I'm not sure I'm all in for that statement. Almost all EMRs these days have pretty robust security controls, and it's rare that celebrity patients come in on unplanned visits where that "all access" kind of response is necessary. Where it is, it's usually handled in the ED, where the expectation of privacy is necessarily low. In the case that the patient is a regular admission, a pre-admit for a procedure/care, or anything other than getting hit by a bus or other trauma, there are well-established practices that protect their identity.

For instance, my last employer had a case where a celebrity's wife came in for Labor & Delivery. The hospital admitted her under a pseudonym, and only her direct caregivers knew the true identity. An audit trail and special VIP protections were placed on her record, so that staff had to electronically "sign" and state a reason why they needed access to her chart if they weren't in the direct care group. For all intents and purposes, she was well protected.

The problem came in when billing entered the picture. You can't bill against a pseudonym, and the local papers broke the story soon after she delivered. Once she left the hospital, her pseudonym was replaced by her real name, and her chart was promptly accessed over 200 times by various personnel across the hospital. In the next week, five people were fired outright for unauthorized access, and about a dozen put on disciplinary action because we couldn't fully prove that their access was unnecessary, if suspect. In an ideal world, the system would have been able to bill out under the pseudonym with the identity correction occurring downstream, but people still talk and the cover would get blown eventually anyway.

Does this anecdote have a point? I'd like to think so: it's that there's only so much mitigation you can do, but a lot of hospitals and EMR vendors could certainly do more. There will always be people like me who have god-like access by necessity though, and as long as that exists, there will always be the potential for abuse and information leaks. I think the real benefit of electronic systems is that, previously, if someone absconded with the paper chart, there was no way to tell who accessed it. Even I leave entries in the logs, and there's pretty close to no way to effectively "leave no trace" of my presence in the system. The biggest benefit of modernization is accountability, but real privacy is a pipe dream that people need to abandon.

Funny, our annual revenues and net profit are very close to yours, yet we support 1/10th the clinicians. Are you supporting multiple EHRs that are interfaced, or running something frankenstein-esque like McKesson? Because that might be the first problem. Our health system has one inpatient system, period, for all entities.

As to the problem list issue, it really came down to the political climate. Physicians have to be dragged kicking and screaming into the 21st century, and as an academic health system they end up in all of the leadership positions. It's only in the last 5 years that they decided they need to even have electronic documentation, and we've been racing to catch up to our peers. I'll level with you--we're about 3 years behind where we really should be for the level at which we're trying to play, but change management due to new regulation is not one of our issues.

As pretty much everyone else has already said, if you don't have a system that can quickly and easily update from ICD-9 to ICD-10, you're so far behind the IT implementation curve that you should be drug out into the street and shot.

It's 2011. They've had many, many years to upgrade, and now they're poised to paid by the government to do so. Hell, my employer stands to gain $50 million dollars over the next couple years from implementing key portions of the HITECH provisions in ARRA. For those reading, that's more than half of my (quite large and well-funded) health system's annual budget.

For our part, we just slapped down a couple hundred thousand for a product that hot-swaps our ICD-9 coding for ICD-10, and also tosses in a problem list that physicians can use that's tied to these coding schema, potentially improving efficiency and accuracy as well. The only excuse, and I mean ONLY excuse for ICD-10 being a problem is poor IT leadership within the health system/hospital--a failing which is incredibly, unbelievably common.

I'm lucky, I work in an IT shop that actually has its shit together.

There's always Amazon. This guy is an intermediary, sure, but a good portion of Amazon's product is now handled through 3rd parties too, so it's really not a big deal.

The real thing that will make BitCoin take off is increasing market capitalization of the currency, which is already happening. I mean, over $50 million dollars of Bitcoins in circulation, with $135,000.00 worth of BitCoins exchanged per hour? Shit man, that's an economy already.

I'm not a futurist, and there are certainly threats to BitCoin from other established internet exchangers, but I think it's got potential, especially for anyone who'd like to see the internet really achieve its true potential as a free medium.

Take a gander at this paper on the subject. Most people have about a 50/50 shot or worse at accurately predicting binary events. The worse part is interesting--that some people are just consistently terrible.

The truth is, you have to have incredibly detailed knowledge about a subject and a philosophic outlook on it that's appropriate. Technological change is especially hairy because there's a lot exciting technology that ends up getting killed by socio-cultural or political reasons. For instance, in the late 70's it was unthinkable that we wouldn't have a moonbase by 2010, but no one was looking at a little defense project called ARPANET. Ooops.

I'm no expert on this shit, so I can't speculate about what's going to be hot in the future. I thought the iPad was stupid, and I think Dark Matter is a bunch of bullshit. I also think Kurzweil is awfully optimistic about the Singularity. That said, I'm aware of my own track record,on prognostication, and unless it's about healthcare IT (my field), I'm ready to be as surprised as IBM was when they ended up having a worldwide market for more than 5 computers.

If only system hardware were the only limitation...oh wait, it's not. Have you ever played FF7? There were mini-games all over the place, including one which was essentially a really shitty RTS. Or how about Halo, where you can go solo or command a small squad, even jumping into vehicles? Hell, Halo: Reach even included space combat.

The problem isn't that games don't cross genres, its that companies that are good at RPGs don't necessarily have the time, budget, or expertise to make a multi-genre game. A good way to think about it is how many shitty "Me too!" games there are out there for every blockbuster that comes out. Even if you're just developing a single-genre game, most companies have a hard time meeting the player's expectations.

You don't have to pick on videogames either--you can look at the traditional market too. The only system I know that combined RPG, Strategic, Tactical (both Naval AND Land), and Diplomatic elements in full was the Birthright setting in 2nd Ed D&D, and even it was crippled by its simplistic and boring tactical component. I'm a miniature wargamer right now playing Warmachine/Hordes, and even though its parent company Privateer Press is making moves to get back into the RPG market, I'm not sure if they'll really be able to pull off a scale-resilient setting and compatible RPG system.

tl;dr: Shit's hard man. Try it sometime.

I call bullshit on the interoperability with most EMRs. Most likely, this thing is just putting HL7 wrappers around some basic ADT info and dumping it into the system, which may or may not have interfaces built to actually use that information. Even if it does, a lot of it will probably come over as free text plopped into some arbitrary field, or worse--will require the hospital/health system using it to direct that information somewhere using eGate or a like technology. This is the sort of thing that healthcare IT shops hate with a passion. It's yet another device we have to support that uses the interfaces that are already unreliable and doesn't put data where we really want it, which is within the clinical documentation that's custom-built at EVERY HOSPITAL IN THE UNITED STATES. Believe me--I'm working weekends right now trying to get an "out of the box" clinical documentation system up, and "out of the box" went "out of the window" about six months ago. I'd rather use that 12-18 grand (plus whatever would be budgeted for making it actually work with the EMR) to send my clinical staff to basic medical translation classes for the languages we see most commonly.

I'm sorry, you start DOS'ing anyone whose website offends you, and it's only a matter of time before you hit a site someone actually cares about enough to take action on. This guy should know this is part of the game, and take it in stride. If they found out who he was in the first place, apparently he wasn't very good either.

Jean Higgins is actually a friend of my family, and let slip about two years ago that the writers never really had a plan, and that the whole show was basically going nowhere. After hearing that, I decided I could pass on ever watching the damn thing.

I graduated a little under a year ago, and I used a laptop in every class from undergrad through grad school. My friends and I would use our time in the class to either take notes or look up relevant articles on the material via Google Scholar or my school's online library. We got A's in almost every class, and were consistently touted as the most productive and engaged students, because our access to material online allowed us to form better questions and support informed debate through key statistics and quotes. Technology can really, really improve class performance, especially laptops. I think the bigger thing is to stop requiring attendance at classes people pay out of pocket for, and to stop making classes just rote dumps of the material. For example, I had a Pharmacology professor who posted all of his lecture powerpoints online, complete with audio so we could listen to the "lecture" on our own time. We were given case studies and problem sets each week, and the purpose of class was to come in and discuss the cases and problems to make sure we understood the material. Class often got out early, and everyone loved that professor.

That's what I was thinking too; and probably just function like an 18-wheeler where a tire can blow out and there's so much support that the load is still distributed adequately.

Basically, all this means is Google designs like Mack while everyone else designs like Chrysler...