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, April 27, 2020

Weekly Australian Health IT Links – 27 April, 2020.

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

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Again, we seem to be suffering from COVID-19 overload. One hopes it will not be too long before we can escape its grip – although I worry it may take longer than any of us will like!
Just enjoy the read and try not to worry too much about the mess we are in!
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Virus tracing app to be launched today

26 April, 8.35am
Richard Ferguson
The federal government’s controversial coronavirus contact tracing app will be launched later today.
The app for mobile phone users will allow health authorities to alert Australians if they had come close to a positive COVID-19 case by using Bluetooth data, which records digital “handshakes” with other phones.
Home Affairs Minister Peter Dutton, who recently recovered from coronavirus, told Sky News that the app would have strong privacy protections and is necessary to get Australia back to normal.
“There are absolute protections that are guaranteed around the privacy,” he said.
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Queensland Health scraps $68 million IT project

By Lydia Lynch
April 24, 2020 — 1.17pm
Queensland's Health Minister has defended his department's decision to quietly scrap a multimillion-dollar IT project.
The decision to dump the $68.5 million plan to replace the state's ageing laboratory information system was announced at the tail-end of a government press release earlier this month.
Queensland Health Director General Dr John Wakefield said the reason to "discontinue" the 10-year project was to "to ensure pathology services are not disrupted during the outbreak".
But Health Minister Steven Miles said the project would not continue, even after the pandemic was over.
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Warning older patients being 'abandoned' in shift to telehealth

One severely disabled patient without internet access walked kilometres to discover his GP was only accepting online bookings, claims AMA SA President Dr Chris Moy
24th April 2020
Tech unsavvy older patients are falling through the cracks, as some practices abandon face-to-face consults and move to online-only bookings, the AMA is warning.
AMA SA President Dr Chris Moy says he's received “distressing” complaints about practices, especially from older patients, who are having more difficulty adjusting than younger ones.
According to Dr Moy, a patient with severe disabilities and no internet walked three kilometres to their usual practice, after leaving several unanswered messages, only to find it was boarded up.
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Australian government offers online safety courses for seniors

In the wake of more elderly people turning to online services during the COVID-19 pandemic.
By Aimee Chanthadavong | April 24, 2020 -- 02:20 GMT (12:20 AEST) | Topic: Security
The Australian government has launched a series of free online safety courses for senior Australians to help them improve their digital skills and avoid potential online risks as more turn to online services during the COVID-19 outbreak.
Hosted by eSafety Commissioner trainers, each webinar will offer Australians aged 65 or over guidance on how to carry out video chats across multiple platforms, order groceries and other shopping essentials online for home delivery, access essential services such as telehealth and banking, along with updated information about coronavirus from the government via its recently launched information app and the australia.gov.au website.
Advice developed by Scamwatch about how to avoid current online scams have also been included as part of the hour-long webinars.
Minister for Communications, Cyber Safety and the Arts Paul Fletcher said the eSafety webinars would reinforce online skills and prepare users for problems they may encounter.
"The online world can often be daunting for senior Australians but it needn't be," he said.
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Australians embrace telehealth to save lives during COVID-19

More than 4.3 million health and medical services have now been delivered to a total of more than three million patients through the telehealth items introduced by the Australian Government for the COVID-19 pandemic.
The Hon Greg Hunt MP
Minister for Health
20 April 2020
Media release
More than 4.3 million health and medical services have now been delivered to a total of more than three million patients through the telehealth items introduced by the Australian Government for the COVID-19 pandemic.
The use of telehealth instead of face-to-face consultations is helping to stop the spread of the virus, protecting both patients and frontline health professionals, and saving lives.
The number of telehealth consultations has rapidly expanded, to more than 700,000 in the past week. This is ensuring Australians get the care they need to look after their general health.
Every patient who uses a telehealth service is helping to maintain social distancing and flatten the coronavirus curve in Australia.
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GP corporate launches 24-hour bulk-billing telehealth

The National Home Doctor Service says phone and video consults will be available to all anywhere in Australia
24th April 2020
Australia’s biggest after-hours GP corporate has begun marketing 24-hour bulk-billing telehealth to patients — adding to concerns of an entrepreneurial gold rush driven by Medicare’s new coronavirus items.
The National Home Doctor Service is now offering phone and video consults through a “sister business” called 24-7MedCare, which promises to bulk-bill all Medicare card holders Australia-wide.
In marketing emails sent out to patients on Wednesday, it said the consults were available for those needing medical certificates, the treatment of common coughs or colds, as well as patients seeking repeat scripts.
Other services on offer include mental health counselling, routine chronic disease check-ups and “any consultation where the trade-off between attending in person and staying at home favours the latter”, it said.
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Bendigo Health to roll out remote monitoring system for suspected COVID-19 patients

The teamplay myCare Companion ‘Pandemic’ application is built upon Siemens Healthineers teamplay myCare Companion chronic care.
April 24, 2020 09:02 AM
Bendigo Health in regional Victoria will become one of the first hospitals in Australia to roll-out telemonitoring used for suspected COVID-19 patients. The system has been trialed with current geriatric patients to ensure its viability in the testing for readiness. The digital care application, teamplay myCare Companion ‘Pandemic’ delivered by medical technology company Siemens Healthineers, allows clinicians to remotely prioritize and manage patients based on their clinical needs, and has the capability to be rolled out to any healthcare service across the country. 
HOW IT WORKS
The cloud-based remote monitoring system, built on a proven secure platform, supplies doctors and nurses with a dashboard of daily updated symptoms and health vitals to remotely stay on top of their patients’ health. Symptom tracking and the use of monitoring devices, such as thermometers and pulse oximeters, will track whether the condition of the patient is deteriorating. 
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NSW Health buys 2000 iPads to monitor COVID-19 patients remotely

By Justin Hendry on Apr 20, 2020 1:15PM

Surge capacity for hospitals.

NSW Health has bought thousands of new Apple iPads to remotely monitor the conditions of COVID-19 patients with mild symptoms in the event that hospitals become overwhelmed.
The 2000-strong fleet of 4G iPads with SIMs will allow the department to observe patients from the comfort of their own home using telehealth and virtual care solutions.
The devices, which will be provided by Telstra at a cost of $1.9 million plus data charges, will be used to free up hospital beds for serious cases of coronavirus if a spike in cases was to occur.
An eHealth NSW spokesperson told iTnews the new iPads will enable “surge capacity for use with current telehealth/virtual care solutions”, though did not provide any further detail.
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Services Australia doubles myGov capacity again to meet demand

By Justin Hendry on Apr 20, 2020 7:36PM

From 150k to 300k concurrent users.

Services Australia has further bolstered the government’s online services portal myGov, as the number of Australians out of work continues to climb in the wake of COVID-19.
Government services minister Stuart Robert on Monday said myGov capacity had now climbed to 300,000 concurrent users in a bid to support those seeking welfare services.
In preparation for the welfare rush created by coronavirus lockdown measures, myGov had already been upgraded to support around 55,000 users concurrently, up from a base of 6000 users.
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Pharmacist Shared Medicines List v1.1.1

The Agency has published the specifications for the new Pharmacist Shared Medicines (PSML) document type.
This is the first public release of the PSML specification. Previous releases were made available on a trial basis to limited audiences.
This version of the specification includes support for healthcare provider organisations that have received an exemption from the need to include the document author’s individual healthcare provider identifier (HPI-I).

Scope

The Pharmacist Shared Medicines List (PSML) clinical document type fills an important gap in managing the safety of medicines for consumers. PSML documents help ensure the continuity of medicine management for consumers across different care settings.
PSML documents allow pharmacists in both hospital and community pharmacy settings to record the outcome of consumer consultations regarding their current medications for upload to the My Health Record system.
The PSML end product leverages the Core Level One Clinical Document technical specifications. The Core Level One Clinical Document is a CDA™ container for clinical information represented as a PDF document. This end product contains the PSML conformance profile and template package, which constrain the generic container document type and make it specific to the needs of PSML.
This version of the PSML document type supports the upload of medicines lists in PDF format. Future versions will have added support for clinical information as structured CDA content.
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Telehealth no excuse for poor patient care, says Medical Board

Any complaints will be judged under the same criteria used for face-to-face consults
23rd April 2020
The limitations of telehealth can be no excuse for poor care and patient complaints will be judged under the same criteria used for face-to-face consultations, the Medical Board of Australia has warned.
Despite government lockdowns and the introduction of Medicare funding for telehealth, the regulator says there will be no watering down of professional standards during the COVID-19 pandemic.
“The law does not change, professional obligations don’t change and patient safety remains the doctor’s first concern,” it said in a statement to Australian Doctor.
“Doctors can deliver safe, effective health services through telehealth by adhering to the same principles they apply when providing care in a face-to-face consultation.”
It added that it would also assess any complaint received about a telehealth consultation in the same way as it would for any other consult, although it added the “individual merits and facts” of any complaint were always considered by investigators.
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Australia's COVID tracing app better than Singapore's: Health chief

By Justin Hendry on Apr 23, 2020 7:10PM

But uncertainty surrounds full release of source code.

Australia’s forthcoming contact tracing app will be fundamentally different to Singapore’s TraceTogether, with improvements having already been made to the latter's functionality.
Acting health department secretary Caroline Edwards told a senate inquiry into COVID-19 on Thursday that although the app is derived from TraceTogether, its code base will be unique.
“I don’t think the Singapore TraceTogether app is the model,” she said in response to questions from Labor senator Murray Watt, adding that it has been an “important contributor”.
“Singapore provided, openly, its code, and we’ve drawn upon that code in developing our own app, which is Australian-based with our own improvements.
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New laws to cover coronavirus app after fears police could access data

By Max Koslowski
April 23, 2020 — 8.55pm
New laws will be passed to cover privacy fears about the coronavirus tracing app after experts and the opposition raised concerns police could get access to the data.
The federal government will introduce legislation in the May parliamentary sitting period, increasing the likelihood that emergency Biosecurity Act powers could govern the app for several weeks before control is handed over to the legislature.
How the tracing app works and what is being done about privacy concerns.
Government sources said on Thursday that while the details were not yet finalised, legislation would be introduced to govern the app, which will be able to identify when users have been within 1.5 metres of other users for more than 15 minutes.
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Call for govt to go slow on virus app

App developers say the Federal Government needs to make sure the technology works on Android and iPhones
23rd April 2020
By AAP
The Federal Government is working with Apple and Google on a new coronavirus surveillance tool, amid warnings that if it moves ahead of the tech giants, it risks its version being useless.
Australian officials are pushing ahead with an app based on the TraceTogether software that is being used in Singapore to find people who were in close contact with someone with coronavirus.
Prime Minister Scott Morrison says the new app has a single job: to help public health officers get in touch with those who may have been exposed to the virus.
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Health minister now unsure if source code for COVID contact tracing app is safe to release

By Julian Bajkowski on Apr 21, 2020 1:58PM

Despite previous assurances by government services minister Stuart Robert.

Health minister Greg Hunt has put a question mark over whether a promise to release all source code for the federal government’s forthcoming COVID-19 contact tracing app is actually possible due to security concerns.
Talking on Triple M Hobart’s ‘The Spoonman’ show with Brian Carlton on Tuesday, Hunt would not commit or back up Government Services minister Stuart Robert’s assurance last week that the full code of the app would be available for inspection.
According to Hunt, the app will drop sometime next week.
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Local tech leaders say contact tracing app will save lives

By Cara Waters
April 22, 2020 — 12.00am
Local technology sector stalwarts have backed the federal government's proposed coronavirus contact tracing app, saying that it will save lives despite some critical technical limitations.
The app is based on the TraceTogether app released by the Singaporean government in March and will use Bluetooth to identify if users have been in close proximity with one another for an extended period of time.
James Cameron of venture capital firm Airtree Ventures said the app appeared to have been thoughtfully designed to protect users privacy as data will be stored in an encrypted form and GPS and location data will not be tracked.
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Attorney-General to ban police from accessing coronavirus app metadata

By Max Koslowski
April 22, 2020 — 10.50pm
Police will be barred from accessing metadata from the proposed coronavirus contact tracing app, after Attorney-General Christian Porter vowed regulatory action to stop access under controversial telecommunications laws.
National security and technology law experts have said the app, which will be able to identify when users have been within 1.5 metres of other users for more than 15 minutes, is attractive to law enforcement agencies looking to prove two people had been in contact with each other.
Government Services Minister Stuart Robert has said the app's metadata would not be available to police, and Prime Minister Scott Morrison said on Tuesday only state health "detectives" will access the data. But experts say existing legislation potentially allows law enforcement agencies to access the app's metadata anyway.
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EFA calls for tracing app scrutiny

Monday, 20 April, 2020
Electronic Frontiers Australia (EFA) has called on the federal government to “start talking meaningfully and in detail” to technologists, rights advocates and the general public about its proposed COVID-19 contact tracing app.
“The government has for some time demonstrated an aversion to transparency and plain speaking. In this public health crisis we need leaders who can speak honestly, transparently and clearly to the public about their plans and what they mean for all of us,” said EFA Chair Lyndsey Jackson.
“The government can’t bully the public into trusting it.”
Jackson said that Australians are “well aware” of the poor technology track record of successive governments, citing problems with the Census, My Health Record, #robodebt and MyGov.
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Government services minister insists COVID tracing app data safe on AWS

By Julian Bajkowski on Apr 24, 2020 1:49PM

Denies CLOUD Act will allow US to pry.

The federal government’s already difficult job of winning sufficient public trust to convince Australians to download a forthcoming COVID-19 tracing app has hit another pothole, after multinational cloud provider Amazon Web Services was handed a deal to host the app’s data.
Reports by respected ABC and former Fairfax investigative journalists Linton Besser and Dylan Welch say the deal was awarded to AWS by limited, invitation only tender despite concerns raised by the Digital Transformation Agency, which has refuted the claims.
The report from the national broadcaster comes as the government prepares a marketing blitz to persuade Australian’s to download the app in the hope it will help health authorities more quickly trace and isolate potential infections before they proliferate.
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ACSC steps up fight against COVID-19 cybercrooks

By Dylan Bushell-Embling
Thursday, 23 April, 2020
The Australian Cyber Security Centre (ACSC) is engaging with hospitals and health service providers across the country to help safeguard the public during the COVID-19 pandemic.
As part of the Australian Signals Directorate’s efforts to combat cyber activity taking advantage of the current crisis, the centre is also working with the federal government to help protect government department networks, including the Department of Health.
The ACSC is meanwhile collaborating with industry, law enforcement and government partners to identify and disrupt malicious offshore activities, such as COVID-19 themed cyber scams and phishing attacks preying on Australian families and businesses.
“Hospitals and other healthcare providers are on the frontline in our fight against COVID-19 and that is why we are working directly with them to reduce their risk of cyber compromise during an already very challenging period,” Minister for Defence Linda Reynolds said.
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Federal data sharing laws in virus limbo

By Justin Hendry on Apr 22, 2020 5:36PM

Last round of consultations paused.

Sweeping new data sharing laws proposed by the federal government have stalled due to COVID-19, with the Office of the National Data Commissioner unable to finish consultations.
In an update on Wednesday, national data commissioner Deborah Anton said the last round of Data Availability and Transparency Bill consultations would be rescheduled in the wake of the pandemic.
“We had hoped to consult on an exposure draft of the Data Availability and Transparency Bill in the first half of 2020, though this will now not be possible,” Anton said.
“We will provide advice on updated time frames when we are able.”
The bill, which was slated to be introduced to Parliament before July, is expected to unlock public sector data for sharing with “trusted” government agencies and academics.
It is the result of almost two years of work by the Office of the National Data Commissioner and follows the 2018 Productivity Commission report into data availability and use.
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How we’re fighting COVID-19 with technology

By Luke Hopewell April 23, 2020

As COVID-19 spreads around the globe, we’re working rapidly with medical and government agencies to ensure that Australia has the equipment and technology needed to stem the outbreak. Here’s how we’re on board to help use our scale and network to help fight COVID-19 and its deadly spread.

Connecting ICUs with CHRIS

The impact of COVID-19 on hospitals and health services around the world has been immense. Existing hospitals have been used to every square inch of space, and in some cases, new facilities have been built to care for the vast influx of COVID-19 patients.
Australian healthcare agencies have observed the impact of COVID-19 and are already implementing new measures to ensure Intensive Care Units (ICUs) can manage peak demand. From today, we’ll be working with 191 public and private hospital ICUs (including neo-natal care units) to manage demand and availability through the Critical Health Resource Information System (CHRIS).
The CHRIS system allows healthcare facilities to move patients to the nearest available ICU hospital, and redeploy vital equipment including personal protective equipment, respirators and dialysis machines to those that need it most.
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RxMx Builds Chameleon Technology Platform on InterSystems IRIS for Health to Accelerate the Safe Use of Medicines Globally
Greater Flexibility and Scalability Enables Automated Risk Management Solutions to Be Delivered More Efficiently and Cost-Effectively
SYDNEY, Australia, April 23, 2020 – InterSystems, a creative data technology provider dedicated to helping customers solve the most critical scalability, interoperability, and speed problems, today announced that fast-growing global healthtech company RxMx has built its new Chameleon platform on InterSystems IRIS for Health™, enabling pharmaceutical companies to more efficiently support the safe use of medicines around the world and powering a new COVID-19 testing and monitoring solution, Certify Covid Clear, for U.S. employers.
The RxMx Chameleon platform delivers automated risk management to keep patients safe, integrating with clinical laboratories and other data sources to analyse information in real time. Portals and apps tailored to the needs of doctors, care teams and patients call attention to critical action-requiring items and provide a community of support for patient monitoring.
RxMx leveraged Chameleon – built on IRIS for Health – to rapidly develop Certify Covid Clear in partnership with physicians, public health experts and leading clinical laboratories. It provides access to diagnostic testing, providing U.S. employers with a secure digital platform to track and manage clinical data to verify which employees are safe to return to work and when.
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Barwon Health teams up with Deakin Uni for telehealth practice

By Matt Johnston on Apr 21, 2020 1:56PM

Delivering mental health services during lockdown.

Barwon Health service has partnered with Deakin University to remotely deliver mental health services during the COVID-19 isolation phase from a new facility at the university’s Geelong campus.
The partnership was in development before the pandemic began, which Deakin’s deputy vice-chancellor of research Professor Julie Owens said was focused on improving care delivery and developing new models and knowledge for mental health care.
"When the COVID-19 measures developed, this partnership was immediately put into action as we could see the urgent need to deliver these services to a vulnerable sector of our community in a safe and supportive way," Owens said.
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Remote robotic surgery in our sights

Tuesday, 21 April, 2020
Imagine a scenario where a person is having a stroke. The patient lives too far away from a major hospital and expert neurovascular surgeons, but they can get to a smaller medical facility. Here, a neurovascular surgeon remotely treats the brain aneurysm using a robotic system. Sounds like science fiction, you say? A robot trained to treat brain aneurysms demonstrates that this technology of the future may not be so far away.
Canadian research presented at this year’s International Stroke Conference reported surgical success using a robotic system specifically adapted for neurovascular procedures. Software and hardware adaptations enabled the system to accommodate microcatheters, guidewires and other devices used for endovascular procedures in the brain, providing the operator with fine motor control.
Reported to be the first time that robotic technology has been adopted for brain vascular procedures, the researchers said using a robot to treat brain aneurysms is feasible and could allow for improved precision when placing stents, coils and other devices. The robotic system could also be adopted for remote surgery.
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TeamViewer to offer remote assistance app for healthcare providers in Australia during coronavirus pandemic

Key use cases for TeamViewer Pilot include real time knowledge transfer and fast remote support for hospitals and medical facilities.
April 22, 2020 12:07 AM
Germany-founded global provider of secure remote connectivity solutions, TeamViewer announced that it is offering its TeamViewer Pilot app to all Australian healthcare organizations for free during the coronavirus pandemic. The app is a fast, easy-to-use solution for remote assistance, powered by augmented reality (AR) and will enable Australian healthcare workers to support one another virtually via smartphones, tablets or smart glasses from anywhere at any time.
WHY IT MATTERS
Australian healthcare workers can use one-to-one TeamViewer Pilot connections to share interactive video streaming and AR annotations to solve problems fast when they cannot be in the same place at the same time. Pilot sessions can also be recorded and shared with others to intuitively explain how to solve similar issues. Remote technical or medical experts can help one another with step-by-step guidance on how to use hospital equipment or devices, as well as collaborate with healthcare staff for on-the-job training or second opinions.
Key use cases for TeamViewer Pilot include real time knowledge transfer and fast remote support for hospitals and medical facilities. For real time knowledge transfer, senior physicians or on-call remote specialists can share their medical knowledge and expertise with new interns, junior staff or other colleagues working at hospitals, guiding them on-the-job using secure live video streaming from smartphones, tablets, smart glasses and wearables.
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Aussie Broadband starts rolling its own fibre to NBN POIs

By Ry Crozier on Apr 21, 2020 3:41PM

Begins work on a 20km dark fibre loop in Melbourne.

Aussie Broadband has started work on its own dark fibre network that will ultimately connect to over 75 NBN points of interconnect and 24 data centres across Australia.
Managing director Phillip Britt said that construction on stage one is underway, which comprises a 20km fibre loop around the Melbourne CBD and Port Melbourne, worth $1.8 million.
“The purpose of this project is to transition our connectivity to NBN POIs onto our own fibre network,” Britt said in a statement.
“This will provide additional benefits such as faster capacity upgrades, improved redundancy, and the opportunity to develop new products.”
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NBN Co expects to pick up broadband tab of 300,000 businesses

By Ry Crozier on Apr 22, 2020 6:59AM

Reveals relief not capped at $50m.

NBN Co has revealed its internal modelling shows around 300,000 businesses are likely to be unable to pay their NBN bills in part or in full between now and October.
The network builder’s chief customer officer for business Paul Tyler also told Ausbiz TV’s The Pulse program that while $50 million of a $150 million relief package is allocated to business, this is an “uncapped” amount, meaning NBN Co won’t need to draw a line in the number of businesses it can temporarily support.
NBN Co unveiled a $150 million relief package late last week, promising fee relief for residential and small-to-medium business customers suffering financial hardship, as well as free temporary internet for unconnected, low-income families with school-aged children.
The flagship of the business portion is the ability to waive half or all of a business’s NBN charges through to the end of September.
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NBN Co creates new basic Sky Muster Plus tier for low-income internet offer

By Ry Crozier on Apr 20, 2020 1:13PM

Comes with 80 percent less metered data quota.

NBN Co will put currently unconnected low-income families in its satellite footprint on a Sky Muster Plus service but with a much smaller metered data allowance than normal.
The network builder revealed a $150 million relief package on Friday last week that includes provisions for getting unconnected low-income households with school-aged children temporarily online.
Within the fixed-line footprint, that means unconnected households will receive free, high or unlimited quota 25/5Mbps services through until the end of September, the first participating retailers indicated over the weekend.
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Friday, 17 April 2020 14:26

NBN uploads soar during COVID-19 lockdown

The NBN has seen a substantial increase in upload traffic as the COVID-19 lockdown changes the way we use the internet.
Business hours peak upload traffic more than doubled to 1.01Tbps in the week of 6 April 2020, compared with the pre-lockdown baseline set in the last week of February.
The additional traffic came from the increased use of videoconferencing and business applications, according to NBN Co.
There were also substantial increases in uploads during the early evening and evening periods. Peak evening busy hours uploads 38% to 1.06Tbps, and peak early evening uploads increased 54% to 1.05Tbps.
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Superloop uses NBN scheme to offer free broadband to 5000 low-income homes

By Ry Crozier on Apr 18, 2020 12:04PM

Opens applications.

Superloop Home Broadband will offer 5000 currently unconnected low-income households free NBN services until the end of September, utilising a new scheme and temporary price promotion run by NBN Co.
The retailer said on Saturday morning that it is launching an “online learning plan” under the NBN scheme and has opened applications.
Superloop’s offer confirms eligibility details first reported by iTnews yesterday: that eligible families must have “a member of the household receiving the JobSeeker Payment or Family Tax Benefit Part A or B; have a school-age child living at their address; and be at an address which is covered by NBN and currently not connected to the NBN.”
Superloop has set a limit of 5000 customers that can sign up to the free offer. 
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Enjoy!
David.

Sunday, April 26, 2020

The ADHA Seems To Be Making Very Heavy Weather Of Secure Messaging And It Is Not Clear Why.

A few months ago this release appeared. At the time I missed some key details.

Media release - Secure messaging standards to be mandatory

20 January 2020: State, Territory and Commonwealth Governments have released a joint statement in support of new standards for secure messaging, stating that the standards will be mandatory in future procurement for applicable systems.
The joint statement was shared with industry at a workshop in December 2019 which was attended by over 50 representatives from clinical and secure messaging software suppliers, governments and clinical representatives.
The Australian Digital Health Agency has been working with industry and governments over a number of years to achieve interoperable secure messaging across different systems – necessary to accelerate use of electronic messaging over fax machines and paper transmission.
The workshop launched the approach to national scaling for a consistent, standards-based approach to secure messaging across Australia, to enable healthcare providers to communicate effectively as part of the National Digital Health Strategy 2018-22.
The workshop was jointly chaired by Ms Bettina McMahon the soon to be interim CEO of the Australian Digital Health Agency, Ms Emma Hossack Chief Executive Officer, Medical Software Industry Association (MSIA) and Dr Nathan Pinskier GP and former Chair of the RACGP Expert Committee – eHealth and Practice Services.
Ms Bettina McMahon said “Many people across industry, governments and peak associations have been working with us since our first meeting in December 2016 to solve what some were describing as an intractable problem. We’ve had quiet confidence that we could co-produce specifications and standards with industry and professionals, try them out in early implementations, and get to a point where Australia’s customers of these systems would require their use.
“We’re now at that point – with Governments confirming that future procurements will reference the standards as mandatory requirements.
Once again government, the health sector and the software industry have come together to address a key priority in the National Digital Health Strategy. It is this level of cooperation and shared insights that will let us achieve the benefits of digital health.”
Ms Emma Hossack said “There is work underway on a standards framework, trust framework and federated directory solution which is marvellous. We have consensus that these will be developed collaboratively and in keeping with the broader digital health interoperability approach. Whilst this can’t be rushed, we are optimistic that future development will occur through agreed standards, validation and conformance which is good news for all Australians using the health system.”
Dr Nathan Pinskier said “In the last three years, we have witnessed a significant level of industry collaboration and commitment in order to resolve a major deficiency in healthcare secure messaging being the lack of seamless interoperability between disparate software products. In this new decade of 2020, this collaborative program is now poised to deliver tangible benefits to both healthcare providers and their patients.”
A Communique on the outcomes of the workshop was released that describes the steps that will be taken to support national scaling of standards-compliant systems.
The Communique acknowledged the work done with industry to co-develop standards which were tested and refined through proof of concept implementations, the balloting of standards where appropriate, and the provision of financial support to industry to implement these standards.
ENDS
Here is the link:
The important part of the outcome was a so-called “Scaling Study” referred to in the Communique.
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National scaling approach

An approach for national scaling was discussed that encompasses the following initiatives:

1.Develop a secure messaging governance framework

2.Develop secure messaging use cases
3.Develop standards and a standards framework
4.Implement a federate directory solution
5.Develop a trust framework
6.Support change and adoption across the health sector
7.Develop a framework of levers
There was support to continue work underway, especially for initiatives2, 3, 4 and 5. Attendees recognised that there is more work to be done on these before commencement of work on the other initiatives.
Attendees agreed that the standards framework and governance arrangements should not be developed in a vacuum, bespoke to secure messaging. A collaborative, not “top down”, approach was endorsed for development in this space. The governance arrangements should be consistent with the broader digital health interoperability approach.
Flexibility in mindset and pragmatism in approach were endorsed as the means for achievement of the goal not aiming for perfection but reflective of current approaches in software and practice. We will develop high-level criteria that define what success looks like. We will consider this over the next six months and agree next time we meet.
Workflow
Attention needs to shift to usability and workflow for end users. Now that barriers to interoperability at the technical layer are largely addressed, with the exception of financial and business models, the success of national scaling is dependent on the experience of clinicians using secure messaging solutions. Attendees agreed that user experience design work is best done by industry in conjunction with end user stakeholders. It was acknowledged that the Agency could assist this important work through facilitation of collaboration across industry and professional associations. The Agency would also have a role with provision of enabling services, such as test environments.
Directories
Attendees acknowledged the critical importance of directories in achieving secure messaging interoperability. There was a recognition of the need to continue work on federated directories, and that the success of our efforts will impact workflows and usability. It was also noted that directories should be open rather than closed federations.
Priorities
Momentum for change and adoption should be created by selecting a use case and a timeframe for achievement of the most widely used message type occurring via secure messaging by a set date. Attendees supported the Agency proposing a use case (e.g. referrals or discharge summaries) to be primarily electronic by a specific point in time, with various change and adoption levers applied in support.
The Agency will consult on a suitable use case and timeframe by April 2020.Success criteria will be defined along with the timeframes for them to be met. Once these criteria have been met, a plan for national adoption will be developed.
Looking to the future
Attendees recognised the plans underway to achieve interoperability across a broad range of healthcare systems, and their relevance to the goal of seamless national secure clinical messaging. Incremental improvements towards interoperability in secure messaging were acknowledged and supported as an approach to date, but the next iteration is now approaching where systems will exchange data through APIs rather than the current transport protocols.
Some software organisations are already investing in this capability, so there will be a time when these new technical methods will supersede current methods. There is a desire to develop for the future, not just for legacy systems.
As we move to new methods including more use of FHIR-based APIsdevelopment should occur through a pathway of agreed standards, validation and conformance criteria.
Clarity in respect of quality control measurements and monitoring will be an essential part of this progress. It was generally agreed that previous approaches have not progressed as quickly or as smoothly as anticipated. In the meantime the digital health environment has continued to develop. The new methods that are emerging will be well suited to the contemporary environment, and these too will be covered by a framework to avoid silos and the mistakes of the past.
----- End Extract
Here is the direct link to the full Communique.
What I did not take enough notice of was an apparently contemporaneous report that runs to over 100 Powerpoint pages (114) that is boiled down to the paragraphs above.
Here is the direct link:
The project ran from late July to early October 2019 with the report delivered on 21 October, 2019.
Frankly the report is a joke.
Examples of the nonsense:
a. A total of 88 surveys of practices nation wide formed the basis of the current state assessment as best one can tell. (Page 20)
The claim was:  “The survey responses provided a unique end user perspective that has been incorporated into the current state analysis” but somehow 76% of the respondents were from Queensland – where Medical Objects alone has 72000 connected users!
b. Consultation with the major providers of Secure Messaging – Telstra, Healthlink, Medical Objects and ReferralNet seems to have been 1 three hour session. (15 August 2019 – p109)
c. It seems that pretty much all the plans don’t get started until June 2020 (p101) or later! Examples of what is to start then  include “Establish a Standards Working Group – seems they don’t have one” or “Develop a case for change” And so it goes!  How you make anything mandatory when the Standards are missing I find pretty problematic! Maybe it is something to do with levers?
d. A really good piece of nonsense is to “mandate the use of NASH” after a review of what seems to have already taken a decade. This also seem to happen before a suitable trust framework id developed! (p101) (Will the pain ever stop?)
It should also be noted that while the Communique notes the importance of FHIR for the future no roadmap etc. is provided for a transition that I can see. Similarly the provider directory seems to be pretty underdone. It is hard to know just how much real progress has been made with this critical piece of work.
I really wonder how such a clearly impractical and non-real world based report can escape.
Updates on all this would be welcome via comment.
David.

AusHealthIT Poll Number 524 – Results – 26th April, 2020.

Here are the results of the poll.

Has The ADHA Made Any Significant Progress With Digital Health Interoperability Since It Was Established In 2016?

Yes 1% (1)

No 98% (124)

I Have No Idea 2% (2)

Total votes: 127

It seems a very large majority feel that the ADHA hasn’t actually made much progress in the last few years!

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

A great number of votes.

It must also have been a very easy question as only 2/127 readers were not sure how to respond.

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

David.