STORIES & SOLUTIONS FOR THE MODERN BUSINESS USER

In my last post, I described the Last Mile Problem in healthcare information technology (IT). To summarize: The Last Mile Problem originated with supply chain and delivery. It is relatively easy to get a manufactured good from the factory to close to the purchaser (note the word relative!). That last mile – from the post office or local storage depot – is by far the most difficult. Are the roads big enough for the truck? Will the driveway support heavy equipment? Will the customer be there when you deliver? Will the object fit through the door? You get the picture.

I started my career many years ago in a mid-sized community hospital in the tri-state area of IN, IL, and KY, in the acute behavioral health field. I was fortunate to work at a great hospital with strong nursing and physician leadership that taught me as a new graduate nurse the value of quality patient care and doing everything with the patient and family in mind. Many mentors helped to guide my approach to nursing care, and what type of nurse and eventual leader I would be. Many of these mentors I still think of and reach out to for advice today.

May 6-12 marks National Nurses Week 2019, a week that recognizes the vast contributions and positive impact of America’s four million registered nurses (RN). We want to bring attention to the nurses who have used their degree and skills to pursue careers beyond the patient bedside for the betterment of patients, families, and the communities where they work. According to the American Nurses Association, National Nurses Week is celebrated annually from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing. This week is a time for everyone – individuals, employers, other health care professionals, community leaders, and nurses – to recognize the vast contributions and positive impact of America’s registered nurses.

Since Epic implemented its quarterly upgrade model, many analysts find themselves in a continuous flow of Nova notes, Sherlock tickets, and the balancing act of responding to current users’ requests and concerns as they approach another time for change and adaptation. While quarterly improvements mean fewer changes all at once (and an easier way to keep up with all that may be offered), it does require analysts and end users to accept that their workflows and tools may change more frequently. Whether they see this as a positive or not is dependent on their role and involvement in the system.

The ERP market has been relatively stagnant over the last two decades but now that there are so many cloud options, many organizations are taking the opportunity to evaluate their business systems with eye on the opportunity to improve. Particularly in healthcare, where organizations have spent the last decade focusing on the EHR to bring rigor to clinical processes and address meaningful use, focus is shifting to the back office and improving business processes, aligning what happens in finance, HR, and the supply chain to what’s happening at the point of care and beyond.

I was recently speaking with a friend about a new endeavor that he is exploring, and he commented that no one has solved the Last Mile Problem – that’s what he’s working on. If you’re not familiar with the concept, the Last Mile Problem describes how it’s relatively easy and cheap to get a product from a far-away factory to very close to a consumer’s house, but getting that delivery to the front door of the purchaser takes a lot of effort and costs a relatively large amount of money. Even though the distance from a local distributor to a home may represent 2% of the journey, the costs may consume 25% of the potential profit.

Rural acute care and critical access hospitals face similar obstacles as their larger healthcare counterparts, but they also face unique challenges. Impediments range from aligning services to their communities’ needs and trying to stay independent amid heavy merger and acquisition activity to addressing value-based care and creating more efficient processes that optimize resources, lower costs, and support patient safety and quality of care goals. Most hospitals use some form of EHR technology to improve clinical efficiency, but dissatisfaction with current EHRs are leading many healthcare organizations to consider EMR/EHR replacement. Providers will often seek third-party consulting partners to collaborate with the EHR vendor and key stakeholders to conduct a rapid, efficient and streamlined implementation.

Recently, WBUR posted an article about a parody Twitter account that satirizes one of the biggest electronic health record (EHR) software vendors: Epic. When the reporter reached out to Epic to ask them if they had any response or reaction to the parody account, Epic replied, “We do not.”

I’m a big fan of fellow pediatrician blogger Bryan Vartabedian’s 33 Charts. While I spent a few years at Texas Children’s Hospital, our paths never crossed, and that’s a shanda because Dr. V says smart things in an entertaining way. If you don’t know his work, you should.

I recently read an article in the New York Times titled “The Joy of Standards: Life is a lot easier when you can plug in to any socket.” The authors begin by diving deep into the topic, discussing standards around the size, consistency, and design of the 8-by-16-inch concrete block. From there, we learn about standards-producing organizations and how they interact with governmental agencies. The article ends with a reminder that society needs a strong base upon which to build: “In an age of breathless enthusiasm for the new and “disruptive,” it’s worth remembering the mundane agreements embodied in the things around us. It’s [the] very ordinariness and settledness of standards that enable us to survive, and to move ahead.”