Quote Of The Year

Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

or

H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."

Thursday, February 11, 2016

The Macro View - General And Health News Relevant To E-Health And Health In General.

February 11 Edition
Here is some other of the recent other news and analysis.
Clearly the big news in the last few weeks has been macroeconomic.
In the last week we seem to be having a significant change for the worse with huge losses now being recorded by the large oil companies for the last quarter of last year (and the oil price has fallen further since) and increasing concern that the effects of the low oil price will impact further.
Out of the blue we now see a continuing bun-fight on health insurance costs. Will be fun to watch.
In breaking news it is now seeming that changes to the GST are increasingly unlikely (Prime Minister on Insiders 7/2/2016)
Here is a summary up until the end of last week:
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General Budget Issues.

Dear central bankers, it's time to try something new

Opinion
Eight years of pumping up markets has failed to deliver, so maybe it's time for central bankers from Beijing to Frankfurt to stop running the same failed experiment ad nauseam, writes Ian Verrender.
Albert Einstein would have made a lousy central banker.
He may have been OK with numbers and pretty nifty when it came to theories relating to matter and energy. But his inability to doggedly persist with proven failed strategies would have raised red flags among the financial elite.
"The definition of stupidity is doing the same thing over and over again and expecting different results," he's reputed to once have said.
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Real challenges are ahead for Turnbull and Shorten

  • The Australian
  • February 1, 2016 12:00AM
The scales should fall from the eyes of both Malcolm Turnbull and Bill Shorten as parliament resumes this week and they confront the same realities but face different challenges.
After almost five months as Prime Minister, Mr Turnbull has set a new tone but is yet to deliver the substance required to benefit the nation and ensure his medium-term political success.
Today’s Newspoll results show sustained goodwill from the electorate, with a primary vote that would ensure a resounding Coalition win, but there are warning signs, too, especially on the fiscal reform agenda. The Opposition Leader, on the other hand, can see that while voters are reticent to give Labor a second chance, there is encouragement for his reflexive campaign against a mooted increase in the GST.
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Mike Baird's new GST plan cuts company tax to 25% and income taxes by 7%

There’s yet another new GST plan on the table, and this time it answers the concerns of federal Treasurer Scott Morrison.
NSW Premier Mike Baird, who last year proposed increasing the GST to 15% in order to pay for looming health and education cost shortfalls in state budgets, has announced a refreshed plan that includes significant cuts to the company tax rate and personal income taxes.
Morrison has flagged his desire to cut both taxes, especially income tax, in any scenario involving an increase to the GST rate.
Baird’s updated proposal, which would raise $32.5 billion in extra revenue in its first year, would involve giving $8 billion in compensation to lower-income households to make up for increased prices. After that, Baird says Canberra could spend $8 billion cutting the corporate tax rate to 25%, and then $16 billion to reduce all income tax brackets by 7 percentage points.
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  • Feb 2 2016 at 11:45 PM
  • Updated Feb 3 2016 at 5:25 AM

Malcolm Turnbull's Swedish solution to lift the GST and balance the budget

Malcolm Turnbull needs to balance both economic and fiscal reform. Following Sweden could help win a mandate for tough changes.

Here's something that just might help the Turnbull government.
As everyone knows, the success of Malcolm Turnbull's prime ministership depends on his being able to persuade voters to accept difficult economic and fiscal reform at a time of elevated unemployment and uncertain economic growth.
The reform can be spread over several years to minimise the adjustment cost – a luxury available to low-debt countries – but the mandate must be won from voters this year.
One survey in which 37 per cent of respondents were open to consider an expanded GST – one component of the required reform – may be an encouraging start, but that's all it is. The cat is still a long way from being in the bag.
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  • Feb 3 2016 at 1:11 PM
  • Updated Feb 3 2016 at 6:42 PM

PBO finds Canberra to blame for 80pc of budget slide

About 80 per cent of the collapse in Commonwealth and state government budgets over the second half of last year has been due to the federal government, according to the independent Parliamentary Budget Office.
Warning that the nation's fiscal outlook has "deteriorated significantly" since state, territory and Commonwealth levels of governments handed down their 2015-16 budgets, the PBO said the combined deficit has jumped 28 per cent, or by $34.1 billion, to $122.1 billion over four years.
The independent adviser to political parties and independent MPs also ramped up its alarm about the risks facing the nation, including the recent jitters over global growth as a major concern.
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Malcolm Turnbull says states must lift taxes to share rising health costs

The prime minister questions whether increasing the goods and services tax will boost economic growth once compensation and tax cuts are taken in
The prime minister, Malcolm Turnbull, in Canberra yesterday. He says the states must share rising cost of health funding. Photograph: Mick Tsikas/AAP
Lenore Taylor, Political editor
Malcolm Turnbull has demanded state governments increase their own taxes – such as land tax or payroll tax – and run health systems more efficiently to share the cost of the looming hospitals funding crisis.
After a week in which the government has appeared to cool on the idea of increasing the goods and services tax, and backbenchers have openly criticised the idea, Turnbull used an interview with Adelaide radio to talk up the complexities of the move and reinforce the growing perception that he is unenthusiastic about it.
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Paul Keating: forget taxing, budget can lose $90bn

  • The Australian
  • February 5, 2016 12:00AM

David Uren

It should be possible to strip $90 billion out of the federal budget — a cut of 20 per cent — Paul Keating claims, based on his achievement as treasurer through the late 1980s.
The former prime minister said yesterday that the burning issue should not be taxes but rather how to adjust the budget to the reality that the income the world was paying us had fallen, and this was cutting both personal and company taxes.
“All these things are pushing down on commonwealth revenue and, when it has been so affected, the penny ought to drop that we ought to be cutting spending,” he said, noting that Scott Morrison was correct to highlight this.
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Turnbull says no GST rise unless it can help economy

  • The Australian
  • February 7, 2016 2:02AM

GST increase speculation continues

Malcolm Turnbull has reiterated his doubts the Coalition government should fight this year’s federal election with a GST increase in its platform, adding the government would not seek to raise or widen the 10 per cent consumption tax without putting it to voters.
That could mean any further consideration of a GST increase would have to wait until the election due in 2019. But he left open the possibility of reductions in income tax rates.
He told The Sunday Telegraph the governing MPs would want to be convinced by Treasury before the May budget that a GST increase would foster economic growth before possibly agreeing to adopt it.
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Health Budget Issues.

Health in 2016: a cheat sheet on hospitals, Medicare and private health insurance reform

February 1, 2016 6.05am AEDT

Author Stephen Duckett

We start 2016 as we started 2015 – with big challenges for the health system and uncertainty as to how governments will meet them.
The health care headaches in 2016 are, in fact, the same ones we faced a decade ago, albeit different in severity and symptoms. They include population growth, ageing and the rise of chronic disease; inequality in access to care and health outcomes; technological change (the good, the bad and the expensive) and the seemingly inexorable rise in health costs.
Circling for landing are three major reviews on private health insurance, primary care, and low-value care. Their recommendations, and the government’s response to them, are very much up in the air.
Adding to the uncertainty is the broader review of federalism and its consequences for public hospital funding, along with speculation around the 2016 federal election date and what each party’s Santa sack of election promises might contain.
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Health expenditure grows year on year to $6248 per person

Date February 2, 2016 - 8:30PM

Jane Lee, Julia Medew, Harriet Alexander

The public cost of Australian health care has grown about four per cent per year over a decade to $6248 per person, a report says.
The Productivity Commission's report on health services on Tuesday showed that the amount that federal, state and territory governments spent on health grew from $4788 per person in 2004/5 to $6248 per person in 2014. This was not due to either inflation or population growth rates, which were both factored in to the results.
Public health experts said the growth was driven by a range of factors, including medical advances, the ageing population and an increase in people suffering chronic illnesses.
It comes as the fight over how health funding should be shared between federal, state and territory governments rages on, with NSW Premier Mike Baird pushing for a rise in GST to cover Abbott-era cuts to hospitals and schools.
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Ley to tackle medical device pricing quirk

February 5, 20166:13am
AAP
Ley to tackle medical device pricing quirk
The federal government will move to fix up a quirk that makes medical devices more expensive in the private health system compared to the public one.
Health Minister Sussan Ley said there were fixed price benefits that private health insurers are required to pay on behalf of customers for more than 10,000 devices including pacemakers, pins and plates.
Under the public system there is no set price and greater competition around purchasing, so private health insurers are often paying twice as much for medical devices, which is then passed on to patients through higher premiums.
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Prostheses list costing patients an arm and a leg

  • The Australian
  • February 5, 2016 12:00AM

Sean Parnell

Excessive prices for replacement hips, pacemakers and other medical devices in the private hospital sector — adding $800 million a year to health spending — have prompted a federal government review expected to reduce pressure on insurance premiums.
The Prostheses List, which the government uses to regulate how much health funds have to pay for prosthetics, human tissues and device implants, will be re­designed and renegotiated by the stakeholders who use it.
Health insurers have long complained that the list has them paying well in excess of what public hospitals pay for comparable items, let alone the cheaper prices available overseas, and believe hundreds of millions of dollars could be saved each year.
The Australian Competition and Consumer Commission has also received allegations of ­private hospitals receiving kickbacks — allegedly sourcing items at a cheaper rate and pocketing the difference — while the Har­per review identified potential for “very substantial efficiencies”.
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Public health needs a jab of private productivity

  • Jeremy Sammut
  • The Australian
  • February 5, 2016 12:00AM
Since the 2013 election, the ­national conversation has been dominated by calls to revive the mojo of the 1980s and undertake economic reform to repair government budgets. Yet according to some analysts, South Australian Premier Jay Weatherill’s plan to raise the GST to fund public health and education services is “doable”.
The real question, however, is whether we should do this kind of so-called “tax reform” at all.
Public hospitals and public schools are the two areas of the public sector that have remained largely quarantined from the reform agenda of the past 30 years. Opening other government utilities — such as electricity, ports and transport — to competition and privatisation has improved performance in those crucial areas of the economy. But social services such as hospitals and schools, which consume huge amounts of government expenditure, continue to be sheltered from reform and propped up by taxpayers.
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How much is Sussan Ley spending on GP care?

Paul Smith | 3 February, 2016 | 14 comments Read Later
The cash spent by the Federal Government on GP care for each Australian rose by $10 last year — despite ministerial claims future funding is unsustainable.
Figures released on Tuesday by the Productivity Commission showed that the government spent $351.30 on GP care per person in 2014/15.
It was a 2.9% increase on the $341.50 spent per person the year before.
The Report on Government Services said the figures included the money for the Practice Incentives Program and the now-defunct Medicare Locals.
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Health Minister Sussan Ley targets $800m medical devices waste

Date February 5, 2016 - 11:29AM

Tim Binsted

Health Minister Sussan Ley has pledged to root out exorbitant pricing of medical devices in private hospitals, which wastes up to $800 million a year, in order to halt surging health insurance premiums.
The Minister said on Friday that reform of prostheses, which includes things like hip and knee replacements, plates and pacemakers, has been made a "priority" to complement the federal review into private health insurance.
"When it comes to medical devices, the first priority always needs to be ensuring they are accessible to patients and safe. But a key part of making sure they are accessible is also making sure they are affordable," she said.
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Health Insurance Issues.

Health insurers urge action on costs in return for lower premiums

Date January 31, 2016 - 4:15PM

Tim Binsted

Reporter

Federal Health Minister Sussan Ley needs to crack down on the surging cost of healthcare if she will not accept requested insurance premium increases, health insurers say. 
Ms Ley wrote to private health insurers on Friday asking them to lower their 2016 premium increases – understood to be about 5 to 6 per cent – or to justify them with further information.
"I request that you rework your application to propose a premium increase lower than was previously submitted," Ms Ley wrote.
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Sussan Ley whacking insurers won’t bring premiums down

  • Terry Barnes
  • The Australian
  • February 2, 2016 12:00AM
Everyone knows the joke about why everyone takes an instant dislike to lawyers. Because it saves time.
It’s a joke that equally applies to private health insurance. Half the Australian population has it, and grumble about their PHI coverage and the annual premium rises that are as predictable as the sun rising. The other half doesn’t have PHI, but decry the billions of dollars they see wasted on the private health sector that should be directed to the public system, and especially overstretched public hospitals.
Premiers, as well-off people with their own private health insurance but struggling to contain the cost of their hospitals, straddle both camps.
By a quirk of Howard-era holdover, PHI premiums have to be approved by the federal health minister.
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  • Feb 1 2016 at 5:05 PM
  • Updated Feb 1 2016 at 9:05 PM

Sussan Ley's attack on health premiums favours big funds, threatens non-profits

Health Minister Sussan Ley's crackdown on health insurance premium increases threatens the viability of smaller funds and may help big players such as Medibank and Bupa take over their smaller competitors, non-profit funds say.
Ms Ley, who is overseeing a review of the $19 billion private health insurance sector, wrote to health funds on Friday asking them to either lower their requested premium increase or justify their initial request.
"Putting the blame on us might get the minister some good headlines, but it could do long-term damage to the industry and force health funds to the wall," said Matthew Koce, spokesman for the not-for-profit Australian Health Service Alliance and chief executive of non-profit fund lobby group HIRMAA.
"Some funds might decide to fold and leave the marketplace or consolidate with others."
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Healthcare insurers queried by Susan Ley over premium increases

  • The Australian
  • February 2, 2016 12:00AM

Sarah-Jane Tasker

Australian health insurers, forced to working on new premium-increase submissions by Health Minister Sussan Ley, expect the federal government to also attack “more obvious” causes of cost escalation.
The minister wrote to health insurers on Friday, more than two months after they had submitted their premium-increase wishlist, telling them to rethink what they were seeking.
In the letter, seen by The Australian, Ms Ley said she was determined to ensure that premium increases were the minimum necessary to maintain insurer solvency requirements, support benefit outlays and meet prudential standards, while also ensuring private health insurance remained affordable and good value for consumers.
She told insurers to propose premium increases lower than what they had previously submitted and asked they take into account their capital adequacy and prudential and solvency requirements.
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Mind the gap

Cathy O'Leary
February 4, 2016, 1:10 am
WA’s biggest health fund has warned that moves to block premium rises could lead to bigger gap payments for patients.
HBF managing director Rob Bransby said it was a false economy for the Federal Government to reject applications for increases on the basis it would be better for consumers.
Health Minister Sussan Ley last week ordered health funds to reduce or justify their planned premium increases, arguing consumers were finding it more difficult to shop around for a better deal.
HBF, which has 60 per cent of the private insurance market in WA, confirmed yesterday it would not back down from its original proposal but would not reveal the amount it was seeking.
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Health funds demand surgeons swear work’s not purely cosmetic

  • The Australian
  • February 4, 2016 12:00AM

Sean Parnell

Australia’s two largest health funds are demanding doctors sign declarations before performing certain surgery on members to prove it is clinically necessary and deserving of benefits.
Amid debate over rising health costs, Medibank Private and Bupa are requiring signatures for procedures they suspect might be ­merely cosmetic even though the doctor is claiming Medicare rebates on the basis they are needed.
Australian Society of Ophthalmologists president Michael Steiner said yesterday surgeons who operated on eyelids and the tear-duct system were booking in procedures, only for the funds to question their decision-making.
Dr Steiner said Medibank Private and Bupa initially had used pre-approval forms, which the ­society deemed illegal, but last month adopted the same pre-­eligibility forms. He said he knew of several cases where surgery had been cancelled because the surgeon refused to sign, including that of an elderly patient who had travelled three hours to hospital.

AMA accuses private health funds of labelling surgeries as cosmetic to avoid pay-outs

The Australian Medical Association (AMA) has accused private health funds of refusing to pay out some legitimate claims by categorising them as cosmetic procedures, in what they say is a dangerous move in the direction of a US-style health system.

Key points:

  • AMA accuses private health funds of refusing to pay out some legitimate claims
  • Concern it is a dangerous step towards a US-style health system
  • Medibank says certain codes used in hospitals classify procedures as cosmetic and funds must check before paying
Two of Australia's largest funds, Bupa and Medibank, have begun asking surgeons to sign declarations about the nature of their procedures to determine whether they are a cosmetic procedure or not.
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Non-smokers worth bonus, say doctors

Kim Macdonald
February 5, 2016, 12:50 am
The Australian Medical Association WA has suggested no-claim bonuses for non-smokers who take private health insurance.
State president Michael Gannon said the move would help address disillusionment with health insurance premiums that are rising about four times faster than Perth’s 1.5 per cent annual inflation rate.
He said “25 years of rolled-gold health warnings” about cigarettes meant anyone born after 1960 should know better than to smoke.
However, he stressed he would not support risk rating on any other grounds because it could discriminate on gender, ethnicity or genetic dispositions to illnesses.
He said premium increases of 6, 7 and 8 per cent year a year were unsustainable, especially when patients questioned the value of their premiums for other reasons.
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Health is also clearly still under review as far as its budget is concerned with still a few reviews underway and some changes in key strategic directions. Lots to keep up with here with all the various pre-budget kites being flown! Enjoy.
David.

Wednesday, February 10, 2016

Now Here Is An Attempt To Make Us All Obsolete - Exciting Stuff I Reckon?

This popped up a few days ago:

New project aims to 'reverse-engineer' the brain

The goal is to make computers learn the way humans do
Teaching computers to learn the way we do is widely considered an important step toward better artificial intelligence, but it's hard to achieve without a good understanding of how we think. With that premise in mind, a new $US12 million effort launched on Wednesday with aims to "reverse-engineer" the human brain.
Led by Tai Sing Lee, a professor in Carnegie Mellon University's Computer Science Department and the Center for the Neural Basis of Cognition (CNBC), the five-year project seeks to unlock the secrets of neural circuitry and the brain's learning methods. Ultimately, the goal is to improve neural networks, the computational models often used for AI in applications including self-driving cars, automated trading, and facial and speech recognition.
"Today's neural nets use algorithms that were essentially developed in the early 1980s," Lee said. "Powerful as they are, they still aren't nearly as efficient or powerful as those used by the human brain."
A computer might need to be shown thousands of labeled examples in order to learn to recognize an object, for example, while a human would require only a handful.
Trying to figure out why that's so will use a technique called two-photon calcium imaging microscopy. Researchers will record the signaling of tens of thousands of individual neurons in mice as they process visual information.
"By incorporating molecular sensors to monitor neural activity in combination with sophisticated optical methods, it is now possible to simultaneously track the neural dynamics of most, if not all, of the neurons within a brain region," said team member Sandra Kuhlman, assistant professor of biological sciences at Carnegie Mellon and the CNBC.
A massive data set will result, offering a detailed picture of how neurons in one region of the visual cortex behave, she added.
More here:
I guess I won’t see the outcome in my lifetime - but for the first time ever I suspect one of these teams mentioned may actually make some real progress. Time will tell.
David.

This Looks To Be A Very Interesting Step Forward For E-Health In Oz and NZ. It Seems To Be Really Working.

This release appeared a few days ago.
MEDIA RELEASE – FOR IMMEDIATE RELEASE
2 February 2016

HealthLink announces the launch of SmartForms

One of the worst kept secrets in the health IT industry has now been publicly confirmed.  HealthLink’s new SmartForms solution is being implemented across all the major practice management platforms and electronic medical records systems in Australia and New Zealand.  HealthLink already has its eyes firmly on a service launch in British Columbia in the not too distant future. 
HealthLink’s SmartForms solution is currently being rolled out across HealthLink’s 13,500 site network.  Almost all of the major EMR systems across Australia and New Zealand have implemented SmartForms or are in the process of doing so.
·         Best Practice     
·         Cloud Appointments
·         Genie
·         Gensolve
·         Houston Medical
·         IntraHealth (windows and Macintosh)
·         MedTech (Medtech32 and Evolution)
·         Medical Director
·         My Practice
·         Peak Software
SmartForms technology has already been developed and implemented across much of New Zealand’s health system over the past five years.  It is being used for a number of purposes including electronic hospital referrals, specialist and allied health referrals, health insurance forms, as well as pathology and radiology service requesting.  The number of SmartForms being sent each month continues to climb.  In November, General Practices sent 170,000 SmartForms. 
One of HealthLink’s key advantages is a close working relationship with the electronic medical record (EMR) vendor community across Australia and New Zealand.  HealthLink works closely with each of these companies as a neutral party and is therefore able to sort out interoperability issues and problems.  HealthLink also funds some of the EMR vendors’ development activities and works closely with their support teams to develop services collaboratively.”
“We are delighted that Australia and New Zealand’s largest electronic medical records vendors have incorporated SmartForms as a key feature within their latest product releases.”
Key to the steady emergence of SmartForms as a robust and dependable industry solution is the Aduro Interface specification.   Aduro is a standards based framework for exchange of clinical information on a large scale is the objective of the Aduro Alliance which is being set up to promote use of the Aduro specification.  For further information please visit www.aduroalliance.com
----- End Release.
More at http://www.healthlink.net/en_AU/
It is good to know the underlying specs are moving to the FHIR approach - which may well turn out to be a very important way forward in the future.
I look forward to hearing from users about their experiences!
David.

Tuesday, February 09, 2016

It Seems That The Evidence That The PCEHR Is A Dud Is Building. The Waste Continues.

This article appeared last week:

E-health records have few fans, study confirms

1 February 2016
MORE patients than clinicians use My Health Record, and most users – both doctors and patients – are generally negative about the system.
But much of the negativity may be because users don’t understand the system, a new factor analysis of studies shows.
By March 2015, about 9% of all Australians were registered with the My Health Record (MyHR) system, previously known as the PCEHR, with some 5000 GP practices (almost 75% of those eligible) and 11,000 clinicians on board, and 44,000 shared health summaries available.
But the analysis notes that most people viewing the information on the system are consumers, with around 20,000 patient viewings per month.
According to the study, published in the Internal Medicine Journal, the potential reasons for GPs not accessing the system are:
  • Doctors believing they know most of what they need to about their patients.
  • The “clunky” MyHR summary display.
  • The fear of missing important information, placing doctors at risk of litigation.
  • The lack of evidence showing the system helps deliver better patient outcomes.
“These findings suggest that Australian consumer and healthcare providers are generally negative towards the PCEHR [now MyHR],” it says. 
“Participants’ uncertainty appears to stem from not knowing the mechanics of the PCEHR”. 
The analysis found that although most Australians appeared ambivalent or negative about the value of the system, a large minority of 42% seemed positive.
More here:
Here is the abstract.

Positive beliefs and privacy concerns shape the future for the Personally Controlled Electronic Health Record

  1. E. C. Lehnbom1,*,
  2. H. E. Douglas2 and
  3. M. A. B. Makeham2
Article first published online: 27 JAN 2016
DOI: 10.1111/imj.12956

Abstract

The uptake of the Personally Controlled Electronic Health Record (PCEHR) has been slowly building momentum in Australia. The purpose of the PCEHR is to collect clinically important information from multiple healthcare providers to provide a secure electronic record to patients and their authorised healthcare providers that will ultimately enhance the efficiency and effectiveness of healthcare delivery. Reasons for the slow uptake of the PCEHR and future directions to improve its usefulness is discussed later.
Paid access to the rather short article is found here:
(Note: The article was submitted in April 2015 and is actually a re-analysis of a study which was actually published in 2014.
“A more recent study sought to survey the Australian general public’s perceptions of having a PCEHR and found that the perceived value and risk associated with the PCEHR were the two most important variables explaining attitudes.7 This survey used questionnaires borrowed from consumer acceptance of interactive communication technology studies, which were not specifically developed for the PCEHR; therefore, its use in examining the attitudes towards the PCEHR is limited. To establish what constituted the key attitudes towards PCEHR in Australia, we performed a factor analysis on previously published data.9”
Here are the 2 references cited
7. Andrews L, Gajanayake R, Sahama T. The Australian general public’s perceptions of having a personally controlled electronic health record (PCEHR). Int J Med Inform 2014; 83: 889–900.
9. Lehnbom EC, Brien JE, McLachlan AJ. Knowledge and attitudes regarding the personally controlled electronic health record: an Australian national survey. In- tern Med J 2014; 44: 406–9.)
This said, it is hard to argue with the concluding recommendations:
“Future efforts to improve to uptake and usability of the PCEHR should focus on alternative structures to present in- formation to enable healthcare providers to find quickly the information they are looking for; evaluate the impact of PCEHR on healthcare delivery and patient outcomes to provide evidence that having a PCEHR makes a difference and track the awareness and knowledge of consumers and healthcare providers of the PCEHR’s potential  benefits.”
I have a sense hell may freeze over before we see these recommendations actually implemented - time will tell I guess.
I do wonder just why these publication are not available without paid subscriptions. DoH should be making them available!
David.

Senate Estimates - E-Health Hearing Tomorrow Late Afternoon (Feb 10, 2016)

 Here is the listing


 Community Affairs (PDF 80KB)
Health: Wednesday, 10 February 2016        
E-Health Section
4:45pm – 5:55pm
Outcome 7: Health System Capacity and Quality
Program 7.1: e-Health Implementation
Program 7.2: Health Information
Program 7.3: International Policy Engagement
Program 7.4: Research Capacity and Quality

Select Program here to watch

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

Enjoy 

David.


Monday, February 08, 2016

Weekly Australian Health IT Links – 9th February, 2016.

Here are a few I have come across the last week or so.
Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

A really quiet week indeed with little happening - other than some new research suggesting the PCEHR needs a great deal more work.
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GPs shun new e-health system

1 February, 2016  
More patients than clinicians use My Health Record, and most users – both doctors and patients – are generally negative about the system.
But much of the negativity may be because users don’t understand the system, a new factor analysis of studies shows.
By March 2015, about 9% of all Australians were registered with the My Health Record (MyHR) system, previously known as the PCEHR, with some 5000 GP practices and 11,000 clinicians on board.
-----

E-health records have few fans, study confirms

1 February 2016
MORE patients than clinicians use My Health Record, and most users – both doctors and patients – are generally negative about the system.
But much of the negativity may be because users don’t understand the system, a new factor analysis of studies shows.
By March 2015, about 9% of all Australians were registered with the My Health Record (MyHR) system, previously known as the PCEHR, with some 5000 GP practices (almost 75% of those eligible) and 11,000 clinicians on board, and 44,000 shared health summaries available.
But the analysis notes that most people viewing the information on the system are consumers, with around 20,000 patient viewings per month.
-----

Positive beliefs and privacy concerns shape the future for the Personally Controlled Electronic Health Record

  1. E. C. Lehnbom1,*,
  2. H. E. Douglas2 and
  3. M. A. B. Makeham2
Article first published online: 27 JAN 2016
DOI: 10.1111/imj.12956

Abstract

The uptake of the Personally Controlled Electronic Health Record (PCEHR) has been slowly building momentum in Australia. The purpose of the PCEHR is to collect clinically important information from multiple healthcare providers to provide a secure electronic record to patients and their authorised healthcare providers that will ultimately enhance the efficiency and effectiveness of healthcare delivery. Reasons for the slow uptake of the PCEHR and future directions to improve its usefulness is discussed later.
-----

The Coalition is stuck in ‘Yes Minister’ mode

  • Business Spectator

Robert Gottliebsen

I find it stunning that so many Coalition politicians are advocating an increase to the GST when there is a multitude of government spending areas that could be slashed without any effect on services.
Longer term, as our population ages, we may need to increase the GST to pay for the additional outlays required. But there should be no GST increases while lazy politicians pander to the public service.
The two most obvious areas of substantial expenditure cuts that don’t reduce services are in none other than health and education. These are exactly the areas where higher-GST advocates plan to spend the money.
When the Coalition government campaigned to replace Kevin Rudd back in 2013, one of its linchpin policies was to end the massive sums being wasted in health and education, plus other areas, through Commonwealth-state duplication.
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Melbourne Health still grappling with Qbot malware

Virus mutations make it hard to contain.

By Allie Coyne
Feb 2 2016 4:59PM
Melbourne Health is still working to contain a dangerous strain of malware that attacked its systems more than two weeks ago due to the virus' ability to mutate and hide itself from discovery.
On January 18 the health network revealed malicious software had infected Windows XP computers through Royal Melbourne Hospital's pathology department.
The malware downed the hospital's pathology systems and forced staff into manual workarounds.
It made its way into the health department through an unnamed zero-day exploit in Windows XP computers, past the agency's full enterprise antivirus suite.
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Malware attacks a Melbourne hospital’s outdated IT system

Australia February 2 2016
Don’t say we (and Microsoft) didn’t warn you, a prominent Melbourne hospital’s IT system that runs on an outdated and unsupported Windows operating system, Microsoft XP, was hacked last week.
Microsoft recently activated the end-of-life phase for Windows 8, 9 and 10 and encouraged users to transition to the company’s supported operating systems in order to prevent security incidents. The same process was undertaken for Microsoft XP in 2014; however the hospital continued to use the platform in some departments.
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“Health IT – to lead or be led” seminar & workshop

EHRs – today’s reality…

  • Lack of clinician engagement with eHealth
  • Silos of data
  • Fragmentation of eHealth activities and clinical data
There is increasingly awareness of the need for use of clinical data to support high quality healthcare delivery.  Yet it has traditionally been difficult for clinicians to engage and participate in influencing the quality of the data that they need to support their care of patients, for research and analysis, to underpin clinical decision support and exchange with other healthcare providers.
Momentum is now gathering in Australia and a number of international eHealth programs to change this, using a new clinician-led approach which involves standardisation and sharing of  high quality, computable clinical  data specifications.
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Data breach notification: Senate calls for government to explain delays

Senate calls on Attorney-General George Brandis to clarify the government’s intentions
The Senate yesterday backed a motion introduced by Greens Senator Scott Ludlam that called on the government to explain delays in introducing a mandatory data breach notification scheme.
The introduction of a data breach notification regime formed part of the government’s response to the report of the parliamentary inquiry into the data retention.
The report of that inquiry had recommended the creation of such a scheme.
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Mandatory reporting of data breaches coming

The Australian Government has proposed that companies with a turnover of $3 million or more must notify people whose personal information may have been exposed in a serious data breach.
The draft bill  is open for submissions until 4 March 2016 but it is understood that it is generally equitable.
LogRhythm, a leader in security intelligence and analytics has joined with IPSec, one of Australia’s leading specialists in information protection to launch IPSecGuard to enable Australian organisations of all sizes to leverage the benefits of a 24/7 fully manned security operations centre (SOC) solution.
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Former NAB exec to lead billion-dollar Centrelink IT overhaul

John Murphy to WPIT.

By Paris Cowan
Feb 1 2016 10:00AM
The Department of Human Services has hired a former NAB banking executive to lead its billion-dollar welfare payments infrastructure transformation (WPIT) project.
John Murphy will start work at the department on 22 February, after being appointed to a new deputy secretary-level role created to lead the mammoth replacement of the mainframe-based system currently used to calculate and pay welfare entitlements across the country.
Murphy joins the DHS from the National Australia Bank, where he currently serves as executive general manager of deposits and transaction services, his seventh executive job title with the financial institution, according to his Linkedin profile.
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Barwon Health appoints health veteran as CIO

Fills vacancy created by the departure of Ann Larkins.

By Andrew Sadauskas
Feb 1 2016 2:23PM
Victorian state-owned public health operator Barwon Health has promoted Sharon Hakkennes to the role of chief information officer, filling a vacancy left by the departure of Ann Larkins last year.
Hakkennes has worked in the healthcare industry for more than 20 years and has served in numerous roles since joining Barwon Health in March 2014. Her previous roles for the organisation include director of health informatics and information management officer.
Outside of Barwon Health, Hakkennes is a director of the Kids Plus Foundation, an organisation that delivers multi-disciplinary therapy programs for young people with neuro developmental disabilities, and a member of the department’s clinical informatics reference group.
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Mobile Health Solutions to use Optus satellite

  • 03 February 2016
New Zealand health care provider Mobile Health Solutions will use Optus Satellite services to deliver health education via videoconferencing.
Mobile Health Services has entered a deal with New Zealand ISP Wireless Nation for satellite-based mobile videoconferencing services. Wireless Nation uses satellite capacity provided by Optus.
Mobile Health will use the link to deliver health education sessions from its van to rural parts of the country.
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New section for pharmacists on the NEHTA website

Created on Wednesday, 03 February 2016
NEHTA has published a new section specifically for pharmacists wanting to use eHealth.
Pharmacists can find a range of helpful information on eHealth benefits, how to use the My Health Record system in their pharmacy and how to promote their pharmacy as eHealth capable. We have also provided a list of helpful contacts, frequently asked questions by pharmacists and additional information around policies, procedures, processes, and guides.
For help, call 1300 901 001 or please email the NEHTA Help Centre at help@nehta.gov.au.

Webinar slides now available for 'Connecting your software to the My Health Record system'

Created on Friday, 05 February 2016
The presentation webinar slides for the Connecting your software to the My Health Record system webinar are now available for download.
The webinar took place on Wednesday 3 February 2016 and follows on from the first webinar Introduction to the national My Health Record system and will outline the steps for software developers to connect your system to the My Health Record system. It also covers the resources available to support your implementation.
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Telehealth solutions from real world learnings

Delivering and bringing scale to telehealth and telemedicine along with practitioner and user experiences of implementations rather than pilots are among the key themes of this year’s Australian Telehealth Conference (ATC) program, which has just been launched.
Confirmed speakers at ATC 2016 include Associate Professor Francesco Paolucci from Murdoch University who will advise delegates on how to remove barriers and bring scale to telehealth services.
Andrew Slater from Homecare Medical in New Zealand will talk about healthcare professionals and organisations already delivering change while Dr Andrew Lin, the founder and CEO of home health technology developers CliniCloud, is presenting on home medical devices moving telemedicine into the mainstream.
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Can Malcolm Turnbull’s pet project fix myGov?

Starts at Sixty Writers
Could Australia’s most frustrating website be saved by the Prime Minster? If so, he will be remembered for doing a great thing for society.
Fairfax media is reporting that management of the myGov website will be taken away from the Department of Human Services and passed over to the Digital Transformation Office.
The DTO is was established  in July 2015 and is part of the Prime Minister’s portfolio. According to the department’s website, its mission is to lead the transformation of government services to deliver a better experience for Australians.
“In any given month, one in eight Australians aged 14 and over will look up government information and services online, totalling around 324 million transactions a year. Of these people, more than half will experience a problem.
Meeting this challenge is vital to our success as a government, and as a nation.”
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ACT government defends seeking access to Canberrans' metadata

Date February 1, 2016 - 12:00AM

Tom McIlroy

Legislative Assembly reporter at The Canberra Times

The ACT government has defended its right to seek access to Canberrans' private phone and internet records without a warrant, in moves designed to assist law enforcement and anti-tax evasion efforts.
Among dozens of federal, state and territory agencies which have sought access to citizens' metadata for criminal investigations or protection of government funds are the ACT Revenue Office and the Access Canberra agency, which sits as part of Chief Minister Andrew Barr's Treasury and Economic Development Directorate.
Last month, the federal government issued a list of 61 non-law enforcement agencies that had applied for the right to access metadata. Australia Post, the Australian Taxation Office, the RSPCA, seven federal departments and local councils are included on the list.
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New project aims to 'reverse-engineer' the brain

The goal is to make computers learn the way humans do
Teaching computers to learn the way we do is widely considered an important step toward better artificial intelligence, but it's hard to achieve without a good understanding of how we think. With that premise in mind, a new $US12 million effort launched on Wednesday with aims to "reverse-engineer" the human brain.
Led by Tai Sing Lee, a professor in Carnegie Mellon University's Computer Science Department and the Center for the Neural Basis of Cognition (CNBC), the five-year project seeks to unlock the secrets of neural circuitry and the brain's learning methods. Ultimately, the goal is to improve neural networks, the computational models often used for AI in applications including self-driving cars, automated trading, and facial and speech recognition.
"Today's neural nets use algorithms that were essentially developed in the early 1980s," Lee said. "Powerful as they are, they still aren't nearly as efficient or powerful as those used by the human brain."
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NBN research: fibre to node satisfies as much as fibre to home

  • The Australian
  • February 5, 2016 12:00AM

Annabel Hepworth

NBN research has found fibre-to-the-node technology as satisfactory as fibre to the home.
Homes with the fibre-to-the-node technology at the heart of the Coalition’s National Broadband Network policy are re­porting the same levels of satisfaction as those with the all-fibre model favoured by Labor, ­research suggests.
The Australian can reveal that initial research finds that both homes getting the NBN over FTTN technology — which uses the century-old copper network for about the last 350m to homes — and those with fibre to the premises are scoring their satisfaction at 7.7 out of 10.
The government-owned company building Australia’s largest infrastructure project will point to the findings today when it delivers its half-year results in Melbourne.
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Good riddance to the Java plugin

Date February 3, 2016 - 8:10AM

Brian Krebs

Java is installed on roughly 850 million computers worldwide.
Good news: Oracle says the next major version of its Java software will no longer plug directly into the user's web browser. This long overdue step should cut down dramatically on the number of computers infected with malicious software via opportunistic, so-called "drive-by" download attacks that exploit outdated Java plugins across countless browsers and multiple operating systems.
According to Oracle, some 97 per cent of enterprise computers and a whopping 89 per cent of desktop systems in the US run some form of Java. This has made Java JRE (the form of Java that runs most commonly on end-user systems) a prime target of malware authors.
"Exploit kits," crimeware made to be stitched into the fabric of hacked and malicious sites, lie in wait for visitors who browse the booby-trapped sites. The kits can silently install malicious software on computers of anyone visiting or forcibly redirected to booby-trapped sites without the latest version of the Java plugin installed. In addition, crooks are constantly trying to inject scripts that invoke exploit kits via tainted advertisements submitted to the major ad networks.
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Enjoy!
David.

Sunday, February 07, 2016

Article Draft: E-Health in 2016. What Can You Expect For This Year? It Will Be One to Watch!

As this is the first article for 2016 I thought it might be useful to lay out some expectations for the rest of the year ahead in National E-Health.
I think it would be fair to say that 2015 wrapped up quietly with those interested in the e-Health domain expecting a lot of back-room activity to be happening after the passage of new PCEHR (now officially called My Health Record (mHR after Jan 16, 2016) legislation causing waves in 2016.
This legislation, among other things, has enabled the conduct of trials of an ‘opt-out’ approach to your personal information being held in the Government mHR system and has enabled a new Australian Digital Health Agency (previously the ACeH) to replace some Department of Health functions and the National EHealth Transition Authority (which is seen as having lost clinician and technical confidence).
The mHR change was seen as necessary by the Department because, after two years, clinician and consumer interest and use in the PCEHR was very low with less than 10% of the population having a record and very few patients or clinicians actually accessing the record. The change was seen as the last throw of the dice to have the system become relevant and useful. If the change is seen as successful, the legislation authorises extension of the record to the whole population.
At the time of writing we have seen the expected activity begin to  manifest. The present announced plan is that there will be two trials of the ‘opt-out’ consent approach conducted. The first will involve about half a million people in Far North Queensland and the second trial will be conducted in Far Western Sydney and the adjacent Blue Mountains.
What the trials will involve is the creation of a health record for each individual with the record then being populated with data held in the Medical Benefits and PBS systems for the individual concerned.
So far there have been consultations with a variety of different health professionals (GPs, Allied Health etc.) where the Government’s plans have been outlined, as discussed above. It is planned that over the next period there will be an educational program conducted to inform the relevant populations of what is happening and to offer anyone who is concerned to not have their record made accessible - although a record will apparently still be created.
Clearly before any trial can begin it will be necessary for GPs, Allied Health and Hospitals to have access to systems where the records are integrated into their present  systems.
If there is no slippage in the time-table (which seems pretty unlikely) it is intended that the records of those who have not opted out will be made available to the individual, so they can set up the access controls they desire for their mHR and then the system will be made available for access by clinicians - around the end of June 2016.
An evaluation team has been funded ($1.4M) until the end of November 2016, which seems to be an extremely short time to complete an evaluation and report on the trial(s).
There have been no criteria made public as to how success of the trials will be determined and, as it is clear that the Department wants to develop a clinical database for additional research purposes rather than direct patient care and safety, it seems likely the system will just proceed - useful clinically or not. The Government has invested close to a $1.0Billion in the system which has so far failed - and committed an additional $0.4Billionover the next few years - so simply walking away - sadly - seems unlikely.
The new Australian Digital Health Agency is intended to commence operations on July 1, 2016 and is the other major e-Health activity for 2016 that we are presently aware of.
The functions of the Agency - as set out in the enabling regulations, is as follows:
(a) to coordinate, and provide input into, the ongoing development of the National Digital Health Strategy;
(b) to implement those aspects of the National Digital Health Strategy that are directed by the Ministerial Council;
(c) to develop, implement, manage, operate and continuously innovate and improve specifications, standards, systems and services in relation to digital health, consistently with the national digital health work program;
(d) to develop, implement and operate comprehensive and effective clinical governance, using a whole of system approach, to ensure clinical safety in the delivery of the national digital health work program;
(e) to develop, monitor and manage specifications and standards to maximise effective interoperability of public and private sector digital health systems;
(f) to develop and implement compliance approaches in relation to the adoption of agreed specifications and standards relating to digital health;
(g) to liaise and cooperate with overseas and international bodies on matters relating to digital health;
(h) such other functions as are conferred on the Agency by this instrument or by any other law of the Commonwealth;
(i) to do anything incidental to or conducive to the performance of any of the above functions.
Essentially the Agency is to become the Operator of the mHR and the co-ordinator and facilitator of national e-Health initiatives.
As with all entities of this type, the selection of the CEO and Board and the quality of those appointed to the various advisory committees which will cover clinical and technical issues, privacy and security issues, consumer issues and jurisdictional issueswill determine how likely success is. One key concern is all the activity on the opt-out trials etc before the agency responsible even exists. One can’t but wonder how sensible this is.
Left out of this discussion is the very wide range of State and private sector initiatives, some of which seem to me to show very considerable promise. They will have to form the basis of a future article.
All in all, 2016 looks to be a pretty big year in National E-Health. At this point it is impossible to know how things will turn out and if the public will receive value for the money being spent. Nevertheless it will be fun to watch!
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Comments welcome!
David.

AusHealthIT Poll Number 306 – Results – 7th February, 2016.

Here are the results of the poll.

Overall, Now It Is Being Wound Up, How Would You Rate NEHTA's Performance Over The Last Decade?

Great 2%

Good 1%

OK 10%

Not Much Good 45%

Pretty Bad 15%

Just Awful 26%

I Have No Idea 1%

Total votes: 92

A really decisive poll. 86% said NEHTA’s performance was Not Much Good or worse. The message is clear - they have been a decade long failure.

Good turnout of votes!

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

David.