A core issue, he states, is that most EHRs are not universally interoperable, meaning health and other relevant patient information they contain is not easily shared either with other EHRs or government public health IT systems
Notes and links on our back door electronic medical record subsidy disaster. We were promised interoperability….
I recently compiled a bit of long term, personal medical history along with an image or two prior to meeting a new physician. I sought to share this digital information efficiently, and save everyone time, if not money.
However and unfortunately, Epic Systems’ My Chart app (Madison, WI based UW Health implementation) lacks the ability to ingest and share patient sourced images or documents…..
A few days later, in clinic, I used iOS’s AirDrop to share the text and graphics to the physician’s iPhone. While helpful, the lack of patient sharing tools meant that a clinic visit was required along with ever increasing deductibles.
Many healthcare providers share personal medical record data via the iPhone’s health app.
However and unfortunately, $3.65B UW Health’s Epic medical records cannot be shared to my iOS health app.
We continue to pay more for less.
The lack of interoperability is a reminder that US taxpayer’s now $40B back door electronic medical record subsidy has been a failure. Costs have exploded and we citizens lack data portability, despite the legislation’s requirement:
The HITECH Act set meaningful use of interoperable EHR adoption in the health care system as a critical national goal and incentivized EHR adoption.[7][8] The “goal is not adoption alone but ‘meaningful use’ of EHRs—that is, their use by providers to achieve significant improvements in care.”[9]
There are pockets of innovation. One Medical’s app supports video visits:
Thankfully, the visit was of no consequence, other than time and money.
Additional reading:
Death By 1,000 Clicks: Where Electronic Health Records Went Wrong
Madison’s Property Tax Base Growth; $38B+ Federal Taxpayer EMR Subsidy
Stillborn 2007 Wisconsin $30M EMR subsidy.
A reader asked me to write tonight about the Health Information Technology for Economic and Clinical Health Act, which is about as far from something I would like to write about as I can imagine, but this is a full service blog so what the heck. The idea behind the law is laudable — standardized and accessible electronic health records to allow any doctor to know what they need to know in order to treat you. There’s even money to pay for it — $30 billion from the 2009 economic stimulus that you’d think would have been spent back in 2009, right? Silly us. Now here’s the problem: we’re going to go through that $30 billion and end up with nothing useful. There has to be a better way. And I’m going to tell you what it is.
The costly flaws in U.S. digital health-data plan
Recent news that Madison’s “total property values” top Milwaukee’s for the first time piqued my interest in the growing $38,220,758,479.00 federal taxpayer subsidy to organizations purchasing electronic medical records. Note that the $38B has been spent since 2011.
I created a chart illustrating Madison’s property tax base from 1977-2018 using data from the City Assessors office.
I displayed the federal taxpayer $38,220,758,479.00 (growing) subsidy from the date of the first payment (May, 2011) through June, 2018.
Tap for a larger version.
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.
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.
2007 Then Wisconsin Governor Doyle’s proposed $30,000,000 state EMR subsidy.
Big Brother in the Exam Room: The Dangerous Truth about Electronic Health Records 1st Edition:
There are serious dangers lurking behind the government’s $30 billion electronic health record (EHR) experiment. This omnipresent technology turns doctors into data clerks and shifts attention from patients to paperwork–while health plans, government agencies, and the health data industry profit. Patients who think the HIPAA ”privacy” rule protects the confidentiality of their medical information will be shocked to discover it makes their medical records an open book.
City of Madison Assessor.
Unfortunately, this $38,220,758,479.00 and growing taxpayer subsidy has failed. We lack medical record interoperability and costs have continued to grow, substantially. US Federal Debt data…
I’ve found it curious that this far larger taxpayer subsidy has gone unmentioned when the $4B FoxConn subsidy has been tossed about within the political theatre.
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.
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.
UPDATE – Paper Trails: Living and Dying With Fragmented Medical Records by Ilana Yurkiewicz
UPDATE 2: Getting your medical records might not be easy:
“There were overwhelming inconsistencies in information relayed to patients regarding the personal health information they are allowed to request, as well as the formats and costs of release, both within institutions and across institutions,” said Carolyn Lye, the study’s first author.
“We also found considerable noncompliance with state and federal regulations and recommendations with respect to the costs and processing times,” Lye, a medical student, said in a university news release.
The researchers also found that 58 percent of the hospitals charged more than the federally recommended $6.50 for medical records stored electronically. One hospital charged $541.50 for a 200-page record.
The study was published online Oct. 5 in JAMA Network Open.
Stricter enforcement of the patients’ right of access is necessary to ensure that the request process across hospitals is easy to navigate, timely and affordable, Lye suggested.
Among the 83 top-ranked US hospitals representing 29 states, there was discordance between information provided on authorization forms and that obtained from the simulated patient telephone calls in terms of requestable information, formats of release, and costs. On the forms, as few as 9 hospitals (11%) provided the option of selecting 1 of the categories of information and only 44 hospitals (53%) provided patients the option to acquire the entire medical record. On telephone calls, all 83 hospitals stated that they were able to release entire medical records to patients. There were discrepancies in information given in telephone calls vs on the forms between the formats hospitals stated that they could use to release information (69 [83%] vs 40 [48%] for pick up in person, 20 [24%] vs 14 [17%] for fax, 39 [47%] vs 27 [33%] for email, 55 [66%] vs 35 [42%] for CD, and 21 [25%] vs 33 [40%] for online patient portals), additionally demonstrating noncompliance with federal regulations in refusing to provide records in the format requested by the patient. There were 48 hospitals that had costs of release (as much as $541.50 for a 200-page record) above the federal recommendation of $6.50 for electronically maintained records. At least 7 of the hospitals (8%) were noncompliant with
A reader asked me to write tonight about the Health Information Technology for Economic and Clinical Health Act, which is about as far from something I would like to write about as I can imagine, but this is a full service blog so what the heck. The idea behind the law is laudable — standardized and accessible electronic health records to allow any doctor to know what they need to know in order to treat you. There’s even money to pay for it — $30 billion from the 2009 economic stimulus that you’d think would have been spent back in 2009, right? Silly us. Now here’s the problem: we’re going to go through that $30 billion and end up with nothing useful. There has to be a better way. And I’m going to tell you what it is.
But first a word from my reader:
A proposal by Gov. Jim Doyle to spend $30 million to help fund electronic medical records systems is just a “drop in the bucket” of what it would take to enable all of the state’s health-care providers to access patients’ histories at the push of a button, medical experts said.
Doyle said Thursday that he wants to create a $20 million grant program to help nonprofit organizations transition from paper documents to technology he says will reduce medical errors and improve quality.
Another $10 million in tax credits would go to for-profit hospitals and doctors to help cover the cost of their transition.
Cullen’s article rightly points out that the “$30M is a drop in the bucket” in a system with billions flowing through it (I don’t think they need a subsidy). Creating another layer of tax redistribution (from payroll and income taxes and fees) for state incentives and health care system funding, given the many other state spending priorities, not to mention the $1.6B structural deficit, is misquided. I wonder who is behind this?
Link Hoewing discusses electronic medical records from Verizon’s perspective (Verizon is installing Fiber broadband to the home in many markets, unlike AT&T).
Consumers Deserve a Data Dividend
Digital identity scheme shot down by voters over data privacy concerns
The blissful political incorrectness of Soviet comedies
Three east London boroughs were already at breaking point. Then the pandemic struck
Saudi Arabia’s Bold Plan to Rule the $700 Billion Hydrogen Market
Gig workers would pay higher taxes under Democrat Party coronavirus aid bill
However you cut it, what we’re talking about when we say “science” just isn’t close to the thing it was seventy years ago.
All Measures Short of a Cross Straits Invasion
The New ‘End of History’
‘your problem, Dad, is that you’re bored by the present’.
Google UX commentary
“O’Brien and Pottinger recommended that Trump immediately ban travelers from China or anyone who had recently been there. Every Trump official opposed the move, even the health experts such as Fauci”.
$38B+ Taxpayer Electronic Medical Record subsidy waste, part X
Complaint Publicization in Social Media
Does Competition Improve Service Quality? The Case of Nursing Homes Where Public and Private Payers Coexist
T-Mobile Is Taking All of Your Sweet, Sweet Data… Unless You Tell It to Stop
Inventor of cassette tape Lou Ottens passed away
Bats and the origin of outbreaks: As the World Health Organization reaches its findings on the zoonotic origins of the novel coronavirus, we explain why bats make such ideal hosts for disease-causing viruses.
Retracing a Donner Party Path, Nearly Two Centuries Later
San Francisco DA Chesa Boudin recall campaign approved
Toyota Chief Says Apple Should Steel for Long Haul if It Enters Auto Industry
Covid-19: NHS Test and Trace ‘no clear impact‘ despite £37bn budget
Apple Tilts to iPhone Playbook for Car as Automaker Talks Stall
Green Bay, Democrats dispute report that private group took over city’s election administration
Shops return to rural Sweden but are now staff-free
Keep Calm & Defend Work
Wheels to Meals: Measuring the Economic Impact of Micromobility on the Local Economy
What a TAZ (temporary autonomous zone) provides
That they are angry and upset is irrelevant.
Grocery store workers are working, meat packers are working, hell bars and restaurants are open in many parts of the country but FDA inspectors aren’t inspecting. It boggles the mind.
If Big Tech has our data, why are targeted ads so terrible?
MacArthur fellow and Stanford professor Heidi Williams ’03 explores the forces that impede advances in healthcare.
It would be helpful if China released Phase III trial data on its vaccines before demanding that people take them
Fortunately the US then had judicial restraints. Judge William Morrow ruled that the San Francisco Board of Health’s actions were “boldly directed against the Asiatic or Mongolian race as a class, without regard to the previous condition, habits, exposure or disease, or residence of the individual” — and were therefore unconstitutional.
Taxpayers have spent more than $38B (!) since 2011 on a backdoor electronic medical record subsidy [1]. Verona based Epic Systems lobbied [2] for these expenditures and has benefited greatly from this federal taxpayer largesse.
Interoperability, that is the ability to move your digital health data anywhere, was one of the arguments for this lavish spending.
However and unfortunately, Epic’s Founder and CEO, Judy Faulkner is now lobbying once again [3], this time to prevent such open movement. Her actions seek to reinforce Epic’s “walled garden” [4], that is creating roadblocks to data leaving their systems.
Curiously, former Wisconsin Governor Tommy Thompson is also advocating Epic’s walled garden position, to the detriment of entrepreneurs everywhere. [5]
Citizens pay for healthcare and therefore vendors such as Epic in many ways, from our local, state and federal taxes to exploding insurance premiums and co-pays.
News flash!
Epic has rolled out ads at National Airport opposing HHS regulations.
The last refuge of the worried lobbyist.
— Farzad Mostashari (@Farzad_MD) January 23, 2020
The ability to move our data opens up many opportunities, including more cost effective services.
[1] $37,920,077,070 in Taxpayer Electronic Medical Record Subsidies: 2009 – January 2018.
[2] 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.
[3] Epic’s CEO is urging hospital customers to oppose rules that would make it easier to share medical info.
[4] Walled garden, or closed platform.
[5] Tommy Thompson HHS’ new health IT rule would hurt Epic and Wisconsin’s economy. Tommy Thompson links: open secrets search
P.S. A few more links on Epic.
Airdrop trumps $40B taxpayer medical record subsidies.
Madison’s property tax base growth and the backdoor electronic medical record subsidy.
2007. Then Governor Jim Doyle’s failed $30M electronic medical record taxpayer subsidy proposal.
A Letter to Ms. Judy Faulkner & Mr. Tommy Thompson.
This is what information blocking looks like boots on the ground.
These are the realities people face when they are living with life-altering, life-limiting, absolutely earth-shattering diagnoses.
While patients and their loved ones can’t get the information they need to make educated, empowered decisions about their care, even while actively dying, hospitals, EHR vendors like Epic, as well as MANY other entities, have ludicrously shared and sold the same patient information for commercial purposes, to “improve hospital operations”, for “re$earch”, leveraging the legal loopholes of HIPAA, stating all is legal, this is business as usual. Without needing informed, explicit patient consent. Without any effort dedicated to patient education, public awareness, and transparency under the guise of “Nothing to see here”.
As patients and carepartners, WE WILL NOT STAND FOR THIS A MOMENT LONGER.
Thank you Ms. Judy Faulkner, CEO of EPIC, for your recent letter urging some of the biggest hospital CEO’s and presidents to oppose the proposed rules to improve interoperability and grant patients access to their information. You have made it crystal clear that you are not aligned with the real-world unmet needs and the barriers patient and carepartners face daily. Thank you for illustrating what paternalism looks like in 2020.
Thank you, Mr. Tommy Thompson, former governor of Wisconsin, for your guest column on why the proposed health IT rules would be a detriment to EPIC and Wisconsin’s economy. You have made it crystal clear that the business priorities of Wisconsin are of a greater importance than legal rights and the sanctity and dignity of the lives of all the patients of this great country of the United States of America.
Thank you for helping me refocus. Thank you for helping me answer the questions and address the self-imposed imposter syndrome that can momentarily cloud one’s perception. The answer is: IT IS ALL WORTH IT.
“We’ve often looked at interoperability in a narrow view, which is just as a replacement for moving the patient’s chart. Modern computing and APIs offer a vastly richer and more empowering global computing environment. Well-built APIs can do almost anything that your creativity allows,” he said.
Before Rucker took the stage at Health Datapalooza, HHS Secretary Alex Azar also addressed the upcoming interoperability rules and the Trump administration’s commitment to putting “patients in charge of their data” and called out industry stakeholders who are “defending the status quo.” They are protecting a health records system that is “segmented and Balkanized,” he said.
“We have a serious problem—and scare tactics are not going to stop the reforms we need,” Azar said.
John Ehrlichman authorized breaking into Dr. Fielding’s office on September 3rd, 1971, to steal Daniel Ellsberg’s medical chart. In those days, medical charts were confidential and access strictly controlled. Any break-in was physical and impossible to miss. Even if the government did steal your private chart, at least you knew about it.
Which is why Nixon’s lawyer, Egil Krogh, went to prison for 4 months for violating Dr. Fielding’s Fourth Amendment right.
One of the many lessons the government learned was that stealing medical charts needed to get easier. This eventually culminated in Executive Order 13335 (69 FR 24059) which ordered that all Americans must have their medical charts in electronic form.
This must be a joke. Please tell me this is a joke. @nih just gave @EcoHealthNYC and Peter Daszak a NEW grant for bat coronavirus research?
Including supplying “viral sequences and isolates for use in vaccine development”?
Nope. Not a joke.
The joke, apparently, is on us. pic.twitter.com/b4p2fORn0u
— Alex Berenson (@AlexBerenson) October 2, 2022
However, it is not the first time Biden has taken pages out of the Trump playbook. On immigration and the pandemic, he has maintained Trump-era policies for some time
Lindt’s legal team also noticed how much Lidl’s rabbits looked like theirs, and it has argued in court that it deserved copyright protection against Lidl’s lookalikes. Last year, Lindt lost its case in Swiss commercial court, but earlier this week, the federal court in Lausanne ruled in Lindt’s favor.
Ah Huawei …. https://t.co/KmtqnMhK1Y
— Steve Conlon (@stevenconlon) October 3, 2022
It’s easy to embrace ambitious green regulations when you pretend there’s no cost. But when Americans are paying more for energy, and especially so in California because of green mandates, those costs are now hitting home. It won’t get better as long as states outsource environmental rule-making to politicians in Sacramento who will long ago have left office when the EV-car mandate strikes.
Surveys are an essential approach for eliciting otherwise invisible factors such as perceptions, knowledge and beliefs, attitudes, and reasoning. These factors are critical determinants of social, economic, and political outcomes. Surveys are not merely a research tool. They are also not only a way of collecting data. Instead, they involve creating the process that will generate the data. This allows the researcher to create their own identifying and controlled variation. Thanks to the rise of mobile technologies and platforms, surveys offer valuable opportunities to study either broadly representative samples or focus on specific groups. This paper offers guidance on the complete survey process, from the design of the questions and experiments to the recruitment of respondents and the collection of data to the analysis of survey responses. It covers issues related to the sampling process, selection and attrition, attention and carelessness, survey question design and measurement, response biases, and survey experiments.
Another astonishing clip from the Cato Institute event today, this one from the influential Adam Posen, head of the Peterson Institute. He says a focus on domestic manufacturing is simply a “fetish for keeping white males with low education in the powerful positions they are in.” pic.twitter.com/ii4F0ssAjY
— Matt Stoller (@matthewstoller) October 6, 2022
New machine pushes company toward goal of $100 genome sequence
The fact that Mr Musk can, in a single week, get into a Twitter spat with the president of Ukraine, in an online discussion forum that he has just agreed to buy, while also sending people into orbit, demonstrates the extent to which his growing technological superpowers have granted him geopolitical clout. Should that be cause for admiration or concern?
“This plan as announced in practice means that, in certain areas, farmers have to reduce their nitrogen emissions by 70%,” he continued. “That means they simply have to quit.”
UW Health says a “significant” donation from Epic Systems will help it address a shortage of healthcare workers. (Electronic medical records are heavily subsidized by taxpayers).
This quote is a strong condemnation of zoning. Does Gray, a scholar affiliated with the Mercatus Center, successfully make his case? He does. I confess that I was somewhat convinced of this before cracking the book. Decades ago, I read a 77?page article by legal scholar Bernard Siegan who made the case that Houston, the one major city in America that has avoided zoning, was doing well. Gray is quite familiar with Houston and, indeed, devotes a whole chapter to laying out in what ways it does well.
The National Security Archives recently published a declassified list of U.S. nuclear targets from 1956, which spanned 1,100 locations across Eastern Europe, Russia, China, and North Korea. The map below shows all 1,100 nuclear targets from that list, and we’ve partnered with NukeMap to demonstrate how catastrophic a nuclear exchange between the United States and Russia could be. If you click detonate from any of the dots, you can see how large an area would be destroyed by the bomb of your choice, as well as how many people could be killed.
Extending BMV to grade 3b would ban solar from about 41% of the land area of England, or about 58% of agricultural land. Much of grade 4 and 5 land is in upland areas that are unsuitable for solar developments.
During her speech at the Conservative party conference last week, the prime minister, Liz Truss, reeled off a list of “enemies”, including green campaigners, who make up what she characterised as the “anti-growth coalition”. However, green campaigners say blocking the building of renewables would make her government part of such a group.
Anonymous DoD official upset that someone built something useful of their own volition. “Look, if it were fifteen years late, and twenty times the original estimate, we’d be thrilled to pay for it.” https://t.co/y84mNT90jJ
— Ashlee Vance (@ashleevance) October 15, 2022
How did this work? In brief, Europe’s political fragmentation spurred productive competition. It meant that European rulers found themselves competing for the best and most productive intellectuals and artisans. The economic historian Eric L Jones called this ‘the States system’. The costs of European political division into multiple competing states were substantial: they included almost incessant warfare, protectionism, and other coordination failures. Many scholars now believe, however, that in the long run the benefits of competing states might have been larger than the costs. In particular, the existence of multiple competing states encouraged scientific and technological innovation.
Google is so aggressive about mining e-mail receipts for data to sell ads that Amazon no longer tells you what you bought in their emails, and now I honestly can’t tell which company is being the bigger asshole to customers.
— Corey Quinn (@QuinnyPig) March 21, 2022
Commentary on iPhone cameras
Asia travel notes.
What Data Do The Google Dialer and Messages
Apps On Android Send to Google
Plus, the black mark on their files means they often can’t get a contract with more favourable fixed rates.
When the device is installed, a stove or anything else requiring 240 volts of electricity won’t work.
Load limiters allow for continued operation of a furnace, a few lights and small appliances (but only one at a time). If too much electricity is used at once, the limiter will trip — turning off the power all together, until the meter is reset physically by the client or remotely by the distribution company.
There are many players in the field – Epic, Cerner, Meditech, AllScripts, AthenaHealth, to name a few. It isn’t necessarily bad to have many players, but these players don’t cooperate in data interoperability, as they see the difficulty of data migration as a competitive moat. (Taxpayers have lavishly subsidized electronic medical record sales)
Hacking Google Maps to fake a traffic jam.
You don’t write the code for the machines, you write it for your colleagues and your future self (unless it’s a throw away project or you’re writing assembly). Write it for the junior ones as a reference.
The Americans came up with a solution: issuing debt to bring the dollar back to the U.S. The Americans started to play a game of printing money with one hand and borrowing money with the other hand. Printing money can make money. Borrowing money can also make money. This financial economy (using money to make money) is much easier than the real (industry-based) economy. Why will it bother with manufacturing industries that have only low value-adding capabilities?
Tom Ochinero, SpaceX: on pace for 50+ launches this year, including 5 Falcon Heavy. Hoping to get regulatory approvals in the next couple months for Starship orbital test flights. #SATShow
— Jeff Foust (@jeff_foust) March 22, 2022
The complete list of alternatives to all Google products
The manager of Blue Origin’s rocket engine program has left the company
Why big nations lose small wars: The politics of asymmetric conflict.
Google routinely hides emails from litigation by CCing attorneys, DOJ alleges
Understanding U.S. values and psychology are not his strong suits. Nor has understanding Russian history and psychology been a strong point of U.S. policymakers.
“When I first noticed the airbrushing on the segment referenced, I thought something was honestly wrong with the video. But then, I watched it again and thought, ‘Wait a minute, this appears to be intentional. Lia’s features are softened,’” Denhoff said. “I then went to my original photo, on the sites that they could access to license the photo, and compared it and immediately saw a difference.”
NCLA Takes on U.S. Surgeon General’s Censoring of Alleged Covid-19 “Misinformation” on Twitter
You can dine and shop well enough in the La Brea district of Los Angeles to forget that its name translates as “tar”. You can savour the treasures of the LA County Museum of Art and ignore the lake of gurgling black goo in the park outside. You can decide against the La Cienega route to LAX and avoid the sight of oil derricks, bobbing up and down like perpetual-motion executive desk toys. In the end, though, even in California, home to the disembodied economy of tech, the coarse physicality of the energy sector is inescapable. And so, ever more, in all our minds, is its importance. The war in Ukraine has put paid to a series of fantasies. No, Germany cannot opt out of History. No, it is not butch to tweet adoringly about a strongman you don’t have to live under or near. Yes, the EU is a dream, not an ogre, for tens of millions of people in its near abroad. Of all the illusions, though, the most quietly punctured is the idea that tech is the industry at the centre of the world: the one that makes it go round. Energy, it turns out, is still a worthier bearer of that mantle. This is an education for anyone born in the half-century since the Opec oil crisis.
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The optimism, however, is the assumption that allowing the war to keep going will necessarily undermine Putin’s position; and that his humiliation in turn will serve as a deterrent to China. I fear these assumptions may be badly wrong and reflect a misunderstanding of the relevant history.
For more than forty years, I struggled to get decent health insurance. My first grown-up job, as a fact checker at a weekly magazine, came with a medical plan, but my wife and I were in our early twenties and therefore didn’t think of that as a benefit. My take-home pay was less than the rent on our apartment, so I quit to become a freelance writer, and for months after that we had no insurance at all. Then my wife, Ann Hodgman, got a job at a book publisher. When our daughter, Laura, was born, in 1984, Ann’s policy covered most of the cost of the delivery.
He began by going to an important center in his industry and becoming an understudy to a master practitioner. Rural Haiti is to health vulnerability what Silicon Valley is to tech innovation. In his early 20s, Paul went there to work for Fritz Lafontant, a Wozniak-like Haitian priest pioneering a community-based approach to the social determinants of health.