Having Had Two Of These There is Pretty Sould Advice Here I Reckon!

 This appeared last week:

 Everything I wish I had known before, and after, my hip replacement

So you’re thinking about a hip replacement. Here’s what you can learn from my experience before and after surgery, from pain management to when to get your teeth cleaned … and will you be able to manage the dog?

Natasha Robinson

15 June, 2025

When I had a total hip replacement earlier this year, like many people I had no idea what I was in for. These are all of the things I wish I’d known before and after the procedure.

Why wait? Your artificial joint might last a lot longer than you think

I was limping around for almost three years before my hip replacement, doing everything I could to delay the procedure. I figured I should wait for as long as possible before going under the knife given what I’d been told about prostheses generally lasting only around 20 years. I was stunned when I went to see my orthopaedic surgeon and he told me the new generation joint he would implant in my body could well last me a lifetime.

Nobody really knows the life of these new joints, but the prospects of them lasting a lot longer than 20 or 30 years seems high, according to orthopaedic surgeons.

One thing that many people don’t necessarily consider when they try to put off hip surgery is the biomechanical impacts on the rest of the body. Lack of mobility in the hips and an impaired gait has knock-on effects on the posture and potentially the knees.

No orthopaedic surgery is without risks, and a total hip replacement is not a decision to be taken lightly. There’s no guarantee of a perfect result, but the surgery is one of the most successful orthopaedic surgeries with a very high rate of good outcomes. Despite being relatively young for this surgery, I’m glad I didn’t wait any longer than I did.

New-generation prosthetic hips may last as long as 50 years.

The surgical approach

The traditional surgical method in a total hip replacement is the posterior approach, in which an incision is made at the back of the hip near the buttocks. During the surgery, the surgeon will split the gluteus maximus muscle to access the hip joint.

Some surgeons instead perform hip surgery via an anterior approach, where the incision is made at the front of the hip. This avoids cutting through muscle and can lead to less soft-tissue damage, less pain and a faster recovery, but it is associated with a small risk of nerve damage.

Another modern technique is hip resurfacing, which involves trimming damaged parts of the femoral head and replacing the hip socket with a metal cap. Hip resurfacing may be suitable for younger people who are keen to return to high-impact exercise after surgery (this is the type of hip surgery the British tennis player Andy Murray had before going on to continue playing professional tennis).

Preparing for surgery

In the weeks leading up to your surgery, you’re going to want to get organised with a set of crutches, a “grabber” to allow you pick things up off the floor as you won’t be able to bend down for several weeks after the surgery, and a shower chair for the first couple of weeks. A raised toilet seat is highly recommended as if you have the posterior approach, it’s recommended that your bottom is always higher than your hips when sitting – this is one of the hip precautions to minimise the risk of dislocation.

For the same reason, a wedge cushion for sitting on chairs or the couch is also very useful. Be sure to have a couple of ice packs on hand at home as well.

In the months leading up to your surgery, you should do all that you can to strengthen your lower body. This will stand you in good stead for your recovery. The stronger you go in to the surgery, the stronger you’ll come out.

Call in help

Be sure to stock your freezer with meals for the first week or two, or organise a food delivery service. If you have a dog, organise someone to walk your dog for a few weeks. Even though you’ll be walking soon after surgery, you won’t be able to manage walking a dog while you’re on crutches. If you’re on your own, as long as you have these factors organised, having a carer with you for more than a couple of days probably won’t be necessary, but be prepared to let the cleaning go for a few weeks.

The days before

Your anaesthetist should call you in the week leading up to surgery. If you’ve taken pain medicines before, make sure you tell them what has worked well for you in the past and what hasn’t. Hospitals typically give endone as pain relief immediately after surgery, but some people are non-responders to this medication and if it hasn’t worked for you in the past, you should tell your anaesthetist. It’s useful to specifically discuss with your anaesthetist what the protocols are for pain management. Oxycodone given orally is the first line of pain management in some hospitals, and believe me if it’s not doing anything for you, you’re going to want to know what the protocol is for accessing stronger drugs or an IV unit.

On the day before the operation, it’s recommended you use an antibacterial wash on your skin the night before and the morning of surgery to minimise infection risk. Make sure you stay really well hydrated the day before surgery. Some people take Gatorade for this reason.

Immediately after the surgery

You’ll typically have a spinal anaesthetic as well as general, so pain should be minimal upon waking up from surgery. Your legs may feel numb from the spinal. Nurses may give you oxycodone orally or via IV once you’re on the ward. It’s very important to stay on top of your pain relief after surgery. Doctors speak of “staying ahead of the pain”, and this means you should never wait until you’re in a lot of pain to take medication. It’s best to take pain meds continually so the pain is manageable – this is really important in order to get you up and moving as soon as possible.

Robinson was on crutches for a short time after her hip replacement. Picture: John Feder

You’ll have a urinary catheter in immediately after surgery so you don’t need to worry about navigating your way to the toilet for the first 24 hours or so.

You’ll typically be visited by a physio within 12 or 24 hours after the surgery who will help you take a small walk supported by a walking frame. Hospital stays after hip replacement are generally a few days, and during this time physios will help you learn to manage stairs and let you know when you may be ready to progress from a walker to crutches. People are generally discharged from hospital on crutches (you’ll need your own).

Don’t worry if you have stairs in your house – navigating stairs after hip replacement is really very easy, with the method being to lead up the steps with your non-operated leg, and down steps operated leg first.

You will be able to shower sitting in a chair in the hospital as soon as you’re mobile – surgical dressings used these days are very waterproof.

Be prepared to deal with constipation – oxycodone blocks most people up. The hospital will generally give you an osmotic laxative daily, but be sure to drink a lot of water and don’t be shy to ask nurses to give you a glycerol suppository if you haven’t moved your bowels after a few days. Prunes and pears are great to have on hand.

Pain and swelling

Don’t be surprised if your operated leg is black and blue after surgery. Significant swelling is also normal, and this should subside within a few weeks but sometimes can hang around a lot longer. Apply ice packs regularly in the days and weeks after surgery.

It’s difficult to predict how much pain you may experience. Hip replacement is major surgery. Some people are in a lot of pain in the days after surgery, and others not. For most people, the worst of the pain subsides within about a week.

Sleeping

For the first couple of days after surgery you’ll have to sleep on your back, which can be a challenge for side sleepers. After a few days, ask your doctor whether it’s okay to sleep on your non-operated side with a pillow between your legs. You won’t feel comfortable to sleep on the operated side until a few weeks after surgery.

Take as many naps as you need in the weeks after surgery. Many people feel a lot of fatigue.

Keep moving

Walking is the best thing you can do for rehabilitation. You can build up a little more every day, but try not to increase your step count or distance too quickly – a little more every day is the key. After two to three weeks, you may be able to walk a kilometre or even two on your crutches, but don’t worry if you’re much slower to progress. All recovery is individual.

Physios in the hospital will give you some exercises to do. Usually these include leg slides in your bed, squeezing your glute muscles in bed, and then progressing to standing lateral raises and vertical raises of your operated leg, and perhaps sitting up and down out of a chair if you’re ready.

If you are in a health fund, your policy should provide you with ongoing physio at home for a few weeks, either through a hospital in the home rehab provider or a private physio. You also have the option of choosing to go to a rehabilitation facility, although the outcomes between these two options are little different, according to the evidence.

Rehabilitation in a swimming pool after a hip replacement is highly recommended. Picture: Getty Images

Once your incision is fully healed, generally after a few weeks, you will be able to move your rehab to a swimming pool if you wish. The water provides excellent resistance during exercises such as walking in the water or performing lateral raises or kickbacks to build up your strength.

Returning to work

I was able to return to work after three weeks, working a couple of days from the office and the rest of the time at home. Some people need a lot longer. Prepare your workplace that you may need six weeks off, or more if you work a manual job.

The long term

After you see your surgeon for the six-week follow-up and get the all-clear to return to exercise, if you wish you can progress your movement to stationary-bike cycling. Avoid treadmills at first as they are too risky given the moving platform. Under the guidance of your physio you should also be able to start to increase the resistance using bands or weights in strength-based exercise to rebuild your legs, focusing on quads, glutes, abductors, adductors and hip flexors. Be sure to be gentle on yourself; after surgery, your body is still working to integrate your metal joint by growing native bone around the prosthesis. If you are a gym-goer, performing upper-body strength work as normal should be fine after six weeks but be guided by your physio.

I would stay away from gym classes for a while as they can be too fast and unpredictable. My surgeon said yoga was OK but just be careful of your hip precautions (such as avoiding too much hip flexion) and let the teacher know you’ve had a hip replacement. My surgeon also recommended never squatting below 90 degrees or deep lunging after a hip replacement, and to avoid any rotational movements for the first few months.

Expect to notice a significant difference in strength between your operated and non-operated leg for a substantial period of time. It’s likely to take a year or even more to feel fully back to normal.

As far as driving goes, you’ll need to get clearance from your surgeon before getting back behind the wheel. You won’t be able to drive until your operated leg has recovered sufficiently to be able to operate the pedals – for most people this generally takes four weeks or so.

Leg length discrepancies

Some people notice that their operated leg seems longer than the other one after surgery. It’s very rare that there is a true leg length discrepancy given that surgeons are so precise in their measurements. Usually the cause is a tilt or twist of the pelvis because of the impaired way you’ve been walking prior to having the surgery. Try not to panic if your legs seem markedly different in length. The body usually naturally balances itself out. If you feel particularly uneven in the longer term you can see a podiatrist who may recommend an orthotic, or you can wear heel lifts in your shoes. Often people may need the other hip replaced in future too – and if this is the case your legs will generally end up the same length once you’ve had your other hip done.

Red flags

There is a small risk for weeks, months or even years after surgery of an infection forming in the prosthesis. A lot of people opt to get a dental scale and clean before the surgery as this procedure can release bacteria into the bloodstream. You should be particularly careful that any cuts or scrapes don’t become infected after you’ve had surgery, and to take antibiotics promptly if you develop a urinary tract infection. If you notice any redness developing around your incision site at any point, contact your surgeon or see your doctor immediately.

Preserving the life of your new hip

Unless you can’t live without it, it’s not recommended to return to jogging or any high-impact exercise after a hip replacement. If you do so, be prepared that your new hip won’t last as long. Otherwise, life can return to normal in every other way after recovering from a hip replacement. Most people are overjoyed to be able to live a pain-free life. Oh, and you’re probably not going to set off any alarms at airport security either. The days when prosthesis triggered alerts seem to be behind us in most airports.

 Here is the link:

https://www.theaustralian.com.au/health/medical/everything-i-wish-i-had-known-before-and-after-my-hip-replacement/news-story/7d81450e275b560b01d14ebf047e7cfa 

 I thought this was a pretty useful summary, from a fellow victim of this surgery!

All I can say is that it is a fabulous operation that has made me pain free and lasted a good two decades. Amazing and just fabulous outcome from my perspective!

David 

You Really Do Sometimes See Absolute Rubbish from Some So-Called Experts!

This appeared last week:

Why Australia’s healthcare future depends on technology

13 June 2025

By Bronwyn Le Grice, CEO ANDHealth

Australia’s health system is rightly celebrated for its world-class outcomes, but beneath the surface, it is straining under the weight of rising costs, workforce burnout and shortages, and growing demand.

At the same time, the health system is being asked to deliver better and more equitable health outcomes and experiences for everyone involved; patients, clinicians, carers, the broader community and administrators.

As the demands on our system mount, it is increasingly clear that we cannot hope to achieve these objectives with the tools and approaches of the past. Technology is not a luxury or an optional extra, but rather, as Dr Tedros Adhanom Ghebreyesus, Director General of the World Health Organisation said, “the future of health is digital”.

The evolution of healthcare goals over recent years reflects a deeper understanding of what it will take to create a system that is not just efficient, but also equitable and sustainable. Where once the focus was on balancing health outcomes, patient satisfaction, and cost, it is now widely recognised that a thriving workforce and fair access for all are equally essential. These aspirations have become the benchmark for health system reform, and achieving them demands digital transformation at its core.

Slow to digitise

For all the sophistication of our clinical care, healthcare in Australia has been notoriously slow to digitise its operations. Paper-based records, faxed referrals, and manual phone calls remain commonplace. The opt-out approach for My Health Record has been a success with 24 million records covering 99% of the population, but only in 2023 was legislation passed mandating health data to be uploaded, starting with pathology and diagnostic imaging. which will improve the accessibility and utility of the platform.

This hesitancy is not for lack of innovation, but rather a legacy of risk-averse processes designed to protect patient safety and a lack of agreed reimbursement models. However, the events of recent years have shown that this inertia is no longer tenable.

As Chris Blake, CEO of St Vincent’s Health Australia, has observed, “At some point we have to stare into that together as an industry and say, ‘you know what, there’s no new money coming in’. We have to change the system to use the money differently.” Technology is the lever that allows us to do just that, delivering more, and better, with the resources we have.

A watershed moment

The COVID-19 pandemic was a watershed moment for digital health in Australia. Almost overnight, telehealth and remote monitoring became not just convenient, but essential. This rapid shift proved that technology could simultaneously enhance patient access, reduce overheads, and safeguard public health, delivering on multiple priorities at once. But realistically, this change wasn’t so much about embedding cutting-edge technology, rather this was a change in policy and payment settings (and a global pandemic) driving a shift to a well-established technology modality.

Thus, today there remains a disconnect between the capability of the available technologies, patient and clinician enthusiasm and the appetite of policy makers and governing entities to fully embrace a software enabled and empowered health system.

While digital solutions are playing a role in everything from appointment scheduling and e-prescriptions to clinical decision support and AI-assisted note-taking, there remains an all-pervading fear of the unknown and a focus on investigating all the possible risks in deploying a new technology, with less focus on the risks in NOT deploying evidence-based technology into healthcare settings.

As recently as this March the South Australian Government implemented a ban on the use of AI scribes in public healthcare settings due to concerns around governance and privacy . At the same time the Australian Medical Association says that one in every four or five Australian doctors use AI scribes, particularly to remove administration burden.

Safe and responsible use

Professor Shelley Dolan, Chief Executive Officer of the Royal Melbourne Hospital, recently commented, “What I know about our clinicians is that they are incredibly bright and incredibly driven. They always find innovative ways to deliver the care and productivity that is required.”

That is not to say use of unregulated or unapproved technologies should be carte blanche, but rather reinforces the need for modernised policy and governance to encourage safe and responsible use. 

These tools are not merely about efficiency; they are about enabling clinicians to focus on care, empowering patients to take charge of their health, and generating the data needed to address inequities and improve outcomes.

As Catherine de Fontenay noted in the Productivity Commission’s report Leveraging Digital Technology in Healthcare, “Australia’s health system delivers some of the best outcomes of any in the world – but the cost of this care and wait times to access it are growing. Making better use of digital technology in healthcare could help address these problems while maintaining or even improving outcomes.”

The pleasing news is that Australia is poised to lead its own transformation. According to ANDHealth’s recent report, “The Rising Giant: Creating a New Economic and Health Future for Australia,” our digital and connected health sector has experienced extraordinary growth, with more than 1,000 companies now active and a compound annual growth rate of 52 per cent since 2019.

This is not simply a story of more companies, but of a sector maturing rapidly: the proportion of mid-to-late stage companies (those at proof of concept or later) has risen from 27 per cent in 2020 to 45 per cent today, signalling a vibrant ecosystem ready for investment and impact.

Momentum continues

This growth is no accident. It reflects the convergence of world-class research, entrepreneurial talent, and a health system that has demonstrated an ability to adapt when the stakes are high. The pandemic accelerated adoption, but the momentum has continued, fuelled by both necessity and opportunity. As a result, Australia is not just keeping pace with global trends; it is poised to set them.

But just as there is often a risk averse approach to adopting technology, the same cautious policy framework results in a difficult environment for smaller Australian companies seeking to place technologies, products and services into local health systems.

Procurement policies which are designed to prioritise locally owned and developed technology or innovations ahead of international competitors would be game changing for Australia’s digital and connected health sector. 

The challenge

The challenge before us is not whether to embrace technology in heath and care, but how to do so in a way that embeds it into the frontlines of care, rather than running technology as a parallel project analogous to the in-house server racks and CD-ROM based software of old.

The second challenge is to make a conscious choice to consume our own world class innovation, putting aside the “nobody gets fired for hiring IBM” mentality and backing our home-grown, world class innovators.

Both of these require investment, policy support, defined reimbursement pathways and a willingness to reimagine how care is sourced, delivered and measured.

As “The Rising Giant” report makes clear, the sector is ready. What is needed now is a coordinated effort to procure our innovative, evidence-based technologies at scale, integrate them into mainstream care, and ensure that future generations of Australians benefit from the best health and care possible.

Here is the link:

https://www.pulseit.news/pulseit-blog/why-australias-healthcare-future-depends-on-technology/

I will leave it to my discerning readers to decide the value of Ms Le Grice’s contribution. To me she is rather re-stating the bleeding obvious......

I look forward to some insightful comments!

David.

We Have To Wonder What Makes The myHR More Useful This Time? I Suspect Mega-Spin And Little Else!

This appeared last week:

Welcome to the second coming of My Health Record: the AusDoc interview

Why did anyone think 100 million PDFs would be a good idea?

Paul Smith

13 June 2025

Doctors have long asked an existential question about My Health Record. Why does it exist? What is its clinical utility?

It has now amassed 1.7 billion documents — from medication lists to radiology results to health summaries.

And yet for many, the system that was intended to reduce patient harm by preventing medication misadventures, bungled diagnoses and unnecessary tests or interventions appears to have no role in the day-to-day workflow of doctors and the wider system.

Despite the recent wonders of digital technology, to its critics, after 15 years, My Heath Record is still a “shoebox of PDFs”.

This is an interview with Peter O’Halloran, chief digital officer with the Australian Digital Health Agency.

Appointed two years ago to make the $3 billion system clinically relevant, his main task is to “atomise” the clinical information in the system so, when medications and diagnoses change, hospital discharge occurs or the pathology results arrive, the details are updated within the doctor’s own software with no fuss or messing around.

Why has something so basic taken so long?

And are non-GP specialists using My Health Record? What would happen to healthcare if you just switched off the system and accepted it had been an expensive waste of time?

In a frank discussion, Mr O’Halloran explains why pulling the plug is not an option, that the system is fundamental to future healthcare.

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AusDoc: First question, why, having spent billions of dollars on the system, were the data never atomised in the first place?

Why did anyone think several hundred million PDFs would be a good idea?

Peter O’Halloran: You have to go back to when My Health Record — the PCEHR as it was back [then] — was first created.

The standards 15 years ago were simply not at a level where data from across the country could be brought together at an atomic level. It was a step too far.

AusDoc: Because of the cost or because of the technology?

Mr O’Halloran: Well, mostly technology. When the PCEHR was designed, iPhones didn’t exist. In fact, a lot of the things we can do now using desktop computers didn’t exist then.

AusDoc: So back then it was assumed that a patient’s health summary — the diagnoses, the medications, the allergies — would be in a PDF even though it could not be updated in the way we can do now?

Mr O’Halloran: Absolutely. But it was always seen [as] the beginning.

It was going to be a kind of document, like a Word document or a PDF back then and the clinician in ED would look at it and the information would be accessed on that level.

That was the intention.

AusDoc: I remember Dr Mukesh Haikerwal, who ended up quitting as the National E-Health Transition Authority clinical lead, talking about the need for atomisation. That was years ago … and I’m sure he’s still talking about it now.

It seems very slow progress. How far has the agency got?

Mr O’Halloran: [We are close] to the next level where the individual data elements can be assembled in clinical software to produce a shared health summary more efficiently.

That means the ability to automatically pre-populate a summary or another document with clinical information on things like allergies and medication alerts and the like.

AusDoc: But in terms of a time frame — how long do you think before it becomes routine?

Mr O’Halloran: In less than two years we should be able to accept all the data at that atomic level. But it will mean software vendors need to modify and update their software.

Some of them are already starting to do that.

So, for early adopters, the changes will come within two years.

I expect [for] everyone in the system the changes will be in place within five years.

I’m impatient, so it feels like a long time to me, but we’re talking about changing the software used by every single clinician in Australia, and so that’s not a quick overnight fix.

However, the real endpoint for us is that we want to move away from My Health Record being seen as an afterthought in terms of how care is provided.

The doctors may not know what is happening beneath the surface but the clinical information they will be given about a patient will come from data from their existing system as well as what’s being sourced from My Health Record.

This will mean, for example, that clinicians will see data sourced from referrals, discharge summaries, shared health summaries and the like relating to allergies, medications and treatments in context in the existing screens in their clinical software without the need to go into separate sections or systems.

The fundamental point is that when this is done it is all displayed seamlessly on one screen, not two different systems.

AusDoc: The software vendors often complain that they need more money and support to change their systems.

This is about them changing their own software to communicate in this new ecosystem, is that right?

Mr O’Halloran: Yes, you are right, but it depends on which software vendors we’re talking about.

The software vendors in the acute hospital sector are generally already using the same data standards that we’re moving to.

So for them, it’s a small amount of work rather than a large rewrite.

For some of the vendors for primary care, their software is often bespoke to Australia.

However, if you look across the sector, you will see Best Practice and Telstra Health have announced massive investments. They are making these modernisation journeys now.

They’re already seeing which way we’re going and they are heavily engaged in that work.

As an agency, one of the big things we’re pushing is the need to use global standards with minimal local customisation which makes it more efficient for them to adapt.

I understand, if you’re in primary care, you probably sit there and say ‘This My Health Record is a horrible, clunky system.’

But that does not recognise the fact that the Australian Digital Health Agency doesn’t provide any software for clinicians in primary care.

Every single element they’re seeing on the screen has been built by their software vendor.

They’re not actually in the My Health Record system but they’re seeing [it] as such.

That is why we’re working with those software vendors.

If the system becomes atomic, you don’t actually have to have a separate screen for My Health Record.

You can just display it in the usual settings that doctors are using.

AusDoc: I’m going to ask you the dumb question. With all the PDFs in the system, literally hundreds of millions of them, doesn’t AI technology have the capacity just to read those PDFs and atomise the information in the way that you’re suggesting?

Mr O’Halloran: There is technology that could do it tomorrow, and we are exploring how we could surface, at an atomic level, the data in the CDA [ER1] wrapper that exist in the background with the PDF.

The question, as always, is what is the clinical accuracy of it?

While it probably doesn’t matter if I use AI to pull some key insights from my thousands of domestic bills, it’s a very different story when we’re talking about clinical data that could be relied upon to make a treatment decision.

But to be clear, the benefit of atomisation is that it lets clinicians integrate data from My Health Record into their main clinical record.

So, when they’re writing a shared health summary or authoring a referral letter, their software could pull in a list of medications and allergies.

They don’t have to type that history themselves.

If these changes come together as they should, it should reduce the administrative burden.

If I look at what’s happening with ambient AI scribes and that type of technology, which is becoming increasingly routine, I think we’re on the cusp of seeing clinicians being [physically] freed from their computers during a consult and able to spend more quality time focused on the patient.

AusDoc: Speaking of AI scribes, their uptake by doctors has been rapid which is in stark relief to the embrace of My Health Record.

The embrace of AI scribes shows clinicians will rapidly adopt technology when you make it useful to them. My Health Record has been a failure up to now because it’s been irrelevant — nothing complex about the reasons.

Mr O’Halloran: When I look at my own My Health Record, five years ago I had almost nothing in it — and that’s despite asking people to share test results or GPs to write shared health summaries.

Two years ago, it had a bit of data in it.

Now every time I get some blood work done or I’ve got a prescription, the data is just routinely in there and this is before the legislative mandates for sharing come into force.

The feedback I’m getting is clinicians are starting to find it useful a lot more often. We are getting to a tipping point now.

We expect within two years that almost all pathology and diagnostic imaging testing for all consumers will just be routinely in the system [whenever someone looks].

And that’s where what we are doing will derive its value. A clinician will be able to see the results and the history in an atomised, easy-to-read format.

That is why it’s worthwhile.

AusDoc: On behalf of fellow technophobes, can I ask a question. When it comes to My Health Record I’ve got a vision that there’s a big warehouse full of computers in Canberra, storing all this information, all the pathology reports, the PDFs. This warehouse, if it exists, is the PDF shoebox people talk about.

What is the reality? Where is all this information? Isn’t it on the cloud?

Mr O’Halloran: All the data of My Health Record is hosted in Australia, in a secure cloud environment.

It’s spread around different geographic regions in different states.

But in essence, if you brought it all together and looked at it, it would simply be a row of computers.

And it would not involve a large amount of space physically. It’s probably smaller than the office I’m sitting in if you put them all in one place.

The data is simply there and available.

The benefit of the cloud is that it lets us get the additional cyber protections and the ability to scale up as more data is being shared with us.

AusDoc: Going back to clinical utility, the hospital discharge summaries for GPs are fundamental for communicating new treatments, new medications, new diagnosis.

But My Health Record is not among the communication mechanisms being used by hospitals to communicate with GPs.

Mr O’Halloran: The discharge summaries are supposed to be shared through My Health Record.

Of course, a lot of hospitals will send them directly to the GP either via secure messaging or occasionally email and really occasionally by hard copy mail.

AusDoc: But the aim is for My Health Record to be the communication channel for discharge summaries?

Mr O’Halloran: Absolutely. That’s the goal in all this.

We want the summaries routinely in My Health Record every time a patient goes to a hospital.

Once clinicians in primary care can expect that every time they go and check when the consumer comes back to them after being discharged, they’ve got access to their data through My Health Record, that really adds to the clinical usefulness of the system.

AusDoc: But again, this depends on the software vendors ensuring their systems are fully integrated?

Mr O’Halloran: It does. As I mentioned, the two biggest vendors of software systems in primary care are embracing the change.

And there are other smaller software vendors out there today who are already doing a lot of these things.

AusDoc: I know you can’t speak on their behalf, but why have the software vendors been so reluctant to embrace My Health Record? There is no incentive for them to make using the system via their software unnecessarily unpleasant for doctors.

Mr O’Halloran: I think it goes back to the history.

Once again, if you look at the PCEHR back in the day, the standards were very rudimentary, and our expectations of the software were much lower.

Also, the awareness of what the system could do and how useful it could be for consumers and clinicians was unknown.

A lot of work was put in in those early days to build the interfaces and to have those basic screens designed, but to be honest, there’s been very little maintenance of them by most of the major software vendors since those days.

AusDoc: GPs have embraced computers from the beginning — but the non-GP specialists, some haven’t even got a computer on their desk.

To what extent are they integrated into this future vision?

Mr O’Halloran: It depends on each specialty, but yes, as a rule, I agree specialists have a lot lower take-up of computers on desks than GPs.

But I would add that certain specialties and the technology they use make the rest of us look like Luddites.

The point is we’re seeing change. The paradigm is starting to change where there’s more and more software designed for specialists that meets their needs because their needs are often quite different, each specialty is often quite different.

When we have more data from the acute sector, more data from primary care — say the pathology and diagnostic imaging data — a lot of those specialists will see the value and embed it into their practice.

AusDoc: You mentioned that in the next two years we will see a big change in the clinical utility of the system.

Does anything worry you in terms of reaching that goal?

Mr O’Halloran: Look, I don’t think I’m worried about anything. I think it’s a lot of work but technically, it’s fairly easy.

It’s about procuring services, bolting it together, going through processes of clinical validation and checking that it works as it should.

The bit that interests me is how we work with the colleges, how we work with the professions to ensure what we’re building is fit for purpose and meets their clinical needs.

AusDoc: Can you give me a picture of what the Digital Health Agency consists of? Again, I’ve just got an idea of lots of people in a room, computer boffins with thick spectacles working on software code.

But it sounds that a lot of your job is about building relationships — with government, with software vendors, with the medical colleges.

You talk about the agency’s core work in creating standards. Forgive me, it sounds quite boring. It’s not Silicon Valley.

Mr O’Halloran: [Laughing] A lot of the kind of stuff we do to do our job is probably on its own quite boring.

What’s exciting is what it enables and how it comes together. I understand [that] may sound tragic, but the true value for me is when I see a clinician say, ‘Hang on, I used this information in my practice, I’ve got data giving me insights into a patient that I hadn’t seen previously.’

That’s where we get excited.

The role of the agency is not lots of computer boffins sitting in a room, and to be honest, we have a relatively small number of deeply technical people.

I would say I spent 80% of my time working with consumers and clinicians across the sector. I’m not sitting there, elbows deep in architectural drawings.

AusDoc: A few years ago, we ran a story which I don’t think won many friends in the PCEHR world, but it was about the clinical uptake of the system which was very low.

From that point onwards we were often wondering why every federal budget millions were still being poured into it.

In fact, there is still an enormous amount of money going into it.

But what do we really lose if you simply turned it off?

Mr O’Halloran: My Health Record is more than just the system.

The legislation underpinning it is actually one of the strongest parts. We now have some of the best legislation in the world in terms of information sharing.

We have unique individual identifiers for healthcare providers, for their organisations, and unique individual identifiers for consumers.

If I look at the US, some 20-30% of the [healthcare] data being exchanged is mismatched or duplicated.

Those are things that don’t really happen in Australia.

I haven’t heard anyone saying we should turn off. That is not part of [the] debate.

I’d refer people to the Senate review into the sharing by default legislation a few months ago.

The legislation was supported by all parties — we’re talking the Opposition, the Government.

The system wasn’t what we wanted it to be necessarily in the past.

But I’d simply say, as you watch My Health Record over the next 12 months, I think the questions will drop away because people will see the value that was originally envisaged 10-15 years ago.

It’s just taken longer to realise the vision than any of us would have expected or wanted.

---

This interview with Peter O’Halloran took place last month. Responses were edited for concision and clarity.

Here is the link

https://www.ausdoc.com.au/news/welcome-to-the-second-coming-of-my-health-record/

Poor Peter, he and his team still have not established a compelling case for any-one to use the myHR. All the data in it is already sent to GPs and specialists as a matter of routine and is in the system(s) they already use.

Pretty much no-one needs the myHR as far as I can tell and after the 10 or 15 years of being useless it is hard to actually see what has changed to make it now useful!

As always, I would really like to hear from people who are finding it useful and valuable. The total cost for this folly must be in the billions by now and they still have not established a compelling use case! How can all this be possibly justified?

Can’t we please stop this nonsense until we have a much better plan, demonstrated need, and proven useful technology to support it!!!

I wonder how many times I have said the same thing over the years? The one small step forward this time is that the ADHA have noticed how important discharge summaries are as a document of record......

David.

AusHealthIT Poll Number 798 – Results – 15 June 2025.

Here are the results of the recent poll.

Do You Think Donald Trump Has Any Idea How To Handle Putin And His Plans For Global Mischief?

Yes                                                                       0 (0%)

No                                                                      32 (100%)

I Have No Idea                                                    0 (0%)

Total No. Of Votes: 32

Clearly a total majority think Putin has Trump’s measure!

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

Not bad voter turnout – answer must have been too easy. 

0 of 32 who answered the poll admitted to not being sure about the answer to the question!

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

David.

This Seems To Be A Pretty Interesting Piece Of Tech!

This appeared last week:

This ring wants to help you live longer. I gave it a try

By Tim Biggs

June 6, 2025 — 3.35pm

From smartwatches to connected scales and even Wi-Fi beds, it’s a well-established idea that access to information about how our bodies are running can help us meet our wellness goals, get an early warning on potential issues and encourage healthy habits. And a new gadget has emerged recently that promises 24/7 tracking in the most subtle way possible; disguised as a ring.

Smart rings from Samsung and Oura have shown what’s possible, and the new Ultrahuman Ring Air is an even lighter and less conspicuous option. At $600 (and no subscription necessary), it’s a plain and extremely light ring in black, gold, silver or grey titanium, with a comfy hypoallergenic epoxy on the inside that lets you peer in at the hardware for measuring heart rate, skin temperature, movement, blood oxygen and more. And, of course, it connects to its own app on your iPhone or Android.

Physically, it’s an undeniably masculine ring, but it does look like regular dumb jewellery at a glance. Mine has picked up a lot of scratches and marks on the coating over a few weeks of wear, so I’m not sure what it would look like in a year. It just feels like wearing a ring, and most of the time I forget it’s there.

The ring takes heart rate readings periodically, counts steps and detects workouts for finer tracking. When you sleep or nap, it calculates stages and monitors movement and timing. And all the data goes to the main platform to be crunched into insights about stress, recovery, alertness and more.

My review ring feels very solid, but it’s picked up a lot more scratches than I expected in a few weeks.

Ultrahuman is a platform based in India that focuses on longevity through data tracking. In addition to the ring, it sells a biosensor for continuous glucose monitoring, so you can see the effect of food on your metabolism, and the software is big on keeping biomarkers within certain zones. While collecting data on our bodies can be good, it’s also known that becoming too attached to the numbers can be decidedly unhealthy, and it’s easy to be reminded of this when glancing at all the goals and dashboards in the Ultrahuman app.

The platform sorts all your data into insights on its main dashboard.

Whether the platform can ultimately help people live longer is a bit beyond the scope of this review. But based purely on my experience with this ring and its app, even if I could somehow be assured that following every one of the suggestions would net me a few extra days on Earth, I’m not certain it would be worth it.

By default, Ultrahuman bombards me with reminders to stick to my “caffeine permissible window”, which apparently doesn’t start until two hours after I wake up; and warnings to limit light exposure by 7pm. I get vague informational updates about sleep debt and stress rhythm, reminders to stretch my limbs and walk around, and prods about infinitesimal changes in my heart rate variability. If you dive into the data in the app, you can get lost in a sea of minima zones, phase advance goals (it’s tracking my progress towards waking my body up earlier, but I already get up at 6.30?), sympathetic activation and hormone health.

I’m sure it’s all grounded in research, but it smacks of a pseudoscience useful to people obsessed with maximising body efficiency, whereas I mainly want to keep an eye out to make sure my data for steps, sleep, exercise, weight and the like are trending towards the healthy middle of the scale rather than the risky outer edge.

The good news is that you can just set all the data to export to the platform of your choice, and turn off whatever notifications you don’t want, so the actual longevity science part is optional. And with the information flowing from the ring through to Apple Health, I found it was pretty good at passively collecting all the tracking data to be graphed over time.

Information on my sleep stages was roughly comparable to that picked up by other tracking methods I pitted it against, and steps, movement and heart rate variability came through looking accurate as well. For granular details on specific workouts, like pace and VO2 Max, a smartwatch would likely be better, but if you just need to log your daily data, the ring’s a reliable method.

The ring is rated waterproof up to 100 metres, for up to 12 hours.

Battery life is obviously a concern in a package this tiny. Ultrahuman says four to six days, but four is a realistic expectation. It takes around three hours to fully charge on the handy little puck, so you should just be able to put it on there every day as you’re getting ready, and it will stay charged.

Going back to the Ultrahuman platform, there are some interesting elements even if you’re not into charts of your supposed stress responses. There’s an entire education section that has videos and podcasts on biomarkers, blood sugar, hormones and exercise. Some of it is from the expected gaunt-looking longevity experts and biohackers, but there’s interesting stuff from athletes and scientists, too.

And if you’re looking for content that might help the readings from your ring trend in a positive direction, there are also a lot of free meditation guides, workout videos and sleep aid stories.

Editor's pick

Ultrahuman says no paid subscription is required, which is a point of difference from its competitor Oura, and that is true; everything I’ve described so far is free on the app. But that doesn’t mean the company doesn’t try to sell you stuff.

There’s a marketplace of sorts called PowerPlugs, which includes paid and subscription offerings. PowerPlugs are tracking modules that focus on specific goals; the circadian rhythm and caffeine window tracking I mentioned above are PowerPlugs that are active by default. Free options include ovulation tracking, sun exposure and screen time. Paid options include “cardio adaptability” (nighttime cardio stress insights) at $4.26 monthly. Other PowerPlugs including jet lag, weight loss and a paid atrial fibrillation detection module, are marked as coming soon.

There’s also a store in the app selling Ultrahuman gear including sleep masks and blue light blocking glasses, plus subscriptions to nutritional supplement review platform Examine+. And of course, Ultrahuman does offer its own subscription too. At around $80 for two years, it includes priority support, insurance against accidental damage, and one free switch to a smaller ring if you happen to lose weight.

All up, it’s a convincing alternative to a smartwatch, albeit one that won’t save you any money despite its lack of a screen or any computing features. Its selling point is how discreet and essentially invisible it is, plus its integration with a data-intensive longevity and exercise platform, if that’s your thing.

Here is the link:

https://www.smh.com.au/technology/this-ring-wants-to-help-you-live-longer-i-gave-it-a-try-20250603-p5m4kv.html

I would love to hear some user reports on how it works out in real life!

David.

I Worry If This Is A Good Idea Or Not For A Test!

This appeared last week:

Alzheimer's

Alzheimer’s blood test can spot people with early symptoms, study suggests

New test accurately picks up on memory problems by examining two proteins in blood plasma, US researchers find

PA Media

Sat 7 Jun 2025 14.51 AEST

A new blood test for Alzheimer’s disease can accurately detect people with early symptoms, research suggests.

Experts from the Mayo Clinic in the US have provided further evidence that blood tests can work to accurately diagnose dementia by examining two proteins in blood plasma.

The proteins – amyloid beta 42/40 and p-tau217 – are associated with amyloid plaque buildup, which is a hallmark of Alzheimer’s disease.

Researchers found the blood test was highly accurate, with 95% sensitivity, which means it was 95% accurate in picking up people with memory problems, with very few cases missed.

It was also 82% for specificity, which means it was also highly accurate in ruling out people without dementia.

The study was carried out on more than 500 people in an outpatient memory clinic, meaning it is real-world data.

The blood test has been approved by the Food and Drug Administration regulator in the US.

Dr Gregg Day, who led the study in the journal Alzheimer’s and Dementia, said the test was as good as more invasive tests in use.

“Our study found that blood testing affirmed the diagnosis of Alzheimer’s disease with 95% sensitivity and 82% specificity,” he said.

“When performed in the outpatient clinical setting, this is similar to the accuracy of cerebrospinal fluid biomarkers of the disease and is much more convenient and cost-effective.”

Overall, researchers found that p-tau217 levels were higher in patients with Alzheimer’s disease versus those without the disease.

Day said the next steps in the research were to evaluate blood-based testing in more diverse patient populations and people with early Alzheimer’s who showed no cognitive symptoms.

Dr Richard Oakley, associate director for research and innovation at the Alzheimer’s Society in the UK, said the results “suggest this test is very accurate” and could be used alongside other tests and observations from a trained health professional.

“This study shows how blood tests are making diagnosis of Alzheimer’s disease quicker, easier and more accessible than ever before in a real-world setting,” he added.

“While focused on Alzheimer’s disease, the test was evaluated in people with other types of dementias too, showing that it may help with differentiate causes of cognitive decline, though more research in diverse groups of individuals and in community-based setting is still needed.

“Currently diagnosis options in the UK are often slow, expensive and can be invasive, meaning thousands miss out on the benefits one can bring.

“It’s great to see blood tests like this approved for clinical use in the US. We hope to see the same in the NHS, which is why we’re part of the Blood Biomarker Challenge.”

The Blood Biomarker Challenge is a multimillion-pound research programme supported by the Alzheimer’s Society, Alzheimer’s Research UK and the National Institute for Health and Care Research. Its goal is to bring blood tests for dementia diagnosis to the National Health Service by 2029.

Oakley said: “Blood tests will be critical to accelerate diagnosis and give more people access to the care, support and treatments they desperately need faster than ever before.

“We must see long-term investment in the tools and workforce needed to ensure everyone living with dementia can get an early an accurate diagnosis, which is even more important with disease-modifying treatments on the horizon.”

Dr Julia Dudley, head of research at Alzheimer’s Research UK, said: “We urgently need to improve how we diagnose dementia and it’s great to see international research working towards this goal.

“Blood tests in this study look at p-tau217 and amyloid beta 42/40 and showed the tests offered high accuracy in confirming Alzheimer’s disease.

“This study adds to the growing evidence that blood tests can detect the diseases that cause dementia in people with early memory and thinking problems.

“An important point to consider is that people taking part in research don’t always reflect the full diversity of those affected by dementia, who might have additional conditions or other characteristics.

“That is why work is needed to understand whether these blood tests work in a real-world setting.

“In the UK, studies like the Blood Biomarker Challenge are helping to build this evidence. The study is testing blood tests, including p-tau217, in thousands of people from sites across the UK.

“This work will be a crucial part of making diagnosis easier and faster, which will bring us closer to a cure.”

Hare is the link:

https://www.theguardian.com/society/2025/jun/07/alzheimers-blood-test-can-spot-people-with-early-symptoms-study-suggests

This is all very good but do I really want to know I am doomed to Alzheimer’s disease any earlier than absolutely necessary. For me I just want to float off to la-la land and never be aware it has happened – with maybe a week or two notice to get my affairs in order and say my goodbyes to those I love.

What do others think about how the onset of dementia should be handled?

If offered a test that could tell how long you had - would you want it? Not sure I would!

A hard one!

David.

This Man Made A Real Difference To How We All Now Use Computers.

This appeared a few days ago:

Bill Atkinson, who made computers easier to use, dies at 74

John Markoff

Jun 8, 2025 – 9.37am

Bill Atkinson, an Apple Computer designer who created the software that enabled the transformative visual approach pioneered by the company’s Lisa and Macintosh computers, making the machines accessible to millions of users without specialised skills, died on Thursday night at his home in Portola Valley, California, in the San Francisco Bay Area. He was 74.

In a Facebook post, his family said the cause was pancreatic cancer.

Atkinson programmed QuickDraw, a foundational software layer used for both the Lisa and Macintosh computers. Composed of a library of small programs, it made it possible to display shapes, text and images on the screen efficiently.

The QuickDraw programs were embedded in the computers’ hardware, providing a distinctive graphical user interface that presented a simulated “desktop”, displaying icons of folders, files and application programs.

Atkinson is credited with inventing many of the key aspects of graphical computing, such as “pull-down” menus and the “double-click” gesture, which allows users to open files, folders and applications by clicking a mouse button twice in succession.

Before the Macintosh was introduced in January 1984, most personal computers were text-oriented; graphics were not yet an integrated function of the machines. And computer mice pointing devices were not widely available; software programs were instead controlled by typing arcane commands.

The QuickDraw library had originally been designed for Apple’s Lisa computer, which was introduced in January 1983. Intended for business users, the Lisa predated many of the Macintosh’s easy-to-use features, but priced at $US10,000 (almost $US33,000 ($50,000) in today’s money), it was a commercial failure.

A year later, however, QuickDraw paved the way for the Macintosh graphical interface. It was based on an approach to computing that had been pioneered during the 1970s at Xerox’s Palo Alto Research Centre by a group led by computer scientist Alan Kay. Kay was trying to create a computer system that he described as a Dynabook, a portable educational computer that would become a guiding light for Silicon Valley computer designers for decades.

Xerox kept the project secret, but Dynabook nevertheless ultimately informed the design of the Lisa and the Macintosh. In an unusual agreement, Xerox gave Apple co-founder Steve Jobs and a small group of Apple engineers, including Atkinson, a private demonstration of Kay’s project in 1979.

The group, however, was not permitted to examine the software code. As a result, the Apple engineers had to make assumptions about the Xerox technology, leading them to make fundamental technical advances and design new capabilities.

In Insanely Great, a book about the development of the Macintosh, Steven Levy wrote of Atkinson, “He had set out to reinvent the wheel; actually he wound up inventing it.”

Atkinson’s programming feats were renowned in Silicon Valley.

“Looking at his code was like looking at the ceiling of the Sistine Chapel,” recalled Steve Perlman, who as a young Apple hardware engineer took advantage of Atkinson’s software to design the first colour Macintosh. “His code was remarkable. It is what made the Macintosh possible.”

In an early Apple commercial for the Macintosh, Atkinson described himself “as a cross between an artist and an inventor”.

He was also the author of two of the most significant early programs written for the Macintosh. One of them, MacPaint, was a digital drawing program that came with the original Macintosh. It made it possible for a user to create and manipulate images on the screen, controlling everything down to the level of the individual display pixel.

Ordinary users without specialised skills could now create drawings, illustrations and designs directly on a computer screen. The program introduced the concept of a “tool palette”, a set of clickable icons to select simulated paintbrushes, pens and pencils.

MacPaint had a significant impact in helping to transform computers from business and hobbyist systems into consumer products that could be marketed as tools to enable individual creativity.

After the introduction of the Macintosh, while under the influence of a modest dose of LSD, Atkinson conceived of a program that would weave text, images and video seamlessly in a simple-to-use database. That experience would lead to Apple’s HyperCard software, a forerunner of the World Wide Web.

The program, first conceived independently by computer pioneers Ted Nelson and Douglas C. Engelbart, was intended to allow nonprogrammers to easily compile information that would be interconnected by digital links known as hypertext.

After a visit with Engelbart while he was designing his system, Atkinson added command-key shortcuts to offer users more computing power after they learned to use pull-down menus.

In 1985, while sitting on a park bench near his home in Los Gatos, California, Atkinson peered up at the stars in the night sky and then looked at the streetlights that surrounded him. He decided that the various lights were like pools of knowledge separated by great distances and remaining unconnected.

“I thought if we could encourage sharing of ideas between different areas of knowledge, perhaps more of the bigger picture would emerge, and eventually more wisdom might develop,” he wrote in Mondo 2000, a Silicon Valley magazine published in the 1980s and ’90s. “Sort of a trickle-up theory of information leading to knowledge leading to wisdom.”

William Dana Atkinson was born March 17, 1951, in Los Gatos, the third of seven children of John Atkinson, an anesthesiologist, and Ethel Dana Atkinson, an obstetrician.

At age 10, after Bill was given a subscription to Arizona Highways magazine, he began cutting out nature photographs and placing them on his bedroom wall. That led to a lifetime passion for nature photography and eventually a second career as a commercial and artistic photographer. A 2004 book, Within the Stone, presented his close-up photographs of stones that had been cut and polished.

Atkinson was studying for a doctorate in neurobiology at the University of Washington when Jobs persuaded him to become the 51st employee at Apple. He decided to leave school after Jobs told him, “Think how fun it is to surf on the front edge of a wave, and how not-fun to dog paddle on the tail edge of the same wave.”

During the early 1980s, when Jobs was leading a small group of young software and hardware designers to create the Macintosh computer, he and Atkinson were virtually inseparable. But when Jobs was forced out of Apple in 1985, leading him to create a new computer company called Next, Atkinson declined to leave with him, citing his commitment to the HyperCard project.

Jobs did not take rejection easily, and their relationship chilled for a number of years.

Atkinson worked on HyperCard as a contractor and stipulated that the product initially be distributed with the Macintosh at no extra cost.

In the late 1980s, the computer industry was awash with interest in building lighter, more portable machines. In 1989, Atkinson, along with Andy Hertzfeld, another former Macintosh developer, and Marc Porat, a Stanford University-educated economist who had recently joined Apple, persuaded Apple’s CEO at the time, John Sculley, to help fund a start-up that they named General Magic. The company developed a handheld computer in competition with the Newton, an internal Apple project.

Both projects would eventually fail commercially, but they are widely viewed as the forerunners of Apple’s wildly successful iPhone and iPad products, introduced after Jobs returned to Apple.

Atkinson left General Magic in 1996 and worked independently on a number of projects, including one for Numenta, an early artificial intelligence company.

He was married three times. He is survived by his wife, Cai, two daughters, a stepson, a stepdaughter, two brothers and four sisters.

Atkinson almost did not survive to see the introduction of the Macintosh. On his way to work one morning, he was in a crash in which the top of his sports car was sheared off. He was taken unconscious to a hospital. A police officer at the scene said Atkinson had been lucky not to have been decapitated.

Jobs raced to the hospital, where he found Atkinson alert. “Is everything OK?” he asked, according to an account by Hertzfeld. “We were pretty worried about you.”

Even in a hospital bed, though, Atkinson’s mind was on software, specifically a key aspect in the design of the QuickDraw system.

“Don’t worry, Steve,” he said, “I still remember how to do regions.”

This article originally appeared in The New York Times.

Here is the link:

https://www.afr.com/technology/bill-atkinson-who-made-computers-easier-to-use-dies-at-74-20250608-p5m5qi

It is interesting to read the story on one of the giants who got us to where we are now with having computers that are so wonderfully easy to use to get our work done. It is easy to forget just how far computer useability has evolved in the past 60 or so years!

David.

This Is A Trend We Should Be Pretty Grumpy About!

This appeared last week:

Hospitals ‘buffing’ surgery wait times to hit KPIs, doctors warn

By Kate Aubusson

June 8, 2025 — 5.00am

NSW hospitals are refusing to accept patients for cancer surgery and other time-critical procedures, pressuring surgeons to downgrade the seriousness of urgent cases to meet their publicly reported targets.

The tactics used to manipulate surgery waitlist data, revealed by senior public hospital surgeons, conceal the true extent of delays for patients with serious medical conditions in overstretched hospitals, where administrators are under immense pressure to meet state government-enforced benchmarks.

Several senior specialists report RPA and Westmead are among the public hospitals refusing to add urgent “category 1” patients to waitlists unless their surgeon can guarantee an available operating theatre session within the clinically recommended 30-day wait time.

“The doctors have the capacity to perform the procedure, but if the hospital doesn’t have the theatre time or resources to get them done [in time], they won’t accept a patient’s booking form,” said general surgeon and Australian Medical Association NSW vice president Dr Fred Betros.

“That way, they won’t breach the publicly reported KPI. Everything looks like it’s under control, so we don’t get the resources and future funding we need to keep up with demand.”

One senior surgeon prohibited from speaking publicly by their employment contract characterised the practice as “buffing the numbers”.

The Bureau of Health Information (BHI), a state government agency, collects and publishes elective surgery data for every NSW public hospital. Its latest quarterly report shows that 99.1 per cent of essential surgeries were performed on time in NSW.

According to the report, no RPA patient has waited longer than clinically recommended for surgery in the last two years.

One senior specialist not authorised to speak publicly said RPA’s administration was “obsessed with its surgery KPIs”.

“Hospitals are not allowed to refuse a recommendation for admission [the form specialists complete to admit a patient for surgery], but they do it all the time,” they said.

NSW Health’s surgery policy states urgency categories must be “based on the patient’s clinical need … and not influenced by the availability of hospital or surgeon resources”.

Another senior clinician not authorised to speak said: “I always thought that the focus of an individual hospital’s executive would be, ‘Okay, we’ve got patients breaching. That means we should tell the ministry we’ve got patients breaching, so we need more resources,’ and the ministry would go, ‘Okay, there’s your resources because your KPIs show that you’re breaching’, but they don’t. They get told to make the problem go away.

“The burden of disease is still there. The people [who need care] are still out there. The problem won’t go away with jiggery pokery.”

NSW Health’s surgery access policy

If a patient is likely to breach the recommended wait time, the clinical director of surgery must consider, in conjunction with the surgeon, patient and senior management:

- Additional theatre time at the same or another facility

- Pooled surgery lists, where patients may be treated by any doctor of the same specialty 

- Transfer patients to another doctor with a shorter surgery list (if available)

- Paying for the patient to be transferred to a private hospital

Dr Jenny King, chair of Westmead Hospital’s Medical Staff Executive Council, described scheduling patients for urgent surgery within a couple of weeks due to the severity of their condition only to have booking staff push the date closer to the 30-day cut-off to bring forward a less urgent patient about to become overdue.

King said one “seriously unethical” strategy involved cancelling overdue paediatric dental surgery lists to prioritise patients breaching wait times that are KPIs, for instance, head and neck cases.

“These paediatric dental patients often have special needs or serious medical issues, but it doesn’t matter if they breach because their wait times are not a KPI, so no one looks at them,” King said.

“Their parents are at their wits’ end, and they have no option but to pay a fortune in the private sector. Often, the private hospitals won’t take difficult kids with behavioural issues.”

A spokesperson for Western Sydney Local Health District (WSLHD) – which oversees Westmead – said a small number of paediatric dental procedures were rescheduled to alternative theatre lists to prioritise more clinically urgent cases.

King said Westmead surgeons had not been pressured to change urgency categories since the appointment of a new associate director of operations for surgery two months ago to oversee efforts to get the hospital to the “magic triple zero” (zero patients overdue in categories one, two and three).

“Our response has always been that if you can’t fit patients on lists in the appropriate time for the condition, then there simply aren’t enough lists,” King said.

In 2022, WSLHD unsuccessfully attempted to contractually bar doctors from adding patients to surgery wait lists unless they could guarantee they had time to perform the procedure within the recommended timeframe.

Health Minister Ryan Park said he expected surgery management to be consistent with health policies, “and if there’s any evidence to suggest otherwise, I’d seek a please explain”. Park ordered an independent review of recategorisation of surgery at Orange Hospital after the ABC reported on similar issues.

The WSLHD spokesperson rejected that surgeons had been asked to prioritise waiting list targets over patient care, saying all RFAs were accepted and waitlisted in line with NSW Health policy.

“WSLHD maintains its commitment to ensuring the efficient and safe management of surgery to deliver the best possible outcomes for patients,” they said.

Risky delays for colonoscopies

Meanwhile, patients with suspected bowel cancer are waiting for months for colonoscopies, which should be performed within 30 days of a positive screening result.

“There are gastroenterologists whose patients have gone well beyond that timeframe because colonoscopy wait times aren’t measured as a KPI reported to the ministry or published publicly,” Betros said.

Professor Nick Talley, gastroenterologist and chair of the luminal faculty at the Gastroenterology Society of Australia, said category 1 patients could wait two or three times longer than they should for a colonoscopy in the public system.

“That’s just not good enough,” Talley said. “Colon cancer will progress from a curable stage to an incurable stage within several months, and that is the kind of time period some people are waiting.”

The WSLHD spokesperson said there are some delays accessing gastroenterology procedures as demand is increasing, and work was underway to address this by implementing a networked approach across the LHD.

‘The tip of a very big iceberg’

Surgeons also reported being asked to re-categorise urgent patients to category 2 “semi-urgent” (recommended within 90 days) if about to breach the 30-day timeframe.

Betros said the tactic was not endemic, but tended to arise at times of overwhelming demand for individual hospitals.

“[Hospital clerical staff] will say: ’We can’t do it within 30 days, but if we can guarantee they will get their surgery five days late, can we change them to category 2?” he said.

Betros said a five-day delay was highly unlikely to affect a patient’s clinical outcome, but the approach obscured the lack of appropriate funding to keep up with demand for surgical services.

“This is the tip of a very large iceberg,” he said. “Our patients are more overweight, they’re more cirrhotic [liver damage] because they’ve got more emphysema [a type of lung disease] than they’ve ever had, and it’s because our public health measures aren’t pushing the tidal wave back.”

The final report from the Special Commission of Inquiry into NSW’s health funding warned the system risked being overwhelmed by ageing and chronically ill patients, characterising the failure to embed prevention into the system as “beyond comprehension”.

“It all gets kicked down the road to become an even bigger problem, and it just compounds with every year,” Betros said.

A NSW Health spokesperson said all LHDs were expected to adhere to the elective surgery access policy.

“Every endeavour is made to ensure patients are treated within the timeframes required for their level of urgency as assigned by their treating doctor,” they said.

Here is the link:

https://www.smh.com.au/national/nsw/hospitals-buffing-surgery-wait-times-to-hit-kpis-doctors-warn-20250604-p5m4xp.html

This hardly comes as a surprise – as you can be sure all the administrative bureaucrats will know their bonuses (and employment etc.) depend on good figures being reported each quarter.

All Joe Public can do is hope the figures reported reflect reality!

I am not sure how we can change things to ensure accuracy, but being sure we are  even getting close to accurate figures would be good!

Having worked in such bureaucracies I know real efforts to keep figures and outcomes accurate are usually genuine!

I love the use of the term 'buff' from the wonderful book "The House of God" by Samuel Shem!  That book really had some great insights as to the reality of busy acute hospitals and EDs!!

David.