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RFID Special Interest Group:
RFID Delivering ROI Through
Process ImprovementHost: David Butler
HIMSS RFID SIG ChairPresident – Heartland Innovations, LLCSt. Louis, Missouri
Moderator: Frank OverfeltHIMSS ME/PI CommunityPresident – Delta Healthcare Consulting GroupSalt Lake City, Utah
Process Improvement with RFID: Panelists
Mobile Medical Equipment ManagementKelly Arnold – Director Project ManagementDeKalb Medical - Decatur, Georgia
Managing Advancements in OR Workflow AutomationDeborah Tuke Bahlman RN, MS – Regional Manager, Surgery Information SystemsProvidence Health and Services Oregon - Portland, Oregon
Moving Beyond Asset TrackingIn Mun, PhD – VP, Research and TechnologyHospital Corporation of America – N. Florida Division – Tallahassee, Florida
Inventory Management of High Dollar Physician Preference ItemsAugustus J. Scarlato, MBA – Senior IT Project Analyst – Mgt. Information SystemsFlorida Hospital Orlando – Orlando, Florida
Workflow Visibility and Automation in the Emergency DepartmentL. Albert Villarin, Jr MD FACEP – Chief Medical Informatics Officer - AEHNAlbert Einstein Medical Center – Philadelphia, Pennsylvania
RFID Special Interest Group:
Process Improvement through RFIDDelivering Measurable Results
Representing the HIMSS ManagementEngineering/Process Improvement CommunityModerator: Frank Overfelt, MBA, LFHIMSS, CHE,Senior Member SHS – Leadership Comm. ME/PICommunity, President Delta Healthcare ConsultingGroup
Agenda
• Background of ME/PI
• Purpose of ME/PI
• Potential Uses of RFID
and their Benefits
Background of HIMSS ME/PICommunity
• Management Engineering was the primary make-up of HIMSS, pre 1988, original founders ofHIMSS (HMSS) in the 60’s
• ME/PI consists of management engineers, processimprovement consultants, lean, six sigmaconsultants, nurses and physicians
• One of several HIMSS Communities
• Meet monthly, publish a newsletter, develop tools,dashboards, and process improvementmethodologies
Purpose of HIMSS ME/PICommunity
• Develop more efficient processes for all varietiesof healthcare organization as internal and externalconsultants
• Design tools for the more effective use of staff inhospitals
• Utilize technologies to enable more effective useof the staff: Modeling and simulations, RFID,Tracking Systems, Management Systems
• “Work smarter, not harder” is the theme.
• Produce validated ROI for work completed.
Potential Uses of TrackingDevices
• Tracking patients to identify bottlenecks inprocesses and to identify next level of care to bedelivered.
• Tracking bed availability to expedite dischargesand admissions
• Tracking assets and other commodities to improveutilization, inventory management and lossprevention
• Tracking Staff to provide patients with expeditedcare
RFID Special Interest Group:
Process Improvement through RFIDDelivering Measurable Results
Process: Mobile Medical Equipment Management
Hospital: DeKalb MedicalDecatur, GA
Panelist: Kelly ArnoldDirector Project Management
Issue: Moveable Medical Equipment Management
• Rental Spend > $260k / year – IVP, SCD, PCA, Epidurals
• Need to right size upcoming new IVP fleet purchase– owned 463 IV Pumps
• Nursing team very unhappy with availability of equipment– spent 11k hours annually searching for and cleaning equipment
• Lost / Stolen units– 5-10% of fleet annually
– never really knew
• Biomed Techs search for equipment to meet PM deadlines– many unsuccessful attempts
• Decatur, GA• 481 beds• Acute care, full service hospital
Solution: Passive RFID Tracking + Structured Process
• VIXIA solution 1/10th cost ofRTLS – EquipmentDistribution Only
• Scan hospital once per day –4 hours, 0.5 FTE – Needpeople to deliver, clean andpickup equipment anyway.
• VIXIA provides processdiscipline and analytics todeliver ROI – Not Hospitalscore competency.
• Future considering RTLSfrom VIXIA to do additionalprocess improvement
All patient rooms and equipmentdistribution points are tagged
900 MHz
Handheld RFID scannersused to associate equipment to
locations
Each equipment item trackedis tagged
Solution: Passive RFID Tracking + Structured Process
• Measure stock and flows at each point
• Optimize distribution – par levels based on data / analytics
Biomed
Measurable Results:
• Rental Cost Reduction Annual Expense Savings = $220k
• Reduced Fleet Purchase from 463 to 320 Units Savings = $587k
• Nurse satisfaction scores measured and improved dramatically
• Lost / Stolen units < 0.1% of fleet now measurable
• No need to take physical inventory
• Biomed team never searches equipment due for PM delivered
RFID Special Interest Group:
Managing Advancements in OR WorkflowAutomation – Profile of an Early Adopterof Workflow Technology
Process: Patient & Equipment Tracking in the Perioperative Setting
Hospital: Providence St. Vincent and ProvidencePortland Medical CentersPortland, Oregon
Panelist: Deborah Tuke Bahlman, RN, MSRegional Manager, Surgery Information Systems
Providence St. Vincent Medical Center
• Largest hospital in Providence Oregon• 523-bed facility• Awarded Solucient Top 100 Hospital 8x• Designated Nursing Magnet facility (ANCC)• Built 60k square foot, state-of-the-art surgery• dept in 2003• 53 preoperative beds/27 ORs/27 post-anesthesia
care unit beds• >22,000 cases annually• Internationally renowned leader in cardiac care, research, and education
Providence Portland Medical Center
• 483-bed facility• One of 100 Most Wired Hospitals in U.S.
• Designated Nursing Magnet facility (ANCC)• Awarded Sustained Performance
Achievement Award for Coronary Artery Disease• 56 preoperative beds/21 Ors/29 post-anesthesia care unit beds
• New sterile processing department• >21,000 cases annually
Background:
• 2002 - Providence St. Vincent Medical Center was the 1st
perioperative site to use automatic patient and equipmenttracking as the foundation for workflow automation usinginfrared locating technology. Integrated tracking solution withnurse call and mobile phones
• 2004 - Providence Portland implemented PCTS trackingsoftware without a real-time locating technology
• 2008 - Providence Portland upgraded to second generationPCTS OR tracking system and added ultrasound locatingtechnology. Integrated tracking solution with nurse call andmobile devices
• 2009 - Providence St. Vincent expanded PCTS automaticpatient and equipment tracking to their Heart & VascularServices
Processes to be Improved:
• Inter-department phone calls about the location and status ofsurgery patients (workflow + healing environment)
• Patient flow
• Staff satisfaction
• Location and status of mobile equipment
• Timely infusion of antibiotics prior to incision
• Notifications of alerts such as latex allergies, bariatric needs,infection control needs, no H&P
• Anticipate staffing needs in post-op by patient acuity
• Timely notification to family members of patient status
• Secure access to the surgery schedule for practitioners
Solution Implemented:Amelior ORTracker® - centralized workflow communication portalinterfaced to our OR scheduling system Visual check for OR pt readiness
(Joint Commission Universal Protocol)Isolation alert
Patient notesNotifications to wireless phonesPediatric patient flag
Solution Implemented:Amelior ORTracker® PACU Case Schedule
Anticipated post-op recovery patients, by acuity, in 30 minute segments
PPMC installed 2nd generation software with advanced workflow featuresincluding action-oriented watch lists, anticipatory workflow suggestions,schedule jeopardy indicator and enhanced management of roadblocks,alerts and checklists.
Measurable Results:
• ↑ Increased add-on case volume of 49 cases per month (2002-03 pre-wave vs.2003-2008 post-wave )
• ↓ Inter- department phone calls by 82%, saved 4.5 hours a day = >1125 hours ayear!
• ↓ Decreased OR turnaround time pre/post implementation (2002 vs. 2008)
Patient In to Surgery Start - 9% faster (2 minutes)Patient Out to Next Patient In – 17% faster (6 minutes)Surgery Stop to Next Surgery Start – 23% faster (18 minutes)
• ↑ Staff satisfaction average baseline score = 2.65, post score = 4.26 (5-pointscale)
• ↓ Reduced time to source movable medical equipment. (did not measure in pre-wave now location identification is instantaneous and we are able to sharesingle-unit inventory)
Measurable Results:
• ↑ Location and status of patients - 100%
• ↑ Improved compliance with Joint Commission universal protocol – OR readinessfor patient
• ↑ % Antibiotic infusion prior to incision, baseline = 42%, post score = 95%
• ↑ Notifications of safety alerts - 100%
PPMC 1/16/2008 – 3/23/2009
1,688 “missing H&P” alerts917 diabetic alerts332 latex allergy alerts302 MRSA isolation alerts (industry estimates range from $27k - $34k inincremental direct medical costs per incident)179 isolation alerts
Measurable Results:
• ↑ Anticipation of staffing needs for post-op by patient acuity - 100%
• ↑ Immediate notification of family post surgery -100%
• ↑ Secure access for practitioners - 100%
Future Plans:
• Increased scope as a workflow visibility solution with real-time locationawareness as the foundation
Interface to Cerner laboratory systems for auto-notification of lab results
Interface to computerized provider order entry (CPOE) system for auto-notification of stat and routine orders
• Further expansion into other procedure areas – diagnostic imaging area isnext
• Future: Interface to online OR nursing documentation
RFID Special Interest Group:
Moving Beyond Asset Tracking
Process: Leveraging Asset Management Infrastructure
Hospital: Hospital Corporation of AmericaTallahassee, FL
Panelist: In Mun, Ph.D.VP, Research & Technology, NFD/[email protected]
Process to be improved:
• Background– Since 2005, an hospital-wide active RFID system from Agility
Healthcare has been installed at 16 hospitals of various sizes toimprove the asset management.
– Observed benefits• Nurse satisfaction
• Rental cost reduction
• Asset level reduction
• Bio-Medical service improvements
• Patient safety improvements
• Questions– How can we sustain the processes?
– What are the applications beyond asset management?
– How can we integrate RFID data with other information?
Solution implemented:
• Sustaining new workflow / culture– Town-hall meetings
– Education / training
– Validating RFID data with direct observations
– Persistent monitoring and fine tuning.
• New applications being tested / implemented– Bed management
– Patient / staff tracking
– ED process management
– OR process management
Measurable Results:
• Rental cost reduction
• Asset level reduction
• Nurse satisfaction
• Bio-Medical service improvements
• Patient throughput
Future Plans:
• Interface with EMR/EHR system to improve patientcare– Unique device ID
– Standardization
• Utilizing 2D barcode information with active RFID tags– Aztec / data-matrix
– Local temporary data / global long term data
• Integrate with other data to support executive decisionmaking processes– Patient throughput management
– Equipment management
– Staff management
RFID Special Interest Group:
Integrated RFID-enabled Inventory Systemin Electrophysiology (EP)
Process: Inventory management of high dollarphysician preference items (PPI)
Hospital: Florida Hospital OrlandoOrlando, FL
Panelist: Augustus J. Scarlato, MBASenior IT Project Analyst – ManagementInformation Systems
Florida HospitalOrlando
Part of a 7 Hospital System
Adventist Health System (AHS)
Established in 1908
$255M, 15-story Ginsburg Tower – November 2008
1200 beds @ Orlando
New Cardiovascular Center CATH Lab – 8 rooms, 6,000 products on hand
EP Lab – 4 rooms, 1,000 products on hand
Vascular – 1 room, 500 products on hand
Process to be improved:
Cumbersome, Error Prone Inventory Management Barcode required for every step:
Receiving – inventory clerk
Usage – nurses, techs
Returns – inventory clerk
>>> This resulted in lack of compliance and the inability to supply accurate inventory counts until year-end
Costly products expire every month Requires checking dates on products – checking 7,000 a month?
Data for purchasing strategies not available Lack of actionable data for deciding on which products to trial, to bulk buy, to consign, to purchase
Available information required significant IT analyst work and was not timely
Patient Safety Improvement Opportunities Right product, right place, right time
Recalls are difficult to comply with Requires checking the lot or serial number of each product
Requires tracking usage of the recalled product to a patient via paper records – 6,000 patients/yr
Charge Capture Capturing product usage at point of care was difficult to audit
We were missing charges
Cardiac Service Line Suppliespose special challenges:
Must be immediately available
Extensive product lines, low par levels for each
New product introductions happen every month
Consigned devices “controlled” by the vendor
Point of use controls have not worked
Clinicians have to manage PPI (Physician PreferenceItems) inventory
Expirations
Recalls
Cardiac Service Inventory is High Dollar$2,000/each
$1,900/each$25,000/each
Solution implemented:
RFID inventory management was identified as the best workflowsolution
RFID solution had to interface to our existing Cardiovasculardatabase –Apollo (Lumedx)
Pilot funding made available by Florida Hospital with roll-outcontingent on success measures
EP Lab chosen for pilot location
WaveMark chosen as pilot vendor
Product level info: lot#,serial#, model, expirations
View stock outs, roomreplenishments, usage, more
3. View information viaWeb portal
Product tagged atmanufacturer orhospital
Automatic inventoryand usage updatesevery 20 minutes
2. Collect data1. Tag product
Item cost $1,200- $2,300 each
Item cost $140 -$1,400 each
EP Lab Storage Before
EP Lab Storage After
Measurable Results (EP Pilot) We met the financial goals:
ROI of 500% Inventory reduction opportunity identified on 1st day = 34% Reset inventory levels resulting in 100% reduction in items per SKU from 7.2 to
3.6. Bulk Buys were done with better data, saving $80,000 in 3 months ACCURATE on hand inventory achieved in real-time No more expired products!
We met the IT goals: Florida Hospital, WaveMark, and Lumedx successfully implemented an HL7 feed
to Apollo for usage capture and inventory reconciliation
We met the workflow and staff satisfaction goals: Waving products at point of care for usage tracking is easier than barcode
scanning and leads to improved compliance
We met the Patient Safety goals: No expired or recalled products on the shelf, Guaranteed! Right Product, Right Place, Right Time
RFID Enabled Greater PPI VarietyWhile Decreasing On Hand Levels
DateTarget Inventory
(par level)On Hand SKU's Avg. # items/SKU
4/17/2008 417 417 58 7.2
5/17/2008* 376 496 100 5.0
6/17/2008 380 431 100 4.3
7/17/2008 329 414 112 3.7
8/17/2008 332 476 134 3.6
Includes CRM Devices*Hanging cabinets installed
Product Mix: On-Hand inventory per SKU:
Measurable Results: Roll-out to CATH Lab
Ongoing financial improvements Inventory reduction is now occurring in the CATH Lab
Bulk Buys are now being contemplated for products notconsidered before, with savings potential reaching $1M
Florida Hospital is already expanding the WaveMark footprint
Upgraded Cabinets, mobile carts, etc.
Since December, 9,690 items havepassed through the system in the CathLab alone, 4,163 items in EP Labssince April 2008
RFID Special Interest Group:
Food for Thought
“The greatest danger for most of us isnot that our aim is too high and wemiss it,
But that it is too low and we reachit!”
-Michelangelo
RFID Special Interest Group:
Process Improvement through RFIDDelivering Measurable Results
Process: Workflow Visibility and Automation in the EmergencyDepartment
Hospital: Albert Einstein Healthcare NetworkPhiladelphia, PA
Panelist: L. Albert Villarin, Jr MD FACEPChief Medical Informatics Officer – AEHNDirector, Medical Informatics, Department of EmergencyMedicine – Albert Einstein Medical Center
Background:
Albert Einstein Medical Center
Philadelphia, PA
- 509-bed teaching hospital
- Flagship of Albert Einstein
Healthcare Network
- 76k-census ED
- Level-1 trauma center
- 48 critical care beds
- 3 pods
- 6-bed fast track area
- Emergency residency program
- Department renovated and expanded in 2004
Process to be Improved:
- Intra-caregiver communications are fragmented across acombination of speech, computers, handwriting and visual tools(such as a white board)
- Attending physicians overseeing treatment of 13-15 patientssimultaneously. This resulted in long wait times, communicationproblems (which can lead to errors), and a general failure toaddress “big-picture” patient flow problems
- Bottlenecked patient flow- the lack of easily assembled patientflow data made it difficult to see how smoothly patients aremoving from one area to another
- Unnecessarily long wait times. Traditional methods ofcommunication were time-consuming and often led to delays intreating patients, including moving them from one point in thetreatment chain to the next.
Solution Implemented:
• Implemented workflow visibility and automation based on thereal-time tracking of patients, staff and assets
• Selected the Amelior EDTracker® system from Patient CareTechnology Systems (PCTS)
• PCTS integrated an infrared positioning system from VersusTechnology
• Real-time location data enabled measurement of interactionsbetween patients, staff and movable medical equipment andidentification/communication of patient status through PCTSsoftware.
• Replaced infrared locating system with ultrasonic technologyfrom Sonitor Technologies in 2008
Measurable Results:
• Reduced LOS – The average amount of time patients spend in the EDfell from approximately 9 hours in 2002 to 3.5 hours in 2008 (despite a24% increase in the number of patients visiting the ED during this timeperiod).
• Fewer Walkouts – The percentage of patients who leave without beingtreated (due to long wait times) fell from approx. 5% in 2002 to 0.5% in2007.
• Fewer Diversions to other Hospitals – The system led to an 89%reduction in the average number of hours that the hospital is ondiversion per month.
Measurable Results:
• Increased Patient Satisfaction – ED patient satisfaction, asmeasured by Press Ganey, increased by 15-20% from 2002-2005.Distinguished with the 7th best ranked in improvement.
• Improved Process – Delivery of initial antibiotic to pneumoniapatients within 4 hours of arrival increased to 94 percent.
• The financial impact of the reductions in patient walkouts anddiversions have been significant for our medical facility.
Year 1 Impact
– Walkout Reduction: $1.2 million (1 percentage pt)– Diversion Reduction: $7.0 million (1500 fewer divert hours)– Total Incremental Revenue: > $8.2 million
Contact Information:
David [email protected]
Frank Overfelt(801) [email protected]
Kelly [email protected]
Deborah Tuke Bahlman, RN, [email protected]
In Mun, [email protected]
AJ Scarlato407-200-2000 [email protected]
L. Albert Villarin, Jr MD [email protected]
