up in the air was good

shit dog

maybe the dagone shrink was right

Love keloid

interesting concept...

i'd love to have

the strength to withstand negativity in all forms

i could be the most powerful person in the world

Peruvian Love
I am no expert. I have barely been here 24 hours, but it seems like Peruvians are pretty cool chill people. And, they gots lots of love. Its not the exhibisionist type of PDA you see in the states though. Its definitely intense, but you don't a feeling that they are just asses and need to take it to the room- well not usually. Its more like they just realy like the person they're with. Like it aint no thang, they're just appreciating it. They aren't grabby, just embracing. Anyway, just observing. Lota culture, fun place. I would def recommend Para-Gliding here if you've never done it before. Its awesome. You feel like spiderman whizin by buildings and cliffs.

Saw "Millions" on the plane to Peru
Pretty awesome movie. I like Danny Boyle and his love of trains.

Obsession

I have started asking people what their current obsession is. I get funny looks. I suppose its not a common club question. I usually always have one. I kinda thought everyone did. Perhaps they don't. I sorta feel its the best way to relate to someone. For me, at any given moment (walking down the street, eating lunch at work, in the shower, working, on the train) im thinking about my obsession, or something related to it. So chances are, if you are a stranger and ask about it, i'll be impressed that you know i have one, AND am thinking about it, and we would be instant friends. Opposed to hey, where do you live, thats nice, what do you do, thats nice. Cool. Nice night right? The DJ sucks. Yea.... Sip. (Fuck, what next?)
Obsession?
Hell yea, so i have been obsessed with getting a scooter for forever. They are so economical, and I think chicks would dig it. Blah blah blah blah blah blah blah
Guy: Fuck yea
Girl: Oh that would be really cool, we could zip around the city while i hug you from behind!

Yeap.

Time

is overrated. it doesnt heal, and it in itself doesn't make anything more special. it just magnifies whatever context its used in. i.e. they have loved each other for 30 years! or i've been in jail for 30 years! or took a shit for 2 hours, or held my breath for 30 seconds!

10 years on its own doesnt quite get the same effect as that dude rode a bike for 10 years without taking a shower or going a mile!

Less is more, and less is a state of mind.

Alife

mmmmmm......

Real New York

Awesome story, i wana watch:

http://www.rottentomatoes.com/m/herb_and_dorothy/

Quality Implementation

A good article that touches upon the fact that not all implementations are created equal

http://www.modernhealthcare.com/article/20090521/REG/305219985/1031

Vision- Growing an electronic organism
One mythical man month at a time

I have this vision.
As i sit here at work
headphones on
building away
loggin it in the remote build tracker
jammin
i had a vision
of this thing called the 48 hour install
(epic speak)
basically, they claim to be able to install a full electronic medical record for a hospital in 48 hours
i don't know where the heck they came up with this
but one thing i do believe.
you can build an entire system in 48 hours if you have the right staff and coordination
i sorta saw the light
similar concept to the engineering firms who have staff all over the country and theoretically design and build 24/7
basically if we can map out predecessor and independent relationships of all of the records in the system, we could design a plan to rapidly build out specialties
you could almost just monitor the build tracker on google docs and see the progress
perhaps we could get a graph that could dynamically map the progress of the build or at least have a count of the records built.
but it could be so streamlined that each person would know what they are responsible for
when a predecessor record is built- an email could get sent to the appropriate party/pool to build the next records
before you know it, you have 100s, 1,000s of records built all by different people but coordinated to make one highly powerful organism
sorta like a transformer (the cartoon/movie kind)
gotta get back to work
this just hit me of a new cool idea for work
p

outbreaks and dr. webby

although i am not the one personally completing the request, i just thought the idea of this is awesome
recent news: swine flu, epidemic/endemic scare, most cases in new york, queens even
my colleague is currently working on a documentation template, likely will be completed today to fire an alert based on certain test result criteria to suggest investigation of swine flu, once confirmed, it will prompt to fill out a templated documentation too to document the case (with both discrete and narrative data)
this can be data mined and analyzed with the right man power almost instantly
can you imagine if all hospitals had a similar system and were asked to fill out the same data template? further more if there was someone monitoring this data real time, how quickly we would be able to track and address outbreaks of diseases?
the ability to track this info, and the speed of accessing it is pretty awesome to me
not so big of a deal with maybe 20- 30 cases appearing
but what if it was a quick spreading disease
within hours, we found 50 casesdays, 100s or even thousands
100s of hospitals trying to combat it at the same timeif they were all on the same system, or in an integrated system1 person could run reports, to analyze by diagnosis what was ordered to treat the disease, and compare that with trended test resultsthey could identify which hospital, which doctor, and which group of patients were improving the best, and develop a suggested method of treatment to quickly treat the outbreak
i haven't really watched the matrix in full, but i feel like its like seeing the light moment
i mean just think- a doctor down in rural Indiana trying to figure out how to treat some disease
you can compare the test results, the patients age, list of diagnoses, problem list, to a large database of the same, and then send suggestions of what it might be and possible treatments
in cases where there is no time, this type of an IT system could be awesome
doctor could tap into hundreds/thousands of doctors experiences and outcomes

another thought i had on the bus coming back
soon wireless access will be common place on planes, buses, trains
a doctor could review your chart, and order medications for you (electronically sent to your pharmacy) from 20,000 feet in the air in the middle of the atlantic, or from a bus stuck at a travel plaza between here and philly
if we really wanted to get crazy, that doc could have a netbook with a webcam and you could have a virtual consult with him on a megabus and you sick as a dog in your bed
show him your watery eyes, red nose, and temperature, and he could just order you some z-pack and send it to Dwane Read pharmacy in LIC.
waiting rooms could become you on a webpage sitting in a queue with a count down timer before the doctor will 'see' you
how awesome would it be to log onto a webpage when you wake up with a lump in your throat and a stuffed up nose, keep sleeping until a chime rings saying the doctor is ready to see you. 15 mins later, you shuffle over to the pharmacy a block away and pick up your meds, some soup, and vitamin water.
sleep all day
100% tomorrow
i think thats just cool

Socio-Economic Perspective

I think people should be aware of a culture before making assumptions on poverty. I bring this up particularly in reference to India. I feel like to a westerner, many dwellings and people's lifestyles may seem like they are underpriviledged. But taken with social and enconomic context, they wouldn't consider themselves poor. They just live comfortably with less. Climate is different, culture is different, values are different, almost everything is different.

Back on the topic of Healthcare IT.

The recent passage of the economic stimulus package including $20 BILLION for Healthcare IT has me ecstatic and nervous. I'm happy because, hopefully this will translate to job security. I didn't know it would happen this quick, but I had a conversation with my old boss about Obama and $$$ for Healthcare IT and I called it. Only problem is- as the original article of this email chain indicated, IT is incorrectly viewed as a panacea.

On the one hand, this may be a good way of killing two birds with one stone- help the economy, and boost healthcare IT adoption. On the other hand, strictly economically speaking, I don't think investment in healthcare IT is the best solution. As I mentioned in my earlier comments- the ROI is slooow. Not helpful to the quick turn around our economy needs.

I am no economist, and I don't quite understand the inner workings of a national economy, but I think we need innovation that the world could use. That's a strong economy. Like the industrial revolution- spittin out cars and machines and things the world's people could use. Services or products that everybody wants or could use. Healthcare is something that nobody really wants- or wishes they could do without. And healthcare IT is simply a tool to help reduce healthcare costs and improve quality of care. Could this $20 Billion improve the US's quality of care enough and reduce its cost (currently eclipsing the rest of the world) to reverse medical tourism? That would be awesome, but I am a tad skeptical. Not that it won't happen, but that it won't happen quick. It is not a traditional medical technology like the x-ray, or the PET. It is technology focused on processes, efficiency, a tool that works more closely with a doctor's decision making than a tool that provides more data (like a lab test, or PET scan). It is going to take a while for doctors to get used to having such a powerful tool to supplement their decision making.

I think it is a stretch to say Healthcare IT will increase the GNP. Sure the stimulus money will go to some US based Healthcare IT companies, and improve the economy that way, but to really help the economy, we need something like the Saudi's oil. US Healthcare would have to be the absolute best in the world, affordable, and accessible for it to truly be an asset to the US economy.

I 100% think this can be achieved. But it will take time, and I am worried when it starts to take too much time, Healthcare IT will get a bad rap. Something like: (1-2 years from now) "Look at those $20Billion in 2009 to Healthcare IT lotta good that did." Then hopefully 5-10 years from now: "US Healthcare: the best and most efficient in the world."

Funny thing is though, I think truly good healthcare isn't really a service- its a lifestyle. Maybe we should spend $15B on how to brain wash people to be healthy, and $5B on healthy supplements, innovations.

What America really needs is what me and my cousin think about every sunny Sunday afternoon- That Million Dollar Idea: Simple, useful, ingenious.

My Critique of: "Why Tech Can't Cure Medical Inflation" by Lee Gomes

First of all, Lee Gomes sounds like a republican; ankles deep, accusations a plenty, and no real plan to fix healthcare costs, just excuses and blame. Second, I 100% completely agree IT will not reduce the cost of healthcare. IT is a tool, it alone will not reduce costs, in fact, a PC as many know, is much more expensive than a binder and paper. It does not take a genius to know that if you want to reduce costs, follow the money! We need to attack the cost of things, how they get paid for, and how much we use them. In my critique of this article I will show how IT can be used as a tool to both increase and decrease the cost of healthcare.Please read below.

Copyright 2009 Forbes Inc.All Rights Reserved
Forbes
January 12, 2009
DIGITAL TOOLS; Pg. 43 Vol. 183 No. 1
741 words
Digital Tools Why Tech Can't Cure Medical Inflation
Lee Gomes

Computers in medicine aren't a cure. They might even make the system sicker.
Whenever President-elect Obama is asked how he'll pay for his ambitious health care reform plans, he invariably talks about the $80 billion in annual savings he'll get from bringing computerized recordkeeping to doctors' offices and hospitals. If only that were true. While there are benefits that might be had from using computers more widely in medicine, doing so won't save us any money and, in fact, will likely make things more expensive. There's even a chance that the quality of care might get worse along the way. That's probably counterintuitive to anyone contemplating the wall of file drawers in a typical doctor's office. Medicine clearly has yet to join the rest of the world in going digital; no wonder, the thought goes, that U.S. health care is so expensive. But while paper records certainly have their inconveniences--filling out your thousandth questionnaire, say--they play a very minor role in galloping health care inflation. Instead, the heart of the problem is the U.S. fee-for-service system, in which doctors get paid to do things to people. The more technical and invasive the procedure, the more money they make. Doctors have responded in the expected Pavlovian manner, collectively shifting away from basic primary care toward expensive specializations that run up costs without necessarily improving medical outcomes. As any chief information officer can tell you, adding computers to this sort of inefficient process only makes the inefficiency happen more quickly.

Its not inefficiency, more accurately, its gaming the
system, and computers help make doctors very efficient at gaming the
system. But lets not knock computers which research studies have shown to
improve the quality of care. Separate IT as a benevolent tool from the
broken payer system.

Much of what doctors or policymakers know about technology comes from vendors, who are busy guilt-tripping the medical sector about being slow to get with it. But more quietly, health care economists have been studying the actual impact of these systems. Their findings should disturb those who look to information technology for an easy fix.

IT is far from an easy fix.

Robert Miller, an economist at UCSF, found that when doctors' offices successfully install computerized health record systems (not a sure thing, by the way, like all complex it), they end up collecting more for their services, not less.

True. Why would healthcare systems aim to be unprofitable? I am
tempted to say that perhaps IT's enabling quality of making gaming the system
super efficient, will isolate and make acute US healthcare's broken financial
system.

That's because the systems make it easy to increase payments by checking off more boxes for the routine tasks doctors perform in the course of an office visit. Miller also found that most doctors never use many of the much ballyhooed features of these systems--like reminding patients to come in for care--simply because they are too difficult.

I am not sure where the author is getting examples from but
I can attest first hand that Sinai employs numerous alerts and reminders.
Their functionality is so easy that one of our doctors alone has created 30 such
reminders. In other institutions these features may be considered phase 2
because you have to walk before you run. Getting physicians and other
providers to input data into the system for alerts to be based on is a
significant task. I firmly believe all of the significant cost savings of
IT will only be realized 5-10 years after implementation. This exact topic
was one of my major projects in my previous job. We actually brokered a
ground breaking deal with a major healthcare IT vendor to build cost savings
metrics into the payment plan, which put approximately 20% of their fee at
risk. Side note, reminding patients to come in for care, would again,
raise the cost of healthcare...

Another example of medical technology not living up to its promise involves electronic prescribing systems, which transmit a prescription from a doctor to a pharmacy. These are considered among the easiest-to-install pieces of medical IT. Even so, Joy Grossman, with the Center for Studying Health System Change, found that many never worked as envisioned. For example, the software is supposed to tell a doctor when two prescriptions conflict; Grossman said many doctors ignore the alerts, since even the most finely tuned systems end up spewing out what some call alert spam.

Firstly, electronic prescribing is highly dependant upon
State Law. Currently NY State does not allow electronic prescription
prescribing. This may be a reason why e-prescribing is not living up to
its name. In fact, NY State Department of Health is so antiquated that
obtaining permission to use prescriptions printed on NY State authorized
watermarked prescription paper has been a difficult task. Secondly, alerts
that physicians receive for conflicting prescriptions at the time of ordering
have almost nothing to do with e-prescribing. Several institutions across
the US including Sinai have this up and running, improving quality of
care. To combat prescription shoppers hopping from hospital to hospital,
would require collaboration and interface between hospitals and pharmacies-
similar to a RHIO. If finely tuned systems are still spewing out alert
spam, they must not be quite finely tuned- having only meaningful alerts can be
achieved- it requires careful thought of the logic, and excellent
training.

A more subtle cause for concern with computerized records involves whether they really capture all that a doctor needs to know about a patient. Some physicians fret they will end up relying on pre-written templates of information about their patients that lack important individualized details.

Doctors and medical boards are smart people, they should never rely on
prewritten templates to achieve quality of care. Most systems are flexible
enough for the institution and the physicians themselves to customize their note
templates. Most physicians are taught to think in terms of templates to
ensure they have considered all pieces of relevant data (on a basic level, think
SOAP note). Chiefs of specialties, quality committees, medical boards, all
do this currently by discussing cases and agreeing upon a policy for standard of
care given a circumstance. IT is a tool that allows easy dissemination of
the standard of care collectively decided up on by the physicians
themselves.

It's true that some well-regarded health systems, like the Veterans Health Administration, rely on electronic medical records. But doctors in these systems all practice medicine the same way and have huge IT staffs to keep everything humming.

IT systems are flexible enough to accomodate varying
practices of medicine. They are also a tool to reduce (when prudent)
largely varying practices of care. In an industry comparison between
entertainment, finance, automotive, healthcare and other industries, healthcare
came last in the % of net revenue devoted to IT.

The notion that computers can save $80 billion stemmed from a 2005 Rand Corp. study. But the study had an important and usually overlooked caveat--that other changes to the system would also have to be made in order for the savings to occur. But the big inefficiencies in the U.S. system won't disappear simply by adding computers. For example, most health care experts say Americans overuse expensive medical imaging devices when X-rays are often just as useful. But imagine the lobbying effort by radiologists and devicemakers if their ox was about to be gored.

Agreed.

Computers have a role to play in medicine, and there are doctors using them to provide better and more profitable care. But the notion they're a panacea is a symptom of the fixation with high-tech gadgets that's part of the problem in the first place.

Agreed, it should not be a panacea, but it should be
considered a tool which can improve efficiencies and quality of care. It
is a powerful too that can be used for good or bad. Not unlike my charming
personality.What you do with it?- The choice is yours.Are you up to the
challenge?

Senior editor Lee Gomes covers technology from our Silicon Valley bureau. Visit him at www.forbes.com/gomes/.
January 2, 2009

Sartorialist

Was just introduced to this site by a friend. Great blog. I love the concept. I've had the same trouble reconciling the shit you see on the runways and real life. This blog is perfect. Its chill, relaxed, REAL, and hip. I think it also represents fashion out of personal style and sometimes necessity. Necessity meaning the styles you create cause you only have so much flow. You get the piece thats important, and work out the rest. I mean, peoples reaction to the economy recreates fashion. You take the designer's vision, use your interpretation of it, and then modify it based on your flow. Its almost like telephone, the end product may not be like anythign what was originally intended. But thats the best part.

I'd love to see another one out there for a different fashion genre because this one clearly caters to a specific genre. Do people not see the urban street fashions of the middle to lower class? Its the best shit out there. IT truly represents something meaningful. Its the ultimate form of diverse creativity. Its the fashionistas that dont even know it yet. The pimp what you got. Shake what ya mama gave ya. Literally. "Heres a twenty, go buy your school clothes" And shit nigga do these kids work that shit out. Hell it aint even about what you buy sometimes, its how you wear it. Take it to the next level. I see this shit alot in 3rd world countries like India. Literally like a whole nother world. But in that world, you better believe even the slumdogs work them fake nike shoes, and zazzy tees. Its all about mod these days. Mod your car, mod your bike, mod your ipod, and fo sho its about modin your clothes as well. I love it. Its so creative. Fresh. Fuck the runway.
Walk down the muthafuckin street!

(note: unfortunately i have only seen this in big cities)