Title:

Using Systems and Technology in the Maintenance Realm

Ray Miller, BS, MSOSH, GP Direct Supply Dir. of Risk & Safety Solutions 414 405 0492; rmiller@directsupply.net

6767 N. Industrial Rd. Milwaukee WI 53223

> Has 33+ years in HC safety/risk (28+ years in post-acute care)

> Is a former corporate safety director for several LTC companies

> Has devoted his career to the development of healthcare risk and safety

strategies, programs and solutions

> Serves on the AHCA Emergency & Disaster Preparation Committee

> Is a founding member of the Direct Supply-sponsored Loss Prevention Forum

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 2

DISCLAIMER

The materials, comments and other information contained in

this presentation are intended to provide general information

but not advice about certain regulations and initiatives.

This information is not and not intended as legal or other

advice and each situation may vary depending on the

particular facts and circumstances.

You should not act upon this information without first

consulting with qualified legal counsel.

Thank You.

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 3

Agenda

1. Introduction

2. Tomorrow and Today

3. How the “Cloud” Works

4. Current Challenges (costs, complexities, contributions)

5. Examples of Possible Technology-based Solutions

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5

Making Your Voice Heard in Washington

Ensuring continuity of cash flow and shaping policy for Senior Living

Networking Groups

Fostering Idea-Sharing & Innovation

11 Organizations

SENIOR LIVING

ECOSYSTEM FUNDING &

DEVELOPMENT

INDUSTRY SUPPORT

& ADVOCACY INTEGRATED

TECHNOLOGY & DATA

NETWORKING

GROUPS PURCHASING

AGGREGATION

SUPPLY CHAIN

REINVENTION

SESSION DESCRIPTION

Technology is becoming an increasingly more likely source for

tracking and documentation solutions as well as resident and facility

monitoring systems.

We’ll discuss the complex and ever-changing world of healthcare

technology with a dual focus on resident health and wellness AND on

building safety and control.

We’ll also consider the importance and benefits of using a

“systems” approach to manage the work load and PM.

SESSION OBJECTIVES*

As a result of this session, attendees will be better able to:

1. (KNOWLEDGE) Recognize the complex, ever-changing world of healthcare

technology and potential solutions

2. (COMPREHENSION) Evaluate current challenges, methods and barriers to

change and the potential benefits to be gained through improving staff efficiency and

amplifying facility marketability using technology

3. (APPLICATION) Use senior living specific processes, resources and solutions to

integrate current practices with new technology-based approaches

Agenda

1. Introduction

2. Tomorrow and Today

3. How the “Cloud” Works

4. Current Challenges (costs, complexities, contributions)

5. Examples of Possible Technology-based Solutions

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5

“Technology will be the key driver for

Senior Living providers looking to reposition

their communities in the future.”

CXO Long Term Care Summit,

2013, Las Vegas, NV

“Health care organizations currently invest

less in IT than in any other information-

intensive industry. …

“Current systems are relatively primitive,

compared with industries such as banking or

aviation.”

© 2002 Bates; licensee BioMed Central Ltd. This is an Open Access article:

verbatim copying and redistribution of this article are permitted in all media for

any purpose, provided this notice is preserved along with the article's original

URL. (http://www.biomedcentral.com/1472-6947/2/7 )

David W Bates The Quality Case For Information

Technology In Healthcare

“Between the health care that we now

have, and the health care we could have,

lies not just a gap, but a chasm.”

Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine: Washington, DC, National Academy Press 2001;

Copyright ©2000 by the National Academy of Sciences. All rights reserved. Permission is granted to reproduce this document in its entirety, with no

additions or alterations

Institute of Medicine Washington, DC,

National Academy Press 20010

"The last national study of IT in nursing homes was completed

nearly a decade ago, and since then, nursing home

administrators have shifted the types of technologies being

used." **

Current Uses?

Admission and discharge, monitoring dietary and pharmacy,

administrative activities, health records, care planning,

communication (between families and residents AND between

caregivers)

** Greg Alexander, AP, MU Sinclair School of Nursing

Delta

Change

Acute and

Post-acute

Technology

Incontinence

Wound Healing

Vital Signs

Recent Clinical Advances

They used

Technology Context*

Resident

Safety Infrastructure

Building

Management

Clinical

Wellness

Community

Connect

Agenda

1. Introduction

2. Tomorrow and Today

3. How the “Cloud” Works

4. Current Challenges (costs, complexities, contributions)

5. Examples of Possible Technology-based Solutions

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5

The “Cloud”

Moving Our “Today” Down the “Technology Continuum”

Resident

Safety

Infrastructure

Building

Management

Clinical

Wellness

Community

Connect

“The Network IS the Computer.”

John Gage, 1984

Sun Microsystems http://enki.co/Blog/cloud-101-lesson-2-the-technology-behind-cloud-computing.html

CLOUD 101 - LESSON 2 - THE TECHNOLOGY BEHIND CLOUD COMPUTING

Cloud Computing

1. A service/utility rather than a product

(i.e. electricity grid)

2. Shared resources / software / info

provided TO computers / devices over

a network (typically the Internet)

3. Classifications: public, private or hybrid

Copyright 2014-2015 Direct Supply, Inc. All rights reserved

REQUIRED ATTRIBUTION: "Internet Connectivity Distribution & Core" by User:Ludovic.ferre - Internet Connectivity Distribution&Core.svg.

Licensed under Creative Commons Attribution-Share Alike 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Internet_Connectivity_Distribution_%26_Core.svg#mediaviewer/File:Internet_Connectivity_Distribution_%26_Core.svg

“LTE” = Long-Term Evolution or 4G LTE

… a standard for high-speed data &

wireless mobile phones, data terminals.

… the natural upgrade path for both 2nd and

3rd generation networks.

… anticipated to become the first truly

global mobile phone standard.

NOTE: The different LTE frequencies and

bands used by different countries will mean that

only multi-band phones will be able to use LTE

in all countries where it is supported.

Who provides the Internet?

1. Currently 6 Tier 1 providers: Level 3 Communications,

TeliaSonera International Carrier, CenturyLink, Vodafone,

Verizon, Sprint, and AT&T Corporation.

2. Currently 24 Tier 1 major/important providers

Copyright 2014-2015 Direct Supply, Inc. All rights reserved

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An ironclad “jail” that limits

access to the system’s resources

What do you think? (by show of hands)

How many of you think that:

1. You have the resources to manage technology initiatives?

2. Your organization is properly invested in technology?

3. Technology is “critically” important to your organization?

What do your counterparts think?*

84%: “We need help to develop and manage technology solutions.”

74%: “We are significantly under invested in technology.”

64%: “We will be acquired by someone more advanced.”

Agenda

1. Introduction

2. Tomorrow and Today

3. How the “Cloud” Works

4. Current Challenges (costs, complexities, contributions)

5. Examples of Possible Technology-based Solutions

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5

1. Technology leap frogging

2. The failure record of past IT projects

3. Limited resources in a “recovering” economy

4. Growing performance demands for technology initiatives

https://www.google.com/search?q=technology+leapfrogging+2014+images&tbm=isch&tbo=u&source=univ&sa=X&ei=pNHvU-XkA42KyAS-hYKICw&ved=0CBwQsAQ&biw=1366&bih=667#facrc=_&imgdii=_&imgrc=Y7pDznvEV0cN9M%253A%3BmXUhi4at-dXGhM%3Bhttp%253A%252F%252Fwww.aci-

institute.com%252Fuploads%252Fpages%252F2014_04_16_10_35_06_tech-in-hands.jpg%3Bhttp%253A%252F%252Fwww.aci-institute.com%252Findex.php%252Fweb%252Fabout_aci%252Finsights_apr%3B580%3B295(http://www.laserfiche.com/ecmblog/article/business-

managers-how-do-you-justify-your-need-for-new-technology) How Do You Justify Your Need for New Technology? by Katie Burke;

Copyright 2014-2015 Direct Supply, Inc. All rights reserved

What are the challenges in getting technology funding?

Expense of 3rd

Party IT Support

Ongoing

Maintenance

Costs

Urgency of LSC-

Related Repairs

(Emergency Trip

Charges)

Multiple Servers &

Lots Of

Equipment

Key Challenge: COSTS

Wander Monitoring

Systems Punch Downs No Local IT

Confusing

Data Closets Multiple Vendors

image

Key Challenge: Complexities

BYOD security and more HC breaches …

A recent roundtable found that a majority of HC providers had defined

procedures for securing devices

… 46% admitted the policies are not being followed. …

Participants agreed that device encryption should be a part of any BYOD

policy … but rarely enforced ... lack of adherence to their own policies.

… Due to sensitive data AND regulatory and compliance requirements, HC

leaders must incorporate better practices when to protect patient data.

BYOD =

“Bring Your Own Devices”

mobile devices, laptops,

desktops, medical devices,

…

Complexities

Complexities: The intense scrutiny on technology investments

How have you handled impacts on:

1. Existing technology

2. Current business processes

3. Internal culture and external relationships

(http://www.laserfiche.com/ecmblog/article/business-managers-how-do-you-justify-your-need-for-new-technology) How

Do You Justify Your Need for New Technology? by Katie Burke; Copyright 2014-2015 Direct Supply, Inc. All rights reserved

Complexities: Four Common Technology Pitfalls

1. Poor resident or environment interface

2. Inadequate implementation plan

3. Inadequate maintenance plan

4. Poor design

Chapter 50. Patient Care Technology and Safety: Gail Powell-Cope, Audrey L. Nelson,

Emily S. Patterson

1. Is there a “technology budget”? (PPD, Capital, CapX)

2. Who agrees with you regarding the need for more IT resources?

3. Can technology actually help you manage your building & expenses?

4. In light of change & innovation, what are your thoughts about the Cloud?

Key Challenge: Your Contributions*

Agenda

1. Introduction

2. Tomorrow and Today

3. How the “Cloud” Works

4. Current Challenges (costs, complexities, contributions)

5. Examples of Possible Technology-based Solutions

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5

Imagine a Future Where….

Technology of Tomorrow, Today.

One Call

Reduced

hardware

costs

Fast

adoption

of trends

Single

Source

Remote

Manage-

ment

Future of Senior Living Technology

Infrastructure

Environmental

Clinical

Wellness

Resident

Safety

Community

Connect

Example #1

Intelligence: Making your facility or

community smarter and your life more

manageable

Future of Senior Living Technology

Resident safety

Community connect

Clinical wellness

Environmental monitoring

Infrastructure

Future of Senior Living Technology

Resident safety

Community connect

Clinical wellness

Environmental monitoring

Infrastructure

Future of Senior Living Technology

Resident safety

Community connect

Clinical wellness

Environmental monitoring

Infrastructure

Example #2

Intelligence: Making your maintenance

and logistics approach smarter and your life

more manageable

Case

Study:

P-3C Orion long range ASW aircraft

4-engine turboprop, anti-submarine

and maritime surveillance aircraft.

"We continue to discover new ways to lower the total costs of ownership. We intend to

improve every aspect of logistics and maintenance using technology developed for

other applications and integrating that technology into an open-architecture system.“ Gisele Welch, director of the Logistics and Maintenance Applied Research Center (LandMARC) at the Georgia Tech Research Institute (GTRI).

“Maintenance accounts for more than 60% of lifetime costs for complex military

systems. These systems continue in active service much longer than their designers

envisioned. Maintenance becomes more difficult, costly and time consuming.” Ron Wagner, a former Navy aviation maintenance officer and co-director of LandMARC

http://gtri.gatech.edu/terms

Example #3

Intelligence: Making your ice machine

smarter and your life more manageable

Has this

happened to

your Ice

Machines? > Bacteria Buildup

> Scale & Lime

> Parts breakdown

Why do

these

problems

occur?

> Improper filtration

> Infrequent cleaning

> Improper maintenance

Scale, lime, and bacteria cause

serious problems…

> F-Tag 252, 327, 371 noncompliance Facilities cited hundreds of times a year for these f-tags –

ice machines are one source of non-compliance

> Maintenance Budget goes up Cost to repair between $400 and $1,500

> Resident Discomfort “From foodborne illness among nursing home residents

are 10 to 100 times greater than for the general population.” Colorado Dept. of Public Health

But, it’s relatively simple to prevent these issues

33%

58%

6%

3%

Cause of Ice Machine Breakdowns

Maintenance

Installation

Operating Environment

Equipment Malfunction

Smart Equipment – The Internet of Things

Smart Equipment – The Internet of Things

Building

Mngmnt.

System

Smart Equipment – The Internet of Things

Building

Mngmnt.

System

Smart Equipment – The Internet of Things

Building

Mngmnt.

System

Smart Equipment – The Internet of Things

Service Provider Facility / Community

Building

Mngmnt.

System

Smart Equipment – The Internet of Things

Ice Machine

Example #4

Intelligence: Making your LSC and

Survey Process “systematic”, smarter and your

life more manageable

Sweden's ability to develop its own

state-of-the-art fighters depends on

blending home-grown and

imported technology.

1. JAS 39E engine = US

2. Radar = Britain

3. Infrared search/track = Italian

4. Airframe may be = Brazil

SIDEBAR: Swedish/Saab-built

JAS 39E Gripen = “Gen 6”

… not the world's fastest, most agile or stealthiest fighter. That’s not a bug, it is a

feature. It’s intended to cost less to develop, build and operate … despite doing almost

everything better.

An engineer: “The Swedish air force could not afford to do this the traditional way”-- and

neither can many others.

https://www.google.com/?gws_rd=ssl#q=JAS+39E+Gripen+capabilities

JAS 39E Gripen: $43,000,000

F-22 Raptor: $150,000,000

SIDEBAR*

What did your last Fire Safety

Survey Report (CMS 2786R) look like?

What LCS technology solutions are there?

1. Tasks

2. Documentation

3. Organized calendar-based work schedule

4. Prioritizes by specific LS code

5. Tracks all LS documentation

6. Instructions on to perform LSC-related tasks (and other maintenance tasks)

142

Annual

Inspection

Tasks

Generator Inspection W

Running generator under load M

Corridor Doors Q

Exit Lights Q

Fire Doors Q

Smoke Doors Q

Wall Penetrations Q

Backflow devices A

Fire Department Connections Q

Fire Hose/ Cabinets A

Fire Pump (if applicable) Churn W

Fire Pump (if applicable) Flow A

Sprinkler Pressure Reading M

Sprinkler System Components A

Sprinkler System Valves M

Waterflow device alarm testing Q

Fire Extinguisher Inspection M

Fire Extinguisher Maintenance A

Fire Alarm Notification Devices Q

Fire Alarm Panel A

Fire Drill Q

Off premise emergency force notification equipment Q

Pull Stations A

Smoke Sensitivity Test 2Y

Smoke/ Heat/ Duct Detectors A

Grease Removal Devices S

Kitchen Exhaust Cleaning S

Kitchen Exhaust Hood S

Kitchen Fire Extinguishing System S

Biomedical Equipment Performance and Safety Check A

Medical Gas System Testing A

Disaster Drills S

Safety Com M

Hazard Safety Surveys Non-Patient Areas A

Hazard Safety Surveys Patient Areas S

Interim Life Safety Measures

Boilers/Water heaters M

Eyewash Stations A

Water Temperatures W

292

Annual

Reports

Regulatory Compliance Reporting

“Other” Regulatory Compliance

Safety Committee’s Responsibilities

1. Over-see mandatory EE education

2. Emergency Response Plan Review

3. Regulated Medical Waste (DOT)

4. On-going OSHA Compliance

5. OSHA 300 A (post/remove)

6. Safety Committee Meeting

7. osha Standards Available

8. MSDS (SDS) Available

Annual osha Evaluations

1. Haz. Com. (Global Harmonization)

2. osha Recordkeeping (EE injuries)

3. Dprtmntl. Hazard Assessments

4. Personal Protection Equipment

5. EE Med Record Access

6. Violence Prevention

7. Lockout / Tagout

8. Confined Space

9. Ergonomics

10.Hep. B

BENEFITS: Compliance and Documentation

Life Safety -- Water temperature, fire drills and generator

testing

OSHA -- OSHA record keeping, bloodborne pathogens,

lockout/tagout, OSHA Log, incident reports, hazard evaluations

Safety Committee Program – Processes, meetings,

membership, minutes

Emergency & Disaster Preparation – Preparation,

Plans, Contacts, Forms, Drills

TECHNOLOGY BENEFITS: Residents and Information

“There is a lot of interest in point-of-care devices for routine

data collection.

Facilities are adopting touchscreen devices, handhelds …

voice-activated devices.

These technologies will dramatically increase the data-flow in

… organizations.”

Peter Kress, VP CIO, ACTS Retirement-Life Communities in Ambler, PA.

TECHNOLOGY BENEFIT: Tracking

TRACKING

1. Repairs

2. Warranties

3. Work Orders

4. Work Schedules

5. Capital Equipment

6. Maintenance Schedules

7. Service Provider Management

8. Department-Based Work Schedules

1. What happened to Blockbuster Video?

2. My Grandfather delivered bottled milk to homes from a truck …

3. The “older generation” almost NEVER likes the “new generation’s” music …

4. How can you use systems and managed-services to operate buildings profitably?

So Now What?

Closing

There story of a man on an oil rig in the North Sea. In the

middle of the night, an explosion set the rig on fire.

The man now faced an awful decision -- stay on the

burning platform and await certain death or jump into the

inky, icy North Sea 100 feet below.

He chose to jump ...

Embrace it … Learn it … Use it

Agenda

1. Introduction

2. Tomorrow and Today

3. How the “Cloud” Works

4. Current Challenges (costs, complexities, contributions)

5. Examples of Possible Technology-based Solutions

Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5