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, March 14, 2017

I Get The Feeling There Are Some Real Gaps In The Evidentiary Approach Being Adopted by The ADHA Strategy Team.

The following is an extract from the following document

Board Meeting 25 January 2017 - Board Papers (Download)

Finalising the strategy and building the evidence base

While consultation continues through January, the project team is transitioning to developing the Strategy and substantiating it with a credible evidence base. We will do this by leveraging leading local and global research on digital innovation, analysing jurisdictional and Australian Government priorities, commissioning targeted evidence reviews, as well as talking with digital innovation experts across the private sector, academia and research institutions. The team is also undertaking structured interviews with Policy leaders in federal and state governments with both health and complimentary (social services) portfolios.
Attachment C sets out the approach to gathering and synthesizing evidence to support the Strategy.
Through synthesis of findings and insights, the Agency is defining the strategic priorities and initiatives to meet the needs identified through the national consultation.
From February 2017, the Agency will commence co-design of the strategic initiatives in collaboration with experts from industry, the science community, clinicians, and healthcare provider organisations. The collaborative design of the strategic initiatives is key to the success of the Strategy, as it will determine whether the Strategy receives commitment from the very people and organisations who need to support and help deliver on the strategic initiatives.
Key stakeholders who will play a substantive role in delivering the strategic initiatives in the Strategy will be presented the Agency’s assessment of the strategic choices and initiatives to prioritise based on the consultation findings, and will have the opportunity to provide input.
The activities to support this process include:

  • an Industry Stakeholder forum with senior representatives from the digital health industry and associations;
  • a Clinical and Consumer forum to be held through partnerships with peak bodies, via a webinar, to broaden reach of feedback; and
  • online polls focusing on the priority areas on conversation.digitalhealth.gov.au.

The first paragraph seems to be all focussed on digital innovation but not to be gathering evidence on Health IT and where it has been shown to work (or not) and what needs to be done to achieve success.
Health is only involved, it would seem, in government entities  being interviewed for requirements?
My view: unless there is a very deep dive into Health IT globally and locally and a clear eyed assessment of where we are right now the Strategy will be a wind driven ‘thought bubble’ un-attached to the ground (reality). Provision on-line of Attachment C of Item 6.1 of the Board papers - the research methodology - would be a good thing I believe
I really hope I am missing something because there is not much time left to get it right! I await the planned activities with considerable interest and hope my concerns are not justified!
David.

Monday, March 13, 2017

Weekly Australian Health IT Links – 13th March, 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

The big news of the week was the commencement of the process to replace the Medicare Payment Systems – which are presently on the edge of failure! Hope it can be done in time and not be typical of other Government IT efforts!
Lots of other material as well – enjoy!
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Facebook-like app might be start of patient connectivity revolution

Posted by Jeremy Knibbs
6 March, 2017
The launch of a relatively simple-looking patient app by Precedence Health Care could be the start of the connected-patient revolution that will fundamentally alter the way medicine is practised in Australia.
Called MediTracker, the smartphone app can connect, in a Facebook-like manner, a patient with their GP, and all surrounding allied-health professionals, in real time.
It can provide patients in Australia, for the first time, with a live and mobile medical record, and a means to manage most points of their clinical care in the one place.
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Govt opens pitches for Medicare payments system replacement

By Paris Cowan on Mar 6, 2017 5:15PM

Races against the clock to modernise ageing back-end.

The Commonwealth government has formally invited pitches from suppliers as it races to replace its ageing Medicare payments processing software.
The controversial IT modernisation made headlines during last year’s election, when the Labor opposition accused the government of testing the market for ways to outsource the payments processing to a third party as a precursor to a full privatisation of Medicare.
The government was forced to back down on its business process outsourcing (BPO) proposal, and commit to keeping the Medicare IT back-end owned and operated by the public sector.
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Commonwealth on the hunt for new Medicare payments system

The Department of Health has kicked off the process to update its 30-year-old payments system that currently supports Medicare and the Pharmaceutical Benefits Scheme.
By Asha McLean | March 6, 2017 -- 23:27 GMT (10:27 AEDT) | Topic: Enterprise Software
The Department of Health has published a Request for Information (RFI), seeking advice on replacing its 30-year-old IT payments system that currently supports the operation and delivery of Medicare, the Pharmaceutical Benefits Scheme, aged care, and related veterans payments.
According to the federal government, each year the department makes in excess of 600 million payments worth approximately AU$50 billion across the health and aged care services via an IT system it called obsolete.
"Just as Australian families have upgraded their computers since the 1980s, the time has come for the government's health payments systems to do the same," the government said in a statement.
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RFI – Seeking advice on new IT payments system

The Australian Government is seeking to replace IT systems supporting health and aged care and related veterans’ payments.
Page last updated: 06 March 2017
6 March 2017
The Australian Government is seeking to replace IT systems supporting health and aged care and related veterans’ payments.
The current systems have evolved over 30 years and are based on obsolete technology. They need to be replaced to ensure that people can continue to receive their payments from the Government.
To support the replacement of the systems, the Australian Government has today issued a Request for Information (RFI).The RFI seeks information on how the new system should be designed and delivered.
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'No plan B' for My Health Record, as registrations near fifth of population

Dr Zoran Bolevich throws support behind opt-out approach
George Nott (Computerworld) 09 March, 2017 13:26
The head of NSW’s digital health agency says there is “no plan B” when it comes to widespread adoption of My Health Record.
Chief executive and chief information officer of eHealth NSW, Dr Zoran Bolevich, said “national collaboration is absolutely critical” to the success of My Health Record, the system formerly known as the Personally Controlled Electronic Health Record (PCEHR).
Bolevich, speaking at the Digital Healthcare conference in Sydney yesterday, said his agency was a big supporter of the Department of Health’s proposal to make My Health Record 'opt-out'.
The opt-out approach, which was first proposed in a 2013 Department of Health review, has been trialled in both the Nepean Blue Mountains and Northern Queensland since June last year.
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Stephen Herczeg inquest: Coroner Mark Johns blasts SA Health’s EPAS over death

Josephine Lim, The Advertiser
March 8, 2017 16 minutes ago
THE State Coroner has slammed SA Health’s controversial new electronic patient records system for “effectively preventing the court from establishing the truth” in the death of a former Socceroo.
Coroner Mark Johns is investigating the death of Stephen Herczeg, 72, at the Queen Elizabeth Hospital on September 19 last year.
SA Health E Health Systems chief director William LeBlanc fronted the inquest on Wednesday and was unable to explain one of the documents assessing Mr Herczeg’s condition that had been generated by EPAS.
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SA coroner raises concerns over EPAS

Published: 5:28 pm, Wednesday, 8 March 2017
South Australian Coroner Mark Johns has slammed the state's controversial new electronic patient records system, EPAS, during an inquest into the death of former Socceroo Stephen Herczeg.
Mr Herczeg, 72, was admitted to the Queen Elizabeth Hospital in Adelaide last year after falling over at his house.
While he was a patient at the hospital his urinary catheter was connected to an oxygen supply, resulting in ruptured internal organs and ultimately, death.
Today the inquest called upon the testimony of the SA eHealth Systems chief director, William LeBlanc, the man in charge of rolling out EPAS through the state.
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Media Release
Department of Health

Telehealth to expand services in Central Australia

9 March 2017
The Central Australia Health Service is once again working closely with the Australian Digital Health Agency (ADHA) to improve Telehealth service delivery in remote Australia.
Representatives from ADHA, headed by the Chief Executive Officer Mr Tim Kelsey, are in Central Australia this week to meet with relevant health professionals and agencies to develop strategies that will see Telehealth opening up further specialties in the region and enhance IT systems to incorporate TeleHealth appointments.   
“The National Telehealth Connection Service has recently been deployed in the Northern Territory to expand the footprint for health service delivery, enabling connections with non-government agencies, such as Aboriginal Medical Services, and interstate tertiary hospitals, such as Royal Adelaide Hospital,” said Mr Stephen Moo, Chief Information Officer for the Department of Health.
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First come the breach disclosures, then come the lawyers

Australia's new data breach notification laws will trigger a wave of litigation to figure out what they actually mean, says Nuix's Chris Pogue.
By Stilgherrian for The Full Tilt | March 9, 2017 -- 04:31 GMT (15:31 AEDT) | Topic: Security
If your organisation has trouble finding a measurable return on investment for its cybersecurity spend, then mandatory data breach notification will give you one, says Chris Pogue, chief information security officer at Nuix.
Australia's new data breach notification laws are expected to come into force some time in 2018. In the US, 47 of the 50 states have had equivalent laws for several years. Pogue appears as an expert witness in data breach cases. He predicts that Australia will experience a similar sequence of events.
First, there'll be a wave of "new" data breaches.
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Delay to digital hospital standards guide

Handbook release pushed back
George Nott (Computerworld) 09 March, 2017 08:44
The release of Standards Australia's Digital Hospitals Handbook has been pushed back to later this year.
As recently as last month, the independent, government-approved standards body, had said the document was on track for a March release, but today reset expectations.
"Our ambition had been to have this handbook ready earlier in this year. It's still under draft with an expectation that it will be published later this year," Standards Australia CEO Dr Bronwyn Evans told the Digital Healthcare Summit in Sydney today.
The handbook – originally proposed by Department of Health and Human Services Victoria – will lay out a set of principles and recommendations that inform the design and implementation of digital hospitals, Evans said.
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  • Updated Mar 7 2017 at 6:05 PM

Medical records being passed onto insurers as doctors obey the documents

Labor senator Deborah O'Neill wants life insurers to be clearer with their customers. Ben Rushton
Changing the way life insurers get consent to access customer medical records will fix the situation of doctors releasing full medical records to the companies, critics of the industry have said.
The issue of insurers getting customers' entire medical records – and the possibility they draw on this to knock back claims – was raised at Friday's Parliamentary Joint Committee looking at the life insurance industry.
Michael Gannon, head of the Australian Medical Association, said his members simply complied with insurers' requests, and the accompanying consent forms signed by patients that often allowed for full disclosure. The reports were usually required at short notice, he added.
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Veterans Affairs Minister Dan Tehan yields to ex-service calls for privacy probe into personal data laws

David Wroe
Published: March 8, 2017 - 10:26PM
New laws that would allow the Veterans Affairs Department to reveal personal information about veterans in the "public interest" will be subjected to a fresh privacy probe after a backlash by ex-services groups.
Veterans Affairs Minister Dan Tehan has told Fairfax Media that he will ask the Australian Government Solicitor to hold an independent "privacy impact assessment" into the laws before they are finalised by the Parliament.
The laws have prompted concern from veterans groups and a change.org petition that has attracted nearly 7000 signatures. The protesters say the laws would allow the department, in effect, to push back against public complaints by veterans that it regards as misleading and therefore detrimental to public confidence in its services.
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10 March, 2017

Veterans’ health information bill raises concerns

Posted by Felicity Nelson
Concerns have been raised over a proposed law that gives the government power to disclose otherwise protected personal information of veterans, including sensitive health records.
The Veterans’ Affairs Legislation Amendment (Digital Readiness and Other Measures) Bill 2016, if passed, would give the government the ability, legally, to release personal information of veterans if it deemed disclosure was in “the public interest”.  The legislation defines public interest as any “threat to life, health or welfare” but also includes “mistakes of fact” and “misinformation in the community”.
There are fears that the last two clauses could allow the release of private information about veterans who criticise the government.
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ADHA - Contracts Manager

  • Ongoing position
  • Canberra location
Better use of data and technology can help people live healthier, happier and more productive lives. Digital health can make a real difference to people's health by giving them greater control and better access to information.
Tasked with improving health outcomes for Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia, the Australian Digital Health Agency (the Agency) commenced operations on 1 July 2016.
The Agency is responsible for national digital health services and systems, with a focus on engagement, innovation and clinical quality and safety. Our focus is on putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them.
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  • Updated Mar 10 2017 at 3:17 PM

IBM's Watson supercomputer leading charge into early melanoma detection

IBM is breaking ground in the early detection of skin cancer using its supercomputer Watson, potentially saving the federal government hundreds of millions of dollars.
The tech giant has partnered with skin cancer detection program MoleMap and the Melanoma Institute of Australia to teach the computer how to recognise cancerous skin lesions.
The initial focus is on the early detection of melanomas, which are the rarest but most deadly type of skin cancer, and make up just 2 per cent of diagnoses but 75 per cent of skin cancer deaths.
IBM vice-president and lab director of IBM Research Australia, Joanna Batstone, told AFR Weekend her colleagues, including melanoma research manager Rahil Garnavi, had so far fed 41,000 melanoma images into the system with accompanying clinician notes and it had a 91 per cent accuracy at detecting skin cancers.
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Please provide a sample: A pathology lab approach to patient data, predicts expert

Deakin Software and Technology Innovation Laboratory is applying machine intelligence to healthcare
George Nott (Computerworld) 10 March, 2017 09:00
An AI expert has forecast the rise of ‘data labs’ in the healthcare sector, that will do for data what a blood lab does for blood samples.
The availability of sensors and wearables was leading to an increase in the amount of data that could be collected on patients, but doctors and GPs were not always able to make use of it, Professor Rajesh Vasa told the Digital Healthcare conference in Sydney yesterday.
“Most GPs are not trained to decipher a month’s worth of heart rate. They don’t know how,” the deputy director of Deakin Software and Technology Innovation Laboratory (DSTIL) said.
“They know how to understand 15 minute's worth but this is a month’s worth of data to make sense of.”
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10 podcasts for GPs (and their patients)

I really enjoy podcasts. There is something appealing about listening to people’s stories via the cloud – and at a convenient time and place. I usually listen on the way to work.

Apparently Australia is the fourth largest consumer of podcasts in the world. In 2014 I posted 6 great podcasts for primary care, one of the most visited articles on this blog. As podcasting seems to be more popular then ever and new podcasts for family doctors have been launched since my last post, it is time for an update.
So here is my top 10. Many podcasts are suitable for a wider audience. Click on the iTunes or SoundCloud logo to listen, and feel free to share your favourites in the comments section.
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How to handle the HPV screening delay

6 March, 2017
From May 1, GPs will be able to offer either a Medicare-rebateable liquid-based cytology test or a Pap smear test as cervical cancer screening under the government’s new deal to manage the HPV screening delay.
Instead of using ThinPrep or Sure Path as an additional, patient-funded test, GPs will be able to use the liquid-based cytology test as an alternative to the traditional Pap smear, but the Medicare rebate will only be available for one as part of the cervical cancer screening, a spokeswoman from the Department of Health told The Medical Republic.
The new Medicare rebate for the test was one of the stop-gap measures introduced in an attempt to deal with potentially ballooning wait times for pathology test results caused by the reduced number of cytologists being employed in anticipation of screening changes.
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6 March, 2017

An idiot’s guide to blockchain

Posted by Felicity Nelson
There’s a lot of things at TMR that we don’t quite understand. The database system called Blockchain is one of them. So we’ve tried to put together a quick explainer that you can use to bluff your way through the next dinner party.
• Blockchain was first used for security by the digital currency Bitcoin, beloved by drug dealers and bankers alike.
• Data is stored in little chunks, called blocks, across a network of computers, rather than a single hard drive. Each block of data has a tag that links it to the previous block.  The tags are encoded in such a way that adding to, or changing, the blockchain requires the network’s whole computing power.
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Most NBN users happy with service: Morrow

NBN Co CEO Bill Morrow has hit back at reports of rising numbers of dissatisfied NBN end users, claiming that most end users of the national broadband Network are happy with the service and that complaints are actually dropping.
According to Morrow, who has been under fire recently for comments claiming that users did not need superfast broadband, reports that there was a massive increase in complaints about NBN services during 2016 were misleading.
Writing for the NBN Co blog, Morrow said: “Most reports said that nbn’s complaints increased by 120% in 2016, but not many of those reports mentioned that actually, as a proportion of end users, complaints had dropped by 12% — this is despite nbn through its RSPs connecting more than twice the number of end users compared to the year before.
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Robot tax may be essential to avoid mass economic inequality

Forget Asimov's three laws of robotics. The big threat of robots isn't that they will kill us; it's that they will make the rich richer and produce mass levels of inequality.
When I was a boy, robots were the stuff of science fiction. Isaac Asimov set forward his three laws of robotics that guaranteed a robot would protect humans, obey humans, and protect itself – in that order.
Like driverless cars, like finding potential earth-like planets, so too robotics is advancing significantly and widespread robotic labour is an increasingly near reality.
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Harvard astronomers theorise about possible alien origin of fast radio bursts

March 10, 20171:20pm
Harvard astronomers have posited a wild theory about frequent radio bursts and alien space travel.
HARVARD researchers have proposed a theory about the possibility of mysterious celestial phenomena known as fast radio bursts (FRB) being caused by alien space travel or advanced alien technology.
“Specifically, these bursts might be leakage from planet-sized transmitters powering interstellar probes in distant galaxies,” suggested astronomers from the Harvard-Smithsonian Center for Astrophysics.
Theoretical physicist Avi Loeb who works at the centre believes because science has so far failed to identify a natural source of FRBs, “an artificial origin is worth contemplating and checking.”
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Enjoy!
David.

Sunday, March 12, 2017

I Am Not Sure We Are Getting The Transparency We Were Promised With The ADHA. Are Things Slipping?

In the last day or so extracts of the February Board Minutes appeared on the ADHA Website.
Here are the links to what we have seen so far.

Board Papers

The intent of the Board is to publish as many Board documents as is feasible. Information and attachments to Board documents that are draft, not finalised or sensitive will not be published. An exception is made for draft material already in the public domain (in this instance the Board Advisory Committee Charters released on 16 September 2016).

Board Meeting 21 February 2017 - Board Papers (Download)

Board Meeting 25 January 2017 - Board Papers (Download)
Board Meeting 15 December 2016 - Board Papers (Download)
Board Meeting 16 November 2016 - Board Papers (Download)
Board Meeting 18 October 2016 - Board Papers (Download)
Here is the overall link:
Browsing this list and the documents themselves raises more than a few issues.
The most obvious of these are the obviously large number of documents that are not being disclosed. There are a huge number of gaps in the item list for each of the meetings!
Next in the documents actually disclosed there are some rather odd items. As an example this from the Feb 21 CEO Report raises more than a few questions:
----- Begin Extract

Improving the culture of the organisation: implementing Organisational Excellence

Our approach to building desired culture is focused on three levels: organisational, divisional and individual. We are building an organisation culture where team members are satisfied and motivated to perform to the best of their abilities. At the divisional level, the highest levels of co-ordination, co-operation, and mutual support need to be in place. Through individual initiative, effective teamwork, and divisional coordination, the Agency will be a high performing organisation.
The culture of the organisation is not where we want it to be. The Organisational Culture Inventory results provided a strong indicator that there are a number of areas which are important to staff that we need to focus on. As an organisation, it is vital we are committed to diversity and transparency. We are developing a dashboard to confirm our commitment to equality and diversity in our workforce. I have been very impressed by the willingness of staff to be open and honest about both the positives and negatives of their experience.
Our divisional workshops are designed to provide a good opportunity to discuss many of the areas of concern.  At an organisational level our focus is on starting to address the below.
  •          Meaningful goal setting;
  •          Building a culture of accountability;
  •          Improving internal communications;
  •          Living values and behaviours; and
  •          Giving recognition
I would like to thank Terence’s team for ensuring all Agency staff and the Executive are supported through this important organisational transformation effort. The Board will be asked in this meeting for their advice on how we implement organisational design to drive a positive performance culture across the Agency.

Workplan delivery

There has been significant progress in the delivery of our 2016/17 workplan and on the priorities agreed by the Board in its last meeting. We have announced a new programme to connect all pharmacies in Australia to the My Health Record. We have made good progress in dialogue with providers of private pathology and radiology services and intend, as per the work plan priorities agreed by the Board in its last meeting, to launch a number of implementations this year to upload reports into the My Health Record. We have also launched an implementation programme for Secure Messaging.
Board members will remain concerned about the capabilities of the new organisation to meet the delivery challenges of the work plan this year and next - and, of course, the potential approval of the Return to Government for My Health Record. Legacy challenges remain real. The Agency has capabilities it does not need and others that it does not have. The Board will discuss management’s proposals for our organisation’s more effective delivery of its workplan in this meeting.
----- End Extract.
Examples are things like “The culture of the organisation is not where we want it to be” leaves one wondering just what is presently not OK.

It also seems that job losses are being strongly hinted at! “Legacy challenges remain real. The Agency has capabilities it does not need and others that it does not have. The Board will discuss management’s proposals for our organisation’s more effective delivery of its workplan in this meeting.”

Additionally the Delivery Report highlights a range of risks – but the Appendix that discloses what is at risk etc. is not provided.

I also wonder just what is meant by the term Return to Government for the myHR? Does this mean that someone is to approve the benefits flowing from the myHR? You would need to be pretty gullible to agree to that I believe.

All in all I have to say I had rather hoped for a good deal more – with the only secrecy being applied to those issues which were personally private or genuinely ‘commercial in confidence’. Mentioning a desire for transparency and then not really delivering is a bit sad. I would hate to see a return back to the bad old NEHTA days – as many apparent insiders in the various comments seem to be suggesting seems to happening at present. Insider comments welcome!

David.

AusHealthIT Poll Number 361 – Results – 12th March, 2017.

Here are the results of the poll.

Should The myHR Program Have Cost So Much Money (Estimated At Close To $2.0B All Up)?

Yes - Info Tech And Skilled Staff Are Expensive 1% (3)

No - It Could Have Been Done For a Lot Less 97% (205)

I Have No Idea 2% (4)

Total votes: 212

I think it would be fair to say readers reckon there has been a fair bit of waste in the myHR Program!

A really great turnout of votes!

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

David.