JohnPatrick.com
Thanks for stopping by. My name is John Patrick and Attitude LLC is the name of my company. My activities include writing, speaking, investing, and board service. My areas of focus include healthcare, Internet and mobile voting, and technology. As you will see in the books I have written, I believe most big problems and big solutions involve Attitude. My latest book is Robot Attitude: How Robots and Artificial Intelligence Will Make Our Lives Better (2019). Robot Attitude and all the prior books are part of a Series called “It’s All About Attitude“. You can find all the details about each book here.
My blog below has more than 2,000 stories about technology, music, motorcycles, travel, business, Internet voting, robots, AI, healthcare, and more. Every Saturday morning, I publish an e-brief which contains an easy to read post or two about new developments in my areas of interest. Please sign up and give it a try. If you don’t like it, you can make one click and you will not receive it again. You can find me on social media on Facebook, LinkedIn, Twitter, and YouTube. You can also find my background in Wikipedia.
What Does Vitamin D Do for Us and Where Do We Get It?
Written: May 2022
Vitamin D consists of a group of fat-soluble secosteroids, a type of steroid. Vitamin D has several positive biological effects. It increases intestinal absorption of calcium, magnesium, and phosphate. Vitamin D also regulates numerous cellular functions in your body. Its anti-inflammatory, antioxidant, and neuroprotective properties support immune health, muscle function, and brain cell activity. A simpler view of Vitamin D is as a nutrient your body needs for building and maintaining healthy bones. Without vitamin D your bones cannot absorb enough calcium resulting in bones becoming brittle, soft, and thin leading to osteoporosis. Research on vitamin D has found it can have positive effects in a wide-ranging set of conditions including cancer, cognitive health, multiple sclerosis, osteomalacia, osteoporosis, psoriasis, and rickets.
The importance of the vitamin raises the question of where we get it. One source is our body. It can produce vitamin D when direct sunlight converts a chemical in our skin into calciferol which is an active form of vitamin D. The amount of vitamin D our skin produces depends on many factors, including the time of day, season, latitude, and our skin pigmentation. If you live in a place which does not get much sun or your lifestyle keeps you indoors, vitamin D production might decrease or even be completely absent. Dermatologists properly tell us to stay out of the sun to prevent skin cancer, but the result can be a decrease in vitamin D production.
How about what we eat? Vitamin D is not found naturally in many foods. Plants are generally poor sources of the vitamin. Most people rely on animal products such as dairy, eggs, and meat. Other sources include fatty fish such as mackerel, salmon, or sardines and from fortified milk or fortified cereal. A new source of vitamin D may be on the horizon.
Researchers are finding gene-edited tomato plants produce a precursor to vitamin D which may provide an animal-free source of the essential vitamin. When the gene-edited tomatoes are exposed to ultraviolet light in the laboratory, some of the precursor, called provitamin D3, is converted to real vitamin D3.[1] It may be quite a while before the discovery is commercialized. One big test is whether the modified plants will thrive when grown outside. Other obstacles include regulatory approvals and consumer acceptance. Both are iffy at this point.
A simple blood test can check your level of vitamin D. If you don’t have enough vitamin D from sunlight or dietary sources, a plan B, or D, would be vitamin D supplements. Taking a multivitamin with vitamin D may help improve bone health. Your doctor can recommend a daily amount of vitamin D ranging from 400 international units (IU) to 800 IU depending on your age. With as many as one billion people believed to be without enough vitamin D, we need all the sources we can find.
[1] Jie Li et al., “Biofortified Tomatoes Provide a New Route to Vitamin D Sufficiency,” Nature Plants (2022).
Survey
Thanks very much for your feedback. Surveymonkey only allows 40 responses unless you pay for a big subscription I would never use. We have exceeded the 40 responses and we have a statistically valid set of data. It was very positive. You can see the results at the following links:
- Overall analysis
- Comments about the weekly e-brief
- Comments about the feature stories
- Comments about which things you read
- Comments – general
Ukraine
I hope a lot of Russians are reading Telegram. President Zelensky, the great leader, said the following today as he addressed the people of Indonesian. Emphasized that the sooner our lands are liberated from the occupiers, the more reliably people everywhere in the world will be protected. Protected from the aggressive desires of those who want to pursue colonial policies, as in the old days. If the world is truly united and honest about this Russian aggression against our sovereign state, the speed of ending this war will be measured in weeks. Weeks, not even months.
Space
The National Oceanic and Atmospheric Administration has shared the first imagery from GOES-18 (Geostationary Operational Environment Satellite), it’s latest weather satellite, which sits on a perch in geostationary orbit observing the Western Hemisphere of Earth. It is the most advanced weather satellite ever sent into space and has a powerful array of instruments and sensors. Anytime you check the weather on your phone, tablet, or get it from any other source, you can thank GOES.– Aaron J. Patrick
Reflection Attitude
A lot more progress on Reflection Attitude this week. A first draft is in the hands of reviewers and blurbers. I am very grateful for the blurbs which have come in so far.
Wall Street
The market reflects investors concluded maybe thing are not so bad. Tech had beaten to a pulp. Techs were up across the board today. All GAMMAT stocks were up. The total is just above $8 trillion. I believe the high since I started reporting this was above $11 trillion. I still remain bullish on tech, large and small. Many of the world’s problems, like supply chain and labor shortages, will be solved by tech. It is going to be a long wait. They are still closer to 52-week lows than highs.
Crypto
As of Friday, there are 19,621 cryptocurrencies. Total market cap of all the crypto is $1.2 trillion. Bitcoin represents 46% of the total and Ethereum 18%. The rest are 36%. There are a lot of great ideas among the rest, but many are fraudulent or what I would call overly creative. The Fed is saying the idea of a stablecoin is not only a good idea but if the U.S. doesn’t create a digital coin then the dollar as the world standard may get weakened.
Written: November 2019
Amazon CEO Jeff Bezos, J.P. Morgan CEO Jamie Dimon and Berkshire Hathaway CEO Warren Buffett last January announced they were teaming up to tackle rising health-care costs. In the year the nonprofit company has been without a name, people have started calling it “ABC.” It’s now called Haven.
In August 2018, The Wall Street Journal reported major tech companies had signed a commitment to “share the common quest to unlock the potential in health care data, to deliver better outcomes at lower costs.” The companies, convened at a White House event focused on healthcare technology. The group included Amazon, Google, IBM, Microsoft, Oracle, and Salesforce. Apparently, Apple was not at the meeting, but is quite active in healthcare, much of it centered around its cardiac monitoring program with the Apple Watch and the Apple Health app.
The promise the companies made should help accelerate the emergence of a data-driven revolution in healthcare. Patients, providers, payers, and researchers all need easier and more compatible access to health records to enhance patient safety and lower the cost of healthcare. Unfortunately, healthcare data today is stored in silos at providers and payers. In large part, our healthcare data is locked up.
In theory, patients have access to their health data since the Obama administration distributed $30+ billion in incentives for the creation of patient portals and electronic health records (EHRs). The reality is quite different. Most people over 65 have multiple providers. Consolidation has occurred and many hospital networks have a range of services. However, some of the sub-specialty providers, such as urology and dermatology, remain outside of the networks. In addition, standalone practices in orthopedics and radiology have their own EHRs and portals. Another factor adding to the complexity is many people choose to get a second opinion or comparison shop on services such as radiology. The result of all this fragmentation is patients don’t have one patient portal, they have multiple. A friend of mine has 15. Nobody in the team of providers has a total view, including the patient.
Healthcare records are incompatible between providers. Even worse, you can look at test results at one provider, but you can’t easily download or email information from a record to another provider. You also cannot sort or search your health data. The bottom line is EHRs have become a train wreck. It is a tie between patients and providers as to who dislikes EHRs the most. EHRs are a failed promise. We can’t live without them, we can’t live with them.
- W. Bush hired a Chief Information Officer to fix this problem more than ten years ago. The CIO knew how to fix the problem but could not pierce the armor of special interest groups who wanted government to stay away from the issue. The CIO resigned in frustration. The current head of HHS, Alex Azar, is saying all the right things but is also having trouble getting past the special interest groups. The bottom line is government has been completely ineffective in solving the healthcare data and related cost problems. Now it is time to see what the tech giants can do.
I am optimistic the promise made by the companies mentioned above will be successful. There are a number of reasons for my optimism. First is healthcare cost has risen out of control to the point where it is nearly 20% of the economy. The tech companies are not startups. They have hundreds of billions in revenue and millions of employees which cost the companies billions of dollars for healthcare. They are motivated to solve the healthcare problem. The second reason for my optimism is technology. Cloud computing and AI have risen like a rocket ship. I believe they will be able to bridge the silos and make data access easier for all. Apple, for example, is making great strides to incorporate EHR data into its Health app.
Security technology has evolved to provide anonymity and protection of the data. Equifax and others have shown their incompetence in this regard, but the tech giants know how to do it. Lastly, mobile technology has advanced rapidly. With fingerprints and faceprints, they offer strong authentication. Mobile apps are easier to use. Banks, travel companies, food services, and many other segments have developed mobile apps which are easy to use and way better than their websites, except in healthcare. I expect Atul Gawande, CEO of the new Amazon/JP Morgan/Berkshire Hathaway healthcare company, Haven, to become a shining light to help rally all the tech companies to work together. They are fierce competitors, but the motivation to solve the healthcare cost problem is huge.
The Wall Street Journal said, “The Trump administration sees better use of health-care data as a key to unlocking savings and holding down costs while improving outcomes.” Seema Verma, Administrator of the Centers for Medicare and Medicaid Services, said, “We want to lean into technology and use it as a potent force to create more efficiencies in our system.” I believe the tech giants will help make this happen.
Another reason for my optimism is Atul Gawande. I first met Atul in 2012 at an event in New York held by The New Yorker. He gave a brilliant and inspiring talk. I have read all his books and follow him on Twitter. He is an incredible physician with superb communications skills. The following are the guiding principles Dr. Gawande stated for Haven:
- We will be an advocate for the patient and an ally to anyone — clinicians, industry leaders, innovators, policymakers, and others — who makes patient care and costs better.
- We will create new solutions and work to change systems, technologies, contracts, policy, and whatever else is in the way of better health care.
- We will be relentless. We will ensure our work has high impact and is sustainable. And we are committed to doing this work for the long-term.
Most of the politicians talk about healthcare coverage, but few talk about healthcare quality and cost, which are the real problems, especially cost. Congress continues to stand in the way of addressing the cost problem. Haven has the right vision and I believe others will join the effort.
My reflections – 2022
I was dead wrong on this one. Haven was basically a tops down approach. It turned out the power of the healthcare lobbies for special interest groups was more than even Amazon and its two partners could break through. However, there are reasons to expect progress from new approaches now underway by Amazon and Apple. Both have developed bottoms up strategies built around the consumer. A few words about each follow.
Yesterday, I saw my family doctor for a routine checkup. He prescribed a new medication for me from his laptop to Amazon Pharmacy. When I got home, an email invited me to complete the order. I put the item in my Amazon Pharmacy cart and headed to checkout. The price for the medication using my Aetna prescription drug insurance was $6.90. The other option shown in the cart was an 80% Prime discount. I paid $1.40 for the medication with free shipping and delivery in two days. Congress has banned Medicare from negotiating the cost of drugs, but Congress cannot prevent Amazon from negotiating directly with drug manufacturers. The combination of consumer demand plus Amazon’s bargaining power will drive a wedge in the corrupt overpriced drug distribution system we have been living with and which has bankrupted families.
Amazon is going after the low hanging fruit of high cost healthcare in America and providing consumer oriented solutions. Amazon Pharmacy is just the beginning. There is much more to come. “Alexa, get me a telehealth appointment.” In a hospital room, “Alexa, tell the nurse I need a pillow.” Amazon is going to help healthcare providers improve healthcare patient satisfaction in ways the healthcare system has not been able to do.
The uniform dislike of EHRs is another issue which has struggled to be resolved on a tops down basis. Apple took a consumer approach. The Apple Health app is built into every iPhone. It is part of iOS, not something you have to the app store to get. In the app you can link your healthcare provider, not yet all of them, but many. If you can a blood test or have a surgery at any of the providers you have linked, you can browse the information on your iPhone. It is far easier than trying to navigate an EHR portal of a provider. The new medication I mentioned in the preceding paragraph has not arrived yet, but it already appears in the Medications section of the Health app.
Survey
Please take a minute to do the surveymonkey. You can find it here. Survey responses are still trickling in, so I will let the survey run for another week. If you did not take the survey yet, it only takes a couple of minutes. I will share the results later.
Ukraine
I am thankful for Telegram. I hope a lot of Russians are reading it. There are now 162,000 subscribers to the English channel Ukraine NOW [English]. I also follow President Zelensky’s personal channel on Telegram. He is an outstanding communicator. While Putin shows how one man can screw up the world, Zelensky is showing how one man can get almost the entire world to get behind him. What a great leader! A leader. Today, he said, “We will gain independence. And it will be in our history the same as in other countries that fought for independence and won. Countries that ceased to be beggars and became subjects. The real masters of their lives and their future.”
Covid
This week finished reading Premonitions by Michael Lewis. He goes deep into how badly the United States botched preparing for and managing the pandemic. I want to give credit to what it is going on now at the CDC. I think Dr. Wallensky is doing a good job, especially in the area of communications. She inherited an organization of 15,000 personnel. Like other major government organizations, it likely has outdated information systems and built-in bureaucracy. Moving with speed and communicating timely is challenging. I give her the benefit of the doubt she can pull it off. Meanwhile, the virus is spreading rapidly. It appears to be less severe than earlier variants but people are dying from it. We should still be cautious and get vaxxed to the max.
Space
After years of delays, NASA’s Boeing Orbital Flight Test 2 (OFT-2) mission finally got off the ground and into orbit Thursday on an Atlas V rocket. OFT-2 is an uncrewed demonstration mission to the International Space Station (ISS) under a public/private partnership between NASA and Boeing. The primary objective for OFT-2 is to demonstrate Boeing’s CST-100 “Starliner” crew capsule’s ability to autonomously rendezvous and dock with ISS then undock a week later and return to Earth for a parachute-assisted, airbag-cushioned touchdown in New Mexico.
Starliner is an Apollo-style capsule designed to ferry up to seven astronauts to and from ISS. The capsule is heavily instrumented and has a dummy astronaut named Rosie the Rocketeer, which is outfitted with 15 sensors to collect data on what a human astronaut would experience during the flight. OFT-1 launched successfully in 2019 but failed to reach ISS due to software problems on Starliner though the capsule was recovered. Pending the successful completion of OFT-2 and subsequent certification for operational flights, NASA would then have a redundant capability to launch astronauts to ISS. SpaceX’s Crew Dragon capsule has been providing crew transport since 2020.
– Aaron J. Patrick
Reflection Attitude
A lot more progress on Reflection Attitude this week. Hoping to distribute a first draft to reviewers and blurbers before end of the month.
Wall Street
The market reflects investors are not sure what to do. Most are selling. I started a little bit of averaging down last week. Nobody knows if this is the bottom. Except for Google, all GAMMAT stocks were down. The total is just below $8 trillion. I believe the high since I started reporting this was above $11 trillion. I know I sound like a broken record but I still remain bullish on tech, large and small. Many of the world’s problems, like supply chain and labor shortages, will be solved by tech. It is going to be a long wait.
Crypto
As of Friday, there are 19,509 cryptocurrencies. It is really easy for anyone to create a new one. Total market cap of all the crypto is $1.3 trillion. Bitcoin represents 45% of the total and Ethereum 19%. The rest are 36%. There are a lot of great ideas among the rest, but many are fraudulent or what I would call overly creative. Terra and its LUNA coin tanked so badly they had to shut it down. It had the idea of a stablecoin which was tied to an algorithm. Interesting theory that did not pan out. That doesn’t help develop trust. Crypto is much more than cryptocurrencies. NFTs and Web3 have a lot to offer. I will be writing more about these. I am especially enthused about NFTs. This week I purchased one called “Fractal World 71″. I’ll display it here at some point.
It seems every week I receive spam emails appearing to come from friends of mine. It is immediately clear they were hacked. How did they get hacked? By having a weak password like the example in the picture above. The top 25 passwords revealed through a study show similar examples like abcd1234, the person’s birthday, their street address, and other easy to guess passwords.
Every year at our country club in Florida, I give a lecture about security, passwords, password managers, having long alphanumeric passwords with upper and lower case, numbers, and special characters, and other best practices. I cannot say my tips on the subject are acted on. It is understandable. Having, managing, and using strong passwords is a pain. Fortunately, there is relief in site. Fairly soon, we will no longer need passwords at all.
It is not just casual observers or victims of weak passwords who are aware of the problem. Apple, Google and Microsoft, the largest players in the tech space, have been working on alternatives to passwords for years. The big three and others have finally reached consensus to get rid of passwords altogether. They have devised a completely new approach for users to log in to their accounts. If the majority of users had good password habits, such a radical change would not be needed, but the tech industry has thrown in the towel. The strain on tech support has grown. Bye bye passwords.
Apple, Microsoft and Google made a joint announcement last week they are collaborating and have committed significant resources to create an entirely new system for passwordless sign-in. Passwordless will become a new word in user vocabularies before the year is over. It will initially be the big three, but I expect all websites will follow over the next couple of years if not sooner.
The simple explanation of the new approach is a change from what we know (our passwords) to what we have (our smartphones). The idea would not have been practical ten years ago, but now the landscape is different. Industry estimates are the number of people who own a smartphone is 7.26 Billion, making up 91.54% of the world’s population.
Here is how it will work. You visit a website. Instead of entering an ID and password, you will open your smartphone. You authenticate on the phone by using your fingerprint or faceprint (the vast majority), a PIN, or a pattern you draw on the screen. The smartphone then shares an encrypted passkey with the website. No user passwords. Instead, it will be the device you have authenticated. The website is happy and you will be too.
No system is perfect but the new passwordless world will be a vast improvement. The industry has agreed on a standard called FIDO, Fast Identity Online, which the FIDO Alliance will be making available to all websites. Your smartphone will store a unique FIDO-compliant passkey which will be shared with a websites for authentication only when your phone is unlocked. The passkey will be stored in your preferred cloud so it can easily be synced to a new device in case you lose you phone or get a new one. Passwordless.
Survey
I really appreciate the survey responses so far. I will let the survey run for another week or two. If you did not take it yet, it only takes a couple of minutes. You can find it here. I will share the results later.
Ukraine
Every day Telegram tells exactly what is going on. I also follow President Zelensky’s personal channel on Telegram. He reminds me of Reagan. Communicate communicate communicate. He is really great at it. A leader. Today, he said, “Russia’s strategic defeat is already obvious to everyone in the world and even to those who still continue to communicate with them. Russia simply lacks courage to admit it so far. They are cowards. And they are trying to hide the truth behind missile, air and artillery strikes. Therefore, our task is to fight until we achieve our goals in this war. Free our land, our people and reliably ensure our security.”
Covid
The CDC has been collaborating with global public health and industry partners to understand Omicron. They are learning how easily it spreads, the severity of illness it causes, and how well available vaccines and medications work against it.
The three most common lineages of Omicron currently are BA.1, BA.1.1 and BA.2. The variants spread more easily than earlier variants. They have learned anyone with Omicron infection, regardless of vaccination status or whether or not they have symptoms, can spread the virus to others. Persons infected with an Omicron variant can have symptoms similar to previous variants. The severity of symptoms can be affected by COVID-19 vaccination status, the presence of other health conditions, age, and history of prior infection. It appears to be less severe but people are dying from it. We should still be cautious and get vaxxed to the max.
Space
The International Space Station (ISS) orbits the Earth at 250 miles above sea level in the part of space known as Low Earth Orbit (LEO). In order to maintain its orbit it travels around the planet at 17,500 MPH. How does it go that fast? Imagine if you’re standing on the ground and you throw a ball in the air. It follows a parabolic trajectory and Earth’s gravity pulls it down by 9.8M/s. However, if you stood on a high enough hill and threw the ball fast enough it would go into orbit. That’s what rockets do.
Launch vehicles like the Space Shuttle, which was the primary launch vehicle used to build ISS, use huge amounts of chemical energy to accelerate out of the atmosphere and deliver payloads into orbit. ISS is not totally free of Earth’s influence though because there is a small amount of atmospheric drag exerted on it, so it periodically needs to be “boosted” to a higher orbit. The energy for such a maneuver is typically provided by a visiting Russian Progress freighter’s engines. ISS and everyone on board are traveling at the same rate of speed, and the boost adds just a little bit more velocity and altitude. When the boost occurs the station accelerates but the astronauts do not. This video shows the effect in action, sped up 8x.
– Aaron J. Patrick
Reflection Attitude
A lot of progress on Reflection Attitude this week. Starting to line up reviewers and blurbers. Edited the Preface and introduction.
Wall Street
The first part of it was another really terrible week, but things turned around a bit on Friday. Nobody knows if this is the bottom. It feels good for now to see all my spreadsheet models shows green instead of red. All the big techs and other techs were up. To keep perspective, all of them are much closer to their 52-week lows than their 52-week highs. The six GAMMAT stocks were $8.3 trillion. I remain bullish on tech, large and small but it is going to be a long wait. Tempting to average down.
Crypto
As of Friday, there are 19,430 cryptocurrencies. It is really easy for anyone to create a new one. Total market cap of all the crypto is $1.3 trillion. Bitcoin represents 45% of the total and Ethereum 20%. The rest are 35%. There are a lot of great ideas among the rest, but many are fraudulent or what I would call over-creative. Terra and its LUNA coin tanked so badly they had to shut it down. That doesn’t help develop trust. My crypto consists of 25 different cryptocurrencies but 95% of the total value is BTC and, if you throw in ETH, it is 96%. The other 23 took a beating. I expect at least a few of them will bounce back. Looking at the big picture, there are billions of dollars invested in crypto-related ideas. I believe some of them will be highly successful. As of 1 pm Friday, Coinbase was up 23%.
Are Customer Satisfaction Surveys a Good Thing?
Witten: October 2020
Surveys have the potential to be very useful tools for any organization to gain insight about their customers, products, and services. The number of surveys presented to us is on the rise but, in my opinion, most are misdirected. The typical survey basically asks two questions.
First is “Based on your most recent interaction with our customer service team, how likely are you to recommend our product or service to friends or family?” I remember back 25+ years ago when this question emerged from the bowels of marketing research firms. The question was shown in some studies to have the most accurate correlation to customer satisfaction. The question has lingered now for decades as the gold standard for surveys. I don’t like the question because I don’t feel it is my duty to make recommendations, pro or con, for any product or service I may have purchased. The question just doesn’t tell the real story about the quality of the product or service.
The other focus of most surveys is to ask about the customer service representative and how they handled your interaction. The questions are focused on the rep, not on the product or service. For example, AT&T, Comcast, Spectrum, Verizon, and other carriers have terrible customer satisfaction. It is not because their reps are bad, it is because their service price, quality, terms and conditions, etc. are terrible, yet they don’t ask about any of that.
Apple and Amazon understand. Although they both survey about their reps’ responsiveness, they also survey about their products and services. Telecommunications providers are not alone as providers of terrible services. Financial services companies also survey about their reps, not the quality of their products and services.
Healthcare is on a level of its own. Medicare requires all patients to receive a survey called hospital consumer assessment of healthcare providers and systems (HCAHPS). It sounds comprehensive but is not. They ask about the quality of the food, the level of noise in the hospital room, communications from doctors and nurses, and the level of understanding the patient had. As healthcare has become more digitally oriented with mHealth and Telehealth, none of the HCAHPS questions ask about how well video consults have worked. I have had five video consults and none of the five had working video, although millions, including children, use Zoom every day with less problems. The survey does not ask how easy it is to retrieve data from lab or imaging studies, how easy it is to transfer information to another provider, or how easy it is to schedule an appointment. I don’t take most surveys because I don’t want to add evidence leading to a rep getting fired because their company’s product or service is terrible.
I practice what I preach. I have created a short five-question, less than one minute to complete, survey about johnpatrick.com. I really want to know what my readers think about it. Are my e-briefs too long or too short, are they informative, etc. All responses are anonymous, and I share the results.
My reflections – 2022
I continue to believe surveys are misdirected, and customer satisfaction is often not great. According to the American Customer Satisfaction Index (ACSI), from 2010 to 2019, about 70% of the companies tracked by ACSI had declining or flat customer satisfaction scores.[i] Since then, American customers have become even more dissatisfied. As of the fourth quarter 2021, almost 80% of the companies have now failed to increase the satisfaction of their customers since 2010.[ii]
All of us can expound on examples of poor customer satisfaction. My latest example was with a major bank. I called to get some information about a financial transaction from some years ago. I was told the bank can only search back four years ago. If you are looking for something older than that, you cannot call, you must provide a request in writing. I sent them a fax with all the information they requested. After not hearing anything for several days, I called to confirm the bank had received my fax. I was told I would hear something within 20 days.
A final thought about customer satisfaction is about comparisons. AT&T should not compare itself to T-Mobile or Verizon. Wells Fargo should not compare themselves to Bank of America or Citi. Hospitals should not compare themselves to other hospitals. They should all compare themselves to Amazon and Apple and other companies with a net attitude. Companies with a net attitude don’t have great customer service because of regulators telling them they have to or because of competition. Their leaders are inspired to be as great as possible. They walk the talk. They put the customer first. They make sure the customer is satisfied with their products and services.
Now, it is time for me to practice what I preach. I have created a short survey about johnpatrick.com. It should take 1-2 minutes to complete. I really want to know what you think about it. Are my e-briefs too long or too short, are they informative, etc. All responses are anonymous, and I will share the results over the coming weeks. Please take a minute to click on the image at the top of this story or here. Thanks!
[i] “American Customer Satisfaction Index,” American Customr Satisfaction Index (2022), https://www.theacsi.org/the-acsi-difference/us-overall-customer-satisfaction/
[ii] Ibid.
Ukraine
I continue to learn a lot of interesting details everyday on the Telegram app or website.
Deputy Commander of the Azov Regiment Captain Sviatoslav Palamar in Ukraine said, “We call on the world community to evacuate civilians and I personally appeal to the Supreme Commander-in-Chief to take care of wounded soldiers who are dying in agony from inadequate treatment. Provide the opportunity to pick up the bodies of soldiers so that Ukrainians can say goodbye to their heroes. Respond appropriately to a critical situation in which the enemy does not adhere to any ethical norms, conventions or laws, destroying people in front of the whole world, guided by permissiveness and impunity! “
Covid
On May 4, there were 105,215 new cases of Covid, mostly all BA.2. Hospitalizations on May 4 were 18,516. Deaths were down, but if hospitalizations continue to climb there may be increased mortality.
The WHO dashboard shows what is going on country by country. Globally, as of May 4, 2022, there have been 512,607,587 confirmed cases of COVID-19, including 6,243,038 deaths. The WHO believes the real number of deaths is closer to 15 million. U.S. deaths are at 986,698. A total of 11.6 billion vaccine doses have been administered.
Space
SpaceX’s Crew-3 mission under NASA’s commercial crew program to the International Space Station undocked from the orbiting laboratory early Thursday morning on a Dragon capsule, splashing down a day later in the Gulf of Mexico after a six month stay.
Rocket Lab, a launch provider startup, had their 26th successful mission this week. Following SpaceX as the next launch provider aiming for reusable rockets, they attempted snatching their first stage from the air with a helicopter. The initial recovery was successful but the pilots ditched their payload. It was later recovered by ship.
– Aaron J. Patrick
Reflection Attitude
Some further progress on Reflection Attitude this week. A new in the Business chapter. Continued editing.
Wall Street
This was another really terrible week. Nobody knows where the bottom is. The ten-year above 3%. Tech continues to hemorrhage. The six GAMMAT stocks were all down and total $8.7 trillion. The other techs are way way down. I remain bullish on tech, large and small but it is going to be a long wait. Tempting to average down.
Crypto
Everything was down except the number of new cryptocurrencies. Bitcoin approaching half of its high. I continue to see signs of cryptocurrency becoming more mainstream. I got my new Gemini credit card this week. Gemini is a crypto exchange started by the Winklevoss brothers. If you use the card at a restaurant, you get 3% in Bitcoin.
Electronic Health Records
Written: May 2014
Electronic Health Records (EHRs) are part of the healthcare solution set, but also are part of the problem. For consumers, two key problems with EHRs are access and understanding. Providers of EHRs have not done a good job of explaining EHRs. There are multiple similar but unique kinds of EHR including: the EHR, electronic medical record, personal health record, and universal health record. Each has a different purpose and use depending on who is describing them. I use the abbreviation EHR throughout my writings.
Although EHRs are an important tool, it is not clear whether you should get the tool from your doctor, your hospital, pharmaceutical company, pharmacy, employer, an independent source, or all of them. Any of them can create an EHR for you. A lot of education will be necessary to understand the relative benefits. Access to an EHR for most people will be through patient portals created by hospitals or physician practices.
The New York Times published a story in January 2013, “In Second Look, Few Savings from Digital Health Records”.[i] The article said companies providing EHR software and services funded a prestigious study in 2005, which forecasted significant savings from EHRs thereby suggesting a conflict of interest. Eight years later, the same prestigious study group said savings have not been realized.
Both the Obama and the Bush administrations believed electronic medical records could provide many benefits for patients and healthcare providers. Policymakers developing the healthcare reform legislation recognized EHR benefits would materialize only if the EHRs were used in a meaningful way. The policymakers developed a set of standards, defined by The Centers for Medicare & Medicaid Services, called meaningful use. Meaningful use defined minimum U.S. government standards for EHRs outlining how clinical patient data should be exchanged between healthcare providers, between providers and insurers, and between providers and patients. Significant financial incentives were offered to healthcare providers who met the meaningful use criteria. Even a small hospital could earn millions of dollars if they met the meaningful use targets by a certain date.
Responsible healthcare executives made achieving meaningful use standards a top priority. If the team developed the comprehensive planning needed to ensure optimum implementation and maximum savings but missed the target date specified for meaningful use incentives to be earned, they would be leaving a lot of money on the table. The government incentives resulted in the desired acceleration of EHR implementations but not necessarily the cost savings expected. Some implementations were technically achieved on time but were not thoroughly tested. Clinicians and patients were not ready either. Although projected savings were missed and implementations were not as smooth as they should have been, the foundations were put in place to leverage the value of EHRs in the future.
Recently a physician friend and I discussed a broad range of healthcare issues, including the status of EHRs. We had both seen the USA Today article written by Dr. Kevin Pho, who presented a negative view of using EHRs.[ii] Dr. Pho’s main point was filling out electronic forms takes time away from the patient. I have experienced this from the patient perspective. It is frustrating to sit next to a doctor who never looks at you because he or she is too busy entering data. The time-consuming data entry task certainly detracts from the positive potential of EHRs, but it should not deter patients or doctors from embracing them.
The time-consuming nature of data entry is real for physicians. Medscape reported a survey from the American College of Physicians revealed, “As more and more physicians adopt EHR systems, they like them less and less.”[iii] Physicians not only find the data entry task demeaning, but they also have not been convinced of the benefits.
Most doctors do not find the EHR software intuitive or easy to use. The focus of the software design taken by the EHR vendors was to assure compliance with the meaningful use criteria set out by the government, not necessarily to make it easy to use. Using the EHR software can be tedious. It is especially laborious and time consuming during the transition from paper records to electronic records.
One of the solutions to the physician data entry problem is the use of scribes. A scribe is a low-level administrative assistant who is present with the doctor, and enters the data spoken by the doctor. This may make sense in an ER setting, but in the privacy of a physician examining room, it is a different story. Patients may not be comfortable fully describing symptoms or concerns with a stranger, the scribe, in the room. Technology can offer a much better solution than scribes. Voice recognition and dictation systems will make it possible for doctors to talk to the EHR instead of typing or using a scribe.
My reflections – 2022
Despite billions of dollars of investment in health information systems and technology and many years of widespread availability, the promised benefits of EHRs are still not being realized. After making an appointment in April 2022, the administrative person asked if I would like a copy of the appointment mailed to me. She didn’t mean email. She meant USPS paper mail. The paper culture is still deeply ingrained. Providers still view the fax machine as the lingua franca of healthcare.
Millions of Americans have second homes in a different state. Even if both healthcare systems use the same software vendor, it is often next to impossible to make all the data synchronized so physicians can easily see physician notes and test results from the other state.
Progress is being made but not at the pace needed to reap the potential benefits of digital healthcare. Apple has stepped into the fray and offers consumers a way to link multiple healthcare providers with the Apple Health app. This is great for the consumer, but it does not solve the lack of interoperability faced by the providers.
The use of scribes is growing and physicians I have talked to like it. Patients, however, don’t necessarily like having a person unknown to them sitting in the room during a conversation about their health concerns with the physician. Cloud based AI scribes are available. The virtual scribe receives extensive training across multiple medical disciplines. They can understand the nomenclature and clinical context of what the physician is saying. Over time, the virtual scribes can ensure consistently accurate clinical charting. Over the next five years, I expect virtual scribes to become more commonplace.
Another advance I believe will happen is the use of blockchain technology for storing EHRs. Blockchains were devised for providing the infrastructure to facilitate cryptocurrency transactions. However, a blockchain can store any kind of information including, digital art, home deeds, car titles, etc. in addition to EHRs. Storing an EHR on a blockchain can make it secure, private, auditable, and accessible to all relevant healthcare providers.
[i] Reed Abelson and Julie Creswell, “In Second Look, Few Savings from Digital Health Records,” New York Times (2013), https://www.nytimes.com/2013/01/11/business/electronic-records-systems-have-not-reduced-health-costs-report-says.html
[ii] Kevin Pho, “Column: The Doctor Will See You Now — on the Internet,” USA Today (2013), https://www.usatoday.com/story/opinion/2013/01/13/doctor-medicine-internet-visit/1830743/
[iii] Robert Lowes, “Ehr User Satisfaction Declines in Meaningful-Use Era,” Medscape (2013), http://www.medscape.com/viewarticle/780336
Ukraine
I learn a lot of interesting details everyday on the Telegram app or website. Weapons from the United States are being delivered to Ukraine using the Air Force C-17. The C-17 Globemaster III aircraft were loaded with ammunition for 155 mm howitzers from the US Air Force Travis Air Force base located on the southern edge of the Sacramento Valley. The Ukrainian Ministry of Defense says thank you to its US counterpart.
The C-17 is an amazing aircraft. It is designed to airdrop 102 paratroopers with their accompanying equipment, but it made headlines around the world for its quick decision to pack in 823 men, women, and children fleeing the Taliban. The maximum payload capacity of the C-17 is 170,900 pounds.
Vaccinations
BA.2 now accounts for nearly all cases. It is about 50% to 60% more transmissible than omicron, but it does not appear to be more severe. Hospitalizations and deaths are what we should be looking at, but we still need to be cautious because cases are growing. There were 700,097 in the last 24 hours. The number is probably low because of more in-home testing without reported results.
The WHO dashboard shows what is going on country by country. Globally, as of April 22, 2022, there have been just over a half billion confirmed cases of COVID-19. The death toll now exceeds 6.2 million. U.S. deaths have finally slowed down to less than 1,000 per day and are now at 982.3 thousand. Global vaccinations are at 11.3 billion doses administered.
Space
Let me introduce my son, Aaron J. Patrick. Aaron lives in Boston but stays on top of what is going on in the space industry. Beginning today, he will be authoring the Space section of the weekly News section on johnpatrick.com.
– John
The first all-private crew to the International Space Station (ISS) returned to Earth Monday after spending 17 days on board. No space tourists, they conducted dozens of science and technology experiments during their stay. Two days later, four NASA astronauts launched on a six month mission to ISS and docked with the orbiting laboratory the same day. They will spend the next six months on board performing experiments, space station maintenance, and public outreach. On Friday SpaceX launched another batch of Starlink satellites into orbit. Starlink is a satellite-based Internet service designed, built, and operated by Spacex that will ultimately be capable of providing connectivity anywhere on Earth with thousands of satellites orbiting the planet. SpaceX is on target to exceed 50 launches this year, or about one a week.
In other space news, the James Webb Space Telescope has completed the process of calibrating all four of its main science instruments. This is a major milestone, which allows the instruments to begin the commissioning phase before becoming ready for science operations in the next few months. The operating temperature of the telescope is approximately -380 degrees fahrenheit.
– Aaron J. Patrick
Reflection Attitude
Some progress on Reflection Attitude this week. Another new story for the Health chapter. Continued editing.
Wall Street
This was a really terrible April. Today felt like 2008. Is there no bottom? The ten-year is steady at 2.9%. Tech continues to bleed and now hemorrhaging. The six GAMMAT stocks were all down and total $8.9 trillion but 23% of S&P 500. The other techs are way way down. I remain bullish on tech, large and small but it is going to be a long wait.
Crypto
Every week I see signs of cryptocurrency becoming more mainstream. This week Fidelity announced it would let retirement accounts they manage for corporate clients to allow employees to put part of their retirement savings in cryptocurrency. They set a limit of 20% but I believe the employers will reduce that to 5 or 10%. Another significant development is Goldman Sachs made its first Bitcoin-backed loan. The global investment bank allowed a borrower to use the cryptocurrency as collateral for a cash loan. High volatility continued, but I believe it will eventually stabilize.
