IE497B Biomedical Device Engineering

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					IE497B Biomedical Device Engineering

         Dr. Richard A. Wysk
             Spring 2008
•   Discuss first two paper opportunities
•   Health Care and Traditional IE
•   Stakeholders and metrics
•   A bit of the landscape
      Paper #1

  Measuring and
Reporting on Health
   Care Quality
     Dana Gelb Safran
New England Medical Center
           Group Members
                Proponents     Opponents

Measuring and   Scott Shimp    Jung Lim
reporting       Larna Citron   Richard
heathcare                      Delange
       Paper #2

Supply Chain Management
 and Health Care Delivery
        Reha Ulsoy
             Group Members
               Proponents      Opponents

Supply Chain   Viren Parikh    Michael Hunter
management                     Robert
Reha Ulsoy     Shane Allison   Vu Tu
     How Does the Healthcare
     Research Context Differ?
• Mostly service model-based
• Analytical methods trail by a decade or more.
• Management engineers were phased out in the
• Healthcare is a complex system of delivery and
• Can you spell I-R-B (Institutional Review Board)?
• IE approach can represent ―disruptive innovation.‖
Healthcare is a Complex System of
   Delivery and Stakeholders.
  Fragmented information
  from various sources
  is used to make decisions
  on treatment for a patient
  who cannot judge clinical quality.

  Furthermore, the treating physician
  is an independent contractor
  paid by third parties (Medicare, BCBS, etc.).
       Can You Spell I-R-B?
• Not just at PSU, but the hospital IRB, clinic
  IRB, etc. Most won’t accept central IRB.
• Also, before you can conduct research
  – Get your shots (Hep B series, MMR, TB)
  – Attend mandatory orientation
• Get clinicians on board
• Next words: HIPAA, JCAHO
 IE Approach Can Represent
    ―Disruptive Innovation.‖
• Hospitals are used to ―sustaining‖ innovations
  (clinical, usually)
  – Specialized cancer treatments
  – Clinical trials
• But, systems to improve processes are
  typically ―disruptive‖
  – Noninvasive techniques, cure for common cold
  – Portable x-ray in MD offices
  – Low-tech, affect many patients with more ordinary
    health problems
  – Impact business processes, culture, MD status
Disruptive Innovations Come
        From Below.

           Source: Will Disruptive Innovations Cure Health Care?
           Christensen, C. M.; Bohmer, R.; Kenagy, John.
            Case No. R00501. Harvard Business Review.
Dissecting a Disruptive

 Source: The Innovator's Solution: Creating and Sustaining Successful
 Growth by Clayton M. Christensen, Michael E. Raynor
    What Makes IEs Suited to
    Healthcare Improvement?
• Proficient in Proven Tools Used in Other
• Focus on Systems Tools and Applications
• Consideration of the Human in Complex
• Conversant with IT
     IEs are Proficient in Proven
    Tools Used in Other Contexts.
•   Lean, TPS, Six Sigma
•   Work methods
•   Quality
•   Performance measurement and
    – What do they measure in the ED?
    – Impact on pt flow, pt care
 IEs Have a Focus on Systems
    Tools and Applications.
• Failure Analysis (FMEA)
• Modeling and Simulation (MedModel)
• Enterprise Management Tools (supply
  chain) (incineration)
• System Dynamics
• Knowledge Discovery (data mining, neural
   IEs Consider the Human in
       Complex Systems.
• Team structures and processes (Mayo
• Decision making
• Fatigue and error
• Work scheduling (resident shifts)
   IEs are Conversant with IT.
• Can coordinate projects with CS, IT
• Trained to identify system requirements for
  each stakeholder (PDA Rx order)
• Drive IT toward objectives of vastly
  improving access to necessary clinical,
  system, and patient information (med
            Some Recent
          IE-Related Efforts
• Patterson (Ohio State/VA National Center for
  Patient Safety)—HF and adverse events
• Stanford—Culture of Safety
• VA National Center for Patient Safety—HFMEA
• Cook & Rasmussen—System Dynamics,
  lessons from nuclear energy
• Miller et al.—Six Sigma applications
• Banner Health (AZ)—Lean applications
• Pebble Partnership—Evidence-based design
    What are Some Research
• Medical Error
  – 100K Lives Campaign (IOM)
  – Medication error
  – Medication labeling
  – Order entry and Rx (delays & wasted $$ in
    dupe tests)
―serious medication errors per
year‖ … ―illegible handwriting,
misplaced decimal points, and
 missed drug interactions and
  Source: from Wall Street Journal
            /Institute of Medicine
―In a disturbing 1991 study, 110 nurses
   of varying experience levels took a
 written test of their ability to calculate
medication doses. Eight out of 10 made
calculation mistakes at least 10% of the
   while four out of 10 made
mistakes 30% of the time.”
Source: from Demanding Medical Excellence: Doctors
    and Accountability in the Information Age, Michael Millenson
    What are Some Research
• Patient Flow
  – ED (50% of pts), inter-unit, to/from ancillary
  – Waiting times, queuing
  – Essentially, Hammer’s ―reengineering‖ (pt
    admission in-room)
    What are Some Research
• Healthcare Information Technology (HIT)
  – Electronic medical record
  – Service and provider integration
  – Rx, treatment order entry and fulfillment
  – Bed availability (HMED)
 Become Familiar with IOM.

 Read: To Err is Human and Crossing
 the Quality Chasm
   See IHI for Improvement Tools
         and Publications.

"When I climb Mount Rainier, I face less risk of death than I'll face on the
operating table."—Don Berwick, M.D. Newsweek/12.12.2005
Study and Implement Now…
No Time to Wait for Optimal
     Tools or Solutions
•   IE tools have a place in medicine.
•   Now is the time to use these tools.
•   Lots of ―red tape‖.
•   Two cultures.

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