Slawson DC, Shaughnessy AF, Bennett JH. Becoming a medical information master: feeling good about not knowing everything. The Journal of Family Practice 1994;38(5):505-13
  2. Tsafnat G, Glasziou PP, Choong MK, et al. Systematic Review Automation Technologies. Systematic Reviews 2014;3(1):74
  3. Coiera E. Four rules for the reinvention of healthcare. BMJ 2004;328(7449):1197-99
Here is the link:
Regular readers will know I have been asking for evidence of value from the PCEHR for years now - and I am sure the lack of such evidence is part of what concerns Enrico, along with other similar interventions, which similarly lack evidence.
The recent poll results reported at the link below I am sure reflects the failure of DoH to actually manage Australian E-Health in an evidence based way. We can only hope the Australian Digital Health Agency is listening and will do better!
See here:
David.

AusHealthIT Poll Number 307 – Results – 14th February, 2016.

Here are the results of the poll.

Who Is Most To Blame For The PCEHR Fiasco?

NEHTA 7% (11)

DoH (e-Health Branch) 79% (122)

The Contractors 2% (3)

DoH System Operator / Secretary 5% (8)

Someone Else 4% (6)

No One (Its A Great System!) 1% (1)

I Have No Idea 2% (3)

Total votes: 154

A really decisive poll on huge voting numbers. I think blame has been accurately apportioned with over 80% blaming the Department and the Secretary.

Great turnout of votes!

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

David.