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Title:
Using Systems and Technology in the Maintenance Realm
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Ray Miller, BS, MSOSH, GP Direct Supply Dir. of Risk & Safety Solutions 414 405 0492; [email protected]
6767 N. Industrial Rd. Milwaukee WI 53223
> Has 33+ years in HC safety/risk (28+ years in post-acute care)
> Is a former corporate safety director for several LTC companies
> Has devoted his career to the development of healthcare risk and safety
strategies, programs and solutions
> Serves on the AHCA Emergency & Disaster Preparation Committee
> Is a founding member of the Direct Supply-sponsored Loss Prevention Forum
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 2
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DISCLAIMER
The materials, comments and other information contained in
this presentation are intended to provide general information
but not advice about certain regulations and initiatives.
This information is not and not intended as legal or other
advice and each situation may vary depending on the
particular facts and circumstances.
You should not act upon this information without first
consulting with qualified legal counsel.
Thank You.
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 3
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Agenda
1. Introduction
2. Tomorrow and Today
3. How the “Cloud” Works
4. Current Challenges (costs, complexities, contributions)
5. Examples of Possible Technology-based Solutions
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5
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Making Your Voice Heard in Washington
Ensuring continuity of cash flow and shaping policy for Senior Living
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Networking Groups
Fostering Idea-Sharing & Innovation
11 Organizations
SENIOR LIVING
ECOSYSTEM FUNDING &
DEVELOPMENT
INDUSTRY SUPPORT
& ADVOCACY INTEGRATED
TECHNOLOGY & DATA
NETWORKING
GROUPS PURCHASING
AGGREGATION
SUPPLY CHAIN
REINVENTION
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SESSION DESCRIPTION
Technology is becoming an increasingly more likely source for
tracking and documentation solutions as well as resident and facility
monitoring systems.
We’ll discuss the complex and ever-changing world of healthcare
technology with a dual focus on resident health and wellness AND on
building safety and control.
We’ll also consider the importance and benefits of using a
“systems” approach to manage the work load and PM.
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SESSION OBJECTIVES*
As a result of this session, attendees will be better able to:
1. (KNOWLEDGE) Recognize the complex, ever-changing world of healthcare
technology and potential solutions
2. (COMPREHENSION) Evaluate current challenges, methods and barriers to
change and the potential benefits to be gained through improving staff efficiency and
amplifying facility marketability using technology
3. (APPLICATION) Use senior living specific processes, resources and solutions to
integrate current practices with new technology-based approaches
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Agenda
1. Introduction
2. Tomorrow and Today
3. How the “Cloud” Works
4. Current Challenges (costs, complexities, contributions)
5. Examples of Possible Technology-based Solutions
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5
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“Technology will be the key driver for
Senior Living providers looking to reposition
their communities in the future.”
CXO Long Term Care Summit,
2013, Las Vegas, NV
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“Health care organizations currently invest
less in IT than in any other information-
intensive industry. …
“Current systems are relatively primitive,
compared with industries such as banking or
aviation.”
© 2002 Bates; licensee BioMed Central Ltd. This is an Open Access article:
verbatim copying and redistribution of this article are permitted in all media for
any purpose, provided this notice is preserved along with the article's original
URL. (http://www.biomedcentral.com/1472-6947/2/7 )
David W Bates The Quality Case For Information
Technology In Healthcare
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“Between the health care that we now
have, and the health care we could have,
lies not just a gap, but a chasm.”
Crossing the Quality Chasm: A New Health System for the 21st Century, Institute of Medicine: Washington, DC, National Academy Press 2001;
Copyright ©2000 by the National Academy of Sciences. All rights reserved. Permission is granted to reproduce this document in its entirety, with no
additions or alterations
Institute of Medicine Washington, DC,
National Academy Press 20010
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"The last national study of IT in nursing homes was completed
nearly a decade ago, and since then, nursing home
administrators have shifted the types of technologies being
used." **
Current Uses?
Admission and discharge, monitoring dietary and pharmacy,
administrative activities, health records, care planning,
communication (between families and residents AND between
caregivers)
** Greg Alexander, AP, MU Sinclair School of Nursing
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Delta
Change
Acute and
Post-acute
Technology
Incontinence
Wound Healing
Vital Signs
Recent Clinical Advances
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They used
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Technology Context*
Resident
Safety Infrastructure
Building
Management
Clinical
Wellness
Community
Connect
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Agenda
1. Introduction
2. Tomorrow and Today
3. How the “Cloud” Works
4. Current Challenges (costs, complexities, contributions)
5. Examples of Possible Technology-based Solutions
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5
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The “Cloud”
Moving Our “Today” Down the “Technology Continuum”
Resident
Safety
Infrastructure
Building
Management
Clinical
Wellness
Community
Connect
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“The Network IS the Computer.”
John Gage, 1984
Sun Microsystems http://enki.co/Blog/cloud-101-lesson-2-the-technology-behind-cloud-computing.html
CLOUD 101 - LESSON 2 - THE TECHNOLOGY BEHIND CLOUD COMPUTING
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Cloud Computing
1. A service/utility rather than a product
(i.e. electricity grid)
2. Shared resources / software / info
provided TO computers / devices over
a network (typically the Internet)
3. Classifications: public, private or hybrid
Copyright 2014-2015 Direct Supply, Inc. All rights reserved
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REQUIRED ATTRIBUTION: "Internet Connectivity Distribution & Core" by User:Ludovic.ferre - Internet Connectivity Distribution&Core.svg.
Licensed under Creative Commons Attribution-Share Alike 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Internet_Connectivity_Distribution_%26_Core.svg#mediaviewer/File:Internet_Connectivity_Distribution_%26_Core.svg
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“LTE” = Long-Term Evolution or 4G LTE
… a standard for high-speed data &
wireless mobile phones, data terminals.
… the natural upgrade path for both 2nd and
3rd generation networks.
… anticipated to become the first truly
global mobile phone standard.
NOTE: The different LTE frequencies and
bands used by different countries will mean that
only multi-band phones will be able to use LTE
in all countries where it is supported.
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Who provides the Internet?
1. Currently 6 Tier 1 providers: Level 3 Communications,
TeliaSonera International Carrier, CenturyLink, Vodafone,
Verizon, Sprint, and AT&T Corporation.
2. Currently 24 Tier 1 major/important providers
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Copyright 2014-2015 Direct Supply, Inc. All rights reserved
http
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An ironclad “jail” that limits
access to the system’s resources
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What do you think? (by show of hands)
How many of you think that:
1. You have the resources to manage technology initiatives?
2. Your organization is properly invested in technology?
3. Technology is “critically” important to your organization?
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What do your counterparts think?*
84%: “We need help to develop and manage technology solutions.”
74%: “We are significantly under invested in technology.”
64%: “We will be acquired by someone more advanced.”
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Agenda
1. Introduction
2. Tomorrow and Today
3. How the “Cloud” Works
4. Current Challenges (costs, complexities, contributions)
5. Examples of Possible Technology-based Solutions
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5
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1. Technology leap frogging
2. The failure record of past IT projects
3. Limited resources in a “recovering” economy
4. Growing performance demands for technology initiatives
https://www.google.com/search?q=technology+leapfrogging+2014+images&tbm=isch&tbo=u&source=univ&sa=X&ei=pNHvU-XkA42KyAS-hYKICw&ved=0CBwQsAQ&biw=1366&bih=667#facrc=_&imgdii=_&imgrc=Y7pDznvEV0cN9M%253A%3BmXUhi4at-dXGhM%3Bhttp%253A%252F%252Fwww.aci-
institute.com%252Fuploads%252Fpages%252F2014_04_16_10_35_06_tech-in-hands.jpg%3Bhttp%253A%252F%252Fwww.aci-institute.com%252Findex.php%252Fweb%252Fabout_aci%252Finsights_apr%3B580%3B295(http://www.laserfiche.com/ecmblog/article/business-
managers-how-do-you-justify-your-need-for-new-technology) How Do You Justify Your Need for New Technology? by Katie Burke;
Copyright 2014-2015 Direct Supply, Inc. All rights reserved
What are the challenges in getting technology funding?
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Expense of 3rd
Party IT Support
Ongoing
Maintenance
Costs
Urgency of LSC-
Related Repairs
(Emergency Trip
Charges)
Multiple Servers &
Lots Of
Equipment
Key Challenge: COSTS
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Wander Monitoring
Systems Punch Downs No Local IT
Confusing
Data Closets Multiple Vendors
image
Key Challenge: Complexities
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BYOD security and more HC breaches …
A recent roundtable found that a majority of HC providers had defined
procedures for securing devices
… 46% admitted the policies are not being followed. …
Participants agreed that device encryption should be a part of any BYOD
policy … but rarely enforced ... lack of adherence to their own policies.
… Due to sensitive data AND regulatory and compliance requirements, HC
leaders must incorporate better practices when to protect patient data.
BYOD =
“Bring Your Own Devices”
mobile devices, laptops,
desktops, medical devices,
…
Complexities
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Complexities: The intense scrutiny on technology investments
How have you handled impacts on:
1. Existing technology
2. Current business processes
3. Internal culture and external relationships
(http://www.laserfiche.com/ecmblog/article/business-managers-how-do-you-justify-your-need-for-new-technology) How
Do You Justify Your Need for New Technology? by Katie Burke; Copyright 2014-2015 Direct Supply, Inc. All rights reserved
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Complexities: Four Common Technology Pitfalls
1. Poor resident or environment interface
2. Inadequate implementation plan
3. Inadequate maintenance plan
4. Poor design
Chapter 50. Patient Care Technology and Safety: Gail Powell-Cope, Audrey L. Nelson,
Emily S. Patterson
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1. Is there a “technology budget”? (PPD, Capital, CapX)
2. Who agrees with you regarding the need for more IT resources?
3. Can technology actually help you manage your building & expenses?
4. In light of change & innovation, what are your thoughts about the Cloud?
Key Challenge: Your Contributions*
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Agenda
1. Introduction
2. Tomorrow and Today
3. How the “Cloud” Works
4. Current Challenges (costs, complexities, contributions)
5. Examples of Possible Technology-based Solutions
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5
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Imagine a Future Where….
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Technology of Tomorrow, Today.
One Call
Reduced
hardware
costs
Fast
adoption
of trends
Single
Source
Remote
Manage-
ment
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Future of Senior Living Technology
Infrastructure
Environmental
Clinical
Wellness
Resident
Safety
Community
Connect
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Example #1
Intelligence: Making your facility or
community smarter and your life more
manageable
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Future of Senior Living Technology
Resident safety
Community connect
Clinical wellness
Environmental monitoring
Infrastructure
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Future of Senior Living Technology
Resident safety
Community connect
Clinical wellness
Environmental monitoring
Infrastructure
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Future of Senior Living Technology
Resident safety
Community connect
Clinical wellness
Environmental monitoring
Infrastructure
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Example #2
Intelligence: Making your maintenance
and logistics approach smarter and your life
more manageable
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Case
Study:
P-3C Orion long range ASW aircraft
4-engine turboprop, anti-submarine
and maritime surveillance aircraft.
"We continue to discover new ways to lower the total costs of ownership. We intend to
improve every aspect of logistics and maintenance using technology developed for
other applications and integrating that technology into an open-architecture system.“ Gisele Welch, director of the Logistics and Maintenance Applied Research Center (LandMARC) at the Georgia Tech Research Institute (GTRI).
“Maintenance accounts for more than 60% of lifetime costs for complex military
systems. These systems continue in active service much longer than their designers
envisioned. Maintenance becomes more difficult, costly and time consuming.” Ron Wagner, a former Navy aviation maintenance officer and co-director of LandMARC
http://gtri.gatech.edu/terms
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Example #3
Intelligence: Making your ice machine
smarter and your life more manageable
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Has this
happened to
your Ice
Machines? > Bacteria Buildup
> Scale & Lime
> Parts breakdown
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Why do
these
problems
occur?
> Improper filtration
> Infrequent cleaning
> Improper maintenance
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Scale, lime, and bacteria cause
serious problems…
> F-Tag 252, 327, 371 noncompliance Facilities cited hundreds of times a year for these f-tags –
ice machines are one source of non-compliance
> Maintenance Budget goes up Cost to repair between $400 and $1,500
> Resident Discomfort “From foodborne illness among nursing home residents
are 10 to 100 times greater than for the general population.” Colorado Dept. of Public Health
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But, it’s relatively simple to prevent these issues
33%
58%
6%
3%
Cause of Ice Machine Breakdowns
Maintenance
Installation
Operating Environment
Equipment Malfunction
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Smart Equipment – The Internet of Things
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Smart Equipment – The Internet of Things
Building
Mngmnt.
System
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Smart Equipment – The Internet of Things
Building
Mngmnt.
System
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Smart Equipment – The Internet of Things
Building
Mngmnt.
System
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Smart Equipment – The Internet of Things
Service Provider Facility / Community
Building
Mngmnt.
System
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Smart Equipment – The Internet of Things
Ice Machine
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Example #4
Intelligence: Making your LSC and
Survey Process “systematic”, smarter and your
life more manageable
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Sweden's ability to develop its own
state-of-the-art fighters depends on
blending home-grown and
imported technology.
1. JAS 39E engine = US
2. Radar = Britain
3. Infrared search/track = Italian
4. Airframe may be = Brazil
SIDEBAR: Swedish/Saab-built
JAS 39E Gripen = “Gen 6”
… not the world's fastest, most agile or stealthiest fighter. That’s not a bug, it is a
feature. It’s intended to cost less to develop, build and operate … despite doing almost
everything better.
An engineer: “The Swedish air force could not afford to do this the traditional way”-- and
neither can many others.
https://www.google.com/?gws_rd=ssl#q=JAS+39E+Gripen+capabilities
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JAS 39E Gripen: $43,000,000
F-22 Raptor: $150,000,000
SIDEBAR*
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What did your last Fire Safety
Survey Report (CMS 2786R) look like?
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What LCS technology solutions are there?
1. Tasks
2. Documentation
3. Organized calendar-based work schedule
4. Prioritizes by specific LS code
5. Tracks all LS documentation
6. Instructions on to perform LSC-related tasks (and other maintenance tasks)
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142
Annual
Inspection
Tasks
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Generator Inspection W
Running generator under load M
Corridor Doors Q
Exit Lights Q
Fire Doors Q
Smoke Doors Q
Wall Penetrations Q
Backflow devices A
Fire Department Connections Q
Fire Hose/ Cabinets A
Fire Pump (if applicable) Churn W
Fire Pump (if applicable) Flow A
Sprinkler Pressure Reading M
Sprinkler System Components A
Sprinkler System Valves M
Waterflow device alarm testing Q
Fire Extinguisher Inspection M
Fire Extinguisher Maintenance A
Fire Alarm Notification Devices Q
Fire Alarm Panel A
Fire Drill Q
Off premise emergency force notification equipment Q
Pull Stations A
Smoke Sensitivity Test 2Y
Smoke/ Heat/ Duct Detectors A
Grease Removal Devices S
Kitchen Exhaust Cleaning S
Kitchen Exhaust Hood S
Kitchen Fire Extinguishing System S
Biomedical Equipment Performance and Safety Check A
Medical Gas System Testing A
Disaster Drills S
Safety Com M
Hazard Safety Surveys Non-Patient Areas A
Hazard Safety Surveys Patient Areas S
Interim Life Safety Measures
Boilers/Water heaters M
Eyewash Stations A
Water Temperatures W
292
Annual
Reports
Regulatory Compliance Reporting
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“Other” Regulatory Compliance
Safety Committee’s Responsibilities
1. Over-see mandatory EE education
2. Emergency Response Plan Review
3. Regulated Medical Waste (DOT)
4. On-going OSHA Compliance
5. OSHA 300 A (post/remove)
6. Safety Committee Meeting
7. osha Standards Available
8. MSDS (SDS) Available
Annual osha Evaluations
1. Haz. Com. (Global Harmonization)
2. osha Recordkeeping (EE injuries)
3. Dprtmntl. Hazard Assessments
4. Personal Protection Equipment
5. EE Med Record Access
6. Violence Prevention
7. Lockout / Tagout
8. Confined Space
9. Ergonomics
10.Hep. B
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BENEFITS: Compliance and Documentation
Life Safety -- Water temperature, fire drills and generator
testing
OSHA -- OSHA record keeping, bloodborne pathogens,
lockout/tagout, OSHA Log, incident reports, hazard evaluations
Safety Committee Program – Processes, meetings,
membership, minutes
Emergency & Disaster Preparation – Preparation,
Plans, Contacts, Forms, Drills
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TECHNOLOGY BENEFITS: Residents and Information
“There is a lot of interest in point-of-care devices for routine
data collection.
Facilities are adopting touchscreen devices, handhelds …
voice-activated devices.
These technologies will dramatically increase the data-flow in
… organizations.”
Peter Kress, VP CIO, ACTS Retirement-Life Communities in Ambler, PA.
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TECHNOLOGY BENEFIT: Tracking
TRACKING
1. Repairs
2. Warranties
3. Work Orders
4. Work Schedules
5. Capital Equipment
6. Maintenance Schedules
7. Service Provider Management
8. Department-Based Work Schedules
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1. What happened to Blockbuster Video?
2. My Grandfather delivered bottled milk to homes from a truck …
3. The “older generation” almost NEVER likes the “new generation’s” music …
4. How can you use systems and managed-services to operate buildings profitably?
So Now What?
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Closing
There story of a man on an oil rig in the North Sea. In the
middle of the night, an explosion set the rig on fire.
The man now faced an awful decision -- stay on the
burning platform and await certain death or jump into the
inky, icy North Sea 100 feet below.
He chose to jump ...
Embrace it … Learn it … Use it
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Agenda
1. Introduction
2. Tomorrow and Today
3. How the “Cloud” Works
4. Current Challenges (costs, complexities, contributions)
5. Examples of Possible Technology-based Solutions
Copyright 2014-2015 Direct Supply, Inc. All rights reserved 5