How Hospitals are Taking the Lead

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How Hospitals are Taking the Lead - Data
Standards Your hosts Curtis Dudley, Resource
Optimization Innovation (an Operating Div. of
the Sisters of Mercy Health System) Joe Dudas,
Director of Accounting and Supply Chain
Informatics, Mayo Clinic, and Chair, Healthcare
Supply Chain Standards Coalition (HSCSC)
Sponsors AHRMM, CHeS and HSCSC
April 24, 2008
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Curtis Dudley Executive Director of
Optimization Management
Curtis assumed his current role in October of
2003 and is responsible for optimizing supply
chain functions by utilizing technology or
process improvement. He joined the Mercy
organization in October of 1989. Over his 18
years at Mercy he has held a variety of
leadership roles in I.T. and Supply Chain. Those
roles include Director of Materials Management,
Director of Perioperative Materials, Systems
Analyst, and Network Engineer. Curtis has led a
number of key initiatives for Mercy, most
recently the enterprise implementation of Lawson
across 19 hospitals and 400 clinics. This
implementation has been cited by Lawson as the
single largest go-live in Lawsons history.
Curtis also led the Mercy Meds patient safety
program, the implementation of the Tecsys
warehouse management system for pharmacy
distribution, and the enterprise implementation
of Pathways Materials Management system. Prior
to working at Mercy Curtis worked for Bass Pro
Shops one of the largest retail distribution
companies where he supervised distribution
activities.
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Purpose of Discussion

• Introduction to Mercy ROi
• Review How Mercy ROi are Currently Using Data
  Standards
• How did we get here
• What we did
• Results
• Obstacles
• Lessons Learned
• Summary
• The Future
• Mayo How is Mayo Implementing Data Standards

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Profile Sisters of Mercy Health System
Member Facilities Assets Total Operating
Revenue Net Patient Revenue Co-workers Medical
Staff Inpatient Discharges Outpatient
Visits Emergency Room Visits Inpatient
Surgeries Outpatient Surgeries Uncompensated
Care Beds

• 18 acute care hospitals
• 2 heart hospital
• 818 integrated physicians
• Managed care organization
• Community based outreach
• 4.0 Billion
• 3.6 Billion
• 2.98 Billion
• 28,000 FTES
• 4,450 (1,045 employed physicians)
• Acute 149,012
• 5,600,796
• 473,396
• 52,134
• 280,781
• 162.3 million
• 4,003 licensed beds (3,232 acute)

In Arkansas1. St. Josephs Mercy Health Center,
Hot Springs2. St. Edward Mercy Health Network,
Fort Smith3. Mercy Health System of Northwest
Arkansas, RogersIn Kansas4. Mercy Health
System of KansasIn Missouri5. St. Johns
Mercy Health Care, St. Louis6. St. Johns Health
System, SpringfieldIn Oklahoma7. Mercy Health
System of Oklahoma
9th Largest Catholic health system in U.S. 26th
Largest health system in U.S.
Information current for Fiscal Year 2004, ending
June 2004
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Sisters of Mercy Health System
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Mercys Model
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ROi Strategic DirectionSupporting Three
Fundamental Goals
Positive Bottom Line
Good Patient Outcomes
Happy Care Givers
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An Example of Internal System Integration
Mercy Meds The logical steps to success
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ROi Model Integration Mercy MedsRepackaging
Distribution Model
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Key Tactical Enabler for Mercy MedsPharmaceutical
Repackaging Operation

• On-site pharmacist
• Rigid SOPs with periodic validation and testing
• RF picking and scanning at tote verification to
  assure quality
• Mil Spec sampling for quality assurance

• Room designed to ISO14644-1 spec
• Repackaging room construction to class 100,000
  standards
• Qualification of environment through testing
• Procedures to minimize contamination and assure
  cGMPs
• Qualified Technicians throughout operations
• Approved Testing Protocols

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Key points on Integration

• Integration to supplier front end is central to
  our strategy
• Information Management is based heavily on
  utilizing supplier information
• Re-packaged product uses the same item identifier
  as bulk product
• Integration between systems is based on standard
  EDI transaction sets
• The NDC number is used to create the Barcode for
  medications
• The Barcoded NDC number drives all the automation
  in the order, pick, pack, ship, and dispensing of
  medications

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Mercy Med/Surg Supply Flow

• Single Lawson System for all 19 hospital and over
  400 clinics
• Over 4000 users of the Lawson System
• Single Item Master
• Central Purchasing
• Central AP
• 60 of transaction are transmitted to vendor via
  EDI using GHX
• Central Warehouse uses Tecsys Warehouse
  Management System
• Internal Logistics Daily Delivery

No
Stock ?
Requisition Self Service
Central Purchasing
Yes
Central Warehouse
Customer
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What Mercy is Doing About Standards

• Based on the success in the pharmacy (Mercy Meds)
  program we want to continue integrate supply
  chain systems with clinical systems
• Mercy is in the process of implementing the EPIC
  clinical system in all our facilities
• The Supply Chain Item Master will interface to
  the EPIC system and update item information for
  clinical use one to one relationship
• Mercy is moving forward with the adoption of the
  GS1 standards for locations ( GLN) and item ID
  (GTIN)
• Mercy has targeted two of its top suppliers and
  GHX to build the necessary integration to
  implement the use of GS1 standards
• The first step is master data synchronization -
  location, item, and contract information
• Mercy is also working with software vendors like
  Lawson to build the functionality to make use of
  the GS1 standards

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What are the Targeted Benefits?
MANUFACTUR E R
PATI ENT
Benefits of Standards

• Supply Chain
• Fewer Invoice Discrepancies
• Reduced Labor
• Contract Compliance / Lower Cost

• Revenue
• Improved Accuracy on Billing
• Improved Revenue Collection
• Improved Cost to Charge Ratio

• Clinical
• Patient Safety (5 Rights)
• Reduced Labor
• Better Product Information

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Vision for the Future
Vendor

• Simplified item master update process supporting
  the information needs of each system

GS1 Data Sync
Mercy Item Master
Finance
Revenue
Clinical
Supply Chain
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Direct Supply Chain Impact of Standards

• In the Month of March the Price Discrepancy rate
  was 11
• At 11 this is 3,487 lines that were discrepant
• If the discrepancy rate was 5 that would mean a
  reduction of 1,901 lines of discrepancy

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Mayo Clinic Data StandardsApril 24, 2008
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Joe Dudas, Director of Accounting andSupply
Chain Informatics, Mayo Clinic

• As director of accounting and supply chain
  informatics at the Mayo Clinic, Joseph Dudas is
  responsible for implementing and optimizing ERP
  technology and business best practices.  He leads
  forums across Mayo organizations to drive
  strategic supply chain, accounting and research
  IT direction, standardization and best
  practices.  Mr. Dudas expertise was instrumental
  in Mayos ability to receive grant funding from
  the University of Minnesota to research
  applicability of RFID in a healthcare setting.
• Mr. Dudas serves as chair of the Healthcare
  Supply Chain Standards Coalition and participates
  in many other industry efforts to improve the
  healthcare supply chain, including AHRMM and the
  Coalition for Healthcare eStandards.  He is also
  a participant in the DoDs ongoing pilot testing
  the GDSN as a potential industry product data
  utility.
• Mr. Dudas brings more than 20 years of
  information systems experience in IT outsourcing,
  telecommunications, retail and healthcare. 
  Previous professional experience includes
  leadership roles in technology at RiteAid
  Corporation and EDS/ATT.
• Mr. Dudas holds an MBA in accounting and finance
  from York College of Pennsylvania, and bachelors
  in management information systems from Indiana
  University of Pennsylvania.

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Topics Covered

• What is Mayo Clinic Doing?
• What are our experiences to date?
• Why have we pushed so hard?
• How did we justify our initiatives?

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What is Mayo doing?

• Involvement
• CHeS, HSCSC,GS1
• SMI, LISN, Wal-mart
• Leadership
• Articles, Presentations,
• Chair, HSCSC
• Industry Pilots
• GLN, DoD

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What is Mayo doing?

• Current Implementations
• Master Data Management, Price Management
• Business Intelligence, Financial Statements
• Value Analysis
• Near Future
• Ecommerce, ERP
• Rebate Management
• Vendor Registration
• Recalls

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What are our experiences?

• The next phase of our maturity for the Mayo
  Clinic Supply Chain.
• Collaboration.
• Closer relationships
• Benchmarking
• Working Smarter.
• Workforce that understands the business processes
• Meaningful Financial Reports
• Category driven Value Analysis.
• End to End Rebate processes.
• SCM to Revenue Cycle.
• Constant Innovation and Improvement.

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What are the risks?

• Do nothing?
• Aging population will place more demands on the
  Healthcare Network.
• The slowdown of the workforce growth rate may
  make it more difficult for firms to recruit
  workers in the future, especially in periods of
  more rapid economic growth.
• A recognition that profit generation is necessary
  for a functional health care economy that covers
  the healthy and cares for the sick.
• Tangible shifts towards a consumer-driven health
  system offering value and choice.

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How did we justify our initiatives?
We didnt ask.
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Mayo SCM Technology Initiatives

• Contract Management
• Fully automated Contracting process.
• On-line Enabled.
• Elimination of Price discrepancies.
• Analytics tools that clearly describe sourcing
  and value and are operationally actionable.
• Data Management
• Ecommerce managed as a business function. System
  to system for all high value transactions.
  Others to be automated with alternative
  technologies.
• Easy to use and fully standardized, automated and
  synchronized master data.
• Enterprise Data Warehouse Reporting (reports that
  span the business as opposed to function).
• Clean data is an asset that has significant value
  (both internal and external).
• ERP
• Single enterprise system.
• Highly integrated with HR and Finance.
• SCM Support
• Independent and highly reliable POU and Logistics
  systems.
• Innovation.

Adoption of standards is philosophical. You
dont implement standards you buy into them and
make it part of your overall strategy.
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The Coalition

• Work with early adopters to implement as well as
  identify gaps in the GS1 system for healthcare
  and advocate for needed enhancements.
• Document the steps for adoption for future users
  ensuring consistent use of the recommended
  standards (How To Guide).
• Assist by providing input to the FDA on product
  data attributes, UDI packaging requirements in
  selection as well as process requirements for the
  UDI.
• Encourage global harmonization of UDI
  requirements.
• Work to coordinate and consolidate industry
  efforts focused on achieving standardization.

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Mayo Clinic

• Custom Account eliminated by end of 2010.
• Custom Product eliminated by end of 2012.
• 2008
• Letter to our vendors stating our direction.
• Change templates used to exchange data to utilize
  standard identifiers.
• ERP requirements for GTIN and GLN
• Transact utilizing GLN with early adopters.
• Exchange item master data via GDSN with early
  adopters.
• 2009
• Expand GLN adoption.
• Expand on GDSN for data exchange.
• Transact utilizing GTIN with early adopters.

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Conclusion

• We need to start thinking differently about
  standards.
• There is a lot you can and should do.
• Standards are part of creating the Supply Chain
  of the future.
• The ends justify the means.

"IN THE END, AMERICANS WILL ALWAYS DO THE RIGHT
THING--AFTER EXPLORING ALL OTHER ALTERNATIVES."
Winston Churchill
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Product Data and Synchronization Series Sponsors

• Association for Healthcare Resource Materials
  Management (AHRMM)
• www.ahrmm.org
• Coalition for Healthcare eStandards (CHeS)
• www.CHeStandards.org
• Healthcare Supply Chain Standards Coalition
  (HSCSC)
• www.HSCSC.org

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GS1 Healthcare US

• GS1 Healthcare US is a new industry group that
  focuses on driving the adoption and
  implementation of GS1 standards in the healthcare
  industry to improve patient safety and supply
  chain efficiency.
• brings together members from all segments of the
  healthcare industry to address the issues that
  most impact healthcare in the United States
• is one of twelve local user groups around the
  world that supports the adoption and
  implementation of global standards developed by
  GS1
• Join GS1 Healthcare US - Be Part of the Solution
• Lead adoption and implementation of GS1 standards
  in the U.S.
• Develop a common approach and use of GS1
  standards to achieve efficiency in U.S.
  healthcare and adjacent supply chain operations
• Share key learning's and best practices with
  other members
• Provide a local voice and ensure the needs of the
  U.S. healthcare community are met by the global
  initiatives of GS1 Healthcare
• Stay informed on what is happening in the global
  healthcare supply chain
• GS1 Healthcare US Workgroups
• Product Identification (GTIN)
• Location Identification (GLN)
• Global Data Synchronization Network (GDSN)
  Implementation
• Traceability Adoption
• Application / AutoID in Healthcare
• Learn more at www.gs1us.org/healthcare