leonth
Joined 15 years ago
Joined 15 years ago
On the other hand, if you are operating at a loss, you will be able to continue doing so indefinitely via continuous cash infusion by investors (which might include the public in case of a public company)... until the cash does run out.
So really, in FreedomLand, you can work and get paid in BTC, but if FreedomLand only recognizes FreedomDollar as legal tender, then when you need to pay income tax, the government will charge you in FreedomDollar, and you need to exchange your BTC to FreedomDollar.
If you cannot or don't want to pay tax, then of course police will prosecute you, and courts will also require settlements in FreedomDollar. Nevermind you have millions of BTC or XBoxes.
Now of course, this "problem" would disappear if FreedomLand recognizes BTC as legal tender, but now FreedomLand government loses all monetary control, and then economic activity descends into chaos.
I can also hazard a guess that there are more Thinking people lurking in HN vs Feeling people, thus the general repulsion towards that style of writing.
In software development, these and other benefits are not as critical or very hard to achieve even with strong enforcement.
The best solution is I believe relentless continuous manual curation, which is discussed below. Automated tools are rather frowned upon in this area because I don't think there is any that is good enough until everyone is comfortable to rely on the black box.
> Can't this be done in parallel ? and why are resources an issue for such an important thing with a clear health ROI and maybe financial ROI ?
It definitely can be done in parallel. It takes years mainly due to political issues - like doctors arguing against each other which treatment/alert/option is the best, doctors/nurses/pharmacists arguing against each other who needs to look out for certain alerts, etc. We are not talking about tens of alerts, the number usually comes up to thousands.
Resource is an issue here because the best people to manually curate are the healthcare professionals themselves, but they are usually, you know, treating patients, so they are hard to find on their desks. And as mentioned elsewhere, the industry is highly hierarchical, so a bunch of minions can propose changes to alerts but everything needs to go to some higher authorities because the stakes are too great. Sometimes this "higher authority" does not decide without a formal consultation with some other authority. (nobody wants to be blamed if an error happens because the hospital just removed a perceived low-quality alert a week ago)
Coupled with the need to perform lots of research to produce high quality alerts, I would presume only large-ish hospitals / clusters (perhaps > 1000 combined bed capacity) can afford full-time people to look into this.
There are important KPIs related to patient health and public health that depend on speed, such as length of inpatient stay, transit time in the ER / ED, time to first antibiotic treatment, turnaround time for medicines and supplies. Compromising these KPIs may lead to non-optimal care too regardless of patients complaining.
An automated "checklist generation" is easy via subscription to data vendors, whereas manual curation takes years (even when only codifying best practices). And we can't just have one set of alerts for the world because everyone's (patient demographics, risk appetite, clinical sophistication level, computer skills, political situation) is different.
There are many business processes in the healthcare field, and the impact and ease of imposing checklists will be naturally very different for each:
* Diagnosis and treatment protocols / pathways - these span long periods of time (days to months), any checklist will probably be quite complex and redundant to the already existing longitudinal case notes.
* Procedures (like surgeries) - some parts like preparation can be subject to checklist. But the procedure itself may need >= 2 clean hands and good concentration, thus glancing over checklists multiple times during procedure, or worse attempting to tick off stuff might cause more harm than good. (don't tell me to add one more guy there - we need him to save another patient, and google glass is dead for now)
* Processes related to ordering, dispensing, and administering medicines: there are probably tens/hundreds of thousands of these processes happening in a hospital at any given day. If a checklist introduces speed penalty it will be rather burdensome for the facility (and patients too). Furthermore, an equivalent of a checklist (e.g. refusing to proceed unless certain required fields are filled) has usually been codified in the hospital systems being used. Also, I feel that adding a checklist for something that you do hundreds of times a day, will not achieve anything, because the muscle memory will take over - you will just do things as per usual and sign off "all done" on the checklist, because you always do them all the time whether you remember or not, right?
Doctors ask "have you ever treated a patient?"
Pilots ask "how many flights have you flown?"