Quote Of The Year

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

or

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

Tuesday, January 24, 2017

Here Is The Sort Of Boundary The ADHA Strategic Planning Process Needs To Address.

Just coincidentally we had some interesting related releases last week.
First we had from ADHA the following pair.

National Medicines Safety Program Established

Created on Thursday, 19 January 2017
The Australian Digital Health Agency is pleased to announce the establishment of a new national Medicines Safety Program.
The Agency’s Executive General Manager Clinical and Consumer Engagement and Clinical Governance, and Chief Clinical Information Officer Dr Monica Trujillo said the program will work with consumers and healthcare providers to explore how digital health can improve the safety and quality of medicines usage in Australia.
Dr Steve Hambleton, former president of the Australian Medical Association and one of Australia’s most respected authorities in digital health has been joined by Mr Steven Renouf, former rugby league star and dedicated advocate for Aboriginal health as Program Co-Sponsors.  Mr Neville Board will represent the Australian Commission on Safety and Quality on Health Care (ACSQHC).
“Evidence from research into medication safety indicates that significant patient harm and sub-optimal use of medicines frequently result from the discontinuity that occurs when patients visit different healthcare providers.  Digital health can help address this,” said Dr Hambleton.
Mr Steven Renouf developed Type 1 Diabetes while at the peak of his sporting career and also has four children with diabetes. A Deadly Choices ambassador encouraging Aboriginal and Torres Strait Islanders to get health checks, Mr Renouf is well aware of the health issues facing the Indigenous population.  
“We need to find ways to help people manage their medicines better, particularly in communities that need it the most.”
Here is the link:
There are also more details available.

Establishment of Medicines Safety Program January 2017

The Australian Digital Health Agency is pleased to announce the establishment of a new Medicines Safety Program.
Good medicines management can help to reduce the likelihood of medication errors and hence patient harm. The Program is designed to improve the access and quality of medicines information through the use of digital health, enabling consumers and healthcare providers to make safe, informed decisions and achieve better health outcomes.
The Program’s Executive Sponsor is Dr Monica Trujillo, the Agency’s Executive General Manager Clinical and Consumer Engagement and Clinical Governance, and Chief Clinical Information Officer.  The Agency welcomes the Programme Co-Sponsors Dr Steve Hambleton and Mr Steven Renouf who will advocate the interests of clinicians and consumers, and Mr Neville Board representing the Australian Commission on Safety and Quality in Health Care (ACSQHC).  
The first Steering Group meeting took place in Sydney on Thursday 8 December 2016 with 27 members in attendance representing a range of healthcare peak bodies and consumer groups.  The group will meet quarterly.  A full list of Steering Group members is at the end of the Communique.    
The Program has four primary objectives:
  1. Undertake and validate an environment scan of all the current and planned digital activities that support access to safer medicines; identify opportunities for improved coordination, collaboration, and investment.
  2. Identify existing Agency projects that should be governed by the Medicines Safety Programme to ensure coordination and prioritisation based on the target outcomes, dependencies, and interdependencies.
  3. Identify new priority projects or activities, through consultation with the healthcare sector, which should be delivered directly by the Agency or through partnerships with other organisations. This will include the investigation of any short-term opportunities for improvement identified through the National Digital Health Strategy consultation, which should be included in the Agency work plan.
  4. Develop an evidence-based, sector-wide digital Medicines Safety Programme roadmap, including a benefits realisation plan to monitor progress of both adoption and outcomes.
In the short term, the group will engage with consumers and clinicians on enhancing medicines management use and capability in the My Health Record system.
Steering Group members
  • Australian Commission on Quality and Safety in Health Care 
  • Pharmacy Guild of Australia
  • The Pharmaceutical Society of Australia
  • The Society of Hospital Pharmacists Australia
  • Australian Private Hospitals Association
  • Australian Nursing and Midwifery Federation 
  • Pharmaceutical Benefits Branch (Commonwealth Department of Health)
  • Therapeutic Goods Administration
  • NPS MedicineWise
  • Australian Medical Association
  • Royal Australian College of General Practitioners
  • Royal Australasian College of Physicians
  • Medical Software Industry of Australia
  • Australian College of Rural and Remote Medicine 
  • Jurisdictional representatives
  • Aged and Community Services Australia 
  • Consumer Health Forum
  • Academic(s)
Here is the link:
At almost the same time this appeared.
ASX ANNOUNCEMENT
16 January 2017
Quarterly Activities Report and Appendix 4C        
Highlights
·       Record operating cash receipts for the quarter, totalling $1.32 million, an increase of 77% on the September quarter ($0.75 million)
·       Strong operational performance across all key metrics
o   Over 600,000 users on the MedAdvisor platform as at 31 December 2016, an increase of over 160% since September 2016
o   Over 45% of Australian pharmacies connected to the platform (30% in September quarter 2016)
o   Patient Engagement Programs (PEPs) experienced rapid traction, closing the quarter with 18 medications using the platform across 9 of Australia’s largest pharmaceutical companies including Pfizer, GSK, AstraZeneca, Novartis & Bristol-Myers Squibb
o   Increased the number of General Practitioners (GPs) benefiting from the platform to nearly 4,000 GPs
o   Tap-to-Refill script ordering function processing an average of $2.5 million in script refill value per week
·       Completion of $8 million oversubscribed capital raising receiving strong  participation from leading Australian financial institutions and pharmacy groups
·       Completion of Healthnotes acquisition, significantly enhancing the MedAdvisor offering and expanding market share
·       Key partnership agreements with Asthma Australia and Osteoporosis Australia, plus extended existing relationship with Bupa into certain Healthscope Hospitals
MedAdvisor Limited (ASX: MDR, the Company), Australia’s leading digital medication management company, has today released its Appendix 4C Report for the three-month period to 31 December 2016 and is pleased to provide a review of the progress during the period.
Financial & Corporate
During the quarter, the Company reported total operating cash receipts of $1.32 million, a 77% increase on the previous September quarter ($0.75 million) The increase was driven by significant growth across all key metrics in the platform, including the number of pharmacies, the number of patients using the platform and a rapid increase in collections from Patient Engagement Programs (PEPs).
Net operating cash outflows for the quarter totalled $0.77 million, compared to the previous September quarter which reported net operating cash outflows of $0.71 million.
The Company closed the quarter with $5.93 million in cash.
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There is a lot more information on the website.
As you can see the company is providing an app to assist people manage their medications and have a pretty large number of patients, pharmacies and GPs involved.
Exploring the web-site is well worthwhile:
The overlap is obvious and I am sure there are other companies also in this area as well.
Surely an important part in the planned strategy is to work out how the ADHA can work with these companies to not re-invent the wheel while at the same time not get in their way.
Government (and agencies) have a poor record in this public / private domain and it would be good if the well-known mistakes made by NEHTA are not repeated.
I hope this paragraph does not presage a closed mind approach to medication management.
“In the short term, the group will engage with consumers and clinicians on enhancing medicines management use and capability in the My Health Record system.” This does not sound good to me, given the variety of options available!
David.

Monday, January 23, 2017

Weekly Australian Health IT Links – 23rd January, 2017.

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

General Comment

It seems the silly season has shrunk a little – with quite a lot seemingly happening.
A new minister, Telstra Health out spruiking its wares and all sorts of steps in medication management – both public and private.
Enjoy the browse.
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Govt proposing automation for health dept

The Australian Government is proposing to extend the use of automation based on big data, to the health department, even though its efforts to do the same with Centrelink have not exactly been a success.
An amendment proposed to the National Health Act of 1953 would, "enable the minister, the secretary or the Chief Executive Medicare to arrange for the use of computer programs to make decisions and determinations, exercise powers or comply with obligations and do anything else related to those actions".
It would also "enable approved pharmacists whose premises have been affected by disaster or exceptional circumstances to supply pharmaceutical benefits at alternative premises in the same locality for a limited period and be paid for claims at the full rate; and ensure that entitlements for concessional beneficiaries and their dependants will apply for pharmaceutical benefits until midnight on the day of a person’s death".
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A quick guide to Greg Hunt, the new health minister

18 January 2017
Former lawyer and long-time Liberal politician Greg Hunt has officially been named Health Minister in the wake of Sussan Ley’s implosion amid an expenses scandal.
Here are 10 things to know about him:
·         He was born into a political family in Melbourne in 1965. His father, Alan, was a member of the Victorian parliament for more than 30 years.
·         He attended Melbourne Law School, where he captained the Australian Universities Debating Team while working casually as a steelworker, fruit picker, waiter and storeman and packer. He became an associate to the Chief Justice of the Australian Federal Court in 1992.
·         He subsequently attended Yale University as a Fulbright Scholar, obtaining a Master of Arts in International Relations.
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Arthur Sinodinos claims innovation as Turnbull reshuffles cabinet again

Cabinet secretary Arthur Sinodinos has been announced as the country's new minister for Industry, Innovation and Science.
By Asha McLean | January 17, 2017 -- 23:51 GMT (10:51 AEDT) | Topic: Innovation
Australian Prime Minister Malcolm Turnbull has announced new changes to his ministry, following the resignation of Health Minister Sussan Ley last week, amid concerns over her travel expenses.
Former Minister for Industry, Innovation and Science Greg Hunt has now moved into the health minister role, with Arthur Sinodinos taking on the vacated innovation portfolio.
Sinodinos is currently a senator representing New South Wales, and was previously former prime minister John Howard's senior economic adviser and chief of staff. Sinodinos was acting in the health minister role immediately following Ley's resignation.
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18 January, 2017

My Health Record ‘threat to public trust’

Posted by Julie Lambert
The Australian government is endangering trust in the My Health Record system by failing to reveal its full list of objectives and obtaining patients’ consent.
This is the conclusion of Professor Danuta Mendelson, Deakin University’s Chair of Law (research) and law lecturer Gabrielle Wolf, writing in the Journal of Law and Medicine last month.
In their analysis, the MrHR system falls short of its statutory objectives such as overcoming the fragmentation of healthcare, but the intentions of successive governments in advancing eHealth records have gone far beyond the reasons set out in the statutes.
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Qld health service expects to save millions with telehealth

By Paris Cowan on Jan 17, 2017 6:31AM

Aussie-first deployment targets most frequent visitors.

For someone who suffers from a chronic disease, the local hospital can become an unwanted second home.
The burden of regular visits to doctors and specialists can easily compound an already debilitating medical condition.
For hospital operators, the cost of treating frequent visitors outstrips the price of all other patients combined.
This is why Queensland’s West Moreton Health and Hospital Service decided chronic disease sufferers should top its priority list for a personalised telehealth push, which it has dubbed MeCare.
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  • Updated Jan 19 2017 at 11:00 PM

Telstra aims to turn e-health into a healthy earner

Telstra is aiming to make e-health a material contributor to earnings in the long-term and is taking its health business into the next stage of development, group executive of new business Cynthia Whelan said.
After a launch nearly two years ago, there has been little noise from the division and Ms Whelan admitted there has not been a lot of clarity around Telstra Health's progress and what the plans for the division are.
"We've completed that acquisition phase of the business, now we're moving into the integration phase," Ms Whelan told The Australian Financial Review.
"We've now amassed a portfolio of foundational companies."
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The pitfalls of taking clinical photos on your phone

16 January 2017
Technology often evolves faster than the law — and this is as true in healthcare as it is in many other industries.
One example is the in-built camera in your smartphone. Phone cameras, with increasingly high resolution, are taking off as a clinical tool, allowing doctors to photograph symptoms without waiting for professional clinical photography units, according to a recent article in the Medical Journal of Australia.
GPs can photograph skin lesions, for example, and send the photos to a dermatologist for their opinion.
But without a clear medicolegal framework, doctors who do this could be asking for trouble, say the researchers from Australia and Qatar.
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National Medicines Safety Program Established

Created on Thursday, 19 January 2017
The Australian Digital Health Agency is pleased to announce the establishment of a new national Medicines Safety Program.
The Agency’s Executive General Manager Clinical and Consumer Engagement and Clinical Governance, and Chief Clinical Information Officer Dr Monica Trujillo said the program will work with consumers and healthcare providers to explore how digital health can improve the safety and quality of medicines usage in Australia.
Dr Steve Hambleton, former president of the Australian Medical Association and one of Australia’s most respected authorities in digital health has been joined by Mr Steven Renouf, former rugby league star and dedicated advocate for Aboriginal health as Program Co-Sponsors.  Mr Neville Board will represent the Australian Commission on Safety and Quality on Health Care (ACSQHC).
-----

Establishment of Medicines Safety Program January 2017

The Australian Digital Health Agency is pleased to announce the establishment of a new Medicines Safety Program.
Good medicines management can help to reduce the likelihood of medication errors and hence patient harm. The Program is designed to improve the access and quality of medicines information through the use of digital health, enabling consumers and healthcare providers to make safe, informed decisions and achieve better health outcomes.
The Program’s Executive Sponsor is Dr Monica Trujillo, the Agency’s Executive General Manager Clinical and Consumer Engagement and Clinical Governance, and Chief Clinical Information Officer.  The Agency welcomes the Programme Co-Sponsors Dr Steve Hambleton and Mr Steven Renouf who will advocate the interests of clinicians and consumers, and Mr Neville Board representing the Australian Commission on Safety and Quality in Health Care (ACSQHC).  
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Let’s kill the Australian identity card zombie once and for all

January 17, 2017 11.33am AEDT

Author Bruce Baer Arnold

Assistant Professor, School of Law, University of Canberra
Some policies are like zombies – toxic, frightening, defiantly unkillable. They reappear, even though they aren’t useful and aren’t pretty. Pauline Hanson’s call for a national identity card is one of those zombies.
The One Nation leader has been calling for a networked biometric card for people who interact with the national government. Put simply, that is most citizens. The card will supposedly significantly reduce fraud by non-citizens who are resident in Australia.
Statements about the card are confusing. Presumably it is meant also to reduce entitlement fraud by citizens – a focus of the current Centrelink debacle – and provide definitive proof of identity in dealing with state or local government and the private sector.
Past enthusiasts for a national identity card, claiming “if you have done nothing wrong you have nothing to fear”, have suggested a “must carry” regime. People would be expected to take the card with them when they use public transport, walk the dog, visit granny, go shopping or otherwise step outside. The card would be the default proof of identity in private sector transactions, stronger than the easily forged driver licence photo cards that are the standard ID for most adults.
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Landmark Australian ruling on what counts as 'personal information'

By Paris Cowan on Jan 19, 2017 12:06PM

Privacy Commissioner knocked back in metadata case.

A full bench of the Federal Court has today handed down a hotly awaited judgment on its interpretation of Australian privacy law, and what qualifies as personal information.
It has served a rebuff to Australian Privacy Commissioner Timothy Pilgrim, who has been fighting to secure a broad definition of personal information in the courts, to ensure that everything that could reasonably be used to identify an individual will fall under the protection of the Privacy Act.
But federal court judges today dismissed the commissioner's appeal, siding with Telstra and the Administrative Appeals Tribunal over whether the telco needs to hand a full suite of telecommunications metadata over to Telstra customer and former Fairfax journalist Ben Grubb, under the personal information access provisions of the Act.
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Pharmacy must be integral in Health Care Homes

Pharmacy needs to be a key part of Health Care Homes if the initiative is to succeed

The Pharmacy Guild said today that it strongly supports the Federal Government’s Health Care Homes primary care reforms, but pharmacists must play a strong role.
Guild National President George Tambassis says the HCHs provide the opportunity to move towards a more integrated and coordinated approach to meeting the primary care needs of patients with complex, chronic health conditions.
But “in order for the HCHs to succeed in delivering better, more cost-effective health outcomes for patients with complex needs, it is imperative that their community pharmacy is an integral part of the primary care team,” Mr Tambassis said.
“More than any other healthcare professional, the community pharmacist is responsible for ensuring that patients are adherent with their medicines and that their medication-related needs are being met. 
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Successful openEHR EHR implementation featured in WHO eHealth report

January 07, 2017  |  from: Heather Leslie
In Australia, the Northern Territory's My eHealth Record service has been featured as the only example of a successful electronic health record (EHR) implementation in a newly published WHO report on eHealth - a great win for the openEHR community as the EHR is underpinned by an openEHR platform.
The whole of  the report, 'Global diffusion of eHealth: making universal health coverage achievable - Report of the third global survey on eHealth' makes interesting reading, but focus on page 106 for the openEHR-related case study.
This  follows a very positive evaluation report, commissioned by NEHTA (now the Australian Digital Health Agency' and completed in August 2015, about the same My eHealth Record service. Importantly, the report stated:
"For the first time in Australia, we have strong evidence of the benefits of eHealth records in bridging the gaps in information that occur as patients move between different healthcare providers in the public and private sectors."
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Case Studies

OceanEHR platform - NT Health, Australia

Published: 16 August 2016

Demonstrates: a secure way of sharing an individual’s healthcare information between care providers

Project:
My eHealth Record - a territory-wide shared electronic health record
Background:
The Northern Territory Department of Health provides health care to all territorians across the vast, remote geographical area of the northern Australia, including servicing the health needs of the indigenous community.
Goals:
  1. To store structured atomic clinical data in a shared Electronic Health Record;
  2. To enable decision support;
  3. To enable advanced care planning;
  4. To consolidate health information using a common data structure; and
  5. To address identified inadequacies in security, access control and privacy management.
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AMA defends its pharmacy trial

13 January, 2017 
AMA Victoria has defended its role in a controversial trial allowing pharmacists to change medication doses, issue repeat scripts and perform point-of-care tests.
The Victorian Government has opened applications for an 18-month pilot where pharmacists will monitor and refine the medication regimen of patients with asthma, hypertension and hypercholesterolaemia, as well as those on anticoagulation medications.
Before the trial begins, the government will train the pharmacists involved to perform blood pressure, spirometry, INR and lipid panel tests.
It is being stressed that the pharmacists will work according to a shared care plan drawn up by the patient’s GP who will also take an active role in the pilot.
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Meet Qld Health's five new technology execs

By Allie Coyne on Jan 18, 2017 10:38AM

Still no fill for long-vacant CIO role.

Queensland's Health department has recruited five new executives into its eHealth Queensland technology arm to turn around the agency's IT fortunes and drive "digital transformation" into healthcare in the state.
The department has welcomed a new chief technology officer, chief digital strategy officer, chief customer experience officer, chief solution delivery officer, and executive director of corporate services.
All report into interim eHealth Queensland CEO and departmental CIO Mal Thatcher. The agency has been searching to recruit permanently into the position since July last year, following the departure of Colin McCririck to IBM in the US. It today was unable to give an indication of when that role will be filled.
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Reducing medication errors in hospital discharge summaries: a randomised controlled trial

Erica Y Tong, Cristina P Roman, Biswadev Mitra, Gary S Yip, Harry Gibbs, Harvey H Newnham, De Villiers Smit, Kirsten Galbraith and Michael J Dooley
Med J Aust 2017; 206 (1): 36-39.
doi: 10.5694/mja16.00628
Abstract
Objectives: To evaluate whether pharmacists completing the medication management plan in the medical discharge summary reduced the rate of medication errors in these summaries.
Design: Unblinded, cluster randomised, controlled investigation of medication management plans for patients discharged after an inpatient stay in a general medical unit.
Setting: The Alfred Hospital, an adult major referral hospital in metropolitan Melbourne, with an annual emergency department attendance of about 60000 patients.
Participants: The evaluation included patients’ discharge summaries for the period 16 March 2015 – 27 July 2015.
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‘Precision medicine’ promises new hope for cancer sufferers

  • The Australian
  • 3:00AM January 17, 2017

John Ross

A shift from mass to personalised medicine promises new hope for cancer sufferers and health authorities, improving patients’ quality of life and saving health budgets billions of dollars by averting perilous and ultimately pointless operations.
A proof of concept study has given the tick of approval to “precision medicine”, which harnesses genomic “knowledge banks” to tailor individualised treatments based on the experiences of thousands of earlier patients.
Scientists reanalysed genetic data from more than 1500 leukaemia sufferers confronted with a harrowing choice: reduce the risk of relapse with a dangerous stem cell transplant or stick to safer but less effective chemotherapy.
It found a precision medicine approach would have changed treatment of about one-third of the patients, slightly boosting survival rates and cutting the number of transplants, while leaving survivors with fewer side-effects.
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Christian Porter, Chris Bowen, Cory Bernardi are among victims of internet security breach

January 17, 201712:26pm
Staff writers News Corp Australia Network
PRIME Minister Malcolm Turnbull has ordered a report from his top cyber security adviser on a Yahoo data breach amid claims more than 3000 Australian government officials — including a federal minister — had private data stolen.
The Prime Minister confirmed he had not been a victim of the massive 2013 Yahoo data breach that has reportedly involved Australian diplomats, Defence officials and high-profile politicians.
Mr Turnbull said, based on what he had seen in news reports, it was unlikely there would be security issues with the politicians whose emails had been hacked.
Social Services Minister Christian Porter, Shadow Treasurer Chris Bowen, Victorian Premier Daniel Andrews, Liberal MP Andrew Hastie, Shadow Health Minister Catherine King and Liberal senator Cory Bernardi were among the victims of the hacking, ABC reports.
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Malcolm Turnbull orders inquiry into theft of ministers’ data

  • The Australian
  • 12:00AM January 18, 2017

Kylar Loussikian

Malcolm Turnbull has ordered a review into data stolen from senior MPs and thousands of public servants as part of a wider leak ­revealed last month by Yahoo.
But the Prime Minister said the hacked accounts related to a time before the Coalition was elected and it was “very unlikely” there would be security issues.
“It begs the question as to ... what was in those accounts and clearly in terms of classified ­government information can only be transmitted or used on approved government communication ­systems,” Mr Turnbull said. “We don’t take any of this stuff lightly or complacently and I’ll be getting a report on this from my cyber adviser, Alastair MacGibbon.”
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2017 should be the year of privacy – healthy paranoia obligatory

If one issue dominated the headlines last year it was Internet privacy – specifically the lack thereof. It was not just the tech giants collecting masses of information via telemetry, search, email, calendars, and document snooping but the massive data breaches of Yahoo! and others that shook our faith in using the Internet, trusting email, and trusting household technology names.
I don’t intend to go into the details – there are 851 million search articles that cover that all too well but I would like to help iTWire readers “walk softly and leave a smaller digital footprint".
The first thing to remember is that there is no inherent, inalienable concept of online privacy – the ability to separate and control sensitive information about yourself (privately identifiable information or PII). There are certain protections about what you do in the privacy of your home, but almost all countries have laws that limit online privacy. It seems that the overlap between privacy and secrecy (concealing information that others might use to their advantage) has led to a one-size-fits-all approach. So it's all up to you!
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ASX ANNOUNCEMENT
16 January 2017

Medadvisor - Quarterly Activities Report and Appendix 4C        

Highlights
-       Record operating cash receipts for the quarter, totalling $1.32 million, an increase of 77% on the September quarter ($0.75 million)
-       Strong operational performance across all key metrics
o   Over 600,000 users on the MedAdvisor platform as at 31 December 2016, an increase of over 160% since September 2016
o   Over 45% of Australian pharmacies connected to the platform (30% in September quarter 2016)
o   Patient Engagement Programs (PEPs) experienced rapid traction, closing the quarter with 18 medications using the platform across 9 of Australia’s largest pharmaceutical companies including Pfizer, GSK, AstraZeneca, Novartis & Bristol-Myers Squibb
o   Increased the number of General Practitioners (GPs) benefiting from the platform to nearly 4,000 GPs
o   Tap-to-Refill script ordering function processing an average of $2.5 million in script refill value per week
-       Completion of $8 million oversubscribed capital raising receiving strong  participation from leading Australian financial institutions and pharmacy groups
-       Completion of Healthnotes acquisition, significantly enhancing the MedAdvisor offering and expanding market share
-       Key partnership agreements with Asthma Australia and Osteoporosis Australia, plus extended existing relationship with Bupa into certain Healthscope Hospitals
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Pensioners and disabled next in line in Centrelink robo-debt campaign

Noel Towell
Published: January 17, 2017 - 10:10AM
The Coalition government is going to target more than 3 million of elderly and disabled Australians with its controversial Centrelink "robo-debt" campaign, Parliamentary documents show.
The mid-year economic forecast tables published last week shows the government has booked savings of $1.1 billion from data-matching the aged pension and another $400 million from the disability support pension.
The move will bring more than 3 million more Australians into the sights of the data-matching program, which uses an automated system to match information held by Centrelink and the Australian Taxation Office and calculate overpayments.
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Enjoy!
David.

Sunday, January 22, 2017

Draft Strategy Submission for Comment - 22 January, 2017

National Digital Health Strategy - Submission - DG More - January 2017

Introduction

The following submission has been prepared to offer some commentary and input to the Strategy process, now underway, and to assist in the ongoing development of the National Digital Health Strategy.
With experience of over a decade of preparing such submissions I have to say the submission is provided in hope rather than based on past experience of making any difference!

Author Of Document

This document is authored by Dr David G More MBBS BSc(Med) PhD FANZCA FCICM FACHI.
I have had over 20 years involvement, in one form or another, in the area of Health Information Technology (e-Health) and been a contributor to many projects in the area including a role in the development of the 2008 National E-Health Strategy and discussions on the 2014 Update.
I am reasonably well known in Health IT circles as the author of a blog on Health IT (www.aushealthit.blogspot.com) which has now been in operation continuously since 2006 and I have been widely quoted in the professional clinical press, the national press and in reports published by the Parliamentary Library.
I have no direct financial interests in any entities involved in Australian Health IT and receive no payments from the work I undertake with respect to the blog.
Over the last 4-5 years I have made submissions in the Health IT domain when requests for such submissions have been made by Government and these are available on the DoH website (www.health.gov.au).

Purpose Of This Document

I wish to provide comments on three aspects of the current consultation.
First I wish to point out that the process is deeply flawed for a number of reasons. Among these are:
1. There has not been an appropriate detailed knowledge base provided to those being consulted to permit informed decision making. At the very least those consulted should have been provided with:
a. A comprehensive review of what is happening in the Digital Health Domain overseas with a review of what has been shown to make a positive difference in terms of either cost, quality, safety or patient satisfaction.
b. A comprehensive review of the current status of the Digital Health Domain in Australia and what has been shown to work (or not) in Australia.
c. A review of the current Digital Health Capabilities and Workforce with deficiencies clearly identified.
d. An economic review of expenditure at a State and Federal level on Digital Health over the last decade and the benefits received for that expenditure.
2. An implicit assumption that seems to be built into virtually all documentation that Digital Health is ‘good’ and we just need to improve to make all right. I conducted a poll on this assumption a little while ago and the outcome was interesting.
AusHealthIT Poll Number 352  – Results – 16th January, 2017.
Here are the results of the poll.

Is The ADHA Correct In Assuming That 'National Digital Health' Is A 'Good Thing' And All We Need To Do Is Work Out How To Do It Correctly And Get On With It?

Yes 21% (22)
No 58% (62)
ADHA Does Not Assume Digital Health Is A Good Thing 0% (0)
I Have No Idea 21% (22)
Total votes: 106
 3. Despite the enormous cost and almost non-existent clinical utilisation of the myHR, there appears to be an implicit assumption that this program is vital and central the Health Care Service Delivery (which it is clearly not).
In summary, the consultation is being conducted based on a combination of relative ignorance, feel good assertions and an absence of evidence of real impact or utility.
Second I believe there is no credible plan being put forward by ADHA and the bureaucracy as to just what needs to be done to move from the present myHR dominated environment to a future state that addresses the real needs of patients and clinicians as a priority, rather than serving the bureaucratic needs to gather detailed personal health information in a centralised database for purposes that are barely disclosed.
As I commented very recently on the call for input:
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In that vein it the second paragraph that stands out.
“ (Quoting ADHA) There’s nothing more important than our health and the health of those we care about. Putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them can help Australians live healthier, happier and more productive lives.”
I am sure all who read here will be well aware of the risk of making ‘sweeping generalisations’, and that somehow glossing over detail a false impression can be created. When this impression leads to government expenditure on a grand scale then we all have a problem.
So stepping back, obviously, appropriately used data and information is crucial for the proper operation of the health system in most aspects from research to patient care etc. Think everything from research management systems to patient management and scheduling systems. Trying to do without these systems would clearly be a waste of time and money – if not impossible – think the management of major clinical trials to the optimisation of patient flow in a major hospital – all basic stuff that, if it did not work, no one would pay for and use it!
Equally there are a zillion technologies that are vital from MRI Scanners and drug discovery to the various monitoring systems that track our patient’s progress. The evidence that these technologies do / have make a positive difference is well documented.
But the ADHA is not interested, as far as I know, with all this. Their interest is in patient specific information and how it is shared and communicated by digital systems and this is where we hit a problem with evidence as well as all the other issues of safety, privacy and so on.
There is no doubt that a well-designed GP System can improve the quality and safety of what the GP does with and individual patient and make it easier to follow a patient’s clinical journey and treatment. There is good evidence to this as well as much evidence that current systems are by no means perfect and still need more work.
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Equally there is decent evidence supporting the deployment of clinical systems in Hospitals and specialist and allied health practices and well as linking them with information providing systems (pathology, radiology etc.).
Where evidence is lacking and history is littered with failures are large national, all things to all men (and women) health system initiatives that centralise information at national scale.
Third, and rather bringing the above two threads together there was a valuable contribution from ACHI to the earlier call for input – in April 2016. I quote a recent blog:
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In response to a draft National Digital Health Strategy made available in April, 2016 ACHI produced some excellent suggestion that are well worth discussion.
This was in the form of some specific and actionable recommendations to Government. These were:
“Recommendation 1: That the strategy reference and benchmark Australian activity with international comparisons.
Recommendation 2: That the strategy properly outline existing activity and lessons learned from outputs from the 2008 strategy and other initiatives.
Recommendation 3: That the strategy outline clearly and unambiguously the problems that it is trying to solve, with specific objectives and indicators for success.
Recommendation 4: That the strategy be properly supported by an evidenced business case for its recommendations.
Recommendation 5: That the strategy outline an informative and comprehensive approach to clinical governance, data and information governance, quality and safety.
Recommendation 6: That the strategy define an approach to development of a strong and highly competent informatics workforce.”
Just wandering around asking people what they want and what their aspirations are is really not the way. What is needed is a defined process of research, information gathering from the front line and a hard-nosed look at what works, what is safe, what is reasonable and what has measurable benefits.
The issue is to then define an idea ‘future state’ and work out how to get there from here!
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Recommendation.

Overall I believe the consultation process to date has been the ‘soft / easy’ part! What is needed now is the ‘hard’ rigour of an evidence based planning process, conducted by real experts, that wins broad patient and clinician acceptance. My take is that ADHA is not even 1/3 of the way there so far and needs to seriously expand the scope, range and depth of what they are doing, if anything useful is going to be delivered. Overall much more detailed evidence-based work and consultation is needed if the whole effort is not to be both flawed and wasted.
Note: I believe this view is confirmed by the recent summary of the findings to date in the Strategy Process which was  published last week:
A Final Crucial Point.
A last and crucial comment is to point out that the Australian Health System is, at an extreme simplification, a public hospital system run by the States and a private clinical delivery system which operates to a large extent separately from Government – except to charge what it chooses – for the services provided. Clinical services are actually delivered – outside Public Hospitals – by a large number of private (usually) small businesses.
A core issue for the Strategy development process is therefore to work out just where a Commonwealth National Digital Health Entity actually fits and just what it should be doing – and more importantly what it should NOT be doing. Sorting this out will be fundamental to the success of any proposed Strategy. At present the raison d'être of the ADHA is not at all clear.
In summary, we need to know just where ADHA fits and just what it should be doing with the enormous resources it seems to have available to actually deliver health improvement for the Australian population, at a level beyond the feel-good motherhood statements so typically trotted out.
22/01/2017

AusHealthIT Poll Number 354 – Results – 22th January, 2017.


Here are the results of the poll.

How Confident Are You Greg Hunt Will Make A Good Health Minister - Especially Regarding The myHR?

Very Confident 2% (1)

Confident 4% (2)

Neutral 51% (23)

Not Really Confident 27% (12)

He Is A Bad Choice 13% (6)

I Have No Idea 2% (1)

Total votes: 45

It seems readers are taking a ‘wait and see’ approach to the new Federal Health Minister.

A good turnout of votes for just a few days.

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

David.