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, March 30, 2017

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

March 30, 2017 Edition.
The big news in the US this week was the defeat of the Republicans on their US Health Care Plans which were defeated because of internal in-fighting. It was the first major political defeat for the new administration.
In Australia the major news has been some success on some of their budget measures – and no seem to be heading to  a budget session after only 4-5 more weeks. It will be very interesting to see how the present financial instability is addressed.
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Here are a few other things I have noticed.
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National Budget Issues.

Land tax: Parliamentary Budget Office costs plan to kill off stamp duty

Eryk Bagshaw
Published: March 19, 2017 - 3:14PM
The Parliamentary Budget Office has costed a proposal that would kill stamp duty and replace it with land tax, saving home buyers up to $40,000 in Sydney and $55,000 in Melbourne, while delivering billions of dollars to fund schools and hospitals.
The costing will put land tax back up for debate when Parliament returns next week as the government looks to mark its authority on the housing affordability crisis less than two months out from the federal budget.
Both the NSW and Victorian governments have thrown their weight behind broader stamp duty tax reform and Treasurer Scott Morrison has indicated his support for a transition to taxing land.
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After the boom, pay packets are ona flatline for all

  • The Australian
  • 12:00AM March 18, 2017

Adam Creighton

One Nation may have flopped in Western Australia’s election but our wage growth, the third weakest in the developed world, is fuelling simmering political discon­tent about everything from house prices to inequality and energy prices. This will have profound political consequences.
The living conditions of Australians are rising at the slowest pace in more than a generation. Wage growth fell off a cliff in 2012 as the resources boom petered out, and it hasn’t recovered. The torrent of foreign cash washing over the economy has receded, leaving a high-wage, heavily regulated economy struggling to compete.
Whether voters maintain the rage will depend on whether the slump is a hiatus between bursts of innovation or a reversion to the mean. It wasn’t until Australia was being settled in the late 18th century that wages, adjusted for cost of living, showed any sign of improvement anywhere.
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Underemployment skyrockets to 1.1 million Australians

Anna Patty Workplace Editor
Published: March 20, 2017 - 12:00AM
Kate Zizys, 46, has been underemployed her entire working life.
Earning less than $20,000 a year from casual work, she is one of 1.1 million Australians who want more hours of work than they are getting.
New figures from the Australian Bureau of Statistics show the official unemployment rate has increased from 5.7 to 5.9 per cent.
"I'm tertiary educated and have been in a casualised system my entire working life," Ms Zizys said.
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Someone has to give if we're to fix the budget

Ross Gittins
Published: March 19, 2017 - 10:18PM
The nation's budget problem still won't be solved when, one day in the distant future, we get the federal budget back into surplus. Only a change in strategy is likely to produce a sustained solution.
As successive intergenerational reports demonstrate, on present policies government spending will just grow and grow, requiring ever-higher taxes.
If we don't like that idea – or politicians regard it as an impossible sell – we need to think a lot harder about what we're spending on, why it's growing so fast, what things we should stop spending on, and how we can make our spending more effective, in the process slowing the rate at which it's growing.
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Treasurer to launch fresh attack on multinational tax avoidance as Parliament resumes

Eryk Bagshaw
Published: March 20, 2017 - 12:15AM
Treasurer Scott Morrison will launch a fresh attack on tax avoidance this week in Parliament in a bid to get the so-called "Google Tax" pushed through and shift public attention towards the Coalition's record on multinational tax crackdowns. 
The Diverted Profits Tax is due to be debated this week, almost a year after it was first introduced in the 2016 budget and less than two months before Mr Morrison hands down his second in May. 
Mr Morrison told Fairfax Media the Diverted Profits Tax would close major loopholes in the system.
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Energy crisis: The 9 questions you were too embarrassed to ask

Jessica Irvine
Published: March 20, 2017 - 12:00AM
When crisis strikes, the natural human response is to shut one's eyes, cover one's ears and wait for it to pass.
But sorry folks, this one's not going away. The energy crisis – with all its mind-boggling complexity, jargon and science-y stuff – is something you'll need to understand. Let's get straight into it.
1. Is there really an energy "crisis"?
Yes, in the dictionary sense of reaching a "decisive moment" or "a time of danger or great difficulty". No, in the sense of widespread disease and destruction. Not yet.
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Paul Keating: Only a reckless government would raid super for housing

Paul Keating
Published: March 20, 2017 - 8:48AM
Countries get one chance in history of putting into place a savings retirement scheme on the scale of the Australian superannuation system.
The right conditions had to be there: a government which saw the need, a policy-induced surge of productivity to pay for it and an organised workforce prepared to defer some current consumption to provide better living in retirement.
The system is the envy of the developed economies.
Only the most reckless and wilful government would abort the policy settings to put the system at risk.
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Scott Morrison's Monty Python moment

Michael Pascoe
Published: March 20, 2017 - 10:59AM
It's a dangerous thing to talk a big game before taking the field. Treasurer Scott Morrison did that pre-departure for the weekend G20 finance ministers meeting in Germany. He's been left trying to claim a big loss was actually a win. Monty Python's dismembered Black Knight comes to mind.
Last week Morrison told Fairfax Media he would take no part in any weakening of the G20's pro-trade stance – but that's just what happened. The G20 was right royally Trumped, its public free-trade commitment blown out of the water.
The mealy-mouthed platitudes of the final communique mean nothing. That's why the US was prepared to go along with it. Instead of the previous pledge to resist protectionism, members only say they'll be "working to strengthen the contribution of trade to our economies" – which could mean anything at all – and that they would "strive to reduce excessive global imbalances, promote greater inclusiveness and fairness and reduce inequality in our pursuit of economic growth".
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  • Mar 20 2017 at 10:23 AM

Scott Morrison greenlights fresh crackdown on property investor loans

Treasurer Scott Morrison has signalled that renewed surge in investor property buying - particularly with interest only loans - is likely to trigger a fresh regulatory crackdown on banks as part of the government's efforts to boost affordability for actual home buyers.
With the May budget due to unveil a series of measures that would "reduce the burden" on those looking to buy or rent a house, Mr Morrison indicated that so-called macroprudential restraints on lenders introduced in 2015 were no longer working as effectively as they were in 2016.
"There remain pressures that have built up again over the last few months," Mr Morrison said in Canberra on Monday.
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Housing market is in an environment of 'heightened risk', but it's not 'the B-word'

Sarah Danckert
Published: March 20, 2017 - 4:07PM
Australia's banking regulator says the country's housing market is in an environment of "heightened risk", but he won't say there's a housing bubble.
Australian Prudential Regulatory Authority chairman Wayne Byres told a Sydney conference that he wouldn't use "the B-word" to describe the housing market.
"I don't use the B-word. I refuse to use the B-word. It implies a binary, that's too simplistic," Mr Byres said speaking at the Australian Securities and Investments Commission annual forum.
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  • Updated Mar 20 2017 at 6:34 PM

Bank regulators backed by Morrison to unleash new crackdown on lenders

Regulators are preparing to impose a fresh wave of constraints on the banks to slow investor lending growth, crack down on interest-only loans, and force buyers to stump up more equity on purchases as they scramble to manage a rampant property boom.
Warning that financial and economic risks have grown in recent months, particularly across east coast property markets, the nation's top financial regulators and Treasurer Scott Morrison unleashed co-ordinated calls for fresh restraint from banks.
"Watch this space," declared Australian Prudential Regulation Authority chairman Wayne Byres on Monday, speaking just hours after Mr Morrison urged APRA and the Australian Securities and Investments commission to use "the levers that they have".
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Treasurer Scott Morrison says there’s no proposal to allow super raid to buy homes

Treasurer Scott Morrison insists the federal government has no proposal to allow first-home buyers to tap their superannuation for a deposit.
Former Labor prime minister Paul Keating has slammed the idea of allowing young people to raid their superannuation, warning it would “pull the backside” out of the system.
Liberal MP John Alexander, who chaired a parliamentary committee into housing affordability, let slip the government was considering the proposal before the May budget.
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We will lose jobs in the future, but it's not all doom and gloom

Ross Gittins
Published: March 21, 2017 - 10:38PM
I can't remember when there's been so much speculation about what the future holds for working life. Or when those who imagine they know what the future holds have worked so hard to scare the dickens out of our kids.
Getting on for 100 years ago – 1930, to be precise – the father of macro-economics, John Maynard Keynes, wrote an essay, Economic Possibilities for our Grandchildren, in which he calculated that if technological progress produced real economic growth per person averaging 2 per cent a year for 100 years, by then people would enjoy a comfortable standard of living while needing to work only 15 hours a week.
He was writing during the Great Depression, so I doubt if many people believed him. He was right, however, to predict the Depression would end and growth would resume, powered by continuing advances in technology.
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Australians not so happy about economy

- on March 21, 2017, 5:56 pm
Australia is one of the happiest nations in the world, but ask people what they think about the economy and their smiles will quickly turn to a grimace.
A United Nations report has found Australia to be the joint-ninth happiest country on Earth with New Zealand.
However, new figures show confidence in the Australian economy has dropped to its lowest level in almost a year, weighed down by rising unemployment and the continued weak pace of wages growth.
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  • Updated Mar 22 2017 at 7:53 PM

Childcare deal leaves $4b in budget cuts in limbo

The federal government has secured Senate support for its childcare reforms in a deal that has left the fate of a net $4 billion in budget savings in limbo, and at risk of being dumped altogether.
The long-stalled childcare package rolls the existing childcare rebate and childcare supplement into a single means-tested payment that will significantly benefit families on lower incomes by skewing the benefits towards them.
Families on combined incomes over $350,000 may miss out altogether due to demands made by crossbencher senators David Leyonhjelm and Derryn Hinch that in return for their support, these people receive nothing.
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Politics ensures Reserve Bank's housing pushback already failing

Michael Pascoe
Published: March 23, 2017 - 12:15AM
The bad news about the regulators' new attempts to hose down housing investment enthusiasm is that they are, at best, second rate. The Law of Unintended Consequences is always at work, ensuring damage elsewhere in the economy, while the most effective tools for the present circumstances remain locked in Treasury's cupboard.
The first punch of this new round of whack-an-investor is NAB and Westpac increasing investors' rates by more than owner-occupiers'. The impact? NAB's 25 point rise will cost investors a little more to service existing loans, so they'll be spending a little less elsewhere in the economy. And it shaves investors' borrowing power for new purchases, so they are more likely to go after cheaper properties – which is where first home buyers tend to concentrate.
Does it do anything to increase housing supply? No. Does it reduce demand? A little bit but it's marginal and not where you'd like it to. And, like the 2015 macro-prudential squeeze, the impact tends to wear off. Thanks to negative gearing the taxpayer will pick up half the tab for investors in the top tax bracket anyway.
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How Turnbull can kill stamp duty and produce a budget to remember

Peter Martin
Published: March 22, 2017 - 11:45PM
The myth about budgets is that they can achieve much at all.
In decades to come few will be remembered for anything other than the introduction of Medicare, the national disability insurance scheme and the goods and services tax.
But in six weeks' time the government will have an opportunity to actually do something that will last; something far more important, and more transformative, than the apparently doomed plan to cut the rate of company tax.
It's an idea from the Greens, but that's a plus. It gives it a good chance of getting through the Senate.
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  • Mar 23 2017 at 10:03 AM

Reserve Bank trapped by housing, says PIMCO

PIMCO's Australian head Rob Mead says indebted Australian households have caught the Reserve Bank in a trap. 
While the US Federal Reserve may have put its foot firmly on the brake if it needs to slow its economy a slight tap by the RBA may prove too jarring. 
The reason the central bank is trapped, he says, is because Australians have taken on more debt at low interest rates, making households "highly sensitive to even small upward changes in the cash rate."
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WA GST return hits 34 cents, blows hole in budget, leaves Treasurer Ben Wyatt 'horrified and furious'

March 24, 2017
The new West Australian Government has been handed a major budget blow, with the state set to be hundreds of millions of dollars worse off due to a lower than expected GST allocation.
Treasurer Ben Wyatt admitted it would be virtually impossible to meet Labor's pre-election commitment of bringing the state budget back to surplus by 2019-20, following the revised figures from the Commonwealth Grants Commission.
WA had been expecting to get 38 cents out of every GST dollar raised in the state in 2017-18, but that has now been revised down to 34 cents.
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Treasurer Scott Morrison pushes crackdown on investor loans

Eryk Bagshaw and James Massola
25 Mar 2017, 6:14 a.m.
Treasurer Scott Morrison has urged financial regulators to crack down harder on loans to real estate investors amid revelations that foreign buyers are spending $8 billion per year on new homes in NSW and Victoria, locking out owner-occupiers.
The call came as the Treasurer and his state counterparts met on Friday to find solutions to problems of housing affordability exacerbated by a return to the market of investors after earlier attempts to contain them had "worn off".
"I have been concerned, over the last couple of months, that the measures that were put in place a few years [ago] have worn off and it is now for the council of financial regulators to determine what the next step is," Mr Morrison said on Friday.
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  • Updated Mar 24 2017 at 11:00 PM

Malcolm Turnbull vows no surrender on company tax plan

The federal government will not give up trying to implement its full package of company tax cuts after the Senate votes next week to allow only the first phase of the 10-year plan – a tax cut for small business.
Ending a week of uncertainty during which the government has declined repeatedly to say what it would do after next week's Senate vote, Mr Turnbull said companies would start leaving Australia if the nation allowed its company tax rate to become increasingly uncompetitive against global rivals.
It is understood Mr Turnbull has reaffirmed to colleagues that the government has no intention of walking away from the tax plan which was the centrepiece of its economic strategy going into the last election. 
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Don't buy into the 'money illusion': Here's what's happening to real wages

Ross Gittins
Published: March 25, 2017 - 12:15AM
Economists may not be much chop at forecasting how fast the economy will grow in the next year or two, but that doesn't mean they haven't learnt a few things about how economies work that the rest of us could benefit from knowing.
It helps us get a better handle on the future if we remember the macro-economists' rule that economies move in cycles, not straight lines.
So something that's been going down will, one of these days, start going back up, and vice versa.
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Turnbull government shifts focus to school funding after childcare reforms pass Parliament

Matthew Knott
Published: March 24, 2017 - 3:04PM
The Turnbull government is aiming to use the successful passage of its childcare reforms, which redistribute subsidies from wealthy to low-income families, as a springboard to overhaul the way schools are funded. 
The government is examining trimming funding to "over-funded" private schools and redistributing money to needy public and non-government schools as part of the new funding model.
Education Minister Simon Birmingham will shift his attention to schools after the Senate passed the government's $1.6 billion childcare package on Thursday night. 
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Health Budget Issues.

Medicare rebate freeze may go in May budget

  • The Australian
  • 2:40PM March 19, 2017

Rachel Baxendale

Health Minister Greg Hunt has given strong indications the Turnbull government will unfreeze the Medicare rebate as part of the May budget.
In the wake of Labor’s damaging “Mediscare” campaign in the lead-up to last year’s federal election, Mr Hunt reiterated the government’s “rock solid” commitment to strengthening the scheme.
Mr Hunt said there were four pillars to the government’s national health plan, namely Medicare, hospitals, mental health, and medical research.
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Home doctor services save taxpayers millions. It's foolhardy to scrap them

Chris Hazzard
Published: March 22, 2017 - 5:27PM
I'm a home doctor. This year it will have been 50 years since I graduated so I actually predate Medicare and its predecessor Medibank. I remember the days when if a patient did not have the money to pay for a consultation, they had to either rely on the charity of their general practitioner or the honorary system in the public hospitals.
We don't want to get back to that. Our health care system is something we take pride in and cuts to the existing service will have a great social impact on millions of families. 
When thinking about the important decisions the federal government has made over the years, the decision to introduce Medibank (now Medicare) is considered by 63 per cent of Australians as a positive decision, with 79 per cent seeing home visits as an important part of the Medicare system. With budget talks now well under way, we find ourselves at the cusp of policy changes that could have serious repercussions on how home visits are accessed, impacting up to two million Australian families.
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Mental health taskforce announced in major review of services

  • The Australian
  • 10:43AM March 23, 2017

Rosie Lewis

The government will announce a new mental health taskforce to undertake a major review of its primary health networks across the country, in a bid to better target services for all Australians.
Health Minister Greg Hunt will today establish the mental health advisory group, to be co-chaired by Mental Health Australia CEO Frank Quinlan and National Mental Health Commission CEO Peggy Brown, as 50 organisations from the sector descend on Parliament House to advocate for policy changes.
Called the Primary Health Network Advisory Panel on Mental Health, it will for the first time look at how the government’s 31 PHNs are commissioning and planning mental health services, more than two years after they were rolled out and replaced Labor’s Medicare Local system.
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Federal Government announce 1100 medicines to have prices cut including Rosuvastatin

Lanai Scarr, Senior Writer, News Corp Australia Network
March 25, 2017 12:00am
Subscriber only
EXCLUSIVE
SICK Australians will save $500 million over four years and up to $200 a year each on the cost of medicines in an announcement by Health Minister Greg Hunt today.
Drugs to treat diseases and illnesses like breast cancer, mental health, eczema, psoriasis and Parkinson’s disease will have prices slashed in a bid to ease cost of living pressures for millions of Australians.
More than 1100 medicines will have their prices cut from April 1.
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Health Insurance Issues.

Two million to quit or downgrade private health insurance cover research suggests

Sue Dunlevy, National Health Reporter, News Corp Australia Network
March 21, 2017 12:00am
EXCLUSIVE
TWO million Australians plan to dump or downgrade their health cover ahead of premium rises three times the inflation rate that take effect next month.
It will accelerate the dangerous health fund membership spiral which started last year that threatens the long term viability of the health insurance industry.
And it puts the government under even more pressure to reform the industry in the budget to put a brake on a decade of premium rises many times the inflation rate.
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New report reveals which health funds have won and lost customers

Esther Han
Published: March 24, 2017 - 6:30PM
Medibank has topped the list of health funds that have shed the greatest number of members, according to a new report.
The Private Health Insurance Ombudsman's latest State of the Health Funds Report shows that Medibank lost 45,676 customers between June 2015 and June 2016, followed by Westfund, which lost 865, and HCF, which said goodbye to 502.
The biggest winners from the exodus were HBF, which welcomed 49,949 new policyholders, Bupa, which won over 38,235, and NIB, which added 19,501.
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Superannuation Issues.

Your guide to super changes as July 1 looms

  • Will Hamilton
  • The Australian
  • 12:00AM March 21, 2017
With June 30 fast approaching there is now limited preparation time for the new superannuation regime which comes into effect on July 1 this year.
This timeframe now makes looking at the impact of the changes on your current superannuation entitlements urgent. Though there has been wide coverage and much discussion of the changes I am still amazed at how little they are yet understood. It makes a lot of sense to try and offer a ‘‘wrap’’ on the subject, so here goes:
The most significant change is the introduction of a lifetime balance capped at $1.6 million. You cannot ‘‘top up’’ this amount once you cross $1.6m.
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  • Updated Mar 23 2017 at 6:37 AM

Older mortgagees and the super squeeze

A new front is opening up in the housing affordability crisis, with unprecedented numbers of Australians set to drain their superannuation not for living expenses in retirement, but to pay off a mortgage.
Leading economist Saul Eslake will on Thursday warn that collapsing home ownership rates are causing major problems at both ends of the adult life cycle.
The former ANZ chief economist will present research at an event called the Conference of Major Super Funds highlighting the extra age pension costs likely to be associated with a wave of Australians currently aged in their 50s and 60s who will hit retirement and still have housing debt.
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Super staring at a ticking housing time bomb — the mortgaged retiree

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

James Kirby

Most of the angst in relation to housing costs relates to first-home buyers — few, it seems, have looked at the other end of the spectrum … how will it hit retirees?
It’s time to pay attention to this issue because it’s going to have major consequences for investors depending on residential property and pension access … in other words, just about everyone.
Two very important pieces of research released in the past few days pinpoint the issue: economist Saul Eslake has shown that the number of homeowners heading into retirement that still have a mortgage has tripled since 1996 to 45 per cent. Meanwhile, Recep Peker, head of research at Investment Trends, reports the portion of Australians who believe their savings will not carry them through retirement is now the ­majority.
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I look forward to comments on all this!
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David.

It Is Good To See The Value Of Telemedicine Being Confirmed Over The Long Term.

This appeared last week.

UC Davis tracks 18 years of telemedicine and finds benefits beyond the bottom line

Rather than only looking at how the technology reduces costs and improves outcomes, researches focused on related time, transportation and environmental factors. 
March 23, 2017 10:58 AM

Telehealth use is growing but the question of whether the technology reduces costs and improves outcomes remains a point of contention.
Whereas the bulk of such analysis focuses on the bottom line of health plans and employers, researchers at University of California Davis instead are looking on how it impacts patients at a more basic level: transportation costs.
Spanning nearly two decades – and undoubtedly many fluctuations in gas prices and internet connectivity capabilities – the study, which was published in the online journal Value in Health, examines 18 years of UC Davis’s own clinical records from 1996 to 2013, evaluating inpatient and outpatient interactive video visits for 19,246 patients.
Typically, the patient would still visit their primary care doctor, but they would then together consult a UC Davis specialist via video. The cost savings were measured based on patient travel to a telemedicine center near their home versus traveling to UC Davis Health in Sacramento for specialty care.
Collectively, telemedicine visits saved patients nearly nine years of travel time, five million miles and $3 million in costs. Of course, on a more granular, individual level, those numbers are a little more modest: over 20 years, one person could see a cost savings of four hours of driving time, 278 miles and $156 in direct travel costs.
The study was regional, but California is a big state, and many rural areas are underserved not just by medicine but also adequate and reliable public transportation. As such, principal investigator James Marcin pointed out, the very real costs of gas, mileage and time are all measurable savings from telemedicine to patients.
“Our findings confirm the benefits of telemedicine in terms of real savings to patients and to the environment,” Marcin, who is also chief of the UC Davis Division of Pediatric Critical Care Medicine, said in a statement. “Because telemedicine is cheaper and more convenient for patients in remote areas, they are more likely to seek medical care. Many patients do not have the time or resources to access healthcare many miles from home.”
UC Davis has been using telemedicine since 1992, and now offers services spanning more than 30 clinical specialties in over 150 locations, representing 56 out of California’s 58 counties. The technology has advanced over the years, and Marcin expects to see more cost savings to the patient as more affordable, sophisticated tools are developed to allow for telemedicine visits to take place entirely within a location of the patient’s choosing. But there is a benefit to having consultations with the primary care physician present as well, the study noted, as they can receive valuable education from the remote specialist to improve their regular care with the patient.
More here:
There is another report from the same author here with a link to the article:

Telemedicine saves time, travel costs, even air quality, new study finds

March 22, 2017
While telehealth policies, technological advancements and utilization continue to grow, whether it actually reduces healthcare costs and improves outcomes is still a point of some contention. As the bulk of such analysis focuses on the bottom line of health plans and employers, researchers at University of California Davis instead are looking on how it impacts patients at a more basic level: driving costs.
Spanning across two decades – and undoubtedly many fluctuations in gas prices and internet connectivity capabilities – the study, which was published in the online journal Value in Health, examines 18 years of UC Davis’s own clinical records from 1996 to 2013, evaluating inpatient and outpatient interactive video visits for 19,246 patients. Typically, the patient would still visit their primary care doctor, but they would then together consult a UC Davis specialist via video consultation. The cost savings were measured based on patient travel to a telemedicine center near there home versus traveling to UC Davis Health in Sacramento for specialty care.
Lots more here:
All in all remote access to a tertiary centre provided locally seems to make life easier and maybe save some money. Who has seen Australian success stories? Would be great to hear about.
David.

Wednesday, March 29, 2017

An Interesting Article In The Conversation Asking Why The MyHR is Not Being Used More?

This appeared on the Conversation a few days ago.

Why aren’t more people using the My Health Record?

March 24, 2017 2.49pm AEDT
My Health Records were a big government investment, but they’re just not being used.

Authors

  1. Bronwyn Hemsley  Associate Professor in Speech Pathology, University of Newcastle
  2. Jacqueline Meredith  Research Assistant, University of Newcastle
  3. Shaun McCarthy  Director, University of Newcastle Legal Centre, University of Newcastle
The My Health Record is an online summary of personal health information that patients can share with health providers. As many as one in five Australians have a My Health Record.
But recent statistics show the My Health Record is only being used by a small percentage of consumers, and even then not to its fullest uses. So how can we get a greater return on the estimated A$1.2 billion taxpayer dollars invested in the system?

1. More health professionals need to add information

To date, approved health-care providers in the system have uploaded only about 1.7 million clinical documents, for the 4.6 million Australians who have a My Health Record. Just over one third of these clinical documents are Shared Health Summaries - listing health conditions, allergies, medications, and immunisations.
Information about health-care recipients is also added to the My Health Record from other sources – including Medicare and the Pharmaceutical Benefits Scheme, along with pharmacy medications information and hospital discharge summaries. Some health-care providers might be willing to share clinical documents, but hold concerns about privacy and may be unsure how sharing the information will improve patient care.
The shared health information in the My Health Record could help many patients recall vital health information. It could be particularly useful for those who struggle with medication management, have multiple health conditions, enter hospital frequently, or have multiple health providers.
The main purpose of the My Health Record is to improve the quality, safety and efficiency of patient care. Reducing medical errors related to the poor exchange of health information between patients and their health providers, or across multiple health providers, is a high priority.
We need more health information added into the system before it’s going to be useful for more people in supporting their health-care decisions. Patients prompting their GP or practice nurse to upload a Shared Health Summary at each visit could increase use of the system, which is designed to improve patient control over their health information.

2. We need to add more information ourselves

Many consumers with a My Health Record have only had one since June 2016 through a trial of “opt-out” sites. Lacking experience or guidance in using the My Health Record, they will not know what they can upload or why, or how to use the technology.
Currently, there are only about 80,000 “Consumer Entered Health Summaries” in the My Health Record. These summaries contain emergency contact details and very brief information on allergies and medications. There are also about 35,000 “Consumer Entered Health Notes” – similar to a health journal or diary.
Fewer than 900 people have uploaded a copy of their Advance Care Directive - a critically important document outlining a person’s wishes for future medical treatment - into the My Health Record. As it is the only national online repository for Advance Care Directives that can be accessed anywhere, more legal information websites need to prompt people to store their Advance Care Directive in the My Health Record.
Not knowing how to use computers, navigate the My Health Record, or save and upload documents will prevent many people from taking advantage of the system.

3. More people need to know how to use it

Currently, the My Health Record places high demands on reading and e-health literacy, making it difficult for many people to use. This could be a barrier for a large number of people.
People with low health literacy, people who lack engagement with digital health, people who lack access to a computer and the internet, and people with limited English literacy could struggle with these online records.
Information about the My Health Record needs to be inclusive, easier to read, and translated into many languages – and use pictures and videos – to enable everyone to use the system.

4. The people who need it most need support to use it

As many as one in five Australians have a disability. Anyone with a condition that affects their ability to explain their health history to others might need help to use the My Health Record. This includes people with dementia, stroke, traumatic brain injury, intellectual or developmental disability, autism spectrum disorder, motor neurone disease, Parkinson’s disease, and people with a wide range of social, physical, cognitive, or sensory impairments affecting communication.
People with communication difficulties have three times the risk of preventable harmful adverse events in hospital, relating to their problems communicating their needs to health providers. The My Health Record might be particularly helpful for this group, who are at risk of exclusion because of their communication impairments and low levels of digital inclusion.
While the My Health Record is set up for use by all Australians, people with communication difficulties and their families may need additional information, funding, and other supports to enable their participation. They might also need help to identify who would be their Nominated or Authorised Representative in the system.
Future enhancements of the My Health Record need to take into account the views and experiences of people with multiple health conditions who are engaging with the My Health Record. Gathering their stories of experience could lead to a greater understanding of the types of support needed for more people to use and benefit from this important e-health initiative.
You can find the original article here:
I pass this on in the hope we can start a conversation about what are the other problems with the myHR.
Comments welcome indeed hoped for!
David.

Tuesday, March 28, 2017

The AMA Points Out Some Home Truths On What Is Needed From The National Digital Health Strategy.

This appeared last week.

Don’t-give-us-high-level-give-us-down-earth-ama-says

17 Mar 2017
The proposed national digital health strategy should be a simple, straightforward list of proposed projects and their benefits, rather than a high-level strategy document, Australia’s peak doctors’ body says.
In its submission to the Australian Digital Health Agency (ADHA), the AMA says it has long advocated for a strategic plan for digital health.
But it warns that clinicians must be involved in both the development of the proposed National Digital Health Strategy (NDHS) and its implementation, saying too many e-health projects around the world have failed because they were developed without consultation with the people who had to use them.
“The AMA is aware of the long track record, both locally and internationally, of e-health projects falling over for failing to consider the social aspects of development and implementation,” the AMA says.
“If no other lessons have been learnt from Australia’s approach to e-health, clearly a ‘build it and they will come’ approach, without coalface clinical involvement, will fail.”
Clinician involvement must not stop at the ‘strategy’ level.
“There is a need for co-produced development and operational plans so providers can see where critical services are heading, over what time frame, and what this means for them,” the AMA said.
“Many doctors and other healthcare providers have a level of scepticism about high level strategy documents, preferring instead to have access to a simple, clear, prioritised and costed list of projects, with tangible products and benefits able to be understood by the non-technocrat.”
The AMA also said that the strategy should have a more balanced and complete coverage of all health practitioners’ needs, compared to the historic over-emphasis on patient-controlled health records – the My Health Record (MyHR) - and support for e-health in general practice.
“This must include specific support for medical specialists other than GPs to take up digital health, including but not limited to the MyHR,” it said.
“The NDHS should also clearly acknowledge that digital health has important and direct implications for the way health care is organised, for health financing and funding, and for existing payment models.
More here:
You can read the full submission from this link:
It is really useful to read the AMA’s summary of their seven page submission. The points made on the directional and clinician related aspects seemed pretty good to me, including their point on the rather overbalanced emphasis currently in evidence regarding the myHR. (Comments on the commercial aspects of digital health  I will leave to others).
I also note their frustration as well as the recognition of just how difficult all this all is!
David.

Monday, March 27, 2017

Weekly Australian Health IT Links – 27th March, 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

A really quiet week until the Council of Australian Governments leapt in and decided we are all going to  be given a myHR. Time will tell how that works out.
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Don’t-give-us-high-level-give-us-down-earth-ama-says

17 Mar 2017
The proposed national digital health strategy should be a simple, straightforward list of proposed projects and their benefits, rather than a high-level strategy document, Australia’s peak doctors’ body says.
In its submission to the Australian Digital Health Agency (ADHA), the AMA says it has long advocated for a strategic plan for digital health.
But it warns that clinicians must be involved in both the development of the proposed National Digital Health Strategy (NDHS) and its implementation, saying too many e-health projects around the world have failed because they were developed without consultation with the people who had to use them.
“The AMA is aware of the long track record, both locally and internationally, of e-health projects falling over for failing to consider the social aspects of development and implementation,” the AMA says.
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Design Aid program to help make Diabetes finger pricking a thing of the past

We’re proud to announce that Deakin University’s non-invasive smart solution for blood glucose monitoring project will be the first recipient of our Design Aid program.
The Design Aid program is part of our mission to give underfunded digital health projects access to world class design.
The winning project is specifically looking to design and implement a state-of-the-art smartphone-based non-invasive glucose monitoring solution using terahertz technology. The project is based on years of collaboration between Australia, the United States and Canada and is about to enter the Visualisation and Prototyping phase of the project – ideally suited to our user experience design expertise in the health sector.
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Why aren’t more people using the My Health Record?

March 24, 2017 2.49pm AEDT
My Health Records were a big government investment, but they’re just not being used.

Authors

  1. Bronwyn Hemsley  Associate Professor in Speech Pathology, University of Newcastle
  2. Jacqueline Meredith  Research Assistant, University of Newcastle
  3. Shaun McCarthy  Director, University of Newcastle Legal Centre, University of Newcastle
The My Health Record is an online summary of personal health information that patients can share with health providers. As many as one in five Australians have a My Health Record.
But recent statistics show the My Health Record is only being used by a small percentage of consumers, and even then not to its fullest uses. So how can we get a greater return on the estimated A$1.2 billion taxpayer dollars invested in the system?

1. More health professionals need to add information

To date, approved health-care providers in the system have uploaded only about 1.7 million clinical documents, for the 4.6 million Australians who have a My Health Record. Just over one third of these clinical documents are Shared Health Summaries - listing health conditions, allergies, medications, and immunisations.
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Illawarra cancer network investigates HoloLens’ potential

Microsoft’s mixed-reality headset could deliver training for nurses at ISCaHN as part of a broader mobility program at the cancer network
Rohan Pearce (Computerworld) 21 March, 2017 08:40
Microsoft’s mixed-reality HoloLens headset will be used for nurse training by the Illawarra Shoalhaven Cancer and Haematology Network (ISCaHN) if a proposal currently under consideration goes ahead.
Kenneth Masters, Illawarra Shoalhaven Local Health District’s oncology information system manager, said the purchase of two headsets has already been approved by ISCaHN’s IT steering committee and directors and was just awaiting a final sign-off from finance.
The initial use for the headsets would be training for nurses in the patient care environment. The headset could allow virtual assets to be set up in a critical care environment, displaying patient information at a bedside and making that same information visible to different nurses.
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Gene therapy: What personalized medicine means for you

From CNET Magazine: What if the next pill you took were tailored to your genetic makeup? That day is almost here.
Sci-Tech
by Marguerite Reardon March 22, 2017 5:30 AM PDT @maggie_reardon
Thuy Truong thought her aching back was just a pulled muscle from working out. But then came a high fever that wouldn't go away during a visit to Vietnam. When a friend insisted Truong, 30, go to an emergency room, doctors told her the last thing she expected to hear: She had lung cancer. Back in Los Angeles, Truong learned the cancer was at stage 4 and she had about eight months to live.
"My whole world was flipped upside down," says Truong, who had been splitting her time between the San Francisco Bay Area and Asia for a new project after selling her startup. "I've been a successful entrepreneur, but I'm not married. I don't have kids yet. [The diagnosis] was devastating."
Doctors at the University of Southern California took a blood sample for genetic testing. The "liquid biopsy" was able to detect tumor cells in her blood, sparing her the risky procedure of collecting cells in her lungs.
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Contractor army wanted for Qld Health's middleware overhaul

By Allie Coyne on Mar 23, 2017 10:24AM

Getting into meaty part of big transformation.

Queensland Health has put a call out to the market for an army of IT contractors it can turn to for help with its long-running middleware overhaul.
In late 2015 the department revealed its intention to incrementally replace its massive legacy environment by implementing new plumbing between the systems.
Addressing the middleware means the agency can overhaul small pieces at a time without impacting stability of other systems and applications.
Later that year it chose Fujitsu to help it implement Orion Health's integration software into its sprawling environment.
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Opportunities for providers as seniors adopt digital healthcare

By Natasha Egan on March 24, 2017 in Technology
A majority of Australian seniors are using digital devices to manage their health, signalling a critical role for consumer-focused technologies in aged care, new report finds.
The report draws on Accenture’s 2016 survey of 7,840 consumers in seven countries – including 241 Australians aged over 65 – and their views on health and healthcare technology.
With a majority of older people reporting they use technology to manage their health at least monthly, the analysis concluded there were many opportunities for aged care providers to offer digital services to Australia’s four million seniors.
Lead author and Accenture Australia principal director – healthcare Ian Manovel said more seniors were using digital health technology than they had been expecting.
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Government cracks down on fake doctors after NSW doctor is impersonated

Sue Dunlevy, National health reporter, News Corp Australia Network
March 24, 2017
FAKE doctors will face longer jail sentences and tougher financial penalties under a crackdown agreed by state and federal ministers after a recent NSW case.
And every Australian will be given an e-health record unless they take action to opt out under a change that could have major privacy implications.
A major overhaul of the regulation of medical practitioners was agreed by state and federal ministers meeting in Melbourne on Friday.
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NSW hospital patients not told their medical records were found in public areas

20 March, 2017
NSW hospital patients have had their confidential details compromised on multiple occasions, including medical records being found in a public carpark.
Many of the most serious privacy breaches have been reported in the Central Coast Local Health District, which runs Gosford and Wyong hospitals.
In 2015, a patient's emergency assessment paperwork was discovered on the ground near Gosford Hospital.
However, the patient concerned was never informed because the Health District said there was not a "serious risk of harm".
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Patients should be able to add notes to their clinical record

20 March 2017
THE ISSUE
Patients have their own agenda for what they plan or hope to do in a consultation, but most clinical software packages don’t provide any means for them to enter this into their clinical record.
Instead, for most clinical software systems, GPs and practice nurses act as the patient’s scribe, with an attendant likelihood of errors, bias, mis-emphasis and selective recording tailored to fit with the GP’s or practice nurse’s agenda.
Sometimes the patient’s agenda or reason for consultation is not recorded at all.
The Health Engine online appointment system allows patients to add notes to their booking with their reason(s) for making the appointment, but those notes do not automatically become part of the patient’s clinical record. As with all communications with or about patients, they should.
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Govt to launch mass data-harvest on Australia's pensioners

Noel Towell
Published: March 23, 2017 - 5:16PM
The federal government is to begin the mass-harvesting of financial information on hundreds of thousands of Australian pensioners as it steps up the "automation" of the nation's welfare system.
Centrelink is to be given the power to force superannuation funds and other sources of income for retirees to hand over the details of payments made to their members.
The move is expected to save up to $38 million each year in reduced administration for Centrelink and fewer overpayments of the age pension.
The welfare reform bill that passed late on Wednesday night contained the clause empowering Centrelink to demand the information, which is expected to be in the form of data-sets, from super funds and other "income stream" providers.
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Balancing act on the right to use, access and protect data

  • Anthony Wong
  • The Australian
  • 12:00AM March 21, 2017
In today’s digital and connected economy, data has become a vital resource that, when combined, could unlock new forms of value, connect previously unseen linkages and provide insights to stimulate growth and innovation in the digital economy.
Organisations of all sizes are taking steps to exploit the competitive advantage that big data, social media and the Internet of Things offer in profiling and analysing customer buying patterns.
Data drives revenue
Facebook reportedly generates 96 per cent of its revenues through targeted advertising that leverages user data, while Google’s sophisticated search capabilities attracted advertising revenues of more than $US57 billion last year. Between them, the two companies accounted for over 70 per cent of digital advertising, creating a global duopoly.
In this data-driven world, however, it’s often the case that the people who generated the data have little or no control over what happens to it once it has been captured. Even our ability to access data relating to personal transactions in areas such as banking, telecommunications and health has become more challenging in our increasingly paperless environment.
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Angus Taylor: we’re delivering on digital projects and promises

  • Angus Taylor
  • The Australian
  • 12:00AM March 21, 2017
Earlier this month the member for Chifley, Ed Husic, published an opinion piece in this paper highlighting the purported weaknesses of the Coalition’s digital strategy. Unfortunately, the piece was a masterclass in why Labor will never truly understand how to lead.
Given that it rather conveniently forgot to address the years of underinvestment in IT and digital under Labor’s watch, it’s perhaps pertinent to look at the transformative work going on inside government to remedy the past mistakes.
As the Assistant Minister to the Prime Minister for Cities and Digital Transformation, I see every day how this government is delivering on its promises — from infrastructure development to industrial relations reform to energy security. In my own portfolio I’m proud of how the Digital Transformation Agency is delivering real reform through an unprecedented government- wide overhaul that the Labor Party didn’t bother to pursue when it had the chance.
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Digital healthcare ‒ addressing cyber security risks for medical devices in the digital age

Australia March 16 2017
Addressing cyber security threats in medical devices proactively will help mitigate the risks associated with the rise of these technologies.
Healthcare, as with most sectors, is becoming increasingly digitised in the modern age. This presents both opportunities and risks for healthcare systems ‒ in particular, the cyber security of medical devices that employ wireless technologies and software.
Recently, the Australian Therapeutic Goods Administration (TGA) and the United States Food & Drug Administration (FDA) have actively addressed this issue. The TGA had previously noted the possibility of unauthorised users gaining remote access to Hospira's Symbiq Infusion System and LifeCare PCA3 and PCA5 Infusion Pump Systems, while both regulatory bodies have turned their attention to potential vulnerabilities in implantable cardiac devices.
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Automated patient check-in for Gold Coast Health

By Australian Hospital + Healthcare Bulletin Staff
Tuesday, 21 March, 2017
Gold Coast Health has launched an automated patient check-in system across its five busiest departments at the Gold Coast University Hospital (GCUH). The check-in system is part of the Q-Flow patient optimisation framework that includes a series of kiosks that patients use to register their presence on arrival, as well as a backend patient management system that organises patient records.
Demand for Gold Coast Health’s services is only increasing, with growth in the number of total patients being seen in clinics across the city going from 699,000 in 2014–15 to 835,000 in 2015–16.
Gold Coast Health has partnered with patient flow management software specialist NEXA to integrate Q-Flow with GCUH’s core systems. The system is helping to eliminate patient queues, while capturing critical performance data from many of the hospital’s departments.
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Government pushes ahead with work on Centrelink payment system

Accenture gets lead systems integrator role on first phase of WPIT
Rohan Pearce (Computerworld) 22 March, 2017 13:31
Accenture has been chosen as the lead systems integrator for the first part of a program to overhaul Centrelink’s payment system.
Human services minister Alan Tudge said that the selection of the company as preferred tenderer for systems integrator services on the first phase of the Welfare Payment Infrastructure Transformation (WPIT) Program was still subject to commercial negotiations.
DHS is currently planning a range of WPIT-related projects including a new online user interface for welfare payments, a new payment utility to deliver payments faster, and work on designing an end-state technology solution for future phases of WPIT.
The government said in October that Capgemini and Accenture were shortlisted for the role.
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Codeine handling ‘suboptimal,’ says study

Newly published research has shown that in roughly a quarter of direct product requests for non-prescription combination analgesics containing codeine, pharmacists weren’t involved

Researchers from LaTrobe University conducted 145 covert pharmacy visits in which one of two scenarios took place, each of which involved a direct product request for Nurofen Plus.
The scenarios involved identical reasons for use, symptoms and medical history but varied previous product use: one involved a first-time user while the other had used the products regularly for the past month.
The research was undertaken between July and August 2015, well before the Pharmacy Guild’s MedsASSIST program began to roll out in March 2016. The product category is to be upscheduled to prescription-only on 1 February 2018.
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National Clinical Terminology Service: Website User Survey

Created on Monday, 20 March 2017
In October 2016, the Australian Digital Health Agency launched the National Clinical Terminology Service (NCTS) website www.healthterminologies.gov.au to provide our customers with a one-stop shop to access our terminology products, tools, applications and supporting resources. We are conducting a survey to seek your feedback on the website and to help identify future improvements to the service.
Click on the link below to start the survey. You have until Thursday 13th April 2017 to complete it. Thank you for your participation!
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National Product Catalogue Data Quality in Health Program

Created on Friday, 24 March 2017
GS1 Australia and the Australian Digital Health Agency (the Agency), in partnership with the Healthcare Industry, are continuing to implement the National Product Catalogue Data Quality Improvement Program to address healthcare industry concerns relating to data quality within the National Product Catalogue (NPC).
Key highlights include new data quality reporting passing the pilot phase of the project with reports now scheduled to be released to the Healthcare Industry by July 2017. This is a significant step forward to improved medical product data being available across healthcare systems via the National Product Catalogue.
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Digital Health in an Era of Precision Medicine — The Genome Generation

Thursday, 23 March 2017
As the Chief Medical Adviser for the Australian Digital Health Agency (the Agency), I'm privileged to have the opportunity to meet with many inspiring people – clinicians, health consumers, researchers and innovators who help us think about the way our organisation can best serve Australians to get a good deal out of our investment in digital health services and technologies. We are delivering key services at the Agency that will enable our health system to remain world-leading in its innovation and ability to support a high standard of health and well-being for our citizens. Our continued efforts to improve and expand our understanding of how our services underpin and interrelate to the broader health and care ecosystem depends upon us continually looking outwards, reflecting and learning about future directions for health and care clinical priorities, as well as focussing on striving for internal excellence in our organisation.
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Enjoy!
David.