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."

Saturday, February 04, 2017

Weekly Overseas Health IT Links – 4th February, 2017.

Note: Each link is followed by a title and 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.
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Four Questions For: Geoff Hinton

Jan 16, 2017 - 8:00 AM CST
You’ve been referred to as the “godfather of neural networks.” Do you believe you’ll see true artificial intelligence in your lifetime?
It depends on what you mean by true artificial intelligence.  If you mean autonomous agents with human level abilities at perception, natural language, reasoning and motor control, probably not.  However, it’s very hard to see more than about 5 years into the future so I would not rule it out. Ten years ago, most people in AI would have been very confident that there was no hope of doing machine translation using neural nets that have to get all their linguistic knowledge from the raw training data. But that is now the approach that works best and it has just halved the gap in quality between machine translations and human translations.
What is there to fear about the existence of true artificial intelligence?
I am not too worried about the popular fantasy that evil robots will take over the world. I am much more worried about what people like Hitler or Mussolini might do if they had armies of intelligent robots at their disposal. I think there is a pressing need for international agreements on militarization of this technology.
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With HHS Pilot, First Responders Can Access Your Health Data Immediately

By Mohana Ravindranath January 26, 2017
One day, first responders will be able to quickly pull up your medical records if they find you during a disaster like an earthquake or forest fire.
That's the vision the Health and Human Services Department is working toward with a pilot that would let emergency medical services pull up clinical documents at the point of care—potentially at makeshift aid stations—so they can "make more informed clinical decisions for patients," according to an HHS blog post.
It's not there yet, and HHS has been working on the project since 2014 when it got a $50,000 seed investment from its internal venture fund; that was compounded by a $2.75 million grant from the Office of the National Coordinator for Health Information Technology.
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'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.
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Shared records starting to make headway

Sharing records between care settings is starting to become much more commonplace, but is viewing patient and clinical data enough to deliver joined-up care?
Vivienne Raper revisits some of the pioneers of information and record sharing, and examines how they are beginning to use shared records to change how they interact with patients.
In 2013 NHS England set out its vision for trusts to achieve a “fully integrated digital care record [IDCR] across all care settings by 2018”.
The vision first set out in Safer Hospitals Safer Wards: Achieving an integrated digital care record, defined an IDCR as the ability of users in local health and care services to view patient and clinical data in a joined-up manner.
According to Markus Bolton, joint chief executive of shared records specialist Graphnet, real progress has been made in achieving the target. He estimates that around 35% of health communities in England now have what he describes as large-scale solutions.
“We already have 12 million patients on our systems on CareCentric [Graphnet’s shared records software]”, he says. “And we’re expecting to double that in nine months – it’s really picking up pace.”
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January 27, 2017

Patient-Reported Symptoms May Be Left Out of EMRs

By Amy Orciari Herman
Patient-reported symptoms may fail to make it into a practice's electronic medical record (EMR), according to a study in JAMA Ophthalmology.
Roughly 160 patients waiting to be seen at an ophthalmology clinic completed an eye symptom questionnaire. After their visits, eye symptoms reported on the questionnaire were compared with those recorded in the EMR.
Overall, there was a high rate of discordance between patient-reported and clinician-recorded symptoms. In particular, reports of glare were discordant nearly half the time; in 90% of these instances, glare was present in the patient questionnaire and absent from the EMR. Similarly, reports of pain/discomfort and redness were discordant a quarter of the time; in roughly 75% of these, symptoms were noted in the questionnaire and absent from the EMR.
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Open source enlightenment needed to end 'dark ages' of health IT

Image: Dark ages of health IT is a akin to medieval alchemy, says Tony Shannon
Tony Shannon
11 January 2017
Your article - "Whatever happened to Open Source in 2016?" highlights the brief vogue that open source recently enjoyed in the NHS – 2014-15 – and now seems to have lost. It raises some good questions and important issues, though I sense some broader perspective may be worth adding here.
It’s worth remembering that healthcare is a well-established science – the first medical school established in the 9th century.  While information technology is still a young science – the first MSc in software engineering dates from 1979.
We know that the relatively risk averse culture of healthcare differs very significantly from the frenetic pace of innovation we see in the software world.
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Gates Foundation gives $279 million to bolster University of Washington Population Health Initiative

The grant will be awarded over the next decade and will help expand the UW’s Institute for Health Metrics and Evaluation as a global population health hub.
January 25, 2017
The Bill and Melinda Gates Foundation awarded $279 million to the University of Washington’s Institute for Health Metrics and Evaluation to support expansion of IHME’s work over the next 10 years, the organizations announced today.
The funding will help IHME build its independent health evidence to foster population health, officials said. Thursday’s award complements past donations from the Gates Foundation, which supports the 25-year vision of the University of Washington’s Population Health Initiative launched in May 2016.
IHME provides measurement and analysis of the most prevalent and expensive global health issues and evaluates strategies to improve outcomes.
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Are EHRs a patient safety necessity or a barrier to care?

Jan 26, 2017 9:20am
Doctors are still divided about whether the physician community should embrace EHRs.
EHRs have emerged as a divisive issue within the physician community, with some urging widespread adoption to improve care, while others lament the administrative burden for doctors.
Both arguments were on display in a recent BMJ article that addressed whether doctors should “embrace” EHRs, underscoring the deep divide among clinicians regarding the benefits and shortcomings of computerized records.
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Johns Hopkins Hospital command center is first of its kind

Published January 24 2017, 6:53am EST
Command centers crammed with monitors displaying real-time data and staffed by personnel hunched over workstations serve as war rooms for the military and space operations facilities at NASA.
However, The Johns Hopkins Hospital in Baltimore has established a similar state-of-the-art command center that is a model for how healthcare organizations can increase their efficiency in managing patient care.
The 2,550-square-foot command center is touted as the first-of-its-kind in healthcare, combining the latest in systems engineering, predictive analytics and situational awareness to better manage patient care and safety, as well as the movement of patients in and out of the Johns Hopkins School of Medicine’s teaching hospital.
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DirectTrust messaging use soars in 2016

Published January 25 2017, 7:08am EST
Use of DirectTrust secure electronic messaging between providers, patients and other healthcare consumers via the Direct Project protocols for secure communications, grew significantly last year, underscoring increasing national interest and activity in exchanging health information during the care delivery process.
The service uses DirectTrust-accredited health information service providers (HISPs) that commit to complying with certain protocols for secure messaging.
More than 98 million Direct message transactions were conducted during 2016, according to the vendor; more than 33.5 million messages were sent in the last three months of 2016 alone. The service reports a total of 165 million transactions since it was launched in 2013.
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Yale researchers tapping into emerging secure cloud platform for sharing patient data

The technology, known as Hugo, empowers patients to compile data from multiple EHRs and synchronize them with a research database.
January 24, 2017 09:12 AM
Harlan Krumholz said the technology makes patients true partners in care and research.
Yale researchers are working with a platform, dubbed Hugo, to mobilize patients so they can help with medical research, by allowing them to share their personal health information with researchers, via a cloud-based platform. Hugo was announced last May and is still in the testing phase.
According to Yale researchers, the platform is “highly secure,” and allows patients to draw records from multiple electronic health records held by a patient’s various healthcare providers. Hugo then synchronizes them with a research database.
“This could be a game changer,” says Harlan Krumholz, a developer of Hugo, and professor of medicine and epidemiology and public health at Yale School of Medicine. Krumholz is also the director of the Center for Outcomes Research and Evaluation (CORE) at Yale-New Haven Hospital. “Hugo harnesses the very latest in digital health technology and puts patients in the center, making them true research partners.”
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Technology—not life expectancy—drives up healthcare costs

Jan 25, 2017 9:43am
Americans are living longer, but that's not the primary driver behind healthcare spending increases.
Even though Americans are living longer and often spending more on healthcare services later in life, pervasive use of new technology is to blame for burgeoning health costs, according to one economist.
A large portion of healthcare spending is tied to chronic conditions, particularly among elderly patients, and longer life spans translate to more services later in life. But technology is the true driver behind healthcare spending growth, health economist Austin Frakt writes in The New York Times.  
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How to ensure your clinical data isn't trapped during migration

Published January 25 2017, 3:20pm EST
One can only sympathize with healthcare CIOs who must struggle with interoperability issues, financial restraints and the threat to hospital networks and patient records posed by hackers.
Unfortunately, there is another challenge with which they will be forced to cope: e-Discovery requirements pertinent to audits, common law, statutes and regulations. As CIOs seek to retire and replace legacy clinical systems, these requirements become even more pronounced.
But in too many cases, they are not prepared. For example, they may not be able to identify and prioritize all the required data sets that need to exist and/or complement each other. They may not understand the common requirements set forth at the federal and state level.
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All-Time High of 1,093 Data Breaches Reported in U.S. in 2016

The number represents a 40 percent increase over the previous year, according to a recent report.
By Jeff Goldman  |  Posted January 24, 2017
According to a new report from the Identity Theft Resource Center (ITRC) and CyberScout, 2016 saw an all-time high of 1,093 reported data breaches, a 40 percent increase over the previous year's total of 780.
ITRC president and CEO Eva Velasquez said it's not clear whether the increase is due an actual surge in breaches or simply due to more states making the information available.
"For the 10 years, the ITRC has been aware of the under-reporting of data breach incidents on the national level and the need for more state or federal agencies to make breach notifications more publicly available," Velasquez said in a statement. "This year we have seen a number of states take this step by making data breach notifications public on their websites."
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New Scottish eHealth strategy focuses on data

Article posted on: January 25, 2017
 “We are trying to get really complex core IT systems in place, delivered by NHS Scotland and the Scottish Government, and going forward we are moving towards much more explicit transformations for the delivery of care,” Pieter van de Graaf, eHealth Clinical Strategy Team Leader at the Scottish Government, told BJ-HC
 [Edinburgh, Scotland] In spite of growing pressures, the Scottish Government is embracing the power of person-centred care while harnessing the use of technology in healthcare. 
The country’s Health and Social Care Delivery Plan, published in December, sets out the main framework for enhancing the quality of services while meeting ‘new patterns of care, demand, and opportunities from new treatments and technologies’.
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EMS use of telehealth helps close care gaps

Published January 23 2017, 3:08pm EST
For the past two years, paramedics in the Houston Fire Department have been using telehealth and electronic health record technology to remotely consult with physicians via iPads when responding to calls to patient homes.
Many times, paramedics respond but find they’re not facing an urgent emergency, but the patient may still be best served by being transported to the emergency department. Or perhaps the best route would be to pay the taxi bill to send the patient to a community health center where they can establish a medical home.
Remote consultation with a physician helps make the right decision, says James Langabeer, a professor of clinical informatics at the University of Texas who oversees the program along with Michael Gonzalez, MD, deputy medical director at the fire department and an assistant professor at Baylor College of Medicine.
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Future of healthcare grounded in data, but details fuzzy

Jan 24, 2017 11:49am
Data will drive healthcare transformation, but experts in both the tech and health industries are still exploring pathways.
The collection and integration of patient data will play a key role in transforming the healthcare industry throughout the United States and across the globe, but exactly how that will transpire is still very much up for debate.
Experts in the healthcare and technology fields discussed the future of patient care at the World Economic Forum in Davos, Switzerland, last week, and a reoccurring theme was how hospitals and emerging technology companies are going to use data to improve outcomes and transform the industry. During a panel discussion about the “hospital of the future,” executives with telemedicine and healthcare technology companies argued that the healthcare industry is moving out of the acute care hospital and into homes and clinics, and wide range of data sources are coming together to help inform treatment plans.
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More on Telehealth

20% of consumers would swap doctors for one that offered telehealth services, American Well says

Interest was especially high among parents of children under age 18, caregivers of elderly or ill relatives, results showed.

Beth Jones Sanborn, Managing Editor
Physicians beware: If you don't offer telehealth services you may start losing patients to those that do. American Well, a telehealth company that partners with dozens of health systems nationwide, said according to the results of their 2017 Consumer Study, 20 percent of respondents would switch their primary care physician to another one in their area if they offered telehealth visits. That amounts to 50 million Americans, American Well said.
Harris Poll conducted two studies online on behalf of American Well in late 2016 to gauge consumer experiences with and perceptions of telehealth. The first was conducted in August among 2,100 adults ages 18 and older. The second was in September and involved 2007 adults 18 and older.
Results showed that among those with a primary care physician, 65 percent are interested in seeing that doctor via video. Parents of children younger than 18 were even more likely to express interest, with results showing 74 percent of that group saying they'd like to see their doctor via video.
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Dr. Eric Topol to shiny new venture-backed Silicon Valley startup: Prove it

In the Merchant of Venice, Shakespeare crafted this phrase for the heroine Portia to help her make a wise choice in picking a husband. The proverb is particularly apt today as technology makes inroads in healthcare promising to make better all that ails this tired, old, fearful-of-change industry.
Take the newest tech kid to jump on the extreme healthcare makeover bandwagon: Forward, which has Dr. Eric Topol, cardiologist author of The Creative Destruction of Medicine scratching his head.
The  San Francisco startup, which launched Jan. 17 to reimagine primary care, has a veritable who’s who of investors: Khosla Ventures, Founders Fund, John Doerr, and First Round Capital as well as angel investors including Eric Schmidt, Marc Benioff, Garrett Camp, SV Angel, Aaron Levie, Joe Lonsdale.
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EHRs offer possible solution for trimming unnecessary healthcare

Published January 23 2017, 7:28am EST
As the nation’s healthcare system continues to grapple with the problems of overuse and low-value care that provides little or no benefit to patients, electronic health record systems can serve as powerful technology platforms for data collection and intervention to address overutilization.
So argues David Bates, MD, chief of the Division of General Internal Medicine and Primary Care at Boston’s Brigham and Women’s Hospital and co-author of a new viewpoint article in the Journal of the American Medical Association.
In the article, “We focus on the problem of overuse and what can be done about it,” says Bates. “One of the biggest changes in healthcare in recent years is that we are now using electronic health records, which could really be very helpful in decreasing the overuse problem.”
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Mostashari: Value-based care demands free-flowing data

Former National Coordinator for Health IT: "Even though EHRs have proliferated, we have yet to achieve the interoperability, usability and full utility of them."
January 20, 2017 01:11 PM
To say that a lot has changed in healthcare since last year’s HIMSS conference is an understatement. Right now, a new Congress and a new Administration are wrestling with how to repeal and replace the Affordable Care Act, the signature health reform law of the Obama Administration.
Despite all that's changed, one thing has not: the move from fee-for-service to value-based care. Not only is this a transformation that pre-dates the Obama years and the ACA, but thanks to the overwhelmingly bipartisan Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, the shift to value is enshrined in our law, and will survive any changes to the ACA.
To make value-based care work, however, we need data – lots of it, and free flowing. When doctors are on the hook for the full cost of care, they need to know: what interventions work and which do not; who has been to the ER and needs follow-up care to prevent a costly readmission; who has not been in the office in a while and may be at risk for a complication; and the list goes on and on.
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Smaller, physician-owned practices struggle to adopt IT

Jan 22, 2017 8:42pm
Smaller, physician-owned practices face challenges in adopting health IT.
With fewer resources at their disposal, smaller, physician-owned practices are slower to adopt health information technology than other organizations with more money, staff and technical know-how.
Although the use of IT in small primary care practices has grown, factors such as practice size, ownership and the availability of financial incentives influence the extent to which practices adopt new technology, according to a study published in the Annals of Family Medicine.  
Researchers conducted 40-minute telephone surveys at 566 small primary care practices with eight or fewer physicians; the first interviews were conducted from 2007 to 2010 and the second round from 2012 to 2013. They asked about 18 measures of IT functions, including record keeping, clinical decision support, patient communication and health information exchange with hospitals and pharmacies. Overall, practices significantly increased the use of 16 functions and decreased use of only two: electronic access to laboratory results and to clinical information on patient visits to the emergency department.
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Harvard study of almost 800k lives shows MedAware technology reduces medication error

January 19, 2017
Researchers at Harvard Medical School have demonstrated a new technology can help reduce a widespread problem that harms some 1.5 million people every year – medication error.
In a study published in the Journal of American Medical Informatics Association, researchers looked at five years of EHR-provided clinical data for 747,985 lives at the Brigham and Women’s Hospital and the Center for Patient Safety and Practice, plus retrospective data from Partners HealthCare BWH and Massachusetts General Hospital. Using the algorithmic software from Israel-based startup MedAware, researchers screened the data to detect outliers suggestive of potential medication errors and compared with an existing clinical decision support screening system.
Existing CDS screening systems can only detect a small number of actual errors, the researchers stated, because they are not patient-specific or sufficiently adaptable. Plus they often result in high false alarm rates. Since doctors get so many fake alerts, they begin disregarding them altogether, and the result is more than $20 billion in healthcare losses every year in the United States.
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Telemedicine Market Will Continue to Grow by 2020

Telemedicine is defined as use of telecommunication and information technology to deliver clinical solutions to the patients. It includes use of various applications and services such as smart phones, emails, two-way videos and wireless tools to deliver efficient results. Use of telemedicine helps in improving individual health with the help of electronic media. It also increases accessibility by reducing distance barriers between medical service providers and patients. Various services, such as primary care and specialist referral service, patients monitoring, medical education and healthcare information, are provided with the help of telemedicine.
E-health is a process of delivering healthcare and health resources by electronic means. It helps healthcare providers and patients to interact with each other with the help of electronic media. It is one of the fastest growing sectors in overall healthcare market. Currently, telemedicine market represents a small percentage of e-health market.
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Enjoy!
David.

Friday, February 03, 2017

The UK Is Making Some Progress In The Use Of Shared Care Records To Co-ordinate Care.

This appeared a little while ago.
Special Report: Shared Records

Shared records starting to make headway

Sharing records between care settings is starting to become much more commonplace, but is viewing patient and clinical data enough to deliver joined-up care?
Vivienne Raper revisits some of the pioneers of information and record sharing, and examines how they are beginning to use shared records to change how they interact with patients.
In 2013 NHS England set out its vision for trusts to achieve a “fully integrated digital care record [IDCR] across all care settings by 2018”.
The vision first set out in Safer Hospitals Safer Wards: Achieving an integrated digital care record, defined an IDCR as the ability of users in local health and care services to view patient and clinical data in a joined-up manner.
According to Markus Bolton, joint chief executive of shared records specialist Graphnet, real progress has been made in achieving the target. He estimates that around 35% of health communities in England now have what he describes as large-scale solutions.
“We already have 12 million patients on our systems on CareCentric [Graphnet’s shared records software]”, he says. “And we’re expecting to double that in nine months – it’s really picking up pace.”
Bristol builds momentum on Connecting Care
Bristol was among three IDCR exemplars named by NHS England in 2014, building on locally-led developments. Today about 2,500 users share records across GP surgeries, three acute trusts, community providers, mental health and adult social care via a portal supplied by Orion Health.
“We’re still in growth mode,” says Andy Kinnear, Connecting Care programme director. “The plan is to get up to about 10,000 users, and it may go beyond that in due course.”
Most of Bristol’s efforts over the last year has been growing the functionality of the shared record by, for example, allowing document sharing and so-called context launching from within native applications. So, for example, a GP can launch the shared record from inside EMIS rather than logging into a separate system.
Connecting Care is due to add children’s social care this month, and has begun conversations with third sector charities and the police.
Kinnear believes having IDCRs across NHS England by 2018 is entirely plausible. “But I think it depends on how you go about it,” he says.
“I think the areas where it will be more challenging are where the people haven’t yet started, but they can be successful if they join neighbouring programmes and adopt solutions that have worked elsewhere.”
Bradford now able to share records at scale
Bradford, another IDCR exemplar from 2014, now has the potential to share most data of 600,000 citizens. The area’s GP practices, acute trust, adult social care and community services all use TPP Systole and can share information across different modules of the same TPP SytmOne system.
“We have the potential to share everything with those agencies,” says Andy McElligott, medical director and Caldicott guardian at Bradford District Care NHS Foundation Trust. “That functionality simply didn’t exist two to three years ago.”
However, Bradford relies on explicit patient consent to share information on a case-by-case basis. “We’ve still got some work to do in getting the information governance exactly right so we’re confident in a wider sharing model,” McElligott says.
Overcoming information governance challenges
In general, the barriers to IDCR are about people and not technology. There are multiple different stakeholders and organisations who must work together, and agree information governance. In Bradford alone, there are close to 100 GP practices, all controlling data.
“Many people in health and social care think and operate at an organisational level,” says Kinnear. “To make programmes like this successful, you need people to think and act system-wide.”
Lots more here:
What I found interesting was the approach being adopted of hastening very slowly and of ensuring explicit individual consent for all the information that is to be shared.
It seems to me this approach, where wrinkles are identified and incrementally addressed, rather than mass, unconsented enrolment has to be much more sensible, and interestingly seems to be working at this point.
David.

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.