Common Sense Descends on the Royal Australian College of GPs. Seems There Has Been A Real Change in Views Internally!

We had this release appear yesterday.

http://www.racgp.org.au/media2011/44498

RACGP identifies critical success factors for Australia’s PCEHR

19 October 2011

The Royal Australian College of General Practitioners (RACGP) is encouraged by the progress made towards providing access to personally controlled electronic health records (PCEHR) for people in Australia, especially with the release of the Department of Health and Ageing’s PCEHR System: Legislation Issues Paper for comment.

However, there are four areas that are of particular concern to the RACGP, and the College would seek to further contribute to the refinement of the PCEHR program. The recent termination of England’s existing National Health Service (NHS) Connecting for Health program has further highlighted the College’s concerns.

1. Need for greater definition of general practice role in PCEHR

A major criticism of England’s NHS Connecting for Health program was a lack of sustained and high level clinical input into the design and implementation processes. The RACGP is concerned that as we move closer to implementation of the PCEHR that there should be greater agreement between the Department of Health and Ageing, the National E-Health Transition Authority (NEHTA) and the RACGP across a broad range of areas, including consideration of data quality and ownership within the PCEHR, the PCEHR’s links with clinical software, and possible impact on clinical and practice workflows which will be a disincentive to widespread adoption.

2. Recognition of GPs’ additional workload

The RACGP is concerned that the current plan does not offer any incentives for general practice to create documents for indexing in the PCEHR such as shared health summaries, and urges the Government to consider how this additional effort will be acknowledged. This applies to obtaining informed consent from a patient (or their carer) to have a PCEHR created for them, as well.

Professor Claire Jackson, RACGP President, said: “We would like to see amendments to the Medicare Benefits Schedule to recognise the additional workload GPs will undertake in consultations initiating and maintaining the patient’s shared health summary and other elements of the PCEHR. To make this program a success, it is crucial that all general practitioners get on board.”

3. Targeted program to encourage patient uptake

.....

4. Patient contribution to PCEHR

......

For more information about RACGP PCEHR related papers, please visit www.racgp.org.au/ehealth/pcehr.

The full release is here:

http://www.racgp.org.au/media2011/44498

I have to say the tone of this release is much less co-operative than others emerging from lower down the hierarchy of the RACGP. I would not know anything but it just might be that those in the College who have been taking NEHTA’s money to do its bidding have been told by the President the membership at large is not happy and that change is needed!

There is press coverage with additional context here:

GPs should be compensated for e-health, says Royal Australian College of General Practitioners

• by: Karen Dearne
• From: Australian IT
• October 20, 2011 5:00AM

THE Royal Australian College of General Practitioners wants GPs to be reimbursed for the work of creating and maintaining personal e-health records.

RACGP chair Claire Jackson has called for new payments under the Medical Benefits Schedule in recognition of the extra workload GPs "will undertake in consultations (including updating) the patient’s shared health summary" and other elements of the Gillard government’s $500 million personally controlled e-health record system.

"We are concerned that the current plan does not offer any incentives for general practice to create and maintain documents for indexing in the PCEHR, such as shared health summaries," Professor Jackson said in a statement on Wednesday.

"We urge the government to consider how this additional effort will be acknowledged.

"This applies to obtaining informed consent from a patient, or carer, for the creation of a PCEHR as well."

She didn't provide an estimate of a minimum level of compensation.

The RACGP has expressed concern over a range of matters which are yet to be considered, just seven months before the PCEHR program is due to start on July 1 next year.

These include questions of data quality and ownership within the PCEHR, system links with doctors’ own clinical and medical practice software, and possible impacts on workflow. 

Lots more here:

http://www.theaustralian.com.au/australian-it/government/gps-should-be-compensated-for-e-health-says-royal-australian-college-of-general-practitioners/story-fn4htb9o-1226170972459

So we now have both the AMA and the RACGP singing from the same song sheet. Guess what all this still does not cover all the other staff and specialists who may be involved in supporting this folly.

It seems that the situation now is that we have NEHTA beating up on staff to get the PCEHR done (see just below) and the clinicians moving to open rebellion if they are not paid for the time and effort.

NEHTA investigated for workplace bullying

By Josh Taylor, ZDNet.com.au on October 20th, 2011

The National E-Health Transition Authority (NEHTA) has been investigated by WorkCover over bullying within the organisation, while reporting an annual staff turnover rate of 30 per cent, a senate estimates hearing has heard.

The company is charged with managing and supporting the delivery of personally controlled e-health records (PCEHR) as part of the Federal Government's $466.7 million investment in e-health. Speaking at an estimates hearing last night, NEHTA CEO Peter Fleming confirmed that WorkCover had been brought into the NEHTA offices in Sydney to investigate a staff complaint over bullying.

"There was, just recently, a very brief investigation. I believe a WorkCover officer came and had a talk to our head of personnel, and I believe that issue was dealt with to their satisfaction," he told the committee.

Australian e-health IT blogger Dr David More had last month posted information that he had obtained from former employees of NEHTA who had claimed there was bullying within NEHTA and WorkCover had been brought in to investigate.

Lots more here:

http://www.zdnet.com.au/nehta-investigated-for-workplace-bullying-339324628.htm

If this is not a project on the edge of either blowing up or costing vastly more to pay people to get involved I have no idea where you would find one closer on that state!

It just gets worse and worse and we are yet to see the Senate Estimates Hansard where I am sure we will find even more revelations!

A mess indeed and all of their own arrogant un-consultative making!

David.

NEHTA CEO Admits Staff Turnover Is Though the Roof!

At Senate Estimates tonight Mr Peter Fleming admitted staff turnover was 28%-30% per annum and said this was because it was a transition authority!

Said the same rates happened in consulting firms. Actually they usually run at 1/2 that in my experience of consulting firms. A small fib one has to say!

Amazing stuff - it has to be clear the place is utterly toxic for staff! This is confirmed by confirmation - at the same session -that NSW Workcover has indeed been investigating some staff complaints.

I guess they hoped no one would be watching so late at night (about 10:20pm)! Well done Senator Bridget McKenzie (I think) for asking at least a few hard questions!

No wonder Australian e-Health is a mess. The so-called leader can't even care for staff properly.

Also - it is rather a pity that the total time allocated to e-Health has to have been less than 20 minutes. Not really enough!

David.

Senate Estimates Hearing: 9:30pm Tonight on E-Heath!

Just an alert:

The program for the Community Affairs Committee is found here:

http://www.aph.gov.au/Senate/estimates/supp1112/ca.pdf

You can view a webcast from this link:

www.aph.gov.au/live

I would watch from about 9:pm to be sure you don't miss the fun!

David.

There Is Going To Be A Real Security Issue Emerge With Health Information Exchanges - Like The PCEHR!

The following interesting article appeared a few days. It is relevant as essentially the proposed PCEHR is actually just a Health Information Exchange at is heart - which it why the Government went out and bought one from Oracle / Accenture.

The Next Big Security Challenges

Joseph Goedert

HDM Breaking News, October 12, 2011

For many security-conscious executives, the next big frontier will be health information exchanges. "HIEs are the biggest access and security challenge moving forward," says Bill Spooner, senior vice president and CIO at San Diego-based Sharp Healthcare. "The usefulness of the HIE will depend on how well we work through it. We want to be absolutely secure in getting patient consent for sharing their information, and at the same time, make sure their information is available."

It's an issue being raised across the country. The University of Pittsburgh Medical Center recently launched a data exchange with several area hospitals. Access to information will be based on having a prior relationship with the patient, says John Houston, vice president privacy and information security. "You want to make sure that not just anyone can query the HIE," he says. "Members will be contractually committed to doing the right thing. But the members will need to enforce appropriate conduct." Technology can only go so far in preserving patients' rights, he says. "The HIE is based on trust."

In addition to data exchanges, the influx of personal portable devices in the health care setting will bring their own set of access challenges.

Providers have been caught off guard by smartphones and other devices, says Noa Bar Yosef, senior security strategist at Imperva, a security software vendor.

"Providers have suddenly woken up to the reality where sophisticated mobile devices are being used as access points to online services and enterprise networks," says Bar Yosef. "The sudden dramatic increase of these devices in the past couple of years left the I.T. and security departments to scratch their heads and wonder how they lost control of I.T. Organizations need to recognize the introduction of these technologies to the workplace, and they need to start planning how to secure the devices and their interaction with the enterprise networks."

The good news, notes Bar Yosef, is that security tools for smartphones are readily available, including anti-malware, encryption and authentication. However, securing the end-device is simply not enough, she contends. "Organizations need to recognize that these devices are accessing the network, which means that even a compromised device might be introduced into the health care organization,"

Full article is here:

http://www.healthdatamanagement.com/news/security-health-information-exchange-mobile-43389-1.html

I find it interesting that the very same point was made a week or so ago regarding the PCEHR and security.

See here:

Harbinger of security warns national e-health system

Written by Nic White Thursday, 06 October 2011 09:00

THE vulnerability of Australia’s planned national e-health system to cyber attacks is not being taken seriously enough, according to a WA security academic.

The weakest points of this system are the individual healthcare providers, particularly the small primary care and specialist organisations which make up more than half the connections in the national e-health system.

ECU secau Security Research Centre senior lecturer Trish Williams says the initiative has multiple points of vulnerability that are unlikely to be fully realised until the system goes live.

The $466.7 million plan will digitise and integrate Australia’s patient record databases to allow much greater sharing of patient information, such as allergies, test results and medications, than the current “safe but not particularly useful” paper system.

Dr Williams says the integration of such a big and complex system is far more susceptible to attack than a decentralised paper one because of the communication between diverse healthcare providers, unlike banks where information is securely stored in one domain.

More here:

http://www.sciencewa.net.au/3654-harbinger-of-security-warns-national-e-health-system.html

This paper seems to me like one we all need to have a look at - and soon!

Williams, P.A.H. (2011). Why Australia’s health system will be a vulnerable national asset. In C. Valli (Ed.) Proceedings of the 2^nd International Cyber Resilience Conference. pp. TBA. Perth: secau- Security Research Centre, Edith Cowan University.

Sadly it does not appear to be available on the web at present. However, Dr Williams did kindly send me her paper in response to an e-mail. The paper does confirm her concerns with ensuring the security of GP systems over time.

I will keep an eye out and let readers know when it appears easily available on the web.

Clearly and expert systematic analysis of all the issues and their remedies is a little overdue!

David.

The Part NEHTA Is Going To Struggle With Are The Systems Which Feed The PCEHR! There Is A Very Long Way To Go!

The following slides from a NEHTA webinar yesterday afternoon somehow turned up in my inbox.

You can have a browse of them here:

http://moreassoc.com.au/downloads/NEHTA%20PCEHR%20Webinar%2017%20Oct%202011.pdf

What becomes really clear from all this is that NEHTA and the Infrastructure Partner (Accenture) are going to deliver a PCEHR system and that, based on the functionality provided by the various Oracle Components, there will be a portal established and some form or repository behind that portal gateway.

The title of the webinar was “Initiating Collaboration on PCEHR Specifications Development”. It seems just astonishing we are in mid-October, 2011 and that we are apparently just now asking the industry to start collaborating on PCEHR Specifications Development for a major national project that is planned to go live in July, 2012 (Some 8 months hence!).

What is also revealed is that the technical approach being adopted is based on a range on International ISO, IETF and Australian Technical Standards which will be mashed together to fit pretty much what Oracle presently does (as already suggested in the blog previously - they don’t have time to do much else - if that!).

Of course where the wheels will come off will be getting a coherent set of feeder systems flowing from the range of potential provider users of the PCEHR. All their system will need fundamental modifications to provide information to the planned repositories that is useable.

Additionally, while internally the PCEHR system will have the appropriate security and audit trails once all the feeder systems are linked pretty much none of this will flow down. I note there is no mention of NASH but rather the IHE Audit Trail and Node Authentication (ATNA) Profile being used.

All in all this webinar has made it much clearer that the PCEHR System will be essentially an out of the box product based on international Standards and IHE profiles - but with the external systems probably having a good (and long) way to go to link in an make anything useful happen.

One suspects what is going on here is NEHTA recognising an existential threat - i.e. the funding for both the PCEHR and NEHTA ending June 30 2012 - and pushing to get just enough to have the whole juggernaut roll on! It is now utterly clear this is a multiyear project and that very little will actually be delivered - other than a log-in portal - by the due date.

If ever there was a need for a review and audit before proceeding this has to be it. Otherwise you can get into a very had cycle!

On a related topic this appeared very recently.

Implementation and adoption of nationwide electronic health records in secondary care in England:  qualitative analysis of interim results from a prospective national evaluation

Ann Robertson1 Kathrin Cresswell1 Amirhossein Takian2 Dimitra Petrakaki3 Sarah Crowe4 Tony Cornford3 Nicholas Barber2 Anthony Avery4 Bernard Fernando1 Ann Jacklin5 Robin Prescott1 Ela Klecun3 James Paton6 Valentina Lichtner3 Casey Quinn4 Maryam Ali3 Zoe Morrison1 Yogini Jani2 Justin Waring4 Kate Marsden4 Aziz Sheikh1

ABSTRACT

Objectives To describe and evaluate the implementation and adoption of detailed electronic health records in secondary care in England and thereby provide early feedback for the ongoing local and national rollout of the NHS Care Records Service.

Design A mixed methods, longitudinal, multisite, sociotechnical case study.

Setting Five NHS acute hospital and mental health trusts that have been the focus of early implementation efforts and at which interim data collection and analysis are complete.

Data sources and analysis Dataset for the evaluation consists of semi-structured interviews, documents and field notes, observations, and quantitative data. Qualitative data were analysed thematically with a sociotechnical coding matrix, combined with additional themes that emerged from the data.

Main results Hospital electronic health record applications are being developed and implemented far more slowly than was originally envisioned; the top-down, standardised approach has needed to evolve to admit more variation and greater local choice, which hospital trusts want in order to support local activity.

Despite considerable delays and frustrations, support for electronic health records remains strong, including from NHS clinicians. Political and financial factors are now perceived to threaten nationwide implementation of electronic health records. Interviewees identified a range of consequences of long term, centrally negotiated contracts to deliver the NHS Care Records Service in secondary care, particularly as NHS trusts themselves are not party to these contracts. These include convoluted communication channels between different stakeholders, unrealistic deployment timelines, delays, and applications that could not quickly respond to changing national and local NHS priorities. Our data suggest support for a “middle-out” approach to implementing hospital electronic health records, combining government direction with increased local autonomy, and for restricting detailed electronic health record sharing to local health communities.

Conclusions Experiences from the early implementation sites, which have received considerable attention, financial investment and support, indicate that delivering improved healthcare through nationwide electronic health records will be a long, complex, and iterative process requiring flexibility and local adaptability both with respect to the systems and the implementation strategy. The more tailored, responsive approach that is emerging is becoming better aligned with NHS organisations’ perceived needs and is, if pursued, likely to deliver clinically useful electronic health record systems.

The full paper is downloadable here:

http://www.bmj.com/content/341/bmj.c4564.full.pdf

To be cited thus:

BMJ 2010;341:c4564 doi:10.1136/bmj.c4564  (Published 17 October 2011)

Again we see just how badly the top down Government applied approach is likely to go. There are lessons here for both State and Commonwealth Governments I believe.

There is sadly a great deal of lack of governance and short-term thinking happening right now in response nonsense political deadlines and we will all suffer in the end!
Also, all this on the various services just ignores all the fundamental issues that are wrong with the PCEHR proposal which both NEHTA and DoHA resolutely refuse to address.
This is the ultimate top-down proposal - but worse those at the bottom are not being seriously helped to be involved.
Just doomed I reckon!

David.

Weekly Australian Health IT Links – 17th October, 2011.

Here are a few I have come across this week.

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

Really a pretty quiet week but you can be sure that under the surface we are seeing all sorts of nonsense going on with policy incoherence and a lack of practical, pragmatic leadership. Not that you heard it here first but I suspect we all now know a lot of this will end badly.

Seems like a good week to remind readers of the blog of Croakey - a useful source of unsponsored and un-tainted information on what is going on in the health sector. Some really interesting stuff is found here.

http://blogs.crikey.com.au/croakey/

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http://www.theaustralian.com.au/australian-it/panic-to-meet-nicola-roxons-e-health-deadline/story-e6frgakx-1226163408510

Panic to meet Nicola Roxon's e-health deadline

• by: Karen Dearne
• From: The Australian

A PLAN to ram through technical specifications to meet the deadline for a national e-health records system is flawed and threatens financial problems for the local medical software industry.

Documents released by the National e-Health Transition Authority show it wants to bypass the usual standards-setting process via "tiger teams" that have one month to come up with 149 "specifications" for the $500 million personally controlled record rollout.

Federal Health Minister Nicola Roxon has repeatedly said the PCEHR will be available to all Australians who want one by July 1 next year.

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http://www.theaustralian.com.au/australian-it/patients-forgotten-in-setting-healthcare-standards/story-e6frgakx-1226163403270

Patients forgotten in setting healthcare standards

• by: Roger Clarke
• From: The Australian
• October 11, 2011 12:00AM

STANDARDS are critical to any system that involves federation among large numbers of organisations.

In some circumstances, there may be a dominant player that can set standards and force everyone else to follow them. Customs, for example, forced change in the import and export sectors 20 years ago to its own benefit, as well as the considerable benefit of others.

That option won't work in healthcare, which is the most complex of all sectors.

It comprises very large, large, medium, small and micro organisations -- and many of each size.

These thousands of organisations have highly varied backgrounds and orientations.

They have varying business models, from government, through semi-government to government-funded, to very much private sector.

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http://www.medicalobserver.com.au/news/were-not-obsessive-civil-libertarians-tell-roxon

We’re not obsessive, civil libertarians tell Roxon

11th Oct 2011 Mark O'Brien and Andrew Bracey

CIVIL libertarians have hit back at Health Minister Nicola Roxon’s comments labelling privacy and civil liberties groups as obsessive with regard to their fears of the risks of the government’s personally controlled e-health records (PCEHR) system.

Civil Liberties Australia (CLA) today renewed calls for Ms Roxon to improve the planned safeguards to ward against data theft and patient records being accessed by those without appropriate permissions.

Answering media questions last week regarding the Privacy Foundation’s fears, Ms Roxon urged the foundation to embrace the possibilities of new technology and suggested the electronic records were likely to be more secure than traditional paper based records.

“We're seeing what is, I think, a borderline obsession that if you use new technology that that's going to create a risk,” said Ms Roxon.

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http://www.theaustralian.com.au/australian-it/it-business/doctors-go-mobile-at-barwon-health/story-e6frganx-1226165325551

Doctors go mobile at Barwon Health

• by: Karen Dearne
• From: Australian IT
• October 13, 2011 12:00AM

GEELONG's Barwon Health Hospital will host the first Australian implementation of Cisco's new Virtualisation eXperience Infrastructure (VXI ), with rollout already underway in its intensive care unit.

It is part of a deal that will see Victoria's South West Alliance of Rural Health (SWARH) install Cisco's virtualisation and collaboration technology in 180 public and private healthcare sites located across some 60,000 square kilometres.

At the same time, Cisco and Dimension Data will take over the operational and support roles, as SWARH outsources its ICT risk and management burden.

Barwon deputy chief executive Paul Cohen said the hospital is focused on making clinicians' jobs easier, and is reaping the benefit of earlier work that has put Geelong and the region at the forefront of e-health adoption.

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http://www.computerworld.com.au/article/404045/virtualization_thin_clients_mobilise_healthcare_rural_hospital_victoria

Virtualization, thin clients to mobilise healthcare at rural hospital in Victoria

South West Alliance of Rural Health will rollout Cisco virtualization infrastructure across its 13 organisations starting with the largest, Barwon Health

• Chloe Herrick (Computerworld)
• 13 October, 2011 15:58

he South West Alliance of Rural Heath (SWARH) has done a deal with Cisco for the provision of its Virtualization Experience Infrastructure to improve the workflow and collaboration throughout its 13 organisations.

The SWARH, which encompasses a mix of public health agencies, non-government organisations and medical clinics, covers an area of 60,000 square kilometres across Victoria with 180 sites.

SWARH CIO, Garry Druitt, said the alliance, which has 4000 phones (to be increased to 8000 in coming months) and 4000-5000 desktops, had been an early adopter of the platform because it needed the solution.

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http://www.zdnet.com.au/vic-doctors-sign-on-for-teleconferencing-339324244.htm

Vic doctors sign on for teleconferencing

By Luke Hopewell, ZDNet.com.au on October 13th, 2011

A council of rural Victorian healthcare providers has signed on with Cisco to wire up new virtualisation and teleconferencing services to support its IT and e-health operations.

The South West Alliance of Rural Health (SWARH) is comprised of over 15 facilities over 60,000 square kilometres in rural Victoria, and has teamed up with Cisco and Dimension Data to deploy the teleconferencing company's new Virtualisation Experience Infrastructure offering (VXI) to improve communication and patient care.

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http://www.smh.com.au/technology/technology-news/dummy-run-as-student-nurses-put-their-skills-to-the-test-20111010-1lhm4.html

Dummy run as student nurses put their skills to the test

Andrew Stevenson

October 11, 2011

LARS is a Norwegian with bad hair, an ill-defined back story and chest pains. He's also a $100,000 mannequin whose vital signs - and even his conversation - can be remotely controlled to keep student nurses Alison Sanders and Karla Aguiba on their game.

They spend less time in hospitals but the University of Technology, Sydney, is hoping when their students nurses arrive to deal with real patients and real problems their extensive interaction with Lars and his like will mean they are much better prepared.

''I've got some pain in my chest. It's right in the middle. It feels like someone's sitting on me,'' Lars tells his carers. ''What are you doing to me?''

After running through some tests the nurses call for a doctor.

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http://www.theaustralian.com.au/australian-it/government/labors-e-health-program-overbudget/story-fn4htb9o-1226166245492

Labor's e-health program overbudget

• by: Karen Dearne
• From: Australian IT
• October 14, 2011 12:00AM

THE federal Health department overspent its e-health implementation budget by $5 million in 2010-11 due to timing of contracts with "key delivery partners" prior to the end of the financial year.

Its actual spending for the period totalled $142.2m.

The department says it has “substantially met” its target for the design and development of infrastructure for the $500m personally controlled e-health record system, due to be operational by next July 1.

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http://www.medicalobserver.com.au/news/paper-files-still-safer-than-electronic-records-experts

Paper files still safer than electronic records: experts

10th Oct 2011 Mark O’Brien

EXPERTS have defended the security of patient information held in hard copy general practice files after Health Minister Nicola Roxon said the government’s personally controlled electronic health record (PCEHR) system would be more secure than traditional paper records.

The minister said last week there were “very few protections” for paper records in general practice, with a spokesperson later telling MO e-health records would be more secure because they would be subject to a range of mechanisms to protect privacy.

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http://www.6minutes.com.au/news/telehealth-improves-rural-stroke-care

Telehealth improves rural stroke care

• By Gemma Collins on  11 October 2011

Telehealth can be used within acute stroke care to “bridge the gap of rural-metropolitan inequality”, a Victorian pilot scheme has found.

A telehealth system known as Telestroke, trialled for a year between an urban and a rural hospital in Victoria, saw an increase in the rate of thrombolysis given to rural patients, according to a study (link) published in the Internal Medicine Journal (online Oct 7)

With many rural patients being denied thrombolysis due to a neurologist shortage, the trial involved 24 patients presenting to the North East Wangaratta Hospital with acute onset non-convulsive neurological symptoms, the chance to have a video consultation with a neurologist at the Royal Melbourne Hospital - around 235km away.

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http://www.smh.com.au/national/health/hospitals-now-safer-as-mistake-rate-drops-20111013-1ln4i.html

Hospitals now safer as mistake rate drops

Mark Metherell

October 14, 2011

DOCTORS may be less likely to operate on the wrong patient in hospitals these days, although there is a slightly higher, if small, risk of patients being left with surgical items in their bodies after operations.

A national hospital hazard checklist instituted five years ago shows that serious hospital mistakes and adverse events have fallen overall from a total of 183 incidents in public and private hospitals to 134.

Procedures involving wrong patient or body part resulting in death or permanent injury totalled 79 in 2005-06 but 10 in 2009-10. Surgical instruments or other material being left in the patient after surgery requiring re-operation numbered 44 cases in both years.

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http://ehealthspace.org/news/new-director-general-qld-health

New director general for QLD Health

Posted Mon, 10/10/2011 - 16:43 by Josh Gliddon

Dr Tony O’Connell has been appointed director general of Queensland Health, effective immediately.

An intensive care specialist, Dr O’Connell has 35 years of frontline experience in hospitals.

Note: The relevance here is that this appointment is also to NEHTA Board

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http://www.computerworld.com.au/article/404155/artificial_muscles_push_bots_bodies

Artificial muscles to push bots in bodies

A team of Australian scientists has developed artificial muscles which it says will make it easier for tiny nano-robots to be used inside the human body.

• AAP (AAP)
• 14 October, 2011 09:47

A team of Australian scientists has developed artificial muscles which it says will make it easier for tiny nano-robots to be used inside the human body.

The group, based at the University of Wollongong in NSW, says the muscles are small and strong enough to push the nanobots along the bloodstream.

The use of nanobots in diagnosing and treating medical conditions such as cancer has received publicity over the past few years, but working out how to move them through the body has been a hurdle until now.

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http://www.smh.com.au/technology/sci-tech/fantastic-voyage-comes-a-tiny-step-closer-20111014-1lo0x.html

Fantastic voyage comes a tiny step closer

Deborah Smith

October 14, 2011 - 11:35AM

NSW researchers have developed tiny artificial muscles that can twist like those in the trunk of an elephant or the arm of an octopus.

Made from a tough, flexible yarn spun from carbon nanotubes, they could speed up the design of futuristic nanobots that can travel through the body detecting and treating disease.

Geoff Spinks, of the University of Wollongong, said a big hurdle to the development of medical nanobots was how to propel them  in the bloodstream.

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http://www.smh.com.au/it-pro/government-it/nbn-falls-behind-schedule-20111011-1lj8l.html

NBN falls behind schedule

Lucy Battersby

October 12, 2011

Telstra deal and construction contracts blamed.

The rollout of the national broadband network is behind schedule because of delays in striking a deal with Telstra and issuing construction contracts.

And an inquiry will be held into the need for large battery units to be installed at all homes and businesses connected to NBN Co's fibre, following complaints from residents testing the broadband network.

NBN Co chief executive Mike Quigley yesterday confirmed the rollout was ''several months'' behind because regulatory and commercial negotiations had taken longer than expected.

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http://www.theaustralian.com.au/national-affairs/health/inquire-into-superclinics-australian-medical-association/story-fn59nokw-1226165338696

Inquire into superclinics: Australian Medical Association

• by: Sue Dunlevy
• From: The Australian
• October 13, 2011 12:00AM

THE Auditor-General has been asked to investigate the government's GP Superclinics after the government moved to axe two of the clinics and revealed only 17 of the promised 64 were operational.

The Australian Medical Association, which opposes the government-funded clinics, yesterday wrote to the spending watchdog asking it to investigate the program.

"It is clear that there are huge problems with the program and the public needs answers about what is happening with a significant investment. I have today written to the Auditor General urging a thorough audit of the Program by the Australian National Audit Office, Australian Medical Association president Steve Hambleton said.

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http://www.theage.com.au/national/foi-act-scores-well-back-in-the-pack-20111009-1lfx0.html

FOI Act scores well back in the pack

MATTHEW MOORE

October 10, 2011

The Commonwealth FOI act scored 85 out of a possible 150 points in a study that assessed 89 countries.

AUSTRALIA'S freedom of information law has been ranked 39th among 89 countries in the first study comparing the adequacy of laws designed to open up the workings of government.

The 30-year-old Commonwealth Freedom of Information Act, which was radically overhauled in 2009 and 2010, scored 85 out of a possible 150 points in a joint European and Canadian study that assessed 61 indicators for each country's law.

The Right to Information survey released this week looked only at the laws themselves, not at how well they work in practice, which explains some surprising results.

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http://www.nytimes.com/2011/10/11/science/11predict.html?_r=1

October 10, 2011

Government Aims to Build a ‘Data Eye in the Sky’

By JOHN MARKOFF

More than 60 years ago, in his “Foundation” series, the science fiction novelist Isaac Asimov invented a new science — psychohistory — that combined mathematics and psychology to predict the future.

Now social scientists are trying to mine the vast resources of the Internet — Web searches and Twitter messages, Facebook and blog posts, the digital location trails generated by billions of cellphones — to do the same thing.

The most optimistic researchers believe that these storehouses of “big data” will for the first time reveal sociological laws of human behavior — enabling them to predict political crises, revolutions and other forms of social and economic instability, just as physicists and chemists can predict natural phenomena.

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Enjoy!

David.

AusHealthIT Poll Number 92 – Results – 17th October, 2011.

The question was:

How Satisfied Are You With the Proposed Legislation to Support the PCEHR?

Really Perfect

-  4 (18%)

Needs a Few Tweaks

-  3 (13%)

Needs Considerable Change

-  5 (22%)

Utterly Appalling

-  10 (45%)

Votes : 22

A pretty clear  vote. 67% do not think the legislation is up to scratch!

Again, many thanks to those that voted!

David.

Is The Overall Direction of The Australian Health System Out of Control? I Suspect So and The Problem Is At the Top!

The following very useful article appeared the other day.

Weary troopers on the front lines of an overburdened system

• by: Adam Cresswell, Health editor
• From: The Australian
• October 15, 2011 12:00AM

LUNCH was supposed to start 40 minutes ago, but the trays of sandwiches and cake brought by a waiting drug rep still sit cling-wrapped on the table.

"I can't, I'm still busy," general practitioner Jeff Regnis tells staff who are gathering for the pre-booked rep's visit, intently filling a hissing steel flask with liquid nitrogen, his grim expression a more effective warning against interruption than his words.

"Jeff's had eight 'extras' this morning," nurse Donna Buckley explains in a lowered tone, as Regnis hurries back into his office through the still-packed waiting room.

Extras, also known as fit-ins, are the urgent patients who somehow have to be squeezed into the schedule of the Thornton Medical Centre on the NSW Central Coast. Today, as a glance at the busy 12-doctor clinic's computerised booking system shows, the schedule is chockers, the handful of slots left empty for priority cases on the day having already been filled.

The booking screen resembles a bathroom wall done in multicoloured mosaic tiles, each tile bearing a different name, each name a living, breathing person with their own story of what happens when the body, or sometimes the mind, decides to go its own way.

The staff who automatically cleared a path for Regnis's trip to the nitrogen bottle barely exchange looks. This is how it goes at the coalface of general practice, where the patients come thick and fast and the problems cover everything from men with lower legs that are threatening to turn gangrenous to a two-year-old girl whose four-year-old sister has tried to chop off her younger sibling's finger with a pair of scissors.

"Luckily, they must have been blunt scissors," Buckley says with the deadpan air of someone who has seen it all.

The pace seems manic but Buckley and the other staff say this is typical, even though today is a Thursday, not even the "crazy day" of Monday when the weekend warriors, the have-a-go renovators, those stuck nursing sick children on the weekend and workers seeking a sick note all flood the phone lines.

Heaps more here:

http://www.theaustralian.com.au/national-affairs/health-of-the-nation/weary-troopers-on-the-front-lines-of-an/story-fn9iqmqf-1226167069588

Later in the article some experts turned to the Medicare Locals and the GP Super Clinics.

“However, the GP super clinics have been tainted by accusations of mismanagement and claims they have been chosen according to political rather than medical need. Most of the government's remaining focus on primary care lies in its strategy to introduce Medicare Locals, a $416m attempt to set up an national network of primary health organisations that will help to co-ordinate GP services with those of hospitals and other health providers. They are also meant to play a leading role in improving after-hours services. But much confusion remains about what they will - or should - be doing.

Lightbody, with most of the Thornton clinic's GPs, believes the health reforms in train "don't touch us", and staff remain unclear about what role Medicare Locals will play: a confusion shared by some of the country's top health experts.

At a recent policy round table hosted by The Weekend Australian as part of the Health of the Nation series, Philip Davies, professor of health systems and policy at the University of Queensland and a board member of one of the first wave of 19 Medicare Locals, revealed even one other member of his own organisation's board was confused about the purpose of Medicare Locals, appearing to believe they were GP super clinics.

"That to me is indicative of an abject failure on the part of the government to actually explain what these bodies are," Davies said at the event.

Another expert on the panel, University of Sydney professor of surgery Mohamed Khadra, says the panel discussion, which involved seven of the country's top medical and health policy experts, turned up "four different definitions of a Medicare Local. Clearly nobody knows what a Medicare Local is."

Yet observing the daily struggles and successes of the Thornton Medical Centre's staff yields a quick checklist of some of the things that go wrong at the GP-hospital interface, which Medicare Locals could devote some of their energies trying to fix.

Regnis says one of the main frustrations GPs face is continuing poor communication from hospitals, which happily discharge their patients into the community, leaving them to the care of the GP surgery long before any account of what treatment they received on the wards arrives.”

Inevitably the PCEHR got a mention - and hardly a positive one from the coalface:

"We have had people come back after having strokes . . . and you are ringing people up, chasing imaging results, blood tests, trying to get to talk to the doctor. We need to know why they went in, what was done and what is the post-discharge care schedule," Regnis says.

The planned system of electronic health records may address this, but there remains doubt about the extent to which patients will trust the system enough to opt in, and whether doctors will want to risk heavy penalties for privacy breaches.”

You can read the views of the experts in more detail here:

If I were health minister . . .

• From: The Australian
• October 15, 2011 12:00AM

THE Weekend Australian convened a panel of some of the nation's leading health policy experts to discuss how to fix the system. We began by asking, if they were health minister, what would be the first thing they would do.

Interviews here:

http://www.theaustralian.com.au/national-affairs/health-of-the-nation/if-i-were-health-minister/story-fn9iqmqf-1226167069907

If there is a theme running through all these interviews it is that the reforms are partial, at best, and not likely to deliver what is needed in the present form.

When you go to the Federal Government Health Reform Site the emphasis is on the following:

GP Super Clinics:

There is a very current update here:

http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr208.htm

More Opportunity for Health Investments as Primary Health Care Reforms Being Delivered

The Australian Government is improving access to frontline health services across the country in a snap shot of primary health care reforms released by Minister for Health and Ageing Nicola Roxon on 12 October.

The sort of issues that are emerging is illustrated here:

AMA calls for super clinics inquiry

13th Oct 2011 AAP

HEALTH Minister Nicola Roxon has taken a swipe at the AMA following the association’s call for the auditor-general to investigate the federal government's GP super clinics program.

The move by the AMA comes after Ms Roxon announced the scrapping of a planned clinic in Darwin on Wednesday and the axing of a Tasmanian super clinic last week.

AMA president Dr Steve Hambleton has written to Auditor-General Ian McPhee "urging a thorough audit of the program by the Australian National Audit Office".

Dr Hambleton accused the government of putting political needs ahead of patients.

"There is emerging evidence that the GP super clinics program is a failed initiative in concept, design and implementation," he said in a statement.

"In terms of planning, the location of clinics appears to be largely a political process that is not necessarily linked to community need."

More here

http://www.medicalobserver.com.au/news/ama-calls-for-super-clinics-inquiry

Medicare Locals:

You can read all about these here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/medilocals-lp-1

For at least one on the ground view try here:

http://blogs.crikey.com.au/croakey/2011/10/10/health-reform-in-whose-interests-and-what-happened-to-the-vision-for-primary-healthcare-reform/

“Lyn Morgain, CEO of the Western Region Health Centre in Victoria, argues that Medicare Locals are a disappointingly long way from the original vision of primary health care reform.”

Lastly, of course is the PCEHR, which is covered in detail in the blog:

The link to the main Health Reform Site is here:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/content/home

Additionally we have to recognise that the reform of Health Funding was blocked by the States and we still have a Therapeutic Goods Administration that can’t actually make sure materials which make therapeutic claims actually have any evidence for those claims.

Bottom line is as follows:

1. Nation Health Funding Reform essentially failed.

2. No one really knows what Medicare Locals are.

3. The GP Super Clinics are being rolled at very slowly with all sort of issues about scope of services, short funding, displacement of established practices and so on.

4. The TGA is an under-resourced toothless tiger, and nonsense scams are able to collect punters money and flourish.
5. Of course the PCEHR is hardly a project which is going well - with 'panic' as to the risk failure now upon us!

With all that going wrong, we now have the Minister responsible for all these implementation difficulties and failures attempting to push the same rather pushed primary care sector into happily and excitedly taking up the extra work associated with the PCEHR.

Dream on Minister is all I can say!

Am I the only one who can’t work out why change (good, bad, misguided or not) is always called reform? I thought reform implied improvement and I can’t see much actual improvement here - and many others seem to have much the same view.

David.