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, December 13, 2018

It Seems Hospital Digital Health Might Have Been Implemented With Less Control And More Cost Than Desirable In Queensland.


This report appeared last week:

Digitising public hospitals

(Report 10: 2018–19)

Audit objective
The objective of our audit was to assess how well Queensland Health has planned, and is delivering, its digital hospitals program and whether it is realising the intended information-sharing and patient benefits.
Overview
The Queensland healthcare system is transforming to meet the pressures of an ageing population, the growing burden of chronic conditions, and changing consumer expectations.

In a digital hospital, processes are streamlined to create a ‘paper light’ approach, integrating electronic medical records (ieMR) with clinic devices, workflows, and processes. An electronic medical record is one of many applications that contribute to a digital hospital. The government has set a target for twenty-seven hospitals to fully implement the ieMR solution by June 2020.

Electronic medical records provide timely, accessible and legible information about patients at the point of care. It also provides the foundation for future transformations in health care delivery, like the ability to gain greater insights and decision support from the system’s data to improve the quality of patient care and operational efficiencies.
Here are the recommendations:

Department of Health and the hospital and health services

We recommend that the Department of Health and the hospital and health services that have implemented the ieMR solution (Note 1):
1. continue to work together to identify the actual cost to date of implementing and operating ieMR. (Chapter 2)
The Department of Health should:
  • use this information to update the Cabinet Budget Review Committee on the actual program cost to date. The information should form the basis for a more reliable estimate of what it will cost to complete the program and of the longer-term costs of maintaining the ieMR solution
  • in consultation with HHSs, consider whether the level of investment by HHSs to implement the ieMR solution is appropriate.
Note 1: The hospital and health services that have implemented the ieMR solution at varying ieMR stages include the Metro South Hospital and Health Service (ieMR advanced), the Mackay Hospital and Health Service (ieMR advanced), the Children’s Health Queensland Hospital and Health Service (ieMR advanced), Cairns and Hinterland Hospital and Health Service (ieMR intermediate), Metro North Hospital and Health Service (ieMR basic), and the Townsville Hospital and Health Service (ieMR intermediate).

Department of Health

We recommend that the Department of Health:
2. completes its refresh of the eHealth investment strategy based on the revised cost of the ieMR program and any impacts it has on the strategy for other programs (Chapter 2)
3. provides the Cabinet Budget Review Committee with:
  • updated timing for the realisation of benefits
  • a balanced assessment of benefits realised (and dis-benefits) across hospitals from all hospital and health services that have implemented the ieMR (Chapter 3)
4. provides greater assurance that it is obtaining ongoing value for money from its ieMR vendor by:
  • investigating options for demonstrating value-for-money pricing, including conducting comparative vendor price analysis where possible
  • assessing and documenting the ieMR vendor’s performance across its service contracts, with input from hospital and health services.
This should occur at appropriate intervals and, at a minimum, before each contract extension decision (Chapter 2).
5. re-visits the governance arrangements for the program as it moves from building, configuring, and implementing the ieMR solution to business-as-usual and optimising the solution 
This should include:
  • re-visiting the focus and roles of the eHealth Executive Committee, eHealth Queensland, and other areas of the department such as the Clinical Excellence Division
  • continuing to obtain an independent review of program benefits periodically. (Chapters 2 and 3).
6. develops and implements an engagement strategy for all current and planned eHealth programs to assess the effectiveness of its engagement with hospital staff and clinicians and the effectiveness of the system implementation (Chapter 2)
This should include:
  • specific actions, performance measures, and data sources to enable the department to assess how effectively the department engages hospital staff and clinicians
  • gathering information about concerns, risks, or dis-benefits that may inform the program about changes or modifications that need to be made to the program.
7. continues efforts to refine the business intelligence strategy and approach, and rollout solutions to hospital and health services to maximise the benefits from the ieMR implementation at each site (Chapter 3)
8. improves the preventative security controls of ieMR user accounts (Chapter 2).
This should include enforcing password complexity requirements and implementing a change management process to educate clinicians on appropriate password settings.

Hospital and health services

We recommend that all hospital and health services participating in the ieMR program:
9. report regularly on their total ieMR project costs and broader costs associated with their digital transformation (separated from ieMR costs) to eHealth Queensland as well as to their own hospital and health service boards (Chapter 2)
10. improve their employee termination processes to ensure they promptly remove an employee’s ieMR access when an employee or temporary staff member terminates their employment with their hospital and health service (Chapter 2)
11. implement a process to monitor whether reviews of inappropriate user access to ieMR patient data are completed (Chapter 2)
12. report dis-benefits to the program so the program can learn from these and if necessary, modify the solution or implementation approach (Chapter 3).
Here I the link:
A summary video is available here:
I have to say the audit has been well conducted and appears to have asked a lot of the right questions. The full .pdf from the link above is well worth a read.
This Fairfax report provides notice of some of the uncertainties.

Queensland hospitals in the dark about future costs of $1.2b project

By Lucy Stone
5 December 2018 — 4:57pm
Queensland’s hospitals still do not know how much it will cost them to run Queensland Health’s $1.2 billion integrated electronic medical record once the controversial project is completed in 2025.
In 2011, the ieMR project was originally projected to cost $600 million, but a 2016 business case showed its cost would blow out to $1.2 billion.
According to an Auditor-General report into Queensland Health’s digital hospital program, tabled in Parliament on Tuesday, the 2016 business case for the ieMR projected savings of $1.89 billion across hospitals from 2015 to 2025 once it was rolled out.
A draft business case this year showed the project’s completion would be at risk if the additional funding was not approved in the 2018-2019 budget.
Queensland Health director-general Michael Walsh said on Tuesday that increased costs were in line with increased scope of the project.
“As we’ve rolled out [ieMR] to hospitals, what we’ve been able to do is learn from each go-live,” he said.
“Hospitals want to maximise what they can deliver as benefits to patients, so they’ve added additional devices to be rolled out, they’ve ensured that there’s training provided to staff and that we’ve increased the scope from either basic, intermediate or advanced in terms of capability that’s rolled out.”
The ieMR project is designed to create a single medical record for each person that will easily be accessed at all hospitals across the state and is being provided by US medical technology company Cerner.
Queensland Health’s hospital network is broken down into several Hospital and Health Services areas under which several hospitals will work, each region managed by its own board and chief executives.
The Auditor-General’s report noted that while each HHS is responsible for their own budget, they had used Queensland Health's business case to create their ieMR budget.
The 2016 business case “significantly underestimated” what it would cost each Hospital and Health Services area to implement the ieMR solution, the Auditor-General found.
Several hospitals have since had to request extra funding to cover more infrastructure and staff costs.
The Auditor-General’s report showed that the cost to date for hospitals implementing the ieMR was unknown because neither Queensland Health nor the hospitals themselves had the necessary software to record and report detailed project costs.
More here:
Basically the summary is that it is costing a fortune, benefits are coming more slowly than expected and some of the forward costs are unknown. This whole thing is going OK but needs tighter control and management.
An audit of this quality of the #myHealthRecord  would be really fabulous!
David.

Wednesday, December 12, 2018

There Is A Fantasy That Data In Medical Records Is All Pretty Good. Sadly Not True It Seems.


A day or so ago I posted a blog on the risks associated with errors in the data held in your medical record.
Here is the link:
I had this commentary on a personal experience from an alert observer sent to me a day later.
To quote:
“A few years ago I attended one of Melbourne's leading tertiary hospitals for a wider excision of a Melanoma which fortunately was diagnosed very early by me and had not had an opportunity to invade or spread. When I was clerked in for the excision I was asked to sign the consent form 'here' which most patients probably would have done, but being a nosy parker I turned it over and asked the nurse "Why am I signing a consent to have my finger amputated?" The melanoma, which had been excised for pathology diagnosis by my GP, was on my flank! Oh, said the nurse, that consent form is for someone else, it must have been put into the wrong record! We fixed that problem.
When I returned 2 weeks later for review the receptionist had difficulty finding my record on the hospital computer system. As it transpired, in the short time that I had been attending the hospital I had been given TWO slightly different surnames and TWO medical (UR) numbers.  We fixed that problem.
The discharge procedures then came into play and I was formally discharged back to the care of my GP. For the next 3 weeks I received 3 follow-up letters from the hospital asking me to please attend for post-op review and discharge which I had already done. We fixed that problem.
During my second visit for post-op review with the consultant dermatologist, being a nosy parker, I looked at my hospital A4 record with the consultant and we were both surprised to find that it did not contain the histopathology report which was also not available in my electronic hospital record.  We followed up with pathology and obtained a hard copy. We fixed that problem. 
On leaving the hospital I was curious to know why I had encountered so many 'issues' with what should have been a relatively simple process - admit, treat, manage, discharge, all the while recording information along the way.  Being very familiar with hospitals and with information technology, on the way out of the hospital I wandered down to the basement and asked to speak with the health record librarian or health informatician as she was then called. We had a delightful and informative chat. She took me on a tour of her department and showed me the pile of documents waiting to be imaged into various patient's hospital computer records. I was stunned to see the size of the pile of documents and to learn how far behind (more than 2 weeks) the department was in imaging the documents into the hospital's computer system.
We discussed the problem. In particular we discussed how dangerous the entire system had become with some information being held in the hospital's manual A4 records and some being held on the computer system and no one reliable source of truth to which doctors and other hospital staff could refer. We couldn't fix that problem.”
And that is just one patient’s experience of confusion and near catastrophe!
All I can say is to point out to be very alert and alarmed while in Hospital and triple check everything. As they used to say “it’s dangerous out there!”. And so it is in Hospital!
David.

Tuesday, December 11, 2018

Commentators and Journalists Weigh In On The MyHR Debate And Related Matters. Lots Of Interesting Perspectives - Week 21.

Note: I have excluded (or marked out) any commentary taking significant  funding from the Agency or the Department of Health on all this to avoid what amounts to paid propaganda. (e.g. CHF, RACGP, AMA, National Rural Health Alliance etc. where they were simply putting the ADHA line – viz. that the myHR is a wonderfully useful clinical development that will save huge numbers of lives at no risk to anyone – which is plainly untrue) (This signifies probable ADHA Propaganda)
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GM Strategy - ADHA

Client Details
Better use of data and technology can help people live healthier, happier and more productive lives. Digital health can make a real difference to people’s health by giving them greater control and better access to information. Tasked with improving health outcomes for Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia, the Australian Digital Health Agency (the Agency) commenced operations on 1 July 2016. The Agency is responsible for national digital health services and systems, with a focus on engagement, innovation and clinical quality and safety. Our focus is on putting data and technology safely to work for patients, consumers and the healthcare professionals who look after them.

Description
The GM Strategy will play a pivotal role in the execution of the strategic aims and outcomes for the Agency. Working closely with and directly for the Chief Digital Officer, and other members of the Executive Leadership team, this role focuses upon stakeholder engagement, evidenced based evaluation, review of legislation and subsequently policy direction, the innovation roadmap and leadership of a tight knit group of professionals that anchor the organisations strategic outcomes.

Profile
This position is a strategic and ‘hands on role’ focused on deliverables against agreed timeframes.  You will have experience working with or in the health industry and have a deep understanding of Australian health policy and system.  Your ability to think on your feet will ensure you can quickly solve problems and resolve issues.  As a market innovator, your proactive approach to problem solving will see you deliver strong results.  You will be an excellent communicator with an ability to manage and influence senior stakeholders including government and peak industry bodies, have experience in leading change across an organisation or system, with a start-up and innovation led spirit, and a track record in delivering programs.   You will certainly be a strong leader to support capability development within the team.
Note: I wonder where the technology experience comes in?
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Talking Point: My Health Record

On Overnights with Rod Quinn
Download 21.08 MB
Opt In or Opt Out? What are you doing about your My Health Record? More than 6.3 million Australians already have a health record online. Rod Quinn looks at the benefits and possible pitfalls of having all your information online with Ariel Bogle, ABC’s Online Technology Reporter.
Duration: 46min 3sec
Broadcast: Fri 7 Dec 2018, 2:00am
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Experts urge Govt to shelve "outdated" My Health Record database

By George Roberts on AM
Download 1.42 MB
The Federal Government is being urged to shelve its digital health database and start again.
A leading surgeon and a medical tech developer say the My Health Record digital database is already a decade out of date.
They say other countries abandoned similar platforms and that this government should, too.
Duration: 3min 5sec
Broadcast: Fri 7 Dec 2018, 6:10am
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5 Dec 2018

The business of health in the digital age

Healthcare providers want to operate efficiently while providing the best possible care for their patients. Here’s how digitisation – My Health Record specifically – can help with both.
By the end of January 2019, every Australian who hasn’t opted out will have a My Health Record – an online summary of their health information. But what impact will this have on the business of providing healthcare?
“Digitisation is going to have a far-reaching impact on how healthcare providers run their practices, manage their time and, ultimately, on the conversations they have with their patients,” says Kate Galvin, Customer Executive, Health at NAB.
“Every business owner, from general and specialist practitioners to hospitals and allied health professionals, is hunting for efficiencies, and digitisation should support that.”
More productive consultations
Digital health can mean better health for all Australians through safe, seamless, secure digital health services and technologies that provide a range of tools for both patients and providers. That’s the vision of Australia’s National Digital Health Strategy, and My Health Record is a significant step in the process of digitisation.
Note: This is a bizarrely ignorant article IMVHO
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My Health Record Update.

An important update on the My Health Record legislation. 
The My Health Records Amendment (Strengthening Privacy) Bill (MHR) has now passed through the Senate. While it has yet to pass the House of Representatives, it represents a significant improvementto current MHR legislation.
The MHR amendments ultimately contained a number of significant improvements to the Government’s originally proposed changes to the MHR system, including some major wins for workers. Through the work of the union movement and in conjunction with the ALP, the legislation has been amended to ensure that all of the most serious issues identified by the ACTU and our affiliates as part of the recent consultations and Senate inquiry have been addressed. The issues addressed include:
  • Preventing employers and insurers requiring the disclosure of MHR information by employees.
  • Preventing the use of MHR information for the purposes of hiring or continuing to employ someone or for use for insurance purposes, including workers compensation.
  • Ensuring that the MHR system cannot be privatised or operated by a private provider.
  • Stronger protections against the use of MHR data for statistical purposes, particularly preventing insurers from using the data.
  • Emphasising the ability to request the complete deletion of a MHR at any time.
  • Further strengthening protections for people suffering from domestic violence.
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Poll – Current as of 2-12-2018

My Health Record: staying in or opting out?

  • Opting out (73%, 358 Votes)
  • Staying in (27%, 135 Votes)
Total Voters: 493
Note: This poll comes from the AMA Doctor Portal and reflects clinician views one would suspect.
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1 in 4 GPs' burnout due to e-health records

Daily IT frustration more than doubles the risk of burnout, US study finds
6th December 2018
One in every four doctors is suffering burnout thanks to e-health records, with female doctors at greater risk, a US study suggests.
The survey of nearly 1800 doctors finds that 70% are suffering stress because of health IT, with around eight in 10 GPs affected.
For 26% of doctors, the stress has led to one or more symptoms of burnout, with female doctors more likely to be affected than their male colleagues, according to the researchers, led by Brown University in Rhode Island.
After adjusting for other factors, doctors who agree electronic records add to their daily frustration have nearly two-and-a-half times the risk of burnout than colleagues who disagree.
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GDPR: Ain’t No Ocean Wide Enough

First extra-territorial enforcement action puts global organisations on notice
Understandably (given the breadth of the new regime and the huge potential fines introduced for non-compliance), the lead up to 25 May 2018 and the months that followed saw many companies frantically preparing for the arrival of the EU’s General Data Protection Regulation (GDPR) and subsequently rushing to put in place robust compliance regimes. By contrast, the European data protection authorities (DPAs) responsible for enforcement of the new regime have so far been relatively muted.
The DPAs have certainly been inundated with complaints in these early days, such as those lodged by notorious privacy activist Max Schrems against Google and Facebook minutes after go-live of the GDPR. However, it was not until 6 July 2018 that the UK’s Information Commissioner’s Office (ICO) issued its first official enforcement notice under the GDPR. The enforcement action is particularly notable as it has been issued against a Canadian company with seemingly no presence in the EU, and therefore may offer some insight into the vexed questions being asked about the extent of the GDPR’s extra-territorial reach.
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Malcolm Turnbull Spends His Morning Trying To Opt Out Of MyHealthRecord

CLANCY OVERELL | Editor | CONTACT
After a taxpayer funded break in New York City, multi-millionaire and “former Prime Minister” Malcolm Turnbull has reportedly spent the whole day on the phone with Medicare as he tries to opt out of his MyHealthRecord account.
Taking the call from his Apple Watch, Turnbull slowly paced around his Point Piper mansion as the call waiting music filled his third living room while Bargain Hunt played in the background on mute.
“Hello? Is anybody going to pick up? I haven’t got all day,” lied Turnbull, jabbing a thumb towards his 85 inch TV screen.
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Introducing integrated e-government in Australia

30 Nov 2018
With the 2016 distributed denial of service attack on Australia’s first fully digital Census and Centrelink’s 2017 automated debt-recovery system glitches still fresh in our minds, it would be easy to pause in the pursuit of digitising government services.
The reality, however, is that there are compelling benefits to expediting government digital transformation, and the case for change is not simply one of customer convenience.
Deloitte Access Economics has estimated that the federal and state governments conduct 811 million citizen transactions each year. It calculated that lifting the share of transactions performed digitally from 60% to 80% over a 10-year period would lead to government productivity benefits worth $17.9 billion, plus a further $8.7 billion in benefits to citizens. 
But the benefits of integrated digital government services extend even beyond time and resources saved. Data is the fuel for many new business models and, according to OECD measures, right now Australia performs only moderately well compared to international peers, particularly in relation to the availability of open government data.
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My Health Record in pharmacy

Monday, 3 December 2018  ADHA Propaganda

Bomaderry-based pharmacist, Rachel Forgan, says access to My Health Record provides vital information to help her deliver better informed patient-centred care.

Bomaderry-based pharmacist, Rachel Forgan, says access to My Health Record provides vital information to help her deliver better informed patient-centred care.
“Pharmacies play a significant role in helping patients understand their medications and ensuring their prescriptions are safe,” said Rachel.
“Without a My Health Record, we rely on the patients’ own recall of their medication and conditions when dispensing prescriptions or selling over the counter medication. Although this can be easy for some patients, others struggle to remember these details.
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What is My Health Record (MHR)?

Posted by Dr Michelle Woolhouse on 2 December 2018
  • MHR is Australia's national electronic health record system. 
  • It provides online storage for documents and data containing information about your health.
  • The information can be uploaded by you, your healthcare providers, or by Medicare.
  • It is you who will decide whether to make your information available to healthcare organisations and health care practitioners.
The My Health Record system has been running for several years. In the past it required you to opt-in, the change is that you will now be automatically registered unless you 'opt-out' before 31st January, 2019.
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Comments welcome!
David.

Monday, December 10, 2018

Weekly Australian Health IT Links – 10th December, 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

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A really interesting week with all sorts of issues in Qld Health, Encryption, Private Data Leakage and so it goes on. You could not make this stuff up. The implications are pretty big I reckon.
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7 December 2018

DHS allows police access to private health data

Posted by Felicity Nelson
While public outrage over access to My Health Record (MHR) data has forced a legislative change in favour of greater privacy, the police have been quietly dipping into another honeypot of health data: PBS and MBS records.
An investigation by The Medical Republic has revealed state, territory and federal police forces have sent around 2,600 requests a year for this sensitive health data to the Department of Human Services over the past two years. The department can legally disclose private health records to the police without a court order.
The department would not reveal how many of these requests were granted, but said the number of disclosures per year had remained stable over the past decade.
Once linked, Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data, can paint a very detailed picture about a person’s medical history.
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Audit into Queensland's digital hospitals finds cost blowout in $600m project

By Lucy Stone
4 December 2018 — 11:26am
Queensland Health's multimillion-dollar project to digitise the state's hospitals is at a "critical junction" as its cost has blown out beyond its budget, an Auditor-General report tabled in Parliament on Tuesday has found.
The report found that the $600 million integrated electronic medical record (ieMR) project has not been proven to provide value for money and is predicted to require another $256 million according to a draft business case from the department.
The project, coordinated by eHealth Queensland which sits within the health department, would provide each patients' medical records in a fully digitised environment for clinicians to access.
Digitising hospitals is designed to reduce costs, lower patient days spent in hospital and improve clinical care.
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Queensland digital hospitals program facing $250m cost blowout

December 4, 2018
A scathing report into the digitising of Queensland public hospitals has found massive cost blowouts, saying the e-health rollout is not providing "value for money".

Key points:

  • E-health project cannot be completed without more funding, the auditor-general says
  • Lack of competition means the ieMR project is unlikely to provide value for money
  • Health Minister says Queensland patients are already getting better health services
The report found cost overruns of $256 million — a jump of 42 per cent — if the implementation was ever to be completed.
Queensland auditor-general Brendan Worrall found the program "is now at a critical junction because it cannot complete implementation in the remaining 12 hospitals without more funding".
He also found insufficient financial information was being provided by member hospitals, and that the Health Department did not have proper software to record project costs.
The auditor-general's report also found the $600 million integrated electronic medical record (ieMR) project had not been proven to provide value for money.
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Queensland hospitals in the dark about future costs of $1.2b project

By Lucy Stone
5 December 2018 — 4:57pm
Queensland’s hospitals still do not know how much it will cost them to run Queensland Health’s $1.2 billion integrated electronic medical record once the controversial project is completed in 2025.
In 2011, the ieMR project was originally projected to cost $600 million, but a 2016 business case showed its cost would blow out to $1.2 billion.
According to an Auditor-General report into Queensland Health’s digital hospital program, tabled in Parliament on Tuesday, the 2016 business case for the ieMR projected savings of $1.89 billion across hospitals from 2015 to 2025 once it was rolled out.
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Qld's digital hospital project primed to blowout by $250m

By Justin Hendry on Dec 4, 2018 4:24PM

Almost 40 percent over budget.

The state-wide rollout of Queensland Health's integrated electronic medical record (ieMR) is projected to blow out by $250 million, pushing the long running project more than 40 percent over budget.
The state's audit office today released its report [pdf] into the department's efforts to digitise hospitals through a single e-health record that have now been running in excess of a decade.
The audit found that “the actual cost of developing and implementing the ieMR is higher than forecast” in the 2016 business case, which put the total capital cost of the project at $612.9 million.
The official probe reveals that “an additional $256.8 million” has been forecast by the department to complete the implementation – an increase of 42 percent on the expected cost in the 2016 business case.
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Exclusive: Report raises concerns about Queensland digital hospital system rollout

11:00am Dec 4, 2018
The long awaited Auditor-General's report investigating the rollout of Queensland's $600 million digital hospital system will be released today.
9NEWS understands the report raises serious concerns about the cost of the project and the relationship and dealings between American software company Cerner and eHealth Queensland.  
The government is also set to announce a shake-up of eHealth's responsibilities over the project.
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Strong digital road map to aid telehealth

  • 11:00PM December 4, 2018
Australia needs a strong digital road map to increase momentum for telehealth, the local head of Philips says and outdated payment models are also in need of an overhaul.
Caroline Clarke, chief executive of ASEAN Pacific at Philips, shared that view following the release of the company’s recent future health index report, which explores the challenges in the deployment of telehealth services in 16 countries, including Australia.
“The report showed that to speed up these new models of care in terms of efficiency and productivity, it was important to have a strong digital road map as a country,” Ms Clarke said.
 “What that means is enabling the capture of data and ensuring that patients feel happy that the data is going to be safe.”
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Can they really say that? GPs and online reviews

Amanda Lyons 5/12/2018 12:24:37 PM
Dr Steven Kaye talks about helping GPs on the thorny question of how to respond – or not – to patients’ online comments.
While it will always be difficult for practitioners to alter or remove negative online reviews, a new RACGP factsheet is designed to help GPs navigate how best to deal with them.
‘The worst GP I have ever seen. I took my daughter to see him when she was very sick. He missed the diagnosis and was deliberately rough with her. It was like we were imposing on his time. I’d ask a taxi driver for medical advice before seeing this GP. Never see him if you are ill – or well.’
This review, which the GP found by googling his own name, was used as a case-study by medico-legal expert Dr Sara Bird in a previous article in Australian Family Physician.
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District health boards in New Zealand leveraging cloud for clinical and non-clinical data

Many boards see moving to the cloud as a key enabler for achieving their information strategy goals and expect a significant uptake over the next three years.
December 05, 2018 08:54 PM
17 of New Zealand’s district health boards (DHBs) are hosting some of their clinical and non-clinical data offsite using cloud services.
The author asked all 20 DHBs what cloud services they are currently leveraging, their future plans and the barriers they see to cloud adoption.
All but three (South Canterbury, Lakes and Tairāwhiti DHBs) are using or piloting cloud services already and all are considering or have definite plans to expand their use of cloud.
Cloud services are supporting key hospital applications across the country, including patient administration systems, clinical portals, laboratory, picture archiving and communication, radiology, pharmacy, eReferrals and ICU systems.
Some primary and community data is being hosted in the cloud via solutions such as the Indici patient management system and the Manage My Health patient portal.
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CBA's CommInsure separation raises medical data access concerns

By Ry Crozier on Dec 3, 2018 10:12AM

Review launched to determine if breach has occurred.

CBA’s work to ringfence its CommInsure business for divestment has uncovered potentially problematic data access controls and internal group functions with access to sensitive medical information.
ABC News reported that medical information from claims lodged by an unknown number of customers had been “made available” outside of CommInsure.
It is understood the data access arrangements and controls were uncovered as part of data segregation works as CBA prepares CommInsure for its $3.8 billion sale to AIA.
A Commonwealth Bank spokesperson confirmed to iTnews that the bank had been investigating the practices since uncovering them in August.
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Commonwealth Bank customers' medical data exposed in potential privacy breach

By Dan Oakes, ABC Investigations
Updated Mon at 11:40am
The Commonwealth Bank is urgently investigating a potential data breach that may have given its staff access to customers' sensitive medical information.

Key points:

  • Sensitive medical data held by CommInsure was accessible to other staff members, including those making decisions on loan applications
  • The bank says it has not found evidence any data was accessed from outside the insurance arm, but it is still investigating
  • A former staff member says there was the potential for the data to be misused
The issue was discovered around late July as the bank made preparations for the $3.8 billion sale of its insurance arm, CommInsure, to the AIA group.
Medical information supplied by an unknown number of customers to CommInsure was made available to other arms of the bank, including to staff who decide whether to approve or decline loan applications.
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Govt tries to plug small business systems security holes with cash

By Justin Hendry on Dec 3, 2018 10:27AM

$10m available for cyber security testing.

Small businesses across Australia are set to benefit from a new government grant aimed at hardening the community's cyber security posture.
The federal government opened the $10 million grant initiative today, meeting a requirement in the 2016 cyber security strategy to help businesses secure their digital assets.
It is aimed at ensuring an adequate level of cyber security to avoid a situation where small business become “the soft underbelly or back door into connected organisations”, the strategy states.
The grant will provide up to $2100 for small businesses to have their cyber security tested by a Council of Registered Ethical Security Testers Australia New Zealand (CREST ANZ) approved provider.
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Via e-mail:

A Change in Leadership at HealthLink

Dear Colleagues and Clients,
I have recently made the decision to step down as CEO of HealthLink, an organisation I co-founded in 1993.  I am delighted that the position of Managing Director/CEO has been filled by Michelle Creighton who has been our Chief Financial Officer for the past four years and has previously worked as a business analyst in Information Technology companies.  I look forward to working closely with Michelle over the next three months as I transition out of the company.
As the leading provider of secure messaging and SmartForms services in both Australia and New Zealand, HealthLink has some very exciting opportunities ahead of it.  Work to establish SmartForms based electronic referrals is progressing well in both Australia and New Zealand and our collaboration with the Australian Digital Healthcare Agency to provide an interoperable messaging infrastructure throughout the Australian healthcare system has helped to further expand secure messaging coverage.  Recent shareholding changes and membership of the Clanwilliam Group of companies brings some very significant opportunities for HealthLink which is now part of a rapidly growing group of  international companies. 
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ACS launches AI guide for businesses

The Australian Computer society has released a guide for businesses to start using artificial intelligence in their organisations, outlining what AI is and what it can do.
The guide — Artificial Intelligence: A Starter Guide to the Future of Business — was released on Thursday, with a number of Australian AI companies present and showing off their wares.
These included the chief executives and founders of Sortal, Gameface and Hyper Anna.
“Artificial intelligence promises to revolutionise the way we do business, optimising business processes and creating entirely new revenue streams,” said ACS president Yohan Ramasundara.
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Australia’s ‘digital identity assets’ in danger, report

What if digital land titles and a century’s worth of newspaper archives went missing?
George Nott (Computerworld) 06 December, 2018 09:51
A scenario: an agency discovers that thousands of digital land titles have been altered, making it impossible for individuals and companies to prove ownership of their assets.
“The stock market moves into freefall as confidence in the financial sector evaporates when the essential underpinning of Australia’s multitrillion-dollar housing market – ownership – is thrown into question. There’s a rush to try to prove ownership, but nowhere to turn,” writes Anne Lyons, a visiting fellow with the Australian Strategic Policy Institute (ASPI), in a report published this week.
“Banks cease all property lending and business lending that has property as collateral. The real estate market, insurance market and ancillary industries come to a halt. The economy begins to lurch,” Lyons’ paper – Identity of a nation: Protecting the digital evidence of who we are – continues.
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3 December 2018

Medical devices and implant regulation: a primer

Authored by Jason Chuen
THE past week has seen the International Consortium of Investigative Journalists (ICIJ) release its Implant Filesthe result of an extensive investigation into the medical implant and device industry. Despite some enlightening reporting, the issues raised can be challenging to understand without a wider background in medical technology.
What is a medical implant?
For the most part, the ICIJ investigation has focused on “medical implants” — devices placed inside a patient to serve a specific medical function. Some of these implants can be very simple, such as a wire or a screw to hold broken bones together, a new hip or knee joint, or a catheter used for kidney dialysis or chemotherapy delivery — indeed even a suture used to sew up a wound (or a mesh used to reinforce and strengthen a wound) can be considered to be a medical implant.
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Future healthcare tech may be beneficial, but also poses risks: report

Hafizah Osman | 07 Dec 2018
Some of the biggest technologies leading digital transformation in healthcare are also perceived to hold the greatest risk, according to a new report. 
ISACA’s recently released 2018 Digital Transformation Barometer found that some of the most hyped technologies in healthcare – including public cloud, the Internet of Things (IoT) and big data – are all noted and rewarding, but also potentially risky. 
ISACA member and Tucson Medical Center Director of Infrastructure and Operations, Susan Snedaker, said global respondents were excited about these emerging technologies and their potential to change the future landscape of IT, but with a lot of unknowns surrounding these technologies, their security is a top concern. 
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  • Updated Dec 4 2018 at 9:11 AM

What your heart rate is really telling you

by Rosa Silverman
Perching nervously on the edge of my sofa, I clutch my smartphone in my left hand and press my right forefinger over the camera.
The device begins beeping, while numbers flash on the screen. I know not what they mean, nor why they're changing, but I'm about to discover my heart rate – courtesy of an app I've downloaded. It cost just €2 ($3), which sounds like a fair price for the infinite number of times it allows me to check my ticker.
After a few seconds, the result is revealed: 71 beats per minute (bpm). To my relief, this is categorised by the app's sliding scale as "normal", as opposed to "slow" or "fast". The "fast" section of the scale is coloured an alarming red, presumably to indicate danger.
But if I found myself in the red, what would that actually mean? A warning of an imminent heart attack, or simply the need to get off my sofa and on to the treadmill?
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Doctor goes from medicine to leading award-winning technology company

By Josh Jennings
2 December 2018 — 1:05pm
Radiation oncology specialist Raghav Murali-Ganesh is having a bumper 12 months at work - just not at the coalface of clinical medicine.
Cancer Aid, the Australian health technology start-up he co-founded in 2015, is busy winning a lot of big-time awards of late. So much so that it would hinge on an ad nauseam exercise to list them all.
Sir Richard Branson was one of the judges behind Cancer Aid's nod in the Best Global Start-up and Best Start-up Creating Social Impact categories at the most recent Talent Unleashed Awards. In fact, the Talent Unleashed Awards were full of spoils. They also gave Murali-Ganesh the opportunity to take part in an all-expenses trip to Silicon Valley to visit leading tech behemoths such as Facebook and Apple.
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Microsoft, Mastercard alliance muscles in on digital identity

By Julian Bajkowski on Dec 4, 2018 11:55AM

We care a lot … (product not included).

Microsoft and credit card behemoth Mastercard have officially jumped into bed together over digital identity provision, announcing a formal tie-up that is likely to assert a heavily American influence on the nascent global industry.
The two US-based multinationals on Tuesday issued a statement extolling a new “strategic collaboration” that pitches a decentralised (federated) model of execution as the two companies bet heavily on a formal affiliation between their payments and software platforms.
However as conspicuous as the mating ritual between the two giants is, it's pulled-up well short of any tangible product, release date, preferred architecture or initial market so far.
Instead, the pair has settled on a broad statement of aim that it says will be fleshed out “in the coming months” to create “a service that would allow individuals to enter, control and share their identity data their way – on the devices they use every day".
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Trust, skills and cloud: Key ingredients needed for 2025

  • By Sassoon Grigorian
  • December 4, 2018
The Australian government’s Digital Transformation Strategy sets a vision to be a top three digital government by 2025 and provides clarity and certainty. What’s needed now is for some of the not-so-secret ingredients of successful digital transformation to be added to make it reality.
Australia is well positioned to reach its 2025 goal, with programs recognised globally for being pioneering and innovative. The opportunity for positive growth through digital transformation is proven by initiatives such as what we’re seeing from Service NSW, where increasing digital service delivery by 60 per cent has resulted in a 97 per cent customer satisfaction rating.
The impact of leadership in digital transformation isn’t just limited to the public service.
A Salesforce commissioned report Accelerating Australia’s Digital Transformation - Strategies for the Fourth Industrial Revolution, estimates the wider economy could be boosted by $9.2 billion by 2020 through an expansion of the nation’s cloud capabilities.
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Government agencies ordered to block online ads, Flash

New cyber security guidelines for government released
Rohan Pearce (Computerworld) 04 December, 2018 11:15
Web browsers on Australian government workstations should, by default, be configured to block online ads, Adobe Flash and Java.
The new security controls — which have been given the priority of “Must” — apply to all systems that deal with official government data, even if it is unclassified.
The controls are part of a major update to, and restructuring of, the government’s Information Security Manual, which for the first time has been officially published by the Australian Cyber Security Centre. The ACSC is overseen by the Australian Signals Directorate, and in previous years the ISM has been branded as an ASD document.
The new controls were “Added to address a gap in guidance on the hardening of web browsers,” a document accompanying the ISM states.
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Imagining the future of Australian health care

While traditional video conferencing in the medical industry has been available for over 10 years in Australia, doctors and specialists had always faced difficulties when it came to implementing it for patient care
Michael Chetner, Zoom (Computerworld) 07 December, 2018 00:00
Between 2015-16, 10.6 million hospitalisations occurred in Australian public and private hospitals. In the same period, 712,000 patients were admitted to public hospitals from elective surgery waiting lists, only half were admitted within 37 days. The medical industry is one of the most important aspects of society, and these figures represent some of the medical industry’s long-running perceived issues such as long wait times and limited access to specialist care.
While traditional video conferencing in the medical industry has been available for over 10 years in Australia, doctors and specialists had always faced difficulties when it came to implementing it for patient care. Medical professionals ran into connection issues and amplified costs due to the roll-out of networks in rural locations. However, with today’s cloud technology, video communication can connect seamlessly, even when internet connection is at a minimal. By adopting video communication, the health sector can create a more convenient service for patients, better help disadvantaged patients and provide solutions that could change how doctors treat patients in the future.
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What do the new encryption laws mean for you?

Landmark laws will give security agencies new powers to obtain the encrypted communications of criminal suspects. How far do the powers go? And what do they mean for you?

By Adam Turner
7 December 2018 — 3:51pm
Landmark laws will give security agencies new powers to obtain the encrypted communications of criminal suspects. How far do the powers go? And what do they mean for you?
Here's what you need to know.
What's happening?
Tech giants such as Apple, Google and Facebook can be forced to help Australia's law enforcement agencies read our private messages under new laws designed to ensure wrongdoers can't hide behind encryption.
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Australia gets world-first encryption busting laws

By Ry Crozier on Dec 6, 2018 7:36PM

Labor passes bill without changes it claimed were needed.

Australia’s law enforcement agencies have a wide range of new encryption-busting powers after Labor dropped all opposition to a highly contentious bill and let it pass without extra changes it claimed all day were needed.
The bill passed into law by 44 votes to 12 in the senate, having already cleared the lower house where just two MPs voted against it.
The law gives law enforcement the power to ask technology companies to create - and then seed - a vulnerability on "one or more target technologies that are connected with a particular person".
Passage of the bill was achieved after it looked destined to fail.
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  • Updated Dec 2 2018 at 12:24 PM

Scott Morrison 'compromising national security' on encryption: Penny Wong

Labor's Penny Wong has accused Scott Morrison of compromising Australia's national security by engaging in a fight over controversial encryption powers, setting up a dramatic final week of federal Parliament.
With four sitting days remaining, the government says the opposition wants terrorists to be able to communicate privately beyond the reach of intelligence agencies — a claim made after negotiations over the laws broke down in acrimony on Friday when bipartisan cooperation faltered over demands by the Coalition for the bill to be rushed through Parliament before Christmas.
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No more WhatsApp? How the proposed encrypted message access laws will affect you

Australia's Government wants to pass world-first laws that would force technology companies to help police access encrypted messages.
Attorney-General Christian Porter has said a high number of people involved in terrorist plots and serious organised crime use encrypted messaging apps.
But not only does encryption keep text messages secret, it underpins the security of the internet, from email to online banking.
Technology companies, human rights groups, lawyers and others aren't happy about the law, and — given the bill's powers will be unprecedented globally — it's unclear how this will play out.
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Encryption bill: Labor dissents with govt on passing legislation

The Australian Labor Party has said that it will be dissenting with the government members on the panel that is inquiring into the encryption bill. But the government says it will be pressing on and presenting the bill in Parliament next week, the last sitting week for the year.
Labor Shadow Attorney-General Mark Dreyfus said in a letter to Attorney-General Christian Porter that the Parliamentary Joint Committee on Intelligence and Security had worked to pass more than 15 national security laws since 2014, with 300 amendments.
But, he said, this time the Labor Party had been pushed too far.
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Australia’s diplomats at odds with crypto bill

By Matt Johnston on Dec 3, 2018 12:00PM

DFAT signs on to Paris Call for cyber stability.

The Department of Foreign Affairs and Trade (DFAT) has said it “is pleased to endorse” international movements for a stable cyber environment free from state interference - a position which appears to put it at odds with some provisions of the government's Assistance and Access Bill.
iTnews reported last month that three Australian representatives, including cyber ambassador Tobias Feakin, attended a meeting of the Global Commission on the Stability of Cyberspace (GCSC).
While Australia’s contributions to the meeting are unclear, the meeting saw the adoption of new “norms” for cyber conduct that included not altering products or services. The Assistance and Access Bill would give the government the power to "require a provider to build a new capability that will enable them to give assistance to ASIO and ‘interception agencies’."
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Law Council, journos, software industry urge caution on encryption bill

Backlash against government attempt to ram through legislation
Rohan Pearce (Computerworld) 03 December, 2018 11:44
An attempt by the government to push through major national security legislation has roused a chorus of concern, with groups representing lawyers, journalists and software companies calling on the Canberra to rethink its rush.
The Telecommunications and Other Legislation Amendment (Assistance and Access) Bill 2018 would give police and security agencies new powers to force tech companies to cooperate with investigations. It would also allow the government to order a company that provides a communications service to build new capabilities designed to assist with investigations.
The government says the legislation is necessary to counter the increased use of encrypted communications by criminals and terrorists. However, critics have argued that it could undermine the security of major online services.
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Why Scott Morrison is right on encryption but wrong on Muslims

By Peter Hartcher
4 December 2018 — 12:04am
On the one hand, the federal government is getting pretty excited over its new counter-
terrorism bill, demanding Parliament pass it this week. On the other, the scale and number of terrorist attacks in Australia is small and the problem seems in check. Is this just a piece of political theatre by a government desperate to show how tough it is and how feeble the Labor Party is? Or is there serious need?
I'd like to call an independent expert witness.
Nick Rasmussen is an American with impeccable credentials. He's a career diplomat with nearly two decades as a senior counterterrorism official. For the last three years he led the overall US effort as head of the National Counterterrorism Centre. He was director of the agency under both Barack Obama and Donald Trump, a reliable clue that he's a respected professional, not a political hack.
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Royal Darwin Hospital improves patient care with virtual desktop program

Hafizah Osman | 03 Dec 2018
The Royal Darwin Hospital (RDH) has introduced a virtual desktop program that enables clinicians to save time on having to keep logging into their devices, in addition to improving the management of patient records. 
The program, named Virtual Desktop Infrastructure (VDI), was implemented by the Department of Corporate and Information Services (DCIS) and the Department of Health, and supports nurses and doctors through a configuration of functionality across ten software products.
This includes accessibility to RDH business applications from the virtual desktop, secure external access from outside the hospital, and cyber security improvements for better security of patient information. 
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Taylor Collison launches med tech company raising

Updated 04 Dec 2018 — 12:14 PM, first published at 10:07 AM
Stockbroker Taylor Collison is seeking to raise fresh funds for ASX-listed medical devices company CardieX.
CardieX shares went into a trading halt on Tuesday morning as its broker launched the deal.
Taylor Collison was seeking buyers for 183.3 million new shares at 3¢ each to raise $5.5 million.
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Quantum leap: Sydney startup launches world-first software product

By Emma Koehn
4 December 2018 — 11:01pm
Quantum physicist Michael Biercuk is launching a world-first software product this week, and while it's not targeted at the everyday consumer it could change their lives in the long run.
His startup Q-CTRL's Black Opal software package aims to help businesses that are working on quantum computing processes to eliminate errors and improve the strength of their hardware.
Quantum computing moves beyond traditional computers that store information as "bits" represented by 1s and 0s, and instead harnesses quantum physics to process information more efficiently.
But as the world works to develop quantum computers that have practical uses, the hardware is vulnerable to breaking down.
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Follow the money: latest govt. print & signage contracts

Outdoor advertiser oOh!media’s 10-year contract for Brisbane City Council’s street furniture business is the headline deal, but a range of other major players including Finsbury Green, IVE Group and Fuji Xerox, as well as smaller signage businesses have all won recent local, state and federal government contracts.
oOh!media, the new owner of Adshel, confirmed that Brisbane City Council has voted to approve a new 10-year contract for an undisclosed amount. The Adshel brand name will disappear in coming months, following oOh!media’s $570m acquisition of the street furniture business in September.
Elsewhere, Finsbury Green signed a $3.5 million contract with the NSW Rural Fire Service for Print Management, Warehousing and Distribution Services, which includes printing and photographic and audio and visual equipment. The three-year deal runs until 30 August 2021.
Sydney-based print & communications business IMMIJ won a $1.98 million contract with the Australian Digital Health Agency for Printing and packaging services.
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Tabula Rasa HealthCare to Acquire DoseMe, a Precision Dosing Software Company

Acquisition projected to expand reach of TRHC’s medication safety technologies in the hospital healthcare system market and internationally

December 03, 2018 08:00 ET | Source: Tabula Rasa HealthCare, Inc.
MOORESTOWN, N.J., Dec. 03, 2018 (GLOBE NEWSWIRE) -- Tabula Rasa HealthCare, Inc. (“TRHC”) (NASDAQ: TRHC), a healthcare technology company advancing the field of medication safety, today announced it has executed a definitive agreement to acquire Brisbane, Australia based DoseMe. DoseMe is the developer of DoseMeRx, an advanced precision dosing tool to help physicians and pharmacists accurately dose patients’ high-risk parenteral medications based on individual needs, resulting in significant improvements to mortality, risk, and patient outcomes.
Already available in over 100 hospitals and infusion providers worldwide, DoseMeRx’s precision dosing capabilities will now be combined with TRHC’s proprietary Medication Risk Mitigation (MRM) technologies in order to enhance and accelerate medication safety solutions available in the hospital setting.
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AI solution to replace nurse call button at Burwood Hospital

Thursday, 6 December 2018   (0 Comments)
eHealthNews.nz editor Rebecca McBeth
Canterbury District Health Board is replacing the traditional nurse call button with a patient communication system using artificial intelligence to triage and relay patient messages.
The DHB is starting a three- to six-month trial of DeloitteASSIST at Burwood Hospital early next year.
The system was developed at The Prince of Wales Hospital in Australia and uses Amazon Alexa voice assistant technology to enable patients to request help without the need to press a button.
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Marriott group hit by massive breach, details of 500m stolen

Hotel group Marriott International has reported a data breach in its Starwood line of hotels and resorts, with the details of up to 500 million guests likely to have been stolen by malicious attackers.
Marriott said it had become aware of the breach on 8 September and investigations had shown that data was being exfiltrated since 2014.
In a statement, the group said for about 327 million of these, the details included a combination of name, mailing address, phone number, email address, passport number, Starwood Preferred Guest account information, date of birth, gender, arrival and departure information, reservation date, and communication preferences.
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Enjoy!
David.