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."

Friday, March 20, 2015

Now Here Is A Real Problem That Too Many Just Ignore. The Elderly and Technology Use.

This speared a few days ago.

Are seniors really game for health IT?

Posted on Mar 12, 2015
By Michelle Ronan Noteboom, Contributing writer
Over Christmas, my 79-year-old father visited me for a few days and joined us for Christmas Eve mass. Just before the service started, my father’s phone rang. He quickly pulled the phone out of his pocket and silenced it. As he did, the people behind us started giggling and said, “Hey look! It’s a flip phone!”
It is a little funny to see my dad with his quaint flip phone, similar to the one I had about eight years ago. My father, who refuses to attempt texting and never checks his voicemail, will probably never switch to a smart phone since the flip phone already has more features than he’ll ever use.
A little background on my dad: He’s a former college professor who spent many years using computers for research, writing, and email. He’s not a technology novice, but he’s far from a sophisticated user: he has a list of passwords taped to his monitor and more than a few times he has told me he “lost” an email he created – only to find it later in that little folder labeled “drafts.”
In other words, his use and acceptance of technology is better than many seniors, but worse than some. And at age 79, he is in the segment of the population with the highest rates for healthcare utilization. His is also the segment least likely to urge their doctors to offer online scheduling tools, electronic access to test results, options for secure email communications and online viewing of their electronic medical record.
How anxious are seniors to take advantage of technologies that promise to extend care to more patients, to improve access to care, and engage patients with providers? A recent Accenture survey put the spotlight on "tech-savvy seniors," finding that two-thirds of those who place a high priority on technology want access to online healthcare services.
More here:
I really liked the last paragraph of the article:
“So all you healthcare technology folks targeting seniors for your next great app, please take note: If you thought clinicians were slow to embrace new technologies, wait until you meet my dad.”
Given the hope for the PCEHR was that the chronically ill would be major users this issue might turn out to need further thought.
David.

Thursday, March 19, 2015

Review Of The Ongoing Post - Budget Controversy 19th March 2015. 2016 Budget Strategy Not Clear At All!

Budget Night was on Tuesday 13th May, 2014 and it is still not finalised. Not much time left before 2016 Budget is upon us.
Both major health and education changes as well as pension changes are still stuck and we have a new Families Package being floated . Also we have less than 2 sitting weeks in Parliament before the next Budget - due to be  handed down Tuesday 12th , May 2015.
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Articles this week include.

General Budget Issues.

Joe Hockey stands by budget measures in Senate

Joe Kelly

JOE HOCKEY has warned the quantum of the savings from the Abbott government’s 2014 budget must be obtained, but signalled the priority in 2015 will be to boost economic growth rather than to make further spending cuts.
The Treasurer said that structural savings were essential to ensure the viability of the tax system moving forward, declaring that failure on this score would make it untenable to remedy bracket creep in the near future.
Mr Hockey also confirmed that a sunset clause would apply to the plan to index the pension to inflation from 2017 ensuring it will not be a permanent change and suggesting a more generous arrangement could be struck once the budget returned to surplus.
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Doomsayers contort the debt debate

IF you listen to members of the Abbott government, you’d be forgiven for thinking there are two types of Australians: those who think Australia is going broke and those who think nothing should be done in the interests of sensible improvements to the budget bottom line.
There is, of course, a third type: those of us who believe in sensible measures in the budget grounded in a debate held in a mature and proper context.
Whether in opposition or government, the Liberal Party has embraced inflammatory rhetoric when it comes to debt and deficit.
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Robb rejects drug monopolies

Sid Maher

TRADE Minister Andrew Robb has directly rejected suggestions the government will agree to measures that increase the cost of medicines as part of Trans Pacific Partnership negotiations.
The University of NSW Centre for Health Equity Training Research and Evaluation, based on leaked texts of the deal, claimed the US was seeking to prevent signatories from refusing to grant patents for minor variations to drugs even when there was no evidence of additional benefit.
The effect of the practice, called “evergreening”, allows manufacturers to extend their monopolies on new drugs and frustrates competition.
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Political Instability.

Tony Abbott does not like what government is doing to pensions: Liberal MP

Date March 11, 2015 - 8:15PM

Heath Aston

Political reporter

Prime Minister Tony Abbott "does not love" the government's plan to peg the age pension at a lower rate and if alternative savings can be found and the budget returned to surplus, a higher rate of increase could be reapplied sooner, a Liberal MP said.
The contribution to the debate on pensions by NSW Liberal Angus Taylor, a strong ally of Mr Abbott, comes amid a push by some Coalition backbenchers to force some kind of backdown on the policy.
Earlier in the week, Liberal backbencher Andrew Laming warned there were "large missiles and torpedoes" aimed at the pension plan that will see increases tied to inflation rather than wages growth from July 2017.
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Abbott fails to fight for causes

"A cause worth fighting for is worth fighting for to the end."
This quote from former US president Grover Cleveland might have been Tony Abbott's mantra. But it's gone by the wayside in recent months.
Having argued against taxpayer handouts for the car industry, the government this week announced it wouldn't be going ahead with its proposed cut to a key funding program.
Asked to justify the cut before the September 2013 election, Abbott said: "No adult prime minister in the heat of an election campaign, in panic over polls, charges down the street waving a blank cheque after anyone."
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Health Budget Issues.

11 March 2015, 6.32am AEDT

Federal health spending is forecast to slow, but states face rising bills

Author Stephen Duckett
The narrative for the upcoming budget appears to be in a state of flux. Is it still to be “tough love” or “we’re from the government and here to help you”?
The framers of the health spending narrative face the same quandary. For the last 15 months all we have heard is the “health system is unsustainable” discourse. However, last week’s Intergenerational Report delivered a confusing prediction: Commonwealth health expenditure will decline over the next two decades.
Previous Grattan Institute work has shown health to be the fastest-growing area of government spending. And the reason for the shift in the 2015 Intergenerational Report is not changed assumptions, since the 2015 ones are very similar to those in previous reports. So, how can this be?
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Private health insurers urged to ditch homeopathy cover

Date March 12, 2015 - 7:30AM

Joanna Heath

Private health insurers are being urged to drop cover for homeopathy after a landmark study by the National Health and Medical Research Council found no credible evidence it is effective in treating health problems.
"I would think in the current financial constraints that health insurers private and public should be looking at ineffective versus effective treatments. Things that haven't been shown to be effective I wouldn't want to see funded publicly or privately," chairman of the NHMRC Homeopathy Working Committee, Professor Paul Glasziou said.
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Sussan Ley holds fire on rebates for ‘useless’ natural therapies

Sean Parnell

TAXPAYERS may continue to subsidise the use of unproven natural therapies by health fund members despite the nation’s leading medical research body finding homeopathy to be a waste of money and in some cases harmful.
As foreshadowed by The ­Australian in January, the ­National Health and Medical ­Research Council yesterday ­declared ­homeopathy to be no ­better than a placebo, warning anyone who used it instead of ­evidence-based treatments would be risking their health.
Homeopathy was the first of 17 natural therapies to be scrutinised by the NHMRC as part of a ­review of the scope of the private health insurance rebate initiated by the former Labor government.
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Patients could be casualty of $57 billion hospital funding shortfall over next 10 years

Date March 14, 2015 - 12:15AM

Dan Harrison, Gareth Hutchens

Exclusive
Patients could cop the brunt of a $57 billion hospital funding shortfall that lies behind the miraculous budget turnaround projected by Joe Hockey in the Intergenerational Report.
The yawning funding gap, that threatens to blow out state budgets as well as hospital waiting lists, will be central to the Abbott government's looming white paper on federalism, which NSW Premier Mike Baird insists must be used to resolve the problem.
The Abbott government is booking savings of $57 billion over 10 years as a result of dismantling the hospital funding system put in place by Labor, and from 2017 moving to a new system in which states receive block grants that are adjusted for population growth and inflation as measured by the consumer price index.
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Co-Payment Issues.

Medicare co-payment could still happen - bulk-billed patients may face gap fees

Date March 8, 2015 - 8:30PM

Dan Harrison

Health and Indigenous Affairs Correspondent

Despite declaring its Medicare co-payment "dead, buried and cremated," the Abbott Government is considering proposals to give GPs the option of charging gap fees to bulk-billed patients.
Under the current rules, if a doctor bulk-bills a patient, they must accept the Medicare rebate of $37.05 as full payment for the service. Alternatively, the doctor must forgo the Medicare rebate and charge the patient a higher fee upfront, usually about $70. The patient then claims the $37.05 rebate from Medicare.
Such a change would reduce out-of-pocket costs for patients who already pay upfront to see their doctor, but would mean the end of free care for some patients, and some advocates predict the change would push up fees over time.
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Why the government thinks bulk billing can go

Date March 9, 2015 - 3:14PM

Marc Moncrief

The medicare co-payment, or some variation thereof, is reportedly back on the table.
It was only a week ago the issue was closed, with Health Minister Sussan Ley telling Coalition MPs "we are not pursuing it at all". 
It's possible no-one in the Coalition party room knew about the chart below, but it's unlikely, and it could lead Liberal MPs to think tinkering with bulk billing is a politically feasible thing to do. It shows the proportion of medical services bulk billed in each electorate.
As the chart makes clear, the electorates with the largest proportion of services bulk billed are overwhelmingly Labor (red), while those with less bulk billing are overwhelmingly Liberal (blue). The yellow bars represent National electorates.
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Medical Research Fund.

$20b medical research fund must proceed

Date March 8, 2015 - 11:45PM

Robin Fitzsimons

Australia needs to commit more to medical research or pay high prices to others who develop treatments.
The GP co-payment has gone. Its planned introduction was linked to a stunning $20 billion Australian commitment to a Medical Research Future Fund. The world noticed.
The issues are now ostensibly again separate. But when will the $20 billion be achieved? Any delay would prejudice Australians' access to modern treatments. And risk its global  research reputation.
The federal government still has not properly explained this most visionary policy of the budget. Put simply, unless we expeditiously invest in medical research Australia will have fewer resources than other developed countries to treat serious illness.
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Pharmacy Issues.

Greens call for audit inquiry

9 March, 2015 Chris Brooker
The Australian Greens are calling for a public inquiry into the administration of the Fifth Community Pharmacy Agreement in the wake of criticisms contained in the recent program audit. 
A report by the Australian National Audit Office, tabled in Parliament on Thursday, 5 March, raised serious concerns over aspects of the administration and negotiation of the 5CPA.
Now Greens health spokesperson Dr Richard Di Natale (pictured) has added his voice to calls by Professional Pharmacists Australia and the Consumers Health Forum for an inquiry to investigate the reports findings.
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No cost cutting immunity for pharmacy: Ley

12 March, 2015 Christie Moffat
Community pharmacy and the PBS remain in the government’s sights for future funding cuts, the health minister says.
Speaking at APP 2015, Health Minster Sussan Ley (pictured) told delegates the government was committed to finding the most cost-effective solutions for the health system, and hinted this could affect future pharmacy funding.
Ms Ley acknowledged the impending 6CPA negotiations, and said that the Department of Health supported the expansion of the pharmacist’s role – however, the industry should prepare itself for some “tough decisions” in the future.
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Pharmacists reluctant to give up on homeopathy

13 March, 2015 Alice Klein
The leader of Australia’s 27,000 pharmacists has rejected calls for pharmacies to remove homeopathic products from their shelves, suggesting they could still be used as effective placebos.
The pharmacy profession is under pressure to stop selling homeopathic products to patients after the NHMRC declared there were "no health conditions for which there is reliable evidence that homeopathy is effective".
But the president of the Pharmaceutical Society of Australia, Grant Kardachi, said the issue was not black and white, and it could be worthwhile for pharmacists to hold minimal homeopathic stocks.
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Pharmacists' clout blunts courageous call from captain Abbott

Date March 14, 2015 - 9:30PM

Paul Malone

Three months ago Prime Minister Tony Abbott was in "debt-and-deficit" mode when he addressed the Pharmacy Guild of Australia's annual dinner.
Reminding the guild that the Howard Coalition government had generated surpluses and Labor governments had generated deficits, he said times were now different to those of just a few years ago and "I cannot stand up and say to you that government will no longer be looking for savings".
The audience had no doubts about which program he was referring to and where he wanted savings.  Although he didn't name it, he was clearly talking about savings taxpayers' dollars in negotiating the Sixth Community Pharmacy Agreement, which needs to be concluded before the old agreement expires in June.
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How a pharmacy monopoly pushes up your medicine price and makes pharmacies million dollar businesses

  • March 15, 2015 12:00AM
  • Sue Dunlevy National Health Reporter
  •  Herald Sun
THEY are the taxpayer funded pharmacy millionaires, 941 chemist shops making more than a million dollars a year from a system that’s hurting consumers and taxpayers.
A shocking audit report has revealed how the taxpayer funded $15.4 billion pharmacy agreement that stifles competition is turning one in six pharmacies into million dollar businesses.
The same system is forcing consumers to pay inflated prices for medicines and sees a $1.10 pack of aspirin cost a patient $13.31.
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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. With the Co-Payment gone - but muttering about other ideas growing louder - but the continuing need for Budget savings continuing we have to ask what next?
One wonders for how much longer all this will go on and just what impact a apparently almost inevitable change of leader might have? I think that change is still coming.
It is interesting to see the Pharmacy Guild under pressure from a recent audit of the Community Pharmacy Agreement and where money was spent.
Enjoy.
David.

Wednesday, March 18, 2015

Surely This Is Using A Sledgehammer To Crack A Nut. Shows Lack Of Any Real Understanding Of the Real Issues Involved.

This appeared a few days ago.

Congressman Takes Aim at EHR Interoperability with Draft Bill

MAR 13, 2015 7:43am ET
Rep. Michael Burgess (R-Tex.), a physician and member of the House Energy and Commerce Subcommittee on Health, has drafted legislation that would establish a congressionally-appointed advisory committee to develop an EHR interoperability standard required for certification that would go into effect by 2018.
The draft bill calls for the termination of both the Health IT Policy and HIT Standards Committees, which are to be replaced with a 12-member advisory committee composed of providers, qualified EHR developers, insurers, group health plans, and other stakeholders. Six of the committee members would be appointed by the House Speaker and minority leader, while the other six would be appointed by the Senate majority leader and minority leader.
The new advisory committee would have until July 1, 2016, to recommend standards for measuring interoperability and then establish criteria for certifying that EHR technology is interoperable by Jan. 1, 2018. Penalties for non-compliance with the certification criteria would go into effect beginning Jan. 1, 2019.
 “At this point the bill is still very much a discussion draft and has not been introduced,” a spokesman for Congressman Burgess told Health Data Management.
The 25-page document is entitled “Ensuring Interoperability of Qualified Electronic Health Records.” For a qualified EHR to be considered interoperable, according to the draft bill, such record must satisfy the following criteria:
*Open Access—The record allows authorized users access to the entirety of a patient’s data from any and all qualified EHRs without restriction;
*Complete Access to Health Data—The record allows authorized users access to the entirety of a patient’s data in one location, without the need for multiple interfaces (such as sign on systems);
*Does Not Block Access to Other Qualified EHRs—The record does not prevent end users from interfacing with other qualified EHRs.
Beginning Jan. 1, 2019, the proposed legislation states that any qualified EHR that does not satisfy the certification criteria “shall no longer be considered as certified under such program” through a process of decertification. Further, starting in 2019 and each subsequent year, the draft bill instructs the Department of Health and Human Services to publicly post on the web a list of non-compliant vendors whose “certification has been withdrawn.”
More here:
This all struck me at all together the wrong place to be trying to solve what are essentially complex technical questions.
Fortunately it seems others much more technically literate than I see this as a little dumb to say the least.

Establishing Interoperability by Legislative Fiat

Posted on March 10, 2015 by Grahame Grieve
h/t to Roger Maduro for the notification about the Rep Burgess Bill:
The office of Rep. Michael C. Burgess, MD (R-Texas) released a draft of the interoperability bill that they have been working for the past several months on Friday. Rep. Burgess, one of the few physicians in Congress, has been working very hard with his staff to come up with legislation that can fix the current Health IT “lock-in” crisis.
Well, I’m not sure that it’s a crisis. Perhaps it’s one politically, but maybe legislation can help. With that in mind, the centerpiece of the legislation, as far as I can see, is these 3 clauses:
‘‘(a) INTEROPERABILITY.—In order for a qualified electronic health record to be considered interoperable, such record must satisfy the following criteria:
‘‘(1) OPEN ACCESS.—The record allows authorized users access to the entirety of a patient’s data from any and all qualified electronic health records without restriction.
‘‘(2) COMPLETE ACCESS TO HEALTH DATA.— The record allows authorized users access to the en- tirety of a patient’s data in one location, without the need for multiple interfaces (such as sign on systems).
‘‘(3) DOES NOT BLOCK ACCESS TO OTHER QUALIFIED ELECTRONIC HEALTH RECORDS.—The record does not prevent end users from interfacing with other qualified electronic health records.
Well, there’s some serious issues around wording here.
Firstly, with regard to #1:
  • What’s the scope of this? a natural reading of this is that “the record’ allows access to all patient data from any institution or anywhere else. I’m pretty sure that’s what not they mean to say, but what are they saying? What ‘any and all’?
  • Presumably they do want to allow the authorizing user – the patient – to be able restrict access to their record from other authorised users. But that’s not what it says
  • The proposed bill doesn’t clarify what’s the ‘patient record’ as opposed to the institution’s record about the patient. Perhaps other legislation qualifies that, but it’s a tricky issue. Where does, for instance, a hospital record a note that clinicians should be alert for parental abuse? In the child’s record where the parent sees it?
  • Further to this, just what are health records? e.g. Are the internal process records from a diagnostic lab part of ‘any and all qualified health records’? Just how far does this go?
With regard to #2:
  • What’s an ‘interface’? As a technologist, this has so many possible meanings… so many ways that this could be interpreted.
  • I think it’s probably not a very good idea for legislation to decide on system architecture choices. In particular, this sentence is not going to mesh well with OAuth based schemes for matching patient control to institutional liability, and that’s going to be a big problem.
  • I’m also not particularly clear what ‘one location’ means. Hopefully this would not be interpreted to mean that the various servers must be co-located, but if it doesn’t, what does it mean exactly?
With regard to #3:
  • I can’t imagine how one system could block access to other qualified health records. Except by some policy exclusivity, I suppose, but I don’t know what that would be. Probably, if this was written more clearly, I’d be in agreement. But I don’t really know what it’s saying
There’s some serious omissions from this as well:
  •  There’s nothing to say that the information must be understandable – a system could put up an end-point that returned an encrypted zip file of random assorted stuff and still meet the legislation
  • There’s no mention of standards or consistency at all
  • There’s no mention of any clinical criteria as goals or assessment criteria
More here:
Really this idea for legislation needs to be simply ignored - while being clear properly managed interoperability is clearly vital. If the political imperative is so intense, which I doubt, then any legislation should only be defining goals and setting sensible timeframes and then standing back and letting the technologists address the perceived problem.
Thanks Grahame for pointing out at least some of the issues associated with this planned approach.
David.

I Think The Present Attorney General Is Just Rude! As a Blogger I Demand Protection Of My Metadata From Government Snooping!

This appeared yesterday.

No protection for bloggers from metadata laws rules George Brandis

Jared Owens

ATTORNEY-General George Brandis has rejected calls to introduce a US-style procedure for journalists to challenge efforts to access their metadata, stressing “media organisations are not the target of this law”.
Senator Brandis this morning also indicated individuals who partake in journalism outside their “profession” qualify for additional safeguards, potentially placing law enforcement officers in the difficult position of judging whether certain broadcasters, commentators and authors are journalists.
Labor and Coalition negotiators yesterday agreed to amend the tougher security regime to compel security agencies to obtain a judicial warrant before checking on a journalist’s phone and internet records.
Labor says it won’t pass the bill requiring telcos to store their customers’ phone and internet records for at least two years unless the safeguard is built into the legislation.
Senator Brandis rejected calls to allow media organisations to argue in court against the issuing of a warrant to access their reporters’ metadata.
“It has never been the case in our system that a party against whom a warrant is sought is given advance notice of the warrant. The warrant process is an application to the court or a tribunal, or in unusual circumstances the Attorney-General,” he told ABC Radio’s Michael Brissenden.
“Media organisations are not the target of this law,” he said, emphasising efforts to stop “criminals, terrorists and pedophiles”.
Asked how he defined a journalist, Senator Brandis said: “I wouldn’t consider bloggers as journalists.”
More here:
How dare he? How can I leak the interesting little documents that come my way if the Government can track the source of the documents?
How can I resist the previous DOH Secretary who bad mouthed me at Senate Estimates if I can be easily tracked and found?
How can we expose NEHTA paying bloggers to attack me on behalf of COAG (who funds NEHTA) etc. if I can be easily tracked on line?
I think I deserve an exemption from warrantless metadata tracking - just as anyone else who has sources, and publishes information, do. And I have a good few sources I want to keep very safe!
All this just confirms my view that Senator Brandis is a pretty hopeless AG! Hope I don’t get sued!
David.

Tuesday, March 17, 2015

Now This Is A Pretty Scary Prospect! How Likely Is It That This Will Be Done Well?

This news appeared earlier in the week.

Welfare systems face $1bn upgrade

Phillip Hudson

Joe Kelly

A new hope to welfare system

SOCIAL Services Minister Scott Morrison has declared there would be near-immediate savings and more effective service delivery arising from the replacement of an antediluvian 1980s era Centrelink computer that poses a new impediment to welfare reform.
Federal cabinet is currently considering replacing the system in a move estimated to cost about $1bn with The Australian revealing today that changing a letter for social security payments takes 100 public servants six months at a cost of $500,000.
Centrelink’s “Income Security Integrated System” which handles $100bn worth of payments each year runs on a Model 204 mainframe considered to be too cumbersome to cope with the overhaul of the payments system proposed by welfare reformer Patrick McClure.
Mr Morrison and Human Services Minister Marise Payne are pushing for funding in the May budget to replace the outdated system.
“This is a system that still has manual processing attached to it… And it’s been left to basically wither for many years,” Mr Morrison told Sky News. “Now, the system’s stable, I should stress, but it could run far more efficiently and effectively both for the users and for the government and more cost effectively as well.”
“No doubt it would save money in the short term even I would suggest with the sort of changes you could make immediately.”
Mr Morrison said that when the system was introduced in the 1980s there were about 2.5 million people receiving payments, but that number had increased to just under ten million people today.
Lots more here:
To me it seems clear that the system from the 1980’s has passed its ‘use-by’ date. The issue is surely how this can be achieved without major delays and cost-blow outs of quite disastrous proportions.
Given the track record of such large and in this case pretty complex systems - where one would have to doubt there was even any written down, complete and reliable set of specifications given the shifting specifications of the 30 years from political change - the chance of the needed systems being developed and implemented without issues would have to be well short of 100%.
The two other obvious issues are how to keep the old systems running while the new systems are brought up and the potential economic impact should payments of this scale to the public fail for any more than a few days.
To me the big challenge is going to be to work out how the workload of the present systems can be divided up and then incrementally transferred. Clearly a ‘big bang’ changeover would be just absurdly risky!

Note: the relevance to e-Health is that these systems interact with the other Human Services systems and so they matter to those interested in e-Health!
How do others think a project of this scale and complexity can be derisked and what salary would you see as fair for the project leader?
David.

Monday, March 16, 2015

Weekly Australian Health IT Links – 16th March, 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

An interesting week with a fair bit happening in terms of Audits and the need to fund major system updates.
Well worth a browse through the headlines
Still no news on the PCEHR.
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ADF health records IT system implementation 'deficient'

Summary: The planning and implementation of the Australian Defence Force's health records management system in 2009 has been found to have been 'deficient', resulting in a AU$110 million blowout of the project's original budget, according to the Australian National Audit Office.
By Leon Spencer | March 10, 2015 -- 06:16 GMT (17:16 AEDT)
Australian Auditor-General Ian McPhee has released a report concluding that the "deficient" planning and implementation of the Australian Defence Force's (ADF) Defence eHealth System (DeHS) in 2009 resulted in a five-fold increase in the project's overall budget by February 2014, to AU$133.3 million.
The initial June 2009 budget for the project was AU$23.3 million, according to the Australian National Audit Office's (ANAO) Report (PDF) into its review of the ADF's electronic health records management system for Defence personnel.
Defence initially planned to develop DeHS as a mature system by December 2011, but did not complete its rollout until December 2014.
The ANAO's report, released on Tuesday, said that it had identified significant weaknesses in the early stages of the project, relating to its planning and budgeting, project management, and implementation.
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Audit blames Defence Department for e-health project bungle

Fran Foo

THE Department of Defence misinformed its minister in an e-health project that subsequently blew out by a whopping $110 million, a new audit report found.
The department was squarely to blame for the blowout in implementing the Defence e-health system, originally known as Jedhi or joint e-health data and information system.
The Auditor-General delivered a scathing report on Defence’s performance, describing the department’s planning, budgeting and risk management for the project as “deficient”.
Weak project governance meant the system went live in December 2014 -- three years after the initial deadline.
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Bad governance behind Defence eHealth cost blowout


Minister in charge not properly informed, auditor finds.

A $110 million cost blowout to the Department of Defence's new eHealth system was a result of deficient planning, budgeting and risk management, the national audit office has found.
Auditor-General Ian McPhee today published his report [PDF] into the Defence eHealth System (DeHS), which was approved in 2009 with a budget of $23.3 million and was scheduled to go live by December 2011.
However, a series of scope changes and budgeting bungles lead to a massive cost overrun - to the tune of $110 million by 2014 - as well as a number of delays to the go-live, McPhee revealed.
He laid the blame for the cost blowout squarely on Defence.
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Health websites ‘too difficult to read’

12 March, 2015 Bronwyn Walenkamp
Information on most consumer health websites is too complex for lay Australians to read and understand, according to their study published in the Australian and New Zealand Journal of Public Health.
The readability of government, not-for-profit, and commercial health websites was found to be above average Australian levels of reading, which for this study was set at year 8.
“Limited availability of easy to read health materials suggests many Australians may not be benefiting from the convenience of the internet,” say Matthew Dunn and Christina Cheng from Deakin University.
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Co-dependent? New stoush between SAI Global, Standards Australia

Simon Evans
A new stoush has developed between the former $1.1 billion takeover target SAI Global and its one-time parent Standards Australia, which owns the 6900 standards and regulations that are the lifeblood of one of SAI's most profitable divisions.
Standards Australia chief executive Dr Bronwyn Evans says her organisation has many options available to it and is annoyed that SAI Global chief executive Peter Mullins referred to the two organisations as being "co-dependent" on each other when delivering his first-half earnings.
The relationship between the two entities is of vital importance to the future valuation of SAI and whether private equity firm Pacific Equity Partners may seek to revive a $1.1 billion buyout proposal that ultimately ended up not becoming binding when a formal sale process began. PEP and partner Kohlberg Kravis Roberts didn't lodge a binding offer after extensive due diligence, largely because of uncertainty surrounding the future of the lucrative publishing agreement held by SAI, which publishes 6900 standards and regulations on behalf of Standards Australia under a 15-year contract, which ends in late 2018.
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Welfare systems face $1bn upgrade

Phillip Hudson

FEDERAL cabinet is considering a $1 billion plan to replace the 1980s-era Centrelink computer system amid warnings it has ­become an impediment to the sweeping welfare overhaul designed to ease pressure on the fastest-growing area of government spending.
With the simple task of changing a letter for social security payments taking 100 public servants six months and costing $500,000, Social Services Minister Scott Morrison and Human Services Minister Marise Payne are pushing for funding in the May budget to replace the system.
Senior public servants have backed the call and have prepared a business case, outlining a three-year plan that was formally handed to the government last month.
Centrelink’s Income Security Integrated System, which handles $100bn of payments a year, runs on a Model 204 mainframe that has been repeatedly patched up by successive governments but is now considered unable to cope with the overhaul of the payments system suggested by welfare reformer Patrick McClure.
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Welfare systems face $1bn upgrade

Phillip Hudson

Joe Kelly

A new hope to welfare system

SOCIAL Services Minister Scott Morrison has declared there would be near-immediate savings and more effective service delivery arising from the replacement of an antediluvian 1980s era Centrelink computer that poses a new impediment to welfare reform.
Federal cabinet is currently considering replacing the system in a move estimated to cost about $1bn with The Australian revealing today that changing a letter for social security payments takes 100 public servants six months at a cost of $500,000.
Centrelink’s “Income Security Integrated System” which handles $100bn worth of payments each year runs on a Model 204 mainframe considered to be too cumbersome to cope with the overhaul of the payments system proposed by welfare reformer Patrick McClure.
Mr Morrison and Human Services Minister Marise Payne are pushing for funding in the May budget to replace the outdated system.
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Records are your best defence

Most doctors are likely to receive one complaint or claim during their professional life. It is a ‘life event’, likely to be stressful and filled with uncertainty. None of us like our professionalism questioned or suggestions that we may have done wrong. 
Upon receipt of a complaint or a claim, you will of course immediately notify your medical indemnity insurer.
Your insurer is unlikely to say – “That’s terrible doctor.  Please come round and have a cup of tea and a biscuit so that we can discuss the matter with you.”  Your insurer is more likely to say – “That’s terrible doctor.  Can you please send us a copy of your medical records and file in relation to this claim, and then we will have you around for a cup of tea and a biscuit to discuss the matter with you.”
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eHealth Integration Sample Code (eHISC) v2.0 March 2015 Release

Created on Thursday, 12 March 2015
NEHTA has released updated specifications for the eHealth Integration Sample Code (eHISC) comprising source code and associated documentation for the software.
It is available for download from the following location on the NEHTA website:
eHISC has had multiple enhancements, please download the Release Note v2.0 to view changes:
The eHISC provides implementers and software vendors with a sample implementation of a communications solution that enables patient administration systems and clinical information systems to interact with the Healthcare Identifiers Service and the personally controlled eHealth record system (PCEHR).
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Establishing Interoperability by Legislative Fiat

Posted on March 10, 2015 by Grahame Grieve
h/t to Roger Maduro for the notification about the Rep Burgess Bill:
The office of Rep. Michael C. Burgess, MD (R-Texas) released a draft of the interoperability bill that they have been working for the past several months on Friday. Rep. Burgess, one of the few physicians in Congress, has been working very hard with his staff to come up with legislation that can fix the current Health IT “lock-in” crisis.
Well, I’m not sure that it’s a crisis. Perhaps it’s one politically, but maybe legislation can help. With that in mind, the centerpiece of the legislation, as far as I can see, is these 3 clauses:
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Coroner's inquest to focus on electronic monitoring of meds

9 March, 2015 Christie Moffat
A coronial inquest into the deaths of three men from Western Australia will focus on the need for an electronic prescription monitoring system.
As reported by the ABC, the Coroner’s Court of Western Australia today commences its two-week inquest into the prescription drug-related deaths, and will examine the importance of doctors and pharmacists being able to access patient drug history in real time.
The inquest will hear from a range of expert witnesses, including a toxicologist, a specialist in pain medicine and representatives from the Pharmacy Guild of Australia and the Western Australia Alcohol and Drug Authority.
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Centrelink IT system costing millions: Abbott

Centrelink's antiquated computer system is set to be scrapped at a cost of $1 billion because of concerns it won't cope with a planned overhaul of the welfare system.
AAP (Computerworld) on 09 March, 2015 13:52
Centrelink's antiquated computer system is set to be scrapped at a cost of $1 billion because of concerns it won't cope with a planned overhaul of the welfare system.
Social Services Minister Scott Morrison said when the system was introduced in the 1980s about two-and-a-half million people received payments.
Now there are about 10 million welfare recipients, with $400 million spent on 50 million transactions every day.
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Electronic medication management outperforms paper system in cost and patient safety

By admin E-Health & Technology Mar 12, 2015
A recent study into the cost-effectiveness of using an electronic medication management system (eMMs) has shown that monetary savings from reduced adverse drug events can offset the cost of implementing the system, making it more cost effective when compared with paper-based prescribing.
Research led by Professor Johanna Westbrook of the Australian Institute for Health Innovation at Macquarie University, and clinical and IT staff from St Vincent’s Hospital in Sydney, found that the implementation of CSC’s MedChart system could provide savings of about $100,000 a year in a 30-bed ward.
“Before now, several studies had shown that health information technologies help to reduce medication errors, particularly prescribing errors among hospital patients. This is the first Australian study to look into the cost savings of these reductions,” said Westbrook.
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Authority scripts to be automated?

12th Mar 2015
THE days of waiting up to 10 minutes on the phone for a clerk’s permission to prescribe certain PBS-listed drugs may be coming to an end.
The Department of Human Services is considering a plan to automate the PBS authority approvals process, in an overhaul that would give GPs online approval to prescribe many drugs. 
In a letter seen by MO, the DHS says it will consider two options to automate authority prescriptions — one built into prescriber software and one accessed through Medicare’s Health Professional Online Services (HPOS) portal. 
Authority approval processes for complex and restricted medications would remain the same for now, the letter says. 
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ABC’s Active Memory brain training website wins AIMIA award

Active Memory, the ABC’s online brain training program, has won the Best Website or Online Services – Healthcare & Pharmaceuticals Award at last night’s AIMIA awards. Active Memory also was highly commended in the Best Website or Online Services in the Learning and Education category.
AIMIA and the digital industry celebrated the outstanding achievements and work produced over the past year by over 100 finalists across 30 categories. The recognition of Active Memory places the ABC brand alongside some of the best digital products in the country.
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St Vincent's bans photography in hospitals amid privacy concerns

Date March 15, 2015 - 12:15AM

Harriet Alexander

St Vincent's Hospital has banned unauthorised photography on its campuses in a bid to protect the privacy of its patients.
Patients and their visitors will now have to seek permission from staff members before taking photographs in all wards except for the maternity ward at the Mater Hospital on the north shore, where celebrity babies such as the daughter of Erica and James Packer and the three sons of Cate Blanchett were born.
The policy follows several episodes where patient privacy has been compromised, including two occasions in which the victims of high-profile assaults were filmed – once by a member of the public – and broadcast on television.
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What can Medicare data tell us about system design?

| Mar 13, 2015 11:35AM | EMAIL | PRINT
Recently, Adjunct Associate Professor at the Menzies Centre for Health Policy, University of Sydney, Lesley Russell published a paper on Scrbd that reminds us how underutilized the data available to us on medical services really areMedicare obstetrics services and costs: an analysis of publicly-available data 2003-04 to 2013-14, demonstrates that data aren’t t always just about answers but can sometimes be  useful pointers to the most pertinent questions. In particular Dr  Russell is keen to demonstrate what examining financial data can tell us about system design and utilization.
The introduction to Lesley’s study is provided below. The full text can be found here.
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VAXXIN8 provides the healthcare sector and organisations that they be exposed to preventable infectious diseases with a centralised, real-time view of the vaccination compliance for each member within their organisation. VAXXIN8 removes the administrative burden to investigate, store and manage vaccination compliance across the workforce.
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10 March 2015, 5.38am AEDT

Apple releases its watch and makes a surprise move into the area of medical research

David Glance
Apple’s event at San Francisco’s Yerba Buena Center was widely expected to focus on the release of the Apple Watch.

ResearchKit

In a move that took everyone by surprise however, Apple also released a new software platform called ResearchKit. Like HealthKit, the platform enables medical researchers to create applications that specifically support the enrolment of subjects in medical trials and the continuous collection of data for research projects. Five sample applications supporting research into Parkinson’s Disease, Cardiovascular Disease and Breast Cancer, were built with partner universities in the US, UK and China for the launch of the kit. Unusually for Apple, the platform will be Open Sourced which means that others can contribute to the core platform.
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Apple aims to help medical studies with ResearchKit software framework

Apple will not see any of the health data collected by apps developed with ResearchKit
Fred O'Connor (IDG News Service) on 10 March, 2015 05:56
Apple introduces ResearchKit, giving medical researchers the tools to revolutionize medical studies
Apple thinks its new software framework can solve some of the biggest challenges facing medical researchers, including recruiting people for studies and collecting health data more frequently.
Called ResearchKit, the framework will allow developers to create apps for medical research studies and turn a smartphone into a diagnostic tool, Apple said Monday during an event in San Francisco. ResearchKit will be released as open source next month and the first five apps are available today, said Jeff Williams, Apple's senior vice president of operations. Because it's releasing ResearchKit as open source, apps can be developed for mobile platforms other than iOS, such as Android.
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Inside the Australian Institute for Healthcare Innovation

The move from the University of New South Wales to Macquarie University by the Australian Institute for Healthcare Innovation (AIHI) late last year caused a stir in industry circles. Many wondered why the Institute had moved from the environment it had been in since its founding in 1999 – was there bad blood? Was money involved? However the AIHI played things close to its chest.
Now Professor Enrico Coiera, a director at the AIHI, has spoken for the first time about the move, and what the Institute has been up to since its move in 2014.
“The idea behind the move was to help us grow,” said Prof. Coiera, in an interview with eHealthspace.org. “It had nothing to do with us being unhappy at UNSW – far from it. In fact we’re still in contact with people there, and still do work with them.”
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NBN Co to test hooking up more premises to HFC

Construction trials for NBN HFC in Queensland and NSW
NBN Co will undertake construction trials in NSW and Queensland to test hooking up to the NBN homes that sit within the footprint of Optus's and Telstra's Hybrid Fibre Coaxial networks.
The trials will include hooking up homes that are not currently connected to the telcos' HFC networks.
The government-owned company said that the construction trials would begin mid-year.
The initial release of HFC commercial services on the NBN is slated for Q1 2016, according to the January 2015 edition of NBN Co's product roadmap.
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  • March 6, 2015, 11:53 AM ET

What Will Life Be Like in an AI Future?

  • By Irving Wladawsky-Berger

Guest Contributor

People have long argued about the future impact of technology. But, as AI is now seemingly everywhere, the concerns surrounding its long term impact may well be in a class by themselves. Like no other technology, AI forces us to explore the boundaries between machines and humans. What will life be like in such an AI future?
Not surprisingly, considerable speculation surrounds this question. At one end we find books and articles exploring AI’s impact on jobs and the economy. Will AI turn out like other major innovations, e.g., steam power, electricity, cars–highly disruptive in the near term, but ultimately beneficial to society? Or, as our smart machines are being increasingly applied to cognitive activities, will we see more radical economic and societal transformations? We don’t really know.
These concerns are not new. In a 1930 essay, for example, English economist John Maynard Keynes warned about the coming technological unemployment, a new societal disease whereby automation would outrun our ability to create new jobs.
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Enjoy!
David.