I Am Not Sure Mr Butler Has A Clue About Health Information Management And The Utility Of The myHR!

This appeared last week:

Minister for Health and Aged Care, speech - 17 October 2024

Read Minister Butler's speech at the Victorian Healthcare Week 2024: Digital Healthcare

The Hon Mark Butler MP
Minister for Health and Aged Care

Media event date:17 October 2024

Date published:17 October 2024

Media type: Transcript

Audience: General public

I would like to acknowledge the traditional custodians of the lands on which we meet, the Wurundjeri Woi-wurrung and Bunurong peoples of the Kulin nation.

I pay my respects to Elders past and present.

Today I’d like to give you a glimpse into the Government’s vision for how upgraded digital health systems will underpin a stronger Medicare and better patient care.

In the past year, our investments in digital health, along with a collaborative engagement with clinicians and software providers, are driving an upgrade to My Health Record that will improve patient care and shift provider behaviour.

Because in Medicare's 40th year, a quiet revolution is underway in digital health, both in approach and in outcome, after a decade of inaction.

Since Medicare was introduced 40 years ago, technology has advanced immeasurably.

Back in 1984, "cutting edge" meant a Sony Walkman in your pocket, an Apple Macintosh on your desk, and a fax machine in your office.

Walk into so many health settings today, you'll find a smartphone in your pocket, a fitness tracker on your wrist, and in the corner where the fax machine used to sit is another fax machine.

That's right: a technology first invented in 1964 - 20 years before Medicare - is still frustratingly, maddeningly, all too common in Australian healthcare settings.

Why is this still the case?

When we came to government, My Health Record was in dire need of an upgrade.

It was still using the old PDF format that Labor installed when we were last in government.

It was cutting edge then, but it is beyond clunky now.

For almost ten years, nothing was done to upgrade the technology that underpinned it.

While the broader economy went through a digital revolution that reshaped industries, My Health Record just sat there, gathering dust.

Without investment, My Health Record remained little more than a shoebox of PDFs - the kind of shoebox every accountant has nightmares about.

You know the one: it came with your running shoes about ten years ago and now is stuffed to the brim with receipts.

Just hundreds and hundreds and hundreds of receipts.

When we came to Government, we discovered that it wasn’t even funded beyond June 30 last year.

On July 1, My Health Record was due to be switched off.

Unplugged. Gone.

So too, the Digital Health Agency.

Lucky we never sold that fax machine, eh?

For the past 10 years, Australia has not kept pace with international best practice to create consistent health information capture and exchange standards.

Instead of playing a coordinating role to allow a patient’s health information to follow them throughout the health system and their life, the former government vacated the space.

Without clear leadership, clinical information systems were built using licenced frameworks that didn't talk to each other.

With many different systems across public hospitals, private hospitals, aged care facilities, general practices and allied health clinics, patient data became effectively siloed behind a wall of proprietary frameworks.

Unsurprisingly, there isn’t much confidence in such an outdated system.

In the most recent Health of the Nation survey by the Royal College of General Practitioners, 31% of GPs said they rarely, or never, use My Health Record.

Even fewer specialists use it: half of them haven’t even registered with it.

Dr Ramya Raman explained to me how frustrating using My Health Record can be, as a GP.

She said - quote - "Every blood test is a separate file. Every scan is a separate file. They're just labelled 'pathology' and it opens up in a window. And the most frustrating thing about it is: you close one window, the whole thing closes".

We have to do better.

There is no reason why Australia can't make My Health Record interoperable with the clinical systems that Dr Raman and other healthcare providers actually use.
 
That clinical software should be able to draw upon the data in My Health Record directly, and publish back to it seamlessly, without any additional data entry required of the healthcare practitioner.

I said as much at the National Press Club in May last year.

And if a patient gets a diagnostic scan or pathology test, then those results should be uploaded.

A week after that Press Club speech, in the 2023 Budget, we announced almost $1.1 billion in new funding to modernise the digital health infrastructure and upgrade My Health Record to a data rich platform.

A bit over one year on, and Australia is seeing the most substantial digital health reforms in more than a decade, across three major areas:

• 1) standards
• 2) medicines
• 3) tests and scans.

First, standards...

Last year, we funded the CSIRO to lead a partnership across the digital health sector called the “Sparked” initiative to deliver a national set of data and exchange standards.

So that the clinical software a health professional uses stores health data according to common standards, enabling sharing across platforms, practices and professional disciplines.

The standards will use the Fast Healthcare Interoperability Resources  framework – or FHIR – that is used widely in the United States, UK and Europe.

The “Sparked” initiative launched in August last year with all Australian governments as founding partners and more than 500 participants comprising technology vendors, provider organisations, consumers, peak bodies and health practitioners.

The first goal was to develop standards for core patient health information covering Procedures, Allergies, Medicines, Problems, Immunisations and Results.

In just 10 months, that goal was achieved.

In June this year, Australia’s first ever national information sharing standard was published and can now be built into clinical systems.

This represents more progress in 10 months than in all of the previous 10 years, combined.

The strength of “Sparked” lies in its bottom-up process of community consultation and consensus, with more than 500 participants rallying  each other toward a common goal.

Now, “Sparked” is looking at how to digitise Chronic Condition Management Plans, capture the reason a patient presents for healthcare, and develop the additional data-sharing attributes needed for a national patient summary record.

This is just one small part of the revolution in digital standards underway across the health system.

Work is also underway to develop a national directory of healthcare providers.

To do that, we’re enhancing the national healthcare identifiers, so that whatever the health setting, all jurisdictions can accurately identify individuals, healthcare providers and organisations.

We’re also working hard with our state and territory colleagues to drive the nationally consistent and timely supply of quality hospital discharge summaries into primary care.

This has been a recurring critical gap that causes needless hospital readmissions and poor health outcomes.

It has been called out time and again through numerous reviews, including the Aged Care Royal Commission and the mid-term review of the National Health Reform Agreement.

Shared national standards will enable My Health Record to become the data-rich platform that Australia needs.

And a few weeks ago, the Digital Health Agency put out a large tender to do just that: to fundamentally transform the interoperability capability of My Health Record.

This is a critical piece of work that will enable clinicians and consumers to discover and access healthcare information where and when it is needed, in a standardised structured format.

The second major area of digital revolution underway is in medicines.

With electronic prescriptions, we have transitioned to a single national prescription delivery service, streamlining the delivery of more than 300 million prescriptions each year between doctors and pharmacists.

More than 100,000 prescribers across the country already use e-Prescriptions, and after extensive engagement across the health system, we are now on track to introduce them to public hospitals.

Each year, a quarter of a million hospital admissions result from medication-related problems and half of them are considered preventable.

We’re working on a framework to enable the rollout of electronic medication charts to more settings beyond the successful roll out in aged care, where nearly 80 percent of facilities have received a grant to adopt them.

The third, and perhaps the biggest, revolution underway in digital health is in the availability of scans and tests in My Health Record.

All states and territories are now sharing pathology and diagnostic imaging reports to My Health Record, with most uploading more than 75 per cent of all tests and scans, and most on track to share 100 per cent of them in coming months.

By the end of the year, for the first time, client support plans will be able to be shared from My Aged Care to My Health Record.

Patients expect their diagnostic scans and pathology tests to be uploaded.

This only happens by exception. It is not the rule.

At the National Press Club in May last year, I said that I intended to make it the rule.

Since that announcement, the number of private radiology clinics connected to My Health Record has more than doubled.

Australia’s largest private radiology provider, I-MED has started sharing by default from all their Western Sydney clinics.

In the ACT and southern New South Wales, Capital Pathology is sharing by default from every one of their clinics.

The third largest private radiology provider, Lumus, is the first to share by default nationally.
 
And since one private pathology provider in Western Australia started sharing by default earlier this year, they now field around 150 fewer calls per day from patients looking for test results.

Over 10 million pathology and nearly 1 million diagnostic imaging reports are being uploaded each month.

In May last year, just one in five diagnostic imaging reports were being sent to My Health Record.

A year later, and one in three reports are now being uploaded.

While this is an improvement, it is still too low and too slow.

Which is why I will soon introduce legislation that will mandate “sharing by default” for all tests and scans in near real-time. 

To enable faster access, I am looking to remove the 7-day delay that prevents patients from seeing their results sooner. 

While near real-time access will be the new standard, in some cases a clinically appropriate delay may remain if appropriate.

Before agreeing an approach, I will consider advice from the Clinical Reference Group, co-chaired by former AMA President Dr Steve Hambleton and Conjoint Associate Professor Carolyn Hullick, the Chief Medical Officer at the Commission on Safety and Quality in Health.

The Clinical Reference Group will provide me with strategic and clinical advice to ensure implementation is aligned with consumer needs and preferences, and healthcare provider clinical workflows.

Test results and scans belong to patients, not providers, and they need to be shared to a patients' My Health Record.

To show that we're serious, the laws will include consequences for companies that do not share.

And let’s be clear about why our government is so committed to this.

Yes, it will make healthcare professionals’ lives easier, by helping them to be more efficient and effective.

Yes, there will be flow on benefits across the system, helping to ensure that every precious dollar in the Medicare system goes to patient care.

Sure, those are important.

But the reason we are driving so hard toward that digital future is not provider benefit or system benefit, but patient benefit.

Patient benefit is – and always will be – our North Star.

Patients find this so frustrating, because every lost test result means another day off work, another waiting room, another procedure and yet another gap fee.

Patients desire and deserve access to their own health data, and agency over how it is used and shared.
 
Digital health technologies should empower patients to monitor and take charge of their health and wellbeing, so they can interact confidently with healthcare providers and build their health literacy.

It moves patients from the periphery of a too-often fragmented system, and puts patients right of the heart of a better connected and more personalised health system.

This is what drives our government’s efforts.

And it’s why the “sharing by default” framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan.

Withhold a patient's results and we will withhold the Medicare payment.

It's as simple as that.

This is not a drastic position for a government to take.

In the United States, for instance, the 21st Century Cures Act requires the portability of health records with open access for consumers to their health information.

Under the legislation, providers that do not have modern cloud-based systems in place to enable this sharing could even be sent to jail.

While our health systems are different, since the U.S. laws were introduced in 2016, study after study has shown a range of benefits to consumers and health providers after the removal of delays to patients viewing their results.

The "sharing by default" legislation will be introduced to Parliament next month.

I'd like the laws to be passed and in place by the middle of next year.

It's clear that we cannot leave patients to rely on the benevolence of private providers.
 
In the financial year to June 2023, Australia's second largest private pathology provider, Healius, had a 25 per cent market share and received almost a billion dollars in Medicare benefits.

In August of that year, Healius was uploading over 800,000 pathology reports a week to My Health Record.

The following month, on the 11th of September, we released for public consultation our intent that pathology companies would share by default by June, with a legal obligation by the end of this year.

No sooner had we released that proposal for public consultation, that very same day, Healius wrote to the Department of Health and Aged Care to say that it would imminently suspend the upload of pathology reports.
 
Despite previously having received close to half a million dollars from the Digital Health Agency to subsidise its connection into My Health Record, Healius stopped uploading pathology reports less than 24 hours later.

With each week that passed, another 800 thousand patient results were not uploaded to My Health Record.

Letters were sent, meetings were sought, and then held, without resolution.

Weeks went by, and still Healius hadn’t resumed uploading patient test results.

Patients were starting to ask the Digital Health Agency why their results weren't in My Health Record.

On 27 November, in response to questions from media and after making no progress convincing the company to reverse its decision, I went public with my deep disappointment that Healius was withholding patient data.

Thankfully, 12 weeks after Healius stopped uploading pathology results, on the 5th of the December, it finally resumed.

By that point, an estimated 10 million test results were missing from My Health Record.

10 million test results that will never be readily accessible to patients or their health providers.

It’s impossible to determine if any of those missing results have since led to additional or duplicate tests.

If even 1 in 20 of those 10 million results need to be re-ordered, then patients and the health system are on the hook for another half a million tests.

Half a million needless Medicare payments.

Half a million times that patients have to take leave from work to give up their time and, in all likelihood, take yet another blood test.

Half a million re-ordered tests may be a conservative estimate.

Studies from the UK’s National Health Service indicate that up to a quarter of all pathology requests may be duplicates or unnecessary.

Now credit where credit is due.

Since it resumed uploading in December last year, Healius has consistently been uploading pathology reports to My Health Record by default, with uploads continuing to grow.

Under its new management, Healius has engaged very constructively in the government's digital health reforms and upgrades to My Health Record.

The government has had no issues with Healius since that time.

However, to be perfectly frank, patients should not have to rely on the goodwill or good management of private providers to be able to access their own health data.

Companies that have built their business model on channeling and control of a patient's health data will have to find a new way to drive profit margins for shareholders.

Let me be clear: withhold a patient's results and we will withhold the Medicare payment.

As well as being better for consumers, a sharing by default scheme that enables patients to access their information in near real time, is also better for the bottom line for healthcare providers.

Because every dollar that goes to a needless or duplicate test or scan, is a dollar that doesn't fund lifesaving medicines or our hard-working doctors, nurses and health professionals.

Every minute a GP doesn't spend searching through My Health Record for a result that may or may not be stuffed into the PDF shoebox, is a minute they can spend with a patient.

Every minute a practice nurse doesn't have to spend manually entering a patient's data into their My Health Record, is a minute that they could be administering a childhood vaccination.

Every minute a practice manager isn't held up on a phone call with a patient chasing up their results, is a minute that another patient doesn't have to wait on hold to make an appointment.

The Productivity Commission estimates more than $5 billion a year could be saved by reforming Australia's digital health infrastructure.

Beyond the savings, it is - quite simply - what patients expect and deserve.

People now routinely view their test results in My Health Record more often than they did at the absolute peak of the COVID-19 pandemic, when they were viewing 700,000 reports each week.
 
Near-real time availability will see an uplift of digital health literacy, better informed consumers and better management and care coordination of chronic conditions.

Just what a stronger Medicare needs to be able to deliver for the patient profile of 21st century Australia.

A bit over a year after the announcement of $1.1 billion in funding, this quiet revolution in digital health is delivering more progress in a single year than in the previous ten years, combined.

By driving revolutionary changes in standards, medications, and tests and scans, a modernised and upgraded digital health infrastructure will deliver a My Health Record that is data-rich, real-time and complete.

Consumers will be able to trust the system, access their information at all times, and won't have to repeat their medical history every time they see a clinician.

By the time Medicare reaches its next milestone birthday, we can confidently expect that the humble fax machine will no longer clutter the offices of health settings.

Like the Sony Walkman or Apple Macintosh, the fax machine will finally become little more than a museum relic.

I'm sure I speak for patients everywhere when I say: that day can't come soon enough.

Thank you.

Here is the link:

https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-17-october-2024?language=en

It really is bizarre that Mr Butler thinks that the data for patient care is all up there somewhere and patients can just get on with downloading it.

I have just had a look at myHealthRecord – given I have had some admissions and treatment in the last few months.

There is a collection of useless junk in the record and zero clinically relevant that I can detect but an amazing list of things done to me – all of which is a variety of item numbers!

The record is a collection of “data junk” and is non-sensical and useless.

The fiasco continues and the myHR is as useless as ever – despite what the Minister says!

David.

 

 

I Think It Is Probably Appropriate To Check Aging Doctors For Fitness To Practice.

This appeared last week:

‘Lacking evidence and probably ageist’: RACGP hits out at medical board’s mandatory health checks for older doctors

'We have serious concerns that this proposed policy is ageist,' says college president Dr Nicole Higgins.

Paul Smith

17 October 2024

The RACGP says the Medical Board of Australia’s push on mandatory health checks for older doctors is backed by no evidence and is probably ageist.

The board wants all doctors aged 70 and over to go through a health assessment at least once every three years as a condition of their registration.

In its consultation paper, it says so-called late-career doctors are 81% more likely to be subject to a complaint than their younger colleagues.

But in a fiery response, college president Dr Nicole Higgins has accused the medical board of failing to show any evidence that mandatory health checks will reduce patient harm or notifications (see box below for the board’s statistics).

“It is unclear [based on the board’s consultation paper] if notifications received by AHPRA were specifically related to the physical or cognitive decline of the doctor, the age of the doctor, and could be avoided by a mandatory health check based on the doctor’s age,” she wrote.

She says that, according to the consultation paper, only 2.58 notifications per 1000 doctors over 70 were for health impairments (0.26%).

“In an inclusive and diverse society, there is no place for ageism, and we have serious concerns that this proposed policy is ageist.”

It is important to “foster a culture that encourages and supports doctors to take good care of their health”, Dr Higgins says.

“Mandatory reporting laws do not help build this culture. Fear of mandatory reporting leads health professionals to avoid getting the help they need.”

She also says the medical board needs to provide information on the medicolegal position of GPs treating older doctors.

“For example, if an assessing doctor has concluded a health professional is fit to practise but AHPRA determines a notification or suspension is required.”

The board’s consultation paper, released two months ago, suggests GPs are only expected to make a notification if the doctor refuses to deal with a health impairment and there is a serious risk of patient harm.

It says it does not want to see the results of any assessment.

However, it expects late-career doctors to declare in their annual registration renewal that they have completed the appropriate health check, including, as now, any declaration that they have an impairment that “detrimentally affects, or is likely to detrimentally affect, their capacity to practise medicine”.

One key element of the board’s plan is that the health assessments conducted by an older doctor’s GP should include cognitive screening.

It acknowledges that the Mini-Mental State Examination commonly used by GPs is flawed.

But it suggests the adoption of either the Montreal Cognitive Assessment or the Addenbrooke’s Cognitive Examination, saying both have “very good sensitivity in detecting mild cognitive impairment”.

The college says any demands for health checks should be evidence based and consistent with the college’s Red Book.

“The Red Book does not recommend screening for dementia in the general population.

“A case-finding approach to dementia is recommended, being alert to risk factors, signs and symptoms of dementia with the best time to identify dementia risk factors earlier in life.”

The college’s stance on mandatory health checks contrasts with the position of the AMA, which says it does not support retaining the status quo in its own submission.

While the AMA’s submission does not explain what system it does want, it stresses there should be no requirement for older doctors to undergo cognitive screening.

“A better model would not include specific cognitive function screening in the health check, but it would make it clear in resources for GPs that they should consider cognition and use their clinical judgement regarding screening and/or write a referral for formal assessment if required,” its submission states.

The medical board’s statistical breakdown on the risk of older doctors In 2023, there were 6975 practising doctors aged 70 and over, including 1035 aged 80 and over. The board’s consultation paper says those aged 70 and over are 81% more likely to be the subject of a complaint than their younger colleagues. It refers in particular to the differences in the rates of complaints about clinical care (15.9 per 1000 doctors under 70 vs 24.2 per 1000 late-career doctors), communication (4.7 vs 11.3) and pharmacy and medication (4.6 vs 12.2). It needs to be stressed that one doctor may be generating more than one notification. In absolute numbers, older doctors last year generated 168 notifications relating to clinical care, 78 relating to communication and 85 relating to pharmacy and medications. There is no detail on the extent to which these notifications are linked to health impairments. The board’s paper stresses that, in terms of overall notifications, 23% of the complaints against late-career doctors resulted in some from of regulatory action — in the vast majority of cases, the imposition of conditions or cautions. The consultation paper says this compares with 14% of the notification against younger doctors. Source: Health checks for late-career doctors impact statement; 7 Aug 2024.

More information:

• Health checks for late-career doctors impact statement; 7 Aug 2024.
• AHPRA news; 7 Aug 2024.

Here is the link:

https://www.ausdoc.com.au/news/lacking-evidence-and-probably-ageist-racgp-hits-out-at-medical-boards-mandatory-health-checks-for-older-doctors/

I have to say I am on the Medical Board’s side here. Anyone over 70 or so should be able to demonstrate they are still cognitively intact, Just how you do this is the trick I reckon – but just like with pilots etc. we need to protect the public against failing cognition!

What do you think?

David.

The Government Really, Really Wants You To See Your Clinical Results – Even If You Have No Idea What They Mean!

These appeared during the week:

Govt pushes ahead with real-time pathology data sharing plan

---

Brandon How
Reporter

17 October 2024

New laws that will force health providers to upload pathology and diagnostic imaging to My Health Record by default or forgo Medicare payments will be introduced to Parliament next month.

In a speech on Thursday, Health minister Mark Butler said “near real-time access will be the new standard” on My Health Record, confirming the government will remove the rule that patients must wait seven days before being given access to their imaging reports.

However, “in some cases a clinically appropriate delay may remain if appropriate”, which will go some way to appeasing medical professional associations, which have argued a blanket change to the rule would create misinformation and stress out patients.

The government had initially hoped default sharing of pathology and diagnostic imaging reports would be implemented from June 30, 2024 but is now targeting mid-2025.

Mr Butler announced the proposed changes in May 2023 and consultations took place between September and October 2023. Last year’s federal Budget earmarked $13 million over two-years for work on the ‘share by default’ framework.

The seven-day delay on granting patients access to pathology results was introduced in 2014 to give follow up healthcare providers sufficient time to review results and discuss them with patients before the reports are available on My Health Record.

However, as at the start of this year, the delay has been removed for a handful of tests including COVID-19 and 13 other respiratory pathogens.

While the ‘sharing by default’ framework has yet to be finalised, Mr Butler said that pathology and diagnostic imaging companies that don’t upload the data to My Health Record “will not get a Medicare benefit for that test or scan”.

“Before agreeing an approach, I will consider advice from the Clinical Reference Group, co-chaired by former AMA President Dr Steve Hambleton and Conjoint Associate Professor Carolyn Hullick, the Chief Medical Officer at the Commission on Safety and Quality in Health,” Mr Butler told the Victorian Healthcare Week conference.

The Australian Medical Association is among the professional groups opposed to a blanket removal of the seven-day delay for patient access to pathology and diagnostic imaging reports, although they have not raised concerns regarding mandatory uploads.

Since announcing plans to implement ‘sharing by deafult’, the number of diagnostic imaging reports uploaded to My Health Record has increased from one in five to one in three.

Now, more than 10 million pathology and nearly one million diagnostic imaging reports are uploaded monthly.

“While this is an improvement, it is still too low and too slow,” Mr Butler said.

All state and territory governments are sharing pathology and diagnostic imaging reports, “with most uploading more than 75 per cent of all tests and scans, and most on track to share 100 per cent of them in coming months”.

The number of private radiology clinics connected to My Health Record has doubled, with Australia’s largest private radiology providers among those that have pre-emptively made the switch to default sharing of reports with the My Health Record.

“Australia’s largest private radiology provider, I-MED has started sharing by default from all their Western Sydney clinics,” Mr Butler said.

“In the ACT and southern New South Wales, Capital Pathology is sharing by default from every one of their clinics. The third largest private radiology provider, Lumus, is the first to share by default nationally.”

Mr Butler also confirmed that the CSIRO-led Sparked consortium – which has led recent work to develop a national set of data and exchange standards – has turned its attention to digitising “Chronic Condition Management Plans, capture the reason a patient presents for healthcare, and develop the additional data-sharing attributes”.

The Department of Health and Aged Care is also looking working on a framework for rolling out electronic medication charts beyond the aged care sector, which has seen 80 per cent uptake, according to Mr Butler.

Here is the link:

https://www.innovationaus.com/govt-pushes-ahead-with-real-time-pathology-data-sharing-plan

Also we have

Butler hopes to introduce ‘sharing by default’ laws next month, warns penalties may apply

17 October 2024

By Kate McDonald

The Australian government will introduce legislation to Parliament next month to support its ‘sharing by default’ policy, which will mandate the sharing of key health information with consumers starting with pathology and diagnostic imaging report uploads to their My Health Record.

Health Minister Mark Butler told the Victorian Healthcare Week conference today that penalties may apply to healthcare providers that refuse to upload results, which will see them lose out on Medicare benefits.

The mandate to share pathology and imaging reports in near real time is expected to see the elimination of the seven-day rule for test result uploads to My Health Record, although this element is still up for consultation.

It will be followed by other mandates on sharing information such as medication events, prescriptions, dispense records, and the administration of medicines in care settings.

Mr Butler said the government’s investments in digital health, along with a collaborative engagement with clinicians and software providers, were driving an upgrade to My Health Record that will improve patient care and shift provider behaviour.

He said that My Health Record was in “dire need” of an upgrade when his government was elected in May 2022.

“It was still using the old PDF format that Labor installed when we were last in government,” Mr Butler said. “It was cutting edge then, but it is beyond clunky now. For almost 10 years, nothing was done to upgrade the technology that underpinned it.

$1.1 billion in new funding was announced in the May 2023 federal budget to modernise the digital health infrastructure and upgrade My Health Record to a data rich platform, he said.

“A bit over one year on, and Australia is seeing the most substantial digital health reforms in more than a decade, across three major areas: standards, medicines, tests and scans.”

He listed the development of the Sparked initiative, led by the CSIRO, to deliver a national set of data and exchange standards based on FHIR.

“The first goal was to develop standards for core patient health information covering procedures, allergies, medicines, problems, immunisations and results,” he said. “In just 10 months, that goal was achieved.

“In June this year, Australia’s first ever national information sharing standard was published and can now be built into clinical systems.

This represents more progress in 10 months than in all of the previous 10 years, combined.”

The Sparked accelerator is now looking at how to digitise chronic disease management plans, “capture the reason a patient presents for healthcare, and develop the additional data-sharing attributes needed for a national patient summary record”, he said.

Work has also been done on medicines, including the transition to a single national delivery service for prescriptions, along with the expansion of electronic prescriptions from GPs and the community into public hospitals.

He also mentioned the roll out of electronic medication charts to aged care, where nearly 80 per cent of facilities have received a grant to adopt them.

But he said perhaps the biggest revolution underway in digital health is in the availability of scans and tests in My Health Record.

“All states and territories are now sharing pathology and diagnostic imaging reports to My Health Record, with most uploading more than 75 per cent of all tests and scans, and most on track to share 100 per cent of them in coming months,” he said.

“By the end of the year, for the first time, client support plans will be able to be shared from My Aged Care to My Health Record.

“Patients expect their diagnostic scans and pathology tests to be uploaded. This only happens by exception. It is not the rule.”

The government now plans to make it the rule, he said. “Over 10 million pathology and nearly one million diagnostic imaging reports are being uploaded each month.

“In May last year, just one in five diagnostic imaging reports were being sent to My Health Record. A year later, and one in three reports are now being uploaded.

“While this is an improvement, it is still too low and too slow, which is why I will soon introduce legislation that will mandate sharing by default for all tests and scans in near real-time.

“To enable faster access, I am looking to remove the seven-day delay that prevents patients from seeing their results sooner. While near real-time access will be the new standard, in some cases a clinically appropriate delay may remain if appropriate.”

A clinical reference group, co-chaired by former AMA president Steve Hambleton and chief medical officer at the Commission on Safety and Quality in HealthCare, Carolyn Hullick.

Mr Butler was particularly critical of an unexplained decision by pathology provider Healius to cease uploading reports to My Health Record last September – which he said meant an estimated 10 million test results were missing from My Health Record and would never be able to be uploaded – although the company has since resumed uploads.

“Test results and scans belong to patients, not providers, and they need to be shared to a patients’ My Health Record,” he said.

“To show that we’re serious, the laws will include consequences for companies that do not share.”

This will include a withholding of a Medicare payment if the patient’s results are withheld, he said, as the “sharing by default framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan”.

“Withhold a patient’s results and we will withhold the Medicare payment.”

Mr Butler said this would benefit healthcare providers as it would reduce spending on needless or duplicate tests or scans, along with productivity benefits.

“Every minute a GP doesn’t spend searching through My Health Record for a result that may or may not be stuffed into the PDF shoebox, is a minute they can spend with a patient,” he said.

“Every minute a practice nurse doesn’t have to spend manually entering a patient’s data into their My Health Record, is a minute that they could be administering a childhood vaccination.

“Every minute a practice manager isn’t held up on a phone call with a patient chasing up their results, is a minute that another patient doesn’t have to wait on hold to make an appointment.”

He said the “sharing by default” legislation will be introduced to Parliament next month, and he’d like the laws to be passed and in place by the middle of next year.

Here is the link:

https://www.pulseit.news/australian-digital-health/butler-to-introduce-sharing-by-default-next-month-warns-penalties-may-apply/

And we have:

17 October 2024

‘No rebate for you’: Butler threatens path labs if they don’t upload results

By

Laura Woodrow

The health minister announced he would withhold pathology companies’ Medicare rebates if they don’t upload patients’ results to the electronic health record.

The federal government will withhold Medicare rebates from pathology services that do not comply with legislation for mandatory My Health Record uploading, says health minister Mark Butler. 

Last year, Mr Butler announced plans to implement mandatory uploading of pathology and diagnostic imaging reports to MHR and to void the seven-day delay on report availability for patients. 

Opening day two of Victorian Healthcare Week’s digital healthcare convention in Melbourne this morning, Mr Butler said laws to be introduced next month would include consequences for companies which did not comply. 

“The sharing by default framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan,” he told delegates. 

“It’s that simple. Withhold a patient’s results and we will withhold the Medicare payment.  

“It’s not a drastic position for a government to take.  

“In the United States, for example, the 21st Century Cures Act requires the portability of health records with open access to consumers to their own health information.  

“Under that legislation, providers that do not have modern, cloud-based systems in place to enable this sharing can be sent to jail, which is not something we’re considering.” 

Mr Butler acknowledged a heckle of “yet” from the audience.  

“Our health systems are obviously different to America’s,” he said. 

“[But] since the US laws were introduced eight years ago, study after study has shown a range of benefits to consumers and health providers after the removal of delays to patients viewing their own results.” 

The Department of Health and Aged Care did not respond to The Medical Republic’s request for information on how the legislation would affect rebates to patients for non-bulk-billed services. 

While near real-time access would be “the new standard”, Mr Butler said he would consult with the Clinical Reference Group about “clinically appropriate” cases where the delay may remain. 

By the end of the year, client support plans will be able to be shared between My Aged Care and My Health Record, added Mr Butler. 

Since the announcement of the plans last year, all states and territories were now sharing imaging reports to MHR, with most uploading over 75% and “on track” to share 100% in the coming months, he said. 

“Since [the] announcement … the number of private radiology clinics connected to MHR has more than doubled.” 

While the needle is shifting, progress remains “still far too low and far too slow”, said Mr Butler. 

“It’s clear that we cannot leave patients to rely on the benevolence of private providers,” he said. 

Healius – Australia’s second largest private pathology provider, which received almost a billion dollars in Medicare benefits in the 2022/23 financial year – was named and shamed. 

“In August of that year, Healius was uploading over 800,000 pathology reports a week to MHR,” said Mr Butler. 

“No sooner had we released [the] proposal for public consultation, that very same day, Healius wrote to DoHAC to say that it would imminently suspend the upload of pathology reports.” 

Despite resuming 12 weeks later, approximately 10 million test results were not uploaded during the boycott. 

“Companies that have built their business model on channeling and control of a patient’s health data will have to find a new way to drive profit margins for shareholders,” said Mr Butler. 

Mr Butler said he hoped the laws would be passed and in place by mid-next year. 

The federal government’s $1.1 billion digital upgrade promises to revolutionise the “shoebox of PDFs” that is the MHR.  

“By the time Medicare reaches its next milestone birthday, we can confidently expect that the humble fax machine will no longer clutter the offices of health settings,” he said. 

“Like the Sony Walkman or Apple Macintosh, the fax machine will finally become little more than a museum relic.” 

Here is the link:

https://www.medicalrepublic.com.au/no-rebate-for-you-butler-threatens-path-labs-if-they-dont-upload-results/111763

It is going to be interesting to see how this all works out – as it will also be interesting to see if any obvious benefits flow from all this, and of course that no harm is caused with patients spooked by results they don’t understand.

The theory is great – I hope it works out as hoped when implemented. There has to be a good chance this will be the case…..I am still waiting to have any of my results mailed to me for my files, despite repeated requests!!!!

David.

AusHealthIT Poll Number 769 – Results – 20 October 2024.

Here are the results of the poll.

Are You Seeing The Influence Of Climate Change In The Recent Hurricane Season In Florida?

Yes                                                                                  16 (84%)

No                                                                                     3 (16%)

I Have No Idea                                                                 0 (0%)

Total No. Of Votes: 19

A very clear vote, with the feeling being that we are seeing the influence of climate change.

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

Hopeless voting turnout. 

0 of 19 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.

I Guess This Is A Warning We Need To Take Seriously – Given Where It Comes From!

This appeared last week – Nobel Prize week

Physics Nobel winner Brian Hinton issues AI alert

Tom Whipple

9 September,2024

Sometimes on the morning when scientists receive the Nobel prize, they thank their colleagues. Occasionally they talk about the surprise of receiving a call from a Swedish number. Often they are simply overwhelmed. Geoffrey Hinton had other concerns.

Less than an hour after receiving the prize in physics, the British-Canadian AI pioneer warned that the technology he helped create could lead to the subjugation of humanity.

Professor Hinton, who was born in London and now works at the University of Toronto, shared the prize with John Hopfield, from Princeton. Together, 40 years ago, they applied techniques from physics to show how mach­ines could in a sense learn for themselves.

In doing so, they provided tools that helped in the development of AI systems. They also created technology that, Professor Hinton said, could be used for tremendous good but had ­significant dangers.

Machine learning works differently from conventional programming. Rather than relying on programs in which computers are given explicit instructions, it enables them to learn from examples in an analogous manner to humans.

Professor Hinton was honoured for his work on reapplying the equations of Ludwig Boltzmann, a 19th-century physicist. Boltzmann had been looking at a way to understand systems that involved lots of individual elements, such as molecules of gas.

Professor Hinton’s insight was to apply the principles to spotting patterns in data. He separately worked on the “back propagation” algorithms that power today’s AI systems.

Although the work was done in the early 1980s, it came to fruition only in the past 15 years, when the growth in data gave computers enough examples to work from and the growth in computing power gave them the capability. It is key to systems such as ChatGPT.

Yet the power of the technology also led Professor Hinton, 76, to quit his work with Google to warn humanity of its dangers.

Speaking to the Nobel committee, he said humanity was only just starting to understand its power.

“I think it will have a huge influence. It will be comparable with the Industrial Revolution, but instead of exceeding people in physical strength, it will exceed people in intellectual ability. We have no experience of what it is like to have things smarter than us,” he said.

“It’s going to be wonderful in many respects. In healthcare, it has given us much better healthcare. In almost all industries it is going to make them more ­efficient.

“People are going to be able to do the same amount of work with an AI assistant in much less time. It’ll mean huge improvements in productivity.”

He added: “We also have to worry about a number of possible bad consequences, particularly the threat of these things getting out of control.”

Asked whether he had regrets, he said: “In the same circumstance I would do the same again, but I do worry the overall consequence of this might be systems more intelligent than us that eventually take control.”

Computer scientist Neil Lawrence of Cambridge University, where Professor Hinton studied, said: “For me, Hinton’s been a total inspiration. (He) is great because of his ability to inspire multiple fields to come together.”

He said, however, that he did not believe AI was a threat in the way Professor Hinton believed.

“I share some of Geoff’s concerns about the societal aspects of these technologies but disagree on the origin of the problems and the form of the solutions,” he said.

The Times

Here is the link:

https://www.theaustralian.com.au/world/the-times/physics-nobel-winner-brian-hinton-issues-aialert/news-story/e883f04be4db8c6e3418609f0e9b20a5

Well, who am I to quibble? We need to stay alert and make sure, as best we can, that innovations are used overall for good!

David.

I Fear This Is A Sad But Inevitable Truth For Many Of Us. I Find It Frightening.

This appeared last week:

Dementia

Dementia set to become Australia’s leading cause of death

Australian Bureau of Statistics says the 250 deaths between heart disease and dementia in 2023 brings the totals ‘the closest they have ever been’

Sharlotte Thou

Thu 10 Oct 2024 17.56 AEDT

Dementia is on the brink of overtaking heart disease as the leading cause of death in Australia, according to the Australian Bureau of Statistics, which says the 250 deaths between the two conditions are “the closest they have ever been”.

In 2023, which recorded 183,131 deaths nationally, the five leading causes of death were heart disease, dementia (including Alzheimer’s), cerebrovascular disease, lung cancer and chronic lower respiratory disease, ABS data revealed.

Covid fell to the ninth leading cause of death, from third in 2022.

If mortality trends continue to follow expected trajectories, dementia will be the leading cause of death in Australia “in coming years”, the report said.

Over the past 50 years the mortality rate for ischaemic heart disease (also known as coronary heart disease) decreased by 87.9% while dementia increased by 842.8%.

The ABS noted that in its peak in 1968, heart disease accounted for almost a third of deaths, while dementia accounted for just 0.2%.

Lauren Moran, the ABS head of mortality statistics, attributed the change to improvements in medical treatment and an ageing population.

However, the ABS emphasised dementia is not an inevitable part of the ageing process and can occur at all ages.

Overall, the death rate of 5.13 deaths per 1,000 people in 2023 dropped from 5.48 in 2022.

Deaths from Covid almost halved and rates of death fell for most other leading causes, the bureau said.

Two-thirds of people who died from dementia in 2023 were female. It remains the leading cause of death among women, which the bureau said was due to their greater life expectancy.

The Dementia Australia CEO, Prof Tanya Buchanan, said dementia represents 12.2% of all female deaths and 6.4% of male deaths and the numbers are projected to worsen.

There are now an estimated 421,000 Australians living with dementia, she said.

“Without a significant intervention, this number is expected to increase to more than 812,500 by 2054.

“It is crucial that we act now to focus on the brain health of the nation as well as provide more targeted, effective support to those impacted by dementia.”

Suicide remained the leading cause of premature death in 2023, at a rate of 12.1 per 100,000 people.

Three in four people who died from suicide were male, though men who lived in remote Australia were twice as likely to die from suicide as men in capital cities. The 2023 data for males, though still premature, was higher than 2020 rates.

The median age of people who died by suicide was 45 (compared with 82 for all deaths) though this decreased to 33 among Indigenous Australians.

Indigenous people (30.2 per 100,000) were almost three times as likely to die by suicide as non-Indigenous people (11.3 per 100,000), which Prof Pat Dudgeon, a professor of Indigenous health at University of Western Australia, described as “unacceptable”.

Dudgeon said the data, which likely under represents true numbers, “reinforces the harsh reality that in Aboriginal and Torres Strait Islander communities losing loved ones to suicide is not the exception, but tragically common”.

The ABS also found Indigenous people were four times more likely to die unintentionally from drug use and five times more likely to die from diabetes.

In 2023, the median age at death was 82 years. Death rates among those aged 45 were the lowest in the last 10 years, with the death rate for females under 25 decreasing by just over 10% since 2022.

Australia’s National Dementia Helpline is 1800 100 500. The crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org

 Here is the link:

https://www.theguardian.com/society/2024/oct/10/dementia-set-to-become-australias-leading-cause-of-death

The only point of mentioning this is to say that doing all you can for your brain matters (control blood pressure, stay as fit as you can, avoid head trauma and use your brain when you can etc.) so that at least you brain sees the same distance as your body time wise!

There is little else we can all do but it has to be worth trying  to keep it going well!

I hope you agree…

David.