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."

Sunday, September 08, 2024

NSW Health May Be Making Some Forward Steps With Patient Information Sharing.

I spotted this a few days ago:

Collaboration sets the stage for next phase of Single Digital Patient Record (SDPR)

29 August 2024

Building a landing zone for technology to take flight

eHealth NSW in partnership with the Single Digital Patient Record Implementation Authority (SDPRIA), Epic Systems and Amazon Web Services (AWS), completed the build of the SDPR hosting environment, known as the AWS Landing zone.

The AWS Landing Zone is a secure, scalable and foundation for how the electronic Medical Record (eMR) will be managed and deployed for SDPR.

Configuration phase moves a step closer to reality

Cutting-edge cloud technologies were developed for the AWS landing zone to improve service delivery. This core foundation means the focus now turns to configuring the SDPR to ensure it meets the needs of NSW Health staff, patients and the people of NSW.

SDPRIA Chief Executive Dr Teresa Anderson AM shares how this milestone is a fantastic outcome and yet another example of excellence in partnering.

“The achievement is the result of tireless collaboration between AWS, eHealth NSW technical teams and Epic Systems and I couldn’t be prouder of the result,” Dr Anderson said.

“It truly demonstrates that our Single Digital Patient Record now has the infrastructure capabilities and readiness, in addition to enhanced security and compliance to ensure it is ready for this exciting next phase of configuration,” - Dr Teresa Anderson AM, (SDPRIA) Chief Executive

Focus now on data migration and integration

The team will focus on data migration and integration, to enable a seamless transition and integration with other systems and workflows as well as ongoing testing and validation said SDPR Associate Director, Service Delivery, Rodney Daly.

“This step signifies the transition from planning and preparation to actual deployment and implementation, ensuring that we have the right infrastructure in place to support the high performance and reliability required for the Epic Systems eMR" - Rodney Daly, SDPR Associate Director

“This milestone while very technical will provide a number of improvements and benefits, including the easy scaling of resources to meet growing demands, enhanced security and improved performance,” said Mr Daly.

Find out more about the Single Digital Patient Record program.

The link points to this screed:

Single Digital Patient Record (SDPR)

The Single Digital Patient Record (SDPR) will provide a secure, holistic and integrated view of the care a patient receives across the NSW Health system. Clinicians will be able to access a patient’s medical information in real-time from a single source.

The Challenge

Clinical information is captured in many different systems across NSW Health. Currently, healthcare teams must access several platforms to get a comprehensive patient history. These include various electronic medical record systems, patient administration systems and laboratory information management systems. This makes it difficult to quickly access comprehensive information about a patient.

Some of these systems are also not connected statewide. This means different care teams must manually request patient information from other local health districts if a patient is visiting multiple health services. Data is routinely collected but is often unable to be shared or integrated in real time. This can create data duplication or information gaps that could affect providing the best patient care possible.

To solve these challenges, a single source of clinical information is needed.

The Plan

The SDPR program will transform how people experience and deliver care across the state, providing benefits for the people of NSW and the NSW Health workforce regardless of their location and role.

It will bring the state healthcare system together, unifying access to patient clinical information in one view. This will help to provide connected, transparent and safe care for any person at any public healthcare setting statewide.

The SDPR program will achieve this by partnering with NSW Health pillars, public health services, staff, clinical leaders and community members who support or interact with the statewide health service. This will include a statewide integration of electronic medical records (eMR), laboratory information management system (LIMS) and patient administration system (PAS).

SDPR will be delivered under the leadership of the Single Digital Patient Record Implementation Authority (SDPRIA). The Single Digital Patient Record Implementation Authority (SDPRIA) has been established to work in partnership with Local Health Districts, Specialty Networks, eHealth NSW, NSW Health Pathology, shared services, Pillar agencies, the Ministry of Health and the EPIC teams to lead the implementation of the SDPR program.

SDPR will be first available in the Hunter New England LHD and Justice Health and Forensic Mental Health Network, followed by a phased roll out schedule across the state. The overall implementation timeline is expected to be completed by 2028. This includes the configuration of the system and roll out.

The Outcome

For the first time in NSW, healthcare teams will be able to use the same digital clinical system to access patient information, record the care they provide, order diagnostic tests and manage medications, no matter which public hospital or community healthcare facility they work in.

The key features of the SDPR will include:

  • Holistic, real-time patient information accessible from a single system
  • Continuity of information provided within a single system across all NSW Health services
  • Improved integration with medical devices and other clinical systems
  • Intuitive, user-friendly design that, for example, pre-fills records based on historic patient data
  • Secure access to patient records and clinical workflows via mobile devices
  • Simplified clinical workflows and streamlined technical support
  • Robust privacy and security functionality
  • Increased analytics, dashboards and reporting to support ongoing enhancement of health services and patient safety.

The Benefits

Having one statewide system will support consistency and continuity of care, particularly for patients receiving care across multiple NSW Health settings.

For patients visiting NSW Health services, it will mean:

  • A reduced need to recall and repeat health information
  • A consistent experience regardless of where they seek care
  • More informed discussions with their health care providers, so they are better able to make decisions about their own health.

For NSW Health clinicians, the SDPR will mean:

  • Easier, faster and more consistent access to comprehensive, up-to-date patient records in a single secure system
  • Enhanced clinical safety and quality, with less duplication of care across sites and providers
  • Less admin, with streamlined record-keeping.

-----

Here is the overall link:

https://www.ehealth.nsw.gov.au/news/2024/single-digital-patient-record-infrastructure-milestone

This all sounds wonderful, but I am curious to know how much of this is beyond the ‘vapour-ware” stage and is actually doing what is intended?

Reading the announcement one really wonders how much of this grand plan is real at present.

It would be good to hear from those on the ground as to how much has thus far been achieved.

I can report – after a very recent stay at Royal North Shore that – at a ward level – virtually all documentation is electronic and is very widely used. (No one goes anywhere without their mobile terminal)

So at a hospital level real progress appears to have been made! I am now wondering what the impact has been?

Anyone care to comment from the work - face?

David.

p.s. Put another way by Adam Ang:

SDPR foundation developed

The "landing zone" for the Single Digital Patient Record (SDPR) in New South Wales has been set. 

According to eHealth NSW, the landing zone, developed with Epic and Amazon Web Services, is the "secure, scalable foundation" for managing and deploying the SDPR. The single EMR project is set to replace nine EMR platforms, six PAS, five pathology LIMS, and other clinical support systems across NSW public health services. 

This step ensures that the right infrastructure is "in place to support the high performance and reliability required for the Epic Systems EMR," said SDPR project associate director Rodney Daly. 

Following this, the project now focuses on configuring the SDPR to meet user requirements, as well as data migration and integration with other systems and workflows, on top of ongoing testing and validation. 

Here is the link:

https://www.healthcareitnews.com/news/anz/sdpr-landing-zone-established-and-more-nsw-briefs

 Reports from the field encouraged!

 D.

AusHealthIT Poll Number 763 – Results – 08 September 2024.

Here are the results of the poll.

Is The RACGP Right To Be Very Nervous Of Government Moves Towards Capitation Based Payments?

Yes                                                                                 21 (84%)

No                                                                                     3 (12%)

I Have No Idea                                                                 1 (4%)

Total No. Of Votes: 25

A very clear vote, and you bet the RACGP should worry about capitation styles of payment if they value their freedom!

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

A totally disconnected voting turnout. 

1 of 25 who answered the poll admitted to not being sure about the answer to the question!

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

David.

Friday, September 06, 2024

If True, This Will See A Very Large Number Of Lives Saved! Pity About Availability And Delays At Present!

This appeared last week:

Ozempic reduces risk of heart failure by 27pc: study

Euan Black Work and careers reporter

Sep 1, 2024 – 3.49pm

Semaglutide, the active ingredient in diabetes drug Ozempic, could reduce the risk of heart failure events by 27 per cent and the risk of cardiovascular death by 29 per cent in people with diabetes and chronic kidney disease, a study has found.

Scientists don’t yet know why. But the findings, taken from a new study of a previous clinical trial called the FLOW trial, are important because heart disease is the leading cause of death in Australia and elsewhere.

They also add to mounting evidence that the drug best known for helping people lose weight could be used to treat conditions besides diabetes.

Published in the Journal of The American College of Cardiology, the study was based on a randomised controlled trial involving more than 3500 people with type 2 diabetes and chronic kidney disease.

The participants were randomly designated into one of two groups and followed for a median of 3.4 years.

The first group was injected with 1mg of semaglutide once a week, while the second group was given a placebo.

The dose for the first group was increased from 0.25mg for the first four weeks to 0.5mg for the next four weeks, before a maintenance dose of 1mg was given for the remainder of the treatment period.

‘Highly promising’

The group treated with semaglutide had a 27 per cent lower relative risk of heart failure events and a 29 per cent lower relative risk of heart-related death.

“We wanted to have a look at whether semaglutide had any impact on the risk of heart failure, and we actually found a very strong effect,” said study researcher Vlado Perkovic, principal investigator for the FLOW trial and provost of University of NSW.

“A 27 per cent reduction in the risk of heart failure is highly promising.”

Professor Perkovic said similar benefits were also found in those who started the trial with heart failure.

For example, people with HF who were treated with semaglutide had a 30 per cent lower risk of cardiovascular death than those in the placebo group who started the trial with HF.

But Professor Perkovic said scientists did not yet know why the drug reduced these risks.

Unclear mechanisms

“It’s unlikely to be related to the glucose-lowering effects [of the drug],” he said.

“That seems the least likely [explanation], particularly because there’s emerging data suggesting it’s also effective in people without diabetes.”

Professor Perkovic told The Australian Financial Review the weight loss caused by the drug might explain the risk reductions, given obesity was a risk factor for heart failure. And the kidney-protective effect of the drug might also be important.

“But there may also be specific effects on the heart,” he said.

“There’s a lot of work being done to try and understand how the drug affects the heart more specifically, but at this stage, it’s not really clear.”

Gastrointestinal disorders were the most common adverse events among those who had to drop out of the trial, which was funded by Ozempic manufacturer Novo Nordisk.

Mounting evidence of benefits

A study published in the New England Journal of Medicine last year found that the drug may even lower the risk of heart attacks and strokes in people without diabetes.

The study involved 17,600 participants who did not have diabetes but were overweight and aged 45 and older. Half received weekly injections of Wegovy, a brand of semaglutide also made by Novo Nordisk, and half received an injected placebo.

Of the 8800 assigned to receive Wegovy, about 130 were spared a heart attack, stroke, or death.

“This number is within the range we would normally see from standard therapies, such as statins, beta blockers or aspirin, used after a cardiac event,” Jason Kovacic, director and CEO of the Victor Chang Cardiac Research Institute, told the Financial Review in May.

“But in this case, the Wegovy benefit was additional to those gains, as patients were also receiving standard therapies.

“The results are impressive and are only over about three years. If you translate them out over a longer period, we expect there would be even more substantial reductions in cardiac events and potentially more lives saved.”

Here is the link:

https://www.afr.com/life-and-luxury/health-and-wellness/ozempic-reduces-risk-of-heart-failure-by-27pc-study-20240901-p5k6wz

On the face of it, this has to be a very good thing! Sadly I understand the price for non-diabetics is around $140 per month, rather than about 1/5 of that on a concessional basis for pensioners with diabetes.

Not only this but I understand that there are very considerable shortages of the drug, not only here but globally!

I suspect it will be next year, or even longer, before things even out and supply can match demand…

David.

Thursday, September 05, 2024

If This Is True We Are Looking At Radical Change In The Hospital Sector

This appeared last week:

Health Department review finds private hospitals ‘uninvestable’

Michael Smith Health editor

Sep 2, 2024 – 5.00am

Health Department officials have conceded that private hospitals are uninvestable and more will close, with Labor MPs increasingly concerned that the government is failing to fix a funding crisis that threatens to spill into the public system.

The preliminary findings of a review ordered into a growing crisis within the health care system by Health Minister Mark Butler, obtained by The Australian Financial Review, warn that private hospitals will close in the next 12 months. The findings also say a shift from overnight stays to same-day procedures is harming profit margins.

The findings, which have not been released publicly, note that private hospital closures will put more pressure on public hospitals. “Decline in investability of the sector risks the contribution it, and the hospital sector as a whole, makes to meeting health needs,” documents summarising the review circulated by Health Department officials read.

“While there is substantial variability in earnings, profitability of the sector has declined over recent years. Average returns in the Hospital Sample may not support continued investment,” the review, led by Health Department secretary Blair Comley, finds.

The concerns raised by the review are similar to those from major private hospital operators such as Ramsay Health Care, which said on Friday that it could not build new facilities because the returns were not high enough.

The pressure building on the health system comes amid an increasingly bitter stoush between private hospitals and insurers over who should shoulder rapidly increasing medical costs. Private hospital providers say profitability has swung too far to insurers. Insurers say private hospitals need to operate more efficiently.

The outcome of that dispute, and Labor’s review, will most affect the 12 million people who are covered by private health insurance. Their fees are regulated by the government, with increases approved once a year.

Patients flooding to public system

The Financial Review reported last week that the government had told key industry participants that it was willing to let facilities close rather than prop them up.

Some Labor MPs, however, are concerned that a flood of patients who were using private hospitals would stretch the public system, in particular in regional areas.

“I know [hospitals] are hoping for some concrete action, but I’m not sure that is going to happen. We need to get these systems working together. If the private hospitals go under, we are in big trouble,” Labor MP Mike Freelander, who chairs a parliamentary committee on health policy, said.

Dr Freelander, a paediatrician, met Ramsay and Healthscope representatives last month and said he had proposed using federal and state funds to pay private hospitals to take on public patients, which would help clear record waiting lists. This does already happen in some states, including South Australia, but health insurers do not like the practice, saying it threatens the quality of care for paying private patients.

If you need a hip replacement and then told you will be slugged X thousands of dollars, it does make sense that people will defer that.

— Dr Michelle Ananda-Raja, Labor MP

“I, personally, have views that may not match the government’s view. We do need to see how we can use the private system to take the pressure off the public system,” Dr Freelander said.

Another Labor MP, Michelle Ananda-Rajah, said she was concerned about people deferring elective surgery because of rising out-of-pocket expenses, an issue she had raised with Mr Butler.

“I know for a fact that private patients are complaining about out-of-pocket costs. It is an issue and maybe affecting throughput [into] private hospitals,” Dr Ananda-Rajah said.

“If you need a hip replacement and then told you will be slugged X thousands of dollars, it does make sense that people will defer that. The problem is that no-one has visibility over what doctors charge. I suspect all of this is feeding into this and causing problems at a systemic level.”

Dr Ananda-Rajah said she had raised with Mr Butler her concerns about the lack of transparency around doctors’ fees and what this meant for out-of-pocket expenses. But the government should not bail out unprofitable private hospitals, she added.

“It is not up to the government to bail them out. Every corporate comes to government searching for a bailout. It is not our task to prop up an unprofitable business model. They need to go away and do some thinking about what their priorities are.”

Reduced maternity, psychiatric services

Mr Comley’s preliminary findings say larger hospital groups have more bargaining power when they negotiate funding from insurers, but he also admits that the outcome of those funding deals do not reflect the higher cost of providing services in hospitals.

The findings also note reduced activity for maternity and psychiatric services in hospitals which are putting pressure on hospitals.

The review says the proportion of private hospitals offering maternity care has declined by 3 percentage points from 13 per cent in 2016 to 10 per cent in 2023. It says nine private hospitals closed maternity wards in that time.

Though the number of people receiving Medicare-subsidised psychiatric services increased 18.9 per cent between 2019 and 2022, the number of services delivered in a hospital declined by 15 per cent in the same period.

The chief executive of a large private hospital group who spoke on condition of anonymity said on Sunday that two facilities his company ran could potentially close, blaming the huge variances in the amount health insurers paid for procedures at different hospitals for shutting down some services.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/health-department-review-finds-private-hospitals-uninvestable-20240830-p5k6nz

I suspect we are in a period of transition and change with both the private and public hospital systems working out just where they fit and how best to play to their various strengths. It is clear change is coming - only the depth and speed is up for discussion....

We are really living in interesting times I believe...

David.

 

Wednesday, September 04, 2024

To Anyone Who Has Worked In A Labor Ward There Is Little News Here!

This appeared last week!

‘We apologise to women’: NSW vows to provide better care during pregnancy

By Megan Gorrey

August 29, 2024 — 5.54pm

Continuous care and improved maternal consent practices will form part of the NSW government’s response to a landmark birth trauma inquiry as Health Minister Ryan Park apologised for the state’s failure to provide a higher standard of care to thousands of women.

The government on Thursday supported 42 of the 43 recommendations from the inquiry, an Australian first, which were informed by more than 4000 submissions and six days of hearings in Sydney, Wollongong and Wagga Wagga between September 2023 and April this year.

It heard harrowing testimonies from thousands of women across NSW who had experienced birth trauma – physical, mental and psychological injury or distress during pregnancy and childbirth.

The government said in its response it would speed up the delivery of five initiatives in the next 12 months to boost access to maternal continuity of care models; provide trauma-informed training for healthcare workers; improve the provision of information for women to enable them to be actively involved in decision-making and to give informed consent for labour and birth interventions; and to better support women who experienced pregnancy complications.

Park praised the courage of women who shared their “deeply personal and difficult experiences” and said the government was committed to improving mothers’ diverse health and wellbeing outcomes.

“We apologise to women who have not received the high standard of maternity care they should have,” Park said.

The inquiry’s final report had recommended as its top priority that all women should be provided access to continuity of care with a known provider throughout pregnancy and birth.

The report also urged that NSW offer comprehensive antenatal education, review laws around informed consent and require informed consent training for maternity health practitioners.

It suggested the state should better support women’s birth preferences, improve mental health support and postpartum services, and adopt trauma-informed practices in maternity care.

In its response, the government noted but did not support the 43rd recommendation as it was a request for the select committee chair, Animal Justice MLC Emma Hurst, to ask the Health Care Complaints Commission to consider publicly reporting maternity care and birth trauma complaints.

Hurst acknowledged the government’s support for most recommendations, but said the women who shared their stories in the hope of triggering “systemic change” needed to be assured that “major reform and appropriate funding will be dedicated to this space, not just tinkering around the edges”.

“I will be holding the government to account and ensuring the recommendations of this inquiry – which came directly from the birthing women in NSW – are fully implemented.”

Hurst had wanted expanded access to the Midwifery Group Practice – a scheme in which women are cared for during their pregnancy, birth and postnatal period by the same small team of midwives.

The government said it was committed to increasing access to midwifery continuity of care models.

Australasian Birth Trauma Association chief executive Amy Dawes said the inquiry highlighted the need for individualised care, whether that meant a home birth or a caesarean by an obstetrician. She said Park’s apology had “acknowledged and validated” women’s experiences.

“As an organisation, we feel incredibly hopeful, especially around the five initiatives to be accelerated,” Dawes said.

Sydney obstetrician and gynaecologist Dr Talat Uppal acknowledged maternity care was a “complex space” and she believed “we need to take women on that journey antenatally better”.

“Women come out on top when they have options,” she said.

The inquiry was triggered by complaints from 30 mothers about maternity services at Wagga Wagga Base Hospital, including allegations some were forcibly held down or given inadequate pain relief.

Australia’s largest study of women’s birth experiences found in 2022 that one in 10 women felt violated disrespected or abused during birth.

Here Is the link:

https://www.smh.com.au/national/nsw/we-apologise-to-women-nsw-vows-to-provide-better-care-during-pregnancy-20240828-p5k65d.html

Talk about “Secret Women’s Business” – more like “Secret Women’s Suffering”!

Somehow the technology we have that could actually mean that 99%+ of births are safe and a reasonably acceptable experience has not reached the Labor Floor. I am totally clueless as to why this might be, other than to wonder that once the nipper is had safely pretty much all the leadup just passes into history and the happy hormones take over!

There is no doubt birth could be vastly improved – but somehow the demand to do so seems not to actually trigger change. I really wonder why!

David.

Tuesday, September 03, 2024

Every Once In A While I Am Provoked To Call Out Rubbish!

This appeared a few days ago!

The Power of Patient Data: Improving Health Outcomes with AI and Data


Della Chan | Updated: 30-08-2024 14:28 IST | Created: 30-08-2024 14:28 IST


Every healthcare professional, whether they’re a surgeon or a counsellor with a Masters in Mental Health, will tell you that good, clear information is absolutely paramount when providing quality healthcare. Whether diagnosing or treating a problem, doctors and nurses need access to accurate, relevant information about their patients, the conditions they may or may not be suffering from, and the treatments they have undergone or planned.

Having said all that, sometimes there’s simply too much data — too much chaff to sort the wheat out from. When researching an illness they’re trying to treat, doctors are routinely confronted with excessive volumes of reference data, research, case studies, and textbooks. Making use of this overwhelming volume of data can be difficult and intimidating. Even when simply working with one patient, there can still be so much data, information, and research that drowns out what they need to make an accurate diagnosis or assign the correct treatment.

Luckily, AI and the modern data science techniques associated with its development and use have become sufficiently advanced to aid in this process. Artificial intelligence can be used to read and summarise large volumes of research, take notes during patient appointments to allow doctors to focus on the patient, and help sort through data about the patient to figure out what information might be relevant to a diagnosis, treatment, or other factor of care.

Different Diagnoses

When it comes to patient data, the best source of reliable information about a patient’s symptoms and other criteria that might be potentially relevant to making a diagnosis and assigning treatment, is often the patient’s electronic health record. In Australia, we have My Health Record, a centralised government database managed by the Australian Digital Health Agency that contains all details of Aussie patients’ medical histories. However it is important to note that patients do have the right to restrict certain documents from being added to their My Health Record. Centralizing health data in systems like this one allows doctors to have consistent, reliable access to a patient’s entire medical history, granting them the maximum amount of data to help them make the best judgment possible about a patient’s situation. This extensive trove of patient data can help doctors find even small details that might inform a diagnosis of a rare condition, or rule out a prescription of a common medication that the patient might happen to have an unlikely but dangerous allergy to. 

But let’s be honest, a comprehensive medical history can mean a lot of data. Sorting through a patient’s entire medical history can be a massive drain on a doctor’s time, which is already in high demand. This is where AI comes in. A recent study demonstrated that ChatGPT, a publicly available generative AI tool by OpenAI, was able to diagnose patients accurately 93.3% of the time when provided with a medical history and additional information, as opposed to 76.6% accuracy with just the medical history.

Bespoke Treatments

It doesn’t stop with ChatGPT. New AI tools are being developed all the time with the specific goal of helping doctors diagnose with greater accuracy. Researchers at George Mason University have produced a new tool called MeAgainMeds.com aimed at improving the process of prescribing antidepressants. The tool helps depressed patients select the medication that is most likely to help them — while this site does not provide medical advice, it provides patients with tailored options to discuss with their healthcare team. 

But AI isn’t the only new tool making waves in healthcare. In reality, AI is just one subgenre of the broader category of data science. While these AI systems appear impressive and presumably complex, in reality, the algorithms that drive them are relatively simple, especially when compared to the complex systems that run products we’re already very used to, like the Google Search algorithm. What makes AI truly useful is the massive volumes of data that the machine learning algorithms are “trained” on — they are essentially compression algorithms that represent generalised data as enormous datasets called “weights” that they call upon to determine the statistically best-fit word to come next in a sequence when outputting text responses. This makes them extremely advanced statistical analysts, but it also limits their usefulness.

Other tools, like data visualisation programs, can pick up where AI loses relevance. While AI can be good at deducing patterns given large volumes of data and generalised situations like diagnosing a medical condition, it often lacks the nuance to interpret more granular data and monitor individual situations, especially as they evolve over time. Data visualisation tools allow doctors to harness their highly trained ability to recognize patterns and situations in which certain treatments might be advantageous by making patient data easier to digest.

More accurate diagnoses, customised prescriptions, enhanced monitoring abilities — these all sound amazing and incredibly useful, but the most important question lingers: how much do they actually improve patient outcomes?

Show Me the Data

One of the best studies on the subject of AI improving patient outcomes does not, as it happens, involve any of these seemingly advanced tools used by doctors to help them perform some of their most difficult tasks. While these areas surely represent massive value and serious potential for AI to make an impact, the most comprehensive longitudinal study to date on the impact of AI systems on patient outcomes was conducted between 2016 and 2019 using an AI-driven triage system. It was found that, over the four years during which the study was conducted, patients triaged using the automated AI-based system stayed in the hospital an average of 1.3 days less. This means that the AI triage system was substantially better at properly identifying the urgency of individual patients’ needs than human nurses, and enabled patients who needed care most urgently to receive treatment faster.

These incredible tools are just the beginning. At the time of writing, the most powerful AI training cluster in the world belongs to Elon Musk’s xAI datacenter in Memphis, TN, with over 100,000 of tech giant NVIDIA’s H100 graphics processing unit (GPU) chips optimised for AI training and inference. And they aren’t even NVIDIA’s largest customer — that honour allegedly belongs to Facebook’s parent company Meta, whose founder and CEO Mark Zuckerberg recently released the world’s biggest open-source AI model to date, Llama 3.1. That means that anyone with a few GPUs at home can now run the world’s best AI. One can only imagine what incredible tools could come from these new advances, for both healthcare and the rest of the world.

(Devdiscourse's journalists were not involved in the production of this article. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)

Here is the link:

https://www.devdiscourse.com/article/health/3068545-the-power-of-patient-data-improving-health-outcomes-with-ai-and-data

All well and good until I got to this:

“In Australia, we have My Health Record, a centralised government database managed by the Australian Digital Health Agency that contains all details of Aussie patients’ medical histories. However it is important to note that patients do have the right to restrict certain documents from being added to their My Health Record.”

Talk about utter rubbish! I am sure most would be very surprised to hear about this!!! – “All details of patient medical histories”

Yet again untrue claims – where does this stuff come from do you think?

Has anyone seen any solid evidence of benefit or improvement from the myHR so far. Only a decade plus and we still wonder if the myHR is worth even a minute fraction of what has been spent on it!!!!

David.

Sunday, September 01, 2024

The Private Hospital Sector Seems To Be Coming Under A Risky Level Of Strain.

These appeared last week:

Private health cover could become unaffordable, Medibank warns

Michael Smith Health editor

Aug 22, 2024 – 9.46am

Medibank says it will take two years to return to market share growth after it missed a target to increase the number of Australian residents taking out private health insurance with the homegrown provider.

This was because of stiff competition from rivals offering cheaper policies, although it was partly offset by a surge in foreign students seeking cover.

Chief executive David Koczkar also warned that private health insurance would become unaffordable for many Australians if a campaign by struggling private hospitals to get insurers to tip more funds into the healthcare system was successful.

Medibank’s 60 per cent jump in net profit to $492.5 million was in line with market expectations, but the company’s shares fell 2.3 per cent after it missed its target to increase permanent resident policy numbers in the year to June 30.

The company’s earnings are under more scrutiny than usual as private hospitals step up a campaign to get profitable insurers to contribute more to the healthcare system. Key players in Health Minister Mark Butler’s hospitals inquiry are meeting on Friday.

Medibank said net resident policyholder growth rose by 14,400 during the year, or 0.7 per cent, which was below its forecast of between 1.2 per cent and 1.5 per cent. In contrast, non-resident policy growth jumped by 69,000 or 25.1 per cent, as more foreign students took up its private health cover.

“It is an intense competitive environment [for insurers] at the moment, and we do expect that to unwind over the next one to two years as the longer-term fundamentals of competition revert back to more normal settings,” Mr Koczkar said in an interview. Medibank expects to increase its market share in 2026 as the industry stabilises.

‘We won’t chase growth at all costs’

“We have seen some unsustainable and commercial practices, which are just not right for our business. We won’t be chasing growth at all costs,” Mr Koczkar said.

He was confident that growth would not be undermined by Opposition Leader Peter Dutton’s pledge to slash permanent migration and cut refugee arrivals, and the Albanese government’s move to cap foreign student numbers.

“We are under share in non-resident workers and visitors, and that is an area of focus for us to grow share regardless of what happens with visa numbers,” he said.

Mr Koczkar said industry growth would moderate this year, after the insurer reported a 14 per cent increase in underlying net profit to $570.4 million for the year to June 30, in line with expectations.

“We think market concerns for claims and margins appear overstated, partly offset by some near-term caution around resident policy growth,” UBS analyst Scott Russell said.

Medibank also announced that it had provided $63 million in one-off support for private hospitals over the past two years. Insurers do not usually report this figure. The insurer said this was a sign that it was supportive of the private system, even as hospital executives say insurers should contribute more.

Medibank’s COVID-19 reserve for the year ending June fell to $110.8 million from $290.1 million a year earlier. This will be wound up next year. The reserve was established to return funds to customers who paid premiums but could not use their cover during the pandemic.

Medibank declared a full-year dividend of 16.6¢ a share – a rise of 13.7 per cent.

Mr Butler is due to complete an inquiry into the private hospital sector at the end of this month. The threat of an exodus of patients from private health into an already strained public system is shaping up as a cost-of-living headache for the Albanese government before the federal election.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/medibank-misses-key-policy-growth-forecast-20240809-p5k15q

Then we had this:

Private patients face Ramsay hospital lockout

Michael Smith Health editor

Aug 30, 2024 – 12.08pm

Millions of patients face significantly higher medical bills after the country’s largest private hospital operator said it would refuse to deal with insurers that did not agree to cover a bigger portion of unexpected cost surges in the future.

Ramsay Health Care, with 70 hospitals across the country, says it has put on hold plans to build or buy any more centres, citing low returns, and warns that even patients with insurance are turning to the public system because of big out-of-pocket bills.

“The shift in profitability from hospitals to health funds over the last four years or so has been significant and it has to swing back,” said Ramsay chief executive Craig McNally.

“We have been really clear over the last couple of years that if there are material shifts in assumptions on what future costs look like then we will bring insurers back to the table,” he told AFR Weekend. “If we don’t get acceptable agreement with health funds, I have been very clear, we won’t have agreements with them.”

Previously rare, hospitals have increasingly ripped up agreements with private health insurers, meaning customers of those funds can only use the hospitals if they are prepared to pay significant expenses themselves.

This month, the country’s largest non-profit provider with 10 hospitals, St Vincent’s, reached a last-minute agreement with NIB after threatening to walk away and leave the insurer’s customers paying higher prices.

UnitingCare Queensland, which owns and operates four private hospitals, this week threatened to walk away from its contract with the Australian Health Service Alliance, a large buying group representing 22 not-for-profit insurers.

Bupa customers were left without insurance at Ramsay hospitals for several weeks in 2022 after the two companies failed to reach an agreement on how to cover costs. Bupa, one of the country’s major health insurers, has more than 4 million customers.

Ramsay said it was not currently in dispute with any of the insurers it dealt with but that could change in the future.

Private hospital earnings are in the spotlight as Health Minister Mark Butler completes a review of the industry, which is battling higher costs and lacklustre patient volumes. Hospitals want insurers to pay more for their services. But insurers have refused, saying they should not have to bail out an inefficient private hospital sector.

A spokeswoman for Mr Butler declined to comment on Ramsay’s statement but said the government was looking into insurance funding as part of its review of the private hospital system.

Mr McNally said he was not confident the Butler review would provide a solution to the industry’s troubles, but hoped it would lead to decision-making about annual premiums – which influence insurer profits and payments to hospitals – being depoliticised.

But the insurance sector has accused Ramsay, and other hospital owners, of simply wanting to make more money at their expense.

“It is important to remember that Ramsay hospitals remain profitable in Australia. It’s just not as much profit as they would have,” said Rachel David, the chief executive of Private Healthcare Australia, a health insurer lobby group.

“The answer to the private hospital sector’s difficulties does not lie in health funds tipping an endless amount of money into the system. Their role is to decrease, not increase, health inflation, which is why we have a highly regulated premium setting process.”

Ramsay is one of the most profitable private hospital providers in Australia, although the company’s shares fell more than 7 per cent to close at $41.30 on Friday after it warned it would take years for patient margins to return to levels seen before the COVID-19 pandemic and said fast-rising wage costs were creating a “critical risk”.

Ramsay, which also operates hospitals in Europe and the United Kingdom, posted an underlying profit of $270.6 million, lower than the $278.2 million a year earlier. It had already downgraded earnings forecasts earlier this month.

Though it has hit targets, investors have abandoned the company because they are concerned about the long-term outlook for private hospital margins. More patients are seeking treatment in day surgeries and public hospitals as household budgets are crunched by higher mortgage payments, rents and utility bills.

Mr McNally said there had been a rise in patients with private health insurance going to public hospitals because they could not afford the out-of-pocket costs. The rate of patient activity in the current financial year would be slower than in the 12 months to June 30.

Health fund payments to hospitals rose 8 per cent to $18 billion in the year to June 30, according to figures released by the Australian Prudential Regulation Authority this week, while benefits hit a record $3.1 billion in the June quarter.

But private hospitals say that, accounting for inflation, payments were significantly lower than before the pandemic. The real decline in benefits paid per episode – the time an insured patient is in hospital – between 2019 and 2024 was 7.3 per cent, they said.

Out-of-pocket expenses per treatment in private hospitals also jumped to $437.51, from $408.38 a year earlier, highlighting the growing amount not covered by their insurance.

But Ramsay still expected to grow earnings despite the challenges facing private facilities. Mr McNally this year said at least 16 private facilities had closed in the previous 12 months across the industry.

“Our initial read is that activity levels have held up well, but pre-pandemic profitability levels may be unachievable from here,” Wilsons Advisory analyst Shane Storey said. “Capex investment levels were also subdued, sending a troubling signal.”

The trading update highlighted Ramsay’s continuing struggle with its offshore assets in contrast to its profitable Australian hospital operations. Those assets are under review.

Woolworths’ head of supermarkets, Natalie Davis, will succeed Mr McNally as chief executive of Ramsay in June, starting a long transition process in October.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/ramsay-health-disappoints-investors-as-rising-costs-crimp-margins-20240722-p5jvgi

And we also have this:

Why Australia’s sick hospitals are on the brink

Australians are paying more for surgery in private hospitals than ever and there is no cure in sight for facilities struggling with record costs and fees.

Michael Smith Health editor

Aug 30, 2024 – 2.31pm

John Karagiannis realised something was wrong with his eyesight when he could no longer see his two sons clearly on the football field on Saturday mornings. He was diagnosed with cataracts after an eye test at his local Specsavers.

Karagiannis, 61, did not think twice about going down the private hospital path. He had had private health insurance since he was 18 and rarely used it. However, he was surprised by the out-of-pocket costs for what is one of the most common surgeries in Australia.

The IT project manager from Sydney says he paid about $5500 for surgery on both eyes, the initial consultation fee, the anaesthetist’s fee and the private hospital fees. He had to pay most of the bills upfront and wait for his insurer to reimburse him. Without private cover, he estimates the cost of the two surgeries would have been triple that amount.

John Karagiannis: “If I didn’t have the money, I wouldn’t have rushed out to do it.”  Edwina Pickles

“Even with insurance you still have to fork out $5500, and you have to fork out a lot of it upfront. You really need to have a spare $5000 around if you are going to do it privately,” he says.

“You get some money back, and the process was pretty quick, but if I didn’t have the money, I wouldn’t have rushed out to do it.”

Karagiannis is one of millions of Australians paying record amounts for surgery, specialists and procedures in a private health system buckling under the strain of soaring costs and wages, and lacklustre patient numbers as more people switch to day surgery.

At the same time, the health insurers that fund the system are warning they will not bow to pressure from hospitals to increase their contributions because it would force them to jack up premiums, making private policies unaffordable for many of their members.

A political headache

The cost of healthcare is shaping up as a key political headache for the Albanese government heading into an election which will be defined by the cost-of-living crisis. While health insurance is supposed to cushion the blow for the 15 million Australians with policies, out-of-pocket costs are soaring, leaving many wondering why they bother to fork out so much for costly policies in the first place.

Doctors and surgeons warn the high-level quality of care taken for granted in Australia is under threat as the symbiotic relationship between over-stretched government-owned hospitals, private facilities which are necessary to ease the burden on the public sector, and the health insurance industry, shows signs of unravelling.

Others argue it is time to reform the entire system as new technology and advancements in care mean people do not need to stay in hospitals as long as they used to.

Health Minister Mark Butler’s inquiry into the viability of the country’s 650 private hospitals has found “surpluses” in the system can no longer support ongoing investment, and notes a big shift to same-day procedures.

“In terms of incentive, the private hospitals need throughput and have no financial incentive to distinguish between whether they are providing ‘high value’ or ‘low-value care’, whereas the insurers do better if people stay healthy and stay out of hospital,” says Nick Coatsworth, a former deputy chief medical officer who now works in a Canberra hospital.

“Given that’s the case, the insurers actually do better in innovating and moving towards preventive medicine and short-stay hospital visits. Both parties need to make a profit, but one has a positive incentive that’s likely to improve healthcare, and the other perpetuates a legacy mode.”

Short-term solutions elusive

Butler’s review of the $22 billion private hospital industry has been collating data for the past two months, even though not all the big operators have co-operated, but it is not expected to come up with any short-term solutions before the next election.

The probe was triggered due to concern that the mass closures of private facilities would put further strain on the public system, where waiting lists are at record highs. However, the number of facilities shutting is disputed within the industry, with hospitals saying 72 have closed since 2019, but insurers and analysts saying almost as many have opened during that time.

One thing is clear, though. Private hospitals, which rely on volume to drive margins, are doing it tough. Ramsay Health Care, the nation’s biggest, is one of the few making decent profits, but it said on Friday that margins were pressured from huge wage increases. Analysts say its margins may never return to pre-pandemic levels.

Butler’s inquiry has also exposed the dysfunctional partnership between hospital operators and the insurers which provide most of their funding. Possible government intervention in the way billions of dollars of hospital funding is negotiated each year is one option on Butler’s table, although many do not see this as part of the solution.

UnitingCare Queensland, which owns and operates four private hospitals, this week threatened to walk away from its contract with the Australian Health Service Alliance, a large buying group representing 22 not-for-profit insurers. It is the second public spat over funding in the sector this year, with St Vincent’s also threatening to break up with health insurer NIB,

If the funding arrangements between big hospital groups and insurers collapse, the results will be disastrous for patients, with up to 2 million people potentially having to pay more for treatment if the Queensland row is not resolved.

“These are commercial negotiations happening between parties which can sometimes have friction in them. That is the norm rather than the exception. We have to look at whether that system is the best system,” says Health Department secretary Blair Comley, who is leading Butler’s inquiry.

“If and when it (the government) is going to do anything, I am not going to comment on that.”

Getting personal

Behind the scenes, the lobbying is aggressive and beginning to become personal. Hospital executives trying to keep facilities afloat are incensed the insurance industry is not stumping up more funds.

“The system is clearly out of balance and the disparity needs to be addressed in the interests of continuing to provide high-quality care to Australian patients,” says Australian Private Hospitals Association (APHA) president Christine Gee, who rejects suggestions that private hospitals are inefficient.

She says insurers made $800 million in net profit in the first quarter this year, a period when 20 hospitals closed.

The highly organised insurance lobby has hit back with a slew of data showing they are pumping record funds into hospitals, and sound commercial arguments for why they should not have to bail them out.

Australian Prudential Regulation Authority data out this week showed health fund payments to hospitals rose 8 per cent to $18 billion in the year to June 30. Benefits hit a record $3.1 billion in the June quarter.

The insurers seized on the data as evidence they are good corporate citizens and contributing their fair share to the system. But the increases are mostly due to the rising costs of providing services. Patient numbers are growing but at a lacklustre rate since the pandemic.

The hospital lobby’s analysis says there has been a 7.3 per cent fall in the benefits paid per patient since before the pandemic. While those payments jumped 12 per cent from June 2019 to June 2024 to $2975.94 using the nominal dollar amount, this was well below the 21 per cent increase in inflation in the same period.

Paying more

Regardless of whether you want to go down the rabbit hole of statistical interpretation by the industry’s various vested interest groups, the APRA data shows patients are paying more than they have in the past. There are also signs that Australians will defer surgery and specialist visits if costs keep rising.

A survey in June by the Australian Patients Association and medical appointments booking platform Heathengine found more than 60 per cent of people were delaying doctor and GP visits, more than half were putting off dental treatment, and 32 per cent were skipping a diagnostic test because they could not afford it.

The APRA data found out-of-pocket expenses per treatment in private hospitals jumped to $437.51 in the June quarter, compared with $408.38 a year earlier. This is up 39 per cent in five years, from $314.51 in 2019.

Data out this week also indicated some patients with private insurance were going to public hospitals because they could not afford the out-of-pocket expenses, according to hospital operators.

But insurers argue people who are covered are not suffering because 87.4 per cent of in-hospital services have no medical gap fee. They say some private hospitals and specialist doctors charge those fees after being paid by a patient’s health insurer.

Insurers also blame cost increases on what it says is a surge in volumes of medical implants and surgical supplies claimed from health funds since 2019. However, the body representing the device industry – The Medical Technology Association of Australia (MTAA) – rejects this, saying the average benefits paid for devices has fallen 17 per cent since 2016.

“Unfortunately, the facts and the analysis show where the money is really going – into health insurers’ own pockets.” MTAA chief Ian Burgess says.

The premium question

A record 15 million Australians now have private health insurance, but the chief executives of both Medibank and NIB have warned over the past week that numbers will drop off if premiums rise too much.

The typical cost of a knee replacement in the private system is about $23,000, with insurers paying the bulk of the cost. Specialist fees are $4900, with patients paying about $880 in out-of-pocket cost, according to government data. Medicare pays around $1900 of those fees, and insurers typically pay $1800.

Insurers argue costs can be lowered by rethinking the traditional hospital model and getting more patients into day care, rather than unnecessarily long overnight stays where the chances of infection and other complications increase. Some in the medical profession disagree, saying the commercial interests of insurers would jeopardise patient care.

“Improved clinical practice and technology means procedures which 30 years ago may have required four nights in hospital, today can be handled overnight or even in the same day. The shorter the stay in hospital the better. The doctor makes this decision,” says Mark Fitzgibbon, the retiring chief executive of NIB, which has been investing heavily in remote access to doctors an–d pharmacists.

With some private hospitals on life support at a time when public facilities have too many patients, something will have to give.

Here is the link:

https://www.afr.com/policy/health-and-education/why-australia-s-sick-hospitals-are-on-the-brink-20240826-p5k5b2

It seems clear we are on cusp of some major transitions as the costs of healthcare rise and the health insurers find it harder and harder to meet the rising costs. It seems very likely the Medicare system is going to increasingly struggle over the next few years and how it finally winds up is still not all that clear.

I suspect we will wind up with all parties having to tip more into the funding pool.

What do you think?

David.