Category: Tech

Death By a Thousand Clicks

For 36 years I worked on the technology side of medical information systems. Around 2010 it became obvious to me that the HITECH program under ARRA would be extremely disruptive.

Not only did HITECH distort the market in significant ways, it failed to produce the intended benefits. One effect of HITECH was hospitals that were already using electronic health records were able to switch vendors and buy more expensive systems, knowing that the government would reimburse them if they met the “meaningful use” requirements.

Kaiser Health News and Fortune Magazine have published a lengthy report on what went wrong.

At the same time that hospital decision makers were looking forward to their HITECH reimbursements, the big players went on merger and acquisition binges, creating large regional medical systems. Left behind were many small rural hospitals, called Critical Access Hospitals, that rely upon Medicaid and Medicare money. Many have closed, either because they didn’t have a buyer or, as covered in a recent Nashville Tennessean story, they chose to remain independent.

Speakerman!

The subwoofer has a new foam surround. It’s one of the relatively few that attaches behind the cone. Have to wait 24 hours for the glue to set before giving it a test run.

Follow-up: Success! It works, and thanks to the plastic shims keeping the cone centered while doing the gluing there’s no rubbing.

My next repair project will be replacing the LCD panel in my 14″ HP laptop. Over the past year it’s developed a rather large and distracting defect.

Foam Home

As previously posted, I’m tackling the dreaded rotted foam problem that befalls all old woofers with suspensions made of that material. I was hoping to avoid removing the dust cap, but I determined that, in this case, the only way to keep the cone centered in the magnetic gap while gluing on the new foam surround would be to secure it in place by inserting plastic shims.

With the easiest part of the rotted foam removal done, and the dust cap removed, the replacement parts are sitting loosely in place. I knew the diameter of the new cap would be 0.125″ too small, but it was the best fit I could find. Unfortunately, that means I’ll have to glue the cap onto the points where the dual voice coil wires leave the cone. It’s too late to turn back now!

Speaker of the House

I’ve been busy with the final steps required to close out the family Trust that was entrusted to me by my late parents. I’m not done yet, but for now I’m back on my hi-fi repair projects. The foam ring has rotted in my old passive subwoofer from Radio Shack.

Optimus Pro SW-12 subwoofer

Some other old speakers I have also need their foam surrounds replaced. It’s like a kingdom being lost for want of a nail. My Sony CD MegaChanger and dual cassette deck just needed new belts, and lubrication for the CD drive rail, and they’re working perfectly again.

An Epic Failure Success

The New York Times has this article about Wisconsin-based Epic Systems. More than half of all patient records in America are stored and retrieved electronically using Epic’s software.

The article is worth reading, despite saying nothing about how Epic became so successful. When the company was starting out it bought operating systems from my former employer, and part of my job early on was generating customized O/S assemblies for Epic. So I know something about the company, and their story is much more interesting than knowing how its sprawling campus is decorated, which is the focus of the NYTimes article.

One important point of business about Epic Systems in the article is that the company is privately held. For contrast, I highly recommend this excellent piece in The New Yorker from last August, about another EHR (Electronic Health Record) company, the publicly traded Athenahealth.

Also in The New Yorker, Atul Gawande talks about the difficulties confronting doctors, including himself, who are required to use Epic’s software. (Note: There is no connection to Epic Games.) If you don’t want to read the article, there is this video explanation, smuggled out of a bunker in an undisclosed location.

https://youtu.be/7fy83E_pFNs

Gawande has no one to blame but himself, however, as his writings were influential on President Obama in requiring the move to electronic patient record keeping. Gawande now has an opportunity to further influence American healthcare, having been picked by Jeff Bezos, Warren Buffett, and Jamie Dimon to head up a new think-tankish venture.