I thought I would take a few rough notes for readers here. E & O E!
Relevant Section -Outcome 7 - E-Health Started 08:34 pm.
Lots of waffle on NICNAS and FSANZ. (Chemicals and Cosmetics!!)
8:58 pm Moved on to TGA.
Refused to discuss medical cannabis….. Questions since June from all sorts of Senators.
Australian Medical Devices are now more able to get easier conformity assessment if approved in EU or, I assume, US.
Outcome 7 - Finished at 9:14pm.
We know where e-Health is heading now - Into Oblivion!
Sleep Well and what a farce - zero accountability!
David.
Wednesday, October 22, 2014
It Seems Practice Management System Vendors Have Been Warned There Are Significant Issues With The PCEHR That Won't Be Fixed Until December 2014.
This alert was sent out today. I am told many system providers (not just Genie) are affected.
Potential issue with PCEHR overviews
We have been alerted by the Department of Health about a potential risk identified within the PCEHR system. This is impacting the way a small number of documents can be viewed in an eHealth record.
This issue results in some Medicare, prescription and dispense documents presenting in the Document List but not appearing in the Medicare Overview or the Prescription and Dispense View.
A permanent solution for this issue has been identified and will be implemented in December 2014 by the Department of Health.
In the meantime, please do not rely on the Medicare Overview or Prescription and Dispense View within the Genie PCEHR-viewer to necessarily provide a complete list of information from a patient's eHealth record. It is recommended that you use the Document List to view all documents.
Here is the link:
This looks to me to have potential safety of use of the PCEHR issues surrounding it. I wonder why there is not an alert on the Department web site and why there is not a press release from the Minister? (Nothing found as of time of writing on the DoH Site)
One really wonders why it needs so long to be rectified?
David.
One really wonders why it needs so long to be rectified?
David.
Senate Estimates Alert - e-Health Scheduled 3:10pm -4pm Today 22/10/2014
To watch go to the following link:
http://www.aph.gov.au/
Then select the Watch Parliament Tab and click on Senate Estimates / Community Affairs Hearing.
Enjoy!
David.
Late Update - Committee is running very, very late.
D.
http://www.aph.gov.au/
Then select the Watch Parliament Tab and click on Senate Estimates / Community Affairs Hearing.
Enjoy!
David.
Late Update - Committee is running very, very late.
D.
Tuesday, October 21, 2014
Edward Gough Whitlam - My Thanks
Gough,
For getting rid of conscription (yes I was sucked in), providing major changes to health and education (yes I really benefited) and getting rid of the death penalty - many thanks!
We won't see his likes again I believe. The meanness we now see in public policy just shows how badly we are presently led - IMVHO. We can care and fund things - but no one wants to try!
Pity about that.
David.
For getting rid of conscription (yes I was sucked in), providing major changes to health and education (yes I really benefited) and getting rid of the death penalty - many thanks!
We won't see his likes again I believe. The meanness we now see in public policy just shows how badly we are presently led - IMVHO. We can care and fund things - but no one wants to try!
Pity about that.
David.
Ebola And Technology Intersect With Hopefully Some Useful Outcomes.
This appeared a day or so ago.
CDC, ONC Target EHR-Based Ebola Screening
OCT 17, 2014 7:30am ET
An initiative launched last year by the Centers for Disease Control and Prevention and the Office of the National Coordinator for Health IT to help providers meet Stage 1 and 2 meaningful use public health objectives is now focusing its efforts on Ebola electronic screening tools.
In August 2013, CDC and ONC established the Public Health Electronic Health Records Vendors Collaboration Initiative. However, with recently confirmed cases of Ebola in the United States, the initiative—which includes public health practitioners and EHR vendors—is currently aimed at trying to get vendors to configure EHR systems to support screening protocols for the deadly disease.
“The overall goal here is for us to explore ways in which the electronic medical record can serve as a prompt to help our healthcare professionals around the country identify individuals that may be at risk for Ebola,” said Dana Meaney Delman, M.D., deputy lead of CDC’s Medical Care Task Force (Ebola Response), during an Oct. 16 CDC/ONC webinar soliciting industry feedback.
“This is a special edition of our normal community of practice calls that we hold with public health and the EHR vendor community,” added Jim Daniel, public health coordinator at ONC. “We do meet on a monthly basis. Please send an email to meaningfuluse@cdc.gov so you can join this group. We talk about other public health and meaningful use measures normally, and we’ll be focusing on Ebola as long as we need to.”
According to a statement from the group, “the EHR vendor community has responded with components within their respective tools to address Ebola and assist within a healthcare environment.” Jon White, M.D., ONC’s acting chief medical officer, told the webinar audience on Thursday that CDC and ONC will be having a separate follow-on call with members of the HIMSS Electronic Health Record Association to gain input.
The CDC has developed a clinical algorithm for “evaluation of the returned traveler” and a checklist for patients being evaluated in the U.S. for Ebola. The objective of the Public Health EHR Vendors Collaboration Initiative is to include a travel history and assessment of pertinent clinical signs and symptoms in an electronic format that can help clinicians diagnose patients infected with Ebola and to isolate them. According to Delman, CDC wants to “ensure that there are mechanisms for healthcare providers to rapidly identify individuals that may have suspected Ebola” and “how we can translate this algorithm into an electronic medical record prompt and perhaps even a decisional tool.”
More here:
This is a really sensible idea. I wonder can the major providers of practice systems in Australia tweak their systems, as a precaution, to achieve a similar outcome.
Surely our tightwad government could manage to stump up a few $ for the vendors to make some carefully considered changes to make sure the right questions are asked early and that the responses are optimal. The small investment they may make might turn out to be the smartest thing they have ever done.
The whole thing becomes even more urgent when we see the issues that have arisen with some system in the US.
Here is a typical link
David.
Monday, October 20, 2014
Weekly Australian Health IT Links – 20th October, 2014.
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
Another quiet and pretty news less week. Lots of private sector activity but the Government is just a black hole with no light or information escaping!
Interesting to see Google Glass gradually becoming more mainstream. The impact of health is far from clear and we will only see what the outcome of the technology a good few years from now.
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Epic Pharmacy injects $1.5 million into Flamingo for healthcare VRM software
Epic Pharmacy managing partner Cathie Reid to join Flamingo board
Adam Bender (Computerworld) on 14 October, 2014 13:48
Epic Pharmacy has invested $1.5 million in Flamingo, an Australian developer of vendor relationship management (VRM) software.
Under the agreement, Epic – which provides hospital, oncology and aged care pharmacy services – and Flamingo will co-create healthcare services for Australian consumers.
The cloud-based Flamingo software is meant to aid businesses in their retention efforts by connecting the business and customer in a “co-creation laboratory” in which customers can customise how they interact with the company, what they’re looking for in the product, and other elements of the customer service experience.
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How social media is changing the healthcare landscape
There seems to be a significant growth of social media usage in the Australian healthcare industry.
In the past years we have seen surprisingly influential social media campaigns, like AHPRAaction, ScrapTheCap, InternCrisis, and very recently NoAdsPlease. These campaigns not only rally for better health care policies; they also signal a shift towards more transparency and accountability.
Characteristics of the social media campaigns are:
- They spread quickly and generate a lot of media attention
- The participants are very passionate about their cause
- They are often supported by different groups including consumers
- They may or may not be supported by professional organisations
- They are very effective.
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Victorian emergency services’ dispatch system upgraded in response to audit
Emergency Services Telecommunications Authority (ESTA) spends $13 million on computer aided dispatch (CAD)
Hamish Barwick (Computerworld) on 14 October, 2014 16:30
An audit of Victorian emergency response ICT systems by the Victorian Auditor-General’s Office (VAGO) has led to a $13 million upgrade of a computer aided dispatch (CAD) system and associated networks.
The upgrade was completed on 1 October, 2014 and is designed to improved network and CAD resilience. In addition, $15 million has been earmarked this year to upgrade the Emergency Services Telecommunications Authority (ETSA) telephony system for call-taking and dispatch.
An ESTA spokeswoman said that the CAD upgrades now mean that there is greater functionality for call-takers and dispatch staff, more robust technical infrastructure, improved disaster recovery and increased network redundancy across the network to make it more reliable.
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15 October 2014
Australian manufacturers of medical devices given a level playing field
The Assistant Minister for Health, Fiona Nash, today confirmed that, under the Government’s Industry Innovation and Competitiveness Agenda, new regulations will be introduced to allow Australian manufacturers to obtain market approval for most medical devices using conformity assessment certification from European notified bodies.
“With these changes, Australian manufacturers can choose to either have conformity assessment conducted by the TGA or an alternative conformity assessment body, such as a European notified body," Minister Nash said.
“This will cut red tape, provide more flexibility for local medical device manufacturers and, in many cases, enable devices to get to market more quickly, which will benefit the public.”
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National launch of vital signs 2014: the State of safety and quality in Australian health care
Professor Villis Marshall, Chair of the Australian Commission on Safety and Quality in Health Care, today released Vital Signs 2014: The State of Safety and Quality in Australian Health Care.
Vital Signs 2014 provides an overview of a series of key topics in relation to the safety and quality of Australia’s health care system.
Professor Marshall said “Vital Signs 2014 is structured around three important questions that members of the public may ask about their health care. Will my care be safe? Will I get the right care? Will I be a partner in my care?”
Each question is considered in its own section using examples of key health issues in Australia, such as healthcare associated infections, dementia and delirium, and health literacy. These sections are followed by two case studies, which focus on the quality of care in some important clinical areas. These case studies present a detailed description and analysis of key quality issues that affect outcomes for patients.
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Performance data caution
Sarah Colyer
Monday, 13 October, 2014
A SURVEY of senior US hospital managers has reinforced concerns about the worldwide trend to publish hospital performance outcomes on websites such as MyHospitals, with claims by the study participants that the measures used are meaningless.
The survey, published in JAMA Internal Medicine, obtained responses from chief medical officers and other leading executives at 380 US hospitals, who were asked about America’s Hospital Compare website. (1)
Hospital Compare is more detailed than Australia’s more recent MyHospitals site, and includes reports on “processes of care” measures such as the percentage of patients hospitalised for acute myocardial infarction treated with β-blockers, as well as condition-specific mortality and readmission rates, patient experience measures and cost and volume measures.
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Orion Health still assessing demand for IPO
- October 13, 2014
Orion Health, a hospital software provider in New Zealand, is still assessing investor demand for its much-anticipated initial public offering that may raise over $NZ100 million ($A90.2m) ahead of its November listing.
It is understood that Orion is meeting fund managers in New Zealand today, after having conducted a round of meetings with Australian fund managers earlier. Orion has not officially set a timeline for the IPO, although sources are expecting the company to list by the end of November.
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Cloud solution delivers a clean bill of health
- The Australian
- October 14, 2014
Jennifer Foreshew
HEALTHCARE provider Mercy Health found underinvestment in IT infrastructure had hurt performance and caused a lot of downtime.
The IT team spent inordinate amounts of time dealing with old hardware and software issues, instead of providing service and supporting new implementations and capabilities.
“The capacity of the IT department to engage more dynamically to accommodate the needs of the business was severely hampered,’’ Mercy Health chief information officer Dmitri Mirvis says.
“It became a no brainer for us that we should be going into the cloud for the data centre as a cost-effective and future-proof approach.’’
Mercy Health, which has 5500 employees, has 31 sites across NSW, Victoria, Western Australia and the ACT.
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Pharmacy must take chances to broaden services: Sansom
15 October, 2014 Chris Brooker
The next community pharmacy agreement will provide a vital opportunity to integrate pharmacy into the primary care network and ensure its survival, eminent pharmacist Lloyd Sansom believes.
Speaking at PAC14 in Canberra last Friday, Emeritus Professor Sansom, the chair of the Pharmaceutical Benefits Advisory Committee, said the political will exists in Australia to increase the scope of pharmacy practice, but the profession must not just expect this to happen as a matter of course.
“In many ways this agreement [6CPA] is more important than any of its predecessors because it provides the opportunity to look at innovative ways of finding additional sources of revenue, and new ways to practice,” he said.
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Online symptom checker drawn up by doctors
13 October, 2014
Sponsored Content Healthdirect Symptom Checker
A new online symptom checker, designed by doctors, will provide credible health information for the growing number of Australians who are to relying on the internet for medical advice.
Based on a program created by the National Health Service in the UK, the healthdirect Symptom Checker is a tool designed to help patients access accurate, safe and clinically validated information and advice about their symptoms, 24 hours a day, 7 days a week.
With approximately 60% of Australians turning to the internet to find answers about diseases and symptoms*, it’s clear that the web is now a key companion to health decision-making.
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Updated: Conformance Profiles for Specialist Letter and Common Clinical Document
Created on Thursday, 16 October 2014
NEHTA has released an updated version of the PCEHR Conformance Profile for the Specialist Letter document type.
Specialist Letter documents can now also be generated for the following three usage scenarios:
- Specialist letters sent that are not in response to a clinician's referral (self-referral)
- Specialist letters sent to referrers without a known HPI-I or HPI-O
- Specialist letters containing recommendations for addressees without a known HPI-I or HPI-O.
The Specialist Letter – PCEHR Conformance Profile has been updated to allow for these additional usage scenarios. The Specialist Letter template packages have been adjusted to reflect these changed requirements.
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New features and new look for MedicalDirector Clinical and PracSoft Summer release
MedicalDirector is excited to be bringing medical practices a list of fresh functionality and features in our upcoming MedicalDirector Clinical and PracSoft Summer release. We have also have taken the opportunity to refresh the entire business to reflect these changes!
“Bringing our customers solutions that work for them is our priority,” says CEO Phil Offer. “The new release features have been prioritised based on an extensive process to gather customer feedback”, he said.
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First reported case of Google Glass internet addiction disorder
Date October 16, 2014 - 10:37AM
Stan Schroeder
When a 31-year-old man receiving treatment for alcoholism was required to remove his Google Glass while completing rehab, he reportedly started to feel frustrated and irritable without the device. He had been wearing Glass for up to 18 hours a day, only taking it off when he slept and bathed.
According to the journal Addictive Behaviors, this was the first case of internet addiction disorder (IAD) involving the use of Google Glass.
"The withdrawal from this is much worse than the withdrawal I went through from alcohol," the journal quotes the man as saying, noting several Behaviours seemingly tied to the man's addiction to Glass, such as dreaming as though he were looking through it. "He would experience the dream through a small gray window," the journal stated.
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Doctor Google will see you now: search giant tests live medical advice
Date October 14, 2014 - 10:35AM
Stan Schroeder
It seems Google is trying to bring an end to all the fake "diagnoses" resulting from folks searching for their symptoms and arriving at the wrong conclusions — or at least alleviate the problem.
An image posted to Reddit shows a Google search for knee pain, and an option for the user to video chat with a doctor about their symptoms.
The company has now confirmed to several outlets that it's a new feature Google is trying out. A spokesperson told Gizmodo, "When you're searching for basic health information ... our goal is provide you with the most helpful information available. We're trying this new feature to see if it's useful to people."
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$27 a month: Turnbull sets out rules to counter TPG FTTB threat to NBN
Communications minister outlines new rules that would force telcos to open up their superfast broadband network to competing retail service providers
Rohan Pearce (Computerworld) on 15 October, 2014 11:35
Communications minister Malcolm Turnbull has published the draft licence condition for telcos that want to roll out infrastructure that competes with the National Broadband Network.
The licence condition, which will require carriers to offer access to their network to retail service providers for $27 per month per port, was drawn up in the wake of a finding by the Australian Competition and Consumer Commission that TPG had not violated 'anti-cherry-picking' rules with its rollout of fibre-to-the-basement (FTTB) services.
The new licence condition would apply to so-called superfast broadband services — that is, those with a download speed of 25Mbps or faster — delivered to residential customers.
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Can HFC be NBN Co's saviour?
- October 17, 2014
NBN Co boss Bill Morrow’s decision to create a separate HFC division was always on the cards. And, as far as connecting Australians to the National Broadband Network (NBN) is concerned, the move can’t come soon enough.
While hiving off the hybrid fibre-coaxial (HFC) network as a separate unit can be interpreted as the first step in a very long journey of splitting up NBN Co, Bill Morrow and his team and have more pressing concerns at the moment.
You have to build the NBN first before you can start thinking about ripping it apart.
The recruitment in July of Dennis Steiger, who brings substantial experience in the HFC space, was an early indication of the sort of role he was destined to play in the new NBN Co regime.
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Why Commodity Hardware Isn't Always The Right Choice
October 15, 2014
Most server rollouts are built on commodity hardware: using standard Intel-based systems running general-purpose stacks, which offer the promise of being able to easily switch between providers. That model isn’t disappearing, but in some contexts engineered systems — platforms which have a much tighter integration between hardware, server and application layers — can be more helpful.
The topic of engineered systems was front and centre during an Oracle media briefing in Sydney yesterday (which we’ve already covered in a discussion of developing for Google Glass). Oracle’s regional director for Fusion Middleware Damien Parkes noted that according to Gartner, engineered and integrated systems are currently a $US6 billion a year market. In 2015, Gartner predicts 35 per cent of total server sales will come from this category.
Obviously, Oracle has a vested interest in promoting engineered systems: it will make more money if it can sell its customers both hardware and software. But that doesn’t mean that the benefits aren’t real for some users.
eHealth for NSW, which provides manages IT platforms for health services across the state, is looking to engineered systems to provide further performance improvements on its systems. It has almost completed a massive upgrade to its core payroll systems. That project took three years and covered 140,000 staff. “With that consolidation and the push to move everything to an online presence, we’re seeing the uptake of our platform grow rapidly,” Farhoud Salimi, corporate IT director for eHealth For NSW, told the briefing.
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Quantum teams claim world records
- The Australian
- October 13, 2014
John Ross
THE University of NSW is claiming world records in the nascent field of quantum computing, after two teams implanted exceptionally accurate quantum “bits” — the processing units of the theoretical computers — into silicon.
The breakthroughs could help make the super powerful computers a reality in as little as five years. “Until you’re able to show that you’ve got bits that keep their memory without losing it in a flash, you’re not really in the game,” said UNSW physicist Andrew Dzurak, co-author of two papers published this morning in the journal Nature Nanotechnology.
“Now we know how to make incredibly good ones — the best in any solid state system, in terms of accuracy. Now’s the time to work with industry to try and get these (computers) built.”
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My computer almost carked it
Date October 16, 2014
The Venture
Tony Featherstone is a specialist writer on small companies and entrepreneurs
The unthinkable happened to my business: a vicious virus almost killed my main computer. Not just one virus, but 43 simultaneously wreaking havoc.
When I woke early to print a boarding pass, the computer screen was purple. No software icons, log-ins or files. Just purple. Several reboots later, a screen appeared saying Windows had not reloaded properly and another restart was needed. Half asleep, I hit okay – only to restart the virus and help it spread.
Rushing to the airport, I wondered if the computer could be saved, how much work was lost, and which clients needed the “dog-ate-my-homework” excuse. I guessed the worst-case scenario was a week of lost work, given the previous back-up.
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Enjoy!
David.
Sunday, October 19, 2014
Is It Time To Declare The PCEHR As A Failure That Is Moving In The Wrong Direction?
There was a very interesting meeting that has considerable impact on where e-Health is heading globally held in the last few days.
There are reports here:
Interoperability's 'game-changer'
Posted on Oct 17, 2014
By Bernie Monegain, Editor
Charles Jaffe, MD, CEO of standards organization HL7, came away from the joint meeting of the federal Health IT Policy and Health IT Standards committees earlier this week, thinking that the industry could move faster on interoperability. And HL7 has just the thing to change the game.
"I don't try to denigrate the success; I try to celebrate it," he told Healthcare IT News.
He blames a stuck-in-the-past approach for the slow pace of progress.
"We embrace a lot of technology that is technology for the past and ways of doing things that were important in the past rather than understanding the ideas that fundamentally change the way we achieve interoperability."
Top of mind for effecting that change is HL7's FHIR, he says. The acronym stands for Fast Healthcare Interoperability Resources. Pronounce it "fire."
According to HL7's official description, "FHIR combines the best features of HL7’s Version 2, Version 3 and CDA product lines while leveraging the latest Web standards and applying a tight focus on implementability."
As Jaffe puts it, "FHIR represents a departure from the notion of messaging and document-centric ideas."
"FHIR is such a significant advance in accessing data, delivering data and the enormous, enormous flexibility inherent in the model," he adds. FHIR doesn't specify the content; FHIR specifies what we mean by the content."
He describes FHIR as a platform and a set of rules.
"If you want to use it for consumer or patient-centric information delivery, or you want to use it for a novel idea about wellness, you can. It doesn't limit you the way messaging does. Moreover when you want to query a system, you don't have to have a registry. FHIR allows you to query systems that have FHIR capability independent of registries. Not only is it easy to use and is fast to develop and implement, but it's also inordinately flexible."
Lots more here:
More coverage is here:
'Actionable' steps to interoperability
Posted on Oct 16, 2014
By Tom Sullivan, Editor, Government Health IT
The highly anticipated final recommendations from the JASON task force arrived on Wednesday afternoon.
JASON, a group of independent scientists who advise the federal government, issued a November 2013 report to the Department of Health and Human Services, the Office of the National Coordinator for Health IT and the Agency for Health Research and Quality on the matter of interoperability.
The resulting analysis, not surprisingly, was highly critical of the current state of interoperability and electronic health record systems vendors.
ONC, for its part, has since established a task force to consider the JASON report.
Calling it the capstone of Wednesday’s joint HIT Policy and Standards Committees meeting, John Halamka, MD, CIO of Beth Israel Deaconess Medical Center and vice chair of the HIT Standards committee, explained that the JASON task force essentially "takes a set of general recommendations and turns them into actionable next steps."
More here:
and lastly here:
CHIME, HL7 applaud ONC road map, JASON task force recommendations
October 16, 2014 | By Dan Bowman
Health industry groups expressed optimism following the Oct. 15 meeting of the federal government's Health IT Policy and Standards committees to discuss a draft interoperability road map unveiled by the Office of the National Coordinator for Health IT.
In particular, the College of Healthcare Information Management Executives and Health Level Seven International (HL7) viewed the road map as a step in the right direction. CHIME Director of Federal Relations Jeff Smith (pictured right), who was critical of the interoperability vision paper published in June from which the draft road map stems, told FierceHealthIT that the updated document represents a "marked improvement" from its predecessor.
"The vision paper was very short on details and wasn't at all clear as to what the next version of things would look like," Smith said in a phone conversation. "Based on what we saw yesterday and based on the conversations that were had at the policy committee, things bode well for the next phase and it sounds like ONC is taking diligence in trying to put together something that is both technically robust, as well as considerate of various policies that fall outside the purview of technical standards."
Smith said CHIME will pay close attention to the governance piece of the road map, calling ONC's recommendations neither good nor bad.
Lots more here:
Essentially what has happened here is that the US has concluded the future direction for e-Health interoperability can be summarised thus:
“Top of mind for effecting that change is HL7's FHIR, he says. The acronym stands for Fast Healthcare Interoperability Resources. Pronounce it "fire."
According to HL7's official description, "FHIR combines the best features of HL7’s Version 2, Version 3 and CDA product lines while leveraging the latest Web standards and applying a tight focus on implementability."
As Jaffe puts it, "FHIR represents a departure from the notion of messaging and document-centric ideas."
"FHIR is such a significant advance in accessing data, delivering data and the enormous, enormous flexibility inherent in the model," he adds. FHIR doesn't specify the content; FHIR specifies what we mean by the content."
This essentially says that the US has decided against progressing the complicated parts of CDA and HL7 V3 while building on what is working in the simpler exchangeable clinical documents and focussing on proven Web Standards and actual implementability rather than having NEHTA developing 1000 page specifications which are still struggling to see the light of day.
At the very least DoH and NEHTA must now respond to the direction being adopted in the US and explain to our system developers what is in and what is now out of future plans. The lack of a recently re-confirmed Standards pathway for the Australian E-Health is deeply problematic given the seismic shifts we are seeing in the US recognising that HL7 V3 has essentially failed and a new path is needed.
As the number of comments to the blog last week makes clear lots of people are interested and we need some clarity about what is going on! It seems to me the Standards base on which the PCEHR has been built may be simply about the become at worst obsolete or at best become an unmaintained technology backwater.
David.
AusHealthIT Poll Number 240 – Results – 19th October, 2014.
Here are the results of the poll.
Should Federal Government Agencies Simply Just Get Out Of E-Health In Australia?
Yes 47% (141)
Probably 6% (18)
Neutral 1% (3)
Probably Not 28% (86)
No 18% (53)
I Have No Idea 0% (1)
Total votes: 302
The closest vote I have seen so far (53% to 46%) - with a small majority thinking the Feds should just leave it others to sort all this out.
Interestingly the definite Yes vs No vote was 47% to 18%.
Again, many, many thanks to all those that voted!
David.
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