Secure email is nearly always implemented as a portal-based system in practice. It’s also typically only used for one-off exchanges. It’s not our first-line method of communication, but it gets used within the facility literally every day.

HIE portals are more commonly used for provider-to-provider exchange that doesn’t justify full data integration.

At any rate, the fundamental point stands: regulatory compliance has absolutely nothing to do with why faxes are still in use in the industry.

To be clear, this is specifically what I was calling incorrect:

An email, even an encrypted one, is not.

Faxes are one compliant means of electronic communication. They’re just not the only one. Secure email is fine.

That’s likely a peculiarity of the niche you’re in. HL7/FIHR are the norm for enterprise-level systems. Hospitals couldn’t function without it and at any given time we typically have multiple HL7 integration projects rolling just as a mid-size regional.

Definitely less defined in the small-practice and patient-side space. Though, like I said, the big problem there ends up being data normalization anyway.

There’s no one standard…except for faxes.

HL7 and FHIR have been around for decades. Exchanging data is actually the easy part.

The problem is typically more on the business logic side of things. Good example is the fact that matching a patient to a particular record between facilities is a much harder problem than people realize because there are so many ways to implement patient identifiers differently and for whoever inputs a record to screw up entry. Another is the fact that sex/gender codes can be implemented wildly differently between facilities. Matching data between systems is the really hard part.

(I used to do HL7 integration, but have since moved more to the systems side of things).

Such a company has little motivation to completely change to something new, since they’d have to retain this for anyone that hasn’t switched.

They’ve had motivation since the HITECH Act passed in 2009. Medicare/Medicaid compensation is increasingly directly tied to real adoption of modern electronic records, availability, and interoperability. Most healthcare orgs rely heavily on Medicare/Medicaid revenue, so that’s a big, big deal.

You’re dealing with it first hand, so you know what’s involved.

I do. Which is why I’m actively and aggressively removing fax machines from our environment. Efaxing (e.g., fax-to-email gateways) will stick around for back-compatibility purposes with outside organizations, but the overall industry trend is to do everything you can to minimize the footprint of fax machines because they’ve traditionally been used in ways that will cost the company serious revenue if they cause you to miss CMS measures.

Speaking as someone who works directly in the field: this is just plain factually incorrect. Encrypted email is compliant with patient privacy regulations in the US.

The issue is entirely cultural. Faxes are embedded in many workflows across the industry and people are resistant to change in general. They use faxes because it’s what they’re used to. Faxes are worse in nearly every way than other regulatory-compliant means of communication outside of “this is what we’re used to and already setup to do.”

I am actively working on projects that involve taking fax machines away from clinicians and backend administrators. There are literally zero technical or regulatory hurdles; the difficulty is entirely political.

Wattage = V x A.

They’re pointing out that it’s impossible to hold both wattage and voltage constant while changing the amperage.

I’m guessing you weren’t around in the 90s then? Because the amount of money set on fire on stupid dotcom startups was also staggering.

The scale is very different. OpenAI needs to raise capital at a valuation far higher than any other startup in history just to keep the doors open another 18-24 months. And then continue to do so.

There’s also a very large difference between far ranging bad investments and extremely concentrated ones. The current bubble is distinctly the latter. There hasn’t really been a bubble completely dependent on massive capital investments by a handful of major players like this before.

There’s OpenAI and Anthropic (and by proxy MS/Google/Amazon). Meta is a lesser player. Musk-backed companies are pretty much teetering at the edge of also rans and there’s a huge cliff for everything after that.

It’s hard for me to imagine investors that don’t understand the technology now but getting burned by it being enthusiastic about investing in a new technology they don’t understand that promises the same things, but is totally different this time, trust me. Institutional and systemic trauma is real.

(took about 15 years because 2008 happened).

I mean, that’s kind of exactly what I’m saying? Not that it’s irrecoverable, but that losing a decade plus of progress is significant. I think the disconnect is that you don’t seem to think that’s a big deal as long as things eventually bounce back. I see that as potentially losing out on a generation worth of researchers and one of the largest opportunity costs associated with the LLM craze.

Sure, but those are largely the big tech companies you’re talking about, and research tends to come from universities and private orgs.

Well, that’s because the hyperscalers are the only ones who can afford it at this point. Altman has said ChatGPT 4 training cost in the neighborhood of $100M (largely subsidized by Microsoft). The scale of capital being set on fire in the pursuit of LLMs is just staggering. That’s why I think the failure of LLMs will have serious knock-on effects with AI research generally.

To be clear: I don’t disagree with you re: the fact that AI research will continue and will eventually recover. I just think that if the LLM bubble pops, it’s going to set things back for years because it will be much more difficult for researchers to get funded for a long time going forward. It won’t be “LLMs fail and everyone else continues on as normal,” it’s going to be “LLMs fail and have significant collateral damage on the research community.”

There is real risk that the hype cycle around LLMs will smother other research in the cradle when the bubble pops.

The hyperscalers are dumping tens of billions of dollars into infrastructure investment every single quarter right now on the promise of LLMs. If LLMs don’t turn into something with a tangible ROI, the term AI will become every bit as radioactive to investors in the future as it is lucrative right now.

Viable paths of research will become much harder to fund if investors get burned because the business model they’re funding right now doesn’t solidify beyond “trust us bro.”

The old FourSevens Quarks used to rotate the tailcap the switch between modes. The newer models since they got bought out ditched it which sucks because it was such a simple interface.

I got a couple of Fenix lights recently that I don’t hate. They still do the “cycle through modes with a button” thing, but it’s at least a dedicated button separate from the tailcap switch.

Because Google holds a monopoly position and Epic doesn’t.

That said, the irony didn’t escape me either.

Crowdstrike is very entrenched in healthcare. Hospitals were routinely at capacity in 2020.

The outage this weekend probably killed some people due to disruptions in delivering care. It definitely would have then.

As somebody that’s a paying Kagi user and generally happy with the service, it is interesting seeing exactly where the tradeoffs are.

While I’d say Kagi pretty much universally returns better results for technical information or things like recipes where it deprioritizes search spam, it’s also pretty clear that there are other areas where the absence of targeting hurts results. Any type of localized results, e.g., searching for nearby restaurants or other businesses tends to be really hit or miss and I tend to fall back to Google there.

Of course, that’s because Kagi is avoiding targeting to the point where they don’t even use your general location to prioritize results. It’s an interesting balancing act and I’m not quite sure they’ve hit the sweet spot yet, at least for me personally, but I like the overall mission and the results for most searches so I’m happy with the overall experience currently.

Searches are supposed to be fast at giving you the answer you’re looking for. But that is antithetical to advertising.

And we have evidence that this is exactly why it happened, too:

https://www.wheresyoured.at/the-men-who-killed-google/

While I’d highly recommend giving either the article a read or the companion podcast a listen because Ed Zitron did some fantastic reporting on this, the tl;dr is that a couple of years ago, there was direct conflict between the search and advertising wings of Google over search query metrics.

The advertising teams wanted the metrics to go up to help juice ad numbers. The search team rightly understood that there were plenty of ways they could do so, but that it would make for a worse user experience. The advertising team won.

The head of the advertising team during this was a man named Prabhakar Raghavan. Roughly a year later, he became the head of Google Search. And the timing of all this lines up with when people started noting Google just getting worse and worse to actually use.

Oh, and the icing on the cake? Raghavan’s previous job? Head of Yahoo Search just before that business cratered to the point that Yahoo decided to just become a bing frontend.

Zitron is fond of saying that these people have names and it’s important that we know who’s making the decisions that are actively making the world of tech worse for everyone; I tend to agree.

Tree nested communication is much more superior than traditional thread based communication

Heavily depends, IMO.

Nested threads are great temporary discussion of a specific story or idea. They’re absolutely miserable for long-running discussions. New posts get lost in the tree and information ends up scattered across multiple threads as a result.

It’s also been my personal experience that the nested threads format just doesn’t seem to build communities in the same way forums did. I have real-life friendships that were made on forums decades ago and I never had that experience with reddit despite being a very early user.

I don’t think that’s entirely due to the ephemeral format, but I do think it plays a part in it. A deep thread between two people on Reddit might last a few hours and a dozen replies before it falls off the page. On forums threads running months or years were pretty common, and that kind of engagement with the same people certainly changes how your relationships develop with them.

80%+ of severe injury and death on a bicycle is caused by motor vehicles, or complications of motor vehicle involvement.

Which would mean ~1 in 5 have absolutely nothing to do with a motor vehicle. That’s significant.

There is considerable evidence that everyone wearing a helmet in a car would save vastly more lives and prevent severe head injury

Then that should be an easy [citation needed] for you because my searches are coming up blank for actual studies. Lots of assertions of it, but I’m not finding anything in terms of actual data.

It’s very easy, on the other hand, to find comprehensive meta analyses on the efficacy of helmet use.

It’s also worth noting that the introduction makes a point of calling out another common online assertion that you repeated – that helmets make people engage in more risk-taking behavior – as false:

There has already been an extensive peer-reviewed literature review conducted by Esmaeilikia et al.5, which found little to no support for increased risk-taking when cyclists use helmets and if anything, they cycled with more caution.

I don’t feel those people should be called stupid for their choice.

I don’t think they’re stupid. I think they’re bad at risk analysis. That’s a pretty inherent feature of humans. It’s the reason I want to see actual data.

A helmet is only needed if you intend to spend significant time in traffic.

The worst wreck I’ve ever had on a bike was without a single car in sight. Pinch flat while carrying speed through a steep downhill curve. I split an expensive MIPS helmet in two and still hit hard enough that I had a minor concussion, road rash up one side of my body, and cracked the face of a week old watch just to pour salt in the (metaphorical) wound. I mostly landed on my head and that helmet is the reason I didn’t have drastically more severe head injuries.

Helmets aren’t just for traffic.

His Forrester is built on a Legacy chassis; it’s a four door sedan with a little lift and a bigger body shell on top.