Since I submitted this, nola.com came out with a more in depth article. The NFL is claiming "who dat" too, which has also been around for years and years, AND the roman numerals XLIV, which have been around, since... well, the Romans. The article goes more in depth about the history of "who dat" which is pretty interesting.
Resident physicians are FLSA exempt not because of their salary, but because they're a "learned profession." So we get $40K to work up to 80 hours a week and take call up to every 3rd night, during which you are expected to go without sleep for up to 30 hours, for which there is no additional compensation. Sucks. And many of the calls are probably the IT equivalent of "I forgot my password." Things like "this medication that the patient isn't asking for because it's 3AM and they're asleep, it's about to expire, do you want to renew it?"
Afterwards, however, there are models where you get paid for call. We have a backup call system in our ER where a physician is a paid a set amount to carry the pager, then gets paid by the hour if they get called in. And I know another guy who gets paid a set amount to carry a pager for an inpatient psych unit here, then he gets paid per admission he sees the next day. As for me, I hate being on call, even if it's home/pager call, so I gravitate towards shift work.
Be OS was a very good OS so we should see good things from Haiku, too. The niche it filled will be different today for Haiku, but still highly relevant. Netbooks are all the rage now. I expect it will be tried there first.
I absolutely loved BeOS! I mean, I love the MacBook I have now, but BeOS was my first love:-)
I don't own a netbook currently, but I would very likely buy one just to run BeOS/Haiku on it when it's ready. Basically, for me the OS would be the killer app that would entice me to buy the hardware.
At the VA, they require us to have a ridiculous number of strong passwords.
When you first start, you get a piece of paper that says: Username Password Access Code Verify Code Signature Code LMS Username LMS Password Met Username Met Password
Then at the bottom it says "Remember within 48 hours." Yeah right.
Then the system forces you to change all of these passwords at varying intervals. So even if you start off by having all of the passwords the same, within a few months they're all different.
I wonder what will be the limit on the thermal sensors. I live in Texas and it would suck if I voided my warranty every time I walked outside with my laptop between the months of June and August. Or got into my 150-degree car after it's been sitting in the sun all day...
Confidentiality is very, very important to businesses and individuals, even more so in the Internet age. One of the reasons to continue to operate your own infrastructure, no matter what the current hype is.
IAAD and I agree that confidentiality is extremely important, and health care professionals have a responsibility to safeguard PHI. However, I also think that IT admins have a responsibility to create an infrastructure that doesn't suck and that takes into account the needs of the people that actually need to use it. Because if it sucks bad enough, people will find a way to circumvent some of the safeguards in order to get their work done. Because it's human nature that getting one's work done is a more immediate need than theoretical concerns about privacy and confidentiality. So if you're going to develop an internal system, looking at what makes "the current hype" so popular might not be a bad idea.
For example, I work at a large county hospital/university system that has adopted groupwise. We are told that PHI is secure if sent through groupwise. However, besides the fact that groupwise is inherently sucky, they've made it extremely inconvenient for residents to use it. We cannot run the real client because we aren't allowed to have VPN access, so we have to use the web client, which has a horrible interface. It has a tiny storage allotment. They will not install the software that will allow it to work on the iphone. So, most people forward their groupwise email to their personal gmail or yahoo mail or whatever. Thus defeating the purpose of having the secure system.
Yes, it's wrong for the doctors to circumvent the security. However, I think it's just as wrong for the IT people to implement a system so crappy that people are driven to do this. Most doctors are thinking along the lines of "I have patients to take care of, I don't have all this time to spend fiddling with this crappy groupwise thing" not "let me violate HIPAA because I'm lazy."
If you think this is bad, consider that most electronic medical records pop up pointless warnings even more frequently. Sometimes they catch a legitimate error, but it's hard to not get conditioned to ignore those without really reading them.
I think I read some story many years ago about a boy who cried wolf... Same principle. Warnings cease to be effective if they pop up all the freakin' time for no good reason.
Don't get me wrong. There are tons of doctors that are computer and gadget freaks, but there are tons more that rarely touch a computer except for basic Internet and MS Office services and have to be guided through the intricacies of an electronic records system and how to use it.
Another explanation is that it's a failure in UI design on the part of the EMR. One should not have to be a computer geek/gadget freak in order to use an EMR. The same skills that lets someone type a word document or use a web browser should suffice. Most of the EMRs have horrible UIs and are not intuitive at all. I myself AM one of those gadget freak physicians, even wrote some of the templates in use at one of our hospitals, yet I still have difficulty figuring out how to do certain things.
But then, I'm a mac user. Perhaps my expectations are too high;-)
I'm a resident physician, and so I've used various EMRs in different hospital and clinic settings, and they pretty much all suck in different ways. EPIC, which is based in Internet Explorer of all things, is the worst, but seems to the the one that's being adopted at the most hospitals.
The UI design is just horrible, but beyond that I had a hard time putting my concerns into words until I read an article somewhere that talked about something called "cognitive support to the physician." That is what most EMRs lack.
As a physician, I want an EMR that lets me rapidly get at important clinical information and give me targeted alerts that I need to make a decision. Instead, the systems are centered around billing and cover-your-ass medicolegal documentation. In the paper chart word, these issues had already diluted the meaningfulness of the chart. (Ever see a hospital chart - maybe 10-20% of it has meaningful clinical data in it, the rest is full of useless legal/billing/redundant crap.) Many EMRs just translate the same troubled paper chart system into electronic format, but then the ease of electronic data entry means that even more useless information is included/required, making it that much harder to find the info you really need to make a clinical decision.
I have to say that the best EMR I have used is still good ol' CRPS at the VA. It's not as slick looking as the newer ones, but the data is easily accessible and I have never had to waste my time looking up a billing code. It's been chugging along for over a decade, sharing data between hundreds of sites across the country. (And the issue in the first article about the EMR causing more deaths because you can't put in orders while the patient is en route - not an issue in CPRS, we do this all the time at our VA.)
My understanding is that the code for CPRS is open and free to anyone who wants it. I would gladly choose CRPS over the ability to type my notes with colored fonts in EPIC. They were considering adapting it for the large county hospital system where I work now, but in the end went with EPIC because... wait for it... it was easier for billing.
It's worse among doctors. It doesn't surprise me that the BBC article contains reports about residents and interns dying. I wonder how many patients get infected via sick doctors?
Large teaching hospitals are dependent on residents who work 80 hours a week to barely cover the workload. If someone calls in sick, then it means your already overworked and fatigued colleagues will have to cover for your "weakness." Oftentimes the onus is on you to find your replacement. And so the culture discourages it - either through active hostility or feelings of guilt and/or machismo on the part of the sick person. This culture is learned in med school and residency then gets carried forward.
I'm a resident physician and every year I have to do some online training for all hospital employees that says to stay home if you're sick, and we residents just laugh. The idea of calling in sick for a low grade temp and a cough is so out of the realm of possibility, it's absurd. I'm not saying this is a good or noble thing - there's a lot of things about the culture of medicine and residency (such as work hours) that are fucked up and end up adversely affecting patient care.
Totally agree, but they should be wary of the airlines that make their bread and butter from regional travel.
A while back a bunch of businesses in Texas formed a consortium to build a high speed rail network linking the major Texas cities. Southwest Airlines effectively lobbied against and killed it.
Which really sucks, because I'd much rather take a train from Dallas to Austin than deal the hassle of air travel. If you factor all of the airport BS, it takes nearly the same time as driving.
The Haiku page says that it's "inspired by" BeOS. So what's that mean exactly - that they're trying to reverse engineer it? What happened to the old Be source code? Seems silly to have to reinvent the wheel if the code is already written and not being used for anything.
I'm sick of these stupid "propranolol deletes memory" headlines. There was even an episode of boston legal or law & order perpetuating this nonsense a year or so ago. The drug does not "delete" a specific memory. The only people who can that are on star trek. The drug simply reduces the emotional significance of the memory, uncoupling it from the autonomic/fear response associated with it. A HUGE difference.
That reminds me: One thing that should definitely be covered is the 3-way "Save file" dialog that comes up when exiting a program/shutting down, and similar dialogs, that offer "Yes", "No", and "Cancel". This confuses the heck out of many users, and it's not reasonable to expect them to figure it out on their own unless they're geeks. They need to know that "Cancel" is a sure-fire way to get nothing done and be back where they started, and that they need to click "No" if they want to continue exiting the program but don't want to save the file.
Which I guess is why the Mac exiting dialog box says "save", "don't save" and "cancel."
I think I read somewhere that it's better UI design to have verbs on the buttons instead of yes and no...
Some dumbass is always printing 300 pages of documents and hogging the printer. Forchrissakes, just figure out what pages you need and print those! Asshole.
Like when I was in grad school, I remember our IT guy was hopping mad because he had to come in on a sunday to reboot the server because some dumbass decided to print the entire mouse chromomome 22 sequence. Something about a spool file and crashing his server...
Me too. Not only have I tripped over the power cord and sent my powerbook flying across the room, only to crash onto my hardwood floor (thank heavens for laptop insurance), but I've also tripped on it such that the cord ripped out of the part that plugs into the laptop. Twice. Those damn things cost $70 to replace!
Life isn't a multiple-choice quiz, and education shouldn't be, either.
They work well at my medical school, where - like it or not - a main goal of our education is to ensure good performance on the multiple choice medical licensing board exams.
One of the biochem professors like to put board-type questions up and have the students respond with the clickers. Then he shifts the focus of his lectures to address topics in which we need more instruction, and not waste our time going over stuff we've already mastered. In that respect, I kinda like 'em.
Also, I understand how some people may think that they take away students' assertiveness. They might, in some settings. Without the clickers, it's black and white - you either have assertive students who answer questions in class, or non assertive students who just sit there. The clickers add a shade of gray - students who are interacting with the professor, just not out loud. In medical school, the students who speak up in class are often annoying little sycophants who are only speaking in order to show off how much they know and suck up to the professor. Oftentimes, regular people who've got something to say will keep quiet for fear of being lumped in with this group. Personally, I usually ask the professor my questions after class or via email to avoid the drama of it all. (And noone who knows me would say I'm not assertive.) Perhaps the clickers will change some of this somewhat, and put the focus on education rather than showing off.
Slashdot Mirror
Since I submitted this, nola.com came out with a more in depth article. The NFL is claiming "who dat" too, which has also been around for years and years, AND the roman numerals XLIV, which have been around, since... well, the Romans. The article goes more in depth about the history of "who dat" which is pretty interesting.
http://www.nola.com/saints/index.ssf/2010/01/post_140.html
What are these people going to find out... my hometown? My college? My favorite tv shows? Who cares?
Sounds like those questions the bank website asks me to prove I'm me...
Resident physicians are FLSA exempt not because of their salary, but because they're a "learned profession." So we get $40K to work up to 80 hours a week and take call up to every 3rd night, during which you are expected to go without sleep for up to 30 hours, for which there is no additional compensation. Sucks. And many of the calls are probably the IT equivalent of "I forgot my password." Things like "this medication that the patient isn't asking for because it's 3AM and they're asleep, it's about to expire, do you want to renew it?"
Afterwards, however, there are models where you get paid for call. We have a backup call system in our ER where a physician is a paid a set amount to carry the pager, then gets paid by the hour if they get called in. And I know another guy who gets paid a set amount to carry a pager for an inpatient psych unit here, then he gets paid per admission he sees the next day. As for me, I hate being on call, even if it's home/pager call, so I gravitate towards shift work.
for apps
and it really was the floor mat. Now I'm OCD about making sure it's in the right spot before I get in the car...
Be OS was a very good OS so we should see good things from Haiku, too. The niche it filled will be different today for Haiku, but still highly relevant. Netbooks are all the rage now. I expect it will be tried there first.
I absolutely loved BeOS! I mean, I love the MacBook I have now, but BeOS was my first love :-)
I don't own a netbook currently, but I would very likely buy one just to run BeOS/Haiku on it when it's ready. Basically, for me the OS would be the killer app that would entice me to buy the hardware.
At the VA, they require us to have a ridiculous number of strong passwords.
When you first start, you get a piece of paper that says:
Username
Password
Access Code
Verify Code
Signature Code
LMS Username
LMS Password
Met Username
Met Password
Then at the bottom it says "Remember within 48 hours." Yeah right.
Then the system forces you to change all of these passwords at varying intervals. So even if you start off by having all of the passwords the same, within a few months they're all different.
And they wonder why people write stuff down.
I wonder what will be the limit on the thermal sensors. I live in Texas and it would suck if I voided my warranty every time I walked outside with my laptop between the months of June and August. Or got into my 150-degree car after it's been sitting in the sun all day...
Confidentiality is very, very important to businesses and individuals, even more so in the Internet age. One of the reasons to continue to operate your own infrastructure, no matter what the current hype is.
IAAD and I agree that confidentiality is extremely important, and health care professionals have a responsibility to safeguard PHI. However, I also think that IT admins have a responsibility to create an infrastructure that doesn't suck and that takes into account the needs of the people that actually need to use it. Because if it sucks bad enough, people will find a way to circumvent some of the safeguards in order to get their work done. Because it's human nature that getting one's work done is a more immediate need than theoretical concerns about privacy and confidentiality. So if you're going to develop an internal system, looking at what makes "the current hype" so popular might not be a bad idea.
For example, I work at a large county hospital/university system that has adopted groupwise. We are told that PHI is secure if sent through groupwise. However, besides the fact that groupwise is inherently sucky, they've made it extremely inconvenient for residents to use it. We cannot run the real client because we aren't allowed to have VPN access, so we have to use the web client, which has a horrible interface. It has a tiny storage allotment. They will not install the software that will allow it to work on the iphone. So, most people forward their groupwise email to their personal gmail or yahoo mail or whatever. Thus defeating the purpose of having the secure system.
Yes, it's wrong for the doctors to circumvent the security. However, I think it's just as wrong for the IT people to implement a system so crappy that people are driven to do this. Most doctors are thinking along the lines of "I have patients to take care of, I don't have all this time to spend fiddling with this crappy groupwise thing" not "let me violate HIPAA because I'm lazy."
That guy from Numbers does this almost every week.
If you think this is bad, consider that most electronic medical records pop up pointless warnings even more frequently. Sometimes they catch a legitimate error, but it's hard to not get conditioned to ignore those without really reading them.
I think I read some story many years ago about a boy who cried wolf... Same principle. Warnings cease to be effective if they pop up all the freakin' time for no good reason.
It's all Howard Wolowitz's fault.
Don't get me wrong. There are tons of doctors that are computer and gadget freaks, but there are tons more that rarely touch a computer except for basic Internet and MS Office services and have to be guided through the intricacies of an electronic records system and how to use it.
Another explanation is that it's a failure in UI design on the part of the EMR. One should not have to be a computer geek/gadget freak in order to use an EMR. The same skills that lets someone type a word document or use a web browser should suffice. Most of the EMRs have horrible UIs and are not intuitive at all. I myself AM one of those gadget freak physicians, even wrote some of the templates in use at one of our hospitals, yet I still have difficulty figuring out how to do certain things.
But then, I'm a mac user. Perhaps my expectations are too high ;-)
I'm a resident physician, and so I've used various EMRs in different hospital and clinic settings, and they pretty much all suck in different ways. EPIC, which is based in Internet Explorer of all things, is the worst, but seems to the the one that's being adopted at the most hospitals.
The UI design is just horrible, but beyond that I had a hard time putting my concerns into words until I read an article somewhere that talked about something called "cognitive support to the physician." That is what most EMRs lack.
As a physician, I want an EMR that lets me rapidly get at important clinical information and give me targeted alerts that I need to make a decision. Instead, the systems are centered around billing and cover-your-ass medicolegal documentation. In the paper chart word, these issues had already diluted the meaningfulness of the chart. (Ever see a hospital chart - maybe 10-20% of it has meaningful clinical data in it, the rest is full of useless legal/billing/redundant crap.) Many EMRs just translate the same troubled paper chart system into electronic format, but then the ease of electronic data entry means that even more useless information is included/required, making it that much harder to find the info you really need to make a clinical decision.
I have to say that the best EMR I have used is still good ol' CRPS at the VA. It's not as slick looking as the newer ones, but the data is easily accessible and I have never had to waste my time looking up a billing code. It's been chugging along for over a decade, sharing data between hundreds of sites across the country. (And the issue in the first article about the EMR causing more deaths because you can't put in orders while the patient is en route - not an issue in CPRS, we do this all the time at our VA.)
My understanding is that the code for CPRS is open and free to anyone who wants it. I would gladly choose CRPS over the ability to type my notes with colored fonts in EPIC. They were considering adapting it for the large county hospital system where I work now, but in the end went with EPIC because... wait for it... it was easier for billing.
It's worse among doctors. It doesn't surprise me that the BBC article contains reports about residents and interns dying. I wonder how many patients get infected via sick doctors?
Large teaching hospitals are dependent on residents who work 80 hours a week to barely cover the workload. If someone calls in sick, then it means your already overworked and fatigued colleagues will have to cover for your "weakness." Oftentimes the onus is on you to find your replacement. And so the culture discourages it - either through active hostility or feelings of guilt and/or machismo on the part of the sick person. This culture is learned in med school and residency then gets carried forward.
I'm a resident physician and every year I have to do some online training for all hospital employees that says to stay home if you're sick, and we residents just laugh. The idea of calling in sick for a low grade temp and a cough is so out of the realm of possibility, it's absurd. I'm not saying this is a good or noble thing - there's a lot of things about the culture of medicine and residency (such as work hours) that are fucked up and end up adversely affecting patient care.
I guess this kinda puts a damper on all the cloud computing hype of late...
Totally agree, but they should be wary of the airlines that make their bread and butter from regional travel.
A while back a bunch of businesses in Texas formed a consortium to build a high speed rail network linking the major Texas cities. Southwest Airlines effectively lobbied against and killed it.
Which really sucks, because I'd much rather take a train from Dallas to Austin than deal the hassle of air travel. If you factor all of the airport BS, it takes nearly the same time as driving.
I loved BeOS and was so sad when it went away.
The Haiku page says that it's "inspired by" BeOS. So what's that mean exactly - that they're trying to reverse engineer it? What happened to the old Be source code? Seems silly to have to reinvent the wheel if the code is already written and not being used for anything.
I'm sick of these stupid "propranolol deletes memory" headlines. There was even an episode of boston legal or law & order perpetuating this nonsense a year or so ago. The drug does not "delete" a specific memory. The only people who can that are on star trek. The drug simply reduces the emotional significance of the memory, uncoupling it from the autonomic/fear response associated with it. A HUGE difference.
Ah, the typo. The bane of my existence. It was chromosome 12. And I also misstyped "chromomome." But alas, I was too quick on the submit button.
:-)
But I still got a +5 funny
That reminds me: One thing that should definitely be covered is the 3-way "Save file" dialog that comes up when exiting a program/shutting down, and similar dialogs, that offer "Yes", "No", and "Cancel". This confuses the heck out of many users, and it's not reasonable to expect them to figure it out on their own unless they're geeks. They need to know that "Cancel" is a sure-fire way to get nothing done and be back where they started, and that they need to click "No" if they want to continue exiting the program but don't want to save the file.
Which I guess is why the Mac exiting dialog box says "save", "don't save" and "cancel."
I think I read somewhere that it's better UI design to have verbs on the buttons instead of yes and no...
Some dumbass is always printing 300 pages of documents and hogging the printer. Forchrissakes, just figure out what pages you need and print those! Asshole.
Like when I was in grad school, I remember our IT guy was hopping mad because he had to come in on a sunday to reboot the server because some dumbass decided to print the entire mouse chromomome 22 sequence. Something about a spool file and crashing his server...
Me too. Not only have I tripped over the power cord and sent my powerbook flying across the room, only to crash onto my hardwood floor (thank heavens for laptop insurance), but I've also tripped on it such that the cord ripped out of the part that plugs into the laptop. Twice. Those damn things cost $70 to replace!
Can it run on dead cats?
Life isn't a multiple-choice quiz, and education shouldn't be, either.
They work well at my medical school, where - like it or not - a main goal of our education is to ensure good performance on the multiple choice medical licensing board exams.
One of the biochem professors like to put board-type questions up and have the students respond with the clickers. Then he shifts the focus of his lectures to address topics in which we need more instruction, and not waste our time going over stuff we've already mastered. In that respect, I kinda like 'em.
Also, I understand how some people may think that they take away students' assertiveness. They might, in some settings. Without the clickers, it's black and white - you either have assertive students who answer questions in class, or non assertive students who just sit there. The clickers add a shade of gray - students who are interacting with the professor, just not out loud. In medical school, the students who speak up in class are often annoying little sycophants who are only speaking in order to show off how much they know and suck up to the professor. Oftentimes, regular people who've got something to say will keep quiet for fear of being lumped in with this group. Personally, I usually ask the professor my questions after class or via email to avoid the drama of it all. (And noone who knows me would say I'm not assertive.) Perhaps the clickers will change some of this somewhat, and put the focus on education rather than showing off.