burbano angelica

8/4/2019 Burbano Angelica

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MODELING THE ADOPTION OF IDENTIFICATION S TANDARDS IN THE U.S.

HEALTHCARE S UPPLY CHAIN

Angelica BurbanoPh.D Student – Dpt. of Industrial Engineering

University of Arkansas

Advisor Prof. Ronald Rardin PhD



OUTLINE

MotivationBackground

Research questionsProposed work plan

Literature reviewCausal loop diagram

Diffusion modeling frameworkConclusions

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MOTIVATION

This research topic emerged as a way to approacha problem I observed during my work as a graduateresearch assistant at the Center for Innovation onHealthcare Logistics (CIHL).

Data standards also referred to as identificationstandards have been around since 1974 when theUniversal Product Code (UPC) was developedwithin the grocery industry.

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MOTIVATION

Think about the check-out process at the grocerystore.

Currently the healthcare supply chain lacks ofidentification standards for the products that flow

through the chain and for the locations associatedwith this product flow.

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THE PROBLEM

The adoption of identification standards and itsassociated technology in healthcare supply chainhas been slow over the past twenty five yearsdespite the evidence of the benefits that can beachieved.This slow adoption process is preventing healthcaresupply chain from reaching the process efficienciesother industries have realized and most importantly,it is affecting the healthcare delivery process.

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OUTLINE





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Manufacturing Distribution Warehousing Usage Patient

Disposal

Manufacturer ProviderDistributor End User

Figure 1. Healthcare Supply Chain (Product Flow)Source: Adapted from EHCR 1996 p.3

HEALTHCARE S UPPLY CHAIN S D P h D

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Fragmentation



IDENTIFICATION STANDARDS

Unique identification of products and locations.

Identification standards are a building block for the

efficient product flow and its associatedtransactions on a given supply chain.

Many to identify a product:

Pharmaceuticals NDCMedical Devices and supplies UPNIndustry HIBCC, GS1 standards

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IDENTIFICATION STANDARDS S D P h D

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Manufacturing Distribution Warehousing Usage Patient

Disposal

Manufacturer ProviderDistributor End User

Figure 1. Healthcare Supply Chain (Product Flow)Source: Adapted from EHCR 1996 p.3

Product identifier

Location identifier



TECHNOLOGY

Technology allows capturing the product relatedinformation as it moves through the supply chainand also helps to store and process product relatedinformation as well as the transactions associatedwith it.

Auto Identification and Data Capture technology (e.gbarcodes and RFID)Information Systems (e.g Material Management

Information systems MMIS or ERP systems)

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Business Process

Transaction (messages)

Catalog

Classification

Identification

RosettaNet

HL7,EANCOM, EDI

UNSPSC

GS1 ( GTIN, GLN..)HIBCC

Internal

External

Betweentransacting

members

TechnologyAuto ID DC, InformationSystems, EDI Figure 2. Supply Chain Standards

Source: Adapted from Hubner 2008 p.108

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TECHNOLOGY

According a 2007 American Hospital AssociationAHA survey less than 16 percent of hospitals werefully using barcode technology for supply chainmanagement purposes; the use of RFID is lessthan 3 percent.Technology has been referenced as one of themajor barriers to identification standards adoption(Natchmann and Pohl 2009).

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P REVIOUS ATTEMPTS

1983 HIBCC was established to promote theadoption of identification standards.

1989 The use of barcode technology for point ofcare applications was promoted among hospitals.

1996 The EHCR study identified more than 6 billion

dollars on saving with the introduction of barcodedriven processes within hospitals.

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P REVIOUS ATTEMPTS

2004 FDA rule for human drug and blood productsmandates that manufacturers print a barcode (onedimensional) on every product at the unit of use.FDA Amendments Act of 2007 was signed into law;this Act includes the establishment of a uniquedevice identification system.2008 (25 years after the first attempt) An industrymovement towards GS1 standards system (GTIN,GLN) adoption was initiated.

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OUTLINE





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RESEARCH QUESTIONS (REAL WORLD )

What is preventing healthcare supply chainmembers and healthcare providers in particularfrom adopting identification standards and itssupporting technologies? What are the majorbarriers?What are the cost implications and benefits for the

healthcare supply chain members and stakeholdersto adopt identification standards? How can they

reach equilibrium?What actions (strategies, incentives, policies) are

required to increase the number of healthcaresupply chain members and healthcare providers

adopting identification standards?

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RESEARCH QUESTIONS (THEORETICAL )

How does the identification standards adoption anddiffusion process compare with the adoption ofother technologies within the healthcare industry ingeneral. (e.g. the diffusion of medical technologiesor Electronic Health Records EHR)?How does the identification standards adoptionprocess compare with the same adoption processin other industries such as retail?

How could existing diffusion models be extended ormodified to model the identification standardsadoption process?

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THE RESEARCH PROJECT

This research project will investigate theidentification standards adoption process withinhealthcare supply chain and develop a theoreticalmodel based on the diffusion of innovations theory;a system dynamics modeling approach will be usedto model this process.

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OUTLINE





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LR / CLD

A literature review includes healthcare supply chain,identification standards and its associatedtechnology, diffusion of innovations theory andsystems dynamics methodology.

The causal loop diagram will formalize the findingsregarding the possible causes (hypothesis) for theslow adoption process and will help to identify thefeedback structure of the system (healthcare supplychain).

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RELEVANT FINDINGS

Inter-firm diffusion of process innovations (Davies1979)Models for innovation diffusion (Mahajan andPeterson 1985)Inter and intra firm effects in the diffusion of newprocess technology (Battisti and Stoneman 2003)Information technology innovations: Generaldiffusion patterns and its relationships to innovationcharacteristics ( Teng et al 2002)

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RELEVANT FINDINGS

A model of the linked adoption of complementarytechnologies (Smith 2004)The effects on new technologies on productivity: Anintra firm diffusion based assessment (Fuentelsazet al 2009)Electronic Health Record adoption

Coordinating quality care: A policy model to simulateadoption of EHR (Otto and Simon 2009)

Systems analysis of Electronic Health Record adoptionin the U.S. healthcare system. Erdil, Nadiye Ozlem,Ph.D. Dissertation, State University of New York atBinghamton, 2009

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DIFFUSION MODELING FRAMEWORK

Theoretical development (model formulation)Simulation model

Interventions designExpected results

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THEORETICAL DEVELOPMENT

An adaptation of the diffusion theory (diffusion ofinnovations) and its associated mathematicalmodels will be required to capture the complexity ofthe identification standards adoption process withinthe healthcare supply chain.This complexity is related to the organizationalnature of the adopting members and the multipleset of innovations (technologies) to be modeled.

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BASS DIFFUSION MODEL S D P h D

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25Single population (member)Single innovation



DIFFUSION MODEL (MODEL FORMULATION )

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26Multiple members (Intra-firm diffusion)Contingent innovations ( Identification standards, Auto ID DC, IS)

Manufacturer

Distributor

Healthcare Provider



S IMULATION MODEL

The simulation model will be validated usingavailable industry data; the GS1 identificationstandards adoption process as a reference. Themodel will be calibrated to reproduce meaningfulresults according to the theoretical development.

The main purpose of the simulation is to test theimpact of different policy interventions (e.g. costsand benefits of each intervention, the impact onadoption rate over the time horizon by member )

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INTERVENTIONS DESIGN

It will be required to develop a mechanism toformulate interventions and also to implement andtest those interventions in the current VENSIMmodel.These interventions can include local, industryand/or government interventions. For example itcould be possible to explore the impact of an FDA aregulation such as the Unique Device Identification

UDI on the identification standards adoptionprocess within the medical device industrysegment.

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EXPECTED RESULTS

Results from the application of the proposed modelto the GS1 identification standards adoptionprocess should provide:

Better understanding of the current systemIdentification of the effect of different policies on thesystem as well as the definition of a possible equilibriumpoint ( if a 4 game players is defined )It will be possible to test for example if the currentsunrise dates for location identifiers by 2010 andproduct identifiers by 2012 can be achieved undercurrent conditionsAn industry adoption curve with an estimated timelinecan be developed (critical mass)

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Questions

[email protected]

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mailto:[email protected]

mailto:[email protected]

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