Post Event Summary
Safer, more efficient care starts with a simple scan
The 34th Global GS1 Healthcare Conference held its three-day event, 30 October – 1 November, in Bangkok, Thailand. Ulrike Kreysa, Senior Vice President, GS1 Healthcare, welcomed more than 250 participants from 13 ASEAN countries and another 20 countries around the globe.
GS1 President and CEO Miguel Lopera presented the value of GS1 standards in helping to address healthcare’s ongoing quest to improve patient safety, fight falsified medicines and increase visibility and efficiency in the supply chain. He announced the recently released GS1 Healthcare Strategy 2018-2022, a new GS1 Application Standard for the identification and barcoding of investigational products in clinical trials, and GS1’s expanded support to Africa.
Digital transformation with GS1 standards
In healthcare, the world is digitally transforming while heading towards a globally standardised approach—one that will be less complex and costly, and significantly improved patient care, safety and outcomes. In Thailand, significant progress is evident with the adoption of GS1 standards and digital technologies as the foundation.
Dr Supakit Sirilak, Deputy Permanent Secretary of the Thai Ministry of Public Health, addressed the conference with a call for the healthcare sector to take full advantage of digital technologies and their transformational impact. The Ministry of Public Health of Thailand has worked closely with the National Health Security Office to improve the quality of healthcare, using digital technology and innovative interventions. In fact, Thailand is one of the first countries in Southeast Asia to have an eHealth strategy.
As co-host of the conference, Mr Supant Mongkolsuthree, Chairman of the Federation of Thai Industries (FTI) opened the conference, recognising the important role of GS1 Healthcare in developing the global healthcare supply chain with GS1 standards. With nearly 20,000 members, including GS1 Thailand, FTI has implemented GS1 traceability standards in both private and government sectors.
Standards, digitalisation and hospitals
How are hospitals approaching digital transformation of business and clinical processes? Alan Foster, CEO, North Tees and Hartlepool NHS Foundation Trust in the UK, kicked-off a panel discussion with an update on the NHS digital strategy and roadmap. The NHS end goal is the “digital hospital of things” and a system where services are digitally connected, ensuring that quality care is consistently experienced, regardless of where patients go.
Dr Kingsley Huang, Postdoctoral Research Fellow of Institute of Clinical Medicine at the National Yang-Ming University and Chief Technology Officer of Xuzhen Medical Co., Ltd in Taiwan, described the country’s steps and challenges associated with implementing Unique Device Identification (UDI) standards. He outlined the application of UDI in the Kaohsiung Armed Forces General Hospital and how real-time data is enabling improved management of medical devices.
Dr Hajo Reissmann, Head of Medical Supplies Controlling, University Hospital of Schleswig Holstein in Germany, advised about the two main requirements for increased efficiencies in hospitals: complete master data and the adherence to standards. Dr Reissmann concluded with a call to action to break down the silos of IT communication with a common language for the healthcare IT landscape.
Patricia Van Dyke, Vice Chair, HL7 International, US, introduced HL7 and its mission to provide standards that empower global health data interoperability. She described the DaVinci Project as well as other initiatives that promote industrywide standards and adoption for improvements in inventory management and patients’ access to and sharing of health information. This is all intended to help nurses do a better job when caring for patients.
Do clinicians care about standards? Yes!
Prof Dr Susan Moffatt-Bruce, CEO of the Ohio State Wexner Medical Centre in the US, and a panel of clinicians discussed how their healthcare systems are transforming to deliver higher quality care at lower costs. Dr Moffatt-Bruce presented the Hospital Value-Based Purchasing programme—a historic change in how US Medicare pays healthcare providers that rewards them for the quality of care they provide to patients, not just the quantity of procedures performed.
Mr David Berridge, Deputy Chief Medical Officer, Consultant Vascular Surgeon, The Leeds Teaching Hospitals NHS Trust in the UK, shared how GS1 standards are being used throughout Leeds hospitals for transformal benefits. For example, more than 130,000 products are uniquely identified, resulting in better inventory management and cost savings. Product recalls are highly efficient; more than 17,000 patients with 22,000 implanted items can be checked in under 30 minutes.
Dr Chun-Che Shih, Chief of Division of Cardiovascular Surgery of the Taipei Veterans General Hospital in Taiwan, discussed the hospital’s results in adopting GS1 UDI standards in the Cardiovascular Surgery department. Medical device barcodes containing UDIs are now scanned, turning manual processes into automated ones in surgical operating rooms. Patient records are automatically updated and expired products are immediately identified to avoid their use in patient treatment. The turnover rate in operating rooms has also increased along with improvements in surgical quality and nursing care.
Dr Hinne A. Rakhorst, Plastic Surgeon of Medisch Spectrum Twente, Enschede, The Netherlands, advised about the country’s selection of the GS1 Global Trade Item Number® for uniquely identifying breast implants and the progress of the Dutch Breast Implant Registry (DBIR). Starting in 2015, the DBIR was established and now houses data on 40,000 implants. The International Collaboration of Breast Registry Activities (ICOBRA) has established minimum data requirements for DBIR.
Implementing value-based healthcare
How does value-based healthcare address today’s challenges? Karen Conway, Chair and Vice President Healthcare Value, GHX, US, set the stage for a compelling panel discussion by defining and exploring value-based healthcare. The healthcare industry needs to think “beyond procedures or an episode of care” to include the “system” that must be optimised for higher quality outcomes at a cost that is sustainable. Healthcare providers are taking value-based healthcare from concept to action.
Keith Jones, Head and Neck Surgeon with University Hospitals of Derby and Burton, UK, outlined Derby’s key strategies for value-based healthcare, including clinical engagement, clinical variations and operational efficiencies. Robust and trusted data—captures at points of care by scanning barcodes—is a significant contributor to improving the value of care for patients and, at the same time, driving efficiencies and reduced costs.
Natalie Lawandi, Senior Manager of Medtronic, Australia, defined value-based healthcare and its approach to healthcare delivery. Data is an essential tool and enabler for value-based healthcare—not necessarily generating more data but improving accessibility to smarter data. Using smart data and taking a standards approach to measure and compare outcomes that matter to the patient helps put the patient at the centre of care.
Dr Dirk de Korne, Deputy Director of Medical Innovation & Care Transformation, KK Women’s and Children’s Hospital, Singapore, provided a reminder that 99% of the patient journey is outside of the hospital. Value-based healthcare starts with the focus on the entire journey—from prevention to management on the care delivery value chain. The Singapore MOH is taking action to focus on better health, better care and a better life for citizens. Dr de Korne outlined some ways health is being addressed, including the use of GS1 standards for traceability and safety in operating rooms.
Improving patient care with single-unit identification
Using single-unit identification of pharmaceuticals and technology is a major strategy for hospitals that aim to achieve safer medication management. Sébastien Langlois-Berthelot, Pharma Global Technical Operations Supply Chain Project Management of F. Hoffmann-La Roche Ltd, Switzerland provided an overview of Roche’s journey, experiences and challenges associated with single-unit identification, using GS1 standards. He provided insights on how the company had removed roadblocks to solve technical issues, implement processes and systems, and prioritise the project internally.
As a hospital pharmacist, Vicki Ibrahim, Senior Clinical Reference Lead for Clinical Strategy and Clinical & Consumer Engagement & Clinical Governance, Australian Digital Health Agency, Australia, is passionate about medication safety. She outlined how technology and unit-dosage packaging can make the patient journey through the healthcare system safer. By using standards-based barcodes with scanning technology, healthcare providers can enable closed-loop medication management—from pharmacy stock control and dispensing to medication administration and closed-loop management.
Dr Guadalupe Fernández Porto, Pharmaceutical Director at the Argentine Institute of Diagnosis and Treatment, Argentina, presented the need for using GS1 DataMatrix barcodes for single-unit dosage identification and labelling. The institution has taken steps (time and resources) to assign unique identifiers with serial numbers encoded in DataMatrix barcodes on pharmaceuticals. It is now working with suppliers to provide this level of identification on chemotherapy and nutrition IV bags.
Pfizer has taken a phased approach for single-unit barcoding for blisters, tubes, bottles, strips, syringes, ampules, vials and plastic bags. Pascal Aulagnet, Senior Manager, Business Technology of Pfizer in France, provided an update on the company’s implementation and advised that the use of GS1 standards is a key component of success. Other lessons learned include the need for collaboration between trading partners and taking a phased approach.
Hospital transformation using GS1 standards
Dr Hajo Reissmann, Head of Medical Supplies Controlling at the University Hospital of Schleswig Holstein in Germany, facilitated a panel discussion that featured three major healthcare systems that are integrating digital technologies, quality data and GS1 standards into their processes for medicines verification, master data management and medical device inventory management.
Jean-Michel Descoutures, Hospital Pharmacist at the Centre Hospitalier d’Argenteuil, France, outlined the major areas of the healthcare’s digital transformation in France. Medicines are uniquely identified with GS1 standards and registered in the country’s Medicines Verification System as they travel from manufacturers to pharmacists for verification before dispensing to patients. In support of the Falsified Medicines Directive, the Argenteuil hospital is testing improved management of medicines as they are received into stock and then delivered to wards for administration. Finally, access to trusted and complete data is essential for automating processes. The e-catalogue for healthcare, provided by Resah, global procurement organisation, provides healthcare stakeholders with the opportunity to share quality data.
Yolanda Bokking, Policy Staff Officer and Process Manager Procurement, Amsterdam UMC, The Netherlands, presented her health system’s focus on master data governance as a significant component of improving performance and outcomes while controlling costs. Amsterdam UMC is collaborating with its network of suppliers to use GS1 standards and the Global Data Synchronisation Network™ (GDSN®) so that all stakeholders will eventually be connected.
Anthony Wong, Senior Pharmacist of the Hong Kong Hospital Authority (HA), shared the status of the pharmaceutical supply chain in Hong Kong’s public healthcare sector. Since 2012, the HA has been implementing ERP and EDI systems as well as working with suppliers to implement GS1 standards to uniquely identify pharmaceuticals. To date, both HA and suppliers are experiencing improved efficiencies and accuracy in logistics processes. Moving forward the HA intends to transition to serialisation for traceability.
Pharmaceutical traceability in healthcare regulations
Traceability is recognised as one of the requirements in the global healthcare industry to improve patient safety. It provides all stakeholders greater visibility into the many processes that comprise the complex healthcare supply chain, enabling these stakeholders to make more informed and timely decisions. Using regulatory requirements, governments around the world are recognising the role of traceability in helping to keep populations safe and healthy. Scott Mooney, Tri-Chair of the conference and Vice President, Distribution Operations, McKesson, US, chaired a panel discussion to explore regulatory updates with the aim of pharmaceutical traceability.
Kritsada Limpananont, Head of Drug Information and Technology Group, Bureau of Drug Control, Thai FDA, Ministry of Public Health, outlined the regulatory system of medicinal products in Thailand and its medicinal product labeling regulation that requires a batch/lot number, expiration date and other pertinent information be displayed on the label. Thai FDA has initiated a project in close cooperation with GS1 Thailand to enter Global Trade Item Numbers (GTINs) into an electronic system for sharing medicinal product information with hospitals and pharmacies.
Scott Mooney, Tri-Chair of the conference and Vice President Distribution Operations, McKesson, provided insights about the three pending milestones of the US Drug Supply Chain Security Act (DSCSA) for product identification (2017-2018), product verification (2019) and an electronic, interoperable system for traceability (2023). McKesson joined GS1 US and two other global wholesalers—AmerisourceBergen and Cardinal Health—in a 2018 barcode assessment. Scanning 26,000 product barcodes, they found only 21% of the products had a two-dimensional (2D) barcode with all four elements encoded: Global Trade Item Number® (National Drug Code), serial number, batch/lot number and expiry date. Mr Mooney also provided information and updates about the 2019 and 2023 milestones. Read the report: 2018 Update: Implementation of DSCSA Barcode Requirements.
Prof Patrick Deboyser, European College of Parma, Thailand, discussed the European Falsified Medicines Directive and its impact on active substances in medicines, internet sales/online pharmacies and safety features. One safety feature is the end-to-end verification system that starts with manufacturers applying the unique identifier (comprised of the product code, serial number, batch/lot number and expiration date) on each pack and encoded in a 2D barcode. Wholesalers provide risk-based verification via the Medicines Verification System database and pharmacists further verify its authenticity using the database. Prof Deboyser also presented the repository system architecture where queries can be made for verifications, using the European Hub.
Pharmaceutical traceability in the healthcare supply chain
Regulatory requirements and milestones are driving manufacturers to implement standards that lay the foundation for traceability. And hospitals are quickly realising the power of using the data provided by these identification standards for the benefit of their patients, clinicians and staff. Humanitarian organisations are also using this data to solve some of the toughest challenges in populations throughout the world.
Dr Guadalupe Fernandez Porto, Pharmaceutical Director, Argentine Institute of Diagnosis and Treatment in Argentina, shared his hospital’s experiences when implementing GS1 standards and GS1 DataMatrix barcodes to track and trace drugs and medical devices. Lessons learned included taking a phased approach by starting with a few drugs that will have high impact, adding the needed personnel and IT infrastructure, and engaging the staff about the importance of traceability.
Lindsay Tao, Corporate Director Global Health Policy, Johnson & Johnson, China, presented the Partnership for Safe Medicine’s research on a drug traceability system for China. Its findings called for conducting a pilot to demonstrate proof of concept of an alternative drug traceability system in China that uses GS1 global standards. Next steps will be to recruit the pilot participants, conduct training, explore traceability solutions, align on the duration and specifics of the pilot, and provide comments on draft guidance to relevant government agencies, advocating policy change.
Physicians at the Srinagarind Hospital in Thailand are using computerised order entry for medications, which has helped reduce error rate by 99.9% in both outpatient and inpatient settings. Associate Prof Cholatip Pongskul, Associate Dean of Information Technology, Faculty of Medicine, Khon Kaen University and Srinagarind Hospital, described how automating processes in the hospital can help drive further improvements in inventory management and medication administration. Faced with different types of barcodes, the hospital needs to use GS1 standards such as the Global Trade Item Number® (GTIN®) to identify pharmaceuticals as well as a national drug database facilitated by the Thai FDA.
Kaitlyn Roche, Manager, Global Standards & Traceability with the USAID Global Health Supply Chain-Procurement and Supply Chain (GHSC-PSM) Program, US, shared the key accomplishments of GHSC-PSM project’s integration of GS1 standards into its supply chain. The project has incorporated contract language that requires pharmaceutical suppliers to use GS1 standards including the Global Data Synchronisation Network™ (GDSN®). Other key accomplishments include the successful completion of integrating 1WorldSync, a GS1-compliant data pool, with GDSN along with providing more technical assistance to support implementing global standards.
Ask the experts during educational sessions
Ask the expert sessions answered questions that are on the minds of healthcare stakeholders as they consider and implement GS1 standards in their business and clinical processes. Experts covered details about data carriers (e.g., barcodes), EPCIS, and how GS1 standards can deliver tangible and significant results. The role of GS1 standards in the digital world, as well as data quality and barcode quality, were also covered during these informative sessions.
Chan-Kuen (CK) Lam, BT Market Customer Engagement, APAC, Pfizer, and Pete Alvarez, Senior Director Identification and Data Strategy Healthcare, GS1 described the various, available data carriers with a focus on the GS1 DataMatrix barcode and the reasons why it is the ideal barcode for use in healthcare.
Craig Alan Repec, Senior Manager Supply Chain Visibility, EPCIS, provided answers about what EPCIS is, how it enables supply chain visibility, and its critical role in supporting regulatory actions in Egypt, Malaysia and the US.
Kevin Downs, Director of Finance and Performance, Derby Teaching Hospitals NHS Foundation Trust, UK, described how the use of GS1 standards by Derby hospitals has resulted in tangible results such as significant savings in stock management, patient and equipment tracking, and procurement.
GS1’s Phil Archer, Director-Industry Engagement, Omni-Channel Retail, and Pete Alvarez discussed how GS1 standards can connect the physical product to its digital self. For example, GS1 standards support users with mobile apps by linking the user to digital content.
Tania Snioch, Director Healthcare, GS1, discussed the importance of data quality in healthcare, how to improve master data management and governance, and the use cases and benefits of trusted data shared by all stakeholders.
Catherine Koetz, Industry Manager Healthcare, GS1, presented the benefits of barcode quality and how to ensure accuracy in barcode scanning. Also included were practical tips on how to get barcode quality right—every time.
Big data, master data, data quality
Catherine Koetz, Industry Manager, Healthcare of GS1 Australia chaired a panel discussion about the value of quality data for healthcare providers and suppliers. Master data management is critical for ensuring the exchange of complete data in many business and clinical processes such as procurement, ETC.
Sarah Lankshear, Operations Manager, Master Data & Analysis, of Stryker South Pacific, Australia, discussed how tenders are the impetus for change to provide healthcare providers with accurate and meaningful data. She shared Stryker’s factors in establishing successful master data management practices.
Dr Eric Hans Eddes, GastroIntestinal and Oncological Surgeon, Deventer Ziekenhuis, Director Dutch Institute for Clinical Auditing, The Netherlands, presented the value of using data to improve outcomes and reduce costs. Quality data enables shared decision- making, the ability to improve the patient experience, and keep patients safe with highly efficient recalls.
Dr Duangpun Kritchanchai, Associate Professor, Mahidol University, Thailand, described the organisation’s journey to increase the efficiency of Thailand’s healthcare supply chain. The roadmap includes the unique identification of pharmaceuticals and medical devices, the creation of a product data catalogue and the implementation of EDI data exchange for benefits like traceability and business intelligence.
Moving products through the supply chain
A wholesaler, distributor and logistics provider shared their experiences of how they are using GS1 standards to help better move products through the supply chain. Speakers from McKesson Pharmaceuticals and AmerisourceBergen in the US and China’s Sinopharm Logistic Company share their experiences about the use of GS1 standards and barcodes in action throughout their processes and in support of regulatory requirements.
Scott Mooney, Vice President Distribution Operations, Supply Chain Assurance, McKesson, described how GS1 standards were integrated into the company’s warehouse, inventory and transport processes as well as in electronic communications and transactions like purchase orders, Advance Ship Notices, Invoices and more.
Jeff Denton, Global Secure Supply Chain, AmerisourceBergen in the US, discussed the importance of GS1 standards in driving interoperability between manufacturers, wholesalers and healthcare providers. Mr Denton advised that GS1 unique product identification, barcoding, location identification and EPCIS help enable traceability and remove ambiguity in operations. The company is currently moving toward the use of serialised products in support of the US Drug Supply Chain Security Act.
Mr Gu Yimin, General Director, Sinopharm Logistic Company, China, outlined steps taken by this global logistics provider to achieve end-to-end traceability. The company selected GS1 standards to help transform its processes—receipt, delivery and on-site operations and would like their suppliers, customers and trading partners to help drive the implementation of global standards.
UDI takes centre stage
During the final day of the conference, discussions turned to Unique Device Identification (UDI) and its role in the digital transformation of healthcare. Speakers from regulatory agencies and organisations in China, South Korea, Japan, Turkey and the US provided information about new UDI regulations and updates on existing UDI implementations.
China is moving forward with UDI regulation. Li Jun, China National Drug Administration, State Administration for Market Regulation, China, provided an update on the proposed regulation that includes unique device identification and a UDI database. Two rounds of public consultation were held in 2018 with the next steps to include designation of standards, construction of the UDI database and a UDI pilot. (Shanghai is being considered for the UDI pilot. See the next article.)
Yan Liang, Director of the Experts Committee, Shanghai International Medical Supply Chain Alliance, Former Director of Law Affairs, FDA Shanghai, China, reported that Shanghai is the most important import port in China for pharmaceuticals, and will be the traceability data hub of the future. The Shanghai government intends to build an international pharmaceutical hub port, using GS1 identification standards in the port’s national customs department for fast and accurate clearances. GS1 resources are supporting the implementation of traceability in China’s healthcare supply chain.
Since 2016, Korea has taken action to develop UDI regulation. Byung-Gwan Kim, Assistant Director, Medical Device Policy Division at Ministry of Food and Drug Safety, outlined the steps, including the development of the Integrated Medical Device System (IMDS). Currently, the government is working to pilot the IMDS for its planned launch in May 2018; Implementing unique identification for Class 4 medical devices is planned for July 2019.
Jackie Elkin, Global Process Owner – Standard Product Identification, Global Regulatory Affairs, Medtronic, US, provided an update on the International Medical Device Regulators Forum workgroup’s activities related to UDI Application Guide.
Turkey’s ÜTS provides the infrastructure to track and trace all medical devices and cosmetics. Erkan Uyar, Chief Researcher, TUBITAK BILGEM Software Technologies Research Institute, provided details about the ÜTS and how products are identified via a unique identifier, lot number and serial code for single-product and lot-number traceability.
Hiroshi Ishikawa, Pharmaceutical and Medical Device Agency, Japan, advised of Japan’s UDI implementation, describing the use of UDI in two hospitals to manage medical devices in operating rooms.
GS1 Healthcare Awards showcase compelling results with GS1 standards
Winners of the GS1 Healthcare Provider Implementation Best Case Study Award were The General Hospital of People’s Liberation Army, China, and Centro Médico Imbanaco de Cali S.A., Colombia.
Winner of the GS1 Healthcare Provider Recognition Award was Dr Jean-Michel Descoutures, Hospital Pharmacist and former Chief of the Pharmacy Department of Argenteuil hospital in France. Dr Descoutures is a great ambassador for the use of GS1 standards in healthcare in France and around the world. He coordinates for over 70 hospitals at Resah, one of the main hospital procurement hubs in France and is an active member of the International Hospital Federation as well as the GS1 Healthcare Leadership Team.
Represented by Prof He Kunlun Vice President, Chief Physician, professor and doctor advisor at Chinese PLA General Hospital and Mr Wang Jian, Director, Medical Logistics Management Department, the General Hospital streamlined operations with GS1 standards-based barcode scanning, implementing a traceability system. Their experiences have also proven valuable for the establishment of UDI regulations in China.
Juan Camilo Rincón, Supply Chain Manager represented Centro Médico Imbanaco. The hospital has used GS1 standards to simplify and automate its clinical processes for increased efficiencies and enhanced patient safety. Based on automated ordering processes, Imbanaco has experienced a 98% improvement in inventory shrinkage and waste, and a 25% reduction in inventory levels at its satellite pharmacies. The time needed to create a patient invoice has been reduced, taking only 18 minutes compared to nearly an hour.
Apocalypse soon? The future of healthcare in an ageing population
During his inspirational presentation, Peter Carter, Board Member, International Society of Quality in Healthcare (ISQua) Australia, called on conference attendees to lead the transformation of healthcare quality and safety—locally and globally. Populations around the world are ageing—some more rapidly than others. Mr Carter offered strategies about how to shift the healthcare paradigm to address the challenges associated with ageing populations.