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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: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:Say Good By to the Rainforests .... (Score 3, Informative) 851

You can't (or at least you shouldn't) fry anything in Olive oil. It will smoke and degrade into potentially unhealthy chemicals.

This is only true for lower quality extra virgin olive oil. High quality extra virgin olive oil with low acidity has a high smoke point. Also, virgin olive oil has a smoke point comparable to refined canola oil (only slightly lower), at 199C vs 204C. For reference, there is a chart of smoke points here. Unless you are using extra virgin olive oil, you are safe frying in light olive oil at about 199C.

Comment Re:People need to settle down... (Score 4, Insightful) 206

...Of course, this being the internet, you have the usual suspects crying chicken little, the sky is falling.

They're also smugly saying "I told you so" - and doing so seemingly without understanding the situation. The situation hasn't changed since the beginning: don't use the service if you don't trust the encryption. If the service is breached and the (open source, peer reviewed) encryption stands up to attack, then the threat is astronomically minimal.

Comment Re:I want my old /. With BlackJack and Hookers. (Score 1) 145

Who's we white man?

Now I'm white and a man?

I really hope that you were joking too. I don't know you, so just in case - here's the joke that I was referencing. :)

"We" is the people that actually do work in the tech industry & engineering. When I go to work in the morning I don't care if you're white, black, purple, gay, straight, trans-gendered, female, pierced, tattooed, et al. All I care about (those that I work about care about) is if you get your work done and if it's quality work. It's been that way for a while and it's been that way with most people I work with and know.

It's why a lot of similar industries don't care about your attire and you can get away with piercings, colored hair and tattoos

It's great that all you care about is results. I wish that there were more people like you. However, it doesn't mean that the tech industry is immune from the wage gap (or position gap) between men and women. It has and it continues to happen. There are some companies who are pioneers in this sense, too. However, these are not the norm. While I am optimistic about progress, we have a long way to go to establish equality. I welcome hearing about it on Slashdot, as the topic is worthy of discussion. To squelch discussion is being complicit with the status quo, which is a form of racism/sexism in and of itself. Please don't take that as me accusing you of anything. It's not my point. My point is to explain the merits of discussing it here.

That's the thing. I believe in social justice. And the way to get 'social justice' is to stop pointing out the differences and turning sides against each other. Women and LGBT have been in 'industry' for a long time. (Grace Murray Hopper graduated from Yale in the 30s) It's not an issue for most people. The only people that think it's an issue are the ones that are trying to grandstand it into something more than it is.

Tim Cook wasn't really deep in the closet before he came out, it's just that it was a non-issue around Apple.

I agree that the tech industry is diverse. However, it continues to be a male-dominated industry. If certain people feel alienated, or there is a wage/position gap - should they not be free to voice their opinion? Should they not be welcome to engage in discussion about it (it's not like anyone is forcing anyone else to participate in it)? What makes Slashdot the wrong place for it? I mean, if they're "nerds" in their field, should they head over to Ms-Slashdot.org and discuss it there? Just because the CEO of Apple's sexuality was a non-issue, does it mean that others in other companies do not experience it on a wholesale basis? Another example: while I am a huge admirer of Grace Hopper, her story is an exceptional one, considering that she practically stands along among history's female computer pioneers.

With respect to how to achieve social justice, I don't know if I agree with you. There is really no way to point out how inequality within the status quo without someone feeling attacked. Every online discussion that I have ever read about gender equality or racism results in a person in the majority (who is usually white, male, and/or heterosexual) attacking back, or at least pushing back in a way that indicates that they feel threatened. This type of behavior is endemic to the status quo. An attempt at social change that will negatively affect the privileged will often result in a negative response. At best, activists of social justice are accused of being divisive or stirring the pot. Maybe they are being divisive, but maybe they're right to be if they've been living with inequality their entire lives.

I also understand your point about grandstanding. However, if we agree to stipulate that there are a few people who grandstand about race/gender/LGBT issues for their own purposes, I don't think that it is fair to dismiss or otherwise not discuss all other claims on that basis. Similarly, when you mentioned in the GPP that you didn't care about Gamergate - I really do. I mean, this was a case of gamers actively harassing outspoken women who wished nothing more than to change the status quo of what they believe is sexist industry and culture. Irrespective of the merit of the actual arguments, the community response was generally despicable, and I couldn't think of a better place for it than Slashdot.

I'm not trying to get into an argument with you here. I honestly respect your opinion - and I can see that we feel differently about this. That's fine. We live in a fairly diverse country, and the tech industry does not exist in the vacuum of a few companies who pioneer. My point is that I welcome hearing voices from all of these people here.

Comment Re:I want my old /. With BlackJack and Hookers. (Score 0, Flamebait) 145

I like a lot of what you had to say, but please forgive me for being pedantic on one point that you've made.

On 'Gamergate', 'sexual equality', 'gender issues', we don't care

Who's we white man? ;)

It's great for you that you're privileged enough to not have to care about issues of gender equality. However, to be clear, I do care about that stuff, and if you have any interest in social justice, I believe that you should too.

My last point with respect to your sinking ship comment, I believe that there is one major shortfall that you missed, and it's not /.'s fault. It's the /. user community itself. Seriously, commenters here are almost as bad as YouTube - going straight for the ad hominem jugular over something as minor as an error in punctuation (or worse, a technical error in a post). I suppose that it's endemic to any Internet forum, but some places are better than others...and this place is worse than many others. It's like a magnet for internet buttholes and tough guys. There isn't much that can be done about it, other than trusting the moderation system, but that kind of environment does tend to stifle productive and respectful dialog.

Comment Re:call me skeptical (Score 4, Insightful) 190

Well, either he did manage to access the flight controls from the entertainment system, or he didn't.

If he didn't, I don't think the FBI has much of a case.

I don't think that this has anything to do with whether or not the FBI actually has a case. I suspect that this is the federal government sending a message to security researchers that airplanes are off-limits. It's the same reason for the TSA's billions of dollars of security theater - it's not about safety, it's about making people feel like they are safe. If average citizens do not feel safe flying, they won't fly and we won't have an airline industry. This would have a tremendous effect on our economy. If average citizens believe that flight control systems can be hacked by a geek in his/her seat with a laptop, they will not feel safe, and may not fly.

I'm not much of a conspiracy theorist, and I'm not about to start now. However, given the fact that it seems other-worldly outlandish that a security researcher can gain control of any flight controls via the wi-fi entertainment system, I strongly suspect that this is the purpose of the FBI's heavy-handed tactics.

Comment Re:How much is his investment in the company makin (Score 3, Informative) 482

No, that is not tax evasion, I believe that you may be confused about the terminology (or are doing it on purpose for the sake of hyperbole, which is even more unhelpful). This is a case of setting up earnings to be tax advantaged (or tax avoidance), either deliberately or as an advantageous consequence of something that is potentially very good. There is a very real difference (see the article heading where it says "not to be confused with tax avoidance"). One is criminal, the other is sound money management. To put it another way, are you suggesting that you do not take any tax deductions?

Comment Not sure that TFA is comparing apples to apples (Score 3, Informative) 72

...is capable of sequential read and write speeds of 2,260 MB/sec and 1,600 MB/sec respectively. Comparable SATA-based M.2 SSDs typically can only push read/write speeds of 540 MB/sec and 500 MB/sec,

Non-SATA M.2 drives are already on the market. Comparing the newest drive to SATA-based M.2 drives does not help much, I'd rather see it compared to what it supersedes. In this case, I'm more interested in a comparison with a PCIe 3.0 4-lane M.2 SSD drive that doesn't support NVMe. The drive specification for the earlier non-NVMe SM951 is not that far off of that of the new drive. The earlier drive is rated at sequential read and write speeds of 2,150 MB/sec 1,500 MB/sec respectively. Again, not all that far off.

That being said...I'm curious to see the difference that NVMe makes in real-world benchmarks, and where the difference is...especially because I just built a new system with a non-NVMe SM951 SSD. :)

Comment Re:USB was no longer standard either (Score 1) 392

When I plug my iphone into my car it constantly resets as it tries to draw too much power and the car circuit breaker kicks in.

Your car has a circuit breaker? Do you drive a Vector, replace your fuse box with a breaker box, or something else that I don't know about? Seriously - I've always wanted to know why cars use fuses and not breakers, and if modern cars are switching over for some applications.

Computers are unreliable, but humans are even more unreliable. Any system which depends on human reliability is unreliable. -- Gilb