I don't understand all these buzz about electronic health records.
The buzz is because there is evidence that using them measurably reduces avoidable medical errors.
The roots of health care crisis are that doctors charge you $500 for seeing you for 2 minute w/o doing anything else and hospital charges thousands for lying on their bed for one night of "observation."
There's a lot wrong with the statement, but rather than the narrow problems, I'll point out the broad one. The roots of the problems in the US healthcare system are a lot broader than that. Inasmuch as the things you point to are accurate, they are symptoms, not roots, of the problem. OTOH, there are major legislative pushes aimed at dealing with the broader problems of access and affordability, but they don't eliminate the utility of dealing with these kind of issues, as well.
Doing anything which requires an exhaustive or near exhaustive database of internet content requires far more resources than it would have in the mid-90s.
True, but largely irrelevant; winning the search engine war might requiring that, breaking into search doesn't. Better results in even a narrow domain would establish a toe-hold, and then you grow it from there.
In the cloud computing means you're not only putting all your eggs in one basket, you don't own or control the basket!
Actually, it doesn't even mean you are putting all your eggs in one basket, much less that all your eggs are in one basket you don't control. There's no reason I can't have my own servers and, say, on demand EC2 instances running the same software, and have them all storing data using a replicated storage arrangement where there are all the non-transient data is updated on my servers, not stored exclusively in the cloud.
BuIf someone creates a significant business infrastructure around an open source software package that has no viable replacement, and in particular makes a significant investment in enhancing it, a revocation contrary to the license's own terms is a perfect setup for the doctrine of promissory estoppel to be applied.
I agree; as an equitable doctrine, however, it usually will not be applied (I'm speaking generally, there is, AFAIK, very little if any gratuitous-copyright-license-specific case law invoking promissory estoppel) the same way a contract would; specifically, promissory estoppel usually won't create a permanent right, it will limit the effect of an exercise of the right to revoke a license. The exceptions I am familiar with are all cases (like the one cited earlier in this thread regarding a license to redirect a stream) where the circumstances make the right essentially all-or-nothing.
I say "all the more so" in the case of copyright licenses, because unlike a gratuitous license to cross one's real property, a gratuitous copyright license does not create an ongoing economic or physical burden on the part of the licensor.
IMO, this is simply not true: not allowing a copyright holder to revoke a gratuitous license creates exactly the same kind of ongoing economic burden on the licensor as does not allowing a real property owner to revoke a gratuitous license to another to make economically-significant use of his land. In either case, the economic utility of the property to the revoking licensor is limited by the courts refusal to give effect to the revocation. Now, there is a reason that estoppel will nonetheless limit the effect given to a revocation -- to avoid manifest injustice to the licensee who reasonably relied on the promise given with the license. But whereas in contract promises will be generally be strictly enforced, with promissory estoppel promises are not strictly enforced, but enforced to the extent of the reliance (or, worded another way, to the extent necessary to avoid substantial injustice given the reliance.)
Now that Lotus have integrated OpenOffice into Notes 8 Standard and are also pushing Symphony, they are the ones with the incentive to ensure the OO momentum is maintained (not to mention ODF).
That's a good argument why being sold to IBM would be good for OOo as a product line, but not for why selling OOo to IBM would be good for Oracle.
Has Microsoft Office (and Access, in particular) helped Microsoft self SQL Server? Could a succesful office suite help IBM move DB2? If so, does it make any sense for Oracle to give IBM OOo at any price IBM would be willing to pay for it?
What I don't get is why do we need the Senate to pass a law for something private hospitals can perfectly do on their own, if it is as economical as you argue.
Its economical in the long-term and reduces errors. However, there can be a very high initial cost, and the "safety net" providers which this bill targets (which may provide services largely, or even exclusively, under public programs which often limit reimbursement to the lower of actual costs, standard rates, and charges to third parties) don't tend to have a lot of cash lying around to implement systems with high immediate costs that offer cost savings in the long term. And there inability to do that also keeps costs higher than they need to be, in the long term, in those public-funded safety net programs. So, this bill seeks money to enable them to do this, which in the long term should improve the quality of the services provided at those "safety net" providers while reducing the costs in the public safety net programs that pay for the services there.
Unless what Dell is claiming is, these are actually second hand sales, and not new sales.
Dell claims both that Tiger sold Dell equipment that was used, refurbished, and acquired from other resellers as new equipment received directly from Dell and that Tiger sold refurbished Dell equipment covered only by a third party warranty under the representation that it was sold with a Dell warranty.
The lawsuit does not appear to claim that Tiger sold new (not used or refurbished) equipment whose warranty had expired as if it had a valid warranty, unless I'm missing it (the posted copy of the suit is a non-OCR'd PDF, and I've skimmed it and only read the parts the seemed relevant carefully.)
(1) Tiger sold used/refurbished Dell computers not covered by any Dell warranty, but covered by a third party warranty, and presented them as being covered by a Dell warranty.
(2) Tiger sold computers that were variously used, refurbished, or purchased from other resellers and advertised them as new, original, and obtained directly from Dell.
I don't see an allegation in the lawsuit that Tiger specifically sold new computers, in the original box, obtained from other resellers and represented them as in warranty when the warranty had expired. I think, to the extent that TFA conveys this impression, it is a misreading of the allegations in Dell's suit conflating two different, but related, misrepresentations that Dell accuses Tiger of making.
We're moving towards government provided health care. You won't get to decide what treatments you are eligible for anymore... At least not unless you're paying cash.
Which is, really, exactly the case now with "insurance company provided healthcare" -- you and your doctor don't decide what treatments you are eligible for unless you are paying cash now.
...that says high ranking government officials are exempt from whatever this bill actually enacts, that it's only the "common man" who will require "Open" medical records.
This bill doesn't, from the summary, mandate anyone to have anything "open" to anyone else. It only provides funding to purchase open source EHR systems, but you'd think on Slashdot, of all places, people would readily distinguish between an "open source" electronic health records system and "open" health records.
What is planned to be done about public leaks of, or illegal alterations to, confidential information of an individual's HIV/AIDS/Other Social Disease/Embarrassing Medical Ailment status?
Since nothing that I've seen published about this bill suggests changes to HIPAA's privacy protections, including the criminal penalties for improper disclosures, I would assume, at least until the text of the bill is available so that we know for sure, that there is no change on that front.
What is the benefit of this system? When healthcare providers have easy access to anyone and everyone's records they'll jack up the prices to everyone but the 'ideal' patients.
Nothing in the summary provided in TFA of this bill suggests it does anything to increase healthcare providesr access to "anyone and everyone's" records. What it does to is provide funding to cover provider costs of converting to use electronic (as opposed to paper) records systems, and seeks to make those systems interoperable with eachother and with billing systems, so that in the circumstances where information sharing is allowed (and, often, necessary) it now can be acheived at lower long-term costs and with greater accuracy. And, perhaps as importantly, even when sharing between providers isn't the issue, the accuracy and completeness of the records readily at hand to physicians during the course of treatment within, say, a single hospital will be improved, preventing avoidable errors.
When healthcare providers have easy access to anyone and everyone's records they'll jack up the prices to everyone but the 'ideal' patients.
Insurers, rather than providers, tend to be the ones that do that.
Dude, I hear where you're coming from but I just for the life of me can't believe anyone wants to trust their health history to the tender mercies of computers and the internet--the same entities that routinely reveal hundreds, sometimes thousands of people's IDs, credit card and bank info for days or weeks at a time to passing thieves.
Maybe some people have seen that providers using EHR rather than hardcopy records have been shown to reduce the instances of fatal medical errors, and prefer the (AFAICT, purely speculative -- while bulk identity theft is easier with electronic records, they also reduce the number of people that are likely to have incidental access to the records in the first place, and reduce the opportunity for one-off identity theft) increased risk of identity theft with EHR to the (demonstrated) increased risk of avoidable, premature death with non-electronic records.
If we end up with an "open source" medical record, and a central, unified medical history becomes available to every doctor that treats me, then they are going to know things I do not want them to know.
For instance, I have a history of amphetamine abuse. I'm past it, I beat it, I'm feeling much better now, thank you.
I do not want a doctor refusing to give me a drug to help me focus because he's afraid I'll relapse. Or not giving a weight loss drug for the same reason.
This is not about a "central, unified medical history". Its about the fact that actual healthcare providers have and use medical records, and that keeping and using them electronically has been demonstrated to have significant benefits in quality of care and cost in the long term; this bill provides funds for providers to implement electronic health care record systems using OSS. The only centralized facilities it creates are fora and programs to promote systems interoperability between EHR systems and between EHR systems and billing systems, so that data which does need to be shared and for which the appropriate consent and disclosures have been made can be shared effectively and accurately.
Nothing I've seen about it suggests that it in any way reduces the privacy protections in HIPAA which require consent for most disclosures and uses of PHI, including health records, or the even more strict confidentiality requirements of 42 CFR Part 2 that apply to confidentiality of records relating to drug and alcohol abuse.
With concerns like yours I would pay attention as more details of this bill become available (including its actual text, which Thomas doesn't seem to have yet) and as it works its way through Congress, but I wouldn't jump to conclusions about it the way you seem to have.
The only thing that would really be open source would be the underlying system, but that could be implemented using either open or closed source systems.
Yes, it could be. This bill provides funds for certain providers that would cover the cost of implementing and maintain EHR systems using open source software for up to five years, with a potential for another 5 year renewal.
The idea is to (1) assure that the providers can afford the cost of implementing EHR by putting up federal funds, and (2) simultaneously to get the maximum public benefit for the buck by only providing those subsidies where the iplementation is done using OSS, and providing support for interoperability workgroups, and doing a number of other things to promote standards.
I absolutely believe that the file formats and interfaces for EHR systems should be open standards, but that's not open source.
Open standards are a great starting point, but it still doesn't deal with the problem that small providers, especially those that participate in public safety net programs that often require that providers be non-profit and limit reimbursement to actual costs, don't have extra funds to implement EHR even if the standard is open. This bill provides funding to enable them to implement, provided that they implement with OSS.
Why not use the one our tax dollars have already developed?
Why not RTFA?
VistA is the VA's EHR system.
FTFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
They should implement this in the military first as a test.
The VA was and other federal agencies already were the "test". From TFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
Just because a license is considered technically "revocable" at law contrary to its own terms does not mean it won't be enforced. A copyright license all the more so.
Saying "all the moreso" doesn't make it so. Diverting a watercourse is a one-time event, the effect of such a license is essentially all or nothing, so if any effect is given by promissory estoppel, it is effectively permanent. (That is, the license effect is temporary -- only to divert the watercourse at one time -- but the change effected is permanent.) This makes it rather unlike the case with most copyright licenses (particularly, the GPL and related open-source licenses.)
A copyright license, OTOH, is more like a license to cross or use land on an ongoing basis, where estoppel (providing the terms of the license relied on didn't provide for immediate termination) would generally prevent from being revoked with immediate effect on a licensee in the course of use, but also would not generally make permanent in the effect of an attempted revocation.
Outside of the US, the comma separates the number and the precision.
While of European parents, I never understood this.
It makes sense if you think of a comma = "and", and numbers being presented as an integer part "and" a fractional part.
Particularly when (as is, I believe, most common) spaces (normal or thin) are used instead of full stops as separators for every three digit group in the whole number portion.
The problem is that "gratuitous license" is a somewhat ambiguous term.
Actually, its not. Its a very clear term: its a license which is not given in exchange for consideration of value.
If you have a citation for a case where a copyright license was held to be revocable contrary to its own text, please post.
If you have a citation for a case, whether regarding copyright or not, where a license that was not for value was considered irrevocable because of its text (or, for that matter, for any other reason), contrary to the general law pertaining to gratuitous licenses, please post.
That is beside the point. He wants to HOST the analytics himself so google doesn't have access to all the raw analytics data.
Its not completely beside the point; while clearly opening the API doesn't help that as directly as opening the engine would, with the API available (and apps using it already) and incentive is created for independent implementations of the API, as well. So this is probably, in the long term, good for people who want to self-host analytics without building their own from scratch.
The funny thing is, once you step outside the bubble that is slashdot, people are generally happy with Vista.
I dunno, I've heard directly from lots of casual users that don't have the kind of general, reflexive hatred of Microsoft you see in many slashdot posters spout all kinds of hate about Vista specifically (both people that hate change, and also complain about things like Office 2007, and people that generally don't have a problem with change and love Office 2007.)
Personally, I don't find it much overall worse than XP the times I've used it. But, I kind of look for more than that in a new version that isn't a free upgrade.
Heck, I look for more than that in new versions that are free upgrades (like successive Kubuntu releases.)
That's irrelevant, because at the heart of things the GPL is not what about what is binding. It is about what is being unbound, specifically you are waiving your rights as copyright holder to some things. You don't really have a contract with anyone, you are stating to the world explicitly what rights you are relinquishing.
Yes, and under US law, such a statement can be revoked if it is not secured by a contract. It's called a "gratuitous license".
The FSF can say the GPL is irrevocable, the GPL can say the GPL is irrevocable, but as long as it is a license not secured by a contract (say, because it lacks mutual consideration), than barring a fundamental change in the law regarding licenses in the US, the GPL and other gratuitous licenses are and will remain revocable, at will, by the licensor.
Slashdot Mirror
The buzz is because there is evidence that using them measurably reduces avoidable medical errors.
There's a lot wrong with the statement, but rather than the narrow problems, I'll point out the broad one. The roots of the problems in the US healthcare system are a lot broader than that. Inasmuch as the things you point to are accurate, they are symptoms, not roots, of the problem. OTOH, there are major legislative pushes aimed at dealing with the broader problems of access and affordability, but they don't eliminate the utility of dealing with these kind of issues, as well.
There's no pleasing some people. Alpha gives slick, detailed results; is it really fair to demand it be right, too?
True, but largely irrelevant; winning the search engine war might requiring that, breaking into search doesn't. Better results in even a narrow domain would establish a toe-hold, and then you grow it from there.
Actually, it doesn't even mean you are putting all your eggs in one basket, much less that all your eggs are in one basket you don't control. There's no reason I can't have my own servers and, say, on demand EC2 instances running the same software, and have them all storing data using a replicated storage arrangement where there are all the non-transient data is updated on my servers, not stored exclusively in the cloud.
I agree; as an equitable doctrine, however, it usually will not be applied (I'm speaking generally, there is, AFAIK, very little if any gratuitous-copyright-license-specific case law invoking promissory estoppel) the same way a contract would; specifically, promissory estoppel usually won't create a permanent right, it will limit the effect of an exercise of the right to revoke a license. The exceptions I am familiar with are all cases (like the one cited earlier in this thread regarding a license to redirect a stream) where the circumstances make the right essentially all-or-nothing.
IMO, this is simply not true: not allowing a copyright holder to revoke a gratuitous license creates exactly the same kind of ongoing economic burden on the licensor as does not allowing a real property owner to revoke a gratuitous license to another to make economically-significant use of his land. In either case, the economic utility of the property to the revoking licensor is limited by the courts refusal to give effect to the revocation. Now, there is a reason that estoppel will nonetheless limit the effect given to a revocation -- to avoid manifest injustice to the licensee who reasonably relied on the promise given with the license. But whereas in contract promises will be generally be strictly enforced, with promissory estoppel promises are not strictly enforced, but enforced to the extent of the reliance (or, worded another way, to the extent necessary to avoid substantial injustice given the reliance.)
That's a good argument why being sold to IBM would be good for OOo as a product line, but not for why selling OOo to IBM would be good for Oracle.
Has Microsoft Office (and Access, in particular) helped Microsoft self SQL Server? Could a succesful office suite help IBM move DB2? If so, does it make any sense for Oracle to give IBM OOo at any price IBM would be willing to pay for it?
Its economical in the long-term and reduces errors. However, there can be a very high initial cost, and the "safety net" providers which this bill targets (which may provide services largely, or even exclusively, under public programs which often limit reimbursement to the lower of actual costs, standard rates, and charges to third parties) don't tend to have a lot of cash lying around to implement systems with high immediate costs that offer cost savings in the long term. And there inability to do that also keeps costs higher than they need to be, in the long term, in those public-funded safety net programs. So, this bill seeks money to enable them to do this, which in the long term should improve the quality of the services provided at those "safety net" providers while reducing the costs in the public safety net programs that pay for the services there.
Dell claims both that Tiger sold Dell equipment that was used, refurbished, and acquired from other resellers as new equipment received directly from Dell and that Tiger sold refurbished Dell equipment covered only by a third party warranty under the representation that it was sold with a Dell warranty.
The lawsuit does not appear to claim that Tiger sold new (not used or refurbished) equipment whose warranty had expired as if it had a valid warranty, unless I'm missing it (the posted copy of the suit is a non-OCR'd PDF, and I've skimmed it and only read the parts the seemed relevant carefully.)
Nope. While the word "unethical" is used a lot in the comment thread, what Dell is accusing Tiger of doing is breaking the law, not being "unethical".
According to the lawsuit, among other things:
(1) Tiger sold used/refurbished Dell computers not covered by any Dell warranty, but covered by a third party warranty, and presented them as being covered by a Dell warranty.
(2) Tiger sold computers that were variously used, refurbished, or purchased from other resellers and advertised them as new, original, and obtained directly from Dell.
I don't see an allegation in the lawsuit that Tiger specifically sold new computers, in the original box, obtained from other resellers and represented them as in warranty when the warranty had expired. I think, to the extent that TFA conveys this impression, it is a misreading of the allegations in Dell's suit conflating two different, but related, misrepresentations that Dell accuses Tiger of making.
Which is, really, exactly the case now with "insurance company provided healthcare" -- you and your doctor don't decide what treatments you are eligible for unless you are paying cash now.
This bill doesn't, from the summary, mandate anyone to have anything "open" to anyone else. It only provides funding to purchase open source EHR systems, but you'd think on Slashdot, of all places, people would readily distinguish between an "open source" electronic health records system and "open" health records.
Since nothing that I've seen published about this bill suggests changes to HIPAA's privacy protections, including the criminal penalties for improper disclosures, I would assume, at least until the text of the bill is available so that we know for sure, that there is no change on that front.
Nothing in the summary provided in TFA of this bill suggests it does anything to increase healthcare providesr access to "anyone and everyone's" records. What it does to is provide funding to cover provider costs of converting to use electronic (as opposed to paper) records systems, and seeks to make those systems interoperable with eachother and with billing systems, so that in the circumstances where information sharing is allowed (and, often, necessary) it now can be acheived at lower long-term costs and with greater accuracy. And, perhaps as importantly, even when sharing between providers isn't the issue, the accuracy and completeness of the records readily at hand to physicians during the course of treatment within, say, a single hospital will be improved, preventing avoidable errors.
Insurers, rather than providers, tend to be the ones that do that.
Maybe some people have seen that providers using EHR rather than hardcopy records have been shown to reduce the instances of fatal medical errors, and prefer the (AFAICT, purely speculative -- while bulk identity theft is easier with electronic records, they also reduce the number of people that are likely to have incidental access to the records in the first place, and reduce the opportunity for one-off identity theft) increased risk of identity theft with EHR to the (demonstrated) increased risk of avoidable, premature death with non-electronic records.
This is not about a "central, unified medical history". Its about the fact that actual healthcare providers have and use medical records, and that keeping and using them electronically has been demonstrated to have significant benefits in quality of care and cost in the long term; this bill provides funds for providers to implement electronic health care record systems using OSS. The only centralized facilities it creates are fora and programs to promote systems interoperability between EHR systems and between EHR systems and billing systems, so that data which does need to be shared and for which the appropriate consent and disclosures have been made can be shared effectively and accurately.
Nothing I've seen about it suggests that it in any way reduces the privacy protections in HIPAA which require consent for most disclosures and uses of PHI, including health records, or the even more strict confidentiality requirements of 42 CFR Part 2 that apply to confidentiality of records relating to drug and alcohol abuse.
With concerns like yours I would pay attention as more details of this bill become available (including its actual text, which Thomas doesn't seem to have yet) and as it works its way through Congress, but I wouldn't jump to conclusions about it the way you seem to have.
Yes, it could be. This bill provides funds for certain providers that would cover the cost of implementing and maintain EHR systems using open source software for up to five years, with a potential for another 5 year renewal.
The idea is to (1) assure that the providers can afford the cost of implementing EHR by putting up federal funds, and (2) simultaneously to get the maximum public benefit for the buck by only providing those subsidies where the iplementation is done using OSS, and providing support for interoperability workgroups, and doing a number of other things to promote standards.
Open standards are a great starting point, but it still doesn't deal with the problem that small providers, especially those that participate in public safety net programs that often require that providers be non-profit and limit reimbursement to actual costs, don't have extra funds to implement EHR even if the standard is open. This bill provides funding to enable them to implement, provided that they implement with OSS.
Why not RTFA?
FTFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
The VA was and other federal agencies already were the "test". From TFA: The Health Information Technology Public Utility Act of 2009 will build upon the successful use of "open source" electronic health records by the Department of Veterans Affairs as well as the "open source exchange model," which was recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative.
Saying "all the moreso" doesn't make it so. Diverting a watercourse is a one-time event, the effect of such a license is essentially all or nothing, so if any effect is given by promissory estoppel, it is effectively permanent. (That is, the license effect is temporary -- only to divert the watercourse at one time -- but the change effected is permanent.) This makes it rather unlike the case with most copyright licenses (particularly, the GPL and related open-source licenses.)
A copyright license, OTOH, is more like a license to cross or use land on an ongoing basis, where estoppel (providing the terms of the license relied on didn't provide for immediate termination) would generally prevent from being revoked with immediate effect on a licensee in the course of use, but also would not generally make permanent in the effect of an attempted revocation.
Its a lot faster than what the US has committed to making universally available.
It makes sense if you think of a comma = "and", and numbers being presented as an integer part "and" a fractional part.
Particularly when (as is, I believe, most common) spaces (normal or thin) are used instead of full stops as separators for every three digit group in the whole number portion.
Actually, its not. Its a very clear term: its a license which is not given in exchange for consideration of value.
If you have a citation for a case, whether regarding copyright or not, where a license that was not for value was considered irrevocable because of its text (or, for that matter, for any other reason), contrary to the general law pertaining to gratuitous licenses, please post.
Its not completely beside the point; while clearly opening the API doesn't help that as directly as opening the engine would, with the API available (and apps using it already) and incentive is created for independent implementations of the API, as well. So this is probably, in the long term, good for people who want to self-host analytics without building their own from scratch.
I dunno, I've heard directly from lots of casual users that don't have the kind of general, reflexive hatred of Microsoft you see in many slashdot posters spout all kinds of hate about Vista specifically (both people that hate change, and also complain about things like Office 2007, and people that generally don't have a problem with change and love Office 2007.)
Personally, I don't find it much overall worse than XP the times I've used it. But, I kind of look for more than that in a new version that isn't a free upgrade.
Heck, I look for more than that in new versions that are free upgrades (like successive Kubuntu releases.)
Yes, and under US law, such a statement can be revoked if it is not secured by a contract. It's called a "gratuitous license".
The FSF can say the GPL is irrevocable, the GPL can say the GPL is irrevocable, but as long as it is a license not secured by a contract (say, because it lacks mutual consideration), than barring a fundamental change in the law regarding licenses in the US, the GPL and other gratuitous licenses are and will remain revocable, at will, by the licensor.