The Impact of COVID-19 on U.S. Hospital Pharmacies

The Impact of COVID-19 on U.S. Hospital Pharmacies

Blog, COVID-19

COVID-19 designThe New England Journal of Medicine reported the first case of the novel coronavirus was confirmed in the United States in January 2020. This means that as of late July, there has been more than six months of sustained uncertainty and instability. We’ve likely all been impacted by COVID-19 in one way or another. Arguably, no one has been more affected than the healthcare workers risking their lives on the front lines every day to care for our loved ones while isolating from their own.

Along with this global pandemic came a wave of fear over the shortage of drugs, be it from supply chain issues or general population hoarding “potential cures” for COVID-19. Over the last 19 years, the American Society of Health-System Pharmacists (ASHP) reports an average of 143 new national drug shortages per year. As of July 20, ASHP is reporting that there is a current shortage of 209 drugs. With the large number of COVID-19 cases, we are battling with shortages of medications that include propofol, fentanyl, and hydroxychloroquine.

To find out how hospital pharmacies are being impacted by COVID-19 so we can share best practices and advice, we reached out to a few of our clients. In this Q&A, we interviewed Meghan, the pharmacy buyer at a large teaching hospital in the Northeast; Kristin, the pharmacy manager at Froedtert Hospital in Milwaukee; and Brian, the Assistant Manager of Pharmacy – Medication Utilization Strategy at University of Virginia Medical Center.

How has your pharmacy team been affected by COVID-19?

Meghan: There have been so many changes to our department affecting so many interdisciplinary teams. A good portion of the team have adjusted their schedules to help out where necessary. There are team members working from home, which is an adjustment. We have staff working in different areas than they are used to. The COVID-19 pandemic has really shown how flexible, talented, and dedicated our department is to our patients.

Kristin: In an effort to remain effective and due to low census, we’ve modified the number of hours staffed and some individuals are now working from home.

Brian: COVID-19 has presented unique challenges. Like many, we’ve learned how to communicate virtually. However, we’ve also seen more shortages of critical drugs at a time when we were already seeing increased usage.

How has COVID-19 affected the state of shortages at your organization?

Meghan: We’ve found the entire drug supply chain to be stressed. We’ve seen some older shortages that we thought were resolving rear their ugly head again (e.g., injectable opioids, IV fluids, heparin). In these instances, we already had plans of action that we could enact. However, COVID-19 has made some of these shortages more severe. We have usage rates that skyrocketed across the system—way over what was previously forecasted. This type of activity creates somewhat of a “perfect storm” where the wholesaler is unable to keep up with our demand, which then carries over to the manufacturer. Fortunately, we started to plan in advance of this pandemic, prioritizing and conserving critical items before we reached the peak.

Kristin: COVID-19 has impacted the quantities available for purchase of products used to treat patients with the virus. Many products have been placed on protective allocations, and we’ve been monitoring these products very closely for on-hand supply. We have also had much more interest in our shortage management process from individuals and disciplines not normally involved.

Brian: There have been more shortages than usual. Some have been more long-term, and many have been temporary. We have also seen challenges in being able to order products since our wholesaler has implemented restrictions to prevent over buying.

How long did it take before you started seeing shortages and what drugs are you seeing major shortages of (example: hydroxychloroquine)?

Meghan: We started seeing shortages almost immediately. We were proactive in adding medications into OrbitalRX so that we would be monitoring them ahead of time and be able to catch trends in our supplies. Some specific medications we’re seeing large declines in are propofol, hydroxychloroquine, cisatracurium, rocuronium, vecuronium, and large volume IV opioids.

Kristin: We started seeing shortages within days of news stories being released and new data emerging. In particular, propofol, Precedex, Nimbex, famotidine, and dexamethasone were the most heavily impacted.

Brian: We began seeing shortages in late February. As the pandemic worsened, many hospitals began purchasing supplies to prepare leading to stress on the supply chain. We have seen significant shortages with metered dose inhalers, opioids, sedation, paralytics and many other critical care drugs. We also saw fluctuating supply of several products that were reported as potential therapeutic options such as hydroxychloroquine, azithromycin, famotidine, and dexamethasone.

How are the shortages impacting non-COVID patients?

Meghan: We’ve implemented restrictions on certain drugs to try to hold that drug supply specific for COVID patients where clinically appropriate. For the most part, we’ve been successful in managing our shortages to the point where there has been little to no impact on non-COVID-19 patients.

Kristin: Fortunately, we’ve been able to maintain supply of all products, so there has been minimal impact for us. We haven’t needed to implement therapeutic interchanges or restrict use to certain populations as of yet.

Brian: Early in the pandemic, many hospitals saw decreases in elective procedures and admissions. Thankfully this allowed us to reserve stock. However, many patients who required critical care were still admitted. For example, we had to work closely with our providers and frontline pharmacy staff to switch between opioids weekly to ensure we had enough of each product when it was most clinically appropriate to use.

Are you experiencing shortages of drugs used to ventilate patients, such as propofol, fentanyl, and morphine?

Meghan: Yes, we saw the biggest hit at the beginning of April, but as of late April/early May, we have a good in-house supply of these items and have a plan in place to move forward in the event these remain in short supply.

Kristin: Yes, these are some of the most impacted products. Many manufacturers have responded by allowing us to purchase directly through them.

Brian: We have seen significant shortages with these agents. Just about any agent used to treat patients with refractory ARDS have been limited. Including those mentioned, we have also seen shortages with paralytics and sedatives such as dexmedetomidine and midazolam.

What adjustments have been made by your team in response to the pandemic?

Meghan: Pharmacy leadership meets multiple times a week as we continue to navigate our way through the health crisis. Our team has been incredibly proactive in preparation. Now that we’re hopefully at the peak, we’re able to project how long our drug supply will last us and determine and predict which items will have the largest impact on our patients. As a pharmacy department, we’re routinely reviewing drug usage and trends in usage so we can quickly pivot when needed.

Kristin: We’ve been closely monitoring specific medications across the system and allocating product to sites as necessary. We’ve also increased buying specific drugs we knew may be used heavily if our COVID-19 volumes increased. We’ve also purchased non-preferred concentrations and vial sizes in order to continue meeting our patients’ needs. Lastly, we’ve increased shift coverage for management of incoming stock and product purchasing.

Brian: We’ve increased our communication and developed strategies for real-time utilization so we can stay on top of any challenges that arise.

What advice can you share with other hospital pharmacies about how to prepare or adjust their strategies?

Meghan: Be flexible. Things will be changing quickly, and teams will need to adjust their plans accordingly. Meet as a team frequently, and discuss all options, changes, and trends you’re seeing. Don’t focus solely on COVID-19 drug supply and usage. Remember to check in on and monitor your pre-COVID-19 drug shortages.

Kristin: Make sure to determine a list of medications that you want to keep a close eye on and create a “goal” for on-hand supply. This gives buyers a clear direction on what to focus on as targets. Be sure to funnel requests for purchasing through one group. This group should be aligned with the team responsible for creating any clinical guidelines and providing direct care to COVID-19 patients. Perform daily monitoring of your supply of critical medications and consider alternate sources outside of your primary wholesaler.

Brian: I recommend keeping an open line of communication with your key stakeholders. Also, pay close attention to the news: you can bet if they report the next “cure” for COVID, it will be short tomorrow and identify a strategy to assess real-time utilization. Lastly, keep track of your changes even if things begin to resolve.

Has OrbitalRX helped your team better manage shortages during this crisis?

Meghan: We’ve been regularly adding records into our OrbitalRx instance and applying COVID-19 labels so we can view all COVID-19-related drugs and their inventory levels at a glance. This was so easy to do. Having notifications is helpful because rather than having to go to the wholesaler and check if a shortage item was back in stock, I can receive a notification that tells me when it’s restocked so I can make a purchase. We’ve been able to better identify trends, such as increasing usage numbers, so we’re able to quickly formulate plans to move forward. OrbitalRx has really made managing shortages so much easier. I’m grateful to have a platform like this during this time to assist in keeping our plans for shortages organized.

Kristin: We’re finding that our process for tracking inventory is much more streamlined. The ability to set a filter for our active shortages that focused on only COVID-19 drugs has been so helpful. Also, the OrbitalRX platform has allowed us to modify our current usage and get a quicker picture of our on-hand supply.

Brian: OrbitalRX was key in keeping track of the many shortages and related inventory. We were able to quickly organize our high use and COVID-19-related shortages by tagging key shortages. At a glance, we were able to see daily inventory for our most critical inventory without having to run multiple reports or getting lost in other shortages. We were also able to give key stakeholder access to our database to allow them to make quick decisions related to ongoing updates.

Thank you to the Workers on the Front Lines
Our team would like to express our utmost respect and gratitude to all of the frontline healthcare workers around the globe. We understand you’re giving 110% to support your patients and community, so we’re giving 110% to building the technology to support your efforts. Contact us if you’d like to schedule a custom demo with our team. We’d love to show you what our platform can do to decrease your workload and increase your efficiency.

About the Author:

Emily Nichols

Emily is the Marketing Director at OrbitalRX. She has been working in marketing in the tech and healthcare sectors for 15 years. The daughter of a medication monitoring and dispensing device inventor, and sister of an Emergency Department RN, the healthcare space was a natural fit for her marketing passion. She has a BS in Communications and Graphic Design.

Juniper Alcorn, PhD

Q&A: Why Predicting Drug Shortages Isn’t the Answer for Pharmacy Leaders

Q&A: Why Predicting Drug Shortages Isn’t the Answer for Pharmacy Leaders

Blog

We talked with OrbitalRX CEO Adam Orsborn, PharmD, and Chief Product Officer Nate Peaty, PharmD, about predicting and managing drug shortages in the age of artificial intelligence. Their answers, based on real-world experience in hospital health systems, may surprise you.

With technology such as artificial intelligence and big data, can’t we predict drug shortages yet?

Peaty: We’re excited to bring capabilities like advanced data analysis, AI and machine learning to help hospital pharmacy leaders. Ask a pharmacy leader, “Would you like the ability to predict shortages?” and of course they would say yes. But how possible is that? It’s debatable. It’s unlikely you can conclusively identify an impending shortage – for example, say with 100% certainty that six weeks from now, a specific med is going to go short.

But we can identify risks and probabilities and provide tools for your health system to effectively manage shortages, so the pharmaceuticals you need are there when you need them.

What about app vendors who claim to predict drug shortages?

Orsborn: It’s much easier to say in marketing materials that you’re using AI to do something really cool, than it is to actually do it. Anybody can dial up AI or machine learning, but you must have a robust and appropriately organized data set for these sophisticated tools to work for you.

You not only have to focus on the data, you also have to take those insights and make sure they fit with your hospital’s workflow. The way each hospital actually works is somewhat unique, and if a software solution doesn’t fit your workflow, and doesn’t work the way you work in the real world, what good is it to you?

Let’s say you could actually predict a drug shortage. What would happen?

Peaty: First ask, “How would knowledge of that impending shortage shape the decisions you make and the actions you take as an organization?” If there’s a 75% chance this med may go short, do you stock up? Do you spend an extra $50,000 to $100,000 stockpiling that med to try to protect yourself from a potential shortage?

If the shortage doesn’t happen, then you just needlessly went over budget on that product. There’s a real financial risk to you acting in a preventative way, anticipating the probability of a shortage that isn’t guaranteed.

Beyond that, if you predict a shortage next week and spook every pharmacy buyer in the country to stock up, it’s going to take out the supply chain. You’re going to go from the possibility of a shortage next week to a guaranteed shortage today, where the system is triggering shortages in the supply chain that may have been otherwise managed. That’s panic buying, and there’s enough panic buying in the marketplace already.

So predicting a drug shortage isn’t the best approach?

Peaty:

The challenge is to use big data, machine learning and AI collaboratively to stabilize, not destabilize, our national health system. We have to think beyond panic buying, which becomes a self-fulfilling prophecy of medication shortages, and instead focus on broader, higher-level objectives.

For us, those objectives are to understand the overall infrastructure that every hospital in this country is working in and depending on, and help health systems navigate that to ensure every health system is getting what they need for their patients.

As we continue to grow and expand the data we’re bringing into the system, we believe AI and machine learning will be best deployed to help identify where you have strategic risks, rather than an acute risk that tends to be addressed through a panic buy or hoarding type of behavior.

What will help health systems manage medication shortages?

Peaty: Our approach at OrbitalRX is to stabilize your pharmacy and health system. We can give you advanced awareness of a supply chain risk, for example, and give you tools to take useful actions with that knowledge.

Let’s look at what inventory you’re carrying in your hospital. How consistently have those products been available in the past? Are there certain items you’re dependent on just one supplier to provide? We help you proactively identify strategies around that, which includes finding additional suppliers for those meds and exploring alternatives.

Helping you easily see, organize, and put all of that information together, in a way that fits your workflow, will enable you to better manage drug shortages.

I want us to consider a more thoughtful approach discussing the harm that comes trying to anticipate shortage, from hoarding and not having solid information about all of the sources available to you in your market.  LogicStream is still saying that they have an “early warning” system.  While that is not prediction, it has the same negative downstream impacts of potentially creating or worsening a shortage where none exists.  At OrbitalRx we partner with health systems and industry stakeholders to make the problem of shortages better for everyone.  The more organizations that join our cause, the better it gets for everyone.  We work to ensure you have all of the information that you need to make the most responsible decision for your patients and all patients who need these medications.

Where do health systems need to focus in order to better manage drug shortages?

Orsborn: We focus on these key areas: your inventory, your supply chain, and how you organize your workflow and communicate your strategy throughout your organization.

In the first area, we help you conserve the inventory you have, using a real-time view of your inventory. What product you have, where it’s at, how fast it’s moving out of your system, and what has happened with this product historically. This helps you better manage what’s happening internally, without affecting the market more broadly.

In the second area, we give you a bigger and better view into what else might be available. We show you all the potential options, in terms of medication alternatives and available suppliers across catalogs. In this way you can spread out your buying strategies, be more secure in them, and quickly see at any time all the options available to you.

The third area, workflow and communication, is about giving you the tools to help you organize and automate all of this information so it’s readily available, wherever you are. Much better than the old way of manually organizing it into spreadsheets that then sit in people’s inboxes.

By focusing on all three of those areas, you can be as responsive as you need to be to effectively manage shortages, regardless of whether there’s an early warning or not.

Are there clues pharmacy leaders should pay attention to?

Peaty: There are data signals that help our clients stay alert to when things are starting to change. It’s all about situational awareness, which means taking the information we make available to you currently and staying alert to where things may be starting to change.

The trick is to identify which data signals and patterns are most consistent with supply chain risk, and then take informed action. With awareness of your current inventory situation, as well as the external supply options in terms of alternative drugs and suppliers, you can use that information to make faster and more informed decisions.

When it comes to managing drug shortages, does what works for one hospital health system also work for another?

Orsborn: The situational awareness around inventory and supply chain is important for every health system. What’s key is for a drug shortage management system to work the way hospital pharmacy departments actually work today. We hear that in every demo we do: the importance of aligning with the health system’s real-world workflow.

Peaty: Most hospitals follow a fairly consistent process: Everybody is contacting their suppliers, their buyers are shopping online, they’re meeting regularly to update stakeholders, and they’re communicating out to external stakeholders. But each site is different and has their own unique challenges, and their workflow has its own special flavor.

We have to be flexible enough to allow sites to work the way they work best, and recognize the things that have worked best for them in the past. But we also have to allow enough structure across each site so we can provide a consistent service and solution for all of our users. With that balance, we can help your health system, as well as the overall national health system, work better.

What’s next in terms of better managing medication shortages?

Peaty: We believe we can do more things collaboratively, and with more transparency, that will help stabilize the national health system, make your health system site the best it can be, and do that in a way that results in a better, more sustainable supply chain.

Things like panic buying and stockpiling don’t help. Our focus is to help you make smarter and more strategic decisions, and to connect those efforts of pharmacy leaders as well as medication suppliers to make the whole system better.

Interested in learning more? The OrbitalRX drug management solution helps reduce complexity, proactively manage data and workflows, and better communicate with hospital leaders and other departments for effective drug shortage management.

To schedule a demo of the OrbitalRX solution, send us a message.

Related:

Nate Peaty
Adam Orsborn
6 Steps for Managing Your Drug Shortage Strategy During COVID-19

6 Steps for Managing Your Drug Shortage Strategy During COVID-19

Blog, COVID-19

Drug Shortage Strategy | Medication​Hospitals nationwide have struggled with their drug shortage strategy during the COVID-19 pandemic, from tests to personal protective equipment (PPE) to other supplies, such as ventilators. While hospitals are beginning to get these shortages under better control, they are confronting a growing challenge: The outbreak has placed a significant strain on the drug supply chain, leading to warranted fears about drug shortages and their effects on patients and providers.

There are many factors contributing to current shortages of drugs. These include reduced global production and distribution, increased use of medications to help treat COVID-19 patients, and people stocking up on drugs for various reasons. In late February, the U.S. Food & Drug Administration (FDA) announced the first shortage caused by COVID-19. In the weeks that followed, medical and industry experts have been increasingly sounding the alarm about drug shortages.

Drug Shortage Strategy: Key Steps to Take

Since these and other challenges are not likely to be resolved any time soon, health system pharmacists must strive to improve their ability to effectively manage their organizations’ drug shortages during this difficult period. Here are six steps to follow to help make this demanding task a little easier.

Step 1: Stay current with external and internal drug shortages

First and foremost, pharmacists must ensure they remain current with the latest drug shortages and discontinuations. There are several good websites that actively monitor the supply chain and provide updates on shortages. These include those from the FDA, American Society of Health-System Pharmacists (ASHP), GoodRx (which sources FDA and ASHP), and Drugs.com.

While staying current on external drug shortage data is critical, so is staying current with internal data. Pharmacists can leverage technology to enhance their management ability. For example, the OrbitalRX platform provides pharmacists with organized, easy-to-assess data about their health systems’ shortages and availability. This knowledge is critical to making educated decisions that can help systems mitigate the ongoing impacts of shortages.

Step 2: Monitor regulatory developments

As part of the effort to combat the chaos unleashed by the pandemic on the U.S. healthcare system, the federal government has undertaken regulatory initiatives. Some have been directed toward addressing the drug shortage.

For example, provisions included in the March “Coronavirus Aid, Relief, and Economic Security Act” (CARES Act) are directed at drug shortages, notes ASHP. These include the FDA prioritizing reviewing applications for generic drugs in shortage and enhanced reporting requirements for manufacturers with drug shortages.

As another example, as FiercePharma notes, the FDA announced in April that it would “… temporarily allow hospitals to source hard-to-find drugs from compounding pharmacies to treat certain patients hospitalized with severe COVID-19.”

In the announcement, FDA stated, “… FDA generally tries to address potential and actual drug shortages by working through the global pharmaceutical supply chain, rather than relying on compounded drugs, and focuses on restoring supplies of FDA-approved drugs. However, in light of unprecedented disruptions to, and demands on, the global pharmaceutical supply chain as a result of the COVID-19 pandemic, and in order to respond to evolving regional conditions, additional flexibility is temporarily needed to help ensure that treatment options are available when hospitals are unable to obtain FDA-approved drugs used for hospitalized patients with COVID-19.”

Pharmacists should work to stay abreast of new regulatory developments and understand how these developments may affect their ability to secure drugs facing shortages.

Step 3: Follow production and accessibility developments

While regulatory developments such as those noted above can help improve the ability for pharmacists to acquire and compound the drugs they need, other significant contributors to drug shortages include disruptions to importing of critical medications and the ability for U.S. manufacturers and distributors/wholesalers to keep up with demand.

In late March, the Center for Infectious Disease Research and Policy (CIDRAP) announced preliminary findings from its Resilient Drug Supply Project — an effort to define and address vulnerabilities to the public health resulting from medical drug shortages. Among the findings: There are more than 150 critical drugs needed for acute care within a few hours to days or patient mortality rises and many of these drugs are made, formulated, packaged, or have an active pharmaceutical ingredient (API) made in China, India, Italy, or other countries severely affected by the pandemic. The pandemic has not only led to curtailed production and shipment of medications in these countries, but also led to countries restricting how much they export in the interest of maintaining enough drugs for their own population.

In April, the Drug Enforcement Administration (DEA) raised production quotas for many medications used to care for patients placed on ventilators. However, as the Advisory Board notes, “… it’s not clear whether companies will be able to adequately ramp up production of the medications to meet the increased demand.” DEA has also announced plans to increase importation of several of the drugs (e.g., ephedrine, pseudoephedrine, phenylpropanolamine).

Drugmakers are issuing their own statements concerning potential shortages. Some are warning of shortages. Others are promising no shortages.

The better that pharmacists and their departments can keep a finger on the pulse of the rapidly changing developments concerning production and accessibility, the better positioned they will be to execute an effective response plan.

Step 4: Step up communication and collaboration with wholesalers and distributors

Due to the rapid and significant developments impacting the drug supply chain, the availability of many vital medications seems to experience frequent, substantial changes. This is a time when communication with a pharmacy’s sources for medications is essential.

Pharmacists should keep open lines of communication with their primary wholesalers and secondary distributors and ensure these sources are well-informed about current inventory and the medications in highest demand in the hospital.

Furthermore, wholesalers and distributors should be encouraged to keep pharmacists informed about developments, such as those highlighted earlier, to ensure nothing of importance missed. Pharmacists should also explore how they can collaborate better with wholesalers and distributors within and outside of their health systems to help ensure medications are directed to the sites where vital drugs are needed most.

Step 5: Strengthen communication and collaboration with clinicians

Strong communication about shortages with affected clinicians — and other stakeholders, including administrators — is also crucial. The Institute for Safe Medication Practices (ISMP) produced a helpful document about managing a drug shortage crisis in 2010 that offers a great deal of information applicable to our current situation. It includes a section on how to establish ongoing communication with staff.

ISMP recommends regularly sharing information with clinicians about the following:

  • Drug shortage, causes, and expected duration (if known)
  • Assessment of current drug availability
  • Temporary therapeutic guidelines, including use limitations for the shortage drug
  • Alternative products and how they will be supplied to units
  • Dosing, preparation, and administration guidelines for alternative products
  • Error potential with alternative products and how to reduce risk
  • Additional patient monitoring and safety steps that may be required when using an alternative drug.

ISMP advises pharmacists to prepare and update daily a report that includes this information on the most critical drug shortages and use this report to keep clinicians and other stakeholders informed. In addition, the organization recommends that pharmacy staff receive daily briefings concerning all aspects of drug shortages so they can serve as a resource to others in the organization.

Pharmacists should also communicate and work more closely with prescribers to coordinate the most effective use and conservation of drugs in short supply. Ways to do so include identifying clinically appropriate alternatives for shortage drugs and developing protocols to guide decisions concerning usage of such medications.

Step 6: Be diligent about diversion

Drug diversion remains a considerable challenge for pharmacists. Pharmacy Times recently reported on findings from Kit Check’s latest “Hospital Pharmacy Operations Report.” It showed that more than half of survey respondents reported having a diversion event within the last year. In addition, 37% were aware of at least one colleague who diverted controlled substances.

The COVID-19 pandemic opens up opportunities for diversion, including of drugs in short supply. Individuals looking to steal medications may try to take advantage of any disorder and reduced oversight in pharmacies and hospital departments. Drugs in high demand often command a high price on the black market, further enticing individuals thinking about diverting drugs to take risks. Some individuals may be interested in diverting shortage drugs for their own needs and the needs of family and friends.

In the rush to secure and distribute shortage drugs to departments and patients who need them, do not let your guard down as this can lead to the loss of vital medications and large penalties. If you’re concerned about diversion, considering implementing some of the recommendations from this HealthLeaders article.

Managing Drug Shortages: Stay Vigilant

Drug shortages were a fact of life before the COVID-19 pandemic. Now shortages are growing worse, putting increased strain on pharmacists and prescribers, particularly since some medications currently in high demand and short supply can be the difference between life and death for patients. Pharmacists must work with everyone involved in the drug supply and administration chain to best minimize interferences with patient care.

As emergency physician Dr. Jeremy Samuel Faust writes in his column titled “Medication Shortages Are the Next Crisis” and published in The Atlantic, “Doctors are only as good as our teams, our equipment, and our medicines. If we get the PPE we need, our teams will stay safe. If we receive much-needed equipment — tests, ventilators, IV pumps — in time, fewer of our patients will die needlessly. But if we can’t provide medications that make what we do effective, all our efforts will be for naught.”

About the Author:

Adam Orsborn PharmD, MS

Adam brings his experience as a successful health-system executive at a top academic medical center; a trusted design, development, and customer success advisor for pharmacy technology companies; and a pharmacy practice leader with extensive experience in specialty pharmacy, finance, operations, and organizational and leadership development to OrbitalRX. As the CEO, Adam is driving the vision and strategy of the company, while following market trends to ensure the product aligns with the needs of pharmacy teams.

Juniper Alcorn, PhD

COVID-19 and the Crisis in Data

COVID-19 and the Crisis in Data

Blog, COVID-19

COVID-19 is most evidently a potent respiratory virus at the heart of a global pandemic—neither of which are unheard of. What sets COVID-19 apart is that it is, at its heart, an unprecedented data crisis. By placing the emphasis on data as the source of truth, we obscure the political processes behind capturing, defining, and institutionalizing data, and downplay the power of the individual in judging and acting on data.

Is there truth in the COVID-19 data?

Data is at its core a contradiction, even when it creates valuable and significant knowledge. What we consider “data” is not an individual piece of knowledge, but the whole, an agglomeration of information presented as numerical insights. The contradiction here is that a single datum, or piece of data, is insignificant on its own, but gains more importance the more data there is. That one piece of information gains power by being understood in larger and larger contexts. So, data is both the annihilation of the individual, and its culmination in the group. 

Despite the fact that data appears interchangeable with knowledge, “truth” in data is a moving target. Because the individual datum is inconsequential on its own, the “truth” of data resides in its interpretation and analysis. “Raw” data is indeed a valuable raw material that requires labor to form it into something meaningful. But because raw data is information (as opposed to some other raw material like cotton or ore), the work to form data into insights doesn’t “use up” the data, it can even endlessly multiply the data: for example interpreting a set of data against new variables, applying new formulas and algorithms, or defining the unit of data differently. There’s only so much cotton in a bushel…but data proliferates.  

When data speaks for itself: COVID-19Johns Hopkins COVID-19 Data Dashboard

COVID-19 is a crisis in data because it brings the contradictions of truth in data to the forefront, and pushes the limits of data-driven decision making. Here I have two key examples: the tepid United States response to the pandemic and the admonition to “flatten the curve.” The first shows the inherent instability of “truth” in data, and the second shows the danger of believing the data is truth.

The United States response

Institutionally, COVID-19 shows how unstable a data-first analysis can be, because one’s point of view–measurements, chosen variables, applied formulas–define the data. As it spread across the world, we saw different countries’ health organizations struggle to analyze and communicate important information. And if key concepts differ between countries (for example, “confirmed cases”) we will get different pictures of the disease in each place. This also assumes that institutional standards and analyses are free of political influence, that everyone is simply “after the truth.” The fact remains that data analysis lends itself to politicization easily. How one researches, changes results. Those results might be overall similar for a layperson (thousands sick), but they will certainly affect public health priorities and policy decisions. This, combined with a capricious and insecure White House, led to a slow and often contradictory response from United States political leaders.

“Flatten the curve!”

Less formally, we hear “flatten the curve”: the slogan of every-day people to persuade others to act in light of the danger of COVID-19. The curve appears as the truth of the situation, be it calamitous or mild, but it requires the good faith (and good behavior) of the individual. Against the “curve” of millions, my individual actions bear statistical weight.To “flatten the curve” is a data-driven (based in fact, truth-bearing) moral argument about an individual’s social obligations to others. Such an argument conflates the factually-based with the inherently social, political, and moral realms of how to act toward others. This conflation contributes to a general moral panic and the social ostracization of those who are seen disobeying the new rules (not social distancing, visiting family, etc). It also serves to justify strong, centralized political institutions to enforce the moral law. 

Thinking into the future of data

Ideally, data supports experienced and educated experts in making day-to-day judgment calls. In light of this, I consider OrbitalRX’s drug shortage management platform to be optimal: we find and organize important data around drug shortages and availability. But this data is not the answer: it serves to support hospital pharmacists in making their own practical decisions as the situation demands. We require this ethical fulcrum of human decision making in Healthcare, but it is the core of any meaningful data-decision.

For some, the lasting impact of COVID-19 will be tragedy. But for all, it will be a historical and political rupture, a sudden and unprecedented shift in governments and economies, that led to quick, extreme, and lasting social changes. I believe COVID-19 will come to define a crisis in our faith in data. The way beyond this crisis is not to search for greater truth in data, but to find the truth that data stands in for, and to attribute meaning to those who make it: the decision makers.

About the Author:

Juniper Alcorn PhD

Juniper received her PhD in Philosophy from The New School for Social Research in 2019, writing on new biotechnologies and their social impact. She works as a Software Developer at OrbitalRX.

Juniper Alcorn, PhD

Managing Hospital Drug Shortages: Better Data Means Better Decisions

Managing Hospital Drug Shortages: Better Data Means Better Decisions

Blog

“Automation removes a lot of the manual work that’s been happening in every department to get at that information. Even more important is automating that data at the point in your workflow where it makes the most sense – the point where that information is particularly valuable, so you can make better decisions.”

To get a basic analysis of how fast a health system’s sites are using a specific drug, a manual approach might require a team member to spend a half-day or more downloading data and using an Excel spreadsheet. In contrast, Orsborn says the OrbitalRX platform requires very little manual entry.

“The vast majority, 90-95+ percent of it, comes from our automated gathering of that data from the catalogs and hospital and inventory systems,” he says. “You type in the code for that drug, and it’s all there in front of you instantly.”

Mobile data solution brings faster decision-making

Managing drug shortages requires plenty of team discussion and decision-making. Many of those conversations take place in hospital conference rooms, hallways, and pharmacy areas, by people who are continually on the move.

A technology solution that gives them quick access to the information they need on their smartphones enables hospital and pharmacy leaders to make good and timely decisions, with accurate, up-to-date information always at arm’s reach.

“Our ability to allow pharmacy leaders to quickly pull up their phone and see if a drug is already on our shortage list, learn the relevant information about it, see what alternatives are available, and have these critical discussions wherever they are is a tremendous time-saver,” says Peaty. “It allows them to be much more efficient in their decision-making and response.”

The OrbitalRX platform uses mobility to place information in the hands of the appropriate user, when and where they are using it, and make collaboration easier. Orsborn says:

“Instead of a spreadsheet that only one person can be in at a time – even though you might have 10 people who need that information at any given moment – you now have up-to-date, mobile data, which can move to anybody who needs it. All members of the shortage management team can be logged in at once, allowing them to meet and make decisions virtually.”

Customization provides flexibility for hospital workflows

Each health system’s workflow has similarities with other hospitals, as well as aspects that are unique to their site.

A drug shortage management system that can offer standard best practices as well as customizations that respect differences in hospital workflows provides a new level of flexibility for shortage management teams.

Some sites might focus more on one pharmacy area as a bellwether for how they’re doing in managing shortages, preferring a fast view and summary of just their central pharmacy inventory numbers. But other site teams may want to see the global picture of all their health system pharmacies from the beginning. Peaty says:

“The trick for us has been to be flexible enough so sites don’t feel like they have to depart from the way they work best, while also allowing enough structure across the site so we can provide a consistent service and solution for all of our users.”

The OrbitalRX solution takes into account the fact that shortage management teams are not all designed the same, and roles and positions can vary from one hospital to the next.

“The ability to ensure our system takes multiple users into account and understands the differences from site to site is important,” Peaty adds. “We can’t build something that can be used only by a pharmacist, if technicians are playing a huge part in these shortage management efforts at other sites.”

Customization recognizes that managing medication shortages may be a team effort at one health system site, while another site may be a one-person show.

“That one person is going to document processes very differently than a site with a ton of people involved,” says Orsborn. “That changes how we configure the system in terms of how clients document tasks and information on a day-to-day basis, according to their needs.”

Historical data and insights add value for decision-making

Drug shortages tend to repeat themselves. Or they can drag on, lasting for months or even a year or more. Either way, hospitals benefit from having easily accessible, historical data on how they’ve dealt with a drug shortage.

From the supplier strategies used, to the alternative medications prescribed, to how shortage management teams communicated with key stakeholders – all of this recorded data helps pharmacy leaders make faster decisions, avoid missteps, and better manage medication shortages.

In “How Your Hospital Pharmacy Can Manage Drug Shortages,” Christopher Van Norman, director of operations for McKesson, emphasizes the importance of data, analytics, and communication strategies:

“The entire supply chain industry is going through a data revolution right now, and the drug supply chain is no different. Technology, data and analytics will be central to everything that you do. But technology, data and analytics won’t mean much if you don’t know what to do with them. You still need to collaborate and communicate. If you do that, you’ll produce better outcomes for your patients.”

Interested in learning more? The OrbitalRX drug management solution helps reduce complexity, proactively manage data and workflows, and better communicate with hospital leaders and other departments for effective drug shortage management.

To schedule a demo of the OrbitalRX solution, send us a message.

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