Case Study

Using RAIN RFID Technology to Achieve Data-Driven Clinical Inventory OptimizationSes s ion # 220, Augus t 12, 2021

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COO, VUEMED

Lana Makhanik

DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.

Director, Heart & Vascular, Loma Linda University Medical Center

Rus s ell Royer, MBA, RCES, SA

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Welcome

Director, Heart & Vascular, LLUMCRus s ell Royer

COO/VUEMED

Lana Makhanik

#HIMSS21

Conflict of Interest

Lana Makhanik

Has no real or apparent conflicts of interest to report.

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Conflict of Interest

Russell Royer

Has no real or apparent conflicts of interest to report.

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Agenda

• Background: Medical device industry and implications when mismanaged

• Loma Linda IHI case study:• Challenges that prompted the changes• Solution chosen – workflow & benefits overview• Results achieved• KPIs review – continuous improvement program

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Learning Objectives• Discuss the essential components of the ways in which RAIN RFID technology works

to capture clinical inventory data• Explain some of the ways in which RAIN RFID technology can optimize clinical

inventory and improve patient care• Design effective KPIs for their organizations that provide the data visibility needed to

achieve inventory optimization, prevent waste, and control supply spend

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Global Medical Device Industry ~$400 Billion/Year

Lack of Full Inventory Visibility and Accountability

Dollar share of products NOT

tracked or accounted for by most hospitals*

Bloated inventory by >20% Excess purchases by >15% Waste levels >20% Missed charge capture >18%

Inventories are poorly managed and not tracked

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From Patients’ Perspective

• 600 - 1,200 medical device recalls issued each year, affecting hundreds of millions of units

• 2-4% are Class I recalls – which pose a serious risk of injury or death - meaning several million

units need to be tracked down, removed from shelves and/or require clinical follow-up

Medical Device Recalls

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Common Inventory Related Pain Points• Operational & workflow impediments

• Stock-outs• Unknown item, impossible to document• Hoarding• Lack of visibility on availability and location• Lack of status on expiration or recall• Manual entry at the point of care• Missing item numbers or billing codes• Delayed billing (items not documented or documented

incorrectly)• Incorrect, incomplete or missing orders

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From Clinicians’ Perspective

• Lack of actionable reporting & analytics• Limited data available• Inconsistent across an IDN• Difficult to mine

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From IT/Information Management Perspective

AI AnalyticsEHRAdmitting/Scheduling Billing

Key Hospital Caregiver-Facing Systems Key Hospital Administrative Systems

Supply Chain Finance IT HRProcedural

Documentation

EPICCERNER

GE McLabIBM Merge

McKesson HorizonPhilips Xper

EPIC PreludeCERNER

Siemens A2KEPIC

CERNER

Examples:IBM

GoogleApple

OracleInfor

Workday

Patient charting/

record repository

Patient scheduling

Patient billing Patient documentation

for specific procedures

• Health Outcomes• Population health• Decision Support

Enterprise Resource Planning

Supply Chain Data Required

Data Gaps Exacerbated by Multiple Complex Systems

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Clinical Documentation

Systems

Purchasing

Value Analysis ClinicalAnalysis

EMR

BillingHospital

ERP

Technology , Standards & Data Gap

Contracting

Distribution

From Supply Chain Perspective

This gap re inforces exis t ing s ilos ins ide hos pita ls and prevents the s upply cha in from being t rans formed into a va lue cha in both ins ide and outs ide hos pita ls

Procure-ment

Point of CarePoint of Delivery

• Poor or NO compliance• Poor or NO inventory visibility &

trackability• Unavailable or inaccurate data

• Clinical• Vendor

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A Day in the Life of a Product, a Story of Many Supply Chains and Unreliable Demand Data

From a Product’s Perspective ….

Supply Chain

Med-Surg ItemCentral Supply/Warehouse

Clinical preference item (owned)Procedural departments (cath, EP, IR,

OR, GI)

Specialty Item (i.e., trunk stock)Procedural departments (cath, EP, IR,

OR, GI)

Clinical preference item (consigned)Procedural departments (cath, EP, IR,

OR, GI)

Receipt Putaway Dispense Use

NA

Bill Order

Perpetual Status NOT available; no data entry or tracking

Perpetual Status available

NA NA

Pay

NA

Error-prone manual data entry, lack of, incomplete or inaccurate data entry

System UsedType of Supply

ERP ERP ERP Procedural Documentation Billing ERP ERP

Mostly automated data entry, complete and accurate, electronic format

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Some Sobering Stats

• >5,000 different items on-hand

• Tens of millions spent annually on supplies per department

• 8% to 20% worth of supplies at risk of waste & expirations monthly

• ~50% of procedures at risk for incorrect or incomplete supplies data

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From Administration/Finance Perspective

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From Clinical Service Line Leadership Perspective

Treat Higher Patient Acuity . . .

…At Lower Costs …With Excellent Outcomes

Supply Costs

Procedure Complexity

Procedure Length

Clinical Resources

Ensure purchases align w/need

Inventory Carrying Costs

Ensure accurate charge capture & billing

Clinical resources on non-clinical work

Ensure accurate data in pt records

Unnecessary variation in utilization

Ensure no expired product placed in pt

Ensure swift recall management

Opportunities to address w/inventory management

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Tools and Data Needed for Effective Resource Planning and Risk Management in Post -Covid World

• How many days on hand of inventory do I have?

• What is my burn rate?

• How much safety stock do I need?

• What critical supplies do I need?

• What can I cut from purchasing if I need to redirect dollars elsewhere?

• How do I ensure that my supplies are safe to use (know where they come from, not expired and not recalled)?

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From Risk Management Perspective

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International Heart Institute (IHI) of Loma Linda University Health (LLUH)

• Academic Medical Center

• Part a 6-hospital system

• >1.5 million annual outpatients

• Covers more than 25% of the state of California

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About LLUH

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• Fewer than 50% of patient cases had their supplies accurately documented

• More than 50% of items on-hand had no traceable purchase history

• Management of supplies was fragmented & siloed

• Highly manual• No real-time visibility • High rates of wasted and unused items

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Challenges Motivating The Implementation of a Solution

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LLUH Chose a Technology Solution to Help

Accurate & comprehensive data capture (lot/serial number, expiry date)

Full visibility, trackability, & management of all supplies

- from delivery to point of care - with no needs for special cabinets- ensuring full UDI compliance

Inventory composition & size improvement, and reduction of product

variation

Substantial ROI - guided by powerful Cloud analytics - focused on savings, waste avoidance and

efficiency gains

RAIN RFID excels at achieving: Optimization software helps achieve:

Hands-free RAIN RFID powered by an optimization software has proven to excel at delivering on LLUMC’s core goals ( )

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Items Get RAIN RFID Tags

Tagging Station

The UDI-encoded RFID tag may be printed with human readable text and a 2D barcode or blank

Tag encoding

Device Identifier Production Identifier Data as applicable:

Lot Number Batch Number Serial Number Expiration Date Manufacture Date HCT/P ID

UDI Compliant RFID Tagging Solution

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Tagged Items Are Continuously Tracked

Any department or floor

Procedure Room

Reception

Main Entrance

Exit door

Main EntranceHallway Movement Tracking

Department and Boundaries Tracking

Procedure Room Procedure Room

Supply Room

Procedure Room Procedure Room

Cloud Reporting & Analytics

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Tagged Items Are Continuously Tracked

Supply Rooms Procedure RoomsHallways / Cabinets

Inside

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Item Data Efficiently Captured & Disseminated

Point of CarePoint of Delivery

Procedure Room

Flow of Medical Products and Devices

Supply RoomDelivery Area/Dock & Disposal

Data Capture & Feed

Clinical Documentation

Systems

HospitalERP

SystemCloud Reporting &

Analytics

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Item Data Centrally Managed for Effective Reporting & Analytics

Universal Item MasterMaintained and updated daily in the VUEMED cloud

Associated DataCustomer-specific data assigned to each SKU

Captured DataTime, location, and item details associated

with each VUEMED Product ID

VUEMED Product ID (assigned to each unique SKU) Product Brand Name Product Catalog Number Manufacturer Product Category Product Type Diameter Length Product Features UPN/DI/GTIN

Lot number Serial number (if applicable) Expiration Date Time Location RFID-based data (EPC, Tag ID)

Reorder number (as identified in the customer ERP/MMIS)

Price Unit of Measure Unit of Measure

Quantity Par Level Reorder Level Consignment Status Billing Code

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Personalized Dashboard

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Organizational and Process Realignment

• Set up clearly defined daily/weekly/monthly protocols for all inventory-related activities:• Auditing & Reordering• Receiving & restocking• Expiration management• Item data management

Process realignment & defining roles & responsibilities

• Set up close collaboration & coordination with multiple constituents:• Supply Chain• IT• Finance

• Set up leadership oversight:• Agreed on a set of monthly KPIs for performance monitoring• Established accountability for following through on desired objectives

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• Automated Processes:• Auditing & Reordering• Receiving & restocking• Expiration management• Recall management• Point of care documentation• Item data management

Results Achieved

• Key Achievements:• Full visibility of items from requisition to patient charting: >90% accuracy • Aligned purchases with consumption: excess inventory reduced by >60%• Waste through expirations nearly eliminated: <0.5% of total inventory value• Increased patient safety: expired items never placed in patients, • no stock-outs, and recalls tracked to individual patients in seconds

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Results Maintained with Actionable KPIs

Typical Sources of Savings: Examples of KPIs Used include:

• Expiring as % of total on-hand inventory: SKUs, Units, Value

• Unused or infrequently used in the last 12 months as % of total on-hand inventory: SKUs, Units, Value

• Purchased vs. consumed in relation to case volume: SKUs, Units, Value

Frequency

Monthly

Quarterly

Monthly

Expiration control

Inventory size reduction

Product purchase rationalization

Clinical utilization management • Cost per each type of case per physician Monthly

KPIs keep Supply Chain, IT and Finance informed and accountable while he lping guide improvement opportunit ies , monitor performance, and meas ure s avings

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KPIs: Expiration Management

Expira t ion Management

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Unus ed Inventory Reduct ion

KPIs: Unused Inventory

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Alignment of Purchas ed and Cons umed Inventory

KPIs: Purchases vs Consumption

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Inventory Reduct ion of ~30% s ince January 2020

KPIs: Inventory Size Reduction

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Pandemic Dip

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Clinica l Ut iliza t ion – Opened Not Us ed Items

KPIs: Opened Not Used (Wasted)

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KPIs: Supply Waste in Relation to Purchases

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• Forecasting supply needs given specific procedure types and volumes

• Supply demand planning based on actual scheduled cases

• Examining cost per physician for same procedures

• Eliminating variation & standardizing clinical practice/utilization

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Next Steps: Predictive Analytics

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Questions

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Thank you!

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Lana MakhanikCOOVUEMED, Inc.lmakhanik@vuemed.com(888) 948-0999

Russell Royer MBA, RCES, SADirector, Heart and VascularLLUMC | International Heart InstituteRGRoyer@llu.eduOffice: 909-558-4000 ext. 15765