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."

Monday, June 24, 2019

Weekly Australian Health IT Links – 24th June, 2019.

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 much busier week with all sorts of announcements and so on. It was especially rich on the security and NBN fronts.
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Digital Health Record to change the lives of those with a chronic illness in Canberra

Posted Sun at 8:27am
When Jen Sutherland winds up in the emergency department in debilitating pain, she is often forced to relay to the staff a decade of complicated medical history before she can be treated.

Key points:

  • The ACT plans to introduce a new single electronic system for patients
  • $70 million has been set aside to build and implement the system over the next four years
  • Chronic illness sufferers have welcomed the decision
The 27-year-old Canberran lives with Type 1 diabetes and endometriosis, juggling multiple medications, specialist appointments and tests each month.
And because Canberra's public health system uses a complex combination of digital systems and paper records, it can be difficult for clinical staff to access patients' medical information.
The burden is inevitably placed on the patient to keep track of their history.
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SA Pathology connects to MHR for better patient and clinician experience

June 17, 2019 03:38 AM
“As a GP who is often forced to waste valuable time chasing down pathology results, especially for a new patient, this will make my job easier and the patient's care safer,” said Dr Chris Moy, Adelaide General Practitioner.
Following Northern Territory Department of Health’s announcement that it will soon become the first pathology provider to link the online test results it is sharing via My Health Record (MHR) with Lab Tests Online, South Australia (SA) Pathology, the statewide pathology provider for the public health sector, has also connected to the MHR.
WHAT’S THE IMPACT
SA Health patients will be able to conveniently access their pathology reports, and clinicians will be able to get pathology results faster. South Australians can now take any pathology request form to any SA Pathology collection centre and their report can be uploaded to their MHR, giving patients timely access to their pathology results.
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The power of synergy: Health IT vendors integrate their technologies at Qld eHealth Expo

Stuart Corner | 19 Jun 2019
Hospitals today are awash with technology: for communication for people and asset tracking; for patient treatment and monitoring.
Trouble is, off the shelf, many of these products don’t talk to each other. So to gain maximum benefit and exploit synergies between them, hospitals must embark on costly custom integration projects.
It doesn’t have to be that way, and at the Queensland eHealth Expo in June the Customer Experience Centre demonstrated what is possible when vendors work with each other to integrate their respective products.
The centre was the brainchild of IT consultant Mitchell Simpson, managing director of Clear Engagement Pty Ltd, with support from Queensland Health. He told Health IT News that it represented the culmination of a long-held vision.
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Fed's digital ID system quietly hits the App Store

By Justin Hendry on Jun 18, 2019 6:36AM

myGovID enters public beta.

Australians are now able to create a digital identity to access online government services after the federal government’s new myGovID system progressed to the public beta stage of testing.
But the digital equivalent of the 100 point ID check currently works with only the Australian Taxation Office’s business portal, as an alternative to the soon-to-be-replaced AUSKey credential.
More online government services are expected to be accessible over the next six months, starting with the ATO’s new tax agent portal, known as online services for agents.
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WA's pathology provider needled for system delays, budget blowouts

By Justin Hendry on Jun 20, 2019 6:50AM

Behind schedule and risking legacy system outages.

Western Australia’s public pathology service PathWest has been blasted by the state’s auditor for the late-running and over budget overhaul of its legacy Ultra laboratory information system (LIS).
The delay is also risking “potential system failure” with PathWest’s existing legacy LIS, which reached end of life a year before the replacement system project began in 2014.
The state’s auditor-general said [pdf] on Wednesday that the project would be two years late and almost $24 million over budget when the system is finally deployed in April next year.
But “poor budgeting and tracking” during the first four years of the project meant that figure could be somewhat higher.
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Women in Perth to benefit as Women's and Breast Imaging joins My Health Record

19 June, 2019 - 9:00
Women in Perth are set to benefit from more convenient and comprehensive access to their scan results as local radiology provider Women's and Breast Imaging this week connected to My Health Record.
The results of scans and tests conducted at Women's and Breast Imaging will be uploaded directly to the patient’s My Health Record. This will give patients peace of mind that they won’t lose their results and will streamline the process between diagnostic clinic and clinician leading to an improved patient experience. It will also ensure that no matter which healthcare professional a patient visits, as long as they are connected to the system, the information is available to them which will cut down on unneeded diagnostic tests.
Perth-based Women's and Breast Imaging is a leading provider of diagnostic imaging for women and specialises in breast disease imaging.
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Chest pain pilot launched

The Australian Digital Health Agency, in partnership with the University of Sydney, has launched a study into the use of My Health Record in Rapid Access Cardiology care

The Agency and the University of Sydney have launched the pilot to investigate how My Health Record can support the management of low to intermediate risk chest pain patients through the Rapid Access Cardiology Clinic (RACC) model, initially based at Westmead Hospital.
The pilot aims to enhance the quality, safety and efficiency of cardiology services, and if successful, may be scaled up to roll out across the country.
It is expected that this study will yield lower rates of hospital readmissions and avoid a rise in major adverse cardiac events, such as heart attacks.
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My Health Record launches Rapid Access Cardiology Clinic testing

19 June, 2019 - 9:00
The Australian Digital Health Agency, in partnership with the University of Sydney, is pleased to launch a study into the use of My Health Record in Rapid Access Cardiology care.
The Agency and the University of Sydney have launched the pilot to investigate how My Health Record can support the management of low to intermediate risk chest pain patients through the Rapid Access Cardiology Clinic (RACC) model, initially based at Westmead Hospital.
The pilot aims to enhance the quality, safety and efficiency of cardiology services, and if successful, may be scaled up to roll out across the country. It is expected that this study will yield lower rates of hospital readmissions and avoid a rise in major adverse cardiac events, such as heart attacks. Furthermore, the pilot, may also help to develop targeted cardiovascular disease prevention programs including lifestyle modifications to address common risk factors such as high blood pressure.
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ADHA, University of Sydney partner on cardio health pilot program

Nathan Eddy | 20 Jun 2019
The Australian Digital Health Agency and the University of Sydney have partnered on a pilot program to assess how the My Health Record platform can improve the cardiology service.
During the study, clinicians at Westmead Hospital will have access to participating patient's My Health Record, drawing on the information within the record to make a quicker diagnosis or decisions for treatment.
Other goals of the pilot program aim to reduce duplicate testing and bolster support for communication among healthcare providers through the My Health Record shared healthy summary feature.
A My Health record provides GPs, pharmacies and health systems with the ability to view a patient's health information securely online.
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NSW government launches $100m ‘digital restart’ fund

Prepares for 1 July launch of Department of Customer Service
Rohan Pearce (Computerworld) 18 June, 2019 14:40
New South Wales will establish a ‘Digital Restart Fund’ in 2019-20 with seed funding of $100 million over the next two years to fund whole-of-government digital transformation.
The measure was outlined in the state’s budget, handed down today by NSW Treasurer Dominic Perrottet.
“We’ll continue to make people’s lives easier with a focus on digital government,” the treasurer said in his budget speech.
Victoria has “copied” the state’s Service NSW approach, Perrottet said. Victoria in 2015 began work on its ‘Service Victoria’ initiative. The NSW Treasurer also noted the decision of the federal government to create Services Australia: A successor to the Department of Human Services that will absorb the Digital Transformation Agency and take responsibility for whole-of-government IT and ICT procurement.
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Australian nurses to benefit from e-learning modules on My Health Record

The new training will ensure nurses are able to use My Health Record in their everyday practice.

The Australian Digital Health Agency, in partnership with the Australian College of Nursing (ACN), has recently announced the roll out of new e-learning modules on My Health Record that will benefit the nurses.
 According to a recent press release, the new training will ensure nurses are able to use My Health Record in their everyday practice.
This training will ensure that that the information is consistent across the healthcare sector to improve patient outcomes.
The Agency partnered with the ACN to develop the training, guaranteeing that all materials are tailored to the nursing role.
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Brain device gets medical research funding

Researchers are striving to crack medical breakthroughs after receiving up to $1 million in funding from the federal government.
Australian Associated Press June 19, 20197:22am
A brain device that can help restore people's eyesight will be further researched to discover other ways it could change lives, with the federal government stumping up more than $900,000 for the project.
The Monash University-led investigation will work with doctors and patients to identify two other ways the technology could be most useful.
The device sits on the surface of the brain and may be able to help grapple with conditions such as epilepsy and depression and restore other neural functions.
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OAIC releases its 12-month notifiable data breaches report

The OAIC have released their first annual notifiable data breaches report, following the introduction of mandatory data breach reporting in February 2018.
Partner, Andrea Beatty and lawyer, Chelsea Payne, discuss the main findings of the report.
The Office of the Australian Information Commissioner (OAIC) has released its 12-month notifiable data breaches report for the period 1 April 2018 to 31 March 2019.
During the period, of the 1,132 notifications made to the OIAC, a total of 964 eligible data breaches were reported.[1] This was a 712% increase in notifications since the scheme was made mandatory in February 2018.[2] Of the breaches reported, 86% involved the disclosure of contact information.[3]
60% of reported data breaches were as a result of malicious or criminal attacks, with phishing and spear phishing the most common and effective measure of attack.[4]
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WA Health begins year-long Office 365 shift

By Justin Hendry on Jun 20, 2019 12:20PM

As part of wider hybrid cloud migration.

Western Australia’s health department is planning to shift almost 45,000 staff to Microsoft Office 365 over the next year as part of its mammoth hybrid cloud migration.
Microsoft said in a blog post on Thursday that the email and collaboration platform was currently being trialled at the department ahead of a wider rollout.
It follows a series of workshops between the company and WA Health’s recently established security and risk management (SRM) team to “ensure maximum advantage” from the platform.
The department aims to have transitioned all 44,000 metropolitan, regional and remote staff from Microsoft Exchange by mid-2020.
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Healthily, MedicalDirector partner on patient education

Nathan Eddy | 19 Jun 2019
Healthily, a firm specialising in patient education and behaviour change, has announced a deal to integrate its GoShare platform into technology from medical software and information provider MedicalDirector.
GoShare is meant to help health professionals deliver tailored and engaging patient education information and resources, officials say, with the goal of improving health literacy and supporting behaviour change.
The platform enables GPs and practice nurses to access and send health information and resources electronically to patients so they can understand how to better self-manage their health and wellbeing.
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Missing backpacker's family pleads for WhatsApp access

By Toby Crockford
June 17, 2019 — 11.58am
The family of a missing Belgian backpacker has made an emotional plea to messaging platform WhatsApp to give police access to his final communications as the search continues in the Byron Bay area.
Theo Hayez, 18, went missing on May 31 and was last seen on CCTV about 15 minutes' walk from his Byron Bay hostel. On Monday, the search concentrated on the area surrounding the Cape Byron Lighthouse.
Tweed Heads Superintendent David Roptell said investigators have asked WhatsApp for access to the backpacker's messages but have been unsuccessful so far. He described Theo's disappearance as "baffling".
Theo's father, Laurent Hayez, broke down as he made a heartfelt plea to WhatsApp and anyone who had information regarding his son's whereabouts to contact police.
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Data#3 wins $32 million Azure deal with NSW Health

Data#3 has won a $32 million contract from NSW Health to provision Microsoft Azure products and services.
A NSW Health spokesperson said the contract was part of an initiative from its internal information and communication technology agency eHealth NSW.
eHealth NSW is partnering with industry to support electronic management of health information, the spokesperson told CRN.
The department did not specify the Azure products used, but tender documents reveal the contract runs from 1 June 2019 to 31 May 2020.
Data#3 declined to comment further on the contract win.
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June 19, 2019 2:35 pm AEST

How Australia’s top-five digital health innovation sectors attract global investment

Austrade has launched a digital health website showcasing Australia as an ideal location for developing, testing and launching the next generation of digital medical technologies.
The site includes listings, case studies and data on sub-sectors where Australia is a significant contributor to global medical solutions. These include telemedicine, precision medicine and genomics, big data and artificial intelligence, digital records and virtual reality.
According to Denise Eaton, Senior Adviser, Austrade, institutions and agencies are rapidly extending the scope of in-country medical research. Australian companies are globally recognised high performers in manufacturing and prototyping, as well as traditional research and development.
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MidCentral publishes digital health strategy

Tuesday, 18 June 2019  
eHealthNews.nz editor Rebecca McBeth
MidCentral DHB has published one of the country’s first district-wide digital health strategies.
Called Te Awa, the five-year strategy is collectively endorsed by the DHB, Central PHO, Manawhenua Hauora, the Clinical Council and the Consumer Council in the region and was developed after extensive district engagement and consultation.
An introductory message says that developing and using digital technology “will help us to improve access to services, to address and minimise health inequality, to improve the quality and safety of our services, and to increase the control people in our district have over their own health”.
The strategy has four guiding principles, which are; people-powered; one district; information sharing; and being a good digital health steward.
The objectives of the strategy are to digitise the consumer, families and whānau experience with improved access to information and to digitise end-to-end processes, allowing the smooth flow of information between services and across organisational boundaries.
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Goggles could help diagnose causes of vertigo, study says

Nathan Eddy | 21 Jun 2019
A study by researchers at the University of Sydney indicates glasses specially designed to measure eye movements during vertigo could help physicians diagnose the type of vertigo a person suffers.
The study, conducted in partnership with Royal Prince Alfred Hospital and published in the journal Neurology, included 117 patients already diagnosed with three types of vertigo, who then used the goggles to video record their own episode of vertigo.
The goggles were able to provide very high accuracy of diagnosis similar to in-clinic hearing tests. Patients studied included those with Ménière disease, vestibular migraine or benign paroxysmal positional vertigo.
Vertigo is a form of severe dizziness that can result in a loss of balance, a feeling of falling, trouble walking or standing, or nausea, and because there is more than one type of vertigo, each with a different cause, different treatment may be required in each specific case.
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BaptistCare cuts manual data handling, paper processes

Venerable aged-care organisation embraces digital opportunities
Rohan Pearce (Computerworld) 20 June, 2019 15:13
BaptistCare is increasingly shifting away from paper-based processes and manual handling of data, with MuleSoft’s integration platform helping provide the scaffolding for its embrace of customer-facing web apps that can feed directly into line of business systems.
BaptistCare has existed for almost three-quarters of a century as a not-for-profit care-based organisation. It operates in two key areas. The first is aged care, which includes residential aged care (nursing homes), ‘BaptistCare At Home’ (in-home care), and retirement living. The other is community service, which includes food support, support for people affected by domestic and family violence, counselling, and community centres.
It operates some 160 different facilities and programs, with around 3500 staff and a thousand volunteers.
Its technology function is mostly in-house, with about three dozen full time employees and typically a handful of contractors. Staff are split between applications and BI, operations , and a business-facing team that includes account management and major project delivery.
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Thursday, 20 June 2019 23:50

Technology underpins new disability accommodation

A new home that is giving people with an intellectual disability a new level of accommodation and support through the use of assistive technology has opened in the Melbourne suburb of Brighton East.
The house, built by Catholic disability care provider St John of God Accord — a division of St John of God Health Care — features assistive technology developed by Internet of Things company, Quantify Technology, and other partners, and designed to give those with an intellectual disability an improved quality of life.
The ASX-listed Quantify (ASX:QFY) designed a solution based on its existing intelligent building technology to match the needs and goals of residents moving into the house.
The company’s devices allow carers to focus on delivering better care outcomes, and residents to live safer, more independent lives by enabling residents to trigger customised living experiences such as morning and night-time scenes, using easily understood sun and moon symbolled buttons.
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Banks blame staff for data breaches

James Frost  Financial Services Writer
Jun 21, 2019 — 3.58pm
Financial services companies, including banks, have reported fewer data breaches than in any quarter over the previous 12 months, but they are unlikely to be ever stamped out entirely, experts say.
The total number of data breaches reported by the sector fell from 40 over the December quarter to just 27 in the March quarter, according to the Office of the Australian Information Commissioner (OAIC).
The financial services sector is second only to the health sector in terms of breach reports.
Banks blamed oblivious staff members for a large proportion of the breaches, saying 41 per cent were the result of human error while the remaining 59 per cent were the result of malicious or criminal intent.
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Australian Catholic University breach nets staff details

By Juha Saarinen on Jun 18, 2019 6:24AM

Unknown number of accounts accessed.

The Australian Catholic University has become the latest tertiary institution to disclose a recent data breach, with sensitive staff information being accessed by unknown attackers.
A brief document from acting vice-chancellor Dr Stephen Weller said the May 22 attack succeeded in compromising a small number of staff logins through a phishing email, purporting to be from the university itself.
ACU has seven campuses across Australia, with over 35,000 students enrolled.
The phishing email contained a link to a fake login page that allowed attackers to intercept staff access credentials.
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Phishers hit ACU, compromised systems

ACU attack follows mammoth ANU breach
Rohan Pearce (Computerworld) 17 June, 2019 17:33
The Australian Catholic University says that a number of staff email accounts and some of its systems have been compromised after a successful phishing campaign.
“The data breach originated from a phishing attack: an email pretending to be from ACU tricking users into clicking on a link or opening an attachment and then entering credentials into a fake ACU login page,” a message issued by acting vice-chancellor Dr Stephen Weller said.
The data breach was discovered on 22 May; around the time that the recent Australian National University breach was unearthed.
“In a very small number of cases, staff login credentials were obtained successfully via the phishing email and were used to access the email accounts, calendars and bank account details of affected staff members,” the message from Weller said.
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LandMark White chairman tight-lipped on takeover talk

By Carolyn Cummins
June 18, 2019 — 12.00am
Embattled valuer LandMark White insists it is still talking to its customers amidst strong market speculation that it has received approaches from interested parties for some or all of the business.
The prospect of a sale was raised in a leaked email from the acting chief executive Tim Rabbitt, reported in the Australian Financial Review, which said in part, that the company was still working on reinstatement to the ASX, "but the directors (as is their responsibility to do now) have to consider alternative options for the business including the potential sale of the whole or parts of the business".
The company made no statement to the ASX on Monday and chairman Keith Perrett declined to comment on what he said was "was market speculation".
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Monday, 17 June 2019 10:18

Monthly average losses to NBN scams soar to new levels in 2019: report

Australians are losing more money to NBN scams, with consumers losing an average of more than $110,000 each month between January and May this year, compared with around $38,500 in monthly average losses throughout 2018 – an increase of nearly 300%.
The latest Scamwatch report from the Australian Competition and Consumer Commission (ACCC) shows that reported losses in 2019 are already higher than the total of last year’s losses.
“People aged over 65 are particularly vulnerable, making the most reports and losing more than $330,000 this year. That’s more than 60% of the current losses,” ACCC Acting Chair Delia Rickard said.
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Monday, 17 June 2019 19:07

NBN Co's CVC pricing may force Launtel to stop 250/100 Canberra plans


Damian Ivereigh: " We recognise that the 250/100 service is one of our unique points of difference and we are loathe to turn this off. However we have been running for almost a year and it is clear this problem is not going to fix itself." Supplied
Small Tasmanian-based Internet services provider Launtel is likely to stop offering its 250/100Mbps NBN service in Canberra due to the "extremely expensive" CVC charges imposed by NBN Co, the company that is building Australia's national broadband network.
In a blog post, Launtel chief executive Damian Ivereigh said NBN Co's CVC pricing construct was the factor that had led to the company reconsidering its offering of this service. "It is extremely expensive to offer these services for a relatively small number of people and we are very disappointed to say that it looks like we will just have to stop offering it," he added.
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NBN Co wants to create a cut-price 100Mbps product

By Ry Crozier on Jun 20, 2019 12:01AM

While providing performance boost to existing 100Mbps users.

NBN Co is set to give existing 100Mbps users a performance boost from September while exploring ways to introduce a cut-price 100Mbps product.
The plans build on a rebate that NBN Co has offered to retail service providers since the start of the year that aimed to encourage more 100Mbps sign-ups.
The company’s ongoing desire to sell 100Mbps services runs counter to a key reason the Coalition used to shift the NBN to a multi-technology mix; that is, that 100Mbps services were of limited utility to most Australians.
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NBN Co backs down on 12Mbps price crunch

By Ry Crozier on Jun 20, 2019 12:01AM

Will now keep current discounts until mid-2020.

NBN Co is calling a temporary halt to a two-year campaign it has waged against over one million users on cheaper plans.
The company will now delay until June 2020 the removal of a key discount offer that allowed retail service providers (RSPs) to sell relatively uncongested 12Mbps services at affordable prices.
iTnews revealed in March that NBN Co would dump the dimension-based discount on connectivity virtual circuit (CVC) purchases made by retail service providers in May.
NBN Co sells products that are priced using both a legacy and newer bundled arrangement.
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NBN Co prepares to roll out more changes to wholesale pricing

Company looking at how to get more households on faster speeds
Rohan Pearce (Computerworld) 20 June, 2019 00:00
NBN Co has launched an industry consultation on wholesale pricing, with the network operator indicating it wants to encourage the uptake of higher speed plans as well as make NBN services more attractive to lower-income households.
The company said that its Pricing Review Consultation Paper was seeking input from telcos in five main areas, including boosting take-up in segments including low-income earners and elderly Australians.
The number of households with entry-level services that use NBN Co’s 12Mbps speed tier has been declining, according to NBN Co data released by the Australian Competition and Consumer Commission (ACCC).
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'Healthy tension': NBN Co gears up for telco price talks

Max Mason Media & Marketing Editor
Jun 20, 2019 — 12.17am
Australia's telecommunications providers hoping for a substantial cut to the price they pay for access to the National Broadband Network are likely to be disappointed as the government-owned business prepares for a new round of industry consultation.
On Thursday, NBN Co will release its wholesale pricing review consultation paper to telecommunications providers such as Telstra, Optus, Vodafone Hutchison Australia, Vocus Group and TPG Telecom as well as a raft of smaller retail providers. The consultation aims to help ease discontent in the industry.
The NBN Co has been heavily criticised over its high wholesale pricing, with  Telstra chief executive Andy Penn saying Australia's largest telco can't make money re-selling the NBN.
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NBN pricing up for review ahead of crucial last rollout year

By Jennifer Duke
June 20, 2019 — 12.00am
The National Broadband Network will review the prices it charges retail providers following intense criticism from Telstra and consumer advocacy groups, as construction of the mammoth infrastructure project edges towards the finish line.
The review, which has a particular focus on low income earners and older Australians who are less likely to connect to NBN services, follows fierce criticism of the taxpayer funded infrastructure provider for the high costs it charges its retail facing customers.
The NBN rollout is now about 80 per complete and expected to finish in 2020. NBN is scrambling to meet its goal of signing up about three-quarters of households covered by the network footprint before telcos launch alternative services, such as 5G fixed wireless.
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Thursday, 20 June 2019 10:58

NBN mess: Labor's sin compounded by Coalition's MTM

The Australian Labor Party's obsession with neo-liberal economics has doomed the national broadband network right from the time it set up a separate company, NBN Co, in 2009 to build a country-wide network that would be unfit for purpose. Thursday's patchwork approach by NBN Co to filling up the cracks is just the latest indication of this.
Any time there is a groundswell of complaints about the cost of NBN connections — either from telcos, both the entitled and unentitled ones, and the masses — the NBN Co, no doubt under pressure from the government, reacts and offers a figleaf to cover its nakedness that has long been exposed.
For the government, those complaints equate to votes and even though one election has been won, it is better not to squander any perceived goodwill. So, there will be some soothing talk and one should not be surprised if the new Communications Minister Paul Fletcher, himself, comes out and makes some soothing noises.
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NBN Co launches new wholesale price review

By Ry Crozier on Jun 20, 2019 6:45AM

Asks over 50 retail service providers to participate.

NBN Co is kicking off its first wholesale pricing review in two years that takes a conciliatory tone with retail service providers and end users.
The company today released a consultation paper to “more than 50 retail service providers (RSPs) selling NBN plans to residential and business customers, and special interest groups such as ACCAN”, it said in a statement.
Chief customer officer for residential, Brad Whitcomb, said the aim was to collaboratively “develop new NBN wholesale price and discount options and bundle discount inclusions” to offer to users.
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NBN mulling introducing 100/20Mbps plans

Most residential customers do not need 40Mbps of upload, NBN has said.
By Chris Duckett | June 20, 2019 -- 00:08 GMT (10:08 AEST) | Topic: Networking
As part of a consultation process over its wholesale pricing, the National Broadband Network (NBN) is mulling the introduction of 100/20Mbps plans.
At the 100Mbps speed tier, NBN currently offers 100/40Mbps plans.
"The new speed tier recognises that most residential customers download far more than they upload and a new product that prioritises download with an associated new wholesale bundle discount may help them to avoid paying a price premium for relatively high upload speeds that most customers do not use or require," the company said in a statement.
NBN is set to boost the amount of included Connectivity Virtual Circuit (CVC), a bandwidth constraint that the wholesaler uses to drive revenue, on its 100Mbps plans from 2.5Mbps to 3Mbps from September 2019. The company also said it would keep its existing dimension-based discounts in place until 30 June next year, to provide certainty as it consults.
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Enjoy!
David.

Sunday, June 23, 2019

Grahame Grieve Provides Some Perspective On Secure Messaging And Axing The Fax.

This appeared a day or so ago and is published here with permission.

Future of Secure Messaging in Australia

Posted on June 19, 2019 by Grahame Grieve
The Australian Digital Health Agency is working hard on a secure messaging project. This is a project to build out a working eco-system so that any clinician can send documents and messages to any other clinician in a secure fashion.
There’s multiple uses of the this kind of messaging:
  • Sending Diagnostic Reports to the requesting physician, along with anyone else the physician asked to be notified
  • Sending Discharge Summaries 
  • Referrals from GP to specialist, and letters back to Specialists
  • Submission of forms to hospitals (usually a form of referral)
  • Requests for further information from other clinicians
Some of these are well in production and have been for many years. Yet clinicians still report being overwhelmed by paper from their faxes, and that’s generated an “Axe the Fax” campaign (that phrase, btw, appears to have come from UK).
About Healthcare and Faxing
Note that the healthcare system is effectively responsible for keeping the fax industry alive (here and overseas). By some estimates I’ve heard, healthcare buys 80% of new faxes (but I can’t find any reference that says that).
Why is faxing so enduring in healthcare in particular?
Most of the commentary focuses in bad incentives around sharing information. I’m not sure that makes sense – ‘we are sharing information by massive volumes of fax because we have no incentive to share information’? I feel like that sentence doesn’t hang together.
The first and proximal reason that faxing is ubiquitous in healthcare is because email is not regarded as secure, and so all the work that’s moved to email in other industries hasn’t moved for health care. 
“You can’t send sensitive healthcare information by email” (Nathan Pinskier)
And the work to get email secure is really signfiicant – no other industry has done it to my knowledge (except the military on closed networks that they build at considerable expense – maybe we should build a healthnet?)
Not that faxing is actually that secure – it’s only as secure as the telco network (not much more secure than email these days – now that email has improved a lot, mainly by reducing the hop count) and the sender’s ability to get the destination fax number correct (see case in the Nathan Pinskier article). I once was part of an investigation into a Queensland premier’s diagnostic report accidently being faxed to a news agent because a GP didn’t notify the diagnostic service when his number changed.
What we need is a secure alternative to email – some alternative protocol that allows for messages to be sent reliably and securely between healthcare providers.
Sending Messages Securely
Of course, here in Australia, we have one of those. SMD “Secure Message Delivery” is an Australian Standards (AS 5552) finalised back in 2010 that specifies how software acting on behalf of any healthcare provider can send a message to any other provider.
But in practice, providers can’t actually do that. They can easily deliver to some participants, but not to others. The government has focused quite some attention on digital health initiatives over the last decade, but none of them have focused on this very day to day operational problem in healthcare, and things haven’t been getting better.
The reason it isn’t just working as desired is not related to the protocol, but to the surrounding support – certificate management, registry administration, and implementation issues. It’s a really simple question – can you find the address of the person you want to send it to, and then encrypt it for them, and send it, knowing that your messaging provider will actually be able to send it? – and that the cost of getting all this to just work will be paid somehow).
Readers should be clear, btw, that whatever else is a problem here, a real part of the problem is the healthcare system’s very conservative approach to technology. There’s no reason at all  for GP practices to be buried in paper – just use a fax server that turns faxes into incoming digital documents (email etc.) internally – it’s cheaper and more convenient, and you can just do it – so why not?
Secure Message Project
Nevertheless, there are real adoption barriers here, many that are really linked to lack of incentives. As a result of stakeholder feedback, the Digital Health Agency initiated a collaborative program with the relevant clinical record software and message delivery vendors, along with some stake holder representatives, with the mission to identify and any reasons that were blocking progress.
That program is still working. (Btw – I consult to the Digital Health Agency on this program a little).
The program is still going ahead, slowly (well, more slowly than the stake holders desire, but not more slowly, so far as I can see, than these programs usually take). It’s generating press recently (see here, and here).
In the last few months, I’ve had a few people express to me the opinion that this program is not making a good investment. The source of this concern comes from architectural and protocol concerns.
Secure Message Delivery Protocol
The SMD protocol is a SOAP based protocol that is designed to do reliable and secure store and forward where the ultimate destination may be unavailable – on the basis that the end point – the clinical desktop – is not available for direct delivery.
That’s yesterday’s technology – why, they ask, are we investing in it?
It’s true that industry has largely moved on from SOAP. We certainly would not use SOAP if we were starting on that specification now. In USA, starting at about the same time, they chose to use a secure email based approach, called Direct, now looked after by Direct Trust). We would certainly chose some approach like that  now, unless we choose an even more direct delivery approach.
The other major factor that is changing is the “not available for delivery” characteristic – the store and forward mechanism that the SMD design is based on is increasingly unnecessary as more and more processing moves to the cloud, where the recipient end points are always available.
In the Cloud
When the Secure Message Program started, industry trends suggested that adoption of the cloud would be very slow – over a decade, if not longer (partly because of the extreme conservatism of healthcare cited above, but also due to security concerns).
However during the time of the program, cloud adoption has accelerated dramatically, and many vendors have already deployed or are in the process of deploying cloud agents that act on behalf of the clinical system, irrespective on whether the system lives in the cloud or on the desktop). Given that environment, it seems as though investing in a store and forward based technology is investing in the past.
A direct delivery protocol – where clinical systems delivered directly to each other by some web service mechanism (there are several obvious candidates) is not only simpler, but can also be more reliable since the receiver can respond directly to the sender with regard to any business issues with the content.
So should we abandon SMD and work on a newer protocol instead?
Tomorrow vs the future
The first issue with this question is that, as I said above, the protocol is not the problem – it’s the certificates, the registries, and the business models around the message delivery that are the problem. So merely changing the protocol… how does that help? 
Well, it might make a difference, inasmuch as it could change the business realities and the considerations around certificates and registries etc. Though those are still the hard problems that need to be solved, and that the Secure Message Program is currently working on solving. So any work done now will at least be empowering and useful for any new protocol in the future.
The real question, though, is whether we should be aiming low, with lower risk, or aiming high, and taking on more risk. That’s a value question, really. Though I think that most people will say that the we should demonstrate that we can walk before we run.
Still I have some sympathy for the idea that we should invest in the future. It’s not rocket science to realise that in the future, everything will be based on web protocols, and that we’ll be running mix of 
·         Pull (providers access information when they want it)
·         Push (providers send information or notifications to other providers when they need to know about it)
·         Subscription (providers ask to be notified about specific events as they happen)
Nor is it much of a stretch to think that you should use one common exchange framework for all 3 of those, and that our best current choice for that is FHIR
I’m not sure how we should consider this question – I’m sure there’s some out there who want to make the transition now, and not invest in SMD anymore. And I’m sure that there’s some out there who think we should just get SMD right and stick with that. I hope that there’s more who think that we will have to make the transition eventually, but aren’t sure when.
----- End Article.
Here is the link:
As if to confirm what Grahame is saying about us not really being there yet and that there are some very real outstanding issues – this appeared.

Calls for BMA to oppose Hancock’s ‘ill-conceived’ ban on outdated tech

Setting “arbitrary dates” to stop using outdated technology puts patients “at risk”, regional medical councils have said as they called on the BMA to oppose blanket policies.
Andrea Downey – 18 June 2019
Several motions are expected to be discussed at the British Medical Association’s annual representatives meeting (ARM), calling on NHS England, NHS Digital and individual trusts to collate the advantages and disadvantages of all communication methods currently used in the health service.
East Midlands Regional Council proposed a motion labelling secretary of state for health and social care, Matt Hancock’s, flagship Axe the Fax and Purge the Pager campaigns “premature and ill-conceived”.
The region is calling on the BMA to oppose the blanket policies until “feasible alternatives” are determined.
The Leicestershire and Rutland division and London Regional Council echo similar calls for communication technology to be upgraded in a “reliable, secure and effective manner”.
Lots more here:
The issue is that we really need to get the workable, practical alternatives to 95-98% or so coverage and availability before we start turning things off with quite unknowable consequences.
Tim Kelsey can big note himself at CEDA sessions all he likes about ‘axing the fax’ and so on but until he has actually delivered a full proven working alternative he is just the purveyor of so much hot air.
Where do you see us as positioned right now and what path should we be taking?
David.