Healthcare thought leaders and solution providers gathered in Fargo last week not just to paint a vision, but to demonstrate solutions that create a connected and integrated chain of care.
Margaret Laub, CEO of Intelligent InSites, kicked off this two-day session discussing the challenges and solutions facing the healthcare industry. Margaret painted a vision of how integrating processes and information can change the patient experience, streamlining and optimizing the providing of care. Margaret pointed to a recent study by the Institute of Medicine called Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. (I have included a snapshot of some of their recommendations in Figure 2.) Margaret pointed out the alignment between the Intelligent InSites partner community’s vision and these recommendations. Margaret painted a vision — possible today — in which the silos in healthcare are broken down and we have end-to-end visibility across the provider’s facilities with all relevant data that supports a better patient encounter as well as optimizes the management of the facility — better care, lower cost.
Today, technology and equipment, drugs and supplies are procured and managed in a convoluted series of processes. Within the hospital setting, each department squirrels away its own supplies. Staffing activities are misaligned.It is interesting to note, reader, if you hail from another industry like high-tech or automotive, that you have seen this movie before. Lack of connection between islands of automation means stockpiles of excess — ‘just-in-case inventory’ — and poor coordination of capacity and people. No doubt when it comes to life saving, receiving inventory a few hours late is not acceptable. However, as we know, optimization in supply chain has achieved a high level of accuracy and can be tuned for 100% service levels (rather than a balanced 95% metric used in most industries). It is interesting to note that studies Intelligent InSites conducted when they implemented the technology demonstrated that they could lower asset counts by providing real-time locating.
For readers who don’t know them, Intelligent InSites is a truly innovative collaborative cloud application platform provider. They use a combination of platform tools upon which partners can develop their own integrated applications and real-time device integration (equipment monitoring, real-time locating, RFID, sensors) that sits on the integrated cloud, plus applications to trace, analyze and deliver healthcare in action. Static transaction IT systems for purchasing, or business intelligence reporting systems that report events after the fact lose the real-time aspect of a process.
To actually manage and optimize processes in real-time, directive and alerting systems are required. Thus, the need for real-time visibility systems across the process. This architecture is here today. The journey has begun.
This was an unusual gathering in Fargo. In the last month we have attended several connected-care conferences hosted by hospitals or conference media companies, but this was a bit different. Here, we actually witnessed a demonstration of automation, monitoring and management of several critical in-hospital processes that instantly needed records, test and treatment protocols as well as equipment for patient treatment. Patients, assets, staffing and appropriate data were all coordinated.
Through a partnership among technology providers led by HP,1 Intelligent InSites, and technology companies that provide critical elements of the patient care chain, a solution providing full visibility and actionable intelligence has been created. This demonstration was a composite based on a panel of Intelligent InSites’ customers including the Veterans Administration, Wake Forest Medical Center, MedWest Health Systems, and Butler Healthcare, Group Health to name a few.
To quote Helen Jones of MedWest Health Systems, “I have been in healthcare for 21 years and I have spent 15 of them looking for equipment!” She described scheduling and planning a procedure, and then hunting down the needed equipment. Often, she said, she knew which nurses where ‘saving’ equipment for themselves and she used her ‘negotiating skills’ to cajole and bribe ‘with muffins’ to secure the equipment. This means our healthcare system is truly fragile if we are relying only on the diligence of the Helen Joneses of the world to ensure timely care.
Brent Bomer, Biomedical Equip Support Specialist at VA Medical Center at the VA in Ann Arbor, Michigan, talked about their ‘pilot’ that has 22 thousand items to track (in Ann Arbor, with 439,000 items across the VA’s VISN 11 project). Of course, that is just the beginning for the VA.2 They have taken a real leadership position in the healthcare industry in the last few years, putting transformative processes and technologies into place to serve their growing patient base. Mark Rheault talked about Wake Forest’s need to locate ‘items’ such as the eight thousand staff, one thousand beds, two thousand patients as well as 17 thousand assets. Orchestrating all this is just the first step to optimizing the process.
These challenges are being addressed by real-time visibility and locating systems, reducing the need for extreme redundancy in equipment and inventory to keep the process afloat. But this is just the beginning.
Big Problems to Solve
Dr. Kevin Fickenscher, President and CEO of AMIA (American Medical Informatics Association), and chair of Intelligent InSites Healthcare Advisory Board,3 led a profound discussion with the advisory board — themselves leaders in the healthcare industry — about optimized healthcare processes to improve care delivery and the patient experience.
A critical component of their discussion was what is embedded in the Affordable Care Act (ACA) and how it is a catalyst to change. Although a lot of IT focus has been on the Electronic Medical Record (a fully integrated portable/sharable patient record), the real action over time will be elsewhere: for example, achieving patient compliance. Dr. Fickenscher stated that the future of healthcare is in our living rooms — not the hospital. Dr. Chen, who spent his career in public health in Oakland, and is the former Deputy Director of the National Leadership Academy for the Public’s Health, spoke about lifestyle and environmental issues that impact health. Dr. Chuck Watts told me, while we were sitting in the airport on the way home,that his hospital had done studies and found that only about 40% of patients actually comply with their regimen — such as taking a full course of antibiotics for pneumonia, for example. “They can come in sick as a dog, get a shot and leave. Even with the pharmacy right in the facility they don’t fill prescriptions and follow through.”
This all points to the need for connected care, using technology — either by the patient or community home healthcare providers — to ensure compliance. Without that, the current rate of recidivism will continue. And with ACA’s metrics focusing on outcome — you came, you got cured; or you come and come again and they did not cure you — healthcare providers will need to ensure ongoing care and compliance after a hospitalization, not just within the hospital. So we can clearly see cloud and mobile playing a huge role in the future of healthcare.
The challenges in healthcare are huge, and it is important to note that Intelligent InSites is taking a collaborative approach to create solutions that use asset tracking and real-time locating (they call it RTLS+) to tackle bigger issues. Partners can integrate into the platform and extend it with their expertise and technology to create richer solutions.
A great example is Wave Mark, a provider of tags, smart shelves and software for tracing and optimization. They have been able to help their customers procure even perishable supplies in an optimized manner — reducing unit costs and inventory levels, and at the same time providing a 100% service level of high-variable-demand items (supporting the Cath Lab, for instance, where the stent sizes are highly variable). Besides procurement and stock room management, the documentation required by the healthcare provider, payor (Insurance, Medicare) and FDA are also part of the process. Users have a documentation trail, as well as real-time tracking from manufacturing through distribution to the patient point-of-care for these critical supplies. So, when you look for something — it’s there, and at a better cost to the healthcare system than in the past.
Recommendations from Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
Science and Informatics
- Real-time access to knowledge – A learning health care system continuously and reliably captures, curates, and delivers the best available evidence to guide, support, tailor, and improve clinical decision making and care safety and quality.
- Digital capture of the care experience – A leaning health care system captures the care experience on digital platforms for real-time generation and application of knowledge for care improvement.
- Engaged, empowered patients – A learning health care system is anchored on patient needs and perspectives and promotes the inclusion of patients, families, and other caregivers as vital members of the continuously learning care team.
- Incentives aligned for value – In a learning health care system, incentives are actively aligned to encourage continuous improvement, identify and reduce waste, and rewards high-value care.
- Full transparency – A learning health care system systematically monitors the safety, quality, processes, prices, costs, and outcomes of care and makes information available for care improvement and informed choices and decision making by clinicians, patients and their families.
- Leadership-instilled culture of learning – A learning health care system is stewarded by leadership committed to a culture of teamwork, collaboration, and adaptability in support of continuous learning as a core aim.
- Supportive system competencies – In a learning health care system, complex care operations and processes are constantly refined through ongoing team training and skill building, systems analysis and information development, and creation of feedback loops for continuous learning and system improvement.
Clearly the journey has begun. Through investments in innovation by healthcare providers and entrepreneurs, we are witnessing the beginning of the transformation in healthcare — tackling the big problems. By connecting care — from the provider to the patient — and creating more transparent and accountable systems, we can leverage the knowledge and information from IT systems to provide better care at lower cost in this decade.
1 HP, the prime contractor and systems integrator for the VISN 11 (one of 21 Veterans Integrated Service Networks) RTLS program, provides overall program management for the implementation process and is responsible for ongoing training, support, and maintenance.
Intelligent InSites, an HP Key Partner for the VISN 11 RTLS program, is providing the VISN-wide RTLS software platform and the end-user RTLS software applications for asset management, temperature monitoring, and business intelligence, as well as the unified user interface and integrations for WaveMark’s consumable asset tracking solution with RFID-enabled smart cabinets, Censitrac® from Censis Technologies for surgical instrument tracking, and Tempsys’ CheckPoint temperature monitoring solution.
The midwest project, already begun, will include 25,000 active RTLS tags, 94,000 passive RFID tags, and 2,000 wireless temperature and humidity sensors, and will cover a combined total of approximately 4.5 million square feet. The system also includes bar codes etched on 255,000 surgical instruments, as well as passive RFID tags for the 63,000 cardiac catheterization lab supplies consumed annually by the seven hospitals. Read data regarding all of these items will be transmitted to the Intelligent InSites software residing on VISN 11’s network. — Return to article text above
2 VA’s VISN 11 encompasses active and passive asset tracking, surgical instrument tracking, Cath Lab supply tracking and environmental monitoring. — Return to article text above
3 Full members of the Advisory Board— Return to article text above
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