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Comment Re:Punishing people who get degrees we need the mo (Score 1) 164

Want to pursue a STEM or other high-paying degree? No problem, but you have to pay a lot more for your degree.

Isn't paying more for something that's worth more just normal market behavior? For that matter, engineering and science programs typically also cost the school more, but are somewhat subsidized by tuition from cheaper humanities programs.

That said, there is the issue that engineering degrees are also more valuable to society, which may want to provide its own incentives.

My idea: involve the employers in these ISAs. Plenty of employers already cover tuition in exchange for working a set number of years with them (including the U.S. government). Universities can act like unions, doing collective bargaining on behalf of the students (I am not assuming the universities' intrinsic benevolence here, but presumably students will choose to go to universities which can get them the best deals). Conversely, government and businesses might do a much better job of bargaining down tuition prices than loan subsidied college students have been doing. And instead of gambling on the future, students enter into the arrangement knowing exactly when they are going to be able to afford a mortgage. There are plenty of potential problems, but I think the present process of "guess a good major to land a job from an unspecified employer and make indefinite earnings and by the way your wager is $100k and 4-6 years of your life" leaves a lot to improve.

Comment Re:Maine has been doing this since 1976 (Score 1) 34

The failures that you have described, I have seen in several places. Telehealth equipment purchased with some sort of rural healthcare grant and dumped on a clinic by technical staff, and left to gather dust because it was not implemented properly. In my experience, it's really easy to get this wrong. As you know, tech people are neither providers nor managed care operators.

You are correct that when I use the term "telemedicine", I tend to use it in the broadest possible way. You alluded to this in your comment - and I'll reiterate that just using the novel terminology (e.g. da Vinci machine and telemed robots) does not do justice to the work that has gone into getting telemedicine where it is now. Telecommunications technology has been used for healthcare since it's inception, and in these broad terms, it certainly counts as telemedicine (early telephone and telegraph use, not to mention NASA's work on remote monitoring for astronauts). We take the low-hanging-fruit solutions where we can, but there is so much regulatory and bureaucratic friction ensuring that telemedicine adoption happens very slowly. (Cross-state physician and nursing licensing is always a problem, CMS regulations prevent billing in many cases, state boards of medical examiners are passing protectionist measures to make it difficult to perform telemedicine - especially across state lines, etc). In building a system, I start small, and take the small victories on the low-hanging-fruit. More often than not, it's the healthcare providers who need to buy into the technology and they are the ones who come up with ideas for how to use the technology. It's very often that I hear something like "I've got a regular ENT clinic, and don't need that scope, but could I use this for after-hours coverage when I only have an RN on duty? I'd bet that with video supervision, we could really reduce the number of ER transports, which is exactly what our client is asking for."

With respect to cardiology, in many cases, a cardiac echo machine and tech are easier (and cheaper) to transport than a cardiologist. It really depends on the circumstance. If it's easy to refer a patient to a clinic with the appropriate equipment down the street, then it makes sense. In a large hospital that already has echo cardio equipment onsite, then it's a no-brainer. In a massive self-contained environment (e.g. native American reservation, prison system, VA network, or university system), this isn't always possible - and this is where we can bring the equipment and tech to the patient. These are the environments where we have seen the greatest successes.

You are also correct in that nobody is going to just "connect" two EHR's overnight. Most of the federal law revolving around these was not really for portability in the charts, but in billing codes. Even that is very complicated and cumbersome. However, getting a partner provider (or a remote employee) access to an EMR is very easy to do.

Yeah, we're closer than it would appear in our opinions on this. It would appear that you've been on the wrong end of more than one bad telemedicine implementation. Throwing technology at a non-problem does nothing for anyone. Pie-in-the-sky promises and deploying poorly implemented systems and walking away moves us backwards on all levels. I've spent the better part of the last decade blowing the dust off of these implementation and making them work. What I do is not bleeding edge robots, but finding small victories wherever possible and then working with stakeholders to identify other opportunities to grow their program (or overcome obstacles that have prevented them from using the technology in the first places). I'm sure that we both totally agree that telemedicine is not a fix-all that will replace in-person care. I've never made this promise to anyone, and never will. However, I've been increasingly surprised by what we've been able to accomplish even with older equipment.

Comment Re:Maine has been doing this since 1976 (Score 1) 34

The idiot TFA basically wants to talk about other things - patents and point of care robots, but really does nothing to discuss the lack of ubiquity that evangelists have been promising.

This is probably the only part of your post that I agree with. Telemedicine is more than telepresence robots, but it's working right now for many people who wouldn't otherwise have access to care. I'm sorry that it's not doing more for you right now.

Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.

I don't mean to attack you, but what you're saying suggests that you either don't work in healthcare, or have never worked within a successfully implemented telehealth program. Further, it sounds like you're confusing telehealth with m-health and home care. I'll say this much as a concession: telehealth isn't for everyone, all the time. If the patient site has qualified staff, telemedicine can absolutely increase access to specialist care for people in rural areas. Your medical record argument does not hold much water, as EMR's and EMAR's are very real things that most modern practices have access to. I've also built shadow record systems to provide consultants with images of patient charts as well. Do some patients need to see a specialist in person for many procedures? Most certainly. The technology absolutely has its limitations, and telemedicine will never replace in-person care. Further, for most of us, many procedures require an onsite visit. Does that mean that the technology has not lived up to it's promise? Absolutely not. You're misinformed.

Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.

Yes and no, but the basic thesis is incorrect. I've spent the last 8 years building and managing a telemedicine network and my company's providers use the technology to see over 6,000 patients per month. Using fairly basic specialty exam cameras and properly trained presenters, many patients in rural settings can be seen and diagnosed by specialists who are far away - who these patients would have not had access to. Perhaps they will have to travel onsite to have certain procedures performed, but the initial consult and follow-up visit can be performed remotely.

So at anything other than the most basic level, it has been thrown together technological bits that have long sought out a reasonable use case.

Again, yes and no. I completely agree that if you just throw technology at a problem without having healthcare operators be a part of the implementation, it will fail. However, there are quite a few more reasonable use cases. I can name a few low-hanging fruits that are being widely used right now:

  • Behavioral health (this is a no-brainer, and productivity is higher than in-person in some clinical settings)
  • Dermatology (generals special derm cam, but a general exam camera works, too)
  • Radiology (um, teleradiology is radiology now
  • Cardiology (tele-EKG was one of the first uses of telemedicine, many decades ago - this tends to do well with a tele-steth, but it works exactly like any other stethoscope - any RN can operate one)
  • Nephrology (Nephrologists don't need to travel to rural clinics for regular follow-ups for dialysis patients)
  • Neurology (Rural hospitals and urgent care clinics are saving lives every day due to stroke protocols providing access to neurologists for stroke victims, where stroke protocols allow for rapid diagnoses and treatment via medications like TP-A)
  • Infectious disease (I'm using the technology to have several HIV & Hepatitis patients seen via ID providers to gain access to 340(b) pricing for life-saving drugs
  • Oncology (This is another no-brainer for rural patients. Oncologists do not administer meds, but need to monitor patients. With a proper EMR, there is no need for an in-person visit when the patient has access to qualified healthcare providers to transmit patient data.)

I could go on and on with this, but you probably get the idea. You seem to have confused home m-health confused with telemedicine as a whole (the former is only a small subset of the latter). Telehealth is here, and it is providing access to care right now. I work with providers to serve patients using the technology every day. I'm sorry that it hasn't touched your life yet...however, you probably don't live in an under-served community - so you've got that going for you.

Comment Re:stupid (Score 1) 305

In the world in which doctors are constantly evaluating all humans for all conditions, I agree with you. But "the average slob" does not go to see the doctor unless he is dying, and when he is dying, his bladder/hairloss/libido issues may not come up.

"end users, ask your sysadmin if systemd is right for you."

"End users, there is this thing called VPN which lets you do your work offsite. Ask your sysadmin if you want privileges enabled on your account."

Comment Re:Reality acceptance issues... (Score 1) 728

The amazing part is that most people don't consider it as a disease to be eradicated.

Clearly, plenty do. There's always some "disease to be eradicated." It could be a religion or other ideology, or an ethnicity. If you haven't had your turn yet to dig the mass graves I'm sure as time goes on the opportunity will arise. Then your ideological allies (if you're not around) can go about eradicating the disease and ushering in the new paradise. It's funny how eliminating these undesirable elements of humanity and thought never seems to produce the promised paradise, however. But I'm sure it will work for you.

Comment First Priority is to Protect the Innocent (Score 1) 121

If the police failed to act on information a rape or murder was planned because they wanted to catch the perpetrator in the act, there would be outcry. You don't jeopardize the safety of the innocent to assail the (potentially) guilty. Collecting foreign intelligence is not more important than heading off immediate threats to domestic citizens. Clearly the NSA views it as all about "catching the bad guy" and has forgotten the reason the bad guys are considered bad. It's like SWAT leaving a bomb in a public building because, "Hey, maybe we could trip it when the bad guys get back."

Comment If you're in Britain (Score 2) 324

Don't store anything on the laptop. The fact they can legally compel you to provide the means of data access means you are in trouble in every case which they have possession of both you and your laptop. You can either do a really good job of hiding the data or you can keep it outside of where they can get it. How about a remote server a trusted person can deactivate if they hear about your situation?

Comment Re:Circadian rhythm (Score 1) 291

But the time we set our clocks to has no bearing on levels of sunlight, that's just how we originally began measuring it. We can start our days at 8am as well as we can start them at 7am. Apparently we really like being able to have everyone in large (but not too large) geographic regions say they 'start work at 7' and that 'Spongebob will be on at 9.' Whatever reasons we have for that, are they reasons which are going to fall apart if things shift by 1 second every couple of years? I'm guessing not.

Comment Re:Another attempt at manipulating the open market (Score 1) 229

Oh, and that is a somewhat difficult skill set to find.

I have it, and guess what? I contract out for pre-sales work all the time. Enterprise B2B people are just drooling over people who can do this. No wonder the talent isn't available to the big companies.

If they are smart, they do what I'm doing, and that is leverage that ability to understand new and old tech, create visions, back them with a strategic business alignment and value, and then help the salesperson pitch that to the execs for new sales.

(take the CIO out to lunch for bonus points)

Comment Something stinks here... (Score 1) 229

Isn't the CIO the generalist who is able to articulate how the business can succeed with technology?

Ok then, get after it. Your new people and old people all have perspective. Get off your arse, talk to them, make some choices and go and sell that to management or prioritize the budget.

Delegating the budget is just fine, but even that needs a basic review. I understand how it is in very large enterprises, but I also understand companies of that size can afford to hire several CIO types too. Not all techs can be business minded, young or old. That's a specific skill set, and as a tech generalist, they would and should be expected to get what they need from the hard core techs, who will gladly give it to them too.

For smaller companies, if they even have a CIO type position, the generalist there needs to do the work to understand what the strategy actually is and what it means.

Comment When there are fewer initial options, people... (Score 1) 270

...grok programming more quickly and easily.

This all comes down to what one has to know in order to attempt some programming. BASIC requires one know very little to get something useful done. They try the PRINT statement, and that's cool. GOTO, INPUT, strings, numbers, basic math follow.

From there, you can do pretty useful programs!

EXCEL works a similar way. You see what cells do, then you find things like autosum, then you put a little bit of math in a cell, and suddenly, you can make some really useful spreadsheets. I know people with about that level of knowledge modeling businesses to great success. It's not the most advanced use of EXCEL, but it works fine, they can change it, they get the benefit of some automation and can communicate advanced ideas to others with relative ease.

Way back in the day, before EXCEL, I had used BASIC to compute a whole pile of useful manufacturing related things. Saved me a ton of time, and I sold those and some CAD system programs to get a reasonable PC. All development was done on some 8088 clunker from a thrifty store. (yes, it ran the CAD system, having exactly the minimum requirements listed on the box)

The CAD system had a BASIC like language built in. Was cake to do this. I did know something about programming, but I also was able to teach others how to make useful programs on just little nubs of knowledge. Some of them advanced, getting into IT, systems, etc... while others just used the programs they made and were happy about it.

Indeed! The print is too small.

Best use case for new programmers, is to maximize utility while minimizing knowledge dependencies. They don't need much to get the spark. Once they get it, as they progress, they will want out of whatever little environment they started in. The ones who really have aptitude will get out and do just fine. For many others, they will just use the thing and be happy, or move on and not care so much.

We really should give everybody a go. Find out who is who.

Think of this like public speaking. We make everybody do it, or most everybody. Most people experience an ordinary, "I can do this" outcome. Some of us find out it's not for us, and still others find out they are great somehow. We lose out if we don't run everyone through.

Comment Re:they serve a purpose (Score 1) 439

In fact, they have to, because haggling is their entire profit margin.

Actually, haggling only represents part of their profit margin. Nearly every manufacturer provides a dealer with a holdback on every sale, usually around 3%. In addition, there are also factory-to-dealer incentives (which dealers are not obligated to pass along to customers), where manufacturers sell cars for less than the invoice price. There are various other rebate programs that manufacturers use to help dealers with their margins and move vehicles. Many manufacturers are willing to sell greater volumes at lower margins (especially when it comes to fleet sales).

It doesn't invalidate your point, but dealers don't survive on the haggling process alone.

Also, if a manufacturer sells directly, what stops states and localities from collecting taxes on the same and use of the vehicle?

Comment Re:This piece is hosted on the internet.. (Score 1) 248

Probably, yes. The development of space exploration could be basically credited to the occurrence of the the second world war. Does that indicate the need for more world wars to advance human civilization?

Anecdotal evidence is inherently flawed here because, no matter what route we had taken, we could always point to whatever we did achieve and say "we wouldn't have that if we had done something else" and not be aware of anything we might have created instead. So it's a kind of evidence that can only support the status quo.

Personally, I think it's obvious that a global communications network was inevitable. The internet was not even the first thing which could be called that. There are various reasons it could actually have benefited us to develop the technology later and/or in a different way. What if we wound up with all data and communications encrypted by default, for example? The internet is great but its existence in its present form is not a proof that society needs to progress through projects undertaken by our department of defense.

The real question is how much *general progress* results from dollars invested in NSF grants etc. verses dollars invested in other ways. That's a difficult enough question that is probably a lot of fair points to be made either way. But by all means lets try to qualify what a dollar of public research spending gets us. We may decide we want to keep public research but still reform how it is set up.

Comment Re:Robots (Score 1) 284

You can always work cheaper than a robot. Whatever a robot costs, there's nothing stopping you from charging less (well, except minimum wage laws). How will you afford to eat? Because thanks to the fact food is now produced by robots and supercheap labor, it doesn't cost very much any more.

People will always be exchanging things. Money facilitates that. It won't ever become the barrier preventing it. What really drives people away from menial labor is having better job options to where trying to outbid robots is not appealing.

Stellar rays prove fibbing never pays. Embezzlement is another matter.