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The Auditor-General for New South Wales Margaret Crawford has released her report, in which she finds that NSW Health’s approach to planning and evaluating palliative care is not effectively coordinated. There is no overall policy framework for palliative and end-of-life care, nor is there comprehensive monitoring and reporting on services and outcomes.
“NSW Health has a limited understanding of the quantity and quality of palliative care services across the state, which reduces its ability to plan for future demand and the workforce needed to deliver it,” said the Auditor-General. “At the district level, planning is sometimes ad hoc and accountability for performance is unclear.”
Local Health Districts’ ability to plan, deliver and improve their services is hindered by:
Multiple disjointed information systems and manual data collection.
Not universally using a program that collects data on patient outcomes for benchmarking and quality improvement.
NSW Health should create an integrated policy framework that clearly defines interfaces between palliative and end-of-life care, articulates priorities and objectives and is supported by a performance and reporting framework. NSW Health should improve the collection and use of outcomes data and improve information systems to support palliative care services and provide comprehensive data for service planning.
The Auditor-General made four recommendations that called for the development of an integrated palliative and end-of-life care policy framework; proper data collection on patient outcomes; a state-wide review of systems and reporting for end of life management; and improved stakeholder engagement.
Some improvements evident
Over the last two years, NSW Health has taken steps to improve its planning and support for Local Health Districts. The NSW Agency for Clinical Innovation has produced an online resource that will assist districts to construct their own, localised models of care. And eHealth, which coordinates information communication technology for the state’s healthcare, aims to integrate and improve information systems. These initiatives should help to address many of the issues now inhibiting integrated service delivery, reporting on activity and outcomes, and planning for the future.
NSW Shadow Health Minister Walt Secord welcomed the report, saying it provided a roadmap for the State Government to improve end-of-life care in NSW.
“As a prosperous nation, Australia and NSW have the means to ensure that the final years, months and days of elderly people and those with terminal diseases are lived in dignity,” Mr Secord said. “In my view our prosperity brings an obligation to do no less.
“We have to recognise that palliative care is a field that will only grow as Australians now have the longest life expectancy in the English-speaking world.
“Accordingly, we need a government response that embraces helping people to remain independent in their homes by finding ways to expand home and community care,” Mr Secord said.
A full copy of the report is on the Audit Office website.
[post_title] => Palliative care: NSW Health must improve
[post_excerpt] => NSW Health has a limited understanding of the quantity and quality of palliative care services across the state.
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[caption id="attachment_27770" align="alignnone" width="300"] You create a lot of healthcare data during your life. What happens after it? Tewan Banditrukkanka/Shutterstock[/caption]
Jon Cornwall, Victoria University of Wellington
Death is inevitable. The creation of healthcare records about every complaint and ailment we seek treatment for is also a near-certainty.
Data about patients is a vital cog in the provision of efficient health services.
Our study explores what happens to those healthcare records after you die. We focus on New Zealand’s legal situation and practices, but the issue is truly a global one.
Read More:Decades on from Henrietta Lacks, we’re still struggling to find an adequate consent model
Previously, healthcare records were held in paper form and stored in an archive. Next came the advent of digital storage in on-site databases. When you died, your records were either shredded or erased, depending on the technology.
But it is now increasingly common for healthcare records to be digitised and held in a central repository. They can potentially be held for an indefinite period after someone dies, depending on the jurisdiction.
Should we be worried?
A question of value
Large, population-based healthcare data sets have immense value.
This is particularly true of records that include genomic information alongside other healthcare data – a phenomenon that will only increase as information about a person’s genes is more widely used in clinical treatment.
These posthumous healthcare data sets, which will grow in size and detail over the coming decades, could tell us a great deal about diseases and heritability. Data sets from generations of families and communities may well be available for research, and able to be analysed.
Information on this scale is worth a lot, especially for data storage companies and those with a financial interest in these data sets, such as pharmaceutical companies. Imagine, for instance, if a company could quickly analyse millions of genomes to isolate a disease that could be cured by an engineered pharmaceutical, and the commercial value this would create.
So how will this affect the individual whose data is held and their surviving family? Many people would be willing to donate medical records if the downstream result was beneficial for their community and country.
Yet the lines become easily blurred.
Would it be acceptable if data sets were sent to foreign companies? What if they provided a cure free of charge to the families of citizens whose data they used?
How about if the cure was half price, or full price, but the other option was having no cure at all? Would it be all right for companies to make millions of dollars out of this information? There is no easy answer.
[caption id="attachment_27771" align="alignnone" width="300"] Every time you visit a doctor’s office, you create data. Keith Bell/Shutterstock[/caption]
What’s the legal situation?
It’s impossible to talk about the long term fate of healthcare data without considering privacy and consent.
As part of medical research, for example, participants are required to provide informed consent and often the gathered data are anonymised. Access to posthumous medical records, on the other hand, is not highly regulated or protected in most countries, and the laws surrounding access are incredibly unclear.
In New Zealand, a deceased person has no privacy rights under the Privacy Act. And while healthcare data has to be held for a minimum of 10 years after death, the regulatory body which is then custodian of that data may decide - broadly - what purposes it may be used for.
Given that the custodian can be anyone from a health board or local doctor to a commercial institution that stores health records, the situation is exceedingly vague.
Read More:Human embryo CRISPR advances science but let’s focus on ethics, not world firsts
It is often argued that use of anonymous data sets do not require consent from an individual – in our case, a deceased person cannot provide this anyway. However the lines of true “anonymity” are becoming more blurred, particularly thanks to genomics.
Your own genome is partly that of your family and relatives. They may also have an emotional stake, and possibly a legal stake, in any action or research where the genome of a deceased family member is involved.
The medical profession has not always dealt well with consent and ethics issues. In one infamous case, the cancer cells of Henrietta Lacks – a 31-year-old American woman who died of cervical cancer in 1951 – have been used thousands of times in research projects.
She unwittingly made an invaluable contribution to global health, yet she never consented and her family was not consulted.
Then there is the fact that if large data bases are readily available, the possibility of data linkage increases – matching data sets that may belong to the same person – potentially undermining the ability to maintain true anonymity for the individual and their family.
What happens now?
The New Zealand and Australian governments have signalled that healthcare data are a widely underused resource. Commercialisation of such data is a possibility.
At some point, large posthumous healthcare data sets from these countries could potentially be accessed by researchers and private institutions around the world.
It is time for the public to decide what they think is reasonable. If the use of posthumous healthcare data is not aligned with the wishes of society, especially its desire for anonymity, the trust between our healthcare providers and patients may become compromised.
Healthcare data sets have immense value, but the public must be consulted about their use. Only then can the potential of posthumous healthcare data sets be properly realised.
Jon Cornwall, Senior Lecturer, Faculty of Health, Victoria University of WellingtonThis article was originally published on The Conversation. Read the original article.
[post_title] => Healthcare records: take them to the grave?
[post_excerpt] => Our healthcare records outlive us. It's time to decide what happens to the data once we're gone.
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Victoria’s Voluntary Assisted Dying Ministerial Advisory Panel (the Panel) has been working on developing a safe and compassionate voluntary assisted dying framework for Victoria.
The Legislative Council’s Legal and Social Issues Committee (the Parliamentary Committee) provided a broad policy direction for voluntary assisted dying that focused on allowing a person to self-administer a lethal dose of medication. The role of the Panel was to consider how this could work in practice and to ensure only those making voluntary and informed decisions and at the end of their life could access voluntary assisted dying.
The Panel determined that voluntary assisted dying implementation should be considered in the context of existing care options available to people at the end of life.
Guiding principles
In formulating its recommendations, the Panel relied on a number of guiding principles. These principles are that:
Every human life has equal value.
A person’s autonomy should be respected.
A person has the right to be supported in making informed decisions about their medical treatment and should be given, in a manner that they understand, information about medical treatment options, including comfort and palliative care.
Every person approaching the end of life should have access to quality care to minimise their suffering and maximise their quality of life.
The therapeutic relationship between a person and their health practitioner should, wherever possible, be supported and maintained.
Open discussions about death and dying and peoples’ preferences and values should be encouraged and promoted.
Conversations about treatment and care preferences between the health practitioner, a person and their family, carers and community should be supported.
Providing people with genuine choice must be balanced with the need to safeguard people who might be subject to abuse.
All people, including health practitioners, have the right to be shown respect for their culture, beliefs, values and personal characteristics.
The Panel recognised the need to balance respect for autonomy with safeguarding individuals and communities in relation to voluntary assisted dying. The Panel believes that the eligibility criteria, the process to access voluntary assisted dying, and the oversight measures recommended appropriately balance these aims.
Eligibility criteria
To access voluntary assisted dying, a person must meet all of the following eligibility criteria:
be an adult, 18 years and over; and
be ordinarily resident in Victoria and an Australian citizen or permanent resident; and
have decision-making capacity in relation to voluntary assisted dying; and
be diagnosed with an incurable disease, illness or medical condition, that:
is advanced, progressive and will cause death; and
is expected to cause death within weeks or months, but not longer than 12 months; and
is causing suffering that cannot be relieved in a manner the person deems tolerable.
The recommended eligibility criteria ensure voluntary assisted dying will allow a small number of people, at the end of their lives, to choose the timing and manner of their death. There is no intention to give people who are not dying access, and the legislation will not give these people an option to choose between living and dying.
The eligibility criteria ensure the voluntary assisted dying framework provides a compassionate response to people who are close to death and choose to request voluntary assisted dying to give them greater control over the timing and manner of their death.
The Panel recommends that a person must have decision-making capacity throughout the voluntary assisted dying process. This requirement is fundamental to ensuring a person’s decision to access voluntary assisted dying is their own, is voluntary, and is not the product of undue influence or coercion. The Panel recognises that this will mean some people who may want to request voluntary assisted dying will be excluded.
People with dementia who do not have decision-making capacity, for example, will not be able to access voluntary assisted dying. People will also not be able to request voluntary assisted dying in an advance care directive. This may disappoint many people in the community, but the Panel is of the view that having decision-making capacity throughout the voluntary assisted dying process is a fundamental safeguard.
In addition, the Panel sets out detailed guidelines as to the qualifications of the medical personnel involved in the approval process, as well as the actual procedure and safeguards in regards to the handling and disposal of the medications used in the voluntary assisted dying process.
The full report is available here.
[post_title] => Voluntary Assisted Dying: how the Victorians will do it
[post_excerpt] => Victoria has developed a safe and compassionate voluntary assisted dying framework.
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[post_content] => Western Victoria Primary Health Network (WVPHN) will soon roll out the GoShare patient education platform to 800 health professionals in Western Victoria.
GoShare allows health professionals to share engaging, timely and evidence-based health resources with patients, empowering them to play a more active role in their healthcare.
Developer of the platform and founder of health promotion company Healthily Dr Tina Campbell said GoShare is an easy-to-use tool for health professionals, which includes health information in a variety of formats (video, animation, text, apps) to accommodate a range of learning styles. Used to complement face-to-face or telehealth interactions, the resources are designed to build the knowledge, skills and confidence of patients, particularly in relation to the self-management of chronic conditions.
CEO WVPHN Leanne Beagley said the size and spread of the region meant there was a need for a new approach: “With a population in excess of 600,000 people, Western Victoria Primary Health Network (PHN) is focused on ensuring better health outcomes for the rural and regional communities across western Victoria.
“We are partnering with Healthily to provide local general practitioners and other health care providers with up to date health information for their patients. GoShare is an innovative patient self-management technology platform that will support people to be as independent as possible if they live with a chronic condition, will help prevent complications and potentially the need to go into hospital.”
Dr Tina Campbell said there was now considerable evidence that interventions that promote patient empowerment and the acquisition of self-management skills are effective in diabetes, asthma, and other chronic conditions. In addition, research shows that Australians of all ages are embracing the digital life. According to the ACMA 2014 Report 92% of adult Australians use the internet with 68% of those aged 65 years engaging online. In 2014, people aged 55 and over showed the largest increase in app downloads.
GoShare’s functionality makes it easy for health professionals to provide care that is responsive to individual patient preferences and needs. Ms Beagley said: “The platform is ‘patient-centred’ supporting health professionals to efficiently tailor and personalise information that responds to questions, concerns or interests expressed in a face-to-face or telephone consultation.
“It’s about ensuring patients have access to the right information at the right time, to gain the knowledge, skills and confidence necessary to manage their health to the best of their ability.”
“In essence, the health professional sends an online ‘information prescription’ to their patients or clients. Depending on the preference of the client these content bundles can be sent via SMS or email,” Dr Tina Campbell said.
Another aspect of the GoShare patient education is the ability of patients to share information with their carers, families and friends.
“Patients and their families play a central role in the successful management of chronic health conditions,” Dr Campbell said. “This includes appropriately monitoring their health, regulating lifestyle behaviours, and dealing effectively with the emotional and social stresses associated with being chronically ill.
“Research proves that listening to people in similar circumstances sharing their health experiences and insights is a very effective way of engaging patients and improving their confidence about their ability to self-manage their condition.”
Western Victoria PHN will roll out the GoShare platform in September this year. In stage one, the tool will primarily be used within general practice, followed by a rollout to pharmacies.
[post_title] => Western Victoria Health to roll out education platform
[post_excerpt] => WVPHN will soon roll out the GoShare patient education platform to 800 health professionals.
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[post_content] => [caption id="attachment_27719" align="alignnone" width="275"] Left to right: David Quilty, Brad Butt, Thanh Le, and Tim Kelsey.[/caption]
The Australian Digital Health Agency (the Agency) and Pharmacy Guild of Australia (the Guild) have signed an agreement to work together to help build the digital health capabilities of community pharmacies and advance the efficiency, quality and delivery of healthcare.
Both strong advocates for the widespread adoption and use of the My Health Record system by community pharmacists to better the health of the public, the Agency and the Guild have now entered into a collaborative partnership aimed at driving adoption and use of the My Health Record system by community pharmacies (supported by education and training) and maximising the medicines safety benefits.
The role of community pharmacists in delivering proper use of medicines is more important than ever, with an aging population and the growing prevalence of complex, chronic disease. All medicines have the potential for side effects and can interact with other medicines. Each year 230,000 people are admitted to hospital, and many more people experience reduced quality of life, as a result of unintended side effects of their medicines. This comes at a cost to the system of more than $1.2 billion.
“The Agency and the Guild have a mutual interest in continuing to develop and deliver community pharmacy digital health that will lead to significant improvements in the quality and delivery of care to consumers.
Specifically, the Agency and Guild will be working on optimising connectivity to the My Health Record system through dedicated community pharmacy support, including continuing professional development and shared care planning, transitional care, telehealth and interoperability with pharmacy clinical service IT platforms,” said agency chief executive Tim Kelsey.
“The Guild welcomes this collaboration with the Agency as a step towards optimised integration of community pharmacies in the My Health Record system. Community pharmacists have long been early adopters and innovators in digital health, and this will spur the sector on to make an even bigger contribution,” guild executive director David Quilty said.
Digital records pilot for hospital patients
On the hospital front, patients requiring urgent medical care will benefit from a hospital emergency department pilot that gives clinicians fast, secure access to health information such as allergies and medicines that may not otherwise be available in hospital information systems.
The pilot will help drive the uptake of My Health Record, a digital system that enables healthcare providers to share secure health data and improves the safety and quality of patient care. To date, over 5 million people have a My Health Record and over 10,143 healthcare providers are connected.
“Where My Health Record is being utilised, we are seeing reductions in duplicated testing and lower hospital re-admission rates.
“However, we need to identify potential barriers to the uptake of My Health Record in hospitals, and enable better integration with primary and secondary healthcare providers,” Mr Kelsey said.
The pilot was announced by the Agency in partnership with the Australian Commission on Safety and Quality in Health Care.
Commission CEO Adjunct Professor Debora Picone AM said that when a patient presents to an emergency department, hospitals can have limited information about the patient and a limited window to provide lifesaving treatment.
“It is time-consuming for hospital staff to gain information on the patient’s medicines, what their GP has been doing to manage the condition, and the procedures provided by other hospitals. This time could be better used treating the patient,” Professor Picone said.
The pilot is based on the successful My Health Record participation trials conducted by the Nepean Blue Mountains and the Northern Queensland Primary Health Networks. These trials demonstrated that clinicians working in hospital emergency departments were able to obtain valuable additional information by accessing My Health Record in real time.
The pilot is expected to take two years with an interim report due to the Agency in June 2018.
[post_title] => Pharmacies, emergency departments to go digital
[post_excerpt] => Pharmacy Guild, emergency departments to trial with Digital Health Agency.
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[post_content] => Chemist Paul Mavor with the first medicinal cannabis imports from Canada last month. Pic: supplied.
Australian Medical Association (AMA) President Dr Michael Gannon has criticised Tuesday’s senate vote, which makes it easier for terminally ill patients to buy unregistered medicinal cannabis from overseas, saying he fears the drug could end up in the wrong hands but cannabis experts have called his reaction unfounded.
The vote was led by Greens leader Richard Di Natale after he lost the same vote in May, but this time it won the support of Labor, One Nation and various crossbenchers after a procedural loophole allowed a re-vote.
Medicinal cannabis will now be classed as a category A drug on the Therapeutic Goods Administration (TGA) list, making it easier for doctors to prescribe the medication to terminally ill people and drastically reducing the time it takes for patients to get hold of it.
The senate vote also means terminally ill people can legally import the drug more easily from regulated overseas markets, provided they have a prescription. The first medicinal cannabis imports came into Australia in May from Canadian company CanniMed.
The Australian medicinal cannabis market is currently in its infancy after it became legal to cultivate, produce and manufacture medicinal cannabis products on October 30 2016. Good domestic product is probably 12 to 24 months away so securing an overseas supply is a necessary option for sick Australians.
Supply is not the only problem, draconian rules around prescription are too.
When the federal government legislated to make medicinal cannabis legal for some terminally ill patients last year, it also tightened up the conditions that had to be met before it could be prescribed.
The drug was previously classified as a category B drug under the special access scheme, which meant doctors had to get prior approval from the TGA, their state or territory health department and their hospital ethics committee or relevant association, before treating terminally ill patients, rather than just informing the TGA they intended to prescribe it.
It has obviously had an impact. Fairfax reported this week that only 133 people have been able to access medicinal cannabis since new laws came in.
But some doctors aren’t in favour of relaxing the rules.
Dr Gannon told Sky News he was ‘disappointed’ with the senate’s decision and said that giving patients access to unregistered medicinal cannabis products from overseas would knock doctors’ confidence in prescribing it.
“You’ve already got a situation where doctors are querying exactly how effective medicinal cannabis is. If you in any way put any doubt in their minds about the safety, you're simply not going to see it prescribed by many doctors,” Dr Gannon said.
But he admitted the risks to patients were minimal.
“Certainly, in the palliative care setting, we're not worried about addiction and, to be honest, we're not too worried about major potential side effects. But we remain concerned about potential diversion into the general community.”
Dr Gannon said cannabis was still a major source of mental illness in the wider community and it was ‘absolutely essential’ any imports were safe.
“If cannabis was the panacea that the people who seem desperate to import it - if it really was that good, then it would be in liberal use across the entire medical system,” he said.
“We're excited about its potential in palliative care, we're excited about its potential when it comes to juvenile epilepsy, and forms of spasticity, but let's look for the evidence.”
His views echo those of federal Health Minister Greg Hunt, who called the senate’s decision ‘reckless and irresponsible’ and argued that cannabis could end up in the pockets of criminals and out on the streets.
AMA’s fears unfounded, says expert
But medicinal cannabis expert Rhys Cohen, who works for the Australian subsidiary of Israeli medicinal cannabis company Cann10, called Dr Gannon’s statements contradictory and ‘completely unfounded’.
He said medicinal cannabis was unlikely to be diverted illegally, partly because it was already ‘incredibly cheap and incredibly accessible’ in Australia and medicinal cannabis was considerably more expensive.
He said only a few countries, including Israel, Canada and the Netherlands, legally exported cannabis and they all tightly controlled their product.
Companies needed export licenses and permits and Australian companies needed import licenses and permits. Prescriptions could still come only from specialist medical practitioners.
“The changes allow people who are very soon going to die to access it faster than previously,” Mr Cohen said. “We’re not talking about Joe Bloggs with a bad leg here but people on their death beds dying of cancer wanting to get relief from pain.
“The idea that there’s a chance they will sell it on the street is just ridiculous.”
While Dr Gannon has argued that cannabis should be treated the same as every other drug, operation or therapy Mr Cohen said it had always been treated very differently from other drugs.
“Any unregistered drug in the medicine world was accessible through special access A, except cannabis,” he said.
Mr Cohen said he thought the AMA’s misgivings were that doctors would be put under more pressure to prescribe medicinal cannabis, especially given pent up demand.
However, while he agreed these concerns were legitimate he said doctors were responsible for educating themselves about medicinal cannabis, especially when it had been proven to work so well for chronic pain, epilepsy and multiple sclerosis.
[post_title] => Doctors on a downer over medicinal cannabis imports
[post_excerpt] => Concerns unfounded, says Australian cannabis expert.
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By Stephen Duckett, Director, Health Program, Grattan Institute
This story first appeared in The Conversation
Leaked documents reported by Fairfax Media yesterday reveal Commonwealth bureaucrats are considering a proposal to simplify how public hospitals are funded in Australia.
While Labor has jumped on the leaks as further proof of the government’s risky approach to public health, Health Minister Greg Hunt has said the proposals would never be government policy.
A byproduct of Australia’s fractured federalism is that both the Commonwealth and state governments fund public hospitals. Currently, public hospital funding is split 38% to 53% between the Commonwealth and state governments respectively – the remaining 9% is private funding.
The Commonwealth also funds a major share of private hospital costs, albeit indirectly through the private health insurance rebate. So about 50% of private hospital funding comes from private health insurers, with a further 30% coming through health insurers, but sourced from the Commonwealth government, because of the private health insurance rebate.
So complex are these arrangements that a funding flow diagram for public hospitals resembles an upended bowl of spaghetti. The leaked plan proposes a seemingly tidy new funding formula dubbed the “Commonwealth Hospital Benefit”.
The leaked plan’s reported headline proposal is that the government rebate, which aims to encourage people to take out private health insurance, be transformed into a direct private hospital subsidy.
In other words, the private health insurance rebate – which subsidises up to 35% of the cost of both hospital and general (ancillary) insurance – would be abolished, as would the Medicare rebate for medical services for private patients in hospitals. Instead, a new rebate would be paid directly to private hospitals, with the level of the payment depending on the type of treatment and procedures provided.
Similarly, Commonwealth block grants to the states for public hospital care would be replaced by a direct payment to public hospitals, again depending on the treatments and procedures provided.
The Commonwealth Hospital Benefit would work in a similar way to the Medicare Benefit Schedule. So the Commonwealth would publish a list of fees it would pay for particular types of hospital care. These fees would be equally available to public and private hospitals.
Presumably the fees would be based on what is called the National Efficient Price – currently used to determine Commonwealth payments to states for increases in public hospital activity – published by the Independent Hospital Pricing Authority. Basing payment on a National Efficient Price will help make the private hospital sector more efficient, in the same way that it has improved efficiency in public hospitals.
Neat and tidy, but…
A Commonwealth Hospital Benefit would certainly be neat and tidy. It would increase transparency of Commonwealth funding support for both public and private hospitals. And it would replace the complex arrangements for private hospitals, where Commonwealth support for private hospital care is partly channelled through private health insurers and partly offered through the MBS rebate and the Pharmaceutical Benefits Scheme (PBS).
But important questions remain. At present, Commonwealth support for public hospitals is capped: it can grow no faster than 6.5% each year. Commonwealth support for private insurance, however, grows with any growth in membership; and growth in MBS and PBS outlays is uncapped. Will the proposed scheme be capped? If so, how?
Current Commonwealth support for public hospitals is conditional on there being no out-of-pocket costs to patients. Would the new scheme retain that condition?
Similarly, the Commonwealth’s indirect support for private hospitals is available only to those with private health insurance – because it is paid through the private health insurance rebate. About 7% of overnight-stay patients and 9% of same-day patients in private hospitals pay in full for their own care.
Further reading: The multi-billion-dollar subsidy for private health insurance isn’t worth it
Will these patients also become eligible for Commonwealth subsidies? That is, will the new private hospital subsidy be available only to those with private insurance and, if so, will any type of private insurance fulfil this condition?
Fairfax claims the leaked report suggests that, on current modelling, the share of Commonwealth support for public hospitals might decline from around 40% now to around 35%. This would require the states to devote a bigger proportion of their already tight budgets to health care.
The premiers could be expected to object loudly to any reduction. They might pass on the budget cut to public hospitals, and sheet home the blame to the Commonwealth. Certainly, the political optics for the federal Coalition – still reeling from Labor’s 2016 election “Mediscare” campaign – would not be good.
What about private hospitals?
Private hospitals and doctors might also not welcome the proposed arrangement. Private hospitals might enjoy the reduced scrutiny by private insurers, but some negotiations would presumably still be needed between insurers and hospitals about what level of out-of-pocket costs members could face.
Private hospitals might also become responsible for paying medical rebates to surgeons, psychiatrists and other doctors who treat patients in their hospital. The private hospital administrators might find dealing with insurers much easier than negotiating how to divide the new “hospital benefit” between the doctors, pharmacists, allied health staff and the hospital, all of whom currently bill separately.
Alternatively, private insurers might be expected to cover these costs. Again, this would require complex negotiations on precisely what payments might be appropriate.
If there was no net change in Commonwealth funding to private hospital care, the financial position of private insurers would be unchanged, because their outlays would be reduced in line with the reduction in the Commonwealth subsidy. But again, there are risks here for insurers.
If the benefit was available to all patients, and not just the insured, private insurers might lose business as members downgrade to the minimum acceptable product. And it could become harder for insurers to persuade people to take up private insurance, given many people see the current private health insurance rebate as ensuring they get value for money from their insurance purchases.
There are good reasons to want to simplify and make more transparent the extremely complex flows of Commonwealth funding to both public and private hospitals. But there are also risks in the change.
[post_title] => Why the seemingly tidy, leaked proposal for hospital funding may be a problem policy
[post_excerpt] => Will the scheme be capped?
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The Health Star Rating System has been slammed as unhelpful and misleading.
By Lucy Marrett
Championed to make packaged food choices simpler, the HSRS was launched three years ago but of late has been receiving criticism suggesting there is a fundamental flaw in the system. The federal government’s Heath Star Rating System (HSRS) has been referred to as flawed and in urgent need of review.
What exactly is the HSRS?
According to the official HSRS website it is: “a front-of-pack labelling system that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars. It provides a quick, easy, standard way to compare similar packaged foods. The more stars, the healthier the choice.”
It was designed as a way to make choosing healthy options simple and quick, taking the hassle out of reading nutrition labels, and instead provide a clear visual guide.
Read more here.
This story first appeared in C&I Week.
[post_title] => Flaws in the health star rating system
[post_excerpt] => The HSRS remains voluntary for food companies.
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The Department of Health has said 22,000 home care packages have been released under the new system and it will release detailed data in July on how it’s performing.
Bonnie Carter says her 84-year-old mother has been waiting for a high-level home care package for more than 70 days.
Ms Carter says that since an Aged Care Assessment Team assessed her mother as needing the package, “nothing has happened.”
“There’s been no contact other than me calling My Aged Care several times to see where she is in the queue and how long she might have to wait,” Ms Carter says.
“Apparently no one can tell anyone anything about this mythical queue until the end of this year,” she adds.
Under the latest aged care reforms that came into force on 27 February, the Department of Health has created a new centralised process for allocating home care packages directly to consumers.
As part of the new system a “national prioritisation process” has been created: after a senior is assessed as needing a home care package they join a new national queue where they wait to be allocated a package.
How long a senior waits on the queue is based on various factors – such as their level of need, how long they’ve been waiting and how quickly a package at their level of need becomes available (the number of packages is increasing but remains capped by government).
It’s a complex new system and, in the absence of transparency around how it is working, confusion is mounting among providers and consumers.
Read more here.
This story first appeared in Australian Ageing Agenda.
[post_title] => Confusion reigns over Health's new aged care queue
[post_excerpt] => My Aged Care under fire.
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[post_content] => First medicinal cannabis import: CanniMed cannabis oil.
Seriously ill Australians can now access imported medicinal cannabis after the first licensed imports of the drug arrived in Perth last week.
The drug was imported by Australian wholesale company Health House International and ASX-listed cannabis company Creso Pharma, a Swiss company.
The cargo contained three different types of cannabis oil from Canadian company CanniMed, each designed to tackle different symptoms and retailing for about $350 a bottle, which should last patients about a month.
The federal government gave the go ahead for companies to grow and manufacture medicinal cannabis late last year but it will still be a while before patients can access Australian product, said Health House Director Paul Mavor.
Mr Mavor said it would take some time for companies to get permission to set up their operations and then get them reinspected and licensed.
“Within 12 to 24 months we will be starting to see some really good [Australian] product and hopefully we will be exporting that,” Mr Mavor said.
Health House International was granted one of the first medicinal cannabis import licences in February, soon after Health Minister Greg Hunt gave the go ahead to fast-track medicinal cannabis imports while local cultivation catches up.
Australian product should be cheaper for patients as there will be much lower shipping costs and no freight duties but this will also depend on domestic (and possibly overseas) demand and whether companies can achieve economies of scale.
Around 100,000 Canadians currently use medicinal cannabis and Mr Mavor is predicting about 70,000 Australians will eventually follow suit.
Interestingly, Mr Mavor said that he had been speaking to some private insurance funds who had indicated they may be interested in subsidising the drug for some people, for example, those involved in car crashes or war veterans, because it could keep them out of hospital and keep costs down.
In a few years it is possible that medicinal cannabis will be listed under the Pharmaceutical Benefits Scheme, once it has been tested in the local market, says Mavor.
“It is likely. Some conditions that some patients are using medical cannabis for, they don’t have any other options.”
Cannabis is cost-effective because it has five different uses in one hit: it can relieve nausea, vomiting, anxiety, insomnia and chronic pain.
Health House International's Paul Mavor. Pic: Supplied.
But Mr Mavor said while demand in Australia is strong, the process for prescribing medicinal cannabis had been made torturously difficult by the federal government, which has left states and territories to set their own rules.
Many demand that patients get approval from both the federal and state or territory health departments because the drug is listed as a Special Access category B drug.
Federal legislation to make the drug category A, which would have allowed doctors to complete online form and obtain instant approval, was blocked in the senate this week by Pauline Hanson’s One Nation and the Nick Xenophon team.
Australian Greens Leader Dr Richard Di Natale said he was deeply disappointed that politicians had put the needs of terminally ill patients second to “their own political games”.
“Patients are currently waiting weeks and sometimes months for access to these treatments. This motion could have reduced that to a day or possibly hours,” Mr Di Natale said.
“For some of these patients, speedy access to medicinal cannabis is the difference between being able to eat or wasting away. These changes add time, stress, and difficulty for terminally ill patients accessing medicinal cannabis.”
Mr Mavor says the strictest prescription regime is in Western Australia, where a huge amount of information is demanded and approval must be sought from federal and state health departments and from the practitioner’s ethics board.
He said the easiest system was in South Australia, where doctors could prescribe the drug for two months for patients at any one time and Queensland, Victoria and NSW were passable.
Once prescription problems are ironed out the industry looks set to have a bright future ahead of it.
David Russell, Chief Operating Officer of Creso Pharma said the first successful import of medicinal cannabis products into Australia was “a ground-breaking moment for patients and the medical industry”.
“The Australian market has been catching up with community expectations while the regulatory framework around medicinal cannabis was being developed,” Mr Russell said.
“Now these products will allow patients to have the option of medicinal cannabis treatments if it is prescribed by their physician. This is particularly important given the unmet but often immediate need to access a timely medicinal cannabis supply across Australia.”
To be prescribed medicinal cannabis products, patients must see a physician who is an authorised prescriber, or apply for SAS Category B prescription under the Therapeutic Goods Administration regulations.
[post_title] => First medicinal cannabis imports arrive in Australia
[post_excerpt] => Prescription rules hold patients up.
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[caption id="attachment_27066" align="alignnone" width="700"] The World Trade Organisation has reportedly rejected a case against Australia’s plain packaging laws.[/caption]
By Lucy Marrett
The ABC has reported on a rumour that the Australian Government has won a dispute regarding international tobacco plain packaging.
The rumoured ruling in Australia’s favour is set to give the green light to other countries to roll out similar laws.
A British American Tobacco (BAT) spokesperson said the news regarding the ruling was “speculation”.
“However, we can say that there is still no proof to show that plain packaging is meeting the objectives set out by the government,” he said.
Cancer Council Victoria said it welcomed recent findings by an independent study released in April which they said found that plain packaged tobacco products “may” reduce the prevalence of smoking.
Read more here.
This story first appeared on C&I Week.
[post_title] => WTO to rule on Australia’s tobacco plain packaging laws
[post_excerpt] => Other countries likely to follow suit.
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Minister for Aged Care, Ken Wyatt.
By Darragh O'Keefe
The Commonwealth has launched an independent review to determine how federal regulators failed to detect the scale of the issues at South Australia’s Oakden facility.
In a damning review the state’s Chief Psychiatrist said the facility was “more like a mental institution from the middle of last century” than a modern older person’s mental health facility.He called for the centre to be closed and replaced by more contemporary services after highlighting a range of concerns around the model of care, staffing, safety, culture and use of restrictive practices.
Last week the State Government said it was closing the centre and would develop a new state-wide model of care for older people experiencing several behavioural and psychosocial symptoms of dementia (BPSD).
After weekend media reports questioning how federal regulators failed to identify the seriousness of the issues at the centre, the Commonwealth on Monday announced a new review into its aged care regulatory processes.
Minister for Aged Care Ken Wyatt said the review would identify any shortcomings in the national regulatory system that meant that the Commonwealth was not aware of the extent of the problems at Oakden.
Read more here.
This story first appeared in Australian Ageing Agenda.
[post_title] => Feds launch review into SA mental health facility
[post_excerpt] => Chief Psychiatrist compares Oakden to 'a mental institution from the middle of last century'.
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By Catriona May, University of Melbourne
The number of GPs in Australia is falling in real terms, as more and more medical graduates choose specialisations over general practice.
A major report from the Melbourne Institute of Applied Economic and Social Research has found that, while the number of new GPs in Australia is growing relatively slowly, for every new GP there are nearly ten new specialists.
Professor Anthony Scott, who leads the team behind the report, says the trend could prove expensive in the long run, and has implications for patient care.
“If we don’t have enough GPs, patients will end up in hospital more than they should,” he says. “If patients can’t get in to see their GP they end up in the emergency department, where they’ll be seen by specialists.
“Specialists tend to do more procedures, which means more expense for the public purse. Potentially, patients may also end up receiving unnecessary treatments.”
The ANZ-Melbourne Institute Health Sector Report is the first major health check of general practice in Australia. It uses data collected through Medicare and the Institute’s Medicine in Australia: Balancing Employment and Life (MABEL) survey, which has been running for 10 years and includes data from over 10,000 doctors.
The results suggest general practice is still relatively unattractive to medical graduates, says Professor Scott.
How Australia is losing the health fight
“Money does matter,” he says. “Specialists are paid two-to-three times what most GPs are, and that’s the route junior doctors want to take. Often it is those who can’t become specialists that move into general practice.
“Unfortunately, it’s seen as second fiddle to specialisation, in terms of reputation and earnings.”
Read more here.
This story first appeared in Melbourne University's Pursuit website.
[post_title] => Taking the pulse of general practice: GPs face a crisis in morale
[post_excerpt] => GP numbers falling in real terms.
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[post_content] => Can Health exorcise the ghosts of failed past government IT projects?
There is a graveyard bigger than Rookwood Cemetery filled with the cadavers of failed government IT projects and haunted by the ghosts of scope creep, budget blowouts, frustrating delays and second rate outcomes.
It is a fate the Department of Health (DOH) will be dearly hoping it can avoid as it pushes ahead to completely reimagine its 30-year-old IT payments system, a system which underpins Medicare, aged care and veterans’ payments and the Pharmaceutical Benefits Scheme.
The project is still in its early stages. The Request for Information (RFI) went out in March this year as the government gathers as many ideas as it can from tech companies of varying sizes to design, deliver and integrate its digital payments platform, a project that will have multiple phases over the next five years, while keeping its procurement options open.
Vendors are likely to be salivating at the chance to score a lucrative, long-running contract which has about the highest public profile there is for a federal government IT project, perhaps surpassed only by the Department of Human Services’ $1 billion, seven-year Welfare Payments Infrastructure Transformation (WPIT), due for completion by 2022.
But it will not be easy money. It is not a straight forward task to disentangle the current system, which has over 200 applications and 90 databases and supports more than 600 million payments worth approximately $50 billion every year.
The Health Department cannot afford to slip up because if it does it will do so very publicly. The multi-million dollar transformation is an endeavour that will affect around 99 per cent of Australians who use the digital payments platform in one way or another.
CEO of business management company Holocentric, Bruce Nixon, who has worked with government clients such as the ATO, NSW Transport Management Centre, Sydney Water and IP Australia, says now is the right time to do it, before the labyrinthine system gets even more complicated.
“It’s pretty exciting and it is long overdue. It’s a good time to be doing it with new technology available,” Mr Nixon says.
“It is very difficult to integrate everything into the application so there are more and more layers on top and they become more and more complex and unwieldy.
“There does come a time where it makes sense to overhaul the system and replace it with something more modern that allows changes.”
Time is also limited so DOH has little choice but to act. Gary Sterrenberg, CIO of the Department of Human Services, which manages health payments for DOH, has said in the past that the current system has only about three years left before it is totally cactus.
There is no doubt that DOH needs to get on with it but it needs to do it well.
Critical to the project’s success, says Mr Nixon, is building expertise and loyalty in-house, rather than shifting the burden and responsibility onto systems integrators, although he says external contractors will be needed and they will bring in fresh ideas.
“You should bet on your own people. Open their knowledge. Bring them into the project as early as possible and keep them involved all the way through,” he says.
“Be upfront about how it’s going to work in the future, the ramifications. It de-risks the project.”
Doing this helps prevent cost overruns and scope creep, as well as skilling up staff, and ensures that the people who know and understand the processes the system is built for are more involved in the project.
It makes it more likely that the system can incorporate any necessary changes to payments further down the track too.
“There are always going to be policy changes and political influences. Transformation is ongoing and it is hard to change if you don’t have in-house skills and knowledge,” Mr Nixon says.
It is the people at the coalface processing payments - not systems integrators - who have this knowledge.
“You need to leverage these skills and engage these staff in the process, rather than relying on systems integrators,” he adds.
Integrating the technical into the operational demands a thorough knowledge of current processes and assessing desirable outcomes, along with building in the flexibility to adjust systems to reflect future changes.
It requires drilling down and looking at how payments are made, defining the tasks workers must do, the rules and obligations they are working under, and thinking about how these integrate into the IT system.
Mr Nixon says it is important to examine what can be done better and the expectations Australians have of the system, for example, of being able to make mobile payments.
“The Department should make sure it takes control of the whole transformation initiative. This is a very complex system that has been around for a long time with a huge amount of transactions that are very important to get right.
“You need to start change management from the early days, not at the end, identify current processes, system capabilities and your future vision."
He suggests building a model to simulate the processes and how things will work, “sort of like a business GPS”.
Mr Nixon says there are lessons to be learned from other IT disasters, whether from Australia or overseas, cautionary tales worth heeding by governments before they blow billions and incur the wrath of ordinary Australians when the systems they rely upon seize up.
“It’s worth being wary of past failures,” he says.
Probably one of the most spectacular domestic IT failures occurred when Queensland Health set out to replace its ailing payroll system in 2006. When the system eventually went live in 2010 thousands of workers were underpaid, overpaid or not paid at all and Queensland taxpayers were left with a $1.2 billion bill for a project that was initially supposed to be a $6 million contract.
The meltdown was primarily due to the organisation’s failure to clearly set out its business requirements or to spell out how it should be delivered and what outcomes were expected. Unrealistic deadlines exacerbated the sloppy planning.
All this set the scene for massive scope creep and proved to be a headache for contractor IBM, which had to deal with multiple requests for changes.
Another epic fail was the Victorian MyKi public transport smartcard, where costs ballooned to $1.5 billion and dragged on an extra seven years, taking nine years instead of two. The ensuing storm of complaints from the public over charges and refunds only amplified the damage done.
The then Victorian Labor government underestimated the project’s complexity and failed to monitor the contract properly.
DOH will be fervently praying that it does not enter the annals of similarly disastrous IT projects and instead gets it right.
[post_title] => Health confronts ghosts of failed govt IT projects in Medicare payments rebuild
[post_excerpt] => Engage staff early, integrate process with systems.
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The Auditor-General for New South Wales Margaret Crawford has released her report, in which she finds that NSW Health’s approach to planning and evaluating palliative care is not effectively coordinated. There is no overall policy framework for palliative and end-of-life care, nor is there comprehensive monitoring and reporting on services and outcomes.
“NSW Health has a limited understanding of the quantity and quality of palliative care services across the state, which reduces its ability to plan for future demand and the workforce needed to deliver it,” said the Auditor-General. “At the district level, planning is sometimes ad hoc and accountability for performance is unclear.”
Local Health Districts’ ability to plan, deliver and improve their services is hindered by:
Multiple disjointed information systems and manual data collection.
Not universally using a program that collects data on patient outcomes for benchmarking and quality improvement.
NSW Health should create an integrated policy framework that clearly defines interfaces between palliative and end-of-life care, articulates priorities and objectives and is supported by a performance and reporting framework. NSW Health should improve the collection and use of outcomes data and improve information systems to support palliative care services and provide comprehensive data for service planning.
The Auditor-General made four recommendations that called for the development of an integrated palliative and end-of-life care policy framework; proper data collection on patient outcomes; a state-wide review of systems and reporting for end of life management; and improved stakeholder engagement.
Some improvements evident
Over the last two years, NSW Health has taken steps to improve its planning and support for Local Health Districts. The NSW Agency for Clinical Innovation has produced an online resource that will assist districts to construct their own, localised models of care. And eHealth, which coordinates information communication technology for the state’s healthcare, aims to integrate and improve information systems. These initiatives should help to address many of the issues now inhibiting integrated service delivery, reporting on activity and outcomes, and planning for the future.
NSW Shadow Health Minister Walt Secord welcomed the report, saying it provided a roadmap for the State Government to improve end-of-life care in NSW.
“As a prosperous nation, Australia and NSW have the means to ensure that the final years, months and days of elderly people and those with terminal diseases are lived in dignity,” Mr Secord said. “In my view our prosperity brings an obligation to do no less.
“We have to recognise that palliative care is a field that will only grow as Australians now have the longest life expectancy in the English-speaking world.
“Accordingly, we need a government response that embraces helping people to remain independent in their homes by finding ways to expand home and community care,” Mr Secord said.
A full copy of the report is on the Audit Office website.
[post_title] => Palliative care: NSW Health must improve
[post_excerpt] => NSW Health has a limited understanding of the quantity and quality of palliative care services across the state.
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The Auditor-General for New South Wales Margaret Crawford has released her report, in which she finds that NSW Health’s approach to planning and evaluating palliative care is not effectively coordinated. There is no overall policy framework for palliative and end-of-life care, nor is there comprehensive monitoring and reporting on services and outcomes.
“NSW Health has a limited understanding of the quantity and quality of palliative care services across the state, which reduces its ability to plan for future demand and the workforce needed to deliver it,” said the Auditor-General. “At the district level, planning is sometimes ad hoc and accountability for performance is unclear.”
Local Health Districts’ ability to plan, deliver and improve their services is hindered by:
You create a lot of healthcare data during your life. What happens after it? Tewan Banditrukkanka/Shutterstock[/caption]
Every time you visit a doctor’s office, you create data. Keith Bell/Shutterstock[/caption]
Healthcare data sets have immense value, but the public must be consulted about their use. Only then can the potential of posthumous healthcare data sets be properly realised.
Victoria’s Voluntary Assisted Dying Ministerial Advisory Panel (the Panel) has been working on developing a safe and compassionate voluntary assisted dying framework for Victoria.
The Legislative Council’s Legal and Social Issues Committee (the Parliamentary Committee) provided a broad policy direction for voluntary assisted dying that focused on allowing a person to self-administer a lethal dose of medication. The role of the Panel was to consider how this could work in practice and to ensure only those making voluntary and informed decisions and at the end of their life could access voluntary assisted dying.
The Panel determined that voluntary assisted dying implementation should be considered in the context of existing care options available to people at the end of life.
Guiding principles
In formulating its recommendations, the Panel relied on a number of guiding principles. These principles are that:
Left to right: David Quilty, Brad Butt, Thanh Le, and Tim Kelsey.[/caption]
The Australian Digital Health Agency (the Agency) and Pharmacy Guild of Australia (the Guild) have signed an agreement to work together to help build the digital health capabilities of community pharmacies and advance the efficiency, quality and delivery of healthcare.
Both strong advocates for the widespread adoption and use of the My Health Record system by community pharmacists to better the health of the public, the Agency and the Guild have now entered into a collaborative partnership aimed at driving adoption and use of the My Health Record system by community pharmacies (supported by education and training) and maximising the medicines safety benefits.
The role of community pharmacists in delivering proper use of medicines is more important than ever, with an aging population and the growing prevalence of complex, chronic disease. All medicines have the potential for side effects and can interact with other medicines. Each year 230,000 people are admitted to hospital, and many more people experience reduced quality of life, as a result of unintended side effects of their medicines. This comes at a cost to the system of more than $1.2 billion.
“The Agency and the Guild have a mutual interest in continuing to develop and deliver community pharmacy digital health that will lead to significant improvements in the quality and delivery of care to consumers.
Specifically, the Agency and Guild will be working on optimising connectivity to the My Health Record system through dedicated community pharmacy support, including continuing professional development and shared care planning, transitional care, telehealth and interoperability with pharmacy clinical service IT platforms,” said agency chief executive Tim Kelsey.
“The Guild welcomes this collaboration with the Agency as a step towards optimised integration of community pharmacies in the My Health Record system. Community pharmacists have long been early adopters and innovators in digital health, and this will spur the sector on to make an even bigger contribution,” guild executive director David Quilty said.
Digital records pilot for hospital patients
On the hospital front, patients requiring urgent medical care will benefit from a hospital emergency department pilot that gives clinicians fast, secure access to health information such as allergies and medicines that may not otherwise be available in hospital information systems.
The pilot will help drive the uptake of My Health Record, a digital system that enables healthcare providers to share secure health data and improves the safety and quality of patient care. To date, over 5 million people have a My Health Record and over 10,143 healthcare providers are connected.
“Where My Health Record is being utilised, we are seeing reductions in duplicated testing and lower hospital re-admission rates.
“However, we need to identify potential barriers to the uptake of My Health Record in hospitals, and enable better integration with primary and secondary healthcare providers,” Mr Kelsey said.
The pilot was announced by the Agency in partnership with the Australian Commission on Safety and Quality in Health Care.
Commission CEO Adjunct Professor Debora Picone AM said that when a patient presents to an emergency department, hospitals can have limited information about the patient and a limited window to provide lifesaving treatment.
“It is time-consuming for hospital staff to gain information on the patient’s medicines, what their GP has been doing to manage the condition, and the procedures provided by other hospitals. This time could be better used treating the patient,” Professor Picone said.
The pilot is based on the successful My Health Record participation trials conducted by the Nepean Blue Mountains and the Northern Queensland Primary Health Networks. These trials demonstrated that clinicians working in hospital emergency departments were able to obtain valuable additional information by accessing My Health Record in real time.
The pilot is expected to take two years with an interim report due to the Agency in June 2018.
[post_title] => Pharmacies, emergency departments to go digital
[post_excerpt] => Pharmacy Guild, emergency departments to trial with Digital Health Agency.
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