Since its first two installations in 2012, med-tracking solution Kit Check has grown its user base to more than 200 hospitals. Kit Check technology has helped track some 8.5 million drugs and restock 850,000-plus pharmacy kits. Without Kit Check, says CEO Kevin MacDonald, healthcare providers would have had to pick up all those medications to check their expirations over 105 million times. Oliver Wyman Associate Terrance Wallace interviewed MacDonald, a former Sun Microsystems executive, on how the Kit Check solution streamlines this process by providing critical systems of engagement and operational decision support to hospital pharmacies:
Terrance Wallace: For those who haven't heard the Kit Check story, could you give us a brief overview?
Kevin MacDonald: It all started over dinner. A friend of my wife is a registered pharmacist working at a large university research hospital. She joined us one evening and was visibly frustrated because she had spent the previous two days checking the accuracy of pharmacy kits. Every hospital uses pharmacy kits. When someone yells, “Code Blue,” in a hospital, someone grabs a pharmacy kit with life-saving drugs. I didn’t know this at the time, but pharmacy kits are used throughout the hospital—for surgeries, intubation, labor and delivery, and that’s just the start of it. Pharmacy kits are an efficient way of putting medications near care providers so they are available when needed. The kits contain dozens or even hundreds of medications and the care provider typically uses only three to five in a procedure. That means the used kit needs to be restocked to be ready for the next patient, but most of the items remain untouched. Traditionally, pharmacy kit restocking has been an entirely manual process. A technician picks up every item in the kit to determine what to restock and identify any remaining medications that should be removed because they are nearing expiration. Then state pharmacy standards require a registered pharmacist to do a complete manual recheck of the kit contents. Each kit takes 20-30 minutes to process and there may be dozens to complete each day. Not only is it time consuming, the process is also error prone. We have seen pharmacy kit error rates ranging from a low of 5% to over 60%. It turns out this is more than just a mind-numbing task. It carries excess cost and patient safety risk.
TW: How does your solution work?
KM: The solution is designed to be simple for the user. Each individual medication has an RFID tag affixed to it. When the kit returns to the pharmacy it is placed inside of a scanning station that we provide to hospitals free of charge. The cloud software identifies the kit and determines what is missing, extra, or nearing expiration in only five seconds based on the RFID tags. The technician then knows exactly what to do to properly restock the kit. After restocking, the kit is scanned again to verify it is complete; a list of the kit contents are automatically printed on a charge sheet; and the data is recorded in the software. The identity of the staff that restocked and checked the kit is also recorded. The kit is then dispatched to the floor and its location recorded. The entire process typically takes three minutes or less, and our clients report time savings ranging from 71-96% with accuracy improvements ranging from 99.5-100%. We also have a solution for tracking anesthesia syringes in the OR called Anesthesia Check. We developed it after a request from several customers. This enables medications to be tracked from vial to syringe to the point of use and the narcotic waste process. All of the data is associated with a specific patient case. In the past, this data was either not recorded, hand written, or partially entered into an electronic medical record. Anesthesia Check automates enhanced data recording and facilitates reconciliation when recording errors occur. It can even provide a warning if the syringe should not be used on a particular patient. Anesthesia Check has extended Kit Check’s footprint into a full lifecycle medication tracking solution for the hospital.
TW: What level of readiness do providers need to take on your system?
KM: The Kit Check solution only requires a willingness to install. It is a cloud-hosted solution so no onsite servers or software are required. You only need access to a web browser and space to place the scanning station. We provide the hardware so there is no capital cost. Users simply purchase tags to affix to medications and we install all of the necessary equipment and train the users. Installation can be completed in as little as a few hours. Anesthesia Check is more involved because we are integrating with the anesthesia information management system. However, the solution is flexible enough to accommodate a wide variety of existing processes and we provide all of the software, hardware, and training. Like the Kit Check solution, Anesthesia Check syringe tags can be purchased from the hospital’s preferred distributor.
TW: How will the increased emphasis on cost reduction and patient outcomes change the healthcare ecosystem?
KM: Healthcare historically has been 100% focused on two things: patient care and regulatory compliance. Operational efficiency wasn’t a core objective. Nor was the impact that operational processes can have on patient care well understood. The increased use of lean management principles and the pharmacy practice management initiative model have started to change the level of awareness. The focus on cost reduction driven by legislation and reimbursement policy has only increased the emphasis in this area. The continued challenge is that hospitals in general and hospital pharmacies in particular do not have tools that are designed to drive efficiency and make the jobs of healthcare workers easier.
TW: What role will Kit Check play in that transformation?
KM: Kit Check is delivering people-friendly systems of engagement that streamline and improve medication tracking and management in the hospital. The legacy hospital software solutions were designed as systems of record. They weren’t focused on making jobs easier to perform. They were designed to be a single source of truth related to patient data. These systems often made processes more cumbersome in the spirit of standardization. They were also built on legacy technologies that are slow and inflexible compared to current computing practices. Systems of engagement are a new class of solutions designed for frequent use and to automate specific tasks. They save cost, improve accuracy, increase management visibility, and often raise staff morale. Working in pharmacy or the OR is not easy. Kit Check’s solutions ease the burden a bit and provide new tools that help pharmacy leaders adjust to the evolving healthcare environment. Since our first two installations in 2012, Kit Check has grown our user base to more than 200 hospitals that have tracked about 8.5 million medications and restocked more than 850,000 pharmacy kits. Even more impressive is that without Kit Check, hospitals would have picked up medications to check their expiration over 105 million times. That is 105 million little tasks that were completely eliminated and the data was captured without introducing human error into the process.
TW: What big changes do you see driving what healthcare looks like in the future?
KM: One critical change that is in its infancy is data-driven healthcare. The old model that assumed physicians knew everything of consequence is no longer viable. There are too many therapies, too many exotic conditions, and too many complex patient health situations for physicians to do it alone. IBM’s Watson is a great example of how data can assist physicians to better diagnose and treat patients. In pharmacy, the introduction of clinical decision support systems help pharmacists identify physician prescribing errors due to complex pharmaceutical interactions and enable better patient monitoring. These tools directly impact the timeliness and efficacy of patient treatment which in turn determines patient outcomes.
TW: What should leaders be thinking about that is NOT on their radars?
KM: The first thing hospital leadership should be thinking about is systems of engagement. Where can you leverage technology to improve operational efficiency and consistency? That is where you want a system of engagement to complement your previous investment in systems of record. Systems of engagement can help save cost and improve the patient care cycle. The second area to investigate is the introduction of operational decision support systems. These provide the visibility and analytics capabilities that enable data-driven operational decision making in the same way that clinical decision support systems facilitate data-driven patient care. Too many hospital leaders are asked to improve efficiency, but they are not given the data and analytical tools necessary to understand opportunities and trade-offs. In addition to medication tracking and management, Kit Check is providing operational decision support to hospital pharmacies today. Pharmacy leaders can see what medications expire most frequently before use, the current value of all kit medications distributed to clinical areas, which staff members are most productive, and even how multiple hospitals compare within an IDN. Healthcare delivery is more complex than ever. Hospital staff need tools to help them see the whole picture and make better decisions.