MitigAID: Harnessing the Power of Data to Tackle Supply Disruptions
This article was featured in the Spring 2024 edition of Canadian Healthcare Facilities – the journal of the Canadian Healthcare Engineering Society.
Many of the public health consequences of the COVID-19 pandemic were immediately obvious. But shortly after governments around the world imposed lockdowns to slow the spread of the disease, another issue became glaringly clear – the impact of the pandemic on the global supply of everything from computer chips to automobiles.
Health care supply chains were no exception, and were, in fact, exacerbated by significant increases in demand. That reality was underscored by the scarcity of personal protective equipment (PPE).
Disruptions Impact Patient Care
Even outside of pandemic times, manufacturer supply disruptions have an ongoing impact on patient care. Changes to clinical protocols can result from product shortages, recalls or discontinuations – resulting in less-than-optimal workarounds. They can also delay surgical procedures or prevent patients from beginning therapy on a preferred medication. Beyond that, manufacturer supply disruptions further burden hospital staff with additional work and reduce time available for frontline patient care.
Mohawk Medbuy (MMC) is a national, not-for-profit, shared services organization for the health care sector and, as such, sees the challenges created by manufacturer supply disruptions for the hundreds of hospitals and health care providers it supports. MMC consolidates the needs of its Member hospitals for medical supplies, pharmaceuticals and capital equipment and conducts large-scale procurements on their behalf – rather than each facility going to market independently. In 2023, hospitals used MMC contracts for more than $3 billion of their purchases. By leveraging hospitals’ collective spend, MMC generates millions in much-needed savings each year that hospitals can reallocate to frontline care.
One key example of a pre-COVID-19 supply chain disruption came in 2017 when Hurricane Maria caused extensive damage to a vital production facility in Puerto Rico, prompting a large-scale supply disruption of IV mini-bags. Hospitals scrambled to find substitutions individually, while distributors and manufacturers were overwhelmed with inquiries. Mini bags are ubiquitous throughout hospitals but, despite having a DIN (drug identification number), which is the domain of Pharmacy, they’re often ordered by Materials Management departments. That overlap in responsibility exacerbated the supply challenges. To deal with this issue, MMC implemented their existing supply disruption support program to help hospital pharmacies navigate the backorder – but the unique dynamics of the mini-bag crisis demonstrated more was needed.
MMC consulted extensively with Member hospitals and vendors in shaping a program that would be embraced across the supply chain. The result was MitigAID™, which launched in 2019. The comprehensive supply disruption management program was developed with a singular objective – helping hospitals minimize the risk to patients in the event of a product backorder, discontinuation, or recall.
MitigAID Database Helps Hospitals Navigate Disruptions
MMC maintains comprehensive spend data for hospitals that allows them to quickly assess the scale and scope of a disruption. This database of hospital spend information is reviewed to determine what facilities are impacted and how much of the affected product each site uses.
Real-time updates are provided over the course of the disruption by the contracted suppliers to keep MMC and hospitals informed. In the event of an actual or pending product supply disruption, vendors are required to log into MMC’s online Portal and submit a notification indicating what products are impacted, the start date of the disruption, estimated end date, suggested substitute products and other relevant information. Through MMC’s Portal, hospitals have 24/7 visibility on the status.
Determining Potential Substitutes
Ensuring hospitals have immediate access to an alternative item is a top priority of MitigAID. Through years of information gathering, MMC has established a database of equivalent products for out-of-stock items. Potential substitutes are assessed by MMC’s clinical team of registered nurses and pharmacists to determine their suitability − reducing the workload of hospital clinicians.
Before advising Member hospitals of a potential substitute item, MMC contacts the vendor to confirm they have the required supply and to pre-negotiate pricing. Throughout the process, MMC never recommends a particular substitute item over others – or selects substitutes for Member facilities. Each hospital always determines what will work best for them and their patients’ needs.
MITIGAID BY THE NUMBERS: 2022/2023
Items in MMC’s Product Master Database: 579,000
Medical / Surgical:’
Manufacturer supply disruptions: 1,650
Disruptions in which substitute item(s) where identified: 71%
Pharmacy:
Manufacturer supply disruptions: 1,056
Disruptions in which substitute item(s) were identified: 80%
Reimbursements remitted automatically to Members: $750,000+
Supply Disruptions Lead to Shortages
In 2023, Canadian hospitals were hit with 518 actual drug shortages caused by backorders, recalls and discontinuations. In many instances, there are therapeutic equivalents (generics) or alternate therapies available – but that still requires multiple steps. Hospital pharmacists need to determine what substitute drug is appropriate and educate prescribers about the change. Pharmacy procurement staff must confirm whether supply of a drug is available, coordinate the purchase and delivery to their facility and input the new product’s information in the hospital’s system.
For some very specialized, high-cost or sole source drugs there may be no equivalent available. In such cases, the hospital will put in place conservation strategies for the backordered drug. But conservation can put doctors in the very difficult position of choosing which patients get the optimal drug for their therapy. In other cases, medications in short supply are rationed to people undergoing treatment at less than the therapeutic dose or frequency.
Surgeries Put on Hold
One area of health care that can be hit hard by supply shortages is the operating room (OR) – a precious resource of hospitals. For patients, a surgery is often a lifechanging event that has been months or years in the making. A cancellation caused by shortages is significant for all concerned. That was the case when a critical instrument used for an elective surgical procedure at one Canadian hospital went on backorder without notice.
In this instance, the instrument – an energy tissue sealing device – is essential for bariatric surgery. Also known as gastric bypass surgery, it’s a major procedure that involves making changes to the digestive system to help people lose weight. In many cases, the patients are contending with serious health issues due to their weight.
Given the hospital’s large catchment area, many patients travel significant distances for the procedure, and undergo two weeks of unpleasant prep in advance. Bariatric surgeries are performed on Mondays and Wednesdays at this particular hospital. One Monday, as the OR was being set up for the first of three bariatric surgeries that day, it was discovered that there were no energy tissue sealing devices due to a supply disruption that would continue for several weeks.
Because the hospital is a regional centre with no nearby facilities that could share the specific instruments, the surgeries had to be cancelled. It was a crushing disappointment for patients, who had been counting on the procedure to give them a new lease on life. It also meant they’d have to go through the challenging pre-surgical prep all over again.
The supply disruption had implications for the hospital as well. An in-demand OR sat vacant on that first Monday. Surgeons and anesthesiologists scheduled to do the procedures were idle while the backlog of bariatric patients grew. From a financial perspective, the hospital receives a portion of its funding based on performing a pre-defined number of bariatric surgeries each year. In the absence of a single instrument, that revenue was now at risk – and making up for the lost days in the OR would require overtime and extra resources.