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.

our last “just war” that was even a little cut and dry was world war two.

The Balkans were pretty cut and dry in justified intent.

It was an intervention into the worst genocide in Europe since WW2. We’re talking not only wholesale slaughter of civilians, but even the establishment of literal rape camps as part of an organized, systemic campaign of ethnic cleansing. What was happening in the former Yugoslavia was absolutely horrific and the US and NATO stepping in to put an end to it was an unequivocally good thing.

That said, there were still questionable incidents like the “accidental” bombing of the Chinese embassy or the numerous cases of civilians killed by NATO bombs. But that mostly emphasizes the fact that there’s no such thing as a clean war. War is always going to leave blood on your hands, even if it’s being fought for the right reasons.

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.

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.

This comment is kind of fascinating because it’s essentially reinventing Slashdot’s metamoderation system 25 years later.

It was good then. No reason it wouldn’t work again today.

Kurt Cobain has been dead longer than Kurt Cobain was alive at this point.

I had a few years of young and dumb followed by struggling through the great recession that pretty well wrecked my credit early on.

I then went through a few years while rebuilding where I really dug into learning how the credit system works and gaming it to my advantage. It was literally a case of getting entertainment out of “number goes up.” I got bored with it once my available lines of credit hit a couple multiples of my annual income, but the end result was having a basically perfect credit score.

It ultimately paid off when it came time to buy a car and get a mortgage. Basically had immediate access to the absolute best rates available and approvals have always gone super smooth.

The flip side of that is my SO who never went through the young and dumb stage and hadn’t needed to rebuild credit, but had a similar “fuck credit” attitude as the OP so they’d never had credit in the first place. The fortunate thing there is we were able to jump start their credit history by adding them as an authorized user on one of my older accounts with a high line of credit – this gave a massive boost to both average account age and available credit and pretty much instantly brought their score up from the 5-600s to low 700s. Add in a few more deliberate things like financing a car instead of paying cash and now they’ve got enough of a credit profile built up that it’ll be okay if anything ever happens to me.

Obviously, that requires a lot of trust, but it’s good info for relationships where one partner has established credit and the other doesn’t.

For myself, I simply dislike the usury present in the debt market for consumers and have decided not to engage with it.

You’re engaged with it whether you like it or not.

Credit cards are a reality of the modern economy. There are costs associated with every credit card transaction and, due to the ubiquity of credit cards, those costs are priced in to nearly every single purchase you make. Because most merchants charge the same price regardless of payment type, this effectively means that your cash purchases are subsidizing my purchases made with a rewards credit card that has its balance paid off each month by a couple of percent.

You can choose to opt out, but that doesn’t mean you’re not playing the game either way.

I request a credit increase every time I get a raise or every 6 months, whichever happens first. Why get credit I dont need? In case I ever do need it, but more important is that debt ratio. That is what gets you good loan rates. Do it before you need it, and you will be set.

There’s also a feedback loop here – once the credit limit increase hits your report, other creditors see it and are more likely to extend increased limits to you. I went through a few years where AmEx and Discover both seemed intent on being my highest limit card and would preemptively offer CLIs after the other one had.

And to expound on your point re: credit utilization ratios - this is another area where having higher limits than you need helps. Your percentage utilized of available credit has a huge impact on your overall score. Having a higher limit means that if you need to carry a balance due to an emergency spend, it’ll have less impact on your score.

e.g., you have an emergency expense of $700 with a line of credit of $1000. Your utilization is now at 70%. This will have a negative impact on your score pretty quickly.

Take the same $700 spend and apply it to a $5000 line of credit and you’re only at 14% utilization. That’ll still have an impact but much less than anything over ~30% utilization.

Even beyond emergencies, if you use a credit card to pay fixed bills each month and then immediately pay them off, you’ll occasionally have months where the payment credits after your statement date and hits your credit report – same deal there. It looks much better on your report if that balance is a fraction of your available credit than if it takes up a large chunk of it.

The last point is purely a configuration thing. Our Teams instance only keeps DMs for I think 30ish days – legal wants to minimize the surface area of discoverable material. Same reason our Exchange instance nukes emails over 12 months old unless you manually move them to an archive.