Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Wednesday, March 14, 2018

Is This Brownian Motion In The Digital Health Space – What Is Going On?

This appeared last week:

Media Release: A new national digital collaborative to improve child health

Tuesday, March 06, 2018
Australia’s states and territories have joined forces in a unique and transformative partnership that harnesses technology to improve the health and wellbeing of Australian children.
In one of the first initiatives of Australia’s National Digital Health Strategy – Safe, Seamless, and Secure, the Australian Digital Health Agency is partnering with eHealth NSW and the Sydney Children’s Hospitals Network (SCHN) to establish the National Children’s Digital Health Collaborative.
SCHN Chief Executive Dr Michael Brydon said that records on a child’s health and development are currently captured in multiple paper and digital systems, meaning they are not always available when they are needed.
“The Collaborative is exploring how every child in Australia can have the option of a comprehensive digital health record from the time they are conceived, through those critical first years and adolescence; readily accessible by parents and healthcare providers and ultimately for that individual throughout their life.
“This will be of enormous value – not only to healthcare professionals providing care to those children – but to the children themselves as they become young adults and start making decisions about their own health and care,” Dr Brydon said.
The Collaborative comprises around 400 clinicians, consumers, IT experts, and researchers from across Australia and is aimed at making a positive impact on children’s health and wellbeing.
Agency CEO Tim Kelsey said the Collaborative is a momentous opportunity to make a lasting difference to the long-term health of all young Australians, given that many predictors of adult disease have their origins in childhood.
“This work will enable the establishment of lifetime digital health records for all Australian children, wherever they live or present for treatment,” Mr Kelsey said.
The Collaborative comprises a wide variety of experts, including clinicians, consumers, governments, researchers, providers and industry representatives, who will co-design and test a way for parents and healthcare providers to easily access standardised information on a child’s health and development.
This initiative will test how information can be captured not only through a child’s interaction with the health system and other services such as school immunisation programs, but also through their mother’s relevant interactions during her pregnancy.
eHealth NSW Chief Executive Dr Zoran Bolevich said the aim is to create a holistic digital view of a child’s health for families who choose to have one. The Collaborative will also test the ways in which parents, carers and healthcare providers want to access this information, including through systems such as My Health Record. This work will then provide a base of evidence and experience with a view to rolling out solutions nationally.
“We want to engage and empower children and their families by providing them with consumer-friendly digital access to their health information and evidence-based health resources,” Dr Bolevich said.
The initiatives identified in the Collaborative align with the National Digital Health Strategy’s models of care to improve accessibility, quality, safety, and efficiency in improving child health.
“In 2016 more than 311,000 babies were born in Australia.* When these initiatives are implemented, Australian children will have a lifelong digital health record their healthcare providers can refer and contribute to. How powerful a treatment aid will that be?” Mr Kelsey said.
Mr Kelsey said this is a platform for innovation for industry to develop new tools and digital health services.
The National Digital Health Strategy outlines a test bed for children’s health that will examine how every child in Australia can have access to a comprehensive digital health record. This record will be readily accessible by parents and healthcare providers, to track key childhood healthcare interventions such as immunisations and to ensure that healthcare providers are able to offer safe, high-quality care.
In October 2017, the Agency’s Board approved funding to design, build, and evaluate proofs of concept for five nationally focused initiatives that include:
1. A National Child Digital Health Record – Currently a child’s health and development information is captured in hard copy baby books, such as the Red Book in Queensland, Blue Book in NSW and Green Book in Victoria. These books must be carried between healthcare appointments by a child’s parents and carers, and are often forgotten or misplaced. This initiative will capture this information digitally so it is easily accessible by a child’s parents and families and available to healthcare providers where and when it is needed. New South Wales and Victoria are leading this work.
2. Upload of school immunisation records to the Australian Immunisation Register (AIR) – The AIR does not currently capture and record all of the vaccinations adolescents receive through the school immunisation programs. Adolescents may be given a paper record of a vaccine they received in school, which is often lost or misplaced, meaning they have an incomplete knowledge of their vaccination history. This results in potentially missed vaccinations or duplicate vaccinations being given. This initiative will support the upload of school vaccination records to the AIR so a full history of a young person’s vaccinations from birth through to early adulthood is stored securely in one place and accessible to them, their parents, and their healthcare providers. Australian Capital Territory and Tasmania are leading this work.
3. A National Digital Pregnancy Health Record – Currently, women’s antenatal or pregnancy records are mostly captured on paper, with women needing to carry them between their healthcare providers and appointments. These handwritten records are often difficult to read and providers need to double-enter the handwritten information into separate paper and digital systems, and this important information is often not brought to hospital when the woman goes into labour. This initiative will develop a digital shared care pregnancy plan accessible by pregnant women and their healthcare providers. Queensland and South Australia are leading this work.
4. National Digital Child Health Checks – Child health checks such as the Medicare Health Assessment for Aboriginal and/or Torres Strait Islander People (MBS Item 715) are conducted by GPs and Aboriginal Medical Services (AMS). However, the information often stays within the GP or AMS software, it is not shared electronically, and it is not readily accessible to other care providers. This may limit the opportunities for early detection, diagnosis, and intervention for common and treatable conditions by a child’s wider care team, and reduces the ability to offer integrated care and to better identify any services a child may require. This initiative will digitise child health checks to help support the early identification of a child’s health and wellbeing needs. Northern Territory and Western Australia are leading this work.
5. Research into the Longitudinal Digital Child Health Record – The implementation of the above four initiatives will help to build a longitudinal child digital health record. This will create a national repository of high quality, commonly understood, and structured child development information contributed by young people, their families and carers, primary care and jurisdictions. This will be a valuable national asset that, following all required legalisation, policy and privacy protocols, could help researchers and policy-makers better understand children’s health and wellbeing needs, and ensure that policies and programs aimed at improving health outcomes for children and young people are evidence-based and informed by robust health research and data systems.
Some of the identified research themes this information could support include: (i) Quality Use of Medicines in pregnant women and children (ii) Prenatal and early childhood influences into obesity’s developmental origins and (iii) Research into early childhood development across developmental domains.
*3301.0 - Births, Australia, 2016, Australian Bureau of Statistics at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/mf/3301.0
Further information Australia’s National Digital Health Strategy – Safe, Seamless, and Secure is available on the Agency website.
ENDS
Notes for Editors
  • The Australian Digital Health Agency commenced operations on 1 July 2016.
  • The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems and the National Digital Health Strategy.
  • The Agency’s focus is on putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them. More than 3,000 people participated in the consultation on the National Digital Health Strategy between October 2016 and January 2017. Public meetings were held in more than 103 locations across Australia. More than 1,000 formal submissions and survey responses were received. These submissions are published at https://conversation.digitalhealth.gov.au.
  • Australian consumers, carers, healthcare providers, and other health stakeholders informed the consultation.
  • Health consumers and carers expressed a strong desire to be increasingly empowered – to take control of decisions regarding their own health, and to be provided with access to their own personal health information.
  • The National Children’s Digital Health Collaborative is a good example of the Agency addressing health consumer’s needs with practical solutions.
Media contact David Cooper, Senior Media Manager
Mobile: 0428 772 421 Email: media@digitalhealth.gov.au
About the Australian Digital Health Agency The Agency is tasked with improving health outcomes for all Australians through the delivery of digital healthcare systems, and implementing Australia’s National Digital Health Strategy – Safe, Seamless, and Secure in collaboration with partners across the community. The Agency is the System Operator of the My Health Record, and provides leadership, coordination, and delivery of a collaborative and innovative approach to utilising technology to support and enhance a clinically safe and connected national health system. These improvements will give individuals more control of their health and their health information, and support healthcare professionals to provide informed healthcare through access to current clinical and treatment information. Further information: https://www.digitalhealth.gov.au/
About eHealth NSW A dedicated agency of NSW Health, eHealth NSW partners with NSW Health organisations in the planning, adoption, and ongoing development of digital technologies and capabilities that deliver value. It plans and manages ICT investments, maintains standards, designs and procures systems, manages implementations and commissions or provides ICT support services. http://www.ehealth.nsw.gov.au/
About the Sydney Children’s Hospitals Network Sydney Children’s Hospitals Network cares for thousands of children each year in our hospitals and in their homes — with one purpose in mind — to help young people live their healthiest lives. http://www.schn.health.nsw.gov.au/
Here is the link:
I read this release with a sense of amazement. Initially all one can say is what a valuable and sensible initiative.
Then you think to yourself just where does the myHR fit in all this and is this a parallel system to the myHR or a voluntary replacement for it for the nippers?
Also you wonder, what is the evidence base for proceeding or is this again an evidence-free but obviously sensible and worthwhile initiative like the myHR?
I have read and re-read the release and the clear implication of the only mention of the myHR is that these additional systems may at some point be accessible via the myHR. To quote the relevant paragraph:
 The Collaborative will also test the ways in which parents, carers and healthcare providers want to access this information, including through systems such as My Health Record. This work will then provide a base of evidence and experience with a view to rolling out solutions nationally.”
All sorts of questions flow like do nippers have both records and so on and how will all this be presented to the public in the light of opt-out with the myHR? Can a nipper have a child record and not a myHR etc?
I think we need to see a detailed PowerPoint of just how all this fits together, what is its funding and cost / benefit case and what does the project plan for its development / implementation look like?
Only then will we be able to form a view as to how sensible and practical all this is?
Is this real or more kite-flying? Since funding was approved all most six months ago by the ADHA Board for initial work there should be much more information linked to the press release.
The time has come for the ADHA to properly explain and justify its plans to the public!
David.

It Looks Like We Have A Little Way To Go On Real-Time Prescription Monitoring Just Yet.

This appeared last week:

Looming workload headache? Fears over national script-monitoring system

It will be less than seamless compared with Victoria's system, say pharmacists
8th March 2018
The Federal Government’s real-time script-monitoring system to tackle opioid misuse will not be integrated with GP software, raising fears it will become a workload headache.
The system is being rolled out this year and aims to give all doctors access to information on S8 drugs prescribed and dispensed.
However, it will be based on the Tasmania system — known as DORA — where doctors have to log in to a state government website and view a record of what a patient has been prescribed.
Concerns about the proposals were raised in a TGA consultation on curbing opioid misuse.
In a submission, the Pharmacy Guild of Australia said there were also concerns about whether a nationwide system would be able to cope with tracking details of 25 million patients, given the DORA software was designed for just 500,000 Tasmanians.
“I’m not here to criticise [the Tasmanian system] in any form, but for larger populations, the query is scalability,” the president of the guild's Victorian branch, Anthony Tassone, said.
The guild said the Federal Government should look to adopt the real-time prescribing system developed for Victoria — SafeScript.
SafeScript is due to come online this year.
More here:
There is more detail about the Guild’s preferred system here (from their submission):

SafeScript

Victoria is much further progressed with implementation than any other mainland state and has thoroughly investigated what is required to implement a high performing system on a Victorian and national scale. A feasibility study commission by the Victorian Government revealed a better alternative to address the limitations of the Commonwealth software which in its current state will not meet the needs of clinicians, nor will its interface with clinical systems encourage high uptake. As a result, Victoria has made the decision to develop SafeScript, based on contemporary technology. It will source data from Prescription Exchange Services (PES) - technology that is already used in the majority of pharmacies and medical clinicsto facilitate electronic transfer of prescriptions. This approach will have significant advantages. SafeScript will be high performing from the outset, and as it will be developed using modern cloud-based architecture, it will be scalable to an increasing volume of prescriptions.
By comparison, significant redevelopment work would have been necessary before the Tasmanian software could have supported Victoria's prescription volume, let alone at a national level. Most importantly, SafeScript will be designed around clinicians' needs and will offer a better user experience and cause minimal disruption to clinical workflow. Clinicians will receive pop - up notifications from their desktops within seconds after a prescription has been issued or dispensed which will prompt clinicians if a review of the records in SafeScript is necessary. The notification will also provide a direct link to the patient's record. The Commonwealth software does not provide these workflow features for clinicians.
Here is the link to the submission:
If indeed the SafeScript system is more scaleable and provides better work-flow support then I suspect the Guild has a reasonable case assuming there are no buried commercial nasties.
We really do need to get this system in place ASAP.
David.

Tuesday, March 13, 2018

It Is Really Sad That So Many Are Being Fooled By The ADHA Propaganda On The MyHR.

This appeared a few days ago.

DTA taking 'one bite of the elephant at a time': Slater

The Digital Transformation Agency's CEO Gavin Slater is drawing on his 17 years at NAB to work towards a more 'competitive' digital experience for those using government platforms.
By Jonathan Chadwick | March 8, 2018 -- 01:32 GMT (12:32 AEDT) | Topic: Digital Transformation
Whether or not an organisation is working in government or the private sector, customers will want for four things, according to Digital Transformation Agency (DTA) CEO Gavin Slater: Being digitally mobile; being secure; offering accessibility; and offering a degree of personalisation.
Speaking at the Salesforce World Tour 2018 in Sydney this week, Slater said that in digitally transforming the government through the DTA, he was able to draw on his experience in the private sector, having spent 17 years in various roles at the National Australia Bank (NAB) before joining the DTA as CEO 11 months ago.
"In the private sector you have something called competition. When I was leading the retail bank at NAB, not a day went by that I wasn't thinking about what CBA were up to, Westpac, ANZ, Bendigo bank, on a range of dimensions. One of them was what was happening with their technology and their platforms and how they were dealing with their customers" he recalled.
…..
Digital identity is now one of the key initiatives that the government must deliver over the next few years, Slater added.
He also pointed towards other innovation across government departments, including digitising the Department of Veterans' Affairs and cutting the process of an application from 107 days on average to 30 days and My Health Record, the government's e-health record system that's set to cover all Australians by the end of this year.
"I think it's easy to assume that the public service is not doing a whole lot around digital innovation and transformation. Well actually nothing could be further from the truth. Clearly there's a lot on across government in terms of the transformation, but I remain really hopeful and ambitious about what can be achieved. But there's lots to be done and plenty of opportunity to partner with the private industry around innovation and ideas and ways we can be farther affected," he added.
"I think solving for digital identity will be one of the most powerful enablers of change for government and enabling individuals and businesses to deal with government digitally."
The full article is here:
My heavens – someone should point out to Mr. Slater that there is nothing very innovative about establishing a huge Government database and then dragooning some 25 million Australians to have a partial, possibly inaccurate and misleading and outdated copy of  their health records held there, and then bribing doctors to contribute additional content to it, so that maybe, one day someone will actually look up the information and find something useful! Those with long memories may recall we have had trouble with bankers in eHealth before!
Someone, with a little curiosity, might even ask to see the evidence that such an ‘innovation’ is ever likely to repay the initial $1.7B establishment cost and the ongoing operating expenses in terms of either clinical benefits or lives and dollars saved.  As far as I know no such credible evidence exists and I would be very pleased to see it if it does!
This is really a pretty sad joke.
David.

Grahame Grieve Wonders About Standards For Blockchain In Health.

Grahame posted this last week and asked for comments:

Blockchain in Heathcare – are standards needed?

Posted on by Grahame Grieve
Last weekend, in the lead in to HIMSS in Las Vegas, several of the FHIR team met with a number of block chain specialists, most particularly including David Huseby from the Hyperledger project at the Linux Foundation. We discussed various use cases for use of blockchain, with the intent of understanding what – if anything – HL7 should do to support blockchain adoption through the standards process. During an open and wide-ranging discussion, several of us came to the following consensus about the use of blockchain in healthcare (and we thank David greatly for his assistance).
Legal Assurance on Audit Trail
The first use case we recognised where blockchain has an obvious and appropriate usage is to provide strong legal assurance that an audit trail has not be tampered with. There’s all sorts of functions that a healthcare provider carries out where they may eventually be asked to provide evidence concerning past actions, and where there is a need to demonstrate that the audit trail has not been tampered with – and that includes against tampering by the system administrators themselves (that’s a very real concern – highly authorised insiders are the most likely attackers on the audit trail). If the audit trail is kept in electronic form, the only IT resource I know of that is proof against this level of attack is a distributed block chain where the system administrators don’t have total control of all the nodes.
There’s any number of compelling use cases for this in healthcare:
  • Compliance with GPDR removal-of-data requests
  • Keeping records around infection control
  • Keeping records involving cases of sexual abuse or other criminal behavior
  • etc
Technically, this is a really unchallenging use of blockchain – the head that creates blocks is completely trusted, so there’s no need for any form of voting/contest creating new blocks (e.g. no energy penalty cost for mining). And the audit trail only needs to contain encrypted copies of the actual records (or, alternatively, hash values for the records, though this introduces uncertainty around keeping hash methods constant over a period potentially spanning decades – though simply encrypting the records just moves the instability of system/version rot around). All the institution needs is one or more partners that can support the blockchain – it can be either private or public.
In fact, given how compelling this use case, it’s surprising that there isn’t commercial escrow type services simply hosting blockchains as a business service (at least, we didn’t know of any such service). It’s something that should be pretty easy to turn into a commodity using something like hyperledger, and there are strong reasons for healthcare providers to pay attention to storing these kinds of records really well.
Of course, this use of block chain is hardly scratching the surface of what block chain can do.
Need for Legally Established Trust
There’s lots of proposals floating around for using blockchain to create new trust arrangements. But whenever we considered actual use cases, we kept finding that in healthcare, any sharing of information, or delegation of trust or responsibility from one party to another starts in a closed regulated system, loaded with legal liability etc. You can’t begin to share information until you’ve established the legal basis for trust by contract – legal agreements and business agreements. And once you’ve established all those agreements, you don’t actually need a block chain – you can just have a central managed database by some consortium or foundation that acts on behalf of it’s members. This is a classic well established pattern in healthcare (see under Commonwell and Carequality – there are many others).
So, in practice, the need for legally established trust in a closed system turns out to mean that many of the proposed uses for blockchain involve quite a lot of hype.
But not all of them. For a start, while you’re going through the negotiations to set up such a consortium agreement, the fact that all the information associated with the agreements will be provably shared amongst all the participants can make it much easier to set up agreements that involve potential commercial benefit to one advantaged player… and I’ve seen several otherwise very useful initiatives flounder on this point.
And given my first law of interoperability – it’s all about the people – that means that blockchain turns out to be potentially pretty useful for interoperability after all, as a tool for changing how people think.
In fact, even just mentioning blockchain right now gets people’s attention – that’s a clear use case for using it, even when there’s no technical merit to the use of block chain directly.
Clinical Credential Tracking
We did discuss one very specific use of a public blockchain where it appears to be very useful – clinical credential tracking in USA. So it was somewhat ironic to see this headlines in USA Today today:

Prescription for Secrecy! USA Today – Dated - March 7, 2018

Standards Support for Blockchain
The upshot of all this is that it’s not at all clear that there’s any need for HL7 to work on blockchain related standards. We’re mainly going to sit back and watch this space and observe to see whether any compelling use case for standardization emerges – because it hasn’t yet (a compelling use case for standardization needs much more than just a compelling business use case for use of blockchain). But we are going to investigate 2 things:
  • Is there anything useful we should do about creating standard ways to create function specific audit trails from FHIR resources/bundles or CDA documents?
  • Should HL7 work on data and format standards to support clinical credential tracking (including, is this a real problem – we didn’t have consensus on this). Also, there are already communities working on it, and so we’d need to reach out to them to see whether formal standards support is useful for them
Comments welcome….

Here is the link:

http://www.healthintersections.com.au/?p=2778

 If you have any views please post a comment on Grahame's blog or here.

David.

Monday, March 12, 2018

Weekly Australian Health IT Links – 12th March, 2018.

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 various things going on and the ADHA releasing a Framework for Action which will need a close read. Enjoy the browse!
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Calls for an end to ‘manels’ and conference gender imbalance, as research shows depth of discrimination against women in STEM

Lynne Minion | 08 Mar 2018
Senior women in STEM have appealed for gender equality on conference programs and an end to all-male panels, as anger grows after an Australian neuroscientist was dropped from a Sydney speaking event for being pregnant.
Associate Professor of Psychology at the University of Sydney’s Brain and Mind Centre, Dr Muireann Irish, was due to speak about her dementia research and experience of working in STEM at a women’s lunch later this year, but organisers removed her from the bill in January when they discovered she would be more than eight months pregnant at the time.
For Dr Marguerite Evans-Galea, a global leader in the field of gene therapies at the Murdoch Children's Research Institute, and co-founder and CEO of Women in STEMM (which adds medicine to the list), it’s “sad” that this can happen in this day and age.
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Looming workload headache? Fears over national script-monitoring system

It will be less than seamless compared with Victoria's system, say pharmacists
8th March 2018
The Federal Government’s real-time script-monitoring system to tackle opioid misuse will not be integrated with GP software, raising fears it will become a workload headache.
The system is being rolled out this year and aims to give all doctors access to information on S8 drugs prescribed and dispensed.
However, it will be based on the Tasmania system — known as DORA — where doctors have to log in to a state government website and view a record of what a patient has been prescribed.
Concerns about the proposals were raised in a TGA consultation on curbing opioid misuse.
-----

New initiative aims to enable establishment of lifelong digital health records for all Australian children

By: Priyankar Bhunia
Published: 8 Mar 2018
The Collaborative, established through a partnership between the Australian Digital Health Agency, eHealth NSW and the Sydney Children’s Hospitals Network, is exploring how every child in Australia can have the option of a comprehensive digital health record from the time they are conceived, through the critical first years and adolescence.
The Australian Digital Health Agency (ADHA) has entered into a partnership with eHealth NSW, the lead agency in the New South Wales (NSW) Government for ICT-led healthcare and the Sydney Children’s Hospitals Network (SCHN) to establish the National Children’s Digital Health Collaborative.
The Collaborative is one of the first initiatives of Australia’s National Digital Health Strategy – Safe, Seamless, and Secure, released in August last year. The initiatives identified in the Collaborative align with the National Digital Health Strategy’s models of care to improve accessibility, quality, safety, and efficiency in improving child health.
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Media Release: A new national digital collaborative to improve child health

Australia’s states and territories have joined forces in a unique and transformative partnership that harnesses technology to improve the health and wellbeing of Australian children.
In one of the first initiatives of Australia’s National Digital Health Strategy – Safe, Seamless, and Secure, the Australian Digital Health Agency is partnering with eHealth NSW and the Sydney Children’s Hospitals Network (SCHN) to establish the National Children’s Digital Health Collaborative.
SCHN Chief Executive Dr Michael Brydon said that records on a child’s health and development are currently captured in multiple paper and digital systems, meaning they are not always available when they are needed.
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Labor pledges to review EPAS

Bension Siebert @Bension1
Friday March 09, 2018
The Labor Party would undertake a review of its controversial electronic health records system, EPAS, if it is returned to Government at next week’s election.
The review would seek input from medical staff in SA Health on how to improve the Enterprise Patient Administration System (EPAS).
Doctors have repeatedly warned that EPAS slows down emergency carethreatens patient safety and blows out waiting lists.
Meanwhile, Labor intends to bring the program up to full functionality at the Royal Adelaide Hospital and install it at Flinders Medical Centre and Mount Gambier Hospital in 2018.
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ADHA Claims My Health Record Expected To Improve Delivery Of Care For GPs

08 Mar 2018
The Australian Digital Health Agency (ADHA) has provided an update on progress of the My Health Record and the benefits it will bring to Australian patients.
Dr Michael Crampton has highlighted how it has led to improved delivery of care for his patients, noting the importance of having easy access to allergy information for the patient, hospital discharge summaries, and other important information that a patient may not remember all the relevant details of their healthcare history.
“When we have one clear, accessible, current and accurate medicines list for every patient it will overcome a lot that goes on,” Dr Crampton said.
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Organisations invited to contribute to the implementation plan for Australia’s National Digital Health Strategy

In 2017, Australia’s National Digital Health Strategy Safe, Seamless and Secure was approved by the Council of Australian Governments (COAG) Health Council putting the consumer at the centre of their healthcare and providing choice, control and transparency. The Agency, in consultation with the states and territories, has drafted a Framework for Action to support the strategy’s implementation and we are now running a consultation phase to gain wider feedback on the draft framework.
The next step is getting collaboration on co-producing its implementation plan – the Framework for Action. A consultation draft is available for comment. It reflects what consumers, healthcare providers and a range of organisations told us during last year’s consultation on the development of the National Digital Health Strategy, and has been developed with assistance from all the governments of Australia.
The draft Framework for Action and consultation form is available at https://frameworkforaction.digitalhealth.gov.au/. You will be able to provide your organisation’s submission in the feedback form until Friday 6 April 2018.
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A new study illustrates why the MBS bean-counters aren't keen on telehealth

9 March 2018

TECH TALK

Telehealth has been put through its paces in various studies over the past few years. Some say it’s more efficient than face-to-face consultations. Some say it’s not as good. Some say it’s suitable for certain patients but not others.
In Australia, however, all of these views end up falling at the same final hurdle — a lack of MBS funding. Without reimbursement, very few doctors will use the technology.
It’s up to the bean counters at the Medical Services Advisory Committee (MSAC) to decide what’s funded under the MBS. Next time the MSAC runs the numbers, it might look at an Australian study in Nutrition & Dietetics.
The research compares the costs of a 12-month, face-to-face dietitian-led weight-loss program against the same program conducted via telehealth.
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Blockchain in Heathcare – are standards needed?

Posted on March 8, 2018 by Grahame Grieve
Last weekend, in the lead in to HIMSS in Las Vegas, several of the FHIR team met with a number of block chain specialists, most particularly including David Huseby from the Hyperledger project at the Linux Foundation. We discussed various use cases for use of blockchain, with the intent of understanding what – if anything – HL7 should do to support blockchain adoption through the standards process. During an open and wide-ranging discussion, several of us came to the following consensus about the use of blockchain in healthcare (and we thank David greatly for his assistance).
Legal Assurance on Audit Trail
The first use case we recognised where blockchain has an obvious and appropriate usage is to provide strong legal assurance that an audit trail has not be tampered with. There’s all sorts of functions that a healthcare provider carries out where they may eventually be asked to provide evidence concerning past actions, and where there is a need to demonstrate that the audit trail has not been tampered with – and that includes against tampering by the system administrators themselves (that’s a very real concern – highly authorised insiders are the most likely attackers on the audit trail). If the audit trail is kept in electronic form, the only IT resource I know of that is proof against this level of attack is a distributed block chain where the system administrators don’t have total control of all the nodes.
-----

Queensland opposition blasts premier over AU$250m IT blowouts

State LNP Leader Deb Frecklington has called out the Queensland government for spending an additional AU$250 million on IT than budgeted for.
By Asha McLean | March 6, 2018 -- 04:17 GMT (15:17 AEDT) | Topic: Enterprise Software
Queensland opposition leader Deb Frecklington has accused Premier Annastacia Palaszczuk of overseeing "IT blowouts" totalling to more than a quarter of a billion dollars.
In a brief statement following her appearance in state parliament on Tuesday morning, Frecklington said the AU$250 million could have instead funded more than 2,300 nurses, 2,400 new police officers, or 3,620 fire-fighters.
"We could have built eight new schools, delivered more than 5,400 ice rehab beds, or funded swimming lessons at all Queensland schools for a generation of kids," she continued. "I won't let these budget blowouts happen on my watch."
In a video shared via social media, the Liberal National party leader said instead of properly managing projects, Palaszczuk is "taking money out of your pocket".
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Sharing the stories of the CIO50 2017: #1 Bill Le Blanc, SA Health

Why Bill Le Blanc was our number one CIO this year
George Nott (CIO) 05 March, 2018 10:10
The new Royal Adelaide Hospital (RAH) opened in September. At a cost of $2.3 billion, it is one of the most expensive buildings in the world
It is “without question” the most technologically advanced hospital in the country, says SA Health chief information officer and executive director of eHealth systems Bill Le Blanc.
The RAH is home to a huge robotic pharmacy distribution system (one of the biggest in Australia); more than 100 automated dispensing cabinets in patient wings to support the accurate and timely distribution of medicines; telehealth facilities for staff to consult with patients across the state, digital imaging technology which allows clinical images to be streamed live from operating theatres and procedural rooms for diagnostic and training purposes; and the largest automated microbiology system in the southern hemisphere.
The 800-bed facility will eventually provide care to an estimated 85,000 inpatients and 400,000 outpatients each year, is also the state’s only public hospital to roll out a digital instrument tracking system to manage its vast collection of medical equipment.
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Researcher behind emergency department software tool heralded by Queensland Health

Lynne Minion | 07 Mar 2018
Queensland Health is celebrating the achievements of women this week, including a researcher behind the software tool that is cutting emergency department waiting times and saving healthcare dollars.
Female researchers in the state are making new discoveries, creating new technologies and improving patient care, and to mark Queensland Women’s Week the government has acknowledged and thanked them in a statement, singling out Professor Julia Crilly for her work to develop the Emergency Department Patient Admission Prediction Tool.
Developed in a collaboration between Gold Coast Health, Griffith University and the CSIRO’s Australian eHealth Research Centre, ED PAPT allows hospitals to forecast how many patients will arrive seeking emergency care at any given time, their medical urgency and how many will need to be admitted to hospital.
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SafeScript

Victoria is much further progressed with implementation than any other mainland state and has thoroughly investigated what is required to implement a high performing system on a Victorian and national scale. A feasibility study commission by the Victorian Government revealed a better alternative to address the limitations of the Commonwealth software which in its current state will not meet the needs of clinicians, nor will its interface with clinical systems encourage high uptake. As a result, Victoria has made the decision to develop SafeScript, based on contemporary technology. It will source data from Prescription Exchange Services (PES) - technology that is already used in the majority of pharmacies and medical clinics to facilitate electronic transfer of prescriptions. This approach will have significant advantages. SafeScript will be high performing from the outset, and as it will be developed using modern cloud-based architecture, it will be scalable to an increasing volume of prescriptions.
By comparison, significant redevelopment work would have been necessary before the Tasmanian software could have supported Victoria's prescription volume, let alone at a national level. Most importantly, SafeScript will be designed around clinicians' needs and will offer a better user experience and cause minimal disruption to clinical workflow. Clinicians will receive pop - up notifications from their desktops within seconds after a prescription has been issued or dispensed which will prompt clinicians if a review of the records in SafeScript is necessary. The notification will also provide a direct link to the patient's record. The Commonwealth software does not provide these workflow features for clinicians.
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Journal Review: Watson for Oncology in Breast Cancer

March 9, 2018 – Enrico Coiera
How should we interpret research reporting the performance of #AI in clinical practice?
[This blog collects together in one place a twitter review published 9 March 2018 at https://twitter.com/EnricoCoiera/status/971886744101515265 ]
Today we are reading “Watson for Oncology and breast cancer treatment recommendations: agreement with an expert multidisciplinary tumor board” that has just appeared in the Annals of Oncology.
This paper studies the degree of agreement or “concordance” between Watson for Oncology (WFO) and an expert panel of clinicians on a ’tumor board’. It reports an impressive 93% concordance between human experts and WFO when recommending treatment for breast cancer.
Unfortunately the paper is not open access but you can read the abstract. I’d suggest reading the paper before you read further into this thread. My question to you: Do the paper’s methods allow us to have confidence in the impressive headline result?
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A new study illustrates why the MBS bean-counters aren't keen on telehealth

9 March 2018

TECH TALK

Telehealth has been put through its paces in various studies over the past few years. Some say it’s more efficient than face-to-face consultations. Some say it’s not as good. Some say it’s suitable for certain patients but not others.
In Australia, however, all of these views end up falling at the same final hurdle — a lack of MBS funding. Without reimbursement, very few doctors will use the technology.
It’s up to the bean counters at the Medical Services Advisory Committee (MSAC) to decide what’s funded under the MBS. Next time the MSAC runs the numbers, it might look at an Australian study in Nutrition & Dietetics.
The research compares the costs of a 12-month, face-to-face dietitian-led weight-loss program against the same program conducted via telehealth.
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Orion Health launches New Predictive Intelligence Using Machine Learning

Orion Health has launched a new machine learning service designed help the health sector reduce operating costs and improve patient care.
Led by research by Precision Driven Health (PDH), a New Zealand partnership between Orion Health, Auckland University and Waitemata District Health Board, the New Zealand-based Orion says it is exploring meaningful ways to minimise wastage in the healthcare sector and help clinicians make more accurate decisions at the point of care.
According to Orion, more than $6.5 trillion is spent on healthcare each year globally, yet typically between 20-40% of spend is wasted on unnecessary services and excess administration.
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Online exams: are the colleges doing it right?

Authored by Hugo Wilcken
FEBRUARY 19, 2018, was indeed a black day for hundreds of junior doctors taking the make-or-break Written Divisional Exam of the Royal Australasian College of Physicians (RACP). After months of study, while generally holding down demanding full-time jobs, and after stumping up the $1900 for the pleasure of sitting the exam, the candidates found themselves locked out of the computer-based testing system halfway through. The decision was taken to abort the exam, leaving many distraught and in tears.
The RACP has rescheduled the exam for two different dates and will be reimbursing candidates the full amount they paid to sit the exam. The computer system’s provider, Pearson VUE, is yet to report to the RACP on the reasons for the failure, except to say that it was due to human error.
The fiasco has put the spotlight on the rapid computerisation of assessment and examination by medical schools and colleges that has taken place over the past few years. What are the benefits and, more importantly in this case, what are the risks?
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'Creepy companions': What COPD patients make of carer robots

5 March 2018

TECH TALK

How would you feel about a robot following you around all day? Would you think it’s cute, a pet you don’t have to feed? Or would you worry that it’s going to turn on you in your sleep and start the anti-human revolution?
The i-Robi robot, a Korean invention, is basically a face, a TV screen and a robot vacuum bolted together, trundling around a bit like R2D2 from Star Wars.
Researchers from New Zealand have been testing the robots as an intervention for patients with COPD in a bid to increase adherence to medication and home rehabilitation, and to improve quality of life and reduce hospital readmissions.
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Seniors travel cards 'breach' privacy laws

Seniors travel cards in NSW have been found in breach of personal privacy laws after one passenger objected to having his identity and travel data linked.
Perry Duffin
Australian Associated Press March 7, 2018 7:00am
Travel cards issued to seniors, pensioners and war widows in NSW are breaching privacy laws by allowing travellers' movements to be tracked, a tribunal has ruled.
But Transport for NSW has not changed how it signs up seniors, arguing personal details are needed "to ensure only those entitled to the substantial benefits of concession fares can access the heavily reduced rate".
The NSW Civil and Administrative Tribunal ruled Gold Opal cards breached privacy laws after an unidentified senior argued the system could be used to link his identity to his travel on trains, light rail, buses and ferries.
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G Medical To Demonstrate Innovative Medical Monitoring Solutions At Himss 2018

Healthcare Information and Management Systems Society (HIMSS) – Las Vegas - Mobile and e-Health company G Medical Innovations Holdings Ltd (ASX: GMV) has announced it will be demonstrating its innovative medical monitoring solutions for the first time in North American at HIMSS 2018, which commences on March 5, 2018.  Demonstration of their integrated consumer and hospital grade monitoring devices marks an important milestone in the company’s planned expansion into the region throughout 2018.
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Hi-tech hearing aid can be adjusted online

  • The Australian
  • 12:00AM March 6, 2018

David Swan

A new piece of technology developed in Melbourne is being hailed as a breakthrough in hearing technology, allowing users to test their hearing and manage their personalised settings via a computer or smartphone with online technical and audiology support.
The Facett hearing aid is the result of collaboration between Blamey Saunders Hears, Extel Technologies, and RMIT and Swinburne Universities.
It allows users to upgrade old hardware without having to buy an entire new hearing aid.
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Lack of guarantees with NBN services puts consumers at risk: ACCAN

Australia’s peak advocacy group for communications consumers, the Australian Communications Consumer Action Network, has raised concerns that consumers currently do not have guarantees in relation to connection, reliability and repair timeframes for broadband with services through their retail service provider and the National Broadband Network (NBN).
According to ACCAN, consumers may have no choice in the network that services them as NBN is, in effect, a monopoly, and without guarantees their services are put at risk.
ACCAN’s concerns are raised in its submission to the Australian Competition and Consumer Commission (ACCC) inquiry into NBN wholesale service standards.
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5G sensor revolution is coming

  • The Australian
  • 12:00AM March 8, 2018

Chris Griffith

Welcome to the age of 5G cellular networks and sensors. It’s the magic combination that will change farming practices, transform infrastructure maintenance, enhance traffic-flow monitoring on highways, and more readily detect bushfires in national parks.
With high-speed 5G cellular phone networks rolling out next year, the biggest news is the parallel rollout of billions of small, affordable, connected sensors that will transform so many aspects of life.
These sensors typically are specialised: each gathers and reports just small amounts of information. The low-energy variety of these sensors use tiny amounts of energy and report their contents only intermittently, so their batteries can last five to 10 years. Yet their signals can penetrate asphalt in the road and increasingly buildings such as shopping centres.
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Major breakthrough in quantum computing quest

  • The Australian
  • 12:00AM March 8, 2018

Sian Powell

Scientists led by Australian of the Year Michelle Simmons have made a major breakthrough in the field of quantum computing: making two single-atom quantum bits, or “qubits”, talk to each other.
Published in the journal Nature Communications, the advance marks yet more progress by Professor Simmons’ team in the long march of quantum computing.
Centre of Excellence for Quantum Computation and Communication Technology director and Scientia Professor at the Univer­sity of NSW, Professor Simmons said the development was an ­important advance in the quest to develop a quantum computer.
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Enjoy!
David.

Sunday, March 11, 2018

The ADHA Framework For Action In Implementing Their Strategy From 2017. How Does It Stack Up?

The ADHA released a draft document last week and requested input by April 6, 2018.
Here is the request for a contribution.

Have your say on the Framework for Action

Australia's National Digital Health Strategy - Safe, Seamless and Secure - outlines a vision for 2022 focused on an evidence base of benefits prioritising national-level digital health activity which will result in:
  • Hospital admissions avoided
  • Fewer adverse drug events
  • Reduced duplication of medical tests
  • Better coordination of care for people with chronic and complex conditions, and
  • Better informed treatment decisions.
Achievement of the outcomes in the Strategy will depend on continued co-production with patients, consumers and carers – and the governments, healthcare professionals, organisations and industry innovators who serve them. That’s why the Agency is working closely with organisations representing these groups on the development of the Framework for Action – the implementation plan for delivery of the outcomes of the Strategy’s seven key priority areas.
The Framework for Action will outline the key activities prioritised for delivery between 2018 and 2022 that are necessary to implementing Safe, Seamless and Secure and realising the benefits of digitally enabled health and care. It will be a living document that is regularly updated to reflect the continuing progress on the Strategy’s outcomes. The purpose of the Framework for Action will be to:
  • Articulate the activities required to deliver on the Strategy’s outcomes, and the roles participants in the digital health eco-system will need to play in order to deliver them;
  • Promote collaboration and information sharing and provide a holistic view of the various investments and projects underway; and
  • Be a guide for organisations that are recalibrating their strategies or forward work programs to align to national strategic priorities.
Download Framework for Action Draft Consultation document here, and you will be able to provide your feedback to the survey form until Friday 6 April 2018.
Here is the link:
The direct link to the 43 page PowerPoint presentation is here:
What to say?
Basically, overall, this is an overly ambitious, mostly evidence-free and assertion rich, unfunded, grossly under detailed, timeline lacking, fantasy.
There is only one measure – and that is that things will apparently happen by 2022. There are no costs, milestones, evidence to justify investment and so on.
Unless there are 20-30 (or more) pages of detail, evidence, timelines, objectives and priority, staffing, risk assessment and a cost benefit analysis provided under each initiative we are essentially no further ahead, and I can really offer little comment. It maybe that such detail exists, but I doubt it. Right now we have a simply fantastic (in the real sense) marketing document without enough detail to make any realistic assessment of what can be funded, delivered and made useful.
If it intended that the Framework is to be useful, then the detail is vital. The scope, range and ambition of this 4 year plan is so grand as to mean lots of choices, sequencing and priorities will need to be considered, and decisions taken as to what should actually happen and be resourced and funded.
Right now we have a grandiose wish-list which will only obtain a modicum of credibility when associated with the necessary detail.
Even development of this detail may take till 2022! To me it is imperative that the detailed plans be developed as it is only with those done and costed can we get a proper appreciation of what is needed, what benefits will flow and whether there is evidence to support conduct of the project(s). Maybe we could then avoid the problems associated with the politically rushed and ultimately poorly executed myHR.
David.