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Solving problems

Ever have one of those problems where the more you dig into it to find a solution, the more complicated it becomes?

A couple of days ago, I started digging into a problem we were having with one of our computed radiography (CR) readers. Techs were complaining that they were starting to have to use much higher x-ray techniques than normal to get properly exposed images. So, I head over, and run some quick checks with some of my test objects, and narrow it down to the CR reader. Sure enough, the reader in question was producing a lower exposure index (a number that’s related to how much radiation the CR plate was exposed to) than an older CR reader next to it.

The next day, I head over there with some more test objects to get some more quantitative data, and confirmed just how much lower the CR reader was responding.

Today, I decided I had better check our other CR readers. They were all relatively new (installed April 2003), and I had data for some of them when they were first installed. The testing is something I usually try to do on a monthly basis, but the summer was a pretty busy one, so I hadn’t been able to get to doing my regular tests on them. Much to my surprise, I found all of the other CR readers producing lower exposure index values too. And to make it worse, they were all lower by the same amount. Each of the CR readers runs a set of diagnostics periodically on various systems, which is very useful. A quick check of those results didn’t reveal anything significantly wrong that I thought would cause the problem though. So now, instead of trying to figure out what the problem with one unit is, I have to figure out what could be causing the same problem on 5 different units. Could it be the laser assembly? The light guide? A photomultiplier tube?

At first my guess was the laser starting to fail. But how does it happen to 5 different units by the same amount? A bad batch of lasers perhaps? Who knows. The more I dig into it, the more perplexing the problem becomes.

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Joint Commission Jitters

In a few short weeks, JCAHO surveyors will be descending on our institution to check on how well we do things. This will be the second JCAHO accreditation survey I’ve been through here. Prior to the first one, there was much scurrying and commotion as everyone tried to get ready for the survey. This time around, most of the scurrying and commotion was spread out over the past year and a half. Still, with a few weeks to go, there’s more and more activity to get everyone ready.

JCAHO accreditation is a big deal for hospitals. Being accredited and getting a good score on surveys is a good marketing tool, and shows the institution follows a tight set of standards and practices. Plus it’s also required to qualifiy for Medicare/Medicaid funding.
Our survey is scheduled for Nov 17. As far as my little portion of the survey, I don’t expect to see much activity. My records are in pretty good shape (much better than when I first started here), and I can pretty much account for everything that I’m responsible for. Since I’m not directly involved with anything patient care related, I will be surprised if surveyors stop by to ask me for anything at all.

Bring it on, JCAHO…

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Healthcare redux

The other day, I was listening to a news story about how there are more people in healthcare working in billing and administration than there are doctors and nurses combined. And for the most part, largely brought on by managed care, the HMOs. So much for the premise that they were supposed to be saving money and reducing health care costs. Imagine that, there are more people working to figure out how much to charge you for your hospital stay than there are people taking care of you while you’re in the hospital.

Actually, after having worked in US hospitals for the past few years, it’s not all that hard to imagine. I noticed shortly after moving to the US that healthcare was definitely much more business oriented than it is in Canada. One of the first things I noted was that I saw a lot more administrative and non-patient care people than I did doctors, nurses or techs while I was walking along the corridors.

Healthcare billing is big business. There are companies that don’t do anything except handle billing and coding for doctors’ offices and hospitals. There are graduate programs in medical billing. The CPT code books are thicker than most unabridged dictionaries.

And the billing process is convoluted. I haven’t seen the entire billing process from start to finish, but this is what I’ve encountered of it. After the doctor sees you, he might check off a few diagnosis codes on a form. Then there might be a dictated report, which is listened to and transcribed by a transcriptionist. From the form and transcripted report, a CPT coder (hopefully a properly trained and certified one) will select the appropriate codes to be billed for, which would then be sent to the billing group (internally or external). So between the doctor and your bill, there are several layers of people (at least 3) with minimal medical training deciding how much it’s going to cost you.

Where am I going with this? Oh, nowhere in particular. Just that getting sick in the US is expensive, and staying healthy in the US is almost as expensive.

UPDATE: And to top it off, who knows where your medical records end up. An article in SFGate (via slashdot) talks about how dictated reports from UCSF Medical Center ended up in a transcriptionist’s hands in Pakistan, apparently through several levels of subcontracted transcription services. So hospitals contract out transcription services to a company, who in turn subcontracts out excess work, which gets subcontracted out to some other company, ad infinitum.

Oh, the insanity…

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Inkblot test

The inkblot test at Emode tells me:

Your subconscious mind is driven most by Curiosity

You are full of questions about life, people, and your own potential. You spend more time than others imagining the possibilities for your life — and you’re open to things others are too afraid to consider.

You have an almost physical need to know and do more. It’s only through new experiences that you feel a greater understanding of yourself and the world. You also have a rebellious streak that shows up when you feel unable to truly influence the world or circumstances around you. Your appetite for novel experiences also shows an openness others don’t have, but wish they did.

Your psyche is very rich; the more you learn about it, the more you will understand who you really are.

Found at Broad at Bat

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Textbook pricing

Well, seems pharmaceuticals aren’t the only thing that’s cheaper to re-import into the US, rather than buying them domestically.

There’s an article at the New York Times (registration required) and discussion over at Slashdot about how a lot of textbooks can be bought for significantly cheaper from overseas markets than locally. Textbooks from Amazon UK can be as much as half the cost of the same textbook purhased from Amazon US.

Apparently, this is starting to cause textbook publishers quite a bit of consternation, which is about time. I’ve always thought textbook prices were outrageous. One of the most expensive textbooks (on a price/page basis) I ever bought was was a skinny little 8×4 textbook on classical mechanics, probably less than 200 pages. The book cost me about $100Cdn at the time (maybe about 10 years ago). I remember textbooks being a significant portion of my education expense during my undergrad year, and that was 10 years ago!. I wasn’t unusual for me to spend $400/semester on textbooks. With my wife back in school, textbook expenses are about the same, but she’s taking fewer classes than I did and most of the books we buy are used, from places like Amazon Marketplace and Classbook.com to name a few. If we bought them all new, I’m sure we’d be close to the $600/semester mark. Now that I know about this overseas thing, it’ll be one more source to check out at textbook shopping time.