This Is Certainly Not An Unexpected Finding On The Utility Of Point-Of-Care Ultrasound.

This appeared last week:

Point-of-care ultrasound streamlines care, curbs costs – and saves lives

POCUS has proven itself a cost-effective diagnostic tool that enhances the physical exam, says one Jefferson Healthcare physician. Money is not wasted on excessive testing and patients avoid the hospital because their disease is recognized quickly.

By Bill Siwicki

October 10, 2024 01:06 PM

One of the biggest daily challenges faced by healthcare providers is obtaining accurate diagnostic answers in a timely manner. Clinicians spend years training in physical diagnosis, mastering techniques such as listening to hearts and lungs with a stethoscope, palpating the abdomen, and examining painful joints.

THE PROBLEM

But even in the most expert hands, these traditional diagnostic methods lack the precision needed, said Dr. Stephen Erickson, a board-certified family medicine physician providing care at Jefferson Healthcare's Townsend Clinic.

"To compensate for this, we rely heavily on costly lab tests, time-consuming imaging studies and further interventions to confirm diagnoses," he explained. "In fact, the cost of diagnostic testing in the U.S. healthcare system is staggering. Annual spending on imaging procedures, including expensive X-rays, CTs and MRIs, has been rapidly rising. We're now spending more than $100 billion on these procedures annually.

"Beyond the financial burden, these tests often come with long wait times, contributing to delays in patient care, unnecessary hospitalizations and increased anxiety for patients," he continued. "This inefficiency strains healthcare resources and impacts clinical workflows, making timely and accurate decision making even harder to achieve."

Point-of-care ultrasound, or POCUS, is helping clinicians overcome many of these challenges, he contended. With the ability to visualize the body at the point of care using a pocket-sized ultrasound, clinicians can streamline the diagnostic process, improve accuracy, and save time and money, he said.

"In fact, POCUS has been shown to outperform traditional diagnostic methods in several cases," Erickson noted. "For much of my career, for instance, a suspicion of pneumonia automatically led to ordering a chest X-ray. Today, we know from multiple research studies that lung ultrasound not only provides quicker and less expensive results but is also more sensitive in detecting pneumonia.

"POCUS is transforming the diagnostic landscape, empowering clinicians to make faster, more informed decisions, and ultimately improving patient outcomes," he added.

PROPOSAL

POCUS technology proposes to resolve the problem of diagnostic delays and inaccuracies across many clinical settings, centered on bringing real-time imaging capabilities directly to the bedside.

"Traditionally, medical imaging was confined to specialized radiology departments, with doctors often relying on bulky, expensive equipment like ultrasound cards, CT scans, MRIs or X-rays to get a comprehensive view of a patient's internal structures," Erickson said. "This process, while still highly valuable in some cases, can introduce significant delays, especially in time-sensitive emergency scenarios or in rural settings where access to radiology is often limited.

"POCUS technology changes this by decentralizing imaging and making it accessible to clinicians outside of the radiology department," he continued. "The handheld nature of POCUS devices enables clinicians to perform targeted, immediate scans at the patient's side, without having to wait for specialized equipment or personnel."

POCUS has the ability to provide immediate answers to critical, yes or no, diagnostic questions. For example, in situations where the primary concern is whether a patient is experiencing internal bleeding, a detailed MRI or CT scan may not be immediately necessary. POCUS offers a faster way to detect or rule out such conditions right then and there, he added.

"Plus, new devices on the market in the last half decade have even made it possible to image the whole body with a single, all-in-one probe," Erickson noted. "By placing this technology in the hands of emergency room doctors, nurse practitioners and physician assistants, POCUS offered a streamlined solution to reduce dependency on costly and time-consuming imaging studies.

"It allowed medical professionals to identify urgent issues – such as pleural effusions, pneumothorax or cardiac tamponade – quickly and confidently, guiding immediate treatment decisions," he continued. "This real-time diagnostic tool, then, was supposed to alleviate the problem by providing a faster and more direct method of assessment, particularly in environments where delays in diagnosis could result in poor patient outcomes or when quick decisions were needed for effective triage."

POCUS technology has enabled healthcare providers to bypass traditional bottlenecks in diagnostic processes while still delivering accurate and life-saving information, he added.

"By doing so, it promised to enhance workflow efficiency, reduce wait times and potentially lower healthcare costs, all while improving patient care quality," he said.

MEETING THE CHALLENGE

At Jefferson Healthcare, the integration of POCUS technology began with its deployment in the emergency department, where physicians urgently needed rapid diagnostic capabilities at any time of day.

"Initially, ER doctors used POCUS to quickly assess critical conditions such as internal bleeding, lung problems and cardiac function, which helped streamline decision making and guide immediate treatments," Erickson explained. "The benefits of POCUS in providing fast, reliable diagnostics without the delays of traditional imaging soon became apparent, leading other departments to request access to their own devices.

"Over time, the body of evidence regarding the usefulness of POCUS has grown," he continued. "With this, more and more specialties have asked to have their own POCUS device in their department. To name a few common use cases – in the anesthesia department, POCUS is used to improve the precision of nerve blocks and to assess patients preoperatively for conditions like gastric aspiration risk."

Obstetricians can use POCUS to monitor fetal well-being and positioning, enhancing both routine assessments and responses to emergent situations. Similarly, in orthopedic, rheumatology and sports medicine, POCUS can be a tool to guide more accurate joint injections and to diagnose tendon or ligament injuries with greater precision.

In primary care, physicians use POCUS not only for diagnostics but also as a patient education tool, showing real-time imaging to help patients understand their diagnoses.

"While POCUS started as a standalone tool, it eventually became integrated with electronic health records and imaging databases, enabling clinicians to seamlessly document and share findings with other providers," Erickson said. "In our institution, we have Butterfly iQ handheld POCUS devices deployed in each primary care clinic, our infusion center and our pre-anesthesia ward.

"We also have cart-based ultrasound machines from multiple manufacturers in various locations in our hospital," he continued. "All POCUS machines are networked with DICOM links to our Epic EHR and PACS servers to allow for more optimal workflow and image accessibility across the continuum of care. We also use Butterfly Compass workflow software for QA review of images coming from any POCUS device across the organization."

RESULTS

The POCUS technology has proven itself to be a cost-effective diagnostic tool that significantly enhances the physical examination, Erickson reported.

"One of the challenges of trying to quantify the success of leveraging POCUS is that it is very difficult to measure the money that was not wasted on excessive testing, or the patients who did not end up in the hospital because their disease was recognized more quickly," he noted. "That said, I think any clinician using POCUS can tell you of cases where this occurred."

Erickson offered a few examples of such cases that took place in the past few months.

"A patient who came to my office late in the afternoon with symptoms to suggest a blood clot in a leg vein," he explained. "This is potentially dangerous because an untreated blood clot can break off, go to the heart, and cause a deadly embolism.

"Traditionally this patient would be sent to the emergency room because I can't get a venous ultrasound exam scheduled quickly enough as an outpatient," he continued. "By doing a POCUS exam at a cost of less than $50, I was able to get my answer, start the right treatment and avoid a $2,000 emergency department bill."

Another example: Placement of intrauterine contraceptive devices can be unpredictably painful for some women.

"A quick POCUS scan before placing an IUD can screen for anatomic variations that are likely to result in pain or even dangerous complications such as uterine perforation," Erickson said. "And after IUD placement, women are traditionally asked to come back in six weeks for a second pelvic exam to confirm that the IUD remains in its proper location.

"It has brought great patient satisfaction to instead perform a quick ultrasound to more accurately confirm IUD position without the patient needing to get undressed," he added.

And a final example: An elderly patient who was unable to talk due to a previous stroke was brought in by his spouse because he "just hadn't been acting right."

"My physical exam yielded little useful information as to why," Erickson explained. "It was hard to know if he needed extensive testing, or reassurance. POCUS, however, quickly demonstrated new, severe systolic heart failure. He was sent right to the emergency department where further tests confirmed a large, silent heart attack.

"I shudder to think about the outcome of that case if I hadn't had my POCUS device," he said.

ADVICE FOR OTHERS

"My advice for healthcare organizations that may be thinking about bringing in POCUS technology is to start setting up the IT system interfaces early to be ready for expanded POCUS use in the future," Erickson advised. "Many departments may eventually want POCUS, and each may have their own ideas of what is best for them.

"But an IT or biomedical department doesn't want to be saddled with trying to manage multiple systems that can't work together," he continued. "Get stakeholders to agree on two or three preferred vendors of ultrasound equipment and take the time to set up the DICOM links to your EHR and PACS. Set up standardized training in these workflows for each new user to make sure proper documentation standards are being followed."

These things take time, but they get progressively harder to institute across multiple departments the longer that non-standardized practices have proliferated, he concluded.

Here is the link:

https://www.healthcareitnews.com/news/point-care-ultrasound-streamlines-care-curbs-costs-and-saves-lives

I have to say this is by no means an unexpected finding. In the hands of sensible physicians use of ultrasound can provide very rapid clinical information and diagnostic answers – often at the patient bedside.

So what is not to like? The most important aspect is that ultrasound use – especially at the bedside – makes extra demands on anatomical and pathological knowledge that may have lost its earlier importance and needs re-awakening when expert radiological opinion is not readily accessible!

This is a good thing but a change we need to be aware of!

David.

I Suspect Regulating Social Media Will Turn Out To Be A Lot Harder Than It Seems!

This appeared a few days ago:

Opinion

One book created panic about social media. But what if it’s bunkum?

Jackson Ryan

Science journalist

October 12, 2024 — 5.00am

I’ve never felt all that comfortable in a tuxedo. But for some formal occasions, only a tux will do. One such event was a recent dazzling evening in Canberra. The kind where you rub shoulders with the nation’s best scientific minds while scoffing delicious (tiny) cuts of meat. On my table? An astrophysicist, an engineer and an environmental scientist. No, that’s not the start of a joke.

Across the evening, representatives from both sides of politics took to the podium reiterating just how important Australia’s scientific community is. They’re right to be proud! I often write about these scientists, sharing their stories of challenge, of triumph, of success. Of world-leading research.

But when the ministers spoke, I squirmed in my seat. It wasn’t the tux making me uncomfortable. It was the hypocrisy. In the same week as this ritzy feast, the Albanese government announced its intention to legislate a minimum age for accessing social media before 2025. The details – what age, what platforms, what method – remain unclear.

In May, the government set up a joint select committee to “inquire into and report on the influence and impacts of social media on Australian society”. It received more than 200 submissions. It’s yet to be completed. And yet, Labor has decided it will push age-limit legislation through before the end of the year. The move has bipartisan support. And, if social media is to be believed (oh god!), it also has backing from worried and exhausted parents.

What it does not have, broadly, is the support of scientists and experts. There are myriad arguments against a ban. The Queensland University of Technology’s Digital Media Research Centre submission to the committee says: “The concept of employing automated processes to manage access to social media is fundamentally misconceived, and we have concerns about this approach from a privacy, security, accuracy and inclusivity aspect.”

Australia’s eSafety commissioner has cautioned against limits, stating they could inadvertently introduce negative outcomes. And ahead of the NSW and South Australian government’s social media summit this week, the Australian Child Rights Taskforce released an open letter, signed by more than 120 academics and world-leading experts, suggesting a ban is “too blunt an instrument to address risks effectively”.

Why, then, is the government so reluctant to listen to those experts? The sceptic would say: politics. They’d be right, of course, but some of the blame surely lies with The Anxious Generation. The book, authored by US social psychologist Jonathan Haidt, has a terrifying – but scientifically flawed – message: childhood is being rewired by digital technologies, social media is one of the “big bads”, and this is leading to an epidemic of teenage mental illness. It suggests restricting access to social media until the age of 16.

Haidt’s arguments have been seized on by radio show hosts and pushed directly to the prime minister. Stories and anecdotes abound about mental illness, depression and anxiety. Parents are shamed into believing they’re doing something wrong by allowing kids to access screens and social media. Haidt’s own campaign asks parents to warn each other about the perils of screen time. And they do.

I get why. We see kids, glued to screens, for hours on end. We see them distracted. Inattentive. Something about it feels wrong. Why aren’t they playing outside, where surely no harm can befall them?

We’ve been primed to be scared of new technology. We can see this, over and again. This same techno-panic happened with Walkmans, computers and video games … even telephones – you know, the things that plug into a wall?

Which is why the ease with which the government has abandoned science and evidence on this issue is so concerning. It’s why it’s so galling to see Australian scientists celebrated one day and invisible the next. Fear and story are powerful things; Haidt wields them to perfection, eschewing hard science for digestible, simple messaging. And it works.

We have to get better at telling the stories of scientists. Because, you might not believe it, there’s a parallel universe where this conversation never occurred.

On basically the same day The Anxious Generation was released, another book hit the shelves. It was written by Bath Spa University psychologist Pete Etchells, and it had a title that does not inspire fear or panic: Unlocked: The Real Science of Screen Time (and how to spend it better).

It’s balanced. Nuanced. It explains that the scientific literature on digital technologies and young people is messy and uncertain, and how the problem of screen time, social media and our connection to devices is complicated. Those advocating for bans, like SA Premier Peter Malinauskas, suggest there’s “a growing body of peer-reviewed research that tells us it is doing children harm”. That is, sadly, ignoring a lot of peer-reviewed literature that says differently, as Etchells points out.

Yes, there are problems, but there are also solutions. However, they’re not quick fixes like social media age limits.

And in that universe, we listened to what many scientists and digital media researchers are saying. They’re not saying big tech companies are innocent, or that their apps are designed flawlessly. Like parents and educators, they’re concerned about the ways children navigate the digital environment.

They’re hoping for smart, evidence-based regulatory interventions and protection for children against abuse and exploitation. Some even back the idea of strengthening age verification, though only in conjunction with investment in age-appropriate digital spaces, co-designed with young people, and digital media literacy programs.

When I left the ritzy feast a few weeks ago, I stood in the chill Canberra air waiting for my Uber. The tux, by then, was looking a little dishevelled. Of course, I pulled out my phone. And I still felt uncomfortable.

Jackson Ryan is a freelance science journalist and president of the Science Journalists Association of Australia.

Here is the link:

https://www.smh.com.au/technology/one-book-created-panic-about-social-media-but-what-if-it-s-bunkum-20240925-p5kdc8.html

A useful article explaining that, as with most things, the simple quick explanation is just too easy and really does not cover the nuances of what flows from social media usage. Quick political fixes are clearly not going to help and so we need more thoughtful research and analysis.

We also need to remember social media has only been with us for a decade or two and so, inevitably, there is a huge amount we do not know!!!!

This well be a long and winding journey into discovery I suspect! It will also be fascinating!

David.

This Was A Rather Sad Episode In Our National Story I Felt.

 It is hard to believe this happened a year ago.

Indigenous voice legacy: hope, division, paralysis

The voice represents a tragic saga for Aboriginal Australians. The wounds are still fresh – and there’s little sign of leadership to identify a way forward.

The major disappointment since the voice vote has been the absence of an initiative from Labor, working with the Coalition and Indigenous leaders, to identify a way forward.

Paul Kelly

10:30PM October 11, 2024.

The defeat of the October 14, 2023, referendum on the Indigenous voice – now at its first anniversary point – represents a tragic saga for Aboriginal Australians, highlights the need to learn the right lessons from the vote and work to repair the national social compact in relation to First Australians.

But the wounds are still fresh. Blame is being attributed in different directions. There is little sign of leadership to identify a way forward. Perhaps the hardest thing is to recognise the limits of the referendum’s defeat – it was not a repudiation of Indigenous peoples; it does not extinguish goodwill; and it cannot be seen as undermining the capacity of Australians to live together.

Much of the country seems confused or indifferent a year later. Bipartisanship remains a lost cause. The major disappointment has been the extraordinary absence of an initiative from the Albanese government, working with the Coalition and Indigenous leaders, to build a new political framework.

There is no excuse for the Albanese government. Professional politicians are expected to regroup after a setback. For Labor and the Yes case the reality is the need for a rethink and new direction. The Yes case was filled with ambition but it overreached, the upshot being a double defeat – no constitutional recognition and no voice. It was a misjudgment on a mammoth scale.

There were, in retrospect, alternative options. For instance, if the legislative route had been taken for the voice, it would have been authorised by the parliament and would be operating by now. And if the symbolic route had been taken for constitutional recognition, based on achievable Labor-Coalition bipartisanship, the referendum (without any voice) might have been carried by now.

The upshot could have been a transformed Indigenous landscape – but this was never an option given the Indigenous leaders insisted on their big gamble. They fiercely rejected symbolic constitutional recognition and rejected creating the voice by legislation even when they had the numbers in both houses to achieve that. Future historians will ponder on this conundrum.

Constitutional recognition and the voice were separate ideas. There was no iron logic saying they needed to be tied together. The mistake the Indigenous leaders made was their high ambition saying that constitutional recognition must come through the mechanism of the voice.

A new direction in Indigenous affairs is the inexorable logic from the referendum defeat. But where that new direction goes is undefined. Anthony Albanese’s retreat from implementing the Uluru Statement from the Heart in full has provoked hostility from many of the Yes campaign Indigenous leaders. The issue of the treaty is being left to the states. Federal Labor seems immobilised.

The leaders of the No campaign, senator Jacinta Nampijinpa Price and Nyunggai Warren Mundine, see the referendum’s defeat as a pivotal opportunity for fresh policy, yet they are being thwarted by a paralysed power structure.

Amid the dismay of the Indigenous leadership at the 2023 defeat, the most powerful philosophical remarks about the future came from Noel Pearson, an architect and campaigner for the voice. Several months ago, he told the author: “In the wake of the referendum loss, we have to find a third way. I am disillusioned because I thought the voice was a third way. But I cannot help but return to the fact that belonging to Australia is the only way forward for us. After the referendum defeat there are three possible responses. One, just capitulate and admit defeat. Two, being bitter, disillusioned and alienated. And the third way – that we keep making the case we belong to Australia, we belong to this nation.

“Our advocacy has got to be about belonging. We are part of the nation. We have nowhere else to go. This is our country and we have to keep making the cause for unity and inclusion.”

Pearson’s message is not for separation, resentment or resignation. It is a call for hope, even when the direction is unclear. It reminds that the quest for reconciliation and “closing the gap” is a permanent process.

Nampijinpa Price told Inquirer, “The Albanese government and proponents of the Yes campaign are completely in denial even a year on from the referendum. There’s an ongoing failure to recognise the need to take action to address the needs of marginalised Indigenous Australians.

“There is no bipartisan approach from this government. It’s their way or the highway and their way is failure. They put a referendum telling us they wanted a voice but they’re not interested in hearing the voices of Indigenous Australians who want practical solutions.”

The message of Jacinta Nampijinpa Price, like that of Mundine, is for practical improvements for Aboriginal people in education, housing, jobs and economic enterprise.

The message from Mundine is not to conflate rejection of the referendum with rejection of Indigenous Australians. Mundine told Inquirer: “Everywhere I went during the campaign – whether I spoke to Yes supporters or No supporters – there was massive goodwill towards Aboriginal people. People wanted things fixed, they wanted the ‘gap’ closed, they wanted practical improvements. I travelled the entire continent and this was the sentiment everywhere. The idea this vote was about racism and bad will towards Indigenous people is absolute nonsense.”

Asked why the referendum was defeated, Mundine said it offended the equality principle: “The reason becomes clear when you look at the successful 1967 referendum. The 1967 vote was about equality, about bringing Indigenous Australians into the wider Australian community. That’s what people wanted; in 1967 they saw this as a no-brainer.

“What happened in 2023 was different: a proposal to put race into the Constitution – and I know the Yes side denies this – but the public saw the proposal as not treating people on an equal basis.

“That was the response I got everywhere I went. It was particularly strong in migrant communities – they saw this as treating people differently by race and they wouldn’t accept it.”

In assessing the referendum’s defeat, two realities should be acknowledged.

First, Albanese as Prime Minister misjudged his responsibilities saying the voice referendum was an invitation by the Indigenous peoples to the Australian people. This was a disastrous formulation, despite suiting some Indigenous leaders who wanted to be front and centre in the campaign. It was Albanese’s job to insist on a process to negotiate the model with the best chance of success.

Albanese as Prime Minister misjudged his responsibilities saying the voice referendum was an invitation by the Indigenous peoples to the Australian people. Picture: AFP

He didn’t do that. Yet with Labor’s record being one win out of 25 referendums since Federation it was essential. During the native title debate Paul Keating as prime minister confronted the Indigenous leaders, negotiated with them and wound back their demands. That’s how a prime minister should act when authorising a referendum question.

Second, the entire debate proceeded in ignorance of conservative and Coalition politics, a catastrophic failure. In retrospect, the voice was lost in October 2017 when it was rejected by the Turnbull cabinet.

Off the back of a recommendation from the independent Referendum Council the cabinet rejected the idea with Turnbull as prime minister, George Brandis as attorney-general and two future Liberal leaders at the cabinet table, Scott Morrison and Peter Dutton. The voice was friendless. The rejection was unanimous. Turnbull and Brandis were Liberal moderates. The author said at the time the cabinet had no sense of political ownership of the proposal.

Turnbull’s formal statement of rejection was explicit. It said Australian democracy was built on the idea of “citizens having equal civic rights” and a “representative assembly for which only Indigenous Australians could vote for or serve in is inconsistent with this fundamental principle”.

This was the argument Dutton used six years later in campaigning against the voice. Virtually nothing had changed in six years. The voice was found against in 2017 on grounds of fundamental principle – breaching the democratic equality along with the electoral view any voice referendum had no hope.

Yet much of the public and media debate in the following years refused to take this cabinet decision seriously, largely ignoring the in-principle basis for rejection, attacking the Coalition for shallow and populist politics and assuming that under pressure the Coalition under Dutton would buckle and change its mind. This was most unlikely. Labor and the Yes case ran on a proposal never likely to win bipartisan support. The shadow of 2017 hung over the 2023 referendum.

Fundamental to the voice legacy is the split in Indigenous leadership exemplified by the division between Nampijinpa Price, and the Yes Indigenous advocates. Nampijinpa Price did not just say No to the voice; she called for a revisionist agenda and a new accountability in Indigenous affairs. Her targets are both the Indigenous and non-Indigenous power structures. This will have long-term consequences.

Nampijinpa Price wants no voice, no treaty, an end to “neo-colonial racial stereotyping” and insists the central blunder in Aboriginal policy has been the elevation of “grievance before fact”. Drawing on her experience in the Northern Territory, Nampijinpa Price said policy had been based on a false priority: race, not need.

Her message, like that of Mundine, is for practical improvements for Aboriginal people in education, housing, jobs and economic enterprise. Nampijinpa Price sees the historical template of Aboriginal people as victims as counter-productive, ruining their agency and a misleading “romanticism” of Aboriginal culture. She is a fusion of conservative and radical. Her standing in Coalition ranks after the referendum means she will exert a huge influence on Indigenous policy within the Liberal and National parties.

Nampijinpa Price’s rejection of campaigns around recognition and treaty points to ongoing fundamental division but, even in their views on how best to “close the gap” Nampijinpa Price and Mundine offer frontal challenges to the progressive orthodoxy and existing power structure.

Nampijinpa Price has been thwarted by the Senate majority in her efforts to establish an inquiry into Aboriginal land councils that have immense control over land and funds, saying such Indigenous bodies are “not functioning the way they could be” and were not promoting economic independence for Indigenous Australians.

Two months ago Mundine published an analysis, Where to Now?, for the Centre for Independent Studies, its central theme being: “Australians do not want divisive and ideology-driven solutions or race-based policies. Australians want real improvements in Indigenous lives and policies directed towards need that deliver outcomes.”

In principle this should gather wide support; in practice the obstacles will be significant. Mundine identified four priorities – economic participation, education, safe communities and accountability. But he wanted a decisive break from existing approaches.

His first big target was “that traditional lands are collectively owned and controlled”. Individual property ownership is not permitted. It is a model of “government-sponsored socialism” that denies “the key building block for a real economy: private land ownership”. The upshot is “communities have almost a complete absence of commerce”. A vicious cycle is set up – low school attendance, low education outcomes, weak business activity, social dysfunction and crime.

A functioning market economy, the proven method of success around the world, is actively discouraged. “Business ownership – the most important foundation of an economy – is almost non-existent,” Mundine said. Yet a system with nearly two-thirds of people in remote communities not working is buttressed by stakeholder interests.

Mundine said: “It is hard to understand why the federal and NT governments have to pay for housing on Aboriginal lands when there are billions in Aboriginal land trusts and other bodies, including from royalty payments and native title payments.”

The real tragedy of the voice proposal is that it was conceived as a measure for a conservative government. The originating discussions were held in 2014 at the Australian Catholic University campus in North Sydney, three years before the Uluru statement, with a small group involving Cape York leader Pearson, his adviser Shireen Morris, Australian Catholic University vice-chancellor Greg Craven, Julian Leeser from the ACU, University of Sydney lawyer Anne Twomey and lawyer Damien Freeman, among others.

The group settled on the voice concept having decided the earlier idea of an anti-racial discrimination clause in the Constitution would be rejected by the Coalition and the conservative movement. Twomey subsequently told the Sydney Institute the voice proposal “was originally designed for a conservative government to put to a referendum” – with Tony Abbott being prime minister at the time and supporting constitutional recognition in principle.

For Pearson, winning conservative support was pivotal. He often called the project a “Nixon goes to China” moment – that is, only conservatives added to centre-left support could deliver the necessary majorities. Three years later in a major political feat spearheaded by Indigenous leaders Megan Davis, Pat Anderson and Pearson the Uluru statement endorsed the voice and a Makarrata to oversee treaty-making. Pearson called the idea “a constitutional bridge to create an ongoing dialogue between the First Peoples and Australian governments and parliaments” to close the gap. In her book on the referendum Morris lamented that the voice came to be viewed as a “progressive” idea and that from the time of Albanese’s election night commitment in May 2022 it “was officially owned by the left”.

That’s true, but it was surely a political inevitability. Once Albanese proceeded without any early effort at a parliamentary or convention process to win broader support the referendum was set to become a Labor-Coalition divide with Indigenous spokespeople on both sides.

Veteran supporter of Indigenous rights Father Frank Brennan said in his post-referendum analysis: “The government’s process was never designed at getting the Liberal Party led by Peter Dutton on board. As a well-intentioned bystander, I had watched the train wreck coming. If you want to amend the Australian Constitution you need a process from which no one is excluded. You’ll never get this unless you’ve got the leadership of all major political parties on board.

“I thought it necessary to do all I could to improve the process and the wording. I failed, as did many others. Peter Dutton, like his predecessors Tony Abbott, Malcolm Turnbull and Scott Morrison when each of them was prime minister, never came aboard. Liberal leaders had ruled out the Pearson option at every turn. In the meantime the Uluru processes ruled out everything except the Pearson option.”

Albanese’s strategy worked only if Australia had changed fundamentally as a country – and many Labor people felt, in the hubris of 2022 and 2023, having won the election, seen the teals steal the prized Liberal heartland and watched the triumph of same-sex marriage, that Australia had gone progressive and the voice was next on the agenda. They misread their country. Being realistic, however, it is difficult to see how even in a constitutional convention the Coalition would have supported the voice.

Moreover, the concessions Albanese would need to have made would have been unacceptable to the Indigenous leaders. Hence, it was a doomed project. Therefore, the legislative route was always the best prospect for its advocates.

The further tragedy is that by putting a flawed referendum new divisions have been created. In The Australian (published on September 27) Geoff Chambers and Paige Taylor sampled opinion among Yes advocates and found resentment towards the Albanese government, frustration at the public’s ignorance of the disadvantage of Aboriginal people living in remote communities and the belief that lies and misinformation were basic to the voice’s defeat.

Constitutional law professor Davis said she was “living in a parallel universe whereby this thing I’d worked on for 12 years was captured by politicians and people of bad faith and there was nothing we could do”. Davis said: “Our people are still grieving. Australia is not what we thought it was. Slowly it’s dawning on people, especially the government, how detrimental misinformation is to public debate. The lies and nonsense about what the voice would do or could do was impossible to combat because lying in politics, especially in the 2023 referendum, was acceptable.”

Davis said there was no evidence “it was the wrong proposal or that it was the wrong time or that it would not work”.

This defies the entire foundation of the No case and majority public sentiment. In essence, the voice was a radical concept – it was a group rights political body, defined by racial ancestry, in tension with the notion of democratic equality, given a constitutional standing virtually in perpetuity, sitting next to the House of Representatives and Senate with a sweeping advisory brief to the parliament and executive government on nearly all aspects of public policy (since most policies affect some Indigenous people) and designed to exert a political and moral influence within the system of government. It is unsurprising the public voted it down decisively. It won’t be easy but the task ahead is to navigate a better direction.

Here is the link:

https://www.theaustralian.com.au/inquirer/indigenous-voice-to-parliament-legacy-redrawing-the-map-to-aboriginal-recognition/news-story/d0037d2dda8cb4a1a2de2ab28b60ab43 

My feeling is that this whole issue should not have been left in limbo after the referendum failure. The Government should have put together a credible plan and roadmap to address Indigenous Disadvantage and faced squarely the issue of entrenched disadvantage where it exists.

There is no doubt this is a very complex problem to address and the designing solutions is both urgent and bloody difficult! To me what is happening to date is little more than 'Brownian motion' and as a country we should be able to do a lot better than that!

Key, of course, will be real listening to those affected and taking up their ideas as to what is needed and has to be done. This is central to any chance of success...

Do you see any sensible ideas that might be explored?

David.

AusHealthIT Poll Number 768 – Results – 13 October 2024.

Here are the results of the poll.

Is Australia Providing Enough Humanitarian Aid To Those Suffering In The Middle East At Present?

Yes                                                                                 12 (50%)

No                                                                                    8 (33%)

I Have No Idea                                                                4 (17%)

Total No. Of Votes: 24

A split vote,  with the feeling being that we are probably doing enough, just.

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

Not a wonderful voting turnout. 

4 of 24 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.

Looks Like They Are Trying To ‘Fix’ The myHR Again!

This appeared last week:

04 October 2024

Lighting My Health Record’s interoperability capabilities on FHIR

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By Laura Woodrow

The Australian Digital Health Agency has put out a request for tender for a $50 million contract to boost My Health Record’s connectivity.

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The Australian Digital Health Agency has put out a request for tender for a $50 million contract to boost My Health Record’s connectivity.

The federal government’s $2.5 billion My Health Record has repeatedly come under fire in recent times, particularly regarding its interoperability with other software.

Even the federal health minister Mark Butler admitted to the platform’s technology being “ordinary”, earlier this year.

As such, the ADHA is on a mission to revamp Australia’s medical data storage and sharing service capabilities, as it plans to make it mandatory for pathology providers to upload results to My Health Record from December this year.

Last week, the ADHA issued a $45-50 million tender request to expand My Health Record’s interoperability capabilities.

This will involve increasing the internal technical platform capabilities and integration to facilitate FHIR interoperability, moving away from the current Clinical Document Architecture-based document repository.

Both FHIR-based datasets and the current CDA datasets will need to coexist during the transition.'[good luck with that]

The tenderer will also need to provide support for FHIR interoperability for future components of the national digital health infrastructure.

The tender sits within a broader $429 million program to modernise My Health Record, announced in the 2023 budget.

The wider aim is to move My Health Record from a document-storage platform to a FHIR-enabled personalised health record system that enables close to real-time access.

The request for tender will close for applications at 2pm (AEST), 1 November 2024.

Speaking at ADHA’s industry briefing on the tender today, chief financial officer Christopher Davis said evaluation of the tender and completion of internal governance and approval requirements was scheduled to be completed by January 2025.

“We would be looking to commence the project as soon as possible after that evaluation period and discussions with the preferred tenderer or tenderers, but it will depend on, specifically, negotiations and progress formalising contracts with those preferred tenderers through that process as well,” he said.

“But certainly, from the agency’s perspective, we are keen to get moving as quick as we can.”

Tenderers may be asked for technical demonstrations during the request for tender, added Mr Davis. [oh, I wonder what they will be 'demonstrating'?]

“This will be at the agency’s discretion, depending on responses received and how we go during our evaluation process,” he said.

Mr Davis denied that the agency had a preference for a particular product when it was suggested that the wording of the statement of requirements “overlaps greatly with a certain product in the market”. [could that possibly be Epic or InterSystems?]

“The agency is certainly product agnostic here, and we are looking for something that maximises the value for money for the agency, government and community as well,” he said.

“I think if there are any similarities, it would be coincidental in nature.”

When asked by an attendee whether the agency had an expectation of the potential consumption increase through My Health Record as a result of the work – which would assist with pricing, the agency said this would be taken on notice. [sounds like it will be very tasty]

Mr Davis reminded tenderers to monitor AusTender for the most up to date documents when preparing tender responses.

The Australian Digital Health Agency told Health Services Daily that there was a “positive” response from the 260-strong attendees at today’s webinar.

“The FHIR Server Solution request for tender is intended to play a vital part in the modernisation of the My Health Record system,” it said.

“This modernisation and other national digital health initiatives including the Health Information Exchange require advanced technologies such as FHIR because they enable interoperability, providing secure access to a consumer’s healthcare information across care settings.”

A recording of the briefing will be available on the ADHA website soon. The timeframe for the delivery of the tender is three years.

Here is the link:

https://www.healthservicesdaily.com.au/lighting-my-health-records-interoperability-capabilities-on-fhir/20276

Does everyone realize we have been on this myHR journey since 2012 and as far as I can tell e have yet to see any enthusiasm for what it offers. Would anyone notice if they quietly shut is down and saved $400M a year?

David.

I Am Not Sure This Is Either Sensible Or Feasible. What Do You Think?

 This appeared last week:

The plan to save Australian lives with nationwide DNA screening

An ambitious vision to introduce mass genetic testing to the entire Australian adult population is being hailed as a solution to the country’s healthcare crisis. But can the health system cope?

Michael Smith Health editor

Oct 4, 2024 – 12.43pm

S even years ago, a scientist and a lawyer working together at Melbourne’s Monash University started collaborating on an ambitious idea.

They knew genetic testing could save lives and ease the burden on Australia’s stretched healthcare system by exposing the hereditary risk of certain cancers and heart disease early.

The science had been around for decades, but it was only more recently that the cost of testing huge numbers of people had come down, the internet was making the logistics easier and the technology existed to stabilise samples being sent by mail.

Jane Tiller, a lawyer and genetic counsellor who led a push to clamp down on life insurers using genetic information to discriminate against policyholders, was surprised DNA screening was not more widespread. Though many Australians were familiar with bowel cancer kits, pap smears and breast screenings, genomic screening was unreachable for most people. Many still do not know it is an option.

Geneticist Jane Tiller wants to scale up the genetic screening project to test 100,000 adults, a possible precursor to a nationwide program. Louis Trerise

Tiller teamed up with Paul Lacaze, a genomics researcher at Monash, to start working on a bold project to test 10,000 adult Australians for gene variants that increase the risk of certain hereditary cancers and heart disease. Logistically, it was challenging, and they needed government funding to make it happen. Their big breakthrough came in 2020 when the project received a $3 million government grant.

“Until then we weren’t sure if we would get funded. We weren’t sure if the health system was ready for this kind of thing,” Tiller says. “When we got that grant that changed everything and that set our course quite clearly in terms of what we were aiming for. We wanted an equitable screening program open to everyone for prevention.”

Tiller and Lacaze are now preparing to take their project called DNA Screen into its next important phase. They want to scale up the program to test 100,000 adults which, if successful, would be the precursor to a nationwide genomic screening program.

This means every adult Australian who wants a test could eventually have their DNA screened for free. Tiller and Lacaze say it would save countless lives by detecting the risk of disease early and save the healthcare system billions of dollars through prevention.

The projection estimates there are 318,000 Australian adults out of 20 million at high genetic risk of the three conditions they are screening for. Given half of those people on average are at risk of developing a cancer or coronary heart disease in their lifetime if it is left unidentified and untreated, they estimate up to 119,000 cancers and 40,000 heart attacks could occur if they are not identified.

“Our long-term goal is for every adult Australian who wants testing to be able to access genomic screening for disease prevention,” Tiller says. “If Australia was to do this, we would be world leaders. There is no country that has a national genomic screening program for adult prevention in the way we are proposing. It is feasible in Australia because of the size of our population, the decreasing cost of testing and our nationally funded healthcare system.”

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DNA tests have been growing in popularity for the past decade. Millions of people, including celebrities such as Oprah Winfrey, are spitting into test tubes to learn about their ancestry, and police are using the science to solve crimes decades after they were committed. Screening as a way to detect the risk of disease is not new, but it is not widespread either.

Angelina Jolie inspired thousands of women to get tested when she had a double mastectomy in 2013 after a screening found a genetic mutation which meant she had a high risk of breast cancer.

While the idea of mass DNA testing for some sounds like something out of a dystopian science fiction movie, Monash says the demand was overwhelming when it launched its pilot in 2020.

Though the original plan was to recruit participants through social media over time, 10,000 people applied online on the first day after the story made the evening television news. “The interest was overwhelming. About 20,000 people signed up in the first week, and we had to turn our social media ads off,” Tiller says.

Monash University genomics researcher Paul Lacaze and senior research fellow and lawyer Jane Tiller teamed up to launch DNA Screen.  

The tests screened for three adult genetic conditions: hereditary breast and ovarian cancer; Lynch syndrome (which increases the risk of colorectal and other cancers); and familial hypercholesterolaemia, which increases the risk of coronary heart disease.

After a simple eligibility test, saliva testing kits were posted to the participants. They would spit into a tube with a temperature stabilising solution and mail the samples back to Melbourne for testing in Monash’s labs. The total turnaround time varied but for many was about six weeks. Samples deemed high risk were then analysed by a curation team and people were notified about the results.

The results of Monash’s DNA Screen national pilot study found about 2 per cent of those tested were high risk. Three-quarters of those people would not have qualified for any reimbursed genetic testing based on current criteria in the public healthcare system. The study also meant Monash could deliver a detailed cost-effectiveness analysis for a nationwide screening program based on testing costs of $200 to $400 per test.

Figures published in The Lancet medical journal state that at $200 per test, genomic screening would be cost-effective under the Australian threshold, and would require an investment of $832 million to screen half of the Australian population aged 18-40.

Monash is waiting on a funding decision for what it is calling the bridging phase. It proposes an investment by the federal government of $50 million to screen 100,000 Australians in partnership with the Department of Health over four to five years as a precursor to a nationwide government-funded screening program, which could be considered as early as 2030.

One problem with identifying such large numbers of people at risk of cancer or heart disease at the same time is the pressure it would put on the country’s already stretched health system. If Monash’s projections are correct, downstream genetic services would be significantly stretched if they received thousands of referrals. Tiller says the goal would be to prepare the health system and genetics services ahead of time.

“We know that genetic services would be significantly overstretched if they received thousands of referrals, and new, streamlined models are required to effectively deliver population genomics. These models need to be developed and tested in real time to generate evidence and ensure system readiness,” she says.

Critically, to achieve the cost-effectiveness, some government investment needs to be shifted into prevention.

With Australia’s healthcare system facing growing pressure from an ageing population and funding shortfalls, doctors are backing the Monash proposal as another investment in prevention. While DNA screening will add pressure onto the system, they say it is better to identify the risks early and save lives and stop unnecessary treatment in the years ahead.

“The system is absolutely creaking at the seams at the moment and the only way to do it is to pivot from treatment to prevention,” says Steve Robson, former Australian Medical Association president who supports DNA Screen.

A key concern about mass DNA testing was addressed last month when the federal government announced a ban on genetic discrimination. This means people cannot be obliged to share their test results with life insurers, who are also not allowed to ask for them.

Potential data breaches also worry some people. Last year, more than 6 million customers at genetics testing company 23andMe had their data exposed to a data breach. Monash destroys samples if people request it but less than 10 per cent of those screened asked for this.

For some, the concept of screening an entire country’s adult DNA will sound dystopian even if it saves lives. The 1997 science fiction movie Gattaca tells the story of the near future where society is divided between those born or enhanced with more desirable genes and those who are not.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/the-plan-to-save-australian-lives-with-nationwide-dna-screening-20240911-p5k9uu

There is no doubt this is an ambitious ‘biggie’ and there is also no doubt that prevention is a very good thing for all concerned.

Whether anyone can successfully execute such a huge intervention has to be unknown at this point and you can be sure it will cost more than the initial estimate. This is one of those projects where the costs and benefits need to be fully worked through and a pretty decently scaled feasibility study conducted at the very least!

If all that lines up it will be a political and funding decision to go ahead - - along with a public education campaign to get the populace on side!

David.