SCANHvBCC 2018/19 First-Place Submission by University of Tennessee, Knoxville

Innovative Supply Chain Solutions for a Healthier Canada

Michelle Davis Supply Chain

Carson Hollingsworth Finance

Morgan Sowers Marketing

Abigail Wegman Healthcare Analytics

Blood Matters Blood bank management is a complex, challenging environment with room for improvement

80%

30%

70%

Hospitals manage inventory via manual processes

Inventory expires on shelves without tracking

Avoidable blood waste caused by expired units

Donor vein

CBS

Existing System Visibility

Donor vein

CBS

Existing System Visibility RFID Tag Added to Blood Product

Hospital

Patient Vein

No Visibility

Hospital

Patient Vein

RFID System Visibility 2

Targeted Solutions That Address Key Issues Use innovative technology to collect and utilize relevant supply chain data RFID Tracing and Tracking System and resulting data collected

Proposed Solution

Key Issues Addressed

Donor Vein

● Automation of supply chain tracking and traceability of blood products ● Integration of supply chain processes with hospital care processes ● Use of technology to strengthen supply chain processes

Targeted Supply

Balanced Inventory

Predictive Demand

● Patient safety outcomes & impact ● Ensuring adequacy of supply

● Reduction of the discard (waste) of blood products

● Demand forecasting & utilization of blood products to support sustainability of blood supply

Mid-Term

Long-Term

Phase 2

Phase 3

Phase 4

Pilot Testing 2021 (Year 3)

Full Implementation 2022-2025 (Year 4-7)

Improvement and Expansion 2026-ongoing (Year 8 forward)

Short-Term Phase 1

Preparation 2019-2020 (Year 1-2)

Patient Vein

3

Why RFID?

RFID Success A superior alternative to barcoding in healthcare and beyond What is RFID?

Why RFID?

Proven Success

● ● ● ● ● ● Tracking system ● Captures information stored on product tag

Healthcare Blood management Garment tracking Pallet shipping Airline safety

● No direct scanning ● Collects all info automatically See Appendix 2.4-2.5 for More Information

5

Technology Comparison Table Of existing technology, Passive RFID is the best fit for CBS Technology Comparison

Application Comparison

Technology

Real-time

Range

Power Source

Passive RFID

Yes

3 inches

None

Active RFID

Yes

100 feet

Required

Small

High ($100), Scanner cost ~$3,000 each

Bluetooth Low Energy (BLE)

Yes

30 feet

Required

Small

Low ($25)

X

X

X

Size

Cost per Item

Low (<$10), Very Small Scanners cost ~$3,000 each

GSM/SMS/ GPRS RealTime

Yes

Unlimited

Required

Large

Very High ($100 onetime + $20/month)

QR Codes

No

Physical Scan

None

Very Small

Very Low (<$1)

Asset Warehouse Fleet Tracking Inventory Tracking X

X

x

X

X

Rationale Not Chosen

Power Source & Cost

Power Source & Application

X

X

Power Source & Cost

Not Real-Time & Scanning Requirement 6

SimplyRFID VITaL: An Innovative Supply Chain Solution Real-time inventory tracking, tracing, and logistics will transform the supply chain of CBS

Inventory Tracking: How it Works ● ●

Assigns a unique tag to each individual blood bag unit that connects to sensors where blood is stored Creates end-to-end communication and visibility

Infrastructure: Compatibilities ● ●

Works with new or existing storage options Retrofitting capabilities

Integration: Joining Processes ● ●

Compatible, secure technology with hospital LIS systems Standalone, or fits into any workflow with integration to EHR and ERP systems

Antennas emit signals that connect to tags in real time & relay data back to software

Printer implants data on RFID tag which adheres to blood bag with identifier information (separate from label)

See Appendix 2.6-2.7 for More Information

7

A Day in the Life of Blood Product in the System Solution fills data gaps to create full vein-to-vein tracking and traceability Collection & Testing

Typical blood collection & labelling

Manufacturing & Distribution Centers

RFID Tag physically attached to product during processing

Hospital Inventory

Hospitals store product in units retrofitted with RFID technology

Use

Management

Clinicians scan badge, pick product, assign product to patient

Real-time data is automatically sent to CBS, enabling end-toend supply chain visibility

CBS Governance Hospital Governance Donor information captured

New VITaL System Existing CBS System

Blood type data added

Blood product, expiration added

RFID UDI linked with donor info

Physical location captured realtime

Physical location captured real-time

Assigned to specific patient in VITaL and hospital systems

VITaL sends automated pull signal when used

VITaL sends realtime signals

UDI = Unique Device Identification

See Appendix 2.8 for More Information

8

Comparing Traceline with SimplyRFID Find the right balance between cost, visibility, and workflow integration Where SimplyRFID surpasses Traceline:

Simply RFID

Traceline

Ease of LIS Integration & Roll- Order Automation out

Considerable training needed

Simple integration with hospitals and CBS

Scanning can trigger reorder, requires integration in existing ERP.

Provides trend support, joins existing IT system

Hardware / Infrastructure Requirements

Full LIS implementation required, software & barcoding

Minimal infrastructure, existing equipment retrofitted

Real-time Inventory

Recipient Characteristic Recording

Data Analytics Capabilities

Additional Considerations

Manual entry, requires separate data entry system

Manual entry, requires separate data entry system

Dashboard generation with limited system compatibility

Success in implementation and waste reduction among other blood systems

Automatic report generation and integration with statistics software

99% accurate and reliable information provided; scalable for future supply chain and healthcare needs & innovations

Sees location of any unit at any time in the supply chain

Attached to patient record when RFID scanned (taken from storage), automatically associates blood unit to procedure and patient characteristics

9

Impacts

Value-Add to All Stakeholders This recommendation has positive impacts on all parties involved, not just CBS

Donor Vein

Patient Vein

DONOR Donor Satisfaction & Confidence in CBS

CAN. BLOOD SRVCS

HOSPITAL

Reduced Waste & Cost

Reduced Cost & Errors

● Increase process efficiency ● Reduce blood waste ● Fewer expedited shipments ● Reduce staff errors

● Increase process efficiency ● Reduce blood waste ● Reduce risk of litigation

● Know donation won’t be wasted ● Know matched with patient to improve outcomes ● Improve processes

Higher Visibility

Recruitment & Collection Productivity

● Ability to track and resolve any adverse events ● Data quality improved

● Strengthen supply chain processes

Scalability ● Standard across hospitals ● Strengthen supply chain processes ● Adequacy of supply

Reduced Stock Outs ● Blood when needed

Improved Patient Safety ● Vein-to-vein visibility ● Improve patient outcomes

Reduced Manual Processes ● Frees up precious human capital resources

PATIENT Confidence in Health System ● Improved outcomes ● Improved patient safety ● Know product has vein-tovein trackability ● Know matched with donor to improve outcomes

Patient Satisfaction ● ● ● ●

Improved outcomes Product quality assurance Reduced time to delivery Hospital staff can be more attentive, efficient

See Appendix 5.3 for More Information

11

Use Data to Efficiently Achieve an Adequate Supply Targeting the right donor and the right product to fulfill real-time recipient needs Key Issues Addressed

Patient safety outcomes & impact Ensuring adequacy of supply

Strategic, cost-efficient recruitment of donors that best meets patient needs in terms of improved safety and outcomes

Strategic Targeting of Donors Automatic real-time data reports for: Product usage, inventory levels, and demand forecasting Analyze the data by key factor such as blood type or hospital / region

Develop targeted recruitment strategies to meet specific needs.

Blood donor recruitment & retention: - Ultimately dictates supply - But is expensive: donor acquisition is 3x more expensive than blood they provide

40% Past donors do not return to donate again

Using data for strategic targeted marketing allows a cost-efficient way for specific needs to be met.

See Appendix 3.1-3.2 for More Information

12

Use Data to Efficiently Achieve an Adequate Supply Targeting the right donor and the right product to fulfill real-time recipient needs Key Issues Addressed

Patient safety outcomes & impact Ensuring adequacy of supply

Strategic Targeting of Donors Automatic real-time data reports for: Product usage, inventory levels, and demand forecasting Analyze the data by key factor such as blood type or hospital / region

Develop targeted recruitment strategies to meet specific needs.

Blood donor recruitment & retention: - Ultimately dictates supply - But is expensive: donor acquisition is 3x more expensive than blood they provide Using data for strategic targeted marketing allows a cost-efficient way for specific needs to be met.

Strategic, cost-efficient recruitment of donors that best meets patient needs in terms of improved safety and outcomes

Ensuring Patient Safety Real-Time RFID tracking for product number & location to easily identify & mitigate potential safety concerns Automatic notifications to clinicians of recalled or expired products Pre-programmed safety mechanisms preventing usage of expired or recalled products

Prevents widespread safety concerns related to: - Inability to locate safety issues when they occur - Lack of information transparency that leads to administration of unsafe products

Increase safety measures elsewhere could potentially warrant more lenient eligibility criteria (which increases number of potential donors)

Improving Patient Outcomes “Vein-to -vein” tracing and integration of data systems between CBS and hospitals allows: ● Connection of donor characteristics with patient characteristics, conditions, & procedures ● Recommendations of ideal donor-patient matches to potentially improve outcomes ● Strategic donor recruitment using certain characteristics that match specific patient needs

Emerging scientific evidence indicates potential influence of donor characteristics on decreased product quality and/or increased morbidity, including: - Mismatching donor and patient sex - Older age of donor - Increased frequency of donation, etc.

More evidence is needed, which CBS could contribute to by uniquely providing data tracing blood from donors directly to recipients.

13

Create a Balanced Inventory to Reduce Waste Having the right blood at the right place at the right time, with less waste Reduction of the discard (waste) of blood products

➔Inventory protects against unpredictable demand and longer lead times. ➔Higher inventory of blood products increases waste from expired product. ➔Real-time visibility allows for more responsive, agile replenishment of inventory and shorter lead times, decreasing the amount of inventory needed, and wasted product.

● ● ● Goals

Key Issues Addressed

Reduce blood waste due to expiration Reduce overall inventory levels without threatening stock-outs Optimize product mix so the right blood is at the right hospital at the right time for the right patient

Real-time pull system pushes to CBS triggers pooling and semi-automated ordering of new product to the hospital.

See Appendix 3.3-3.5 for More Information

14

Pool Inventory to Reduce Waste Pooling demand allows for less waste from expired hospital inventory Current System

Future System

Hospitals

Hospitals

Right blood at the right place, only at the right time → Reducing waste ●

DC

DC

●

CBS controlled inventory allows for pooling prior to hospitals Reduce inventory at hospitals but retain required service level Expected Outcomes

10% Key

reduction in wasted blood product

Inventory See Appendix 3.3-3.5 for More Information

15

Predict Demand to Avoid Stockouts Improved algorithms in connection with real-time data feeds create more accurate forecasting Key Issues Addressed

●

Goals

● ●

●

Theory

● ●

Demand forecasting & utilization of blood products to support sustainability of blood supply

Use RFID in conjunction with current systems for vein-to-vein traceability and trackability Increased patient health by having the right blood, at the right time, in the right place Simple, user-friendly interfaces with hospitals for disposition, recall, and expired blood products

Forward Netting Logic typically used in systems (ex. SAP, Oracle) result in too much safety stock Use a Croston Model for blood products with low demand and occasional spikes Use a Base Stock Model for blood products with typical demand

Execution Initial Setup of Safety Stock: - Set as 3 worst consecutive days in each hospital’s history by product type or SKU Inventory & Ordering Logic: - Pool inventory across hospitals in similar regions, reducing aggregate demand - Option to borrow inventory from closer hospital rather than expedite from CBS

Expected Outcomes

15% reduction in expedited shipments

Day 0 and Moving Forward: - Utilize dashboards to see real-time demand, spot trends and react faster, reducing bullwhip effect - Additional information will improve forecasting algorithms See Appendix 3.6 for More Information

16

Implementation Plan

Building an Implementation Plan in Four Phases Achievable execution with key milestones to monitor progress Mid-Term

Long-Term

Phase 2

Phase 3

Phase 4

Preparation

Pilot Testing

Full Implementation

Improvement and Expansion

2019-2020 (Year 1-2)

2021 (Year 3)

2022-2024 (Year 4-6)

2025-ongoing (Year 7 forward)

Short-Term Phase 1

Year 1: ● Develop RFID supplier partnership ○ System design ○ Demo testing ○ System security

● Engage stakeholders ○ Form and train HLS and hospital management team ○ Hospital readiness survey

Develop protocol and procedures for implementation and usage Year 2: ● Installation of RFID systems in pilot hospitals ● HLS training of hospital staff and solving barriers ●

● Pilot hospitals: Saskatchewan ● Control hospitals: Manitoba ○ Maintain Traceline system

● Measure success ○ Implementation issues ○ Data integration & management ○ KPIs against goals

● Compare key measures between pilot and control ○

Evidence for success

● Revise policies & procedures as necessary

● RFID implemented in all hospitals ● SimplyRFID performs all deployments, integration, upgrades, and ongoing servicing ● Measure success ○ Implementation issues ○ Data integration & management ○ KPIs against goals ● Utilization of data for supply chain improvement purposes ○ Targeted supply ○ Balanced inventory ○ Predicted demand

● Continuous monitoring of success and performance evaluation ● Evaluate extension of RFID programs to additional opportunities, including tracking and tracing of: ○ Other CBS products ○ Hospital equipment and supplies ○ Hospital staff

See Appendix 4.1-4.6 and 5.1-5.3 for More Information

18

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2019

Stage 0

Pre-Preparation ●

Phase 1: Preparation

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 19

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2020

Stage 0

Pre-Preparation ●

Phase 1: Preparation

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 20

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2021

Stage 0

Pre-Preparation ●

Phase 2: Pilot Testing

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 21

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2022

Stage 0

Pre-Preparation ●

Phase 3: Full Implementation

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 22

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2023

Stage 0

Pre-Preparation ●

Phase 3: Full Implementation

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 23

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2024

Stage 0

Pre-Preparation ●

Phase 3: Full Implementation

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 24

Implementation Rollout A phased approach allows for quick wins and achievable scaling

2025

Stage 0

Pre-Preparation ●

Phase 4: Improvement & Expansion

●

Preparation

Stage 1 ● ●

● ● ●

● ● ●

Stage 2

Stage 4

Implementation and utilization of RFID system Measurement of KPIs against goals Monitoring and resolving issues

Maintenance

Stage 3

Stage 3

SimplyRFID installation in hospitals HLS train pilot hospitals staff & solve barriers

Implementation

Stage 2

Stage 1

Form and train HLS and hospital management team Readiness survey at all hospitals

Continuous measurement of KPIs Monitoring and resolving issues Utilization of data for supply chain improvement purposes

Extension

Stage 4 ●

Expansion of RFID system to future opportunities (organ donations, hospital equipment, etc) in excelling hospitals 25

Key Measures to Evaluate RFID Solution Implementation Continuous measures to inform process improvement with each phase Phase 1: Preparation

Phase 2: Pilot Testing

Phase 3: Full Implementation

Phase 4: Improvement & Expansion

Implementation Metrics ● ●

% of hospitals with full compliance # of implementation / utilization issues (correct application, function, etc)

Hospital Readiness Survey

Data Management

● Laboratory Information Systems (LIS) ● Other systems and technology ● Staff knowledge and abilities

Key Outcome Metrics

Repeated as needed annually to measure resolution of / additional issues

● ●

● ● ●

% of blood transfusion patients with full “vein-to-vein” visibility Data quality - validity and reliability of data collected

Targeted supply (ensuring safety & adequacy) Balanced inventory (reducing wastage) Predicted demand (reducing stock-outs & rushed orders)

Stakeholder Input Qualitative and quantitative feedback on: ● ● ● ●

Satisfaction with system Ease of use / Issues with use Labor hours used / saved Perceived effectiveness See Appendix 5.1-5.3 for More Information

26

Key Measures to Evaluate RFID Solution Outcomes and Impacts Metrics and goals to evaluate key outcome impacts for all involved parties

Donor Vein

Patient Vein

DONOR Donor Satisfaction & Confidence in CBS ● Electronic survey measuring donor satisfaction and confidence ● Administered to all previous and current donors quarterly ● Goal: >20% ↑

Recruitment & Collection Productivity ● # donors, donor attrition ● Existing CBS benchmarking measures ● Goal: >20% ↑ recruitment; >10% ↑ collection

CAN. BLOOD SRVCS

HOSPITAL

Reduced Waste & Cost

Reduced Cost & Errors

● # wasted blood products; Goal: >10% ↓ ● # expedited shipments; Goal: >15% ↓

● # wasted blood products

Reduced Stock Outs

Scalability

Improved Patient Safety

● Implementation metrics ● % hospitals with full compliance; Goal: >90%

Higher Visibility ● Data management metrics ● % hospitals with full veinto-vein data; Goal: >90%

● # stock-outs; Goal: >20% ↓

● # of safety-related incidences and post-transfusion complications / morbidity; Goal: significant ↓ ● % of patient-donor matches of characteristics; Goal: 40%

Reduced Manual Processes ● # of nursing labor hours used / saved

PATIENT Confidence and Satisfaction in Health System (CBS / Hospitals) ● Electronic survey measuring patient satisfaction and confidence ● Administered to patients electronically (quarterly) ● Goal: >20% ↑

Patient Safety and Outcomes ● # of safety-related incidences and post-transfusion complications / morbidity; Goal: significant ↓ ● % of patient-donor matches of characteristics; Goal: 40%

See Appendix 5.3-5.4 for More Information

27

Final Considerations

Future Considerations and Strategies Solutions to keep CBS at the forefront of supply chain optimization in healthcare

Implementation Challenge

Third-Party Risk

Market Risk

Internal & External Pushback

Contract & Sustainability

Population & Tech Disruption

Contract Viability

Population Disruptions

Internal Pushback ● Pre-implementation survey for readiness to expand ● Hospital Liaison training ● CBS/ Hospital call “Helpline”

External Pushback ● Public relations roll-out plan concurrent with marketing ● Clear purpose of data collection ● Brand/donor ambassadors

● Ensure security and ownership of data collection ● Engage legal counsel in development and renewals

Provider Sustainability ● Financial stability and continuous R&D improvement ● Third-party default protection ● Lock in supply costs

● Keep updated donor info to target in public health crises ● Analyze data to follow trends and possible threats in market

Emergent Tech & Regulation ● Ensure data collection and system process in compliance ● Engage IT provider to develop new tech when available See Appendix 6.1 for More Information

29

Investing in the Future with SimplyRFID Initial investments and considerations will yield beneficial long term results

Cost Considerations - Implementation investment of $6,300,000 (CAD) - Recurring annual costs of ~$250,000 (CAD) for upkeep and maintenance - Investment accounts for ~.51% of annual expenses based on 2017 financial reports - Implementation phases will vary based on number of hospitals and donor collection sites

Passive RFID Tagging Components

$175,000

- One tag per unit bag of blood - Tag unit cost of 15 cents - Assumes one donation = one bag of blood, 10% fluctuation

Infrastructure & Hardware Requirements

$5,300,000

- Thermal printers at manufacturing sites for RFID tag generation - RFID hardware including readers, antennas, wiring,, installation - Additional digital interface to accommodate increased IT usage

Software and IT System

$500,000

- Initial software investment and roll-out - Yearly licensing fee/relationship with SimplyRFID - Maintenance

Human Capital Accommodations

$325,000

- Training throughout implementation period - Additional positions for system and inventory analysis

Lives Saved = Priceless

Initial Year 1 Investment (CAD):

$6,300,000

Overall Assumptions ● CBS financials reflect industry benchmarks ● Existing labels/ printers can continue to be used on bags ● Existing pilot systems continue in use as we phase in new operating IT system to mitigate contractual obligations ● Similar savings as comparable size countries that implemented RFID systems ● Savings scale up from what is currently happening in Manitoba with Traceline ● No bulk pricing discounts ● Potential sharing of cost with hospital system similar to Traceline ● CBS current financial trends reflect previous financial reports

See Appendix 6.2 for More Information

30

Annual Savings Generated with SimplyRFID Efficiencies created with SimplyRFID technology will yield annual operational savings

Savings Opportunities - 10% reduction in product outdates yielding ~$1.7M (CAD) in savings annually

- 5% reduction in excess inventory based on industry implementation of RFID - 15% reduction in ASAP/STAT (expedited) deliveries resulting from increased data visibility - Additional savings through other supply chain efficiencies and scale

Reduction in Total Product Outdates

$1,760,000

- Based on past product outdate trends of RBC and Platelets - $400 per unit cost of RBC and $500 per unit cost of platelets

Reduction in Expedited Shipments

$2,200,000

- Real-time data visibility and efficiencies in ordering frequency - Demand forecasting and increased utilization levels

Excess Inventory Working Capital Savings

$1,500,000

- Reduction in excess inventory - Retains required service levels at hospitals

Full Implementation Annual Savings (CAD)

$5,460,000

Overall Assumptions ● Considers annual operational efficiency savings once fully implemented across CBS ● Considers data from 2013 CBS performance review conducted by Ernst & Young ● CBS current financial trends reflect previous financial reports and performance reviews ● Existing pilot systems continue in use as we phase in new operating IT system to mitigate ● Potential sharing of cost with hospital system similar to Traceline ● Rolls-out system improvements in phases

Approximate payback period of 2 years based on implementation rate See Appendix 6.3 for More Information

31

Recommended Solution Impacts Solution will bring benefits to CBS and its partner hospitals across multiple areas KEY GOAL: Right Blood, Right Place, Right Time, Right Patient Recommendation: Information technology infrastructure with track and trace, partnering with SimplyRFID Donor

CA Blood Services

Donor Satisfaction & Confidence in CBS

Hospitals

Patients

Reduced Waste & Cost

Reduced Cost & Errors

Confidence in Health System

● Increase process efficiency, reduce blood waste

● Increase process efficiency, reduce blood waste ● Reduce risk of litigation

● Blood when needed

● Improved outcomes ● Improved patient safety ● Know product has vein-to-vein trackability ● Matched with donor to improve outcomes

Improved Patient Safety

Patient Satisfaction

● Know donation won’t be wasted ● Matched with patient to improve outcomes and processes

Higher Visibility

Recruitment & Collection Productivity

● Ability to track and resolve any adverse events ● Data quality improved

● Strengthen supply chain processes

Scalability

● Vein-to-vein visibility

● Standard across hospitals ● Strengthen supply chain processes ● Adequacy of supply

Reduced Manual Processes

Reduced Stock Outs

● Frees up precious human capital resources

● ● ● ●

Ultimately: Patients in Canada are happier and healthier

Improved outcomes Product quality assurance Reduced time to delivery Hospital staff can be more attentive, efficient

32

Appendices

Appendices Table of Contents Click links to quickly navigate Appendix 1 - References

Appendix 3 - Impact

Appendix 5 - Measures

Targeted Supply

Readiness Survey

Balanced Inventory

Outcomes & KPIs

Predictive Demand

Satisfaction Survey

Appendix 2 - Background

Appendix 4 Implementation

Appendix 6 - Future & Financial Analysis

Internal Analysis

Ireland Case Study

Risk Strategy

Case Studies

Roles

Cost Analysis

SimplyRFID VITaL

Governance

Savings Analysis

Future Use of RFID

34

Appendix 1. References

1.1 References and Resources Used to Inform Our Strategy and Recommendations 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

Bjursten H, Dardashti A, Bjork J, Wierup P, Algotsson L, Ederoth P. Transfusion of sex-mismatched and non-leukocyte-depleted red blood cells in cardiac surgery increases mortality. J Thorac Cardiovasc Surg; 2016;152:223-32.

Boylan, J., Syntetos, A. & Karakostas, G. J Oper Res Soc (2008) 59: 473. https://doi.org/10.1057/palgrave.jors.2602312 Canadian Blood Services. Tomorrow changes today: Annual report 2016-2017. 2017 Canadian Blood Services. 2013 Performance Review. 2013. Available at: https://www.blood.ca/sites/default/files/2013Review-TOC.pdf Canadian Blood Services. Consolidated Financial Statements of Canadian Blood Services Year Ended March 13 2016. Available at: https://www2.gov.bc.ca/assets/gov/british-columbians-ourgovernments/government-finances/public-accounts/2015-16/sup-e/canadian-blood-services-fs-2015-16.pdf Canadian Institute for Health Information. Access Data and Reports. 2018. Available at: https://www.cihi.ca/en/access-data-and-reports Canadian Institute for Health Information. In-Depth Results on Saskatchewan Health Care. 2016. Available at: https://yourhealthsystem.cihi.ca/hsp/indepth?lang=en&_ga=2.51704809.1738193260.1542410429-911114318.1542410429#/theme/C7082/2/ Canadian Institute for Health Information. In-Depth Results on Manitoba Health Care. 2016. Available at: https://yourhealthsystem.cihi.ca/hsp/indepth?lang=en&_ga=2.18216185.1738193260.1542410429-911114318.1542410429#/theme/C600/2/ Chang F, Gupta N. Progress in electronic medical record adoption in Canada. Can Fam Physician. 2015;61(12):1076-84.

Chassé M, McIntyre L, Tinmouth A, et al Clinical effects of blood donor characteristics in transfusion recipients: protocol of a framework to study the blood donor–recipient continuum BMJ Open.

2015;5:e007412. doi: 10.1136/bmjopen-2014-007412 Coustassee A, Cunningham B, Deslich S, Willson E, Meadow P. Benefits and barriers of implementation and utilization of radio-frequency identification (RFID) systems in transfusion medicine.

Perspec Health Inf Manag. 2015, Jul 1;12:1d.

Coustasse A, Tomblin S, Slack C. Impact of radio-frequency identification (RFID) technologies on the hospital supply chain: a literature review. Perspect Health Inf Manag. 2013;10(Fall):1d.

Published 2013 Oct 1.

Coyne A. Inside BloodNet: Austrailia’s real-time blood database. Itnews. 2016, Feb 11. Available at: https://www.itnews.com.au/news/inside-bloodnet-australias-real-time-blood-database414890 eHealth Ireland. Electronic Blood Tracking System (EBTS). Available at: http://www.ehealthireland.ie/Case%20Studies/Electronic-Blood-Tracking/ Gould, G. Investor Roundtable Presentation. Haemonetics. 2015, May 19.

Knels R, Ashford P, Bidet F, ...Wray B. Guidelines for the Use of RFID Technology in Transfusion Medicine. Vox Sanguinis. 2010; 98 Suppl 2. 1-24. 10.1111/j.1423-0410.2010.01324.x.

Ning S, Heddle NM, Acker JP. Exploring donor and product factors and their impact on red cell post-transfusion outcomes. Transfusion Medicine Reviews, 2018;32:28-35.

Paaske S, Bauer A, Moser T, Seckman C. The benefits and barriers to RFID technology in healthcare. 2017;21(2).

SCAN Health. Canadian Blood Services: “Vein-to-Vein” Traceability to Achieve Value. 2018.

SimplyRFID. VITaL Inventory Management. 2018. Available at: https://www.simplyrfid.com.

Waller, Daniel. Methods for Intermittent Demand Forecasting. Available at: http://www.lancaster.ac.uk/pg/waller/pdfs/Intermittent_Demand_Forecasting.pdf Willems, Sean. Single Location, Single-SKU Inventory Models. 2018, November.

36

Appendix 2. Background

2.1 Targeted Solutions That Address Key Issues Use innovative technology to collect and utilize relevant supply chain data RFID Tracing and Tracking System

Proposed Solution

and resulting data collected

Key Issues Addressed

● Automation of supply chain tracking and traceability of blood products ● Integration of supply chain processes with hospital care processes ● Use of technology to strengthen supply chain processes

How Key Issues Addressed

Provides a fully automated system with accurate, real-time visibility and easy data integration that allows maximum supply chain optimization

Donor Vein

Targeted Supply

Balanced Inventory

Predictive Demand

● Patient safety outcomes & impact ● Ensuring adequacy of supply

● Reduction of the discard (waste) of blood products

● Demand forecasting & utilization of blood products to support sustainability of blood supply

➔Real-time tracking to recruit specific supply needs based on demand ➔Tracking & monitoring expirations and recalls to ensure patient safety ➔Visibility of donor/patient characteristics & needs to strategically recruit matches that optimize outcomes

➔Accurate, real-time visibility of current inventory in stock & usage data ➔Automated analysis & reporting of trends that can be used for efficiency planning ➔Proactive alerts to prompt physicians towards usage of near expiring items

➔Improve accuracy of forecasting through improved algorithms and more data ➔Real-time data provides more accurate demand signal, reducing lead time and bullwhip effect ➔Set ideal inventory levels, avoiding stock-outs while reducing waste

Patient Vein

38

2.2 Using a SWOT Analysis to Guide Solution Development Identifying and exploiting key internal and external business factors Harness STRENGTHS Supply:

- High levels of safety and quality - Recent changes in donor eligibility increasing potential for donors Inventory: - Advisories during inventory shortages: evaluates stock & usage - Pilot programs (in select hospitals) using tech for inventory control: Traceline (barcoding), Inventory Replenishment Objective Demand: - Access to some usage data from CIHI / DAD - Blood briefs: engagement with hospitals, provides usage trends Overall: - Hospital Liaison Specialists (HLS): relationship building, optimizing utilization, data gathering

Mitigate WEAKNESSES Supply:

- Difficulties with adequate recruitment & retention of donors (25% annual turnover) - Inefficient screening for product safety (high costs, refusing donors) Inventory: - Lack of visibility for real-time levels & usage - High wastage levels due to inefficient forecasting and management Demand: - Lack of efficient forecasting (due to data limitations: inconsistencies and aggregate form) - Lack of tracking of usage and recipient outcomes / characteristics Overall: - Lack of cohesive, system-wide strategies for communication & technology - Lack of CBS control over data (reliant on the accuracy and extent of hospital reporting)

Realize OPPORTUNITIES Supply:

- Using evidence that donor characteristics influence outcomes for recipients to support collection & usage of donor characteristics to improve outcomes Inventory: - Vendor-managed system Demand: - Predictive modeling to better predict usage for different Hospitals, areas, patients, diseases, blood types, etc Overall: - Software that provides real-time electronic tracking and tracing data for blood products from donor to recipient - Utilization of data from the software to improve supply chain optimization, patient experiences, and health outcomes.

Eliminate THREATS Supply:

- Generational changes / views → decrease supply from donors - Lack of evidence to support measures/criteria for donor eligibility to ensure safety Inventory: - Complexities in collecting, managing, & distributing blood: perishability, variable / unique storage & distribution requirements, short shelf-life Demand: - Decline in demand (2-3% annually) due to improvements in medical procedures & practices Overall: - Variabilities in supply & demand make forecasting difficult - Variances in hospitals’ processes, reporting, and capabilities - Funding system does not encourage optimal use of blood, further limits improvement options - Hospital’s perceived limitations to CBS’ jurisdiction/role as just provider 39

2.3 Real-Time Data Usage Through RFID Collection Collecting real-time data is critical to a transparent, balanced supply chain

Donation

Automate Supply Chain Tracking and Traceability Unique unit number assigned. Collected information includes user ID, demographics (sex, age, etc), time & date, collection period, weight, blood group, and previous donations.

Supply Chain

Use of Technology to Strengthen Supply Chain Processes

Hospital Integration

Integration of Supply Chain Processes with Hospital Care Processes

Outcome

RFID technology links unique unit number to the CBS data warehouse with direct linkage to ensure â&#x20AC;&#x153;vein-to-veinâ&#x20AC;? trackability. Technology has option to allow for temperature monitoring throughout supply chain.

Direct linkage of encryption information allows hospitals to trace the donor information through to transfusion. RFID allows for cross-checking the blood before the transfusion process.

Improved Patient Outcomes Characteristics are matched between donor and end-user (patient). Patient outcome is tracked after an infusion and data can be analyzed to sustain process improvement.

40

2.4 Look to Proven Success within Healthcare Industry best practices show proven success in RFID and vein-to-vein tracking

RFID in Healthcare

Vein-to-Vein Visibility

Healthcare organizations embracing RFID technology boast improved patient safety, tracking, efficiencies in patient care, and provider satisfaction.

RFID in the operating room increased patient identification from 75% to 100%, physician time-out completion rates improved from 43% to 70%, and instrument loss decreased from .146% to .089%.

Blood management organizations shifting towards a vein-to-vein model experienced significant improvements when gaining insight into hospital blood bank inventory management. By identifying points in the supply chain process where collections or products were discarded, organizations were able to implement initiatives to reduce these occurrences.

In the instance of blood sampling, results show that systems correctly identify medical staff, patient IDs, medications and blood sampling data in real time.

One organization increased RBC yield of 7% (70,000 donations a year) as well as cut blood wastage by $10 million annually by using â&#x20AC;&#x153;vein-to-veinâ&#x20AC;? data.

RFID in Transfusions

Global pilot programs for RFID systems used in transfusion medicine promise substantial results. A pilot program in the United States identified a 3-10% reduction in misidentification of patients and / or blood products during transfusion when utilizing RFID technology.

Additionally, the Transfusion Medicine RFID Consortium realized a 33% reduction in errors due to misidentification, a total elimination of delivery errors, and an 87% reduction in product loss.

41

2.5 Additional Case Studies of RFID Industries outside of healthcare have had great success using passive RFID systems

RFID in Airline Safety

RFID in Garment Shipping

RFID in Pallet Tracking

Airlines have affixed passive RFID tags to safety life vests. Instead of having to individually examine and check every vest was not expired, flight attendants are now able to quickly scan multiple life vests quickly.

Mississippi government contractor applies RFID tag to finished garments, then automatically scans the codes during packing and shipping rather than hand-checking each garment for accurate size and style.

Custom folding carton company previously tracked inventory through physical observation and manual data entry. The company affixed RFID tags to pallets, obtaining the ability to track and monitor real-time movement.

This has saved the airline hours per plane, per day and decreases the likelihood of human error.

This has reduced manual shipping labor costs by 50% and also lowered shipping-error rate from 5% to 0.2%.

This has eliminated manual entry, reducing the risk for human error, and allows for accurate inventory level tracking.

42

2.6 SimplyRFID Informational Video An introduction to inventory management and a step-by-step utilization explanation

43

2.7 SimplyRFID Credibility & International Presence A wide range of past successes and implementations

44

2.8 A Day in the Life of Blood Product in the System Solution fills data gaps to create full vein-to-vein tracking and traceability Collection Donorâ&#x20AC;&#x2122;s blood product collected

Testing

Manufacturing

Distribution Centers

Blood product manufactured; RFID Tag physically attached

Blood product tested

Stored in DC, await delivery to hospitals

Hospital Inventory Stored in hospital inventory, await disposition to patient

Use Blood product given to patient

CBS Governance Hospital Governance Donor information captured

Blood type data added

Blood product, expiration added

Physical location captured real-time

RFID UDI linked with donor info

New VITaL System

Assigned to specific patient in VITaL and hospital systems

Physical location captured real-time

VITaL automatically sends pull signal

Existing CBS System

UDI = Unique Device Identification

Mobile Site

Manufacturing

Testing

Dispatched to Patient

Hospital Inventory

CBS Inventory

No

Permanent Site

Blood ok?

No

Blood Discarded

Yes

separ ated?

Yes

Blood ok?

Yes No

Blood Discarded

Yes

Blood ok?

No

Blood Discarded 45

Appendix 3. Impacts

3.1 Targeted Supply Examples One way to target supply for certain characteristics is through text messages

1

2

Communication

Time

Prompt Action

1. Request to Donate

When supply is low for targeted blood product

Schedule appointment through app / website; walk-in appointment

2. Thank You for Donating

Immediately after donation

Download app to prompt future relationship

3. Donation Used

When blood product is either used or destroyed due to expiration

Schedule future appointment through app / website

4. Eligible to Donate Again

When donor is eligible to donate blood again, after prescribed time period

Schedule appointment through app / website; walk-in appointment

5. Updates from CBS (ex. New app)

As needed, when relevant updates are available

Dependant on update (ex. Download new app)

3

4

47

3.2 Integrating with Current CBS Donor Strategy SimplyRFID strategy integrates with existing CBS strategy On CBS Website: blood.ca

1:1 Communications

Real-time inventory visibility: feed information to the “National blood inventory” graph ● Chart could be expanded by province to elevate urgency for certain provinces

Real-time inventory visibility: personally solicit need for donations through new and existing channels of communication, based on donor characteristics, location and previous donation history

Donor characteristics: securely collect relevant information based on emerging scientific evidence, allowing hospitals and CBS to match with patients

Donor characteristics: securely collect information and understand donor trends - donation locations, frequency - add to existing programs such as recognition programs

48

3.3 Base Stock Model Theory Reduction in safety stock inventory at the SKU level through inventory theory

Theory is used to set safety stock levels of items with relatively constant demand, with known lead times for a periodic review inventory model: â&#x2014;? Order period held constant â&#x2014;? Variable is how much to order

This discrete time kanban system is a policy where the amount ordered equals the total amount consumed since the last order.

We propose using this theory as a foundation, as demand over longer time periods is relatively stable and quick replenishment covers periods of volatility.

49

3.4 Base Stock Model Data Applied to CBS Visibility and frequent reviews reduce wasted inventory at hospitals

When reviewing only 1x a week, the scientific inventory that should be held to reach a 99% service level target is high, likely resulting in wasted products.

Simply by increased visibility and reviewing daily, the scientific inventory required drops dramatically, while still allowing for a 99% service level target.

Significant savings on inventory can be achieved through more frequent review. The impact will be greatest on provinces with high blood product needs.

50

3.5 Croston Model Theory Forecasting model for slow-moving SKUs with periodic high spikes in demand

Separates in-sample demand rate and out-of-sample demand rate for two types of period demand. ● In-sample demand: period of low-demand, including when demand is 0 ● Out-of-sample demand: period of spiked highdemand

We propose using this theory as a foundation for a few slow-moving SKUs in areas where rapid fulfillment of spiked demand is possible.

Theory is used to set safety stock levels for product with low typical demand and large spikes in demand for a periodic review inventory model: ● Forecasting model smooths overall inventory, preventing bloated safety stock ● Estimates the inter-demand levels, accounting for periods when demand is 0 51

3.6 Use Dashboard Tools to Manage Dashboards allow for collaboration and management on a variety of issues

Dashboard for CBS & Hospitals Enabled through real-time, vein-to-vein visibility

Amount of expiring product ● How many units expiring in time period (24-hours, 72-hours, 1 week, etc.) ● View by SKU, set proactive supply pull signal to trigger increasing supply or preparing shipments

Instigate recalled product process

Reduce time spent documenting inventory

● Trigger recall of products ● Auto-notifications to hospitals to pull recalled inventory ● Redundancies in system prevent clinicians from assigning recalled units for patient

● Create scheduled reports or pull ondemand to observe inventory ● Allows hospital staff to spend less time counting and documenting and more time with patients

Real-time demand to spot trends faster ● See one-time events occur in real-time, prompting alerts to CBS to proactively respond ● Prepare for replenishment or additional inventory needed

52

3.7 Recommended Solution Impacts by Function Solution will bring benefits to CBS and its partner hospitals across multiple areas KEY GOAL: Right Blood, Right Place, Right Time, Right Patient Recommendation: Information technology infrastructure with track and trace, partnering with SimplyRFID Supply

Inventory

Demand

Other Benefits

● Cost-effective targeted marketing strategies based on specific demand & usage data ● Improved patient safety mechanisms allow for more efficient donor eligibility and product testing ● Improved patient outcomes by matching donor and characteristics

● Real-time visibility of inventory by product type ● Decreased product waste due to expiring product ● Make the right product available to the right hospital ● Reduce aggregate inventory without threatening stock-outs ● Opportunities to share inventory across multiple hospitals

● Automated demand ordering based on real-time pull signals and pooling ● Improved forecasting algorithms to decrease variability and make future predictions ● Dashboards to spot trends and react more quickly, reducing the bullwhip effect ● Eliminates hoarding of products ● Less stress on demand

● Increased communication and visibility within hospitals ● Reduced errors from paper documentation and manual entries ● Increased productivity of hospital staff, which accounts for half of the total landed cost of blood products ● Scalable to other CBS products such as organs or stem cells

Ultimately: Patients in Canada are happier and healthier 53

Appendix 4. Implementation Plan

4.1 Learning from Ireland’s Electronic Blood Tracking Implementation Parallels between Ireland’s successful electronic blood tracking implementation and our proposed approach

Ireland

Canada

BloodTrack

SimplyRFID

5 Years

6 Years

3 phases with pilot test

4 phases with pilot test

Stakeholder engagement

Hospital readiness survey at the start of each phase

Hospital readiness survey at start and then annually

Management and support team

● ●

● ● ●

System used Full implementation completed in Phased approach

Hospital integration system

Overall project team Nominated lead at each hospital

Integrates with LIS

Overall project team HLS for each province Nominated lead at each hospital Integrates with LIS 55

4.2 Learning from Ireland’s Electronic Blood Tracking Implementation Details for evidence of strategies for a multi-phase successful implementation Details on three-phase implementation approach

Suggested short- and long-term benefits of project for the PATIENT ● ● ● ●

Increase public confidence Product quality assurance (built-in safety mechanisms) Increased patient safety Reduce time to delivery

● ● ● ● ● ● ●

Standardized system across hospitals Reduction in staff errors Increased process efficiency Reduced blood wastage Ability for full audit of all activity (informs improvement) Frees up nursing resources by increasing efficiency Ability to track and resolve any adverse events

ORGANIZATION

GOVERNMENT ● Cost savings (increased efficiency & reduced blood waste) ● Frees up nursing resources to be used for other duties ● Improved patient safety & reduced patient risk (reduced risk of litigation) 56

4.3 Utilizing Hospital Liaison Specialists (HLS) as Implementation Managers Extending their established roles and responsibilities to strengthen the RFID implementation plan CBS has a large strength of already having established Hospital Liaison Specialists (HLS) for each province with established hospital relationships and responsibilities directly relevant to the implementation of RFID in the hospitals. These HLS will work with a nominated hospital management representative from each hospital to facilitate the RFID implementation and use.

Current Stated Role Responsibilities in RFID Implementation

Build Stronger Relationships

Encourage Optimal Utilization

Assist with Data Intelligence Gathering

Assist with data gathering for assessing hospital readiness to implement Helping hospitals to problem solve barriers to implementation Train and assist with implementation and utilization of the RFID system Act as a point of contact and reference between project team and hospitals Collect qualitative data (interviews) from hospitals regarding system input and opinions

57

4.4 Using a Pilot Test to Directly Compare Traceline and RFID Proposed pilot test acts as a controlled comparison of the respective tracking systems Manitoba & Saskatchewan chosen for the pilot test due to: ● ● ● ●

Similarity in characteristics (population size, disease prevalence, health status, etc) Similarity in number of hospital establishments Similar location in Canada - similar access to CBS resources Both already having Traceline system in place (with Manitoba being first to implement)

Total population (2016) Number of Hospitals (2015) % acute inpatient cases with blood transfusions (2013-2018)

Electronic Medical Records (EMR) adoption rate (2013) Data Tracking System

Manitoba

Saskatchewan

1,318,128

1,150,632

72

70

6.14%

5.84%

60%

62%

Traceline

Traceline

Success of each system will be determined based on 4 comprehensive areas of key outcomes and metrics measured before and after the pilot study (see appendix 5.2 for details): ● Implementation metrics ● Data management ● Key outcome metrics ● Stakeholder input

This pilot test will act as a pretest-posttest quasi-experimental design to determine the effectiveness of RFID compared to Traceline 58

4.5 Everyone Has an Important Role in This Planâ&#x20AC;&#x2122;s Success Description of the Roles and Responsibilities of Each Party for Each Required Task TASK

SimplyRFID

CBS

HLS

Hospital Staff

Product design, installation, integration, support, upgrades, & ongoing servicing Training of HLS in product features and usage Identification of hospital readiness to implement and potential barriers Development and revision of protocol and procedures for implementation & usage

Training of hospital staff and resolving potential barriers Data collection to measure metrics of success, progress, & issues Interpreting and utilizing data for metrics of success, progress, & issues Data collection and utilization for supply chain improvement purposes Deciding and implementing expansion of RFID system to new opportunities *CBS: Canadian Blood Services HLS: Hospital Liaison Specialists

= lead party responsible = other party involved / providing input

59

4.6 Expanding RFID Use Beyond Blood Tracking Potential opportunities to extend RFID use to other CBS or hospital systems Once RFID systems have been successfully implemented in all hospital systems, there is the potential to easily extend the use of RFID to other uses, including tracking and tracing of:

Other CBS Products Including plasma-based pharmaceuticals, stem cells, organ and tissue donations.

Hospital Equipment and Supplies Including low- and mid-cost supplies, implantables, devices, pharmaceuticals, mobile assets, etc.

Hospital Staff Including measuring availability, movement (for process flow and efficiency improvement), activities (comparison against standard procedures), etc.

60

Appendix 5. Measurement & Outcomes

5.1 Ensuring Hospitals Are Prepared for Successful Usage of RFID Surveying hospitals to assess challenges and needs of hospitals prior to implementation As part of the preparation phase, each hospital will be provided with an initial survey by their respective HLS that assesses their readiness to implement the RFID system. Survey results will be used to address and solve barriers and challenges prior to implementation. The survey will be re-administered annually to monitor any unsolved or additional barriers or challenges.

Survey Measures

Laboratory Information System (LIS)

Other Systems & Technologies

Staff Knowledge & Abilities

● Presence of system ● Compatibility / interaction with RFID system ● Upgrades needed

● Current shelf storage used for blood supply ● Compatibility of current storage / processes with RFID system ● Presence of wifi / broadband systems for communication with RFID

● ● ● ●

Current knowledge of RFID Perceptions and opinions of RFID Ability / confidence with using RFID Any other potential challenges in implementing RFID in current processes

Potential actions:

Potential actions:

Potential actions:

- Implementation or upgrade of LIS system - Troubleshoot communication of RFID with current system

- Retrofit or upgrade storage shelves to be compatible with RFID technology - Improve wifi / broadband to be compatible with RFID technology systems

- Staff training to increase knowledge, positive opinions, and confidence & abilities with RFID - Collaboratively resolve any barriers in the current processes with hospital staff 62

5.2 Key Measures to Evaluate RFID System Implementation Details regarding key measures to ensure and improve RFID system success Data Category

What

Who

When

Where

Why

How

Metrics Measured

Who is Responsible

Frequency of Measurement

Targets of Measures

Purpose of Measure (what data is used for)

Data Collection Method

Implementation metrics

● % of hospitals with full compliance ● # of implementation / utilization issues (correct application, function, etc)

CBS (prehospital); HLS (hospital)

Bi-annually (every 6 months) for compliance; monthly for issues

Distribution Centers (application of RFID); hospitals (utilization, function of RFID)

Proactively measure and correct for potential issues or areas of noncompliance

Audit / system of report with standardized form

Data management

● % of blood transfusion patients with full “vein-tovein” visibility ● Data quality - validity and reliability of data collected

CBS (help from Simply RFID)

Continuously; metrics consolidated and report generated monthly

Throughout entire vein-to-vein process (collection, testing, manufacturing, distribution, hospitals)

Assess and improve quality of data to ensure usefulness in improvement measures

Audit and statistical analysis of collected data

Key outcome metrics

● Targeted supply (ensuring safety & adequacy) ● Balanced inventory (reducing wastage) ● Predicted demand (reducing stock-outs & rushed orders)

Simply RFID (help from CBS)

Continuously; metrics consolidated and report generated weekly

Throughout entire vein-to-vein process (collection, testing, manufacturing, distribution, hospitals)

Inform and improve targeted key supply chain outcomes - right blood, right place, right time, right patient

RFID reported metrics resulting from use of the system

● Satisfaction with system ● Ease of use / issues with use ● Labor hours used / saved ● Perceived effectiveness

HLS (help from hospital reps)

Quarterly: quantitative surveys; bi-annually: in-depth qualitative interviews

Hospitals

Measure progress and acceptance of system, solve for issues and improve system usage

Qualitative and quantitative interviews

(see appendix 5.3 for details)

Stakeholder input

63

5.3 Key Measures for Outcomes and Impacts Ensuring long-term success through defined objectives and measurable goals Recommended Solution

RFID Technology

Targeted Supply

Balanced Inventory Predictable Demand

Objective: Purpose of Solution

Key Metrics: How to Measure Success

Goal: How to Define Success

Implementation of RFID technology to: ● Automate supply chain tracking and traceability of blood products ● Integrate data with CBS and hospital information systems

● % of total hospitals successfully implemented & regularly using RFID technology ● % of all blood product records with complete “vein-to-vein” data available

Pilot: > 50% and Full: > 90% ● Of all hospitals have implemented RFID technology ● Of all blood products will have complete “vein-to-vein” data available

Use the RFID technology to expand CBS’ Corrective and Protective Actions (CAPA) for the purposes of: ● Improving patient safety ● Improving patient outcomes

● # of safety-related incidences ● % of patients matched with donors based on characteristics ● Post-transfusion complications and morbidity ● Other relevant disease-specific outcomes

● Significant ↓ in safety-related incidences post implementation (vs. pre-implementation) ● 40% of patients matched with donors ● Significant ↓ in post-transfusion complications & morbidity for matched patients (vs. non-matched patients)

Ensuring adequacy of supply by: ● Increasing number & amount of donations ● Maintaining a steady donation supply ● Obtaining specific donations that meet patient needs

● # of donors (new and returning) ● Donor attrition ● Donor satisfaction and CBS confidence survey ● Existing CBS benchmarking measures: Recruitment productivity, collections productivity

● > 800,000 donors / year ● < 25% attrition / year ● >20% ↑ in satisfaction / confidence each year ● > 20% ↑ in recruitment productivity ● > 10% ↑ in collections productivity

● Reduction of the discard (waste) of blood products

● # of units discarded due to expiration date

● >10% reduction in wasted blood

● Reduction of stock-outs and data usage to make predictive algorithms

● # of stock-outs ● # of expedited shipments due to low inventory

● 20% ↓ of stock-out occurrences ● 15% ↓ of expedited shipments 64

5.4 Measuring Donor and Patient Satisfaction Important impact measures at the start and end of the vein-to-vein process It is very important to include measures that will evaluate donor and patient satisfaction and confidence to ensure the blood supply is adequate and effective.

This will be accomplished by: ● Short, simple online surveys ○ 10-15 minutes to complete ○ Anonymous and voluntary participation (to protect patient / donor identity) ○ Administered quarterly ○ Participants: current and former donors, as well as patients who received blood transfusions during that quarter. ○ Goal: 30% participation ● In-depth qualitative follow-up interviews ○ Togather more information from these individuals or a representative sample of other individuals. ○ Administered bi-annually ○ Goal: 10-15 individuals participating Results of these surveys and interviews will be used to inform and measure quality improvement processes. ● Potential for statistical analysis by different groups to make predictions ● Analyze data over time to measure improvement

Example Questions For Each Group

Donor Survey

Patient Survey

● Frequency of donation: ○ Last time donated ○ How frequently donate ○ Why? ● Willingness to donate ○ 7-point Likert scale ○ Why or why not? ● Overall opinion of donation process ○ Overall satisfaction (7-point Likert scale) ○ Ease of donation ○ Positive aspects ○ Potential areas for improvement ● Perceived confidence in CBS regarding efforts to ○ Ensure patient safety ○ Improve patient outcomes

● Patient experience and outcomes ○ Overall experience at hospital ○ Desire / satisfaction with matching of donor characteristics ○ Presence of adverse complications ● Overall opinion of blood transfusion process ○ Overall satisfaction (7-point Likert scale) ○ Positive aspects ○ Areas for improvement ● Perceived confidence in CBS & hospital regarding efforts to ○ Ensure patient safety ○ Improve patient outcomes

65

Appendix 6. Final Considerations

6.1 Future Considerations and Strategies Solutions to keep CBS at the forefront of supply chain optimization in healthcare

Market Risk

Third-Party Risk

Implementation Challenges

Internal: Hospital Systems and Donor Network ● ●

Pushback, loss of solo inventory governance Potential negative perception of data collection and security of private information of donors

● ● ● ●

External: Government and Public

●

● ●

●

Pushback, funding sources and tax implications Coordination/negotiation with provinces and territories throughout implementation phases

Third Party Contract and Sustainability ● ● ● ●

Data ownership and security Firm-specific risk: SimplyRFID no longer sustainable Firm technology no longer in date Increasing unit costs for RFID tags

● ● ● ● ● ●

Emergent Technology and Regulation

●

● ● ●

●

Stay up-to-date through implementation phases Better systems/ RFID technology comes on-line Tracking/medical process regulatory changes

● ●

Population Disruptions ● ●

Emergence of disease/improper blood supply Changing demographics and criteria or eligibility to donate blood

● ●

Pre-implementation survey to see what level of competencies / readiness to implement & address any barriers.

Issue evidence-based best practice guidelines for managing blood inventory using RFID to hospitals.

Train and utilize current Hospital Liaison Specials as “point people” during roll out (activities overlap with current role). Also Implement CBS “helpline” for hospitals to call with any issues/questions during process.

Present clear information regarding the full tracking of blood at the point of blood donation. Give donors opportunity to see information given with assurance that tracking blood instead of their personal information.

Present clear benefits of improved medical supply chain (e.g. cost efficiencies, lives saved, etc.). Engage ministers of health and board throughout implementation.

Prepare public relations media plan concurrent with any donor communication / marketing. Stress not-for-profit purpose of CBS. Engage current and regular donors as “brand ambassadors”to help showcase the work of CBS. Ensure Ensure data data collection collection and and every every step step of of data data flow flow is is in in compliance compliance with with Personal Personal Information Information Protection Protection policy. policy.

When exceedcurrent currentpolicies policies.

When contracting contracting IT IT systems, systems, check check proper proper data data safety safety measures measures that that meet meet//exceed Engage general general counsel counsel in Engage in forming forming proper proper contract contract with with third third party party IT IT system. system. Ensure Ensure financial financial stability stability and and R&D R&D capabilities capabilities in in system. system. Invest Invest in in regular regular maintenance maintenance on on system system and and infrastructure infrastructure throughout throughout the the blood blood chain. chain.

Terms keep existing technology and ensure can same utilizeinfrastructure same infrastructure and processes Terms to to exit exit contract contract//existing technology and ensure we canCBS utilize and processes with a with a differentRFID RFIDprovider provider. different Work with IT system provider to ensure new technologies are implemented as the new processes roll-out through different hospital systems.

Step-by-step roll out of system in phases that allows for changes in process as deemed fit in addition to adoption of LIS systems for hospitals not currently utilizing them.

Reallocate supply as needed throughout different provinces/territories using new IT system efficiencies.

Exceed quality of regulatory reporting and labeling of medical products to stay in compliance and maintain best practices with other healthcare systems.

Keep updated donor information to target healthy donors in the event of decreased blood supply or population health crisis.

Actively analyze data provided by SimplyRFID to follow trends and potential threats in the external environment.

67

6.2 Cost Considerations

68

6.3 Savings Opportunities ● 10% reduction in total product outdates (once fully implemented) will lead to annual savings of $1.76 M based on on past product outdate trends. Over time, this would decrease due to diminishing returns. ● RFID, once fully implemented, will bring about a 15% reduction in expedited shipments leading to $2.2M in annual savings. This is based on 2013 EY Performance Review of CBS and efficiencies from reducing ASAP/STAT deliveries. ● 5% reduction in excess inventory yields $1.5 M equivalent savings in working capital. This is based on 2013 EY Performance Review of CBS that estimated firm holds $35M in excess inventory with assumption of 15% improvement over past 5 years. ● Increased efficiencies with 5% reduction in LHU at collection sites: $1.12 M equivalent in labour savings.

69

6.4 Financial Considerations

70

6.5 Financial Considerations

71