5/3/2004JIT Vandy D2 Oct 7 6pm 1Just in Time- Inventory ControlOcto Barnett, M.D.Octo Barnett, M.D.Laboratory of Computer ScienceLaboratory of Computer ScienceMassachusetts General HospitalMassachusetts General HospitalDepartment of MedicineDepartment of MedicineHarvard Medical SchoolHarvard Medical SchoolJIT -Manufacturing Inventory PartsJIT -Manufacturing Inventory PartsInventory storage supply partsInventory storage supply partsLarge storage area required Large storage area required --cost storagecost storageMaintain inventory of parts in storageMaintain inventory of parts in storageIf dynamic manufacturing processIf dynamic manufacturing process))Existing parts out of dateExisting parts out of date))Delay in obtaining correct new partsDelay in obtaining correct new partsJIT InventoryJIT InventoryDynamic small inventoryDynamic small inventoryWork with supplier to get parts only when neededWork with supplier to get parts only when neededNo outNo out--ofof--date; no delay in obtainingdate; no delay in obtainingKnowledge Access - JITKnowledge Access - JIT““EvidenceEvidence--based decision making. Patients based decision making. Patients should receive care based on the best should receive care based on the best available scientific knowledge. Care should available scientific knowledge. Care should not vary illogically from clinician to not vary illogically from clinician to clinician or from place to place.clinician or from place to place.””----IOM Report: IOM Report: ‘‘Crossing the Quality Chasm: A new Health Crossing the Quality Chasm: A new Health System for the 21System for the 21ststCentury. Recommendation 4Century. Recommendation 4Medical SchoolConferences, CME, LecturesClinical ReportsMedicalRecordBooks, JournalsGuidelinesAdministrative IssuesDecisions, Decisions, DecisionsCurbside ConsultationJIT - Clinical KnowledgeJIT - Clinical KnowledgeSources of Clinical Knowledge Sources of Clinical Knowledge --In siteIn siteLong term memory of medical schoolLong term memory of medical schoolLong term memory of past experienceLong term memory of past experienceShort term memory of last few patientsShort term memory of last few patientsBooksBooksJournalsJournalsLectures, seminars, conferencesLectures, seminars, conferencesHallway conversationsHallway conversationsWing itWing itJIT-Physician as Information ManagerJIT-Physician as Information ManagerEvidence Based MedicineEvidence Based Medicine‘Best’ Clinical Practice‘Best’ Clinical PracticeGuidelines/Protocols Diagnosis/TreatmentGuidelines/Protocols Diagnosis/TreatmentAdministrative/ Paper Work TasksAdministrative/ Paper Work TasksInsurance issuesInsurance issuesLink Knowledge Access to WorkflowLink Knowledge Access to WorkflowLink Knowledge Access to RecordingLink Knowledge Access to Recording5/3/2004JIT Vandy D2 Oct 7 6pm 2TOS - Text on ShelfTOS - Text on ShelfLack of availability of appropriate textLack of availability of appropriate textMassive amount information in textMassive amount information in textTime consuming to find relevant contentTime consuming to find relevant contentText is not focused on specific issueText is not focused on specific issueInadequate indexingInadequate indexingOften outOften out--ofof--datedateIPA - Internet Provides AllIPA - Internet Provides AllMassive amount of informationMassive amount of informationVariable quality Variable quality --much is worthlessmuch is worthlessPoor authentication, reliabilityPoor authentication, reliabilityInadequate indexing Inadequate indexing --a keyword is not a concepta keyword is not a conceptOften not maintained up to dateOften not maintained up to daterecent review AHRQ recent review AHRQ --75% need updating75% need updatingPCOI - Primary Care Office in SitePCOI - Primary Care Office in SitePrimary Care Unit leadershipPrimary Care Unit leadershipEvidenceEvidence--based Medicinebased MedicineEasy to Use Easy to Use --rapid accessrapid accessProblem/ Issue Specific, Relevant, FocusedProblem/ Issue Specific, Relevant, FocusedOrganized, Indexed ContentOrganized, Indexed ContentAuthenticated, UpdatedAuthenticated, UpdatedWorkflow support and integrationWorkflow support and integrationFinancially supported by hospitalFinancially supported by hospitalKnowledge/Guidelines (Just In Time)Knowledge/Guidelines (Just In Time)Primary Care Guidelines Primary Care Guidelines Evidence based Evidence based MGH developedMGH developedSpecific recommendations Specific recommendations Patient Instructions Patient Instructions --consistent contentconsistent contentFormulary Formulary --drug informationdrug informationMedical CalculatorsMedical CalculatorsAlertsAlertsWorkflow SupportWorkflow SupportFormulary Formulary --insurance coverageinsurance coverageFormsFormsHow ToHow ToReferral InformationReferral InformationAdministrative Administrative --MGH eventsMGH eventsA Portal – One-stop Shopping A Portal – One-stop Shopping PubMedPubMedUp To DateUp To DateScientific AmericanScientific AmericanPDRPDRDXplainDXplainWhatWhat’’s News NewSEARCHSEARCHFEEDBACKFEEDBACK5/3/2004JIT Vandy D2 Oct 7 6pm 35/3/2004JIT Vandy D2 Oct 7 6pm 4Patient Instructions (cont)Patient Instructions (cont)5/3/2004JIT Vandy D2 Oct 7 6pm 5Independent Insurance CoverageUsers’ Sessions (per week) 10/24/1999 –4/24/2004Users’ Sessions (per week) 10/24/1999 –4/24/20045/3/2004JIT Vandy D2 Oct 7 6pm 6PCOI Survey Result Comparison for 2001 to 2003Importance of Web Site in Patient CarePCOI Survey Result Comparison for 2001 to 2003Importance of Web Site in Patient Care2003: 206 out of 294 surveys returned = 70%2002: 180 out of 257 surveys returned = 70%2001: 99 out of 139 surveys returned = 71%On a scale from 1-5 where 1=Of no use and 5=Very useful—“It helps me give much better patient care.”PCOI Survey Result Comparison for 2001 to 2003 Saves Time Per Day2003: 206 out of 294 surveys returned = 70%2002: 180 out of 257 surveys returned = 70%2001: 99 out of 139 surveys returned = 71%31% of users, or half of this 63%, said PCOI saves them 25-30 minutes per dayWhat Factors