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.

The old FourSevens Quarks used to rotate the tailcap the switch between modes. I’ve got one of the older QT2L-Xs that’s probably my favorite light ever for that reason. That and it’s the perfect size for pocket carry while still being decently bright. 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.

You tell them you don’t work for $500.

Or you tell them that you do.

Per hour.

But since they’re clearly such great mates with dad, you can cut them a deal.

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.

They literally show in the video that the majority of the surface area on the RAM truck they filmed was blocked off by plastic paneling because it’s not needed to actually cool the motor. A large part of the point is that these grills don’t have any actual utility and are killing people for purely aesthetic reasons.

There are plenty of good arguments in favor of EVs; this specific issue is not one of them.

It’s part of his Jeff Bezos rowboat video.

https://youtu.be/VGhcSupkNs8

All of his videos are brilliant but that one is unironically a masterpiece of a production.

You can also just spend $10 on a domain name with a registrar that offers dynamic DNS. Offhand, both Namecheap and Cloudflare do. I have no idea what my public IP address is because my router just updates it automatically for me. Plenty of DDNS desktop clients around if your router can’t for whatever reason.

I generally remap to swap caps lock with left control. Having control on the home row makes Ctrl shortcuts way less of a contortion act.

Useful in general but especially so on laptop keyboards.

PEDS aren’t limited to bulking up via steroids. A lot of PEDS use is about shortening recovery time. As an example, cycling is the kind of sport you’re describing where increased bulk is a disadvantage and doping in the sport has been absolutely endemic for years. It’s what the Lance Armstrong controversy was about and Armstrong was more representative of the norm at high levels than not.

Healthcare is consistently the most targeted industry for these types of attacks and it’s an industry where both vendors have traditionally had very lax security postures and where IT tends to be severely understaffed and underfunded since executives have viewed it as a non-core cost center.

In reality, hospitals are extremely data heavy organizations these days, but the people running them have been extremely slow to recognize and embrace this fact. It’s going to take a very long time for most healthcare organizations to get up to modern security standards and practices.

And, based on recent events in Crimea, may be of limited effectiveness in any future conflict.

Wasn’t this one where they just outright invented ‘facts’ wholesale?