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."

Thursday, February 19, 2015

Review Of The Ongoing Post - Budget Controversy 19th February 2015. Now We Are Working On The 2016 One!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot. Indeed more than a few commentators are now wondering out loud if the Abbot Government will last for a second term - indeed lasting until next week might be tricky after the Spill etc..
The modified Medicare co-payment plan - announced late last year  - has now gone very quiet with the Government disarray of the last 3 weeks. The Queensland election has hardly helped especially since they now have a new Premier! Amazingly there is still no clarity as to where the co-payment plan from anyone in Government.
It is also amazing that with the 2014 Budget still not passed we are seeing submissions regarding the 2015 Budget.
As early warning it looks like the 2016 Budget is handed down Tuesday 12th , May 2015. That is now less than 3 months away! Interestingly Parliament seems to have a long break from the 26th of March until Budget Night so sorting out 2015 is getting pretty urgent!
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Other articles this week.

General Budget Issues.

The political price of betraying public trust

Date February 7, 2015
Editorial
No matter how the crisis that has engulfed and in effect crippled our national government is resolved, our national interest compels that first principles replace unseemly internecine power plays as the paramount concern of our elected representatives.
An overarching principle is that people in public office are in positions of public trust. There is no higher office than that of prime minister. Tony Abbott's authority has collapsed precisely because he has lost the trust of so many voters. This has been made abundantly clear to the traumatised members of his party room by their electors throughout a summer of simmering discontent.
Trust is earned, paid for by the currency of integrity. This in turn flows from honouring commitments – another first principle. Mr Abbott's standing in the community and in his own party room, which is poised to determine his fate next Tuesday morning, has deteriorated so dramatically primarily because so many Australians are aghast at the failure of the Prime Minister and his government to keep promises and to justify measures – particularly funding changes to higher education and to healthcare – that were not announced before the 2014 election.
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As our economy suffers, cue the clowns

Opinion
Mon 9 Feb 2015, 8:37am
The pantomime being played out in Canberra has only served to divert attention from the grim reality facing the economy and the absence of any cogent plan to restore the nation's finances, writes Ian Verrender.
Everyone loves the circus; the spectacle, the drama, the danger, the sheer exhilaration.
When the chips are down, when all seems lost, the tantalising prospect of escape, no matter how temporary, can be a wonderfully therapeutic experience.
Take our current predicament.
A breathless silence has descended through the big top. Fear and apprehension have gripped the assembled throng.
After an endless series of back-flips, the acrobat, having taken to the high wire in desperation, has lost his footing and is clinging on by his fingernails as the enthralled crowd far below gazes on at his hopeless predicament.
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Budget pressure is set to plague the Coalition

Pressure on the government’s finances is set to intensify in the lead up to this year’s budget, regardless of the outcome of this morning’s partyroom meeting, with the shock of plunging commodity prices only just beginning to flow through the economy.
The Reserve Bank’s rate cut last week assumed there would be no further effort by the government to trim spending to match falling revenues. As the bank explained in its economic update on Friday: “Large falls in commodity prices have not affected the forecast extent of fiscal consolidation materially, since governments have generally chosen not to respond to the most recent reduction in tax and royalty revenue implied by lower commodity prices, and have left spending plans unchanged.”
It noted that Western Australia, where there have been some large cuts to spending, is an exception, but added it was too small to have an effect on national demand.
In his pitch to the National Press Club last week, Tony Abbott suggested the hard work had been done in last year’s budget.
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Time to break the budget logjam

David Uren

Economics Editor
Canberra
THE will for further budget repair appears to have wilted in the wake of the Coalition’s Queensland election drubbing and the challenge to Tony Abbott’s leadership as the Prime Minister foreshadowed yesterday that this year’s budget would not repeat the errors of his government’s first.
“We will not buy fights with the Senate that we can’t win unless we’re absolutely determined they are the fights we really, really do need to have,” he said.
Reflecting on where his government had gone wrong, he commented: “It was a bold and ambitious budget last year. With the wisdom of hindsight it was perhaps too bold and too ambitious. We did, with the wisdom of hindsight, bite off more than we could chew, but I’ve listened, I’ve learnt and I’ve changed, and the government will change with me.”
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Why the government is a brake on the economy

Date February 10, 2015 - 10:36AM

Peter Martin

Abbott says we’re on the right path, but the numbers paint a different picture. Such exaggerated claims have eaten away at the public’s trust.
Here's what's missing: trust. Not just between Abbott and his backbenchers, but also between Abbott and us. If anything,  the leadership contest has made things worse.
As Abbott brought forward the timing of the leadership vote on Sunday, his supporter and finance minister Mathias Cormann told the ABC the economy was "heading in the right direction". He wanted "to build on the achievements we made in 2014".
Without trust we lack confidence. We are neither spending nor investing what we should.  
Take a moment to consider the achievements and the direction in which things are heading. That year began with a quarterly rate of economic growth of 1 per cent. After the budget, it slid to 0.5 per cent, and then to 0.3 per cent. It's falling, rather than rising. The direction is down. (Ignore the through-the-year figures Cormann quoted. They make the budget look good by including the very strong economic growth that preceded it.)
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Retreat on budget goals will break country: Peter Costello

Dennis Shanahan

Annabel Hepworth

PETER Costello has warned that any retreat from the federal government’s savings push could “completely break the budget and the country in the years ahead”.
Australia’s longest-serving treasurer and the chairman of the Future Fund told The Australian yesterday that the government would be “letting down the country” if it “gave up the effort to ­balance the budget”.
“We have to do this because the situation is going to get more challenging, and unless we get our expenses and revenue back in equilibrium now, those changes will completely break the budget and the country in the years ahead,” Mr Costello said.
His warning came as Joe Hockey informed colleagues that dumping the Coalition’s economic initiatives would sacrifice a return to budget surplus.
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Budget may never get back to surplus, says Joe Hockey

Date February 10, 2015 - 7:40PM

Peter Martin and Mark Kenny

So big is the hit to the budget from commodity prices and the measures held up in the Senate it may "never get back to surplus", Treasurer Joe Hockey has told the Coalition party room.
The embattled minister made the claim as an independent assessment of the damage to the budget since May put it at $46 billion to $56 billion.
The total includes only the major measures held up in the Senate, among them the cuts to the Medicare rebate associated with the introduction of a co-payment for bulk billing ($3.5 billion), the cuts to higher education ($4 billion), the cuts to pharmaceutical benefits scheme ($1.3 billion) and the reintroduction of fuel excise indexation ($2.1 billion but now being pursued by administrative means that may themselves be disallowed in the Senate).
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Joe Hockey ups the ante on fiscal reform

David Crowe

Joe Hockey meets Olivia Harker, 7, on a visit to the Hodgkinson family property at Murrumbateman, southern NSW. Picture: Ray Strange Source: News Corp Australia
BUDGET pressures will crush the country if Australians do not ­accept further action to fix the ­nation’s finances, Joe Hockey has warned, in an attempt to clear the way for new measures to cut spending or raise revenue.
The Treasurer also took on the central argument against his budget by declaring it was “fundamentally unfair” to avoid unpopular cuts when this would mean passing a bigger burden on to the next generation.
The government also suffered another round of conflicting messages on the next steps on the GP co-payment, one of the central features of last year’s budget, when one frontbencher said it was dropped while Mr Hockey kept up his arguments for a fee on visiting the doctor.
Former treasurer Peter Cost­ello told The Australian this week that a retreat on fiscal reform would “break the budget and the country” in the years ahead.
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Unemployment hits 6.4 per cent. Will Joe Hockey do a Wayne Swan?

Date February 13, 2015 - 8:58AM

Peter Martin

Economics Editor, The Age

Analysis
Never at any point during Labor's reign or during the global financial crisis did Australia's unemployment rate hit 6 per cent.
It sailed past 6 per cent shortly after Joe Hockey's first budget in June and hasn't been back since. The January figure of 6.4 per cent is the worst for 13 years - the worst since 2002 when Tony Abbott was employment minister, Hockey was small business minister and John Howard was yet to be blessed by the mining boom.
It's a reminder that nothing much has emerged to drive the economy since the mining construction boom ended; nothing much apart from home building. And that's the problem. Home loans are booming. Leaving aside refinancing, half of all new loans are now going to investors. Many of them are better described as speculators. The housing construction industry is working full bore in parts of the country and any further borrowing spurred by further interest rate cuts is likely to be diverted into pushing up house prices.
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Budget revenue retreat tops $30 billion

David Uren

Adam Creighton

JOE Hockey is facing a massive budget shortfall of at least $30 billion by the end of next financial year as revenue growth retreats from the average rate of the past two decades that underpinned Labor’s spending sprees.
Analysis by The Weekend Australian shows revenues this financial year are growing at only 3.3 per cent compared with the 5.3 per cent estimate in latest budget papers.
Between 1993 and 2013, federal government revenues grew at an annual average pace of 6.4 per cent. If the 3.3 per cent growth continues this and next financial year, the government will receive $11.2bn less this year and more than $20bn less in 2015-16.
The government would have enjoyed revenues of $383.4bn this financial year, rising to $407.9bn next year, had the Coalition been fortunate enough to enjoy average rates of revenue growth.
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Health Budget Issues.

Tony Abbott signals retreat on Medicare reforms

Sarah Martin

TONY Abbott will only pursue changes to Medicare that win the support of doctors, bending to ­demands from disgruntled MPs to retreat on the GP co-payment.
Backbenchers who have been lobbying the government to scrap the proposed $5 cut to Medicare benefits for non-concession ­patients, welcomed the Prime Minister’s pledge yesterday that he would not pursue policy changes that did not have the broad support of the sector.
Mr Abbott is understood to have told yesterday’s partyroom meeting that he had no intention of fighting a war with doctors’ groups, and would not introduce health reform legislation into the Senate if it was likely to fail.
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10 February 2015, 6.18am AEDT

Abbott redux needs to revisit ‘sustainable’ health spending

Jane Hall

Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation at University of Technology, Sydney

Kees Van Gool

Health economist at University of Technology, Sydney
The Abbott government “reset” yesterday provides a valuable opportunity to reconsider health policies based on the idea that Australia’s health system is unsustainable. But first it will need to embrace a new understanding of what a sustainable health-care sector actually is.
The idea of sustainability has spread from ecology to apply to most aspects of human endeavour. In the context of health care, it can mean many things. The English National Health Service (NHS), for instance, launched a strategy for a sustainable health system in 2014 with emphasis on reducing environmental damage and promoting healthy lifestyles.
But discussions about Medicare’s sustainability under the Abbott government have only concerned how much we spend on the health sector.
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Medicare Co-payment Issues.

'Extremely angry' doctors demand PM dump planned Medicare rebate changes

Australian Medical Association says whoever is prime minister after Monday should dump proposed changes and talk to frontline GPs
Australian Associated Press
GPs expressed their anger over planned changes to the Medicare rebate after hundreds met in forums in Melbourne, Sydney, Adelaide and Brisbane.
“Doctors are extremely angry, frustrated and concerned at the raft of changes the government continually tries to enforce upon healthcare and medical practice in Australia,” Dr Tony Bartone, Australian Medical Association Victoria president, told reporters on Sunday.
Bartone said the plan to freeze rebates for four years would make it increasingly difficult for doctors to run a viable practice.
“There’s concerns that the costs may continue to blow out because of these changes, and it may cost as much as $100 for a child to be seen with an ear infection,” he said.
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Confusion in govt over GP co-payment

Updated: 11:24 am, Monday, 9 February 2015
Health Minister Sussan Ley has clarified the government has no plans to dump GP co-payment.
Her comments come after Liberal MP Luke Simpkins told Sky News Tony Abbott promised the party room there will be no changes to Medicare.
Mr Simpkins said that the prime minister announced a series of 'radical changes' including a 'greater level of consultation' over the GP co-payment.
When asked by Sky News' David Speers if the Prime Minister had said the co-payment was dead Mr Simpkins said: 'Yeah, basically, it looks like it.'
Upon further questioning Mr Simpkins walked this back.
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GP co-payment architect calls for $5 fee for doctor's visits to be dropped

Date February 9, 2015 - 6:28PM

Dan Harrison

The former Howard Government advisor who put a GP co-payment on the political agenda has called for the Abbott government to scrap its plan to introduce an "optional" $5 fee to visit the doctor.
Policy consultant Terry Barnes, whose 2013 submission to the Commission of Audit kickstarted debate about Medicare fees, said controversy about the government's proposed $5 co-payment was getting in the way of more substantial reform of the health system.
"My view is that the pointless fighting between the medical profession and the Government over the current co-payment and rebate cut proposals are swamping progress towards the comprehensive structural reform of Medicare," Mr Barnes said.
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No co-payment without doctors: Abbott

10 February, 2015
Tony Abbott has promised not to push ahead with any new Medicare co-payment proposals without the support of doctors.
Some Liberal MPs were confused about whether or not the prime minister promised to dump controversial Medicare changes after surviving a spill motion in the party room on Monday morning.
Mr Abbott later said there would be no new co-payment plans without the backing of the medical profession.
"It is important to maintain the support of the medical profession because, let's face it, they have the best interests of their patients at heart," he told reporters in Canberra.
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Joe Hockey vows to persist with changes to Medicare

Asked if the government will pursue widely criticised budget measures, embattled treasurer says, ‘We have no choice’
The government will persist with some of its least popular budget policies, including proposed changes to Medicare, according to the embattled treasurer, Joe Hockey.
When asked on the ABC’s 7.30 program on Tuesday if the government would pursue widely criticised budget savings measures, Hockey replied that it would, because “we have no choice”.
Earlier in the week, the prime minister, Tony Abbott, had promised his party room that no new changes to Medicare would be proposed without proper consultation with doctors’ groups. The health minister, Sussan Ley, is consulting with doctors’ and patients’ groups on plans to reduce the Medicare rebate by $5 for non-concessional adults.
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Is the $5 GP fee on or off? The Prime Minister’s own parliamentary secretary doesn’t seem to know

  • February 11, 2015 7:05PM
  • Sue Dunlevy National Health Reporter
  • News Corp Australia Network
CONFUSION over the fate of the government’s unpopular $5 GP fee continues to dog the government with the Prime Minister’s Parliamentary secretary telling radio listeners it has been scrapped.
Not so, says the Health Minister Sussan Ley.
Discontent with the $5 cut to the Medicare rebate that will bring an end to bulk billing for general patients and push up the cost of seeing some doctors to $65 was central to this week’s challenge to Tony Abbott’s leadership.
MPs demanded the Prime Minister scrap the charge which their voters are opposed to in order to turn around the government’s poor polling.
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Confusion as Health Minister Sussan Ley's office insists $5 GP co-payment is going ahead

Joanna Heath
The office of Health Minister Sussan Ley insists the government is proceeding with its consultation on the proposed $5 co-payment for GP visits, despite three government members expressing doubts over its continued existence this week.
On Wednesday afternoon, Parliamentary Secretary to the Prime Minister Alan Tudge declared the government had "dropped the Medicare co-payments and we're starting again from scratch".
"The policy which we had on the table in January and February is gone so we're now starting again from scratch in terms of a deep conversation with the Australian people and with the medical profession as to how to make Medicare sustainable," Mr Tudge told ABC Radio.
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Co-pay 'architect' says policy is dead

13 February, 2015 Paul Smith
There is an air of bemused frustration in the words of Terry Barnes. But you can understand why.
Back in 2013, Mr Barnes (pictured) put together a paper, what he describes as a "conversation starter", for the health policy experts, suggesting that maybe more people should dig into their own pockets when they see their GP.
No, the health world was not set alight by its release.
But in a mysterious journey yet to be fully documented, that paper ended up on the desks of government ministers and bureaucrats who apparently read it, thought about it and then a few months later unleashed one of worst health policies of the past 20 years: the GP co-payment plan.
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Pharmacy Matters:

Maximise your 100 leading customers

9 February, 2015 Chris Brooker
The Pharmacy Guild of Australia has officially launched its newest online CPD course titled ‘Know and love your top 100 customers’.
The new course will highlight the value your top 100 customers add to your business, providing recommendations on programs and services to help increase their engagement and loyalty.
The Guild has partnered with its former national president, Kos Sclavos, in the development of this course, utilising his industry knowledge and expertise in business management.
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Government briefed on 6CPA urgency

12 February, 2015 Chris Brooker
Sixth Community Pharmacy Agreement negotiations are yet to formally commence, but Guild officials say they have been active in keeping pharmacy in the forefront of the Canberra health agenda.
Writing in Guild newsletter Forefront, Guild executive director David Quilty said they had “made clear to the Government that this negotiation is urgent and time critical”.
“We know how much price disclosure is hurting pharmacy businesses and that the next Agreement must address this problem,” Mr Quilty said.
“The Guild has not left a stone unturned in ensuring every relevant politician and public servant fully understands how price disclosure is impacting pharmacy businesses, staff and patients”.
Mr Quilty said the Guild had “put a comprehensive proposal for the next Agreement to the Health Minister as well as other key political offices”.
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Guild slams 'misleading' News Corp report

12 February, 2015 Christie Moffat
A media report implying that pharmacists have double-standards concerning supermarkets is misleading and omits key information, the Pharmacy Guild of Australia says.
The News Limited article focuses on QCPP Pharmacy of the Year finalist SuperPharmacyPlus in Stafford, Brisbane, which contains an IGA Xpress supermarket on the premises.
The pharmacy along with the connected supermarket is owned by a group of six pharmacists, and the article implies this is an unfair contradiction to the Guild’s strong stance against pharmacies being owned by supermarkets.
The article also highlights the delayed release of a report by the Australian National Audit Office (ANAO) over whether the Community Pharmacy Agreement provides value for money.
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Consumers and doctors to have a say in medicine prices as study finds patients ditch high cost drugs

  • February 12, 2015 10:00PM
  • Sue Dunlevy National Health Reporter
  • News Corp Australia Network
THE high cost of subsidised life saving prescription medicines is seeing general consumers abandon them and a planned $5 hike in prices will exacerbate the problem a new study shows.
A study comparing concessional medicine users who pay just $6.10 to general consumers who pay $37.70 for scripts found general consumers were 1.63 times more likely to stop using their drugs.
The research comes as the government is planning to hike the price of prescription medicine by $5 to $41 a script for general consumers and it warns of serious consequences.
“The impact of a recent proposal to further increase copayments for general users by $5 would likely have a negative impact on adherence,” the study warns.
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Minister invites doctors' say on 6CPA

13 February, 2015 Chris Brooker
The Federal Government is calling for consumer and allied health professional input as part of its Sixth Community Pharmacy Agreement consultation process.
The announcement came as Health Minister Sussan Ley (pictured) was reported to have said she will “seek to clarify” the Pharmacy Guild’s position on supermarket ownership in the wake of the revelation that a Pharmacy of the Year finalist also contains a supermarket. 
At a meeting of health interest groups in Canberra Ms Ley said the government wanted to canvass views from a wide range of pharmacy bodies, as well as from other health stakeholders such as the AMA and the Consumers Health Forum.
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Supermarket threat imperils community cohesion

13 February, 2015 Christie Moffat
If supermarkets integrate pharmacies into their stores it will change the community “for the worse”, a senior business figure believes.
Peter Strong, executive director of the Council of Small Business Australia (COSBOA), says that pharmacies in supermarkets would lead to lower quality customer care, and would also cause a fall in employment, as some pharmacy tasks could be “absorbed” into the role of checkout operators.
In an opinion piece for online financial magazine SmartCompany, Mr Strong said that supermarket duopoly Coles and Woolsworths pay their staff time and a half on Sundays, whereas pharmacies are required to pay their staff double time.
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Comment:
I also have to say reading all the articles I still have no idea what is actually going to happen with the 2015 Budget (or the Government) at the end of the day.
One wonders for how much longer this will go on and just what impact a change of leader might have?
Enjoy.
David.

Wednesday, February 18, 2015

Good To See That It Is Becoming Clearer How Information Exchange Will Move Forward.

This appeared a little while ago.

Optimizing the HL7 C-CDA?

Viet Nguyen, MD, Systems Made Simple,
As healthcare organizations move toward population health management and care coordination models, they are becoming increasingly dependent on technology to enable meaningful information exchange across the continuum.
Underpinning electronic information exchange is HL7’s C-CDA (Health Level Seven International’s Consolidated-Clinical Data Architecture), which defines the structure and semantics of key clinical documents to allow complete and accurate information sharing between healthcare organizations.  HL7 C-CDA Release 1.1 governs nine document types, which represent the major information resources for clinical care: Continuity of Care Document (CCD), Consultation Note, Diagnostic Imaging Report (DIR), Discharge Summary, History and Physical (H&P), Operative Note, Procedure Note, Progress Note, and Unstructured Documents.
At this time, most EHRs can only share one of the aforementioned reports externally—the CCD—which provides a patient snapshot, including past medical history, medications, the problem list and allergies. While sharing the CCD is a step toward interoperability, it is a relatively small one. EHR vendors have been focused on exchanging this particular report to meet Meaningful Use requirements, but they now need to take the next step and enable additional C-CDA documents that include more detailed and timely information.
Consider the example of an 85-year-old patient who comes to his primary care physician with respiratory symptoms and a fever. The physician is concerned the patient may have pneumonia and refers him to the local hospital, which admits the patient and starts treatment. While the CCD provides the hospital with basic information, the primary care physician’s progress notes would be much more valuable as they go into greater detail on the patient’s current condition and the physician’s perceptions of the patient’s needs. Being able to share the progress notes electronically would not only save the hospital time and facilitate faster treatment but also ensure delivery of the most appropriate care given the patient’s existing condition and past history.
The hospital also has a key document worth sharing. Before sending the patient home, the hospital creates a discharge summary describing the care the patient received in the hospital—chest x-ray, IV antibiotics and so on. This summary needs to be shared with the primary care physician, so he or she can be fully informed about what occurred in the hospital when examining the patient at the scheduled follow-up visit.
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What is your long-term strategy for data interoperability? Embracing HL7 C-CDA is just one step along the interoperability journey. For example, the next evolutionary stage is HL7 Fast Healthcare Interoperability Resources (FHIR). This evolutionary interoperability paradigm will enable more granularity in sharable data as well as real-time information exchange. Right now, C-CDA documents represent one point in time, and as such, may quickly become outdated. FHIR resources, on the other hand, will give providers up-to-the minute information on which to base patient care decisions. When asking vendors about their interoperability goals, organizations should listen for information about FHIR and the vendor’s plans to incorporate it going forward.
More here:
Just how these plans will fit with the PCEHR and its direction is unknown as we have not had a strategic update for the PCEHR in living memory.
Just why is that do you imagine?
David.

Tuesday, February 17, 2015

The Productivity Commission Provides Some Interesting Information on the ePIP Program. Raises Some Questions.

A week or so ago the Productivity Commission provided some interesting information on the ePIP program.
Here is the page and link to the full report.

Health

The Health volume E includes performance reporting for Primary and community health, Public hospitals and Mental health management.
It also includes a sector overview for Health. This volume was released on 4 February 2015.

Download the full volume

Download the sector overview

The sector overview provides an introduction to the Primary and community health (chapter 10), Public hospitals (chapter 11), and Mental health management (chapter 12) chapters of this Report. It provides an overview of the health sector, presenting both contextual information and high level performance information.
Here is the link:
The ePIP requirements are outlined here (p548):
“In accordance with the purpose of the PIP eHealth incentive to encourage general practices to kee p up-to-date with the latest developments in eHealth, new eligibility requirements were introduced from 1 February 2013, requiring practices to
1- integrate healthcare identifiers into electronic practice records;
2- have a secure messaging capability;
3- use data records and clinical coding of diagnoses;
4- send prescriptions electronically to a prescription exchange service;
5- and, participate in the eHealth record system and be capable of creating and uploading Shared Health Summaries and Event Summaries using compliant software.
A number of practices took time to meet these requirements, as reflected in the sharp decrease in the share of PIP practices registered as having taken up the eHealth incentive in May 2013 and the recovery in May 2014.
Under the previous requirements, practices were required to :have a secure messaging capability provided by a n eligible supplier; have (or have applied for) a location/site Public Key Infrastructure(PKI) certificate for the practice and each practice branch, and make sure that each medical practitioner from the practice has (or has applied for) an individual PKI certificate; and, provide practitioners from the practice with access to a range of key electronic clinical resources.”
The participation rates in receiving payments were:
April 2014 - 86.3%
May 2013 - 72.2%
May 2012 - 88.3%
May 2011 - 87.6%
May 2010 - 78.5%
It is also interesting that participation is 85+% in and close to cities and down to 60% in the remote areas.
What I find interesting with all this is 86% complying with point 5 (PCEHR Connectivity and Use) and being paid while we see such low reported use by clinicians.
My read is that they can use the PCEHR but don’t see the value or can ‘t be bothered.
It will take real genius to fix this I reckon despite the claims of NEHTA and DOH.
David.

Monday, February 16, 2015

Weekly Australian Health IT Links – 16th February, 2015.

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

Again a quiet week with the biggest news being the continued push of Telstra into the e-Health space with lots of mentions of e-Health and their plans from the Telstra CEO when announcing the results for the half year. It now looks like more than $100 million has been spent on the various e-Health systems which Telstra now owns. I wonder how they will get a return on this investment?
Other than that it is good to see Google working to improve the quality of the health information it finds.
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Dr Google given a medical check to steer users from shonky advice

Date February 12, 2015 - 10:37AM

Esther Han

Consumer Affairs Reporter

Search the web about "headaches" and you will be hit by lists of causes - ranging from eye strain to brain tumours - and treatments, including options long dismissed as snake oil.
But, from this week, digital giant Google will respond to medical queries with pre-vetted fact boxes and illustrations in a bid to steer users away from websites with shonky, possibly dangerous, advice.
If you have symptoms of gonorrhea, for example, you can save yourself from some embarrassment and first talk to your smartphone via Google's Now.
"We'll show you typical symptoms and treatments, as well as details on how common the condition is - whether it's critical, if it's contagious, what ages it affects, and more," Prem Ramaswami, Google's product manager, said in a blog post.
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Why Dr Google isn't all bad

Date February 13, 2015 - 5:24AM

Leigh Tonkin

COMMENT
I have a confession to make: I see Dr Google far, far more than I see my GP.
And for that, my GP should be grateful. She doesn't get the litany of questions that plague someone who doesn't want to admit she's probably a borderline hypochondriac.
It all goes into the great internet oracle, from persistent headaches to sore muscles after exercising (it's called being out of shape, if you're wondering) to a strange bump on my leg that won't go away. And it's just not me I worry about - I Google my husband's symptoms, I research operations my father has had to have and have even been known to check up on my cat's condition.
A lot of these symptoms just seem way too silly to say out loud to another human, especially a doctor who deals with legitimate medical emergencies on a daily basis.
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Sometimes it's ethical for the doctor to Google you

Doctors need guidelines about when it's appropriate for them to use search engines to discover information about their patients.
The medical community needs ethical guidelines for doctors who Google their patients for information because such a move can erode confidence and trust.
That's the recommendation of a recently published research paper by professors at the Penn State College of Medicine. The study highlights how physicians have been left to navigate search engine waters on their own -- and it points out the moral ambiguities involved in the practice.
"In some ways, it could be viewed by patients as somewhat weird that a medical provider might be trolling their online profile to get more information about them," said Maria Baker, a Penn State associate professor of medicine and co-author of the research paper. "Googling a patient can undermine the trust between a patient and his or her provider, but in some cases it might be ethically justified."
The research comes at a time when young physicians and doctors in training are more often using Internet search engines in connection with their work. In addition to that, wearable devices such as Google Glass are being used more often in the healthcare industry.
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Being online – is it bad for your health?

| Feb 13, 2015 10:48AM | EMAIL | PRINT
If you’re reading this post while you’re eating lunch – don’t! Or breakfast or dinner. Please, pay attention to your food and then go for a walk, if you can. But do come back and consider some important and, yes, challenging thoughts and research about the way we spend time online.
***
Dr Lareen Newman and Kristina Dryza write:
Many Westerners have jumped on the Digital Bandwagon in buying into the assumption that using digital devices and riding the Internet super-highway is predominantly a good thing. It gets us connected, gives us access to new opportunities, something interesting to do with our ‘free’ time, makes banking more convenient, and enables us to take more control of our own healthcare. For others there’s no real choice in the matter – their employer demands they be online so they can fulfil their job description.
The Australian Government is also encouraging the general population to get online for the benefit of our health – to set up our own Personally Controlled Electronic Health Record (PCEHR), open a MyGov account to deal with Medicare, download the QuitBuddy App to quit smoking, or to visit the E-Mental Health Portal.
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Foreign multinationals circle Medicare

Date February 13, 2015 - 11:30PM

Noel Towell

There is big foreign interest in taking over Medicare payments.
Foreign multinationals are jostling to take over the payment of tens of billions of dollars in Medicare and other Australian government benefits.
Companies from the US, Germany, Japan and Britain have approached the Commonwealth, interested in taking over the Medicare, Pharmaceutical Benefits Scheme and Veterans Affairs payments in an outsourcing deal.
Only three home-grown players, Eftpos, Australia Post and Telstra offshoot Stellar, are in the hunt to secure the massive contract if the Abbott government decided to go ahead with the privatisation.
But British  services giant Serco, Japanese-US outfit Fuji-Xerox, German software behemoth SAP as well as American outsourcing powerhouse Accenture are all circling too, according to well-placed sources in the local "business process outsourcing" industry.
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Doctor rating websites no indicator of quality

12 February, 2015 Kate Aubusson
Doctor rating websites are no indication of quality care, US research suggests.
Despite an estimated one in three US patients selecting or avoiding a doctor based on their online reviews, there was “no evidence” that these ratings were associated with clinical quality measures, according to the study of 1300 doctors.
More than 60% of the doctors had been rated on at least one of the eight websites included in the study, with an average of six patient ratings per doctor, reported the health policy researchers at the University of Minnesota.
But there was only a small and insignificant association between their online ratings and clinical quality measures, which were based on 25 practice improvement items derived from medical records and patient surveys, the authors reported in JAMA Internal Medicine.
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Virtual GP practice set to launch online

6th Feb 2015
A NEW GP service, which does away with a bricks and mortar practice and uses video chat to see patients instead, is set to launch in New Zealand this month.
Doctor2Go promises patients 24/7 secure video-chat access to their GP for a monthly enrolment fee of NZ$99 ($94) per person. A 15-minute consultation costs an additional NZ$59 ($56), jumping to NZ$99 after hours.
Discounts are offered for families and businesses. 
Michael Haskell, chief executive of Third Age Health, the parent company of Doctor2Go, says the prices will drop once it has signed on to a primary health organisation, a move expected to be finalised when the business is officially launched.
New Zealand Doctor talked to Mr Haskell using Doctor2Go’s telemedicine technology and the browser-based video connection was sometimes patchy, with the audio lagging after several minutes. 
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Thodey delivers for Telstra shareholders

David Thodey is continuing to lead Telstra along a delicate path between the group’s ambition of creating a post-national broadband network growth path and his shareholders’ voracious appetite for cash returns.
Today’s interim result says that he remains on track, with Telstra’s future starting to emerge while it continues to manage down the legacy business that will ultimately be displaced by the NBN.
A hallmark of Thodey’s tenure has been that he hasn’t overpromised but has delivered on the promises that he has made and the result was no different.
A 1 per cent increase in revenue translated to a 0.5 per cent increase in earnings before interest, tax, depreciation and amortisation, which in turn was leveraged into a 7 per cent increase in earnings from continuing operations. (There was a loss of income and earnings as a result of the sale of Telstra CSL mobiles business in Hong Kong.)
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Telstra buying back the faith in shares

  • John Beveridge
  • Herald Sun
  • February 12, 2015 9:00PM
FOR a company with such a strong engineering heritage, it should come as no surprise that Telstra has taken to financial engineering like a duck to water.
Its $1 billion share buyback is one excellent example and the superbly timed reintroduction of the dividend reinvestment plan is another.
In the completed buyback, Telstra managed to spend $1 billion — including some “spare’’ franking credits — to purchase a pile of its own shares for $4.60.
At the end of trade on Thursday after unveiling a 22.4 per cent higher first-half profit of $2.085 billion, those same shares were travelling at $6.45.
That leaves those remaining Telstra shareholders with a handy 408 million reasons to think it was a pretty good idea, plus the buyback helped to pump up the earnings per share and return on equity.
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Millions of welfare, Medicare files handed to US data giant Iron Mountain

By Noel Towell
Sept. 28, 2014, 11:30 p.m.
Millions of Australians' Centrelink and Medicare files are being handed over to a United States multinational corporation as the federal government closes filing warehouses around the country.
A record management unit in Darwin has been closed by the Department of Human Services while a warehouse in Adelaide will shut next year. Storage units in Townsville and Tasmania are open but  "under review".
The warehouses hold decades worth of Medicare, Centrelink and Child Support Agency files.
Human  Services says the role of US-based Iron Mountain in managing the records will grow as each storage unit closes.
The news comes as the department seeks private players to take over Medicare payments, and Telstra employees prepare to  answer phones in some government call centres from next month.
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Treating Depression Online with e-couch

Date: Thursday, 12th February 2015 - Thursday, 12th February 2015
Time: 6:30pm - 7:30pm
Venue:
Online Webinar 8:00pm AEST
Presenter: Black Dog Institute
Primary care of mental health problems can usefully incorporate e-Mental Health (eMH) programs which, evidence shows, improve patient outcomes.
The Black Dog Institute is presenting a series of webinars for GPs, designed to explore the use of evidence based online resources in general practice. Each stand-alone webinar aims to familiarise GPs with these locally-developed resources and build their confidence in recommending and monitoring the use of the resources appropriately.
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The dark side of a fully wired world

FORTY-five years after the introduction of the internet and eight years after Apple revolutionised smartphone use with the release of its first iPhone, the once futuristic vision of a fully wired world is about to be realised.
Three billion people, about 40 per cent of the world’s population, are connected to the internet. Mobile penetration is even greater, with seven billion subscriptions globally, half of them in Asia and the Pacific.
Real-time, people-to-people connectivity across time, space and even linguistic barriers is only half of this remarkable story.
Connecting machines with machines — the “internet of things” — is about to pass a remarkable threshold. US networking giant Cisco Systems estimates that by the end of this year about 15 billion devices will be connected to each other via the internet (excluding computers and mobiles). This figure is expected to grow to 40 billion by 2020.
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Researcher releases 10 million usernames, passwords from data breaches

The data is already public but has been cleaned up to enable better analysis
A researcher has released 10 million usernames and passwords collected from data breaches over the last decade, a step he worries could be a legally murky but one that will help security research.
The data comes from major data breaches at companies including Adobe Systems and Stratfor, all of which have already been publicly released and can be found through Web searches, said Mark Burnett, a Utah-based security consultant who has written several networking and security books.
Most of the passwords are likely invalid, and he has scrubbed other information such as domain names to make it unusable for hackers, Burnett said. Still, usernames or passwords found on the list that are still used should be changed.
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Artificial intelligence could encourage war, experts fear

Date February 11, 2015 - 5:58PM

Tim Biggs

Technology reporter / producer

It's the theme of so many dystopian sci-fi books and movies: a super intelligent machine in charge of lethal military hardware becomes self-aware and decides to wreak havoc. But could it actually happen?
At the Association for the Advancement of Artificial Intelligence's annual conference in Texas last month, a workshop was held on the ethics of AI development and a panel discussed whether or not so-called 'lethal autonomous weapons' should be banned.
"There are many arguments, legal, ethical, political and technical for a ban," Toby Walsh, head of the Optimisation Research Group at Australia's research body NICTA and chair of the proceedings, told Fairfax Media.
"One that particularly appeals to me is that [autonomous weapons] will lower the barrier to war. If one side can launch an attack, without fear of bodies coming home, then it is much easier to slip into battle," Professor Walsh said.
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Enjoy!
David.

Sunday, February 15, 2015

Here Is The Proof That Starting Simple And Evolving Can Really Work In Health IT.

This report appeared a few days ago.

SCR reaches 50m patients

9 February 2015   Sam Sachdeva
The NHS Summary Care Record has reached the 50 million patient mark, with more than 30,000 record views now occurring each week.
The milestone is the latest demonstration of the SCR’s growing use, after it was initially bedevilled with criticisms about confidentiality and low viewing levels.
The Health and Social Care Information Centre announced last week that there are now 50 million people with an SCR created from their GP records, meaning that 90% of the population is now covered.
The record provides a core set of required clinical data, including allergies, medications and adverse reactions, pulled from GP systems, which can be viewed by health professionals involved in a patient’s care.
In July 2013, it was expanded to include patients’ end-of-life care information, immunisations, and significant past problems and procedures.
Richard Jefferson, NHS England’s head of business systems, told EHI News the milestone is a demonstration of the “significant benefits” that the SCR is delivering to clinicians and patients across the country.
“The fact that over 50 million records are now available means it should be business as usual for clinicians to have access and utilise this critical source of care information.”
Jefferson said there has been a rapid growth in viewing levels across urgent care settings in the last year, with over 30,000 views a week.
“With both CQC and Monitor identifying the sharing of care information as expected best practice, we expect this positive trend to continue.”
The HSCIC said the SCR programme will be working with GP systems suppliers in 2015 to expand the capabilities of the record.
Lots more here with a link to some commentary:
The NHS Summary Care Record (SCR) is the UK version of the PCEHR with a few differences.
The differences are:
1. It takes advantage of the fact that patients are enrolled in practices, have a NHS number (a HPI equivalent) and virtually all GP Practices are automated.
2. The system is not patient controlled and is automatically created - but it is possible to opt out, although pretty much no one does.
3. GP Systems in the UK upload an updated SCR (which is a very basic record) whenever the doctor updates the patient record - and the summary replaces the earlier one. There is no attempt to display historical data - just the current data that might actually be useful.
4. The record holds the minimum amount of data for facilitate emergency care, which is the intent of the record  and which is where the record is accessed - A&E Departments.
5. GP practices are the information and history holders and the centralised system is just used to provide access to a current system to help in acute presentations.
So simple, useful and evolving beats complicated, over specified and no clear purpose.
Now the system is having 30,000 accesses a week it will be interesting to see if some benefits arising from the system can be identified.
Maybe we could update the PCEHR to do something useful like this and actually have it work with simplicity etc.?
David.

AusHealthIT Poll Number 257 – Results – 15th February, 2015.

Here are the results of the poll.

Do You Believe A Centralised Government Driven National Approach To E-Health Is The Correct Strategic Approach?

Yes 12% (12)

Probably 4% (4)

Neutral 9% (9)

Probably Not 29% (28)

No 45% (44)

I Have No Idea 1% (1)

Total votes: 98

A pretty clear response with large majority on the negative side of centralisation (72%) to those keen on centralisation (16%).

Good to see a clear outcome with a lot of responses.

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

David.