What Do You Think Of Australia’s 10 Year Digital Health Plan?

Somehow this was released while we were all busy with other things.

Australia's digital health pipeline in 10 years

The government is doubling down on modernising My Health Record and building a framework for national health information sharing.

By Adam Ang

January 12, 2024 03:26 AM

In the coming decade, Australia is expected to carry out several digital health initiatives that it outlined in its recently published blueprint. 

An accompanying Action Plan to the 2023-2033 Digital Health Blueprint explains each initiative and how target outcomes are going to be met in short, medium, and long-term horizons.

Many of those initiatives, such as electronic prescribing, the Health Delivery Modernisation Program, and several digital population health tools, are ongoing. Meanwhile, a couple of initiatives outlined are in the pipeline, including:

·         continued modernisation of My Health Record and making sharing of other key health information by default to My Health Record;

·         connecting Allied Health to My Health Record;

·         supporting preliminary work to develop a national legislative framework on health information sharing in states and territories;

·         establishing Genomics Australia, which will guide the responsible collection, storage, use and management of genomic data;

·         Dollars Going to Care, which will publish standardised and benchmarked financial information of residential aged care providers, promoting financial transparency and accountability;

·         Government Provider Management System, which will allow aged care providers to self-manage, view, and maintain their records with the government

WHY IT MATTERS

The modernisation of Australia's digital health record system is a major focus of the Department of Health and Aged Care in the coming years. It is working to fulfil some of the recommendations provided by the Strengthening Medicare Task Force last year, including overhauling the "clunky" My Health Record and establishing robust national governance and legislative frameworks to better connect health data across the health system.

"Planning for the modernisation of the My Health Record system to meet [national health information] sharing requirements for consumers and healthcare providers is underway, with future phases to be considered by [the] government," it said. 

Last year, the government also invested A$5.8 million ($3.8 million) to help allied health software vendors connect to My Health Record. Funding was also set aside for initial legislative policy and analysis work by states and territories to establish a national legislative framework for national health information sharing across settings and borders.

THE LARGER CONTEXT

Australia's Digital Health Blueprint envisions a "trusted, timely and accessible use of digital and data underpins a personalised and connected health and wellbeing experience for all Australians."

It has identified four key outcomes which revolve around digitally empowering consumers and the health workforce, safe data and information sharing, and building modern digital foundations of a standard-based health system. 

The blueprint was created to meet growing expectations and demand from consumers to have more control over their health through digital means. It consolidates the federal government's long-term investment in digital health, as well as complements the National Digital Health Strategy, which is currently being redefined.

More here:

https://www.healthcareitnews.com/news/anz/australias-digital-health-pipeline-10-years

Here is the reference:

https://www.health.gov.au/sites/default/files/2023-12/the-digital-health-blueprint-and-action-plan-2023-2033_0.pdf

Digitl Helth Blueprint 2023-2033

A more personlised and connected helth and wellbeing experience for all Australians

There is extensive commentary here:

How to make GP digital health gravy

By Jeremy Knibbs  - 12 January, 2024

A short critique of our Gravy Day digital health blueprint.

On 21 December last year DoHAC published what should rank as one of our most important health planning summary documents for decades: the Digital Health Blueprint

2023-2033. So I wrote a quick song …

Hello Dan, it’s Jeremy here, I hope you’re keeping well
It’s the 21st of December, and they’re ringing the Blueprint bell
If you turn out to be a saviour, we’ll be out of here by July (2033)
Hope to kiss patients on Christmas Day (2033), please don’t let them (continue to) cry…

GPs will be familiar with the song but probably not Dan(iel) McCabe, who is the main man inside the Department of Health and Aged Care running a pretty good new digital health agenda for the country, and one which will eventually impact GPs in a big way.

So what’s with the timing on something so important?

I was Christmas shopping at the time the plan came out, as I suspect were most other people who might have found it interesting.

We at TMR had largely stopped all our news services to go on break. We do still break big news over Christmas if it’s big enough, but even though this is a very important document, there wasn’t exactly any breaking news in it.

I did eventually read the blueprint and its associated action plan over my break. When East of Eden starting to get really slow (after the 350-page mark if you haven’t read it yet), I’d stop every now and then and read a bit of the blueprint, until eventually I’d read it all.

Maybe this explains the timing.

People need to be relaxed and have nothing much else to do to get through an important summary document like this, thus allowing them to savour the ideas a bit longer and ponder what might really come of it.

That’d be my get best attempt at a “get out line” if Mark Butler sent a WTF email though to my boss on the timing of the plan’s release – which if he didn’t, he probably should have.

If you haven’t read it yet, and everyone – including GPs – should at least try, here’s a tip: skip the blueprint and read the action plan first.

The blueprint is the sort of political PR aspirational puffery that might turn away the most hardened digital health nerd from persisting even with the far more important action plan.

For those non hardened nerds who want to save even more time and not even give the action plan a decent go (I’m going to assume a lot of GPs might be in this category), here it is in shorthand (note, my interpreted words not the blueprint’s):

By 2033 we want:

• Patients and healthcare providers to be able to share meaningful and important health data in real time anywhere, anyhow
• We want to empower both providers and patients to make much better health decisions in real time using this meaningful information
• We want to make the system transformationally (not a real word, but it fits) more efficient, not just for cost but convenience, for providers and patients

We’re going to do that by:

• Improving the relevance and functionality of the My Health Record significantly
• Getting technology vendors and providers to play ball by quickly agreeing to sets of standards which would enable modern web-based sharing technology to be implemented nationwide and create the ability for meaningful real-time data sharing
• Aligning the states, the federal government and emerging private providers on healthcare data sharing standards, data privacy and sharing legislation and technology so it all works for providers and patients

Of course this is a somewhat kindly (and horrifically simplified) summary (and you probably can’t see the word GP in there, but you’re there big time, believe me).

The first thing I’d say is that to at least have a government with these collective goals and some plan to achieve them – no matter how insanely wicked many of us know the detail under it actually is – is probably a very important starting point for transforming health in Australia, and a not a point we’ve been at, probably since someone pretty clever thought of Medicare (Medibank back then) in the early 70s, and how that might help things along much better for quite a few years.

On the other hand, given just how wickedly complex the issues are, you soon realise that what detail there is is not the detail required to inspire a lot of confidence that this plan is achievable, even given its 10-year horizon.

The action plan does list quite a few actual projects, either in play already, or in planning (way too many in planning), and most of them do go to the overall goals above, some even with just a whisper of co-ordination, which is another glass-half-full observation of the document.

They include (with some short observations in brackets):

• modernising the My Health Record (“modernising” says it all given we’ve spent over $2 billion and 10 years on it for no net meaningful result so far)
• enhancing digital medication management (expand a pretty good start on e-scripts across hospitals, aged care and so on)
• creating national standards to support real-time data sharing (doable big goal with a lot of power to change things quickly; question is, when?)
• create e-requesting for pathology and imaging in the mould of the national e-scripts service (big issues here emerging with software vendor resistance, especially GP software vendors – more below)
• create a national Health Information Exchange capability (sounds good but no one is sure how it could happen, given how eclectic our state-federal system is; and if it could do what is being suggested it might, why would you need the My Health Record?)
• equip the health workforce digitally (whatever that means, and, the key issue here, what workforce? We need digital faster precisely because we know we are never going to have the workforce we’re predicted to need)
• fix mental health with lots of cool new digital apps (I’ll expand below)
• get genomics fixed in Australia and integrate that infrastructure to the whole plan (noble goal and a smart thing to do, but probably completely unrealistic given the major basic interoperability issues to overcome first and the government funding paradigm)
• fix aged care with all of the above (it’s getting silly now, the plan is far too sprawling, but you can’t not mention aged care in a digital health blueprint)
• and a throwaway par about AI and health (I guess there had to be one as this is a digital plan and AI is going to help at some point if we get it right).

You may have recognised that some of really cool things in here that we’ve done already (electronic scripts for instance) are not the product of superior goals and planning from the past, but accidents of a pandemic that forced us all to drop our weird bureaucratic and protectionist behaviours for a couple of years.

But everything in this list (bar perhaps the My Health Record) all go to a set of collective aspirations and goals which are mostly sensible.

You may also have again noted that there is still not a lot about general practice. But keep reading. If the government does what it can do now fast, general practice is going to see a lot of change in how it interacts with the rest of the healthcare system and its patients within a couple of years.

Back to my awkward reinterpretation of the first verse of a Paul Kelly classic for a sec.

Can we afford to wait 10 years to achieve some of the key goals in this plan?

It’s a question I think everyone in charge should be pondering a lot harder following the release of this blueprint.

We know the time frame is not the government giving themselves tons of wiggle room to protect themselves. If you include some of the big throwaways in the blueprint at the end – “we’re gonna fix aged care and mental health with this here plan” – 100 years might be a better time frame.

Even if we look at the basic obstacles this plan faces in just getting data sharing, standardisation and technology alignment going, 10 years is pretty optimistic.

Ten years can also easily be argued a wise time frame if we are to avoid large scale and very expensive screw-ups given the complexities, politics and interdependencies associated with healthcare provision. Mind you, if anyone ever wants to get honest about the ROI of more than $2 billion for the My Health Record, it’s pretty hard to see how anyone today could engineer an ongoing mistake that big again.

So, it’s sensible to plan this long, right?

I don’t think so.

Here’s why:

• Some parts of our system are going to crash almost certainly soon without bolder faster action. The most immediately identifiable collapse is within most aspects of our health workforce. All areas of workforce are vita and stressed but if our general practice network collapses our system will collapse entirely and the time frame for fixing that will be a lot longer than 10 years.
• Ten years is good and bad for healthcare planning. The bad side is that a lot of organisations and people can keep doing average and even bad things, often driven by natural commercial pressures, without being outed in such a long-term plan. Such constant long-term resistance can be very destructive in the end. Being bolder makes everyone clearer about what is going on and provides very little room for bad actors to hide.
• We’ve wasted maybe 20 years in Australia trying to get our act together in digital health and we find ourselves a very long way behind. We should learn from our many and large mistakes, trust our new plan and instincts, and not be afraid to be a little bold. We owe it to Australian health consumers and providers.

I think most people looking at where we are might recognise a climate change-type problem in our healthcare system.

Nearly everyone’s livelihoods and security – perhaps except GPs who are getting slaughtered anyway, so haven’t got a lot to lose through change – are tied in some way or another to the system not changing, or at the least not changing fast.

Vastly more follows here

https://www.medicalrepublic.com.au/how-to-make-gp-digital-health-gravy/104186

Having gone this far I am sure most readers need a summary in a line of two!

Basically the Government wants to run the decrepit, dysfunctional My Health Record for more years forward that I expect to be on this earth and still hope that it will be suddenly found useful and worthwhile.

In the meantime, as far as I can tell, the rest of Australia is getting on with their life and the usage of the myHR is as low as ever.

Have a look here to see just what little change there is in record use over 18 months or so. The thing just sits there with data going in and no apparent impact or use.

https://www.digitalhealth.gov.au/initiatives-and-programs/my-health-record/statistics

The key to all this is the lack of clinical impact and the total lack of any attempt to measure impact.

As we go into 2024 and beyond the myHR becomes less relevant and hopefully other Digital Health initiatives will be better supported and encouraged.

For the sake of the Almighty can’t we kill off the myHR and spend the funds on the other much more useful Digital Health initiatives like referrals and prescribing! That would be a Blueprint we could all agree on!

David.

 

It Looks Like 2024 Is Really Going To Have Us Face Some Heard Questions In The AI Domain!

This popped up over the break: 

New laws to curb danger of high-risk artificial intelligence

By Lisa Visentin

January 14, 2024 — 5.00am

Legislation will govern the use of artificial intelligence in high-risk settings such as law enforcement, job recruitment and healthcare, with the Albanese government poised to legislate mandatory safety requirements in its first steps towards regulating the technology.

Industry and Science Minister Ed Husic said a new advisory body would work with government, industry and academic experts to devise the best legislative framework and define what constituted high-risk technologies and their applications across industries.

He said the starting point for assessing high risk would be “anything that affects the safety of people’s lives, or someone’s future prospects in work or with the law. Those are areas that are likely to be targeted by future changes.

“These technologies are going to shape the way we do our jobs, the performance of the economy and the way we live our lives. So what we need to ensure is that AI works in the way it is intended, and that people have trust in the technology.”

The move to legislate safeguards for high-risk AI forms a key plank of the government’s interim response to a consultation process launched last year on the safe and responsible use of AI, to be unveiled by Husic this week. The government received more than 500 responses to its discussion paper, including from tech giants Google and Meta, major banks, supermarkets, legal bodies, and universities. It said almost all the submissions called for action on “preventing, mitigating and responding” to the harms of AI.

Many countries are grappling with how to respond to the emerging risks from AI without stifling innovation, as the rampant take-up of generative chatbots like ChatGPT and automated machine learning systems has highlighted the potential for the technology to revolutionise entire industries. Consulting firm McKinsey has calculated the technology could add between $1.1 trillion and $4 trillion to the Australian economy by the early 2030s. website called ChatGPT is raising questions about the role of artificial intelligence in our education, work and relationships.

But the breakneck speed of AI development has triggered concern over the potential ethical and moral harms posed by its use and has led to a furious debate in tech circles. Last year, more than 350 researchers and executives working in AI, including ChatGPT creator and OpenAI chief executive Sam Altman, signed an open letter warning that mitigating the “risk of extinction from AI should be a global priority alongside other societal-scale risks such as pandemics and nuclear war”.

Husic said the decision to focus on high-risk technologies while leaving low-risk applications unregulated was driven by the view that the vast majority of AI use was safe and driving major advancements in areas like education and medicine.

The government’s approach, at this stage, does not include mirroring steps like those taken by the European Union which, through its proposed AI Act agreed to by policymakers in December, will seek to ban certain uses of AI that pose an “unacceptable risk”. These include the creation of social credit-scoring systems, biometric profiling, and scraping of images from the internet to create facial recognition databases.

But Husic said the government would keep an open mind to stricter regulatory responses and was watching developments in other countries.

“If other jurisdictions like the EU are doing things that we think will work locally, then we’re very open to it. If there is a potential impact on the safety of people’s lives or their future prospects then we will act,” he said.

The new AI advisory body will consider options for the types of legislative safeguards that should be created and whether these should be achieved through a single AI Act or by amending existing laws.

One issue it will likely consider is how best to safeguard against algorithmic bias arising from incomplete data sets that can discriminate against people based on characteristics such as race or sex, which the Industry Department’s discussion paper highlighted as a major concern. The paper referenced overseas cases of law enforcement agencies relying on AI models to predict recidivism that disproportionately targeted minority groups, and employers using recruitment algorithms that prioritised male over female candidates.

Here is the link:

https://www.smh.com.au/politics/federal/new-laws-to-curb-danger-of-high-risk-artificial-intelligence-20240111-p5ewnu.html

There was also an associated editorial! 

 Government must meet challenge of identifying high-risk areas of AI

By The Herald's View

January 14, 2024 — 5.00am

The consensus of thinking around artificial intelligence (AI) is that 2024 is the year when we will really start to feel its impact.

The abilities of ChatGPT to write poetry in the style of William Wordsworth, for example, or to compose computer coding is now familiar. The useful and commercial potential of AI when it comes to medicine and science is rapidly being investigated and exploited. Researchers are now exploring whether AI can be used to interpret the results of bowel cancer scans faster and more accurately than a human.

Much like the impact of the launch of the World Wide Web in 1993, AI comes with very obvious and immediate benefits as well as yet-to-be-realised and potentially detrimental ramifications.

Apposite, then, that the federal government will take steps to endeavour to control the impacts of AI applications after a consultation process it began last year, seeking views on whether Australia has the right governance in place to support the safe and responsible use and development of AI.

As our political correspondent Lisa Visentin writes today, more than 500 submissions were received in response to the government’s discussion paper, and almost all of them called for the government to act on “preventing, mitigating and responding” to the harms of AI.

As a result, the government will this week unveil its interim response, which will include mandatory safety guardrails for AI in high-risk settings. The government concedes: “When AI is used in high-risk contexts, harms can be difficult or impossible to reverse such that specific guardrails for AI design, development, deployment and use may be needed.”

That, it says, could mean amendments to existing laws or through a dedicated legislative framework to be implemented by the establishment of a new expert advisory body.

The government recognises the upside of AI; economic modelling estimates that adopting AI and automation could add an extra $170 billion to $600 billion a year to Australia’s GDP by 2030.

In formulating a policy response, the federal government recognises the vast majority of AI uses are low risk and says legislation that targets high-risk areas allows the low risk to flourish unimpeded.

But therein lies the challenge. We want to enjoy the benefits of AI, but this brings with it the need and responsibility to identify high-risk areas that could have big impacts, particularly irreversible ones.

The European Union is further down the path of legislation, reaching a provisional agreement on the Artificial Intelligence Act to ensure AI in Europe “is safe, respects fundamental rights and democracy, while businesses can thrive and expand”.

The list of banned applications, exemptions, obligations for high-risk systems and proposed guardrails is a complex one.

The definition of high risk includes AI systems with significant potential harm to health, safety, fundamental rights, environment, democracy and systems used to influence the outcome of elections and voter behaviour.

The proposed EU legislation means citizens will have a right to launch complaints about AI systems and receive explanations about decisions based on high-risk systems that affect their rights.

Infrastructure systems (water, gas, electricity), systems determining access to educational institutions or recruitment, law enforcement, border control, administration of justice, biometric identification and emotion recognition are also areas deemed high risk.

Brando Benifei of Italy’s Partito Democratico said after the agreement: “Thanks to the European Parliament’s resilience, the world’s first horizontal legislation on artificial intelligence will keep the European promise – ensuring that rights and freedoms are at the centre of the development of this ground-breaking technology. Correct implementation will be key.”

The Australian government is to be applauded for its early recognition of the potential risks posed by AI. We believe it should now move forward with equal expediency in closely identifying and ring-fencing the high-risk areas. Sufficient financial resources must be given to ensure that it can achieve those goals without delay. Australian citizens should expect nothing less.

Here is the link:

https://www.smh.com.au/national/nsw/government-must-meet-challenge-of-identifying-high-risk-areas-of-ai-20240112-p5ewuc.html

I have the feeling tis is going to be a transitional year as many service and entities figure out just what the role of AI will be, what the economic and human impact will be and what the right way to proceed is.

In healthcare clinical decision support (a form of AI) has been around for decades and many are used to the way our various activities and processes are influenced by automated guidance.

In many other disciplines AI is yet to be explored as fully but you can be sure work is underway apace!

Tools like ChatGPT have made a huge impact and opened thinking widely on what is possible to a huge degree. They are also turning out to be useful testbeds.

I expect an ongoing and fascinating news flow all this year and on into the future. Let me know how I went with this one this time next year!

David.

AusHealthIT Poll Number 729 – Results – 14 January, 2024.

Here are the results of the poll.

Will The Rather Sudden Banning Of Addictive Vapes Nationally Cause A Large Black Market To Emerge Pretty Quickly?

Positive                                                                         46 (100%)

Negative                                                                            0 (0%)

I Have No Idea                                                                  0  (0%)

Total No. Of Votes: 46

As clear a vote as we ever see on this little poll. The message is that the powers that be had better get their act together or there will be addictive vapes everywhere

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

A great number of votes. But also a very clear outcome! 

0 of 46 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.

This Is An Important Statement Of A Perfectly Sensible Position On Health Information Access.

This was released a day or so ago.

GPs and pathologists raise concerns over plans to remove 7-day delay for all pathology results on My Health Record

Royal Australian College of GPs and Royal College of Pathologists of Australasia

The Royal College of Pathologists of Australasia (RCPA) and the Royal Australian College of General Practitioners (RACGP) have warned the Government’s proposal to remove the 7-day delay for all pathology and diagnostic imaging reports on My Health Record may lead to misinformation and patient distress.

Both the RCPA and RACGP support sharing healthcare data with patients, but want the current 7-day delay for tests not already available in real time to remain in place. This allows doctors to help patients understand and interpret results in a safe and caring setting. The colleges also request the Government include them in any future consultation.

President of the RCPA, Associate Professor Trishe Leong, said patients should review results with a specialist.

“The RCPA believes that patients should be fully engaged in managing their care, and access to diagnostic information is part of that management,” Associate Professor Leong said.

“We therefore support the sharing of information without barriers to access, such as the 7-day rule, overall. However, it is critical that if these delays are removed, consumers are advised to review their results with their GP or other specialist and are also provided with evidence-based information on pathology testing such as Pathology Tests Explained, and contact details for general support services, such as GPs and Lifeline.

“Whilst the RCPA acknowledges that there is potential for improved care through the quicker provision of results and less patient anxiety, we must consider the unintended consequences of a patient failing to return for a clinical appointment because results are within the normal range or misinterpreted. This significantly impacts patient care and requires a system for monitoring. Similarly, the impact on healthcare providers needs to be considered, with increased communication from patients to the referring healthcare providers or directly to the laboratories, wanting to know the meaning of an unexpected abnormal result.”

Currently, patients must wait seven days before they can access most pathology and diagnostic imaging reports that have been shared to My Health Record. This delay allows healthcare providers to review and schedule appropriate follow-up with their patients.

Under the proposed changes, the 7-day delay will be removed for all pathology and diagnostic imaging reports, meaning patients will be able to access results as soon as they are shared to My Health Record.

RACGP President Dr Nicole Higgins said the delay gives GPs and patients a vital opportunity to discuss results.         

“We strongly support patients having access to their results and medical history,” Dr Higgins said.

“GPs and other specialists don’t seek to be medical gatekeepers, but we are there to support our patients to understand their results, treatment options and next steps. The 7-day delay gives us and our patients time to make an appointment where we can sit down and have those important conversations.

“Much of the terminology entered into My Health Record, is written for doctors, by doctors, and has to be understood in the context of a patient’s medical history and other health factors and conditions. Patients often get good insights and find support by looking into their results, but it’s important they know what their results mean for them. That’s the value of having a usual GP.

“A pathology result can be stressful, so there’s real value to having a two-way discussion with a trusted medical professional. There is also a worrying amount of vague, unapplicable, and outrightly incorrect information online. Patients who have worked with a doctor to understand their health are better supported to know what information applies to them, and what doesn’t.

“If this change does go ahead, at the minimum it should not happen without an education campaign for patients so they can understand the risks of interpreting their own results. There will need to be clear advice in the My Health Record advising patients to discuss results with their doctor.”

Both colleges recommend some diagnostic tests are considered for exclusion if the 7 day rule is removed. This includes anatomical pathology and cytopathology reports, which are often discussed at multidisciplinary team meetings to determine an appropriate clinical path, and genetic test results which often carry broader, more long-term, and more complex implications than other pathology results.

“Anatomical pathology and cytopathology reports can be very complex, and consideration is required as to whether their immediate release is in the consumers’ best interest,” Associate Professor Leong said.

“Genetic test results are often probabilistic, have consequences for family members, have potential psychological impacts, can have unanticipated implications, and vary in their actionability and therapeutic options. Post-test counselling is therefore considered crucial to prevent potential patient harm from specific genetic tests and results.

“Pathologists and requesting doctors are best placed to determine when specific genetic tests or results require post-test counselling. To allow for such counselling, providers should have the discretion to delay releasing results for up to seven days when clinically warranted.”

Noting that there will be exceptions to immediate publication to My Health Record, the RCPA and RACGP recommend that there is broad consultation on the exceptions. The colleges request that they are a partner in those consultations with Government to ensure there is appropriate oversight and governance of these decisions.

About the RACGP

The Royal Australian College of General Practitioners (RACGP) is the peak representative organisation for general practice, the backbone of Australia’s health system. We set the standards for general practice, facilitate lifelong learning for GPs, connect the general practice community, and advocate for better health and wellbeing for all Australians.

Visit www.racgp.org.au. 

About the Royal College of Pathologists of Australasia (RCPA):

The RCPA is the leading professional organisation representing pathologists, medical specialists and scientists who provide pathology testing in Australasia.  Its mission is to train and support pathologists and to improve the use of pathology testing to achieve better healthcare.

For further information on the RCPA, please visit www.rcpa.edu.au or see updates on Facebook - @PathologyRCPA, X (Formerly Twitter) - @RCPAPresident, @PathologyRCPA, or Instagram - @the_rcpa #RCPA #pathology #MedicineIsPathology.

Media contacts:

John Ronan
Media Adviser

Ally Francis
Media Adviser

Stuart Winthrope
Media Officer

Contact: 03 8699 0992 / media@racgp.org.au

Follow us on Twitter: @RACGP and Facebook.

---- End Release.

The position stated above is more than sensible and will minimize worry among patients by making sure results that are concerning are able to be explained by the patient’s doctor to the patient.

David.

 

The AIDH Appoints An Experienced Conference Organiser As CEO – Digital Health Experience Not So Much.

 This release appeared today.

AIDH appoints new CEO

Jan 10, 2024 | AIDH news, Australian Health News, Board, Featured, Member news

The Australasian Institute of Digital Health (AIDH) Board is pleased to advise that Anja Nikolic will soon be joining the Institute as CEO.

Anja has had an extensive career in membership organisations, working across Business Development, Conference/Events Management, Product, Member Services and Communications. She is currently the Chief Executive Officer at the Australian Physiotherapy Association (APA); a national organisation with over 30,000 members.

Anja is excited to take on the opportunity to grow the influence and impact of the AIDH, to support the digital capabilities of the healthcare workforce and achieve our vision of Healthier Lives, Digitally Enabled. Anja will commence at AIDH on 25 March 2024.

The Board would like to thank Mark Nevin FAIDH for his term as Interim CEO since July 2023, through to the time Anja commences in March. Mark has worked tirelessly to lead the AIDH team, support delivery of quality programs, and improve maturity in internal governance and controls. We look forward to continuing to work with Mark in his capacity as a Fellow of the Institute and wish him all the best for the future.

----- End Release

I do really feel it would be nice to have some Digital Health expertise – but there you go!

I guess the AIDH is mainly a conference organiser these days – for better or worse!

David.

Funny How Your Past Can Come Back All In A Rush! A Good Reminder Of Times Past.

 I noticed this a day or so ago.

Colorful Mystery Solved: Scientists Discover Enzyme That Makes Urine Yellow

Finding Could Illuminate Future Studies of Gut Health and Inflammatory Bowel Disease

Researchers at the University of Maryland and National Institutes of Health have identified the enzyme responsible for giving urine a yellow hue, and it’s more than a matter of idle curiosity or grade-school giggles.

The microbial enzyme known as bilirubin reductase was introduced in a study published Wednesday in the journal Nature Microbiology, paving the way for further research into the gut microbiome’s role in ailments like jaundice and inflammatory bowel disease.

“It’s remarkable that an everyday biological phenomenon went unexplained for so long, and our team is excited to be able to explain it,” said lead author Brantley Hall, an assistant professor in UMD’s Department of Cell Biology and Molecular Genetics.

When red blood cells degrade after their six-month lifespan, a bright orange pigment called bilirubin is produced as a byproduct. Bilirubin is typically secreted into the gut, where it is destined for excretion but can also be partially reabsorbed. Excess reabsorption can lead to a buildup of bilirubin in the blood and can cause jaundice—a condition that leads to the yellowing of the skin and eyes. Once in the gut, the resident microorganisms can convert bilirubin into other molecules.

Lots more here:

https://today.umd.edu/colorful-mystery-solved-scientists-discover-enzyme-that-makes-urine-yellow

Reading this I was reminded that 50 years ago I was also interested in bilirubin and its damaging effects on premature neonates. The high bilirubin levels were a marker of an immature metabolism and very high levels often warned of a poor outcome, and a nasty syndrome called kernicterus, which is associated with mental impairment.

I was reminded of this VERY old paper:

Clin Chem  1975 Oct;21(11):1638-43.

Fluorometric determination of "albumin-titratable bilirubin" in the jaundiced neonate

S B McCluskey, G N Storey, G K Brown, D G More, W J O'Sullivan

• PMID: 1164793

Abstract

We report a fluorometric technique for determination of albumin-titratable bilirubin in the jaundiced neonate. Although bilirubin alone has very little native fluorescence, considerable emission is observed in the presence of albumin under acid conditions. Analysis of the plasma sample alone and in the presence of excess human serum albumin solution appears to reflect the bilirubin tightly bound to albumin and the total serum bilirubin, respectively. The difference between these two values has been designated as "albumin-titratable bilirubin". Where the concentration of albumin-titratable bilirubin is considerable, a typical saturation effect is observed. In samples where the circulating bilirubin is strongly bound to endogenous albumin, no change in fluorescence is seen when exogenous albumin is added. Results correlate well with the clinical picture.

Here is the link:

https://pubmed.ncbi.nlm.nih.gov/1164793/

In the 50 years since this work was done it really seems that the importance of neonatal jaundice and what to do about it is well established and that has to be a very good thing!

I have had a quick browse to find a current reference site and this looks like a great place to start and to see how things have moved on since I was first interested!

https://www.ncbi.nlm.nih.gov/books/NBK532930/

Neonatal Jaundice

Betty Ansong-Assoku; Sanket D. Shah; Mohammad Adnan; Pratibha A. Ankola.

Author Information and Affiliations

Last Update: February 20, 2023.

Great to see progress really does happen, and from all over! I certainly can’t take any credit!!!!

Hoping Digital Health news ramps up soon!

David.

It’s 2024 And It Seems Like The Hackers Are Still Winning. For How Much Longer?

This appeared a few days ago:

Low cost, high reward: The hackers holding Australia to ransom

By David Swan and Colin Kruger

January 6, 2024 — 5.00am

If the skull and crossbones wasn’t already threatening enough, the accompanying message made the situation clear.

“If you see this text, then your files are no longer accessible, because they have been encrypted” was the text that greeted workers when they switched on their computers at Cadbury’s factory in Hobart. “Perhaps you are busy looking for a way to recover your files, but don’t waste your time. Nobody can recover your files without our decryption service.”

The Petya ransomware attack in June 2017 halted chocolate bar production in Hobart and ultimately cost Cadbury’s parent company, Mondelez International, an estimated $140 million in lost revenue. It was also among the first of what has become an avalanche of ransomware attacks to hit Australian businesses, which industry insiders say are chronically underprepared to deal with such incidents.

St Vincent’s Health and Court Services Victoria recently joined the fast-growing list of high-profile organisations scrambling to respond to debilitating cyber incidents, which have by now impacted almost every Australian.

The attacks are not an outlier but are instead a “new normal”, according to cyber professionals, who say a cultural shift is needed more than any new suite of technical defences. They say Australia was never a primary target for cybercriminals until recently, and they hope the recent spate of attacks will serve as a belated wake-up call after years of a lack of interest and underinvestment.

Jamieson O’Reilly is the founder of cybersecurity firm Dvuln, which Australian companies and government agencies pay to find IT vulnerabilities. “Security in Australia is by and large still considered a grudge purchase,” O’Reilly says. “We need a cultural shift.”

A 17-year-old can pay less than $100 to gain access to an infected computer belonging to an employee of a billion-dollar company, according to O’Reilly, and the balance of power now rests squarely with the hackers.

While the idea of a teenage “script kiddie” – a novice hacker using unsophisticated tools – might seem like the stuff of a bad 1990s movie, the threat to some of Australia’s biggest businesses is very real.

“Optusdata”, the anonymous hacker who in late 2022 made away with the personal data of more than 10 million Optus customers before backing down from a $1.5 million ransom threat, was described as “unprofessional” and “stupid” by their hacker peers on the dark web.

The Optus mass data breach occurred through an unprotected and publicly exposed end point, meaning anyone who discovered it could connect to it without submitting a username or password. The attack was far from sophisticated, according to O’Reilly and other experts.

“For attackers, especially those utilising low-cost, high-reward strategies, the investment is minimal compared to the potential pay-off, which can range from financial gain to significant data breaches – or even reputational damage to the targeted organisation,” O’Reilly says.

According to the Australian Signals Directorate, an intelligence agency, more than 127,000 hacks against Australian servers were recorded between the 2022 and 2023 financial years. This marked an increase of more than 300 per cent over the prior year – and O’Reilly says that matches what he’s seeing on the ground. 

In the shadows

O’Reilly spends much of his time monitoring the dark web, which ransomware groups use to leak data and boast about their bounties. He regularly reports his findings to the Australian Signals Directorate.

The dark web is a shadowy part of the internet accessible only through special software, allowing users to remain anonymous. It is commonly used for illegal activities such as buying and selling drugs and weapons, as well as stolen credentials.

The group suspected to be behind the 2022 Medibank data breach, Russian cybercriminal gang REVil, posted customer names, birthdates and Medicare details under “good” and “naughty” lists on its dark web site named Happy Blog. The leaked data included patients who had undergone treatment for drug addictions and terminated non-viable pregnancies.

“I recommend to sell Medibank stocks,” the group said in the post, along with a quote from Confucius: “A man who committed a mistake and doesn’t correct it is committing another mistake.”

A person claiming to be the Medibank hacker told this masthead in broken English via email during the incident that they would have not leaked the stolen data had the company paid up. Medibank publicly ruled out paying the hackers the $US9.7 million ($14.5 million) they demanded, and the federal government had also advised against payment.

The government is currently weighing a total ban of ransomware payments, though company directors say the payments may be justified to avoid catastrophic outcomes.

“We do business in our way, and we never targeted any particular people for that – only companies,” the purported hacker said via email.

“We ask a similar price, as on blackmarket for that detailed data about Medi customers. And where Medi refuses to pay – we should earn some money, to cover our efforts. Talking that way, Medibank in fact forces us, to sphread [sic] customers data.”

With attacks surging, the federal government is under increasing pressure to help organisations defend themselves. Cybersecurity Minister Clare O’Neil described financially motivated hackers and extortionists as “public enemy No.1” when she launched the government’s new cyber strategy late last year.

O’Neil said Australia faced the most challenging circumstances since the Second World War, and that cybersecurity would be integral to how the events of the coming decade played out.

‘A good start’

The federal government’s “six shield” strategy includes $291 million in support for small and medium-sized businesses, including the creation of a cyber health-check program offering free and tailored cybersecurity assessments to business owners. It has a stated goal of making Australia the world’s safest cyber nation by 2030.

Many cybersecurity professionals aren’t convinced that’s possible but acknowledge it’s a goal worth pursuing.

“What Claire O’Neil and the current government have been doing is a good start, but it’s been attempted before, and we need to ensure it survives future political changes. Cybersecurity is no longer a nice to have; it’s a fundamental component of everything we do,” O’Reilly says.

He says Australia needs to find a way to ensure cybersecurity strategies are consistent across jurisdictions and are not beholden to the government of the day.

“One thing we can learn from our so-called ‘adversaries’, the people hacking us, is that consistency is key.”

In late 2022, in response to the Optus and Medibank breaches, the parliament passed legislation that can result in businesses being fined $50 million for repeated or serious data breaches.

Tony Burnside, head of Asia Pacific at cybersecurity giant Netskope, says we should be encouraged that Australia has a hands-on and proactive government when it comes to cybersecurity.

“The new cybersecurity strategy, which I think we can say has been well received overall, focuses on the right issues that need to be addressed now, and will act as a good framework for new legislation that will help Australian organisations and individuals be more secure,” he says.

“Our global alliances, especially in the context of AUKUS, also equip us with solid offensive and defensive state cybersecurity capabilities.

“Some organisations and parts of the populations are still fairly vulnerable compared to other countries, though... We weren’t exactly a primary target for cybercriminals until recently, and this has created some complacency and a feeling that major cyberattacks wouldn’t occur here.

“In the past 18 months there has been a wake-up call.” 

Bolstering the defences

Netskope’s most-recent threat report found the majority of cyber threats targeting Australian organisations were criminally motivated, with only 12 per cent of attacks having a geopolitical motivation. Both the Medibank and Optus hackers demanded millions in ransom payments.

At Medibank’s shareholder meeting in November, chairman Mike Wilkins emphasised that the private health insurer had ramped up its security.

“The board has been overseeing a group-wide program of work that aims to continue uplifting and embedding the technology, processes and security culture within Medibank to support our customer promise of being a trusted health partner,” he said.

Port operator DP World, another recent hacking victim, is improving its security as well.

“We undertook a thorough review of our security controls with the assistance of third-party cyber expertise,” a spokesman says.

“In order to reduce the likelihood of similar incidents occurring, we are working through a cyber remediation plan to implement additional controls, limit access to external applications to certain addresses and countries only, implement additional end-point and network detection and response capabilities.”

CBA chief Matt Comyn said the bank was “conscious of and spend a lot of time, effort and resources on issues such as cybersecurity given the risks presented by such threats nationally and globally”.

“We’ve already seen a number of examples of how damaging a breach of cybersecurity can be and that is a warning to us all to take the necessary and vitally important steps to protect ourselves from these increasing attacks,” Comyn said.

But some of Australia’s biggest companies such as IAG, the insurance group behind brands like NRMA Insurance, CGU, SGIO, are not waiting for hackers to come knocking.

“We take cyber and data risk very seriously and we continue to invest heavily in this area,” says IAG’s chief risk officer, Peter Taylor.

“We are also an active participant in broader industry and government initiatives to enhance cyber resilience more generally.”

Cybersecurity provider CyberCX is working with St Vincent’s Health to remediate and respond to its recent cyberattack. It’s still unclear whether any sensitive health data was stolen in that attack, which people close to the investigation say was likely financially motivated. The company is also working with the Australian Open to safeguard the coming tournament. 

All organisations at risk

The Medibank and St Vincent’s Health data breaches were facilitated through compromised staff accounts, according to investigators. Hackers typically compromise accounts through social engineering or phishing attacks – emails that seem legitimate and encourage users to enter their login information.

All Australian organisations are at risk, according to CyberCX’s financial services and insurance industry director, Shameela Gonzalez.

“More than green text on a black screen, executives are anxious about the 2am phone call, or the contact from a customer instead of catching it themselves,” Gonzalez says.

“It’s the combined challenge of scrambling to understand what has happened, re-securing systems without inflicting more damage, and communicating effectively in a matter of hours … It’s a tough ask, even before you consider that someone out there is working just as hard to do you harm.

“Simply buying more tools and more technology isn’t the answer here.”

Gonzalez agrees with O’Reilly in that one clear answer when it comes to cybersecurity is a cultural one.

“Organisations that weather and thrive following a cyber incident have a strong culture of resilience, have invested in securing their networks and systems to do what they can to prevent a breach, and have prepared as best they can for an attack in this ‘when’, not ‘if’ environment.”

Another answer may be for businesses to simply collect less data on their consumers. In November, the government flagged a review of mandatory data legislation, passed in 2015, which requires telecommunication companies to hold customer information including names, call records and other data for two years. 

Attacks To Intensify

Ashwin Ram, cybersecurity evangelist at Check Point Software, says an organisation in Australia is being attacked on averaged nearly 700 times a week over the past six months.

He says it’s a mistake, however, to read the recent headlines about the St Vincent’s Health and Court Services Victoria hacks and assume that they are the work of a criminal mastermind. “There’s nothing sophisticated about these cyberattacks,” Ram says.

“These recent ones appear to be financially motivated, and cybercriminals are extorting as much as possible from their victims. Many attacks begin with some form of social engineering, such as the one against Court Services Victoria, where email was the delivery mechanism for initial access.

“The most common attack vectors include phishing, cloud misconfiguration, software vulnerabilities, and compromised credentials, as was the case in the St Vincent’s Health breach. ”

For Ram, it’s not the regularity of the attacks that is most worrying. It’s that cybercriminals also now have access to generative AI tools, allowing them to create highly effective phishing campaigns that are nearly impossible to detect.
Attacks to intensify

Ram and other cyber experts are predicting a further surge in cyberattacks over the next year given the rise in AI tools such as ChatGPT.

“Over the next year, cybercriminals will increasingly leverage generative AI to develop new tools for cyberattacks,” he says. “This trend will also lower the barrier to entry, enabling less technically proficient individuals to engage in malicious activities, as advanced skills are no longer a prerequisite for creating attack tools.”

More here:

https://www.smh.com.au/technology/low-cost-high-reward-the-hackers-holding-australia-to-ransom-20240105-p5evcg.html

It is a rather sad state of affairs that so early in the year we have to be reminded of the evil-doers out there and how we are really continuing to loose to war!

Each year the stakes are just that much higher and it really seems that we have reached some form or truce in the cyber war with the harm done being bad but not bad enough to provoke a really successful and sustained response!

I wonder will this be the year where AI and intelligent agents of some sort just clean up behind us and harm is reduced to an insignificant level permanently. I am sure such an outcome is in our futures. If not this year, some time soon!

David.