Sunday assorted links


#7 - prefer Gary Graffman:

thanks. i hadn't seen that before.

IMHO this is one of the greatest classical albums ever produced.

#6 - the only thing surprising is that we'd be at all surprised that when the Gov't Good Fairy waved her majick Wand, EHRs didn't automatically spring forth from the ground perfectly formed and interoperable. Round up the usual suspects and blame them.

This looks like classic crony capitalism.

"Thanks to the White House's stimulus-era initiative to bring the health care industry into the digital age, her company has grown into the country's leading vendor of software in the $9.3 billion electronic health records (EHR) sector. Epic pulled in $1.8 billion in 2014 and is expanding at a rate of about 1,000 new employees a year. ...Meanwhile, Faulkner—Epic's CEO and a major Democratic donor—landed a spot in 2009 on the Obama administration's Health IT Policy Committee, which helped shape the regulations guiding health care software and pushed to rapidly implement EHR in hospitals without first figuring out how to trade records between different systems."

High end donor gets placed on government policy committee, shapes regulations, and her company rakes in billions implementing such systems.

Google should get into this business. They've already got their own version of a smartwatch -- they could integrate the fitness tracking functions with other sources of information, including medical records. Give away the software, publish the API's, and only charge some reasonable amount for using their cloud-based database. The current situation is such a mess that there's an opportunity for them to take it over.

Grabbing as much data as possible is their core business. This would be the Mother Lode of valuable personal data. If they start now, they could capture this. And then there would be all kinds of synergies with their other activities. This would be far more valuable to Google than some freaking car.

"Grabbing as much data as possible is their core business. This would be the Mother Lode of valuable personal data. If they start now, they could capture this. And then there would be all kinds of synergies with their other activities. This would be far more valuable to Google than some freaking car."

Using medical records in the way you describe is a big no-no and would get Google sued.

" This would be the Mother Lode of valuable personal data. If they start now, they could capture this. And then there would be all kinds of synergies with their other activities "

You gave your consent by not changing the default privacy settings when you signed up.

Google flirted with and then got out of that business.

This is kind of a buried lead:

Epic is not the only barrier to a seamless medical records system. Thanks to legislative maneuvering by former Rep. Ron Paul (R-Texas) in 1999, the federal government can't fund any sort of system with unique health care identification numbers. (Paul saw individual medical IDs as further creep of Big Brother.) Social Security numbers aren't a good fill-in; they're not on insurance cards, and in April Obama signed a bill that will strike them from Medicare cards in order to reduce identity theft.

That right there is enough to prevent it from working.

Without unique ID you cannot reliably identify a patient, you cannot transfer a record.

What kind of Congress would pass such a law and then amend to make it, explicitly, a pointless effort?

I mean geez, anyone with minimum database training know that unique ID is the foundation, without it you only have possible matches between "John Smith" and a blood glucose level.

Q. How many congressman or their hotshot young lawyer staffers have minimum database training?

A. Not enough to be writing this type of legislation.

"Social Security numbers aren’t a good fill-in; they’re not on insurance cards,"

Social security numbers are legally only to be used for social security purposes, not for identification. Nevertheless, why would establishing unique health care identification numbers be easier than putting social security numbers on insurance forms? The fixation with enumerating and identifying every human being is a disease endemic to bureaucracy for which there seems to be no cure.

This strikes me as a typical America in the twenty tens dysfunction. The bill may not have been perfect, and then it was rigged for positive failure.

This is why we can't have nice things.

The NSA can track your every move, but people are worried about the government having a database which uniquely identifies its citizens?

Hmmm... on second thought, the NSA would probably be the first one to hack that database. Maybe not a good idea if you're worried about the ever creeping spy state.

We should probably have a national conversation about that list of nice things we can't have because of the broad, and uniquely American, fear of national ID.

The fact that emergency room doctors can't have your medical history is one.

Banks lose us, have to give our deposits to the government, not our heirs.

Delivery of our email depends on us keeping a gmail or etc address for life. This is definitely a suboptimal solution.

Delivery of snail mail depends on filing 101 address changed forms.


You`re probably right. But a presidential candidate or party could never campaign on it, because it would be EVIDENCE that they were surely intending to erect a dictatorship in the early months of the presidency.

This suggests that maybe parties could maneuver to pull it off mid-term. But whoever was seen as supporting it too much, well that would be EVIDENCE that they were planning to erect a dictatorship very soon, and best destroy them at the soonest electoral possibility.

So then maybe they could try to pass something sort secretly, when no-one was paying attention. Of course the secrecy would be INCONTROVERTIBLE TRUTH that they were planning to erect a dictatorship and bring the Stasi into play very soon.

To pull a number out of my butt, perhaps this reasoning applies to about 20-30% of the electorate, ensuring defeat for whoever tries to pull it off.

But the NSA can spy on everyone all the time and that`s OK, because everyone is patriotic and hates terrorists (all two of them).

"We should probably have a national conversation about that list of nice things we can’t have because of the broad, and uniquely American, fear of national ID."

Perhaps if the U.S. didn't have a paranoid, aggressive government that regularly violates its citizens civil liberties, then Americans would be less afraid of a National ID.

"Within five years, all of America's medical records are computerized," he announced in January 2009, when visiting Virginia's George Mason University to unveil his stimulus plan.

-Ah, now I see why this article is linked.

Why would anyone think medical records are a good idea? We really want every private decision we have ever made open to inspection by the nice women who work at the DMV? Do you want your medical records on TMZ?

Implementing it in a way that protected patient privacy would be relatively easy. Download a copy of everyone on to people's smart phones. But no, they do not want that. They want to compile a massive database of every interaction you have ever had with your doctor. No privacy or civil liberties issues here!

One answer to why medical records are a good idea is that i didn't have to repeat my vaccinations to volunteer at a health care facility. They just called them up, added on the TB skin test they did, and I'm set. No idea where to get paper record of that stuff.

Pretty sure if you try to show the EMR you downloaded on your smartphone in 2015 to a doctor in 2055 that it won't be readable and you'll have lost it that one time you deleted all your contacts.

It is about three orders of magnitude easier to make sure we can read files from 2015 in 2055 than to build this monstrosity of a pork barrel data base.

Yes, there is, in theory, a reason to have electronic medical records. But it means that when you volunteer, your boss gets to find out about your little problem with a rash back when you were at college. All the psychiatric care you might have had. And no doubt the first thing everyone will do when they start work for the government is check how many abortions Taylor Swift has had.

There is a simpler way to get around the problems you cite. In many countries they give you this low-tech device called a medical record book. The doctor writes down, with a pen, what vaccinations you have had. Oddly enough it does not involve the State trawling through your medical records to see if you are drinking too much.

"Download a copy of everyone on to people’s smart phones. But no, they do not want that."

Will smartphones be mandated to be bought at conception, or can it wait until birth?

Which brand smartphone will you mandate we buy?

Who will decide the brand of smartphone we must buy? The government? doctor? hospital? What if each one mandates a different smartphone, will we be charged to move the 200 megabyte imagine from the Apple cloud to the Google cloud when the imagining center picks Apple and the cancer doctor picks Android?

Apparently none of you has seen the prescient movie "Brazil".

It should save money maintaining and transmitting records, and ensure that you don't miss out on key information when going to a different doctors, using a specialist, or being hospitalized.

What bothers me is that there doesn't appear to be any interest in making it easy for patients to access their own medical records, and instead that the health system(s) is still basically in control of it.

5. Note there's handsome whistle-blower compensation in such cases (% of recovery). No more schlepping to class for Herr Rasmusen, perhaps.

6. A combination of neanderthal doctors (the last vestige of fax machines!) and "choice" has made the conversion to EMR slow at best. What do I mean by "choice"? Alternative software that won't work together, as each vendor tries to capture the market (or avoid death). Of course, everyone has experienced "choice" with PC and Mac. Is that government's fault?

Well if Steve Jobs or Bill Gates sat on the US government policy committee and drafted the specific regulations, then yes it would be government's fault.

Electronic medical records are more focused on making it easier to bill for services than to record things of medical significance. So maybe blame the payers.

5. The IRS won't pursue the lawbreakers because Republicans in Congress side with lawbreakers over the rule of (tax) law. What if whistle blower lawsuits become the accepted practice for enforcing tax laws? Apple's scheme is transparently ridiculous (apportioning billions in income to a file drawer in Ireland). I know lots of investors who would sign on to a whistle blower lawsuit against Apple (and many other tax evaders). Capitalism at work.

"5. The IRS won’t pursue the lawbreakers because Republicans in Congress side with lawbreakers over the rule of (tax) law."

First, the IRS is under the executive branch and that's run by a Democrat, and secondly, the specific person behind the lawsuit (Eric B. Rasmusen) is a conservative.

And third, Rasmussen's suit alleges underpayment of New York State taxes, which are not administered or collected by the IRS. Learn your Civics 101!

rayward October 25, 2015 at 3:20 pm

5. The IRS won’t pursue the lawbreakers because Republicans in Congress side with lawbreakers over the rule of (tax) law.

The government won't pursue Lois Lerner or anyone else at the IRS despite some of the most gross abuses of government office since .... I don't know when. Worse than anything Nixon ever did.

So frankly I am not in the mood to give a damn. If I am called up for jury duty I have no intention of voting to convict anyone for a tax offense. The consensus on things like tax break down when it is clear the laws are only for the little people.

When Apple doesn't pay taxes, when anyone doesn't pay taxes, who do you think pays more taxes? Duh.

Apple pays it's taxes. Stop your baseless accusations.

Read much?

If you Google it, you will find that quite a lot of legislators disagree.

Companies pay taxes on profits, not revenues.

#1) The author's claim that divestment doesn't affect share prices but does allow non-divesting investors to earn higher returns seem to conflict with each other. Non-divesting investors earn higher returns *because* they are able to buy stock at lower prices, thanks to the divesting investors. That also means that firms' cost of capital is higher (need to offer the prospect of higher expected returns to entice investors to invest) relative to non-divested firms. Another way of stating that "sin stocks" outperform other stocks by 2.5% per year is to say that sin stocks' cost of capital is 2.5% higher. I am skeptical of divestment strategies and believe their main effect is to transfer wealth from "socially responsible" investors to everyone else, but this author seems to be falling into the trap of believing that an anti-divestment article can only make and acknowledge anti-divestment claims. It's possible to make a strong anti-divestment argument while acknowledging facts that, when viewed in isolation, appear to be pro-divestment.

On another note, it's interesting to look at the list of "sin stocks": alcohol, tobacco, gambling, defense, pornography, energy. There are private firms that provide us energy, entertainment (alcohol, tobacco, gambling, pornography), and security, but there are apparently no private firms to boycott for those that dislike over-regulation, the economic drag of the welfare state, or other encroachments on our individual freedoms. It appears that, for some reason, anti-libertarian ends are pursued mainly using the force of government; there appear to be very few private sector contributors.

With any database, like electronic medical records, the first issue that must be decided is who owns the data. The way we operate today, the providers own the data. This works reasonably well for the VA and saves them time and money. But most people don't have a VA entity that provides almost all of their care. So most of us have a fragmented record stored in multiple databases which defeats the purpose of having an electronic medical record in the first place.

Until we fix the ownership issue I don't see how we ever get any real value out of electronic medical records.

Are you flagging NY Times articles so we can be careful with our 10 article a month ration? If so, thank you.

You can also google the NY Times headline to read an article.

Just delete your cookies and the article count resets.

What am I going to do when all of the technologically impaired old people move on? No more free nyt :(

Tyler: You can help the elderly by using a 'Feeling Lucky" link with the name of the article as the query. This will route the link to google's first result (which will almost always be the NYT article).

Example:"NPR Voice Has Taken Over the Airwaves"&btnI

I wouldn't take coup rumors so lightly. Xi's anti-corruption campaign is ruffling many feathers, including in the highly corrupt PLA. China is facing many severe problems (air pollution, water crisis, etc.) but corruption is the big one. If Xi can pull this off, he will will make an enormous contribution to China's future prosperity and maturation as an advanced modern civilization.

The problem is that "if" part. He's trying to reform an enormous bureaucracy that doesn't want to be reformed.

If. Such an important word. I would start out by asking if Xi is engaged in an anti-corruption campaign. I would think not. I would think he says he is, but it is an excuse to get rid of people he doesn't like.

After all, how poor do you think Xi is?

A coup is unlikely because no one has been executed in public with an anti-aircraft gun. At least not that I have heard. When they start dragging corpses through the streets of Beijing then I will believe there has been a coup attempt.

If that's not crushing my business in Macau, I'd like to know what is.

#1: No shit, Sherlock.

4. The loathsome thing about the NPR voice is how so many hosts' needy desperation to make themselves part of the story has been tolerated to the point of (in my view) disrespecting the audience and the subject matter. The regularity with which otherwise-listenable content is interrupted by puns, reaction takes, goofy pop culture references, and other "look at me!" banalities routinely leads me to other places on the dial, and that's saying a lot given the drive-time Los Angeles alternatives.

In my view Warren Olney is the model host who gives it to you straight without any clownishness. The scarcity of others like him leads me to conclude that I'm just not in the sweet spot of NPR's target audience.

The knock on NPR during the 90s and early 2000s was their boring delivery. Remember those SNL skits that mocked them for that? Maybe the current style is a calculated attempt to make NPR programs more relatable to the listener.

Yup. When it was just one terrible voice doing "personal journals" or whatever This American Life calls their Not News Stories, it was fine -- listen if you like the topic ignore if you don't. The proliferation into nearly all types of semi-intelligent vocal entertainment is an annoying one. Right now I find the biggest offender to be Radio Lab, which offers outstanding information but in the worst tone possible.

On the flip side, I think Planet Money uses it fairly well. Economic news coverage is notoriously dry, and they do well with using the pop culture references to make actual explanations rather than just show how witty and relevant they are.

Also, to what extent is "NPR" voice just "relativity young and hip New York Jew" voice?

"Also, to what extent is “NPR” voice just “relativity young and hip New York Jew” voice?"

FTA: "Mr. Glass found inspiration in Susan Stamberg, who began hosting NPR’s “All Things Considered” in 1972. “She seemed like some Upper West Side, New York lady leaning into the microphone, mensch-ily talking into the radio,” he told Mr. Baldwin."

Howard Stern falls into a different but related category. Maybe a reaction to the formal WASP voice of the 40s and 50s?

Take any cultural explanation with a grain of salt. It always comes down to what the audience wants in the end.

5. The fact that the NYT covered this shows they (journalists) don't understand the professor will be embarrassed for such a frivolous lawsuit.

He'll be one of the most embarrassed guys with $80 million in his pocket that you've ever met.


"The (Norwegian) government seems to finally close down floppy distribution at the beginning of 2016, forcing any remaining doctors over to newer electronic patient journals. The chosen strategy is just to offer paper printouts instead, requiring error-prone rekeying at the doctor’s office. The future may be here at last, entering via paper detour."

#2. AWWWWWW!!! So AdorABLE!!!!!!!11

#6, the growth of Epic, is mostly about path dependency and the conservative nature of those making decisions in corporate healthcare IT.

No, the article completely misses the most salient point in the lack of data sharing capabilities, and that is the role of the notoriously over-strict and antiquated HIPAA rules have on health care IT. HIPAA has rules for data protection that are much more strict that how we handle classified military information, and it directly impedes the flexibility and stability of the EMR systems.

Comments for this post are closed