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Why a combination of nurses and EDI will never succeed in OR. A fantastic 6 min recap of the core problem

Why a combination of nurses and EDI will never succeed in OR. A fantastic 6 min recap of the core problem

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Shmulik Bakerman, a former deputy CEO of the Israeli GPO and today VP of IDENTI’s sales, explains in 6 minutes why hospital management will forever have a hard time running an operating room, how it relates to the nurses’ burnout, the disappointment from EDI systems, and the `never ending` fear around transplanting expired and recalled item.

Shmulik: We’re talking about operating rooms that have about 25% unexpected events, coming from the emergency room… a car accident that no one planned for during the day…

The OR is in constant motion. They finish one surgery and immediately start the next. When you look closely, who is in charge of the entire operation? The head nurse, who was never trained to run operating rooms. Logistics and Materials Management do not set foot in operating rooms. I mean this is an environment in which doctors and nurses have exclusive access.

This creates a gap that is supposed to close somehow. Over the years, hospitals have invested a lot of money in ERP systems, thinking that the software will improve efficiencies. So first of all, to implement ERP and EHR systems, which are very heavy information systems, say SAP or ORACLE, is not something suited to the unique environment of the operating room. It’s suitable for warehouses but not operating rooms. And then you ask the nurse to use and report within those systems. These are things she does not know how to do and that’s when you get failures.

For instance, an item is missing. She has to run to the shelves before the operation and start counting and suddenly she discovers that the item she needs has expired or a recall was issued on the item and no one knows the item is on the OR shelf.

We realized that there is a critical problem with documenting utilization in ORs, which is happening at the end of the chain and is the root cause of all the failures at the beginning of the chain.

We come to the surgical environment and say: We have the tools that give you an edge; tools that will allow you to be in control. You no longer need to be anxious that an item may not be in stock, because we reflect what you have and give you the means to manage it much better.

We do not come and say replace your software. You have the best software in the world it’s true, but there is a missing link.

Interviewer: How was the documentation before you arrived?

Shmulik: Today, most usage reporting is documented with barcodes.

Interviewer: With a barcode just like …

Shmulik: Yes, during the operation, a nurse takes a barcode scanner and then she encounters all the problems of the ERP/EHR system. You cannot report because there is no inventory. There is inventory, and suddenly there is no stock, or the part number does not exist in the system—all sorts of things. And at some point, the nurse just says, “leave me alone. I’m done.”

Then we have reporting compliance on the global level. I’m talking about the United States in which only 48% of items used are reported to the EHR. This means 52% are undocumented. It’s like you are not recording anything. What’s the implication of all the items that you are not documenting? One, amazingly, is that you do not know how much a surgery costs. In a private company this is trivial. You always know how much your production line costs. You know how much the product that just came off the line costs. You need this information to price it.

So, this huge apparatus that we are talking about, the surgical department, makes up about 50%—maybe even more—of the total revenue of the hospital and also of expenses. It is also very difficult to manage at the operational level: supplies, unexpected events, and all that stuff. It’s a “black box.” You do not know how much it costs.

We solve this problem from different angle. We came from an angle that no one thought about. We thought to take a photo of the package and extract the information on it. All the nurse must do is place the package under the camera and she gets a green light. That’s it. She has finished her job.

Interviewer: The behind-the-scenes system is actually already inputting the product or item information where it needs to be inserted automatically.

Shmulik: Since our software has a very extensive database—I’m talking about hundreds of thousands of items—chances are a given product will be in our database. If an item cannot be identified, our back office will look for it in the manufacturer’s database. Then we return it through an interface to the ERP system or to the clinical system (EHR) of the hospital and in doing so we have solved the problem.

Interviewer: This is basically closing a circle.

Shmulik: Yes, we closed the circle. Earlier I talked about the aspect of pricing. I talked about the aspect of regulation. Now I talk about the supply chain. If I know from the supply management what I sent to the OR, and now at the point-of-use I know what was consumed, then what is in the middle, is already transparent right? Because I know what is in stock. Even if I do not manage the inventory at the point-of-use, the operating room, I still know through the delta what’s inside the surgical unit’s supply rooms.

If you are able through our system to produce a situation where you reduce OR inventories because you increase their level of certainty, it a) leads to reduced inventories, which means more space in the ORs themselves. Instead of overstocking for unexpected situations, there is now more room for medical usage. And b) You are saving money which allows for better medicine. I mean, you can transition from constraint-based implementation, an all-too-familiar situation, to a world where there is more room for decisions that can improve patient care.

Interviewer: Thank you very much for being with us Shmulik. I wish you again a lot of success. Thank you very much.

Identi's VP of Sales explains in 6 min the core problem of managing OR

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FAQ

Snap & Go is an easy-to-use system that enables medical product identification and charge capture through image recognition technology.

Full UDI information is digitally populated in the hospital’s EMR/ERP/MMIS systems: manufacturer’s name, ref no., batch\lot no., expiration date, and serial number as required by FDA regulations.

SNAP&GO™ Patent-protected image recognition technology
SNAP&GO™
Patent-protected image recognition technology

 

Snap & Go helps reduce sentinel events by providing safety alerts of expired and recalled items at the point of care, including external inventory. 

Visual proof of use is documented automatically as part of the charge/data capture process. The platform, powered by AI and machine learning, maintains a daily-updated global manufacturer catalog list database including UDI and UPN raw data, which enables the automatic charting of items used during a procedure. 

When the system cannot identify an item a remote human back-office team updates the missing information and corrects “bad data” on the fly, to enhance the integrity of items registered in the hospital item master and to provide more than 99% reading accuracy. Relieving the clinical team of time-consuming data entry and obtaining more precise surgery costs means capturing lost revenue through accurate charge-capture, better forecast planning and timely reimbursement.

Kanban for Healthcare offers a reliable and efficient supply management method that helps hospital replenish their medical inventory while reducing waste and avoiding counting errors.

When the method is applied, RFID technology is incorporated to provide automatic re-order. There is a wide range of solutions that differ in the amount of involvement required by the medical staff. The most autonomous solution is the wireless and smart weighing bin by IDENTI Medical, which offers a portable scale with a digital display that automatically creates an inventory order according to the weight of the items inside the bin. 

The GS1 (Global Standards 1) recently adopted a new standard for item identification that permits for the use of one of two methods to obtain GS1 compliance: barcoding or UHF RFID.

Several multinational medical suppliers, including Johnson & Johnson and Boston Scientific, have opted to use UHF RFID and are now in the process of tagging all their products accordingly.

IDENTI Medical provides a complete solution for the next generation of Smart Cabinets that includes advanced UHF RFID embedded in the cabinet and a seamless connection to cloud services and business intelligence-based management software, connecting all stakeholders in the medical supply chain.

RFID Smart Cabinet for hospitals is an automated inventory system developed to helps cath labs, neurosurgery, ophthalmology, EP labs, orthopedics, plastic surgery, gastro and many more operation rooms with their medical inventory management.

The technology tracks at individual item level tagged items stored inside the cabinet, including batch numbers and expiration dates.

The most advanced smart cabinets incorporate a new generation of ultra-high frequency (UHF) RFID tags that are capable of transmitting longer and can be covered by multiple antennas. This enables every stocked item to be read, no matter the size or placement of the items within the cabinet.

TOTAL-SENSE-smart cabinet
TOTAL-SENSE-smart cabinet

 

Specialization in such technology requires in-depth knowledge of RFID technology, its capabilities, and applications. IDENTI Medical is one of a few companies that has managed to provide the high level of accuracy required in the medical sector.

The UDI system was intended to provide easier traceability of medical devices, reduce safety errors, to fight against falsified devices, and eventually significantly improve the effectiveness of operational inventory management and waste. There are many options to record UDI data in hospitals, but today, many medical centers chose to capture UDI information through image recognition technology. The technology, which is fully utilized in various industries, has proven to be efficient and accurate because it decodes a digital image of the product without the need to rely on external tagging or a limited barcode structure. Hence the technology can pull all the relevant information—manufacturer number, serial number, batch number, expiration date—directly from the product label without human involvement, and to populate all the hospital’s software systems.

Healthcare inventory management, or supply chain management is an inclusive term for the group of processes by which healthcare providers are able to perform perpetual inventory tracking, purchases, orders, payments, and more.  The main goal in implementing such systems in large and decentralized organizations is the ability to manage medical inventory in a single centralized management software that can synchronize all internal inventory management processes automatically, to save human resources and avoid revenue losses. One of the biggest problems in recent years is the amount of time and effort required from clinical teams. Today the goal is to develop semi-autonomous systems that do not burden the medical staff with these administrative tasks.

Smart cabinets are an automatic method for managing medical inventory in healthcare organizations, which enable digital tracking and full transparency of implants, tissue and medical devices. Smart cabinets, which are based on RFID technology, can manage inventory at the item level and therefore becomes the most appropriate method for transitioning into consignment stock management. UHF RFID is the most up-to-date and accurate technology for this task due to its ability to accurately read the tags on the product regardless of the angle, orientation, or type of product.

Expiration date management is a protocol which is used to ensure that surgical inventory is safe and proper before being used on a patient. Expired products have the potential to harm or cause detriment to a patient’s health. While the importance of removing expired products and supplies from hospital inventory may seem obvious, 7% to 10% of products expired sit on hospital shelves. Hospitals over the years have tried to address the problem by applying automated expiration date solutions, but the real problem begins when expiring products that were not in the original inventory planning and do not undergo validation reach the operating room theatre—emergencies that require immediate products, products that come directly from the supplier, products taken from other kits are most likely to use expired products. It is therefore important to implement an expiration validity solution that addresses these cases as well. Expiration date management is a problem for many hospitals because they continue to rely on manual processes that slow down their staff and leave too much room for error.

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