Sunday, January 23, 2011

The GrEening of America


I'm a little disturbed by GE, which probably comes as no surprise.

My readers know I've had some ups and downs with General Electric. Fortunately, the majority of that animosity has been put to bed. My group owns two GE MRI's, and I work with several other GE machines. If I ever get funding for a SPECT/CT scanner, I will give the Discovery 670 proper consideration. I still am no fan of Centricity PACS, but we'll still let bygones be bygones.

So why am I troubled? Just in the past few days, President Obama announced that Jeff Immelt, CEO of GE, will lead the President's Council on Jobs and Competitiveness:
“Jeff Immelt’s experience at G.E. and his understanding of the vital role the private sector plays in creating jobs and making America competitive makes him up to the challenge of leading this new council.”

Well, that isn't bad, is it? Mr. Immelt replaces former Fed Chairman Paul Volker. As the head of a Really LarGE company, Mr. Immelt ought to have a very good idea of how the private sector works. No doubt he can help the country. But I'm still disturbed.

Why? Because GE and Mr. Immelt are a little too cozy with the Obama administration. This sort of thing is nothing new, as I'm sure my more liberal friends will point out that former Vice President Richard Cheney (Aunt Minnie censors the name Dick, and I've been conditioned to say Richard instead) was head of Halliburton. But read on and decide if perhaps the current situation is a little different.

It seems there are quite a few areas where GE has made some inroads into the way the country works. Let's start with the Green initiative (rather ironic that GE's main color is a rather bright shade of green.) Who makes a larGE percentage of green energy equipment? Ever hear about the GE line of windmills, solar panels, and so forth? There's a lot of money to be made out of thin air.

And lest we forget, those nasty energy-wasting incandescent bulbs, which were sold mainly by GE, are to be phased out starting next year. The replacements, including mercury-containing compact fluorescent bulbs (CFL's), are offered in wide variety, from...GE. Sorry, Kermit, it is quite easy to be Green, or at least sell Green, if the President pushes your products.

NBC, which is about to be spun off to Comcast but still under GE auspicies, has had a pretty big Green initiative with Green Week and Earth Week. And no one will doubt that MSNBC has been rather pro-Administration. We'll see how they behave once they are under different management. Fortunately Keith Olbermann managed to leave MSNBC all by himself.

GE has been front and center in the health care debate, and has a huge presence on the CCHIT and HITECH boards, as I have mentioned in the past. GE's own site lauds this, and well they should:
GE Healthcare has actively advocated on behalf of our customers and participated in the development of the final rule, and we look forward to working within the final guidelines to help ensure success for our customers...GE Healthcare’s Stimulus SimplicityTM program is designed to help hospitals and physician offices accelerate EMR adoption by taking advantage of zero percent financing with deferred payments from GE Capital along with a certification warranty for the EMR solutions from GE Healthcare. It addresses the current obstacles to EMR adoption of stimulus complexity, uncertainty around future standards and affordability.
And we all know who sells a LOT of imaging equipment. Clearly, support for the Health Care Abomination has the potential to be quite lucrative. Indeed, Ken Terry from BNET.com noted in 2009:
General Electric’s announcement today that it will invest $6 billion in a worldwide “Healthymagination Initiative” raises familiar questions about the interplay of free enterprise and healthcare reform in the U.S. While some components of GE’s plan could help lower costs, raise quality, and increase access, as CEO Jeff Immelt contended in a press conference, the overall program seems designed to expand GE’s healthcare business and its profits. As Immelt put it candidly, “We don’t run a charity at GE. We’re in business to make money for our investors.”
But these piddly items are just the beginning. In 2009, Vanity Fair reported:
The issue at hand was this: Would Obama go against the signals he had put out earlier and dismantle the so-called Eastern European shield? By taking apart this defense system, he risked angering many of those who had voted for him, but he would please Putin. So what did Obama do? As the major news outlets reported at the time, he simply gave the go-ahead to have the shield dismantled. In exchange, according to Reuters, Putin agreed to meet with “several U.S. executives ... from firms including General Electric, Morgan Stanley, as well as TPG.” [Italics mine.] G.E. is supposed to bring good things to life; in this case, it powered Obama’s growing pragmatism.

In a similar development that proved greatly to the benefit of G.E., the Obama team apparently reversed course on another deal. For many months it sent out strong signals that it would not support a nearly $1 billion U.S. allocation that would allow the survival of a costly defense initiative called the Joint Strike Fighters engine program. Military buffs know that G.E. is teamed with the U.K.’s Rolls Royce in the development of this jet-engine project; so it should not come as a shocker that Obama last month quietly included the plan in the 2010 Defense Authorization Bill, which he signed with no apparent hesitation.

Making the G.E.-friendly developments more suspicious is the fact that Immelt was appointed to Obama’s Economic Recovery Board earlier this year. Soon afterward, The Washington Post reported that G.E. had become “the biggest beneficiary” of the federal bailout program. And Immelt was caught boasting, in a November 17, 2009, Wall Street Journal report, that he expected to gather in roughly $192 million for his struggling company in government-funded projects.

Chief among these, it now seems, is the coming Afghanistan surge. Available documents show that G.E. has made out quite nicely from the wars of recent years, gaining a $3 billion contract to provide power to the rebuilding of Iraq and a $5.9 million deal to provide power to air bases in Afghanistan.
To be fair, GE no longer does business with Iran:
GE doesn't do business in or with Iran. Due to the developing circumstances there, the concerns of our shareholders, and and our view of our corporate responsibilities, GE and its board decided in 2005 to stop doing business in Iran. There have been two exceptions to this: completing the work for existing contracts as quickly as possible and humanitarian activity, which is authorized by U.S. Government licenses. As of June 2008, we have completed all business in Iran. GE at all times acted in full compliance with U.S. and other laws. We have always required our businesses to follow U.S. sanctions and other applicable laws. In fact, our policies have been more restrictive than U.S. law.
Billy Hallowell of FrontPageMag.com, notes the ultimate irony in all this:
The U.S. government has always been . . . a viable GE partner, but the changing political landscape is paving the way for the company to receive transformational benefits and control. Immelt realizes this, which is likely one reason that Obama was the top recipient of GE contributions during the 2008 presidential campaign (after all, Immelt is a Republican and a former McCain supporter who has no other reason apart from profits to partner with Obama). With such extensive reach into sectors that impact the daily lives of Americans and with international policy at stake, it is in the public’s best interest that close attention be paid to the alliance between GE and the Obama administration.
In the end, Fox News sums up the problem, the reason I'm disturbed by Mr. Immelt's recent appointment:
It is unclear how the administration plans to deal with the ethics challenges created by having a CEO whose income is determined by stock performance leading a panel designed to recommend government policies. G.E. (2009 revenue: $157 billion) is a huge government contractor and is always in the market for new subsidies and incentives.
Yes, I'm a Capitalist, and a GE stockholder, and I do applaud GE's increased profits. But, still, I'm disturbed. Is it OK to unlevel the playing field via governmental intervention? Is it right for a larGE company to influence the government at the highest levels for its own gain? Perhaps. But I'm still a bit disturbed by the whole thing. Perhaps I just don't have a healthy-enough imagination.

iPad EMR's?

Since I authored the articles on radiology apps for the iPad, I've been contacted by various other medical iPad supporters. Austin Merritt, COO of Software Advice, a site dedicated to "free advice for software buyers" comments on the availability of EMR apps for the iPad. Are Vendors ready?
The answer to that question is a surprisingly resounding “No!” The medical software industry is far from supporting the iPad on a meaningful scale. Buyers would think that vendors eager to grow market share would quickly adopt new, flashy technologies, but software vendors are surprisingly slow to react. Electronic health records vendors need to get on board or face the prospect of losing market share to faster-moving competitors.

There is no doubt that buyer demand for the iPad is surging. A past Software Advice poll (below) found that nearly 35% of healthcare providers were “very likely” to purchase a tablet PC in the next year. Don’t forget that the iPad enjoys 87% market share of the tablet PC market. That’s a lot of potential customers looking for iPad EHRs.
Merritt cites the two companies that have so far built EMR's for the iPad from the "ground up," Nimble and Dr. Chrono. Of the two, Dr. Chrono seems a little more robust, with capabilities including image viewing, something close to my heart. Of course, these programs, and in fact the various iPad/iPhone/laptop apps and applications are essentially portals into the database, be it in the cloud or elsewhere. As Nimble puts it:
Nimble connects directly to the ClearPractice cloud via a secure internet connection so no data is stored on the device, making it both secure and HIPAA compliant. Because the ClearPractice servers do all the heavy lifting, the system is blazing fast, whether connected to a wireless or 3G network.
And therein lies the thought process behind most everything iPad. If you look at them critically, most apps are not much more than stylized portals to the web, i.e., they are thin clients.  Nimble's claim to fame is its interface:
Taking a typical point-and-click EMR system and moving it to the iPad environment often means fumbling fingers and a less than optimal workflow. In contrast, Nimble is a native iPad application, designed and built to be used specifically on an iPad and takes full advantage of the intuitive iPad user experience. Because Nimble is native to the iPad environment, we were able to rethink the EMR experience and remove all the common impediments of traditional EMR systems that slow down and frustrate busy doctors.
And here is a screenshot of this simple view:


But is it really desireable for the system to be completely iPad-based? Well, probably not. Keyboard entry of data on the screen would be tedious. Of course, there are Bluetooth keyboard attachments, which would help some:


Since there are only a few iPad-based EMR's, Merritt asks:
So where are the 300+ other EHR software companies? They have iPad apps “in the works,” but not ready yet. This really comes as no surprise. The medical software industry is notoriously slow to adopt new technologies. Have you ever seen your doctor’s office running a system that looks like it is from the 80s? We hear from these practices every day. Plenty of software vendors are still selling outdated, DOS-based systems with Windows interfaces (we will withhold names to protect the innocent).

As a result of this slow movement, we expect a number of newer software companies to quickly gain popularity and seize market share from vendors who are slow to move. Interestingly, a number of garage-based startups are already poised for growth: medical iPhone and iPad app developers.

Blogger John from EMR and HIPAA answers:
I’d have to argue the opposite. I think that almost all the EMR vendors that I see have an iPad strategy. Nothing wrong with a web based version for the iPad either. In fact, watch for the web to win out on the iPad eventually. At HIMSS I’m sure that one of the most common conversations will be EHR vendors iPad approach.

Also remember that even nimble, which you mention, is only parts of the EHR and not the full EHR software. I wrote about that.  I think that many more EHR vendors will adopt this type of approach to iPad EMR.
I tend to agree. I'm sure this is a foolish observation for all but the least-savvy on such things, but it does bear stating: The iPad is a wonderful window through which to view data, images, etc. It is convenient, portable, and dare I say, even cute. Obviously, it cannot stand alone as an EMR, and I have my doubts as to using it as the sole point of entry. Certainly, it will be a very nice adjunct to a "real" or a "larger" or whatever system, a nice addition to the physician's office. Can something like Nimble satisfy "Meaningful Use"? I'm thinking not, but then no one really knows what "Meaningful Use" is anyway...

Sunday, January 09, 2011

A 24-Carrot Monitor

More than once, I've predicted something in tongue-in-cheek fashion, only to find my wish to have been fulfilled years later. 

Perhaps you remember this fanciful rendition of my new "reading room"?


Note especially the huge rotating monitors.

Enter Carrot Medical.  Their new C-View monitor system bears an uncanny resemblance to my weird cartoon idea:

video

From the C-View product description:

See the big picture like never before. Carrot Medical helps you See Better!

C-View changes the inefficiency of multiple monitors with a single 56-inch LCD display that is four times sharper than standard high-definition monitors. The advanced 3840 x 2160 panel has substantially more scanning lines than conventional HD screens for ultra-clear detail

C-View gives you the control and flexibility to:
• Integrate images from as many as 24 sources. (VGA, DVI, coaxial, light or room cameras, etc.)
• Display up to 16 images simultaneously, and expand any image to fill the entire 56-inch panel.
• Use preset configurations to display specified images for optimal size and orientation.
• Add, remove, re-position and re-size images as priorities change during the procedure.
• Control the screen with a variety of input methods. An iPhone app to manage presets from the palm of your hand. There’s an app for that!
I've always wanted an 8 megapixel monitor.  My birthday is rapidly approaching, folks...  No, I don't know how much this lovely Carrot costs.

Thursday, January 06, 2011

Green Advertising?



Even Green River in North Carolina isn't this green.  The photo above, courtesy of the National Post (Canada) is not retouched, at least not by me.  Apparently, someone threw something in the Goldstream River in Victoria, British Columbia, which turned it flourescent green for several hours.  No dead fish or animals were found, so the colorant was thankfully something benign. 

Now, just who would consider doing such a thing?  Some teenagers looking to pull a prank?  A mad chemist?  Or perhaps some larGE company that favors this lovely shade of green?  Just askin'...

Sunday, January 02, 2011

The "6.5" Thousand Dollar Question

We are extremely fortunate to have three in-house Night-Hawks (not related to Nighthawk or VRC!) who work from 8 P.M. to 8 A.M. on weeknights, and 6 P.M. to 8 A.M. on weekends.  They are very, very sharp, and stand up to the punishing schedule and workload without complaint.  That is, until now:
All, I am fit to be tied. I had to restart my IMPAX workstation 11 times in 12 hours last night because I can't get the work done. All i want to do is my job. I can't with this system. We all know the issue, when you try to read CTs or MR back to back to back the cache seems to be full, then skipping images starts, etc. its worse with large CTA and MRA exams. Plain films are not an issue. This problem is progressive, it gets worse and worse the longer you go before restarting. I got a new error last night, black box with X says "problem downloading images, will attempt to retry". One of the other guys started seeing this same error last week also. I can't get my work done. I refuse to cut corners, though it is tempting to not review the images as I normally would. My nerves are shot.
We have seen this problem minimally before the 6.5 IMPAX upgrade, but several of my partners are now experiencing the laggy scrolling issue on a routine basis.  Interestingly, several of us have never had this happen, leading us to think that the problem lies in some obscure setting in the individuals profiles. 

I'm happy to say that Agfa has been working very intently on this problem, and I have no doubt it will be fixed.  These are truly conscientious people, and they want things to be right.  I'm sure avoiding blog appearances such as this play only a miniscule part in that.  Really.

It does speak, however, to the complexity of the IMPAX client software, that one setting buried deep in someone's profile settings could knock out the function of the workstation.  Here are two clues that our local Agfa technical guru has found, which may help someone in Waterloo get to the heart of the problem. 

First, at one point I had activated the "Display Pointer Trails" option, which leaves a trail of little cursors to help us old folks figure out where we are on the screen.  At about the same time, IMPAX started to balk at scrolling color images from PET/CT's displayed on the third monitor.  We turned off the trails, and things went back to normal. 

Secondly, I noticed one day that the cursor would not move properly across one of the Barco monitors.  The fix here was to adjust hardware accelleration for that particular monitor.

Subtle clues, yes, but the answer is in there somewhere.  I'm thinking there is some nasty glitch that doesn't play well with video display, which is a major problem given the fact that this business is all about video display!

Again, I'm sure Agfa will fix this problem.  I wonder why it didn't show up in the testing phase...

EPILOGUE

A followup from the 'Hawk in question:
I am happy to report that our PACS Goddess reset my profile last night and has continued to help me rebuild on the fly. The issue with scrolling and skipping has resolved. Looks like this whole time "the profile" was the problem. I worked through last night with no forced restarts or other related issues.   I am very grateful to have my old life back. Thank you all!
Another crisis resolved.

Saturday, January 01, 2011

The Soviet Story (WARNING: EXTREMELY GRAPHIC!)



I will apologize in advance for the horrific images in this documentary. Well, on second thought, perhaps I won't. We need to realize, understand, and digest the truth about our once and future ally, and moreover, the philosophy behind its actions.

From the film's producers comes a brief synopsis:

The film tells the story of the Soviet regime.

- The Great Famine in Ukraine (1932/33)
- The Katyn massacre (1940)
- The SS-KGB partnership [in the late 1930s the KGB was called NKVD (more info)
- Soviet mass deportations
- Medical experiments in the GULAG.

These are just a few of the subjects covered in the film.

“The Soviet Story” also discusses the impact of the Soviet legacy on modern day Europe. Listen to experts and European MPs discussing the implications of a selective attitude towards mass murder; and meet a woman describing the burial of her new born son in a GULAG concentration camp.
The Soviet Story is a story of pain, injustice and “realpolitik”.
In other words, the USSR and Nazi Germany were only a hair's-breadth apart in their thinking. The Soviets persecuted anyone they thought disagreed with them, and the Nazis, anyone who was part of a group they disagreed with, Jews, Gypsies, homosexuals, Catholics, etc. Stalin provided tremendous aid to Germany in the early part of World War II, enabling Hitler to proceed with his plans of domination of Europe. Stalin hoped to step in and pick up the pieces after Hitler paved the way. In their own right, the Stalinist Soviets murdered 20,000,000 of their own citizens, generally in most horrible ways.

Sadly, modern Russian leaders aren't so terribly far removed from this mentality, and there are still many in Europe who think Marx and Engles had it right (pun intended), that if only the inferior folks who are incapable of understanding what they were trying to accomplish were eliminated, a whole new era, a new race of human, would be forthcoming.

Human nature is what it is. This is not tragic, it is simple truth.
When it comes to understanding human nature, the left and their do-gooder utopian fantasies get failing marksMarx. They have a persistent biological fantasy that human nature is 'perfectable'; and that by some magical means, the implementation of their 'perfect' ideology will force people to behave in some 'perfect' fashion. Their delusional biological and psychological hallucinations about human nature always end in misery, suffering and death for large numbers of imperfect homo sapiens wherever it is implemented. No matter how many times this happens, the die-hard Marxists, communists, ocialists and all their variants and heirs keep trying force humans into some "ideal" state.

All their attempts and systems failed the real-world tests in the last century; and all current versions of these ideologies will also eventually fail and fade away (even Obama's). To the extent that they attempt to incorporate some aspects of "human nature" into their failing system, they may last a bit longer (e.g., China); but it is much more likely that human nature will transform the ideology than the reverse.
The one good thing about Marx's motivations is that, from all I have read about him, he genuinely thought of himself as a "humanist" who wanted to free the human spirit with his theories. Unfortunately, he never fully appreciated how his theories would be used to enslave the human mind (or, perhaps he had a some sense of the evil he had unleashed when he exclaimed later in his life, "I am NOT a Marxist!") Like his heirs today, he meant well.

Too bad, so sad that his 'good' intentions have caused so much fanatical revolutionary fervor and so much death and oppression.
So, what's the relevance to us today? Dr. Sanity continues:

These rich 'cultural Marxists' identify themselves as Democrats because it is just so cool and hip--and virtuous--to champion the 'poor and oppressed.' How unfortunate for them that this virtuousness requires them to nurture and maintain a never-ending supply of the 'poor and oppressed'; and to encourage and support victimhood and entitlement.

The truth is that the poor who are not brainwashed by this victimhood/oppression BS, aspire to the middle class and want to be free to improve their lives and those of their children. Most normal people don't want endless handouts, bailouts or pity. Nor do they want to be the recipient of some do-gooder's endless charity when it is based on the assumption that they are somehow inferior or defective and can't possibly be successful without being perpetually 'championed'. Funny, isn't it, that in spite of all the billions of dollars spent on the poor, it only seems to perpetuate their poverty? The old saying, "“Give a man a fish; you have fed him for today. Teach a man to fish; and you have fed him for a lifetime" comes to mind; but the last thing that the left or Democrats; or Marxists really want is for the poor to become independent of their virtuous and compassionate largesse.

. . .Here is where the Marxist garbage of "oppressor vs oppressed" has had the most impact on American society. Having been taught from kindergarden on that capitalism is a zero-sum game (and by definition, evil) many Americans have difficulty in thinking of resources or wealth as ever-expanding, and tend to think that someone else's gain must be their loss. If you have only two choices--to be either an "oppressor" or one of the "oppressed", most people would generally prefer the latter because it means they must be nicer people.
This kind of thinking inevitably leads to envy, and a cult of victimhood with all the associated social and political conflicts those emotions generate. Envy, in particular, is the lovely human emotion that drives all socialist systems; and it exists in pure, unadulterated and vicious form in those systems.

And, in answer to the unspoken question, yes; capitalism also thrives on envy--and even greed.
But, capitalism within a democratic and politically free system of government offers a healthy channel for the redirection of negative emotions like envy and greed into something positive for both the individual and the larger society.

Something, I might add, that Marxism, socialism and all its malignant variants completely fail to do. You cannot escape the reality of this dark side of human nature. You can either channel that dark side and use it constructively to benefit the individual and incidentally the society he lives in; or you can encourage and facilitate it in all its destructive power, and by doing so create the hell on earth we've come to associate with communist and marxist societies.
The Socialist/Communist model simply doesn't work. It never has, and it never will. There are still many who think it could work, if only the right folks (themselves, of course) were in charge. I'll get a lot of grief for this one, but I firmly believe that many of the people in high offices in the US believed just that. By the Grace of God, I'm hoping we are on our way back from that wilderness.

I've quoted this passage from Jacob Bronowski before, and it is apropos here as well:
It is said that science will dehumanize people and turn them into numbers. That is false: tragically false. Look for yourself. This is the concentration camp and crematorium at Auschwitz. This is where people were turned into numbers. Into this pond were flushed the ashes of four million people. And that was not done by gas. It was done by arrogance. It was done by dogma. It was done by ignorance. When people believe that they have absolute knowledge, with no test in reality--this is how they behave. This is what men do when they aspire to the knowledge of gods. Science is a very human form of knowledge. We are always at the brink of the known; we always feel forward for what is to be hoped. Every judgment in science stands on the edge of error, and is personal. Science is a tribute to what we can know although we are fallible. In the end, the words were said by Oliver Cromwell: "I beseech you, in the bowels of Christ: Think it possible you may be mistaken." We have to cure ourselves of the itch for absolute knowledge and power. We have to close the distance between the push-button order and the human act. We have to touch people.
Think about it. Which side of the political debate constantly calls members of the other "stupid"?
None of us possess the Absolute Knowledge Bronowski spoke of, and none of us can be absolutely correct, not the Right, not the Left, not the Church, Judaism, or Islam. It is when we dare to believe that we do posess the knowledge of the gods that we give ourselves the power to do the unthinkable. To kill so as to "purify". To steal so as to "give". To taunt so as to dominate.
Let 2011 be the year we touch people. Gently.
(Hat tip to Dr. Sanity.)