I can say this about doctors, because I am one: yes, we're very unreasonable with IT, and it's because IT slows us down. Horribly. Our professional success depends on seeing patients rapidly and efficiently. Most doctors have a very streamlined patter for patient interviews and record-keeping that they have spent their entire professional lives developing. When your program doesn't work with their style, you are asking them to change how they have done something for as much as thirty or forty years in order to please bureaucrats in Washington (but without actually being able to do what it is that we were supposed to do with EMR's: interoperate). The new system is slower than the old one, requires touch-typing (particularly important among older physicians), and is different at every single hospital and every single office. It does not usually pay for itself (let alone increase collections), it does not speed up patient encounters, it does not make their life better.
Well, only hospitals or huge groups (sometimes huge groups belonging to hospitals) could afford all the IT investment that is going to be required. Not only that, I think everyone sees how the ACO model is going to reward those who have good relationships with hospitals, and the hospital and the major groups that practice there are all pulling tighter together. Of course, in the end the hospital will swallow the practice as they both fight to stay alive. Solo practitioners or two-man partnerships just become outright employees.
Is this a chicken or egg problem? Providers don't switch because the software is overpriced and crappy, and the software is that way because there's no competition, and there's no competition because not enough providers are switching?
Sounds like Linus Torvalds, Apple, and Microsoft need to get in a development war in the healthcare space so we can get some decent software:)
The products are crappy because the government has forced EHR/EMR on American medical systems, even in many cases where any conceivable benefit is vanishingly small before you count the startup and maintenance costs. The vendors have no incentive to improve product or lower prices because the vast majority of hospital customers are stuck with whatever works with their current back-end system (the part that the hospitals implemented long ago and which few can afford to replace). Clinics want something inexpensive and easy to maintain. Too many systems spend zero effort on organizing data in such a way as to make reviewing them easy; their "notes" look more like a database dump rather than anything a doctor would write by hand.
Protip about medical records: the best way to make sure that your records are easily available is to choose one full-service hospital (i.e., it offers the full suite of adult healthcare - interventional radiology, neurosurgery, cardiac surgery, oncology, 24-hour proper ER) near you and go there for all your needs. Choose your doctor based on people who practice there. Staying inside one institution makes an enormous difference in ease of use for doctors. It also means that copies of your latest lab work and other tests will always be available via the existing "EHR" systems - the ones that currently hold scanned copies of dictation records, labs, and diagnostic studies.
Are algorithms and logic the real stumbling blocks to understanding? Speaking as a non-programmer (though I did take CS 101 and 102, learned a little C++ back in the 90s), those were always the parts of programming that I found interesting and reasonably straightforward. What kept me from ever really trying it was that it felt too much like accounting to me - there were interesting things going on but there was so much tedious work to get there that the rewards didn't come often enough to keep me going.
Stephen King is estimated by Forbes to make $45 million/year. Now, I understand that in certain circles that isn't really considered "rich", but if that's your peer group then I think we can safely conclude that you're not going to be on welfare any time soon.
That's an interesting article. Caveat: that looks at the population as a whole and counts local taxes too, which are low for most people but not for me. Not saying I pay anything like NY or CA rates of tax, but then again I don't get NY or CA levels of service, either - the public schools aren't good enough to send your children to, so you have to pay for private education; city parks are few and mostly maintained by the neighborhoods that surround them (the city cuts the grass, etc., but any beautification beyond the minimum is usually a neighborhood group). There has been pretty steady hostility toward raising taxes, of course, but there really hasn't been any movement here to cut them. That's all I really wanted to point out - it's not necessarily true that any money raised would be used on a tax cut instead of Medicaid (we'd probably find some other way to piss it away).
10 times as likely to die of suicide in the home. Doesn't count the ones who die outside it. Given that men usually choose violent deaths, only a knife or gun is going to do the job in the home - other methods will mostly require going outside the home.
If 200k/year is a "filthy rich fucker" as opposed to a "moderately successful businessman", I'd say that's something wrong with your society. To each his own, eh?
4) Black people. Southern whites are not models of health, but blacks are off the charts. Black Americans have such incredibly high sensitivity to developing obesity, hypertension, and diabetes that even thin fitness nuts develop them; when whole families have nobody under 300 pounds, how can you win?
I wish. Mississippi's taxes are not that low. People think that just because it's a reliable Republican state these days that it's an economically Republican state. It's not; it's a socially conservative state. In the past, Mississippi was actually at the forefront of a lot of Progressive stuff. The fact that the Democrats would look the other way about Jim Crow wasn't the only reason the Solid South used to be Democratic, and we still have an infestation of trial lawyers.
You have obviously not dealt with the worse kind of American utility.
Also, one big impediment to socialization of health care in the US that is often glided over is that it would make doctors who entered practice and based their lifestyle (and their student loan payments) on the kind of income that an active solo or group practitioner makes suddenly get a rather significant pay cut in order to become a government employee. They already presumably considered working for the VA, which means they've already compared the two and found the government job lacking.
I imagine that every remotely normal person doesn't want more school children dying in senseless acts of violence. However, the proposed solution trashes Constitutional rights without solving the problem.
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I don't give a shit if you've been practicing for 100 years, this is something you're going to have to get used to.
Obviously, you don't. Is this how you treat all your potential customers?
Get over yourselves; despite what you may think, the world does not, in fact, revolve around you.
Mote, plank, it writes itself.
Probably. I don't imagine they do a lot of Medicare/Medicaid billing.
I can say this about doctors, because I am one: yes, we're very unreasonable with IT, and it's because IT slows us down. Horribly. Our professional success depends on seeing patients rapidly and efficiently. Most doctors have a very streamlined patter for patient interviews and record-keeping that they have spent their entire professional lives developing. When your program doesn't work with their style, you are asking them to change how they have done something for as much as thirty or forty years in order to please bureaucrats in Washington (but without actually being able to do what it is that we were supposed to do with EMR's: interoperate). The new system is slower than the old one, requires touch-typing (particularly important among older physicians), and is different at every single hospital and every single office. It does not usually pay for itself (let alone increase collections), it does not speed up patient encounters, it does not make their life better.
Well, only hospitals or huge groups (sometimes huge groups belonging to hospitals) could afford all the IT investment that is going to be required. Not only that, I think everyone sees how the ACO model is going to reward those who have good relationships with hospitals, and the hospital and the major groups that practice there are all pulling tighter together. Of course, in the end the hospital will swallow the practice as they both fight to stay alive. Solo practitioners or two-man partnerships just become outright employees.
Is this a chicken or egg problem? Providers don't switch because the software is overpriced and crappy, and the software is that way because there's no competition, and there's no competition because not enough providers are switching?
Sounds like Linus Torvalds, Apple, and Microsoft need to get in a development war in the healthcare space so we can get some decent software :)
The products are crappy because the government has forced EHR/EMR on American medical systems, even in many cases where any conceivable benefit is vanishingly small before you count the startup and maintenance costs. The vendors have no incentive to improve product or lower prices because the vast majority of hospital customers are stuck with whatever works with their current back-end system (the part that the hospitals implemented long ago and which few can afford to replace). Clinics want something inexpensive and easy to maintain. Too many systems spend zero effort on organizing data in such a way as to make reviewing them easy; their "notes" look more like a database dump rather than anything a doctor would write by hand.
Protip about medical records: the best way to make sure that your records are easily available is to choose one full-service hospital (i.e., it offers the full suite of adult healthcare - interventional radiology, neurosurgery, cardiac surgery, oncology, 24-hour proper ER) near you and go there for all your needs. Choose your doctor based on people who practice there. Staying inside one institution makes an enormous difference in ease of use for doctors. It also means that copies of your latest lab work and other tests will always be available via the existing "EHR" systems - the ones that currently hold scanned copies of dictation records, labs, and diagnostic studies.
If you have the skills to make that work properly, there's a lot of money waiting for you.
Do they never do controlled burns to reduce the burden of undergrowth? Seems like they keep having large bush fires threaten important stuff.
Are algorithms and logic the real stumbling blocks to understanding? Speaking as a non-programmer (though I did take CS 101 and 102, learned a little C++ back in the 90s), those were always the parts of programming that I found interesting and reasonably straightforward. What kept me from ever really trying it was that it felt too much like accounting to me - there were interesting things going on but there was so much tedious work to get there that the rewards didn't come often enough to keep me going.
These comments aren't getting modded up. Perls before swine, I suppose.
God, that's useful.
personal DVD ripping
That was the whole point of the DMCA: to make key steps in the decoding of DVD information illegal if you didn't have a license. They were doomed.
Stephen King is estimated by Forbes to make $45 million/year. Now, I understand that in certain circles that isn't really considered "rich", but if that's your peer group then I think we can safely conclude that you're not going to be on welfare any time soon.
I don't think he paid for that one.
That's an interesting article. Caveat: that looks at the population as a whole and counts local taxes too, which are low for most people but not for me. Not saying I pay anything like NY or CA rates of tax, but then again I don't get NY or CA levels of service, either - the public schools aren't good enough to send your children to, so you have to pay for private education; city parks are few and mostly maintained by the neighborhoods that surround them (the city cuts the grass, etc., but any beautification beyond the minimum is usually a neighborhood group). There has been pretty steady hostility toward raising taxes, of course, but there really hasn't been any movement here to cut them. That's all I really wanted to point out - it's not necessarily true that any money raised would be used on a tax cut instead of Medicaid (we'd probably find some other way to piss it away).
If you can't afford health insurance and you're pregnant, go get Medicaid. That's what it's there for.
10 times as likely to die of suicide in the home. Doesn't count the ones who die outside it. Given that men usually choose violent deaths, only a knife or gun is going to do the job in the home - other methods will mostly require going outside the home.
Stalin screamed bloody murder for a second front in Europe to be opened as he lost hundreds of thousands of troops in single battles.
I believe that falls under the category of "a pox on both their houses" or "Fascists fight Communists; can they both lose?"
If 200k/year is a "filthy rich fucker" as opposed to a "moderately successful businessman", I'd say that's something wrong with your society. To each his own, eh?
4) Black people. Southern whites are not models of health, but blacks are off the charts. Black Americans have such incredibly high sensitivity to developing obesity, hypertension, and diabetes that even thin fitness nuts develop them; when whole families have nobody under 300 pounds, how can you win?
I wish. Mississippi's taxes are not that low. People think that just because it's a reliable Republican state these days that it's an economically Republican state. It's not; it's a socially conservative state. In the past, Mississippi was actually at the forefront of a lot of Progressive stuff. The fact that the Democrats would look the other way about Jim Crow wasn't the only reason the Solid South used to be Democratic, and we still have an infestation of trial lawyers.
You have obviously not dealt with the worse kind of American utility.
Also, one big impediment to socialization of health care in the US that is often glided over is that it would make doctors who entered practice and based their lifestyle (and their student loan payments) on the kind of income that an active solo or group practitioner makes suddenly get a rather significant pay cut in order to become a government employee. They already presumably considered working for the VA, which means they've already compared the two and found the government job lacking.
I imagine that every remotely normal person doesn't want more school children dying in senseless acts of violence. However, the proposed solution trashes Constitutional rights without solving the problem.
"Gun deaths" include suicides, who presumably would have died anyway, just via a different method.
True, but they're just so much fun...
The amount of gun violence in the US is infinitesimal outside of the drug trade.