Cross Docking Information

Version 1.24 Healthcare – February 2009

Cross Docking Information

A new perspective in managing information

“Creating unique value through smart, coordinated systems”

Preliminary table of contents

Abstract
1. Introduction: the real challenge
2. Information Logistics
2.1 The basic concept
2.2 The “Decoupling Point” in the goods flow
2.3 Guidelines for the use of Cross Docking
3. Physical Logistics versus Information Logistics
3.1 Traditional way of maintaining information
3.2 Cross Docking Information
3.3 Guidelines for the use of Cross Docking Information
4. Practical applicability
4.1 The healthcare industry
4.1.1 Customer
4.1.2 Current information governance/structure
4.1.3 User interaction and customer experience
4.1.4 Information Product
4.1.5 Information Element
4.1.6 Cross Docking Information applicability
4.1.7 Conclusions

Authors: Jan P.H.M. Willems, Jan – Eric Slot, Andrzej K. Hajdasinski

International Journal of Systems Sciences

Submitted February 2009

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 Cross Docking Information

Abstract
Processing the huge volumes of information that many organizations encounter in
today’s business climate can be challenging—especially given the premium placed on
knowledge. The speed and ability of a person to process information into knowledge can
be the difference between success and failure, and can result in them gaining an
advantage over the competition. Knowledge workers have been working hard
collecting, understanding and distributing information that was not always relevant.
Consequently, the performance of knowledge workers is the next issue that needs to be
solved. This is especially true in those cases where information processes and elements
become both more critical and more complex.

It is expected that principles that apply to the logistics of physical products (Physical
Logistics) could be used to evaluate the distribution of information (Information
Logistics). One such principle is the Cross Docking method (CD) for physical products.
This Cross Docking method is well known in physical logistics. This emphasizes
minimizing inventory levels and reducing lead-time, while increasing customer services
through flexibility and responsiveness, resulting in an increase in performance and a
reduction in costs. In this article the method of CD is used to manage complex
information, placed in the structure of a coordinated system. The capability (smartness)
of the system to recognize and address an individual user’s needs is meant to support
the individual user experience, resulting in a faster response and higher quality
information (Information Product).

Interviews in the healthcare industry have been conducted to investigate the

applicability of CD for information management, which is currently an important topic.
CD could be applied to improve the quality of information management.

The aim of Information Logistics (IL) is to deliver the right Information Product (IP),
consisting of the right Information Elements (IE), in the right format, at the right place, at
the right time to the right people and all this driven by customer demand.

An Information Product is simply any final product in the form of information that a
person needs to have. This Information Product consists of several Information
Elements, which are located in the organizational value chain. A successful
implementation of IL can be seen based on the number of activities involved within the
process, the degree of organizational flexibility and responsiveness, correctly addressed
user needs and, finally, the quality of information itself.

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 Cross Docking Information

1 Introduction: the real challenge

Since the end of the 20th century, the rise of the knowledge-based economy has shifted
the world economic model from manufacturing into a paradigm where knowledge as an
asset determines the success of an enterprise. The importance of knowledge was not
widely recognized in the past. Large enterprises focused on tangible assets to sustain
their competitive advantages, such as investments in infrastructure and machines for
low-cost mass production. Nowadays knowledge has become the main driver of the
economy. Business people put more effort into acquiring, using and managing
knowledge within companies. Within an organization, knowledge can be represented as
information. For business, information carriers can be seen as Information Elements,
which are part of an Information Product. Examples of information carriers are emails,
presentation slides, images, and so on.

In order to remain competitive, the ability of people to grasp the right information,
supporting business processes, is crucial. The rapid changes of the information
landscape and the role of technology—especially during the last 15 years—contributed
to the complexity and large amounts of unstructured information. As a result, the job of
processing information into knowledge has become time consuming. Hardware- and
software-driven improvements of information management are apparently no longer
sufficient.

The white paper of Ricoh says that knowledge workers spend at least 40% of every
working day processing information. Approximately 80% of this information is
unstructured, of which 90% is unmanaged. 22% of the time is spent retrieving
information (unsuccessfully 50% of the time, resulting in the recreation of existing
information). Consequently, the real challenge today is not about dealing with the
enormous amount of information on offer, but about how to deliver:

The right Information Product (IP), consisting of the right Information Elements (IE), in
the right format, at the right place, at the right time to the right people and all this driven
by customer demand.

The lead time in finding the right information and the accuracy of the information
together determine the result of decisions and thus have a direct impact on the success
of an enterprise. [1],[2],[3].

This paper describes a new concept within the realm of Information Logistics, called
“Cross Docking Information” (CDI). This concept is based on the well known Cross
Docking method (CD), already implemented in the Physical Logistics (PL).[4]. The
coordinated system will be parameterized within the concept of CDI. The applicability
of CDI will be researched within the healthcare industry.

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2 Information Logistics
2.1 The basic concept

People deal with information everywhere and everyday. Information sits at the heart of
all business activities and the role of disruptive technology has changed the way people
conduct their business. The world has “flattened”, a term popularized by Thomas
Friedman as he described the changes in the world due to rapid globalization,
demographics, technological development and regulation. [5] The cost in acquiring
information has been decreased in such a way that people can now share information
easily, and from anywhere. The impact on the business world is that people now rely
heavily on the importance of information in order to beat the competition. People are
competing for information to become the most knowledgeable in their field. People who
“know” more can lead the rest of the competition. The operational priorities must shift
from “spending money” on information to “making money” from information.
Companies now spend substantial sums on information technology, in order to manage
their information. Companies also invest heavily in infrastructure to enable knowledge
sharing within the organization. The question then arises: how much time would one
need to acquire the right information?

Issues of speed, effectiveness and accuracy in acquiring the right information also
happen in daily life. For instance, within a thirty-two-page newspaper, how many pages
would contain the actual information that one is really looking for? What percentage of
emails, which people check daily, is ultimately relevant to them? How long does it take a
driver to read and to understand a map direction? How often do people switch
television channels or radio channels in order to get to the program they want? These
questions arise when people need accurate information under time pressure and they
have to search within a complex organization. [6]

Ranganathan (1956) defines Information Logistics as a branch of information

management, which deals with information flows inside an organization. He says that
the goal of Information Logistics is the optimization of availability and retention time of
information. The right information management, using the right technology, is meant to
support the efficiency of the information distribution, which in the end should be able to
satisfy the individual needs of users.

The Ricoh white paper defines Information Logistics as the management of information
bridging time, distribution and presentation in such a way that it renders optimal
company results in harmony with the costs of capturing (creation, maintenance, and so
on), searching, obtaining towards delivering in time to the right environment. The white
paper also mentions that the application of Information Logistics is based on Just-in-
Time (JIT) theory to the supply of information and communications, and on the
development of Industrial Engineering: more specifically on Goldratt’s theory of
constraints (bottleneck). Additionally, according to the white paper, the focus on the
Just-in-Time theory is shifted from the supply-driven, which is collecting and storing
information, to the demand-driven, which is the usage of information. [2], [7]

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 Cross Docking Information

2.2 The “Decoupling Point” in the goods flow

Information logistics (IL) and Physical Logistics (PL) have a lot in common. That’s why
some methods within PL can be used in IL. The “Decoupling Point” in the goods flow is
a fundamental and straightforward concept. The “Customer Decoupling Point” is the
point that separates the ‘part of the organization oriented towards customer orders’
from the ‘part of the organization based on planning’. There are five Customer
Decoupling Points as shown in the following figure.

o Decoupling Point 1 is ‘make and ship to stock’

o Decoupling Point 2 is ‘make to stock’
o Decoupling Point 3 is ‘assemble to order’
o Decoupling Point 4 is ‘make to order’
o Decoupling Point 5 is ‘purchase and make to order’. [8]

Fig.1 How far does a customer order penetrate?

In PL, CD has been one of the radical solutions used to minimize stock levels and has
been implemented by many companies. Apte and Viswanathan (2000) define CD as the
process of moving product through distribution centers without storing it. [9].
Furthermore, they describe CD as a warehousing strategy that involves the movement of
material directly from the receiving dock to the shipping dock with a minimum settling
time in between. In addition, Apte and Viswanathan (2000) explain two benefits of
implementing CD system as a warehouse strategy. The first is that CD can effectively
bring substantial reductions in transportation costs without increasing inventory while
simultaneously maintaining the level of customer service. The second is that CD can also
lead to a reduction of order cycle time, thereby improving flexibility and responsiveness
of the distribution network. (See fig. 2)

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 Cross Docking Information

A1
C1
{A} => {C}
A2
C2

An
Cm

A I = Article driven (I = 1, 2, …n)

C j = Customer driven (j = 1, 2, …m)

Fig. 2 Cross Docking of Physical Products

First of all, materials are brought using trucks from various vendors to a specific
warehouse. Next, materials are unloaded from trucks at the receiving dock and then
directly distributed to specific trucks that are loaded with specific materials to identical
destinations. Finally, the materials are transported to various retailers. This whole
process does not even include any inventory because in CD for Physical Products,
materials are distributed unceasingly to different trucks right after being unloaded into
the warehouse. The minimum inventory level necessary within CD will result in lower
costs—such as holding, handling and maintenance costs at the warehouse. Moreover,
since CD needs a minimum settle time between the receiving and shipping docks, and
an effective and efficient information management system, it creates a reduction of order
cycle time, and thus improves the flexibility and responsiveness of the whole
distribution operation. In the end the right product will always be delivered to
customers at a minimum of time and cost, which will increase the level of customer
satisfaction. These two benefits are also the aims of an ideal IL system. Therefore, CD of
Information Products is derived from CD of Physical Products, which is illustrated in
the next section.

2.3 Guidelines for the use of Cross Docking

For CD to work properly, the items that come into the warehouse should be demanded
or pulled out by the customers quickly. The demand rates of the items are therefore
critical in the daily planning of CD. If there is an imbalance between the incoming load
and the outgoing load, CD will not work effectively.

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 Cross Docking Information
Hence, items more suitable for CD are the ones that have demand rates that are fairly
stable and constant. For perishable items and chilled goods, the demand rate tends to be
stable since the customers cannot buy and store large quantities, and therefore have to
make regular repeat purchases.

The warehousing and transportation requirements of products with stable demand are
much more predictable, and consequently the planning and implementation of CD
becomes (relatively) simpler for these products. Such products also require less safety
stocks for both customers and warehouses. Another factor of importance that influences
the decision to use CD is the level of unit stock-out cost or the cost of lost sales on a
single unit of product. CD inherently leads to a minimal level of inventory at the
warehouse, and thereby strips the system of safety stocks traditionally held at the
warehouse. Consequently, CD raises the probability of stock-out situations. However, if
the unit stock-out cost is low, CD can still be the preferred strategy, since the benefits of
reduced transportation costs under CD can outweigh the increased stock-out cost. As
shown in figure 3, CD is therefore preferred for products with stable and constant demand
rates and low unit stock-out cost. On the other hand, for products with unstable or
fluctuating demand and high unit stock-out costs, the traditional warehousing and
distribution strategies remain preferable. When the demand rate is constant, but unit
stock-out cost is high, CD can still be implemented, but more precise planning systems
are required to ensure that instances of stock-out/lost sales are kept to a minimum.
Similarly, when product demand is fluctuating, but unit stock-out cost is low, CD can
still be implemented with the proper systems and planning tools to keep instances of
stock-outs and the associated stock-out cost to a reasonable level.

Guidelines for the use of

Cross Docking (CD)
High Cross Docking can Traditional
be implemented warehousing/
with proper distribution
systems and preferred
Unit stock-out planning
costs
Cross Docking Cross Docking can
preferred be implemented
with proper
systems and
planning
Low
Stable & Constant Unstable & Fluctuating

Product Demand Rate

Fig.3 Guidelines for the use of Cross Docking

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3 Physical Logistics versus Information Logistics

3.1 Traditional ways of maintaining information

Traditional ways of maintaining information involves many complex activities. One

example could be an insurance company which, obtaining information from customers
and delivering information to customers, will need a great deal of time and effort to
process and store that information within several departments. An insurance company
may need several weeks to process the application of one customer because of the
sequential activities. It is also common that several activities are repeated many times
because of low information quality—such as missing data or data inaccuracy. The
number of activities involved will influence the lead-time, the responsiveness and the
flexibility in providing the right information to the person who demands it. In order to
avoid high costs as a result of process inefficiency, several solutions exist. Examples
include business process redesign, department or cross-functional integration,
standardization and so on.

3.2 Cross Docking Information

Through the concept of Cross Docking Information (CDI), discussed in this paper, one
might find a different alternative to deal with the same problem. The idea of CDI is to
apply the Cross Docking method to manage the distribution of information using a
smart coordinated system.
Smart systems [4] are defined as intelligent miniaturised technical subsystems with an
own and independent functionality. They can sense and diagnose complex situations.
They are “predictive”, they have the capability to decide and help to decide as well as to
interact with the environment. A smart coordinated system therefore will optimize the
functionality of a smart system with the objective of cross docking information i.e.
manage the distribution of information better, faster, more reliable, more accurate,
complete and according customer demand.
All parties within a group or a network of groups are users of this information
distribution system. For instance, one of the users might be an information supplier
involved in the process of delivering a unit of information (Information Element).
Another user could be a customer demanding an Information Product. A third user
could be an IL professional dealing with managing the supply, transformation, storage
and distribution of Information Elements and Information Products. The fourth user
could be a subject matter expert adding value to the provided Information Elements
resulting in a new Information Element or in an Information Product. In service
industries we often see that the supplier of Information Elements could be also the
customer requiring the Information Product. [6]

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 Cross Docking Information

IE 4

IE i = Information Element driven (i = 1, 2, … n)

IP j = Information Product driven (j = 1, 2, … m)

Fig.4 Cross Docking of Information Products

The supplier of information should enter only valid information into the system once,
and all other sequential activities within departments should be minimized. The result
will be a shorter lead-time and the storing of information—except in the smart
coordinated system—will not be necessary. Based on a specific user profile, the smart
coordinated system will determine what information is relevant to which user.

3.3 Guidelines for the use of Cross Docking Information

Based on the guidelines for the use of CD, explained in chapter 2, CDI guidelines have
been developed and explained in Fig. 6. As in Cross Docking, within CDI the
Information Product demand is of a quick response nature. If there is an imbalance
between the incoming amount of information and the outgoing amount of information,
CDI will not perform well. As a result, information demand rates should be fairly stable
and constant. The logistic requirements of Information Products with stable demand are
much more predictable, and consequently the planning and implementation of CDI
become relatively easy for these products. Such products have less need for capacity
reservations (time, energy) at both customer and knowledge worker/supplier. The unit
stock-out cost or the cost of lost sales on a single unit of product within CDI is replaced
by the variety of Information Elements. The higher the number of different Information
Elements required, the more planning problems in capacity of people will occur that will
inherently lead to non-delivery of the IP within the required service levels. CDI is
therefore preferred for products with stable and constant demand rates and low
Information Elements variety. On the other hand, for Information Products with
unstable or fluctuating demands and high Information Elements variety, the traditional

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 Cross Docking Information
Information Logistics way of working (storage, retrieval and distribution) is preferable.
When the demand rate is constant but Information Elements variety is high, CDI can be
implemented, but a smart coordinated system (intelligence, more precise planning, and
so on) is required to ensure that missing information or decreased service levels are kept
to a minimum. Similarly, when the demand for Information Product fluctuates but
Information Elements variety is low, CDI can still be implemented with the support of a
smart coordinated system to keep service to a reasonable level.

Guidelines for the use of

Cross Docking Information (CDI)

High CDI can be CDI is not

implemented with a recommended,
smart coordinated traditional IL is
system preferred
Information
Elements
variety CDI is the preferred CDI can be
solution implemented with a
smart coordinated
system

Low
Stable & Constant Unstable & Fluctuating

Information Product Demand Rate

Fig.5 Guidelines for the use of Cross Docking Information

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4 Practical applicability
4.1 The healthcare industry
4.1.1. Customer
The Academical Medical Center, Amsterdam is a 1000 bed University Medical Center in
the Netherlands. Its three main domains in order of size are Patient care, Research and
Education (medical students, nurses and medical specialists, PhD students). It has
around 7000 employees and a turnover of 700 M€. It has all the characteristics of an
information driven environment and provides information to a wide variety of external
parties, including government bodies, public health inspectors, health insurers,
individual patients as well as patient advocate groups.

The eight University Medical Centers in the Netherlands increasingly work together in
covering the patients’ needs, in particular in the Medical research domain where there
initiatives have resulted in sharing data around eight common research topics, in the so-
called Parelsnoer Initiative, centers of expertise residing in different University Medical
Centers.

4.1.2. Current information governance/structure

To support its activities, AMC has three main domains and one support domain, with a
total of more than 2000 applications:

Patient care with 600 applications

Research with 1200 applications
Education with 50 applications
Support systems with 250 applications

The availability of information, contained in the aforementioned applications, should

help the hospital to understand better and/or earlier the patients, researchers and
students real needs. Value is heavily based on Information Logistics performance. The
aim of Information Logistics (IL) is to deliver the right Information Product (IP),
consisting of the right Information Elements (IE), in the right format, at the right place, at
the right time to the right people and all this driven by customer demand

Based on the right information a doctor can among 1000 diabetic patients, establish the
handful that requires intensive treatment by experts, while a nurse can help the others
twice a year. [10]

In mind of the general public there is the feeling, that doctors will best be supported by
having all the available historic information available for diagnostic purposes. The fact is
that the main process is to reduce the amount of data to come to a likely hypothesis
about the cause of the symptoms that can be falsified or proven. For example, from a CT
scan of a patient, consisting of 132 images, usually the radiologist report is sufficient to
conduct a good treatment. The rest of the available information may however be
important for research and teaching purposes.

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4.1.3. User interaction and customer experience
In Healthcare it is well-known that in some cases where a patient needs surgery the
procedure has to be postponed because of last minute new information, like new
medication or recent allergies, or because the patients’ condition has deteriorated that
additional preparation and tests are necessary to find out whether anaesthesia is possible
and safe.
In terms of new user interaction within the AMC, some patients fill out a pre-operative
questionnaire. This questionnaire is used as the entry point before the patient presents
himself for surgery. Anaesthesiologists and nurses will use the information in the
questionnaire to schedule additional tests when necessary and thus avoid last minute
postponement of the operation. Especially in the case of day-surgery—where patients
have surgery in the morning and return home in the afternoon— the availability of
information has become crucial.

Another example of an ‘early’ pre-assessment is the case where an injured patient is

brought by ambulance from a location (accident) to the hospital while a pre-assessment is
conducted and the information distributed instantaneously to the next step in the medical
process. [11]
Today, more necessary patient information is available upfront and in a much faster
manner than in the past. This is the basis that allows the University Medical Center to
carry out better triage to improve the quality of treatment.

Information technology is already being used to help and advise the customer in a direct
and fast way. For example, in Disease Management settings a ‘box’ with built in
automated diagnostics is available to consult diabetic patients, resulting in daily coaching
of their behaviour.

In building the customer experience, a system should be ‘smart’ enough to understand

customer needs. Within the AMC, an Electronic Medical Record (EMR) is implemented,
consisting of 6 layers with different capabilities:

1. Laboratory, radiology (reports on line)

2. Medication (prescriptions)
3. Order management
4. Elimination of paper records (structured data entry)
5. WFM (Work Flow Management)
6. DSS (Decision Support System)

Although many applications can already perform smart data processing while having
their own smart intelligence, the AMC is still adding smart intelligence into the
aforementioned layers. The AMC is at the development level between layer 4 and 5; in
other words, the elimination of paper records and the introduction of Work Flow
Management.

The ability of an information system to support the primary patient processes is highly
dependent on the quality of the information or data. In dealing with this issue, AMC is
emphasizing the importance of direct feedback loops at the first moment data is stored

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 Cross Docking Information
(data entry). The data quality in the beginning will have a huge impact on the efficiency
of the following activities in the process.

4.1.4. Information Product

In the end, the role of Information Logistics should enable hospital like the AMC to shift
from simply treating diseases to preventing complications (from curing to preventing).

The information architecture, as used by the AMC, is “best of breed”. [12] It consists of
different subsystems A, B, C, D and E, all connected to a central Enterprise Bus and
organized as a closed loop. This means that data entry, visible for every participant, has
to be done only once and that direct feedback from other users is possible. This central
access to the data is of great importance to the performance of the doctor and/or the
medical staff regarding the patient, in particular across specialties.

Enterprise Bus

Fig.6 Closed loop front office subsystems with Enterprise Bus

This information architecture (including data and business rules) is in fact the basis for
creating entirely different Information Products, for instance:
(1) Data/information regarding the patient. Doctors have to log on only once, establish
the relationship with the systems and get the data needed for their work.
(2) A medical registration list, sent monthly to the government, showing all the
procedures that the hospital has undertaken.
(3) A periodical report for the insurance company to get the treatments financed.
(4) A Key Performance Indicator report for the inspector general of public health, to
inform on quality and quantity performances; for example, average stay, number of
complications, and so on.

None of these Information Products come directly from one specific system, but are
pulled from different subsystems. Some of them are automated (application software),
while some of them have to be made up at the moment of the report, because requests
from outside the hospital are continuously changing.

Providing relevant information is of utmost importance for the patient; in other words,
getting sufficient knowledge of the procedure and understanding the quality required.
The patient should be informed upfront about what can happen and should be free to
choose the medical treatment and hospital. The doctor should support the patient in
making the right choices, acting as a real ‘consulting surgeon’. One of the main questions
to be solved nowadays is how to get the right ‘consulting general practitioner’ that fits
the patient’s need.

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4.1.5. Information Element
Data needed to create Information Elements or Information Elements coming from one
system belonging to one domain can also be used in other domains. An example of this
situation in the healthcare industry is data of the patient that are also used for research.
In general people within the AMC don’t have problems with the storage of information
elements. However they do face problems with getting the right information elements in
the right format in order to deliver the right information product at the right place, at the
right time to the right people. In a lot of cases people need to spend extra time to
overcome (information) bottlenecks regarding availability and context.

In an increasing number of cases, the process of building Information Elements into

Information Products is being automated. An example is the medical treatment
discharge letter being sent by the surgeon to the general practitioner. This letter is built
up by Information Elements ‘laboratory, medication and diagnosis’. These Information
Elements—combined with space for the Information Element ‘free text’—are assembled
into the Information Product ‘Patient consult’. The information carrier of the ‘Patient
consult’ is a physical and tangible structured ‘paper based’ document. The systems used
by the AMC are in most cases meant to create Information Elements or sub Information
Products. Why are they not capable of creating Information Products? The main reason
is that the healthcare industry consists of many organizations dependant on their own
(sub) systems delivering different parts of Information Products, thus creating
Information Elements. Due to a lack of transparency in the overall healthcare chain of
activities, the terms ‘Information Element’ and ‘Information Product’ are not explicitly
defined and in use. The National Institute for ICT in Healthcare (NICTIZ) is introducing
the term Professional Summary to address this, but this is not widely accepted or used
yet, as a reflection that in Healthcare organizations, the awareness level of Information
Logistics is insufficiently developed.

4.1.6. Cross Docking Information applicability

To create a first look and feel at the applicability of the CDI matrix, a few practical
examples with impact on the AMC organization, were selected.

DBC
DBC stands for ‘Diagnose Behandel Combinatie’, or in English ‘Diagnosis Treatment
Combination’. It’s the basis for charging in the right way the cost regarding diagnosis
and treatment of patients.
DBC can be positioned in the upper left corner: stable and constant Information Product
Demand Rate with high Information Elements Variety. In the case of a simple and
visible injury or disease the diagnosis will be short and the cause of the injury is
absolutely clear. This will result in a manageable treatment, transparent for all the
stakeholders. However in case of a complex mental disease it’s hard to understand all
the details in one time. The diagnostic process will go through several layers (phases)
before the real cause of this disease can be found, being a basis for a good treatment. [13]
In case of DBC one can therefore speak of different Information Elements, leading to
different Information Products with different cost implications.

Simple appointments
An application for scheduling and managing appointments (in Dutch this is called
`afspraak systeem’) is not that difficult. The template for making appointments is well

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known and predictable. It’s easy to make an appointment at the general practitioner’s
office. So here we talk about stable and constant Information Product Demand Rate with
low Information Elements Variety. This case will be positioned in the bottom left corner.

Complex appointments
In the case of a complex clinical picture the scheduling of multiple and combined
appointments in the right order within a certain timeframe are often of utmost
importance. These appointments are interdependent and can result into more
appointments. One can therefore talk about different Information Elements, leading to
different Information Products. Within the AMC this is often the case. So one can talk
about a stable and constant Information Product Demand Rate with high Information
Elements Variety. This example will be positioned in the upper left corner.

Information about quality

Inspection for Dutch Healthcare is asking for information about hospital performance
quality. The first time this question was asked, no organization, process and system
were in place to support measurement and communication.
Today this organization publishes a lot and continuously about all kind of quality topics
regarding healthcare. All the information needed for writing and publishing these
reports are coming from hospitals like the AMC. So a lot has changed since the
beginning.
The consequence is that the organization of measuring and reporting needs to be
integrated in the daily hospital operations. So to say this extra work for `third party
stakeholder Inspection’ has become an integral part of the AMC organization. This is
causing extra workload and energy of the AMC knowledge workers.
In this case one can speak of unstable and fluctuating Information Product Demand Rate
with low Information Elements Variety. This example is therefore positioned in the
bottom right corner.
Guidelines for the use of Guidelines for the use of
Cross Docking Information (CDI) Cross Docking Information (CDI)
AMC
High CDI can be CDI is not High CDI can be implemented CDI is not recommended,
with a smart coordinated traditional IL is preferred
implemented with a recommended, system
smart coordinated traditional IL is DBC
system preferred Complex
Information Information appointments
Elements Elements
variety CDI is the preferred CDI can be variety
CDI is the preferred solution CDI can be implemented
with a smart coordinated
solution implemented with a system
smart coordinated Information about
Simple
system appointments quality
Low Low
Stable & Constant Unstable & Fluctuating Stable & Constant Unstable & Fluctuating

Information Product Demand Rate Information Product Demand Rate

Fig.7 Guidelines for the use of CDI within AMC

At this moment the CDI matrix is not applied by the AMC. However, there is already an
agreement for further research in finding out how this CDI matrix could become the
basis for a more professionalized approach in developing new, more effective and
efficient processes for a variety of healthcare Information Products.

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4.1.7. Conclusions
1. The first analysis shows possibilities for CDI concept application within the
healthcare industry and more specifically within the AMC environment.
2. Elements of ‘smart coordinating systems’ have already been implemented within
the AMC and in some cases might even be integrated in a more central form.
3. Information Elements and Information Products already exist within the AMC
environment but not in a defined form—more as intuitive components of a
virtual system.
4. CDI matrix seems to be the correct (and interesting) tool that supports the right
design of the IL environment for selected processes.
5. CDI is recognized as an interesting methodology for further research and
possible implementation within the healthcare industry.

References

1. From Having to Using, Jan Willems, Nyenrode Research and Innovation Institute
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 Cross Docking Information
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