Please create an account to participate in the Slashdot moderation system


Forgot your password?
Slashdot Deals: Deal of the Day - 6 month subscription of Pandora One at 46% off. ×

Comment Not the first full recovery from space (Score 1) 113

SpaceShip One touched space and all elements were recovered and flew to space again.

BO's demonstration is more publicity than practical rocketry. It doesn't look like the aerodynamic elements of BO's current rocket are suitable for recovery after orbital injection, just after a straight up-down space tourism flight with no potential for orbit, just like SpaceShip One (and Two). They can't put an object in space and have it stay in orbit. They can just take dudes up for a short and expensive view and a little time in zero gee.

It's going to be real history when SpaceX recovers the first stage after an orbital injection, in that it will completely change the economics of getting to space and staying there.

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:Another in a long series of marketing mistakes (Score 1) 136

You'd need a popular product to pull off obtaining second-clientage from governments, and you'd need not to reveal that your device had legal intercept.

This is just a poorly-directed company continuing to shoot itself in the foot. It's not made its product desirable for government, or for anyone else.

Comment Another in a long series of marketing mistakes (Score 2) 136

There's a truism in marketing that you can only differentiate your product on the parts that the customer sees and uses. Blackberry just can't learn this lesson. They tried differentiating on the OS kernel, which the customer never sees. And now on an insecurity feature that the customer won't be allowed to use. It's been a protracted death spiral, but it's a continuing one.

Comment What's Wrong with the Hobbit? (Score 2) 174

The Hobbit books are to a great extent about race war. The races are alien and fictional, but they are races, and the identification of good or bad is on racial boundaries. This isn't all that unusual in the fantasy genre, or even some sci-fi.

Lots of people love those books. And there's lots of good in them. To me, the race stuff stuck out.

Comment Re:This is great (Score 2) 73

it could put a call out to any EV currently plugged in saying "I'll pay 6 cents per kWh for what's in your battery". If they don't get as much power as they need, they would put out another request at 7 cents. If you paid 4 cents the previous night, that's a good deal for everyone.

You'd be an idiot to accept that deal!

1) Your EV's battery doesn't charge/discharge at anywhere near 100% efficiency.
2) Batteries have a fixed number of charge/discharge cycles, so the energy you pull out is significantly more expensive than the electric rates. It may not be much cheaper than running a gasoline/electric generator in your back yard...
3) On a TIMEÂ-OFÂ-US rate schedule, you pay about SIX TIMES HIGHER for your daytime electrical usage. I just found Nevada Electric TOU summer rates of $0.06159 for off-peak, and $0.36554 for peak (all-day, really). So until they're paying you more than $0.40, you'd be far better off serving your own household's electric needs from your EV's battery, not selling it back to the grid. Of course nobody does that because of point #2 above.
4) If it was at all a profitable proposition, the power company would cut-out the customer, distribution losses, retail rates, etc., and build their own battery banks. That they don't should be a huge hint that the economics don't work.
5) As an added bonus, your car doesn't have its full range when you suddenly need it, and it will take an hour to top-off the charge.
6) If utilities would quick trying to heavily penalize residential PV customers, they would quickly get lots of Summer peak power.

Comment Re:This is great (Score 1) 73

Buy power to charge up on windy nights and sell on hot days. (In summer, anyway) Bulk wind power in Texas on the spot market has actually dropped below zero on a few occasions.

Except that's not a viable business model. It costs way the hell too much money to build a huge energy-storage facility, to not maximize day-in, day-out profits. In other words, you can't leave your battery-bank half-charged every day, waiting around for the occasional free electricity to take advantage of. In fact it's most profitable to build a facility that doesn't quite meet all the demand.

Also, wind power in Texas only goes negative by 1/3rd of the subsidized price (i.e. producers are earning positive money), so when the subsidizes get reduced or go away, so does the free electricity.

Comment Re:Data data everywhere and not a drop to think (Score 1) 366

It still boggles my mind how we live in the Information Age and this data was not automatically uploaded and calculated.

If you should have learned anything about "the information Age", it's that life-critical systems should NOT be highly interconnected. If it's just a single 5-digit number that needs to go from point-A to point-B, plain-paper sneakernet is quite convenient and by far the safest and most reliable option.

Comment Re:Reward networks for not upgrading (Score 1) 75

What happens on eBay is just a market. It's fundamental that a properly working market works to determine the optimum price for whatever is being sold. A properly working market would have multiple sellers and multiple buyers, all with somewhat differing circumstances. Improperly working markets are dominated by a single vendor, etc. No market works perfectly, there are always factors that cause markets to be less efficient than they should be.

Demand pricing is something one vendor does deliberately and with calculation. In contrast, the market pricing is arrived at as the aggregate of the behavior of many people. The market's actually broken if the calculation of one person can influence it disproportionately.

Comment Re:Amazon Model (Score 1) 75

First, there's no shortage of interurban data links for these companies to use if they're willing to. A shortage of infrastructure is a myth.

Second, the customers will indeed abscond, but not to conventional telephone companies.

Anyone who is considering how to jack up voice call pricing is moving around deck chairs on the Titanic.

Every little picofarad has a nanohenry all its own. -- Don Vonada