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, April 12, 2018

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

April 12, 2018 Edition.
This has really gone past absurd with nonsense and posturing regarding trade with China and the US National Guard taking over the Mexican border. The man is a menace and I get the sense both Wall St and Amazon may be planning some actions to bring him back in control. And of course now he is planning a war with Russia etc.
This article shows some of the risks he is running.

China has the 'financial arsenic' to ruin the US - but will it use it?

By Ambrose Evans-Pritchard
7 April 2018 — 8:21am
China's leaders must be sorely tempted to activate the "nuclear option" and punish the capitalist running dog, the tango dancer in the White House.
They could at any time start to liquidate their $US1.2 trillion ($1.5 trillion) holdings of US Treasury debt, switching the proceeds into euro, sterling, krona, Aussie, or peso debt to stop the yuan exchange rate soaring.
Even a small dose of this financial arsenic would - in the minds of Beijing's ultra-nationalist faction - set off a salutary panic. It would crater the US bond market at the very moment when Donald Trump's fiscal depravity is driving the US budget deficit to a stratospheric $US1 trillion.
The contagion would spread instantly through US mortgages and consumer credit, and would detonate a Wall Street equity crash - the "Trump crash" in blood and gore.
In OZ we have lived through the nonsense of 30 losing NewsPolls so madness and incompetence of almost Trumpian levels continue and public frustration and anger continues to rise with the lost of them as far as I can see.
-----
Here are a few other things I have noticed.
-----

Major Issues.

  • Updated Mar 30 2018 at 3:06 AM

Big techs tech-induced change disrupts sector: Mohamed El-Erian

by Mohamed A. El-Erian
Big tech continues to dominate the news and has become a major driver of US stock markets. But the sector's dominant narrative has changed in the last few months. Amazement at the power of disruptive innovation to change not just what we do but also how we do it is now accompanied, if not tempered, by concerns about misuse and other unintended adverse consequences.
This has raised important questions about interventions by governments, companies' self-regulation, incentive alignments, corporate responsibility and financial prospects.
It is also an inherently fluid situation. Consider the following six issues:
-----

Tony Abbott is wrong about lots of things, but not immigration

By Tony Walker
1 April 2018 — 11:00pm
Just because Tony Abbott advocates a particular course of action doesn’t mean it’s wrong. Nor should his strange decision to launch a book by the anti-immigrant campaigner Pauline Hanson preclude reasonable consideration of his views on contentious issues of the day.
Former prime ministers are entitled to be heard, whether you agree with them or not.
What Abbott had to say in a recent address at the Sydney Institute about reducing immigration to enable the country to pause while an infrastructure deficit is overcome represents a reasonable response to an extraordinary level of community concern.
-----

The fundamental operating model of Australian politics is breaking down

By Lachlan Harris & Andrew Charlton
2 April 2018 — 11:51pm
Is there any Australian left who hasn’t complained, or at least rolled their eyes about the state of politics in Canberra? Most of us tend to blame the politicians for all this, but a new analysis of voter data suggests a less comfortable truth. The problem is not just them. It’s also us.
The fundamental operating model of Australian politics is breaking down. The data, from the Australian Election Study (AES), reveals the dramatic polarisation of Australian politics over the last two decades. In 1996 more than one in three Australian politicians (37 per cent) rated themselves as “moderate” – that is, centre-left Liberal and centre-right Labor politicians. This share has shrunk dramatically. At the most recent federal election in 2016 only one in 10 politicians described themselves as moderate.
The AES looks at long-term trends in federal elections. It is a massive source of data, with more than 100 questions put to thousands of voters and hundreds of candidates at every election since 1987. The survey, run by the Australian National University’s School of Politics and International Relations lifts the lid on many of the deep issues in our political system that can’t be seen in fortnightly polls or snap surveys.
-----

How to survive the next crash

  • Percy Allan
  • The Australian
  • 12:00AM April 3, 2018
For any investor traumatised by the 2007-09 financial meltdown this should be front of mind for 2018-19. Why? Because the US stockmarket, which accounts for over half the global market, is more overvalued than at any time in its 147-year history other than the dotcom bubble of 1999.
To restore fair value to its adjusted price-earnings ratio, the S&P 500 index would need to fall by 50 per cent, but the drop could be as much as 70 per cent if it overshoots on the downside.
On average the US sharemarket has crashed every 3.4 years. It’s now been nine years since the end of the last crash so another one is well overdue. By a “crash” is meant a fall of 20 per cent from the index’s peak to its trough. The 10.2 per cent fall of the SPY index between January 26 and February 8 earlier this year was not a crash, but a mild “correction”. Any slip below 10 per cent is just a “pullback”.
-----
  • Updated Apr 2 2018 at 11:00 PM

Global trade war would be worse than 2009 global recession: KPMG

A global trade war would be worse than many imagine, tipping much of Europe, the UK and Canada into recession and costing as many as 285,000 Australian jobs in an economic shock likely to last longer than the global financial crisis.
Even a modest barrage of retaliatory measures against the Trump administration by target countries such as China would see Australia's economy shrink as trade flows are squeezed and global demand is suppressed, according to economic trade modelling by KPMG.
A more dramatic round of tit-for-tat actions that would raise tariffs on goods by an average of 10 percentage points would trigger a 1 per cent fall in Australian gross domestic product and wipe out more than half the employment gain of the past 12 months, the firm found.
-----

A new coal-fired power plant would cost $3 billion, drive up energy prices and take eight years to build

By Nicole Hasham
3 April 2018 — 5:41pm
The impact on the grid from AGL’s plan to shut down Liddell in 2022 has drawn a group of conservative MPs to on push the government to keep it open.
A backbench push for a new taxpayer-funded coal fired power station has been derided as "ludicrous" by energy analysts who believe it would cost at least $3 billion, drive up energy prices and take eight years to build.
The plan, led by a group of conservative MPs including Tony Abbott, Eric Abetz and Kevin Andrews, emerged as Commonwealth and state energy ministers prepare for a new round of negotiations in late April over the Turnbull government's signature energy policy, the National Energy Guarantee.
-----

RBA cash rate steady with no end in sight

By Peter Martin
Updated 3 April 2018 — 2:31pm first published at 2:30pm
The Reserve Bank has kept its cash rate on hold for a record 20 consecutive months, giving no clues as to when it will move, amid talk of another 20 to come.
The cash rate was last cut in August 2016. Tuesday’s decision to keep it at 1.5 per cent marks the twentieth consecutive month it has been steady, eclipsing the previous record of 19 months set when the rate was held at 7.5 per cent between December 1994 and July 1996 rather that cut as the government wanted as the economy recovered from the early 1990s recession.
The statement released by Reserve Bank Governor Philip Lowe after Tuesday’s meeting provides few clues as to when it will move.
-----

Australia is richer but meaner than ever

By Matt Wade
3 April 2018 — 9:59pm
How Australia has changed. Back in 1995, as the economy recovered from the deep recession earlier that decade, we reached a ranking of 9th on the international league table of overseas aid donors measured by the share of gross national income devoted to overseas development assistance.
That year Australia contributed 34 cents for every $100 dollars of national income to help poorer nations.
Now, after more than a quarter of a century of uninterrupted growth, we’ve slipped to 17th place on that donor ladder.
-----
  • Apr 4 2018 at 11:55 AM

Scott Morrison blasts coal rebels, says new coal power twice as expensive

Treasurer Scott Morrison has blasted a call by Coalition MPs for the government to build a coal-fired power station, saying it would not provide cheap electricity as claimed, but power that could be twice as expensive.
With a ginger group of Liberal and Nationals MPs called the Monash Forum demanding the government invest up to $4 billion to build a High Efficiency, Low Emissions (HELE) coal-fired plant in Victoria, Mr Morrison said such a project would take many years to build and the electricity it produced would be far more expensive than that being generated by existing coal-fired power stations.
"There's a difference between old coal and new coal. Old coal bids into the energy grid at about $30 a megawatt hour, it could be up to $40,' he told The Australian Financial Review Banking & Wealth Summit.
-----

Could Costello save the Coalition in 2019?

By Imre Salusinszky
4 April 2018 — 7:45pm
On election night in 2007, as John Howard stood up in Sydney's Wentworth Hotel conceding the defeat of his government and the loss of his seat, there was obvious disappointment among the Liberal Party faithful. But there was no sense of panic or shock.
For 11 years, Australia had been served by one prime minister, and one treasurer. For all the friction between them, Howard and Peter Costello had delivered political and economic stability through tumultuous times. The party was in sound health, knew what it stood for, and was well placed to regroup quickly. Howard kick-started that process at the Wentworth by anointing Costello as his successor.
The shock and panic came the following day, in Melbourne, when Costello announced he was exiting politics to spend more time with his family and pursue business opportunities. But, just over a decade later, could a comeback be on the cards?
-----

Political paralysis will cost us all, warns business

By David Crowe
4 April 2018 — 6:43pm
Australians are being warned of a growing cost to economic growth from the repeated failure of their politicians to fix chronic policy problems, as a key business group calls on all sides to “lift their game” before the next federal election.
The nation’s top company directors are blaming “political wrangling” and “turmoil” in parliament for the drift in national policy, saying Australia was falling behind its global peers.
In an analysis to be issued on Thursday, the Australian Institute of Company Directors calls for changes including a mammoth infrastructure deal with the states and sweeping federal tax reform to give the nation a boost.
-----

Australian financial advisers move to cash for their clients

  • The Australian
  • 5:24PM April 4, 2018

James Kirby

Australian financial advisers swung away from recommending share market investments in the wake of the recent sharp correction on global equity markets, says a new report which claims a unique view of adviser trends.
As share markets remain unsteady with overshadowing fears of both a trade war and higher inflation, advisers oversaw ‘a dash to cash’ across February, according to the report from Lonsec Connect.
While the move towards cash in the first quarter could be expected in the wake of any market correction, the longer term trends identified by the report also reveals a deeper shift away from share market investments
-----
  • Updated Apr 5 2018 at 4:59 PM

The big problem with 50-year-old coal plants

One of the biggest challenges running a coal power station like AGL Energy's Liddell power station beyond its standard lifetime of 50 years is to avoid killing people.
AGL has already spent about $150 million trying to ensure Liddell runs as reliably and efficiently as an ageing plant can since buying it from the NSW government several years ago.
But Liddell has still suffered frequent outages – including a critical one during the heatwave in February last year when NSW ran short of power and AGL had to switch off Tomago Aluminium's potlines at great risk to the operation.
-----

Populist drum beats, wrong numbers drive our migration debate

By Michael Pascoe
6 April 2018 — 12:15am
As the populist drums beat louder for cutting Australian immigration, the numbers used to attack the program get ropier, ranging from questionable statistical concepts and oversights to the simply inane.
In the former category, we’re arguably overstating annual net overseas migration (NOM) by about 20 per cent.
In the latter, there’s Dick Smith’s “Do any of us really want to live in a city of eight million people?” question. Self-evidently, eight million people would, just as five million want to live in Sydney now, 14 million want to live in London and 20 million want to live in New York.
-----

Not for sale: AGL's Andy Vesey defies Malcolm Turnbull

By Peter Hannam
5 April 2018 — 11:54pm
AGL will defy pressure by the Turnbull government to sell its ageing Liddell power plant, warning that interference in the market would raise issues of ‘‘sovereign risk’’ that could deter investment in new energy assets.
In a rare interview, chief executive Andy Vesey told Fairfax Media the much-publicised interest in AGL’s Hunter Valley coal-fired power station from smaller rival Alinta had been limited to a phone call on Tuesday evening from Alinta chief Jeff Dimery and a follow-up email on Wednesday.
Mr Vesey said his rival had indicated in the email a ‘‘desire to engage in a potential acquisition” of Liddell and asked about the purchase process.
-----

Ideas matter more than money in politics

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

Adam Creighton

Every time a new policy idea is announced politicians and media seize on the “losers” — how many dollars different types of households will lose from the change.
We might learn how Betty, 63, from Frenchs Forrest, NSW, is furious about losing $880 in refundable franking credits. “This is outrageous; I worked hard,” she says. Or perhaps there’s Rebecca, a single mum with 3 kids in Frankston, Victoria, incensed at slower indexation of family tax benefits, which could see her lose $31 a fortnight in two years. “It’s bloody disgusting,” she says.
Highlighting losers is easy and understandable, but their relentless profiling fuels the perception that households vote strictly in their economic interest. They don’t; ideas seem to matter more.
-----

Dark matter clue was a false dawn

  • Tom Whipple
  • The Times
  • 10:00AM April 6, 2018
Dark matter just got a little bit darker. The mysterious substance that makes up the majority of the matter in the universe but cannot be seen by telescopes turns out to be even more mysterious than we believed after a key insight about its properties was found to have been a calculation error.
An estimated 80 per cent of the matter in the universe is dark matter. The substance is so named because it does not reflect light at all and can pass straight through normal matter. Its presence is apparent only in its gravitational effects.
However, in 2015 astronomers from Durham University made what appeared to be a sensational discovery. By looking at a galaxy 1.3 billion light years away and measuring the effects of its gravity on passing light, they seemed to find that the dark matter had been stripped away and separated.
-----

Fascism 'goes unnoticed until it's too late': Albright sounds dire warning on Trump

By Nick O'Malley
6 April 2018 — 12:06pm
If there is anything approaching a universal truth in online debate it is the acceptance of Godwin’s Law, which asserts that if any argument goes on long enough someone will eventually raise a comparison to Hitler, at which point they have lost their debate.
Godwin’s Law was first described by the author and lawyer Mike Godwin in the internet’s dark age, 1990. This, some will remember, was a happier time. The Berlin Wall had fallen and the Cold War was ending. Americans would soon be discussing the “peace dividend” to be enjoyed as funds once spent on weapons were redeployed to the public good. In his book The End of History, Francis Fukuyama would soon argue that the success of liberal Western Democracy might even signal an end to human socio-cultural evolution.
Such optimism seems almost impossible from today’s perspective, when it is commonplace for even the most sober analysts to wrestle in their writing with the rise of authoritarianism across the world.
-----
  • Updated Apr 7 2018 at 3:54 AM

Fed chair Jerome Powell holds fast to gradual rate hike path

by Craig Torres and Matthew Boesler
Federal Reserve chairman Jerome Powell said the outlook for inflation and the US labour market support further gradual interest-rate increases while the lack of a spike in wage gains shows the labour market is "not excessively tight".
"We will continue to aim for 2 per cent inflation and for a sustained economic expansion with a strong labour market," Powell said Friday in his first speech since becoming chairman in February. "As long as the economy continues broadly on its current path, further gradual increases in the federal funds rate will best promote these goals," he told The Economic Club of Chicago.
Powell's comments hewed closely to remarks he made to reporters last month that emphasised the stronger US economic outlook after the Fed raised interest rates and signalled at least two more moves in 2018.
-----
  • Updated Apr 7 2018 at 12:15 AM

Bad news in markets keeps investors wary and hurts shares

Feeling gloomy about investment markets? Join the club. An endless parade of bad news is keeping investors wary and hurting shares, but solid underlying fundamentals will likely win out in the end.
The market is caught between narratives and numbers. The former won't let stocks make a material turn for the better, while the latter puts a floor under the losses.
It's what keeps corrections from turning into bear markets, but makes investors hesitant to buy the dip.
-----

The trade stand-off that could shake the world

By Kirsty Needham
Updated 6 April 2018 — 3:29pm first published at 3:28pm
Beijing: It is no trade secret that visiting executives of major Australian companies operating in China leave the office smartphone and laptop behind when boarding the plane for Beijing.
Such is the risk of cyber theft of intellectual property by rivals in China, the precaution is routine.
There is nothing in the findings of the US trade representative Robert Lighthizer's investigation into Chinese intellectual property theft, and the forced transfer of US technology, that would surprise international business chambers.
-----

Big tech's ability to get inside our heads is a challenge we must address

By Simon McCarthy-Jones & Susie Alegre
5 April 2018 — 4:42pm
The news that 311,127 people in Australia may have been caught up in the Cambridge Analytica scandal and had their Facebook information “improperly shared” with the data analytics company illustrates the reach of one of the greatest ethical challenges facing our generation; the potential of tech companies to deploy their expertise to influence users’ thoughts, feelings and behaviours. And to use this to influence our elections.
Such activities threaten our right to freedom of thought and democracy itself.
Tech has an ever increasing ability to get inside our heads and work out what we are thinking. In 2015, researchers reported that access to a user’s Facebook footprint allowed them more insight into that person's personality than their close friends and family. This basic approach was used by Cambridge Analytica when it accessed millions of Facebook profiles and used them to target people with personalised political advertisements.
-----

Monash Forum: Coal-fired foolishness not enough to dislodge Malcolm Turnbull

  • The Australian
  • 12:00AM April 7, 2018

Peter Van Onselen

Two peas in a pod: the Greens and the reactionary conservatives in the Liberal Party. Both called for more government intervention this week.
Greens leader Richard Di Natale did so in a National Press Club address on Wednesday. He wants a universal basic income (Thomas Pik­etty style) and a people’s bank to be run by the Reserve Bank. In fairness, though, the Greens don’t hide their support for big government behind a party name with the word liberal in it.
The Coalition delcons have formed an inappropriately named club, the Monash Forum, to push for a government-owned coal-fired power station. Fancy being so self-important as to name your group after a distinguished World War I general. Sir John Monash wasn’t even a sniper.
-----

National Budget Issues.

What would Jesus do about tax and government spending?

By ROSS GITTINS
1 April 2018 — 8:33pm
It’s Easter, so let me ask you an odd question: have you noticed how arguments about governments’ intervention in the economy – should they, or shouldn’t they – often rely on an appeal to Christ’s parable of the Good Samaritan?
No, me neither. Until I read a little book called, The Political Samaritan: How Power Hijacked a Parable, by Nick Spencer, of the British religion-and-society think tank, Theos.
This is my take on what I read.
Polling in 2015 by the British Bible Society found that 70 per cent of respondents claimed to have read or heard the parable, but in case you missed that day at Sunday school, I’ll summarise.
-----

Ken Henry says spending surge makes talk of tax cuts absurd

  • The Australian
  • 12:00AM April 2, 2018

Adam Creighton

Former Treasury secretary Ken Henry has slammed the emerging bidding war between the Turnbull government and Labor to cut taxes as “theatrically absurd” given the rising tide of public spending baked into the budget.
A few weeks after dismissing the increasingly fractious tax ­debate as “a small set of very narrowly cast propositions”, Dr Henry, speaking to The Australian, took aim at a lack of transparency about the growth of public spending, arguing taxes would need to rise, rather than fall, unless spending was reined in.
Dr Henry, who served as ­Treasury secretary from 2001 to 2011, said he was “amazed that the ­issues we observed in 2009 ­remained completely unaddressed”, referring to the tax ­system’s inability to meet future spending needs, as laid out in his eponymous 2009 tax review.
-----

Labor now sees the frugal as today’s class enemy

  • The Australian
  • 12:00AM April 3, 2018

Nick Cater

Labor may yet regret its return to class war politics. Separating the needy from the greedy in a complex, middle-class economy like ours is less easy than it might seem.
It was hard enough for Vladimir Lenin to pick off class enemies in Tsarist Russia after the emancipation of the serfs that blurred the line between peasants and kulaks. Fortunately, he did not have to face an election, unlike Bill Shorten, who cannot solve his problems by transporting disappointed voters to Siberia.
History, it seems, has nothing to teach us any more, so let us turn instead to Labor’s challenge of seeking a mandate to govern using the language of class war.
The negative reaction to Labor’s plan to end franking credits on dividends paid by Australian companies illustrates Shorten’s difficulty in pitting the asset poor against the asset rich.
-----

Morrison's dilemma: Awash with money, but not enough

By Peter Martin
4 April 2018 — 7:34pm
Just quietly, the budget is in an excellent position to deliver tax cuts. A year ago, it wouldn’t have been thought possible. Certainly the Treasurer Scott Morrison didn’t think it was possible. He used the May budget to announce a tax increase (a hike in the Medicare Levy) without which he wouldn’t have been able to credibly continue to promise a surplus by the end of the decade.
His budget pencilled in a wafer-thin surplus of $7.4 billion in 2020-21. Without the Medicare levy increase, it would have been even less: a "rounding error" surplus of $3.15 billion, a mere fraction of a per cent of GDP.
Since then, money’s been rolling in. At first in a trickle (the December budget update lifted the 2017-18 revenue estimate $3.6 billion) and then a flood. By the end of February the government had taken in $5.5 billion more than it had expected in predictions made just three months earlier.
-----

GST carve-up: Winners and losers announced by Scott Morrison

  • The Australian
  • 3:27PM April 5, 2018

Rachel Baxendale

Treasurer Scott Morrison has hailed a more than 5 per cent increase in the GST pool as the product of integrity measures introduced by the government, while pledging to revise the funding formula ahead of the next election.
Victoria and Western Australia received big boosts in the Commonwealth Grants Commission’s $65.8bn GST carve-up, announced by Mr Morrison this afternoon, with Queensland losing out.
But pressure remains for WA to get a greater share, after it received only 4.9 per cent of the carve-up, despite having 10.9 per cent of the Australian population.
-----

Health Budget Issues.

Labor alleges health insurance ‘cover-up’

  • The Australian
  • 12:17PM April 1, 2018

Rachel Baxendale

Health insurance premiums rose today by an average of 3.95 per cent amid the revelation that tens of thousands of Australians have policies which do not comply with the law, prompting Labor to accuse the Turnbull government of a “cover-up”.
As The Australian revealed on Thursday, members of health insurance funds will need legal protection from unexpected tax debts after an extraordinary 11-year misinterpretation of insurance rules.
Twelve insurers are offering benefit restrictions which include waiting periods made illegal when Tony Abbott was health minister in 2007.
-----

Your health insurance just got more expensive

By Lisa Martin and Kaitlyn Offer
1 April 2018 — 3:25pm
The cost of private health insurance is rising again, but a trip to the chemist will be cheaper for patients with high blood pressure, diabetes, depression, cancer, arthritis or asthma.
Insurance premiums are rising by close to four per cent from Sunday, which will result in Australians paying $200 a year more for their cover.
Health Minister Greg Hunt insists the 3.95 per cent premium rise is the lowest government-approved hike since 2001.
-----

Battle looms over rebates as Labor eyes changes to private health insurance

By David Crowe
2 April 2018 — 5:38pm
Labor has sparked a political fight over the private health insurance rebate claimed by millions of Australians, refusing to rule out changing the policy after declaring it will “look at” the scheme if it takes power at the next election.
The new signal puts families on notice to watch for changes to the $6.4 billion annual assistance under a Labor government, amid calls to scale back the rebate to boost the budget bottom line.
The new remarks triggered “great concern” among the private health insurance industry, which is calling on Labor to outline a “Plan B” for households and insurers if the rebate is scaled back.
-----

Labor clarifies insurance rebate plans

Labor's health spokeswoman Catherine King now says the opposition is not considering any changes to the private health insurance rebate.
Jennifer Jennings
Australian Associated Press April 3, 20188:45am
Labor's health spokeswoman now says her party isn't considering changes to the private health insurance rebate, despite earlier confusion.
Catherine King refused to rule out changes to the 30 per cent rebate when asked in a media interview on Monday.
Questioned if the party was open to looking at changes to the rebate if recommended by its own proposed Productivity Commission inquiry into the system, Ms King told Sky News: "Let's wait and see."
-----

‘Profits before patients’ in aged care

  • The Australian
  • 12:00AM April 3, 2018

Rick Morton

The billion-dollar aged-care company Regis Healthcare is one of the most frequent users of a legal grey area where residents are “dumped” in hospital emergency departments for basic care, saving providers significant money in a move that has become part of their “business model”.
At one Regis Healthcare centre in Brisbane, almost one resident a week since the start of the year has been transferred to a state hospital for minor catheter and wound management, both of which are common care requirements for which nursing homes receive federal government funds.
Three senior medical sources at The Prince Charles Hospital, a major teaching hospital in Brisbane, have declared the flow of residents from the nearby Sandgate aged-care home “extraordinary” and “unnecessary”.
-----

GPs in the crosshairs as the Productivity Commission strikes again

Its latest report is remarkably short on evidence despite being 500 pages long
29th March 2018

ANALYSIS

The Productivity Commission’s brand probably hasn’t reached the heights of, say, Beyoncé or Kim Kardashian.
But it has a generous, taxpayer-funded budget in line with the incomes of modern-day celebrities and its pronouncements on ways to bring efficiencies to the Australian economy has apparently resulted in an excitable fan base in Canberra.
For the past couple of years, the commission has had the last bastions of the closed shop — medical specialists — in its crosshairs to ensure patients get the best deal for their health dollars.
-----

Big pharma under fire for spruiking strong painkillers to doctors

By Aisha Dow
4 April 2018 — 12:01am
Drug companies have come under fire for allegedly using a crackdown on codeine sales as an opportunity to market stronger painkillers to doctors.
Since February, pharmacists have been banned from offering weaker codeine tablets such as Nurofen Plus over the counter, with the medication now available only via a doctor’s prescription.
One of the concerns about the change was that doctors could end up prescribing even stronger medication to pain sufferers.
-----

Patients grappling with $10,000 out-of-pocket medical bills, survey reveals

By Esther Han
5 April 2018 — 12:01am

In numbers

·         Survey respondents treated for breast cancer who incurred out of pocket costs of more than $10,000 27%
·         Survey respondents with autoimmune conditions who incurred out of pocket costs of more than $10,000 38%
·         Number of CHF survey partcipants 1200
For 30 years, Tracey Barnett and her husband Jim have paid thousands of dollars each year for top-level health cover to ensure complete peace of mind in times of need.
Three years ago she was diagnosed with breast cancer, and while she's grateful for fast access to treatments, "awesome" medical staff and private rooms, Ms Barnett is shocked the out-of-pocket expenses have added up to $14,000. She had to dip into her superannuation.
-----
  • Updated Apr 4 2018 at 3:11 PM

Study takes a hard look at where older doctors are falling short

Just like the rest of the population, doctors are vulnerable to the vagaries of ageing and now a new Australian study has provided strong evidence for their professional competence to be routinely tested from the age of 70.
This study, thought to be the largest of its kind in the world, has taken a hard look at where older doctors are falling short.
It looked at complaints made against all doctors across the country over a four-year period.
-----

Call for action over $10k out-of-pocket hit for cancer patients

  • The Australian
  • 12:00AM April 5, 2018

Greg Brown

Health Minister Greg Hunt has been urged to back Labor’s proposal for a Productivity Commission investigation into the private health sector “crisis” after a survey revealed a quarter of breast cancer patients experienced out-of-pocket costs of more than $10,000 despite being covered by health insurance.
The survey of 1200 people by Consumers Health Forum of Australia found more than a third of people with chronic conditions such as multiple sclerosis also reported out-of-pocket costs of more than $10,000.
An accompanying report ­argued an independent investigation was needed.
-----

Labor pushed to explain rebate cut on ‘junk’ policies

  • The Australian
  • 12:00AM April 5, 2018

Sarah-Jane Tasker

Australia’s health insurers have called on the Labor Party to reveal what effect its plan to remove the rebate on “junk” policies will have on low income earners.
Private Healthcare Australia chief executive Rachel David has said Labor must explain the changes it would make to the private health insurance rebate after creating confusion on its plans for the sector.
Opposition health spokeswoman Catherine King earlier this week refused to rule out further changes to the rebate, but the Labor Party later issued a ­clarification, saying there would be no changes in addition to what it had already announced on the issue.
-----

The alternative to private health insurance proposed by dentists

By Georgina Dent
5 April 2018 — 5:21pm
If you are among the 13 million Australians with private health insurance as of Easter Sunday - April Fool’s Day as it was – you are paying more each month for the pleasure. Private health insurers were entitled to lift their premiums by an average of 3.95 per cent from April 1. While this constitutes the lowest change in annual premiums in nearly two decades (yes, really), it will cost the average single Australian an extra $73 a year and $143 a year for families. Considering wage growth and inflation rose by roughly 2 per cent last year, premiums rising by almost 4 per cent is steep.
In approving the price hike earlier this year, the federal health minister Greg Hunt flagged that delivering the lowest annual premium change in 17 years was proof the Turnbull government is taking the pressure off private health insurance. But the minister conceded there was plenty more work to do to ensure private health cover is affordable and provides value for money.
He was not wrong. Australian consumers are increasingly conscious of the price they’re paying for private health insurance, which is why many policy holders are downgrading their cover. For many policy holders it means they’re paying the same, or more, to be covered for less.
-----

Feds still owe $700m to hospitals: Qld

Canberra will pay more than $300 million in backdated funding for Queensland's hospitals. (AAP)
The federal government will pay $300 million in backdated funding for Queensland's hospitals, but the state's health minister says $700 million is still owing.
Updated April 6, 2018
Queensland will receive more than $300 million in backdated hospital funding, although the state government says Canberra still owes it $700 million.
The Turnbull government has agreed to pay $309.2 million in back pay for 2014-16, sweetening the deal for Queensland to sign on to the new federal hospital funding plan.
-----

Questionnaire to shape Labor policy on private health

  • The Australian
  • 12:00AM April 7, 2018

Rick Morton

Bill Shorten lashed out at a ­“culture of hate” within the ­Coalition as he laid the groundwork for an overhaul of the ­private health insurance system by going directly to voters with a ­national survey.
The Opposition Leader yesterday ­announced a private health questionnaire would inform Labor policy, leaving the door open to more changes in addition to a 2 per cent cap on premium rises for the first two years of a Shorten government.
“We will defend the system, but what we won’t do is write a blank cheque of taxpayer money and not get something back in ­return for consumers,” he said. “It should be the consumers who run our health insurance system, not the big end of town.”
-----

International Issues.

  • Updated Apr 1 2018 at 9:45 AM

'Tired of the wait game': Donald Trump is calling his own shots

by Philip Rucker and Robert Costa
President Donald Trump began the past workweek cutting into steaks at the White House residence on Monday night with his political soldiers, including former advisers Corey Lewandowski and David Bossie, strategist Brad Parscale, and son-in-law and senior adviser Jared Kushner.
He ended it dining on the gilded patio of his Mar-a-Lago estate with eccentric boxing promoter Don King, who said he vented to the president about the Stormy Daniels saga. "It's just utterly ridiculous," King said he told a nodding Trump on Thursday evening as the president began his holiday weekend in Palm Beach.
Nowhere to be seen was John Kelly, the beleaguered White House chief of staff and overall disciplinarian - nor were the handful of advisers regarded as moderating forces eager to restrain the president from acting impulsively, who have resigned or been fired.
-----

'High degree of caution': Australians in Russia warned of harassment

By Adam Gartrell
1 April 2018 — 3:58pm
Australians in Russia have been warned to brace for harassment and a rise in anti-Western sentiment amid worsening political and diplomatic tensions.
The Department of Foreign Affairs and Trade issued new travel advice for Russia on Sunday amid the ongoing global fallout from the assassination attempt in the UK of double agent Sergei Skripal and his daughter Yulia.
The Turnbull government last week expelled from Australia two Russian diplomats suspected of being spies as part of a coordinated Western response. Russia has retaliated by expelling Western diplomats, including two Australians.
-----

China hits back with new tariffs on US meat, fruit, other products

2 April 2018 — 8:37am
Beijing: China said it is imposing new tariffs on meat, fruit and other products from the United States as retaliation against taxes approved by US President Donald Trump on imported steel and aluminum.
The Chinese finance ministry said in a statement that the new tariffs would begin this Monday. The announcement follows warnings Chinese officials have made for several weeks in an escalating trade dispute between the world's two largest economies.
China's Customs Tariff Commission is increasing the tariff rate on pork products and aluminum scrap by 25 per cent. It's also imposing a new 15 per cent tariff on 120 other imported US commodities, from almonds to apples and berries.
-----

Trump Twitter storm: no deal on 'dreamers', lashes Mexico on border

By Philip Rucker
2 April 2018 — 5:52am
Palm Beach: President Donald Trump has said  there will be no deal to legalise the status of millions of "dreamers", undocumented immigrants brought to the United States as children, stating that the US border with Mexico was "getting more dangerous" and directing congressional Republicans to pass tough new anti-immigration legislation.
Trump also criticised Mexican authorities as being too lax about border security, saying the US-Mexico border was "getting more dangerous". He threatened to "stop" the North American Free Trade Agreement if Mexico does not "stop the big drug and people flows".
President Donald Trump said Mexico needed to help the US stop people from flowing through the US-Mexico border and he also said in a tweet that the DACA deal was off.
-----

Australia's united response to Russia puts US, UK to shame

By Peter Hartcher
2 April 2018 — 8:49pm
Vladimir Putin was hosting a summit of the G20 nations in St Petersburg and Australia's leader decided he'd have to pull out. So Kevin Rudd, then prime minister, phoned Putin to apologise.
Rudd had just called the 2013 federal election and the dates clashed. He'd need to stay home to campaign, he explained to the Russian President. After chatting, Putin suggested that Australia and Russia should deepen their cooperation. "We have no fundamental contradictions between our countries," he told Rudd.
Rudd replied that he'd be delighted, and that the countries had a number of areas where they could cooperate, including the shared annual forums of the East Asia Summit and the G20 itself. But then came the kicker: "Mr President, the reason Australia and Russia have gotten along so well and have no fundamental contradictions is that we've hardly had anything to do with each other for the last 70 years," said Rudd. Putin's response to this undeniable truth was a belly laugh.
-----

US TV giant under siege over Trump-related 'fake news' message

A news 'promo' which aimed to cultivate distrust of the broader media has exposed the political bias of one of America's largest local TV station owners.

By Michael Idato
2 April 2018 — 2:53pm
The script was simple enough in its message: "Some members of the national media are using their platforms to push their own personal bias and agenda."
The problem is the script, sent by the US television company Sinclair Broadcast Group to almost 200 local television station newsrooms under its control, came with a corporate directive to broadcast the message as written.
A video clip editing those individual voices into a disturbing chorus of corporate compliance, has exposed Sinclair as an architect of the sort of journalistic laziness it claimed it was opposing.
-----

No room in the Skripal saga for alternative theories

By Monica Attard
2 April 2018 — 12:05am
As is the way of Cold War protagonists, Britain is weighing up whether to give Russia consular access to Yulia Skripal, the daughter of Russian double agent, Sergei Skripal. It is a tiny step forward in an otherwise unedifying display of politics trumping common sense.
Since the poisoning of the Skripals in Salisbury several weeks ago, the rebirthing of Cold War paranoia and hostility has ramped up daily. Western nations, including Australia, evicted Russian diplomats, alleged to be spying for their motherland. This was quickly followed by predictable tit-for-tat action from Moscow.
There seems to be no room in this scenario for some basic forensic questions to be answered: why would Moscow have shot itself in the foot by attempting to assassinate someone previously in its custody and his daughter, at a time when it wants Western sanctions to be lifted? Who stood to win from such a brazen act?
-----
  • Apr 4 2018 at 9:43 AM

The Chinese economy is rebalancing, at last

Consumption is at last becoming the most important driver of demand in the Chinese economy. This is a long-awaited and desirable adjustment. It promises to shift China away from its excessive reliance on inefficient, debt-fuelled investment.
But it still has a long way to go. As the shift is being completed, the country will need to manage an overhang of bad debt. But the adjustment has begun.
In 2007, premier Wen Jiabao argued rightly that "the biggest problem with China's economy is that the growth is unstable, unbalanced, uncoordinated and unsustainable".
-----

Donald Trump seeks Syria pullout as advisers warn on Islamic State

4 April 2018 — 6:10am
Washington: US President Donald Trump said on Tuesday he wanted to "get out" of Syria and promised decisions soon, even as his advisers warned of the hard work ahead to defeat Islamic State and stabilise areas recaptured from the militant group.
Trump's remarks suggested he believed that the US military-backed campaign against Islamic State in Syria was close to being complete. The Pentagon and State Department, however, have suggested a much longer-term effort is necessary.
President Donald Trump has announced that he is considering pulling US troops out of Syria, and will make a decision soon about reducing support in the war-battered country.
-----

Radar boffins debunk Russia's 'invisible missile' MH17 claim

By Nick Miller
3 April 2018 — 11:41pm
Radar boffins have debunked the 'invisible missile' theory that Russia used in an attempt to discredit the investigation into the crash of Malaysia Airlines flight MH17, in which 38 Australians died.
Russia had claimed “irrefutable” raw radar data showed no missile was fired at the flight from the area that Western investigators including Australian federal police had established - a part of eastern Ukraine under the control of Russia-backed rebels.
But independent aviation experts said the radar data proved no such thing: and Russia may even have manipulated the data to hide its tracks.
-----
  • Apr 4 2018 at 11:07 AM

US-China trade fight escalates over tariffs

Trump to unveil China tariffs this week
Tit-for-tat trade penalties have escalated between the world's two largest economies as they inch closer to the brink of a damaging international economic conflict.
The Trump administration on Wednesday "proposed" 1300 Chinese items chiefly in the advanced technology and heavy industry sectors to be slugged by US tariffs that will target $US50 billion ($65 billion) of goods.
In a bid to pressure the US president to rethink his mooted trade sanctions after Beijing expressed hopes to resolve tensions peacefully, China's Commerce Ministry warned it would take "equivalent" measures on US goods at the same scale.
-----

'Risk and uncertainty': JPMorgan chief warns US-China trade war will shake global economy

By Hugh Son
6 April 2018 — 6:30am
JPMorgan Chase & Co. chief Jamie Dimon said the US has legitimate grievances with China on trade, but that "anything that starts to resemble a trade war" will pour risk and uncertainty into the global economic system.
China has increased tariffs by up to 25 percent on 128 US products, from frozen pork and wine to certain fruits and nuts, escalating a spat between the world’s biggest economies in response to US duties on imports of aluminium and steel.
As tensions escalate between the nations, set off by US President Donald Trump's move to levy tariffs on Chinese goods, Dimon laid out his prescription for solving the debacle in a letter to shareholders Thursday.
-----

Iran, Russia and Turkey isolate US in planning Syria's future

5 April 2018 — 4:44pm
Istanbul: The leaders of Iran, Russia and Turkey have met for high-level talks on ending the Syrian war, cementing their influence on political survival of Syrian President Bashar al-Assad and isolating the United States from the region's most crucial diplomacy.
The three presidents - Recep Tayyip Erdogan of Turkey, Hassan Rouhani of Iran and Russia's Vladimir Putin - gathered in the Turkish capital, Ankara, on Wednesday, when they pledged to cooperate on reconstruction and aid.
They also vowed to protect Syria's "territorial integrity," even as all three nations carry out military missions inside the country. The trio called for more support from the international community and emphasised their opposition to "separatist agendas" in Syria.
-----

Why China is so confident it can beat Trump in a trade war

By Steven Lee Myers
6 April 2018 — 6:39am
Beijing: China's leaders sound supremely confident that they can win a trade war with President Donald Trump.
The state news media has depicted him as a reckless bully intent on undermining the global trading system, while presenting the Chinese government as a fair-minded champion of free trade. And China's leader, Xi Jinping, has used the standoff to reinforce the Communist Party's message that the United States is determined to stop China's rise — but that it no longer can. China is already too strong, its economy too big.
China's Ambassador to the United States Cui Tiankai said it was China's preference to resolve the trade dispute with Washington through negotiations but 'it takes two to tango.'
-----

Beijing launches enormous South China Sea live-fire exercise as three US carrier battle groups pass by

FORTY Chinese warships and three American aircraft carrier battle groups are converging on the South China Sea as dangerous tensions between the superpowers simmer.
Jamie Seidel
News Corp Australia Network April 6, 201811:27am

Chinese aircraft carrier flexes its muscles

CHINA’s navy has sent its aircraft carrier and more than 40 warships into the South China Sea for its largest live-fire military exercise in the troubled region yet.
And it comes as the United States has three aircraft carrier battle groups converging on the contested waterway for its own exercises.
Chinese state media says the exercises are centred on the aircraft carrier Liaoning, with warships combining from the North, East and South Sea fleets in an overt display of military muscle.
-----
I look forward to comments on all this!
-----
David.

This Is A Rather Important And Cautionary Story - To Say The Least!

This appeared last week:

Parents are snubbing their infants in favour of digital devices according to leading WA paediatrician

EXCLUSIVE, Katie Hampson | The West Australian
Wednesday, 4 April 2018 4:00AM
Babies are missing key developmental milestones because their parents are glued to digital devices at times when they should be interacting with their infants, a leading WA paediatrician says.
Joondalup Health Campus paediatrics head Desiree Silva said the $26 million Origins Project was investigating the impact of electronics on a child’s health as part of a decade-long study of how a child’s environment influenced their risk of chronic health problems.
“Social interaction from an early age is changing and we are finding that some babies at six weeks of age are not smiling ... and smiling at six weeks old is a key milestone,” Professor Silva said.
“What we’ve noticed is a lot of parents are holding their phone or iPad and not actually looking at their child. What worries us, as paediatricians, is that platform of the child’s brain might be affected.
 “That early brain development could be affected by that lack of interaction, or reduced amount of interaction, because parents are distracted by their phone.
“These devices are very addictive. So what does it replace? Basically, interacting with your child, or looking at what your child’s needs are, or responding to what your child is doing.”
More here:
I have little to add rather than to suggest we focus on the nippers, and not devices, when they are nippers. After that they can use their own devices, associated with whatever issues that causes!
David.

Wednesday, April 11, 2018

Showing Benefits From Digital Health Is A Good Deal Harder Than It Seems.


This appeared last week:

How much do EHRs impact heart failure patient care?

Post a comment / Apr 2, 2018 at 12:40 PM
A new study from the Journal of the American Heart Association found there was not an association between a hospital’s degree of EHR implementation and improved quality of care and outcomes for heart failure patients.
The research examined participants in the Get with the Guidelines—Heart Failure program who were admitted to the hospital with heart failure in 2008. Get With the Guidelines is a national registry of hospitalized patients with heart failure.
The hospitals involved had differing degrees of EHR implementation, categorized as “no EHR, partial EHR and full EHR.”
A total of 21,222 patients were eligible for the study. Approximately 1,484 individuals went to a hospital with no EHR; 13,473 were admitted to a hospital with a partial EHR; and 6,265 went to a hospital with a full EHR.
Many of the patients had comorbidities, such as hypertension, diabetes mellitus and hyperlipidemia. The majority of hospitals involved — 76 percent — were teaching hospitals.
Overall, the results show there isn’t an association between degrees of EHR implementation and better care quality, 30-day post-discharge death or readmission. The study only showed improvement in one area related to EHR use: beta blocker at discharge.
More here:
The full article is available freely on-line. Here is the Abstract:

Association of Electronic Health Record Use With Quality of Care and Outcomes in Heart Failure: An Analysis of Get With The Guidelines—Heart Failure

Senthil Selvaraj, Gregg C. Fonarow, Shubin Sheng, Roland A. Matsouaka, Adam D. DeVore, Paul A. Heidenreich, Adrian F. Hernandez, Clyde W. Yancy, Deepak L. Bhatt

Abstract

Background Adoption of electronic health record (EHR) systems has increased significantly across the nation. Whether EHR use has translated into improved quality of care and outcomes in heart failure (HF) is not well studied.
Methods and Results We examined participants from the Get With The Guidelines—HF registry who were admitted with HF in 2008 (N=21 222), using various degrees of EHR implementation (no EHR, partial EHR, and full EHR). We performed multivariable logistic regression to determine the relation between EHR status and several in‐hospital quality metrics and outcomes. In a substudy of Medicare participants (N=8421), we assessed the relation between EHR status and rates of 30‐day mortality, readmission, and a composite outcome. In the cohort, the mean age was 71±15 years, 49% were women, and 64% were white. The mean ejection fraction was 39±17%. Participants were admitted to hospitals with no EHR (N=1484), partial EHR (N=13 473), and full EHR (N=6265). There was no association between EHR status and several quality metrics (aside from β blocker at discharge) or in‐hospital outcomes on multivariable adjusted logistic regression (P>0.05 for all comparisons). In the Medicare cohort, there was no association between EHR status and 30‐day mortality, readmission, or the combined outcome.
Conclusions In a large registry of hospitalized patients with HF, there was no association between degrees of EHR implementation and several quality metrics and 30‐day postdischarge death or readmission. Our results suggest that EHR may not be sufficient to improve HF quality or related outcomes.
---- End Abstract.
While the study happened a few years the Hospitals that were in the active arm of the study where advanced EHR users by our present standards so the implication that there is more work needed to achieve clear beneficial outcomes is almost certainly valid.
I do which the Digital Health spruikers would listen to incoming evidence more and maybe work to improve things and design real world studies that show the technology is making a real positive difference rather than just wishing it were so.
David.

The Coroners Recommendations On A Death At Least Partially Caused By Electronic Prescribing Misuse. Sensible Stuff!

Last week we saw a number of reports on the Inquest into the death of Paul Lau.
Here is one such:

Computer prescribing error turns 'uneventful' procedure fatal

An anaesthetist accidentally used the wrong patient file
4th April 2018
A father of two died in hospital following a routine knee reconstruction because his anaesthetist accidentally entered fentanyl into the wrong computer file, the NSW Coroner’s Court has found.
Paul Lau, 54, died from multiple drug toxicity after being mistakenly prescribed fentanyl intended for another more complex surgical patient at Sydney’s Macquarie University Hospital in June 2015.
The most likely explanation for the prescribing error was that the anaesthetist, Dr Orison Kim, left Mr Lau’s file open on a computer and then returned to theatre, the inquest heard.
He’d been using the hospital’s new electronic prescribing system, TrakCare, and came back to the computer at a later time to enter medication for another patient. However, he accidentally prescribed a fentanyl patch and patient-controlled analgesia for Mr Lau, whose file was still open.
Mr Lau had already been prescribed oxycodone tablets and paracetamol for an “uneventful” anterior cruciate ligament reconstruction.
Dr Kim overrode 22 alerts in three batches while entering the medications, selecting “consultant’s decisions” and entering his password each time.
“It is clear that Dr Kim failed to exercise proper care, diligence and caution whilst prescribing medication erroneously in Paul’s TrakCare record,” acting State Coroner Magistrate Teresa O’Sullivan said in her findings.
Lots more here:
Following up here are the full recommendations to the Hospital:
To the Macquarie University Hospital
1.  That a working party be established to consider lessons learned and possible reforms which could be implemented at Macquarie University Hospital (“the Hospital”) as a result of the death of Paul Lau on 19 June 2015:
a.  That the working  party comprise a representative from at least Information Technology (“IT”), the Anaesthetics & Perioperative Services Department (“Anaesthetics Department”), the Nursing directorate, the Macquarie University Pharmacy (“the Pharmacy”) and the Patient Safety and Quality Manager.
2.  That the working party consider, or in the alternative, the Hospital considers, the most effective way to implement the following suggested reforms:
Presentation of Paul Lau’s Case
a.                             A staff seminar or seminars be conducted with the participation of staff from at least the Anaesthetics Department, nursing staff and the Pharmacy about the missed opportunities to detect the prescribing error in Paul Lau’s case and the lessons learned from his death;
That the nursing staff involved in Paul’s care be consulted about how that seminar be presented and have the  opportunity  to address the seminar if they wish; and
c.    That the seminar address, at a minimum, communication, handover, opioid policy, observation of patients on high-risk medication, Schedule 8 checks and responding to patient deterioration.
TrakCare Changes
d.    Give ongoing consideration to a method of verifying patient identity before medical practitioners submit medication orders on TrakCare, including specific consideration of:
i.  Urgent short term methods of ensuring patient identity verification if software changes are likely to be prolonged in implementation; and
ii.  The manual entry of the patient’s name prior to submitting a medication order;
e.    A field/box labelled “current medications” or “medications history” (as determined appropriate) be included in the pre-anaesthetic assessment (see Tab 36C, Annexure C of Exhibit 1);
f.     A field labelled “post-operative pain plan” (or other description as determined appropriate) be added to the Recovery Progress Notes template (see Exhibit 5);
g.    That investigation be undertaken into the feasibility and efficacy of an alert when medications are added to a patient’s chart after the patient file is allocated to PACU/Recovery;
h.    That representatives of at least IT and the Anaesthetics Department consider the most effective way of ensuring that TrakCare alerts enhance patient safety without unduly distracting or diverting anaesthetists; including
i.  How to safely reduce the number of alerts;
ii.  Removing the default ‘batch’ override system;
iii.   Creating a hierarchy of alerts;
Creating a distinct alert for identical duplicate “one touch” prescribing;
v.       The effective use, if any, of font, format, sound, colour and placement for alerts; and
vi.        Known literature and clinical guidelines on safe e-prescribing.
TrakCare Proficiency
i.                   That medical practitioner accreditation include a TrakCare assessment process whereby it is mandatory for a person separate from the user to confirm that the  user is proficient  to safely use the system;
j.                   That consideration be given to the most appropriate person to conduct the assessment and if the assessment would be more effective in person or on-line; and
k.               That TrakCare proficiency for anaesthetists be assessed by the use of simulations or scenarios designed in consultation with the Anaesthetics Department.
Handover Practices
l.                   That a staff seminar or seminars be held involving staff from nursing and the Anaesthetics Department about handover practices which would include simulations of handovers by staff, the provision of feedback and discussion of mechanisms to enhance the communication between nursing staff and anaesthetics staff;
m.           That an audit or audits be conducted in relation to safe handover practices at the Hospital with particular priority given to practices at PACU/Recovery;
n.              That there be a minimum number of audits conducted annually at appropriate intervals; and
o.              That the results of those audits be published on the Hospital intranet and be held by the Nursing Directorate.
Perioperative Management
p.              That, at least, representatives of the Anaesthetics Department and the nursing staff consider mechanisms to provide safe and effective perioperative management for patients, including:
i.  Monitoring of patients taking high risk medications;
ii.  Postoperative review of patients by anaesthetists in PACU/Recovery and on the ward;
iii.   The introduction of a pain service; and
iv.  Relevant existing clinical guidelines including Australian and New Zealand College of Anaesthetists guidelines, Clinical Excellence Commission guidelines and any known proposed upcoming reform.
----- End Extract
Here is the link to the full report:
I have to say this report seems very much to be a consensus co-operative finding where some very sensible approaches are recommended and are apparently being implemented.
To my mind it is a combination of inadequate user training and poor system design and screen layout that are at fault and that serious efforts are being made on both these fronts.
All that remains is to educate the whole of the profession of the risks and work to optimize design safety with the software.
David.

Tuesday, April 10, 2018

The ADHA Is Not Providing What Patients Want Because They Don't Care. They Want The myHR To Do Something Entirely Different!

This appeared last week:

Almost 14m patients using online GP services across England

3 April 2018
Almost 14 million patients across England are now using online GP services to book appointments, order repeat prescriptions and view their records.
According latest figures from NHS England, there has been a 42% increase in the number of people who are signed up for online services compared to the same time last year.

This means 24 per cent of patients (13.9 million) in England are now registered, which NHS England hopes will ease pressure on GPs and their staff and save patients time.

NHS Digital figures from February 2018 show an average of one million appointments are being made or cancelled online every month and nearly 2.3 million prescriptions ordered online, as more practices and their patients increasingly use digital technology.

Juliet Bauer, chief digital officer for the NHS, said: “We’re delighted to see an almost doubling in the numbers of people accessing digital services in GP practices since last year.

More here:

https://www.digitalhealth.net/2018/04/14m-patients-online-gp-services-england/

Frankly these are just amazing figures that make it utterly clear as to what patients actually want. They want to be able to make appointments, ask for prescription repeats and view their ACTUAL LIVE health record (not some incomplete partial copy – which will never provide the functionality they want and need).

To me seeing the voluntary response you get to Digital Health when you provide patients with what they want, compared with having to dragoon them into having something they don’t want, is a pretty stark condemnation of the ADHA’s policy performance, direction incompetence and frankly evil intent.

It really is as simple as that.

Just what is causing this stubbornness to persist in the face of clear evidence is now becoming clear and the bottom line is that the ADHA and the DOH are playing the Doctors (AMA, RACGP etc.) and the public for mugs. The myHR is intending to be a giant health information data-base, contributed by patients and their doctors for free, to allow the Government to better monitor and ultimately control the medical profession and what they do for their patients and what mistakes they make in the Government's eyes.

Just ask yourself just why else would they spend what is now heading towards $2 Billion and move towards compulsory use of the system if that was not their goal? This is nothing to do with patient safely and quality of care and all about Government attempting to manage, by deceit, one of their largest cost centres.

We all understand the backlash against Facebook when their cunning plan was exposed. The same will be the medical and patient backlash when they realise they are just unpaid data collectors.

Spread the word and explain to your friends how they are being deceived - as seems to be more common than it used to be with Government these days (think robo-debt, data disclosures etc.)!

David.