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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



October 2014

Products & Services

New Technology

Origin of Ebola outbreak may be a bat and virus has rapid mutation rate

The Ebola virus has mutated 300 times since the deadliest outbreak in history began in West Africa in May, and these transformations lead scientists to conclude that it is unlike any past Ebola epidemic. This could make it both harder to treat and harder to diagnose, according to a study published in Science magazine.

The outbreak began as a single human infection, the authors write, but the genetic sequences observed in the 78 patients sampled showed a rapid spread in both the number of people infected and the geographical regions affected. As it stands, the virus is unlike anything seen in the past, which will hinder the creation of treatments and make it difficult to fully contain the contagion, the study found.

"We’ve uncovered more than 300 genetic clues about what sets this outbreak apart from previous outbreaks," said Stephen Gire, a co-author and disease researcher at Harvard.

The initial infection, contracted by a woman in Sierra Leone, came from one of five strains of Ebola known to affect humans called the Zaire strain. The Zaire strain came about a decade ago in a related strain from an animal host.

Researchers are not positive which animal hosted the virus, but said it was most likely was a bat in Guinea. At least one species of fruit bat has a geographic range that spreads from Guinea to Sierra Leone. If bats are really the culprit, "about 150 million more people than previously thought are at risk of the disease," according to a previous study published in Science about Ebola.

The virus then crossed into Sierra Leone when the first woman diagnosed attended a funeral for someone who had recently been in contact with Ebola in Guinea, the study found.

Since then, it "has exhibited sustained human-to-human transmission subsequently, with no evidence of additional zoonotic [animal] sources."

One of the problems with this particular outbreak is that scientists have not been able to fully trace the virus from 2004 in Guinea to the current outbreak. Being unable to predict where it will next appear makes it very difficult to contain. The World Health Organization said that it hopes to stop the spread by 2015.

Clues from the study have scientists hopeful that nonstop research on mutations will help develop new diagnostic tests and treatments. In the study, 99 Ebola samples were taken from 78 patients diagnosed with Ebola from May to late June. More than 50 people co-authored the study with help from Harvard University scientists and the Sierra Leone Health Ministry. Five of the authors died before the paper was even published.


All teched out with somewhere to go?

Photo courtesy Motorola

Product, service evaluation is
serious business

by Rick Dana Barlow

Teching the halls with bells and whistles simply ain’t what it used to be in a healthcare facility.

Just ask the doctors of yore who may have spotted something cool at a conference exhibition or trade show or were wowed by a sales representative who just happened to bring something along to the operating room to show off or solve an immediate problem. Just like that, a sale was nailed but a process was installed — one of "shadow purchasing" directly expensed to a department or filed under "miscellaneous."

Not so much anymore. Those gift/wish lists coming true are best left to mall Santas now. At least, that’s supposed to be the plan.

More healthcare organizations today maintain stringent access procedures for sales reps with Supply Chain, by and large, serving as the formal and official gatekeeper to protect the clinical staff from "undue" influence as well as product and service contractual obligations via group purchasing organizations (GPOs).

Healthcare facilities also seek to manage product introductions via some form of committee process, either through product evaluation or larger and more thorough value analysis projects that investigate high-tech, low-tech and certainly new-tech offerings but through the proper channels.

Entrepreneurs and small companies contend that this strict environment, which they largely view as being controlled by GPOs, actually stifles competition and innovation because if a hospital has a GPO-negotiated contract with a supplier then they’re effectively "shut out" of consideration, which is detrimental to their growth.

Consequently, GPOs and providers alike each established countermeasures to those perceptions with "new technology" committees and dedicated forums to allow companies to promote their innovations.

But do all of these developments and machinations really stifle innovation or set much-needed limits on what had been more of a Wild West approach to spending?

Much ado about…?

Providers and suppliers offer candid and varied observations about product evaluations today that generally occupy a portion of the value analysis process, if not serve as the de facto value analysis process for some facilities.

Perry Willmore

Perry Willmore, Director, Supply Chain Management, Agnesian HealthCare, Fond du Lac, WI, told Healthcare Purchasing News his organization implemented a value analysis (VA) process about a year ago, driven by a Surgical team and a Med/Surg team. Willmore, a supply chain veteran with surgical services management experience, defended the process, when done properly.

"Both teams have been very successful in reducing cost and driving standardization," Willmore said. "Personally, I don’t believe the VA process restricts innovation. If used correctly, it can drive standardization as well as allow innovation. The key is to make sure the right people are sitting at the table. If you don’t have the appropriate physician/clinician representation involved in the process, your VA team is going to fail either way."

As the process develops and evolves, the debate continues to center on price vs. cost.

Joe Colonna

"As an industry, value analysis is going through a transition," noted Joe Colonna, Vice President, Supply Chain, Piedmont Healthcare, Atlanta. "This is part of a recognition that what got us to this point will not get us to the next level of cost reduction based on true ‘value.’ In our organization we are going through a transition from a price focus to a true value focus and one that is more customer-centric and customer-led. This new process is proving to be much more impactful."

Mercy netted its own improvements, courtesy of service lines, GPO contracting, visibility into contracts, and the strengthening relationship between the hospital and the GPO, according to Betty Jo Rocchio, CRNA, MS, Vice President, Perioperative Performance Acceleration.

"The better the relationship between the GPO and the hospital, the more success you will see with reducing costs on the supply side," she noted. "When the GPO allows the clinical side to give input and drive contracting strategy and selection of products, the costs will decrease as providers will be in compliance with the product agreements. Our next body of work surrounds better data management surrounding the evidence-based outcomes and product mix."

JoAnne Levy

Because ROi operates an integrated supply chain model, "providers are actively involved in product review and selection, which provides the opportunity and forum for review of new technology and innovations," said JoAnne Levy, J.D., MBA, ROi’s Vice President, Integrated Sourcing Solutions. "We have found that if clinicians have that voice, they will bring new technology and innovation opportunities to standard value analysis processes, which promotes the consideration and balancing of clinical, operational and financial factors. When suppliers understand and respect that process, we find that they too bring new technology and innovation opportunities to standard value analysis processes."

Robert T. Yokl, Chief Value Strategist, Strategic Value Analysis in Healthcare, Skippack, PA, believes industry efforts remain a work-in-progress.

Robert T. Yokl

"Most hospitals aren’t controlling their spend with their current product evaluation and value analysis procedures," he said. "In fact, based on our observations, they are actually spending more money than is necessary. As I see it, evaluators see it as their role to make sure new products are appropriate for their intended purpose, but are less sensitive to the cost of a new product."

But Yokl doesn’t blame the product evaluation or value analysis process for any shortcomings yet room for improvement lingers.

"I really don’t think current product evaluation and value analysis procedures are restricting innovation or trade," he insisted. "Generally, hospital evaluators are open to looking at new technology if presented to them for evaluation. Product evaluation and value analysis teams can do better by looking at lower-cost alternatives for everything they buy because too often we are buying the sizzle and not the steak at a higher cost than is functionally required."

Michael Rudomin

Michael Rudomin, Principal, HealthCare Solutions Bureau LLC, Bolton, MA, and a former hospital supply chain executive, delineated the differences between general product and high-end technology evaluations.

"I’d say for the lower cost, more routine med/surg items these efforts have been very successful when evaluating new and improved technologies," he said. "Vendors generally feel that, if they can’t actually be present at the meetings, they can rely upon the Supply Chain folks to present new technologies as long as there is either an unmet clinical need or it is reasonable relative to its cost. I would say there has been less success at these committees managing technologies in the high-tech areas like the OR and Radiology, although there has been quite a bit of success in the [Cardiology] arena with pacemakers, ICDs, and contrast media."

Joseph Dudas

Rochester, MN-based Mayo Clinic doesn’t restrict innovation or trade, according to Joseph Dudas, Vice Chair, Category Management, Supply Chain Management, and strives to be strategic in asset deployment. But he admitted they’re far from perfect.

"A few high-tech categories do not function as competitive markets nor are they truly aligned to the needs of the patient," Dudas opined. "In my opinion, the orthopedics category is a market that has to change significantly as it is not currently meeting the needs of its stakeholders. Most understand this, but both the suppliers and the providers get paralyzed by the way things work today and the amount of complexity that has evolved. Both parties fear change, and as a result, neither are happy. [It’s] a great example of a supply chain stalemate. However, when both parties are unhappy change is inevitable and competition will eventually break through — one way or another. There is a lot happening very fast in this category, but it will take more than a new joint — or an old one — to truly change this market."

Others are more upbeat in their assessments.

John Freund

"I’ve been excited to see the resurgence of value analysis in the past several years," said John Freund, CEO, Jump Technologies Inc. "While never gone, the value analysis teams of 10 years ago seemed to have slowed down as price and only price became the decision driver. And now, they’re back. Again, the [Cost-Quality-Outcomes] movement should stoke the fire of value analysis teams’ efforts. It’s never been more important that we understand the products being used in context of quality and outcomes. It’s through these efforts we’ll determine whether a higher-cost product actually drives a better outcome, reducing overall costs in the long-run. We need this broader view."

Ron Barth, Executive Vice President, Medline Industries Inc., concurred, emphasizing the need to unite business with clinical.

"The need for greater balance between cost, quality and outcomes is bringing the clinicians and business managers around the same table at more and more hospitals," he said. "That’s what’s driving our innovation initiatives and spending. One example is our ERASE CAUTI program. It is an example of combining product design and education to improve outcomes. One aspect of the program is to actively reduce the number of unnecessary catheter insertions. This is the best way to prevent an infection and a pretty unusual approach for a manufacturer to take.

Ron Barth

"Medline also just launched an Innovation Challenge inviting the brightest industry minds to help us bring more progressive products and solutions to market," Barth continued. "But advances in healthcare are not just about inventive products. It’s also about creating greater efficiencies and effectiveness with what we have today. That’s what needs improving and has our utmost attention every day."

Freund’s suggestions for improvement hinge on transparency.

"Let’s not wait to tap into cloud-based technology and broadly share, and even compare, results from value analysis teams," he urged. "We could reduce costs for organizations if these results were accessible in the cloud, providing a solid starting point for the next team that wants to consider a new product. There’d be huge benefit for both clinicians and supply chain team members."

Unreasonable demands

Any evaluation process invites unreasonable demands but they can be molded and shaped to steer efforts and not derail them.

"Historically, when providers attended conferences and/or trade shows Supply Chain could always expect requests for all the new bells and whistles," Willmore admitted. "I’m not saying this doesn’t happen anymore, but I do believe it’s not happening as frequently. If health systems are communicating appropriately with their providers, they understand the challenges of the future and are more likely to partner rather than demand."

Yokl refuted the idea of unreasonable demands and expectations based on his experience with clients. "To the contrary, most evaluators aren’t demanding enough of their sales reps to prove their technology really works," he added.

Rudomin contended that some tension routinely will exist between clinicians and administrators and between providers and suppliers.

"The docs’ perspective is usually that the hospital exists to treat patients and they can/should be the sole determinant as to what technologies are best to achieve this objective, and management’s job is simply to find a way to afford it," he noted. "The vendors, of course, want totally unfettered access to the docs and to sell their goods, and that the high price — especially to recoup R & D costs — is simply what the hospital needs to deal with in order to have this ‘special, unique’ technology. In both cases, I find this unreasonable in that such decisions cannot be made in a vacuum and must be the product of a reasoned discussion where clinical needs are balanced against financial realities.

"We live in a world of constrained resour­ces, and in the end, no money, no mission," Rudomin concluded. 

Rocchio felt that hospitals expecting that requested items be brought into the facility for next-day use was unreasonable. "Every new product should go through the same evaluation process and be coordinated across all hospitals if part of a system," she added.

"Providers are understandably anxious to try new technology and to be cutting edge in their patient care," Levy concurred. "Sometimes, they can get impatient with standard value analysis processes, which do take time. The structured approach and careful weighing of clinical, operational and financial factors typically pays off in the long run, helping ensure that providers are paying more only for new technology and innovation that will drive improved patient outcomes."

Healthcare organizations must maintain a delicate balance, according to Colonna.

"The days of ‘I want to use what I want to use when I want to use it’ are over," he asserted. "Having said that, clinicians should all have access to what they need to provide high-quality care. Working with our clinicians, I think we are better defining ‘need’ over ‘want.’"

All of the stakeholders must focus on patient value because "it is not all about price," Dudas urged.

"The difference [is] whether you view your GPO as a partner or not," he continued. "If our GPO treated our relationship as a customer/supplier model it would not work. We collaborate and ensure we are both centered on the needs of the patient. Additionally, while commitment is key, we cannot lock out truly innovative technology that might benefit our patients. We require the ability to carve out compliance for true innovation and rarely, if ever, commit 100 percent of our market share."

Freund said access to clinical outcomes data should and will change behavior that hopefully unites participants.

"Provider organizations are looking for more clinical and outcome information prior to considering a product — including long-term outcome data," he said. "The reality is manufacturers won’t be able to study new products and truly understand results over multiple years without introducing the product to the marketplace. Once approved for use, a manufacturer can continue to gather results that are more accurate because they’re spanning larger patient populations. In other words, once a product or device is approved, it’s time for healthcare organizations to work together to gather and share information about long-term outcomes from products. In the future, I’d see manufacturers, providers and payers working together in a cloud-based environment to build a knowledge base that feeds our Cost, Quality and Outcomes (CQO) efforts."

Added Barth: "Introductions and evaluations of new technologies or products will inevitably require changing behavior. Even when our customers have chosen a great new product, without an engaged staff that is trained in how to use it, they will not get the outcomes they want and need. This is why we have made significant investments in the resources to help our customers in this process. Both through people in accounts in servicing and online education through Medline University, we have tried to ensure the highest quality of training while not burdening our customers’ already scarce resources."

See the sidebar: Grading on the innovation curve