Operations

Creating a Supply Chain Roadmap for Today and Beyond

Supply chain management in a health system

A spike in demand, stockpiling and supply chain uncertainty since the World Health Organization (WHO) declared the COVID-19 pandemic has left everyday consumers and healthcare professionals alike groping the backs of empty shelves, publicly shaming price gougers and resorting to do-it-yourself, making do and in the worst of cases, going without. Inside the healthcare industry and beyond, a wide array of items have gone through waves of scarcity, including hand sanitizer, baking yeast, toilet paper, rubber gloves, roller skates, jigsaw puzzles, ventilators and canned beans.

Global shortages of personal protective equipment and COVID-19 testing supplies persist, even after the world transitioned from 2020 to 2021. A survey of CLIA-certified labs showed we’re still seeing shortages of both commercial testing kits and testing supplies necessary for COVID-19 laboratory designed tests. And with the first COVID-19 vaccines being administered, the process of getting supplies where they need to be efficiently is again the focus of many conversations.

With these complex layers of the pandemic spotlighting the need for proper infrastructure and processes, the world discovered just how important supply chain is.

Supply Chain Management Basics

[A] linked set of resources and processes between multiple tiers of developers that begins with the sourcing of products and services and extends through the design, development, manufacturing, processing, handling, and delivery of products and services to the acquirer. − National Institute of Standards and Technology (NIST)

This process affects nearly everyone in the healthcare industry. Healthcare depends on ready access to pharmaceuticals, equipment and supplies that are vital for the provision, coordination and operation of healthcare delivery. Synthetic organic chemists play an integral role in the discovery, development and improvement of pharmaceutical compounds that must travel from the lab bench to the drug store. Cybersecurity experts anticipate and prevent dynamic technology-based threats on essential health system hardware and software.

The pandemic has shined a bright light on the topic, said HIMSS Executive Director of Clinical Research Anne Snowdon, RN, PhD, FAAN, in an interview with HIMSS President & CEO Hal Wolf on HIMSS TV. She pointed out that at the outset of this pandemic, 90% of North America relied on manufacturers in China, which became the first region shut down for quarantine.

“This pandemic has been a very, very important time in health systems to really understand the critical strategic asset of ensuring every health worker is safe and protected, they have the supplies, equipment, products they need to deliver care, and they have it in the volumes they need it,” she said.

 

HIMSS President & CEO Hal Wolf noted that the topic is building momentum.

"We have some major gaps in supply chain at the hospital level, and our care delivery systems in the United States and globally have usually been based upon, 'How much did I pay for that widget?'" Wolf said. "Now suddenly we've seen supply chains broken. We don't necessarily track the quality at the individual level of an item. We're starting to do that more effectively.

"I mean, just look at the studies that were coming out about the quality of N95 masks," he said. "So tracking the source, understanding the quality, getting the volumes out, ensuring supply chain isn't interrupted—and then thinking about the price and then inventory control, all of these pieces—we have really under-focused on supply chain. So this is something that I'm really thrilled to see coming around. I think that's a huge leap."

A study of global value chains and medical supplies identified a key question in COVID-19 medical supply shortages: Is the problem “structural flaws or rigidities in their supply chains, as numerous critics have alleged, and whether and how supply chains could be made more resilient or ‘antifragile’ to confront new threats.”

COVID-19 Vaccine Distribution, in Theory and in Practice

WHO previously reported more than 50% vaccine wastage around the world.

From the earliest speculations about COVID-19 vaccines, health systems and healthcare professionals have been preparing to manage the critical issue of strategy. Vaccine rollouts produce thousands of data points, such as manufacturer information, recipient demographics, risk factors, timing and side effects, which can contribute to a dataset that can inform outcomes and forecasts, a critical opportunity to ensure people around the world have access to the vaccine.

In particular, the prospect of two-dose vaccines and very specific transport and storage requirements have presented complex challenges that compete with vaccine expiration factors.

“Some of the vaccines that we’ve seen are going to require incredibly cold storage all the way up to the point of where they’re used,” Wolf said. “So how do you do that in [other] markets where they may not have the same facilities? This becomes an access issue, it becomes a social determinant issue. We always come back to the singular point that when one individual is vulnerable we are literally all vulnerable.”

Wolf said the healthcare industry must figure out how to overcome social determinants to achieve equal access and distribution. All of the logistics of distribution, access, safety, quality and positive outcomes require a robust, digitally enabled supply chain infrastructure.

U.S. President Joe Biden, promised 100 million vaccinations in his administration’s first 100 days in office. By the end of the first month, the U.S. Centers for Disease Control and Prevention reported more than 32 million doses of the COVID-19 vaccine had been administered in the United States, about 65% of the 49,936,450 doses distributed. The CDC data showed more than 26 million people had received at least one dose of the vaccine, and nearly 6 million people had been fully vaccinated.

One country experiencing a successful vaccine rollout is Israel. The countries smaller size and universal healthcare system have helped make this possible. According to Reuters, “More than half of eligible Israelis –about 3.5 million people—have now been fully or partially vaccinated. Older and at-risk groups, the first to be inoculated, are seeing a dramatic drop in illnesses.”

While higher income countries have the ability to pre-order the vaccine, globally, there’s the potential that low-income countries may not be vaccinated until 2023 or 2024. “The 27 member states of the European Union together with five other rich countries have pre-ordered about half of [the doses]…” according to Nature, yet these countries only account for about 13% of the world’s population. Many middle- and low-income countries are relying on COVAX, a group of organizations including WHO, which is buying vaccines and distributing to countries that are not able to purchase vaccines at the same rate as other countries.

The Path Ahead

“Supply chain matters, and I think if there’s one silver lining to this tragic and very challenging time, it is an awakening around what’s possible and maybe even an acceleration with the help of the HIMSS network to help health systems get there.” − Anne Snowdon, HIMSS Executive Director of Clinical Research

Proper infrastructure allows for automatic inventory acquisition, supply tracking and transparency into the consumption of supplies, all vital factors in successful health crisis management as well as everyday challenges.

Wolf said worthwhile solutions focus on a combination of people, process and technology to develop guideline and roadmaps that systems can follow.

By focusing on the development of this process and understanding what needs to be done from a health system perspective, we can create a roadmap that allows us to take advantage of this process, shard Wolf. “All of these things are being talked about within our communities, and it gives us a chance, from a community standpoint, to put the spotlight on supply chain and start to develop that entire value proposition.”

Visibility and transparency allows senior decision-makers to know what they can access, how to make the best use of each item, and how to make sure they have the products, equipment and the confidence of the workforce in a particular health system as they face the daily as well as extraordinary challenges.

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