Electronic Health Records

Human HeartI continue to deplore Congress for not talking about the real problem in American healthcare, the cost of delivering healthcare. Premiums and deductibles are high because the cost of healthcare delivery is high. Drug prices are in runaway price growth. When the CEO of a major drug company was asked why they keep raising prices, he said, “Because we can”.

The ACA has many problems needing a fix, and I offer solutions in Health Attitude. One of my recommendations is to combine Medicare and Medicaid and then turn it over to the states to run, with certain standards provided by the Federal government. It is clear from the current situation states are different. They are also big and know how to run healthcare systems. They have been doing it with Medicaid for many years. Trying to force all the states to manage healthcare in the same way will never happen, in my opinion.

One of the Federal standards which should be strengthened is compatibility of Electronic Health Records (EHR). At many hospitals, the EHR in the ER cannot be read in the OR, let alone trying to transfer your medical records from CT to FL. Congress, as with other special interest groups, is in the pocket of the EHR software vendors. They claim government should not interfere in the private sector. Fortunately, Congress did not understand the Internet in the early days. If they had taken the same approach, there would be no Amazon or eBay or millions of other globally reachable websites. 

There is some progress being made. Yesterday, I had a routine echocardiogram at 8:30 in the morning. Thankfully, the result was good. At 1:30 PM I received an email saying there was new clinical information in my EHR. I read the complete report of the doctor who read the data from the procedure with my EHR iPhone app. Later yesterday, my doctor sent me an email confirming the good results. That is how healthcare should work. There are two missing ingredients: a national standard for interoperability of the EHRs and more effective and more affordable EHR software. The Federal government should put down an iron fist, and tell the vendors it is ok to compete on price, ease of use, features, support, etc., for EHRs, but not on data compatibility.

Posted in Electronic Health Records, Healthcare, Healthcare cost, Healthcare Policy, mHealth Tagged with: , , , , , , , , ,

The Senator’s Vote

VoterEstonia has had Internet voting for more than ten years. Using a national ID card, Estonian citizens can vote privately and securely. The voting system has proven to be secure, but the country is about to unleash an update to make it even more secure and end-to-end verifiable. This update should satisfy some of the world’s experts who have continuously criticized Internet voting.

In the U.S., we are paralyzed. The words Russia or hacking scare voting officials even though the risks are mostly theorhetical. Policymakers and experts want to compare Internet voting to a perfect system we will never have. They refuse to compare it to the flawed paper-based system we have today. One hundred million people who could have voted in 2012 and 2016 did not vote because of difficulty in getting to the polls. 

We are so paralyzed about voting technology, the Senate Majority Leader postponed voting on healthcare legislation because one important senator could not vote for medical reasons. In order for a senator’s vote to count, the senator has to be in Washington on the floor of the Senate. Think about the billions of decisions made everyday by consumers, businesses, and many arms of the government.

The press coverage about the senator’s situation and inability to vote has been 100% political. I have not seen one question about why it is the senator cannot cast his vote electronically.  For that matter, by telephone with witnesses. This would not address the 100 million people who did not vote, just one. The other reason why the medical issue stops things is the senator has to be “on the floor” to “manage the voting process”. We can do much better.

I am not making a political statement with this issue, but merely the process which works the same way it worked 100+ years ago. Computer scientists across the country have accomplished extraordinary developments in cloud computing, analytics for big data, the Internet of Things, artificial intelligence, and an inter-planetary Internet. All of these areas faced skeptics and critics who said, “It couldn’t be done”. I believe working with election officials, voting machine vendors, computer scientists, and software engineers we can solve the challenges and complexities of Internet voting. As a result, Americans could be proud of a stronger democracy with the highest voter participation in the world. We certainly could do it for one senator who is temporarily unable to get to Washington.

Posted in Election Attitude, Internet voting, Voting Tagged with: , , , ,

3D-Printable Knees

3D Printed Knee Implants

One subject among my weekly e-briefs which consistently generates a lot of feedback is knees. One thing baby boomers have in common is the need for joint replacements. The number of hip and knee replacements in the U.S. is roughly one million per year, 2/3 of which are knees. Over the years ahead, projections indicate there may not be enough surgeons to handle the rapidly growing demand. In many cases, the need for the replacement comes from overuse, injury, or osteoarthritis that led to destruction of cartilage, the flexible connective tissue in hip, shoulder, and knee joints. The common phrase uttered by those facing the joint replacement is “I am down to bone on bone”. All this will change with the development of artificial cartilage and 3D Printing. 

Every week, I see something new in the development of artificial cartilage. The 3D printers are quite advanced and able to print body parts. The picture at the beginning of this post, provided by Feichen Yang, a graduate student at Duke University, shows 3d-printed knee parts. The challenge is not the printer, the challenge is the “ink”. 

The most promising material is hydrogel, a colloidal gel consisting mostly of water. Yang explained two different types of hydrogels — one stiffer and stronger, and the other softer and stretchier. He called the combination a double-network hydrogel which is very strong. By changing the amounts of the two hydrogels, it is possible to fine tune the strength and elasticity of the mixture. The goal is to eventually create cartilage equal to or better than human cartilage.

The Duke researchers added an additional ingredient, a nanoparticle clay. The clay makes the hydrogel flow through print head like water, but then immediately harden into its printed shape. The process of taking a CT scan and printing the  new menisci takes about a day. In other words, hospitals will be able to do a CT scan of your knees and then print the replacement parts in-house, and have them ready the next day. 

Read the full story about what is going on at Duke here. Read more about 3D printing and regenerative medicine in Health Attitude: Unraveling and Solving the Complexities of Healthcare.


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Posted in 3-D Printing, Health Attitude, Healthcare Devices, Regenerative medicine Tagged with: , , , , ,

Ranked Choice Voting

VotingMany benefits will accrue once we get Internet voting. Presently, the various hacking fears and calls to go 100% paper ballots, we will eventually get there. In addition to more accurate, safe, private, and verifiable voting, a new capability called Ranked Choice Voting (RCV) will be possible.

Ranked choice voting, sometimes called instant run-off voting is an alternative method of voting which Internet voting could make possible. RCV can be used when there are more than two candidates. Instead of voting for one candidate, voters rank the candidates in order of preference, indicating first choice, second choice, third choice, etc. for as many candidates as appear on a ballot. RCV avoids split votes and counter-majoritarian outcomes.

Often, candidates can and do win election to offices like mayor or governor despite being opposed by most voters. That’s because when more than two candidates run, a majority of votes may be split among the two or more losing candidates. For example, in Maine, nine of the 11 gubernatorial elections between 1994 and 2014 were won with less than 50% of votes.

With ranked choice voting, if a candidate receives a majority of the first choice votes cast for an office, that candidate will be elected. If no candidate receives a majority of the first choice votes cast, the runoff process begins. The candidate who received the fewest first-choice votes is eliminated. Next, each vote cast for the losing candidate is transferred to the voter’s next ranked choice among the remaining candidates. The elimination process continues until a candidate receives a majority and is deemed the winner. The runoff happens instantly because all the votes are digital.

Another problem addressed by ranked choice voting is gerrymandering, a process whereby an entrenched minority can redefine congressional voting districts to bias how many representatives will be selected from each party in a state. Some have referred to the process as politicians picking their voters, instead of the other way around. Both Democrat and Republican politicians have used gerrymandering. A ranked choice voting process can ensure the majority of voters will always be able to elect a majority of seats, rather than the entrenched minority ensuring they stay in office.

The strongest proponent of ranked choice voting is FairVote, a non-partisan, 501(c)(3) non-profit organization which seeks to make democracy fair, functional, and more representative. It conducts research and proposes common sense changes to strengthen our democracy. FairVote believes democracy is strongest when more voices are heard. Ranked choice voting, where more than two candidates compete without fear of splitting the vote, ensures all voices are heard and every vote counts in every election. Read all about Ranked Choice Voting in Election Attitude – How Internet Voting Leads to a Stronger Democracy.


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Posted in Blockchain, Election Attitude, Encryption, Internet Technology, Internet voting, Mobile, Public Policy, Security, Voting Tagged with: , , , , , ,

Home Attitude: Alexa’s Dollhouse

Home Automation

One of you summer projects is to finish writing Home Attitude: Everything You Need to Know To Make Your Home Smart, the fourth in a series of Attitude LLC books. One of the topics I am writing about in chapter 9 is about how to communicate with your smart home is by voice. Talking to your house, sometimes called voice activation, and asking to turn on a light or put down the shades is not a new concept. In the 1968 science-fiction film, 2001: A Space Odyssey, Dr. Dave Bowman, played by Keir Dullea, used voice activation with the space station’s intelligent onboard computer, H.A.L. 9000. “Open the Pod bay doors, HAL”, he said. After no response, he said “Hello, HAL, do you read me?” After a few requests, HAL said, “Affirmative, Dave. I read you.” After an unsuccessful dialog, HAL wrapped it up with, “Dave, this conversation can serve no purpose anymore. Goodbye.”

I tried voice activation in my home some years ago. It was not as threatening as HAL taking over the space station, but I found it to be very unreliable. The microphone and translation technology was primitive. I would find myself yelling at the house and often getting no action or, worse yet, the wrong action.

Today, controlling things by voice has become very sophisticated with the advent of highly accurate voice recognition and the use of artificial intelligence (AI) to understand your words and interpret what you want done. As of this writing, Amazon has a significant lead over Apple and others with its Echo technology. If I say, “Alexa, turn on the office lights”, it works 100% of the time. Echo does not interface will all hubs, but I am confident it will in the very near future. Without a doubt, Amazon’s AI will soon enable you to say, “Alexa, I am cold”. The Echo will then communicate with the hub, determine what room you are in by motion sensing, read the current temperature, and raise the heat set point on the smart thermostat.

As with all technology, there can be a dark side. Andrew Liptak wrote in The Verge about a six-year-old in Dallas, Texas who was talking with her family’s new Amazon Echo. She said, “Can you play dollhouse with me and get me a dollhouse?” The Echo readily complied and ordered a $250 KidKraft Sparkle mansion dollhouse.[i] The parents figured out what happened and updated their voice purchase settings in the Amazon Alexa app. They also donated the dollhouse to a local children’s hospital.

[i] Andrew Liptak, “Amazon’s Alexa Started Ordering People Dollhouses after Hearing Its Name on TV,”  The Verge (2017), 

Posted in Home Attitude, Home Automation Tagged with: , , , ,
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