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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership


July 2011

People & Opinions

Worth Repeating

"Surgical-site infection in joint arthroplasty, especially in knee and hip procedures, is a concern. Among patients who have had knee or hip surgery, 1% to 2% go on to develop a postoperative infection. These infections have been found to increase treatment costs by $35,000 to $90,000 per patient in the U.S."

Kevin Leach, director, marketing, wound therapeutics, ConvaTec

"It’s estimated that healthcare workers in the non-hospital settings account for about 60 percent of the healthcare workforce today. And while we’ve seen significant adoption of safety engineered devices in the hospitals, we’ve seen a lack of adoption of safety engineered devices in non-hospital settings. As professionals are moving from hospitals to non-hospital settings, they’re moving into a riskier environment in terms of the potential for needlestick injuries."

Elizabeth Woody, public policy and
government relations office, BD

"The focus on preventing healthcare-acquired infections has increased the awareness of healthcare facilities to incorporate best practices in terminal sterilization and high-level disinfection throughout the organization."

Barbara Trattler, RN, MPA, CNOR, CNA, director of clinical education, Advanced Sterilization Products (ASP)

"When a hospital understands how much, how often, and the cost of bringing in a particular product, they can then make an intelligent decision if the product should be ordered in different quantities or brought into the organization via a different channel. Analytics is key in doing the right thing."

Carl "CJ" Joyner, CEO, TRIOSE Inc.

"Utilize supply chain dashboards to give your C-Suite real-time visibility into your supply chain activities, value analysis projects, savings targets, savings to date, etc., so they can feel an integral part of your supply chain team. Naturally, you would want to ask for their thoughts, comments and ideas on your supply chain initiatives to keep them connected."

Robert T. Yokl, Chief Value Strategist, Strategic Value Analysis in Healthcare


GS1 declares: No sunset on horizon

GLN, GTIN progress remains very much in progress, experts report

by Rick Dana Barlow

The road to adopting and implementing supply data standards for medical/surgical products is less a race against time and waning interest and more like a convoy trudging toward bankable financial and operational efficiencies.

So says a group of supply data standards advocates now simultaneously promoting GS1’s Global Location Number (GLN) and Global Trade Item Number (GTIN). The much-publicized sunrise date for the GLN happened as the stroke of midnight ushered in 2011. The GTIN sunrise date is scheduled for the close of 2012.

Looking back at the GLN marketing efforts and achievements, these advocates remain bullish that interest will continue and not fade in the face of the next fashionable acronym known as the GTIN.

Ed Miles

"The demand for GLN will continue to increase, and even accelerate," predicted Ed Miles, vice president, GS1 Healthcare US. "Current implementers continue to drive GLNs further in their systems. More and more hospitals are working with their supply chain partners to increase use. The Healthcare Transformation Group, which includes Geisinger Health System, Intermountain Healthcare, Kaiser Permanente, Mayo Clinic and Sisters of Mercy/ROi, is taking a very strong action-orientation towards accelerating GLN and GTIN implementation. These are among many recent key indicators that the demand is increasing and we anticipate that it will continue to grow."

Corwin Hee, Covidien’s director, E-Business Standards, agreed with the rosy assessment because the standards might assist healthcare organizations to tackle emerging challenges. "Overall demand for GLNs will probably continue to increase as more trading partners begin to use this new identifier," Hee noted. "We will also become more sophisticated in our approach to GLNs. We may have to add new identifiers or locations in order to accommodate a number of complications like 340Bs (Public Health programs) and retail pharmacies."

Dennis Byer

Dennis Byer, Novation’s senior director, Industry Standards, also anticipates continued demand for and growth in GS1 standards for fundamental reasons.

"Providers see it in their interest to implement the GLN from a supply chain transparency perspective," Byer said. "The providers also understand that the GTIN is tied to a bar code, which allows bedside scanning and allows for automating the prevention of mistakes and improvements in patient safety. The FDA [Unique Device Identification] rule requiring a global standard for product identification, the future ePedigree requirements for Pharmacy and the requirements for a global ‘track and trace’ capability will cause the demand for GS1 standards to continue to increase. Also, healthcare must find a way to lower cost throughout the industry. In order to be successful in lowering cost and improving efficiencies, foundational data standards like the GLN and the GTIN must be used."

With software and service suppliers working to keep pace, if not ahead of anticipated demand, providers and product suppliers will have few credible excuses to ignore adoption and implementation, according to MJ Wylie, GHX’s director of global data standardization.

MJ Wylie

The level of awareness in the marketplace in 2010 generated informative user groups, workgroup sessions and implementation projects that brought early adopters together to share technical and business process lessons for the healthcare industry," Wylie said. "Now that many supply chain partners have either scheduled or are completing system upgrades to support global data standards adoption, the demand for services to enable the use of GLNs in order management transactions should only increase in 2011."

Allen Esses, president, DataPros for Healthcare proffered a realistic scenario. "Like any new initiative, we will reach a tipping point in the industry once critical mass is achieved," he said. "We had our Early Adopter Group, now we see the fast followers. The appetite is there, we just need to keep moving the needle in the right direction."

Meanwhile, Mayo Clinic charges forward with its end goals in sight, regardless of industry momentum, reflected Joe Dudas, director, accounting and supply chain management informatics, Division of Supply Chain Management.

"We currently have $250 million in trade converted and as planned will continue conversions," Dudas noted. "We are hopeful in 2012 we can say that we are no longer accepting or maintaining proprietary account numbers."

GLN lessons for GTIN?

Based on what happened with the GLN campaign pre- and post-sunrise date supply data standards supporters admittedly learned a few valuable lessons.

"We are spending far less time defending or promoting standards," Dudas said. "The industry seems to have taken that role. This has allowed us to focus 100 percent of our energy on conversion. GTIN is going to be harder as it is more pervasive in the supply chain."

Corwin Hee

One major difference between GLNs and GTINs is in visibility, Hee emphasized. "While few customers have actually seen a GLN, nearly every customer has seen a product package," he said. "Covidien is in the midst
of a major rebranding campaign. We will feature new GTINs for all of our products. We intend to work closely with our entire customer base in order to minimize confusion with our move to the new packaging. It may be much easier for customers to associate the GTIN with our packaging because of the immediate visual linkage."

BD continues to support the GLN initiative even as it pushes for GTIN acceptance, according to Dennis Black, BD’s director, e-Business. "In order to maintain this support and momentum going forward, we are asking healthcare providers who are interested in transacting with GTINs to implement GLNs also," Black said. "In addition to the 2012 Sunrise Date for GTINs, the FDA’s pending UDI Regulation should help spark additional interest in GTINs."

Allen Esses

Byer and Esses reinforced stepped-up GPO support as an indication that momentum has shifted to second gear.

"With the GTIN Sunrise, we are expecting that the majority of our suppliers will be providing GTINs for their products and publishing their product information to the GDSN by December 31, 2012," Byer noted matter-of-factly.

"A major step forward was when MedAssets added a GDSN service contract in their portfolio in December 2010," Esses added. "It is the same solution implemented in the Early Adoption Group for healthcare. Now GPO member hospitals have one click access to a vetted purchased service contract from both a data pool and a solution provider which gives them what they need to implement GS1 standards in one data sync and services package." GDSN stands for GS1’s Global Data Synchronization Network.

"We are leveraging the lessons learned from GLN and applying it to GTIN implementation initiatives," Miles reflected. "The industry is starting earlier on GTIN adoption activities, as through the GLN experience trading partners have a better understanding of any complexities involved and who to bring to the collaboration table, and see the value in moving forward now. Already, many early healthcare provider adopters have begun GTIN implementation activities, including Mayo, Geisinger, Intermountain, Kaiser, Sisters of Mercy ROi, and BJC Healthcare, to name a few. Many manufacturers, such as Abbott Vascular, Baxter, BD and J&J Medical Devices & Diagnostics Companies are providing a cross-reference of their product catalog numbers to the appropriate GTINs on their websites in advance of the 2012 GTIN Sunrise.

"For years, many in the industry have been interested in the notion of having a single, unique product identification system due to its obvious connection to improved patient safety," Miles continued. "The GTIN can play a significant role in ensuring that the right product is used for patient care every step of the way, from manufacture, to delivery, to use, to the recording of that product in the patient’s electronic medical record, to billing and beyond, and the industry seems to understand that. We expect that healthcare will be working to drive adoption earlier than the sunrise date, and possibly ahead of any regulatory activity that pertains to using unique device identification to improve the collective ability to track and trace products through the supply chain. The industry appears to be rallying around the GTIN as the standard of choice for product identification, and we have seen the demand increasing."

Piggybacking on GLN?

Not surprisingly, many experts encourage providers and suppliers to hook their GTIN efforts on GLN accomplishments to date.

"There’s built-in momentum for GLN adoption in 2011 as many GPOs are requiring clean GLN structures for their provider rosters and supplier reporting," Wylie said. "In addition, the focus on clean organizational identification reflects the need for more accurate data management throughout the healthcare supply chain."

Basically, the two are complementary, according to Byer and Miles.

"The GLN and the GTIN are complementary standards in the sense that the use of one requires the use of the other," Byer noted. "GLNs will be used to indicate who produced a product and where that product was shipped to, which are critical data elements for product recalls and track and trace. As we start to incorporate the use of the GTIN, a GLN will be used to identify who published that product’s information to the GDSN and a GLN will be used by a subscriber to request access to that manufacturer’s product information."

Echoed Miles: "Both initiatives are complementary, build upon each other and can be implemented in parallel. It just so happened that the industry decided to focus first on GLNs as this initiative was clearly going to be led by the providers, and some felt it would be an easier process to start with and test out. From the GLN implementation experience, we now have a framework to follow in pursuing other standards implementation initiatives. The primary drivers of GTIN are the suppliers and we will focus on broad awareness and adoption activities for this segment in 2011.

"For our part, GS1 Healthcare US will continue to educate, report progress and communicate the results of GLN implementation," Miles continued. "The industry members will continue to promote the use of GLNs in healthcare and work with supply chain partners not yet engaged. This should enable the industry to continue the momentum of GLN while beginning to focus on GTIN."

Dennis Black

BD’s Black agreed. "With proper planning, GTINs won’t necessarily crowd out or obstruct GLN implementation efforts," he noted. "GTINs may even help create synergy for GLN implementation. For BD specifically, we believe that both the GLN and GTIN are necessary building blocks to achieve ‘Perfect Order.’ Perfect Order can enable the industry to become much more efficient and reduce total costs. Now that the industry has set the foundation with GLNs, we can’t afford to abandon our efforts."

Because GLNs are so connected to GTINs it only makes sense to overlay adoption and implementation efforts.

"The GLN educational and best practice library is robust because the community shared their successes," Esses said. "We need to do the same thing on the GTIN side with the focus on the value GTINs bring to the supply chain. Every materials manager has felt the frustration of misaligned [units of measure] so the value of the GTIN will become apparent. Once everyone sees the success of well known providers and documented return on investment, GTIN, and therefore GDSN, will gain the same momentum."

Joe Dudas

Dudas and Hee already are trying to stay at least one step ahead.

"We transitioned our GLN efforts from project to production this year," Dudas said. "It is basically business as usual and highly repetitive. That has allowed us to focus, from a project perspective, on Sunrise 2012. We are very confident that we will successfully implement early 2012 and begin the ramp up process similarly to GLN," he added.

"We plan to sharpen our focus on specific business processes," Hee indicated. "One example of this is through our efforts with the GS1 US GLN workgroup. They have created a team to focus on the use of the GLN in the tracing, chargeback and rebate process. We hope to identify key obstacles and come up with solid recommendations to help improve the process through the intelligent use of the GLN."

Chicken or egg?

Providers and suppliers shouldn’t complicate adoption and implementation efforts by needlessly debating whether GLNs or GTINs should be tackled first to the point of indecision and inactivity, experts urged.

"You could do GTIN first. We have always considered GLN as a schoolmaster and so far that has proven to be true," Dudas quipped.

"You can work on both simultaneously, but the GLN is the key to unlock the GTINs residing within GDSN because it is the only way to request supplier data," Esses advised. "If the goal is GDSN, which it should be to maximize the value of the GS1 system, than it makes sense to have your GLN in progress before you take the next step."

Hee asserted that users "do not need to complete your GLN work before your GTIN work. They are completely separate issues. There are challenges for each identifier that need to be addressed now.

"In order to use GLNs successfully, it is extremely important to determine the business processes you wish to support," Hee continued. "That work requires personnel from across any number of internal disciplines. It will be important to ensure that those questions are answered or addressed in your GLN enumeration.

"GTINs are a bit more straightforward," he said. "However, there are still important nuances that need to be considered. As an example, many systems typically assign a single quantity to an item. With the GTIN, there may be multiple GTINs representing various packaging levels for the same product. That complexity can wreak havoc unless you prepare your systems properly for a transition."

Byer argued that implementing the GLN before the GTIN makes the most sense to him based on his experience. "I believe that the industry is also focused on that sequence of activities," he said. "We advise Novation members to move forward with GLN implementation today. Our feeling is that you can easily implement the GLN before GTINs are available. Many of our members want to get started, the GLN is an excellent starting point that can provide immediate value and pave the way for future success with the GTIN. I think the reality is that there will be organizations who implement both the GLN and GTIN in sequence, in a relatively close timeline to each other. I think it’s problematic to implement GTINs prior to implementing the GLN."

Black politely and respectfully disagreed.

"GLN is not a prerequisite for GTIN adoption," he said. "In fact, BD implemented GTINs before we started on GLNs. It is possible to implement GLNs and GTINs simultaneously. BD was a member of the Healthcare Supply Chain Standards Coalition when the Industry Sunrise Dates were originally established. HSCSC decided to create two separate Sunrise Dates to simplify the implementation process. The thought was that creating two separate Sunrise Dates would enable more effective planning and additional focus."   

Panning, scanning for GLN, GTN gold

Before healthcare organizations decide to do anything it seems they must have credible evidence of a return-on-investment. With that in mind, Healthcare Purchasing News asked six supply data standards supporters to qualify and quantify any ROI data that may be available today stemming from GLN and GTIN adoption and implementation. Here’s what they reported.

Standards are foundational, and I would hesitate to put a specific value on them. From a supply chain perspective Mayo achieved $80M in documented savings last year. That type of performance comes mainly from great people, but you have to give them the tools and information to effectively perform. Standards are obviously related as the top healthcare supply chains are all very active in these initiatives.

– Joe Dudas, director, accounting and supply chain management informatics,
Division of Supply Chain Management, Mayo Clinic, Rochester, MN

DataPros for Healthcare performed an extensive manual assessment of price discrepancies of one hospital of a large system when compared to the GPO portfolio for the IDN. This was done without the use of GTINs. The results were astonishing. Hard dollars based on an analysis of Unit of Measure (UOM) discrepancies resulted in real dollar price discrepancies of approximately $900,000. The result showed a net gain to the hospital of approximately $300,000 solely by aligning the item and contract UOM. This could have been more easily accomplished by building a one for one relationship using GTINs as the key. Better yet, the discrepancy would have never occurred if standards had been fully implemented.

– Allen Esses, president, DataPros for Healthcare

One benefit of working with GLNs is a focus on the account number structure with specific manufacturers. We have heard of many customers who were able to eliminate unused or unnecessary account numbers. The use of GTINs should help our customers by reducing unnecessary duplication and increasing supply chain visibility. Coupled with additional supply chain improvements, we expect that our customers will enjoy significant supply chain savings that may also help increase patient safety.

– Corwin Hee, director, E-Business Standards, Covidien

The grocery industry could not measure an ROI when the first pack of chewing gum was scanned in a checkout lane nor should healthcare expect to be able to quantify savings at the beginning of the GLN journey. Since the industry is still early in the GLN adoption cycle, it is not yet possible to document real savings. Before we can see a real ROI, the industry needs to achieve a critical mass of:

• Healthcare Providers enumerating their locations with GLNs

• GLNs used in purchases

• GLNs used in additional transactions (e.g., Advance Ship Notice, Invoice, Price Contract, Purchase Order, Recalls, Returns, Sales Reporting, etc.)

• Re-design of internal systems and processes.

Although we can’t measure savings at this point, I can report that BD’s GLN and GTIN implementation efforts with specific trading partners have succeeded. Transactional errors have decreased when we clearly identified locations and products using data standards. If we stay the course, the industry can collectively share in the efficiencies and achieve and return on our collective investment. Look at the evidence from retail and other industries.

– Dennis Black, director, e-Business, BD

I think it’s too soon to really see a lot efficiencies or savings being generated by the use of GS1 standards and until adoption is more widespread efficiencies and savings will continue to be elusive. That being said, Novation is building analytics tools that use the GLN as the basis by which hospitals can reconcile purchase volumes to administrative fee volumes. We have seen initially, that there are opportunities for additional recoveries of funds due to our members in the administrative fee and rebate areas, and using the GLN as a common data element linking a purchase order to sales reporting makes this type of analysis easier to do.

– Dennis Byer, senior director, Industry Standards, Novation

BJC HealthCare has seen improved data accuracy, reduced billing and shipping errors and greater process efficiency in using GLNs.

Geisinger Health System reported initial benefits of GLN that they are observing in reduction of time spent creating/maintaining cross reference tables, mis-ships, pricing errors, invoice errors, as well as time spent resolving administration fee and contract/rebate issues.

Print Media, a supplier of recording consumables, has significantly decreased their time in sales trace reporting (from 4 weeks to 1-2 days per month).

We have heard from some manufacturers that since the providers have established their hierarchies in the GLN Registry, it has provided a clearer understanding of who their real customers are, which has been valuable for financial and sales reporting activities. In addition, a cleaner hierarchy has allowed both segments to scrub data bases and eliminate thousands of redundant addresses, and the built-in inefficiencies that go along with housing those redundancies.

Additional benefits reported by providers include streamlined communications, cleaner business documents and stronger supply chain partner relationships.

Those early in the process are finding that preparing for GLN implementation has brought value in providing organizational visibility of their corporate and operational structure, as well as more accurate view of how their suppliers see their organization.

– Ed Miles, vice president, GS1 Healthcare US