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IHFDA tackes Drug Diversion in Healthcare Facilities

10/01/2018 : 0 Comments  

John Burke, the President and Co-Founder of the International Health Facility Diversion Association (IHFDA), wrote a great article detailing his 40 years of law enforcement experience with the current opioid crisis in America. In particular, he states:

When I was with the Cincinnati Police Department and our squad worked full-time on drug diversion issues, we arrested a health care facility employee an average of once a week for stealing medication. This resulted in 50 nurses per year being caught and offered treatment through the courts. Most of these individuals successfully completed the treatment programs and had their criminal records wiped clean. A sizable number were able to continue their nursing profession and reclaim their lives.

I got tired of the media’s asking me how big the problem was in the country, especially because there was a lack of reporting. So I used 9 years’ worth of statistics, and considering Cincinnati’s population, it came out to 102 of these cases per day. But nowhere near that number is addressed annually. It is not because they are not discovered; rather, facilities choose to either allow the people to quit or fire them. This violates regulatory and often criminal mandates to report these offenses.

Of course, some of these health professionals move on to other facilities and continue to struggle with addiction without getting help and in turn endanger patients. Some of the same health care facilities that have failed to report the offenses can also become victims of this practice when they unknowingly hire someone from another facility who also left because of an addiction incident that was not properly addressed.

John’s belief that most individuals caught early in the drug addiction cycle can reclaim their career and lives is something we share at Invistics. We believe The best way to combat drug diversion is to catch diversion early, before addiction can spiral out of control and endanger the Healthcare Worker and the patients under their care. We designed the Flowlytics Drug Monitoring and Diversion Detection system to highlight non-compliant and suspicious healthcare transactions as soon as they occur, as early as day 1 of diversion.

  

Revolutionizing Supply Chain with Machine Learning

10/01/2018 : 0 Comments  

 

 

 

 

 

 

 

 

 

 

Louis Columbus of Forbes.com published an informative article titled, “10 Ways Machine Learning is Revolutionizing Supply Chain Management”.

Machine Learning has been a transformative tool adopted across multiple industries to quickly detect patterns in data and highlight what the most influential factors are in the data. Columbus states:

“Discovering new patterns in supply chain data has the potential to revolutionize any business. Machine learning algorithms are finding these new patterns in supply chain data daily, without needing manual intervention or the definition of taxonomy to guide the analysis. The algorithms iteratively query data with many using constraint-based modeling to find the core set of factors with the greatest predictive accuracy. Key factors influencing inventory levels, supplier quality, demand forecasting, procure-to-pay, order-to-cash, production planning, transportation management and more are becoming known for the first time. New knowledge and insights from machine learning are revolutionizing supply chain management as a result.”

In particular, Invistics has adopted the following 3 attributes of Machine Learning in order to better manage our customers Supply Chains:

#1 Machine learning algorithms and the apps running them are capable of analyzing large, diverse data sets fast, improving demand forecasting accuracy. One of the most challenging aspects of managing a supply chain is predicting the future demands for production. Existing techniques range from baseline statistical analysis techniques including moving averages to advanced simulation modeling. Machine learning is proving to be very effective at taking into account factors existing methods have no way of tracking or quantifying over time. The example below shows how a wide spectrum is being used to accomplish demand forecasting, and Lennox is using machine learning today.

#3 Machine Learning and its core constructs are ideally suited for providing insights into improving supply chain management performance not available from previous technologies. Combining the strengths of unsupervised learning, supervised learning and reinforcement learning, machine learning is proving to be a very effective technology that continually seeks to find key factors most affecting supply chain performance. Each of the endpoints defined in the taxonomy below is derived entirely by algorithm-based logic, which ensures algorithms scale across a global enterprise.

#10 Combining machine learning with advanced analytics, IoT sensors, and real-time monitoring is providing end-to-end visibility across many supply chains for the first time. What’s needed in many supply chains today is an entirely new operating platform or architecture predicated on real-time data, enriched with patterns and insights not visible with previous analytics tools in the past. Machine learning is an essential element in future supply chain platforms that will revolutionize every aspect of supply chain management.

The beauty of Machine Learning is in its self-learning iterations, where as the data grows and changes, so do the algorithms and pattern-detection of the artificial intelligence. Analyzing all the data points in a complex supply chain system can be a daunting task, but with the capabilities of Machine Learning, the burden of making sense of the Key Performance Metrics falls on the Machine rather than a manual, human process.

  

Invistics 2018 Upcoming Conference Tour!

02/28/2018 : 0 Comments  

Travel

In an effort to stay up-to-date on new strategies, ideas, and solutions in the industries that we serve, we will be attending the following upcoming conferences. Feel free to introduce yourself and say “hi” to our team, and we’ll be happy to answer any questions you may have regarding our company and solutions.

Upcoming Itinerary:

2018 NADDI Healthcare Facility Rx Diversion Summit
Date: 4/24/2018 – 4/25/2018
Location: Minneapolis, Minnesota at the Hilton Minneapolis/St. Paul Airport
Website: NADDI Website

2018 ASHP Summer Meeting & Exhibition
Date: 6/2/2018 – 6/6/2018
Location: Denver, Colorado Convention Center 700 14th St
Website: ASHP Summer Website

2018 NASCSA Conference
Date: 10/30/2018 – 11/2/2018
Location: Scottsdale, Arizona , at the Hotel Valley Ho
Website: NASCSA Website

2018 IHFDA Annual Conference
Date: 10/22/2019 – 10/24/2018
Location: Dallas, Texas, at the Embassy Suites, Dallas-Frisco Hotel
Website: IHFDA Website

  

Silos and the silo effect

02/16/2018 : 0 Comments  

Growing up in Illinois, I had crisscrossed the “prairie states,” met my share of co-op farmers, and seen plenty of silos. I never gave much thought to the gigantic storage tanks. Until three weeks ago.

It took a trip to rural Georgia and a conversation with a silo manufacturing company to develop an appreciation for the importance of silos in our lives.

Silos

Crabapple Silos – photo by Stephanie True Moss

While traveling through a former farming community, I learned that the farmers who originally inhabited the area built several large brick silos for harvest storage. Homes were built near the silos and up sprang the towns of Roswell, Alpharetta, and Milton, Ga. Today, these historical silos stand as a “link with the past” and have created a sense of pride for the community.

By sheer coincidence, two weeks after visiting the Crabapple Silos, I had a conversation with the largest maker of agricultural silos in North America. During my conversation with a senior manufacturing executive, I learned silos are extremely complex to design, build, transport, and assemble.

A vice president at the company mentioned that even though making silos is complex, even more complicated are the “intellectual silos” that are a daily occurrence in manufacturing plants.

The phrase “silo effect” has become popular in business and especially in manufacturing. It commonly refers to a lack of open communication and common goals between departments in an organization. This “silo effect” gets its name from the farm storage silo. Each silo is designated for one grain or specific product.

To a manufacturing executive, a lack of communication and “silo thinking” causes departmental breakdowns and a lack of free-flowing ideas from other departments. The net effect is confusion and a disruption of efforts toward common business goals.

The “silo effect” is caused by a remarkably small number of people who gradually drain the silo‘s grain. Its negative impact can be huge on the performance of the total team; eventually leading to a loss of business. However, I’ve seen clients successfully deal with these “silo effects” within the walls of their company. I’ve sat in on several Pull Design Workshops and have personally seen this transformation occur.

It takes a concentrated and ongoing process improvement program. During these workshops we gather the thoughts of the leadership team and then, in one to two days, work with them to develop a course of action to reduce the “silo effect” and develop a sustainable process improvement program. The result is improved productivity, right-sized inventories and more working capital. Often workshop attendees see improvements in customer service, too, once the strategies are implemented.

What are you doing to break down organizational silos? What’s been successful for your organization?
Post by Bill Z.

  

Webinar with IQVIA: Best Practices in Sample Management

02/12/2018 : 0 Comments  

Webinar Summary
To effectively and efficiently distribute samples through your field force to prescribers you need a formalized approach that ensures the optimum amount of sample product is at the right places at the right time. Balancing the needs of your sales representatives, the prescribers they call on, and your overall sample marketing objectives with full regulatory compliance can be challenging.

Register to learn the key components of a robust sample allocation solution and how these components address how to:

1.) Optimize inventory levels for each step in the drug sample delivery chain
2.) Achieve visibility into the flow of samples within the supply chain
3.) Link the supply of drug sample manufacturing with delivery
4.) Find the right balance among inventory levels, customer demand, costs and cycle times

Speakers
Paul Hamby, Group Director, Compliance for IQVIA
Tom Knight, Founder and Chief Executive Officer, Invistics

Register For the Webinar: Registration Link

  

Porter Survey: Drug Diversion in US Health Care Systems - Are We Doing Enough?

01/08/2018 : 0 Comments  

In 2017, Porter Research conducted a survey about the theft of narcotics by US healthcare workers. One-hundred fifty health care professionals, representing over one-hundred forty health care organizations, were asked about drug diversion in their organizations. Because the respondents were close to the problem, they recognized the impact of drug diversion and the resulting fallout on the safety of patients, healthcare workers, and hospitals. The survey assessed the consistency, effectiveness and efficiency of drug diversion prevention programs across the United States, with a details into the methodology, resources, and technology employed to prevent diversion.

Download the Porter Survey Results Here: Porter Research Survey Results

  

Forecasting Leads to Improved Inventory?

12/04/2017 : 0 Comments  

Lora Cecerce, founder of Supply Chain Insights, posted a very insightful article in Forbes called “Does Better Forecasting Improve Inventory? Why I Don’t Think so Anymore”.

Inventory has always been necessary in supply chain management to buffer against supply and demand variability. With the advent of high-mix manufacturing and the need to produce a longer tail of SKUs with more equipment changeover, this is more true than ever before. Lora, in her recent analysis of planning benchmarking for large mult-nationals, states:

“A mistake that I see companies making over and over again is improving forecasting, but not improving inventory levels because of the lack of a holistic focus. After the implementation of a forecasting system, and getting basic functionality in place and providing a reliable forecast with minimal bias and accuracy, there is only minimal value in continuing to refine the forecast. Most companies do not have a forecasting problem. Instead, they do not know how to use the forecast to drive inventory strategies.

Why do I state this so boldly? The forecast is always wrong. This is true by definition. Improving it by a few percentage points on forecast accuracy is not going to drive the improvements in inventory that most people think. While most companies focus on the numbers, it is understanding the probability of demand and translating it to supply strategies that makes a difference.”

Lora counted four trends that lead her to rethink how inventory should be managed.

Cycle Stock is the Opportunity for Most Manufacturers

“Cycle stock is most effectively managed through the successful implementation of production planning. (Cycle stock is the management of stock required to cycle through production runs and procurement buys effectively. It involves complex logic on batch size, change-overs and production sequencing.) With the rise of item complexity, improving production planning becomes more important. This planning technology is tricky to implement and many of the technologies are not up to the task; but doing it well is essential.”

One of the cornerstone of Invistics’ solution is to view Inventory holistically as a combination of Cycle Stock and Safety Stock. It’s very common for companies to order materials in large quantities, often to meet a bulk discount, but then to skip the next step of figuring out bulk discount savings vs cycle stock inventory management costs. Even if you save 20% by ordering a years worth of product X in bulk, you must account for the holding, movement, and obsolescence risk of that left over inventory as it sits in your warehouse for the next year.

Download our Whitepaper to Learn More: Optimizing Cycle Stock, Lot Sizes, and Rhythm Wheels in High-Mix Manufacturing

Inventory is the Most Important Supply Chain Buffer, but Requires Design

“The most important buffers–shock absorber for volatility– in the supply chain is inventory and manufacturing capacity. The reduction of cost and improving asset utilization is usually the charter of the supply chain team. As assets become more and more utilized, manufacturing loses the ability to buffer volatility through manufacturing capacity optimization. In parallel, with more and more manufacturing outsourcing, companies lose the capability to buffer through the use of manufacturing capacity. As a result, inventory becomes the critical buffer to absorb demand and supply volatility. Designing the supply chain and making conscious choice about push-pull decoupling points, cycles, and late-stage postponement helps.”

At Invistics, we also stress the design before the implementation for three reasons. 1.) It builds consensus. 2.) It develops a relevant business case to get stakeholders invested, and 3.) it identifies processes and tools that are require to support the new approach. Our workshops begins with sketching out the “As-Is” value streams vs the future “Should-be” value streams, and discusses many of the items Lora mentions such as when to use Push vs Pull.

Technology can Help

“More and more companies are purchasing inventory technologies, but failing to give planners time to plan. This is a mistake. With the rise of the global multi-national. There is more and more need for an inventory planning role to manage the form and function of inventory and develop inventory strategies. Buying the technology and not having clear processes and accountability does not help. We are still in our infancy in the use of multi-tier inventory optimization technologies, but as shown in Figure 2, there is a strong impact when implemented correctly.”

Most high-mix environments will require technology due to sheer numbers. Traditional “rule of thumbs” approaches to inventory management such as “let’s hold 4 weeks of supply for product X” are becoming more and more outdated in a world where demand and supply rates fluctuate quickly. Often times you need a tool that can drill down into the just the items you are managing, to pull data from multiple computer systems, and can give you an accurate solution without tying up IT resources to sustain. If interested, here is a demo of a multi-tier inventory optimization technology called the Inventory Advsior: https://www.invistics.com/inventory-optimization-software/

Executive Understanding

“One of the surprises for me in the benchmark data is the gap in understanding of inventory strategies by the supply chain executive team. The concepts of planning and the management of form and function of inventory are not well understood. Most executives believe that the answer lies in having a better forecast. They are not able to have a discussion on the form and function of inventory. It takes training. The strategy requires careful definition with finance. However, it is worth it. Inventory turns correlate to market capitalization, and who can argue with improving market capitalization?”

Leadership is the key to sustainability. All the planning and software tools in the world aren’t enough to effect change if your companies management isn’t on board with visible metrics and staff training to ensure the new processes are being implemented with care.

To share with you an example from Invistics past, we completed a new inventory management workshop at a large company where we “capped” inventory using Pull-driven methods. Later on, when we came back to audit the shop floor, planners were still relegating to their old habits and focused only on maximizing machine utilization even when there was no demand for more of the product. In the planner’s eyes, the waste was due to letting a machine sit “unused”, instead of the storage and handling cost of the piles of unnecessary inventory. Leadership is key to bridge such communication gaps.

We hope this blog article was educational. If you have any questions or would like a consultant with Invistics please contact us using the contact button at the top of the page. And oh, a Happy Holidays to all.

  

DEA Is Cutting Production Of Prescription Opioids By 25 Percent In 2017

10/06/2017 : 0 Comments  

 

 

 

 

 

 

 

 

 

 

 

 

In a notice published Wednesday in the federal register, the DEA finalized a previous order on 2017 production quotas for a variety of Schedule I and II drugs, including addictive narcotics like oxycodone, hydromorphone, codeine and fentanyl. The agency has the authority to set limits on manufacturing under the Controlled Substances Act.

Invistics has a suite of software for Quota Management and Quota Reporting that can help Pharmaceutical manufacturers make the most of their Quota requests.

  

Survival Tips for Manufacturers

10/05/2017 : 0 Comments  

I’ve been following this discussion for a few weeks now: Top 10 Survival Tips For Manufacturers: What Are Yours?

If you are not a member of Manufacturing Executive community, you probably should be. Here is this great list from Guy Morgan, president of Performance Improvement LLC and managing director of business advisory consultants BBK

  1. Maintain your focus
  2. Reinvent your products regularly
  3. Enhance product and process design
  4. Manage your supply chain
  5. Rethink off-shoring
  6. Improve quality
  7. Diversify your customer base
  8. Embrace globalization
  9. Invest in your employees
  10. Facilitate total productive maintenance

And a Lean mentality naturally supports several of these points. I might change #8 to “embrace  change” – as globalization is part of the changing world we live in. And I would add #11 – “measure the right metrics.”

What are your survival tips for manufacturers?

  

Significance of Diversion in Hospitals and Health Systems

07/10/2017 : 0 Comments  

The Significance of Diversion in Health Care:

Numerous investigations and studies have found that roughly 10% of U.S. Health Care Workers (HCW) abuse controlled substances, a rate that matches abuse within the U.S. population. The latest data released in 2007 by the U.S. Substance Abuse and Mental Health Services Administration estimated that an average of 103,000 doctors, nurses, medical technicians and health care aides a year were abusing or dependent on drugs. Most drug diversion by HCWs is not discovered, and when it is discovered it is often not reported or prosecuted. Precise data on drug diversion in individual hospitals is difficult to obtain, due to the clandestine nature of diversion, as well as the culture in place in many health care institutions that leave diversion undiscovered and unreported.

The estimated cost of just Controlled Substance drug diversion and abuse to public and private medical insurers is $72.5 billion a year, much of which is passed to consumers through higher health insurance premiums. (National Drug Intelligence Center, 2009) The overall economic cost of drug abuse in the United States is estimated at $193 billion in 2007 (Office of National Drug Control Policy, 2016).

Drug diversion is a significant crime with multiple-victims – patients, HCWs, hospitals, and communities:

  • For patients, diversion can lead to them receiving substandard care from an addicted HCW whose job function is impaired by drugs. The HCW might also divert prescribed pain medication away from patients who require them. Also, there have been multiple documented cases of diverting HCWs infecting dozens of patients with Hepatitis, HIV, or other blood-borne infections when the HCW uses a shared syringe to divert the drug.
  • For HCWs, nearly every hospital has employed people who became addicted to a drug, and many facilities have dealt with the overdose death of a HCW, often on hospital premises. Beyond general risks to health, drug diversion often ends with civil malpractice actions, loss of professional licenses, and/or felony criminal prosecution for theft and fraud. Annually, hundreds of HCW forfeit their training and medical license following diversion and subsequent addiction.
  • For hospitals: there is significant financial damage when drug diversion occurs. Stolen drugs must be replaced without reimbursement, with additional costs due to absenteeism and turnover by addicted HCWs. When drug diversion stories hit the press, hospitals see millions of dollars in lost revenue and fines. For example, Massachusetts General Hospital paid a $2.3 million settlement to the DEA when its employees stole thousands of pain pills. These stories also damage to the hospital’s reputation in the community and harm employee morale. In cases where HCWs have entered falsified administration data and payers were charged for diverted drugs, these fines can involve the False Claims Act or Medicaid fraud, with triple damages.
  • For communities fighting drug abuse: HCWs could divert drugs for personal use or provide for others. In 2014, a review of more than 200 prosecutions since 2008 for drug diversion by HCWs discovered just 15% of the prosecuted HCWs were stealing drugs for personal use. Shockingly, many of the involved doctors, nurses and other HCWs were diverting on a large scale, for profit, sending thousands of unprescribed pills to drug abusers in the community.

Problems with Current Methods to Detect Drug Diversion:

Current approaches to preventing drug diversion in hospitals include three complementary techniques:

  1. 89% of US hospitals lock-up narcotics and other addictive drugs in Automated Dispensing Machines (ADM) like Pyxis and Omnicell machines.
  2. Most hospitals run “Anomalous Usage” reports that compile ADM data to flag HCWs with unusually high Controlled Substance usage, using commercial off the shelf software (COTS) like Pandora or RxAuditor. Unfortunately, these reports contain significant errors, both Type II “false negative” errors, in that they fail to detect actual drug diversion cases, as well as Type I “false positive” errors, in that the reports flag normal events as possible drug diversion. In short, Type II false negatives let diverters get away, while Type I false positives rob hospital staff and supervision of precious time investigating innocent people. Hospitals typically set an arbitrary threshold of 2-3 standard deviations to define “anomalous” usage, and this arbitrary approach guarantees 0.3-4.5% of HCWs are flagged as potential diverters, most of which is Type I error.
  3. Many hospitals implement Controlled Substance Diversion Prevention Programs (CSDDP) to limit diversion, with investigation teams, training, and other administrative approaches.

Despite these activities and the investment of significant time and money, drug diversion continues. Leading healthcare institutions admit that new approaches are required. Recognizing the ongoing problem, the American Society of Health-System Pharmacists (ASHP) has updated Controlled Substance procedures for all hospitals. Hospitals broadly agree that current methods to detect drug diversion have two main weaknesses:

  1. Data in the ADM only show part of the equation: the dispensing of the drug from the locked cabinet. Detecting diversion also requires drug administration data in the Electronic Medical Record (EMR), as well as data from other systems such as Wholesaler Purchasing Systems, Internal Inventory System(s), or Employee Time Clocks.
  2. Motivated diverters can game the system with falsified data entries to avoid detection. Moreover, historical anomalous usage reports contain so many “false positives” that overworked supervisors must comb through haystacks of false positives to find true diversion. More advanced algorithms are required to reliably detect diversion without excessive false alarms.

Recognizing these two weaknesses, Invistics is working with the support of the National Institute of Health to develop a solution that can fill the gaps in current Drug Diversion technology with the goal of improving patient and health care worker safety.

Invistics would love to learn more about how we can help your health care system. Call us at 1800-601-3456 to schedule a call or visit our Health Care page to learn more about the Flowlytics solution in Healthcare.