Alternatively, Roosevelt despised the industrialists who had actually built power companies and founded agencies like the TVA in order to prevent them from profitably electrifying the rural areas of the country.
There's nothing hypocritical about it. He doesn't want to go to jail; he does want to smoke weed. Hypocritical would be advocating for harsher penalties for pot possession.
But you find errors because every sheet has a patient label on it, right? That's the real concern with EHR - if you accidentally enter information on the wrong patient, you often can't just rip it out and move it to the correct chart (the way you can rip a piece of paper out of a paper chart) because of auditing.
Hard to read information that isn't there. Asking people what's wrong with them, in their own words, is a very useful guide to dealing with them, because it gives you a good idea from the start how well they understand what is going on.
Sorry you've had such bad experiences with my profession. There are some inexcusable jackasses out there, and I regret them.
No, it's not technophobia. I'm a technophilic physician, and I know a lot of technophilic physicians, so I may be able to help you understand.
EHRs really cover several different areas. Some areas clearly benefit from computerization; lab reporting is so clearly better done via computer than phone that it makes no sense not to. Having radiology studies available for review outside the radiology department is of significant benefit. Having transcriptions of dictated reports available is tremendously useful.
Some areas are somewhat suspect. For example, nurses now often have to perform their hospital admission documentation on a computer. This is somewhat slower than using a handwritten method, and so nurses tend to dislike it - they are now doing data entry that is of only marginal benefit to them; the primary benefit is to the physician. Nonetheless, because a nurse will probably spend 20 minutes doing that admission work, the login/logout process is not usually painful (vital sign checks, on the other hand, are incredibly tedious on computer).
Finally, there are areas where the benefit is fairly small by comparison to the cost. From a doctor's perspective, a brief note in the chart is a trivially easily way to make a small update on a patient's status or convey an important point to consultants - much faster than finding a computer, logging in, waiting for Windows to load (the VA, for example, does not have generic logins to Windows - in addition to logging into the EHR, you have to log into Windows to be able to access the EHR), loading the EHR software, logging into it, and then finding the appropriate spot to enter a note. You can't flip back and forth between two pages in an EHR, the way you can with a paper chart.
With too many EHRs, doctors become data entry clerks for the hospital and insurance companies, and we don't like doing that. People are naturally resistant to changing how they do things if they bear all the cost while someone else reaps all the benefit.
Photographing the entire contents of a filing cabinet takes a long time. It's silly to make obscurity your only security, but it's always a nice part of a balanced system.
It's not cheap, but using some Citrix product as your Web interface to any decent PACS system should provide a secure interaction. My hospital uses Citrix clients as the primary means of offsite access. If you want the remote site to be able to download, you'll probably need a VPN, as well as a better (and more expensive) PACS system. I'm not a radiologist, but Philips' iSite is the easiest one I've ever used. And it easily exports to DICOM.
It's an important part of the strategy of the game, though, unless you want every question to be Final Jeopardy. This is actually most interesting in team-based competitions. When I was in high school, we had a pretty specialized Quiz Bowl team: one "twitch" guy for the ones everyone knew, one history buff, one science and math, and one slow-but-deep who would never ring in first but who knew every obscure topic.
Gosh, to read that, you'd almost think that I hadn't mentioned what the median household income is in the United States in my post. To me, "rich" is someone who doesn't have to work in order to maintain their lifestyle. Lots of people with six-figure incomes have net worths well below zero, and my whole post was an attempt to show people that it takes a long time and a lot of sacrifice to build wealth with savings.
The US has a different tax structure from many other countries; we depend heavily on individual and corporate income taxes for governmental revenue. There is NO national sales tax of any kind; sales taxes are purely state matters. Imagine if your local council were to have the authority to put up an additional 5% tax on all purchases.
A politicians job is NOT to manage the budget, but to try to do what it's constituents want.
Well, that's certainly the attitude that's gotten us into this mess. There are few things that we absolutely NEED government to supply.
The is a delusion going on that the US government has a lot of waste. IN truth, it doesn't. In fct a large majority of govenrment programs are extremely efficient and costs are well contained.
Have you had a lot of experience with government programs? In my experience, they are generally meticulously documented, account properly for every penny, and still are completely stupid ideas. It's not the process that's inefficient; it's the goal. Before we married, my now-wife managed an NSF grant for a public school system. She was careful to dot her i's and cross her t's, and the money was - at least on paper - spent quite properly. But the items the money was spent on were of questionable value, and the cash tended to flow to well-connected firms exclusively. Before she left, she made enough copies of the appropriate documentation to make sure that, should anyone investigate, she wouldn't be the fall guy. Yes, if you look at it from the Washington perspective, it was a great success - a grant was managed with less than 10% administrative expenses and provided a number of services to the local community. But from the local perspective, it didn't do anything really useful.
There is a real misconception on/. about money. You, and probably almost everyone else here, think that someone making $300k/year is rich. They're not; they're making a lot of money, but that's not the same thing as rich. Let's do the gedankenexperiment: Let us assume I make $300k. FICA, federal income tax, and state income tax reduce that to about $180k. For this experiment, we will make me the sole breadwinner in a family, and I will spend my income as though I were the median American household - which has an income just over $50k. Taxes take a much smaller chunk of that income, so let's call it $40k. I'm going to save $140k/year. Over a forty-year work life, I will be able to save $6.4M, barring growth in investments. Assuming that I invest in 5% interest bonds, I'll get to $18M - but with a constant, well-controlled 2% inflation rate over that time, that's only worth as much as $9M today.
Nine million dollars is a lot of money, until you try to live off it as one of the idle rich. You rapidly find that you can only take about 1%-2% of the money per year to live on, if you want to stay ahead of inflation and the occasional market downturn. You can thus count on this: living off 1/8 of your pretax income for 40 years straight in a high-paying field will allow you to grant one of your grandchildren an idle life on the grand sum of about $120k/year. The truly rich are not living in the same world as the rest of us, even the upper middle class, and there aren't enough of them to make a difference. Any scheme designed to get money from "the rich" is going to fall disproportionately on the professional classes, because we're the ones who actually make the bulk of the money. And while we make quite a lot, most of us didn't come from privileged backgrounds, so I'd appreciate it if you'd tone down the class war rhetoric. Society didn't give me jack - my parents did, by living well below their means in order to send me to good (private) schools.
Early 90s? What search engine were you using back then? Webcrawler was quick but rarely any good, what became Lycos (back when it was at CMU) was thorough but sloooooooow. I can't even remember the other ones we used back then... Altavista was the first decent search engine I ever used, and unless the key words were there you could forget about it. Google was a huge leap forward on that front - there's a reason it's the default for search.
You have to rely on being able to dispute the charge. Every cashier has access to everything needed to run up a bill on your card, and the system basically depends on chargebacks and innate honesty to keep people from abusing it.
Barring that, given that you used to live here, do you have any American friends that would let you set up a credit card billed to their address? A friend of mine who lives in Geneva keeps a nominal address at his sister's home so that he can access the US iTunes store, etc., that require a US address and credit card.
Leave the card inside, fill the tank, go back in and have the transaction processed. Only tedious if the line is long, which it won't be if you're catching an early flight.
Commando Libya for the Commodore 64. The bonus round consists of mowing down a bunch of guys lined up against a wall, and you enter your initials (if you get a high score) by dialing each letter in on a guy who then walks up and is guillotined. Screen resolution was not very high, but the gibs were there.
You can always take your credit card inside and pay there. No ZIP code required. Unfortunately, if a card is stolen a massive gas-station fraud is likely the first thing that will be attempted, because it can be done without involving another human being. As a result, they're very cautious at pay-at-the-pump terminals.
You're on a family plan. The price is much less appealing for an individual, who is forced to buy their own unlimited text and data plan as well as a voice plan (and the cheap voice plans don't include rollover).
She wasn't fired for being honest about the mental abilities of her students. She was fired for doing it publicly, rather than in parent-teacher meetings, and for being an ass about it.
Maybe the kids should toughen up. Or maybe it's trivially easy for an adult to pick out the weaker members of the class and hold them up to ridicule for her own amusement, especially when they're forced to spend an hour or more a day with her, and so we don't let them get away with it.
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Alternatively, Roosevelt despised the industrialists who had actually built power companies and founded agencies like the TVA in order to prevent them from profitably electrifying the rural areas of the country.
There's nothing hypocritical about it. He doesn't want to go to jail; he does want to smoke weed. Hypocritical would be advocating for harsher penalties for pot possession.
But you find errors because every sheet has a patient label on it, right? That's the real concern with EHR - if you accidentally enter information on the wrong patient, you often can't just rip it out and move it to the correct chart (the way you can rip a piece of paper out of a paper chart) because of auditing.
they fail to read charts
Hard to read information that isn't there. Asking people what's wrong with them, in their own words, is a very useful guide to dealing with them, because it gives you a good idea from the start how well they understand what is going on.
Sorry you've had such bad experiences with my profession. There are some inexcusable jackasses out there, and I regret them.
I'll bet I can easily find an attorney to argue that the patient's request for that information constitutes authorization to transmit in the clear.
lack of understanding and technophobia
No, it's not technophobia. I'm a technophilic physician, and I know a lot of technophilic physicians, so I may be able to help you understand.
EHRs really cover several different areas. Some areas clearly benefit from computerization; lab reporting is so clearly better done via computer than phone that it makes no sense not to. Having radiology studies available for review outside the radiology department is of significant benefit. Having transcriptions of dictated reports available is tremendously useful.
Some areas are somewhat suspect. For example, nurses now often have to perform their hospital admission documentation on a computer. This is somewhat slower than using a handwritten method, and so nurses tend to dislike it - they are now doing data entry that is of only marginal benefit to them; the primary benefit is to the physician. Nonetheless, because a nurse will probably spend 20 minutes doing that admission work, the login/logout process is not usually painful (vital sign checks, on the other hand, are incredibly tedious on computer).
Finally, there are areas where the benefit is fairly small by comparison to the cost. From a doctor's perspective, a brief note in the chart is a trivially easily way to make a small update on a patient's status or convey an important point to consultants - much faster than finding a computer, logging in, waiting for Windows to load (the VA, for example, does not have generic logins to Windows - in addition to logging into the EHR, you have to log into Windows to be able to access the EHR), loading the EHR software, logging into it, and then finding the appropriate spot to enter a note. You can't flip back and forth between two pages in an EHR, the way you can with a paper chart.
With too many EHRs, doctors become data entry clerks for the hospital and insurance companies, and we don't like doing that. People are naturally resistant to changing how they do things if they bear all the cost while someone else reaps all the benefit.
Photographing the entire contents of a filing cabinet takes a long time. It's silly to make obscurity your only security, but it's always a nice part of a balanced system.
It's not cheap, but using some Citrix product as your Web interface to any decent PACS system should provide a secure interaction. My hospital uses Citrix clients as the primary means of offsite access. If you want the remote site to be able to download, you'll probably need a VPN, as well as a better (and more expensive) PACS system. I'm not a radiologist, but Philips' iSite is the easiest one I've ever used. And it easily exports to DICOM.
It's an important part of the strategy of the game, though, unless you want every question to be Final Jeopardy. This is actually most interesting in team-based competitions. When I was in high school, we had a pretty specialized Quiz Bowl team: one "twitch" guy for the ones everyone knew, one history buff, one science and math, and one slow-but-deep who would never ring in first but who knew every obscure topic.
Gosh, to read that, you'd almost think that I hadn't mentioned what the median household income is in the United States in my post.
To me, "rich" is someone who doesn't have to work in order to maintain their lifestyle. Lots of people with six-figure incomes have net worths well below zero, and my whole post was an attempt to show people that it takes a long time and a lot of sacrifice to build wealth with savings.
the median American household - which has an income just over $50k
I know it's too much to ask you to RTFA, but please RTFP.
Unlimited voice+text+data plans go for a whopping $45 in the US
With whom? And I do mean after-tax, after-fees.
The US has a different tax structure from many other countries; we depend heavily on individual and corporate income taxes for governmental revenue. There is NO national sales tax of any kind; sales taxes are purely state matters. Imagine if your local council were to have the authority to put up an additional 5% tax on all purchases.
A politicians job is NOT to manage the budget, but to try to do what it's constituents want.
Well, that's certainly the attitude that's gotten us into this mess. There are few things that we absolutely NEED government to supply.
The is a delusion going on that the US government has a lot of waste. IN truth, it doesn't. In fct a large majority of govenrment programs are extremely efficient and costs are well contained.
Have you had a lot of experience with government programs? In my experience, they are generally meticulously documented, account properly for every penny, and still are completely stupid ideas. It's not the process that's inefficient; it's the goal. Before we married, my now-wife managed an NSF grant for a public school system. She was careful to dot her i's and cross her t's, and the money was - at least on paper - spent quite properly. But the items the money was spent on were of questionable value, and the cash tended to flow to well-connected firms exclusively. Before she left, she made enough copies of the appropriate documentation to make sure that, should anyone investigate, she wouldn't be the fall guy. Yes, if you look at it from the Washington perspective, it was a great success - a grant was managed with less than 10% administrative expenses and provided a number of services to the local community. But from the local perspective, it didn't do anything really useful.
Please, do tell me where I can get my 25% return.
/. about money. You, and probably almost everyone else here, think that someone making $300k/year is rich. They're not; they're making a lot of money, but that's not the same thing as rich. Let's do the gedankenexperiment:
There is a real misconception on
Let us assume I make $300k. FICA, federal income tax, and state income tax reduce that to about $180k. For this experiment, we will make me the sole breadwinner in a family, and I will spend my income as though I were the median American household - which has an income just over $50k. Taxes take a much smaller chunk of that income, so let's call it $40k. I'm going to save $140k/year. Over a forty-year work life, I will be able to save $6.4M, barring growth in investments. Assuming that I invest in 5% interest bonds, I'll get to $18M - but with a constant, well-controlled 2% inflation rate over that time, that's only worth as much as $9M today.
Nine million dollars is a lot of money, until you try to live off it as one of the idle rich. You rapidly find that you can only take about 1%-2% of the money per year to live on, if you want to stay ahead of inflation and the occasional market downturn. You can thus count on this: living off 1/8 of your pretax income for 40 years straight in a high-paying field will allow you to grant one of your grandchildren an idle life on the grand sum of about $120k/year. The truly rich are not living in the same world as the rest of us, even the upper middle class, and there aren't enough of them to make a difference. Any scheme designed to get money from "the rich" is going to fall disproportionately on the professional classes, because we're the ones who actually make the bulk of the money. And while we make quite a lot, most of us didn't come from privileged backgrounds, so I'd appreciate it if you'd tone down the class war rhetoric. Society didn't give me jack - my parents did, by living well below their means in order to send me to good (private) schools.
Early 90s? What search engine were you using back then? Webcrawler was quick but rarely any good, what became Lycos (back when it was at CMU) was thorough but sloooooooow. I can't even remember the other ones we used back then... Altavista was the first decent search engine I ever used, and unless the key words were there you could forget about it. Google was a huge leap forward on that front - there's a reason it's the default for search.
You have to rely on being able to dispute the charge. Every cashier has access to everything needed to run up a bill on your card, and the system basically depends on chargebacks and innate honesty to keep people from abusing it.
Barring that, given that you used to live here, do you have any American friends that would let you set up a credit card billed to their address? A friend of mine who lives in Geneva keeps a nominal address at his sister's home so that he can access the US iTunes store, etc., that require a US address and credit card.
Leave the card inside, fill the tank, go back in and have the transaction processed. Only tedious if the line is long, which it won't be if you're catching an early flight.
Commando Libya for the Commodore 64. The bonus round consists of mowing down a bunch of guys lined up against a wall, and you enter your initials (if you get a high score) by dialing each letter in on a guy who then walks up and is guillotined. Screen resolution was not very high, but the gibs were there.
My favorite is when he jumps against walls in 8-2 (start at 3:50) to get out of the pit.
And does anyone know why he's usually jumping facing backward? Does Mario go farther that way?
Because the US invested heavily in magstripe readers before chip-and-PIN became a standard, and we would have to re-buy the entire infrastructure.
You can always take your credit card inside and pay there. No ZIP code required. Unfortunately, if a card is stolen a massive gas-station fraud is likely the first thing that will be attempted, because it can be done without involving another human being. As a result, they're very cautious at pay-at-the-pump terminals.
Because nothing says "stick it to the man!" like using a bit of flex time to give yourself a three-day weekend. How bold of them.
You're on a family plan. The price is much less appealing for an individual, who is forced to buy their own unlimited text and data plan as well as a voice plan (and the cheap voice plans don't include rollover).
She wasn't fired for being honest about the mental abilities of her students. She was fired for doing it publicly, rather than in parent-teacher meetings, and for being an ass about it.
Maybe the kids should toughen up. Or maybe it's trivially easy for an adult to pick out the weaker members of the class and hold them up to ridicule for her own amusement, especially when they're forced to spend an hour or more a day with her, and so we don't let them get away with it.