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Source: INTALERE BEST PRACTICES COMPENDIUM: Supply Chain/Data Management or Supply Cost Efficiency
The difficulty in monitoring, track and replace expiring and obsolete medical supplies were costing Bell Ambulance thousands of dollars annually in overhead. Bell Ambulance was stockpiling supplies that had a limited shelf life to avoid the running out of crucial items. This led to a great deal of wasted capital and an increased the required amount of physical space to store the extra supplies.
Bell Ambulance implemented a multi-faceted approach to lower overhead costs and reduce waste caused by the expired supplies. SKUs were prioritized consistent with company objectives, using the appropriate number of product categories and leveraging the investment to maximize fill rates. Safety stock levels were updated dynamically, with levels for each category based on the financial goals of the business, which served to reduce safety stock inventory and out-of-stock situations, and increase revenue. A central supply office was developed to ensure all equipment is well maintained, inventory levels are verified and items with approaching expiration dates are placed on more frequently used ambulances.
Successful implementation of centralized ordering and the stocking processes have resulted in maximizing efficient and cost-effective purchasing and storage solutions. Medical supply purchasing decreased by 8.5% in the first fiscal year while call volume increased by 5.5%.
ABOUT BELL AMBULANCE, INC.
Bell Ambulance is the largest Emergency Medical Transport company in Wisconsin. The agency is headquartered in Milwaukee. It has a fleet of 60 emergency vehicles and a staff of 350 employees. Bell Ambulance responds to 70,000 medical calls annually. It is a progressive, client-oriented company devoted to providing high-quality emergency and non-emergency medical services. Bell Ambulance began using Operative IQ in 2009 to control their medical supplies and equipment.
SOURCE: BOUNDTREE UNIVERSITY
Author: Robert Avsec, Battalion Chief Robert Avsec (Ret.)
Today’s complex EMS environment requires administrators to constantly juggle issues like tightening budgets, drug shortages, strict governmental regulations and a highly engaged and connected staff — all while operating in a litigious society. Using yesterday’s approach to inventory management and supply and logistics is no longer an acceptable practice .
There are several significant aspects to automated inventory control and management for today’s EMS agencies, in both the public and private sectors. Having a reliable, effective and efficient inventory management system can help an organization reduce costs, limit waste, improve employee relations and limit liability. It can also positively impact patient care by having the right supplies and drugs available when needed .
For some time now, private-sector EMS agencies have used automated solutions to improve their fiscal bottom line by reducing costs and limiting waste. Increasingly, public-sector EMS agencies are seeing a similar need as their local funding from government or donations from stakeholders have declined or remained stagnant.
EMS agency leaders cannot continue to rely on emotional appeals to their stakeholders to justify their fiscal needs. The trend in local governments is for transparency and accountability to show taxpayers where and how their money is being spent .
EMS agencies across the board are also facing more demanding requirements for reimbursement from medical insurance companies, Medicare and Medicaid for the supplies and drugs used when rendering patient care. The health care environment is rapidly changing with reduced reimbursements, new government regulations and an increased focus on compliance. This added complexity makes managing billing and coding in house much more challenging .
Inventory control and management software benefits
Current and developing technologies in ICM can enable EMS agencies to improve both their efficiency and effectiveness in a variety of ways including, but not limited to :
Preventing medical inventory from expiring or being overstocked
Centralizing inventory control among departments and vehicles
Improving EMS medical staff productivity and performance
Ensuring that every ambulance is fully equipped with life-saving medications and devices
Logging the movement or usage of medical inventory
Inventory control to prevent narcotics diversion
Diversion is the theft of any pharmaceutical to be sold or traded for personal gain. Resale of narcotics is not limited to common street crime but also can involve Medicare fraud, theft from other providers, organized crime and a host of other crimes .
In its simplest form, detection of the loss of pharmaceuticals is a basic inventory control function. The three variables are replenishment of warehouse or central inventory, documented usage, and replenishment of in-station or in-ambulance inventory. Depletion of inventory is fairly predictable over time and can therefore be forecast as well .
Here is a common sense, simplistic example of monitoring inventory: You order what you use. There is no reason to order anything more than at the rate you use it and by using percentages of increase, the variances become highly recognizable. Use percentages because in drug inventories, units may not raise a flag .
For example, an increase of 10 units of morphine in this months requested inventory for Station #6 may not seem out of line compared to the stations ordering history, but if those 10 additional units of morphine represent a 15 percent increase over what’s previously been ordered each month that might be cause for a closer look.
Electronic tracking of supplies
Barcoding has become the basis for the majority of ICM systems on the market today. A barcode-based system streamlines the process by enabling an agency to track the life-cycle of any item: from the initial receipt of an item at the warehouse; the distribution of the item into the supply chain such as sending it to a specific EMS station; use of the item for patient care. Key inventory management and control functions that lend themselves to barcoding include :
1. Managing Inventory of Standard Medical Consumables
Keep it simple by barcoding and tracking standard inventory items by location, number and quantity. Track a variety of standard stock inventory like bandages, gauze, and more.
2. Tracking Medication Inventory
Categorize medication using batch-lot numbers to efficiently and effectively keep track of expiration dates. Having an accurate picture for medication ins and outs, as well as on-hand quantity and reorder levels, can ensure that each EMS vehicle has the right medication inventory on board when an emergency strikes.
3. Serialized Inventory Tracking
Track chemicals and oxygen tanks individually using serial numbers to meet government mandated requirements, and to better prepare yourself when serialized inventory items are needed.
Electronic medication dispensing systems
Cart-mounted electronic medication dispensing systems, also known as med carts, have been a fixture in most medical facilities, such as hospitals and nursing homes, for many years and are now making their way into the EMS realm. Keeping medications under lock and key is an inventory security control measure for sure, but it’s not an effective strategy for managing and controlling how those medications are used.
Electronic medication dispensing systems provide benefits for both EMS providers and managers. Providers benefit from:
Secure, automated access to narcotics and supplies
Better adherence to controlled substance policies
Intuitive and easy-to-use software to accurately and completely document usage
Integration of usage into the patient care/billing report
The management/ownership benefits of an electronic medication dispensing systems include improved:
Compliance with state and DEA regulations for medication storage and dispensing
Inventory control and dispensing of narcotics
Control of EMS provider access rights
Inventory tracking and documentation of drugs used in patient care
Billing accuracy for medications used in patient care
One of the top components of inventory control and management is biometric security, which uses an individual’s biometric finger print to verify all transactions. This prevents someone from making false transactions or supervisors or managers having to make sense of illegible paper signatures. For added speed and security the biometric reader can also be used to login to inventory control software.
Beyond paper-based data collection and information management
In addition to inventory control and management, today’s electronic information management systems for EMS operations can include a host of other data collection and reporting features that improve an EMS agencies efficiency and effectiveness. One example is performing vehicle inspections with an electronic check sheet. If the inspection check sheet is integrated with inventory management and fleet maintenance software it can greatly enhance an agency’s operational intelligence. By replacing time-consuming paper check sheets crew members can be more accountable for supplies and equipment. All information captured during the inspection processes can be used to manage and report on an agency’s operations performance and needs [6,7].
Another example is the use of a web-based inventory check sheet to conduct inventory of on-hand supplies. Expiration dates on medical supplies are also captured to ensure that inventory is safe and ready for administration. On-hand inventory is balanced against par stocking levels to automatically generate supply requests. Optimally those supply requests are sent electronically to the supply room and processed based on an agency’s operational procedures.
The equipment used by EMS providers to provide patient care, particularly biomedical equipment such as defibrillators and medication pumps, represent a significant financial investment by the agency. Keeping track of that equipment as it moves through the operation is a critical risk management activity.
Electronic asset tracking enables end users to verify that equipment checked out to a station or vehicle is indeed at the location or report the missing equipment. If equipment is subsequently located, they can add it to their inspection and automatically transfer ownership to the new location or vehicle allowing missing assets and assets in motion to be recovered. If an asset requires maintenance the user can also record the maintenance while in the field using the check sheet.
Logging supplies by call
Using electronic reporting also enables the EMS provider to capture the supplies used on a per call basis. Crew members can enter the run number or ePCR number and enter the supplies used on the call. Once completed, the vehicle’s inventory is updated and a supply request is created. These electronic call records can later be used to report on supply usage and matched up with an agency’s ePCR records for quality assurance reviews.
General inspection questionnaires
Electronic reporting programs on the market today enable an agency to create customized questionnaires for any type of location or equipment inspection. These questionnaires are a basic element to any inspection process and provide supervisors and fleet managers with timely alerts on anything from narcotics usage to vehicle mileage and repair orders.
Fleet management integration
Fleet managers can receive information from electronic reporting check-sheets that will provide them with vehicle mileage, operating hours and any repair orders in real time. This makes planning scheduled maintenance and handling off-schedule repairs much easier.
Before you get started
Before purchasing any software vendor’s product, it is useful for an agency’s leadership to conduct a self-assessment to answer some key questions.
Why do we need to collect and analyze data?
What data should, or must, be collected?
Who will be responsible for entering the data?
How will the responsible parties enter the data?
These are important internal assessment questions. Far too often software purchasing decisions are made by those in leadership or technology positions within an organization without much thought about one of the most important components in any automated system: the end user who needs to integrate use of the software with their primary mission of patient care.
A majority of the data that most EMS agencies need to collect and analyze for their ICM originates at the level in the organization where the services get delivered. The earlier in the process that an agency’s managers gain input from these stakeholders, the greater the chance that whatever reporting software is eventually chosen will be the right one.
About the Author
Battalion Chief Robert Avsec (Ret.) served with the Chesterfield (Va.) Fire & EMS Department for 26 years beginning as a firefighter/EMT; he retired as an EMT-Cardiac Technician (ALS provider) certified by the Commonwealth of Virginia. During his career he was an active instructor, beginning as an EMT Instructor, who later became an instructor for fire, hazardous materials, and leadership courses at the local, state, and federal levels, which included more than 10 years as a Contract Instructor with the National Fire Academy. Chief Avsec earned his bachelor of science degree from the University of Cincinnati and his master of science degree in Executive Fire Service Leadership from Grand Canyon University. He is a 2001 graduate of the National Fire Academy’s Executive Fire Officer Program. Since his retirement in 2007, he has continued to be a life-long learner working in both the private and public sectors to further develop his “management sciences mechanic” credentials. He makes his home near Charleston, W.Va. Contact Robert at Robert.Avsec@FireRescue1.com
1. 4 ways to better manage EMS inventory http://www.ems1.com/ems-products/ems-data-management/articles/1876952-4-ways-to-better-manage-EMS-inventory/
2. Avsec, R. 5 steps to buying fire department reporting software. FireRescue1.com http://www.firerescue1.com/fire-products/emergency-response-software/articles/2010807-5-steps-to-buying-fire-department-reporting-software/
3. McKesson. EMS Medical Billing & Revenue Cycle Management. http://www.mckesson.com/bps/solutions/services/ems-medical-billing-and-revenue-cycle-management/
4. ASAP Systems. Barcode Inventory System for Fire Rescue & EMS.
5. nMed. Prescription Drug Theft & Pharmacy Security.
6. ASAP Systems. Barcode Inventory System for Fire Rescue & EMS.
7. Operative IQ. Electronic Check-sheets.
Source: EMS1 BrandFocus Staff, EMS1
There’s no doubt that public safety companies led by those who have served in the field have a unique advantage when it comes to product development, especially for the emergency medical field.
This is certainly true at software innovator EMS Technology Solutions, which has several EMS veterans on its C-suite team, including Vice President Shane Garrison. We asked Garrison about his career and how a firefighter/paramedic can use his or her field experience to develop the right products for the EMS industry.
When did you know you wanted to be a paramedic?
My grandfather and uncles were firefighters. I had been around fire stations growing up, and like most young boys, I liked the fire trucks and seeing the firefighters work.
My grandfather asked me when I was in college, “So what are you thinking about doing?” When I was unable to provide a clear answer, he mentioned the fire department was hiring. He said it would be a good fit.
I went to an EMT course because that was something that the department was starting to require. As soon as I stepped foot on my first ambulance for a clinical rotation, I ran my first true emergency call. It was a head-on collision. I was assigned to assist with taking care of some of the less critical patients. I really didn’t do that much, but I knew that I was making a difference and I was needed.
From that first call, I was hooked. That was 27 years ago, and I still have a passion for taking care of patients.
You are co-founder of Puckett Emergency Medical Services, based in Cobb County, Ga. What are the challenges of running a private ambulance service?
Probably the biggest challenge of building a successful private ambulance service has been the ever-changing reimbursement rules and regulations that must be navigated.
The profit margins are very thin in the ambulance business. You must bring your A game every day in this business. There is very little room for error.
In 2007, you founded EMS Technology Solutions. What has this endeavor taught you about leadership?
Sometimes the best way to lead is to just get out of the way. Great teams are made up of people with different skills. As a leader, sometimes you must realize that someone else is a better quarterback than you are. Give them the ball and let them go to work.
This is how teams win – putting the right people in the right positions at the right time.
You are a 27-year EMS veteran. How has technology changed the industry?
In my opinion, technology has absolutely changed the industry for the better.
Technology has improved patient care. The flow of information throughout the call process has improved response times, decreased expenses by allowing us to better manage unit hours and has improved patient outcomes by allowing us to share information with the receiving hospitals prior to our arrival.
Twenty years ago most agencies were not utilizing GPS Systems for routing, transmitting 12-lead EKGs or using electronic patient care reports. In today’s EMS environment, it is rare to not see these technologies being utilized by most services.
I feel that we have just scratched the surface of what technology will do for the EMS industry in the future. As battery technology becomes smaller and the devices and data becomes faster, we will see more advancements in EMS.
Telemedicine in the EMS environment is happening today and will become more common place.
I see the things like RFID technology that our development team has married together with Operative IQ, and I am amazed at how an entire ambulance can be inventoried in just a few seconds.
How has Operative IQ changed operations management?
Operative IQ has harnessed the massive amount of data that can be gathered from an agency’s inventory and vehicles.
It is providing that data to supervisors and administrators so they can get a clear picture of what’s going on with their operations.
Operative IQ is cutting down the nonproductive time used to manage vehicles, stations and supplies, cutting costs and limiting the risk and liability of operations by providing accountability and clear records.
How does Operative IQ help serve the evolving tech landscape in EMS?
In today’s environment everything moves much faster. Demands on your services are greater, expectations are higher, and the amount of equipment and the supplies used in managing an operation are enormous.
Operative IQ has been able to lead and adapt to the changing landscape to serve hundreds of EMS and fire departments, helping them gain control over their operations by harnessing the data, reducing costs and better managing risk.
What are some of Operative IQ’s main features?
Operative IQ is a modular system, so it can be used with the smallest of departments all the way up to the biggest of the big. There are four main components:
What is the greatest lesson you learned about using technology for EMS?
If you are going to survive in health care, you need to embrace technology. It’s no longer an option.
Technology is going to continue to evolve, and if you are not engaged now, you will find it difficult to get up to speed later down the road when competitive pressures make it difficult to run a profitable operation.
Centreville, MD – April 13, 2016 – Queen Annes County DES implemented IQ Genius, a vehicle based RFID asset and inventory tracking system, on 5 of their ambulances in the fall of 2015 and has already validated three of the critical use cases for using RFID technology to track equipment used in providing patient care.
Queen Annes County DES responded to a structure fire that resulted in a civilian being rescued. This was a critical patient and a lot of equipment was taken off the ambulance and brought into a chaotic scene. As they prepared to transport the patient, EMS Lieutenant Kevin Brenner glanced up at the IQ Genius RFID unit and noticed the equipment status light was GREEN. This green light provided a great sense of relief indicating that all of the RFID tagged assets were on the unit before leaving the scene.
On a separate occasion an oncoming crew noticed a bag was missing from a unit. Immediately Lieutenant Brenner was able to use IQ Genius to locate the missing equipment. A quick look at asset management data in Operative IQ revealed the last READ location of the bag. The crew was able to drive to that address and retrieve the equipment. This allowed us them to narrow their search and save a lot of time looking for missing equipment.
Ongoing the IQ Genius system enables lightning fast pre-trip inspections of tagged inventory and equipment. Reducing the time it takes to prepare an ambulance for service.
Kevin Brenner is the EMS Lieutenant for Queen Annes County DES and has provided leadership for the deployment of new technology, including IQ Genius RFID, to aid in EMS operations management.
It’s amazing to hear how Operative IQ is transforming the way our clients manage operations. We love to draw on this excitement when developing new applications, always seeking innovative ways to bridge the physical and virtual worlds we work in today. We are excited to share how IQ Mobile and IQ Status Board are bridging the gap between our worlds.
IQ Mobile, a powerfully simple tool for inventory management. Allowing you to use your mobile phone or tablet to manage inventory, assets and purchases. Laser barcode readers are available for most mobile devices as well as a small laser barcode reader that can be worn on a lanyard or clipped to your belt. The IQ Mobile application is included with your Operative IQ service. Talk to your Operative IQ Account Manager about barcode scanning equipment options. Read More
IQ Status Board brings key data to the big screen while adding mobility to access your status board from a mobile device. Status boards are customized to your requirements allowing you to display information that is critical to your operation’s managers on a beautiful HDTV. If your not in the office or shop, no problem you can pull the status board up on your phone. Talk to your Operative IQ Account Manager about creating a IQ Status Board for your operation. Read More