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, September 04, 2014

Review Of The Ongoing Post - Budget Controversy 04th September 2014. It Just Rolls On!

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot.
It is amazing how the discussion on the GP Co-Payment just runs and runs. Lots more this week.
Here are some of the more interesting articles I have spotted this fourteenth week since it was released.
Last  week we saw Parliament back and it really seemed not much was moving - on the surface at least.

General.

Government digs in over budget

Date August 25, 2014

James Massola

Political correspondent

The federal government is digging in over unpopular cuts in the budget, with cabinet ministers warning other savings measures will be found if a compromise cannot be reached with the opposition and Senate crossbench.
Finance Minister Mathias Cormann said on Sunday that if the budget spending cuts and savings measures, including the $7 GP co-payment, the rise in fuel excise and changes to university fees, were not passed then "the only alternative to balance the books is to increase taxes".
Education Minister Christopher Pyne said universities could face a "worst case" scenario of research funding cuts if the Senate did not pass his proposed higher education reforms, which will be introduced to the Parliament on Thursday and include deregulated university fees, cuts to course funding by about 20 per cent and increased interest payments on student loans.
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Primary health care: great expectations

25 August, 2014 Amanda Davey
A group of researchers say they have managed to figure out an evidence-based list of core primary health care (PHC) services that should be available regardless of where a patient lives.
The researchers from Flinders and Monash universities engaged 39 policy-makers, academics, clinicians and consumers in a qualitative study they hope will assist in determining policy and resource allocation.
“Currently policy-makers and health service planners charged with the responsibility for allocating health resources to rural and remote communities do so in the absence of any comprehensive and agreed national listing of what constitutes core or essential PHC services,” they write in BMC Family Practice.
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‘No more ideology,’ Abbott cabinet told

Phillip CooreyChief political correspondent
The federal government’s chances of a budget breakthrough any time soon are bleak, with Senate crossbenchers saying they will not be “bullied” by threats of tax increases.
There was no sign of breakthrough in the standoff a day before Parliament resumed as members of cabinet were advised by Coalition party officials to show more public discipline.
Following a six-week winter break marked by bungles, gaffes and mixed messages on budget and other policy issues, Liberal Party federal director Brian Loughnane and his Nationals counterpart Scott Mitchell spoke to the cabinet on strategy.
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Tony Abbott has two weeks to fix 12 months

Date August 26, 2014

Mark Kenny

Chief political correspondent

The six-week parliamentary break has done less to improve the government's parlous reputation with voters than it had hoped.
If anything, the lay-off has exacerbated a sense of drift and occasioned the odd break-out of political desperation.
The next two weeks of parliamentary sittings must be used to turn this around or Tony Abbott's first year will be judged as mediocre, even by his barrackers.
An opening year "fail" grading would not be terminal for Abbott's leadership nor for his government's re-election hopes, but it would make both more problematic.
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Crucial fortnight for Coalition

Date August 26, 2014 - 5:44AM

Mark Kenny and Latika Bourke

Federal cabinet met on Monday in a bid to reframe its confused budget messaging as Labor confirmed it would not be compromising on stalled measures forcing the government further towards retreat or compromises with the independents.
The talks followed a harsh political reaction to suggestions from senior ministers about possible tax increases or cuts to university research spending if budget savings remained unlegislated.
The otherwise routine cabinet meeting came as even some of the nation's conservative commentators urged the government to regain the initiative, amid confusion over the language being used by senior ministers to describe the budget impasse.
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Attack tax expenditures. It's where the money is

Date: August 26, 2014 - 6:50AM

Peter Martin

Economics Editor, The Age

The finance minister is two-thirds right. He says if the government can't balance its books by cutting spending, "the only alternative to balance the books is to increase taxes".
There's only one other option. It's neither an increase in tax nor a cut in spending. It's an attack on tax expenditures, something the committee drawing up next year's tax white paper would have been asked to examine in any event.
Superannuation is Australia's biggest tax expenditure; the tax breaks given to contribution and to the earnings on those contributions when they are in the funds amount to $36 billion a year on Treasury estimates.
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Labor targets ‘weak link’ Joe Hockey

Fleur Anderson
Some federal ministers vomit from nerves before entering the high-stakes arena of question time. Others memorise their answers or perform superstitious rituals to get them through their days under the floodlight of public scrutiny.
For weeks, Treasurer Joe Hockey has been lampooned and attacked for botching the government’s budget sales job, so it was no wonder he looked pale and sweating back on the floor of Parliament on Tuesday.
It was the first parliamentary sitting since July 17 and with the MH17 tragedy and atrocities in Iraq still raw in the public’s memory, the Abbott government turned its focus from budget emergency to national security.
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29 August 2014, 6.48am AEST

Abbott government health policy needs a sharper focus

Jim Gillespie

Deputy Director, Menzies Centre for Health Policy & Associate Professor in Health Policy at University of Sydney
The Coalition entered the 2013 federal election without a health policy. After a year in government, it remains without one. While there has been activity in the health arena, there’s been little coherent direction.
The government’s first month was spent on an ideological campaign against agencies identified with the “nanny state”. The Alcohol and Other Drugs Council of Australia (established by the Holt government in 1966), for instance, was axed.
The Australian National Preventive Health Agency, which had long been a target for conservative critics, was a more expected casualty. It lost its funding in the Abbott government’s first budget, its functions disappearing within the Department of Health.
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There’s a simple fix to the budget

Capital idea
Brian Toohey
The Lowy Institute’s Sam Roggeveen recently posted a video on his blog with the comment: “Holy crap, this video is terrifying.”
Called Humans Need Not Apply: An Economic Horror Movie, the video was made for YouTube by CGP Grey. Roggeveen’s response probably reflects a common reaction to Grey’s case for why the workforce burden from ageing populations will be far worse than even the bleak official projections.
Grey’s view is pertinent to the sustainability of the budgetary costs of Australia’s twin retirement income streams, the age pension and superannuation. Even if Grey is wrong, the projections are bad. Despite more optimistic assumptions, they forecast the “dependency ratio” of those between 15 and 65 to those over 65 will fall from 5:1 today to only 2.7:1 by 2050. This means fewer workers will have to fund budget assistance for retirees who will often be able to fend for themselves.
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Health minister Peter Dutton sees smaller medical fund on cards

Jemima Whyte and Jessica Gardner
Health minister Peter Dutton has said the government will push through a smaller Medical Research Future Fund if its embattled GP co-payment fails, as business and medical researchers ramp up the pressure to get the proposed $20 billion fund over the line.
“The medical research future fund without the co-payment will be much smaller, no doubt about that,” Mr Dutton said in an interview with Nine’s Financial Review Sunday program.
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Medicare Sale and GP Trials.

Primary can do health insurance: Bateman

Primary Healthcare chief executive Ed Bateman says the healthcare company intends to create its own private health insurance offerings in response to Medibank Private's attempts to secure less generous contracts ahead of its IPO.
According to The Australian, sources indicate Medibank Private has told healthcare companies it plans to pay 30 per cent less for diagnostic work than it has previously.
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Medibank goes up for sale

Date August 30, 2014

Peter Martin and Jessica Gardner

Mum-and-dad investors and superannuation funds will soon own the bulk of Australia's biggest private health insurer following the government's decision to dispose of Medibank Private by Christmas.
The decision to sell to the public rather than to a single buyer was announced in April, while the move to bring forward the $4 billion sale was announced on Friday.
The position of Medibank policyholders is uncertain. Hundreds of them have petitioned the government demanding free shares on the grounds that their contributions built the fund from its inception in 1976. The government says it will consider their position in coming weeks.
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Medibank boss wanted its members to get priority treatment in emergency departments

Date August 29, 2014

Dan Harrison

Health and Indigenous Affairs Correspondent

 Medibank chief executive George Savvides floated the idea of privately insured patients receiving priority treatment in public hospital emergency departments at a function with doctors in March.
Speaking at a dinner in Parliament House on Wednesday night, Australian Medical Association president Brian Owler said "the CEO of a large private health insurer" who was invited to speak at an AMA function "tried to tell us that they wanted patients with private insurance in a public hospital emergency department to receive priority."
"His question was if your son breaks his arm and goes to the emergency department, and you have private health insurance, why shouldn't little Johnny get priority?"
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Medibank’s $4b listing due before Christmas

Jessica Gardner

Key points

  • Mum and dad expected to dive into health insurance company listing.
  • Labor says privatising not shown to benefit health system or policyholders.
Retail investors are expected to lap up shares in the $4 billion float of Medibank Private, which will proceed before Christmas.
The timeline for Medibank’s listing on the Australian Securities Exchange, which will be the biggest since the $4.6 billion privatisation of rail freight business QR National in 2010, was outlined by Finance Minister Mathias Cormann on Friday.
After previously allowing a window that extended until the end of the 2015 financial year, the Coalition government said Medibank will list in December. The early flick of the switch was flagged this month by Street Talk, which noted bankers working on the deal had recently stepped up the pace to allow for a float before year’s end.
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GP Co-Payment.

Eddie The Experts In The Health System Are Everywhere

Jennifer Doggett | Aug 29, 2014 6:53AM | EMAIL | PRINT
Who should we be listening to in the debate over co-payments in the health system? Why do Governments take advice from unions, such as the AMA, with clear vested interests, rather than from expert researchers and consumer groups?  In the following piece, Anne Cahill Lambert builds on Marie McInerney’s work on the co-payment to question the role of ‘expert’ in the health policy arena.  She writes:
I am intrigued about the latest furore about the $7 Medicare co-payment.  Aside from the fact that I don’t agree with it, I have been fascinated about who has been consulted or whose views have been reported.
Dealing with my disagreement first, the major claim is that a free public health service is unsustainable.  Of course, Medicare is not free.  It is a universal health system that is predominantly supported through a levy on taxpayers.  I think many commentators, including our Health Minister, are muddling the terms universal and free.  The beauty of our Medicare system is that all citizens are covered.  It is the centrepiece of Australia’s health system of which I am extremely proud.
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Peter Dutton shifting on GP co-payments

David Crowe

Stefanie Balogh

TALKS on the government’s $7 charge on visits to the GP have opened up room for a compromise as Health Minister Peter Dutton negotiates with crossbench senators on the idea of “scaling up” the fee from a lower starting point.
Family First senator Bob Day backed the concept of the $3.5 billion savings measure but called for a shift in the way it was implemented to ease community concerns over paying to see the doctor.
The talks came as government officials countered some of the claims about Australians being burdened by soaring “out of pocket” expenses for healthcare.
Health Department analysis shows one-third of the growth in the out-of-pocket costs is the ­result of consumer demand for non-­prescription medicines ­inclu­ding vitamins and supplements.
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Linking GP co-payment with medical research fund a mistake, says Nobel prize winner

Date August 26, 2014 - 6:53AM

Dan Harrison and Latika Bourke

A Nobel prize-winning medical researcher has questioned the federal government's decision to link its proposed medical research fund with unpopular health savings, such as the controversial GP visit fee.
Rolf Zinkernagel, who together with Peter Doherty won the 1996 Nobel prize in physiology or medicine for work on how the immune system recognised virus-infected cells, said the research fund and a fee for visiting the doctor were fine ideas, but linking them was a mistake.
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PUP says co-payment is dead

Australian Broadcasting Corporation
Broadcast: 26/08/2014
Reporter: Tom Iggulden
Clive Palmer says the government's plan to introduce a seven dollar doctor's fee co-payment is dead and the Palmer United Party will do all it can to make sure it is never raised in Parliament again.
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The point of $7 GP fee is to stop people seeing the doctor

  • 10 hours ago August 27, 2014 12:00AM
  • Jessica Irvine National Economics Editor
  • News Corp Australia Network

Palmer won't support any co-payment

EVERYONE is missing the point on the GP co-payment.
An unfair assault on the sick and the poor?
Hardly.
A device to deter overuse of GP services and expensive, taxpayer-funded, medical testing?
Well, yes.
Economics teaches that we will always over consume things that are free.
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AMA: We must discourage our bulk-billing culture

Date August 28, 2014 - 12:00AM

Brian Owler

The government's budget proposal for a general practice co-payment has been universally condemned since it was announced, and deservedly so. It is bad health policy.
At the request of the Prime Minister, the AMA developed an alternative co-payment model. Last week, we released that proposal. It aims to protect vulnerable groups in our community, while suggesting that where people can afford to contribute they should do so.
The AMA proposes a co-payment of $6.15 for concession card holders and those under 16 years of age, which would be paid for by the government, and not from their own pocket. Only non-concession patients over 16 years of age would be asked to make a co-payment of at least $6.15. This amount was chosen on the basis that it is the current GP bulk-billing incentive. The amount would be indexed.
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AMA hits back at 'money grab' claims

28 August, 2014 Sam Worrad
The AMA has hit out at claims its GP co-payment policy is a cash grab and repeated its opposition to private health intervention in primary care, at a function attended by Health Minister Peter Dutton.
At an AMA parliamentary dinner, president Associate Professor Brian Owler pointedly responded to Mr Dutton’s criticism of its alternative co-payment plan, which calls for a $6.15 co-payment and scrapping the proposed $5 MBS rebate cut.
Mr Dutton is reported to have said: “I note that the current proposal put forward by the AMA with regards to the $7 co-pay will result in a windfall for doctors while wiping out 97% of the government’s estimated savings."
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Ricky Muir open to co-payment talks

27 August, 2014 AAP
Motoring Enthusiast Party senator Ricky Muir says his "ears are open" to negotiations on the $7 GP co-payment, a day after his political partner Clive Palmer claimed to have killed off the charge.
Senator Muir (pictured), who has formed a loose alliance with the Palmer United Party, said under its current form the Medicare co-payment was "very hard to support".
However, he was willing to consider an alternative model for the payment.

Pharmacy Related Articles.

Is it time to revisit pharmacy ownership?

Jennifer Doggett | Aug 26, 2014 5:17PM | EMAIL | PRINT
With the Government desperately trying to revive a co-payment policy that has been declared DOA by Senate balance-of-power holder Clive Palmer, attention is turning to other areas of health financing that could deliver Budget savings.  A senior health policy analyst and regular Croakey contributor who writes under the name of “William Foggin” has provided the following analysis of the current regulatory environment for pharmacy. He proposes a number of reform measures, in particular lifting current ownership restrictions, that would both save health dollars and leave the door wide open for major chain stores and corporations to enter the previously closed pharmacy market.
“William Foggin” writes:
As the Government struggles to find savings to replace those that may be lost in the Senate, it could usefully return to the pharmaceutical benefits scheme.  The budget included significant savings to the budget from increasing co-payments under the scheme: a simple cost transfer from taxpayers generally to sick people.  But it did nothing to address the cost of the scheme as a whole.
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Responding to change

The National President of the Guild, George Tambassis, and I have just returned from a meeting with six sister organisations representing community pharmacies in English-speaking countries.
As well as Australia, the members of Pharmintercom comprise New Zealand, the United Kingdom, Ireland, South Africa, Canada and the USA.
From the discussions over the three days, it is clear that pharmacies in all these countries face similar pressures to our members in Australia.
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Comment:
It seems the fuss is not yet settled - to say the least.
Lots to browse with all sorts of initiatives going rather pear shaped - think security, sanctions and so on!
One really has to wonder if all this security alarm is not meant to distract from the Budget….
I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget at the end of the day!
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, September 03, 2014

The Irish Have Identified Just How Hard National E-Health Can Be! And Seems To Have A Sensible Plan.

This appeared last week.

Ehealth plan designed to save money and patients

Hiqa is working on standards for a new ‘health identifier’ system that aims to simplify medical records

Elaine Edwards
First published: Tue, Aug 26, 2014, 01:00
One of the many challenges facing new Minister for Health Leo Varadkar will be to oversee the Government’s ehealth strategy, published by his predecessor, James Reilly, at the end of last year.
It will require investment not just in information technology but in new work practices and governance structures in the health service. It will be a slow process but, if handled properly, should pay big dividends for patient safety and for the healthcare system generally.
Ehealth is described as a fully integrated digital supply chain, involving “high levels of automation and information sharing”. In English, that means making consistent, accurate information about every patient available when and where it is needed, eliminating duplication, increasing patient safety and improving, for example, the management of chronic illnesses.
The strategy document claims investment in ehealth infrastructure has the potential to bring significant economic benefits.
Healthcare is changing radically as a result of demographic, organisational and resourcing factors, as well as the proliferation of new technology, it notes.
“These factors mean that future healthcare systems will need to be radically different in order to respond efficiently and equitably to forecasted demand.”
Prof Jane Grimson, acting chief executive of the Health Information and Quality Authority (Hiqa), says forecasts suggest healthcare will consume a large percentage of GDP in most developed countries by 2050.
All developed countries and many developing countries have ehealth strategies, she says. “They’re all investing in ehealth because everybody is convinced it can really offer benefits in terms of improved patient safety, as well as improved efficiencies.
“There’s plenty of evidence to suggest that this is true. However, the really good, strong evidence about benefits of ehealth tend to be mostly at local hospital level or a GP practice level.”
Prof Grimson says implementing ehealth solutions at a national level “has been a challenge everywhere”.
“A lot of countries have invested and wasted a lot of money and had to start all over again.”
Creating electronic health records, integrating information from multiple sources – including monitoring devices and sensors – as well as major changes in governance and work practices and a realignment of health budgets will all be part of the huge challenge.
Lots more here:
The caption for the picture for the article says it all.
Prof Jane Grimson: ‘We have the opportunity to learn from other people’s mistakes.’
I have to say what I read that Prof. Grimson is saying makes a great deal of sense. I hope she succeeds so there will be one decent example of things being done is a more sensible fashion - slowly, carefully, evidence based with decent leadership and governance.
I wish them the luck of the Irish with this!
David.

Tuesday, September 02, 2014

The Government Seems To Be Trying To Make a Difference With Mental E-Health. Good Heavens It’s Actually Evidence Based!

This release appeared last week:

New Online Forums to Support People Living with Mental Illness

Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched by the Minister for Health, Peter Dutton.
Page last updated: 27 August 2014
27 August 2014
Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched in Canberra today by the Minister for Health, Peter Dutton.
Minister Dutton said the SANE Australia Online Forums would help people by giving them trusted and anonymous access to reliable mental health information, advice and referrals.
“While almost half of the Australian population will develop a mental illness at some point in their lives, only 46 per cent of this group will seek any form of support or treatment,” Minister Dutton said.
“We know that there are many reasons that people do not seek treatment like a fear of being stigmatised, living too far from a medical practitioner and not knowing how to get information and care. Online mental health services like the new SANE Australia Online Forums can combat this to reach people who might otherwise not receive the support they need.”
The two forums – one for carers and one for people living with mental illness – were developed by SANE Australia with funding from the Department of Health and will provide nationwide online peer-to-peer support services.
“Today, the Internet is a major source of health and medical information” Minister Dutton said.
“International and Australian research has demonstrated that online therapy can be just as effective for people with anxiety and depression as face-to-face therapy.”
“The Government recognises the potential of e-health and e-mental health to improve health outcomes for Australians, wherever they live. We are investing in e-mental health as part of our overall plan to build stronger, better, primary health care,” he said.
The SANE Australia Forums will complement existing e-mental health services which the Government is providing funding of $122 million over the next four years.
To access the SANE online forums, please see the Carers and Lived Experience forums website.
The full release is found here:
Here is the link to the forums:
There is a post on the motivation for all this on the Croaky blog:

Taking care of each other online

| Aug 25, 2014 8:06AM | EMAIL | PRINT
One of the benefits of the Internet is its use as a tool to create communities among people who previously would have been isolated from each other.  Nowhere is this more apparent than in the growth of online forums for people with chronic illnesses and disabilities.  These are playing an increasingly important role in providing information, support and assistance to people with serious and chronic illnesses but they remain an under-researched area of the health system.   Susan Stewart Loane, a PhD Researcher at Macquarie University, is addressing this gap through her research and provides the following report of her findings. She writes:
No one had heard from Tracey for a while, which was a concern because Tracey had Motor Neuron Disease (MND).  Members of Tracey’s social circle tried valiantly to contact her with no success.  Finally, someone decided to drive 250km to her house and check that she was ok.  She was.  She’d had a fall and was too dizzy to use the computer.  The friend got the message out and everyone was relieved.  But a week later Tracey still hadn’t got in touch and they started to worry again.  Someone who lived closer (but who barely knew Tracey) offered to drive to her house and check on her.  Again Tracey was found to be ok, but still recovering.
What is extraordinary about this story is that all of those involved, the two people who visited Tracey and the more than 100 people who were concerned, are strangers to each other.  Their only connection to each other, and to Tracey, is that they all have MND or know someone who has, and they are all members of an online forum for people living with MND.
Online health forums are typically known as places where information about treatment and symptoms is shared between people who are ill, and where strangers deliver online support to one another.  As a researcher in this field I make a point of asking my own medical service providers, as well as medically-trained friends, for their view of online health communities.  Few have ever used one, but around half of those I’ve asked express concerns about unsafe information being shared or about the general weirdness of strangers comparing medical details across geographic borders.  The most positive reactions come from more experienced medical specialists who are excited about the potential for people to provide forms of support to each other than can’t sustainably be provided within the health system.
My research** has convinced me that genuine bonds can develop between people who use online forums for health purposes.  Social support delivered through posts and threads can build community, as evidenced by Tracey’s story.  Communities look after their members in ways that bureaucrats and formal service providers cannot.  Unless a doctor or other health professional has experienced the same health condition, they simply can’t communicate with their patients in the same way that a fellow-sufferer can. 
Lots more here:
Here are the 2 references cited
Stewart Loane, S., Webster, C. M., & D’Alessandro, S. (2014). Identifying Consumer Value Co-created through Social Support within Online Health Communities. Journal of Macromarketing, Online First.
Stewart Loane, S., & D’Alessandro, S. (2013). Peer-to-Peer Value through Social Capital in an online Motor Neuron Disease Community. Journal of Nonprofit and Public Sector Marketing, 25(2), 164-185.
Here is the abstract from the most recent paper:

Identifying Consumer Value Co-created through Social Support within Online Health Communities

  1. Susan Stewart Loane1
  2. Cynthia M. Webster1
  3. Steven D’Alessandro2

Abstract

Consumers increasingly turn to online health communities for health information and social support. Yet, the type of value consumers derive from online health communities is not well understood. This study examines social support as the mechanism through which consumers co-create and experience different types of value. Cutrona and Russell’s typology of social support and Holbrook’s consumer value typology are applied to posts and threads obtained from two online communities for people with Parkinson’s Disease and ALS. Results demonstrate that online health communities give consumers the opportunity to create and experience forms of consumer value that would not otherwise be available in a traditional health delivery system. The results lend support to a re-conceptualisation of medical practice and health delivery for consumers with chronic conditions.
Here is the link:
How good is this!
A funded government initiative which has an evidence base! I look forward to some deeper evaluation of what works and what doesn’t after a year or two of operation.
Pity there was not similar attention paid to evidence with respect to the PCEHR.
David.

Monday, September 01, 2014

Weekly Australian Health IT Links – 01st September, 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

The review of the NBN and what will now apparently be delivered, as far as broadband is concerned, to a waiting populace. It is a compromise but seems as though it might just deliver some useful improvement reasonably quickly. As always it seems, time will tell!
Otherwise the consultation period on the PCEHR Review concludes today and now we wait to discover what we all think. Hopefully will only take a few weeks and then the outcomes can become public - in my dreams I fear!
Enjoy the browse.
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FTTP needed for teleHealth, say Labor MPs in open letter

Two Labor members of Parliament have written an open letter to Malcolm Turnbull asking him to reconsider his scrapping of the Coalition’s FTTP NBN plans.
They argue that the greater bandwidth of Labor’s fibre to the premises (FTTP) plan is necessary for the effective provision of teleHealth – using the Internet for remote diagnostics and monitoring and the like.
The letter some two days after the Vertigan panel on the NBN’s cost-effectiveness concluded that an FTTP network would be much less cost-effective than the Coalition’s ‘multi technology mix’ model.
The main criticism of Vertigan’s findings is that its conclusions are made on assumptions about the future value of broadband services, when we cannot put a value on applications we cannot know about. The Vertigan report assumes the Internet will be used much as it is now, while the open letter explores one specific class of new applications - teleHealth
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eHealth NSW gets busy on technology rollouts

CIO Michael Walsh and CCIO John Lambert give an update on the several e-health projects underway
Rebecca Merrett (CIO) on 29 August, 2014 09:00
eHealth NSW CIO, Michael Walsh, and newly appointed chief clinical information officer, John Lambert, have laid out some of the technology projects they are focusing on this year, as part of the state’s $400 million e-health strategy.
At an AIIA event in Sydney this week, Walsh and Lambert gave an update on clinical portal HealtheNet, an enterprise image repository, incident management system, StaffLink HR system , videoconferencing, and how the organisation is increasing bandwidth.
The HealtheNet portal is a Commonwealth funded project that links multiple hospital databases to give clinicians a single view of repositories. It also integrates with the national Personally Controlled Electronic Record (PCEHR).
Walsh said he is currently working with the federal government on integrating pathology reports into the PECHR so that clinicians using HealtheNet do not have to re-do recent reports.
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E-health needs information, not just data: CIO

By Natasha Egan on August 29, 2014 in Government, Technology
Data collected for e-health must be useful information to clinicians and system managers otherwise it is not worth collecting and providing, NSW Health’s chief information officer has told an information industry forum in Sydney this week.
Michael Walsh, who is also the newly-appointed CEO of the government’s two-month old e-health entity, was giving an update on the state’s 10-year $1.5 billion e-health strategy to the Australian Information Industry Association’s state healthcare forum on Wednesday.
Mr Walsh gave a glimpse of the thinking in eHealth NSW’s forthcoming draft strategic plan, which, while originally due in August, would be released later this year for public consultation, he said.
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Telstra says answer to healthcare lies in the cloud

Jessica Gardner
Healthcare companies hoping to tap into growing Asian markets should focus on innovative cost-saving measures that help governments reduce their exposure to ballooning medical care budgets, experts have said.
Telstra’s head of health Shane Solomon told an Asialink Business event in Melbourne that although countries in the region were spending to improve their healthcare offering, companies should not expect an easy windfall based on exporting systems in place in Western economies. “These [Asian] systems are not rich,” he said. “The real disrupter in Asia will be the low-cost solutions.”
Mr Solomon, who was poached from KPMG last year to lead Telstra’s foray into health technology, said countries like Indonesia, where there are 0.6 hospital beds per 1000 people, cannot simply respond by building expensive infrastructure. “[The government is] looking to understand how can the population benefit from the advances in the economy without having to build ­squillions of hospitals,” he said.
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Telstra plans to move into e-health before Asia push

Telstra executive Gordon Ballantyne says the telecommunications giant will use domestic markets as a proving ground for its burgeoning health business before pushing into growth markets in Asia.
Telstra has made a number of investments in start-ups such as pharmacy software provider Fred IT and doctor booking website HealthEngine after announcing, just over a year ago, that it would make a play in the health technology sector.
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J Am Med Inform Assoc doi:10.1136/amiajnl-2014-002804

The double-edged sword of electronic health records: implications for patient disclosure

  1. Celeste Campos-Castillo1,
  2. Denise L Anthony2

Abstract

Objective Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients’ global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure.
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EPtalk by Dr. Jayne

Recent research at the University of Michigan finds that patients with low literacy and low comprehension of numerical concepts are less able to understand online lab results. The Internet survey of 1,800 adult patients looked at simulated diabetes results and whether patients understood if labs were within or outside of reference ranges. Less literate patients were also less able to determine when they should call their doctor, based on the data.
Researcher Brian Zikmund-Fisher is quoted as saying, “We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them.” At the other end of the spectrum, over three-quarters of patients with higher literacy skills could identify levels outside the reference range. He goes on to state the need for more research on the best ways to display lab data.
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New Online Forums to Support People Living with Mental Illness

Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched by the Minister for Health, Peter Dutton.
Page last updated: 27 August 2014
27 August 2014
Support for people living with mental illness and their family, friends and carers is the focus of two new online forums launched in Canberra today by the Minister for Health, Peter Dutton.
Minister Dutton said the SANE Australia Online Forums would help people by giving them trusted and anonymous access to reliable mental health information, advice and referrals.
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Taking care of each other online

| Aug 25, 2014 8:06AM | EMAIL | PRINT
One of the benefits of the Internet is its use as a tool to create communities among people who previously would have been isolated from each other.  Nowhere is this more apparent than in the growth of online forums for people with chronic illnesses and disabilities.  These are playing an increasingly important role in providing information, support and assistance to people with serious and chronic illnesses but they remain an under-researched area of the health system.   Susan Stewart Loane, a PhD Researcher at Macquarie University, is addressing this gap through her research and provides the following report of her findings. She writes:
No one had heard from Tracey[*] for a while, which was a concern because Tracey had Motor Neuron Disease (MND).  Members of Tracey’s social circle tried valiantly to contact her with no success.  Finally, someone decided to drive 250km to her house and check that she was ok.  She was.  She’d had a fall and was too dizzy to use the computer.  The friend got the message out and everyone was relieved.  But a week later Tracey still hadn’t got in touch and they started to worry again.  Someone who lived closer (but who barely knew Tracey) offered to drive to her house and check on her.  Again Tracey was found to be ok, but still recovering.
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Department of Human Services uses big data analytics to measure staff performance

DHS health and information deputy secretary Barry Sandison says call centre staff are measured on how quickly they answer the phone
Hamish Barwick (CIO) on 26 August, 2014 09:52
The Department of Human Services (DHS) is striving to improve its customer service through the use of big data analytics.
Speaking at the Teradata Summit in Sydney, DHS health and information deputy secretary Barry Sandison told delegates that it has a “gigantic database” of customer behaviour information.
“Every Australian is in the database and we divide our data sets into child support, Centrelink and Medicare. There are 23.5 million active records,” he said.
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Pharmacy project stops drug misuse

By ARYELLE SARGENT
Aug. 26, 2014, 3:33 p.m.
BEFORE a program called Project STOP, people could walk into a pharmacy off the street and purchase cold and flu tablets for the pseudoephedrine to make ice.
Pharmacy Guild of Australia state president and Coventry Pharmacy Latrobe pharmacist John Dowling said customers looking to make the drug would go to several pharmacies to buy enough tablets to avoid suspicion.
Project STOP has nipped this in the bud with a national database that records who buys cold and flu tablets containing pseudoephedrine.
This requires those buying the tablets to show a valid drivers’ licence.
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How Medibank embraced cloud, overcame shadow IT

Medibank enterprise security manager Mark Burns says it has embraced the cloud rather than trying to stop staff using services
Hamish Barwick (Computerworld) on 27 August, 2014 11:09
Medibank is allowing staff outside of the IT department to sign up to cloud services such as Amazon Web Services (AWS) to reduce website hosting costs, while at the same time including IT security in the process, according to Medibank enterprise security manager Mark Burns.
Speaking at the Gartner Security and Risk Management Summit in Sydney this week, Burns told delegates that IT security has received 20 separate requests over the past six months to use different cloud services such as online storage.
“One of the key challenges for my security team is dealing with the potential loss of visibility. Traditionally, we were able to force the business to engage with IT because they were relying on us to deploy the server, install the software or open up the firewall,” he said.
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DHS to roll out network ‘stress testing’ for agencies

Department of Human Service's data centre environment has become more complex following integration of other agencies in mid-2011
Byron Connolly (CIO) on 28 August, 2014 11:24
The Department of Human Services (DHS) has tendered for testing and network infrastructure to benchmark and validate changes to its data centre to support the integration of Centrelink, Medicare and CRS Australia.
These agencies were rolled into one DHS portfolio in mid-2011, which has increased the scale and complexity of its data centre environment.
In February last year, DHS told CIO it was hoping to cut the number of system outages across its environment by 5 per cent per quarter until early 2014. The agency experienced 137 system reliability outages in the 12 months between October 1, 2011 and September 30, 2012.
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The many tribes of informatics

August 29, 2014
My learned and senior informatics colleagues spend much time debating the different professional roles that together are needed to support the practice of informatics (e.g. informatician, informatasist). Over the years I have assembled a set of definitions for these professional roles, as well as allied concepts. I feel this list is unlikely to help the debate at all.
Informatocyst [In-for-mata-s-ist, n] (see also, legacy system). A collection or build up of information, walled off from the greater information system by a barrier of incompatible or aged interchange standards.
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Paging Dr. Watson, IBM's medical adviser for the future

IBM's Watson could help doctors by analyzing the masses of literature in the field
Joab Jackson (IDG News Service) on 29 August, 2014 07:39
IBM Watson can match possible treatments to genetic disorders
IBM continues to make the case for the nascent field of cognitive computing, showing off some Watson prototypes Thursday that could help speed scientific discovery in the medical field, by scanning large volumes of literature and data far more quickly then humans can, and suggesting possible leads.
The New York event was to promote an update to a cloud service, called Watson Discovery Advisor, that can help researchers find fresh connections within mass realms of data.
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Diagnostic software may detect cancer in X-rays

  • Elizabeth Dwoskin
  • The Wall Street Journal
  • August 26, 2014 12:00AM
WHAT if software akin to the program that recognises faces in Facebook photos could detect cancer in an X-ray?
That’s the idea behind Enlitic, a new US startup founded by Jeremy Howard, who is a heavy hitter in big data — he’s data strategist for Silicon Valley venture capital powerhouse Khosla Ventures and former president and chief scientist of Kaggle, which hosts big-brain predictive modeling competitions.
Enlitic aims to use advances in machine learning to make medical diagnoses.
The company says it has partnered with hospitals and medical imaging companies — Howard won’t say which ones — to mine a host of data sources, including X-rays, lab results, handwritten doctors notes, and claims records. The company is building software algorithms to identify otherwise invisible patterns in these data sources, making for sharper diagnoses.
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Thatcher reflects on ten years at Mater

Longstanding Mater Heath Services chief information officer, Mal Thatcher is set to move to the new strategically focused Chief Health Information Officer role at Queensland Health. The move, which involves a 12 month leave of absence from Mater, is set to commence next month.
While Thatcher was circumspect about what his placement will involve at Queensland Health – he said he was waiting until he hit the ground – he was willing to look back over his decade plus time at Mater.
“I have two roles at Mater,” he said. “I am chief information officer, and also executive director for information and infrastructure.”
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Australian startup snapshot: Vimcore

Connecting business employees to healthcare providers
Adam Bender (Techworld Australia) on 29 August, 2014 16:06
Vimcore is a Sydney B2B startup that connects its customers’ employees to local healthcare providers. When not running the business, the company’s co-founder, Jessica Evans, advocates women entrepreneurship in the largely male tech startup scene.

The pitch

Vimcore targets businesses that care about employee health and want to provide a simple way for their staff to access healthcare advice and find medical services.
Evans, a physiotherapist, has experience in the corporate world, including a previous job at Sanitarium. She said she has seen first-hand that large companies often struggle to provide good healthcare information and services to employees.
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CDA Validator v2.0 and Template Packages Available for Download

Created on Thursday, 28 August 2014
NEHTA has released the next major version of its CDA Validator tool for the automated validation of clinical documents. This new version helps implementers reduce development and test times by performing a wider range of checks for clinical documents.
Version 2.0 of the CDA Validator now covers validation of:
  • The CDA document itself;
  • The CDA package containing the CDA document, attachments and additional material;
  • Updated versions of clinical terminology.
The validation of CDA documents can now be performed against different versions of clinical document specifications. This is supported by the publication of all available template packages for these specification versions on the NEHTA website. CDA Validator v2.0 can perform CDA document validation against any of these template packages.
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Astounding finding - NBN benefit not worth cost

The long awaited Vertigan cost benefit analysis of the NBN has found that Labor’s version was a waste of money, while the Coalition’s offers much better value. Wow!
One of the main criticisms Malcolm Turnbull and the Coalition levelled against Labor’s FTTP (fibre to the premises) NBN was that no cost benefit analysis (CBA) was ever conducted.
Now, as part of the Government’s never ending NBN review process, we have such a CBA. It finds that Labor’s FTTP NBN provides much worse value for money than the Coalition’s ‘multi technology mix’ (MTM) NBN. The unsurprising finding is based on a number of assumptions that unfortunately do little to dispel the view that the report’s conclusions are tailor-made to suit the Coalition’s purposes.
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NBN cost-benefit analysis signals the end of an era

The long-awaited cost-benefit analysis of the National Broadband Network suggests the days of politicians shooting from the hip with taxpayer dollars are numbered.
The long-awaited cost-benefit analysis of the National Broadband Network suggests the days of politicians shooting from the hip with taxpayer dollars are numbered.
As Labor’s NBN unfolds amid reviews and revelations, it’s apparent the NBN was a political move based on romantic notions of policy-making ending in Labor’s electoral defeat in 2013.
In government, the Coalition called for a strategic review of the NBN, revealing a number of problems with the project’s implementation. Malcolm Turnbull also promised to deliver an independent cost-benefit analysis of the economic and social costs and benefits of the NBN.
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Cost benefit analysis shows Turnbull plan has $16b advantage

Date August 27, 2014 - 11:00AM

Matthew Knott, Peter Martin

The Abbott government's pared-back broadband plan is three times more cost effective than Labor's ambitious scheme and would leave Australians $16 billion better off, according to the first independent cost-benefit analysis of the national broadband network.
In a scathing verdict on the Rudd and Gillard governments' plan to introduce fibre directly to 93 per cent of premises, the cost benefit analysis finds the policy is so expensive it would barely leave the community any better off in net terms than if broadband investment remained frozen at present levels.
The much-anticipated report finds households and businesses will benefit from quicker downloads but the much-vaunted societal benefits of fast broadband – such as improvements to health and education services – will probably be extremely limited.
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Government low-balling us on second-rate NBN

Date August 29, 2014 - 11:52AM

Gadgets on the go

Adam Turner is an award-winning Australian freelance technology journalist with a passion for gadgets and the "digital lounge room".

Justifications for the multi-technology mix only add up when you ignore the inconvenient numbers.
This week's NBN review supports the government's decision to scrap the national fibre-to-the-premises rollout and instead take a patchwork multi-technology mix approach – hooking up a quarter of homes to fibre but relegating the rest to HFC cable, fibre-to-the-node or satellite. It's telling that Communications Minister, Malcolm Turnbull, was happy to sign off on this approach before the report was completed, after criticising Labor for favouring fibre-to-the-premises without first crunching the numbers.
If you're still not convinced that the NBN-lite is a bargain, Turnbull is happy to spell it out for you on a whiteboard – explaining why fibre-to-the-node is more cost-effective than fibre-to-the-premises. The always articulate Turnbull makes some valid points, but the numbers only stack up if you assume low growth in bandwidth demand, ignore the costs in maintaining legacy infrstructure and don't factor in the possibility of future fibre upgrades.
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High-speed broadband can quickly be delivered at a reasonable cost

Henry Ergas

THAT the release of the cost-benefit analysis of the National Broadband Network has generated as much heat as light is perhaps unsurprising. The debate about the NBN has always been drenched in politics. And the analysis itself is lengthy and complex, making its findings difficult to communicate and absorb.
But every voter needs to understand what is at stake in Australia’s biggest infrastructure project. So here is “an intelligent reader’s guide to the NBN CBA”.
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Explainer: Which NBN scheme is best for you?

Date August 31, 2014 - 9:00AM

Peter Martin

Economics Editor, The Age

It was going to be bigger than the Snowy Mountains Scheme and it was going to revolutionise our lives. Four years ago Labor began an audacious program of connecting every house and business in the country to the internet, all over again. It was to cost $43 billion and it commenced without a cost benefit analysis. This week the Coalition released the results of a cost benefit analysis into Labor's NBN, the first. It finds the benefits would never have approached the cost. Who's right, and who's offering the best plan now? Peter Martin runs the numbers.
WHAT WAS LABOR OFFERING?
Every address in every city and reasonable sized town was to be offered the chance to be wired up to an optical fibre cable. Remote locations were to be connected by satellite and wireless. As of June this year NBN Co had connected 210,000 locations and had millions to go. The promised speed for the fibre links was 100 megabits per second, with the whole system upgradable later to 1000 Mbps, each far faster anything that was available at the time.
WHAT COULD IT BE USED FOR?
The cost benefit study finds most uses don't require anything like 100 Mbps. Ultra high definition TV comes closest. The government's advertising stressed instead the unknowable nature of its uses saying the NBN would be used "in ways we only dream of".
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DIY blood pressure better than doctor, study finds

  • AP
  • August 27, 2014 7:27AM
 “DO-IT-YOURSELF” blood pressure measurements and medicine changes work better than usual doctor-office care in some patients, a study of older adults in England found.
Those who did their own readings at home and adjusted their medicine as needed had healthier blood pressure levels after a year than those who got standard doctors’ care.
Self-care patients weren’t completely on their own — any changes they made were part of a treatment plan previously OK’d by their doctors. But the patients didn’t need to consult their doctors every time they increased the dose if it was part of the original treatment plan.
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Enjoy!
David.

Sunday, August 31, 2014

So What Happens Next Now The Consultation On The PCEHR Review Has Finished?

Regular readers will be aware that over approximately the last 2 months Deloitte has been assisting DoH in consulting stakeholders on the PCEHR as produced by the Royle Committee the report of which was released in May.
There is a link discussing all this here:
About a month ago we had the astonishingly botched release of an online survey for the public and others (vendors and clinicians) to respond to. You can read about all that here:
and here:
There was also an article I published a month ago pointing out that the options for the PCEHR Review were pretty limited. See here:
Finally we have had a leak of a NEHTA Report dated June 2014 which basically said most GPs who were surveyed and were PCEHR enabled were basically not at all impressed and were not using the system.
Internally we know that present Government E-Health leadership are in denial on the usability and utility of the PCEHR and really seem, for some evidence free reasons, to think that the thing should rumble on.
We also know that many stakeholders (RACGP, Software Providers, many academics etc.) are aware there are major problems with the whole program and have been providing feedback to that effect, as I have been. See here:
So what happens next? It seems to me there are three basic options.
Option 1. - Abandon the whole PCEHR program and move back to a progressive funded implementation of a revised National E-Health Strategy with a collaborative approach with the private sector - accepting National Programs need to develop from the ground up and not top down.
Option 2. - Decide to announce consultation on a National E-Health Strategy Refresh and defer consideration on the fate of the PCEHR until the Strategy is developed, agreed and funded.
Option 3. - The Ostrich Option - pretend all is well and just continue with what is presently happening and going no-where.
I would be OK with Options 1 or 2 but fear we will get Option 3!
David.

AusHealthIT Poll Number 233 – Results – 31st August, 2014.

Here are the results of the poll.

Do You Believe The NEHTA Leadership Should Be Held Accountable For The Slow Progress In E-Health Over Almost The Last Decade?


For Sure 48% (79)

Possibly 34% (56)

Neutral 6% (10)

Probably Not 5% (8)

No Way 4% (7)

I Have No Idea 2% (3)

Total votes: 163

This is a clear cut outcome. The readers of this blog largely believe NEHTA has failed and needs major change.

Again, many, many thanks to the many that voted!

David.