#system interoperability

[vorro]

Hello lightning-fast speed and farewell mistakes.

Enter the era of data magic now!

Learn more: https://vorro.net/solutions/interoperability/

[mostlysignssomeportents]

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

[roreadsrandomly]

Joseph Gordon Levitt: Why Tiktok should be more like Email

He wrote this wonderful article on Substack, link's below but I just had to put this quote cause its basically the TLDR.

Imo the internet is basically a bunch of gated communities.

[fusionseo]

How I Made Patient Data Access Instant with the Right Electronic Medical Records Software

Managing a clinic is not easy. Between treating patients, handling billing, and keeping up with paperwork, it can feel overwhelming. One of my biggest struggles was finding patient records quickly. Searching through files or switching between systems took a lot of time. I wanted a better way to manage everything. That’s when I found the right **electronic medical records software** and it completely changed how my clinic worked.

The Problem with Paper Records and Outdated Systems

Before using electronic medical records software, we used a mix of paper files and an old computer system. It was messy. Sometimes, files would be in the wrong place. Other times, the system would crash or take too long to load, causing delays and making patients wait longer.

It wasn’t just about being slow. Having to dig through files also meant we missed small but important details in a patient’s history. These delays affected our workflow and sometimes made patients feel we weren’t well organized.

Choosing the Right Software for My Clinic

I knew I needed a better system. But I didn’t want something complicated or expensive. I needed something:

Easy for my team to use

Fast when searching for patient data

Safe and secure for storing personal information

Affordable for a small clinic like mine

That’s when I started looking into modern electronic medical records software. After trying a few options, I found one that was just right.

How the Software Improved Patient Data Access

Once we set up the new software, the changes were clear from day one.

Simple Dashboard for Quick Search

The dashboard made it very easy to find patient records. We could search by name, phone number, or date of birth and get results in seconds. No more flipping through papers or waiting for slow systems.

Updated Patient Info in One Click

Whenever a patient visited, we could quickly check their past appointments, prescriptions, test results, and notes. Everything was available in one place.

Easy to Share Within the Clinic

If I was busy with another patient, my assistant could access the same records without delay. Everyone was on the same page, and this helped the entire team work better.

Extra Features That Helped

The electronic medical records software came with other features that made our daily work smoother:

Automatic appointment reminders for patients

Online billing and easy payment tracking

Space to upload reports, x-rays, and notes

Backup options so we never lost data

All these features saved us time and reduced stress for both staff and patients.

My Patients Noticed the Difference

Patients started commenting on how smooth their visits felt. They didn’t have to repeat information. Follow-ups were faster. Reports were ready when they arrived. They felt more cared for—and that’s what really mattered.

Conclusion

Making the switch to electronic medical records software was one of the best decisions I made for my clinic. It saved time, improved patient care, and helped my team stay more organized. If you’re running a clinic or practice and are still using paper files or an outdated system, now is the right time to consider a better solution.

Call to Action

Are you tired of digging through files and wasting time on old systems? Try switching to electronic medical records software and see how fast and simple your clinic can become. It’s a step that helps both your team and your patients every day.

[verofax]

Interoperable Blockchain System

Operational risks caused by inadequate internal processes or external events pose a high risk to the oil and gas industry. Talk to our experts to know how Verofax can help.

Know more: https://verofax.com/oil-and-gas

[featuredblogs]

Unlocking the Future: Exploring the Wonders of KNX in Home Automation

In the realm of home automation, where technology seamlessly intertwines with our daily lives, KNX stands out as a beacon of innovation. This article will unravel the mysteries of KNX, a standardized communication protocol that has revolutionized the way we control and interact with smart devices in our homes. Let's embark on a journey to understand the essence of KNX and its transformative role in shaping the future of home automation.

What is KNX?

At its core, KNX is more than just a set of letters; it's a powerhouse in the world of home automation. KNX, which stands for Konnex, is a standardized communication protocol that enables smart devices in a home to communicate with each other. Imagine a home where lighting, heating, security systems, and more work together seamlessly. That's the magic of KNX.

Advantages of Using KNX

The beauty of KNX lies in its versatility and compatibility. Unlike proprietary systems, KNX is an open standard, allowing devices from different manufacturers to communicate effortlessly. This interoperability ensures that your smart home system can evolve and expand without being confined to a specific brand or technology.

Components of a KNX System

To understand KNX fully, we need to peek behind the curtain. KNX systems consist of actuators and sensors, forming the backbone of the smart home. The KNX bus system facilitates communication between devices, while programming tools and software provide users with the flexibility to customize their automation setup.

The Role of KNX in Home Automation

Imagine arriving home, and the lights automatically adjust to your preferred ambiance, the thermostat adjusts to the perfect temperature, and your security system is armed—all triggered by a single command. KNX makes this scenario a reality, offering a centralized and streamlined control hub for various aspects of home automation.

Installation and Setup

While the wonders of KNX are vast, the installation process is surprisingly straightforward. Professional installation ensures optimal performance, and once set up, users can easily configure and adapt their smart home to suit their changing needs.

KNX vs. Other Home Automation Protocols

In a world of competing protocols like Zigbee and Z-Wave, KNX holds its ground. Its unique features, including wired communication and broader compatibility, make it a standout choice for those seeking a reliable and scalable home automation solution.

Applications of KNX in Different Settings

KNX isn't limited to residential spaces. Its adaptability extends to commercial and industrial settings, where precise control and automation play a crucial role in enhancing efficiency and reducing energy consumption.

Challenges and Solutions in Implementing KNX

While the benefits of KNX are evident, users may encounter challenges during implementation. This section will guide you through common hurdles and provide strategies to overcome them, ensuring a smooth transition to a KNX-powered home.

KNX and the Future of Home Automation

The journey doesn't end here. The future holds exciting prospects for KNX, with ongoing developments and emerging trends promising to elevate home automation to new heights. Stay tuned as we explore what's on the horizon for this innovative technology.

User Experiences with KNX

Real-world stories often speak louder than technical specifications. Discover how individuals and businesses have transformed their spaces with KNX, turning their homes and offices into intelligent, responsive environments.

Cost Considerations for KNX Systems

Investing in a KNX system may raise questions about costs. This section will break down the initial investment and highlight the long-term benefits, showcasing why KNX is a worthwhile investment for homeowners and businesses alike.

Security and Privacy Concerns with KNX

As with any connected system, security and privacy are paramount. Learn about the measures in place to address potential risks, ensuring that your KNX-powered home is secure and your privacy is protected.

KNX Certification and Standards

To guarantee the reliability of your KNX system, certification is key. This section explores the importance of KNX certification and the adherence to industry standards, providing peace of mind for users.

Conclusion                      

In conclusion, KNX is the key to unlocking the full potential of home automation. Its open standard, interoperability, and adaptability make it a frontrunner in the race to create smart, connected homes. As technology continues to evolve, embracing KNX opens doors to a future where our living spaces are not just smart but truly intelligent.

FAQs                        

Is KNX only for residential use?

No, KNX is versatile and finds applications in both residential and commercial settings, offering tailored solutions for diverse needs.

How often do KNX systems need updates?

Updates depend on technological advancements and individual preferences. However, KNX systems are designed to be future-proof, minimizing the need for frequent updates.

Can I integrate non-KNX devices into a KNX system?

KNX's open standard allows integration with devices from different manufacturers,

[rhk111sblog]

The Army Artillery Regiment (AAR), Army Aviation Regiment (AAvnR) and Special Forces Regiment (Airborne) SFR(A) recently conducted their first Interoperability Exercise (IOX) in Nueva Ecija, which included the live-firing of the Philippine Army’s (PA) newest Artillery Asset, the Autonomous Truck MOunted-howitzer System (ATMOS)

SOURCES:

Army Artillery "King of Battle" Regiment, Philippine Army Facebook Page Post, 09/23/23 – 1119H {Archived Link}

Army Artillery "King of Battle" Regiment, Philippine Army Facebook Page Post, 09/22/23 – 2105H {Archived Link}

Check out the Links to my other Social Media Accounts at https://linktr.ee/rhk111

If you like my Work, buy me a Coffee to help support it at https://www.buymeacoffee.com/rhk111

[saxonai]

5 Benefits of Interoperability in the Healthcare System 

The year 2023 marks the year when interoperability in the healthcare system is a priority. Before we delve into the topic, don’t you agree that the efficient and effective execution of high-quality healthcare is critical? 

Originally published at https://saxon.ai on May 24, 2023.

[darkmaga-returns]

A German military assessment exposes major issues with NATO weapons in Ukraine. The PzH 2000 howitzer, while advanced, is so technically fragile that its combat usefulness is in doubt. The Leopard 1A5 tank is used mostly as makeshift artillery due to weak armor. The Leopard 2A6 is too expensive and complex to maintain at the front. Air defense systems also face problems. The IRIS-T works well, but ammo is too costly and scarce. The Patriot system is called “unsuitable for combat” because its MAN carrier vehicles are outdated and lack spare parts. This information was revealed in a transcript of a lecture given by the deputy military attaché of the German embassy in Kiev. The summary of the paper is very clear: “Hardly any large German piece of equipment is fully suitable for war.”

The report cites “an internal paper of the Bundeswehr” about the real practicality of Germany’s top weapons. We can assume that the very same results extend to the entire constellation of NATO weaponry in general, since they are virtually all constructed with the same design philosophies, often even with interoperable systems—like the 120mm Rheinmetall tank barrels shared between the Abrams and Leopard series.

Also, for the sake of thoroughness and to establish context, Spiegel explains that the ‘report’ was taken from a lecture given to junior officers of the Bundeswehr by a ‘deputy military attaché of the German embassy in Kiev’:

The paper, which is available to SPIEGEL, is a transcript of a lecture given to around 200 junior officers of the German Armed Forces in Delitzsch, Saxony. The speaker was the deputy military attaché of the German embassy in Kyiv, who spoke at the end of January about the experiences of the Ukrainian armed forces in the fight against the Russian war of aggression. He spoke in clear terms about the problems the Ukrainians had with German weapons in combat. An army officer eagerly took notes in order to use the findings for training in the Bundeswehr.

Spiegel minces no words when they declare that the attaché’s report is in large part “devastating”.

[mariacallous]

Multiple current and former government IT sources tell WIRED that it would be easy to connect the IRS’s Palantir system with the ICE system at DHS, allowing users to query data from both systems simultaneously. A system like the one being created at the IRS with Palantir could enable near-instantaneous access to tax information for use by DHS and immigration enforcement. It could also be leveraged to share and query data from different agencies as well, including immigration data from DHS. Other DHS sub-agencies, like USCIS, use Databricks software to organize and search its data, but these could be connected to outside Foundry instances simply as well, experts say. Last month, Palantir and Databricks struck a deal making the two software platforms more interoperable.

“I think it's hard to overstate what a significant departure this is and the reshaping of longstanding norms and expectations that people have about what the government does with their data,” says Elizabeth Laird, director of equity in civic technology at the Center for Democracy and Technology, who noted that agencies trying to match different datasets can also lead to errors. “You have false positives and you have false negatives. But in this case, you know, a false positive where you're saying someone should be targeted for deportation.”

Mistakes in the context of immigration can have devastating consequences: In March, authorities arrested and deported Kilmar Abrego Garcia, a Salvadoran national, due to, the Trump administration says, “an administrative error.” Still, the administration has refused to bring Abrego Garcia back, defying a Supreme Court ruling.

“The ultimate concern is a panopticon of a single federal database with everything that the government knows about every single person in this country,” Venzke says. “What we are seeing is likely the first step in creating that centralized dossier on everyone in this country.”

DOGE Is Building a Master Database to Surveil and Track Immigrants

[seat-safety-switch]

I think that our civilization doesn't give enough credit to things that are stackable. If you're anything like me, and the court has taken specific actions to ensure that my particular contagion cannot spread, then you currently possess stuff thrown all over hither and yon. That's French for "on the fucking floor."

Most of this is simply because things like to be on the floor. Gravity pulls them there. Who am I to fight the whims of the universe, right? Another reason this happens is that many desirable things in life are not easy to stack.

If you look at your shelves right now, you will notice that there is tons of unused vertical space above many of your favourite objects. You could fit more stuff in those shelves, easy, if only you could pile them safely on top of each other. Sure, we've all done a precarious wedge-and-hope from time to time, but it always results in something expensive or irreplaceable taking a penguin slide to the floor anyway.

Society has designed a lot of little moulded-plastic "organizers" which are meant to help with this. The idea is that you will buy into their system, which is meant to all interoperate with each other, and then all of your things will go neatly into the boxes that you have purchased, which themselves are stacked neatly on the shelves. Your parole officer will be impressed. Don't be fooled by this fool's gold of a dream. None of your shit fits in those bins, and even if it did, you won't be able to agree on an organizational scheme.

So, is there a solution to this problem? Yes: it's called velcro. All you need to do is glue a bunch of velcro strips to the top and bottom of your favourite things, and then you can just stick them together. Nothing will fall out, because it's all held in place by the space-age miracle of the hook-and-loop fastener.

Sure, it makes an ungodly noise when you remove them from the stack, and the 3M Corporation will soon be trying to put poison into my morning coffee over having misused their trademark, but it's the only way to go. Now if you'll excuse me, I need to go figure out why all my computers keep dying from static electricity.

[mostlysignssomeportents]

Kickstarting a book to end enshittification, because Amazon will not carry it

My next book is The Internet Con: How to Seize the Means of Computation: it’s a Big Tech disassembly manual that explains how to disenshittify the web and bring back the old good internet. The hardcover comes from Verso on Sept 5, but the audiobook comes from me — because Amazon refuses to sell my audio:

https://www.kickstarter.com/projects/doctorow/the-internet-con-how-to-seize-the-means-of-computation

Amazon owns Audible, the monopoly audiobook platform that controls >90% of the audio market. They require mandatory DRM for every book sold, locking those books forever to Amazon’s monopoly platform. If you break up with Amazon, you have to throw away your entire audiobook library.

That’s a hell of a lot of leverage to hand to any company, let alone a rapacious monopoly that ran a program targeting small publishers called “Project Gazelle,” where execs were ordered to attack indie publishers “the way a cheetah would pursue a sickly gazelle”:

https://www.businessinsider.com/sadistic-amazon-treated-book-sellers-the-way-a-cheetah-would-pursue-a-sickly-gazelle-2013-10

[Image ID: Journalist and novelist Doctorow (Red Team Blues) details a plan for how to break up Big Tech in this impassioned and perceptive manifesto….Doctorow’s sense of urgency is contagious -Publishers Weekly]

I won’t sell my work with DRM, because DRM is key to the enshittification of the internet. Enshittification is why the old, good internet died and became “five giant websites filled with screenshots of the other four” (h/t Tom Eastman). When a tech company can lock in its users and suppliers, it can drain value from both sides, using DRM and other lock-in gimmicks to keep their business even as they grow ever more miserable on the platform.

Here is how platforms die: first, they are good to their users; then they abuse their users to make things better for their business customers; finally, they abuse those business customers to claw back all the value for themselves. Then, they die:

https://pluralistic.net/2023/01/21/potemkin-ai/#hey-guys

[Image ID: A brilliant barn burner of a book. Cory is one of the sharpest tech critics, and he shows with fierce clarity how our computational future could be otherwise -Kate Crawford, author of The Atlas of AI”]

The Internet Con isn’t just an analysis of where enshittification comes from: it’s a detailed, shovel-ready policy prescription for halting enshittification, throwing it into reverse and bringing back the old, good internet.

How do we do that? With interoperability: the ability to plug new technology into those crapulent, decaying platform. Interop lets you choose which parts of the service you want and block the parts you don’t (think of how an adblocker lets you take the take-it-or-leave “offer” from a website and reply with “How about nah?”):

https://www.eff.org/deeplinks/2019/07/adblocking-how-about-nah

But interop isn’t just about making platforms less terrible — it’s an explosive charge that demolishes walled gardens. With interop, you can leave a social media service, but keep talking to the people who stay. With interop, you can leave your mobile platform, but bring your apps and media with you to a rival’s service. With interop, you can break up with Amazon, and still keep your audiobooks.

So, if interop is so great, why isn’t it everywhere?

Well, it used to be. Interop is how Microsoft became the dominant operating system:

https://www.eff.org/deeplinks/2019/06/adversarial-interoperability-reviving-elegant-weapon-more-civilized-age-slay

[Image ID: Nobody gets the internet-both the nuts and bolts that make it hum and the laws that shaped it into the mess it is-quite like Cory, and no one’s better qualified to deliver us a user manual for fixing it. That’s The Internet Con: a rousing, imaginative, and accessible treatise for correcting our curdled online world. If you care about the internet, get ready to dedicate yourself to making interoperability a reality. -Brian Merchant, author of Blood in the Machine]

It’s how Apple saved itself from Microsoft’s vicious campaign to destroy it:

https://www.eff.org/deeplinks/2019/06/adversarial-interoperability-reviving-elegant-weapon-more-civilized-age-slay

Every tech giant used interop to grow, and then every tech giant promptly turned around and attacked interoperators. Every pirate wants to be an admiral. When Big Tech did it, that was progress; when you do it back to Big Tech, that’s piracy. The tech giants used their monopoly power to make interop without permission illegal, creating a kind of “felony contempt of business model” (h/t Jay Freeman).

The Internet Con describes how this came to pass, but, more importantly, it tells us how to fix it. It lays out how we can combine different kinds of interop requirements (like the EU’s Digital Markets Act and Massachusetts’s Right to Repair law) with protections for reverse-engineering and other guerrilla tactics to create a system that is strong without being brittle, hard to cheat on and easy to enforce.

What’s more, this book explains how to get these policies: what existing legislative, regulatory and judicial powers can be invoked to make them a reality. Because we are living through the Great Enshittification, and crises erupt every ten seconds, and when those crises occur, the “good ideas lying around” can move from the fringes to the center in an eyeblink:

https://pluralistic.net/2023/06/12/only-a-crisis/#lets-gooooo

[Image ID: Thoughtfully written and patiently presented, The Internet Con explains how the promise of a free and open internet was lost to predatory business practices and the rush to commodify every aspect of our lives. An essential read for anyone that wants to understand how we lost control of our digital spaces and infrastructure to Silicon Valley’s tech giants, and how we can start fighting to get it back. -Tim Maughan, author of INFINITE DETAIL]

After all, we’ve known Big Tech was rotten for years, but we had no idea what to do about it. Every time a Big Tech colossus did something ghastly to millions or billions of people, we tried to fix the tech company. There’s no fixing the tech companies. They need to burn. The way to make users safe from Big Tech predators isn’t to make those predators behave better — it’s to evacuate those users:

https://pluralistic.net/2023/07/18/urban-wildlife-interface/#combustible-walled-gardens

I’ve been campaigning for human rights in the digital world for more than 20 years; I’ve been EFF’s European Director, representing the public interest at the EU, the UN, Westminster, Ottawa and DC. This is the subject I’ve devoted my life to, and I live my principles. I won’t let my books be sold with DRM, which means that Audible won’t carry my audiobooks. My agent tells me that this decision has cost me enough money to pay off my mortgage and put my kid through college. That’s a price I’m willing to pay if it means that my books aren’t enshittification bait.

But not selling on Audible has another cost, one that’s more important to me: a lot of readers prefer audiobooks and 9 out of 10 of those readers start and end their searches on Audible. When they don’t find an author there, they assume no audiobook exists, period. It got so bad I put up an audiobook on Amazon — me, reading an essay, explaining how Audible rips off writers and readers. It’s called “Why None of My Audiobooks Are For Sale on Audible”:

https://pluralistic.net/2022/07/25/can-you-hear-me-now/#acx-ripoff

[Image ID: Doctorow has been thinking longer and smarter than anyone else I know about how we create and exchange value in a digital age. -Douglas Rushkoff, author of Present Shock]

To get my audiobooks into readers’ ears, I pre-sell them on Kickstarter. This has been wildly successful, both financially and as a means of getting other prominent authors to break up with Amazon and use crowdfunding to fill the gap. Writers like Brandon Sanderson are doing heroic work, smashing Amazon’s monopoly:

https://www.brandonsanderson.com/guest-editorial-cory-doctorow-is-a-bestselling-author-but-audible-wont-carry-his-audiobooks/

And to be frank, I love audiobooks, too. I swim every day as physio for a chronic pain condition, and I listen to 2–3 books/month on my underwater MP3 player, disappearing into an imaginary world as I scull back and forth in my public pool. I’m able to get those audiobooks on my MP3 player thanks to Libro.fm, a DRM-free store that supports indie booksellers all over the world:

https://blog.libro.fm/a-qa-with-mark-pearson-libro-fm-ceo-and-co-founder/

Producing my own audiobooks has been a dream. Working with Skyboat Media, I’ve gotten narrators like @wilwheaton​, Amber Benson, @neil-gaiman​ and Stefan Rudnicki for my work:

https://craphound.com/shop/

[Image ID: “This book is the instruction manual Big Tech doesn’t want you to read. It deconstructs their crummy products, undemocratic business models, rigged legal regimes, and lies. Crack this book and help build something better. -Astra Taylor, author of Democracy May Not Exist, but We’ll Miss It When Its Gone”]

But for this title, I decided that I would read it myself. After all, I’ve been podcasting since 2006, reading my own work aloud every week or so, even as I traveled the world and gave thousands of speeches about the subject of this book. I was excited (and a little trepedatious) at the prospect, but how could I pass up a chance to work with director Gabrielle de Cuir, who has directed everyone from Anne Hathaway to LeVar Burton to Eric Idle?

Reader, I fucking nailed it. I went back to those daily recordings fully prepared to hate them, but they were good — even great (especially after my engineer John Taylor Williams mastered them). Listen for yourself!

https://archive.org/details/cory_doctorow_internet_con_chapter_01

I hope you’ll consider backing this Kickstarter. If you’ve ever read my free, open access, CC-licensed blog posts and novels, or listened to my podcasts, or come to one of my talks and wished there was a way to say thank you, this is it. These crowdfunders make my DRM-free publishing program viable, even as audiobooks grow more central to a writer’s income and even as a single company takes over nearly the entire audiobook market.

Backers can choose from the DRM-free audiobook, DRM-free ebook (EPUB and MOBI) and a hardcover — including a signed, personalized option, fulfilled through the great LA indie bookstore Book Soup:

https://www.kickstarter.com/projects/doctorow/the-internet-con-how-to-seize-the-means-of-computation

What’s more, these ebooks and audiobooks are unlike any you’ll get anywhere else because they are sold without any terms of service or license agreements. As has been the case since time immemorial, when you buy these books, they’re yours, and you are allowed to do anything with them that copyright law permits — give them away, lend them to friends, or simply read them with any technology you choose.

As with my previous Kickstarters, backers can get their audiobooks delivered with an app (from libro.fm) or as a folder of MP3s. That helps people who struggle with “sideloading,” a process that Apple and Google have made progressively harder, even as they force audiobook and ebook sellers to hand over a 30% app tax on every dollar they make:

https://www.kickstarter.com/projects/doctorow/red-team-blues-another-audiobook-that-amazon-wont-sell/posts/3788112

Enshittification is rotting every layer of the tech stack: mobile, payments, hosting, social, delivery, playback. Every tech company is pulling the rug out from under us, using the chokepoints they built between audiences and speakers, artists and fans, to pick all of our pockets.

The Internet Con isn’t just a lament for the internet we lost — it’s a plan to get it back. I hope you’ll get a copy and share it with the people you love, even as the tech platforms choke off your communities to pad their quarterly numbers.

Next weekend (Aug 4-6), I'll be in Austin for Armadillocon, a science fiction convention, where I'm the Guest of Honor:

https://armadillocon.org/d45/

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

https://pluralistic.net/2023/07/31/seize-the-means-of-computation/#the-internet-con

[Image ID: My forthcoming book 'The Internet Con: How to Seize the Means of Computation' in various editions: Verso hardcover, audiobook displayed on a phone, and ebook displayed on an e-ink reader.]

[usafphantom2]

U.S. Approves Foreign Military Sale for South Korean F-15K Upgrade

The State Department has approved the possible sale of components that will allow South Korea to upgrade its F-15K Slam Eagle fleet to a configuration similar to the F-15EX Eagle II.

Stefano D'Urso

F-15K upgrade

The U.S. State Department has approved on Nov.19, 2024, a possible Foreign Military Sale (FMS) to the Republic of Korea of components that will allow the upgrade of the country’s F-15K Slam Eagle fleet. The package, which has an estimated cost of $6.2 billion, follows the decision in 2022 to launch an upgrade program for the aircraft.

The State Department has approved the possible sale of components that will allow South Korea to upgrade its F-15K Slam Eagle fleet to a configuration similar to the F-15EX Eagle II.The F-15KThe new capabilities

The Slam Eagles are the mainstay of the Republic of Korea Air Force’s (ROKAF) multirole missions, with a particular ‘heavy hitting’ long-range strike role. According to the available data, the country operates 59 F-15Ks out of 61 which were initially fielded in 2005. In 2022, the Defense Acquisition Program Administration (DAPA) approved the launch of an upgrade program planned to run from 2024 to 2034.

In particular, the Defense Security Cooperation Agency’s (DSCA) FMS notice says a number of components were requested for the upgrade, including 96 Advanced Display Core Processor II (ADCP II) mission system computers, 70 AN/APG-82(v)1 Active Electronically Scanned Arrays (AESA) radars, seventy 70 AN/ALQ-250 Eagle Passive Active Warning Survivability System (EPAWSS) electronic warfare (EW) suites and 70 AN/AAR-57 Common Missile Warning Systems (CMWS).

In addition to these, South Korea will also get modifications and maintenance support, aircraft components and spares, consumables, training aids and the entire support package commonly associated with FMS. It is interesting to note that the notice also includes aerial refueling support and aircraft ferry support, so it is possible that at least the initial aircraft will be ferried to the United States for the modifications before the rest are modified in country.

A ROKAF F-15K Slam Eagle drops two GBU-31 JDAM bombs with BLU-109 warhead. (Image credit: ROKAF)

The components included in the possible sale will allow the ROKAF to upgrade its entire fleet of F-15Ks to a configuration similar to the new F-15EX Eagle II currently being delivered to the U.S. Air Force. Interestingly, the Korean configuration will also include the CMWS, currently not installed on the EX, so the F-15K will also require some structural modifications to add the blisters on each side of the canopy rail where the sensors are installed.

“This proposed sale will improve the Republic of Korea’s capability to meet current and future threats by increasing its critical air defence capability to deter aggression in the region and to ensure interoperability with US forces,” says the DSCA in the official notice.

The upgrade of the F-15K is part of a broader modernization of the ROKAF’s fighter fleet. In fact, the service is also upgrading its KF-16s Block 52 to the V configuration, integrating a new AESA radar, mission computer, self-protection suite, with works expected to be completed by 2025. These programs complement the acquisition of the F-35 Lightning II and the KF-21 Boramae.

Ulchi Freedom Shield 24

A ROKAF F-15K Slam Eagle, assigned to the 11th Fighter Wing at Daegu Air Base, takes off for a mission on Aug. 20, 2024. (Image credit: ROKAF)

The F-15K

The F-15K is a variant of the F-15E Strike Eagle built for the Republic of Korea Air Force’s (ROKAF) with almost half of the components manufactured locally. The aircraft emerged as the winner of the F-X fighter program against the Rafale, Typhoon and Su-35 in 2002, resulting in an order for 40 F-15s equipped with General Electric F110-129 engines. In 2005, a second order for 21 aircraft equipped with Pratt & Whitney F100-PW-229 engines was signed.

The Slam Eagle name is derived from the F-15K’s capability to employ the AGM-84H SLAM-ER standoff cruise missiles, with the Taurus KEPD 350K being another weapon exclusive to the ROKAF jet. The F-15K is employed as a fully multi-role aircraft and is considered ad one of the key assets of the Korean armed forces.

With the aircraft averaging an age of 16 years and expected to be in service until 2060, the Defense Acquisition Program Administration (DAPA) launched in 2022 an upgrade program for the F-15Ks. The upgrade, expected to run from 2024 to 2034, is committed to strengthening the mission capabilities and survivability of the jet.

The F-15K currently equips three squadrons at Daegu Air Base, in the southeast of the country. Although based far from the demilitarized zone (DMZ), the F-15K with its SLAM-ER and KEPD 350 missiles can still hit strategic targets deep behind North Korean borders.

An F-15K releases a Taurus KEPD 350K cruise missile. (Image credit: ROKAF)

The new capabilities

It is not yet clear if the F-15K will receive a new cockpit, since its configuration will be similar to the Eagle II. In fact, the F-15EX has a full glass cockpit equipped with a 10×19-inch touch-screen multifunction color display and JHMCS II both in the front and rear cockpit, Low Profile HUD in the front, stand-by display and dedicated engine, fuel and hydraulics display, in addition to the standard caution/warning lights, switches and Hands On Throttle-And-Stick (HOTAS) control.

Either way, the systems will be powered by the Advanced Display Core Processor II, reportedly the fastest mission computer ever installed on a fighter jet, and the Operational Flight Program Suite 9.1X, a customized variant of the Suite 9 used on the F-15C and F-15E, designed to ensure full interoperability of the new aircraft with the “legacy Eagles”.

The F-15K will be equipped with the new AN/APG-82(V)1 Active Electronically Scanned Array (AESA) radar. The radar, which has been developed from the APG-63(V)3 AESA radar of the F-15C and the APG-79 AESA radar of the F/A-18E/F, allows to simultaneously detect, identify and track multiple air and surface targets at longer ranges compared to mechanical radars, facilitating persistent target observation and information sharing for a better decision-making process.

F-15K upgrade

A ROKAF F-15K Slam Eagle takes off for a night mission during the Pitch Black 2024 exercise. (Image credit: Australian Defense Force)

The AN/ALQ-250 EPAWSS will provide full-spectrum EW capabilities, including radar warning, geolocation, situational awareness, and self-protection to the F-15. Chaff and flares capacity will be increased by 50%, with four more dispensers added in the EPAWSS fairings behind the tail fins (two for each fairing), for a total of 12 dispenser housing 360 cartridges.

EPAWSS is fully integrated with radar warning, geo-location and increased chaff and flare capability to detect and defeat surface and airborne threats in signal-dense and highly contested environments. Because of this, the system enables freedom of maneuver and deeper penetration into battlespaces protected by modern integrated air defense systems.

The AN/AAR-57 CMWS is an ultra-violet based missile warning system, part of an integrated IR countermeasures suite utilizing five sensors to display accurate threat location and dispense decoys/countermeasures. Although CMWS was initially fielded in 2005, BAE Systems continuously customized the algorithms to adapt to new threats and CMWS has now reached Generation 3.

@TheAviationist.com

[fusionseo]

Where to Find the Most Reliable Electronic Health Record Systems for Small Clinics

Running a small clinic comes with many responsibilities. One of the most important parts of managing a clinic is keeping patient records safe, updated, and easy to access. This is where electronic health record systems (EHR systems) play a big role.

Small clinics need systems that are not only easy to use but also helpful in managing patient care, billing, and follow-ups. In this blog, let’s look at where you can find the right electronic health record systems that work well for small clinics.

Why Electronic Health Record Systems Are Important for Small Clinics

Keeping paper records is time-consuming and risky. Files can be misplaced, damaged, or lost. Electronic health record systems make it simple to keep everything in one place. These systems help doctors and clinic staff:

Save time by quickly pulling up patient history

Reduce paperwork and manual errors

Keep patient data safe and secure

Improve communication within the clinic

Make billing and insurance processes smoother

For small clinics with fewer staff members, having a digital system saves both time and effort.

What to Look for in an Electronic Health Record System

Not all systems are the same. Some are made for big hospitals and may be too complex for small clinics. When choosing an electronic health record system, it’s important to check the following:

Easy to Use

The system should be simple to understand and easy for everyone on your team to use—even those who are not very tech-savvy.

Affordable

Small clinics often have limited budgets. Choose a system that offers good features at a price you can afford.

Cloud-Based Option

Cloud-based systems let you access data from anywhere. This is great if you want to check records from home or another location.

Good Customer Support

You may need help setting up or using the system. Make sure the company provides help when you need it.

Secure

Patient data is private and sensitive. Choose a system with strong data protection and privacy settings.

Best Places to Find Good Electronic Health Record Systems

Search Online

Many EHR providers have websites that show what their system can do. Look for systems that mention support for small clinics.

Read Reviews from Other Clinics

Reading what other small clinics say can help you understand which systems are easy to use and helpful in real situations.

Ask Other Clinic Owners

If you know someone who runs a clinic, ask them which system they use. Their experience can guide you in choosing the right one.

Try a Free Demo

Some companies offer free trials. You can try the system before paying for it. This gives you a better idea of how it works and whether it’s right for your clinic.

Services That Come with EHR Systems

Some electronic health record systems offer extra features that can help your clinic run better:

Appointment booking

Billing and insurance claim tools

Automatic reminders for patients

Reports and analytics to help track clinic performance

Integration with lab reports or prescriptions

These added features save time and allow doctors to focus more on patient care.

Conclusion

Electronic health record systems have become a must-have for small clinics. They help reduce paperwork, improve patient care, and make day-to-day tasks easier for everyone in the clinic. While there are many options out there, it’s best to choose a system that is simple, affordable, and built for smaller healthcare setups.

Call to Action

If you run a small clinic and are still using paper records, now is the perfect time to move to electronic health record systems. Look for a system that suits your clinic’s size and needs. A good EHR system will save you time, cut down on errors, and help you give better care to your patients every day.

[elumish]

keeping in mind the strategic/operational/tactical failures discussed in your earlier post, what would be the major failure point of the worldbuilding in iron flame? feel free to spoiler tag. is it the nature of the enemy and the common public narrative about that?

Okay so even though I finished Iron Flame fairly recently, I have also read a lot of books in the interim, so this may be a little general and may not get every detail totally correct. I'll stick all of my thoughts under a Read More, so if you don't want Fourth Wing/Iron Flame spoilers, just skip this post.

Strategic: To be totally honest, I didn't have a huge issue with the strategic-level worldbuilding of the Empyrean. I think the question of why dragons take part in this whole thing and also why dragons vs. griffins are totally neatly divided by country borders that are relatively new is not clear and sort of a problem, but I could mostly suspend disbelief there.

It definitely is not the most well built out/robust strategic worldbuilding, but I was basically fine with it. My feeling basically boiled down to "it didn't make me actively annoyed so I lived with it and can't currently think of a major issue." Also I like dragons.

Operational: Okay! So!

I found the entire organizational structure/setup of this entire world absolutely baffling to the point of being incomprehensible.

This probably doesn't need to be said, but I will anyway: a major goal of a military is to have as many trained fighters as you can. Attrition is one of the biggest issues faced by militaries (other than logistics) and the more people you are starting with, 1) the more you can do in general and 2) the more people you can afford to lose.

This means that you really want as close to 100% of your potential fighting force to survive training. Even if you only view people as cannon fodder, literally the point of cannon fodder is to put them in front of the cannons, not kill them in training.

I know the argument presented in the series by Violet is that it inures them to death so they can keep going when their teammates die, but that is terrible for a military. Yes, people need to be able to keep going when their teammate dies, but the training system has them killing each other. They are incentivized to kill each other! And so this school is literally training them to commit friendly fire incidents. Do you know what happens in a military that trains its soldiers to commit friendly fire incidents? They all kill each other and can't work effectively as a team. And being inured to that? That's just PTSD! You are just fucked up!

So having this military school system where they need to kill each other to win makes for a dramatic story but is an absolutely awful military training setup.

But also these are (or should be, if they had a non-awful system) highly trained members of the military, which makes them extremely valuable and also extremely expensive. People who fail out should just get stuck in a different part of the military instead of basically being killed.

And actually to that point, this whole setup would make much more sense if they had the equivalent of basic training and then had people specialize, the way they do in the real military. You absolutely want your military forces to be interoperable, and they are not even a little bit in this world.

Also why the hell don't these people use more ground forces? The number of dragon riders is limited to the number of dragons, but you can just have as many infantry as you can logistically sustain. Set up an effective border defense.

If you look at the traitor people (I can't remember what they're called right now), sticking them in the elite fighting force school also doesn't make any sense. I know they gave some in-universe reason for it, but especially because of the incomprehensible "if more than three of them are near each other then we can't magically surveil them" system if they were actually viewed as a security risk, they shouldn't have been allowed anywhere near the military, much less in the dragon forces.

They're a literal flight risk! There is absolutely nothing keeping them from defecting en masse. They can't be surveilled when they're together! Also they could commit friendly fire attacks! None of it makes any sense!

I also never really understood why they were keeping the real enemy a secret and why there was such a concerted effort. It didn't seem like the military leadership/king got any real benefit from maintaining a massive conspiracy to...kneecap their own military force.

The funny thing is that since finishing Iron Flame I've read basically all of Rebecca Yarros's other books, which are basically all contemporary romance, and she writes a lot of military-adjacent books, and they generally don't have this problem. Her husband was (is?) in the military, and she seems to have a decent understanding of it, so I'm not sure why she threw that all away for this.

Tactical: Okay so this is a lot related to the issue of "why are the trainees incentivized to kill each other" but Violet's ability to poison her way through her sparring didn't make any real sense if they was any point to the sparring. She should have just been made to spar with some instructors. And also they should have had some real fighting training. Though again that's more an operational issue.

Violet definitely had a lot of Plot Strings (the plot "coincidentally" moving her to the right place at the right time to do something only she could do): especially, that she (the person who happened to have the father who knew all of the plot-relevant things for some reason) happened to get magically soul-bonded to Xaden (the person leading the group that happens to know the truth about everything). I understand the whole situation with her mother, but her mother didn't control the soul bonding.

Overall the issue on a character level was more of a "wow this person just happens to have/be exactly what we need at this time" (the prince! who was just there! until he was extremely plot relevant coincidentally just when we needed him!) but each character was mostly believable taken in isolation.

[apas-95]

most usamericans don't even know what their consistent unit of mass is, because their commonly used units aren't actually mathematically consistent, and require conversion factors; so for interoperability's sake, engineers in the rest of the world have to, alongside the globally-used system, also use and learn a system of US-only measurements the US population isn't even really aware of themselves