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Comment Re:Why? (Score 1) 331 331

You don't like it when other folks are better than you at your own game ?

Better than us at our own game? I bet the Western World would be really competitive at manufacturing injection molded plastic garbage if we discarded all of our pesky labor and environmental laws.

"Thank you China; you make our Happy Meals possible." -Stephen Colbert

Comment Re:clipboards? (Score 1) 59 59

I won't disagree that medical billing is still a nightmare, but it's not the fault of CPT codes. No insurance company will sign a blank check and ask the doctor to fill in the amount; they all have a maximum they'll reimburse for, say, a broken leg, and they'll reimburse "broken leg" differently for a simple fracture than an unexpected amputation that took a crack team of surgeons 32 hours to reattach.

The codes are just a standard way to quantify exactly what was done. The "standard" part is important since most docs wouldn't be able to deal with more than a single insurance company if they all spoke a different code set. Absent a code set, it's much harder to determine how much your treatment should have when all you have are subjective descriptions from multiple doctors about what each thought they did. Codes remove that ambiguity, which insurance companies otherwise use to delay paying you and the hospital for as long as possible.

Generating the codes in the first place is complicated in the clipboard world, where a medical coder has to pore over sometimes hundreds of pages of scribbles to find out whether your vitals ever spiked into a danger zone that would have required more frequent nursing attention (at a higher cost), whether you were ever given certain kinds of medication, and, more subjectively, trying to divine what you actually had from the doctor's free-form notes, and what codes best describe that particular malady. Since this requires examining linear yards of flowsheet annotations (where an individual, critical cell might be missed) and subjective interpretation (does this description of a fracture qualify for Break-1 or Break-2?), different medical coders can end up coding the same chart differently.

Computers, in theory, can solve this. The computer knows exactly which medications you were given, how often, and at what cost. It knows exactly how often nursing took care of you, and can unambiguously determine your acuity. It knows every human in the operating theater, how long they were there, how much they cost, and every roll of gauze they used. Even free text notes are often templated, with doctors filling in blanks on standardized forms with multiple-choice answers, each of which can be unambiguously evaluated. Computers can instantly and unambiguously determine who too care of you, exactly how much it cost to take care of you, what codes best describe those services, and can communicate that information electronically to your insurers.

Where this falls down is a lot of computer systems grew organically--first a program for scheduling, then a program for billing, then a program for tracking clinical notes, then a program for monitoring vitals, etc., rather than some comprehensive monolith springing forth fully-formed right at the start. This means that to bill for a pregnancy, a medical coder might have to hunt through a dozen different systems: An ADT suite to determine where the patient was roomed and for how long, since a regular bed costs much less than intensive care. A specialty labor and delivery system, to gather the myriad of data states and to defend against lawsuits. An often separate fetal heart monitoring suite. An often separate ultrasound modality, with its own operating system that may or may not speak industry standards, that may or may not pair with a separate vendor-specific image viewer on computer workstations. A separate OR suite for doing documenting personnel, and doing counts and checks (to make sure you're billed for the roll of gauze they did use, not billed for the one they didn't, and that neither were left inside you.) A still-separate anesthesia suite, to make sure they don't gas you to death. An inpatient system for tracking medications and vitals, which may or may not be missing the medications and vitals collected by the labor and delivery suite, which may or may not have the vitals collected by the fetal heart monitor, which may or may not have the vitals collected by the OR suite for your C-section, which may or may not have collected anything at all if they hooked the monitor to the anesthesiology suite instead. Complete billing requires searching multiple systems for the medications given and supplies used, others to determine how long you stayed and where, individual ultrasound carts (or, if you're lucky, a single RIS suite) to determine if any ultrasonography was performed, others to determine who was present and for how long, and yet another set of systems to find out all of the above for your new youngling(s). Labs are often third-party and are even more likely to have a separate computer system than any of the above specialties, so billing for tests and their interpretation requires more branching.

Interfacing the cross product of software applications is difficult and expensive, even when they comport to speak industry standards, and even when they don't involve third-party labs, so it often happens imperfectly if at all. This means the same manual, subjective, error-prone, hunt-for-the-charge style of billing that made clipboards suck. This also ignores the fact that most doctors aren't hospital employees--the surgeon has his own practice, and merely has privileges to operate at the hospital--and therefore bill separately for their own labor.

The best computer systems make all this go away--all the documentation is accurate and in one place, bills are generated automatically and unambiguously, and include professional fees (which the hospital knows how to remit). Those systems really do make billing better for hospital, physician, and patient, if not the insurance company. The worst computer systems make things worse, with dozens of individual programs grafted into a Frankenstein and dropped into the laps of an outsourced third-party coder to deal with. It's that stuff that leads to the nightmare I'm sorry you and yours have to deal with.

Comment Re:clipboards? (Score 4, Informative) 59 59

What was so bad about clipboards again?

Clipboards have a bunch of known deficiencies. They're effectively write-only, especially if no one else can read the doc's handwriting.

Then, they're hard to duplicate. Should you end up in the hospital (heaven forbid), hopefully you're conscious enough to explain your drug allergies to the EMT, because it'll take a while to find out which clinic you normally see and get a copy of their clipboard. Then the copy of the clinic clipboard ends up in the hospital's clipboard, but the stuff in the hospital clipboard probably won't make it back to the clinic clipboard.

There's also only one copy of the hospital clipboard, so the cardiologist treating your heart attack can't put notes in your clipboard if the hospitalist took it to figure out what meds you were (or should be) on. If they do make copies, someone has to make sure the cardiologist's annotations make it into all of them without error. Those charts then have to be stored in a giant bunker somewhere, forever.

Clipboards are also bad at medication safety. When you're giving millions of med administrations to millions of patients, eventually you end up giving the wrong drug to the wrong one. Clipboards can't verify that you nabbed the right patient or the right drug, which kills people once you scale up the mistakes that would have happened to a national level.

Even before the nurse gives the meds, a clipboard can't tell the doctor that one of the medications he's ordering will interact with the medications someone else ordered. That also kills people. If one lot of those medications was tainted and recalled, it's also really, really hard to find out who was affected if all your administrations are documented on paper.

Finally, it's really hard to bill correctly if all of your documentation is on paper. If the coder going over the clipboard misses a charge, the hospital loses out on money. If the coder invents a charge, you lose out on money. If the coder can't find whatever documentation a kafkaesque insurance company demands to justify a procedure, you both lose out on money. Also harder to reject a claim for not being written in blue pen with block caps when the claim is electronic.

There's a bunch of other ways clipboards suck, and a bunch of ways the clipboard-replacements suck, but the former tends to suck a lot more than the latter.

Comment Re:IE all over again (Score 3, Interesting) 364 364

When I upgraded to Windows 10 yesterday, there was a screen that came up that asked me if I wanted to reset the default apps. I said no for my browser and media player, and when it completed, Chrome and VLC were still the default applications. I think it's a little underhanded, but not as underhanded as the article suggests.

Mozilla is whining anyway; when they switched search providers from Google to Yahoo I had to go through and specify it on EVERY INSTANCE of Firefox I have. Since I use --no-remote and segment my web browsing this was actually a royal pain in the ass. Granted, Google was the old "default," so I had never changed it, but it was still an undesired change in behavior. If they're going to whine about Microsoft doing the same thing then they ought to look at their own behavior.

Firefox is still my browser of choice for personal use but for others I've started to recommend Chrome. It's just less hassle to support it for your luser friends. The future of Firefox and Mozilla is not an encouraging one, which is a pity.

Comment Re:I'm surprised they missed "Wi-Fi Sense." (Score 1) 483 483

uploads a supposedly-encrypted form of your wireless AP's password to a Microsoft server for safe-keeping

It's a bit hard to get outraged at MSFT when GOOG has been doing the exact same thing for the last three or four Android versions.

Comment Re:Right to Privacy in One's Backyard? (Score 1) 1175 1175

That's not destruction of property, that's maintenance of property. Want a better analogy than the soccer ball? If your neighbor parks in your driveway without permission you can probably have him towed. What you can't do is take a 9 Iron to his headlights.

Comment Re:Right to Privacy in One's Backyard? (Score 1) 1175 1175

No, that would still be destruction of property. The fact that it's on your property does not give you the right to destroy it. If the neighbor's kid kicks a soccer ball over your fence does that give you the right to slash it with a knife before you return it to them? Of course not.

Comment Re:Investigating if laws were broken (Score 5, Insightful) 312 312

This is a legal principle that literally goes back to Greek antiquity.

In Common Law jurisdictions we have another principle that goes back for 800+ years: mens rea. Meaning that you have to have a guilty mind (i.e., intent) to have broken the law. Unfortunately this principle is being steadily eroded in favor of "strict liability" laws that require no intent, thus criminalizing more behavior and further expanding the power of the State.

Comment Re:Reasons I'm not a judge. (Score 1) 331 331

Webster defines terrorism (emphasis mine) as "the use of violent acts to frighten the people in an area as a way of trying to achieve a political goal"

The FBI also requires a political bent: "Appear to be intended (i) to intimidate or coerce a civilian population; (ii) to influence the policy of a government by intimidation or coercion; or (iii) to affect the conduct of a government by mass destruction, assassination, or kidnapping"

Swatting is not terrorism, at least in this instance. Not by the definition of the word or as it is commonly applied by western law enforcement agencies. *shrug* Sometimes an asshat is just that, an asshat, with no deeper motivation than the desire to be a dickhead.

Comment Why not use Tcl, or Python, or Perl? (Score 1) 91 91

Seriously. To do any serious task requires state, and the problem with a minimal shell is that it can't remember much. The major scripting languages where all written to solve this problem, as well as integrate with embedded code in C. I'm a fan of Tcl myself, but virtually any scripting engine would be an improvement to a network enabled Pseudo-BASH with a whitespace delimited language.

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