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, September 25, 2015

Clinical Decision Support Is Becoming Increasingly Important - A Useful Update.

This appeared a little while ago:

Clinical decision support: no longer just a nice-to-have

Posted on Jul 14, 2015
By Mike Miliard, Editor
Since Hippocrates first brandished a pair of bronze forceps, care providers have aimed for quality. It's always been the goal to deliver safe and effective care to best extent possible.
But there's always room to improve. And nowadays, with the shift from volume to value finally taking hold, moving toward better clinical care is no longer optional.
This past fall, the U.S Department of Health and Human Services announced it will invest $840 million over four years to help 150,000 clinicians improve patient outcomes, reduce unneeded tests and avoiding unnecessary hospitalizations. One of the central pillars of its Transforming Clinical Practice Initiative is to help providers regularly use electronic health records to examine data on quality and efficiency.
A few months later, in January of this year, HHS upped the ante – making an 'historic' announcement of ambitious new timelines toward value-based care. Furthering its embrace of alternative reimbursement models such as accountable care organizations and bundled payments, HHS set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016.
"We believe these goals can drive transformative change, help us manage and track progress, and create accountability for measurable improvement," said HHS Secretary Sylvia Burwell.
The clock is ticking on clinical quality improvement. If hospitals and practices want to be paid in the years to come, it's incumbent on them to show they're delivering better care.
"Provider organizations are under this increasing imperative to move the needle on high-priority targets as we shift from volume to value," says Jerry Osheroff, MD, a former chief clinical informatics officer and the founder of TMIT Consulting, which seeks to help providers, vendors and other stakeholders improve processes and outcomes.
"What does 'value' mean? It means taking care of chronic disease, taking care of acute disease, not causing unnecessary harm," he says. "There's now measures associated with all these things, and performance on those measures is driving reimbursement. Having care delivery be efficient and effective is no longer a nice-to-do, which it's been for many decades. It's now a gotta-do."
Osheroff is also editor-in-chief of HIMSS' award-winning guidebooks on clinical decision support. And CDS, he says, is a crucial component in helping providers get to where they need to go with their quality improvement projects.
But a proper understanding of what CDS is (hint: it's not about EHR alerts) and how to approach it (people come first!) is essential.
Help wanted
In his just-published HIMSS book on clinical informatics, Ken Ong, MD, chief medical informatics officer of New York Hospital Queens, illustrates just how important CDS tools and processes are to modern practice.
To take just one example: The number of medical journal articles has quadrupled from 200,000 in 1970 to more than 800,000 in 2010, Ong points out: "With the current number of articles published annually in medical literature, a recent medical school graduate who reads two articles every day would be 1,225 years behind at the end of the first year."
Indeed, "if a physician followed all the recommendations from national clinical care guidelines for preventive services and chronic disease management and added the time needed to answer phone calls, write prescriptions, read laboratory and radiology results and perform other tasks for a typical patient panel of 2,500, he or she would need 21.7 hours per day," he writes. "Information overload coupled with a paucity of time suggest the value of CDS and greater team-based care."
Clinical decision support tools are myriad and varied.
"The most frequently cited example of CDS is a drug-allergy interaction alert to a physician at time of order entry," Ong writes. "Drug-drug, drug-allergy and drug-food interaction alerts are indeed prototypical examples of CDS, but there are other tools in the CDS toolbox. Each CDS intervention can have a different use case, target audience and fit in a particular point in the clinical workflow."
The book offers a long list of examples: alerts and reminders; clinical guidelines; clinician patient assessment forms; data flow sheets; documentation templates; infobuttons; order facilitators (order sets, order consequents, order modifiers); patient data reports and dashboards; protocol/pathway support; task assistants; tracking and management systems.
But the optimal approach to clinical decision support should not be focused primarily – or even secondarily – on technology.
"This work is about people, processes and technology – in that order," says Gregory Paulson, deputy director of programs and operations at Trenton Health Team.
There is a great deal more found at this link. It’s a long and useful article!
The scope of the CDS domain is now huge and growing. Well worth a read.
David.

Thursday, September 24, 2015

2016 Budget -Parliament Over for A Few Weeks and A New Cabinet. Who Knows What Next?

September 24 Edition
The big news this week  has two strands.
1. We got a new PM
2. The US Fed kept interest rates at zero - and upset the markets more than somewhat.
Budget Night was May 12, 2015. It now seems to have been forgotten and in the Press we seem to be hearing just a little more about recession.
The big question will be if we see some more confidence in the whole country with a new PM. Only time will answer that question!
Of course I suspect what will happen next is going to be hard to work out for weeks and all previous commentary may now be safely ignored.
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Well at least it is really feeling like it is Spring!
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Here is some other of the recent other news and analysis.

New PM - A Few Articles.

6:15am September 15, 2015

What a new-look Turnbull cabinet could look like

ninemsn
Finally got there...PM-designate Malcolm Turnbull with perennial deputy Julie Bishop following the leadership spill. (AAP)
Joe Hockey's scalp is almost certain to be among those on the pile as Prime Minister-designate Malcolm Turnbull looks to form a new cabinet in the wake of yesterday's dramatic spill that saw Tony Abbott rolled as Liberal leader.
Social Services Minister Scott Morrison is being tipped to replace the much-maligned Mr Hockey as treasurer, despite the member for Cook declaring his support for Mr Abbott shortly before last night's ballot.
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Malcolm Turnbull to be Australia's new PM after ousting Tony Abbott in Liberal party vote

Former communications minister beats incumbent leader by 54 votes to 44 and promises respectful, slogan-free leadership style
Government whip Scott Buchholz announced the news that Malcolm Turnbull has been elected Liberal party leader with 54 votes to Tony Abbott’s 44. Link to video
Malcolm Turnbull is set to become Australia’s new prime minister after beating Tony Abbott by 54 votes to 44 in a snap Liberal party ballot and promising the country a new, respectful, slogan-free leadership style.
The Liberal party whip Scott Buchholz announced the results to waiting journalists about 30 minutes after the meeting of parliamentarians began. There was one informal vote.
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Malcolm Turnbull era: Joe Hockey’s grand designs end in tears

  • The Australian
  • September 16, 2015 12:00AM

David Uren

Joe Hockey is angry at being made the scapegoat for the fall of the ­Abbott government, believing the economy is doing well con­sidering the headwinds from the China downturn and the end of the resource construction boom.
The Treasurer believes small-business tax incentives in this year’s budget helped fire up employment and retail spending and are contributing to the best business trading conditions since before the global financial crisis. He contrasts the 20,000 jobs being created each month with the 2000 monthly tally in the final months of the former Labor government.
But the big promises made when he came to office — ending an “age of entitlement”, fixing the budget and securing the foundations for future growth — remain unfulfilled.
Joe Hockey set out his ambition as treasurer in a speech to the British free-market think tank, the Institute of Economic Affairs, in London 18 months before he became Treasurer. The challenge for Western governments was public entitlements increasing to a point where the cost in higher taxes and debt was choking growth.
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  • Editorial
  • Sep 16 2015 at 11:45 PM
  • Updated Sep 16 2015 at 11:45 PM

Prime Minister Turnbull must reset the budget process

If the core purpose of the Turnbull government is to create a new mindset for economic growth, one of the most important tasks confronting the likely new Treasurer, Scott Morrison, will be to get the federal budget back on the rails.
It was the political failure to convince Australians that leaving the public finances so entrenched in the red would both frustrate a return to economic growth and leave them without any cushion from trouble ahead, that killed the Abbott government and Treasurer Joe Hockey.
After his Labor predecessor, Wayne Swan, unveiled what he promised to be a mere "temporary" budget shortfall, Canberra is now well on its way to racking up a dozen years of deficits approaching $400 billion in total. While rightly pressing the emergency button on this before being elected, Tony Abbott and Mr Hockey failed to prepare Australians to reduce their resource boom-inflated expectations of what services and transfers the budget could sustain.
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Sep 19, 2015

Kicking the Abbott

It is no exaggeration to say Tony Abbott is the worst prime minister Australia has had. To the extent that his brief and destructive leadership of the country is remembered, it will not be remembered well.
Abbott is a prime minister without a legacy. In attempting to defend one this week, he came up with not much: some jobs, a few trade agreements, an infrastructure project, a border protection regime founded on human rights abuses, a royal commission so compromised by bias its own commissioner had to consider removing himself.
Abbott governed for the past and the few conservatives desperate to continue living there. He governed against science and in contempt of the environment. He governed in opposition to social equality, in terror of reform. His was a government of fear and avoidance, a rolling sideshow anxiously avoiding the fact it had nothing to add and no idea what to do.
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General Budget Issues.

Abbott v Turnbull: Challenger no ordinary Joe

  • The Australian
  • September 15, 2015 12:00AM

David Uren

Malcolm Turnbull has exploited widespread public dissatisfaction with Joe Hockey’s performance and the belief within the Coalition that Scott Morrison would do a ­superior job as treasurer.
Mr Morrison has won a reputation as a minister who can get things done, both in his immigration portfolio, where he is credited with stopping the flow of asylum-seeker boats and, since the beginning of this year, in charge of the $150 billion social services portfolio. He has built a profile as an economic minister in charge of social services, emphasising the economic goal of lifting workforce participation alongside the social goal of alleviating poverty.
Mr Hockey’s tenure as Treasurer has been marred by the failure of last year’s budget and by a series of unforced errors, most ­famously his comment in support of indexing fuel excise that “poor people don’t drive cars”.
Mr Hockey forcefully rejected Mr Turnbull’s claims the government’s economic strategy was failing. “He has never said to me or to the cabinet that we are heading in the wrong direction,” he said ahead of last night’s ballot. “We have an economic plan that is being delivered and is working.”
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Joe Hockey has been a good treasurer with our best interests at heart

Date September 16, 2015 - 7:12AM

Peter Martin

Economics Editor, The Age

COMMENT
Defending his record in what may be one of his last days as Treasurer, Joe Hockey told Parliament on Tuesday that the Australian economy was $68 billion bigger than when it had been entrusted into his care.
Without Hockey that result may not have happened. Had the Coalition slashed spending in order to quickly return the budget to surplus as it implied it would, or made cutting debt its number one priority as it said it would, the economy might not have grown at all.
Hockey stood in the way of those wanting to cut spending sharply, delivering a clever first budget that provided for big spending cuts over time, rather than upfront.
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Liberal leadership switch to Malcolm Turnbull: Scott Morrison is no Joe Hockey

Date September 15, 2015 - 7:58PM

Gareth Hutchens

ANALYSIS
Prime Minister Malcolm Turnbull is relying on this fact: Scott Morrison is no Joe Hockey.
When challenging Tony Abbott for the Liberal Party leadership on Monday, Mr Turnbull said it was "clear enough" that the government was not providing the economic leadership that Australia desperately needed.
Things had to change, he said, otherwise Labor would win the next election.
It was a denunciation of Abbott and his Treasurer, Joe Hockey. The attack didn't mention Hockey specifically, but it didn't need to.
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Tax avoidance crackdown: 1000 multinationals face tax squeeze under new rules

Date September 16, 2015 - 7:46PM

Heath Aston

Political reporter

'I'm not going to buy into that'

Joe Hockey refuses to feed speculation that he could be replaced as Treasurer by Scott Morrison under the new Prime Minister Malcolm Turnbull.
The Turnbull government expects to raise "hundreds of millions of dollars" from 1000 multinational companies through new rules designed to extract more tax from profits made in Australia but accounted for overseas.
In what could be his last act as Treasurer, Joe Hockey made good on a budget promise, introducing to Parliament a bill altering existing tax laws to target companies suspected of avoiding their fair share of tax through complex offshore arrangements.
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Joe Hockey's reckoning: budget outcome $8b worse than forecast

Date September 18, 2015 - 8:31AM

Peter Martin

Economics Editor, The Age

Joe Hockey has concluded his first and only financial year as treasurer with a budget outcome $8 billion worse than forecast.
In May 2014 Mr Hockey forecast a budget deficit of $29.8 billion, itself a big step up from the $24 billion forecast by the Treasury at the end of Labor's term in office.
Treasury documents to be released on Monday will show the final budget outcome for 2014-15 was a deficit of $38 billion, a figure well below the peak of $54.5 billion reached under Labor during the global financial crisis, but well above the number first forecast by Mr Hockey and at odds his pledge ahead of the election to "deliver a surplus in our first year and every year after that".
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Health Budget Issues.

Doctors accuse Abbott government of delaying health cuts until after Canning

Date September 14, 2015 - 7:17AM

Matthew Knott

Communications and education correspondent

Doctors have accused the Abbott government of delaying the introduction of Medicare changes that would increase out-of-pocket health costs until after next Saturday's crucial Canning by-election.
The government has proposed saving $270 million by changing the Medicare safety net, which covers out-of-hospital services such as in vitro fertilisation, specialists, and some pathology and diagnostic imaging services.
The increased thresholds, due to come into effect in January 2016, mean patients would need to spend more on out-of-pocket medical expenses to become eligible for additional Medicare benefits.
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Medicare review chief says 30pc of treatments of little benefit

  • The Australian
  • September 16, 2015 12:00AM

Sean Parnell

A quarter of the services listed on the $21 billion Medicare Benefits Schedule do not appear to be supported by evidence, while about 30 per cent of all healthcare treatments would be of little benefit to patients, ­according to the head of a federal government taskforce.
Bruce Robinson, the dean of the Sydney Medical School chosen to lead the Medicare review, told The Australian significant changes would be ­required for the 5500 items on the MBS if the health budget were to become sustainable and the health system more responsive.
Finalising a discussion paper yesterday, Professor Robinson said the taskforce had an opportunity to convert the MBS from an administrative and accounting system to a clinical tool powerful enough to influence how patients are tested, referred and treated.
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How bulk-billed healthcare payments reward quantity, not quality of treatment

Date September 16, 2015 - 9:00PM

Vlado Perkovic

With rampaging overall health spending in a system which is geared for quantity over quality, perhaps it is time for change.
Take this example. Mr Jones is a 50-year-old man who goes to see his GP about back pain. He is overweight, smokes, does no regular exercise and has had back pain on and off for a few years. It worsened after some gardening, hence the visit. His doctor has a cursory look at his back and gives him a form for an X-ray and advice to take painkillers.
Within six minutes, the consultation is over, the fee is bulk-billed, with the patient happy that he is not out of pocket, but returns in a week to discuss the results of the X-ray.
The taxpayer has paid for the consultation and the X-ray – a test that is not recommended for uncomplicated back pain - and the patient has received an ineffective therapy. The pain returns a few weeks later after another bout of gardening.
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Medicare review placates AMA by agreeing to stagger changes

  • The Australian
  • September 17, 2015 12:00AM

Sean Parnell

The powerful Australian Medical Association has won an early concession out of much-anticipated Medicare reforms, with the head of a review taskforce agreeing that recommended changes should be staggered to protect doctor and practice incomes.
The Australian revealed yesterday that Bruce Robinson, who is heading the review of the Medicare Benefits Schedule, believed that a quarter of the services listed on the $21 billion MBS were not supported by evidence, while about 30 per cent of all healthcare treatments would be of little benefit to patients.
Professor Robinson, the dean of the Sydney Medical School, said a properly focused MBS could become a clinical tool powerful enough to influence how patients were tested, referred and treated.
The review, and an accomp­any­ing primary practice review, were announced by the government after it scrapped the second version of its unpopular GP co-payment. At the time, Health Minister Sussan Ley said the government­ would reconsider its freeze on Medicare rebates if stakeholders helped find suffic­ient savings elsewhere.
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Sussan Ley tipped to remain as health minister

Paul Smith | 15 September, 2015 |
Federal Health Minister Sussan Ley is expected to keep her job in the wake of Monday night's political bloodbath.
Tony Abbott was ditched as Prime Minister by his party MPs last night and replaced by Communications Minister Malcolm Turnbull who is now tasked with appointing a new cabinet in the coming days.
Ms Ley has managed to neutralise health as a hot political issue following the turbulent tenure of her immediate predecessor Peter Dutton and his disastrous push for GP co-payments.
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Pharmacy Issues.

Penalty rates under siege

14 September, 2015 Chris Brooker 
Leading pharmacy owners say their service to the public is being hindered by “egregious” Sunday and public holiday penalty rates.
In a series of submissions to the Fair Work Commission’s review of modern award penalty rates, pharmacy owners have outlined the impact of penalty rates on their opening hours, customer services and ultimately to health outcomes.
The Pharmacy Guild of Australia is asking for a series of changes to the current Pharmacy Industry Award 2010 penalty rate regime including:
  • Removing the current 25% loading for permanent employees and 50% loading for causal employees work performed between 7pm and 9pm on Monday to Friday. They also want to reduce by 25% the loading from 9pm to midnight.
  • Halve the loading from 9pm to midnight on Saturday (from 100% to 50% for permanent employees with a 25% reduction for casuals).
  • Institute an across the board 50% loading for Sunday work, replacing the current 100% loading for permanent employees and 125% for casuals.
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It is going to be very interesting to see what happens to the polls and consumer confidence over the next 2-3 months with the present market chaos. I hardly see it improving in the short term.
Enjoy.
David.

Wednesday, September 23, 2015

With This Sort Of Innovation We Will See Major Change In Medication Management I Suspect.

This appeared a few days ago.

MedAdvisor is Josh Swinnerton’s mother of all medication advisers

Sarah-Jane Tasker

A strong desire to help his mum manage her supply of medications drove software engineer Josh Swinnerton to develop ­MedAdvisor — a platform he hopes to expand offshore through a backdoor listing on the Australian market.
The company has kicked off a roadshow to drum up investor support to raise about $5 million through a backdoor listing via mining shell Exalt Resources.
Chief executive Robert Read, who was recently appointed to oversee the listing, said the Med­Advisor software, which helps people manage their medication, was driving adherence by up to 20 per cent.
“From a big macro picture, adherence is probably the biggest, preventable health cost,” he said.
“There was a study done that showed there was half a trillion dollars of preventable health care costs attributed to medication mismanagement. That is a problem that needs fixing to save lives and MedAdvisor goes someway to addressing that.”
The drive for the app came from Mr Swinnerton’s mother who has multiple illnesses, including Parkinson’s and rheumatoid arthritis, for which she takes up to 11 long-term prescriptions.
“For Parkinson’s some of the common medication you have to take four hourly, 24 hours a day and if you forget, your symptoms in an hour or two get more severe.
“With my awareness of her issues, it had always struck me as an obvious opportunity that a smartphone has to be a great place to put a tool to help people manage all aspects of their medication.”
Mr Swinnerton, who has a background in IT and software engineering, said the market listing may appear to be early in the life of the 3½-year-old company but it had already engaged with close to one quarter of Australian pharmacies.
Lots more here:
I have to say there are a large number of people on complex medication regimes for whom this app would seem to be very useful. The issue will be to get the necessary technology into the hands of those who need it and to then train and educate them to use it effectively.
Clearly the most obvious path to market and adoption is via pharmacists - while it is also that the GP also regularly reviews the total medication picture. It is those who need this app most who are those who may be at risk of polypharmacy and will be in need of regular review.
I look forward to understanding just what the business model for the application is and how it can be maintained into the future while providing some sort of return to the shareholders. One might even wonder that if the app is shown to be effective and safe that the ACeH might take over its care and maintenance into the future.
It really is interesting just how mobile and personal technology are increasingly causing change in all professions.
David.

Tuesday, September 22, 2015

Another Example Of Why We Really Need To Upgrade The Leadership And Governance Of E-Health.

This appeared earlier in the week:

Telehealth lacks consistency

Nicole MacKee
Monday, 14 September, 2015
AUSTRALIA lacks nationally consistent telehealth clinical standards as its rollout gathers pace and new business models enter the field, say leading telehealth proponents.
Rural GP Dr Ewen McPhee, chair of Queensland Health’s Telehealth Advisory Committee, said a lot of work had been devoted to developing telehealth standards, but Australia still lacked a consistent, national framework for clinical governance.
“There are so many players who want to be a part of this space, but the issues around clinical safety, confidentiality and consent are all in a state of flux in Australia”, Dr McPhee told MJA InSight.
“It’s such that people don’t quite know what they are consenting to and what the implications are in telehealth and home monitoring. We certainly don’t explain it well”, said Dr McPhee, who has successfully integrated telehealth into his practice in Emerald, Queensland.
His comments came as the American College of Physicians released a position paper last week outlining an overall approach to the development of telemedicine in the US. (1)
The 13-point position statement aims to help balance the benefits of telemedicine against the risks to patients.
An accompanying editorial noted that: “The innovation that telemedicine promises is not just doing the same thing remotely that used to be done face to face but awakening us to the many things that we thought required face-to-face contact but actually do not”. (2)
Dr McPhee said his practice’s telehealth model had developed around existing clinical relationships with medical consultants, which had provided a “safety net”. However, he said as services began to offer consultations with specialists the treating GP did not know, issues with clinical governance might come to the fore.
“The most important thing about referrals is good clinical handover”, Dr McPhee said. “It’s not just about … the convenience of it all — it’s asking, has this actually improved the care of this person? Has there been a positive outcome from this event, or is it just another way of promoting a business model?
“We need to think more deeply into how we implement telehealth. We need to think about the evidence for what works and what doesn’t.”
Dr Victoria Wade, clinical director of Adelaide Unicare e-Health and Telehealth Unit, agreed that Australia had failed to develop nationally consistent models of telehealth care.
“About 30% of the population might live in a telehealth-eligible area, but the number of telehealth consultations is way under what it potentially could be”, said Dr Wade, who is also a research fellow at the University of Adelaide.
More here:
Here are some useful references:
If ever there was an area of e-Health that has been the victim of non-strategic dis-coordinated leadership and governance telehealth is it. E-Health Division of DoH and the Communications Department (NBN) have each funded initiatives and the success from both groups have crossed over, messed up and achieved very variable outcomes.
It is time the proposed ACeH was given a mandate to properly govern and encourage the area and to evaluate what is working - as much certainly is - and then foster and encourage the successes while being open to trials of potentially valuable initiatives that can be bought to critical mass and evaluated for continuing support.
It is not that hard - just needs some nouse, consultation with the proper stakeholders and decent leadership!
David.

Monday, September 21, 2015

Weekly Australian Health IT Links – 21st September, 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

What a busy week with PCEHR Legislation introduced and some more interesting news from Telstra.
Next step is to see what impact a new or the same health Minister will have. Watch this space.
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Govt introduces bill for opt-out e-health records

By Paris Cowan
Sep 17 2015 4:28PM

New criminal penalties for breaches.

The federal government has introduced a bill into parliament that will enable it to transform its stalled e-health records regime by automatically creating a record for every Australian by default.
The bill entered parliament before the Department of Health commenced pilots of the new ‘opt-out’ approach to getting healthcare recipients registered for an electronic record.
The bulk of the pilots are due to be carried out in 2015-16, at a range of sites.
The new laws will allow health authorities to automatically set up online accounts for selected participants using names, addresses and health identification numbers pulled out of the Medicare database.
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PCEHR renamed to My Health Record, automatic account creation trialled

Nearly two-years after a review was performed on the government's struggling e-health platform, new changes based on recommendations the review made were introduced into legislation on Thursday.
By Asha Barbaschow | September 17, 2015 -- 07:33 GMT (17:33 AEST) | Topic: Enterprise Software
The Australian government introduced legislation on Thursday which will see its struggling personally controlled e-health record (PCEHR) system renamed and individuals automatically given an account.
PCEHR will now be known as My Health Record, and in a bid to boost recruits, the government wants to conduct trials which will see individuals automatically have an account created for them, which will require them to opt-out if they do not wish to continue with the online service.
If the trials are successful, the government will consider rolling out automatic accounts nationally.
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Govt push to boost e-health records uptake

AAP | 17 September, 2015 | 
Legislation to increase uptake of the national electronic health record scheme was introduced to Parliament on Thursday by the Federal Government.
The new laws will allow the government to trial a new e-health record scheme that will only allow people to opt-out of the scheme. Rather than the current system where they have to opt-in.
If trials are successful, the government will consider rolling out automatic accounts nationally.
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eHealth records: Government seeks to clear way for opt-out system

The federal government has introduced a bill to shake up the national eHealth record system
The federal government has introduced a bill that will allow trials of an opt-out approach for the national eHealth record system.
The Health Legislation Amendment (eHealth) Bill 2015, introduced into the House of Representatives today, will rename the Personally Controlled Electronic Health Record (PCEHR) to My Health Record.
The proposed legislation implements the government's $485 million budget announcement on eHealth, health minister Sussan Ley said when introducing the bill to the house.
The bill is based on a 2013 review of the PCEHR and a review of the Healthcare Identifiers Service, which is a foundation of the electronic health records system.
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NEHTA publishes flawed pathology terminology

2015-August-01 | 16:53 By: Filed in:
On its  shiny new website  under About NEHTA , NEHTA now starts its strategy statement with: “With the foundations built, the infrastructure in place…“.
Nothing can be further from the truth. No amount of shouting from the rooftops, even by NEHTA’s Chairman, can change the facts. Most of us involved at the coalface of e-health know only too well that the foundations are not built and that the infrastructure simply is not in place!
Over the past decade, NEHTA has really struggled to develop and introduce useful terminology products for the Australian e-health community. The few it has developed, such as the Australian Medicines Terminology have been largely ignored by vendors, jurisdictions, systems integrators and others. When it comes to supporting diagnostic tests, NEHTA walked away from leading the terminology foundation development for years and years.
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Architect of UK’s hated Care.data scheme quits NHS, flees from Britain

Tim Kelsey grabs the reins at Oz's Telstra Health next July

17 Sep 2015 at 13:29, Kat Hall
The architect of Blighty's hated Care.data scheme, Tim Kelsey, has today announced he will quit as the NHS's National Information Director.
Kelsey will leave the British health service in December and take the new role of director at Australia’s telecoms biz Telstra Health next July.
Curiously, the NHS did not list Care.data among his achievements in its press release announcing Kelsey's departure. The scheme has been subject to severe delays, due to the serious concerns regarding the sharing of sensitive personal data with private sector third parties.
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Cameron adviser leaves controversial NHS data scheme for private sector

Former journalist who led error-strewn care.data programme goes to work for Australian telecoms company
One of David Cameron’s top advisers on technology, Tim Kelsey, has resigned from the NHS to take up a job with the health data division of Australia’s largest telecommunications company.

NHS patient data plans unachievable, review finds

A controversial figure who led the error-strewn care.data programme, which aimed to create a single database of all English patients’ medical records, Kelsey will leave his role as NHS England’s national director for patients and information in December.
News of Kelsey’s departure comes on the day that board papers released by the Health and Social Care Information Centre (HSCIC), a centralised repository of NHS data, revealed that it had made key objections about care.data in mid July.
However a week later Kelsey wrote to MPs on the health select committee to say that the HSCIC board had “reviewed” the project but did not say they had sought to amend the scheme.
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Kelsey to leave NHS England

Thomas Meek & Lyn Whitfield
17 September 2015
Tim Kelsey will step down as NHS England's national director for patients and information in December to take on a new job in Australia.
Kelsey has been with NHS England since 2012 and was appointed chair of the National Information Board last year, which is leading on the drive towards a 'paperless NHS' by 2020.
His new role is commercial director at Telstra Health, the healthcare arm of Australia-based telecommunications company Telstra.
Telstra Health bought Kelsey’s former company Dr Foster earlier this year.
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Telehealth lacks consistency

Nicole MacKee
Monday, 14 September, 2015
AUSTRALIA lacks nationally consistent telehealth clinical standards as its rollout gathers pace and new business models enter the field, say leading telehealth proponents.
Rural GP Dr Ewen McPhee, chair of Queensland Health’s Telehealth Advisory Committee, said a lot of work had been devoted to developing telehealth standards, but Australia still lacked a consistent, national framework for clinical governance.
“There are so many players who want to be a part of this space, but the issues around clinical safety, confidentiality and consent are all in a state of flux in Australia”, Dr McPhee told MJA InSight.
“It’s such that people don’t quite know what they are consenting to and what the implications are in telehealth and home monitoring. We certainly don’t explain it well”, said Dr McPhee, who has successfully integrated telehealth into his practice in Emerald, Queensland.
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Smartphone health apps tested by VicHealth

  • September 14, 2015 11:04AM
PEOPLE should be cautious when using smartphone apps to lose weight and stay healthy, the Victorian government says.
VICHEALTH has launched a Healthy Living App Guide, rating more than 200 apps for their effectiveness in helping people shed weight and live a healthier lifestyle.
They say it is the first time that health apps, which are used by two in five Australians, have been independently tested on a large scale to compare quality and effectiveness.
"We rated them out of five and the best rating achieved was three," VicHealth CEO Jerril Rechter said.
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Lessons from overseas: e-health in Canada ‘significantly impacting home care’

By Natasha Egan on September 14, 2015 in Technology Review
AUDIO: Improved quality and access to care for consumers and increased productivity for clinicians, are among the positive impact digital health is already having on home care in Canada, an international conference has heard.
Fraser Ratchford, group program director or consumer health and innovation at Canada Health Infoway, gave delegates at the recent ACSA/IAHSA Joint International Conference in Perth a glimpse into Canada’s home care landscape, which he said was having a significant impact on care.
Mr Ratchford said Canada had laid many digital health foundations, which empowered consumers were now using to make better healthcare and quality of life decisions.
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Must-have app for breast self-examination

18 September 2015
IT is recommended that women of all ages are familiar with how their breasts look and feel.
The Breast Self-Examination app has been developed by BIOCORE Applied Research Group at Coventry University, UK, in collaboration with the National Health Service, and provides basic instruction.
The app provides a point guide on the breast changes to be looking for during breast self-examination (BSE) such as a lump, thickening or pitting of the skin. There are video demonstrations of, firstly, how to perform a visual inspection and, secondly, a systematic guide to how to palpate the breasts.
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Medical practices targeted in Medicare rort

17 September 2015
THE DEPARTMENT of Human Services has been accused of failing to ensure the security of Medicare clients’ bank details after criminals allegedly stole records from medical practices in Sydney’s southwest. 
The thieves allegedly managed to change the patients’ bank details registered with Medicare, set up fake accounts in the patients’ names and had rebates diverted to the new accounts. 
The opposition says Human Services Minister Marise Payne “dropped the ball” after being questioned about the security issue last month.
“I raised the issue just under a month ago with the minister and nothing has been done,” Senator Doug Cameron told reporters in Canberra today. 
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10 social media tips for GPs

16 September 2015
The RACGP is holding two webinars on social media for GPs in advance of next week’s GP15 conference in Melbourne.
Here are 10 handy social media tips for the busy GP, according to RACGP Western Australia Faculty Chair Dr Tim Koh:
  1. “If you wouldn’t say the comment in public, it’s most likely not appropriate to post. The same laws on patient confidentiality apply to social media.
  2. Social media can be great for communicating important information from your practice with your patients and community, such as opening and closing times or new doctors joining the practice.
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Human Services kicks off welfare payments system upgrade

The Department of Human Services on Friday published an expression of interest document, with a tender pinned for 2016, to replace the existing 30-year-old welfare payments platform.
By Asha Barbaschow | September 18, 2015 -- 07:31 GMT (17:31 AEST) |
The Department of Human Services on Friday published a Request for Expressions of Interest (REOI) from the IT industry to help design and begin construction of a new welfare payment system to replace the 30-year-old system the department has in place called Income Security Integrated System (ISIS).
The decades-old system is currently used to process family support payments, letters, income assessments, and other notifications for around 100 programs, and as of June this year, was undertaking more than 50 million transactions per day.
The REOI said the department currently relies on ISIS to deliver payments to 7.3 million Australians, with Centrelink payments totalling over AU$100 billion annually.
"The start of procurement marks the first milestone for the Welfare Payment Infrastructure Transformation (WPIT) programme,'' Minister for Human Services Senator Marise Payne said. "This is one of the largest social welfare business transformations undertaken worldwide; success will depend on establishing strong industry partnerships.''
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Guide to mandatory data breach notification in the PCEHR system

Note: This Guide and the mandatory data breach notification obligations in the PCEHR Act only apply to the PCEHR System Operator, registered repository operators, and registered portal operators. Registered healthcare provider organisations and registered contracted service providers who experience a data breach should see the OAIC’s Data breach notification guide: A guide to handling personal information security breaches for guidance on dealing with the breach.
September 2015
A guide to mandatory data breach notification under the Personally Controlled Electronic Health Records Act 2012 for the System Operator, registered repository operators and registered portal operators.
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PDF attachments in HL7 messages

2015-August-04 | 11:35 By: Filed in:
Last year in Australia there was an agreement amongst a number of parties, led by the Australian Department of Health, for the results of diagnostic tests to be sent to the national electronic health record system for accessing by both care providers and the individuals for whom the tests were performed. The current proposal to support this specifies that a single PDF report for each test be sent by the laboratory through to the national electronic health record system.
That proposal has led to an increased interest in PDF renditions of pathology reports as well as kindling an interest in how to add attachments to both HL7 v2 messages and CDA documents ( and probably via FHIR now too ). Of course, PDF lab report files are not the only sort of attachment that can be carried by either of these two media. Images, HTML, RTF, Word documents, and a number of other formats can be used. Electronic referrals and discharge summaries are also likely candidates for carrying attachments of various kinds.
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CSIRO uses to 3D printing to create new ribs for cancer patient

Anatomics and CSIRO collaborated to create a customised titanium implant
A Spanish cancer patient has a new, customised titanium sternum and ribcage, thanks in part to a collaboration between the CSIRO and a Melbourne medical device company.
Melbourne-based company Anatomics used the CSIRO's 3D printing facility, Lab 22, to create the implant.
The federal science and industry minister, Ian Macfarlane, revealed details of the project today.
The 54-year-old patient, who suffered from a chest wall sarcoma that meant his sternum and part of his ribcage needed to be replaced, is recovering well and has been discharged, the CSIRO said.
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MedAdvisor is Josh Swinnerton’s mother of all medication advisers

Sarah-Jane Tasker

A strong desire to help his mum manage her supply of medications drove software engineer Josh Swinnerton to develop ­MedAdvisor — a platform he hopes to expand offshore through a backdoor listing on the Australian market.
The company has kicked off a roadshow to drum up investor support to raise about $5 million through a backdoor listing via mining shell Exalt Resources.
Chief executive Robert Read, who was recently appointed to oversee the listing, said the Med­Advisor software, which helps people manage their medication, was driving adherence by up to 20 per cent.
“From a big macro picture, adherence is probably the biggest, preventable health cost,” he said.
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Intuitive Surgical: invest in the future through robotic surgery

We recently wrote on the advances and proliferation of robotics in the industrial world. There are other areas where robotics is having a significant impact.
Recent advances in sensors, machine vision, drive motors, electronics and hydraulics are giving rise to technologically superior robots that can augment skilled human endeavour. These machines are raising productivity, improving outcomes and having significant economic impact.
Healthcare is an area where robotic surgery is increasingly making inroads. This is also the area where there is an investable opportunity: Intuitive Surgical (ISRG US), a publicly listed, US-based pioneer in the design and manufacture of robotic surgery systems.
Intuitive Surgical has had a virtual monopoly in the robotic surgery space since it was founded in 1995. The company went public in 2000.
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NBN and our first hi-tech Prime Minister

Just before he became Prime Minister I had a telephone discussion with the then Minister for Communication, Malcolm Turnbull, regarding an article I wrote in which I expressed my disappointment about various issues around the NBN. He invited me for a deeper discussion on this, I think the time might be ripe to review the NBN and start adding the Fibre-to-the-Home (FTTH) extension to it
I was very critical of the minister in my article but at the same time I am well aware of his knowledge on ICT-related issues, and in most of my blogs where I have talked about this I expressed my high regard for his technical understanding. That was why I expressed my surprise and frustration at his lack of support for a proper NBN and the absence of a visionary drive from him on how we should get there. The multi-technology network (MTM) is simply not good enough in the long term.
With Turnbull now in the top job, he will have far greater freedom to express his views on these issues – views that will most certainly be far more liberal than conservative, which the industry would welcome.
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Start me up: Malcolm Turnbull plugs in to the IT crowd

Glenda Korporaal

On the Friday after the budget in May Communications Minister Malcolm Turnbull addressed the end-of-week get-together at Fishburners, a start-up co-working space in the inner-Sydney suburb of Ultimo.
Among the entrepreneurs who listened to Turnbull was Danny Adams, a 35-year-old former aeronautical engineer who had just founded a fuel-saving start-up called GoFar.
Adams and his co-founder Ian Davidson just happened to be in the middle of a Kickstarter campaign to raise funding for GoFar, a device that plugs into the car to give driver feedback on fuel ­efficiency.
Adams explained his vision for GoFar to Turnbull who then sat down at a computer and used his credit card to pay for the $120 needed to order a GoFar Ray, a space-age-looking device that sits on the dashboard of a car and provides colour-coded feedback on the car’s fuel efficiency.
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Federal government: A worthy benchmark for IT security?

The federal government is, and realistically should be, the benchmark for cyber security in Australia.
It has the most to lose, holding not only our most sensitive state secrets, but also managing air traffic control, billions of dollars in welfare payments, and databases of financial details for each and every one of us.
Canberra took a big step forward in 2013, making the Australian Signals Directorate’s ‘Top 4 Strategies to Mitigate Targeted Cyber Intrusions’ a mandatory part of the Australian Government Information Security Manual.
The ASD boasts that these four strategies - application whitelisting, patching applications, patching operating systems, and minimising who has admin privileges - will defend against 85 percent of all successful intrusions it sees every year.
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Enjoy!
David.