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![TMCNet: What's your app-titude? [Healthcare Purchasing News]](http://images.tmcnet.com/siteart/invisible.gif)
What's your app-titude? [Healthcare Purchasing News]
(Healthcare Purchasing News Via Acquire Media NewsEdge) Smart phone, tablet PC apps slowly nudging supply chain's head in the cloud
Apparently, there's an app f or just about everything. Send in the clouds.
Whether you're trying to equip your smart phone or tablet PQ you'll find many options to fill your megabytes and gigabits of memory, a virtual toy store of silly-to-sublimeto-uniquely-useful little programs.
In fact, Healthcare Purchasing News is inundated with media callouts and press releases touting this new mobile app or that one and why it's the best product since [fill in the blank.]
Certainly in healthcare, smart phones and tablet PCs represent the latest efficiency craze for clinicians to handle such tasks as scheduling, medical records, orders and prescriptions, diagnostic imaging (but not for actual diagnoses, mind you) and even patient vital signs, among others.
On the administrative side, C-suite financial and operations executives rely on their smart devices for quick and as-detailed-as-possible views on how the business of healthcare is running, using diagram- and digit-filled dashboards and databases, electronic scheduling programs, satellite GPS (global positioning system) and reporting tools.
Within the healthcare supply chain, however, the use of function-specific apps remains spotty, particularly if the supply chain professional cannot link his or her smart phone or tablet PC to the facility's materials management information system (MMIS) or supply chain enterprise-resource planning (ERP) module.
As a result, HPN tapped a number of supply chain professionals to gauge the breadth and depth of available supply chain-specific mobile apps, as well as how they're used to augment current information technology tools and improve processes.
What are the key trends? You have to dig a bit deeper into supply chain's component functions for relevant apps as supply chain leaders tend to rely more on general business apps to manage their own workflow. But experts largely agree that there's plenty of opportunity and promise to expand the scope of those must-have electronic digital assistants.
Happtique Inc., a subsidiary of GNYHA Ventures Inc., the business arm of the Greater New York Hospital Association, offers a healthcare-centric mobile application store geared highly for providers.
Happtique President Corey Ackerman acknowledged that provider interest in mobile apps may be booming, but supply chain has yet to catch the wave.
"From our review of the market there are very few healthcare supply chain apps, and also few supply chain apps in general," Ackerman told HPN. "We would like to see this change and expect it will in the future. Unfortunately, during the past year and in the immediate future, the focus of providers is understandably on [electronic health record] solutions, and hospitals are struggling to get those implemented."
Beyond cool, trendy
That said, some contend that smart phone and tablet PC apps, by and large, can be useful tools for managing supply chain operations - more substantial than merely looking "cool" or "trendy" because you're sporting the latest tech toy to text contacts and update your social network.
"From a sales perspective, don't underestimate the 'cool' factor," scolded Niklaus Fincher, vice president, VHA Inc., which offers members mobile supply benchmarking applications under the LYNX brand. "Even two years after its introduction, I still get lots of questions when I fire up my iPad about how it works and what I use it for. People just seem to want to play with the cool toy."
Fincher, whose team sells the VHA LYNX apps, marvels at customer reactions he sees at first sight. "My LYNX sales team uses our LYNX supply benchmarking applications to better understand member spend and proactively identify opportunities for cost reduction," he indicated, further noting that the market-centric app goes beyond GPO pricing. "When we pun up information that provides this level of market-centric info on our phones or tablets, our members or potential subscribers immediately begin to realize the impact [that] having this tool to carry with them anywhere, anytime could have on their organization."
Vance Moore, senior vice president, operations, Sisters of Mercy Health System, remains an avid iPad user who keeps his smart device routinely in tow. While he said he is not aware of any specific apps that really help supply chain leaders he admits the mobile platform can offer "tremendous benefit" if apps supported core functions.
"Smart phones could replace [radiofrequency] scanners and dynamic dispatching tools/' Moore posited. "Every smart phone has a camera and with apps like RedLaser, they can scan products or locations and provide real-time transaction-level information that could be processed and optimized to direct or dispatch supply chain personnel to the next most efficient task. This transactionlevel detail could also be used to track the productivity of the workforce and to establish work standards that will help in assuring the maximum utilization of all human and physical assets. This takes place every day in most professional warehouse management systems using RF-directed pick commands - we could enable highly productive and proven tools using a new input device that everyone carries."
Ackerman agreed. "In addition to being able to use mobile apps to link into the MMIS and ERP systems, we believe it would be helpful for mobile users to be able to use apps to compare products side by side from a price, clinical, and outcomes perspective," he noted. "We also expect to see more and more healthcare distributors and suppliers offer applications for their customers."
Moore admitted that they are not able to link to the MMIS or ERP, but can "sync" with their office suite of products, such as e-mail, contacts and calendar. "The exception to this is Concur for expense report management," he said. "Concur has built an app to make life easier using smart devices. Other healthcare solution providers need to adopt this consumer-centric approach. I see most internal systems as being very closed - not much time being spent on the interface - most time spent on developing more functionality."
Further, Moore isn't aware of suppliers offering any apps to support their products or services. "The one exception would be FedEx and UPS," he added. "We use their tracking system when necessary but it is usually not needed due to the service confidence we have with both firms."
At Los Angeles-based Keck Medical Center of USC, however, Jean Sargent, CMRP, CRCST, FAHRMM, director, supply chain, said she uses smart devices for access to the ERP, vendor product inquiries and links to various Web sites.
"This is a recent development that has improved operational efficiencies by allowing administrators to login to the ERP to perform activities such as approval of requisitions in between meetings," she said. "In the past the administrators would be approving the requisitions late at night."
Sargent touted the clinical benefits of supply chain-driven mobile apps. "I believe having the ability to scan a product and get information from a manufacturer's Web site immediately will have a significant impact for clinicians as they will have the ability to acquire pertinent product information quickly," she said. "This change will significantly improve patient safety."
Mary Starr, assistant vice president, AdvantageTrust, HealmTrustPurchasingGroup, Schaumburg, IL, foresees several ways apps might be appropriate and useful in supply chain "If I'm away from my desk but need some specifications on a product, an app to look at a product catalog would be very helpful," she said. "I think an app for some ordering processes might be appropriate, as well as a dashboard app that when tied in to your MMIS can enable you to pull out measurement data that could be monitored from wherever a person that needs to see it is."
But for now, Starr remains content with business apps, such as Concur for travel and Amex. "I would say the biggest impact on my work life with the smartphone, is travel," she admitted. "I can check in to my flight, change seats, check flight status on the airline app. I have a GPS on the phone and I can use Concur mobile to take pictures of my receipts and file those on the road, something that would have had to wait until I got back to the office. It really has made my work during travel as productive as being in the office."
Down at Greenville (SC) Health System, Executive Director of Supply Chain Operations John Mateka, FAHRMM, confessed that smart phone and tablet PC use within his organization remains limited, but he believes the tech offers opportunities and options. He noted that their biomedical engineering team uses mobile apps to download repair schematics for equipment service, for example, and the doctors use tablets for online patient information when they conduct rounds.
"We were using the phones for our couriers for GPS but moved away from them for a customized tracking device," Mateka said. But supply chain could use mobile apps to connect clinicians to their products more quickly. "I can see the day when we interface to a tablet for RFID whereby nurses and clinicians can pull up an item and request its location, or select an item from a picture menu and request the item from central distribution," he added. "I can also see where we could provide a picture menu screen of various supplies typical to a particular diagnosis, and the nurse can simply click on what specific supplies she will need for the patient - that list sent to central distribution that picks and assembles the supplies to be delivered to the patient room."
Micro MMIS?
Moore highlighted elements of his mobile app wish list that would prove useful to supply chain leaders, managers and other professionals. In fact, he said he foresees apps that link to MMIS and ERP systems to provide higher-level service information.
"If a nurse goes to a supply location and finds it empty, she could scan the locator and the device could tell her the closest location within the hospital where the product could be selected," he said, theoretically designing his own app. "It could also tell the nurse what a viable alternative to the product is - if a clinical cross map were determined - and could possibly suggest an alternative. At that point, the device could ask if she would like the product delivered or will she retrieve the product herself. This could trigger data indicating how much time nurses spend searching for supplies. It could also automatically trigger a stock-out notification dispatching a replenishment order to the unit. If the nurse decides to go to the alternative location and select the product, the app could record the transaction and automatically make the financial and operational transaction indicating a different department sourced the product."
A potential mobile app could address price identification, according to Moore. "A user could scan the product and the price, location and suggested alternatives with the same information could be highlighted," he said. "This information could help clinical leaders make sound financial decision without negatively impacting care.,"
Finally, an app could help locate "dynamic assets," Moore noted. "Almost all transport systems track their assets using real-time feedback on the asset's current position," he added. "The system could proactively route the assets based on real-time traffic conditions thereby avoiding unnecessary delays."
Jumping the gun
John Freund, president and CEO, Jump Technologies Inc., acknowledges the value mobile apps offers the supply chain.
"Smart phones and tablet PC apps are tremendously useful for managing healthcare supply chain operations," Freund asserted. "Smart phones are nearly ubiquitous and tablets - bothiOS and Android - are starting to outpace traditional PCs. It's a mobile, alwayson, and more importantly, always connected and accountable world, and we are seeing major shifts in adoption in the healthcare vertical, specifically with the onset of new business productivity apps that betters inventory and supply management, order processing, and proof of delivery.
"Look at a device as simple as an iPod Touch," Freund continued. "It has all the power of an iPhone without the expense of the phone. For $200 you can put a powerful computer in the hands of a nurse or materials manager that has applications that help manage the supply chain right at the point of use. A nurse may have an app for recording patient vitals, drugs provided to the patient and any supplies used in the room. All might be different apps yet all exist on a platform that allows the facility to decide what apps are used. No longer does the nurse or materials manager have to carry a bulky proprietary device with them. They carry a device that can run more than 500,000 different applications in their pocket just like they would their phone."
As a result, Jump Tech offers the free JumpTrack proof-of-delivery (POD) and signature capture app for the iPhone, iPad and iPod Touch, while the Android system smart phone uses a cloud-based service that easily integrates with back-end systems, according to Freund. In addition, the JumpCart inventory management system is designed to help customers reduce their requisition-to-order costs and eliminate maverick spending by cutting rush shipments, avoiding procedure delays that are caused when the proper inventory is not available as well as reducing carrying costs for lower on-hand inventory.
Further, Jump Tech serves as the conduit between the smart device and the MMIS or ERP. "We manage the data between the device and our cloud as well as the data between our cloud and the MMIS or ERP system, allowing data to flow from the MMIS system to the phone and back again," Freund said. "All our solutions work either on smart phones, tablets or inexpensive bar code scanning technology costing less than $100."
VHA's mobile apps support VHA PriceLYNX, which is the supply benchmarking application, VHA PharmaLYNX, which is the pharmacy benchmarking application, NovaPLUS, which is Novation's privatelabel program, Supplier Diversity, which is Novation's database of diverse suppliers, and Spend Essentials, which is an automated med/surg contract maximization tool, according to Fincher.
Fincher credits the need for proximity as the underlying reason why mobile apps make sense.
"As patient care moves to the bedside or even non-traditional areas of delivery, such as non-acute settings, supply chain questions and decisions will have to follow the care path," he noted. "Mobile apps allow caregivers and their supply chain support resources to access immediate/ accurate information whenever and wherever it's needed.
"There's a significant amount of supply chain related business activities, such as product evaluation or purchase negotiations that occur outside of the typical office environment, such as trade shows, dinners and/ or site visits," Fincher continued. "Mobile apps allow instant access to information which can significantly impact the outcome of the activity."
Familiarity and ease-of-use also contribute to pending growth.
"As the need for supply chain cost management awareness continues its migration to all areas of a healthcare organization, mobile apps provide low-cost, easily accessible tools for caregivers to access information in formats and on equipment that they are used to using, such as their iPhones and iPads," Fincher said. "This ease of use is critical to their acceptance and participation in cost management programs. Additionally, users inform us they feel empowered by having access to information that ultimately impacts patient outcomes and satisfaction."
Moore urged smart device development to get smarter. "My belief is we are sitting on a very flexible device, and very few folks are enabling the industry to use," he said. "For the most part, smart devices are toys or entertainment devices. I believe the next wave of devices will be robust enough to supply the needs of consumers at both work and play."
For an additional sidebar, ''The app mil see you now", visit www.hpnonline.com/inside/2012-02/1202-PS.html
FDA eyeing mobile apps
With the proliferation of smart devices (e.g., smart phones and tablet computers) the Food and Drug Administration is turning a watchful eye on the use of mobile medical apps. But the federal agency only is targeting several types in its guidance.
Specifically, FDA is issuing regulatory requirements to those mobile medical apps that either are "used as an accessory to a regulated medical device" or "transform a mobile platform into a regulated medical device."
FDA's "guidance does not specifically address wireless safety considerations, classification and submission requirements related to clinical decision support software, or the application of quality systems to software. The FDA intends to address these topics through separate guidance(s)."
The FDA's guidance does not address the following apps because the agency does not include these apps in its specific definition of mobile medical app:
* "Mobile apps that are electronic 'copies' of medical textbooks, teaching aids or reference materials, or are solely used to provide clinicians with training or reinforce training previously received. These types of apps do not contain any patientspecific information, but could show examples for a specific medical specialty. Examples of such medical text books include the electronic Physician's Desk Reference and similar reference materials that are typically used as part of course instruction and are implemented as electronic books. Exemplary teaching aids and reference materials include: flash cards or quizzes that are used for training purposes or as reference material (e.g., with preloaded medical images, conditions, pictures, graphs, etc.); slideshows of common conditions; lists of medical terminology; and review materials that are to be used by medical students during training. (In contrast, mobile apps that allow the user to Input patient-specific information along with reference material to automatically diagnose a disease or condition are considered mobile medical apps).
* "Mobile apps that are solely used to log, record, track, evaluate, or make decisions or suggestions related to developing or maintaining general health and wellness. Such decisions, suggestions, or recommendations are not intended for curing, treating, seeking treatment for mitigating, or diagnosing a specific disease, disorder, patient state, or any specif ic, identifiable health condition. Examples of these apps include dietary tracking logs, appointment reminders, dietary suggestions based on a calorie counter, posture suggestions, exercise suggestions, or similar decision tools that generally relate to a healthy lifestyle and wellness.
* "Mobile apps that only automate general office operations with functionalities that include billing, inventory, appointments, or insurance transactions. Examples include: Apps that determine billing codes like ICD-9 (international statistical classification of diseases); medical business accounting functions and aids that track and trend billable hours, procedures, and reminders for scheduled medical appointments or blood donation appointments; apps that automate functions such as collecting patient histories that replace paper-based entry; apps that enable insurance claims data collection and processing; and other apps that are similarly administrative in nature.
* "Mobile apps that are generic aids that assist users but are not commercially marketed for a specific medical indication. Examples include apps that use the mobile platform as a magnifying glass (but not specifically for medical purposes),11 recording audio, note-taking, replaying audio with amplification, and other similar functionalities.
* "Mobile apps that perform the functionality of an electronic health record system or personal health record system."
11 Medical purpose magnifiers are classified devices and regulated either under 21 CFR 886.5840 - Magnifying spectacles ("devices that consist of spectacle frames with convex lenses intended to be worn by a patient who has impaired vision to enlarge images"), or under 21 CFR 886.5540- Low-vision magnifiers ("a device that consists of a magnifying lens intended for use by a patient who has impaired vision. The device may be held in the hand or attached to spectacles").
Source: FDA, July 2011
(c) 2012 KSR Publishing
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