For the better part of two decades this century, forward-thinking executives from providers, suppliers and supply data standards service companies have preached the gospel of adopting and implementing supply data standards either incrementally for selected product lines or service lines or in full within healthcare organizations.
These spirited evangelists for such familiar (and they should be by now) acronyms as GLN, GTIN, GDSN, GUDID and UDI have shared the good news on how adopting and implementing supply data standards can help with product tracking and traceability, increased accuracy, inventory visibility and waste reduction, among other benefits. Indeed, all of these justifications have been shown in studies and in practice to generate decreased process and product costs and enable more time for clinicians to devote to patients.
Even so, Healthcare Purchasing News has tracked provider and supplier adoption and implementation progress via reader surveys and reporting for at least the last decade with mixed results.
Based on survey data from varying respondent pools, several trends consistently have emerged. Roughly a third of respondents either have implemented supply data standards in part or in full, another fifth are “looking into it or planning to within 12 months,” another third haven’t or won’t and the remainder simply “don’t know.” Of those who haven’t or won’t, the top two reasons continue to be that it takes too much effort or work or they don’t have enough budget or resources for it, particularly if the majority of providers and suppliers already aren’t doing it and the government isn’t requiring it with penalties for non-compliance.
Now with the world being whipsawed by the COVID-19 pandemic, can or should providers and suppliers use that as yet another convenient excuse to claim something else has higher priority than supply data standards?
Following a pregnant pause, the logical answer by numerous sources to HPN is “nope.”
Imagine how the active use of supply data standards could help locate the products necessary for protection from, identification of and treatment for COVID-19?
Nearly a dozen supply chain leaders and professionals with whom HPN spoke see enough value in adopting and implementing supply data standards for all the right reasons … or at least make it a higher priority, even now in a pandemic-rattled and riddled world.
V-decrypt
Amid the more obvious industry deficiency in terms of product shortages the use of standards can spark visibility – as in what’s seen right away – followed by tracking and traceability, even though some might interchange the two.
Thad Mac Krell, CEO, PAR Excellence, counts inventory visibility as probably the most important benefit of supply data standards “because it relates directly to consumption and patient care” – justified against the backdrop of the COVID-19 pandemic.
“Post COVID-19, this obviously takes on new meaning and urgency,” Mac Krell told HPN. “Our industry has dealt with recalls and counterfeit products in the past ([involving] product tracking, tracing and accuracy) and while messy, sometimes slow and often embarrassing, we can collectively get the job done. The recent large-scale recall of packs is a reasonable example. But this pandemic has created a new long pole in the tent – availability.
“The goal of these standards should be end to end inventory management to ensure availability,” Mac Krell continued. “If we can create a framework that ensures end-to-end visibility, from the nurse’s outstretched arm back to the manufacturing plant, we can simultaneously address accuracy, traceability, authenticity, etc., using enabling technology like Blockchain, etc.”
Mac Krell likens the concept to the framework of “a staircase wherein any participant can see at least one-to-two steps up and down from their position with nearly real-time updates.” PAR Excellence historically has focused almost exclusively on the last two steps before patient care is delivered, he noted, which tends to be the storeroom and bin/shelf at the point of use.
“We can access, in real time from our offices in Cincinnati, the status of more than one million PAR scales in hundreds of hospitals,” he said. “We can see what item is on the scale, how many there are and even predict when replenishment will be needed.” He further added that they’ve even integrated Amazon’s Alexa into the weight-based technology so that the caregiver can ask questions of the PAR system, such as “Where is the nearest location with more of product XYZ?”
Mac Krell laments that without data standards, “we are left to map products across customers to enable our inter-client analytics platform. COVID-19 has taught us that such details are needed in and between hospitals, distributors and manufacturers, especially for some critical but relatively inexpensive items like PPE.”
As concerns about the COVID-19 pandemic heightened, inventory visibility – or the lack thereof – has been at the root of supply confusion, product shortages and allocation issues that we have seen in healthcare, according to Siobhan O’Bara, Senior Vice President, Community Engagement, GS1 US.
“In some cases, the products existed, but their whereabouts were uncertain,” O’Bara observed. “Not knowing how many N95 masks, PPE gowns, or ventilators are in inventory – or where they are – quickly became a crisis affecting the entire country. Providers scrambled to locate the supplies they needed. Discrepancies came to light. The release of government stockpile and warehoused equipment was backlogged by a dearth of information about where they were needed most. In many cases, the lack of shareable information about products in the inventories of suppliers, distributors and provider facilities just exacerbated the impact of shortages caused by unanticipated demand.”
Still, tracking and traceability, as well as accuracy, remain key benefits of inventory visibility, she insisted.
“It is critical for providers to know not only where medical devices are, but also whether they are interchangeable with supplies needed elsewhere,” she indicated. “Understanding device interoperability relies on robust attribute information that can be captured in the master data maintained by health systems.”
O’Bara cites a ventilator as a prime example. A ventilator made for use in the U.S. is configured to work at 110 volts, but that same machine could not be used in Europe where the standard is 220 volts. The voltage configuration is just one of the attributes that should be associated with the product’s GTIN in the hospital’s master database, along with other pertinent details, she added.
“Full inventory visibility with complete and accurate data also allows providers to plan for procurement, maintenance and replenishment,” she said.
“When the virus hit, hospitals found they were unable to track how much inventory they had, where it was located, when they would run out, and who was using it,” Freund said. “Having data standards that emphasize supply chain visibility would make it easier not only to answer these questions for a single hospital, but it would make it easier for an entire health system or government agency to access current inventory data on a city, state and regional basis.”
The model extends beyond what happens inside of a facility to what happens between facilities, too.
“Standards are big internally but they are equally important externally,” Freund acknowledged. “I think hospitals can work with their current distributors and manufacturers today just fine as there are data standards in place for that level of communication. Standards become much more important when trying to communicate externally beyond your current integrated supply chain. When and if another pandemic hits, the entire healthcare supply chain needs to be able to communicate using the same ‘language,’ or in this case, data standards. If I am in need of N95 masks and want to see what is available around me either from a distributor, manufacturer, other hospital or government agency, we all need to be calling an N95 mask the same thing. So if I could look up a single item number that indicated that this was an N95 mask, it would make it very easy for me to have visibility into all N95 masks in my hospital, IDN, city, state, region or country.”
Inventory Optimization Solutions’ (IOS) Vice President Business Development, Jeff Lawrence, concurs that visibility within a single facility or across a nationwide enterprise should be the ultimate goal.
“Data standards can act as the Rosetta Stone to inventory management, helping achieve new levels of accuracy that aren’t based on inconsistent product descriptions or an inventory clerk’s recall,” Lawrence said. “Why is this important? You’ll always know how much [and] what you have where, and combined with better insight to usage, you’ll improve management of on-hand inventory, which is how we can reset supply levels, reduce spend, eliminate waste, and most importantly, improve cash flow.”
“One of the most important benefits of standards is that it enables multiple parties to speak the same language, or in other words – as I like to say in highly technical language – to call the same thing, the same thing, regardless of what we are doing with the thing,” she said. “This, in turn, helps functions and organizations across the healthcare ecosystem to share, analyze and act upon the data for multiple purposes, including but not limited to inventory management, product tracking and tracing, waste reduction and visibility into how products are performing in routine clinical practice.”
Connecting the dots
“Standardization allows for data to be defined, categorized, connected and interpreted more easily. By adopting standards, the entire internal and external supply chain will be communicating the same way, and this will allow for a consistent identification and cross collaboration across all industries involved in the support and delivery of healthcare in a timely and efficient manner, Amell said.
These efforts migrate to reimbursement as well with financial implications, according to Jean Sargent, Principal, Sargent Healthcare Strategies, a veteran supply chain leader and healthcare supply data standards evangelist.
“CMS is working to update the billing form to capture the UDI,” Sargent indicated. “This information will be included in the Merit-Based Incentive Payment System (MIPS). When this information is not included the reimbursement will be effected. The better argument is for recall, evidence-based outcomes [and] registries. If a patient has a total hip [procedure] in California, is now traveling to Florida and has an issue, the physician must know what type, brand etc. of the current implant. Until then, there is a delay in surgery, which may have an impact on the patient’s health. If the UDI is in the American Joint Registry by UDI, the time to surgery is lessened by up to days.”
From a surgical theater standpoint, accuracy is paramount with tentacles extending into tracking and traceability, visibility and waste reduction, urges Trent Pierce, Clinical Advisor, Kermit software, PA & Associates Healthcare.
Ken Cyr, Senior Director, Supply Chain Consulting, CSI Specialty Group, an Intalere subsidiary, agrees that standards are vital for accuracy but that accuracy is necessary for standards with system integration being essential.
“One of the biggest barriers to the final evolution of the healthcare supply chain is the lack of seamless integration in healthcare informatics, Cyr said. “In most cases clinical departments have implemented the suite of clinical systems provided through the larger clinical Electronic Health Record (EHR) platform. The supply chain organization (SCO) on the other hand has implemented one of a handful of Materials Management Information System (MMIS) providers. The ‘integration’ of these systems through various interfaces is mandatory to unlock the core benefits of a clinically driven supply chain.”
This stems from a unified item master shared between each system that “requires establishment of hospital-wide item/data naming and product category standards that are clinically accurate and meet both supply chain and clinical needs” as shared between Supply Chain and Perioperative Services, he noted. All of this data can be incorporated into the clinical information system, including for scheduling, preference cards/pick tickets and online charting and patient charging of supply items.
All told, data standards are created to ensure accurate operational budgeting, spending and cost analysis, and to ensure synchronization of items across perioperative, financial and supply chain systems, he added.
Nudging the standards needle forward
by Rick Dana Barlow
Short of government edict requiring healthcare organizations within the provider and supplier communities to adopt, implement and use supply data standards for all products, little has motivated behavior change and demand quickly or even deeply within an organization – be that by product or service line.
If anything, the onset of the COVID-19 novel coronavirus starting as an epidemic before fully developing as a global pandemic sheds light on the absence of standards as well as the inherent need for them to locate, track and trace product availability for patient care. If there ever were an incentive to “standard up,” besides regulatory requirements and ties to reimbursement, it’s a pandemic sequestering millions and infecting many others.
So what’s it finally going to take for healthcare providers and suppliers to embrace supply data standards? What’s one process or product improvement that can facilitate a commitment to data standardization? Ten healthcare supply chain leaders and professionals share their impressions.
Siobhan O’Bara, GS1 US
“Providers need modern, integrated and well-maintained data systems built on a foundation of standards that can associate all clinical information, billing, operational procedures and inventory. Hospitals simply can’t optimize their operations without a good system for gathering and sharing key data, which they can use to develop informed analysis and insights.
“Pharmaceutical and medical device suppliers are adopting standards to meet regulatory requirements of the FDA’s Drug Supply Chain Security Act (DSCSA) and Unique Device Identifier (UDI) Rule. They are required to mark products with GTINs and other specified data elements embedded in 2-D barcodes. There is a different set of requirements for healthcare providers to capture that information, and those who are already implementing standards to achieve this have an opportunity to use the data captures to gain insights for improved efficiency, accuracy, inventory control, cost savings, and patient safety. Hospitals that have already incorporated standards and barcode scanning to track products within their own supply chains and facilities have reaped impressive advantages.
“For example, the Veterans Affairs (VA) Medical Center in Miami is now scanning barcodes on medical devices as they are received, pulled from inventory, and used in patient care. The data is also scanned into the patient’s electronic health record (EHR). Scanning device barcodes enables the Miami VA hospital to improve efficiency, productivity and inventory management since it can now easily and accurately keep track of medical devices. Most important, patient safety has improved since scanning barcodes helps to eliminate human errors in manual data entry.
“Franciscan Missionaries of Our Lady Health System (FMOLHS), a non-profit healthcare system in Louisiana, is also implementing GS1 Standards to manage and control product inventory and location information. Using standards enables FMOLHS to share more accurate and complete product data internally and with suppliers to ensure that the right products are delivered when and where they are needed. In operating rooms, nurses scan barcodes as products are used to populate the patient’s electronic health record (EHR) and other internal management systems. When a product is needed, it can be precisely located using the GTINs and GLNs and pulled from inventory within minutes.
“These examples demonstrate that standardization is most successful when it is prioritized and advocated at the executive level within organizations across the entire supply chain. The challenges of cost, technology, resources and workflow are real, but the ultimate benefits are crucial to the delivery of quality healthcare every day – and even more so in a crisis. It takes commitment to work through the challenges, make the investment and allocate the necessary resources. With executive dedication to the goal, it can be accomplished over time – the sooner the better. Providers can access guidance to help map out the processes required to implement the right standards throughout their operations and realize the greatest benefits in terms of operations and most importantly, patient safety – and preparedness to provide it.
“The pandemic has demonstrated the importance of agile supply chains and coordinated information sharing between healthcare suppliers and providers. There can be no more question about its significance in the industry’s management of assets and supplies to care for patients where and when the need arises.”
Melissa Amell, Infor
“I would incentivize all healthcare organizations, manufacturers and distributors to comply with a defined standard and assign a start date. Due to many organizations having conflicting priorities and constrained resources both fiscal and staff, their data management strategy in Supply Chain is not a primary area of focus. It needs to be defined and treated as a critical national goal for all organizations involved in the healthcare delivery network.”
Thad Mac Krell, PAR Excellence
“Adopting data standards in our industry has historically been like pushing a string – lots of activity but not much progress. To drive rapid and sustained adoption of product data standards the one change that merits consideration is tying compliance to Joint Commission accreditation. Joint Commission accreditation has in the past proven to drive adoption of electronic medical records, quality standards, etc. Recent industry reports by Joint Commission highlight the potential for supply chain savings through the better use of analytics, which in part presumes the widespread adoption of data standards.
“Under one scenario for such a scheme, Joint Commission examiners would review a hospital’s MMIS as matched against a database of compliant suppliers and products. Use of location and position labeling standards could be inspected by the examiner. A low standards score would impact the hospital’s accreditation report. Using the cudgel of accreditation shifts the motivation to adopt standards from the manufacturers, where the direct benefit is low, to the providers, where the benefit is high and makes the penalties tangible. In all likelihood, this mechanism would only need to be in place for one-to-three accreditation cycles before standards adoption was widely adopted and irreversible.”
Karen Conway, GHX
“I believe an important step toward the adoption and implementation of supply data standards would be to bring together representatives of the various functions that would benefit from their use to also understand how the other parties are using or could use the standards. Too often, the standards are viewed solely by one function, such as supply chain or regulation, without a full appreciation for the needs of other functions. As a result, well-intended efforts to optimize the rules around the use of the standards for one purpose often have unintended consequences for another use. This then creates barriers to broader adoption of the standards.
“As we seek to understand how products can improve our ability to deliver better quality care at a more affordable cost, we need to look at products holistically from a variety of perspectives – clinical, financial, operational, regulatory, etc. That can’t be done without broad use of the standards by multiple parties and functions.”
Trent Pierce, PA & Associates Healthcare
“If it were up to me, this first thing that I would implement toward adopting and implementing supply data standards would be the creation of, and enforcement of, a universal symbology on the package of every medical device indicating the bar code on the package that contains the UDI-DI/UDI-PI. Many packages contain multiple scannable bar codes on the package, with the end users not knowing which one contains UDI.”
Carl Gomberg, Premier Inc.
“We must operationalize the use of standards within our healthcare IT systems. In the United Kingdom, National Health Service efforts to utilize global trade item numbers (GTINs) in their product recall process reduced recall time from eight hours to around a half hour. However, enterprise resource planning solutions (ERPs) and EHRs in the U.S. have not gone far beyond having fields in which to store the identifiers.
“This has created hurdles that prevent true adoption and discourage those who look into utilizing unique identifiers only to discover that the systems are not mature enough to make adoption worthwhile. Many ERPs also still have separate fields for GTIN and health industry bar code (HIBC), which confuses users who are looking for a single “UDI” field in which to load their identifiers.
“Overarchingly, unique identifiers should go beyond the status of ‘attribute’ and be used by ERPs in every aspect of the procure-to-pay process, including all related reporting. Furthermore, EHRs that currently store UDI for implants should be expanded to facilitate bedside scanning to prevent the use of recalled product. Production information scanned at the point of receiving could be used to better manage inventory, preventing loss due to product expiration and significantly improving the recall process.
“All of this is dependent on interoperability – a robust application programming interface (API) must be developed that will allow fast and thorough transfer of UDI information across all health IT systems. Once we have matured the utility of supply data standards within our IT systems, the value of standards will be plainly evident and vastly more compelling.”
John Freund, Jump Technologies Inc.
“Make GTIN or UDI data readily available and free of charge so that every ERP and EMR can easily import the data into their system. GTIN and UDI has been around for a long time, but the cost to implement and maintain it, and the amount of effort required to populate systems with GTIN or UDI data has limited the adoption of this standard.
“There are many companies trying to do this, including Prodigo, GHX and others. There is a cost component to it today because it is so hard to do and the cost to produce this data today is very high. Because the standards don’t exist, third-party companies have to create their own and implement them within solutions that they sell. I’m not necessarily talking about creating a national item master where we are standardizing on descriptions and the like – rather a way to be able to quickly identify critical materials so we can manage that supply chain to save lives.”
Jean Sargent, Sargent Healthcare Strategies
“Utilizing UDI data in supply chain item masters, clinical systems and payer systems is a part of the daily routine. Cross the bridge into a land where patient health records contain all of the vital information needed. One day it will be you that wants this information.”
Carl Henshaw, Vizient Inc.
“Mandatory FDA fields that are part of the UDI requirement [should] match the same level of information needed to transact. For example, at this time there is no FDA requirement surrounding unit of measurement, catalog number, or even product description. Roughly 40 percent of all items within the GUDID database are missing one or multiples of these key identifiers, which means that the data cannot be utilized to reap the benefits of data standards.
“For context, the FDA has established a unique device identification (UDI) system to adequately identify medical devices through their distribution and use. A UDI is composed of two parts, a device identifier (DI), which is based on global standards, and production identifiers (PI), which may include the lot number, serial number, expiration date, etc. The FDA required that all Class III devices licensed under the Public Health Service Act have UDI by 2014, all implantable, life-supporting and life-sustaining Class II devices to be compliant 2015, all other Class II devices by 2016, and lastly Class I and unclassified devices by Sept. 24, 2020. When fully implemented, the label of most devices includes a UDI in human- and machine-readable form.
“The structure of the FDA GUDID database, and the elements/item attributes contained within, is a comprehensive framework that could house a tremendous amount of useful information. Hospitals need to be able to match supplier data with their item masters, which feed many day-to-day critical functions, including purchase orders, inventory control and operations services for multiple hospital services.
“The FDA requirement of entering UDI in the patient EHR is a good end-point, but to truly reap the benefits of having a standard, supply chain professionals should be transacting with the UDI. Otherwise they are only able to manage product recalls and backend efficacy.”
Jeff Lawrence, Inventory Optimization Solutions (IOS)
“Our healthcare supply chain needs better visibility of products from the manufacturer to the distributor to the hospital, surgery center, urgent care center, PAR area and even to the last supply cabinet. Adopting universal product codes (such as GTIN) would give a much needed push through disconnects we see today. With the entire supply chain selecting, adopting and consistently using a system of universal product codes, we’d enable complete, end-to-end supply chain visibility.”
Satisfying the COVID-19 effect
How to make standards standard in a pandemic world
by Rick Dana Barlow
When the novel coronavirus COVID-19 emerged last December as an epidemic in China that quickly blossomed into a pandemic around the world, demand for a variety of products necessary to protect oneself from exposure soared to the apex of disrupting the global supply chain.
Could the adoption, implementation and ongoing use of supply data standards and integrated databases have made a difference? Supply chain leaders and professionals offer a cautiously optimistic yes with something of an escape clause. While supply data standards likely would have facilitated the location of much-needed product already in storage, in transit or even in various stages of production, it would have done little to factor in consumer demand spikes without more complex forecasting algorithms in place for planning.
Looking back as healthcare organizations and the world continues to slog through COVID-19’s wake, 11 supply chain experts share their initial lessons learned in battling a pandemic that many clinicians believe is far from over.
Running lean can upset routine
“Although data standards would have helped to identify functional equivalents and potential availability of products more easily, the supply shortages created by this world-wide pandemic and the enormity of the situation was too much for any supply chain to handle. Many hospitals run very lean by keeping minimum stock on hand for disposable products and do not have the capital funds to maintain extra idle equipment. This, coupled by the fact that many of the needed products are manufactured overseas and healthcare organizations have been on allocation for many PPE products since late last year, contributed to the overall strain on the delivery network. I suspect when healthcare organizations and industry are able to look back at areas of improvement and develop lessons learned, there will be further discussion around product sourcing and production, dependency-manufacturer/distributor relationships, pandemic/emergency planning, and government affairs on the local, state and federal level.”
– Melissa Amell, Infor
Vast visibility and extensive consumption/demand tracking
“With consistent, widely-adopted data standards in place, our entire healthcare ecosystem can alleviate some of the supply shortages experienced during the COVID-19 pandemic. How do supply data standards actually change the game? We’d be building visibility to every location where supplies exist within the supply chain. Manufacturers and distributors would know precisely what they have available in current inventories. Provider organizations would be able to look across their entire network of facilities – any types of facilities – and see what they have on-hand that they can transfer to locations experiencing the greatest need. Standalone organizations would know what was in each and every supply location in their facility. I’d build on this thought by adding that understanding consumption, and tracking usage over time, is a huge contributor to understanding what we’ll need in the future, especially as we build our data set to incorporate our experience with COVID-19. This deeper knowledge would also be extremely valuable to the supplier community trying to forecast demand. Knowing what will be needed enables a much more efficient operation that benefits all supply chain participants.”
– Jeff Lawrence, Inventory Optimization Solutions (IOS)
Sourcing alternative caches
“I don’t believe standards could have prevented the shortages we have experienced as a result of COVID-19 as there were multiple contributors to the crisis, e.g., simultaneous increases in demand and reductions in production and logistics capacity, coupled with broad adoption of lean manufacturing and inventory practices. I do believe standards could have facilitated the heroic efforts taken by supply chain leaders to find alternative sources of critical products needed to support both healthcare workers and patients.
“As hospitals quickly realized they would not be able to source enough of the products they usually buy from their traditional suppliers, they began to look for the same product from different vendors and/or similar products from different vendors or manufacturers. The combination of a standard identifier, such as the UDI device identifier, in association with a classification schema, such as the Global Medical Device Nomenclature, can facilitate building out lists of products and suppliers within specific essential supply categories. It’s worth noting the value of standardizing those lists versus having each organization create their own. The World Health Organization (WHO) develops such lists to support a variety of disease states and is building out a classification schema that can be made available at no charge. GHX leveraged the WHO list, as well as work by the Centers for Disease Control and Prevention and McKinsey, and our product content databases to create complimentary reference lists that we continue to expand as the [virus] progresses and the use of both supplies and pharmaceuticals has increased and evolved. You can access the lists at https://www.ghx.com/covid-19/updates/managing-critical-supply-shortages/.
“Unique device identifiers, if adopted globally in a harmonized fashion, could also help source products certified for use in other countries. For example, as critical supplies, such as N95 respirators, experienced significant shortages, the FDA gave permission for hospitals to source comparable products that had received marketing authorization from regulatory authorities in Europe, Canada, Australia, Brazil, Japan, Mexico and China. If these countries were to establish publicly accessible databases like the FDA’s Global UDI Database (GUDID), providers and others around the world could easily access more information about these authorized products from other markets.
“The COVID-19 supply shortages have also raised interest in the value of mapping upstream supply risk to understand where products are produced. In this way, buying organizations can identify if a manufacturer only produces products in limited locations, which raises risk of shortages if something happens to that supply source. This process could be enhanced through use of both product identifiers, such as Global Trade Item Numbers (GTINs), and location identifiers, such as Global Location Numbers, to map risk.”
– Karen Conway, GHX
Building a pandemic-motivated product database
“Knowing where critical supplies are at any given moment would certainly help! By entering GTINs and GLNs into a hospital’s master data systems, hospitals could gain visibility into their inventories that could alleviate some of the confusion that arose in the U.S. during the COVID crisis. Hospitals should also be building a database that lists the GTINs for every product they buy, along with GTINs for a hierarchy of clinical equivalents and substitutions. This information would enable the provider to quickly source needed products from secondary suppliers if their primary suppliers are unable to meet their need so that patient care is given the highest priority.
“The ability to share and trust reliable data can improve communication between providers and suppliers, facilitating better collaboration to support their mutual commitment to patient safety. The data systems need to be robust enough to dynamically manage an ever-changing inventory and make informed decisions about how to deploy it. Full inventory visibility at the provider level, along with standardized data sharing, enables communication with suppliers so they can plan production and execute against demand.”
– Siobhan O’Bara, GS1 US
Follow pharma’s lead
“The Drug Supply Chain Security Act has requirements that outline the process needed to safely track prescription drugs from manufacturing to dispenser, and there is work being done to develop the messaging standards for a distributed ledger, but the same approach hasn’t been taken for medical products. Adding the country of origin as a requirement to the UDI would increase visibility of potential weaknesses in the supply chain and allow providers to know what supply pipelines could be at risk as a result of geographic disruption. Vizient has recently partnered with OneNetwork to create a resiliency solution that would address this exact issue.
“In addition, the World Health Organization (WHO) has released a set of categories of products needed to diagnose or treat COVID-19 patients. The United Nations Standard Products and Services Code categorization is prevalent in the healthcare Industry and these can be mapped to these WHO categories. Providers and suppliers could then track products used in these categories to match supply and demand across the country.”
– Carl Henshaw, Vizient Inc.
Missing links unnecessary
“There are technology applications that can read, parse and even track the physical location of scanned medical devices that are within AccessGudID. Considering that most, if not all, supplies being used within the COVID-19 battle are medical devices, equipment or supplies, all of these devices should be within GudID. Having insight to the quantities and locations of the necessary medical supplies would provide greater and more real-time visibility where the available COVID-19 supplies could be sourced from.”
– Trent Pierce, Clinical Advisor, PA & Associates Healthcare
Accuracy needed to thwart expiry
“Hearing that much of the national stock pile had expired product, use of UDI would have allowed for better tracking, specifically when the expiration date is captured in supply systems. Items are not easily trackable today [because] the catalog number is used, which is modified by the end user. Use of the UDI is THE number that would solve that issue. The use of protective attire may be tracked to an employee acquiring an infection due to lack of protection. There is no way to track that in today’s time when we are purchasing whatever product we can get our hands on to attempt to protect the employees.”
– Jean Sargent, Sargent Healthcare Strategies
Keeping out the counterfeits
“The use of standards, combined with track and trace and claims reporting, can provide much greater transparency and management of the healthcare supply chain, including strategies that could be helpful in managing supply demand around COVID-19. On their own, standards reduce ordering errors and allow for improved inventory management. Providers can better track expiration and lot/serial numbers to manage a local stockpile of PPE that can be effectively used and replenished during the course of normal business. Track and trace would allow suppliers, distributors and providers to prevent the introduction of counterfeit product into the supply chain – something which we’re now starting to see in news reports around COVD-19. Finally, including UDI in claims reports to CMS will allow government agencies and health IT companies to better gauge inventory requirements per patient case per day and direct precise levels of surplus PPE to areas with increasing need.”
– Carl Gomberg, Premier Inc.
Taking stock of tracking stock
“Like all hospitals in heavily hit areas, many of our customers were caught off-guard when the PPE shortages hit. The good news was that our JumpStock platform allowed them to see where PPE inventory existed within the hospital because it tracks inventory from the loading dock to the patient. One of many major challenges hospitals faced was keeping track of numerous new supply sources in the ERP system – from donated government inventory to community donations. This posed challenges when tracking inventory. The JumpStock system allowed hospitals to easily create new supply sources for these materials that weren’t tied to invoices. Customers were able to set up single supply sources for donated materials and track them in the same way as items they purchase. They used the increment and decrement audits available on the platform to match invoices coming in from disparate vendors.
“We have had over 50 hospitals and healthcare systems respond to our offer to help manage their PPE in JumpStock for free. In all cases, these hospitals had visibility of their inventory in their warehouse, but had no idea what happened to inventory once it left the warehouse. They couldn’t identify hoarding or shrinkage, they didn’t know where anything was. In their words, ‘Materials come into the dock and leave 10 minutes later. To where we don’t know.’ It is obvious that hospitals will very soon need to enhance their workflows and visualization in order to manage critical inventory in the next pandemic.”
– John Freund, Jump Technologies Inc.
Armed with access to more information
“Not only are data standards essential to the operational financial and clinical efficacy of the [supply chain organization], they provide critical information to track utilization, substitutions, inventory requirements and logistic parameters. Armed with this information, the healthcare supply chain could have approached the pandemic proactively instead of merely reacting to events that have already occurred.”
– Ken Cyr, CSI Specialty Group
Standards lead to visibility
“In and of [itself], adopting product/location numbering conventions would probably have had a modest impact on supply management during COVID-19. However, standards, once adopted, coupled with visibility, once enabled, will fundamentally change the market relationships between buyers and sellers. The most dramatic will eventually be “Inventory-as-a-Service” (IAAS) in which [third-party logistics] (3PL) service providers – often as an extension of the primary distributor – facilitate inventory management and stock optimization across an IDN for a service fee. A distributor service provider who retains ownership of the product until consumption could even extend their control/reach across different IDNs, optimizing stock of an entire geography. Having product identification and location standards along with inventory level visibility to a third party tasked with optimization would have had a profoundly positive impact on the management of PPE in hard-hit markets like New York City and Detroit. This outsourcing model is well-established in healthcare for both clinical and non-clinical services. Likewise, distributor inventory management as a service is more the norm in many markets like grocery, electronics, etc.
“It will be interesting to see if the experience of COVID-19 is in the end a sufficient motivator for our industry to adopt standards. If so, it is likely that the innovation and service model opportunities such standards would enable will naturally and quickly follow and benefit all.”
– Thad Mac Krell, PAR Excellence
Rick Dana Barlow | Senior Editor
Rick Dana Barlow is Senior Editor for Healthcare Purchasing News, an Endeavor Business Media publication. He can be reached at [email protected].
