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Comment Re:It is obvious that support most be provided... (Score 4) 125

If MS put real effort into providing good security [...]

You're bitching about an OS with mandatory access controls, DEP, ASLR, virtualized filesystem access, application whitelists, secure boot, and that runs its own authentication daemon in a VM so that not even the kernel itself can directly manage password hashes. You're doing this bitching in an article about a tool they maintain so you can harden and sandbox third-party programs, even when those programs weren't built with stack smashing or ASLR or all those neat Visual Studio canaries in mind.

[...]it would destroy the lucrative market for anti-malware software.

They bundle anti-malware software with the OS. They're, clearly, very concerned about not destroying all that filthy McAfee lucre.

Comment Re:illogical summary (Score 2) 360

There's no proof, and the "Global Competitiveness" crap in TFA is irrelevant to the millions of Japanese SMEs, because they are not competing globally.

Japan is on the edge of a demographics crisis. 25% of their population is over 65, compared with 59% that work. Having only ~2.36 people paying into public healthcare and social insurance for each person drawing out is not a good ratio, and with their notoriously low birth rates, is only going to worsen as time goes on.

In the meanwhile, Japan's racking up shittons of debt, and has to import nearly all of their energy.

So, what does this mean? It means productivity is really fucking important. If your aging population has fewer than 2 workers to cover each retiree, those workers better be really fucking productive or those healthcare costs are going to be an incredible burden. If you need to import 94% of your energy at great expense, you better put that energy to really fucking good use--i.e., be productive--or otherwise you're spending everything on coal and petrodollars instead of your own people. If your government debt is skyrocketing, but has fewer and fewer taxpayers to pay it down, those people better be really fucking productive or you're not going to have a government.

That latter point is especially important. Japan can get away with its debt load because of Japan's famously high savings rate--lots of people (or banks using people's savings) buying savings bonds means you can issue those bonds really cheaply. But, when people retire, they by necessity stop saving and start drawing on their savings instead. The government has double their yearly income in what's essentially an adjustable-rate mortgage, and the interest rates are going to skyrocket right as fewer people are there to pay it down.

Comment Re:How embarrassing (Score 1) 157

He's right though. We spend much more per person on healthcare than even the yuuros do, and we die sooner despite that (fig 1). That's not to say that our hospitals are bad (though some states really fail at not killing people), or that we aren't awesomely good at treating specific diseases, but none of that means you'll live any longer than the slackers across the pond.

Even worse, despite being a nominally private healthcare system, our government still spends more per person than even the UK (fig 3). As in, we'd have less government in medicine if we went full-retard universal care.

That's not to say I'm a fan of single payor systems--our nanny state is already trying to micromanage how many ounces are in a soda even when they're not paying for your fat ass. But, it's simply wrong to say that the single-payor systems don't provide better care for less money.

That said, I'd much rather we emulate Singapore. They make you pay for everything out of pocket from a savings account drawn off your paycheck. Paying cash for everything keeps prices in check, the mandatory contributions mean no one's "uninsured," and no insurer or HMO limits what you can buy. Subsidies help the truly indigent, and you can draw on it like a 401(k) in your dotage should you prove unusually resilient.

The Little Red Dot lets you be as much of a fat-ass as you care to pay for, and ain't that the American way. Japan, in the meanwhile, has an honest-to-God fat tax.

Comment Re:Do it yourself, here is why... (Score 1) 193

You raise a good point, but constantly fixing someone else's computer problems is draining, especially if the help is one-way and never reciprocated. It does nobody's relationship any good if you dread every call for the hour it's going to take to fix whatever broke.

Imagine instead if their computers actually worked, and you could therefore instead talk about whatever you wanted instead of why the printer isn't working. "Spending time with your child" is one thing, but I'm welcome to visit even when the Internet isn't broken; and, when visiting, I'd rather spend the time with them instead of their computer. Likewise, my folks are welcome to visit me even when I don't have a busted clutch slave cylinder or leaking fuel tank; and, likewise, the time is better spent on discretionary projects we want to tackle for the purposes of fun and/or bonding as opposed to helping with an emergency.

Comment Make Things Easier (Score 1) 193

I have no idea what you can expect from big box phone support, or if "good" phone support even exists. There are a bunch of things you can do to make tech support easier, however, if you haven't done them already.

  1. The best thing you can do (again, if you haven't already) is take away the Administrator account. I used to get weekly calls about my grandparents' PC, which saw a lot of use by relatives and grandchildren, until I did that. Suddenly, all the toolbars, viruses, Bonzi Buddies, random driver issues, and how-does-that-even-break issues just stopped. The occasional call to go type in the password and install something was much quicker than the frequent calls to uninstall something added by a well-meaning uncle or a young cousin.

    Yes, some people were angry that they couldn't install things any more. But, they didn't want to take the support phone calls, so they didn't get the admin password. Everyone else was happy that the communal PC was suddenly much more likely to work when they wanted to check e-mail or play Facebook games.

  2. Install Team Viewer. It's free for non-commercial use. When they call you with a problem, you tell them to click the big Team Viewer icon on the desktop and give you the code. Then you remote in and fix whatever broke--and the set of breakable things is much smaller on a limited account than on an admin.
  3. If you still have issues, purchase a copy of Faronics Deep Freeze--absent a password, it prevents any changes to the file system outside of certain allowed areas, like My Documents and the rest of the user profile. When I was an IT monkey, we used this in our computer labs, and it worked great--people could install whatever they wanted, delete whatever they wanted, vandalize the Windows install in whatever way they could think of, and it'd all be gone with a reboot.
  4. If you have more hardware issues ("the printer stopped working"), think about getting new hardware. I have a Phaser 6125N, for example, which is overkill for most anything, really, but toner lasts forever and the drivers are completely free of crapware--you just plug in an Ethernet cable and forget about it. If their printer frequently causes issues, weigh the cost of a newer, more enterprise-y printer with the time saved by not having to fuck with it every week.

    Ditto for modems, routers, whatever. If you have to walk them through rebooting their router every week, weigh the cost of a more reliable router over the time saved helping them turn it off and back on again.

  5. Finally, work on your phone support. If you ask someone if the network cable is plugged in, they'll always say "yes," especially if they're a professor too proud to crawl underneath his desk and check for a lowly IT monkey.

    Instead, ask them if it's plugged in the right way, because Ethernet cables are directional, you see. Make them flip it around (which, coincidentally, verifies a solid connection at both the wall and the PC). If that fixed the issue, they'll forever believe that Ethernet cables actually are directional, but it'll save you the trip to push a cable that last 1/8" into the jack.

    This is necessary because most people--even family--are loathe to actually check e.g. what color some lights are, especially if checking involves some modicum of effort. While most people won't outright lie, they'll give you whatever they think is correct, or whatever answer sounds good off the top of their head, which is especially easy to do for yes/no questions.

    So, never ask "is it plugged in"--the answer's always "yes," because of COURSE they plugged it in they're not an idiot and checking is effort. Ask them to switch the cable around. Don't ask if the lights are on--ask what color they are. Don't ask them to reboot their computer--ask them if their computer makes a noise when they hold the power switch for ten seconds.

...But, yanking admin accounts by itself solved nearly all of my tech support issues, and the few that remained were easily and gladly fixed with a few minutes on Team Viewer. If you can reduce your support burden to a combined total of an hour per year, I don't think you'd mind in-sourcing it again.

Comment Re:About damn time (Score 5, Interesting) 130

It's harder than you're probably giving it credit for, especially for miles-long freight trains, where a hill can mean one segment of the train is accelerating while another is decelerating. We're just about there, though, insofar as we have software that automatically drives throttle, brakes, and other controls. Link:

Norfolk Southern, an American rail operator, now pulls roughly one-sixth of its freight using locomotives equipped with "route optimisation" software. By crunching numbers on a train's weight distribution and a route's curves, grades and speed limits, the software, called Leader, can instruct operators on optimum accelerating and braking to minimise fuel costs. Installing the software and linking it wirelessly to back-office computers is expensive, says Coleman Lawrence, head of the company's 4,000-strong locomotive fleet. But the software cuts costs dramatically, reducing fuel consumption by about 5%. That is a big deal for a firm that spent $1.6 billion on diesel in 2012. Mr Lawrence reckons that by 2016 Norfolk Southern may be pulling half its freight with Leader-upgraded locomotives. A competing system sold by GE, Trip Optimizer, goes further and operates the throttle and brakes automatically.

Comment About damn time (Score 5, Insightful) 130

The article's a bit short on details, but this is where I expect autonomous driving to take off first--long-haul trucking. Controlled-access highways present fewer complications like pedestrians, four-way stops, and the like, and I imagine automating that would take care of 80% of the driving. Even if you still needed a human driver to reel 'er in at the warehouse gates or even the city limits, it still strikes me as a huge improvement.

Laws and liability are going to be the biggest limiting factor to commercial deployment, especially if they boil down to "a human must be ready to intervene at any time," but I think there are fudges around that. You could have one human operator in a remote control center "driving" multiple trucks, kind of like a cross between drone pilot and remote ICU monitoring.

Not that even a human sitting in the seat with hands on the wheel would be likely to intervene effectively should something go wrong after eight hours of idle monotony. But, having a human somewhere supervising in some capacity would soothe the more irrational fears that also serve as part of the reason we still keep human pilots flying planes, while still yielding the benefits that come with automation--self-driving trucks are much less compelling if each one still needs a full-time human driver to comply with laws.

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.

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Life would be so much easier if we could just look at the source code. -- Dave Olson