Time on a Farm

Driving through rolling hills is a visual treat.

Add the challenges of farming said hills, managing livestock and running a milking operation. These operations require a strong constitution, an appetite for risk and the ability to constantly improve the business.

I saw waste repurposed to compost, ongoing investments in labor saving tools and the use of software to smartly plant hilly ground, saving precious seed and fertilizer.

Making these operations go on a family scale is not for the faint of heart.

PS. Dairy prices are worth a look.

The New, New Thing and Tokyo, 2018

Exploring, creating and sharing new information methods has long been of great interest to me.

Voracious readers, my parents subscribed to three newspapers (four, now that I reflect on those times) and many magazines during my early years. The depth and breadth of these publications allowed me to explore many topics, including technology, from creation to application development.

I learned that many technologies are useful, but some remain an answer in search of a question, or perhaps ahead of their time.

The development and release of Quicktime VR created a first wave of experiences and applications. Many were crude, but illustrated a vision, if not a future opportunity – one day, “real soon now”.


There have been stops and starts, potholes, investments and failures along the way.

Just a few years ago, I received a message from a second year Computer Science major. A mutual physician friend suggested that we talk.

The student arrived at our meeting over tea with an iPad running a javascript based virtual shopping experience. He sought my feedback (!)

I replied that I’ve seen it before, in the late 1990’s, using Quicktime VR.

Yet, we now seem to be approaching a new period of possibility, if not exuberance, investment and opportunity.

The supremacy of powerful, mobile devices featuring beautiful displays and emerging 3D technology offers an interesting playground for creators and explorers.

The IVRPA has, for twenty years, provided a place to learn and share immersive experiences. As such, it’s a privilege to participate in their upcoming 2018 conference.

I plan to discuss a family project: the amuz app: App Store. Play store availability “real soon now”.

amuz is designed to be fast way to explore new places and experiences using a variety of media.

It’s a fun project and one that may be useful for many people around the world.

This chart, illustrates the exploration opportunity:

We’ll see.

$37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018

Centers for Medicare & Medicaid Services:

Here’s where you’ll find Medicare and Medicaid Electronic Health Records Incentive Program payment and registration data in report form.

As of January 2018, more than 543,400 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. In May 2013, CMS announced that more than half of all eligible health care providers had been paid under the Medicare and Medicaid EHR Incentive Programs.

The taxpayer outlay is updated monthly. January, 2018.

Background links:

How the Cleveland Clinic grows healthier while its neighbors stay sick .

Why Americans are avoiding the doctor.

On the Growth of Epic Systems:

Part of the company’s recent growth has stemmed from $30 billion in federal incentives included in the recovery act passed in 2009 during the financial crisis.

The incentives were designed to give a final shove to hospitals and physicians to make the costly and difficult transition from paper records to electronic records.

In 2008, only 1.5% of U.S. hospitals had a comprehensive system for electronic records implemented in all major clinical units, and an additional 7.5% had a basic system that included certain features in at least one unit, according to the results of a survey published in the New England Journal of Medicine.

Even fewer physician practices had made the transition.

By 2014, 75.5% of hospitals had at least a basic system, according to an annual survey.

Before the federal incentives, academic medical centers, hospitals that were part of health systems and large physician practices were most likely to have begun the transition to electronic health records. Epic focuses on those customers. But the incentives have contributed to the surge in the company’s growth.

That, though, has come at a price.

Epic’s size and success have made it a target for critics of electronic health records and the way the $30 billion federal program has evolved.

Critics contend that the systems are difficult to use, that entering information is time-consuming and detracts doctors from focusing on patients, that the records frequently are cluttered with unneeded information and that hospitals and physicians often can’t exchange information.

David Dranove, Craig Garthwaite, Christopher Ody, Bingyang Li:

In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH.

Subsidies given for computerizing, but no reporting required when errors cause harm:

President Obama and Congress poured $30 billion in taxpayer subsidies into the push for digital medical records beginning in 2009, with only a few strings attached and no safety oversight of the vendors who sell the systems.

The move was touted as a way to improve patient care and help rein in medical costs. Five years later, the explosion in the use of the electronic records has created the potential for efficiencies and safety benefits but also new risks for patients, the scope of which still is not fully understood.

But the scramble by doctors and hospitals to cash in on the incentives has thrust complex, balky, unwieldy, and error-prone computer systems into highly sensitive clinical settings at a record pace. From 2008 to 2013, the percent of US doctor’s offices with electronic health records rose from 17 to 48 percent. Growth in hospitals was even more dramatic, from 13 to 70 percent.

Mike Ivey:

Officials at Epic Systems are not commenting on a New York Times report Wednesday that the firm was central in lobbying Congress on a $19 billion “giveaway” (now $37B and growing) to convert all U.S. medical records from paper to computers.

The story contends that executives of the largest digital records companies — including Epic, Cerner and Allscripts — poured hundreds of thousands of dollars into a behind-the-scenes effort to promote the use of electronic records, effectively pushing aside smaller competitors.

Those efforts paid off handsomely in 2009, when legislation promoting the use of electronic medical records was included in President Obama’s economic stimulus bill. The $780 billion package included nearly $20 billion in incentives aimed specifically at software made by Epic and others.

The stimulus package also included penalties for doctors who don’t adopt the new technology. Providers who don’t install electronic records by 2014 will face reductions in their Medicare reimbursements.

Unfortunately, this $37,920,077,070, and growing taxpayer subsidy has failed. We lack medical record interoperability and costs have continue to grow, substantially.

April

Tap for larger versions.

While on travel over Easter weekend, an airport gate agent, after exchanging pleasantries mentioned that “any day that I am breathing is a good one”!

A bit of snow recently, but it has quickly disappeared.