s Australian Health Information Technology | I2P: Information to Pharmacists - Archive
Publication Date 01/12/2012         Volume. 4 No. 11   
Information to Pharmacists


From the desk of the editor

Welcome to the December homepage edition of i2P- Information to Pharmacists E-Magazine.
This homepage will be utilised for both December 2012 and January 2013 with irregular updates to get us through the holiday period.
This enables all i2P writers to relax before what appears to be a challenging year in 2013.
It is estimated that the pharmacy business/professional cycle (45 years) will be bottoming out over 2013 with more disturbance to pharmacy profitability and its ability to provide regular levels of employment.

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Recent Comments

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News Flash

Newsflash Updates over December 2012 & January 2013

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated.

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Feature Contribution

Countdown to Supermarket pharmacies - Advantages and disadvantages?

Joseph Conway

Editor's Note:
With a researcher's perspective and a pair of fresh eyes, Joseph Conway has mapped out his version of the trends and future directions for pharmacy, community pharmacy in particular.
In presenting his logic he argues from two opposite points of view - a model comprising supermarket majority ownership compared to a more traditional model of pharmacist ownership.
His article is presented in four parts, with supermarket ownership looked at first.
2013 will be an extraordinarily difficult year as the 45 year pharmacy business and professional cycle bottoms out with no soft landing.
The hiatus in pharmacy leadership that is apparent in the lack of a cohesive forward plan leaves all pharmacists (pharmacy owners and non-owners) with no sense of direction, a mix of disjointed "bits and pieces" that is the substitute for a clear and definitive plan
While Joseph has outlined some options, it will be up to individuals to complete the puzzle and fill in all the gaps.

Comments: 6

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Countdown to Supermarket pharmacies - Advantages and disadvantages? - Part Two

Joseph Conway

Editor's Note: Joe Conway continues with Part Two of his four-part series on Australian pharmacy and its direction.
Please post comments at the foot of his article to help expand the debate.
Pharmacy has to change quite drastically to drag itself into the 21st century.
It has hesitated for too long a period of time.

In New Zealand, the launch of Countdown pharmacy seems to have gone down with little fuss. However, from an Australian pharmacy perspective, the issue of concern is that Countdown Pharmacies are at least in part owned by Woolworths.
In part 1, I outlined what I thought were the potential advantages of Supermarket pharmacies in Australia. In part 2, I would like to give my opinion as to the disadvantages of allowing Supermarkets to run pharmacies in store.

Comments: 1

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Countdown to Supermarket pharmacies - Advantages and disadvantages? - Part Three

Joseph Conway

Editor's Note:Joe Conway Introduces Part three of his four-part series on the potential impacts of supermarket pharmacies in Australia (if introduced). Part three discusses impacts for patients.

Countdown Pharmacies are at least in part owned by Woolworths. This raises the possibility that Woolworths is using this Kiwi venture to hone its skills in the area of pharmacy before a possible bid to be allowed to provide such services here in Australia.
People aren’t marching the streets in Australia wanting pharmacies in Supermarkets and the Discount model of pharmacy is already providing Australians with access to cheaper medicines that is the catch-cry of the Supermarkets when extolling their virtues as potential custodians of prescription medicines.
An example of this was Chemist Warehouse supplying the Lipitor® generic Atorvastatin Sandoz® for $0 for a limited time on a valid prescription.
You can’t get any cheaper than that? In part 1, I outlined what I thought were the potential advantages of Supermarket pharmacies in Australia.
In part 2, I gave my opinion as to the disadvantages of allowing Supermarkets to run pharmacies in store.
In part 3 I would like to explore potential patient attitudes in this debate.

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Countdown to Supermarket pharmacies - Advantages and disadvantages? - Part Four

Joseph Conway

Editor's Note: This is the fourth article in a series by Joseph Conway.
He has made a number of assumptions and predictions within the article series, floating the proposal that if Australia adopts the New Zealand model of Countdown Pharmacy, there are a range of advantages and disadvantages.
In this final article Joe blows apart the notion that supermarkets are cheaper than pharmacies by completing a survey of products held by pharmacies and supermarkets in common.
To his surprise, he found that pharmacy is currently more than competitive with supermarkets, taking away the supermarket trumpet call that they would provide cheaper prices than pharmacies.
It would seem that pharmacy can still remain in the race to be competitive, with the point of difference being provision of patient information. The latter service may need to be tidied up, even charged for if there is value for money.

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The Role of the Consumer in Health

Gerald Quigley

The Guild’s least favourite combatant at the moment is the Consumer's Health Forum.
I’ve been a member of this organization for a few years now, and I’ve come to acknowledge their expectations that they, as a representative body for the Australian consumer, should have a say in health.
And I’m beginning to understand now that this organization might, in fact, reshape our role in health.
I can’t get over the wide variety of contacts they have, the panels in which they are involved and more especially, their positioning as the voice of the consumer.
Perhaps we can take a leaf out of their book?

Comments: 1

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The Ten Top Issues we need to think about in 2013

Neil Johnston

No matter where you appear within the “food chain” of pharmacy, uncertainty is the common background theme.
Students are wondering if they will succeed in getting an internship.
Interns are worried about continuing employment and becoming registered.
Newly registered pharmacists are wondering if they are in over-supply with the prospect of reduced (or no hours) of employment at hourly rates not much above pharmacy technicians.
Career pharmacists are wondering about their prospects in a rapidly changing and stressful environment.
Clinical pharmacists are wondering when community pharmacy is going to embrace them as part of a solution.
Senior pharmacists (those that do not want to retire) are wondering if the workplace will ever become friendly to the extent that some of their working day can be in a seated position, to take stress off aching joints. Also to be valued in a mentoring role to other pharmacists.
Owner pharmacists, in varying degrees, are wondering whether they will have sufficient capital to sustain their businesses into the future.

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How Do Your Customers See Your Business?

Chris Foster

Businesses tend to focus on profits with no consideration as to whether these profits are good profits or bad profits.
Good profits would be defined as those profits earned from customers who are delighted with the products or services provided – so much so that they will voluntarily refer your business to their friends and associates - in other words, become an advocate for your business

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In 2012 community pharmacy didn’t get any easier. Time to think about 2013

Neil Retallick

A funny thing didn’t happen recently.
I rang our (Global Pharmaceutical Company) territory manager and she didn’t answer.
In fact, her mailbox was so full I couldn’t leave a message.
Several days later, her manager rang to inform me that she had been made redundant as a part of a company-wide restructure.
Then, a couple of days ago I had a meeting with the State Manager of another Global Pharmaceutical Company.
He told me that 300 jobs had been made redundant in the pharmaceutical industry in the previous five weeks.

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Slow Medicine, Slow Foods - Concepts for Future Good Health

Neil Johnston

A growing number of medical leaders are calling for “Slow Medicine.”
They are calling for a similar rationale which evolved as the “Slow Food Movement” that originated in Italy as a reaction against fast food and industrialised agriculture.
Slow Food links the pleasure of growing and consuming good food with a commitment to community and the environment.
The movement exists in Australia and information about it can be found here
i2P first wrote about slow food here.

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Reach Out, Connect, Engage

Barry Urquhart

Omni-channel and multi-channel are in-vogue phrases and concepts.
They reflect the presence and need for parallel and compatible avenues to reach out, connect with and to engage existing and prospective clients and customers.

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Rationing Healthcare

Steve Jenkin

What level of Individual Responsibility do we each have in managing our Health and Well-Being, given that 40% of "total health" is due to lifestyle choices and behaviour and only 10% Healthcare Delivery? [1]
How much "free" healthcare, taxpayer funded, are we prepared to give individuals?
Should we limit it?
Unlimited Free Goods guarantee unlimited demand for them.

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Lessons they don't teach you in school

Harvey Mackay

Education is a stepping stone to success, but some of the most important lessons aren't taught in class. There are plenty of life lessons that we need to know, and the textbooks often do not have chapters on them.
Here are some lessons you should learn in order to grow both in your career and in your personal life.

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National Go Home On Time Day – do you go home on time?

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Wednesday 21 November 2012 was National Go Home On Time Day in Australia (www.gohomeontimeday.org.au/). 
This event is an initiative of the Australia Institute (www.tai.org.au), an independent public policy think tank based in Canberra. 
Other supporters are beyondblue (www.beyondblue.org.au) and the ACTU. 
On Wednesday 21 November the address at the National Press Club in Canberra was given by beyondblue CEO and pharmacist, Kate Carnell and ACTU President, Ged Kearney.
A recording of the address, which I recommend, can be viewed at:http://www.abc.net.au/news/2012-11-21/national-press-club-ged-kearney-and-kate-carnell/4384590.
Despite differing political backgrounds both presenters were united in their view that life-work balance is essential to a healthy and productive workforce. 
This is something which, I believe, many pharmacists need to consider and apply to their lives.

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I've been thinking about circumcision, Starbucks and FDR's four freedoms

Mark Neuenschwander

Well before Starbucks began roasting exotic blends, Yuban took a swing at it. Not sure they hit the ball out of the park, but they were getting more for a pound of coffee than number-one Folgers at checkout stands across America. Do you remember Yuban commercials during the 1960s? They concluded with that deep trained-for-television voice saying, “As John Arbuckle says, ‘You get what you pay for.’”

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Chiropractic mallets & other wacko widgets

Loretta Marron OAM BSc

The philosophy behind 'fundamentalist' chiropractic is that spinal 'blockages' cause most illnesses and that removing them will restore health.
A range of chiropractic 'medical devices' are claimed to locate and remove these 'blockages'.
So what types of devices do chiropractors use, are they registered with the federal government, and do they work?

Comments: 2

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It’s Good to See a Unity Theme Emerging

Peter Sayers

I2P has already commented that unless pharmacy leaders become united, the profession will continue a decline that has been building for over a decade.
We are now in the “bottoming-out” phase of the pharmacy business/professional cycle that will become extended if there is no sign of cohesiveness emerging over the next twelve months.
Pharmacy leaders must sort out their various differences and support each other where strengths exist and need to be nurtured.
The last thing pharmacists want to see is a prolonged battle for power, wasteful in resources and energy and depressing for individual pharmacists struggling to find an identity and build their professional roles.
i2P will support any progress towards unity because we can see how close pharmacy is to major destruction, caused by weaknesses created over the last decade through in-fighting and power broking.

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Remembering a legend, Zig Ziglar

Harvey Mackay

When I was cutting my teeth in the sales game right after college, I made sure to read or listen to everything I could get my hands on from a handful of sales and motivational legends - Napoleon Hill, Earl Nightingale, Dale Carnegie, Norman Vincent Peale, Jim Rohn and Zig Ziglar.

I, like many people around the world, was saddened to hear about the recent death of my friend Zig. He was one of a kind. I was fortunate to share the stage with him several times - and I will be forever grateful for those opportunities.

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Is the Guild getting value for money in radio?

Gerald Quigley

Recently, whilst I waited to be interviewed on a regional Victorian afternoon radio program, I was put “on hold”, so I was able to listen to the messages going out to the radio public.
I was staggered however, to listen to a Pharmacy Guild sponsored message, outlining the best option to help the obesity issue………..bariatric surgery!

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A Basic Right to Good Health

Neil Johnston

Everybody has the right to good health.
Governments spend $’s billions ensuring that their constituents have access to:
* Good Food
* Clean air
* Clean water
These are the basic elements of self care that are all components of human rights
However, industrialisation has caused contamination and adverse effect on health as pollutants have made their way into these basic elements of food, air and water, often being unwittingly ingested in micro-amounts over long periods of time.

Comments: 2

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Gilding the Lilly

Mark Coleman

According to recent reports in Bloomberg, Eli Lilly has been consistently bribing officials for a period of up to 20 years, in countries such as China, Russia and Brazil.
The mechanism employed is through the use of “offshore marketing agreements” that established bank accounts that could be accessed by employees based in those countries.
Little, or no checks were performed on these offshore accounts as to how the money was spent – just as long as business flowed from that type of investment.
The American Securities and Exchange Commission has fined Lilly an amount of $29.4 million under the Foreign Corrupt Practices Act.

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More street-smart ideas for success

Harvey Mackay

Sometimes the columns that get the biggest reaction are those that offer the simplest advice.
A couple weeks ago I wrote about street-smart ideas and was inundated with requests for more.
A few readers shared their ideas too.
Because I truly believe in the importance of street smarts for success, I'm continuing the list.

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Understanding the Elements of a Paid Pharmacy Clinical Service

Neil Johnston

In 1975 I began life as a marketing and management consultant.
I specialised in two primary services:
* Inventory management- because every pharmacy was overstocked due to manufacturer pressure and poor pharmacist management expertise.
* Income tax management-because pharmacists were unable to pay their income tax, because the overstocks had soaked up their liquidity.
Pharmacy in 1975 was characterised by successful looking pharmacies, profitable on paper, but choking to death because of a lack of liquidity and management controls.
I am wondering whether that may sound familiar today.

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Our ageing Pharmacists offer too much value to be consigned to the dust heap!

Gerald Quigley

I read a recent article written by Harold Mitchell, the media mogul, philanthropist, and all round great bloke.
If you want a great read, try his autobiography.
I was lucky enough to sit beside him at a function years ago, and he left a lasting impression on me.
Harold explains in his article that he had spoken at a function attended by Australian former business icons, like the chairman of Qantas, managing director of Ford, managing director of the ANZ Bank, CEO of the NAB and a number of top-end medicos.
They all had the feeling that they could do more, but society had pushed them aside because of their age.

Comments: 2

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Every company should have a Santa Claus attitude

Harvey Mackay

Do you believe in Santa Claus?
Whether you ever did - or still do - there's something about the jolly old elf that wise businesses should consider emulating if they want to establish a year-round aura of good will.
Santa has a number of attributes that easily translate beyond the holidays.
Here are some that I think are worth noting:

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Supporting Senior Pharmacists

Neil Johnston

Being a senior pharmacist and also being very conscious of the limited roles that pharmacists in a senior age bracket are afforded, I was pleased to read Gerald Quigley’s comments on the subject in this edition of an i2P update for December 2012.
A quick search of the Internet revealed there was no association in Australia to represent senior pharmacists (but there were doctor groups).
The UK seemed to be the only country where a formal group has been established for retired pharmacists under the umbrella of the Royal Pharmaceutical Society.
It is known simply as the Retired Pharmacists’ Group.

Comments: 3

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The Pharmacist and the Consumer

Gerald Quigley

I had the privilege of attending a recent symposium called by the Consumers Health Forum of Australia, to assess the Community Use of Medicines from the Perspectives of Carers.
The key objectives of this project included:

* Providing strategic advice regarding consumer perspectives on QUM issues

* Supporting consumers to contribute to, and participate in, NPS advisory groups

* Developing and building diversity around key topical health areas

There are approximately 2.6 million carers in Australia.
They are recognized by the Carer Recognition Act 2010, which defines carers as people who provide unpaid personal care, support and assistance to other individuals who are in need of support due to disability, medical condition, terminal or chronic illness, mental illness, or who are frail and aged.

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The Workplace Future

Neil Johnston

For many of us in the workforce (including me) there was at one stage, a vision  we could retire around age 55.
However, with the many shifts and vagaries that have occurred within the Australian economy, most have abandoned that dream as their savings depleted.
In fact those depletions have contributed to the thought that it might be more prudent to work for as long as possible. This thought has also been fuelled by the knowledge that lifespans are increasing and that it is difficult to sustain a social structure outside of a workplace because most of us have been defined by our work and it is difficult to embrace major or abrupt changes as we age.

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A Model For Clinical Pharmacist Communication

Neil Johnston

Professional isolation is a fact of life in community pharmacy.
Gone are the days where an average pharmacy could support around four pharmacy job skill levels (apprentice, unregistered pharmacist, registered pharmacist and master pharmacist). Also gone is the collegiate and mentoring environment with the sharing of information and various techniques including the skill of patient interviewing, and the identification of various conditions and how to treat them with remedies compounded and formulated by a clinical pharmacist.
While nobody expects professional development to stand still, what has replaced these skills has not been for the better, with patient personal interest and care becoming the primary casualty.
The four-wall syndrome, a phenomenon that developed in the mid-1960's has slowly strangled job satisfaction parallel with government control through the PBS system.
With the advent of modern communication systems it is now possible to recreate a model of information and technique sharing that could well revive what was previously a vital and viable clinical experience. Like an expanded version of information sharing in a social media format-something like a secure medical Facebook.

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ASMI calls on Government to boost investment and innovation in consumer medicines and support self care reforms

Staff Writer

Editor's Note: Pharmacy has always been at the forefront of primary care and self-care.
Politically, these activities seem to have been hijacked through unusual and unacceptable drug scheduling decisions (children's cough mixtures etc) and the bureaucratic and unnecessary trans -Tasman harmonisation operation.
Decisions in both the above areas have had nothing to do with patient safety or patient care and they are both examples of bureaucratic insults against the pharmacy profession, as there was no problem that needed fixing in the first place.
The proposal by ASMI as part of a Federal Budget Submission is an interesting one for pharmacists and unless there is proper pharmacy representation to ensure that another carving up of the community pharmacy market does not occur, we may yet lose a further opportunity - because of poor pharmacy leadership.
At least we should demand that both PSA and PGA have a major role here and that they should agree the boundaries of their responsibilities.
We can no longer afford nor tolerate continuing disunity.

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Australians double their antidepressants

Staff Researcher

The use of antidepressants doubled in Australia between 2000 and 2011 and they now account for two out of every three psychotropic medications prescribed, a new study by the University of Sydney reveals.
It also shows that over the last decade there has been a dramatic 58 percent increase in the use of psychotropic medications by the Australian population, which has only increased by 13 percent over that time.

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Electronic nose could be used to detect sleep apnea

Staff Writer

An electronic nose, used to detect the presence of molecules in the breath of a patient, could be used to diagnose obstructive sleep apnoea.
A new study, published online in the European Respiratory Journal, could make the diagnosis of the condition quick and inexpensive compared to current methods.

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Bacterial spores could replace hypodermic needles for vaccinations

Staff Researcher

Taking the “ouch” out of injections is a worthy endeavor, but what if they could be avoided entirely?
New research conducted at Royal Holloway, University of London offers the hope of achieving just this, by using a bacterium to deliver a vaccine which can be administered via nasal spray, oral liquid, capsule, or small soluble film placed under the tongue, thus reducing the risk of spreading infectious diseases like HIV.

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Milk that protects against HIV

Staff Researcher

Melbourne researchers have developed cows’ milk that protects human cells from HIV.
The milk contains antibodies which defend against human immunodeficiency virus (HIV).
The next step will be to develop it into a cream which women can apply to protect themselves from contracting HIV from sexual partners.

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Can your gums tell you if you will get arthritis?

Staff Researcher

Adelaide scientists have found that mice with gum disease develop worse arthritis.
The scientists are using this knowledge to investigate whether treating mouth conditions could help relieve arthritis.
As part of  her PhD studies, Melissa Cantley worked with colleagues at the University of Adelaide to develop a new way to study these two diseases and their relationship. She is presenting her research this week as part of Fresh Science — a national program for early-career scientists.

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Australian Prescriber

NPS Spokesperson

The December issue of Australian Prescriber is now online.

This is the largest edition of Australian Prescriber ever published - 40 pages. There will be something for everyone in the wide variety of topics - ranging from common conditions as in Jo-Ann See's review of acne to the infrequently encountered idiopathic interstitial pneumonias reviewed by Lauren Troy and Tamera Corte. Pneumococcal pneumonia is one of the conditions which may be considered for treatment with intravenous antibiotics in the patient's home . David Looke and David McDougall's article will be of interest to health professionals in hospitals and in the community. The quality use of medicines is important fo! r all health professionals . As it is 20 years since Australia's policy was launched, Tony Smith reflects on what has been achieved. Looking to the future, the conference on national medicines policies in our region reports that there is still work to be done.

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Serotonin, more than just the happy hormone

Staff Researcher

Serotonin – often dubbed the happy hormone for its ability to regulate moods – plays a vital and perhaps lesser known role in everything from blood clots to bone density.
Yet despite its significance in the human body, researchers do not fully understand how serotonin is released into the bloodstream.

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First image of insulin ‘docking’ could lead to better diabetes treatments

Staff Researcher

A landmark discovery about how insulin docks on cells could help in the development of improved types of insulin for treating both type 1 and type 2 diabetes.

For the first time, researchers have captured the intricate way in which insulin uses the insulin receptor to bind to the surface of cells. This binding is necessary for the cells to take up sugar from the blood as energy.
The research team was led by the Walter and Eliza Hall Institute and used the Australian Synchrotron in Melbourne. The study was published today in the journal Nature.
For more than 20 years scientists have been trying to solve the mystery of how insulin binds to the insulin receptor. A research team led by Associate Professor Mike Lawrence, Dr Colin Ward and Dr John Menting have now found the answer.

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Pharmacists’ Support Service welcomes contribution from the Pharmacy Guild of Australia

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

The development and expansion of the Pharmacists’ Support Service (PSS) has been given a significant boost through support from the Pharmacy Guild of Australia (PGA). 
The PGA has now joined the other pharmacy organisation supporting PSS both financially and through participation in the PSS Management Committee.

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Fruit and veg flavanoids give cardioprotective effects - Black tea is one of the highest sources of quercetin.

Staff Researcher

A STUDY published in the journal of Biochemical Pharmacology suggests major flavonoid quercetin is beneficial in reducing the risk of cardiovascular disease (CVD).
The study highlights the cardioprotective effects certain dietary flavonoids have when consumed as part of a normal diet.
Study supervisors Medical Research Foundation and UWA research fellow Natalie Ward and UWA School of Medicine and Pharmacology professorial fellow Kevin Croft say quercetin is one of the most widely abundant flavonoids in the diet.

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New norovirus strain could cause severe gastro epidemic

Staff Researcher

UNSW researchers have discovered a new strain of norovirus that they warn could cause a severe epidemic of acute gastroenteritis in Australia this winter.
Known as Sydney 2012, the highly infectious mutant virus has already caused an epidemic of nausea, vomiting and diarrhoea in Europe, with an estimated 1.2 million cases of gastro in the UK during the colder months.
It has led to the closure of dozens of hospital wards there, and affected schools, age-cared facilities, cruise ships and workplaces, resulting in headlines in the British press such as the Chunder from Down Under.

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Fair Work Ombudsman to Check Claims by APESMA

Staff Writer

Editor's Note: In a flurry of press releases issued by the pharmacists' trade union, APESMA, it would appear that a challenge has been presented to the PGA to put its house in order.
The challenge appears to have the backing of the Fair Work Ombudsman, who will audit a selection of 400 pharmacies from all states and territories.
The press releases seem to indicate a carefully planned campaign is under way and that pharmacy owners need to be compliant before April 2013.

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Prescription Exchanges Becoming Interoperable

Neil Johnston

Editor's Note:
Electronic Prescription Exchanges in Australia have been sputtering along with little momentum, for quite a few years now.
Not surprisingly, the two main players in the field have been the doctors (in the form of the Royal Australian College of General Practitioners) and the pharmacists (in the form of the Pharmacy Guild of Australia).
The former has endeavoured to comply with all the specifications of NEHTA (the organisation established by government to oversee all e-health developments), which has spectacularly blown its budget on numerous occasions, with little to show.
On the other hand, the PGA developed its exchange outseide of NEHTA Guidelines.
Both the PGA (in the form of the eRx system) and the RACGP (in the form of the Medisecure System) have each tried to become the dominant system, a battle that has considerably drained cash resources on both sides.
We have asked Mark Coleman to comment on a media item describing recent developments that was published in Pulse IT.

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Australian Health Information Technology

Dr David More

articles by this author...

From a Medical IT Perspective: I am vitally interested in making a difference to the quality and safety of Health Care in Australia through the use of information technology. There is no choice.. it has to be made to work! That is why I keep typing. Disclaimer - Please note all the commentary are personal views based on the best evidence available to me - If I have it wrong let me know!

Visit my blog http://aushealthit.blogspot.com/

This blog has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on how things are progressing in e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Note: Each link is followed by a title and a paragraph or two. 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 payment.


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Friday, November 30, 2012

It Seems Health Information Exchange Throws Up Similar Problems All Over.

The following appeared last week.

Monday, November 19, 2012

Patient Consent for Information Exchange Comes Into Focus

by Ken Terry, iHealthBeat Contributing Reporter

Federal and state laws require that patients give permission or be allowed to withhold consent for health information exchanges to use their individually identifiable health information (IIHI) for purposes other than direct patient care. Consequently, as health care providers start to adopt new care delivery models that necessitate clinical data exchange, patient consent is becoming a hot issue.

Despite the existing regulations -- or because of them, in some cases -- patient consent involves legal, technical and practical issues that are far from being resolved. Which circumstances require patient consent, which parties can be allowed to access particular information and whether patients must opt in to health information exchange or should be allowed to opt out are all open questions.

One reason for the lack of clarity is varying state requirements. According to the Office of the National Coordinator for Health IT, for example, slightly more than half of states are planning to deploy an opt-out model in their statewide HIEs. The rest are using or plan to use various kinds of opt-in approaches.

While the federal HIPAA law allows treating providers to exchange patient information directly without a patient's consent, some states place restrictions on those direct exchanges, according to Micky Tripathi, CEO of the Massachusetts eHealth Collaborative. There also are differences among states in whether they require prior consent for the aggregation of data by an HIE, he pointed out.

But moves are afoot to introduce some national uniformity in this area. Last March, ONC issued a program information notice to its state HIE grantees that includes guidance on patient consent. The key concept in this guidance is "meaningful choice," described as follows:

"Where HIE entities store, assemble or aggregate IIHI beyond what is required for an initial directed transaction, HIE entities should ensure individuals have meaningful choice regarding whether their IIHI may be exchanged through the HIE entity. This type of exchange will likely occur in a query/response model or where information is aggregated for analytics or reporting purposes."

ONC and the Health IT Policy Committee, a federal advisory body, say that states can use opt-in or opt-out models as long as they offer patients meaningful choice, which requires advance notice, "full transparency and education" and revocability, among other things. Simply providing a "boilerplate form" in a physician's office or directing patients to read material posted on a website is not enough, Kathryn Marchesini, senior analyst and adviser to ONC's chief privacy officer, said.

"We're focusing on engaging the patient in an interactive manner so they understand the options that they have," she said.

Lots more here:


Here are some useful links from the article.


The article provides a really useful summary of the consent issues that can be faced - including by the NEHRS / PCEHR which is (after all) at core just a Health Information Exchange on a rather grand level.

It is interesting that among the US States about ½ have gone for an opt-out approach and the other half an opt-in.

The full article is well worth a read for all the wrinkles experienced.


Posted by Dr David More MB PhD FACHI at Friday, November 30, 2012 0 comments

Thursday, November 29, 2012

The US ‘Fiscal Cliff’ Might Make A Mess Of E-Health In The US. Could Be Ugly.

This appeared a few days ago.

The Fiscal Cliff and Meaningful Use: Be Very Afraid

By Joseph Goedert

NOV 16, 2012 8:11pm ET

During the congressional tax/budget debate coming very soon, someone in the Republican Party is going to demand another $20 billion or so cut from an entitlement program or another government program that is near and dear to the Democratic Party. Someone in the Republican Party will mention that boondoggle health information technology initiative in the hated stimulus bill, and someone in the Democratic Party will decide that’s where another $20 billion in savings can come from. Whatever federal funds are left to support electronic health records meaningful use, health I.T. workforce training, health information exchanges, best practices dissemination, regional extension centers and anything else in the HITECH Act will be gone.
Don’t believe all the talk of how health I.T. has bi-partisan support. Nothing but the most sacred cows will be considered sacred in the upcoming budget battle. Since health I.T. doesn’t pass the sacred test, the spigot is in danger of running dry unless the nation’s physicians and hospitals rise up en masse and scare the hell out of their congressional representatives and senators.
Yes, AMA, you have to stop whining about ICD-10 and focus elsewhere on the real here and now. Yes, AHA, all of your hospitals are spending millions of dollars on EHRs and soon won’t be getting those rebate checks, unless you also turn them loose to fight for what they were promised. Yes, insurers and employers, if you want to have any government funding for information systems that will support bending the cost curve and moving to payment models better than fee-for-service, you also have a lot of work to do. And you all need to do it now.

More here:


The US ‘fiscal cliff’ is a series of taxation measures and spending cuts which have already been legislated and which begin to bite come January 1, 2013. The net effect on US GDP will be a contraction of the order of 4% of GDP next year - and given the fact US growth is only about 2% presently, this - if unchanged - may turf the US back into recession according to the non-partisan Congressional Budget Office.

There is going to have to be some serious ‘horse trading’ to avoid this cliff given the political divide we have in the US. At present the President rather has the upper hand in getting some concessions as he has a veto over any legislation that might prevent tax rises.

As the article points out there is a very large Health IT incentive program and you can bet those who want some spending cuts will want to wind that back big time.

We live in pretty interesting  times as, if the US does not sort this out - as most expect - we will also be hit down under.

I am reminded of Winston Churchill’s comment on the Americans - ‘They will always do the right thing - after having exhausted all other possibilities’ We can but just wait and watch.


Posted by Dr David More MB PhD FACHI at Thursday, November 29, 2012

Wednesday, November 28, 2012

The Commonwealth Funds Provides A Primary Care And Health IT Report. Useful Stuff.

This report has had a lot of coverage in the last week. For example:

UK GPs top for use of EMRs

15 November 2012   Rebecca Todd

More than two thirds of UK GPs use electronic medical records and can also order tests or prescriptions online, manage patients lists or generate patient information electronically, a new survey reveals.

The 2012 Commonwealth Fund International Health Policy Survey of 8,500 primary care doctors in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, the United Kingdom and the United States, places the UK at the top of the table in their use of electronic records.

The report, published today, shows that more than two thirds (68%) of GPs in the UK said they have ‘multi-functional HIT capacity.’

Lots more here:


and here:

Aussie GPs lag behind on e-record use

21st Nov 2012

Danielle Cesta

AUSTRALIA’S high rate of GPs keeping electronic patient records has declined since 2009 and Australia lags behind other countries in terms of electronic exchange of patient summaries with doctors in other practices, new research shows.

A survey by the Commonwealth Fund of 10 countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the UK and the US – found progress in the use of health information technology in healthcare practices, particularly in the US.

Yet a high percentage of primary care physicians in all 10 countries reported they did not routinely receive timely information from specialists or hospitals.

Of the 500 Australian GPs surveyed, the use of electronic medical records was high but fell from 95% to 92% from 2009 to 2012 while the other nations mainly recorded increases.

Australia also had one of the lowest rates of GPs reporting they could electronically exchange patient summaries and test results with doctors outside their practice, at 27% – third last when compared to the other nine countries, with only Canada and Germany trailing.

More here:


Here is the link to the original report:


The key part worth quoting is the summary of findings:

Key Findings

  • Two-thirds (69%) of U.S. primary care physicians reported using EMRs in 2012, up from less than half (46%) in 2009. Both U.S. and Canadian doctors expanded their use of health information technology (HIT), though the two countries lag the U.K., New Zealand, and Australia in EMRs and use of HIT to perform a range of functions, like generating patient information or ordering diagnostic tests.

  • In the U.S.—the only country in the survey without universal health coverage—59 percent of physicians said their patients often have trouble paying for care. Far fewer physicians in Norway (4%), the U.K. (13%), Switzerland (16%), Germany (21%), and Australia (25%) reported affordability was a concern for their patients.

  • More than half (52%) of U.S. doctors said they or their staff spend too much time dealing with insurers’ restrictions on covered treatments or medications—by far the highest rate in the survey.

  • In each country, only a minority of primary care doctors reported always receiving timely information from specialists to whom they have referred patients, while less than half said they always know about changes to their patients’ medications or care plans.

  • U.S. physicians were the most negative about their country’s health system, with only 15 percent saying the system needs only minor change.

The full article and associated downloads are well worth a download and read. The report clearly identifies some gaps that Australian GPdom could do well to work on - as well as some areas that are going pretty well.

A part of the report I found interesting regarding GPs was the apparent drop in use of EMRs by a few per cent since the last survey in 2009 and the ongoing low level of connectivity and patient focussed services offered in Australia for patients electronically. There is a market opportunity for someone there I believe.

It is also of interest how few Australian GPs presently use secure messaging exclusively to transmit prescriptions rather than transmit the prescription and also print out a copy for the patient to present to pharmacist - to scan the barcode to download the prescription. Just a system difference I guess.


Posted by Dr David More MB PhD FACHI at Wednesday, November 28, 2012

Tuesday, November 27, 2012

It Looks To Me Like Those Operating The NEHRS Are Not Very Good At Their Job. Additionally No One Is Using It.

This very revealing article popped up today in The Australian.

More bumps in e-health road

THE Gillard government's personally controlled e-health record system is facing more bumps in its rollout following frequent disruption to its software vendor testing environment.

In the past seven months, only five vendors have passed the requirements for their software to be connected to the live e-health production platform. There are more than 250 software vendors who need their 300-400 products certified for the PCEHR.

The PCEHR is intended to be a secure electronic summary of people's medical history that is stored and shared in a "network of connected systems".

Software used by hospitals, GPs, allied health professionals, dentists and radiologists is often custom-made and needs to be compliant with the web-based national PCEHR system.

The longer it takes to test the systems, the longer it will take to roll out the software to hospitals, GPs and others who need to use it.

Sources close to the e-health project told The Australian the test environment had been going offline two to three times a week. This included planned and unplanned outages. The Department of Health and Ageing declined to comment on the outage frequency.

However, a spokeswoman said: "Obviously the test environment exists so things can be trialled before going live in the main system. That's the normal way IT systems like this operate the world over."

As recently as last Tuesday, the test system was offline for nine hours, but the spokeswoman said the test environment was stable.

She declined to provide reasons for unplanned outages.

The test environment had been available to software vendors since April this year, she said, adding that unavailability of the test environment had no impact on the live system.

"Software vendors are not permitted to connect to the (live) production system without passing testing in the software vendor test environment," the spokeswoman said.

"The test environment has absolutely no impact on the access to or functionality of the main system -- that is, patient and doctor use of the main system is not affected at all."

She declined to say how many times the test platform had been offline since it became available.

Meanwhile, 19,617 people had registered for an e-health record, the spokeswoman said.

The full article is here:


Looks like the system is unstable and no one much is using it. Worse those who have to use the test environment are being messed about.

As for clinical use this paragraph says it all.

“As of last Thursday there were 16 shared health summaries and one discharge summary uploaded into the PCEHR, the spokeswoman confirmed.”

Amusingly in a separate article we discover the geniuses who are running the program are so worried people might be alarmed about how things are being done that they have blocked the management minutes from FOI. This really shows they have something to hide! See here for article:


All in all this just seems to be going from bad to worse...At this stage it seems to be costing $20,000 per summary. The Return on Investment on all this is a bit dubious to say the least.


Posted by Dr David More MB PhD FACHI at Tuesday, November 27, 2012 7 comments

Monday, November 26, 2012

Weekly Australian Health IT Links – 26th November, 2012.

Here are a few I have come across the last week or so.

Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.

General Comment

Again a very quiet week. We have seen some interesting comparative work on IT use in General Practice and a number of (rather small) telehealth initiatives.

My weekly visit to the NEHRS revealed that the performance is still pretty dreadful - 5-10 seconds from click to complete page being painted (on a fast internet link).

At least my name remained stable over the week!



Aussie GPs lag behind on e-record use

21st Nov 2012

Danielle Cesta

AUSTRALIA’S high rate of GPs keeping electronic patient records has declined since 2009 and Australia lags behind other countries in terms of electronic exchange of patient summaries with doctors in other practices, new research shows.

A survey by the Commonwealth Fund of 10 countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Switzerland, the UK and the US – found progress in the use of health information technology in healthcare practices, particularly in the US.

Yet a high percentage of primary care physicians in all 10 countries reported they did not routinely receive timely information from specialists or hospitals.

Of the 500 Australian GPs surveyed, the use of electronic medical records was high but fell from 95% to 92% from 2009 to 2012 while the other nations mainly recorded increases.



Australian GPs drag the chain on e-mail

20 November, 2012 Julie Robotham

Australia’s general practices lag the world in communicating electronically with patients even though more than 90% store patient records electronically.

In an international survey of primary care doctors, only 20% of the 500 polled in Australia said they accepted patients’ questions or concerns by e-mail.

Even fewer – 7% - allowed patients to go online to book appointments or request referrals, and just 6% accepted electronic requests for script refills, according to the study from US health policy foundation The Commonwealth Fund.



GPs see specialists as poor communicators

21 November, 2012 Paddy Wood

GPs think specialists are poor communicators who rarely provide timely information about patients and often alter medications without notice.

In a survey of 500 Australian GPs, just 13% said specialists made information about patients available when it was needed.

Less than a third agreed they were always advised of changes that specialists made to their patients’ medications or care plans, and 32% said they always received a report from specialists with “all relevant health information.”



Script exchanges together

FRED IT’s eRx Script Exchange is set to become linked to rival MediSecure, with the government providing almost $10 million in funding to make the systems interoperable. According to an application revealed by the Australian Competition and Consumer Commission, the so-called ‘Electronic Transfer of Prescription (ETP) Prescription Exchange Service Interoperability Initiative’ aims to “significantly improve the uptake and use of electronic prescriptions”. E-prescribing is a significant policy component of the Fifth Community Pharmacy Agreement, and according to early analysis there are large numbers of electronic prescriptions being lodged by prescribers “ but the number being downloaded by dispensers is quite low” - due to patients presenting to a pharmacy which is not connected to the prescription exchange containing the e-script.



Invitation to Participate in the SMD-POD Project

20 November 2012.  NEHTA is pleased to invite Secure Messaging Vendors to participate in the Secure Message Delivery – Proof of Inter-connectivity and Deployment (SMD-POD) project.  The purpose of the project is to provide financial assistance to Secure Messaging Vendors to "provide proof that standards-based secure messaging can be deployed in a scalable way, utilising National Infrastructure Services, and to also demonstrate that different conformant Secure Messaging Vendor products are capable of interconnecting within the Australian Primary Care sector and with other healthcare providers".

General Practice is a key sector; the inter-connectivity to other healthcare providers is vital because GPs communicate with each other and also to others, such as Medical Specialists and Allied Health Professionals. In addition, hospitals with gateways can also introduce Secure Messaging to the customers of all participating Secure Messaging Vendors. This activity will allow more healthcare providers to participate and use technology (eHealth).



Projects to Better Connect Health and Aged Care

Applications have been opened by Minister for Mental Health and Ageing Mark Butler, for more than $17 million in projects to better connect Australia’s aged care system with the health and hospitals systems.

16 November 2012

Applications were opened today by Minister for Mental Health and Ageing Mark Butler, for more than $17 million in projects to better connect Australia’s aged care system with the health and hospitals systems.

“Successful applicants will carry out innovative projects that will see aged care providers work intensively with healthcare providers and medical insurers,” Mr Butler said.

“This will help give older people better access to complex health care, including palliative and psycho-geriatric care.”



New Telehealth Centre officially opened at Princess Alexandra Hospital

The Minister for Broadband, Communications and the Digital Economy, Senator Stephen Conroy, and the Queensland Minister for Health, Mr Lawrence Springborg today officially opened a new telehealth centre at Princess Alexandra hospital, which is making healthcare more accessible to people living in regional and remote Queensland.

The centre is part of the $5.1 million Princess Alexandra Hospital Online Outreach Services project (PAH Online), which is jointly funded by the Australian and Queensland governments through the Digital Regions Initiative program.

"This centre is a glimpse into the future of healthcare delivery right across Australia," Senator Conroy said.



Feds announce $3.3m aged care telehealth program

Posted Mon, 19/11/2012 - 16:31 by Will Turner

Virtual access to general practitioners will be trialled under a $3.3 million five year telehealth pilot at residential aged care facilities (RACF) announced by the federal government.

Commencing in February 2013, the program will involve up to 30 RACFs and is intended to develop a business case for video consultations as a means of delivering better GP access to residents.



Better access to specialist neurological care for regional NSW

9 November 2012

People in regional NSW will have remote access to multiple sclerosis clinics in Sydney thanks to a new telemedicine facility in Dubbo.

The facility will improve the quality of life for people with multiple sclerosis (MS) and other neurological diseases, who often find travel to be physically and mentally exhausting and, for some, unaffordable.

"It is logistically impossible for many patients with multiple sclerosis to travel to our clinic on a regular basis, potentially compromising their medical care," said Dr Michael Barnett, leading MS neurologist and researcher at the University of Sydney's Brain and Mind Research Institute (BMRI).



The state of broadband 2012: achieving digital inclusion for all

Read the full text

PDF     The state of broadband 2012: achieving digital inclusion for all

30 September 2012With this Report, the Broadband Commission expands awareness and understanding of the importance of broadband networks, services, and applications for generating economic growth and achieving social progress. High-speed affordable broadband connectivity to the Internet is essential to modern society, offering widely recognized economic and social benefits (Annex 1). The Broadband Commission for Digital Development promotes the adoption of broadband-friendly practices and policies for all, so everyone can take advantage of the benefits offered by broadband.



The dilemmas behind creating a better you

Date November 22, 2012

David Ewing Duncan

Cutting-edge therapies are under way that may lead to a host of physical enhancements.

If a brain implant were safe and available and allowed you to operate your iPad or car using only thought, would you want one? What about an embedded device that gently bathed your brain in electrons and boosted memory and attention? Would you order one for your children?

In a future election, would you vote for a candidate who had neural implants that helped optimise his or her alertness and functionality during a crisis, or in a candidates' debate? Would you vote for a commander in chief who wasn't equipped with such a device?

If these seem like tinfoil-on-the-head questions, consider the case of Cathy Hutchinson. Paralysed by a stroke, she recently drank a canister of coffee by using a prosthetic arm controlled by thought. She was helped by a device called Braingate, a tiny bed of electrons surgically implanted on her motor cortex and connected by a wire to a computer.



Martin Delatycki: Genetic explosion

THE announcement in 2003 that the human genome had been sequenced brought much excitement to both the scientific and the general community. Almost 10 years on, what has changed as a result?

We can now diagnose many disorders, allowing individuals and families options in terms of medical care and preventive treatments. Discovery of new genetic causes of disease is a daily event. Discovering genes took many years in the 1990s but can now take a matter of weeks.

We are now on the cusp of a quantum leap in what can be done. Next-generation DNA sequencing, which is also called massive parallel sequencing, allows the exome or genome to be sequenced in hours.



UXC wins $40m contract for Gold Coast hospital

UXC will supply all ICT infrastructure for the hospital.

UXC has won contract with Lend Lease worth more than $40 million to provide and install ICT equipment at the new Gold Coast University Hospital at Southport.

UXC will supply all ICT infrastructure for the hospital.

The contract includes a data centre, wired network and wireless LAN, unified communications, IP telephony and firewalls and security.



Sydney hospital ditches PCs, chooses zero clients on wheels

Summary: How do you deploy an additional 200 to 300 desktops in a hospital that just doesn't have the room? The answer is: you don't — not physically, anyway.

By Michael Lee | November 19, 2012 -- 05:40 GMT (16:40 AEST)

Speaking at VMware's vForum 2012 event in Sydney last week, Sydney Adventist Hospital (SAH) solutions architect for Information Services John Hoang led the audience through the way in which the private hospital uses virtualised and mobile workstations in a bid to move toward a paperless, digital hospital.

Hoang said that SAH had been "dreaming of what we would consider a healthcare nirvana — a complete paperless, digital hospital. One where we're able to capture all patient data electronically, deliver information to clinicians in a digestible matter, and do so in a manner that is synergistic to the way clinicians work."



Privacy commissioners seek greater power as breaches increase

Regulators lack "clear mandate," said New Zealand privacy commissioner Maria Shroff

Privacy commissioners of Australia and New Zealand said they need more enforcement authority to combat data breaches and other privacy concerns.

Regulators “have to be responsive” to increasing privacy incidents, New Zealand privacy commissioner Maria Shroff said in a speech this morning at the International Association of Privacy Professionals (IAPP) Privacy Summit. If breaches continue to occur, “people will lose trust.”

The Office of the Australian Information Commissioner (OAIC) received 1357 privacy complaints in the 2011-2012 fiscal year, Australian Privacy Commissioner Timothy Pilgrim told the Privacy Summit in a separate speech.



NSW Information Commissioner sends email to wrong list

Do as I say, not do as I do

By Simon Sharwood, APAC Editor

Posted in Government, 20th November 2012 05:27 GMT

The Information Commissioner in the Australian state of New South Wales, an officer whose job it is to offer and enforce best information management practice for the State, has apologised after sending an email to the wrong list.

The email in question advised of a conference at which the Commissioner, Deirdre O’Donnell, is due to speak.

But the mail, intended for members of the NSW Public Sector Right to Information/Privacy Practitioners Network, ended up elsewhere.



e-med Medical Dictionary

By Wednesday Digital | November 23, 2012


The e-med Medical Dictionary is a searchable database of medical information that can be used as a starting point for medical enquiries. The app can also be used by anybody to initiate free consultations with the e-med nurse and contains extra functionality for current e-med members.



Government cracks down on identity fraud

Date November 22, 2012

Jane Lee

PEOPLE who use the internet or a phone to use other people's identities to commit a crime could be sentenced to five years in jail under a new law.

The law, passed on Wednesday, expands the crime of identity fraud to include a number of activities such as flying interstate or booking domestic flights online using a fake identity.



Big future for ehealth in USA and UK

Posted Mon, 19/11/2012 - 08:29 by Will Turner

Barack Obama’s reelection is being seen as a major step forward for ehealth in the USA, while the UK government has committed to 100 percent patient access to ehealth records by 2015.

The main reason put forward by health IT experts why Obama’s victory is a win for ehealth is the secure future of the Affordable Care Act, which was the president’s major health reform in danger of repeal by Republican contender Mitt Romney.



Windows 8 PC orders weak, says analyst

Sales at Asian firms that assemble PCs for HP, Dell and others show lower expectations for Windows 8 pop

Computer sellers have scaled back their expectations of the sales pop they'll get from Windows 8 this year, according to an analyst.

Brian White, of Topeka Capital Markets, said that his checks of Asian computer manufacturers -- the relatively unknown firms that build desktop and notebook PCs to specifications issued by the likes of Hewlett-Packard and Dell -- found that orders last month climbed by less than half the average of the last seven years.

"With all of the sales numbers out for our ODM Barometer, October sales rose by 2 per cent month-over-month and below the average performance of up 5 per cent over the past seven years," White said in a note to clients earlier this month. "This is weaker than our preliminary estimate of up 5 per cent month-over-month in October and speaks to the continued challenges in the PC market."




Posted by Dr David More MB PhD FACHI at Monday, November 26, 2012

Does Anyone Know Who Else Is On This Group? Any e-Health Experts?

I was asked this and have no idea.

They are meant to make the NEHRS safe.

Clinical safety audit program for the Personally Controlled Electronic Health Record (PCEHR)

The Commission has established an independent Clinical Governance Advisory Group (CGAG) and a clinical safety audit program for the Personally Controlled Electronic Health Record (PCEHR).

This national clinical governance function complements and strengthens the work being performed by the National E-Health Transition Authority in assuring the safety and quality of the standards and specifications supporting the PCEHR and will provide external assurance on PCEHR clinical safety issues.

The CGAG meets quarterly to consider the clinical safety audits of the PCEHR and other clinical safety issues relating to the PCEHR and provide advice to the Department of Health and Ageing. The CGAG comprises experts from across Australia, and is chaired by the Chief Medical Officer Professor Chris Baggoley.

Page is here:


Google - asked for “Clinical Governance Advisory Group” - finds the UK entity but not much from Australia.

Any clues?



Posted by Dr David More MB PhD FACHI at Monday, November 26, 2012 1 comments

AusHealthIT Poll Number 146 – Results – 26th November, 2012.

The question was:

How Do You Rate The Design Of The User Interface Of The NEHRS / PCEHR?

Excellent 5% (2)

Pretty Good 3% (1)

Neutral 0% (0)

Not Good 21% (8)

Plain Incompetent 64% (25)

I Have No Idea 8% (3)

Total votes: 39

Very interesting. It would seem the vast majority (85%) feel NEHTA has failed to deliver a decent design for the NEHRS / PCEHR.

Again, many thanks to those that voted!


Posted by Dr David More MB PhD FACHI at Monday, November 26, 2012 0 comments


Sunday, November 25, 2012

Standards Australia Lets The Side Down Badly. What On Earth Gives?

In researching one of the other blogs this weekend I had occasion to visit the Standards Australia e-Health Site.

You two can visit it at:


There was only one glaring problem. The site is just unusable with Firefox 17. Just awful!

Interestingly the site looks just fine on both IE 9 and Safari (via an iPad).

What this means to me is that the web site has not been developed to appropriate international standards.

One question - just why would that be from Standards Australia?



Posted by Dr David More MB PhD FACHI at Sunday, November


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