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."

Friday, January 20, 2017

I Really Wonder How This Nonsense Proposal Ever Saw The Light Of Day.

I spotted this last week.

Trial to give pharmacists more power over scripts

| 12 January, 2017 |  
Pharmacists will be free to change medication doses, issue repeat scripts and perform point-of-care tests for patients with chronic diseases under a trial starting this year.
Running for 18 months, the Victorian trial is a way of freeing up GP time to deal with complex clinical issues, according to the state government.
Supporters argue the trial will not fragment care and GPs will retain control over what happens to patients.
The GPs taking part will write shared care plans that will guide pharmacists in monitoring and refining the medication regimen of patients with asthma, hypertension and hypercholesterolaemia, and those on anticoagulation medications.
Only pharmacists with an established relationship with a GP clinic will be able to take part.
But under the trial, they will perform blood pressure, spirometry, INR and lipid panel tests to monitor patients’ conditions.
They will be expected to report regularly to GPs and refer the patient back if their condition changes.
The state government says many GP visits for patients with chronic diseases merely involve renewing prescriptions or making dose adjustments, a view the Pharmacy Guild of Australia claims is supported by research.
AMA Victoria described the proposal as risky when it was first flagged in 2015.
Members of the AMA have since worked on the government’s advisory group to work out details of the trial, including the four chronic conditions considered suitable.
The trial will start off with just three pharmacies and three GP clinics, with one trial site in Melbourne and two in rural areas, and a cap of 30 patients at each site involved. 
More here:
The proposal is so controversial that it attracted 34 on-line comments in only 3 days!
To me the huge issue is just how complicated it will become when something goes wrong. Who is to blame and which insurer is liable.
Secondly with a tiny trial it might just work – but the scalability has to be pretty dubious.
Thirdly how will all this work with electronic medication record and dispensing systems? – there has to be a lot of risk for mistakes in this area.
This really should just be stopped before it starts in my view. If the pharmacist has an issue with a script – simply ring the prescriber!
David.

Thursday, January 19, 2017

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

January 21  Edition.
The macro view is dominated this week by the inauguration, on Jan 20, of the new US president.
There is no doubt this is a biggie with the evolving Russian bromance and the systematic poking of the Chinese Dragon.
FWIW my view is that the game has been changed in a set of rather unpredictable and sinister ways.
This does not bode well:

Trumponomics gets the thumbs down from Nobel-winning economists

Rich Miller
Published: January 8, 2017 - 12:09AM
A pack of Nobel Prize-winning economists gave Donald Trump and his policy plans the thumbs-down on Friday, with one saying the president-elect's programs could lead to a deep recession.
Speaking on a panel during the first day of the annual American Economic Association meeting in Chicago, the Nobel laureates voiced a variety of concerns about the billionaire developer's stance, from his haranguing of US companies about their outsourcing plans to the risk that his tax and spending proposals could lead to run-away budget deficits.
"There is a broad consensus that the kind of policies that our president-elect has proposed are among the polices that will not work," said Joseph Stiglitz, summing up the views of the panel that included his fellow Columbia University professor Edmund Phelps and Yale University's Robert Shiller.
Such disapproval though is likely to fall on deaf ears. Trump rode to victory on the back of an unconventional campaign that was short on advice from PhD economists -- relying more on a team of wealthy businessmen -- and there's no indication that's about to change.
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Also, read this superb report to see what I mean:
This also points at the world in flux:

Davos Wonders If It’s Part of the Problem

Did the global elite’s devotion to borderless capitalism sow the seeds of a populist backlash?
by Matthew Campbell and Simon Kennedy
13January,2017, 11:00 am AEDT
Kenneth Rogoff can pinpoint the moment he started to grow concerned Donald Trump would be the next U.S. president: It was when Rogoff’s fellow attendees at the World Economic Forum’s annual meeting last January said it could never happen. “A joke I’ve told 1,000 people in the months since leaving Davos is that the conventional wisdom of Davos is always wrong,” says the Harvard professor and former chief economist of the International Monetary Fund. “No matter how improbable, the event most likely to happen is the opposite of whatever the Davos consensus is.”
The repeated failure of business and political elites to predict what’s coming—last year, that included the U.K.’s vote to leave the European Union—doesn’t strike those returning this month to the Swiss Alps as very funny. After a year in which political upsets roiled financial markets and killed off the careers of once-dominant Davos-going politicians, the concern for delegates attending this year’s meeting isn’t that their forecasts are often wrong, but that their worldview is.
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Note as I type there are rumours of the British PM (Theresa May) planning a very hard Brexit which will surely cause trouble this week as well.
Locally we seem to have been careless enough to lose our senior Health Minister to a touch of abuse of public funds – although the amounts were trivial compared with the financial abuse on us all of the myHR!
For mine 2017 is shaping up as being way too interesting!
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Here are a few other things I have noticed.
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National Budget Issues.

The pension is a victim of the great Australian muddle

Emily Millane
Published: January 3, 2017 - 12:00AM
In 1966, Richard Downing, professor of economics at the University of Melbourne, appeared on an ABC television forum on whether the pension means test should be retained. With high levels of old age poverty, there was much debate at the time about the design of the age pension and whether the means test should be abolished. Downing was an advocate for retaining the means test, where "benefits go to the poor and the benefits are paid for by the people who are not so poor, because they are rich enough to pay taxes".
This is one view of how the social security means test is intended to work. The changes to the means test that took effect on January 1 are to bring the reality closer into line with the intention of the system. 
There are two deeper stories going on here, not that you would know it from the media maelstrom and the unedifying spectacle of the ACTU's robocalls to pensioners who stand to lose their benefits. 
Firstly, the means test changes are imperfect and result in some unintended consequences. 
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Rent or buy? The evidence is in

Jessica Irvine
Published: January 9, 2017 - 12:00AM
There is perhaps no question more vexing for young Australians today than the decision whether to buy or rent a home.
Of course, for many, there is no choice at all. Lacking the substantial deposit required to enter the property market in many Australian cities, they rent by default.
But for many, the logic of home-ownership is unquestionable. Rent money is dead money. Why pay off someone else's mortgage? Property prices always go up.
But this one-eyed view of property ownership overlooks some of the substantial costs involved. There's stamp duty, maintenance, local council charges, water bills and strata levies to consider. Plus the hundreds of thousands of dollars in interest payments.
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Retirement will disappear like the fax machine

Elizabeth Henderson
Published: January 9, 2017 - 12:00AM
My children and I were born into different technological worlds but one thing we have in common is none of us had heard of a fax machine until our early teens. My daughter once asked "Mum, what's a fax?" I could've asked the same question at her age. Although 1990s office workers couldn't imagine working without one, in truth barely a generation relied on the fax for any meaningful period.
Australians today can't imagine working without retiring, spending decades of healthy, active years not needing to work. A century ago retirement barely existed. In the late 19th century, half of American men aged 80, and three-quarters of British men over 65, worked and only a minority lived that long to begin with. Most people worked until they died. A recent ad features a child and his grandfather visiting a museum exhibit of a couple driving in a convertible. "What are they doing grandpa?" the child asks. "They're in retirement," grandpa responds longingly. Grandpa may well have had to explain the exhibit to his own grandfather too.
Australia introduced the aged pension in the early 1900s when life expectancy at birth for men was 55 and for women, 60. If you made it to pension age, and most didn't, you'd expect to live on the pension for no more than a decade.
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Morrison rejects IMF, OECD calls to use boost debt spending

The IMF is also pushing Australia to increase its budget spending.
  • The Australian
  • 12:00AM January 9, 2017

David Uren

The OECD believes falling interest rates have given the Australian government the scope to more than double its net debt to stimulate the economy, while it calculates that it could spend an additional $8 billion a year on ­infrastructure for about two years without affecting the long-term trajectory of its debt.
Both the OECD and the IMF have been urging the Australian government to ease up on budget repair and lift spending as part of their global campaign to lift ­economic growth.
They are using the concept of “fiscal space”, or the ability to raise additional debt without ­provoking an adverse market ­reaction, to argue that governments, particularly in the ­advanced world, should be using fiscal policy rather than relying on central banks to support their economies.
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GOLDMAN SACHS CHIEF ECONOMIST: There are 3 big risks for 2017

Jan 10, 2017, 7:11 AM
LONDON — The second half of 2016 will probably be remembered for its geopolitical shocks and uncertainty rather than as a period of benign economic data.
But to do so would be to only have one half of the story.
According to Goldman Sachs’ measures of economic activity, the last two quarters of 2016 were really pretty encouraging.
“If you look at economic data for the past few months, there’s been an impressive acceleration in growth,” Jan Hatzius, chief economist at Goldman Sachs, said in a speech in London on Monday.
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Governments are bystanders as inequality festers

Tracey McNaughton
Published: January 10, 2017 - 12:00AM
It is ironic that just as governments around the world are coming to the realisation that large portions of their populous have been left behind as a result of rising income and wealth inequality, the political capital needed to do anything about it has been depleted.
Voters worldwide are increasingly turning to non-mainstream parties that promote a more nationalistic agenda. With so many disparate parties winning support, the formation of a stable, effective government has become more difficult.
Globalisation, free trade, large-scale immigration programs, and free-market ideologies in general have produced the most rapid progress in living standards that the world has ever seen. Millions have been raised out of poverty.
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Goldman Sachs tips three key areas for equity investors

Julie Verhage
Published: January 10, 2017 - 7:09AM
Goldman Sachs has identified three big items that will shape the equity landscape this year - and they all hinge on the impact of President-elect Donald Trump's policies.
Tax reform, the strength of the US dollar and the pace of wage gains stand to set the tone on the American market this year, chief US equity strategist David Kostin and his team at the investment bank wrote in a note to clients. Here's why:
Tax Reform
"Corporate tax reform represents key source of hope,'' the strategist wrote. That's especially true for sectors that tend to have higher tax rates, such as brick-and-mortar retailers, energy producers and makers of consumer products.
It's not yet clear how Trump's proposed measures will look when they come out of Congress, so Goldman ginned up a table on how various scenarios would impact earnings for S&P 500 companies. A cut to 25 per cent from the current 35 per cent statutory rate on domestic income, for instance, would boost profit in the large-cap benchmark by 8 per cent.
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Savings account interest rates dip below inflation

Clancy Yeates
Published: January 10, 2017 - 2:40PM
A handful of banks have cut the interest rates paid to savers over summer, as average returns on a key type of savings account dipped below the rate of inflation.
In a sign of the miserable returns being paid to many savers, including retirees, analysis shows several banks, including ANZ Bank and Westpac, cut interest rates on savings accounts in December.
Canstar, an interest rate comparison website, said there had been 13 cuts in savings account interest rates across its database of banks in December, compared with only two increases. There were also 16 cuts in savings account rates in November, compared with one increase.
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Scott Morrison’s targeted tax strike on digital economy

  • The Australian
  • 12:00AM January 11, 2017

David Crowe

David Uren

The federal government is ­urgently preparing new budget measures to deal with the explosive growth of the online economy, as Scott Morrison vows to confront the growing pressure on tax revenue.
The plans include a pilot program to put more government services online as Australians increase their digital payments to more than 10 billion transactions a year, while scaling back their use of cash and cheques.
After creating a “Google tax” to stamp out tax avoidance and a “Netflix tax” to capture more ­online purchases, the government is drafting a wider digital agenda for the year ahead in the hope that the shift away from cash could shore up the integrity of the tax system.
“You’ve got to make sure your tax base is just not comprehensive but make sure it is modern,” the Treasurer told The Australian.
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Pensioners' payments reduced amid anger over politicians' entitlements

Bianca Hall and Naomi Neilson
Published: January 12, 2017 - 7:47PM
Judith Daley is one of the unlucky ones. Amid simmering anger over politicians' entitlements and the government's Centrelink debt clawback, the Sydney retiree is one of about 327,000 pensioners to have had her pension reduced or cut altogether this year.
Ms Daley, 72, has lost her part pension and health benefits under changes to the aged pension introduced on January 1.
"I have lost the health benefits that come with the age pension card," Ms Daley said. "I don't quite know at this stage what that means. I have serious ongoing health issues and they will be degenerative as I age."
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We haven't learnt anything from the rise of Trump and Brexit

John Hewson
Published: January 13, 2017 - 12:00AM
German philosopher Georg Hegel once remarked: "Rulers, statesmen, nations are wont to be emphatically commended to the teaching which experience offers in history. But what experience and history teach is this – that people and governments never have learned anything from history, or acted on principles deduced from it."
The key question for 2017 is just how much have the "elites" learnt from recent experience? How have they actually responded to Brexit, Trump, Hanson, and so on.
The obvious answer, so far, is that the "elites" have simply not learnt anything: they have not responded substantially, rather attempting to close ranks against the "outsider", treating such events as but a mere aberration to their social agenda, soon to return to their "normal". This will not, and cannot, be a sustainable response.
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Why we can't be sure we are in a housing bubble

Michael Potter
Published: January 13, 2017 - 11:20AM
House prices are out of control in some Australian capitals. And this week comes a proposal that this should be countered by halting interest rate cuts, a move that would not only fail to solve the problem but also have detrimental impact on the rest of the country, where housing is not booming.
In 2016, the prices of dwellings rose by 16 per cent in Sydney, 14 per cent in Melbourne and 11 per cent on average across all the capitals, according to CoreLogic, but prices fell by 4 per cent in Perth.
The ABS has capital city prices almost doubling since 2003, with Sydney prices increasing by 50 per cent since 2013.
Certainly, this rate of increase cannot be sustained. House prices in the booming cities are growing much faster than incomes, and are either going to slow or fall. It may not happen soon, but it will happen.
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Lessons still to learn as 10-year anniversary of GFC approaches

Jessica Irvine
Published: January 14, 2017 - 2:15AM
Where does the time go? This year will mark the 10th anniversary of the onset of the global financial crisis.
By the middle of 2007, the wheels had well and truly started falling off the US sub-prime mortgage market, eventually prompting the collapse of US investment bank Lehman Brothers in September 2008.
As the world financial system froze over, the Rudd government unleashed the biggest fiscal stimulus in Australian history.
Two major packages totalling almost $100 billion were announced, including cash cheques, pension boosts, first-home buyer incentives, local council grants, school halls and pink batts. Everything but a kitchen sink.
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Health Budget Issues.

Health Minister Sussan Ley apologises for Gold Coast trip, agrees to repay expenses

Matthew Knott
Published: January 8, 2017 - 6:09PM
Embattled Health Minister Sussan Ley has admitted she made an "error of judgment" by charging taxpayers for a trip to the Gold Coast in which she bought a $795,000 apartment and will repay the cost of four taxpayer-funded trips.
Ms Ley's decision followed a conversation with Prime Minister Malcolm Turnbull in which he said she had not met the standards he expects of ministers. 
Ms Ley had come under intense pressure to provide a full explanation of the May 2015 trip or resign from the ministry since it was revealed on Friday. Government records show Ms Ley has frequently visited the Gold Coast on taxpayer-funded trips over recent years. 
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Maternity services bundled payments ‘will put mums at risk’

  • The Australian
  • 12:00AM January 11, 2017

Sean Parnell

A landmark bid to save money in public hospitals by bundling government payments for maternity services has gained support, but not from obstetricians and gynaecologists, who fear it will put vulnerable mothers at risk.
The Australian last year ­revealed the Independent Hos­pital Pricing Authority, which ­advises governments on activity-based funding, wanted to introduce a package deal for treating expectant mothers to encourage providers to look for more ­efficient models of care.
For example, a hospital might be paid a set amount to cover all staff, interventions and accommodation, thereby encouraging hospital managers to negotiate better deals with clinicians.
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Linking hospital funds to error rate raises fears of secrecy over bungles

  • The Australian
  • 12:00AM January 12, 2017

Sean Parnell

A plan to penalise public hospitals financially for procedures that resul­t in errors or avoidable side effects is proving more difficult than governments first thought.
Some jurisdictions are concerned that hospitals might be more reluctant to admit to mistakes if they will lose money as a result, while others question what it means for an adverse outcome to be considered preventable.
The Council of Australian Governments agreed last year to work on new hospital funding mechanisms that penalise unnecessary or unsafe care, with federal Health Minister Sussan Ley putting the Independent Hospital Pricing Authority in charge.
But the first round of IHPA consultation has elicited a cautious response from state and territory governments, even if the federal Department of Health is in favour, and suggests implement­ation will be a slow process.
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Sussan Ley: Where it all went wrong

  • The Australian
  • 3:08PM January 13, 2017

Sean Parnell

All Sussan Ley had to do was calm the health stakeholders and leave the big decisions to others. Yet she spooked everyone with her expenses, becoming a symbol of what is wrong with governments everywhere, and lost her job before she could do anything with it.
Ley was elevated to cabinet just before Christmas 2014, the then prime minister Tony Abbott recognising her potential and the health sector welcoming a pleasant change from her predecessor, the abrasive Peter Dutton.
The new minister set about consulting stakeholders and was forgiven for some early misunderstandings about health. Being a cabinet newcomer, Ley was also forgiven for lacking the authority that comes with big portfolio experience; it would come in time.
The key policies – largely consolidation and prioritisation of spending – were already in place, and Ley just had to keep things ticking over. The former punk rocker, waitress, cleaner, farmer, air traffic controller and commercial pilot settled into her new role and knew her place. Even after Malcolm Turnbull took the leadership, Ley remained health minister.
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Superannuation Issues.

Barriers to home ownership the real hurdle to a comfortable retirement

John Collett
Published: January 10, 2017 - 2:01PM
Our super system is not in need of restructuring as some commentators suggest.
But millennials worried about whether they will ever save enough to afford a comfortable retirement should be giving priority getting into the housing market. Property owners retire wealthier than renters.
It's not only that capital city property prices have risen strongly leaving renters in the shade, the family home is exempt from assets test applied for the age pension.
No capital gains tax payable on the sale of the family home and, given the political sensitivities of the issue, that's not likely to change.
There's also peace of mind that comes with home ownership.
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Health Insurance Issues.

Arthur Sinodinos moves into health hotseat on insurance premiums

  • The Australian
  • 12:00AM January 10, 2017

Sean Parnell

One of the first tasks Arthur Sino­dinos will have in the health portfolio is deciding how much health insurance premiums should rise this year and what the government can do to help cash-strapped consumers.
Sussan Ley stepping aside as minister comes at a challenging time for the Turnbull government, which was expected to spend the year on policy after the Coalition’s first term of spending cuts ended in the so-called “Medi­scare” election.
Ms Ley had been more consultative than her predecessor, the abrasive Peter Dutton, and has major stakeholders more willing to discuss issues than debate them. Nonetheless, Treasury still has a heavy influence on health decisions — Ms Ley said as much during the election campaign — and the arrival of former assistant treasurer Sinodinos may be met with suspicion.
Among the first tasks for Senator Sinodinos is deciding the level of insurance premium increases for April 1.
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Private health insurance nears crisis point as costs soar

  • The Australian
  • 12:00AM January 14, 2017

Sarah-Jane Tasker

Health insurance chiefs have warned that the issue of affordability is close to crisis point as the head of the industry body argues reform will take “more courage” from the Turnbull government than it has previously shown.
HBF boss Rob Bransby, president of Private Healthcare Australia, said 2017 had to be the year when the government showed it was serious about putting a brake on the rising health costs that were forcing up insurance ­premiums.
The call for reform comes as Malcolm Turnbull is forced to find a new health minister after Sussan Ley resigned yesterday following her travel expenses scandal.
Ms Ley’s replacement will be taking on the portfolio at a crucial time for the sector, with a number of reviews under way and this year’s annual premium increase close to being finalised. The rise will increase affordability concerns and sector heads have warned they expect downgrades and almost no growth this year.
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Aussies paying more but getting less cover from their private health insurance

http://pixel.tcog.cp1.news.com.au/track/component/article/f520ec95ee04c82cf08e447a20c92fb4?esi=true&t_template=s3/chronicle-tg_tlc_storyheader/index&t_product=HeraldSun&td_device=desktopSTEPHEN DRILL AND KAREN COLLIER, Herald Sun
January 14, 2017 8:00pm
AUSTRALIANS are paying more but getting less cover from their private health insurance.
The latest Australian Prudential Regulation Authority report into health funds shows a drop in payouts for dental, chiropractic, physiotherapy and optical extras of up to six per cent.
iSelect Health spokeswoman Laura Crowden said some private health insurers were reducing benefits in new policies to rein in rising costs.
Pregnancy, spinal and brain surgery were increasingly excluded from mid-range cover.
Cover for insulin pumps, cochlear implants, dental implants and weight loss surgery were also being removed from more products.
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I look forward to comments on all this!
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David.

Wednesday, January 18, 2017

AusHealthIT Poll Number 353 – Results – 18th January, 2017.

Here are the results of the poll.

Who Would You Prefer As The Next Health Minister?

Sen. Fiona Nash 2% (1)

Sen. Arthur Sinodinos 2% (1)

Peter Dutton 2% (1)

Tony Abbott 3% (2)

Ken Wyatt - Present Assistant Min 2% (1)

Dr David Gillespie - Present Assistant Min 70% (45)

Someone Else 16% (10)

I Have No Idea 5% (3)

Total votes: 64

Enough said – the readership was on top of the issue!

A good turnout of votes for 3 days.

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

David.

This Rather Strikes Me As Being A Bit Economical With The Truth.

This appeared a couple of weeks ago:

Phone access makes health care easier

Chloerissa Eadie
Tuesday, January 03, 2017 12:25PM
BECAUSE Bunbury woman Sandra Motteram could access her daughter Eliza’s health records on a phone, the four-year-old went through with a scheduled vaccination instead of having to make another appointment.
Ms Motteram visited the Bunbury Community Health Centre to find that the computer system was down, which meant medical staff could not access Eliza’s health records, requiring the pair to come back at a later date.
However, because Ms Motteram was registered for My Health Record she pulled up her daughter’s records on her phone, allowing her to receive the vaccination on the spot.
“It was really convenient at that time and everyone pretty much has a phone on them these days,” she said.
Community health nurse manager Marie O’Donoghue said it was “a particular glitch” which prevented the centre from accessing the records.
“It saved a lot of time, because children are often apprehensive when they come in for an immunisation at that age and Sandra had prepared her well, so it was important that we followed through on that,” she said.
More here:
The ADHA also cited this case:

Child Immunisation and Digital Health

Monday, 09 January 2017
The week before Christmas 2016, with temperatures peaking at 43 degrees, I travelled with our CEO, Tim Kelsey and Chief Medical Adviser, Clinical Professor Meredith Makeham to Perth, Bunbury and Busselton in Western Australia.
The trip was part of our national conversation with the Australian people about digital health; how we can best shape it around Australia's needs, wants and aspirations. This conversation is part of a larger consultation activity as we work towards co-producing a National Digital Health Strategy for the Australian Government.
All up, we talked to around 100 people across the WA health sector. Many subjects were raised and discussed, including the important subject of child immunisation.
Dianne Ritson, Regional Manager, and Jo Moore, Director Population Health, both from Country WA Primary Health Network, introduced us to Sandra who had a fantastic story about how the My Health Record helped her as a busy parent. Sandra took her 4-year-old daughter, Eliza, to the Bunbury Community Health Centre for a vaccination. But on the day of the visit, the health centre's IT system was down. Fortunately, Sandra had set up a My Health Record for Eliza, and she was able to access her daughter's immunisation* information on her phone and Eliza could receive the correct vaccination immediately without issue.
Without the My Health Record, Sandra would have had to come back to the centre another day and prime Eliza for her vaccination all over again. "It was really important that we did it that day," Sandra said, echoing the sentiment of parents everywhere.
More here:
However it is the little (*) that matters:
* Immunisation data accessed via the My Health Record is sourced from the Australian Immunisation Register, a national register that records vaccinations given to people of all ages in Australia.
We all need to remember the Immunisation Register was set up to ensure children were vaccinated and additionally, now, to permit compulsory enforcement for No Jab, No Pay! This of course means people on various benefits have a financial incentive to keep the records up to date!
It is a totally different animal to the myHR and is updated and maintained even if a myHR did not exist.
Additionally a vaccination  provider can access the register directly on-line.
See here:
I will leave it to you assess the quality or reporting and the ADHA Blog (I note the author does not seem to be named). Of course having multiple routes to access the register did assist in this unlikely combination of events - but is hardly a justification for the myHR!
David.

BREAKING NEWS: Mr Greg Hunt Announced As New Senior Minister For Health And Sport.

Mr Ken Wyatt has become Minister for Aged Care and Indigenous Health.

Dr David Gillespie remains Assistant Minister for Health.

David.

Tuesday, January 17, 2017

I Think It Is Important We All Express Our View On This. Time Is Running Out.

This appeared a little while ago.

National Digital Health Strategy consultation: What have we learned so far?

Created on Friday, 13 January 2017
How should Australia take advantage of the opportunities that new technologies offer to improve health and care? What do Australians want and expect from a modern healthcare system?
Over 600 online submissions have been received and more than 2,500 people have attended meetings, forums, workshops, webcasts and town halls across Australia – watch the video below to see what the Australian community has been saying!

Survey and written submissions

Our survey provides you or your organisation the opportunity to have your say about the future of digital health in Australia.
Alternatively, you are also welcome to send us a written submission. To provide us a written submission, email your feedback directly to yoursay@digitalhealth.gov.au.
Submissions will be collected until Tuesday 31 January 2017, 5pm AEDT.
For more information and how to have your say on the future of digital health, visit https://conversation.digitalhealth.gov.au or follow our hashtag #YourhealthYoursay
Have any further questions? Please contact us on 1300 901 001 or yoursay@digitalhealth.gov.au.
Here is the link:
As you watch the video there are some interesting issues raised.
1. Lots of people want to be able to request repeat scripts (myHR can’t do this)
2. Clinicians want, among other things, communications with patients before and after consults (myHR not designed for this)
3. Clinicians want high quality, complete information on which to base decisions. (Enough said.)
4. Clinicians want technology to save them time…(in their dreams navigating the myHR!)
5. Clinicians want better Standards and for them to be used to enable interoperability. (What a good idea after 10 years of NEHTA beating up on Standards Australia.)
6. Privacy and security need to be a focus for clinicians.
Amazingly from all this they seem to conclude that putting technology and data to work safely will improve the lives of citizens and foster happier and healthier lives! To me, and my recent poll supports the idea, this is quite a big leap.
See here:
The bottom line is that those who are interested, no matter what their view, should put something in!
David.

Monday, January 16, 2017

Weekly Australian Health IT Links – 16th January, 2017.

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

The message of the break seems to have been how bad IT can really ruin your holidays and have you spending hours on the phone trying to sort things out…..what a fiasco!
Other interesting stuff also happened so do browse on!
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Screw-up nation: Why the tech we count on keeps letting us down

January 8, 20177:23am
THE Centrelink debacle that’s slugged thousands of Aussies with unfair debt is the latest in a string of disasters in which technology has let us down - with devastating consequences.
We have become a nation where screw-ups are the new normal.
Almost exactly a year ago, Centrelink was in the middle of another storm, when it was forced to apologise for a New Year’s computer glitch that incorrectly told 73,000 families they were in debt.
When Family Tax Benefits claimants checked their accounts online, they were wrongly shown to owe money, with one mother mistakenly charged more than $700.
The Australian Bureau of Statistics then paid IBM $9.6 million to run the bungled 2016 Census because its own systems were antiquated and unreliable. The national survey was a massive failure, with the website going down for 40 hours and a Senate Committee inquiry finding “significant and obvious oversights” in its delivery.

Centrelink crisis 'cataclysmic' says PM's former head of digital transformation

Paul Shetler, appointed to transform the government’s digital approach, says Centrelink’s error rate would put a private firm out of business
The man handpicked by Malcolm Turnbull to head the government’s digital transformation has said the error rate in Centrelink’s data-matching process is so unfathomably high that it would send a commercial enterprise out of business.
Paul Shetler, the former digital transformation office head, criticised the government’s response to its latest IT crisis, telling Guardian Australia it was symptomatic of a culture of blame aversion within the bureaucracy.
“It is literally blame aversion, it is not risk aversion,” Shetler said. “They’re trying to avoid the blame, and they’re trying to cast it wide.
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Trial to give pharmacists more power over scripts

Antony Scholefield | 12 January, 2017 | 21 comments Read Later
Pharmacists will be free to change medication doses, issue repeat scripts and perform point-of-care tests for patients with chronic diseases under a trial starting this year.
Running for 18 months, the Victorian trial is a way of freeing up GP time to deal with complex clinical issues, according to the state government.
Supporters argue the trial will not fragment care and GPs will retain control over what happens to patients.
The GPs taking part will write shared care plans that will guide pharmacists in monitoring and refining the medication regimen of patients with asthma, hypertension and hypercholesterolaemia, and those on anticoagulation medications.
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Better broadband needed in the bush

BETTER BROADBAND NEEDED IN THE BUSH
AMA Position Statement on Better Access to High Speed Broadband for Rural and Remote Health Care
The AMA has warned that health services in rural, regional, and remote Australia could fall even further behind city services, without urgent Government action to ensure all Australians have access to affordable and reliable high speed broadband.
The AMA today released its Position Statement on Better Access to High Speed Broadband for Rural and Remote Health Care, which calls on the Government to improve internet access across the nation.
AMA Vice President, Dr Tony Bartone, said that rapid improvements in technology have the potential to deliver better health outcomes at lower cost outside major cities and towns through telemedicine and eHealth.
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Doctors underwhelmed by NBN for e-health

By Ry Crozier on Jan 10, 2017 5:12PM

Peak medical body calls for fibre and wireless expansion.

Australian GPs have delivered a lukewarm assessment of the NBN as an enabler of e-health services in regional, rural and remote Australia, just days after the network builder publicly talked up its credentials in the space.
The Australian Medical Association (AMA) unveiled a position statement Tuesday calling on the government to take “urgent action” on bush broadband to ensure regional Australia could access “the same standard of healthcare … as those living in the major cities”.
It warned that without access to telemedicine and e-health services, those in regional, rural and remote Australia “could fall even further behind” in terms of access to quality health services.
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Ehealth: AMA call for bush broadband boost

NBN fixed line and fixed wireless footprint should be extended wherever possible, says the Australian Medical Association
Rohan Pearce (Computerworld) 11 January, 2017 10:27
The Australian Medical Association has called on the government to tackle barriers to the use of ehealth and telemedicine in rural and regional Australia.
In a position paper released this week the AMA argued that “the utilisation of telehealth and telemedicine in rural and remote Australia remains patchy and is not used to full potential, because of no, or inadequate internet access”.
Internet connections in rural areas are often expensive, slow and have relatively small download allowances, the AMA said.
The AMA called for “measures to prioritise or optimise the broadband capacity available by satellite for hospitals and medical practices, such as exempting or allocating higher data allowance quotas, or providing a separate data allowance”.
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Health starts briefing vendors on new Medicare IT

By Paris Cowan on Jan 9, 2017 3:15PM

Meetings begin this week.

Officials from the Department of Health are set to meet with IT industry representatives in Sydney and Melbourne this week, as they prepare to take bids for the right to build Australia’s new Medicare payments engine.
The agency will partner with a third party systems integrator to build the new IT system, after plans to fully outsource the end-to-end process of calculating and paying health rebates to a bank, telco or other organisation were officially canned during the 2015 election campaign.
The Turnbull government was forced to turn its back on a proposal to privatise the rebate processing work after a major public backlash threatened to derail its re-election prospects in July.
It had been tentatively taking market proposals from potential outsourcers, including Australia Post, since August 2014.
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Reform the PBS, consumer group demands

Chris Brooker 11/01/2017

Government should scrap co-pay increases and move to electronic recording, CHF says

The Federal Government should reform the PBS safety net so consumers with high usage of PBS medicines have “smoothed out annual co-payments”, the Consumers Health Forum believes.
In its 2017-18 Budget Submission, released last week, the CHF calls for reforms to PBS administration and payments to better aid consumers, with these proposals winning support from the Pharmacy Guild of Australia.
The CHF endorsed pharmacy as a “key element in the strong and sustainable primary healthcare system that Australia needs”, while calling for its integration into ongoing health structural reforms.
“CHF supports the strengthening of this crucial sector through: the removal of the PBS co-payment increase, the development of a new health payment system and through the reform of the PBS safety net”, the submission states.
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Personal health records now available online

12 Jan 2017, 10:25 a.m.
Following a Federal Government trial in Western Sydney, local hospitals are now uploading around 570 discharge summaries to My Health Record each month.
What this means is that GPs can easily access information about their patients after a stay in hospital and our clinicians can access important health information about patients that their GPs have uploaded.
As a resident of the Nepean Blue Mountains regions, which also includes Hawkesbury residents, can access their personal health record online and even set access restrictions and add information about allergies, medication and other important health information.
“In the event of a medical emergency, residents will know that their health information is stored safely and securely and can be accessed immediately by emergency doctors if required,” a spokesperson said.
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How the Turnbull government killed off its big website dream

Noel Towell
Published: January 12, 2017 - 11:48AM
The Turnbull government has quietly killed off one of its biggest plans for "digital transformation": the hugely ambitious GOV.AU website project.
Fairfax understands that Minister for Digital Innovation Angus Taylor pulled the pin on the program, at the urging of the powerful Finance Department, just minutes before plans for its next phase were due to go to cabinet in August 2016.
Mr Taylor's office insists that a rebadged version of the plan will go ahead and that it is a "priority project".
The dramatic dropping of the much-hyped centrepiece of Malcolm Turnbull's "agile and innovative government agenda" came after a Canberra turf war that had raged for months between Finance and the Prime Minister's pet public service project, the Digital Transformation Office.  
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Three simple ways to avoid more IT failures like Centrelink and the census

Centrelink’s debt recovery system is just the latest IT failure by government. It needs to fix labour hire practices if it wants better software
Centrelink’s software problems, like those of Queensland Health, the Census and Victoria Police before them, arise from pathologies created by the powerful labour hire and outsourcing industries.
Centrelink’s software invents second employers and additional income. Queensland Health bungled the pay of nurses and doctors and also sent them nasty legal letters. Queensland lost a staggering $1bn through that disaster. The census website system fell over.
These would be extraordinary mistakes even for a small business, and yet they’re being made by government departments with hundreds of millions of dollars to spend. How does this happen? 
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Commonwealth Ombudsman launches Centrelink investigation

Tom McIlroy
Published: January 9, 2017 - 4:19PM
Pressure is growing on the Turnbull government over the Centrelink debt-recovery controversy, after the Commonwealth Ombudsman launched a wide-ranging investigation amid calls for the system to be shut down.
The ombudsman moved to initiate an investigation this month over significant concerns about automated data-matching processes being used to check welfare recipients' eligibility for some Centrelink payments, leading to outcry over the Christmas period as about 170,000 debt notices were issued.
Independent MP Andrew Wilkie and South Australian senator Nick Xenophon both referred the matter to the Ombudsman in December, but the investigation was already under way within the office.
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Centrelink debt recovery drive has caused summer from hell, Bill Shorten says

Matthew Knott
Published: January 9, 2017 - 12:15AM
Opposition Leader Bill Shorten has called on the Turnbull government to immediately suspend Centrelink's controversial automated debt recovery program, describing it as a "toxic mix of incompetence and cruelty" that has ruined Christmas for vulnerable Australians.
Mr Shorten, who is on summer holidays until the end of the week, has not previously commented on the project, which the government estimates will add an extra $4.5 billion to the budget. The automated system has been accused of miscalculating bills and sending debt notices to people who do not owe.
Stories have mounted in recent weeks of Australians – including asylum seekers and people with disabilities – who say they have been sent inaccurate debt notices.
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Centrelink's debt debacle: It's going to get worse, says union

Noel Towell
Published: January 10, 2017 - 12:15AM
Beleaguered Centrelink staff are bracing for a "perfect storm" of customer service problems in the coming weeks, heaping more misery on the welfare agency's millions of clients, according to the main workplace union.
The ongoing debt recovery debacle already has public servants at Centrelink stretched to breaking point, the CPSU is warning, and the agency's workers will soon have to cope with hundreds of thousands of student benefit applications and pensioners trying to make sense of changes to their payments.
But the department says customer demand is normal for this time of year.
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New digital health chief to get $522,000 a year to fix troubled My Health Record system

Daniel Burdon
Published: January 11, 2017 - 11:08AM
The head of the Turnbull government's six-month-old Australian Digital Health Agency will be paid a tidy $522,000 annual salary package after beating more than 100 other applicants to take the role fixing the plagued My Health Record system.
The chief executive's pay comes with the difficult task of overseeing the $156 million agency and its remit to digitise the nation's health systems, including fixing the delayed national roll-out of My Health Record.
Despite a number of teething problems, about 4.4 million Australians have signed up so far, as the government moves towards an "opt-out" system rather than the previous "opt-in" system.
The government's creation of an agency dedicated to improving digital health systems was been widely supported, although some stakeholders have been sceptical of how much the agency will achieve given past problems.
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Australian Medical Association appoints new group CIO

Chartered Accountants ANZ’s former ICT strategy chief joins AMA
Rohan Pearce (Computerworld) 12 January, 2017 08:06
The Australian Medical Association has appointed a new group chief information officer to replace Colin O'Sullivan, who left the AMA last year to return to Ireland for family reasons.
An AMA spokesperson told Computerworld Australia that the organisation had recruited Phil Barton to take charge of IT.
Barton joins the doctors organisation from UGL Unipart – a joint venture between Australia’s UGL and the UK’s Unipart Rail that provides heavy maintenance and supply chain services for Sydney’s rail fleet.
At UGL Unipart Barton was head of program, which included developing the consortium’s ICT roadmap and strategy and leading its project management team. Barton joined the company in April 2015.
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National Digital Health Strategy consultation: What have we learned so far?

Created on Friday, 13 January 2017
How should Australia take advantage of the opportunities that new technologies offer to improve health and care? What do Australians want and expect from a modern healthcare system?
Over 600 online submissions have been received and more than 2,500 people have attended meetings, forums, workshops, webcasts and town halls across Australia – watch the video below to see what the Australian community has been saying!

Survey and written submissions

Our survey provides you or your organisation the opportunity to have your say about the future of digital health in Australia.
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Child Immunisation and Digital Health

Monday, 09 January 2017
The week before Christmas 2016, with temperatures peaking at 43 degrees, I travelled with our CEO, Tim Kelsey and Chief Medical Adviser, Clinical Professor Meredith Makeham to Perth, Bunbury and Busselton in Western Australia.
The trip was part of our national conversation with the Australian people about digital health; how we can best shape it around Australia's needs, wants and aspirations. This conversation is part of a larger consultation activity as we work towards co-producing a National Digital Health Strategy for the Australian Government.
All up, we talked to around 100 people across the WA health sector. Many subjects were raised and discussed, including the important subject of child immunisation.
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12 January 2017

Smartwatches know you’re getting a cold days before you feel ill

By Alice Klein
Once we had palm-reading, now we have smartwatches. Wearable tech can now detect when you’re about to fall ill, simply by tracking your vital signs.
Michael Snyder at Stanford University in California experienced this first-hand last year. For over a year he had been wearing seven sensors to test their reliability, when suddenly they began to show abnormal readings. Even though he felt fine, the sensors showed that his heart was beating faster than normal, his skin temperature had risen, and the level of oxygen in his blood had dropped.
“That’s what first alerted me that something wasn’t quite right,” says Snyder. He wondered whether he might have caught Lyme disease from a tick during a recent trip to rural Massachusetts.
A mild fever soon followed, and Snyder asked a doctor for the antibiotic doxycycline, which can be used to treat Lyme disease. His symptoms cleared within a day. Subsequent tests confirmed his self-diagnosis.
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Engineering technology resilience through informatics safety science

Enrico Coiera, Farah Magrabi, Jan Talmon
DOI: http://dx.doi.org/10.1093/jamia/ocw162   First published online: 31 December 2016
With every year that passes, our relationship to information technology becomes more complex, and our dependence deeper. Technology is our great ally, promising greater efficiency and productivity. It also promises greater safety for our patients. However, this relationship with technology can sometimes be a brittle one. We can quickly cross a safety gap from a comfortable place where everything works well, to one where the limits of technology introduce new risks. Whether it is through a computer network failure, applying a system software patch, or a user accidentally clicking on the wrong patient name, it is surprisingly easy to move from safe to unsafe. As the footprint of technology across our health services has grown, so to by extrapolation, has the associated risk of technology harms to patients.1 It is the potential abruptness of this transition to increased risk of harm, this lack of graceful degradation in performance, and the silence accompanying degradation, that remain unsolved challenges to the effective use of information technology in healthcare.
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Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review

Restricted access
Mi Ok Kim, Enrico Coiera, Farah Magrabi
DOI: http://dx.doi.org/10.1093/jamia/ocw154 First published online: 23 December 2016

Abstract

Objective: To systematically review studies reporting problems with information technology (IT) in health care and their effects on care delivery and patient outcomes.
Materials and methods: We searched bibliographic databases including Scopus, PubMed, and Science Citation Index Expanded from January 2004 to December 2015 for studies reporting problems with IT and their effects. A framework called the information value chain, which connects technology use to final outcome, was used to assess how IT problems affect user interaction, information receipt, decision-making, care processes, and patient outcomes. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
Results: Of the 34 studies identified, the majority (n = 14, 41%) were analyses of incidents reported from 6 countries. There were 7 descriptive studies, 9 ethnographic studies, and 4 case reports. The types of IT problems were similar to those described in earlier classifications of safety problems associated with health IT. The frequency, scale, and severity of IT problems were not adequately captured within these studies. Use errors and poor user interfaces interfered with the receipt of information and led to errors of commission when making decisions. Clinical errors involving medications were well characterized. Issues with system functionality, including poor user interfaces and fragmented displays, delayed care delivery. Issues with system access, system configuration, and software updates also delayed care. In 18 studies (53%), IT problems were linked to patient harm and death. Near-miss events were reported in 10 studies (29%).
Discussion and conclusion: The research evidence describing problems with health IT remains largely qualitative, and many opportunities remain to systematically study and quantify risks and benefits with regard to patient safety. The information value chain, when used in conjunction with existing classifications for health IT safety problems, can enhance measurement and should facilitate identification of the most significant risks to patient safety.
  • health information technology
  • patient safety
  • adverse events
  • systematic review
  • unintended consequences
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Downside of fitness trackers and health apps is loss of privacy

December 23, 2016 6.08am AEDT
Do you know how the data from your running app is being used?

Author

  1. Victoria J Palmer
Postdoctoral Researcher Applied Ethics, University of Melbourne
At the touch of an app, Emma tracks her diabetes. She enters food, exercise, weight and blood sugar levels, then sets up medication reminders.
Suzanne uses the latest wearable device to track her running route and distances walked. As she has not slept too well in the past month, she also records her sleep patterns.
Richard takes his tablet for schizophrenia. The tablet contains a sensor that communicates with central health databases to tell health professionals if he has taken his medication.

The participatory health revolution

This is the participatory health revolution, where people use apps and wearable devices, and swallow sensors, to keep track of their health and well-being, to take control in the name of empowerment.
Latest figures indicate two in three Australians have a social media account and most spend almost the equivalent of one day a week online. In 2017, 90% of Australians will be online and by 2019 most households will have an average of 24 home devices (like alarms, phones, cars and computers) connected online.
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Enjoy!
David.