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."

Saturday, October 08, 2016

Weekly Overseas Health IT Links – 8th October, 2016.

Note: Each link is followed by a title and few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.
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ONC issues new EHR contracting guide for providers

Sep 26, 2016 11:33am
The Office of the National Coordinator for Health IT has unveiled a new tool to help providers better understand electronic health record contracts so they can negotiate more equitable terms with vendors.
The guide is geared toward helping providers navigate the sometimes “daunting” process of selecting a new or replacement EHR. Released as part of the kickoff of National Health IT Week, the advice given focuses on the acquisition of EHRs, although it can apply to other health IT products. It is designed to help buyers better understand and communicate their requirements to potential vendors, negotiate contract terms and consider and manage risks that may arise in buying and using an EHR.
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AMA: Docs want HIT vendors to prioritize workflow, efficiency

Sep 26, 2016 11:36am
If health IT vendors want doctors to be enthusiastic about new digital tools, they must prioritize improving workflow and efficiency, according to a new survey from the American Medical Association.
Tools such as electronic health records must be easy to use, not detract from face-time with patients and improve clinical care, respondents said. The survey of 1,300 physicians asked about their motivations and requirements for integrating digital health tools in their practices, according to an announcement.
The three biggest selling points for a tool, respondents indicated, were improving work efficiency, improving diagnostic ability and increasing patient safety. Doctors said they are looking for technologies that fit within those already in place, including integrating with their current EHRs. They also want tools that provide data privacy and security, and that are covered by malpractice insurance.
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Direct messaging: Not just for meaningful use anymore

Nemours shares lessons from its success using the Direct protocol, including a look at common message types. The takeaway: this still-underused method of health data exchange has considerable potential.
September 29, 2016 01:12 PM
While Direct messaging has had a circuitous path into health information exchange, Nemours is already using the protocol to meet the 10 percent threshold for sending electronic summary care records when transitioning patients to other care settings under meaningful use.
Nemours has Direct messaging integrated with its EHR and also contracts with a separate HISP – health information services provider – which senior manager of strategic process implementation Alex Koster likened to "a telecom company for Direct messaging," during a National Health IT Week webinar on Wednesday.  
In Nemours' case, the HISP is Surescripts, but others include DataMotion MedAllies, Medicity, Orion, RelayHealth and many more.
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3 ways machine learning will transform healthcare

Sep 30, 2016 6:33am
Better algorithms, not more data, will transform healthcare in the not-too-distant future, say Harvard Medical School's Ziad Obermeyer and the University of Pennsylvania's Ezekiel Emanuel.
The authors, in an article published this week in The New England Journal of Medicine, cite the ability to consider millions of variables as the machine learning advantage over humans. For example, with dramatic advances in computational power, computers can look for anomalies at the pixel level of radiographs, they say.
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The New Data Experts Our Health-Care Professionals Need

By Drew Harris
Sep 29, 2016 6:04 pm ET
Dr. Drew Harris (@drewaharris) is director of health policy and population health at Thomas Jefferson University’s College of Population Health in Philadelphia, where he focuses on the interplay between public health, medical care and public policy.
Our nation’s health-care professionals have access to more data than at any time in history.
We are at the verge, for instance, of fully integrating the doctor’s electronic medical record into a spectrum of insightful data sources ranging from the genes to the community-level. Health-care providers will be able to fully characterize an individual’s physical condition and their behavioral, environmental and social exposures to better identify and address all the determinants of health. Even more exciting, is the ability to use this information to find new cures and treatments and to develop unique prevention strategies that work with whole communities.
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By The Numbers: Our Progress In Digitizing Health Care

September 29, 2016
Over the past seven years, the United States has seen a historic health IT transformation, moving from a primarily paper-based health system to one where virtually everyone has a digital footprint of their care because of the dramatic uptake of electronic health records (EHRs). Recent data have helped quantify just how rapidly technology has transformed clinical settings. Today, nearly all hospitals (96 percent) and nearly eight in 10 (78 percent) physicians use certified EHRs. This transformation is the result of 2009’s Health Information Technology for Economic and Clinical Health (HITECH) Act, when fewer than one in 10 hospitals and 17 percent of physicians used EHRs. This rapid uptake of technology reflects the unyielding effort by clinicians and health systems across the board who helped usher in this new era of medicine. The result of this effort is a vast amount of electronic health data now exists which simply did not seven years ago.
This transformation represents more than simply digitizing paper health records. It also puts us at a global competitive advantage and is leading to real-world impacts in the clinical setting. Systematic reviews of academic literature found that 84 percent of studies showed that certified EHRs had a positive or mixed positive effect on quality, safety, and efficiency of care. Other recent studies found that EHRs can reduce adverse events among cardiovascular, surgery, and pneumonia patients and that switching EHRs did not result in adverse safety events.
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HIT Think Why curing patient matching issues won’t be easy

Published September 28 2016, 3:14pm EDT
Unless you’re off the grid, your email box is full of newsletters and news stories focused on the patient matching conundrum. Trying to solve our country’s patient identification woes has many highly respected healthcare experts talking about this billion-dollar problem—some even going so far as to put their money where their mouth is.
Recently, the phrase “digital identity” has been tossed around whenever talk turns to solutions. Healthcare organizations and vendors alike are weighing in on how technologies being developed under this umbrella will help to solve this costly problem. Smart cards, magnetic stripe cards, bar-coded cards, biometrics (such as iris recognition or palm vein scanning) and smartphones/mobile devices are all authenticator-type technologies being developed to chip away at identification errors.
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Wachter calls for three point IT implementation plan

Laura Stevens
28 September 2016
A successful implementation strategy, a network of clinical information professionals, and interoperable systems, should be the top three things on the government’s digital to-do list, according to Robert Wachter.
The US ‘digital doctor’ gave his suggestions from Texas via Skype into the Healthcare Efficiency Through Technology show in London.
He was speaking after the publication of the results of his review of NHS IT at the Health and Care Innovation Expo in Manchester earlier this month.
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Ewan Davis: EPS – is it my fault?

Ewan reflects wonders why he keeps running out of his repeat medication, ponders the hapless state of the so called Electronic Prescribing Service, fears that both are his fault, and says lessons need to be learned if the problems afflicting EPS are not to derail further digital health efforts.
27 September, 2016
It’s probably my fault. I have been struggling with the Electronic Prescribing Service. I want to get to the point where I don’t have minus five days’ supply of one if my repeat medications and 12 months’ worth of another.
Not that EPS has caused this problem (it was ever thus) but it hasn’t solved it. Yet it should have, and I have this nagging doubt it my fault!
Twenty years ago, in Wales
I’ve tried my best. I’ve worked out when the supply of each of my medicines will run out and I’ve suggested what should go on both of my two monthly repeat scripts over the next six months.
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Big Data: Healthcare must move beyond the hype

The biggest hindrance to progress is that tools like artificial intelligence, cognitive computing and machine learning conjure images of sci-fi movies rather than real-world uses. Here’s what one Harvard Medical School expert said needs to happen next.
September 28, 2016 07:06 AM
Harvard Medical School assistant professor Leonard D’Avolio said the term Big Data needs to be clarified before healthcare providers can make significant strides with related technologies. D’Avolio and colleagues are building an organization called Cyft to deal with these issues.
The hype surrounding so-called Big Data – the computational analysis of vast data sets to uncover patterns, trends and associations – is “bi-polar.” That’s how Leonard D’Avolio, an assistant professor at Harvard Medical School, describes all the chatter around this technology.
“Either we are reading about how Big Data will cure cancer or about how it’s foolish to believe Big Data will replace doctors,” D’Avolio said. “I think the narrative should be in the middle, where we are talking about these technologies as tools that could be used to complement the work of not just clinicians but also healthcare administrators, operational leaders and others. Big Data is another set of technologies with pros and cons.”
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Tips for reading Big Data results correctly

A prominent MIT healthcare economist explains how Big Data can be misleading, and discusses methods for properly studying such information.
September 27, 2016 01:32 PM 
MIT healthcare economist Joseph Doyle spends his time measuring the returns on healthcare spending and outcomes with the goals of identifying value and waste in the $3 trillion U.S. healthcare system along with helping to create a higher-quality, more cost-effective approach to healthcare. And data drives Doyle’s empirical, evidence-based approach for answers.
One area Doyle has been studying is whether hospitals that spend more money on healthcare achieve greater outcomes. The answer is not a simple one to uncover, said Doyle, Erwin H. Schell professor of management and professor of applied economics at the MIT Sloan School of Management.
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Med ordering errors linked to CPOE use

Sep 28, 2016 3:27pm
Computerized physician order entry can reduce medical error rates, but also can also facilitate new types of errors, according to new research published in the Journal of the American Medical Informatics Association (JAMIA).
For the study--with contributors from Atrius Health, Brigham and Women’s Hospital, Columbia University Medical Center, Kaiser Permanente Northwest, Partners HealthCare, the University of Illinois at Chicago and the University of Pennsylvania--researchers reviewed all patient medication error reports from six sites participating in a Food and Drug Administration-sponsored project examining CPOE safety.
Of 2,522 reports of errors in the medication ordering phase, more than half (51.9 percent) were related to CPOE. Of these, CPOE facilitated the error in 13.1 percent and potentially could have prevented the error in 86.9 percent. Mistakes facilitated by CPOE included erroneous names in the system for drug formularies, problems entering the order leading to a workaround, outdated order sets, protocols and dictionaries, and pull down menu problems. Errors where CPOE could have prevented an error but failed to do so included inadequate clinical decision support alerts, lack of electronic communication of discontinuation of a CPOE order to the pharmacy and medication reconciliation errors.
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Google Glass is a way for docs to ‘look patients in the eye again’

Sep 29, 2016 12:13pm
It’s a long way from Marcus Welby, M.D. In fact, the device that more doctors may soon wear on their heads looks more like something out of Star Trek.
The sleek, metallic device is Google Glass, which roughly 500 doctors in 27 states now use to live-stream patient exams, according to The Washington Post. The doctors wear Google Glass, which look like high-tech eye glasses, during office visits, live-streaming the exams to virtual scribes, many of them who work in India, who look on to take detailed notes for the patient’s electronic health record.
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Data sharing key to creating a successful learning health system

Sep 29, 2016 9:51am
Sharing data to create a learning health system will require both a change in culture and new technology. However, despite the high potential for such a system, incentives often are not in line with requirements to make this happen, says Yale School of Medicine cardiologist Harlan Krumholz.
According to Krumholz, Sharon Terry of the Genetic Alliance and Joanne Waldstreicher of Johnson & Johnson--writing in a viewpoint article published online this week in the Journal of the American Medical Association--those in possession of data, including health systems, researchers and others, generally bear the costs associated with data sharing. It’s difficult, they say, to fully integrate data from various sources, to fully analyze and to apply it.
Among the strategically important aspects, then, will be ensuring patient access to their data, which may require new tools and infrastructure as well as regulatory changes,the authors write.
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Gov. Brown Signs Bill Targeting 'Doctor Shopping' For Opioids

California doctors will be required to check a database of prescription narcotics before writing scripts for addictive drugs under legislation Gov. Jerry Brown signed Tuesday that aims to address the scourge of opioid abuse. Jean Elle reports. (Published Tuesday, Sept. 27, 2016)
SACRAMENTO - California doctors will be required to check a database of prescription narcotics before writing scripts for addictive drugs under legislation Gov. Jerry Brown signed Tuesday that aims to address the scourge of opioid abuse.
The measure attempts to crack down on a practice known as "doctor-shopping," in which addicts visit multiple providers to obtain prescriptions for addictive drugs. The action by the Democratic governor comes amid an intensifying national focus on the problems that stem from prescription and illegal opiates.
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Survey: Digital Divide Between Patients, Physicians Continues

Alicia Ault
September 28, 2016
A digital divide of sorts still exists between physicians and patients in how they view the use of technology such as electronic health records (EHRs), patient portals, and smartphone apps for self-diagnosis.
That's according to a recent Medscape survey of 1423 health professionals (including 847 physicians) and 1103 patients. The biggest gap was seen with EHRs. Eighty percent of patients said EHRs make a practice more efficient, compared to just 54% of physicians. Just over 90% of doctors said they used EHRs, but 1 of every 2 said it reduced their efficiency.
Web portals were also viewed favorably by patients, with two thirds saying they improved the relationship with the doctor. More than half of patients said a portal was available for accessing their physician, and about a fifth said they always or almost always made use of the communication method.
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Cyberattacks on personal health records growing ‘exponentially’

Joe Davidson | Columnist September 28
This year marks the 20th anniversary of the Health Insurance Portability and Accountability Act, better known as HIPAA. Since it took effect, doctors’ offices, hospitals and other health-care providers have been very careful about releasing information.
Sometimes frustratingly so.
I’ve had providers refuse to send my information to me by email, because that form of communication is considered less secure than the now-ancient practice of faxing.
A new Government Accountability Office report shows that concern is warranted, now more than ever.
In 2015, 113 million electronic health records were breached, a major leap over the 12.5 million the year before. In 2009, the number was less than 135,000. The number of reported hacks and breaches affecting records of at least 500 individuals rose from none in 2009 to 56 last year, almost double from 2014.
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FDA eyes plan to lessen review burden for software updates

Published September 28 2016, 6:42am EDT
The Food and Drug Administration is getting high marks from Health IT Now, a coalition of patient, provider, and payer groups, for a potentially streamlined regulatory pathway for software products.
According to HITN, the FDA is considering a “pre-check like system” of quality controls for developers—when it comes to medical device software updates—that is modeled after the Transportation Security Administration’s expedited security screening process at airports.
Jeffrey Shuren, MD, director of the FDA’s Center for Devices and Radiological Health, discussed the concept on Monday as part of a panel at the Digital Health Technology Expo co-hosted by the FDA and the Consumer Technology Association.
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Standard interventions prove better than wearables for weight loss

Users may become overly dependent on devices to help change their health when they might do better by relying on a simple diet and exercise plan.
September 27, 2016 07:04 AM
Wearable devices, often associated with health and fitness, may not be useful tools for weight loss, according to a new study published in The Journal of the American Medical Association.  
Rather than motivating users to exercise more, the devices were actually less effective at encouraging people to lose weight than simply following a diet and exercise plan, a two-year study by the University of Pittsburgh School of Education’s Department of Health and Physical Activity found.
Users may in fact become overly dependent on the devices to help change their health, leading to a false sense of security – and they might do better by relying on a simple diet and exercise plan.
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The great digital divide: Patients and docs disagree on role of technology

Sep 28, 2016 11:53am
Patients and doctors have very different opinions on the role technology should play in healthcare.
Nearly 90 percent of patients feel entitled to access their physicians’ notes, while only 60 percent of physicians embrace such clinical information sharing. But this changes a bit, the more years a doctor has practiced medicine, according to a recent Medscape survey, which includes responses from more than 1,400 healthcare providers and nearly 850 patients.
While less than half of physicians under the age of 34 wanted patients to have access to their notes, two-thirds of physicians 45 and older supported sharing their notes with patients.
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Intermountain's Marc Probst: We're not close to solving interoperability

Sep 28, 2016 11:58am
Interoperability and reimbursement for telehealth were among several persisting healthcare IT challenges discussed by hospital CIOs and others who gathered Tuesday on Capitol Hill for an event hosted by the College of Healthcare Information Management Executives.
In talking about the former issue, Intermountain Healthcare CIO Marc Probst said that despite the fact that some progress has been made with help from the Office of the National Coordinator for Health IT, there is still a long way to go for the industry to be truly and semantically interoperable.
“We have not solved interoperability,” said Probst, who also is the current board chair for CHIME. “We’re not even close.”
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HIMSS, CHIME seek to separate health IT, health informatics, health information management occupations

Written by Akanksha Jayanthi (Twitter | Google+)  | September 26, 2016 |  Print  | Email
As the Standard Occupation Classification Policy Committee is making revisions to its classifications for 2018, it may consider distinguishing occupations related to health informatics, health information management and health information technology.
CHIME, HIMSS and 36 other organizations wrote to the SOCPC regarding their desire to separate these three job categories into their own unique codes, saying they are "concerned with the conflation" of the occupations.
Occupations are classified into codes by the Bureau of Labor Statistics for purposes of collecting, calculating and disseminating data.
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Clinical Alarm Safety Improvements are a Team Effort

Jennifer Thew, RN, September 27, 2016

The Joint Commission has called for improvements in clinical alarm safety, but nurses can't do it on their own. They need the help of device manufacturers, hospital leaders, and quality and risk management specialists.

When was the last time you responded to the sound of a car alarm? The noise may have been irritating, but it probably didn't raise enough concern to warrant a call to the police.
"When car alarms first came out, we heard those and were like, 'Hey, someone's ripping that guy's car off!'" says Michele M. Pelter, RN, PhD, assistant professor at University of California, San Francisco School of Nursing and director of the ECG monitoring research lab in the school's department of physiological nursing.
"And then we realized, well no it isn't [being stolen]. Somebody bumped it, or it's the wind, or a motorcycle went past. And so we now ignore those."
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Robots--not people--may solve healthcare’s nursing shortage

Sep 27, 2016 11:39am
Developing technologies may offer a possible solution to the nation's shortage of nurses.
Finnish think tank EVA estimates that robots could be employed to do as much as a fifth of nurses’ work. And some hospitals in other countries are already taking advantage of them.
For example, some hospitals in Japan use Terapio, a medical cart that can make rounds, deliver medications to patients and grab medical records, according to The Daily Beast. When it follows a clinician, the robot can also be used to update patient data.
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Apple Said to Expand HealthKit From Tracker to Diagnosis Tool

September 26, 2016 — 8:00 PM AEST
So far Apple Inc.’s HealthKit has mostly collected fitness data from its devices. In the future, if the company gets its way, the software will interpret that information, turning it into advice for users, doctors and others.
Scores of health-care experts hired by Apple in recent years are building improved electronic health record software that can better analyze and understand the implications of patient data, according to people familiar with the team’s plans.
The iPhone maker is also working on new apps for the Apple Watch. One helps users track sleep patterns, one of the people said. Another app gauges fitness levels by measuring the time taken for the heart rate to fall from its peak to resting level, according to one of the other people. Apple already has an app that measures heart rate, but doesn’t interpret that data.
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ONC Launches Health IT Playbook

Resource aimed at helping docs best use health IT

by Joyce Frieden
News Editor, MedPage Today

09.26.2016
WASHINGTON -- As healthcare providers work to implement electronic health records (EHR), the Office of the National Coordinator for Health Information Technology (ONC) has developed a resource aimed at helping them.
The Health IT Playbook, which the ONC is launching today, is aimed at helping solo providers, and those in small and medium-sized practices, get the most out of their health information technology, Thomas Mason, MD, ONC's chief medical officer, told MedPage Today in an exclusive interview.
Over the years, the ONC had implemented tools such as its Beacon Community Program and regional extension centers to help doctors get started with EHR and other health information technology. "We were in the process of aggregating and reviewing all of the content we'd put together ... and we thought it would be great to put this together in a way that was user-friendly and intuitive," Mason said in the phone interview, at which a public relations person was present.
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This Data Exchange Framework Sets the Bar High

Scott Mace, September 27, 2016

In Massachusetts, a service used for securely sharing data between physicians and emergency departments is being called a "game changer."

In the battle to reduce hospital admissions and readmissions, the struggle to share information remains on the front lines.
But in Massachusetts, data-sharing arrangements between physicians and emergency departments are making progress. One example is Worcester-based Reliant Medical Group, a multi-specialty group practice with more than 500 providers.
If a patient of one of Reliant's physicians arrives in an emergency department at nearby Saint Vincent Hospital or Milford Regional Medical Center, the EHR systems of those EDs will automatically generate and send a message to the physician.
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WEDI: EHR support for genomic medicine lacking

Published September 26 2016, 6:50am EDT
Genomic medicine requires high-quality data that can be readily accessed and applied in the patient care setting. Yet, despite improvements to electronic health record systems, much work remains to optimize their ability to support genomically informed care.
That’s the contention of a new white paper from the Workgroup for Electronic Data Interchange.
Written by WEDI’s Genomics Workgroup, the document asserts that for the potential of genomic medicine to be realized a computer-based infrastructure must be built to harness the power of clinical data linked with molecular data, to begin storing and utilizing genetic and genomic data from a centrally-managed resource.
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Video The advantages of telehealth

Published September 23 2016, 4:37pm EDT
Healthcare doesn’t end when patients check out of the hospital or leave their doctor’s office. In fact, some of the most important steps in the healthcare process take place in the critical days and weeks after initial care is delivered.
Telehealth is an important step forward to ensure that patients continue to stay engaged in their own healthcare by using technology to facilitate communication with their doctors and using self-service tools to gain access to vital information.
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Physicians report willingness to adopt digital tools

Published September 26 2016, 6:38am EDT
Most physicians are using some digital tools and expect to increase the use of assistive technologies in the near future, findings from an American Medical Association survey shows.
The survey of 1,300 physicians from research firm Kantar TNS also finds high expectations for such tools as telemedicine, mobile and wearable devices, mobile apps and remote monitoring, as 85 percent of respondents believe these tools can help improve patient care.
Further, nearly half of respondents are enthusiastic about potential benefits of the tools improving clinical decision support, workflow enhancements and consumer access to care, among other factors.
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Is telemedicine the key to curbing rural hospital graveyard shift expenses?

September 22, 2016
by Lauren Dubinsky , Senior Reporter
For rural hospitals that are having difficulties with night coverage, telemedicine may be the way to go. Hospitals that leverage one of Eagle Telemedicine’s solutions have achieved up to 40 percent in savings on nighttime coverage.
“The interest from rural hospitals in telemedicine is exploding,” Dr. Talbot McCormick, president and CEO of Eagle Telemedicine, told HCB News.
The telemedicine solution is a robot on wheels with a two-way videoconferencing monitor. A physician from a remote location can directly interact with the patient and monitor them with a stethoscope, otoscope and blood pressure gauge.
At the National Rural Hospital Association’s 15th Critical Access Hospital Conference this week in Kansas City, Eagle Telemedicine will discuss the benefits that its customers are experiencing including an increase in patient census, avoiding transfer and addressing staffing gaps.
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EHR Health Data Collection to Impact Health Industry Shift

By Sara Heath on September 23, 2016

A new PwC report details the driving forces behind an impending healthcare industry shift, highlighting EHR and health data collection as primary factors.

EHRs and health data collection will be primary drivers behinds a shifting healthcare ecosystem over the course of the next decade.
According to a report from the PwC Research Health Institute , the healthcare industry is facing a “seismic shift” driven in part by the transition from volume to value, the growth of health technology, and focus on patients as consumers. In order to thrive in that change, PwC researchers suggest that healthcare professionals prepare for swift data collection via the EHR.
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We're told data breaches cost millions on average - but this security study disagrees

New research suggests that the average cost of data breaches is lower than many estimates and too low to drive greater investment in cybersecurity.
By Liam Tung | September 23, 2016 -- 12:41 GMT (22:41 AEST) | Topic: Security
Far from running into millions, the average cost of a data breach is less than $200,000, or roughly what firms are spending on IT security systems, according to a study from non-profit thinktank RAND.
The study, published in the Journal of Cybersecurity, challenges the much higher cost estimates provided by the Ponemon Institute. This year that research organization put the average cost of a breach at $4m.
Graeme Hackland, IT director at Williams Martini Racing and Williams Advanced Engineering, tells ZDNet how the organisation works to avoid the nightmare scenario of getting hacked.
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Global healthcare information systems market to reach $53.2B by 2019: 6 key trends

Written by Anuja Vaidya (Twitter | Google+)  | September 22, 2016
The global healthcare information systems market is set to grow at a rapid pace over the next few years, according to a Persistence Market Research report.
Here are six trends:
1. The global healthcare information systems market was valued at $35.2 billion in 2013.
2. It is expected to grow at a compound annual growth rate of 7.1 percent from 2013 to 2019 to reach a value of $53.2 billion.
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Reducing digital burden by deleting social media accounts for a 'digital clean slate'

John Halamka, MD, recently started a process that some may consider regressive. He began deleting his social media accounts to improve the signal-to-noise ratio in his life.
September 23, 2016 11:05 AM
Last weekend, I started a process that some may consider regressive. I began deleting my social media accounts to improve the signal to noise ratio in my life.
10 years ago I wrote about the importance of social media and building networks of colleagues, collaborators and relationships.
During that decade our social norms have changed to the point that we walk off cliffs, text while driving, and document every microsecond of our lives on devices that have become the centerpiece of our waking hours.
The problem has gotten so profound that Google has introduced artificial intelligence technology to respond to messaging for you – "LOL," "cute dog," "a movie at 7 pm is great."
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Medical Record Mix-Ups a Common Problem, Study Finds

The opportunities for the mistakes, which can be deadly, are increasing as health care becomes more complex

By Melinda Beck
Sept. 25, 2016 7:00 p.m. ET
A patient in cardiac arrest was mistakenly not resuscitated because clinicians confused him with a patient who had a do-not-resuscitate order on file.
Another patient was given an okay to undergo surgery based on a different patient’s records and was found dead in his hospital room the next day.
Such patient-identification mix-ups are common and can have deadly consequences, according to a report from the ECRI Institute, a nonprofit research group that studies patient safety.
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AMA surveys docs on digital health

09/26/16 10:00 AM EDT
With help from Arthur Allen (@arthurallen202)
FIRST IN MORNING EHEALTH: AMA SURVEY ON DIGITAL HEALTH: Eighty-five percent of doctors see either a definite or likely potential for digital tools to improve patient health, a survey of 1,300 physicians conducted by the American Medical Association finds.
A few other key surprisingly optimistic findings:
-Doctors are most attracted to digital health because they think it’ll help them practice more efficiently and improve patient safety. Patient demand is still a low-driver, however.
-Digital tools must be integrated with the EHR, uphold privacy and security and be covered by malpractice insurance.
-Doctors are high on mobile apps extending the reach of their systems, but are looking to someone else – a practice leader – to make the jump.
More from the survey on the AMA’s website.
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Enjoy!
David.

Friday, October 07, 2016

Now This Is A Very Interesting Use Of Remote Technology!

This appeared a few days ago.

U.S. Hospital Night Shifts Are Being Monitored From Australia

When the sun goes down in America, Australians are starting their day.

23/09/2016 11:21 AM AEST | Updated September 23, 2016 15:13
Hospital accidents are more likely to occur during the graveyard shift. When the sun goes down, much of the medical staff goes home while patients' circadian rhythms slow to sleep.
To combat the statistically significant increase in overnight incidents, six U.S. hospitals with group Emory Health care are stationing a 'remote Intensive Care Unit' in Sydney, Australia, paving the way for similar arrangements for the outback and remote areas.
The team will be based at Macquarie University's health sciences centre and hospital MQ Health where they'll monitor things like a patient's heart rate, while on-the-ground staff can contact them in patient's rooms to ask questions.
Centre director Cheryl Hiddleson told The Huffington Post Australia it was about providing support to staff.
"In the day time, there are the usual staff, physicians, registrars -- there are plenty of people taking care of patients but at night those people tend to go home, so there's less help and less resources," Hiddleson said.
More here:
I wonder how much the team in Australia are being paid for the service and how the registration to practice in the US issues (and liability issues) are being handled?
David.

Thursday, October 06, 2016

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

October 6  Edition.
Parliament has now risen and won’t be back until next week. (Back October 10, 2016).
The world economy is still feeling a little fragile with concerns regarding Europe and China.
Australia is seemingly pretty good at present, while subject to global winds
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Here are a few other things I have noticed.
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Budget Issues.

Christian Porter flags replacing family benefits with tax breaks

  • The Australian
  • 9:34AM September 25, 2016

Sarah Martin

Social Services Minister Christian Porter has flagged replacing family welfare payments with direct tax breaks when technology improves, saying the current system has “deep structural inefficiencies” that must be addressed.
Mr Porter said there were “hundreds of thousands” of families paying about $12,000 in tax each year, who were then receiving the same amount back in family tax benefits.
“You can imagine that that is an extremely inefficient and costly system to, in effect, draw money from one group through tax to give it straight back to them, with all of the administrative costs and loss that occurs in moving that money through government back to the pockets of the people from whom you took it in the first place,” he told Sky News’ Australian Agenda.
“So there are quite deep structural inefficiencies in the system that has kind of grown in an ad hoc way.”
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Australia has knowledge and means to overcome social inequality

  • Michael Marmot
  • The Australian
  • 12:00AM September 24, 2016
What do Tanzania, Paraguay, Latvia and the top 25-earning hedge fund managers in the US have in common? The answer is that the 48 million people of Tanzania, the seven million people of Paraguay, the 2 million people of Latvia and the top 25 hedge fund managers each have an annual income of between $US21 billion and $US28 billion.
If the 25 hedge fund managers gave up their income for one year and transferred it to Tanzania, population 48 million people, it would double the income per person. The hedge fund managers wouldn’t feel it, because they will get $US1bn the next year. I am not suggesting that you simply give the money to each individual Tanzanian, but think of clean water that could be supplied, the clean cook stoves, the teachers and nurses that could be employed.
The point is that we have a great deal of money sloshing about.
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RBA may be forced to cut rates further: Lowe

  • The Australian
  • 12:00AM September 26, 2016

David Uren

Reserve Bank governor Philip Lowe believes Australia’s economy does not warrant lower rates, but he has left open the possibility that he may be forced into it by the monetary policy action of central banks elsewhere.
The Bank of Japan’s vow last week to maintain its extraordinary monetary policies until its inflation rate is in excess of 2 per cent shows the offshore pressures on the Reserve Bank will keep on coming. It also shows why the US Federal Reserve choked yet again at the cusp of a decision to raise rates.
Lowe is optimistic about the Australian outlook. Commodity prices have been firmer this year and the wind down of investment in the resources sector will be completed early next year.
“If we are seeing the end of the mining investment fall and if we have got some stability in the terms of trade, I think there are reasonable prospects that we will continue to see good activity in the non-mining economy that will see a stabilisation and even a gradual pick-up in wage growth. That will feed through in time to inflation,” Lowe told the House of Representatives economics committee last week.
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  • September 25 2016 - 9:00PM

Global leaders change direction while we play games

Ross Gittins
It's strange the way Malcolm Turnbull and Scott Morrison keep shooting off overseas to compare notes with world economic heavies, but come back none the wiser.
Fortunately, the wonders of the internet allow us to read for ourselves what they're being told by the trumps at the Organisation for Economic Co-operation and Development and the International Monetary Fund.
It's clear those at the leading edge are getting increasingly worried about the outlook for the world economy and are urging a marked change of policy direction.
But while the trumps see a need for policy to swing back to the centre, our unruly Coalition is intent on drifting off to the far right.
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Everyone to blame for our budget spiral of hopelessness

  • The Australian
  • 12:00AM September 26, 2016

Phillip Hudson

Fixing the federal budget is turning into a ridiculous game of inches. No dollar of spending will be easily surrendered. Every cut is taking money away from some vested ­interest.
Even when Labor and the ­Coalition agree and have the ­numbers, as they did during the last sitting of parliament to pass the $6.3 billion omnibus package of cuts, it took more than six hours of debate to navigate through the Senate.
One measure, which Finance Minister Mathias Cormann told the Senate was an “absolutely minuscule” saving worth $3.6 ­million over four years to veterans ­affairs, was the subject of a 55-­minute argument as Jacqui ­Lambie and the Nick Xenophon Team’s Skye Kakoschke-Moore passionately fought the move. That is their right. They never had a hope of winning, but would not yield quietly.
As the clock ticked past 11pm, Derryn Hinch asked Cormann to concede the government was pushing ahead too quickly.
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Coalition backs down on $500m backpacker tax, cuts proposed rate

Date: September 27 2016
James Massola
The federal government has backed down on its proposed $500 million backpacker tax in a deal that will please Nationals MPs who had campaigned against the measure.
Under a deal hammered out by Treasurer Scott Morrison and Nationals leader Barnaby Joyce, the plan to impose a 32.5¢ tax rate on backpackers from the first dollar they earn while working in Australia has been scrapped, and instead the rate will be set at 19¢.
The 19¢ rate will apply up to $37,000, and then normal tax rates will apply.
And Mr Morrison trumpeted the fact that the change would "wash its face" and be revenue neutral, with the cost of the foregone made up by a $5 increase in the Passenger Movement Charge (PMC) that applies when people leave Australia, from $55 to $60, and by an increase in the tax on working holidaymakers paid on their superannuation payments to 95 per cent when they leave Australia.
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  • Updated Sep 28 2016 at 11:45 PM

Australia has just five years to prepare for risks from China debt: Morrison

Australia has five years to make its budget more resilient to a potential economic shock from booming debt levels in China, Treasurer Scott Morrison says.
His warnings came after the release of the latest World Economic Outlook from the International Monetary Fund on Wednesday, which said China must allow its economy to slow to stop a "disorderly deleveraging", triggering contagion in emerging markets, and hitting asset prices in advanced economies.
The IMF said China's financial links with the rest of the world were now sufficient for a major shock to affect global stock prices, debt markets and currencies, particularly for Beijing's major trading partners such as Australia.
"Adverse shocks in China reduce equity prices both in advanced and in emerging market economies, with stronger effects on countries with higher trade exposure to China," the IMF said.
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  • September 30 2016 - 12:00AM

Scott Morrison's blunt warning: embrace immigration and trade, or face 'great danger'

James Massola
Australia must embrace immigration, trade and foreign investment - or risk the prosperity of future generations, according to Treasurer Scott Morrison.
In his third and final post-election headland speech, to be delivered at the Lowy Institute in Sydney on Friday, Mr Morrison will argue Australia has built its wealth on the back of freer trade and that, for two centuries, it has relied on the influx of foreign capital to fund domestic investment and grow the overall size of the economy.
At the same time, the nation's targeted immigration program has been a prime driver of population growth and, therefore, economic growth, while the "composition of our immigration intake has been equally important. Our immigration program sets itself apart from other countries, as it is built on attracting people and families to Australia who want and are able to make a contribution, rather than take one".
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Health Budget Issues.

Government is paving way to private Medicare: Catherine King

  • AAP
  • 2:54PM September 25, 2016
The federal government has rejected claims frontline Medicare services will be shut down, causing delays to rebate repayments.
Human Services Minister Alan Tudge said there had been some consolidation of shopfronts over the past years but most people are still able to find a service centre within a few kilometres of their home.
Rebates are now being processed in one of 17 centres nationwide, but from the patient’s perspective there is no change, Mr Tudge told reporters today.
“Every single aspect of Medicare which is currently operated by government will continue to be operated by government, including the processing of the Medicare rebate,” Mr Tudge said.
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Leaked documents reveal long Medicare delays

Updated: 7:34 pm, Sunday, 25 September 2016
Leaked Medicare documents have revealed patients who don't process their claims online, are facing long delays.
Whistleblower public servants have told News Corp they had been told by December there will no longer be any face-to-face Medicare services and they had been banned from telling patients their Medicare claims will be sent off-site for processing.
Patients undergoing expensive medical treatments could be left out of pocket for weeks after the documents revealed the federal government has outsourced processing to new centres and closed Medicare shopfronts.
Human Services Minister Alan Tudge said back of house processing had been consolidated due to a huge reduction in demand for face-to-face claiming and services for people who are unable to use digital services will remain the same.
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Health Minister Sussan Ley has denied reports of changes to Medicare

September 25, 20167:51pm
Charis Chang and AAPnews.com.au
HEALTH Minister Sussan Ley says there’s no truth to claims people will have to wait longer for their Medicare refunds.
She told SkyNews today that people would be able to claim their Medicare refunds in exactly the same way as before.
In explaining what was changing, Ms Ley said instead of being processed at every single office that they were collected, Medicare forms would instead be processed through 15 centralised hubs.
She said there would be no job losses and no employees would be forced to move.
Ms Ley described reports that processing of Medicare claims would be slowed down as “alarmist nonsense”.
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Issues of price exposed by knee replacements’ $1.2bn bill

  • The Australian
  • 12:00AM September 26, 2016

Sean Parnell

Knee replacements cost the health system more than any other procedure, amounting to well over $1.2 billion a year.
But there are concerns that inflated prices for manufactured knee parts on the federal Pros­theses List are adding to the cost burden in the private sector, where some patients may also be having procedures they don’t need.
Among the 10 items on the Prostheses List that cost the most overall last year were two different brands’ components for total knee arthroplasty, priced at $2550 and $3650, making up $13,027,950 and $15,330,000 of the total spend.
Also in the top 10 was another company’s separate component for knee arthroplasty, priced at $4100 and making up $11,270,900 of the total spend. Health Minister Sussan Ley reportedly pushed for Prostheses List price cuts earlier this year but the Coalition instead opted for further committee talks.
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EXCLUSIVE
  • September 26 2016 - 6:00AM

Families to save hundreds of dollars under PBS changes

·         James Massola, Fergus Hunter
Australians will be able to save hundreds of dollars a year from October 1 as prices are cut for more than 2000 medicines covered by the Pharmaceutical Benefits Scheme.
And people will now be able to go online and calculate their savings, with non-concessional patients and those with multiple chronic conditions set to benefit most from the changes.
The cuts to the price of medicines, one of the largest ever, has been driven by a shift to greater use of generic brands and the savings will multiply for people taking drugs for multiple conditions.
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  • September 26 2016 - 9:17AM

Five ways that the $160m same sex plebiscite could be spent in health

Harriet Alexander
Public health experts have called for the same-sex plebiscite to be abandoned, arguing that it will incite community conflict and the $160 million would be better invested in health.
The Public Health Association of Australia (PHAA) and Chronic Disease Network of the Northern Territory became the latest groups to add their displeasure over the plebiscite at their combined annual conference, with a unanimous resolution to call on Parliament to can the plebiscite.
Malcolm Turnbull spoke of the societal benefit of more marriages in Australia while introducing the contentious same-sex marriage plebiscite bill on Wednesday.
PHAA chief executive Michael Moore said the money should be funnelled into areas that would benefit the community such as health and education instead.
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Bulk-billing rates stay high for poor, increasing for wealthy

The 10 electorates with the highest rate of bulk-billing have held steady over the past three years.
  • The Australian
  • 12:00AM September 27, 2016

Sean Parnell

Bulk-billing remains high in lower socio-economic areas and is ­increasing in wealthier electorates where patients have traditionally paid to visit a GP, according to Medicare figures.
In trends that undermine Labor’s so-called “Mediscare” campaign, the 10 electorates with the highest rate of bulk-billing have held steady over the past three years despite a Turnbull government freeze on rebate ­indexation.
The electorates where bulk-billing is most prolific are mostly held by Labor MPs, including Chris Bowen, Tony Burke, Jason Clare and Ed Husic. Each has a rate of bulk-billed GP services above 95 per cent.
Yet the biggest shift, albeit off a lower base, comes among the 10 electorates with the lowest rate of bulk-billing. Curtin in Western Australia, held by Foreign Minister Julie Bishop, had a rate of 55 per cent in 2013-14 but last year it had climbed to 58.8 per cent.
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Mediscared government delays $30 fees for blood tests until next year

September 28, 20167:32pm
Sue Dunlevy News Corp Australia Network
PATIENTS have won another temporary reprieve from a new $30 charge for a blood test but only until January as the government reels from Labor’s powerful Medicare election campaign.
Days before the axe was due to fall on Medicare bulk billing incentives for blood and other pathology tests the government has backed off.
The cuts were due to take effect on Saturday and pathology companies had warned they would see an end to free blood tests with a new fee of up to $30 per test likely.
But the reprieve is only temporary with industry sources now expecting the cuts to take effect on January 1.
And the delay will add to the government’s budget woes, adding more than $2.3 million a week to the budget deficit.
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GP bulk billing only applies to two out of three consults: survey

index&t_product=AdelaideNow&td_device=desktopSue Dunlevy, National health writer, News Corp Australia Network
September 30, 2016 12:30am
index&t_product=AdelaideNow&td_device=desktopONE in three GP consultations are not being bulk billed and these patients are paying an average $48 out of their own pocket to see the doctor a startling new survey shows.
The Royal Australian College of General Practitioners (RACGP) commissioned the research to gauge the impact of the Turnbull government’s six year freeze on GP rebates and found 31.4 per cent of GP consults were not bulk billed.
Fifty per cent of these patients were left more than $40 out of pocket after receiving their Medicare rebate and the average out of pocket expenses was $48 the survey found.
This contrasts with the Federal Government’s own Medicare data that states a record 83.7 per cent of GP services are bulk billed.
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Sussan Ley attempts to make peace with GPs

Paul Smith | 29 September, 2016 | 
Minister for Health and Aged Care Sussan Ley has told the RACGP's annual conference that she has no views “one way or another” on whether GPs are providing low-value care, such as writing repeat scripts or giving patients trivial test results, in return for Medicare funding.
The health minister fronted the RACGP conference in Perth on Thursday to declare that general practice and the government were “working in partnership” with each other.
But she also attempted to cool the fires sparked by claims quoted in last month’s MBS Review Taskforce Interim Report that some GPs were offering low-value services in return for Medicare.
Responding to the angry backlash from the specialty, which saw the lauch of the #justaGP Twitter campaign, Ms Ley said: “Despite the inaccurate and misleading claims of some, I do not hold a view on these individual items one way or another — and will not, until I receive the expert advice from the MBS review committee on general practice.
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Health Insurance Issues.

  • Updated Sep 26 2016 at 11:45 PM

Why Medibank spends $30m a year on taxis, handrails and talking scales

Medibank Private says better management of chronic disease patients is showing early signs of reducing unnecessary hospital visits through tailored care plans, but has found that some measures are as simple as ensuring patients don't miss their specialist appointments.
The $7 billion health insurer has been running its CareComplete program since mid 2014 in an attempt to take better care of its sickest members and reduce the number of times they visit hospital. After kicking off with a 100 person pilot, the program now covers 5000 of Medibank's 4 million members and costs about $30 million a year.
Dr Andrew Wilson, Medibank's group executive, provider networks and integrated care, says investing in chronic disease patients makes strategic sense because "it combines health outcomes and fiscal responsibility".
The Australian Institute of Health and Welfare estimates that of the 10 million hospitalisations each year –1.2 million of which Medibank funds – about 6 per cent are unnecessary or preventable. Many of these admissions are likely to come from chronic disease patients and could have been prevented "through people receiving better care in the home and in primary care", Dr Wilson said.
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Medical device-makers hit back on prices

  • The Australian
  • 12:00AM September 28, 2016

Sarah-Jane Tasker

Johnson & Johnson Medical’s Australian head, Gavin Fox-Smith, has defended his sector, which is facing intense scrutiny over the price of devices, saying it is at the centre of the most important health policies and has earned its seat at the table.
Mr Fox-Smith, managing director of US giant Johnson and Johnson’s Australian subsidiary focused on medical devices, called on the sector to unite as one voice to fight what he said was a push by private health insurers to cut the price of the devices they sell.
“It is more important than ever that industry comes together and speaks with one voice to our stakeholders, including government, patients and clinicians,” he said.
“We continue to face a private health insurance industry actively demanding the government make cuts to the benefits on the Prostheses List. We remain optimistic that decision-makers have listened to our evidence-based arguments that put patient welfare first. But we do know the government is committed to looking at the benefits on the Prostheses List.”
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Health insurers’ promises of quick premium relief ‘are fantasy’

  • Andrea Kunca
  • The Australian
  • 12:00AM September 28, 2016
It has been a clever and well-funded campaign by the private health insurers. They’ve turned the focus of the government private health insurance consultations — initially to investigate the high cost of premiums — towards an attack on the medical device industry.
Why would the health funds choose to focus on medical device reimbursement, given it represents only 14c in every dollar that private health insurers pay out under hospital cover policies?
The medical technology industry delivers life-changing and lifesaving medical devices through its innovative technology. And the Australian public agrees.
Four in five Australians support clinician choice for medical technology. We support this.
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Medicines and medical devices reform

Australia September 26 2016
The Australian Government has released its response to the Review of Medicines and Medical Devices Regulation, with reforms to be progressively rolled out over the next 2 years.
Background and scope of review
An independent review of medicines and medical devices regulation by an expert panel was announced in October 2014.  The expert panel reports on Medicines and Medical Device Regulation were published in July 2015 (available here), including 58 recommendations for reform.
The scope of the review was to benchmark TGA regulatory requirements against international authorities, to ensure there is an appropriate balance between risk and benefit in the regulation of prescription, over-the-counter, complementary medicines and medical devices and to simplify and streamline the approval processes undertaken by the TGA.
The Review did not concern any aspect of the Pharmaceutical Benefits Scheme or reimbursement or subsidy of medicines and medical devices.
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$1bn saving goes begging in public-private health cost shift

State governments are encouraging public hospitals to identify patients with ­insurance and convince them to bill their health fund. Picture: Mitch Bear
  • The Australian
  • 12:00AM September 29, 2016

Sean Parnell

Health Minister Sussan Ley is under pressure to intervene in a $1 billion cost-shifting dispute ­involving public hospitals admitting patients, often through emergency departments, and having them bill their insurer for treatment.
In another illustration of the complexity of healthcare funding arrangements, state governments are encouraging public hospitals to identify patients with ­insurance and convince them to bill their health fund, even though Australians have a right to be treated publicly for free.
Patients are under no oblig­ation to declare insurance status. However, hospital administrators now offer to pay their ­excess and, in some cases, offer additional incentives such as free parking and meals for family members. But the practice is helping to drive up insurance premiums and has inflamed tensions between health funds and hospitals.
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‘Aggressive’ stance to health reform will backfire, warns Ley

  • The Australian
  • 12:00AM September 29, 2016

Sarah-Jane Tasker

Federal Health Minister Sussan Ley has warned private health stakeholders, in a veiled threat, that they will be worse off if they gamble on an “aggressive” strategy in reform talks with the government.
Ms Ley, speaking at the Medical Technology Association of Australia’s annual conference in Sydney yesterday, said it was not surprising there had been the usual politics and posturing played out in public view by those trying to get the best deal for members.
Private health insurers and device manufacturers have been lobbying the government over plans to reform the Prostheses List, which regulates the price of medical devices in the private system.
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Public hospitals face penalties for medical blunders

  • The Australian
  • 12:00AM October 1, 2016

Sean Parnell

Public hospitals would be forced to repay money to the commonwealth if staff commit any of a ­series of catastrophic mistakes, under a funding model being ­developed on the orders of the Turnbull government.
Health Minister Sussan Ley has quietly given a regulatory ­directive to the Independent Hospital Pricing Authority to look at financial penalties for so-called sentinel events, such as surgery on the wrong body part, the suicide of a patient, or a newborn being given to the wrong parents.
The most recent data on sentinel events, for 2013-14, details 102 such reports across Australia, ­including 36 patient suicides, 27 instances where instruments or other material were left inside a patient after surgery, and 20 medication errors leading to the death of a patient.
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Pharmacy Issues.

These 10 medicines are about to get much cheaper in Australia

Medicinal price discounts encourage savings for both consumers and taxpayers alike.

From 1 October, more than 2000 medicines listed on the Pharmaceutical Benefits Scheme (PBS) will incur price reductions, saving consumers up to $20 per script and taxpayers $900 million over four years.
The reductions were delivered through the PBS Access and Sustainability Package reforms, which passed Parliament last year.
Australia's minister for health Sussan Ley says more than 80% of price markdowns will result in direct saving for consumers, while the remaining 20% - those priced above the general PBS co-payment of $38.30 – will save taxpayers big bucks.
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Superannuation Issues.

$66 billion blowout in the cost of public service super scheme

David Uren

Falling world interest rates have pushed up the cost of servicing the lucrative public service ­defined-benefit superannuation pensions by $66 billion over the past year.
The final budget outcome for 2015-16 shows a sum of $314bn would be required to cover public sector superannuation liabilities at the government bond rate of 2.7 per cent, up from $248bn a year ago.
The government’s deteriorat­ing financial position is also shown by the rise in net debt, up by 18.5 per cent to $296bn over the past year.
The final budget outcome shows the overall deficit for 2015-16 was $39.6bn, worse than the $35.1bn predicted when it was announced by Joe Hockey in May last year but $300m better than the most recent Treasury update in this year’s budget ­papers.
Both spending and revenue dipped in the final six weeks of the financial year; however, the gains on the spending side of the budget were largely one-offs, such as Victoria’s failure to get its application for funds from the asset recycling fund in on time, whereas weakness in revenue will carry into this year’s budget.
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I look forward to comments on all this!
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David.

Wednesday, October 05, 2016

It Looks Like The Department of Health Has Rather Backed Down On The ePIP Requirements For A Few Months.

This appeared last week:

Practices win reprieve on e-PIP upload target

Antony Scholefield | 29 September, 2016 |  
Practices will still be able to claim the e-health Practice Incentive Program payment even if they failed to meet the upload targets following a reprieve from the Department of Health.
The requirement for GPs to upload shared health summaries to the MyHealth Record for at least 0.5% of their patients has a new deadline of 31 January 2017.
The moratorium announced on Thursday by Health Minister Sussan Ley comes after a large number of practices fell short of the upload target and so failed to qualify for the e-health PIP in the third quarter (Q3) of the year.
Missing the target meant practices losing an average of $23,000 a year in federal funding.
Just 1500 of the 5000 eligible practices hit the target in Q3 and more than 200 practices withdrew from the program.
AMA president Dr Michael Gannon said the reprieve would give practices more time to prepare.
More here:
It looks like a good number of GPs have called the Minister’s bluff and made it clear they are rather less than convinced they deserve such a scale of penalty when their rebates are frozen.
General Practice really does not see the Minister and Department as trusted friends!
David.