innovate arkansas

Nurses become nurses to care for people - help ease their pain and make them healthy. Yet health-care industry analysts estimate that nurses spend more than half of their working hours entering data on a computer or searching for needed materials. This reality, says Ron Rardin, epitomizes the shortfalls of health-care delivery in the United States.

"The reason the delivery system works at all is because of the dedication of doctors, nurses and other professionals," says Rardin, Distinguished Professor and the John and Mary Lib White Systems Integration Chair in Industrial Engineering. "If they didn't make the effort, the system would often fail. But we need to free up these highly trained professionals to care for people and perform the tasks they're trained to do. As important, we need to assure the right materials are in the hands of doctors and nurses where and when they are needed."

The health-care delivery system Rardin describes is too frequently a world in which medical records and life-saving drugs are lost, identical patient information is requested and documented numerous times - sometimes by inappropriate or overqualified personnel - and materials and equipment are unavailable, overstocked or duplicated because clinics do not have an adequate system to manage inventory. These kinds of failures have compromised quality of care and patient safety and led to significant waste, all of which have contributed to rising health-care costs.

"It's a huge problem," says Rardin, who accepted the White Chair - he and Chancellor John A. White have been friends for many years - in January but has focused on healthcare engineering for the past 10 years while at Purdue University and the National Science Foundation. "We're all so impressed with advancements in medicine - pharmaceuticals, imaging, implantable devices and things like that - that people don't appreciate how deeply flawed the health-care-delivery system sometimes is. And that is where you actually bring all of this wonderful technology to the patient."

As director of the new Center for Innovation in Healthcare Logistics, Rardin will lead an interdisciplinary team of researchers who will investigate the supply-chain network and information and logistics systems within the broad spectrum of U.S. health care, from acute-care hospitals, physicians' clinics and pharmacies to long-term care facilities, laboratories and distance-medicine facilities. Throughout their research, the overriding question will be: How can information and logistics technology make these systems and processes more efficient and improve health-care quality and safety while saving money?

Rardin and other industry experts already know that technology - or lack of it - is a big part of the problem. With arthroscopy, ultrasound and wonder drugs, consumers find it difficult to believe that U.S. health care suffers because of inadequate investment in technology. But that's the truth, not so much with medical technology such as pharmaceuticals, surgical tools and diagnostic and monitoring equipment, but with software and other information technology that, as Rardin says, "deliver" the benefits of medical technology to patients. For example, 75 to 80 percent of all patient records exist in paper format. In contrast, Rardin says, the banking industry spends, on average, four times as much on information technology to deliver its products to consumers.

One thing information technology can provide - but too often doesn't in the health-care industry, Rardin says - is the ability to follow material around and know not only what it is but where it is supposed to go and exactly how much of it is needed. By whatever method, tracking and product visibility are critical components of any service organization, regardless of whether it's a private company trying to turn a profit or a government office delivering postcards from Hawaii. With a sophisticated understanding of the supply-chain network, corporations like Wal-Mart Stores Inc. and Federal Express have mastered logistics. Technology - tracking software, barcodes and radio frequency identification - are among the tools that have made this possible.

The College of Engineering and the Sam M. Walton College of Business have a core of researchers specializing in supply chain, logistics and RFID technology. For the most part, their research has not been connected to the health-care industry. One of the primary goals of the center is to harness this expertise. For example, as an initial investigation target, the center will work with researchers in the Walton College's RFID Research Center to discover whether RFID tags, barcodes and other visibility solutions can improve the flow of materials within and between hospitals, outpatient clinics, pharmacies and other facilities.

"We want to understand the supply chain from end to end, manufacturer to patient," he says. "It's so important to see the flow of clinical supplies, medical devices, pharmaceuticals and diagnostic materials. All these things are possible if you have some kind of computer-readable capability. In many cases, we do not have that today, so human beings follow paperwork and re-enter data in computers to do tracking. Errors are bound to be introduced."

In addition to adapting logistics and supply-chain solutions from other industries, the center's researchers will identify and replicate proven applications within health care. For example, Rardin's team will investigate a hospital group that has begun to practice what researchers call "postponement" with surgical packs, or pre-packaged sets of surgical tools and equipment.

Most surgical units or operating rooms use generic packs, one-size-fits-all packages for all surgeons performing a procedure. The problem is each surgeon may perform the same surgery differently than others, which means that different tools and equipment are necessary. With surgeons using a generic pack, many of the contents are wasted and have to be thrown away or donated to medical facilities in developing countries. To address this problem, at least one hospital group created a variation of the generic pack by including a smaller set of essential tools, such as scalpels and clamps. This group postpones the delivery of more advanced tools and adds them later as customized packs, the contents of which depend on the surgeon's specific approach.

"It may not seem like a big deal," Rardin says, "but these packs are complex and expensive. In the end, these modest modifications can have a big impact.

"We know there are many smart applications out there. We just need to find them, replicate them and demonstrate their superiority and efficiency to other groups. We want to add targeted research to overcome gaps and roadblocks. If this can be done, patients, providers, and the nation as a whole will see major benefits."

(This article was originally published in the November, 2007 issue of the University of Arkansas' Research Frontiers magazine.)