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, February 26, 2015

Review Of The Ongoing Post - Budget Controversy 26th February 2015. Now We Are Working On The 2016 One!

Budget Night was on Tuesday 13th May, 2014 and it is still not finalised by any means.
Both major health and education changes as well as pension changes are still stuck and it seems we have only 4 sitting weeks in Parliament before the next Budget..
Thus with the 2014 Budget still not passed we are seeing submissions regarding the 2015 Budget.
As early warning it looks like the 2016 Budget is handed down Tuesday 12th , May 2015.
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Other articles this week.

General Budget Issues.

Is Australia spending over $100m a day more than collected in revenue?

By Expert Panel | 16.02.2015
By Miranda Stewart, Australian National University
“At the moment, we are spending over $100 million a day more than we’re collecting in revenue. Now that’s unsustainable, particularly given we’re spending nearly $40 million a day on the interest on the debt that we have.” – Treasurer Joe Hockey, interview with Alison Carabine on RN Breakfast, February 3, 2015.
Mr Hockey has made similar statements in multiple interviews to support the government’s position that cuts to spending are needed to reduce the deficit.
To get $100 million of “overspending” a day, the Treasurer has relied on the Commonwealth Government fiscal balance recorded in the Mid Year Economic and Fiscal Outlook statement (MYEFO). The MYEFO, released in December mid-way through our financial year, updates the figures from the May Budget – including the deficit.
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Australian economy ‘sliding down the precipice’

Stephen Cauchi
The Australian economy is "sliding down the precipice" due to "glacial" reform efforts, with a weakness in domestic demand that was "recession-like", according to a research note from JP Morgan.
JP Morgan analyst Stephen Walters argued in the note that Australia was failing to make up the lag created by the plunge in mining investment.
Furthermore, the Reserve Bank was trying to mask the economy's structural weakness with monetary stimulus, he said.
"We knew for some time a plunge of mining investment in Australia was fast approaching," said Mr Walters. "The economy now is sliding down the precipice pretty much at the pace expected, as the sector moves from expansion to production."
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Expensive homes could reduce age pension payments

Phillip Coorey Chief political correspondent
The federal government is canvassing the prospect of including the family home in the pension assets test as it strives to keep the retirement system sustainable over coming decades.
Social Services Minister Scott Morrison has discussed the issue in talks with peak seniors groups in recent weeks, while Kelly O'Dwyer, the parliamentary secretary to the Treasurer, said on Monday the matter will "almost certainly" need to be debated following the release of the intergenerational report within weeks.
A taskforce has also been established within Treasury to look at retirement incomes.
The two seniors groups, National Seniors Australia and Council on the Ageing (COTA) Australia, are both amenable to putting the issue on the table, with conditions, which include that other sectors of the economy are prevailed upon to help balance the budget.
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Superannuation tax concessions are valuable, if inflammatory political territory for Treasurer Joe Hockey

Date February 17, 2015 - 12:00AM

Peter Martin

Australia needs a big, untapped revenue stream to balance its books, and superannuation ticks all the boxes.
Joe Hockey may have just let the cat out of the bag.
The Treasurer has an awful problem. Government revenue is falling well short of expectations and is about to slide further. Since his May budget, the iron ore price has slid 40 per cent. The oil price, which sets the price of exported gas, has slid 50 per cent. The lower dollar will not come close to offsetting the hits to export income and tax revenue. They are yet to reach the budget.
The really big dollars have to be found where the government hands out money and where the government forgoes money by handing out tax concessions. The really big dollars are in superannuation. 
Already, as Hockey puts it, "the government is spending $100 million more than it collects every day. It has to borrow that $100 million per day just to pay its bills".
The $100 million figure comes from dividing the forecast budget deficit by the number of days in a year. It's accurate, and unless Hockey comes up with something clever it's about to grow.
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Hockey faces gloomy backdrop for budget

By Colin Brinsden, AAP Economics Correspondent
February 18, 2015, 4:27 pm
Joe Hockey will be putting his second May budget together against the backdrop of a still sluggish economy.
The latest Westpac-Melbourne Institute leading index continues to signal an economy growing at 2.75 per cent over much of 2015 rather than a trend pace of 3.25 per cent.
It suggests the jobless rate could be still rising at a time when the federal treasurer is trying to get the budget back in order.
"The economy needs more stimulus and the Reserve Bank, with ample scope to cut, should be acting accordingly," Westpac chief economist Bill Evans says.
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Business ignores Hockey warnings

Shane Wright Economics Editor
February 16, 2015, 12:50 am
Business is ignoring Treasurer Joe Hockey’s warnings about the Budget, calling for tax cuts to help them navigate tough economic times.
Budget submissions from lobby groups all effectively argue for less tax and more spending in their areas of need.
This year’s Budget already faces a deficit blowout which, in December, was forecast to reach $31.2 billion after initially predicted to edge down to $17.1 billion.
But a sharp fall in commodity prices, a lift in unemployment and slower than expected wages growth have punched a hole in Government revenues.
Those declining revenues have not stopped business groups looking for assistance. The Australian Industry Group wants a 1.5 per cent cut in company tax for all businesses. So far the Government has only committed to giving it to small firms.
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Both sides of politics falter in fairness test

Paul Kelly

FAIRNESS as a political idea relating to moral obligations by government has been integral to the near destruction of the Abbott government — yet Australia’s so-called fairness debate has been weak, populist and deceptive.
Neither side of politics satisfactorily meets the fairness test. The Abbott government last year misjudged fairness as a public issue and brought down a budget far too unfair in its redistributive impact.
At the same time the Shorten opposition turned fairness into a populist drumbeat, attacking many budget measures and arguing the budget was unfair because of the hurt it imposed — on pensioners, patients, motorists and students.
The start point is the recognition that Australia has one of the most progressive or fairest tax-transfer systems among OECD nations. This was highlighted this week by the parliamentary secretary to the Treasurer, Kelly O’Dwyer, who provided statistics on personal income tax.
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Strained budget risks AAA rating

Standard & Poor's Ratings Services has backed warnings by Australia's central bank that the federal budget would be vulnerable to a global economic shock, which could put the country's AAA rating at risk.
Australia's budget outlook has weakened sharply in the last six months as commodity prices have plunged, said S&P's sovereign analyst Craig Michaels.
Sliding prices of coal and iron ore, the country's biggest export, are hurting economic growth, denting corporate profits, driving higher unemployment and eroding government tax receipts.
Goldman Sachs recently calculated that Australia could lose $500 billion in national income in the next decade because of the drop in commodity prices, which includes a 50% drop in iron ore.
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Nick Greiner tells Tony Abbott: break super promise to avoid 'train wreck'

Nick Greiner says if the budget stand-off is not resolved, the country will grind towards a 'train wreck.' Fairfax Media Australia -
Andrew Clark
Prime Minister Tony Abbott must bring the states and federal opposition together in a "grand compromise" to end the budget stand-off or risk the country grinding slowly towards a "train wreck", says former NSW Premier Nick Greiner.
Mr Greiner, who was premier of NSW from 1988-93 and is close to so-far-unannounced federal Liberal Party leadership aspirant Malcolm Turnbull, says there's "an imperative and a need to do something" and that the government should break its promise not to change superannuation this term by reversing the overly generous Howard-era superannuation tax concessions.
He sees the current, more contested, political situation – including the leadership tensions – as an opportunity. "The situation is better now that the states are 3-all (Liberal and Labor). That's an opportunity, not a problem, because if it was all Liberal or all Labor, including the federal government, all that means is that whoever is not in government they just don't buy into it."
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Political Instability.

Good government starts today ... er, maybe tomorrow

Date February 15, 2015 - 11:24AM

Jacqueline Maley

"Good government starts today," Prime Minister Tony Abbott declared after Monday's spill motion, which was defeated by a self-esteem damaging 61 votes to 39.
This pronouncement, designed to reset the government as though it was a dicky watch, or a digital Tamagotchi pet which had accidentally been left to die, was itself declared an own goal.
If good government was only to commence now, what had the previous 18 months been? Performance art?
Since then, Abbott/Australia have had a week's worth of good government in which to bask. How have we fared?
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Scary Joe Hockey has cried wolf too often

Date February 20, 2015 - 4:00PM

Michael Pascoe

BusinessDay contributing editor

In a volatile and uncertain world, Joe Hockey had a hot tip for Australians this week: sit on the floor.
That's because he promised that Treasury's looming inter-generational report will make Australians "fall off their chairs".
And so the Treasurer was back in character as "Scary Joe", ready to star in a horror movie cut of the intergenerational report.
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Fairness debate gets traction

THIS week the case for budget repair shifted into new territory. The ABC is finally on board, recognising fiscal consolidation is required as a matter of urgency. The Abbott government, too, is adjusting its strategy, timing and messaging, having blundered its way since winning office. The imminent release of the Intergenerational Report must be used by Joe Hockey to propel the argument, reinforcing the powerful contributions from our top two economic bureaucrats, the Reserve Bank’s Glenn Stevens and new Treasury secretary John Fraser. Their warning is unequivocal. Australia is poorly placed to deal with the next shock the world throws at us.
Fixing the structure of the budget, especially the spending side, is not a new cause for this newspaper. For the past decade we have argued, often as a lone media voice, that the historic gift of a spike in our terms of trade needed to be carefully managed; that the revenue bonanza should go into a sovereign wealth fund; and that we should not build into the budget’s framework spending that could not be sustained when export prices returned to normal. We documented the excesses of John Howard’s handout culture and the unbridled waste of taxpayer funds after the global financial crisis by Labor under Kevin Rudd and Julia Gillard. As a result of this folly, government debt is headed for $667 billion over a decade if nothing is done.
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Does the PM have a political death-wish?

  • Samantha Maiden
  • The Sunday Telegraph
  • February 21, 2015 12:09PM
IT was the leak that rocked the 2010 election, claims that Julia Gillard had opposed an increase to the age pension.
According to Channel Nine’s Laurie Oakes, the woman who ousted Kevin Rudd as Prime Minister was sceptical, telling the budget razor gang that “elderly voters did not support Labor”. The sabotage campaign was later cited in an internal ALP review as not only devastating internally but highly damaging to Labor’s electoral chances.
For Tony Abbott, it was time to pounce on another juicy leak from the divided ranks of the Labor Party.
“There is some terrible malaise at the heart of this Government when you’ve got this kind of leaking going on,’’ Mr Abbott said at the time.
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Health Budget Issues.

For real health reform, turn the spotlight on specialists’ fees

Michelle Hughes | Feb 18, 2015 11:04AM | EMAIL | PRINT
With thanks to The Conversation for allowing us to cross publish this piece by Lesley Russell.
The impact of specialist fees on government and patient budgets has received little reform attention. This is despite the government’s push for controls in health-care spending and growing evidence of the affordability problems faced by sick Australians.
A high-quality specialist sector is an essential component of an effective health-care system; patients rely on specialist doctors when they are sickest and most vulnerable. And when their treatment inevitably involves expensive treatment options. But specialist care in the community is increasingly hard for many Australians to access, due to geography and cost.
In 2011-12, the number of people who reported seeing a medical specialist in the preceding year varied nearly two-fold across Medicare Local populations nationally, from 22% to 42%. But there was no strong association between health status and seeing a specialist. And up to 14% of people reported they had delayed seeing a specialist because of cost.
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Ideology and good health policy do not mix

Date February 18, 2015 - 5:00PM

Brian Owler

 The NSW Nurses and Midwives' Association has invented a fictional scenario to push a dangerous health policy.
Claiming that the Baird government is introducing United States-style privatised managed care by stealth in order to promote walk-in clinics, where nurses would do the work normally undertaken by highly-trained doctors, is drawing a very long bow.
General practice is at the core of the sustainability of our healthcare system. 
The proposal is bad health policy. Unfortunately, the NSW Labor opposition has embraced it.
The evidence is clear – quality primary care is best delivered by teams led by doctors.
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Pay doctors more but only when they provide the right care say health funds

  • 11 hours ago February 19, 2015 12:00AM
  • Sue Dunlevy National Health Reporter
  •  News Corp Australia Network
EXCLUSIVE
Doctors would be paid 30 per cent more by Medicare and health funds but only when they provided quality care under a controversial plan being pushed by private health insurers.
Private Healthcare Australia chief Dr Michael Armitage has presented a plan to the government that shows taxpayers could save billions if Medicare and health funds pay for evidence based care in line with clinical guidelines.
It comes as health funds are poised to this month win approval for a premium rise worth over 6 per cent or three times the inflation rate.
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Medicare system is sicker than the patients

  • Simon Benson
  • The Daily Telegraph
  • February 20, 2015 12:00AM
THE government this week ­released analysis that ­revealed why Medicare is in trouble, yet it has come a year too late to have any policy impact.
Like Labor’s failure to make the case for the mining tax, the Abbott government stuffed up Medicare ­reform by unveiling the cure before alerting people to the presence of disease.
But that doesn’t mean the problem will go away. If anything, it will get worse.
If the headline figures are to be taken at face value, people in Sydney are among the sickest in the western world.
On average, they are now going to the doctor 16 times a year each. That’s right: Once every three weeks.
Health Minister Sussan Ley released the research while ­visiting doctors in Western Sydney. It showed the value of Medicare claims in NSW had more than doubled in the past decade to more than $6 billion a year. The actual number of Medicare-accessed services — most being visits to the GP — had ­increased by 52 per cent in 10 years. There are now around 120 million visits to the doctor a year in NSW alone, with the number growing more than four times higher than the rate of the population.
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Sussan Ley’s next big challenge

CLAMBERING into the rickety cabin of a single-engine Cessna where new Health Minister Sussan Ley sits at the controls flicking switches and checking dials, my butterflies flutter disconcertingly.
“I’ve got my good-luck scarf,” she jokes of a blue and mauve patterned neck tie worn the day she won Liberal pre-selection for the south-western NSW National Party stronghold of Farrer in 2001. She wriggles free from her black ankle boots for the comfort of socks that have sprung a hole where her big toe with its bright red nail pokes through. “Clear prop” she sings out over her shoulder with the unflappable spirit of a squadron pilot from the Biggles paperbacks that fired her childhood thirst for adventure. She gives me a headset to muffle the roar as we rocket down the runway of Albury’s airport, lifting into a clear blue sky above the political dust storm threatening to bury Prime Minister Tony Abbott.
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Medicare Co-payment Issues.

Axe for Medicare co-payment

Sid Maher

EXPECTATIONS are growing that Tony Abbott will dump the Medicare co-payment as he moves to reset the health debate and win support for his looming families package.
Coalition MPs told The Aus­tralian yesterday they expect the Medicare co-payment will be dropped amid continued opposition from medical groups.
Health Minister Sussan Ley is continuing to consult with the medical profession but The Australian understands she has been told by key groups they will not support the policy.
Under the policy, the Medicare payment to doctors will be cut by $5, but the government will make it possible for doctors to charge a contribution from patients to ­recoup the $5.
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Fee rise backed if GPs keep the cash

Sarah Martin

DOCTORS support charging some bulk-billed patients more for consultations, as long as the “modest” extra fee is kept by GPs to improve services.
Royal Australian College of General Practitioners president Frank Jones said the proposal, which was put to federal Health Minister Sussan Ley in meetings last week, would let the government send a price signal to patients while not penalising doctors.
The government has argued that a price signal is needed to ensure that those who are able to ­afford to pay for doctor visits are charged accordingly. Its first ­option of a $7 co-payment announced in last year’s budget was replaced with a $5 cut to the rebate in December.
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Bulk billing: Federal Health Minister Sussan Ley won't guarantee savings will go into medical research fund

By political reporter Eliza Borrello
February 18, 2015, 6:50 am
Federal Health Minister Sussan Ley says she will not guarantee savings from the Government's new bulk billing plan will go towards a medical research future fund.
The federal budget revealed the Government's plan to charge bulk billed patients $7 to see a doctor and put the proceeds in a new medical research fund.
But in December the policy could not pass through the Senate and was dumped in favour of a $5 payment charged at a doctor's discretion.
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Health Minister Sussan Ley hints $20 billion Medical Research Future Fund might not go ahead

  • 37 minutes ago February 18, 2015 11:17AM
  • MALCOLM FARR National Political Editor
  • news.com.au
REMEMBER the Budget that was going to cure cancer? Well the Government’s quest for a miracle medical breakthrough now looks decidedly ill.
Health Minister Susan Ley today said she could not guarantee the $20 billion Medical Research Future Fund — designed to look for cures for a range of illnesses — would go ahead as planned.
“I’m not going to guarantee something that relates to a consultation that I haven’t completed ... that would be duplicitous of me,” Ms Ley told ABC radio.
“The Medical Research Future Fund has money coming into it now and it’s not dependent on one particular policy.”
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'It really is a zombie idea': English health chief slams GP co-payment

Date: February 19, 2015 - 2:57PM

Amy Corderoy

Charging people upfront fees for healthcare is an ideological "zombie idea" that leads to higher costs and worse health outcomes yet is repeatedly brought back to life, the long-serving former head of England's National Health Service says.
David Nicholson, who served as chief executive of the English health system between 2006 and 2013, under both Labour and Conservative governments, said there was clear evidence that charging copayments for GP visits is an ineffective measure for reducing health costs.
The federal government is currently consulting on ways to reduce the number of people receiving bulk-billed treatment from GPs with no upfront costs, after two earlier attempts proved politically unpopular. Health Minister Sussan Ley told Fairfax Media "doing nothing was not an option", as the number of Medicare services provided in Australia had increased by 57 per cent since 2003.
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Health Minister clarifies earlier suggestion of new multi-tiered co-payment system for GP visits

Alexandra Kirk reported this story on Wednesday, February 18, 2015 18:11:00
MARK COLVIN: The Federal Health Minister Sussan Ley has tried to clarify comments earlier today that appeared to raise the prospect of a new multi-tiered co-payment system for doctor visits.
The Minister said she was aiming for agreement on a way to ask patients to pay something if they could afford to, with those on high incomes asked to pay more, but she didn't explain how that could be done.
The Minister now says she was reflecting on what already happens in general practice.
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Co-payment need not be a dirty word in restructuring healthcare

THE healthcare system is at a crossroads. The system we set up in July 1975 when Medibank officially began almost 40 years ago no longer meets our needs. But when we consider the population in 1975 was 13.9 million as opposed to the 23.7 million we are today then this should be no surprise.
Treasury’s first Intergenerational Report in 2007 forecast government expenditure on health was projected to increase as a ­proportion of gross domestic product from 3.5 per cent in 2006-07 to 7.3 per cent in 2046-47, with about a quarter of these increased costs coming from an ageing population.
Treasury’s 2010 Intergenerational Report identifies several drivers of the expected rise to extend beyond just an ageing population to include population growth, demographic pressures, demand for higher standards of care, as well as rapid technological innovation.
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No payments, copayments and faux payments

Michelle Hughes | Feb 18, 2015 1:54PM | EMAIL | PRINT
Many thanks to Margaret Faux for this précis of an article published in the Internal Medicine Journal on 4 February 2015 No payments, copayments and faux payments: are medical practitioners adequately equipped to manage Medicare claiming and compliance?
Margaret Faux writes:
In an article recently published in the Internal Medicine Journal, my co-authors and I have summarised a selection of available literature concerning medical practitioners’ understanding of Medicare claiming and compliance.
The seed of the paper originated in a systematic review of literature in this area which found that despite much commentary and opinion, little if any empirical research exists on this topic.
We examined the complexity of day-to-day Medicare claiming, which has become labyrinthine to the point where it is beyond the comprehension of many, including medical practitioners who are largely dependent on Medicare for their livelihoods. The literature proffers that between $1-3 billion is leaked from Medicare each year as a result of inappropriate claiming (approximately 5-15% of total Medicare expenditure), yet no research has ever sought to critically analyse the potential causes of this phenomenon beyond suggestions of deliberate misuse of the system by rogue clinicians.
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Comment:
I also have to say reading all the articles I still have no idea what is actually going to happen with the 2015 (or the 2016) Budget (or the Government) at the end of the day.
One wonders for how much longer this will go on and just what impact a change of leader might have?
Enjoy.
David.

Wednesday, February 25, 2015

Senate Estimates Have Just Totally Ignored E-Health - Not A Peep As Of 6:50pm! - Updated 8.15pm

Hopeless!

David.

Late Update. Sen Di Natale asked some e-health questions 3 hours late.

All of them were parried saying Government still had no clue what it was doing and what was happening.

D.

The Australian Healthcare And Hospitals Association Submission On The Upcoming Budget. A Little Gentle On E-Health I Believe.

This was released a few days ago:
The section on E-Health is on page 7 of the 8 page submission:

Commonwealth Leadership on System Integration

The AHHA acknowledges the Commonwealth Government’s continued support for the national implementation of ehealth tools and resources as holding immense potential to support high quality and consistent care, as well as supporting a number of efficiencies and reduction of waste.
The benefit and value of the use of standardised use of electronic health records are well documented: better information sharing and communication between healthcare providers and between patient and provider; reduced duplication or over servicing; more efficient and more appropriate treatment; responds to needs of both clinicians and consumers by being portable and transferrable.
Electronic health resources also stand to better support prescribing and referrals for tests and other procedures and would align with other efforts to reduce inappropriate or unnecessary testing and medication prescription.
Greater use and entrenchment of personal electronic health records would:

  • Further integrate and support appropriate care regardless of the point of access in the system.
  • Provide a greater focus on a digital healthcare system would also support better performance reporting
  • Enhance the capability to allow for performance reporting in real time and across a community through linked data collected and analysis to support quality service provision, achievement of health outcomes and responsiveness in delivery programs and services that meet identified needs.
  •  Allow for information sharing across health services, both public and private, enabling governments and other funders to identify better utilisation of resources for health.

The establishment of Primary Health Networks provides the opportunity for strong Commonwealth leadership to establish primary health care as the cornerstone of a responsive and strong health system.
It is vitally important that Primary Health Networks are provided with adequate long term funding and supports to establish themselves and adapt to the needs of their communities. Insufficient and uncoordinated primary care services inevitably lead to increased demand on acute hospitals through outpatient clinics, emergency departments and hospital admissions. Funding arrangements should reflect the nature of community needs and should allow for facilitating the right care in the most appropriate environment and supporting unnecessary hospital admissions and presentations.
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I have to say what worries me about all this is the lack of any comment on the lack of clarity about the future funding and purpose, the lack of comment regarding the lack of evaluation of what has been done to date and a distinct sense of the submission being a triumph of hope over experience in the last decade or so.
The AHHA could afford to push a little harder for more concrete outcomes and evaluation!
David.

E-Health At Senate Estimates - On Today - Scheduled For 4.55pm 25 Feb, 2015

Here is the planned programme for the day.

http://www.aph.gov.au/~/media/02%20Parliamentary%20Business/25%20Senate%20Estimates/add1415/ca.pdf

Here is the link to watch live:

http://www.aph.gov.au/News_and_Events/Watch_Parliament

Go to Community Affairs Committee.

Enjoy!

David.

Tuesday, February 24, 2015

It Is Interesting To See What Is Happening With A State Wide EHR in Alberta. Talk About A Slow Burn.

This web site was pointed out to me last week:
Here is the description from the home page:

Welcome to Alberta Netcare

Alberta Netcare is the name for all the projects related to the provincial Electronic Health Record (EHR) — a secure and confidential electronic system of Alberta patients' health information.
This website has resources for the Alberta public, Alberta health care providers, and people outside of Alberta who are interested in learning more about this innovative initiative. Please read the section below "How to Use this Website" to find information that will be most relevant to you.”
The web site is interestingly dated 1995-2015. So this has been underway for 20 years or so.
Before going further some basics.
Alberta is a province of Canada with a population of a little over 4 million.
Here is some background to the Health System from Wikipedia:

“Health care

Alberta provides a publicly funded health care system, Alberta Health Services, for all its residents as set out by the provisions of the Canada Health Act of 1984. Alberta became Canada's second province (after Saskatchewan) to adopt a Tommy Douglas–style program in 1950, a precursor to the modern medicare system. Alberta's research institutions and hospitals give AHS the title of third-best-run hospital centres in the world for Edmonton and Calgary, and fourth-best research institution, referring to the University of Alberta's health campus.[92]
Alberta's health-care budget was $171.9 billion during the 2013–2014 fiscal year (approximately 45% of all government spending), making it the best funded health care system per-capita in Canada. [93] Every hour more than $1.9 million was spent on health care in the province in 2013. In 2014 this went up to $2.4 million an hour, totalling $210 billion when both private donations and government spending are accounted for.[94] Per person in Alberta, $51,220 was spent on in the health-care sector.”
This figure is to be compared with Australia where the total expenditure (Govt. and Private) according to the AIHW is $A147 Billion per annum for about 24 million people- so they are big spenders!
For the EHR we have this description:

Alberta Netcare: Created in Alberta for Alberta Health Professionals

How does the EHR work?

The EHR is not a single database, but rather a network of data repositories and information systems. Each has an important function and together they form the provincial EHR.
Clinical data is collected through point-of-service systems (in hospitals, laboratories, testing facilities, pharmacies, and clinics), and is sent through secure messaging to the provincial repositories and information systems. When a health professional logs on to the EHR through the Alberta Netcare Portal, and searches for a patient record, the portal retrieves all of the available information from the provincial systems and presents it as a unified patient record.”
The current status page is very interesting.

Current Status: When Will Alberta Netcare be Complete?

Drug Domain: near complete

Approximately 95% of the expected drug dispenses from community pharmacies are successfully entered into the EHR. 96% of Alberta's community pharamacies are actively submitting their dispense data. 
Currently health professionals view medication profiles through the Alberta Netcare Portal viewer. Two projects are underway to deliver medication information directly to local systems, which will eliminate the need for health professionals to open the Alberta Netcare Portal to view the information. Read more about System to System for EMR and System to System for Pharmacy.
The next major development for this domain will be to introduce electronic prescribing or e-Prescribe, which will see community physicians entering a prescription into the EHR, and pharmacies dispensing against that prescription. This e-prescribe function will be piloted in late 2013.

Laboratory Domain: near complete

Approximately 99% of all public and private laboratory facilities are submitting information to the EHR. Currently, Alberta Netcare is working on a Laboratory Information System Standards and Terminology Adoption project, which will standardize the transmission of data to the EHR, and will improve the quality and reliability of laboratory data.

Diagnostic Imaging Domain: near complete

The Diagnostic Imaging project (involving X-rays, ultrasounds) achieved a 100% filmless environment for all hospitals in Alberta in 2009. These images were made available province-wide through the implementation of a Provincial Image Viewer in June 2011. In 2013d Alberta Health Services completed the selection and implementation of a provincial voice recognition system and a provincial diagnostic imaging 3D reconstruction application. Approximately 92% of diagnostic imaging facilities are providing information to the provincial EHR. Read more about Diagnostic Images in the EHR.

http://www.albertanetcare.ca/images/Switch-Arrow-close.gifShared Health Record: underway

The Shared Health Record will introduce additional information to the EHR, such as patient encounters and immunization records from community sites. The Shared Health Record will also allow two-way communication between physician offices and the EHR, enabling clinicians to download EHR information to update their local systems. Read more about the Shared Health Record.

Physician Office Automation: underway

Automation of primary care physician offices is a key component of a complete provincial EHR. Currently, 77% of eligible physicians are being funded to adopt Electronic Medical Record systems, which will allow them to fully participate in the EHR.

Personal Health Portal: underway

In May 2011, a website was launched to provide a source of trusted health information and health management tools. As it evolves, a personal health record function will be introduced, allowing Albertans to create their own secure online health records. These personal health records will be enhanced to receive information from the provincial EHR. Read more about MyHealth.Alberta.ca.
The EHR is a dynamic network of systems, each designed to collect and contribute information from the various health system domains. The EHR is constantly evolving in response to the changing needs of the health system, and drawing upon new technologies as they emerge.
Since the EHR is made up of a number of systems, the status or the "level of completeness" of the EHR is expressed in relation to each domain. Alberta Netcare has made excellent progress in the drug, laboratory and diagnostic imaging domains, with content and functionality near completion. The EHR will continue to implement enhancements to improve patient care, however, it is expected that the majority of required functionality will be complete by 2020.
----- End Extract.
Further browsing revealed that only clinicians can access the portal based record - and can’t access their own record - and if the individual want to know what the record contains they can request a printout!
Also all records are derived automatically from the various services in Alberta picking up data from pharmacies, labs and radiologists.
This system looks to be the absolute opposite of the PCEHR - with no personal control or electronic access to the EHR that the doctor can access!
Well worth a browse around the whole site. Does anyone know of any published evaluations of clinical effectiveness?
David.

Monday, February 23, 2015

Weekly Australian Health IT Links – 23rd February, 2015.

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 big news this week is the change of the CEO at Telstra with David Thodey being replaced by Andy Penn. What will be interesting will be to see if emphasis remains on e-Health remains.
The other big news is the schism that has occurred between HL7 and Standards Australia. What a mess.
Otherwise a very quiet week with still with no news from the new Health Minister on the PCEHR.
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New Telstra chief Andy Penn has a challenge in taking investors along for the ride

  • John Beveridge
  • Herald Sun
  • February 20, 2015 1:02PM
TELSTRA is set to ramp up its investment in Asia as Andrew Penn takes on the top role at the big telco.
While David Thodey has always had a stretch target for Asia to provide 20 per cent of Telstra’s revenue, the task of getting there will largely fall on Andrew Penn.
And Penn is almost uniquely qualified for that task.
As chief executive of AXA Asia Pacific, he was instrumental in building and operating a range of Asian wealth businesses before they were taken over by French parent company AXA.
At Telstra, he has also been in charge of offshore growth as well as looking after the company’s finances.
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Doctor-rating website using AHPRA records

18th Feb 2015
Flynn Murphy  
AHPRA says a mysterious new website that lets patients anonymously rate their doctors is using the agency’s records without permission.
The DoctorInspector website – which bills itself as an “open crowdsource doctor rating site” – has been the subject of several complaints to the agency in the past weeks. 
Many Australian health professionals – from GPs, to pharmacists, to radiographers – will now find an internet search for their name returns a DoctorInspector page dedicated to them. The page includes their AHPRA number, details, a star rating and reviews. 
The site does not accept responsibility for the accuracy of its information, and doctors appear to have no way to correct its records and reviews, to remove themselves from the site or to contact the site’s owner.
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HL7 Australia announces new team for 2015

  • 18 February 2015
Today HL7 Australia named two new part time staff to assist with the implementation of the HL7 Australia 2014-2015 Strategic Plan.
Associate Professor Trish Williams, Chair of  HL7 Australia said, “We are delighted we have been able to attract two such experienced staff who are keen bring their expertise and energy to support the volunteer HL7 Australia Board and the HL7 user community. HL7 Australia works to supports the creation and effective use of e health standards in Australia and these new appointments will assist us enormously.”
Bridget Kirkham will be assisting with increasing HL7’s profile, membership, third party relationships and advocacy.  Bridget has been working for not-for profits in health for over 30 years in Australia, the UK and the USA.
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New Zealand health boards to move to IBM cloud

New platform expected to improve reliability following a number of outages over the past two years
Up to 20 district health boards across New Zealand will roll out cloud infrastructure, which is expected to slash IT infrastructure costs across the group by $23.9 million over the next 10 years.
The boards are rolling out a National Infrastructure Platform (NIP), which will host applications and systems they use each day to deliver healthcare services to citizens. The move to the new platform – based on cloud services provided by IBM – will start in mid-2015 and is expected to take three years.
IBM and crown company, Health Benefits Limited (HBL) announced the agreement, with individual health boards now signing contracts to use the platform.
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IBM wins 'foundation' role for NZ health IT cloud

Summary: A deal announced between IBM and Health Benefits Ltd enables the consolidation of 40 datacentres down to just two.
By Rob O'Neill | February 16, 2015 -- 21:44 GMT (08:44 AEDT)
New Zealand's National Infrastructure Platform (NIP) for health is moving to an IBM-managed cloud, enabling a massive consolidation of datacentre facilities in the sector.
Announced on Tuesday by government-owned Health Benefits Ltd (HBL) and IBM, the National Infrastructure Platform will host applications and systems that New Zealand's 20 district health boards (DHBs) use to deliver healthcare.
DHBs will migrate from 40 datacentres to just two IBM-managed facilities -- one in Auckland and the other in Christchurch.
The current datacentres vary in size, age, quality, and adherence to standards, IBM and HBL said in a statement. The two IBM-managed facilities will offer higher security classifications, better reliability, and higher service levels.
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Dropped health monitoring functions won't hinder Apple Watch sales

Apple reportedly ran into problems with some advanced features
Although the Apple Watch will offer fewer health features than initially planned, it's still expected to be a powerful contender in the wearables category when it goes on sale in April.
Problems with sensor technology forced Apple to shelve plans to have the device monitor blood pressure, stress levels and heart rate, according to the Wall Street Journal. The sensors recorded inconsistent measurements that were affected by factors like dry skin, hairy arms and how tightly the watch was worn, according to anonymous sources cited by the Journal. Instead of more advanced features, the watch will include a basic pulse-rate monitor.
Omitting these features isn't a "deal breaker" for buyers, said Ramon Llamas, research manager for wearables and mobile phones, at IDC. The appeal of the Apple Watch isn't limited to health and fitness tracking but includes communication functions like the ability to compose text messages and emails and make calls from the wrist, said Llamas.
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Hospital errors killing hundreds of thousands

Date February 19, 2015

Julia Medew

Health Editor

An Australian study published in 2011 showed many catastrophic healthcare errors were not being reported to authorities.
Hospitals in developed countries are accidentally killing hundreds of thousands of patients every year, a world-leading patient safety expert says.
Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in the US, says healthcare errors are claiming about 400,000 American lives every year - the equivalent of two jumbo jets every day.
Common errors include misdiagnoses, medication mistakes, infections due to poor hand hygiene, pressure ulcers from neglectful nursing and miscommunications in teams that lead to catastrophic oversights.  
While many advances have improved safety over the past decade, Dr Pronovost said one of the biggest problems in hospitals today was an ever-increasing number of devices that do not talk to each other and distract health professionals from their most important tasks. This trend has occurred at the same time as budget cuts that have caused staff to work under maximum pressure with limited resources.
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Inside Healthdirect Australia with Colin Seery CEO

There’s no question the internet is a key part of our lives, with many people turning to online resources for first line information about their health. However the massive array of resources available also gives rise to questions about the reliability of “Dr Google.”
In a bid to plug this informational hole, Healthdirect Australia has a range of services designed to provide Australians with access to trusted information and advice they need to manage their own health and health related issues.
According to Healthdirect Australia chief executive Colin Seery, the service was established as a COAG initiative and is funded by the federal government, along with most states and territories.
“Healthdirect Australia provides all Australians with access to health information and advice. No matter where people live, or what time of the day or night it is, they can talk to a health professional, find trusted advice online about the appropriate care for their health issue and find the closest local services that are open when they need them,” Mr Seery told eHealthspace.org.
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Electronic Health Records in the UK: Patient Access Remains a Hot Topic

The gradual adoption of electronic health record systems has been in the works in more than a handful of countries around the globe, from the Kingdom of Jordan to Canada and India, all with various levels of success and interoperability. However, in the European market at least, it seems that the UK is the most proactive country in this respect, being the country with the highest uptake of EHR in the region.
A year ago, UK Health Secretary Jeremy Hunt stated that the National Health System is projected to become completely dependent on EHR within the next 5 years, a development which will allow continuity of care to become more seamless and more effective, making it possible for a physician a patient has never met before to view their complete medical history and make accurate and meaningful assessments about what the best course of action for the patient’s condition is.
For insight into just what is important to doctors when it comes to tackling the transition from paper to electronic records, Creation Healthcare conducted a mini-study of online conversations among healthcare professionals, including more than 400 tweets posted since the beginning of 2014.
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The folly of the obsession with source code

20/02/2015 wolandscat
My favourite topic these days is the phenomenon of fundamentalist thinking. You don’t need to go to Iraq to find it, it’s all around us….
Recently I chanced upon a post entitled ‘Coding is not the new literacy’ by Chris Granger, who as far as I can tell is one of the smart young generation of start-up developers creating interesting new ways of doing software. I suspect he is not yet 30, going by his ‘about’ page. Not a bad post for a young guy. It essentially says the following:
  • coding is ultimately the act of externalising our mental models into computer-understandable form
  • the main game is building and refining those mental models
In his view, ‘modelling is the new literacy’. He says:
Modeling is creating a representation of a system (or process) that can be explored or used.
I happen to agree with this, and I would go so far as to say that if you think that coding is the main activity of understanding or formalising a solution to a problem, you are profoundly wrong.
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Australian Childhood Immunisation Register and Medicare DVA Benefits Report - February 2015 Release

Created on Tuesday, 17 February 2015
NEHTA has released the specifications for the Medicare - Australian Childhood Immunisation Register and Medicare DVA Benefits Report.
These specifications are intended for implementers who are designing and developing clinical information systems to parse, extract and process information contained within the Australian Childhood Immunisation Register and Medicare DVA Benefits Report clinical documents that have been retrieved from the personally controlled electronic health record (PCEHR) system using the business-to-business gateway.
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Jane McCredie: Taming Big Data

Jane McCredie
Monday, 16 February, 2015
WHEN we do a Google search, most of us are probably focused on the data we are trying to access.
We tend to be less aware that the very search terms we choose are in themselves data — information that can be used by corporations or governments to monitor everything from political movements to consumer behaviour.
Google search terms are just one element of so-called “Big Data”, the vast quantities of information being generated by our constant digital engagement.
At the end of last year, I wrote about the potential benefits of Big Data for public health, while also touching on the ethical issues this might raise.
As “digital epidemiology” begins to take its place in the public health armory, one group of researchers is arguing that the established rules for surveillance and research may no longer provide an adequate ethical framework.
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Postdoctoral Research Fellow or Research Fellow In Consumer Informatics

at Macquarie University
Macquarie University is a workplace like no other. From our inception we have crossed traditional boundaries. We developed the first electronic calculator for people with vision impairment, wireless internet technology and the Macquarie Dictionary. We were the first university in Australia to introduce childcare on campus and the first to appoint a female Vice-Chancellor. We were founded to be different, and we have always been at the forefront of changes to the way we work, live and learn.
We are recognised globally as one of Australia's leading research universities. We recently earned a 5-star rating in the QS World Rankings, including the highest rating for employability. We have been among the top-rated employers in the Australian Workplace Employers Index since it was founded 2010.  We are, definitively, a world-class university for students and staff. We're investing heavily in new buildings, courses and staff, and collaborating with businesses here and around the world including Cochlear Ltd, Intel and the CSIRO.
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HISA Advisory Services

Short term advisory service designed for rapid response

» Provided by health experts and managed by HISA!

HISA Advisory Services draws from the skills of the most experienced clinical, academic and management members of HISA to provide input and opinion on a wide range of digital health and health workforce questions. Service specialty areas include:
  • Primary care
  • Aged care
  • Medical imaging
  • Nursing workflow
  • Emergency discharge processes
  • Medication management
  • Data definition and collection design
  • As well as many others
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Premier & Health Minister @camerondickqld seeing first hand the Telehealth services at the PA Hospital. #qldpol
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Getting patient notes right

19 February, 2015 Dr Simon Young
Every Friday, I go mountain biking with my best friend Tony, an orthopaedic surgeon. At the end of climbs, we catch our breath and catch up on the week. At the top of one hill, we gasped through this exchange:
"M [Tony's wife, also a hospital specialist] and I were arguing about GP referrals last night," Tony panted.
"Oh yes?" I wheezed.
"We agreed there is no compulsion to send GPs letters, but I argued that out of all the specialists, psychiatrists at least should do it."
"Um, Tony, have you or M ever read the [Medical Board of Australia's] code of conduct?"
"Ah ... nope."
Five years spent writing medicolegal reports have made me quite familiar with the code of conduct.
Tony and his wife need to look at section 4.2 — ‘Respect for medical colleagues and other healthcare professionals'
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All the bottom-line action

February 16, 2015
Mind Australia leverages Qlik to track and manage business KPIs
Qlik
has announced that Mind Australia, a leading provider of community mental health services in Victoria and South Australia, is using QlikView to streamline reporting processes and provide managers visibility into how they are tracking against business targets and key performance indicators (KPIs) – all ultimately translating to how many people’s lives they’ve helped transform. Mind supports over 18,000 Australians with mental health issues by providing services that help them to live independent, productive, and purposeful lives through a range of community and residential services.
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Orange to spin off e-health subsidiary Almerys - report

Sunday 15 February 2015 | 13:53 CET | News
Orange is preparing to sel lits 64 percent stake in Almerys to its co-founder Global Services Sante (G2S), reports Les Echos, citing unnamed sources. Described as an amicable divorce, Orange found it too difficult to find synergies between its e-health division and Almerys, which specialises in health service data management.
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Hands-on review: Raspberry Pi 2

Date February 18, 2015 - 8:27AM

Gadgets on the go

The little PC that could just got a big upgrade.
The palm-sized Raspberry Pi isn't the only barebones PC out there, but it's certainly one of the most popular and has a vibrant developer community. With the latest upgrades the $41 Raspberry Pi 2 also offers excellent bang for your buck alongside more expensive barebones options.
We've seen several iterations of the Raspberry Pi since it was launched in 2012, but until now it's stuck with a lowly single-core 700MHz processor. The new Pi 2 is blessed with a quad-core 900MHz processor, accompanied by double the RAM at 1GB.
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Raspberry Pi: a $35 computer can do a lot

  • Joanna Stern
  • The Wall Street Journal
  • February 18, 2015 10:58AM
OUR computers have become too easy to use.
Right out of the box, they’re ready to go. No installing operating systems, no typing into a command-line prompt like in the old days. We don’t even have to hit save anymore.
Most weeks, I’m the first to celebrate this and to say I miss nothing about the way it used to be. But not this week.
This week I’ve been using the $US35 Raspberry Pi 2, a bare-bones Linux computer no bigger than a juice box. And I’ve rediscovered something I had forgotten: the thrill of tinkering with a machine and its software. Of course, that thrill is accompanied, from time to time, with the urge to take a baseball bat to an inanimate object.
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Enjoy!
David.