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, November 20, 2014

Review Of The Ongoing Post - Budget Controversy 20th November 2014. No Sign Of Stopping!

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. Some more this week.
Here are some of the more interesting articles I have spotted this 25th week since it was released.
Other financial matters are still also bubbling along but the G20 has really been the big one this week! Tony Abbott complaining just how hard it is being to make budget progress and reports of huge budget blowout also featured.
The Government response to Ebola seems to be finally lifting off and the war between doctors and pharmacists seems to have gone ballistic. How stupid are these turf wars!

General.

Abbott's lost credibility: no surprises, no excuses

Date November 10, 2014 - 12:15AM

Ross McMullin

Australia's most successful federal opposition leaders since 1950 - in fact, probably since Federation - have been Tony Abbott and Gough Whitlam. They could hardly have been more different in how they went about it.
Whitlam transformed the ALP, spearheading a tempestuously contested overhaul of his party's procedures and policies, and conspicuously outperformed three Liberal prime ministers in the process. He was forward-looking, optimistic and creative.  Some of the recent tributes underplayed his sheer brilliance as opposition leader - understandably, as it was overshadowed by the pyrotechnics that came later in government.
Whitlam's success in opposition was all the more striking because of the context. He became ALP leader when the party was reeling from its 1966 electoral disaster, Labor's eighth defeat in a row and a particularly dispiriting one.
-----

$51 billion black hole in Treasurer Joe Hockey's budget

Date November 11, 2014 - 12:00AM

Peter Martin

Economics Editor, The Age

The Senate and the deteriorating iron ore price have knocked a $51 billion hole in Treasurer Joe Hockey's first budget, an independent analysis has found. It says part of the problem is that the budget is seen as "unfair".
Presented as Mr Hockey prepares to meet international finance ministers in Brisbane to push for measures to accelerate world growth, it shows the growth outlook for Australia has slipped, with growth of just 2.1 per cent expected in 2015-16 instead of the 3 per cent forecast in the budget.
When the budget was struck in May the iron ore price was $US103 ($119) a tonne. It has since fallen to $US83 taking as much as $10 billion out of tax revenue and helping push wage  growth to its lowest level in a decade.
So low has wage growth become that "it seems that not even bracket creep can get the budget back into surplus",  says the Canberra consultancy Macroeconomics in a report delivered to clients on Tuesday.
-----

$51 billion budget black hole forecast 'wrong', Treasurer Joe Hockey says

Date November 11, 2014 - 9:10PM

Lisa Cox and Latika Bourke

Independent analysis pointing to a $51-billion black hole in the Abbott government budget is wrong, says Treasurer Joe Hockey, after earlier on Tuesday declining to deny the figure.
The Treasurer changed his tune in an afternoon radio interview with Sydney station 2GB after earlier on Tuesday failing to refute the figure when it was put to him in an interview with Adelaide radio 5AA.
"The figure is wrong," Mr Hockey told 2GB, while refusing to provide any further insight into the government's budget forecasts. "I am confident it's not going to be around that mark."
He said the government was still finalising its numbers for the mid-year budget update in December and was waiting on ABS data that would be released.
-----

Doctors hauled in over rebates rort at major clinics

Sean Parnell

DOZENS of doctors have been implicated in a patients-for-profits scam running out of major medical clinics across Australia.
The Department of Human Services used data-matching technology to identify 207 health practitioners with suspect billing practices and has now gathered evidence against a quarter of them. Medicare investigators interviewed the suspects amid concerns they were generating more government rebates and patient co-payments than their peers and, in the process, potentially putting patients at risk of misdiagnosis.
While doctors are normally red-flagged only if they breach the 80-20 rule — 80 or more services on 20 or more days over a 12-month period — the investigation has focused on 60 mostly urban clinics where four or more doctors were billing at high levels.
The Australian can reveal the department has referred 16 medical practitioners to the Professional Services Review to determine a suitable punishment. A further 42 practitioners have been put on notice that if their billing practices do not change in the next six months, they too will be referred to the PSR.
-----

Joe Hockey's constituents not buying the Treasurer's tough on tax avoidance talk

Date November 11, 2014 - 8:24AM

Heath Aston

Political reporter

Treasurer Joe Hockey has made tax avoidance by the world's largest companies one of the cornerstone issues for discussion by the world's most powerful leaders at the G20 summit in Brisbane this week – but it appears he still has some way to go to convince those closer to home that the government is serious about extracting a fair tax contribution from companies operating in Australia.   
Three-quarters of people in Mr Hockey's own electorate believe the Coalition has not done enough to tackle corporate tax avoidance, a poll has found.
A ReachTel poll of 789 constituents of the seat of North Sydney, found a majority of Liberal voters – 59 per cent – responded no to the question: "Do you think the government is doing enough to stop corporate tax avoidance".
Based on 2013 election results, only one in five people vote for Labor in North Sydney. But of those, 72 per cent were dissatisfied with the government's performance on company tax.
-----

Does your area have lower life expectancy than Iraq? New data reveals remote areas in Australia have shorter life expectancy 

Remote western New South Wales, Northern Territory and Western Australia have shorter life expectancy of North Korea and Iraq 

Life expectancy of 67.8 years for western NSW 

North Korea life expectancy is 69 and Iraq is 68.5 

Northern Territory's life expectancy is equal to that of Liberia, which is currently in the midst of the Ebola crisis 

Western NSW high death rate occurs due to the amount of people with diabetes, obesity and heavy smoking rates

For 10 years now rural towns in western NSW has been among the bottom 10 areas for life expectancy 

People living in remote western New South Wales have a shorter life than someone who lives in North Korea or Iraq, the Australian Bureau of Statistics has reported in their latest data.
The life expectancy in rural NSW is one of the worst in the country, according to an analysis by Fairfax Media
Andrew Lewis, the mayor of Bourke Shire -which is one of the worst affected areas in Australia, said your chances of death is much higher when living in a rural area.
-----

Hockey's Treasury attacks return to haunt him

The mid-year economic and fiscal outlook to be released next month will be very interesting. Scary, but interesting.
Among other things, it will help settle an old score that goes right back to 2009. That’s the year in which the Coalition began accusing Labor of massaging Treasury figures to make false promises of a budget surplus.
Labor’s reply through the GFC years and beyond was that the government -- and Treasury’s forecasting team -- were simply blindsided by global forces that shredded the revenue base.
A new study released on Monday by consultancy firm Macroeconomics provides an independent analysis of Treasurer Hockey’s first full year running the budget, and does much to reignite the debate.
-----

New hit to budget in wages weakness

David Uren

David Crowe

THE federal budget is about to take another blow that could deepen the deficit and intensify pressure on Joe Hockey to search for spending cuts next year.
As the Treasurer warned of “lost ground” in tax revenue, falling wage growth is the latest headache to trouble the budget forecasts, with individual tax payments unlikely to deliver the $50 billion revenue boost Mr Hockey was counting on.
The budget is already expected to suffer a shortfall on company tax as a result of falling mining company profits, but the softening wage growth will present a second threat to the government’s economic plans.
Mr Hockey blasted Labor yesterday for preventing the passage of his budget savings but the opposition has rebuked the Treasurer over the tax shortfall when he had claimed in the past there was no “revenue problem” facing the government.
-----

Crikey slams Hockey for its own Budget stupidity

Australian budget
It’s all care and no responsibility at Crikey today as Bernard Keane and Glenn Dyer lash Joe Hockey for missing his Budget forecasts:
The government was committed to “more realistic long-term assumptions on the economic and fiscal outlook,” said Treasurer Joe Hockey last December when he released the Mid-year Economic and Fiscal Outlook. Finance Minister Mathias Cormann chimed in: “It is a matter of record that the previous government invariably overestimated revenue and underestimated expenditure. They kept promising surplus budgets and kept delivering more deficits. Our core commitment with this budget update is to draw a line in the sand as the Treasurer said and to provide a believable set of figures.”
As we’ve since seen, the line in the sand has already had to be redrawn at least once, and now we know it will be redrawn yet again in next months’ MYEFO.
-----

AMA says budget woes driving health policy

Updated: 5:10 pm, Thursday, 13 November 2014
Budget woes, not patient care, are driving the Abbott government's health policies, the head of the Australian Medical Association says.
Associate Professor Brian Owler has used a speech on the sidelines of the G20 summit to attack the government's lack of real health policies.
The AMA president says it's focused instead on meeting its election commitment to repair the budget.
-----

No rash cuts in MYEFO: Hockey

  • AAP
  • 13 Nov, 8:22 PM
Treasurer Joe Hockey won't be panicked into making more budget cuts for fear of harming the economy.
Such assurances came as a major US investment bank cut its Australian economic growth forecasts for this year and the next in anticipation of soft consumer spending.
Mr Hockey is due to hand down his mid-year budget review in December.
It will have to take into account an unexpected decline in export revenue due to a 30 per cent drop in iron ore prices and less tax revenue from lame wages growth.
Also, a number of measures from the May budget remain stuck in the Senate.
But Mr Hockey says the economy is still growing and he does not expect a bigger deficit next year.
-----

What are the critical health issues for G20 leaders?

Michelle Hughes | Nov 13, 2014 9:35PM
Global meetings like the G20 Leaders Summit are not generally reported through a health lens, although the decisions undertaken at the conference can have profound ramifications for health, at a local and global level.
For example, yesterday’s landmark agreement  between the US and China ,which included the announcement of further emission reduction goals, lends some hope to meaningful discussion regarding climate change and health at the summit.  The health impacts of climate change,  social and economic inequality and the TPP are just some of the concerns Croakey contributors would like to see discussed at the G20.
-----

Opinion: Lesson learnt from GFC is that prosperity doesn’t come from austerity

  • Paul Syvret
  • The Courier-Mail
  • November 15, 2014 12:00AM
AUSTRALIA received another reminder this week that the aftermath of the global financial crisis, which sparked the creation of the G20 in its current form, is still causing considerable economic pain.
Consultancy firm Macroeconomics in recent days released a review of the Australian Budget that concluded our deficit will blow out by a cumulative $52 billion over the next four years.
Treasurer Joe Hockey has conceded that since handing down the May Budget, conditions have deteriorated markedly, although he maintains the $52 billion figure is off the mark.
Macroeconomics sheets attribute some of the blame to “successive governments’ wasteful spending and tax cuts that frittered away the windfall gains from the mining boom”, as well as a raft of key Budget measures that remain blocked in the Senate.
-----

Ebloa.

Australia pledged Ebola workers three weeks before telling public, David Cameron reveals

Date November 14, 2014

Heath Aston

Political reporter

It was supposed to be a light-hearted aside in praise of the can-do approach of Foreign Affairs Minister Julie Bishop. But an anecdote by British Prime Minister David Cameron during his address to Parliament has inadvertently shed light on the Abbott government's much-criticised path to committing health workers to the Ebola crisis in West Africa.
The government offered to send doctors and nurses to Sierra Leone more than three weeks before informing the public.
During his speech, Mr Cameron recalled running into Ms Bishop at a summit in Italy.
"Only last month, your Foreign Minister strode across the room towards me … I wondered for a moment whether I was heading for what I'm told we now need to call a shirt-fronting," he said.
-----

GP Co-Payment.

11 November 2014, 6.30am AEDT

Medicare spending on general practice is value for money

LAuthors

Helena Britt

Christopher Harrison

Clare Bayram

Graeme Miller

Joan Henderson

Julie Gordon

Last year taxpayers spent A$6.3 billion on GP services through Medicare, about 6% of the total government health expenditure. This was a 50% increase (A$2.1 billion) in today’s dollars over the past decade and equates to about A$60 more per person in real terms.
Health Minister Peter Dutton says this growth is “unsustainable”. He plans to introduce a GP co-payment in hope of reducing the number of times Australians visit a GP and to ensure users foot some of the bill.
But targeting primary care for cost savings could backfire. Research we’re releasing today shows that while the number of GP visits has increased, the services are cost-effective. If the same services were performed in other areas of the health system, they would cost considerably more.
-----

Medicare co-payment: government accused of planning 'backdoor move'

Labor calls the changes a ‘tax on sick Australians’ and fears they will be pushed through by bypassing parliament
The government may be about to bypass parliament and push through the controversial Medicare co-payment scheme in a “sneaky backdoor move”, the opposition has claimed.
Labor has highlighted a message from the health department to medical practice software companies telling them to prepare to incorporate changes to accommodate the $7 payment.
The opposition says any move to impose “a tax on sick Australians” should be ruled out unless it is “put to the people”.
At the same time, the Abbott government is facing a budget crisis as the treasurer, Joe Hockey, warns of falling revenue combined with a Senate logjam on the Coalition’s budget cuts, leaving a bigger financial hole.
-----

Co-payment could raise health bill

Nov. 11, 2014, 5:05 p.m.
THOSE in need will be unable to afford essential medicines if proposed increases to the Pharmaceutical Benefits Scheme co-payment are introduced as planned in January. 
The Pharmacy Guild of Australia said previous increases in PBS costs or changes to the safety net had resulted in patients opting not to fill original or repeat prescriptions. 
The guild fears this could lead to a higher cost across the health system through a combination of increased demand for GPs and specialists as well as unnecessary hospital visits. 
-----

GP co-payment doubts

Andrew Tillett Canberra
November 12, 2014, 5:49 am
A new report has cast fresh doubt over the Abbott Government's proposed $7 co-payment for doctors' visits, finding GPs can deliver medical services more cheaply than other parts of the health system.
Sydney University's annual Bettering the Evaluation and Care of Health report found that Medicare cost $6.3 billion on GP services in 2013-14, which made up just 6 per cent of total government spending on health.
The report highlighted how the average cost per service at a GP clinic was $47, plus a $5 contribution from the patient.
But if the same service was performed in a hospital emergency department, the cost to taxpayers shot up to $599 in the case of WA.
-----

The $7 GP fee is headed for defeat in parliament but Federal Government tells medical software providers to prepare so doctors can charge it

  • Sue Dunlevy National Health Reporter
  • Herald Sun
  • November 12, 2014 9:00PM
FEARS the $7 GP fee could be implemented without parliamentary approval have been heightened with the government telling medical software companies to incorporate the fee in their products.
Health Minister Peter Dutton has previously refused to rule out bringing in the charge via regulation, bypassing parliament in the same way the government reintroduced indexation of petrol excise.
In an email to software providers on November 7, the Department of Human Services signals it is preparing apace for the introduction of the GP co-payment fee even though it hasn’t been considered by parliament.
“The Australian Government Department of Human Services (Human Services) anticipates implementing the Patient Contribution Budget Measure from 1 July 2015,” the email says.
-----

Govt has secret plan for co-payment: Labor

AAP
November 13, 2014, 9:15 am
Labor believes the federal government is planning to bypass a hostile Senate and introduce its controversial GP co-payment via the back door.
The opposition has seized on an email the Department of Human Services sent to software companies telling them to make changes to accommodate the $7 charge.
It claims that is proof the government will implement the measure without legislation, in defiance of parliament and public opinion.
The government recently used tariff regulations to reintroduce indexation of the fuel excise, a move that needs parliamentary approval within 12 months.
-----

MBS rebate cut to sneak in the back door?

13th Nov 2014
THE ALP believes the federal government is planning to bypass a hostile Senate and introduce its controversial GP co-payment via the back door.
The opposition has seized on an email the Department of Human Services sent to software companies telling them to make changes to accommodate the $7 charge.
It claims that it is proof the government will implement the measure without legislation, in defiance of parliament and public opinion.
The government recently used tariff regulations to reintroduce indexation of the fuel excise, a move that needs parliamentary approval within 12 months.
-----

Co-pay could trigger financial chaos for clinics

13 November, 2014 Paul Smith
GP software providers are privately warning of financial chaos across general practice should the Federal Government push ahead with its $7 co-payment reform.
The concerns centre on the millions of dollars that are meant to flow into GP clinics under a planned safety net that the government has claimed would protect vulnerable patients from large, out-of-pocket costs.
Under the proposed reform, due to start from July, rebates for all GP attendance items, pathology and radiology services will be cut by $5.
However, for concessional patients these items will be restored to their current levels once they have paid $7 gap fees for 10 services.
-----

Pharmacy Related Articles.

Chemists now on front line of health care

By Nicole Langdon

Nov. 10, 2014, midnight
PLUNKETTS Chemmart Pharmacy has joined a national push to step up the role of community pharmacies, easing the burden on our back pockets and on over-worked general practitioners (GPs).
Pharmacist Judy Plunkett described the campaign launched at Parliament House last week as a win-win for the community and the ailing national healthcare system.
In a lot of cases, she said, clinically-trained pharmacists can provide the same advice and assistance as GPs, free of charge, without an appointment or long waiting times at accident and emergency or a medical centre.
-----

Chemist Warehouse ads attract complaints

12 November, 2014 Chris Brooker
Questions have been asked in Federal Parliament regarding possible breaching of the advertising code by pharmacy chains.
Chemist Warehouse was mentioned by name in the Senate as the subject of complaints regarding ethical advertising.
The existence of possible investigations into pharmacy advertising was raised at a meeting of the Senate Economics Legislation Committee on 31 October.
-----

Pharmacy pay in the spotlight

14 November, 2014 Christie Moffat
The Pharmacy Guild of Australia and Professional Pharmacists Australia have met to discuss future changes to the Pharmacy Industry Award and penalty rates for pharmacy staff.
During the meeting, which took place earlier this week, the PPA presented 1235 pharmacist petition signatures that called for an increase in the base rates of the Pharmacy Industry Award, and the need to address low pay in community pharmacy.
Dr Geoff March, PPA president, said that the Guild had been invited to join its advocacy efforts to the Fair Work Commission to increase the base salary for employee pharmacists, as part of its four-yearly review of all employment Awards.
-----
Comment:
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. Maybe the next few weeks of parliament will clarify things this time but I doubt it. The Reps come back on Nov 14 for a British PM speech and the Senate in the following week. Both rise until the new year on Dec 4, 2014.
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, November 19, 2014

Position Paper - Clinical Results In The PCEHR. A Good Idea Or Not? - Draft For Comments.

This paper considers the place of holding diagnostic investigation information in the PCEHR. Before reviewing the proposition there are some assumptions which may or may not be true and need to be surfaced.
These include:
1. That there is a demonstrable benefit of holding diagnostic results in the PCEHR to be accessed by providers and consumers.
2. That diagnostic results can be safely and accurately displayed to relevant users.
3. That navigation and search for results, as well as trend information presentation, is much improved.
4. That overall the ease of use of the PCEHR is improved and that there is a commitment to ongoing support for continuing improvement of all aspects of the system.
5.  That all operational, security, information integrity and privacy issues can be resolved.
I will leave it to the reader to decide the their position on the truth of these claims.
Issues To Be Addressed.
Once and if it is decided it is reasonable, sensible, justifiable and beneficial to load results into the PCEHR the next issue to be considered is what is required of the process.
On the face of it the following are important:
1. The timing of result transmission to the PCEHR.
2. The mode of storage of the information.
3. The mode of presentation of the information is suitable for both professional and consumer use.
4. That there be at least some level of consumer decision to assist understanding (maybe a help line etc.)
5. Avoidance of consumer anxiety while making it easy for the sophisticated / experienced user to benefit from results.
I think it is arguable these issues can be addressed by adopting the following approach.
How Should It All Work?
On the assumption that it is generally agreed results information in the PCEHR is a good and worthy idea, and assuming that the contents of one’s PCEHR should be controlled by the individual, as the name of the PCEHR implies then it seems this has to be the way things happen.
1. Treating clinician decides on need for investigation.
2. Investigation ordered and patient asked if they want results uploaded to PCEHR when finalised, at this point the clinician can discuss with patient what they are looking for and what potential results might mean. (This can be a simple tick box, to approve upload, on the request form which the information provider then actions when results are finalised)
3. Patient says fine and results are uploaded - results come to clinician, are reviewed and if needed follow-up arranged.
4. Patient says no and results are not uploaded - results come to clinician, are reviewed and if needed follow-up arranged.
Why can’t it all be just this simple?
A poll finalised today made it clear readers also believe consent to upload of results should be obtained before it happens.
See here:
Of course there are some other approaches available - especially if the PCEHR is taken out of the equation or treated as the secondary system it is. Ideas like having the information provider provide access directly on authorised patient request or having a tick box which results in the results being sent to the patient on request might be considered.
There are all sorts of more radical things which might be possible, for example, the patient being given a digital key when the test is done and then being e-mailed an encrypted result when it is available.
Overall I believe that placing test results in the PCEHR is being pushed because the PCEHR exists and is looking for a reason for existence rather than because use of the PCEHR is the best way to provide patients with access to their results. Maybe some thinking outside the square might be useful.
David.

Tuesday, November 18, 2014

This Really Sounds Like, While They Are Not Saying It Yet, The Opt-Out PCEHR Is Coming.

This appeared today.

PCEHR pulls off a billion-dollar comeback

David Ramli
It has taken four years and over $1 billion but one of Australia’s biggest taxpayer-funded failures has almost been cured, according to the senior doctor leading the project.
The Personally Controlled Electronic Health Record (PCEHR) initiative is designed to be the foundation on which Australia’s future healthcare system will be built.
At its most basic it is designed to provide every Australian who wants it with a centralised medical record that can be accessed by doctors and hospitals across the nation, from general practitioners to emergency rooms.
National e-health transition authority (NEHTA) chairman and former president of the Australian Medical Association, Steve Hambleton, told The Australian Financial Review the project had been treading water for several months while the government considered its response to a review of the troubled project that was commissioned in November 2013.
But he also insisted the ­much-criticised project, which has burned through more than $1 billion since it was announced in 2010, has bounced back and is ready pending the belated government go-ahead.
The spokesman for Health Minister Peter Dutton said previous implementations were rushed and chaotic and that it was determined to take its time and not make the same mistakes.
Lots more here:
The article seems, from the headline, to be saying that ‘all is fixed’ but what we read is:
1. We are waiting for the Government to agree to  ‘opt-out’ i.e. everyone having a PCEHR record created unless they specifically tell the Government to go away.
2. The system is hardly being used (10,000 accesses a week from a 2 million person user base).
3. The doctors are not at all interested (if they have even heard of it) and we will need more marketing for docs and patients needed (Aspen Medical will love that!).
4. It is going to cost ‘a lot’ to implement.
5. There will be a fair few Liberal voters not at all happy with this sort of arrangement (Note: I am pretty sure some legislation will be needed)
On the same track I was asked today, from another source,  the following:
“I've been told that, in preparation for the "opt out" version  of the PCEHR/MYHR, all public health records are being batch downloaded by the DoH to the PCEHR that will become operational in 2015, without anyone's consent or knowledge.”
As the old saying goes there is seldom any smoke without a fire somewhere!
In parallel we have seen a push to upload non-consented diagnostic test results.
Additionally we have this:

Coming Soon: Invitation to Apply – Private Hospital PCEHR Rapid Implementation Programme

Created on Tuesday, 18 November 2014
With more than 260 public hospitals and health centres now connected to the personally controlled electronic health record (PCEHR) system, NEHTA will shortly be inviting private hospital organisations to apply for a funding contribution to support their integration to the system.
The Private Hospital PCEHR Rapid Integration Programme will assist successful applicants to deploy PCEHR viewing and/or clinical document upload capability. Look out for information soon on the Tender and Offers page of the NEHTA website.
The source is here:

So it seems NEHTA has some money to splash about on something that will not come to fruition if NEHTA and / or the PCEHR are to be gone.
 
If this is not all a concerted push by NEHTA and its new chair to both survive and thrive I will be very surprised.
Stand by to see the Abbott government add mightily to the Debt and Deficit Disaster on the basis of precisely zero evidence or evaluation.
 What do others think or know? It is hard to believe seeing all this at once is not suggesting that a major announcement is imminent.
David.

Monday, November 17, 2014

Weekly Australian Health IT Links – 17th November, 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

A very interesting week, but, as ever with very little out from the Government still on what is happening with the PCEHR and so on.
I am not sure there is a trend here but there does seem to be a lot more private sector e-Health activity than we have seen for a while.
Of course lobbing a probe on a comet is really just amazing as well. I do hope some sun shines on the probe soon so more work can happen at some point.
-----

eHealth and the missing links

10 November, 2014 Associate Professor Ivor Katz*
Telehealth is one of the great promises of the internet age. A system that allows patients throughout remote and rural Australia to attend virtual specialist appointments without leaving town.
All the essentials are there, including government cash and commitment, an expanding national broadband network and simple and affordable video-enabled devices.
So, by 2014 telehealth should be gaining traction. There should be a growing number of rural GPs and patients telling positive stories about their positive experience. It should be closing the geographical health gap. Telehealth should be saving lives, health dollars and time.
-----

Researchers, medical workers seek tech answers to Ebola outbreak

Sharon Gaudin (Computerworld (US)) on 08 November, 2014 06:40
WORCESTER, Mass. -- Researchers in robotics will meet with health care and aid workers around the country Friday to get ideas on how technology could help fight the deadly Ebola outbreak, as well as the spread of other dangerous viruses.
"When someone says robots, I'm old enough that this is what I see," said Catherine Brown, a veterinarian with the Massachusetts Bureau of Infectious Disease, looking at an image of R2-D2 and C-3PO from Star Wars during a session this morning at Worcester Polytechnic Institute. "I know this is not what robotics is really like, but I'm not sure what that is... You're always chasing the last outbreak. That's really unfair and it's a huge, huge problem for the countries involved. We're going to be talking about opportunities for the robotics community to engage with the public health and the medical community."
Led by WPI and Texas A&M University, the workshops are aimed at providing a forum for health care workers to discuss with technologists what they need to better care for Ebola patients, to help stop the spread of the virus and to protect care givers from contracting the disease.
-----

Telstra makes new e-health push

Telstra has forged deeper into the burgeoning e-health sector, snapping up a strategic stake in New Zealand’s Orion Health, which is scheduled to list on the Australian and NZ stock exchanges later this month.
The telco’s move into the Auckland-based company, which provides software to hospitals and clinics in more than 30 countries, reflects its strategy to become a leading player in the business as the medical industry gravitates from inefficient paper-based ­administration processes to an electronic patient records system.
Telstra declined to comment on the acquisition, however, it is understood an announcement on the move is imminent.
-----

Protecting the community through real-time prescription monitoring

Friday, 14 November 2014
A re-elected Coalition Government will develop a real-time prescription monitoring system to protect Victorian patients and their families, friends and loved ones from the tragic and often fatal consequences of prescription drug misuse.
  • $6.98 million investment over five years to link prescription records
  • Protecting the community from the impact of pharmaceutical abuse
  • Napthine Government building a healthier Victoria 
Minister for Health David Davis said the commitment reflected the Coalition Government’s concern about the number of deaths in Victoria resulting from pharmaceutical abuse.
-----

Victorian real-time monitoring commitment

14 November, 2014 Chris Brooker
The Victorian government has committed to introduce real-time prescription monitoring if it is re-elected at the upcoming state election.
The promise follows a call by state coroner Ian Gray for urgent action after real-time prescription monitoring recommended eight inquest findings since February 2012.
Health Minister David Davis says the government will invest $7 million over five years to institute real-time monitoring.
The move has been welcomed by Victorian pharmacists.
-----

Doctors ‘paternalistic’: CHF

10th Nov 2014
THE claim by a consumer group that electronic health records are under attack by “self-interested doctors” has been roundly dismissed by experts.
The row stems from the looming integration of pathology and diagnostic results into the personally controlled electronic health record (PCEHR) system, slated to begin 30 November, which could involve test results being automatically sent to patients.
In a statement last week, the Consumers Health Forum said the “full potential” of the PCEHR was being threatened by “self-interested doctors who wrongly claim they are putting patients’ interests first”.
GPs have warned of potentially dangerous consequences arising from the misinterpretation of results, a view CHF CEO Adam Stankevicius told MO was “paternalistic rubbish”.
-----

Ultranet's costly failure an education in politics and procurement

Date November 15, 2014 - 9:51AM

Richard Baker, Nick McKenzie and Ben Preiss

On Friday August 27, 2010, Victoria's then education minister Bronwyn Pike joined students at Hume Central Secondary College as they logged on to computers to chat live to 20 of their contemporaries 8000 kilometres away.
Days earlier, students from Glen Waverley and Balwyn secondary schools touched down in buzzing Shanghai with education department deputy secretary Darrell Fraser and a multimillion-dollar, life-sized classroom to show the world Victoria's "classroom of the future".
Thankfully for Pike and Fraser, the video link to China worked. Just two weeks earlier, the pair had been embarrassed by the shambolic debut of Labor's high-tech online schools learning system dubbed the Ultranet.
-----

America's Youngest Female Billionaire Explains How She's Transforming Medicine

Kevin Loria Nov 13, 2014, 10:17 AM
If you were to visit your doctor today, that doctor might send you to a lab to get a blood test. Then you’d go for a follow up exam, but if that blood test raised other questions, you might have to go get another vial drawn from your arm. Finally you’d return for a third doctor’s visit.
Three doctors visits and two trips to get blood drawn in a lab. That’s expensive and inefficient. Between 40 and 60% of people don’t even end up getting the lab tests their doctors ask them to, due to the cost, time involved, and perhaps a fear of needles, according to Elizabeth Holmes, who spoke at TEDMED in Sept.
Holmes wants to change that.
She is a Stanford dropout who founded a company called Theranos that’s trying to revolutionise the blood test. Instead of having to go to a lab to get blood drawn and then having the results interpreted by a doctor, Theranos has set up a system where people can walk into a Walgreens for an apparently painless fingerprick that draws a tiny drop of blood.
-----

2012 funds finally make it to Victorian hospitals

By admin Finance Nov 12, 2014
The Victorian Government has finally released the funds established in a $100 million e-health pool that was established in 2012, distributing it to hospitals and health services. Victorian Health Minister David Davis announced Monash Health as the big winner, with $40 million allocated for the institution to kick start its electronic records and electronic medication management system. For more on this system, see the latest edition of Transforming the Nation’s Healthcare.
Monash Health emerged as a big winner in the funding round, being given $40 million to start its implementation of integrated electronic medical records and an electronic medications management system.
-----

Online assistance to help mentally ill

By NATALIE KOTSIOS

Nov. 14, 2014, midnight
THE internet could be used more widely in treating rural people with mental health concerns, helping patients finally beat the tyranny of distance.
The prospect of e-health services was just one of many topics covered at the annual Rural and Remote Mental Health Symposium, held at the Commercial Club in Albury yesterday, and touched upon by guest speaker Senator Fiona Nash.
The Nationals senator for NSW and Assistant Health Minister said while physical, face-to-face services were sought as much as possible, online services could be a way for those with limited access to still get the help needed.
“I think people in rural areas realise there isn’t a heart surgeon on every corner, for example, but they do want and expect a reasonable level of access,” she said.
-----

Updated: Use Cases and Conformance Requirements for Healthcare Identifiers

Created on Monday, 10 November 2014
NEHTA has released an updated version of the use cases and conformance requirements for healthcare identifiers, to allow healthcare providers to request a verified Individual Healthcare Identifier (IHI) for a newborn child.
When a child is born in a hospital setting or other organisation that offers maternity services (e.g. Indigenous Health Services) a patient record is created for the child in the local clinical information system. The clinical information system can now access the Healthcare Identifiers (HI) Service to request a verified IHI to be created for the newborn child.
-----

Coleman: Health Informatics NZ Conference, Auckland

Tuesday, 11 November 2014, 4:56 pm
Hon Dr Jonathan Coleman
Minister of Health
11 November 2014
Speech to Health Informatics NZ Conference, Auckland
Thank you to Liz Schoff, HiNZ Board Chair, for the invitation to speak to you all today.
This conference has had a 30 percent increase in attendance since last year, which highlights the increasing importance of health informatics and the broader topic of eHealth.
It’s pleasing to see that Clinicians Challenge has attracted a record 79 entries. This shows clinicians recognise the importance of using technology to improve clinical practice and lift outcomes for patients.
As a doctor, I know the value of clinicians stepping into leadership roles to drive progress in our health system, with the patient at the centre of everything we do.
-----

Innovative eHealth idea wins $10,000

Wednesday, 12 November 2014, 9:35 am
Health Minister Jonathan Coleman has congratulated the winner of a challenge to find innovative IT ideas to improve health services.
“The Clinicians’ Challenge encourages health professionals to find ways technology can solve problems they face in their day-to-day practice and make a difference to the health of New Zealanders,” says Dr Coleman.
This year’s Clinicians’ Challenge has been won by Dr Tom Morton, an emergency physician at Nelson Marlborough DHB, who presented ‘Emergency Department at a Glance’, an information system that displays data for managing patients’ journey through an emergency department.
-----

Visage 7 Elevates Enterprise Imaging

November 11, 2014 15:08 ET| Source: Pro Medicus Ltd.
SAN DIEGO, Calif., Nov. 11, 2014 (GLOBE NEWSWIRE) -- via PRWEB - Visage Imaging Inc. ("Visage"), a wholly owned subsidiary of Pro Medicus Ltd. (ASX: PME), announced today that the latest release of the industry-leading Visage® 7 Enterprise Imaging Platform will be demonstrated at the 2014 Radiological Society of North America (RSNA) conference, November 30 - December 4, in Chicago, Illinois, at Visage Imaging Booth #4365, McCormick Place-South Building. Integration to Visage 7 will also be demonstrated at prominent vendor exhibits across the RSNA show floor reinforcing Visage's leadership role in best-of-breed, Deconstructed PACS SM. Visage has also announced the release of Visage Ease Pro for mobile diagnostic image and results access, available for users in Canada, Australia and the European Union (EU). Visage 7 enables enterprise imaging with amazingly fast, thin-client, server-side processing technology.
-----

Global Health MD Mathew Cherian discusses recurring revenue at Investor Forum

Friday, November 14, 2014 by Proactive Investors
Global Health's (ASX:GLH) managing director outlined to investors in Melbourne this week the company's revenue generating e-health software applications.
Currently 95% of GLH's revenue comes from healthcare clients, with software licences and recurring subscriptions between 70% to 80% of total revenue.
GLH's business model is to connect clinicians and consumers, through a combination of on-premises and cloud applications across healthcare segments.
-----

ResMed unveils the invisible sleep monitor

14/11/2014
By Jamie Hinks, CONTRIBUTOR
Sleep monitoring usually conjures up images of sensors placed all over the room or even in the bed making you think so much about the devices that you struggle to get off to sleep.
ResMed thinks it has the solution with its S+ system that it brags is the world’s first non-contact sleep system to come onto the market by using a wealth of data to give tips on how to sleep better.
S+ uses bio-motion sensors to measure the stages of sleep through breathing patterns and body movement, light, noise and temperature levels from within a room.
-----
Aconex, provider of a leading cloud collaboration platform for the global construction industry, has deployed its new Dynamic Manuals product for mobile asset information management at The Royal Melbourne Hospital (RMH), one of the world’s leading clinical hospitals. The hospital’s operations team uses the tablet-based, Windows 8-compatible solution to access and update its digital operation and maintenance (O&M) manuals on site.
-----

NBN Co takes a stand for common sense

NBN Co’s statement of the principles that will underlie its multi-technology rollout are statements of common sense in an area of policy blighted by absurdities.
There is nothing radical or surprising within the principles, given that they are directed by Turnbull’s desire (and that of NBN Co’s relatively new board and management) to deliver the NBN as quickly as practicable at the lowest cost to taxpayers.
They do, however, provide clarity as to what broadband technology consumers might expect to be connected to.
There are three key differences between the national fibre-to-the-premises network originally announced by Labor’s Stephen Conroy and Kevin Rudd.
-----

Fibre to the node becomes default NBN deployment

Summary: NBN Co has formally ended the plans to roll out fibre to the premises to 93 percent of Australian premises, mandating that fibre to the node should be the default technology choice.
By Josh Taylor | November 13, 2014 -- 04:37 GMT (15:37 AEST)
Australian homes and businesses not on the schedule to get fibre to the premises on the National Broadband Network (NBN) today will likely not get fibre to the premises (FttP) under the new plan from NBN Co.
Since the change of government in September 2013, NBN Co has moved from a 93 percent fibre-to-the-premises rollout, to be "agnostic" in its technology choice for the NBN, opting for a "multi-technology mix" where the most cost-effective technology for each area is determined when the company moved into that area and assessed the quality of the copper network to meet the government's minimum 25 megabits-per-second download speed guarantee. 
NBN Co CEO Bill Morrow had said that NBN Co would like to roll out more fibre to the premises than fibre to the node if cost savings could be found.
-----

Unions key to payroll success, says NSW Health

CLOSE collaboration with key union groups was one of the driving forces behind the success of an ambitious payroll systems upgrade for 40,000 employees at NSW Health.
NSW Health is in the final stages of a multi-year project to upgrade to a new version of Oracle’s payroll platform.
It has 3000 awards and 27 different types of customers -- making for a very complex environment, said NSW Health corporate IT director, e-health, Farhoud Salimi.
The payroll upgrade, part of Oracle’s e-business suite 12, has been implemented across core local health districts and health agencies to replace legacy systems.
-----

Microsoft Band review: Unlike any other wearable and uniquely yours

Summary: The Microsoft Band is a data collection machine and with the ability to select your tile interface, it can do as much or as little as you want it to.
By Matthew Miller for The Mobile Gadgeteer | November 13, 2014 -- 15:00 GMT (02:00 AEST)
Daily activity tracker, multi-platform smartwatch, GPS sport watch, heart rate monitor, and fitness coach. The Microsoft Band can be whatever you want and that is the real power of the Band.
I've now spent nearly two weeks with the Microsoft Band — read my first impressions — and it has secured a place on my wrist for the foreseeable future.
As a guy who covers the mobile space, I use smartphones running every mobile operating system; the Microsoft Band is currently the only wearable to work across Windows Phone, iOS, and Android. Come to think of it, I will have to test it with my BlackBerry Passport and the Android Microsoft Health app since my Pebble works through this approach.
-----

The 5 SMART stats that actually predict hard drive failure

Backblaze released data showing SMART stats are inconsistent from manufacturer to manufacturer and don't always indicate a failure.
Lucas Mearian (Computerworld (US)) on 13 November, 2014 05:29
Hard drive firmware that IT administrators use to monitor hard drive health is highly inconsistent from drive to drive and manufacturer to manufacturer, according to figures collected from nearly 40,000 spindles.
The data, released today from cloud service provider Backblaze, also indicated which five of the 70 metrics that SMART stats cover are likely to predict a hard drive failure.
SMART, or Self-Monitoring, Analysis, and Reporting Technology, is nearly ubiquitous firmware that vendors embed as tools to alert IT admins to impending problems.
-----

Probe lands on comet in historic first

  • AP
  • November 13, 2014 5:53AM

Rosetta spacecraft makes first-ever landing on comet

HUNDREDS of millions of kilometres from Earth, a European spacecraft has made history with a successful landing on the icy, dusty surface of a speeding comet — an audacious first designed to answer big questions about the universe.
Scientists at the European Space Agency control room in Darmstadt, Germany, cheered and applauded when the probe began sending signals from the comet after a walking pace descent of 20km through space.
The landing of the Philae probe on comet 67P/Churyumov-Gerasimenko required immense precision, as even the slightest error could have thrown the spacecraft far off course and imperilled the mission. In the end, the touchdown of the Philae lander appeared to be almost perfectly on target, said Paolo Ferri, head of mission operations for the European Space Agency.
-----
Enjoy!
David.

Sunday, November 16, 2014

Emerging Issues And Complexities Regarding The Commonwealth’s PCEHR System.

Prompted by the recent discussions in some quarters regarding the holding of laboratory and radiology results in the Federal PCEHR I thought it might be worthwhile to go back to basics and ask a basic elementary question.
The really key and crucial question might be “What was the PCEHR intended to do and achieve?”
This might be best answered by referring to the 2009 report developed by the National Health and Hospital Reform Commission and finalised in April 2009.
The document was entitled:
Person-controlled Electronic Health Records
The key messages were:
1. Health care is knowledge intensive. The timely and accurate communication of pertinent, up-to-date health details of an individual can enhance the quality, safety and continuity of health care.
2. Current health information systems are disjointed, which often results in health care professionals operating with incomplete or incorrect patient information. It is estimated that up to 18 per cent of medical errors are a result of inadequate availability of patient information.
3. As technology, work practices and medical knowledge continue to evolve in the coming years, the complexity of health care interactions will become greater, which means the need to document and readily access a patient’s health profile will become more critical.
4. A person-controlled electronic health record would enable people to take a more active role in managing their health and making informed health care decisions.
5. Investment in health IT lags well behind that of other information-centric consumer industries such as the financial and telecommunication industries, which have invested heavily over the last 20-30 years to achieve global connectivity.
6. According to recent research commissioned by the National Electronic Health Transition Authority (NEHTA), 82 per cent of consumers in Australia support the establishment of an electronic health record (EHR).
7. The implementation and widespread use of information technology in the health sector (e-health) is one of the most important enablers of personal health management and quality health care.
8. The overall economic benefit from increased productivity and reduced adverse events that would be achieved with a national individual electronic health record in Australia has been estimated to be between $6.7 billion and $7.9 billion in 2008-09 dollars over 10 years.
9. The protection of privacy and confidentiality is a key factor in winning widespread community acceptance and uptake of electronic health records.
10. Health providers and the IT industry must work together to develop open, nationally-agreed standards for the secure electronic capture and storage of personal health information.
11. The essential role of governments in a new e-health environment is to protect the public’s interest through legislative reform and ensuring people retain control over who has access to their personal health information.
----- End Extract.
Viewed from the vantage point of some five and a half years later it seems what was being proposed in the other 18 pages of the document were a mixture of over-ambition, misunderstanding and naiveté regarding the complexity of the health sector and health information technology.
What strikes one most forcefully in all this is the apparent lack of impact of the PCEHR System and a seemingly wilful lack of keenness to make assessments of the system success, despite the fact such evaluation was planned. While there is information on numbers enrolled and records automatically updated there are no actual usage statistics by consumers or clinicians in terms of clinical records actually access etc.
One question that comes up out of this, as mentioned above,  is around just what the PCEHR was intended to do? On the basis of the extract above what was originally hoped for was:
1. Improved patient engagement in their healthcare.
2. Improved speed and accuracy of the communication of health information.
3. Improved quality and safety of care.
4. Improved co-ordination of care delivery.
5. Savings for the Health Budget.
After 5.5 years, and a $1.0 Billion expenditure, if these were the objectives it would seem the evidence for success, so far, is pretty limited.
Can we form a view yet or is it too early to tell? If the claim is that it is too early to tell then surely there should be clear performance hurdles, and a defined budget, before more is spent? Otherwise we just have a very dark black hole in front of us!
Additionally we need to be clear that the stated objective of a personally controlled record has rather drifted with such a deluge of largely useless information being fed  into the record (MBS of tests and bills etc.) not under any apparent sort of consumer control! Once you have a record all this just seems to arrive. (I wonder did I consent to all this when the PCEHR stated 2.5 years ago - don't remember) Interestingly the PCEHR does not appear to have changed much in the roughly 12 months since I last logged in. The user interface is just as awful as ever.
Was a dog an age ago and still looks to be.
David.

AusHealthIT Poll Number 244 – Results – 16th November, 2014.

Here are the results of the poll.

Should Patients Be Asked To Consent To The Uploading Of Their Investigative Results To The PCEHR Before It Happens?

For Sure 73% (145)

Probably 16% (31)

Neutral 2% (3)

Probably Not 4% (8)

No Way 5% (10)

I Have No Idea 1% (1)

Total votes: 198

A very clear response with a big majority seeing consent as crucial before results are sent to a PCEHR.

Good to see such a clear outcome and lots of votes.

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

David.