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."

Tuesday, September 06, 2022

Commentators and Journalists Weigh In On Digital Health And Related Privacy, Safety, Social Media And Security Matters. Lots Of Interesting Perspectives - September 06, 2022.

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This weekly blog is to explore the news around the larger issues around Digital Health, data security, data privacy, AI / ML. technology, social media and related matters.

I will also try to highlight ADHA Propaganda when I come upon it.

Just so we keep count, the latest Notes from the ADHA Board were dated 6 December, 2018 and we have seen none since! It’s pretty sad!

Note: Appearance here is not to suggest I see any credibility or value in what follows. I will leave it to the reader to decide what is worthwhile and what is not! The point is to let people know what is being said / published that I have come upon.

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https://www.hospitalhealth.com.au/content/technology/sponsored/a-new-imperative-post-pandemic-shifts-in-australia-s-healthcare-industry-1489506137

A new imperative: Post-pandemic shifts in Australia's healthcare industry

Philips Australia & New Zealand
Friday, 02 September, 2022

The height of the COVID-19 panic in Australia has subsided, and the nation’s attention has turned from its own health to that of the economy. But while many sectors are moving to a post-pandemic perspective, the healthcare industry continues to manage the COVID-19 frontline. Case numbers have surged due to new variants of the virus and the ongoing strain on healthcare workers is growing, with 87% of the Royal Australasian College of Physician members concerned about workforce burnout[1]

Adapting in response, Australia’s healthcare facilities have implemented large scale change to the way they operate. Remote health solutions are becoming more mainstream, digitisation continues to accelerate, and the Medicare Benefits Scheme (MBS)[2] telehealth funding arrangements have increased uptake and acceptance of digital healthcare models. Together these unique forces are shaping the priorities of Australia’s healthcare leaders, according to the findings from the Future Health Index 2022 Australian report (FHI 2022).

Based on survey responses from 200 Australian healthcare leaders, this year’s report explores how healthcare leaders are reassessing their priorities to address key challenges including staff shortages and retention, extending care delivery, and harnessing the power of big data and predictive analytics.

And while the industry continues to face a vast array of challenges, from a decline in public hospital beds to overstretched emergency and acute care settings[3], the extreme disruption created by the pandemic has forced many senior executives to rethink their strategic goals and use disruption as a force for resilience. From tackling inherent systemic challenges to healthcare delivery that were exacerbated by the pandemic, to growing some of the positive technological changes, Australia’s healthcare leaders are refocusing their attention to create a path forward for positive long-term change.

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https://digitalhealth.org.au/blog/student-placement-and-the-use-of-digital-systems/

Student placement and the use of digital systems

Aug 29, 2022 | Aged care, Community Chats, Community of Practice, Data, Digital Health, eHealth, Innovation, Nursing & Midwifery Informatics

Sally Duncan

Chief Nursing & Midwifery Information Officer, Northern Sydney Local Health District

Before digital health, things were much simpler for both the student nurse, and midwife, in relation to learning how to document assessments, medications, observations, and care. Back in the early eighties, when I trained in both areas, we had a very hands-on integrated approach to learning how to document, compared to today’s world, with basic observational charts, fluid balance charts, medication charts and what was known as a ‘Nursing/Midwifery Kardex’ to document care and plans. What we learnt around nursing and midwifery documentation in the classroom, was then emulated on our placements under the supervision of the registered nurses/midwives and tutors. At the end of each placement, we mastered the art of caring for and documenting our patient’s/woman’s/baby care assessments, goals, treatments and interventions, for that specialty/area.

Today, it has become much more complex. There is not only paper documentation but more often than not there is a digital health record and other digital health technologies to learn. Do the current nursing and midwifery undergraduate students have the same experience in preparing them for their placements? With the fairly rapid rise in digital health, it seems university education around preparing students for digital health systems has lagged. In 2013, Baillie et al. [1] conducted a survey that investigated student nurse and midwife experiences of using the electronic medical record (EMR) in practice. The results indicated that there needed to be more opportunities to enable students to be more competent in using EMRs prior to placement, with a request for more hands-on practice in a simulated environment. Following the published paper, a collaboration between the university and its affiliated health organisations established governance around onboarding and guidelines around usage, and also provided formalised EMR training for their students.

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https://www.smh.com.au/national/queensland/unable-to-keep-up-information-commissioner-issues-budget-warning-20220902-p5betk.html

‘Unable to keep up’: Information Commissioner issues budget warning

By Sean Parnell

September 2, 2022 — 11.27am

Information Commissioner Geraldine Falk has warned the Albanese government her office cannot be expected to keep doing more work without an increase in funding.

The former Coalition government initially proposed to abolish the Office of the Australian Information Commissioner, but instead left key vacancies unfilled and restricted funding. In the FOI area, that led to a blowout in timeframes relating to complaints about government decisions and policies.

In a letter to Attorney-General Mark Dreyfus, obtained by Brisbane Times under FOI laws, Falk said her office continued to “support integrity, transparency and accountability of government through year-on-year increases to the efficiency with which we acquit our responsibilities”.

“However, as you will see from the attached information, we are unable to keep up with the incoming work with less funding for this function than we received in 2014-15, owing to the increased volume and complexity of the work,” Falk wrote.

Dreyfus was given background information showing “the OAIC’s most critical budget pressure relates to its FOI functions”.

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https://wildhealth.net.au/is-halo-connect-a-pragmatic-big-step-to-better-system-data-sharing/

31 August 2022

Is Halo Connect a pragmatic big step to better system data sharing?

By Jeremy Knibbs

Halo’s middleware multi-point FHIR connector idea has the potential to become a bridge between our old and new digital health ecosystems and, possibly even, between hospitals and primary care in the short term

From little things…

Last week’s coming out of Halo Connect to the digital health community might have passed with too little fanfare, given what the product might actually mean for our health system moving forward.

The product announcement itself was reasonably low key: a single FHIR-Open API based integration layer for our largest national primary care patient management system (PMS), Best Practice (BP).

It means that all those integrations to BP (there’s about 100 of them), which is probably somewhere north of being on the desktops of 60% of our GPs, can build their own APIs to talk to this “middleware”, and after that they largely can get on with developing their IP and not worry any more about upgrading versions to make sure they connect properly with BP.

As a one-off build for all those integrators, it should end up paying back very quickly.

For any new integrators it will make things a lot easier.

All this is the first part of the Halo idea.

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https://medicalrepublic.com.au/what-does-the-us-open-access-decision-mean/76058

31 August 2022

What does the US open access decision mean?

By The Conversation

This is a huge step in efforts to make government-funded research available to all.


Last week, the United States announced an updated policy guidance on open access that will substantially expand public access to science not just in America, but worldwide.

As per the guidance, all US federal agencies must put in place policies and plans so anyone anywhere can immediately and freely access the peer-reviewed publications and data arising from research they fund.

The policies need to be in place by the end of 2025, according to President Biden’s White House Office of Science and Technology Policy (OSTP).

A substantial step

The new guidance builds on a previous memo issued by then president Barack Obama’s office in 2013. That one only applied to the largest funding agencies and, in a crucial difference, allowed for a 12-month delay or embargo for the publications to be available.

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https://medicalrepublic.com.au/cybersecurity-is-patient-care/76032

31 August 2022

Cybersecurity is patient care

KnowCents Technology

By Holly Payne

Compromised data means compromised patient care, according to a new report looking at the Australian healthcare system.

Think of every patient’s file as a Ferrari.

No, really – that’s how valuable the information inside can be to a hacker, according to a new report from professional services firm RSM Australia’s health arm, titled Building resilient healthcare organisations in Australia: Innovation, data and security.

In comparison, credit card details are more like a beaten-up old Ford.

“With a stolen credit card, the most you can use it for is five days, if you’re lucky,” RSM director of cyber security Ashwin Pal said.  

“However, with patient data and all of the information you get with it, you can actually go in and get five credit cards, five mortgages, three personal loans … and off you go to Mexico.”

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https://www.smh.com.au/technology/big-tech-must-crack-down-on-child-sexual-abuse-material-20220830-p5be0t.html

Big tech must crack down on child sexual abuse material

The Herald's View

August 30, 2022 — 6.01pm

There has been ferocious debate in Australia over the past few years about the responsibility big tech companies should bear for content on their platforms.

In the wake of incidents such as the livestreaming of the Christchurch mosque massacre in 2019, companies have become much more proactive in monitoring content that could encourage violence or other crimes.

Since then, Twitter has banned Donald Trump for spreading lies about the presidential election that encouraged the rioting at the Capitol on January 6, 2021.

During the election campaign this year, then-prime minister Scott Morrison promised to use a new law on defamation to fight trolling and cyberbullying.

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https://www.innovationaus.com/skills-shortage-behind-digital-restart-funding-pause-dominello/

Skills shortage behind Digital Restart funding pause: Dominello

Justin Hendry
Editor

30 August 2022

The New South Wales Government’s flagship investment vehicle for digital projects was not topped up in this year’s state Budget due to Treasury concerns over labour market constraints.

The state’s Minister for Customer Service and Digital Government Victor Dominello said a request for additional funding had been made for the Digital Restart Fund, but that the bid was ultimately knocked back.

“I made a pitch to Treasury. I wanted it to be topped up, but Treasury reported back to us that we had challenges in relation to supply,” he told a Budget Estimates hearing on Tuesday.

“The challenge is … there’s just not enough supply [in the market] in relation to talent coming through; the coders, the engineers we need to actually do the product.”

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https://itwire.com/business-it-news/security/over-third-of-australians-would-delete-themselves-from-internet-if-they-could-study.html

Tuesday, 30 August 2022 12:18

Over third of Australians would delete themselves from Internet if they could: study

By Staff Writer

More than a third of Aussies (35%) would delete themselves from the internet if they could, according to a new study commissioned by cybersecurity company NordVPN.

And when asked about the reason, 40% of Australians said they don’t trust the internet, while 39% feel used because companies exploit their data to their advantage.

Another 38% say they fear that someone will eventually hack their devices, and around the same percentage say they have no reason to have their name on the internet.

According to respondents from the survey - commissioned by NordVPN and conducted by Cint - of 1,000 Australians, more than half (56%) said that they would most like their personal financial information to be deleted from the internet - and other information Australians want deleted from the internet include:

  • 38% - Unflattering photos/videos    

·         32% - Embarrassing moments 

·         27% - Old dating/social media profiles

·         17% - Previous employment history  

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https://medicalrepublic.com.au/wheres-your-health-data-now/75941

30 August 2022

Where’s your health data now?

Comment Data KnowCents

By Dr Margaret Faux

Privacy must be maintained, but it’s a poor argument against coding outpatient visits – that already happens in hospitals.


Pause for a moment and ask yourself where your health data is right now.

The answer is probably: in a variety of locations all over the world.

For those of us who handle health data every day, managing privacy and security is central to everything we do, and the key to survival. Data breaches are the stuff of nightmares, so companies that handle large volumes of health data mitigate their risks by going to extraordinary lengths to protect data security.

There is usually an array of physical, technical, and administrative safeguards in place, as well as ISO accreditations, regular penetration tests and of course cyber insurance, now essential for all MedTech companies.

Keeping health data secure, while also allowing it to exit bricks and mortar buildings, is an international challenge that always requires a regulatory response. Most countries have data security and/or privacy legislation, which typically does not seek to prevent health data crossing borders, but rather, seeks to govern that process.

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https://ia.acs.org.au/article/2022/aussie-businesses-falling-behind-on-tech.html

Aussie businesses falling behind on tech

Data and AI use well below where it should.

By Casey Tonkin on Aug 29 2022 08:38 PM

Australian businesses are continuing to fall behind on technology adoption, especially when it comes to data analytics and artificial intelligence, an interim Productivity Commission report into Australia’s data and digital dividend has found.

When stacked up against OECD countries, Australian businesses performs fine when it comes to basic internet connectivity and cloud adoption but is at the bottom of the pile for data and AI.

“Technologies such as artificial intelligence, robotic automation and big data analytics could revolutionise how businesses operate and help lift Australia’s productivity growth by reducing costs, improving the quality of goods and services, and increasing product choice for consumers,” Productivity Commissioner Dr Stephen King said in a statement.

“Digital technology and data will continue to shape global economic growth and social change in coming years.

“Whether we fully realise the productivity dividend offered by these opportunities will depend on how effectively governments, businesses and individuals can recognise and safely harness these changes for Australia’s benefit.”

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https://itwire.com/your-it-news/entertainment/entertainment-services-subscription-up-by-16-in-the-last-12-months-amid-soaring-prices-analyst.html

Monday, 29 August 2022 11:43

Entertainment services subscription up by 16% in the last 12 months amid soaring prices: analyst

By Kenn Anthony Mendoza

The Telsyte Australian Subscription Entertainment Study 2022 found entertainment subscription services have become essential to Australians’ content consumption and discovery across video, games and music.

Services and higher demand for “at home” entertainment and services increased by more than six million to 48.4 million during the twelve months to June 2022.

SVOD, streaming music and games-related subscription services all experienced growth during the measured period (22%, 17% and 19%, respectively) while traditional pay TV continued with a 9% year-on-year decline.

Telsyte’s research found streaming entertainment is now considered “essential” for more than half (54% for SVOD and 52% for music) of users.

Despite macroeconomic headwinds and “cost of living” pressures, Telsyte continues to forecast growth for all sectors, with games growing the fastest to 2026.

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https://www.smh.com.au/healthcare/fetal-heart-monitors-implicated-in-stillbirths-neonatal-death-20220825-p5bcm1.html

Fetal heart monitors implicated in stillbirths, neonatal death

By Kate Aubusson

August 29, 2022 — 5.00am

The medical watchdog is investigating the dangers of at-home fetal heart monitors following three stillbirths and one neonatal death linked to the devices.

The Therapeutic Goods Administration (TGA) will consider banning handheld fetal dopplers for personal use after they were linked to multiple cases of pregnant women being “falsely reassured” that their unborn baby had a healthy heartbeat, leading to delays in seeking medical attention.

Health authorities reported three stillbirths and one early neonatal death to the TGA in the past 12 months, prompting a review of the device’s safety, benefits and harms.

“While the deaths may not have been avoidable, the use of home fetal dopplers delayed the women’s presentation for timely review by providing false reassurance about their baby’s wellbeing,” the TGA said in a statement.

“Without training, the sounds detected from the mother or placenta could easily be misinterpreted as the fetal heartbeat, providing potentially inaccurate reassurance.”

There were also reported cases where parents couldn’t find a fetal heartbeat using the devices, causing unnecessary panic, the TGA said.

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Unlocking the secret to private messaging apps

UNSW

 Unless your messaging app offers end-to-end encryption, your private conversations may be accessed without your consent.

Whether you’re sharing confidential information or swapping movie ideas with a friend, people are turning to private messaging apps that offer end-to-end encryption to protect the contents of their conversations.

When data is shared over the Internet, it often traverses a series of networks to reach its destination. Apps such as WhatsApp, owned by social media giant Meta (formerly Facebook), provide a level of privacy that even challenges Government agencies from accessing encrypted conversations.

However, with the apps constantly changing their security and privacy policies, are the messages still safe from being decrypted?

Back in May 2021, disapproval by the online community with the changes to WhatsApp’s privacy policy for business entities using the platform, saw many users switch to other private messaging apps such as Signal and Telegram.

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https://itwire.com/business-it-news/security/australia-and-increasingly-attractive-traget-for-cybercriminals-report.html

Friday, 26 August 2022 10:18

Australia an increasingly attractive traget for cybercriminals: report

By Staff Writer

The global cyber threat environment has intensified and Australia is an increasingly attractive target for malicious actors and cybercriminals, according to a new report.

The alert comes from the Cyber Security Industry Advisory Committee (IAC) i its Annual Report 2022, with Chairman and Telstra CEO Andrew Penn commenting that deteriorating geopolitical tensions, the expansion of hybrid work outside traditional corporate firewalls and adaptive offenders saw cybercrimes including ransomware, mobile malware and business email compromise (BEC) significantly increase this past year.

“New technologies and the move to more time being spent online as a result of COVID has created greater opportunities for cybercriminals,” Penn said.

“At the same time geopolitical tensions have grown following Russia’s attack on Ukraine, and the risk of attacks on Australian networks – whether directly or inadvertently – has also increased.

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https://www.afr.com/technology/how-promedicus-turned-a-us3-5m-deal-into-5-5b-in-value-20220823-p5bc5l

How ProMedicus turned a $US3.5m deal into $5.5b in value

Yolanda Redrup Reporter

Aug 28, 2022 – 12.26pm

When you think about return on investment, it doesn’t get much better than Pro Medicus acquisition of imaging technology company Visage for $US3.5 million.

It was January 2009 when Pro Medicus co-founder Sam Hupert paid a visit to Bell Potter senior analyst John Hester, who was working at the now defunct Linwar Securities. Dr Hupert excitedly told Mr Hester the medtech company, which was trading at less than $1 at the time, had just bought some revolutionary new technology, developed by a team out of a research and development lab in Germany.

“He said ‘I’ve just bought this fantastic piece of software, it’ll change the world’. Everyone rolled their eyes, but that was the turning point,” Mr Hester told The Australian Financial Review.

“Prior to that, Pro Medicus was a very different company. It had this run-of-the-mill picture archiving and communications system that was highly vanilla and not differentiated from the market.

“With Visage, Sam saw this vision that no one else had wanted to tap.”

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David.

Monday, September 05, 2022

Weekly Australian Health IT Links – 05 September, 2022.

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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There seems to be a good bit going on this week so lots to browse!

The trial of AI in aged care was quite amusing in a sad sort of way….

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https://medicalrepublic.com.au/whos-to-blame-when-the-software-gets-it-wrong/75863

30 August 2022

Who’s to blame when the software gets it wrong?

Medicolegal Technology

By Pursuit

Clinical decision support tools can open a whole new can of medicolegal risk for clinicians.


Doctors are being increasingly encouraged to rely on digital technology to guide care, but who carries the blame if doctors rely on software that makes mistakes, leading to patient harm?

Imagine this. A patient has recovered enough from a heart attack to be discharged from hospital. The presiding doctor sorts out the discharge using a hospital computer that has clinical decision support software, which compares the patient’s data with inbuilt algorithms to make recommendations for their care.

Clinical decision support tools are increasingly used throughout our healthcare system to promote high-quality care aligning with evidence and guidelines.

In this case, the software generates a pop-up alert recommending that the doctor prescribe a specific medication on the basis that the patient isn’t already taking it. The doctor prescribes the medication, and the patient goes home. A few days later, they die. An investigation finds that the patient had twice the recommended amount of the medication in their system.

It turns out the patient was already taking a dose of this same medication in a tablet that was combined with another drug. As a result, because of the new prescription, the patient had actually been taking a double dose of the medication, which proved to be fatal.

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https://www.healthcareitnews.com/news/anz/australian-institute-health-and-welfare-gets-2m-covid-19-linked-data-project

Australian Institute of Health and Welfare gets $2M for COVID-19 linked data project

The linked data can be used to look at the effects of COVID-19 on health outcomes and health service usage.

By Adam Ang

August 30, 2022 11:39 PM

The Australian Institute of Health and Welfare is receiving A$2.9 million ($2 million) from the federal government for its COVID-19 linked data project.

The agency is one of the 14 research groups being funded a total of A$31.5 million ($22 million) by the government's Medical Research Future Fund to help improve Australia's understanding of COVID-19.

WHAT IT'S ABOUT

AIHW's national linked data platform is combining COVID-19 case data from participating states and territories with other data sets, such as on aged care, deaths, and hospitalisations. It will also include data from the Medicare Consumer Directory, National Notifiable Disease Surveillance System, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and the Australian Immunisation Register. 

The agency is protecting an individual's identity and privacy by de-identifying their information. To reinforce the management of privacy and confidentiality of its data, it uses the Five Safes Framework, which minimises the risk of re-identification by only supplying data to researchers in secure access environments. 

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https://www.healthcareitnews.com/news/anz/australian-institute-health-and-welfare-gets-2m-covid-19-linked-data-project

Australian Institute of Health and Welfare gets $2M for COVID-19 linked data project

The linked data can be used to look at the effects of COVID-19 on health outcomes and health service usage.

By Adam Ang

August 30, 2022 11:39 PM

The Australian Institute of Health and Welfare is receiving A$2.9 million ($2 million) from the federal government for its COVID-19 linked data project.

The agency is one of the 14 research groups being funded a total of A$31.5 million ($22 million) by the government's Medical Research Future Fund to help improve Australia's understanding of COVID-19.

WHAT IT'S ABOUT

AIHW's national linked data platform is combining COVID-19 case data from participating states and territories with other data sets, such as on aged care, deaths, and hospitalisations. It will also include data from the Medicare Consumer Directory, National Notifiable Disease Surveillance System, Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and the Australian Immunisation Register. 

The agency is protecting an individual's identity and privacy by de-identifying their information. To reinforce the management of privacy and confidentiality of its data, it uses the Five Safes Framework, which minimises the risk of re-identification by only supplying data to researchers in secure access environments. 

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https://www.itnews.com.au/news/esafety-office-uses-powers-to-demand-answers-from-big-tech-584593

eSafety office uses powers to demand answers from 'big tech'

By Staff Writer on Aug 30, 2022 10:21AM

Apple, Meta, others must show how they meet “basic online safety expectations”.

eSafety Commissioner Julie Inman Grant will issue "legal notices" to Apple, Meta (including its WhatsApp operation), Microsoft (including Skype), Snap, and Omegle, requiring them to detail anti-child-exploitation measures.

The notices are part of the powers created by the Online Safety Act 2021, under which the government sets out what are called “basic online safety expectations”.

Those expectations set out the minimum safety measures expected of tech companies operating in Australia.

In its announcement, the Office of the eSafety Commissioner explained that the notices are an information gathering exercise that “may reflect a range of factors, including the number of complaints that eSafety has received, the reach of a service, or whether limited information is available on a company’s safety actions or interventions on their services.”

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https://www.theaustralian.com.au/business/morning-after-pill-delivery-service-midnight-health-attracts-12m-investment-from-nib/news-story/f3a33f935b611493390eb13775c08db0

Morning after pill delivery service Midnight Health attracts $12m investment from nib

CITY BEAT Glen Norris

12:00AM August 31, 2022

Brisbane serial entrepreneur Nic Blair is on a roll, with his health-tech startup Midnight Health attracting a $12m investment from insurance giant nib.

The cash injection is nib’s second investment in the digital healthcare platform giving the startup a valuation approaching $50m. Last November, the insurer kicked in $4m.

Midnight Health, founded by 36-year-old Blair and Matt Anderson last year, already has more than 30,000 customers who can access a range of services including telehealth consultations, home delivered prescription medicines, skin care treatments and birth control.

Midnight Health, which operates under a number of brands including Youly and men’s health platform Stagger, attracted national headlines when it offered an emergency delivery service for the morning after contraceptive pill.

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Alcidion - FY22 Full Year Results and Investor Webcast recording

 

Melbourne, Australia – Alcidion Group Limited (‘Alcidion’ or the ‘Company’) today releases audited full year results and Annual Report to Shareholders for the Financial Year ended 30 June 2022 (FY22).
 
Highlights:

  • FY22 full year revenue of $34.4M, up 33% on prior corresponding period – PCP ($25.9M)
  • Recurring revenue of $23.3M, up 42% on PCP ($16.3M)
  • Positive Underlying EBITDA of $0.9M, up 68% on PCP ($0.5M)
  • Positive operating cashflow of $1.0M (PCP $1.5M); $3.1M excluding one off acquisition costs
  • FY22 new sales with total contract value (TCV) of $57.7M, up 96% up on PCP
  • Signed milestone contract as part of Leidos Consortium to support delivery of healthcare services across the Australia Defence Force with initial TCV of $23.3m over six years  
  • Transformational acquisition of Silverlink PCS Software in December 2021, provided Alcidion with capability to deliver a cloud-native, modern, and modular Electronic Patient/Medical Record
  • Cash reserves of $17.3M and no debt as of 30 June 2022
  • Entering FY23 with $28.3M of contracted revenue (up 87% on PCP) and a further $2.9M of scheduled renewal revenue expected to be recognised in FY23

 
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https://www.healthcareitnews.com/news/anz/develop-pandemic-data-standards-improve-data-sharing-australias-csiro-suggests

Develop pandemic data standards to improve data sharing, Australia's CSIRO suggests

It has also recommended improving the country's capabilities to link health data with non-health data.

By Adam Ang

August 30, 2022 02:38 AM

The ​​Commonwealth Scientific and Industrial Research Organisation, Australia's national science agency, is suggesting developing national pandemic data standards to improve the data collection and sharing as part of the country's future pandemic response.

This is one of the agency's recommendations to the government on data sharing for informed response strategies during pandemics. 

WHAT IT'S ABOUT

CSIRO stressed the importance of data recording and messaging standards to improve data quality at the point of entry, and thus, enable interoperability. Due to the lack of uniform data standards in Australia, there has been difficulty in exchanging data across health systems. This challenge was further exacerbated during the pandemic, especially for novel pathogens, as standards were developed independently among health regions and even institutions.

It said specific pandemic response data collection standards and implementation guides could be developed for major diseases caused by the identified priority viral families. 

The government could build on existing initiatives to streamline this development, such as expanding the Australian Digital Health Agency's (ADHA) work on a digital standards catalogue to include data standards to support a pandemic response; using existing standards, such as SNOMED CT for clinical data and HL7 FHIR for exchanging information, as foundation; or aligning national standards with international standards to facilitate global collaboration.

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https://wildhealth.net.au/data-sharing-key-for-pandemic-preparedness/

31 August 2022

Data sharing key for pandemic preparedness

Technology

By Talia Meyerowitz-Katz

To prepare for future pandemics, Australia would do well to strengthen its data sharing capabilities, according to a CSIRO report released this week.  

The report warned that viral disease outbreaks will only increase in occurrence and severity. It identified six key areas in science and technology that Australia should invest in to prevent more pandemics, data sharing being one.  

“Data sharing across the healthcare system in a pandemic is critical for the efficient and effective operation of health services and for the benefit of patient outcomes and treatment,” wrote the authors. 

The report found that despite data sharing being crucial to pandemic decision making, Australia faces significant limitations in this area.  

A lack of standards and interoperability were found to be biggest barriers to efficient data sharing. 

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 https://www.itnews.com.au/news/better-data-would-help-pandemic-response-says-csiro-584598

Better data would help pandemic response, says CSIRO

By Richard Chirgwin on Aug 30, 2022 12:16PM

Privacy gets in the way.

The CSIRO appears to want a weakening of privacy protection so health data is more easily sharable.

In its publication Strengthening Australia's Pandemic Preparedness, the science agency canvasses change its 80 respondents said are needed in Australia’s data sharing arrangements as part of future pandemic planning.

The report stated that “data sharing limitations” exist because of “varying governance of health systems within and across jurisdictions,” as well as limited interoperability between systems.

Recommendations in the study included that Australia develop “national pandemic data standards”, improve its ability to link health and non-health data, as well as design “smart analytics that can share and analyse sensitive data at a national level”.

It’s well down into the detail of the report before CSIRO raised privacy as inhibiting pandemic responses.

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https://www.sydney.edu.au/news-opinion/news/2022/08/29/historic-478m-investment-to-change-australian-healthcare-forever.html

Historic $478m investment to change Australian healthcare forever

29 August 2022

University announces largest ever capital investment

The University of Sydney today announced its largest ever capital investment, a landmark $478 million to build a nation-leading biomedical precinct to fast track research and patient care in New South Wales.

The Sydney Biomedical Accelerator (SBA) will create a first-in-Australia, 36,000m2 health, education, and research precinct co-located at Royal Prince Alfred Hospital and the University’s Camperdown campuses, within the Tech Central precinct. The Accelerator will tackle some of our most complex health challenges, including cancer and neurodegenerative diseases and position Sydney as a global leader in biomedical research. 

Scientists at the Accelerator will conduct cutting edge research into the building blocks of life, regenerative medicine, drug discovery and medical device development and harness the latest in nanotechnology and gene and stem cell therapy to transform health outcomes in the state. 

Vice-Chancellor and President, Professor Mark Scott AO, said the investment is a key component of the University’s new 10-year strategy. 

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https://www.itnews.com.au/news/south-australias-aged-care-ai-trial-produced-12000-false-alarms-584693

South Australia's aged care AI trial produced 12,000 false alarms

By Ry Crozier on Sep 1, 2022 8:35AM

In the space of a year.

A trial of CCTV and AI technology to detect accidents or abuse in two aged care facilities in South Australia produced 12,000 false alarms in a year, a review has revealed.

The Australian-first project was intended to pilot the use of cameras and AI to aid monitoring of residents under care, with a view to making the lives of staff easier.

However, a review of the pilot by PwC [pdf] showed the technology produced false positives at such a rate that alert fatigue among staff set in, and at least one actual incident - a resident falling over - went unresponded to.

The technology was programmed to detect four key incident types, defined as “falls, assist, call for help and/or screams”.

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https://www.innovationaus.com/botched-aged-care-ai-camera-trial-generates-12000-false-alerts/

‘Botched’ aged care AI camera trial generates 12,000 false alerts


Justin Hendry
Editor

1 September 2022

A 12-month pilot of AI-based surveillance technology designed to detect falls and abuse in two South Australian aged care homes generated more than 12,000 false alerts, a review has found.

The sheer number of alerts created alert fatigue that “overwhelmed” already overworked staff, and in at least one instance, the persistent false alerts meant a staff member did not respond to a true resident fall event.

The CCTV pilot began at Mt Pleasant Aged Care and Hortgate House in March 2021, with cameras and microphones installed in common areas and resident bedrooms. Consent for the recording devices to be turned on in bedrooms was given by 41 of the 57 residents or their guardians.

The project aimed at “exploring the acceptability and viability of using surveillance and monitoring within residential care settings” against the backdrop of improving the quality of support and safety in aged care.

Confronting reports about the sector were heard during the three-year Royal Commission into Aged Care Quality and Safety, which made dozens of recommendations for improvement in its final report in March 2021.

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https://www.australianageingagenda.com.au/technology/lumary-joins-forces-with-hayylo/

Lumary joins forces with Hayylo

Healthcare software provider for the disability and aged care industries Lumary and aged care service platform Hayylo have partnered.

“Our partnership with Hayylo is about the all-important circle of care,” said Lumary head of strategic partnerships Rick Russo. “There is a market need for an integrated digital solution that supports communication between everyone involved in the planning and delivery of care – connecting clients with their families, communities and service providers so collectively they can make decisions and improve care outcomes.”

Hayylo is an ITAC-award winning platform that connects key people across aged care services in a unified platform with secure alerts, enquiries, social updates and messages via a customer’s preferred channel – including app, SMS, phone, and email.

As providers’ need for improved communication, cost efficiency and greater transparency across facilities continues to grow, the partnership couldn’t have come at a better time, said Mr Russo.

“Hayylo is industry-specific, fit-for-purpose and user-friendly. At Lumary, it is important to us that we always deliver the best user experience for all stakeholders involved and this partnership supports that.”

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https://wildhealth.net.au/band-aid-solutions-just-wont-do/

31 August 2022

‘Band aid solutions’ just won’t do

By Harriet Grayson

A lack of collaboration, not an absence of technology, remains the biggest hinderance to reforming healthcare in Australia, according to Kylie Woolcock, newly appointed CEO at Australian Healthcare and Hospitals Association (AHHA). 

“[There’s] no doubt that we have a wonderful health system and a competent health workforce. 

“But we just need to focus on looking after our workforce and ensuring that their skills are used effectively, and ensure their work aligns with the reason why they entered the health workforce to start with in order to improve health outcomes.” 

In an interview with Wild Health, Ms Woolcock discussed barriers that must be addressed in order to build a more connected health system; and how we might start paving the way for primary care to embrace technology in the same way as hospitals.  

“Innovative solutions are really challenged by regulation, by policies, by cultures across the fragmentation that is our system, whether it’s different government sectors, agencies, professions, or services. 

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https://wildhealth.net.au/nib-invests-in-text-consult-business/

28 August 2022

NIB invests in text-consult business

By Francis Wilkins

NIB’s acquisition of a majority stake in telehealth provider Midnight Health this week bolsters its push into “self-managed healthcare”, with patients able to access short, text-based GP consultations via Midnight Health’s hub.health brand. 

This kind of move has historically left the general practice community uneasy. 

While GPs and doctor groups have raised concerns about some telehealth services due to the absence of face-to-face care, NIB defended Midnight Health’s approach, noting that in cases such as rural and remote health, “something is better than nothing”.  

NIB’s $12 million investment in Brisbane-based Midnight Health, announced earlier this week, follows a $4m investment in November 2021, which delivers the private health insurer a majority stake in the health-technology startup. 

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https://www.hospitalhealth.com.au/content/clinical-services/news/ai-model-to-predict-anti-seizure-medication-456414288

AI model to predict anti-seizure medication

Wednesday, 31 August, 2022


A study led by Monash University has demonstrated an artificial intelligence (AI) model that can potentially predict the best personalised, anti-seizure medication for patients with newly diagnosed epilepsy.

The predictive model, once fully developed, would spare these patients the uncertainty of not knowing when their lives would be returned to normal by taking anti-seizure medications, and possibly the harmful side effects associated with some drugs.

Professor Patrick Kwan, a neurologist and researcher from the Monash Central Clinical School’s Department of Neuroscience, is leading an international collaboration that is ‘training’ the deep-learning prediction model (deep learning is a type of machine learning).

Epilepsy affects 70 million people worldwide. Currently, choosing anti-seizure drugs for a patient is a process of trial and error with clinicians unable to predict which drug a particular patient will respond to, Kwan said. 

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https://www.hinz.org.nz/news/615471/ePrescription-Service-to-cover-controlled-drugs.htm

ePrescription Service to cover controlled drugs

Tuesday, 30 August 2022  

NEWS - eHealthNews.nz editor Rebecca McBeth

The ePrescription Service is being expanded to include controlled drugs and increase the period of time covered by a single ePrescription.

The Covid pandemic
significantly increased use of the NZ electronic Prescription Service (NZePS). The number of eScripts issued rose from around 620,000 in March 2020, to more than 1.5 million in March of this year.

However, the service could not be used for the prescription of any controlled drugs such as morphine.

Health Minister Andrew Little announced at a Digital Health Association (DHA) event in Parliament on August 24 that prescriptions for controlled drugs will no longer have to be in hard copy, with a physical signature.

“We will, finally, be able to say goodbye to fax machines,” he said.

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https://www.hinz.org.nz/news/615268/Digital-projects-successful-in-ACC-Innovation-Fund.htm

Digital projects successful in ACC Innovation Fund

Monday, 29 August 2022  

NEWS - eHealthNews.nz editor Rebecca McBeth

Three data and digital projects are amongst this year’s recipients of ACC’s Innovation Fund.

Five were chosen from more than 100 applications and have each been awarded $100,000 to develop innovative programmes that will help New Zealanders recover from injury faster. 

HealthOne has received a grant to develop a digital interface enabling ACC allied health providers access to the South Island shared electronic record system.

HealthOne general manager Rachael Page says ACC providers in allied health organisations have long been asking for access to the system.

“This grant means we can finally progress the innovative integration work and further begin to welcome allied health providers to the HealthOne community,” she says.
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https://news.wapha.org.au/clinical-yarning-elearning-program-improving-communication-in-aboriginal-health-care/

Clinical Yarning eLearning program improving communication in Aboriginal health care

29 Aug 2022

Aboriginal health

Good communication between clinicians and patients is the foundation of high-quality health care, however cultural and language differences between clinicians and patients can make this challenging at times.

Aboriginal health is not just physical wellbeing but refers to the social, emotional, and cultural wellbeing of the whole community. To improve the quality and cultural security of care for Aboriginal patients and their families, the WA Centre of Rural Health at the University of Western Australia has launched the Clinical Yarning eLearning program.

The Clinical Yarning eLearning program provides clinicians with skills and tools to enhance clinical communication with Aboriginal patients. It is based on the research yarning framework developed by Professor Dawn Bessarab.

Clinical yarning is a style of communication that enables health clinicians to engage with Aboriginal patients in a way that is culturally appropriate and friendly.

For further information on Clinical Yarning:

Visit the website www.clinicalyarning.org.au

Watch the video Clinical Yarning Introduction

Read the paper Yarn with me: applying clinical yarning to improve clinician–patient communication in Aboriginal health care

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https://developer.digitalhealth.gov.au/specifications/national-infrastructure/ep-3620-2022/dh-3615-2022

My Health Record Software Vendor Welcome Pack - Vendor Declaration Form Instructions v20220216

This document assists vendors in completing the My Health Record Conformance Vendor Declaration Form.

Identifier:  DH-3615:2022

Date:  16-02-2022

Size:  852.11 KB

Type:  application/pdf

SHA256 Checksum: 

4afe90fcb880eea336e950fb568fec0fb536ea6d2481d07905db643b754f5699

Hide Also belongs to these file packages

My Health Record Software Vendor Welcome Pack v20220216

My Health Record Software Vendor Welcome Pack - Vendor Declaration Form Instructions v20200311

Published: 11-03-2020

My Health Record Software Vendor Welcome Pack - Vendor Declaration Form Instructions v20190903

Published: 03-09-2019

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https://build.fhir.org/ig/AuDigitalHealth/ci-fhir-r4/namingsys.html

Australian Digital Health Agency FHIR Implementation Guide 0.1.0

Naming Systems

Identifier systems

The following identifier systems are defined using a NamingSystem resource and form part of this implementation guide.

Identifier systems are for use in the system element of the Identifier data type. If a URI is defined here, it SHALL be used in preference to any other identifying mechanism. If an identifier system is not listed here, the correct URI may be determined by working through the following list, in order:

  • HL7 AU Base Implementation Guide for the associated Identifier profile
  • the HL7 OID Registry or International OID Registry
  • the documentation associated with the identifier
  • consulting the owner of the identifier
  • requesting advice from the Australian Digital Health Agency

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https://www.nationaltribune.com.au/australian-digital-health-agency-seeking-expert-health-advisors/

Australian Digital Health Agency seeking expert health advisors

Health

30 Aug 2022 8:21 am AEST

The Australian Digital Health Agency is seeking applications, through a Request for Tender process, for suitably qualified, experienced, and interested individuals to join their group of expert advisors.

Digital Health Expert Advisors are critical to this role and support the Agency by applying everyday health industry experience to the design, development and implementation of Agency products and services. This includes focusing on the clinical safety, quality and usability of all products and services developed by the Agency, and the systems within which the Agency operates.

– Subject matter expertise: contributing clinical and/or digital health subject matter expertise into the Agency’s work program to ensure that our products, services and activities align with contemporary clinical practice and are high quality, clinically safe and usable;

– Strategic advice: providing strategic advice within their area(s) of expertise, on approaches, processes, services and products, via participation in expert committees, advisory groups and other forums;

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https://www.ada.org.au/News-Media/News-and-Release/Latest-News/Australian-Digital-Health-Agency-seeking-applicati

Australian Digital Health Agency seeking expert health advisors

30 August 2022

The Australian Digital Health Agency is seeking applications, through a Request for Tender process, for suitably qualified, experienced, and interested individuals to join their group of expert advisors. 

Digital Health Expert Advisors are critical to this role and support the Agency by applying everyday health industry experience to the design, development and implementation of Agency products and services. This includes focusing on the clinical safety, quality and usability of all products and services developed by the Agency, and the systems within which the Agency operates. 

- Subject matter expertise: contributing clinical and/or digital health subject matter expertise into the Agency’s work program to ensure that our products, services and activities align with contemporary clinical practice and are high quality, clinically safe and usable; 

- Strategic advice: providing strategic advice within their area(s) of expertise, on approaches, processes, services and products, via participation in expert committees, advisory groups and other forums; 
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https://healthcarechannel.co/australian-digital-health-agency-moves-for-an-improved-healthcare-system/

Australian Digital Health Agency moves for an improved healthcare system

Ritchelle Drilon Aug 30, 2022

The Australian Digital Health Agency has signed a Memorandum of Understanding with Health Level Seven Australia Ltd (HL7) to support the robust development and implementation of digital health standards and specifications to help improve connectivity across the national healthcare system.

Agency CEO Amanda Cattermole said the Agency’s partnership with HL7 affirms the importance of a thriving digital health standards ecosystem and would have a direct impact on consumers gaining better access to their health information through the Australian healthcare system.

“Digital health standards are critical to the safe, secure and seamless movement of consumer health information between different healthcare providers,” she said.

“Fostering and enabling interoperability in the health system is critically important and standards have a key role to play.

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https://allevents.in/greenacres/introduction-to-my-health-record/10000406628375417

Introduction to My Health Record

Thu Sep 22, 2022

Introduction to My Health Record

Learn how to download and use My Health Record with help from our Digital Team.

About this Event

In this session, gain an overview of the platform as well as an opportunity to access and use a My Health Record.

Bookings Required.

Refreshments provided.

You may also like the following events from City of PAE Libraries:

Also check out other Health & Wellness Events in Adelaide.

Tickets

Tickets for Introduction to My Health Record can be booked here.

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https://allevents.in/greenacres/introduction-to-my-health-record/10000406628375417#

Introduction to My Health Record

Thu Sep 22, 2022

Find Tickets

Introduction to My Health Record

Learn how to download and use My Health Record with help from our Digital Team.

About this Event

In this session, gain an overview of the platform as well as an opportunity to access and use a My Health Record.

Bookings Required.

Refreshments provided.

You may also like the following events from City of PAE Libraries:

Next Thursday, 3rd September, 06:00 pm, Port Adelaide Enfield Anime Club in Enfield

This October, 4th October, 01:00 pm, Parks Repair Café in Angle Park

Happening on, 20th June, 01:00 pm, IoT Experimenters in Greenacres

Also check out other Health & Wellness Events in Adelaide.

Tickets

Tickets for Introduction to My Health Record can be booked here.

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https://itwire.com/it-people-news/people-moves/nbn-exec-brad-whitcomb-appointed-as-telstra-group-executive-for-consumer-and-small-business.html

Wednesday, 31 August 2022 08:44

NBN exec Brad Whitcomb appointed as Telstra group executive for consumer and small business

By David M Williams

Telstra has announced its new group executive for consumer and small business will be Brad Whitcomb, making the jump from chief customer office for NBN Co. He replaces Michael Ackland who has transitioned to chief financial officer.

Incoming Telstra CEO Vicki Brady said Whitcomb joins Telstra with extensive global experience in telecommunications customer roles.

“Brad has had a remarkable career with a long list of customer-focused roles across the US, Japan and Australia. In his current role as chief customer officer for NBN Co, he is accountable for delivering more than $5 billion in annual wholesale broadband services revenue across a range of access technologies, giving him an intrinsic understanding of the Australian telco market,” Brady said.

Whitcomb has spent over eight years at NBN Co in various roles, including accountability for residential customers, strategy, culture and transformation.

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https://www.itnews.com.au/news/nbn-cos-brad-whitcomb-to-head-to-telstra-584655

NBN Co's Brad Whitcomb to head to Telstra

By Ry Crozier on Aug 31, 2022 8:45AM

Starts next year.

NBN Co’s chief customer officer Brad Whitcomb is set to shift to Telstra after almost eight-and-a-half years with the government-backed network operator.

Telstra said in a statement that Whitcomb would replace Michael Ackland as group executive of consumer and small business.

Ackland was promoted to chief financial officer at Telstra in early May, replacing Vicki Brady who is now the incoming Telstra CEO.

Brady said that Whitcomb “has had a remarkable career with a long list of customer-focused roles across the US, Japan and Australia.”

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Enjoy!

David.

Sunday, September 04, 2022

Nursing And Other Health Professions Are Changing Rapidly As Digital Health Penetrates The Workplace!

I strongly suspect this issue does not get enough attention…

Student placement and the use of digital systems

Aug 29, 2022 | Aged care, Community Chats, Community of Practice, Data, Digital Health, eHealth, Innovation, Nursing & Midwifery Informatics

Sally Duncan

Chief Nursing & Midwifery Information Officer, Northern Sydney Local Health District

Before digital health, things were much simpler for both the student nurse, and midwife, in relation to learning how to document assessments, medications, observations, and care. Back in the early eighties, when I trained in both areas, we had a very hands-on integrated approach to learning how to document, compared to today’s world, with basic observational charts, fluid balance charts, medication charts and what was known as a ‘Nursing/Midwifery Kardex’ to document care and plans. What we learnt around nursing and midwifery documentation in the classroom, was then emulated on our placements under the supervision of the registered nurses/midwives and tutors. At the end of each placement, we mastered the art of caring for and documenting our patient’s/woman’s/baby care assessments, goals, treatments and interventions, for that specialty/area.

Today, it has become much more complex. There is not only paper documentation but more often than not there is a digital health record and other digital health technologies to learn. Do the current nursing and midwifery undergraduate students have the same experience in preparing them for their placements? With the fairly rapid rise in digital health, it seems university education around preparing students for digital health systems has lagged. In 2013, Baillie et al. [1] conducted a survey that investigated student nurse and midwife experiences of using the electronic medical record (EMR) in practice. The results indicated that there needed to be more opportunities to enable students to be more competent in using EMRs prior to placement, with a request for more hands-on practice in a simulated environment. Following the published paper, a collaboration between the university and its affiliated health organisations established governance around onboarding and guidelines around usage, and also provided formalised EMR training for their students.

A recent qualitative study by Peacock, Slade & Wilson [2] around nursing and midwifery students’ perspectives on the use of digital systems during placements revealed that moving between paper and digital records was quite taxing. Whilst they recognised the benefits of documenting digitally, the participants considered paper much easier to use and documenting digitally at the bedside proved onerous for many. Again, for many, a lack of preparation and access granted to them to use the system was often challenging and frustrating. The study summarised that the students felt that being able to practice in a simulation centre with the ability to have interactive modules prior to placement would make them more confident in using the systems to review and document patient care.

In addition to learning how to document in an EMR, a student also has to work with other digital technologies, such as smart intravenous pumps, wearables, virtual care, and cybersecurity, to name a few. They are also required to understand nursing and midwifery data terminology, and the use of clinical technologies is only looking to expand in the future [3-4]. Within Australia we have had an explosion of digital health maturity – Queensland Health has adopted a single digital record strategy [5], NSW is in the process of finding a vendor to consolidate the domains of its digital records and pathology into one single digital health platform [6], and both Western Australia and Tasmania have announced budget and planning for a single digital health platform [7-8].

Where does this leave our student nurses and midwives today? Some great work has already been achieved to assist not only students but the general nursing and midwifery workforce, with the development and publication of a National Nursing and Midwifery Digital Health Capability Framework [3], and free competency-based learning modules hosted by the Australian College of Nurses [9]. According to the Australian College of Nursing, “interactive online resource has been developed specifically for Australian nurses, midwives and nursing and midwifery students to support the development of their knowledge and skills in relation to digital health technologies. The content of the resource has been informed by the National Digital Health Strategy, the development of which was led by the Australian Digital Health Agency (ADHA) in collaboration with key stakeholder groups including, amongst others, the Australian College of Nursing” [10].

Most students are frequent internet and social media users [10]. But for them to gain confidence in using digital health systems, there is a need for more digital health training [10-13], particularly around learning the concepts of digitally documenting, and a standardised approach, given there appears to be so much variability currently across university curricula. Foundational nursing and midwifery studies need to provide more digital health literacy interventions [10].

More here:

https://digitalhealth.org.au/blog/student-placement-and-the-use-of-digital-systems/

The increasing use of Digital Health technology is becoming more and more routine these days with the use of Electronic Health Records and other documentation systems – in nursing and elsewhere – becoming routine.

The issue in all this is just how well Digital Health skills and understand are being delivered to current cohorts of trainees and just how well  those  who were trained over the last 40 years are bought up to speed.

The ADHA appears to be aware of the problem but does not seem to be really pushing hard to dramatically improve things being much more focused on their “products”. See here:

https://www.digitalhealth.gov.au/healthcare-providers/initiatives-and-programs/workforce-and-education

The AIDH is similarly aware of the problem and runs courses (CHIA) for digital health experts and sees the need for workforce growth but does not appear to be seized of the need to get down to the grass roots of front-line workers.

Maybe a conference on how the skills of those on the front line can be improved and some wider research on just where things stand and where the gaps are could be pretty useful. Action would surely problem – as will the action follow after the regular coronial findings of software problems in the sector.

A recent reminder came to notice on the topic last week. See here:

https://medicalrepublic.com.au/whos-to-blame-when-the-software-gets-it-wrong/75863

While all this stuff is not as exciting as other Digital Health issues to most we need to research and plan properly to safely and comprehensively in this vital domain or much of the more exciting efforts won’t really get all that far.

Time for the ADHA, the States, Colleges and the AIDH to develop, fund and implement a coordinated national approach to Health Workforce Digital Health knowledge and literacy!

David

AusHealthIT Poll Number 647– Results – 4th September, 2022.

Here are the results of the poll.

Are You Getting Some Value From Reading This Blog?

Yes                                         55 (98%)

No                                           1 (2%)

I Have No Idea                       0 (0%)

Voters: 56

A clear vote suggesting at least some are finding the blog useful

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. and a clear outcome. 

0 of 56 who answered the poll admitted to not being sure about the answer to the question!

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

David.