Quote Of The Year

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

or

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

Thursday, February 02, 2017

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

February 2  Edition.
After about 10 days of the Trump administration we certainly have had some action! Just how it will all play out is hard to know but at least on Nobel Laureate does not see much good coming from it all!

Making the Rust Belt Rustier

Donald Trump will break most of his campaign promises. Which promises will he keep?
The answer, I suspect, has more to do with psychology than it does with strategy. Mr. Trump is much more enthusiastic about punishing people than he is about helping them. He may have promised not to cut Social Security and Medicare, or take health insurance away from the tens of millions who gained coverage under Obamacare, but in practice he seems perfectly willing to satisfy his party by destroying the safety net.
On the other hand, he appears serious about his eagerness to reverse America’s 80-year-long commitment to expanding world trade. On Thursday the White House said it was considering a 20 percent tariff on all imports from Mexico; doing so wouldn’t just pull the U.S. out of NAFTA, it would violate all our trading agreements.
Why does he want this? Because he sees international trade the way he sees everything else: as a struggle for dominance, in which you only win at somebody else’s expense.
His Inaugural Address made that perfectly clear: “For many decades we’ve enriched foreign industry at the expense of American industry.” And he sees punitive tariffs as a way to stop foreigners from selling us stuff, and thereby revive the “rusted-out factories scattered like tombstones across the landscape.”
Unfortunately, as just about any economist could tell him — but probably not within his three-minute attention span — it doesn’t work that way. Even if tariffs lead to a partial reversal of the long decline in manufacturing employment, they won’t add jobs on net, just shift employment around. And they probably won’t even do that: Taken together, the new regime’s policies will probably lead to a faster, not slower, decline in American manufacturing.
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Enough said – this won’t end well I fear.
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Here are a few other things I have noticed.
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Trump Material.

With Donald Trump in the White House, what now for the Asia-Pacific?

Brendan Taylor
Published: January 23, 2017 - 12:00AM
As Donald Trump enters the Oval office, speculation is rife regarding what his presidency will mean for stability in Australia's Indo-Pacific region.
Will Trump slap tariffs on Chinese imports, sparking a trade war between the world's two largest economies? Will he forge a new great power alignment with Moscow, leaving Beijing out in the cold strategically? Will he abandon free-riding Asian allies and encourage them to develop their own nuclear arsenals? Or is all of Trump's bluster geared toward putting Beijing off balance as he seeks to strike a better "deal" for America with a rising China?
The truth is that we simply don't know what a Trump presidency will mean for Indo-Pacific stability. And we probably won't know until the incoming Trump administration confronts its first major crisis here.
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China eyes opportunity as US pulls out of Trans-Pacific Partnership

Justin Sink and Toluse Olorunnipa
Published: January 24, 2017 - 6:36AM
Washington: President Donald Trump's formal withdrawal from a long-planned trade deal with Pacific Rim nations creates a political and economic vacuum that China is eager to fill, offering a boost for beleaguered US manufacturing regions while damaging American prestige in Asia.
The move is a sledgehammer blow to former President Barack Obama's attempt to recentre US foreign policy from the Mideast to Asia.
As the Trump administration retreats from the region by ending US participation in the Trans-Pacific Partnership, China's Communist leaders are ramping up their globalisation efforts and championing the virtues of free trade.
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Wall Street Questions If Trump Can Turn His Promises Into Policy

Increasing doubts about corporate taxes, infrastructure spending
by Julie Verhage
24January,2017, 2:06 am AEDT
It's a lot easier to say you'll do something in Washington than to actually get it done. 
A number of Wall Street analysts are becoming increasingly concerned that President Donald Trump won't be able to follow through on several key proposals that he campaigned on, such as lowering corporate taxes and increasing infrastructure spending. If he doesn't, or aspects of the reforms are pared back, their outlooks would become much less optimistic.
Stocks in the U.S. have rallied more than 8 percent since Trump was elected, but all of those gains were made between Nov. 8 and Jan. 6. Since then, markets have stalled as has consumer confidence.
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Now that Trump is US president, world braces for Trumpnomics

Professor Carmignani
Published: January 23, 2017 - 4:52PM
If Australia does indeed catch a cold when the US sneezes, should we be preparing for a crippling dose of influenza when Trumpnomics takes hold?
In the months following the end of the US presidential campaign, the rhetoric of Donald Trump moved from boisterous statements on (mostly undoable) plans to build walls and ban Muslims to more practical announcements about economic policy.
This rhetoric reflects Trump's understanding that the way to make America great again is through economic prosperity. Hence the need to articulate an economic plan, which, with this weekend's inauguration, will soon become reality.
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Donald Trump turns his back on the world

Peter Hartcher
Published: January 24, 2017 - 5:37AM
Donald Trump's America does not exist in a vacuum. Other nations are calculating and positioning to take advantage.
Much has been said about Russia. But the rising great power competing with the US for leadership in the Asia-Pacific and for authority worldwide is China.
Strikingly, Beijing has decided that Trump represents a great opportunity to win power and influence at America's expense.
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TPP: Australian dollar breaks through US76c on 'global trade war' fears

Jens Meyer
Published: January 24, 2017 - 2:09PM
The Australian dollar has topped US76¢ for the first time in more than two months as the greenback continues to weaken on worries that the Trump administration's protectionist stance will include seeking a weaker currency.
Talk of trade wars pushed the Aussie as high as US76.09¢ early Tuesday afternoon. Overnight, the US dollar spot index, which measures the greenback's value against a basket of major currencies, dropped below the mark of 100 for the first time since early December, falling as low as 99.89 before recovering slightly to 100.16.
US President Donald Trump has targeted trade policy in his first days in office, pulling America out of the Trans-Pacific Partnership on Monday as well as threatening a "very major" border tax for companies who shift production out of the US.
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We’re with Donald Trump in uncharted territory

  • The Australian
  • 12:00AM January 25, 2017

Paul Kelly

Donald Trump’s inaugural ­address, playing to a dark age of US “carnage” that he pledges to extinguish, should leave nobody in doubt: the President is a populist reactionary and radical, not a conservative, whose transformation agenda is hostile to the traditions and principles of US conservatism.
The essence of his politics is the enshrinement of victimhood at the hands of a corrupt ruling order. Exploiting the stagnation of real wages over a generation and huge inequities in US society, Trump blames the Washington establishment, foreigners, rival nations and companies that have exploited US riches, stolen its jobs, enticed its corporates, plundered its middle-class wealth and left its heavy industry in ruins.
He paints a dark past from which he will liberate America. Yet he arrives as an outsider with few institutional allies in the US system, a compulsion to create enemies, and an almost reckless addiction to creating huge expectations for his presidency. He declares the “empty talk” is over and the “hour for action” is at hand. He tells his legions of voters not to countenance talk of failure, to reject the naysayers, to believe the long era of politicians who practice “all talk and no action” is finished. He declares America stands “at the birth of a new millennium”.
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Donald Trump's economic package unlikely to match rhetoric

Jessica Irvine
Published: January 25, 2017 - 9:04AM
Sharemarkets will likely shrug off Donald Trump's decision to withdraw from the Trans-Pacific Partnership trade deal. On best estimates, the deal would have delivered only minor benefits for the US and Australian economies.
What really matters is what becomes of the rest of his ambitious economic agenda.
The Aussie bourse surged more than 10 per cent after the US election, spurred by Trump's election night promise of a huge infrastructure spending spree, along with massive tax cuts.
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Donald Trump's America has Malcolm Turnbull scrambling in a changed world

Daniel Flitton
Published: January 25, 2017 - 8:29PM
In three ways - and in just three days - Donald Trump's "America First" mantra has profoundly unsettled Australia's assumptions about the world.
Trump hasn't provoked a crisis in foreign policy but there is a new intensity that will especially challenge Malcolm Turnbull in the coming weeks on vexed political questions ranging from refugees to China.
US forces get the nod?
An unnamed official from the Trump team has flagged expanding or adding new bases in Australia as part of a wider strategy to counter China's influence in the region.
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Australia is investing billions in madman Donald Trump

Michael Pascoe
Published: January 27, 2017 - 1:19PM
There are several hundred Australian defence personnel deployed in Iraq. The Commander in Chief of the nation controlling their action has just told Iraqis that the US should have taken their oil after invading their country in 2003. He then left the door open to have another crack.
This wasn't a second-hand report of a private conversation: it was an in-depth one-on-one interview with America's ABC News' 20/20 program. President Trump repeatedly said the US should have taken or "kept the oil."
"We should've taken the oil," he told ABC anchor David Muir. "And if we took the oil you wouldn't have ISIS. And we would have had wealth."
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Donald Trump’s election a rejection of identity politics

  • The Australian
  • 12:00AM January 28, 2017

Paul Kelly

As Donald Trump’s new presidency surges across our politics, creating chaos and uncertainty, there is one element in his victory where most Australian politicians remain in ideological denial — the revolt against identity politics.
Trump, in effect, was given permission to win the election by the US progressive class despite his narcissism, his coarseness and his smashing of the orthodox bounds of political and policy behaviour.
In retrospect, the 2016 US election story is a grand joke — enough voters in Middle America decided to tolerate Trump’s juvenile viciousness because they felt the narcissism of prevailing closed-minded progressive ideology was no longer to be tolerated. In the end, the alternative was worse than Trump. Is this too difficult an idea to grasp?
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National Budget Issues.

Scott Morrison looks to London to solve housing affordability crisis

Michael Koziol
Published: January 22, 2017 - 5:18PM
The Turnbull government appears to be moving toward establishing a government backed-bond vehicle for affordable housing as Treasurer Scott Morrison heads to Britain to seek guidance on Australia's housing affordability crisis and Prime Minister Malcolm Turnbull prioritises the issue.
Similar to the Clean Energy Finance Corporation, which the former Abbott government wanted to abolish, a housing bond aggregator would give affordable housing providers access to cheaper and longer tenor debt for the construction of new homes.
It was the leading recommendation of bureaucrats in a report handed to state and federal treasurers in December, who agreed to establish a taskforce to design the model by mid-2017. The report made an exemplar of Britain's Housing Finance Corporation, which in 2014-15 issued more than £4 billion ($6.55 billion) in loans to housing agencies.
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Sydney has the second least affordable housing in the world: study

Latika Bourke
Published: January 24, 2017 - 5:19AM
Australia is a world leader in "severely unaffordable" housing, a study of global housing markets has found, with Sydney the second most unaffordable major housing market in the world, coming behind only Hong Kong.
Sydney and Melbourne are among the top 10 least affordable major housing markets, according to Demographia's 13th annual International Housing Affordability Survey.
The survey found that of Australia's 54 housing markets, just four, including Karratha, Port Hedland and Kalgoorlie in Western Australia and Gladstone in Queensland, are considered affordable. However the survey says these markets are heavily reliant on the resources sector and without it could also be ranked unaffordable.
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Automated Centrelink a fast track to Turnbull's demise

Ross Gittins
Published: January 24, 2017 - 10:58PM
Of the loads of films I saw last year, the most memorable was Ken Loach's I, Daniel Blake. I go to the movies for escapist entertainment, not to give my emotions a good workout but, even so, it left a lasting impression.
It was the story of a 59-year-old carpenter in Newcastle, England, whose cardiologist told him not to go back to work for a few months after he'd had a heart attack on the job.
What we saw was Blake's mistreatment at the job centre he went to for social security payments at the height of the Cameron government's austerity spending cuts.
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Consumer price index: Rates on hold as inflation bottoms

Peter Martin
Published: January 25, 2017 - 6:47PM
The Reserve Bank has been given licence to leave interest rates on hold at its first board meeting for the year, after the delivery of a low inflation result in line with its expectations and signs it will lift.
Australia's inflation rate was just 0.5 per cent in the December quarter, down from 0.7 per cent in the September quarter. But the more closely watched measure of "non-tradables" inflation climbed from 0.5 per cent to 0.8 per cent.
Non-tradables inflation excludes goods and services that can be traded overseas, providing a measure of movements in prices that are domestically generated.
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Turnbull's fearful, pessimistic, ageing vision for Australia

Peter Martin
Published: January 25, 2017 - 11:45PM
Malcolm Turnbull and Donald Trump might be at loggerheads over the Trans-Pacific Partnership, but in other respects they're in sync.
Trump's inaugural address focused on what he was against: elites, Islamic terrorism, crime and gangs.
Turnbull's remarkably dark new year message was about economic challenges, international conflict and "Islamist terrorists". It was about fighting things rather than doing things.
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What Scott Morrison Will Learn From London About Housing Affordability

Australia is unique when it comes to negative gearing.

25/01/2017 10:02 AM AEDT | Updated 25/01/2017 10:03 AM AEDT
  • Doug Cameron Shadow Housing Minister. Labor Senator for New South Wales
LONDON, ENGLAND - JANUARY 24: British Chancellor of the Exchequer Philip Hammond greets Scott Morrison (R) outside Number 11 Downing Street on January 24, 2017.
After three and a half years of policy chaos, mistakes and inaction, Scott Morrison is heading to London to seek guidance on how the Turnbull government might tackle Australia's housing affordability and related homelessness crises.
The first thing he will learn is that, in the UK, there is no combination of negative gearing and capital gains tax concessions that distort the housing market by providing perverse and unfair incentives for investment in existing property.
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Cut tax or we’ll be stranded, warns Scott Morrison

  • Simon Benson
  • The Australian
  • 12:00AM January 27, 2017
Scott Morrison has warned that Australia is now facing the real risk of being globally stranded by crippling taxes that would erode the nation’s living standards if the government continues to be blocked politically from its company tax reforms.
In a speech today to business leaders in London, the Treasurer will lay down the challenge to parliament that unless Australia follows the example of Britain, which cut its tax rate to 20 per cent while in a worse budget position, then it will rapid­ly lose its competitive place in the world.
In a bid to escalate pressure on the Senate crossbench to support the government’s plan to cut the company tax to 25 per cent, Mr Morrison said Labor would have to wear the responsibility for Australian businesses left behind as other countries moved to a lower tax environment.
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Health Budget Issues.

Doctors go public over fears of Medicare levy hike

- on January 22, 2017, 6:37 pm
Doctors have gone public with their fears of a Medicare levy rise in the federal budget.
They’re worried taxpayers will be forced to hand over even more for health care; potentially costing families hundreds more a year.
The incoming health minister Greg Hunt say his commitment to Medicare is a personal one.
“I have, and we have, a rock solid commitment to the future of Medicare,” he said.
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Big pharma should have to come clean

Published: January 22, 2017 - 7:19PM
Everyone with an email address has received them – messages publicising a petition that seeks government recognition in some form for a medical condition; recognition of the condition itself, or for a particular treatment, or a Pharmaceutical Benefits Scheme subsidy for a new drug.
They tug at the heartstrings, with pictures of photogenic sufferers and an emotional plea for assistance for some individual in need. The issues seem so simple. Why won't the government help? How can it be so cruel?
As we reported last week, the issues are rarely as simple as they are made to seem. Behind the one publicised individual battling a rare condition is most likely a patient support group – a collection of former and current sufferers, medical professionals, researchers and perhaps drug company representatives.
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Specialists’ fees drive up out-of-pocket costs for patients

  • The Australian
  • 12:00AM January 23, 2017

Sarah-Jane Tasker

Australian patients are increasingly being forced to pay higher out-of-pocket costs for common procedures, with some specialists boosting their fees more than 300 per cent above the federal government rebate.
New data released by health ­insurance giant Medibank reveals that for common overnight procedures, such as childbirth and knee replacements, the average out-of-pocket cost to private patients has jumped, despite the insurer also increasing the average benefit it paid.
Medibank’s chief medical officer Linda Swan said in many cases the insurer was paying for its ­customers’ healthcare at rates that were well above the fees set by the federal government’s Medicare Benefits Schedule.
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Can GPs expect anything different from Greg Hunt?

23 January 2017
EDITORIAL
If he succeeds on even a fifth of the things he promises, people will think him a healthcare revolutionary, writes political editor Paul Smith.
It has become almost obligatory for those with designs on becoming a Federal Health Minister to speak of GPs, prevention and mental health. And then, when hard politics begins, to fall victim to amnesia.
When news of his new job came, Greg Hunt was before the media declaring: “I want to re-establish [GPs’] value, their role, their importance, their trust in the community ... I want to be their health minister.”
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Is 'big food' political lobbying helping shape health policies at the public's expense?

Daniel Burdon
Published: January 23, 2017 - 8:00PM
Lobbyists for 'big food' are potentially swaying health policies in favour of their corporate bottom line in Australia, new research has claimed.
A Deakin University study published Monday has reported finding "direct evidence" of food industry political tactics that had the potential to shape public health-related policies, at the expense of public health.
The research conducted interviews with 15 former politicians, current and former public servants and senior executive officers with non-government organisations over a four month period who had exposure to the industry's "corporate political activity".
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Medicare levy increase on the table as Turnbull budget speculation begins

Adam Gartrell
Published: January 22, 2017 - 12:15AM
Doctors believe the Turnbull government could be contemplating another increase in the Medicare levy.
The Australian Medical Association has used its pre-budget submission to plead with the government to return any extra revenue raised by the tax to health rather than using it to fix the deepening deficit.
"It is equally important to understand that any increase in the Medicare Levy does not absolve governments from the critical need to continue to reinvest in Australia's health, including lifting the MBS freeze," the peak group says in its submission to the government ahead of the May 9 budget.
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Complementary medicines: A $4.2 billion dollar question

23 January, 2017 Tessa Hoffman 
On a busy shopping strip on Sydney’s north shore lies a pharmacy where you won’t find a homeopathic product for sale.
The owner, Nick Logan, simply refuses to stock them.
“They’re proven beyond a shadow of a doubt not to work and my customers expect me to not stock bogus products,” says Mr Logan, who was named PSA Pharmacist of the Year in 2009.
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Health Insurance Issues.

Tens of thousands of patients using health insurance in public hospitals

Julia Medew
Published: January 24, 2017 - 1:57PM
Tens of thousands of Victorian patients are using their health insurance in public hospitals without any guarantee it will get them faster care, a choice of doctor or a private room.
And some people are getting stung by unexpected bills for more than $1000, an insurer says.  
New data shows the number of patients using their insurance in Victoria's biggest public hospitals has been creeping up for the past three years to reach an expected rate of about 15 per cent this financial year.
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Bupa warns health insurers face unsustainable cost increases

Bupa has warned the Turnbull government the sector is at a tipping point
  • The Australian
  • 12:00AM January 26, 2017

Sarah-Jane Tasker

Bupa has warned the Turnbull government that affordability con­cerns have driven the private health insurance sector to a tipping point, as it calls for a new lifetime cover discount for young people and an increase in the Medicare levy surcharge for high-income earners.
In its pre-budget submission, sent this week to the government, the insurance giant states that membership growth will probably fall this year and it asks the government to promote public awareness of the benefits of private health insurance.
Dwayne Crombie, the Australian boss of Bupa’s health ­insurance arm, said that as well as recommendations outlined in its pre-budget submission, he had come to the view that the freeze on Medicare payments should be lifted for primary care and ambulatory procedures.
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Health insurers, customers hope for a win on premium increases

  • The Australian
  • 1:45PM January 27, 2017

Sarah-Jane Tasker

New health minister Greg Hunt could look to score a “win” with consumers and approve the lowest average health insurance rate increase in a decade.
As insurers wait for the new health minister to sign off on this year’s annual premium increase, analysts have suggested a new minister taking on the portfolio at such a late stage in the process had the potential to complicate the outcome.
“It is possible that a new minister may want to minimise political attention at this time but he could also try to use this opportunity to score a win for consumers by approving the lowest average rate increase in a decade,” Citi analyst Nigel Pittaway said.
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Just what the doctor ordered

index&t_product=HeraldSun&td_device=desktopJeff Whalley, Herald Sun
January 28, 2017 12:00am
AFTER taking the helm of a company losing customers and racking up record numbers of complaints, Craig Drummond knows he needs to shake Medibank Private out of its malaise.
Now six months into his posting as chief executive of Australia’s biggest private health insurer, Drummond is well versed in the challenges it faces as the industry rapidly evolves.
And he believes the solution for the group lies in better understanding the needs of its customers.
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Federal Health Minister Greg Hunt could hit health insurers, Citi warns

Jeff Whalley, Herald Sun
January 28, 2017 12:00am
HEALTH insurance premiums could grow this year by the smallest amount in a decade as the Federal Government tries to “score a win” for consumers, an industry expert believes.
In a blow for insurers such as Medibank Private and Bupa, new Federal Health Minister Greg Hunt could try to appease fund members amid a climate of weak wage growth and increasing healthcare costs, according to investment bank Citi.
The forecast comes after Mr Hunt stepped into the portfolio last week, succeeding Sussan Ley, who stood down amid a scandal over travel expenses.
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I look forward to comments on all this!
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David.

This Has To Be Very Good News For All Of Us Living In Australia. A Useful Advance It Seems.

This appeared a few days ago.

'Automated dermatologist' detects skin cancer with expert accuracy

By Susan Scutti, CNN
Updated 2337 GMT (0737 HKT) January 26, 2017
(CNN)Even though the phrase "image recognition technologies" conjures visions of high-tech surveillance, these tools may soon be used in medicine more than in spycraft.
A team of Stanford researchers trained a computer to identify images of skin cancer moles and lesions as accurately as a dermatologist, according to a new paper published in the journal Nature.
In the future, this new research suggests, a simple cell phone app may help patients diagnose a skin cancer -- the most common of all cancers in the United States -- for themselves.
"Our objective is to bring the expertise of top-level dermatologists to places where the dermatologist is not available," said Sebastian Thrun, senior author of the new study, founder of research and development lab Google X and an adjunct professor at Stanford University. He added that those who live in developing countries do not have the same level of care as can be found in the US and other industrialized nations.
Melanomas represent fewer than 5% of all skin malignancies diagnosed in the US, yet they account for nearly three-quarters of all deaths related to this form of cancer. If detected early, the five-year survival rate for melanoma is 99%. When detected in its latest stage, the survival rate plummets to just 14%.
Generally, dermatologists identify whether a mole or other abnormality is cancerous by looking at it. They can confirm their diagnosis with follow-up biopsies and tests.
With a team of researchers, Thrun developed a deep learning computer system to perform the first task in detecting skin cancer: identifying it at a glance.
Essentially, the team created an automated dermatologist.

How it works

Thrun and his colleagues began by coaching a computer to develop pattern recognition skills. The method they used is an algorithm-based technique known as "deep learning."
Specifically, the research team employed a convolutional neural network.
Carl Vondrick, a Ph.D. candidate at MIT's Computer Science and Artificial Intelligence Lab, who was not involved in this study, explained the process.
"A convolutional neural net is a type of computer software that is very good at learning to recognize different concepts," he said. By downloading digital images, researchers can "tell" the computer they are images of skin cancer, or without skin cancer. The machine will basically try to learn some rules that can predict whether it's cancer.
"An algorithm is just a fancy name for a sequence of steps that the computer takes. So in this case, the algorithm refers to the whole process that they did to train the system," Vondrick said.
Andre Esteva, co-first author of the new paper with Brett Kuprel, both electrical engineering Ph.D. students at Stanford, said he, Thrun and their colleagues began by "basically teaching the algorithm what the world looks like."
"We taught it with cats and dogs and tables and chairs and all sorts of normal everyday objects look like," Esteva said. "We used a massive data set of well over a million images." This phase of learning took about a week.
Then, Esteva trained the algorithm in different skin conditions. Here, the team addressed a complex problem: Cancerous and noncancerous skin aberrations vary greatly in appearance from patient to patient.
To overcome this difficulty, the researchers presented the now-trained -- or "artificially intelligent" -- computer with an extensive dataset of 129,450 images representing more than 2,000 skin diseases. The images came from 18 doctor-curated online repositories as well as the Stanford University Medical Center.
Since each image of a mole or abrasion had been diagnosed, the computer was fed this information as well.
Lots more detail and explanation here:
Great news and I am sure we are going to see just more and more of this sort of AI based solutions.
We sure live in interesting times.
David.

Wednesday, February 01, 2017

This Has To Be Worst Saga Of Government IT Program Failure I Have Ever Heard Of! Just Dreadful.

This article appeared last week.

IBAC finds disastrous Ultranet project for schools was a 'corrupt' shambles

Henrietta Cook, Benjamin Preiss, Timna Jacks
Published: January 27, 2017 - 5:10PM
Education Department officials wasted up to $240 million of taxpayers' money during a corrupt tender process for a school IT project, Victoria's anti-corruption watchdog has concluded.
The officials could now faces criminal charges over the "appalling waste" following a lengthy investigation by the Independent Broad-Based Anti-Corruption Commission.
The Ultranet project promised to deliver an online platform that connected teachers, parents and students, but was plagued by technical issues and rarely used after its rollout by the former state Labor government in 2010.
In a long-awaited report tabled in state parliament on Friday, IBAC found that department officials purchased shares in CSG – the company awarded the Ultranet project – influenced the tender process and accepted inappropriate gifts from suppliers including flights and lavish dinners.
"The willingness of some senior leaders in the department to deceive has resulted in the waste of millions of dollars of public money," the report said.
It follows revelations by Fairfax Media in 2014 that four senior senior education department officials bought shares or took jobs with CSG.
Operation Dunham, an IBAC investigation into the alleged misconduct, found that former regional director John Allman purchased shares in CSG knowing it would likely win the lucrative contract.
His colleague, former regional director Ron Lake, bought $100,000 in CSG shares while on the Ultranet board. Former regional director Wayne Craig and his wife purchased 6000 CSG shares after the company won the contract.
"The behaviour suggests that at least some used confidential information to which they were exposed in the course of their work for private gain," the report said.
The man who spearheaded the Ultranet project, former deputy secretary Darrell Fraser, used $1 million of department money to "corruptly inject funds into CSG to ensure it had sufficient cash flow to properly deliver the Ultranet project", IBAC found. 
It said Mr Fraser – a former principal at Glen Waverley Secondary College – was "instrumental in manipulating procurement processes to ensure the Ultranet contract was awarded to the CSG/Oracle consortium – companies with whom he had a longstanding relationship".
Lots more here:
There are some even more alarming details here:

Corruption claims over failed $240m Ultranet project

Inquiry finds evidence of process corruption, improper diversion of funds, conflict of interest and mismanagement
George Nott (Computerworld) 27 January, 2017 15:00
The launch was extravagant. Dancers and singers were hired to perform a specially choreographed musical number. A bespoke stage was constructed to look like a giant laptop. Kindles and iPads were given away as spot prizes.
A branded bus ferried then Victorian education minister Browyn Pike and special guests to the ‘Big Day Out’ event at Melbourne Convention and Exhibition Centre. Today, they would launch Ultranet, a virtual learning portal that promised to ‘revolutionise learning’ for every Victorian school pupil.
Poised at their computers in schools across the state, teachers readied themselves to log-on to the system as it went live. It crashed. The million-dollar event was a damp squib. And so was Ultranet.
Three years later, in 2013, plagued by limited functionality and declining student take-up from an already pitiful base of 10 per cent, the Ultranet project was abandoned. Although the exact cost is unknown, estimates go as high as $240 million.
Today Victoria’s Independent Broad-based Anti-corruption Commission (IBAC) said its investigation into the project had “exposed a range of improper actions and behaviours by senior departmental staff that effectively corrupted the tender process.”
“Central to many of the allegations examined”, the report released by IBAC today says, is former teacher turned senior state politician Darrell Fraser who one person told IBAC “broke every f---ing rule in the book”.
Serious concerns
The anti-corruption agency’s report was tabled in state parliament today. It accuses the former education department official and other senior departmental staff of making decisions that were “contrary to the proper procurement process”. These decisions resulted in a preference for systems integrator CSG “despite serious concerns about its commercial credentials in the relevant area” and an Oracle-based solution.
“Mr Fraser was instrumental in manipulating procurement processes to ensure the Ultranet contract was awarded to the CSG/Oracle consortium – companies with whom he had a longstanding relationship,” the report says.
Lots more here:
This all reads rather like a novel rather than a Government report that raises incompetence, corruption, fund diversion, conflicts of interest and even worse Ministerial Stupidity in managing a significant IT project.
Government IT of all forms really needs to have its own skilled supervision body to keep the whole delivery of these critical services on the rails. A sort of IT ICAC if you will!
David.

Tuesday, January 31, 2017

Is There A Lesson In All This For The Health Sector? - I Suspect So!

Few can be unaware of the issues around the use of data-mining to attempt to identify individuals who have been overpaid from Government coffers.
This is a good summary if you have not been paying attention.

How the Centrelink debt debacle failure rate is much worse than we all thought

Peter Martin
Published: January 24, 2017 - 8:20PM
It has become the most widely cited figure in the Centrelink robo-debt debate: that 20 per cent of the debts identified by its data-matching machine are wrong.
But the figure itself is wrong. The true number of mistakes is almost certainly higher, perhaps as high as 90 per cent.
Twenty per cent has become the accepted truth in part because the figure is big - big enough for critics to use to condemn the data-matching program and big enough for Centrelink to use to fob off requests for the truth.
Even Malcolm Turnbull's disenchanted former digital transformation chief Paul Shelter embraced it.
"All I can say is, if they were a commercial company, you would go out of business with a 20 per cent failure rate, a known 20 per cent failure rate, you would go out of business," he told The Guardian this month.
Labor frontbencher Anthony Albanese backed him up, wrongly saying that "on the government's own figures, 20 per cent of people who've been sent debt letters, often accompanied by threats of debt collection agencies being involved, have been sent them on a false basis".
The 20 per cent isn't the proportion of debt letters sent out that are false. We won't know that for a long time, if ever. Some people have been paying up even when the debt letters are wrong, sometimes because they don't have the records to argue otherwise, sometimes because they trust the government, and sometimes because they can't be bothered dealing with Centrelink.
A Centrelink whistleblower alleges that, disgracefully, staff have been ordered not to use information in Centrelink's possession to correct false debt notices. Another says that of hundreds of debt notices reviewed, only a few dozen turned out to be correct.
Here is where the 20 per cent figure comes from. Between July and December, Centrelink's computer sent out 232,000 letters asking people to log on to a website to confirm or update their income history. Around 169,000 did so. (An email to Fairfax Media from the office of Human Services Minister Alan Tudge implies that none of the 63,000 who did not log on have been issued with debt notices. Their cases are "are still active and in progress or require further review".)
More here:
This is also a good recent summary:

Automated Centrelink a fast track to Turnbull's demise

Ross Gittins
Published: January 24, 2017 - 10:58PM
Of the loads of films I saw last year, the most memorable was Ken Loach's I, Daniel Blake. I go to the movies for escapist entertainment, not to give my emotions a good workout but, even so, it left a lasting impression.
It was the story of a 59-year-old carpenter in Newcastle, England, whose cardiologist told him not to go back to work for a few months after he'd had a heart attack on the job.
What we saw was Blake's mistreatment at the job centre he went to for social security payments at the height of the Cameron government's austerity spending cuts.
It was run like an assembly line, with "clients" processed as fast as possible, with a complete lack of flexibility or consideration.
Nothing Blake said was listened to, but at his first sign of frustration he was rebuked for his utterly unacceptable behaviour and threatened with removal by security guards. He was repeatedly threatened with the "sanction" of having his dole suspended for such crimes as being late for his appointment.
He got nowhere when he visited the centre, had to hang on for ages when he phoned, and was always being told to fill out forms online. Small problem: he didn't have a computer and didn't know how to use one.
Sorry, online forms are "mandatory".
Why would a government treat its citizens so badly? Well, reading between the lines you saw the centre had been handed over to a private business. It probably underquoted to get the contract and had turned the centre into a sausage machine in the hope of saving enough on staff to make a profit.
I thought of Daniel Blake when I read of the way the Turnbull government is using an "automated debt recovery program" to harass former users of Centrelink.
It's using a computer program to go back several years, checking Centrelink benefit payments against records from the Tax Office, to look for apparent overpayments and demand the money be repaid.
Trouble is, the exercise is hugely prone to error. Eligibility for social security benefits is assessed on a fortnightly basis, whereas tax information is annual. The machine merely divides the annual figures by 26 and often gets the wrong answer.
Lots more here:
The simple lesson we can all take from this is that the Government is not over endowed in skills in getting such IT programs to work as desired – and certainly does not seem to grasp the needs for rigorous system design and testing.
With the Department of Health busily trying to gather a large national data-base of patient information we have to assume they have in mind some use for the data. Clearly the clinical utility of the information would not make such an exercise worthwhile – so what are they up to?
Maybe they want to manage fraud, maybe regulate access to services or maybe something else?
Informed speculation more than welcome.
David.

Monday, January 30, 2017

Weekly Australian Health IT Links – 30th January, 2017.

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

With a week broken up by Australia Day we don’t seem to have had much going on other than yet another amazingly messy Government IT debacle with Ultranet!
At the same time we still have the Centrelink data mining and letter generation system under more than considerable fire.
Enjoy the browse.
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When it comes to privacy, patients trust e-health more than faxes

23 January 2017
ANALYSIS
Stories about digital health data being compromised, hacked or accidentally leaked seemed to be a theme last year. 
In October, more than 500,000 blood donors had sensitive data, including sexual health details, posted online after a mistake at Australian Red Cross. In the same month, the Federal Department of Health released one million lines of MBS claims data online, not realising it could potentially identify individual doctors.
Concerns have also grown in recent months that the government’s prized MyHealth Record system could suffer a breach. 
However, a new US study says despite the fact digital health data breaches are attracting more and more media attention, patients are not spooked by this.
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25 January, 2017

One step forward then two back for digital health?

Posted by Jeremy Knibbs
Spare a thought for Tim Kelsey and his new, and, so far, tightly knit, team at the Australian Digital Health Agency (ADHA).
Faced with an almost impossible task of re-igniting a spark under our digital health agenda, his group had, by year’s end, done an amazing job of re-enlisting large numbers of a mostly disenfranchised and cynical healthcare community into a rebooted crusade for digital change.
Since assuming the top job at the ADHA in mid-August, Kelsey travelled much of Australia, listening to patients, clinicians and regulators at the coalface, and quickly decided on a new team. This team included selected ex NEHTA staff who could provide valuable corporate memory and experience, and had done much of the key initial work required to deliver a cohesive, workable and believable new digital healthcare strategy.
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New ePIP deadline looms for practices

Antony Scholefield | 25 January, 2017 | 
GP practices have until 31 January to meet Federal Government targets for uploading shared health summaries to the MyHealth Record system.
Under the e-health Practice Incentives Program, clinics will have to ask their GPs to upload the summaries for at least 0.5% of the clinic’s patient list or face losing an average of $25,000.
The original deadline for the uploads was 31 July 2016, but it emerged in August that about 1500 practices had not met the target and would have to repay the ePIP cash.
In response, the original deadline was pushed back six months to January.
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Slick, misleading YouTube clips pose health threat

24 January, 2017 Rachel Worsley 
Parents should be advised to avoid YouTube for medical information because it is packed with slickly produced but ultimately misleading video clips, child health researchers warn.
UK paediatricians who reviewed 400 patient-uploaded clips of children with croup or dehydration found just 15 provided good clinical examples.
Worryingly, misleading clips were often more technically accomplished than reputable ones.
Even paediatricians find it laborious to track down good-quality child health videos on YouTube, the authors say, and it is likely even harder for parents to separate the helpful from the harmful.
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Senior citizen walkers drawn to fitness tracking devices

Seniors and baby boomers have joined the younger, healthy set in using fitness tracking devices, according to new research which shows that the older brigade in Australia are emerging as a major market for fitness tracking devices as they take up health technology and devices as rapidly as young people.
The survey of 1000 Australians by data insights and programmatic media company Pureprofile reveals that walkers over the age of 60 make up the largest number of users of fitness devices, such as smartphone apps and wrist bands.
According to Pureprofile, walking is by far the most popular activity, with an average of 53% of survey respondents claiming it is their main fitness activity, followed by gym/workouts (17%), running (9%) and swimming (5%).
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My Health Record

My Health Record is the name of the National digital health record system. Having a My Health Record means your important health information like allergies, medical conditions and treatments, medicine/prescription details, blood test results and scans as well as hospital discharges can be shared.
You control what goes into it, and who is allowed to access it. Your eHealth record allows you and your doctors, hospitals and other healthcare providers to view and share your health information from anywhere they need to, like in an accident or emergency.
After you create your Electronic Health Record ask your GP at Hornsby Fountain Medical Centre to upload your medical file. You can go through with the GP and see/choose what you would like shared or not.
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Advance notice: Plan to call for Expressions of Interest for secure messaging proof of concept projects

Created on Tuesday, 24 January 2017
The Australian Digital Health Agency (Agency) is providing advance notice to jurisdictions, industry and the healthcare sector that it plans to call for Expressions of Interest as part of its secure messaging program.
Proposals will be sought from industry secure messaging suppliers, clinical information system/applications suppliers and end users to collaborate on implementation projects to prove the concept and demonstrate a working model going forward for three key use cases to support the adoption of secure messaging capabilities across the health sector:
  1. General Practice referral to Specialist
  2. Allied Health message to General Practice or Specialist
  3. Hospital Discharge Summary to General Practice and/or other Provider
The EOI will seek consortiums of suppliers and users (possibly organised through a healthcare organisation or group such as a PHN or LHD)  to respond with written fixed-price proposals from supplier/s who can collaborate with other suppliers, and end user sites who demonstrate the ability to implement secure messaging capabilities.
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FHIR Product Roadmap January 2017

R3 plans
The FHIR project is presently finalising “STU3” (Standard for Trial Use, release 3). This 3rd major milestone is currently close to completion. We’ve been meeting in San Antonio this week to finalise ballot reconciliation, perform testing and quality activities, and we are now focusing on preparing the final publication package. Following our publication plan we expect to be publishing release 3 on or about Mar 20.
R4 plans
Once R3 is published, we will start working on release 4. The various committees that manage the different parts of Release 4 have been discussing their scope of work for R4, and planning their engagement and implementation activities to support that this week.
Some of the major things under consideration for Release 4:
  • Improvements across all domains
  • Cds-hooks integrated in FHIR Specification
  • Query language framework
  • Support for integrating research and clinical practice
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Initial foundations for clinical workflow

Posted on by wolandscat
Over the last 6 months or so I have been working on two projects, but one theme: implementing computable clinical workflow. For as long as I can remember, ‘workflow’ and ‘process’ are the main words that excite most clinical professionals in health informatics. They get mildly enthused about data, modelling tools, and applications, but what they really want is for the IT layer to help them work with other clinicians and the patient through time. From my point of view, they’ve always been right, but I’ve also thought we needed to get something working in the data layer to even have a chance at solving process.
Today I think we have enough going in terms of a semantic health data platform in openEHR, and some of the smarter EMR systems, such as at Intermountain, Kaiser etc to consider the next layer. Serendipitously, I’ve recently had the chance to concentrate on the process question.
Making workplace processes computable is a huge challenge, and it would be difficult to over-estimate the effort that has gone into it over some decades. There are dozens of process languages and workflow tools, and endless reams of research to cover. In some industries, notably manufacturing, there have been successes, but creating similar solutions for healthcare seems endlessly elusive. Intuitively, it’s not hard to understand why. Most workflow solutions are based on the idea of modelling deterministic processes that can then be performed by agents, i.e. humans, robots, or other devices. This can work well in e.g. car manufacturing, where there are very few unknowns (the amount of time for specialist human welders to finish a weld will vary somewhat for example).
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IBAC finds disastrous Ultranet project for schools was a 'corrupt' shambles

Henrietta Cook, Benjamin Preiss, Timna Jacks
Published: January 27, 2017 - 5:10PM
Education Department officials wasted up to $240 million of taxpayers' money during a corrupt tender process for a school IT project, Victoria's anti-corruption watchdog has concluded.
The officials could now faces criminal charges over the "appalling waste" following a lengthy investigation by the Independent Broad-Based Anti-Corruption Commission.
The Ultranet project promised to deliver an online platform that connected teachers, parents and students, but was plagued by technical issues and rarely used after its rollout by the former state Labor government in 2010.
In a long-awaited report tabled in state parliament on Friday, IBAC found that department officials purchased shares in CSG – the company awarded the Ultranet project – influenced the tender process and accepted inappropriate gifts from suppliers including flights and lavish dinners.
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Corruption claims over failed $240m Ultranet project

Inquiry finds evidence of process corruption, improper diversion of funds, conflict of interest and mismanagement
George Nott (Computerworld) 27 January, 2017 15:00
The launch was extravagant. Dancers and singers were hired to perform a specially choreographed musical number. A bespoke stage was constructed to look like a giant laptop. Kindles and iPads were given away as spot prizes.
A branded bus ferried then Victorian education minister Browyn Pike and special guests to the ‘Big Day Out’ event at Melbourne Convention and Exhibition Centre. Today, they would launch Ultranet, a virtual learning portal that promised to ‘revolutionise learning’ for every Victorian school pupil.
Poised at their computers in schools across the state, teachers readied themselves to log-on to the system as it went live. It crashed. The million-dollar event was a damp squib. And so was Ultranet.
Three years later, in 2013, plagued by limited functionality and declining student take-up from an already pitiful base of 10 per cent, the Ultranet project was abandoned. Although the exact cost is unknown, estimates go as high as $240 million.
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Director Enterprise Patient Administration System (EPAS) Clinical Delivery

  • Central Adelaide Local Health Network, Royal Adelaide Hospital
  • Temp F/T (up to 1/3/2019) – SAES Level 1
You will be accountable to the Chief Executive Officer, Central Adelaide Local Health Network (CALHN), through the Executive Director new Royal Adelaide Hospital (RAH) Activation, for managing the delivery of the Enterprise Patient Administration System (EPAS) across CALHN to achieve successful and sustainable implementation. Working with the CALHN Executive and EPAS Leadership, you will provide authoritative advice, leadership, oversight and management for the coordination of the operational outcomes for the EPAS Program implementation. This will include planning, leading, coordinating, controlling and managing timely, high quality and cost effective projects and providing expert advice and consultancy services. Overseeing operational changes required across all EPAS-live sites in CALHN, you will deliver recommendations regarding resource allocation and changes to key workflows and business processes. You will also act as the overall site lead during EPAS activation at the new RAH, providing direction, coordination leadership and single point of liaison with the EPAS Team during this period.
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Complex algorithms can use a little of that human touch

  • Anthony Wong
  • The Australian
  • 12:00AM January 24, 2017
Recent publicity over Centrelink’s automated debt recovery program has reignited the debate on how algorithms and data matching are used to inform decisions, in both the public and private sectors, and the need to ensure that human judgment continues to play a role.
The use of complex algorithms to automate processes might reduce costs, but ICT professionals need to ensure that appropriate checks are in place to achieve the desired result. No one would argue the government’s right and indeed responsibility to protect public moneys by ensuring that welfare recipients receive their exact entitlements and no more.
The government has clarified its approach, while making adjustments to soften the impact and ensure that recipients under the debt recovery program understand what steps are available to them and how to exercise their rights.
Labor is pushing ahead with calls for a Senate inquiry and demanding that Centrelink’s data matching system be suspended until a comprehensive review has taken place. The Commonwealth Ombudsman is conducting his own investigation after receiving a series of complaints.
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Centrelink staff speak out against DHS over data matching bungle

By Allie Coyne on Jan 25, 2017 11:11AM

Claim the department ignored warnings.

Unionised Centrelink staff have banded together to speak out against the Department of Human Services' botched data matching system, claiming the agency refused to listen to warnings that it was problematic.
The Community and Public Sector Union - representing "thousands" of unionised departmental staff - today published an open letter to Centrelink customers acknowledging the 'unfairness' of the automated debt notice system.
"We need to tell you that we see your pain and acknowledge your fear. We know you are angry and we are too. We know that the people of Australia deserve better," the open letter states.
"We know that the automated debt notices are unfair, unjust and callous. We acknowledge that in a great many cases, they are not your debts.
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Using genomics to predict heart risk

Authored by Charlotte Mitchell
THE clinical application of genomic risk scores for coronary heart disease (CHD) has been debated by experts, after new research finds that genetic variants can be more predictive of disease than traditional clinical risk scores.
Lead authors of the research from the University of Melbourne, Dr Gad Abraham and Associate Professor Mike Inouye, told MJA InSight that current clinical approaches for detecting increased heart disease risk were “severely” limited because they depended on elevated levels of known risk factors, while ignoring the substantial genetic component of the disease.
“Consequently, a large number of individuals who will experience myocardial infarction cannot be detected ahead of time.
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1stGroup rebrands health portal as MyHealth1st

Australian online heath portal group 1st Group has rebranded its health portal to MyHealth1st from 1stAvailable.
1st Group managing director Klaus Bartosch said the new brand made it clear that the company is a “consumer-centric health portal which brings a more accessible, less intimidating way for people to connect with their preferred healthcare providers”.
He said the new name conveyed that the portal and related apps delivered a “simple connection to better health and wellbeing”.
Bartosch said the portal had transitioned from being a free online appointment booking platform for healthcare appointments to a platform with significantly expanded scope and functionality. “The MyHealth1st portal today enables access to a much broader range of products that leverage the booking platform, supporting an expanded range of healthcare services.”
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Pioneering medical research institute seeking CIO

Garvan Institute of Medical Research looking for experienced IT chief
George Nott (Computerworld) 20 January, 2017 15:46
The Garvan Institute of Medical Research – home of Australia’s first clinical whole-genome sequencing service – is seeking a new CIO.
A major focus of the role will be “bringing business discipline to the way IT is used within the organisation”, a job listing noted.
The successful candidate would be “commercially astute” and have experience in driving transformation change.
The CIO will lead the institute's IT department and report to Chief Operating Officer Philip Knox, formerly CFO of broadcaster Austrar.
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Federal Court erred in Grubb metadata ruling

The Australian judicial system has usually proved itself to be one that applies the common sense principle when confronted by technological cases. But in the case of the recent ruling on what is, and what is not, personal information, the Federal Court has erred and badly too.
Over the years, the court system has handled the Kazaa case, the Sony case, the iiNet case, the Dallas Buyers Club copyright case and more recently the copyright case involving Foxtel and Village Roadshow.
In every case, the judges have shown that despite fears to the contrary, they have a more than adequate understanding of technological detail to make an informed judgment.
Over and above this, they have always shown that they are worldly-wise and aware of the extent to which some entities try to use scare tactics to frighten members of the public.
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Future shocks: beyond drones, driverless cars and 3-D printing

Sophisticated artificial intelligence could ultimately decide it can run things better than humans.
  • The Australian
  • 12:00AM January 28, 2017

Graham Lloyd

It is fitting the future has come first to fashion. Buying shoes will never be the same again. Customers can simply scan their feet with a smartphone and use the digital file to 3-D print a bespoke, perfect pair. It is a future that has already arrived.
Soon, customers will be able to instruct a personal robot to summon a battery-powered driverless transportation pod. This will be when the “internet of things” (when everything is connected) gets really interesting.
Driverless vehicles will all but eliminate car ownership — and accidents. Roads will be freed up, cutting insurance rates to shreds.
Alternatively, a drone can whiz the new shoes to the buyer’s hands using enhanced geo-satellite tracking that has mapped the physical world to the square millimetre.
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Enjoy!
David.

Brief Report On The ADHA Consultation Webinar Conducted 30 January, 2017

The discussion and questions ran for 1.5 hours.

The most interesting thing I gleaned was that the emphasis of the new - approximately 5 year - Strategy would be to get what Tim Kelsey referred to as the 'foundations' in place and that the foundations now included the myHR - along with SMB etc. (So this is really an admission that from 2008 (The old Strategy) to 2016 we were spinning our wheels and now is the time to move boldly forward.)

The process will be that now we have all been consulted  (ends tomorrow) there will be the creation of a Strategy, this will be approved by the COAG health ministers and then will be made public along with a four year work plan and, presumably, some funding.

Interestingly it seems the opt-out evaluations are virtually complete - and have apparently been successful - and that the new Strategy will be focused on the collection of evidence of benefit of all this new investment going forward. Apparently no evidence has been gathered of benefit to date - or at least it was not mentioned that I heard.

I guess we all just wait and see what happens next.

David.