About Me

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I have worked in health care information management for more than 13 years. I have been a patient of many physicians for much longer. I have found most physicians to be devoted and conscientious but captive to systems and processes that they often don't even think about. We could all benefit from better communication. I'm on LinkedIn (http://www.linkedin.com/in/mpmeier)

Tuesday, September 3, 2013

Governor, You're Misguided

Before I begin, I do understand the complexity of balancing government services with minimizing the tax burden on citizens.  This balancing act is performed at every level of government including school districts.

I have lived and paid taxes in Iowa, Minnesota and Ohio both as an individual and as a business owner.  These things I know:
  1. Ohio has far and away the most byzantine und unnecessarily complicated tax reporting structure I have ever encountered.
  2. No business owner or entrepreneur makes decisions on where to locate based on tax rates alone.
  3. As a partner in an Ohio business, I was required to make monthly and/or quarterly reports (and payments) to no fewer than five separate taxing bodies within the state of Ohio.
  4. Each of these taxing bodies was interested in the same information with only a few minor differences.
Ohio's government is currently directed by self-described fiscal conservatives who advocate for smaller and more efficient government AND reduced tax rates.  The situation described above (1-4) cries out for simplification and streamlining.  One would think that this would be a natural focus for these [fiscal] conservatives.  Instead, we get promises of reduced rates with no reduction in complexity.  There seems to be an assumption that everyone has an accountant or a lawyer (or both) retained to handle the tax relationships with the State of Ohio.  If we really want to encourage entrepreneurism, we need to re-examine the entire Ohio tax situation.

One suggestion, Governor, is to give new business startups a three-year running start with no business taxes of any kind during that time.  From my own experience, starting a new business usually means doing everything yourself.  Tax reporting in Ohio diverts an amazing amount of attention and effort away from where it really needs to be.

Maybe in three years I'll be able to afford to hire an accountant and/or lawyer but until then I have to do it myself.  A side effect of DIY tax accounting is mistakes and the fallout from those mistakes.  It's really no wonder that so many new business starts last less than three years.  How much I pay is important but manageable.  How I pay is even more important and is unmanageable.  Most new business starts do not go to investment bankers, they are forced to use sweat equity wherein the owner's time is the most important component and the only resource with a hard limit.

Governor, saving those with incomes > $350,000 an additional $10,000 MIGHT help you get reelected but it isn't going to win you very many friends.

Flag Frustration

We just returned from a walk here in central Ohio.  During the course of this 20 minute walk we passed several businesses as well as a Post Office.  What I noticed this morning was the flag poles, each of which displayed the US flag and some of which displayed the Ohio state pennant as well as (in one case) an ISO flag.

Some but not all displayed the US flag at half-staff.

I spent several years as a Cub Scout/Boy Scout/Explorer and many more as an adult leader.  I spent 5+ years on active duty with the Air Force at bases and Army posts in Texas, California, Alaska and Berlin (which was not part of Germany at that time).  I guess I have soaked up something about the proper display of the flag.

  1. ALL US flags are flown at half-staff or NONE are.  This is not individual choice.
  2. No one is forced to display the flag so if we choose to do so, we owe it to the community to do it properly.
  3. Half-staff is accomplished by raising the flag to the top of the mast or staff and then lowering it to a point (at least) one-third of the way down.  This half-staff position is designed to keep large flags from touching the ground or interfering with pedestrian or other traffic.  This may be especially important when multiple flags are flown from the same halyard (rope).
  4. The flag should be in good condition and not visibly dirty or frayed.
  5. Unless the flag is lit, it should be retired at dusk and during inclement weather. 
These come from the manual from which NCOs are tested to qualify for promotion.

If you search the internet for flag etiquette you will find many interpretations, some of which refer to laws governing flags and their display.  US law is summarized at http://www.senate.gov/reference/resources/pdf/RL30243.pdf

The President or the Governor of a state or possession may order flags in their jurisdiction to be flown at half staff.  There is no authority for anyone else to do so.

Why display a flag?  Some sites are prescribed in the law.  All others are optional.  Typically the flag is displayed in the interest of patriotism.  While feelings of patriotism are desirable, display of the flag for this purpose is optional.  A patriot will become informed about the laws and traditions in order to display the flag intentionally to reflect on himself and his country. 

I'm going to try to put this aside now so that I can enjoy my walks again.

Wednesday, June 12, 2013

PRISM and Me

Nothing that calls itself "news" is complete today without offering something about the NSA's project (called PRISM) to gather information about telephone and internet traffic.  My ears perked up when I heard the term "metadata".  Call me a geek or a wonk, but data has been where I lived for the past thirty years. 

Getting anyone at all to pay attention to something called metadata has been harder than making the average person care about mathematics or history.  Now that it's out there in the public vocabulary, its use brings up several other issues.

  1. The use of the term seems calculated to disarm suspicion.  It's just metadata about your communications and not the communications themselves so don't get your underwear in a knot.
  2. The term is used in a way that is inappropriate to the issue.  It wouldn't matter to the issue of government intrusion if it was the actual communications that were being monitored.
  3. I heard a man on a call-in show the other day talking about "my information" as though he were the owner of the information merely because it concerned something that he did.
  4. There has been much discussion of exchanging privacy for security.  That discussion is moot when the privacy being discussed extends only to data.  If there is anything at all to be learned from cyber-bullying or phishing scams or on-line impersonations it is that the information itself has no value.  It is only the use to which the information is applied that has any ethical or moral value.  I realize that this is the same argument advanced by gun control opponents but on this, at least, they have a valid point.  THERE IS NO PRIVACY.  THERE IS NO SECURITY.  There is only more (or less) private and more (or less) secure.
  5. Finally (for this post) the term metadata is defined in these reports as data about data.  This is semantic sleight of hand.  What is data and what is data about that data shifts as we go from person to person or perspective to perspective.  ATT and Verizon do not record calls (we hope) so the information being gathered by the NSA is data and NOT metadata.  The information is what the communications companies use for billing purposes.  Yes, from the perspective of the caller or the callee, this could be thought of as metadata if they thought of it at all prior to PRISM but here is a case in which a new piece of knowledge (or data) causes the world to recognize something that never existed before--namely metadata about their communications.
Is the government (in the person of an agency, NSA, tasked with National Security through application of electronic rather than human resources) acting legally?  Given that the government defines "legal", the answer has to be "Hah!"  This is what the NSA does on a worldwide basis though not usually by coercing companies into handing over information.  Would the answer be any different if the NSA hacked the corporate servers that store all of this communication-related data?

Bottom line: if situations like this one are the only time we pay attention, we deserve whatever happens.

Friday, March 29, 2013

Jon Stewart Don't Know Squat About Data

This past Wednesday (Mar 27, 2013), the Daily Show included a segment on the backlogs within the VA and found the cause to be
  • The reliance on paper to transfer medical records between the DoD and the VA
So far, so good. Good investigative reporting. If they had only left it at that and allowed viewers to form their own conclusions...

Instead, John Stewart made a joke about validating his preconceived ideas concerning Republican responsibility. He played a clip of a Republican member of the Defense Appropriations committe comparing AHLTA (the DoD healthcare information system) and VistA (the VA's Healthcare Information umbrella) to Play Station and X-Box which, though both can use the same TV, cannot talk to one another. AND THEN Mr.Stewart suggested that the parent of the household, if he/she wanted to minimize contention and confusion, could impose a single solution on the household. A photo of President Obama was displayed during this, clearly indicating that all the blame could be laid at the President's feet.

Nothing could be further from the truth. The VA has been assembling the components of VistA since 1987 and it was fully formed by the late 1990s. AHLTA was introduced amidst much fanfare at the beginning of 2004. The birthing process for AHLTA overlapped the adolescence and maturation of VistA, indicating a conscious decision (pre-2004) by the DoD to ignore the VA's efforts.

This entire mess is too complex in its origins and effects to discuss in a single blog entry so I'll content myself with one last piece of exculpatory evidence on behalf of anyone who has assumed elected office since 2004. The only way to move information from AHLTA to VistA is
  1. Generate paper from AHLTA
  2. Send the paper to the VA
  3. Enter the information from the paper into VistA
This is also the reason why the DoD can't simply replace AHLTA with VistA.

There is a lot more to be said on this subject but, among other things, it seems clear that this is but one (albeit very painful) example of the inability of our health care "system" to adopt anything approaching a standardized view of the enterprise. Interoperability is something to be wished for but which cannot exist in an environment in which healthcare systems vendors are the X-Box, the Play Station, and Wii.

Monday, December 24, 2012

Violence and Firearms

A statistic led me to this point.  In reporting on the NRA's response to the Newtown tragedy, the networks reported that the organization has 4 million members.  I was struck by the small number and how disproportionate was their influence.

In a nation of 300 million people, how does 1.3% of that population get to control the debate on the regulation of firearms manufacture, sales and ownership?

Some background on my perspective: I have owned several firearms--as many as three shotguns, two rifles, two handguns and an air rifle at one time.  I enjoy hunting, target shooting and taking care of the weapons.  I do not own or possess any firearms currently.  In the interests of full disclosure, I should also say that I have been a member of the NRA.

Now that those cards are on the table, my opinion of the NRA is that it is an extremist organization.  When I was a member, I was sent messages and asked to pass them along to my elected representatives and/or network media figures.  The language in these messages was, to my mind, extreme and I could not, in good conscience, do as requested by Wayne Lapierre or Charlton Heston.

So how does the NRA wield so much influence?  It's mainly because their voice is the well-orchestrated one.  A voice for something always drowns out the voice against.  They have consistently made the issue about the Constitution and for a right cited in the Second Amendment.  The opposition, such as the Brady Campaign to Prevent Gun Violence, is portrayed as being against the "right" cited in the Second Amendment.

This much is obvious, right?  It's also obvious that the voice that is heard is easily interpreted as the majority.  The NRA is very good at whipping up a frenzy of fearful indignation amongst the membership.  They can generate 4 million (I don't imagine there were too many others like me) emails, letters and phone calls, frequently to multiple targets.  The Brady Campaign can't do this nearly as well.

As we saw in Mr. Lapierre's most recent statements, it is easy to sow seeds of confusion and generate several tangential debates while all the while adamantly holding the flag of the Second Amendment high and calling on loyal Americans to rally to its defense.

In fact, there is no justification for high-capacity magazines and high rate-of-fire except as a thrill for certain kinds of enthusiasts.  (There must be another term for an enthusiastic extremist--or maybe enthusiastic is redundant.)  You can get quite a thrill from cocaine or meth, too, but those thrills are illegal.  I have been in the woods during deer season and heard a single weapon discharge 10,15,or more rounds in the space of a few seconds.  It made me profoundly uneasy as I sat there with my single-shot rifle.  Thrills for a few are not sufficient justification for the level of danger presented.

The Second Amendment could be satisfied with a muzzle loading black powder weapon.  Let's shrug off the "right to keep and bear arms" as the central issue and stay focused on issues more central to the public welfare.

Saturday, December 8, 2012

Grace

Grace is the slender but unbreakable thread upon which we are all suspended.  If you happen to be a Christian (as I am) you should know this already.  Other faiths may share this dependence in some way.  Buddhists, for example practice to become at one with life, accepting everything as part of the journey, believing that it is possible to transcend the journey.

I'm sure that Buddhists would express this differently and I won't even attempt a similar expression for Islam or the other religions.

In my mind the most elegant expression of grace is the story (in John chapter 8) of the woman who was apprehended in adultery and brought to Jesus as a test.  Jesus had given the religious Jews the idea that he might not support the ancient Law.  They asked Jesus to condemn the woman according to the Law.  As you will recall, he agreed that she had violated the Law and suggested that whoever among them had not violated the Law should be the one to throw the first stone.

One by one they were shamed by this until none were left.  At this point Jesus asked the woman who was condemning her.  When she answered that there was no one, he said, "Neither do I condemn you."

That's grace.  He then sent her on her way, suggesting that she give up her life of sin.  It would be startling to find out that she had been stoned the very next week after being caught in adultery again.  I put myself in the shoes of this woman and think that if I had been required to confess in order to escape punishment, I would certainly have done so.  Then I would have begun resenting that coercion immediately.  That resentment would certainly have led me back to the sinful life.

It is critical to the concept of Grace that Jesus never asked the woman for anything.  No seed of resentment was planted.  I could walk away completely free and begin at that moment a new kind of life. 

If you believe that confession is a prerequisite to forgiveness, you're probably not a parent.  As a parent, I know that I can demand a confession and apology and I will probably get them.  I also know that an assurance of love and forgiveness will elicit truly sincere remorse including repentance.  Repentance in avoidance of punishment is cheap and unreliable.  Repentance in response to forgiveness (grace) can last the rest of one's life.

You are loved and your are forgiven.  Let your life be a response to that.

Sunday, December 2, 2012

The Origin of Species (When is a theory not a theory?)

There are just a couple of things that continue to bother me when discussion turns to evolution. 

First, we're told that this theory explains how higher organisms (like us) gradually developed from much simpler organisms.  This is based on observations of certain small birds which are identical to other small birds except that their beaks are longer (or shaped differently).  We're told that the difference happened by accident (a mutation) and that this accident allowed the mutant bird to survive in a changing environment.  We're told that the mutation was passed on to offspring and that, over time, the birds showed a mating preference for others with the same beak so that after many generations, all descendants of the original mutant possessed the new beak.

This part is believable, though improbable.  The likelihood of a stable mutation that can be genetically transmitted to offspring is small.  The likelihood of the original mutant surviving to produce offspring is small.  The likelihood of the mutant successfully mating, given that differences are generally not accepted by prospective mates, is quite small.  The likelihood of sufficient mutants reaching adulthood and mating with one another to produce a stable breeding population is very small.  Entire breeding populations (known as flocks or herds or packs...are often wiped out completely by sickness, fire, storm, famine or any of a host of devices that nature keeps for such purposes.

As you may know, the probability of a series of things happening together is the product of their individual probabilities.  For example, let's say that the probability of a successful/useful mutation is one in a hundred (1%).  For many species in the wild, the probability of surviving to breeding age is one in three (33%).  Let's imagine that the probability of attracting a mate given that you are visibly different is one in five (20%).  Let's further assume that the probability of any specific individual becoming the basis of a stable breeding population is one in 100 (1%).  The actual probabilities may be much lower but these will do for this illustration.  There are many other conditions, each with it's own probability that might also come onto play but with only these few variables we calculate the probability of success at .01 x .33 x .20 x .01 = .0000066 or less than one in one hundred thousand.

By the way, at this point we have only succeeded in producing a new sub-species because we have assumed that the mutants have bred with non-mutants within the species.  One of the defining characteristics of a species is that interbreeding with another species is not possible or at least highly improbable.

Evolutionists deal with improbability through the use of time.  If enough time goes by, they say, virtually anything is likely to happen, regardless of its probability.   That's hard to argue with.  Hard to argue isn't quite the same as persuasive, though.

The point that is most difficult to accept is the mutation that produced sexual reproduction.  We go from a time in which all reproduction (in single-cell organisms) is via mitosis.  The cells simply split and become two identical cells.  Suddenly, everything changes.  We now need another individual in order to procreate.  This is not a mutation.  The difference can't be explained by evolutionary (meaning incrementally small changes over a long period of time) change.  It seems we are left with only a handful of choices.
  • We need more complexity in the origins.  At least we need both sexual and asexual reproduction to be represented in the universe.
  • If we insist on a single original lifeform, we need to change the basic building block of evolution from mutation to something else.
  • We have to relegate evolution to a much smaller role.
Of course there are many other theories out there to explain the breadth and depth of the diversity of lifeforms on our planet.  They aren't getting enough attention because only one theory, evolution, has been granted the "scientific" seal.

It's not important to me to explain how we became what we are because the the real value comes in understanding how we will become what we should be.  It just raises my hackles when someone says that they have an explanation for Homo sapiens and it is evolution.