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, June 17, 2017

Weekly Overseas Health IT Links – 17th June, 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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NQF maps out measures for interoperability

The National Quality Forum is set to finalize a framework that can measure health data interoperability and identify gaps in progress.
June 08, 2017 04:02 PM
The National Quality Forum moved closer to finalizing a framework for measuring interoperability. NQF said the framework will help identify in the nation’s progress to enable widespread health data exchange. 
The agency’s initiative comes as hospitals and electronic health records vendors are struggling with interoperability and the Office of the National Coordinator for Health IT is working to advance standards that enable information sharing. 
“Interoperability is more than EHR to EHR, and all sources of data should be taken into consideration,” NQF said. “All critical data elements should be included in the analysis of measures as interoperability increases access to information.” 
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A growing number of people with chronic conditions also lack internet access

Jun 9, 2017 11:08am
Lack of internet access coupled with high rates of chronic disease plague more than 60% of rural counties.
More than 36 million people live in counties across the United States where high rates of chronic disease are exacerbated by low rates of broadband connectivity.
The Federal Communications Commission (FCC) refers to this trend as a “double-burden” of need, and according to new data released (PDF) by the agency’s Connect2Health Task Force, those numbers are increasing. Between 2014 and 2015, one million additional Americans lived in counties with “double burden.”
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4 ways hospitals can prevent a ransomware attack

Jun 9, 2017 12:09pm
Hospitals are a prime target for hackers, and they can take a few simple steps to help protect their systems from cyberthreats.
Hospitals are a prime target for hackers, but providers can take steps to ensure their systems are better protected against ransomware and other cyber threats.
The federal government has taken steps on the national level to improve cybersecurity, but hospital leaders can also encourage staff to engage in simple behaviors to prevent cyberattacks, wrote Paul H. Keckley, Ph.D., healthcare analyst and author of The Keckley Report, in an article for Hospitals & Health Networks.
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Could Automation Solve the Healthcare Industry’s EHR Problem?

Automating certain tasks within the systems could be the key to settling EHR dissatisfaction.

Kate Monica

June 08, 2017 - As healthcare professionals attempt to navigate an increasingly data-driven, high-tech industry, some providers and patients remain skeptical that increased reliance on EHR systems is the right move.
EHRs have their advantages: several studies cite examples of the systems being key assets in efforts to improve preventive medicine, patient-provider communication, and positive drug interactions. Additionally, EHR systems offer patients increased transparency through patient portals providing a view of their own health information.
However, not everyone is a fan of the technology. The question of whether EHR systems help or hurt the industry has driven a wedge between providers on either side of the argument.
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Patients with metastatic cancer live longer using web-based tool

Published June 09 2017, 6:56am EDT
A web-based tool that enables patients with metastatic cancer to report their symptoms in real time, providing alerts to clinicians, has been shown to have major benefits, including longer survival rates.
In a randomized clinical trial of 766 patients, those who used the tool to regularly self-report symptoms while receiving chemotherapy lived a median of 5 months longer than those who did not use the tool. Results of the study were presented June 4 in the plenary session of the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago.
The study was led by Ethan Basch, MD, professor of medicine at the Lineberger Comprehensive Cancer Center of the University of North Carolina, who was practicing at Memorial Sloan Kettering Cancer Center in New York when the clinical trial was conducted.
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HIT Think Why using AI in healthcare requires a balance of efficiency and ethics

Published June 09 2017, 4:50pm EDT
Along with predicting epidemics, diagnosing diseases and counseling patients, artificial intelligence is also proving its worth in healthcare delivery to enable a better patient experience.
From making sense of the unwieldy mass of medical data trapped in healthcare systems to tapping into the collective knowledge gathered from several thousand healthcare providers and millions of patient visits, doctors can now start to analyze which treatments work best and when.
Now, AI can recommend a line of action even in clinically challenging situations, assisting radiologists in analyzing simple cases, prescribing a first line of treatment to patients before they see a doctor and help monitor health and medication in chronic conditions.
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The AI Doctor Orders More Tests

Google and its rivals are pushing into machine-learning diagnoses.
by  Mark Bergen
June 8, 2017, 8:00 PM GMT+10
Few U.S. industries are growing as fast as health care, but the big public-cloud companies—Amazon.com, Microsoft, Google—have struggled to crack the $3.2 trillion market. Even as hospitals and insurers collect mountains of health data on individual Americans, most of their spending on extra data storage is for old-school systems on their own premises, according to researcher IDC.
The public-cloud kingpins are trying to lure health-care providers with artificially intelligent cloud services that can act like doctors. The companies are testing, and in some cases marketing, AI software that automates mundane tasks including data entry; consulting work like patient management and referrals; and even the diagnostic elements of highly skilled fields such as pathology.
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Electronic Alerts Help Reduce Missed Sepsis Diagnosis in Children

Alexandra Wilson Pecci, June 9, 2017

Using this method to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76%. 

It’s long been said that health IT should enhance, but never replace, traditional medicine, and a method of identifying sepsis in children that combines electronic alerts with physician judgement is an example of that idea. 
Researchers found that using this method to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76%. The study, along with an accompanying editorial, were published online in Annals of Emergency Medicine.
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Patient safety jeopardized by EHR downtime, JAMIA says

A three-year study on a large mid-Atlantic hospital found that the laboratory department was hit the hardest during downtime, with patient identification as the largest challenge.
June 07, 2017 03:59 PM
Downtime events in hospitals that shut down the functionality of the electronic health record can result in serious patient safety risks, according to a recently published study in the Journal of the American Medical Informatics Association.
In fact, over the three-year analyzation period of a large health system in the Mid-Atlantic, 76 incidents were reported that were directly related to downtime. And that included scheduled downtime, as well.
Downtime hit the lab department the hardest -- accounting for about half of the reports. Medication administration was the second most-affected with 14.5 percent of all incidents. And about 13.2 percent of the reports stemmed from a general delay in care.
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New PRSB standards published on e-discharge summaries

Laura Stevens

7 June 2017
A re-worked version of the e-discharge summary standard has been published by the Professional Record Standards Body.
Issued 31 May, the revisions aim to improve communication between hospitals and primary and community care. Changes include how information about a patient’s medication is entered.
Using this standard, hospitals can now transfer standardised clinical information using PRSB headings and coded data (SNOMED CT and dm+d), which can then be transferred directly into GP IT systems.
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How technology upgrades sparked a financial resurgence at two rural hospitals

Jun 8, 2017 8:11am
Coteau des Prairies Health Care System in rural South Dakota has leaned heavily on telehealth to streamline costs and patient care.
On his second day as CEO of Coteau des Prairies (CDP) Health Care System in Sisseton, South Dakota, Michael Coyle had to borrow $500,000 to make payroll. That was just the start of the hospital’s financial struggles.
CDP is a 25-bed critical access hospital located about 160 miles north of Sioux Falls on the edge of the Lake Traverse Indian Reservation. When Coyle arrived in December 2014, the hospital faced an array of financial issues, most of which were tied to delinquent payments from Indian Health Services. Several years earlier, the hospital saw a massive increase of ER visits after the reservation demolished its hospital and replaced it with a medical clinic.
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Main Characteristics of Successful EHR Vendors, Technologies

The most successful EHR vendor technologies used by hospitals and health systems around the globe share several traits in common.

Kate Monica

June 06, 2017 - EHR vendors are experiencing an upsurge in client acquisitions as EHR adoption and implementation continue throughout the healthcare industry, most notably in the form of EHR replacement.
While hundreds of technology vendors and solutions remain on the market, a select few repeatedly rise to the top each year as the most popular vendors among healthcare organizations.
Specificity and range of functionality
Recent market share reports show hospitals of different sizes, specialties, and regions have different priorities when choosing an EHR system that best fits their practice.
For small hospitals, that means specificity.
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Mobile Health Technology is Breathing New Life Into CPAP Therapy

Healthcare providers are using mobile health technology to transform clunky CPAP devices into high-tech mHealth platforms, giving doctors better insight into sleep and breathing problems.

Source: ThinkStock

Eric Wicklund

June 07, 2017 - Healthcare providers are turning to mHealth technology to make CPAP therapy more productive – for both doctors and patients.
Continuous positive airway pressure (CPAP) machines have been around for decades, helping doctors to monitor patients with breathing problems, like obstructive sleep apnea (OSA). But the clunky devices, which typically consist of an airflow generator, hose and full face mask, aren’t comfortable, and often prevent the patient from getting a good night’s sleep.
Now companies like ResMed, SRETT and Philips Respironics are developing mobile health platforms that connect wirelessly to the CPAP machines and care providers, enabling patients to use the devices at home, rather than in a sleep lab.  With that online connection, data from CPAP devices, including vital signs and sleep activity, is transmitted to providers, who in turn can track and identify problems and intervene, or offer coaching and support.
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Coast Guard next to pick Cerner? Vendor is already prepping its EHR for the high seas

USCG ranked interoperability with DoD and VA as a priority while Cerner, meanwhile, has been testing its software on submarines.
June 06, 2017 03:10 PM
Now that Veterans Affairs Secretary David Shulkin, MD, revealed that VA has officially opted to replace its VistA EHR with one from Cerner, the overarching question: Is Cerner now a shoo-in for the Coast Guard’s upcoming EHR implementation?
USCG, after all, listed interoperability with DoD and VA as among the top attributes it is seeking in an electronic health record platform.
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Researchers, healthcare providers navigate a new era of data sharing

Jun 7, 2017 11:45am
Data is an integral part of advancing medical research and improving clinical care. Sharing it is the next critical step.
Data is quickly becoming king in the healthcare industry, and that means sharing it is increasingly important and complex for researchers and health systems.
Data sharing is particularly important in the quest to advance cancer therapies, the directors of the Swedish Cancer Institute at Providence St. Joseph Health in Seattle and the Sylvester Comprehensive Cancer Center at the University of Miami Health System wrote in an op-ed for Stat.
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Patient mortality could be predicted through computer analysis of organs

Written by Honor Whiteman
Published: Monday 5 June 2017
Using a computer to analyze CT images of patients' organs, researchers were able to predict their 5-year mortality with almost 70 percent accuracy. This is according to a new study recently published in the journal Scientific Reports.
Lead study author Dr. Luke Oakden-Rayner, of the School of Public Health at the University of Adelaide in Australia, and colleagues believe that their findings could advance the field of precision medicine.
The National Institutes of Health (NIH) define precision medicine as "an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person."
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Cybersecurity Taskforce Issues EHR Security Recommendations

An HHS taskforce recently submitted recommendations to Congress including improvements to EHR security.

Kate Monica

June 06, 2017 - A healthcare industry cybersecurity taskforce recently submitted a report to Congress analyzing and addressing various issues with healthcare security including problems unique to EHR technology.
The task force was initially convened in March of 2016 by HHS and consisted of members representing organizations ranging from hospitals to pharmaceutical companies.
Throughout the year, taskforce members shared information regarding cybersecurity best practices, trends, threats, and general concerns regarding health IT safety.
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HIT Think How to mitigate the risks of browsing in healthcare organizations

Published June 07 2017, 4:33pm EDT
The freedom to browse comes with inherent security risks. While healthcare organizations must adhere to strict compliance rules to ensure data security and privacy, ransomware and malware threats are widespread and show no signs of slowing down.
We have seen hospitals such as Hollywood Presbyterian and major healthcare organizations, such as the UK's National Health Service, held hostage by cyberthreats. Even healthcare organizations with more proactive security measures are vulnerable. For example, Urology Austin, which operates in 13 locations throughout Texas, managed to thwart a ransomware attack –but despite early detection, the medical records and associated personal information of nearly 280,000 patients had already been exposed by the hack.
The reality is that today’s healthcare organizations are increasingly relying on cloud infrastructure, mobile devices and browser-based applications to support both front- and back-office processes. Thus, organizations are challenged with maintaining a balance between deploying solutions that provide the utmost in accessibility and security without impacting workflow and most importantly, day-to-day operations.
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Electronic scripts could aid fight against opioid abuse

Published June 07 2017, 4:24pm EDT
Since 2016, electronic prescribing of controlled substances has been legal in all 50 states, an initiative that is helping to fight the opioid abuse epidemic, but that form of prescribing is not mandated in all states.
Mandate or not, physicians treating patients with opioids need to go electronic, contends Bob Twillman, executive director at the Academy of Integrative Pain Management.
The organization oversees federal and state pain management policy developments with a mission to advance a person-centered integrative model of pain care. It also offers education and certification programs on the treatment of pain for physicians, physician assistants, nurse practitioners and other prescribers.
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Harnessing the full potential of eHealth

‘Health is a difficult place to work – The Irish Healthcare Awards give recognition’
The signing of the commencement order in relation to the Individual Health Identifier (IHI) — winner at last year’s Irish Healthcare Awards — provides the “fundamental block” in building a better health service through the availability of digital solutions, IMT reports.
One of the award winning projects at last year’s Irish Healthcare Awards has taken an important step towards its ultimate goal of digitalising Ireland’s health service, IMT reports.
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VA decision to select Cerner EHR gets high marks

Published June 06 2017, 7:14am EDT
Monday’s announcement by the Department of Veterans Affairs that it plans to follow the lead of the Department of Defense and acquire a commercial off-the-shelf electronic health record system from Cerner was met with approval from healthcare IT groups and stakeholders.
They contend that the VA’s decision to replace its decades-old legacy Veterans Health Information Systems and Technology Architecture (VistA) with Cerner’s Millennium EHR, the same platform that DoD is currently implementing, has a symmetry and logic to it.
“The Department of Veterans Affairs’ selection of Cerner to develop its electronic health records system is wonderful news for U.S. veterans and their families,” said David Kibbe, MD, president and CEO of DirectTrust.
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VA secretary: Cerner EHR choice brings big clinical gains

Seamless interoperability with MHS Genesis will enable development of better treatment plans between VA and DoD physicians – and could help prevent veterans' suicides, which Shulkin says is his "top clinical priority."
June 05, 2017 04:06 PM
Veterans Affairs Secretary David Shulkin, MD, addressed reporters at the White House on Monday to explain the agency's decision to update their EHR system with Cerner.
Veterans Affairs Secretary David Shulkin, MD, said he was speaking as a physician when he said choosing Cerner to replace VistA was "the right thing to change veterans' healthcare."
Addressing reporters at the White House daily briefing on Monday, Shulkin said that "having an electronic health record that can follow a veteran during the course of his treatment is one of the most important things you can do to ensure their safety, health and well-being."
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Hospitals, turn up the heat on vendors if you want EHRs to improve

EHRs are essentially multi-million dollar products that capture data, but what hospitals really need is decision support information that reduces the possibility of physician errors to improve patient safety, expert says.
June 05, 2017 03:19 PM
NEW YORK — The time has come for hospital IT executives to become much more demanding customers of their electronic health records vendors to bolster clinical decision support, reduce medical errors and ultimately improve patient safety.
“It’s up to us to demand that EMR vendors provide us with good decision support,” Mount Sinai President and COO David Reich said at the HealthImpact East Conference Monday. “Interacting with Epic or other EMR vendors presents certain challenges because they tend to want things in their domain, so we have to innovate outside their domain.”
Part of the issue is that the healthcare industry currently has a lot more innovation than it does validation, according to Neil Carpenter, Vice President of Strategic Planning and Research at LifeBridge Health.
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New research shows patients value the convenience of telehealth—even for bad news

Jun 6, 2017 10:58am
Patients and primary care physicians are enthusiastic about the convenience of telehealth.
Patients appear to be climbing aboard the telehealth bandwagon for the convenience of staying at home, and doctors are keen on the ability to use video consultations for follow-up care.
All 19 telehealth patients at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia indicated they were satisfied with their telehealth visit, according to a series qualitative interviews published in the Annals of Family Medicine.
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How a simple tech tool can help cancer patients live longer

Laurie McGinley June 4
CHICAGO — Doctors often don't hear about the serious side effects of chemotherapy because patients are reluctant to complain or don't have enough time to talk about such problems during jam-packed office visits, experts say.
But a new study points to a potential solution: using simple technology to encourage “real time” reporting of symptoms. Its findings show that patients with advanced cancer who reported side effects frequently via an online tool lived a median of five months longer than those who waited to mention problems during office visits.
Lead study author Ethan Basch, an oncologist at Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, acknowledges that a five-month improvement might sound modest. But, he notes, it is a greater benefit than what's provided by many targeted drugs for metastatic cancer.
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Patient-Generated Health Data is Valuable Personalization Tool

Consumers are starting to feel empowered to make personal decisions based upon the patient-generated health data from their mHealth devices.

Thomas Beaton

June 05, 2017 - Sixty-two  percent of consumers believe that patient-generated health data (PGHD) from their mHealth devices will put them in control of their own health, according to an industry report from Ericsson.
In a survey of 4500 mHealth and broadband users, researchers found that a majority of consumers saw PGDH as a way to improve their preventative care needs.
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Only 3% of FL Emergency Medicine Providers Consistently Use Opioid Database

Alexandra Wilson Pecci, June 5, 2017

More than half of health providers surveyed said they only use the database when they suspect a patient may misuse the medication.

Despite Florida's availability of a statewide database that aims to reduce opiate abuse and diversion, just 3% of emergency medicine providers reported using the database every time they prescribed opioid pain relievers, according to researchers at University of Florida Health.
Instead, 51% of health providers surveyed said they only use the database when they suspect a patient may misuse the medication.
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Scottish Government seeks views on its eHealth strategy

Written by Sooraj Shah on 6 June 2017 in News
Government wants to know about successes and failures of telecare and telehealth plans to ensure its vision is on the right path
The Scottish government’s health and sport committee is seeking views from citizens and healthcare professionals on its approach to eHealth.
The committee said that it wanted to hear about the successes and failures of existing telecare and telehealth strategies and the opportunities future developments might present. It said that it also wanted to explore barriers to innovation in the NHS.
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HIT Think 5 takeaways from the WannaCry ransomware attacks

Published June 02 2017, 3:21pm EDT
Will information technology ever reach the point in the future where security is strong enough, reliable enough, secure enough to block any and all attacks?
It’s a dubious proposition made more uncertain by the recent WannaCry ransomware incident that started a couple of weeks ago and continued around the globe for several days. The virus was seemingly halted on Friday, May 12, when a security researcher found weaknesses in the code, but additional versions without those weaknesses have been sent out since.
Whoever is sending out WannaCry will continue—or someone else, someplace else, will send something similar or more virulent. The war is never over.
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What would the end of net neutrality mean for healthcare?

Not only telehealth, but cloud-based EHRs and remote monitoring connectivity could all be affected by regulation rollbacks, Health Affairs says.
June 01, 2017 03:53 PM
The Federal Communications Commission hasn't yet overturned existing net neutrality rules, but the Republican-led agency is widely expected to soon.
Even ardent supporters of rules to ensure web traffic isn't subject to preferential treatment by internet service providers seem ready to throw in the towel on the fight, including Netflix CEO Reed Hastings, whose company (along with Google, Facebook and many others) has long fought for stronger regulations on ISPs such as Comcast, AT&T and Verizon.
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HHS task force spells out ‘urgent challenge’ of cybersecurity in healthcare

Jun 5, 2017 10:45am
A much-anticipated cybersecurity report highlighted the gaps among small and medium-sized providers.
Classifying cybersecurity as a patient safety concern, a long-awaited report by a federal task force identified some of the key cybersecurity vulnerabilities in healthcare and stressed the importance of collaboration between all stakeholders to close those gaps.
Over the past year, 21 members of the Department of Health and Human Services’ (HHS) Cybersecurity Task Force discussed some of the key vulnerabilities facing the industry. On Friday, the group released (PDF) a report that many had been anticipating for the last month, particularly in the wake of the WannaCry ransom attack that impacted dozens of NHS hospital and left others concerned that subsequent attacks could have an even bigger impact on patient care
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Study: Real-time electronic symptom reporting helps cancer patients live longer

Jun 5, 2017 11:38am
New research shows that reporting symptoms electronically helped cancer patients live longer.
Promising new research shows that technology can help extend the lives of cancer patients by giving providers real-time updates on treatment symptoms.
Patients that electronically reported chemotherapy symptoms to their provider using a tablet or computer lived five months longer than those that reported symptoms during their monthly checkup with their oncologists, according to a study published over the weekend in JAMA. It’s one of four “clinically significant” studies presented at the American Society of Clinical Oncology annual meeting on Sunday.
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HHS task force wants cybersecurity treated as a patient safety issue

By Rachel Z. Arndt  | June 2, 2017
The Health Care Industry Cybersecurity Task Force today released the final version of its cybersecurity report, calling on the government to write policies that would help healthcare organizations boost their defenses—a need made even more evident after last month's WannaCry ransomware attacks.

The final report, which was mandated by the Cybersecurity Information Sharing Act of 2016, barely differs from the draft that hit the web
in early May (most of the changes were to punctuation). As in the earlier version, the final report sets out six "imperatives" for bolstering cybersecurity, including better information-sharing about threats and developing ways to protect research and development from cyberattacks. The task force called for a new healthcare-specific cybersecurity framework and for amendments to the Physician Self-Referral Law and the Anti-Kickback Statute to make it easier for large health systems assist smaller practices with their cybersecurity.
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VA picks Cerner to replace legacy EHR system

Published June 05 2017, 2:49pm EDT
In an effort to achieve interoperability with the Department of Defense, the Department of Veterans Affairs has decided to replace its decades-old electronic health record system with a commercial off-the-shelf EHR from Cerner.
While the VA will not be adopting the identical EHR that DoD uses, it will be on a similar Cerner platform. The U.S. military has started to deploy Cerner’s Millennium system, the same platform that has now been named as the replacement for the VA’s legacy Veterans Health Information Systems and Technology Architecture (VistA).
VA Secretary David Shulkin, MD, made the announcement on Monday at a news briefing at the department’s headquarters in Washington.
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HIT Think It’s time to stop and refocus EHR efforts

Published June 05 2017, 4:47pm EDT
Every day, physicians, nurses, pharmacists, therapists, orderlies and janitors walk into a hospital, clinic or medical office with only one thought in mind: “What little part can I do today to help heal those who are sick?”
Healthcare’s uniqueness stems from its personal and emotional characteristics, and deep ties to our sense of humanity. While workers in other industries focus on delivering great service or exceptional products, only in healthcare do staff experience the joy of saving a life or the pain of sharing bad news with a patient’s loved ones.
Yet as health providers moved to quickly deploy EHRs, many in the profession believe we had put up barriers between ourselves and our patients. We now regularly hear patient complaints about their caregivers “treating” their computers rather than talking directly to them as patients, and of physicians and nurses putting in extra hours just to complete documentation that, in their view, has no impact on patient care.
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Enjoy!
David.

Friday, June 16, 2017

Now Here Is A Demonstration Of How EHRs Can Make A Real Difference.

This popped up a few days ago.

Electronic Alerts Help Reduce Missed Sepsis Diagnosis in Children

Alexandra Wilson Pecci, June 9, 2017

Using this method to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76%. 

It’s long been said that health IT should enhance, but never replace, traditional medicine, and a method of identifying sepsis in children that combines electronic alerts with physician judgement is an example of that idea. 
Researchers found that using this method to identify children in a pediatric emergency department with severe sepsis reduced missed diagnoses by 76%. The study, along with an accompanying editorial, were published online in Annals of Emergency Medicine.
“Sepsis is a killer and notoriously difficult to identify accurately in children, which is why this alert is so promising,” lead study author Fran Balamuth, MD, PhD, MSCE, of Children’s Hospital of Philadelphia, in Philadelphia, Pa, said in a statement.
“Identifying the rare child with severe sepsis or septic shock among the many non-septic children with fever and tachycardia in a pediatric ER is truly akin to finding the proverbial ‘needle in a haystack.’ This alert, especially with the inclusion of physician judgment, gets us much closer to catching most of those very sick children and treating them quickly.”

Researchers built a two-stage alert (ESA) and implemented it into the hospital’s EHR. The first-stage alert is triggered when an age-based elevated heart rate or hypotensive blood pressure is documented in the EHR at any time during the emergency visit. If the patient also has a fever or infection risk, the alert triggers a series of questions about underlying high-risk conditions, perfusion, and mental status. If the answer is yes to any of these questions, a second-stage alert triggers.
More here:
Enough said – really fantastic stuff.
David.

Thursday, June 15, 2017

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

June 15, 2017 Edition.
A big week internationally with Theresa May almost getting booted out – it may still happen – and President Trump being beaten up by the James Comey (Former FBI Boss) testimony. Trump is now saying he will testify under oath – always the sign of desperation. My guess is that all this will not end well for him.
On the Australian front we have seen a new energy plan from Alan Finkle and we still seem to have increasing talk of an economic slowdown. Time will tell just where all this will land up.
The two most interesting bits of news this week were these:

Sharemarket risk at highest level since before GFC, says Bill Gross

John Gittelsohn and Erik Schatzker
Published: June 8 2017 - 7:49AM
US markets are at their highest risk levels since before the 2008 financial crisis because investors are paying a high price for the chances they're taking, according to Bill Gross, manager of the $2 billion Janus Henderson Global Unconstrained Bond Fund.
"Instead of buying low and selling high, you're buying high and crossing your fingers," Gross, 73, said on Wednesday at the Bloomberg Invest New York summit.
Central bank policies for low-and negative-interest rates are artificially driving up asset prices while creating little growth in the real economy and punishing individual savers, banks and insurance companies, according to Gross.
The US economy is expected to grow 2.2 per cent this year and 2.3 per cent in 2018, according to forecasts compiled by Bloomberg. Trump administration officials have said their policies will boost annual growth to 3 per cent.
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National Accounts weakest since the GFC: Warning on housing as GDP growth slips

Peter Martin, Eryk Bagshaw
Published: June 7 2017 - 7:58PM
The OECD has named house prices as the biggest domestic threat to economic growth as new figures push annual growth to its lowest point since the global financial crisis.
The Australian economy grew just 1.7 per cent in the 12 months to March, down from 3 per cent three years earlier. The result is the worst since the 1.2 per cent recorded during the depths of the financial crisis in September 2009.
Gross domestic product grew 0.3 during the March quarter after growing 0.7 per cent, falling 0.4 per cent and growing 1.1 per cent in the four quarters before that.
"It has been very lumpy," said Treasurer Scott Morrison. "It's what I would describe as modest growth."
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Here are a few other things I have noticed.
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National Budget Issues.

Uncertain waters ahead for the Australian economy

Jessica Irvine
Published: June 4 2017 - 11:45PM
If the figures add up, we may be heading into our first technical recession in 25 years.
Beware out there this week, folks. There's a storm a'comin'. An economic data storm, that is.
Economists are tipping the good ship "Oz economy" has struck shallow waters in the first half of 2017.
Official accounts on Wednesday are expected to reveal the extent of the damage to our economic output in the March quarter from an unexpected drop in business investment and continuing caution among highly indebted households.
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RBA becomes a lonely rate-cut candidate on Aussie growth doubts

James Thornhill
Published: June 5 2017 - 8:10AM
A month can be a long time in economics.
Since the Reserve Bank of Australia's last policy decision on May 2, market bets on an interest-rate cut by the end of this year have doubled.
While that chance is still only less than 20 per cent, swaps traders late on Friday saw the nation as the only developed economy where cuts are possible in the coming year after data during May pointed to anaemic growth in the first quarter.
For now, a mixed picture means governor Philip Lowe will likely hold the benchmark rate at a record-low 1.5 per cent on Tuesday.
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GDP forecasts mixed as company profits soar, wages flatline

Peter Martin
Published: June 5 2017 - 6:09PM
Higher commodity prices pushed up company profits almost 40 per cent in the year to March at a time when the wage bill grew 0.9 per cent.
The so-called partial indicators released by the Bureau of Statistics ahead of Wednesday's national accounts have company profits climbing 6 per cent during the March quarter and wages only 0.3 per cent.
The wage measure is affected by both record-low wage growth and a drop in the number of hours worked.
Mining profits jumped 13 per cent in the quarter and non-mining profits 2.4 per cent. Retail profits were up 4.9 per cent, manufacturing profits up 2.4 per cent, utilities profits up 2.1 per cent, and wholesale profits down 5.8 per cent and finance industry profits down 2.8 per cent.
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Australia stumbles to economic record as cautious RBA leaves rates on hold

Eryk Bagshaw
Published: June 6 2017 - 5:41PM
Treasurer Scott Morrison has warned the economy's future is not yet secure as Australia prepares to stumble across the line on Wednesday to grab the world record for the longest period of consecutive growth.
The median updated forecast of all 23 economic institutions surveyed by Bloomberg is for growth of just 0.3 per cent, enough to put Australia on level pegging with the Netherlands for the longest run of uninterrupted growth.
But several banks have revised down their forecasts ahead of the release of the national accounts, with the Commonwealth Bank predicting growth of just 0.1 per cent. The National Australia Bank has forecast a negative result of -0.1 per cent.
Figures released on Tuesday showed Australia's current account [the difference between all imports and exports] recorded the smallest deficit in 15 years, but it may not be enough to stave off only the fourth quarter of negative growth since the recession of the early 1990s.
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Don’t fret the GDP score – watch the game instead

Michael Pascoe
Published: June 6 2017 - 6:50PM
It looks like déjà vu all over again for Scott Morrison as he fears another weak gross domestic product figure on Wednesday, perhaps even a repeat of the September quarter's fall.
That would be a little politically embarrassing so soon after doing the Little Orphan Annie impersonation on budget night, singing a heart-felt Tomorrow and following it up in subsequent interviews with variations on Happy Days Are Here Again and The White Cliffs of Dover.
But beyond the embarrassment, whether the March-quarter GDP score is high, low or indifferent doesn't matter nearly as much as the economic commentariat may presently be indicating.
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Reboot for flawed NDIS systems as agency acts on complaints

  • The Australian
  • 12:00AM June 7, 2017
The $22 billion National Disability Insurance Scheme will be overhauled to rebuild faith in the concept plagued from day one by critical staffing gaps, computer system malfunctions and planning bungles which have left participants confused and angry.
National Disability Insurance Agency chief executive David Bowen yesterday announced “major work” behind the scenes to redesign how the scheme reached 460,000 participants in 2020. Although details are scarce, the reform is expected to move away from Centrelink-style phone planning — revealed by The Australian last year — and back to face-to-face meetings with clients, new or improved IT systems and significant retraining of staff.
“It is now well recognised that before the commencement of transition to full scheme in July 2016, the quality of the NDIA’s internal preparation warranted significant improvement,” Mr Bowen said. “The NDIA’s processes and systems have not resulted in a participant and provider experience during transition that is of the consistently high standards that the NDIA expects.
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GDP: Australia grabs record for longest time without a recession

Eryk Bagshaw, James Massola
Published: June 7 2017 - 3:55PM
Australia has taken the record for the longest run of uninterrupted growth in the developed world, figures released by the Australian Bureau of Statistics have revealed. 
Gross domestic product grew by 0.3 per cent in the three months to March, matching economists' expectations of the country crawling across the line to grab the record from the Netherlands, which suffered a minuscule recession after 82 quarters but otherwise grew consistently for 26 years. 
It has now been 103 quarters since Australia had a technical recession, defined as two consecutive quarters of negative growth. 
Treasurer Scott Morrison said the figures demonstrated the resilience of the Australian economy. 
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Price hikes threaten to take shine off golden years

John Collett
Published: June 6 2017 - 7:00PM
The prices of electricity, health care and even taking companion animals to the vet have risen far in excess of price rises generally.
Figures released by the Association of Australian Superannuation Funds (ASFA), based on the consumer price index data from the Australian Bureau of Statistics, show the extent to which prices have risen over the past period of a little more than 10 years. 
General prices, as represented by the consumer price index, have risen 28.6 per cent over the period.
However, electricity costs have risen 124 per cent, health care 60 per cent, insurance costs are up 72 per cent and property and charges are 83 per cent higher.
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Nine different reasons for record-low wages growth

Tony Featherstone
Published: June 8 2017 - 12:15AM
Economists are in a lather about Australia's record-low wages growth. Their models cannot explain technological, social and economic forces that are crushing pay rises and consigning millions of workers to years of static income.
Annual wages growth is the lowest since records began in 1997. Pay packets in aggregate rose a measly 0.9 per cent over the past year – not nearly enough to keep up with rising living costs or help consumers pay off a mountain of debt.
Official wages growth tells only half the story. On an hourly basis, many pay packets are going backwards as more people work longer to keep their job. Or take on greater responsibility and stress for the same pay.
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Low emissions target: On carbon schemes, no one says the same thing for long

Peter Martin
Published: June 8 2017 - 8:46AM
If you don't know the difference between a carbon tax and an emissions trading scheme, or a low emissions target and an emissions intensity scheme, it's time to wise up.
On Friday Malcolm Turnbull gets the report of the Finkel review of the electricity market and later this year the report of the official review of his government's climate change policies.
What he does next will affect how much we pay, how much we use, the types of electricity we use, how quickly we cut emissions and how often the system breaks down.
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The Finkel review explained: what's in it, and why you should care

Stephanie Peatling
Published: June 9 2017 - 8:07AM
Alan Finkel, Australia's chief scientist, is due to release his review of Australia's energy market on Friday afternoon. The review has the potential to dramatically shake up the future energy supply of this country. So what do you need to know about it?
First, what is the Finkel review?
The Finkel review is the shorthand name for a review of the national electricity market, commissioned by federal and state energy ministers last year.
It was prompted - in part - by the blackouts in South Australia, which focused national attention on energy security.
The review will provide governments with a blueprint for energy security across the grid. It will also look at affordability and sustainability, as more renewable energy flows into the electricity system, and coal-fired power stations close.
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Who says consumer debt is irrelevant?

Danielle DiMartino Booth
Published: June 10 2017 - 12:15AM
Oh, but for the days the hawks had a hero in Sydney. Against the backdrop of a de facto currency war, the Reserve Bank of Australia stood as a steady pillar of strength. The RBA held the line on interest rates, maintaining a floor of 2.5 per cent, even as its global central bank peers drove rates to the zero bound and beyond into negative territory.
The abrupt end to the commodities supercycle drove the RBA to join the global currency war. The mining-dependent nation's economy was so debilitated that policy makers felt they had no choice but to ease financial conditions. In February 2015, after an 18-month honeymoon, the RBA reduced its official rate to 2.25 per cent, marking the start of a cycle that ended last August with the fourth cut to a record low of 1.5 per cent.
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Home loans fall for third month in a row

Eryk Bagshaw
Published: June 9 2017 - 3:50PM
The number of home loans being given to Australians has fallen to a two year low, fuelling speculation of a property downturn following a crackdown on investor loans by the federal government.
The figures, released by the Australian Bureau of Statistics on Friday, show loans to investors have fallen to their lowest level in seven months, down from a high of above 50 per cent in January.
The number of all home-loan approvals dropped 1.9 per cent in April after falling for the third month in a row, as banks begin to react to the orders of the market watchdog to tighten lending due to risks to the broader economy.
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Is Australia's economy really a world-beater? The spurious 26-year 'record'

Tim Colebatch
Published: June 9 2017 - 3:38PM
The claim that Australia has gone 26 years without a recession is true, but only if you accept three assumptions. Unfortunately, none of them has any official or intellectual basis.
The first is that a recession is best defined by a single measure: the total output of the economy, which we call gross domestic product, or GDP.
The second is that if GDP goes backwards for two consecutive quarters, however slightly, then you're in recession. And if it doesn't, you're not.
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Minimum Wage: Pay hikes don't cost jobs. Really.

Peter Martin
Published: June 11 2017 - 12:15AM
What was it thinking? On Tuesday, the normally hard-hearted Fair Work Commission drove up the cost of labour 3.3 per cent.
From July 1 the full-time minimum wage jumps from $34,975 to $36,135 – that's an extra $22 a week, the biggest increase in ages.
It will spread far beyond the lowest-paid. The Commission believes that 23 per cent of Australian workers, almost 1 in 4, will benefit from the flow-on increase to awards. And it'll spread further, to enterprise agreements that need to compete with awards.
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Health Budget Issues.

Damning AMA survey reveals the toll of overworking junior doctors

Kate Aubusson
Published: June 7 2017 - 5:00AM
Getting home safely after a gruelling night shift is not something Dr Tessa Kennedy takes for granted.
Three of her junior doctor friends have crashed their cars driving home after a night shift, one on her way to pick up her daughter from daycare. 
She has caught herself falling sleep behind the wheel at the end of her 16-hour shifts and 90-hour weeks.
The paediatric trainee has battled sleep-deprived panic attacks before medical exams, and cried inconsolably as she sat in her car after a narrowly escaping a crash for which she says she would have been responsible. 
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Healthcare atlas shows big differences in hysterectomy, spinal procedures between areas

Harriet Alexander
Published: June 7 2017 - 5:00AM
Patients presenting with identical conditions can be up to 21 times more likely to be given certain treatments depending on where they live and in some cases the interventions may not be warranted, according to a biennial report on healthcare variation.
The Australian Atlas of Healthcare Variation reveals Sydney's eastern suburbs are the national capital of lumbar spinal decompression procedures and Hawkesbury residents have one of the highest rates of appendix removal in the western world.
Meanwhile, Hurstville women are eight times more likely to sustain a third or fourth degree perineal tear during labour and Richmond women are four times more likely to get a hysterectomy than those living in Dubbo.
The report is the second produced by the Australian Commission on Safety and Quality in Healthcare Agency on variations in procedures between different geographic areas.
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After-hours home doctor services deemed poor value for money by taskforce

Harriet Alexander
Published: June 8 2017 - 12:08AM
Home doctor services that provide after-hours visits face stricter conditions on their Medicare billing practices after a government review found they did not represent value for money to the taxpayer.
As part of a broader review of Medicare items, the Medicare Benefits Schedule Review Taskforce examined after-hours services in response to concerns they were increasing far in excess of population growth.
Medical deputising services, which perform after-hours services on behalf of GP practices, have been booming since they expanded to regional areas and advertised their services, and providers such as the National Home Doctor Service and Dial-a-Doctor have become household names.
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Public health ‘needs private patients’ to help keep specialists

  • The Australian
  • 12:00AM June 9, 2017

Sean Parnell

Queensland Health Minister Cameron Dick has defended the practice of public hospitals billing health insurers, warning the commonwealth that any intervention would threaten the state’s ability to recruit doctors.
As The Australian revealed yesterday, Queensland public hospitals have been arguing with health funds over whether short-stay units were general wards or part of the emergency department. Queensland Health argued the former, which would have allowed them to bill treatment to health funds, but the seven insurers maintained they were the latter and therefore out of scope.
Federal Health Minister Greg Hunt has called on the states to curtail their private billing — more than $1 billion a year — out of concern it would drive up insurance premiums and the cost of the federal rebate.
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We're richer, but sicker and less equal, according to the Lateral Economics Index of Wellbeing

Jessica Irvine
Published: June 10 2017 - 12:15AM
Is life getting better in Australia?
Our record run of economic growth continues, according to Wednesday's official national accounts, which revealed tepid growth in economic output, but a jump in national income thanks to higher commodity prices.
As a nation, we pocketed $334 billion in the March quarter, on one important measure of national income.
Yippee.
But that can't be the end of the story.
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Health Insurance Issues.

Health funds refuse to pay as public hospital costs rise

  • The Australian
  • 12:00AM June 8, 2017

Sean Parnell

Public hospitals have been arguing with health funds over what constitutes a general ward, as the states continue to subsidise their operations by billing insurers more than $1 billion a year.
Federal Health Minister Greg Hunt has called on the states to curtail their private billing, out of concern it will drive up insurance premiums and the cost of the federal rebate. The states argue the billing is legal and necessary, but NSW Health Minister Brad ­Hazzard has vowed to help Mr Hunt address any concerns.
Documents obtained by The Australian under Right to Information laws show seven smaller health funds were refusing last year to reimburse Queensland public hospitals for the cost of treating members in the state’s short-stay units.
The health funds argued that the treatment was in emergency departments, and was required to be funded by the state government under national rules.
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International Issues.

London attack: 'We need to be prepared for more of this coming' experts warn

Deborah Snow
Published: June 4 2017 - 8:07PM
It took only eight minutes for three men armed with a transit van and knives to wreak havoc near the heart of London's popular South Bank entertainment district, packed with patrons on a fine Saturday night. 
Eight minutes to leave at least seven innocent people dead and up to 50 wounded. "Can you imagine what would have happened if it had gone on for half an hour," says Neil Fergus, an Australian-based security consultant with extensive expertise in counter-terrorism. 
"The response by British police and emergency services was outstanding, but it shows the amount of damage that can be caused by motivated people in a short period of time, just with a vehicle and bladed weapons." 
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Trump was right to scrap Paris

Tom Switzer
Published: June 5 2017 - 12:15AM
This time the West really is divided, probably irrevocably.
In the early 1990s, my friend Owen Harries made a startling observation: that the collapse of Soviet Communism would mean the "collapse of the West".  The West, he explained in Foreign Affairs, has been and would remain a culture defined by representative democracy, the rule of law, the market economy and so on. But a common civilisation is one thing; political unity is another.
"The West," Harries pointed out, has been usually divided politically: think of Europe's wars. "It took the presence of a life-threatening overtly hostile 'East' to bring [the 'West'] into existence" as a strategic entity. "It is extremely doubtful whether it can now survive the disappearance of that enemy." The political unity of the Cold War would give away to differences of national interests and strategies.
It has taken a quarter century, but Harries' prediction has come true. The clash between the Europeans and the Americans over NATO and the Paris climate treaty could prove to be breaking points in the political West. True, there have been earlier rifts: Suez, Vietnam, Iraq come to mind.
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China has defied the rules with impunity

Peter Hartcher
Published: June 6 2017 - 12:15AM
We hear a great gush of affirmations of the "rules-based order" that keeps the peace in the Asia-Pacific region. But whose rules? They must be Tinkerbell's rules – clap if you believe.
US Defence Secretary Jim Mattis referred to a "rules-based" order five times in his weekend speech to the big annual defence conference in Singapore, the Shangri-la Dialogue. "We have a deep and abiding commitment to reinforcing the rules-based international order," for instance.
Malcolm Turnbull spoke of the region's rules seven times in his speech to the same forum: "If we are to maintain the dynamism of the region then we must preserve the rules-based structure that has enabled it thus far."
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Address by Minister Freeland on Canada’s foreign policy priorities

Speech

June 6, 2017 – Ottawa, Canada
Check against delivery. This speech has been translated in accordance with the Government of Canada’s official languages policy and edited for posting and distribution in accordance with its communications policy.
Mr. Speaker,
Here is a question: Is Canada an essential country, at this time in the life of our planet?
Most of us here would agree that it is. But if we assert this, we are called to explain why. And we are called to consider the specifics of what we must do as a consequence.
International relationships that had seemed immutable for 70 years are being called into question. From Europe, to Asia, to our own North American home, long-standing pacts that have formed the bedrock of our security and prosperity for generations are being tested.
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At least Donald Trump is true to himself about climate change

Ross Gittins
Published: June 6 2017 - 1:50PM
We are trying – admittedly, without much success so far – to make our home a Tr*mp-free zone. It's just too depressing. Watching a great nation disgrace itself before the rest of the world.
The former proudly self-proclaimed leader of the free world suffering a loss of confidence and applying for early retirement.
A nation that every year scoops the pool of Nobel prizes, electing a crazy, ignorant, wilful old man, not so much Trump as Chump.
His latest stroke of genius – reneging on America's commitment to the Paris climate agreement – has been almost universally condemned, including by a great number of Americans, especially many business leaders.
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South Korea suspends US THAAD antimissile system

Motoko Rich
Published: June 8 2017 - 5:29AM
Tokyo: South Korea's newly elected president, Moon Jae-in, has suspended the deployment of a US missile defence system, an apparent concession to China and a significant break with the United States on policy toward North Korea.
In comments to reporters, a senior official from the presidential Blue House in Seoul said Wednesday that the two launchers of the Terminal High Altitude Area defence system that had been installed could remain but that four launchers that had yet to be deployed would not be set up until the administration completed an environmental assessment.
The missile defence system, known as THAAD, has been controversial in South Korea and has drawn sharp criticism from China, which views the system's radar as a threat. Beijing has taken retaliatory economic measures against Seoul, including curtailing the flow of Chinese tourists and punishing South Korean companies in China.
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Watergate 'pales' compared with Donald Trump, says former US intelligence chief

David Wroe
Published: June 8 2017 - 1:59AM
The infamous Watergate scandal "pales" in comparison to the allegations about the Trump administration's links to Russia, former United States intelligence chief James Clapper has said in an explosive set of remarks in Canberra.
Mr Clapper, who served as Director of National Intelligence under Barack Obama and in senior roles with Republican leaders as well, also said he would "understand" if US allies such as Australia withheld intelligence from American counterparts because of Mr Trump's demonstrated lack of discretion with such sensitive secrets.
The 50-year veteran of the military and the intelligence community painted a picture of disconcerting dysfunction in Washington with "assaults on American institutions coming from both external and internal sources" and most strikingly said the Trump-Russia links were much worse than the notorious scandal that toppled former US president Richard Nixon in the 1970s.
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US-Australia bond transcends transitory occupant of White House: James Clapper

James Clapper
Published: June 7 2017 - 5:27PM
I first came to Australia in 1984, visiting Alice Springs as commander of the US Air Force Technical Applications Centre. More than three decades of association with this country has reinforced my conviction of the importance of the United States' extensive relationship with Australia and its national security community.
Australia's outgoing Defence secretary Dennis Richardson said recently that "Australian governments have generally been pragmatic and hard-headed in weighing alliance considerations on matters of war and peace".
This is, of course, both true and proper.
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In two short sentences, Trump's White House just partially excused terrorism

David Wroe
Published: June 8 2017 - 10:47AM
Donald Trump has once again diminished his country with an appalling White House statement.
We're sorry. But you sort of deserved it.
That's the takeout from the White House's response to the Islamic State-claimed attacks on Iran's capital yesterday, in which at least 12 people were murdered at the Parliament building and the Ayatollah Khomeini mausoleum.
"We grieve and pray for the innocent victims of the terrorist attacks in Iran, and for the Iranian people, who are going through such challenging times," the White House statement reads. "We underscore that states that sponsor terrorism risk falling victim to the evil they promote."
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'A very big deal': James Comey testifies Donald Trump sought to change Russia probe

Paul McGeough
Published: June 9 2017 - 11:00AM
Washington: "It's my judgment," sacked FBI director James Comey told US senators, "That I was fired because of the Russia investigation - I was fired in some way to change, or the endeavour was to change, the way the Russia investigation was being conducted. That is a very big deal."
Americans watched agog on Thursday as Comey used his forensic legal skills and flashes of anger to inflict significant damage on US President Donald Trump, laying out a case of what seemed to amount to a presidential obstruction of justice.
But at the last minute, he declared it was not his job to write the charge. "Crazy" and a "nut job" this man is not. 
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I look forward to comments on all this!
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David.