The DICOM standard that you're referring to happens to be 3000 pages long (there's alot of ground to cover, as medical imaging is a very large field, actually). The problem is that there are different interpretations on how to implement the standard. But generally speaking, it's an open standard and if a medical device is DICOM compliant, you have pretty good assurance that it will be interoperable with other DICOM equipment.
And for what it's worth, there are already plenty of open source medical imaging programs out there, such as ClearCanvas, DCM4CHEE, OsiriX, and KPACS.
Correct me if I'm wrong, but doesn't a true Turing complete computing device require an infinitely long tape? Meaning, an infinite amount of memory? I was under the impression that there doesn't actually exist any Turing-complete machine in existence, nor will there ever be, due to the infinite tape length problem. All we have is approximations of a Turing-complete device. That being said, we create machines with more memory, they become better approximations.
You're very correct. When we 'program' a human being, it usually involves parents reading to their kids, taking the kid around showing it things, playing with blocks and dolls, etc. etc. Without a body through which to experience the world, this brain-on-a-chip isn't going to be able to gain an anthropomorphic perspective. But, what with advances in carbon nanotube muscles and the like, I wouldn't be surprised if we just put the chip into an android body, and program it that way.
But much of science fiction becomes science fact. At one time, rocket ships going to the moon were science fiction. At one time, talking through the ether to another continent was science fiction. At one time, submarines were science fiction.
Granted, not all science fiction becomes fact. But some of it does.
Remember, our parents thought that if "they" can put a man on the moon, then "they" would have pills that would reverse aging. Well, there are no such pills that can really do that.
You're really not up on your anti-aging science are you? I recommend doing a some google searches on antioxidants, sirtuin, and resveratrol. There's been a lot more research and progress on that particular topic than you may be aware of.
Granted, except for Moore's Law. In my 30 years on this planet, I've been aware of Moore's Law for 20 of them. And in that time, the futurology has been spot-on. 20 years go, the folks said that processors speeds and density of microchips was going to double every 18 months, and that's pretty much where we're at today (with allowances for multi-core processors, etc). Interesting, I've also been seeing similar effects with biology; particularly synthetic biology, and our understanding of DNA. Something similar is going on in that field also.
And if you really want to extrapolate, Moore's Law was cited back in the 60s, I guess. He was working at Texas Instruments at the time, I think. So, it's really been nearly 50 years of accurate futurology and predictions.
You present a good, insightful analysis, that has one critical flaw in it's assumption, I think. That flaw is that the the size of the border remains constant through each tech iteration. If the border size remains constant, and you divide the area by an increasing number of pixels; then, yes, the amount of 'dead space' increases, and you loose information. But that's not necessarily the case. By and large, the photocell designers are taking border size into account also, and that border size is decreasing also with successive tech generations.
However, within a single tech generation, I'd agree that that the pixel borders are probably going to be consistent, and your D40x is going to have more dead space than the regular D40. However, between generations, I don't think that's the case. Your D80 is going to effectively have the same amount of dead space as the D40, even though there is a much higher pixel count. How? They've made the pixel border smaller in the successive tech generations.
Is that really the core of their business? I always thought that it was providing the means to perform high-end, complex computations and simulations. That certainly could involve selling servers, but I'm not sure it's a necessity.
True. However, while I agree with you in your interpretation of the Open Source Philosophy, there is another interpretation going on here which has to do with the Intelligence Community being a part of the national government and the Freedom of Information Act. Grandparent isn't just pointing at any random Joe and saying "give me that code". Rather, the grandparent post is pointing at the US government and saying 'give me that code, because I payed for it with my tax dollars'. It has to do with the fact that any work done by the federal government is, by definition and law, in the public domain.
Yeah, sorry if I was defensive and/or curt; just wasn't understanding which math you were talking about, and thought you were critiquing something else.. Sigh... good example of how simple typos, miscommunications, and assumptions can snowball into more complicated misunderstandings.
Anyhow, kudos to you for working at a hospital. Don't get burned out; it's easy to do (speaking from personal experience). Peace.
All it requires are two pottery bowls, and some water. The water creates the airtight seal. The trick is that it's only useful for something that's sticky enough to click to the upside down bowl. Hence, it's discovery in application to the storage of butter. It was well known in France by the Middle Ages, and might have conceivably be used as early as the Greek and Roman days. We know that the Greeks understood the concept of buoyancy and the displacement of water with air, by way of Archimedes. They definitely had the technology and understanding of physics to do this kind of experiment.
Regarding germ theory, I'd point out that one of the greek goddesses, Hygeia, daughter of Aesclepius, was known for the healing power of cleanliness. She was supposed to have introduced the idea of washing patients with soap and water, and had lots of hospital shrines. Hence, our modern word 'hygiene'.
My guess is that there were plenty of people who worked out simple experiments that disproved spontaneous generation, particularly within the healthcare community. But lack of printing presses and the difficulty in replicating the experiments led to the results of those experiments not being widely disseminated. Or, possibly, the people performing said experiments didn't realize the scope of what they were testing for.
In hind sight, we can say 'oh, the greeks never worked out a single experiment to disprove spontaneous generation!'. Whereas, would say that they never phrased it in those terms. Rather, they were asking themselves 'why does this butter go bad so quickly?' and 'how can we make butter last longer without spoiling?'. Then, they do some experiments, a couple of them find out that a Butter Bell works to keep butter longer, and it's a practice that's adopted in a couple communities. But without printing presses and mass communications, the concept didn't spread, and was probably rediscovered dozens or hundreds of times, until it caught on permanently in France.
If you define all human thought as philosophy, then the word is so broad as to be meaningless. What do you call that field which is practiced by the people we generally call "philosophers?"
The term you're asking about is 'meta-philosophy'. The Philosophy of Philosophy, is what people practice who are generally called 'philosophers'. But lots of people practice plain-old-normal philosophy. Got a PhD? Practicing philosophy. What many people are trying to point out in this discussion is that philosophy is a broad term. It's as broad as the number of people holding PhDs. But it's not a meaningless term, and it has rather specific definitions.
One other poster expressed it very nicely: Philosophy encompasses metaphysics(what is), epistemology(what I know), ethics(what should I do), aesthetics(art), and politics(how to live with others).
Does somebody with a PhD in Physics discuss metaphysics, epistemology, and ethics? Certainly. But so do those people with PhDs in Biology, Art History, Literature, and any number of other areas. You don't have to have a title of Philosopher to practice philosophy, just as you don't have to have the title of Scientist to use the scientific method.
Science is a subset of Philosophy. Ergo, they were using both.
Science is predominantly concerned with Who, What, When, Where, and How. It does not concern itself with 'Why', which is generally the realm of Religion and Philosophy. But, unlike Religion, Philosophy does not have established dogma. Philosophy can be as maleable as needed. Want a philosophy that is consistent with Science? Fine. Do so. There are no religion dogmas telling you otherwise.
But when you get outside the process of making observations and testing hypothesis to confirm how the world works, you're entering a realm of reasoning that's different than Science. When you start questioning they 'why', as in 'what ought i do based on these results', then you're getting into Philosophy. As grandparent points out, the choice to make survival and reproduction as a standard is a value-judgement. And value-judgements are the realm of Philosophy. To be sure, you can have Philosophies that utilize scientific reasoning, because Science is a subset of Philosophy.
Again, as mentioned elsewhere, Science is a subset of Philosophy. To be sure, as a subset, it adds a process of testing and a value-judgement to value consistent explanations. But it's a philosophy unto itself about how the world works. A philosophy with a great many adherents, to be sure. But a philosophy none-the-less.
And, for what it's worth, the idea that the Universe is rational and can be observed in a repeatable manner is not quite as common-sense as one might think based on human experiences. You use the rock analogy and point to gravity as being a common-sense observation. But why the rock example? Why not the winds and clouds? I walk outside and see a cloud. I stand under it. The cloud blows east. I stand under another cloud on another day, and it blows south. Where's the repeatability in that? The rationality? I repeated an experiment, but the universe was not consistent. It was not repeatable in the way that the rock example is. So, while I do agree with you that Science is a pretty nifty concept, I don't think it's as common-sense as it seems. We happen to live in a world where the Scientific Method has become entrenched and new generations of humans are brought up with this concept from infancy. But it wasn't always that way.
Anyhow. There are plenty of philosophers out there who create philosophical constructs about how the world works that can be tested, ranging from Nietzche to Bentham to Rand. But, like Science, you have to subscribe to their system of beliefs, make observations within that system, and judge whether the results are consistent with the world. By the same token, many philosopher's ideas are discarded because they have been found wanting.
Science also starts with a value-proposition, in regards to the Goedel incompleteness theorem, in that it values a consistent set of rules rather than a complete set of rules.
But what if a Philosopher starts with axioms that are based on observations? Therein is the catch that you're not considering.
Historically, Physics and Philosophy have been considered to be very closely related. However, in the past 100 years or so, there seems to be a meme going around that they're not related and are separate fields. At the undergraduate level, this may be a reasonable distinction, in so far as there are only so many hours of the day, and one has to list classes in a course catalog. But at the more advanced levels, practicing Physics becomes an exercise in thinking and philosophizing about how the world works. That is, Physicists use philosophical and analytic reasoning to judge their observations and create hypothesis and theorems from them.
Also, for what it's worth, I have a degree in the History and Philosophy of Science from the University of Chicago. And, having taken a number of classes on the history of science from a University that has done it's share of physics research, I'd have to agree with the grandparent. It's a subtle distinction of ontology and taxonomy, but Physics is generally considered a subset of Philosophy by those who study this particular topic for a living. And lastly, as evidence that Physics is a subset of Philosophy, I'd point out the type of degree that is awarded to the most advanced practitioners of physics:
If we're living 'in a hologram' where we are unable to perceive an extra dimension that exists and affects us, then is it really that different from Plato's example?
One thing to note: In Plato's Allegory of the Cave, he describes human perceptions as shadows of higher-order objects. That is, shadows are displacement of light, by high-order objects. Thus, a shadow can be formally considered as a projection from 3D space to 2D space.
The hologram hypothesis is, in some ways, precisely opposite to what Plato was proposing, in that it's claiming that 3D space is encoded on the 2D surface of some super-universe sphere thingy. That is, 3D space is a projection from 2D space.
Put another way, Plato was suggesting downcasting from N-dimensional to 3-dimensional, whereas the hologram hypothesis is suggesting upcasting from 2-dimensional to 3-dimensional.
Yet, the similarity is striking between the two world views. Plato might not have gotten the particular's right, but he definitely seemed to grok that the world we live in is only a projection of something else.
Actually, grandparent post and great-great-grandparent post are making references to Book VII of Plato's Republic, and the Allegory of the Cave. Plato goes on for 10 or 15 pages about how we perceive and understand the physical universe around us. Of particular note to this thread is that the Allegory of the Cave is a discussion on light, optics, and shadows (displace of light). Plato suggests that the things we observe in life are the displacement, or the shadow, of a more profound universe. This is slightly different that then notion of perfect forms, which he develops more at length elsewhere. Side poster gives a good summary of the allegory.
It's interesting, because there are two perspectives to 'state of the art' going on here, which basically revolve around which 'art' is being considered. On the one hand, there is the Art of Medicine, while on the other hand, there is the Art of Programming. From the view of the clinician, 'state of the art' is what you mean it to be. And one essential aspect for an EMR to be 'state of the art' is that it covers the entire range of medical practice, and brings all of that information into a single repository. As you mention, it must containt meds, labs, orders, notes, diagnosis, imaging, imaging results, surgery reports, pathology reports, admissions, discharges, providers, and so forth. New vendors in this area don't understand that, and people who haven't worked on EMRs don't realize that to get that amount of functionality, you must often invest hundreds of millions, if not billions, of dollars in R&D. So, to that extent, I definately agree with you that a state-of-the-art EMR has to be able to be installed in all departments of a hospital, and integrate those separate departments into a common framework.
To that extent, I would say that VISTA was probably the first EMR to integrate all those separate areas. But it's not the only one nowdays. In particular, I'm also thinking of GE Centricity and Cerner Millennium. I haven't worked in a Centricity environment, so I can only speak from experience regarding a Cerner Millennium environment. Suffice it to say that Cerner has an integrated EMR also. What's more, they've spent well over a billion dollars in R&D on developing their EMR, and are working through their second billion. Unlike VistA, they've also added genetics, pharmacy, nursing home, cardiology, oncology, physician practice, and emergency room specific modules. So, by 'state of the art', I have to ask in regards to VistA, "Where is the Genetics module? Pharmacy? Nursing home? Physician Practice?"
Also, you talk about the VA system being installed at all the VA hospitals. This is, in my opinion, one of the great strengths of VistA, in that it's consistent throughout an entire healthcare network. But this isn't a feature of the EMR, in so much as it's a feature of the Veteran's Administration. The fact that you can pull up records of a patient and see what treatment they've had at any other VA hospital doesn't make VistA more advanced. That's a fairly easy feature to implement from a technical perspective, and all the competing EMR products have it. What's challenging, and what makes the VA hospital network stand apart in this regard, is that they've managed to install the same EMR at all of their hospitals. That's the challenge.
Lastly, I'd mention the 'Art of Programming'. For better or for worse, VistA was written in MUMPS. From a programming perspective, MUMPS has a a couple of really neat benefits, and a lot of really big problems. In particular, it's code is prone to obfuscation. At best, it can be said to resemble Perl and is 'concise'. At worst, it's an unmaintainable mess. There are also other issues of the MUMPS, involving data types and a couple other features of the language, but I won't get into them here. Suffice it to say that supporting MUMPS is a nightmare, and the number of people working with MUMPS is slowly dwindling. I've been involved in phasing out a MUMPS system that had been running a Department of Radiology EMR for 20 years. Both of the businesses that supported it either went out of business, or stopped offering service contracts for the equipment because they couldn't get anybody to maintain the code. Nobody wants to learn MUMPS, and the people who know it are retiring. This is going to be a problem for the VA down the road as people who know MUMPS are going to become more and more scarce.
The simple fact is that VistA may be state-of-the-art in regards to medical practice, but it's code base is slowly loosi
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The DICOM standard that you're referring to happens to be 3000 pages long (there's alot of ground to cover, as medical imaging is a very large field, actually). The problem is that there are different interpretations on how to implement the standard. But generally speaking, it's an open standard and if a medical device is DICOM compliant, you have pretty good assurance that it will be interoperable with other DICOM equipment.
And for what it's worth, there are already plenty of open source medical imaging programs out there, such as ClearCanvas, DCM4CHEE, OsiriX, and KPACS.
Correct me if I'm wrong, but doesn't a true Turing complete computing device require an infinitely long tape? Meaning, an infinite amount of memory? I was under the impression that there doesn't actually exist any Turing-complete machine in existence, nor will there ever be, due to the infinite tape length problem. All we have is approximations of a Turing-complete device. That being said, we create machines with more memory, they become better approximations.
You're very correct. When we 'program' a human being, it usually involves parents reading to their kids, taking the kid around showing it things, playing with blocks and dolls, etc. etc. Without a body through which to experience the world, this brain-on-a-chip isn't going to be able to gain an anthropomorphic perspective. But, what with advances in carbon nanotube muscles and the like, I wouldn't be surprised if we just put the chip into an android body, and program it that way.
But much of science fiction becomes science fact. At one time, rocket ships going to the moon were science fiction. At one time, talking through the ether to another continent was science fiction. At one time, submarines were science fiction.
Granted, not all science fiction becomes fact. But some of it does.
Ah. Well, you got a point there. Agreed.
Remember, our parents thought that if "they" can put a man on the moon, then "they" would have pills that would reverse aging. Well, there are no such pills that can really do that.
You're really not up on your anti-aging science are you? I recommend doing a some google searches on antioxidants, sirtuin, and resveratrol. There's been a lot more research and progress on that particular topic than you may be aware of.
Granted, except for Moore's Law. In my 30 years on this planet, I've been aware of Moore's Law for 20 of them. And in that time, the futurology has been spot-on. 20 years go, the folks said that processors speeds and density of microchips was going to double every 18 months, and that's pretty much where we're at today (with allowances for multi-core processors, etc). Interesting, I've also been seeing similar effects with biology; particularly synthetic biology, and our understanding of DNA. Something similar is going on in that field also.
And if you really want to extrapolate, Moore's Law was cited back in the 60s, I guess. He was working at Texas Instruments at the time, I think. So, it's really been nearly 50 years of accurate futurology and predictions.
You present a good, insightful analysis, that has one critical flaw in it's assumption, I think. That flaw is that the the size of the border remains constant through each tech iteration. If the border size remains constant, and you divide the area by an increasing number of pixels; then, yes, the amount of 'dead space' increases, and you loose information. But that's not necessarily the case. By and large, the photocell designers are taking border size into account also, and that border size is decreasing also with successive tech generations.
However, within a single tech generation, I'd agree that that the pixel borders are probably going to be consistent, and your D40x is going to have more dead space than the regular D40. However, between generations, I don't think that's the case. Your D80 is going to effectively have the same amount of dead space as the D40, even though there is a much higher pixel count. How? They've made the pixel border smaller in the successive tech generations.
Woosh....
They want to push this illusion that the Postal Service can or is self supporting.
Pray tell... what is that $0.42 stamp used for, then? Besides offsetting operation costs, that is.
Is that really the core of their business? I always thought that it was providing the means to perform high-end, complex computations and simulations. That certainly could involve selling servers, but I'm not sure it's a necessity.
True. However, while I agree with you in your interpretation of the Open Source Philosophy, there is another interpretation going on here which has to do with the Intelligence Community being a part of the national government and the Freedom of Information Act. Grandparent isn't just pointing at any random Joe and saying "give me that code". Rather, the grandparent post is pointing at the US government and saying 'give me that code, because I payed for it with my tax dollars'. It has to do with the fact that any work done by the federal government is, by definition and law, in the public domain.
Mod parent up. Excellent point about ostracization and grudges.
Yeah, sorry if I was defensive and/or curt; just wasn't understanding which math you were talking about, and thought you were critiquing something else.. Sigh... good example of how simple typos, miscommunications, and assumptions can snowball into more complicated misunderstandings.
Anyhow, kudos to you for working at a hospital. Don't get burned out; it's easy to do (speaking from personal experience). Peace.
Well, to answer your question, in all seriousness, take a look at the Butter Crock, also known as a Butter Bell.
http://www.webexhibits.org/butter/crocks.html
All it requires are two pottery bowls, and some water. The water creates the airtight seal. The trick is that it's only useful for something that's sticky enough to click to the upside down bowl. Hence, it's discovery in application to the storage of butter. It was well known in France by the Middle Ages, and might have conceivably be used as early as the Greek and Roman days. We know that the Greeks understood the concept of buoyancy and the displacement of water with air, by way of Archimedes. They definitely had the technology and understanding of physics to do this kind of experiment.
Regarding germ theory, I'd point out that one of the greek goddesses, Hygeia, daughter of Aesclepius, was known for the healing power of cleanliness. She was supposed to have introduced the idea of washing patients with soap and water, and had lots of hospital shrines. Hence, our modern word 'hygiene'.
My guess is that there were plenty of people who worked out simple experiments that disproved spontaneous generation, particularly within the healthcare community. But lack of printing presses and the difficulty in replicating the experiments led to the results of those experiments not being widely disseminated. Or, possibly, the people performing said experiments didn't realize the scope of what they were testing for.
In hind sight, we can say 'oh, the greeks never worked out a single experiment to disprove spontaneous generation!'. Whereas, would say that they never phrased it in those terms. Rather, they were asking themselves 'why does this butter go bad so quickly?' and 'how can we make butter last longer without spoiling?'. Then, they do some experiments, a couple of them find out that a Butter Bell works to keep butter longer, and it's a practice that's adopted in a couple communities. But without printing presses and mass communications, the concept didn't spread, and was probably rediscovered dozens or hundreds of times, until it caught on permanently in France.
If you define all human thought as philosophy, then the word is so broad as to be meaningless. What do you call that field which is practiced by the people we generally call "philosophers?"
The term you're asking about is 'meta-philosophy'. The Philosophy of Philosophy, is what people practice who are generally called 'philosophers'. But lots of people practice plain-old-normal philosophy. Got a PhD? Practicing philosophy. What many people are trying to point out in this discussion is that philosophy is a broad term. It's as broad as the number of people holding PhDs. But it's not a meaningless term, and it has rather specific definitions.
One other poster expressed it very nicely: Philosophy encompasses metaphysics(what is), epistemology(what I know), ethics(what should I do), aesthetics(art), and politics(how to live with others).
Does somebody with a PhD in Physics discuss metaphysics, epistemology, and ethics? Certainly. But so do those people with PhDs in Biology, Art History, Literature, and any number of other areas. You don't have to have a title of Philosopher to practice philosophy, just as you don't have to have the title of Scientist to use the scientific method.
Science is a subset of Philosophy. Ergo, they were using both.
Science is predominantly concerned with Who, What, When, Where, and How. It does not concern itself with 'Why', which is generally the realm of Religion and Philosophy. But, unlike Religion, Philosophy does not have established dogma. Philosophy can be as maleable as needed. Want a philosophy that is consistent with Science? Fine. Do so. There are no religion dogmas telling you otherwise.
But when you get outside the process of making observations and testing hypothesis to confirm how the world works, you're entering a realm of reasoning that's different than Science. When you start questioning they 'why', as in 'what ought i do based on these results', then you're getting into Philosophy. As grandparent points out, the choice to make survival and reproduction as a standard is a value-judgement. And value-judgements are the realm of Philosophy. To be sure, you can have Philosophies that utilize scientific reasoning, because Science is a subset of Philosophy.
Again, as mentioned elsewhere, Science is a subset of Philosophy. To be sure, as a subset, it adds a process of testing and a value-judgement to value consistent explanations. But it's a philosophy unto itself about how the world works. A philosophy with a great many adherents, to be sure. But a philosophy none-the-less.
And, for what it's worth, the idea that the Universe is rational and can be observed in a repeatable manner is not quite as common-sense as one might think based on human experiences. You use the rock analogy and point to gravity as being a common-sense observation. But why the rock example? Why not the winds and clouds? I walk outside and see a cloud. I stand under it. The cloud blows east. I stand under another cloud on another day, and it blows south. Where's the repeatability in that? The rationality? I repeated an experiment, but the universe was not consistent. It was not repeatable in the way that the rock example is. So, while I do agree with you that Science is a pretty nifty concept, I don't think it's as common-sense as it seems. We happen to live in a world where the Scientific Method has become entrenched and new generations of humans are brought up with this concept from infancy. But it wasn't always that way.
Anyhow. There are plenty of philosophers out there who create philosophical constructs about how the world works that can be tested, ranging from Nietzche to Bentham to Rand. But, like Science, you have to subscribe to their system of beliefs, make observations within that system, and judge whether the results are consistent with the world. By the same token, many philosopher's ideas are discarded because they have been found wanting.
Science also starts with a value-proposition, in regards to the Goedel incompleteness theorem, in that it values a consistent set of rules rather than a complete set of rules.
But what if a Philosopher starts with axioms that are based on observations? Therein is the catch that you're not considering.
Historically, Physics and Philosophy have been considered to be very closely related. However, in the past 100 years or so, there seems to be a meme going around that they're not related and are separate fields. At the undergraduate level, this may be a reasonable distinction, in so far as there are only so many hours of the day, and one has to list classes in a course catalog. But at the more advanced levels, practicing Physics becomes an exercise in thinking and philosophizing about how the world works. That is, Physicists use philosophical and analytic reasoning to judge their observations and create hypothesis and theorems from them.
Also, for what it's worth, I have a degree in the History and Philosophy of Science from the University of Chicago. And, having taken a number of classes on the history of science from a University that has done it's share of physics research, I'd have to agree with the grandparent. It's a subtle distinction of ontology and taxonomy, but Physics is generally considered a subset of Philosophy by those who study this particular topic for a living. And lastly, as evidence that Physics is a subset of Philosophy, I'd point out the type of degree that is awarded to the most advanced practitioners of physics:
PhD Physics = Doctorate of Philosophy in Physics.
If we're living 'in a hologram' where we are unable to perceive an extra dimension that exists and affects us, then is it really that different from Plato's example?
One thing to note: In Plato's Allegory of the Cave, he describes human perceptions as shadows of higher-order objects. That is, shadows are displacement of light, by high-order objects. Thus, a shadow can be formally considered as a projection from 3D space to 2D space.
The hologram hypothesis is, in some ways, precisely opposite to what Plato was proposing, in that it's claiming that 3D space is encoded on the 2D surface of some super-universe sphere thingy. That is, 3D space is a projection from 2D space.
Put another way, Plato was suggesting downcasting from N-dimensional to 3-dimensional, whereas the hologram hypothesis is suggesting upcasting from 2-dimensional to 3-dimensional.
Yet, the similarity is striking between the two world views. Plato might not have gotten the particular's right, but he definitely seemed to grok that the world we live in is only a projection of something else.
Actually, grandparent post and great-great-grandparent post are making references to Book VII of Plato's Republic, and the Allegory of the Cave. Plato goes on for 10 or 15 pages about how we perceive and understand the physical universe around us. Of particular note to this thread is that the Allegory of the Cave is a discussion on light, optics, and shadows (displace of light). Plato suggests that the things we observe in life are the displacement, or the shadow, of a more profound universe. This is slightly different that then notion of perfect forms, which he develops more at length elsewhere. Side poster gives a good summary of the allegory.
Ah. Good catch. I stand corrected.
Thank you for the thoughtful response,
It's interesting, because there are two perspectives to 'state of the art' going on here, which basically revolve around which 'art' is being considered. On the one hand, there is the Art of Medicine, while on the other hand, there is the Art of Programming. From the view of the clinician, 'state of the art' is what you mean it to be. And one essential aspect for an EMR to be 'state of the art' is that it covers the entire range of medical practice, and brings all of that information into a single repository. As you mention, it must containt meds, labs, orders, notes, diagnosis, imaging, imaging results, surgery reports, pathology reports, admissions, discharges, providers, and so forth. New vendors in this area don't understand that, and people who haven't worked on EMRs don't realize that to get that amount of functionality, you must often invest hundreds of millions, if not billions, of dollars in R&D. So, to that extent, I definately agree with you that a state-of-the-art EMR has to be able to be installed in all departments of a hospital, and integrate those separate departments into a common framework.
To that extent, I would say that VISTA was probably the first EMR to integrate all those separate areas. But it's not the only one nowdays. In particular, I'm also thinking of GE Centricity and Cerner Millennium. I haven't worked in a Centricity environment, so I can only speak from experience regarding a Cerner Millennium environment. Suffice it to say that Cerner has an integrated EMR also. What's more, they've spent well over a billion dollars in R&D on developing their EMR, and are working through their second billion. Unlike VistA, they've also added genetics, pharmacy, nursing home, cardiology, oncology, physician practice, and emergency room specific modules. So, by 'state of the art', I have to ask in regards to VistA, "Where is the Genetics module? Pharmacy? Nursing home? Physician Practice?"
Also, you talk about the VA system being installed at all the VA hospitals. This is, in my opinion, one of the great strengths of VistA, in that it's consistent throughout an entire healthcare network. But this isn't a feature of the EMR, in so much as it's a feature of the Veteran's Administration. The fact that you can pull up records of a patient and see what treatment they've had at any other VA hospital doesn't make VistA more advanced. That's a fairly easy feature to implement from a technical perspective, and all the competing EMR products have it. What's challenging, and what makes the VA hospital network stand apart in this regard, is that they've managed to install the same EMR at all of their hospitals. That's the challenge.
Lastly, I'd mention the 'Art of Programming'. For better or for worse, VistA was written in MUMPS. From a programming perspective, MUMPS has a a couple of really neat benefits, and a lot of really big problems. In particular, it's code is prone to obfuscation. At best, it can be said to resemble Perl and is 'concise'. At worst, it's an unmaintainable mess. There are also other issues of the MUMPS, involving data types and a couple other features of the language, but I won't get into them here. Suffice it to say that supporting MUMPS is a nightmare, and the number of people working with MUMPS is slowly dwindling. I've been involved in phasing out a MUMPS system that had been running a Department of Radiology EMR for 20 years. Both of the businesses that supported it either went out of business, or stopped offering service contracts for the equipment because they couldn't get anybody to maintain the code. Nobody wants to learn MUMPS, and the people who know it are retiring. This is going to be a problem for the VA down the road as people who know MUMPS are going to become more and more scarce.
The simple fact is that VistA may be state-of-the-art in regards to medical practice, but it's code base is slowly loosi
Sorry for replying to myself, but a note on my math above: i counted the 50% twice. The math should be:
150,000 x 0.5 x 2 x 10.5MB = 1.5TB per year
alternatively,
750,000 x 2 x 10.5MB = 1.5TB per year
Add an extra gigabyte for US, MR, and CT studies, and you get the 2.5TB that we recorded.