Archive for August, 2014

Watch out for China. They are getting more aggressive and are not our friends.

August 23, 2014

This is a sample of what is going on with China. They are not only throwing elbows at their neighbors, but also now willing to openly challenge us.

While the Ukraine and Iraq get all the attention, China is the more vexing problem. They are obviously assuming a more aggressive posture, have a massive military, openly spy/hack/steal our technologies and data, own a mountain of our debt, and have our manufacturing inside their borders. They have played the table expertly. They see themselves as going up and the USA as in decline.


We could have crippled ISIS early on. Now we can regret it.

August 22, 2014

Now it is clear to even the greatest dullards that ISIS is a threat to civilized peoples across the planet. Sadly it took the deaths of thousands before it finally sunk in.

Now recall that shortly after their blitzkrieg of Iraq began that we missed a golden opportunity to cripple them. They had already taken a couple of major Iraqi cities and were moving as a mass on open highway. They were sitting ducks and our Air Force could have left them as ashes.

Unfortunately our nation’s leadership dithered. ISIS went on to slaughter thousands more before the USA finally was rousted from slumber when Iraq’s main dam was captured. The beheading of a US journalist for the cameras was further prodding.

Had the US acted while ISIS was vulnerable on the highway, the attempted genocide of the Yazidi would have been prevented. Collectively thousands of Yazidi, Christians, Jews, Shia Muslims, and just plain ole men, women, and children were murdered by this collection of kooks. When a group gets it jollies out of cutting off heads and posting it on social media — that should be a clue it is hostile.

The excuse at the time for not unleashing death from the skies was not wanting to be seen as Maliki’s air force. Nonsense! An enemy of civilization itself — with a goal to wipe out everyone who didn’t adhere to its branch of Islam — was on the move. You could mark their trail by the piles of bodies.

Now our own defense secretary is calling them capable of unleashing 9/11 destruction targeting our nation. They are the wealthiest terror group in history and have several thousand battle-hardened fanatics willing to be martyrs. They have access to OUR weapons and all sorts of fun toys of mass-destruction as they plunder Iraq. Could they cobble together a radioactive dirty bomb and leave a major city contaminated? Yes, it appears they have that capability.

Would they do it? The river of blood they have shed over the last few months indicate a perfect willingness to commit any atrocity.

Again, they were massed on an open road with no ability to stop an air attack. Had Hell been unleashed on them, they could have been crippled and limped back into Syria. Instead they got the idea Allah was with them and so they butchered their way forward.

What fools we are at times…

What it the impact of all of those HITECH Act billions for EHR and HIE?

August 15, 2014

Frankly, none that I can see at a patient level as I spend time in the health care system dealing with a melanoma (from diagnosis to aftermath).

I still get clipboards with stacks of paper forms to fill out one at a time at each medical encounter. Even simple stuff like having my name and birthdate pre-populated are missing from the forms. The people who change the oil in my car can prepopulate forms – and none of them got “meaningful use” taxpayer loot!

The best I have had for online interactivity is some of the forms being available as downloadable PDF. I can’t fill anything out online and have it saved, of course. I can just fill out the PAPER FORMS in advance (though my wife can edit the PDFs and at least type in the info).

Each providers and hospital seems to offer me a different patient portal – none of which share records with the other. They are also missing critical data like pathology reports. Cancer patients NEED pathology reports.

The oncologist’s office today was CALLING MY WIFE THE MORNING OF THE APPOINTMENT to try to get a copy of my original biopsy report. This was an essential record for the appointment, but they didn’t have it the morning it was supposed to take place.

(I thought the days of patients needing to carry all of their paper records around were over.)

I was booked for a set of CT scans (pelvis, abdomen, chest, and neck) – and had to tell the oncologist that I had just had two of those scans done at the end of June (UTI hospitalization). Had I not spoken up I could have received an unneeded high dose of radiation.

The office staff of one of the providers was honest and told me the problem is that none of these EHR systems can actually talk to each other. So, each office asks for the same stuff over and over again, even if you have already given it to multiple other doctors and hospitals.

Now, I did get handed a sheet of paper with a basic summary of information I had given them earlier from — of all place — my eye doctor. It was labeled as being for “meaningful use”. Unfortunately the summary contained the same errors that I had corrected when updating info at the start of the appointment.

One doc was willing to send me a PDF of a biopsy report via email, while another refused to do it citing HIPAA. C’mon, it is 2014 and patients use email! I will supply whatever HIPAA authorizations are needed, but I want my information sent to me electronically. Paper hard copies are 1914, not 2014.

I could go on, but basically I can’t find much evidence anything has changed after all those billions. Epic and a handful of other big EHR vendors got a massive infusion of taxpayer funds. That seems to be the big benefit of all of the HITECH Act spending.

Basically, at the patient level, it is still a disconnected, isolated, largely paper-based world. I am still the backup for ensuring Doctor A knows what Doctor B is doing – and have started leaving copies of medical records in the back seat of the car in case anybody needs them.

The HITECH Act may end up a colossal flop and plummeting Stage 2 and 3 meaningful use participation rates demonstrate that the promise of HIT isn’t meshing with the reality.

My prescription: A good first step would be to have prefilled forms waiting at physician and hospital offices, as I get tired of spelling out my name, birthday, and the same information countless times. If the most expensive and high-tech health care system in the world can’t pre-populate forms, then it isn’t really interested in demonstrating patient convenience. But then, if they REALLY want to do a good thing, get their @#$# portals to consolidate into one system that lets me see all my medical crap at once. It would be like if Facebook required you to have a separate Facebook account for each site you visited!

UPDATE: I did get a portal via the oncologist run by McKesson that, after a SNAFU in setting up, did have lab data on it. Yes! A small victory for patient convenience!

No sign of spreading from the Stage IIB melanoma

August 3, 2014

I had the mole site cleaned up with a wide lateral excision and two nearby lymph nodes removed and tested. The lymph nodes were two that radioactive tracers injected into my neck indicated drained the mole site region.

Both the surgical site perimeter and the nodes were negative for melanoma cells. So, no signs of spreading at this time.

That is obviously welcomed news for the whole family.

This melanoma episode costs me a lot of copayments and co-insurance costs, two incisions on my neck (maybe 6″+ in total), a chunk of neck around and under the original mole site, and two lymph nodes. If that is the total damages for a Stage IIB melanoma, then I got off lucky.

I note that less than ten days passed from melanoma diagnosis to surgery, which is remarkably fast. In this case, the USA health care system moved at blazing speed and efficiency. If you must have a cancer diagnosis in your life, hope and pray it is in the USA. Our cancer survival rates tend to be the envy of the world.

There will be follow-up items, most of which will involve checking for other melanomas attempting to sprout on my quite sun-damaged skin.

The two incisions are healing nicely and the scarring will be minimal. The surgeon tried to align the cuts to blend in with existing creases in my neck.

Bottom line: I might have avoided a painful, expensive, and potentially life-threating episode had I worn wide-brimmed hats instead of baseball caps. Oh, and if I had used sunscreen, that also might have been helpful.

So, if you like to go outside in the Texas broiler-oven sun — wear a hat.