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, September 22, 2016

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

September 22 Edition.
Parliament has now risen and won’t be back for a good few weeks. (Back October 10, 2016).
Seems that last week was good for the Government with lots of Budget Savings passed and receiving Royal Assent and apparent resolution of a range of issues around Superannuation.
The big issue for this week will, for once not be focussed on just what a mess politics seems to have become but some relative co-operative success!
On the global stage things will be clearer by the time you read this.
Thursday Update:
With both Japan and the US continuing very loose policies our markets (and theirs) have done well so far this week!
-----
Here are a few other things I have noticed.
-----

Budget Issues.

  • September 11 2016 - 11:30PM

Scott Morrison says government, Labor inching towards deal on $6 billion savings

James Massola
The Coalition and Labor are inching towards a deal to pass the $6 billion so-called omnibus savings package, Treasurer Scott Morrison says.
Federal parliament resumes this week and debate will begin on the savings package, which contains 26 savings measures the government argues Labor indicated it would adopt during the election campaign.
Labor has partly disputed that claim, arguing its election policies did not explicitly commit to a $1 billion cut to the renewable energy agency ARENA, nor to a $1.3 billion cut to the clean energy supplement, originally linked to the axed carbon tax, which would actually deliver a cut in real terms to the incomes of Newstart recipients.
A rearguard action has been underway within Labor, publicly led by shadow cabinet minister Anthony Albanese and backed by welfare groups such as ACOSS, to oppose the cut to the supplement and, behind the scenes, the government and opposition have been negotiating over a way to find alternative savings.
Mr Morrison told Fairfax Media on Sunday that, since the bill had been introduced to the Parliament, discussions over a compromise deal had been "constructive".
-----
  • Sep 12 2016 at 11:45 PM
  • Updated Sep 13 2016 at 7:51 AM

Coalition compromises on dole cuts to win budget deal with ALP

The Coalition has scrapped plans to cut welfare payments by $1.3 billion as part of a deal with Labor to secure the passage of the omnibus budget bill and still deliver most – if not all – of the promised $6 billion in savings.
Following backroom talks led by Finance Minister Mathias Cormann and shadow treasurer Chris Bowen, sources said the government agreed to drop the largest of the 24 spending cuts in the bill – the removal of carbon tax compensation from the payments to future welfare recipients.
It is understood that the revenue will be recouped by cuts elsewhere in welfare. It is believed there will be a further paring back of the Family Tax Benefit end-of-year supplements which the government has wanted to abolish altogether since the 2014 budget. 
-----
  • September 13 2016 - 3:59PM

Credit rating downgrade would have 'very little to no' impact, says AOFM chief executive Rob Nicholl

Jessica Irvine
The man responsible for managing the nation's credit card says a credit rating downgrade would have "little to no" impact on the government's cost of borrowing or investors' willingness to lend.
The observation undermines some of the rhetoric about a "budget emergency", as the government and Labor commit to $6 billion in cuts to funding for students, families, and families.
And in an unprecedented move, the government's debt manager will issue the first 30-year Australian government bond next month.
Governments borrowing on 30-year terms is common overseas, but this is the first time an Australian government has ever sought to borrow for such a long time.
-----
ANALYSIS
  • September 14 2016 - 12:15AM

Malcolm Turnbull promised economic leadership. A year later we're still waiting

Peter Martin
Unveiling his surprise strike against Tony Abbott a year ago, Malcolm Turnbull identified just one reason for rolling a sitting prime minister: "economic leadership".
"It is not the fault of individual ministers," he told a packed press conference in a Parliament House courtyard. "Ultimately, the Prime Minister has not been capable of providing the economic leadership our nation needs.
"We need a style of leadership that explains complex issues, sets out the course of action we believe we should take, and makes a case for it. We need advocacy, not slogans. We need to respect the intelligence of the Australian people."
-----
  • Sep 13 2016 at 6:30 PM
  • Updated 45 mins ago

Budget deal to keep wolves from the door for now: Scott Morrison

A landmark deal between the government and Labor to deliver $6.3 billion in spending cuts would satisfy the credit agencies for now but much more was needed if the nation's AAA rating was to be preserved and the budget ever restored to balance, the federal government says.
Peak business groups welcomed the deal, which involved significant compromise from both sides, as a positive start to the new Parliament but also cautioned it was just a first step.
In a boost for the government and Malcolm Turnbull, who marks his first anniversary as leader on Wednesday, the Coalition secured support for the passage of the budget omnibus bill that originally contained 24 spending cuts worth $6 billion.
-----

Negotiations boost savings to fight Budget deficit

September 13, 20162:55pm

The government and Labor have agreed to a $6.3 billion cut in spending over four years

THE government and Labor have quietly and carefully agreed to a $6.3 billion cut in spending over four years, and produced a rare offer of cross-aisle congratulations.
At issue was the content of a $6 billion omnibus Bill Treasurer Scott Morrison said was needed to repair the Budget deficit, and which included measures the Opposition had proposed during the election.
The negotiations dropped some measures but provided alternatives, which boosted savings by $300 million.
One of the biggest single casualties in negotiations was the Baby Bonus, dumped to save $300 million even though it was a favourite of the National Party. Its removal was described by Labor as a government “capitulation”.
-----

Compromise on budget repair a welcome relief amid bickering

- on September 14, 2016, 11:52 am
Just when it appeared that the hotchpotch Federal Parliament delivered at the last election would never work together to produce anything of worth, a light has appeared on the horizon.
Yesterday, as bickering and division continued over the marginal issue of same-sex marriage, the major parties came forward with a compromise over the so-called Omnibus Bill to begin the process of budget repair.
WA Senator and Finance Minister Mathias Cormann and shadow treasurer Chris Bowen managed to negotiate an outcome to deliver $6.3 billion into the bottom line.
While Labor supported only 20 of the 24 measures in the Turnbull Government’s Omnibus plan, the total savings are in excess of what was originally outlined.
-----

Cuts in government spending alone can lower Australia’s deficit

  • The Australian
  • 12:00AM September 15, 2016

David Uren

Former treasurer Peter Costello proudly claims that of the 13 balanced budgets delivered in the past 40 years, he was responsible for 10. While the mining boom may have helped deliver some of them, it was not dreamt of when the first of Costello’s balanced budgets was achieved in 1997-98.
Costello noted, in a speech to the Minerals Council of Australia this week, that he was producing big budget surpluses in 2000, when the iron ore price was below $US13 a tonne. “We were in surplus at the low point of the mining cycle. It was at the height of the boom that we were running deficits,” he said, adding that the tragedy of Aus­tralia’s fiscal policy was that the Rudd government’s fiscal stimulus was overdone, then never withdrawn.
There is certainly a stark contrast between Costello’s 11 budgets and the nine that followed. Where Costello’s budgets delivered a combined surplus of just under $100 billion, the deficits from 2008-09 through to this year reach $355bn.
-----
  • September 15 2016 - 9:00AM

Government 'nudge unit' to attempt to change people's behaviours

Nick Miller
London: Psychological tricks used by governments to "nudge" how citizens behave may soon be applied to the contentious area of living wills and end-of-life decisions.
After early wins in areas such as persuading people to pay fines on time, or cut down on fizzy drinks, the so-called behavioural scientists are raising their sights, said Dr Rory Gallagher, head of the Behavioural Insights (BI) Team in Australia.
"We are now looking at corruption at an international level, we are dealing with issues like anti-microbial resistance … pretty complex topics," he said.
"So I would hope that in a couple of years' time we could start to get into things like end-of-life – very pressing issues, but very amenable hopefully to our methods."
-----

Turnbull says compromise to be expected

September 16, 20162:39pm
Paul Osborne, AAP Senior Political Writer Australian Associated Press
Malcolm Turnbull says voters outside the "political bubble" expect the government to make some compromises on its election promises to get them through parliament.
The prime minister on Friday hailed the passing of $11 billion in budget savings over four days of parliament sittings as evidence the coalition was delivering on its pledges.
Labor has criticised the government for making changes to what Mr Turnbull called "iron clad" policies, such as superannuation which was also earmarked for amendment this week.
Labor's vote was central to the parliament on Thursday night passing the $6.3 billion omnibus budget bill, which was also amended to win support, and the $4.6 billion hike in tobacco excise on Wednesday.
-----
COMMENT
  • September 17 2016

Is the power of king coal overstated?

Ross Gittins
If you want to shock and appal a politician, just suggest Australia join the United States and China in limiting the building of new coal mines.
Think of all the growth we'd be giving up, they protest. All the jobs that wouldn't be created. Some even argue we have a moral duty to sell more coal to the world. How else will the poor countries be able to develop their economies so they become as rich as we are?
Coal seam gas, fracking, extraction: here's what it all means.
Short answer: by relying more on other, less carbon-emitting forms of energy.
Surely the sooner we arrest global warming the better off we'll all be, rich and poor.
-----

Health Budget Issues.

Sweeping Medicare changes to curb rorts

  • 12:00AM September 12, 2016

Sean Parnell

The taskforce reviewing the $21 billion Medicare Benefits Schedule is finalising the most sweeping changes in more than a decade to crack down on rebate rorts and protect patients, including restricting GPs ordering powerful scans for back pain and reducing the ­number of colonoscopies and sleep tests.
The MBS Review Taskforce has called for feedback on a series of landmark recommendations from specialist clinical committees established to examine areas as diverse as diagnostic imaging and maternity care.
The new proposals include a requirement for mandatory health testing for pregnant women and new mothers, restrictions on GPs ordering expensive service such as low back scans, and a strict limit on surgeons ­ordering multiple MBS items for a single service.
-----

Focus MBS funds on right tests at right place and time

  • Bruce Robinson
  • The Australian
  • 12:00AM September 12, 2016
In April last year, the government commissioned a review of the 5700 items covered in the Medicare Benefits Schedule.
Clearly, the first comprehensive review in 30 years of all the health procedures, consultations and diagnostic tests subsidised under the MBS is long overdue.
The changes in the practice of medicine over the past three decades are enormous. The schedule, meanwhile, continues to fund procedures and tests now overtaken by better treatments and approaches to care. As it stands, it does not fully reflect the wealth of research evidence coming out of universities, hospitals and clinics that provides guidance to clinicians on the best practice of medicine.
The MBS taskforce has spent the 16 months since it was commissioned reviewing thousands of different medical tests, procedures and clinical consultations against the research evidence. At the front line of its robust methodology are expert committees, comprising clinicians and patient representatives working through lists of Medicare item numbers, considering whether each reflect the best clinical practice. One of the earliest problems identified are the inconsistent rules that determine access to services. Across all item numbers, the committees look to ensure that there is consistency and value delivered for every dollar spent.
-----
12 September 2016

Person-centred care vital to Health Care Homes

Authored by Leanne Wells
IT IS self-evident that we should build health services around the needs of the patient, isn’t it?
But this becomes all the more compelling when we consider the evidence: approaches to person-centred care such as shared decision making and self-management support can improve a range of factors in addition to patient satisfaction such as care quality and health outcomes. When person-centred care practices like these are adopted, people tend to choose less invasive and costly treatments because they have been informed and supported in their decision making.
We have seen our policy makers and health system drift towards a preoccupation with organisational efficiencies and budgets. These are important, but not as important as the needs of patients for individually-tailored attention. While Medicare is embedded in our health landscape and its current design effectively funds episodic care, relatively little attention has been given to how to better meet the needs of the more frequent users of the system: patients with chronic and complex conditions.
-----
  • September 13 2016 - 2:01PM

Australian Institute of Health and Welfare report card: seven ways to grade our health

Kate Aubusson
We're living longer than ever before and our death rates are falling, but the Australian Institute of Health and Welfare's national report card shows where we're still falling down. 
The Australia's Health biennial report released Tuesday "shows that Australia has much to be proud of in terms of health," AIHW director and chief executive Barry Sandison said.

An integrative approach to tackling diabetes

Mt Druitt Medical Centre is leading the way with an integrative approach to diabetes treatment and the results are proving positive.
A baby boy born between 2012 and 2014 can expect to live to 80.3 years old and a baby girl's life expectancy is 84.4, and our disease survival rates are rising. 
But how well did Australians score on our national report card?
-----

Ageing population pushes hospital visits higher

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

Sean Parnell

Australians are more likely to be hospitalised now than 10 years ago and are also admitted more often, with private hospitals leading the growth, according to data from a federal health agency.
The Australian Institute of Health and Welfare yesterday provided a voluminous update of the nation’s health status, drawing together previously published information on specific conditions with new data on shifts in hospital service provision.
In 2013-14, when $155 billion was spent on health, $145bn of that was recurrent spending, predominantly hospitals (40 per cent) and primary healthcare (38 per cent). Governments, and their taxpayers, contributed $105bn overall.
Hospitalisations rose faster than population growth between 2003-04 and 2013-14 — the biggest increases were in age groups above 44 — although patients were more likely to be admitted and discharged on the same day.
-----

Labor 'playing politics with cancer': govt

September 13, 20167:09pm
Australian Associated Press
Labor has been accused of playing politics with cancer, potentially delaying the rollout of an improved cervical cancer test.
The federal government wanted legislation to establish a new national cancer screening register to pass parliament this week, in time for a new five-yearly cervical cancer test to be rolled out from May 2017, replacing the two-yearly pap smear.
But Labor and the Greens joined forces on Tuesday to send the bills to a Senate inquiry for further scrutiny, to report back on October 11.
Health Minister Sussan Ley launched a scathing attack, accusing the opposition of sending the bills into a vacuum.
-----
  • September 14 2016 - 7:37PM

'Worksharing' agreements with overseas authorities to mean faster approval for medicines

·         Harriet Alexander
Medicines that have been approved in the United States or Europe will be fast-tracked into the Australian market under new medicine regulations to be introduced by the federal government.
The move is estimated to reduce by 4½ months the amount of time that Australians wait for new medicines, and bring more medicines into the market.
Health Minister Sussan Ley on Thursday will release the government's response to a review of medicines and medical devices regulations, 15 months after it was submitted by independent expert Lloyd Sansom.
​ She said the government would adopt most of the recommendations, including greater use of comparable overseas regulators such as the US Food and Drug Administration and the European Medicines Agency. 
-----

The treatments for sleep disorders are improving

  • The Australian
  • 12:00AM September 16, 2016

Sean Parnell

Chris Hart was clutching at straws, figuratively and literally. On a work trip to Mount Isa, the Brisbane dentist was tired of feeling tired, of having his busy days sabotaged by nights with sleep apnoea.
As he drank more coffee in a city cafe, Hart fiddled around with drinking straws on the table, fashioning a rudimentary prototype of a device to help him breathe. That night, desperate for a decent sleep, he rigged up some dental tubes and glue in hope it would keep his airway clear during the night.
“And it worked,” Hart says of that unplanned experiment in 2012. “I then made one out of wax and tried that, but I chewed through it because it was soft. Then I had my lab assistant make one out of plastic, but it was time consuming and I thought we needed better.”
-----

Australian hospital parking fees are now costing some families more than their weekly rent

September 17, 20168:22pm

Hospital parking fee calamity

THE sickest patients and their families are paying over $100 million a year in hospital parking fees with some unable to afford to visit sick and dying relatives.
The fees, which can be charged more than once per day if families make more than a single visit to the hospital, are striking at the heart of Australia’s promise of a free public hospital system.
Some families have reported they are spending more on parking than they are on rent if they have a sick relative they need to visit every day.
The Consumer’s Health Forum chief Leanne Wells says exorbitant parking fees are “distressing” and an extra stress on families trying to care for sick loved ones.
A News Corp investigation has found the revenue raised from hospital parking fees in NSW has soared by 37 per cent to $38.7 million in the last three years, twelve times the rate of inflation over the same period.
-----

Superannuation Issues.

Government’s super, pension test changes will hit 70pc

  • Glena Korporaal
  • The Australian
  • 12:00AM September 13, 2016
Seventy per cent of Australians would be worse off from a combination of tighter pension assets test and superannuation tax changes coming into force next year, a government briefing paper circulated to backbenchers says.
The report, distributed by Scott Morrison to explain the federal government’s proposed super changes, shows people benefiting the most from the combined changes would be those on the lowest income levels.
The combined impact of the two changes means, however, that everyone earning above the bottom 30 per cent of incomes is worse off. The government’s superannuation proposals include retention of the Low Income Tax offset for people earning $37,000 and below, which was due to end in mid-2017.
Other changes are designed to hit higher income earners including capping the total amount that can be rolled into tax-free superannuation at $1.6 million, cutting the concessional and post-tax ceilings on super contributions, effectively wiping out the attractions of the current transition-to-retirement scheme and increased taxes on super contributions for people earning more than $250,000 a year.
-----

Super taxation as a cash grab won’t work

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

Judith Sloan

Scott Morrison and Revenue and Financial Services Minister Kelly O’Dwyer may well regret ever hearing the word superannuation. Having experienced a rush of blood to their heads and working on the basis of misleading and deceptive advice given to them by activist bureaucrats, they now find themselves in a right royal pickle.
The ill-considered and over-engineered package of superannuation changes announced in the budget — out-Laboring Labor — has produced a monumental headache for the dynamic duo.
Their problems started from the decision to opt for the faulty definition of the purpose of superannuation offered in the Murray report into the financial system. (At a general level, it has to be said that the Murray report was much weaker on superannuation than on other aspects of the financial system.)
-----
COMMENT
  • September 14 2016 - 12:29AM

Super tax reforms will give Malcolm Turnbull boasting rights

Ross Gittins
Everyone wants to know what achievements Malcolm Turnbull can point to after his first year as Prime Minister. Well, I can think of something: his reform of the tax breaks on superannuation – provided he gets it through without major watering down.
Why is it such a big deal? Because it ticks so many boxes. Because it makes the taxation of super much less unfair.
Note, I didn't say much fairer. It will still be an arrangement that gives the least incentive to save to those who find saving hardest, and the greatest to those whose income so far exceeds their immediate needs that they'd save a lot of it anyway.
A report by John Daley and others at the Grattan Institute, A Better Super System: Assessing the 2016 tax reforms, independently confirms the government's claim that the changes will adversely affect only about the top 4 per cent of people in super schemes.
-----
COMMENT
  • September 15 2016 - 1:31PM

Scott Morrison's super cap change a cave-in to the wealthy

John Collett
You'd have to say Treasurer Scott Morrison's re-set of the cap on non-concessional superannuation contributions is a deft move.
It's a big cave-in to the wealthy dressed up as something less generous. The best tax shelter for the well-off this side of the Cayman Islands survives pretty much intact.

Government's super compromise

Treasurer Scott Morrison has announced changes to the Government's superannuation policy after much opposition to the original plan.
The change to the cap should see the government's entire superannuation package of reforms passed by parliament. So it looks as if we can be fairly certain that this will now be the rules under which super will work for many years to come.
-----

Morrison, O’Dwyer will keep messing with superannuation policy

  • The Australian
  • 12:00AM September 17, 2016

Judith Sloan

The biggest take-home message from this week’s superannuation changes by the government is that the Coalition can never be trusted on superannuation. Its leaders say one thing and do another, trying to out-Labor the ALP when it comes to imposing higher taxes on savers who are seeking to provide for their retirement.
And how should we interpret the government’s backflip on the crazy backdated lifetime post-tax super cap? During the election campaign, Malcolm Turnbull was adamant: “I’ve made it clear there will no changes to the (superannuation) policy. It’s set out in the budget and that is the government’s policy.” I guess that was then. What a complete fiasco the superannuation saga has been. Mind you, Scott Morrison and Revenue and Financial Services Minister Kelly O’Dwyer have only themselves to blame. They were hoodwinked by extraordinarily complex and misleading advice given by deeply conflicted bureaucrats. The only conclusion is that they are just not that smart.
How do I know this? Because Treasury has been trying to convince treasurers for years that these sorts of changes must be made to the tax concessions that apply to superannuation. Mind you, these concessions apply because superannuation is a long-term arrangement in which assets are locked away until preservation age is reached.
I look forward to comments on all this!
-----
David.

This Is An Interesting Outline Of What Victoria Is Doing With Health IT. Worth A Browse!

This appeared a few days ago.

EXCLUSIVE – Moving towards a ‘Person-Centred’ approach to healthcare

OpenGov Asia speaks to Andrew Saunders, Health CIO, Department of Health & Human Services, Victoria to learn more about his role and aim to transform the healthcare services sector

14/09/2016
How long have you been in your current role? Were you brought in with a specific objective, drawing on your experience in the private sector to achieve a certain goal?

I joined in August 2015.
The department wants the Health CIO to work collaboratively in the Victorian public health sector devolved governance model, be able to bring the sector together and agree a digital health strategy, especially around the sharing of clinical information, and support the health services in working together on joint initiatives.
In Victoria, we have 86 health services and 32 independent community health services. My team supports the health services in providing health ICT design and shared service, as well as performing a sector wide ‘health systems management’ role to ensure that the end to end system is working together, meeting minimum standards and positioning itself to leverage future technological advances.
Another key part of the role is to enable the appropriate sharing of information between the health and social care functions of the department to support a person centred approach to health and well-being.
What are the core priorities that you are looking to implement or may have started to implement over the coming years?
Health systems within Australia and around the world are grappling with how to mitigate the increasing cost pressures on health, and Victoria is no different. One of the strategies being developed is moving to a more person-centred system that focusses on meeting individual and place based needs, with the aim of keeping people healthy and well throughout their lives.
Technology is an enabler in connecting the disparate parts of the system together , to enable clinical information to be shared in such a way that the overall health system is safer, better able to meet individual needs and produce better outcomes in a more cost effective way.
Whilst technology is an enabler, change management and developing new workflows is the key for success, and we need to ensure that patients, clinicians and health service administration work together to develop the new digital health workflows.
We have 6 building blocks for the realisation of our Digital Health strategy:
  • Digitise clinical systems so that appropriate clinical information can be shared to provide safer and more effective clinical outcome
  • Create a person-centred systems approach that deals with the specific needs of the individual from a health and social care perspective, and provide a seamless pathway to accessing appropriate services
  • Provide ‘clinical grade ICT integration’ across the whole sector to ensure we have robust and secure ICT infrastructure that can support the real time decision making required to assist in saving lives
  • Creating a shared clinical information system to enable clinicians to better support their patients from an integrated and continuum of care perspective.
  • Enhance applied health research, quality & safety and education through deeper analytics of de-identified health datasets.
  • Identify opportunities for targeted preventative health and early intervention.
Our plan for the next 3 years is to progress each of the building blocks, the pace of change dependent on the funding received. In summary, we want to ensure we are collecting clinical information in digital form that can be part of a person’s health record, is able to be appropriately shared, is robust and secure, and can be used to deliver better health and wellbeing outcomes for the person.
In terms of technologies that are important to you and your department- you talked a lot about recording of data, do you store that on Cloud or in data centres? Where are you recording your data?
The majority of data is currently stored in data centres in Victoria, though we are investigating the use of cloud based software services.
What is your time frame to go paperless?
Our strategy is to have a fully digital health record rather than have paperless as an end goal, and the timeframe will be dependent on funding and the ability of the health service to implement the significant change management required.
We’ve made good progress over the last few years, with many health services now at a high digital clinical standard or have projects underway.

With regards to recording, storing and securing the data, what information would be useful to you or the CIOs reporting to you?
Our focus is moving to health and well-being and to do that we need a person-centred view over the individual’s lifetime rather than just treat them when they are unwell. This will require a longitudinal view of the person, and making it available in a private and secure way when some form of treatment or support is required.
More here:
We often do not hear much from those at the coal face at the State level. Always interesting to see what others are planning.
This all sounds reassuringly sensible to me!
David.

Wednesday, September 21, 2016

There Are Pros And Cons To Having Email Access Between Doctor And Patient. Education Is Vital.

This article appeared a little while ago.

To email your patients or not to email

Authored by Cate Swannell
ONLINE portals using secure pathways may be the best available solution to the dilemma of doctor-patient email communications, which sees practices lagging behind the “willingness of their patients” to connect via email.
A systematic review published in Family Practice showed that far more physicians want to use email communication with their patients than actually do use it. In Europe, for example, it was shown that only 7.4% of the European population communicated with a physician using email or the web.
“In the UK, 52% of general practitioners responded as willing to use such a communication with their patients, and 37% had already received one or more emails from their patients,” the author of the review, Assistant Professor Jumana Antoun from the American University of Beirut, wrote.
“Factors that may explain this discrepancy between physicians’ willingness and actual practice of email communication are: 1) physicians differ in their experience and attitude towards information technology, 2) some may not be convinced that patients appreciate, need and can communicate by email with their doctors, 3) others are still waiting for robust evidence on service performance and efficiency in addition to patient satisfaction and outcome that support such practice and 4) many are reluctant to do so because of perceived barriers.”
Mr Des Clarke, a practice manager for three practices, collectively known as Your Doctors, in Sydney’s inner west, said that his biggest concern with patient emails was “the triage issue”.
“The worst nightmare is someone sending an email to their doctor about their chest pain, and the email not being seen straight away,” Mr Clarke told MJA InSight.
“That is my top concern, always, with our online appointment booking system, which has a section where patients can write a note about their problem. If they’re not understanding that they can’t get an immediate response from their doctor, then it’s a worry if what they’re experiencing is chest pains, for example.
“We’ve been using the online appointment booking system for about 18 months, and we’ve had only two issues of that kind.”
The Family Practice review listed four “barriers and concerns” physicians perceived blocking their use of email communication with patients:
  • potential increase in workload;
  • lack of reimbursement;
  • security and confidentiality issues; and
  • medico-legal concerns.
“Current literature has not yet shown that email communication with patients increases physicians’ workload,” Assistant Professor Antoun wrote. “For example, early adopters have reported an average of 2–5 messages per day only (here, here and here).”
More here:
I think the key message from this is that any e-mail communication needs to be properly and safely managed with patients fully understanding (and being educated to understand) what sort of issues can be addressed via e-mail and what needs to be addressed via traditional means.
Both clinicians and patients need to be sensible about e-mail use.
Clearly you should not try to ask about your chest pain by e-mail!
David.

Tuesday, September 20, 2016

It Is My View The Labor Party I Being Way Too Ideological and Impractical On Major Health System Initiatives.

Last week the Labor Party said they would oppose the Legislation authorising the new planned national screening register.

Telstra's $178m cancer register deal under attack

By Allie Coyne on Sep 15, 2016 3:01PM

Labor, Greens want operation in government hands.

Labor and the Greens are fighting the government's $178 million plan to outsource its new national cancer screening register to Telstra, arguing the sensitive data should not reside with a private company.
Telstra won the five-year contract for implementation and maintenance of the system, which will record the cancer screening results of 11 million patients, in May.
The register will replace eight state and territory cervical cancer screening registers, and one paper-based bowel screening register, to provide a single record for each individual. The system will interact with My Health Records, Medicare and private health providers.
The database will be used by state and territory governments, general practices and pathology services, and private and public health providers.
However, Labor and Greens MPs argue the data in the register is too sensitive to be handed to a for-profit private sector organisation to look after.
The government tried to pass legislation that would enable the register this week, but came up against the two parties when they combined their votes to send the bills to senate committee for scrutiny.
Labor and the Greens want to add amendments to the legislation that will mean only the government or not-for-profits could operate the register.
"The government signed the contract despite no legislation having been passed to establish the national register, and they are now trying to rush through legislation without giving parliament the time to properly consider the implications of their hushed deal," Labor health spokesperson Catherine King said.
More here:
In parallel we have this announcement:

No, the Medicare payment system won't be privatised

13 September 2016
The Department of Health has disbanded the unit looking at outsourcing Medicare payments, effectively confirming the system won't be privatised.
The department also directed PricewaterhouseCoopers - the private firm advising the unit - that the payment system must remain delivered by government.
It reflects an election commitment made emphatically and repeatedly by Prime Minister Malcolm Turnbull that all Medicare services currently delivered by government would stay that way.
In an email to staff seen by AAP, Secretary Martin Bowles advised he's establishing a Medicare and Aged Care Payments Division from Monday.
Staff working on the $5 million 'digital payments services task force' - which was used as partial proof by Labor that the coalition was planning to privatise Medicare - would be transferred to the new division.
More here:
Just a few observations on all this.
First just what is the difference between Accenture, Orion and others being the commercial providers for the myHR and Telstra Health operating a Cancer Registry? We need to remember that it was Ms Roxon from Labor who contracted Accenture / Orion for the PCEHR!
Second elsewhere Labor has outsourced major IT projects in  other domains (e.g. NDIS etc.)
To me the opposition to Telstra and the resistance to outsourcing the Medicare Payments systems are political opportunism and opposition for the sake of it, and nothing to do with what Labor would do (and has done) in Government.
No wonder we are all sick of the ways our pollies are behaving at present. They simply could not lie straight in bed as they say!
David.

Monday, September 19, 2016

Weekly Australian Health IT Links – 19th September, 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

Quite a busy week with lots of problems with ePIP, Cancer Registries and a range of other issues.
Lots of headlines to browse and to click through.
-----

Englishman now in charge of $1 billion digital health records system doctors refuse to use

September 11, 20165:37pm
Sue Dunlevy News Corp Australia Network
EXCLUSIVE
THE man who led the dumped UK digital health record system has been put in charge of Australia’s bungled $1 billion e-health record and is being paid as much as the Prime Minister to fix it.
Former journalist Tim Kelsey will be paid a total remuneration package worth $522,240 a year, almost the same as Malcolm Turnbull and just shy of the $548,360 paid to the Chief of the Navy and more than the Chief Scientist, the head of the Fair Work Commission and the Inspector General of Taxation, a remuneration tribunal determination reveals.
The former NHS executive is an interesting appointment as CEO of the Australian Digital Health Agency because he was in charge of the UK digital health records scheme Care.data dumped by the UK’s National Health System in July.
The Department of Health stated that Mr Kelsey is uniquely suited to the role because of his experience with data and digital platforms in health and personal privacy.
-----

To email your patients or not to email

Authored by  Cate Swannell
ONLINE portals using secure pathways may be the best available solution to the dilemma of doctor-patient email communications, which sees practices lagging behind the “willingness of their patients” to connect via email.
A systematic review published in Family Practice showed that far more physicians want to use email communication with their patients than actually do use it. In Europe, for example, it was shown that only 7.4% of the European population communicated with a physician using email or the web.
“In the UK, 52% of general practitioners responded as willing to use such a communication with their patients, and 37% had already received one or more emails from their patients,” the author of the review, Assistant Professor Jumana Antoun from the American University of Beirut, wrote.
-----

Unleashing the power of people - How digital services can transform healthcare

Created on Monday, 12 September 2016
The Agency will shortly be launching an Agency blog. Here is our first post from the Agency CEO Mr Tim Kelsey.
Everybody in Darwin is hoping for rain: it is heating up and a humid summer is coming. We drive along the foreshore towards Palmerston, past the mangroves that mantle the ocean. I have been invited by Dr Sam Heard to come and listen to patients and staff in his practice, the Palmerston GP Super Clinic. It is a great innovation – a joint venture between Charles Darwin and Flinders universities to give local people access to comprehensive primary care services in one setting, from medical and pharmacy through to podiatry. It has more than 100,000 patient encounters every year. It is a training centre – there are 18 registrars and 10 students and you can tell people really want to work here. This is how you learn to be a great clinician – working in teams, bringing every professional skill to bear to improve outcomes for your patients. Sam, who would never say this himself, is a globally respected expert in primary care and has championed the importance of data and technology in medicine for many years.
Sam introduces me to David who is 35 and drives through the door in his wheelchair, with a broad smile on his face. David tells me his story. He was an internet entrepreneur and ran a website that reviewed software, until his life was shattered by illness eight years ago. He went into hospital for a routine operation and was the victim of a hospital-acquired infection, and everything went wrong for him after that. At this point, David says that hospitals are dangerous places – and best to be out of them. He has had both feet amputated (as a consequence of diabetes) and has been in hospital for very long periods with a variety of conditions, including pancreatitis. This is a brave man, somebody who knows the desolation of ill health.
-----

Labor moves to block $220m contract with telco giant for medical register

September 13, 2016 3:08pm
TELSTRA and the Federal Government are in a major brawl with Labor which wants to veto the telco as the operator of a register of highly-sensitive medical information.
At issue is the privacy of records ranging from Pap smear results to gender transitions.
The Opposition wants to bar all for-profit companies from running the register of cancer histories, part of Labor’s determination to keep health management within the public sector.
A decision to give Telstra control of a mountain of cancer screening data was revealed by the Health Department just four days before the election, and before legislation creating the register had been approved.
-----

Govt’s Telstra cancer register contract criticised

Telstra earlier this year won a $220-million contract to establish and operate the National Cancer Screening Register
Rohan Pearce (Computerworld) 13 September, 2016 16:29
Labor’s shadow health minister, Catherine King, has launched an attack on the government over its decision to award to Telstra a contract to operate the new National Cancer Screening Register.
The National Cancer Screening Register Bill 2016 and the National Cancer Screening Register (Consequential and Transitional Provisions) Bill 2016 are currently before the House of Representatives. The bills will create the National Cancer Screening Register, which will replace nine existing registers including the states’ cervical cancer register.
In May the Department of Health announced it had awarded the contract to establish and operate the register to Telstra. The $220 million contract has an initial term of five years with an option for a 10-year extension.
-----

Telstra will not run cancer-screening database if Labor has its way

Labor has said it will try to ensure that only government or non-profit organisations are able to handle sensitive health data for the National Cancer Screening Register.
By Chris Duckett | September 14, 2016 -- 04:24 GMT (14:24 AEST) | Topic: Enterprise Software
A push is on to prevent Telstra from implementing a AU$220 million contract it won prior to the July federal election, with Labor looking to introduce changes that would prevent the telco from handling the data.
In May, Telstra Health was awarded a deal to construct and run the new Australian National Cancer Screening Register for the next five years, with the database to maintain patient records for cancer testing across the country.
Shadow Minister For Health And Medicare Catherine King said on Tuesday that the government signed the contract despite not having legislation in place to establish the Register, and it would allow Labor to make amendments.
-----
14 September, 2016

Despite glitches, most meeting eHealth upload targets

Posted by Julie Lambert
General practices that fail to meet upload targets for the eHealth incentive program may escape financial penalties if they can show their efforts were foiled by software glitches.
Practices that fell short of the target and did not opt-out of the new incentive scheme introduced in the May-July quarter are being asked to give back payments they may have received.
The Health Department has confirmed officials are reviewing Practice Incentive Program and My Health Record data to check whether practices are meeting the ePIP requirements to upload a portion of their patients’ health summaries to the MHR system.
But the department has also signalled a possibly more flexible approach that may avoid penalising those that come up short.
-----

GPs failing to regularly upload e-health records

By Paris Cowan on Sep 14, 2016 5:00PM

AMA slams new ‘penalties’ for doctors.

As many as 1500 GP clinics have failed to meet the minimum benchmark for My Health Record participation in the past quarter and risk losing thousands of dollars in incentive payments as a result, the Australian Medical Association has claimed.
It said as many as 40 percent of GPs are still not equipped to regularly upload shared health summaries into the system, and one-third of the clinics previously receiving funds to help them with the e-health transition now risk a shortfall of more than $24,000 a year.
The AMA slammed the government’s move to toughen the eligibility criteria for incentive payments for MyHR participation, claiming it will “erode the goodwill of GPs” rather than prompt them to upload more patient data into the national health records system.
-----

Doctors forgo $23,000 and opt-out of uploading patient data to MyHealth record

September 14, 20167:13pm
Sue Dunlevy News Corp Australia Network
DOCTORS are so opposed to the troubled $1 billion taxpayer funded e-health record they are refusing a $23,000 incentive payment to upload patient information into the system.
From May doctors had to upload 0.5 per cent of their patients’ records to the new system to qualify for a $23,000 practice incentive payment as the government struggles to get doctors to use it.
The AMA has revealed 30 per cent of GPs will miss out on the payments because they have refused to do this.
Without these records outlining a patient’s health condition these records are virtually useless and it means even though taxpayers have spent $1 billion on the record doctors are not using it.
-----

Government to investigate e-health PIP failure

Antony Scholefield | 15 September, 2016 |  
The Federal Health Department will investigate the e-health Practice Incentives Program after more than one thousand practices failed to hit targets for uploading shared health summaries.
Due to a controversial revamp of the e-health PIP in May, practices are now required to upload shared health summaries to the MyHealth Record system for at least 0.5% of their patients.
However, it emerged on Wednesday, that out of more than 5000 practices registered for the e-health PIP, 1500 had not met the new requirements for their quarterly payments.
A further 222 practices had simply withdrawn from the program, according to the AMA.
-----
  • Opinion
  • Sep 16 2016 at 1:29 PM
  • Updated Sep 16 2016 at 2:09 PM

Exploding phones and heart-stopping hacks its a dangerous tech world out there

Hackers have been targeting pacemakers and medical records, which is a big reason to feel scared for many.
A worried air hostess leans over and says, "be careful! Your Samsung Galaxy Note 7 might explode in your hands!"
I'm holding a Nexus 6, but she shakes her head ruefully anyway: Technology, it's deadly. Yes, Samsung has recalled 1 million of their new premium mobile phones because of serious fire and burn hazards. A fault with the rechargeable lithium battery prompted the handset to explode in the hands of a 6-year-old in Brooklyn, New York and he was rushed to hospital.
Since then, reports of the phones catching fire have quadrupled.
Understandably, the boy has reportedly refused to go near any smartphones, though it's probably helpful to point out that rechargeable lithium batteries themselves are the workhorses of portable power; they're in powertools, e-cigarettes, vibrators and Samsung's new wireless earbuds.
-----

Detailed Clinical Model Library - Clinical Informatics

Created on Monday, 12 September 2016
The Clinical Informatics unit is pleased to announce the latest release of the Australian Digital Health Agency's Detailed Clinical Model Library (v4.4).
Download the full release file bundle from the following location on the Agency website:
The accompanying release note outlines changes in the Detailed Clinical Models and the triggers for the changes.
-----

Will you play a part in driving the digital transformation of Australian healthcare?

Created on Friday, 16 September 2016
Message from Jim Birch, Chair of the Australian Digital Health Agency: Will you play a part in driving the digital transformation of Australian healthcare? The Board of the Australian Digital Health Agency is calling for people to support it in driving the digital transformation of Australian healthcare.
To ensure we get the best minds in the country to support us in this critical work, we are appealing to people across the community to express their interest in joining an Advisory Committee to support the Board and help shape the Agency’s focus and work.
We are establishing Advisory Committees in the areas of:
  • Clinical and Technical
  • Consumer
  • Privacy and Security
  • Audit and Risk
  • Digital Health Safety and Quality Governance
-----

EXCLUSIVE – Moving towards a ‘Person-Centred’ approach to healthcare

OpenGov Asia speaks to Andrew Saunders, Health CIO, Department of Health & Human Services, Victoria to learn more about his role and aim to transform the healthcare services sector

14/09/2016
How long have you been in your current role? Were you brought in with a specific objective, drawing on your experience in the private sector to achieve a certain goal?
I joined in August 2015.
The department wants the Health CIO to work collaboratively in the Victorian public health sector devolved governance model, be able to bring the sector together and agree a digital health strategy, especially around the sharing of clinical information, and support the health services in working together on joint initiatives.
In Victoria, we have 86 health services and 32 independent community health services. My team supports the health services in providing health ICT design and shared service, as well as performing a sector wide ‘health systems management’ role to ensure that the end to end system is working together, meeting minimum standards and positioning itself to leverage future technological advances.
Another key part of the role is to enable the appropriate sharing of information between the health and social care functions of the department to support a person centred approach to health and well-being.
-----

What are the hottest tech jobs in Australia?

IT leaders in high demand during 2016.
Holly Morgan (ARN) 16 September, 2016 05:30
The IT industry's hiring activity is expected to surge as Australian businesses continue to align business strategy with IT investment.
According to findings from recruitment firm Hays, the alignment driving this increase in IT hiring is aimed at supporting new business models and systems to boost efficiency, and enhance customer engagement in the digital era.
As the ongoing reliance on digital technologies, such as the Internet of Things, continues, candidates with the ability to translate data into actionable business outcomes will be valued, alongside cyber security expertise in protection, compliance and audit of such data.
-----

No, the Medicare payment system won't be privatised

13 September 2016
The Department of Health has disbanded the unit looking at outsourcing Medicare payments, effectively confirming the system won't be privatised.
The department also directed PricewaterhouseCoopers - the private firm advising the unit - that the payment system must remain delivered by government.
It reflects an election commitment made emphatically and repeatedly by Prime Minister Malcolm Turnbull that all Medicare services currently delivered by government would stay that way.
In an email to staff seen by AAP, Secretary Martin Bowles advised he's establishing a Medicare and Aged Care Payments Division from Monday.
-----

Plenty Valley and Northern Health eReferral Prokect leads pilot program to co-ordinate services

Katrina Hinschen, Whittlesea Leader
September 13, 2016 12:01pm
PATIENTS’ medical referrals will be a click of a doctor’s mouse away under a new electronic system being trialled in Melbourne’s north.
Plenty Valley and Northern Health eReferral Project, led by Plenty Valley Community Health Service, is one of three Victorian health services consortiums selected to lead the pilot program.
Health Minister Jill Hennessy said the Victorian eReferral Program will make patient referral processes more efficient, safer and reliable.
“Instead of relying on old fashioned paper referrals that can be easily lost or misplaced — this cutting-edge electronic technology makes it quick and easy for GPs to make a referral,” Ms Hennessy said.
-----

Mandatory Breach Reporting For Health Records – What You Need To Know

Last Updated: 13 September 2016
Most Read Contributor in UK, August 2016                                           
Mandatory data breach reporting is the buzz word in privacy and cyber risk circles. Many Australian governments (including the incumbent) have sought to introduce legislation requiring all Australian businesses to report data breaches that compromise personal information collected or held by those businesses. But no government has yet succeeded. Except that is, for certain health service providers, who should take note – if you're handling certain types of health records, you may already be required to report such breaches.

What is 'mandatory reporting' – and is it relevant for my business?

The Privacy Act applies to Australian individuals and businesses with a turnover of over AUD 3 million, and to those providing a health service and who hold health information irrespective of turnover. Currently, the Privacy Act does not require that your customers or the Office of the Australia Information Commissioner (OAIC) be notified of a data breach that compromises their personal information. That is likely to change in time – and draft legislation could (if implemented) extend such mandatory reporting obligations to all businesses subject to the Privacy Act. In the meantime, notifications are encouraged by the OAIC as part of a data breach response plan, where the disclosing party thinks there may be a real risk of serious harm to the individual as a result of the breach.

I run a health services business – how does this affect me?

In addition to the requirements of the Privacy Act, healthcare providers accessing, processing and storing 'My Health Records' are subject to a mandatory data breach reporting regime. This regime has been in place since the inception of the My Health Record scheme in 2012 and requires notification, in certain circumstances to the My Health Record System Operator (i.e. the Secretary of the Department of Health) and the OAIC, of data breaches affecting an individual's My Health Record.
-----
12 September, 2016

Man overboard: Why has MedicalDirector swapped CEOs?

Australia’s largest patient management system provider,  MedicalDirector, has quietly changed its CEO of nearly three years, Phil Offer, replacing him with Matthew Bardsley, previously the Chief Information Officer at Primary Healthcare
Although it only came to light last week that Offer had been replaced – he has been seen around the traps spruiking the new cloud-based version of MedicalDirector at various events as CEO – it is apparent that the change took place as a result of MedicalDirector’s acquisition by private equity (PE) some five months ago.
No-one at MedicalDirector or Affinity, the PE owner of the group,  was prepared to comment on the change.  PE tends to be like that – private. But the shift to Bardsley, if it is meant as a longer-term change, could be an indication that the new owners want more speed at the pointy end of the business – technology. Bardsley has been a long-time presence at MedicalDirector as a tech lead. His shift to CEO might be so the company can get more progress on its new versions of the software, especially the cloud-based Helix edition.
-----

HCF backs Curo Tecnologies’ sensors for elderly

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

Supratim Adhikari

Health insurer HCF is investing $1 million into Curo Technologies, a Melbourne-based health tech start-up that is looking to better leverage wireless sensor technology to help the elderly.
Founded by Victorian brothers Matt and Tim McDougall, Curo is one of the first graduates out of HCF’s Catalyst program, an annual initiative run in partnership with accelerator program Slingshot that is designed to help local healthcare-focused companies ­develop and accelerate their businesses.
Catalyst is Australia’s first corporate-supported accelerator aimed at start-ups in the health tech space. While Curo is one of nine businesses to graduate from the 2016 HCF Catalyst program, it is the only one HCF has decided to put money into, with chief strategy officer Sheena Jack saying Curo’s solution tackles one of the key challenges facing the healthcare industry in Australia.
-----
  • September 15 2016 - 10:48AM

Federal intelligence agencies recruiting hackers to attack government systems

Henry Belot
Federal intelligence agencies are hiring hackers to test the security of government infrastructure and to attack foreign targets.
The recruitment drive, which offers recruits "a licence to hack", comes after a number of attacks on government agencies including the Department of Human Services during the census collection period. 
Other targets include Austrade, the Defence Science Technology Group and the Bureau of Meteorology, which was breached last year by Chinese-based hackers. 
Another 97 federal departments have reportedly been told to encrypt more data amid hundreds of attempted intrusions every month.
-----

Defects and delays keep Royal Adelaide Hospital on critical list

  • The Australian
  • 12:00AM September 16, 2016

Rebecca Puddy

Today the doors of the nation’s most expensive building, the ­imposing 10-storey Royal Adelaide Hospital, standing tall on the banks of the River Torrens, should swing open to receive patients.
The $2.3 billion facility, which has earnt the accolade of the world’s third most expensive building (after New York’s One World Trade Centre and Bucharest’s Palace of the Parliament), is set to be Australia’s first paperless hospital delivering state-of-the-art healthcare, with private rooms and lush gardens.
But in reality, the site remains a 24-hour building site, a mecca for workers in hard hats and high-vis vests. Delays and mistakes in the building of the nation’s most ­advanced hospital have continually pushed back deadlines, prompting a bitter legal battle ­between the state government and its builders.
-----
COMMENT
  • September 11 2016 - 11:00PM

We should get technology to the people who need it most - the homeless

·         Melanie Raymond
Digital technology has great potential to be a force for empowerment, and, in so many ways, it has already allowed us to be a nation of self-publishers, commentators, entrepreneurs and disrupters.
But access to technology is far from universal. Research from welfare groups shows a nation heavily reliant on mobile technology but it also reveals a strong digital divide. Nearly half those on welfare payments, especially those living alone and older people, do not have home internet access. While rates of mobile phone ownership are high, low-income groups routinely run out of credit sooner than expected and experience "bill shock".
Far from empowering all people, technology can deepen and reinforce the disadvantage already experienced by the nation's homeless, estimated to be at least 105,000.
-----

Hills Health plans merger with Lincor Solutions

ICT services company Hills is to spin off its Health Solutions business as it prepares to merge with technology company Lincor Solutions and create a new stock market listing.
Hills, maker of the iconic Hills clothes hoist, announced on Tuesday that it had entered into a conditional merger agreement to combine its HHS business with Lincor.
Hills chairman Jennifer Hill Ling said that while the company’s expanding healthcare solutions operations had the potential to become a key profit driver within Hills in coming years, “the opportunities for the healthcare business and its growth potential are much greater as part of Lincor Limited on a global basis”.
-----
Enjoy!
David.