Saturday, June 02, 2012

Some Random Thoughts At The Foot Of Arenal

The Arenal Volcano, from Springs Resort, La Fortuna, Costa Rica

I'm reporting today from The Springs Resort, in the shadow of the Arenal Volcano in central Costa Rica. We are just at the edge of the Rain Forest, and at the beginnings of the rainy season, so you can imaging just how lush and tropical the surroundings are down here. (And by the way, when it rains, IT RAINS!!)

ABC filmed an episode of The Bachelor on the grounds of The Springs, which is how Mrs. Dalai learned of it, and so here we are for Dalai, Jr.'s high school graduation present. Words cannot do this place justice, and the photos on the website don't begin to convey just how wonderful it is. I would place it just below Jade Mountain (another former Bachelor venue) in beauty of the facility and the surroundings. In fact, the view of Arenal is really reminiscent of the Piton in St. Lucia. The service here has been just as good, and by that I mean incredible. 

We even made a new local acquaintance, Señor Gato, although I suspect the next occupants of the room won't appreciate our cultivating his friendship...

For better or worse, there is WiFi in the room, and so I've managed to keep in touch with the outside world.

Let's start with the "for better"...From lifeIMAGE comes word of some tools to ease image exchange from within any other system, which means that if IT cooperates, my PACS could talk to your PACS:
Newton, Mass. – May 29, 2012 – lifeIMAGE announced today it is releasing certain open application programming interfaces (APIs) that can be used by developers of healthcare information technologies (HIT) or imaging devices to enable the secure exchange of medical images and related patient records directly from their software.

The lifeIMAGE network has been used to share over 160,000,000 medical images across diverse healthcare providers representing 40,000 affiliated physicians. lifeIMAGE is the go-to network for on-demand  clinical exchange of imaging exams along with related information such as reports or EKGs. This secure and high-speed network is used by physicians on five continents to collaborate on time sensitive patient cases.

With API integration, more providers will have the ability to tap into the network by enabling their existing systems to securely share imaging information on demand. PACS, EMR, dictation and reporting, CD/DVD writer, visualization, or personal health record (PHR) application vendors can integrate with open APIs to give their end-users the added benefit of a simple workflow for sharing patients’ imaging history.

“Our CD burning systems that have been in place for several years at an academic medical center in the Washington D.C., in addition to other customer sites, are used to publish imaging results to other providers outside their network using the lifeIMAGE cloud service,” said Cyrus Samari, a co-founder of Sorna. “When our customers have an exam that needs to be sent to an outside referring physician, or to the patient, with a single click, they have the option of burning a disc or sending it electronically on the lifeIMAGE network, all from the same interface - automatically.”

Norman Young, President & CEO of ClearCanvas, said “We were founded on the simple belief that medical imaging informatics should be accessible to all.  Now, using a lifeIMAGE open API, users of our FDA-cleared diagnostic viewer will be able to instantaneously share images that are in front of them with any one.”

“Whether it’s a simple CT or a complicated cardiology exam, whether it’s arriving through the door on a CD with a patient or arriving via the cloud, open and secure exchange of patients’ imaging history is key to improving patient care and driving down our country’s healthcare costs, said Hamid Tabatabaie, President & CEO of lifeIMAGE.   “We are eliminating the technological barriers to timely access to information by making our API available to all developers of related software. Now, HIT companies can use the open API to differentiate their services and ensure their users have the power to exchange information on demand.”

“lifeIMAGE recently delivered an API to a large academic medical center to enable their Epic users to upload or view images directly from the applications they use to check patients in or when accessing medical records of patients,” Tabatabaie added.  “A separate API is being used to provide access to employees who use WebMD’s PHR. Employees are able to share imaging content with any physician directly from their PHR, where other important medical history may also be available. ”

Companies that want to use the API can visit lifeIMAGE at the annual SIIM conference in booth #426, or request more information at
Since I won't make it to SCAR SiiM this year, I'll request more information. Does it work with IMPAX?

Which brings us to the "for worse"...

I've heard nothing from Agfa about Western Australia, and I would really like to know their take on the situation. Have I been fed incorrect information? Is the system working perfectly? Or is it such a disaster that no one wants to talk about it? As always, I will gladly post any official (or semi-official) statement from Agfa.

And worse yet, an email trail has been released, courtesy of the GOP, rather clearly outlining the level of Thugocracy under which we must live and function. Did you think the authors of the Affordable Care Act really had your best interest at heart? Ha. The ACA was gleefully crammed down this nation's collective (pun intended) throat by the Obama/Pelosi/Reid axis of evil, and there were any number of back-alley deals, in truth, threats and bribes, to assure the lock-step (goose-step?) cooperation of the drug and insurance industries. Read this from the (Republican-chaired, thank Heaven) House Energy and Commerce Committee:
WASHINGTON, DC – The House Energy and Commerce Oversight and Investigations Subcommittee, chaired by Rep. Cliff Stearns (R-FL), today released a memo and supporting documentation outlining a series of intricate policy negotiations used to craft the health care law, the full details of which have never been released to the public. The memo is part on an ongoing investigation the committee launched more than a year ago to shine light on a process that excluded both the American people and many of their elected representatives. Despite the White House’s unwillingness to make these negotiations transparent, even after the fact, the investigation has uncovered a series of emails and internal documents that paint a much clearer picture of the tools and tactics used by the Obama administration to secure a narrow, partisan victory and see PPACA signed into law...

Documents released by the committee today show major negotiation milestones throughout 2009 as the White House attempted to secure a deal with the interest groups who had been invited to the bargaining table. The materials reflect negotiating tactics used by top White House personnel including threats of public criticism and policy declarations. They also show that PhRMA was assured a “direct line of communication” with the White House, and that the organization was offered private reassurances about the deal remaining intact in spite of congressional concerns.
From the Washington Times:
Top administration officials cut backroom deals with the nation’s top drug companies to win support for President Obama’s health care overhaul, threatening them with steeper taxes if they resisted and promising a better financial deal for the industry if they acquiesced, according to internal documents released Thursday by House Republicans.

In some of the key deals, Mr. Obama agreed to drop his long-standing support for letting Americans buy cheaper foreign prescription drugs — something the pharmaceutical industry vehemently opposed — and the drugmakers promised to mount a public campaign to sell the public on the health care legislation...

The material released by House GOP members provides a rare insider look at the wheeling and dealing on Capitol Hill as Mr. Obama tried to shepherd his bill through Congress, in the face of near-unanimous GOP opposition.

The details emerged as House Republicans released emails it obtained during a yearlong investigation into the closed-door negotiations between the White House and lobbyists for drug companies. House Republicans said those negotiations violated the promises of transparency Mr. Obama made during his 2008 campaign.

“We really have now been able to build a case that there was a sequential, planned, organized strategy for the White House to trade policy for politics, if you will,” said Rep. Michael C. Burgess, Texas Republican. “They were willing to give up on things they thought were sound principles.”

The documents show that former White House Chief of Staff Jim Messina and health care reform point woman Nancy-Ann DeParle told drug company representatives in June 2009 that if they didn’t cooperate on the initiative, Mr. Obama would demand a 15 percent rebate on Medicare drugs and push to remove the tax deduction for direct consumer advertising — items that could cost the industry $100 billion over the next decade.

The threats appeared to work, and the parties met the next month to hammer out a final deal. The drug companies agreed to pay higher Medicaid rebates and a new health care reform fee to raise $80 billion for the legislation, and promised to run positive television ads about it.

In exchange, the White House gave them direct input into the new policies and promised to let them continue to set their own drug prices. Ms. DeParle threw in an extra prize to reward pharmaceutical companies for their cooperation, saying she and other officials decided to reverse the administration’s position on drug importation, which Mr. Obama supported while running for president.

“I made [the] decision, based on how constructive you guys have been, to oppose importation on this bill,” she wrote to Bryant Hall, chief lobbyist for the Pharmaceutical Research and Manufacturers of America(PhRMA).

Administration officials have denied that they negotiated directly with PhRMA, instead saying it was Senate Democrats who brokered the agreement.

But Republicans said their findings contradict the White House and confirm what the GOP has long contended: that the White Housebypassed members of its own party to iron out specific details with the drug companies.

The White House didn’t respond to requests for comment, but congressional Democrats defended the deal-making, saying it was no different from what had been done for major legislation under previous presidents...

PhRMA said the industry’s negotiations with the White House were a normal part of doing business...

Republicans said the investigation punctured a hole in Mr. Obama’s pledges of transparency during the 2008 campaign — including a vow to televise all of the health care negotiations so Americans could see who was lobbying for the drug companies and other big players in the debate.

“When you are supposedly acting in the public’s behalf, when you have promised that this is going to be the central feature of your administration, you darned well better behave that way,” Mr. Burgess said...
Yes, yes, I know. Business as usual in D.C. Except this piece of garbage gives the Socialists Democrats control over our very lives.

I'm presently in a nation with Socialized Medicine, and I've asked around about it. Everyone in Costa Rica pays a 9% tax for their "free" healthcare. However, if you need something beyond the basic, you have to wait (sometimes a year or two) for an appointment, or pay $30 for a primary-care visit outside the "free" system, or have your employer dock you for more insurance, which is a big hardship on most. As my guide Juan Carlo put it, "you might not think $30 is a lot, but for me and my friends, it's impossible."

Americans who believe in the increasingly mis-named Affordable Care Act would do well to heed the examples of the rest of the world. Governmental CONTROL (as opposed to Regulation) does not work very well for any prolonged period of time. Don't even bother to tell me of the few anecdotes you've heard about wonderful "free" care your cousin's friend's uncle received in England. The majority of the care isn't wonderful, and it certainly isn't free. Someone is paying for it, rest assured.

I don't think anyone is particularly surprised by this latest revelation of corruption by our illustrious leaders, both in the Administration and the Pharmaceutical industry. But it should certainly give us pause. The whole welfare state in America, and with that I include Medicare, Medicaid, and Social Security, are little more than governmental thuggery, redistributing wealth in a very small part to those who are truly in need, but also to the cronies of those in power, and to many (the looters or moochers, as Ayn Rand calls them in Atlas Shrugged) who don't need it at all.

Medicine in particular has been corrupted by the unholy alliance of Left-Leaning (and sometimes Right-Leaning too) Government, Big Pharmacy, Big Insurance, and not a few thieving physicians. It has become all about the money, and only tangentially about the health of the patient. Personally, I blame Government most of all (what a surprise...) It has set the rules, and the rest of the louts simply follow them or skirt them in the most barely legal manner possible to their own benefit. Nothing personal, of course.

I've got the answer, but if I told you how to fix this, too many of the above would be on the next flight down to Costa Rica with the express purpose of dropping me into the active C-Crater of Arenal.

In the meantime, I'll be on my porch, appreciating the beauty of Arenal and the flora and fauna around her, sipping on yet another Imperial.

Pura Vida!

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