Monday, June 1, 2009

Real Time Healthcare?

Warehousing. Storage. Overstocking. These are some of the biggest costs in product-delivery businesses today. BMW and Amazon are just two companies that have each spent millions on technologies to achieve the goal of "Real Time Delivery" (RTD). And in many healthcare models--particularly the revenue-driven US system--patient wait times, materials storage and pharmaceutical overstocking are viewed as "cost-centers" and "productivity negatives." They are leading drivers of some of the largest cascade costs; construction, patient transport, bed allocation and purchasing among them.

There are already solutions being applied to services of healthcare; supply and transport. After all, Real Time Delivery is most obviously about "delivery." Velocity Express, a pharmaceuticals delivery company in Connecticut has customized their services to reduce the management impact on hospital staff and to refine the ability of pharmacies to schedule their deliveries later at night within a 15 minute window. An even more explicit delivery solution is Inform's (of Aachen, DE) SyncroTESS system, software for resource management of ambulances and patient transport resources. But these are solutions developed by vendors for themselves--vendors using their knowledge of their own industries and technologies to streamline their own processes. They then market themselves as working to "take the strain off...care nursing sectors" thus "allowing them to focus on patient care."
In these cases, just as in the cases of outsourced pharmacy management, healthcare is not yet using RTD, but is only paying vendors for the benefits of their own RTD solutions.

So what would RTD of healthcare really be? And can hospitals do it for themselves?

BMW is a leader in RTD, and bumpers at BMW do not mind waiting on the factory shelf. healthcare is different--patients do mind waiting. Wait time reduction is a priority for patients. A 2006 survey found that more Canadians ranked a "patient wait times guarantee" as the Number One priority for the government (42%)--more than twice as many wanting lower taxes (19%) and three times those worried about crime (14%). In response, the government of Canada is now spending millions to reduce wait times in all areas of care ($5 Million at Radiation Oncology in New Brunswick and $38 million to reduce wait times in Ontario regional service clinics are just two examples).
Technology is being applied to this; improved scheduling tools, time-motion studies of "bed-turns," and aggressive support for EMRs. King's Daughters Medical Center in Kentucky US instituted and EMR system in the ED and reduced patient wait times almost by half, from 220 minutes to 118. The EMR, in combination with increased staff to manage workflow, reduced the time spent by staff on paperwork and charting, allowing more time for patient interaction. The goal of RTD is a wait time of zero, and the reduction at King's Daughters is impressive, and ED staff are known as the fastest, most efficient providers in a hospital, so why is there still an average wait time of nearly 2 hours?
A reason that is heard in hospitals everywhere is not about the the ED--it is about the rest of the hospital. The disconnect between inpatient resource management and ED outpatient completion. RTD in the ED needs to address not the real-time delivery of patients TO the ED but the real-time delivery of patients FROM the ED to inpatient systems.
EDs have unique issues and are not as controllable as scheduled outpatient clinics. Yet, average wait times in dialysis clinics and family-care clinics are notoriously long. the average patient wait time in some regional dialysis clinics in Ontario can run to 4 hours. There are no sudden strains on resources as in the ED. But, even with careful time-motion studies and more accurate time-per-treatment metrics, patients are still scheduled for a block of time "Wednesday morning" and required to wait their turn within that period. This drives unnecessary costs in clerical staff time spent managing the on-site patients and accompanying support givers, the costs of these support givers, the need for building and maintaining larger waiting facilities to host both patients waiting for treatment as well as patients waiting for transport after treatment. These wait times could certainly be reduced by automating patient intake with an EMR, as was done in the ED in Kentucky.

But these things requires more than just an EMR. RTD is about an entire system from beginning to end, and a REAL real-time solution requires a systemic approach--an organic, interactive connection of bed management to staff notification to diagnostic scheduling to pharmacy right through to nutrition.
A hospital could choose a solution of a single unified system (like the great promise of EPIC's million miles of modules). Or a facility could opt for a customized automated messaging system (like Commtech of Perth, Australia) in combination with specially trained clerical staff. Either way, the facility is still paying a vendor for a solution. Why? Hospitals do all sorts of things, don't they--from birth to death and everything in between, right? So why can't they do this for themselves?
Well, that's for tomorrow; "The 7 Myths of Healthcare Technology: Healthcare People Can Do Technology......"

BMW and Amazon have each spent millions on technologies to reduce the costs or warehousing, stock and delivery to achieve the goal of "Real Time Delivery" (RTD). At BMW's Spartanburg plant, the goal is to have each batch of new bumpers delivered to the line just as the last one is pulled off the shelf. Amazon is working to order more copies of "Blogging for Dummies" at exactly the right moment to ensure that the new stock arrives at the back of the warehouse just before the last one gets loaded into the Fedex truck out front. Millions have been spent to save billions in storage, excess capacity, shipping and control.
As healthcare has become a business like any other, how to manage the same bottom-line demands? And how to map commercial production solutions to healthcare practices?
There are already solutions being applied to services of healthcare; supply and transport. After all, Real Time Delivery is most obviously about "delivery." Velocity Express, a pharmaceuticals delivery company in Connecticut has customized their services to reduce the management impact on hospital staff and to refine the ability of pharmacies to schedule their deliveries later at night within a 15 minute window. An even more explicit delivery solution is Inform's (of Aachen, DE) SyncroTESS system, software for resource management of ambulances and patient transport resources. But these are solutions developed by vendors for themselves--vendors using their knowledge of their own industries and technologies to streamline their own processes. They then market themselves as working to "take the strain off...care nursing sectors" thus "allowing them to focus on patient care." In these cases, just as in the cases of outsourced pharmacy management, healthcare is not yet using RTD, but is only paying vendors for the benefits of their own RTD solutions.

So what would RTD of healthcare really be? And can hospitals do it for themselves?

BMW is a leader in RTD, and bumpers at BMW do not mind waiting on the factory shelf. Healthcare is different--patients do mind waiting. Wait time reduction is a priority for patients. A 2006 survey found that more Canadians ranked a "patient wait times guarantee" as the Number One priority for the government (42%)--more than twice as many wanting lower taxes (19%) and three times those worried about crime (14%). In response, the government of Canada is now spending millions to reduce wait times in all areas of care ($5 Million at Radiation Oncology in New Brunswick and $38 million to reduce wait times in Ontario regional service clinics are just two examples).
Technology is being applied to this; improved scheduling tools, time-motion studies of "bed-turns," and aggressive support for EMRs. King's Daughters Medical Center in Kentucky instituted an EMR system in the ED and reduced patient wait times almost by half, from 220 minutes to 118. The EMR, in combination with increased staff to manage traffic, reduced the time spent by staff on paperwork and charting, allowing more time for patient interaction. The goal of RTD is a wait time of zero. The reduction at King's Daughters is impressive, and ED staff are known as the fastest, most efficient providers in a hospital, so why is there still an average wait time of nearly 2 hours?
A reason that is heard in hospitals everywhere is not about the the ED--it is about the rest of the hospital. The disconnect between inpatient resource management and ED outpatient completion. RTD in the ED needs to address not the real-time delivery of patients TO the ED but the real-time delivery of patients FROM the ED to inpatient systems.
EDs have unique issues and are not as controllable as scheduled outpatient clinics. Yet, average wait times in dialysis clinics and family-care clinics are notoriously long. the average patient wait time in some regional dialysis clinics in Ontario can run to 4 hours. There are no sudden strains on resources as in the ED. But, even with careful time-motion studies and more accurate time-per-treatment metrics, patients are still scheduled for a block of time "Wednesday morning" and required to wait their turn within that period. This drives unnecessary costs in clerical staff time spent managing the on-site patients and accompanying support givers, the costs of these support givers, the need for building and maintaining larger waiting facilities to host both patients waiting for treatment as well as patients waiting for transport after treatment. These wait times could certainly be reduced by automating patient intake with an EMR, as was done in the ED in Kentucky.
But these things requires more than just an EMR. RTD is about an entire system from beginning to end, and a REAL real-time solution requires a systemic approach--an organic, interactive connection of bed management to staff notification to diagnostic scheduling to pharmacy right through to nutrition.
A hospital could choose a solution of a single unified system (like the great promise of EPIC's million miles of modules). Or a facility could opt for a customized automated messaging system (like Commtech of Perth, Australia) in combination with specially trained clerical staff. Either way, the facility is still paying a vendor for a solution. Why? Hospitals do all sorts of things, don't they--from birth to death and everything in between, right? So why can't they do this for themselves?
Well, that's for tomorrow; "The 7 Myths of Healthcare Technology: Healthcare People Can Do Technology......"

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