1,443 karma · joined March 23, 2009
[ my public key: https://keybase.io/kgrinberg; my proof: https://keybase.io/kgrinberg/sigs/WEI_d3HGjUIUBsOtsfBAyLlxPP2GxVWvgMAg5oxxwJE ]
Apparently it's a sort-of-known issue, the workaround is to turn off WiFi before starting your call (wtf?) or use another carrier.
Google, wyd?
We're a custom dev agency, specializing (but not exclusively) in Django. We work with a diverse roster of interesting clients, across different industries (everything from healthcare to rock'n'roll).
We've been in business for 12 years, and the company is profitable. We're currently three full-time developers, looking to add an additional developer and our first in-house full time designer to the crew.
Details: https://www.activefrequency.com/join-us
kevin _at_ activefrequency.com
It gets into some (though hardly all) of the issues of why EHR software is the way it is, and why (some) doctors hate it. (Among my friends who are doctors, some hate Epic, and some absolutely love it - depends on specialty, age, institution, how it's configured, etc.)
Among some interesting issues:
- As others in this thread have noted, the buyer (administrator concerned with maximizing billing) is not the user. That's the easy one that's common to a lot of enterprises.
- Epic makes it easier for medical directors to track population health and impose standard protocols of care. Individual practitioners don't always like that! I am not expert enough in those fields to say who's right, and I suspect there's not always an obviously correct answer.
- A lot of doctors dislike the underlying mechanic - being forced to actually write down everything they're doing and why - on top of sub-par UIs. The goals of the system conflict with the goals of the practitioner.
- Interoperability sucks, but it's true that standards aren't really there, and it's hard to get consensus... plus everything you put in prod needs to be back-compatible approximately forever. A lot of institutions got burned by maintaining internal software built over decades that you can't turn off because lives depend on it, and Epic/etc. are part of trying to avoid repeating that mistake.
There's more. I only have a toehold in that world now, but love to chat about it. Email in profile.
There are a lot of details, though, that make this complicated and not necessarily viable for all states (MA is both relatively wealthy, has relatively wealthy neighboring states, and has a somewhat unusual healthcare market).
nslookup techblog.netflix.com 8.8.8.8
Yes, eventually you'll (hopefully) upgrade all your projects to the newest and shiniest versions of all your dependencies, but if you need to maintain some semblance of stability, that's not always immediately possible/practical.
Rough ballpark: 300 million combos - let's say you buy 6000 tickets/hour (which I think is actually optimistic probably by a full order of magnitude), for 25 hours a day (assume shifts and magic days), you're still looking at 2,000 person-days.
There are of course also the extreme cases of specifically asking for a given prescription, but like the parent mentioned, just having a few patients persistently ask the doc about X is enough of a motivator to get the doctor to pay [marginally] more attention to the doctor-facing literature/ads/sales force.
Granted - I'm a tiny account (3 employees). That said, it's frustrating that it takes weeks to get answers to questions (some simple, some less so). When I finally do get someone's attention, the resolution is generally a good one, but it just feels like they're flat-out understaffed on the support side - which is disconcerting when dealing with things like payroll, taxes, etc.
I certainly wish ZP all the best, and perhaps this expansion into new lines of business will help them hire more support staff... but a part of me feels like, "guys, get your house in order first before your start expanding."
Obviously you're not (currently) targeting Big Enterprise, but even within your present target market there's got to be a difference in how much value you're delivering for different clients... price based on that!
The trade-off is: they do a background check and take some biometrics, and in exchange you can skip the conversation with an immigration agent where they ask you where you're been, etc. - you just answer the usual customs-form questions at a kiosk.
It's actually a pretty reasonable trade-off, and speeds the process of going through Customs - which, unlike some of the TSA stuff, is in no way unique to the US (having gone through immigration/customs in 20+ countries, I can say with some experience that the US is far from the worst...)
Is it though? I live in Boston, home of the notorious* Big Dig[1]. While particularly egregious, it's far from the only large-scale civil engineering project that's gone off the rails. In fact, I'd argue that until fairly recently, many more public works projects shared the "surprise factor" of software projects. I'd recommend Caro's "The Power Broker"[2] for a fascinating history of NY-area public works (among other things - great book all around), including how much of that process was about adapting the plan to new things the builders were learning along the way ("oh, turns out that soil is completely different than we planned...")
That's not to say that there aren't particular features that make software engineering its own special snowflake - as there are meaningful differences between how civil, structural, mechanical, etc. engineers operate. But spend some time in another engineering organization and you'll find it's different, but not as different as you think it is.
(And FWIW, even civil engineers sometimes follow "agile" concepts - a company I once worked for was contracted to design a highway, and even after the construction started, engineers were "embedded" with the builders to make on-the-fly adjustments based on the environmental factors they discovered throughout the process... I wish I could find their project write-up, but it was a while ago and the company has long since been gobbled up by a bigger company).
* As a (subjective) kicker, I'd add that the Big Dig, over-time and over-budget as it was, was ultimately quite worth it... much like many software projects!
[1] http://en.wikipedia.org/wiki/Big_Dig
[2] http://www.amazon.com/The-Power-Broker-Robert-Moses/dp/03947...
YMMV of course, but iOS/Android (and Dragon/et. al.) are pretty good at recognizing words, less so entire sentences - and remember, this is 5 years ago, so adjust accordingly (unsurprisingly, consumer-grade speech recognition has improved dramatically in the past half-decade).
Indeed, early on in Android's life, Google was much more hands-off with the OEMs, letting a thousand flowers bloom... we got fragmentation and subpar devices, developers and consumers complained, and Google set forth on tightening the reins and exerting more control such that when people buy an "Android" phone, it means a particular experience. (And of course there's nothing stopping OEMs from shipping AOSP-based devices and just not calling them Android - as in fact a number have done).
It may be a clever hack for a few early adopters, but is likely to be somewhat self-defeating if/as it grows. (Though in fairness, "shipment auditing" is a much bigger and more interesting play than refund harvesting specifically).
> Are women your target audience?
Not exclusively, but they're ~50% of the population, so they're certainly a part of it!
> Why no option to import my likes from last.fm, IMDB, or something similar?
Working on it!
> How do you guys come up with your people to like?
A combination of manual curation and what's trending/etc. You can also type in a like that's not in "Likeables" in the text box at the top right, but it sounds like that's not as discoverable as it should be!
I'll check on those two - I think you're right that synonym support will be important.