Christopher Herot's Weblog

Franklin v. Apple at al

TechCrunch speculated today on what was behind the class action suit filed against Apple in the U.S. District Court for the Southern District of Alabama this week. As was predicted, the plaintiffs allege that Apple did not support MMS until long after the iPhone 3G was shipped, even though both Apple and AT&T advertised that the phone included the feature.

They quote the Apple Web site:

Send MMS.

Take a photo or shoot some video, then send it via Messages. You can also send audio recordings from within Messages, information from Contacts, and directions from Maps.

Once customers purchased the phone, they found out that they couldn't actually receive MMS messages on the phone but needed to go to a Web page. From the AT&T site:

Customers who are sent a MMS message and own a non-MMS capable device will receive a text message instead of an actual MMS message. The message will contain the website address of www.viewmymessage.com/1 or www.viewmymessage.com/2 as well as a user name and password. To view the MMS message, please access the website from a computer and enter the user name and password provided in the text message.

It is strangely reminiscent of the class action suit against Verizon for the lack of Bluetooth on the Motorola V710.

You can read the Apple complaint here.

Health Care Statistics

In the current debate over health care reform, one assertion that is often made is that the USA spends twice as much on health care than other industrialized countries, for an outcome that is no better. Some recent statistics from the OECD confirm that assertion but call into question some conventional wisdom, such as the theory that American health care is so expensive because having a third party payer encourages excessive consumption. In fact, Americans go to see the doctor less often than people in other countries (3.8 times a year vs. 6.8 for the OECD average) and when they go to the hospital the average stay is 5.5 days, versus an OECD average of 6.5. Americans smoke and eat less than the average, but 34% of the population is categorized as obese, vs. 15.1% for the OECD in general and 3.4% for Japan.  The net result is that life expectancy at birth is 78.1 in the US vs. 79.0 for the OECD and 82.6 for Japan.

Much of this is nicely summarized in a chart in this week's Wall Street Journal report on Innovations in Health Care Delivery.

Enough of the Facebook Fan Pages

National Grid

The gas company sent someone yesterday to replace our gas meter, but as it turns out, the procedure apparently dislodge the hundred year old service pipe coming in from the street.

We called them and within an hour a crew was outside our house until 6:00 am the next day. Fortunately they managed to snake a new plastic pipe inside the old steel one, so they didn't need to dig up the lawn but they did have to make (and patch) a hole in the street.

Photo album here.

Hi res version here.

Is there a legal standard for quality in video medical interpretation?

Since the passage Title VI of the Civil Rights Act of 1964 health care providers have moved to accommodate individuals with disabilities, sometimes voluntarily and sometimes after prodding by the government and the courts. In the case of people with hearing disabilities or limited English proficiency this accommodation usually involves the provision of an interpreter, whether in person, on the phone, or by videoconference. In Gillespie v. Dimensions Health Corp (8:05-cv-00073-DKC) the U.S. District Court for the District of Maryland was asked not only to compel Dimensions' Laurel Regional Hospital to provide interpreter services but to rule on whether video-based interpretation satisfied the requirements of the law.

The case arose out the experiences of Elizabeth Gillespie and five other patients when they sought medical care in 2003 at the Laurel, Maryland hospital. According to their complaint, the hospital refused to provide them an in-person interpreter and provided only limited use of a video-based interpreting service. Among their specific allegations:

• The one video device was in a room that was occupied by another patient, resulting in a wait of several hours to communicate.
• the staff was not properly trained and took 20-30 minutes to set up and operate the device.
• the quality of the video was so poor that the patient could not understand the sign language
• the placement of the screen was such that it could not be seen clearly by a patient whose condition precluded them sitting up.

The resulting lack of communication was not only distressing, but arguably had an adverse effect on clinical outcomes,such as when a patient who had a spinal tap did not receive instructions to remain immobile.

During the pretrial maneuvering, the U.S. Department of Justice joined the case as a plaintiff-intervenor and a settlement was reached. In addition to the usual confidential financial terms, the hospital agreed to a consent decree which spelled out in some detail the hospital's obligations to provide interpreting services. While the case is not binding in other jurisdictions, it is significant in that it sets down what the government considers an acceptable policy with regard to video interpretation. The section on video reads as follows:

C.     Video Interpreting Services.

1.     Video interpreting services can provide immediate, effective access to interpreting services seven days per week, twenty-four hours a day in a variety of situations including emergencies and unplanned incidents. The Hospital will maintain a contract with a VIS provider with the capability of providing VIS and technical assistance 24 hours a day, seven days a week, 365 days a year, with interpreters promptly available on this basis who are qualified to interpret in medical situations, and who are familiar with medical terminology.

2.     The Hospital’s VIS shall meet the following performance standards:

a.     high quality, clear, delay-free full-motion video and audio over a dedicated high-speed Internet connection;

b.     a clear, sufficiently large, and sharply delineated picture of the interpreter’s and the Patient/Companion’s heads, arms, hands, and fingers, regardless of the body position of the Patient/Companion;

c.     clear and easily understood transmission of voices; and

d.     non-technicians will be trained to accomplish efficient set-up and operation.

3.     The Hospital shall ensure that appropriate Hospital Personnel shall be trained, available, and able to operate and connect the VIS system quickly and efficiently at the Hospital at all times. Training shall include attention to the limitations of VIS technology, such as with respect to (i) Patients who have limited ability to move their heads, hands, or arms; vision problems; cognitive or consciousness issues; or pain issues; (ii) Patients who may be moved to areas of the Hospital that do not have a designated high speed Internet line; and (iii) Patients who will be treated in rooms where space considerations mitigate against using the service. In circumstances where the limitations of VIS technology mitigate against its use, Hospital Personnel shall conduct another Communication Assessment as required by Section IV (B), in order to reassess the need for an alternative auxiliary aid or interpretive service to ensure effective communication.

 

Power Outage

tUsers of herot.com experienced a brief power outage today, occasioned by a brief rain shower punctuated by a loud pop as a tree branch fell on a power line.

NSTAR was on the scene in half an hour, and replaced a stretch of broken high voltage wire. I'm always impressed by how such a thin wire can supply power to an entire neighborhood. I=P/E which means for large values of E (voltage a.k.a. Electromotive Force) the amperage, I, is rather small and thus the wires don't need to be so large.

More photos here.