Connectivity Opens Doors

Key Insights and Decisions

 

Key Decision:

 

  • As we explored both the input and output of relevant logistics information into and out of the maintenance area of the Marine Corps, we realized our goal as a group was becoming extremely spread out. As we began thinking about how we could wrap up two different problem that were connected but still required separate solutions, we came across an article explain a issue similar to ours that finance firms encounter and have hire outside firms to accomplish similar goals to what we have been proposing between GCSS and TCPT. After deliberating as a team, we have decided focusing our remaining few weeks on developing and enhancing the “Connectivity” piece of our teams overall model. This means we are abandoning the idea of a maintenance app for a few reasons.
    • The solutions to the input issue only tackle small parts of it and none of these issues caused enough pain nor solutions caused enough value to make it worth the effort of developing a product to solve just one pain point.
    • A solution that would provide enough value to be worth development would potentially require a significant amount of time to develop as well as would require an amount of cooperation that has seemed to be unreasonable from the 2nd MLG.
    • In the private sector, this idea of connecting isolated systems is perhaps more important than we had originally believed. An industry that was at $250 million in 2016 and is projected to reach over $2 billion in 2021. We may be a bit late to the party, but having worked with the Marine Corps to understand some of the most fundamental issues with systems that do not communicate and understand the value of a flexible solution that could potentially continue to evolve into a valuable tool that requires little technical knowledge to use. We believe this along with the idea that most of the companies who have utilized this service are primarily large cap corporations that have the money to spend on customized services. If we are able to develop a generic solution, we would allow for business of all sizes to benefit from systems that communicate.

 

  • We will spend the remainder of the semester exploring areas (Beneficiary Discovery) of both the public and private world where this appears to be an issue, with the goal of sizing a market and developing an extremely rudimentary version of what could potentially be used outside of the Marine Corps to solve this reoccurring issue.

 

With that being said, the hypothesis we intended to examine this week was:

 

  1. The idea of connecting siloed systems is one that would provide significant value to other areas of the military and civilian industries through saved time, more accurate data, and more timely information.

 

This week, in part because of Spring Break, in part because we changed directions, we were unable to fully attack the areas of the hypothesis we had hoped we’d be able to. However, we were able to look into a few other areas that seem promising for expansion. The one area we have had the most luck in finding beneficiaries on three minus day notice has been healthcare. We have been able to talk with the retired CIO of a hospital, a CTO of a health IT start-up, as well as the head nurse at a private clinic regarding the practice of sharing medical information between clinics, hospitals and other healthcare providers. The overarching idea being that clinics with different Electronic Healthcare/Medical Records (EHRs/EMRs) systems have various but similarly labor intensive processes for keeping patients records updating in their own system. All of which require varying levels of the manual entry of data from another healthcare provider’s system to their own.

Next Couple Weeks:

 

Interviews

 

David Ward:

  • Four different clinics he has worked with has asked if this is an issue his company could solve. While his company is not in this business, he has often noted the demand for this.
  • His understanding of the process:
    • There is one major player in the EMR system business in his area (EPIC), large healthcare groups (conglomerates, hospitals, etc.) are the firms that can
      • Afford it – Many clinics that don’t have the large revenue base either from the government or private practice are unable to pay the large cost of EPICs system.
      • Be payed attention to – There are many specific features smaller clinics or groups need for their specialty, size or simply because they want it. And EPIC does not have the capacity to implement changes into every individual organization and thus reverts to only customizing the larger groups. Therefore, smaller organizations are forced to contract out their work, often resulting in 5-10 EMR systems implemented within even a small community.
  • He was unfamiliar with the specific process of transferring EMR data between clinics but has said he can get us plenty of people who do (including Emily Jacobs, see below)

Emily Jacobs:

  • Overview of patient record transfer:
    • Roughly 5% of the time, the referring clinic/hospital has the same EMR system and in that case all information is perfectly transferred, no paper.
    • Three ways patient information gets from one clinic to another (Keeping in mind that at the other clinic that the patient came from this information has already been entered into their chart.):
      • The referring doctor sends the patient notes over with them (20% of the time). When this happens, the receiving nurse takes the patient information (PDF/Handwritten) and enters it into that patients chart in their EMR system.
      • The patient’s notes are not sent over but the clinic has access to the online system of the other clinic, meaning the nurse logs into the other system, prints off a PDF of the information and then manually enters it into their system. (50% of the time)
      • The patient’s notes are not sent over and the clinic does not have access to the online system of the other clinic. This is the absolute worst scenario for them, they must call the other clinics and request the information. This takes hours and sometimes doesn’t get processed until the next day. Resulting in patients care being delayed as their information on prescriptions, diagnosis, and recommended action are unknown to the receiving clinic and likely the patient as well, as this information is generally technical and requires very specific components such as amount of a certain medication or specific muscle/bone/organ that is injured. (25% of the time)
  • “Certainly one of the most frustrating parts of my job”
  • This is an issue with 95% of patients meaning it is happening from the time they open until close.
  • Has a couple other nurses in her clinic she wants me to talk to.

Capt. Baker:

  • Informed her of our change in direction toward a focus on connectivity. She understands the decision and supports us, she is hoping to get us through the Defense boundaries in order to get our solution implemented effectively.
  • Discussed who we need her to call for military contacts. These will be people we hope to expand our efforts with
    • Medical Group
    • Engineering Support
    • Infantry
    • Special Forces
  • Need her help with TCPT and GCSS
    • Have the project manager of GCSS’s name but need to get in touch with him
    • Need the PM of TCPT
    • Need some sort of IT team to talk with.
  • She is planning on calling them all this week and will hopefully have a few names for us by EOW.

Parker Erickson:

  • Does not work in RPA/tech space; only insight is from a policy perspective
  • Could see RPA being beneficial in a lot of ways
    • Interest groups often have tons of personal data about constituents (name, address, etc.) but lists can be outdated/inaccurate
    • Healthcare ERP
      • Cut need for bloated admin staff / get doctors more patient time
    • From lobbying prospective, attending/scheduling meetings, conducting research, sending/processing emails would be nice to have automated
      • Interns might send the same email to a list of Hill contacts dozens of times
      • Would be helpful to RPA search congress.gov, find appropriate contacts and then email (e.g. letter of support w/ correct office, addressee, etc.)
    • Personally, would like to have expense accounting automated
      • Keep track of receipts, submit to accounting
      • “Pain in the ass”
      • Does at least once a month, can take several hours

Cpt. Trinh

  • Seymour Johnson AFB has made substantial progress since Team 5
    • Revamped workflow
      • Moved pharmacists to filling station
      • Pod system
    • Delegation of hours
      • Call in and activate refills, can’t pick up until next day
      • Refill during off hours
    • Text notification
      • Turned on for refill verification
    • QFlow
      • Still down, not fully integrated
  • RPA
    • USAF already doing this for MDG’s
    • Genesis
      • Cnytrx?
      • DoD did a bid on it 15 years ago to integrate entire medical system
        • Order drugs, verify scripts, can pull medical records from different bases, etc.
      • Currently in Phase 1 (1.5yrs), rolled out around half a dozen bases (USAF, USN, Army)
        • First year rough, bugs fixed and new features added
        • But, if one system goes down, you’re sort of left with nothing
        • Planning on rolling out DoD-wide in 5 years (doubtful)
        • Overall, very positive response

Charlie Covin

  • IT-based communication between hospitals and clinics is a longstanding problem area for basically every area of operation: ordering tests, transmitting results, patient record exchange, payment/reimbursement, scheduling.
  • Communication between institutions is quickly escalating in importance due to the progress made in implementing electronic medical records (EMR). Hospitals/practices have largely put their own houses in order with regards to implementing EMR systems.  Now they are looking externally. There is not an EMR standard. There is also not an intercommunication standard for EMR and other areas. As a result, hospitals and individual practice systems frequently cannot communicate.
  • This is not a sporadic situation as it is not uncommon for a physician with hospital rights to have his practice on a different system than the hospital.

 

Dale Swink

  • Thrilled to hear about the progress on connecting GCSS & TCPT.  He just met the Colonel in charge of GCSS recently and should be able to find the contact info.
  • Because of his group’s work, he is exposed to a number of different systems that do not communicate but should. As a result, he sees lots of “swivel chair” hand-offs between functions. He actually wrote a paper about it and will send it over.
  • At least one of the groups he works with – and requires a swivel chair handoff – uses a Navy system. Chasing this one down could lead to applications within the Navy.
  • He volunteered to circulate a write-up of the dispatcher solution to some of his contacts to surface even more areas in which it might be applicable.

John Myrka

  • Thrilled to hear about the progress connecting GCSS & TCPT.  He has the contact info for the TCPT program manager and will send it over when he gets back to the office.
  • Bridging a one-way connection from GCSS to TCPT is great. It would be even better if you could also go from TCPT to GCSS. (This was news to us!) Turns out motor operations should be entering the vehicle mileage from last service back into GCSS to spark the routine maintenance cycle.  I wondered at why no one had mentioned this in all of my conversations. Our guess is because people just aren’t doing it because of the hassle.
  • John also cited a number of other processes that have inter-system gaps. On the supply side – there is frequently a gap between the Distribution Management Office and Material Distribution Center.  Specifically, only partial data is communicated such as the first line of a crates contents. That means that the Material Distribution Center is aware one of their parts is on the way but has no idea what else is on the way.
  • John also raised additional gaps that took us into potential applications of the scanner technology and app concepts we explored for other areas.  He saw promise in a few different areas particularly for forward operating elements such as MARSOC operating in low bandwidth environments that could not support full GCSS.

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