If healthcare organizations are truly focused on enhancing quality and customer service, streamlining operating efficiencies and improving the bottom line, then it would seem that automated surgical instrument management should already be in place in their facilities – or, at the very least, on their radar screens.

While it’s no surprise that budgets are tight and purchases are scrutinized in virtually every healthcare organization, facilities that have allocated funds for comprehensive automated instrument management systems would agree that it’s money well spent. When looking at the tens of thousands of devices in hospital inventories, each costing $50, on average, and the costs associated with hunting down and replacing lost instrumentation, it’s easy to see why.

It’s been shown that lost or misplaced instruments can cost a 500-bed facility roughly $200,000 annually. What’s more, surgical delays that can stem from incorrectly assembled or unavailable instruments cost hospitals roughly $1,000 per hour, on average.

"As a manager, automated instrument management is something I just can no longer live without. I can’t begin to explain how much it’s done for us," raved Michael Mancebo, manager of material processing for Reid Hospital and Healthcare Services, Richmond, IN, of its automated tracking solution, AlexGold, by TGX Medical Systems. "It’s definitely made our job easier. It’s helped in terms of accountability and facility-wide visibility, and has improved quality on so many levels."

Reid Hospital is hardly alone in its decision to automate. While recent figures aren’t available regarding the percentage of U.S. hospitals using automated instrument management systems (a 2004 Lawson Software survey revealed that only 27% of respondents had an automated surgical instrument and tray tracking solution in place), vendors agree that adoption is finally going more mainstream.

"Every month, more and more hospitals are embracing automated surgical instrument management," said Steffan Haithcox, industry marketing director, healthcare, Lawson Software, adding that success stories that came from facilities that use the technology have helped spur the increasing interest and push automation beyond A hospitals and into B and C facilities as well.

Of course, success stories aren’t the only factor driving the more widespread acceptance. Each year, it seems, instrument management solution providers are building more flexibility and functionality into their barcode-based systems to help facilities further drive down costs and realize a faster return on investment. Less comprehensive tracking solutions offered free of charge or for a modest fee from instrument manufacturers and service providers are also making it easier for facilities to board the automation bandwagon.

Scanning the options

Few can argue that one of the greatest benefits of automated instrument management is its ability to provide an accurate snapshot of current inventory and follow its location across the organization with a few simple strokes of the computer keyboard. Such visibility can significantly reduce unnecessary instrument replacement and precious time spent searching for missing instruments, and put a stop to the so-called "blame game" that often goes on between departments.

These days, more instrument management systems have the capability of tracking to the individual instrument level, via adhesive barcode labeling (the InfoDot), laser etching or TherMark laser marking, which laser bonds a barcode onto a device and creates a smooth, permanent mark (The CensisMark, offered by Censis Technologies, is an example). Despite the multitude of benefits of unit-based barcoding – such as being able to track an individual instrument’s use (right down to the patient on which it was used), location, and processing, repair and maintenance history – the practice may not be for every facility because it can be costly and labor intensive.

"Tracking to this level can slow down the overall process and increase the financial commitment of the system. As the technology expands and more players come into the marketplace, it is a safe assessment that this will continue to evolve and become more affordable for the hospital," said Michael Good, CEO of TGX Medical Systems, Carmel, IN, adding that AlexGold is capable of tracking to the individual instrument level.

To meet the needs of those that do want to track to the individual instrument level now, as well as those that may want the option in the future, instrument management software vendors have stayed committed to providing flexible solutions.

"We have a broad range of capabilities and individual instrument tracking is one of them," said Clay Cannady, head of sales, marketing and business development for Mequon, WI-based Material Management Microsystems. The company’s Sterile Processing Microsystem solution works in conjunction with the InfoDot.

"The goal is to provide a solution that matches each customer’s needs. Some may want to manage instruments down to the individual unit level, while others may only want to track high-volume, high-dollar instruments like scopes. Others may currently not want to track to that individual level at all, but may want to in the future."

Facilities interested in unit-based tracking may be pleased to learn that the barcoding methods themselves are becoming more flexible – and durable. Key Surgical’s InfoDot, for example, has undergone some improvements to reduce the likelihood of premature flaking. "The first InfoDot we brought to market was durable, but still not as rugged as we wanted it to be," said Peter Huck, general manager, Key Surgical Inc., Eden Prairie, MN. "We have recently developed a dot with a different material that is far more rugged." The second generation InfoDot is now being trialed in several facilities and Huck said the company hopes to officially roll out the new version March 1.

Facilities that haven’t yet decided which marking process they want to adopt can keep their options open. Some solutions, such as Lawson Software’s Surgical Instrument Management system and Cardinal Health’s IMPRESS Scan Surgical Instrument Management System, work with either technology.

"We believe it’s important to provide customers with that type of flexibility," said Flavio Marin, senior manager of marketing for Cardinal’s IMPRESS Scan surgical instrument software.

Customers may find that blending the two barcoding technologies is the best solution. "There are definite strengths with both the InfoDot and direct part marking, so a hospital may want to use the dot on some instruments and the mark on others," Huck explained. He noted that while direct part marking with TherMark laser marking technology can be costly and may be difficult to read on some instruments, customers are understandably drawn to its permanency. " I think using the dot and the mark in conjunction may be the way to go." In the future, Key Surgical may form strategic partnerships with those that can offer direct part marking to customers that want it. "I envision us being able to offer both and provide our customers with a turnkey solution," Huck noted.

Scanning for opportunities

Hospitals that assume automated instrument management is limited to just tracking a device’s location may need to take a closer look. In fact, today’s systems are so advanced that solution vendors are now shying away from the limiting "instrument tracking" definition altogether.

"Customers are demanding to see the track record of a system, including the support behind the product, the customer base, the ability to evolve the product with new technology, the ability to interface with other products in the environment, and most importantly, the ability to have a major impact in the environment, including streamlining the process, tracking the productivity and identifying the bottlenecks," noted Good.

Capturing processing and sterilization cycles is one key function of comprehensive automated instrument management systems. Vendors such as Censis Technologies, Material Management Microsystems, Lawson Software, TGX Medical and Cardinal Health, for example, offer robust sterilization modules with the capability of storing records electronically and generating printable reports. With sterilization tracking, facilities can simply scan barcoded instruments or trays and quickly and easily capture critical data from each load, including its content, cycle times, biological indicator results and even the sterile processing professional operating that load.

"This electronic archiving makes it possible to get rid of those bulky three-ring binders that require regular, time-consuming updating and can easily result in errors," explained Blair Myers, vice president of sales and marketing for Censis Technologies Inc., Franklin, TN.

Not only does such comprehensive sterilization reporting help meet stringent regulatory record-keeping requirements, it can play a vital role in infection control by allowing facilities to pinpoint possible processing errors and track an instrument that may have been contaminated directly to a patient.

"I don’t think many people fully understand the positive impact that automated instrument management can have from an infection control and risk management perspective," Cannady said. "Having high-level connectivity and broad visibility into instrumentation can go a long way toward protecting healthcare organizations and their patients."

Recognizing the value of sterilization tracking, processing equipment manufacturers are beginning to build automation connectivity into their products. Censis’ Censitrac and Material Management Microsystems’ Sterile Processing Microsystem solutions, for example, can interface directly with STERIS systems, allowing users to easily track virtually every parameter associated with that load.

Electronically tracking instrument repairs and maintenance is also a snap with today’s automated solutions. Leading instrument management systems can track utilization and repair or individual instruments and sets, and even electronically flag devices for preventive maintenance service.

"Facilities can be easily burned if they don’t have a reliable system in place to track repairs," stressed Marin. He explained that some instruments may be serviced more than necessary and others not enough, and some devices sent out for repairs may somehow wind up unaccounted for or relocated to the wrong area. Cardinal’s IMPRESS Scan Surgical Instrument Management System is brand neutral, meaning it can track any instrument – regardless of the device manufacturer and repair company used by the facility. The newly enhanced IMPRESS solution is also Web-based and wireless capable, enabling customers to use handhelds and quickly access data in real time from virtually any location.

Olympus America has become the latest instrument manufacturer to join the automated instrument repair tracking pool. As part of the vendor’s service portal, provided free of charge to all Olympus customers, the newly released repair and service tool allows customers to electronically submit service orders and track instruments in real time, 24 hours, seven days a week. The solution even allows customers to print out an airbill.

"We recognize that customers don’t have a lot of time, so we wanted to provide them with a tool that can help them use their time more efficiently," said Patricia Strohlein, customer solutions manager, Olympus America Inc.

As Dan Scalzo, Olympus’ executive director of production operations, explained, the system is the same one Olympus uses to track products on the shop floor. "We just took a piece of that manufacturing execution system and made it available to the customer." The service portal allows customers access to as much information about their instruments as they need. With an established account and password, customers can securely submit and approve orders, access repair history and even pinpoint where a device is in the repair process. Beyond repairs, the service portal gives customers enhanced inventory and purchasing visibility, according to Scalzo.

Surgical instrument and service provider Teleflex Medical, Research Triangle Park, NC, is also making big changes to its instrument management solution offerings in an effort to better meet the needs of its customers. The company will be sunsetting its Trakker Pro instrument tracking system and partnering with Censis Technologies to provide customers with the Censitrac system.

"Software is not Teleflex’s primary strength and we decided our solution was no longer providing customers with the [high-level] functionality that they needed," said Ivars Ivanov, product manager for instrumentation at Teleflex Medical. "This strategic partnership with Censis will better complement and strengthen our own instrumentation and product offerings. It’s a unique partnership that will greatly benefit our customers."

Pushing the boundaries

Another key advantage of instrument tracking is the ability to trace loaner instruments across a network of facilities.

Material Management Microsystems has become focused on providing its customers with "multi-site database functionality" to give facilities broader visibility of loaner items. "With the multi-site database functionality, customers can work off of a single database and maintain complete control of their audit trail. If you’re at Hospital A, for example, you can see all items that were loaned to Hospital C."

The benefits of automated instrument management don’t end there, either. Solution providers are building in even more value by incorporating new functionalities and modules that can operate seamlessly with one another. Taking a whole supply chain management approach, Lawson Software, for example, has built three enterprise-call products that share the same, scalable, wireless platform. In addition to the SIM solution, Lawson customers can also access (via desktop or laptop computers or handhelds) the Par and Cycle Counting and Receiving and Delivery platforms.

"Surgical instrument management is one component of overall supply chain management. We have become committed to being a one-source solution for our customers," Haithcox said, adding that through the Supply Chain Management Suite, customers can benefit from end-to-end resource optimization – all with a user-friendly interface and single sign-on.

In the future, the demand for such modularity and scalability is sure to continue, particularly as facilities proficient in automation look to broaden their current applications and those new to computer-based tracking seek out systems with add-on modules that can maximize their long-term investment.