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, January 11, 2018

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

January 11, 2018 Edition.
Well, here we are in the second week 2018 and it seems almost nothing has changed.
Trump is still in the Whitehouse smarting at the release of Fire and Fury by a Mr Wolff. He seems to have captured what many believe about Trump and the President does not like it! Worse he is now claiming to be a ‘stable genius’. Not in this universe – won’t this soon end? (#stablegenius)
This rather summarises the reaction:

Fire, fury and factual errors... book on Trump feels alarmingly accurate

Mick Brown
Published: January 6 2018 - 10:17AM
London: There is something deliciously fitting in the fact that it is the American journalist Michael Wolff who has taken the axe to Donald Trump.
Wolff, whose trade is writing about big business and media, and whose previous most famous book was about Rupert Murdoch, is a man about whom few have a good word to say, a journalistic bruiser in designer suit and spectacles, often accused of making up things to suit his own agenda. He may remind you of someone.
The first thing to be said about Fire and Fury - Inside the Trump White House is that it is absolutely tremendous and impossible to put down and delivered in a punchy, abrasive style.
"From the start," Wolff writes, "the leitmotif for Trump about his own campaign was how crappy it was, and how everybody involved in it was a loser". What it lacks in refinement it more than makes up for in remorseless accumulation of detail.
The tone is more The Sopranos - with a dash of Kafka - than The West Wing. Swathes of it you read peeping disbelievingly through splayed fingers, staggered at the chronicle of rank incompetence and mendacity. But even as you race through it, you stop to ask yourself - is this the unvarnished truth?
Trump's definition of "fake news" is anything he doesn't want to hear. Which is clearly most of the contents of this book. But you can't help feeling that, in some respects at least, he might have a point. Critics have already begun to catalogue Wolff's numerous factual inaccuracies.
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Keep an eye on what is going on in Iran – it might still be important but seems to be being brought under repression again!
Europe is still in a post – festive haze – in the UK the NHS is under severe stress and Australia is all still at the beach believing life is good!
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Here are a few other things I have noticed.
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Major Issues.

Shadow sector mortgages surging ahead

  • The Australian
  • 12:00AM January 1, 2018

Michael Roddan

The shadow banking sector is continuing to expand rapidly in the nation’s $1.7 trillion mortgage market despite regulatory attempts to reduce growing housing risk in the financial system.
Due to tough new restrictions on lending launched by the prudential regulator in March, borrowing by property investors and speculators from banks has stalled over the past year.
However, loans and advances to borrowers sold by unregulated “shadow banks” surged 9.3 per cent over the year through to November — the fastest pace in 9.5 years.
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Cash payment decline tipped to gather pace in 2018

Clancy Yeates
Published: December 31 2017 - 3:20PM
 A $1 billion piece of infrastructure to be switched on in early 2018 is likely to accelerate the decline of cash and further cut into already tumbling use of cheques, payments company BPay Group predicts.
In a change that Reserve Bank governor Philip Lowe has described as potentially “transformational,” the new payments platform is due to be switched on soon after Australia Day in 2018.
The project, which is going through its final stages of testing over summer, will offer consumers the ability to make real-time payments to customers of other banks. The system will also allow people to link bank accounts to phone numbers or email addresses, removing the need to enter a BSB or account number when transferring money.
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Australia's least-competitive industries earning 'super-profits'

Ross Gittins
Published: December 31 2017 - 11:01PM
Economists joke that, whereas they are taught that any barriers to new firms entering a market are bad, allowing profits to be too high, MBA students are taught that "barriers to entry" are good, and shown ways to raise them.
Economists have no quarrel with businesses making profits. The shareholder-owners who provide the financial capital needed to sustain those firms are entitled to a return on their investment, one that reflects not only the (opportunity) cost of their capital, but also the riskiness of the particular business they're in.
Economists call such a return on equity "normal profit". But sometimes the various barriers to new firms entering a market limit competition, allowing the incumbents to make profits in excess of those needed to induce them to stay in the industry.
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The squeeze on the middle class

Damien Murphy
Published: January 1 2018 - 12:00AM
The collapse of Australian middle class wages and conditions and the western world phenomenon that has seen millions turn to politicians promising the panaceas of the past were first evident in the declining years of Paul Keating's Labor government.
Cabinet papers from 1994 and 1995 released on Monday reveal a middle class under pressure as their salaries and conditions had unexpectedly started to be eroded by workplace reforms.
The change was recorded in reports to Cabinet on Labor's $6.5 billion Working Nation program aimed at halving unemployment rate and reducing the long-term jobless rate.
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Plunge in volatility stokes fears of stock market crash

Tom Rees
Published: January 1 2018 - 8:47AM
Stock market volatility has ended the year at record lows, adding to concerns that complacent investors are sleepwalking into the next crash as stock markets around the world hit new highs.
The VIX Index, a widely-used measure of expectations of future volatility, slipped a further 21 per cent in 2017, finishing at an end-of-year record low of 10.40. In the past, low volatility has predated some of the biggest market collapses.
According to the VIX index, also known as the Fear Index, volatility tumbled to an intraday low of 8.56 in November, its lowest level since the index began in 1990, while FTSE-100 volatility is also at an end-of-year record low at 9.56.
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In 2018 politicians must appease Australia’s angry middle class

Shane Wright, Economics Editor
Monday, 1 January 2018 12:34PM
At a key point in the fifth instalment of J. K. Rowling’s Harry Potter series, the young wizard opens up to his godfather Sirius.
“I just feel so angry, all the time,” he says.
In the Muggle world, the anger is palpable.
From voters in Australia who seek solace and solutions with an increasingly wide array of Left and Right populist parties to Donald Trump’s “drain the swamp” mantra to Britain’s Brexit disaster, the biggest emotion of recent years has been anger.
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Change is coming, but some retailers aren't ready for slavery laws

Patrick Hatch
Published: January 1 2018 - 11:55PM
Some of Australia's major retailers are woefully unprepared for new laws likely to be brought before parliament that will force them to show how they ensure their products are not made with slave labour.
A joint federal parliament committee last month called on the government to introduce a Modern Slavery Act,  including mandatory supply chain reporting for large companies.
The committee's chair, Liberal MP for Dunkley Chris Crewther, said he was "quite confident" legislation would be introduced to parliament in 2018, and warned that some companies were not doing enough to vet how their goods were made.
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For most, predicted downturn will be little more than a blip

Jennifer Duke
Published: January 3 2018 - 12:15AM
Sydney property prices are tipped to fall as much as 10 per cent over the next 12 to 18 months by some of the country’s leading property data providers and researchers.
Double-digit price falls may sound concerning to home owners who have only ever known rising values, but even this "worst-case scenario" is not a crash.
The Sydney market peaked in August, when the median dwelling price hit $909,914, according to CoreLogic. It has since come off 2.2 per cent.
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  • Jan 3 2018 at 1:55 PM

Housing bubble or not: The property market is repeating US mortgage mistakes

by Richard Holden
For all the endless discussion of housing prices in Australia, it is very hard to tell if there is a bubble. Sydney price-to-income ratios are the second highest in the world—above London and New York—but hey, Sydney is a great place to live. Supply is constrained by zoning laws, two national parks, a mountain range, and an ocean. Yet demand continues to grow, so prices tend to rise.
I don't know if there's a bubble in the Australian housing market, but there are some very troubling markers that suggest impudent borrowing and lending. Just the sort of things that preceded the US housing implosion nearly a decade ago. And I worry that bankers, borrowers, and regulators seem not to have learned the lessons of that very painful piece of economic history.
First, the markers.
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Fed sees rate increases in 2018 but lacks consensus on frequency

Binyamin Appelbaum
Published: January 4 2018 - 8:42AM
The Federal Reserve has entered 2018 without a clear plan for raising its bench mark interest rate and with the added uncertainty of an imminent change in its leadership.
An account of the Fed's final meeting of 2017, which the central bank published on Wednesday, said officials generally agreed that the Fed should continue to raise its bench mark interest rate in the new year. But the frequency of future hikes remains a question, with a range of views among officials.
Six of the 12 officials on the Federal Open Market Committee predicted in December that the Fed would raise rates three times this year. But three other officials predicted a pair of hikes, and three officials said the Fed would raise rates four times.
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A decade lost to political point-scoring

Nicholas Stuart
Published: January 4 2018 - 12:15AM
It's that time of year when we can anticipate, in hope and expectation, what the coming months will bring. After all, last year was better than the year before and there's no sign that this year won't be even better! And this is the exact point at which any incurable optimists should stop reading this column.
After all, the surf's up, the heat haze will soon begin shimmering and, tonight, the soft light of summer nights will again envelope the evening in hope and expectation, instead of knowledge of the long dry to come.
But if you're still reading, you'll probably want to step back for a moment and consider the past 10 years, rather than a shorter period of time, because that's where the meaning kicks in. What happened over that long decade provides an interesting guide to the future. Looking back at it allows us to perceive the broader trends that are shaping our lives and, importantly, act to enhance them.
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Bill shock as standard of living slumps

  • The Australian
  • 12:00AM January 5, 2018

David Uren

Australians have endured their longest period of falling living standards in more than a quarter of a century as growth in costs outstripped earnings for the fifth consecutive quarter, leaving households worse off than they were six years ago.
After allowing for inflation, taxes and interest costs, average household incomes dropped 1.6 per cent in the year to September, capping a sustained fall in ­living standards that has not been seen since the 1990-91 recession.
Economists say more than half the cost increases for households are being driven by electricity, rent, health, new housing and tobacco, while modest wage rises are being partially absorbed by workers being pushed into higher tax brackets.
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For Coalition, the battlers’ vote is now a political danger

  • The Australian
  • 12:00AM January 5, 2018

David Uren

The best academic evidence shows there has been no material increase in inequality of incomes in Australia over the past decade, as Labor claims, but the squeeze on household living standards is real and is a political danger for the government.
For 15 years following the election of the Howard government in 1996, living standards rose by a steady 2.5 per cent a year.
By 2011 — which marked the peak of the resources boom — the average household had a living standard more than 40 per cent higher than in the mid-1990s. Since then, there has been nothing.
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Five things to fear in a strong global economy

Daniel Moss
Published: January 4 2018 - 11:50AM
The world economy entered 2018 on a stronger footing than many economists and investors dared predict.
Growth is picking up almost everywhere and deflation is no longer feared. Central banks are making themselves less dominant without scaring markets. Japan is no longer a euphemism for failure, Europe is showing some hard-earned vigour, and China isn't unravelling. Even Brazil is looking better.
What could go wrong? Well, a few things:
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National Budget Issues.

Scott Morrison tips investment to boost jobs, consumer sentiment

  • The Australian
  • 12:00AM January 2, 2018

David Urenwidget&td_bio=false

Australians can look forward to a year of strong economic growth, Scott Morrison believes, with business investment generating more jobs and consumers becoming more confident about the ­outlook.
The government’s plans for personal income tax cuts in the May budget are calculated to ­support a revival in consumer spending.
The Treasurer says last year brought a “tipping point” for the economy, as business responded to historically low interest rates and a revival in profits to start lifting their investment.
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New laws and changes that will affect Australia from January 1, 2018 and beyond

YESTERDAY, a bunch of changes started to come in that will change how we live in Australia. This is what will affect you.
Shoba Rao, AAP
News Corp Australia Network January 2, 20186:01am
FROM January 1, there are a raft of changes coming to welfare, health, education, housing, gay marriage and many other living expenses.
This is what’s coming and how it will affect you and your family across Australia.
WELFARE
* $10 million will be set aside for treatment services for job seekers affected by proposed drug testing trials, despite the pilot program being blocked in the Senate
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IMF tells Morrison to go hard on debt in budget

  • The Australian
  • 12:00AM January 3, 2018

David Uren

The government should abandon its long-delayed goal of achieving a budget surplus of 1 per cent of GDP and instead set a hard target for reducing net debt, an International Monetary Fund study ­recommends.
Repeated deferral of the return to a substantial surplus, including in the 2017-18 budget, is threatening the credibility of the government’s budget strategy and creating uncertainty for households and business, the study says.
“Thus far, the current budget repair strategy has not delivered on the promise of the medium-term fiscal strategy. The net debt-to-GDP ratio continues to drift upwards and reaching the ­medium-term balance anchor ­appears to be at a horizon drifting further into the future.”
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Budget repair demands sustained welfare reform

  • The Australian
  • 12:00AM January 3, 2018
Few Australian workers spend their precious summer holidays perusing federal budget pie charts. If they were so inclined, however, they’d be feeling less relaxed. And the need for major welfare reform (or cuts, to be blunt) would be apparent immediately. This year, income tax paid by individuals will raise $210 billion. More than $164bn of it (about 80 per cent) will be spent on social security and welfare, the biggest spending item in the budget. The cost to taxpayers of health, defence and education combined ($140bn) does not even come close to the welfare bill.
That’s why The Australian applauds the Turnbull government and the Nick Xenophon Team for working towards an agreement on overhauling welfare, as Rosie Lewis reports today. The reforms, announced in last year’s budget, have been designed to simplify the welfare system along the lines implemented successfully by the Key and English governments in New Zealand.
The reforms are designed to combine seven existing payments — the Newstart, Sickness, Partner, Bereavement and Widow allowances, along with the Wife Pension and the Widow B Pension — into a single JobSeeker payment.
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  • Updated Jan 5 2018 at 11:00 PM

Malcolm Turnbull's tax trilemma made trickier by Donald Trump

At the heart of Malcolm Turnbull's agenda is a trifecta of promises: a company tax cut, an income tax cut and a budget surplus. But can he have it all? Probably not, is the consensus.
Deloitte Access Economics' Chris Richardson fears it will be the budget that falls by the wayside.
"For a long time the politics of budget repair has been horrendous, although this government, to its credit, continues to fight that fight," he says.
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Health Budget Issues.

Staff raise concerns over St Vincent's Hospital's six-week slowdown and executives' $25k bonuses

Kate Aubusson
Published: January 1 2018 - 12:15AM
St Vincent's Hospital in Sydney has tripled its usual holiday slowdown period to stanch its budget blowout, temporarily suspending most non-urgent elective surgery.
The inner-city hospital has stretched its "reduced activity period" from December 18 to January 28 in an effort to claw back savings in hospital resourcing and staff wages.
Doctors, nurses and other staff who expressed concerns over the length of the slowdown were also dismayed by bonus packages of more than $25,000 paid to two executives.
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Greg Hunt urged to make doctors publish fees

  • The Australian
  • 12:00AM January 2, 2018

Sean Parnell

Health Minister Greg Hunt is under pressure to investigate whether doctors should be forced to publish their fees or other key financial indicators to help consumers shop around and avoid “bill shock”.
A Senate committee dominated by non-government members recently made a series of recommendations to address high costs in health insurance, including that the minister “instruct the ­Department of Health to publish the fees of individual medical practitioners in a searchable database”. Successive governments over several decades have looked at such a concept but have been unable to make it work.
What was perhaps more interesting about the Senate committee report, however, was the fact the government members Slade Brockman and Jonathon Duniam, did not dismiss that recommendation entirely. While applauding insurance reforms announced by Mr Hunt in October, and claiming other recommendations were unworkable, the Liberal senators proposed the minister also instruct a committee to “consider the merit of publishing the fees of individual medical practitioners”.
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Medicare: MBS review savings reinvested

  • The Australian
  • 12:00AM January 2, 2018

Sean Parnell

Almost 99 per cent of ­additional funding provided by the Turnbull government for Medicare since the last budget came from a once-controversial taskforce looking for outdated, inappropriate and wasteful rebate-funded services.
The Medicare Benefits Schedule review taskforce was established in 2015 by then health minister Sussan Ley to examine more than 5700 items on the MBS. In the wake of the GP co-payment proposal, and the Medicare freeze, doctor groups initially feared the taskforce would make cuts and little else.
But the mid-year budget update last month ­revealed the MBS review had not only found $409 million in savings but the government had reinvested the money in Medicare. That is ­despite the review running well behind schedule, ­according to the Health Department.
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Investigation into medical bill shock

An expert committee will investigate ways to help patients avoid bill shock from out-of-pocket medical expenses.
Updated 2 January, 2018
Patients hit with hefty surprise medical bills may be in for some pain relief in coming years.
The federal government has asked the chief medical officer and a new expert committee to investigate the issue of unanticipated out-of-pocket fees.
Health Minister Greg Hunt said some patients were unaware of the scale of fees at the time of their initial referral to medical specialists.
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Bupa slams comparator websites for diverting funds from healthcare and demands transparency

Esther Han
Published: January 2 2018 - 5:18PM
One of Australia's biggest health funds has accused comparator websites of being a "significant cost on the system", diverting $200 million a year from healthcare to their own bottom line.
Bupa's managing director Dwayne Crombie said, based on his calculations, comparator websites – which usually take a chunk of the first year's premium as commission – were costing health insurers $150 to $200 million a year and pushing up premiums.
"The customer might not have to pay more to use a comparison website, but the health insurers have to pay direct, and what happens when the health insurers do that, is it comes into their price, so the customers are then paying for it indirectly," he told Fairfax Media.
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Single medical bills ‘one step too far’ as doctors stand their ground

  • The Australian
  • 12:00AM January 3, 2018

Sean Parnell

A Liberal Party election promise that patients would receive a ­single bill will be opposed by the Australian Medical Association, as flashpoints emerge in the push for greater transparency of consumers’ health expenses.
AMA president Michael Gannon said his organisation would never support the concept of a ­single bill and neither would other professional bodies. The election commitment, made in June 2016 under then minister Sussan Ley, was to “simplify billing so that consumers can receive a single bill covering all costs of a medical procedure — such as the surgeon and anaesthetist — to avoid unplanned bill shock”.
A spokesman for Health Minister Greg Hunt in November said single bills would be considered, but Dr Gannon has declared single bills a step too far, partly because of the power it would give whoever was entrusted to co-ordinate and issue them.
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Medical bills and illness are making us bankrupt

  • The Australian
  • 12:00AM January 4, 2018

Sean Parnell

More Australians are being forced into bankruptcy because of sickness and lack of health insurance than from the most common ­business-related cause of personal insolvency.
An analysis of federal government data shows “ill health or the lack of insurance” was the primary cause of non-business-related personal insolvency for 1830 people in 2016-17.
By comparison, the biggest business-related cause of personal insolvency accounted for only 1779 cases, and it was a broad category of “economic conditions affecting industry, including competition and price cutting, credit restrictions, fall in prices, increases in costs”.
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Price concerns stop patients seeking treatment

  • The Australian
  • 12:00AM January 4, 2018

Sean Parnell

More than 7 per cent of Australians say they have delayed or cancelled an appointment with a medical specialist because they did not think they could afford it.
According to the Australian Bureau of Statistics, which conducts an annual health experiences survey, 7.3 per cent of people in 2016-17 said they had at least once delayed seeing, or did not see, a medical specialist due to cost.
This was more often the case for those who rated their health as fair or poor and those who had a long-term health condition.
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Health insurance rebate cut hits patients’ wallets

  • The Australian
  • 12:00AM January 6, 2018

Sean Parnell

Health fund members looking for more affordable policies this year will be short-changed by complex, bureaucratic changes to the insurance rebate, with the subsidy set to be reduced as premiums rise again in April.
In a double whammy for members, premiums will continue rising faster than inflation as the rebate keeps being eroded, with every dollar saved by the government being a dollar more paid by members.
So significant is the diminishing taxpayer subsidy that the 30 per cent rebate introduced by the Howard government in 1999 may become a 25 per cent rebate within months.
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Moderate health insurance premium rises tipped for 2018

  • The Australian
  • 12:00AM January 6, 2018

Sarah-Jane Tasker

Affordability concerns fuelled a reduction in health insurance participation rates among Australians in 2017, but consumers could be in for some relief with this year’s premium increase tipped to be lower.
Craig Drummond, chief executive of health insurance giant Medibank, told The Weekend Australian he was confident that the work his company had done on controlling its costs over the last 12 months would be reflected in the 2018 premium rate change. Medibank’s average rate increase in 2017 was 4.6 per cent, its lowest in 15 years. It was also below the industry average of 4.84 per cent, which was a decade low.
“While we expect the (2018) premium rate change to be more affordable for our customers, we can’t rest,” Mr Drummond said.
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International Issues.

  • Jan 1 2018 at 9:28 AM

Alexander Downer's link to the Russia probe on Donald Trump confirms one reality

The revelation that Australia's Alexander Downer helped trigger a US Federal Bureau of Investigation probe into Russia's meddling in the US election confirms at least one reality.
Donald Trump, a former celebrity TV star, had surrounded himself with some political neophyte apprentices during his haphazard campaign in the lead up to the November 2016 poll.
How naive - or perhaps drunk – was junior foreign policy adviser George Papadopoulos to let slip over evening drinks with Australia's top diplomat in London that the Russians had political "dirt" on Democrat Hillary Clinton?
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Explainer: What has brought Iranian protesters to the streets?

Published: January 1 2018 - 6:03AM
London: Iran warned of a tough crackdown on Sunday against demonstrators posing one of the boldest challenges to its clerical leaders since nationwide unrest shook the Islamist theocracy in 2009.
How serious are the protests?
Political protests are rare in Iran, where security services are pervasive. And yet tens of thousands of people have protested across the country since Thursday. The demonstrations are the biggest since unrest in 2009 that followed the disputed re-election of then-President Mahmoud Ahmadinejad.
They began in Iran's second city of Mashhad in the northeast on Thursday and spread to Tehran and other urban centres. Iranians vented their anger over a sharp increase in prices of basic items like eggs, and a government proposal to increase fuel prices in next year's budget.
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Kim Jong-un says he has a ‘nuclear launch button’ on his desk in threat to America

KIM Jong-un has brought in the new year with an alarming escalation in his threats against the rest of the world.
Fox News January 1, 201812:37pm

Trump to Declare North Korea a Terror Sponsor

NORTH Korean leader Kim Jong-un claims to have a “nuclear launch button on his desk”.
During a televised New Year’s Day speech, the dictator said the US would never be able to start a war with the rogue nation after it had developed the ability to hit all of the American mainland with its nuclear weapons.
“The entire United States is within range of our nuclear weapons, and a nuclear button is always on my desk. This is reality, not a threat,” Kim said.
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  • Updated Dec 31 2017 at 5:26 PM

Under Donald Trump, a once unimaginable presidency becomes reality

by Peter Baker
When President Donald Trump meets with aides to discuss policy or prepare for a speech, he may ask about the pros and cons of a new proposal. He may inquire about its possible effect. He may explore the best way to frame his case.
But there is one thing he almost never does. "He very seldom asks how other presidents did this," said John F Kelly, the White House chief of staff.
Trump is the 45th president of the United States, but he has spent much of his first year in office defying the conventions and norms established by the previous 44, and transforming the presidency in ways that were once unimaginable.
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  • Jan 2 2018 at 8:45 AM

The case for optimism in 2018

by Gideon Rachman
The year 2018 is beginning with economic and geopolitical indicators pointing in very different directions. Global stock markets are at record highs and economic confidence is growing across most of the developed world. But while investors are bullish, followers of international politics are very nervous.
In recent years, it has tended to be the Middle East that delivers bad news, and Asia that specialises in optimism. This year could reverse that pattern. The biggest geopolitical risk is a war on the Korean peninsula. If the US carries through on President Donald Trump's threat to use "fire and fury" to disarm North Korea it will be the first time that America has gone to war with another nuclear-armed state. The risks are literally incalculable.
By contrast, there are several big things that could finally go right in the Middle East. The combination of turmoil in Iran, liberalising reforms in Saudi Arabia and the final defeat of Islamic State on the battlefield would all be serious setbacks for the most fundamentalist and confrontational forms of Islamism.
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Trump's ambitious agenda: 7 things to watch in 2018

David Jackson and Deirdre Shesgreen
Published: January 2 2018 - 11:02AM
Washington: US President Donald Trump may have big policy plans for 2018, but political distractions are likely to shadow prospects of big legislative achievements.
White House officials say Trump wants to rein in the threat from North Korea and list four top domestic priorities on his 2018 agenda: Repealing and replacing President Obama's 2010 health care law, welfare reform, immigration, and a new infrastructure plan.
Yet the Republican-controlled Congress has been struggling to pass some of Trump's major priorities since his election - and their challenges will only increase in 2018. The GOP's Senate bare majority will shrink when Alabama's newly elected senator, Democrat Doug Jones, is sworn in.
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Deaths in Iran amid nationwide protests

Published: January 2 2018 - 7:32AM
Istanbul: At least 10 people have been killed in nationwide protests in Iran including a police officer, Iranian state television said Monday, even as President Hassan Rouhani appealed for calm and demonstrations broke out in several cities.
State media said security forces repelled "armed protesters" who tried to take over police stations and military bases. Some videos circulating online have showed protesters in violent confrontations with police.
A protester killed one police officer and wounded three others, the Iranian government said, in the first reported death among the security forces since a wave of protests broke out across the country last week.
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Kim Jong-un's strategy: drive a wedge between South Korea and the US

Choe Sang-hun
Published: January 1 2018 - 9:20AM
Seoul, South Korea: North Korea's surprise call on Monday for direct talks with South Korea could drive a wedge into the decades-old alliance between Seoul and Washington that undercuts President Donald Trump's tough approach to the nuclear-armed North.
A New Year's Day speech by Kim Jong-un, the North Korean leader, contained a dramatic shift in tone and policy regarding the South. After ignoring South Korea for years, Kim called for urgent dialogue to discuss improving ties and easing military tensions on the divided Korean Peninsula, even as he claimed an ability to strike the mainland United States with nuclear missiles.
Kim also agreed to a request by President Moon Jae-in of South Korea to send a North Korean delegation to the Winter Olympics to be held in the South next month.
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About that Trump ‘autocracy’

  • WSJ Editorial Board
  • The Australian
  • 3:12PM January 2, 2018
As Donald Trump heads into his second year as President, we’re pleased to report that there hasn’t been a fascist coup in Washington. This must be terribly disappointing to the progressive elites who a year ago predicted an authoritarian America because Mr. Trump posed a unique threat to democratic norms. But it looks like the U.S. will have to settle for James Madison’s boring checks and balances.
“How to stop an autocracy,” said a February 7, 2017 headline on Vox, ruminating on a zillion-word essay in The Atlantic on how Donald Trump might impose authoritarian rule. Academics and pundits mined analogies to Mussolini, Hitler and Vladimir Putin.
Four political scientists even formed something called Bright Line Watch — with the help of foundation money — to “monitor the status of democratic practices and highlight potential threats to American democracy.” Readers won’t be surprised to learn that the only graver threat than Mr Trump is the Republican Congress that refuses to impeach him.
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  • Updated Jan 2 2018 at 2:25 PM

Donald Trump's fatal culture of governance

by Bret Stephens
Tax cuts. Deregulation. More for the military; less for the United Nations. The Islamic State crushed in its heartland. Assad hit with cruise missiles. Troops to Afghanistan. Arms for Ukraine. A tougher approach to North Korea. Jerusalem recognised as Israel's capital. The Iran deal decertified. Title IX kangaroo courts on campus condemned. Yes to Keystone. No to Paris. Wall Street roaring and consumer confidence high.
And, of course, Neil Gorsuch on the Supreme Court. What, for a conservative, is there to dislike about this policy record as the Trump administration rounds out its first year in office?
That's the question I keep hearing from old friends on the right who voted with misgiving for Donald Trump last year and now find reasons to like him. I admit it gives me pause. I agree with every one of the policy decisions mentioned above. But I still wish Hillary Clinton were president.
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'Critical battles' looming: the biggest threats facing China's economy

Published: January 3 2018 - 10:52AM
China's economy begins 2018 facing what its own leaders call three years of "critical battles."
Those fights to tackle domestic debt, poverty and pollution pose a hat-trick of risks to the world's No. 2 economy even before higher interest rates and trade war threats from the US are taken into account.
While the nation is starting from a position of strength, with full-year growth in 2017 poised for its first acceleration since 2010, the expansion is seen slowing in 2018.
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US to withhold aid from Pakistan

Published: January 3 2018 - 6:18AM
United Nations: The United States is withholding $US255 million ($A357 million) in aid from Pakistan because of its failure to cooperate fully in America's fight against terrorism, US Ambassador to the United Nations Nikki Haley says.
"There are clear reasons for this. Pakistan has played a double game for years," she told reporters at the United Nations on Tuesday. "They work with us at times, and they also harbour the terrorists that attack our troops in Afghanistan.
"That game is not acceptable to this administration. We expect far more cooperation from Pakistan in the fight against terrorism."
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  • Updated Jan 3 2018 at 9:04 AM

The new world disorder and the fracturing of the west

We have reached the end of an economic period, that of western-led globalisation, and a geopolitical one –  the post-cold war "unipolar moment". This is what I argued almost exactly a year ago. The question was whether the world would experience an unravelling of the US-created, post-second world war liberal order into deglobalisation and conflict, or a resurgence of co-operation. A year into the presidency of Donald Trump, we should return to this point. In brief, unravelling is even more likely.
Experience has underlined the special character of Mr Trump's presidency. On a daily basis, he violates the behaviour and attitudes the world expects of a US president. But the exploitation of office for personal gain, indifference to truth and assault on institutions of a law-governed republic are all as one should have expected. A liberal democracy only survives if the participants recognise the legitimacy of other participants. A leader who calls upon his officials to prosecute erstwhile opponents is a would-be dictator, not a democrat.
Character is one thing; actions quite another. So far, Mr Trump has governed mainly as a traditional Republican "pluto-populist", delivering policies to the plutocracy and rhetoric to his angered base. Yet his characteristics are still to be seen, in his consistently mercenary attitude to US alliances and narrowly mercantilist views of trade.
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The ‘Nuclear Button’ explained: for starters, there’s no button

Published: January 4 2018 - 9:18AM
Hong Kong: President Donald Trump and Kim Jong-un, the leader of North Korea, traded threats this week about the size, location and potency of their "nuclear buttons."
The image of a leader with a finger on a button — a trigger capable of launching a world-ending strike — has for decades symbolised the speed with which a nuclear weapon could be launched, and the unchecked power of the person doing the pushing.
There is only one problem: There is no button.
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Revolutionary Guards deployed to quell Iran's uprising

Bozorgmehr Sharafedin
Published: January 4 2018 - 9:07AM
London: Iran's elite Revolutionary Guards have deployed forces to three provinces to put down an eruption of anti-government unrest after six days of protests that have rattled the clerical leadership and left 21 people dead.
The protests, which began last week out of frustration over economic hardships suffered by the youth and working class, have evolved into a rising against the powers and privileges of a remote elite especially Supreme Leader Ayatollah Ali Khamenei.
Defying threats from the judiciary of execution if convicted of rioting, protests resumed after nightfall with hundreds hitting the streets of Malayer in Hamadan province chanting: "People are begging, the supreme leader is acting like God!"
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Nuclear war is 'closer than ever before' but, for Americans, it's the new normal

Rick Noack
Published: January 4 2018 - 4:43AM
When nuclear weapons were deployed against a US enemy at the end of World War II for the first and last time, the US public initially mostly supported their use. That changed when the fallout - killing tens of thousands within seconds around the Japanese cities of Hiroshima and Nagasaki - became apparent.
It's a sentiment which has lasted for decades, and if anything only appeared to get stronger - until recently.
When President Barack Obama paid tribute to the people of Hiroshima in May 2016, he urged the international community to "choose a future when Hiroshima and Nagasaki are not considered the dawn of atomic warfare but as the start of our own moral awakening".
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The deterioration of White House policy debates

Daniel Drezner
Published: January 4 2018 - 12:05AM
I spent my holiday break perusing the assessments of President Donald Trump's first year in office. Peter Baker's account in The New York Times was one of the more noteworthy ones, because Chief of Staff John F. Kelly commented on the record. Clearly, one of the political themes of 2017 is the professionalisation of White House operations under Kelly. And these paragraphs reveal what Kelly thinks he has accomplished:
"Even Mr Kelly, a retired four-star Marine general who took over in July as chief of staff, has met the limits of his ability to guide the president. Rather than seek to control Mr Trump, Mr Kelly has tried to control the information that gets to him and make sure it is vetted. The structure he has established resembles that of previous presidents. That does not mean Mr Trump adheres to it.
"I'm not put on earth to control him," Mr Kelly said. "But I have been put on earth to make this staff work better and make sure this president, whether you voted for him or not, is fully informed before he makes a decision. And I think we achieved that."
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  • Jan 5 2018 at 11:06 AM

Donald Trump revealed as bald and childish in new book

by John Wagner
During his campaign and tumultuous first year in office, President Donald Trump demonstrated little knowledge of policy details. He was not interested in advice that conflicted with his instincts, and it was often impossible for White House staff to figure out what course he wanted to take. One compared it to "trying to figure out what a child wants."
The portrait that emerges in the new book "Fire and Fury" by Michael Wolff - which became the talk of the town in Washington - is hardly a flattering one.
Trump is depicted as presiding over a chaotic White House, struggling to settle into his new reality and eagerly trying to maintain his normal golf habits.
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Trump says he is a 'genius' as he defends mental fitness

Alex Wayne and Arit John
Published: January 7 2018 - 2:33AM
President Donald Trump described himself as a "very stable genius" in a series of tweets on Saturday, a day after the author of a book about the White House said "100 per cent of the people around" the president question his intelligence and fitness for office.
In a tweetstorm on Saturday morning, the president said one of his greatest assets was being "really smart" . He cited his career in business and reality television and his victory in last year's election as evidence of his mental prowess. And he again lashed out at the ongoing special counsel investigation into his campaign's contacts with Russian operatives, calling suggestions that he colluded with Moscow a "total hoax on the American public."
"Throughout my life, my two greatest assets have been mental stability and being, like, really smart. Crooked Hillary Clinton also played these cards very hard and, as everyone knows, went down in flames," Trump tweeted to his 46 million followers.
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I look forward to comments on all this!
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David.

I Wonder Is The ADHA Going To Send A Team To Help?

This appeared last week:

Pushing for better health care

By Joyetter Feagaimaali’i-Luamanu , 05 January 2018
Timely and quality health information will improve healthcare service delivery and provide routine evidence performance of Samoa’s health services. 
That is according to the Minister of Health, Tuitama Dr. Leao Tuitama, on the Samoa’s Health Sector eHealth Policy and Strategy 2017-2022.  
The vision behind the launching of the Samoa eHealth Policy will guide the Samoa eHealth Strategy implementation.
The report says the Government of Samoa is committed to using eHealth to deliver quality healthcare services to the people of Samoa through the proper use and management of Information, Communications and Technology (I.C.T.).
Tuitama in the report notes the move require a functioning Health Information Systems (H.I.S.) capable of capturing accurate data in order to produce information reports for healthy decision making. 
“It sets the long-term pathway and roadmap in improving, strengthening and incrementally developing the complex and phased approach of Samoa’s Health Sector eHealth planned development system. 
“Samoa’s H.I.S. has been characterized by fragmentation and lack of coordination, prevalence of manual systems and lack of automation, and where automation existed; there was a lack of interoperability connectivity between different systems. 
“This eHealth policy and strategy will be guiding the development of Samoa’s Health Sector H.I.S. from the current status to an integrated and well-functioning national system, based on agreed upon scientific and technological standards for interoperability in combating challenges of improving efficiency of clinical care, produce the indicators required for monitoring and evaluation reporting, facilitate patient mobility and supports healthcare professionals.
 “The architecture of this system will ensure patient and health information confidentiality is maintained to its highest level even when it is enabled to interface with other transversal systems when and if required. 
Lots more here:
I wonder do the Samoans feel they could use a little help and if so might the ADHA get the gig. After all they are pretty experienced travelers one reads! Would be a nice spot to visit!
David.

Wednesday, January 10, 2018

It Seems Blockchain For Health Data Ideas Are Popping Up Everywhere. It’s Getting Crowded!

This popped up a few days ago:
  • 01.04.18

Can This App That Lets You Sell Your Health Data Cut Your Health Costs?

CoverUS wants to use the blockchain to let healthcare companies reward you for the data they now buy from your insurance company.

Americans could do with new ways to save on healthcare. Obamacare-administered plans are set to get more expensive by up to 50% this year amid uncertainty around federal subsidies that help pay for premiums. The cost of employer-sponsored insurance, meanwhile, continues to jump well above inflation. Many of us are hit with surprise medical bills we can’t afford.
CoverUS, a startup, has one idea: monetizing our health-related data. Through a new blockchain-based data marketplace, it hopes to generate revenue that could effectively make insurance cheaper and perhaps even encourage us to become healthier, thus cutting the cost of the system overall.
It works like this: When you sign up, you download a digital wallet to your phone. Then you populate that wallet with data from an electronic health record (EHR), for which, starting in January 2018, system operators are legally obliged to offer an open API. At the same time, you can also allow wearables and other health trackers to automatically add data to the platform, and answer questions about your health and consumption habits.
A prototype of the app. [Screenshots: CoverUS]Why bother? To create a richer picture of your health than is currently held by the EHR systems, health providers, and data brokerages that buy and sell data from doctors, clinics, pharmacies, and other sources. By collecting all our data in one place, CoverUS wants to give us more autonomy over who uses our personal information and who makes money from it.
“From a moral standpoint, we think people should own their healthcare data. It’s currently being brokered to the tune of hundreds of billions of dollars without most of us knowing that it is happening,” cofounder Christopher Sealey tells Fast Company. “Secondly, we believe that healthcare data is most valuable when it’s in an individual’s hands because your electronic medical records and prescriptions only paint part of the picture. Nobody knows better than you how you are doing.”
The health data brokerage industry includes companies like Iqvia, Cinven, and Veeva. They buy and sell anonymized data under the Health Insurance Portability and Accountability Act (HIPAA), as well as non-anonymous health data not covered by that privacy standard, including what you put into search engines and health websites. Drug companies use this data to develop new products and target treatments to particular doctors and hospitals based on prescribing patterns. The data mining companies are often criticized for being intrusive, but it’s arguable if their profiles are even consistently accurate. When a reporter for The Atlantic downloaded her file last year, she found that the data was missing a good deal of necessary information.
CoverUS, which plans to launch in the first quarter of 2018, will pay for the data we gather in the form of a fixed-price cryptocurrency called CoverCoin. Users generate coins by signing up and then sharing their data. The startup then hopes users will be able to spend the coins on services that improve their health (like gym memberships) or deposit them in a health savings account where the coins can be exchanged for insurance plan savings. Sealey says it’s in discussions with several providers.
More here:
I was instantly reminded of this article just a week or so ago:

Rebuffed by the ADHA, E-Nome looks to GP and hospital systems to enable people to access their health information and sell it on

Lynne Minion | 19 Dec 2017
The Australian Digital Health Agency has denied claims by technology start-up E-Nome that patients will be able to access their My Health Record and sell their medical data to researchers, governments, pharmaceutical companies and insurers via the company’s upcoming app.
But head of E-Nome Nick Curtis has told Healthcare IT News Australia the My Health Record data isn't crucial to the success of the company's platform, with plans to integrate into GP, hospital, allied health services and wearables systems, enabling people to trade their most private of information, including genomes.
The Daily Telegraph reported on Monday that E-Nome was seeking investors to fund the development of its online platform.
According to the company's Position Paper, the app will allow individuals to share their de-identified health data with whomever they choose.
“E-Nome’s business is about providing a platform by which the consumer is empowered to be placed in the middle of a global market worth billions of dollars a year trading their data,” E-Nome’s position paper says.
“Current data collection and transfer is managed by major corporate intermediaries. These corporate intermediaries profit directly from the inefficiency and constraints in data collection. E-Nome is seeking to disintermediate data transfer in the health sector.”
The company is seeking to raise revenue by offering a new crypto-currency called Nomes for sale and hopes a two-stage investment process raises up to $60 million to fund the development of the “E-Nome Ecosystem”, including the E-Nome App, E-Nome Research Portal, E-Nome Medical Practitioners Portal, E-Nome Electronic Data Warehouse and the E-Nome Core.
Vastly more is found here:
It rather looks like there are a few players emerging in this domain. I wonder is the ADHA considering blockchain technology as part of the “replatforming” efforts?
That would move them to the bleeding edge!
David.

Post script:

Steve Wilson has tweeted a useful link as a bit of an antidote to all this:

http://lockstep.com.au/library/ehealth/how-healthy-is-blockchain

Thanks Steve.

David

It Seems Portals Allowing Access to Health Information Do Not Make Much Of A Clinical Difference.

This appeared last week:

Study shows patient portals have no impact on hospital readmissions or mortality

Jan 3, 2018 10:33am
Previous research has have tackled patient portal usability and satisfaction among users, but few studies have looked at the impact of portals on hospital outcomes.
A new study out of the Mayo Clinic Hospital in Jacksonville, Florida, does just that with relatively uninspiring results.
Researchers found that 30-day readmissions, inpatient mortality and 30-day mortality were virtually the same when comparing hospitalized patients that used portals versus those that did not, leading them to conclude that patient portals may not ultimately improve hospital outcomes. The results were published last week the Journal of the American Medical Informatics Association.
But that doesn’t mean patient portals are entirely worthless. The researchers noted that of the 44% of patients that registered for a portal account, just 20.8% accessed it while they were hospitalized. Therefore, higher adoption rates could have a bigger impact on outcomes. 
Portal usage may also be more impactful for patients managing chronic diseases rather than an acute illness. Several other factors including mobile device availability, education and real-time access to physician notes could also have a positive influence on engagement and perhaps tip the scales when it comes to outcomes.
More here:
Yet another reason to be a little skeptical of the various claims of benefit that are made for the myHR portal.
It would be really good to see some real evidence of significant benefit flowing from the myHR. Thus far there has been little credible evidence of benefit I have seen.
David.

Tuesday, January 09, 2018

Some Extra Questions and Thoughts On Re-Platforming From Grahame Greive

Here is the post: 
Australian Digital Health Strategy Question

On the subject of replatforming the MyHR, the Australian Digital Health Strategy has this to say:
Every healthcare provider will have the ability to communicate with other professionals and their patients via secure digital channels by 2022. Patients will also be able to communicate with their healthcare providers using these digital channels. This will end dependence on paper-based correspondence and the fax machine or post.
I’m doing some consulting to the Agency around Secure messaging, and I’m thinking about this. I haven’t heard any discussion about this anywhere – what would it look like?
  • Would patients have to communicate through a MyHR portal? Or could they choose to use their normal Email? Or should there stringent security requirements?
  • Would doctors ask patient’s for the email id? or would the register it via their MyHR?
  • Would patients get a Doctor’s email from their website? Or would they look it up in the national healthcare directory?
  • What kinds of workflows would you build on top of that? Care plans? Scheduling?
Obviously this is all just idle speculation. Surely there’ll be formal consultation and design and so forth later. But maybe we can toss around some ideas now…

Here is the link:

http://www.healthintersections.com.au/?p=2772

Looking forward to some useful comments.

As an opening question where will technology be in 5 years and what sort of impact will that evolution of tech have on any imagined futures? 2022 is a fair way off in technological terms I reckon? 

David.

It Seems Health Information Exchange and Record Location Without A Central Data Base Is Practical and Useful!

This appeared last week:

Strategic Health Information Exchange Collaborative launches new initiative to share patient records nationally

Jan 5, 2018 10:01am
SHIEC's new initiative lays the foundation for interoperability between regional HIEs.
A national trade association for health information exchange organizations has launched a new initiative that allows regional HIEs to share patient medical records across the country.
The Patient Centered Data Home (PCDH), launched by the Strategic Health Information Exchange Collaborative (SHIEC) on Thursday, expands several smaller regional implementations designed to allow HIEs to synchronize patient records and notify physicians when their patient experiences a health event away from home.  
“The HIEs working together to create PCDH built a powerful foundation for interoperability between HIEs—and we managed to do it using our current technologies,” Dan Porreca, executive director for HEALTHeLINK, Western New York's HIE, and chair of the SHIEC board of directors, said in an announcement. “We also created and agreed to a national, legally-binding agreement, which laid the foundation for HIEs sharing data with each other across state lines and throughout communities.”
The national initiative lays the groundwork for medical records to follow patients across the 60 HIEs that make up SHIEC’s membership. When a patient visits a medical facility away from the area where they live, the provider generates an admissions message that includes the patient zip code. Using that information, PCDH notifies the treating physician that previous medical records for that patient are housed in another HIE. Likewise, the system can alert the patient's regular physician that a new record has been generated through a distant HIE.
More here:
Here is the full release with more details:

SHIEC’s Patient Centered Data Home™ Initiative Launches Nationally

Nationwide Expansion of PCDH Lays Foundation for HIEs to Support Better Patient Care by Making It Possible to Share Patient Medical Records Across Geographies

January 04, 2018 09:30 ET| Source: Strategic Health Information Exchange Collaborative (SHIEC)
GRAND JUNCTION, Colo., Jan. 04, 2018 (GLOBE NEWSWIRE) -- The Strategic Health Information Exchange Collaborative (SHIEC), a national collaborative representing health information exchanges (HIEs), today announced the organization’s Patient Centered Data Home™ (PCDH) initiative is now live and serving tens of millions more patients through the network. PCDH is a secure health data exchange system that helps patients by proactively alerting their providers when they have a health event away from home.
The PCDH network makes this possible by synchronizing patient identity records among the several HIEs whose participants are caring for the patient, and it provides detail about where the patient record is located for easier, faster query and response. For patients, this provides reassurance they can receive high-quality, personalized care regardless of where they are in the country.
This national launch unifies three smaller regional implementations in which 17 HIEs worked together to prove the concept of inter-HIE information sharing and notification. Based on the success of the implementations, the participating HIEs have each agreed to a common, national agreement for participation, which set the stage for connecting the regional implementations together and rolling out the full-scale, national implementation.
According to Dan Porreca, executive director for HEALTHeLINK and chair of the SHIEC board of directors, “The HIEs working together to create PCDH built a powerful foundation for interoperability between HIEs – and we managed to do it using our current technologies. We’re very proud of this accomplishment and the milestone we’ve achieved. We also created and agreed to a national, legally-binding agreement, which laid the foundation for HIEs sharing data with each other across state lines and throughout communities.”
SHIEC’s launch of PCDH marks an important milestone in making it possible to achieve health episode notification and efficient data sharing across the country.
What is PCDH?
At its core, PCDH is an inter-HIE notification and data sharing system that allows a patient’s records to follow them wherever they seek care. Because patients are unrestricted by geographic boundaries when they seek care, it is common for a person to be treated by a doctor, clinic or hospital a distance from where they live. Frequently the “away” treatment facility is not a part of the same HIE in which the patient’s “home” doctors participate. As a result, there is a higher risk that the clinician treating them will not have access to the patient’s full medical records to support diagnoses and treatment plans.
To more quickly alert the treating physician that there are medical records available for access from the patient’s doctors at home, and to provide a specific query location to retrieve those records, HIEs worked together to create the technical ability for HIEs to automatically notify each other regarding the existence of a patient’s medical records and to synchronize the patient’s identity among the HIE systems.
The mechanism that makes this work is very straightforward. When a patient presents at a medical facility away from home, that facility will generate an Admission, Discharge, Transfer (ADT) message. This message includes demographics about the patient; information such as the patient’s name, the patient’s location in the hospital, his or her address, phone number, gender, etc. By including ZIP Code information in the ADT, PCDH can automatically detect when a patient is being treated within a ZIP code outside of their normal home area.
When these events occur, the “away” HIE alerts the HIE in the patient’s home area, and that home HIE, known as the patient’s “data home,” automatically lets the treating HIE know they have records for the patient so the treating HIE can generate a query to access those records. Once the treatment encounter concludes, PCDH also makes it possible for the “away” HIE to alert the patient’s home HIE that there are new records for their patient that the home HIE providers can access in order to better care for the patient on an ongoing basis. This new capability makes it possible for a patient’s comprehensive medical history to follow them wherever they seek treatment.
National Approach for Triggering Effective Data Sharing Built on Regional Collaboration
To prove the viability of the PCDH model, SHIEC set up three regional implementations: the western implementation, the heartland implementation and the central implementation. Each of these regional implementations involved coordination among multiple HIEs – which collectively spanned geographic areas and states. The trial implementations were constructed this way to prove the concept worked with multiple different HIE systems.
With the successful completion of the trial implementations and the creation of SHIEC’s national legal framework, PCDH is now being rolled out on a national level. With the implementation of the national agreement, SHIEC has connected the three regional networks into a nationwide network for securely sharing patient information when and where it is needed most to improve health and save lives.
About SHIEC
SHIEC is the national collaborative of health information exchanges (HIEs) and strategic business and technology partners. As the unbiased data trustees in their communities, the 60 member HIE organizations manage and provide for the secure digital exchange of data by medical, behavioral, and social service providers to improve the health of the communities they serve. Collectively, SHIEC members serve almost 75 percent of the U.S. population. For more information about SHIEC, visit info@strategichie.com and follow us on Twitter at @SHIEClive.
Here is the link:
I am sure there are some wrinkles in all this but it does rather seem to be a much better way architecturally to solve the mobile patient problem and avoid a great big vulnerable database.
The myHR is looking more like yesterday’s idea as each day goes by!
David.

Monday, January 08, 2018

Weekly Australian Health IT Links – 8th January, 2018.

Here are a few I have come across the last week or so. Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Again a very quiet week with little going on as the summer daze rolls on.
Enjoy the quick read!
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Opinion: AMAQ calls for real-time monitoring for codeine prescriptions to tackle addiction

Richard Kidd, The Courier-Mail
January 2, 2018 1:00am
A FEW months ago President Donald Trump told a crisis meeting at the White House that the US’s opioid drug epidemic was a “national emergency”.
Unusually for President Trump, his comments did not attract controversy.
That’s because fatal drug overdoses in the US hit 59,000 last year – a massive jump from the 1990s when the annual toll was under 10,000.
It is no longer heroin that is America’s drug scourge, but powerful prescription opioid drugs such as oxycodone.
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  • Updated Jan 3 2018 at 12:15 AM

BabyGlimpse DNA testing app affords couples a look into their baby's future

by Allison Eatough
What will my baby look like?
It's a question expectant parents have had for centuries as they await the birth of their little one. Now, a new app co-founded by Calvert County, Maryland resident Jennifer Lescallett is offers an answer.
BabyGlimpse uses a couple's individual DNA to explore everything from a baby's potential hair and eye colour to whether it will be lactose intolerant, prefer sweet or salty snacks or sneeze when it looks towards the sun. It's one of the latest examples of a growing direct-to-consumer genetic testing industry, where companies market genetic tests to consumers and then work with labs to sequence, analyse and interpret the customer's DNA.
"BabyGlimpse is sort of like the bright side of genetics," said Lescallett, a mother of three and former genetics research associate. "We've coined it sunshine science. You get to look at the fun part of your potential future baby versus some of the scary stuff."
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Consumer health care priorities for 2018

MEDIA RELEASE Thursday 4 January 2018
In this new year, the Federal Government should look to harness the forces transforming the health system and recognise the contribution health makes to national productivity, the Consumers Health Forum says.
“The internet-enabled consumer power that has transformed people’s interaction with the economy in areas such as banking, travel and telecommunications is rapidly creeping into the tradition-bound world of health care,” the CEO of the Consumers Health Forum, Leanne Wells, said.
“The dynamics of health are shifting towards a stronger role for consumers.  With the right support through self-management programs and services, many of which can be digitally enabled and delivered, and roles leading and shaping health care policy, consumers are better placed than ever to drive innovation and improvement in health care.  In 2018, developments on a variety of health fronts will reinforce this trend.
“The gradual roll-out of consumer-centred primary care, the critical need to put in place community-based alternatives to hospital care, expansion of the My Health Record and proposals for a database where patients can check their surgeons’ fees and performance records when taking up a referral, exemplify the changing influences in health.
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03 Jan 2018
Transcript: AMA President Dr Michael Gannon, 6PR, Breakfast with Lisa Barnes and Geof Parry, Wednesday 3 January 2018
Subject: Dr Google
LISA BARNES:   The Australian Medical Association President, Michael Gannon, joins us now. Good morning, Michael.
MICHAEL GANNON:   Good morning, Lisa.
LISA BARNES:   I'm not sure if you heard that call then with Judy, but it seems she had a good experience in using Dr Google yesterday. Is that what you're finding among other patients as well?
MICHAEL GANNON:   I think there'd be plenty of patients who would have positive experiences, and there'd be plenty of patients that are led down the garden path. I think that if you put into a search engine the basic symptoms, in my experience most patients end up diagnosing themselves with either leukaemia or a brain tumour. But if you ask for something very specific, there's some very credible and very useful health information that gives patients an idea how to proceed.
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So, it IS okay to Google your symptoms: AMA chief says patients can seek credible advice about their health online

  • AMA boss Michael Gannon said patients Googling symptoms was beneficial
  • Research enabled them to have 'more informed conversations' with doctors
  • But patients shouldn't substitute the internet for doctors visits 
Australian Medical Association president Michael Gannon said doctors should not be annoyed if patients sought information from 'credible sources' on the internet
Patients looking up their symptoms online before going to a doctor could be beneficial, Australia's top doctor advised.
Australian Medical Association president Michael Gannon said doctors should not be annoyed if patients sought information from 'credible sources'.
The veteran doctor said Googling their symptoms would enable people to have 'more informed conversations' with medical practitioners.
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Hospital discharge letters too slow say frustrated GPs

Grant McArthur, Herald Sun
January 3, 2018 8:30pm
PATIENTS’ lives are being risked daily because of hospitals’ and specialists’ failure to provide timely discharge letters, frustrated GPs say.
The lack of instructions for patients and their family doctors after operations and other hospital stays are leading to thousands of costly readmissions to hospital, and a worsening of Victorians’ health, the Royal Australian College of General Practitioners says.
The problem has also increased pressure on state and federal governments to roll out electronic hospital records.
A State Government spokeswoman said health services were expected to provide GPs with timely patient discharge summaries, and the Commonwealth was encouraging more clinics to adopt technology to receive the information from hospitals.

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The Advertiser Letters to the Editor, January 2 2018

The Advertiser
January 2, 2018 1:00am

Costly mistake

THE “motherhood” vision offered by AMA President William Tam for our health care prospects in the year ahead (The Advertiser, 29/12/17) avoids the harsh reality of the parlous state of our health and hospital systems.
The downgrading and fragmentation of hospital services with Transforming Health has resulted in serious problems in equity and access to health care. These problems must be addressed urgently in 2018 and beyond.
Remediation of the system requires administrative reform. SA Heath is beset with governance problems, inefficiencies and a lack of continuity in senior management; it presides over a toxic culture with poor staff morale.
A new overarching executive body should be established, with significant input from clinicians, and professional and industrial organisations, to provide an effective bridge between government, the bureaucracy and health workers.
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  • Updated Jan 1 2018 at 11:30 AM

Sweat: Tobi Pearce and Kayla Itsines' $100m 'Netflix of health and fitness'

Tobi Pearce compares the Sweat health and fitness global empire he has built from Adelaide with his fellow Young Rich List member Kayla Itsines to a software business or Netflix.
And following in those footsteps, with 28-minute workouts, dietary advice, yoga and post-pregnancy plans all tailored to women aged 20-35 around the world, is how Pearce says Sweat will maintain its relevance and keep growing in 2018 and beyond.
Sweat has a huge presence around the world and has hit upon the magic formula of combining fitness, the endless search for ways to lose weight and maintain a healthy diet with a huge social media presence.
The secret, according to Pearce, has been to harness his and Itsines' passion for workouts with tech savviness and pinpointing exactly what their consumers what via relentless data mining and consumer research.
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Flying Doctor Service looks to the future

With 69 planes covering seven million square kilometres, the Royal Flying Doctor Service has come along way from one plane on loan from Qantas.
Best known for medical retrievals of Australians in some of the most remote parts of the continent, the service will mark its 90th year in 2018.
And as it does, it will continue to evolve and innovate, bringing Australians a broader range of services.
"We want to ensure we take the right services to the right people at the right time, that's the ambition," RFDS chief executive John Lynch says.
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Living with robots: expect evolution at home, in AI, social VR and AR

  • The Australian
  • 12:00AM January 4, 2018

Chris Griffith

They say all roads lead to Rome, but this year all technology roads lead to human-like robots. Better sensor technology, computer vision, object recognition, speech, voice recognition, artificial intelligence and unnervingly human facades will see the mechanical species increasingly viable.
But an elegant walking, talking robot is a way off. While AI is developing at an astonishing rate, the one area holding back robots is the mechanics of movement. They may move around on rollers but you struggle to find one that can walk gracefully, dexterously stack the dishwasher or clear the dinner table.
The beginnings of robots in the home are humble. We have Google Home, a speaker device you can talk to and request information such as the weather and news and speak commands to control your home.
This year Google Home will connect with an increasing number of Australian businesses and services. Already you can contact Officeworks, Optus and eBay, and Uber is coming.
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It will take decades ‘if ever’ for cost of NBN to be recouped: Telstra

Jennifer Duke
Published: January 5 2018 - 12:15AM
NBN Co’s business model has been slammed by major telecommunications providers, which say the government needs to reconsider whether the company should have to fully recoup its investment costs.
In public submissions made in response to an Australian Competition and Consumer Commission review of the communications sector, Optus, Telstra and other leading retail service providers said a review of NBN's costs and pricing was needed sooner rather than later.
The government requires the $49 billion NBN to recover the cost of its rollout around Australia, which directly affects the prices it charges telcos for access to its network, which they pass on to consumers.
The ACCC's draft report, released in October, included a proposed recommendation that the government consider whether the NBN should continue to be obliged to recover these costs.
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What you need to know about the big chip security problem

Ian King
Published: January 4 2018 - 2:24PM
Intel Corp has said that most of the processors running the world's computers and smartphones have a feature that makes them susceptible to attack. The largest chipmaker is working with rivals and partners on a fix, but the news sparked concern about this fundamental building block of the internet, PCs and corporate networks.
What's the problem?
Modern processors guess what they'll have to do next and fetch the data they think they'll need. That makes everything from supercomputers to smartphones zippy. Unfortunately, as Google researchers discovered, it also provides a way for bad actors to read data that had been thought to be secure. In a worst-case scenario that would let someone access your passwords.
How bad is it?
This won't stop your computer working and doesn't provide an avenue for hackers to put malicious software on your machine. There's been no report so far of anyone's computer being attacked in this manner, but in theory this puts important data at risk. Hardware and chip-level security has long been pushed by the industry as more tamper-proof than software. Those claims may have been overstated.
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What you can do to protect against chip flaw

  • Jay Greene
  • Dow Jones
  • 3:32PM January 5, 2018
While tech giants grapple with the chip security flaws disclosed this week, there are steps people can take now to mitigate potential harm to their iPhones, Windows PCs, Android devices and other gadgets.
The most important is ensuring software on any device is up to date.
Apple acknowledged today that its mobile devices and computers — even the Apple TV — are affected by one of the vulnerabilities, called Meltdown, but said it already issued updates to fix the problems.
For iPhones and iPads, iOS version 11.2 released last month includes the latest fix. You can update via the settings app.
For Macs, Apple pushed out version 10.13.2 to its High Sierra operating system last month. Users can find the update by clicking “About this Mac” under the Apple icon.
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Enjoy!
David.

Sunday, January 07, 2018

It Looks Like Health Information Exchange Can Be Done Well With A Proper Interoperability Framework Like That Provided By ONC in the US.

This appeared last week:

ONC releases its Trusted Exchange Framework establishing a single ‘on ramp’ for interoperability

Jan 5, 2018 1:14pm
After several months of public meetings and industry input, the Office of the National Coordinator for Health IT has released its Trusted Exchange Framework and Common Agreement designed to improve data sharing between health information networks.
The framework (PDF), mandated by the 21st Century Cures Act, provides the policies, procedures and technical standards necessary to exchange patient records and health information between providers, state and regional health information exchanges and federal agencies.
It also aims to eliminate the burdens of costly point-to-point interactions that healthcare organizations currently face by creating a common set of practices to allow providers, patients, payers and health IT vendors to securely communicate with one another.
The voluntary framework is also an attempt to resolve some of the nagging issues inhibiting data sharing across the industry, including inconsistencies within the terms and conditions of health information networks. Genevieve Morris, principal deputy national coordinator for health information technology at ONC, compares those variations to the early days of cell phones when texting over different networks was not yet possible.
“This is just the floor of what those required terms and conditions are,” she told FierceHealthcare. “We all just have to agree to the same terms in order for that exchange to happen.”
The draft framework is broken into two sections. Part A provides guardrails and standards to “engender trust between health information networks,” addressing issues around transparency, security, patient safety, and data-driven accountability.
Part B outlines a minimum set of terms and conditions addressing authentication, trusted exchange rules and core operational policies.
More here:
There is more coverage here:

ONC releases draft Trusted Exchange Framework to aid interoperability

Published January 05 2018, 3:59pm EST
The Office of the National Coordinator for Health IT on Friday released a draft Trusted Exchange Framework to enable interoperability across disparate healthcare information networks nationally, as directed by the 21st Century Cures Act.
The draft framework is designed to support nationwide interoperability by outlining a common set of principles, as well as minimum terms and conditions for trusted data exchange. According to ONC, the document focuses on policies, procedures and technical standards that build from existing HIN capabilities and enables them to work together to provide a “single on-ramp” to patient information regardless of the HIT vendor they use or the health information exchange (HIE) with which they contract.
“Currently, there are more than 100 regional HIEs and multiple national level organizations that support exchange use cases,” states ONC’s draft Trusted Exchange Framework. “While these organizations have expanded interoperability within their particular spheres, the connectivity across all or even most of them has not been achieved. This has limited the patient health information that a provider or health system has access to, unless they join multiple networks.”
According to ONC, the proposed Trusted Exchange Framework supports the agency’s goals of achieving nationwide interoperability by—among other capabilities—having “open and accessible application programming interfaces (APIs) to encourage entrepreneurial, user-focused innovation to make health information more accessible and to improve electronic health record (EHR) usability.”
National Coordinator for HIT Donald Rucker says provisions of the Cures Act seek to advance the interoperable exchange of electronic health information, and the agency’s draft Trusted Exchange Framework will help guide the country toward interoperability.
 “It’s a national challenge—it hasn’t been easy,” said Rucker. “Folks have made some great progress, but obviously there’s a lot of work to be done. One of the approaches that ONC is taking is exactly this Trusted Exchange Framework…the very specific request of Congress.”
Genevieve Morris, ONC’s principal deputy national coordinator, said the draft document is in part the product of three public listening sessions with industry stakeholders.
After a 45-day public comment period and refinements to the draft document, a final Trusted Exchange Framework will be implemented by ONC in collaboration with a Recognized Coordinating Entity—to be selected through a competitive process—which will use the policies, procedures, technical standards, principles and goals to develop a single common agreement that qualified health information networks and their participants will voluntarily agree to adopt.
…..
In addition, ONC has released a User’s Guide to Understanding the Trusted Exchange Framework and the US Core Data for Interoperability (USCDI) Glide Path to identify a roadmap for broadening the data that can be exchanged via the TEFCA. The agency is also seeking public comment on the USCDI Glide Path.
The full article is here:
I have to say this all looks like a rational approach to getting health information to be available to all who need it. (patient, provider and payer) and it does indeed do sensible things like avoid a great big vulnerable centralized database.
You can download the 48 page Draft framework from the links provided in the text.
The ADHA might usefully have a very close look at the document to see how some / many of the ideas may assist in Australia. Does anyone know just where the ADHA is up to with their Framework – has been pretty quiet recently?
I particularly like the approach to the private sector reflected here.
David.

AusHealthIT Poll Number 404 – Results – 7th January, 2018.

Here are the results of the poll.

Overall, How Would You Assess The Progress Made In 2017 In Australian Digital Health?

Great 1% (2)

Minor 27% (58)

Non Existent 56% (121)

Gone Backwards 17% (36)

I Have No Idea 0% (0)

Total votes: 217

Any insights welcome as a comment, as usual. It really seems that in the eyes of those that read here 2017 did not go all that well for the ADHA.

A really great turnout of votes!

We note there were no respondents who were clueless, but two seemed a little confused!

Again, many, many thanks to all those that voted!

David.