Getting to the point

"HMS MM POI has been a great tool so far, a 100% improvement. We're able now to quantify in dollars lost revenue and lost cost - data that I had no way of quantifying before. That's the good thing about HMS; there's a lot of data in the HMS system that you can extract to fit your needs. POI has given us the ability to perform an audit to tell what items have been lost so we can see where improvements need to be made."

Several years ago, HSC Medical Center was experiencing some very common business issues: misplaced inventory items, inaccurate charge capture and disorganized emergency department. But when Alan Haefele, director of Materials Management, came to HSC in 2006, he knew just what to do. He implemented HMS Materials Management-Point of Issue (MM-POI) online purchasing and inventory system to improve efficiency with real-time management of vendor performance, inventory control, purchasing activities and patient charging.

Organization profile

Hot Spring County (HSC) Medical Center
Location: Malvern, AR.
Type of Care: 72-bed acute care
Number of Sites: Hospital, Home Health

The challenge

When I came to HSC in 2006, implementing Materials Management-Point of Issue (MM-POI) was my number one priority. There were several business issues we were trying to address, and MM-POI seemed to offer an answer to those.

We wanted to accurately capture charges, which is always a facility's number-one focus - to be correct when billing patients. Before MM-POI we weren't even able to quantify lost charges. With POI you have less opportunity to make those mistakes than you would with the paper or sticker system. It's easier for a nurse to scan than to peel a sticker off and wonder where that sticker goes, because if you're not careful you could put a duplicate charge on a patient bill, and you're going to get calls from patients if you do that. Other concerns with the sticker system is nurses will walking out with stickers plastered to them, which is basically lost revenue walking out your door.

Accurate documentation was also important. When you are dealing with patients and IVs and such, accurately capturing their use in the patient chart is critical; there is no room for error. MM-POI, we knew, would satisfy that need as well. In addition, we had an increased level of inventory that wasn't necessary. By implementing POI we knew we would be able to isolate those issues and bring areas to a reasonable inventory level, while providing nursing and other departments with the documentation that we didn't need as much inventory.

Preparation begins

Before implementation, we needed to make sure that everything was correct: that our product was correct, that unit measures were correct, that all our contracts were correct, that our prices were loaded, that everything was current and that everything was in line with the specs HMS provided in order to have a successful launch. These are basic things you would do to have a good solid inventory, but those things can get out of hand if you don't do regular maintenance.

The biggest challenge was with our Charge Code Master; a lot of items had the same charge code. We had to identify those items and get the correct unique charge codes. We wanted this process to go smoothly, so we analyzed our inventory thoroughly to make sure we had what we needed in order to scan and for things to go well.

Achieving buy-in

Anytime there's change, there is usually resistance. You have to sell the process change as a benefit to the users. People are comfortable with continuing with things as they are. What the nurses, for example, didn't realize is that the existing process was quite cumbersome. They had to take the exchange cards, whether they were stamping them or putting a sticker on them: put them on each patient chart and put them at the bedside, then pull labels and put the labels on the charts. Compounding that was the fear of walking out with the labels and not knowing where they went.

POI addresses these challenges while streamlining the process. Each unit has a designated POI storage area well organized with standard bin locations and bar codes and stations with a scanner and touchscreen monitor. Users go into the POI area and touch the area that they are in, pull the patient up, select that patient, scan the label on the item bin with the wireless scanner, take the item and clear the area before taking the item to the patient. It's simple - just like going to Wal-Mart. The unit secretary no longer has to take care of the cards, and nursing doesn't have to figure out where the stickers go. Once they realized how easy it was, they loved it.

The resistance was still there, but we presented it as a change to benefit everyone. That's where upper management support is so important. Their support of POI comes from the opportunity to increase revenue while decreasing costs, but their communication of how the change specifically impacts the users is how buy-in is achieved.

ER makes it work

I thought the hardest obstacle I was going to have to face was ER; there were a lot of different items in a lot of different areas. The biggest resistance we encountered was convincing them of the wisdom of pulling all of the items out except for a few critical items and putting them into one area. I had worked in a hospital where that was successful, so I sat down with the ER manager and we discussed how everything was going to be set up and where everything would be and what we could do to make it easier for them. We agreed to try it, because one good thing about the system is that we can always change it, always alter according to our needs.

We got all the supplies from all the different areas in the different rooms, four in all, consolidated into one area. But I left their inventory levels high because I needed to give them that comfort level. We took the barcode stickers, laminated them and affixed them to the wall, so if they used something, they would just scan the item number on the wall. At the end of the day it's replenished from the stock room based on the par level, and we get the report.

Eventually, we got to the point where we could produce reports and show them what was and was not moving. Leadership was the key: they took ownership because they realized it was doable. All the rooms still have the essential things, to start IVs and O2 tubing to administer oxygen, etc., but we were able to take the number of items they had in those rooms and cut it by three-quarters and take the number of units and cut it by three-quarters.

To deal with ER's trauma situations, together with nursing and ER we created a trauma cart with everything they need in its own POI location. If they have a trauma, they roll that cart into the room so they can concentrate on taking care of the patient first. After the patient is stabilized, they pull the cart and check the remaining items against the par level and scan the bar coded items, which automatically charges the patient accordingly while also depleting the inventory and alerting us to how much is needed to refill that cart. They don't have to worry about stickers or lost charges.

Our ER has been our most successful department. As far as dollar amounts, they have less cost loss and less revenue loss, and they're the busiest area, not volume but as far as urgency is concerned. The leadership has a lot to do with that success. Their experiences clearly demonstrate that POI allows you to concentrate on patient care while solving a business issue, accurately capturing charges.

Looking forward

POI has been a great tool so far, a 100% improvement. We're able now to quantify in dollars lost revenue and lost cost, data that I had no way of quantifying before. That's the good thing about HMS; there's a lot of data in the HMS system that you can extract to fit your needs. POI has given us the ability to perform an audit to tell what items have been lost so we can see where improvements need to be made.

When we started, we did an audit every other day, and now we're down to once a week and once a month in some areas, because they're doing so well. We graph the audit findings on a spreadsheet and present it to upper management where it really gets attention. That puts it in perspective. Everybody has taken ownership, and we're all working toward the same goal. We have the reports to show that scanning results in benefits.

Advice from HSC

Change can be challenging, but clear communication paves the way to the successful implementation of a new project. If your facility is looking to implement MM-POI, you may want to heed the following advice from HSC:

• Educate everybody up front.
  • Everybody at every level has to have the knowledge, down to the most minimally involved tech.
• Everybody has to buy in and understand the benefits.
  • The change is the hardest part, but once buy-in is achieved the system will eventually sell itself.
• Administrative support is key.
  • When the process change is embraced by and advanced by leadership, the facility will be the better for it.