The Challenge

• Drug shortages often come as a surprise to health systems and hospitals and are often only identified when orders are not fulfilled or accepted by wholesalers and suppliers.
• Pharmacy teams struggle to get real-time data related to what medications are in stock, the utilization rate, upcoming orders and shipments, and the days on hand based on the total inventory that is tracked by the electronic health record (EHR), the automated dispensing system (ADS), and stock on the shelves that needs to be manually counted.
• Pharmacy information is stored in disparate systems (EHR, wholesaler purchasing system, and inventory systems like ADS and central pharmacy systems) and is in inconsistent formats in all these systems. If teams can access this information it is a lot of work to get it in a usable format. Therefore, health systems typically rely on purchasing history versus actual drug usage.
• Understanding the demand-side of the equation and which prescribers, departments, hospitals, or specialties are driving demand for medications is a blind spot.
• Alignment of the entire drug shortage team and communication related to which medications are on shortage, how critical a shortage is, approved substitutions, and the steps required to manage the shortage is often uncoordinated or happening in silos.
• System-wide communication to the clinical team versus focused communication is ineffective. Sending mass communication instead of contacted targeted individuals or groups many times still leads to depletion of supplies.
• Shortage managers have difficulty closing the loop on the tasks assigned, who they were assigned to, the current status of the work that needs to be done, and what is still outstanding and required to manage a shortage. On the back-end of a shortage, knowing what was done and needs to return to the previous state is difficult to track.
• Inability to identify specific packages of medications that are utilized and whether those packages are in fact the medication on shortage can drive unnecessary purchasing and excess medication spending.
• When a shortage reoccurs, which often happens, health systems struggle to remember what they successfully did last time to quickly put a plan in place, as well as to apply this to other shortages versus assessing each one individually.

Solution

Identifying shortages earlier allowing for proactive mitigation versus reactive response to ensure there is a sufficient supply of critical medications for patients.

The Drug Shortage App combines ASHP Drug Shortages data, publicly available information, data captured in information systems from hundreds of hospitals included in the LogicStream Health community, and utilization data from the health system and its hospitals to provide an early warning and weighted relevance for medications that are showing signals of becoming a problem due to lack of inventory. Instead of multiple staff scouring publicly available information and spending hours working on one shortage, one system now manages its entire list of shortages in 30 minutes twice a week. While this time savings is important, it’s the agility behind it that has allowed them to save money and improve outcomes through more rapid and proactive management of shortages.

Drug shortage managers and teams are often operating in a completely reactionary mode. Typically these teams do not have quick access to the information needed in one place and in a usable format to be able to make quick decisions. This leaves the team to react to a lack of medication availability, scramble to find inventory, or make higher-priced purchases.

The Drug Shortage App allows shortage teams to be proactive in their management of drug shortages because the application pulls information in from all the disparate systems and normalizes it so they have usable information at their fingertips. Within a few minutes, they can see how much they are using, how much they have in inventory, and the days on hand so they can rapidly determine and put a mitigation strategy in place. This can allow them to either conserve the stock they have for the most needed cases being able to weather the shortage or quickly purchase the stock they need without hoarding. This ensures they not only have what they need but that other health systems can have access to medications without experiencing a shortage or exacerbating the problem.

Easily understanding the complete picture of medication inventory and gathering all the information from the EHR, the ADS, inventory on the shelf, and upcoming shipments and deliveries.

The Drug Shortage App combines all the information from disparate systems, normalizes the information to make it usable, and provides actionable insights for shortage teams. This allows customers to immediately understand where inventory is located, the utilization rates for each department and prescriber, the current runway and expected out of stock date/days on hand, and when they are expecting a fresh supply of medications. This allowed one customer to modify the process when discovering shortages from making a purchase decision to, in some cases, pulling all inventory into the central pharmacy and distributing as needed. For an average shortage, this can save approximately $10,000 depending on the cost and utilization of the medication and for one year this can equate to up to $1M of avoided drug spend.

Managing communication among drug shortage team members, pharmacists, and prescribers to keep everyone up to date on shortages impacting the organization.

The Drug Shortage App allows anyone in the organization access to all the information related to shortages. Pharmacists at one customer review the medications and updates in the system every day. Another customer uses The App to track all the simultaneous actions taking place to manage every shortage. Action Plan Tasks are assigned to team members and tracked in The App to allow them to close the loop. Both customers interviewed also use The App to target communications to prescribers or departments who are driving demand. Before The App, the teams would have an idea of who the main drivers of demand were and target communication to those people or groups. With The App’s easily accessible utilization information by prescriber, they have discovered individuals they would not have included in their communication and been able to drive down usage to manage through an event. With the information captured in The App, team members can immediately see the highest prescribers of medications and proactively approach them to discuss the situation, alternative therapies, or changes in prescribing behavior, instead of blanket messages to all prescribers and hoping for compliance with changes and understanding of the desired action of conserving medications. With medication errors costing health systems in the United States an estimated $30B per year, this allows customers to ensure their prescribers are aware of changes and alternatives so education on dosing recommendations and alternative medications can happen ahead of care being delivered to patients and reducing the likelihood of adverse drug events or risks to patient safety.

Targeting medication ordering and purchasing to specific packages utilized at the hospital or health system and understanding if the packages impacted by a shortage will impact care delivery.

The Drug Shortage App allows customers to only order what they need, leaving inventory at the wholesaler or distribution center for other hospitals and providers to access for optimal patient care, and avoiding worsening the situation for the entire region. They also now purchase based on utilization patterns to ensure they are only ordering the amount of medication they will need versus everything available. This results in changing medication buyer behavior and provides transparency for the entire team instead of the buyer being the only person who is aware of what is available at the wholesaler.

As shortages reoccur pharmacy teams struggle to remember what was done previously to manage the situation or what changes were made.

The Drug Shortage App allows teams to create Action Plans that capture every step taken to manage the situation. This often includes moving inventory, identifying approved alternatives, creating alternative medication alerts, modifying EHR content, notifying and educating clinicians on changes and alternative medications, and identifying prescribers who are, and who are not, following guidelines for use of medications in shortage. When the shortage resolves the action plans allow the team to ensure the steps are reversed. The Action Plans are then archived and saved in the system so teams can revisit them at any time and understand what was successfully done last time as well as for other shortages compared to starting from scratch each time. This allows teams to manage more shortages instead of focusing on just one shortage.

Lack of transparency throughout an organization about the impact of drug shortages on pharmacy teams.

In many organizations, it is often the medication buyers or procurement staff who are first aware of a potential shortage and the individuals tasked with taking action to manage the situation. When necessary they will enlist the help of members of the pharmacy staff or shortage team to escalate the need for management, but many times the communication stops there. Because shortages can immediately become the top priority for those involved with managing them, other work such as patient consultations, medication use evaluations, order verifications, and biosimilar conversions falls lower on the list of things that need to get done. The Drug Shortage App gives buyers and pharmacy staff that time back by allowing for efficient management of shortages and reducing the time spent on shortages by up to 75% , so they can work on things like inventory management, diversion management, medication reconciliation, and other projects that benefit the health systems and the patients that are being cared for at the hospital.

Inability to track targeted medications that can be impacted by seasonality, spikes in diseases, or global pandemics.

In an era where hospitals and health systems have been ravaged by COVID-19, customers of The App can quickly understand their inventory, usage, and utilization of critical medications to treat patients presenting with symptoms of the disease. Specifically looking at spikes in demand for inhalers and nebulizers in particular patient populations and ensuring the supply of medications was available in the correct departments has enabled them to better care for those patients. Using trending data and identifying spikes as cases surged, they can understand dispensations and monitor availability to know what needed to be ordered and stocked and redeploy medications where they were most medically necessary. The system also allows for ongoing tracking of critical medications that are continually being watched to ensure they do not fall below the desired days on hand.

Outcomes

• Significant reduction of time in resolving drug shortages
• Significant savings due to improved drug shortage management
• Improved patient safety and related savings