“There’s got to be a better way.”

I have been to hundreds of surgeries worldwide. It always amazes me how much time people spend scurrying around trying to get the right products into the OR for a specific surgeon and procedure.

Until now, surgeons, surgical support staff, and facilities have had few options for overcoming the frustrating deficiencies associated with how orthopedic devices are currently delivered, sterilized, managed and utilized within a healthcare facility. The implants and instruments contained in the steri- trays are sometimes missing and/or damaged, go through multiple cleaning cycles, may not be thoroughly cleaned prior to sterilization, are prone to sterility compromise, and may be incorrect, insufficient, or even unavailable for the case. Manufacturers require field sales personnel to deliver and manage the inventory while healthcare facilities must provide staff and equipment to store, sterilize, and transport the steri-trays. Resources are also needed to manually track what was used, leading to errors in documenting part numbers and lot numbers of implants that can lead to costly overpayment and/or reimbursement losses. The presence of a supplier representative in the operating room also adds to the bioburden load, further increasing infection risk. All of this leads to increased patient health risks, inefficient OR use, and excessive cost to the facility.
Seen as an opportunity to make a meaningful impact, “there’s got to be a better way” ultimately became the genesis for a startup in Dallas, GEO.  GEO is a technology-based hybrid startup focused on a complete end-to-end supply chain solution, and the manufacturer of orthopedic medical devices.
While there is substantial attention from orthopedic device manufacturers on developing innovative new products for surgery, far less effort has gone into improving the basics of the underlying supply chain, especially when it comes to what’s commonly termed the “last mile” – which in the case of orthopedic devices, is the operating room. From its inception, GEO was built with the goal of delivering that “better way”, not just for the surgeon, but for the healthcare facility and ultimately the patient.
GEO was founded in late 2014 and the Texas-based company was born with the purpose of re-inventing the supply and delivery of orthopedic devices and reducing many of the associated costs. Beginning with the end in mind, GEO set out to first design an end-to-end process for orthopedic product delivery, then develop the hardware, software, and technology to implement the plan. This approach allowed GEO to anticipate and address a multitude of real-world issues that directly shaped the company’s end product.
Those within the industry are keenly aware of the way orthopedic devices are contained, distributed, tracked, cleaned, sterilized, and utilized in surgery, but for the most part, the associated pitfalls have gone either unrecognized, unsolved, or disregarded by product providers. GEO, in contrast, focused on the underlying issues from a customer-based viewpoint using one of the few advantages a startup has – a clean slate on which to build an entire solution from the ground up.

GEO soon discovered that the ultimate solution for addressing the variety of problems related to device supply issues required three basic elements:

  1. eliminating the autoclave sterilization process by providing sterile packaged products,
  2. having all GEO products at the ready in the OR, and
  3. minimizing inventory management requirements at the healthcare facility through automated processing and data communication. The resulting platform became known as the GEO CART®.
The GEO CART® is a self-contained mobile inventory storage and management warehouse for medical devices, designed as a Point of Sale system to be placed into surgical operating rooms. It consists of RFID technology, communication, and power management systems integrated into a medical-grade mobile cart. Additionally, a touch-screen all-in-one computer running proprietary custom software provides a user interface for surgical and administrative staff to easily access the cart functions. GEO CART® provides a number of solutions to the legacy problems of the current orthopedic device supply system.
Outfitted with sterile packaged products designed by GEO, the GEO CART® eliminates the need for cleaning or sterilization at the healthcare facility, and because the GEO CART® can house 2,000+ packaged implants and instruments, concern over missing, damaged, or incorrect implants or instruments for a case is eliminated. The GEO CART® and its inventory are available 24/7 in the operating room and can be configured with many different types of product for various procedures, effectively bringing the entire product catalog to the surgeon and minimizing any wasted time due to product unavailability. Taking advantage of RFID technology, internet connectivity, and the GEO cloud, the GEO CART® automatically keeps track of both available and consumed parts, allowing each GEO CART® to be custom-configured to the surgeons’ needs based on real-time usage data, and replenished quickly as parts are used.
The RFID system integrated into the GEO CART® automatically tracks each implant and instrument that is used for a case, eliminating the need for healthcare facilities to manually document product usage, and create/process an Implant Usage Form. The sterile packaged products also eliminate the need for pre- or post-surgical cleaning and sterilization, thereby significantly reducing the need for the expensive overhead associated with sterile processing departments. GEO provides a unique serial number for each packaged part, including individual implants and instruments, that is automatically associated with the case it is used on, reducing the liability of improper tracking of devices to a patient. Because the GEO CART® functions without the need for a supplier representative to be present, fewer interactions, disruptions, and reduced bioburden benefit OR efficiency and patient safety. The potential for surgical delay is also minimized when compared to the use of steri-trays for delivering products, leading to greater OR utilization and faster turn-around.
Recognizing the potential health risks of repeatedly sterilizing implants and instruments, GEO placed great importance on patient safety. The benefits of pre-sterilized packaged products are obvious in relation to minimizing infection risks to the patient and are less commonly available but not unique to GEO. The additional impact of the GEO CART® with respect to patient safety is unique however and may be realized in several ways. Because the GEO CART® system is semi-autonomous, ancillary support of supplier representatives is not needed so bioburden can be reduced with fewer people in the OR. More importantly, the large number and variety of devices that the GEO CART® can house offer less potential that additional types and sizes of implants or instruments are not available, reducing the probability that a lack of appropriate devices would be the cause of the surgical delay. Taking advantage of “starting with the end in mind”, the development of the GEO CART® was founded on making sure that the surgical staff is focused on the patient and not sidetracked by new equipment or a new task. The GEO CART® eliminates the need to prepare and clean up steri-trays, track devices that were used, or manage Implant Usage Forms.
GEO is a technology company that is focused on both product delivery and the implants and instruments housed in the GEO CART®. Though the initial vision of GEO was based on a customer-centric perspective, the company discovered early on that the solution for the customer also became a benefit for itself. The GEO CART® is at its core a means to collect data, and that data provides information critical to controlling, tracking, allocating, and managing inventory. Each GEO CART® autonomously conducts a complete physical inventory daily and creates, and electronically transmits, implant usage data in real time to the GEO cloud, enabling the company to react dynamically and quickly to, among many things, conduct immediate replenishments, configure cart inventories based on usage, and predict and control the production pipeline. The products GEO offers go hand-in-glove with the GEO CART® because the integration of the product, packaging, labeling, and RFID tagging combine to form the basis for its functionality.
The RFID technology is at the heart of what makes the GEO business model different from other approaches in this field. However, implementation of the RFID system, specifically in the orthopedic medical device industry, posed a significant challenge for reading the tagged packages within the GEO CART®. A number of factors had to be addressed, not the least of which was quickly and accurately reading hundreds of RFID tags in close proximity to a high density of metallic objects. The result is a unique remote warehouse system that contains a very large inventory of products available at any time, without delay and within the operating room. Additionally, these challenges inspired the development of several novel characteristics of the system, resulting in pending patent inventions.
GEO CART® also serves as a platform for future capabilities in the domain of the Internet of Things (IoT). Because of the relative autonomy, the GEO CART® provides in managing remote inventory, and because of its connectivity to the internet, there are additional benefits lying in wait for healthcare providers that utilize the GEO CART®. GEO has plans for adding a variety of functions and capabilities to further support healthcare providers utilizing the GEO CART®.
Based on what I have seen so far, GEO is well on the way to realizing their vision of improving healthcare by revolutionizing how orthopedic medical product delivery can better serve today’s healthcare market.

For more information please contact GEO directly at www.gramercyortho.com or contact Michael Nugent at mnugent@gramercyortho.com.