The healthcare industry faces increasing demands and a growing shortage of healthcare professionals.^1,2 Healthcare professionals and practitioners can potentially boost efficiency, minimise cost, free up their time and focus on more critical work with the help of advanced technologies and features, and innovations. (e.g., Process redesign, automating or streamlining irrelevant/repetitive/time-consuming tasks, adopting sophisticated manufacturing and supply chain solutions)³. 

The following are the current challenges:

1. Need for a more holistic, efficient and organised solution (e.g., process, system, tools) to manage hospital medical consumables: The Nursing team seeks innovative and complementary ideas and methods to improve efficiency in the following areas. 

a. Integrate and complement the institution’s existing workflow/system to manage the retrieval, usage, and auto periodic automatic replacement (PAR) level monitoring, and top up of hospital stock and non-stock medical consumables (excluding medication) from the department clean utility, decentralised storage areas and decentralised ward supply carts. Today, the institution leverages a two-bin Inventory system to track utilisation and trigger top-ups (This is a system used to determine when items or materials require replenishment. When items in the first bin have been depleted, a card is dropped into a box to trigger replenishment. The second bin is supposed to have enough items to last until the replenishment arrives) . Staff must manually key the utilisation into the electronic medical records (EMR) to charge the patients accordingly.

b. Reduce manual effort and time spent on:

i. Collating the varying mix of consumables needed for different patient profiles via Artificial Intelligence (AI) technology with resource management systems.

ii. Data entry and reconciliation to capture hospital medical consumables (excluding medication) used for each patient. 

iii. Requests for PAR level changes due to bed surge/increase in consumable demands because of influx for specific patient groups (e.g., dressing set usage due to a complex wound).

iv. Facilitating the dispensing of consumables based on the type of inpatient ward-based procedures without manual picking. This can save the time of manual picking, reduce missing out on items, and reduce existing practice of manual pre-procedure prepared trolleys for various procedures.

2. Improve billing accuracy and reduce manual billing interventions: Frequent manual interventions and manual data capture of hospital consumables (excluding medications) result in extensive time spent reconciling billings. This is a common issue across inpatient settings. There needs to be a robust interface in the proposed system to cater to current charging norms (i.e., factored in packages) while catering to ad-hoc charging of consumables previously factored in packages. In addition, the system vendor must configure their system to cater for admission discharge transfer (ADT) interfaces to account for charging directly into the correct encounter in National Billing System (NBS). 

3. Prevent missed/no charging, which frequently happens in decentralised storage places. The decentralised storage places were created to improve workflow efficiency in clinical areas and reduce clinician, especially nursing non-clinical time. However, in the current system, charging is manual or clinician-dependent, resulting in missed/no-charges leading to financial leakages. 

¹Lee, B., & Lim, J. (2022, December 14). Commentary: Singapore needs more doctors, but setting up a fourth medical school isn't the answer. CNA. Retrieved February 6, 2023.

²RSM Chio Lim LLP. (2022, March 29). Navigating workforce shortages in healthcare sector. RSM Singapore. Retrieved February 6, 2023.

³Haleem, A., Javaid, M., Pratap Singh, R., & Suman, R. (2022). Medical 4.0 technologies for healthcare: Features, capabilities, and applications. Internet of Things and Cyber-Physical Systems, 2, 12–30.

How might we enhance the hospital medical consumables management processes to reduce manual operations, and improve staff productivity, efficiency and waste prevention in the end-to-end management of medical consumables, including activities such as ordering, top-up with predictive capability, and timely charging?

• Interoperability – the proposed system must be able to integrate and/or complement the institution’s existing systems to show that supplies are being removed. The solution should:
  • Indicate in the central inventory management system that the supplies are being removed.
  • Indicate supplies are placed into the ward supply carts via a mobile inventory management system. Subsequent removal of the supplies from the ward supply carts should automatically reflect in the central inventory management system.
  • Integrate with relevant hospital systems and any other relevant applications (e.g., tools, dashboards) that may collectively be used to facilitate the management of medical consumables. This includes the existing EMR system used to receive necessary ADT information. Once the consumables have been allocated to the necessary bed/patients via the mobile inventory management system, the data will be passed downstream to the NBS for charging purposes. The ADT information, such as the National Registration Identity Card (NRIC) or Central Provident Fund Submission Number (CSN), is necessary for NBS to tag charges to the correct encounter.
• Enhanced productivity and efficiency – aide staff to prepare and issue consumables for patients and alleviate manual, burdensome, and time-consuming tasks leveraging solutions not limited to automation and process redesign, inventory management systems, smart shelf and sorting systems, video AI, etc.
• Improved resource management supplies accuracy – ensure accurate capture of consumables supply and usage to facilitate accurate billing and inventory management.
• Predictive capability – to predict patient acuity and care needs concerning the needs for consumables so that proactive or just-in-time top ups can be done without manual activation. In healthcare, the predictive capability can enhance patient safety, especially when involved in a lifesaving scenario.

Note: The team is open to alternative solutions that might not complement the two-bin system. Please propose one that best addresses the overall performance requirements.

2. General performance requirements: 

• Intuitive User Experience: All nurses and hospital operational staff must be able to quickly self-help with the digital solution with minimal guidance.
• Scalable: The proposed solutions must be easily scaled across Singapore Healthcare Clusters (Hospitals) and with potential roll-out to Nursing Homes within one to two years, following successful trials and refinements. 
• Well-secured: Any recommended solutions must undergo regular risk assessment and adhere to the cybersecurity standards to secure private health data/protected health information. 
• Cost-effective: The proposed solutions must be cost-effective to support the solution to scale across hospitals and other potential healthcare settings (i.e., nursing homes).