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, March 03, 2016

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

March 3 Edition
The macroeconomic stresses seem to have eased ever so slightly - but are probably resting rather having been resolved.
This article provides a few hints:

Budget 2016: as jobs go, global economy falters, says G20 report

  • The Australian
  • February 26, 2016 12:00AM

David Uren

Scott Morrison will come under pressure at his first G20 meeting in Shanghai this weekend to use the budget to launch a new round of stimulus spending — the first since the global financial crisis — as the IMF warns finance ministers that the world is at risk of a new downturn.
In a bleak report prepared for the meeting — and against the backdrop of thousands of new job losses in Australia after the closure of the Dick Smith retail chain — the International Monetary Fund says the global economy is faltering and governments have done too little to boost demand.
“The global economy needs bold multilateral actions to boost growth and contain risk,” it says. “The G20 must plan now for co-ordinated demand support using available fiscal space to boost public investment and complement structural reform.”
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Also, in Australia, we are now see a continuing bun-fight on pathology funding, health insurance costs as well as negative gearing and superannuation. Will be fun to watch. Mr Morrison seems to have disappointed with the lack of a clear plan.
Last week we heard there would be a before the Budget announcement of  tax proposals so that will happen soon. Stay tuned!

Thursday Update: Markets have perked up more than somewhat - will it be sustained? Who knows...
Here is a summary of interesting things up until the end of last week:
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General Budget Issues.

Iron ore recovery offers budget boon hopes

Date February 22, 2016 - 9:48AM

Mark Mulligan

Senior markets and economy writer

Treasurer Scott Morrison is facing a potential multibillion-dollar revenue windfall as he prepares his first budget, with a surprising rally in the price of iron ore coming at just the right time for the government.
The commodity has surged to its highest level in three months – putting it back to about $US48 a tonne –as Chinese steelmakers ramp up production after their Lunar New Year break, a sign that global demand for iron ore could increase significantly in coming months.
Share prices have soared for iron ore miners, with BHP Billiton jumping 17 per cent in the last four weeks to $16.61 a share, and Rio Tinto climbing11 per cent, to $42.62 a share.
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Turnbull government ponders radical move to bring forward the federal budget

Date February 22, 2016 - 1:40PM

James Massola

Political correspondent

EXCLUSIVE

Senate reform goes to parliament

The government is legislating to change senate elections. Malcolm Turnbull says the current system has been 'gamed' by 'preference whisperers'.
A radical idea to bring forward the federal budget from May 10 has been floated among senior members of the Turnbull government.
Although such a radical move is considered unlikely by Turnbull government insiders – and it has not been formally considered in forums such as cabinet – Fairfax Media has confirmed the idea has been discussed.
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  • Feb 24 2016 at 12:43 PM
  • Updated Feb 24 2016 at 3:01 PM

It's official: Treasury gets budget revenue forecasts wrong by $682b, PBO says

It's official - the size of the nation's budget forecasting blunder across the boom and bust years since 2002 is $682 billion.
That's the staggering combined amount of revenue that successive Coalition and Labor governments both under-estimated during the upswing in the years leading up to the global financial crisis, as well as the even greater shortfalls in revenue posted since the end of the commodity price surge in 2011.
The bad news is that the downgrades during the near seven years of budget famine forecast out to 2018-19 are $124 billion greater than windfalls received during the years of relative budget plenty between 2002-03 and 2008-09. 
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  • Feb 24 2016 at 6:25 PM
  • Updated Feb 24 2016 at 6:25 PM

Turnbull moves to defuse state funding election bomb

Malcolm Turnbull is moving to defuse a bruising election-year clash with state premiers over health and education funding cuts with a deal that would result in a further deterioration in the federal budget bottom line.
While Treasurer Scott Morrison has been maintaining pressure on states to fix their own budget shortfalls, the Prime Minister is signalling to state leaders that he is open to an interim funding fix.
The stop-gap measure would still leave open the longer-term question of the division of funding and service responsibilities between states, territory and federal governments – something that would need to be addressed in years to come.
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Turnbull walks away from tax reform: only caps on super, negative gearing left

Date February 25, 2016 - 7:27AM

Peter Martin

Economics Editor, The Age

Tax reform eludes government

The government all but abandons serious tax reform - at least for now. Peter Martin explains what's in and what's out.
The Turnbull government is preparing to abandon serious tax reform.
It has ruled out major change in favour of a pair of savings measures seen as politically safe: curbing the excessive use of negative gearing by wealthy investors, and reducing extensive parking of pre-tax income in superannuation accounts.
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Terrified on tax: why Malcolm Turnbull will squib it

Date February 25, 2016 - 12:15AM

Peter Martin

Economics Editor, The Age

So much for big reforms. Don’t expect Malcolm Turnbull to present a bold tax plan. He’s too scared of putting voters offside.

Tax reform eludes government

The government all but abandons serious tax reform - at least for now. Peter Martin explains what's in and what's out.
A decade ago in a speech titled The Way Ahead, Malcolm Turnbull labelled negative gearing "tax avoidance". Tellingly, he observed that "every tax deduction, once created, develops a constituency which will fight to defend it".
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Defence white paper: big spending means other portfolios hit

  • The Australian
  • February 26, 2016 12:00AM

David Uren

Defence will become one of the fastest growing budget programs, with spending rising by an average of 6.8 per cent a year across the next decade, demanding big savings from other portfolios.
The rapid growth in defence outlays, which will raise its share of government spending from 7 per cent to 8 per cent, comes as Treas­ury has been downgrading its estim­ates of economic growth.
Although the slower growth has made it easier to get defence spending to 2 per cent of gross domestic product, a commitment made by Tony Abbott in the 2013 election campaign, it has made Scott Morrison’s budget challenge more difficult.
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  • Feb 26 2016 at 1:23 PM
  • Updated Feb 26 2016 at 3:45 PM

The path to reforming our economic leader Malcolm Turnbull

Where does Malcolm Turnbull, economic leader, go from here?
It's a depressing moment. Having given up the battle to expand the role of the GST, the government appears to have scaled back its cuts in personal income and company tax. The economic gains from the change in the national tax mix now will depend in part on how cleverly the premiers fill the gap left by Turnbull's GST decision.
At the same time, the prime minister has used the opposition's proposed policy on negative gearing to launch a scare campaign rather than seize the opportunity to embrace the Henry tax review's proposed tax discount for all income from personal savings, including capital gains on highly geared rental properties.
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Malcolm Turnbull hasn't been the messiah and doesn't seem to have a gospel

Date February 26, 2016 - 11:30PM

Jack Waterford

Canberra Times columnist

Over the next month Malcolm Turnbull will make – must make – the decisions which will determine the period of his prime ministership. He's still an odds-on favourite to be prime minister at the end of the year, but, in the past month, he has looked beatable.
Some decisions before him involve the budget that his Treasurer presents in early May, and others the policies that he puts to the public at the next election. Another involves the timing of the election itself, and whether he has much to gain from double dissolution.
Much more important, however, are decisions by which he shows voters a sense of purpose and direction, laying out a path Australians will want to follow. Only by that can he demonstrate that he is still in charge of his, and Australia's, fate. His decisions will show if he has become, as Tony Abbott, Kevin Rudd and Julia Gillard did before him, a prisoner of his past, increasingly unable to control his future.
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Health Budget Issues.

Government could save $175m a year by ending pathology companies' ‘free ride’

Pathology industry has massive efficiency savings that are not shared with taxpayers and the government, leading health economist, Stephen Duckett, says
The federal government could save $175m each year by ending the “free ride” it has given to pathology companies, a leading health economist, Stephen Duckett, says.
Duckett has called for reform to the way pathology is paid for so the massive efficiency savings the industry enjoys are shared with taxpayers and the government
The federal government announced in its budget update in December that it would scrap the bulk-billing incentive it pays to health professionals for pathology services, representing savings of $101m per year.
As a result, the pathology industry has threatened to pass the costs onto patients by introducing a $30 co-payment for common tests, including pap smears.
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Sonic Healthcare, Primary Health Care hogging profit from automation, says report

Date February 21, 2016 - 9:00PM

Simon Evans

Federal Health Minister Sussan Ley has stepped up the fight against big pathology companies opposing cuts to bulk-billing incentive payments for blood tests, X-rays and MRIs, saying a report by the Grattan Institute is further proof they are embarking on a scare campaign to protect profit.
Big ASX-listed pathology companies such as Sonic Healthcare and Primary Health Care are at the forefront of vigorous lobbying and a consumer campaign running in 5000 pathology collection centres. They are attempting to stop $650 million in cuts to bulk-billing incentive payments for providers identified by the federal government in December 2015 in a budget update.
A new report by the Grattan Institute released on Sunday revealed that taxpayers had got "minimal benefit" from the automation of processes across the industry, which had led to "ever-cheaper ways of delivering services".
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Think tank needles pathology funding

  • The Australian
  • February 22, 2016 12:00AM

Sarah-Jane Tasker

Australia’s pathology services funding system needs urgent reform as top companies in the sector have fattened their bottom line on increased volumes subsidised by taxpayers, a new report has found.
Stephen Duckett, health program director at the Grattan Institute, has produced a report — to be released today — that outlines reforms to pathology payments could save the government at least $175 million a year.
The government, through Medicare, spent $2.5bn on pathology services in 2014-2015 and Mr Duckett argued it was the large corporate companies that were benefiting most from that spend.
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12:17pm February 22, 2016

Pathologists condemn Grattan report

By AAP
Pathologists say a scathing report into their industry is grossly inaccurate and at best a flawed opinion piece.
The Grattan Institute report accuses the industry of using patients as pawns to keep shareholders happy, saying proposed Federal funding cuts to its services don't go far enough.
But the Royal College of Pathologists of Australasia says the report contains many errors and misinterpretations, while the data used to support its conclusions is inconsistent.
The report rejects claims women may be forced to fork out $30 for pap smears and calls for a major shake-up of the industry to protect patients from co-payments and rein-in pathology costs.
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Healthscope boss urges federal spending fix on $96m profit

  • The Australian
  • February 24, 2016 12:00AM

Sarah-Jane Tasker

The head of Australia’s second largest private hospital group, Robert Cooke, says a reform of the federation is the “holy grail” of healthcare, adding a change to state funding would be a “game changer” for his business.
The Healthscope chief executive officer, delivering a 64 per cent jump in half-year profit to $95.9 million, said yesterday the federal government should roll out a national price for healthcare funding.
“They can give the states 40 per cent of that price for each patient in a public or private setting and then we would negotiate with a health fund on the other 60 per cent,” he said. “That would be a game changer for our business. We would be building more beds than what we are proposing at the moment.”
Despite his support for federation reform, Mr Cooke said it was unlikely to occur because of political reasons.
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Half of patients may face pathology gap fees

25 February, 2016 Alice Klein
One in two patients may be asked to pay a standard pathology gap fee of around $30 if impending cuts to bulk-billing incentives are enforced, say pathologists.
The warning has been issued in response to Federal Government cuts to bulk-billing pathology incentives, due to come into force on 1 July, which the industry says it is unable to absorb.
The incentive cuts - worth $1.40-$3.40 per service - would translate into out-of-pocket costs for all non-concession card holders, said Dr Michael Harrison, president of the Royal College of Pathologists of Australasia (RCPA).
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Health Insurance Issues.

Costing private patients an arm and a leg: Health Minister Sussan Ley demands quick price fix on prostheses

Date February 25, 2016 - 5:23PM

Heath Aston, Jane Lee

EXCLUSIVE
The price of hip replacements, heart valves and pacemakers is set to tumble for private hospital patients as the Turnbull Government seeks election-year relief from steep rises in health insurance premiums for consumers.
Fairfax Media has learned that the medical devices industry has been given less than a fortnight to identify more than $500 million in savings or face a blanket price cut in what health insurers have to pay for prostheses like new hips and knees.
Prosthetics procedures in private hospitals cost almost $2 billion a year and it is understood that Health Minister Sussan Ley wants that bill cut by about $600 million, with some reports suggesting the target is up to $900 million.
The federal government controls the cost of 10,000 medical devices, including human tissue, screws and plates, through the Prostheses List - similar to the pharmaceutical benefits scheme.
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nib profit jumps 5pc to $43m

Date February 22, 2016 - 4:19PM

Tim Binsted

Reporter

Private health insurer nib said it is alert for acquisition opportunities as smaller health funds question their future following the $5.7 billion privatisation of Medibank Private.
Group managing director Mark Fitzgibbon said that the renewed assertiveness of Medibank, which recently announced a $100 million profit upgrade and is planning an advertising spree, has changed the local industry.
"There is much more awareness of the competitive threat with the two behemoths, Medibank Private and Bupa. Smaller health insurers are worried about what the future looks likes and consolidation might be something worth revisiting," he said.
Mr Fitzgibbon said he had no particular takeover targets in sight, but he is alert to the possibility of a deal.
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Out-of-pocket costs a growing pain for health fund members

  • The Australian
  • February 24, 2016 12:00AM

Sean Parnell

Health fund members have copped the biggest increase in out-of-pocket expenses for hosp­ital treatment in five years as insurers seek to share the burden of rising costs.
According to the latest industry data, reported by the Australian Prudential Regulation Authority yesterday, out-of-pocket expenses for the December quarter rose 4.4 per cent compared to the same period in 2014. The dollar difference was about $12.50 to an average bill for members of $291.51, and followed several years of declining out-of-pocket expenses.
Over that period the industry enjoyed a 6.9 per cent increase in premium revenue, against a 6 per cent increase in benefits paid. Health funds are awaiting a decision on their applications to increase premiums again in April.
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Private health insurance providers’ profits soar as premiums rise faster than payouts

February 24, 2016 12:30am
John Rolfe Cost of Living Editor News Corp Australia Network
HEALTH insurers are getting more and more profitable, pocketing an extra $106 million in the past year — an increase of 10 per cent.
As policyholders brace for yet another budget-breaking premium increase of five per cent-plus, new official figures from the prudential regulator show funds’ collective net earnings rose to $1.19 billion in 2015 from $1.08 billion the year before.
The rate at which their profits are expanding sped up by 50 per cent, because the 2014 result was an increase of only $70 million.
This is due to a widening in their “gross margin” as premium revenue growth ($1.38 billion to $21.4 billion) outpaces the increase in payments to customers receiving treatments ($1.037 billion to $18.5 billion).
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7:41pm February 25, 2016

Private health fund members complain of financial pain despite insurance due to growing gap and out-of-pocket expenses

AAP
Australians with private health insurance are making gap payments more than ever before and are unhappy about the out-of-pocket expenses, a 9NEWS investigation has revealed. 
Out-of-pocket expenses for Australian patients have increased in the past year, with the number of operations that have a gap rising by 311,112. 
Dissatisfaction is also rising, with a survey of 40,000 people commissioned by the Health Minister and obtained by 9NEWS revealing that 71 per cent of respondents believed they would be out of pocket if they required treatment.

Superannuation Issues.

Super opt-out ‘despicable’: Labor

Allowing low-income earners to opt out of compulsory superannuation would be a “despicable attack” on people’s future retirement, Labor says.
The Turnbull government is reportedly being urged to consider the “opt out” idea in pre-budget submissions by industry groups.
The move could give thousands of part-time and casual workers earning less than $37,000 a 9.5 per cent pay rise — the amount paid by employers into superannuation — or up to $63 a week, News Corp reports.
“This is a despicable attack on the very foundations of a decent retirement for working Australians,” Labor’s superannuation spokesman Jim Chalmers told reporters in Brisbane on Sunday.
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Super reforms ‘discriminatory, unfair and dumb’

11:30pm, Feb 24, 2016
Mark Skulley Columnist
ANALYSIS: Superannuation changes could hurt women and young workers.
The suggestion that low-income earners should be able to “opt out” of the compulsory superannuation system is unfair, discriminatory and just plain dumb.
It would be particularly bad for women and young workers, who have enough trouble building a superannuation nest egg.
It’s unclear which employer group or groups proposed it, in the submissions being made to the Turnbull government ahead of the next federal budget in May.
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Pharmacy.

Give us control: Guild

Guild wants pharmacy to play a key role in chronic health management, despite resistance

Community pharmacy should be empowered to play a vital role in the management and prevention of chronic disease, the Pharmacy Guild of Australia believes.
Guild national executive director David Quilty and Victorian branch president Anthony Tassone have appeared before the House of Representatives inquiry on chronic disease prevention and management in primary health care to emphasise the key role they believe pharmacy can play in this area.
In its submission to the inquiry, held by the House Standing Committee on Health, the Guild coordinating the health system in an affordable way to manage chronic health “will only be facilitated by better alignment and coordination within the Federal Government though the Community Pharmacy Agreement”.
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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 still being flown! Enjoy.
David.

Wednesday, March 02, 2016

The Pharmacy Guild And The AMA Are Talking At Crossed Purposes Regarding The mHR.

The AFR is continuing its interest in e-Health. This popped up in the Saturday Weekend paper.

Pharmacists, doctors feud over 'botched' e-health record rollout

by Ben Potter
Feb 26 2016 at 5:13 PM
Pharmacists and doctors are feuding over the federal government's struggling electronic My Health Record system.
The pharmacists' lobby chided doctors for failing to support My Health Record to help cut waste in the $155 billion healthcare sector. But the doctors' lobby said the system will not succeed in cutting waste because the rollout has been botched. 
"We have all got to be in it – it's either all in or none in," said George Tambassis, national president of the Pharmacy Guild of Australia. Health spending is being targeted by health minister Sussan Ley
Government data shows nearly half of medicines dispensed are wasted. Mr Tambassis said My Health Record could cut waste by identifying patients who were going to the doctor too often, doctor-shopping or pharmacy-shopping, doctors over-prescribing or pharmacies double-dispensing. 
But he said all healthcare providers had to be on board for this to happen and there was no excuse for them to stay out, because technology problems such as security and interoperability had largely been solved. 
He said pharmacies were already using technology to upload prescriptions into the cloud and track sales of over-the-counter products containing codeine and pseudoephedrine. 
But he said they were unable to share the data among themselves or with doctors until My Health Record was more widely used. 
Australian Medical Association president Brian Owler said the organisation backed e-health records as a way of controlling health costs, but the government had failed to ask medical specialists what they needed to make My Health Record work.
Professor Owler admitted many specialists did not use electronic health records, but said most medical practice software was aimed at GPs and was not suitable for specialist practices. 
"Until we start to engage with people as to how it might work and the software vendors are on board, it's never going to work," he told AFR Weekend.
Professor Owler said My Health Record would not succeed in cutting waste in pharmaceuticals because while most GPs used electronic prescribing, some hospitals, specialists and other healthcare providers don't, and where they do, their software "doesn't talk to each other". 
"The Pharmacy Guild owns chemist shops and they have point-of-sale systems, and they have electronic systems to print out the stickers, but that's a long way from our main interest, which is actually provision of care to patients." 
More here:
Sadly both sides are both right and wrong. Waste will not be addressed by the mHR without a fundamental system re-design - as it is just a store of old prescription data rather than a system that interacts with the prescriber - and we already know that is not on the agenda.
We also know the AMA is not going to get seriously involved unless all the usability and workflow issues are resolved so that the system actually adds value rather than costs time!
All that said it is good to see the AFR taking an interest.
David.

Tuesday, March 01, 2016

When The ABC Is Reporting HealthIT In WA Is A Mess Things Must Be Pretty Grim.

When this appeared last week I suspect most of us thought all the bad news was out. We have this:

WA Health avoids IT corruption inquiry, for now

But premier warns it could still eventuate.

By Allie Coyne
Feb 23 2016 11:47AM
The WA Corruption and Crime Commission has opted not to investigate the state health department's botched multi-million dollar IT contract with Fujitsu, but the state's premier has warned the department could still end up in front of the anti-corruption watchdog.
A damning report released last week by the WA auditor-general found the four-year, $45 million centralised computing contract had blown out by $81.4 million thanks to weaknesses in oversight and controls.
The audit office found the contract had been varied 79 times since its 2010 signing, with the department acquiring extra data centre equipment that it was unlikely to use.
Around half of the $81.4 million in contract extensions were made by staff that weren't authorised to make such decisions. The employees have since been sacked.
At the time of the report's release, WA health minister Kim Hames said the case had been referred to the Corruption and Crime Commission.
In the days following, the anti-corruption watchdog said it welcomed the audit report but would not undertake a separate investigation into the matter.
It said while the report highlighted "serious failings" in Health's systems, there was no evidence to suggest serious midconduct by individual employees had occurred.
Lots more here:
And for more browse here:

http://www.itnews.com.au/news/wa-govt-admits-to-systemic-it-issues-at-health-department-415455

But no! On Sunday this little ripper on an equally messy issue popped up from the ABC.

Warnings about problem-plagued digitisation of WA hospitals 'ignored', technology experts say

By the National Reporting Team's Courtney Bembridge
February 28, 2016
Technology experts say a plan to digitise hospitals was destined to fall short, and their warnings were ignored.

Key points:

  • Experts say problems should have been picked up sooner
  • Funds for multi-million dollar IT contract mismanaged
  • Fears IT problems could derail the Perth Children's Hospital project
With pockets full from the mining boom, Western Australia sunk billions of dollars into the introduction of "new hospital IT" — trying to bring hospitals into the 21st century and make paper records disappear.
Instead, implementing the new technology has been costly and plagued with problems.
It has caused lengthy delays at one major hospital, while systems have been shelved at another hospital because technical glitches posed an unacceptable risk to patients.
Curtin University researcher Shirlee-ann Knight has authored academic papers on health information technology.
She said the complexity of the health system was underestimated and IT systems were never going to live up to expectations.
"A one-size-fits-all approach, which is the way we've taken it, in my view just won't work in a hospital environment," Dr Knight said.
"It's inevitable that this would happen and it's inevitable it will happen again."
Do you know more about this story? Email investigations@abc.net.au
The problems first became apparent at the $2 billion Fiona Stanley Hospital, where technology was supposed to replace paper records.
The plan was abandoned, but not before the opening of the hospital was delayed by more than six months and a committee found the cost had blown out by $330 million.
Dr Knight said she raised concerns in the years before the hospital opened, but they fell on deaf ears.
"I think it's far more complex than what the people who were in positions of power in 2009, 2010 and 2011 actually believed," she said.
Problems have also been identified at the newly opened St John of God Midland Public Hospital.
The technology allowing health systems to share information with one another was found to be seriously flawed and could not be implemented.
The extent of the problem was outlined in an internal memo from October 2015, a month before the hospital opened.
It found that when Midland Hospital tried to update patient notes, it would override or delete existing patient information.
"Due to the incomplete data being sent by St John of God Midland Public Hospital which 'overwrites' the existing Department of Health data, an extreme clinical risk presented whereby public patient data, including alerts and allergies for each patient... would be inaccurate and not up to date."
IT experts are still working to fix the problem and the system is not expected to go live until later this year.
Much more disturbing detail here!
This quote from the Premier is just astonishing!
“Premier Colin Barnett conceded the plan to go paperless was too ambitious, and mistakes were made.
"Government has been notoriously bad at handling ICT contracts ... it has been one problem after another going on for several years," he said last week.
"The whole area of so-called eHealth which has been talked about for the last 10 or 15 years across Australia has got lots of these stories.
"We're not alone, and it's not an excuse, but we're not alone in this and other major hospitals and health systems have had the same difficulties."
This just confirms the poll of last week. Clearly a party in a brewery is way beyond out health IT bureaucrats!
Wanders off wondering how this can be fixed with head shaking sadly!
David.

Monday, February 29, 2016

Weekly Australian Health IT Links – 29th 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

Dodgy State matters seem to have dominated matters this week - with patient privacy a major theme. All is not well in at least 2 States.
Other than that it now seems the NBN will be at least reasonable for the next few years until at least streaming 4K movies takes over in a few years’ time!
Enjoy browsing!
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  • Feb 26 2016 at 5:13 PM

Pharmacists, doctors feud over 'botched' e-health record rollout

by Ben Potter
Pharmacists and doctors are feuding over the the federal government's struggling electronic My Health Record system.
The pharmacists' lobby chided doctors for failing to support My Health Record to help cut waste in the $155 billion healthcare sector. But the doctors' lobby said the system will not succeed in cutting waste because the rollout has been botched. 
"We have all got to be in it – it's either all in or none in," said George Tambassis, national president of the Pharmacy Guild of Australia. Health spending is being targeted by health minister Sussan Ley
Government data shows nearly half of medicines dispensed are wasted. Mr Tambassis said My Health Record could cut waste by identifying patients who were going to the doctor too often, doctor-shopping or pharmacy-shopping, doctors over-prescribing or pharmacies double-dispensing. 
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Lack of expertise restricts e-health

Jennifer Foreshew

BIG e-health systems are prone to mistakes in the design stage because of a lack of expertise in the field, an expert says.
University of NSW's Centre for Health Informatics director Enrico Coiera said there was a "skills gap" in e-health despite it being so pervasive.
"We don't really have enough expertise available to help us make the right decisions," he said. "I think that is probably more of a problem in Australia than other countries."
Professor Coiera, who also directs the $2.5 million NHMRC Centre for Research Excellence in E-health, was speaking ahead of a Special Dean's Lecture he will give tomorrow at the University of Melbourne.
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WA govt admits to "systemic" IT issues at Health department

Opposition calls for minister to resign.

By Allie Coyne
Feb 22 2016 12:44PM
The Western Australian government has admitted "systemic" IT issues plague the state's health department after an auditor-general's report detailed massive cost blowouts and mismanagement of the agency's centralised computing contract with Fujitsu.
Late last week the WA auditor-general revealed the four-year, $45 million contract had blown out by $81.4 million owing to a lack of proper oversight and controls.
The department is facing a potential corruption investigation over the issue after the case was referred to the state's Corruption and Crime Commission for investigation.
The Fujitsu deal was signed to provide primary and secondary data centres as well as ongoing management and support, but the auditor found the contract had been varied 79 times since it was signed in 2010.
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WA Health avoids IT corruption inquiry, for now

But premier warns it could still eventuate.

By Allie Coyne
Feb 23 2016 11:47AM
The WA Corruption and Crime Commission has opted not to investigate the state health department's botched multi-million dollar IT contract with Fujitsu, but the state's premier has warned the department could still end up in front of the anti-corruption watchdog.
A damning report released last week by the WA auditor-general found the four-year, $45 million centralised computing contract had blown out by $81.4 million thanks to weaknesses in oversight and controls.
The audit office found the contract had been varied 79 times since its 2010 signing, with the department acquiring extra data centre equipment that it was unlikely to use.
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Thirteen clinicians caught spying on medical records of Phil Walsh’s son Cy Walsh

February 23, 2016 5:35pm
Brad Crouch Medical Reporter The Advertiser
THIRTEEN clinicians have been disciplined for gaining unauthorised access into the medical records of Cy Walsh, charged with murder of his father and former Crows coach Phil Walsh last year.
The medical records, including toxicology results from Walsh’s hair are crucial to the trial.
Health Minister Jack Snelling and SA Health chief executive David Swan have both condemned the snooping — which could have consequences for the trial — and said the clinicians have been counselled for accessing the electronic records.
Walsh was taken to Flinders Medical Centre for tests following the death.
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Health staff caught spying on Cy Walsh's medical records

Date February 23, 2016 - 11:22PM

Nick Toscano

Cy Walsh pleads not guilty

As reported in early February, son of slain Adelaide Crows coach Phil Walsh re-enters his not guilty plea, saying he was mentally incompetent the night his father was killed.
More than a dozen unauthorised medical staff have been caught accessing the confidential records of Cy Walsh after he was arrested over the murder of his father, former Adelaide Crows coach Phil Walsh.
His electronic records, including test results that could relate to the criminal trial, have been accessed by at least 13 health workers across South Australia in what authorities have called a serious privacy breach.
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Doctors disciplined for snooping in patient records

AAP | 25 February, 2016 |
More than 20 medical staff have been caught snooping in patient files, including records related to the son of slain Adelaide Crows coach Phil Walsh.
Thirteen clinicians, including doctors and nurses, were formally disciplined after they inappropriately accessed the medical records of Cy Walsh following the death of his father last year.
Mr Walsh, 27, was taken to Flinders Medical Centre in Adelaide for tests following his father's death and was later charged with the 55-year-old's murder.
SA Health Minister Jack Snelling revealed on Wednesday that a further eight clinicians had been disciplined for inappropriately accessing the records of other patients over the past 12 months.
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Patient privacy breach ‘is tip of the iceberg’: cancer patient

  • The Australian
  • February 26, 2016 12:00AM

Michael Owen

Cancer patient Andrew Knox has called for an independent judicial review into the South Australian government’s patient record management system, saying a fresh furore over serious privacy breaches is just the “tip of the iceberg”.
Mr Knox, 67, said yesterday his medical records relating to an incorrect chemotherapy dose may have been destroyed. “There’s not a single record that reflects the actual dose that I purportedly received ... some­thing’s not right,” he said yesterday. “The authority to give me prescriptions in the doses no longer exists ... there’s this cavalier attitude to records.”
More than 20 South Australian medical staff have been caught snooping on patient files, including records related to the son of Adelaide Crows coach Phil Walsh, who is charged with his father’s murder.
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This app provides a handy guide to haematological conditions

24 February 2016
THE ASH pocket guide is released by the American Society of Hematology to provide information on a specific set of haematological conditions. 
The main menu offers a choice of topics. 
There are three guides on sickle cell disease including acute and chronic management of complications, as well as hydroxyurea and transfusion therapy. 
There are also three guides on thrombo­cytopenia covering heparin-induced thrombocytopenia, immune thrombo­cytopenia and thrombocytopenia in pregnancy. 
The single guides are to red cell transfusion, anticoagulant dosing and von Willebrand disease (VWD). 
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How to improve the recording of patient refusals

24 February 2016
How to improve the recording of patients' refusal of or ineligibility for preventive services.
What's the issue?
The provision of preventive care is a major role and task for GPs, but some patients refuse one or more preventive services, and some patients some or all elements of preventive or other care are not indicated because of the patient’s clinical situation.
GPs need to document their patients’ refusal of or ineligibility for care for the purposes of good clinical care, maintaining good relationships with patients, accreditation* and protection against claims if adverse outcomes such as illness or an unwanted pregnancy occur because the patient did not receive relevant care. However, the clinical software packages marketed for use in Australian mostly provide no organised way of doing this, and to try to meet this need, GPs are creating their own workarounds which do not and cannot adequately serve the required purposes.
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SA health minister rejects calls for e-health record privacy inquiry

Doctors caught accessing info on murder suspect.

By Paris Cowan
Feb 24 2016 5:04PM
South Australian health minister Jack Snelling has knocked back calls for an independent inquiry into the privacy of the state's e-health records, despite revelations 13 clinicians were caught abusing their privileges to access information on a murder suspect.
Cy Walsh was charged with the murder of his father, high-profile AFL coach Phil Walsh, last year.
Snelling told parliament this afternoon that a routine audit of user logs had exposed clinicians' unauthorised access to Walsh's information within the the state’s electronic medical records system.
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E-health: A cautionary tale from a leader in the field

23 February 2016
As healthcare data becomes increasingly digitised, authorities are struggling to balance usability with privacy.
COMPARING international medical systems is like discussing whether apples, oranges or pears are best. But in the pioneering field of e-health, several key issues are universal:
  • Interoperability, that is, the ability of computer systems from different health sectors to communicate with each other
  • Privacy/patient identification
  • The ability to turn GPs’ freehand notes into meaningful data via codes.
E-health enthusiasts often cite Denmark as a gold standard for getting most of these right.
The Australian public/private system differs significantly from the entirely public systems of Scandinavia, and each has its historical, political and cultural quirks. 
But Denmark has several natural advantages. 
It has a small population in a small area (about 5.7 million people in 43,000km2, which is 0.6% the size of Australia).
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Lambie spent $30k to keep records private

February 25, 2016
By Belinda MerhabAAP
Lambie spent $30k to keep records private
Independent senator Jacqui Lambie claims she was forced to spend $30,000 to keep her private medical records from being splashed across News Corp newspapers.
The former soldier told parliament a journalist from The Australian went on a fishing expedition to get access to her medical records following her long battle against Veterans' Affairs a decade ago for compensation.
She spent $30,000 fighting it and managed to redact details from the records after the Administrative Appeals Tribunal granted the journalist access.
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The Clinical Terminology February v20160229 Release is now available for download

Created on Friday, 26 February 2016
The Clinical Terminology February v20160229 Release is now available for download from the NEHTA website.
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Pitfalls of smartphone images in diagnosis

Nicole MacKee
Monday, 22 February, 2016
THE use of mobile phone cameras to capture radiological images from computer screens can lead to misleading information being conveyed and is of little use in the diagnostic process, a leading radiologist has warned.
Dr Greg Slater, president of the Royal Australian and New Zealand College of Radiologists, said a single-frame image transmitted by a mobile phone was not nearly as much help in the diagnostic process as it might seem.
“There is a lot of potential harm in this. [A single image] is a very limited part of the study, it’s transmitted in a non-private way, and it’s transmitted in a way that markedly reduces image quality. It can be misleading and can be missing a lot of diagnostic information,” Dr Slater told MJA InSight.
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Cancer Support App Wins Health Industry Backing

A team of ambitious Sydney doctors have won crucial industry backing in their quest to raise the standard of doctor-patient communication in cancer hospitals.
Dr Nikhil Pooviah, Dr Raghav Murali-Ganesh and Dr Akshat Saxena have put their clinical careers on hold to develop an app that puts everything a cancer patient needs to know about their disease and treatment on their device. Patients can then easily share updates on their condition with family, friends and other treating doctors.
Called CancerAid, the project was selected from more than 300 applicants to receive business development funding and support through HCF’s Catalyst program. It is also keenly supported by Sydney’s world-class cancer treatment centre, the Chris O’Brien Lifehouse.
HCF Chief Executive Officer Shaun Larkin said: “As someone who has gone through the journey of cancer with a close family member, I can personally see exciting promise in CancerAid to deliver better outcomes for patients. We look forward to working with the team to make that promise a reality."
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How far can medical 3D printing go?

Charlotte Mitchell
Monday, 22 February, 2016
EXPERTS are debating how widely 3D printing should be used in Australia, but they all agree that when the technology is used, it offers big benefits for doctors, patients and the health care system.
Dr George Dimitroulis, an oral and maxillofacial surgeon, told MJA InSight that “the sky is the limit for 3D printing because anything you can design on a computer, you can use”.
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Infrastructure Australia and PriceWaterhouseCoopers weigh into the NBN debate: Paul Budde

February 22, 2016
Is the NBN a white elephant? Paul Budde
Both Infrastructure Australia and PriceWaterhouseCoopers (PwC) have now weighed into the NBN debate. They have looked at the value of the NBN in relation to the future sale of the company.
The eventual privatisation of the NBN is one of the few areas on which both sides of politics agree. That being the case then it would be prudent to build an NBN that maintains its value and will fetch a good price. Let’s say that it should at least cover the costs of the project at the time a sale is being considered. Because of the national interest it could be argued that simply covering the cost would be sufficient.
However building a potential white elephant in the form of the multi-technology mix is certainly not going to deliver on this. There is global consensus that eventually the majority of the national fixed telecoms networks will need to be based on FttH. In Australia the NBN company is not building such a future-proof network – quite the reverse – it is using out-of-date technologies with no plan as to how to move on from this version to a robust network fit for Australia’s interconnected economy. Those who eventually might buy the NBN will have to make a massive investment in getting rid of the MtM and replacing it with FttH, not something many potential buyers will be interested in.
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nbn HFC achieves average trial speeds of 84Mbps

The National Broadband Network has achieved end-users average download speeds of 84/33Mbps with a pilot of its HFC network, drawing recognition from analyst firm Ovum that the upload speeds are among the fastest delivered over commercial HFC networks globally.
The nbn HFC trial was conducted at Redcliffe in Queensland with Retail Service Provider – Telstra, iiNet and Exetel  - delivering end-users speeds of up to 100Mbps download and 40Mbps upload.
nbn says it now has its sights set on launching commercial HFC services in June.
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Enjoy!
David.

Sunday, February 28, 2016

The US And UK Governments Make It Clear What Is Needed For EHR Adoption. We Were / Are Not Even Close With The mHR.

The following report appeared a little while ago:
February 2016

The adoption and use of digital health and care record systems:

International success factors

A collaboration between NHS England and US Department of Health and Human Services

Here is the link to the report .pdf
The report outlines the following purpose and objectives:
Introduction and purpose
This publication sets out the findings of a collaborative work program undertaken between the US Department of Health and Human Services, NHS England and the Health and Social Care Information Centre; to investigate ‘what good looks like’ in terms of the successful adoption and optimization of digital care records for patients. While technology is evolving, particularly in terms of usability, this report focuses on the steps providers can take to ensure successful adoption and maximize technology utility. It is hoped that this report and its supplemental materials may be used by providers of care services to accelerate the adoption process, educate the workforce, and enable provider replication of best practices in order to mitigate common challenges.
Clearly such a study has some relevance to what is presently going on with the mHR.
The concluding section and what is needed for successful adoption is what matters:

6. Conclusion

The findings from this work program have been synthesised into a set of essential attributes which can be used by organisations to consider when embarking on a digital health transformation program. These are derived from the key learning points addressing cultural aspects, workflow design, and workforce competency and leadership qualities. All of these attributes require significant initial and on-going effort, often with delayed but ultimately positive results.
Our findings were clear in that there were a number of factors which were seen as pre-requisites (must have’s) and others which, although still essential, could not work without the former. For example, core standardised infrastructure was seen as one of the ‘must have’s’, whilst localised workflow design although extremely important, would not be possible without the other.
In piecing together these critical factors, a distinction between them was made; the ‘must do’s’ were labelled Primary Attributes, with the others being labelled as Secondary Attributes, yet all still being essential .
The synthesised findings are set out overleaf, which taken together with the accompanying toolkit comprising materials from both countries, can support both those who are early into their digital journey as well as those who are more advanced on their path to digital care records.

7. Essential attributes of successful adoption

Primary attributes
Need to be in place before the secondary attributes, and remain so throughout the development and continued use of the system.
a.> Ownership and inclusiveness needs to be felt by all staff, with support for patient care as the central focus of the deployment and genuine leadership commitment. This needs clear and regular communication across the whole workforce and transparency and realism around timelines and outcomes. A culture of trust should be developed throughout the development and continued use of the system. Consider the needs of patients, engaging with them as well as clinical and administrative staff. Take time to pause, and get it right.
b.> A solid core standardised and reliable infrastructure is imperative (i.e. networks and databases) which is able to support clinical and reporting requirements. Standardised, secure, uniform interfaces, reports, and templates across the organisation are important to ensure consistency in information aggregation and reporting. Local customisation has proved to be key to successful adoption.
c.> Establish and maintain a strong working relationship with the vendor/ supplier. Work together to establish a fair contract and ensure the product meets organization and/or practice needs, ensures accessible interoperability, and identify opportunities such as participating in user groups to both learn and provide feedback to vendor/supplier to influence and inform future developments.
d.> Interoperability with other systems is imperative. Patient information must be able to flow freely among patients and providers alike, enabling them to securely send, receive, find, and use the right information at the right time.
Secondary attributes
These need to be met through mobilising the primary attributes in order to continue to successful adoption.
a.> System workflow design should be a top priority and follow intuitive care pathways where possible. It should encourage patient engagement with their record and offer efficient, flexible and relevant data input solutions. The ability to customise and adapt the solution to local requirements has been found to overcome barriers to use.
b.> Training should be continuous. A core set of competencies is a must and should include information input, retrieval skills, security, confidentiality and quality management; with some knowledge of project and benefits lifecycles.
c.> Extra skill-sets should be identified and invested in according to clinical level of use. This will help with the retention of local expertise and key roles.
d.> Local expertise and key roles need to be retained, achieving a stable and motivated workforce.
e.> Easy access and effective use of other health IT technology, including mobile technologies, should be an important part of digital strategy. Use of hand held devices, barcodes, RFID, voice recognition etc.
----- End Extract.
From alienation of the private sector, lack of training on to totally ignoring workflow consequences on GPs it is clear you would have to mark the PCEHR a fail on pretty much all criteria.
I reckon we all know why our DoH and NEHTA were not consulted on this - even though one of our academics is cited. Of course the Department / NEHTA just ignored him as best as I can tell!
David.

AusHealthIT Poll Number 309 – Results – 28th February, 2016.

Here are the results of the poll.

Do Politicians And Bureaucracies Understand Just How Hard And Complex Successful Delivery Of E-Health Is?

Yes 1% (1)

No 97% (129)

I Have No Idea 2% (3)

Total votes: 133

A really decisive poll. It seems most reading here don’t think the powers that be understand what they are attempting.

Great turnout of votes!

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

David.