commandar

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.

lol and this is exactly why that decision was so baffling.

The game has absolutely nothing to do with the 3D Realms Prey game. It's truer to System Shock than the Bioshock series ever was. It routinely goes on sale for next to nothing -- highly recommended if you're a fan of SS2.

This is ridiculously well trod ground, but Prey also wasn't at all helped by Bethesda's marketing.

They had what is probably the truest successor to System Shock 2 that's been made on their hands and Bethesda made Arkane use the title of a 15 year old portal based shooter that had absolutely no relation to the game and didn't do particularly well because they owned the IP.

The entire Bethesda-Arkane relationship has been pretty thoroughly mismanaged.

A cheap Allwinner SoC has enough compute to do what they're showing. So, yeah, China.

Likely more expensive since you need enough onboard compute to run the computer vision.

That said, it's potentially reusable. The next logical step would be to add some sort of tether that entangles the target drone. Right now, it's just relying on direct impact to knock the other drone out of the sky, but all you really need to do is ensnare the props. That's doable without destroying the hunter drone.

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."