The Workaday World

I'm still trying to figure out the politics of my new job, and this week got another surprising lesson, at least to me. We have lots of tedious manual processes that I've wondered why people put up with them. Now I know.

Last week, my cohort and I worked through the laborious process of closing the books for the end of the month. We started at about 4pm and finished up at 11:30pm. I was frustrated and exhausted, he was jubilant. From my point of view, the whole thing was a pain in the ass, for him it was 7 1/2 hours of overtime, even more than usual. Probably because my inexperience slowed him down.

The next day he pointed out that he usually does the process from home, where he can do other things during the long periods of computer processing, but he always books 6 or more hours of overtime.

This week, I took one of the most manual parts of the monthly process and wrote some scripts do the work. I had a chance to test them out in our development environment since it needed a month end close for some other things they were doing. I ran my scripts. Less than 10 minutes, they were done, versus a solid hour of typing away for the manual method. Not only that, I had complete logs of the process that showed there were no errors. I was jubilant, some of my colleagues were not.

I am threatening their "rice bowl". My nature is to improve things, these other guys are more into milking things. I wonder how this will play out?

My new Religion

In the news today is a pastor from Florida who has declared "Burn the Koran" day for next Saturday, which is also September 11th. That is supposed to be inflammatory towards Muslims and not in good taste PC wise. I don't think it's such a bad idea and I'll do it one better. I hereby declare "Burn Holy Books" day.

In all religions the original founder/prophet/messenger from God had his ideas taken over and warped and rewritten by the next generation or two of followers. I think they all get it wrong, their motivations have become contaminated by ego, power and wealth. To combat this problem, I think first of all we should demand that only teachings from the original prophet be allowed. And secondly we should keep the entire religious literature to one page.

For the Christians, let's keep it to the 10 commandments. For the Moslems, they have their equivalent. The Buddhists are pretty hard to pin down, let them come up with something. And same for the rest.

I realize this will put out of work thousands of scholars from so many religions but so be it. They would learn and teach a lot more useful information if they had to get a real job. Religion should be a part of life while being a member of society, not an ivory tower to escape into and hurl down pronouncements onto us poor mortals.

So gather up your books and come on down. We'll have a whole lot of fun.

Medical

Now that I've worked in the medical biz for a couple months, I know what's wrong with it and how to fix it. Well, not really but I have observed a few things. I characterized it as a business because that's the end I'm in, I know nothing about treating patients but I am learning about the business end of things.

The problem is the doctors. Not exactly just them but them and the culture that's been created around them. Anyone who's spent any time in a hospital can easily recognize the actual doctors amongst the multitudes of other workers. The doctors wear white lab coats and have stethoscopes draped over their shoulders. Why? It's not that there's that much need for a stethoscope at any moment, it's a symbol. The symbol says doctors rule. And they do, the nurses in all their flavors (and colors) right on down to the orderlies and cleaners bow down and do their bidding.

In the hospital setting maybe this makes some sense, but on the business end it's a disaster. Doctors are control freaks who think they can know everything. Hello, they don't know accounting. So the billing and insurance processing is a complete mess. It's slow, error prone, arbitrary and generally dumb. I wonder if this is a result of being created by physicians who operate in an ambiguous environment of percentages and hopes.

At our place the doctors own the processing company. And even in the office you can immediately tell who's a doctor. I swear there's one guy that always has a large envelop like for an xray tucked under his arm in case there was any doubt. Like I didn't notice your ill fitting suit and arrogance that you carry around?

Sorry for us peons but we fall into the culture so easily. Yes, Dr. so and so, and yes sir.

Time to knock the doctors down a notch and get some real management and accounting and computer people in and make it a properly run industry. But the AMA sets the codes and ensures that the docs get their (well deserved, to them) deference and we all suffer to keep this mess going. Search the internet for "medical codes" to get a taste of the problem.

Getting to that point

I've been banging my head against a hard problem at work for a while. Without getting into too much detail, I'm trying (as I often do) to get a program to do what I want, not what the creators designed it for. At least that's how I've been looking at the problem and it's been very frustrating and now I come to find out that I was wrong. Very wrong and very stubborn and maybe the head banging is part of my natural learning process, I've been through similar things before.

We've got a program that is mostly used by people sitting at PCs (or any kind of terminal) and interactively doing the tasks required to get medical bills and prescriptions and office schedules to behave the way we want. The problem is that there are cases where a person sitting at a terminal is just too error prone and slow and overall a silly way to do things. Like processing 986 claims (like we did this morning) to see if they should be paid and then printing a check for each that is valid.

We've been using a couple ways of simulating a person at a keyboard and hooking that up to the application and getting things done faster than a real person. The main technique has been to script a terminal emulator program to send keystrokes in the correct sequence to get a process done. This way the application thinks it's attached to a real terminal and behaves normally. A proper script can automate the process by becoming the perfect user.

Except that the terminal emulator program itself has problems. If the application doesn't send back the expected prompt quick enough, like if the system gets busy, then the emulator stops waiting and starts sending the next keystrokes which the application isn't expecting and the whole process falls apart. Other random failures are occurring, in these cases the perfect synchronization between the emulator sending keystrokes and the application expecting them fails and nothing much gets done.

I have been focusing on sending the keystroke data to the application in different ways without the emulator being involved at all with little success. You know this button across the top of your keyboard? Labeled F1, F2 etc...? They send out special codes that the application needs if it is attached to a terminal and are very difficult to send without a real keyboard or an emulator.

That was the key insight that has broken my logjam. If the application is attached to a terminal... Well, how about if it's not? Like if it's a batch job reading input from a file? Then, it behaves completely differently. The application running in batch happily reads an input file without needing the troublesome function key commands. Almost like someone designed it that way. I think they probably did but nobody bothered to tell me. My predecessors and then myself were focused on one mode that was driving us all crazy, not knowing that there was another mode that did everything we wanted. If we had only known.

Hopefully, with this breakthrough, I can move forward to getting this place out of the stone age. With a reasonable batch control system, scheduling and monitoring batch processes nirvana can be just around the corner. At least that's how I feel now until the next unexpected roadblock. But optimism for now and face that when it comes.

The end of masculinity

I've noticed for a while that the feminine side has been taking over the modern world. Boys are having trouble being boys because they need to jump around and find frogs and all kinds of non PC behaviors. It also means that they need to discover skills that are not in any book. Like finding your way around. I learned it with a bicycle in a small town and the freedom to roam. These days moms don't let boys roam, they take them to school, practice, camp, gym, ballet, errands. Boys just veg in the back seat with an electronic game until they are deposited at their destination. Then they do whatever behavior is expected and wait until getting picked up.

This last bastion of maleness has now been totally destroyed. The male pride of comprehension in navigation has been wiped out. That business about asking for directions was just a small step, now every last prideful thing has been wiped out by GPS navigation particularly in cars.

As a male I take pride in knowing where I am, and knowing how to get somewhere. In fact where I live it's pretty simple, the ocean is on the west (where the sun goes down) and the mountains are on the east (where the sun comes up). To go north, simply keep the ocean on your left, to go south, keep it on your right. The main freeways go north and south in the bay area except when you need to get to the mountains and then you just head off to the east. It's as hard as picking highway 80 or 50 depending on which end of Lake Tahoe you want to get to. 80 for North, 50 for South.

Our new car has a navigation system. Very fancy with lots of buttons and screens and a thick manual. No longer can the wife just say "why don't you ask?". Now it's "why didn't you enter the destination", "are you in the right mode?" "Where's the way point?" "The screen says SR242, are we on that?" "You missed the last turn!". "Why don't you listen?". But this time, it's not why didn't I listen to her, but why didn't I listen to the stupid machine.

I'll tell you why I don't listen, because I know my way around and that stupid machine won't accept my home address as a valid address and I don't want to be bossed around by a computer and I hate it so much but I can't even figure out how to turn it off.

The last straw? It has a female voice.

Your BMI and EHR and meaningful use

As part of the government's recent health care bill, there is $20 billion allocated to get doctors to use electronic health records (EHR). For us Kaiser members this is nothing new, that company spent some billions recently and put all the records on the computer. Long gone are my fond memories of the Doc coming into that little uncomfortable room with a fat paper file that was me since age one month.

In order to get the private doctors into the digital age, the health care bill offers $44,000 to a practice that can demonstrate "meaningful use" of EHR. Two years later the final rules are now in place defining what constitutes "meaningful use". It basically means the practice has to use a certified software package and to also meet the requirements on a checklist of items for things like ordering prescriptions and procedures that can vary based on the doctor's specialty.

My current employer provides computer services for more than 800 physicians in the San Francisco bay area. The numbers are a little vague because it's not really a public company so the annual report is pretty skimpy. More pictures of the good life than financial data. But whatever the actual numbers, $44k times hundreds of practices is a good chunk of change. So the company is scrambling to get these docs to meet the standard and then we all can share a piece of the reward. We're good on the software, what we offer is certified, the challenge is the extra checkoff items. Some doctors don't care and some do, so are guys are out there pumping as fast as they can.

Sounds good right? Simple to take your records to a new doctor and continue with seamless treatment? Well, sort of. The certified systems don't always inter-operate so well. You can be reduced to paying your current doctor to print out some of your records and then carry them to the new place to be entered into the new system. But some data is standardized and portable between certified systems. Like your Body Mass Index (BMI) for example. Is this a good idea? The government is already asking to collect this data for every patient who receives care from a provider that receives any government money. In other words, they can collect the data about everybody! Prepare to be in a new database.

Now I'm not much of a conspiracy theorist, but I wonder when I'll get a letter from Uncle Sam reminding me to eat more vegetables. Or do they already know from the traffic cameras?

Mansfield Park

Did you ever put a book down and lose your place? And then try to figure out where you were when you lost track? My little brother used to do that to me on purpose when I had left a book near my bedside, but this current situation is on a whole 'nother level. Back then, I could look at the side of the book and guess the place based on the wrinkles in the pages and then search back a forth a couple times until I was back on track. (or I could spent eight bucks for a gizmo like this)

This time, the cleaners knocked my book off the side table and then replaced it with no bookmark at all. I found the marker on the floor. But I have not been able to locate where I was reading. Why? It's all the same! The book is Mansfield Park by the much beloved Jane Austen, published in 1814. I admit I was having trouble figuring out what was going on, it took until about half way through (and a peek at the introduction) to realize that Fanny, the poor relative staying amongst the richer sisters was the main subject. Now when I pick a page to try to find my original place, it reads just the same as any other page I pick. It's completely confusing. It doesn't really matter that I had mostly figured things out, it's all gibberish now.

What's the lure of Sotherton? Why did Sir what's his name go to the West Indies? And why did he return at such an inopportune time and marry off that daughter so suddenly? And who the heck is Mr. Rushworth? Is that another name for Edmund? Why did Mr. Yates come and go so suddenly? And why did the author insist on using first names sometimes and surnames on other occasions? Was that to ensure I couldn't get things straight?

I am reassured by the fact that even the Austen fans don't all like this book. I think more experienced writers can get the idea that making sense is not that important and that's what this seems like to me. Even Ms. Austen's mother criticized the characters. Check out Austen.com to see what the Derbyshire Writers Guild thinks, it's a real hoot. Since Austen died a couple years after the publication, maybe she just didn't have it together anymore. Makes sense to me.