Health Systems Group Seeks GS1 Standards

Speakers at GS1 Connect in June shared several business reasons to standardize product identification. Health systems representatives spoke of efficiencies that standardized identification could bring in product and patient identification and tracking as well as improvements in billing, ordering, and inventory. Many spoke of the need for standards, such as the GS1 family of standards. These include the GS1 Global Trade Item Number (GTIN) for identifying products, the GS1 Global Location Number (GLN) for identifying locations, and the GS1 Global Data Synchronization Network (GDSN) for sharing standardized product information.

Members of the Healthcare Transformation Group (HTG) spoke of the need to advocate for data standards using “one voice,” explained Mayo Clinic’s Karen Wolfe, who is responsible for GS1 data standards implementation acron across Mayo organizations. Other systems in the HTG include Geisinger Health System, Kaiser Permanente, Mercy Health/ROi, and Intermountain Healthcare.

“We want to drive change across the supply chain,” explained Wolfe. “We need product on time, at the right place, for the right patient. We feel that GS1 standards will enhance patient safety.”

Clinician confusion could be eliminated, explained Michael Innes, Kaiser Permanente’s Program Director, Procurement and Supply Chain Processes, during his presentation. Showing the audience a label with three bar codes, Innes said that “confusing package labels directly impact patient care, safety, and quality.” Users get frustrated with multiple codes, he said, and may just resort to manual processes.

Wolfe asked her audience to imagine the manual processes that health systems must manage today. “We cannot tell you on a day-to-day basis the products we use. They are often one-offs,” she said. “If we use GTINs, we know we are speaking about the same products, and data synchronization enables end-to-end transactional efficiency.”

Explained Dennis Black, director of e-Business for BD, who spoke later in “The Perfect Order and Beyond for Healthcare” with Curtis Dudley, vice president of integrated business solutions at ROi from Mercy Health on their collaboration: “We know of a hospital system that had over 350 separate records for BD in its Vendor Master. We would have expected that they would have had one or perhaps two records for BD. Most hospitals also store and utilize alternate product numbers that they or a distributor have assigned to a supplier’s product. Think of the confusion this causes, not only in transactions, but also in the event of a recall. Healthcare providers could improve their Vendor Master and Item Master by implementing GLNs and GTINs.”

Standardized automatic identification could improve efficiency and accuracy, speakers suggested. “GS1 standards will give us perfect order with little human intervention,” said Wolfe, referencing BD and Mercy/ROI’s end-to-end program to integrate GLNs and GTINs. “With data synchronization and GTINs, we can be able to forecast.”

Health systems also see economic benefits, especially as reimbursement rates continue to decline. Explained Innes: “We see operating costs associated with manual interventions for recalls and by clinicians. We see lost revenue when items are not captured. The inability to scan causes us to leak revenue. We also face a cash flow issue when additional time is needed to close a patient log because clinicians need time to manually log product information. The longer a patient file stays open, the longer the billing time. And if I cannot pay vendors on time and guarantee continuity of supply, I could see a credit hold, which could impact patient safety.”

If nurses can scan at the point of care, however, “they can bring in accurate data to billing processes and electronic health records,” said Innes.

Mercy/ROI and BD had started working together on standardized coding to take “the mess and waste out of transacting and discovered that bar codes could be scanned and effectively utilized all the way to the patient,” explained Black and Dudley.

BD assigns a GTIN to all packaging levels and prints the associated bar code on most or all levels of packaging. Those codes are scanned and recorded at each GLN as shipments move along the distribution path from BD to ROi. Codes are also scanned inside the health system, including at the patient bedside, where they are captured in patient electronic health records.

Such collaboration has resulted in significant improvements. “We’ve reduced the outstanding days payable by 30%, and we’ve reduced discrepancies by 73%,” said Black. Added Dudley: “Collaboration between trading partners eliminates daily orders.”
And there are quality assurance benefits, too. “Scanning GTINs and production data during the manufacturing and distribution process ensures right product, right package, etc. It also enables accurate tracking of lot numbers and expiration dates,” said Black.

Audience members did express concerns about the costs of uniquely identifying products at every packaging level. While marking medical devices with bar codes is typically straight forward, some products may present challenges. For instance, the label may be smaller than the bar code, existing labeling requirements may already take up all available package space, bar coding may cost more than the products themselves, some packaging materials may be difficult to print on, and there may not even be a package on which to print.

Also, challenges persist with determining the need for GTINs for all kit components and units of measure. Many types of kits exist in the healthcare industry. Not all of the components in a kit have GTINs assigned to them or even have a package on which to print a bar code. If GTINs needed to be assigned and printed, packages may need to be created for products that currently don’t need them, such as gauze, swabs, etc. In addition, scanning bar codes at the kit and each level could also cause products to be double counted, leading to inaccuracies.

Finally, audience members also raised concerns about being ready to share GTINs and GLNs, but finding few prepared trading partners.

Wolfe acknowledged the concerns, saying that the HTG as well as GS1 Healthcare are looking at solutions and best practices.

Nonetheless, she suggested that companies using GS1 standards might begin to gain a competitive edge. “If GS1 standards are used and prices are higher, we may just select it,” she said.

“What we want is for suppliers to register their products in the GDSN and develop a long-term strategy to commit to work with the HTG to resolve issues and move forward with adoption, added Wolfe. “Utilize provider GLNs, assign GTINs at all levels, and mark products.” She later told the audience: “Inefficient and inconsistent data is costing you sales!”

Added Innes: “We cannot afford to do business with vendors that do not adopt a standard.”

Standardized auto ID could also help the healthcare industry itself sustain growth, speakers suggested. “How does the supply chain support more inventory and more locations with more customers without adding labor? Automation,” said Dudley.

Healthcare effectiveness could potentially be tracked, too. Noting that standardized product identification can be used in “the recall piece, the research piece, and the reimbursement piece,” Innes said that such data could be used in patient-centered outcomes research. “If you could farm data in cancer treatment, you could make links,” he said. Dudley agreed, speaking about feeding such transactional data into the EPIC patient care database: “The next big thing that comes out of this is outcomes-based analysis.”

Said Wolfe: “I am improving the processes that will one day be needed for me. [We need to] move standards forward so that we are improving safety for ourselves.”

For more details on the Healthcare Transformation Group, please visit www.healthcaretransformationgroup.com.

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