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Want To Anger a Nurse? Make Smug Comments about Grocery Store Barcoding

December 12, 2007 Editorials 5 Comments

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly “Best Of” series for HIStalk. This editorial originally appeared in the newsletter in February 2007. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

One reason we hospital IT types aren’t taken seriously is the “grocery story” analogy. You know, when some well-meaning government official, non-healthcare CEO, or your next-door neighbor smugly proclaims, “There’s more automation in the grocery story checkout line than in most hospitals.” Ha, ha, what an insightful observation – first time we’ve heard that one.

Randy Spratt, McKesson’s CIO, recently trotted out the old warhorse in an interview with Fortune. I’m sure his intention was benign (i.e., “buy more of our barcoding stuff to enlarge my executive bonus”) but perhaps his lab systems background makes him insensitive to how steamed nurses get when someone trivializes the barcode verification process on their end. If it were easy, everyone would be doing it.

(Hint to Randy: those same nurses are often involved in barcode system selections, with one of their possible choices being your employer’s own AdminRX product, currently running last in a three-horse KLAS barcoding product race. Better stroke them a little next time.)

Ann Farrell, BSN, RN and Sheryl Taylor, BSN, RN sent me a list of why the grocery store analogy is not only inappropriate, but offensive to nurses. Their list was detailed, persuasive, and passionate, so naturally I decided to go more for the ironic and humorous with my own imitative list. Theirs will be published, I believe, and they’re working with HIMSS people and that same Fortune magazine. Until their more authoritative tome sees daylight, this will be your amuse-buche.

If grocery stores were like hospitals:

  • They would buy Doritos by the bag, but would have to repackage and label individual chips, and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs.
  • They would have to set up an internal barcoding factory since grocery makers would refuse to barcode their products until all stores collectively agree to pay extra.
  • Each clerk would serve 15 checkout lanes simultaneously.
  • Every customer would enter the store at precisely 9:00 a.m., 1:00 p.m. and 6:00 p.m., but having any of them wait more than 15 minutes is a fireable offense.
  • It would be the clerk’s job to prevent customers from buying both Doritos and potato chips since they serve the same purpose.
  • Barcode scanners would be so poorly designed that clerks would need a full two days of training to use them.
  • Stores would not be self-service. Instead, clerks would take the customer’s list, try to decipher their illegible handwriting, and run around the store to assemble several such orders for different customers at the same time. Each item would have to be documented twice: one when pulling it from the shelf and again when giving it to the customer. Customers would be encouraged to change their lists constantly. Most stores would not have the capability update the clerk’s list electronically, so items would be scratched off and handwritten on the same ratty sheet of paper.
  • Somber-looking inspectors could show up unannounced demanding to see a list of customers who bought hot dogs in the last year or the complete grocery purchases of a specific person named John Smith, but only the right John Smith.
  • Clerk supervisors, exasperated over loss of productivity, would suggest keeping paper copies of commonly used barcodes to save time over scanning the real thing.
  • Instead of wheeling their cart to the checkouts, customers would ring the little “I need help” button wherever they happen to be, requiring the clerk to lug the cash register to their location to scan their item.
  • The loyalty card of every customer must be scanned before selling them anything, even if they showered with it and ruined the barcode.
  • Soda would be sold like paint – the clerk would have to mix and label whatever flavor the customer wants using stock ingredients.
  • Once barcodes are scanned, instead of being recorded electronically, the information would print a duplicate receipt to be filed forever.
  • Clerks who ring up the wrong price could kill the customer, would be barred from future clerk jobs, and could be jailed.
  • When working alone in a 24-hour store after everyone else has gone home, the clerk would cut meat, mop the floors, make pastries, unload the truck, show compassion, attend to family needs, and humor abusive superiors who take credit for accomplishments that mostly occurred while they were offsite making ten times what the clerk is paid.


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Mr. HIStalk’s editorials appear each Thursday morning in the subscribers-only version of Inside Healthcare Computing’s E-News Update.  To subscribe, please go to:  https://insidehealth.com/ihcwebsite/subscribe.html or call 877-690-1871.

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Currently there are "5 comments" on this Article:

  1. I’m not quite sure why nurses should be so offended by the barcoding/grocery store analogy. That comparison is no more a cheap shot at nurses than it is praising the efficiency of grocery store clerks.
    The point is, and always will be that hospitals have not done nearly enough to help their employees succeed. This list is a fairly accurate representation of how complex working in a hospital is and just how likely we are to fail in those scenarios. Trying to succeed in that environment with archaic 19th century processes is certainly deserving of mocking in a national forum such as Forbes. I just don’t know why the nurses are so defensive about it….

  2. UPC Codes are only secondarily used for tracking in grocery stores. In medical settings, barcodes (and RFID) are always used for tracking. A better analogy would involve barcodes used in supply chain processes.

  3. Ok, I take away from this article that:

    1.) Nurses want you to believe that they have the worst job in the world
    2.) They’re hypersensitive about it and don’t like someone suggesting they could be doing it better.

    Did I miss anything?

  4. Forget the UPC codes, they are passé and not comprehensively implemented. RFID is acceptable, so what’s the problem with immediate implementation? Is cost an issue as it once was for Wal-Mart?

    Word to the wise who dare think Neuromorphic systems.
    (http://www.andcorporation.com/frame_company.html) I want to walk up to any clinical portal in the world that I have privileges and access the EMR with my FACE. Simple facial presentation to a web camera at the port of entry could solve a problem for ubiquitous single sign on. If facial recognition is good enough for prisoner identification in Atlanta, then it should help obliterate the HIT prison we have built for ourselves.

  5. Evidentlyby his “take aways”, Leopold Stotch missed the point of this editorial. Nor does he understand the trenches from which this was written. I agree that Nurses shouldn’t be upset by the argument that there is more automation in a grocery store than in a hospital.

    Nurses don’t like asking the patient what their allergies and current medications are over and over, not because we are “verifying” them, because we really don’t have a very good process in place and don’t know. Patient’s certainly don’t like it. The technology exists to simplify our lives, just not in healthcare. Vendors and/or regulations/legistlation make it difficult to pull together… but then there are very few emergent situations in a grocery store.

    Don’t belittle what nurses have to go through to provide care. Try recognizing the things nurses do to ensure that care is provided and use IT to improve processes to all them to provide efficient care.

    Oh, BTW I don’t think there is a eMAR out there that provides a smooth workflow for nurses.(some like Meditech are atrocious UI’s) and I do self scan my grocery items including grapes that require a PLU.







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