The document summarizes a case study comparing barcode and RFID technologies for improving traceability of medical instruments between an operating room and central sterilization department at a hospital. The study involved documenting the current "as-is" process, evaluating different "what-if" scenarios using barcode or RFID, and simulating the scenarios using Arena simulation software. Key findings from the simulation results showed that using RFID technology provided benefits like reducing the average time medical instrument sets spent in the system and average costs of resources compared to using barcode technology and case carts.

1. Process Redesign for Improving Traceability
of Medical Instruments: Barcode vs RFID
Afrooz Moatari-Kazerouni
ESG-UQAM, Montreal, Canada
Under the direction of Ygal Bendavid
LATECE Seminar May 6th, 2015
Laboratoire de recherche sur les
technologies du commerce électronique

2. Presentation outline
• Traceability: what, why, how?
• Case study context and approach
– Documenting “As-Is”
– Evaluating “What-If”
• Traceability value proposition
2

3. Traceability is…
“The ability to track forward the movement of
products through specified stages of the supply
chain and trace backward the history,
application or location of products under
consideration.”
3

4. Why track & trace?
Reducing
Asset Cost
Efficient
Workflow
Retain
Surgical
Items
4
Infection
Control
Costly Time
Technician
Training

5. How track & trace?
5

6. Context of study
• Case study at a hospital in Montreal, Canada
• Construction of a new building
– Dilapidated infrastructure
– Space deficiencies
• Transfer of the most acute and critical cares to
the new infrastructure
– Central Sterilization Department (CSD), Operating
Room (OR)
6

7. – Canadian Council on Health Services Accreditation
– Operating Room Nurses Association of Canada
Why implementing a traceability
system?
Streamlining and improving
the process in new building
7

8. “Past is experience, present is
experiment, future is expectation”
8
PAST
Scanning single
instruments
Incomplete
instrument tagging
Corrupted database
Hardware
malfunctions
No formal process
PRESENT
Scanning
instrument trays
Complete crate
tagging
Updated database
New hardware
Designed process
flow
FUTURE
RFID technology
RFID tagging and
antenna installation
Integration with ERP
system
Design process flow

9. Traceability system is important for…
Keeping records of
disinfection cycles
Reducing mistakes
in assembling
9
Linking patients
with instruments
Locating medical
instrument at time

10. Perform What-if Analysis
Measure, simulate and analyze
(prospective) alternatives
Model the future processes
TO-BE Analysis
FEEDBACK
Model the current
processes (traceability of
equipment)
AS-IS Analysis
Select one scenario, manage
transition (pilot project )
and monitor performance
Implementation &
measurement
- Objectives
- Stakeholders
- Inputs/outputs
- Control
- Information systems
- Performance monitoring
frameworks
- KPIs
- Stakeholders/Roles
- Information systems
Understand the current
hospital’s business
processes
- Simulation Tools (Arena)
- Business process tools (Visio; Aris/Software AG)
Data gathering
Using different options
- Manual data capture
- 1D and 2D bar codes (item level)
- RFID technologies (item level)
- Hybrid options (RFID + bar code)

11. Analytical approach
• Data collection:
Onsite observations, interviewing
employees, reviewing reports
• Methodology:
– Developing different scenarios on
traceability system
– Mapping business process (MS Visio)
– Simulating the scenarios (Arena®)
– Evaluating and comparing
performance of different scenarios
11

12. As-Is process flow between OR & CSD
12

13. What is scanned?
13
1 2 3
4
(4) Reusable resistant 1D barcode on the outside of
crates: scanned at the CSD.
(1) Preparation crates (2) one time use 2D barcode label
on the set/crate or (3) on the blue wrapped sets: scanned
at the OR before surgery.

14. To-Be process flow between OR & CSD
Traceability Throughout the Case Cart Preparation Process – High Level Mapping
OR-
SterileCore
OR-General
Management
CSD-SoiledCase
CartZone
CSD-CleanZoneCSD-SterileZoneCSD-StorageZone
MaterialManagement
andPurchasing
OR-
OperatingTheatre
CSD-SoiledZone
Legend
Determine
the surgery
list for next
day
Get a case
cart
Pick items
from carousel
and shelves
Transport case cart
to OR-sterile core
via clean elevators
Take the cart inside
operating theatre
Surgery
starts
Pick rest of
items from
Sterile Core
Surgery
ends
Nurse put Soiled items
In case cart and leave it
in Soiled Holding Zone
OR attendant transport
case cart to CSD via
soiled elevator
Empty the
case cart
Wash the soiled
case card in
washing machines
Decontaminate
and wash the
intruments
Park the
soiled
case cart
Case carts
are ready
to be used
Assemble the
instrument
sets
Sterilize
instrument
sets
Restock
carousel
and shelves
Instruments
are ready to
be used
Opera
Carousel
System
Order based on
the purchasing
demands
Receive
ordered
items
Record and
de-box
items
Restock
carousel
and shelves
Items
ready to
be used
ERP
system:
Logibec
Restock the
sterile core
storage
Items are
ready to be
used
Park the case
cart near the
operating
theatre
Items should
be stored in
CSD?
Transport
items to CSD
Transport items to
sterile core
NO
Preparing
case
cart
O
perating
Theatre
and
Sterile
Core
Reprocessing
ofsoiled
instrum
ents
M
aterial
M
anagem
ent
Once a surgery list
is planned, A
preparation list
request Is
transferred to CSD
(about) 24hrs in
advance; at 9pm of
the day before
surgery by the
latest
The preparation of
case carts starts
during the night shift
(10pm-6am). When
the night shift
employees arrive,
the CSD supervisor
provides the printed
preparation list.
OROR
CSDCSD
MMMM
A,B
Responsible from OR (nurse,
team leader…)
Sterilization department
employee
Responsible from material mgt
(store keeper, employee…)
Purchasing demand
CSD: Central Sterilization Department
OR: Operating Room
ORMS: OR Management System
Flow of information In ERP
Beginning/end of a process
Employee/system interaction
Transport of items or case cart
Operation
Decision
Links between high level processes
and detailed level processes
Links between different sections
of detailed level processes
Print & attach
preparation
list to each
case cart
Scan the cart/s
(barcode on the
preparation list)
Instrumental
Scan the case
cart and
instrument sets
Opera/
Instrumental
Scan the
instrument trays
and the case cart
Instrumental
Scan the tray for
opening the
assembly recipe
Instrumental
Generate
production label &
attach to the set
Scan the production
label (recording which
sterilization machine)
Instrumental
Record
itemsCSDCSD
CSDCSD
CSDCSD
OROR OROR
OROR
OROR OROR
MMMM
CSDCSD
CSDCSD
CSDCSD
CSDCSD
CSDCSD
CSDCSD
MMMMMMMM
Yes

15. Process flow scenarios
• Scenario 1: traceability with barcoding
and case cart
• Scenario 2: traceability with RFID
15
Reprocessing of
instruments at CSD
Traceability at tray level

16. Scenario 1: Barcode and case cart
16
Reprocessing of Soiled Instruments in CSD
AssemblyZoneDecontamination-WashZoneSterilizationZoneOR-OperatingTheatre
Scenario1: Barcoding and Case Cart System
Soak the
soiled
instruments
Disassemble &
brush soiled
instruments
Put in crate/
wrap
instrument set
Steam
sterilization
possible?
Sterilize items
by steam
Leave sterile
items to cool
Take out sets from
cart and to the
decontamination
Washable with
ultrasonic
machine?
Use
ulterasonic
Use
mechanical
washer
Take clean
instruments to
assembly table
Check and sort
instruments
Assemble the
set
Include filter
paper & chemical
indicator
Sterilize items
by STRAD
Sets are ready to be
sent to storage zone
Yes
No
Scan the
barcode on
crates
Employee
log in to the
system
Scan trays for
opening the
assembly recipe
InstrumentalInstrumental
Generate
production label
and attach to set
Scan production
label (record
sterilization info)
Scan and
record the
sterilized set
No
Instrumental Instrumental
Instrumental
Take the cart
inside the
operating thetre
Surgery
Scan barcode on
the instrument
sets
Put soiled
instruments in
crates and cart
Transport to CSD
via elevators
Count instruments
and check within
system
Leave
instruments to
cool down
Verify with
checklist
Yes
Transport to
sterilization zone

17. Scenario 2: RFID technology
17
Reprocessing of Soiled Instruments in CSD
AssemblyZoneDecontamination-WashZoneSterilizationZoneOR-OperatingTheatre
Scenario2: RFID Technology
Soak the
soiled
instruments
Disassemble &
brush soiled
instruments
Put in crate/
wrap
instrument set
Steam
sterilization
possible?
Sterilize items
by steam
Leave sterile
items to cool
Take out sets from
cart and to the
decontamination
Washable with
ultrasonic
machine?
Use
ulterasonic
Use
mechanical
washer
Take clean
instruments to
assembly table
Check and sort
instruments
Assemble the
set
Include filter
paper & chemical
indicator
Sterilize items
by STRAD
Sets are ready to be
sent to storage zone
No
Read the RFID
tag on crates
Employee
log in to the
system
Read crate’s
RFID tag for
opening the
assembly recipe
Read crate’s RFID
tag (record
sterilization info)
Read crate’s RFID
tag to record the
sterilized set
No
Take the cart
inside the
operating thetre
Surgery
Put soiled
instruments in
crates and cart
Transport to CSD
via elevators
Leave
instruments to
cool down
Yes
Transport to
sterilization zone
Read RFID tag on
instrument sets
Verify with
checklist
Yes

18. Simulation with ARENA
• Arena Discrete Event Simulation Software
– Enables modeling and simulation of business
processes
– Designed for analyzing the impact of changes
involving significant and complex redesigns
associated with (logistics) processes
18
Imitate
Application
https://www.arenasimulation.com/

19. Simulation with ARENA
19
Arena User’s Guide
Building the
simulations

20. Barcode simulation
20
oper at ing t heat r e
Take t he car t inside
inst r um ent set s
Scan bar code on
Sur ger y
cr at es and car t
inst r um ent s in
Put soiled
t o decont am inat ion
f r om car t and t ake
Take out set s
cr at e
Scan bar code on
Soak br ush
Disassem ble_ T r u e
F a ls e
machine
Wash wit h ult rasonic
Use ult r asonic
wash
Use m echanical
t o cool down
Leave inst r um ent s
t o assem bly t able
Take inst r um ent s
r ecipe
openning assem bly
and scan f or
Log in t o syst em
sor t inst r um ent s
Check_assem ble_
Assem ble t he set
paper
indicat or and f ilt er
I nclude chem ical
wr ap
Put set in cr at e or
and at t ache t o set
pr oduct ion lablel
G ener at e
st er ilizat ion zone
Tr anspor t t o
lable
Scan pr oduct ion T r u e
F a ls e
possible?
St eam st erilizat ion St eam st er ilizat ion
st er ilizat ion
STRAD
st er ilized set
Scan and r ecor d
Leave t o cool down
zone
send t o st or age
Set s ar e r eady t o
syst em
check wit hin
inst r um ent s_
Count
washer s
Tr anspor t t o
checklist
Ver if y wit h
zone
CSD_Decont aminat ion
CSD
f rom O R t o
CLean elevat or
OR-Operating Theatre
CSD-Decontamination
CSD-Assembly
CSD-Sterilization
Traceabilitywith Barcode
ult r osonic
Assign set f or
m echnical wash
Assign f or
st eam st er ilizat ion
Assign set t o
st er ilizat ion
Assign t o STRAD
O R
Set s com es out of
Set s r eady t o st or e
Average time set in system
# sets ready to store
Average cost of resources
0
0 0 0
0 0 0 0
0
0
0
0
0 0 0 0 0 0 0 0 0
0
0
0
0
0
00
0
0 0
0
Nu mb er o f rep ro cessed sets
Time
14401380132012601200114010801020960900840780720660600540480420360300240180120600
Sets
0
S C A N N E R
S C A N N E R
S C A N N E R
S C A N N E R
0.00
0.00
0.00

21. RFID simulation
21
t heat r e
inside operat ing
Take t he car t
set s
on inst rum ent
Read RFI D t ag
Surger y
cr at es and car t
inst r um ent s in
Put soiled
decont am inat ion
t ake t o
f r om cart and
Take out set s
on crat es
Read RFI D t ag
Soak
br ush
Disassem ble_ Tr u e
Fa ls e
machine
Wash wit h ult rasonic
Use ult rasonic
wash
Use m echanical
cool down
inst r um ent s t o
Leave
t o assem bly t able
Take inst rum ent s
assem bly r ecipe
t ag f or openning
and read RFI D
Log in t o syst em
sort inst rum ent s
Check_assem ble_
Assem ble t he set
paper
indicat or and f ilt er
I nclude chem ical
or wrap
Put set in cr at e
set
and at t ache t o
pr oduct ion lablel
G ener at e
st er ilizat ion zone
Tr anspor t t o
st er ilizat ion inf o
t ag t o r ecor d
Read crat e RFI D Tr u e
Fa ls e
possible?
St eam st erilizat ion st er ilizat ion
St eam
st er ilizat ion
STRAD
st er ilized set
t ag t o r ecor d
Read crat e RFI D
down
Leave t o cool
zone
send t o st or age
Set s are r eady t o
washer s
Tr anspor t t o
checklist
Verif y wit h
zone
CSD_Decont aminat ion
f rom OR t o CSD
CLean elevat or
OR-Operating Theatre
CSD-Decontamination
CSD-Assembly
CSD-Sterilization
Traceabilitywith RFID
ult rosonic
Assign set f or
m echnical wash
Assign f or
st eam st erilizat ion
Assign set t o
st er ilizat ion
Assign t o STRAD
of O R
Set s com es out
st or e
Set s r eady t o
Average time set in system
# sets ready to store
Average cost of resources
0
0 0 0
0 0 0 0
0
0
0
0
0 0 0 0 0 0 0 0 0
0
0
0
0
0
00
0
0
0
Nu mb er o f rep ro cessed sets
Time
14401380132012601200114010801020960900840780720660600540480420360300240180120600
Sets
0
S C A N N E R
S C A N N E R
S C A N N E R
S C A N N E R
0.00
0.00
0.00

22. Simulation results comparison
22
30 replications
24hrs each
407
14
341
375
519
16
353
387
0
100
200
300
400
500
600
All resources.busy
cost
System number out Set.VA time Set.Total time
RFID
Barcode

23. Traceability system: value proposition
23
Reduce:
- Packing time
- Storage level
- Counting time
- Set accuracy
- Free up time for medical care
- Proactive alert to ensure sterile process
- Reduction of retain surgical instruments
Reduce:
- Instrument disappearance
- Surgical cancelations
- Cost of repeated surgeries
- Lawsuits

24. Toward a smart hospital
With RFID…
– Upstream traceability
– Fast recall
– Patient safety
– Accurate statistics
– Cost neutral
24
What is management’s
perception about cost of
RFID and ROI?

25. Thank you!
UQAM, School of business
315 Ste-Catherine est
Montréal (Québec) Canada
H2X 3X2
Afrooz Moatari-Kazerouni
moatari_kazerouni.afrooz@courrier.uqam.ca