Wednesday, September 28, 2016

EpiPenalty vs. EpiPenance

Fast  Foreward

The brilliant minds at beleaguered Theranos Inc. must have heaved a sigh of relief as Mylan Pharmaceuticals usurped as much negative publicity as word leaked out the company had been price gouging for years its EpiPen product that delivers life-saving epinephrine quickly to those suffering allergic reactions.

Online message boards and social media outlets erupted at the gall, lambasting Mylan’s actions and for the CEO’s reported exorbitant compensation package, she the daughter of a U.S. Senator, which somehow made it even more heinous.

Armchair moralists cried foul, calling for boycotts (unrealistic), government intervention (do we really want federally mandated price controls?) and all sorts of compensatory and punitive punishments for the CEO and her C-suite cronies. One commenter even suggested that the way for the CEO to make amends is to dedicate one full year of her compensation package to a trust fund designed to support those organizations and individuals who cannot or may not afford to pay for access to the desired product. Good luck with that.

But such a magnanimous gesture may not be part and parcel of her personality. Maybe it wouldn’t even be in ours were we faced with such opportunity. After all, we live in a capitalistic, free-market economy. Prices are set based on supply and demand, as well as what the market allows and will bear, but especially what the general public will accept.

To counter the vitriol aimed at its pricing structure, Mylan introduced a generic alternative at half the price. Critics remained unimpressed. Was the product as potent as the brand-named version? Would you need to buy more to achieve the same outcomes as the original? Was this a way for Mylan to retain its profit quotas and expectations?

Mylan may have “cut” the price via generic alternative as a “magnanimous” gesture, but the real issue is that our system enables all of this behavior. This really doesn’t represent a capitalistic free-market economy. After all, if it did, people would protest and stop buying the product once competitors emerged or were forced by government edict/executive order, shifting to lower-priced competitors (if they existed), which would drive Mylan to reduce their prices.

The issue here is that Mylan raised prices to an egregiously obnoxious level over a 10-year period, justifying it partly on the high quantities of free product they have to give to schools. To some, that redefines the concept of “free” markets. To others, it’s merely the Sheriff of Nottingham canceling Christmas while Robin Hood rallies the educational system around unfunded charity mandates.

This doesn’t mean schools and other organizations should not have access to EpiPen inventory. It just means that everyone should realize the fundamentals of economic inertia: For every action/decision, there is an equal but opposite reaction/decision. You poke a balloon on one end and if it doesn’t pop you’ll find a protrusion on the other end.

Gravity, physics and good sense. Sigh. 

Perhaps the better — or at least less sticky and stinky solution — is to allow the feds a little regulatory latitude, albeit heavily checked, for them to require that any product brought to market has a generic alternative readily available to guarantee competition right from the start. The caveat? The generic version would have to be owned by a completely separate company with no shared stockholders or venture capital investment houses. This way, the market can be allowed to dictate pricing. This also means that Mylan would have to divest its generic version either as a spin-off or outright sale to another company. Sound draconian and intrusive? Maybe. Maybe not.

There’s something of a precedent in the telecommunications industry. Back in the go-go 1980s, the perceived hegemonic monopoly AT&T (colloquially known as “Ma Bell”) had to divest a variety of assets (a “voluntary” settlement as a hedge against federal fiat). AT&T spun off its research and development conceits and its local calling operations, but retaining the long-distance calling market. The local calling operations broke into smaller regional corporations to enable competition. Furthermore, as communication technology started migrating to fiber-optic cable from copper wire, these regional companies and their “Baby Bell” subsidiaries (I worked at Illinois Bell Communications, for example) were “encouraged” to lease “available” lines to smaller companies to engender competition.

Can Big Pharma or any other healthcare corporate entity learn from the telecommunications industry? You bet. Whether on Wall Street or via private equity venture capitalists, it’s a “just call,” because “we’re all connected.”

Rick Dana Barlow

Wednesday, September 21, 2016




Salt Lake City, UTAH

Two companies. One war.
Hundreds of victors.

A war was brought to truce through service at the Globus Relief headquarters in Salt Lake City, Utah in August. Companies NFP/FirstWest Bene t Solutions, a Utah-based insurance broker and health and retirement bene ts consultancy, and Hospice for Utah, an in-home hospice service company, waged a wellness war over the summer months, each challenging the other to better living through a system of points won for healthy habits and positive life changes made. And the prize to the victor? The losing team had to convert the winning team’s points into donation dollars at a rate of 5 cents per point.

The teams tallied the nal results at the end of summer and NFP/FirstWest was dubbed champion. The resulting donated funds were used to help resupply a local Utah dental o ce that had been devastated by re earlier in the year, su ering a quarter of a million dollars’ worth of damage. Because of Globus Relief’s unique acquisition and distribution methods, the funds produced a humanitarian impact multiple times greater than the original donation.

The companies celebrated the victory on August 15 at Globus Relief’s warehouse in Salt Lake City. Representatives from each company joined Globus Relief sta in re-packaging medication administration packets to be sent to humanitarian e orts worldwide through Globus Relief’s many charity partners. The true victors of this story turned out to actually be the victims of other wars waged – hundreds of poverty-stricken people in need.

Please keep Globus Relief in mind for any excess medical supplies, instruments or equipment you may have available.

Thank you for your generous donations that make it possible for Globus Relief to supply Eyes4Zimbabwe with equipment and supplies in this manner. To continue supporting healthcare and humanitarian efforts throughout the world, please contact Globus Relief.

Globus Relief is Your Humanitarian Non-Profit Inventory Solution. Please contact us if you have medical or dental equipment, instruments, and supplies or other resources available for donation.

Tuesday, August 23, 2016

Tower Power

Fast  Foreward

During the Independence Day holiday this past summer, the Barlow family visited the Smithsonian Air & Space Museum at Dulles International Airport in Washington, DC.

One of the exhibits was a replica air traffic control tower. Visitors were able to watch airplanes take off and land as well as read detailed displays and watch videos that explained what air traffic controllers and operators do, how they do it and why they matter.

We all have a general idea of how they operate, of course. A station at the exhibit stated that "the air traffic control systems main purpose is to prevent collisions by separating aircraft from terrain, obstacles, and other aircraft.

"Air traffic controllers organize the flow of traffic; keep the traffic flowing smoothly, safely, and efficiently; and coordinate the movement of aircraft around bad weather… provide information about weather and unexpected events and advise pilots about more efficient routes."

In short, their efforts can make the difference between life and death.

Thoughts of the healthcare supply chain leaders operating in a similar manner came to mind. How so?

"Supply chain leaders organize the flow of products and other resources; keep the products and resources flowing smoothly, safely, and efficiently; and coordinate the movement of products and resources around changes in demand and usage… provide information about consumption and practice patterns and unexpected demand changes and advise clinicians about more efficient product and service options to help them improve business and clinical operations, their individual practices and patient care as a whole."

In a way, their efforts can make the difference between life and death, too.

Supply chain leaders - just like air traffic controllers - function as advisers and facilitators, continually amassing and analyzing data on resource consumption patterns, clinician practice patterns (doctors and nurses) and supplier production patterns so that they can provide useful information to their clinical, financial and operational customers when they ask for it, if not before they ask for it.

Such applications of data science from a supply chain control tower represent the litmus test for the supply chain executive and leader of the future.

Of course, whether you’re ready may hinge on the maturity of your supply chain operation. A few weeks ago, Healthcare Purchasing News hosted a webcast sponsored by Ryder Systems Inc. where Ryder supply chain pros highlighted the importance and magnitude of supply chain operations as the second-largest cost center behind labor with the gap between the two closing as the years advance. (To access the webcast,visit

One key element for success? Effectiveness as a baseline before efficiency for supply chain practices. Basically, perform it right before you decide to improve it to the point of doing it well — or at least better.

The challenge? Ryder execs cited research from the Center for Innovation in Healthcare Logistics at the University of Arkansas that showed more than 50 percent of supply chain execs surveyed classified their operations as "ad hoc" and "defined," which CIHL and Ryder termed as "immature."

The bottom line: You have to walk before you run, and apparently many organizations have miles to traverse.

So the question remains: Do you have what it takes to build and maintain a supply chain control tower operation?

Doctors, nurses, your healthcare organization and the patients you serve — not necessarily in that order — depend on it.

Rick Dana Barlow

Thursday, August 4, 2016





Bondo, Kenya

Daniel had a huge growth over one eye when Ralph and Linda Bartholomew firrst met him in Bondo, Kenya. They also met a young woman who was blind as a result of cataracts. Two di erent people that needed medical intervention and had been in need for a long time, but could not be helped. Daniel because his illness had taken over his entire body, and the young women because the medical personnel did not have the expertise or instruments to remove cataracts. Daniel passed soon after while the young woman continues to struggle with lack of sight.

When Ralph and Linda left for Kenya with the help of their local church, The Way International, they went under the guidance of Foundation Stone Ministries who operate an orphanage in Bondo and support free clinics for the people in and around Bondo. They knew the mission trip may bring di culties their way, but they did not expect to feel so helpless as they worked tirelessly to treat thousands of wounds.

Bondo, and its surrounding communities, is made up of about 30,000, many of whom live in the bush. Medical care is rarely available, and if so, it is beyond the means of most, and often not given the priority it should. During their time in Bondo, Ralph and Linda helped out in a medical clinic generally treating wounds that had been ignored., several a result of complications from diabetes. With the supplies they brought, over 2,500 patients, including a woman with leprosy, were treated.

Another woman with elephantitis had open, festering wounds that had not received treatment to the point that her leg was going to be amputated. With the much needed supplies and time, her leg was saved. She is one of many who benefi tted greatly from treatment. Ralph & Linda know good was accomplished, that their presence and the vital supplies they brought made a di erence in so many lives, yet the fi rst thing Ralph will say is, “There are still so many that we can’t help.”

Please keep Globus Relief in mind for any excess medical supplies, instruments or equipment you may have available.

Thank you for your generous donations that make it possible for Globus Relief to supply Eyes4Zimbabwe with equipment and supplies in this manner. To continue supporting healthcare and humanitarian efforts throughout the world, please contact Globus Relief.

Globus Relief is Your Humanitarian Non-Profit Inventory Solution. Please contact us if you have medical or dental equipment, instruments, and supplies or other resources available for donation.

Wednesday, July 20, 2016

Supply Chain Inc.

Fast  Foreward

CHICAGO - Whenever someone mentions that Supply Chain should be concerned about revenue, eyes tend to roll and lungs heave sighs of resignation. After all, Supply Chain doesn’t generate revenue. That’s a top-line concern. Supply Chain manages expenses. That’s a bottom-line concern, best left to those boys and girls in the basement.

Not so fast, posit a number of speakers at Eye for Transport’s 3PL Summit and CSCO Forum in Chicago. Time to hop into the elevator to control and manage a considerable piece of the organizational pie: Data.

Powerhouse IT companies, such as IBM, Oracle and SAP are spending billions of dollars on data analytics firms, according to Steve Banker, Supply Chain Services Director, ARC Advisory Group. Banker argued that "supply chain people" need to recognize and understand that analytics is being used across departments and processes. Data should be the link that balances supply and demand to help an organization meet its growth objectives. In fact, that’s why companies are spending money on systems to improve revenue and not necessarily to reduce costs, he added.

Even CHRISTUS Health, the 2016 Supply Chain Department of the Year, has invested in data analytics and informatics that is paying dividends for operations and patient-care delivery. And the recent Pensiamo joint venture announced at press time between IBM Watson Health and UPMC (the 2014 Supply Chain Department of the Year) signals this developing trend in healthcare that already has planted roots in industries outside of healthcare.

On the dais with Banker, Competitive Insights CEO Richard Sharpe cited that by 2020, 35 zettabytes of data will be produced annually with data volume doubling every 18 months. That’s not just Big Data; that’s Big Data on PEDs. "Data is growing exponentially so we need to find value in it," Sharpe asserted.

No kidding.

Banker and Sharpe both posited that data analytics fused with data management - fueling the blossoming profession of data science - will prove to be a boom and boon for Supply Chain to wield this asset (data) around the administrative, clinical, financial and operational realms of the C-suite.

"Supply Chain is having a hard time putting their hands around revenue generation," Banker said, but controlling the data card may be the answer to driving changes throughout the organization. It’s one thing to know what happened when and why; it’s another thing to know how to respond with intelligence.

Supply Chain pros should not dismiss this informatics notion as an IT project. IT builds the clock; data science via Supply Chain reads the time and figures out how to manipulate and use it to support business functions throughout the organization - not just the warehouse, stockroom or operating room and nursing floor supply closets.
This extends well beyond the trite "show docs the data" refrain. Through data science, Supply Chain effectively can demonstrate to the C-suite how a service line, care offering or business decision can be profitable for the organization - clinically, financially and operationally.

Fortified with an enterprise-wide view, end-to-end access and a cognitive ability to analyze anything, predict behavior and demand and prescribe workable comprehensive solutions that "make money" along a "net-X" mindset versus a more limited "save money" mentality is just what the Supply Chain profession needs to deliver - and what the C-suite needs Supply Chain to deliver.

Breaking through that artificial barrier should propel Supply Chain from relevance to reverence. It’s about time.

Rick Dana Barlow

Wednesday, June 22, 2016

Think of your loved ones

Fast  Foreward

The most expedient policy covering validation of the twin components of sterile processing procedures — cleaning and disinfection/sterilization — calls for good parenting skills.
Actions lead to consequences.

When an auto racer fails to follow the rules and commits an error on the track — accidentally or flagrantly — he or she earns a black flag. That driver then must leave the track, regardless of position, return to his or her pit, bring the car to a complete stop and then return to the track. The risk? The driver may lose hard-earned positioning and be taken out of contention for the win. But that’s the price you pay for violating a rule.

Within the last few weeks, we’ve spotted several news reports shining a spotlight on breakdowns in the sterile processing field.

For one article, a reporter and her editor questioned whether bioburden left on a surgical instrument after the cleaning process poses any problems once the instrument exits the sterilization process. Certified, experienced and forward-thinking sterile processing experts know the answer.

In another article, a hospital failed to notify patients that contaminated duodenoscopes were used on them, leading to post-operative infections. Furthermore, the hospital failed to follow proper cleaning guidelines. To wit: They used canned compressed air from an office supply store to dry scopes.

In yet another article, the FDA issued mixed messages about a prominent manufacturer of automated washers, originally ordering a recall based on questions about the equipment’s effectiveness and how it handles duodenoscopes, but then backpedaling from that recall to allow the equipment to be used on "instruments including most endoscopes — just not duodenoscopes." Call this "in-dispute" technology.

For both cleaning and sterilization, effectiveness should be the prerequisite for efficiency — and certainly cleaning first and foremost. Nothing should be left behind in the cleaning process; only a completely clean instrument can be sterilized with the finished product being an instrument ready for duty with absolutely no residual moisture. Many sterile processing pros know this. Others apparently need reminding: Only a completely clean instrument should be sent through the sterilization process.

This philosophy has been the mantra for decades, even before the debut of more complex minimally invasive instruments in the 1980s.

One challenge with MIS instruments is that their guts cannot be visualized easily, typically requiring disassembly and/or running a tiny camera through them, if necessary. But that can add time to the reprocessing process, which affects patient throughput and revenue. To compensate, facilities either invest in more costly MIS instruments or cut corners and hope for the best.

It’s more important to be effective first than to be efficient. Once you can demonstrate effectiveness, then and only then should you concern yourself with efficiency. If you don’t accept that then you should not be allowed to practice medicine or be in the business of delivering healthcare. Quibbling hospital executives who tacitly value revenue over safety should be forced to partake personally in this game of surgical Russian roulette. Ask them to think of any of their loved ones on the surgical table. Or themselves. Watch how fast opinions, policies and procedures change when their long-term health security is called into question.

This is as it should be. The only way to make change is to personalize the consequences of doing nothing.

Everyone needs to share in the responsibility.

First, the FDA must require validation of cleaning and sterilization of all surgical instruments and the sterile processing equipment through which they’re run — preferably via certified independent, third-party laboratories.

Second, hospitals should be required to tell patients in advance of a surgical procedure whether they are using recalled or "in-dispute" products.

Third, to influence patients with their decision, the insurance companies — including Medicare and Medicaid — should issue a directive denying reimbursement (e.g., coverage) for any procedure where recalled or "in-dispute" products are used or any product is used without proper validation credentials. This gives the patient the opportunity to choose another healthcare provider or assume the risk if they don’t.

We need to act responsibly. And fast.

Rick Dana Barlow

Tuesday, May 17, 2016

Airing out dirty hands

Fast  Foreward

On Cinco de Mayo, the day that this “Fast Foreward” column was written, the healthcare industry was “celebrating” World Hand Hygiene Day with the launch of the Centers for Disease Control and Prevention’s new “Clean Hands Count” campaign.

At the Premier Safety Institute, veteran safety advocate Gina Pugliese RN, promoted this clever and creative campaign to remind all of us about something so fundamental, so basic.

“The science is clear: Clean hands protect patients from life-threatening infections!” Pugliese wrote in her “SafetyShare” newsletter. But if you continue reading her column, you’ll find some disturbing nuggets to give us pause.

“Dirty hands are a contributing factor in the spread of healthcare-associated infections that affect 1 in 25 hospital patients on any given day,” she wrote. Apparently, a 4 percent ratio is not alarming enough to cause behavioral change.

“Despite the success in achieving 100 percent compliance with hand hygiene in many healthcare organizations,” she continued, “studies show that some healthcare providers perform hand hygiene less than half the time they should. So our work is not done yet.”

No, it’s not. Shame on us.

Despite the detailed research, reporting and presentations by noted and well-respected infection prevention expert Elaine Larson, PhD, RN, FAAN, CIC, going back two decades at least, and the continuing campaigns of federal, state and local agencies and providers and suppliers, clearly the message is not resonating.

In fact, the message is fine. We have all the data and justification we need — clinical, financial, operational.

We just need to act and change our behavior.

Surely as infection preventionists assemble in Charlotte this month for the Association for Professionals in Infection Control and Epidemiology (APIC) annual meeting, this issue continues to hover as a sore spot that they struggle to enforce.

Education and information can work, so long as both are understood and heeded. So far, many seem to “get it,” but they largely don’t comply, tacitly rejecting it with a variety of excuses, such as daily distractions and duties to downright forgetfulness.

Nonsense. This is one area where experts — such as Larsen and Pugliese and countless others — have connected the dots and demonstrated cause and effect. To ignore that is nothing short of stupidity. Ultimately, we all suffer.

Federal regulators and public and private payers have refused to penalize lax hand-washing practices by denying reimbursement. Unfortunately, among those “Never Events” they target, the link to hand-washing deficiencies remains fuzzy at best.

We have access to a variety of tracking mechanisms that slam up against privacy issues and IT connectivity concerns, among others. Anti-shaming attitudes and bandwidth bias trump unnecessary exposure to micro-organisms that can harm and kill us.

It’s high time to change direction and discourse.

The only logical solution? The air around us.

Obviously, even the most intelligent experts and the most creative educational campaigns won’t motivate us to change our behavior, and compensatory and punitive actions won’t be accepted or tolerated either.

We need something ubiquitous: A device that emits a form of light, sound or aspirated chemical compound that’s safe to breathe in or touch our skin but absolutely lethal to the micro-organisms that can hurt us. This device can be affixed to doorframes, on ceilings and walls, in vents or maybe even worn on your body. Just like high-tech real-time location system technology, they’d always be on, always doing what we apparently refuse to do — clean us as we seem to be so incapable of cleaning ourselves.

This device would be different than those room decontamination “robots” that emit pulsed light beams to kill microbes but cannot make contact with or be in proximity to humans.
While we have the scientific and technological know-how to create such a device, however, we most likely would be sending the wrong message by “legalizing,” if not rationalizing, poor hygiene habits.

Perhaps it’s a Catch-22 situation, but we’re all catching bugs for it instead of killing them.

Rick Dana Barlow