OpenEMR is Ridiculous

March 18th, 2008

Having “open” electronic medical records (EMR) is absolutely ridiculous.

ReadWriteWeb believes that we should be able to control and transfer medical records personally. However, this is felt impossible because health care is “controlled by big business and government.” Furthermore, they state that “decentralizing this network and giving the power for each American to control their own medical record could ensure higher reliability, less poor diagnoses, and can handle scale.”

Wrong. Wrong. Wrong.

Yes, our current medical record system needs to change. As a practicing physician, I frequently see test duplication and delays in diagnosis due to our current closed system. Doctors at one hospital will likely not get results from other hospitals in a reasonable amount of time. Even if a physician knows to request the records, often the physician may not know specifically what to request. Worse yet, these records are usually faxes from one hospital to another.

With these problems, the brainstem reflex is to let each person control his or her own medical history. Let me, the patient, control who and what accesses my medical records. It is romantic. It is crazy and flawed.

Actually, if the patient was always YOU, then an open EMR might work. You are probably not crazy. You probably do not abuse the system, drugs, or your body. But you are the same person who actually accurately keeps up with medical history now. Any medical record system works well for you.

Let me a take common ICU admission for you. Young lady found down unresponsive and barely breathing. Maybe by searching her house or testing her urine we can estimate that she has overdosed. Maybe she has been in the hospital before and we know that she has been depressed or has a history of overdose. Maybe she also has a rare disease like adrenal insufficiency that can be fatal if not also concurrently treated.

Assume that we fix this lady up and forward her medical records to her EMR carrier of choice. If it is truly open, she can forward it to anyone. Perhaps she forwards it to a “lockbox” carrier who promises to keep it hidden from other systems. Her physicians will never know about her suicide attempt or her potentially life threating illness. Perhaps she forwards it to a “edit” carrier who promises to sanitize or grossly edit the medical record for her. She pays a little extra so her medical record will now show that she has a crippling pain syndrome and requires narcotic pain medications.

Open is open. An open medical record system is an untrustworthy medical record system. Now, I agree that people should have the ability to view and make comments about their personal medical records. Doctors and tests are not perfect, and a patient should have the right to make his/her opinions known.

Luckily, this is not complicated. Just get the EMR companies to come together a establish a universal document standard and communication API. The government would host and secure the common database that would store all the information. Patients could log in and make comments to clarify the record, but information could not be removed or edited.

Medical records are as essential as legal records. Should legal records be open too? Frequently life and death decisions are based upon these documents. A truly open EMR system allows for manipulation and abuse. A universal medical records system will save money and lives. It is vital and essential to insure that the record is inclusive and precise. In this circumstance, being “open” is not the solution.

I will be glad to detail and debate further issues in the comments below.

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The Gawker Network has recently changed it’s pay structure to encourage popularity over quantity.

In the new and old system, Gawker pays a base salary. In the old system, authors were paid a $12 per post bonus above the base salary. In the new system, an author’s bonus is based on having more pageviews than expected for that site.

Under the new system, posts that receive a high number of pageviews will likely yield a bigger bonus than the old system. However, lesser popular posts may never reach the pageview threshold; and in that case, the blogger will not get paid anything over the base salary.

ratdiary describes in further detail how many authors may lose money under the new terms. After claiming Gawker’s big man Denton has “no vision beyond page views”, one Gawker author has quit after only one day on the job.

Under this system, Denton is assuming that pageviews are the most important metric. This should not be surprising. Radio and television are already largely driven by popularity. More pageviews = more ad views = more clicks = more $$.

Sadly, this is why our main stream media is being diluted with pop-culture, britney spears / paris hilton junk. Popularity may equal money; however, it does not equal quality.

This is certainly not a knock against Denton. Trying to prevent dilution is hard. Here at tech-recipes we will continue to utilize a straight profit sharing model. The advantage of the profit sharing model is that it rewards quality and popularity. The money made on an article is a factor of pageviews and what an advertiser is willing to pay to be near that content. High quality content (regardless of popularity) is more likely to receive better paying advertising.

Denton’s model, for better or worse, only rewards authors for half of the equation.

The Ten Internet Trends of 2007

December 17th, 2007

When we look back on 2007 in a few years, these ten topics and companies will be the milestones that will be referenced and debated:

  • 1. Google Pushes Its Power
  • 2. Aggregators Polluted by the Mobs
  • 3. Mobile Web. Why?
  • 4. User-Submitted Profits
  • 5. Apple Leaps
  • 6. Microsoft Tumbles
  • 7. DRM. Die. Die. Die.
  • 8. Main Stream Media Invasion
  • 9. Politics’ Internet Fruitfulless
  • 10. Social Network Assimilation

1. Google

Google is currently the most powerful technology company in the world. With dominance in search and advertising, profits and stock prices have been impressive.

This year will be remembered as the point that google starting flexing its power to change people’s actions on the internet. Matt Cutts confirmed that google would punish people buying and selling links to influence search engine placement.

Google decreased the clickable adsense area which decreased some publishers’ income by well over 50%.

Google has openly started attacking social networks such as Facebook by joining the smaller networks through the OpenSocial API and by socializing Google services such as Google Reader. This dilutes the power that any one social networking system has. Google’s purchase of Jaiku is a direct competitor to IM candy Twitter. Google’s Android dilutes the potential power of a cellular network as well.

Wikipedia and squidoo will soon be feeling the google crunch next. Collaborative content is one of the most amazing products being created and delivered on the internet. Google’s Knol wants to compete here as well. Like many others, TechCrunch is worried about the conflict of interest:

Google says that Knol pages will be indexed into their search engine but will have no special ranking. That’s a little bit untrue, since they’ll be hosted by Google and will have the advantage of Google’s hefty PageRank to lift them in search results. And since no one will be auditing Google to ensure that Knol pages are treated just like everyone else, there are bound to be claims of conflict of interest.

This first started by competing with Microsoft through online services. Is Google’s strategy to dilute any potential collection of power?

2. Web 2.0 Aggregators

Digg and Reddit have moved away from tech. Sad.

Mob Rule. Tyranny of the Majority. Ochlocracy. Whatever you call it, these sites are the weak, fluffy versions of what they used to be. As the less-geek have moved in, the content of these aggregators have followed. Even the creators cannot control the sites anymore.

Unless you have a large social connection within these sites, you have no chance of getting an article viewed… (unless you pay for it.) Socializing is more important than quality.

Although I view both of these sites on a daily basis, they are frequently gamed, overcome with political manipulation, often filled with spamish links, and are utterly unrealiable as news sources.

What’s the alternative? You can always read what the A-List boys’s club is echoing about on techmeme. Or you can watch the main stream news… which is frequently gamed, overcome with manipulation… You get the idea.

3. Mobile Web

The mobile web is growing and growing. However, unless you are selling ringtones, nobody has figured how to make money from it. Even mobile web experts are puzzled on the exact nature of making money through mobile devices.

Plus, does there have to be a special “mobile web” anymore? The iPhone displays regular web content through a cell interface. Instead of manipulating content to look pretty on tiny browsers, manipulate the cell web browser to view existing content well on the cellular interface. When was the last time you remember visiting a mobi site?

4. User-Submitted Profits

Everybody is making money on the back on the users.

NewsVine, Squidoo, Wikipedia, Digg, Reddit, YouTube, Facebook. If you really think about it, none of these companies would work without the public building content for them. You are building content for them. Congratulations! When do you expect your check?

Even blogs and forums get boost from comments and discussions created within their communities. (Please comment, please, please, please…)

How long will people continue to sow content in the sites of others for free?

5. Apple

I personally believe that this was an amazing year for Apple. Apple stocks are certainly booming.

The iPhone has changed the cellular landscape that parallels how the iPod changed the portable musical player market. Apple’s commericals are painfully clever in their attacks against Microsoft. Leopard’s problems have been far less damaging than Vista’s which has helped as well. Overall, more and more people are considering moving to Apple’s platform.

Apple has shown areas of weakness, however. The AppleTV push has really died for the general public. With an anorexic iTunes movie selection, the AppleTV has little appeal to the nongeek. iTunes itself is having growing pains with content providers. NBC/Universal have decided to play hardball with TV shows and music. It’s difficult to know how it is going to play out. Apple is understandingly becoming weaker and weaker for DRM as well.

Being less ambitious than Vista has played well for Leopard. However, the new OS X is still causing growing pains for a lot of people. Feeling the vapor, we are still wondering where the much promised ZFS is?

6. Microsoft

As a one time Microsoft zealot, I am pained to see what has happened to Microsoft this year. Vista is failing because it has taken users too many steps as once. We all had to throw away most of our old hardware when XP rolled out. Most of us accepted this because the pre-XP experience was so unstable. XP was the successful promise of easy usage and stability. I wanted to install XP for my parents because I knew it would make things easier for them.

Today the market is different. Things worked pretty well before Vista. People do not want to sacrifice most of their hardware to get things working correctly. Plus, now we have 32-bit versus 64-bit discussion and “ultimate” products that add little except confusion.

Away from the OS, Microsoft’s search engines and ad networks are stagnant, and Microsoft certainly seems to be trying to kill html email usability. From my experience at FOWD, Sean Siebel is not an impressive “User Experience Evangelist.” At least Scoble tried.

Microsoft has made a few positive steps this year. The Microsoft Home Server is a new idea for a new market. If done well, it could be an essential box in every household. IE7 is a large improvement over IE6. Microsoft is investing in Facebook. Even the second Zune release (and the free software upgrade to the first version) is finally generating a little positive Microsoft buzz. Silverlight and Surface are sexy and innovative.

7. DRM

Could 2007 be the year that DRM finally starts to die?

Die. Die. Die.

Shawn Fanning’s original idea of drm-free Napster could exist in several different forms over the next few years. iTunes Plus and Amazon’s DRM free shows that the big guys are creeping into this direction. Steve Jobs thinks this way, too.

Radiohead’s In Rainbows “pay us what you want” experiment is exciting. Saul Williams and Trent Reznor are doing something similar.

Give them the music for free and sell them on the other stuff. It’s coming.

8. Main Stream Media

How about give them the content for free, too?

The New York Times is finally free. Online circulation is having to make up for the dying dead trees distribution:

Nationwide, average daily paid newspaper circulation declined 2.6 percent in the six months that ended Sept. 30, compared with the previous year, according to the Audit Bureau of Circulations, an independent organization that monitors the industry. Sunday circulation dropped 3.5 percent nationwide during the same period.

As the main stream media looks to supplement eyeball views with online content, their articles are appearing more and more in news aggregators. How long until we figure out that some of digg’s top users are on the payrolls of popular newspapers or public relations companies?

As advertising dollars move from TV and newspaper to the internet, the main stream media is following. How much this will drown out the current boom on citizen journalism is unclear.

9. Internet and Politics

Howad Dean’s success and subsequent failure seemed to grow from within communities within the internet. Was online activism a good idea too early? Will the traditionally nonvoting, young, internet crowd actually play any role in the upcoming elections? These are the questions that campaigns are asking .

Campaigns are on MySpace, FaceBook, and YouTube. You can not read digg or reddit without reading about Ron Paul or Kucinich. Of course, strike911 received active buzz throughout the internet without getting support from the general public or receiving any real main stream press.

This campaign cycle should be a great test to see if online voting and protesting will cause any offline results.

10. Social Networks

Online social networks have continued to grow throughout 2007. The large players like MySpace and Facebook are ubiquitous. How they are changing our interactions with our personal worlds are staggering. The influence and entertainment role of TV is being largely supplanted by these social networks. For many, offline social interactions are first initiated and planned online. Small niches of personalities and beliefs can find like-minded partners.

The success of YouTube and Flickr is obviously dependent on their social interactions. Digg and reddit are driven by social interactions. Dating networks are thriving.

As more of our social lives are played out online, more of our personal information is accessible online as well. More of our personal actions and characteristics are targeted by advertisers. More of our actions can be collected and used against us. Will an insurance company be able to find out that you are a member of a tobacco social group or a Huntington’s disease facebook group? The ultimate balance between profit and privacy will be difficult.

11. Memes?

Oh wait.. I left out lolcats. I am not sure if that’s a trend or a plague, but 2007 is certainly the a year of it. Or maybe it’s not a trend, maybe it is a meme. Who knows anymore…

As I reread my article, my overall feeling is that our experience on the internet is becoming more complex. The name “google” no longer gives most people warm and fuzzy feelings. Digg and reddit are often manipulated more than main stream media. Facebook is looking to trade privacy for profits.

The idea of a “do no evil” company is more likely an untruth than an oxymoron. Previously, we thought it was possible on the internet. No more.

Of course, I would not want to do without Facebook, Digg, Reddit, or Google. We all benefit from the battles between Apple and Microsoft. Companies need to make money to survive. The balance is tough.

The real world continues to invades our idealist internet utopia. “Toto, I’ve got a feeling we’re not in Kansas anymore,” but I would rather be here than anywhere else.

Techcrunch lets us know that newsvine acquired by Newsvine had raised $1.5 million in capital prior to this.

Considering the estimated metrics of newsvine, this really surprises me. Of course, all of these services are estimations. Let’s look at the numbers:

I’ll include tech-recipes in the comparisons for a baseline…


Compete – SnapShot of,
Alexa – Graph of,
Quantcase –,

ShamansTears today posted his 500th tutorial to tech-recipes — how to backup skype contacts.  Wow, five-hundred!  Currently, he is our number one author and has easily surpassed the tech-recipes founding fathers.

In addition to the hardware that we have purchased for him in the past, soon we will be mailing him his choice of an Nokia internet tablet or a year’s worth of cellular wi-fi.

Shaman’s tutorials frequently writes about Microsoft related topics such as XP, Vista, Office, Outlook, or Zune.  His tutorials have helped hundreds of thousands of people so far.  His content has been featured on lifehacker, digg, stumbleupon, and multiple other high quality sites across the internet.  Articles that you have probably seen of his include the following:

As wonderful and valuable as his tutorials have been, Shaman is just a cool guy as well and we are so happy that he is part of the tech-recipes family.  When he is not writing tutorials, he is either blogging or playing on twitter.

If you think you could be more of a tutorial god than shaman, please drop us a line.  We pay well and love to reward our authors with free swag and toys.

Recently a post appeared on the front page of digg suggesting that Fox would purchase YouTube.  Nobody yet knows if this rumor is true or not; however, it should be.  YouTube must combine with a media giant in order to develop the next killer facet of their project — YouTube TV.

In combining with a media network, YouTube could easily convert its content into TV channels.  With tagging and classification, most of the work has been done already.  Just like satellite radio, users would select a TV channel based on the genre they want.  Want to watch a stream of funny video clips? Turn on YouTubeTV Comedy.  Want to watch the most popular videos on YouTube?  Turn on that channel instead.

YouTube will be the first internet media company that can immediately make a large impact on ”old school” media such as television.  Content is king and YouTube has plenty of it. 

However, YouTubeTV will not be funded through traditional content surrounded and interrupted by commercials.  YouTubeTV will have integrated videos that in many ways will be indistinguishable from the normal YouTube content.  YouTube actually does this already, in fact.  Ethical or not, the best performing adsense sites are those that have adsense that appears to blend in with the content.  In the world of DVRs and TIVOs, integrated commercial content will even be more vital.

Imagine it.  You are getting your ADHD fill of YouTube content sitting on your couch.  One short clip after another after another.  Imagine how easy it will be to slide in a video that continues with the channel’s theme but really contains a commercial message…  

You are watching the Sports YouTube channel.  Currently you are in the middle of a 15 minute run of the best YouTube submitted slam dunks.  In this dunk, you see a player 5’6″ guy slam over a 7 foot giant.  Amazing slam!  In the replay now, the camera pauses just a brief second on the logo on the player’s shoe.  YouTubeTV has just fed you a commercial.

Of course, google already has a TV station.  It is a cheap option that cable companies can add to their channel list.  Current TV, however, displays the high end, better-than-amateur, safe content.  YouTubeTV should not be so foolish.  Most people do not watch YouTube to see documentaries on albino, multilingual sock puppet performers in Seattle.  (I think that one has run on like four times now.)  YouTubeTV will just take the best of the submitted content, strip out the material they can’t get copyright permission, and then will gladly feed the rest to us.  Raw.

We are no longer a TV generation.  We are an internet generation.  Previously we would have used the internet to get a torrent of one of our favorite TV shows.  Soon YouTubeTV will allow us to get our internet fix — our YouTube fix — with a remote control in our hand and a high-def TV across the room.

And what about Fox buying YouTube?  From the company that brought us MySpace and American Idol, Fox might be the perfect schizophrenia media magnet to pull all of this off. 

May God help us all.  (Now where is my remote?)

Flashback: Moan and Groan Page

November 26th, 2005

Translation: The Moan and Groan Page. Like all self-respecting computer users, you say to yourself that now is the time to rejuvenate your machine, which has aged very quickly. Before spending astronomical amounts of money for new equipment, it is a good ideas to have a quick look at this page. It is chock full of stories and tales of woe and disasters concerning hardware and software. The problems are arranged by order of brands and products, and you surely understand that this is a free technical assistance service. A kind of efficient S.O.S. for computers.

When I was in college many, many moons ago, I was angered over the huge amount of computer junk that was being released into the marketplace. I collected people’s horror stories and posted them on my web page. The entire site was manual and maintained with donated server space and users time. The site was a hit worldwide and I was interviewed by many of the PC magazines of the day. Many users used it to organize class action lawsuits. Some companies tried to help themselves by posting fixes and work arounds on our site; however, many others tried to sue the site to take it offline. Lawyers donated their time and kept the site up and legal.

The site eventually imploded due to its size and popularity. We had tried to keep different sections on the multiple different donated servers to distribute the load. At that time I had no means of editing the site dynamically, so I had to hardcode every section and every update. As I entered medical school, the site could be maintained no longer.

If I would have known MightyQ back then, I have no doubt that we would have been more successful than eopinions. Of course, if so, I would have never learned medicine either. Things happen for a reason.

I believe that we were one of the first online communities to support consumer’s rights. Companies hated to hear about us and that was a good thing. The internet was much different back then. No advertisements were allowed. The “commercialization of the internet” was a supposed evil apocalypse still on the horizon. However, as different as the internet was, people still came together to help each other. At that time webmasters donated web space, users donated time, and lawyers donated shields. Now, people on sites like ours and across the internet still spend their valuable time to help each other. Although the media may change, good people still do good things.

We should all be thankful for that.