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, July 21, 2016

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

July 21  Edition.
“This is being written over the weekend and to date we seem to know that Malcolm Turnbull will remain PM with a level of majority that is yet to be determined.” I wrote this a week ago and it is still true. Maybe next week the result in both the reps and Senate will be clear!
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Thursday Update - still waiting for final seat and Senate results - but Government has been sworn in and Ms Ley back as Health etc. Minister.
Globally we seem to be going to hell in a hand basket! What a mess!
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At a global level we have had all sorts of horror in France and Turkey and the financial world seems also to have a major issue lurking in Europe. See below:

Why Italy's banking crisis will shake the eurozone to its core

16 July 2016 • 4:41pm
They call them le sofferenze – the suffering. The imagery is striking, the thousands of sofferenze across Italy, unwanted and ignored, a problem unsolved.
But despite the emotional name, these are not people. They are loans. Bad debts, draining banks of profits and undermining economic growth.
The name is less clinical than the English term “non-performing loans”, a reflection of the Italian authorities’ emotional rather than business-like approach to the problem.
None the less, the loans are indeed causing real suffering. The €360bn (£300bn) of sofferenze from Italian banks show borrowers are weighed down with debts they cannot afford, while the banks are struggling to offer new credit to the households and firms that need them.
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Here the most amazing thing is the AMA coming out suggesting a new Medicare Co-payment. No matter what is meant by his remarks the optics are awful and the reaction has been pretty loud.
See here:

Health groups slam AMA president over co-payment suggestion

Editor: Melissa Sweet Author: A coalition of health and social groups on: July 15, 2016
In a radio interview this morning, the new AMA president, Dr Michael Gannon, appeared to open the door to supporting further discussions about a GP co-payment, although he later issued this tweet.
Meanwhile, a coalition of health groups has put out this statement opposing the suggestion in the strongest possible terms. (It’s not a good look for the AMA.)
Today’s suggestion by the Australian Medical Association (AMA) that the Coalition’s abandoned general practice (GP) co-payments policy might be resurrected has been strongly condemned by the Australian Healthcare and Hospitals Association (AHHA), Public Health Association of Australia (PHAA), Consumers Health Forum of Australia (CHF), National Aboriginal Community Controlled Health Organisation (NACCHO) and Australian Council of Social Services (ACOSS).
Here is the report:
15 Jul 2016 - 7:16am

AMA boss suggests rethink of GP co-payment

AAP - 15 Jul 2016 - 7:16 AM 
The head of the Australian Medical Association has suggested a rethink of the federal government's deeply unpopular GP co-payment.
Michael Gannon says the problem with the co-payment - declared "dead, buried and cremated" by the government last year - was that it didn't give GPs the opportunity to make a judgment about which patients could afford it.
"I'm happy that anything can be on the table but we cannot have policy that doesn't protect the most vulnerable," he told ABC radio on Friday.
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Here are a few other things I have noticed.

General Budget Issues.

  • Jul 10 2016 at 11:45 PM
  • Updated Jul 10 2016 at 11:45 PM

$100 billion of spending, taxing measures in hands of new Senate

There is scope for significant budget improvement – built around both the 2016 budget and so-called zombie measures from earlier budgets – despite the make up of the new Senate, according to a new analysis of party positions on crucial budget measures.
The analysis by the Australia Institute summarises the various outstanding budget measures that need Senate approval and notes that up to $100 billion of spending cuts and revenue measures over 10 years are up for negotiation in the new Senate with the most expensive measure overall being the Coalition's proposed company tax cut. 
Australia Institute executive director Ben Oquist argues there are potential budget improvements to be had both from the Senate passing, amending and blocking policy proposals in the wake of the election outcome.
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Property prices forecast to fall as glut kicks in

  • The Australian
  • 12:00AM July 11, 2016

Samantha Hutchinson

A new wave of apartment development is combining with stalling population growth to create a glut in some pockets of the housing market.
Homeowners and property ­investors are facing steep falls in house prices and a weakening rental market as a new wave of apartment development combines with stalling population growth to create a glut in some areas.
In perhaps the bleakest assessment of the local housing market so far, BIS Shrapnel analysts have predicted median house price falls, an oversupply of apartments and serious vacancy issues which will bite all capital cities by June 2019.
Homes in Sydney, Melbourne and Adelaide are likely to sustain falls of 2 per cent in nominal terms, and steeper drops of 10 per cent in real terms — which takes inflation into account — as population growth plummets to 10-year lows and more than 220,000 new homes started this year ­approach completion.
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Treasury has economic googly for Scott Morrison

  • The Australian
  • 12:00AM July 11, 2016

David Uren

Since his appointment as Treasurer in September, Scott Morrison has emphasised his focus on issues within his control.
Treasury’s brief for Scott Morrison will emphasise the importance of implementing savings measures in the May budget and pushing harder to break a deadlock over measures stalled in the Senate; it will also point to worrying signs in the global economy.
The International Monetary Fund’s global economic update in two weeks is expected to downgrade estimates of global growth to the weakest level since 2008-09 and will highlight the risks from both Britain’s decision to leave the EU and the slowing economies of China and the rest of Asia.
Mr Morrison would be expected to attend the G20 finance ministers and central bank governors’ meeting in Chengdu in China on July 23-24, having missed the last meeting in Washington in April.
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Federal election 2016: Chris Bowen signals tough line on budget repair

  • The Australian
  • 7:56AM July 11, 2016

Jared Owens

Opposition treasury spokesman Chris Bowen has signalled a tough line to the government’s efforts to repair the budget, saying the Coalition should adopt Labor’s election policies if it wants to balance the nation’s books.
Mr Bowen also demanded Malcolm Turnbull make public whatever coalition agreement he strikes with Nationals leader Barnaby Joyce, so that Australians can see where the Prime Minister has decided to “sell out” Liberal positions.
Mr Joyce has made passing the effects test, which is aimed at preventing big businesses acting in a way that damages small businesses, a key priority of the next parliament as well as cracking down on $1 milk offers by major supermarkets.
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The Coalition must switch to a budget for all Australians

Date July 13, 2016 - 12:00AM

Ross Gittins

The Sydney Morning Herald's Economics Editor

 Maybe those who complain about a boring election campaign are condemned to an exciting election finish. Many in the establishment – particularly the business establishment – have convinced themselves the country is off to hell in a handcart, but it doesn't have to be like that.
The nation won't be ungovernable provided Malcolm Turnbull is willing to negotiate with the minor parties when necessary – hardly a new experience for governments, which rarely have a majority in the Senate.
Surely Turnbull will use this opportunity to find Morrison "a job to which you're better suited". 
Nor does it follow that the government will be unable to hasten the budget's return to surplus.
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How to fix the budget and the Parliamentary Budget Office so our leaders tell the truth

Date July 14, 2016 - 12:00AM

Peter Martin

Economics Editor, The Age

What if budgets, and candidates for office, told the truth?
Nick Xenophon and the rest of the Senate crossbench have been handed an unparalleled opportunity to remake the budget and political process while their bargaining power is at its peak.  
All it would need is a few simple changes to the law. Each is within reach. Nick Xenophon and the rest of the Senate crossbench have been handed an unparalleled opportunity to remake the budget and political process while their bargaining power is at its peak. Malcolm Turnbull probably wouldn't even mind. Like his predecessors, he would like things to work better, but left to himself he'll never get around to it.
Nick Xenophon and the rest of the Senate crossbench have the opportunity to make a big difference.
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Moody’s warns on Coalition’s slim majority

  • The Australian
  • 11:49AM July 14, 2016

Michael Roddan

Moody’s has added to ratings agencies’ recent warnings on the nation’s credit outlook, saying Malcolm Turnbull’s mandate to govern has been weakened by the government’s slim majority in parliament.
“The latest results indicate that the Coalition of the Liberal and National parties will govern with a weaker mandate than it has had over the past three years,” Moody’s senior vice president Marie Diron said.
“A narrow win in the House of Representatives for the Coalition, combined with the likelihood of a more splintered outcome in the Senate, is credit negative for the sovereign because it will challenge the government’s ability to implement measures aimed at curbing the budget deficit,” she said.
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Think twice before throwing open the government coffers

July 16 2016
Ross Gittins
Labor's Mediscare will have a benefit if it causes our politicians to think twice before they resort to "outsourcing" or "contracting out" the provision of government services, a practice that's led to a string of disasters.
The pretext for Labor's claim that the Coalition was planning to "privatise" Medicare was the Turnbull government's intention to save a little money by shifting the processing of Medicare's many bank transfers from its giant cheque-writing agency, the Department of Human Services, to a private provider.
We wouldn't even have noticed this back-office switch, but Malcolm Turnbull felt obliged to swear the proposal would be abandoned.
This probably means he'll also have to give up any thought of outsourcing all the many other, pension, allowance and benefit payments the department makes.
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IMF boss Christine Lagarde calls turn away from globalisation world's top challenge

July 15 2016
·         Andrew Mayeda
The risk of countries turning their back on global co-operation is the biggest challenge facing the world, as low growth and rising inequality fuel the rise of populism, said IMF managing director Christine Lagarde.
"It did not take the Brexit vote to understand that low growth, rising inequality, and a lack of jobs have combined with social and geopolitical concerns to fuel the rise of populism and inward-looking forces," Ms Lagarde said in the text of a speech on Thursday at the Centre for Global Development in Washington.
"The greatest challenge we face today is the risk of the world turning its back on global co-operation - the cooperation which has served us all well."
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Health Budget Issues.

Costly Coalition failure to heed health warnings

  • Michael Gannon
  • The Australian
  • 12:00AM July 11, 2016
Since election night, there has been much conjecture about the significance of health policy, and the use of a scare campaign in changing votes.
The Coalition has attacked Labor over its Mediscare campaign that deliberately painted a picture of a fully privatised Medicare. The Prime Minister subsequently called it an “extreme act of dishonesty”.
The AMA, too, is critical of the opposition’s Medicare privatisation claims. There is and was no move to privatise Medicare. All that was announced, and later withdrawn, was a plan to ask the Productivity Commission to look at outsourcing some backroom administration arrangements in the antiquated payments system, something the AMA would still welcome and support.
Nevertheless, the political reality is health played a major part in this election, and it was the Coalition that created and nurtured the fertile ground that allowed the scare campaign to grow and thrive.
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  • Updated Jul 10 2016 at 9:39 PM

Election 2016: Both sides planning frontbench reshuffles

Prime Minister Malcolm Turnbull and Labor leader Bill Shorten are both planning to reshuffle their frontbench lineups ahead of the start of a new Parliament next month.
While Mr Shorten is planning to move people around to fill what he regards as gaps in Labor's performance, Mr Turnbull's hand has been forced by ministers losing their seats, the Nationals demanding as many as three more spots, pressure for conservatives to boost their representation, and speculation Health Minister Sussan Ley will be shifted.
Upon declaring victory on Sunday, Mr Turnbull acknowledged that he had said before the election there would be no changes to his frontbench if he won, given it had only been last settled in February. On Sunday, the Prime Minister said there would have to be "some changes" but they would not be "large scale".
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Cost of visiting a GP may overload public hospitals

Date July 10, 2016 - 11:45PM

Anna Sublet

In the days straight after the federal election, I stood in a doctor's waiting room, with a sad, soon-to-be panicked child. As I looked around the reception area for notices regarding bulk billing eligibility and restrictions, I had the strange realisation that this small regional medical centre did not bulk bill.
The election had brought Medicare into sharp focus, and here we were, city dwellers, usually with a choice of medical services at our doorstep, at a small-town GP, shelling out $80 for a consult.
Money wasn't the main focus for me, luckily, but I was aware, in this post-election mess, that for many, such a trip to the doctor for a kid's school holiday injury could break the weekly budget. After the GP, there was the X-ray in a neighbouring town ($90), a return to the GP, and the instruction to "go to the hospital". Yes, there was a fracture. It might need surgery, she said, maybe inserting a wire.
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Coalition returned, but what next for Ley, copayments?

With the Coalition returned in the narrowest of victories – at the time of writing, it had gained the 76 House of Representatives seats it needed to form Government – attention is now turning to who will be the Health Minister.

In May, Health Minister Sussan Ley told the ABC’s Fran Kelly on RN Breakfast that should the Coalition be returned to Government, the increased prescription co-payment and increased safety net would still be on the table.
“The measure is on the table and the reason why is that we are taking a responsible path back to a surplus,” the Minister said at the time.
“I had negotiations with my colleagues when the measure was in the Senate across the Independents, around where we might position additional payments and Safety Nets, that’s small, modest additional payments.”
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Govt talks up Medicare record, but remains cautious

11 July 2016
THE coalition is determined to prove its commitment to Medicare but cautions any extra spending must come from cuts elsewhere.
The government will spend the next three years proving to Australians again that "the coalition is the best friend Medicare ever had", Cabinet Secretary Arthur Sinodinos told ABC TV on Sunday.
He acknowledged Labor's election campaign scare over privatising the service was "scratching away at an itch that people had about Medicare and our attitude to Medicare".
But Senator Sinodinos said whatever the cabinet decided to do about Medicare had to be looked at in terms of the overall budget because there's no blank cheque.
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Coalition MPs seek to firm up policy on Medicare

  • The Australian
  • 12:00AM July 12, 2016

Joe Kelly

Coalition MPs are canvassing possible changes to health policy that will reaffirm the government’s commitment to Medicare while also pressing home the need for savings to ensure the system remains sustainable.
While some have questioned whether Health Minister Sussan Ley was absent in countering Labor warnings that a returned Turnbull government would privatise Medicare, others came to her defence yesterday.
The Australian understands that Ms Ley was ready to fight the Labor “Mediscare” tactic during the election period and had made clear her expectation before the May budget that Bill Shorten would seek to campaign on health leading into polling day.
West Australian Liberal senator Chris Back yesterday said Ms Ley had performed well and suggested she should negotiate with the Australian Medical Association to find agreed areas where savings could be found.
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Most Australians pay too much for health care - here's what can be done

13 July 2016
HEALTH policy was an important factor in the election outcome, but one of the most important issues in the health sector – out-of-pocket costs – was mostly ignored.
Labor made health policy a battleground at this election, claiming the poll was a “referendum on Medicare”. The ALP tried to whip up alarm by highlighting the risks of “privatisation”, bringing out former prime minister Bob Hawke as part of its campaign.
The Coalition naturally tried to keep health off the front page, even avoiding the normal National Press Club debate between the health minister and her shadow.
In health policy, as elsewhere, the second Turnbull government’s wafer-thin majority constrains what is possible. Some changes can be implemented administratively or with immediate bipartisan support. Some will only occur if the government takes the time and political capital to build public support for the proposal. Other changes should simply be ditched.
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13 July, 2016

Health funding: something else for PM to worry about

Posted by The Conversation
In turning its attention to health policy, it appears the Turnbull government has learnt from its near-death experience.
It now must reconcile the political sensitivity of Medicare and the need for fiscal discipline.
Turnbull could draw on the Menzies strategy of appropriating the best parts of Labor’s proposals. For example, a higher Medicare levy, as Victorian Premier Daniel Andrews proposed last year, could raise funds for health care. Long-term issues of equity and efficiency could be handled through a standing health care reform commission, as Labor proposed in the election campaign.
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  • Updated Jul 13 2016 at 6:21 PM

Dispute over aged care cuts

The peak body for older Australians is demanding the government reveal the modelling that underpinned its surprise decision to cut $1.6 billion from residential aged care. 
What is known as the aged care funding instrument is being altered to save $1.2 billion over four years.
The cut in the May budget comes on top of $472 million in cuts to the sector announced in late 2015.
The measures are key elements of the government's budget repair plan. 
The perception is that providers are stretching the truth when assessing the needs of residents to attract more money. 
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Dear PM, You have a health problem. Let us help…

Editor: Melissa Sweet Author: Melissa Sweet on: July 15, 2016
Dear Prime Minister
Clearly you are in some serious need of life-saving health advice. As you have yourself admitted, the Coalition has to “do more to reaffirm the faith of the Australian people in our commitment to health and to Medicare”.
Croakey to the rescue. We offer three ideas to help re-make you as a visionary leader for health.

1. Establish a new over-arching portfolio: The Ministry for Health in all Policies

This is a really tough gig, as the Minister will be charged with working across all portfolios to assess the impact of all policies upon the population’s health, and particularly upon health inequities.
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Health Insurance Issues.

Time to review the $6 billion private health insurance subsidy, academic says

Date July 11, 2016 - 12:00AM

David Ellery

Reporter for The Canberra Times.

Cutting the private health insurance subsidy, increasing the Medicare levy and tackling the overuse of pathology and diagnostic imaging services are just some of the ways to tackle rising medical costs, the University of Canberra's Professor Laurie Brown has said.
Professor Brown, who said the Turnbull Government should drop the freeze on indexing the Medicare rebate for doctors if it is returned, told Fairfax many critics thought the $6 billion per annum private health insurance subsidy was poor value for money.
The Greens called for the subsidy to be abolished earlier this year, saying up $10 billion could be saved over the next four years.
A 2014 Grattan institute report put the savings at $3 billion a year at a time when the subsidy was costing about $5.5 billion a year.
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Superannuation Issues.

Federal election 2016: Victory for Turnbull, now for the super battle

  • The Australian
  • 12:00AM July 11, 2016

Sid Maher

Sarah Martin

We have resolved this election: Turnbull

Malcolm Turnbull faces party pressure to review controversial superannuation changes amid fresh Treasury warnings about the need for budget savings after yesterday claiming election victory with an expected wafer-thin ­majority.
After eight days of counting put the Prime Minister on the verge of a majority, Bill Shorten yesterday telephoned Mr Turnbull to concede defeat in one of the closest elections in the nation’s history, following a marathon campaign.
With the Coalition holding leads in the Queensland seats of Capricornia and Flynn, and postal votes trending towards the government, Mr Turnbull is on track to hold at least a bare majority of 76 seats in the 150-seat parliament. His grip on power could be ­extended if trends continue and the Coalition overhauls Labor in the Townsville seat of Herbert.
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Superannuation: Coalition’s changes undo the trust

  • The Australian
  • 12:00AM July 13, 2016

Glenda Korporaal

Chances are the Turnbull government will get most of its May budget proposed changes to super implemented.
Its problem has never been support from the Labor Opposition, which would never have dared to propose such drastic changes to the system itself, and is more than happy to see the government continue to support its own low income super tax offset.
The real problem has always been with the Liberals’ own constituency which is the one hit hardest by the proposed changes.
It does seem that the Coalition leaders, particularly Malcolm Turnbull and Scott Morrison, will press to keep as much of the budget super package as possible — mainly from a revenue point of view.
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Federal election 2016: PM stares down revolt on super reforms

  • The Australian
  • 12:00AM July 13, 2016

David Crowe

Prime Minister Malcolm Turnbull is under pressure to modify the government’s reforms to superannuation.
Malcolm Turnbull is staring down backbench demands for drastic changes to the government’s tax hike on superannuation, launching phone briefings with colleagues to defend the $6 billion package and insist on the need to legislate the changes as soon as possible.
The Prime Minister is holding the line against growing pressure from Coalition MPs to scale back the reforms and remove a “retrospective” cap on lifetime super contributions, amid a damaging blame game over how the issue hurt the government’s election campaign.
Angry MPs are determined to press for changes at a partyroom meeting on Monday in the first major test of Mr Turnbull’s authority after the election came dangerously close to forcing him from power.
Mr Turnbull’s allies are insisting the super tax reforms should go ahead without dramatic change on the grounds they were outlined in the May 3 budget and subjected to weeks of election ­debate, giving the government a mandate to enact them.
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Federal election 2016: Turnbull should cop it on the chin

  • The Australian
  • 12:00AM July 13, 2016

Judith Sloan

It’s hardly surprising that Bill Shorten has agreed to pass most of the government’s budget changes to superannuation, subject to an independent review that assesses whether some of them are retrospective.
I have sitting on my desk an opinion — well, it’s actually ­gobbledygook — of a QC commissioned by Assistant Treasurer Kelly O’Dwyer concluding that none of the changes — even the backdated lifetime cap on non-concessional contributions — is retrospective.
Pull the other one, I say. Even Scott Morrison is aware of the duck rule: looks like a duck, quacks like a duck, is a duck. Earlier this year he described Labor’s proposal to impose a 15 per cent tax on superannuation pension earnings above $75,000 a year as retrospective.
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ASFA’s Pauline Vamos urges 10-year freeze on super meddling

  • The Australian
  • 12:00AM July 14, 2016

Glenda Korporaal

Pauline Vamos, the chief executive of the Association of Superannuation Funds of Australia, has called on the government to “promise in blood” it will freeze changes to superannuation for 10 years after it implements its current proposals.
She said a bipartisan agreement not to touch superannuation for a decade, after the proposals were put through the new parliament, was needed to restore confidence in the system.
“The government should say, ‘This is why we are making the changes’, and then promise in blood that they are not going to change things for 10 years,” she said in an interview with The Australian ahead of her departure this week from the job she has held for the past nine years.
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Treasurer Scott Morrison to avert party revolt by offering costly exemptions

Samantha Maiden, National political editor, The Sunday Telegraph
July 17, 2016 5:00am
TREASURER Scott Morrison is preparing a super backdown that will offer big exemptions to a $500,000 lifetime cap to allow divorced couples, farming families and people who inherit from deceased estates to stash more cash.
The big exemptions under consideration to avert a Liberal Party revolt will allow the Treasurer to save face because the $500,000 cap on non-concessional contributions that was taken to the election will remain in place.
However, the exemptions will be so big that anywhere from half to 90 per cent of the $550 million in savings will be wiped out.
For example, women who get divorced would be able to breach the $500,000 lifetime cap if they put their divorce payout into super, relatives who inherit from a deceased estate may also be able to breach the lifetime cap. Another example might be the sale of farming assets.
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I look forward to comments on all this!
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David.

Wednesday, July 20, 2016

A Reminder Of The Need To Properly Protect Electronic Medical Records From Un-Authorised Access.

This appeared last week.

GP suspended after accessing wife's medical records

11 July 2016
A DOCTOR accused of domestic violence by his wife has been suspended after trawling through her medical records without her consent.
The wife of Dr Tahir Shah claimed their marriage was increasingly volatile and eventually led to a death threat against her.
She complained in June 2012 that he was looking through her medical records without permission.
In a sworn affidavit she said he replied to the effect: “Why not? You are mine, everything of yours is mine … I am your husband … I can check anything I want”.
He was then alleged to have described the Privacy Act as “westernised … rubbish”.
She said she left their apartment in Nambour, Queensland, on 12 August, after making a complaint to local police. She stayed with a friend to escape her husband's alleged harassment.
She claimed that Dr Shah did not attempt to contact her until he received a letter from the Department of Immigration telling him that his visa has been suspended because of their separation.
The Medical Board of Australia alleged that, some two weeks later, Dr Shah emailed an oncologist who was treating his estranged wife's cancer.
The board said he was "trying to find out information about or involve himself in her treatment regimen".
On that same day — 25 September — Dr Shah unexpectedly turned up with flowers to a chemotherapy session his wife was undergoing at the Royal Brisbane and Women’s Hospital.
His wife, who has since died, was so distressed that a social worker was called in by nursing staff.
Dr Shah accessed her online medical records on 26 September and then again on 27 September.
…..
  • Read the Queensland Civil and Administrative Tribunal decision here.
More here:
What is interesting in reading the findings if the Tribunal is that there is no comment as to just how the doctor accessed the records and just why he was able to without explicit authorisation.
Overall, given we can assume the Dr was not on the staff of the Cancer Centre, it is hard to know just what was going on that he could access the records.
That said, in my view it is vital the holders of electronic records ensure they are properly secured. I actually wonder just why the Tribunal did not query how access was obtained. The bottom line is that he should not have been able to!
David.

Tuesday, July 19, 2016

This Is A Pretty Sad Story With An Important Lesson Or Two Regarding Use Of Prescribing Systems.

This very sad story appeared a little while ago.

Censured GP blames lack of 'red flag' alerts for script errors

| 6 July, 2016
A country GP who prescribed contraindicated antihypertensives to a pregnant woman whose baby died has put the error down to 'red flag' alerts being switched off on his software.
Dr Sunil Kumar Dan, a 73-year-old GP who has practiced in Moree in NSW for more than 30 years, has been found guilty of unprofessional conduct over the treatment of a patient during several antenatal visits in 2012 in a decision of the Medical Council of NSW’s Professional Standards Committee.
The woman was nine weeks pregnant during the first antenatal visit in July 2012 with Dr Dan, her GP of over 20 years who had been treating her for hypertension since 2009.
At the appointment, the woman presented with a BP reading of 115/79mmHg and left-sided chest wall pain, and Dr Dan noted she would stop taking Caduet due to pregnancy.
But when the woman returned one month later, the GP prescribed Micardis Plus despite recording her BP as 101/67 and the drug being contradindicated in pregnancy.
On 21 September, the woman returned at 17 weeks gestation, when Dr Dan recorded a BP of 100/50 and chest wall pain, and prescribed Caduet.
In November, Dr Dan prescribed the woman with a third contraindicated medication, Celebrex, for a knee complaint.
He later told the professional standards committee he had known at the time that this would mean she was now taking the so-called “triple whammy” combination of an ACE inhibitor, thiazide diuretic and NSAID which can result in renal failure, but he felt a short course of Celebrex was “preferable to doing nothing”.
The woman returned at 26-weeks gestation and again the GP prescribed Micardis Plus and Caduet.
The woman’s baby later died; however, it is not detailed in the decision whether this was in utero or following birth.  
In its finding, the professional standards committee said the death was "likely to have been associated with the Micardis Plus and Caduet Patient A was inappropriately prescribed".
Lots more discussion here:
As you read the rest of the report it becomes clear that the GP was relying on the drug alert system in his practice system to make sure he was warned if he was prescribing medications which were not appropriate in pregnancy.
He claimed that the warning system had been turned off but surely that can’t be true. I can’t imagine any reason why, once a patient is recorded as being pregnant, anyone would not want to be warned if a drug was unsuitable for the pregnant and that any software provider would enable such a setting. For mine I would prefer to be warned if prescribing for women ‘of possible child bearing age’ if I was planning any medication that might threaten the child – so I could ask a few direct questions regarding pregnancy risk, and go from there.
This has to be one of a range of design decisions for practice / prescribing software that really must be carefully thought through to ensure patient safety, which is, after all the purpose of clinical software.
That said, we have to be clear it is the prescriber is ultimately responsible for all prescribing decisions and need to exercise more than due care at all times!
David.

Monday, July 18, 2016

Breaking News - Ms Sussan Ley Continues As Commonwealth Health Minister.

David.

Weekly Australian Health IT Links – 18th July, 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

An interesting week with a fair bit of activity in the private and academic sector. Useful to see some stats on use of the myHR.
All seems to be very quiet on the ADHA front this week.
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8 July, 2016

GPs warming to e-health records

Posted by julie lambert
The financial pinch on GPs is clearly sharpening interest in electronic health records.
According to the latest figures, 1085 general practices uploaded health summaries to the My Health Record system in the week to 19 June, more than 2.5 times the weekly average of 400 a week during April.
In the same period, the number of health summaries uploaded has jumped from 2000-3000 per week to more than 8000, while the number of views by healthcare providers has shown a similar increase from around 400 per week to almost 1100.
The spurt in activity is clearly linked to the threatened loss of the eHealth Incentive PIP for practices that fail to upload a quota of shared health summaries under new rules adopted on 15 May.
“Following the implementation of these changes to the eHealth Incentive, use of the system by general practitioners has increased significantly,” a Health Department spokeswoman said.
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HealthTech makes a difference

Hello HealthTech — a technology challenge to improve Australia’s health care sector — is in full swing and iTWire readers can vote for the people’s choice.
Westpac’s head of healthcare, Leon Berkovich, said this year’s Innovation Challenge had attracted more than 250 applications from start-ups and entrepreneurs across Australia in just three weeks. It has announced the five finalists for its Innovation Challenge, a platform for entrepreneurs to put forward innovative solutions to further improve Australia’s healthcare sector.
“The quality and number of entrants have been fantastic, with ideas ranging from mobile health management applications to hospital and practice communication tools, data management solutions and modern diagnostics capabilities,” Berkovich said.
“I’d like to thank all of the entrepreneurs for submitting their ideas and congratulate this year’s finalists on being recognised among such a strong field of applicants. It’s fair to say there’s no shortage of innovative ideas on how to leverage technology to further improve the healthcare industry,” he added.
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Why 'medjacking' is a real and present danger

8 July 2016
MEDJACKING was thrust into the global consciousness when the US vice-president, no less, was assassinated before our very eyes, with his pacemaker being remotely ramped up to initiate fatal cardiac arrest. 
The demise of vice-president William Walden — okay, this was the TV drama Homeland, but obviously as close to real life as it comes — could have been brushed off as the stuff of fantasy.
But the fact that the then real holder of that office, Dick Cheney, reacted to the story by disconnecting the wireless function of his heart defibrillator suggested the cyber attack scenario was not too far-fetched.
And several years on, and the US Food and Drug Administration (FDA) deemed it necessary to issue guidelines on the management of cybersecurity in medical devices.
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Vic Human Services under data protection probe

By Paris Cowan on Jul 15, 2016 11:17AM

State privacy commissioner steps in.

Victoria's Department of Health and Human Services says it welcomes impending scrutiny from the state’s privacy watchdog, after newspaper reports exposed serious shortcomings in the way the agency treats sensitive data.
The state's Commissioner for Privacy and Data Protection is preparing to launch a wide-ranging review of information controls at the DHHS.
A spokesperson for the office confirmed to iTnews that the commissioner had "served notice on DHHS to produce documents and information relating to the review".
"The commissioner urges all who consider that the security of their personal and sensitive information may have been compromised to contact our office on 1300 666 444," the spokesperson said.
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National Clinical Terminology Service Connectathon: 5-6 July 2016

Created on Friday, 15 July 2016
The Australian Digital Health Agency, HL7 Australia and CSIRO, gathered more than 40 national and international software developers and implementers in Sydney for the third National Clinical Terminology Service (NCTS) Connectathon.
Building on the previous two Connectathons (February and  May), the two-day session provided a further update on the NCTS and its use of the Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR®) specification.
The Connectathon was invaluable in providing further input into the development of the specifications and infrastructure for the NCTS, ahead of the upcoming public launch. This included specific discussion and feedback in relation to the specifications as well as understanding the priority functionality that implementers require.
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Google's AI is learning how to save your life

Health care is the next frontier for DeepMind, says researcher David Silver
AlphaGo's uncanny success at the game of Go was taken by many as a death knell for the dominance of the human intellect, but Google researcher David Silver doesn't see it that way. Instead, he sees a world of potential benefits.
As one of the lead architects behind Google DeepMind's AlphaGo system, which defeated South Korean Go champion Lee Se-dol 4 games to 1 in March, Silver believes the technology's next role should be to help advance human health.
"We'd like to use these technologies to have a positive impact in the real world," he told an audience of AI researchers Tuesday at the International Joint Conference on Artificial Intelligence in New York.
With more possible board combinations than there are atoms in the universe, Go has long been considered the ultimate challenge for AI researchers. AlphaGo was trained first on expert human moves, then on millions of games of self-play. In its victory against Se-dol, its moves were described by experts as "creative" in that they obviously didn't derive strictly from its training materials.
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What do some doctors have against smartphones?

12 July 2016

Used appropriately, smartphones and tablets can be a powerful adjuncts to learning, writes James Lawler. 

I’VE been warned by academics at my university multiple times before about using a smartphone or tablet during clinical placements, especially in general practice where I’ll soon start another rotation:
"It’s rude to use a mobile phone in General Practice."
"You might be looking up drug names to help your understanding, but the GP will think you are texting your friends and they will be offended."
"Use a clinical handbook instead if you want to read up whilst on placement."
Let me be clear – it is would be rude of me to be using my phone while someone – doctor or patient – was talking to me. It might also be rude to be constantly on my phone during consultations. But I’d argue it is only as rude as using the Oxford Handbook of Clinical Medicine in the same way.
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Federal election 2016: Medicare payments dated, says ex-AMA head

  • The Australian
  • 12:00AM July 14, 2016

Sarah Elks

The Medicare payment system is antiquated, complicated and needs to be fixed, according to a former head of the Australian Medical Association.
Practising GP Steve Hambleton, deputy chairman of the Medical Benefits Schedule Review Taskforce, said the remit of the taskforce should be broadened to investigate an overhaul of the payments system.
“Anything that’s 30 years old needs to be fixed,” Dr Hambleton told The Australian. “By definition, it’s out of date … it’s all very complicated and antiquated. We (have) a Medicare Benefits Schedule Taskforce that’s looking at the whole schedule (to target obsolete rebate items), so it’s a good opportunity to have a look at the rest of the activity as well.”
The review, launched in April last year and headed by former Sydney Medical School dean Bruce Robinson, is examining the evidence base and usage of about 5700 items on the $21 billion MBS.
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To remain relevant, doctors should learn to write computer code

14 July 2016
COMMENT
Learning how to write Java, C or Python is no less important than learning about medians, modes and confidence intervals, writes cardiology registrar and software developer Dr Jerome Goldstein.
I WAS always certain my experience would be different to the factory workers replaced by cheaper and more efficient computerised machinery. But technology is changing the face of medicine so quickly that nobody is safe. Doctors included.
Doctors are naturally a conservative bunch. So it hardly surprises that it has taken the medical community some time, two decades to be exact, to embrace the wired world. But, on the whole, we are still bystanders.  So my question is, should we speed up our involvement? 
Here is your answer. Last month my hospital held its inaugural “hackathon”. Doctors and computer programmers sat together and collaborated. Congratulations to the organisers. It may have been the first of its kind in an Australian public hospital. But it is at least 10 years overdue.
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Is e-health contributing to doctor burnout?

Antony Scholefield | 12 July, 2016 | 
Health technology is supposed to make doctors’ work easier, but according to a US study, it could lead to higher rates of professional burnout.
Researchers from the Mayo Clinic found doctors who used electronic health records, and ordered medications and issued instructions electronically were generally less satisfied than those who did not.
Those using electronic systems were less likely to think the time they spent on clerical tasks relating to patient care was reasonable, and most didn’t think the systems increased their efficiency.
More worryingly, doctors using e-health systems had a 30% higher risk of burnout even after adjustments for hours worked, specialty, setting, sex and age.
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Censured GP blames lack of 'red flag' alerts for script errors

Tessa Hoffman | 6 July, 2016 |
A country GP who prescribed contraindicated antihypertensives to a pregnant woman whose baby died has put the error down to 'red flag' alerts being switched off on his software.
Dr Sunil Kumar Dan, a 73-year-old GP who has practiced in Moree in NSW for more than 30 years, has been found guilty of unprofessional conduct over the treatment of a patient during several antenatal visits in 2012 in a decision of the Medical Council of NSW’s Professional Standards Committee.
The woman was nine weeks pregnant during the first antenatal visit in July 2012 with Dr Dan, her GP of over 20 years who had been treating her for hypertension since 2009.
At the appointment, the woman presented with a BP reading of 115/79mmHg and left-sided chest wall pain, and Dr Dan noted she would stop taking Caduet due to pregnancy.
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Could visual analytics be the cure for Australia’s healthcare?

  • Charlie Farah
  • The Australian
  • 11:18AM July 11, 2016
Healthcare has always been an expensive necessity and remains a top priority, even if it is a strain on the wallet. As the world continues to age, we need to swallow an even more bitter pill: healthcare costs are only going to increase. With the Australian government cutting funding to services such as pathology and imaging, healthcare organisations are facing increased costs and several healthcare companies intend to pass these onto an ageing population. As life expectancy increases, so too does the amount we have to pay in order to sustain a good, healthy quality of life.
Healthcare wastage costs $20 billion a year in Australia, according to the government’s Health Safety and Quality Commission. There is the potential to cut 15 per cent off the $150 billion national health bill if health efficiency is improved and entrenched waste is eliminated. To reduce costs, organisations must find ways to be more efficient in their daily operations. Visual analytics — which helps us see the whole story in the data — can allow us to make and identify better business decisions and opportunities.
Visual analytics: A prescription for smart healthcare to reduce costs
With Australia’s healthcare system undergoing major reviews this year ahead of the upcoming budget, there is a growing need to optimise efficiencies in order to maintain high standards of performance and patient care services in the face of rising costs. Health fund members are bracing for premium hikes four times the inflation rate this April, as the government subsidy for health insurance falls from 30 per cent to 25 per cent. On average, health insurance premiums have been growing about 6 per cent a year.
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eHealth Queensland appoints former staffer Malcolm Thatcher as interim CEO/CIO

Queensland Health on the lookout for CEO/CIO to lead the IT and eHealth agenda
Jennifer O'Brien (CIO) 14 July, 2016 09:54
Long-time CIO of Mater Health Services, Malcolm Thatcher, has accepted the interim CIO/CEO position at eHealth Queensland, a seat vacated by Colin McCririck who left the position in January after reportedly being linked to a corruption scandal.
McCrinick, who was reportedly caught up in a nepotism scandal and stood aside for four months while the state’s Crime and Corruption Commission (CCC) investigated, was reinstated after the CCC made no findings against him.
However, he decided to quit the agency and ventured overseas to work for IBM in the United States.
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GP suspended after accessing wife's medical records

11 July 2016
A DOCTOR accused of domestic violence by his wife has been suspended after trawling through her medical records without her consent.
The wife of Dr Tahir Shah claimed their marriage was increasingly volatile and eventually led to a death threat against her.
She complained in June 2012 that he was looking through her medical records without permission.
In a sworn affidavit she said he replied to the effect: “Why not? You are mine, everything of yours is mine … I am your husband … I can check anything I want”.
He was then alleged to have described the Privacy Act as “westernised … rubbish”.
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Ursys Signs Capacity Deal with Optus Satellite

 [Via Satellite 07-12-2016] Optus Satellite has announced a new wholesale relationship with Ursys, a designer and provider of satellite based voice and data communications, specifically for complex networks in remote and rural areas.
Ursys will use dedicated satellite capacity on Optus’ D2 satellite, stationed at 152 degrees east, and will also have access to third party international satellite providers. In addition, Ursys will use Optus’ teleport facilities at Belrose, north of Sydney, and the wider Optus infrastructure.
A current initiative of Ursys is Remote Outback Satellite Infrastructure e-Health (ROSIE), a tele-health network for 23 remote health clinics across North Western Australia, the Northern Territory and South Australia. ROSIE uses commercial grade communications services to enable health applications normally only available in city or regional clinics. These applications allow direct access between remote clinicians and city specialists in real time.
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New e-health centre opens

Valerina Changarathil, The Advertiser
July 11, 2016 12:30am
RESEARCH into the use of digital technology to deliver positive outcomes for the sick and aged will be at the heart of the Flinders Digital Health Research Centre to be launched today.
Based at Tonsley, the centre will be headed up by digital healthcare experts Professor Anthony Maeder and Professor Trish Williams as co-directors.
Mr Maeder is currently chair of Digital Health Systems and joined Flinders in April this year from the Western Sydney University, where he founded the Telehealth Research and Innovation Laboratory.
Professor Trish Williams, Cisco Chair and Professor of Digital Health Systems is internationally recognised for her medical information security expertise, wrote the first clinical record system for Australia in 1986 and is an expert in e-health informatics standards.
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By comparing data on the genes involved in patients' cancers with data on genes from lab-based cancer cell lines, researchers have begun to predict, on a large scale, which drugs will best fight various cancers. Scientists are starting to accumulate huge datasets on which genes mutate during cancer, allowing for a more systematic approach to “precision medicine”. In a study published in Cell, researchers from the Wellcome Trust Sanger Institute in the UK compared genetic mutations in patient tumours to those in cancer cell lines and then tested the cell lines’ responses to therapeutic compounds. By analysing where these datasets overlap, researchers can begin to predict on a large scale which drugs will best fight various cancers. The researchers analysed data from two public datasets, the Cancer Genome Atlas and the International Cancer Genome Consortium, and other studies, gathering genetic information for more than 11 000 tumour samples. The team then compared these tumour samples to about 1000 cancer cell lines used in labs, looking for lines that had the same types of mutations as the patient samples, and which therefore might more closely mimic patient responses. Once they mapped the tumour mutations onto the cell lines, the researchers looked for the genetic mutations that could best predict the cancer cells’ response to 265 different anti-cancer compounds at various stages of development. The drugs covered a range of mechanisms, including chemotherapeutics, small-molecule inhibitors, epigenetic modulators, and cell death regulators. Many of the mutations that occurred both in tumour samples and cell lines did signal whether the cancer cells would be sensitive or resistant to different compounds, largely depending on the type of tissue in which the cancer originated.
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Microsoft cloud chosen to drive New Zealand’s electronic health systems

"It comes at exactly the right time, as globally we are at an inflection point"
For many, the next phase of computing involving dynamic cloud processing symbolizes nothing more than a place to store old smartphone photos, tax documents, and college reports perhaps mixed with an occasional voice query of the internet. Where businesses and large enterprises have been chided for their pace of consumer-facing trends of adoptions, they are using the cloud at a much more sophisticated level.
Microsoft New Zealand confirmed in an announcement today, that “Microsoft’s core cloud services Azure, Office 365 and Dynamics CRM Online, have met the Ministry’s requirements for storage of personal health information.”
Clearing the regulatory bar, Microsoft has now been given the green light to become the public cloud and back-end support for the eHealth agenda in New Zealand.
For Microsoft’s part, the company is pleased to offer its cloud platform for health care to the area.
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Scientists confirm first instance of water clouds outside our solar system

Date July 11, 2016 - 10:18AM

Carli Velocci

A cloudy day here on Earth might be a sign for gloom, but elsewhere in the universe, to behold one is a scientific achievement. In this case, a team of researchers from UC Santa Cruz announced that they have detected water clouds for the first time outside our solar system on a brown dwarf known as WISE 0855, which is around 7.2 light-years away from Earth.
The study was published back in May in Astrophysical Journal Letters and updates what we currently know about the dwarf, which was discovered in 2014 by NASA's Wide-field Infrared Survey Explorer (WISE). Scientists had detected tentative water clouds back in the original study, but had limited photometric data and needed a deeper infrared image to confirm.
Using the Gemini North telescope in Hawaii, they were able to use spectroscopy to gather more information. Researchers confirmed that the dwarf's atmosphere is "dominated by water vapour and clouds."
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Enjoy!
David.

Sunday, July 17, 2016

It Looks Like The Stick Is Working Well On The GPs As Far As The myHR Is Concerned. Not That The System Is Actually Being Used Much!

This appeared a few days ago.
8 July, 2016

GPs warming to e-health records

Posted by julie lambert
The financial pinch on GPs is clearly sharpening interest in electronic health records.
According to the latest figures, 1085 general practices uploaded health summaries to the My Health Record system in the week to 19 June, more than 2.5 times the weekly average of 400 a week during April.
In the same period, the number of health summaries uploaded has jumped from 2000-3000 per week to more than 8000, while the number of views by healthcare providers has shown a similar increase from around 400 per week to almost 1100.
The spurt in activity is clearly linked to the threatened loss of the eHealth Incentive PIP for practices that fail to upload a quota of shared health summaries under new rules adopted on 15 May.
“Following the implementation of these changes to the eHealth Incentive, use of the system by general practitioners has increased significantly,” a Health Department spokeswoman said.
Some doctors are unhappy about the use of financial incentives to promote the system, saying privately the rule could amount to coercion of GPs who are strapped financially by the four-year freeze on Medicare rebates.
But others see a lot more carrot than stick in adopting the new system, which is an “opt-out” model for patients which replaces the failed “opt-in” Personally Controlled Electronic Health Record.
“From my personal point of view I can only see the advantages,” says Dr Chris Goodall, a GP in Cairns, part of the north Queensland PHN area where one of the two MHR trials is getting under way.
In the tropical city, with a large itinerant population, the ability to share and view patients’ health records will save huge amounts of time and avoid duplication of tests, he says.
“At this time of year, 10 to 20% of our business is travellers and holidaymakers,” Dr Goodall told The Medical Republic.  “There are lots of grey nomads and people escaping the southern winter, and all of them are on a white tablet with a line down the middle and they can’t remember the name of it.
“It will be massive for us that we don’t have to send faxes down to their local GPs asking for a fax back with their medication summaries and that sort of thing.  It will save us a lot of time. That’s the principal reason why I am interested.”
Dr Goodall, an early user of the PCEHR, said colleagues who had had concerns about the system tended to be less well informed.
“A lot of my colleagues probably weren’t aware of what was going on and were quite worried. I think they’re now starting to see the advantages. Once you know what you are doing, uploading takes three clicks of a mouse.  You click on the health summary and upload what you want.”
Another Cairns GP, Dr Peter Vanrietvelde, says he is very positive about the concept but is concerned about the heavy cost of the e-health system development while rebates remain frozen and the advantages remain far in the future.
There is a lot more here:
What I found interesting here – other that just how effective the ePIP payments were being were the statistics on the myHR.
There is a useful, pretty current page on the statistics the Government is releasing on the myHR.
Here is the link:
So what we have, after one million people where opted in to the system, we have a total of 16% of the population registered. It has taken now over four years to get to this point.
However the total number of shared health summaries held is all of 166,000.This means that only 4.3% of enrolled people and less than 1% of the total population have a shared health summary.
Each shared summary seems to have cost $7,200 which really does make one wonder about the value for money we are receiving – especially given that the expenditure is still running at $100M p.a. ongoing.
Note also there is absolutely no information on how often anyone has actually looked up a Shared Record. I wonder just why that is?
So we seem to have a pile of hard to search documents masquerading as an usable electronic health record. What a money wasting joke!  I also feel sorry for the GPs forced to use this awful ill-conceived system for the ePIP payments.
David.

AusHealthIT Poll Number 328 – Results – 17th July, 2016.

Here are the results of the poll.

With The Election Over, Should Ms Sussan Ley Continue On As Health Minister?

Yes 24% (28)

No 52% (60)

I Have No Idea 24% (28)

Total votes: 116

It seems a small majority are in favour of a change. To whom one may wonder?

A great turnout of votes.

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

David.