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The moment the GOP actually tries or does end any of the programs you mentioned

Well, they're not defending the program against lawsuits, so I guess it's time to hand it to them, yes?

The H1B's I've had to work with over the last 3 years have by and large been unable to find their asses with both hands. I've been forced to spend hours upon hours in futile "training", after which they are no more capable than before. What they are is *submissive*, which is what's important to a certain low caliber of manager. The executives of this company suck in tens of millions. They all have enough money to live in luxury for the rest of their lives. If they truly gave a shit about being cost effective they'd cut their own salaries back to $100k or less. http://www.modernhealthcare.co...

It doesn't really matter. If they have not been penetrated yet, it is only a matter of time. The more valuable a database the sooner it will be cracked. The personal info that blood donation organizations collect is pretty valuable, so its going to get hacked eventually. I looked into donating blood over a year ago and they told me that if I donated blood I had to give up my personal info and that it would go in a computer database. They gave me the standard spiel about it being private but they were obviously not IT experts. The place is basically a volunteer organization so they have even less ability to address security than big corps like Target, Anthem and the thousands of other companies that have already been hacked.

FWIW, I think organizations like that should just keep the data on paper in a filing cabinet in a locked room. Use the computer for scheduling and tracking, but keep all of the personal info offline. It is basically write-once, read-never anyway. They only need it when there is an exception so the efficiency gains of keeping it online do not come anywhere near to compensating for the security risks.

But wait... these are being used as medical devices! You can't make them better and cheaper over time, the government regulators say so!!!

I do hope this was intended as a joke, because I have grown rather tired of hearing the geek talk like a quack when the subject turns to medicine.

Top 10 Supply Items by Total Spend - January 2015 Tracks 10 supply items, often known as ''physician preference items,'' based on total amount spent on those items during the month by hospitals and other provider organizations.

because of the ACA the cost has went up since insurance companies know you're required to buy it ...

The facts: The ACA puts a hard limit on profits the insurance companies may make by requiring them to spend 80% of premiums on medical care. If they fall under that line, they have to refund the difference to their customers.

In 2011, that refund totaled 1.1 billion dollars. In 2012, as insurers began to moderate their prices to align more closely with costs, 504 million was refunded. In 2011, they got even closer, and refunds due to excessive margins dropped to 332 million.

But this only reflects the overcharges made according to the new ACA rule. The estimate of what consumers saved due to insurance companies being hard limited is much higher - according to HHS, that amount exceeded 4 billion dollars in 2013 alone.

Refunds cite

So no, the ACA has not enabled insurance companies to gouge you via your insurance premiums. The truth is exactly the opposite.

A flexible endoscope is cleaned in a machine more like a kitchen dishwasher than an autoclave. The scope has internal channels for shooting air and water out of a nozzle on the tip. It has a large channel to pass instruments into the patient (biopsy forceps, cauterizers, even other more narrow endoscopes). An ERCP scope has an additional channel that carries a stiff wire that is used to deflect instruments coming out the end. This channel and wire is a very tight fit, so it is more difficult to clean.

Attachments to the channel ports should circulate the sterilizing fluids through all the channels. It's not difficult to imagine a clog preventing the fluid from circulating. Testing for leaks and clogs is part of the cleaning procedure, but in practice, of course, errors happen often:

Similar story from just last month:
http://www.modernhealthcare.co...

A biggy at the VA a few years ago:
http://health.usnews.com/healt...

Correct, it is not really an encounter, but it is not the entire medical record. CCR was designed as a way for clinicians to share information about a specific incident/episode of care and not the entire medical record. I sort of think of it as a new "medical document" (i.e. just as problem list is another document type), rather than a real data exchange mechanism.

As for CCD being an abysmal failure, I think you may be incorrect. CCD was just approved by HITSP and is moving forward. From article http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20071023/FREE/310230003/0/FRONTPAGE

"The CCD is in effect a CCR implementation within HL7's Clinical Document Architecture. The CCD was approved by HL7 in January. HL7 has since dropped work on its own Care Record Summary."

Check john halamka's blog reviews HITSP approval for CCD:
http://geekdoctor.blogspot.com/2007/12/standards-for-personal-health-records.html

You should also check out this critical review of the CCR and CDA. They authors claim that the CCR v1a (which I called v2 in my prior post) is very complicated and not at all a step in the right direction. Interesting read:

http://www.jamia.org/cgi/content/full/13/3/245?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Hammond&andorexacttitle=and&titleabstract=ccr&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&fdate=1/1/1997&tdate=1/31/2007&resourcetype=HWCIT,HWELTR