Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, July 03, 2014

Review Of The Ongoing Post - Budget Controversy 3rd July 2014. It Is Sure Going On and On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
Here are some of the more interesting articles I have spotted this sixth week since it happened. Since the budget was handed down all hell has broken out in the Health Sector and has been continuing.
It was interesting to see the AMA President continue come out so strongly against the co-payment. Does not bode well for success in the Senate when it changes on July 1. The level of comment on this issue is also seemingly unending.
Listening to the political conversation last week it seems like very little of the Government’s agenda has an assured passage through the Senate any time soon!
We sure do live in interesting times!
-----

General.

Australia has health success but also challenges

  • AAP
  • News Corp Australia
  • June 25, 2014 2:00PM
AUSTRALIANS are living longer and smoking less but eating themselves to death, new research shows.
The nation ranks in the top 10 in the world for life expectancy, living 25 years longer than they did a century ago.
But while smoking rates continue to fall, and vaccination rates have increased, more than three in five adults are overweight or obese.
The latest health snapshot by the Australian Institute of Health and Welfare says even though there is much to be proud of, lifestyle-related diseases are a growing concern.
The biennial report shows Australian men ranked sixth among Organisation for Economic Cooperation and Development (OECD) countries when it comes to life expectancy, and Australian women seventh.
-----

Canberra chips in for less of health bill, AIHW study finds

Sean Parnell

Health Editor
Brisbane
HEALTH costs are rising but the Commonwealth’s share of the total bill is decreasing, according to a new analysis.
The Australian Institute of Health and Welfare’s 2014 check-up on the population and the system itself has found that while the federal Government continues to provide the majority of health funding, its overall share is declining. The Commonwealth’s contribution dropped from 44 per cent in 2001-02 to 42.4 per cent in 2011-2012, while the States’ contribution grew from 23.2 per cent to 27.3 per cent over the same period.
The report, released today, shows that the proportion of total revenue spent on health is increasing for the States, and decreasing for the Commonwealth, ensuring that, overall, health spending is taking up a greater proportion of government revenue — 26 per cent in 2011-2012, or six percentage points higher than before the Global Financial Crisis. That is likely to feed into the debate between the States and the Commonwealth over the Abbott government’s decision to abandon Labor’s commitment for the Commonwealth to pay a greater share of public hospital costs, and also the other controversial Budget decision to introduce a $7 co-payment for basic Medicare services. Prime Minister Tony Abbott has promised to reform the Federation and negotiations are likely to focus on the perceived imbalance between the States’ obligation to fund service delivery and their limited revenue streams.
-----

Starting on the long task of shrinking government

June 24, 2014
Josh Frydenberg
Among the furious political debates over Medicare co-payments, the indexation of pensions and the deregulation of university fees, one key theme in this year’s budget has been sadly overlooked.
The move to a smaller and more efficient government with the extensive consolidation in the number of government bodies, committees and boards.
Nearly 100 government entities covering areas from agriculture to aid and infrastructure to insurance will be merged or abolished in the most concerted effort undertaken at the federal level to streamline the delivery of services and to reduce cost, complexity and confusion for stakeholders.
The gains are potentially enormous, with net savings of about half a billion dollars expected over the forward estimates.
-----

Crisis in general practice feared with deregulated uni fees

24th Jun 2014
THE federal government's decision to deregulate university fees could spark a crisis in the general practice workforce, stakeholders have warned.
In a letter to Education Minister Christopher Pyne, AMA president Associate Professor Brian Owler said medical students could face debts of more than a quarter of a million dollars each by the time they graduate. 
"With high demand for places, there is no reason to think that competition will keep fees under control," Professor Owler said.
"If [planned] fee structures were to be adopted for domestic students, this would leave a medical student with a debt of over $259,000 plus interest once they have completed both [medical] degrees. On any measure, this is a significant debt, and no matter what upfront loan assistance is provided, it will deter students from low-income backgrounds from entering medicine."
-----

Fact check: Has public hospital funding been cut by $50 billion?

June 23, 2014
Treasurer Joe Hockey says the Federal Government's hospital funding is unaffordable, and his recent budget shows $80 billion of savings from changes to school and hospital funding over the next 10 years.
In response, Labor has accused the Government of breaking promises. Opposition spokeswoman for health, Catherine King, says: "Instead of providing the growth funding that was promised, promised to the Australian public and promised to the states to run the public hospitals, this budget of broken promises in fact cuts a whopping $50 billion from Australia's public hospitals."
But Mr Hockey argues the Government is still growing funding for schools and hospitals, "just not as fast as what Labor suggested they would do".
-----

Health ministers vote to reinstate healthy food star rating website

Date June 27, 2014

Amy Corderoy

Health Editor, Sydney Morning Herald

State and federal ministers will reinstate a healthy food star rating system that was controversially pulled offline by federal Assistant Health Minister Fiona Nash and her junk-food lobbyist chief of staff.
At a meeting in Sydney this morning they voted to reinstate the website, and affirmed support for the scheme that will allow food producers to adopt a voluntary system for comparing the healthiness of different types of foods. 
Similar foods, such as cheeses or drinks, will be given a rating out of five based on their levels of both nutritious and unhealthy ingredients.
-----

Health star rating system on track

Australian and New Zealand Food Ministers agreed further steps for the voluntary healthy star rating front of pack labelling system at the Legislative and Governance Forum on Food Regulation.
Page last updated: 27 June 2014
27 June 2014
Australian and New Zealand Food Ministers agreed further steps for the voluntary healthy star rating front of pack labelling system at the Legislative and Governance Forum on Food Regulation (the Forum) in Sydney today.
Assistant Minister for Health Fiona Nash chaired the Forum, which also considered pregnancy warnings on alcohol products, and food standards.
Minister Nash welcomed New Zealand’s decision to join the Health Star Rating system on a voluntary basis, and acknowledged the work and communication between the Australian and New Zealand Governments regarding the Health Star Rating system.
-----

Medical Research Fund.

Medical research not the only way

THE federal government’s proposed $20 billion medical research fund could be a success, but not at the expense of ripping funding away from other innovation engines, a venture capitalist says.
Australian venture capital firm OneVentures partner and managing director Paul Kelly said the country’s wealth of research and inventiveness was not limited to medical research.
“What the government should be looking to do is to foster innovation across the board and really fuel our transformation into an innovation economy,’’ he said.
“You can’t do that by ripping out or undermining engines of innovation such as NICTA.’’
The Abbott government will direct $20bn from January to ­establish the Medical Research ­Future Fund.
-----

GP Co-payment.

GPs say “no way” to co-payment – Australia’s healthcare quality at serious risk

20 June 2014
The leading representative body for general practice in Australia, the Royal Australian College of General Practitioners (RACGP), will not support the Federal Government’s $7 co-payment scheme as proposed which threatens universal access to healthcare.
The RACGP today released an official position statement on co-payments in general practice in response to wide-spread opposition from the general practice profession and Australian public regarding the Government’s proposal.
RACGP President, Dr Liz Marles said the statement aims to clarify and further reiterate the RACGP’s position on the controversial move and sends a strong message that the RACGP does not support the co-payment proposal.
“The RACGP has been steadfast on its position regarding the introduction of a co-payment model since it was first rumoured at the end of last year,” said Dr Marles.
-----

Rethink rebate and co-payment: AMA

23rd Jun 2014
THE AMA will ask the government to reverse the $5 rebate cut for practitioners and revise its proposed $7 co-payment after talks at the weekend.
A meeting of the AMA’s Council of General Practice reinforced its position of rejecting the planned rebate cut for GP attendances and other items. 
“We don’t accept the rebate cut is fair or viable for practices. The previous rebate has been inadequate and fallen behind over many years from what the proper fee should be,” the council’s chair Dr Brian Morton told MO.
“We call on the government to actually talk to the profession, and specifically the AMA, because it really is a whole-of-profession issue involving diagnostic imaging and pathology, and that goes to other specialists as well.”
-----

Medicare co-payments – Has Tony Abbott closed Australia for (private health insurance) business?

Marie McInerney | Jun 24, 2014 3:50PM |
In this first of a series of posts about Medicare, Margaret Faux notes that the Abbott Federal Government appears to be trying to gain some traction from former Labor Prime Minister Bob Hawke’s introduction of co-payments. But she says, more can be garnered from considering why they were not introduced by John Howard.
Faux is a lawyer, the founder and managing director of one of the largest medical billing companies in Australia and a registered nurse. She has been involved in Medicare claiming for 30 years and is a research scholar at the University of Technology Sydney examining the interface between Medicare and medical practitioners.
-----

Medicare co-payment: AMA rejects Coalition's compromise offer

President of the AMA says doctors will not accept any proposal which reduces the Medicare rebate
The Australian Medical Association (AMA) says the health minister’s willingness to exempt nursing home residents from the proposed $7 co-payment is not enough to win their support for the controversial measure.
Peter Dutton signalled this week that aged care residents would be exempt from the co-payment as part of a compromise in the wake of the May budget.
But Brian Owler, the president of the AMA, which is the peak body representing doctors, says doctors will not accept any proposal which reduces the Medicare rebate.
Under the proposed co-payment the Medicare rebate would be reduced by $5, leaving patients to make up the difference. Doctors fear they would financially penalised for bulk billing.
-----

Tony Abbott to ‘consider alternatives’ to $7 fee for GP visits

Laura Tingle Political editor

Key points

  • PM met the AMA president over doctors’ concerns about Medicare payments.
  • Tony Abbott later reinforced the Coalition’s commitment to a new price model for GP visits.
The first signs have emerged that the Abbott government may make concessions on its controversial $7 Medicare co-payment, with the Australian Medical Association reporting Prime Minister Tony Abbott said he was ­prepared to look at alternative models.
Mr Abbott and Health Minister Peter Dutton met AMA federal ­president Brian Owler in Canberra on Tuesday after the doctors’ body expressed trenchant opposition to the $7 payment on GP visits, as well as ancillary services such as pathology and diagnostic imaging.
The AMA argues the plan, which is forecast to raise just under $3.5 billion over three years, would hit patients on low incomes hard, be bad for ­community health and would have a devastating impact on GP practices across the country.
-----

Coalition says it’s committed to the GP co-payment, after PM told AMA he was willing to revisit model

THE Australian Medical Association says Tony Abbott signalled he’s willing to revisit the $7 GP co-payment, although the Coalition insists it’s committed to the policy.
AMA president Brian Owler, speaking after a “very constructive” meeting with the Prime Minister and Health Minister Peter Dutton in Canberra, said Mr Abbott had told him he was willing to examine alternative models for the co-payment.
He said he would return with alternative co-payment models that would enjoy the public support of his organisation, if adopted.
The currently proposed $7 fee on medical services is designed to discourage unnecessary doctors’ visits and pour $20 billion into a medical research future fund.
Dr Owler said: “The Prime Minister made it fairly clear in the meeting that they were willing to look at alternative models and consider those on their merits.
-----

Tracking GP co-payments could cost 'hundreds of millions'

24 June, 2014 Antonio Bradley
A system that reliably tracks in real time the number of co-payments a patient has made would cost “hundreds of millions” and take years to implement, an IT expert has warned.
Knowing how many co-payments patients have made is a key component of the Federal Government's planned overhaul of general practice funding.
The plan involves cutting all rebates for GP attendance items by $5, along with rebates for pathology and diagnostic imaging.
But to protect children and concession card holders from paying too much, the government said it would return those rebates to current levels once these patients had made a total of 10 $7 co-payments.
-----

Co-pay changes flagged after AMA talks

26 June, 2014 AAP
Prime Minister Tony Abbott says the government will press ahead with the $7 co-payment for GP visits, but is open to discussing changes in its implementation.
AMA representatives held talks with Mr Abbott and Health Minister Peter Dutton in Canberra on Wednesday to discuss the peak body's concerns.
AMA president Brian Owler (pictured) described the talks as "constructive", saying Mr Abbott had indicated a willingness to consider changes.
The AMA does not oppose the principle of a co-payment, but has been critical of the government's design.
-----

Australian Age care residents could be exempt from the $7 GP fee

  •  June 27, 2014 12:00AM
  •  SUE DUNLEVY NATIONAL HEALTH REPORTER
RESIDENTS in aged care homes could be exempted from the $7 GP fee in the first sign the government is prepared to compromise on the controversial Budget measure.
Health Minister Peter Dutton has said he agrees with the Australian Medical Association there are issues with charging the fee in aged care homes where residents have no access to money.
“There are issues that we’ve agreed with the AMA that we can work on, particularly around aged care,” Mr Dutton said yesterday.
“I think there’s more that we can do to try and provide GP and nursing services into aged care, and they’re the discussions we’re having with AMA President, Professor Owler,” Mr Dutton told John Laws on Sydney radio.
-----

Abbott backtracks on co-payment plan

26th Jun 2014
PRIME Minister Tony Abbott has signalled for the first time that he is prepared to soften the impact of proposed $7 co-payments for GP services.
Doctors’ groups have been in intensive talks with senior politicians on both sides of politics, picking over a list of health budget measures that have alarmed many practitioners and face a hostile reception in the Senate.
AMA President Brian Owler emerged from talks with the prime minister and Health Minister Peter Dutton on Wednesday, describing the discussions as “very constructive”. 
The AMA agreed that “a form of co-payment would be an acceptable model”, but it could not accept the proposal for $5 cut in the Medicare rebate to doctors and the impact on most vulnerable patients, he said.
-----

Cost already a barrier for one in eight indigenous seeing a GP, COAG Reform Coucil warns

Date June 26, 2014 - 12:27AM

Michael Gordon

Political editor, The Age

The report finds that three quarters of deaths of indigenous people under 75 were avoidable through early prevention or treatment. Photo: Sasha Woolley
The Abbott government has been warned to think again on its Medicare co-payment, with a major study reporting that cost is already barrier for one in eight indigenous people seeing a GP.
The final report card of the COAG Reform Council also reveals that more than two out of five indigenous people delayed, or did not see, a dental professional due to cost, and one-third delayed, or did not fill, a prescription for the same reason.
In a blunt warning, the council chairman, John Brumby, has observed that much of the good work to close the gap on health outcomes could be undone if barriers are put up to healthcare access for indigenous people.
In a speech launching the report at an indigenous health summit in Melbourne on Thursday, Mr Brumby says when people start to avoid going to their primary or community care provider because of cost they often end up in hospital.
-----

On the risks of private health cover of GP visits & the need for a “real” national conversation on health

Marie McInerney | Jun 23, 2014 11:23AM
In this post below, public policy expert John Menadue agrees with Health Minister Peter Dutton that we need a national conversation about health. He disagrees however that we are having one, saying we are instead seeing an “ill-considered and ideologically driven course” on both co-payments and the prospect of private health insurers being able to cover GP visits.
Quoting US super-investor Warren Buffet who has described the private health industry as “the tapeworm in the US health sector”,  Menadue’s article – cross-posted with permission from his Pearls and Irritations blog – says private health insurance involvement in primary care should be “strenuously resisted”, with international evidence showing it pushes up costs dramatically and does not improve health outcomes.
Primary practice has been until now off limits to insurers, despite their strong advocacy, but all eyes are on the current Medibank Private trial program in southeast Queensland that effectively subsidises GP services.

Co-payment still causing strife

23 June, 2014 Amanda Davey
The RACGP has strengthened its staunch opposition to the Federal Government’s $7 co-payment scheme by releasing an official position statement on Friday to clarify its stance.
Joining the AMA and other doctor’s groups, the RACGP has condemned the Government’s controversial move, arguing the co-payment threatens universal access to healthcare.
The general consensus among doctors groups, including the RACGP, is that the proposed $7 co-payment model will hit vulnerable Australians the hardest.
RACGP President Dr Liz Marles said the position statement sends a strong message.
-----

Health Minister Peter Dutton “100 per cent confident’’ $7 Medicare co-payment would pass the new ­Senate

  • Renee Viellaris
  • The Courier-Mail
  • June 23, 2014 12:00AM

Modelling missing on Medicare co-payment 0:58

CROSSBENCH Senators will be offered sweeteners and the chance to look good in their states by Abbott Government tacticians determined to pass the $7 Medicare co-payment.
Health Minister Peter Dutton, who will next month ­directly lobby independent Senators, has opened the door to horsetrading with the eight powerbrokers, all of whom have different pet causes.
Mr Dutton told The Courier-Mail he was “100 per cent confident’’ the co-payment would pass the new ­Senate, but signalled lowering the $7 fee was not negotiable.
“In NZ the co-payment is $17.50, the Commission of Audit recommended $15. We haven’t gone with an ambit claim and we didn’t strike it at $17.50 hoping that it would give us room for negotiation,’’ he said.
“We’ve struck it at the price we believe is best for the Australian people.’’
-----

Hospital Impacts.

Queensland Health jobs could go under shake-up

Date June 23, 2014 - 9:16AM
Queensland's health minister has conceded jobs could be lost as local health boards gain control of staffing from a centralised bureaucracy.
From July 1, eight of the state's 16 regional Hospital and Health Services (HHS) boards will take control of staffing from Queensland Health.
The other eight HHS boards will gain staffing control in July 2015.
Health Minister Lawrence Springborg said the transfer of staffing power from Queensland Health to local health and hospital boards could lead to job losses in the department.
-----

Pharmacy.

Guild vows to take compensation fight to Libs

26 June, 2014 Chris Brooker
The fight for community pharmacies to be compensated for the expected financial effects of accelerated price disclosure will continue, the Pharmacy Guild of Australia vows.
Guild leaders are set to take their case to the Liberal Party’s Federal Council meeting this week.
In the Guild’s Forefront newsletter, executive director, David Quilty, says he and Guild national president, George Tambassis are to speak to a range of federal ministers, including Health Minister Peter Dutton, and Treasurer, Joe Hockey.  
Mr Quilty said the reality of accelerated price disclosure has been brought home by the release of the October list of molecules impacted by PBS cuts. These included cuts of 37% to the price of rosuvastatin and 46% to atorvastatin. (To see the full list, click here).
-----

Profession wants price disclosure compensation: poll

24 June, 2014 Chris Brooker 0 comments
A substantial majority of pharmacists believe the profession should be compensated for the financial impacts of price disclosure, a Pharmacy News poll reveals.
In total 138 readers responded to the poll, with 65.2% agreeing that ‘pharmacy should be compensated for the impact of accelerated price disclosure’. Perhaps surprisingly, the remaining one third did not believe the profession was entitled to compensation.
When the acceleration to the PBS price disclosure scheme was announced last year by the then ALP government, there had been hope that there may be some form of compensation for a policy that is estimated to strip up to $90,000 from pharmacy bottom lines in the 2014/15 financial year.
-----

Medicare Local Impacts.

Closure of urgent care service

26 June 2014|0 Comments

EMML has been advised that Ekera Urgent Care at 157 Scoresby Road, Boronia has closed effective as of Thursday 26 June 2014.

-----

After-hours GP Access service at risk: poll

By ASHLEIGH GLEESON

June 27, 2014, 9:30 p.m.
A SERVICE that helps up to 80,000 sick people each year in the Hunter access  after-hours healthcare advice and treatment is at risk.
The GP Access After Hours Service takes pressure off the region’s hospital emergency departments by diverting less urgent patients to its clinics.
But Hunter Medicare Local clinical director Dr Lee Fong said it could be lost after  funding runs out in June next year.
Newcastle GP Dr Annette Carruthers described the service as the ‘‘jewel in the crown’’ of primary healthcare in the Hunter.
-----

Hunter Medicare Local CEO resigns amid concerns over after-hours GP service

April 23, 2014
As concerns are being raised about the future of the Hunter's GP Access After-Hours service, the head of the organisation that administers it has resigned.
Hunter Medicare Local says its CEO Carol Bennett, who only took up the post in February this year, has left the job due to the ill health of a family member.
The organisation's Chair Karen Howard says the Board appreciate Ms Bennett's efforts and wish her well into the future.
Ms Howard says John Baillie, who is a previous CEO with NovaCare, will replace Ms Bennett as head of the organisation, effective immediately.
-----

Carol Bennett third Hunter Medicare Local CEO to quit in 12 months

By GABRIEL WINGATE-PEARSE

June 22, 2014, 10:30 p.m.
THE future of Hunter Medicare Local and the services it provides is hanging in the balance with the abrupt departure of its third chief in less than 12 months, key staff say.
Chief executive Carol Bennett has resigned after just five months in the job, at what is a crucial time.
The organisation, which runs the highly acclaimed and popular GP Access After Hours service, will not be funded past June 30, 2015.
-----
Comment:
It seems the fuss is not yet settled - to say the least. Will be fascinating to see how all this plays out. No Parliament for the next two weeks It is clear the GP co-payment issue is still red-hot and right now it is hard to see how this measure will pass.
To remind readers there is also a great deal of useful health discussion here from The Conversation.
Also a huge section on the overall budget found here:
Enjoy.
David.

Wednesday, July 02, 2014

This Is The Most Important Article I Have Seen This Year -An Absolute Must Read!

This appeared last week:

Essay

Evidence based medicine: a movement in crisis?

BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3725 (Published 13 June 2014)
Cite this as: BMJ 2014;348:g3725
  1. Trisha Greenhalgh, dean for research impact1,
  2. Jeremy Howick, senior research fellow2,
  3. Neal Maskrey, professor of evidence informed decision making3
  4. for the Evidence Based Medicine Renaissance Group
Author Affiliations
  1. Correspondence to: T Greenhalgh p.greenhalgh@qmul.ac.uk
Trisha Greenhalgh and colleagues argue that, although evidence based medicine has had many benefits, it has also had some negative unintended consequences. They offer a preliminary agenda for the movement’s renaissance, refocusing on providing useable evidence that can be combined with context and professional expertise so that individual patients get optimal treatment
It is more than 20 years since the evidence based medicine working group announced a “new paradigm” for teaching and practising clinical medicine.1 Tradition, anecdote, and theoretical reasoning from basic sciences would be replaced by evidence from high quality randomised controlled trials and observational studies, in combination with clinical expertise and the needs and wishes of patients.
Evidence based medicine quickly became an energetic intellectual community committed to making clinical practice more scientific and empirically grounded and thereby achieving safer, more consistent, and more cost effective care.2 Achievements included establishing the Cochrane Collaboration to collate and summarise evidence from clinical trials;3 setting methodological and publication standards for primary and secondary research;4 building national and international infrastructures for developing and updating clinical practice guidelines;5 developing resources and courses for teaching critical appraisal;6 and building the knowledge base for implementation and knowledge translation.7
From the outset, critics were concerned that the emphasis on experimental evidence could devalue basic sciences and the tacit knowledge that accumulates with clinical experience; they also questioned whether findings from average results in clinical studies could inform decisions about real patients, who seldom fit the textbook description of disease and differ from those included in research trials.8 But others argued that evidence based medicine, if practised knowledgably and compassionately, could accommodate basic scientific principles, the subtleties of clinical judgment, and the patient’s clinical and personal idiosyncrasies.1
Two decades of enthusiasm and funding have produced numerous successes for evidence based medicine. An early example was the British Thoracic Society’s 1990 asthma guidelines, developed through consensus but based on a combination of randomised trials and observational studies.9 Subsequently, the use of personal care plans and step wise prescription of inhaled steroids for asthma increased,10 and morbidity and mortality fell.11 More recently, uptake of the UK National Institute for Health and Care Excellence guidelines for prevention of venous thromboembolism after surgery has produced significant reductions in thromboembolic complications.12
Despite these and many other successes, wide variation in implementing evidence based practice remains a problem. For example, the incidence of arthroscopic washout of the knee joint, whose benefits are unproved except when there is a known loose body, varies from 3 to 48 per 100 000 in England.13 More fundamentally, many who support evidence based medicine in principle have argued that the movement is now facing a serious crisis (box 1).14 15 Below we set out the problems and suggest some solutions.

Box 1: Crisis in evidence based medicine?

·         The evidence based “quality mark” has been misappropriated by vested interests
·         The volume of evidence, especially clinical guidelines, has become unmanageable
·         Statistically significant benefits may be marginal in clinical practice
·         Inflexible rules and technology driven prompts may produce care that is management driven rather than patient centred
·         Evidence based guidelines often map poorly to complex multimorbidity
The further many pages and references are found here:
The rapid responses to the article are also excellent reading including a less useful one from yours truly.

Re: Evidence based medicine: a movement in crisis?

22 June 2014

This is just fantastic stuff but somehow seems to beg the question of just where the trustworthy, easily assimilated and person / patient centric information can be consistently sourced.
I think we all have a pretty clear idea of the problem - it is how we now set out to manage it that worries me.
I would love to know the answer to this, as well as to understand how we can shorten the time gap between established clinical practice and large scale clinical understanding and adoption.
My sense is that complexity is one of the issues we really have to address.
Dr David G More MB, PhD, FANZCA, FCICM.
I suggest those who are interested can happily spend a good hour or two learning a great deal and coming to understand just how far we have to go in all this. The relevance of all this to electronic clinical decision support cannot be overstated!
David.

Tuesday, July 01, 2014

Summary Of the Coverage Of The New NEHTA Chairman. Hardly Much Variety But Some Useful Quotes!

Over last week I kept an eye on the different reporting on the new NEHTA Chairman appointment following the release from NEHTA that is found here:
Here is what we saw.

Former AMA chief to take e-health chair

Fran Foo

Technology Reporter
Sydney
FORMER Australian Medical Association president Steve Hambleton will replace David Gonski as chair of the National E-health Transaction Authority.
NEHTA said that Mr Gonski had served two consecutive terms, or six years, as chair and wasn’t eligible for a third term according to its constitution.
The organisation said Mr Gonski was responsible for revitalising the board and galvanising cooperation between the governments of Australia to deliver urgently needed infrastructure and standards for health information.
And here:

Hambleton steps into NEHTA chair

Former AMA president Dr Steve Hambleton has stepped into the role of Chair of the National E-Health Transition Authority. He replaces David Gonski, who had served two terms as chair, beginning in 2008.
Dr Hambleton said his new role is key in maintaining a connection between NEHTA and the front line of healthcare. “NEHTA has done some good things, and it’s a matter of taking what they have done and deliver what the government and the profession is looking for in terms of NEHTA’s role.”
As part of this connection, Dr Hambleton said he intends to maintain a part-time private practice in addition to his new role. He begins the role of chair immediately.
And here:

E-health reviewer appointed to chair NEHTA

Summary: Former Australian Medical Association president Dr Steve Hambleton will chair the National E-Health Transition Authority after co-authoring a report calling for the organisation to be dissolved.
By Josh Taylor | June 26, 2014 -- 01:46 GMT (11:46 AEST)
Former Australian Medical Association president Dr Steve Hambleton will become the new chairman of the government-owned National E-Health Transition Authority (NEHTA), succeeding David Gonski.
NEHTA is responsible for overseeing the rollout of Australia's billion-dollar electronic health record system across the country.
Gonski, most associated with compiling a review into Australia's education system for the former Labor government, has ended his two-term chairmanship for NEHTA, and is not eligable for a third term according to NEHTA's constitution.
And here:

Hambleton heads NEHTA

26th Jun 2014
THE new face of e-health is a familiar one with Dr Steve Hambleton appointed chair of the National E-Health Transition Authority (NEHTA) as of today.
Queensland GP and immediate past president of the AMA Dr Hambleton said it was a huge opportunity to get e-health "back on the rails".
"NEHTA's done some really good things – the Individual Healthcare Identifier, Australian Medicines Terminology... what we need now is a platform that's seamless, easy to use, and fits in with workflow in general practice.
Dr Hambleton said under his leadership NEHTA's focus would be on integrating e-health into primary care in a way that engaged with people "in the engine room of healthcare".
And here:

Gonski departs NEHTA board

Steve Hambleton appointed chair of e-health org
Rohan Pearce (Computerworld) on 26 June, 2014 13:36
The National E-Health Transition Authority (NEHTA) has announced that former Australian Medical Association president Dr Steve Hambleton will be organisation's new chair.
Hambleton will replace David Gonksi, who served two terms as chair of NEHTA's board. Gonski was appointed in 2008. Under NEHTA's constitution, Gonksi was not eligible for a a third term.
Hambleton took part in a review, instigated by federal health minister Peter Dutton, of the troubled Personally Controlled Electronic Health Record (PCEHR) program. NEHTA is in charge of the PCEHR rollout.
And here:

Hambleton heads up NEHTA

27 June, 2014 comments
The National E-Health Transition Authority (NEHTA) has a new leader in Dr Steve Hambleton who until recently headed up the AMA.
Announced on Thursday, Dr Hambleton (pictured) replaces David Gonski AC, who had served two consecutive terms at NEHTA during which time he was responsible for revitalising the board and improving cooperation betweenfederal and state governments to lift infrastructure and standards in e-health record keeping.
-----
The most interesting quotes that I spotted from the articles were :

“He tempered his view of NEHTA as a whole, however, stating that the organisation had done good work in terms of the national medicines terminology, SNOMED CT and the individual healthcare identifier.”

“Dr Hambleton told 6minutes he thought NETA had done “an enormous amount of good work” and that his challenge will be to leverage off many of the initiatives already in place such as Personal Child Health Records (PCHR), secure message protocol and the new classification system for diseases.”

“We can’t be driven by the techos,” Dr Hambleton said in August.

“Dr Hambleton will spend several months reviewing NEHTA's current situation, with his appointment effective immediately. He replaces former chair David Gonski, who has concluded his constitutionally allowable term. Dr Hambleton will also continue to practise medicine.”

I found it interesting the some things that were picked out as ‘good bits’ I would suggest had made very little impact, if any, to date.

I am also a little concerned by Dr Hambleton’s view that NEHTA will go on forever and that e-Health is an unambiguously ‘good thing’. I am sure many would be concerned with a lot of this!

I am also a little concerned there is some misunderstanding of just what influence a part time chairman can have - or are there plans we don't know about?

David.

Monday, June 30, 2014

Weekly Australian Health IT Links – 30th June, 2014.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Clearly the big news for the week was the Departure of David Gonski as the Chair of NEHTA and the ascension of Dr Steve Hambleton to the role. I have provided some thoughts on this earlier.
Also interesting is the departure of Jane Halton from DoH to the inner circle of Government, but not, however, as close to the centre as she may have desired.
It is also interesting that it seems the GP Co-Payments seem to have a technical issue that may be pretty expensive to fix!
All in all quite a lively week.
-----

Gonski steps down as NeHTA chair, replaced by Hambleton

High profile corporate and education leader David Gonski has stepped down from his role as the chairman of the National eHealth Transition Authority and will be replaced by the immediate past president of the Australian Medical Association (AMA), Dr Steve Hambleton.
The changing of the guard comes as the cross-government body tasked with making a national electronic health and medical records scheme a functional reality faces a pivotal year after its funding was extended for just one year in the federal Budget.
The departure of Mr Gonski was widely anticipated as he is ineligible to serve a third term as chairman under NeHTA’s constitution.
Mr Gonski, whose name has since become synonymous with the ambitious education reforms of the former Labor Federal government, became the NeHTA’s chairman in 2008 and is widely credited with keeping the massive and frequently challenged project alive through his quiet but formidable style of diplomacy.
-----

Privacy fears curb e-health’s growth

June 25, 2014
Mark Eggleton
In a twist on the old highwayman demand of “Your money or your life” we finally have an answer when it comes to e-health. Our personal finances win while our health takes a back seat.
Right now most Australians when they want to get a snapshot of their financial situation can go online and find up-to-the-minute information on their bank balance and outstanding debts. We’re pretty comfortable with the level of security afforded our financial details and even happy to give out further details if we’re keen on purchasing goods or services. Unfortunately, we’re a little leery about having our health records available online beyond what’s stored in a computer on our GPs desk.
Security of data was one of the major focuses of the recent Big Data in Healthcare roundtable held by The Australian Financial Review in partnership with GE in Sydney with most participants agreeing it was an issue.
-----

Tech giants launch new e-health network

Christina Farr and Thomas Escritt
Dutch healthcare and lighting company Philips said it was teaming up with Salesforce, one of the biggest cloud-computing companies in the United States, to offer online management of chronic diseases.
The venture will involve a cloud-based software platform that will take data fed from networked medical devices in homes and hospitals to allow nurses and doctors to monitor the health of hundreds of patients simultaneously.
The companies said they would launch two new medical applications, Philips eCareCoordinator and Philips eCare Companion, later in the summer as part of the partnership.
Philips’ chief executive Frans van Houten told journalists in Amsterdam the services would make it easier and cheaper to monitor the health of patients.
-----

Verbal nursing handovers go digital

Dr Leif Hanlen is the Health Team Director at NICTA, Australia’s Information Communications Technology (ICT) Research Centre of Excellence in Canberra, where he is currently involved in several projects that focus on large scale ehealth data analysis – and have the potential to improve patient outcomes while also reducing workloads for health professionals.
A recently completed project used the text in hospital radiology reports to identify an infection, invasive aspergillosis, threatening transplant and cancer patients.
“We’re looking at text processing services that help the clinical work flow, rather than trying  to develop a brand new text or health analytics box that adds to the clinical burden,” he says.
One key project involves recording and classifying the clinical data transferred in a typical nursing hand-over to improve accuracy of information and reduce the administrative burden.
-----

Jane Halton leaves Health for Finance, Treasury still open

Prime Minster Tony Abbott has announced another round of musical chairs at for Canberra’s public service chiefs, but put off naming a replacement for outgoing Treasury head Martin Parkinson.
High profile Secretary of the Department of Health, Jane Halton will take on the role of nailing down government expenses as the head of the Department of Finance as a replacement for David Tune who has opted to retire from the Australian Public Service and will finish-up his term at the end of this week.
The move by Ms Halton to Finance, for a five year appointment, is likely to fuel continued speculation that she is a likely successor to incumbent APS chief and Secretary of the Department of Prime Minister and Cabinet, Dr Ian Watt.
-----

System to track GP visits ‘a big ask’

Fran Foo

Technology Reporter
Sydney
TAXPAYERS will have to pay “hundreds of millions of dollars” to build a centralised database for 25 million people that would update in real time to cater for the Abbott government’s proposed $7 medical co-payment scheme, IT experts say.
The government has proposed that people pay $7 each time they visit a GP, get an X-ray or a blood test from July next year. A patient who visits a doctor and needs a pathology test and an X-ray will be slugged with $21 in upfront fees.
The $7 fee is applicable to everyone except concession card holders and children under 16 who will pay for the first 10 services combined.
The controversial plan has drawn the ire of consumers and many in the healthcare fraternity who say it marks the demise of universal access to healthcare in Australia.
-----

New breast cancer tests finds more cancers than traditional mammograms

Date June 26, 2014

Amy Corderoy

Health Editor, Sydney Morning Herald

Adding three-dimensional mammograms to normal mammograms can catch breast cancer earlier, a new study has found.
But experts warn that the study, while promising, does not show 3D mammograms provide any long-term benefits over traditional screening, which is provided free to all women aged over 40 in Australia.
The study analysed data from more than 450,000 examinations, some of which were only done with mammograms and others that used the combination test, which captures multiple images of breast tissue that are built up to provide a 3D image.
The combined test caught 41 per cent more cancers than traditional mammography alone, according to the research, which was published in the Journal of the American Medical Association and funded by Hologic, which produces 3D mammography machines.
-----

Fitness bracelets ‘a dying business’, says Misfit CEO

  • Katherine Rosman
  • The Wall Street Journal
  • June 25, 2014 7:02AM
IN another sign that the shine is coming off the much-ballyhooed wearable hardware market, health-tracking device maker Misfit is announcing today that its software and its iOS app will be compatible with the smartwatch from competitor Pebble.
Pebble says the partnership is part of its longstanding strategy to make its watch a dynamic tool for those who like to monitor fitness and health metrics. But for Misfit, the move is partially influenced by the anticipation of Apple’s rumoured plan to release a smartwatch later this year.
The Shine is sold in Apple stores, which makes the device particularly vulnerable.
“If you buy one of these [Apple] devices you’re not going to buy an activity tracker,” says Sonny Vu, Misfit’s chief executive, adding that he predicts Android-powered watches will undo the fitness bracelet market. “Why should we cling on to a dying a business?”
-----

Data from wearable devices could help

  • Elizabeth Dwoskin and Joseph Walker
  • The Wall Street Journal
  • June 26, 2014 12:00AM
MANY runners and fitness fanatics have been quick to embrace wearable wireless tracking devices for measuring physical activity and calories burned. Now, a growing number of physicians are formally studying whether such “wearables” can improve patients’ health by spurring people to get moving.
Amy Wheeler, a doctor at Massachusetts General Hospital, hopes that wireless tracking devices can help motivate her obese patients to do what they haven’t been able to on their own: lose weight.
Last year, Dr Wheeler was one of a group of US doctors who gave FitLinxx pedometers to 126 patients with Type 2 diabetes, often related to poor diet and excess weight.
The pedometers tracked how many steps the patients took and linked to a software program that calculated whether they met their exercise goals. Based on their progress, data from their electronic medical records and whether it was sunny or rainy, patients would receive motivational tips via text message.
-----

Ambulance Victoria rushing data to hospital as well

Date June 24, 2014

Trevor Clarke

Ambulance Victoria has joined the big data movement by establishing a real time data exchange system to provide hospitals greater visibility of incoming patients' needs.
The organisation has been working with four hospital emergency departments in the state for the past two months to trial the new arrivals system.
“That is a real time reporting stack where we take a half million events, including GPS coordinates, and present that out to the hospitals on a large monitor in the [emergency department] so they know, for example, that an ambulance is arriving and it is a priority one and the estimated time of arrival is 10 minutes," Ambulance Victoria manager of enterprise architecture, John Dousset, told IT Pro.
The data comes from Emergency Services Telecommunications Authority (ESTA), which runs the 000 number. This feed provides 500,000 transactions or “events” every day and includes information such as when an ambulance is dispatched and arrives, along with GPS coordinates of ambulances in motion (every 300 metres) or stationary (every 15 minutes). The information is fed to emergency departments at Monash, Austin, the Northern and St Vincent hospitals. 
-----

Robot ‘legs’ help people walk

  • AP
  • June 28, 2014 12:00AM
US health regul­ators have approved a first-of-a-kind set of robotic leg braces that can help some disabled people walk again.
The ReWalk system functions like an exoskeleton for people paralysed from the waist down, allowing them to stand and walk with assistance from a caretaker.
It consists of leg braces with motion sensors and motorised joints that respond to subtle chan­ges in upper-body movement and shifts in balance.
-----

Apple, Google, Samsung vie to bring blood sugar apps to wearables

Date June 24, 2014 - 8:54AM

Christina Farr

For decades, medical technology firms have searched for ways to let diabetics check blood sugar easily, with scant success. Now, the world's largest mobile technology firms are getting in on the act.
Apple, Samsung and Google, searching for applications that could turn nascent wearable technology like smartwatches and bracelets from curiosities into must-have items, have all set their sights on monitoring blood sugar, several people familiar with the plans say.
These firms are variously hiring medical scientists and engineers, asking US regulators about oversight and developing glucose-measuring features in future wearable devices, the sources said.
The first round of technology may be limited, but eventually the companies could compete in a global blood-sugar tracking market worth over $12 billion by 2017, according to research firm GlobalData.
-----

Governments' IT projects needn't cost the world. Here's how we can do better

Australia has ambitious targets to improve the relationship between citizens and the government: all correspondence will be able to be conducted online by 2017
The man responsible for the UK government’s technology, Liam Maxwell, walks around with a very simple motto stickered onto his smartphone and Macbook: “What is the user need?
Maxwell is Her Majesty’s government’s chief technology officer but his outlook, attitude and clothes he wears are far closer to Steve Jobs than to Sir Humphrey.
His job as part of the efficiency reform group – created in 2010 when the UK government was facing its largest deficit since the second world war – is to equip government departments with the right technology to deliver great digital services and to cut IT spending. But it’s more accurate to say his real mission is closer to reimagining the role of government and its daily relationship with citizens.
-----

In your face: booming biometrics puts security ahead of privacy

Date June 25, 2014

Natasha Singer

The row over covert use of computer face recognition technology was kicked off in 2001 and there's no end in sight, writes Natasha Singer.
Who he? A New York supported at the infamous 2001 "snooper-bowl" final where police used embryonic face-recognition technology on the crowd - and launched a mighty row.
Joseph Atick watched the Ronald Reagan Building and International Trade Centre in Washington as if he owned the place. In a way, he did. He was an organiser of the event, a conference and trade show for the biometrics security industry. Perhaps more to the point, many of the wares on display, like an airport face-scanning checkpoint, could trace their lineage to his work.
A physicist, Atick is a pioneering entrepreneur of modern face recognition. Having helped advance fundamental face-matching technology in the 1990s, he went into business and promoted the systems to government agencies looking to identify criminals or prevent identity fraud.
‘‘We saved lives,’’ he says. ‘‘We have solved crimes.’’
-----

Astronauts to build giant telescope

  • The Times
  • June 23, 2014 12:00AM
SCIENTISTS are planning a space telescope so large it will have to be built by astronaut construction workers because no rocket is capable of lifting it from the Earth in one launch.
The Atlast, or advanced technology large-aperture space telescope, is being designed to take the first direct images of Earth-sized planets orbiting distant stars, allowing experts to analyse their atmospheres to see if alien life might have evolved on them.
The challenge of gathering light from such tiny and distant objects will, however, require a mirror measuring up to 16m in ­diameter — larger than anything of its kind yet built.
This means it would have to be assembled in space more than 1.5 million kilometres from Earth, four times further than the moon.
-----
Enjoy!
David.

Sunday, June 29, 2014

There Is Something Really Odd Going On Here. There Are A Lot Of Questions To Answer!

A day or so ago we had this announcement appear.

New Chair for NEHTA

Created on Thursday, 26 June 2014
After completing six years in office, David Gonski AC has concluded his role as the Chair of the National E-Health Transition Authority (NEHTA).
Mr Gonski has served two consecutive terms as Chair and in accordance with NEHTA’s constitution is not eligible for a third term. 
The Board of Directors would like to sincerely thank Mr Gonski for the leadership he has shown in his role as Chair.
Mr Gonski became Chair in 2008 and was responsible for revitalising the board and galvanising cooperation between the governments of Australia to deliver urgently needed infrastructure and standards for health information.
NEHTA CEO Peter Fleming is pleased to announce that Dr Steve Hambleton MBBS FAMA, immediate past president of the Australian Medical Association (AMA) has been appointed the new Chair of NEHTA.
Dr Hambleton was elected Federal President of the Australian Medical Association (AMA) in May 2011, after serving a two-year term as Federal Vice President. He was most recently one of three panel members responsible for conducting the Government’s review into the personally controlled electronic health record system.
The clinical expertise and leadership Dr Hambleton brings to this role will be vital in ensuring that eHealth becomes widely adopted in clinical settings across Australia.
Here is the link:
The best commentary I have seen is here:

Gonski steps down as NeHTA chair, replaced by Hambleton

High profile corporate and education leader David Gonski has stepped down from his role as the chairman of the National eHealth Transition Authority and will be replaced by the immediate past president of the Australian Medical Association (AMA), Dr Steve Hambleton.
The changing of the guard comes as the cross-government body tasked with making a national electronic health and medical records scheme a functional reality faces a pivotal year after its funding was extended for just one year in the federal Budget.
The departure of Mr Gonski was widely anticipated as he is ineligible to serve a third term as chairman under NeHTA’s constitution.
Mr Gonski, whose name has since become synonymous with the ambitious education reforms of the former Labor Federal government, became the NeHTA’s chairman in 2008 and is widely credited with keeping the massive and frequently challenged project alive through his quiet but formidable style of diplomacy.
His succession by Dr Hambleton is a clear sign that NeHTA’s stakeholders – which essentially comprise of state health authorities, the federal government and the medical sector – have opted for a stronger influence from clinicians who have repeatedly taken both NeHTA and the Federal Department of Health to task over the usability of the technology that NeHTA is creating.
More here:
I have been mulling and discussing this for a couple of days now and I am more confused now than I was when the announcement first appeared.
Among the questions are:
1. Why is this announcement made my Peter Fleming and not by the Minister for Health and Sport (Mr Dutton)?
2. Why has this announcement been made in the absence of a Government Response to the PCEHR Review where the dissolution of NEHTA was recommended?
3. What does this announcement mean for the various projects that NEHTA is presently involved in?
4. What will the role of NEHTA in any planned new Governance Framework for e-Health in Australia or is there going to be no change?
5. How is the e-Health industry in Australia meant to plan for the future while questions regarding the future of e-Health are so up in the air?
6. Does this announcement mean that, other than a new chairman the NEHTA Board is to remain the same - led by the same - but rapidly changing Board - that has brought us such successes as NASH and the AMT.
7. How, without a radically different Board, is a distinctly part time Chairman going to make any real difference to NEHTA?
8. Where is the press release from the new Chairman explaining his plans and future direction he sees for NEHTA?
9. Would not it be more effective in terms of making a difference to have a properly qualified clinician CEO rather than Chairman or even change both and a few other board members?
10. What is to be the fate of the rest of the obviously improved e-Health Governance Framework that the new Chairman recommended with his two colleagues in the PCEHR Review?
For what it is worth my view is that this announcement and the way it has been made, as well as the lack of answers to the questions I raise is a reflection of the apparent chaos in e-health.
A simple step the new Chairman could take that would make a real difference is to have the detailed minutes of each NEHTA Board Meeting promptly made public so stakeholders can much more properly understand just what is going on.
I look forward to some answers to my 10 questions - but an cynical enough to believe that while change may be apparent little will change!
What do you think?
David.

AusHealthIT Poll Number 224 – Results – 29th June, 2014.

Here are the results of the poll.

Is It Right For Investment In The PCEHR Still To Be Continuing Before The Government Has Responded To And Decided What It Will Do With The Program?

Yes 15% (7)

Probably 9% (4)

Neutral 0% (0)

Probably Not 30% (14)

No Way 45% (21)

I Have No Idea 2% (1)

Total votes: 47

Seems most think we should not spend until the decisions are made.

A lower number of votes but a clear outcome with few fence sitters this time as well.

Again, many thanks to all those that voted!

David.