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KSR Publishing, Inc.
Copyright © 2016
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         Clinical intelligence for supply chain leadership

 
 

INSIDE THE CURRENT ISSUE

March 2016

Special Focus

Where are those case studies, examples and icons to connect the dots?

Supply data standards not about chasing windmills

 
 

Where are those case studies, examples and icons to connect the dots?

Looking backward we can see a supply data standards movement that predated the first healthcare reform movement by a decade, outlasted the first healthcare reform movement under President Bill Clinton, skated through a healthcare information technology reform movement under President George W. Bush and currently endures through the second healthcare reform movement under President Barack Obama.

Historically, healthcare providers and suppliers alike have clamored for actual case studies and cost savings examples, and countless articles, educational sessions and promotional campaigns about adoption and implementation. Yet they haven’t inspired a mass movement to make supply data standards a key priority. Or have there not been enough?

What must providers, suppliers, software vendors, payers and government regulators do to move the needle? Here’s what nine experts and observers say.
 

"I haven’t seen any studies that tie all this together. We may have shown we’re more efficient in the supply chain, but isn’t that our job? Why would supply chain efficiency be something that changes the patient care environment? That seems a little backward.

"We need to start the discussion around the patient and the care process. Over the past few years we’re seeing more informed patients. We’re seeing more options for care other than going to an acute care hospital. And we’re seeing the cost of care, to the patient skyrocket. Yet, if I as a patient, ask for a detailed report of everything that was used and every person that was involved in my care, I can’t get that. I was on a cruise recently, where the cruise line was able to provide me with a comprehensive list of everything we did and what the cost was. We get the same when we exit a retail or grocery store. We receive regular recall notices for automobiles we own, because we can tack car parts from raw material through to the latest owner.

"In the end, patient awareness and safety will drive out the clinical variation, waste and redundant work processes we deal with each day. As provider leadership we need to ask, ‘if we’re focused on clinical variation, quality outcomes, patient safety, and actual cost per episode of care, how can we get there without data standards?’"

William Mosser, Vice President, Materials Management,
Franciscan Missionaries of Our Lady Health System

"First, I do not think we have robust, widely-applicable case studies and cost savings examples. Those would certainly help. However, I think that there are only two real external drivers: Regulation, meaning organizations must comply, or money, meaning organizations want to. Both could take a myriad of forms. Absent those, we will continue to spin. 

"The [return-on-investment] has been difficult to capture as we implement standards for safety first. Again, looking at the pharmaceutical example, the bar code was regulated to be marked on the product. However, the Bar Code Medication Administration (BCMA) is a standard of care in most every hospital without a requirement. 

"The case studies and examples have been from the same few IDNs. There are many supply chain professionals that are waiting for more real life scenarios instead of taking the lead by actually implementing. I believe you will see more adoption through this year as others determine they want to take the lead and assist others in blazing the trail. Education, articles and white papers will be necessary for many years as we progress through the curve."

Jay Crowley, Vice President, UDI Services and Solutions,
USDM Life Sciences

"In healthcare today, most radical change has been driven by changes to how [provider] systems get paid. Supporting the UDI information to be required on claims will take advantage of the historic ability and driver to initiate change and get the standards not only adopted, but used. As more costs shift to patients via higher out-of-pocket expense, they will realize more the value of having the information and will become a louder voice in the demand for better, trusted information."

Deborah Petretich Templeton, Chief, Care Support Services,
Geisinger Health System

"Interoperability is key. We must focus on interoperability in order to progress as an industry. Today, most providers have disparate IT systems that don’t talk to each other. Ultimately, those systems need to integrate with one another if we are to gather the data that we need to make the best possible business and patient-care decisions. Providers, suppliers, software vendors –everyone in the industry – can only make the best decisions when we have the data that allow us to connect the dots. If we don’t connect our systems, we can’t connect our data points. A lot of great minds in the technology industry are thinking about interoperability and how to future-proof it. I have no doubt that we can achieve interoperability across the healthcare industry."

David Reed, Vice President, Healthcare Business Solutions and Operations, and Corporate Compliance Officer,
Cook Medical

"The government plays a significant role to insure that future regulations keep requiring the healthcare industry to embrace data standards and to the UDI from an end-to-end perspective. The ONC EHR regulation is an example of that effort. We are watching the ‘21st Century Cures’ act to ensure that this regulation continues to drive the need for data standards. There needs to be a concerted effort across the healthcare industry to work together and resolve the issues that exist today and that need to be solved in order to make this supply chain continuum process work as intended. This is going to require manufacturers, distributors, GPOs, and hospital providers to work together. This is the primary focus of GS1 Healthcare US and the working groups. GS1 US has accepted the role of a collaborator/coordinator in order to make this collaboration happen. Every participant of this effort needs to see that this is going to be a win-win for everyone in the industry. This is the only way that the healthcare industry will take significant cost out of the supply chain and improve the overall patient safety which is through the adoptions of data standards. We believe that our projects will be instrumental in helping to drive change."

Greg Bylo, Vice President, Healthcare, GS1 US

"Each of these techniques is effectively driving us closer to overall adoption, but I don’t think a mass movement is a realistic expectation. UDI is a very difficult and costly endeavor in a tough healthcare economic environment. But eventually enough supplier organizations will adopt the standard. Distributors then payers, and eventually providers, will then migrate because first, suppliers will pressure or even require use of the standard to reap the rewards from their mandated adoption, and second, the cost of implementation will actually be outweighed by the benefits. Although UDI implementation has been slow, I am encouraged by the belief and stamina of those driving it."

Paul Helmering, Vice President of Information and Technology Solutions, ROi

"The healthcare providers that are already on their way to implementing data standards seem pleased with their progress and achievements. Other healthcare providers should see the value in following the lead of their peers and take advantage of the UDI investments that manufacturers have made. For those that do not, and are choosing not to voluntary adopt, then an implementation of mandates or regulations should be suggested. It may take some time to integrate but those that embrace and leverage the common standards will lead in the most effective management of their device supplies."

Dennis Black, Director, e-Business, Solutions Group,
U.S. Region, BD

Supply data standards not about chasing windmills

Adoption and implementation practical, not quixotic

by Rick Dana Barlow

Last year, Franciscan Missionaries of Our Lady Health System embarked on a quest that may have seemed quixotic to some.

FMOL’s Supply Chain team, under the leadership of William Mosser, Vice President, Materials Management, viewed the adoption and implementation of supply data standards as so paramount, serious and tantamount to clinical, financial and operational success and a necessary service for the patient that they decided to document their experiences.

Unwilling to wait any longer for the anticipated – and promised – wealth of meaningful case studies justifying the standards movement, finding a continual dearth instead, they chronicled their own.

For FMOL, chasing windmills morphed into showing how they work.

FMOL’s handy 58-page guide, “FMOLHS GS1 U.S. Data Standards Master Process Implementation Plan,” represents a comprehensive playbook, based on their own experience, for healthcare organizations to use to embark on their own quest. If anything, the guide serves to remove one more excuse to deny, procrastinate or shelve the decision until enforcement by government edict or payer reimbursement denials.

For FMOL, this decision was a no-brainer even though it required mental braun.

FMOL’s vision or end game focused on three major areas, according to Mosser. Addressing clinical variation, redesigning their financial model and implementing “Perfect Order with Data Standards,” the latter of which they used from Strategic Marketplace Initiative (SMI).

Healthcare Purchasing News asked Mosser to share his organization’s plan in his own words.

“In reverse order, the implementation of Perfect Order using Data Standards forces us to build a foundation to transition from a reactive supply management environment to a practice Supply Chain,” Mosser said. “We, in both the provider and supplier communities, spend an exorbitant amount of resources attempting to translate and maintain data within our systems with our own proprietary nomenclature and numbering systems. So for every supply item that already has a manufacturer part number, we assign our own numbering for supply management and a different number to charge the patient. In many cases, such as pharmaceuticals, we don’t even capture all of the data within our systems. Rather, we rely on wholesaler systems to maintain that data for use. We have the same level of effort in maintaining contract and pricing information. And since we don’t do a stellar job with either of these, we also have extra resources at the tail end trying to reconcile invoices for payment.

“The reality is that very little of the data we need to be efficient is created by the provider or distributor,” Mosser continued. “We take data from our suppliers and GPOs and re-enter it into our business and clinical systems, but we are adding little true value in that process. Other industries share their product and contract data and are able to track chain of custody from the manufacturing process through to the point of use. You’d think that since we’re handling life-supporting and life-sustaining products we would be able to do the same. So our goal here is to access manufacturer product and contract data directly from them, and utilize the data standards to ensure we’re identifying the items in an aligned and systematic manner. We call this our Virtual Item Master and Comprehensive Contract Database. They will contain every item, using the GTIN as the identifier, that we have contracted for, regardless of who negotiated the contract or if the item is a stock or non-stock item. Our expectation is that this Virtual Item Master will be shared interoperably with our clinical and revenue cycle systems as the source of truth for purchasing, inventory, patient charging, registry management and tracking purposes. All will use the common identifiers of GTIN and GLN as the interoperable links.

“Once we have this complete Virtual Item Master in place, we’ll be positioned to capture/track the location and use of any and all products in an episode of care,” Mosser said. “In other words, as we see in the retail environment, we want to capture, through bills-of-material, RFID or bar-code scanning technology, all that is used to care for our patients, and we want that data in our electronic health Record. With the ability to determine what products or drugs are used in every episode of care, using GTIN as the common link, we’ll be able to determine the actual supply cost per episode of care. And if we can do that for supplies, why not for labor involved in the care process? As this all comes together, and we’re able to determine actual cost for an episode of care, we see opportunity to shift the industry from a patient charge/revenue-driven model to an actual cost – or activity-based cost – model.

“Finally, capturing this level of detail per episode of care, we gain the information to share with our clinical leaders that can show variation of supply and drug use in each similar care process. So if we’re using a different supply, device or drug to care for our patients, it’s likely we have variation in process as well. By identifying this variation and linking it to key quality measures, we’ll be able to identify best clinical practice, while driving standardization where possible. With that level of detail, recalls or early warning communications can also be addressed. And decisions on new technology can be based on evidence gathered during the care process.

“Capturing data at this level in the care process, all linked interoperably with GTINs and GLNs, presents the industry with another opportunity to consider,” he said. “We’re all focused on linking data from a supply chain perspective that will feed into our individual clinical environments. There is current debate about the value of including this data in the claims Forms and revenue cycle processes. From my perspective as a patient, I see the day when there is an ability to link product or drug data to specific outcomes and long-term results, allowing a more informed patient population to better understand the cost and benefit of the various options they are presented by their providers. This is true evidence-based decision making. I don’t know how we’ll do any of this efficiently without data standards in place.”

Into the end zone

From the observers outside looking in, FMOL’s efforts establish a beacon for others to see and a playbook from which to drive their own efforts.

FMOL’s publication gained a ringing endorsement from BD, which actively participated in the project.

“This guide will help align practices in areas that are outside of the FDA’s UDI scope,” said Dennis Black, Director, BD’s e-Business, Solutions Group, U.S. Region. “BD had the opportunity to participate in this project and gain exposure to the playbook, which is an excellent plan for healthcare providers to follow. Bill Mosser, Sandi Michel, and their team have shared much information with their healthcare provider peers. This guide can reduce uncertainty and may help reduce the time and resources necessary for healthcare providers to implement UDI and data standards.”

David Reed, Vice President, Vice President, Healthcare Business Solutions and Operations, and Corporate Compliance Officer, Cook Medical, praised FMOL’s efforts and achievement.

“FMOL realized that there was no playbook for implementing data standards,” Reed said. “They wanted to create a tool for healthcare professionals who want to implement data standards but don’t know how to do it. This playbook will help them bridge the gap between the conceptual goals and the executable steps for achieving those goals. It will tell them which steps to assign to which roles in their organization and which milestones to hit along the way. We know what we need to do in principle to implement data standards, but now organizations can follow the steps that FMOLHS took to execute an implementation plan successfully.”

Deborah Petretich Templeton, Chief, Care Support Services, Geisinger Health System, expressed appreciation for what FMOL accomplished for itself and the industry at large, too.

“The value of the FMOL guide, or the countless other guides, papers and  workgroups that are out there will be driven by supply chains that actually use the information to get their own systems up and running in the deployment of standards,” Templeton said. “Adoption of the standards into operating process takes work. Waiting for someone to come along and make it easy will not happen. However, taking the adoption bit by bit and piece by piece, fitting it in to your current structure, or recognizing things that need to be put in strategic plans for necessary future change will drive the value of work being published by others today. The ultimate attestation of the value will be to our patients who will not have to wonder what implant they have, what recalls might be associated with it, how the implant is performing and carrying valuable information about the implant on a paper card that can be lost, misplaced, etc.” 

Paul Helmering, Vice President of Information and Technology Solutions, Resource Optimization & Innovation, similarly was effusive.

“[FMOL] has demonstrated their commitment to the UDI standard, run and documented a complicated project, which included a wide range of participants, under the leadership of Sandi Michel and Bill Mosser, and shown their generosity by making this playbook available to all,” Helmering said. “With the playbook, organizations can more easily understand what it takes to implement the standard. They can create a more accurate cost-benefit analysis for evaluation, and control project costs during the implementation.”

Greg Bylo, Vice President, Healthcare, GS1 US, certainly understands the motivation behind creating the guide as well as receiving it.

“Many organizations do not have the resources and time to develop a methodology required to implement a data standards program,” he said. “What FMOL has done is create a template that they are willing to share with anyone who would like to use this as a starting point for their organization. GS1 US has two additional projects we are executing in 2016 to build similar frameworks, one for master data and the other for non-sterile orthopedic implants. The master data project will focus on understanding the flow of item level data across various entities in the supply chain. The non-sterile implants project will focus on understanding business and clinical requirements for scanning item level data into EHR systems and creating standards to support those business requirements.”

C-suite sweetness?

While FMOL’s efforts may play well enough in the supply chain trenches, how well might it resonate in the C-suite so that senior-level executives make supply data standards adoption and implementation a key priority? Or should it?

“The challenge with the C-Suite is showing them a return on investment estimate that could be realized as a result of approving and executing the data standards project,” Bylo said. “It is not that hospital providers don’t want to do the project. Instead it is that they have many projects that are competing for the same resources and money. Most organizations have a portfolio management process which ranks project by return-on-investment. If the data standards project does not show a high-enough ROI, it won’t be approved. There is a need to develop an ROI estimate and framework which can be used to convince the C-suite of the merit of the project.”

Mosser placed C-suite concerns into what he feels is the proper perspective for Supply Chain leaders.

“Regarding C-Suite recognition, we need to stop thinking of data standards as a ‘supply chain’ thing,” he said. “In the overall scheme of things, the supply chain is here to support the clinical care process. We’re support…not drivers. With that in mind, we’re identifying data standards as a foundational piece to address those other priorities, such as EHRs, Meaningful Use, patient safety and reimbursement. Frankly, without using data standards, and interoperable data sharing, the manual record-keeping required to optimize EHRs and Meaningful Use and align these with reimbursement and patient safety initiatives is cost prohibitive. We need to reduce costs, not add to them. If we can demonstrate our journey and its impact on the total cost of care, we believe that will be a powerful outcome that others will pursue.”

Mosser remained magnanimous about his organization’s playbook.

“Our hope is that by sharing our journey, including our failures and successes, our cohorts will gain a better understanding of the need to move in this direction and the resources required to get there,” he told HPN. “The more providers we have involved, the stronger our voice becomes to change the industry. This isn’t easy and it is taking considerable time. We know we aren’t perfect and we are learning new things every step along the way. But over the years, we’ve learned so much from our provider peers and supplier community that has saved us time and effort. We think returning the favor is the right thing to do.”