Hi, bahminj-ga !
Just-in-time strategies can be applied to various aspects of the
Healthcare industry.
At the individual hospital level, JIT can be used to streamline the
delivery of medicines to the wards and the patients. An article by
Bonnie Darves (Dec 2002) for Premier Healthcare Resource Inc:
http://www.premierhealthcare.com/cgi-bin/article.cgi?article_id=1315
is headed " Just-in-Time Drug Delivery Pays Off". It outlines the
Ocean County (NJ) Medical Center's implementation of Just In Time
policies for medication delivery. It states that:
"The new system involves using pharmacy technicians both on nursing
units and in the emergency department and implementing just-in-time
(JIT) delivery of medications to replace the traditional 24-hour cart
system. Patient safety has improved, time savings have accrued, and
nurse and patient satisfaction has increased dramatically."
You can register with this site to read the full article.
At the level of the providers of supplies to hospitals, JIT also comes
into play for inventory management. This is described by Allegiance
Healthcare Corporation at:
http://www.primavera.com/files/customers/allhealth.pdf
Allegiance provide medical supplies to hospitals, clinics and
laboratories, as well as surgical tools and supplies. Through
just-in-time delivery they help medical professionals control cost and
minimise the space needed to store inventory.
A major area of development of JIT techniques is in the management of
information overload, and in the provision of quick and timely access
to information for healthcare professionals. The Financial Times of 21
February 2001 carries an article on using JIT techniques coupled with
electronic storage to manage information overload:
http://specials.ft.com/ftit/FT32LI6YCJC.html
David Firn writes:
" Medicine is about complex decision-making and most diagnosis relies
on a balance of probabilities. About 2m pieces of new medical
information are added to the literature every year, but humans can
only usually use three or four variables. There is just too much
information out there.
... What doctors need is fast access to fairly simple information. 'I
don't need expert systems,' says Prof Detmer. 'I need simple systems
that stop me doing dumb things.'
A number of companies have seized on this fact to put information into
what Prof Detmer calls 'just in time knowledge.'
In the UK, South Norfolk Primary Care group is using WAX info's
ActiveLibrary in 75 practices across the county. The system uses a
browser adapted to create virtual libraries of e-books.
In the US, Unbound Medicine and Up To Date.com are introducing
hand-held and internet technologies to provide doctors with answers to
medical questions, wherever and whenever they are needed. These ...
provide drug prescribing data and information from medical journals by
the bedside. "
As similar idea by Sun Microsystems is outlined at:
http://www.sun.com/products-n-solutions/healthcare/docs/nextgenerationbr.pdf
They call it "Medbiquitous!" Executive Director Peter Green MD claims
that:
it "will make it easier for physicians to get 'just-in-time' clinical
information closer to the point of care..." In other words, they won't
have to go back from the hospital to their surgery to look something
up.
A Harvard Business Online article on how this may work in practise is
available for purchase at:
http://harvardbusinessonline.hbsp.harvard.edu/b01/en/common/item_detail.jhtml?id=R0207H
In brief summary:
"Like all primary care physicians, Dr. Bob Goldszer must stay on top
of approximately 10,000 different diseases and syndromes, 3,000
medications, 1,100 laboratory tests, and many of the 400,000 articles
added each year to the biomedical literature. That's no easy task. And
it is, quite literally, a matter of life and death. .... No matter
what the field, many people simply can't keep up with all they need to
know. ... Partners HealthCare has started to embed knowledge into the
technology that doctors use in their jobs so that consulting it is no
longer a separate activity. Now when Dr. Goldszer orders medicine or a
lab test, the order-entry system automatically checks his decision
against a massive clinical database as well as the patient's own
medical record. Knowledge workers in other fields could likewise
benefit from a just-in-time knowledge-management system tailored to
deliver the right supporting information for the job at hand."
In Australia the University of New South Wales is currently trialing
"Just in Time" medical education through Quick Clinical:
http://www.chi.unsw.edu.au/QC/reg_done.htm
"BRINGING EVIDENCE BASED MEDICINE TO YOUR DESKTOP PC
General practitioners are invited to participate in the trial of Quick
Clinical, an on-line system that provides access to clinical evidence.
Quick Clinical retrieves clinical information from multiple sources on
the Internet and is designed to fit the needs of busy clinicians. The
aim of this trial is to evaluate the functionality and usefulness of
Quick Clinical in general practice.
.... The benefits of joining this trial include free access to
electronic textbooks, journals and medical databases from your
practice. ..."
Similarly Allscripts Healthcare Solutions provides "point-of-care
decision support solutions for physicians – solutions that can
eliminate medication errors, reduce lost charges and improve
workflow." Their Touchworks (TM) software "provides Just Right, just
In Time solutions for physicians".
http://www.idx.com/Allscripts/
At the institutional level companies such as InfoPartners offer:
"....more IS systems analyst and management boost to complement our
client's resources and talents, yet in a cost-effective, 'just in
time' delivery fashion. We help our healthcare clients maximize their
information systems and technology investment, while giving them
access to a broad set of managerial and analytical resources when and
where they are needed."
http://www.infopart.com/ismp.html
InfoPartners apparently provide their clients with a live human
relationship manager with access to senior level resources on a
"Just-in-time" basis.
Education is another field where JIT solutions are being developed.
Courseware on CD aimed at assisting nursing staff with "just-in-time"
training among other goals is available from CorExcel at:
http://www.corexcel.com/html/cd.roms.ceus.htm
Also Healthstream, in partnership with Pearson Prentice Hall, plan to
offer online education for nurse professionals from mid 2003:
http://www.healthstream.com/PressReleases/2002_12_10.html
"With only approximately ten minutes needed to complete an online
module, busy nurse professionals can access a 'just-in-time' learning
solution to enhance skills, cross-certify in other specialties,
demonstrate competencies, or pick up a quick knowledge refresher. "
An excerpt from the book "Human Capital" by M2 (a broker for
consultants) outlines the advantages of using "just-in-time talent"
at:
http://www.msquared.com/M2_HumanCapital.pdf
This outlines the use of independent consultants to add their
expertise "just-in-time": "Independent consultants provide spot-market
expertise when you need it, for only as long as you need it."
In a sense this is what the tradition of using specialists in the
Healthcare system has always been about.
At the individual clinic level this concept is the subject of a study
by Birmingham's Gulf War Veterans' Illness Demonstration Clinic (VA).
The objective is given as:
"...There are currently a variety of clinical settings such as Primary
Care Clinics and Gulf War Special Emphasis Clinics that provide
healthcare for Gulf War veterans suffering from undiagnosed and
ill-defined illnesses. It is possible that improvements can be made in
the current situation by enhancing the care provided ... by adding
"just in time" support services to a new Demonstration Clinic
(actually a Special Emphasis Clinic with increased support services)
that might increase patient satisfaction and functional outcomes while
decreasing utilization and costs. This study will look at the
effectiveness of these settings in providing optimal treatment and
patient satisfaction for these veterans. "
http://www.gulflink.osd.mil/medsearch/Treatment/VA56.shtml
The eventual aim is "Following ... initial evaluation and determining
the baseline data for the Special Emphasis Clinic, they will then
increase services in the Special Emphasis Clinic in the form of "just
in time" support services (psychologist, benefits officer, social
worker, chaplain, and pharmacist) thus changing the Special Emphasis
Clinic into a "new and improved" Demonstration Clinic. We will then
compare the Demonstration Clinic to the baseline Special Emphasis
Clinic to demonstrate whether the "just in time" services improve ...
outcomes in Gulf War veteran patients. "
Finally, IBM Global Financing promotes the concept of "Just-in-Time
financing for the Healthcare industry in its online brochure at:
http://www-1.ibm.com/financing/pdf/fihealth.pdf
Thank you for an interesting question.
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