ChubbyThePhat posted:

I think you must be mistaking EMR software for something else. Literally all of it is terrible garbage. Maybe I'm jaded from what is offered in my area but jesus christ is it not a fun time.

larchesdanrew posted:

I met a girl recently. We've been on a few dates. She's pretty cool, and things have been going well.

A few days ago she confessed she's in an open marriage and has three other boyfriends.

ChubbyThePhat posted:

The long weekend for us Canadians is this weekend

larchesdanrew posted:

He asked me what medical emergency was more important than representing my department

MJP posted:

poo poo. My wife and I are driving up to Montreal on Sunday. On a level of 1 to 10, 1 being "dang, my local Tim Horton's is out of Capp mix" and 10 being "armed Quebequois independence uprising" how hosed are we?

pr0digal posted:

I love when my fellow support engineers don't put notes in their tickets. Really helpful when a client puts in a ticket saying that something done during a maintenance visit might have broken something and there are no notes in the corresponding maintenance ticket.

It's a common problem with a certain person who is still somehow employed.

larchesdanrew posted:

He asked me what medical emergency was more important than representing my department

Wilford Cutlery posted:

Is there a thread for running newer OSes on older hardware, even if just for fun? I have a fairly old desktop that never made it past Vista, and I'm tempted to try out Windows 7/8.1/10 on it.

odiv posted:

The sooner you stop telling me how important you are, the faster I can help solve your problem.

If you preface every single call and email with how important you are, I can't help but wonder who you're trying to convince.

Samizdata posted:

(Core2Quad Q8200, upgraded to 8Mb of RAM, GTX 760

MJP posted:

poo poo. My wife and I are driving up to Montreal on Sunday. On a level of 1 to 10, 1 being "dang, my local Tim Horton's is out of Capp mix" and 10 being "armed Quebequois independence uprising" how hosed are we?

nitrogen posted:

The only good EMR software is the software my company makes.

DACK FAYDEN posted:

If you ask IT, they're all good!

(source: I work at an EMR software company so I knew this specific and incredibly confusing tidbit - they're not that much easier to work with on the backend so I don't get it)

DACK FAYDEN posted:

If you ask IT, they're all good!

(source: I work at an EMR software company so I knew this specific and incredibly confusing tidbit - they're not that much easier to work with on the backend so I don't get it)

DACK FAYDEN posted:

If you ask IT, they're all good!

(source: I work at an EMR software company so I knew this specific and incredibly confusing tidbit - they're not that much easier to work with on the backend so I don't get it)

ChubbyThePhat posted:

The problem doesn't care how important you are

Collateral Damage posted:

Maybe you're like a karmic counterweight. Every time someone wins the lottery jackpot, narrowly escapes bodily harm, or lucks into meeting that special one life takes a poo poo on you to make up for it.

Potato Alley posted:

Holy poo poo how did you get modern Windows running on 8 megs of RAM?

nitrogen posted:

The only good EMR software is the software my company makes.

(this is true for anyone who works for an EMR company, and whatever their product happens to be.)


Seriously, most EMR software is garbage due to government mandates on how it should work. Obamacare was part of some of those mandates.

https://www.youtube.com/watch?v=xB_tSFJsjsw

spankmeister posted:

I am 100% certain EMR would still be poo poo tier garbage software without the government to blame their inadequacies on.

Arsten posted:

At the beginning, yes. But a lot of that crappy corporate software that needs millions to upgrade every sixteen months is ebbing away in industries where that sort of thing isn't absolutely required because most of that functionality is being offered for a lot less by competitors. It took 20 years for it to happen, but it's been happening over the last 10 in a snowball effect.

Competition drives down costs and increases efficiency. Making mandates over how you can even participate in a market destroys competition by tossing the little guys (who can't afford $1 m of compliance costs every single year) with their offerings off a cliff.

Migishu posted:

Eh, it's not Bastille day, or St Jean Baptiste, so you'll be fine. Also, we've got no team in the NHL playoffs so everyone'll just be chilling.

Unless you plan on going to La Ronde, in which case you're hosed.

If you need any good fooding options, I know a few good ones downtown. If you want a good pint, try Brutopia on Crescent St.

Potato Alley posted:

But I think the problem again here is that this is a market where the outcome HAS TO BE GOOD. In other words there is no room for crappy software, in terms of the actual performance of the software, because if the software has a bug where a line item gets changed randomly or something, well maybe that happened to be a dosage measurement and whoops someone died. So as much as I agree with you about enterprise software in general finally getting its legs cut out from underneath, and that being a good thing, I really don't necessarily want a cheaper medical procedure because the hospital bought cheaper medical software that hadn't been tested.

So as with any other such market where the outcome requires that kind of thing, it means that you by definition can't have real competition because of those compliance mandates, and that means it's not actually a free market. And if it's not a free market, then it shouldn't be operated like one, and the best way to do that is have the customer be bigger than the suppliers, instead of having a bunch of different customers in the form of separate hospitals and insurance companies. In other words, single-payer, where the leverage of the biggest company in the US (i.e. Uncle Sam) can, maybe, do something to force those costs down.

Maybe that wouldn't actually be how it worked, but having one giant customer setting prices would certainly get rid of a lot of the bullshit in medical billing today. Pity that we'll probably never see it happen since even the lovely Republican plan from 1994 is now being regarded as a socialist horror by the same party (well, in name) that came up with it and trying to get anywhere near real government healthcare would drive them into a rabid frenzy.

Arsten posted:

Arsten posted:

As for "single payer" keeping the costs down, it's the worst possible way and destroys efficiency. Paying 25+% of every dollar to manage the payment program that tells doctors what they have to make is pointless and backwards. And, if you think that it would get rid of a "lot of the bullshit" of medical billing, you haven't met the industry that makes a mint by writing the laws for the government to implement.

Arsten posted:

Yeah, except that the outcome isn't good now, with the mandates. All the mandates do is drive up the price of the software without increasing the quality of anything. Security? Exists like it's 1999. So, sure, maybe the EMR your hospital uses works perfectly on the database and will never incorrectly record a dose. Too bad it uses ActiveX, JavaScript, Flash, and/or a version of Java that's two versions out of date.

And, along those lines: what happens, today if a software is found to have given John Doe extra dosing? From experience, the software vendor pays the cost of the mistake (extra care, whatever) and then everyone signs NDAs with a little payoff envelope attached. So, how would you even know if your local hospital's EMR is going to kill you or not? You just assume because it passed the horribly-written and poorly conceived mandate?

As for "single payer" keeping the costs down, it's the worst possible way and destroys efficiency. Paying 25+% of every dollar to manage the payment program that tells doctors what they have to make is pointless and backwards. And, if you think that it would get rid of a "lot of the bullshit" of medical billing, you haven't met the industry that makes a mint by writing the laws for the government to implement.

Which is another thing you need to rethink: The old 1994 R and D plans were written by the same people: The insurance industry. As was the currently unfolding ACA, which was written a decade after the original plans were hard pushed in the 90s and has elements of both of those old legislations. The reason the US will never have single payer is because both parties push whatever legislation the largest paycheck tells them to and all the voters do is blame whichever color they want to hate instead of holding who they elect accountable for their own BS.

AreWeDrunkYet posted:

Isn't Medicare's medical loss ratio something like 97%, compared to 80-85% for private insurers (and even then only because they legally can't go any lower)?

Medicare is also able to get away with paying less for most procedures than private insurers because of its leverage. Putting everyone on the program would give them even more ability to put downward price pressure on providers, which is the real problem with US healthcare costs.

Methanar posted:

What can I do to help.

anthonypants posted:

Now tell us the one about how unions drive wages down, grandpa!!

Arsten posted:

It's not "leverage" it's mandated pricing for medicare payments if you accept medicare. Hospitals routinely switch medicare status based on their financial status. If they get a lot of non-medicare volume, they often won't accept medicare. Doctors switch status less frequently, but they will drop medicare coverage if there are too many medicare patients and they can't pay their bills. (Note that a large majority of doctors are being consumed by large health networks because of the ACA.)

Arsten posted:

The MLRs for private insurers cannot go below 80% for small group and 85% for large group as a part of the ACA. But that's not really all that different from the pre-ACA days, where an insurance company, if it was a great year, would hit ~70%. But MLR is a terrible metric to judge insurance companies (it only matters because the public hears about it in relation to shareholder concerns, at least IMHO). MLR, at the basics, gauges how much of the money taken in is used for paying out for services. The way this number moves around is almost impossible to predict year to year, but it does tell you how hosed the stock becomes at year end - which drives a lot of insurance companies to spend their time trying to screw with the number in their favor. (Especially in the 90s, where the HMO idea almost tore down the insurance industry and companies were hitting numbers like 110 or 115%).

The reason this number doesn't work for measuring success is multi-fold. First, everything on the "profit" side of that number goes to paying all of the bills of the insurance company. People, power, gold-plated bathrooms. The usual. Medicare, however, has that PPGPB category paid for by DHHS directly and thus it can "be cheaper / be better" without any real effort: They just pretend those expenses don't exist when they price their premiums.

Arsten posted:

Second, this doesn't measure efficiency or quality of care. Maybe your insurance plans are heavy with people who only go to ERs when they are about to die (this is an actual subset of both the insured and uninsured in the US). This will kill your MLR, but it doesn't mean that your people are getting bad care, just the the care is expensive. Maybe your plans are heavy with people who are older and sicker? This will also kill your MLR for the same reason: Older, sicker people cost more money on average because their human meat sack is breaking down over many years.

Arsten posted:

Third, ratios are terrible accounting metrics (Despite how common they are). For instance: Operation A made a cost:income ratio of 1:2 (50% profit). Operation B made a cost:income ratio of 1:10 (10% profit). Operation B should be shut down, right? If you agreed, then you just hurt the company. Operation A was a $100,000 project. Operation B was a $5m dollar project. At true dollar amounts, B made the company $500k and A made the company $50k. In a ratio, the numbers (And what made up those numbers) matter more than the ratio - especially when comparing company to company or company to government.

Ghostlight posted:

Is this really the thread for Reagonesque lengthy diatribes about how single payer is more expensive and results in worse healthcare.

AreWeDrunkYet posted:

That's called leverage! If Medicare weren't such a prominent payer, most providers wouldn't bother at the rates that it sets. But excluding that much of the market is more of a problem than the lower reimbursement for most providers, so they make it work. Adding more people to Medicare rolls only exaggerates that effect.

AreWeDrunkYet posted:

That's whole point. Private insurers "competing" with each other couldn't match Medicare regardless of the magic of the free market because there are additional costs inherent to operating an organization like that. Medicare doesn't have additional billing and collection costs (the IRS is already collecting taxes), doesn't have marketing costs (where else are you going to go?), doesn't have to pay for those gold-plated bathrooms and stock options (the CEO of UHC makes about 400 times as much as the head of CMS), and and it has practically no cost of capital (rather than being forced to turn a profit to stay afloat). It is not that bureaucrats are magically more efficient, it's just that a for-profit payer system has structural costs which are very hard to overcome.

AreWeDrunkYet posted:

To an extent, this helps the numbers in favor of Medicare. But the costs per patient for the payer aren't fixed, and those older, sicker meat sacks are responsible for substantially more claims that have to be processed. And even private insurers administering Medicare (so effectively the same population) have a significantly lower loss ratio than CMS.

AreWeDrunkYet posted:

Except that's all completely irrelevant in context since we're talking about the ratio of overhead payers are sucking out of the system. Why should it matter if it's one or a dozen small insurers are skimming 20% off the top, while Medicare manages ~3%?

Ghostlight posted:

Is this really the thread for Reagonesque lengthy diatribes about how single payer is more expensive and results in worse healthcare.

Varkk posted:

From the limited exposure I have had to medical software (one client is a gp clinic). The main issue is not the core software but the fact that there are so many different vendors and agencies who install plugins and modifications in to it. If there is any issue you are not sure who to call. And when you do they play hot potato with all of the other related vendors until you can nail one down to take ownership of the problem.

Entropic posted:

So you need up with ridiculous situations where somehow a company that's checked all the security boxes that the onerous laws require has a product that they recommend you only use with IE 8.0.

MJP posted:

Other than bagels, smoked meat, poutine, and Au Pied du Cochon, any suggestions on stuff that simply cannot be found outside Montreal or Quebec in general?