Posts Tagged ‘computer’

Has your eye doctor asked you to disrobe and bend over for a prostate exam?  You might want to think about getting a new eye doctor if your answer was yes, but that scenario might not be as absurd as you think.

The United States government, in all its infinite wisdom and good intentions, is changing the way your doctor takes care of you.  Now this is a government that can’t adequately fund or run the Social Security System, Medicare or Medicaid, but they know what is best for your health.  They can’t run the Post Office without a loss, but they know the best way to deliver your health care, and starting in the near future, in addition to no mail you likely won’t be able to get health care on a Saturday.

After all, what would a doctor know about delivering health care?  They went to medical school instead of business school!  They weren’t elected to protect your rights!

Enter Electronic Health/Medical Records (EHR or EMR).  Physicians are “mandated” to computerize medical records.

According to Michelle Malkin:

Buried in the trillion-dollar stimulus law of 2009 was an electronic medical records “incentive” program. Like most of President Obama’s health care rules, this top-down electronic record-sharing scheme is a big fat bust.   Oversight is lax. Cronyism is rife. The job-killing and privacy-undermining consequences have only just begun.   The program was originally sold as a cost-saving measure. In theory, modernizing record-collection is a good idea, and many private health care providers have already made the change. But as with many government “incentive” programs, the EMR bribe is a tax-subsidized, one-size-fits-all mandate. This one pressures health care professionals and hospitals across the country into radically federalizing their patient data and opening up medical information to untold abuse. Penalties kick in for any provider that hasn’t switched over by 2014.

Like so many federal programs, the EHR incentive is advertised as an optional program.  I don’t have to convert to medical records if I don’t want to.  But, oh, by the way, if I don’t convert by 2014, Medicare is going to penalize me.  The federal government has a long history of such extortion–think of the 55 mph highway speed limits that were enforced in the 70’s and 80’s.  States could legalize higher limits, but then they would lose federal funding.  You don’t have to participate . . . but we know you will!

I don’t have to participate in Medicare, but here is the reality:  80-90% of my ophthalmology practice is Medicare.  If I don’t participate, my waiting room will be empty.  The vast majority of Medicare covered patients can’t afford to pay for services out of their own pockets, so they will go to physicians that do accept the coverage. I can’t blame them–I would too.  So I participate because I have to–not because I want to.

And such is the case with EHR.  I can’t afford to collect less from Medicare.  Seriously.  The reimbursement for a cataract surgery today is 1/3 what it was when I started in practice in 1994 and about 1/4 of what it was in 1986 (I now perform THREE surgeries to get paid the same as I used to get paid for ONE!)

Think about that for a moment.  If you are a farmer, you must now plant and harvest three fields to make the same profit you used to get for farming one field.  If you are a salesperson, you must now sell three times as much to keep your salary the same.   Or keep it even more simple–if you are paid an hourly wage, you must now work three hours to take home the same pay you used to work one hour for.  That sounds fair, doesn’t it?  And that is without taking into account inflation and the fact that a 1986 dollar is worth more than a 2013 dollar, not to mention the fact that cataract surgery today is safer and more predictable than it was in 1986.  When you factor in inflation, it is criminal what the federal government has forced upon physicians.  And now there is the 2% sequestration loss on top of all that.

The worst part of the whole thing is that I spent 12 years of my life (four years of college, four years of medical school and four years of residency) and well over a $100,000 for my education, and I am only trained to be an ophthalmologist.  It’s not like I can take my training and skills set and join another company.  I’m not qualified to do anything else, except consulting in some capacity or teaching ophthalmology.  Judging by the page views on this blog, I couldn’t make a living doing this!

So the government dragged me into EHR kicking and screaming, but I have not yet seen one cent of any “incentive” that was promised.  Why?  It’s not because we aren’t using EHR–all of my new patients and 90% of my old patients are now computerized.  It was a long, arduous and frustrating process.  It was expensive.  Anyone in our office that needs access to a chart–from technicians, schedulers, phone operators and insurance filers–must now have a computer and each computer has to have a rather expensive software license.  And every time we submit to get our incentive, there is a new reason why we failed to meet the criteria. No soup for me!

And if the computers go down–I can not access a new patient’s information.  It’s backed-up somewhere, but I can’t get to it until IT figures out what the Hades is wrong with the software or server.

The whole process of computerization and data collection sounds nice on the surface.  This site outlines the process like this:


Improved communication, quality measures, patient access and efficiency are all wonderful buzz words that make it sound like a fairy tale come true.  But it’s the details of the process that are horrendous. It’s the “meaningful use” of that technology that is problematic.  The fine print for meeting these criteria include 15 CORE objectives for physicians, apparently regardless of specialty (“one size fits all”):

1.  Computerized provider order entry (CPOE)
2.  E-Prescribing (eRx)
3.  Report ambulatory clinical quality measures to CMS/States
4.  Implement one clinical decision support rule
5.  Provide patients with an electronic copy of their health information, upon request
6.  Provide clinical summaries for patients for each office visit
7.  Drug-drug and drug-allergy interaction checks
8.  Record demographics
9.  Maintain an up-to-date problem list of current and active diagnoses
10.  Maintain active medication list
11.  Maintain active medication allergy list
12.  Record and chart changes in vital signs
13.  Record smoking status for patients 13 years or older
14.  Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
15.  Protect electronic health information

If you are a non-physician and you look at this list, you are probably thinking to yourself that physicians should probably be doing these things anyway–and in fact, good physicians have been doing most of these things on paper for years.

Who wouldn’t want an electronic prescription as opposed to a scribbled, illegible one from the doctor?  Or an office note that is typed and legible rather than scrawled by a dyslexic platypus?   Have you ever used a computer?  Have you ever mis-typed a text message or email?  Clicked the wrong icon?  Have you ever tried to submit an on-line form that was refused because you missed one of the starred items or entered something incorrectly?  Have you ever sent a text or email that someone didn’t get?

In the short period of time we have been adhering to the eRx mandate, we have had multiple calls from pharmacies where patient’s are waiting to pick up their eye drops but no prescription was received.  Our computer says it was sent.  I know you probably find that impossible to believe because computers are perfect and people are not, but how many essential prescriptions do you think might be lost and the patient not realize they didn’t pick up all the meds they were supposed to?  Or what if the doctor clicked the wrong medication in the drop down menu by accident and didn’t pick up the mistake because he was trying to save encounter time so he could ask you about smoking (see below)?

It’s not as though folks couldn’t forge or change their prescriptions before to get controlled drugs.  They did.  But how long do you think it will take hackers to figure out ways to illegally transmit prescriptions for controlled substances, if they haven’t already?  (Actually, I think controlled substances still need a paper Rx, but as an eye doctor, I haven’t written for a controlled substance in 21 years, so don’t quote me on that.)

We are on the Titanic chugging along here folks, and this is only the TIP of the iceberg.  Medicare is telling us to move ahead full speed!

Number 12 mandates that we “record and chart changes in vital signs.”  Sounds like a good idea, doesn’t it?  Why didn’t a doctor think of that?!

Here is what your hard-working government–and I swear they employ people to stay awake all night thinking up ways to screw all of us–is doing for you:

Record and chart vital signs: height, weight, blood pressure, calculate and display

BMI, plot and display growth charts for children 2-20 years, including BMI

So you show up for your eye appointment.  Your doctor’s assistant asks you to step on the scale.  They calculate your BMI (body mass index) and determine that you are overweight.  Wait a minute, you came here for glasses, didn’t you?   Or a cataract?

Your podiatrist now is asking you about smoking.  And they are handing you materials about smoking cessation.  All you had was an in-grown toenail.  WTF?

How long will it be before I have to put my patient, who is getting glasses, into a paper gown and ask them to turn their head and cough?

Or better yet, “I’m sorry Mrs. Jones, but before I can take out your cataract, Medicare requires I document a rectal exam!”

Don’t laugh!  They are changing these rules as we speak.  And I’ll give you a hint–they only make it worse.  The Academy of Ophthalmology fought the Centers for Medicare Services (CMS) for relief from having to buy scales and waste clinical time discussing your weight instead of your eyes, but I am still being forced to ask my patients about smoking.  And while that does have a modicum of relevance for macular degeneration patients who are at higher risk for the wet type as smokers, for the vast majority of patient encounters, it is just one more thing we must document for no other reason than to make Mr. Obama and his merry band of legislators happy.

We are treating the computers (and legislators)–not our patients.

Seriously, if you are a smoker, you probably know already from the media and lawsuits that smoking is bad for you.  Your general medical doctor, lung specialist or cardiologist should discuss that with you.  But if you are being checked for cataract or getting contact lenses, is that really necessary?  How many people are really going to stop smoking because their eye doctor or foot doctor or proctologist told them to do so?

But wait!  There’s a pamphlet for that!

Vital signs should be appropriate to the specialty–blood pressure and pulse for the cardiologist, respiratory rate for the pulmonologist, vision and eye pressure for the ophthalmologist, etc.  But the government system won’t allow for individuality or common sense.  There are universal protocols for everything, from infection control to marking a surgical patient, regardless of what the infection or surgery may be.

And it only continues to get worse.

So maybe you don’t care if your eye doctor is making less money as you sit in the over crowded waiting room (because I now have to see three times as many patients to maintain my income AND pay for this new computer system I don’t want.)

But if you have to disrobe and bend over, you might just start to care.

I just hope it isn’t Obamacare.

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Are you one of the 1.01 billion Facebook users?

Then surely you have had the occasion to check out the ads that pop up along the right side of your screen.  They are the modern billboards of the Internet’s Route 66.

For instance, there is Wal-Mart . . .


I’m not exactly sure what those numbers mean.  27 million people LIKE Wal-Mart, but only 3 million have been there.  Even less are actually talking about it apparently. And how do THEY know that?  Can THEY hear me through my computer?  Now I am just scared.   And if there truly are a billion Facebook users, then only 2.8% of Facebook users actually LIKE Wal-Mart.  Kind of insignificant when you look at it like that.  And what about the rest. . . do they HATE Wal-Mart?  Why don’t they have a HATE option?  For that matter, why isn’t there a LOVE option?  But I digress.

So here are some ads that have popped up along my travels on this information superhighway . . .


I didn’t even know I had a golf death move!  Holy Shit!  I could have killed someone!  I probably have–and I didn’t even know it.  And what’s worse, this site promises to eliminate my #1 death move.  What about my #2?  Or #3?  I’m pretty sure my game is bad enough I could wipe out the population of a small village large city with little effort.

Facebookad2I am so sorry if this blog has infected you.  I need Real to Read that Book.  NOT.

Facebookad3Thirty Eight pages of instructions is . . . easy????  Thank God there are pitchers or I might wind up building a nuclear submarine from those parts instead of a windmill for my miniature golf course (beware:  playing miniature golf may be dangerous for your health, especially if your partners have unresolved death moves.)

Facebookad4Twenty-one people ‘like’ false allegations?  I hope none of them are my friends!

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Oh, Check My Flow

It all started so innocently enough.


Two paddles.  A square ball.  Black and White.

And then came Asteroids and Space Invaders.  PAC Man and Frogger.  Tetris!  Super Nintendo and Super Mario.  I don’t even know or understand what is out there today . . . Guitar Hero?  Assassin’s Creed?  Halo?  Hello??? McFly!

Somewhere along the line, Bill Gates invented the computer and there was Solitaire.  And it was good.  And Hearts.  Even better.

Then, Al Gore invented the Internet.

So much technology.  So much programming.  So much time of my life wasted.  Curse you Angry Birds!

And while my true addiction still lies in playing MahJong on Facebook, I have recently discovered a new game to keep me from spending time with my family, or working and earning a living, or eating, or breathing, or blogging, or pretty much anything else.


The concept, like Angry Birds, is so simple, yet the game is somehow compelling.

A grid is displayed.  As you play and move up levels, the grid gets larger–5×5, 6×6, 7×7, 8×8, oh I think you get the picture, and more colored dots are added.  Is it politically correct to call them colored dots?

On this grid, the computer displays pairs of colored circles.  The human must then connect these colored circles (blue to blue, yellow to yellow, etc.) without crossing another other color and leaving no squares unfilled.  (No square left behind!) It’s like a color based Sudoku!  Actually, it’s eerily reminiscent of Twister where you have to connect the green circle with your right hand and the red circle with your left eyeball, except in Twister, you did get to cross other people, and if you were lucky, they were of the opposite sex and cute.  Or drunk.  Or both, which is even better.  (Okay, for some people, it didn’t even have to be the opposite sex, and I don’t want to imply that there might be something wrong with that since it’s politically impolite to offend ANYONE these days, and it appears I have seriously transgressed digressed here.)

Back to my FLOW.Flow

My general requirements for a game these days is that it is FREE, easy to understand the rules, FREE, and doesn’t require me to play with any other human beings.  It’s not that I don’t like other people.  I really want to like people.  But most of them are just so damned stupid and ignorant, that I can’t possibly like them, let alone play a game with them.  Let’s face it, most people are alive because it’s illegal to kill them.  I really think that’s why some of the video games my kids play are so popular.  They get to kill people–without being thrown in jail or fried for it.  And I have digressed again.  Did I mention that the game has to be FREE?  OK–doesn’t have to be–I tried the FREE Angry Birds, and you just know that I ended up buying the full version like some crackhead purchasing his fix.  And even though there is no killing involved (even Angry Birds involves blowing things up with kamikaze birds) Flow fits these criteria well.

This is all my daughter’s fault.  She asked me to help her with a level while we were waiting for our food at a restaurant.  Five minutes later, I was hooked.  Does that make her a pusher?   There ought to be warnings on these games.  Support groups.

I’d discuss the game and strategy more, or maybe seek some professional help, but I really feel the need to go and play it right now.


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Tech Support

It sounds like a jock strap or bra for geeks.  Support your Tech!  There is nothing worse than a sagging or unprotected Tech, is there?  If you can’t be a Tech, be a tech supporter!

Like most folks living in our modern age, I had to confront the dreaded bane of our existence:  computer failure.

The cavemen had to worry about their flint not sparking a fire.

Fire Support:  Hello, this is fire support.  My name is Bob.  What is your problem?

Of course, “Bob” sounds like he is in India.  I just saw a quip in the latest Reader’s Digest attributed to Jimmy Fallon . . . “I read about a new 24-hour day care that’s opening in India.  Yeah, it’s pretty cute:  instead of playing telephone, the kids just play tech support.”  Pretty freaking funny until you actually have to translate one of them.  But I digress.

Caveman:  I can’t light a fire with my flint.

Fire Support:  Have you tried turning it off and then back on?  (Because that usually works!)

Caveman:  Of course I did.  (As he turns it off and back on while having this conversation since he didn’t actually try that.)  It still doesn’t work.

Fire Support:  Well what operating system are you using?

Caveman:  Flint XP.

Fire Support:  Have you thought about upgrading to Flint Vista?  Or Flint 7?

Caveman:  Uh, no.  This was working just fine yesterday.  I just want to keep using this one.

Fire Support:  Well, I can reset it back to the factory condition, but you will lose all the data on your previous fires.

You get the point.  We’ve heard it all before.

To make a long story short (too late!) my hard drive died the day after I got back from vacation.  Just died.  It worked the night I got home.  It was dead the next morning.  No prolonged illness.  No stay in a nursing home.  No ventilator.  No suicide note.  Just death.

Well, I couldn’t live without my computer (think freezing cold caveman unable to light his fire) so I bought another one.  The computer repairman told me he could just put a new hard drive in the old one–for $400.  Might as well buy a new computer.  Besides, when I asked him if maybe something was wrong with the computer that caused the hard drive failure, he just shrugged.

He says that hard drives do that these days.  They aren’t built to last.  Tech companies aren’t stupid.  If they sell you a hard drive that lasts ten years, you’re only going to buy one hard drive in ten years.  If they sell you a cheap-ass product that fizzles in two years for the same price, they sell you FIVE cheap-assed products in ten years for five times the profit.  Brilliant!  And I digressed again!

So after using my new computer for about three weeks, I ran into a problem.

My flint don’t make fire.

Actually, after the computer went into sleep mode, when it came back on there was just the desktop picture.  Nothing else.  No icons.  No task bar.  I got me a cursor to jiggle around across the purty pitcher, but I can’t run a damned program.  CTRL-ALT-DEL gets me a blank screen.  Black.  Even worse than no picture.  At least I could look at the pretty picture and imagine some beach . . . somewhere.

I have Norton Security (although it reminds me of Ralph Kramden’s neighbor on The Honeymooner’s every time I see that.)  “Nah-ton!”  Did I catch a virus?  I didn’t notice any sniffles.  Or that the computer was running a fever.  My God, it might die again!

Now I could turn the power off and restart and it would work fine–until it went to sleep mode.  Pretty picture.  No freaking useful icons anywhere in the background.  I could right-click and try to select properties . . . but nothing happened.  Pretty picture.  Mocking me.  I think my computer is possessed.  Do I call an exorcist or tech support?

So in desperation, I called TECH SUPPORT.  I bought the computer from Best Buy (ain’t that a bit ironic right there!) so I called the Geek squad.  Damned, but that’s some more funny stuff right there.

Yes, I have rebooted.  I have to, you twigging idiot.  Didn’t I just tell you that?

With no icons or task bar, might as well be a painting.

It doesn’t sound like a virus, he tells me.  I don’t know where he got his medical degree from, but if this baby dies, I’m suing you for malpractice.

We, or rather me with the pretty useless picture for a computer tried ALT-TAB.  ALT TAB?    Isn’t that like a diet drink or something?  Not the hell sure what that would do, but it didn’t work.  He said to keep pressing the TAB key.  I felt like the moron standing at an elevator and repeatedly pressing the button as though that will make the car come faster.  He was probably on the other end LOL-ing with his geek friends about the idiot he had on the phone.  I got a little suspicious when he got to the part about me standing on my head and using my toes to type in the pass code.

Finally, he settled on a solution.  Turn off the sleep mode.  He then went on this long dissertation about how desktops don’t need sleep mode and that it was designed for laptops to conserve battery power.  So just why do they put it on desktops?  Is it the same reason they put Braille on the key pads of drive thru ATM machines?  Won’t my hard drive die even faster if it never sleeps?

If that didn’t work, I could always bring it in for him to look at, but I’m thinking if he can’t help me over the phone, just what exactly is he going to do looking at it.

“That’s a damned fine desktop picture you got there.”

“Why thank you.  I pixeled it myself.”

But I was desperate.  I did not want my computer to die.  I turned off the sleep mode.

It worked.


Then we’re back to pretty picture with no god damned icons anywhere.  ANYWHERE!  Not even one.  Come on Microsoft and throw me a freaking bone here!

I should have called the exorcist.  If it starts spewing pea soup at me, so help me God I’m gonna call a priest.  Or Ghostbusters.

But then I realized a couple of things as I desperately played with this stupid picture and tried to figure out how to get the icons back.  If I went to CTRL-ALT-DEL, even though it was a blank screen, if I used the down arrows (as if I was selecting one of the options such as restart or to start task manager) and hit enter, I could restart the computer.  It was working.  I just couldn’t see it.

I think the same thing was happening when I right-clicked the pretty picture and nothing appeared to happen.  Somehow, someway, my computer was hidden behind this bucolic scene.

At one point, I noted on the right-click an option for HP Magic Canvas.  I don’t know what that is.  It was an icon on the desktop, but I had never had any reason to click it before.

I needed me some magic now.  So I selected it.

Lo and behold, I get an error message that I can see telling me that Magic Canvas can’t be used when the screen is in extended mode.

Extended Mode?  Holy Tech Speak, Batman!  Instead of pie ala mode, I got me pi extended mode?  What in the name of God is this?

So I googled it.  After some quick researching, rebooting my computer, and then finding the right place in the Control Panel, I discovered that my system had magically been switched into a two monitor (I only have one!) mode, and when I unclicked the box and saved the change, I haven’t had a problem since.

I bet the kids in India could have told me that.

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