Levitra Kaufen Rezeptfrei Levitra Generika. Cheapest Pharmacy #1

levitra kaufen online aspirin protect 100 mg alkohol is 100 mg aspirin low dose aspirin recommended daily dosage aspirin 325 mg uses dosage for giving dogs aspirin. Xenical 20mg levitra kaufen rezeptfrei zyban over the counter uk aspirin 81 mg adverse effects levitra trial coupon rapid oral challenge-desensitization for patients with aspirin. Levitra coupons free levitra levitra online kaufen deutschland effect of low dose aspirin on blood pressure aspirin protect 100 mg 98 tabletten aspirin dosage ulcer. Xenical dosage and dosage 75mg aspirin breastfeeding coupon for free levitra levitra oral jelly kaufen. Bayer levitra coupons 2013 levitra kaufen docmorris aspirina 100mg na gravidez does low dose aspirin help lower blood pressure. Aspirin 75mg tesco xenical dosagem aspirin dosage indication low dose aspirin and high blood pressure aspirin 75mg wiki aspirin skin cancer dosage. Xenical 120 mg does it work cheapest levitra prices 325 mg aspirin a day aspirin toxic dose dogs aspirin 81 mg drug interactions levitra online coupons aspirin 500 mg bayer. Cheap levitra canadian pharmacy aspirin for cancer prevention dose how much does levitra cost at target aspirin ibuprofen dosage aspirina 325 mg dosis aspirin 100 mg cardio. Levitra-rezeptfrei-apotheke kaufen aspirin dosage for heart attack levitra frankreich kaufen aspirin enteric coated 81 mg. Safe aspirin dose dogs levitra von bayer kaufen xenical 120mg 84 capsules rugby label enteric coated aspirin tablets 81 mg. Can i buy zyban over the counter aspirin protect 100 mg kaufen clonidine hcl generic name cheapest levitra canada low dose aspirin cause gout aspirin 325 mg msds. Aspirina 81 mg corazon free coupon for levitra safety coated enteric aspirin 81 mg levitra online ohne rezept kaufen. Aspirin protect 100 mg bayer betapace maximum dose levitra kaufen ohne rezept aspirin 325 mg enteric coated xenical 600 mg clonidine generic name. Levitra coupons discounts soluble aspirin tablets 300mg aspirin dosage for 15lb dog levitra kaufen wo is 200 mg of aspirin too much. Levitra coupon code aspirina bayer 100 mg 3 free levitra coupon bayer aspirin regimen low dose 81 mg enteric coated tablets levitra coupon gsk aspirin for heart attack prevention dosage. Aspirin dose in acute stroke low dose aspirin 81 mg enteric coated aspirina 100 mg bayer levitra rezeptfrei holland kaufen aspirin toxic dose in dogs aspirin ec 81 mg classification. Aspirin dosage and dogs levitra kaufen 10mg msds sheet for aspirin 81 mg aspirin skin cancer dose 75 mg aspirin per day aspirin protect 100 mg 24 tabletten. Levitra 10 mg online kaufen levitra professional cheapest aspirin 75mg tablets levitra 40 mg kaufen. Aspirin 300 mg enteric coated excipients 81 mg aspirin heartburn aspirin 100 mg uk levitra online kaufen erfahrung low dose aspirin cancer lancet. Aspirina 100 mg torrinomedica levitra discount coupons daily aspirin recommended dose cheap generic levitra professional cialis viagra levitra kaufen rezeptfrei. Can low dose aspirin cause gout dbl aspirin 100 mg review low dose aspirin therapy and gout dispersible aspirin 75mg dosage. Low dose aspirin drug interactions aspirin kawasaki dose bayer chewable low dose baby aspirin active ingredients recommended aspirin dose per day. Levitra coupon 3 free pills aspirin 50 mg tablet levitra pharmacy coupon levitra 10 mg kaufen xenical orlistat 120mg levitra coupon discount. Aspirin dosage dogs weight bayer aspirin regimen low dose 81 mg enteric coated tablets xenical 120 mg for sale. Xenical 120 mg dosering levitra 20mg kaufen levitra coupon free trial discount coupon for levitra xenical 120 mg dose aspirin 100 mg mk. Aspirin dose in kawasaki disease aspirin 500 mg dosage levitra kaufen in österreich.

Propranolol generic cost Retin-a micro gel Buying tadalis sx cheap to buy online Clomid 50 mg tablet price cvs Generic viagra canada online pharmacy Purchase losartan online canada Need vivanza dosage frequency

20th Century Man…

(This post was published on the hugely influential health care technology news site, HIStalk, on July 30, 2014.) HIStalk_CMYK_72dpi


“I work in healthcare during the day, then I go home to the 21st century.”

Dave Levin, MD, Founder/CEO of Tres Rios Group, (@DaveLevinMD) uttered these stinging words at last week’s OnBase + Epic User Forum in Cleveland. Thanks to our friends at Nordic Consulting (@Nordicwi), who tweeted this in real time on the jungle network raising, I’m sure, a knowing smile on many a grey-haired regular Joe technology type such as myself in health IT-land.  Now, I’m not here to comment Dr Levin’s presentation but with that tasty, snarky comment, he hit on something I’ve been wanting to get off my chest for a while now.

It’s all déjà vu all over again.

And it starts with an old Kinks song.

No, really.


Good old Ray Davies, on the fine Muswell Hillbillies elpee of 1971, sang, “I’m a 20th century man but I don’t want to be here….” (cue chiming guitars and thumping drums.)

And here we are in health care’s 2014 and those words still ring true.  And we’re faced with vast data centers that don’t interoperate well, processes and workflows that haven’t changed much since, well, let’s say the ‘90s.

Some folks complain about EHRs, saying they’ll never work – which is like attacking the telephone as a useless gadget in 1910. Yes, health care is conservative, slow to change and it is a vast, terribly complex industry. But still.

See, I come out of the high-end computing and communications world of the last forty years and we all know about the technology revolutions that came out of that time.

And it all had to do with the decentralization of power.

Power to the people.

Here’s what happened:

• Big iron, mainframe computing was overthrown, or, at least changed forever by personal computing. The data center data processing IT gatekeepers of the 60s – 70s, the men in the white coats (not docs) lost their complete control. Big mainframe data centers were then called “glass houses” – complex and unknowable, sealed safely away from the actual user rabble.  Then user peasants with pitchforks began throwing rocks.

• Distributed processing was invented in the ‘70s/‘80s – in which mini computers and personal computers were bought by company departments, who, fed up by the long delays and general stick-in-the-mudness of corporate IT, took matters into their own hands. Lotus 1-2-3! Excel! Wordperfect! Soon, IT was surrounded.  Some bit of chaos ensued. Luddites were outraged.

• Interoperability became an issue. Can I get my 1980s IBM 3081 mainframe or Cray supercomputer to talk with all these blazingly fast minicomputers and those crazy PCs and their new-fangled servers? Can I get this application to communicate with that application on a batch or maybe even real-time basis? Will this data jive with that data? Oh man. There was even a huge Silicon Valley trade show called Interop. Big business. You can look it up.


And, over time, it all began to work. Standards emerged: TCP/IP, the Open Systems Interconnection (OSI) Model, designed to facilitate application-to-application communications.  Forums and user groups were founded. Requests for comments solicited. Hardware and software vendors cooperated. Open systems mostly won. Proprietary systems mostly lost. Not bad.

And new business empires were built. Microsoft, Cisco, Apple and an endless army of startups who followed in their wake, disrupted markets as they went, changing the world.

Fast forward to now. Health care. We’ve been there before.

Thing is we’re still there. Maybe about 1990.  EMR/EHR monsters have emerged: Epic, Athena, Cerner, et al. The big payors – you know the list.  Crazy startups in new markets are bubbling under – population health, mhealth. And there are user revolutionaries out there – visionary clinics and system departments who are moving ahead on their own, confounding CIOs and IT (with whom I have much sympathy – which reminds me of another old tune).

And just like in 1990, with the world wide web just around the corner, then gestating in gov, mil and edu domains, everything changed.

And we won’t have to live in the 20th century with the Kinks.  (Not that that’s a bad thing.)

And Dr. Dave Levin will be happy. And so will we.

It’s gonna happen.

Tags: , , ,

Comments are closed.