I recall reading, sometime in the last 2-3 years, and my wife's often told me, that the solo practitioner has to see a minimum of 48 patients per day in clinic to pay the bills. A few years ago, I suspect this included some salary for the practitioner. Today I bet the number of patients is higher, and the practitioner's take is smaller. My friends are leaving private practice in droves. They're going to hospital or (large) clinic practices. It's how they can earn a living.
HIPAA was envisioned to protect you, the consumer, from data mining, especially by insurers who wanted to use those data for rate adjustments and denials. Or so the theory went. What HIPAA became was a behemoth with an implementation plan designed to make data sharing nigh well impossible, and with costs to the health care provider, clinic and patient that were never anticipated.
I'll posit that a _GOOD_ implementation of an EMR, with a valid and robust data exchange plan, and which has accounted for the human factors aspects of physician, nurse, advanced practitioner, specialist, physical therapist and pharmacist, might reduce costs and provider errors. I'll state that, of the one's I've seen, and from colleagues I've talked to, it just doesn't exist yet.
Post Sandy, at the NYU Medical Center, they recounted the problems associated with no access to EHR after their systems went down. Bad enough when they were still in their own hospital, but very serious when they transferred patients to other hospitals. The story is that staff physicians, nurses and residents went with patient cohorts to the receiving hospitals and served as verbal medical records to get their patients situated best.
Well crafted database and server replication might help in a scenario like this, but so much of the infrastructure in NYC was broken, I doubt it would have.
This is an IT problem but it also extends beyond that simple statement. It requires human factors, so that the medical personnel can use it readily. It requires that common conditions be addressed (e.g., in obstetrics, it should be able to calculate EDC from LMP and project a due-date). I'll accept having separate adult, pediatric and neonate elements to help with dose calculations; that's not too bad and almost everyone's smart-phone can do those calculations close to automagically now. It needs customizable checklists for common procedures, AND an ability to go outside the checklist for issues/complications. It needs a good problem list generator and then a tracking system to allow repeat visits to recognize a problem list entry and bring it up at the next visit... or for a home phone call sooner if need be.
And did I mention it needs a data exchange format that really works? Recent experience: I had to see someone in a new city for care. My primary care physician's clinic (using a large EMR system they're abandoning in favor of EPIC) printed and faxed the whole chart to the doc's office in the other city. And when I asked the doc to send stuff back to my PCP? Yep. They faxed it all back (save the important stuff which didn't get sent at all).
EMR's something I've loked at for over 20 years and played with off and on. I was playing with it when the best way to automate was to create a lab-reporting system using VAX PDP-8's and DECterminals. Expensive? Slow? Yes but with a little screen building and database work, it was useful. I've watched HL7 and its predecessors over the years and they continue to get more robust, so getting the infrastructure standards in place isn't too hard.
What's hard is getting the INDUSTRY to stop being greedy and decide to interoperate. And to respond to the primary users, who are the medical professionals who have to hammer on the damned systems daily.
RFC1149/2549 coupled to a keyboard under a line of birds?
Besides, if the film has to be translated to the native language, why worry about piracy of a non-translated version?
Agreed. I used to be a PC only gamer (engineer, computer geek etc bla bla..) but since I got a PS3 I'm totally sold on consoles. Easy to use, comfortable to play from my couch, in general a better experience as a whole for me. It also fits nicely with my home theater system.
Sure, the PC can do all those things, but not as easily and would require more maintenance and configuration. Especially getting wireless controllers set up to work well with each game.
Sweden has a progressive tax system which pays for the move
While I don't know the details, I do know that a good chunk if not all of the cost is paid by the mining companies. Either way if tax money is being used that money is easily recouped in the form of taxes from the mining operation.
in Russia if you aren't connected to the government you're almost irrelevant, other than to be a moron to be manipulated to give Putin a shine of legitimacy.
I do see your point and I'm not surprised, I guess in Russia neither the mining company nor the government would pay for an operation like this, screwing over the local residents.
There are a few places in Sweden where entire towns are in the process of being gradually moved due to the expansion of neighboring mines. The thing is, these towns were built _because_ of those mines in the first place, generations ago. The citizens don't mind, they actually support it, since they know their towns would become ghost towns without the mines.
That being said, from the sound of things this town should have undergone similar procedures a long time ago. But there is more than one side to this type of situation.
Several years ago, I had a netbook (before netbooks were cool) made by compaq. As this was in the days before every kid had a computer, and before, well, wifi, and before Facebook, I didn't succumb to today's general distractions. I took abbreviated notes in class often using vi. I'd find a quiet spot later, although the keyboard was too loud to do it in the library, reorganize the notes and rewrite them using complete sentences, add equations (via an equation editor), and generally make 'em useful. These served me well. I've gotta say, though, that the "improvements" to Notepad, Office, OpenOffice, etc., and the advent of tablets overall, has made it HARDER to use a computational platform to do what I did, rather than easier. I'm going back to pencil and paper.
And, I've found that the act of writing the notes, even when I never used them again, helped me better understand and recall the material from the lectures.
When I read the title, I assumed immediately that the intent was to use the word, 'queue' in appropriate context: Line'em up. Sorry, you blew it.
Boy, ain't that the truth. Ad, having a GS-5 doing the keyword reviews doesn't work well either.