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."

Monday, January 21, 2019

Weekly Australian Health IT Links – 21st January, 2019.

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

The silly season rolls on for just one more week and then we are back to work etc. Enjoy the quick browse and back to sleep!
-----

Has My Health Record been a sensible use of $2 billion?

The national audit office will consider the question
15th January 2019
It has taken six years and $2 billion, but government officials have finally thought to ask whether My Health Record has been a waste of taxpayer money.
As the much-maligned system becomes fully opt-out next month, the Australian National Audit Office is launching a review of its implementation and calling for feedback from the public.
The audit office says it will examine whether My Health Record “promotes achievement of its purposes”, whether the administrative risks are well managed and whether the evaluation arrangements are effective.
-----

Are e-scripts and automated dispensing failing on patient safety?

Technology has eliminated some errors but introduced new ones
17th January 2019
Electronic prescribing and automatic dispensing are failing to deliver the promised improvements in patient safety, according to data from a US survey of more than 500 pharmacists.
Participating pharmacists identified errors that occurred and were prevented within six months of the introduction of electronic prescribing and automatic dispensing cabinets.
Technology eliminated or prevented a number of errors, such as labelling mistakes. However, there were persistent errors related to prescribing or dispensing the wrong dose or drug, the researchers from Creighton University and Wisconsin University found.
Technology had also introduced new errors, such as duplicate prescriptions, they report in a manuscript accepted for Research in Social and Administrative Pharmacy.
-----

AI in the hunt for cancer diagnosis

  • 12:00AM January 16, 2019
A new batch of Australian start-ups are using AI to tackle some of the country’s most pressing healthcare problems, including diagnosis and treatment of cancer, and connecting hard-to-reach patients with doctors.
Elliot Smith is the CEO of Maxwell Plus, a Brisbane start-up applying artificial intelligence to improve medical diagnosis.
The tech company uses medical imaging, blood tests and patient data to deliver a diagnosis of prostate, breast and lung cancer that Dr Smith says is more accurate and faster than traditional methods.
Dr Smith said Maxwell Plus’s vision was to diagnose non-communicable diseases accurately, and to flag disease risk so doctors could act faster.
“We’re able to use a number of AI algorithms to analyse medical data across medical imaging, blood data and in the future genomic data, to help clinical teams to better understand that data,” he said. “The algorithms look for factors in the images that might be indicative of cancer.
-----

New Year, New Life Checks to Prepare for Longer, Better Lives.

Millions of Australians are being asked to take a free online Life Check on a new website launched today
Page last updated: 15 January 2019

Millions of Australians are being asked to take a free online Life Check on a new website launched today, as the Liberal National Government continues rolling out its More Choices For A Longer Lifemeasures, supporting Australians to live longer, better lives.

“Taking a Life Check means having more choices for a longer life,” said Minister for Senior Australians and Aged Care Ken Wyatt AM.

“Life Checks have been carefully designed to help your health, wealth, work and social wellbeing.

“This is one of the best New Year’s resolutions you can make in 2019 and it’s something to tell you friends about, because spending a few minutes taking a Life Check could make a lifetime of difference.”
-----

We must share and interpret information effectively

Yvonne Zurynski
Mary Dahm
Jeffrey Braithwaite
FOR a person with a severe or profound disability something as simple as a meal plan outlining safe foods and meal-time procedures may save their life. Overlooking or ignoring it can be a death sentence.
We know that there have been cases in New South Wales in which people with a severe disability living in residential care have been recommended certain foods and meal-time assistance but died from aspiration pneumonia as a result of their care giver not using the information in the plan to deliver a safe meal. Inhaling food or saliva into the lungs is a terrible way to die and is mostly avoidable.
People with complex and chronic conditions and disabilities, whether young or old, require their health care needs to be met no matter which health care settings they happen to be accessing, whether in primary care, in hospital or in residential care facilities and regardless of private, public or hybrid private/public funding models. Often, this does not happen, as illustrated by the example provided.
-----

Home Affairs perpetuating myths about encryption law: CA chief

A document issued by the government-funded Australian Cyber Security Growth Network, aimed at providing "information to industry about key economic concerns" over the encryption law that was passed in December, has been dismissed by the Communications Alliance as a bid by the Home Affairs Department to perpetuate myths about the legislation.
The AustCyber document was based on a survey it sponsored which was carried out by the Australian Strategic Policy Institute. ASPI is partly funded by the government but also receives funding from a number of big players in the defence industry.
The poll sought the views of 512 industry players, but succeeded in obtaining answers only from 63.
-----

Free government decryption keys save ransomware victims millions

By Ry Crozier on Jan 14, 2019 4:15PM

But most don't benefit from such good fortune.

Government authorities in the US have saved “millions of dollars” for private companies hit by ransomware attacks by sharing decryption keys for free.
John Mullen - partner at law firm Mullen Coughlin, which specialises in handling security breaches - told last week’s Consumer Electronics Show (CES) that the government had helped out on cases his firm handled.
“There has been a few cases where the federal government has come in,” Mullen said during a panel discussion.
“We talk to them all the time on these cases - sometimes they can help, sometimes they can’t, there’s no promises.
-----

Queensland paramedics launch digital system for medical emergencies

Hafizah Osman | 16 Jan 2019
Queensland Ambulance Service (QAS) has rolled out a digital system that aims to give paramedics greater access to a patient’s vital medical information in an emergency.
The SafeMate emergency medical information program is under trial for Medibank customers with chronic illnesses that are living in Queensland. Patients must be enrolled under Medibank’s CareComplete chronic disease management service.
The SafeMate program houses a patient’s medical and personal information that they enter online. QAS personnel can then access this data by scanning a QR code on a patient's SafeMate card using iPads. 
“This is crucial information that a patient wants the paramedic to know in a medical emergency,” Queensland Government Minister for Ambulance Services Steven Miles said. 
-----

Queensland Ambulance wants its first-ever CIO

By Justin Hendry on Jan 18, 2019 7:05AM

Position created for digital push.

Queensland’s Ambulance Service has begun the search for a chief information officer to lead its digital transformation ambitions.
The agency has created the position of ICT executive director to lead the implementation of its new digital strategy, dubbed ‘Towards 2027’, over the next five years.
QAS’ deputy commissioner, service planning and performance Dee Taylor-Dutton told iTnews the role was “pivotal” for ensuring results with the agency’s digital transformation.
She said this would see QAS “connect healthcare, deliver healthcare, pursue innovation supporting a mobile workforce, facilitating better decisions driven by better information, and to ensure value for money.” 
-----

Smart garments aim to stop falls in people with Parkinson's disease

17 Jan 2019
NeuRA/UNSW
A team of researchers from NeuRA and UNSW have received funding to test eHealth and smart garment technologies designed to prevent falls in people with Parkinson’s disease.
A team of researchers from Neuroscience Research Australia (NeuRA) and UNSW Sydney has received a grant from The Michael J. Fox Foundation and the Shake It Up Australia Foundation for Parkinson’s Research to test eHealth and smart garment technologies to prevent falls in people with Parkinson’s disease.
UNSW and NeuRA’s Dr Matthew Brodie and Associate Professor Kim Delbaere, who will lead the study, are working with industry partner Sensoria Health and aim to make StandingTall-PD the leading eHealth solution for maximising mobility and preventing falls in people with Parkinson’s disease.
“Existing dopamine therapies offer benefit in treating motor dysfunction in Parkinson’s but may not alleviate gait and balance challenges,” says Jamie L. Hamilton, PhD, Michael J. Fox Foundation (MJFF) Associate Director. “This project has the potential to become an affordable option to address gait and balance issues and improve overall quality of life for people with Parkinson’s.” 
-----

Troy Hunt reveals details of mega-MEGA password dump

Have I Been Pwned operator adds ‘Collection #1’ to security notification service
Rohan Pearce (Computerworld) 17 January, 2019 10:52
Troy Hunt, the operator Have I Been Pwned, has revealed details of what he described as the largest single dump of emails and passwords he has encountered.
Hunt dubbed the 87GB dump “Collection #1”. The collection comprised more than 12,000 files and was found on file-upload service MEGA. Hunt said that the dump had been discussed on a “popular hacking forum”.
“The post on the forum referenced ‘a collection of 2000+ dehashed databases and Combos stored by topic’ and provided a directory listing of 2,890 of the files,” Hunt wrote. The security researcher has posted a copy of the directory listing, which includes 32 .com.au domains and subdomains.
Collection #1 includes 1,160,253,228 unique combinations of email addresses and passwords, Hunt said. In total, there are 772,904,991 unique addresses (and 21,222,975 unique passwords).
-----
17 January 2019

Aboriginal health TV network goes live

Posted by Francine Crimmins
The first Indigenous health-focused television network has been launched in Bunbury, Western Australia by the Minister for Indigenous Health, Ken Wyatt.
Aboriginal Health Television (AHTV) will play wellbeing messages for patients while they sit in waiting rooms at Aboriginal Community Controlled Health Organisations.
The health messages include topics on smoking, sexual health, skin conditions, and drug and alcohol treatment services.
The service starting in Bunbury is developed by Tonic Health Media and is expected to be broadcasting in 100 primary care facilities across Australia by May this year.
“We have evidence that this period in the waiting area is a time when people are most open to information which can improve their health and offer relevant questions to ask their health professional when they see them in the next few minutes,” Dr Norman Swan, co-founder of Tonic Health Media, said in a media statement.
-----

Electronic marking in high-stakes medical registration exam

Sunday, 13 January 2019  
The Medical Council has introduced electronic marking to its registration examination (NZREX Clinical).
The NZREX Clinical tests clinical skills and knowledge at the level of a recent New Zealand medical graduate. About 80 overseas trained doctors choose to sit the examination each year with successful candidates able to register as a doctor in New Zealand. Once registered, they can work in restricted and supervised practice with further assessments.
Examinations director Steven Lillis says, “this was a very good start to our journey to implementing a state-of-the-art system in this exam”.
-----

Online Health Needs Assessment tool live in Northland

Wednesday, 16 January 2019   (0 Comments)
 eHealthNews.nz editor Rebecca McBeth
 Northland DHB has launched a web-based interactive version of the Health Needs Assessment.
The 2018 HNA site went live at the end of last year and is attracting at least 2–3 new users every day, with little promotion so far.
District health boards must produce an HNA report every 5–7 years as a way of monitoring the health and wellbeing of the population, as well as their need for health services.
These are usually published as lengthy paper-based or PDF documents.
-----

Machine learning will help EHRs fulfill precision medicine's promise

AI will be key to the high-intensity modeling needed for personalized care – and New Zealand is offering a unique test bed for the development of new approaches.
January 18, 2019 12:04 PM
Electronic health records are very good at being repositories for valuable patient data. But they need help when it comes to putting that data to work for more innovative care delivery. The ever-expanding volume and variety of clinical and social-determinant factors will require more advanced technologies to be optimally harnessed for precision medicine.
Enter AI and machine learning, which "will play a growing role in healthcare, under two main categories – generating knowledge and processing data," said Auckland, New Zealand-based Kevin Ross, who will speak next month at HIMSS19.
Ross is general manager at Precision Driven Health, launched as a partnership between Orion Health (where he is director of research) and government agencies and academic organizations in New Zealand to explore and promote precision medicine. He sees machine learning as a key enabler in the years ahead as health systems look to unlock the data and in their EHRs and put it to work for more personalized care.
-----

ResMed finalises Propeller Health deal

  • 11:54AM January 8, 2019
Dual-listed sleep device manufacturer ResMed has completed the $US225 million purchase of Wisconsin-based asthma and pulmonary specialist, Propeller Health.
ResMed, listed in both the US and on the ASX, said on Monday it will allow Propellor to operate as a stand alone business as partof its new parent’s Respiratory Care portfolio.
Propeller’s digital medicine platform consists of small sensors that attach to consumers’ asthma inhaler and pair with a mobileapp to automatically track medication use and provide feedback and insights.
-----

Bureau of Statistics looks to avoid the mistakes of 'censusfail'

By Doug Dingwall
16 January 2019 — 12:00am

Talking points

  • Tech giant IBM built online platforms for the 2016 census
  • The website was shut down on census night in the debacle known as 'censusfail'
  • IBM has confirmed it will not be involved the 2021 project
  • Statistician David Kalisch says the ABS has learnt from the mistakes in 2016
The tech giant at the centre of the "censusfail" furore is not bidding to build the Australian Bureau of Statistics website for the 2021 national survey.
IBM has confirmed it is sitting out the project to develop, host and support the online platform for the next census.
The bureau, which is looking to avoid a repeat of the two-day shutdown that shredded its reputation for IT in 2016, expects three quarters of the nation's households to complete the 2021 survey online.
Its open search for a contractor is a break with its decision before 2016 to engage IBM without market testing, a move blamed for the bungled online census delivery on August 9-10 that year.
-----

Lessons from government's biggest tech turkeys of 2018

By Justin Hendry , Julian Bajkowski on Jan 17, 2019 7:09AM

And what's on the block for 2019.

As the 2019 work year begins in earnest, public sector technology leaders across Australia will be happy to finally see the back of a swag of projects from 2018 as they brace for elections in NSW and federally in the first half of the year.
While there's little argument that IT and digital pursuits now routinely improve services for citizens while improving efficiency and productivity, its the lessons drawn from projects that don't go to plan that can be the most valuable for future planning and resilience.  
It's fair to say that as political and public sector ambitions for technology increase, not all projects land as intended after launching, and these are where some of the most pertinent lessons are learned.
In many respects, 2018 was a difficult year for government IT projects across Australia, with a gaggle of tech turkeys popping up during the year.
-----

Walgreens and Microsoft partner to develop digital healthcare services

Microsoft will become Walgreens' cloud provider
Reuters (Computerworld) 16 January, 2019 08:52
US pharmacy chain Walgreens Boots Alliance and Microsoft have entered a seven-year agreement to research and develop new methods of delivering healthcare services through digital devices.
As a part of the deal, the companies will focus on virtually connecting people with Walgreens stores and provide services on therapeutic areas ranging from preventative self-care to chronic disease management.
Early last year, Amazon.com Inc, Berkshire Hathaway Inc and JPMorgan Chase & Co had said they will form a company that could eventually negotiate directly with drugmakers and healthcare providers and use their vast databases to get a better handle on costs.
-----

Unlocking meaning in EMRs

By Solange Plebani*
Monday, 14 January, 2019
When clinicians are delivering care, time is often critical. The evolution of electronic medical records (EMRs) in the healthcare industry has been rapid and impactful. In their current form EMRs are predictive, precise and personal, aid better access to care for more people, enable a seamless patient experience and leverage AI to turn complex data into actionable insights.
EMRs were first explored in the healthcare industry as a way to address the pressure of time-in-care delivery. By digitising arduous paper processes, EMRs were able to assist in addressing this challenge and improving clinical efficiency.
The healthcare landscape then continued to evolve, with more structured and connected processes introduced to EMRs to further reduce the duration and complexity of traditional processes, while minimising the resources required for tasks that affect overall healthcare operations delivery.
We then saw the role of EMRs shift to further support streamlined clinical workflows and with that, improved patient safety. Many tasks that were recognised as onerous or difficult are now seamlessly performed by EMR solutions, allowing care providers to focus on their patients and make informed clinical decisions using shared data along the value chain.
-----

InterSystems IRIS Data Platform™ Now Certified on AWS Marketplace

Unified data platform available for streamlined access and utilisation

SYDNEY, Aust., January 16, 2019 – InterSystems, a global leader in information technology platforms for health, business, and government applications, today announced the availability of the InterSystems IRIS Data Platform™ in the Amazon Web Services Marketplace. AWS Marketplace availability will allow developers and customers to instantly access and use InterSystems IRIS with “one-click” provisioning. InterSystems IRIS Data Platform is available as a free Community edition, as well as a “Bring Your Own License” option.

InterSystems IRIS™ is now available on the three largest cloud providers, building upon recent deployments in the 
Google Cloud and Microsoft Azure marketplaces.

The company has made it easy for developers to 
try InterSystems IRIS via various “Quick Start” modules, including accelerating development through the use of the multi-model architecture, development on InterSystems IRIS with Java and .NET, optimising SQL performance, and exploring Big Data analytics including the data platform’s built-in Apache Spark Connector.
-----

Telcos and NBN on collision course over 5G

By James Fernyhough
14 Jan 2019 — 11:00 PM
Australia's third-largest mobile provider Vodafone is pushing for the government to release a large swathe of unused 5G spectrum it says could lower the cost of 5G services, in a move that sets them on a collision course with the national broadband network.
Vodafone said the NBN, which has exclusive access to this unused band, is not using a large portion of it, and that there is no justification for preventing other telcos from accessing it for their own 5G networks.
"Ultimately, without access to this additional spectrum, consumers will miss out on earlier access to 5G, better network performance, lower costs and a more competitive 5G market in Australia," Vodafone chief strategy officer Dan Lloyd said.
-----
Enjoy!
David.

Sunday, January 20, 2019

This Article Poses A Question All Those In Digital Health Need To Think About! How Do We Empower And Support Care Givers Fully?

This appeared last week:

Digital health success hinges on four principles

Bianca Phillips
Bernard Robertson-Dunn
This is the third article in a series on the making of the digital health revolution.
Dr Topol’s book is excellent in describing the problems with the current health care industry. At the end of the book he observes:
“Not a single aspect of health and medicine today will ultimately be spared or unaffected in some way. Doctors, hospitals, the life science industry, government, and its regulatory bodies: all are subject to radical transformation.”
Dr Topol’s book was written over a decade after a report from the Committee on Quality Health Care in America, which was part of the Institute of Medicine – Crossing the quality chasm: a new health system for the 21st century.
Why are we still far from seeing mainstream uptake of digital health?
The major reasons are that it is unclear whether the benefits of digital health technologies outweigh the risks and costs. There is also the fact that digital health involves a shift in mindset about how medicine should be practised. And we don’t have a consensus among clinicians, technologists and lawmakers of what the future should be, other than it must be different from what we have today.
The current approach      
In applying IT to health care a common assumption is that the application of technology that was designed to solve other problems through standardisation, industrialisation and production lines will work with health care. What is happening in some cases, electronic health records being an obvious example, is that technology-driven solutions cause more problems than they solve. There are an increasing number of reports that doctors are spending considerable time on data entry resulting in dissatisfaction and sometimes burnout.
Many digital health initiatives today focus on symptom-driven, statistical, pattern-matching, correlation and risk reduction approaches. The transformation of health care requires a radical change to this approach to make medicine more personalised to the individual patient.
The future paradigm
The advancement of personalised medicine is a priority of governments and research institutions around the world, and rightly so given the impact that it could have on individual health and wellbeing.
Personalised medicine is concerned with understanding the uniqueness of individuals, not just from assessing their DNA but their lifetime experiences, their behaviour, and their interactions with their environment, and diagnosing and treating patients by identifying causes and effects and treating the cause.
In order to shift towards personalised medicine four things are needed:
  • the acquisition of more and better data from the patient at the time and point of care;
  • diagnostic tools and models that understand and interpret these data;
  • treatment that addresses the cause of the problem; and
  • a health care system that efficiently utilises this radically different approach to clinical medicine.
Real advances will not come from automating what is done today, but from a deeper understanding of how to identify the key characteristics of a person, their condition as presented at the point of care, and individually tailored treatment plans that are constantly monitored and adapted as the patient adapts.
An illustration of the complexity of understanding and treating the unique systems of the individual is the example of neurogastroenterology.
Medical science is discovering that the human digestive tract has a nervous system second only to that of the brain. There are also biological sensors and actuators that control the complex behaviour of digestion, absorption and waste disposal. Fully understanding this subsystem of human biology will require engagement with those more familiar with industrial automation and control systems. Achieving a good understanding is made more complex because there is no definitive design; it is often self-healing and is constantly interacting with external influences. Neurogastroenterology is only one area where the study of dynamic systems and control theory are essential to the transformation of health care.
The personalised medicine movement explores individualised health from various perspectives. One such perspective is that of pharmacogenomics, which looks at how our genes affect our reaction to particular medications. The United States Food and Drug Administration recently approved a direct-to-consumer pharmacogenomic test, offered by company 23andMe.
The limitation at present is that tests such as these are still far from being relied upon in clinical practice:
Eric Topol, a geneticist at the Scripps Research Institute, points out that the genome variants they are analyzing are very limited. It’s simply too early. A review published by the American Psychiatric Association task force concludes that while initial data on the association of genetics and drugs has been promising, there’s not enough evidence to justify the widespread use of pharmacogenetic tests”.
Other advances in the field of personalised medicine include epigenomics, which seeks to understand the “on” and “off” switches of our genes, how these switches are altered by our environments, and the ways in which genetic instructions are used by cells when these changes arise.
“Until recently, scientists thought that human diseases were caused mainly by changes in DNA sequence, infectious agents such as bacteria and viruses, or environmental agents. Now, however, researchers have demonstrated that changes in the epigenome also can cause, or result from, disease. Epigenomics, thus, has become a vital part of efforts to better understand the human body and to improve human health. Epigenomic maps may someday enable doctors to determine an individual’s health status and tailor a patient’s response to therapies.”
National Human Genome Research Institute
Epigenomics
A direct-to-consumer epigenomic test is currently offered through the company Chronomics. However, the test is limited to assessing biological age, smoke exposure and metabolic state.
The exposome is another field of enquiry looking at how our environment influences our health. The exposome focuses on how the totality of our environment from conception onwards affects our internal environment. Digital health technologies can serve an important role in this field:
“New tools and technologies that can be applied to address these challenges include exposure biomarker technologies, geographical mapping and remote sensing technologies, smartphone applications and personal exposure sensors, and high-throughput molecular ‘omics’ techniques”
Other areas that will have implications for personalised medicine include transcriptomics, proteomics, phenomics, microbiomics and metabolomics.
More here:
To me what is being raised here is the suitability of our present technological paradigms to address what really makes the delivery of safe, quality and consistent care so difficult. We need tools that empower and support clinicians, in all aspects of care delivery, and to date we have not been able to properly imagine, design and implement those tools.
The level of frustration and annoyance with what presently exists tells us that.
This recent article highlights the problem:

Study Links Stress from Using EHRs to Physician Burnout



December 7, 2018
by Heather Landi, Associate Editor
More than a third of primary care physicians reported all three measures of EHR-related stress
Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.
A commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.
Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.
Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.
“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."
Here is the link:
Here is what the US Government is thinking about the issue:
Bottom line – a fundamental rethink and so on is required. You can be sure the myHR is not part of the answer!
What do you think is?
David.

AusHealthIT Poll Number 458 – Results – 20th January, 2019.


Here are the results of the poll.

Will The ADHA And The Department Of Health Proceed To Move To Opt-Out For The #myHealthRecord After January 31, 2019 Or Defer The Process Again?

Proceed After Jan 31, 2019. 54% (52)

Defer Opt-Out Again. 29% (28)

I Have No Idea. 17% (16)

Total votes: 96

What an amazing poll. A touch over 50% see the ADHA just steam ahead . Another 30ish% see it wait longer and a fair few have no idea.

Any insights on the poll welcome as a comment, as usual.

A reasonable turnout of votes for the time of the year!

It must have been a very hard question as only 17/96 readers were not sure what the appropriate answer was.

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

David.