cardinaldirection: Give a read to the Third Law of Thermodynamics.

While the body strives to homeostasis, it ultimately fails. Time and age are not friends of the human body. Nothing but wine and cheese get better with time...and them? Only to a certain point, after which vinegar and a moldy, fermented mess.

Our spirits (non-alcoholic) may strive for wholeness and harmony, but the Universe is remarkably uncooperative.

i am quite familiar with entropy, and having studied physics and the world around me for decades i couldnt disagree with you more.  however this is not the place for that discussion.

regarding homeostasis, aging and death are hardly enemies, any more than sleep is.  they are character building exercises ; natural cusps on the cycle of life: contractions and transferences of energy.  homeostasis IS a quite apparent phenomenon of life.  organisms constantly yearn for harmony; death is merely one method of reuniting with the whole.  it is not the universe and its ways that are uncooperative, but us with them.

the death of cheese is the birth of mold - the symbiosis between life and death: cusps on a very balanced and harmonious cycle.

out of curiosity, does this community have a voip server?

I think I get it.........Chinese hackers breaking into hospital records (death of privacy/security) gives birth to identity theft/fraud etc.    It's all just a harmonious cycle......hehe  

Quoting the_Monk, reply 28

 

I think I get it.........Chinese hackers breaking into hospital records (death of privacy/security) gives birth to identity theft/fraud etc.    It's all just a harmonious cycle......hehe  

End of the_Monk's quote

There ya go... 

Pond scum comment from the cesspool.

EHR's are garbage and mostly unusable in any meaningful sense, save for a few time-saving components (e.g., electronic prescription writing).  They exist primarily to mine data for third parties, particularly the government, not to help doctors better care for patients or make the delivery of healthcare more efficient.  The tighter the security, the more cumbersome and unusable the system.  However, so many people of unknown integrity have access to them, well outside the circle of people immediately responsible for care, as to make technical security safeguards meaningless.  Protected Health Information, as a concept, is a joke.  You can't get a thing done in the healthcare system without giving access to everything to everybody.  The ability to share the important narrative information with people who need to know it in a timely fashion has been completely hamstrung by EHR's.  They generate stream-of-consciousness documents with multiply redundant and mostly useless minutiae so dense as to make ferreting out clinically useful information orders of magnitude more difficult.  A 10-page report of an ER visit for a laceration serves only to waste electronic storage and bandwidth.  And makes my brain hurt.  Patients ultimately suffer when the stuff that matters to their well-being gets buried in a blizzard of useless bullshit.  They haven't been able to separate the stuff that should just be metadata from the substantive stuff (Do I really need to have a listing of hourly vital signs for the duration of a 4 day hospital stay in the discharge 'summary'?).  The means have become the ends, totally divorced from reality.

Other than that, I love EHR's.

If you framed that more poetically, you would have written the medical Ecclesiastes:

"There is a time to look for something. You look for something that you have lost.

            And there is a time to stop looking for it.

There is a time to keep things.

            And there is a time to throw them away."

The worst part? They actually have deluded themselves and people into believing that their care has become better, by false logic: The only useful information is that which is instantly available, anywhere and everywhere. Everything is important, the more information the better. If it wasn't written down it didn't happen.

Where do these idiots come from?

You don't even want to get me started on the major fuckuperry these walking-talking collection of pharmaceutical-kick-back-laden asswipes are capable of and how they have gone out of their way to destroy any and all faith I may ever have had or will have in the medical community. From putting stuff in my file that wasn't true to the latest...telling me I absolutely HAD to forgo ALL my pain medication for a procedure I had done a couple weeks ago.  What I take on a daily basis, just my morning dose, would knock the average person out for a good 24 hours, I'm sure. Some nurse got it in her head that I needed to go at least 15 hours without ANY of it before the procedure. The day of the procedure, as I sat crumpled in the hallway going in, crying from withdraw, insane pain in my my back, knees, legs and everything else, I realized once again why I bring my wife with me to most of these appointments...it's so I don't do anything that will land me on the evening news to one of these morons. 

I don't know what is worse. That they keep doing shit like this to me or that I keep nodding and going along with the shit they say like the last fuckup never happened and I can actually trust them to know what the fuck they are doing.

Colleges. Universities. Nursing Schools. With diplomas in hand. Isn't the first rule of medicine something like 'Do no harm'? I think it's time to start suing the universities and colleges these idiots graduate from...go right to the source,,cause obviously by the scale..the rather LARGE scale of idiots running amok out there with PhD's and other licenses to poke...something is being left out of their education and I would venture to guess it's the part about serving humanity, having humanity, and knowing what humanity means.

Their parents. Universities teach knowledge, not attributes.

That comes from the person him/herself and the home...not from school.

Now, would you like some fries and ketchup with a side of compassion? 

It's all about the $$$ anymore. The humanity part left a long time ago..

Now that depends on the product you are using. 

Where would you be without a good PACS system? Would you rather go back to film?

I know that McKesson / Horizon products are a complete and utter disasters that do NOT play well together at all.

I've seen some EHR products that the physicians actually raved about though.

As for security being a "hassle" and making the product too cumbersome...

Once again, it depends on the scenario. I myself have seen way too many cases of "cumbersome" being used as a means to justify stubborn attitudes and delusions of grandeur instead of actually following policy and becoming proficient with the product. 

By way of background, FWIW, I'm a bit of a geek.  I've been using a computer to do my clinical documentation since 1984, with my practice having always been to have every encounter note include all pertinent historical and current information concisely on no more than a single page.  We've been using an EHR in my 4-physician practice for over 4 years and I'm the office SysAdmin, with a 'real' IT support guy always in the bullpen.  So I am a fan of what technology can bring to the table in a medical practice and my opinions have some basis in real-life experience.

Problem is 'following policy' has become more important than taking care of the patient.  No offense, Phoon, but a good clinician beats 'policy' every time.  And there are only two things a good clinician can bring to bear in caring for a patient: knowledge and time.  I would rather my clinician be spending his time researching and reflecting on my issues than having his head buried in a computer screen clicking box after box after box to meet the demands of documentation policy.  It's a terrible waste of a highly valuable resource, one that both the clinician and society have invested very heavily in.  If the real-world result of EHR use was greater efficiency for the clinician delivering care, enabling the clinician to devote greater time and energy to clinical work, I'd be one of those 'raving' supporters.  Just the opposite is the case, unfortunately, despite information-access benefits.  If my livelihood depended on using our EHR as designed, with a full load of patients, I would have pursued other employment long ago.  I've found ways to use the beneficial pieces of the EHR while avoiding the template-based documentation that spits out verbose but sterile, generic pabulum that fails to meaningfully integrate all the problems & issues with which a patient may be contending.

As for PACS, I've been waiting 3 years for a 64-bit client to become available to access images.

Speaking of efficiency 'benefits' of EHR's.  I had a recent experience with a family member visiting an ER for an acute problem.  In addition to the nurse, ER tech and physician, this particular hospital had resorted to hiring a 'scribe' who's job it was to document the patient-physician encounter, in the manner of a court reporter.  Had his own laptop on a mobile workstation and followed the doc around from patient to patient.  His only function was to 'feed the beast', sparing the physician of some technical & clerical work in the process.  To that extent, it was good for the physician, but it demonstrates how EHR implementation can entail unintended or unanticipated costs.

Daiwa, thank you for taking the time to explain it from your stance! You provide legit concerns and points that unfortunately fail to sink in to the brains of the politicians and corporate giants. You, as well, are outside of the  "pond scum" realm.  The ones I've been so colorfully referring to are just simply arrogant ass holes that think they are above following policy, and that is their only justification. I've seen many of them and the below mentioned corporate entities let them get away with it because they make money for the corporation. 

Agreed.. HIPAA in it's current form does strangle the productivity aspect. If that productivity goal is in the best interest of providing the best care to the most people in the least amount of time then it is sad indeed.

If the productivity goal is a banner set by a corporate CFO/CEO ( aka... Community Health Systems ) with the sole intent of getting more income at any cost then that is another story. 

Oh.. and a bit of inside FYI... Community was hacked because they failed to maintain patching on a VPN device. That was the entry point. Don't know if they used any known credentials to do it or if it was a known weakness in the system...

No shit.

My pain management doctor (and the one before this one) don't even want to see patients anymore unless they are laying face down under a fluoroscope. I swear, I cannot remember the last time I ever saw one that wasn't running around with a mask (how appropriate as they charge upwards of $800 or more per fucking shot) and a lead apron trying to inject as many backs as they can in a day. When I do get to talk to him (usually AFTER I have asked a few dozen times) he doesn't remember me from doodley-squat. 

I shit you not, not even 6 months....^ mother-humping months after putting a spinal cord stimulator in my back (which requires fusing part of it to your spine and embedding the battery for it in the fat of your lower back...AND charging the insurance around $100K) he came into the exam room in his little apron and mask after one of my 'can I PUHLEEZE see my doctor instead of the PA..PUHLEEZ events, he looked me right in the eye and asked if I had ever had a spinal cord stimulator put in my back. God as my witness.  AND I WAS ASKING TO SEE HIM BECAUSE THE FUCKING THING WASN'T DOING WHAT IT WAS SUPPOSED TO!

I could write a fucking book. I really could.

It's all about the money. These fuckers have set up (by fuckers I am referring to pain management doctors I know) a conveyor belt of people in desperate...and I cannot emphasize the word 'desperate' enough...in desperate need of relief from pain and..AND someone who understands this and actually listens to them..remembers their faces, their problems, their names, AND WHAT FUCKING HARDWARE THEY HAVE MEDICALLY FUSED TO THEIR BODIES...not someone who is trying to figure out how to squeeze in 50 more injections in a work week.

It's because they do this that the government is cracking down on the medications they prescribe...because they keep such shitty charts and don't know their patients. When they are audited or asked about a specific patient, they can't even remember what procedures they have performed on them!!!!! I've laid eyes on charts not properly updated...I've argued with nurses and doctors who couldn't remember the last time they saw me, injected me, or wrote a script. (I actually had to have the drugstore pull the records to shut up one nurse who claimed they NEVER prescribed me ANYTHING)

And people look at me..up and down...and want to know why I look like shit or seemed so depressed. Or worse, say things like 'Maybe if you got some excersize'.... 

I think the only reason I keep any sanity at all is because I have come to expect the worse and have found I am disappointed a lot less by doing so. And that pisses me off more than I can say.

That's very distressing to me, Po, though nothing to how it distresses you.  I'm embarrassed on behalf of the profession and very sorry you've had to suffer such fools.

A pessimist can always be pleasurably surprised....

An optimist can only be disappointed.

I tend to be a pessimist....;)

Po's been through the mill. So unhappy about your suffering. 

Po, from my experience western medicine knows very little about the nervous system.  While working with specialists and surgeons to resolve my issue, I've found acupuncture, acupressure, yoga, and deep breathing techniques to relieve my pain IMMENSELY; and unlike meds, actually enhance my productivity.  Just food for thought if you haven't tried any "eastern" routes yet.  Perchance they will help you too.

Best,

Don't lose hope!