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Comment Re:Give me a choice (Score 1) 122

It doesn't do ANYTHING you are talking about

EHRs absolutely do do all of those things, including checking drug interactions, allergies, and pregnancy and lactation warnings, and there absolutely is scholarly evidence of their effectiveness if you care to Google. Here's one concluding barcoding and CPOE are "vital."

If your EHR doesn't do those things, then that's a defect peculiar to whatever software you're using.

The medication lists are ALWAYS wrong or misleading as they are huge and hard to read, harder to update

You think they were any shorter, easier, or more up to date on paper? A bad computer system can make med rec harder, but even a good one can't make anyone give a shit about the patient's PTA meds. Nor can a hospital losing Joint Commission accreditation, apparently.

results from another EMR is always incompatible, so you have to scan it in

Yes, that's very common. It doesn't have to be the case, but it usually is.

Have you read an EMR progress note?

Yes. I have read lots and lots of EMR progress notes. I've seen notes filled with pages of stale labs because computers make it easy to copy forward the entire chart. I've seen notes flagged by the built-in plagiarism tools because copy-pasting an old note (and getting paid when you file it!) is easier than actually rounding on the patient. I've seen SOAP notes filed with weeks-old vitals because one group of residents preferred copying things into and out of Microsoft Word, which didn't exactly have the latest telemetry. I've seen notes with assessments that weren't done, filed on patients that weren't rounded on, because easy money.

But you know what? You can read them. And so can the doctor who sees the patient after you.

Comment Re:Give me a choice (Score 1) 122

Certain kinds of errors have decreased dramatically. Computers reduce wrong patient/wrong medication errors dramatically, especially in systems that require you to scan the patient's barcode (to make sure you have the right patient), and then scan each medication's barcode (to make sure you've got the right meds). There's a lot of scholarly research available if you search for EHR medication errors, but this is one of the first non-paywalled things that pops up in Google.

Other issues are more challenging. You might have grabbed the right IV bag, and the computer might have confirmed that it had the right barcode, but that alone doesn't prevent pharmacy from filling the bag with the wrong fluid in the first place, or putting the wrong barcode on the wrong bag. It also doesn't stop a harried nurse from failing to mix both diluent and active ingredient of a vaccine when filling a syringe, or from using the same insulin pen on multiple patients; nor do computers keep toddlers from digging fentanyl patches out of the trash, overdosing on painkillers, and dying.

TL;DR most kinds of medical errors are decreasing, and computers tend to help--they're good at checking meds, and good at counting how many sponges you had in the OR field before and after cutting the patient up. Others are still around--handwashing compliance can still be flakey, silk neckties encounter years of sick people yet are never laundered, and "nosocomial infections" are still troublesome. Pick your favorite kind of medical error and give it a Google for recent stats.

Comment Re:Give me a choice (Score 3, Informative) 122

I hear you--even within a hospital system, and even where standards exist, it's a pain. Ultrasound machines (for those that aren't imaging informaticists) are supposed to speak DICOM, but some do it creatively--one technically sent DICOM messages over the network, but most of what they contained was wrapped inside a proprietary XML blob rather than standard DICOM fields. What standard fields were implemented were implemented strangely, waffling between spelling out measurements ("centimeters") or using their abbreviations, mixing case, and reporting measurements to absurd precision (dozens of zeroes after the decimal point, for a bone measured in millimeters).

Sharing charts between hospitals is a mire of politics. There's the government's own Direct standard, which they mandated every hospital use to send charts, without any indication of what the recipient is supposed to do--a lot pipe them to /dev/null, because the vaguely defined content of the message is often useless and redundant with existing methods of communication. They're now working on legalese to require that you "do something" with the messages you receive, but exactly what that is (and how to objectively prove that you did it) they're still figuring out.

Then there are organizations like Commonwell, trying to monetize a data-sharing "standard" not even their founding members could be bothered to implement. They haven't sent a single chart as far as I know, but that doesn't stop them from issuing press releases praising their "interoperability" with the same frequency AT&T issues press releases praising their gigabit fiber.

Then there are HISPs (centralized, sometimes quasi-public, repositories of patient information). Some have managed to legislate themselves as mandatory middlemen, and, having done so, have proceeded to extract monopoly rents over the transmission of outdated and incorrect patient information. Even better is provider look-up--if they give you the wrong fax number for a physician, you are responsible for the HIPAA violation when a random gas station gets someone's medical information. This causes them to care as much as you'd expect about the integrity of the data they peddle (and that you're required to buy).

It's frustrating, because medical information has to be shared for it to be of use--there's no use having a mammography if no one will read the results, or if the people treating you can't access the study and have to order their own.

Comment Re:clueless management (Score 1) 122

Being licensed profession will stop clueless management from force stuff to be so easy to hack / not willing to pay the costs to have be done right.

If you're going to make it illegal for literally anyone else to write software, then maybe. I'd love to see you square your favorite licensing regime with anything resembling open source development.

Comment Re:Give me a choice (Score 5, Insightful) 122

I wish I could request paper records.

You really don't. I've shilled for EHRs before, but the TL;DR is

  • Paper charts kill people. They don't check for drug interactions; they don't double-check that you've got the right patient when you're operating or administering medications; in the case of a recall, they can't tell you who received a bad batch of a vaccine; and they certainly can't tell a first responder that unconscious you is allergic to blue dye, unless they already happen know your regular clinic and have a fax machine in the ambulance.
  • Paper charts are useless for patient care. The hospitalist trying to reconcile what you were taking at home with what they want to give you in the hospital can't actually determine whether they're about to kill you if the cardiologist treating your heart attack happened to take the only copy of the chart to enter his notes. If they made a second copy for the cardiologist, there's no guarantee his notes and medications will ever get entered into the hospitalists copy, or into pharmacy's copy, who might also wonder why two different doctors plus your PCP are trying to dose you on blood thinners, or into your regular doctor's copy, who might be totally unaware of the cardiologist's findings
  • Paper charts are expensive. If nobody knows that you already had a lab or an X-Ray, they're going to order it again. If they do know you had one of the above, you're going to have to wait for a fax, or for them to mail negatives. Because handwriting and general disorganization, especially over a long admission, tends to make them write-only, it's much harder to know exactly what they gave you and why, which makes it harder to justify to the government or an insurance company why they should pay your tab.

That doesn't mean the electronic versions don't have terrible, even maddening, flaws, but even the worst are better than paper.

Comment Re:it was the McCarthy era (Score 1) 282

SF is the art of the technical class. The central message is "You can fix it or create wonders by applying intelligence and dilligence to the problem."

Huh? That is not the central message of SF. That is one single theme used in some SF, and used in the most generic sci-fi out there. The conflict is man v. nature/technology or man v. society (or even man v. self), where the virtues extolled are up to the writer. Besides intelligence and diligence, some other virtues often key in SF include self-reliance, capacity for specific emotions (love/empathy/etc), having morals, willingness to deviate from the norm, etc.

Mainstream fiction is the propaganda of control of the general population: The central message is futility

What the hell kind of mainstream fiction did YOU read that was contemporary with Bradbury? In 1953, when Fahrenheit 451 was published, the books that topped the Adult Fiction bestseller charts were: The Silver Chalice (Costain), East of Eden (Steinbeck), Desiree (Selinko), Beyond This Place (Cronin), and Lord Vanity (Shellabarger). None of these books had a message of futility OR conformity; very much the opposite.

You are saying that Bradbury imported the mainstream fiction message of "Do what the authorities tell you to do. No matrer HOW badly they're doing and HOW bad things get, don't try to improve them. Anything you try will make them worse.". Not only was that not the mainstream message of the day, you would be hard-pressed to find that as a theme in any of Bradbury's works. I ask you to please name a single work of Bradbury's where this could conceivably be the case.

Comment Re:Bad comparison? (Score 1) 119

Depends on the game. A few MM*s are happy with giving you time off. Those are generally either pay-to-own like Guild wars or free to play and supported by a microtransaction model. Some, like Path of Exile, let you idle for as long as you like. Others, like League of Legends (admittedly a MOBA but with the same kind of non-pay-to-win microtransactions), will release your account name after a period of inactivity, although if I remember correctly, LOL allows you to recover an inactive account somehow.

I may be wrong on that last one; I dropped LOL for good when I realized it wasn't really for me.

One thing I do know is that most of my friends avoid subscription-based MMOs like the plague. Too expensive, too demanding.

Comment Re:WoW! really its taken this long to figure that (Score 1) 119

True. I play Path of Exile a lot although I don't see it as an MMO - it's more like a Diablo clone with great multiplayer. That's the appeal, actually: I don't have to run through shared areas, competing with random strangers over who gets to kill the mobs. I don't have to put up with random strangers forcing me into PVP so they can get off over how superior their optimized PVP build is to someone else's PVE build. I can party with my friends whenever we feel like it, though. The game is effectively a singleplayer game with drop-in multiplayer support. I like that.

And it doesn't do subscriptions. It has a microtransaction model that avoids the whole pay-to-win issue by only selling you cosmetic items and a few non-essential convenience things. That makes it easy to pick up and put down as well as making it completely invisible to TFA's subscription metric.

I don't really play any other MMOs. But then again I'm not into massively multiplayer games and PoE only sticks with me because it doesn't play like an MMO. Some games just fit into more than one genre.

Comment Re:the USA is Portugal (Score 1) 87

"The USA" doesn't mean a lot now that private companies have sprung up. You do have a point, however: NASA is damn good at payloads. Their stuff usually works really well once it's up but, well, they kinda suck at launch vehicles. The most likely reason is pork. It's hard to spread out manufacturing of a space probe over fifty states but a new launch vehicle? Easily. And once parts manufacturers exist they must never go away, hence the SLS, which most likely will be unneccessarily expensive while performing worse then a vehicle that wasn't designed to generate revenue for every damn state in the union.

Honestly, NASA would probably do better if they sold their launch assets to SpaceX and focused entirely on payloads and missions. Whether they'll end up launching with rockets from Russia, Japan, SpaceX or even Copenhagen Suborbital is no matter as long as the rockets are reliable. The existing rockets have a track record and it's often a good one. NASA's new launcher doesn't.

All great discoveries are made by mistake. -- Young

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