18-04-20 OpenHIE and SCM.pptx
Chris Wright
Hi all – here is a high-level description (for discussion) of where the “connectors” might be between the HIE and the SCM system. 😊
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 | chris wright Practice Lead, Data Visibility & Use CELL: +41.77.951.7144 | WWW.JSI.COM/SUPPLYCHAIN   |
Derek Ritz
Hi Chris.
Thanks for starting the discussion on this! Can I ask, though, why you think this approach would only work for single-dose GTINs? My example illustrated consumption based on a 100-dose pack (and assumed 50 doses wasted).
I agree – if we’re considering multi-dose vials, it is important to summarize vaccination transactions by DAY, because the vials are (often) not usable the next day. I tried to lay out a daily-consumption example in my deck to illustrate this… but obviously I didn’t do a good job of explaining it. So… here goes:
If GTIN-1 has 10 doses per vial of Vaccine-1 and we log in the HIE’s shared health record (SHR) that there were 42 vaccination events on April-20 then we can imply the number of vials by applying a “round up” to the next whole integer for vial consumption and then some modulo math to get open-vial wastage…
42 / 10 = 4.2 rounded up = 5 vials of GTIN-1 with 10 - 42mod10 = 8 open-vial doses wasted
If GTIN-2 has 5 doses per vial of the same Vaccine-1, then the modulo math gives…
42 / 5 = 8.4 rounded up = 9 vials of GTIN-2 with 5 – 42mod5 = 3 open-vial doses wasted
Of course, a place where an implied consumption approach doesn’t work well is when a facility has multiple GTINs of the same vaccine (which is not especially common… but happens sometimes). In places where there is a 1:1 relationship between GTIN and vaccine, the implied consumption heuristics yield pretty good results. In high-volume environments, we sometimes try to leverage multiple GTINs (e.g. lower price-per-dose 50-dose GTINs alongside higher-priced 5-dose GTINs) to reduce overall prices while still attempting to mitigate vaccine dose wastage. Usefully, these high-volume clinics are also often the contexts where barcoding technologies can be adopted to explicitly track GTINs (and lots).
An implied consumption approach also does not work especially well when the attempt is made to summarize over a whole week or a whole month (or any time period longer than a vial can remain open). This is because of the issue you’ve identified, Chris. The systemic error such an approach introduces is illustrated by “lazily” trying to imply the weekly consumption of GTIN-2…
Monday: 42 doses
Tuesday: 35 doses
Wednesday: 36 doses
Thursday: 41 doses
Friday: 27 doses
---------------------------
Total: 181 doses
If I apply the heuristic across the entire summarized week…
181 / 5 = 36.2 rounded up = 37 vials of GTIN-2 with 5 – 181mod5 = 4 open-vial doses wasted
When actually we should have done a daily summaries to yield…
Monday: 9 vials with 3 doses wasted
Tuesday: 7 vials
Wednesday: 8 vials with 4 doses wasted
Thursday: 9 vials with 4 doses wasted
Friday: 6 vials with 3 doses wasted
---------------------------
Total: 39 vials of GTIN-2 with 21 open-vial doses wasted
I don’t think your example was TMI at all! We need to look at ways to leverage data from the HIE that will work in the contexts we are implementing them. I was not trying to be theoretical (in an academic way)… I was trying to illustrate an implied consumption heuristic that we could actually use.
Re: your comments about open-vial vs closed-vial wastage… the suggested algorithms could be leveraged to develop both of these from just the periodic physical stock-counts. Using the 1-week example from above…
Physical count of usable GTIN-2 at end of prior week: 100 vials
Physical count of usable GTIN-2 at end of current week: 56 vials
Closed-vial wastage = 100 – 39 – 56 = 5 vials of GTIN-2 = 25 closed-vial doses
Lastly, it is worth noting that these algorithms can support cost optimization. Over the course of a year, analytics could be employed to develop an economic model to inform which pack size (e.g. 5-dose GTIN-2, 10-dose GTIN-1, 20-dose GTIN-3) is the “right” one for each clinic, based on the clinic’s transaction volumes. There will be, for each clinic, a “sweet spot” where the lower price/dose of larger pack sizes trades off against the higher open-vial wastage to yield an optimal pack size.
Sorry if this was TLDR… but I’m hoping at least a few of our teammates will be willing to wade through all these examples!
Warmest regards,
Derek
Derek Ritz, P.Eng, CPHIMS-CA
ecGroup Inc.
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