Famous People You meet on Layovers

Yes my friends that is the one and only, Greg "The Hammer" Valentine. I had the most horrific layover in houston. Horrific because the bar closed at 11:30pm and the flight left at 1:30AM. Thus 2 hours with out bar service. :-)

But low and behold who did I meet but THE HAMMER. I actually saw this guy from across the bar and said. "I bet he is a pro westler" He just had that look about him and he looked vaguely familiar.

We had a blast and I bought him a shot of crown and he invited me to work out at his gym in clearwater/largo. (I think my gift was much better )

http://en.wikipedia.org/wiki/Greg_Valentine

Dinner at Whisques

Tonight I had Dinner at Whisques. Nice restaurant on the West Side of ABQ. They have mesquite grilled steaks and seafood. Website is http://www.whisque.com/Menu.aspx The Kobe Sliders were great. I hear they make a great mojito. Did not try one tonight. Had a fun filled day of teaching customization. The Doctors are fun to work with and you can tell they love their job. You forget how dry it is here compared to Tampa. I wake up with a stuffy nose and dry lips Yuck! Guess you would acclimate after a few months. I really enjoy coming to Albuquerque. Nice people they have a very laid back attitude.

ABQ Bound... Look out Garcia's here I come!!

Headed to Albuquerque New Mexico today! I'm excited! I get to see tall mountains, breath air from 6,000 ft. and eat great southwestern food. Man nice combo that is! Right!.

So I land and get my car from budget. The Bus driver was not talkative at all. She had on a Santa hat and I mentioned "Nice Hat"... Not a word. Hmmm Must be a deaf /mute? Not sure if that is even politically correct to use any more. Woman behind me by 2 minutes says the same thing and same reaction. Not a word. Guess she is tired of hearing "Nice Hat" Must be required to wear it and hates it I guess.... people are so funny.....

So I make the b-line to The Original Garcia's and order some green chili stew, Carne Adovada and fresh tortillas. MMM man what a nice reminder of why I like this town. The green chile stew is awesome and the Carne Adovada is nice tender chunks of slow roasted pork in a red sauce. Great to dip the fresh flour tortillas into the stew and the adovada. The tortillas are big and thick and fresh.

Website has their menu: http://www.garciaskitchen.com/

Worth a stop if you are in ABQ!!

Blog back online

Wanted to let everyone know My blog is back up and online again. Check out my EMR Install map it's still growing.

Here is a nice link to a Christmas greeting.

http://ecard.ashland.edu/2004admission/index.html

Reminds me of all the great times spent in Virginia making snowmen and playing in the snow. No way to do that in Florida. I'm looking forward to a trip to Albuquerque next week to see some snow!

Panera in a Pinch for your corporate training center!

Panera was turned into our corporate training center at my recent visit to a client in Deerfield Beach Florida. This client has such a secure site for their multiple businesses that we could not get an outbound connection to our training server hosted in Cary. We had to go "off Campus" to a Panera and use their free wifi. I think I drank more Lattes that one day than the past 4 months combined.. Thanks to the quick thinking of the office staff we saved the day by relocating to Panera. Yeah!

The Dr was a trooper through the whole process. We secured a training site for the next few days at a Hilton hotel nearby. The training was a success and we are well on our way to getting a nice install at this site in Deefield beach. Favorite hotel to stay at is the Doubletree in Boca Raton. Nice place and great rates for a newly renovated hotel. And you can't beat the free cookies either!

Great Local restaurants...

The Grill on Congress

http://southflorida.metromix.com/restaurants/american/the-grille-on-congress-boca-raton/127577/content

Neighborhood Sports Bar and Grill

http://local.yahoo.com/details?id=14428339

Blue Fin Sushi (Sushi and Thai... YUM!)

http://www.bluefinsushi.com/

A practice that lives up to their name!

I had a great time implementing this practice! Two nurse practitioners at this Family practice are friends from high school and Nursing school. They have a fun office staff and take extra time to make sure each patient gets special attention from the all female staff.

I had to stay in in the next town over and commute 5 miles each day to the site but I also picked up a few new restaurant as well. golden Rule BBQ. A Local Alabama original with great ribs and sauces. Unique history as well.. May need to look at a Florida Franchise... Top O the River Catfish Restaurants. I ate at the Guntersville , AL store. Nice fried pickles... Great seafood! The Hampton Inn in Ft Payne is the only hotel worth staying in at this location. They also had a Ruby Tuesday's and a Steak restaurant.

Golden Rule BBQ - Great Ribs and sauces!

http://www.goldenrulebbq.com/

Top O the River Catfish restaurant in Guntersville, AL. http://www.topotheriverrestaurant.com/gadsden_tour.php

Plant City Florida known for great Strawberries!

My two latest EHR prodigies! These two guys have a nice office in Central Florida. They are in an aggressively growing urban area in Central florida. Nearby Plant City is know for its' Strawberries in the Spring and Tomatoes all year long. They are also home to the Strawberry Festival in February. http://www.flstrawberryfestival.com/ (Check out the Strawberry festival site! Click on the Royalty tab when you get to the site... That's cracking me up with the Royalty tab.. !!)

The city had the parade down our street while we were customizing a few weeks ago. We were shut ins due the the parade going right down our street so we made sure a drug rep brought lunch that day to keep us nourished during the jam session of template production!

the Lead Dr. is no stranger to the Healthmatics EMR from A4. He went through Family practice residency with 3 doctors I took live on Healthmatics 3 years ago in Jacksonville. (Queue the "It's a Small World" music!) This is the fourth client I have had where they all had ties to the Same Residency class from St Vincent's in Jacksonville.

The Dr did the research for the other Dr's and chose Healthmatics. He has been instrumental in securing 3 or 4 customers for us without even owning his own EMR at the time! (He was still a resident at St Vincent's in Jacksonville) The Dr. recently left a large clinic in Central Florida who has been seeing a sudden decrease in their physician staffing due to a rough transition to their EMR. Seems like workflow was not well thought out and customization was not put in place soon enough to allow for a smooth transition. You hate to see that regardless of who the vendor is... Hopefully they get it turned around ... This has been the 4th Physician I have heard who left that clinic to go solo and purchased the EMR I implement.

Both Dr's were quick studies and they have learned to customize and are getting a nice head start while they are building their practice. We already have the LabCorp interface up and going at Go-Live and they just need to set their webpage up to get the Patient portal running. He should have fun over the next few weeks getting all the toys tweaked. The new practice also purchased all the bells and whistles from Midmark with the Spirometer and EKG that can interface to the EMR.

I'm excited for them I always enjoy working for a new start up practice. This is my 4th start up practice to install this year and I have had 10 or 11 start ups in the past year. I have 2 more new start up practices that I was just assigned this week so I'm looking forward to the initial setup of these offices and watching them grow. It's a nice change from the established offices withtheir mountains of patient charts on an intricate chart rack system and years of consistent scanning ahead of you. Nothing better than a new office with no chart rack in site!! Love those offices!!

• Plant City Links:
• http://goflorida.about.com/od/tampawestcoast/a/plantcity.htm
• Parkesdale Farm the best Strawberry Milkshake in the world!!
• http://www.parkesdale.com/
• Record Strawberry Crop!
• http://www.theledger.com/article/20071222/NEWS/712220457/1338/NEWS00
• Winter Strawberry Capital of the world!
• http://stickygooeycreamychewy.blogspot.com/2008/03/strawberry-fields-forever.html

Phreesia Tablets

Wanted to share my experience with the new Phreesia Tablet. I'm doing an EMR go-live this week and the Dr. at this site in Plant City Florida, was contacted via a postcard mailer to try the Phreesia tablets. They are pretty cool Tablets that allow the patient to enter their medical data into a question and answer software. These Tablets are provided free of cost from Phreesia. They are supported by ads that the patient can watch after they are done entering their data. The tablet has a card reader built in. You may be able to see it on the right side of the tablet. They received two identical units that the Dr. configured and set up on his network. They are wireless and come with a wireless router you install in your network and software you place on a PC on your network. That software allows you to review and configure the application on the tablets.

Configuration is setup of the questionnaire which is basic patient history like allergies, past medical, Family History, Demographics, Insurance info, Social History, Medications, Review of systems, and a chief complaint you can pick from a list of most common complaints. Not sure if you can customize any templates or chief complaints. The patient swipes their credit card in the reader and it reads their information and provides a name. (Or they can type the name) Then they are asked for a Date of birth and a pin like the last 4 of your social security number. They are asked gender, demographics, etc. and the interview proceeds with the user touching buttons on the tablet or using a stylus to click through. After the interview the patient is shown an ad from the sponsor of the day. They can skip this ad and then get patient education provided which is linked to the chief complaint they entered earlier. If they had Headaches, it lists patient education on headaches, if they also entered High Blood pressure as an additional complaint, it provides that also. Pretty neat and gives the patient something to do and information to read prior to the visit.

The practice then either prints a PDF of the data or gets a CCR download. This looks like a good first step and is a great idea for practices with no kiosk, patient portal or waiting room kiosk like a Galvanon (which is expensive I hear)

A few draw backs I have noted.

1. The data is in text format and not "codified" so it's not discreet data yet.
2. The patients have had some resistance in using this each visit new and follow up.
3. The patient portion and the MA data entry time is longer than an MA interview while entering data.
4. The Medications do not contain dosages etc for a script.
5. They do not read Driver's Licenses yet.
6. Specific Complaints do not trigger special interviews geared toward those complaints.
7. The data does not interface to an EMR at this time.
8. The only data exchange is via a CCR record which has no standards yet.

Some Benefits

1. It is really cool technology to have!
2. It gets patients in the mode of using a wireless device to enter their own data
3. Easy to use and large buttons are easy on the eyes and on the Grandparents.
4. Lots of data ports on the tablet.
5. Prints off a nice PDF that you can scan in or use for data entry.
6. Second visit is easier since data is retained from each visit.
7. Prompts patients to provide information that they might not feel comfortable writing on a piece of paper.
8. Reduces spelling errors by patients.
9. Reduces reliance on poor penmanship by the patient.
10. Can prompt the patient for specific data needed.
11. Places the burden of data entry on the patient.
12. provides a PDF or CCR that can be loaded into an EMR at some point.
13. Can be used to collect co-pays and payment in a few months.
14. Does not feel guilty asking the patient to pay their portion of the bill or a bill in full.

It's a great first step and I think this company has a great idea they just need to codify it quickly and get it interfaced to an EMR where you can import the ROS, P/E and HPI sections of the note along with History, Demographics and Insurance data to match the power of a Kiosk or patient portal.

All in all it's a neat device and with a few modifications and additions in the software will make a great addition to any waiting room.

LINKS about Phreesia:

http://venturebeat.com/2008/03/06/six-health-20-firms-reinvent-doctor-patient-ties/

http://pharmexec.findpharma.com/pharmexec/E-Marketing/Turning-Patients-onto-Tablet-PCs/ArticleStandard/Article/detail/455791?contextCategoryId=43871

http://www.medicaltabletpc.com/content/view/592/29/

http://forbesontech.typepad.com/my_weblog/2007/09/demofall-what-r.html

http://www.eweek.com/c/a/Health-Care/WiFi-Devices-Bring-Drug-Firms-Messages-to-Doctors-Waiting-Rooms/

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Common Ground Health Clinic Gets An EMR!

It is with great pride and pleasure that I'm able to fill you in on the fact that Common Ground Health Clinic is now Live on an EMR. HIMSS helped in getting a donated EMR to this free clinic to help provide better care for their patients. They completed go live the week of February 18th. I was able to provide training and go-live support and attend Mardi Gras... At least I have my priorities straight right?

What a great experience this has been personally for me to take this client live. Great thanks to everyone at my company for allowing me to participate in this client’s project. I’m really humbled at how hard these volunteers work to provide FREE healthcare to the people of New Orleans.

When I was assigned this account in late December I was told we need to get them live prior to HIMSS the last week of February. I heard they were a free clinic staffed by volunteers and was a little worried about this project. They have a great staff and once I met everyone and saw how dedicated they were I knew they would do a fantastic job!

Common Ground Health Clinic was founded a few days after Hurricane Katrina hit the Gulf Coast. This free clinic started as a street clinic and eventually moved into a local Mosque for a few months before moving across the street to a vacant store located in the Algiers section of New Orleans. Their reach is felt over a 20 mile radius. Healthcare and medications are dispensed from MD’s, NP’s and Nurses who are all Volunteers at the clinic.

Post Katrina many of the normal healthcare channels that provided free or low cost care to the people of New Orleans were closed due to the closing of many local hospitals and clinics. This clinic was started on September 9th by street medics who were basically EMT’s Nurses and Healthcare clinicians that decided to provide free care to people in need.

Since this is a free clinic, this was a radical change from the standard install we do every week. First of all they do not bill the patient. As an Implementer that has implemented EMR’s for over 10 years I’m programmed to naturally seek the best path for our client to seek maximum reimbursement from the insurance company. Everything in our daily life is geared towards coding, and I mean everything. At his clinic there is a completely different approach, everything is provided free of charge and donations are accepted but not necessary. All staff are volunteers which means new people every day. They are staffed with 5 Volunteer MD’s one Full time Nurse Practitioner and 5 volunteer nurses as well as volunteer front desk and office staff, 18 staff in all. The client’s website is located here. http://www.cghc.org/

Also a You Tube Video that provides insight into the process of how the clinic started. And the feelings in New Orleans that prompted volunteers to do something for their fellow neighbors. Their Slogan is “Solidarity not charity”. The little clinic that could video shows the Narrator Anne who is the Nurse practitioner. Ed is the Man in the video that works at the front desk now. Both are great people to work with! http://video.on.nytimes.com/?fr_story=a9f880e1527ab17b6c3b1c04e937a6ddb8b280d6

The clinic opens at 8:30 AM and is a Walk-in clinic where healthcare and medications are provided on a first come first served basis. Walk-in charts are assigned a number 1 to 30, etc depending on how many people show up and they are seen in sign up order.

The patient is taken through “Intake” where a nurse triages the patient and uses our intake FastTrack to guide them from screen to screen to capture vitals, chief complaint, Allergies, Social History and provide basic labs of a glucose check, if Diabetes is in their Family history, or provide basic immunizations or other in office labs. The patient is then placed back in the waiting area until the MD or NP can see the patient. The MD takes over the chart and provides the additional care. They utilize the Wal-Mart $4 prescription list as their “Formulary” for medications. They also dispense free meds from supplies attained from Drug companies and other health clinics that send in their overstock of free samples. If you are affiliated with a drug company make sure you contact the clinic to see how you may contribute to their project.

The Volunteer doctors are thrilled to be using E-prescribe. They all work in other clinics for their Day job and many use EMR’s but none had e-prescribed before.

Thanks to the Assisting Dr. who mentored the Staff during go live. The Dr. was on site a few days and saw abut 10 patients each day himself in the EMR, and provided a tremendous amount of education and advice to the clinic from his 10 years of using an EMR. David Collins from HIMMS was onsite also and was responsible for gathering donations from my employer and other vendors like Dell, HP, and Fujitsu etc for all the donated equipments to the clinic. http://www.himss.org/ASP/ContentRedirector.asp?ContentId=66788&type=HIMSSNewsItem

McKesson donated $20,000 in cash. Great Job Big Mc! They have since received a grant to provide health services and with that grant of course comes the need to provide information.

I’m very proud of my company for their role in this project. It was a great day to wear RED when this client went live on our donated EMR system. From the server to the software to the desktop PC’s, Hand Held Fuji tablets, Fuji scanner, HP Laser printer, Cisco Access point etc… All were donated by my company and individual vendors to get this project going. HIMSS took this clinic under their wings and mentored them through to the finish. This is a great example of how my company is giving back to the community.

I was onsite for staff training last week and trained 5 MD’s, 6 Nurses, and 7 office personnel, for a total of 18 volunteers. We started seeing a few patients in the EMR last week and then saw all patients Monday and Tuesday of this week in the EMR. Totals were 18 patients for Labs Monday morning, 20 patients Monday afternoon, 28 patients Tuesday in the clinic. All notes were completed in the EMR 100%!!

The office is doing great and I’m so proud of all the staff and how hard they worked to get this accomplished. This clinic has done a fantastic job of getting ready for the EMR tidal wave that hit them this week. It’s great to work with people who are excited and LOVE what they do every day and are doing it out of compassion rather than for a paycheck.

The clinic is so thrilled to be using a top notch EMR! They marvel every day at just how far they have come from a street clinic on a sidewalk to a full fledged clinic with 5 exam rooms 4 intake areas and even Herbalists on site to provide Alternative medicine.

We are waiting to hear from LabCorp to see if they will supply a Lab Interface… If you have contacts with LabCorp in New Orleans ... Please drop a note and let them know how great a result interface will be for this group. OR better yet a donated LabCorp Phlebotomist and a Bi-directional interface.

If you have other stories similar to this please post them to comments so we can share how EMR companies are giving back to help those clinics who are not able to afford an EMR.

I return the end of April and first of May to complete their project. This just happens to coincide with the Jazz and Blues Festival. Let the good times roll!!

Comparing Oysters in Nawlins

Acme Oyster House in the French Quarter is where these beauties came from!. I sat on the corner of the oyster bar next to the front door and ate a half dozen raw. Man were they sweet! I also had the Grilled oysters which were great. They are comparable to the Famous Drago's grilled oysters. I had Drago's grilled the night before. Loved the multiple Tabasco Sauces. The smoked one was new for me and it was just right on one of the oysters. I also love the Trio Oyster Sampler at Bourbon House Seafood and Oyster Bar. The Fonseca is the best for me. The BBQ oysters at Redfish Grill on Bourbon street are very unique and surprising ly not as hot as I thought they wuld be very good appitizer.

http://www.acmeoyster.com/
http://www.dragosrestaurant.com/
http://www.bourbonhouse.com/index.php
http://www.redfishgrill.com/menu_detail.php?menu=7

Allscripts- Misys Merger

Having spent the past 25 years in Healthcare IT. I have seen a lot of companies come and go.
The past 19 years of my career have been spent at +Medic (Misys) and A4 Healthsystems (Allscripts). I have to admit I had an inkling this merger would occur for the past year. I went through the +Medic – Misys merger and the A4 – Allscripts merger and have seen great benefits from both.

Announcement day I did feel a little like Luke Skywalker when he found out Darth Vader was his father! The dark side had now become one with the force.
Reflecting on this merger for the past week has lead me to believe that it is a very important first step towards a more effective approach to solving the Healthcare EHR adoption rate in this country while fast forwarding the “interopability” rates of the current EMR’s/EHR’s.

Yes there are a ton of products and yes there will be some sun setting of current EHR’s take a look around HIMSS and see how many little companies are doing the exact same thing with little or minimal differences in their software. I think we tie ourselves to a product or brand name and derive our sense of personality and who we are from a piece of software. We should step back and analyze more from the stand point are we helping or harming the Physician and how they practice medicine. I also realized how many of my friends are still at Misys and how many family members we will now have at Allscripts, once this merger completes. I think Dr Morrow summed it up well in his article. Free registration gets you the article.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20080321/REG/199294076/1031/FREE

I think we need to re-evaluate our emphasis on what we are really trying to achieve here. We should have less focus on my software can kick your softwares ass... and more focus on what service are we really providing for our providers. Are we first seeking to do no harm?

Much has been said here about workflow and how we can’t change an offices workflow and have the software adapt to the provider and not vice versa.

Let’s take a look at a few examples of where workflow should change. Option A (antiquated) vs option E (EHR) I can list 20 or 30 of these off the top of my head but lets start with this simple one.

A. Patient calls to speak to the Dr to get results on a lab test. If you are lucky enough to talk to the Dr you get your results on that one call. (We all know this rarely if ever happens) What usually happens is the phone operator without an EMR writes a hand written message then passes that to a medical records clerk who pulls the chart and paper clips the message to the chart and places the chart on the provider’s desk. The provider who is busy with patients may see the chart and make a call back at Lunch (if there is no drug rep chatting them up at lunch) or after the day is done, which usually means a message on a cell phone or answering machine. The patient meanwhile sits and waits and worries for hours or days until contacted. Once contacted, and usually by an MA or front desk person, who may not have the results in front of them or know how to interpret the results, they are told they are WNL (Within Normal limits). The patient then asks for a copy of the results (so they can Google them to get some answers for a change) and are told they can not be faxed to your home since it is not a secure fax but you can pick up a copy at the office. You pick up a copy the next day or whenever you can get by the office and notice a few lab values at the upper limits of normal. You call again to ask about these values and you now start this whole process over again. Now if you are happy with that work flow continue to seek out an office with no EMR. If you prefer a more modern approach try this.

E. Your results come back via a lab results interface and the physician signs off on the results within minutes of receiving them and publishes these results to their patient portal. The patient receives an email that they have results posted to their portal and can access their secure login to the portal from home or office and receive the physician’s message as well as the results. The results can then be printed on their home computer or exported to their personal health record. You reply to the physician about the top end normal’s via a secure direct email to your physician. Your physician replies within minutes to your concerns. This is all completed in less than an afternoon. So take your pick which workflow works best for you versus works best for the Doctor? Why preserve the paper version?
I was providing follow up training at an OB/GYN practice this past week in rural Georgia. We are talking a tiny, tiny town here people way up in the mountains. This practice is 100% EMR after being on the EMR for 2 months. I’m talking GYN patient and OB patients. (If you are not familiar with this specialty and the trials of going on an EMR then let me tell you that’s a remarkable feat!) They get how this product can change their ability to provide service to the community. The Hospital meanwhile maintains a paper chart.

While I was training a provider on a template design tool on how we can process their Hospital Short Stay report from our EMR and fax to the hospital while in the Hospital rather than complete it by hand in the hospital…. The Caregiver received a call from Labor and Delivery in regards to an OB patient who was in the ER and the nurse had a few questions. The Caregiver without getting up from her chair… Pulled the patients chart, accessed her pregnancy record, (ACOG form) reviewed a few items, reviewed the online fetal monitor Real time, and was also able to have her discharged in a few mins. She even e-prescribed an antibiotic to the pharmacy which would be ready for the patient once she arrived. This all took about 3-5 minutes, if that. Most was taken up by conversation to the Nurse.

When she hung up I asked how long that transaction would have taken on paper. She replied, “Hours.. and that’s if I could find her chart… I also would have had to drive over to L&D and review her monitor tapes and her chart there.” Again, which workflow do you want to preserve? Keep the mother in the ER for hours needlessly on a fetal monitor and IV etc., or let her go home and pick up her script while on the way home and be done in 15 minutes??? How much was actually saved in ER time and valuable Nursing time not to mention supplies etc with the new workflow? We may never know but you can guess hundreds or thousands of dollars a day.

I routinely contact every client I take Live on our EMR one year and two years after their go-live and ask how things are going and would they go back to paper. Every client has answered no way. Now if you ask this question at 2 weeks or 6 months they may say heck yes take me back! But once they make the move to a total electronic record they rarely if ever want to go back to paper. You have to put in the effort and the results will come … some immediately like e-prescribe, lab interfaces, completing charts notes in the same day, no more lost charts, and faxing consult letters at the end of the visit etc…. Others benefits take a few months or years.

I think this is a bold first step towards a much needed consolidation of the EHR Market place. Many more will soon follow and I can’t wait to see how 10 years from now this will be reflected back on as the starting point of a great expansion in beneficial Healthcare technology. Working toward a common benefit rather than erecting competing fiefdoms that do little to advance EHR adoption.

Allscripts and Misys need to remember that a company is made up of people. Those people provide the companies reputation. People enjoy working for a company where quality of life and a fun factor are present. How the company treats its employees and how much of a fun factor they maintain will go a long way in determining their future and their reputation. Which will also lead to more clients and higher revenue.

The US is taking a beating

OK ok... I have to admit . When I saw this article in Forbes it shocked me. I have to tip my hat to you guys from India and Russia. You are rocking it when it comes to new Millionaires and total Millionaires / Billionaires. Keep up the good work and share the wealth.

Cadiz and everyone who commented on my blog. Smile for a few minutes and then go make friends with a new Indian or Pakistani or Russian who is new to your company, neighborhood or church. We are all American and that's all that matters.

Here is the impressive chart from Forbes.

First the Article. http://www.forbes.com/2007/03/07/billionaires-worlds-richest_07billionaires_cz_lk_af_0308billie_land.html

And secondly the entire list.

http://www.forbes.com/lists/2007/10/07billionaires_The-Worlds-Billionaires_Rank.html

8 out of the top 24 are from the US.
4 of the top 24 are from India

BNA Bound

Headed to BNA today (Nashville) I'm providing Follow up training to a Family practice that is a new office in Murfreesboro, TN. I have a ton of great stories to tell and will blog my butt off when I get to the hotel in Murfreesboro Tonight. The flight leaves at 6:50am. So another 4:00am wake up call to catch the first flight up. The kids have games this weekend first day of Spring baseball and softball. Michael and Katie are doing well and they are standouts on their respective teams. I met with the Oncologist today for my 3 month follow up they drew blood and I'll know results in a day or two. Going in for another MRI Friday AM. Hoping to find no difference in the spleen. Looking forward to getting back to NOLA later in the spring. Common Ground is doing well and I checked on their server last night and it looks like they are maintaining their ability to enter progress notes. I had to add this Picture of the Tennessee Scrubs. My Wife Went to UT in Knoxville and when you are in Tennessee you can't escape the big orange or the power T. Go Vols! The Medical Assistant at Genesys Family, Valerie, had to show them off.

Hangin with the captain

A Little fun time prior to my Install at Common ground.

Here is a quick vidoe on the little clinic that could... My next install.

http://video.on.nytimes.com/?fr_story=a9f880e1527ab17b6c3b1c04e937a6ddb8b280d6

Lunch at mothers

Just plain Lazy?

I had a very long, verbose reply from Cadiz12 to my most recent blog. Her reply to me that America was not fair on its Visas and immigration was to point to a young Korean Girl in New York who is stuck in limbo... Evidently this Korean girls parents moved to the Miami area when she was 3. Her parents came here on an H1 Visa for her father to work in the country. H1 Visas allow you to work in the country but you are not granted citizenship. She's now in her twenties or thirties and laments how her younger brother was born into citizenship while here in America. Yet she is now stuck in Limbo as a Legal Alien since she did not get citizenship via her parents getting citizenship or getting it on her own.

Sounds like she has forgotten that she was able to take advantage of the Public school system while here as well as a better standard of living and not to mention a little better weather in Miami than her home country of Korea. If her parents obtained citizenship prior to her 18th birthday she would have been grandfathered in with them and the issue is closed. You would think a little urgency may have set in if she intended to stay here and achieve citizenship. She seems to have lost her lucky brake by letting so many years go by comfortable in the life that America offers. Now she laments basically her laziness of not taking care of an issue for what 15 years? Looks like she needs to look no further than herself or her parents...

Of course she is complaining about not getting jobs due to her status. This does not prevent her from starting her own business or consulting? Not sure where we need to feel sorrow for a person who basically lacks drive or desire to map out a strategy to stay here. Genius is not the first word that pops into my mind when I read her whiny post. FYI Cadiz... I interviewed a Peruvian National today who moved here with Her Asian Peruvian Husband about 20 years ago and went through the same situation. Her husband came here on a Student Visa to attend Med School. They however, understood the importance of obtaining citizenship prior to her oldest son turning 18. She remarked that 9/11 was the impetus of her conversion but is now glad she did it since her children are all now citizens. (In this same office is a German Native who has desired to retain her German citizenship and continues to renew her Visa.) This woman also has a brother from Peru here on a business visa. He has a business in Peru and opened one here in the US. He maintains both as a requirement to retain his Business visa. Her Uncle stayed in Peru to run the Peruvian Branch for her brother while he is here to run the US branch and obtain US citizenship. She has brought her niece over and plans to bring another niece as well as her mother and uncle. She stated this process will take about 10 years. So there are many routes available to US Citizenship.

I have a few Indian nationals I know (And often go out with for stimulating conversations, bowling etc.)that work on H1 Visas at my wife’s company and they are very diligent and precise on when they need to do specific paperwork etc to go to the next step. All of these people learned the rules and mapped out a strategy rather than rely on a future Amnesty program and just hit the bars partying rather than get their homework done.

Cadiz also posted a link to that interesting Youtube video about how shift happens. In this video it states some remarkable predictions... Many I think are a little off... but pay attention to the slides that state that China and India have more Honors students than we have students... Hmmm what the hell do they do with all these gifted people? If this small little country we call the United States of America can generate a robust economy so awe inspiring that these gifted students all flock to us maybe we need to again contemplate what is not working in their country? Especially since the 25% to 28% of their country has higher IQ's than all of the US.. Hmm Guess Freedom and hard work are paying off over here. What the hell are all these High IQ geniuses doing over there? Booking flights to America?

Cadiz also rants about racism and the wrong side of the tracks and how poor kids are stuck joining the military. Sounds like a Kerry Supporter... You forgot to mention that your Korean Girlfriend could also join the military and through her service to this country obtain US citizenship. If she is so against doing her homework a and getting her citizenship herself or marrying for citizenship maybe she can serve her adopted country with Military service and get the gift of citizenship in return? Sounds fair to me. I live in Tampa where we have MacDill airforce base. I work and socialize with many friends who are in the Army, Marines, Navy or Airforce. I've yet to meet one person in the military I would consider from the wrong side of the tracks. Many have Masters Degrees or higher and are hardworking family people who also volunteer their time for Scouting, Baseball etc. Many are deployed for months or longer yet I never hear them complain about it.

Check out the wikipedia entry for some sobering stats... at just how many people worldwide are flocking here for a chance at a better life. Did you forget that 9/11 occurred? We have to restrict our immigration policies due even more due to an attack on our sovereign nation. I think Bill Clinton said it best when a heckler screamed at him that 9/11 was an inside job. Hope you are not a follower of these whacky theories, which are obvious stunts pulled by america haters....
The US of A should be special and dear to you, to become a US Citizen should mean something. You should not be able to steal citizenship by sneaking in the back door.

I think the Korean girl with the immigration problem should be thankful that she is here. If not head back to South Korea and help take care of Kim Jung Il so we don't have to clean up her old neighborhood for her. Cadiz you may want to remind you friend Jinius that there is a DMZ that is staffed by the greatest of American citizens, whom you denegrate by referring to them as from the wrong side of the tracks, that stand point to protect Jinius's former homeland from the Mad man to the North.

How embarrassing that she sits here and complains while taking full advantage of all America has to offer. I'm sure Millions would trade places with her. At least a few million REAL geniuses from India and China....

Boom Shac-a-lack-a

Open Arms

OK to those of you who have read and commented on my blog entry about India and China. Know that it was a form of comic relief... Come on you have to admit many were funny. This was written in the space of 45 minutes.... And was due to an email I received. I'm tired of hearing how today's kids are not going to compete against kids from China and India. I have 4 very intelligent kids and know they will face awesome competition for college etc... But, we are not the Greatest Democracy on the face of the earth because of luck. It takes many centuries of hard work and mostly an entrepreneurial spirit to get to where we as a country are today. Many brave people explored, this country, raised families and gave their life's work to create companies and advance ideas that were once dreams of theirs.

America has always had open arms and accepts all people of any country... NOT just the best and brightest. America is a GREAT country due in large part to our Freedom, the constitution, and the ability for free people to be creative and grow, by not being under the thumb of an oppressive empire.

Neither China nor India have been able to duplicate this effort. And for that matter Russia and any other country.

I'm not saying we are better. Just different in a way that encourages growth, and the entrepreneurial spirit. I don't see where this has been duplicated anywhere with the exception of maybe Israel. The UK has bounced back recently too. And this is THE MAIN attraction that brings many of the worlds best and brightest to our country to learn and live and raise a family.

There are many industrious people who bring great talent and knowledge to this country but you have to wonder why they are not as successful in their home country?

I think there are obvious reasons and some that are not so clear. China is not a free society. You are property of the state over there. India has too much ingrained racism. I know they call it a Cast system.. But come on it's just another name for racism. Apartheid was similar. We had similar prejudice in this country back in the early years of the 1600's-1800's and the 1900's were where a change started... We have a way to go as well.

Ask any Indian and you will understand why you can almost always tell what a person does for a living and what Cast they are in depending on their last name. Also the cast determines who you may marry. I often did genealogy with my mother as a young child and there were similarities with this in America and Europe as well. Last name of Miller meant you created mills etc.

Now I do like the fact that marriage is often delayed till later in your 20's or early 30's in India. I still don't understand the need to get married and raise kids right out of high school but we still have millions that do that over here.

If my mother and Father lined me up with 6-10 women to pick one to possibly marry that would have been pretty cool... But I can tell you I would have had nothing to do with it... When I was in my 20's.

If you operate from a stand point that anything man can conceive he can achieve.... you get close to the entrepreneurial spirit that makes America great. If you give freedom and stand back and watch creative people do what they do best you get amazing results. From freedom comes great industry and invention.

I admire poeple from all countries who come here to make a better life for themselves. I just can't help but wonder what is hampering this same person from doing the same in ther home country. IF we could raise the level in all countries what a great future we would hold indeed.

I meet many Indian and Pakistani Doctors and professionals who have come to practice Medicine in America. I like them alot... Friendly, polite as well as well educated, and very strong family values. I have never shared a bit of knowledge with an Indian or Pakistani and been told I was a smart alec. They thirst for knowledge and seem to understand that all knowledge is good and openly share this with whomever they meet. I often found that throughout my life I was so proud to share my knowledge with others.. only to be considered arrogant or a know it all... All I wanted to do was share knowledge not make you feel like you were not as smart or to be a show off.

I just wonder how much their country could benefit if they brought back what they have learned here. You just can't stop asking... Why can't they do as well at home?

I'm amazed at how quickly all that America has to offered is absorbed by many who move here to better their life. Multiple jobs, schools, degrees... Etc. I think they are on the right track by emphasizing education. Now if we could just get that Lame Charlie Crist from Florida to get education as his top priority maybe Florida could graduate 90% of it's young people instead of the paltry amount we do now. http://nces.ed.gov/programs/coe/2007/pdf/24_2007.pdf

USA - China - India

Ok... I'm REALLY tired of hearing this crap about how much better India and China are than the US of A... Ok? I get bombarded every friggin day about how we are going to be losing major industries to China and India and how we the US of A will end up being a third world country in just a few short years.

First ... This is BULLCRAP!! And I will take a few minutes of my very valuable time to discuss this with you few unfortunate souls reading my blog at 4 am.

We are inundated with how stupid and unprepared all our kids are out of high school going into college and how we will end up being second class to India and China.

Here are a few irrefutable points to mull over.

1. I have yet to meet ANY person who is heading over to India or China to open an Office as a Doctor, Dentist, Veterinarian, engineer, etc, etc because he / she can make more money in India or China.

2. I have never heard of a break through Medication discovered in India or China.... or even Russia, Mexico or Canada for that matter.....

3. I have yet to see an industry changing surgical procedure or mathematical formula that was credited with an Indian or Chinese discoverer. OK Russia had an eye surgeon that was cool.

4. When we have a mad Exodus of Physicians and intellectuals (Engineers, Mathematicians, Scientists) going over to India or China and they start standing in line waiting for H1 Visas to get into that country to be an indentured servant for 5 years ... Let me know because we might have 20 more years before we have a trend.

5. I have never heard of 1 person who sells everything to go to the promised land of India , China, Mexico, or Russia to live the good life and leave the squalor of America. Not 1!!

6. Bill Gates did not even graduate from college.... !!! He was a dumb, stupid retro bate according to some new criteria now that says you have to have a masters degree or better to amount to anything.

7. Every day I hear about all the top colleges in India, China and Russia that students are lining up to get into... So much so that Brigham Young University, Harvard, Yale, Princeton, Stanford, USC, UCLA, The Ivy league in general, the Pac 10, Big 10, SEC, ACC etc etc. Colleges don't even compare. Give me a break. you can get a better education at a community college than most non USA Colleges.

8. All the rich Saudi kids are going to India and China now to study, computer science, engineering, medicine etc. ( Yeah right .... Dream on brother.... ).

9. The Global economy is reacting to market trends in India. Hmmm. Whats the name of their stock market? London is Footsie, France is CAC, I know Hong Kong... Yang see or what ever... Never heard of the Indian Stock Market and all the earth shattering IPO's going on over there.

10. When will Europe be concerned that an Indian in India, can't buy a house due to a credit crunch or a housing market fluctuation???... Give me a break!!...

11. The world shudders when India and China have off years at the hectic Christmas shopping season over there... (Yeah right!!)

12. What ever happened to Japan? They were going to kick our ass and take names later... Did they fall off the map? Are they on Mars now?

13. Kids in India or China say.. "Daddy is everything made in the USA"?? since outsourcing to the USA is cheaper than making it in China and India due to labor costs.

14. The Indian film industry just blows away all American films and grosses more than any American Film Company. (Actually insert any American industry and you get the same question)

15. I'm a China man In China and I call my electronic gadget support desk and get some hayseed in the middle of Alabama who trys to answer my question but I can't understand them due to their outsourcing accent.

16. That Indian Software conglomerate ______, which I hate so much, gets another $200.oo out of me so I can buy their latest operating system, upgrade or newest gadget... ( Insert favorite Indian or Chinese company).

17. Hot American Women are marrying all these Filthy Rich Indian and Chinese men and are moving to India and China to raise passels of kids because they are such hot catches ....

18. Business news channels are now broadcasting 24 hour a day and 365 days per year from China and India....

19. The hottest sports car is made in India and the most admired CEO is a Chinese CEO of a company that is Chinese founded, funded and deeply rooted in the business history of China. (And it does not have it's root in slavery... etc.)

20. Paris Hilton moves to China or India to be with the cool hip people.

21. India and China are constantly bailing our ass out of natural disasters like Hurricanes,( tsunami's) and earthquakes... Because we are too dumb to even train a cadaver dog....

22. All Major Industries in America can trace their origins back to an Indian or Chinese Company.

23. The international jet set flocks to China and India to Ski, Gamble and relax at their million dollar villas for a few weeks.

24. More Billionaires and Millionaires are being made every day in China and India than the good old US of A....

25. I know the name of the leader of China and India. ... Nope never heard of them... Guarantee they all know George W is the leader of the free world.

26. Israel starts buying military armaments from India and China because they are more high tech, hot and sexy than the US stuff.

27. The Indian and Chinese Military are routinely mentioned in US Military training Videos and are the ones to look out for and not mess with since they are so well trained....

28. People in India or China have a cork message board in their office with the first Indian/Chinese dollar bill they ever made pinned to it....

29. The best place to send your kid after graduating from high school to get a world class education is India or China.

30. Michael Moore creates a documentary in China or India out lining how much better the health care is in the USA than India or China....

31. The Indian and Chinese $100.00 bill equivalent is the most forged currency in the world.

32. There is a black market in the US funded by Chinese and Indian currency since it is more valuable.

33. Indians and Chinese are coming to America to Adopt American children and save them from a life of poverty.

34. The UN moves to India or China.

35. Osama Bin Laden declares Jihad on the Great Satan of China or India....

36. American speak Chinese or Hindu since it is the international language of business.

37. The best quality aircraft are made in China and India. (Please give me a break!!)

38. Hugo Chavez ships free oil to the inner cities of India and China to embarrass the leaders of the free world.

39. When China or India need a great programmer at bagain prices they turn to the USA to get that filled.

40. Chinese and Indian computers blow ones made in the US of A away.




OK that's Fourty... I'll take a break now.

I agree we need to tweek the education in the country. I also agree the Middle school and High school years are the most important.