OpenEMR: Electronic Medical Records and Medical Practice Management Software - <AUTHOR> http://www.open-emr.org/ <comment><USER2> I'm currently working on my thesis, I'm trying to design a radically different take on EMR/EHR systems - [http://barnett.surge.sh/](http://barnett.surge.sh/)

I've come to realize healthcare software is a significantly trickier problem than most realize. Not in terms of technical possiblity, but other factors.

Building healthcare software is really hard - which seems like such a paradox, because surely ensuring highly trained individuals have half decent tools would be a huge goal for society - but almost all healthcare software is still frankly, terrible.

After heaps of reading I've narrowed it down to 3 reasons why healthcare software is so hard to build.

1 - Modern healthcare is complex, and varied. Building any healthcare softawre is no easy task, even simple systems have many other systems to integrate with. But what makes this worse, is that no two places do healthcare quite the same. Between regions, and institutions, healthcare can vary a shit ton.

2 - Healthcare is risky. Sounds obvious, but if your software fails, people die - but this risk creates an attitude of "dont touch it". Changing systems has such a risk, that institutions will use the same software until it's so out of date its not funny. This impeeds improvement and innovation.

3 - Healthcare software is hard to sell. Not in the sense that its unprofitable, but that it takes ages to get users. Say if I made video editing software - I could get professionals trying it out tommorrow. However, if I make a PMS, I have to sell it to the entire practice - not just a few keen doctors. From making contact to actually getting a small practice using your software could literally be years - making it super hard to enter the market.

I've been working on this topic fulltime for a year now - and I must admit, I don't have the golden answer. However, I'm designing a system as a response to these factors, an alternative to interoperability, and would love to talk anybody in the industry about it.

[http://barnett.surge.sh/](http://barnett.surge.sh/)

firstname.lastname@example.com

<comment><USER3> As far as I can tell, there's no economic incentive for health care systems to undergo these transformations willingly. Remember, the digital transformation didn't occur until the HITECH act in 2009, which mandated the use of electronic health records. Why digitize your operations and worry about maintaining tech infrastructure when you can do everything on paper with a handful of secretaries? You could argue providing better data-driven healthcare to patients, but guess what--most health systems don't care because _they make money every time you get sick._ [0]

With HITECH, the government forced them to transition to EHRs, and here's what hospital systems optimized for...

1\. Reliability

2\. Optimizing billing

3\. Guaranteeing compliance with different protocols, particularly those related to billing

Openess? Interoperability? _They don 't care._ You're piling on more technical and administrative costs without the promise of future returns.

> ensuring highly trained individuals have half decent tools would be a huge > goal for society - but almost all healthcare software is still frankly, > terrible.

You know who hates EHRs the most? Doctors. Do you know who loves them? Hospital administrators. Guess who pays for the EHR? ;)

[0]: An exception to this is Kaiser Permanente. They insure the patients for which they care, so they're incetivized to improve health to reduce costs over time.

<comment><USER4> I don't see why any physician implements an EMR. My family doctor, who was part of a midsize practice was punished hard by adopting a system. They did it in 2007 thinking they would save money... which didn't happen as they were only able to eliminate 1/4 clerk positions and had to pick up an IT guy and a consultant. Then they really got the shaft when the solution they chose wasn't meeting Medicare guidelines. They ended up getting another system that is worse.

Now they got swallowed up by a regional medical system and have yet another EMR, plus they have _6_ clerical staff versus 3 and whatever outsourcer handles IT for the hospital system.

My other doctor friend is a ophamologist. It's a small practice with 3 full time and 1 part time doctor. They pay the fine every year for not having an EMR and use paper and have a standalone system for sending prescriptions. He is enormously happy with paper and feels that's it better in every way, including cost. I agree -- I see zero value in the EMR systems.

<comment><USER5> I saw one system that seemed like a must have: apps that ensure you got the prescription right. Paper-loving doctors screwing up prescriptions harms a lot of patients. Especially when they insist on writing in cursive.

Much of your post seems to be about bad tech, though. It could mostly be mitigated with a supplier that gave a shit.

<comment> gm-conspiracy Also sounds like a shitty pharmacist and pharmacy tech.

<comment><USER5> I'm not going that far. What I read implied it was either a mental slip or illegible writing. Some of the drug names look similar when they're written in chicken scratch.

</comment></comment></comment></comment></comment></comment><comment><USER6> As other comments mention, this project has been going for a while, the central reason it (or something like it) has not been robustly built out and deployed universally is because of the way congress chose to structure the funding for development of EMRs/EHRs. Rather than trying to find a system that could be universalized, the (idiotic) plan has been to give millions of dollars to multiple corporations to develop systems, then subsidize the purchase cost to providers to encourage adoption. Then, only once everyone has invested in their own proprietary system will they begin trying to universalize the system by developing cross compatibility. This methodology is perfectly in line with the free-market approach that the US has championed for decades. It is also the opposite of how almost every other country has developed and adopted universal EMRs. Sad. Especially because we know that a good, affordable universal EMR would significantly enhance the ability to deliver care for almost all sizes of healthcare providers.

<comment><USER7> As a programmer for an American EHR firm -- all of the market share already belongs to one of those companies you malign.

You could not have had the government sponsor some new software which would eliminate a billion dollar software market.

It's a non-starter. All the hospitals already are signed on multi-year contracts with those large providers. Some of the EHR providers began writing medical software for hospitals in the 1960s and 1970s. These companies have multi-decade relationships with the hospitals they service, and decades of patient data stored.

What Obama and the Democrats did was to break the "paper cycle". Many hospitals used paper-only system with very little software even into the 2000's and 2010's.

The point of investing in each company was to jumpstart their products into meeting the huge new regulations, and the point of giving clients money to buy this new software was to break the paper cycle.

There is no "one size fits all" option in the American market.

I find it funny that you malign our practice as "(idiotic)" when it is your plan, quite frankly, which is so ignorant to the complicated history and reality of medical providers and their software, that seems idiotic to me.

Your opinion sounds to me like "The US Gov should, instead of using MS Windows, pay a company to invent a new operating system, then ban all use of Windows, OSX and Linux to ensure all firms must use the single new solution".

We already had so many options that have existed for decades, with so many clients, and so much built-out software infrastructure. There was no "one- size-fits-all" solution unless your solution includes "Destroy the entire industry, and use force of government to destroy a half dozen major software companies in favor of the government mandated and almost assuredly inferior option"

The crux you may not realize is how customized every major hospital system expects their EHR software to be. I don't think you realize the sheer level of customization these networks require, due to the size and scope of their businesses. It takes entire teams of my company to service certain major clients. The idea of a one-size-fits-all would have been laughed out of our country.

<comment><USER8> But most physicians don't work for hospitals. They work at small practices with 10 physicians or fewer (according to the AMA).

There was a completely open market, made of the majority of physicians, regardless of existing provider contracts with hospitals.

I know I talked to a few physicians (and other healthcare professionals) in the mid-2000s who lamented the paperwork they had to do every day and the lack of available computer automation.

<comment><USER9> The issue with small practices and even slightly larger physician's groups is that an EMR is often just a cost, with very little benefit.

If you're a hospital with lab facilities, imaging facilities, surgical facilities etc. it's hugely useful to have medical records flow internally (quasi-)seamlessly. The EMR does that well, and the large cost of typing things into the EMR (it's slow, painful, annoying, never met a doc who preferred it to the old clipboard and notes system) is totally worth it.

For a small practice, that intercommunication problem isn't anywhere near as large, but the cost of typing things in painfully is the same. So small practices hate it.

And before you say, "but it's useful to share medical records between offices/specialists/hospitals when they move around", it turns out that a lot of these systems don't play very well with one another. Even between two healthcare systems that share the same software provider (in this case Epic, one of the big two, the other one is Cerner), I've heard people finding it easier to print it out, fax it over, and scan it back in. Yes there are people who want to solve that problem, (see YC's own [https://www.patientbank.us](https://www.patientbank.us)), but it's a tough area because who pays for the service? How expensive is it to build software that interacts with all the 10 zillion different flavors of Epic? How do you harmonize the peculiarities in how people actually record the data in those systems? It's really really hard.

<comment><USER10> So I am a physician with a large hospital system that uses Epic. I think your comments about poor communication (btw Epic systems) are outdated. For the last two years when I admit a patient I can easily access all Epic records not only in other hospitals in my state, but in the country through their system labeled "CareEverywhere". It is a game changer and is really the main reason why I rank Epic above other EMRs I've used.

<comment><USER11> How do they prevent abuse? How does a patient know who is accessing their records?

<comment><USER10> Also, in reply to who is accessing your records you don't know. I suppose you could ask for records of who had accessed it by a certain date, but once your records are in there they will likely be accessed by your insurance company for billing purposes.

You can add an additional layer of warning in Epic. I see this most often with psych records or pts who want an extra layer, such as if they work in the same hospital. All this entails though is an extra prompt warning requiring you to put in a reason why you are accessing the records, and put in your usr/pwd again and warns you it is being recorded, etc...

<comment><USER11> Thanks- ideally the auditing would be done regularly, and require a reason to be entered for any access the first time a new provider accesses your information. Even better each patient would have a USB stick with a One Time Token generator that would 1) hold basic emergency information on the USB drive) 2) Generate One Time Keys to grant access to new providers. Of course, in an emergency situation where a provider has an ID but can't find your USB key, they could enter an over-ride with a reason- which would be strictly audited. Also, patients should have a list of who has accessed their information and why- and even be able to sign up for alerts anytime someone new accesses it.

<comment><USER10> So I think your ideas are good, but you have to realize the multiple competing priorities in healthcare. When you say ideally, you mean from a privacy standpoint. In my opinion "best health outcome of the patient" should be the highest ideal.

Say I am working a night where I may be paged on 100 patients who I am meeting for the first time. Just opening their records on The EMR eats a significant amount of time. Time which I need to take care of people. Adding an additional click would mean even less time and poorer outcomes.

You also have to realize that nobody is going to carry a USB. I have worked in diabetes clinics where most pts don't remember to bring in their glucometer, which is the entire point of the clinic. You have to realize that the patient population also includes the average American (and half by definition are below average intelligence.)

I mean, I could go on for hours and make my own personal list of the issues with American Healthcare and I wouldn't list pt privacy in the first 100....

Not trying to be dismissive but I'm just trying to give you computer technical folk an idea of why EMR is such a hard field and how many factors you have to consider which is really difficult if you aren't 'in' the system. Even I who knows more about programming than 99% of docs feel completely ignorant when I talk to healthcare IT folks about HL7, etc...

<comment><USER11> I see your points- I agree that "best health outcome of the patient" is the priority. I don't think that is always at the cost of privacy, though. In fact, if people feel more secure about the privacy of their information, they will be more likely to be open and to even visit a health care provider in the first place. (Some people may not care either way, but there are those who do- and certain circumstances that people are more likely to care about than others).

I don't think the challenges you mention are unsurmountable-

An ER doctor seeing 100 patients a night might have the system setup to automatically log in as an emergency, and they already need to log the reason for the appointment- or else there is no there is no record of it...

Setting up the initial access should be handled by staff during check-in for non-emergency visits.

Patients are generally already expected to carry a health insurance card (at least in the US- not sure how that is handled in countries with Government provided health-care). As the system becomes more widespread, it would become normal for everyone to have a security token, and they could use those tokens for access to multiple systems, not just health care (The USB disk thing is probably optional, just a slight improvement for when the network is down or you can't otherwise access the information).

I also think the User Experience on the systems I have seen could be greatly improved to reduce unnecessary clicks- and I have noticed that more often then not though- loading information over a slow network takes more time than navigating the GUI.

I would agree that the problems with health care go far beyond EMR systems, but they were the topic of the discussion.

Thanks for participating, I want to better understand all of the issues and these types of discussions help a lot toward that goal.

<comment><USER10> I agree that the challenges aren't unsurmountable, but we have to make sure that we realize everything we change has unintended and unforeseen consequences, even things that seem as simple as adding an additional click or checkmark.

You are right there are those who do not seek care because of privacy, but in my experience they are by far a minority compared to the people who don't get healthcare because there aren't enough providers to get an appointment (mostly because they are all already too busy and overwhelmed to take on new patients), are worried about cost, or who just are in denial about how sick they are.

The deal with insurance cards though is that there is no problem or issue if you don't remember to carry it. Registration can still be done, they just look you up by name, address, or SS# if needed. Not to belabor the point (because as you mention you could use a network) but any system that depends on people carrying something will have a lot of caveats.

No matter what you pick it will sometimes not work, the network will be down, the USB flash memory will no longer work, the USB port will be broken, etc... so there will have to be a non-emergency allowance for 'token' system not working. How are you going to verify it really isn't working and that people aren't just clicking 'not working' because it is easier (or because they are malicious and lying to steal data...).

With regards to automatically logging people in: Consider your ER doctor system, ok that works when it is logged as an emergency in the ER. Now consider my role. I am a hospitalist, meaning I admit patients to the hospital and take care of the ones already admitted. Should I already be covered under the emergency since they are sick enough to be in the hospital or do I have to go through additional steps to log in to address a patient who just needs some extra nausea or pain medications or a sleeping pill? If I have to log in it detracts from the time I can spend dealing with a patient who suddenly has a more pressing issue (such as new chest pain that needs to be seen)? Of course, I am going to see the chest pain patient and so the nauseated patient is miserable for a few extra minutes. Now this sounds like squabbling over a loss of seconds but in reality managing an inpatient service is juggling multiple pages at once for sometimes several hours straight on many patients, triaging what needs to be done urgently vs later, and admitting patients, etc... It can be nonstop. So just one additional step really does add up.

So you can then say, why not have it set up that once a patient is admitted, they get logged in once and then you don't have to worry. I would then answer that that is basically what we do now. When you get admitted to the hospital you sign a release which covers this.

I will bring up another issue: you say a new provider should only have to log in once. Do you really want a provider you saw maybe 5 years ago for a one time visit have access to your records. How long until they have to reregister?

Another issue: What if you have tests done that aren't resulted by the time you leave the hospital. For example you have a blood culture that becomes positive after 5 days which means you need to be notified to get new labs done. The doctors that took care of you are off shift or on vacation. Usually this is taken care of by another provider, who you may never meet, are they going to be covered under the token system?

Out of curiosity what is your background in this since you mention User Experience?

</comment></comment></comment></comment></comment></comment></comment></comment></comment></comment></comment><comment><USER12> EMR is simply too messy for openEMR to put a dent in the issue. I truely wish it were different. If insurance carriers are permitted to operate across state lines in the future, i think there is a chance of a Google or Microsoft getting into the space which I think is the right way to go. Right now, the large companies managing EMR and huge monoliths that simply don't care about innovation. They are like defense contractors to the military.

If the market ever opens up and consumers have more choice, its clear that someone like google or MS would win and I honestly believe really give healthcare a boost in this country.

<comment><USER13> Google actually gave it a shot, and then eventually gave up. [https://en.wikipedia.org/wiki/Google_Health](https://en.wikipedia.org/wiki/Google_Health)

<comment> FLUX-YOU That sounds more like a patient portal used by patients. Building something for physicians, nurses, revenue personnel, lab personnel, and practice managers is a completely different game.

<comment><USER14> I think the idea they were going for is that Google Health would be an EMR intended to be used by institutions except that the patient is in control of their record - enabling them to take their health record to any provider. The problem is that institutions have close to no reasons for investing into something like that.

I think Microsoft HealthVault was more of what you describe, where it's a portal intended to be used by patients.

<comment><USER15> No, @FLUX-YOU has it right. Google Health was only ever intended as a patient portal (PHR) and was a direct competitor to Microsoft HealthVault. Google never added any EMR features. In fact after the initial release they never added any features at all; they just lost interest in it and shut it down.

</comment></comment></comment></comment></comment><comment><USER16> Norway has been building a universal and state-run system the last couple of years, which gathers all the patient information in one centralized system. Existing commercial companies that already deliver solutions to doctors and hospitals have integrated this new system into their existing products. It is practically interoperable by now. I believe this is the way to go. The system was beta-testet last year, and is being rolled out to doctors offices this year.

This will benefit both doctors and patients, as they no longer need to manually juggle between countless different systems (and plain old paperfiles). Overmedication (and dangerous drug interactions) has been a real problem for decades, because one doctor does not know what the other has been doing. When a patient has to visit different hospitals, they have to take new blood samples, tests etc.

Patients can now log in to one service (helsenorge.no), with the same security as other state-run services (taxes etc), they get access to their complete health journal, they can order an appointment at their local doctors office, order an online consultation, reorder prescriptions etc.

Maybe something for other countries to learn from?

<comment><USER11> How do patients authorize a new care provider to access their data? How do patients prevent the government from accessing their private health data? (Obviously the latter is a problem even for distributed systems, but a lot easier if the government already has the data on servers they control!)

</comment></comment><comment><USER17> If people had any idea how much antiquated medical software is out there in production running on Windows 98, 2000 or XP and coded in _Visual Basic_ they would run away screaming. It's seriously that bad.

<comment><USER18> I did some work for a company that had 100+ banks running accounting software developed in Visual Basic in the early 90s.

Unfortunately, this experience, supporting obsolete, spaghetti-code-nightmare, opened my eyes to the world that business is done in a much dirtier way than how I imagined growing up.

<comment><USER17> Willing to bet you $5 that the spaghetti code accounting software written in VB in the early 1990s is actually a GUI front end on top of an AS/400 or an IBM system/360 thing that's now running in emulation on a "mainframe".

<comment><USER19> Showcase ODBC is what we used to talk to Big Iron databases. People could not learn the IBM Mainframe or AS/400 systems. So we made a VB GUI frontend using Showcase ODBC to contect to the database. It was a lot easier that way.

</comment></comment></comment></comment><comment><USER20> Please read about our groundbreaking v5 release here: [https://medium.com/openemr/complete-meaningful-use- certifica...](https://medium.com/openemr/complete-meaningful-use- certification-1627b989d9bb#.5c9it7a59)

<comment><USER21> Congrats.

</comment></comment><comment><USER22> Does anyone know of a EMR system that could house my household/personal health data? One of the struggles I have is organizing my own health data in a singular place with structured data formats, document uploads, etc.

The closest thing I have found is [http://mymedicalapp.com/](http://mymedicalapp.com/) but it appears to have been abandoned by the developer.

<comment><USER23> picnichealth.com

<comment><USER22> Thanks for the recommendation. It is what I am looking for except that it doesn't seem to offer any upload options if there are holes in the data they retrieve. Still, a step in the right direction and I'll give it a try.

<comment><USER24> PicnicHealth CEO here. You won't have this problem because we don't miss any data :) But really, if you have old stuff we can't get anymore we can find a way for you to send it over.

</comment></comment></comment></comment><comment><USER25> I think it's great that there are projects like [http://www.open- emr.org/](http://www.open-emr.org/) , [https://oscar- emr.com/oscar/](https://oscar-emr.com/oscar/) , [http://openmrs.org/](http://openmrs.org/) , and [https://www.hl7.org/fhir/http.html](https://www.hl7.org/fhir/http.html) ;

I think these tools would be even better if they released their code under LGPL (instead of GPL) so that lazy commercial EHR developers would reuse and help maintain some core modules to promote more interoperability.

I don't think it's going to ever be possible (or that it is even desirable) to ever have a "Universal EHR" that everyone is forced to use through either government intervention or through market/economic forces. We can all exchange emails with each other, but we aren't all forced to use the same email client

The reason that the entire healthcare system seems broken to most consumers is legacy EHR systems in large hospitals. These legacy enterprise vendors are essentially what Oracle was 20 years ago in the rest of the enterprise software market before companies like Salesforce.com came along. Another part of this "broken" feeling is the difficulty of exchanging data between different EHR systems; but this doesn't have to be the case.

"If you've seen one HL7 standard implementation, you have seen exactly one HL7 standard implementation." Which means most systems don't interoperates with anyone else's systems unless there is an existing commercial relationship that forced everyone to interoperate on a local scale.

For anyone looking to work on an idea to improve healthcare check out: [https://www.drchrono.com/api/](https://www.drchrono.com/api/) and/or [https://www.drchrono.com/careers/](https://www.drchrono.com/careers/)

<comment><AUTHOR> Very clear and interesting concept:

[https://app.drchrono.com/ehr-emr/medical-form- templates/5561...](https://app.drchrono.com/ehr-emr/medical-form- templates/556163/initial-assessment)

</comment></comment><comment><USER26> this project has been around for a long time. I always take a look at it when I need a reference system for thinking about data models or ux related issues for health record type projects.

looks like it got a major facelift since the last time I checked it out. that must of been a lot of work. congrats to the contributors for making that happen, looks more modern.

<comment><USER27> Yep there was a lot of work both above and under the hood to modernize OpenEMR on the most recent release. Also was a several year effort to get complete meaningful use certification. Can see here for some more details on both efforts: [http://www.openhealthnews.com/content/openemr-achieves- compl...](http://www.openhealthnews.com/content/openemr-achieves-complete- meaningful-use-certification-breakthrough-release-50)

</comment></comment><comment><USER28> We've been gathering various open source health projects here. [https://github.com/kakoni/awesome-health](https://github.com/kakoni/awesome- health)

<comment><USER20> Just sent both an issue and a PR. Great idea!

</comment></comment><comment><USER29> How are they planning on pushing it to hospitals? All major players have adopted Epic EMR, at least here in Colorado. And once they have a system, they'll stick with it due to premium support and huge cost will prevent switching.

<comment><USER30> Epic, Cerner and Meditech are the largest EHRs and they combined control just about 50% of the market. Epic and Cerner tend more towards the Academic hospitals and Meditech and McKesson (#4) tend towards the Commercial hospitals.

There has also been a ton of incentive payments from CMS that have almost exceeded the EHR industry as a whole.

There have also been quite a few big switches from the 90s to today, a bunch of them from Meditech/Epic/Cerner to others, so it can definitely happen.

</comment></comment><comment><USER31> Github repo: [https://github.com/openemr/openemr](https://github.com/openemr/openemr)

</comment><comment><USER32> This is huge. I previously worked for a healthcare startup, and it seems like for every other healthcare startup we worked alongside or networked with, all roads lead to EMRs. It was (felt like) an impossibly large task without a clear path to execution due to the tangled web of healthcare IT & regulations.

Something like this is huge, especially to potential competitors that now have a target to aim for.

<comment><USER30> Unfortunately most of the time you end up having to individualize so much data structure for each deal it's a gigantic pain.

</comment></comment><comment><USER33> What is the different with OpenMRS [http://openmrs.org](http://openmrs.org) ?

</comment><comment><USER34> There's a pretty nifty open source OpenMRS app called Bahmni that is widely used in poor countries. A lot of my friends contribute to it. Worth checking.

</comment><comment><USER35> There is even open source dental software, open source is seriously eating the enterprise (and healthcare) software world!

I run OpenDental for my wife's practice in North Beach, SF. It's licensed as AGPL, but I'll still take it :)

<comment><USER36> I supported this for a few years as a sysadmin. The most flexible EMR application I have ever seen.

<comment><USER35> I think it's getting more and more popular, hearing about a lot of offices switching to OpenDental. I'm not sure how proprietary software will compete in the future.

It's been pretty easy to run, no complaints other than the usual MySQL ones.

</comment></comment></comment><comment><USER37> Having HTTPS enabled on their site would go a long ways for software like this.

<comment><USER20> It's an issue with Source forge. We're working on this.

<comment><USER38> After sourceforge bundled malware with downloads, it's hard to trust a project that stuck with them, especially with health data, especially when there are numerous alternatives that are better.

<comment><USER20> It's just for our website and wiki. We've moved to Github for the most part.

There is talk between myself and a couple of other contributors to move the site and wiki to AWS :).

Feel free to volunteer to speed this up, of course.

EDIT: Misread your comment. We are hosting downloads on the SF site. Really need to move to AWS...

<comment><USER37> How much traffic do you get? and is it all static?

</comment></comment></comment></comment></comment><comment><USER12> As much as I would love this, I simply dont think it will work. Why? Epic is simply too big and has too much of the market and they are too far behind.

I use picnichealth.com to deal with this EMR mess and I love it!

<comment><USER9> The pricing seems incredibly high, am I understanding correctly that they want ~$300 up front then $33/month thereafter?

That said, working in this industry, I know exactly how hard it is to do this right. In many ways this is what it costs to do the job, if not more, but I'm not sure I'd pay it. There's the tragedy of the whole EMR/patient data story: bloody expensive, who pays?

<comment><USER24> PicnicHealth CEO here. We did raise prices to keep quality super high as we scale, but here's a nice discount for our HN friends. Enjoy! [https://picnichealth.com/friends-of-picnic](https://picnichealth.com/friends- of-picnic)

</comment></comment></comment><comment><USER39> We've had an incredibly well adopted open-source EMR solution here in Canada for quite a while.

OSCAR

[https://oscar-emr.com/oscar/](https://oscar-emr.com/oscar/)

</comment><comment><USER40> I use open dental. Tell me how open it is. An open EMR in healthcare does not mean much. Take a look at the necessary support needed to have the proper compliance.

<comment><USER20> Not sure what you mean... can you please be more specific?

OpenEMR is 100% open source. It's GPL'ed :).

As far as compliance, we are happy to inform you that OpenEMR is now 2014 ONC Ambulatory EHR Certification complete.

EDIT: If you're asking about support, there are over 30 professional vendors. Community support is also available.

If you have further questions, feel free to reach out to my email (in my profile).

</comment></comment><comment><USER41> I came here to ask the question "Has anyone (hopefully) done a 3rd party security audit of this open source medical records software?"

But then I saw this: [http://www.open- emr.org/wiki/index.php/FAQ#What_is_ImageMagi...](http://www.open- emr.org/wiki/index.php/FAQ#What_is_ImageMagick.3F)

And then this: [http://www.open- emr.org/wiki/index.php/FAQ#What_are_the_corr...](http://www.open- emr.org/wiki/index.php/FAQ#What_are_the_correct_PHP_settings_.28can_be_found_in_the_php.ini_file.29.3F)

..... [http://www.open- emr.org/wiki/index.php/FAQ#What_do_I_do_if_I...](http://www.open- emr.org/wiki/index.php/FAQ#What_do_I_do_if_I_am_locked_out_of_OpenEMR.3F) [http://www.open- emr.org/wiki/index.php/FAQ#What_is_OpenEMR.2...](http://www.open- emr.org/wiki/index.php/FAQ#What_is_OpenEMR.27s_default_Username.2C_Password_and_other_related_issues.3F)

God help us all.

<comment><USER27> Agree that security is an important topic.

Note there has not been a default password for about 5 years, and will update the FAQ.

Regarding the other FAQ links you posted, what specific security issues are there with those?

To get an idea of OpenEMR's security, recommend checking out the following section on the wiki(1 of those links has several 3rd party security audits): [http://www.open- emr.org/wiki/index.php/OpenEMR_Wiki_Home_Pag...](http://www.open- emr.org/wiki/index.php/OpenEMR_Wiki_Home_Page#Security)

<comment><USER41> It shows the use of ImageMagick, a legendarily buggy and insecure application and library. It shows the use of system crypt() for password hashes, which isn't really very secure since (afaik) it doesn't support pbkdf2 on most systems or bcrypt (not the blowfish one) or script. It shows hardcoding database credentials in a flat file. And it shows it uses PHP, which has its own security problems as well as being well known as a language used by people not aware of secure coding practices.

</comment></comment></comment><comment><USER42> If you're interested in or working on medical software, you might be interested in Clinical Meteor: [http://clinical.meteorapp.com/](http://clinical.meteorapp.com/)

"clinical:meteor is an open-source project creating a next-gen framework for building healthcare apps".

</comment><comment><USER43> Does it allow anonymization of patient data, so that it can be used for research?

<comment><USER44> Yes, openEMR allows for de-identification of patient data!

</comment></comment><comment><USER45> My first permanent IT job was actually working with practice management software. It worked across multiple jurisdictions with fairly minimal changes - an appointment is an appointment in any country.

I actually suspect it violated several laws - I remember I had full access to a database stored offshore where patient notes were there in plain text, along with their names and addresses. I emailed the privacy commission about it but they wanted to me to name names and I was scared of losing my job.

So yeah, I hope you encrypt notes.

</comment><comment><USER46> I don't mean to come across as an asshole; I applaud the effort!

But seeing hierarchical menus just made me close the tab immediately. There are others, much more human-approachable, UI paradigmas.

If we want to push meaningful software to the non-tech-savvy people to make their lives better, we have to start letting go of ancient UX methodologies.

<comment><USER21> What would you use instead?

<comment><USER46> I would analyze the most used click paths and extract the real-life scenarios people are serving with them, and just make buttons for them. Clicking them will provide you with a wizard-like interface that aims at a specific need.

Obviously this cannot replace all menus but hey, it's a start.

Please note: I am not an UX expert. It's just what I subjectively find as a common-sensical approach.

</comment></comment></comment><comment><USER47> Is it easy to use? Does it reduce the amount of paperwork to be done? How safe is it?

<comment><USER44> I think it is easy to use, and yes it has the potential to nearly (if not completely) eliminate all paperwork in your clinic.

As far as safety, openEMR is fully HIPPA compliant as well as 2014 ONC Complete Ambulatory EHR certified (a/k/a Meaningful Use 2).

</comment></comment><comment><USER48> firstname.lastname@example.com; ask me your questions and I will give answers to what I can.</comment>


Start up fire sale--everything must go - <AUTHOR> http://sfbay.craigslist.org/sfc/fuo/4536986948.html

<comment><USER2> That's the first time I've seen a San Francisco startup with _each employee_ having their own landline telephone.

</comment><comment><USER3> > PC Laptops:: These PCs have not been wiped, but are close to factor install

What could possibly go wrong.</comment>


Decay: Physics students at LHC produces a zombie flick set in CERN - <AUTHOR> http://www.newscientist.com/blogs/culturelab/2012/12/zombie-horror-infests-the-large-hadron-collider.html?cmpid=RSS|NSNS|2012-GLOBAL|online-news

<comment><USER2> full film on youtube: <http://www.youtube.com/watch?v=n-NwLUPZWZc>

(it is _awesome_ :) )

</comment><comment><USER3> Pretty cool to see the inside of the CERN in such a casual, off-beat manner.

Also, the LHC hiring protocol for students must have a attractiveness clause. ;)

<comment><USER4> _> Also, the LHC hiring protocol for students must have a attractiveness clause. ;)_

Almost anyone can look like that with some decent lighting, makeup, hair and wardrobe etc. That and the body-language of self confidence are all it takes. Editing out all the shots where you look weird helps too. Celebrities and the like are almost universally unremarkable-looking when not at work.

Don't tell the entertainment or cosmetics industries I let you in on that little secret though, or I might end up in the back of van. Sometimes it seems like the whole of western society is built on people being kept in the dark about this fact.

<comment><USER3> I realize this, it was just an off-hand compliment to those involved.

<comment><USER4> I'm sure you do, my comment was more for the benefit of any unhappy young people that might be reading.

Also I think you might mean "backhanded compliment," although off-hand works quite nicely here as well.</comment></comment></comment></comment>


Operationalizing Node.js for Server Side Rendering (2018) - <AUTHOR> https://medium.com/airbnb-engineering/operationalizing-node-js-for-server-side-rendering-c5ba718acfc9 <comment><USER2> This was a strange article for me to read. It starts out with a long discussion of Node's "single-threaded compute / multi-threaded I/O" model as if it were a problem for compute-bound applications. But multithreading doesn't magically make compute-bound tasks go faster. Multiprocessing does, but you can fork a Node server so it runs across multiple processors quite easily.

(Keeps reading...) Ah, about halfway through the article they talk about introducing multiprocessing using the `cluster` module. But then they say the process is tied up until the request is fully received, bottle-necking the process based on client speed, which is not how I understand Node to work at all. Sure, the slow connection will tie up a socket and memory, so a buffering proxy makes sense, but it shouldn't affect compute. Maybe it's a limitation of `cluster`? My experience is with `worker-farm`.

Which brings me to the second oddity: CPUs are _fast_. What is Airbnb doing that takes so much compute? Perhaps server-side React is slow? On my own, admittedly low-traffic Node site, I use jade/pug for templating, and the initial template compile step can be expensive. But then I cache the compiled template and everything is too fast to care about thereafter.

I don't doubt that they had a problem, or how they fixed it, and I enjoyed this deep dive. Nonetheless, their reasoning about the underlying causes don't ring true for me.

<comment><USER3> so, after reading the article, yeah, think he explained it a little bad. basically what he's saying in a single node thread node's parallel model doesn't magically fix compute requirements. that graphic of fn1 and fn2 and compute is confusing.

personally never used clustering and the cluster module (we did that at haproxy lvl with containerised individual node processes), but I think that's exactly what he's saying, that the cluster module is the limitation ([https://nodejs.org/api/cluster.html](https://nodejs.org/api/cluster.html)). not sure how they use it but it seems to imply requests being fully read in the cluster PID than passed to the workers

</comment></comment><comment><USER4> Was hoping for a second there that they found the way not to include the serialized state (as json sitting inside the script tags) in the body of the html document (to make the page lighter), but no, that's not the case.

Anyway, it's interesting how they separate the code for fetching data (making it a responsibility of one server) from the code for rendering data (making it a responsibility of another, Node-based, server). Which means that although they re-use the code for components, the code for data fetching logic must get duplicated.

<comment><USER3> you don't NEED to include the serialized state in the body of the HTML, this is the common practice, you can wait for the client to parse your js and then make a separate request for the state data.

I don't get point 2, if they are to 'hydrate' the react renders in node with data, they have to have a 'fetching' logic in there, the fact that it connects to an 'API' instance makes no difference, the client could use the same connection with same logic client side.

<comment><USER4> > I don't get point 2, if they are to 'hydrate' the react renders in node with > data, they have to have a 'fetching' logic in there

The way I am understanding their blog post, they have a dedicated server (let's call it server1) for api requests, and then a server for rendering (let's call it server2). Server1 does all the fetching logic and then sends the received and appropriately processed json to server2, which needs only to use this data for rendering.

</comment></comment></comment><comment><USER5> It took less time than I imagined to come full-circle.

</comment><comment><USER6> Anybody out there using J2V8([https://github.com/eclipsesource/J2V8](https://github.com/eclipsesource/J2V8)) for such purposes?

</comment><comment><USER7> What are the pro et contra for react vs php for server rendering ? I thought react was php for the frontend. So running it on the backend seem backwards.

<comment><USER4> > I thought react was php for the frontend.

Erm. In what way? Ubiquity? Code quality?

<comment><USER7> Most people don't know what templates and MVC pattern means. But that's basically what you do in PHP, maybe in a more simple form, but still. Basically how all traditional web apps are built whether its Java perl or cgi. React is pretty much the same, like all other web frameworks, but more powerful as it can rerender parts of the view - instead of the whole view. But if you use it server side I really see no benefit, as you would have to render the whole view. Does this make any sense ?

<comment><USER4> If you are then re-using the same React code on the client side (and you generally are), then of course it does. This is the enticement of "universal" frameworks — you use the same code (perhaps with occasional slight modifications here and there) to run on the server side and on the client side. Imagine your Symfony, Django or Rails app that runs not only on your server, but in your browser as well. That's roughly the luxury that server- side React (or Angular Universal, or Vue, etc.) gives you.

<comment><USER7> Component reuse would be a selling point. But what about stateful components that change colour or what not, do they still run on the client side? And what about a todo-list like the one on the react start page, will it "magically" use hidden forms and make http posts to update the server state ?

<comment><USER4> > what about stateful components that change colour or what not, do they still > run on the client side

Yes :-)

Statefulness of a component is not useful for server-side rendering anyway, because component state will only change on the client side. But yes, stateful components work both client-side and server-side.

> And what about a todo-list like the one on the react start page, will it > "magically" use hidden forms and make http posts to update the server state

I am not sure what you mean. Filling in and submitting a form only makes sense on the client side. It can be pre-populated with data during server-side rendering though. Naturally, http requests for form submission will work on the client.

</comment></comment></comment></comment></comment></comment><comment><USER8> [http://davmac.org/davpage/linux/async- io.html](http://davmac.org/davpage/linux/async-io.html)

[https://blog.libtorrent.org/2012/10/asynchronous-disk- io/](https://blog.libtorrent.org/2012/10/asynchronous-disk-io/)</comment>


How to hire a good software development team? - <AUTHOR> Hi everyone!<p>I have an idea for a mobile app, but I haven't got any coding skills. What is the best option for me: hiring a dedicated team of developers, trying to learn to code on my own, or looking for a freelancer? <comment><USER2> A software Engineer with 10+ years of experience here.

I would say that all depends on the idea itself and the technical complexity of the app.

If it is a pretty straight forward app you should probably hire a single developer/ team of 2 person to develop the app.

If the idea involves a lot of technical complexities it will be a good idea to get a technical partner first and then look for outside help. The technical partner will help you with some part of the code and managing the freelancer/team etc.

If you are not a technical person, you should really write down what exactly you need from the freelancer even before you start looking for one.

Do not go for the cheapest freelancer that you can find.

</comment><comment> Lis-sa Agree with raooll. If your idea is complex enough and you need to cover various intricacies, you'll better hire a dedicated team that will take full responsibility for the development process.

Here is a software development company that built a high-quality mobile app ([https://www.itechart.com/services/mobile- development/](https://www.itechart.com/services/mobile-development/))</comment>


Probability Decision trees, and an oddity In tennis - <AUTHOR> http://www.solipsys.co.uk/new/AnOddityInTennis.html?HN2 <comment><AUTHOR> I promised a few people I'd post this when I wrote it up, so here it is. The same techniques can be used to analyse decisions in business, but I'm leaving that for another day.</comment>


A simple terminal app for Google Authenticator - <AUTHOR> https://medium.com/@AbhishekBharadwaj/how-to-make-a-terminal-app-for-google-authenticator-af1c5d93f7d8 <comment><USER2> > One _small caveat_ is this script creates 'secrets.txt' in the same > directory so anyone can open that file and access your codes. I am planning > to add some level of encryption to that in future. If you have any > idea/suggestions send me PR here is the repository.

pass-otp(1)[0] already has encryption ready; and it also adds another warning:

> This method is provided as a means to transport your TOTP tokens to other > devices, disconnected from your single factor authentication part. If you > add those secrets into the same basket of eggs, you will be defeating the > whole purpose of the multi factor authentication[1] mantra. Please think it > through before running this migration.

[0] [https://github.com/tadfisher/pass-otp](https://github.com/tadfisher/pass- otp)

[1] [https://en.wikipedia.org/wiki/Multi- factor_authentication](https://en.wikipedia.org/wiki/Multi- factor_authentication)</comment>


A two column hacker news? - <AUTHOR>

Would anybody else find it useful to have the 'new' posts listed on the right hand side of the default HN page? (such that they update every 'n' minutes, or scroll)<p>I tend to end up not reading the 'new' posts and focus on the top rated posts. It is probably just the way I read HN, but maybe being able to see the 'new' news posts ON THE SAME PAGE as the top rated posts might help many of the new posts that fly past completely unseen by many people...<p>(I would have normally knocked up a screen shot, but I am restricted to install anything remotely useful onsite) <comment><USER2> Protip: use pixlr.com - it's free and requires no installation!

I made a quick mockup. Is this what you had in mind? (Warning: not a design person) <http://i.imm.io/jQMl.png>

Such a thing might be useful. Don't know how much an auto-updating feed would impact the very non-live vibe I get from HN, but it'd change post distributions and such for sure. The feature I'd personally love to see is the ability to collapse chains of comments without using an external script. :)

<comment><AUTHOR> Perfect! good thinking and you read my mind!

</comment></comment><comment><USER3> There is always a tendency by people to place more content on the frontpage or above the fold to give it 'more attention'. This is a fallacy.

An extra column clutters the homepage and adds no functionality to what a simple click on 'new' (which is the most important link, right next to the brand name) would also do.

If it is the case that too few good articles arrive on the homepage, since everyone is ignoring the new ones, then the algorithm should be changed. But I don't think that is the case at all.

As an extra, I like reading HN on my mobile phone. And with the current one column design this works very neatly. An extra column would complicate that. You might handle that with CSS media queries, but I still think it wouldn't be elegant.

<comment><USER4> There's an option C: most everyone ignores the new ones (because most people don't click the 'new' page and upvote articles), but pg generally does not change anything on HN.

So we are relatively stuck. No algorithm change, no UI change, increasing volume of submissions and few people upvoting - means most articles that bubble up are link-baity.

<comment><AUTHOR> Yes, I've noticed this quite a lot recently, that somebody posts an article that become popular, soon after there appear 'secondary' articles which seem to be trying to ride the same wave. It could be genuine, but I also suspect people just quickly knock up 'follow up' articles to get the traffic. This almost always seems to happen when a new PG essay is posted.

How could the quality of HN be measured? (very Robert Persig!)</comment></comment></comment>


Ask HN: Review our startup - EventGel - <AUTHOR> http://eventgel.com/ev/startup-school/

<comment><USER3> First criticism, concerns, then praise in no particular order. Apologies for duplicates feedback. And I may have gotten carried away...

Criticism:

* We'll start with the offcolor comment: the name EventGel sounds like something KY or Trojan Condoms would sell. This may or may not be a plus depending on your audience and market.

* I am not a fan of the timeline widget (third party?). It's difficult to use and not entirely intuitive. Click-and-drag is slow to respond and when I click on a location in the zoomed out timeline at the bottom it doesn't jump to that location in the main timeline. Why considerations made you choose a timeline widget instead of a calendar layout?

* The design seems clunky and boxy. Maybe if you removed the horizontal bars at the top. In firebug I made all of the top 3 bars the same color as the 3rd bar and it already seemed more "together".

* Blue text on black background is hard to read. * It seems like the yellow help box should be at the top of the landing page, not the bottom. The description you currently have doesn't really pop out visually or promotionally.

* Consider a multi-column layout or a sidebar for things like the twitter feed. You have a lot of different information to present and presenting it in a list makes it hard to find the information I'm looking for.

* Your textareas do not resize when I resize the browser.

* I agree with the comments on the map being too small.

* On the front page, I click on an event and it doesn't tell me where it is. And the bubble that pops up says: "This is the schedule bar for your event." The purpose of the date range is obvious. This text is probably unnecessary or could at least be condensed.

* I agree with the comments about dates. No military time or seconds. Also, please add timezone abbreviations.

* Add the time of day to the activities list.

Concerns:

* Why should I be interested in the site, what is it this is providing that I can't get via a number of other tools like facebook or craigslist?

* How is this going to scale by location? I'm in Boston, why should I care about events anywhere else, unless they are virtual? Will you add an event filter?

* Do you have a plan to avoid spam? Already I see an activity for "Have sex"

* Like spam, how are you going to handle signal to noise ratio on the front page?

* You may want to consider having a proper logo.

* Can you add a description field for the events? What is the event about? What do I need to bring? Etc.

* You seem to have duplicated functionality between the discussion and twitter feed. What is the distinct purpose of each?

* Do you have any plans on helping people promote their events?

Praise:

* I like the twitter feed on the events. Seems like a good marketing tool.

* Big points for the easy signup.

* This is cool. I like the openness of the concept. I agree that this has a lot of potential. Any thoughts on monetization? I could see this being very useful for event planners and caterers and the like to get new business.

* You've covered the event details of when, where, who (but not what).

* The activity feature is helpful for planning events with a lot going on.

<comment><USER4> We really appreciate that you've taken all the time to give us this feedback - if there's any duplication it just tells us that you're not the only one who feels that way :D

We've started the process of fully redesigning the site based on this feedback and the other great feedback from this thread. Hopefully we'll have something up in the next few days to reflect some of the great design feedback we've gotten here.

I think down the road we will probably remove some of the event focus from the front-page; our focus isn't as much event discovery as it is what happens when the event actually starts.

Thank you for taking the time to give us such in-depth feedback, it really gives us a lot to consider.

</comment></comment><comment><AUTHOR> Paul (icey) and I have been working on a tool that helps people coordinate plans while attending an event. We've put together a sample "Startup School" event for you to play with.

We're still early in the process of starting up, so any and all feedback will be really helpful to us.

The idea for this came out of frustrations trying to keep track of what was going on at a number of events; right now people are forced to coordinate over the phone, twitter, email, texts, etc. We think that having a central location for everything makes coordinating these activities easier.

Check it out and let us know what you think.

If you think email would be better to get it touch with us, it is : firstname.lastname@example.com

</comment><comment><USER5> Congrats on the launch. I second much of the feedback that's already been given on this page, but I wanted to mention two other specific things I've noticed:

1) Your "What is EventGel?" box at the bottom of the page (which is evidently anchored to #help) has too much text. It looks like you've listed every feature of your app. Can you reduce that to a few bullets that speak to EventGel's primary benefits, and maybe move the longer copy to an "about" page?

2) Under each comment is a "permalink" link. I think permalinks to your comments here are probably unnecessary in general, but right now those are links to the event page itself rather than to a comment.--so that an event page with dozens of comments has dozens of links to itself labeled "permalink".

Also, tk999 mentioned difficulties scaling the timeline widget. Just as another datapoint: In my experience where this starts to fall down is in the user exprience when you have very many events in the timeline. It is difficult to get this to look and work just right with a large number of user or programatically generated events. But you could also spend some time on design within the timeline. (For examples of both, see, for instance, <http://open.britannica.com/timelines?id=128>. The timeline UI becomes unwieldy when the events are densely packed, eg. <http://open.britannica.com/timelines?id=107>) But as previously mentioned, I'm not sure the SIMILE timeline is the right widget for you to be using anyway. I think I'd look to other approaches to display the event information.

<comment><AUTHOR> Thank you.

1) Fixed.

2) Fixed.

Yup, we are taking care of the timeline issues.

</comment></comment><comment><USER6> One nitpick: when scrolling up and down the page (using either two-finger drag on macbook, or mouse wheel) the scrolling gets "trapped" once the cursor gets over the timeline.

<comment><AUTHOR> Good point. We'll fix it.

<comment><USER7> Meanwhile, you need to becareful about the timeline widget. We used it before but it did not scale up to couple thousand points. I think at the end, you need to write your own timeline widget.

<comment><USER4> Thank you for the heads up - We've been looking at writing a more specific version of the timeline already, and it's useful to know there may be other issues with the timeline when we try to figure out what to work on next.

</comment></comment></comment></comment><comment><USER8> A few things that I noticed right away:

\- While I personally like 24h time for start and end time, I doubt most other people will feel the same way

\- The map is tough to read being so short, a little bit of height there would go a long way.

\- Links in discussions would be a lot easier to use if they were auto- hyperlinked.

\- The "X attending" under the attend this event button is almost unreadably (did I just make up a word?) small.

I think it's got potential, how do you plan on differentiating yourself from something like meetup.com?

<comment><USER4> Thanks for the input!

We'll definitely have a think about 12h vs 24h time formatting, you're the first person who's actually mentioned that and it is a bit of an oversight on our part, thank you :D

With regards to differentiating ourselves from meetup: we're building a tool that takes over once the event has started. Evite, meetup, etc are great at getting people to an event, but tools for organizing random mobs of people are lacking once an event kicks off.

I guess you could say that we're focusing on more ad-hoc event planning than something structured like a Meetup.

Thank you as well for your feedback regarding readability!

<comment><USER8> That differentiation totally makes sense, thank you for that. I can see this being really useful for something like SXSW where there are a lot of impromptu meetups/gatherings.

Something else that just stood out at me: The margin for the description under the "Activity Calendar" section doesn't seem to match the margins used under those sections elsewhere.

<comment><USER4> _" I can see this being really useful for something like SXSW where there are a lot of impromptu meetups/gatherings."_

You just made me really happy, that's _exactly_ the sort of thing we're targeting!

(Looking in to the margin issue now, thanks!)

</comment></comment></comment></comment><comment><USER9> I'd recommend placing some focus on what it looks like when printed. The nature of many events is that people will be going somewhere they may not be familiar with. If you look at how things are printed out, you'll see that it spans multiple pages, and isn't very easily readable. The printable version probably only needs a subset of what you show on the on-screen view, but you should lay it out in a manner so it can all fit on one piece of paper.

<comment><AUTHOR> Great point. Thank you! We'll put together the printer-friendly page.

</comment></comment><comment><USER10> The interface makes me feel very "uncomfortable" and a little confused. You should consider laying things out a little nice - perhaps side by side?

The logo / menu / page title instantly create some confusion and clutter. The timeline doesn't look too user-friendly either.

I'm just commenting on the interface though, I haven't looked at the functionality too much yet.

<comment><USER4> Side by side layout sounds interesting; do you mean putting the activities next to the timeline?

So far, this has definitely been "design by developer"; so feedback regarding the interface is most definitely welcomed.

<comment><USER8> Since you mention that it's been developer designed - Ryan Singer of 37signals gave a really great talk at WindyCityRails on how developers can build better UIs that you might want to check out: <http://windycityrails.org/videos#4>

<comment><USER4> Thanks for this, I have it bookmarked now to check out this evening.

</comment></comment></comment></comment><comment><USER11> It looks like it was designed by programmers.

<comment><USER12> So does Google.

<comment><USER13> Google's UIs always look slightly odd and unpolished at first glance but their apps are all nice and elegant. When actually using it you quickly notice that everything is thought through and works as expected. It's not flashy, the overall theme is a little childish, but all the elements are at the right spot.

I don't want to start that old stupid thing about programmers and how they are unable to create useful UIs (Sorry programmers, you don't get off the hook so easily.), that's just stupid. The above linked site was made by someone who is clueless about UI design. You maybe a programmer, but that's no excuse. And just some polishing won't do.

(I would just like to add: I think the idea is great an practically screaming for a sleek UI.)

<comment><AUTHOR> Good points. Thank you. We definitely want the very best UI and we are not thinking that it is of secondary importance or that we can just spray it on. We _will_ get it right.

</comment></comment></comment></comment><comment><USER14> When you sign up, it automatically fills in where it thinks you live. I'd be careful about this since I signed up @ work and it is not where I actually reside. I'd like a bit more information about myself in the profile, but I understand this is just the first iteration. I'd work on the profile page if you want this to be socially focused.

<comment><USER4> That's an interesting point; we'd kind of gone back and forth over this one a few times (guessing your location).

We are going to be changing to allow you to modify your location pretty soon here.

What sort of information do you think is useful in a profile for something like this?

(Also, thank you for taking the time to provide feedback, it is really helpful to us!)

</comment></comment><comment><USER15> It's timely, considering that this came up yesterday:

<http://news.ycombinator.com/item?id=881636>

You should convince the HN/Chicago crowd to use it.

<comment><AUTHOR> It would be awesome if they did! Thanks.

</comment></comment><comment><USER16> You might wanna consider adding an address book import feature or some kind of invite sending feature via which you can invite folks you know.

Great concept. All the best

<comment><AUTHOR> Thanks. Good idea. We'll add that feature.

</comment></comment><comment><USER17> your probably aware that clicking on the 'test' activity seems to cause some sort of exception?

MultipleObjectsReturned at /ev/startup-school/test/ get() returned more than one Activity -- it returned 2! Lookup parameters were {'urlname': u'test', 'event__urlname': u'startup-school'} Request Method: GET Request URL: <http://eventgel.com/ev/startup-school/test/> Exception Type: MultipleObjectsReturned Exception Value: get() returned more than one Activity -- it returned 2! Lookup parameters were {'urlname': u'test', 'event__urlname': u'startup-school'} Exception Location: /usr/lib/python2.5/site-packages/django/db/models/query.py in get, line 307

<comment><USER4> Ouch, thanks for the heads up, we'll take care of it right now.

</comment></comment><comment><USER18> Ha, I had a similar idea. Now I don't have to create it myself, I can use yours, thanks guys :)

</comment><comment><USER4> I should mention that since this is in an early stage that you guys are welcome to enter data or say you're going to attend events that you don't intend to actually go to. I promise you won't hurt anyone's feelings.

</comment><comment><USER19> honestly, trying to be consumer minded, i opened your link, throat vomited at the design, and closed it.

You may have a valid product, but the design, and I'm going to assume the usability, is killing you. consumers like shinny and clean.

Now i'll take a second look at your site and provide some feedback on the tool itself.

congrats on going live. It's an accomplishment no matter what state it's in.

<comment><USER4> Sorry about that; design has been the #1 suggestion we've gotten so far and we have made design our top priority now.

</comment></comment><comment><USER20> I don't like the tagline: "Events made interactive" from your about statement I think you want something like "Collaborative events"

</comment><comment><USER21> Congratulations, Kirubakaran and Paul!

<comment><AUTHOR> Thank you! :-)

</comment></comment><comment><USER22> This is great! I'm so glad to see you guys launch something. The first step is the biggest.

I don't want to repeat what the others have said, but I've been playing around a little bit and off the top of my head:

      - Separate dates and times into their own fields
      - Only one date field for single day events
      - Add Day of Week
      - Use Date Mask MM/DD/YY
      - Don't use military times.  Don't show seconds.
      - Map widget is too small to be useful.
      - Instead of depending solely on text, add some data fields.
         Some possibilities:
           - Who's Attending
           - Reviews of previous instances of this event
           - <USER2>
           - Public Transportation
           - Dress Code
           - Don't forget to bring...
           - Wifi available?
         (You get the idea)
      - Sort/filter events by date, location, who's attending

More to follow...

<comment><USER4> I can't thank you enough for the detailed feedback!

I think right now we're going to focus on getting the design up to snuff, and then we'll probably hit a significant number of these shortly thereafter.</comment></comment>


A New Fashion Catches On in Paris - Cheap Bicycle Rentals - <AUTHOR> http://www.nytimes.com/2008/07/13/world/europe/13paris.html?em&ex=1216094400&en=5c7f90db34c58472&ei=5070

<comment><USER2> In Copenhagen we have free city cycles in the entire central city area. Just slip in a coin and you can take the cycle out for as long as you want. When done park it at any of the stations and take your coin back.

Also, pretty much every street here has a dedicated cycle lane on each side of the road.

<http://www.bycyklen.dk/english/thecitybikeandcopenhagen.aspx>

<comment><USER3> I read that some cities had problems with too many bikes ending up at a select few stations. For instance, you'd bike to the shopping center and then take your groceries home via train or bus. Have you noticed this problem happening in Copenhagen johnnyzee?

<comment><USER2> I haven't noticed or heard complaints about it. They have teams of people taking care of the fleet in exchange for unemployment benefits, I believe this includes redistributing once in a while.

</comment></comment></comment><comment><USER4> The "white bicycle" concept dates from 1965 and was proposed by Provo, a Dutch counter-culture movement. In a manifest (see <http://www.gramschap.nl/provo/chrono/prpk5.jpg>) they announced that they would place a white painted bike in the city center of Amsterdam which would become public property. The goal was to counter pollution of the city but it was also a statement against the increase of consumerism. After they placed the bike it was immediately confiscated by the police because it didn't have a lock.

</comment><comment><USER5> This kind of projects brings fun traffic management challenges.

On late Friday/Saturday nights, it was impossible (experienced it myself) to find a bike for the taking in central Paris, since the flow of bikes was from the inner towards the outer Paris at that time.

Similarly, trying to find a bike after 9am on weekdays if you do not live in the center of Paris was impossible (experienced it myself): the flow of bikes was from the outer towards the inner Paris at that time.

That was Fall 2007.

<comment><USER6> In munich they had a system where you would get money back if you cycled from the outer circle into the inner circle.

I still don't think those bikes became a great hit, mainly because signing up for them was too much hassle (in my opinion). They are still around, but I can't imagine that they make a profit.

</comment></comment><comment><USER7> As China embraces the car, Paris embraces the bicycle.

[http://www.chinadaily.com.cn/english/doc/2004-11/11/content_...](http://www.chinadaily.com.cn/english/doc/2004-11/11/content_390685.htm)

<comment><USER8> The fact that the government's keeping a cap on gas prices doesn't help either. On the other hand, since my trip there in 2000, electric mopeds/scooters were already immensely popular there, way before I started see them here in North America.

</comment></comment><comment><USER5> It's coming in Montreal too in Fall 2008: [http://www.canada.com/montrealgazette/news/story.html?id=654...](http://www.canada.com/montrealgazette/news/story.html?id=654c09d8-d549-4dd1-a3f8-b294b2aef3df)

From the Gazette's article: _Montreal plans to be the first city in North America to set up a large-scale "self-serve" public bicycle rental service._

</comment><comment><USER9> This was tried in England, and was a complete failure. The bicycles were almost immediately vandalized by chavs. Some cities are ready for it, some just aren't.

BoJo, the new Mayor of London, is a keen cyclist, we shall have to see what he comes up with.

</comment><comment><USER10> I was there last fall and these bicycles were massively popular. I think they made quite a lot of people ride who wouldn't have otherwise.

<comment><USER5> Especially since last Fall saw the serious public-transportation strikes in Paris. This for sure is a good incentive to force people to use those bikes :) People were getting up extra early to maximize their chances of putting their hands on a bike to go to work, as they couldn't use the subway!

But don't get me wrong, this project is an unequivocal success (as well as a political investment for Paris mayor Delanoë, preparing for the presidential elections in 2012).

</comment></comment><comment><USER11> There is a program in Barcelona, too (<http://www.bicing.com/>).

</comment><comment><USER12> I'm in Rome now and these things are everywhere.

</comment><comment><USER13> I was in Paris when they introduced these things and it was really great. Everybody collectively figuring out how to use these things; tourists teaching locals about the system and all-round fun. I really loved it.</comment>


RFC 8205 – BGPsec Protocol Specification - <AUTHOR> https://tools.ietf.org/html/rfc8205 <comment><USER2> This is a widely known security flaw since at least 2008 when a Pakistani telecom company shutdown Youtube. There's been plenty of talks since then at blackhat and defcons and papers.

I'm just impressed on how so little has been done yet.

<comment><USER3> The problem was known well before that:

[https://en.wikipedia.org/wiki/AS_7007_incident](https://en.wikipedia.org/wiki/AS_7007_incident)

> The AS 7007 incident was a major disruption of the Internet on April 25, > 1997, that started with a router operated by autonomous system 7007 (MAI > Network Services, although sometimes incorrectly attributed to the Florida > Internet Exchange[1]) accidentally leaking a substantial part of its entire > route table to the Internet, creating a routing black hole.

And that's just one specific example I can think of off the top of my head which is older than the one you mentioned. I'm sure there were a number of them before and since.

<comment><USER4> Vinnie Bono!!!

<comment><USER4> [http://seclists.org/nanog/1997/Apr/444](http://seclists.org/nanog/1997/Apr/444)</comment></comment></comment></comment>


Top 20 best free apps for the iPad - <AUTHOR> http://www.aneesoft.com/tutorials/ipad/best-20-free-ipad-apps.html

<comment><USER2> Claims to be a list of free apps, but there are at least 3 that aren't free.</comment>


Melody - Movable Type's open-source fork - <AUTHOR> http://openmelody.org/

<comment><USER2> It makes little sense to use a hybrid Perl/PHP product these days. MT was suffering from being a Perl/CGI product and patched it up with PHP only to still be eaten by WordPress. Too little too late.

<comment><USER3> Sounds like Melody is an attempt at addressing the hybrid problem (amongst a lot of other problems).

<comment><USER2> Perhaps, but the source right now is exactly as I described. Seems odd to start from the CGIs if you want an all PHP system.

<comment><USER4> no, They want an all Perl system using CGI::Application, why would they want an all PHP system?

<comment><USER2> I don't know why they would want either honestly, it's not a real interesting problem and there are already plenty of solutions.

</comment></comment></comment></comment></comment><comment><USER5> Movable Type was already open source. Their FAQ is unclear to me why this was forked in the first place. Wouldn't it be better to contribute improvements back to the actual product?

</comment><comment><USER6> Has anyone actually tried this out? I'd be very curious to see how people like it and how it compares to MT in general, as well as to WordPress.</comment>


Ask HN: Supreme Court sales tax ruling GDPR implications? - <AUTHOR> Note: not seeking legal advice. I noticed that two subjects that have been discussed here may have some intersection, and want to see what people's thoughts are.
Often when GDPR is discussed here there is a sub-discussion over whether or not the EU can actually enforce it if you do not have an EU presence or any assets they can reach.
The US often will allow foreign judgments to be enforced in the US [1], if the US agrees that the foreign court had both personal and subject matter jurisdiction, and that you had notice and the opportunity to defend yourself.
With no physical presence, there was a good chance US courts would find you did not a "nexus" with the foreign state, meaning that they do not have personal jurisdiction.
But late last week, in SOUTH DAKOTA v. WAYFAIR, INC., ET AL., the Court overturned its earlier precedent and decided that doing online business in a state that you have no presence in can be enough to establish a nexus. The exact parameters of this are yet to be determined, other than it will probably require that the revenue or number of transactions you do in the state must be above some threshold to establish a nexus.
Will this loosened standard for what can establish a nexus only apply to taxes between states, or is this the new standard for all inquiries a to the existence of a nexus? If so, does that mean it will now be easier to establish that a foreign court had personal jurisdiction, and so easier to get foreign judgments enforced in the US?
There are some categorical limits on foreign judgments. For example tax and penal judgments will not be enforced by US courts. I do not know if GDPR fines fall under any of the forbidden categories.
If they do, a US GDPR transgressor still might not be safe, because GDPR also allows the data subjects themselves to sue for compensation, and foreign judgments for compensation are usually allowable I believe.
[1] https://uk.practicallaw.thomsonreuters.com/0-619-6072 <comment><AUTHOR> Meta: HN cannot count. The original version [1] of this question was 2907 characters long, exceeding the 2000 character limit for text posts. I edited it down to 1993 characters [2] and it still was rejected for being over 2000 characters.

The present version is 1971 characters. My first guess was that maybe the length of the title is being counted too, but this version plus the title is 2029 and was obviously accepted.

[1] [https://pastebin.com/sDrZjAv8](https://pastebin.com/sDrZjAv8)

[2] [https://pastebin.com/jh10V0UX](https://pastebin.com/jh10V0UX)

<comment><USER2> Looking at the API response[1] implies a bit of formatting being done on the HN side. Maybe some of that is done before the limit.

The published version, with opening html paragraphs (except the first one, for some reason) and with html entities translated back into single characters, comes out to 1979 characters.

Your second link, formatted the same way, comes out to _exactly_ 2000 characters. The limit could potentially be strictly _less than_ 2000 characters. You may have been exactly one character off.

[1] [https://hacker- news.firebaseio.com/v0/item/17388936.json?pri...](https://hacker- news.firebaseio.com/v0/item/17388936.json?print=pretty)

</comment></comment><comment><USER3> Well, US states and other nations are distinguishable, no?</comment>


Why a Pterosaur Is Not a Dinosaur - <AUTHOR> https://www.smithsonianmag.com/science-nature/why-a-pterosaur-is-not-a-dinosaur-87082921/?no-ist <comment><USER2> _"Dinosaur" is a word for a specific group of creatures united by shared characteristics and which had their own evolutionary history—it is not a catch-all term for anything reptilian and prehistoric "_

Fascinating, didn't know Pterosauria split off from Dinosauria so far prior to either's evolution.

</comment><comment><USER3> > Calling a pterosaur a dinosaur is an error of the same order of magnitude as > saying that our species is a marsupial

I'd say it's more like the error of calling a tomato a vegetable. While it's true that from a phylogenetic perspective that pterosauria aren't dinosaurs, they still have many basal characteristics (relative to today's flying dinosaurs, the aves) that give them a certain dinosaur-like quality in the imagination. Besides, they're contemporaneous with the true dinosaurs. Grouping them with the dinosaurs is understandable. The grouping is incorrect under one classification scheme, but correct under another.

BTW: this site screws up copy and paste, appending marketing junk to any text copied to the clipboard. I wish it were possible to prohibit these clipboard shenanigans.

<comment><USER4> > I wish it were possible to prohibit these clipboard shenanigans.

It is in Firefox, at least:

      about:config

      dom.event.contextmenu.enabled = false

      dom.event.clipboardevents.enabled = false

<comment><USER5> Great tip!

</comment></comment></comment><comment><USER6> When they were building their taxonomy, why did not they name its level, that includes both what they now call "dinosaur" and pterosaurs "dinosaur", and come up with a different name for their "dinosaur", if it is a common conception?

<comment><AUTHOR> I think the "common conception" comes from Land Before Time and Jurassic Park, it seems almost everything we learned about dinosaurs from those movies is wrong.

Edit:

I just looked it up and discovered both were made by Steven Speilberg...

<comment><USER7> Nah, pterodactyls and such were commonly taught to children to be dinosaurs before Jurassic Park and Land Before Time came out.

Source: was child before 1988.

<comment><AUTHOR> Where do you think it originated then?

</comment></comment></comment></comment><comment><USER8> Ehh, they're using the name "Dinosauria" as evidence that people use "dinosaur" wrong. I'd say they're misunderstanding the word "dinosaur".

It's a bit like (though in reverse) how "canine" is often used for the Canis genus (dogs), but is easily confused for "canid" (the Canidae family) which includes foxes and tanukis.

<comment><USER9> This reminds me of the "fun fact" that people throw around about tomatoes being a fruit.

Really there are two sets of terms - culinary and botanical. Botanically tomatoes are a fruit yes, but they are also a vegetable. And in the culinary context you would never use a tomato like a fruit.

The English language is defined by it's usage, and the same word can mean different things in different contexts. Dinosaur is used commonly to refer to Pterosaurs in the "general" context, so a Pterosaur _is_ a Dinosaur in that context. If you were instead a biologist talking in the context of academia then a Pterosaur would not be a Dinosaur.

<comment><USER10> I'm nitpicking but tomatoes are (sometimes) use as a fruit in culinary context: [https://en.wikipedia.org/wiki/Tomato_jam](https://en.wikipedia.org/wiki/Tomato_jam)

<comment><USER11> To be pedantic, the first Wiki link in that article goes to the Fruit preserves article[0], which begins with: "Fruit preserves are preparations of fruits, vegetables and sugar, often stored in glass jam jars."

So while tomato jam is a type of fruit preserve, not all fruit preserves are made of fruits (despite the name).

[0] [https://en.wikipedia.org/wiki/Fruit_preserves](https://en.wikipedia.org/wiki/Fruit_preserves)

</comment></comment></comment></comment><comment><USER12> On a tangential note, I'm still trying to wrap my head around the notion that a flying reptile the size of Quetzalcoatlus (believed to have wingspan on the order of 10 meters) could ever get airborne.

This has made me wonder if it's possible that juvenile Quetzalcoatlus could fly but adult Quetzalcoatlus could not. Natural selection would presumably select towards smaller and smaller wings on adults, but maybe this could be offset by a serious evolutionary advantage bestowed on juveniles from being able to fly.

I don't know of any bird existing or extinct with this kind of lifecycle, but maybe you can find something similar in insects?

<comment><USER13> No, pterosaurs had wings built out of hand bones, and hands develop their size early in vertebrates. Therefore if you've got the right proportions to fly as a grownup, you should be able to as a kid. Whether that was right to birth is still debated, but certainly they could fly from being young.

By contrast birds and bats use arm bones in their wings, and so cannot fly until nearly an adult. That imposes child care needs on the parents that are pretty severe if you are large.

Now when species compete, they usually don't do it head on. Instead each specializes on what it does better. Pterosaurs couldn't do much about the fact that feathers are more efficient flight surfaces than their hair. But they had one advantage - it was easier for them to grow big. And that is why at the end of their time, the last niche that they held was a freakishly big carrion eater. (And dinosaurs could make for some freakishly big carrion for them to eat!)

<comment><USER14> > No, pterosaurs had wings built out of hand bones, and hands develop their > size early in vertebrates. Therefore if you've got the right proportions to > fly as a grownup, you should be able to as a kid. Whether that was right to > birth is still debated, but certainly they could fly from being young.

You've got the GP's question exactly backwards - they aren't questioning whether the juveniles could fly, only the adults. If you develop the full hand size early in life, and that supports flying with 20kg of mass, a 15kg juvenile is going to have a much better time of things than a 50kg adult. (Numbers pulled out of my ass, I'm not sure what the actual ones would be)

</comment></comment></comment><comment><USER15> Useless fact but since where talking about naming things. The word helicopter is a combination of helix and pteron (spiral wing). [https://en.m.wiktionary.org/wiki/helicopter](https://en.m.wiktionary.org/wiki/helicopter)

<comment><USER16> Greek _helix_ (genitive _helikos_ ) + _pteron_ "wing" (from PIE root _pet-_ "to rush, to fly").

[https://www.etymonline.com/word/helicopter](https://www.etymonline.com/word/helicopter)

That page says ' _helix_ : "a spiral thing", a word used of anything in a spiral shape (an armlet, a curl of hair, the tendril of a vine, a serpent's coil)' \- though all these examples are helices, not spirals; I suspect the author(s) didn't know the difference.

<comment><USER17> Well you piqued my interest, what's the difference?

I note that Wiktionary, and the Oxford Pocket Dictionary (which I believe is what Google use), consider them to be synonyms.

For example this from the latter's definition of "spiral" -

"winding in a continuous curve of constant diameter about a central axis, as though along a cylinder; helical. synonyms: coiled, helical, helix-shaped, corkscrew, curling, winding, twisting, whorled"

<comment><USER16> A spiral is 2D, like the Archimedean spiral. A helix is 3D, like a spring, or DNA's double helix. Calling them _Archimedean helix_ or _DNA 's double spiral_ would make no sense.

Dictionaries aren't a great place to find the actual meaning of words. :-) ..mathematical terms, anyway.

<comment><USER18> Mathematics isn't a great place to find the actual meaning of words, either, if by actual meaning you mean the meaning understood by the general native- speaking population.

</comment></comment></comment></comment></comment><comment><USER19> Related : a ladybug is not a bug. [1] Scientific nomenclature and common language often disagree!

[1] [https://theamericanscholar.org/a-bug-is-not-a- beetle/#.W5-t5...](https://theamericanscholar.org/a-bug-is-not-a- beetle/#.W5-t5p8pA0M)

</comment><comment><USER20> This article is incorrect, a pterosaur may not be a dinosauria but it definitely is a dinosaur.

Dinosaur has become a generic term. You can even refer to humans who have old- school ideas as dinosaurs.

<comment><USER21> Metaphorical use doesn't count as turning something into a generic term. You can call obstinate humans buttheads, and yet, etc.

This is more in the 'a gorilla is not a monkey' or 'a dolphin is not a fish' category. Getting this sort of thing wrong is going to get you torn apart by gangs of roaming five-year-olds on your next natural history museum visit.

<comment><USER22> Even though mammals are a subset of the descendants of things that are unquestionably fish, we don't call mammals fish, and we do call things fish that are of separate ancestry, so I feel there is kind of an arbitrary double standard here if we get pedantic about dinosaurs. There's no question that in general, categories of living creatures don't have to be monophyletic.

<comment><USER23> "Fish" is a bad category, or to be more precise from [https://en.wikipedia.org/wiki/Fish#Taxonomy](https://en.wikipedia.org/wiki/Fish#Taxonomy)

> _Fish are a paraphyletic group: that is, any clade containing all fish also > contains the tetrapods, which are not fish. For this reason, groups such as > the "Class Pisces" seen in older reference works are no longer used in > formal classifications._

I think we mostly agree, because you wrote

> _There 's no question that in general, categories of living creatures don't > have to be monophyletic._

But I think that the main effort is to make all the categories monophyletic, and drop/replace the other one when possible. Some non monophyletic categories are very useful in practice and they are keep to make communication easier.

The problem is that if you try to make "fish" a monophyletic category you must put "dolphins" inside them, because the dolphins are distant descendants of some fish (as you and me and all mammals).

But Pterosaur and Dinosaur are sibling categories, neither of them descend of the other. Using much smaller categories, it is like comparing penguins and orcas (both are black and white, both swim, both have to breath air, both eat fish), but neither of them descend of the other.

</comment></comment></comment></comment><comment><USER24> The article linked at the top of this one is quite readable, a few technical terms aside. I recommend it. The referenced part about how pterosaurs launched is very near the end.

</comment><comment><USER25> because pluto isn't a planet? I mean sure, inside the discipline knowing the distinction between an integer and an ordinal number matters, but outside? Less sure.

I'm going to keep mentally filing pterosaurs in dinosoar memory. I think 99% of the non-obsessives older than 12 will do likewise. Pluto came back from the dead, after all...

</comment><comment><USER26> Pelicans seem to evolve from pterosaurs but ostriches seem to have come from theropods. Since those are both birds, I would guess pterosaurs and theropods are just as closely related as pelicans and ostriches.

<comment><USER3> I'm really curious about where you learned that.

<comment><USER26> Natural history museum in LA. They have a big exhibit on theropods and pterosaurs and show the birds that possibly evolved from them. Birds are dinosaurs under all the usual biological classification schemes. Similar phenotypes, similar genotypes.

<comment><USER27> Are you sure it was "evolved from" and not "looks like"?

Because pterosaurs have no living descents, and all birds descended from therapod dinosaurs (even if birds were already widespread before the end of the Cretaceous).

<comment><USER26> Yeah it might seem that way but pelicans don't come from pterosaurs.</comment></comment></comment></comment></comment>


Practical Design: Messaging - <AUTHOR> http://themacro.com/articles/2016/08/practical-design-messaging/ <comment><USER2> This is one of the very few Macro articles which reads like advertising spam.

The core of the article links to another site ([http://www.black.design/messaging/](http://www.black.design/messaging/)) which requires users to "Write your email address here, so we can send you your custom Market Messaging".

</comment><comment><USER3> This would surely be downvoted into oblivion if it was any other blog.

</comment><comment><USER4> I was hoping this was going to be about designing message-passing systems.

<comment><USER5> I was actually happy it was about messaging/positioning, which are hard. There are already a lot of posts about designing messaging systems :)</comment></comment>