Do you know exactly who Medicare, your GP, specialist doctor or local area health service are sharing your personal medical information with?

Electronic Frontiers Australia, media release, 26 August 2019: 

Australia, Melbourne — Monday 26 August 2019 — EFA, Future Wise, Digital Rights Watch and APF today call again for a comprehensive review of privacy provisions for healthcare data. 

 Following the HealthEngine scandal in 2018, and the recent use of Pharmaceutical Benefits Scheme (PBS) data to assist recruitment into research on Bipolar disorder, a Twitter user on Friday 23 August shared a SMS message attempting to recruit him into a clinical trial. 

This appears to have occurred through the use of Precedence Healthcare’s InCa (Integrated Care) health platform. Research by members of digital rights organisations today revealed that sensitive patient details—including contact details, demographics and complete medical histories—can be shared with a wide range of partners, including, it appears, private health insurers. 

Dr Trent Yarwood, health spokesperson for Future Wise and a medical specialist, said “Secondary uses like this are a very ethically murky area. People don’t generally expect to have personal details from their healthcare providers made available to anyone, even if well intentioned.” 

The terms and conditions of the application include access to data from myHealthRecord. “While the My Health Records Act includes privacy provisions, once this data is accessed by an external system, these provisions no longer apply,” continued Dr Yarwood. “I’m very concerned that practices making use of this system are not aware of just how widely this data can be shared—and that they are expected to fully inform patients of the nature of the data use,” he concluded. 

“This kind of barely-controlled data sharing is only possible because of how little privacy protection is provided by the current legislation,” said Justin Warren, Electronic Frontiers Australia board member. 

“People have made it clear time and time again that information about their health is extremely personal, private, and they expect it to be kept secure, not shared with all and sundry,” he said. “What people think is happening is quite different to what actually is, and these companies are risking catastrophic damage to patient trust with their lust for data.” 

“If you found out your doctor was sharing your full medical history with private health insurers, or the police, would you keep seeing them?” he added. 

Robust privacy protections are needed for all Australians, such as by finally giving us the right to sue for breach of privacy, requiring explicit consent for each disclosure of medical or health data to a third party, and proper auditing of record-access that is visible to the patient. It is imperative that the risks of health data sharing receive greater attention. [my yellow highlighting]

Australian Health Information Technology, 25 August 2019: 

This Seems To Be A System Of Sharing Personal Health Information That Is Rather Out Of Control. 

I noticed this last week: How does Inca collect and share health information? 

Updated 1 month ago 

Precedence Health Care’s Integrated Care Platform (Inca) is a cloud- based network of digital health and wellness services, including MediTracker mobile application services. 

It is important that all users of Inca services understand how the network collects and shares health information (“personal information”) and are aware of their responsibilities for gaining informed consent from patients. 

To the extent applicable (if at all), the Health Privacy Principles (or equivalent), which operate in some jurisdictions, should guide your actions. In the absence of applicable Health Privacy Principles, you should refer to relevant Commonwealth, State or Territory privacy legislation, and assistance can also be derived by referring to the website of the Office of the Australian Information Commissioner. You should make sure you are familiar with the applicable principles or other relevant guidance, and also with Precedence Health Care’s Privacy Policy. 

Inca collects and shares personal information about patients and other persons under care (also called “consumers”) who consent to this information being stored and shared in the network. This information may come from a variety of sources, including the clinical software systems used by GPs (e.g., Medical Director, Best Practice); other members of the patient’s care team (e.g., allied health professionals, medical specialists); the patient themselves; participating health services and pathology services; and the Commonwealth’s My Health Record. 

Inca uses this information to provide a range of health care and wellness services to the patient and their care team. 

Prior to contributing a patient’s personal information to be stored in or used by Inca, users must obtain informed consent from patients for the collection and sharing of this information. Ensuring that patients are informed about what will happen with the information that is being shared is a fundamental component of best practice in privacy, so it is important that all Inca users and patients know what information is available on Inca and who has access to that information. 

When a patient’s GP or other person authorised by the GP uses Inca to collect personal information from their general practice clinical system, Inca will extract and share the following information: 

· Patient demographics 
· Alcohol consumption and smoking status 
· Allergies and adverse reactions 
· Family and social history 
· Observations and results 
· Current medications 
· Immunisation history 
· Current and past problems 

If the patient or the GP does not wish to share some of this information, the GP’s clinical system should provide a means for declaring such data “confidential” and thereby preventing it being sent to Inca. 

GPs who do not know how to do this should contact the provider of their clinical software. Inca may also collect and share information obtained from other sources. 

These include: 

· Information that the GP or any member of the care team or the patient themselves adds to the patient record or to any notes concerning the patient’s care using Inca services, web sites or mobile devices. This information may include contact information, measurements, care plans, assessments, referrals, progress notes, appointments, and other related personal and health information. 

· Information from participating Health Services, including discharge summaries and emergency department attendance. 

· Information obtained from My Health Record. This information may include some or all of the data stored in the patient’s My Health Record. 

It is the responsibility of the provider of information stored in or used by Inca, or the person who grants access to such information, to inform the patient of the type of personal information that is so provided or made accessible. 

Inca will provide access to a patient’s personal information with the patient’s GP and care team, the patient (or their carer as authorised by the patient), participating Health Services, and some others as necessary to provide the services of Inca. Precedence Health Care may share de-identified data (that is, data from which it is impossible to ascertain who you are) to persons or organisations who are engaged in research, trials and analyses relating to improvements in health and the management of health services. The way Inca shares and protects this information is described in the Precedence Health Care Privacy Policy. 

It is important that patients understand what information is being shared, who it is being shared with, and for what purpose. It is the responsibility of the persons providing this information to ensure that each patient is aware that their personal and health information is being stored on a computer system hosted on a secure site in Australia, as described in the Precedence Health Care Privacy Policy. 

It is also important for all users of Inca to be aware that this information may not be complete, up to date, or accurate. 

In seeking informed consent to participate, patients should be advised that any measurements or notes that they enter into Inca are not continuously monitored and will be available to members of the patient’s care team only when the provider next logs in to Inca. 

Patients who are concerned about any condition should contact their GP or other health care provider using their normal means (e.g., phone) and should not use Inca for this purpose. 

Please contact Precedence Health Care’s Privacy Officer on (03) 9023 0800 or email privacy@precedencehealthcare.com if you have any questions or concerns about our Privacy Policy, or if you wish to suggest improvements. You may also contact your State’s Privacy Commissioner or Ombudsman to get advice about privacy or make a complaint. 

Here is the link: https://phc.zendesk.com/hc/en-us/articles/360021090952-How-does-cdmNet-collect-and-share-health-information- 

For background Precedence Health run a shared patient data base which is accessible to GPs, Specialists and Allied Health Staff for the purpose of care planning and co-ordinating care. Using their system allows GPs to claim a Medicare Item No for this service. They also provide patient access to the data and have services such as reminders etc in an app. 

All that said this system, on its own statements, just sucks information from everywhere (GP systems, health services and the myHR) and pops it into one database. One user, who is now switching it off, revoking consent and getting out has described to me a collection of erroneous and mis-sorted data on their record. 

More they seem to be happy to hand out the data to others claiming it is de-identified – and we all know how in-effective that can be! 

The rather loose way consent rules for disclosure appear to be enforced is also a worry. 

They even have the legendary myHR disclaimer that “It is also important for all users of Inca to be aware that this information may not be complete, up to date, or accurate.” Doh! 

You can see the Privacy Policy here if you wish! https://phc.zendesk.com/hc/en-us/articles/360021091012-Privacy-Policy- 

Don’t know about you but none of my information would go anywhere near this if I could help it! It looks like a serious unthought through shambles to me. 

What do you think? 

David.  [my yellow highlighting]

NSW Independent Commission Against Corruption (ICAC): the case of the $100,000 cash political donation

Sometime after 2 November 2015 the NSW Electoral Commission appears to have noticed that on 12 March 2015, around two weeks before a NSW state election, an organisation known as Chinese Friends of Labor raised $138,000 from an event held in a 750-seat Chinese restaurant in Haymarket, Sydney. 

What piqued the Electoral Commission's interest was that $100,000 of this money appears to have been raised by Chinese Friends of Labor as cash from 12 donors - five of whom were employees or former employees of a second 350-seat Haymarket restaurant usually described as being serving staff, two who were related to that restaurant's general manager and two who were associated with property development company Wu International Investments Pty Ltd.

The NSW Electoral Commission began to wonder if some of the named donors were perhaps 'straw men' for one or more property developers.

Property developers are of course prohibited by law from making political donations in New South Wales. 

As members of the NSW Liberal Party will recall if they think back on the 2016 NSW Independent Commission Against Corruption (ICAC) Operation Spicer investigation into political funding which found the Free Enterprise Foundation and "Raymond Carter, Andrew Cornwell, Garry Edwards, the Hon Michael Gallacher MLC, Nabil Gazal Jnr, Nicholas Gazal, Hilton Grugeon, Christopher Hartcher, Timothy Koelma, Jeffrey McCloy, Timothy Owen, Christopher Spence, Hugh Thomson and Darren Williams acted with the intention of evading laws under the Election Funding, Expenditure and Disclosures Act 1981 (the election funding laws) relating to the disclosure of political donations and the ban on donations from property developers. Messrs Grugeon, Hartcher, Koelma, McCloy, Owen, Thomson and Williams were also found to have acted with the intention of evading the election funding laws relating to caps on political donations. The Commission also found that Craig Baumann, Nicholas Di Girolamo, Troy Palmer and Darren Webber acted with the intention of evading the election funding laws relating to the disclosure of political donations and that Bart Bassett knowingly solicited a political donation from a property developer".

On 15 January 2018, after further investigation, the Electoral Commission referred the matter of Chinese Friends of Labor & Labor Party state campaign accounts to ICAC and on 26 August 2019 public hearings in Operation Aero began. 

Five witnesses are to be called this week: Kenrick Cheah (NSW Labor community relations director), Steve Tong (former employee Wu International Investments), Kaila Murnain (General Secretary of NSW Labor), Ernest Wong (former NSW Labor MLC) and Sam Dastyari (former Federal Labor senator).

It has been alleged that Chinese billionaire property developer Huang Xiangmo was the source of the $100,000 cash donation. 

Readers might remember that this particular billionaire was the subject of allegations that he paid a five-figure sum in order to have a private lunch with Minister for Home Affairs and Liberal MP for Dickson Peter Dutton during the period he was seeking Australian citizenship.

Political tragics can follow the hearings here.

More koala news....

Last Friday morning my neighbour James alerted me to this boy who he followed across the Barrage. He was a young dispersing male looking for a new home,from Lismore to Ballina LGA. Koalas often just keep on their merry way even with a car @Matt_KeanMP @greencate @KateRWashington pic.twitter.com/UL5V5K3WvR

— Maria Matthes (@talkingkoala) August 25, 2019

Bully Boy Donald Trump has become a global threat to national economies

The picture is becoming clearer - Donald Trump is not just a political wildcard - he is a very real threat to the U.S. and the rest of the world.

Financial Review, 25 August 2019: 

A world of deepening political body-blows from Donald Trump to Brexit and Hong Kong are fast turning into genuine economic shocks that threaten to overwhelm central banks' powers, Reserve Bank of Australia governor Philip Lowe has warned. 

In a speech to a closed-door gathering of some of the world's most powerful monetary policymakers, Dr Lowe criticised the global rush to lower interest rates as ultimately counterproductive but acknowledged the lack of political stability was making the pressure difficult to resist. 

While Dr Lowe refrained from mentioning Donald Trump by name, he referred to Friday's tumultuous market turmoil unleashed by the President's extraordinary attacks on the US Federal Reserve boss, who he suggested may be a bigger "enemy" than Xi Jinping, and a bizarre demand that US companies withdraw from China. 

The President's tantrum against Fed chairman Jerome Powell stunned many participants at the annual three-day Jackson Hole symposium over the weekend. 

While the central bank and academic participants refused to criticise Mr Trump in public, in private conversations with The Australian Financial Review many were scathing. 

One who was prepared to voice his outrage, former Fed vice-president Stanley Fischer, seething at how few members of the central banking fraternity were prepared to challenge Mr Trump, told the forum the greatest threat to the international monetary system was the President. 

He was "trying to destroy the global trading system", Dr Fischer said...... 

On the global political turmoil that dominates headlines, Dr Lowe said it was prompting businesses to shun investment and could end up weighing on their hiring plans. 

By contrast, a return to political stability could unleash around the world "a very prosperous period as we catch up with delayed investment and a period of easing financial conditions". 

With the US-China trade war set to deepen, as well as ongoing doubts about other flash points, central banks around the world have cut interest rates in recent months. 

However, Dr Lowe cautioned that if every central bank acted in the same way, no country would enjoy the normal benefits that rate cuts provided via exchange rate depreciation. 

 Read the full article here. 

The Sydney Morning Herald, 25 August 2019: 

The Australian sharemarket is set to follow Wall Street sharply lower at the start of the week after fresh salvos in the trade war between the United States and China over the weekend. 

ASX SPI 200 futures point to a decline of 1.33 per cent, or 86 points, when trade opens on Monday morning extending Friday's slide in European and US markets.
“President Trump’s trade war escalated again on Friday…whacking US stocks sharply lower with a flow on to other sharemarkets likely to be seen early in the week ahead,” Shane Oliver, head of investment strategy and chief economist at AMP Capital, told clients. 

All major US stock indices slumped more than 2.4 per cent to end the week, led by the tech-heavy Nasdaq Composite Index which tumbled 3 per cent. Major European markets such as the German DAX and French CAC also shed more than 1 per cent for the session. 

The steep falls were caused by an unexpected and sudden escalation in the trade conflict between the United States and China with both sides announcing tariff increases on the others imports on Friday......

“At this stage there is still no end in sight and so sharemarkets likely have to fall further to pressure Trump to solve the issue and de-escalate,” said AMP Capital’s Oliver. 

The resumption of trade in Chinese markets is also likely to be influential on the performance of Australian shares, dollar and bonds later on Monday.

Australian Stock Exchange close of trading, Monday 26 August 2019:

UPDATE

News.com.au, 26 August 2019: 

The Australian share market has been hammered, losing $24 billion after a dramatic escalation of trade hostilities between the US and China over the weekend. 

The benchmark ASX200 tumbled at the open but recouped some of its losses by close to finish the day down 1.27 per cent. 

The Australian dollar was also hit hard, falling below 67 US cents to its lowest point in a decade but recovered slightly to be buying 67.37 US cents shortly after 4pm.

It's Koala Breeding Season in the NSW Northern Rivers - keep an eye out for animals crossing the road and slow down when driving at night

Images: @talkingkoala

Although the Koala is a tree dwelling marsupial it often has to travel across the ground, especially during breeding season when males are searching for females. 

These photos are of a Clarence Valley male koala hit by a car on 24 August 2019 at a crossing 'hot spot' on Broadwater-Evans Head Rd .

He was partially scalped, with multiple wounds and sheared nails. 

Please drive with extra care, so this scene is not repeated with you at the wheel.

Morrison Government's understanding of human rights and aged care appears flawed

"Restrictive practices can elicit concern for a number of reasons. Fundamentally, they impact on the liberty and dignity of the care recipient. In circumstances where they are not absolutely necessary, their use is likely to sit uncomfortably for many. Their use without lawful consent may infringe the resident’s legal rights and constitute a civil or criminal offence, such as assault or false imprisonment, although there are very few cases in Australia where a criminal or civil complaint has been pursued to challenge the use of a restraint in an aged care setting. Physical and chemical restraint can have significant adverse effects on a resident, both physically and psychologically. There are also fundamental questions about their effectiveness."  [Royal Commission into Aged Care Quality and Safety, Background Paper 4, May 2019]

9 News, 20 August 2019: 

The Commonwealth government recently introduced changes aimed at limiting the use of restraints in residential facilities. 

But experts believe the regulations have created many more problems than they solved. 

They are urging the Commonwealth to scrap the regulations and start again from scratch. 

Queensland's public guardian Natalie Siegel-Brown said the changes placed her agency and the community in a "really compromising" position. 

"Unfortunately in their current form, the principles actually regress the recognition of human rights of people living in aged care, particularly with respect to chemical restraints," she told the committee in Sydney on Tuesday. 

"But the entire suite itself lacks any monitoring, enforcement or oversight in any event, and this can lead to greater problems." 

Colleen Pearce, from the Victorian Office of the Public Advocate, said aspects of the regulations were flawed and ambiguous. 

"We consider the principles are inconsistent with people's human rights (and) would preferably be contained in legislation," 

Dr Pearce told the committee. "(The principles) introduce, in the case of physical restraints, a new flawed and ambiguous substitute decision-making regime, provide virtually no regulation of chemical restraint usage, and lack the safeguards of other restrictive practices regulatory schemes." 

Joseph Ibrahim, the head of the Health Law and Ageing Research Unit at Melbourne's Monash University, described the regulations as stupid. 

"There is no monitoring mechanism, there are no sanctions associated, there is no way of implementing or making sure the law comes into effect," Professor Ibrahim said. 
A group of advocates believe the government should be prohibiting the misuse of restraints and over-medication, rather than regulating them. 

They argue medication should only be used for therapeutic practices and be administered with a patient's free and informed consent. 

The group includes Aged and Disability Advocacy Australia (ADA) and Human Rights Watch, both of which addressed the hearing on Tuesday. 

"Older people in nursing homes are at serious risk of harm if this new aged care regulation is allowed to stand as is," ADA chief executive Geoff Rowe said. 

"Australia's parliament should act urgently to ensure that everyone, including older people, is free from the threat of chemical restraint.".....

The Canberra Times, 21 August 2019:

New rules on the use of restraints in aged care could lead to more elderly residents being sedated, a parliamentary inquiry has heard. 

The regulation is also unenforceable, and does nothing to relief the staffing pressures that have led to the use of restraints, expert witnesses have said..... 

Professor Joe Ibrahim from Monash University's Health Law and Ageing Research Unit said the regulation also did not recognise the pressures within aged care that forced staff to use restraints. 

"Staff restrain residents to get through their day because they don't have enough hands to get through what's needed or they don't have the skills, knowledge, ability to assess why a person has responsive behaviours or unmet needs to address that," Professor Ibrahim said. 

"A law that isn't monitored, has no sanctions, no way of checking, it will drive practice underground." 

Queensland Nurses and Midwives Union professional officer Jamie Shepherd said he knew of a case where one registered nurse had to administer medication to 166 residents on night shift, and management resisted rostering on an enrolled nurse to help until the RN threatened to call an ambulance each night to assist. 

Australian Nursing and Midwifery Federation federal professional officer Julie Reeves said through a recent member survey, she learnt of an aged care home where there were just six staff rostered on overnight to look after 420 residents. 

"We cannot always effectively manage challenging behaviour issues for dementia residents while at the same time caring for others who have very complex health issues. 

We receive little to no support from management when things don't go as planned," she quoted the member as saying. 

Australian Human Rights Commission president, Emeritus Professor Rosalind Croucher said while parts of the regulation had merit, it should not be allowed to proceed unless there was a mechanism for independent oversight. "If it's a choice of it or nothing, nothing might be better than it as it is," Professor Croucher said....

Physical restraining devices currently allowed in Commonwealth-funded aged care facilities are:

Bed rails
Chairs with locked tables
Seat belts other than those used during active transport
Safety vests
Shackles
Manacles
[my yellow highlighting]

Chemical restraint is any medication or chemical substance used for the purpose of affecting a person's behaviour, other than medication prescribed for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition. 

Use of chemical restraint is specifically excluded from assessment in the National Aged Care Mandatory Quality Indicator Program. [See p.15]


BACKGROUND:

 Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019

Barnaby Joyce has all the tact and grace of a lumbering hippo (apologies to all hippopotamus amphibius )

Disgraced former Deputy Prime Minister & MP for New England Barnaby Joyce isn't finding many allies in the NSW Northern Rivers region.... 

The Daily Examiner, 21 August 2019, p.3: 

Chris Gulaptis has delivered a clear message to Nationals counterpart Barnaby Joyce over his controversial foray into the NSW abortion debate.

On Monday, Clarence Valley residents received anti-abortion robocalls from Mr Joyce, the Federal member for New England. 

In the pre-recorded message Mr Joyce makes a number of false statements regarding the abortion bill including that it would allow “sex selective abortions” and “abortion for any reason right up until the day of birth”. 

He then urges members of the community to contact their local member to voice their opposition to the bill. 

However, Clarence MP Chris Gulaptis said he was “disappointed” by the actions of his National Party colleague. 

“We certainly don’t interfere with federal matters and I encourage him not to interfere with NSW state parliamentary matters.” 

Mr Gulaptis re-iterated his support for the private members bill which would remove abortion from the state’s Crimes Act, which he voted for as it went through the lower house last week 59-31, after a marathon debate. 

Mr Gulaptis voted for some of the amendments to the bill and was “interested to see what amendments come down from the Upper House” but was as “happy as I can be” with it. 

“The intent of the bill is to remove abortion from the criminal code and put it into health where it should be,” he said. 

“Our primary concern is to support women who have to make these decisions which will be with them for the rest of their lives.”

And Barnaby is rather upset......

EXCLUSIVE – Barnaby Joyce's threat to quit the Nationals Party – he tells #7NEWS he WILL resign and sit on the crossbench IF at least 4 state Nationals members publicly declare they have lost support in him. Full story at 6pm. #auspol

— Jennifer Bechwati (@jenbechwati) August 22, 2019