Unified Electronic Medical Records!

by hilzoy

More good news:

"President Obama announced plans on Thursday to computerize the medical records of veterans into a unified system, a move that is expected to ease the now-cumbersome process that results in confusion, lost records and bureaucratic delays.

Medical information will flow directly from the military to the Department of Veterans Affairs' health care system. At present, veterans must hand carry their medical records to Veterans Affairs' facilities once they leave active-duty service. The Veterans Affairs system has a backlog of 800,000 disability claims, which means that veterans typically wait six months for decisions on their cases.

The task of creating a unified system will be handled by the Departments of Defense and Veterans Affairs. The undertaking has repeatedly confounded the two agencies in the past, and it remains unclear how long the project will take and how much it will cost. (...)

Mr. Obama also voiced support for a measure that would allow Congress to approve the money for veterans’ medical care one year in advance. Congress has been routinely late in passing the bill that finances the Department of Veterans Affairs, a delay that hampers medical care for veterans and makes planning difficult. (...)

Paul Rieckhoff, the executive director of Iraq and Afghanistan Veterans of America, said that modernizing medical records and allowing the two systems -- military and veterans affairs -- to talk to each other would have a dramatic effect on care.

Recently, Mr. Rieckhoff said, a Veterans Affairs doctor told him he had encountered a soldier with a brain injury, an amputation and a septic leg. The doctor had no idea how the man had been hurt because he did not have a complete file, he said.

"If you are a wounded service member, you have no continuity through the system," Mr. Rieckhoff said on Thursday."

This is really important. In a world in which medical records can be stored electronically, there's no excuse for veterans, especially wounded veterans, having to trudge around taking their files from one office to another. There's even less of an excuse if it delays their getting the care they need.

One of the things I minded about the Bush administration was that they didn't seem at all interested in trying to get government to work better. Unfortunately, this was dwarfed by little things like torture, starting unnecessary wars, and defying the law, but still. Likewise, this was, unfortunately, not at the top of my reasons for supporting Obama, but his legislation always included a lot of good, workmanlike ways of making things work better, and I imagined he'd do the same as President. I'm so glad he is.

Comments

[Johnny Canuck]

and the reason the republicans will oppose this is?

[Jesurgislac]

and the reason the republicans will oppose this is?

Because this is how it's done in countries with socialized medicine. So, obviously, it must be bad.

[Anthony Damiani]

I keep hearing unpleasant things from the doctors and nurses I know about the expense and amount of time that EMR are taking up...

[Jesurgislac]

Anthony, when the GP practice I am registered with adopted unified medical records, the first month or so the entire staff kept saying "New system!" as they couldn't do something, or couldn't find information they wanted.

Now? It's great.

[Brett Bellmore]

I suppose the downside is when somebody slips somebody with access to the system a bit of money, and suddenly a half million people's private medical records are leaked. But I agree the current paper system is loony.

[rea]

when somebody slips somebody with access to the system a bit of money, and suddenly a half million people's private medical records are leaked.

(1) I can see why someone might want to bribe a records keeper to disclose a particular record. Bribing someone to reelase half a million records to the public seems rather purposeless.

(2) The present system seems as vulnerable to bribery/leaking of a particular record as does the electronic system.

(3) The present system seems to do a much better job of keeping medical records confidential from treating pysicians, however.

[Brett Bellmore]

" Bribing someone to reelase half a million records to the public seems rather purposeless."

A failure of imagination. Abortion records are medical records, are they not? Mightn't pro-lifers see this as a useful exercise in outing murderers?

Heck, for that matter, imagine the utility of being able to effectively target ED spams.

Medical records aren't quite as immediately translatable into cold, hard cash as financial records, but it can be done, and an electronic system would allow it to be done on a mass basis.

[Slartibartfast]

and the reason the republicans will oppose this is?

Uh...this is a given, somehow? WTF?

I'd want VA rules to go even further. I've got a good friend who is a veteran, and his files haven't been adequately annotated to reflect his condition. Why? Because if they did annotate the files correctly, he'd be eligible for more disability, and potentially have grounds to sue the VA.

He's been told that this isn't the VA policy, but the leverage to actually make things change isn't there. So he's going through his congresscritters, and doing a lot of letter-writing.

A single source of records is a good thing. There's no reason at all, in this day and age, for VA patients to have to lug their own paper medical records from place to place.

suddenly a half million people's private medical records are leaked

The potential for leakage is quite large, isn't it, when you've got multiple different sources of data. Put all the data on a secure server, and make it so you don't have to (for instance) lug huge amounts of it around on a laptop that can be stolen, and you're already more secure. Need to do data analysis on the data? Have your analysts remote-desktop in and host their spreadsheets on the server itself.

There are probably better ways; point is, there are ways.

[Brett Bellmore]

"The potential for leakage is quite large, isn't it, when you've got multiple different sources of data. Put all the data on a secure server, and make it so you don't have to (for instance) lug huge amounts of it around on a laptop that can be stolen, and you're already more secure."

You know, this illustrates one of the differences I've noticed between liberals and conservatives, which isn't really ideological: Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

Under the current system, we don't achieve all the benefits a unified system could achieve, but data leaks are small scale, limited. Under the proposed system, we'd gain benefits a piecemeal system can't deliver, but at the cost of making truly massive data leaks possible.

Myself, I'd forget centralized records at all, and store the medical records on redundant RFID chips in the patient themselves. So that if you've got the patient on hand, you've got all the up to date records. But no central data base would exist to be abused.

At least, I'd propose that if I could figure out a feasible way of avoiding somebody walking by with a gadget in their pocket and reading out your medical records.

[Jesurgislac]

Brett: Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

You know, you were making good comments in there until you started blethering this kind of horsecrap. Why do you want to undercut a rational argument with fantasies about "conservatives" and "liberals"? Trolling?

[Slartibartfast]

Conservatives tend to want to limit the potential downside

That's me, Brett. I'm all about downside-limiting AND upside-encouraging. I'm an optimist, in the sense that I'm to a certain extent about optimizing.

Hopefully you haven't jumped to some tragically wrong conclusion about my political leanings, although it does appear that you have.

[Slartibartfast]

but data leaks are small scale, limited

Sure they are. Like this leak? Small.

[Slartibartfast]

Brett, the absolute safest thing is for the doctors to carry your medical records around in organic memory. That way, no one could swipe your records.

There are problems with that, though, just as there are problems with making veterans hand-carry their records around. You've got to consider the harm/benefit tradeoff.

There are other ways to safeguard the data and discourage theft, such as encrypting the records and limiting key access. But I tend to leave that sort of exploration to people who know what they're talking about, rather than pretend that nothing at all can be done to safeguard the data.

[cleek]

an electronic system would allow it to be done on a mass basis.

unless you are insured by Amish Mutual, your insurance company already has electronic copies of all of your healthcare info, from every doctor you've visited while under their plan.

[cleek]

let me amend that... insurance companies have the high-level info about everything your doctor has charged you for. no, they don't have the detailed notes. but just the high-level info will be enough to show who has had an abortion (per your example), since most insurance co's cover elective abortion.

[Eric Martin]

cleek wins

[Johnny Canuck]

Brett: Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

Brett, thank you for this observation. It would be nice if the resident philosopher Hilzoy were to share her comments on this point. Is it that liberals are, depending on one's own perspective, "optimistic" or "foolishly naive", and conservatives "timidly obtuse" or "realistic"? (I realize there are less charitable characterizations of one's opponents.)

Perhaps if equal emphasis were placed on both sides of the equation, as formulated by Slartibartfast, you'd have a successful outcome.

[John Miller]

cleek is only partially correct. In a day and age when so many medical procedures need to be approved by the insurance companies, and when so many managed care companies are focused on long term control of conditions like diabetes, they have a lot more of the clinical information than most people know.

Insurance companies can request, and withhold payment if their request is refused, all notes about treatment provided to a patient if they so desire.

Granted, it isn't a normal process, but the ability is there.

[gwangung]

You know, this illustrates one of the differences I've noticed between liberals and conservatives, which isn't really ideological: Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

This assumes that both sides assess the risk properly AND balances it properly.

In this particular instance, I don't believe that you've properly assessed the risk.

[(The Original) Francis]

while we're all beating up on Brett, I'd like to return to the RFID idea. He wrote: "store the medical records on redundant RFID chips in the patient themselves.

Now, where exactly are you planning on sticking that chip? In my *ss? And this is a conservative idea -- you can either have paper records or a chip (wait ... he wrote "redundant", make that multiple chips) jammed into your body?

wow.

[Slartibartfast]

Shades of Papillon!

[cleek]

cleek is only partially correct. In a day and age when so many medical procedures need to be approved by the insurance companies, and when so many managed care companies are focused on long term control of conditions like diabetes, they have a lot more of the clinical information than most people know.

<Jonah>
I believe this only strengthens my point!
</Jonah>

:)

[Pjs]

I hope I'm not giving away any military secrets here, but the VA already has a computerized records system. I know. I've been in it for about twenty years. For routine care, I see a PA in a local clinic. For oncology, I see a specialist a hospital forty miles away. For cardiology, it's a different hospital, still further away. A nuisance, making those trips? Sure, but here's the point. Each of those facilities knows what treatment I've received at the others. If the cardiologist wants a blood test, I don't have to take a day off and drive to her hospital. I take half an hour and drive to the local clinic; a couple hours later, she has the results.

I've run into the snags any bureaucracy throws in your path, but overall, the VA has given me excellent, well-coordinated care.

Why so much bad news lately? Because there's been bad treatment. Why bad treatment? My theory:
• One, the Bush Administration horribly underestimated the toll its wars would take on the military.
• Two, top VA administration, like so much of the Executive Branch, was filled with political hacks who, as is customary with political hacks, reacted to problems with denial and evasion rather than prompt, positive action.

[John Miller]

Cleek, yes it does, which is why I put it in there. The partially correct only meant you actually undrestated not overstated the situation.

[John Miller]

PJ, your experiences are similar to most vets. The key difference here is that any medical records that are complied while a member of the military is on active duty is automatically transfered into the VA system.

That is where the problem had been in the past. What care was provided while on active duty had to be collected and then have the member take to the VA to be entered.

This is a tremendous upgrade.

[Slartibartfast]

the VA already has a computerized records system

Yes. Getting back to the actual topic, what's getting computerized is the connection between military and VA records.

Which, it seems to me, carries minimal risk. Quite a few responses in this thread, my own included, seem to overlook that the only thing being proposed here is a connection between military and VA medical records.

[LauraM]

You know, this illustrates one of the differences I've noticed between liberals and conservatives, which isn't really ideological: Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

I'm going to go against everyone else and say that I think there's some truth to this. Or, anyway, that there used to be some truth to it. Nowadays, I'm not so sure. Conservatism has moved so far from what I used to think it was--a reasonable caution about far-ranging plans to change and improve society--that it's not even recognizable as that any more. Possibly I was simply wrong about what it represented, I don't know. But these days, conservatism doesn't remotely fit that description. "Conservatives" these days are the radicals, who want to redesign long-standing institutions (like Social Security and the income tax, for example), often without anything that looks like caution about possible downsides.

[rea]

OMG, Brett want to protect everyone's privacy by implanting microchips in everybody? I'm . . . speachless.

[Pjs]

John (and others):

You're right, of course. I wanted to point out that we are talking, not about establishing a new system, but about improving access to what is already a pretty good system. I also think it is true that political and administrative ineptitude more than systemic flaws are responsible for the grotesque failures.

[Slartibartfast]

peachless? speechless? both?

[rea]

Speachless--and orthographically challenged.

[Uncle Kvetch]

Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

Which explains why self-described conservatives overwhelmingly opposed the Iraq War. Except that they didn't.

[Chris Johnson]

I'm a physician who's used electronic medical records for about three years (after wrestling with paper charts for over thirty). As someone said upthread, there's some inevitable initial pain and anguish, plus the obligatory whining in the doctors' lounge. Then . . . then, things get much better.

Besides the convenience, I think the EMR makes patients safer. For example, the computer has all sorts of built-in safeguards that just plain won't let you order things, such as drugs, that are dangerous for that patient.

As an intensive care doc, I also love having all the data right there in front of me in real time.

So I'm in the dinosaur-doc generation, but I'm a fan of the EMR

[Bernard Yomtov]

Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

This theory explains the strong conservative support for social welfare programs financed by fairly high and progressive tax structures.

[d'd'd'dave]

I'm for electronic records.

However, this sequence pricked my imagination:

//I've got a good friend who is a veteran, and his files haven't been adequately annotated to reflect his condition. Why? Because if they did annotate the files correctly, he'd be eligible for more disability, and potentially have grounds to sue the VA....A single source of records is a good thing. There's no reason at all, in this day and age, for VA patients to have to lug their own paper medical records from place to place.//

Hmmm. Only one source...in control of the VA....the folks that don't want to give you benefits (alleged)...."Your missing organs, soldier? What missing organs? We have no record of that sir."

[d'd'd'dave]

//Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.//

Disclaimer: I'm not sure the above is true. If I assume it's true, here is my two cents: To the extent someone else is in charge of my destiny (Big Brother) I want to limit the downside. To the extent I am in charge of my own destiny, I'm willing to take a more balanced approach. I sincerely believe that distributed decision making is more apt to self-correct faster and with less overshoot than central decision making. Sure, if we all put everything else aside and focus on just one thing we can probably achieve that one thing. However, last time I checked, it is hard to find any two people who completely agree on anything.

[Catsy]

You know, you were making good comments in there until you started blethering this kind of horsecrap. Why do you want to undercut a rational argument with fantasies about "conservatives" and "liberals"? Trolling?

Jes, how was Brett's observation all that different from mine a month or so back about the difference in how conservative and liberal belief systems tend to prioritize?

[russell]

Conservatives tend to want to limit the potential downside, at the cost of not achieving the greatest possible upside. While liberals tend to want to maximize the potential upside, at the cost of increasing the potential downside, too.

I think this is true of conservatism with a small 'c'; a conservative point of view is relatively more likely to think, 'first, do no harm'.

By "conservative with a small 'c'" I mean conservatism as a personal preference or tendency, a personal habit of mind. It has almost nothing to do with current day, or even historical, American political conservatism in either doctrine or practice.

In fact, American conservatives have demonstrated themselves to be only too eager to double down on any number of insanely high risk crap shoots. Lately, it's kind of what they do.

To my eye, American political conservatism is about enhancing and preserving the privileges and rights of property and ownership, full stop. Nothing more, nothing less. Has been, is now, and most likely will continue to be.

Yes. Getting back to the actual topic, what's getting computerized is the connection between military and VA records.

The analogy in the private arena would be allowing your doctor's office and your insurance company to share information electronically. Which they do.

If our level of trust in either our doctors or our insurance industry doesn't allow for them to share information about our medical conditions and history, we have a much larger problem then technology will be able to address.

To the extent I am in charge of my own destiny, I'm willing to take a more balanced approach.

Nobody is in charge of their own destiny.

[Jesurgislac]

Catsy: Jes, how was Brett's observation all that different from mine a month or so back about the difference in how conservative and liberal belief systems tend to prioritize?

I'm embarrassed to have to admit this, but I do not, in fact, have total recall of every single comment made at Obsidian Wings from a month ago. If you actually want me to answer this question, I fear you'll have to link to your comment so that the two can be compared.

If you just want a rhetorical answer, I'd say it's probably because you're not a jerk.

[Brett Bellmore]

I think you have to take into account the distorting effect of Republican party dynamics: Outside of some liberal enclaves where the GOP has adapted rather than just writing them off, you pretty much need to at least claim to be a conservative, in order to get anywhere in the Republican party.

Take Bush, for instance: He really isn't that much of a conservative. How much of a conservative isn't he? When he first ran for President, he called himself a "compassionate conservative", demonstrating that he had a really low opinion of actual conservatives, so low that he had to qualify the term in order to bear appropriating it for himself.

And yet, you probably consider him to be an example of what conservatives really are.

You might see the same dynamic in the Democratic party with liberal, if "the L word" weren't something to run away from, rather than wrap around yourself.

So, while there is a conservative trend in American politics to which my description applies, it's obscured by a lot of pretenders. And any institutional conservative movement is vulnerable to takeover by the Republican party; Political parties aren't very fond of independent power centers, after all.

Oh, and Jes? I'd be worried if you didn't think I was a jerk, that's how much I respect your judgment.

[russell]

Take Bush, for instance: He really isn't that much of a conservative.

Oddly, this is not a point of view I remember anyone holding ca 2000, or even 2004.

It seems to only have emerged after W demonstrated himself to be an utter and incorrigible f*ckup.

The True Conservative, it seems, is an elusive creature.

[Slartibartfast]

Oddly, this is not a point of view I remember anyone holding ca 2000, or even 2004.

Odd how memory works. My memory has me and my friends in near-universal agreement that Bush was never much of a conservative, as much as he was a loyal Republican.

Oh, sure, he played to the Religious Right fairly well. We're probably back to a no-true-Scotsman discussion with that, though.

[Turbulence]

Odd how memory works.

Odd indeed. If you ran polls right now, you'd find that 80% of voters remembered voting for Obama. Or 70% remembered being steadfastly against the Iraq war. Memory is plastic and to avoid cognitive dissonance, people rewrite their memories after the fact. I'm not suggesting that's what you've done here, but I am suggesting that there are a lot of people who screamed "Bush is conservative" a few years ago and now insist the opposite.

[Slartibartfast]

I am suggesting that there are a lot of people who screamed "Bush is conservative" a few years ago and now insist the opposite.

Possibly. But I'm nearly certain that I wasn't one of those people. The Left Coaster recalls a few others who didn't think Bush was very conservative.

Not sure what it says about you, though, if Grover Norquist thinks you're doing it wrong.

I do recall a lot of leftward-leaning folks crying that Bush was conservative ("ultraconservative", even) years ago; possibly they're still saying that.

No one whose opinion I regarded highly enough to pin a name on, though.

[Jesurgislac]

Slartibartfast: My memory has me and my friends in near-universal agreement that Bush was never much of a conservative, as much as he was a loyal Republican.

You could always correct your memory by readng back through the comments and posts you made in defense of Bush prior to November 2004.

Of course, I can see why remembering that you were always against Bush would be a much nicer memory to have...

[Slartibartfast]

...of course, the time scale here is long enough that John Cole was still an avowed Republican. No, really; check his archives and see. That was back when norbizness actually said things, on occasion, in complete seriousness.

You could always correct your memory by readng back through the comments and posts you made in defense of Bush prior to November 2004.

Anyone have any idea what this has to do with Bush being conservative vs. not very conservative? I sure don't. Nor have I said that I've always been against Bush.

Because that would be contrafactual. 's got nothing to do, though, with my opinion of Bush's political leanings, historically speaking.

[russell]

My memory has me and my friends in near-universal agreement that Bush was never much of a conservative, as much as he was a loyal Republican.

You'll forgive me, I hope, for my lack of familiarity with your opinion and that of your friends, ca 2000 or 2004, on the topic of Bush's conservatism.

Everyone I knew, heard, or read who self-identified as a conservative considered him their standard bearer. Frankly, they couldn't get enough of the man. If they could have, they would have eaten him up with a spoon.

If you want to tell me that there are many people who are authentically conservative, who consider the Republican party a gang of opportunistic poseurs, but who vote (R) while holding their noses because there isn't a realistic alternative, all I can say is I feel your pain. It's been sixty or seventy years since there was a meaningful, credible, constructive left in this country. I go through what you're talking about every time I cast a vote.

But as far as I can see, there is not enough distance to admit an ounce of daylight between any organized group of political actors in the United States of America who self-identify as conservative and the Republican Party.

Maybe Ron Paul would be the exception, but I'm not sure he's that attractive as an alternative. I appreciate his principled stand on a lot of things, but I think it's too late to turn the clock back to 1898.

And to Brett's point, it's all well and good to reply "Yeah, but they're not *really* conservative" everytime another outbreak of Republican insanity breaks out, but somebody sure as hell is voting for these folks, sending them money, listening to their TV and radio shows, reading their publications, receiving their mass mailings, showing up for their tea party adventures, or otherwise participating in the efforts of the Not Really Conservative party, and it sure as hell is not me.

If the Republican party is not "what conservatives really are" you all need to get busy, because they're giving you a really, really, really bad name.

[Slartibartfast]

You'll forgive me, I hope, for my lack of familiarity with your opinion and that of your friends, ca 2000 or 2004, on the topic of Bush's conservatism.

Nothing to forgive, russell. And it's not as if I can ask you to take my word for it.

[Jesurgislac]

Slarti: Anyone have any idea what this has to do with Bush being conservative vs. not very conservative? I sure don't. Nor have I said that I've always been against Bush.

So, this has to do with this imaginary definition of "conservative" which any number of reliable Republicans who supported Bush in 2000 and 2004 are now saying always, in their view, excluded Bush... they just never happened to mention it to anyone but, er, off-Internet friends and relations? Okay. Just so we know.

...of course, the time scale here is long enough that John Cole was still an avowed Republican. No, really; check his archives and see.

Yeah, but the key difference between John Cole and these people who are saying "oh, Bush was no conservative, never thought he was", or "I always wanted Bush impeached", is this:

John Cole admitted he was wrong, and that he'd now changed his mind. He did not attempt to BS anyone that he'd "always" been against the Iraq war, or against Bush, or against the modern Republican party, or supported impeachment. He just owned up to having been very, very wrong, and moved on. Which is the classy way to do it.

[Slartibartfast]

I still have no idea what relevance you think all of that is to the point, Jesurgislac. And as I'm disinclined to help you make your own point, I'll wait for you to try and make it yourself. Or not, as suits you.

There's always Google. If you were really curious who thought Bush wasn't very conservative back in, say, 2002-2003, Google can help.

You might even find where I compared Bush to Stephen Hawking.

[Jesurgislac]

I still have no idea what relevance you think all of that is to the point

Ditto. That you actively supported Bush in 2000 and 2004 strikes me as much more relevant than whether or not you had an idiosyncratic definition of "conservative" and Bush did not fit it.

Perhaps you could explain why you think it's important we should know that although you supported Bush, you didn't think of him as "conservative"?

[Slartibartfast]

That you actively supported Bush in 2000 and 2004 strikes me as much more relevant than whether or not you had an idiosyncratic definition of "conservative" and Bush did not fit it.

Ok, fine. Whatevs. It's not as if it's a secret that I supported Bush, or that I'm trying to somehow make it look as if I hadn't.

Perhaps you could explain why you think it's important we should know that although you supported Bush, you didn't think of him as "conservative"?

I don't think it's important that you know anything at all about me, Jesurgislac. As far as I'm concerned, you can completely disregard all of my comments.

If you're mystified as to why I bothered to mention it at all, though, I recommend that you read back through the thread, starting here. If that doesn't help, nothing will.

[Slartibartfast]

or that I'm trying to somehow make it look as if I hadn't

Oops. What that ought to have said is that I'm not trying to make it look as if I hadn't supported Bush, because I had, overtly.

[russell]

So, among people in public life today, who *is* a real conservative?

By which I mean, who is advocating and championing and authentically conservative point of view, and expressing that point of view in concrete legislation or policy proposals?

Not who you hold your nose and vote for because it's a good as you're going to get, but who is actually championing a point of view that you support without reservation?

In the interest of fair play, I should disclose that mine would probably be Bernie Sanders and maybe Russ Feingold. My idea of a constructive, pragmatic centrist is Howard Dean.

Yes, it's true, my preferences are risibly out of step with the mainstream.

We're OT here, but I'm curious to know what true conservatism looks like when it acts in the public sphere.

Thanks -

[Slartibartfast]

I've always maintained that no True Conservative would ever voluntarily run for public office, russell.

Unresponsive, I know. But I see mostly opportunists, not men and women of principle.

[Jesurgislac]

By which I mean, who is advocating and championing and authentically conservative point of view, and expressing that point of view in concrete legislation or policy proposals?

Barack Obama.

Ha ha only serious...

[russell]

I've always maintained that no True Conservative would ever voluntarily run for public office, russell.

That's too bad. More's the pity.

[Jay Andrews]

EMR is used by most medical practices. A fast electronic medical record system requires less time invested in trouble shooting and allows more time invested in caring for patients.