Saturday, July 28, 2012

I'm trying out a new social networking site called, which touts itself as the new and better Facebook.  So far, I don't think I would go that far, but I've just been on it briefly.

If you are so inclined, join up via this LINK. In the interest of full disclosure, I must tell you that doing so will link you to me, and also give me vShares, sort of a virtual share of stock for the site. Which at this point, appears to be worth exactly nothing. Supposedly, a vShare is 1/1,000,000 of Zurker, which as near as I can tell is still worth pretty much nothing. But it doesn't cost anything either. Unless you want to actually buy more vShares with real cash, which is an option. I am not going to be doing that for the foreseeable future.

Anyway, tell me if you like it! (And be gentle if you don't!)

Sunday, July 22, 2012

Lonely Occupiers Of FAIRville

Mrs. Dalai and I have just returned from what I call our Midwest Odyssey, having spent two weeks on the road visiting children, old friends, old haunts, and one of several "Redneck Paradises" that can be found in the Deep South. We put about 3,000 miles on the gas-guzzling SUV, and had a great time in the process.

Perhaps the most wonderful invention in the automotive realm since the automatic transmission is satellite radio. No longer must we fiddle with the dial, looking for the next station as we meander about the country. Since both of us came of age, music-wise, anyway, in the 1970's, we generally keep the radio tuned to XM 7, which is the 70's channel. On occasion, I switch over to Fox News, channel 114 if you needed to know. More on that later.

One of my favorite Oldies programs is the rebroadcast of Casey Kasem's American Top 40, which is plucked from the same week of some random year in 1970's.

As we were passing through some rural parts of Ohio, "Lonely Boy" by Andrew Gold came up on Casey's playlist. As I listened, it occurred to me that this melancholy ballad might just be the theme song for some of those to the Left of Center.

Check out the lyrics, and then we'll return to the discussion...
He was born on a summer day, 1951
And with a slap of a hand, he had landed as an only son
His mother and father said what a lovely boy
We'll teach him what we learned, ah yes just what we learned
We'll dress him up warmly and we'll send him to school
It'll teach him how to fight to be nobody's fool

Oh, what a lonely boy
Oh, what a lonely boy
Oh, what a lonely boy

In the summer of '53 his mother brought him a sister
And she told him we must attend to her needs
She's so much younger than you
Well he ran down the hall and he cried
Oh how could his parents have lied
When they said he was an only son
He thought he was the only one

Oh, what a lonely boy
Oh, what a lonely boy
Oh, what a lonely boy

Goodbye mama, goodbye to you
Goodbye papa, I'm pushing on through

He left home on a winter day 1969
And he hoped to find all the love
He had lost in that earlier time
Well his sister grew up and she married a man
He gave her a son, ah yes a lovely son
They dressed him up warmly, they sent him to school
It taught him how to fight to be nobody's fool

Oh, what a lonely boy
Oh, what a lonely boy
Oh, what a lonely boy
Mr. Gold's proxy was quite content when his Mommy and Daddy could devote ALL of their attention to him. The selfish little turd shit brat fellow becomes angry and hysterical when he finds out he isn't the "only one" in the world that is worthy of stuff, and he leaves home at the first opportunity, looking for someone else to coddle him as he thinks he deserves. Good luck, pal. Apparently the nephew is going to go through a similar crisis should Mr. Gold's sister and brother-in-law be such horrid parents as to have another child beyond their own second-coming.

The Lonely Brat exhibits an infantile approach to life, one which we see today among many of our friends to the Left of center. Providing a new "Mommy" to curb childish fears and wants seems to be the goal of the Liberal. Daren Jonescu, writing for American Thinker, notes:
One who falls short of even this baseline confidence in the face of life's vicissitudes displays the cowardice of a man who simply never grew up. It is to respond to adult challenges in the manner of the four year old who loses sight of his mother in the market: "I can't face this strange world alone!"

A free society, as the great political thinkers and statesmen have always contended, depends on the virtue of its citizens. Nowhere is this more urgently true and evident than in the once-freest of societies, the United States. Life in a free republic demands that minimum basic confidence -- the individualist's self-reliance -- as a prerequisite for maintaining social order and civility. The so-called "rugged individualism," which has fallen into disrepute and parody thanks to generations of collectivist education, is nothing more than the simple willingness to face life's obstacles, trials, and genuine hardships like a grown-up, relying on one's own resources, and on what can be earned through one's own effort and voluntary interaction.

A free society cannot survive the death of such self-reliance.As this basic, quotidian form of courage wanes, the petulant, self-congratulatory nouveau cowards who have been raised to take over society's reins fall into doing what the excessively fearful always do. They overcompensate in the direction of "security." They refuse to face even adult humanity's most unavoidable challenges -- supporting yourself, planning for potential misfortunes, taking care of your own -- without a "safety net" purchased at the price of their freedom. They sell their liberty -- and their neighbors' -- for a child's idea of security: that is, security provided by someone else, by a mother surrogate, by "society," i.e., by government...

This coward's quest for a safety net that can only be achieved through coercion is the antithesis of good citizenship. It means, in principle, that everyone is seeking to sacrifice everyone else to himself. The mutual respect of the citizens of a free society evaporates into mutual envy and resentment; in short, into an entitlement society...

Today's ever-expanding "entitlement mentality" is literally shamelessness elevated to the status of a moral code. Progressivism has created an entire euphemistic vocabulary to justify the unabashed demand that others sacrifice their liberty to save me from my childish fear of facing life as an adult. "Positive rights," "social justice," "redistributive justice," "creative individuality," and so on, are all part of the leftist lexicon of cowardice.

You need something? Don't be afraid, mother government will make someone give it to you.

You're unable to get something? Don't be afraid, mother government will find someone who has too much of it, and force him to share it with you.
Not all Liberals want their Mommies. Some want to play at BEING Mommies to these big babies, and use everyone else's resources to accomplish this. From my favorite psychiatrist, Dr. Sanity:
Everyone is, of course, familiar with the "selfish narcissist"--this is the type of narcissism we all know and don't love much. Indeed, selfishness and a preoccupation with one's own needs and desires at the expense of everyone else's is what is classically associated with the concept of narcissism.

But there is in society today a disguised type of narcissism that masks itself in a selfless, compassionate concern for others, yet is really all about fueling the need to feel superior and to exert control and power over others.

This second type of narcissism is more subtle, but equally (if not more so in human history) destructive and dysfunctional as the first. It derives from an aggressive idealism/utopianism which is pursued despite the misery it causes in other people's lives; and despite the dead bodies it leaves behind. This malignant narcissism is always justified because it is "for your own good"; or, "for the common good"; or, "to make the world and people better."

Along with the selfish narcissist (whose overt preoccupation is "ME, ME, ME!" and using others for their own aggrandizement and reward), the selfless narcissist ("LOOK AT HOW WONDERFUL I AM FOR MAKING YOU BETTER!") does not see other people as distinct individuals with needs and desires of their own, but only as fodder for the expression of aome IDEAL; or as pawns to achieve the utopian fantasies of their own ideology. And because they think they are the "superior" ones who know what is best for all, if they happen to benefit financially, socially and culturally--all the better! They deserve it for their extraordinary compassion and good works.
But, but, but...shouldn't we help people who need help? Yes, of course we should. This is charity, and it is a commandment for most religions to participate. But as I have quoted in my last ethical opus, Ethically Right, the great philosopher, physician, and scholar Moses Maimonides says that:
The greatest level, above which there is no greater, is to support a fellow Jew by endowing him with a gift or loan, or entering into a partnership with him, or finding employment for him, in order to strengthen his hand until he need no longer be dependent upon others...
(Keep in mind, this was written when there were too few Jews to help the rest of the world, let alone all of the poor among the Jews!) This is a restatement of the same old Chinese proverb about teaching a man to fish so he will eat for the rest of his life, rather than giving him a fish that will sustain him for only a day or so.

But how did the Left get from charity to wealth-redistribution? The answer is ENVY. Dr. Sanity again:
People who specialize in ENVY usually don't really want the good things the other person has as much as they want to insure that the other person doesn't have them or that they don't get to keep them.

If they do desire someone else's possessions, that desire comes in a distant second to the desire to destroy the good that others have.

ENVY is the underlying emotion behind the Marxist trope, "from each according to his ability; to each according to his need". The "enlightened" and morally bankrupt among us have always believed that economic self-interest means simply voting yourself a share of the money earned by others.

Such individuals wouldn't know how to create wealth if their lives depended on it; that's why they seek power over others--they see it as the only way they can survive in the real world. Since they cannot admit that painful truth to themselves, they will seize other people's wealth with one hand, while signing the political bills that make it impossible to create the wealth on which they themselves depend.

The truth is that they deeply hate those who create the wealth they want to steal, and seek to destroy them--even though at some level, they understand they cannot survive without them.
This applies both to those who would take from us directly, and those who would redistribute what is ours to others, the latter indulging in selfless narcissism as Dr. Sanity explains. As often as not, the petulant children/Mommies attempt to hide behind the meme of FAIRNESS. Lonely Brat thought it UNFAIR that his baby sister took his parent's attention away from him. The Left's (including a certain Leader of the Free World) bleating about taxation is little more than a plaintive, infantile wail..."It's not FAIR that the "wealthy" don't pay their FAIR SHARE!"  In other words, "It's not FAIR that you have more than others, and we won't rest until we take it away!" And to do so, the Left employs taxation.

A Fox News discussion I chanced upon while motoring through Indiana put it in perspective. Sadly, I can't find the transcript online, but the FAIR and balanced piece included pundits from both sides. The Liberal talking head kept badgering on and on and on about "the wealthy" not paying their "FAIR share" because their overall rates were lower. The conservative correspondent tried to make her understand that the discrepancy was because many "wealthy" people are receiving income from dividends and such, earned from monies upon which they have ALREADY paid tax. This went right over her head, and she continued to bleat about FAIRNESS. Sadly, the fellow to the Right of Center didn't sandbag her with her own argument...if taxation is to be FAIR, then everyone should be paying the SAME percentage of income, either with a FAIR Tax (sales tax, which I think highly of, by the way) or a flat tax. But I'll guarantee that if this had been mentioned, it would have been shot down in a blaze of fury. You see, FAIRNESS really isn't what the Left wants at all. Look at how taxation is distributed today:

"You got the top 2 percent paying almost half of all income taxes. Is that fair?" Sen. Jon Kyl, R-Ariz.

Kyl was referring to official figures showing how much various income levels earn of the nation's total income compared to how much they pay of the nation's total income taxes.

IRS figures show the top 1 percent of earners take home 16.9 percent of the nation's total income, but pay 36.7 percent of the nation's income taxes.

The top 5 percent take home a little more than 31 percent of total income but pay almost 59 percent of all income taxes.

And the top 10 percent earn just over 43 percent of the total income but pay more than 70 percent of all income taxes.

"How are you going to make it fairer? If they pay 75 percent?," asks Arthur Brooks of the American Enterprise Institute. "If they pay 90 percent? If they pay all of it? Will that finally be fair?"

As it now stands, 90 percent of all Americans pay only 30 percent of all income taxes.
Yes, indeed, that sure sounds FAIR, doesn't it? Right. Oh, and for what it's worth, the proverbial One Percenter's lost a lot of ground income-wise between 2007 and 2009, while the lowest earners actually gained, as reported on (of all places)

I wouldn't think that's FAIR at all. FAIR would be if everyone's income rose. Capitalism is not a zero-sum game, as the Left would like to portray it. It's far more FAIR than that. Everyone has the opportunity to work to their potential and possibly hit it big, joining the ranks of the wealthy, or at least bettering their position, and knowing they have done so through their own efforts, and not from the confiscated charity of others.

The FAIRNESS scam is just that. It temporarily satisfies the pangs of the infantile and the selfless narcissist, at a very high cost. Leftists/Liberals/Democrats (overlapping populations) may pay lip service to FAIRNESS, but what they are really after is power. Destructive, Totalitarian power over everyone and everything. Work with them and you will get your FAIR SHARE. As long as you are useful, anyway.

Lonely Brat was born on a Summer day, 1951. He would therefore be 61 years old now. Let's hope he reconciled with his parents and got a job. Although I have no doubt he is anxiously awaiting his chance to collect Social Security and sign up with Medicare. Sigh.

Saturday, July 21, 2012

Fear Your EMR??

Sorry, but this is the best image I could find that combines EMR and Fear! (Apparently there is a movie dealing with the image if you're bored.)

I've been in favor of the EMR concept for many years, and in fact I've been howling for a regional if not national PACS database since I started blogging. My enthusiasm has been tempered somewhat by Meaningful AbUse, which I take to be nothing more than our very own US Government bribing us to create databases they can ultimately tap. Hey, just because you're paranoid doesn't mean they aren't out to get you!

While I've been fretting the government's hand in the EMR frenzy, I sadly forgot to look over the other shoulder to see what our dear friends the trial attorneys might do with this technology. Fortunately, Leslie Kane, MA of Medscape looked into this issue, and discovered some very unsettling material:
Picture this: You've been sued, and now the plaintiff attorney has the right to send in an expert to sit at your computer and examine information in your electronic health record (EHR). Besides any mistakes you might have made, system-wide bugs or design flaws that lead to data inconsistencies could be found and held against you in the discovery phase of a malpractice lawsuit.
Yup, folks. Picking the wrong EMR could get you sued, and if you happen to get sued for something else, the EMR could drag you down even further.
"Every aspect of EHR selection, implementation, and use may be examined in the course of medical malpractice discovery to uncover the source of the incident, or undermine the records that are being presented in defense of the malpractice claim," says Ronald B. Sterling, CPA, MBA, national EHR expert, Silver Spring, Maryland, and author of Keys to EMR Success(Greenbranch Publishing; Phoenix, Maryland; second edition, 2010). "Anything could be a malpractice issue, from the product itself, the way it was set up, or how you've been using it."
Talk about the gift that keeps on giving...And the problems might not even be your fault!
"Even if the practice does everything perfectly, there could be design flaws in the electronic health record or the way the practices uses it or sets it up. This gets exposed in the light of discovery during a malpractice suit. If the plaintiff attorney spots errors in the record -- even if the system, not the physician, creates them -- it calls into question every record you produce and every statement you make."

Once an investigator starts looking into your EHR, there's no telling what they might find. Even though the scope of what they can legally look at is limited, they can compare printed paper records with what appears on your screen.
Oy. Do read the entire article for a list of the various ways in which EMR owners can get in trouble.

Perhaps you think the vendors will help you out of the little messes they've created. Think again...
"The doctor can be held liable because most vendors' contracts (signed by the physician) essentially say, 'We do not practice medicine; it is up to the physician to make sure this EHR is being used correctly.' The practices have to understand what they're using and verify that the system is appropriately set up to document the care they provide..."

In a trial, the doctor would be held responsible for product problems.

But just as scary, doctors could be held responsible for following vendor instructions. "I've seen situations in which the vendor tells doctors to do something, and doctors are relying on vendor and not doing their own proper analysis and design of the EHR that's tailored for their own practice," says Sterling. "The vendor is not the one responsible for maintaining the patient's medical record."
Basically, you can't win. But here's one piece of advice:
Document your selection process for your EHR. This will show that you did due diligence to pick the appropriate product. In a malpractice trial, if you've chosen an EHR system that does not provide the information you need in the way you want it, this will count against you as far as back as why you ultimately selected that system.
That's assuming you DID do your due diligence in the selection process. No, "no one ever got fired for choosing (fill in larGE company here)" will NOT cut it in the courtroom.

It's funny...just today I had a long chat with one of my internist friends. He was bemoaning our EMR/CPOE system. "Dalai," he said, "when we sold the practice to the hospital, I suddenly was making more money than I ever had before. But having to use this piece of shit takes up more of my time than ever, and it takes away from my time with my family. It just isn't worth it."

We seem to be back to Square One with respect to the human interfaces with medical software. They still suck for the most part. They are written by engineers who haven't a clue how doctors work or think (not that anyone really does, but you see what I mean.) 

And now, Big Brother is bribing us to have these crappy systems in place, AND we now walk a legal tight-rope even if we try to comply.

I think it's a good time to be anything other than a physician...

Sunday, July 01, 2012

Caveat Emptor:
BIG Vendor Bails On EMR Install, Keeps $$$$

The Wall Street Journal's Joel Schectman relates a rather ominous tale of EMR adoption and abandonment:
Girard Medical Center, a rural hospital in Kansas which services mainly uninsured patients and the elderly, wanted an electronic medical record system to better share information with its clinic offshoots and to claim federal incentives. But a year-and-a-half and more than a million dollars later, the hospital says it’s no closer to having electronic medical records, and is blaming its vendor for the failure of the project.

Whether the fault for the failed project should rest on the big corporate vendor or the small hospital is unclear. But Girard’s story illustrates the risks for organizations of all kinds when they attempt to innovate by bringing in new, and unfamiliar, technologies and vendors.

The hospital brought in Cerner Corporation in September 2010, one of the biggest vendors of electronic medical records, to provide an all-in-one fix that would allow doctors to prescribe medicines and order tests electronically, and for administrators to fulfill HR functions like tracking time and attendance. But the hospital claims that instead of Cerner “providing one throat to choke,” the company provided “many products to buy,” said Frankie Forbes, an attorney for Girard.

According to a complaint filed in U.S. District Court in Kansas City by Girard, Cerner raised its charges, instead of doing all the work for the original price, and then abandoned the project when (Girard) complained and eventually suspended payments. The 25-bed rural health-care provider claims in a lawsuit that despite paying Cerner more than $1.2 million in fees, it still has no electronic medical record system and still doesn’t qualify for federal monies to pay for one. A spokeswoman for Cerner, in an email, declined to comment. The case is now in court-ordered arbitration.

“We just kept running into things that weren’t included,” in the original $2.9 million price tag the hospital initially agreed to pay, said Holly Koch, the hospital’s chief financial officer. “They weren’t holding up their end of the bargain.”

But Koch and other hospital officials also acknowledge that neither they nor the board had a complete understanding of the contract on which they signed off.

“It was incredibly complex and difficult to understand,” Koch said. “We relied on them to explain to us what the contract represented.”

Koch and board members say they relied on a presentation in Fall 2010 from Cerner which promised a “fully integrated” patient records and administrative system. That presentation was included by Girard with its complaint and has been reviewed by CIO Journal.

After initially promising these features were included in the $2.9 million price, Cerner later told the hospital that attendance-tracking features, lab test functions, and electronic billing would increase Girard’s annual costs, for the five year contract, by around $100,000, according to Mike Payne, CEO of Girard.

After failing to reach an agreement last summer over pricing, Payne said he began to stop paying invoices from Cerner.

“I didn’t see any way to get where we wanted to go unless I got their attention,” Payne said.

The hospital did get Cerner’s attention: in September 2011 a Cerner employee emailed administrative staff to say they were walking away from the project, according to the complaint.

Girard’s tale illustrates the inherent risk as health-care providers of all sizes move towards implementing electronic medical records. While hospitals are eager to pick up some of the $19 billion in funds the Obama Administration made available in 2009 as part of the stimulus package, they often lack the in-house expertise to contract with and supervise vendors on the complex implementation of records systems.

“Health-care systems are putting in these systems with all due haste to try to get this money,” said Dave Garets, executive director of the Advisory Board Company, a health-care research firm. “But you’ve got to have the people in-house who really understand this process and these people don’t come cheap.”

The federal government predicts a shortage, by the year 2015, of 50,000 healthcare IT specialists, like healthcare informaticists and chief medical information officers — the type of experts that would have helped Girard to manage the implementation of its electronic records system.

Any company hiring outside IT vendors faces this type of risk, said Chris Andrews, an analyst at Forrester Research. Companies often look for the best quote for a new technology product, but fail to allocate enough internal staff to supervise the process.

“There is an unrecognized cost to just making any relationship work,” said Andrews.

When Girard hired Cerner, the hospital had just two IT staff members – neither with a specialty in electronic medical records, said Koch.

Payne, Girard’s CEO, says he has since brought in an outside “vendor neutral” consulting firm to help the hospital make an unbiased decision on what’s next for the hospital’s EMR program.

“It means swallowing your pride and knowing what you don’t know and finding someone who does know it,” said Payne.
This is bad on so many levels, it's hard to know where to begin to lay blame. But I'll give it a try anyway.  I lay the blame about 90% on Cerner. Assuming Mr. Schectman, the author of the above article, has his facts straight, and WSJ writers usually do, Cerner knew they were dealing with electronic neophytes at Girard. Come on, folks, this is a 25 bed hospital, and they aren't going to be able to muster a great deal of IT expertise. Granted, Girard should have grasped the concept a bit better before setting off down the road, but they didn't, and therein lies their share of the blame. A rather vague analogy might be the case of a little old lady wandering into the Chevy store and laying down cash to buy a Corvette with a manual transmission (do they still make those?) while not knowing how to drive even an automatic, hoping they would teach her how to drive. And, oh, by the way, she never took delivery on the car, but the dealer kept her money.

I don't mean to insult the brass at Girard, but perhaps they should have done a little more due diligence. But wait, they probably thought they did by hiring the biggest name in the business. How could they go wrong?

Sadly, bigGEst is not necessarily best, and paying top dollar might not guarantee anything but a lighter wallet. Again, assuming the veracity of the above report, Cerner pretty much executed a bait-and-switch scam on Girard. You would think a company of this size and this reputation wouldn't do such a thing. You would be wrong.

I have the joy of Cerner in one of my hospitals, courtesy of an IT department that wanted to change things, and of course didn't get much if any opinion from the end users. It is about as user-friendly as Form 1040, and nowhere near as well-written.

I am a staunch capitalist, as you are all well-aware, and I firmly believe in letting the market do its thing. Therefore, I'm doing my feeble best to bring this situation to light, which should inspire those in the market for an EMR to look elsewhere. Cerner pocketed some money on this unfortunate situation; it stands to lose a lot more once word of its behavior is widespread. Until they make this right, or come up with a satisfactory explanation (which I will be glad to publish), I would suggest that one not buy anything from Cerner. Anything.

THIS is what happens when the government urges, forces, or taxes us into buying things like EMR's, or insurance. Caveat emptor, caveat civis.