fredsmith42

I don't know anything about crypto. Why can't he contact someone on the receiving end of the transaction and say "I really messed up, please transfer this money back to me?". I know crypto transactions can't be undone, but a new transaction of equal value in the reverse direction could be done, right? And if not, why the hell not?

If you own a Quest VR headset and have purchased games, a ban means you cannot play or download them. I would hope that would be reasonable grounds for a suit in small claims court. If they make membership in the social network a requirement of using a product you purchased, that comes with responsibilities on their end too.

How could it be an antitrust issue when a broken machine literally sends the consumer to a competitor? It's anti-antitrust.

How much of the billion dollars will you get?

It sounds like working there has become a distraction to working there, which means that working there has become fratcally stupid. Quitting sounds like a reasonable position to take.

Some hospital labs. The systems are scheduled to be replaced within a couple of years.

I just finished a contract at a client that still has a live OpenVMS system running a mission critical application. It was interesting to compare my 25 year old fond memories of the OS with the practical experience of using it on a daily basis. No command line history, crazy long file paths, and case insensitive passwords were a shock. On the other hand, the built in DCL programming language was a saving grace. My wife, amazingly, found my decades-old copy of the "Writing Real Programs in DCL" book. Because of that, I looked like a VMS superhero.

I've got COBOL experience, but Everytime I check into these positions they aren't paying very well. I don't know about this particular case, but in general COBOL programmers aren't valued very much, despite the high demand within the narrow niches that still use COBOL.

Would this be applicable to SETI?

I don't think that Windsor was compiled with the debug flags turned on.

The EMR market is consolidating on two big vendors: Epic and Cerner. Depending on how you measure it (Hospitals on a system or Medical Records under management), either Cerner or Epic is #1 and the other is #2.

At this point, in the U.S., it is almost impossible for a newcomer to break into the market. There are many companies out there slowly losing market share to Epic or Cerner. Allscripts, Nextgen, McKesson/HBOC, GE, and others. Some are big, well-funded companies, others are more like startups with OK funding. Most of them are falling by the wayside, casualties to the bitter Epic/Cerner market war.

The HITECH act really exacerbated this point by accelerating spending on EMR's since 2008. Meaningful Use meant that a lot of homegrown systems had to be replaced, simply because hospitals couldn't keep up with the regulation and complaince. Likewise, smaller companies had to spend more money on compliance than adding features and also faded. Sure, there are plenty of Allscripts and HBOC customers out there, but their number is shrinking, not growing.

In a way it's a shame, because the two biggest vendors each have critical flaws. Cerner has a decent store in Oracle, but is hobbled by reliance on its own homegrown language for integration and middleware. The language is CCL and is like a cross between PL/SQL and TCL with HL7 Domain knowledge thrown in. Epic has an ancient store with Caché, which is really MUMPS with some OO and relational hooks tossed in. Cerner excels at customization, while Epic excels at disciplined project implementation. You can browbeat Cerner into giving you what you want, but you can implement Epic pretty much close to on time and close to budget with an impressive reliability.

Neither system really wants to interoperate with the other. It can be done, but it takes a months-long project with specialists writing HL7 interfaces to pass demographic, lab, and document data between each system. And this interoperability, once established, doesn't really help the patient. Docs can see orders entered in Cerner Powerchart displayed in Epic Hyperspace, but the patient doesn't necessarily get access to either the order or the result unless it goes to either system's portal.

Finally, you have to realize that you are dealing with a very powerful and conservative management culture. Many Silicon Valley startups with whizbang solutions have foundered when they run up against the entrenched incumbents. Well-funded companies with highly competent engineers have failed because they don't have the patience to spend a couple of decades building up a user base. Investors realize that they can get more bang for their buck elsewhere and leave the game. If you even want to make a dent, you have to be willing to spend at least 15 years and untold amounts of money just trying to take on the big guys. If you're going against a market with relatively short turnarounds, like a calendaring app or even a game console, you have a shot. If you're going against a market that is very conservative and waits at least a decade before reevaluating installed systems, you have a very tough row to hoe.

Ultimately, at least in the U.S., I think that implementing a new EMR is a sucker's game. You can spend millions and lose.

In New Zealand, the market is different at this point, but how long can they resist the network effects of the big vendors? Cerner and Epic are currently battling it out in Australia, and will exert pressure in NZ once that market is settled. I know for a fact that Cerner went after NZ in the late 90's but pulled back after it became clear that entrenched corruption in the NZ procurement system would determine the winner. I don't have names and places for you, but I was in Sydney at the time and remember the disappointment of the executive team when they realized that NZ at that point was not a genuinely open market.

You have mentioned in another post that you are concentrating just on records, and avoiding the extra complexity of the other systems in terms of patient management, practice management, supply management, etc… With all due respect, I think you are being naïve. A modern EMR system has to take into account the entire needs of the practice and how to manage it. When a health care practice is spending a buck, they want to get as much out of that dollar as possible. If vendor A is offering "just records", but vendor B is offering records plus practice management, they will go with vendor B. Every time.

In any case, I wish you the best of luck. I have a lot of experience in this sector and would be happy to share my knowledge with you.

Most if not all health care systems are implementing FHIR as a layer over HL7. Most of those systems don't have people really conversant with web technologies. Interoperability is, I think, a mirage built on top of already overworked integration staffs.

Um, what? I've spent 20 years implementing EHRs. You seem to be implying that hospitals were using paper until 2009. I've implemented lab systems with electronic charts in VMS. The systems weren't, and aren't, interoperable, but they were definitely recognizable as EMRs.

That is great for other accesing records from other hospitals that use Epic, but what happens if you want to access the records of a patient who also visits a VA or Cerner hospital? You are still in the dark.