Armed Polite Society
Main Forums => Politics => Topic started by: Balog on January 29, 2014, 01:50:57 AM
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http://www.huffingtonpost.com/2014/01/28/obama-gun-control-state-of-the-union_n_4684426.html
From the SotU speech. Hard to tell if this is meaningless pandering or a rare moment of honesty about the knife he's about to put into our back.
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With every word that dumbass says in regards to gun control, he puts more armament into the hands of citizens.
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Crap. I was going to pick up some lowers when I get home. Now they'll be out of stock or $200 again.
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Thankfully I don't think very many people are actually paying attention to this dog and pony show any more.
I'm betting that after the mid-terms when he's lame ducking it and has most likely lost a lot of D seats, he'll try to ram an EE through that draws on the centralized Obamacare medical records database to disqualify anyone who's ever been diagnosed as mentally ill. A no fly list for gun owners. And of course since the latest DSM artificially inflates numbers of diagnoses (cause if you're sad for more than a few days after a loved one dies you're depressed) and millions of kids have wrongly been RXed stuff for ADHD etc... lotta folks get DQ right away.
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Thankfully I don't think very many people are actually paying attention to this dog and pony show any more.
When he talked about the state of the union, did he mention how broke we are? No? Then how can he be addressing the "state of the union"?
And I remember Richard Nixon promising to cure cancer, in a SOTU address.
In a moment of perverseness last night I tried to bring it up on whitehouse.gov. "Error, try again later".
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That wasn't a state of the union address, it was a overly dramatic campaign speech.
Which is to say, it was like most every other speech the ahole has given over the past five years.
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Best description of the spectacle I've heard yet.
The annual State of the Union pageant is a hideous, dispiriting, ugly, monotonous, un-American, un-republican, anti-democratic, dreary, backward, monarchical, retch-inducing, depressing, shameful, crypto-imperial display of official self-aggrandizement and piteous toadying, a black Mass during which every unholy order of teacup totalitarian and cringing courtier gathers under the towering dome of a faux-Roman temple to listen to a speech with no content given by a man with no content,
http://www.nationalreview.com/article/369607/great-caesars-ghost-kevin-d-williamson (http://www.nationalreview.com/article/369607/great-caesars-ghost-kevin-d-williamson)
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Thankfully I don't think very many people are actually paying attention to this dog and pony show any more.
I'm betting that after the mid-terms when he's lame ducking it and has most likely lost a lot of D seats, he'll try to ram an EE through that draws on the centralized Obamacare medical records database to disqualify anyone who's ever been diagnosed as mentally ill. A no fly list for gun owners. And of course since the latest DSM artificially inflates numbers of diagnoses (cause if you're sad for more than a few days after a loved one dies you're depressed) and millions of kids have wrongly been RXed stuff for ADHD etc... lotta folks get DQ right away.
There is no centralized Obamacare medical records database. If there was, I could sit here in my office and read your chart. I cannot.
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That wasn't a state of the union address, it was a overly dramatic campaign speech.
Which is to say, it was like most every other speech the *expletive deleted* has given over the past five years.
Personally, I think they are all campaign speeches, no matter who is President. I kind of wish a State of the Union address would be given by bean counters with boring executive summary powerpoints of boring real data on spending and infrastructure, so I would have some idea of what's been going on. Not that I could count on the truthfulness of those data, but I would still get more information than in an "Americans are great!" speech. I know I'm great. Show me some numbers on what's been happening under your watch.
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There is no centralized Obamacare medical records database. If there was, I could sit here in my office and read your chart. I cannot.
Isn't the stated end goal to have all records digitized so as to be accessible to any practitioner the patient goes to? And such a database would by definition allow a central body with the correct permissions to access those files.
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Isn't the stated end goal to have all records digitized so as to be accessible to any practitioner the patient goes to? And such a database would by definition allow a central body with the correct permissions to access those files.
There's financial incentives for practices to conform to "meaningful use" initiatives, and some of the requirements to conform include mandatory reporting capabilities.
As-yet, there's no centralization. But the groundwork is being laid.
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Isn't the stated end goal to have all records digitized so as to be accessible to any practitioner the patient goes to? And such a database would by definition allow a central body with the correct permissions to access those files.
Absent some stunning developments, I do not anticipate this will happen in my lifetime and I am 54 years old now. There are several major players in the hospital and outpatient clinic electronic medical records software market. The ability of different programs to talk to each other and share data is extremely limited, if not non-existent. As an example, the large multi-state system that I used to work for made a command decision two years ago to move all their EMR systems over to Epic. They are moving from state to state converting over all the hospitals and medical clinics owned by the system. Interestingly enough the hospital verison of Epic has serious difficulty in talking to and sharing/retrieving data from the medical clinic version of Epic, with all these facilities owned by the same healthcare system and these two versions are produced by the same company. Epic cannot talk to or share data with Centricity or NextGen or AllScripts or Cerner and vice versa. There is a lot of speculation that the EMR companies do this deliberately to make it far more difficult to change to another EMR system down the road. If you have a proprietary database that cannot be accessed by another program, or at least cannot be accessed without a whole lot of expensive custom programming, this is a considerable exit barrier to changing systems.
Probably the closest thing we have to a single system that can be accessed from multiple facilities that uses the same database is the EMR system used by the VA. They have done a crackerjack job in implementing VISTA throughout the VA system so that a patient in Arkansas can go to a VA clinic or hospital in Idaho and the Idaho facility can open up their chart and provide immediate care. But if that same patient goes to St. Alphonsus hospital in Boise, their version of Centricity EMR cannot access the VA system and vice versa. So there is no information exchange to facilitate patient care. The VA can print pages from the chart and fax them to St. Alphonsus, but there is no electronic transfer. When St. Alphonsus gets those VA records, they have to be scanned into their EMR system as a GIF or PDF, and you can do no data analysis in these scanned records.
The DOD also has a uniform EMR system throughout all of their facilities, so the notion of a military member hand-carrying their medical records file jacket from one duty station to another is a thing of the past. There has been much talk in Congress about how the VA and the DOD systems cannot talk to one another, and should both the VA and DOD adopt the same system? Millions, if not billions of dollars have been sunk into trying to get the systems to talk to each other, and last time I checked, they had pulled the plug on the project. Both the VA and the DOD have done much wailing and gnashing of teeth over adopting the other parties's EMR.
Now, what I think we may very well end up with in my lifetime is a centralized database of medical billing and coding information. The one thing that every EMR system can do is uniformly use and submit billing and coding using the ICD and CPT coding systems. This ensures that the healthcare facility gets paid. Medicare and the private insurers already uses internal databases with this information for data mining to see which facility and provider provides the best and cheapest care. This was happening long before Obamacare. It will be interesting to see if the Feds pass a law mandating a single database with data from all the governmental and private insurance payors. If that happens, then Balog's fears may come true: you can run a search to identify all people in the database with a particular diagnosis. You could argue that the existing government database that is supposed to get reports of all persons denied firearms ownership due to involuntary committments fills this role. But this is very different than some government functionary in Massachusetts being able to read your actual chart notes from your doctor in New Mexico.
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So it's only a technical difficulty, then ???
I'm sure that Big O will put somebody to work on that fast and furiously =D
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There is no centralized Obamacare medical records database. If there was, I could sit here in my office and read your chart. I cannot.
That's just what the NSA wants you think think [tinfoil]
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There is no centralized Obamacare medical records database. If there was, I could sit here in my office and read your chart. I cannot.
I take it then your office isn't in this building . . .
(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fupload.wikimedia.org%2Fwikipedia%2Fcommons%2Fthumb%2F8%2F84%2FNational_Security_Agency_headquarters%252C_Fort_Meade%252C_Maryland.jpg%2F769px-National_Security_Agency_headquarters%252C_Fort_Meade%252C_Maryland.jpg&hash=9cc5059a9adfda5c2325565dafee64a2453d2901)
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So it's only a technical difficulty, then ???
I'm sure that Big O will put somebody to work on that fast and furiously =D
More of a money difficulty. A few years ago, the National Health Service in the UK was looking into creating a uniform system such that a patient could go from the tip of Scotland to the bottom of England, and any hospital or clinic in the NHS could use the same system for care. It was in concept much like the VA here. What they were going to do is create a 'spine' using a centralized database, and all of the different and proprietary EMR systems used by NHS hospitals and clinics would hook into the spine and use it to share, read and write information. So you could keep your favorite EMR system in Liverpool, and still have the advantages of being able to care for any NHS patient from any location. After sinking 12 billion pounds into it, the NHS scrapped the project. Last time I checked, they were going to try for more regionalized information sharing rather than a national system.
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Typical software design =(
The interface is inextricably coupled with the data :facepalm:
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Now, what I think we may very well end up with in my lifetime is a centralized database of medical billing and coding information. The one thing that every EMR system can do is uniformly use and submit billing and coding using the ICD and CPT coding systems. This ensures that the healthcare facility gets paid. Medicare and the private insurers already uses internal databases with this information for data mining to see which facility and provider provides the best and cheapest care. This was happening long before Obamacare. It will be interesting to see if the Feds pass a law mandating a single database with data from all the governmental and private insurance payors. If that happens, then Balog's fears may come true: you can run a search to identify all people in the database with a particular diagnosis. You could argue that the existing government database that is supposed to get reports of all persons denied firearms ownership due to involuntary committments fills this role. But this is very different than some government functionary in Massachusetts being able to read your actual chart notes from your doctor in New Mexico.
From a web and infrastructure guy that uses primarily open source tech, I'm always vaguely shocked at how difficult and how badly ERP systems interact with their databases. The level of performance is abysmal for the amount of hardware thrown at the problem. I've designed and build ecommerce sites that can smoothly handle millions of diverse data requests at a very high level of performance. I gather you are correct, that the design philosophy is intentional. Big, confusing, complex, clunky and inelegant is damn near a license to print money if you get people to buy the product.
Web tech tends to be open, modular, spread out logically, run on commodity servers and fast/agile. Use DNS to load balance your load balancers, have a bunch of web servers that handle dynamic content, a bunch of hyper lightweight web servers for static content if you don't want to build/buy a CDN, and a mess of backend database servers that only talk to the dynamic web servers. It's not hard to expand or contract the various resource pools to maintain speed. Not rocket surgery. Otherwise, your site is essentially the Obamacare site.
Whenever I crack open damn near any ERP, I'm always shocked. No many how many times I've done so. I've... seen things you people wouldn't believe... [contemptuous laugh] Progress databases on fire off the shoulder of Orion. I watched COBOL and BASIC code in production glitter in the dark near the Tannhäuser Gate. All those... moments... will be hopefully lost in time, like [small cough] sysadmin's tears... in... rain. Time... to reboot...
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I wasn't particularly thinking of random .gov employee reading my chart notes. Given the troubles you outline, I would think an expansion of mandatory reporting would be more likely. Of course since we're nationalizing healthcare the feds could always just mandate a common system be used. How much lobbyist money can the EMR folks send to DC? Bribe enough congresscritters and they'll make your product mandatory cough cough ethanol cough cough.
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^^^ I have been around long enough to remember that EMR systems were originally sold with one primary purpose: to generate the reams of documentation necessary to support unbundling and upcoding your care to maximize your reimbursement from the government and private insurance payors. The vendors would talk about how much more money you could get from Medicare or the Blues if your bought their system.
It was only many years later, after the payors cracked down on upcoding and unbundling, that the vendors shifted over to 'quality, and patient safety, and coordination of care'. Most of the data to date does not indicate that EMRs contribute materially to these goals. Except for care coordination in the clinics, if the clinics all use the same EMR system, and in hospitals, the EMRs can reduce medication errors caused by ordering the wrong thing, for example if the patient is allergic to the med, or the med is contraindicated by something else the patient is already taking.
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I'm an ETL guy, day in and day out. Extract/Transform/Load. Basically, pull data from database A, organize it to fit record structure B, and incorporate it.
I've built several interfaces for disparate EHR and EPM systems.
The catalyst for me doing it? My boss tells me to. When he says "do it," I don't have a choice if I want my paycheck. Some of those have been quite daunting and kept me working 90-100 hour work weeks for several weeks on end, despairing at the likelihood of success until I stumble on a solution.
The ONLY thing stopping a central database of key medical record information from existing, is government has not said "do it."
It can be done. I promise. All you need is the definition of the target record structure (database schema). Make a law that all EHR systems must support record extraction in such-and-such format. They'll write a stored procedure or view that queries their original schema and outputs the new requirements for input into the central system.
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I have always said that until and unless the Feds mandate that all EHR systems use a common data format, data interchange and vocabulary, there will be no data interchange between different EHR systems. There has been talk of this especially with the Nationwide Health Information Network standards being developed.
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I have always said that until and unless the Feds mandate that all EHR systems use a common data format, data interchange and vocabulary, there will be no data interchange between different EHR systems. There has been talk of this especially with the Nationwide Health Information Network standards being developed.
That'd probably be good for the country, if not world. As long as it's an open standard.
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I guess that we can take some consolation in the fact that Big Brother is a moron :lol:
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I'm not expecting too much to come of it. Mainly a soundbite and optics for his own ego, and for the various anti-RKBA .org's to have something to hold onto.
As far as I'm concerned, the biggest EO impact to come down post-Sandy Hook was the attempt at the new 41p rule for the ATF that's trying to close the corporation and trust "loophole" for the NFA and force everyone to go through CLEO sign-off. The deadline for the rule to go into effect was June of this year, and it's already slipped to March of 2015, and presumably that is when the lawsuits start.
And if any of the suing parties get an injunction, it'll drag out well past 2016 when Obama is gone, and the optics for the useless idiots/voters of how he can "get tough" with his pen and telephone is long past.
I lay even odds on 41p even actually ever getting into effect. Unless Hillary is elected, and actually cares enough about gun control to keep fighting for it. And even if she wins, I think the .gov and ATF will just drop it.
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There are several major players in the hospital and outpatient clinic electronic medical records software market. The ability of different programs to talk to each other and share data is extremely limited, if not non-existent.
You know what that sounds like?
Anyone want to take a guess as to what system I'm thinking of here?
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I have always said that until and unless the Feds mandate that all EHR systems use a common data format, data interchange and vocabulary, there will be no data interchange between different EHR systems. There has been talk of this especially with the Nationwide Health Information Network standards being developed.
http://www.ihe.net/
http://www.commonwellalliance.org/
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I guess that we can take some consolation in the fact that Big Brother is a moron :lol:
:laugh: :laugh:
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Psalm 37:1-3 NASB
Do not fret because of evildoers,
Be not envious toward wrongdoers.
For they will wither quickly like the grass
And fade like the green herb.
Trust in the LORD and do good;
Dwell in the land and cultivate faithfulness.
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Proverbs 22:3 ESV
The prudent sees danger and hides himself, but the simple go on and suffer for it.
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Proverbs 22:3 ESV
The prudent sees danger and hides himself, but the simple go on and suffer for it.
What do the ones who just don't give a flying F#%*k anymore do?
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Psalm 37:1-3 NASB
Do not fret because of evildoers,
Be not envious toward wrongdoers.
For they will wither quickly like the grass
And fade like the green herb.
Trust in the LORD and do good;
Dwell in the land and cultivate faithfulness.
Of these
Therefore pride is their necklace;
violence covers them as a garment.
Their eyes swell out through fatness;
their hearts overflow with follies.
They scoff and speak with malice;
loftily they threaten oppression.
They set their mouths against the heavens,
and their tongue struts through the earth.
Asaph says
But when I thought how to understand this,
it seemed to me a wearisome task,
until I went into the sanctuary of God;
then I discerned their end.
Truly you set them in slippery places;
you make them fall to ruin.
How they are destroyed in a moment,
swept away utterly by terrors!
Like a dream when one awakes,
O Lord, when you rouse yourself, you despise them as phantoms.
http://www.esvbible.org/Psalms+73/ (http://www.esvbible.org/Psalms+73/)
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SAM: You don't really think Tuttle and the girl are in league?
JACK: I do. Goodbye.
SAM: It could all be coincidental.
JACK: There are no coincidences, Sam. Everything's connected, all along the line. Cause and effect. That's the beauty of it. Our job is to trace the connections and reveal them. This whole Buttle/Tuttle confusion was obviously planned from the inside.
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The plan to make as much of the population criminals through regulations, dictates and unpopular legislation is marching along nicely thank you.
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I was gonna guess that Millcreek works here:
(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fmedia.glassdoor.com%2Fm%2F35163%2Fepic-systems-corporation-office.jpg&hash=f22738ad67ab64b2c33d7eee55ad64afc163a3f5)
(Epic Systems, Verona WI - working very hard to become THE medical database and software owners across the entire US of A)
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I was gonna guess that Millcreek works here:
(https://armedpolitesociety.com/proxy.php?request=http%3A%2F%2Fmedia.glassdoor.com%2Fm%2F35163%2Fepic-systems-corporation-office.jpg&hash=f22738ad67ab64b2c33d7eee55ad64afc163a3f5)
(Epic Systems, Verona WI - working very hard to become THE medical database and software owners across the entire US of A)
I don't work there but have been back to their offices about five times now. I think Madison is a really nice town.
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(Epic Systems, Verona WI - working very hard to become THE medical database and software owners across the entire US of A)
Quoted for truth. Our 3 largest hospital systems, here in Cincinnati, use Epic.
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http://pjmedia.com/tatler/2014/01/29/holder-confirms-obama-ready-to-use-executive-order-on-guns-in-absence-of-meaningful-action-by-congress/
Attorney General Eric Holder said at a Senate Judiciary Committee hearing today that President Obama is open to using an executive action to push through gun-control and/or associated mental health measures that haven’t found approval in Congress.
Bold is what worries me. Given the NRA's stance I think they might support some "get tough on all those crazy people" BS measure, and then whoops look at that we've defined %80 of Americans as mentally ill.
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http://pjmedia.com/tatler/2014/01/29/holder-confirms-obama-ready-to-use-executive-order-on-guns-in-absence-of-meaningful-action-by-congress/
Bold is what worries me. Given the NRA's stance I think they might support some "get tough on all those crazy people" BS measure, and then whoops look at that we've defined %80 of Americans as mentally ill.
Anyone who didn't vote for Dear Leader is insane ;/
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Anyone who didn't vote for Dear Leader is insane ;/
If they change it to anything other than "forcibly institutionalized as a danger to themselves or others" or however it's exactly phrased today, we are done.