This document summarizes a presentation given by Ken Lim on the perioperative supply chain optimization project at Torrance Memorial Medical Center. The project aimed to clean up and synchronize the item master between their EHR (Cerner) and financial system (Lawson) to improve surgical supply availability and accuracy of case costing. Key outcomes included cleaning over 7,000 outdated items in Cerner, reducing duplicate procedures, and standardizing preference cards to reduce daily reconciliation by nurses. Challenges included estimating project timelines and coordinating resources across departments. The project helped improve end-user satisfaction through more available supplies and easier item searching.

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2. Ken Lim
Sr. Solutions Architect, CORE Integration
Wednesday - November 16, 2016
Perioperative Supply Chain Optimization

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1. Understand Project Vision & Goals.
> Problem / Why ?
> Solutions
2. Understand Project Plan, Tasks, and Requirements.
3. Understand Achieved Project Outcomes.
4. Review Project Challenges.
5. Open Forum (Q&A).
Presentation Objectives:

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Introduction – Torrance Memorial Medical Center
• Torrance, CA
• 445-bed, non-profit medical center serving South Bay, Peninsula, and Harbor communities
of Los Angeles County for 90+ years.
• Magnet Facility
• U.S. News & World Report Best Regional Hospitals
• 9 Specialties in Los Angeles, CA
• HIMMS Level 6
• Early Cerner Millennium Adopter (2001)
• Code Level 2015.01.02
• 2 Surgical Tower Suites (20 ORs Operational)
2015 Surgical Statistics
Inpatient: 9673
Outpatient: 7113
Total: 16846

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Cerner Millennium Timeline at TMMC
2000 2010 2015
2000 - 2002
Conversion from Power Chart
Classic to Millennium
 PathNet
 SurgiNet
 FirstNet
 RadNet
Item Master Sync
Interface Breaks
2013 - 2014
Revenue Cycle
5 Years of Item Master Sync Gap

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Inefficient multiple manual step(s) to build surgical items from Lawson to Cerner.
Outdated and inaccurate Cerner surgery item master.
Frustrated End-Users / Labor intensive daily free text item reconciliation by charge
nurse due to unavailability of chargeable items on the day of surgery as actual items in
the system.
> Up to 30 items per/day
Lack of accurate data and insight on actual surgical case costs.
Problem / Why ?
1 2 3 4

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Project Vision:
• Increase cross
functional
coordination
• Increase Efficiency
• Surgeon/Nursing
Satisfaction
• Case Cost Analysis
• Item Master Sync
• Basic Item Details
• Item Costs
• Standardize Procedure
Descriptions.
• Reduce Ambiguity
Eliminate Duplicate
Procedures.
• CPT Codes* Streamline
Procedure
Master
Connect item
Master and
Enhance
Accuracy
Improve
Maintenance
Process
Enhance Case
Cart Picking
Process
Enhance
Preference Card
Accuracy
Gain Financial
Insight

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Project Goals (Solutions):
Immediate:
1. Perform Item Master cleanup and re-implement item master Synchronization Interface:
• Item Master clean up against Lawson Data.
• Inbound interface from Lawson to update Cerner Item Master with basic item information.
2. Perform Procedure Master Update:
• Standardize procedure master by removing duplicate and inactive historical procedures.
3. Perform Preference Card (Picklist/Comment Clean Up)
• Build Free Text Items.
• Instruments/Preps/Specialty Supplies (Non-Chargeable & Implants)
Distant:
1. Improve Preference Card Maintenance Process via Analytics
• Cerner mPage.
2. Improve surgical profit margin through case cost analysis via Analytic
• Cerner CCL reports / HealthE Intent / SAP BO / Advisory Board Surgical Compass).
3. Prepare foundation for Meaningful Use (MU) 3 Supply Chain Requirements
• Unique Device Identifier (UDI) by 2020.

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Project Plan Overview:
June – October 2015 November – February 2016
Phase 1:
Foundation Data + Interface
Phase 2:
OPS Process / Financial Improvements
Data Clean Up
•Item Master
•Procedure Master
Interface Solutions Case Cart Accuracy/Savings Goals
•Item Master Sync
*Supply Usage*
1. Preference Card Clean Up
• Picklist
• Comments (FREE TEXT ITEMS)
 Non-Chargeable
• SP Sets/Trays
• Preps/Ins
2. Qualitative Case Cart Analysis
• OR Waste Item Pilot
Track “Opened Un-Used”
3. Quantitative Case Cart Analysis
• Examine top 10 procedures
case cart cost per specialty.
Pre-Interface Tasks/Requirements:
• Perform Quantitative Data Analysis:
 Item Numbers
 Cerner Only Items
 Lawson Only Items
 Item Classification
• Re-Design Supply Locations:
 2 Tower OR Supply Locations, Central, Sterile Processing,
• Validate Item Unit of Measure Validation (UOM)
• Identify Redundant Historical Procedures
• Standardize Procedure Naming Convention

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Project Outcome:
June – October 2015 November – February 2016
Phase 1:
Foundation Data + Interface
Phase 2:
OPS Process / Financial Improvements
Data Clean Up
•Item Master
•Procedure Master
Interface Solutions Case Cart Accuracy/Savings Goals
•Item Master Sync
*Supply Usage*
1. Top 10 Surgeon Preference Card
per specialty updated:
• Picklist/Comments
• (FREE TEXT ITEMS)
 Non-Chargeable
• SP Sets/Trays
• Preps/Ins
2. Qualitative Case Cart Analysis:
• OR Waste Item Pilot Result:
Minimal “Opened Un-Used”
3. Quantitative Case Cart Analysis
• Conduct Case Cost Analysis Reporting
(Planned VS. Actual Expenses)
(Submitted Charge VS. Expenses)
Pre-Interface Requirement Key Findings:
 84% (7166/8528) of items in Cerner item master
identified with outdated item info.
 42% Decrease in total # of procedures.
(2100  1000)
 15% Decrease in total # of preference cards.
(12,000  10,000)
 8.5% (600) of the outdated items lived in preference
cards and were replaced.
 9500 Lawson only SURG Items to be built into
Cerner.

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Our Quant, Quantitative Data Analysis
Total Number of Items
Cerner Only Cerner Only % Lawson Only Lawson Only % Cerner & Lawson Cerner & Lawson % Total
2 Characters 1 0% 0 0% 0 0% 1
3 Characters 11 0% 0 0% 0 0% 11
4 Characters 175 2% 0 0% 1144 4% 1319
5 Characters 822 10% 0 0% 1646 6% 2468
6 Characters 1290 15% 2617 29% 20157 73% 24064
7 Characters 240 3% 1 0% 1 0% 242
8 Characters 60 1% 8 0% 2 0% 70
9 Characters 5897 69% 6510 71% 4652 17% 17059
10 Characters 16 0% 6 0% 0 0% 22
11 Characters 3 0% 0 0% 0 0% 3
12 Characters 7 0% 0 0% 0 0% 7
13 Characters 4 0% 0 0% 0 0% 4
14 Characters 2 0% 0 0% 0 0% 2
Total 8528 100% 9142 100% 27602 100% 45272
Identifying Discrepancies in Items

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More Quant, Key Findings in Cerner
7166
1362
0%
25%
50%
75%
100%
Cerner Only Items
Inactivate Keep in Cerner
Define
• 8,528 Cerner Only items
Identify
• 1,362 items to remain in
Cerner
• 7,166 items to be inactivated
Analyze
• 618 items to be inactivated
are on preference cards

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End-User Satisfaction Wins:
 Availability of items in Cerner on the day of surgery and ease
of item searching through manufacturer catalog number.
 Over 80% decrease in daily free text implant items reconciliation
by surgical charge nurse.
30 to < 10

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Project (challenges):
Getting Started, the momentum, keeping it going.
 Estimating project hours: exactly how many?
 Uncovering the unknown from the data:
o Adjusting to new variances, assessing impact, and formulating
solutions.
 Communicating the whys behinds technical decisions to clinicians.
Resource Availability and Coordination:
 Service line lead availabilities after OR shift.
o “Nursing first, then preference card homework”
o 1-2 Hours per day, 2-3x per week.
o Minimizing Overtime.
Ideal: Experienced FTE Surgical Tech with Circulating Experience.

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Open Forum (Q&A)

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Special Thanks To
TMMC Project Team Members:
Project Sponsor/TMMC Periop Director: Deborah Butler RN, MSN, MBA, CNOR
Surgical Service Line Leads: Mona Miller, Kathy Torres, and all.
Periop Charge Nurse: Chris Moore
Interim Assistant Periop Director: Sharron Jordan, RN, MBA, MSN,CNOR
Periop Business Manager: Frank Gonzalez, MBA
Central Service Manager: Chance Krutsinger
Periop Sterile Processing: Corey Miller
Lawson Systems Analyst: Melvin Ridgle
Application Analyst: Jiteshkumar B. Patel
Supply Chain Ops/Purchasing Director: Cindy Kassotis
Supply Chain Ops/Purchasing Manager: Philip Cutler
Supply Chain Ops/Purchasing Analyst: Courtney Jeng
Cerner Project Team Members:
Lead Supply Chain Consultant: Caleb King
Perioperative Consultants: Anna Lim / Sydney Malackowski
Supply Chain Executive: Susan Morris
FSI Engineer: Matthew A. Smith
Engagement Leader: Brian Farrington

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Thank you, for more questions
contact Ken.Lim@tmmc.com