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, November 16, 2017

The Macro View – Health, Financial And Political News Relevant To E-Health And The Health Sector In General.

November 16, 2017 Edition.
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Trump has wandered off to Asia and has visited China and Japan for significant stays. In China the new Chinese Emperor has wowed him and in Japan the Americans have sold a lot of missiles etc. to protect Japan against North Korea. Also big news it the fact we are now starting to see genuine electoral push-back on Trump policies will some actual election wins from election day a week or so ago. A hopeful sign?
Both Brexit and Catalonia are still festering along with no resolution to either! May’s hold on power is looking ever more tenuous by the day!
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Big Mal went off to Vietnam  and now the Member for Bennelong has resigned as well! It is really going very badly for everyone as we all wonder who will be next and when a General Election will be called. It surely can’t be long!
We now officially have a minority Government and you have to be sure there is more to come – on both sides!

And to add to it all we got 61.6% vote yes in the Postal Survey on Wednesday so the Senate is madly debating to make it real!
Elsewhere we have to be grateful most of the State Governments continue to function although Qld is looking a little fragile at present.
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Here are a few other things I have noticed.
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Major Issues.

Few noticed we just saw a radical shift in reform thinking

Ross Gittins
Published: November 5 2017 - 9:00PM
Reading the Productivity Commission's grand plan to "shift the dial" on micro-economic reform gives me a feeling of deja vu all over again.
When I started in this business in the mid-1970s, macro-economics had become a pitched battle between Keynesians and monetarists. It took years for a resolution of that conflict to emerge.
The monetarists didn't win the war, but they did win a lot of battles, and management of the macro economy was changed forever.
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Lovers, prospectors and predators

David Brooks
Published: November 5 2017 - 7:08PM
Harassment is not just sex and it's not just power; it's a wicked mixture of the two.
The world seems full of sexual predators these days. But I don't think good men wake up one morning and suddenly start thrusting their tongue down the throats of people they barely know. You've got to walk through a certain number of doors before you're capable of that kind of behaviour.
Most men are raised with a certain way of thinking about sex. It's the way contained, implicitly, in every children's love story, in most every classic novel and in the lived experience of most married parents. It is: Sex is something you do with the person you love.
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Ignorance is no defence for these idiot dual-citizens

Nicholas Stuart
Published: November 6 2017 - 12:15AM
There is no more crucial requirement for a government than upholding the constitution. This is the basis from which everything else flows. Flawed and in need of amendment though it may be, the constitution is Australia's foundation stone.
Nothing more displays the contempt that Malcolm Turnbull apparently feels for our country's birth document better than his casual dismissal last week of the urgent need for a full audit of parliamentarians' nationality.
The provisions outlined in section 44 may be silly; many laws are. They have, however, always been crystal clear. The simple requirement – that any parliamentarian should be only an Australian citizen – was debated and engraved in that document way back in 1901.
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Why the cost of necessities is forcing Australians to shut the door on shopping

Weak retail figures suggest households are not confident enough to spend any increase in income at the shops
The latest retail trade figures show consumers are shutting their wallets. Retail spending has remained flat for two months in a row – the worst result since 2012. Weak wages growth clearly is having an ongoing effect. But the latest re-weighting of our spending habits by the Bureau of Statistics also shows us moving our spending away from retail towards a mixture of more expensive necessities such as rent, education and utilities, and areas that were cheaper than in the past such as restaurant meals and international holidays.
We used to love to go shopping. From the start of 1990 through to the end of 2007, retail trade spending grew on average by 5.7% each year. The latest figures out last Friday showed that our spending grew by just 2.0% in trend terms in the past 12 months – the lowest ever recorded:
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The fantasy behind America's mass shootings

Michael Pascoe
Published: November 7 2017 - 12:20PM
"I think that mental health is your problem here…this isn't a guns situation," said President Trump of the latest American mass murder. And he is so clearly wrong.
There seems to be something like relief in gun-loving Texas that the Sutherland Springs slaughter was a "domestic situation",  without a racial or sectarian motive. And only in America could the state's attorney general subsequently recommend more people bring guns to church.
There tends to be multiple factors in any disaster, but a key part of the latest American killings big enough to make international headlines is hiding in plain sight: the end result of the fantasy that goes with buying and possessing machines specifically designed for killing people and killing as many people as possible.  Indeed, the gun industry generates around $US13 billion a year ($16.9 billion) in revenue annually in the US.
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ASX at 6000: The long and winding road

Patrick Commins
Published: November 7 2017 - 6:15PM
The ASX 200 sharemarket index achieved a key milestone on Tuesday when it closed above 6000 points for the first time since the global financial crisis.
A powerful rally in resources stocks on Tuesday was the prime mover behind the day's 60-point, or 1 per cent, gain in the ASX 200 index, which ended the session at 6014. The last time it closed above 6000 points was in the teeth of the GFC in January of 2008, towards the beginning of what would ultimately be a 50 per cent sharemarket crash.
The 6000 threshold had become somewhat of a psychological barrier for the Australian stockmarket in recent years after the index came close a number of times only to fall agonisingly short and ultimately drop away. Through March and April of 2015 the ASX 200 moved within three points of crossing 6000 on three separate trading days, and within 15 points on another. The next time it looked close was in April and May of this year, only to fall away again as investors dumped heavyweight bank stocks in response to the government's announcement of a major bank levy.
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Life expectancy. From 45 to 82 years, we've come a long way

Peter Martin
Published: November 6 2017 - 11:45PM
One hundred and fifty years ago on Tuesday  The Sydney Morning Herald broke news that these days would be considered shocking.
The first 'life table' prepared for the British colony put the expected lifespan of a newborn non-Aboriginal Australian at just 45.6 years.
The Bureau of Statistics now gives newborns a lifespan of 82.5 years; 80.4 for boys, and 84.6 for girls.
And that's almost certain to be an underestimate. Improvements in medical technologies throughout 80 years of life are likely to add an extra four years to those totals.
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Better economic days ahead? Sorry, not yet

Peter Martin
Published: November 8 2017 - 11:45PM
Why do people feel so rotten?
It's because they don't believe the federal Treasurer when he says there are "better days ahead".
He's said it 25 times, roughly once a week since April.
If things were really looking up, retailers wouldn't need to cut prices to maintain sales. During the June and September quarters, retail prices fell 0.2 and 0.4 per cent. Fell. It's rare for prices to fall across the entire retail sector for an entire quarter. It's even rarer for them to fall for two consecutive quarters, and rarer still for them to fall that much. It's the biggest wave of discounting this century.
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Hasty interest rate hikes could trigger a property crash, UBS warns

Jessica Sier
Published: November 10 2017 - 1:45PM
A recent correction in Australia's housing market could turn into a full-blown crash if the Reserve Bank hikes rates too soon or too fast, a global investment bank has warned. 
The end of the nation's world record housing boom and the drawing down of household savings has caught the RBA in an interest rate trap, says George Tharenou, chief economist at UBS. 
Dubbing it the "household wealth effect", he has outlined a scenario where rising asset prices, falling savings and the fact that consumption has grown faster than wages leave Australians particularly vulnerable to interest rate hikes.
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Why it has never been more important to tax the rich

Peter Hartcher
Published: November 11 2017 - 12:05AM
Australia's deputy tax commissioner for international affairs, Mark Konza, was looking through an early scan of just a few of the documents from the 13.4 million leaked this week under the name of the Paradise Papers.
One phrase in the papers, all from a single law firm specialising in offshore tax havens, Appleby, happened to catch his eye. One solicitor had emailed another with a striking description of a client. That particular client "stinks", the solicitor remarked.
"We thought, 'that's odd, let's have a look at that'," Konza tells me. "The complaint about the client was 'they've asked us to backdate a document again'." Backdating a document is, of course, fraud.
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Robots coming for our jobs? The data says no to Chicken Little

Simon Cowan
Published: November 11 2017 - 12:15AM
Overnight, on November 10, striking workers broke into a factory and smashed up the machines, reportedly angry that the factory owners were hoarding profits and thinking of cutting jobs.
If you missed this story it's because it happened on November 10, 1811, not 2017. But if it sounds familiar, it's because fears over technology have been around for as long as technology itself. Indeed, the term for someone afraid of technology – Luddite – comes from that 1811 revolt.
Perhaps this is why dire predictions that technology will destroy all our jobs are so persuasive: they tap into long-held fears. And those fears tend to multiply when the predictions extend to the loss of white-collar jobs, as well as typically grim prognoses for blue-collar ones.
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Financially stressed? Please don't blame high prices

Peter Martin
Published: November 11 2017 - 11:45PM
When Tony Abbott first stood for prime minister, he complained about the price of bread.
He told the leaders debate it had shot up 12 per cent. It hadn't. The Bureau of Statistics found it hadn't increased at all – it had been stuck for a year at $3.88.
Head to Woolworths online today and you'll see a variety of prices, for different kinds of loaves. I've averaged them. Today's price is $3.55.
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The neverending story of an election that could take out Malcolm Turnbull

Mark Kenny
Published: November 11 2017 - 5:02PM
Technically, the Korean war is ongoing. Technically, the 2016 Australian election has become similarly open-ended.
Its distended double-dissolution campaign was excruciating at the time, imparting a sense that it would never end. Now we find... it hasn't!
Even the "job lot" evaluation of the "citizenship 7" by the High Court in October, failed to settle things.
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National Budget Issues.

‘Pay your tax’: Morrison issues warning to multinationals

  • The Australian
  • 12:58PM November 6, 2017

Greg Brown

Scott Morrison has warned multinationals to “pay your tax” as he defends moves from his government to crack down on tax minimisation following a leak of tax records out of a law firm in Bermuda.
The Treasurer said this morning the Australian Taxation Office was “on the front foot” in tackling tax avoidance following the data leak from the offshore tax haven, known as the “Paradise Papers”.
“Australia is doing what we must be doing in relation to these latest revelations. We have been leading the charge in relation to international jurisdictions since the last set of papers,” Mr Morrison said this morning.
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Reserve Bank: Interest rates remain on hold as lending restrictions take effect

Eryk Bagshaw
Published: November 7 2017 - 3:08PM
The Reserve Bank has left the cash rate on hold at the record low of 1.5 per cent for the 15th month in a row, as economists warn any lift in interest rates would hit consumers, leading to slower economic growth and fewer new employment opportunities. 
Governor Philip Lowe warned household debt had been outpacing the slow growth in household income for some time and this was "a continuing source of uncertainty".  
Tighter lending practices and housing market slowdowns in Sydney and Melbourne have had the desired effect of a rate rise, without impacting broader spending across the economy, a factor the central bank is keen to avoid in an environment of non-existent wage growth. 
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$30bn boost for Turnbull’s tax reform plan

  • The Australian
  • 12:00AM November 8, 2017

Simon Benson

The full rollout of the Turnbull government’s company tax plan will deliver a $30 billion revenue return to the federal budget, effectively halving the claimed total cost of the policy, according to an official Treasury report to be ­released today.
The report also warns that Australia could suffer a “permanent reduction in the level of GDP and real wages” if it fails to ­respond to the changing global tax environment — fuelled by Donald Trump’s renewed push to cut the US rate to 20 per cent.
The government is likely to seize on the official research ­report to try to shift the focus back to economic management, having seen its agenda derailed by the deepening citizenship scandal, which now threatens its slim parliamentary majority.
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Health Budget Issues.

Australia's health watchdog accused of 'too close' relationship with industry

Joanne McCarthy
Published: November 5 2017 - 3:38PM
Australia's drug and medical device watchdog, the Therapeutic Goods Administration, needs a complete overhaul to distance it from the health industry and allow consumers to sue it for negligence, say academics and consumer advocates after the regulator quietly announced moves to classify all pelvic mesh devices high risk after years of controversy.
"The current regulatory framework is a complete bypass of the interests of consumers. They don't have a stake at the table," said University of Canberra academic Wendy Bonython, after the TGA said the new classification would mean "higher evidentiary requirements" before new devices are approved for use in Australia, and for existing approved devices.
The move comes more than a decade after many pelvic mesh devices were cleared for use by the TGA with little or no independent evidence of safety and efficacy.
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PBS drug price reforms come up $840m short

  • The Australian
  • 12:00AM November 6, 2017

Sean Parnell

A much-lauded savings measure for the Pharmaceutical Benefits Scheme came up $840 million short last year when the returns to government and taxpayers were 26 per cent lower than forecast.
While price disclosure is still delivering savings, the shock ­result is the biggest variation since the measure was introduced a decade ago and raises questions about whether market conditions have changed or the modelling is wrong.
Federal Health Minister Greg Hunt will not update savings forecasts until the next budget in six months and also has other changes to price disclosure before parliament.
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Why cost-shifting, a mammoth-sized rort, is allowed to continue

7 November 2017

COMMENT

Why does everyone ignore the mammoth-sized rort?
The cost-shifting problem has been happening for 15 years. It is done at a localised level. We’re talking about tens of millions of dollars in costs being shifted from state to Federal Government. The feds do care about the issue. They would want to stamp it out — whether it’s a Liberal or Labor government.
But it goes on because state hospital budgets are usually fairly stretched and the hospital managers can get away with it. So yes, it’s a blatant rort: a deliberate breach of the terms of the National Health Reform Agreement.
The problem is that the government is not resourced to investigate every instance when a public hospital doctor is magically transformed into a private bulk-billing doctor who happens to be working in a public hospital.
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Insurers discriminating against people who get genetic test results could hobble research, bioethicists warn

Kate Aubusson
Published: November 8 2017 - 12:15AM
Edwina Sawyer has been denied life insurance by half a dozen policyholders, but she's not sick.
She doesn't smoke or drink excessively, and has taken drastic preventative measures to guard against cancer.
But a genetic test she had a decade ago is barring the mother-of-two and her family access to insurance, she says.
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GPs’ fees up $1 as health funds ask for $200 premium rise

Sue Dunlevy, National Health Reporter, News Corp Australia Network
November 8, 2017 10:00pm
CASH-strapped families are facing soaring medical bills with health funds hiking premiums by $200.
On top of this, doctors fees are set to jump $1 per visit after the Australian Medical Association last week recommended GPs increase their fees by $1 to $79 for a standard consultation.
Health funds are on deadline to present Health Minister Greg Hunt with their applications for their annual April premium rises by November 10.
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APRA tick for government health insurance reforms

  • The Australian
  • 4:02PM November 8, 2017

Sarah-Jane Tasker

New figures showing health ­insurance benefits rising at a ­similar rate to premium increases and hitting a record $19.83 billion highlighted the case for recent ­reforms to the industry, its peak body said.
The 2016-2017 annual report into the private health insurance sector, released yesterday by the Australian Prudential Regulation Authority, comes as the industry finalises requests for the 2018 ­premium increase ahead of tomorrow’s deadline for submissions. This year’s increase was an average of 4.84 per cent and the federal government is expecting next year’s figure to be lower, on the back of the reforms it ­announced last month. Total benefits paid rose 4.5 per cent
Rachel David, chief executive of Private Healthcare Australia, said the annual financial report on the sector highlighted where the Turnbull government was coming from with its health ­insurance reforms.
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  • Updated Nov 10 2017 at 10:00 PM

Private health insurance premium rises likely to slow

Households could get some respite from rising health insurance premiums next year amid signs that insurers' costs are growing at the slowest rate since the global financial crisis.
With the deadline for insurers to lodge their proposals for premium rises with the Health Department expiring Friday, new figures show that the rate of increase in the dollars health insurers paid for benefits for patients in 2016-17 grew by just 4.5 per cent, down from 5.2 per cent previously and the slowest annual rise since at least 2010.
The data from the Australian Prudential Regulation Authority suggests the average increase in health premiums this year could be well below the 4.8 per cent last year, although it will still be far above the rate of general consumer price inflation.
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International Issues.

South Korean adviser warns secret back channels with North Korea have collapsed

Nick O'Malley
Published: November 6 2017 - 12:15AM
Seoul: On the eve of President Donald Trump's first visit to South Korea, tensions remain critical because secret back channels with North Korea have collapsed, says South Korea's First Deputy Chief of National Security Strategies, Sang-chui Lee.
Mr Lee, whose post is similar to that of a deputy minister, said North Korea's nuclear tests had added to the tensions on the Korean peninsula due to the vast conventional forces that have long been posed against one another across the Demilitarised Zone that has marked the border between the two nations since the end of the Korean War.
But he said until recently effective back channels existed between the two armed forces.
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Trump administration is up to its neck in Russians

Jennifer Rubin
Published: November 7 2017 - 5:48AM
The number of Russian connections to President Donald Trump's campaign and to his administration should stun and worry even the most credulous Republicans. We have never seen such a multiplicity of connections to a hostile foreign power and lack of transparency in a presidential campaign or administration - nor have we ever had a campaign in which Russians interfered in such a widespread and deliberate manner.
Newly leaked international documents reveal even more of the Trump team's Russian ties, according to NBC News: "Through offshore investments, [Commerce Secretary Wilbur] Ross held a stake in Navigator Holdings, which had a close relationship with the Russian firm. Ross did not disclose that connection during his confirmation process on Capitol Hill." NBC's report also states:
"Top White House adviser Jared Kushner, Trump's son-in-law, is also implicated. The documents reveal that Kremlin-connected interests invested in social media giants Facebook and Twitter through one of Kushner's business associates. Russian tech leader Yuri Milner, who funnelled the money to Facebook and Twitter, has a stake in a company partly owned by Kushner."
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Donald Trump has done Australia a favour

Peter Hartcher
Published: November 7 2017 - 7:42AM
Could it be that, despite everything, Donald Trump is doing Australia something of a favour? He has jolted the world's confidence in US sanity, shaken the trust of US allies and shattered progress in global market-opening. In other words, he's undercut the fundamental principles and systems that have sustained the America-centric global order since World War II. Yet because of this shock to the system, he is forcing Australia's leadership to think.
Australia's default position for most of the postwar era has been to contract out to Washington most of the thinking on foreign affairs and defence. Australia has automatically relied on the US alliance as the national insurance policy, and sent small contingents to support America's fights in the Middle East as payments to make sure the policy remained current.
It wasn't that Australia lacked independence. It's that we chose dependency. As former diplomat Allan Gyngell​ puts it in an essay in the new journal Australian Foreign Affairs: "No one has forced us to fight particular wars or pursue particular goals. It was all our own doing.
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  • Nov 7 2017 at 10:10 AM

Xi Jinping, Donald Trump and their North Korea problem

by Gideon Rachman
With the threat of another Korean war looming, this week's US-China summit in Beijing could be the most important in decades.
Most western commentary on North Korea has focused on President Donald Trump's warnings of "fire and fury" to combat the regime's nuclear threat. But the Korean crisis also poses a huge risk to China. If a war breaks out, China will literally be on the frontline - potentially exposed to nuclear fallout, refugee flows and dramatic shifts in the regional balance of power.
These acute risks have produced a startling variety of opinions among Chinese experts about the best way forward. There are some who even argue that China and the US should co-operate in joint military operations against North Korea. Others take a completely different line - contending that Washington's policy is leading to disaster, and that it is time for Beijing to break publicly with the US.
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The risk we take when we panic about China's rise

James Laurenceson
Published: November 8 2017 - 12:05AM
 Sometimes Australia can slip into panic mode when confronted by China's rapid rise. Australian universities are now the centre of attention. They increasingly employ Chinese citizens and Chinese-Australians as researchers, and nearly 40 per cent of the fee-paying, international students they host are also from China.
The most recent claim is that Australian universities are collaborating with top military technology universities in China to the benefit of the People's Liberation Army, and to the detriment of our security ally, the United States.
These are serious allegations that deserve an airing and further investigation. At the same time, what is the evidence being offered? A swath of scientific papers co-authored by researchers who had worked or studied at Australian and Chinese institutions, many published in leading peer-reviewed, English-language academic journals.
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Trumpism without Trump: A losing formula in swing-state Virginia

Michael Tackett
Published: November 9 2017 - 2:53AM
For Ed Gillespie, Trumpism was an ill-fitting suit.
His resume was pure Establishment - national Republican Party chairman, counsellor to President George W. Bush, well-connected lobbyist. But the messaging of his campaign for governor of Virginia was that of a cultural flamethrower, emphasising crimes by unauthorised immigrants, monuments to Confederate heroes, even suggesting that his opponent, a pediatric neurologist, supported child pornographers.
As the Republican candidate for governor in Virginia, Gillespie tried to run in a very narrow lane, by embracing some of the most divisive elements of President Donald Trump's agenda while treating him like Voldemort and mostly refusing to utter his name. It was enough to motivate Trump's supporters in rural parts of the state, but fell far short in Northern Virginia on Tuesday, where the wealthy and well-educated voters who were once reliably Republican continued their march toward becoming solidly Democratic. He lost by a margin twice as big as predicted.
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Voters deliver first forceful rebuke to President Donald Trump

Jonathan Martin and Alexander Burns
Published: November 9 2017 - 6:15AM
Voters have delivered their first forceful rebuke of President Donald Trump, with the Demoratic Party capturing governorships in two key states and making significant inroads into suburban communities that once favoured the Republican Party. 
The Democrats crowning success on Tuesday night came in Virginia, where Lieutenant Governor Ralph S. Northam, an understated physician and Army veteran, won a commanding victory for governor, overcoming a racially charged campaign by his Republican opponent and cementing Virginia's transformation into a reliably Democratic state largely immune to Trump-style appeals.
Mr Northam was propelled to victory over Ed Gillespie, the Republican nominee, by liberal and moderate voters who were eager to send a message to Trump in a state that rejected him in 2016. Mr Northam led Mr Gillespie by nearly nine percentage points, the widest victory in decades for a Democratic candidate for governor of Virginia.
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  • Nov 9 2017 at 10:01 AM

Why Donald Trump and the House of Saud are a match made in heaven

by Edward Luce
You might say it is a match made in heaven. With their taste in gold elevators, the Trump family and the House of Saud were destined to alight at the same penthouse.
But the affinity between Donald Trump, US president, and Mohammed bin Salman, Saudi Arabia's de facto monarch, goes beyond a shared aesthetic for "dictator chic". It is chiefly transactional. The US-Saudi relationship is the quintessence of Trumpian diplomacy. Its flowering symbolises the decay in the US-led global order.
Mr Trump's approach to foreign relations is a blend of family and money and a weakness for flattery. Japanese prime minister Shinzo Abe pledged $US50m to the Ivanka Trump-inspired Women Entrepreneurs Finance Initiative — the World Bank's effort to seduce America's first family. Mr Abe, whose first gift to Mr Trump was a gold-plated golf club, hosted Ms Trump in Tokyo shortly before her father turned up.
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'He said he didn't meddle': Trump says Putin denies Russia tampered in US election

Ashley Parker and David Nakamura
Published: November 12 2017 - 2:43AM
Hanoi: US President Donald Trump said on Saturday that Russian President Vladimir Putin has again denied his nation tampered in the US presidential election last year.
Mr Trump told reporters that he and Mr Putin had more than one informal discussion after crossing paths at the Asia-Pacific Economic Cooperation (APEC) forum in Danang, Vietnam, before Mr Trump flew to Hanoi for a bilateral meeting on Sunday with Vietnamese leaders.
The conversations mostly centred on the war in Syria, Mr Trump said, but he added that he pressed Mr Putin on Moscow's role in attempting to tamper in the elections.
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I look forward to comments on all this!
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David.

This Threat Will Rather Put The ePAS Project Under Some Stress. It Could Get Messy.

This appeared late last week:

SA Liberals would halt controversial EPAS electronic patient record system if elected

8th November, 2017
South Australia's Opposition Leader would pull the plug on the rollout of the state's controversial electronic patient records system if elected next March.
Speaking at a breakfast hosted by the SA branch of the Australian Medical Association (AMA) today, Liberal leader Steven Marshall slammed the State Government's rollout of the EPAS software, describing it as "completely mishandled".
"This is a program which needs urgent review," he told the gathering of doctors, also attended by Premier Jay Weatherill and SA Best party leader Nick Xenophon.
"We will immediately stall the rollout of the system to any other sites in South Australia and, more than that, we will immediately undertake an independent review to see what the options are for South Australia."
Mr Marshall told the meeting the cost of the EPAS rollout had blown out from $422 million to around $471 million.
"It's an extraordinarily expensive system and we still don't have it in critical hospitals like the Lyell McEwin Hospital, Modbury Hospital [and] Flinders," he said.
The EPAS system has been plagued by problems, with doctors previously complaining it is slow and clunky, complex to use when ordering drugs and therefore potentially dangerous for patients.
But Mr Weatherill defended the system in front of senior doctors on Wednesday, describing it as a necessary part of "modernising" the state's health system.
"Its initial phases have been challenging but it will be an important part of ensuring that we provide the best possible care in the future," he said.
"It's almost staggering to believe that people would want us, in this day and age, to be confined to paper-based records."

Xenophon and AMA at odds on EPAS review

SA Best party leader and state election candidate Nick Xenophon said the rollout of EPAS had been "botched" by the Government.
He said he supported the Liberal Party's call for an independent review.
"I spoke with a clinician last night who described EPAS in these words — that it's slow and cumbersome, and that the parts that work are fine, but the bits that don't work don't fit in with the rest of the health system," he said.
More here:
Additionally we have this going on as first noted last week

SA pours another $49m into troubled EPAS

By Justin Hendry on Nov 7, 2017 6:45AM

For a major system upgrade.

The South Australian government has funnelled another $49 million into the Department of Health’s troubled electronic patient administration system (EPAS) for a "major upgrade" intended to make the system run better.
It brings the total cost of the project to $471 million to date.
The state-wide system, underpinned by Allscripts technology, has long been a cause for concern, suffering numerous delays, usability issues and cost overruns since the project was initiated six years ago.
Although budgeted at $408 million at the time of cabinet approval in December 2011, the cost of the project quickly rose to $421 million shortly after.
That figure has since grown to $471 million.
According to SA Health’s deputy chief executive Don Frater the money will be used for a “major system upgrade”.
Lots more here:
I really wonder if the Liberals have actually thought this through – given the ‘blood and treasure’ already expended.
David.

Final Submission - Secondary Use Of MyHR Data.

Submission  - Secondary Use Of My Health Record Data  - November 2017.

Background to Submission Author.

Dr. David G More MB, PhD, FACHI, the author of this submission, is a registered medical practitioner with an over 20 year background in Digital Health implementation and use.

Short Summary.

Overall I would just like to be sure that whatever Framework the Consultation comes up with we have strong public accountability as to who is doing what with whose data and that it is conducted under ethical supervision - assuming that we decide we agree to proceed with Secondary Use  - which I remain sceptical of - given the context of reduced public trust of institutions and other risks. If Secondary Use is to proceed I also offer what I believe is a sensible and pragmatic approach to implementation.

Background To Submission.

On behalf of the Commonwealth Department of Health HealthConsult has been tasked with assisting to develop a “Framework for the Secondary Use of My Health Record Data”
Conceptually this framework is to enable use of the data in this system (which is identified clinical and administrative data) of the purposes of extraction, analysis and reporting on any manner of data elements held in the record for health related purposes and for the ‘public good’.
Apparently specifically excluded is use of the data ‘exclusively’ for commercial or administrative purposed but ‘mixed’ use is apparently permitted.
An example of mixed use might be the use by a for-profit drug company of the data to assist in locating individuals for a clinical trial – as recently discussed on RN’s AM.
See here:
It seems to me that all those who have a myHR should at the least be offered an opportunity to opt-out and any Secondary Use while retaining their myHR if so desired.

Issues That Will Need To Be Addressed In The Final Framework.

Individual Consent
There is a general privacy principle that indicates the personal information should, in general, only be used, by anyone, for the purposes it was collected. As far as the myHR is concerned this would suggest the information held in the system is to be used for the purpose of delivering or supporting the individuals health care. Clearly using this same information for research, management etc. is unrelated to the direct care of the individual and so on is not what the data was given to the myHR for.
Data Quality
The data held in the myHR is largely held in rather old fashioned data-bases in forms where the is very little quality control and where it is held in forms that makes it very problematic to actually search or use the data. This has been openly acknowledged by the ADHA.
History Of Government Attempts To Misuse Health Data.
It was public opinion in the UK that resulted in the cancellation of the so called care.data program and in Australia data releases have been withdrawn after issue with the quality of anonymization were discovered. At the very least these issues should result in extreme care and caution with the use of the data or maybe have some actual experts oversee what Government does.
If There Is Any ‘Social License’ For Unannounced Use Of Personal Health Data Held In The myHR
It can be, not unreasonably, argued that unless individuals are fully informed and provided consent for data use that use of their data is a violation of the ‘social contract’ between the individual and the Government and that it is this sort of retrospective change of ‘the rules’ that is a contributor to the current lack of trust is government as starkly revealed in my recent poll.
----- Dated 12 November, 2017:

Do You Trust Government To Keep Safe And Not Abuse Private Information You Share With It?

Yes 4% (4)
No 95% (99)
I Am Not Sure One Way Or The Other 1% (1)
Total votes: 104
There Is Internal Government Awareness Of Complexity In, and Risks Of, Allowing Access To The Data
Discussions with the ADHA have not only confirmed major data quality and accessibility issues but also significant issues with safely providing any form of individual data access or downloading.

Proposal For Ethical Use Of Data Held In The myHR If It Is To Proceed.

Given that it is important that health data be properly used (where ethically possible) for the benefit of everyone I recommend the following approach to secondary use of the data held in the myHR system.
The approach also permits linkage to other relevant data sources.
1. All use of the data be as a result of a written publicly available proposal. This can be developed with the analytic entity. (A possibility for this entity may be a unit of the Australian Institute Of Health And Welfare)
2. The secondary use proposal is formally reviewed by an independent appropriately qualified and diverse expert ethics committee, and only proceeds if approved. The details of the Ethics Committee discussion should be publicly released. There should be a clear set of guidelines developed to explain what, and what not, constitutes ethical use.
3. All data analysis and reporting done in house – at a small group or sole purpose entity expert in handling data extraction, linkage and analysis. NO raw data leaves the analytic entity.
4. Researchers are encouraged to work with the entity experts to conduct analysis and reporting – but no data actually leaves the Government controlled repositories.
5. All summary reports resulting from the research  / analytics  is made publicly available on a dedicated web-site which also has the research proposal and ethic committee comments.
6. The supervising analytic entity should be within Government and publicly accountable.
This approach provides maximum transparency, considerable assurance of proper use of the information, reasonable data access and high security. There can also be total public confidence in what is done being done due to mandated transparency and disclosure. Additionally since no data is actually released, except in summary report form, the need to consent is obviated.
The disadvantages may be that outcomes may take a little time and may be more costly than simply handing the data over for use (and potential misuse).
I am happy to provide more details as may be useful to assess the proposal.
It should be noted that this submission is based on the assumption that the myHR Program proceeds as presently intended by the ADHA.
To be clear, overall I do not see Secondary Use of myHR data as either inevitable or positive, especially given the fact that most of the data is held and can be used elsewhere within Government, is more accessible there, and use of those sources avoids many of the privacy concerns associated with the myHR.
David More 16/11/2017.

Wednesday, November 15, 2017

The COAG Health Council Addresses Some Issues Around The myHR.

This was released early last week:

Communique 3 November 2017

Federal, state and territory Health Ministers met in Canberra today at the COAG Health Council chaired by Meegan Fitzharris MLA, ACT Minister of Health and Wellbeing to discuss a range of national health issues.
Health Ministers noted the Queensland Parliament is in caretaker mode and the Queensland Minister was not present.
The meeting made progress in protecting patients with items dealing with the health risks associated with cosmetic procedures.
Ministers also agreed to pursue a national approach to supporting the mental health of health professionals including progressing reform of mandatory reporting. Ministers noted a suite of resources to help improve the safety and security of health professionals working in remote locations and protecting our children and seniors with advanced influenza protection, including the importance of investigating the benefits of flu vaccinations for children 6 months to 5 years. Significant progress was also reported by the Commonwealth towards the early roll out of a new Meningococcal Quadrivalent vaccine.
Other items discussed included:

Long term health reform

Ministers agreed on directions for long term health reform in the upcoming National Health Agreement noting that sustainable funding is a critical factor and requires further consideration.

Commonwealth Activity Based Funding Determination for 2015–16

Health Ministers noted the desire of all parties to finalise the independent review of funding and activity growth for 2015-16 and work to the earliest possible resolution.

National Health Genomics Policy Framework

Health Ministers approved the National Health Genomics Policy Framework 2018–2021.
The Framework agrees a high-level national approach to policy, regulatory and investment decision-making for genomics. Advances in genomics have the potential to help people live longer and better lives by reshaping clinical practice to fundamentally change the way we prevent, diagnose, treat and monitor illness, providing the opportunity to have more precise and tailored treatments. The ability to respond to this change is dependent on further
developing Australia’s capacity, capability and infrastructure needed to support integration of genomic technology into the national health system.
Health Ministers also agreed to the development of an Implementation Plan for the National Health Genomics Policy Framework that will identify actions to support the strategic priority areas.

Framework on Mandatory Reporting under the Health Practitioner Regulation National Law

Health Ministers have made considerable progress towards consensus on a national approach to a Framework on Mandatory Reporting under the Health Practitioner Regulation National Law, including:
  •  Agreeing to progress with a predisposition to a national system that supports the mental health of the health professions whilst protecting patients, for consideration by the COAG Health Council out of session as a matter of urgency and
  • Agreeing to continue finalising the CHC position noting that Queensland is in caretaker mode and any national legislation will need to be passed by the Queensland Parliament.

Health Risks Associated with the use of Medicines in Cosmetic Procedures

Health Ministers noted the recent investigations undertaken by New South Wales into cosmetic clinics and acknowledged the need for jurisdictions to continue to monitor and review regulation in this area to help reduce the health risks associated with the use of medicines in cosmetic procedures.

Current and projected usage of the My Health Record and update on jurisdictional infrastructure scalability plans

Health Ministers noted the current state of connection of state and territory health IT systems to the My Health Record, which shows variations in hospital systems connected across different jurisdictions and the degree to which information in the My Health Record is viewed.
Ministers agreed that the expansion of the My Health Record for every Australian will require changes to jurisdictional health IT systems and that all jurisdictions should assess the readiness of their infrastructure to handle increased uploading and viewing.
The Australian Digital Health Agency is working with jurisdictions on their readiness for the My Health Record expansion, including educating healthcare providers and preparing for increased load.

Options to reduce pressure on private health insurance premiums – feedback from the public consultation process

Health Ministers noted the Commonwealth summary of feedback received as part of the public consultation process on the paper Options to reduce pressure on private health insurance premiums by addressing the growth of private patients in public hospitals.
Here is a direct link:
The two discussions I fund interesting were the one on Genomics and the one on the myHR.
As far as Genomics is concerned this really seems to be rather late to the party and especially regarding how EMRs and the myHR will handle and preserve Genomic data. Will be interesting to see what commentary comes out as time passes.
On the ‘compulsory’ enrollment in the myHR it is clear from the report I cited on Tuesday that adoption and use of the myHRis limited and many are not connected.
On chart 8 we find that less than 5% specialists are even connected, a little over 20%  of Pharmacies and about 15%  of Aged Care facilities are connected. Even in GP land there is just over 60% are connected.
Given the switch to opt-out is due next year one wonders how this will play out, and just what will be ready.
David.

Health Affairs Puts The Place Of Technology In Health Care In A Larger Perspective.

This appeared last week:

How The Rise Of Medical Technology Is Worsening Death

10.1377/hblog20171101.612681
Our aging population is at risk from a most benign-appearing source—the medical technologies we trust to keep us healthy.
When they were first widely used in the 1930s and 1940s, breathing machines did what humans could never have imagined a generation earlier: They kept young polio victims alive until their bodies cleared the virus that had temporarily weakened their respiratory system. Thanks to these miraculous machines, tens of thousands of these patients recovered and went home to live out the rest of their lives. This bold new use of medical technology riveted the world and set the stage for a new era in medicine, in which an overriding faith in the curative powers of technology prevailed. Over the next several decades, doctors assumed that everyone wanted and deserved access to these treatments. The breathing machine, or mechanical ventilator, was the first of many life-prolonging technologies to come. Now, there are machines to substitute for a wide range of physiological functions, including the pumping of the heart and the oxygenation of the blood.
Ideally, life-support technology should serve as a bridge to recovery, in which the failing organ is supported until the underlying disorder improves. But when the underlying disease or failing organ will not recover adequately to resume independent living, the recipient is likely to remain dependent on the machine. Unlike the polio victims, whose young and otherwise healthy bodies were often able to spring back to life after their illness had passed, the frail elderly and terminally ill are much less likely to recover. And so they are attached surgically to machines, most commonly through a tracheostomy tube in the neck and a feeding tube in the stomach. These patients cannot live at home and must remain in facilities where they are cared for by trained personnel. Most will never get out of bed again, eat independently, or talk. Many will lie in hospital beds, their arms tied down to prevent dislodgment of tubes, until they die.
According to the Department of Health and Human Services, over the next 45 years, the population of people older than age 65 will double. From 46.2 million in 2014, the number will climb to 98.0 million in 2060. In 2030, one out of every five Americans will be older than age 65. If trends continue on the current path, this will translate into millions of elderly patients on life support.
The SUPPORT Trial of 1996 was the first wake-up call to the medical community on the state of dying in America. It reported astonishing rates of mechanized deaths, accompanied by significant patient pain and suffering. Often, patients or their families had little or no prior communication with physicians about decisions to use these treatments. The mechanical ventilator, cardiopulmonary resuscitation, and dialysis machines are familiar mainstays of intensive care, and unless patients opt out, they drive the treatment plan. Doctors reach for them. And most patients, educated on these topics by inaccurate media portrayals, expect them. Substantive conversations about prognosis and treatment plans rarely take place, and patients’ understanding of their condition and treatment options are poor. But despite subsequent efforts by the palliative care community and others to reverse this situation, in 2013, the Journal of the American Medical Association reported an increase in intensive care unit (ICU) stays for patients older than age 65 in their last month of life.
Today, there is a steadily expanding menu of technological treatments designed to support a multitude of failing organs. An example is extracorporeal membrane oxygenation (ECMO), a form of cardiopulmonary bypass (CPB). CPB was developed in the mid-twentieth century for use during heart surgery. Like hemodialysis, which compensates for failing kidneys, CPB can take over for hearts while under the surgeon’s knife. The blood circulates through the machine, transported in and out of the body through large cannulae. The CPB machine oxygenates the moving blood and then pushes it back into the body, maintaining pressure and circulation. ECMO is conceptually and mechanically similar but is intended for longer-term support in patients who will remain, for days, weeks, even months, in the ICU. It was initially conceived in the 1940s but was largely relegated to research purposes and then to the treatment of neonates. However, during the swine flu pandemic of 2009, survival rates for adults receiving ECMO for respiratory failure were found to be higher than seen in earlier studies of the technology. Following that, there was a substantial rise in the number of ECMO centers worldwide, going from 148 in 2008 to 298 in 2015.
The ECMO machine can serve to support diseased lungs, or hearts, or both. Large catheters bring poorly oxygenated blood from the body to the machine, where it is oxygenated and then sent back to feed the tissues of the body. The goal is to support the body until the lungs and/or heart recover, or are transplanted. In the meantime, the patient can live in the ICU on this machine. While some patients are able to move around in the ICU, with staff carefully carrying the machine and catheters behind them, others lie in beds, either too weak to move or dependent on the breathing machine.
Intended as a bridge to recovery or a bridge to transplant, for some, this technology becomes what is called a bridge to nowhere. If a patient’s organ will not recover and the patient is not a candidate for transplantation, the remaining options are bleak. Such patients will likely suffer many complications aside from their underlying condition, including increased risk of bleeding, profound fatigue, cognitive decline, deconditioning, and serious infections with drug-resistant organisms. But arguably more difficult is the decision they face about how to proceed. Unlike patients on breathing machines, these patients are often awake and able to communicate. And so they must answer an important question. Are they willing to live the rest of their life in an ICU? If not, when to disconnect the machine? Most, once disconnected, will die within a very short period of time. How do doctors ask patients, many of whom didn’t elect for this treatment but were placed on it while in extremis, to decide what day they want to die? And one cannot ignore the issue of resource allocation. If a person does not wish to end his or her life, he or she may be using a precious and scarce resource that could save another patient.
Lots more here:
Health technology seems now like it may just be going a little too far in some areas and while I am sure it is not true for Digital Health just yet, we need to be alert to side effects and harm, risks and unintended consequences!
David.

Tuesday, November 14, 2017

The ADHA Minutes For October 2017 Show The Usage Of The myHR Has Essentially Died.

The ADHA published the Board Minutes last week:

Board Papers

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

Board Meeting 11 October 2017 - Board Papers (Download)

Here is the link to the page:
On usage we have the following from the notes:
“BACKGROUND
The layout of the Dashboard remains unchanged from the previous Board meeting. However, as part of ongoing continuous improvement, a few minor changes have been made to a number of charts:
-          Chart 8 on page 2. Compared to the dashboard tabled at the August Board meeting, this shows more providers and the proportion connected to the My Health Record; and
-          Charts 9 (page 2) and 12 (page 3) have been changed to monthly to be consistent with the data in other charts in the Dashboard.
It should be noted that while it appears that participation has decreased substantially in September 2017, the data for this month only covers two weeks.
SUMMARY OF ISSUES
There are now more than 5.1 million Australians with a My Health Record. Based on current consumer registration rates, this is increasing by approximately 100,000 every six weeks.
Consumer Participation (refer to Attachment A)
In the four weeks to 10 September 2017, an average of 17,568 consumers were registered each week. The majority of registrations were conducted by healthcare providers.  Average registrations has decreased since the August Board meeting and is likely due to the date of this dashboard being part way through an ePIP quarter (ends 31 October 2017) as well as less consumers logging onto MyGov. 
The number of documents uploaded and viewed by consumers has dropped which is consistent with patterns seen after the end of ePIP quarters in the last 12 months.
Organisation Participation (refer to pages 2, 3 & 4 of Attachment A)
There has been a continuing trend of steady increase in registration of most types of healthcare provider organisations over the past 12 months (Chart 6). However, in late August, there was a spike in the number of “Public Hospitals” and “Other” types registered. Western Australia and South Australia connected 24 hospitals between them and in Queensland, there were a significant number of public health centres connected (Chart 7).
The number of providers uploading the different clinical document types has slightly decreased (Chart 9), however Chart 10 shows that the volume of documents being uploaded overall still has peaks and troughs.
Chart 12 shows that the number of provider organisations viewing clinical documents has dropped slightly since July and the number of documents being viewed is also decreasing.
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Despite the commentary that the data was only for 2 weeks in September all the graphs (Charts 12 – 17) show usage has unwound since July.
As an example of how unused the system is, is that in August only 200 or so Shared Health Summaries were accessed in the month by all hospitals.
Equally only a thousand Shared Summaries were looked up by GP practices in August and only about 3000 summaries were uploaded in August.
With 5,100,000 patients having a record this is just a joke. Even 100 times the use would be pretty wasteful.
All this data is in the Section 8.1 Attachment A pages 2 and 3 from the .pdf link above.
No wonder the ADHA is desperate to attract a great deal more use and so much of the data refers to cumulative data! It has to rise (sigh).
One is really forced to wonder just what difference forcing pretty much everyone is going to make if this is the usage ePIP payments and 5 million "users" generate. It really is already a failure I reckon!
David.