The operating room supply chain consists of two interdependent components: products and information. The products are all the consumables, implants, and instruments used in surgery. The information is indication for use (when to use the products) and instruction for use (how to use the products). Sounds relatively simple, right?
The complexity of the O.R. supply chain is initiated by limited resources (high cost of products) and remote resource location (limited space for on-hand inventory in an operating room). This complexity is compounded by fault intolerance (mistakes are bad for patients, and can cause lawsuits).
(As a result, device sales reps have often become overly integral in the O.R. supply chain process - which will be addressed in our next article.)
The actual point of use in the operating room is primarily within the sterile field. Some products used are pre-sterilized, and in packages that can be scanned and traced to origin of manufacture. Most implants, however, are in removed from their packaging and placed in trays, and sterilized for availability in the surgical field. Their usage is recorded manually, usually over several steps, and then manually entered into software at multiple points. The data can be inaccurately recorded, as the part numbers are long, complex, and may not be clearly marked on crowded implant trays. Rotating break schedules for nurse and surgical technicians can add to the confusion. As a result patient implant data is often incorrect. As mentioned, a device rep is often on hand to help make sure the usage data is more accurately recorded.
Examples of implant usage tracking from the sterile field: The Head of the Snake. Note the confusion (scratch outs, incorrect numbers, haphazard and duplicate entries).
Manual recording of implant usage cascades into multiple manual transfers and multiple manual inputs of the data...
Let’s be clear: manual recording, manual transfer and manual data input in the operating room is the start of an very expensive problem, by some estimates costing the healthcare industry billions. It is the “head of the snake”.
Now involved as part of the supply chain process, the device rep is often tasked with ordering, filling, and otherwise making sure the sets are properly restocked - sometimes with limited or no checks and balances. If the hospital is busy, the rep is often managing these tasks for many implant trays every day. This results in a long, costly, manual O.R. implant supply chain (details of which which were outlined in our previous article "Healthcare's Billion Dollar Problem"). This process leads to discrepant billing, excess inventory, slower payment, and higher transaction costs.
It also results in huge conflict of interest: commissioned sales reps managing million dollar service lines for the hospital. Most major, urban hospitals are still reliant on this model.
“Rep-centric” O.R. implant supply chain: long, manual, error prone, and costly.
The point is that the entire management of orthopedic trays throughout their usage cycle is manual. The entire process hasn’t really changed much in 50 years, despite the rest of the world (and all other departments in the hospital) adopting digital management of assets and supply chain. The cost in incomplete or inaccurate implant counts, excess inventory, and lost time through the inefficient management processes is wasteful and very expensive for the global healthcare industry.
So, how is the snake killed, and this costly problem solved?
It must start with the head: manual data recording at the point of use. It’s the source of the entire problem. And the solution is scanning at point of use - automate the OR implant supply chain.
Why hasn’t automation/scanning been adopted in the OR?
For two main reasons, one cultural, the other technological. Culturally, the O.R. is a walled off, isolated environment. Best business practices that work in other departments are slower to arrive in the operating room due to its insular nature. The second reason is that standard optical scanning technology has not worked well for use in the sterile field. Barcodes don’t survive the rigorous reprocessing steps that sterile instruments and implants must be repeatedly exposed to. As a result, the entire OR implant tracking process remains archaic, relying on pens, paper, and stickers to record usage. The technology to scan in the sterile field has simply not been available.
Summate Technologies has developed Velox™, the first total scanning system for the operating room. The solution is comprised of patented, microchip- based marking technologies (called TAGS) which are applied to implant trays, cloud software (Velox) for recording implant usage via scanning the marks, and proprietary hardware which enables scanning and tracking all facets of implant usage directly from the sterile field at point of use by the surgical technician. Summate’s TAG marking solutions have solved the barcode problem by proving durable through hundreds of reprocessing cycles.
For the first time, the key weaknesses of the implant supply chain - manual recording, multiple manual data transfer and data entry steps - have been eliminated. Additionally, Velox scans and tracks all consumables handed into the field. Summate is the first company that offers scanning of everything used during surgery. Scanning at point of use is the gateway to efficient supply chain management for any industry, and is used in hospitals everywhere but the operating room. Scanning at point of use brings all the benefits of digital data management to the O.R. supply chain, including greater accuracy, cost transparency, and more detailed cost tracking and analysis. It also helps to improve patient care, by freeing up O.R, nursing staff from time consuming and tedious data entry tasks during surgery.
Velox takes the current supply chain from 4-6 manual, error prone and time consuming steps and reduces it to one automated, accurate process:
The Velox OR Supply Chain: Simple, efficient, accurate.
How it works…
So, how does Velox work? It’s actually quite simple. Summate's proprietary marking technologies (TAGS) are used to mark individual implant locations on trays (screws/plates etc), so they can be scanned. The Summate TAG marks are microchip-based, and certified to be FDA sterility confident and guaranteed for 2 years. They wont fade, chip, and stop working like barcodes. Summate’s proprietary laser reading wand can be sterilized, and used in the sterile field by the surgical technician to precisely scan the usage of implants as they are selected during the procedure. All implant dispositions (add to patient, return to tray, and wasted) are controlled from the field as well.
Additionally, all consumables that are passed into the sterile field during surgery, from biologics to suture, can be scanned as well. Velox software runs on our unique Einstein data cart, adjacent to the field. Einstein is battery powered, wireless, and has a narrow space foot print due to a vertically mounted touchscreen. It has been designed to fit into an already crowded operating room.
Velox is an open solution, and works with any device implant tray, regardless of vendor.
Operationally, using Velox is simple, and its benefits are many:
It’s all about the Data: Data integration at HCP/Surgery Center
Studies show that 46% of patient implant logs are incorrect. Scanning at point of use is more accurate, and eliminates the multiple manual entry steps that cause these errors. Its used in every industry, and in every other department of the hospital, EXCEPT the O.R. Scanned data can be transferred to hospital EHR and inventory management software (MMIS) seamlessly, eliminating several manual recording and data entry processes. The data can even be sent to the vendor for resupply.
Data for the OEMs: Summate TotalConnect™
In addition to the shorter supply chain benefit, the data transferred to the OEM/Device company though use of Velox comes with huge and transformational information that will enable the OEMs to better manage their business. We call this data service Summate TotalConnect.
In the traditional “sales rep” centric model prevalent in the OR implant business today, the most precious market data (“who is using what for which procedures”) has been trapped at the sales rep level, and loosely quantifiable, as the rep calls in amalgamated orders. Using Velox, all orders arrive at the OEM instantly and electronically along with the surgeon and procedure information. This important data will allow the OEMs to develop deeper and more accurate information with regard to their customers , and be able to immediately note trends and develop far more detailed marketing strategies.
Another problem that has plagued the device industry is detailed knowledge of asset turns. Again, this knowledge is trapped and vaguely known at the sales rep level. Companies have invested hundreds of millions, perhaps billions, of dollars in consigned field inventory, and have little or no real granular data as to ROI on this investment. The Velox software can track set turns and ROI for consigned inventory down to the penny, in real time. This information should be incredibly valuable to the OEMs for asset management.
Automated OR Supply Chain and Digital Set Management: Benefit Summary
In summary, every other industry in the world, and every other department in the hospital, manages their asset supply chain digitally, with point of use scanning being the gateway to greater efficiency. There is no reason that all hospitals can’t adopt this technology, better manage their own implant supply chains, and reap the benefits. Some hospitals have made significant progress in this regard, and others almost none.
And with the obvious benefits to the OEM device companies, they should be eager to assist and help in the rollout and integration process. As the HCP market will demand that Velox be a platform and not a “siloed” solution, its important that the license be open to all OEMs and suppliers. Its a total win-win for both participants.
With regard to HCPs and OEMs, Summate’s Velox solution would be an additional tool for the former, and transformational for the latter. It would provide greater efficiency and cost savings for both. The operating room is typically the biggest profit center for a hospital. Managing this supply chain digitally would result in greater profits for both parties.
Its time for the operating room and the entire device industry to put “Scan in Its Plan” with Summate Technologies.
Contact: Phil Sayles