V is for visibility

May 25, 2020
Pandemic, epidemic response should drive supply data standards use

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.


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.

The COVID-19 pandemic has shown the importance of using a single data standard to provide and promote supply visibility, insists John Freund, President and CEO, Jump Technologies Inc.

“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.”

Yet Karen Conway, Vice President, Healthcare Value, GHX, points out that supply-data-standard-enabled visibility should not be limited to inventory.

“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

Product tracking and traceability likely will take center stage within many organizations in a post-COVID-19 world because of the benefits to both internal and external business processes within a healthcare provider, according to Melissa Amell, Director, Healthcare Industry & Solution Strategy, Infor.

“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.

“Product tracking and traceability is the pinnacle of utilizing data standards in supply chain,” said Carl Henshaw, Director, Standards Implementation, Vizient Inc. “The ability to track products brings increased accuracy, waste reduction and inventory visibility. Additionally, within health care, this enables another critically important benefit, which is the ability to track outcomes and manage product recalls, which in some cases is a matter of life and death. The FDA put in place unique device identification (UDI) requirements to track products all the way from the manufacturer to the electronic health record. The UDI has the ability to tie the entire supply chain together.”
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.”

Health Information Exchange requirements under Meaningful Use Stage 3 play an important role in the regulatory tract, according toCarl Gomberg, Lead Solution Analyst, Premier Inc. “Providers are required to include UDI for implantable devices in the [electronic health record], which has been the primary reason that Premier’s customers have adopted data standards in recent years,” he said.

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.

“My 28 years of clinical, technical and administrative experience in the OR has taught me that the single most important benefit for driving adoption and implementation of data standards is for increased accuracy,” he said. “Without increased accuracy, product tracking and traceability is inaccurate. Inventory tracking will be inaccurate, and consequently documentation will be inaccurate. If you start with bad or inaccurate data, everything else relying on that data throughout the life cycle of the item being traced will be just as inaccurate as not having the data to begin with.” Before joining PA & Associates Healthcare, Pierce served as Implant Coordinator, Shock Trauma Operating Room, University of Maryland Medical Center.
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. 

About the Author

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].