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, December 01, 2016

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

December 1  Edition.
Again, only one real bit of news dominated again this week, and continued to rattle around was the election of President Trump. We
Our parliament finishes up today until some-time in February 2017, which will be after President Trump is inaugurated.
We all now need to take a Christmas Break and see just what happens in the US in first six months of next year. I am sure it will be interesting.
Closer to home there also seems to be some emerging evidence all might not be all that well in OZ.
This one says it all….

$24 billion budget blowout. MYEFO to confirm the worst on December 19

Peter Martin
Published: November 21, 2016 - 12:15AM
Much lower than expected wage growth has knocked a hole in the government's budget projections, blowing out deficits right through until 2019-20.
The worse position, confirmed by Treasurer Scott Morrison, comes despite a doubling in the price of coal and a 50 per cent jump in the price of iron ore.
It will unveiled in a mid-year budget update to be released on December 19.
Mr Morrison said the government would adopt a "cautious" approach to commodity price assumptions in the update, allowing projections of weaker personal and company taxes from weaker wage growth to overwhelm projections of improved company tax revenue from better resource prices.
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Backed by this:
  • Updated Nov 21 2016 at 6:40 PM

Scott Morrison is going to have to hit the reset button on the budget

There is a certain inexorability to the fact the Coalition is going to have to hit the reset button on its budget rhetoric.
The only problem is that, having persisted too long with the argument that there was no revenue problem in the budget, the government is now stuck somewhere between ratings agencies breathing down its neck over the size of the budget deficit and the changed dynamics of an international tax debate anticipating lower tax rates from a Trump US presidency.
For a long time, Treasurer Scott Morrison told us there wasn't a revenue problem in the budget, just a spending problem.
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Here are a few other things I have noticed.

Trump Election Issues.

Getting the measure of Trump is a short-term game for investors

Mark Bouris
Published: November 20, 2016 - 12:15AM
The biggest news last week was the election of Donald Trump, and the second biggest news were the gains seen in the American markets after Trump won.
After shaky starts, the major Wall Street indices surged as markets backed Trump's policies for the US economy. 
By the end of election week, $US1 trillion was wiped off the US bond market and invested in equities.
Australia had an initial downturn before our markets stormed back. 
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The moment the US gave the world to China

Peter Hartcher
Published: November 22, 2016 - 12:00AM
The Chinese didn't imagine that the US would walk away from global leadership so readily.
But it has happened, in plain view.
On Friday. In Peru, of all places.
In April, Barack Obama said: "If we don't write the rules, China will write the rules out in that region," the Asia-Pacific.
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National Budget Issues.

End the age of entitlement: cut tax perks for seniors, says Grattan Institute

Peter Martin
Published: November 20, 2016 - 9:00PM
Australia's tax system has become skewed towards a growing and apparently untouchable group of "taxed nots": older Australians who pay about $1 billion a year less tax than younger ones with identical incomes, according to a Grattan Institute report.
"It used to be that between one-quarter and one-third of seniors paid tax," said the report's author John Daley. "Now it's half that. We gave them a Low Income Aged Persons Rebate, then we gave them a Senior Australians Tax Offset, then we made their super tax-free, and hey presto, they dropped out of the tax system."
Mr Daley said many of the changes took place during the prime ministership of John Howard, while Peter Costello was treasurer.
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  • Updated Nov 20 2016 at 9:00 PM

Grattan Institute push to end the age of entitlement for over 65s

The age of middle-class welfare entitlement is coming to an end – unless you're well off and over 65, according to a Grattan Institute call to scrapping of unjustified age-based tax breaks that cost the budget $1 billion a year.
With the government already crunching working-age households by curbing benefits such as family payments and baby bonuses, the institute argues that keeping similar perks for older but very comfortable "taxed-nots" is patently unfair.
It warns that with the population ageing rapidly, government will need to act fast on curbing these breaks or face a growing block of older voters reluctant to help with budget repair.
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Why special tax breaks for seniors should go

November 20, 2016 9.01pm AEDT

Authors

  1. John Daley
  2. Brendan Coates
  3. William Young
The federal government could save about A$1 billion a year by winding back three tax breaks for older Australians that are unduly generous and have no sensible policy rationale, according to our new Grattan Institute report.
Many seniors pay less than younger workers on the same income as a result of the Seniors and Pensioners Tax Offset (SAPTO) and a higher Medicare levy income threshold. They also get a higher rebate on their private health insurance than younger workers on the same income.
The tax-free thresholds for seniors and for younger people have diverged over the last 20 years. Seniors do not pay tax until they earn A$32,279 a year, whereas younger households have an effective tax-free threshold of A$20,542.
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'That's simple maths': Scott Morrison signals another surplus delay on the cards

James Massola, Chief Political Reporter
Published: November 21, 2016 - 9:40AM
Treasurer Scott Morrison has signalled a return to budget surplus in 2020-21 could again be delayed, with low wages growth holding back government revenue.
The warning from Mr Morrison comes as Deloitte Access Economics' Budget Monitor predicted a $24 billion blowout in the deficit over the next four years ahead of the mid-year budget update on December 19.
The latest blowout will put further pressure on Australia's AAA credit rating, with ratings agencies closely monitoring the Turnbull government's ability to strike deals in parliament that cut government spending and raise revenue.
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8:41am November 21, 2016

Company tax cuts will boost growth: govt

By AAP
Finance Minister Mathias Cormann has rejected suggestions now is not the right time to introduce tax cuts for Australian companies.
A $50 billion government plan over 10 years would boost investment, productivity, growth and over time wages, he said.
The planned 25 per cent tax rate - down from 30 per cent for companies with a turnover of more than $2 million - was middle of the pack by international standards.
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Former minister Craig Emerson urges inquiry into LNG tax revenue hole

Heath Aston, political correspondent
Published: November 20, 2016 - 11:45PM
One of the architects of Australia's tax system on natural resources, Craig Emerson, has backed calls for a parliamentary inquiry into why the boom in liquefied natural gas exports is failing to deliver any meaningful contribution to the public purse.
Mr Emerson – who designed the petroleum resource rent tax with economist Ross Garnaut in the Hawke government – believes particular scrutiny should be given to extra concessions won by the oil and gas sector since the tax was first imposed on offshore projects in the mid-1980s.
Fairfax Media has revealed over recent months that just 5 per cent of 150 oil and gas ventures are paying any PRRT, despite Australia being poised to eclipse Qatar as the world's single biggest exporter of LNG by 2020.
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Voters losing faith in Turnbull’s capacity to steer the economy

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

Phillip Hudson

The Turnbull government desperately needs to show voters it is in charge, that it has a credible economic plan and can win ­battles on the floor of parliament.
The Coalition enters the final fortnight sitting of parliament with its ministers comfortable on the Treasury benches but voters ­unsure about the government’s authority.
As the latest grim news from Deloitte Access Economics suggests the budget deficit is getting worse, Malcolm Turnbull finds he needs to build up his economic credibility, which has tumbled below 50 per cent for the first time since he became Prime Minister as the government continues to languish behind Labor in two-party terms.
With the Prime Minister ­defiantly trading on his election slogan of “jobs and growth”, today’s Newspoll showing only 48 per cent think he is the most capable of handling the economy will be a worrying sign inside the government.
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Morrison sticks with $50b company tax cuts

- on November 22, 2016, 6:44 am
Scott Morrison has vowed to press ahead with $50 billion worth of company tax cuts while conceding the Federal Budget is bleeding revenue and is unlikely to reach the Government’s latest target date to get back to surplus.
Amid warnings the Government has increased the risk of losing the nation’s AAA credit rating, Mr Morrison said the tax cuts — facing opposition in the Senate — were the best way to improve the Budget.
Figures from Deloitte Access this week suggest the Budget bottom line has deteriorated by $24 billion since May on the back of record slow wages growth and a stagnant full-time jobs market.
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Morgan Stanley warns Australia's economy may have gone backwards

Jessica Sier
Published: November 24, 2016 - 4:19PM
While markets including the ASX have shot higher following Donald Trump's surprise election win in the US, some economists suggest Australia might be in for a rude shock.
A continued unwind in resource investment, contracting activity in the housing sector, and weaker household incomes are on track to push Australia's economy to shrink over the three months to September 30, argues Morgan Stanley.
"We have been arguing that Australia's 'real GDP' of 3.3 per cent year-on-year feels overstated," say the team of analysts, led by equity strategist Chris Nicol, who suggest Australia's GDP growth may come in at -0.3 per cent over the June quarter – well below the consensus forecast for 0.5 per cent growth. It would also be just the fourth quarter in the past 100 to post a contraction.
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Scott Morrison in caged fight to save AAA credit rating

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

Alan Kohler

Scott Morrison is in a kind of cage fight with Standard & Poor’s.
The ratings agency is itching to downgrade Australia from AAA. Its competitors, Moody’s and Fitch, are more relaxed — they both have Australia on AAA “stable” — but S&P has us on a “negative watch” and is looking sternly over its glasses at the government.
This week, the head of sovereign ratings for S&P Australia, Craig Michaels, delivered another stiff lecture.
The problem, he said at a conference on superannuation in the Parliament House theatre, is not the government’s balance sheet, which is strong, but the economy’s balance sheet, which is very weak indeed — “one of the weakest we look at globally”.
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Australia's budget repair problem can't be swept under the carpet

Simon Cowan
Published: November 26, 2016 - 12:15AM
Peter Costello delivered the last federal budget surplus on May 8, 2007. The following year, new Labor treasurer Wayne Swan promised a $20 billion surplus, which turned out to be a nearly $30 billion deficit. One decade and one day later, on May 9, 2017, Treasurer Scott Morrison will almost certainly deliver a budget deficit at least as large as Swan's first.
Throughout the past 10 years, politicians on both sides have claimed they were fixing Australia's fiscal problems. Both have relied on budget trickery, pretending the deficit was a short term problem that would be fixed by future revenue growth.
Even in the supposedly horror 2014-15 budget, revenue increases were almost twice as large as the projected reduction in expenses. The extent of "austerity" in Australia has been limited to arguing over the size of the increase in spending – large or very large.
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Health Budget Issues.

Government Medicare watchdog threat to GP home visits

index&t_product=DailyTelegraph&td_device=desktopSue Dunlevy, National Health Reporter, News Corp Australia Network
November 21, 2016 12:30am
index&t_product=DailyTelegraph&td_device=desktopEXCLUSIVE: They are the after hours lifesavers beloved by families and emergency departments alike — but a government crackdown could make it harder for a GP to make a house call in the dead of night.
There could also be increased pressure on hospital emergency departments, a doctor’s group has warned.
A quadrupling in after hours visits over recent years to 2.8 million has caused a Medicare cost blowout as bulk billing services target working families who can’t get to a GP during working hours.
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Rational testing vital to improved GP care

Authored by Joseph Ting
BETWEEN 2000 and 2008, the number of Medicare funded pathology tests increased 54% in Australia, a volume increase from 62.1 million to 95.7 million tests. Over this period, pathology costs increased from $1.2 billion to $1.9 billion.
However, 25–75% of tests are not supported by evidence. Inappropriate testing increases health care costs, wastes resources and incurs further costly delineation of incidentalomas that may also bring on harmful treatment. Excessive reliance on testing has been allowed to supplant clinical acumen. It is crucial that GPs identify patient concerns and address expectations on the rationale for individual test ordering.
Although GPs experience pressure to comply with parent or patient requests for diagnostic tests to preserve good relations and avert medicolegal liability stemming from missed or delayed diagnosis, there are risks and harms associated with ordering tests that are not clinically appropriate.
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  • Updated Nov 22 2016 at 10:14 PM

Soft drinks tax would raise $520m and cut obesity, says Grattan Institute

A tax on sugary drinks would add 15¢ to the price of a 375ml can and 80¢ to a 2 litre bottle, slugging the $4.4 billion industry $520 million a year, a new report says.
Sugary drinks should be hit with the special tax to reduce their role in soaring obesity rates, especially among children, the Grattan Institute report says.
Obesity – the number-two health risk after tobacco – is linked to higher rates of type 2 diabetes, heart attack, stroke, high blood pressure, cancers, sleeplessness, cholesterol and fatty liver. These diseases increase absenteeism and reduce job prospects, incomes and wellbeing.
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A $520 million soft drink tax will probably make us less fat. But here's what it will do to prices

Peter Martin
Published: November 23, 2016 - 6:17AM
Soft drinks should be taxed in the same way as cigarettes and leaded petrol to boost the budget by $520 million per year and tackle Australia's obesity epidemic, according to a new report.
The supertax, to be applied to the sugar content of non-alcoholic water-based drinks in addition to the GST, would be set at 40 cents per 100 grams of sugar.
Unless it spurred manufacturers to cut the sugar content of their drinks, it would add 80 cents to the price of a 2 litre soft drink, 15 cents to the price of a 375ml can, 14 cents to the price of a 600ml sports drink, and 11 cents to the price of a 250ml energy drink like Red Bull.
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AAMRI’s Tony Cunningham says medical research fund can fill gaps

  • The Australian
  • 12:00AM November 23, 2016

John Ross

The federal government’s $20 billion Medical Research Future Fund could help resolve the sector’s two overriding issues: subterranean grant success rates and inadequate funding of indirect research costs.
But, to do so, it will have to overcome clunky funding mechanisms and align itself more closely with the National Health and Medical Research Council’s administrative settings, according to the peak body for medical research institutes.
Tony Cunningham, who assumed leadership of the Association of Australian Medical Research Institutes two weeks ago, said ensuring complementarity between the NHMRC and MRFF would be one of the big planks of his presidency.
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A vision for a high performing and sustainable health care system

by Martin Bowles
22.11.2016
The Manderin
SPEECH: Australians are yet to realise the nation-changing potential from parts of the health reform agenda. This future-proofing is complex, and requires political vision, bureaucratic capability, and stakeholder consensus.
Australia,  the United States – and many countries across the globe –face similar issues with their health systems.
We have ageing populations, and rising life expectancy – in Australia, it’s 80 for Australian boys, mid-80s for girls.
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Health Care Homes 'will mean 10% funding boost'

23 November 2016
THE Health Department is batting away concerns that the Health Care Homes trial is being done on the cheap, asserting that participating practices will receive more funding for chronic disease care than they do at present.
In stage one of the trail — due to start in 200 practices in mid-2017 — practices will receive bundled payments of up to $1795 annually to manage enrolled patients with complex chronic conditions.
In a major reengineering of funding, practices will then use the money to bankroll a GP management plan that is not tied to MBS items.
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Health care homes — 11 key questions answered

23 November 2016

It's peddled by ministers as a once-in-a-generation reform that will revolutionise the treatment chronic diseases. But many fear the journey to come. Here's what we know about Health Care Homes.

How will it work?

Patients with chronic conditions will be encouraged to enrol with a GP practice. Practices taking part will receive “bundled payments” to provide non-acute GP care to that patient. The argument being made in its favour is that fee-for-service fails to support chronic disease management. Policymakers often refer to the numbers of potentially preventable admissions to hospital in Australia — more than 600,000 a year. Many of these admissions are for chronic disease complications, particularly diabetes.
In return for these bundled payments, practices and GPs will no longer be restricted in terms of what they do by the dictates of the MBS schedule. In theory, the money can be used to fund non-face-to-face care. Care can be carried out via email or over the telephone. Practice staff will be freed up to work to their full scope of practice. In theory, practices could make greater use of technology, make improvements in wound care management or point-of-care testing where current MBS items offer nothing. This is, however, in theory — because all this still requires money to make it real.
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25 Nov 2016 - 12:08am

Labor to hold health reform summit

Labor will bring together patients, providers and stakeholders for a national health reform summit.
Source:  AAP
25 Nov 2016 - 12:08 AM  UPDATED 6 HOURS AGO
Labor will convene a national summit on health policy to fill what it says is a reform void by the Turnbull government.
Opposition Leader Bill Shorten says the forum, to be held in early 2017, will bring together patients, providers and stakeholders to contribute to the health debate.
It'll be announced by opposition health spokeswoman Catherine King at the national primary health care conference in Melbourne on Friday.
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Malcolm Turnbull has no health policy, says architect of the GP co-payment

Latika Bourke
Published: November 25, 2016 - 4:26AM
The architect of the GP co-payment has it out at the Turnbull government, accusing it of having no health policy. He also savaged the performance of Health Minister Sussan Ley and her predecessor, Peter Dutton, saying the latter should have been sacked for bungling the policy.
In a scorching address to the policy think tank the Centre for Independent Studies (CIS), Terry Barnes said the government had brought the so-called Mediscare campaign on itself by failing to set out its own plans for the healthcare sector. He said the coalition showed no sign of learning the lessons of the election campaign, despite it almost costing the government office.
He also suggested further radical reforms to the idea of universal healthcare, saying drunks, smokers and diabetics did not deserve free treatment because of their lifestyle choices.
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Wealthiest Aust postcodes the healthiest

November 24, 201612:18pm
Sarah Wiedersehn Australian Associated Press
Australia's wealthiest postcodes are the healthiest postcodes.
A new online health tool, Australia's Health Tracker by Area, has localised the state of our nation's health postcode by postcode.
It shows West Australians have relatively low rates of high blood pressure, at 9.3 per cent; Tasmania is soaring with 12.1 per cent have high blood pressure; and the Northern Territory has the highest rates of diabetes in the country at 7.1 per cent.
The sunshine state, Queensland, has topped the table for a high rates of obesity, 30.4 per cent, in Australia.
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Health Insurance Issues.

AMA At The Table On Health Insurance Reforms

21 Nov 2016
The Federal Government continues with its reforms to health care, shifting focus to the private health sector.
Health Minister Sussan Ley has recently established a Private Health Ministerial Advisory Committee (PHMAC) to develop recommendations across a range of policy areas relevant to private health.
The PHMAC follows on the work earlier in the year of an industry working group on reforms to the Prostheses List. The Prostheses List sets out the reimbursement amounts for thousands of prostheses used in the private health system.
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Sussan Ley told to take on states over public-private billing

  • The Australian
  • 12:00AM November 21, 2016

Sean Parnell

An advisory committee will urge Health Minister Sussan Ley to do battle with the states over public hospitals billing health funds more than $1 billion each year for care provided to their members.
The Australian ­revealed last month that the Private Health Ministerial Advisory Committee had unexpectedly made private ­patients in public hospitals a prior­ity issue for reform.
With premiums set to rise by 5-6 per cent next year, and members clawing back their level of cover to save money, Ms Ley has moved to reform prostheses pricing but is under pressure to enable further cost-cutting.
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HBF warns of health stress

- on November 22, 2016, 12:40 am
The head of WA’s biggest health fund has warned that the Federal Government needs to do more to make premiums affordable, as new figures show the percentage of West Australians with cover has fallen for the first time in 15 years.
HBF boss Rob Bransby is worried the Government is making only a “token gesture” to take pressure off premium increases and seeking to shift blame elsewhere for rising costs.
He said that overburdened public hospitals would face further stress as people abandoned private health insurance in the absence of reform.
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Is the investment in private health insurance worthwhile?

November 22, 2016 6.24am AEDT
It’s basically impossible to tell the difference between various policies and levels of cover. from www.shutterstock.com.au

Author

Lesley Russell
Adjunct Associate Professor, Menzies Centre for Health Policy, University of Sydney
A frequent topic of conversation at any social or workplace gathering is the cost and unfairness of private health insurance. Despite guaranteed free treatment in public hospitals, we are both conditioned and persuaded to purchase a costly product that too often fails to deliver value for money or provide the expected choices and peace of mind.
Now, for the first time in 15 years, as premiums and complaints rise, the proportion of the population with private health insurance is declining. And recent polling shows 20% of those who have private health insurance (46.8% of the population) expect to downgrade or drop their cover in the next six years.
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Private health insurers should wind back 'aggressive tactics' – AMA head

Australian Medical Association chief calls on insurers to stop selling inappropriate policies and says behaviour of some risks undermining system
In 2016 the private health insurance industry ‘successfully lobbied this government to increase their premiums by a weighted industry average of 5.59%’, said the head of the Australian Medical Association. Photograph: Dan Himbrechts/AAP
The head of the Australian Medical Association, Dr Michael Gannon, has called on private health insurers to stop selling inappropriate policies and to wind back “aggressive tactics” that undermine doctors and consumers.
“We continue to be concerned by the behaviour of the larger insurers,” Gannon told a conference of senior health insurance fund staff, representatives from the Australian Prudential Regulatory Authority and senior staff from the Department of Health in Melbourne.
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Pharmacy Issues.

Govt working to ‘reconcile’ risk sharing arrangements

The federal government is confident agreement will be reached with pharmacists over risk sharing arrangements, the Prime Minister believes.

Speaking in Canberra last night at the Pharmacy Guild’s annual Parliament House dinner, PM Malcolm Turnbull said Minister for Health Sussan Ley was working with the Guild “to reconcile these issues in a timely manner”.
The issue relates to a shortfall in estimated PBS expenditure in 2016. The Guild believes this should trigger a risk sharing clause in the 6CPA that allows pharmacies to be reimbursed for the shortfall.
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New website offers prescription drugs at cost prices, undercutting pharmacies

November 24, 20168:42pm
Rebecca Sullivan news.com.au@beck_sullivan
authorBlockSingle“WHEN a patient comes to us for help, money is the last thing on our minds,” is how sydneydrugs.com, a new online subscription pharmacy service which launched this week, sells itself to consumers.
The members-only service provides prescription medications at cost price in exchange for an annual subscription fee of $99, $199 or $449 a month, depending on how many extras you want.
“We’re a platform that gives Australians an opportunity to purchase pharmacy items without paying a profit margin to the pharmacy. We are all about making medications affordable,” the site promises.
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Sussan Ley aims to remove red tape for pharmacies

24 November, 2016
It will be much easier for PBS pharmacists to move to alternative premises after a fire or flood under changes to the law proposed by Health Minister Sussan Ley.
The proposed changes, which were read in parliament on Thursday, would allow a pharmacy's PBS approval number to be used at nearby premises for up to six months.
The average number of pharmacies affected by disaster is three a year, says the minister. However, seven have been affected in the past year, one by storm damage and six by fire.
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Superannuation Issues.

Getting a handle on looming superannuation tax changes

  • Bruce Brammall
  • The Australian
  • 12:00AM November 26, 2016
Now we know the sweeping super changes are to become law, you need to understand superannuation tax. And for those who do have a good grasp, you need to understand how things will change in relation to tax from July next year.
The basics
When you earn money outside of super, you pay tax at your marginal tax rate. This ranges from zero per cent to an effective rate of 49 per cent, which kicks in once you earn more than $180,000 a year.
Superannuation, however, is taxed concessionally. This means, in a general sense, it is taxed less than if you had the same investments outside of super.
Superannuation is taxed at no more than 15 per cent to encourage people to put money away for their super.
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I look forward to comments on all this!
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David.

One Rather Has To Feel Sorry For The SA Health CIO. He Seems To Have Beed Dropped In it!

Despite my hopes – SA Health has dropped back into view again this week.

SA Health's Bill Le Blanc hits back at EPAS critics

Health authority CIO responds to electronic records system doubters
George Nott (CIO) 25 November, 2016 13:17
It’s been a trying few weeks for SA Health CIO Bill Le Blanc. Earlier this month he faced the wrath of medical unions and the scrutiny of the national media after a glitch caused an outage in the health authority’s electronic patient records system, EPAS.
Two more outages occurred over last weekend. On Tuesday morning page three of Adelaide’s The Advertiser newspaper read “EPAS fails ‘will be fatal’”. By the afternoon Le Blanc was being grilled live on radio.
“I never anticipated when I applied for this job I would have to go on radio, TV, the paper,” he said at the CIO50 awards in Sydney last night. “People screaming that IT…is basically going to kill a patient.”
Speaking as part of a panel, Le Blanc held aloft the damning newspaper report before defending the EPAS system, which is currently live across seven SA Health services.
“I went head to head with the head of the doctor’s union on talkback radio,” Le Blanc said, “and his claim was this system, an incorrect prescription, is going to kill someone. I said well let’s talk about incorrect prescriptions…”
Le Blanc, who was appointed to the role of CIO at the end of 2013, hit back at critics of electronic health records referring to hospital safety audits which he said reveal that “in a paper-based world where doctors are writing on script pads”, one in 20 of all prescriptions are incorrect.
“It’s either given to the wrong patient or the wrong dosage or given at the wrong frequency,” he said, adding that 12 per cent of people are discharged with incorrect medication.
“With the kind of systems we're putting in place those hospitals where we have already deployed it… the prescription error rate dropped from five per cent to 0.03 per cent. One in three thousand,” Le Blanc said.
Of last weekend’s outage Le Blanc explained that his team patched a server that EPAS was running on at 1.30am and experienced a five minute outage.
Lots more here:
This appeared after more reports and an editorial appeared.

Maligned EPAS patient records software system suffers two more outages in Adelaide

November 22, 2016
South Australia's troubled electronic-patient records system has suffered two more outages over the weekend.
SA Health said issues with a software update and servers caused delays to EPAS for 13 minutes early on Sunday morning and another for about 40 minutes on Sunday night.
SA Health chief information officer Bill le Blanc said it did its best to minimise inconvenience to staff and patients.
"From time to time our ICT computer systems will experience glitches, and we have procedures in place that the staff are well-versed in," he said.
"They used the procedures in this instance to ensure that care was not compromised."
The American-developed software has suffered a number of setbacks since its roll-out to metropolitan hospitals since 2013.
Health workers found ordering drugs could be complicated and in one case it took up to 10 minutes to change a paracetamol dose from intravenous to oral.
More here:
Here is the editorial from the Adelaide Advertiser.

The Advertiser Editorial: Failures crash confidence in health system

The Advertiser
November 22, 2016 12:38am
TWO failures within 24 hours of the controversial computer patient management system at the Queen Elizabeth Hospital are cause for deep concern.
The latest problems with the $422 million Enterprise Patient Administration System follow a 10-hour shutdown a fortnight ago.
They come as the metropolitan hospital system is undergoing unprecedented change, both from Transforming Health reforms and the looming opening of the new $2.3 billion Royal Adelaide Hospital.
Both of these are underpinned by sensible logic — the need for a new hospital and to better manage the metropolitan hospital system. But, like the EPAS, sensible concepts are proving difficult to deliver.
There is a strong argument for the EPAS, designed as the foundation for delivering South Australia’s statewide electronic health record. The new system’s aim is to put SA public hospitals and health care sites at the forefront of e-health advancements.
The system was introduced at the QEH in late June. Health Minister Jack Snelling had already conceded it would not be ready for the new RAH’s opening and faced revelations the hospital’s floors would not be strong enough to hold paper records.
Doctors are expressing concern that the EPAS faults pose a fatal risk which, clearly, must be treated extremely seriously.
But there is another community risk — that necessary health reform will be bungled as a sceptical public loses patience with repeated faults.
More here:
I really hope this is the last time we hear about this mess for a while. It is getting boring.
David.

Wednesday, November 30, 2016

I Have To Say I Am Not Sure Just Why This Has Taken So Long? Inertia I Guess.

This appeared late last week:

Prescription approvals to move online

24 November, 2016
Doctors will no longer have to make calls to get approval for prescribing certain medications under proposed new laws.
Legislation introduced to parliament on Thursday will allow for the full-automation of a number of administrative decisions in a bid to save time, reduce errors and make the process more efficient.
"For prescribers and patients, online prescribing approvals will return precious minutes lost to telephone calls back to consultation time," Health Minister Sussan Ley said.
Around 6.8 million requests were made over the phone last financial year.
A majority of those requests will be able to be done online under the proposed measures, Ms Ley said.
More here:
There is also some coverage in Australian Doctor here:

PBS authority script line's 'Smooth Steve' to be replaced by bot

Paul Smith | 25 November, 2016 |
Authority script phone line operators will be replaced by computers under the latest attempt to streamline the system that sucks up hours of GP time.
This week, Minister for Health and Aged Care Sussan Ley introduced new legislation before Parliament allowing the PBS to make use of “computer programs for administrative actions and decision making”.
She said the legislative changes would trigger a “major leap forward in the [PBS] use of technology”, with prescriber requests processed online rather than by health department staff.
The AMA had previously estimated that 25,000 patient consultations were lost every month while doctors used the system.
Some 6.8 million telephone calls and postal requests were made each year for permission to prescribe drugs, Ms Ley said.
She claimed the changes would free up time for thousands of consultations, saying that on average doctors were currently spending one minute 27 seconds on the phone waiting for approvals.
But, while the looming revolution will be welcomed by GPs, it could mean GPs having to say goodbye to 'Steve', the mythical authority script line operator known by his husky voice
More here:
For a Government that claims to have deep digital deployment insights and motivation, and given the amount of time GPs presently waste on the phone to the PBS seeking approvals, this is well overdue.
The next thing to be watched is just how clunky or not the implementation will be. I won’t be holding my breath for a beautifully integrated and quick to use app, well integrated into the usual practice management systems.
As they say, time will tell!!
David.

This Sounds Rather Like A Success On The Part Of The Pharmacy Guild. I Hope The App Is Making A Real Difference.

This popped up last week.

MedsASSIST tops 4 million transactions

More than four million transactions have now been recorded in MedsASSIST, the Pharmacy Guild says.

As of yesterday (21 November) the codeine real-time recording and monitoring system had clocked up over four million transactions, and of these two per cent were for a deny/non-supply.
Guild data also shows that 86% of consumers who had made five or more purchases were recommended to take follow-up action, such as a referral to a doctor or pain specialist, pain management care plan, drug or alcohol service, to assist them to seek further help in managing pain and addiction.
“There is strong evidence that MedsASSIST is having an effect as intended and reducing inappropriate OTC codeine use for people who might be at risk of codeine dependency, while maintaining access for legitimate use,” the Pharmacy Guild says.
The Guild is working with Painaustralia and a number of Primary Health Networks to develop further resources to assist pharmacists and their patients to pursue alternative treatment options where chronic pain and/or dependence are suspected/apparent.
The TGA’s decision on whether or not to upschedule codeine-containing preparations which are currently OTC to doctor prescription only has been tipped to take place in the next few weeks, with Health Minister Sussan Ley telling the recent ASMI conference that the final decision would likely come before the end of the year.
However, the Guild’s commissioned report, “Fiscal impacts of codeine changes by Cadence Economics November 2015,” estimates an additional 8.7 million GP visits a year would be generated as a result of moving codeine medicines to prescription only.  
The MBS outlay of the additional GP visits is estimated to be $316.44 million each year, the Guild says.
These figures do not take into account losses in time and productivity for patients.
Costs to the PBS are also not included as these medicines would not be subsidised, although there is the potential that the higher strength, PBS-subsidised alternatives might be prescribed more often, the Guild says. Other industry sources have also indicated that they would expect this outcome.
More here:
Here is a basic outline of how the system works:

How MedsASSIST works

The pharmacist will assess the therapeutic need of a codeine medicine for the individual patient in accordance with the current practice for the supply of Pharmacist Only Medicines.
  1. The pharmacist will assess the therapeutic need of a codeine medicine for the individual patient in accordance with the current practice for the supply of Pharmacist Only Medicines.
  2. The pharmacist will then ask for a photographic ID and seek consent to record the ID number in the system which is protected, controlled and operated by the Pharmacy Guild of Australia. It is only the unique number on the photographic ID that is recorded in the system. The system does not record other details such as name, date of birth and address.
  3. If the patient does not consent to providing a photographic ID card number for recording and monitoring in the system, the pharmacist may choose not to supply the medicine because they cannot be sure it is safe to do so. In such circumstances, the pharmacist may elect to offer alternative medicines or recommend other treatment options including referral.
  4. The pharmacist also records the name and the quantity of the requested codeine medicine and reviews any previous purchases of codeine medicine.
  5. If a supply is made based on therapeutic needs, the reason for use and recommended duration of use will be recorded in the system.
  6. If the pharmacist decides it is not therapeutically appropriate to supply a codeine medicine, they will explain the reason for this decision and may provide further clinical information or recommendations to support your health. This will also be recorded in the system.
I note that the first 2 million transactions took till mid-August 2016 so the system is seemingly getting increasing use.
It will be good to see evidence of broad clinical impact in due course. Of course OTC codeine is a very commonly purchased medicine. I wonder how many packs are purchased each year?
David.

Tuesday, November 29, 2016

Do You Reckon This Success In New Zealand Might Just Help Reshape Our Digital Health Strategy? A Critical Post I Believe!


This appeared a few days ago:

Online health portals prove popular in New Zealand

November 21, 2016 2PM Shannon Williams
Nearly a quarter of a million New Zealanders are now using a patient portal to access their health information, the Government has revealed.
In 2015, a $3 million funding boost gave more New Zealanders access to patient portals, included $500,000 for an awareness campaign.
Health Minister Jonathan Coleman says it great to see a significant increase in portal users.
“Patient portals enable patients to manage aspects of their own healthcare such as booking appointments, requesting repeat prescriptions and messaging clinical staff directly,” says Coleman.
“It’s great to see the number of patient portal users significantly increase from around 175,000 in June 2016 to over 241,300 in September 2016 – a 38% increase in just over three months,” he says.
Coleman says the number of practices offering a portal service has also increased over this period, from 335 to 423 - a rise of 27%.
Compared with September 2015, the number of portal users increased by around 160%, and practices offering portals increased by 56%.
“Patients can now access their personal health information whenever they need it,” says Coleman.
More here:
Well what a surprise!
Provide patients will a portal that is useful to get repeats, make appointments, check results and communicate with clinicians and they use it. Who would have guessed. Provide a myHR with none of this after 5 years of development and it gets ignored – amazing….
Maybe the myHR system should be re-designed to deliver what patients want. Is this not what the consultation should be showing?
If these points are not addressed it will be clear to all we are having a Clayton’s consultation process!
David.

Monday, November 28, 2016

Weekly Australian Health IT Links – 28th November, 2016.

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

General Comment

A pretty quiet week, with some discussion on the myHR and, again, all sorts of other activity being reported on with SA’s ePAS somehow again attracting some unwanted attention.
Enjoy browsing!
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Can MyHealth Record be resuscitated?

Antony Scholefield and Paul Smith | 23 November, 2016 | 
Five e-health experts tell Australian Doctor whether they think the MyHealth Record system will eventually work or if the restart button needs to be pressed on the whole project.
After four years and an estimated $2 billion dollars of taxpayers’ money, the MyHealth Record system remains largely unloved and unused by GPs.
It raises serious questions about whether the whole enterprise should be put out of its misery, and become another footnote in the list of IT disasters that were big on promises and small on delivery.
However, there is still hope among some that it can be salvaged.
Tim Kelsey, a colourful e-health evangelist, has been brought in from the UK to head up the Federal Government’s Australian Digital Health Agency.
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Maximising My Health Record.

22 Nov 2016
There is no doubt the evolution of the shared electronic medical record, or the My Health Record as it is now known, has been a costly exercise, with more than $1 billion spent to date. Many observers would argue that is a lot of buck for little or no bang.
Certainly, the My Health Record is not yet perfect. But a recent demonstration of its use to the AMA Council of General Practice (AMACGP) was promising, and GPs who had previously dismissed it might consider taking a second look.
We all want the My Health Record to work. It has the potential to support much better patient care, particularly when your patients see another doctor or health care provider.
By uploading key medical information via a Shared Health Summary, you are making sure other doctors who may be treating your patient in an emergency situation, or while they are away on holiday, have the information they need to appropriately care for your patient, thereby reducing the likelihood of your patient experiencing an adverse medical event or unnecessary testing.
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MedsASSIST tops 4 million transactions

More than four million transactions have now been recorded in MedsASSIST, the Pharmacy Guild says.

As of yesterday (21 November) the codeine real-time recording and monitoring system had clocked up over four million transactions, and of these two per cent were for a deny/non-supply.
Guild data also shows that 86% of consumers who had made five or more purchases were recommended to take follow-up action, such as a referral to a doctor or pain specialist, pain management care plan, drug or alcohol service, to assist them to seek further help in managing pain and addiction.
“There is strong evidence that MedsASSIST is having an effect as intended and reducing inappropriate OTC codeine use for people who might be at risk of codeine dependency, while maintaining access for legitimate use,” the Pharmacy Guild says.
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Prescription approvals to move online

24 November, 2016 0 comments 
Doctors will no longer have to make calls to get approval for prescribing certain medications under proposed new laws.
Legislation introduced to parliament on Thursday will allow for the full-automation of a number of administrative decisions in a bid to save time, reduce errors and make the process more efficient.
"For prescribers and patients, online prescribing approvals will return precious minutes lost to telephone calls back to consultation time," Health Minister Sussan Ley said.
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PBS authority script line's 'Smooth Steve' to be replaced by bot

Paul Smith | 25 November, 2016 | 
Authority script phone line operators will be replaced by computers under the latest attempt to streamline the system that sucks up hours of GP time.
This week, Minister for Health and Aged Care Sussan Ley introduced new legislation before Parliament allowing the PBS to make use of “computer programs for administrative actions and decision making”.
She said the legislative changes would trigger a “major leap forward in the [PBS] use of technology”, with prescriber requests processed online rather than by health department staff.
The AMA had previously estimated that 25,000 patient consultations were lost every month while doctors used the system.
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Who will be crowned healthcare CIO of the year?

By Staff Writer on Nov 25, 2016 6:40AM

Healthy competition for the trophy.

When it comes to healthcare, time really is a critical - and often scarce - resource.
The three project leaders in the running to take out the healthcare category of the 2017 iTnews Benchmark Awards have all turned to technology to preserve this precious commodity.
All have taken very different approaches to handing time back to both the doctor and the patient, with the common end goal of improving health outcomes.
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Census reports highlight government IT incompetence

Inquiries by the Australian Senate and the PM's special advisor on cybersecurity highlight 'significant and obvious oversights' by the Australian Bureau of Statistics, which 'couldn't handle a predictable problem'.
By Stilgherrian for The Full Tilt | November 25, 2016 -- 02:50 GMT (13:50 AEDT) | Topic: Security
As details of the train wreck that was Australia's 2016 online Census have emerged, ZDNet has observed how it was a confluence of failure, indeed, an omnishambles of fabulous proportions. It was inexcusable.
On Thursday, though, came two reports that not only provided further evidence of incompetence at the Australian Bureau of Statistics (ABS), but they were also official. Their subtitles said it all.
One, the report of the Senate Standing Committees on Economics inquiry into the Census, was subtitled "Issues of trust".
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Govt slammed over 'intimidation' on Medicare website

The activist group GetUp has slammed the federal government over its threat to an elderly man who runs a website called Save Medicare where he publishes information about government changes to healthcare services and launched a petiton asking Canberra to back off.
Last Thursday, Mark Rogers, whom GetUp described as a 66-year-old grandfather from suburban Sydney, received a legal threat from the solicitor-general asking him to take down his website within 48 hours.
He was told that he would also have to agree to never again use Medicare branding.
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Big Data report recommends big changes for healthcare

Antony Scholefield | 24 November, 2016 |
Most GPs would probably think the Productivity Commission’s 650-page draft report Data Availability and Use sounds incredibly boring. And they’d be right. But there’s a reason to pay attention anyway.
Many of the report’s draft recommendations, if implemented, could have a big effect on healthcare.
The report recommends that all trend data that don’t identify individuals and are not confidential should be made public and open access, or at least available on request.
That would mean Australian Doctor’s mission to find the real statistics on bulk-billing would be readily available and wouldn’t require a fee or months of waiting.
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More could be done to flag renal issues when prescribing

23 November 2016

The Issue

Impaired renal function is common, especially among older people.
Many common medicines can accumulate in these patients or further impair renal function.
This can cause a range of biochemical disturbances, particularly when the drugs are used in combination.
GPs might prescribe medicines that put the patient at risk of either of these consequences without being aware of this.
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HIPS November 2016 Release

Created on Friday, 25 November 2016
The Australian Digital Health Agency is pleased to announce the release of HIPS v6.1. This version supersedes and combines the functionality of HIPS v5.0 and eHealth Integration Sample Code (eHISC) v6.0, and provides the basis for all future HIPS releases.
HIPS v6.1 also provides fixes for a number of high-priority issues, and support for three views introduced with recent releases of the My Health Record system.
New functionality
HIPS v6.1 supports the following views of the My Health Record system:
  • Pathology Report View;
  • Diagnostic Imaging Report View; and
  • Health Record Overview.
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Two more EPAS glitches at QEH, with warnings crashes will cost patient lives

Health Reporter Katrina Stokes, The Advertiser
November 22, 2016 12:51am
TWO computer glitches at the Queen Elizabeth Hospital in just 24 hours put patients’ lives at risk — and it is only a matter of time until someone dies, doctors warn.
They are calling on the State Government to scrap the controversial $422 million electronic patient records system because it is not “reliable or dependable”.
SA Health has confirmed an “IT update and server error” forced “delays” to the EPAS (Enterprise Patient Administration System) for 13 minutes between 1am and 2am on Sunday and again at 9.20pm for 40 minutes but insists there was no risk to patient safety.
The latest issue comes just two weeks after another software glitch saw the system crash at the QEH for 10 hours, with doctors labelling the situation as a “dangerous, chaotic crisis” and potentially fatal for patients.
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The Advertiser Editorial: Failures crash confidence in health system

The Advertiser
November 22, 2016 12:38am
TWO failures within 24 hours of the controversial computer patient management system at the Queen Elizabeth Hospital are cause for deep concern.
The latest problems with the $422 million Enterprise Patient Administration System follow a 10-hour shutdown a fortnight ago.
They come as the metropolitan hospital system is undergoing unprecedented change, both from Transforming Health reforms and the looming opening of the new $2.3 billion Royal Adelaide Hospital.
Both of these are underpinned by sensible logic — the need for a new hospital and to better manage the metropolitan hospital system. But, like the EPAS, sensible concepts are proving difficult to deliver.
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Maligned EPAS patient records software system suffers two more outages in Adelaide

November 22, 2016
South Australia's troubled electronic-patient records system has suffered two more outages over the weekend.
SA Health said issues with a software update and servers caused delays to EPAS for 13 minutes early on Sunday morning and another for about 40 minutes on Sunday night.
SA Health chief information officer Bill le Blanc said it did its best to minimise inconvenience to staff and patients.
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SA Health's Bill Le Blanc hits back at EPAS critics

Health authority CIO responds to electronic records system doubters
George Nott (CIO) 25 November, 2016 13:17
It’s been a trying few weeks for SA Health CIO Bill Le Blanc. Earlier this month he faced the wrath of medical unions and the scrutiny of the national media after a glitch caused an outage in the health authority’s electronic patient records system, EPAS.
Two more outages occurred over last weekend. On Tuesday morning page three of Adelaide’s The Advertiser newspaper read “EPAS fails ‘will be fatal’”. By the afternoon Le Blanc was being grilled live on radio.
“I never anticipated when I applied for this job I would have to go on radio, TV, the paper,” he said at the CIO50 awards in Sydney last night. “People screaming that IT…is basically going to kill a patient.”
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Personal data de-identification practically impossible: expert

The Australian government may well have to reconsider its plan to release data about its citizens for use by businesses or scientists, with a top expert in security and privacy engineering telling iTWire that de-identification of datasets so that they cannot be traced back to the original is very hard, to the point of being practically impossible.
George Danezis, professor of security and privacy engineering at University College, London, offered the response after being asked about de-identification of datasets in connection with the leak of personally identifiable details in health data that was released by the government.
Researchers at Melbourne University were able to trace back the data and after the government was made aware of this, the released dataset was taken offline.
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WA Health rules out legal action over $81m data centre blowout

By Paris Cowan on Nov 23, 2016 11:53AM

Won't chase criminal, civil charges.

WA's Department of Health has confirmed it won't take any further disciplinary action against former workers who were found signing off on data centre purchases way above their financial delegation.
Auditor-general Colin Murphy exposed the procurement scandal in February, when he revealed the agency’s ongoing data centre deal with Fujitsu threatened to balloon to $175 million despite originally being valued at just $45 million.
He tracked down dubious orders that missed checks and balances and left WA Health paying for hardware and floor space it didn’t need.
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Food Safety Website now live for industry and consumers

Australian ministers and the New Zealand minister responsible for food have released a revamped food safety website designed to give stakeholders better access to information about the joint Australian and New Zealand food regulation system.
Page last updated: 25 November 2016
25 November 2016
Australian ministers and the New Zealand minister responsible for food today released a revamped food safety website designed to give stakeholders better access to information about the joint Australian and New Zealand food regulation system.
Assistant Minister for Rural Health, Dr David Gillespie, launched the new website in conjunction with the Ministerial Forum on Food Regulation meeting in Brisbane.
“Food regulation is a complex system that involves all levels of the Australian and New Zealand governments,” Dr Gillespie said.
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Promise of genetic sequencing frustrated by the cost of medicines for rare cancer patients

Harriet Alexander
Published: November 24, 2016 - 11:19AM
Ann Bantoft feels like she has been asked to put a price on her son's life - and she cannot afford it.
It is the price of a wonder drug that is the young man's last hope to defeat a tumour that has proved oblivious to radiation, indifferent to chemotherapy and too perilous for surgery - and it costs $8612 a month.
But although the drug is listed on the Pharmaceutical Benefits Scheme, it is not subsidised for the likes of Brad Williams, because it has only been approved for melanoma patients and his tumour is growing in his brain.
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Online health portals prove popular in New Zealand

November 21, 2016 2PM Shannon Williams
Nearly a quarter of a million New Zealanders are now using a patient portal to access their health information, the Government has revealed.
In 2015, a $3 million funding boost gave more New Zealanders access to patient portals, included $500,000 for an awareness campaign.
Health Minister Jonathan Coleman says it great to see a significant increase in portal users.
“Patient portals enable patients to manage aspects of their own healthcare such as booking appointments, requesting repeat prescriptions and messaging clinical staff directly,” says Coleman.
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New online 'Australia's Health Tracker by Area' a welcome step forward

24 November 2016
A new online interactive map of health in Australia, ‘Australia’s Health Tracker by Area’ is a welcome step forward in highlighting areas for attention in health, as well as areas that could act as examples to follow, according to the nation’s leading public healthcare body, the Australian Healthcare and Hospitals Association (AHHA).
‘Australia’s Health Tracker by Area’ was released today by the Australian Health Policy Collaboration at Victoria University, Melbourne, which developed the product with the Public Health Information Development Unit at Torrens University, South Australia.
‘This new digital platform provides instant mapping and localised data on deaths, for example from cancer cardiovascular disease, and suicide, as well as localised estimates of chronic diseases such as diabetes, and health risk factors such as overweight and obesity, high blood pressure and risky alcohol consumption’, said AHHA Chief Executive Alison Verhoeven.
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  • Nov 21 2016 at 10:00 AM

'Next Cochlear' 4Dx closes capital raise as FDA approval enters sight

by Yolanda Redrup
Medical imaging startup 4Dx has raised $2.5 million from a range of retail and high net worth investors, which the business will invest in its clinical trials that will see the company approved by the US Food and Drug Administration by mid next year.
The company, which already has one major deal with Los Angeles hospital Cedars Sinai to use its lung imaging technology, also has an additional $2.5 million committed that is expected to close this week, taking its total series A raise to more than $5 million. 
Chief executive Andreas Fouras said the company had developed a strong investor base featuring healthcare professionals and business bigwigs from retail, resources and banking and finance, making him confident the company could go achieve its ambitions of being as successful as Cochlear.
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Who’s who of Aussie ICT

November 21, 2016
VITALCARE has pioneered nurse call and critical messaging systems for over 30 years. The company designs, manufactures, installs and services the most innovative systems available through a national network of company owned branches and authorised distributors. The company provides advanced technology systems for nursing homes, retirement villages, hostels and other dependent care facilities. Since 1989 facilities in Australia, New Zealand, the United States and Canada, have chosen Vitalcare’s systems for the peace of mind they provide their residents. Vitalcare is the first manufacturer to integrate IoT (Internet of Things) technology in its two-way waterproof pendants and call points along with cloud integration for advanced reporting, supervised maintenance and data analysis. www.vitalcare.com.au
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Enjoy!
David.