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."

Wednesday, June 13, 2012

ABC’s 7:30 Covers The Planned Impending Introduction of e-Health In 2 Weeks. Watch on iView Tomorrow Early AM.

Just watched a quite balanced approximately 10 min segment on 7:30 on ABC1 beginning about 7:40pm.
Notable that the Minister, Mr Fleming and Ms Halton were not interviewed.
You will be able to watch the program at www.abc.net.au/iview after about 7am tomorrow morning.
Enjoy the watch - Comments welcome.
David.
All the details are now available here:
http://www.abc.net.au/7.30/content/2012/s3524583.htm
D.

Here Is The Sort Of Problem Clinical Safety Assessment Is Meant To Address But Struggles With.

The following appeared a few days ago.

Doc: EHR Problems Affect Patient Relationships

JUN 8, 2012 12:21pm ET
Electronic health records systems definitely affect the willingness of patients to share medical information, sometimes in a negative way, says psychiatrist Scott Monteith, M.D.
He spoke during a session at the Health Privacy Summit in Washington. Monteith, medical informaticist at Michigan State University, uses an EHR in his practice. A recent patient, feeling stigmatized by past diagnoses, opted not to reveal private medical information, he said.
Two years ago, another of Monteith’s patients found an error in her electronic health records that indicated a history of inhalant abuse. It turned out that the EHR did not distinguish between four similar diagnostic codes, which included inhalant abuse, which the patient had not experienced, and caffeine addiction, which she had.
The EHR bundled the four diagnoses, and the viewing window had room to display one--the erroneous inhalant abuse. The patient was grateful for efforts to find and rectify the problem, but stopped coming in, Monteith said. Two years later, the problem--resulting from errors by the software vendor and implementation contractor--remains, in large part because the vendor has been unresponsive.
Lots more here:
There are so many lessons here it is hard to know where to start.
We have a patient feeling stigmatised and as a result not continuing with treatment.
We have a Health IT Vendor who seems to think a system that is clearly linked to clinical problems can be left in a faulty state for 2 years.
Lastly we have a clinician who is unable to get a remedy quickly to a problem that is clear, defined and fixable.
All one can do is sympathise. We have to wonder just how responsive to errors of this sort being identified will we find the NEHRS provider and their subcontractors to be. Governance that does not address issues like this swiftly will be a danger for all involved.
David.

Tuesday, June 12, 2012

Good Heavens - It Seems The NEHRS Will Be Like The Old Scanned Electronic Record Systems Where Search-ability , Decision Support and Discrete Data Is Out The Window.

The following appeared a while ago - and I missed it for a while.
MAY 2012 | Published by RCPA
Issue #014

Pathology results will miss this year’s eHealth debut

The long-anticipated eHealth initiative will make its debut on July 1 this year, and it’s been a long journey to date. But the journey’s not over yet, especially for pathology which won’t be included in this year’s eHealth rollout. It’s not a case of omitting pathology from eHealth, but more a case of advocates such as the Royal College of Pathologists of Australasia (RCPA) ensuring that pathology results are uploaded and viewed in the safest possible way.
“The RCPA have been working cooperatively with the National E-Health Transition Authority (NeHTA) on this project,” explains Dr Bronwen Ross, Deputy CEO of the RCPA. “However, patient safety is paramount so we have been making sure pathology results will be uploaded into eHealth records in a way that ensures their complexity and context are not lost in the transition.”
The official title of this new eHealth patient record is the National Electronic Health Record System (NEHRS), although older information may refer to it as a Personally Controlled Electronic Health Record (PCEHR). Whatever its name, Professor Michael Legg from the Centre for Health Informatics and eHealth Research at the University of Wollongong says the roll out will be slow with the initial benefits mostly favouring people who are outside of their normal caring group of health practitioners.
“There’s a good example of this in action on the eHealth information website1 which gives the example of Kelvin’s eHealth journey to demonstrate its usefulness in this situation.”
Prof Legg, who is also a Fellow of the Faculty of Science of the RCPA, says eHealth is an important initiative but he also shares Dr Ross’ concerns about the risks of uploading pathology results in a fragmented way.
“If you grab bits of a pathology report and cut and paste it into an eHealth record then it can lose its context, especially if there are differences in the units and reference ranges used by different laboratories.”
Dr Ross says the RCPA is working on standardising certain aspects of pathology reports, but like any major project it will take time.
“Pathology results are not just a group of numbers or a commodity that can be put wherever people like,” she stresses. “There is medical analysis by a pathologist behind them and that’s one of the reasons why they must be represented in context. For example, microbiology is one area where uploading fragmented information can have serious consequences because the reports deal with different organisms and cultures as well as specific recommendations by pathologists.”
Dr Ross says a group of pathology stakeholders have agreed on a model where the results will be uploaded into the eHealth record in a PDF format so the report is viewed in full. This has the added advantage of enabling treating practitioners to view additional information such as who wrote the report as well as the laboratory’s contact details.
More explanation and details are found here:
Further on we also find the target date for result availability is a year after the NEHRS was meant to go live for large pathology providers and a year later for smaller ones.
It seems that while discrete pathology results (as well as those in PIT format) have been provided by a range of secure message providers for years that we are now going to settle for the foreseeable future on a ‘data lump’ format for the NEHRS.
What needs to be quite explicit here is that this problem has been known about for years by NEHTA. It has always been the intent that the new Secure Messaging standards from NEHTA would support proper interoperability.
Here is a title page from an old presentation. (Not surprisingly Google does not now find it!)
NEHTA

Moving to Interoperability in eHealth

12 July 2006
Andy Bond
General Manager Interoperability
----- End Extract.
Page 14 of the presentation makes it clear that not only e-Results but also e-Ordering are to come. Six years later - Oops missed that one and it will now take a few more years.
I will leave it to others to explain why so much has been spent on NEHTA and why this work still isn’t done. It beats me.
That we have not reached agreement on how to provide discrete information to clinical systems is really a very sad outcome - given the how ‘blob’ formats make things like clinical decision support that much harder.
Use of .pdf files is really such a technically poor outcome that one only wonder why more work has not been done to get a better outcome by those involved - RCPA, NEHTA and DoHA.  Why do I get the feeling there is more than technology involved here - turf preservation or politics maybe? Maybe a careful rethink with the interests of clinicians and patients might be a good idea?
Remember that, of course, once second best gets established - how long will it be before a new improved version emerges? Your guess is as good as mine!
David.

Monday, June 11, 2012

Weekly Australian Health IT Links – 11th June, 2012.

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

A pretty quiet week as the wait for the wimper that will be the start-up of the NEHRS. The hosing down of expectations has really reached fever pitch and what will now be interesting is to see just what is actually delivered when and for how many.
Of some amusement is to see how gradually the term NEHRS is being adopted  by more and more reports and releases. I wonder why this is happening as I have not heard any official commentary - other than the Ministerial Speech a month or two ago.
On a related matter I am told Standards Australia are saying the approved term is now ‘eHealth’. Just so you know!
-----

September start for PCEHR

4 June, 2012 Michael Woodhead
GPs will have to wait until September for software to allow PCEHR features such as shared care summaries to be set up, health department officials have said.
While patients will be able to register for the PCEHR system from 1 July, the actual system will be introduced via a “slow rollout” that will see operational features coming online later in the year, officials told a Senate Estimates committee meeting last week.
----

Just another day in the e-health evolution

05/06/2012
Emma Connors
Anyone hoping for fireworks when a new $467 million-plus e-health system goes live next month is going to be disappointed.
In recent weeks, Health Minister Tanya Plibersek has been hosing down expectations. Last week, it was the turn of the Health Department secretary Jane Halton.
“One July is the beginning, not the end point,” Ms Halton told a Senate estimates committee hearing last week.
“We do not expect everyone to be registered on that date and we did not expect all the capability to be available on that date.”
-----

Doctors in dark about electronic health records

Posted June 06, 2012 12:54:04
Local doctors say they have yet to see details about how a new electronic health records scheme will work.
The Federal Government is due to begin rolling out the system next month.
-----

E-health software products to be available to GPs within months

5th Jun 2012
GPs can expect to connect to the national e-health record system (NEHRS) within months, according to experts who say clinical software packages incorporating the system will be widely available by September.
The system’s 1 July launch date has been significantly played down over the past six months by Health Minister Tanya Plibersek, who has said it would now only signify the date when patients could start to register for a record.
But evidence from National E-Health Transition Authority (NEHTA) officials during senate estimates last week suggested practitioners may not be far behind and Medical Software Industry Australia president Jon Hughes said GPs would be in the vanguard.
-----

Publicity truck hits the road, but AMA warns ehealth launch will drive into bugs

June 6, 2012
THE government's ehealth agency has deployed a truck to tour Australia promoting electronic health records.
Pathology and X-rays are headlined on the side of the truck as patient info that ''travels with you'' once ehealth kicks in.
But there is still a long way to go - perhaps years - before patients will be able to log on to their diagnostic records, despite the July 1 start for the personally controlled electronic health record.
-----

E-health's 1 July launch to be soft

By Josh Taylor, ZDNet.com.au on June 4th, 2012
The government has been preparing for the launch of personally controlled e-health records (PCEHRs) for two years, but what will be available on 1 July will be far from a complete e-health record system.
When the government announced the e-health record system in 2010, it was vague in detailing exactly what would be on offer from July 2012. The intention was that personally controlled electronic health records would be "rolled out from July 2012", but what the Australian public would actually be able to do from day one was a mystery.
Previous Health Minister Nicola Roxon held press conferences extolling the virtues of the system, which she said would eventually be like accessing a bank account online.
-----

Litigation warning on eve of e-Health

FOUR weeks before the introduction of a $1 billion e-Health scheme, key medical indemnity insurers are warning GPs not to participate as they could be exposed to a new wave of litigation.
There is concern doctors could be sued if patients are harmed because records are not kept up to date or clinical information is omitted. They are also worried by the ability of patients to restrict access to parts of the record.
Insurers are advising doctors not to use the e-Health records until the issues are settled.
-----

GPs advised to avoid ‘absurd’ PCEHR

5 June, 2012 Sarah Colyer
Medical indemnity insurers are warning GPs not to take part in the looming national e-health system as they will be liable if patient records are hacked.
Under conditions labelled “absurd” by MDA National, GPs wanting to take part in the personally controlled electronic health record (PCEHR) scheme would have to sign a contract agreeing that the government is not liable for breaches of patients’ records.
Doctors’ medical indemnity insurance policies would also not cover them if someone in their practice accessed a patient’s record without authorisation.
-----

Premiums may skyrocket due to e-health

5th Jun 2012
AS THE government continues to bargain with GP groups over the conditions practices must agree to when using the national e-health record system, experts have warned the legal liabilities attached to the records could push premiums up.
The first draft of the agreement caused outrage across the profession by requiring practices to assume all legal liability for the system and grant health department officials unrestricted access to their premises and records.
Department officials were due to meet RACGP representatives today to discuss the latest draft of the agreement, which sources said was the fourth so far, but MO understands the major GP organisations are still unhappy with many of the conditions.
-----

Pathology results will miss this year’s eHealth debut

The long-anticipated eHealth initiative will make its debut on July 1 this year, and it’s been a long journey to date. But the journey’s not over yet, especially for pathology which won’t be included in this year’s eHealth rollout. It’s not a case of omitting pathology from eHealth, but more a case of advocates such as the Royal College of Pathologists of Australasia (RCPA) ensuring that pathology results are uploaded and viewed in the safest possible way.
“The RCPA have been working cooperatively with the National E-Health Transition Authority (NeHTA) on this project,” explains Dr Bronwen Ross, Deputy CEO of the RCPA. “However, patient safety is paramount so we have been making sure pathology results will be uploaded into eHealth records in a way that ensures their complexity and context are not lost in the transition.”
The official title of this new eHealth patient record is the National Electronic Health Record System (NEHRS), although older information may refer to it as a Personally Controlled Electronic Health Record (PCEHR). Whatever its name, Professor Michael Legg from the Centre for Health Informatics and eHealth Research at the University of Wollongong says the roll out will be slow with the initial benefits mostly favouring people who are outside of their normal caring group of health practitioners.
-----

KPMG audit recommends Newman Government act swiftly and take multi-pronged approach to fix Queensland Health

A MULTI-pronged attack is the only way to stop continuing problems with the Queensland Health payroll system, an audit has revealed.
The KPMG report has recommended the Newman Government act swiftly to homogenise the highly variable awards of health workers, replace paper rosters with an electronic system by 2014 and move pay dates by a week to end the clash with rostering so last-minute shift changes can be logged in time.
It also urged the Government to accelerate the recovery of $91 million in mistakenly overpaid wages to help avoid a hefty fringe benefits tax bill that could climb as high as $110.4 million if the overpayments have to be written off.
-----

QLD Health payroll: IT "train wrecks" preventable

The Australian Computer Society says project committees are not utilising existing knowledge on project management effectively
IT project "train wrecks" such as Queensland Health’s $1.2 billion payroll failure are preventable, but require foresight, skilled senior staff and above all else, planning, according to the Australian Computer Society (ACS).
“At some point the scope [of the project] changed quite substantially, or an understanding of the scope changed during the course of the project, and it appeared that the overall project leadership therefore changed,” ACS president, Nick Tate, told CIO Australia following the release of an audit by KPMG into Queensland Health's payroll system.
-----

$1bn to fix Queensland Health payroll

07/06/2012
Mark Ludlow
The cost of Queensland Health’s payroll debacle will exceed $1.2 billion over the next five years, according to an audit by KPMG.
The report, which has been tabled in state Parliament, found the cost of fixing the payroll system to the end of this financial year was expected to reach $416 million. A further $837 million would be needed to keep it running until the end of 2017.
-----

NEHTA Videos

The National E-Health Transition Authority Limited (NEHTA) was established by the Australian, State and Territory governments to develop better ways of electronically collecting and securely exchanging health information.
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NEHTA inks contracts with aged software panel vendors

NEHTA has recognised the importance of the aged care sector in a move to boost provider readiness for the PCEHR. With this in mind, NEHTA has signed contracts with shortlisted vendors on the aged care vendor systems software panel.
-----

NEHTA signs up Aged Care Software Vendors for eHealth Panel

The National E-Health Transition Authority (NEHTA) CEO Mr Peter Fleming said today NEHTA has successfully completed the Expression of Interest (EOI) process for Aged Care Vendor Systems and had executed contracts with all shortlisted vendors.
Mr Fleming said the objective of the EOI was to establish a vendor panel for vendors to provide software solutions to aged care providers, including those operating residential aged care facilities and community care services, with the primary objective of driving Personally Controlled Electronic Health Record (PCEHR) uptake.
"NEHTA recognises the importance of consulting closely with the software industry as we build the new eHealth records system," Mr Fleming said.
-----

Secure Message eXchange (SMX) for healthcare organisations

7 Jun 2012
Three of the leading organisations providing secure electronic message services to the health industry have formed a collaboration to enable exchange of messages between their respective customers.
The founding members of the Secure Message Exchange (SMX) are Global Health, HealthLink and DCA, who service the industry with their ReferralNet, HealthLink and Argus products respectively, and have a combined presence of over 85% of the current messaging users.
Up until now, users of each product could only send and receive electronic messages to other sites with the same vendor product. With the SMX, systems from each of the vendors’ products will be able to seamlessly interchange messages, Australia – wide.
-----

Orion Health lands $18.5m Irish deal

3:00 PM Tuesday Jun 5, 2012
New Zealand software company Orion Health has won an $18.5 million contract with Northern Ireland's public health service.
Auckland-based Orion Health's seven-year deal with Health and Social Care Northern Ireland involves the implementation of its Electronic Care Record (ECR) software, which allows better sharing of patient data between healthcare organisations.
The contract follows a successful pilot of the ECR in Ulster Hospital, Belfast City Hospital and two general practices in 2009 and 2010, said Orion Health chief executive Ian McCrae.
-----

E-health record conditions still up in the air

4th Jun 2012
The health department is still at odds with GP groups over conditions it expects practices to sign up to in order to participate in the national e-health record system, almost two months after its first draft caused outrage across the profession.
The first draft of the conditions required practices to assume all legal liability and grant department officials unrestricted access to their premises and records; it prompted the AMA secretary general to warn the conditions would “deter every medical practice in Australia from participating”.
A second draft, which was sent to GP groups in mid-May and subject to strict confidentiality rules, failed to win the support of the RACGP while a third draft is due to be discussed between college and department representatives tomorrow.
-----

Records defects risk patients health

A LACK of uniform coding in the electronic health record system could see doctors prescribe penicillin to a patient who was allergic to it, with devastating results.
Incomplete or missing patient records, missing allergy status alerts and a lack of a common medical coding system are "tolerable risks" for the new $1 billion national electronic health information system, says the body charged with delivering the system.
The National e-Health Transition Authority has identified these key clinical risks in the federal government’s personally controlled e-health record system in a clinical safety case report lodged on its website late last month.
-----

ThoughtWorks recruits to build open e-health standard

Seeks Aussie developers for Agile project.

ThoughtWorks is recruiting Australian software developers to build an open, global medical records standard for developing nations on a voluntary basis.
The Agile software development house last night held the first of a weekly series of “hack nights for humanity”, aiming to support the OpenMRS platform.
OpenMRS is a community-driven, open source platform, that was created by two US philanthropic organisations in 2004 to facilitate the exchange of medical information between clinical and research organisations.
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Pulse 2012: User identity lessens security risk for Mater Health

Health provider identifies what websites patients, clinicians are browsing to avoid risks such as malware
Concerned that patients and clinicians could be unwittingly exposing NSW private health provider Mater Health to malware, IT security manager Peter Param decided that its broadband network needed monitoring.
Speaking at Pulse 2012 in Sydney, Param told delegates that it does intend the monitoring to be for nefarious “Big Brother” uses, but to cut down activity on its network which could be classed as malicious and dangerous for the provider.
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Medicare Locals chief hits back at Dutton

The Federal Opposition’s pledge to pull the plug on Medicare Locals will leave patients languishing in the hospital system, the leader of the network warns.
The network of Medicare Locals — due to be in place by July — was attacked by Opposition health spokesman Peter Dutton last week when he described it as an "unnecessary bureaucracy".
Pledging to "defund" the network, which has cost $477 million to set up over the past four years, Mr Dutton claimed Medicare Locals would divert funding from frontline services.
However, Dr Arn Sprogis, chair of the Australian Medicare Local Alliance, hit back at Mr Dutton’s claims.
-----

Modified iPads being used by spinal injury patients

Spinal injury patients with limited hand function are able to access the internet through modified iPads
Spinal patients at the Prince of Wales Hospital in Sydney are using modified iPads to help them browse the Web and connect with family and friends.
The specially configured iPads have been modified for the needs of patients with paraplegia and tetraplegia, who often spend around six to nine months in hospital undergoing rehabilitation after an accident.
The iPads were first trialled by three patients at the hospital, with another six iPads deployed later as part of the trial.
-----

'Diet glasses' fool wearers into eating less

June 5, 2012 - 9:32AM
Goggles that trick the wearer into thinking the plain snack in their hand is a chocolate biscuit, or make biscuits appear larger have been unveiled in Japan, offering hope to weak-willed dieters everywhere.
Researchers at the University of Tokyo have developed devices that use computer wizardry and augmented reality to fool the senses and make users feel more satisfied with smaller - or less appealing - treats.
-----

NBN pre-poll rollout tilted to Labor seats

THE National Broadband Network rollout favours suburbs in Labor-held seats before the federal election due next year, with three out of every five to be connected to the $36 billion project falling in ALP electorates.
Analysis by The Australian of NBN Co's three-year rollout plan has shown that by June 30 next year 416 of the 700 suburbs to be connected to the NBN's fibre rollout, or 59.4 per cent, are in Labor electorates, compared with 34.9 per cent or 244 suburbs in Coalition seats.
The figures are supported by the seat split, which shows 58 per cent of the electorates that will have some part of the NBN rollout completed within 12 months are held by Labor, compared with 35 per cent for Coalition-held seats. Labor and the Coalition each hold about 48 per cent of the nation's electorates.
-----

Turn off IPv6, say security experts

June 8, 2012 - 11:01AM
World IPv6 launch day - when businesses, web hosts and equipment manufacturers were encouraged to switch from the old internet protocol version 4 to the new version 6 - came without any noticeable hitch this week, but device owners should disable the protocol until there's a compelling reason to activate it, according to two security experts.
IPv6 will eventually replace IPv4 as the communications protocol that enables internet traffic to move between addresses and past switches, routers and other networking equipment.
The new protocol will deliver a range of inbuilt security features, like IPSec, that should improve authentication and encryption on the web in a way that supports an expansion of web addresses to include things like fridges, toasters, toilets and lights.
-----
Enjoy!
David.

AusHealthIT Poll Number 125 – Results – 11th June, 2012.

The question was:
Do You Believe The DoHA Estimates Of the Benefits That Will Flow From The PCEHR are Realistic?
Yes
-  4 (10%)
No
- 32 (84%)
I Can't Tell
-  2 (5%)
Votes 38
There seems to be a clear view they these benefits projection are not all that realistic.
Again, many thanks to those that voted!
David.

For The Record - From The Queen’s Birthday Honours List Announced Today.

This was pointed out to me this morning.
Dr Ian Norman REINECKE, Point Piper, NSW. For service to information technology, particularly through leadership in the development and implementation of uniform national health systems and as an adviser and co-ordinator of the technology capability of the Sydney 2000 Olympic Games.
See here for full list.
It is worth the blog’s readership being aware of the honour, hence the post.
I will leave it for others to comment.
David.

Sunday, June 10, 2012

What Fun Rejecting Spam Posts! Very Satisfying To See The Time They Are Wasting!

I have a problem - the blog seems to be attracting hits (630,000 so far) so the spammers want to get links in to elevate their Search Engine Optimization client's rankings.

So far 500+ have been blocked and none will get through. So just go away and stop trying. I have seen all the tricks before!

Best wishes for trying elsewhere.

David.


This Article Makes A Really Interesting Point And I Wonder What The Impact Will Be? Messy I Suspect.

Every now and again I see an article that provides real food for thought. The following is definitely one of those.

For Healthcare, Windows Picks a Bad Time for a Facelift

Scott Mace, for HealthLeaders Media , June 5, 2012

By my calculations, 2013 will be one of the trickiest years in tech since Y2K.
Why? Not because of EHRs, HIEs, or the other technology acronyms so familiar to healthcare executives. The biggest reason is the release of Windows 8, Microsoft's most radical rethink of Windows since Windows 95.
Windows remains the dominant OS in healthcare institutions, as at most organizations. The new interface-lift is expected as early as fall 2012, to be followed by a long period of upgrades and retraining. Gone will be the familiar overlapping windows and pull-down menus so familiar to Windows users since way, way back. (I used Windows 3.0 back in 1990, so I'm a longtime menu puller-downer.)
Replacing this will be the radically new Metro user interface, where applications are tiled but not overlapping, where menus and mouse movements give way largely to gestures and touch-driven commands to make applications maximize, minimize, and do cool stuff.
It's all very inspired by the success of the iPad, itself a radical rethink on the old Macintosh user interface. Apple doesn't officially support the iPad with a mouse, although at the recent American Telemedicine Conference, I saw a variety of iPads paired with third-party keyboards and even a few mice to recreate that PC experience.
Metro still retains the mouse when running on desktops, but it's the "Windows 8" name that will cause healthcare (and many users in general) the most grief. As of last Saturday, purchasers of systems with the current Windows 7 installed are eligible to upgrade to Windows 8 for less than $15.
Generally these upgrades are a headache for all of IT. It's usually better to start with a fresh system. I wish Microsoft would dispense with the whole idea of upgrading from one OS to another. There's a history of bad experiences.
Lots more here:
This change to the user interface is, I suspect going to be a bit messy. This will especially be the case in the transition phase - which will take years at least - and while people find themselves using both. Remember the time it took for move from the green alpha numeric screens to the initial versions of Windows and the Macintosh interfaces with a graphical interface, mouse and so on.
Given the efforts the UK NHS undertook to make sure the older Windows Interface was clinically usable and safe one wonders if any work has been done on the METRO interface.
At first look it does not look all that intuitive. Just how things like cut and paste and drop down menus are handled will be important as well.
As someone said ‘Toto, I don’t think we are in Kansas anymore!’
David.