Barbara Graverson is shopping online. She has her favorite site bookmarked. She scours the search engine for the goods she needs. As soon as she finds them, she fills her online shopping cart and heads for the checkout.
With a few keystrokes, she's sailing through the secure server. One click later, her order is processed and her items are on the way.
But Graverson isn't looking for books on Amazon.com. In fact, she's shopping on company time. She's the clinical services coordinator for the University of Wisconsin-Madison health office, one of 60 locations within the University of Wisconsin Hospitals and Clinics (UWHC) system.
When Graverson shops online, she's likely purchasing bath linens, catheters or I.V. supplies. And her site of choice is UWHC's own intranet catalog.
"If you can use Amazon.com, you can use this," Graverson says. "It's that easy."
Materials managers, nurses and other professionals have traded cumbersome catalogs and reams of paper for an online shopping center.
Thanks to a joint effort between central service and information systems (IS), more than 2,000 medical and surgical supplies can be ordered through the intranet.
The new system has saved money and manpower, notes Robert Scheuer, UWHC's director of materials management and distribution.
The online ordering has cut down on mistakes and even improved communications between departments.
Orders that used to take a half-hour or more to fill can be completed in five minutes, Scheuer says.
The sniping between departments over missed orders or poor processing has all but vanished. And it didn't require a huge investment or a crash course in computer technology.
"Ultimately, our job is to get the right items to caregivers as fast as possible. That's what's best for our patients," Scheuer says. "This system is making that happen."
Quite a comparison
The UWHC system hasn't always run as smoothly as it does today. In 2000, no one on either side of the supply chain thought much of the ordering process. At one end, clinicians, nurses and unit clerks thumbed through a massive and obsolete catalog.
"Even if you could find the book, it was completely useless," says Sue Rees, R.N., UWHC's nursing director.
Pages fell out. Listings didn't include photos. Products were grouped alphabetically instead of with similar items. Scalpels, for example, weren't bunched with other surgical supplies. They were found under "S" next to stethoscopes.
New paper catalogs, printed once a year, were obsolete almost immediately upon arrival in mailboxes. Clinicians stayed up-to-date by scribbling the newest product entries into the margins.
"It was like looking for someone in a phone book, but only knowing their first name," Rees says.
Central service was no less frustrated with the system. Rather than quickly filling orders, the staff's work hinged on deciphering handwriting and guessing the customer's intent. Order forms rolled off fax machines with smudged unit numbers and illegible addresses.
Some customers described one item, but ordered a different one. Some included serial numbers for which there was no product. Often, customers wrote their address wrong--or neglected to include one at all.
"We'd get orders that said, 'I need a 14-french catheter, STAT!'" Scheuer recalls. "But they wouldn't include who they were or where to deliver the item. We'd have the item in hand and say, 'OK, now what do we do with it?'"
Too frequently, customers ordered several different items hoping the one they needed would be among them. Then they'd mail back the unused products for credit. Central service staff found themselves filling and refilling useless transactions. And the tension along the supply chain was palpable. "Things could get testy," Scheuer says.
There seemed to be no way to fix the problem. How could busy health care professionals be persuaded to improve their handwriting? How could a supply staff be asked to read a customer's mind?
"We needed a faster and easier way to communicate with our customers," Scheuer says. "We've always had trouble getting everyone on the same page."
Plugged in
The solution was at Scheuer's fingertips--or at least his keyboard.
The health care system's IS department had already created an intranet, a UWHC-wide computer service that connected all of its locations.
"Think of the intranet as a giant filing cabinet," says Nathan Morris, a senior e-technology developer for the e-health office. "It's a central place for employees to get access to all the information and all the tools they need to do their jobs."
Unlike the Internet, where Web sites are accessible to virtually anyone with a modem, the intranet is primarily used by people within the UWHC system. (Some outsiders such as athletic departments, hospice care and the Madison fire department also use the system, but must be given a password to enter through the security firewall.) Most departments used the intranet to post such important content as hospital policies or health fact sheets. But Scheuer suggested that the same technology could support an online catalog.
From a technology standpoint, the plan hinged on two aspects: the intranet and the materials management software capable of searching a large database of products.
UWHC already had both the intranet and the software, which was from PeopleSoft, Pleasonton, Calif. The next step was finding people with the time and knowledge to pull the plan together.
Working with an IS intern, Scheuer walked the supply corridors, cataloging and digitally photographing each of the 2,000 stocked items.
As he worked, he tried to imagine how a customer might view the catalog. "I'd have an item in my hand and think, 'Does it make sense to show a picture of the box, or should I photograph what's inside the box?'" he says.
Just as important as the pictures and listings was the search engine. Customers had to easily find a product, no matter which name they used for it. One item might be called several different names by several different departments.
Take, for example, a respiratory vial of saline used for suctioning patients with tracheotomy tubes. A clinician might call it normal saline--or use its scientific term, NACL. But nurses on the floor may know it as a "fish" because of the hooked shape of the vial, Graverson says.
But, all the names are fairly useless to the supply staff who fill the orders. They know it by a seven-digit serial code.
"Our staff are not clinicians, but our customers are," Scheuer says. "The customer asks for an item by its clinical name. Our staff wants the number so they can pick it off the shelf. You can imagine the trouble when someone says 'I want a widget.' We ask for the number and they say, 'I don't know the number. Just get it!'"
The online catalog's search engine doesn't distinguish a fish from an NACL. But it allows three methods of searching: by a family of products such as linens or gloves; by a partial item number; or by a description.
Let's say a customer wants to order a latex glove; but they haven't committed the serial number to memory, and they may not know a specific brand or size specification. Rather than thumbing through a paper catalog in hopes of tripping over the exact item, the customer can browse through groupings of gloves.
And each item is listed with a photo and price. Pictures help users choose their supplies more efficiently. Graverson says she and a nurse review a printout of the catalog and pick the items they need.
The pricing information has helped Graverson's budget by easily allowing her to comparison shop.
Scheuer even won over technophobes by getting their input early and showing them how to easily navigate the catalog.
After testing about a dozen variations, Scheuer and the IS staff used both central service and nursing units as focus groups to clean out the bugs.
At the same time, they overcame the point-and-click reluctance among "pen-and-paper people," as Scheuer puts it. "Before they use it, there's always some cynicism about whether the new way is really going to work," Scheuer says. "If they use it once, they see how easy it is."
On the supply end, central services receives a bar coded printout on each order, complete with delivery information. Scheuer and the IS staff keep the system updated by adding new items as they arrive rather than making custo-mers wait up to a year for a new printed catalog.
For UWHC, the costs of creating the catalog were minimal, mostly because the software and online system were already in place.
While most health systems likely already own materials management software, the initial intranet investment, which is used for far more than just ordering supplies, is massive.
Designing and creating an individual intranet system can run from the tens of thousands to more than a million dollars, Morris estimates. Health care systems without an existing intranet can still create an online catalog by setting up a separate Web site.
That site, however, would be accessible to anyone outside the system, making security issues even more vital.
Scheuer hasn't studied the savings of the catalog yet. "I hesitate to put a number on it," he says. "But I think the biggest impact is on labor savings, both on the part of my staff and nursing."
By eliminating the inefficiencies of the old system, Scheuer says the catalog has freed clinicians to spend more time with their patients and less time on order forms. And it's taken the guesswork out of central services' order fulfillments.
Graverson has become an expert at surfing the site. She's memorized the order numbers for everything from exam table paper to culture swabs. She's also browsed the catalog to find new supplies.
While searching orthopedic items for crutches, she found a listing for walking boots. "I didn't even know we carried them," she says. "It's like hanging out at the mall. You never know what you're going to find."
John DiConsiglio is a freelance writer based in Arlington, Va.
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