automated case management for the or - logi-d orcircuit-id solution has been developed to fully...

Automated case management for the OR

A resourceful solution by

Resourceful knowledge Logi-D was originally created as a hospital supply chain consulting group with a research affiliation with the HEC Montréal business school. Our consulting and research experience has provided us with an in-depth understanding of dominant healthcare supply chain issues. Building on this experience, we continuously expand our knowledge by sourcing best practices, emerging technologies and leading standards across borders and industries, which has resulted in a comprehensive and resourceful knowledge base.

Resourceful ideasHowever, simply knowing the sector does not distinguish us from our peers. It is through our core competency of innovation that we connect the dots in new ways and convert our knowledge into resourceful solutions, just as we have transformed ourselves into a hospital logistics solutions integrator. We strongly believe that an end-to-end solution generates the best results, given the dynamics of the supply chain, and that the standard solutions available on the market today do not always solve the issues. It is with this in mind that we have developed our iD-SUITE, a unified solutions platform of best-of-breed solutions designed to interface easily to host applications.

Resourceful integrationOur OR CIRCUIT-iD solution has been developed to fully integrate and automate all OR materials management processes, including charge capture.

With the implementation of OR CIRCUIT-iD, all processes are linked together to optimize your supply chain, from case picking to the updating of preference cards.

OR CIRCUIT-iD also seamlessly integrates all of the Logi-D solutions, including its internationally recognized 2BIN-iD replenishment system. This integration enables the sharing of a common database, which simplifies data maintenance and interfacing with host applications.

Resourceful benefits• Best of class case costing• Automated demand capture • Ongoing optimization of preference cards• Automation of initial building of

preference cards• Minimal clinical staff involvement • Automated charge capture integrated into

material management processes • Complete integration and visibility of OR

supply chain data flow• Interface capability to all external applications

Precise case costingThe OR CIRCUIT-iD solution delivers the most precise real-time case costing in the industry. All data related to supplies picked at the various stages of case preparation as well as those returned unused following a procedure are captured with minimal human intervention.

Resourceful EMR linkageOR CIRCUIT-iD automatically makes the critical link between patients and supplies and has been designed to pass this information to the electronic medical records with no additional staff involvement required.

GS1 compatibleAlthough not limited to these standards, our system is GS1 compatible. It will read GTIN barcodes when available and uses GLNs when in use for the management of product locations.

Patents pending : 2.565.934 — 2.645.696 — 12/327401 — 2.587.186 — 2.663.781 — 12/4280952 3

1. Plan the case

Management of preference cardsDepending on the OR management system being used, OR CIRCUIT-iD can host preference cards, only requiring the electronic file of the OR schedule on an ongoing basis. OR CIRCUIT-iD can also receive preference card files from the OR management application, should the client wish to maintain the cards in its OR management system. If your preference cards are still paper based, we offer support to automate their documentation within a fraction of the time usually required (please see Data cleansing section on page 11).

Resourceful RFID trackingThe initial process is completed by printing the pick list for the procedure as well as a label containing an RFID inlay. The RFID-enabled label is affixed to the pick list, which will follow the procedure during the entire cycle and will be used to identify the procedure to which items will be added or removed. This in turn generates a precise, real-time patient charge record.

Product code

104

05/03/2009

Picking list

(12.35) Cataract surgery majorSurgeon: 15 Graham Rachel

Intervention: 102 Basket: 1

Number:

Alexandre GrahamPatient:

Description Qty Location Voice

Procedure:Interventio

102Procedure:

12.35

PlaceRFID

label here

þThree-Quarter sheet 110008 CSD/ A.2.1.P

þGaz sponges 2X2 12 ply 210001 CSD/ A.4.1.P

þLow adherent absorbent dressing 4X4 210002 CSD/ A.4.2.P

þTransparent dressing 4 X 4 3/4 310007 CSD/ A.6.1.P

þConvertors 110009 CSD/ A.12.1.P

oInstrument tray 1G10 CSD/ B.1

oSyringe with needle 3cc/ml 212005 Centre core/ A.8.1.P

oChloride injection USP 0.9% Sodium 112012 Centre core/ A.14.1.P

oSuture 1G2 Centre core/ A.10

oNurse gloves 1G1 Centre core/ A.4

oLens 1C1 Centre core/ B.1

Product code

104

05/03/2009

Picking list



Number:




102Procedure:

12.35

PlaceRFID

label here












Surgeon Procedure Patient

P P P

2. Pick predictable items

Resourceful pickingDesigned as an optional add-on module, VOX-iD enhances case picking procedures of predictable items through the use of voice recognition technology. When implemented with OR CIRCUIT-iD, VOX-iD allows multiple cases to be picked simultaneously following an efficient picking sequence, which significantly reduces both picking times and risk of errors.

By generating the preference card pick list, all predictable items are automatically added to the patient charge record. The printed pick list specifying the items and quantities that need to be picked as well as each of their storage locations can then be used to pick these predictable items. Depending on the logistical flow configuration, these items may be picked in distribution, central sterilization or the center core.

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Pre-case unpredictable supplies that are defined just prior to the surgery (e.g. nursing glove size) are usually picked in a common area such as the center core from the 2BIN-iD storage units.

Resourceful data capture The patient charge record can be updated as unpredictable supplies are picked. Using a finger-held Bluetooth-enabled scanner, products are linked to a procedure when users first scan the RFID-enabled pick list and then scan:• the product bin label, which contains an RFID transponder,

or,• the manufacturer’s barcode on the product’s packaging.

3. Pick unpredictable items Using to replenish supplies2BIN- D

At the heart of our solutions is our internationally-recognized 2BIN-iD replenishment system for the inventory management of most stock and non-stock items.

This solution has been designed to manage replenishment processes for the majority of items used in a range of hospital units, including the OR, cath lab, radiology and inpatient units. In the OR, the 2BIN-iD system is used to manage items that do not require item-level traceability.

Resourceful inventory management The Logi-D 2BIN-iD replenishment system is unique in that it gathers replenishment information from remote locations in real time without requiring any counting or data entry in the user department and requiring only limited involvement from clinical users. In essence, it automates replenishment and facilitates the control of inventory levels and stock rotation, thus preventing the expiration of products. Our 2BIN-iD solution also provides a selection of management reports, including optimization reports that suggest quotas based on actual consumption and replenishment time, a list of slow moving items, and a list of locations where any given item can be found to name just a few.

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4. In-case consumption

Resourceful item-level traceabilityThe consumption of high-value items requiring item-level traceability is recorded automatically for inventory management purposes. Such items are added to the procedure cost record, and ultimately the patient file, when their packaging is disposed of in the CC-iD intelligent receptacle located in the treatment room. In order to link supplies to the procedure, as the case begins, the employee initiates the receptacle through the kiosk. All item packaging subsequently disposed of in the CC-iD receptacle will automatically be associated with the procedure.

Consumption Checkpoint

Replenish items requiring unit-level traceability The following information on delivered supplies is captured by scanning the manufacturer’s barcode:• Manufacturer’s product number • Serial number or lot number• Expiry date

Data is transferred to CC-iD in real time. The application then automatically retrieves the following information from the hospital’s database:• Internal product number• Internal product description• Requesting department/specialty• Storage location

An RFID printer automatically prints a removable self-adhesive label that contains a unique RFID transponder. Pertinent product information is also printed on the label, including its storage location. The label is then affixed to the product packaging.

When delivered to the user department, the product is swiped in front of the 2BIN-iD board to update the CC-iD application database. This action records the time that the product was delivered to the user department and confirms that it is ready for use.

When the product is used and its packaging disposed of in the CC-iD intelligent receptacle in the clinical procedure room, the intelligent receptacle technology transmits the item’s unique identifier, recorded in the RFID transponder, to the CC-iD database. This registration creates a replenishment request transaction. The same information can also be transferred to other information systems, such as the patient file or billing application.

Conditioning

SN60WF210DAlcon

Intraocular lens 21.0D

Serial: 10855543073Lot:Expire on: Aug. 31 2013

Dept: ORRoom: 012Cabinet: ABin: 3

Storage

8 9

To complete the process, items not used during the case are returned to their storage locations. It is important to track these returns, not only to obtain precise case costing but also to identify patterns in returns to optimize preference cards and avoid unnecessary initial picking of items.

Resourceful put away To facilitate the return of unused items, Logi-D offers VOX-iD, its optional add-on module that uses voice recognition technology to enhance OR CIRCUIT-iD. VOX-iD guides users through the put away sub-process by querying a database via voice prompts. In addition to reducing dependence on the knowledge and experience of staff members, this add-on reduces the risk of misplaced items and shortens the put away process substantially.

5. Return unused items

As a result, the institution need no longer rely on the knowledge of specific employees regarding the physical location of products, the return process for unused items is considerably shortened, and the charge capture is as precise as can be.

Proactive statistics In addition, the system uses the statistics gathered over time to suggest updates to the list of items used for each procedure. This reduces the number of unnecessary picks and returns, ultimately optimizing the overall case picking process.

Data cleansing and the computerization of preference cards are the foundation of efficient OR supply chain and case costing processes. Such an initiative will ultimately allow case picking to be delegated to non-clinical personnel.

Procedure and surgeon preference cards are often incomplete or outdated, meaning manual updates can take several months, yield disappointing results, and delay the realization of significant gains.

The OR CIRCUIT-iD solution automates data collection and preference card management, which greatly reduces the involvement of clinical staff and project length and helps achieve the targeted objectives.

Logi-D offers the following support in organizing preference cards:• Preparation of preference card structure • Definition of categories (predictable vs. unpredictable) • Data collection support through RFID technology

Data cleansing and the computerization of preference cards

Surgeon X Surgeon I

Surgeon II

Surgeon III

Surgeon IV

Surgeon YSurgeon Z

Interface

Procedure A

Procedure B

Procedure C

Procedure D

Department

Predictable item 1

Predictable item 2

Unpredictable item 1

Unpredictable item 2

Treatment room

Resourceful preference cards

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Charge capture and replenishment process

Product code

104

05/03/2009

Picking list



Number:




102Procedure:

12.35

PlaceRFID

label here












Product code

104

05/03/2009

Picking list



Number:




102Procedure:

12.35

PlaceRFID

label here












Surgeon Procedure Patient

P P P

5 R

etur

n u

nuse

d i

tem

s

Update

Plan the case

Pick predictable

Pick unpredictable

In-case consumption

1

2

3

4

5

2BIN-iD charge captureUnpredictable items are picked in a common area from the 2BIN-iD storage equipment just prior to the case. These items are associated with a procedure when the user scans the RFID-enabled pick list and then scans the 2BIN-iD replenishment label of the required item. This action records the product that was picked and links it to the procedure and ultimately the patient.

Voice recognition technologyWhen the RFID-enabled pick lists are generated, all predictable items are automatically added to the patient charge record and picked. To optimize case picking, we offer VOX-iD, which employs voice recognition technology to enable batch picking of multiple cases at the same time. This module also facilitates the return of unused items following a patient procedure by guiding users through the put away process via voice prompts. Enhancing OR CIRCUIT-iD with VOX-iD results in precise case costing and continuous preference card updating.

Preference card trackingFirst, a treatment or procedure is transferred to our OR CIRCUIT-iD system. This information may include the list of required supplies or simply the procedure/treatment reference number. This can be performed through an interface from the scheduling application or other clinical application or entered manually. The initial process is completed by printing the pick list for the procedure as well as a label containing an RFID inlay. The RFID-enabled label is affixed to the pick list and will be used throughout the procedure to add or remove items and update the patient charge record.

In-case items requiring traceabilityThe consumption of items requiring item level traceability is recorded automatically for inventory management, charge capture and patient file purposes when an item’s packaging is disposed of in the CC-iD intelligent receptacle. In order to link supplies to the procedure, the employee swipes the RFID-enabled pick list across the CC-iD intelligent receptacle. When an empty package is subsequently placed in the intelligent receptacle, CC-iD performs the charge capture and triggers a replenishment request for the item.

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Resourceful project execution

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Simulation and consultingThe Logi-D TRIAX-iD consulting services represent a unique offering. Our consulting services focus on building hospital supply chain automation business cases through analysis and optimization. Reaching beyond our own proprietary solutions, we are committed to recommending and implementing only those solutions that bring the highest value to our clients’ specific context; we thus integrate leading practices from other vendors as needed.

For every project that we are involved in, we establish a detailed project plan and timeline to ensure that we meet our client’s specific needs and objectives.

Implementation servicesLogi-D has developed a unique methodology to implement its automation solutions. The principal phases include:

Pre-implementation: assessment of the existing situation, review and validation of the proposed processes, proposal of a detailed implementation plan, etc.

Implementation: coordination of the main steps of our implementation methodology, training, and coordination of meetings in order to maintain project focus and identify any corrective actions required immediately, etc.

Post-implementation: post-implementation results and compliance measurement as needed, remote monitoring of the systems, etc.

Case study

Resourceful simulationIn the following case study, the Logi-D methodology was used to measure the impact of implementing its automation solutions for the OR supply chain. The study was conducted in a three-site, 37 OR-theater hospital. The objective was to establish a detailed profile of the existing situation and assess the impact of implementing the Logi-D suite of automation solutions.

Based on the analysis of the data gathered, the existing annual cost of logistics activities in the three operating rooms was established at close to $1.6 M, with nursing staff involved in just over 50 % of the logistics activities.

Resourceful estimatesA simulation of the Logi-D solution in the 3 ORs revealed that the investment to automate the supply chain with the Logi-D solution would be slightly more than 3 million dollars over 5 years, with an estimated payback within 1.4 years.

The anticipated gains associated with the implementation were estimated as follows:• Annual recurrent replenishment process productivity

gains of more than $ 0.56 M

• Reduction in supply costs due to a decrease in inventory shrinkage of $ 0.7 M annually

• Total OR gains of $ 8.32 M over 5 years

SIMULATING...

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automated case management for the or - logi-d orcircuit-id solution has been developed to fully...

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