219:
How to Do Business
With HTG
Kevin Capatch, Geisinger Health System
Michael Innes, Kaiser Permanente
Matthew Mentel, Mercy Healthcare
Cynthia Shumway, Intermountain
Healthcare
June 12, 2014
AGENDA
•  Who is HTG
•  What HTG is doing with GS1
•  How we are Driving Standards
•  Labeling for GS1 Compliance
•  Preview of our 2014 Summit
•  Supplier Interaction
•  Meet the Members
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Who is HTG?
Healthcare Transformation Group
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WHO IS HTG
!
The HTG is a coalition composed of
the following:
•  5 Integrated Delivery Networks (IDN’s)
•  Geisinger Health System
•  Mayo Clinic
•  Intermountain Healthcare
•  Mercy Health
•  Kaiser Permanente
•  Over $50B in combined operating
revenue
•  Over 100 Hospitals represented
•  Over 300K employees
•  Over 18K licensed beds
•  Over 800,000 procedures / yearly
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How Are Standards Driving HTG?
People – Process – System/Technology
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PEOPLE - ORGANIZATIONAL AWARENESS
– UDI – we have engaged our organizations to resolve
GAPs
– UDI education with sourcing and standards teams
– Assembling of Community of Practice (CoP) to drive
ongoing capture of the UDI into our EHR
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PEOPLE - ORGANIZATIONAL AWARENESS
(MAYO)
•  GLN
– 75% of total med/surg spend
– 75 Suppliers
–  All Purchase Order contain GLN
•  GTIN
– 6% of total med/surg spend
– approximately 6,000 GTINs
– 4 Suppliers
•  Utilize both GDSN and Supplier supplied worksheets
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PEOPLE - ORGANIZATIONAL AWARENESS
(IHC)
•  GLN
–  Actively maintain all Intermountain locations in the GLN Registry 500+
–  All Purchase Orders contain GLN
•  GTIN
–  22,000 GTINs loaded
–  GTINs sent on all transactions. 16 Suppliers actively receiving
•  Utilize both GDSN and Supplier supplied worksheets
•  Lot/Serial/Expiry captured at point of receipt and distribution as applicable
–  Lot/Serial integrated from Surgical Services in consumption interface
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PROCESS – OPERATIONAL AWARENESS
Geisinger
Operational Awareness around UDI:
•  Has allowed us to rank the priority address UDI GAPs, such as:
•  Insuring our systems are agnostic to UDI to minimize clinician point-of-care impact upon
disposition of devices.
•  Accepting non-GS1, but driving for all GS1
Mayo
Kaiser Permanente
•  UDI Sharing to EHR to Billing to Patient Portal
•  UDI language is being incorporated into contract templates
–  UDI in Sourcing & Contracting
–  GPO & GDSN alignment
•  Expanded use of GTIN / GLN in Purchase Orders and Invoices
•  Better understanding how UDI could be used in billing
•  Scanning GTIN and serial number into OR System
•  Project well under way to incorporate GTIN and Expiration date via. interface from
OR System to EMR
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Intermountain
PROCESS – OPERATIONAL AWARENESS
•  Integration with OR system and project in progress for scanning during case
•  Project in progress for scanning in Ambulatory, Med/Surg and Cath Lab areas
•  Expiration and recall alert assessment
•  Using UDI to document in procedural areas
Mercy
•  Point of Use Scanning to all Procedural Areas except OR, OR Deployment next
•  Leveraging UDI to identify Expired Product
•  Using UDI in reporting to drive Comparative Effectiveness and track Adverse
Events
•  UDI/GDSN language is being incorporated into contract templates
•  Working to better understand use of UDI in the Global Supply Chain thru to Product
traceability, including Recalls
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PROCESS – OPERATIONAL AWARENESS
Execution of Consumption based Model
Mercy Hospital – Patient Room
•  Patient arm band is scanned identifying location and
patient in point of care system
•  GTINs on product packages are scanned at the point
of care capturing critical information to drive:
•  Product consumption
•  Inventory replenishment
•  Patient charging
•  Cost accounting
Mercy Hospital – Operating Room
•  Products used during the procedure documented on
the patient chart
•  GTIN data tracked all the way from the point of order
to the near exact time the product was applied to a
specific patient
•  Recall and Expired Product Notifications
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PROCESS - INDUSTRY AWARENESS
•  Sharing between provider Portals
•  X12 UDI Subgroup meeting
– Preparation for testimony to National Committee on
Vital and Health Statistics (NCVHS)
•  FDA/UDI SUDID Cath project
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SYSTEM/TECHNOLOGY PREPARATION
•  Working to ensure the most efficient path to relate or store non-transactional UDI
attributes
–  The GDSN data pool will be the majority of our storage
•  Building connections to FDA GUDID, or our GPO may be an alternative for nonGS1
•  UDI has exposed GAPs in our information systems
–  Ensure our Inventory systems can notify in case of a recall
–  Ensuring our supply chain transactional systems can feed the clinical systems in the
most efficient manner
–  Ensure our clinical systems can notify if patients affected by a recall or device
warning (MRI-awareness)
•  Efforts around UDI in the Product Recall
–  UDI Value stream mapping exercise to begin with key Med_Surg Supplier
•  Efforts in UDI Capture & Expand Use
–  Validation that Clinical Point of Use Systems/ Interfaces/ and ERP support GS1
Standards
•  Leveraging our GPO for our GDSN – they are updating information as available daily
through the use of our on line Item request process
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SYSTEM/TECHNOLOGY PREPARATION
Patient Level
Product
Scanning
Major Process
•  Scanning product
barcode to
patient
•  Capture of UDI
including lot /
serial / exp date
of product
•  Capture cost per
case
Inventory
Mgmt.
Major Process
•  Tracking of shelf
level inventory
•  Shelf level
tracking of lot /
serial / exp date
of product
•  Automated
inventory
replenishment
Automated
Charging
Major Process
•  Automated
charge capture
•  Lost charge
reporting
Goal: Enable capture of the UDI to the patient…
Apply automation to highly manual process
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How We Are Driving Standards
Our HTG tool set
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HOW WE ARE DRIVING STANDARDS
•  Website
•  Linked In
•  Education/Videos
•  Scorecards
•  Contract Language
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HTG WEBSITE
www.healthcaretransforma/ongroup.com33
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HTG LINKED IN GROUP
www.linkedin.com/groups/Healthcare9Transforma/on9Group94812256333
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EDUCATION / VIDEOS
www.youtube.com/watch?v=g7D6pm_bLyU&feature=youtu.be33
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SCORECARDS
HTG Scorecards Measure based on the following Criteria:
1.  Fully Support the Standard
2.  Support the use of GLN on a PO
3.  Support Scanning at the Point of Care/Product Label
with GTIN at the Unit of Use
4.  Support GTIN in Item File/ Products have Assigned
GTINs
5.  Support GTIN on a PO
6.  Support the use of GTIN in Recalls
7.  Support the use of GDSN
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SCORECARDS - MEMBERS
•  We use scorecards to measure ourselves
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SCORECARDS - SUPPLIERS
•  We use scorecards to measure our supplier partners
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CONTRACT LANGUAGE – KAISER PERMANENTE
•  Kaiser Permanente supports and is adopting in an accelerated time frame the implementation of
the GS1 Device Identification System in the health care industry as the standardized system for
marking medical devices and products with unique device identifiers (UDIs) at all units of use (e.g.
box, case, each) . Kaiser Permanente also supports an accelerated timeline for the implementation
of UDI using the GS1 Standard in an effort to improve the safety and effectiveness of medical
devices.
•  Kaiser Permanente requires each Supplier of medical devices and products to implement the GS1
System requirements as described below:
–  (a) Supplier must assign a GTIN to identify each medical device and product at all applicable
levels of packaging (e.g. case, box, each) and provide the GTIN information to the Kaiser
Permanente Customer via the Global Data Synchronization Network ("GDSN").
–  (b) Supplier must label each medical device and product in accordance with the FDA Unique
Device Identification (“UDI”) Rule at the appropriate levels of packaging (e.g. case, box, each)
using the GS1 labeling system, and (b) publish this information to a certified GDSN data pool.
–  (c) Unless otherwise agreed by Kaiser Permanente, Supplier must comply with the time line set
forth below for implementation of our GS1 requirements:
•  Time Lines
–  Class I, II and III Medical Devices and Products
Immediately
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CONTRACT LANGUAGE- INTERMOUNTAIN HEALTH
DATA STANDARDS.
–  Company must be compliant with GS1 standards.
–  Company must reconcile and transact with Intermountain using
Global Location Numbers (GLN).
–  Company will participate in the Global Data Synchronization
Network (GDSN) and subscribe and publish their data to a certified
data pool.
–  GTINs are assigned to healthcare products.
–  GTINs are marked on appropriate packaging levels (unit of dose).
–  Labeling/barcoding as well as human readable must be available
on product.
–  GTINs are used in product returns and recalls.
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CONTRACT LANGUAGE – MERCY/ROI
6.3
Electronic Commerce. VENDOR and ROI shall engage in electronic commerce through Global Healthcare
Exchange (GHX) or any other designated electronic commerce ROI so delegates. In additional VENDOR agrees to
facilitate Product identification and data synchronization efforts in accordance with prevailing industry standards. At
a minimum, engaging in electronic commerce, facilitating Product identification and data synchronization efforts
means the following Electronic Data Interchange (EDI) transaction sets:
1.  The VENDOR’s responsibility shall include use of the following standard electronic transactions:
a)  810 – E-Invoice
b)  855 – Purchase Order acknowledgement
c)  856 – Ship notice/manifest
2.  ROI’s responsibility shall include use of the following standard electronic transactions:
a)  820 - Electronic Funds Transfer
b)  850 - Purchase Order
c)  867 - Sales reporting (if requested by Vendor pursuant to Section 11.2)
3.  Vendor and ROI agree to use the following electronic standards:
a)  The use of barcodes utilizing Uniform Code Council (UCC) standards and (GS-1).
b)  The use of either:
i.  Universal Product Number (UPN) utilizing UCC standards
ii.  Universal Product Code (UPC)
iii.  National Drug Code (NDC)
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CONTRACT LANGUAGE – MERCY/ROI
(CONT.)
f)  GLN – Global Location Number. The GLN is a 13-digit code registered by the GS1 organization and is used to
uniquely identify healthcare supplier and provider locations. VENDOR will provide ROI a GLN code to use for
differentiating VENDOR locations and for use when transacting electronically. VENDOR further agrees that the
provider GLN code be used as a differentiator of ROI locations, in addition to, the customer number in the
supplier system. VENDOR agrees to accept the GLN code as the customer number in the ST N104 segment of
Electronic Data Interchange (EDI) transactions.
g)  GTIN – Global Trade Identification Number. The GTIN is a code registered by the GS1 organization for each unit
of measure and each product recognized for use in the healthcare industry. The GTIN is assigned to individual
items as well as to each different packaging configuration. VENDOR agrees to provide ROI with the unique
GTIN for each different packaging configuration for every item under contract.
h)  GDSN – Global Data Synchronization Network. The GDSN is a network of certified data pools that enables the
standardization and synchronization of supply chain data between trading partners. VENDOR agrees to
populate the GDSN to at least one data pool acting in accordance with the GS1 GDSN.
i)  UNSPSC – United Nations Standard Products and Services Codes. The UNSPSC is a GS1 coordinated
classification system for products and services. VENDOR agrees to provide ROI with the UNSPSC for each
Product identified within the scope of this Agreement.
2.  An appropriate World Wide Web address and link to include a recognizable “handshake” for members for use within
Internet address; and
3.  VENDOR’S willingness to provide Internet web addresses for item catalog Products for linkage by other
applications.
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Labeling for GS1 Compliance
An HTG Perspective
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LABELING FOR GS1 COMPLIANCE
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PRODUCT LABEL
•  In GS1 bar code as well as in human readable format:
–  GTIN
–  Expiration (if tracking is required)
–  Batch or Lot/or serial number (if tracking is required)
•  In human readable format place:
–  Catalog number
–  Name and Description of Product
–  Quantity/Count
•  Bar Code label format (Application Identifier)
–  GTIN: AI (01)
–  Expiration Date: AI (17)
–  Batch or Lot Number: AI (10)
–  Serial number: AI (21)
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PRODUCT LABEL SAMPLES
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SHIPPING LABEL
•  In GS1 bar code as well as in human
readable format
–  ASN reference number (preference is
use of GS1 SSCC)
–  PO number
–  Ship To Global Location Number
(GLN)
•  In GS1 bar code as well as in human
readable format
–  GTIN
–  Expiration (if tracking is required)
–  Lot and/or serial number (if tracking is
required)
•  In human readable format place:
–  Catalog number
–  Name and Description of Product
–  Quantity/Count
–  Ship From name and address
–  Ship To name and address
–  Deliver To name and address
•  Bar Code label format (Application
Identifier)
–  Customer Purchase Order Number: AO
(400)
–  GLN: AI (410)
–  GTIN: AI (01)
–  Expiration Date: AI (17)
–  Batch or Lot Number: AI (10)
–  Serial number: AI (21)
–  SSCC (Serial Shipping Container
Code): AI (00)
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SHIPPING LABEL SAMPLES
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Preview of Our 2014 HTG Summit
What’s Coming Up With HTG
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PREVIEW OF OUR 2014 HTG SUMMIT
9/17 – 18th Wed & Thur
Theme: Share/Drive/Transform
Day 1: Share/Drive
– 
– 
– 
– 
Transparency in our industry
Collaboration and Coordination between Suppliers and Providers
Develop Deeper relationships with our partners
Take cost out of the system beyond simple contracting
•  Scorecards
•  Application of Use Cases for Standards
Day 2 Transform
•  Transformation
– 
– 
– 
– 
Speaker #1 - Gartner
Speaker #2 – SMI
Speaker #3 –Pew Charitable Trusts
Speaker #4 – TBD
Afternoon - Transformative Technology
–  Technology Vendor #1
–  Technology Vendor #2
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INDUSTRY ITEM MASTER
Barcode Driven
Industry Maintained
GHX UDID
GDSN
Inventory &
High Use Items
Industry Item
Master
Lawson Item Master
Optiflex -POU
Accurate product data
recorded at time of
use
Scan Product
Product information
retrieved on-demand
from most appropriate
source
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STAGE III MEANINGFUL USE
•  "We request that HITPC consider including an objective
and certification criteria, under the “Improving Quality,
Safety, and Reducing Health Disparities” goal, that allows
EHRs to incorporate the Universal Device Identifier
(“UDI”) established under pending FDA regulations.
•  EMR – ongoing maintenance
– Implementation of UDI into EMR via OR/Clinical
systems information completion end of 3rd quarter
– Connections with ERP ordering will improve as more
suppliers implement GDSN
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Supplier Interaction
Q&A
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SUPPLIER INTERACTION
What barriers do you
(suppliers) see in standards
adoption and realization of
efficiencies and benefits?
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SUPPLIER INTERACTION
What are your (suppliers)
internal challenges to
accelerating standards
adoption?
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SUPPLIER INTERACTION
What can the HTG or your
other customer / providers
do to help in the adoption of
the standards?
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SUPPLIER INTERACTION
How do you see a Industry
Item Master coming
together? What would you
do to make this happen?
What’s holding you back
from this initiative??
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SUPPLIER INTERACTION
What are you working on
currently? What will you be
working on next?
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Meet the Members
Open Forum
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MEET THE MEMBERS
Member
Contact Information
Kevin Capatch
Director, Supply Chain
Technology and Process Engineering
Geisinger Health System
570.271.5555 ext. 53234
570.271.5944 (fax)
[email protected]
www.geisinger.org
Michael Innes
Program Director, National Supply Chain
Kaiser Permanente
510.625.2866
[email protected]
Matthew Mentel
Executive Director, Integrated Performance Solutions
Mercy
314.628.5625
[email protected]
www.mercy.net
Cynthia Shumway
Supply Chain Business Applications Director
Intermountain Health
801.442.2994
[email protected]
Karen Wolfe
Systems Analyst
Mayo Clinic
517.261.2172
[email protected]
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