HTG focuses on cross-industry problem solving

Six years ago, five of the most notable names in healthcare delivery — Geisinger Health System, Intermountain Healthcare, Kaiser Permanente, Mayo Clinic and Mercy — formed the Healthcare Transformation Group (HTG) to advance the healthcare supply chain. The first initiative on the table — adoption of GS1 standards, including the Global Trade Item Number (GTIN), Global Location Number (GLN) and the Global Data Synchronization Network (GDSN). Since its formation, HTG members have met at least once a week in various workgroups to move their mission forward. That kind of time commitment led some attending the September annual HTG industry stakeholder meeting to lament that the industry is not farther along. But the overall tone of the meeting was positive: the nature of the conversation has changed — with a higher level of collaboration among the stakeholders, including manufacturers and technology or solutions providers, and I would add sophistication as to the topics discussed. We may not be as far along as some would like, but there is intentional work underway to build the technological infrastructure and facilitate the change management process to get the most out of GS1 standards. In other words, this is not as easy as some may have first envisioned. That has raised awareness of the need for cross-stakeholder collaboration to realize value not only through greater efficiencies and transaction accuracy, but also better understanding of what products are being used in patient care and the corresponding impacts they have on both quality and cost.

HTG members are admirably very candid and conservative in how they are reporting their own level of usage of GTINs and GLNs in various aspects of the procure to pay process. There is a wide range in the percentage of transactions incorporating the standards among the HTG members, with some organizations focusing first on capturing product identifiers at the point of use with transactional usage planned for later. For GLNs, Mayo Clinic leads the pack, with 93 percent of its purchase orders (POs) including the location and organizational identifier.

Reporting data on use of GTINs gets a bit more complicated. Since formation of the HTG, the U.S. FDA published the UDI regulation, which requires manufacturers to assign a unique device identifier (UDI) to their products, to label their products with that UDI and to publish additional data about those products to the Global UDI Database (GUDID). As much as some members of the HTG would have preferred the FDA to mandate only a single issuing agency for UDI — GS1- the regulation allows for three: GS1, the Healthcare Industry Business Communications Council (HIBCC) and ICCBBA, the latter of which focuses on identification and tracking of products of human origin. But according to a survey conducted by HTG with manufacturers, more than 90 percent of device identifiers in the GUDID are GTINs. When reporting use of product identifiers in transactions, the HTG members report on use of UDIs in specific transaction sets. Intermountain Healthcare reports the highest usage, with UDIs used in nearly 50 percent of PO lines, more than 18 percent in the confirmations returned by suppliers, and around 5 percent usage in electronic invoices (810s) and price catalog updates (832s). Intermountain and others called on suppliers to let them know if they are ready and able to transact with GS1 standards.

The use of GS1 standards in contracting was a hot topic at the September meeting. HTG members said manufacturers often redline language in contracts that would require them to use GLNs and GTINs.  They contend that some of those manufacturers have the capability to use the standards but their legal or commercial teams may not realize it. The consensus is there is not broad understanding within manufacturing organizations about what they can and cannot support. The answer: more internal education.

The HTG members are also busy educating their own organizations. Mercy, for example, is integrating clinical specialty councils, made up primarily of surgeons, into the contracting process and educating them on the value of product identification, from more accurate clinical supply documentation at the point of use to comparative effectiveness research and cost-per-case analyses.

Point-of-use capture remains a challenge, with many of the HTG members reporting only a 30 to 40 percent scan success rate. When clinicians cannot find the right barcode to scan, or when the scan does not link to product data in systems, they are understandably frustrated and must enter the data manually. The root cause of scan failures is being investigated, and it could range from use of old GTIN formats to existing field inventory that does not yet bear UDI-compliant labels

HTG members also focused on data quality issues. One of the identified problems is a non-healthcare friendly approach to unit of measurement (UOM) in the GDSN, which has its origins in the retail industry. Data quality in the GUDID has also been identified as a concern and is being addressed by the Learning UDI Community (LUC), hosted by the Association for Healthcare Resource and Materials Management (AHRMM).

The barriers to adoption of GS1 standards are many, but the spirit of collaboration and desire to understand and eliminate the root causes of those barriers are greater. Those attending the meeting left with a renewed desire to work together to identify challenges, and to develop and test solutions. The presentations from the meeting will be posted at the HTG website (www.healthcaretransformationgroup.com).