Masanori Akiyama MD, PhD - GS1 · 2015-04-20 · •Comprehend logistical data by the “minimum unit ... Canceled or chang ed orders 180 orders/day (318Rp/day) About 37 thousand/month

© 2007 MIT Center for Digital Business. All rights Reserved.

Trend of SCM with auto-identification for medical field in Japan ~ from factory to bedside ~

Proprietary & Confidential

Masanori Akiyama MD, PhDSloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USAInternational Medical Center of Japan , Tokyo, Japan

GS1 Healthcare Conference London, UK, 29-31 October 2007

2 Proprietary & Confidential © 2007 MIT Center for Digital Business. All rights Reserved.

The concept of the Hospital IT system in Japan isnot only a management material but also integrated management resource, prevent

medication errors, application to EBM by the data mining of medical records.

As for this system, it has become to grasp medical practice and medical material, which did not understand on current electronic receipt, billing slips processing system accurately.

In POAS (Point of Act System), it is saved the management information, so-called, “man, money, material, and information.”

We concluded that this system has remarkable investment effect, over four million dollars per year, since it is a hospital management system including logistics management. In addition, the quality of care has been improved dramatically while error rates have been reduced – nearly to zero in some case.


What is POAS?

Real-time Consumption Data Capturing System•Collects, manages, and uses consumption data at the point of consumption (e.g. Hospital bedside)–In the form of When, Where, Who, to Whom, Why,

What, How (6W’s, 1H)•The first application is hospital

–International Medical Center of Japan (since 2002)•Current technology is PDA/bar code, but RFID technologies are now in processing


What can POAS do?

By collecting data from wireless PDAs, examination room terminals, and laboratory equipment, POAS can:

•Record medical actions in detail, everywhere•Assist practicing medical treatment to patients•Monitor patient symptoms continuously•Comprehend logistical data by the “minimum unit”→ In real-time.

Useful for automatic single size item identification

UDI


Ward / Outpatient (HIS)

750 orders/day2,329 drugs/day

IV drip bottleIV drip bottle

Neither cancellations Nor changes

570 orders/day

No change to route speed454 orders/day(802 Rp/day)

Nurse station(HIS)

570 orders/day(1006 Rp/day)

1,770 drugs/day

Bedside(Mobile terminal)

1006 Rp/day

Issue injection prescription

Perform mixed injection

Action entry

Canceled or changCanceled or changed ordersed orders

180 orders/day180 orders/day(318Rp/day)(318Rp/day)

Canceled or changCanceled or changed ordersed orders

180 orders/day180 orders/day(318Rp/day)(318Rp/day)

About 37 thousand/monthAbout 37 thousand/monthAbout 37 thousand/monthAbout 37 thousand/month

The effects of making injection action entries (calculated from performance data)The effects of making injection action entries (calculated from performance data)

Changes made to Changes made to route speedroute speed

116 orders/day116 orders/day(204 Rp/day)(204 Rp/day)

Changes made to Changes made to route speedroute speed

116 orders/day116 orders/day(204 Rp/day)(204 Rp/day)

There is a possibility of misadministration of There is a possibility of misadministration of about 40%about 40% if if the change of order is not communicated in realthe change of order is not communicated in real--time.time.

２４％２４％２４％２４％

１５％１５％１５％１５％


Comparison of the number of times mixed injections were checked and error rate (%) (between each 30 minutes segments)

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

0 5,000 10,000 15,000 20,000 25,000 30,000

混注確認実施件数

エラー発生率(%)

Hand-over time(0:30-1:00)



Coefficient of correlation＝－0.6

The number of check actions and the error rate have a slightly negative correlation.The smaller the number of

injections a nurse performs that day, the higher the alarm rate.

Alarms between each 30 minutes segmentsAlarms between each 30 minutes segments

Erro

r rat

e (%

)

Number of times mixed injection was checked


Alarm status according to different time segmentsTime segments with higher alarm rates become even clearer when seen in 30-minute increments.

368

124

8862

4633 33

47

125

649

691

420

229

173 181

120

260

537

737

543

442

238

297

222

305

556

458

373 360 354329

357

323

445463

415

462

571

365 363343

500

301 292 294

40

438

990

6.66.66.7

6.5

4.0

4.5

4.0

2.8

2.0

2.32.4

2.6

3.5

3.8

5.0

6.3

4.5

5.0

3.7

3.3

3.2

3.0

3.53.4

3.6

4.1 4.1

3.9

4.5

5.5

6.6

6.2

6.4

4.7

4.3

3.5

3.7

3.4

3.1

3.33.4

4.2

3.94.0

4.7

4.9

6.0

4.7

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

0:000:30

1:001:30

2:00

2:30

3:00

3:30

4:00

4:30

5:00

5:30

6:00

6:307:00

7:308:00

8:30

9:00

9:30

10:00

10:30

11:00

11:30

12:00

12:30

13:00

13:30

14:00

14:30

15:00

15:30

16:00

16:30

17:00

17:30

18:00

18:30

19:00

19:30

20:00

20:30

21:00

21:30

22:00

22:30

23:00

23:30

エラー発生率(%)

0

200

400

600

800

1,000

1,200

エラー件数

Number of errors for different time segments (30-minute increments) and error rates.




＝Before hand-over time

＝After hand-over time＝Hand-over time

Num

ber o

f erro

rs(%

)

Erro

r rat

e (%

)


Error rates for time elapsed on nurse duty (before and after hand-over time)

Work status of nurses who trigger alarms around the hand-over time.

2 36

3

1114

18

39

20

0

5

10

15

20

25

30

35

40

45

0 1 2 3 4 5 6 7 8

6

01

78

7

10

17

12

0

2

4

6

8

10

12

14

16

18

0 1 2 3 4 5 6 7 8

24

34

20

8 79 9

36

16

0

5

10

15

20

25

30

35

40

0 1 2 3 4 5 6 7 8 9

1 03

0 1 2

22

89

77

11

0

10

20

30

40

50

60

70

80

90

100

0 1 2 3 4 5 6 7 8 9

1 03 1 1 2

22

82 83

10

0

10

20

30

40

50

60

70

80

90

0 1 2 3 4 5 6 7 8 9

8 10

1 3 2 3 3

34

54

71

10

0

10

20

30

40

50

60

70

80

0 1 2 3 4 5 6 7 8 9 10

1 0 0 1 14

23

79

56

17

0

10

20

30

40

50

60

70

80

90

0 1 2 3 4 5 6 7 8 9

10 0 0 0 0

8

22

11

2

0

5

10

15

20

25

0 1 2 3 4 5 6 7 8 9

6

4

0 0 0 01

7

14

9

1

0

2

4

6

8

10

12

14

16

0 1 2 3 4 5 6 7 8 9 10

HandHand--over time over time segmentsegment8:30－9:00

16:30－17:00

0:30－1:00

Before handBefore hand--over over timetime8:00－8:30

16:00－16:30

0:00－0:30

After handAfter hand--over over timetime9:00－9:30

17:00－17:30

1:00－1:30

<Time elapsed on nurse duty that day (hr)><Time elapsed on nurse duty that day (hr)>Nurses right before the end of their shift

Day shift

Day shift

Semi

Semi--night shift

night shift

Error rate6.3％

Error rate6.2％

Error rate6.6％

Error rate6.4％

Error rate6.6％

Error rate4.5％

Error rate5.0％

Error rate6.7％

<Num

ber o

f err

ors>

<Num

ber o

f err

ors>

Nurses right at the beginning

of their shift

Error rate4.7％

Late night shiftLate night shift


Study of alarm status of “First injection/IV drip” Study regarding the phenomenon where the alarm ismore likely to be triggered on the first injection or IV drip on a nurse’s shift.

1527

802

669613559

460454395358318309292

240206191174166147

11711793 74 77 66 64 55 50 40 47 36 35 28 31 16 17 19 21 17 6 9 8 7 6 3 3 5 5 3 6 3 1 2 1 2 3 2 1 1 1 1

0

200

400

600

800

1000

1200

1400

1600

1800

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59

看護師当日injection数

アラーム件数

Alarms on the first injection= 1,527

Alarms on the second injection= 802

The alarm rate for a nurse’s first injection of the day was unusually high.

There was a significant increase in the alarm rates for first injections.P=0.000000000000000000000082397(10-23)

Number of injections performed by a nurse that day.


Time that injection and IV drips were started and order frequency

平均

0

10

20

30

40

50

60

0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00

0

20

40

60

80

100

120

140点滴開始

注射

中止オーダー

新規・変更オーダー

AverageBegin inspection

New order / order change

Cancellation order

Injection


Injection operations from the perspective of medical safety

Physician Pharmacy

Ward

Enter prescription

Mixing

Administer drugsCancel - change

Change the prescription if you

see these exam results!

The speed and accuracy at which the changes are reflected

is important.

●●An interAn inter--divisional safety system is neededdivisional safety system is needed..●●A system is needed that reflects changes and cancellations A system is needed that reflects changes and cancellations in the information given to medical staff within a timeframe of 2 in the information given to medical staff within a timeframe of 2 seconds.seconds.

Digitalization of this section was

achieved with the use of POAS.


Injection prescription11/1 to 11/3Rp1) 5% glucose 500 ml

Vitamedin 1A morningRp2) Saline500 ml

K2 1A eveningRp3) Saline100 ml

Pansporin 1 gMorning and evening

Injection prescription11/1 Rp1) 5% glucose 500 ml




Injection prescription11/2Rp1) 5% glucose 500 ml




Data granularity

Order

Act1Task:5W1H

Act2Task:5W1H

Act3Task:5W1H

Data unit = Invoice (payment) unit

Injection prescription11/3Rp1) 5% glucose 500 ml




Data unit = People’s actions (changes) single item based

Management of the number of items

Individual (ID) management

Conventional system ID: Drug codePOAS system ID: Drug code + serial code

X


Unusually high alarm rates among certain nurses or physicians

Distribution of alarm rates for number of actions taken by each nurse.There were certain nurses with relatively higher alarm rates..

看護師別アラーム率

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

0 200 400 600 800 1000 1200 1400 1600 1800 2000 2200 2400

実施件数

アラーム率

主治医別アラーム率

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

0 1000 2000 3000 4000 5000 6000 7000 8000

実施件数

アラーム率

Nurses with relatively highalarm rates

Physician in charge with relatively high alarm rates

Nurses mainlyserving Ward A

(年間100件以上実施者のみ)

同じく主治医毎の実施件数に対してのアラーム率の散布図です。

Number of actions taken

Number of actions taken

Alarm rates by nurse

Alar

m ra

te

Alarm rates by physician in charge

Alar

m ra

te


Cancel data 4/01/2004 – 3/31/2005

10.689.9410.029.75 Cancel rate(%)

35,95955,289102,127108,535,086Cancel336,682556,2831,019,2291,113,386,619Normality

The number of injection and shotRp numbersNumberCostType

About the unit priceNormal: I calculate by an actual unit price by the inventory. Cancel: Because drawing is released and it is drawn by other patients after returned goods unsold, a real unit price is uncertain. Therefore, the agreement unit price of a period concerned and the trial.

About the divisionNormality: After the medicine is mixed, discontinuance ( for the abandonment ) is contained. Discontinuance: Medicine that was discontinued before medicine is mixed, and returned.

It was uselessly abandoned this amount if there was no confirmation before mixing the medicine.

10.689.9410.02Cancel rate(%)

35,95955,289102,127108,535,086 Cancel Type2 336,682556,2831,019,2291,113,386,619Normality

The number of injection and shotRp numbersNumberCost (Yen)Type

About the unit priceNormal: I calculate by an actual unit price by the inventory. Cancel: Because drawing is released and it is drawn by other patients after returned goods unsold, a real unit price is uncertain. Therefore, the agreement unit price of a period concerned and the trial.

About the divisionNormality: After the medicine is mixed, discontinuance ( for the abandonment ) is contained. Discontinuance: Medicine that was discontinued before medicine is mixed, and returned.

It was uselessly abandoned this amount if there was no confirmation before mixing the medicine.

cost saved : $1M / year


POAS can improve inventory management.

Stock All

600

H w/o POAS

D w/o POAS

E w/o POAS

F w/o POAS

G w/o POAS

Hospital

A w/o POAS

B w/o POAS

C w/o POAS

IMCJ with POAS

500

2,500

7

300

300

4008,000

10,000

2,000

10

7

10

7

4

6

2

7,000700

Staff N

155

108

32 1

200

65

1,150

800

741

720

8,000

3,500

7,700

20,000 300

Area ofwarehouse（㎡）

Item number

300

1,900

6,800

500

1,000

1,320

Beds

925

1,205

1,203

1,178

1,154

Inventory was cut to a tenth. A cost reduction of 225.5 million yen was achieved forpharmaceuticals and 241.62 million yen for medical supplies.


POAS can be improved hospital management.

Prevent medical accidents.

Thorough inventory management

Keywords are “realreal--timetime entry” and “serializationserialization for single item management.”

The accurate acquisition of information on bedside actions is crucial.

Acquire cancellation and change data. • Only about 60% can be acquired in conventional systems. • POAS gives an overall picture. • POAS can save 4 million dollar per yearsave 4 million dollar per year.

This improves medical safetysafety and management efficiencymanagement efficiency.


Item data , sales catalog, ship notice, invoice

request for quotation, planning schedule, POSElectronic Commerce Information Flow

RSS / RFID GS1-128 RSS / RFIDGS1-128 GS1-128

GS1: Product Identification through the Supply ChainGS1: Product Identification through the Supply ChainPHYSICAL ITEMS & DATA FLOWPHYSICAL ITEMS & DATA FLOW

Mfg Item Case Pallets Trucks Distributor Trucks Pallets Case Item Store UserMfg Item Case Pallets Trucks Distributor Trucks Pallets Case Item Store User

End User

212345 6789072 212345 6789072

Supplier

21234567890722123456789072

GTIN / Serial ID GTIN SSCC GTIN GTIN / Serial ID

Granularity of shipping Granularity of single item

Granularity of single item

Automatic granularity exchange


Un-digitized space

Bedside, ER (emergency), (OP) operating room and ICU*verbal communication *high risk, and high cost

4G: Ubiquitous medical information systems for most dangerous / high costs areas

3G: EPR : paperless electronic medical charts

Digitized spaceEHR

Department systems

The evolution of hospital information systems 1G: Billing and Lab test : medical affairs and specimen exams

2G: CPOE : ordering

Outpatient / nurse station POES

Billing

Medical affairs section / Exam section

We need standardized UDI !

Whole saller

病院

truck Hospital

ダミートラック

Supplier

Track/trace（EPCIS）

HIS

Feasibility study on medical field in Japan

Dr Ns Patient

order prepare

Ph/Ns

Audit Injection

Ph

pharmacy

Factory to supplier

In-Hospital

RFIDtag UHF

SCM

製薬企業

製薬

factory

RFIDtag HF

運送

トラックOut of study

Lot No Pdoduct ID Drug code ・・・

100000 A1111 76532S

100000 A1112 76532S

100000 A1113 76532S

100000 A1114 76532S

Drug ID Status Date/time ・・・・

A1111 患者A 200708172210

A1112 病棟A 200708172210

A1113 薬剤部 200708172210

A1114 薬剤部 200708172210

Product ID Status Date/time ・・・・

A1111 入庫In 200708170900

A1111 倉庫 200708171000

A1111 出庫 200708171500

A1112 入庫 200708170900

Internet


Thank you for your attention.Any Questions?

Think !

What kind of system do you want, if your son or daughter were a patient?

EE--mail: [email protected]: [email protected]

Documents

Masanori Akiyama MD, PhD - GS1 · 2015-04-20 · •Comprehend logistical data by the “minimum unit ... Canceled or chang ed orders 180 orders/day (318Rp/day) About 37 thousand/month