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, November 10, 2016

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

November 10  Edition.
Parliament  has come back on the 7th of November. However things are a bit messy with the election of two senators now being reviewed by the High Court.
US election comment and economic fallout.
No need to say much. We all know we have to expect President Trump to be inaugurated on 20 Jan 2017.

Time will tell what it means for all of us. As of Thursday morning markets are all up. I suspect that might not last!
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Here are a few other things I have noticed.
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Budget Issues.

  • October 31 2016 - 12:15AM

Company directors to face penalties for ignoring climate change

Jessica Irvine
Australia's fall from grace as a global leader in the fight against dangerous climate change was rapid and inglorious.
But any Australian business leaders who think they got away with sticking their heads in the sand should think again.
New legal advice by senior Sydney silk Noel Hutley being released on Monday, suggests it is almost certain that directors of an Australian company will one day face legal action for neglecting to properly account for the potential impact of climate change on their business.
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Morrison/Hanson fight wrong battle on welfare reform

at 12:15 am on October 31, 2016
Treasurer Scott Morrison took his war against the unemployed to another level over the weekend, vowing to end the “welfare creep” that encour­ages thousands of Australians to avoid getting a job. From The Australian:
The Australian yesterday revealed that 43,200 welfare recipients were getting more than they could if they worked at the average wage.
The government stood by the analysis that shows at least 43,200 people received at least $45,032 tax-free last financial year from the single-parent payment, childcare rebates and family tax payments.
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Lenders at risk if housing prices continue to soar warns S&P

  • The Australian
  • 10:59AM October 31, 2016

Daniel Palmer

Standard & Poor’s has trimmed the outlook on 25 Australian lenders to negative amid developing concerns around swelling house prices and high private sector debt.
In a statement this morning, the ratings agency warned any further build-up in house prices from its base case of moderating growth for the next two years would raise the threat of a “sharp correction”.
“Our base-case scenario remains that the growth in property prices and private sector debt will moderate and remain at relatively low levels in the next two years,” S&P said.
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31 Oct 2016 - 4:14pm

Xenophon mocks Roller to clunker PPL

Senator Nick Xenophon will meet with ministers Scott Morrison and Christian Porter this week as the government seeks support for $6 billion of savings.
Source: AAP
31 Oct 2016 - 4:14 PM  UPDATED YESTERDAY 4:14 PM
Senate powerbroker Nick Xenophon will meet with key ministers this week as the Turnbull government attempts to garner support for some $6 billion in welfare budget cuts.
Topping the agenda will be discussions with Social Services Minister Christian Porter over the government's planned changes to paid parental leave provisions to save $1.2 billion.
The government is pursuing an end to what former Liberal treasurer Joe Hockey labelled "double dipping" - a term Mr Porter is now keen to avoid - to stop new mums accessing the taxpayer-funded minimum wage scheme if their employer is running its own leave plan.
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COMMENT
  • November 2 2016 - 6:18AM

It is not the budget that's bankrupt, it is the government's penny pinching

Ross Gittins
Did you know our social security system is so open to rorting that it's possible for some people to get more from benefits than they'd earn if they took a job? And we wonder why we have problem with debt and deficit.
This scandalous state of affairs was leaked to an  Australian newspaper by sources close to the minister for Social Services, Christian Porter.

Government to end long term welfare reliance

Young parents, carers and students will be the target of a major shake up of the welfare system.
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Governments tax forecasts wilt, peak deficit blows by $30bn

  • The Australian
  • 12:00AM November 3, 2016

David Uren

The failure of tax revenue to meet the excessively optimistic predictions of federal and state Treasury departments has forced the forecast peak in Australia’s public sector debt to be raised by $30 billion since the end of last year.
The Parliamentary Budget Office estimates that the combined federal and state debt will reach a peak of $428.7bn or 20.8 per cent of GDP in 2019-20, based on forecasts contained in their latest budgets.
The federal government is ­responsible for more than 80 per cent of the debt, with its share ­expected to reach $356.4bn. Former treasurer Joe Hockey scrapped a legislated $300bn ceiling on federal debt soon after gaining office in September 2013.
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Our Treasurer Must Face Up To Some Urgent Home Truths

Every night in Australia there are enough homeless children to fill Sydney’s Allianz Stadium.

03/11/2016 5:34 AM AEDT |  
"Mr Morrison is wrong to devolve responsibility to the states to fix housing affordability through planning changes alone."
Call me a cynic but I don't think it's a coincidence that Treasurer Scott Morrison made his recent speech on the housing affordability crisis just a week before the Housing Ministers meet in Sydney. Especially when Mr Morrison's key line was to say the housing affordability crisis was a supply and state planning issue. It feels remarkably well timed to pre-empt tomorrow's meeting, where funding, and what the Federal Government will contribute, will be the topic of the day.
As it stands, thousands of people across the country are homeless or living precariously hand to mouth, simply because they can't afford the rent. And hundreds of homelessness services, which help those people find and keep a tenancy, are at risk of having their funding cut.
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  • November 3 2016 - 11:45PM

Half the jobs are going, and they're not coming back

·         Gwynne Dyer
"The notion that Uber in London is a mosaic of 30,000 small businesses linked by a common 'platform' is, to our minds, faintly ridiculous," said one of the judges on the employment tribunal. So the tribunal ruled that Uber's 30,000 drivers in London were actually employees, and therefore entitled to be paid the minimum wage, to be given sick pay, even to have paid holidays.
Uber promptly appealed the ruling, because it would wreck its business model in Britain and, if the example spread, worldwide. But it was only a temporary victory for workers' rights, because just as the real jobs have been replaced by fake "freelance" jobs like Uber that strip people of their old legal protections, so the "freelance" driving gigs will soon be replaced by – no jobs at all.
The first self-driving cars are already on the roads. Automation, in the form of artificial intelligence, will probably abolish almost all the driving jobs in the next 20 years. In Britain alone that means 400,000 jobs driving big trucks and almost 300,000 licensed taxi drivers. (The jobs driving delivery vans will last a little longer.) Three-quarters of a million jobs gone, say, and nothing plausible coming down the road to replace them. Scale it up to the size of the United States and that's about 4 million more American jobs gone, not to foreign competition and "outsourcing" but just to technological change. It's harder to replace drivers than bank tellers – "every ATM is the ghost of three bank tellers" – but it just takes a little longer to develop the right software.
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Commodity surge hasn't quelled rating row

By AAP | 03.11.2016 01:42 PM
Suddenly the path to budget repair has gotten murkier.
Global ratings agencies like Standard & Poor's raised concerns about the make-up of the Senate following the July 2 federal election and what it would mean for legislation.
Little did they expect the larger crossbench would have started dropping like flies, leaving a big question mark over future government legislation should Labor and the Greens join forces to oppose government bills.
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Health Budget Issues.

Rent deal followed Coalition criticism

  • The Australian
  • 12:00AM November 2, 2016

Sean Parnell

The Coalition gave an election commitment to help the pathology sector with rental costs only weeks after stakeholders “dis­agreed vigorously” over the issue, according to minutes of a meeting convened by the ­Department of Health.
During an election debate in May, Malcolm Turnbull ­announced the Coalition had agreed to help pathology companies get cheaper rent for collection centres located in GP clinics. In exchange, Pathology Australia agreed to stop campaigning against the Coalition’s plan to remove bulk-billing ­incentives at a time when Labor was also rallying to save Medicare and was holding events outside pathology clinics.
Pathology Australia is backed by Sonic Health Care, a major pathology provider and former donor to the Coalition. The deal has angered the Royal Australian College of GPs and the Australian Medical Association.
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Department of Health warning over market value of space in GP clinics

  • The Australian
  • 11:43AM November 4, 2016

Sean Parnell

Adopting the pathology lobby’s definition of market value for space in GP clinics would render most of the existing leases for 5600 collection centres illegal, the Department of Health was warned.
Under an election campaign deal between the Coalition and Pathology Australia, the definition of market value for space in GP clinics will be altered to better protect leases.
The deal was intended to help offset the impact of the planned removal of pathology bulk-billing incentives and came on the proviso Pathology Australia cease its campaign against the Coalition.
But the Royal Australian College of General Practitioners, the Australian Medical Association and some pathology providers have declared it anti-competitive and likely to push up GP costs.
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  • November 4 2016 - 1:39PM

Cartel claims against surgeons to be investigated

Julia Medew
Concerns about potential cartel behaviour among Australian surgeons has been referred to the Australian Health Ministers' Advisory Council for further investigation.
In September, Fairfax Media revealed claims that overseas-trained surgeons were facing anti-competitive behaviour that reached into the Royal Australasian College of Surgeons - a powerful group that largely controls the supply of surgeons in Australia and, allegedly, the level of competition and fees they can charge.
NSW Health Minister Jillian Skinner said after discussing the issue at the Council of Australian Governments' meeting of health ministers last month, concerns about unprofessional behaviour had been referred to the ministers' advisory council.
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The nation’s sickest patients could be at risk after a massive Medicare shake-up

November 4, 20167:34pm
Sue Dunlevy News Corp Australia Network
THE nation’s sickest cancer patients and people with diabetes and other chronic illnesses will get a maximum of $1795 worth of GP care a year funded by Medicare under a revolution in the way doctors are paid.
And Medicare will fund just five extra visits to the doctor if these people need medical attention for issues aside from their chronic illness under the Turnbull Government’s Health Care Homes model.
Doctors were expressing deep concern about the adequacy of the payment levels that were released without consultation with medical groups on November 4.
“The modelling is concerning and potentially leaves the whole program at risk of falling over because of being underfunded from the beginning,” AMA vice president Dr Tony Bartone said.
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  • November 6 2016 - 12:01AM

New front in Malcolm Turnbull's health war as doctors unite on pathology deal

Adam Gartrell
Prime Minister Malcolm Turnbull's war with doctors is set to intensify as GPs unite to kill off a government deal with pathologists they claim will force bulk-billing practices to start charging or even shut down.
Doctors say patients will be charged an average of $15 to $20 more to visit a GP if the government proceeds with plans to regulate the rents they can charge pathology companies that co-locate in their practices.
But pathologists say they are being charged obscene rents that are jeopardising their ability to keep bulk billing for their services.
The issue is heating up as Health Minister Sussan Ley prepares to unveil her final plans in the coming weeks, with GP practice owners uniting under a new group – the Australian GP Alliance – to force a government rethink.
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Extreme Home Makeover — The Role of Intensive Home Health Care

Luis Ticona, M.D., M.P.P., and Kevin A. Schulman, M.D.
N Engl J Med 2016; 375:1707-1709 
November 3, 2016 DOI: 10.1056/NEJMp1608301
Audio Interview
Interview with Dr. Kevin Schulman on intensive home health care as an alternative to hospitalization. (6:11)
·         Listen
In 2010, the department of health in Victoria, Australia, announced the construction of a 500-bed hospital without bricks and mortar. This “virtual hospital” has 33,000 admissions each year, accounting for almost 5% of all acute care bed-days in the state of Victoria and adding much-needed hospital-bed capacity.1 The Australian health system has since expanded this program to reduce the strain on available hospital beds in other regions as well, while avoiding capital expenditures and preserving the quality of care. What incredible technological advance permitted achievement of these impressive results? Home visits.
Intensive home health care services as an alternative to hospitalization are becoming a standard option in many health systems around the world, perhaps most notably the United Kingdom, France, New Zealand, and Australia. These health systems deploy multidisciplinary home health care teams after emergency department evaluation and diagnosis, outpatient evaluation, or an ultra-brief hospital stay to provide acute care services, comparable to hospital-level care, in the patient’s home rather than a hospital. They bundle existing services, including physician oversight and backup, nurse visits for ongoing evaluation and delivery of interventions, home infusion technology and pharmacy resources, telehealth interactions, point-of-care testing, and home health aide services to create comprehensive, customized programs of intensive care at home. Indeed, it’s the existence of these technologies and the growth of the skilled-nursing workforce that enable the creation of such service lines.
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Health Insurance Issues.

Health funds’ poor practices show need for reform

“Poor practices” by some health funds are exposing consumers to bill shock and inadequate cover, the Australian Competition and Consumer Commission has found in a new report.
“The ACCC report on health insurance to the Senate indicates that the increasing number of changes health funds are making to their policies are often poorly communicated with unfortunate consequences for their members,” the CEO of the Consumers Health Forum, Leanne Wells, said.
“Not only do we have confused and frustrated consumers, at worst the consequence of bill shock and high-premium low-value cover is reduced access to health care.
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  • October 31 2016 - 7:11PM

Health insurance customers left in the dark over policy changes: ACCC

Rania Spooner
Think your health insurance covers that? You might want to check again.
The Australian Competition and Consumer Commission has found insurers are not adequately notifying customers when their coverage or benefits are slashed, and - in some cases - failing to disclose changes entirely.
The more extreme failures identified by the consumer watchdog's annual report on health insurers related to contract changes between insurers and health providers, which would affect benefits payable to customers.  
Confusing and "unhelpful" communication tactics included unclear and misleading language, single notifications without follow up, relying on email, and the blending of benefit change information with marketing information, the ACCC reported.
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Health insurer NIB says further price cuts needed for medical devices

  • The Australian
  • 12:16PM November 2, 2016

Sarah-Jane Tasker

NIB chairman Steve Crane has warned the Turnbull Government further cuts to the price of medical devices are needed to address health insurance affordability concerns.
Mr Crane, speaking to shareholders at today’s annual general meeting in Sydney, said the recent announcement by Federal Health Minister Sussan Ley that the price of some medical devices used in the private system would be cut, would help relieve pressure on future insurance premiums.
But he said despite those cuts, there was still more that could be done to lower prices on prosthetic and medical devices.
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  • November 2 2016 - 2:38PM

Health insurance premium rises are starting to fade: NIB

Brian Robins
The steam may be finally running out of the fast-paced rise in health insurance premiums of the past decade, with one of the nation's largest insurers seeing the level of 'claims inflation' nearly halve over the past year.
NIB chief executive Mark Fitzgibbon said on Wednesday the slowing trend of cost increases encountered by health insurers that was seen over the past year has continued.
For his company, claims inflation fell to 2.9 per cent in the year to June, well below the expected rate of closer to 5 to 6 per cent. For the year ahead, that is seen moving to between 3 and 5 per cent.
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HCF boss Shaun Larkin calls for health insurance reform

  • The Australian
  • 12:00AM November 3, 2016

Sarah-Jane Tasker

HCF managing director Shaun Larkin says change is needed in the health insurance sector to ­address affordability concerns, as he flags the product is evolving, with consumers taking more control of their health needs.
Mr Larkin said the question around the affordability of health insurance was becoming an important one for consumers.
“We need to work out how to solve it,” he said. “The challenge will be that solving it isn’t going to be through some incremental change of what we currently have in place, it will have to be significant change.”
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  • Nov 3 2016 at 2:42 PM

Medibank Private attracts double its share of complaints

Medibank Private was the driving force behind a record-breaking number of private health insurance complaints between July and September, the  industry's ombudsman has revealed.
Despite accounting for a 28.6 per cent share of the $20 billion industry, Medibank's customers accounted for 60.7 per cent of complaints and 42.9 per cent of disputes that the Private Health Insurance Ombudsman had to deal with in the three months ended September 30.
Overall claims hit 1683, up 60 per cent on the same time last year and an increase of 23 on the prior quarter, which was a record, PHIO said. "This presented a challenge for the staff of the PHIO and some health insurer complaint handlers."
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  • November 6 2016 - 12:45AM

Medibank continues embarrassing streak of record complaints to the Private Health Insurance Ombudsman

Esther Han
Medibank has single-handedly caused the Private Health Insurance Ombudsman to announce a record: the greatest number of complaints in any quarter of its 20-year history.
Despite having less than a third of the market, Medibank's policyholders accounted for 61 per cent of the 1683 complaints made to the ombudsman between July and September, a huge 60 per cent jump in total complaints compared with the same quarter last year.
Medibank is scrambling to save its reputation by promising to offer more value, exceed expectations and invest in customer service, after losing 225,000 customers in the past financial year.
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I look forward to comments on all this!
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David.

I Wonder Who Will Be Asked To Take Over This E-Health Gig?

This appeared a few days ago:

Telstra's inaugural Health boss resigns

By Allie Coyne on Nov 4, 2016 9:13AM

To leave long health career for retirement.

The executive who helped establish Telstra's healthcare division will step down from the role and retire in February next year.
Shane Solomon has served as the inaugural head of Telstra Health since the business was established in 2014.
Its goal is to connect predominantly rural and remote patients - as well as travellers and people wanting out-of-hours care - with hospitals, GPS, government and health funds, through partnerships with healthcare providers.
Its first telehealth service ReadyCare - a partnership with Medgate that allows patients to consult with GPs remotely using voice or video - went live mid last year. 
Solomon came to the telco's healthcare services unit from a stint at KPMG's health practice, and has a long history in the healthcare sector.
More here:
Good luck to Shane in retirement. He has certainly aggregated some excellent e-Health assets under the Telstra Health name. I hope they are all effectively used and nurtured.
David.

Just So You Know What You Are Getting With President Trump. Might Not Be Good For Australia!

Here is the Manifesto.
DONALD J. TRUMP CONTRACT WITH THE AMERICAN VOTER
What follows is my 100-day action plan to Make America Great Again. It is a contract between myself and the American voter – and begins with restoring honesty, accountability and change to Washington
Therefore, on the first day of my term of office, my administration will immediately pursue the following six measures to clean up the corruption and special interest collusion in Washington, DC:
                 FIRST, propose a Constitutional Amendment to impose term limits on all members of Congress;
                 SECOND, a hiring freeze on all federal employees to reduce federal workforce through attrition (exempting military, public safety, and public health);
                 THIRD, a requirement that for every new federal regulation, two existing regulations must be eliminated;
                 FOURTH, a 5 year-ban on White House and Congressional officials becoming lobbyists after they leave government service;
                 FIFTH, a lifetime ban on White House officials lobbying on behalf of a foreign government;
                 SIXTH, a complete ban on foreign lobbyists raising money for American elections.
On the same day, I will begin taking the following 7 actions to protect American workers:
·         FIRST, I will announce my intention to renegotiate NAFTA or withdraw from the deal under Article 2205
·         SECOND, I will announce our withdrawal from the Trans-Pacific Partnership
·         THIRD, I will direct my Secretary of the Treasury to label China a currency manipulator
·         FOURTH, I will direct the Secretary of Commerce and U.S. Trade Representative to identify all foreign trading abuses that unfairly impact American workers and direct them to use every tool under American and international law to end those abuses immediately
·         FIFTH, I will lift the restrictions on the production of $50 trillion dollars’ worth of job- producing American energy reserves, including shale, oil, natural gas and clean coal.
·         SIXTH, lift the Obama-Clinton roadblocks and allow vital energy infrastructure projects, like  the Keystone Pipeline, to move forward
·         SEVENTH, cancel billions in payments to U.N. climate  change programs and use themoney to fix America’s water and environmental infrastructure
Additionally, on the first day, I will take the following five actions to restore security and the constitutional rule of law:
·         FIRST, cancel every unconstitutional executive action, memorandum and order issued by President Obama
·         SECOND, begin the process of selecting a replacement for Justice Scalia from one of the 20 judges on my list, who will uphold and defend the Constitution of the United States
·         THIRD, cancel all federal funding to Sanctuary Cities
·         FOURTH, begin removing the more than 2 million  criminal illegal immigrants from the
country and cancel visas to foreign countries that won’t take them back
·         FIFTH, suspend immigration from terror-prone regions where vetting cannot safely occur.  All vetting of people coming into our country will  be considered extreme vetting.
Next, I will work with Congress to introduce the following broader legislative measures and fight for their passage within the first 100 days of my Administration:
1.  Middle Class Tax Relief And Simplification Act. An economic plan designed to grow the economy 4% per year and create at least 25 million new jobs through massive tax reduction and simplification, in combination with trade reform, regulatory relief, and lifting the restrictions on American energy. The largest tax reductions are for the middle class. A middle-class family with 2 children will get a 35% tax cut. The current number of brackets will  be reduced from 7 to 3, and tax forms will  likewise  be greatly simplified. The business rate will be lowered from 35 to 15 percent, and the trillions of dollars of American corporate money overseas can now be brought back at a 10 percent rate.
2.  End The Offshoring Act Establishes tariffs to discourage companies from laying off their workers in order to relocate in other countries and ship their products back to the U.S. tax-free.
3.  American Energy & Infrastructure Act. Leverages public-private partnerships, and private investments through tax incentives, to spur $1 trillion in infrastructure investment over 10 years.  It is revenue neutral.
4.  School Choice And Education Opportunity Act. Redirects education dollars to gives parents the right to send their kid to the public, private, charter, magnet, religious or home school of their choice. Ends common core, brings education supervision to localcommunities. It expands vocational and technical education, and make 2 and 4 -year college more affordable.
5.  Repeal and Replace Obamacare Act. Fully repeals Obamacare and replaces it with Health Savings Accounts, the ability to purchase health insurance across state lines, and lets states manage Medicaid funds. Reforms will also include cutting the red tape at the FDA: there are over 4,000 drugs awaiting approval, and we especially want to speed the approval of life-saving medications.
6.  Affordable Childcare and Eldercare Act. Allows Americans to deduct childcare and elder care from their taxes, incentivizes employers to provide on-side childcare services, and creates tax-free Dependent Care Savings Accounts for both young and elderly dependents, with matching contributions for low-income families.
7.  End Illegal Immigration Act Fully-funds the construction of a wall on our southern border with the full understanding that the country Mexico will be reimbursing the United States for the full cost of such wall; establishes a 2 -year mandatory minimum federal prison sentence for illegally re-entering the U.S. after a previous deportation, and a 5-year mandatory minimum for illegally re-entering for those with felony convictions, multiple misdemeanor convictions or two or more prior deportations; also reforms visa rules to enhance penalties for overstaying and to ensure open jobs are offered to American workers first.
8.  Restoring Community Safety Act. Reduces surging crime, drugs and violence by creating a Task Force On Violent Crime and increasing funding for programs that train and assist local police; increases resources for federal law enforcement agencies and federal prosecutors to dismantle criminal gangs and put violent offenders behind bars.
9.  Restoring National Security Act. Rebuilds our military by eliminating the defense sequester and expanding military investment; provides Veterans with the ability  to receive public VA treatment or attend the private doctor of their choice; protects our vital infrastructure from cyber-attack; establishes new screening procedures for immigration to ensure those who are admitted to our country support our people and our values
10. Clean up Corruption in Washington Act. Enacts new ethics reforms to Drain the Swamp and reduce the corrupting influence of special interests on our politics.
On November 8th, Americans will be voting for this 100-day plan to restore prosperity to our economy, security to our communities, and honesty to our government.This is my pledge to  you.
And if we follow these steps, we will once more have a government of, by and for the people.
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Well that should keep him busy. Might not be all that good for us and our economy to attack China as he proposes!
David.

Wednesday, November 09, 2016

I Have Seen Some Poorly Researched Articles On Australian E-Health But This One Takes The Biscuit!

This appeared a little while ago:

New Oz eHealth strategy

Article posted on: October 31, 2016
For around two decades, Australia has been working under various governments and schemes to implement a national eHealth strategy – and finally, on 1 July 2016, the new formed Australian Digital Health Agency (ADHA) started operating, reports an article in this month’s HIMSS Insights magazine.
The agency, which is pushing for a wider adoption of electronic health records, spearheads the Commonwealth of Australia’s revised approach to eHealth policy. Australia’s current national eHealth strategy dates back to 2008, reports Cornelia Wels-Maug, in the piece. This strategy consists of several elements, including the implementation of an electronic health record (EHR) system, ePrescribing and dispensing of medication, telehealth programmes for people in remote areas and a national healthcare identifier service that enables healthcare stakeholders to exchange medical information on a specific person. However, the execution of the eHealth strategy across the six states and two territories that constitute Australia has been patchy and, unsurprisingly, each state and territory has meanwhile come up with its own eHealth roadmap. This results in a multitude of individual state and territory systems that operate under different legislation, compliance regimes and do not facilitate a nationwide exchange of information.
Later this year, a new eHealth strategy, the so-called ‘National Digital Health Strategy 2016-19’ will be released. However, details on its content will depend on the incoming government that was elected in July, reports Wels-Maug, although it is widely believed that any government will push an increased use of digital solutions in the healthcare field.
You can read the full story here - Revamping eHealth Down Under
Here is the link:
Given the consultation on the new “National Digital Health Strategy 2016-19” does not end until late January 2017 this has the feel of being a little disconnected from reality.
From the announcement:
“Individuals and groups can attend the face-to-face events, or participate online via the survey at website: conversation.digitalhealth.gov.au.
The survey is open from Thursday 3 November 2016 until Tuesday 31 January 2017 at 5pm AEDST.”
See here:
As for thinking anyone has taken any notice of the 2008 National E-Health Strategy, which was agreed but never had a dollar allocated, in the last five years they are dreaming. It is a sad lonely .pdf and has been so for many years.
Reading the full downloadable story just compounds the errors made. What a farce!
David.

Tuesday, November 08, 2016

It Is Good To See Some Hospital Implementations Sharing Their Experiences! Helps Us All But Self Promotion Not As Helpful.

This appeared last week:

Digital revolution rolling out in hospitals

Authored by  Charlotte Mitchell
TWO Australian hospitals have successfully gone completely digital, and one of the project leaders says there’s no reason others can’t start the process.
Ms Jackie McLeod, project director of the electronic medical record implementation at the Royal Children’s Hospital (RCH) in Melbourne, told MJA InSight that with careful preparation, a digital transformation can have incredible results.
“You have to involve clinicians and executives, and make it the total focus of the organisation. It isn’t easy, but the benefits are there,” she said. “Would a hospital really choose to run on paper forever? To me that’s not acceptable.”
Ms McLeod was commenting on an article published today in the MJA which discussed the digital transformation of the Princess Alexandra Hospital (PAH) in Brisbane over a 2-week period. PAH was chosen as the exemplar site for a Queensland-wide electronic medical records (EMR) program and to become Australia’s first tertiary digital hospital.
The authors said it was a difficult task to transform such a large, diverse organisation and clinicians had valid concerns about the adequacy of training, maintaining hospital workflows and patient safety. Additional training was provided to staff, and software was customised to enable practice across different hospital settings. A patient safety team was also deployed to monitor adverse events.
“Although adverse events continued to occur, we did not detect any significant harm directly attributable to the transformation,” the authors wrote.
They said that with patient records available throughout the hospital, “data from the EMR will be collated to provide rich clinical information to facilitate system improvements”.
Lead author of the article and co-director of clinical service improvement at PAH, Dr Clair Sullivan, told MJA InSight that initially there was widespread disruption of normal hospital workflows. This disruption continued to lessen, yet remains a challenge.
“Digital transformation is the future of health care but it is hard.”
Dr Sullivan said that some of the challenges that remain at PAH included data extraction and pathology workflows, and ongoing work was being done to deal with those issues. There also still needed to be a completion of the clinical workflows with electronic prescribing.
Ms McLeod said that when the RCH decided to go digital, they went to the market for a vendor and selected Epic, a popular system used throughout the United States.
“Unlike [PAH] which has implemented one part of the roll-out, we took the step of implementing everything together,” she said.
What we wanted was a system that went right across the patient journey, not just being digital in one area and not in another. After we signed with Epic, we then went through a 19-month implementation with the whole suite of Epic modules.”
Lots more here:
This article is based on a paper in the Medical Journal Of Australia.

Pioneering digital disruption: Australia’s first integrated digital tertiary hospital

Clair Sullivan, Andrew Staib, Stephen Ayre, Michael Daly, Renea Collins, Michael Draheim and Richard Ashby
doi: 10.5694/mja16.00476
Digital technology now underpins most industries; however, the health care sector (particularly in hospitals) has been slow to transform from traditional paper-based systems of care. In the United States, for example, federal legislation and financial incentives have facilitated the implementation of electronic medical records (EMRs);1 but there are only a handful of advanced EMRs in hospitals outside the US.2 The roll-out of a digital hospital includes an EMR system and other technical components, such as integrated digital vital sign monitoring and digital electrocardiogram (ECG) records. This transformation prompts revolutionary change in the way health care is delivered and monitored.
The enthusiasm for digital transformation in health has been tempered by previous failures, such as some of the unsuccessful EMR installations in the National Health Service in the United Kingdom.3 Digital health care in Australia is well established in primary care and private specialist settings, but so far it has been chequered and controversial in hospital settings, with several independent reviews previously commissioned by government and other bodies.4
There are known adverse consequences and costs accompanying digital transformation of a hospital. These can include poor physician morale, increased frustration and reduced efficiency of care — particularly in the emergency department (ED) and outpatient setting.5,6 Previous EMRs have also struggled to support traditional clinical workflows, with the American College of Physicians calling for EMRs to support the cognitive flow of physicians.7
However, there are many benefits to the installation of an EMR system, which include more efficient and effective care, clinical decision support and a reduction in adverse events.8,9 There is no doubt that digital health care is the future. We describe here the challenging digital transformation of the Princess Alexandra Hospital (PAH) into the first integrated digital tertiary hospital in Australia.

Digital transformation

PAH was chosen as the exemplar site for a statewide EMR program and to become Australia’s first tertiary digital hospital. It is an adult teaching hospital that delivers quaternary level care to a diverse, high acuity patient cohort. PAH has 6529 staff members, 833 overnight beds and cares for over half a million outpatients a year. The aim was to build an integrated digital hospital which provided care across the emergency, inpatient and outpatient settings. Vital sign monitoring and ECGs are digitised and delivered to the EMR via Wi-Fi for immediate viewing. Medications are the only significant component not included in this implementation and are planned for early 2017.
After an 18-month pre-implementation stage, the digital transformation of PAH was achieved using a big bang approach, with digital conversion occurring rapidly over 2 weeks.
Lots more here:
Both these articles make interesting reads and are well worth the time spent.
I am interested regarding the claims in the title that this is a novel innovation in Australia. Having seen all of this at RNSH 2-3 months ago it must be that there has been a major delay in publication. I note also there are a few hurdles in Brisbane to be overcome!
Read all about what I found in August 2016 here:
David.

It Rather Looks Like Staff Security Training At SA Health Needs A Thorough Review.

This appeared a few days ago.

Steve Herczeg’s inquest hears nurse allowed student to record details on electronic system using her password

Andrew Hough, The Advertiser
November 1, 2016 6:57pm
A STUDENT nurse was wrongly allowed to record critical medical observations on a former Socceroo, under a supervising colleague’s name, in an Adelaide hospital’s controversial electronic system, an inquest has heard.
South Australia’s first World Cup qualifying player, Stephen Herczeg, 72, of North Haven, died in agony last month in the Queen Elizabeth Hospital from respiratory failure caused by a ruptured bladder and collapsed lungs.
State Coroner Mark Johns is conducting an urgent inquest into the “catastrophic”, but mysterious circumstances, surrounding the September 19 death.
Mr Johns has heard how Mr Herczeg, a Hungarian-born grandfather known as “Steve”, died when his catheter bag was mistakenly connected to “high-flowing” oxygen tubes pumping 15l of air a minute.
The inquest has heard this was caused by a series of hospital mistakes, although police have speculated he may have caused his own death through “delirium”, based on a senior’s doctors comments.
On Tuesday in the Coroners Court, registered nurse Waitmatai Fiorentino admitted to a series of care errors as she oversaw his “handover” from the emergency department to a general ward.
Ms Fiorentino, a former administration officer who had been in her role since April, admitted she had wrongly allowed a student nurse to record key details in the hospital’s electronic system, EPAS, using her password.
More here:
What this bit of the awful saga makes clear is that the Allscripts implementation of ePAS is flawed. Adding information to an electronic health record should be protected by user log-ons being covered by at least two security factors and sensible time-outs of a few minutes so there can be some confidence as to who exactly it is who is recording information.
As the push to electronic records accelerates, and courts have to rely more and more on these records, the consequences of not having staff properly trained as to their responsibilities (and decent security)  will have both clinical and medico-legal consequences.
After this evidence it seems clear some serious policy and technical change seems to be required in S.A. with the ePAS.
I note in passing Allscripts does not seem to be going all that well although it is still a pretty big compny:

Allscripts Q3 Results

Allscripts posts Q3 results: revenue up 11 percent, adjusted EPS $0.14 vs. $0.13, missing analyst expectations for both. The company also issued disappointing earnings guidance.
Allscripts shares are down 17 percent in the past year and have dropped 44 percent in the past five years. The company’s market value is $2.16 billion.
Netsmart contributed $38 million in revenue for the quarter. Allscripts and a private equity firm acquired the behavioral EHR vendor in April 2016 for $950 million and merged it with the homecare software business of Allscripts with the expectation of generating $250 million in annual revenue and $60 million in annual profit, although the Allscripts ownership stake was not specified. Netsmart acquired LTPAC EHR vendor HealthMEDX on October 27, 2016 for $36.3 million in cash.
 Here is the link:
It will be interesting to hear what the Coroner recommends.
David.