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, October 19, 2017

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

October 19, 2017 Edition.
Trump has been pretty busy this week attacking Obamacare with all sorts of attempts to defund it while really failing to get to grips with a range on natural disasters in California etc.
It is hard to believe he is making such a mess of being President as it seems is Theresa may who is pretending to be British PM while sliding ever downwards into some abyss. And add to that the Philippines President is about to declare some form of revolutionary council to stop being ousted..
This really continues to be a very bad dream from which we all need to wake up!
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In Australia the SSM Postal Survey seems to be working and it already 65.0+% have voted as of Friday. Roy Morgan the pollster says it all over and ‘yes’ have clearly won (60%+)  We will all see mid-November.
Energy policy continues to be a putrid mess - but may be on the improve with the announcement of the National Energy Guarantee - the next week or so will tell!
Health Insurance has got a new package of measures – well intentioned – but doomed to fail I suspect.
Worse, the Reserve Bank is so worried it is about to start ‘stress testing’ the banks!
  • Updated Oct 13 2017 at 9:09 PM

Reserve Bank to stress test banking sector as risks rise

The Reserve Bank of Australia is opening the door to even tougher regulatory restraints on risky bank lending after announcing it would do its own "bank stress tests," a task usually performed by the prudential regulator.
Amid a fresh barrage of warnings that limits on investor lending would not reduce high household debt levels, the Reserve  flagged plans to gauge how resilient the financial system is to a potential meltdown for the first time.
Preliminary work by analysts unveiled by the central bank in its twice-a-year Financial Stability Review on Friday suggest fallout of a sudden surge in bad loans in the banking sector can be unpredictable and sudden.
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Time to be at least alert if not alarmed!
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Here are a few other things I have noticed.
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Important Articles.

GST system broken 'beyond comprehension', Productivity Commission finds

Peter Martin
Published: October 9 2017 - 8:17AM
Australia's system of dividing Goods and Services Tax revenue between the states is broken "beyond comprehension by the public, and poorly understood by most within government", the Productivity Commission has declared in a landmark report.
Although it has broad support, GST embodies an "undeliverable ideal": to bring all states up to the financial capacity of the strongest state, which at the moment is Western Australia.
"The pure may be the enemy of the good," the commission says.
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GST: Productivity Commission proposes a softening of the edges rather than a revolution

Peter Martin
Published: October 9 2017 - 4:54PM
The Productivity Commission has found that the way the GST is divided up is broken, and much of it "beyond comprehension". But it has also found something more important: that the brokenness doesn't much matter.
Treasurer Scott Morrison asked it to examine the influence of the current system on "productivity, efficiency and economic growth".
In short, the commission found there was none, or none it could find.
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We're all human: 'Nudge' theorist Richard Thaler wins economics Nobel

Published: October 10 2017 - 8:56AM
US academic Richard Thaler, who helped popularise the idea of "nudging" people towards doing what was best for them, won the 2017 Nobel economics prize for his work on how human nature affects supposedly rational markets.
Influential in the field of behavioural economics, his research showed how traits such as lack of self-control and fear of losing what you already have prompt decisions that may not have the best outcome in the longer term.
"I think the most important impact (of my research) is the recognition that economic agents are human and economic models have to incorporate that," Thaler, a professor at the University of Chicago Booth School of Business, said in a call broadcast at the Nobel news conference.
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Global data shows 2017 is shaping as the best year ever

Matt Wade
Published: October 11 2017 - 12:05AM
Amid mass shootings, super storms and talk of nuclear conflict, here's some good news.
Barring a global catastrophe, 2017 is shaping as best year ever for the world's average person.
That doesn't mean everyone is better off, of course, but the positive trend in international wellbeing data since 2000 is striking.
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Part-time work and 'gig' economy are breaking down the welfare system, IMF warns

Eryk Bagshaw
Published: October 11 2017 - 12:01AM
Social security systems that have underpinned Western economies since World War II will not be able to cope with the rise in the "gig economy", part-time work and stubbornly low wage growth, the International Monetary Fund has warned.
The outlook from the world's leading financial stability organisation, to be released on Wednesday, could force policymakers in Australia and abroad to re-think the foundations of welfare as businesses increasingly look to hire workers on an as-needed basis.
There are now 1.1 million underemployed Australians, up from 170,000 in the 1970s, according to the Australian Bureau of Statistics, while the number of people employed in the casual "gig economy" has surged alongside services such as Uber and Airtasker.
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  • Updated Oct 11 2017 at 11:45 PM

Sydney's median house price drops 1.9pc: Domain

Sydney's median house price fell 1.9 per cent in the three months to September, the first decline in almost two years as rising interest rates for investors hit demand, the latest figures from Domain Group show.
The decline that pulled the median house price in the NSW capital to $1,167,516 was the largest during a third quarter that also saw the national median price fall 0.5 per cent – its steepest drop in six years – to $819,455.
Even in Melbourne, where the median house price rose 1.3 per cent to $880,902, the gain was the weakest quarterly gain in three years and was a sign that regulator-driven efforts to cool housing demand by driving borrowing rates for investors were having an effect, Domain chief economist Andrew Wilson said.
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  • Updated Oct 11 2017 at 6:31 PM

Tax bills to surge for the middle-class: PBO

Australia's middle classes – already battered by rising energy costs and debt burdens – will be heavily hit by the Senate's failure to wrestle control of spending, with around 1.6 million taxpayers confronting surging tax bills in the next four years.
With both sides of politics locked into reversing the nation's entrenched budget deficits primarily by collecting a growing share of income taxes, research by the independent Parliamentary Budget Office underscores the growing political temptation for Canberra to slug the nation's top 20 per cent of income earners more heavily.
The research confirms the Howard-era tax cuts have been almost completely wiped out for almost 80 per cent of taxpayers, with the top 40 per cent now paying almost 3 percentage points more than when the Coalition lost office in 2007.
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Higher taxes to hit 1.6 million Australians, Parliamentary Budget Office report reveals

Eryk Bagshaw
Published: October 12 2017 - 9:27AM
More than one million Australians will be hit with increased taxes over the next five years as the rising wages of middle income earners force them into higher tax brackets. 
The assessment from the Parliamentary Budget Office, released on Wednesday, could set the stage for pre-election personal tax cuts as early as next year. 
The Budget Office found the average tax rate will climb 2.3 per cent over the next five years and affect at least 1.6 million Australians. 
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  • October 12, 2017

Retirement in Australia is unrealisable for most workers: Satyajit Das

by Satyajit Das
Australians make up barely 0.3 per cent of the globe's population and yet hold $2.1 trillion in pension savings - the world's fourth-largest such pool.
Those assets are viewed as a measure of the country's wealth and economic resilience, and seem to guarantee a high standard of living for Australians well into the future. Other developed nations, aging even faster than Australia and subject to fraying safety nets, have held up the system as a world-class model to fund retirement. In fact, its future looks nowhere near so bright.
Australia's so-called superannuation scheme is a defined contribution pension plan funded by mandatory employer contributions (currently 9.5 per cent, scheduled to rise gradually to 12 per cent by 2025).
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Scott Morrison moves to reassure investors Australia's housing market isn't heading for a crash

James Massola
Published: October 12 2017 - 11:45PM
Treasurer Scott Morrison has moved to reassure US investors – and Australian mums and dads – that Australia is not headed towards a housing market crash, arguing house prices are high but their value is still "real".
And in a speech in New York to investors overnight, Mr Morrison pushed back at a recent warning from the International Monetary Fund about particularly high levels of household debt in Australia by pointing to a series of measures taken by prudential regulator APRA to constrain access to credit.
He outlined three major risks to the Australian economy – household debt; a rise in Chinese debt and a subsequent slowing of growth in that country; and the risk of high levels of federal government debt.
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RBA review warns on mortgage shock

  • The Australian
  • 1:31PM October 13, 2017

Michael Roddan

The Reserve Bank has revealed deep concerns about the property market, warning interest-only borrowers are vulnerable to “payment shock” and that many households could be forced to dump their homes onto the market.
In a stark admission of the heightened threat to financial stability amid endless increases in household debt and rampant property prices, the RBA will launch “top down stress tests” of the banking system, which will be carried out on top of the supervision from the Australian Prudential Regulation Authority.
It’s another layer of scrutiny on the banking system, which being investigated by the corporate watchdog for possible breaches of responsible lending laws when interest-only loans are sold to customers.
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National Budget Issues.

Be alert, not alarmed, about Australia's high household debt

Jessica Irvine
Published: October 8 2017 - 9:05PM
Another day, another dire warning that Australian households are about to crumple under the crushing weight of debt.
The Chicken Littles of this world were set chirping last week by a special report by the International Monetary Fund, which today kicks off its annual meetings.
Central bankers from around the world, including Australia, are presently winging their way to Washington DC clutching copies of the special new analysis titled "Household Debt and Financial Stability".
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Meet La Niña, the little girl spreading fear in commodity markets

Anna Isaac
Published: October 9 2017 - 10:11AM
Most people don't fear little girls, but meteorologists know better when it comes to this one, and so do economists.
In September, the risk of La Niña, (Spanish for "little girl"), a weather pattern that in its strongest manifestation has been blamed for flooded mines in Australia and failed crops in Brazil, was tripled to 60 per cent by the US Climate Prediction Centre.
La Niña is part of what is known as the El Niño-Southern Oscillation cycle. While El Niño warms waters in the central Pacific Ocean, La Niña has an opposite effect. And the changes in sea temperature caused by these weather events can trigger large shifts in weather patterns.
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Coalition searches for escape from its Western GST nightmare

Mark Kenny
Published: October 8 2017 - 8:48PM
Malcolm Turnbull and Scott Morrison are not insensitive to their WA-based federal colleagues regarding that state's GST shortfall, it's just that the problem is so diabolical.
To date, they have praised MPs from the resource-rich west for their advocacy, while conspicuously failing to give them comfort.
Both know retaining WA seats is fundamental to their own survival as well.
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Ethical and socially responsible investing: A real force for change or just a gimmick?

Nassim Khadem
Published: October 10 2017 - 10:34AM
In an ideal world, companies would care about people as much as profits.
They would pay and treat their employees and customers fairly, be honest and transparent with them, deliver only products and services that were beneficial to people and the planet, and pay taxes relative to profits.
I did say ideal. As a spate of recent banking and financial planning scandals has proven, far-too-often the reverse is true.
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Australia gets into the missile defence game as rogue threat rises

David Wroe
Published: October 7 2017 - 11:45PM
Standing on the deck of Australia's newest and most powerful warship, HMAS Hobart, this week, a young naval officer explained the array of chunky sensors that look like a fat, grey shish kebab upended on the top of the ship.
The large Lockheed Martin SPY-1D radar panels see for at least 200 kilometres in every direction.
There is a forward-pointing satellite dish, the fire control radar, which "paints" a target. The circular "identification, friend or foe" sensor speaks pretty much for itself.
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Health Budget Issues.

Private patients foot the bill for health insurance rebate cuts

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

Sean Parnell

Labor’s changes to the health insurance rebate meant federal government spending on the subsidy dropped for the first time in 2015-2016, according to figures that demonstrate how the cuts will deliver savings to taxpayers at the expense of the privately insured.
Australian Institute of Health and Welfare figures show the rebate cost the government $5.79 billion in 2014-2015 but the next year total spending fell to $5.74bn.
Labor introduced a means test and then tied indexation of the rebate to general inflation, not the higher amount that premiums rise by each year, meaning its dollar value to health fund members will decline over time.
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Medibank invests in home-based hip rehab

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

Sarah-Jane Tasker

Health insurance giant Medibank is beefing up its push for more home care with a $4 million investment in knee and hip rehabilitation, to shift patients out of the expensive hospital setting.
Andrew Wilson, Medibank’s group executive of healthcare and strategy, said the insurer wanted to provide more healthcare choices for its customers, no matter what their needs were.
“If you look around the world, more and more care is being delivered in the home,” he said.
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$187,000 to $6.30: Turnbull government subsidy gives hope to cancer sufferers

Adam Gartrell
Published: October 9 2017 - 8:03AM
A breakthrough leukaemia and lymphoma drug that normally costs $187,000 per treatment will become easily affordable under a new $460 million Turnbull government subsidy.
Ibrutinib, known as Imbruvica, will cost patients $38.80 a script – or $6.30 for concessional patients - once it is listed on the Pharmaceutical Benefits Scheme from December 1.
The drug will be available to all eligible patients with relapsed or refractory chronic lymphocytic leukaemia (CLL) or small lymphocytic lymphoma (SLL).
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Sick Aussies unable to afford X-rays and other scans due to Medicare rebate freeze

Sue Dunlevy, National Health Reporter, News Corp Australia Network
October 8, 2017 10:00pm
PATIENTS are facing an average $100 hit to their hip pocket for X-rays and other scans because Medicare rebates have been frozen since 1998.
A Deloitte Access Economics report, commissioned by the Turnbull Government, has found Medicare rebates for scans are set at a level 20 per cent below the cost of delivering the service.
In response, the report urges that Medicare rebates for X-rays and other scans must be increased to slash massive out of pocket expenses faced by patients.
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Dementia helping to fuel the private insurance premium surge

Michael Pascoe
Published: October 11 2017 - 1:55PM
Private health insurance premiums continuing to outpace inflation tell two stories: treatments keep rising in cost; we're using those treatments more as the population ages. PHI critics, such as me, tend to overlook the impact of the latter.
Nowhere is that aging impact more obvious than in the elevation of dementia to the status of the biggest single cause of death for Australian women. It's second overall, thanks to men's predilection for heart disease, but that's changing fast. On the trends recorded by the Australian Bureau of Statistics, men will be joining women soon enough.
The rise of dementia as our primary killer is itself testimony to the success (and expense) of our health system in prolonging lives, but we all still have to die of something and the longer we live, the more likely that "something" will be dementia.
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Health fund premiums to be slashed by up to 10 per cent for young Australians

Sue Dunlevy, National Health Reporter, News Corp Australia Network
12 October, 2017
HEALTH fund premiums for people under the age of 30 will drop by up to 10 per cent under a major overhaul of private health insurance to be announced by the government tomorrow.
And premium rises for those aged over 30 will be bought back closer to the inflation rate with the government planning to slash by hundreds of millions of dollars the amount health funds pay for prostheses like hip and knee replacements.
The government will also try to end the confusion surrounding the choice of the best health fund policy by revamping its private health insurance ombudsman website and giving the ombudsman more staff.
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  • October 12, 2017

Why are private health insurers in trouble?

It's no secret that private health insurance is seen by many consumers as being something of a "grudge purchase." As premiums continue to rise, many have begun to question the value of taking out cover at all, and that has pushed the sector to breaking point.
Analysts at UBS estimated that premium rates needed to increase by 6 per cent a year to hold net margins steady, prompting NSW Health Minister Brad Hazzard to say that something must be done to ensure health insurance is cheaper.
"There are a lot of costs that are currently charged, for example in surgery, by both the medical practitioner and by the medical device companies that are excessive. I think we need to really drive the competitive element amongst those who provide health services," he said.
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  • October 12, 2017

How the government plans to cure Australia's health insurance crisis

Young people will be offered discounted premiums and consumers promised more clear cut information about what policies cover as part of sweeping changes to address the crisis facing the health insurance industry.
After two years of consultations with medical and consumer groups, Health Minister Greg Hunt will unveil a 14-point plan for reforming the sector it hopes will reverse the exodus of members from funds.
The key focus of the government will be take the pressure off premiums, which have consistently risen by double the inflation rate in recent years. Across the industry, premiums jumped by an average of 4.84 per cent this year.
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Private health insurance reforms: What you need to know

YOU won’t be able to claim for some things anymore, but other cover will increase. Here is everything you need to know.
AN OVERHAUL of the private health insurance system will see cheaper premiums and easier access to mental healthcare introduced.
Health Minister Greg Hunt on Friday will announce a major shake-up of the system, with those under 30 expected to be the biggest beneficiaries.
Young people are being targeted as they are generally healthy and less likely to claim.
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International Issues.

'What the law says': Catalonia will follow through with independence declaration - leader

Adrian Croft
Published: October 9 2017 - 6:06AM
Barcelona: Catalonia will apply the law that calls for a declaration of independence following a majority 'yes' vote, Catalan leader Carles Puigdemont says in a television program to be broadcast later on Sunday, local time.
"The declaration of independence, that we don't call a 'unilateral' declaration of independence, is foreseen in the referendum law as an application of the results. We will apply what the law says," Puigdemont says in the program on Catalonia's TV3, according to excerpts on the broadcaster's website.
The Catalan government says more than 90 per cent of people who voted in the October 1 referendum voted in favour of independence from Spain. The referendum was declared illegal by Spanish authorities and turnout was only 43 per cent.
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  • Oct 9 2017 at 2:00 PM

Trump's tax plan 'absurd or dishonest', writes Lawrence Summers

Lawrence Summers doubts whether a corporate tax cut in the US will lead to significant economic or productivity growth. Bloomberg
by Lawrence Summers
The US administration's tax plan is not a plan. It is a mélange of ideas put forth without precision or arithmetic.
It is not clear enough to permit the kind of careful quantitative analysis of budget costs, economic impacts and distributional implications that precedes legislation in a serious country.
It is clear enough to demonstrate that the claims of Steven Mnuchin, Treasury secretary, Gary Cohn, director of the National Economic Council, and Kevin Hassett, chair of the Council of Economic Advisers, are some combination of ignorant, disingenuous and dishonest.
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Harry Harris, China's least favourite American, is firming as Trump's man in Oz

Peter Hartcher
Published: October 10 2017 - 12:05AM
The Trump White House is now carrying out consultations in Washington to test reactions to the appointment of Admiral Harry Harris as ambassador to Australia, and the reactions so far are strongly positive.
This signals a rising likelihood that the four-star commander of America's Pacific Command will be nominated to the post, a very deliberate message of commitment to the military alliance with Australia.
Who is the intended recipient of the message? The first is Canberra as the US seeks to reassure its anxious ally. The second is Beijing. The Trump administration wants to tell China that it cannot divide Australia from America.
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Failure to check North Korea's nuclear ambitions could embolden other nations

Julie Bishop
Published: October 11 2017 - 12:01AM
 North Korea's ballistic and nuclear weapons programs are illegal and in violation of eight resolutions of the United Nations Security Council.
It is vital that the authority of the Security Council is upheld as the custodian of international order and international law in the global system.
The responsibility for defending that authority lies most heavily with the five permanent members, the US, China, Russia, the UK and France.
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Donald Trump threatens to abandon Puerto Rico recovery effort

John Bacon
Published: October 13 2017 - 5:36AM
President Trump warned on Thursday that the Federal Emergency Management Agency and the US military can't provide aid to Puerto Rico "forever," even as the hurricane-battered island struggles to provide power, water and other basic services three weeks after the devastation wrought by Hurricane Maria.
Trump's tweets drew a sharp response from San Juan Mayor Carmen Yulin Cruz, who referred to the president on Twitter as a "hater-in-chief."
Trump also tweeted that Congress must decide how much money the federal government will spend and noted that "electric and all infrastructure was disaster before hurricanes."
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Trump is tying his presidency to the stock market. He might come to regret that.

Heather Long
Published: October 14 2017 - 12:21PM
President Donald Trump seems to have another obsession: The stock market. He mentions it almost daily now, touting how the Dow Jones industrial average - a popular US stock market indicator - is up 25 per cent since Election Day.
It's almost as if, in Trump's mind, the stock market is his report card. At a time when the polls give him about a 40 per cent approval rating, he seems to view the market as giving him a standing ovation.
Trump's tweet from Wednesday is a much different tone than a year ago, when Trump warned America to beware of a "big fat bubble" in stocks.
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Duterte threatens to declare revolutionary government amid coup fears

Lindsay Murdoch
Published: October 14 2017 - 11:39AM
Philippine president Rodrigo Duterte has warned he will declare a revolutionary government and arrest all his critics if a plot to oust him escalates.
"I will not hesitate to declare a revolutionary government until the end of my term and I will arrest all of you and we can go to a full scale war against the Reds," he said.
For days senior officials and Mr Duterte's administration have been warning of a plot to overthrow the mercurial president whose war on drugs has left more than 10,000 mostly poor Filipinos dead in the largest loss of civilian lives in Asia since the 1970s.
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'They will not be able to avoid a disaster': Julie Bishop comments prompt North Korea threat

Published: October 14 2017 - 10:38PM
North Korea has criticised and threatened Australia for aligning itself with South Korea and the United States and for its attitude toward the Pyongyang regime, according to state-run media.
"Lately, Australia is showing dangerous moves of zealously joining the frenzied political and military provocations of the US against the DPRK," state-run news agency KCNA said in a statement on Saturday.
"The Australian foreign minister personally expressed her support for the stand of the US to consider all options including the use of force towards the DPRK, and turned up at Panmunjom on October 11 together with the Australian defence minister to condemn the DPRK during her visit to South Korea," it added.
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I look forward to comments on all this!
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David.

Grahame Grieve Points Out That The Architecture Of The myHR Is Fatally Flawed And Needs Change!

 Grahame Grieve posted this a day or so ago - and remarked to me that the audience here would expect me to repost it for their consideration and discussion!

Argonaut in Australia, and the MyHR

Posted on October 17, 2017 by Grahame Grieve
Project Argonaut is coming to Australia. That is, at least one major US EHR vendor is planning to make their SMART-on-FHIR EHR extension interface available in Australia during 2018 (discussion about this at Cerner Health Conference where I was last week). HL7 Australia will work with them (and any other vendor) to describe what the Argonaut interface looks like in Australia (short answer: not much different: some different patient extensions, a few terminology changes (not RxNorm), maybe a couple of extensions on prescriptions for Reg24 & CTG). Also, HL7 Australia will be planning to engage with Australian customers of the US EHR vendors to help build a community that can leverage the capabilities of the SMART on FHIR interface.
This is a big deal for Australian EHR vendors that compete with the US vendors – they better start offering the same capabilities based on the same standards, or one of their key market advantages will be consigned to the dust of history. They’ll also find themselves competing with established SMART on FHIR Application vendors too. So I look forward to good engagement with Australian companies as we flesh this out (I know at least one will be deeply involved).
This also offers us an opportunity to consider what to do with the MyHR. The government has spent a great deal of money on this, and results have been disappointing. (Yes, the government publishes regular usage stats which show continuous increase, but these are not the important usage metrics, and they’re not the kind of stats that were hoped for back when we were designing the system). And it’s hardly popular amongst the typical candidate users (see, for example, AMA comments, or for more color, this or even David More’s blog).
But I’m not surprised at this. Back when it was the pcEHR, the intentions were solid, and though the original timeline was impossibly tight, it came together in an amazingly quick time (kudos to the implementers). But as it came together, I knew it was doomed. This is inevitable given it’s architecture:

Salient points about this architecture:
  • The providers push CDA documents to the central document repository
  • Patients can view documents about them
  • Patient’s can write their own documents, but providers won’t see them
  • Patient’s can exert their control only by ‘hiding’ documents – e.g. they can only break the flow of information (reminder, the internet age treats censorship as damage and routes around it)
  • Clinicians can find and read documents
  • Each document is it’s own little snap shot. There’s no continuity between them, no way to reconcile information between them
  • There are no notifications associated with the system
You can’t build any process on that system. You can’t even build any reliable analysis on it (stakeholders worried about the government using it for secondary data analysis shouldn’t, in general, worry about this, it’s too hard to get good data out of most of the CDA documents). These limitations are baked into the design. That’s why I went and developed FHIR – so that when the full reality of the system become evident, we’d have a better option than a document repository.
Well, 10 years later, and we’re still trying to load ever more use into the same broken design, and the government sponsors are still wondering why it’s not ‘working’. (at least we stopped calling it the ‘personally controlled’ EHR, since it’s the government controlled EHR). And as long as it exists and is the focus of all government efforts to make digital health happen, it will continue to hold up innovation in this country – a fact which is terribly evident as I travel and see what’s happening elsewhere.
But it doesn’t have to be like this.
The MyHR is built on a bunch of useful infrastructure. There is good ideas in here, and it can do good things. It’s just that everything is locked up into a single broken solution. But we can break it up, and reuse the infrastructure. And the easiest way I can see to do this is to flip the push over. That is, instead of the source information providers pushing CDA documents to a single repository, we should get them to put up an Argonaut interface that provides a read/write API to the patient’s data. Then, you change the MyHR so that it takes that information and generates CDA documents to go into the MyHR – so no change needed to the core MyHR.
What this does is open up the system so all sorts of innovation, the most important of which is that the patient can authorise their care providers to exchange information directly, and build working clinically functional systems (e.g. GP/local hospital, or coordinated care planning), all without the government bureaucrats having to decide in advance that they can’t be liable for anything like that. That is, an actually personally controlled health record system not a government controlled one. And there’s still a MyHR for all the purposes it does exist for
This alternative looks like this:


All the providers – even the MyHR – put up the same Argonaut interface.
The salient features of this architecture:
  • The providers make healthcare information services available using an Argonaut interface (including write services)
  • Patients can control the flow at the source – or authorise flows globally through myGov (needs new work on myGov)
  • Systems can read and write data between them without central control
  • The MyHR can pull data (as authorised) from the sources and populate the MyHR as it does now
  • Vendors and providers can leverage the same infrastructure to provide additional services (notifications, say)
The patient can exert control (either directly at the provider level, or through mygov as an OAuth provider) and control the flow of information at the source – they can opt-in or -out of the myHR as appropriate, but they can also share their information with other providers of healthcare services directly. Say, their phone’s very personal health store. Or research projects (e,g, AllofUs). Or, most importantly and usefully, their actual healthcare providers, who can, as authorised by the patient, set up bi-directional flows of information on top of which they can build better coordinated care processes.
These features lead to some important and different outcomes:
  • Clinical Trials and companies can innovate to build distributed care models that provide a good balance between risk and reward for different populations (instead of the one-size suits bureaucrats that we have now)
  • Patient’s can control the system by enabling the care flows that they want
  • Clinicians can engage in better care processes and improve their process and outcomes (though the US process shows clearly that things get worse before they get better, and you have to plan for that)
This isn’t a small change – but it’s the smallest change I know of that we can make that preserves the MyHR and associated investment, and gives us a healthcare system that can innovate and build better care models. But I don’t know how we’ll think about getting there, given that we’re still focused on “make everyone use the MyHR”.
Note: Adapted from my presentation yesterday at the HL7 Australia Meeting

Here is the link to the original blog:

http://www.healthintersections.com.au/?p=2720

To me this is spot on but it is my view there are additionally some other issues that add to the 'fatally flawed' case. Among these I would highlight that you can't build a system for both patients AND docs and that any secondary system is intrinsically dangerous because of synchronisation and currency issues. I hope the ADHA is listening!

Enough said - this is Grahame's blog!

Comments welcome!

David.


Wednesday, October 18, 2017

The Minister Responsible For The NBN Is In Cloud Cuckoo Land On How It Is Going!

From Wikipedia:
Cloud cuckoo land refers to a state of absurdly, over-optimistic fantasy or an unrealistically idealistic state where everything is perfect. Someone who is said to "live in cloud cuckoo land" is a person who thinks that things that are completely impossible might happen, rather than understanding how things really are. It also hints that the person referred to is naive, unaware of realities or deranged in holding such an optimistic belief.
Mitch Fifield penned to following for the AFR:
  • Updated Oct 9 2017 at 11:01 AM

NBN critics 'disconnected from reality': Communications Minister Mitch Fifield

by Mitch Fifield
Clickbait headlines like "NBN slower than Kenya, ex-Soviet bloc" might be eye-grabbing, but they're completely disconnected from reality.
In a case of "lies, damned lies, and statistics", the article published in The Australian Financial Review (October 5) repeats a number of misleading claims about Australian broadband speeds – including the howler that Australia's internet is slower than Kenya's.
The facts tell a very different story. Kenya has a broadband penetration rate below 2 per cent – meaning that 98 per cent of people living in Kenya have no access to a fixed broadband connection.
Contrast this with the National Broadband Network rollout in Australia, which will connect 100 per cent of Australian premises by 2020. Today, the NBN already passes 6.4 million Australian premises and close to 3 million premises already have an active connection – compared to fewer than 200,000 premises in Kenya that can access broadband at all.
If Australia's global broadband ranking was judged solely on 2 per cent of Australian premises in the wealthiest, most densely-populated areas, we'd shoot up the charts – but this completely misses the point.
The National Broadband Network rollout has the objective of making high-speed broadband available to 100 per cent of Australian premises.
The 98 per cent of Kenyans without any access to broadband at all would no doubt take issue with the fatuous claim that Kenya is somehow better off than Australia.
It's a cute coincidence that Kenya has fewer than 200,000 premises with access to high speed broadband, because that's how many premises in Australia had access to the NBN after two terms of Labor government and $6 billion sunk into the rollout of Labor's slow, expensive fibre to the premises network.

'Faster, more affordable rollout'

After four years of the Coalition's faster, more affordable NBN rollout, the NBN is now being made available to around 150,000 new premises every single month.
And it's worth mentioning that the report which ranks Kenya's sub-200,000 broadband users above Australia is mostly measuring non-NBN connections in Australia, given that the majority of Australian households are yet to transition to the NBN.
As more homes disconnect from old ADSL services and get on the faster NBN, expect Australia's average internet speeds to climb.
The article claims that internet speeds make it "tougher for workers to move from major cities and ease pressure on house prices in Sydney and Melbourne". This argument misses the point that the rollout of the NBN is more advanced in regional areas than major metropolitan areas, thanks to the Coalition's decision to prioritise regional areas which had typically languished with poor connectivity.
The rollout in regional Australia is more than two-thirds complete, and the fixed wireless technology often used in regional outskirts offers broadband speeds of up to 50Mbps, soon to be 100Mbps – much faster than ADSL services available in cities.
The article goes on to claim that Australia's internet speeds "makes it harder to boost productivity". The reality is that the best way to improve productivity is to roll out the network faster – not to roll out a gold-plated all-fibre NBN.
The Coalition's NBN is due to be complete by 2020, giving 100 per cent of Australians access to the productivity benefits of high-speed broadband at affordable prices.

No need for all-fibre switch 

Were Australia to revert back to an all-fibre rollout, parts of Australia would be waiting until 2026-28 to have access to high-speed broadband – in the meantime they would be expected to languish on pre-NBN technology – hardly providing a boost to productivity.
The article repeats another great furphy of the NBN debate – that nations around the world are rolling out fibre-to-the-premise networks. Nothing could be further from the truth.
Nations around the world are overwhelmingly rolling out a mix of technologies to deliver high-speed broadband in the most economically pragmatic fashion.
Fibre to the premises might make sense in city-states like Singapore and Hong Kong where almost the entire population lives in high-rises. But for the rest of the world a mix of technologies is enabling people to connect to high-speed broadband faster and at lower cost.
The Coalition's NBN is one of the greatest corporate turnaround stories in recent memory. From a network that had just 51,000 active users in 2013 to almost 3 million users in 2017, the NBN doubled its footprint in the past year and will do so again in the coming year.
While Labor's plan would have taken six to eight years longer and cost an additional $30 billion to complete, the Coalition's NBN will stop household internet bills from rising by up to $43 per month. There's not much point rolling out the world's fastest broadband network if nobody can afford the monthly bills.
The Coalition is the only party that can be trusted to improve Australia's internet speed ranking – by getting the NBN connected to as many Australians as quickly as possible.
Mitch Fifield is the Minister for Communications
Here is the link:
No mention of all the complaints, problems and difficulties many are having and no recognition that even the PM admits there are a number of issues to be addressed:
See here:

Malcolm Turnbull defends NBN rollout, says comparison to Kenyan internet is 'rubbish'

Tim Biggs
Published: October 6 2017 - 12:11PM
Prime Minister Malcolm Turnbull has said he is "keenly aware" of the pain and disappointment NBN installations are causing the public, but says the issues are related to marketing and customer service, not the network's technology itself.
"[NBN Co has] got to improve the installation experience. That's a people management, a process management issue. And they're getting on top of that", Mr Turnbull said in an interview with 3AW's Neil Mitchell, adding that complaints about poor installation experiences were one of the two areas causing the majority of the strife.
The second, he said, was that retail service providers were "not buying enough capacity" to deliver the speeds they are promising to consumers.
"People are being told by the telecom retailers that they're going to get speeds which are not being delivered at peak times. And we've got a number of changes to ensure that that problem doesn't continue", Mr Turnbull said.
Lots more here:
Its more than the installation experience, it the total user operation experience and total missing of reasonable expectations! Even the PM agrees more work – not denial – is needed. Kenya references are a distraction - the actual shambles of a roll-out is not!
Cloud Cuckoo Land is spot on to describe the Ministers pathetic attitude I reckon!
Ba humbug!
David.

This Is A Sensible Decision You May Have Missed. A Good Idea I Believe!

This popped up last week:

Why Australians won't use myGov to opt out of e-health records

By Justin Hendry on Oct 10, 2017 6:30AM

Govt builds separate portal.

Australians that choose to opt-out of the My Health Record will do so through a standalone portal and not via the myGov online service portal, the Australian Digital Health Agency has revealed.
The e-health record operator has created the opt-out portal to remove the need to force individuals to register for a myGov account.
It was first tested during the opt-out trials in the Northern Queensland and Nepean Blue Mountains Primary Health Networks last year, at a time when myGov was plagued by complaints about its reliability and usability.
myGov has since undergone a $50 million overhaul by the Department of Human Service, Australian Taxation Office and the Digital Transformation Agency to address concerns about usability on mobile devices and offer simpler navigation.
A spokesperson from the ADHA told iTnews that the opt-out portal was created to “provide a direct process for people whose sole desire for interaction with government services is to opt-out, whereas myGov’s purpose is to provide simple and secure access to government online services”.
“Consumers are required to go through sign-up process in order to be authenticated every time when accessing myGov, which is a barrier for people wanting to opt-out [of a My Health Record],” the spokesperson said.
The spokesperson also noted that evaluations of the standalone opt-out portal during the opt-out trial had found it to be “cost effective” and “easy to use”.
The ADHA is now planning to use the portal in the shift from opt-in to opt-out e-health records next year.
Lots more here:
Given all the leaks and breaches going on at present I would be going to the site in a flash!
David.