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ElectronicHealthcare 8(4) April 2010 : e30-e39
HIMSS Analytics Column
Saskatchewan's Strategy for Moving e-Health Forward: Prepared to Implement Patient First Review Recommendations
Patrick Powers
In October 2009, the Saskatchewan Ministry of Health (MOH) released the findings and recommendations of the Saskatchewan Patient First Review, For Patients' Sake. It provides a comprehensive description and analysis of the strengths and weaknesses of the health system in Saskatchewan, the birthplace of Canada's Medicare system for healthcare delivery and funding. The Review, which consisted of patient experience and administrative components, concluded with the Commissioner's 16 Recommendations, which were organized under nine major topics (Table 1). In the history of Canadian healthcare reviews, it is considered to be unique "in its focus on the care and caring experience" (Government of Saskatchewan 2009b: ii).
Table 1. Patient First Review – major recommendations
1 For a patient- and family-centred health system
2 For equitable care
3 For coordinated care
4 For convenient, timely care
5 For communicative, informative care
6 For comprehensive care
7 For respectful care
8 For functional e-Health care
9 Improving system performance and leadership
Although less than one of the Review's 78 pages was devoted to outlining the need for information technology (IT) transformation in healthcare administration, the IT imperatives were prominent for their forcefulness and urgency. The province's leading healthcare stakeholders were mandated to "invest in and accelerate development of provincial IT capabilities within a provincial framework" (Government of Saskatchewan 2009f: 30). Specifically, the province's e-Health Council was mandated to develop an e-Health implementation plan by early 2010, less than six months after the Patient First Review was issued. Other mandates involve funding for the provincial electronic health record (EHR) and Health Region (HR) implementation requirements, as well as determining the preferred service delivery structure for IT at the HR level. Working on the assumption of the continued existence of the province's current organizational structure of 13 HRs in tandem with the provincial Health Information Systems Centre (HISC), the Review pressed the claim that implementing the Commissioner's Recommendations for patient-centric healthcare in short order depends heavily on enhancing the province's capabilities for electronic healthcare delivery to improve patient safety and clinical outcomes.
The primary mandate of HISC, which operates under the Saskatchewan MOH, has always been to direct implementation of the province's e-Health initiatives.1 In light of the Patient First Review, HISC is expected to "assume more of a strategist-integrator-steward role for the [province's] health system" (Government of Saskatchewan 2009a: 2). Looking back at the history of HISC initiatives, it seems that the provincial e-Health organization has been preparing for this moment for a decade.
The extensive portfolio of HISC initiatives currently under way reflects the province's commitment to an ambitious strategy of e-Health efforts geared to "getting the right information, to the right individual, at the right time, in the right place!" (Government of Saskatchewan 2007). The most important initiatives include an interoperable EHR (iEHR)/Laboratory Results Repository, Pharmaceutical Information Program (PIP), Provider Registry System, Diagnostic Imaging Project, Radiology Information System (RIS)/Picture Archiving and Communications System (PACS/Archive), Shared Client Index or Client Registry, Telehealth, Panorama Public Health system and an Electronic Medical Record (EMR) Program for physicians.2 The province's foundational e-Health strategy, which HISC is responsible for achieving through the specific initiatives mentioned above, is built on development, implementation and integration of three IT pillars:
A province-wide integrated EHR
Regional capabilities for a paperless clinical environment across the full continuum of care, including acute, primary, community and public healthcare
A physician office EMR environment
For Saskatchewan, as for other provinces, territories and Canada Health Infoway, the endgame of e-Health is to develop an iEHR. The function of Saskatchewan's EHR is to "give authorized healthcare providers rapid access to patients' pertinent, up-to-date health information to support clinical decision-making and case management. A shared patient-centric health record will provide a longitudinal view of an individual's key health history and care" (Government of Saskatchewan 2007).
If Saskatchewan's EHR strategy is to be viable and useful, then the province must first implement the means enabling the collection, entry and transmission of patient care data to populate the EHR for every Saskatchewan resident. For this reason, HISC has prioritized implementing the second IT pillar of electronic clinical capabilities in collaboration with the province's 13 HRs, and the third IT pillar of the physician office EMR environment in collaboration with the Saskatchewan Medical Association (SMA).
HISC Strategy for Regional Clinical IT Enhancements
Sometimes being behind the national e-Health implementation curve can produce long-term advantages for success. In more populous and well-funded provinces, the demand for early adoption of electronic clinical applications led HRs in the same province to implement different vendor solutions, with the consequent difficulties of achieving province-wide integration of disparate electronic clinical environments. In contrast, little advanced clinical IT implementation has occurred throughout Saskatchewan's HRs. In developing its EHR, the province is able to avoid the major challenges involved in attempting integration of diverse clinical vendor environments with extensive interfaces or replacing multiple vendor applications with a costly single province-wide solution.
Since 2001, Saskatchewan has had an agreement with the 13 HRs that the province would fund and, in most cases, host remotely a single province-wide vendor solution for all ancillary and clinical application suites across the continuum of care. These application suites are essential to feeding a robust EHR that will drive improved patient safety and care outcomes.3 Currently, the province has adopted standardized vendor solutions for an Integrated Clinical System encompassing acute care, clinical, ambulatory and home-health environments (see Table 2). At most sites, especially outside Regina and Saskatoon, most new installations of standardized vendor solutions are the first instances of an electronic application going live and operational. In general, only the Regina and Saskatoon HRs will have to replace some previously installed vendor solutions in order to adopt the provincial standard solutions. Although the implementation schedule is stretched out over a decade, with many implementation dates as yet undefined due to limited fiscal and personnel resources, the strategy is in place and the long-term commitment is secure.
Table 2. HISC-hosted provincial applications – integrated clinical system
EMR/EPR Acute Care Environment: Eclipsys' Sunrise Clinical Manager
Pharmacy Management System: Interactive Business Systems' WinPharm
Client Patient Index/Registration: Momentum Healthware's Wincis
Laboratory Information System: Soft Computer Corp.
Shared Client Index/Electronic Master Person Index: Initiate Identity Hub
PACS: Philips Healthcare's Stentor, Inc./isite
Radiology Information System: Cerner's Quadris
Home Care Administration System: Procura's InterRAI MDS-HC
The complete suite of the Integrated Clinical System will be implemented in only nine HRs. These are home to the largest 18 general or full-service hospitals out of the province's 60 acute care facilities. Even in these HRs and at these hospitals, components will be implemented selectively. Saskatchewan has adopted a province-wide strategy of maximizing equal access for all residents to high-quality healthcare by focusing investments in acute care clinical systems at its largest and more complex care facilities. At the same time, there will be broad implementation of systems across the province to support delivery of community-based services such as home care, primary healthcare and public health.
The clinical vendor solution for Saskatchewan's Integrated Clinical System is being provided by Eclipsys and its Sunrise Clinical Manager (SCM) product. Saskatchewan first acquired a license to the core functionality of SCM in 2001, followed over the last three years by license agreements for content modules in the following clinical areas: Emergency Department Manager, Order Communication, Clinical Documentation (Physician and Nursing), Exit Care and Clinician Portal.
Currently, implementations of SCM's core functionality have been completed or are under way at eight facilities in four HRs: Five Hills Health Region (Moose Jaw Union Hospital), Regina Qu'Appelle Health Region (Regina General and then Pasqua Hospitals), Saskatoon Health Region (Saskatoon City Hospital, St. Paul's Hospital and Royal University Hospital) and Sunrise Health Region (St. Peter's Hospital and Yorkton Regional Health Centre). Eclipsys core installations are contracted but not yet installed for an additional ten facilities in five HRs (Cypress, Kelsey Trail, Prairie North, Prince Albert Parkland and Sun Country).
Saskatchewan's strategy and timeline for going live and operating with the full suite of clinical applications in the Integrated Clinical System is best reflected in the efforts of the Regina Qu'Appelle Health Region and Saskatoon Health Region. These are the province's two leading HRs and encompass the two largest cities; they are working toward securing a completely paperless environment at their major acute care facilities.
Saskatchewan e-Health Case Study – Regina Qu'Appelle Health Region
At first glance, Regina Qu'Appelle Health Region (RQHR) might seem to be behind the curve on e-Health readiness. The province's capital HR has not yet met the minimal requirements for an electronic clinical environment in which all major ancillary systems are installed for Pharmacy, Laboratory and Radiology. However, the current slate of live and operational clinical systems in RQHR does not reflect the breadth of e-Health initiatives and timelines under way for acute care services. Regina has a host of "installations in process" at the two urban acute care facilities, Regina General Hospital (RGH) and Pasqua Hospital. These include the Radiology information system, a clinical decision-support system (CDSS), computerized practitioner order entry (CPOE), nursing documentation and possibly physician documentation. Plans to also implement some or all of these applications at the Health Region's two main rural acute care facilities (Moosomin and All Nations Healing Hospital – Fort Qu'Appelle) are scheduled to begin in late 2010.4
An important key to understanding RQHR's approach to working towards an electronic clinical environment is its agreement with the provincial decision to implement modules of SCM, the Eclipsys clinical solution for a comprehensive acute care eHealth environment. For in-patient care, the province and HRs have adopted a single-vendor solution, acquired the license for most modules of the Eclipsys product, developed a strategy for implementing a full suite of clinical applications at the province's full-service facilities and scheduled sequenced implementations of specific modules as finances, personnel and time permit. For the RQHR, RGH has been designated as the hospital scheduled in the near future for implementation of CPOE coupled with nursing documentation, along with enhanced CDSS capabilities related to evidence-based medicine protocols.
Installation of RQHR's first Radiology information system is under way with implementation of the Philips Healthcare Ximis Inc./Xiris product at RGH, as well as the region's eight other acute care facilities. By their target date of September 2010 for reaching EMRAM Stage 1, RQHR hopes to have secured funding to quickly bring CDSS live and operational at RGH for rudimentary conflict checking. With the Clinical Data Repository (CDR) of Eclipsys's Sunrise Clinical Manager being fed data from the three ancillary systems, and with RQHR physicians able to retrieve and view results on Eclipsys' Clinical Viewer, RQHR would reach Stage 2 during fiscal year 2010–2011.
Unusual in a typical e-Health implementation sequence is RQHR's next step to enhance its eHealth clinical capabilities at the 418-bed RGH. Saskatchewan's capital HR will bypass implementation of order entry (OE) for Stage 3, choosing instead to bring Nursing Documentation (Stage 3) live and operational in tandem with CPOE (Stage 4) – including documentation and use of CDSS to conduct error checking – possibly to be followed soon thereafter by Physician Documentation.
Instead of applying the "big bang" approach to simultaneously implementing Nursing Documentation and CPOE across all service units in a facility, RQHR has opted to implement them one service unit at a time. Initial implementation of the appropriate applications and technology will occur in the maternity service unit at RGH; the implementation is being coordinated with a bricks-and-mortar renovation under way at the facility's Rawlco Centre for Mother Baby Care, scheduled for completion in fall 2011. Along with CPOE and Nursing Documentation, monitoring devices are being connected electronically to clinical systems in the unit.
While RQHR is currently not looking beyond the clinical requirements associated with a fully functioning CPOE environment, the region is considering all applications and technologies germane to a fully electronic environment for the Mother Baby Care unit. This could include implementation of an electronic medication administration record (Stage 5). As well, existing wireless connectivity in the urban acute care facilities, which allows practitioners to order and document at point of care, raises the possibility of implementing use of hand-held devices, including C-Motion Tablets that were originally purchased for use in the Emergency Department.
A major consideration favouring RQHR's piecemeal approach to clinical implementation by service unit, in addition to restricted finances, is the change management challenge RQHR faces in assisting physicians to use CPOE for all facets of patient encounters. Having decided not to mandate use of CPOE for its physicians (as Winnipeg Regional Health Authority is doing in Manitoba at St. Boniface Hospital), RQHR hopes that the long-standing collaborative work habits of the Mother Baby Care unit's 20 physicians will facilitate an easy and speedy transition to substituting CPOE for paper notes and transactions at point of care. Odds favour the success of RQHR's strategy, given that the region's two Senior Medical Officers support the Clinical Information System (CIS) Plan and the CPOE project at the Rawlco Centre. Currently, no HR in Saskatchewan has implemented CPOE.
Saskatchewan e-Health Case Study – Saskatoon Health Region
Saskatoon Health Region (SHR) is also poised for significant e-Health implementation advances over the next two years. As with RQHR, the current state of live and operational clinical systems at SHR's acute care facilities does not reflect the full story of the region's strategic planning for, and near-term scheduled implementation of, the Eclipsys SCM.
Currently, SHR has the three ancillary applications installed at all acute care sites.5 The solution for the Laboratory information system is provided by SCC Soft Computer's SoftLab application. The Pharmacy management system is GE Healthcare's Centricity product. Finally, the Radiology information system is Cerner's Quadris solution. The provincially-hosted single repository PACS – Philips Healthcare's Stentor, Inc./iSite product – delivers nine of ten PACS modules, excluding Orthopedics. SHR's EHR environment, which will be primarily Eclipsys based, is a project that stands before the province's largest HR. A legacy order management system for Laboratory and Diagnostic Imaging, though not for Pharmacy, is currently in operation only at Royal University Hospital. Beyond this, SHR has not yet gone live with a CDR, CDSS, CPOE or a vendor solution for OE, Nursing Documentation, Physician Documentation or eMAR.
However, major components of SHR's EHR environment are due to become operational starting in June 2010, when the first phase of the SCM implementation will be completed for the Emergency Departments (EDs) at three SHR urban sites (St. Paul's Hospital of Saskatoon, Saskatoon City Hospital and Royal University Hospital). The initial clinical implementation of Eclipsys in the ED is in line with a similar ED undertaking by RQHR and the provincial mandate to improve patient flow through the province's over-worked EDs. Eclipsys functionality being installed includes the foundational clinical database and data repository; interfaces to existing systems for Admissions, Discharges and Transfers; Laboratory, Diagnostic Imaging and Transcription; and context mapping to the provincially hosted PACS and PIP applications. In addition to the ability to view results online, specific Eclipsys technology is being implemented to support the ED, electronic triage note and a patient status/tracking board.
SHR's journey to implementation of CPOE has recently begun under the leadership of the region's chief medical information officer. SHR is currently exploring options for the purchase of packaged order sets to be implemented across all acute care sites inside and outside Saskatoon. Unlike the challenge faced by other jurisdictions, the delay in introducing CPOE is not due to physician reluctance. A key group of physician leaders understand and embrace the concept that electronic order entry at the point of care improves patient safety and quality of care.
As for CDSS, the Eclipsys CPOE product comes with the ability to fire alerts and with embedded links to references and protocols. SHR leadership, in concert with the region's physicians, has not determined what direction to take with regard to evidence-based content behind CPOE/CDSS. Given the various vendor solutions, SHR intends to evaluate the costs and benefits of purchasing an off-the-shelf CDSS product or building it from scratch. Likewise, the timeline for implementation of Nursing Documentation will be determined in conjunction with a collaborative decision on CPOE, as it is needed to support implementation of physician order entry.
More important to SHR's e-Health progress than the schedule of near-term implementations is the strategic work of the region's e-Health Strategy Council. Charting the future direction of SHR's EHR initiatives, which will be determined by the Council, will require striking a balance between aligning with the province's mandated strategy for meeting the Commissioner's Patient First Review Recommendations and also meeting region-specific strategic goals for improving patient safety and quality of care.
HIMSS Analytics' EMRAM Scores for Hospitals and Ambulatory Settings
The state of Canada's progress at implementing a comprehensive e-Health strategy for acute care facilities in ten provinces and three territories is documented in the HIMSS Analytics Canada EMR Adoption ModelSM 2009 Q4 scores, which are based on the 2009 Canada Information and Communications Technology (ICT) Study for acute care hospitals.
Since 2007, HIMSS Analytics has conducted an annual survey of ICT systems at acute care hospitals in Canada. In late 2009, an annual survey of ICT systems at Canadian ambulatory health centres and outpatient clinics was initiated. The annual surveys target detailed information about an acute care or ambulatory facility's EMR environment. In United States terms, EMR refers equally to an in-patient hospital or outpatient ambulatory environment. In Canadian terms, EMR refers most often, as in Saskatchewan, to the ambulatory environment of physician offices, health centres or outpatient clinics; whereas electronic patient record (EPR) refers, as in Saskatchewan, to the in-patient hospital environment.
The outcomes of the Annual ICT Survey are measured by the HIMSS Analytics' EMR Adoption ModelSM (EMRAM) score for acute care hospitals and the future Ambulatory EMR Adoption ModelSM score. Currently, HIMSS Analytics publishes quarterly EMRAM scores for Canadian hospitals, based on the most recent data collection for the acute care environment across the ten provinces and three territories. An Ambulatory EMRAM score will be based on the Canadian data collection for physician offices, health centres and outpatient clinics that has recently been inaugurated.
The acute care EMRAM Score measures levels of acute care EMR/EPR capabilities ranging from limited ancillary department systems to a fully electronic environment on a continuum of eight stages from zero to seven (Table 3). Stage 7 allows clinical information to be readily shared via electronic transactions or exchange of electronic records within a health information exchange, including other healthcare organizations, government entities and patients in Canada or the US.6
Table 3. Canada EMR Adoption ModelSM
Data from HIMSS Analytics™ Database © 2010. N=660
The Ambulatory EMRAM Score will measure levels of an EMR environment at physician offices, health centres or outpatient clinics ranging from an entirely paper environment to a fully electronic environment on a continuum of six stages from zero to five.7 The major indicator of Stage 5 is participation by a physician office in an interconnected regional community of physicians, hospitals, lab companies, the pharmaceutical industry, imaging companies and patients, allowing easy sharing and exchange of information and collaboration for improved patient care and development of evidence-based medicine protocols (Table 4).
Table 4. Ambulatory EMRAM Score – Stage 5 indicators
Proactive and automated outreach to patients for preventive care and chronic disease management
Proactive searching for patients with particular conditions and medications as new clinical evidence (including recalls) develops
Interconnected regional community of physicians and healthcare organizations to easily share and exchange information, and collaborate, for improved patient care
Ability to mine data for clinical research
The methodology and algorithms of the hospital EMRAM Score are currently used to automatically score more than 5,000 hospitals in the US database and more than 650 Canadian acute care facilities participating in the 2009 Canada ICT Study. Of the 76 benchmarking reports that HIMSS Analytics makes available to participating regional healthcare organizations and their hospitals, 33 compare their EMRAM scores to factors such as IS Department Operating Budget, Nurse FTEs, IS Department FTEs and other hospitals' EMRAM scores.
Measuring Saskatchewan Acute Care Clinical Capabilities: the HIMSS Analytics EMRAM Methodology
EMRAM results from HIMSS Analytics' ICT 2009 Complete Study of Saskatchewan's 13 HRs and their 60 acute care facilities reflect only the current live and operational state of the province's existing e-Health clinical capability. The province's EMRAM scores do not measure the extent to which installations of advanced clinical systems for the acute care environment are already in process, or contracted but not yet installed in various HRs, with projected dates for going live and operational in the next 12 to 24 months. Nor do the province's EMRAM scores reflect the extent to which Saskatchewan is substantially prepared to implement a master plan for a tiered geographical approach to clinical e-Health readiness, as soon as fiscal and personnel resources permit.
Canadian regional organizations and their hospitals, which complete the annual HIMSS Analytics' ICT Study, have easy web-based access to combined 76 benchmarking reports, including 47 at the hospital level and 29 at the regional level. Each of these reports allows them to compare their organization against ten de-identified peers selected on the basis of 33 hospital or 13 regional factors including bed size, adjusted patient days, facility type, total operating expense, system installed, location, etc. Benchmarking comparisons include information system department operating statistics such as full-time equivalents, operating budget and salary expense, in addition to EMRAM score comparisons.
For Saskatchewan's largest 18 general or full-service hospitals, the province's acute care environment EMRAM scores for 2009 Q4 ranged, on a scale of 0 to 7, between 2.0920 and 2.0750 on the high end for Sunrise HR's Yorkton Hospital and St. Peter's Hospital, respectively; and 0.0720 to 0.0050 on the low end for eight of 18 general hospitals.8 For 2009 Q4, the mean EMRAM score for Saskatchewan's 18 general hospitals was 0.7521, compared with a pan-Canada mean EMRAM score for all hospitals of 1.5609.9
Many of Saskatchewan's hospitals, including eight of 18 general hospitals, have yet to reach Stage 1 because one or another of the three ancillary applications for Laboratory, Pharmacy and Diagnostic Imaging (Radiology) is not yet live and operational. Still, for five of the hospitals a RIS is currently being installed or has been contracted but not yet installed. As noted above, by June 2010 RQHR will have a RIS live and operational at Regina General Hospital and Pasqua Hospital, two of Saskatchewan's largest general hospitals. Likewise, Kelsey Trails HR has a RIS contracted but not yet installed at Melfort Hospital and Nipawin Hospital, and Five Hills HR has a RIS contracted but not yet installed at Moose Jaw Union Hospital; these are three of the province's general acute care facilities.
The Saskatchewan regions with comparable high scores for all acute care facilities are Sunrise HR and SHR. In Sunrise HR, Yorkton Regional Health Centre, St. Peter's Hospital and St. Anthony's Hospital have moved into Stage 2, with EMRAM scores above 2.0000. In each case, all three ancillaries are live and operational, as well as the Eclipsys CDR, document imaging and some clinical documentation. Currently, scores for all four hospitals in SHR are between Stage 1 and 2, with all three ancillaries live and operational and other implementations. With the implementation by June 2010 of the core components of Eclipsys' Sunrise Clinical Manager at all four facilities, including the clinical data repository, SHR will move into Stage 2.
It is important to note that the EMRAM scores for Saskatchewan's hospitals should be read in light of the province's distinctive strategy for implementing a full continuum of care For Patients' Sake. In order to provide Saskatchewan's slightly more than one million residents, who are fairly well distributed over an extensive geography, with the highest patient safety and care benefits of a comprehensive electronic clinical environment, the province will most likely focus on outfitting the handful of tertiary care hospitals in the southern sector around Regina and the central sector around Saskatoon to develop an advanced electronic clinical environment (Stage 7) that can best serve the needs of all residents in all three southern, central and northern sectors.
From the perspective of the Patient First Review recommendations mentioned above, the investment of resources, including academic medicine personnel, in primary healthcare services is as important for advancing the province's healthcare strategy as the development of advanced clinical capability for inpatient tertiary care. Among the Commissioner's Recommendations, for example, were suggestions for creating urban urgent care centres to alleviate the inappropriate usage of emergency rooms; outpatient or self-help programs for promoting good health and preventing illness and injury; and a chronic disease management strategy that connects patients with multidisciplinary healthcare teams.
In order to successfully implement these Patient First Review Recommendations for the non–acute care, outpatient environment, Saskatchewan needs to educate and retain sufficient physicians. It needs to assist physicians in acquiring the electronic clinical resources of a physician office EMR system that will enable them to provide patient care in accordance with the standards of evidence-based medicine. Finally, it needs to develop sound methodologies of measuring best practices for the physician office environment.
Physician Retention – Necessary for Implementing the Patient First Review
More than other provinces, Saskatchewan has long been challenged to recruit and retain sufficient physicians, as well as nurses, without whom it is impossible to provide timely patient access to health services, especially primary care. According to the MOH, the province ranks ninth out of 13 provinces and territories in the number of physicians as a percentage of population. Also, Saskatchewan is home to fewer family physicians and far fewer specialists than the national average, and retains fewer of its medical graduates. In common with other provinces, physician shortage is most acute in the rural areas, especially in northern Saskatchewan, home to the bulk of the province's First Nations and Métis populations (Government of Saskatchewan 2009c).
In spring 2009, the MOH announced a multi-faceted and prioritized strategy of physician recruitment, committed $3.5 million to the effort and initiated a process of immediate implementation. Four primary avenues for increasing physician numbers have been targeted.
Persuade expatriate physicians trained in the province to return and practice
Retain current students and residents at the University of Saskatchewan's (U. of S.) College of Medicine
Enhance medical training, and improve programs addressing professional and personal lifestyle issues, to attract more physicians to urban and rural settings outside Saskatoon
Establish a Saskatchewan-tailored program to attract foreign-trained physicians (Government of Saskatchewan 2009c)
Immediate measures taken to realize these objectives include adding 24 additional seats at the U. of S. College of Medicine and 24 new residency positions for 2009–2010 in order to meet the previously established goal of 100 undergraduate seats and 120 residency positions by 2011. As well, a pan-Saskatchewan team of healthcare representatives led by a member of the province's health workers recruitment agency have recruited in Ireland, where approximately 450 Canadian students study medicine.10
To address the long-term challenge in a permanent way, a physician recruitment agency is being established in spring 2010. Nine major parties with a stake in resolving the province's physician shortage will form the new provincial agency's board (Government of Saskatchewan 2009d). The agency will be responsible for meeting the province's major physician retention targets by 2013. The targets are:
Reduce the annual turnover of physicians to less than 10%
Increase the number of U. of S. medical students and residents training outside Saskatoon by 25%
Increase the percentage of U. of S. medical graduates establishing practices in the province by 10%
Increase the percentage of Canadian-trained physicians working in the province by 10%
More advanced than the physician recruitment process is the partnership of the Saskatchewan Union of Nurses and the Government of Saskatchewan (SUN/Government Partnership). The first of its kind in Canada, it was established in 2008 to increase nursing numbers and excellence of care. By October 2009, the province had already achieved 70%, or 560, of the target number of 800 new registered nurses and registered psychiatric nurses; the target was established in late 2007. As well, nursing vacancies had declined from 518 in October 2008 to 403 as of June 30, 2009, salaries were now competitive with those of other provinces, and hiring targets had been established for every HR. The MOH has already issued substantial reimbursements to the HRs for progress made in meeting their nursing hire targets. Among the major outstanding challenges are continuing vacancies in some understaffed critical nursing units and the constant turnover of nurses due to retirement, the combination of which burdens newly hired and novice nurses (Government of Saskatchewan 2009e).
Physicians and EMRs – Important for Achieving Patient First Review
In concert with much of the rest of Canada, Saskatchewan has prioritized physician adoption of the physician office environment EMR as a sine qua non for securing advanced healthcare that improves patient safety and quality outcomes. As elsewhere in Canada, educating and persuading physicians to use an EMR in their patient clinical workflow is the major challenge. Currently, many physicians limit use of IT in their patient practice to a practice management system for patient billing and scheduling. In US healthcare, with its pervasive medical malpractice environment, the legal protections and patient safety benefits of using an EMR to document all patient encounters is a significant pressure and incentive for physician EMR adoption. Without the pressures of a litigious environment, persuading Canadian physicians to employ an EMR in their clinical workflow is often more effective when implementation proceeds incrementally.
Saskatchewan offers physicians on going change management support and financial incentives to adopt an EMR for documenting all patient encounters – both pre-assessment and outcomes – electronically rather than by paper. Saskatchewan's strategy is to enhance the value of EMR for physicians by integrating their EMR with the province's EHR services such as the delivery of lab results, chronic disease management and ePrescribing through a staged approach. This integration will occur once enough EMR sites are up and running, and the vendors of these systems are able to implement the necessary standards-based interfaces in accordance with annual integration priorities established by the province in conjunction with physicians.
The Saskatchewan EMR Program, which went live in September 2009, is a partnership between the Saskatchewan Medical Association (SMA) and HISC.11 The SMA organized and conducts the EMR Program for approximately 1,300 of the province's nearly 1,700 fee-for-service physicians,12 while HISC oversees the program for nearly 300 salaried primary healthcare (PHC) physicians and other health professionals operating in multi disciplinary PHC teams. The SMA opted to offer participating physicians the choice of hosting their EMR system locally in their office (client server) or having it hosted centrally via broadband by the application service provider (ASP). For the province's PHC teams, their EMR will be centrally hosted, given the tighter integration required with other health region programs. SMA reasoned that, because most Saskatchewan practitioners have historically practised in isolated environments, either alone or in pairs, most physicians are accustomed to relying on the resources in their office, both paper and electronic, rather than on Internet technology and communications with remote service providers. As a precaution against the risks of using client server for the EMR, the SMA recommends that physicians back up all patient data nightly and store backups off-site.
In September 2009, the SMA concluded the physician office EMR vendor selection process with the announcement that three of four vendor offering slots had successfully completed initial (functional) conformance testing. From among the 14 original vendor applications and seven finalists, SMA selected four EMR solutions: Optimed Software, Med Access, Practice Solutions® EMR and Nightingale Informatix. These Canadian vendors, familiar with Canadian physician clinical work flow issues, had previously been selected as well for physician office EMR projects in other provinces, including British Columbia, Ontario, Alberta and Nova Scotia. Approximately 250 physicians, mainly members of large clinics, were early adopters of the EMR prior to the announcement last fall of the vendor choices. Although nearly all had selected the Optimed solution (and 80% opted for client server access), the SMA expects each of the four vendor solutions will eventually be selected by physicians in substantial numbers.
By contrast with the SMA process, HISC selected a single vendor solution, Med Access, for the approximately 300 PHC physicians who practise at PHC sites, which are administered by the HRs. Since November 2009, the Med Access solution has been implemented at four PHC sites (see Table 5), three of which employ academic family medicine physicians. The next implementations of Med Access EMR at a PHC site will take place this year in Prairie North Health Region, where more than 55% of the region's residents rely on a PHC provider.
Table 5. PHC physician office EMR implementations
A remote PHC facility of Heartland Regional Heartland Authority in lower western Saskatchewan with one physician and two nurse practitioners employing Med Access
West Winds Primary Health Centre, an urban interdisciplinary academic medical clinic with a total 200 allied professionals from the University of Saskatchewan's College of Medicine; 42 physicians and residents are employing Med Access:
La Ronge Health Centre, an academic family centre in the northeastern Mamawetan Churchill River Health Region with nine physicians on Med Access
The Regina Academic Family Medicine Unit, an urban, multidisciplinary and cooperative academic family medicine site located in Regina Qu'Appelle Health Region with 11 physicians on Med Access
Since the implementation schedule of the EMR Program for all PHC physicians is regulated by HISC in collaboration with the health regions, rather than voluntarily opted for by the SMA's fee-for-service physicians, measurable outcomes on the return on investment (ROI) will be more readily available.
Conclusion: Measuring the ROI for Patient First Review Objectives
There are important advantages to Canada's provincial approach to healthcare delivery. Given the wide diversity of population size, urban concentration and rural sprawl among the provinces and territories, one size for healthcare delivery does not fit all provincial needs. At first glance, Manitoba and Saskatchewan, neighbours with apparently similar population and geographic profiles, would seem suited to adopt the same approach to healthcare delivery. But the fact that Manitoba has one huge urban centre with 60% of its population, while Saskatchewan has two medium-sized urban centres with less than combined 40% of the provincial population, has led to a more centralized approach to healthcare delivery for Manitoba and a more decentralized approach for Saskatchewan. Promoting the physician office EMR environment is important to both provincial healthcare strategies, but with differing orientations. Manitoba eHealth prioritized achieving early adoption of CPOE at its leading urban hospital, even before its physician office EMR project got off the ground. Saskatchewan has prioritized securing adoption of a physician office EMR environment for its academic family medicine clinics, even before targeting hospital-based CPOE implementations.
In this light, it will be especially important for Saskatchewan, early on, to develop methodologies for scoring physician progress at maximizing the potential of the EMR environment for improving patient outcomes and safety. More than the HIMSS Analytics EMRAM for acute care hospitals, Saskatchewan will find the HIMSS Analytics Ambulatory EMRAM, which measures and evaluates levels of an EMR environment at physician offices, health centres or outpatient clinics, to be useful for moving the province's For Patients' Sake strategy forward.
As noted above, the six stages of the Ambulatory EMRAM range from an entirely paper environment to a fully electronic environment on a continuum from zero to five. The indicators confirming that a physician office EMR is fully functioning at Stage 5 include the following:
Clearly, all four indicators of Stage 5 of the ambulatory model address the Commissioner's Patient First Review Recommendations. Nonetheless, in Saskatchewan, where physicians tend to work independently in a solo or a two to three physician environment, and at geographically great distances from other physicians, the most important patient benefit of educating physicians to embrace the EMR environment for their clinical workflow is their capacity to participate in an electronically enabled collaborative healthcare environment. EMR-enabled physicians have the opportunity to contribute to an interconnected regional community of physicians, hospitals, lab companies, pharmaceutical industry, imaging companies and patients, allowing easy sharing and exchange of information and collaboration for improved patient care and development of evidence-based medicine protocols.
In this light, Saskatchewan's focus on early implementation of the Med Access EMR system at all the province's academic family medicine PHC sites promises the possibility of early measurement of an EMR system's utility in enabling all healthcare stakeholders to meet the Recommendations laid out in the Patient First Review Commissioner's Report. In particular, early measurement of EMR implementation at all PHC sites should provide useful lessons and best practices for more effective utilization of EMRs by all 2,000 Saskatchewan physicians to assist them in meeting the most important of the Commissioner's Recommendations. In the spirit of the name of the Report, For Patients' Sake, the first recommendation exhorts "… the health system (to) make patient- and family-centred care the foundation and principal aim of the Saskatchewan health system, through a broad policy framework to be adopted system-wide" (Government of Saskatchewan 2009b: 8).
Patrick Powers, PhD, is a Senior Research Manager at HIMSS Analytics with oversight responsibility for the Canada ICT database and research, and a visiting professor in humanities, philosophy and government at several US colleges and universities.
Government of Saskatchewan. 2009a. Commissioner's Recommendations. Retrieved March 1, 2010. <http://www.health.gov.sk.ca/patient-first-review-documents>.
Government of Saskatchewan. 2009b. Patient First Review Commissioner's Report. Retrieved March 1, 2010. <http://www.health.gov.sk.ca/patient-first-review-documents>.
Government of Saskatchewan. 2009c. 2009, May 7. "Physician Recruitment Strategy Announced." [News Release] Retrieved February 26, 2010. <http://www.health.gov.sk.ca/electronic-health-record>.
Government of Saskatchewan. 2009d. 2009, December 7. "Putting Patients First: Improving Access to Physicians through New Recruitment Agency." [News Release] Retrieved February 26, 2010. <http://www.gov.sk.ca/news?newsId=dbf28fc0-6733-4c4e-9e0c-5aad778ae910>.
Government of Saskatchewan. 2009e. 2009, October 1. "Saskatchewan Union of Nurses and Government of Saskatchewan Partnership Achieves 70 Per Cent of Goal to Hire 800 Nurses." [News Release] Retrieved February 26, 2010. <http://www.gov.sk.ca/news?newsId=53aa0b60-16cf-4dc6-a6a6-0cc8a454b0f7>.
Government of Saskatchewan. 2009f. The Need for Transformation in Health Care Administration. Retrieved March 1, 2010. <http://www.health.gov.sk.ca/patient-first-review-documents>.
Government of Saskatchewan. 2007. Electronic Health Record. Retrieved February 26, 2010. <http://www.health.gov.sk.ca/electronic-health-record>.
HIMSS Analytics
1. HISC is also responsible for delivering non-e-Health IT services to governmental healthcare organizations.
2. For more information on each of these projects, go to <http://www.health.gov.sk.ca/her-strategy>.
3. Information and data on HISC IT strategy is based on the HIMSS Analytics 2009 ICT Study and follow-up communication.
4. Information and data on Regina Qu'Appelle Health Region's clinical software applications is based on the HIMSS Analytics 2009 ICT Study and follow-up communication.
5. Information and data on Saskatoon Health Region's clinical software applications is based on the HIMSS Analytics 2009 ICT Study and follow-up communication.
6. For a full description of the eight stages of the EMRAM Score for Hospitals, see HIMSS Analytics' EMR Adoption Model, <http://www.himssanalytics.org/hc_providers/emr_adoption.asp>.
7. For a full description of the six stages of the future Ambulatory EMRAM score, see HIMSS Analytics': EMR Adoption Model, <http://www.himssanalytics.org/hc_providers/emr_adoption.asp>.
8. Saskatchewan EMRAM scores are published with permission of HISC.
9. For a full account of results for the Canada EMR Adoption Model, 2009 Q4, go to <http://www.himssanalytics.org/hc_providers/emr_adoption.asp>.
10. For more information, go to <www.HealthCareersinSask.ca>.
11. Information and data on the Saskatchewan EMR Program is based on communications with the Saskatchewan Medical Association and HISC.
12. Some specialists, such as anesthesiologists and radiologists, were not eligible for the EMR offering.
Use of High-Reliability Principles in the Evolution of a Hospital Command Centre
Barbara E. Collins
Making Practical Progress on Climate Change in Healthcare: Seizing Opportunities
Kathleen Morris
Leveraging Our Strengths to Achieve Sustainable Healthcare
Edward Xie and Fiona A. Miller
Transitions in Labour Force Participation over the Palliative Care Trajectory
Denise Guerriere, Amna Husain, Denise Marshall, Brandon Zagorski, Julia Kennedy and Peter C. Coyte


Water Pennywort in Copperopolis, CA can be a real problem for municipal and home owners ponds and lakes as well as golf course ponds throughout the State of California. Now there is help with controlling and removing Water Pennywort in Copperopolis. Check out our machines at DK Environmental.
Water plants are plants that have adjusted to residing in aquatic locations (saltwater as well as fresh water). They are also known as hydrophytes or macrophytes. These kind of plants will require special modifications for dwelling submerged in water, or even at the water's surface. The typical variation is aerenchyma, but floating foliage and very finely dissected leaves are also prevalent. Aquatic plants can only flourish in water or in soil which is completely soaked with water. They are for that reason a normal a natural part of wetlands.
Aquatic vegetation is by and large a beneficial portion of the water body, be it a lagoon or perhaps pond. The water vegetation is a source of nutrition, refuge and oxygen to the creatures dwelling in the pond or lake. Yet unfortunately left uncontrolled these aquatic plants can certainly spread out fairly quickly and constrain the activities within the water-feature and / or lake. That is when these kinds of water plants turn into aquatic weeds.
A straightforward classification of an aquatic weed is a plant which grows (commonly too densely) inside an area such that it impedes the usefulness and / or enjoyment of that area. Some typical kinds of water plants that may end up being undesirable weeds are water milfoil, duckweed, pondweed, Water Pennywort, Water Pennywort, cattail, bulrush, ludwigia, and many more. They'll grow within fish ponds, lakes, streams, rivers, navigation channels, storm water basins and channels, wetlands and lagoons. The growth may be due to a range of factors such as an excessive amount nutrients in the water or even introduction of rapidly-growing exotic varieties. The difficulties caused by water weeds are numerous, ranging from unsightly growth and nuisance smells to constricting of waterways, flood damage, boat damages, or perhaps drowning and impairment of water quality.
Usually it will be far better plus economical to hire a qualified professional water weed control business to clear out and control your aquatic weed situations. When it comes to California essentially the most knowledgeable business is DK Environmental. DK Environmental is located in the San Francisco Bay area yet performs water weed extraction everywhere in the State of California. The machines that DK Environmental uses is extremely different to the western U . S .. With its fleet of DK can access any kind of water system.


text:
How Green Activists Target the Military and Endanger Our Security
by Kevin Mooney
Not only could you lose your job under the current environmental regime, but you could also lose your life.
That is one of the inescapable conclusions that can be drawn from a recently released book authored by Diana Furchtgott-Roth, a scholar with the Manhattan Institute, who was kind enough to discuss some of her key findings at her office in Washington D.C.
With President Obama re-elected to a second term, green activists who hold considerable sway with federal agencies are well-positioned to advance policies that jeopardize not just the economy, but also America's geo-political standing, she explained.
That last part often gets overlooked, but in reality the nation's energy policy is inextricably linked to national security. Unfortunately, top officials within the Defense Department have already succumbed to environmental directives that could work to the advantage of military adversaries, Furchtgott-Roth observes.
"What many environmentalists view as morally superior, could have very negative policy ramifications, not just for the economy, but also for our military," she said. "If the military does become more reliant upon renewable energy and biofuels, as opposed to more traditional energy sources, there are ways this could conceivably be exploited by a future adversary."
The Obama White House has already pressured the Air Force and Navy into becoming more reliant upon renewable energy, according to the book. While this may be politically fashionable, these plans could undercut military readiness, Furchtgott-Roth warns.
"Although shipping diesel and gasoline to remote battlefields is costly, using renewable energy has its own set of challenges," she tells readers. "It takes up massive amounts of land to gather very diluted energy streams. Recharging a laptop with a fold-up solar panel is plausible, but larger devices would require more substantial panels, or even windmills, that could be spotted by the enemy."
Nevertheless, recent statements from Defense Secretary Leon Panetta indicate that climate change is now viewed as a pressing national security threat.
"Rising sea-levels, severe droughts, the melting of the polar ice caps, the more frequent and devastating natural disasters all raise demand for humanitarian assistance and disaster relief," he said during an address to the Environmental Defense Fund in May 2012. The Defense Department's re-evaluation of its energy use, and its pursuit of renewable fuel sources is linked to the debate over climate change.
Furchtgott-Roth's book, entitled, Regulating to Disaster: How Green Job Policies Are Damaging America's Economy, argues persuasively that it is the anti-energy global warming policies, not global warming per se, that are the real national security threats.
Take the Keystone XL pipeline, which environmentalists have delayed from going into full production. Along with all its economic advantages, there was a national security component at work in that the pipeline would provide the U.S. military to critical energy resources in a stable, friendly region of the world. But it has not yet been approved by the U.S. State Department.
"Environmentalists attacked the proposed Keystone XL pipeline because it would expand the use of the oil sands in Alberta, Canada, which is a more carbon-intensive form of oil than that produced from traditional underground reservoirs," Furchtgott-Roth explains. "Yet in the State Department's environmental review it was noted that 'Oil sands mining projects have reduced greenhouse gas emissions intensity by an average of 39 percent between 1990 and 2008 and are working toward further reductions.' "
But there's no point in bothering Team Obama with the facts.
Instead of pursuing policies that would create new job opportunities, the administration is peddling the concept of green jobs, an elusive, nebulous concept that is defined differently across federal and state agencies. There is often a short degree of separation between the duties and responsibilities of green workers and non-green workers.
"While you are writing this article it is possible that you have a green job," Furchtgott-Roth said. "My book could qualify as an environmental book since it is about green jobs. Book publishers are also green if they issue environmental books."
She added, "Creating new jobs is hard work. It is a lot easier to simply redefine an existing job as a new job, a distinguished job. Let us call it a 'green job.' And to show we have made progress, let us say we have made lots of green jobs. Our government may not be good at creating jobs but it excels at relabeling existing jobs as green jobs."
At the federal level, the Department of Labor's Bureau of Labor Statistics (BLS) is responsible for determining what qualifies as a green job, and what does not. What this means in practice is that some positions are viewed as environmentally virtuous, while "other jobs languish in moral inferiority without the benefit of government subsidies," Furchtgott-Roth said.
Green jobs include work "in businesses that produce goods or provide services that benefit the environment or conserve natural resources" or "jobs in which workers' duties involve making their establishment's production processes more environmentally friendly or use fewer natural resources," according to the BLS.
Some creates some very odd juxtapositions. For example, farmers who produce corn for consumption are not viewed as green workers, while farmers who produce corn for ethanol earn the label. Although the former may be providing food to needy populations, he does not enjoy a favored standing.
Furchtogott-Roth's book delves into the environmental movement's view of moral superiority and how it is used to rationalize a larger role for government often at expense of public safety and the larger national interest. Consider the new minimum fuel efficiency standard the President Obama set in July 2011 and the Corporate Average Fuel Economy (CAFE) regulations, first enacted in the 1970s. In response to these regulatory changes, automakers have been forced to downsize their vehicles, and add in new technology that is passed to the consumers in the form of vehicle that are more expensive and less safe.
Furchtgott-Roth cites a 2002 study in her book from the National Research Council that found the first CAFE standards were responsible for anywhere from 13,000 to 26,000 more Americans on the receiving end of severe injuries on the road because they were in lighter cars.
Up until now, it has not been made clear to the public how dangerous green policies can be to their livelihood.
But now that green policies have established a foothold in the Pentagon, Furchtgott-Roth sees an opening to reframe the debate over regulatory policy.
"Gambling taxpayer dollars, Americans' livelihoods, and the lives of drivers is bad enough, but certainly even the greenest of environmentalists can admit that it has gone too far when the lives of American soldiers become the playground of environmentalists," she said.
Former Sen. Chuck Hagel of Nebraska, who has been nominated by President Obama to become U.S. secretary of defense, has expressed skepticism toward the idea that human activity drives climate; that's promising. But he also appears open to the idea that climate change should be linked in with national security; that could mean trouble. Senators who have misgivings about Hagel's nomination ought to inquire about his stance on green policies.
Photo: UPI.

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text:
Why are Australians so gloomy about the future?
Snap out of it Australia. Despite our wealth, health and good weather an international survey has revealed consumers here are among the gloomiest in Asia. And it's been that way for most of this decade.
When citizens across 15 Asia-Pacific nations were asked about the outlook for their economy, employment prospects, income prospects, and quality of life only three countries – Taiwan, Sri Lanka and Malaysia – were more pessimistic than Australia.
The poll, conducted twice a year by card payments company Mastercard, showed our confidence ranking was more than 30 per cent below the regional average.
Movements in consumer sentiment don't always correlate with what actually happens in the economy. But the regional comparison is telling.
Its really not to hard to find a good reason why Australians are much gloomier about their economic circumstances than most of their Asian neighbours, including New Zealand.
Australian political parties for the last decade have continuously told us how our economy is in terrible shape and we have this huge BLACK HOLE enveloping us. The answer to this problem? Well apparently the economy can only be saved by electing either one of the very parties that continue this lie.
So why are we Aussies so depressed, well our politicians and media have been taking about black holes for so long now they actually believe their own invention.
Remember if people are told a lie often enough
for long enough they come to believe it.
Ten or more years of this lie has convinced us that we are doomed!!
Labels: Current Affairs, Politics, Strange but true?
Wrong taxi, one less bomb?
Did a taxi mix-up limit Brussels bombing carnage?
A mix-up by a Brussels taxi dispatcher may have prevented more carnage at the city's airport, Belgium's DH newspaper reported, saying the cab firm sent a smaller car to pick up the bombers than the one ordered.
Citing unidentified sources, DH said Ibrahim El Bakraoui and two other men suspected of carrying out the attack had called for a minivan to take them to Zaventem airport, laden with bags, early on Tuesday (local time) from an apartment in the north of the city.
When the driver turned up in a saloon, the three found they could not fit all four heavy holdalls into the trunk. They left one behind.
Two men blew themselves up in the airport's departure hall and the third ran off, leaving the heaviest explosive device which security services later detonated.
After the taxi driver called police to relate the tale, they found a large nail bomb in the apartment in the borough of Schaerbeek and defused it. Police had no comment on the report.
"What would have happened if all the explosive devices found in the Schaerbeek search had been taken to Zaventem?" DH asked.
Bunnings blunder hard to understand?
Widow criticises Bunnings' no-defibrillator position
By Vaughan Elder on Mon, 28 Mar 2016
A woman whose husband died of a heart attack in a Bunnings store has slammed the company's stance to not have defibrillators in its stores.
Wellington woman Sharron Gilmore, whose husband Peter died of a heart attack aged 62 in Bunnings Naenae in 2005, made the comments after the company's management "put its foot down'' and forced its Dunedin staff to give the store's defibrillator to a community group.
Social club members from Bunnings Dunedin raised $1300 to buy the defibrillator about three years ago, after one of their colleagues died from a heart condition, but the company's management has since called for it to be removed.
A Bunnings staff member, who did not want to be named due to fear of disciplinary action, said Bunnings New Zealand manager Jacqui Coombes visited the Dunedin store on Wednesday.
Why are we cutting education funding and sacking CSIRO scientists. Is this a new type of innovation?
Its Crucial for the development of new jobs and new industries, yet the government seems to be going in the opposite direction.
Fact:- Innovation and science are critical for Australia to deliver new sources of growth, maintain high-wage jobs and seize the next wave of economic prosperity.
Innovation its about new and existing businesses creating new products, processes and business models.
Its also about creating a culture that backs good ideas and learns from taking risks and making mistakes.
Innovation is important to every sector of the economy – from ICT to healthcare, education to agriculture, and defence to transport.
Education and science are at the heart of innovation and this government is bleeding our heart to death.
Labels: Australia, Coalition, Current Affairs, Opinion, Politics, Strange but true?
Malcolm Turnbull:-Is he really such a good actor, has he fooled us all?
So Mr Turnbull has just been pretending to be pathetic for the past few months, he's silently endured weeks of dismissive commentary branding him a hopeless ditherer " - is this a big act.
All his chopping and changing on tax policy, letting Tony Abbott and his supporters have free rein sniping and undermining of him and letting the likes of George Christensen and Cory Bernardi run him over on the Safe Schools scheme. Then on top of that he gave no viable response to Labor's new policy on negative gearing.
We are asked to believe it was just a ploy.Only a ploy,really?
What of his abandonment of the Republic and marriage equality, he allowed the opponents of equal marriage to announce that they wouldn't abide by the results of a plebiscite anyway. He didn't utter a word of condemnation, not a word.
So calling a 'Double D' and bashing the Senate over the head has suddenly made him a real leader(or has become a very ordinary politician who is clinging to power).
All these things are a positive for Mr Turnbull according to press commentators who now love him because he has finally made a decision. Where does that come from?
All we have been seeing was massive relief that Abbott was gone. The sort of psychic relief that comes from waking up alive in intensive care after a particularly horrific car crash.
Scarred and bruised we were and in need of ongoing care after having a bout of 'Abbottism'. However all our limbs are intact and our organs are functioning. We are still in recovery, though we are sipping through a straw."
Now we're in recovery and the doctor we first see in recovery is 'Malcolm' and he seems like god, he'll make us better.
Now fully recovered and the Malcolm we first saw has disappeared.
Now he may have been rotated just like other staff, however we looked forward to seeing that particular Malcolm again because he promised so much.
Where has that 'Malcolm' gone?????????????????? WILL HE RETURN?
Labels: Australia, Coalition, Funny, Malcolm Turnbull, Opinion
The crazy saga of great CSIRO sell-off
Continuing crazy saga of great CSIRO sell-off that hurts the public good
PETER BOYERMercury Edited by S.W.T.Read
The CSIRO building on the Hobart waterfront.
COMPETITION is not everything. Communities also need people to be neighbourly, tolerant and well-mannered — the civilised attitudes and behaviours that bind us.
Based on this need, we created public services and amenities and thought up ideas like democracy and the rule of law, universal education, human rights.
We call these benefits the public good.
Centuries of effort by numberless people have created our public good, each contribution adding to previous ones like the stones that make a cathedral. It belongs to everybody. It can yield financial returns, but its most valuable benefits are not financial.
But when the public good is turned into a commodity to be bought or sold, it ceases to be a public good and our civil society is diminished.
CSIRO's global reputation rests heavily on its non-commercial investigations of space and the atmosphere, ocean and landforms, ecosystems and other attributes of our region. To Australians this work is part of the public good, serving us all.
But a series of politically expedient decisions have put that notion under threat.
Clinging to the neoliberal nonsense that market economics has the answer to everything, governments have behaved as if public good research is a burden to be got rid of. For 25 years CSIRO funding has been cut back.
It has been told to get its money from corporate sources but, in the bizarre world of government finance, any success that it has in doing this is seen as reason for yet more funding cuts.
Once, scientists were put in charge of CSIRO, but no more.
In 2013, the Abbott government plucked Larry Marshall out of a crowded field of applicants for CSIRO chief executive. He has a physics degree but since the late 1980s has been a venture capitalist in California.
It shows. After being appointed he told scientists they had a "duty" to be entrepreneurs and start companies, as he had done.
Around the same time he won the Australian Skeptics' Bent Spoon award for pseudoscience, for speculating that water-divining might have scientific merit.
Then last month he astonished the science world by boldly stating that we no longer need to measure or model climate and climate data gathering, modelling and other positions would be cut to make way for new teams to work on adaptation solutions.
I accept CSIRO should help secure funding for its work but disagree with Marshall that scientists must also be fundraisers and entrepreneurs. Science and entrepreneurship require radically different skill sets, in my experience rarely if ever found in one person.
And Marshall is wrong to think he is serving business by targeting atmospheric and marine research. Like the rest of us, business needs all the climate knowledge it can get its hands on.
After thousands of climate scientists from 63 countries signed a letter to Malcolm Turnbull about the threat to critical data gathering and modelling posed by the Marshall Plan, this month a New York Times editorial deplored its impact on "arguably the greatest challenge facing the planet".
The PM has not replied to the letter and is silent about the international furore, while science minister Christopher Pyne and environment minister Greg Hunt both say that it is a matter for CSIRO.
In other words,we took the wheels of your car, now you've got to make it work without them.Its not our fault. The is innovation and cleverness?
Consider these facts. The first quarter of 2016 is set to break all heat records globally.
Unprecedented warming of coastal waters is bringing tropical fish to Tasmania and bleaching the Great Barrier Reef.
About 500km of the Murray River has been poisoned by an algal bloom.
What is the government doing to address this?
Having put a venture capitalist in charge of our premier science body and told him to let the market determine its future, it stands aside, its leader remaining silent, while he announces plans to cast aside those people best able to provide guidance, to make way for "digital solutions?".
Meanwhile it continues to oppose carbon pricing and approves new coal mines. It misrepresents Australia's rising emissions as a good news story. It pledges to abolish clean energy agencies.
Groucho Marx could not have written a crazier plot. Do they have any idea what they are doing?
Labels: Coalition, Malcolm Turnbull, Opinion, Strange but true?
CSIRO cuts to water science will guarantee Australia cannot manage its most valuable resource
In a world heading for a major water crisis, CSIRO cuts to water science will guarantee Australia cannot manage its most valuable resource into the future, says Bruce Haigh.
WATER IS VITAL for a sustainable future, particularly in Australia. To survive – and therefore for all of us to survive – water needs all the care and compassion it can get. Not so in Australia.
The new and brash head of CSIRO, Larry Marshall, recently announced plans to get rid of scientists from the Land and Water division. Apparently, there has been a judgement that they do not have the capacity to make money for the organisation.
Labels: Australia, Strange but true?
The ONION-gate the Caper that killed a Prime Minister!
March 14 Marks Important Political Milestone, Missed By Australian Media
By New Matilda on March 14, 2016 The Insider
March 14 may mark the six-month anniversary of Malcolm Turnbull's ascension to The Lodge, but a far more important political anniversary appears set to pass without notice.
Today is also one year to the day since Tony Abbott ate a raw onion.
At a factory somewhere in wherever, the Prime Minister of Australia made a speech about something or other… and then bit into a raw onion. With the skin on. In front of television cameras. For now apparent reason other than he "likes onions".
The incident quickly became known as one of the most important vegetable moments in Australian political history. It also helped hasten the downfall of a Prime Minister struggling in the polls.
But more than any other issue, Onion-gate helped a confused nation better understand Tony Abbott, the man leading their country.
Turns out, he's just really, really weird.
Labels: Australia, Opinion, Politics, Strange but true?, Tony Abbott
Will the real Malcolm Turnbull please stand up!
Exert from an article by David Tyler
Malcolm Turnbull's disunited Government is bumbling along in chaos, as the PM himself descends into undignified Abbott-style fear campaigns.
A Newspoll result suggests that Super-Mal is tanking. It's panic stations in the LNP camp. Ministers duck for cover. Back-benchers bolt. Like a rat up a drain pipe, our survivalist PM drops policy and shifts his tack to fearmongering.
Gone is the "better economic manager" his treasurer wrecked that role for him by failing to produce any kind of economic plan last week. No new idea after two-and-a-half years makes the innovator claim wear thin, too. Fading badly also is the allure of Mal the closet progressive. What is left? Mal the reactionary who will do and say whatever it takes keep power.
Labels: Coalition, Opinion, Politics
Work Choices will never be dead and buried. If it looks like duck and quacks like a duck its still a bloody duck.
March 27 will mark 10 years since Work Choices was introduced. While that policy won't ever return under that name, the impetus which drove it remains deeply embedded in the liberal philosophy.
It's all about less power to employees and more power to those employers who will exploit their workers for profit.The strange thing is that firms that value their workers tend to pay them more than stipulated in awards, and guess what, they're very profitable.
That impetus is one which always views IR reform as requiring less employee power. And it's a desire that is never stated.
This impetus is seen again and again in data which shows that now more than ever, workers lack power, and yet the demand for that power to be lessened never slackens.
The LNP and certain sections of the media have a blinkered view, they will never admit that just like some union representatives who flout the system there are firms that also flout the system. There are bad apples in every barrel and both sides need to be policed.
The current bill before parliament to police unions and not employers is an example of blind justice.
Labels: Australia, Coalition, Opinion, Politics
Who benefits from media reform?
Not the public!
I know someone who's laughing all the way to the bank.
Many narratives flow from the current set of proposed changes, but the most alarming consequence is the collapse in diversity of news reporting – which is already compromised by regional TV networks closing newsrooms.
If mergers of regional licensees with city affiliates go ahead, the number of Australian commercial TV networks may become as few as three (plus Imparja in Alice Springs).
The proposed changes to the points system, which deals with the number of news stories relating to "local" areas, seeks to support diversity.
Like so much government regulation, conscientiously planned by those with little experience of the industry it will affect, it will be easy to meet the target without honouring the purpose.
Story selection, buying in copy, sourcing amateur footage from mobile phones and using uncorroborated eyewitness accounts are among the many ways of covering the surface of events without providing the depth that serious news journalism demands.
The history of television regulation in Australia reveals two key lessons. First, licensee interests outweigh the public interest in the government's eye, no matter what party is in power.
And if it is Sydney or the bush, bet on Sydney.
Labels: Australia, Current Affairs, Opinion
Windsor will shine a harsh light on Turnbull's NBN
Based on an article by ROB BURGESS Economics commentator
Former independent MP Tony Windsor plans to use use national issues to unseat deputy PM Barnaby Joyce. At the top of the list will be the Coalition's 'fast-enough' NBN.
When Tony Windsor announced on Thursday that he would be running against Deputy PM Barnaby Joyce at the next election, he cited the National Broadband Network among his key motivations for getting back into politics.
Mr Windsor has long seen the NBN as essential nation-building infrastructure.
In 2010, Mr Windsor and fellow independent Rob Oakeshott included NBN choices on their shortlist of reasons for backing Julia Gillard to form government over Tony Abbott.
They supported an all-fibre network, with a 'roll-in' from the regions towards the city, which was an economic argument with several elements.
Getting regional centres connected to high-speed broadband helps alleviate some economic disadvantage.
Farmers, for instance, are increasingly employing internet-enabled technologies to improve crop or livestock production – so called 'smart-farming'.
Click to compare internet speeds:
First published by The Conversation.
And regional Australians stand to gain the most in e-health applications, including in-home aged care, and online education – again, because of reducing the number of times they have to travel.
Sydney and Melbourne, both of which have large infrastructure deficits in road, rail and other services, are growing increasingly expensive and difficult to live in.That might not interest city folk too much, until you look at the flip-side of the regional coin.
That's why an increasing number of regional cities are putting money into marketing campaigns to coax resident away from the Big Smoke.
See, for instance, the TV ad for living in regional Victoria – featuring, of course, a bloke using a laptop in his garden.
Sooner, cheaper, slower
'So what's the problem', you might ask? The Coalition won government in 2013, with then-Communications Minister Malcolm Turnbull releasing a plan to complete the NBN "sooner and at lower cost" than Labor's scheme.
The Coalition's NBN is cheaper because it only provides full-fibre connections to 20 per cent of premises. The rest is a combination of fibre-to-the-node (points in the street), HFC cables (used for cable TV) and some wireless and satellite services.
Mr Windsor said at Thursday's news conference, that the NBN is "a national issue of very high importance within the country areas – absolutely critical".
"Go to Armidale and see what they've done there and what they are planning to do, and you will see that it is actually a cost benefit to be in the country … It has to be fibre to the home, and I will fight to see that restored as well," he said.
Mr Windsor is going to put economic arguments around the NBN back onto the national stage.
Mr Windsor will be shining a light on the 'fast-enough' NBN – a network that will be significantly eclipsed by broadband speeds in our trading partners in the years ahead.
The graphic below, also created by Rod Tucker, shows how far behind we are falling.
Labels: Australia, Current Affairs, Politics
Tony Abbott: Little boy lost with uncontrolled weeing
Opinion based on article by Mungo
Tony Abbott has made it very clear in the past week that he's not going anywhere, which means Malcolm Turnbull can't expect any clear air - now, or even after an election, writes Mungo MacCallum.
When US president Lyndon Baines Johnson was reviewing the reappointment of his adversary, the FBI chief J Edgar Hoover, LBJ opined: "It is probably better to have the son of a bitch inside the tent pissing out than outside the tent pissing in."
Malcolm Turnbull would undoubtedly prefer Tony Abbott not to urinate anywhere; indeed, the Prime Minister would prefer his predecessor not to do anything much at all. But the reality is that Abbott remains defiantly inside the tent, pissing out, in, and in every direction.
His self control does not seem to be a strong point.(as in point percy at anything beginning with 'M')
Labels: Coalition, Current Affairs, Malcolm Turnbull, Opinion, Politics, Strange but true?
Donald Trump and the mob. This is the US of A today
Based on an article by Micheal Bradley
A mob doesn't think; it feels. Its members have fully engaged the emotional parts of their brains, and everything else is temporarily switched off. A mob can do things which its constituents would never individually contemplate and of which they are later ashamed; the testimonies of people who participated in such horrors as the Rwandan genocide and, yes, what the Nazis did, provide plentiful evidence of this. Much of history is a record of lynchings, witch hunts, pogroms and genocides, all perpetrated by ordinary people who one day lost their moral bearings and became a mob.
To dismiss Trump's supporters as a dumb racist swill is to entirely miss the point. Almost everyone in the world is latently racist to at least some extent; when a big enough section of society feels lost and alienated from the power structures which govern them, and a putative leader comes along who speaks the language of their rage and promises to speak brutal, impolitic truth to that power; then if that leader understands the emotional levers of his audience, he can turn it into a mob and wield its force for his own ends.
That's Trump in a nutshell. He gets all this. He plays the cards of racism, misogyny, inclusion/exclusion, demonisation of The Other in whatever form is momentarily convenient, to manipulate the elevated emotions of the mob he has attracted and keep his face plastered all over the news. He wants to be president. It's possible, if the mob keeps growing and maintains its present rage.
Labels: America, Current Affairs, Opinion, Strange but true?
Peter Dutton spreads fear, he hasn't got his virus(Abbottism) under control.
Fear makes up for no policies?
Federal Cabinet Minister Peter Dutton has forecast an economic disaster if Labor introduces its tax policies. This is an "outlandish scare campaign".
The Opposition's plan would restrict negative gearing to new properties and halve the capital gains tax discount from mid-2017, while protecting existing landlords.
Labor said the measures — costed by the Parliamentary Budget Office — would save $32.1 billion over a decade.
"I think the economy will come to a shuddering halt and I think the stock market will crash," the Immigration Minister told Sydney radio station 2SM.
"I think once people realise how dangerous Labor's economic proposal is I think they'll be happy to see an election and deal with it.
"Labor's essentially said they want to lower house prices and they want to increase rents and I think that would be a disaster."
The Government has yet to release a negative gearing or capital gains policy of its own.
Industrial relations: Employers really shouldn't be complaining given these results - The Drum (Australian Broadcasting Corporation)
Employers live in the past, still bagging employees when things are good for them.
Industrial relations: Employers really shouldn't be complaining given these results - The Drum (Australian Broadcasting Corporation):
Malcolm does an Abbott again.Fear is the weapon coming up to the next election apparently. Not policies!
Based on an article in Independent Australia
Like a seasoned rabble-rouser Malcolm is was hell-bent on instilling fear and loathing amongst the aspirant and middle classes. What is there to be afraid of?
Well if you vote Labor?
"Vote Labor and see your house price go down. That's what Labor is offering. Lower house prices, poorer Australians."
Forget the national interest, social policy, or the fate of the economy, what we should really be scared of is the Labor party's tax policies.
"70 per cent of Australians who own houses will see the value of their single most important asset smashed."(This is actually a figure plucked from the sky)
The words might be about tax, but the real agenda is about creating fear to get votes. Until recently, we had "stop the boats". Now, Turnbull trumps up with a new one "better stop the evil lefties from sending you to the poor house".
Turnbull doesn't really know where he or his party stands on the issue of Capital Gains Tax with all of his back-flipping and front-flipping over the issue. He is out to rescue the polls by trying to discredit the opposition, he is downright decisive about the dangers of voting for anyone but him, after all he was born to rule.
It's sad to see someone who showed such promise lobotomize himself. He's likable and articulate, why doesn't he just wheel out some good policies the electorate is waiting.
He not in opposition he's the PM he has the whole public service to work on policies.
God forbid that we could have a repeat of Abbottism rearing its ugly head, I thought that they had found a vaccine for that disease.
Labels: Australia, Coalition, Current Affairs, Malcolm Turnbull, Opinion, Politics
America, Please Don't Do This to Us. What have we ever done to you?
Based on an Article by Thor Steinhovden
At first, we all treated Donald Trump's popularity as a joke. Like many fellow Australians I laughed at his hair, his behavior, and his outlandish speeches.
I took solace in the fact that, the GOP would need to go through a few polarizing candidates before settling on a more stable nominee.
As the caucuses and primaries got under way, I started shifting uncomfortably in my seat I was feeling the urge to race to the toilet. He was still a joke, but now with in a more eerily tone: "He said what? And he's still in the race? and He's leading?"
I think I speak for many fellow Australians when I say that I have now moved into full-blown panic mode: America, what the hell are you doing?
Trump has commanding leads in close to all the states that will vote in the SEC Primary on Tuesday. He is no longer a potential front-runner; he is someone who may possibly sweep Super Tuesday, yes that's what I said, this guy is becoming very dangerous.
What an incredibly terrifying thought, because it puts him within target range of the White House, the red button and close to the nuclear codes.
Let me quote a British friend who recently summed up quite succinctly what many people are thinking down under.
"I can't take it anymore. I have children! I want to be able to rationalize and deride Trump in a constructive way but all I do is panic inside every time I see his face".
Fellow Australian, don't worry I have a plan
We will tow Australia south, closer to the Antarctic, as far away from the USA as possible. Then again the moon looks inviting!
Labels: Australia, Current Affairs, Funny, Strange but true?
Why are Australians so gloomy about the future? ...
Why are we cutting education funding and sacking C...
Malcolm Turnbull:-Is he really such a good actor, ...
CSIRO cuts to water science will guarantee Austral...
The ONION-gate the Caper that killed a Prime Minis...
Work Choices will never be dead and buried. If it ...
Who benefits from media reform? Not the public!...
Windsor will shine a harsh light on Turnbull's N...
Peter Dutton spreads fear, he hasn't got his virus...
Industrial relations: Employers really shouldn't b...
Malcolm does an Abbott again.Fear is the weapon co...
America, Please Don't Do This to Us. What have we ...


text:
Doctor Who: The Trial of a Time Lord Collection
6th Doctor Novelisation
By: Terrance Dicks, Philip Martin, Pip & Jane Baker
Narrated by: Lynda Bellingham, Colin Baker, Bonnie Langford, Michael Jayston
Doctor Who: The Dalek Collection
1st, 3rd, 4th Doctor Novelisations
By: Terrance Dicks
Narrated by: William Russell, Peter Purves, Jean Marsh, and others
Original Recording
In 'Doctor Who and the Dalek Invasion of Earth' the TARDIS lands in the 21st century to find a ravaged London at the mercy of familiar foes. In 'Doctor Who: Daleks - Mission to the Unknown' and 'Doctor Who: Daleks - The Mutation of Time' conquest of the universe seems assured for Mavic Chen and his allies, the Daleks. In 'Doctor Who: Death to the Daleks' the Doctor and Sarah are drawn to the planet Exillon, shortly before the Daleks arrive.
Doctor Who: The Minds of Magnox
By: Darren Jones
Narrated by: Jacob Dudman
A brand new stand-alone adventure for the 10th Doctor, which also forms part of the Time Lord Victorious story arc, read by Jacob Dudman. The Doctor travels with Brian, the Ood assassin, to the planet Magnox, one of the greatest receptacles of knowledge the universe will ever know. The Doctor needs to ask a vital question, but the answer is grade-one classified! In order to gain an audience with the Minds of Magnox themselves he must take a dangerous test. Is he smart enough to get through?
Doctor Who: The Second History Collection
1st, 2nd, 4th, 5th Doctor Novelisations
By: Donald Cotton, Gerry Davis, Malcolm Hulke, and others
Narrated by: Shane Rimmer, Anneke Wills, David Troughton, and others
Five exciting novelisations set in Earth's past history, featuring the Doctor and his companions. The stories are Doctor Who - The Gunfighters, Doctor Who - The Highlanders, Doctor Who and the War Games, Doctor Who and the Talons of Weng-Chiang and Doctor Who - Black Orchid.
Doctor Who: The Lost TV Episodes Collection Three
1st and 2nd Doctor TV Soundtracks
By: Brian Hayles, Kit Pedler, Gerry Davis, and others
Narrated by: William Hartnell, Patrick Troughton, Anneke Wills, and others
Six narrated TV soundtrack adventures starring William Hartnell and Patrick Troughton as the First and Second Doctors - plus bonus features. Absent from the TV archives, these stories survive in their entirety only as soundtrack recordings. Now remastered, with additional linking narration, you can enjoy them again: plus bonus interviews with Anneke Wills, and the BBC Radio 3 programme Dance of the Daleks.
Doctor Who: The Third Alien Worlds Collection
First, Fourth, Sixth, Seventh Doctor Novelisations
By: Ian Marter, David Fisher, Eric Saward, and others
Narrated by: Maureen O'Brien, Tom Baker, Colin Baker, and others
In 'The Rescue', the First Doctor meets the sole survivors of a crashed spaceliner on Dido. In 'Doctor Who and the Creature from the Pit', the ruthless Lady Adrasta is keeping an unusual visitor prisoner on the planet Chloris. In 'The Twin Dilemma', a newly regenerated Doctor tries to become a hermit on the planet Titan 3. In 'Paradise Towers', the Doctor and Mel meet the residents of a dystopian hell, and in 'The Happiness Patrol' the TARDIS lands in trouble on the colony world Terra Alpha.
Doctor Who: The Lost TV Episodes Collection Two
1st Doctor TV Soundtracks
By: Terry Nation, Dennis Spooner, John Lucarotti, and others
Narrated by: Peter Purves, William Hartnell, Jackie Lane, and others
Four more thrilling soundtrack adventures from the early days of Doctor Who, featuring serials lost from the TV archive. The pictures may be lost, but each of these stories survives as a soundtrack recording. Remastered, and with additional linking narration, they can be enjoyed once more. In The Daleks' Master Plan, the Daleks have stolen the Time Destructor, and are threatening to destroy the fabric of time itself. In The Massacre, the TARDIS materialises in Paris, 1572. Also including The Celestial Toymaker and The Savages.
Doctor Who: The Second Monsters Collection
3rd, 4th, 5th, 7th Doctor Novelisations
By: Robert Holmes, Dave Martin, Andrew Smith, and others
Narrated by: Katy Manning, Jon Culshaw, Matthew Waterhouse, and others
Five exciting novelisations of classic TV stories in which the Doctor and his companions encounter a colourful assortment of aliens.
Doctor Who: Twice Upon a Time
By: Paul Cornell
Narrated by: Mark Gatiss
An unabridged reading of the brand-new novelisation of the Twelfth Doctor's dramatic final adventure. Still reeling from his encounter with the Cybermen, the First Doctor stumbles through the bitter Antarctic wind, resisting the approaching regeneration with all his strength. But as he fights his way through the snowdrifts, he comes across the familiar shape of a blue police box and a mysterious figure who introduces himself as the Doctor....
Doctor Who: The Lost TV Episodes Collection Four
Second Doctor TV Soundtracks
By: Ian Stuart Black, David Ellis, Malcolm Hulke, and others
Narrated by: Anneke Wills, Frazer Hines, Patrick Troughton, and others
Absent from the TV archives, these stories survive in their entirety only as soundtrack recordings. Now remastered, with additional linking narration, you can enjoy them again: plus bonus interviews with Anneke Wills and Frazer Hines.
Doctor Who: The Alien Worlds Collection
By: Bill Strutton, Brian Hayles, Terrance Dicks, and others
Narrated by: William Russell, David Troughton, Tom Baker, and others
Five classic novelisations. In Doctor Who and the Zarbi, the First Doctor and his companions are trapped on the remote planet Vortis. In Doctor Who and the Curse of Peladon, the Third Doctor and Jo are mistaken for delegates of the Galactic Federation on a primitive world. In Doctor Who and the Brain of Morbius, the Fourth Doctor and Sarah find the living remains of a renegade Time Lord. In Doctor Who and the Leisure Hive, the Fourth Doctor and Romana find corruption lurking beneath the surface of the pleasure planet Argolis. In Doctor Who: The Greatest Show in the Galaxy, the Seventh Doctor and Ace fight for their lives on Segonax.
Doctor Who: The Second UNIT Collection
By: Malcolm Hulke, Terrance Dicks
Narrated by: Caroline John, Geoffrey Beevers, Katy Manning
In Doctor Who and the Green Death, the Third Doctor, Jo and the Brigadier find a Welsh mining village beset by sudden deaths and a swarm of giant maggots. In Doctor Who and the Time Warrior, the Third Doctor and Sarah investigate disappearances from a top secret research establishment. In Doctor Who and the Dinosaur Invasion, UNIT presides over the evacuation of London caused by the arrival of prehistoric monsters. In Doctor Who and the Planet of the Spiders, UNIT is attacked by an alien influence seeking to retrieve something in the Doctor's possession.
Classic!
By Charmaine Spears on 02-10-2020
Doctor Who: The Nest Cottage Chronicles
4th Doctor Audio Originals
By: Paul Magrs
Narrated by: Tom Baker, full cast, Richard Franklin, and others
Tom Baker stars as the Fourth Doctor in 15 full-cast audio dramas written by Paul Magrs. Also included in this edition are a previously unheard interview with Tom Baker, outtakes from the original studio sessions, promotional trailers and a PDF booklet featuring sleeve notes by writer Paul Magrs.
Four exciting novelisations in which the Doctor is on trial for his life.
In The Mysterious Planet, the Doctor is brought before the court of his fellow Time Lords. If the Valeyard can prove him guilty, the Doctor must sacrifice his remaining regenerations.
In Mindwarp, the second piece of evidence against the Doctor is presented to the court. One thing is certain: on the evidence of the Matrix, the Doctor is guilty as charged!
In Terror of the Vervoids, the Matrix relates how the Doctor and Mel arrive on a space liner just as a series of grisly murders begins.
In The Ultimate Foe, the Doctor asserts that the evidence of the Matrix has been tampered with. In a dramatic intervention, the Valeyard's true identity is revealed....
Lynda Bellingham, Colin Baker, Bonnie Langford and Michael Jayston read these four suspenseful adventures by Robert Holmes, Philip Martin and Pip and Jane Baker.
©2019 Terrance Dicks, Philip Martin, Pip & Jane Baker (P)2019 BBC Worldwide Ltd
Doctor Who: Tales from the TARDIS: Volume 2
Doctor Who and the Claws of Axos
Doctor Who and the Mutants
Five Children and It
What listeners say about Doctor Who: The Trial of a Time Lord Collection
Misleading NOT a (new) "novelisation".
Pre-ordered this based on the misleading description "6th Doctor Novelisation". Mistakenly thought it was a *new* release with an updated/expanded revision similar to Shada, City of Death, Pirate Planet, etc. Also incorrectly assumed that since Colin Baker was listed as one of the narrators, thought he would be narrating the part of the 6th Doctor throughout the entire release, but was mistaken. Turns out this is merely a collection of the four previously released audio books comprising this series. Ex: Bonnie Langford narrates "Terror of the Vervoids", Colin Baker narrates "Mindwarp", Michael Jayston narrates "Ultimate Foe", and Lynda Bellingham narrates "Mysterious Planet". As I was expecting a "15 hour release (novelisation)" and not merely a repackaging of four existing titles, will be returning this. Nothing wrong with the release, just not was I was expecting. Ex: Am also keeping an eye on the the release "Doctor Who: The TV Movie" (not to be confused with "Doctor Who: The Novel of the Film") which I am guessing to be a "new" release and not a reprint of the 1996 release and previous audio release,etc.
D. Baker
Another good value set: but where's PDF this time?
It's another good value collection of previously released audiobooks - particularly nice to revisit the late Linda Bellingham's excellent reading of The Mysterious Planet, and of course Michael Jayston is a brilliant audiobook narrator, so to hear him re-enact his role as The Valeyard is great. But BBC Digital Audio: where is the PDF that we have been used to with the other collections? It's a real selling point, and as I have 2 of these already, would consider returning this title without it - and not buying future releases if this omission is a permanent change.
Daddy Bear
As always I love hearing the Doctor Who audiobooks. Thoroughly enjoyed each section. I was hoping that Colin Baker would perform Sil's laugh. He didn't but still didn't disappoint with his characterisation of each character including a reasonable Brian Blessed. Initially I was tentative with Bonnie Langford and wondered how she'd characterise male characters. I was very impressed. She made me laugh out loud as she seemed to make them sound like Grandfather Flumo, Father Flump and Perkin Flump. Really enjoyed it. Michael Jayson brought such a rich gravitas to the final story The Ultimate Foe. His sinister tones as The Master was not an Anthony Ainley impersonation but a dark, menacing interpretation. Was sad when it finished but glad it had the epilogue which explained how Mel was delivered back to her own time stream with The Doctor.
RobbieC
Flawed but fun
A flawed story but colourfully written and read especially by Colin Baker and Bonnie Langford.
even better than the new Blu-ray
this is a brilliant collection of stories that make up the Trial of a Timelord even the weakest story narrated by Bonnie Langford is actually very good. If you've seen the series this makes it better if you haven't seen it listen to this first.
Mum23
It was a great time?
great narration great story's and Bonnie Langford being Bonnie Langfor! Overall just great everything 👍👍👍
Ian Howarth
Some good ones
Not the best stories but worth a listen some great v reading it was a fast 15 hour listen lol
better than the TV version
started off a bit slow and never been a fan of mind warp. but the ultimate enemy was the highlight, especially the surprising epilogue