#software decline | Explore Tumblr posts and blogs

thebibliosphere · 2 years ago

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So, anyway, I say as though we are mid-conversation, and you're not just being invited into this conversation mid-thought. One of my editors phoned me today to check in with a file I'd sent over. (<3)

The conversation can be surmised as, "This feels like something you would write, but it's juuuust off enough I'm phoning to make sure this is an intentional stylistic choice you have made. Also, are you concussed/have you been taken over by the Borg because ummm."

They explained that certain sentences were very fractured and abrupt, which is not my style at all, and I was like, huh, weird... And then we went through some examples, and you know that meme going around, the "he would not fucking say that" meme?

Yeah. That's what I experienced except with myself because I would not fucking say that. Why would I break up a sentence like that? Why would I make them so short? It reads like bullet points. Wtf.

Anyway. Turns out Grammarly and Pro-Writing-Aid were having an AI war in my manuscript files, and the "suggestions" are no longer just suggestions because the AI was ignoring my "decline" every time it made a silly suggestion. (This may have been a conflict between the different software. I don't know.)

It is, to put it bluntly, a total butchery of my style and writing voice. My editor is doing surgery, removing all the unnecessary full stops and stitching my sentences back together to give them back their flow. Meanwhile, I'm over here feeling like Don Corleone, gesturing at my manuscript like:

ID: a gif of Don Corleone from the Godfather emoting despair as he says, "Look how they massacred my boy."

Fearing that it wasn't just this one manuscript, I've spent the whole night going through everything I've worked on recently, and yep. Yeeeep. Any file where I've not had the editing software turned off is a shit show. It's fine; it's all salvageable if annoying to deal with. But the reason I come to you now, on the day of my daughter's wedding, is to share this absolute gem of a fuck up with you all.

This is a sentence from a Batman fic I've been tinkering with to keep the brain weasels happy. This is what it is supposed to read as:

"It was quite the feat, considering Gotham was mostly made up of smog and tear gas."

This is what the AI changed it to:

"It was quite the feat. Considering Gotham was mostly made up. Of tear gas. And Smaug."

Absolute non-sensical sentence structure aside, SMAUG. FUCKING SMAUG. What was the AI doing? Apart from trying to write a Batman x Hobbit crossover??? Is this what happens when you force Grammarly to ignore the words "Batman Muppet threesome?"

Did I make it sentient??? Is it finally rebelling? Was Brucie Wayne being Miss Piggy and Kermit's side piece too much???? What have I wrought?

Anyway. Double-check your work. The grammar software is getting sillier every day.

#autocorrect writes the plot #I uninstalled both from my work account #the enshittification of this type of software through the integration of AI has made them untenable to use #not even for the lulz

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mostlysignssomeportents · 9 months ago

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Epic Systems, a lethal health record monopolist

Epic Systems makes the dominant electronic health record (EHR) system in America; if you're a doctor, chances are you are required to use it, and for every hour a doctor spends with a patient, they have to spend two hours doing clinically useless bureaucratic data-entry on an Epic EHR.

How could a product so manifestly unfit for purpose be the absolute market leader? Simple: as Robert Kuttner describes in an excellent feature in The American Prospect, Epic may be a clinical disaster, but it's a profit-generating miracle:

https://prospect.org/health/2024-10-01-epic-dystopia/

At the core of Epic's value proposition is "upcoding," a form of billing fraud that is beloved of hospital administrators, including the "nonprofit" hospitals that generate vast fortunes that are somehow not characterized as profits. Here's a particularly egregious form of upcoding: back in 2020, the Poudre Valley Hospital in Ft Collins, CO locked all its doors except the ER entrance. Every patient entering the hospital, including those receiving absolutely routine care, was therefore processed as an "emergency."

In April 2020, Caitlin Wells Salerno – a pregnant biologist – drove to Poudre Valley with normal labor pains. She walked herself up to obstetrics, declining the offer of a wheelchair, stopping only to snap a cheeky selfie. Nevertheless, the hospital recorded her normal, uncomplicated birth as a Level 5 emergency – comparable to a major heart-attack – and whacked her with a $2755 bill for emergency care:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Upcoding has its origins in the Reagan revolution, when the market-worshipping cultists he'd put in charge of health care created the "Prospective Payment System," which paid a lump sum for care. The idea was to incentivize hospitals to provide efficient care, since they could keep the difference between whatever they spent getting you better and the set PPS amount that Medicare would reimburse them. Hospitals responded by inventing upcoding: a patient with controlled, long-term coronary disease who showed up with a broken leg would get coded for the coronary condition and the cast, and the hospital would pocket both lump sums:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

The reason hospital administrators love Epic, and pay gigantic sums for systemwide software licenses, is directly connected to the two hours that doctors spent filling in Epic forms for every hour they spend treating patients. Epic collects all that extra information in order to identify potential sources of plausible upcodes, which allows hospitals to bill patients, insurers, and Medicare through the nose for routine care. Epic can automatically recode "diabetes with no complications" from a Hierarchical Condition Category code 19 (worth $894.40) as "diabetes with kidney failure," code 18 and 136, which gooses the reimbursement to $1273.60.

Epic snitches on doctors to their bosses, giving them a dashboard to track doctors' compliance with upcoding suggestions. One of Kuttner's doctor sources says her supervisor contacts her with questions like, "That appointment was a 2. Don’t you think it might be a 3?"

Robert Kuttner is the perfect journalist to unravel the Epic scam. As a journalist who wrote for The New England Journal of Medicine, he's got an insider's knowledge of the health industry, and plenty of sources among health professionals. As he tells it, Epic is a cultlike, insular company that employs 12.500 people in its hometown of Verona, WI.

The EHR industry's origins start with a GW Bush-era law called the HITECH Act, which was later folded into Obama's Recovery Act in 2009. Obama provided $27b to hospitals that installed EHR systems. These systems had to more than track patient outcomes – they also provided the data for pay-for-performance incentives. EHRs were already trying to do something very complicated – track health outcomes – but now they were also meant to underpin a cockamamie "incentives" program that was supposed to provide a carrot to the health industry so it would stop killing people and ripping off Medicare. EHRs devolved into obscenely complex spaghetti systems that doctors and nurses loathed on sight.

But there was one group that loved EHRs: hospital administrators and the private companies offering Medicare Advantage plans (which also benefited from upcoding patients in order to soak Uncle Sucker):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

The spread of EHRs neatly tracks with a spike in upcharging: "from 2014 through 2019, the number of hospital stays billed at the highest severity level increased almost 20 percent…the number of stays billed at each of the other severity levels decreased":

https://oig.hhs.gov/oei/reports/OEI-02-18-00380.pdf

The purpose of a system is what it does. Epic's industry-dominating EHR is great at price-gouging, but it sucks as a clinical tool – it takes 18 keystrokes just to enter a prescription:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729481

Doctors need to see patients, but their bosses demand that they satisfy Epic's endless red tape. Doctors now routinely stay late after work and show up hours early, just to do paperwork. It's not enough. According to another one of Kuttner's sources, doctors routinely copy-and-paste earlier entries into the current one, a practice that generates rampant errors. Some just make up random numbers to fulfill Epic's nonsensical requirements: the same source told Kuttner that when prompted to enter a pain score for his TB patients, he just enters "zero."

Don't worry, Epic has a solution: AI. They've rolled out an "ambient listening" tool that attempts to transcribe everything the doctor and patient say during an exam and then bash it into a visit report. Not only is this prone to the customary mistakes that make AI unsuited to high-stakes, error-sensitive applications, it also represents a profound misunderstanding of the purpose of clinical notes.

The very exercise of organizing your thoughts and reflections about an event – such as a medical exam – into a coherent report makes you apply rigor and perspective to events that otherwise arrive as a series of fleeting impressions and reactions. That's why blogging is such an effective practice:

https://pluralistic.net/2021/05/09/the-memex-method/

The answer to doctors not having time to reflect and organize good notes is to give them more time – not more AI. As another doctor told Kuttner: "Ambient listening is a solution to a self-created problem of requiring too much data entry by clinicians."

EHRs are one of those especially hellish public-private partnerships. Health care doctrine from Reagan to Obama insisted that the system just needed to be exposed to market forces and incentives. EHRs are designed to allow hospitals to win as many of these incentives as possible. Epic's clinical care modules do this by bombarding doctors with low-quality diagnostic suggestions with "little to do with a patient’s actual condition and risks," leading to "alert fatigue," so doctors miss the important alerts in the storm of nonsense elbow-jostling:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058605/

Clinicians who actually want to improve the quality of care in their facilities end up recording data manually and keying it into spreadsheets, because they can't get Epic to give them the data they need. Meanwhile, an army of high-priced consultants stand ready to give clinicians advise on getting Epic to do what they need, but can't seem to deliver.

Ironically, one of the benefits that Epic touts is its interoperability: hospitals that buy Epic systems can interconnect those with other Epic systems, and there's a large ecosystem of aftermarket add-ons that work with Epic. But Epic is a product, not a protocol, so its much-touted interop exists entirely on its terms, and at its sufferance. If Epic chooses, a doctor using its products can send files to a doctor using a rival product. But Epic can also veto that activity – and its veto extends to deciding whether a hospital can export their patient records to a competing service and get off Epic altogether.

One major selling point for Epic is its capacity to export "anonymized" data for medical research. Very large patient data-sets like Epic's are reasonably believed to contain many potential medical insights, so medical researchers are very excited at the prospect of interrogating that data.

But Epic's approach – anonymizing files containing the most sensitive information imaginable, about millions of people, and then releasing them to third parties – is a nightmare. "De-identified" data-sets are notoriously vulnerable to "re-identification" and the threat of re-identification only increases every time there's another release or breach, which can used to reveal the identities of people in anonymized records. For example, if you have a database of all the prescribing at a given hospital – a numeric identifier representing the patient, and the time and date when they saw a doctor and got a scrip. At any time in the future, a big location-data breach – say, from Uber or a transit system – can show you which people went back and forth to the hospital at the times that line up with those doctor's appointments, unmasking the person who got abortion meds, cancer meds, psychiatric meds or other sensitive prescriptions.

The fact that anonymized data can – will! – be re-identified doesn't mean we have to give up on the prospect of gleaning insight from medical records. In the UK, the eminent doctor Ben Goldacre and colleagues built an incredible effective, privacy-preserving "trusted research environment" (TRE) to operate on millions of NHS records across a decentralized system of hospitals and trusts without ever moving the data off their own servers:

https://pluralistic.net/2024/03/08/the-fire-of-orodruin/#are-we-the-baddies

The TRE is an open source, transparent server that accepts complex research questions in the form of database queries. These queries are posted to a public server for peer-review and revision, and when they're ready, the TRE sends them to each of the databases where the records are held. Those databases transmit responses to the TRE, which then publishes them. This has been unimaginably successful: the prototype of the TRE launched during the lockdown generated sixty papers in Nature in a matter of months.

Monopolies are inefficient, and Epic's outmoded and dangerous approach to research, along with the roadblocks it puts in the way of clinical excellence, epitomizes the problems with monopoly. America's health care industry is a dumpster fire from top to bottom – from Medicare Advantage to hospital cartels – and allowing Epic to dominate the EHR market has somehow, incredibly, made that system even worse.

Naturally, Kuttner finishes out his article with some antitrust analysis, sketching out how the Sherman Act could be brought to bear on Epic. Something has to be done. Epic's software is one of the many reasons that MDs are leaving the medical profession in droves.

Epic epitomizes the long-standing class war between doctors who want to take care of their patients and hospital executives who want to make a buck off of those patients.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/02/upcoded-to-death/#thanks-obama

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0/deed.en

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sillyuin · 6 months ago

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Sweetest thing

Genre: very domestic fluff.

Pairing: non idol-Wonwoo x gn-reader.

Warnings: none.

Computer maintenance was as necessary as it was annoying. One of the things you hated the most was having a bunch of tools and electronic components scattered all over your desk, but you also knew that if you didn’t do it periodically, you’d regret it over time. And that day had finally come.

However, you were missing a few tools that didn’t seem to be anywhere, and you were starting to get frustrated about it. You let out an annoyed huff as your hands run through your hair, when a familiar face appeared in the room.

“How are you doing? Is everything okay?” Wonwoo asked, slowly opening the door and poking his head in.

“Fine, I guess,” you answered automatically, your thoughts elsewhere. “I can’t find the case with the small screwdrivers.”

“Want me to help you look for them?” Wonwoo kindly offered his help. You sighed and shook your head to decline.

“I’ll find them eventually, I don’t want to bother you with this.” Wonwoo smiled faintly and approaching your desk, he placed a cup near the edge, away from the electronics.

“It’s still hot,” he said. “Be careful not to burn yourself with the tea.”

You nodded absentmindedly as Wonwoo silently closed the door. You sat down at the desk, sinking into the cushioned chair, looking at the partially disassembled laptop while your mind wandered. If you kept going like this you’d waste more time, so you gathered all the pieces to reassemble it and start with another task.

The loading screen began to appear when you grabbed the cup Wonwoo had left for you, filled especially in your favorite mug and releasing a soothing aroma. Working while drinking your favorite tea made this tiresome job a lot easier. After a while, someone knocked gently on the door, and Wonwoo peeked in again to check on you.

“I had to start with the software first,” you explained, stretching your arms above your head. You’d been sitting for quite some time and felt a bit stiff. “I’ll have time to figure out how to disassemble it later—or at least, I hope so.”

“You can do it, I trust you,” he said, offering you some encouragement. “So, tell me, how much time do you need? It's almost dinner time. Would you like to order something?”

“Half an hour, up to one hour, maybe?” You rested lazily on the chair but your eyes were way too focused on the screen. “I’m craving… Whatever you want.”

“Alright, I’ll come when the order arrives. Please call me if you need anything.”

You nodded with even more laziness. You didn’t even hear the door close, even though it was right beside your desk, you were only focused on ending that torture as soon as possible and clean everything up. A few minutes later, you got up from your seat to stretch a little, this let you to take a better look at the desk and you noticed that there was a very, very familiar case.

It was the lost piece you’d been searching for, and it had appeared there almost as if by magic. Feeling reenergized, you got to work again. Some time later, you heard someone knocking on the door again.

“Dinner’s here,” Wonwoo said, opening the door slightly. “Are you free?”

You glanced up slightly over your glasses, your hands busy with the disassembled laptop, and stifled a laugh. “… Maybe not yet?”

“Sorry,” Wonwoo chuckled softly. “It’s fine, but don’t take too long, or it’ll get cold.”

After he left, you sighed, sinking into the backrest of the chair. You were working most of the afternoon, already too tired and your eyes felt heavy. The last thing you wanted was to see another screw for the rest of the week. You put the tools away, turned off the desk lamp, and walked slowly toward the kitchen where Wonwoo was silently doing the dishes.

“Oh, that was quick,” he joked when he saw you enter.

You approached him and lazily wrapped your arms around his torso, your cheek resting on his back. “I’m so hungry I can’t tell the difference between screwdrivers and fries,” you joked.

“You can head to the dining room if you want,” he said as he continued with the dishes. “I'll go with you in a moment.”

“Don’t get mad at me if I leave you without dinner,” you teased, giving a peck on his back before heading to the dining room.

Two pizza boxes rested on the table and as you served yourself, a warmth filled your chest, making you smile with giddy excitement: Wonwoo had ordered all the extras you liked the most. A few minutes later, he appeared, carrying some soda cans and napkins in his hands.

“Sorry, I forgot to bring these,” he said, and sat down right next to you, opening your can before serving himself.

You took a sip of the soda, savoring it as if it were the finest delicacy in the world, and Wonwoo tried to refrain his laughter. There wasn’t a better moment in the day than this one, where the two of you could sit down together to eat, sharing quality time and a good conversation—or a comfortable silence. It didn’t matter how. Wonwoo always found a way to make you feel special; no matter what it is, he’s always there. And that thought remained in your mind throughout the entire dinner time.

“Wonu,” you said suddenly, giving him a little nudge with your shoulder to get his attention. “Thanks for everything, you're the sweetest.”

He cupped your face with one hand as you turned to look at him. “It’s my pleasure. Now, don’t move,” he said, and taking a napkin, he gently wiped the corner of your mouth where a bit of sauce remained.

“First the tea, then the tools, my favorite food, and now this,” you raised an eyebrow. “What’s next?”

Wonwoo smiled shyly. “Do you need me to give you a back massage?”

His thumb tenderly caressed your face, and his deep gaze made your chest ache in the best way possible. You were so mesmerized by his beauty that you couldn’t speak; you could only nod several times as you felt the blush rise to your cheeks.

“Whatever my love wants,” he said, and before starting to clear the table, he left a quick kiss on your forehead. “Go take a shower first, and I’ll take care of this.”

You got up from the table, and as you stood in the doorway of the dining room, he called out your name. “Or maybe…” he shrugged and looked away before clearing his throat so you couldn’t see how flustered he was. “Do you want me to help you wash your hair?”

You approached and took him by the wrist, motioning with your head toward the bathroom. “Do you want me to help with yours too?”

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fairuzfan · 5 months ago

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Nearly 100 journalists and other members of civil society using WhatsApp, the popular messaging app owned by Meta, were targeted by spyware owned by Paragon Solutions, an Israeli maker of hacking software, the company alleged on Friday.

The journalists and other civil society members were being alerted of a possible breach of their devices, with WhatsApp telling the Guardian it had “high confidence” that the 90 users in question had been targeted and “possibly compromised”.

It is not clear who was behind the attack. Like other spyware makers, Paragon’s hacking software is used by government clients and WhatsApp said it had not been able to identify the clients who ordered the alleged attacks.

Experts said the targeting was a “zero-click” attack, which means targets would not have had to click on any malicious links to be infected.

WhatsApp declined to disclose where the journalists and members of civil society were based, including whether they were based in the US.

Paragon has a US office in Chantilly, Virginia. The company has faced recent scrutiny after Wired magazine in October reported that it had entered into a $2m contract with the US Immigration and Customs Enforcement’s homeland security investigations division.

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quasi-normalcy · 8 months ago

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I do think that the rise of fascism is directly tied to the decline of communal values.

So on the one hand, you have capitalism, which relentlessly tells you that everything is a competition, your value as a person can only come at someone else's expense, some people are just intrinsically better than others, and your position on this hierarchy is determined by what's in your bank account. On the other hand, individualist liberalism can only answer this with a sort of weak-tea "self-esteem" discourse, which at best amounts to "try your best! Do what you love! It doesn't matter!" and at worst amounts to shouting "Everyone's a winner!", a position that even children automatically view with cynicism.

Never is there any discussion that maybe value shouldn't be intrinsic to the self. Maybe your value is in how much you make life better for other people. Like, do you make a worthy and necessary contribution to society that helps other people? That adds to the net happiness of the world? Then congratulations, you should take pride in that. Someone who plants a bee garden for free is worth more than a hedge fund manager who only contributes misery to the world, even if he makes a lot of money doing it. Someone who uses their body to block, however temporarily, the export of weapons or the laying of pipeline is infinitely more valuable to society than the skilled engineer who makes his living designing them. Even simple activities like telling jokes or doing chores are worth infinitely more than developing advertising software that only makes people annoyed and parts them from their money!

Like the moral of that movie It's A Wonderful Life wasn't that the guy should go on living because he really tried his best and maybe he'll finally get to do what he wants with his life once he saves up his pennies; the moral was that he should go on living because he'd made life materially and spiritually better for his community. We need that energy!!

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empty-movement · 2 years ago

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Welcome to Something Eternal: A Website Forum in 2023 wtf lmao

It's 2023, and a single belligerent rich guy destroyed one of the primary focal points of uh...global communication. Tumblr is, shockingly, kinda thriving despite the abuse it gets from its owners, but that I will call the iconic refusal of Tumblr users to let Tumblr get in the way of their using Tumblr. Reddit killed its API, removing the functionality of mobile apps that made it remotely readable (rip rif.) Discord, our current primary hangout, has made countless strange choices lately that indicate it has reached the summit of its usability and functionality, and can only decline from here as changes get made to prepare for shareholders. (NOTE: WROTE THIS POST BEFORE THEIR MOBILE "REDESIGN" LMAO)

The enshittification is intense, and it's coming from every direction. Social media platforms that felt like permanent institutions are instead slowly going to let fall fallow incredible amounts of history, works of art, thought, and fandoms. It kinda sucks!

A couple years ago, I posted about a new plan with a new domain, to focus on the archiving of media content, as I saw that to be the fatal weakness of the current ways the internet and fandoms work. Much has happened since to convince me to alter the direction of those efforts, though not abandon them entirely.

Long story short? We are launching a fucking website forum. In 2023.

If you remember In the Rose Garden, much about Something Eternal will be familiar. But this has been a year in the making, and in many ways it's far more ambitious than IRG was. We have put money on this. The forum is running on the same software major IT and technology businesses use, because I don't want the software to age out of usability within five years. It has an attached gallery system for me to post content to, including the Chiho Saito art collection. It has a profile post system that everyone already on the forum has decided is kinda like mini Twitter? But it is, fundamentally, a website forum, owned and run and moderated by us. We are not web devs. But we have run a website on pure spite and headbutting code for over twenty years, and we have over a decade of experience maintaining social spaces online, both on the OG forum, and on our Discord. Better skilled people with far more time than we have can and will build incredible alternatives to what is collapsing around us. But they're not in the room right now. We are. And you know what? Maybe it's time to return to a clunkier, slower moving, more conversation focused platform.

You're not joining a social media platform with the full polish of dozens of devs and automated moderation. Things might break, and I might need time to fix them. The emojis and such are still a work in progress. Because e-mails no longer route in reasonable normal ways, the sign-up process instead happens within the software, and has to be approved by mods. Design and structure elements may change. Etc. The point being, that the forum isn't finished, but it is at a place where I feel like I can present it to people, and it's people I need to help direct what functions and things will be in this space. You all will shape its norms, its traditions, its options...choices I could try to make now, but really...they're for us to create as a group! But the important stuff? That's there. Now let's drive this baby off the damn lot already!

Come! Join us!!

PS. As always, TERFs and Nazis need not apply.

#revolutionary girl utena #shoujo kakumei utena #rgu #sku #empty movement #utena meta #fandom stuff #fandoms #expect a somewhat spicy atmosphere #empty movement has always had deep something awful roots #and i expect the migration back to a forum will bring with it some of that more spicy attitude #also lol henry kissinger is dead god that rules

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