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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



March 2014

Products & Services

New Technology

FDA approves first tissue adhesive for internal use

The Food and Drug Administration (FDA) approved TissuGlu, the first tissue adhesive approved for internal use. Manufactured by Cohera Medical Inc., PA, TissuGlu is a urethane-based adhesive that a surgeon can use to connect tissue flaps made during surgery to remove excess fat and skin or to restore weakened or separated abdominal muscles (abdominoplasty surgery). Connecting the tissue flaps with an internal adhesive may reduce or eliminate the need for postoperative surgical draining of fluid between the abdominoplasty tissue flaps.  

Drops of liquid TissuGlu are applied by a surgeon using a hand-held applicator. After applying the drops, the surgeon positions the abdominoplasty flap in place. Water in the patient’s tissue starts a chemical reaction that bonds the flaps together. The surgeon then proceeds with standard closure of the skin using sutures.

The FDA’s review of TissuGlu included data from a clinical study of 130 participants undergoing elective abdominoplasty. Half of the participants received surgical drains while the other half received TissuGlu and no drains.

The study results showed that 73 percent of participants who received TissuGlu required no postoperative interventions to drain fluid that had accumulated between the abdominoplasty tissue flaps.

Participants who received TissuGlu without surgical drains were generally able to return to most daily activities such as showering, climbing stairs, and resuming their usual routines sooner than those who had surgical drains. There was no difference between the two groups in reported levels of pain or discomfort due to the surgery.

Certain heart drug, antibiotic combo might be fatal for seniors

The combination of a widely used heart medication and a commonly prescribed antibiotic seems to more than double the risk of sudden death in seniors, a new study says. Spironolactone (brand name Aldactone) is a diuretic widely used in treating heart failure. It protects the heart by blocking a hormone that causes salt and fluid buildup.

But taking spironolactone alongside the antibiotic trimethoprim-sulfamethoxazole (brand names Septra, Bactrim) can cause blood potassium to rise to potentially life-threatening levels, said study lead author Tony Antoniou, a scientist with the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto.

Trimethoprim-sulfamethoxazole is frequently prescribed for urinary tract infections, with more than 20 million prescriptions written every year in the United States for a variety of infections, the researchers said. Both spironolactone and trimethoprim-sulfamethoxazole are individually known to increase blood potassium levels, according to the National Institutes of Health.



Pushing supply chain into the Connected Age

Will mobile device usage usher in point-of-demand service?

by Rick Dana Barlow

Armed with your app-laden smart phone or tablet computer, you stand at the door of a storeroom or warehouse. The app on your device identifies you and where you are located and then shows you where the product you’re seeking is shelved, relative to your current position. The app also points out the product’s price points, contract information and other pertinent supplier details you might need. When you remove the product from the shelf the app senses the demand and triggers a restocking request to that supplier.

Suddenly, "point of use" has been supplanted by "point of demand."

This scenario may be close to reality, if not standard practice now, within the manufacturing, food and retail industries outside of healthcare, and more likely within the healthcare manufacturing and distribution industries. So just how close are healthcare providers to adopting and implementing this model? Are supply chain departments able, ready and supported to invest time, money and effort into mobile devices connected to the enterprise resource planning (ERP) system, materials management information system (MMIS), surgical services information system, electronic health record (EHR) system, as well as that of payers and suppliers?

Fifteen years ago, provider supply chain professionals were all a-twitter about online buying exchanges and the convenience and perceived efficiency of dot-com procurement. Are mobile device capabilities reaching a similar fever pitch?

Not quite, Healthcare Purchasing News has learned. HPN sought to explore the possibility of mobile supply chain flexibility, point-of-demand efficiency and effectiveness and the feasibility of mobile devices migrating to provider supply chain operations. But sources indicated that the promise of mobile devices continues to outpace the practice.

"The biggest impact that portable electronics have is on reducing the acceptance barrier to automation," said David Schneider, Marketing Manager, Hänel Storage Systems. "Electronic inventory control and automated systems seem less daunting to users who are well-versed on the latest smart phone apps. Users are also growing accustomed to having easy access to whatever information they need at their fingertips so antiquated paper-based inventory tracking systems are no longer acceptable. Automated systems have the option for Web-access to inventory and control of inventory from mobile terminals, providing an even greater degree of mobility and flexibility."

Triggering the enabler

Doug Brown

Doug Brown, Vertical Marketing Manager, Honeywell Scanning & Mobility, noted that mobile devices are squarely embedded in the healthcare supply chain but their applicability continues to develop and improve.

"Hand held mobile computers have been used in hospital stockroom applications for more than 10 years now, and virtually every supply chain software provider now supports mobility," Brown said. "As experience and maturity in this mobile workflow has grown it has become apparent that current generation mobile devices were basically ‘one-trick ponies’ which were optimized for bar-code scanning, data entry and durability, but really did not provide features outside that core benefit.

"Smart phones and tablets come at this application and workflow from the opposite direction," he continued. "In the case of the cell phone, it was at first a phone and texting device, a true communication tool that was optimized for one hand always present use. The smart phone expanded on the cell phone to add applications which basically added computing power in the palm of your hand. So you have a powerful mobile computer and world-class communication device with all the software at your fingertips, but you lack all the requirements of bar code, durability, battery life, and perhaps legacy stockroom software compatibility."

Basically, a hospital-based supply chain that uses a smart phone improves workflow through enhanced communication," according to Brown.

"Let’s face it, rarely does material flow into the hospital and out to the floors without issues such as backorders, lost or misplaced deliveries, or an unexpected increase in product demand," he said. "A smart phone and tablet gives the delivery staff the ability to answer these issues real-time when face-to-face with the nursing staff outside the stockroom. [It’s] much like asking a [retail] employee in the iasle of the store about an item we can’t locate who immediately references their smart phone about quantity on hand and location. They even have the ability to check stock in other nearby stores standing right there in the isle of their store."

Michelle Robbins

Michelle Robbins, Industry Strategy Director, Healthcare, Infor, maintained that mobile devices remain ubiquitous in supply chain operations.

Every day, a steady stream of supplies flow into and through the typical healthcare facility," she said. "It may surprise many to discover that this entire process can and is now supported by mobile applications. For example, Infor Lawson provides a holistic approach to supply chain management of a healthcare organization through mobile applications, supporting all necessary functions in the procure-to-pay process. Applications such as requisitioning, procurement punch-out, PAR management and counting, receiving and delivery, inventory management, AP invoicing and analytics are all supported by mobile applications today."

The "low cost and permeation of tablets and smart phones for delivery" are helping to drive deployment, she added.

"Mobile devices, along with the applications that run on them, offer organizations the opportunity to re-imagine their processes and discuss innovative ways to improve efficiency," said Chris Haupt, Mobility Solutions Architect, CDW Healthcare. "Currently, most areas of healthcare are seeing cautious adoption of mobile devices — especially in departments that keep an organization running, such as supply chain management. That said, tablets and custom applications, in particular, can drive greater efficiencies in key areas of supply chain management.

"One way to see where mobile devices could have an immediate impact is to look at what supply-chain related processes an organization currently performs manually, and assess how mobile devices can help to accelerate processes and ensure that the appropriate materials are in the right location at the right time," Haupt continued. "The results of implementation can be impressive, often leading to competitive advantages and improved logistics management for the organization."

Shlomo Matityaho, CEO, LogiTag Systems, classified these mobile devices as triggers and enablers.

"From one end, they enable recognition of the person (name, role), their physical location (inside and outside of the facility) and a very easy method for [tracking] actions, movements and activities without the need to recognize the individual," Matityaho noted. "There is no need, for example, to pass a card each time you come into a room. It can be done automatically.

"On the other hand mobile devices are simply means to an end — an enabler for a much larger ecosystem," he continued. "You can track the entire flow. You can track higher-cost medical devices, for example, from the time they leave the vendor’s warehouse, arrive at the hospital central supply room, are used by medical staff (doctors and nurses), are registered with the patient record, enter the billing system, and get re-ordered again — all automatically. The entire information is transferred to the cloud where designated people can get applicable reports. Nurses open their mobile app, and see what devices/kits are on the way. Sales reps know which items are used and how frequently."

For example, a nurse can enter a supply room, check the smart phone or tablet, which can alert him or her that the specific supply she seeks is in another room or is scheduled to be delivered in a few hours, according to Matityaho. Similarly, a doctor can place an order for a particular orthopedic implant via his or her mobile device, which recognizes the doctor, hospital, building and who his or her patients are for this procedure, as well as the location of the sales rep en route.

"Mobile devices are the triggers, enablers of an entire ecosystem," he said.

John Freund

One key benefit of using smart phones and tablets is that they don’t run on proprietary mobile platforms like other hand-held supply chain devices, according to John Freund, CEO, Jump Technologies Inc.

"This means users can have many apps from many different companies on them that perform various different functions related to that staff person’s job function," Freund indicated. "For example, you may have clinicians who are using an iPad running applications like CipherHealth’s patient rounding app and Micromedex’s pharmaceutical knowledge app, as well as running an inventory management app. When they suddenly notice they are out of a specific supply on the shelf, they can use the ‘Find Item’ feature of JumpStock to see that item’s current inventory levels in all locations throughout the hospital. Finding exactly what they need can help avoid the typical problems of maverick spending, inventory hoarding, waste and rush shipping charges typically associated with stock-outs, not to mention helping keep inventory levels in check."

Another involves staff training because of the proliferation of smart phone usage, Freund noted. He cited a PEW Research study from June 2013 that found 56 percent of U.S. adults used a smart phone, a number that likely has grown. What also helps is standardizing the user experience, he added.

"Applications that run on mobile devices are developed using guidelines and standards provided by Apple for iOS, Google for Android and Microsoft for Windows," Freund said. "These guidelines provide for a very common user experience across all applications. This translates into shorter training time for new users as well as quicker implementation time of the solution, which translates to real dollar savings for the hospital."

Having the supply chain functions necessary for creating requisitions, pulling inventory, receiving inventory, transferring inventory, finding inventory, creating products, adding images via camera and adding UPC data to items can all be done conveniently on a single device, he concluded. 

Arnold Chazal

Arnold Chazal, CEO, VUEMED Inc., cautioned against relying on the silver bullet analogy.

"The emphasis should really be on the whole solution, not just one component of it, such as whether the device is mobile or not," Chazal advised. "The solution is what drives the efficiency in the supply chain, and is usually a combination of sophisticated software and hardware that may be mobile/portable; however, portability is not necessarily the best hardware option in the hospital environment. It is true that because the supply chain extends all the way to the procedure room and the patient, smart phones and tablet PCs may seem attractive due to their format and portability."

These devices do have their limits, he continued.

"Their inherent physical limitations — namely their limited screen size — can constrain the full potential of the app or software which are really the solution’s brain," he said. "Additionally, mobile/portable electronic devices are fragile and can get lost, damaged, dropped or stolen more easily than other types of hardware that are less sexy but much more suitable in many ways. I think it is a mistake to believe that the portability of the hardware is paramount. And how about solutions that do not require human intervention or devices that do not need to be operated by humans at all?"

Provider perspective

While the premise and promise sound convincing enough, practice continues to lag behind.

Dave Hunter

Dave Hunter, Vice President, Supply Chain, Engineering, & Hospitality, Providence Health & Services, Seattle, certainly recognizes the longer-term applications for smart phones and tablets.

"The devices will replace the current handhelds we use when inventorying and maintaining our PAR levels and department inventories," Hunter acknowledged. "Staff, particularly younger staff, already use these devices so training is minimal." However, current practice hasn’t reached that point yet. "We currently use a typical large handheld unit [that] works well but is somewhat clunky."

Still, the future looks bright enough, according to Hunter.

"The amount of change with these devices will be increased as new apps can be quickly written for hospital or organizational needs," he said. "We won’t need to wait for the MMIS provider to do an upgrade. I think the app field is moving fast enough that the MMIS systems will have to learn to accept their downloads [via] some sort of common language connection." 

Jim Robbins, who operates the Virtual Inventory Management network at Parkview Health, Fort Wayne, IN, also remains more of a realist.  

"We are not currently using [smart] phones or tablets in supply chain," he admitted. "We do have a point-of-use system [with] scanners. One challenge is to capture those decentralized supplies at the bedside. Conceivably, mobile devices could be a solution for consumption and patient charge. The central supply room concept could be much enhanced with mobile technology. You, in essence, develop a more robust VIM (Virtual Inventory Management) model."

Robbins envisioned improvements in supply consumption at the bedside, patient charging, decentralized supply management, and mobile shipping and receiving.

Joseph Volpe, Vice President, Supply Chain, Wheaton Franciscan Healthcare, Glendale, WI, also acknowledged some hesitation.

"At this point, use is limited," he said. "Once most products are on unique catalogue numbers, the bar codes can be loaded into our item file. Currently, we can add them but we need to scan each product and associate the bar code to the item file. In our current state, these numbers are not unique and they change so we have not pushed this functionality yet.

"Once this issue is fixed, the clinical staff will be able to scan all the supplies that are used on patients just like they do the ‘5 rights’ for drugs," he continued. [Then] we will have a wealth of data about our real costs of treating various conditions. This also could become the primary way supplies are ordered by the units without any further steps. We will move to auto [purchase orders] in the next few months. Scanning would allow the order to be created and sent without any other touches needed if some basic criteria are met."

Device capabilities have a way of shaping consumer demand, according to Brown.

"These new computing devices bring communication to the mobile worker, but they also bring a consumer market-driven user experience and expectation of capabilities," he noted. "That consumer experience and expectation increases the number of people that are thinking of new uses for these mobile devices in their workplace. Can you think of a reason why a stockroom employee delivering supplies might need to take a picture of something they believe their supervisor needs to see? Because of our consumer experience snapping pictures at any given moment when the thought occurs, it is now obvious that a camera is a ‘free tool’ now available to the workflow."

Mastering the mobile device sales pitch