birdog1960

well, if you didn't get vaccinated for measles, you might not be allowed in disneyland: http://www.npr.org/blogs/health/2015/01/22/379072061/disneyland-measles-outbreak-hits-59-cases-and-counting the arguments against vaccination are weak and selfish. the benefits greatly outweight the risks.

in the same thread we have obama the oligarch and obama the socialist. how is that possible.

well, that's awesome. i'll be very happy to see it as will legions of clinicians. search "ehr fail" and see what comes up. there's almost no one that cares for patients that thinks this technology has met any of it's promised goals. in most cases, it's made things worse. except for the insurance companies that have all that valuable data and are exempt from hippa. makes you kinda wonder what the real purpose was and why people aren't screaming about privacy when huge corporations have their intimate details. why the feel better about those companies access than the gov'ts is a mystery to me... and i never bought into the amateur hour (years) of ehr's primitive infancy and i suppose, now, adolescence. my employer did when the incentives and disincentives became too large to ignore. i was rightly convinced when in private practice that the available systems would neither benefit me nor my patients. i truly hope you prove the naysayers (including me) wrong. unlike others here, i believe it is possible. it's a question of priorities. it amazes me that a $300 phone can incorporate voice recognition to find wegman's in fairfax, tell me when it's open and give me turn by turn directions but that currently available ehr's can't recognize the voice recognition produced words "flu shot" and collate them. same for sophisticated investment programs and defense systems. i gotta think the designers of these things are better paid and more highly sought after than the majority of those working for the aptly described "awful software companies". why is that? is the health of friends and family such a low priority? at any rate, good luck. if it works as planned, everybody here can say "i used to argue with that guy" when we see you at national meetings and being interviewed on cnbc.

no need for judgement. algorithms could achieve all the tasks i mentioned. i'm happy to provide the judgement. in fact, i thought i just did.

if what i'm requesting is magic, then useful and efficient ehr's are a pipe dream. i don't believe it requires magic. ibm has a computer that can beat humans in jeopardy. i used a program 25 years ago (written by a physician) that spit out a pretty thorough and accurate differential diagnosis based on symptoms and findings. yet a program that parses notes and collates information already entered into it in whatever form (notes, lab reports, X-rays) is not possible. i dictate that someone had a flu shot this year in a note and the computer can't pick that up a put it in a preventive flow sheet? that's magic? a number is entered for a blood thinner range from the lab and the program can't automatically populate a blood thinner flow sheet with that info? that's magic? i want to search for every imaging study done on the chest of cancer patient in the last 5 years and i can't do it using a search function? that's magic? no, that's not ready for primetime and the product of a scrub squad of programmers.

no point in reproducing all that garbage. the answer to your question is when the programmers/designers realizre that they need to build sytems around the way medicasl professionals have been taught to think for generations not the way these nonclinical people believe we should think. they should have first studied how clinicians process/disseminate/collate and historically have documented information and designed a system around that, not designed around how they think it should be done and then have the clinicians adapt. oh, and how bout a bit of artificail intelligence in the prorams so they can parse the info on their own? it also seems no one designing these things has experience with a search function. i've yet to see a system with even a primitive one allowing search for a specific test or series of tests of even a keyword in notes. so the answer to your question is they'll be ready for primetime when you and your collleagues decide to make them. they're not even close now. they're embarrisingly rudimentary and simplistic. and most people aren't using these things like cookie cutters because they don't want to stand out. they do it because the programs are designed to produce cookie cutter results. the desigers were no where near sophisticated enough in medical matters to produce anything else. stop blaming the victims (clinicians forced to use these pos tools).

firstly, this is total bs. i certainly don't fall into the category you descried. nor do any of my direct colleagues. we dictate and scan almost all of our documentation because we feel it avoids just what you're alluding to. each note is unique. and we meet meaningful use. the cookie cutter notes are a direct product of an EHR industry that is still not ready for primetime. it's the maker of the square hole that so many providers are forced to push round pegs into. the entire industry has been complicit in generating an historic, epic fail. i'd be ashamed to associate myself with it. secondly, nuances in documentation are a far cry from questioning the basis of the science of medicine. the analogy i would think of in medicine as compared to climate science is sterile technique. people didn't understand microbiology. they didn't even know the bugs existed. but midwives had much lower infection rates than doctors of the time. because they were cleaner. more hygienic. and then louis pasteur and others figured out why that was important. such changes are rare. and they're generally brought about by brilliant people. i don't see any climate change deniers meeting that criteria.

Yes, because I've never met or heard of a physician who has put in time, effort, and possed the innate intelligence required to become a physician.... ....ever massage his data to get his drug/treatment/device though clinical trials and on to FDA approval. Why would he spend his entire life on a lie? It wouldn't be because if that drug gets approved, he gets public noteriety, significant recognition from his peers, and a boatload of cash would it? I mean, that physician has the skills and the drive necessary to change his career path then or even now. Why would he choose to lie about his new thinger? This never happens. All of these guys are beyond reproach. You are pretending something that occurs in your profession, every single day, first, does not occur, next, cannot occur in another profession, for reasons passing understanding. here's the problem. we're not talking about a single physician in this analogy. we're talking about indicting an entire specialty group like the ACP, AHA, ACC. it's the fringe players that are willing to bet heavy on taking on the establishment views of groups like this. occasionally, they're correct and can prove it. much more often they're just nuts trying to make a name for themselves or doing some benefactors or investors bidding. very rarely, they are thought leaders and become the establishment rather than bucking it: https://www.ted.com/speakers/eric_topol. this is exactly what i believe is happening in climate science. i don't believe dr curry = dr topol, however. far from it.

it's the american way. thems the rules. change the game, change the rules. but most don't want to. somehow they believe that given the right opportunity, they can win. becoming prez is winning. it comes with perks.

so which of the definition would you choose or do you agree that he's not an oligarch?

read it again. is said he's rich but not very rich or oligarch rich. and so it is.

not gonna cut the unabridged forbes list. he's rich. very rich? oligarch rich? i think not.

right about now would be the time to post 15 sentences on the distinction between income and wealth....

so which definition is fitting? noun: oligarch · plural noun: oligarchs a ruler in an oligarchy. (especially in Russia) a very rich businessman with a great deal of political influence if you choose #1 then all US presidents are necessarily oligarchs choice #2 is not applicable since obama is and never has been a businessman. and by american standards, i don't think he qualifies as very rich. so he's not an oligarch. maybe he's a politician trying to make things more equitable within the constraints of an economic system that is designed to result in just the opposite.

because incentivizing training to produce workers with needed skills thereby improving the economic outlook for both individulas and scociety as a whole is just like what you describe.... and speaking of sedition: http://www.washingtonpost.com/politics/daddy-issues-are-ron-pauls-hard-core-stands-a-problem-for-sons-presidential-bid/2015/01/25/e23b1cdc-a4a9-11e4-a7c2-03d37af98440_story.html

we could certainly incentivize needed degrees over less needed by the amount and interest rates for gov't loans available for each. no reason similar incentives couldn't be imagined to prioritize in-demand degrees at 2 year schools. it wouldn't require a stick when a carrot would work better. when i read/hear such sentiments, i'm often of the impression that those speaking are actually in favor of eventual mass treason…and then somehow rationalize it as patriotism.

again from davos: fits nicely with the community college argument. In the West, too many young people are graduating from expensive colleges with high debts and the wrong skills, while in developing countries a big majority are not achieving their economic potential. http://www.cnbc.com/id/101364321

i don't embrace her. the article i linked was very critical of her imo.

a nice feature article on dr curry in that rag science publication, nature: http://www.nature.com/news/2010/101101/full/news.2010.577.html. some background is often helpful.

bias exists. no doubt. the presence of people like curry however, speaks to the fact that there will always be those in science that question whatever is perceived to be the truth at the moment. that's what scientific method is all about. to me, it appears she's had her say in multiple forums including those of the AMS and is still widely considered an outlier. http://climatecrocks.com/2014/01/20/judith-currys-testimony-where-theres-smoke/ the o ring example was answered by tom; a set of events i was unaware of. sounds eerily familiar to bush II's stifling of NASA's opinions on climate change during his reign. my colleagues in ENT would be surprised to know that there is only one recognized mechanism for tinnitus. http://www.mayoclinic.org/diseases-conditions/tinnitus/basics/causes/CON-20021487. that would make their job a wehole lot easier.

i don't agree with your premise. more and more power is being concentrated in fewer and fewer hands, just, not coincidentally, like wealth. the hope for the rest of us is that those meeting in davos see that the current course, left unaltered, doesn't end well for them, either.

it's an economic summit organized and attended mostly by elites (with private planes). the environmental stuff is window dressing as iare the 1 or 2 lectures by oxfam reps on the prediction that over 1/2 of the worlds wealth will be in the hands of 1% starting next year. they'll likely be 20 reporters and 2 attendees at these talks. http://www.reuters.com/article/2015/01/19/us-davos-meeting-inequality-idUSKBN0KS0SW20150119

i guarantee that the good folks of davos are worried about the issue. skiing there has been pretty iffy there the last few winters, even at the highest elevations... http://www.onthesnow.com/graubunden/davos-klosters/webcams.html

hawks hired carroll. bills hired gailey. nuff said. no one is absolving lynch. he became a great player elsewhwere. might have become one here had circumstances been different. they might well have had more rewards had they played elsewhere like lynch.