Problem is that the definition of 'medical record' is about as precise as the definition of 'medicine'. The DICOM standard, which just concentrates on radiology and medical imaging, is over 3000 pages long, because it has so many different areas to cover. That's not even getting into other areas like laboratory, pharmacy, cardiology, etc. Add to that the concept that there are different schools of medicine and different perspectives on how things are.
Yes, but you have to worry about data smudge. Lossy compression will average data between pixels. So, even if you have a 10 megapixel image, if you compress it with a lossy algorithm, resolution will be lost at a per-pixel level. That has the possibility of smudging out a hairline fracture.
JPEG standard also defines a lossless compression. In particular, the JPG2000 standard is commonly used in medical settings, as per the DICOM standard. Must industries don't need lossless compression, and would rather have the benefits of smaller file size; so software engineers don't implement the lossless compression in most commercial software. But it's part of the standard.
Depends on whether or not you're working in research or clinical setting. If you're doing neuroimaging in research, then yeah... it's all Analyze format, and a couple others. But in a clinical setting, you're going to be using.DCM files, as specified by the DICOM standard, and those are just encapsulated JPG files (typically JPG2000 lossless, nowdays). The "normal" graphics format is there, it's just encapsulated in a way that's not familiar to most users.
For what it's worth, for approximately 1/2 of the MRIs in existence, you'd still have to schedule and wait for an exam even at 2:00am. CT and MRI scanners are often worked 'round the clock.
Except a single breach can get you millions of patients files vs. having to grab a handful of paper charts.
By the same token, a single payout at Vegas can make you a millionaire. But the odds of that are extremely small. Most payouts in Vegas are much smaller. People are lucky if they leave Vegas with more money than they went there with. Rare are the people who leave with tens of thousands of dollars more than when the went.
Similarly, data breaches with medical records rarely involve millions of records. As an attacker, you would have to not only get access to the database via some type of social engineering tactic or network attack, but you'd need to be able to dump the database, access the file system, store the data, or automate a network attack that siphons off the records one by one. You're talking about not just gigabytes of data, but terrabytes and petabytes of data.
More likely, is that somebody walks away with a few backup tapes or optical disks, and gets maybe 100 patients worth of data; or somebody manages to get 10 minutes on a workstation and looks up a particular person's records without access. Those are the types of scenarios that are likely to occur.
Most newer systems have audit logs, for what it's worth, of who accesses records. Sort of like closed-circuit television security systems; except for medical records. So, in theory, there is an audit trail, and therefore an accountability trail.
We had a former president of the united states visit the hospital system that I used to work at for surgery, and a number of techs and office workers and transcriptionists took the liberty to peek at his medical records, in just the way that you're describing. A couple weeks later, the hospital announced that all those people were under suspension and review of their jobs. They canned a lot of people after that incident. Like a dozen people, from what I recall.
Gummi bears can be used to bypass finger print readers. Personally, I think swipe cards on lanyards around the neck are the way to go (having used both systems).
Wow. So you'd totally waste a medical doctor's time with things like scheduling and insurance, thereby depriving other fellow patients of the opportunity to consult with the doctor. Very selfish of you. A full 2/3rds of that hypothetical conversation is stuff that a person with a high-school education could cover; and who could be paid a fifth of what the doctor is making (assuming the doc is making $200K a year, and the receptionist is making $40K). Moreover, by having the receptionist take care of stuff like, say, scheduling and insurance, the doctor could see 3x more patients than the way you're describing.
Oh, you'd be surprised at how important ergonomics is to doctors, particularly Radiologists. From foot pedals for controlling workflow, to voice recognition headset microphones, to glow-in-the-dark keyboards, to applications launch and open each other.... if Radiologists aren't reading cases, they're probably spending time trying to figure out how to minimize the number of clicks necessary to read a case and streamline workflow. They're very keen on ergonomics, in fact.
Yeah, but the problems are more extensive that simply the user interface. MUMPS only has a single datatype, for crying out loud! At least Epic is using strongly typed data fields, like chars, strings, integers, floats, and doubles. And don't get me started on command abbreviation or case sensitivity in MUMPS. The language is truly unlike anything most modern programmers are accustomed to.
VA system is integrated and has a large installation basis. Because of that, it has a very large network value, because it has hundreds of nodes successfully interoperating. But don't confuse that with it being particularly good software or technology. It's very antiquated and quickly becoming obsolete.
I think you might be surprised at what some of the integrated EMR systems, like Cerner can do. The cutting edge 4th and 5th generation EMR systems nowdays have diagnostic support software agents. They're basically software agents that data mine a patient records, cross reference against diagnostic rule sets, and proactively help the physician by alerting him or her to patient allergies and medication contraindications, and flexing order sets based on available resources and patient history. Very sophisticated stuff. The newer enterprise grade EMRs from Cerner, Epic, and the like are really starting to leave VistA behind in terms of functionality. Then again, companies like Cerner have invested billions of dollars in R&D in their products, too.
The problem with the Libertarian ideal is that not all parties are able to be their own best advocates and enter into agreements as rational entities with liberties. For any number of reasons, ranging from genetics and upbringing to wealth and education, many people simply aren't able to enter into social contracts competently. Thus, rather than using the slave/slave owner metaphor, you wind up needing to use something more along the lines of the sheep/shepherd metaphor.
You really have no idea what you're talking about, I'm afraid. Socialism is very different than centrally planned production economies, which is what communism is. Socialism in the context of what the grandparent was referring to referring to Canada, Sweden, Norway, Denmark, etc. They're doing just fine. You're thinking of Communism, which is distinctly different.
You might be surprised. Protestant Work Ethic. Spirit of Capitalism. All that. It's more common than you would suspect. I've certainly lived in numerous communities throughout the midwest where that was the norm. And for what it's worth, I *have* met lottery winners who continued to work after putting millions into the bank. That was a sad story, because the two people I'm thinking of lost their son to a motorcycle accident a few years after winning the lottery. They tried doing the not working thing for awhile, but eventually they just put it all in the bank, and went back to work like everybody else (but with a lot less stress). Here's a tip: money isn't everything, and it gets boring sitting around not having a job.
Socialistic Democracy works pretty damn well in Canada, Norway, Sweden, and Denmark. That's what he's referring to. There are a lot of people in the US who would like to see the US be more like Canada.
So, you're saying that places like Canada and Norway and Sweden are Hell on Earth? Interesting perspective. If that's so, sign me up! At least their hellholes have universal healthcare and respect civil rights.
You haven't met socialists of the northern european variety, it seems. Many of them are well adjusted, much like Canadians. I think it has something to do with the cold weather, perhaps, and the idea that everybody has to really work together to survive the cold winters. Socialism doesn't seem to work quite as well in the warmer climates, where you can basically live off the land (low hanging fruit, literally) and people get obsessed about property rights and who gets to control the tree or plant with the low hanging fruit.
I digress a bit, but I'm actually rather serious. Socialism does work, particularly with small groups (just an extension of kin-group selection and altruism theory, if you want to look at it from an evolutionary biology perspective). Only problem is that it doesn't scale too well, and centralized economies to support socialism particularly don't work well (i.e. communism). But socialism on a small scale, and in harsh environments, works rather well.
Unfortunately, you don't seem to have had the opportunity to have met socialists from the northern countries or smaller community farm based environments.
1. VistA is a hospital information system that isn't appropriate for all clinical practices. It would be overkill many times over for a single physician practice, and would even be too complicated for most Radiology practices even.
2. The technology that VistA was developed on is *very* antiquated, and makes most developers cringe. In fact, it's nearly impossible to find MUMPS programmers anymore, and the entire project is stagnating horribly. The computer industry has simply moved on. There are 100x more C, C#, and Java programmers than there are MUMPS programmers, so new open source projects are being written in the newer languages, and the older projects in MUMPS are slowly stagnating into obscurity.
That entity doesn't necessarily need to be a a business or government. Why not something like an exocortex with medical record installed on a virtual appliance that follows a person throughout life? You would simply install the virtual appliance with medical history, personal photos and files, and what ever else, onto the cell phone or other PDA device that you're using. And simply migrate the virtual appliance to whatever hardware you're currently using. It's basically what I'm doing.
Slashdot Mirror
Problem is that the definition of 'medical record' is about as precise as the definition of 'medicine'. The DICOM standard, which just concentrates on radiology and medical imaging, is over 3000 pages long, because it has so many different areas to cover. That's not even getting into other areas like laboratory, pharmacy, cardiology, etc. Add to that the concept that there are different schools of medicine and different perspectives on how things are.
Yes, but you have to worry about data smudge. Lossy compression will average data between pixels. So, even if you have a 10 megapixel image, if you compress it with a lossy algorithm, resolution will be lost at a per-pixel level. That has the possibility of smudging out a hairline fracture.
JPEG standard also defines a lossless compression. In particular, the JPG2000 standard is commonly used in medical settings, as per the DICOM standard. Must industries don't need lossless compression, and would rather have the benefits of smaller file size; so software engineers don't implement the lossless compression in most commercial software. But it's part of the standard.
Depends on whether or not you're working in research or clinical setting. If you're doing neuroimaging in research, then yeah... it's all Analyze format, and a couple others. But in a clinical setting, you're going to be using .DCM files, as specified by the DICOM standard, and those are just encapsulated JPG files (typically JPG2000 lossless, nowdays). The "normal" graphics format is there, it's just encapsulated in a way that's not familiar to most users.
For what it's worth, for approximately 1/2 of the MRIs in existence, you'd still have to schedule and wait for an exam even at 2:00am. CT and MRI scanners are often worked 'round the clock.
Except a single breach can get you millions of patients files vs. having to grab a handful of paper charts.
By the same token, a single payout at Vegas can make you a millionaire. But the odds of that are extremely small. Most payouts in Vegas are much smaller. People are lucky if they leave Vegas with more money than they went there with. Rare are the people who leave with tens of thousands of dollars more than when the went.
Similarly, data breaches with medical records rarely involve millions of records. As an attacker, you would have to not only get access to the database via some type of social engineering tactic or network attack, but you'd need to be able to dump the database, access the file system, store the data, or automate a network attack that siphons off the records one by one. You're talking about not just gigabytes of data, but terrabytes and petabytes of data.
More likely, is that somebody walks away with a few backup tapes or optical disks, and gets maybe 100 patients worth of data; or somebody manages to get 10 minutes on a workstation and looks up a particular person's records without access. Those are the types of scenarios that are likely to occur.
Most newer systems have audit logs, for what it's worth, of who accesses records. Sort of like closed-circuit television security systems; except for medical records. So, in theory, there is an audit trail, and therefore an accountability trail.
We had a former president of the united states visit the hospital system that I used to work at for surgery, and a number of techs and office workers and transcriptionists took the liberty to peek at his medical records, in just the way that you're describing. A couple weeks later, the hospital announced that all those people were under suspension and review of their jobs. They canned a lot of people after that incident. Like a dozen people, from what I recall.
Gummi bears can be used to bypass finger print readers. Personally, I think swipe cards on lanyards around the neck are the way to go (having used both systems).
Wow. So you'd totally waste a medical doctor's time with things like scheduling and insurance, thereby depriving other fellow patients of the opportunity to consult with the doctor. Very selfish of you. A full 2/3rds of that hypothetical conversation is stuff that a person with a high-school education could cover; and who could be paid a fifth of what the doctor is making (assuming the doc is making $200K a year, and the receptionist is making $40K). Moreover, by having the receptionist take care of stuff like, say, scheduling and insurance, the doctor could see 3x more patients than the way you're describing.
Oh, you'd be surprised at how important ergonomics is to doctors, particularly Radiologists. From foot pedals for controlling workflow, to voice recognition headset microphones, to glow-in-the-dark keyboards, to applications launch and open each other.... if Radiologists aren't reading cases, they're probably spending time trying to figure out how to minimize the number of clicks necessary to read a case and streamline workflow. They're very keen on ergonomics, in fact.
Yeah, but the problems are more extensive that simply the user interface. MUMPS only has a single datatype, for crying out loud! At least Epic is using strongly typed data fields, like chars, strings, integers, floats, and doubles. And don't get me started on command abbreviation or case sensitivity in MUMPS. The language is truly unlike anything most modern programmers are accustomed to.
VA system is integrated and has a large installation basis. Because of that, it has a very large network value, because it has hundreds of nodes successfully interoperating. But don't confuse that with it being particularly good software or technology. It's very antiquated and quickly becoming obsolete.
I think you might be surprised at what some of the integrated EMR systems, like Cerner can do. The cutting edge 4th and 5th generation EMR systems nowdays have diagnostic support software agents. They're basically software agents that data mine a patient records, cross reference against diagnostic rule sets, and proactively help the physician by alerting him or her to patient allergies and medication contraindications, and flexing order sets based on available resources and patient history. Very sophisticated stuff. The newer enterprise grade EMRs from Cerner, Epic, and the like are really starting to leave VistA behind in terms of functionality. Then again, companies like Cerner have invested billions of dollars in R&D in their products, too.
Fascist? I think that word doesn't mean what you think it means.
The problem with the Libertarian ideal is that not all parties are able to be their own best advocates and enter into agreements as rational entities with liberties. For any number of reasons, ranging from genetics and upbringing to wealth and education, many people simply aren't able to enter into social contracts competently. Thus, rather than using the slave/slave owner metaphor, you wind up needing to use something more along the lines of the sheep/shepherd metaphor.
You really have no idea what you're talking about, I'm afraid. Socialism is very different than centrally planned production economies, which is what communism is. Socialism in the context of what the grandparent was referring to referring to Canada, Sweden, Norway, Denmark, etc. They're doing just fine. You're thinking of Communism, which is distinctly different.
So, it sounds like you did, in fact, have a job. You were just lucky enough to be able to work pro-bono, which is basically what volunteer work is.
You might be surprised. Protestant Work Ethic. Spirit of Capitalism. All that. It's more common than you would suspect. I've certainly lived in numerous communities throughout the midwest where that was the norm. And for what it's worth, I *have* met lottery winners who continued to work after putting millions into the bank. That was a sad story, because the two people I'm thinking of lost their son to a motorcycle accident a few years after winning the lottery. They tried doing the not working thing for awhile, but eventually they just put it all in the bank, and went back to work like everybody else (but with a lot less stress). Here's a tip: money isn't everything, and it gets boring sitting around not having a job.
Socialistic Democracy works pretty damn well in Canada, Norway, Sweden, and Denmark. That's what he's referring to. There are a lot of people in the US who would like to see the US be more like Canada.
So, you're saying that places like Canada and Norway and Sweden are Hell on Earth? Interesting perspective. If that's so, sign me up! At least their hellholes have universal healthcare and respect civil rights.
You haven't met socialists of the northern european variety, it seems. Many of them are well adjusted, much like Canadians. I think it has something to do with the cold weather, perhaps, and the idea that everybody has to really work together to survive the cold winters. Socialism doesn't seem to work quite as well in the warmer climates, where you can basically live off the land (low hanging fruit, literally) and people get obsessed about property rights and who gets to control the tree or plant with the low hanging fruit.
I digress a bit, but I'm actually rather serious. Socialism does work, particularly with small groups (just an extension of kin-group selection and altruism theory, if you want to look at it from an evolutionary biology perspective). Only problem is that it doesn't scale too well, and centralized economies to support socialism particularly don't work well (i.e. communism). But socialism on a small scale, and in harsh environments, works rather well.
Unfortunately, you don't seem to have had the opportunity to have met socialists from the northern countries or smaller community farm based environments.
Amen! Mod parent up!
1. VistA is a hospital information system that isn't appropriate for all clinical practices. It would be overkill many times over for a single physician practice, and would even be too complicated for most Radiology practices even.
2. The technology that VistA was developed on is *very* antiquated, and makes most developers cringe. In fact, it's nearly impossible to find MUMPS programmers anymore, and the entire project is stagnating horribly. The computer industry has simply moved on. There are 100x more C, C#, and Java programmers than there are MUMPS programmers, so new open source projects are being written in the newer languages, and the older projects in MUMPS are slowly stagnating into obscurity.
That's a transmission standard, not a storage or document structure standard.
That entity doesn't necessarily need to be a a business or government. Why not something like an exocortex with medical record installed on a virtual appliance that follows a person throughout life? You would simply install the virtual appliance with medical history, personal photos and files, and what ever else, onto the cell phone or other PDA device that you're using. And simply migrate the virtual appliance to whatever hardware you're currently using. It's basically what I'm doing.