GE Healthcare and FS Mobile Asset Management White Paper

Reduce Your Cost Whilst Improving Patient Care & Satisfaction: Inefficient Use of Mobile Assets is Costing Australian Hospitals more than $60 million a year

A Frost & Sullivan White Paper

in collaboration with GE Healthcare

www.frost.com

http://www.frost.com

CONTENTS

Reduce your costs whilst improving patient care and satisfaction www.frost.com

I. Executive Summary..............................................................................................................................

II. About this White Paper.........................................................................................................................

III. Definitions...........................................................................................................................................

IV. Public Hospital Expenditure in Australia.............................................................................................

V. The Cost of Inefficient Mobile Asset Management..............................................................................

VI. Current Processes for Managing Mobile Assets................................................................................

VII. Costs Associated with Mobile Asset Management.........................................................................

VIII. Other Costs Associated with Inefficient Mobile Asset Management.............................................

IX. The patient experience is impacted.................................................................................................

X. Adoption of Mobile Asset Management Solutions............................................................................

XI. Systems and Processes to Cut Through the Clutter........................................................................

XII. Appendix.........................................................................................................................................

Contact..................................................................................................................................................

Legal Disclaimer......................................................................................................................................

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I. EXECUTIVE SUMMARY

Inefficient use of mobile assets is a crucial

issue in the Australian hospital system,

resulting in higher costs, inefficiencies in

patient care, and poor patient experiences.

Mobile assets (such as infusion pumps,

oxygen cyl inders, intra-venous ( IV)

pumps, ventilators/breathing devices, and

pulse oximeters) are increasingly used in

Australian hospitals as an integral part of the

patient care process. Many of these devices

are utilised in multiple areas of hospitals,

and shared across different wards and

departments.

However, in many hospitals across Australia

mobile assets are being ineffectively utilised.

Few hospitals have tracking or location

systems in place for mobile devices, and

the inability to locate the devices when

needed is creating significant inefficiencies

in hospital operations, with a major impact

on operating costs.

Public hospitals in Australia spend as much as $250 million a year on buying, renting and maintaining mobile assets. Inefficient management of these mobile assets cost hospitals around $64 million each year.

Table 1: Impact of Inefficient Mobile Asset Management at Australian Public Hospitals

Key Concern

Daily loss in patient care time

32,500 hours

Over-purchased mobile assets

$16 million per year

Inventory replacement costs from loss or mishandling


Under-utilisation of mobile assets


Other concerns Delays in admissions, treatment start times or discharges

Impact

Source:Frost & Sullivan research.

Based on data from 2013.

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Frost & Sullivan research has identified that:

• The average number of mobile devices used

in hospitals (currently about eight per bed in

general wards) is increasing every year;

• The average total value of mobile devices in use

(currently about $3,000 per bed in general

wards) is escalating every year;

• The average utilisation of mobile assets is 50%

to 60%, far below the optimum level hospitals

can potentially achieve;

• Hospital staff are often unable to locate mobile

assets when needed;

• Nurses spend an average of about half an

hour per shift to locate mobile assets, which

impacts patient care; and

• Around 10% of mobile assets need to be

replaced annually due to loss or mishandling

of devices.

Frost & Sullivan estimates that public hospitals

in Australia are wasting more than $60 million

per year as a result of inefficient management

of mobile assets. In addition, approximately

32,500 hours of patient care time are lost due to

medical staff trying to find mobile assets. There

are other non-quantifiable consequences such as

delays in admission or treatment start times, or in

discharge procedures.

With the mounting cost pressures on healthcare

delivery in Australia, wastage resulting from inefficient

mobile asset management is an unacceptable

cost burden on the public healthcare system.

Many hospitals have not defined adequate

processes and workflows that align their services

with device usage. Few hospitals have identified

the resources that can potentially be shared across

cost centres to help reduce inventory. Likewise,

few deploy technology systems on top of their

business processes that provide real-time tracking

of mobile devices, to enable time- and cost-

efficient collaboration and resource-sharing across

their services.

While there is growing awareness of the impact

of under-utilisation of mobile assets on costs,

workflow efficiency, and quality of care, factors

such as budget constraints and uncertainty about

the potential benefits of asset management and

tracking solutions restrict their adoption.

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II. ABOUT THIS WHITE PAPER

Australian hospitals have generally been early

adopters of digital healthcare solutions. An important

aspect of hospital workflows is the management

of mobile assets and their associated costs. The

objective of this white paper is to assess the impact

of current mobile asset management practices and

technology solutions at Australian public hospitals

on healthcare costs, staff productivity, and patient

experience. The report also aims to identify areas

of improvement, focusing on both technologies

and processes that could deliver real value to

healthcare providers.

A combination of primary and secondary research

has been used to understand the spending

trends across Australian public hospitals, and

the effect of mobile assets on overall costs.

Frost & Sullivan has assessed the asset management

and tracking solutions currently being used to arrive

at an objective opinion on the level of market and

technology development.

This white paper is based on 20 discussions and

one forum with representatives from Australian

public hospitals to obtain their views on asset

management practices at their facilities. In order to

ensure fair representation from relevant stakeholder

groups, discussions were conducted with end users,

including nurse unit managers and heads of nursing,

as well as hospital decision-makers including

biomedical engineers, asset managers, finance

managers, and C-suite executives. Data used in this

white paper was provided by hospitals based on

their 2012-2013 financial year. All expenditure, cost

and revenue figures are stated in Australian dollars

unless mentioned otherwise.

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II. DEFINITIONS

Hospital inventories include a wide range of medical

devices, from heavy-duty, expensive capital

equipment to less expensive portable devices

and consumables. Mobile assets include infusion

pumps, oxygen cylinders, IV pumps, ventilators/

breathing devices, pulse oximeters, continuous

veno venous hemofiltration (CVVH) machines,

sequential compression devices, crash carts,

isolation carts, vital signs monitors, hypothermia

units, beds, specialty beds, stretchers, wheel chairs,

specialty wheel chairs, telemetry units, and mobile

work stations. Most of these devices are not fixed

to a particular department or area, and tend to be

used in multiple departments.

Utilisation of mobile assets is defined as the number

of devices in use at a given point in time. While

under-utilisation of mobile assets indicates that the

entire inventory of mobile assets at a hospital is not

being used to its full capacity.

Mobile asset management refers to the procedures

and practices implemented at a hospital to ensure

efficient utilisation of mobile devices, in a manner

that reduces costs and improves the quality of

patient care. This includes maintaining appropriate

inventory levels, ensuring adequate but not

excessive usage, providing the right devices at

the right place and the right time, and recording

maintenance and replacement schedules as well

as costs of devices.

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IV. PUBLIC HOSPITAL EXPENDITURE IN AUSTRALIA

The quality of healthcare is no longer only evaluated in terms of improvements in population health and

clinical outcomes. Sustainability and efficiency of healthcare delivery are emerging as important parameters

in assessing the success of a healthcare system. In 2013, Australia was ranked 7th globally in terms of the

efficiency of its healthcare system, based on life expectancy and the relative and absolute per capita cost

of care.1 Australia spends significantly more per capita on healthcare than other developed Asia-Pacific

economies. While Australia’s universal health system has delivered significant benefits over the past three

decades, the country now faces increasing challenges in managing healthcare costs due to an ageing

population, higher incidences of chronic diseases, and the escalating costs of advanced pharmaceuticals

and medical equipment.

Health expenditure is increasing inexorably, placing a bigger burden on both consumers and governments.

Healthcare expenditure in Australia was $140.2 billion in 2011-2012, or 9.5% of GDP, compared to 9.3%

of GDP in 2010-2011. In the past five years, healthcare expenditure has surged by over 35%. Government

healthcare expenditure, which accounts for nearly 70% of total expenditure, has increased by almost 38%

over the past five years placing an increasingly unsustainable financial burden on public spending.2

1Bloomberg Visual Data, “Bloomberg Best (and Worst): Most Efficient Health Care: Countries” http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries 2Australian Institute of Health and Welfare, “Health Expenditure Australia 2011-12,” http://www.aihw.gov.au/publication-detail/?id=60129544658 (25 Sept 2013)

Figure 1: Healthcare Expenditure in Australia, 2007-2008 to 2011-2012

160,000

Expenditure ($ Mn)

Private Expenditure ($ Mn)

Government Expenditure ($ Mn)

Total Healthcare Expenditure ($ Mn)

120,000

80,000

40,000

02007 - 08

32,411 35,098 36,506 40,202 42,426

71,152 78,563 84,847 90,108 97,815

103,563 113,661 121,353 130,310 140,241

2008 - 09 2009 - 10 2010 - 11 2011 - 12

Source: Australian Institute of Health and Welfare (AIHW)

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3Australian Institute of Health and Welfare , “Health Expenditure Australia 2011-12”, http://www.aihw.gov.au/publication-detail/?id=60129544658 (25 Sep 2013)4Australian Institute of Health and Welfare, “Health Expenditure Australia 2011-12”, http://www.aihw.gov.au/publication-detail/?id=60129544658 (25 Sep 2013)

Hospital expenditure can be categorised into capital expenditure and recurrent or operating expenditure.

In 2011-2012, capital expenditure was $7.9 billion while recurrent expenditure, which includes expenditure

on mobile devices, consumables and wages, contributed to around 94.4% or $132.3 billion of the total

healthcare expenditure. Approximately $3.8 billion of the recurrent expenditure was spent on aids and

appliances, with growth of around 10% annually.3

Public healthcare services in Australia are provided by 753 hospitals, with 535 facilities having less than 50

beds, 136 facilities having 50 to 200 beds, and 82 facilities with more than 200 beds.

In 2011-2012, public hospitals accounted for the largest component (31.5%) of the recurrent healthcare

expenditure. Between 2007-2008 and 2011-2012, the recurrent healthcare expenditure on public hospital

services grew by almost 35%.4

Note: Others include patient transport services, research, community health, public health, administration, etc. Source: AIHW

Figure 2: Healthcare Expenditure by Area of Expenditure in Australia, 2011-12

Total Healthcare Expenditurein 2011-2012

$ 140.2 billion

Capital Expenditure$ 7.9 billion (5.6%)

Public Hospitals$ 41.6 billion (31.5%)

Private Hospitals$ 11.5 billion (8.7%)

Dental Services$ 8.5 billion (6.4%)

Others$ 23.1 billion (17.4%)

Medical Services$ 24.1 billion (18.2%)

Medications$ 19.7 billion (14.9%)

Aids & Appliances$ 3.8 billion (2.9%)

Recurrent Expenditure$ 132.3 billion (94.4%)

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V. THE COST OF INEFFICIENT MOBILE ASSET MANAGEMENT

Spending on public hospital services in Australia has increased by almost 2.5 times from $16.8 billion in

2001-2002 to $41.6 billion in 2011-2012.5 The cost of hospital care per casemix separation has been

escalating over the past two decades, mainly due to the advances in medical care and technology and

higher demand for health services with an ageing population and growing incidence of chronic diseases.

The cost of hospital care per casemix separation in public hospitals has increased from $4,215 in 2007-

2008 to $5,204 in 2011-2012 at a compound annual growth rate (CAGR) of 5.4%.6

5Australian Institute of Health and Welfare, “Health Expenditure Australia 2011-12”, http://www.aihw.gov.au/publication-detail/?id=60129544658, http://www.aihw.gov.au/publication-detail/?id=6442467479 (25 Sep 2013)6Australian Institute of Health and Welfare, “Hospital Performance: Cost per Casemix-adjusted Separation”, http://www.aihw.gov.au/haag11-12/hospital-performance-cost-per-separation (25 Sep 2013)

Figure 3: Cost Per Casemix-adjusted Separation in Public Hospitals in Australia, 2007-2008 to 2011-2012

5600

4400

3200

2000

Cost per Casemix-Adjusted

Separation ($)

2007 - 08

4,2154,531

4,7064,918

5,204

2008 - 09 2009 - 10 2010 - 11 2011 - 12

Source: AIHW

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7Bloomberg Visual Data, “Bloomberg Best (and Worst): Most Efficient Health Care: Countries,” http://www.bloomberg.com/visual-data/best-and-worst/most-efficient-health-care-countries 8Grattan Institute, “Controlling Costly Care: A billion-dollar Hospital Opportunity,” http://grattan.edu.au/publications/reports/post/controlling-costly-care-a-billion-dollar-hospital-opportunity9Frost & Sullivan analysis based on data collected through interviews and published data. Average salary of nurses taken as $29.45/hour based on nursing wage rates published by Queensland Heath.

Although Australia is ranked among the most efficient healthcare systems in the world,7 it can still reduce

its healthcare spending without compromising the quality of care. While factors such as medical errors,

hospital-acquired infections, treatment variations, ineffective use of information technology (IT), preventable

hospital admissions and readmissions can result in higher costs, under-utilisation of mobile assets also

contributes to hospital over-spending. It is estimated that $1 billion can be saved by having a better pricing

system for public hospital treatment in Australia.8 There is a huge gap between the treatment costs in high-

and low-cost hospitals with the funds being spent inefficiently in the hospitals that provide the same level

of care at a higher cost.

The total cost of mobi le assets for publ ic hospitals, which

includes expenditure on inventory, rental, and maintenance, is

estimated at around $250 million in 2013 and growing at almost

8% annually.9

For public hospitals, the total cost of inefficient mobile asset management is

estimated as:9

• Around $32 million annually due to under-utilisation of mobile assets.

• Approximately $16 million annually in inventory that needs to be replaced due

to either loss or mishandling of mobile assets.

• Roughly $16 million annually in maintenance of over-purchased mobile assets.

• As much as 32,500 hours of nursing time each day. Equivalent to $957,000 in

nursing staff salaries and a negative impact on patient care and satisfaction.

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9Frost & Sullivan analysis based on data collected through interviews and published data. Average salary of nurses taken as $29.45/hour based on nursing wage rates published by Queensland Heath.

One of the more significant costs of inefficient mobile asset management is the amount of time spent by

nurses in locating mobile devices. With an estimated 65,000 nurses employed in public hospitals, and with

around 30 minutes on average lost each shift to find mobile assets, the daily loss is estimated at 32,500

hours in patient care, equivalent to around $957,000 per day in salaries.9

In 2011, all States and Territories agreed to a range of National Health Reforms by signing the National

Health Reform Agreement. One of the key provisions under the agreement was the adoption of activity-

based funding (ABF) as the primary basis for funding the majority of public hospital services, with an aim

to improve timely access to quality care and maintain sustainability and efficiency of public health services.

With ABF, hospitals get paid for the number and mix of patients they treat. A facility receives more funding

if it treats more patients and complicated treatment cases. Thus, it is important for hospitals to be able to

accurately allocate costs and expenditure, including recurrent costs, based on the patient load.

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VI. CURRENT PROCESSES FOR MANAGING MOBILE ASSETS

Tracking hospital expenditure and allocating cost by service is a critical task for hospitals, as it directly affects

funding decisions and the allocation of resources. However, while capital expenditure is relatively easy to

plan and monitor, recurrent expenditure, particularly for hospital consumables and equipment costing below

a threshold value, is more difficult to measure and manage due to the lack of adequate and consistent

procedures to track these costs. Frost & Sullivan research, based on data from the Australian Institute of

Health and Welfare (AIHW), shows that recurrent expenditure has increased, on average, at 10% per annum

in public hospitals. Our study has indicated that the higher healthcare expenditure has been primarily due

to a general increase in prices of devices and consumables. Only one in 10 of the respondents interviewed

by Frost & Sullivan stated that recurrent healthcare expenditure had increased due to investments in more

sophisticated devices and technologies.

Figure 4: State of Current Asset Management Processes at Australian Public Hospitals

Real WorldIdeal World

Point of Care

- Delayed Return

- Reactive Maintenance

- Erroneous Record Keeping

Point of Care

EquipmentStore

EquipmentStore

- Timely Return

- Central or distributed- Electronic Recording of Entry and Exit

- Timely Return

- Timely Maintenance

MaintenanceMaintenance

Dept. XDept. X Dept. YDept. Y

LostEquipment

- Delayed Return

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According to interviews with biomedical engineers, investments in new technologies and infrastructure

are evaluated based on their impact on both delivery of care and hospital costs. The return on investment

(ROI) in terms on improvements in the quality and efficiency of care is becoming an increasingly important

management discussion, even in public hospitals. One out of three nursing unit managers reveals

that investments directly associated with better care delivery are generally given priority over other

infrastructural improvements.

Almost all respondents state that their hospitals maintain electronic inventories of mobile assets, but only

one reports the current use of a tracking system which notifies equipment managers when a mobile device

is moved between designated areas. At all the other hospitals surveyed, asset tracking is conducted through

register entries by staff. There are conflicting opinions surrounding the management of electronic inventories

– half of the respondents prefer centrally-managed stores, while the other half are likely to delegate the task

to the respective departments. In this context, existing processes for mobile asset management can be

summarised as follows:

Even in an ideal situation, with existing asset management practices and solutions, hospitals are unable to track movement and usage of high-volume, low-to-medium value equipment in real-time, allowing room for precious data and time to be lost between processes.

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Only a small number of hospitals are considering investing in real-time location sensing (RTLS) technologies

that allow automated, real-time asset tracking (see Table 3).

There is an opportunity for improvement in the area of asset maintenance. Current asset management

systems do not support advanced analytics capabilities, or the ability to integrate with clinical information

systems and electronic health records (EHR).

Table 2: Current Mobile Asset Management Practices in Public Hospitals

Source: Frost & Sullivan research

Current State ofAsset Management Systems

Electronic asset management system only 30% 25%

0% 5%

25% 5%

Asset management and tracking system

No electronic system

Proportion of Hospitals by Bed Size<500 Beds >500 Beds

Table 3: Proportion of Hospitals Considering an Electronic Asset Management and Tracking Solution

Considering an electronic asset managementand tracking solution

15% 20%


Source: Frost & Sullivan research

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VII. COSTS ASSOCIATED WITH MOBILE ASSET MANAGEMENT

As healthcare facilities strive to reduce costs and improve the quality of care, mobile asset management

becomes a highly-critical issue. The efficient management and tracking of mobile assets ensures the

availability of the right device to the right person at the right time and place, resulting in improved clinical

workflow and allowing the hospital staff to concentrate on patient care.

Key factors that impact mobile asset management include:

• Level of utilisation of equipment;

• Level of loss and misplaced equipment;

• Equipment turnaround time;

• Level of maintenance and cleaning of equipment; and

• Level of inventory in relation to equipment.

Mapping mobile device demand and trends within hospitals is a complex function as it varies considerably

across departments. Acute and emergency care departments are device-intensive with a higher average

cost of devices per bed compared to sub-acute, general wards, and aged care units. The cost of mobile

devices has risen significantly at public healthcare facilities in Australia. While currency fluctuations have

contributed to price increases, another primary driver is market perception, where prices for healthcare-

related assets, even on standard purchases such as mattresses for hospital use, tend to be marked at a

premium price by vendors. Maintenance and replacement costs of mobile devices have escalated as well,

especially for the acute and emergency care units.

This Frost & Sullivan study has gathered data and opinions on the following areas:

• Volume of mobile devices per bed;

• Cost of mobile devices per bed;

• Utilisation of mobile devices;

• Cost of maintenance, repair and replacement of mobile devices; and

• Capital expenditure and rental cost of mobile devices.

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As shown in Table 4, most public hospitals have less than 10 mobile devices per bed. Approximately 90%

of hospitals with less than 500 beds and 75% of hospitals with more than 500 beds have less than 10

mobile devices per bed. The average number of mobile devices per bed is slightly higher at larger hospitals

(more than 500 beds).

Table 4: Average Number of Mobile Devices per Bed in Public Hospitals in Australia, 2013

Source: Frost & Sullivan research.Note: Some of the respondents did not provide exact numbers on average number of mobile devices per bed.

Assumptions were made for these facilities based on their bed size.

Average number ofmobile devices per bed

<5 34% 38%

58% 38%

8% 24%

6-10

>10


Around 70% of hospitals have seen an increase in the average number of mobile devices per bed in their facilities in the past three years. While this growth, driven by the introduction of advanced technologies, focuses on improved patient monitoring and new treatment options, it also increases many complexities for hospital personnel. Without proper asset management, staff are forced to either spend more time locating equipment, or maintaining quality care. This can potentially drive procurement costs up as there is a critical need for devices to be readily available when required.

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Table 5: Average Cost of Mobile Devices per Bed11 in Public Hospitals in Australia, 2013

Source: Frost & Sullivan researchNote: Some of the respondents did not provide exact numbers on average cost of mobile devices per bed.


Average cost ofmobile devices per bed ($)

<2,000 25% 12%

67% 50%

8% 38%

2,000-4,000

>4,000


As shown in Table 5, the average cost of mobile devices is around $3,080 per bed in public hospitals, but

the cost is higher in hospitals with more than 500 beds ($3,500 per bed) compared to hospitals with fewer

than 500 beds ($2,670).

The average cost of mobile devices per bed is increasing at approximately 8% annually, with more than 90% of hospitals saying they have seen an increase at their facilities in the past three years. As a result, hospitals are spending a significant amount of funds on mobile assets. Lack of attention in improving the management and usage of these devices also escalate the associated costs.

11Respondents were provided a list of mobile assets that could be used in their facility. We obtained an estimate of the number of devices attached to an occupied patient bed in a general ward followed by the respondent’s estimate on the average cost of these devices attached to the bed. The average cost does not include cost of maintenance or loss of mobile assets.

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Table 6: Utilisation of Mobile Devices in Public Hospitals in Australia, 2013

Source: Frost & Sullivan research Note: Some of the respondents did not provide exact numbers on utilisation of mobile devices.


Utilisation ofmobile devices

<40% 18% 0%

40% 50%

42% 50%

40%-60%

>60%


In an ideal scenario, utilisation of mobile assets should be more than 80%, with units like emergency care

running at over 90% utilisation.12 However, as shown in Table 6, our research indicates that in 50% of

hospitals with up to 500 beds, the utilisation of mobile devices is less than 60%. Although, the utilisation of

mobile devices is slightly higher for larger hospitals (more than 500 beds), it is nowhere near the optimum

level. Under-utilisation has significant cost implications as it leads to over-purchasing of assets, increased

asset loss, and reduced staff productivity due to misplaced devices.

Based on Frost & Sullivan research, the total value of mobile devices at a typical 500-bed public hospital is estimated at $1.8 million. In a best-case scenario the hospital is using devices at 60% utilisation, whereas the latest Real-time Location System (RTLS) systems have shown that utilisation of up to 80% can be achieved. Thus, a 500-bed hospital that carries mobile assets worth $1.8 million can expect to reduce just its purchasing cost of inventory by $360,000 annually through advanced asset management and tracking solutions. This does not include the benefits provided in reducing maintenance and staffing costs.

12Interviews conducted by Frost &Sullivan, GE Healthcare, “Out of Control: Little-used Clinical Assets are Draining Healthcare Budgets”, http://partners.gehealthcare.com/07_HFM_July_horblyuk.pdf (Jul 2012)

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13Source: NSW Health, “NSW: Hospitals Get $70 Million Injection For IV Pumps,” http://ehln.org/?p=382 (10 Sep 2009) and Frost & Sullivan analysis

Figure 5: Trends in the Volume, Cost, and Utilisation of Mobile Devices in Public Hospitals in Australia, 2010-2013

Source: Frost & Sullivan analysis based on data collected through interviews.

As shown in Figure 5, around 50% of hospitals are seeing an increase of over 10% in the number of mobile

devices per bed and at around one-third of hospitals the cost of mobile devices per bed is increasing by

over 10%.

In 2009, NSW Health invested $70 million in 10,000 new state-of-the-art infusion

pumps to improve the safety of IV medication delivery in the State’s public healthcare

facilities. If the State health department had performed a thorough assessment

of metrics using an asset management and tracking solution to evaluate the actual

demand for pumps, pump utilisation, pump delivery time to understand the number of

pumps it had at hand, how the pumps were being used by staff, and actual purchase

need, it could have saved around $14 million in capital expenditure and additional

operating costs for maintenance and service per year by increasing pump utilisation by

only 20%.13

100%

50%

0%

Proportionof Respondents

Number of mobile devices per bed

Average cost of mobiledevices per bed

Average utilisationof mobile devices

18%

35%

18%

6%

23%

54%

20%

54%

13%

13%38%

8%

Increase (>20%) Increase (10-20%)

Decrease (10-20%) Decrease (<10%)

Increase (<10%) No Change

Decrease (>20%)

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Table 7: Average Annual Cost and Trend in Capital Expenditure, Rental Cost, Replacement Cost, and Maintenance Cost of Mobile Devices for a Typical 200 Bed Public Hospital in Australia, 2010-2013


Rental cost of mobile devices $35,000

$53,000

$280,000

Replacement cost due to mishandling or loss of mobile devices

Maintenance cost of mobile devices

Average Cost $ (2013) Trend (2010-2013)

Public hospitals have witnessed an increase in rental, replacement, and maintenance fees of mobile devices

over the past three years (see Table 7).

Most hospitals prefer to buy rather than rent mobile devices, excluding oxygen cylinders, specialty beds,

mattresses, and wheelchairs, to avoid potential delays that often occur when rental companies are unable to

deliver products on time. Additionally, a number of hospitals complain about the inconsistency in the quality

and condition of devices supplied. The higher emphasis on buying and storage leads to unpredictability in

the investment required for purchasing mobile devices each year.

Approximately 10% of the asset inventory needs to be replaced annually, due to either loss or mishandling

of devices. A typical 500-bed public hospital is estimated to spend an average of $175,000 per year on

replacing mobile devices and an average of $700,000 on maintenance of existing mobile devices every year.

1-4%annual growth

5-8%annual growth

>8%annual growth

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Top 3 Myths Regarding Mobile Asset Management

• A High Level of Asset Utilisation is a Positive Performance Indicator

Around 50% of respondents state that their hospitals have mobile asset utilisation

over 60%, with three reporting above 90% utilisation. However, these estimates

are largely based on a shortage of functional devices at the respective hospitals

and staff having to manage with the limited devices available. Even with 90%

utilisation rate, hospitals still report the inability to find devices when needed, as

well as a large part of inventory requiring maintenance and repairs. Respondents

state that often device utilisation is high because there is low availability. Therefore,

asset utilisation alone is not a reliable indicator of hospital efficiency.

• Misplacement of Mobile Assets Do Not Impact Patients

Mobile devices tend to move around a healthcare facility according to patient

needs. Fixing devices and restricting their mobility through rules and policies

limits patient mobility, and has a substantial impact on the patient experience.

Moreover, nurse unit managers report delays in patient admission and start times

of IV therapies and other procedures because they are unable to access the right

equipment in a timely manner.

• Technology is the Solution to All Problems

Employees at healthcare facilities seek technological solutions to address

challenges in asset management. However, few seldom take into consideration

the existing processes and workflows at their facilities. Technology deployment

without a rigorous analysis of current workflows is not likely to create a significant

improvement. Instead it could lead to further obstacles and inefficiencies in the

long run as the very workflows which act as a foundation to the technology would

be unproductive.

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The cost associated with inefficient mobile asset management in hospitals is significant as it can lead to

devices being misplaced or lost, equipment requiring frequent repairs or replacement, and clinical staff

spending considerable amount of time locating equipment, which increases investment in assets, escalates

hospital expenditure, and affects the quality of healthcare services.

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VIII. OTHER COSTS ASSOCIATED WITH INEFFICIENT MOBILE ASSET MANAGEMENT

The financial impact of inefficient asset management is only half the story. Ineffective mobile asset

management is an essential source of frustration for hospital staff, including for example, nurses who

interact with patients and use the devices, and equipment managers responsible for management and

maintenance of the devices.

Our study has identified the following issues related to inefficient mobile asset management:

• Inability to locate mobile devices when needed;

• Time lost locating mobile devices;

• Challenges in working with multiple vendors for renting mobile devices; and

• Mishandling or loss of mobile devices.

Figure 6: Frequency of the Inability to Locate Mobile Devices When Needed

Note: Respondents were asked to rate the statement “Inability to locate mobile devices when needed”on a scale of 1 to 5 where 1 stands for “Never” and 5 stands for “Frequently”.Source: Frost & Sullivan analysis based on data collected through interviews.

5

4

3

2

1 Never

Frequently100%

50%

0%


Inability to locate mobile devices when needed

10%

25%

25%

40%

Average rating = 4.0

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As shown in Figure 6, the hospitals surveyed agree that they are sometimes unable to find devices when

needed, with 65% of hospitals reporting that they face this challenge frequently at their facilities.

Around 95% of end users believe that the inability

to locate medical devices when needed affects

the quality of healthcare delivery, as it leads to

delayed patient treatment. Searching for missing

devices also places more pressure on the nurses

who are responsible for delivering timely patient

care. It significantly adds to their physical effort and

“sneaker time” during the course of the day.

Lost or misplaced devices are also a concern for equipment managers and biomedical engineers, because

timely delivery of appropriate devices is a key performance indicator for them. Some respondents describe

weekly search procedures which require a nurse to spend several hours in a week to collect devices that are

not in the correct location and return them to their appropriate stores. There is opportunity for automation

here that will allow biomedical engineers to capture 100% of performance quality and calibration checks

while eliminating the need for human resources and reducing the chance of error or oversight.

This morning we had to discharge an older person and we needed a wheelchair, and you can never find one when you need it so her discharge had to be delayed.

Table 8: Number of Minutes a Nurse Loses per Day in Locating Mobile Devices in Public Hospitals in Australia

Source: Frost & Sullivan research.

Average number of minutes a nurse loses per dayin locating mobile devices

Less than 15 minutes 17%

32%

9%

42%

15-30 minutes

31-45 minutes

Greater than 45 minutes

Proportion of nurses

25


As shown in Table 8, nurses on average

spend about half an hour per day

locating mobile devices, with over 40%

of nurses saying they spend more than

45 minutes on this activity. Respondents

believe that nurses have to give up

time with patients for this activity,

which hinders the provision of efficient

patient care.

One respondent mentioned that they were able to overcome this issue of locating mobile equipment at their

facility after investing in an asset tracking and RFID system, which led to faster equipment turnaround time

and better utilisation of equipment.

Sometimes nurses spend up to an hour a day (locating mobile assets). It impacts the quality of service because when they are looking for devices they are not getting their patient carework done.

The Royal Adelaide Hospital campuses have over 2,000 nurses. Each nurse

spends an average of 30 minutes per day locating mobile devices. This

is equivalent to around 125 nurses in the campuses spending their entire

day on this activity and not being able to devote any time for patient care.14

14Source: Royal Adelaide Hospital, http://www.rah.sa.gov.au/nurse/n_e_overview.php and Frost & Sullivan analysis based on data gathered through the study.

26


As shown in Figure 7, working with multiple vendors for the

rental of mobile equipment is not considered to have a big

impact on operational workflow, with only 13% of respondents

considering it as a major challenge. However, respondents

have raised particular issues in dealing with multiple vendors.

These include the impact on staff productivity as they need

to determine whether the products are of suitable quality,

conduct rigorous product comparisons from different

vendors prior to procurement to prevent delivery delays or

substandard quality, and organise timely delivery.

Staff spend more time dealing with vendors, chasing up orders, and generally doing things they really don't need tobe doing.

Figure 7: Challenges in Working with Multiple Vendors for Renting Mobile Devices

Note: Respondents were asked to rate the statement “Working with multiple vendors for renting mobile devices”on a scale of 1 to 5 where 1 stands for “Not a challenge” and 5 stands for “Major challenge”.


5

4

3

2

1 Not a Challenge

Major Challenge100%

50%

0%


Challenges in Working with Multiple Vendors for Renting Mobile Devices

13%

27%

40%

20%


27


As highlighted in Figure 8, all respondents experience

mishandling or loss of mobile devices, with half reporting that

this occurs frequently at their facility. Some respondents were

able to quantify the cost impacts, including an estimated

$225,000 annually (570-bed hospital), $100,000 annually

(400-bed hospital), $60,000 (370-bed hospital), $50,000

(250-bed hospital), and $24,000 (200-bed hospital) due to

mishandling or loss of mobile devices. Other respondents

gave additional quantifiable results such as:

• Replacement of 50% of wheelchairs in the past 18 months;

• Replacement of 10% of equipment every year;

• Impact on patient care due to loss of vital signs monitors;

• Loss of IV pumps as they are moved around between wards; and

• Loss of around 15 out of 70 wheelchairs purchased two years ago.

S i x y e a r s ago, I had 80 wheelchairs. I am down to about 15 simply due to the loss of these wheelchairs.

Figure 8: Occurrence of Mishandling or Loss of Mobile Devices

Note: Respondents were asked to rate the statement “Mishandling or loss of mobile devices”on a scale of 1 to 5 where 1 stands for “Never occurs” and 5 stands for “Frequently occurs”.


5

4

3

2

1 Never

Frequently100%

50%

0%


Occurrence of mishandling or loss of

mobile devices

25%

25%

31%

19%


28


Device maintenance is conducted based on defined timelines and procedures. Current systems are neither

predictive in terms of required maintenance schedules or costs, nor are they able to detect or diagnose

ad-hoc maintenance and repair needs. A few respondents describe incidents where mobile devices were

found left at inappropriate locations. It is difficult for biomedical engineers to locate abandoned devices and

spend additional time and money to repair them. Repairs can take up to six months and the hospital has

to bear the opportunity cost of not having the device readily available.

Public hospitals have severe space constraints which can make device storage difficult. Many hospitals cite

this as a major reason for being unable to create a central store for all equipment. Creating a central storage

location requires significant space, and adds to the staff’s time and effort to retrieve the devices. Hospitals

generally maintain their own inventories – each department is responsible for the maintenance, safety, and

storage of its pool of devices. However, this does not prevent devices from moving around departments

without the original owner being informed, leading to conditions that further increase device search times

as well as create an atmosphere where co-workers compete for resources.

29


The impact of ineffective asset

management on patients

and the quality of care has

emerged as a critical issue

in our research. While most

hospital decision-makers

state that gaps in hospital

asset management did not

affect patient care at their

facility, 90% of nursing staff

respondents agreed that patients do feel the impact. Furthermore, around 25% of respondents report

delays in admissions, treatment start times or discharges due to lack of immediate availability of mobile

devices, such as IV pumps and wheelchairs. In some conditions, procedures are delayed and affect the

quality of care and prognosis, which is noticed by patients and care givers.

Some respondents have provided specific examples of how inefficient asset management can affect the

quality of patient care:

• Delays in discharging patients due to the inability to find a wheelchair;

• Slow to start IV therapy for a patient as staff unable to find the necessary equipment;

• Inability to shift patients from accident & emergency (A&E) department to the general ward due to

unavailability of a telemetry system; and

• Constant calls from the recovery ward as they are short of patient-controlled analgesia

(PCA) pumps.

IX. THE PATIENT EXPERIENCE IS IMPACTED

Inability to locate devices impacts patients because there is a lag between the expected and actual service time. It makes patients and their families nervous and sometimes becomes a hurdle in procedures as well. Overall, it leaves a bad impression of an under-staffed, poorly-managed hospital.

Sometimes it can become a life and death situation especially with certain devices that are hard to locate.

30


With the adoption of ABF as the primary basis for funding a majority of hospital services, public hospitals

are being encouraged to maximise the delivery of services with available funds and prevent delays in

providing clinical care. There is also a push to introduce “pay-for-performance” schemes – payment models

that reward physicians, hospitals, medical groups, and other healthcare providers based on performance

measures for quality and efficiency. Queensland Health is the first to incorporate pay-for-performance

elements into hospital funding in Australia through their Clinical Practice Improvement Payment (CPIP) trial

program, where hospitals are paid to achieve targeted levels of patient safety and quality.15

The Commonwealth and State and Territory governments have agreed to improve patient access to elective

surgery, emergency department, and sub-acute services under the National Health Reform Agreement.

The National Emergency Access Target (NEAT) is a component of the agreement with an aim to ensure that

by 2015, 90% of all patients presented to a public hospital emergency department (ED) will either physically

leave the ED for admission to hospital, be referred to another hospital for treatment or be discharged

home within four hours. The National Elective Surgery Targets (NEST) is another component with the aim

to progressively increase the timeliness of elective surgeries performed so that by 2016, 100% of patients

receive their elective surgery within the clinically-recommended time.16

Healthcare facilities must commit to improving workflow efficiency, patient throughput, staff productivity as

well as patient and staff safety to implement these initiatives and programs. Improvements in management

of mobile assets will be a critical component in ensuring that patients receive appropriate medical care at

the right time, and that nursing staff spend their time on patient care, which is their principal responsibility,

rather than locating mobile assets.

15Queensland Health, “Patient Safety and Quality Plan 2008-2012”, http://www.health.qld.gov.au/psq/governance/docs/s&q_patient_plan_v4.pdf16New South Wales Health, “National Elective Surgery Targets”, http://www.health.nsw.gov.au/Performance/Pages/NEST.aspx

31


As hospitals adopt more healthcare IT solutions to enhance quality, safety, and efficiency, implementation of

mobile asset tracking and management solutions becomes a crucial requirement to overcome the challenge

of improving quality of care while lowering costs.

In late 2013, South Australia Health went to market with a tender inviting suppliers to submit responses for

a state wide clinical asset solution. The primary objective of the South Australian Biomedical Engineering

(SA BME) directorate of SA Health, Infrastructure is to assure the safety, effectiveness, availability and

compliance of biomedical technology used directly for patient diagnosis, treatment or monitoring for or in

connection with the public hospital and healthcare facilities of SA Health.17

While all respondents agree that there are inefficiencies in the current asset management practices at their

facilities, a majority do not have a robust functional system that can overcome the impact of inefficient

mobile asset management (see Figure 9).

X. ADOPTION OF MOBILE ASSET MANAGEMENT SOLUTIONS

17NSW Health, “Annual Report 2012-2013”, http://www.health.nsw.gov.au/publications/Publications/annualreport13/HealthAR-2012-13-ch06-Funding-and-Expenditure.pdf

Figure 9: Current Usage of an Asset Management and Tracking Solution in Public Hospitals in Australia, 2013


100%

50%

0%


200-500 beds >500 beds

40%

60%83%

17%

Yes

No

32


As shown in Figure 9, although a majority of

respondents, especially in hospitals with fewer than

500 beds, have an asset management solution in

their facility, these systems are not comprehensive

and do not cover all the aspects of a complete

asset management and tracking solution. With

the exception of one respondent, all the facilities

surveyed have solutions that do not have real-time

tracking capabilities for mobile equipment. Most

of the systems installed at these facilities do not

perform any analytics, lack predictive capabilities,

and are not integrated with the hospitals’ core

IT system.

Although a majority of respondents express a desire

to have a comprehensive mobile asset tracking and

management solution implemented at their facility,

the acquisition cost is a key barrier to the adoption

of the system. Other barriers include:

• Uncertainty about the potential benefits against

the high cost of implementing the system;

• Lack of funding or budget constraints;

• The belief that only private hospitals are able to

adopt such a solution as they can pass on the

cost to patients;

• Change management issues related to the

implementation of such a system as it demands

major operational changes; and

• Lack of initiative from the hospital management.

The solution is essentially an inventory of assets that links back to various cost centres. It does not provide any usage or analytics or even updated information on maintenance. It does not include tracking as well. It is more a post-event log rather than a predictive solution.

We are looking for a real-time GPS tracking for both equipment and staff. My ideal system would look like something with GPS tags or wireless system throughout the organisation. Aligned with that should be a software program with a live view and printing capabilities.

33


In order to improve the adoption of mobile asset tracking and management solutions, there is an immediate

need to increase the awareness of the benefits of these solutions among hospital stakeholders and decision-

makers, in areas such as:

• ROI achieved through cost savings (capital and operating expenditure) even if the initial outlay

is high;

• Benefits such as improved patient care, staff productivity, and workflow efficiency; and

• Processes in place to assist the hospital staff to adapt to operational changes.

The cost of the technology to have a system is high. The benefit versus the cost does not really stand out at the moment so I doubt if I would consider investing in a tracking solution. I can't see a lot of benefit in it unless you are a private hospital.

I don't know why the management has not thought about this. Maybe it is the cost or just something that has never been brought up either internally or externally.

34


An essential process missing in technology implementations today is the mapping of hospital workflows.

Few hospitals have conducted an analysis of their existing business structure and associated workflows to

ensure that their operations are in line with their business goals. Frost & Sullivan research has found that

cost centres and hospital workflows are often not in line with actual revenue-generating activities, resulting

in significant inefficiencies in managing resources that are shared across cost centres.

Once, hospital workflows have been streamlined, a best practice is to design automation systems that

overlay the workflow blueprint. The goals of automation should be to:

• Reduce human intervention and the chances of human error;

• Capture as much data in the shortest time possible;

• Reduce costs; and

• Improve the comfort for both end-users and patients.

The AgileTrac Asset Manager provides hospitals with the technology and workflow solutions to break the

cycle of mismanagement and underutilisation of mobile assets such as IV pumps, monitors, and wheelchairs.

This facilitates much-needed gains in achieving patient care, staff productivity, and cost management goals.

XI. SYSTEMS AND PROCESSES TO CUT THROUGH THE CLUTTER

Advanced Solutions to Improve Asset Management –

AgileTrac Asset Manager from GE Healthcare

35


Using the RTLS technology, AgileTrac enables the tracking of mobile medical assets via easy-to-use web

tools. Users get direct access to the information they need to:

• Locate equipment quickly;

• Control distribution by using real-time inventory tracking to manage stock levels of critical assets;

• Improve compliance and safety by tracking device lifecycles, generating reports on the percentage

of time in use, storage, cleaning, and repair;

• Reduce rental expenses by calculating rental cost per day and tracking due dates for timely return

to avoid excess fees;

• Decrease capital expenditures by right-sizing the equipment inventory and preventing impulse

buys; and

• Prevent loss through customised loss prevention alerts that help keep vital equipment where it

belongs.

Here are examples of how hospitals are improving efficiency and reducing costs with the AgileTrac

Asset Manager.

• One hospital had two pumps for every patient. With more efficient workflow processes, they

were able to take 250 pumps out of the mobile equipment inventory. Capital expenditure fell by

US$450,000 and operational expenses by US$30,000 per year.

• By redesigning asset workflows and implementing AgileTrac, one hospital reduced its pump

inventory by one-third, resulting in maintenance savings of US$104,000 per year. It also eliminated

730,000 minutes of pump search time – the equivalent of 7.5 FTEs.

• A 350-bed hospital was able to cut pump inventory by 20% for lease/rental savings of US$1

million and virtually eliminate equipment-related delays in patient care with AgileTrac.

• A health system uses AgileTrac to manage more than 11,000 assets from wheelchairs to IV pumps

in four hospitals. Within five years, the system has saved more than US$5 million by reducing

inventory and improving asset utilisation and staff productivity.

Please visit the following website for additional information on GE Healthcare’s asset

management solutions:

http://www3.gehealthcare.com.sg/en-GB/Services/Comprehensive_Services/Asset_Management

36


Case studies on how asset management solutions from GE Healthcare

have benefitted hospitals

Case Study 1

Client:

Ellis Medicine, a 438-bed community and teaching healthcare system serves as the principal healthcare provider for more than 800,000 people in upstate New York.

Challenge:

In 2010, Ellis Medicine was considering upgrading its analog infusion pumps to newer-generation “smart” pumps that improve the safety of IV medication delivery. At the time, Ellis had approximately 500 pumps at its main hospital, but nurses continually complained that it was difficult to find one when needed. The facility wanted to understand what it had on hand, how staff were using the pumps, and what it really needed to purchase.

Solution:

Ellis Medicine engaged GE Healthcare to find the answers to its questions. Initial analysis revealed that the hospital had more than enough pumps, but ineffective workflow and pump management processes were hampering distribution and causing perceived shortages. Working with GE, Ellis staff determined a desired future state of operations and developed a procedure to better manage IV pumps. Central to that solution was the AgileTrac real-time location system, where an RFID tag is placed on a piece of equipment so its location can be tracked in real-time on computers throughout the facility. Ellis has expanded its mobile asset tracking to include other pieces of equipment such as telemetry units and wound vacs.

Benefits:

Improved mobile asset management has had a significant operational impact for Ellis Medicine:• Reduced inventory expenses: Although there were 500 IV pumps in circulation, Ellis Medicine

discovered it only required around 340 to meet patient needs efficiently, which helped in reducing both capital and operating costs for maintenance and service.

• Avoidance of capital expenditure: In purchasing next-generation IV pumps, Ellis was able to reduce its projected capital outlay by 30%.

• Lower rental costs: With more effective distribution and tracking of mobile assets, Ellis now leases fewer pieces of equipment.

• Improved biomed efficiency: One unforeseen benefit was the ability to quickly locate critical pieces of equipment to fulfil regulatory inspections.

The reductions in capital and operating expenditures have generated more than US$1.1 million in savings and cost avoidance for Ellis Medicine since 2010, more than twice the financial return guaranteed by GE Healthcare.

37


Case Study 2

Client:

Virtua, a healthcare system in New Jersey consists of four hospitals, 885 beds, and several additional facilities including two urgent-care centers.

Challenge:

In 2010, Virtua was preparing to open a new replacement hospital in New Jersey. At the time, in order to locate one of Virtua’s 10,000 mobile medical devices, staffers often had to hunt through hallways and make multiple phone calls.

Solution:

Virtua embarked on an initiative of deploying GE Healthcare's AgileTrac solution to better monitor and assign beds, as well as the IV pumps, telemetry units, and other mobile medical equipment nurses and doctors rely on to care for patients. Each piece of equipment was tagged with an RFID tag that enabled managers to track assets throughout the hospital on the computer, making it easier and quicker to findneeded equipment.

Benefits:

Virtua cut equipment wait times saving an estimated US$1.2 million after installing the solution. Improved mobile asset management has provided significant operational impact for Virtua:• Prior to implementing the system, the average wait time between asking for an urgently-required

piece of equipment and receiving it was 202 minutes. The average wait time is now 12 minutes – an improvement of 94%;

• For routine equipment, which are not urgently needed, response time improved by 92%, or from an average of 184 minutes to 14 minutes; and

• In the case of frequently used, high-demand equipment, such as IV pumps, AgileTrac alerts the equipment depot when inventories are low so that supply can be replenished before requests are made.

38


Contact:

David Dembo

GM Solutions

GE Healthcare ANZ

03 9239 8493

0410 649 789

[email protected]

Rhenu Bhuller

Senior Vice President,

Healthcare –

Asia-Pacific

P: +65 6890 0986

E: [email protected]

David Venning

Asset management product leader

GE Healthcare ANZ

03 9239 8482

0417 247713

[email protected]

Maz Khan

Industry Director,

Healthcare –

Australia & New Zealand

P: +61 2 8247 8908


Natasha Gulati

Industry Manager,

Connected Health –

Asia-Pacific

P: +603 6204 5876


XII. APPENDIX

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