Repertoire June 19 - Post Acute by BOC design Inc

vol.27 no.5 â&#x20AC;˘ June 2019

Point Person Come November, Repertoire readers in the long-term-care market may find themselves calling on a new decision-maker.

repertoiremag.com

ease of choice for you, ease of use for your customer (this is what we call a win-win proposition)

IMMUNOASSAY SYSTEM

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SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE / 800-332-1042 / WWW.SEKISUIDIAGNOSTICS.COM © 2019 Sekisui Diagnostics, LLC. All rights reserved. OSOM® is a registered trademark of Sekisui Diagnostics, LLC. Silaris™ and Because every result matters™ are trademarks of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.

JUNE 2019 • VOLUME 27 • ISSUE 6

EDITOR’S LETTER The Good Life..............................................................6

PHYSICIAN OFFICE LAB Little Bugs, Big Picture...........................................8

NDC EXHIBITION 2019

Infection Prevention: Progress, Not Perfection The trends look promising, but there’s room for improvement

NDC celebrates ‘Power of Partnership’..............................12

DISTRIBUTION

24 POST ACUTE CARE

Point Person

Henry Schein Medical

‘Extra mile’ is meeting theme................................. 18

Come November, Repertoire readers in the long-term-care market may find themselves calling on a new decision-maker.

Enhancing Access to Care Henry Schein Medical and Henry Schein Cares Foundation partner with Children’s Health Fund to help enhance access to care for underprivileged........................ 22

repertoire magazine (ISSN 1520-7587) is published monthly by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2019 by Share Moving Media. All rights reserved. Subscriptions: $49.00 per year for individuals; issues are sent free of charge to dealer representatives. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address. POSTMASTER: Send address changes to Repertoire, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors. Periodicals Postage Paid at Lawrenceville, GA and at additional mailing offices.

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June 2019

JUNE 2019 • VOLUME 27 • ISSUE 6

WINDSHIELD TIME

TRENDS Protecting the Channel The Grey market: Financial issue. Patient safety issue.................................................................... 41

Primary Care Meets the Opioid Challenge Needed: A shared understanding among staff of how patients on chronic opioid therapy are managed................................................................ 44

Innovation in Healthcare Amazon’s Alexa launches 6 HIPAA-compliant services............................................... 52

QUICK BYTES

Automotiverelated news

IDN OPPORTUNITIES

Nothing But the Truth

Technology news.......................................56

SMART SELLING HIDA It Takes More Than One Great Relationship To Ensure Customer Loyalty.......................... 61

REP CORNER

Health system believes science – and data – can beat marketing

Family Legacy

58 4

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His parents’ sacrifice years ago continues to present opportunities for Gino Liongson, his wife and their children........................................ 62

INDUSTRY NEWS News.......................................................................... 66

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PUBLISHER’S NOTE

The Good Life Well gang, it’s June. Where did half the year go? I don’t know about you, but it’s been a

good year so far, and I’m looking forward to a nice summer with BBQ, trips, and time off. I typically talk about selling consumables in the summer, and making sure you’re getting all the base products in your accounts so you don’t find yourself in a bidding war on the big ticket items. While important, you also need to take time for yourself and your family. Last month I was asked to write several graduating seniors a note that they would open the day before graduation. My common theme was “The next four years of college will be the best years of your life, so be sure you stop and recognize how great it is and how fast it goes.” As I started this Publisher’s Letter, it hit me that every phase of life is good in its own way, and every phase flies by when you look back. So this summer, secure your base business with the lotions, potions, gloves and table paper – but also go on vacation. Talk to your accounts about their vacations and tell them about yours. This deepens your relationships. My good friend Rob Saron always sends post cards from his travels. My challenge this month to you is to send your top accounts a post card from your family vacation, and thank them for the ability to serve them and the business they give you to provide for your family. Have a great summer and remember to stop and recognize how fortunate we are to be in an industry that saves lives and provides for our families.

Scott Adams

Dedicated to the industry, R. Scott Adams

repertoire is published monthly by Share Moving Media 1735 N. Brown Rd., Suite 140, Lawrenceville, GA 30043 Phone: (800) 536-5312, FAX: (770) 709-5432; e-mail: info@sharemovingmedia; www.sharemovingmedia.com

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Lizette Anthonijs Lizette@sharemovingmedia.com (800) 536.5312 x5266

managing editor

content manager

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ggarrison@sharemovingmedia.com editor-in-chief, Dail-eNews

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publisher

Scott Adams sadams@ sharemovingmedia.com (800) 536.5312 x5256 founder

Brian Taylor

Subscriptions

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2019 editorial board Richard Bigham: IMCO Eddie Dienes: McKesson Medical-Surgical

btaylor@ sharemovingmedia.com

Joan Eliasek: McKesson Medical-Surgical

circulation

Doug Harper: NDC Homecare

Ty Ford: Henry Schein

art director

Laura Gantert

Mark Kline: NDC

Brent Cashman

lgantert@ sharemovingmedia.com

Bob Ortiz: Medline

bcashman@sharemovingmedia.com

sales executive

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Keith Boivin: IMCO Home Care

WELCH ALLYN AND HILLROM We’re unifying our brands to advance connected care.

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PHYSICIAN OFFICE LAB

Little Bugs, Big Picture By Jim Poggi “In all things, balance. In balance there is harmony.”

That’s a little on the “zen” side, but balance is the best way to describe the relationship between the human immune system and the complex community of microbiota that surround us internally and externally. While we cannot see them with the naked eye and rarely think about them in daily life, the bacteria and other microorganisms on our skin, GI tract and in contact with our bodies are a living part of us. It’s becoming even more apparent that a healthy balance of these microbiota is important to human health and wellness. When the microbiota community is in balance, it is believed to have a positive impact on overall health and

wellness. When that balance is upset by antibiotic therapy or an infection by a pathologic agent, bad consequences result, including sepsis and organ failure in extreme cases. There’s an emerging body of evidence that gastrointestinal microbiota have impacts on health far beyond the GI tract. So, what does this all have to do with the POL and things of interest to distributor account managers? I was hoping you would ask. The short answer is that your customers see patients with a variety of symptoms caused by an infection, no matter whether they are in a primary care practice, a specialty practice, or work in an urgent care or ER setting. Some of the more common infections, along with the infectious agent and a brief listing of the most commonly used tests, are below.

Infections your customers care about

Site of infection

Source of Infection

Test/Test Type

Comments

Upper respiratory tract

Group A strep, influenza, metapneumovirus, others

Lateral flow, molecular

The broadest range of waived and non-waived tests are aimed at this source of infection

Urinary tract

E. coli, staphylococcus, proteus, klebsiella, enterococcus, and pseudomonas

Routine urinalysis, urine culture, molecular

One of the most common infections, particularly in the elderly

Genitals

HIV, HPV, trichomonas, chlamydia, gonorrhea, syphilis, gardnerella, others

Lateral flow rapids, molecular

Skin (bacterial)

MRSA, staph, strep, others

Molecular, routine microbiology

Many of these diseases may lead to sepsis

Skin (tick, parasite)

Lyme disease, rocky mountain spotted fever, others

Lateral flow rapids, molecular

Rising in incidence; new diseases being uncovered

GI tract

HAV, HBV, HCV, H. pylori, C. diff

Lateral flow rapids, immunoassay, molecular

Both hospital acquired and community acquired infections are in this category

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Some of the first molecular methods were targeted against these diseases

Realize the value of Point-of-Care PT/INR testing with CoaguChek® solutions Point-of-care (POC) PT/INR testing can be a valuable component of a successful warfarin therapy program. Rather than sending patient blood samples to the lab and waiting days for results, in-office testing: • Enables immediate therapy decisions by delivering on-the-spot results • Saves valuable time and unnecessary steps • Helps reduce risk and cost of treatment related complications1 • Improves patient satisfaction2

To learn more about POC PT/INR testing with CoaguChek systems, visit coaguchek-usa.com 1 Wurster M, et al. Dis Manag. 2006 2 Campbell PM, et al. Dis Manag Clin Outcomes. 2002 2 Giles T, Roffidal L. Results of the prothrombin office-testing benefit evaluation [PROBE]. Cardiovasc Rev Rep. 2002;23:27-33.

PHYSICIAN OFFICE LAB When your customers care

Where your customers care

Routinely, clinicians managing healthy patients for an annual physical or wellness exam see patients whose microbiota community are in balance and really do not even think about the impact of imbalance. But, for the symptomatic patient, whether they have respiratory, GI or other symptoms, suddenly the emergence of a pathogen and the apparent imbalance of the microbiota become a critical concern. When all is said and done, both the importance of understanding whether a patient has a bacterial or viral infection and understanding of which organism is the causative agent is a critical crossroad in diagnosis and treatment.

While respiratory infections and urinary tract infections are common reasons for patients to see their primary care physician, some of the other infections we are considering are more likely to be seen in a more acute care setting, including an urgent care, free standing emergency room or hospital-based emergency room. Many of the more painfully symptomatic GI and skin infections, including tick-based diseases, are first diagnosed in these settings. Genital infections tend to run the gamut from community healthcare clinics to private primary care to the emergency room depending on the severity of the symptoms. So, no matter what your call point or customer type, the clinicians you call on see some or all of the most common sources of infection and can benefit from a range of the solutions you and your valued suppliers can provide. The range of tests available has increased significantly and the speed and quality of the results provide easily accessible lab tests to help diagnose these infections.

No matter what your call point or customer type, the clinicians you call on see some or all of the most common sources of infection and can benefit from a range of the solutions you and your valued suppliers can provide. The remarkable advances in molecular testing have paved the way to enable testing for a far wider range of bacteria and viruses than ever before with results that are faster, more accurate and more actionable than we could have achieved fewer than 10 years ago. As you look through the eyes of your customers, probably the most meaningful change is this: New molecular methods, in combination with other advances in lab technology including procalcitonin and newer hematology system parameters aimed at helping to diagnose sepsis, mean that the customers we call on are better armed than ever to evaluate the cause of infection for a patient, whether the infection is respiratory, skin or wound based or enteric. This is a remarkable move forward. The clinician can now evaluate and diagnose the patient on a holistic basis, irrespective of where the infection resides.

June 2019

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Why you should care In addition to growing our business, we are charged with helping our customers to provide the best available care to their patients and acting as a savvy and well-informed consultant. Spending time with your key suppliers and learning about the solutions they offer to the myriad infectious diseases our customers see every day is an excellent way to move beyond being an expert on flu and respiratory tests. We can help our customers to create tremendous patient care value by accurate, early diagnosis of infections. We can help reduce the spread of contagious diseases in our community and reduce the possibility of development of sepsis from certain respiratory and skin infections. Accurately diagnosing Lyme and other tick-borne illnesses can lead to more effective treatment and reduce time to diagnosis, costs and patient suffering. Timely diagnosis and treatment of infections based on lab results is a critical element of antibiotic stewardship. Finally, no matter what the practice setting, the bottom line of timely accurate diagnosis of infection is better patient care. Weâ&#x20AC;&#x2122;re key providers of the information and the tests available to improve health care to the clinicians we call on who see infections every day. Make a difference.

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NDC EXHIBITION 2019

NDC celebrates ‘Power of Partnership’

Keynote Speaker, Doug Lipp, presenting to a rapt audience

NDC Exhibition 2019: Power of Partnership brought

over 980 attendees to the Gaylord Opryland Resort & Convention Center in Nashville, Tennessee, on April 7 – 9. Over the course of the two-and-a-half-day event, attendees had the opportunity to learn from some of the nation’s top speakers and network with strategic partners, all while enjoying the Music City. Attendance was at a record high this year, including 181 distributor companies and 175 manufacturer companies from across the country, resulting in a 25 percent increase over the previous record set in 2018. During his opening remarks to kick off the event, NDC President & CEO Mark Seitz reinforced why independent distribution remains relevant, and he elaborated on how NDC is committed to serving its growing network as an innovative and dedicated business partner. Seitz also discussed the investments NDC has made, both in technology and talent, to continue providing value to manufacturers and distributors alike. The keynote, sponsored by Midmark Corporation, was delivered by Doug Lipp, a former Disney executive,

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Attendees enjoying the Welcome Lounge as they arrive in Nashville

distinguished international consultant and eight-time author, who gave a powerful and emotive presentation on creating and perpetuating a culture of significance within organizations. Other exceptional speakers included Conor Cunneen, IrishmanSpeaks, who discussed the power of humor in sales; and Michael Lovdal, who used data and insights to enlighten attendees about the mega-trends that are reshaping U.S. healthcare.

NDC Platinum Partners, Sekisui and BD, with Scott Adams

New events The annual awards event was held to recognize and honor the achievements of NDC’s 2018 top-performing partners. Additionally, NDC introduced several new events this year: Post-Acute Marketplace, NDC ED Talks, and Military Appreciation Night. The Post-Acute Marketplace targeted distributors who were interested in new selling opportunities in this space. They were able to discuss these opportunities face to face with manufacturers. NDC staff experts presented “ED Talks” on various topics, including marketing tips, selling strategies and NuEdge partnerships. Each session left attendees with action items to implement immediately. Military Appreciation Night, sponsored by GOJO, was held at John Rich’s new honky-tonk bar, Redneck Riviera, where all past and present military members, veterans, police officers, firefighters and first responders were honored. Over 234 attendees joined together for this great salute. The last day of the Drake White performing at the Closing Celebration at the Exhibition was reserved world-famous Wildhorse Saloon for the cornerstone of

President of DUKAL Corporation, Gerry LoDuca, performing with his band, The Defibrillators

Dick Moorman and Mike Carver

NDC’s event – the annual tradeshow, where over 136 manufacturer booths were on display. Later that evening, attendees gathered at the world-famous Wildhorse Saloon for the Closing Party, sponsored by BD and DUKAL Corporation, to celebrate the power of partnership. Gerry LoDuca, President of DUKAL Corporation, and his band, The Defibrillators, took to the stage first, followed by country music sensation Drake White and the Big Fire. Next year’s NDC Exhibition will be held in Dallas, Texas, at the Gaylord Texan Resort & Convention Center on March 29 – 31, 2020.

Winner of the NDC Member of the Year Award, CME Corp

A recipient of the Outstanding Performance Award, B. Braun Medical, Inc.

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June 2019

Sofia 2 Lyme FIA: CLIA-waived Results in minutes, not days. Diagnosing Lyme disease is hard. Symptoms are broad and generic, mimicking many other conditions. Patients feel horrible and want answers. It doesn’t help that current testing methods may take hours or days for results. Not anymore! Sofia 2 Lyme FIA uses a fingerstick whole blood sample to provide accurate, objective and automated results in as few as 3 minutes, getting doctor and patient on a path to treatment much sooner. Sofia 2 Lyme FIA is the only rapid, near-patient testing solution that provides IgM and IgG differentiated results in a single test. It has demonstrated accuracy on par with current testing methods — all with less than 1 minute hands-on-time. And as you’ve come to expect from Sofia 2, our Lyme assay functions in WALK AWAY and READ NOW modes, providing flexible workflow options based on your needs.

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NDC EXHIBITION 2019 NDC awards Distributor awards • NDC Member of the Year: CME Corp • Fast Track Award: Diagnostics Direct, Inc. •T rendsetter Award: Coastline Medical Management Supplier awards Outstanding Performance Awards: • Ansell • GOJO Industries, Inc. • B. Braun Medical, Inc. • Mölnlycke Health Care • Midmark Corporation Simply Powerful Partner Awards: •C amille Earthman, DUKAL Corporation • S helton Hand, PTS Diagnostics • Art Miller, Omni International • Linda Musnoff, Sempermed Club members: Million Dollar Club: • Advantage Medical Supply • Allied Medical Products, Inc. • AOSS Medical Supply, LLC • BP Gamma Medical • CME Corp • Delcrest Medical Services, Inc. • Dove Medical Supply • Ecologically Sound Medical Services • Marathon Medical Corporation • MasterFit Medical Supply, LLC • Med-Plus Inc. • Medical Supplies Depot, Inc. • MVAP

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• O&R Medical Sales & Service • Pharmaceutical Health Care • QB Medical, Inc. • R. Weinstein, Inc. • Rally, Inc. • School Nurse Supply • Sharp Medical Supplies • Source Products • Suncoast Surgical & Medical Supply • Sunset Pharmaceuticals • T-Plex, A Federated Healthcare Supply Company • Turenne PharMedCo • United Medical Supply • Wilburn Medical, Inc. Multi-Million Dollar Club: • 4MD Medical Solutions, LLC • All Med Medical Supply • American Medical Depot • Anda • Buffalo Hospital Supply Co., Inc. • The Claflin Company • Cobalt Medical Supply, Inc. • Diagnostics Direct, Inc. • ECP Distributors • EKLA Corporation • Grogan’s, A Federated Healthcare Supply Company • HemaSource, Inc. • J & B Medical Supply Co. • Lynn Medical • Medical Specialties Distributors, LLC • Mercedes Scientific • Metro Medical Supply, Inc. • M idwest Veterinary Supply, Inc. • Neil Medical Group

•P ark Surgical, Inc. a.k.a Dealmed • Reidy Medical Supply • RHS Healthcare Solutions Inc • Shared Service Systems, Inc. • S outheastern Emergency Equipment • The Stevens Company • Tiger Medical, Inc. • US Medsource Diamond Club: • 4MD Medical Solutions, LLC • Advantage Medical Supply • American Medical Depot • Arkansas Surgical Supply • CME Corp • Cobalt Medical Supply, Inc. • EKLA Corporation • Elim Preferred Services •G ill Podiatry Supply & Equipment • Hankins Surgical Supply • HemaSource, Inc. • IHMS Holdings, LLC •M arathon Medical Corporation • Medical Supplies Depot, Inc. • Medical Supply Corp • Mercedes Scientific • M idwest Veterinary Supply, Inc. • MVAP • Qual-Med Supply, Inc. • Rally, Inc. • Shared Service Systems, Inc. • Sharp Medical Supplies • Summitek, Inc. • United Medical Supply • US Medsource

Offer your customers the safer alternative. Therapeutically equivalent to ethyl chloride, but non-HAZMAT, non-toxic, and non-flammable, CryoDose TA is also lower in cost.

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DISTRIBUTION

Henry Schein Medical ‘Extra mile’ is meeting theme Henry Schein Medical hosted its 21st annual National

Sales Meeting – “The Extra Mile” – this spring in Aurora, Colorado. The meeting brought together more than 1,350 attendees from Henry Schein and supplier partners. Henry Schein Chairman and CEO Stanley M. Bergman, Henry Schein Medical President Brad Connett and other company leaders encouraged the team to go the “extra mile” by asking themselves how to help customers adapt to the pressure and pace of change in today’s health care marketplace while also helping to advance their efforts to deliver high quality patient care. “The National Sales Meeting provides an opportunity for our sales consultants to harness the power of us,” said Connett. “No matter how big we get, or how many countries we serve, the value system of Henry Schein Medical will not change, and at the core of that value system is

June 2019

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institutional trust. To build that trust, play your position and commit to working as a team. To be successful, we must be early adopters in times of change.” Awards recognizing 2018’s top performers, supplier partners, and products in the following categories included: • Supplier Partner of the Year (Solutions, Pharma, Lab, Equipment, Med/Surg). • Clinical Lab Specialist of the Year. • Capital Equipment Specialist of the Year. • Dialysis Sales Consultant of the Year. • EMS Sales Consultant of the Year. • Foot & Ankle Sales Consultant of the Year. • Insource Sales Consultant of the Year. • Solutions Consultant of the Year (Field Sales, Telesales).

Say hello to the NEW Midmark Workstations. Spending time hunched over a computer screen can have big impacts on a caregiver’s body and a health system’s bottom line. Midmark Workstations are the only products on the market today that truly support the range of motion needed for 95% of users in the clinical setting. Offer your customers an exclusive solution while increasing revenue potential in the exam space—better care is better business. midmark.com/workstationsREPjun

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• National Account Manager of the Year. • Regional Account Manager of the Year. • Strategic Account Manager of the Year (Ambulatory Surgery Centers, Upmarket, Midmarket). • David Vann Award. • Telesales Consultant of the Year. • Telesales Manager of the Year. • Rookie of the Year. • Field Sales Consultant of the Year. • Regional Sales Manager of the Year. For the second year in a row, Schein team members participated in the We Care Global Challenge, a companywide initiative in which employees at 15 company locations in four countries assemble comfort kits for people with cancer around the world. At the Medical National Sales Meeting, 4,250 kits were assembled to support the American Cancer Society’s Hope Lodge program. These kits, in addition to the 750 built by Schein employees at the company’s headquarters in Melville, New York, will be distributed to over 30 Hope Lodge locations throughout the U.S. Each Hope Lodge offers cancer patients and their caregivers a free place to stay when their best hope for effective treatment is in another city. Logistics support for the project is provided by Heart to Heart International.

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LEADERSHIP DEVELOPMENT CURRICULUM 2019 Leadership program for developing your skills and furthering your influence PWH® has partnered with Katie Snapp, Founder, Better-Leadership.com to offer distance learning courses with an opportunity for participants to earn Certificates in Leadership Development, or a Master Certificate in Leadership Development by completing all three courses. Each course provides: • Three lessons delivered online over five weeks or less • Three group coaching sessions • One personal coaching session

COURSE #1

COURSE #2

YOUR LEADERSHIP STORY:

INTERACTING WITH OTHERS:

Both women & men welcome! COURSE #3

SEASONS OF CHANGE:

ROOTING YOUR STRENGTHS & NATURAL SKILLS

ENGAGING WITH THE ENVIRONMENT AROUND YOU

A PERENNIAL VIEW OF RESILIENCY & PRODUCTIVITY

Achieve results while honoring your uniqueness in a gender-balanced workplace.

Great leaders sense their surroundings and build productive environments.

Adjust to ups and downs by understanding the organic cycle of change.

In this course you will:

• Understand the difference between a leader and a manager • Assess the cultural challenges in the healthcare industry that affect you • Determine where your confidence stumbles so you can tackle fear and self-doubt • Discover your intuitive leadership style, its assets and liabilities (includes a self-assessment of the Intuition Model) • Leverage your genuine strengths as a woman OR a man so that you can find comfort in leading • Set a plan for a stellar career

• Build the collaborative relationships in the workplace that you see as crucial • Review how the concepts of power & influence can work • Study emotional intelligence in a way that is easy to grasp and build upon • Reinforce your personal bio to take it from drab to fab! • Find out how to Role Model others and become a Role Model FOR others • Other skill-building includes putting your best face forward, and listening openly

Course 1 begins: August 9, 2019 Deadline to register: July 26, 2019

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• Realize the challenge of managing your self-confidence in critical situations • Gracefully accept criticism from others • Learn to coach others to success and deliver positive feedback • Discover personal productivity techniques for efficiency and sanity • Other specific skill-building includes translating loss into forward progress, sensing and managing conflict, and initiating difficult conversations

Course 3 begins: November 1, 2019 Deadline to register: October 18, 2019

DISTRIBUTION

Enhancing Access to Care Henry Schein Medical and Henry Schein Cares Foundation partner with Children’s Health Fund to help enhance access to care for underprivileged

Henry Schein Medical, the U.S. medical business of

Henry Schein, Inc., and Henry Schein Cares Foundation, Inc. (HSCF) announced a multi-year partnership with Children’s Health Fund (CHF) to support the nonprofit organization’s efforts to deliver high-quality health care to America’s most disadvantaged children.

Team Schein Members together with CHF and Montefiore.

Henry Schein Medical and HSCF, a 501(c)(3) organization that works to foster, support, and promote medical and dental health by helping to increase access to care in communities around the world, will provide a combination of cash and in-kind product donations valued at nearly $525,000 over four years. This donation will include a wide range of medical and dental products to support CHF’s mobile medical clinics and pediatric programs at the following 12 locations: • Children’s National Medical Center (Washington, D.C.); •C ommunity Pediatric Programs at Montefiore (New York, NY); • Dell Children’s Medical Center (Austin, TX); • Family Health Services (Twin Falls, ID); • Le Bonheur Children’s Hospital (Memphis, TN); •L ucile Packard Children’s Hospital at Stanford (San Francisco, CA); •O ur Lady of the Lake Regional Medical Center (Baton Rouge, LA); • Parkland Health & Hospital System (Dallas, TX); • Phoenix Children’s Hospital (Phoenix, AZ);

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• Teen Xpress at Arnold Palmer Hospital for Children (Orlando, FL); • Tulane University School of Medicine (New Orleans, LA); and • University of Miami School of Medicine (Miami, FL). As part of the agreement, each site had an opportunity to request a custom product mix to meet their unique needs, ensuring Henry Schein’s donations were strategically allocated to fulfill the most critical patient needs by location, according to a release.. “Henry Schein Medical is pleased to partner with Children’s Health Fund as part of our ongoing commitment to ‘helping health happen’ and enhancing access to care for those most in need,” said Brad Connett, President, U.S. Medical Group, Henry Schein. “Our new relationship with CHF reflects the important role public-private partnerships can play to help strengthen the health care infrastructure, and demonstrates how we as a company leverage our relationships with customers and supplier partners to drive corporate social responsibility activity that ultimately impacts the communities we serve.” “We are extremely grateful for this new partnership with Henry Schein Medical and HSCF, which helps us provide resources to targeted programs and mobile clinics across the country,” said Dennis Walto, Chief Executive Officer at Children’s Health Fund. “Having additional support allows our programs to fulfill their primary focus: the delivery of high-quality medical care to children who need it most. Together, Children’s Health Fund and the team at Henry Schein Medical and HSCF are working on a common mission: to ensure children and families have access to the health care solutions they deserve.” Since its founding in 1987, CHF has helped expand access to comprehensive primary care; reduce health barriers to learning; respond to the needs of children impacted by major health crises; and improve the health and well-being of children through advocacy and public education efforts.

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Infection Prevention: Progress, Not Perfection The trends look promising, but there’s room for improvement

ach day, approximately one in 31 U.S. patients contracts at least one infection related to his or her hospital care, reports the Centers for Disease Control and Prevention. That might not sound like great news. But it does signal progress. “Overall, there is a lot to be happy about,” says Keith Kaye, M.D., MPH, FIDSA, FSHEA, professor of medicine in the Division of Infectious Diseases at the University of Michigan Medical School, referring to CDC’s recently released “2017 National and State Healthcare-Associated Infections (HAI) Progress Report.” “Pretty much all device-associated and MDRO [multidrug-resistant organism] metrics are improved from 2016 to 2017,” says Kaye, who is past president of the board of trustees of the Society for Healthcare Epidemiology of America, or SHEA. “This improvement occurred on top of notable progress that had already been made prior to 2016.” According to the CDC, nationally, between 2016 and 2017, acute care hospitals experienced: • About 9 percent statistically significant decrease in centralline-associated bloodstream infections (CLABSIs). (Largest decrease – 10 percent – occurred in wards.) • About 5 percent statistically significant decrease in catheter-associated urinary tract infections (CAUTIs). (Largest decrease – 8 percent – occurred in ICUs.) •A bout 3 percent statistically significant decrease in ventilator-associated events. •A bout 8 percent statistically significant decrease in methicillinresistant Staphylococcus aureus (MRSA) bacteremia. • About 13 percent statistically significant decrease in C. difficile infections. • About 1 percent statistically significant decrease in surgical site infections (SSIs) related to 10 select procedures tracked between 2016 and 2017. (That said, no significant changes in abdominal hysterectomy SSIs or colon surgery SSIs.)

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Infection Prevention: Progress, Not Perfection Compared to the 2015 baseline standardized infection ratio (or SIR, a comparison of the number of actual infections in a facility and the number of infections that were “predicted” to have occurred based on previous years of reported data): •F orty-one states performed better on at least two infection types. (Of these, 37 performed better on at least three infection types, and 23 performed better on at least four). •F ive states performed worse on at least two infection types.

in acute care settings, as many infection prevention programs target these procedures to reduce the risk of infection associated with them. The numbers suggest there is still more room for improvement.” “We can do better,” adds Kaye. “Surgical site infections are one of the most common healthcare-acquired infections, and continued focus on optimizing SSI prevention is called for.” SHEA published “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update” to provide recommended strategies based on available scientific evidence and guidance, he says.

Compared to the 2017 national SIR: •T wenty-four states performed better on at least two infection types. (Of these, 14 states performed better on at least three infection types, and three performed better on at least four.) •T wenty-seven states performed worse on at least two infection types.

Progress, not perfection

“I was pleasantly surprised by the continued sharp and significant decreases in CLABSI, MRSA bacteremia and C. difficile,” says Kaye. “Decreases approached or exceeded 10 percent for each of these measures. These are large, impressive decreases, particularly when considering that these occurred in the setting of notable improvements leading up to 2016.” “We are very encouraged to see steady progress,” says Arjun Srinivasan, M.D., associate director for healthcareassociated infection prevention programs, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC. “It’s a reflection of the hard work that folks in hospitals are doing day in and day out to follow CDC recommendations and best practices, to make sure they are delivering the best care.”

Room for improvement Marie H. Wilson, RN, CIC, infection preventionist at Methodist Dallas Medical Center and a spokesperson for the Association for Professionals in Infection Control and Epidemiology (APIC), agrees that the Progress Report shows encouraging trends. Even so, much remains to be done, she says. “It is surprising to see that no significant changes were detected in reducing colon surgery surgical site infections

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Indeed, progress in infection prevention is never a straight line. For example, CDC reports that although U.S. rates of hospital-onset MRSA dropped 17 percent each year

“ Genuinely embracing a culture of safety and making your institution a highreliability organization are critical in the journey towards reducing HAIs.”

– Keith Kaye

between 2005 and 2013, progress against methicillin-susceptible staph (MSSA) may be rising in communities, and progress against MRSA has slowed in hospitals. And “zero HAIs” may be an impossible dream, if for no other reason than new challenges continually arise. For example, healthcare facilities in several countries – including the United States – have reported that a type of drug-resistant yeast called Candida auris has been causing severe illness in hospitalized patients, reports CDC. But that doesn’t deter infection prevention professionals from seeking continuous improvement. “I am not certain that ‘zero HAIs’ is always obtainable, due to severity-of-illness issues that some patients experience,” says Kaye. “However, in my opinion, more important than reaching zero, is to make certain that all preventive processes are in place and are being utilized

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Infection Prevention: Progress, Not Perfection and activity. If we take our eye off the ball, we can run into a situation where we stop making progress.” Patients are sicker than they’ve ever been, he says. “Providing care is complex, and the more complex it is, the more difficult it is to remember all the things that need to be done. To counter that, a lot of our focus at CDC has been to figure out how we can make the safe practice the easy thing to do.” Example: Providers may forget to wash their hands before and after each interaction with a patient. “Here’s a simple fix: Mount an alcohol-based hand dispenser outside every room,” says Srinivasan. “It’s easy to access the dispenser, and it’s a visible reminder to wash your hands.” Another key to infection prevention is antibiotic stewardship, that is, prescribing antibiotics only when they are needed, and making sure regimens are properly adhered to. fully so that infection prevention is “It’s incredibly important,” says optimized.” These processes range Srinivasan. “We know that the bigfrom hand hygiene to limiting ungest infection type where improved necessary indwelling devices, manantibiotic use can play a role is C aging indwelling devices with approdiff, which is a problem in nursing priate hygiene, avoiding unnecessary homes and hospitals. It’s a major antibiotics and optimizing the environarea of focus at CDC, and we are mental hygiene of a hospital, he says. thinking about the best way to de“The biggest barriers to impleliver best practices across the specmenting and complying with these trum of healthcare. processes include limited infection “There is an evolving underprevention resources and competing standing of how we deliver healthissues that face the hospital. Genu– Arjun Srinivasan care,” he adds. “In the past, nurses inely embracing a culture of safety played their role, and physicians and making your institution a highplayed their role, etc. We’re increasingly understanding reliability organization are critical in the journey towards that healthcare is a team sport. For example with antibireducing HAIs and improving the safety of patients.” otics, the physician might be the one writing the order, but the pharmacist is the one who dispenses it, and the Make the right thing easy nurse is the one who administers it. Each one plays an “This is not a one-and-done proposition,” says Srinivaequally important role.” san. “These are infections that require constant diligence

“It’s a reflection of the hard work that folks in hospitals are doing day in and day out.”

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Work smarter, closer As important as antibiotics are, experts agree that greater success against healthcare-acquired infections rests with better data, better processes and close working relationships among provider staff. More than 21,000 hospitals and other healthcare facilities provide data to the CDC’s National Healthcare Safety Network (NHSN), which in turn is used for national- and state-level analyses, and for targeted prevention initiatives by healthcare facilities, states, regions, quality groups, and national public health agencies, including CDC. Providers,

in turn, can use that data to track and compare their antibiotic usage and infection rates with other facilities. “Reaching ‘zero’ requires sustainable collaboration among an interprofessional team, including those in the acute care setting and beyond,” says Wilson. “As our patients come to us sicker than ever, our challenges to keep them infection-free will continue to increase. “Successful health systems support collaborative environments among care partners, monitor leading measures, and respond to infection prevention risks with calculated and evidence-based interventions.”

For further information: The 2017 National and State Healthcare-Associated Infections (HAI) Progress Report provides a summary of select HAIs across four healthcare settings; acute care hospitals (ACHs), critical access hospitals (CAHs), inpatient rehabilitation facilities (IRFs) and long-term acute care hospitals (LTACHs). (https://www.cdc.gov/hai/data/portal/progress-report.html) Vital Signs, Centers for Disease Control and Prevention, March 2019, https://www.cdc.gov/vitalsigns/staph/index.html

A new threat: Candida auris The Centers for Disease Control and Prevention has advised healthcare providers to watch for a type of yeast – Candida auris – which has been causing severe illness in hospitalized patients. What makes C. auris so threatening is that it is difficult to identify, and it does not respond to commonly used antifungal drugs. Limited data suggest that the risk factors for Candida auris infections are generally similar to risk factors for other types of Candida infections, according to CDC. These risk factors include recent surgery, diabetes, broad-spectrum antibiotic and antifungal use. People who have recently spent time in nursing homes and have lines and tubes that go into their body (such as breathing tubes, feeding tubes and central venous catheters) seem to be at highest risk for C. auris infection. Infections have been found in patients of all ages, from preterm infants to the elderly. C. auris has caused bloodstream infections, wound infections, and ear infections. It also has been isolated from respiratory and urine specimens,

but it is unclear if it causes infections in the lung or bladder. CDC reports that it doesn’t know if patients with invasive C. auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30% to 60% of people with C. auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death. C. auris is harder to identify from cultures than other, more common types of Candida. For example, it can be confused with other types of yeasts, particularly Candida haemulonii. That’s why special laboratory tests are needed to identify it. Most C. auris infections are treatable with a class of antifungal drugs called echinocandins, according to CDC. However, some C. auris infections have been resistant to all three main classes of antifungal medications, making them more difficult to treat. In this situation, multiple classes of antifungals at high doses may be required to treat the infection.

For more information, see “General Information about Candida auris,” https://www.cdc.gov/ fungal/candida-auris/candida-auris-qanda.html

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June 2019

Infection Prevention: Progress, Not Perfection Manufacturers’ perspectives Several manufacturers recently offered their perspectives to Repertoire on progress in reducing healthcare-acquired infections (as reported by the Centers for Disease Control and Prevention), as well as on those areas where more work is needed. “There is no doubt that patients are overall safer compared to a few years ago,” says Megan DiGiorgio MSN, RN, CIC, FAPIC, clinical manager, GOJO Industries. “Healthcare-associated infection (HAI) incidence rates have fallen due to increased federal, state and local attention to quality and

patient safety. However, HAIs continue to take a major human toll on society. The latest HAI progress report highlights our success but is also a reminder to not take our eyes off the ball. “Hand hygiene remains at the core of all infection prevention efforts,” she says. “Many healthcare facilities have fundamentally changed the way they approach hand hygiene with a focus on substantially changing habits and having the difficult conversations that need to occur. For many, electronic hand hygiene monitoring has been a springboard to reaching next level improvement.

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“When high quality products are combined with technology and a multimodal approach, sustained improvement and true culture and behavior change can occur. We look forward to more widespread adoption of hand hygiene technology and believe it’s the future.” Says M. Jordan Smith, quality assurance and regulatory affairs leader for Ventyv®, “Infection prevention is at the forefront in the battle against healthcare-associated infections (HAIs). With the release of the 2017 Healthcare-Associated Infections Progress Report by the CDC, there is renewed buzz about HAIs, and deservedly so. “Industry is using a multifaceted approach to this complex issue,” he continues. “However, we must ensure our efforts coalesce effectively. Cooperative hygiene programs – like the Hand Hygiene Project from 2010 – can be seen popping up across the industry. Healthcare facilities are employing dynamic infection prevention and infection control programs based on the best information available. Additionally, these facilities remain flexible in their approach, often modifying their policies and procedures – a key to fighting complacency. FDA and other government agencies are creating policy and initiatives to aid the fight. “Manufacturers of medical devices are joining the fight, too, by creating new devices that are less invasive, anti-microbial, and more durable. Ventyv remains ever optimistic about infection prevention efforts.”

Inpatient infections Among hospital inpatients, healthcare-associated infections (HAIs) lead to the loss of tens of thousands of lives and cost the U.S. healthcare system billions of dollars each year. These factors raise the risk of HAIs: • Catheters (bloodstream, endotracheal, and urinary). • Surgery. • Injections. • Healthcare settings that aren’t properly cleaned and disinfected. • Communicable diseases passing between patients and healthcare workers. • Overuse or improper use of antibiotics. Common HAIs patients get in hospitals include: • Central-line associated bloodstream infections. • Clostridium difficile. • Pneumonia. • Methicillin-resistant Staphylococcus aureus (MRSA). • Surgical site infections. • Urinary tract infections. • Catheter-associated urinary tract infections. Source: Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services (https://health. gov/hcq/prevent-hai.asp)

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POST ACUTE CARE

Point Person Come November, Repertoire readers in the long-term-care market may find themselves calling on a new decision-maker.

Effective Nov. 28, long-term-care

facilities will be required to have in place at least one infection preventionist, that is someone for whom the facility’s infection prevention and control program is a major (though not necessarily full-time) responsibility. It’s F-Tag 882, that is, part of the revised Requirements for Participation for Nursing Homes, which were published in November 2016. The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are helping long-term-care facilities gear up for the change. In March, the two agencies announced a free, online infection prevention and control training program for nursing home staff, which includes a half-hour module on the role and responsibilities of the infection preventionist.

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POST ACUTE CARE a particular problem. AHRQ estimates that 7% to 10% of all longterm-care residents have urinary catheters, including 12% of all new admissions at the time of transfer from acute-care facilities.

Most frequently cited But two of the most frequently cited impediments to effective infection control in the long-termcare setting are also two of the most basic: failure by staff to adequately wash their hands, and incorrect (or inadequate) usage of gloves. “A common reason hand hygiene is cited is because people don’t wash their hands long enough,” says Amy Stewart, MSN, RN, DNS-MT, QCPMT, RAC-MT, vice president of curriculum development, American Association of Nurse Assessment Coordination. In the live clinical setting, staff are often preoccupied with patient-care-associated exigencies, and hence may hurry the handwashing process. Regarding gloves, facilities need to educate not just the nursing staff on proper usage, but also those in environmental services, laundry, dietary and other areas where gloves are required. “These deficiencies can be eliminated or be cited at a lower scope and severity if staff are provided with education on these two very important aspects of infection control,” says Stewart. “I would suggest facility leaders consider providing staff competency education. This would include providing staff with the knowledge about facility-specific practices, along with a return demonstration of what was learned. Then, to ensure the information is carried over into the live clinical setting, facility leaders should audit staff to ensure proper knowledge was carried over into practice.” Given inevitable staff turnover, leaders should include such training in the facility’s orientation program, and they should offer it regularly throughout the year.

“ It’s safe to assume that the infection preventionist will be a key decisioninfluencer or decision-maker regarding infection-prevention-related supplies, devices and equipment.” An estimated 1 to 3 million serious infections occur every year in nursing homes, skilled nursing facilities and assisted living facilities, according to the CDC. Infections include urinary tract infection, diarrheal diseases and antibiotic-resistant staph infections, and they are a major cause of hospitalization and death. As many as 380,000 people die of infections in long-term-care facilities every year. What’s more, infections almost always involve big expenditures. The Agency for Healthcare Research and Quality estimates that LTC facilities spend from $38 million to $137 million annually for antimicrobial therapy and $673 million to $2 billion for hospitalizations. Catheter-associated urinary tract infections are

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POST ACUTE CARE

Infection among the elderly The following factors contribute to infections among the geriatric population, according to the U.S. Department of Health and Human Services: • Limited physiologic reserve. • Defects in host defenses. • Higher rates of coexistent chronic diseases (e.g., Type 2 diabetes, chronic obstructive pulmonary disease). • Increased risk of poor nutrition. • Loss of functionality and mobility. • Poor responses to therapy. • Increased frequencies of therapeutic toxicity (secondary to increased rates of liver and renal failure). • Complications from invasive diagnostic procedures. • Risks of infection from exposure to multidrug-resistant pathogens. • Delays in diagnosis and therapy. The most commonly reported healthcare-associated infections in long-term-care facilities include the following: • Urinary tract infections. Studies suggest that the majority of UTIs in long-term care are not catheter-associated. Many older individuals develop weakened pelvic muscles, resulting in incomplete emptying of the bladder, urinary retention, and bacterial colonization of the urinary tract. Significant morbidity is associated with UTIs, and they are a leading driver of hospitalizations. • Lower respiratory tract infections (influenza-like illness and pneumonia). Streptococcus pneumoniae (also known as pneumococcus) is the most frequently identified cause of bacterial pneumonia in people over 65. Diagnosing lower respiratory tract infections is difficult because the

presentation frequently is atypical. The only evidence of infection might be general malaise, anorexia, nonspecific weakness, behavioral changes or weight loss. Altered mental status has been found to be the most common presenting symptom in 40 percent of elderly adults with bacterial pneumonia. Declining oral hygiene increases the risk of aspirating bacterial agents into the lungs among individuals with difficulty swallowing or diminished cough reflex, especially in residents with underlying neurologic conditions (i.e., stroke).

• Skin and soft tissue infections. With aging, the physical barrier of the epidermis becomes thinner and protective subcutaneous fat declines, which allows for skin tears, decubitus (pressure) ulcer formation, and subsequent bacterial infection. • Gastroenteritis (most often due to either Clostridium difficile infection or outbreaks of norovirus gastroenteritis). It is estimated that more than half of all healthcare-associated CDI cases will manifest in nursing homes.

Source: National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination, Office of Disease Prevention and Health Promotion, Department of Health and Human Services, April 2013, https://health.gov/hcq/pdfs/hai-action-plan-ltcf.pdf

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The infection preventionist must be at least a part-time employee, and though they don’t necessarily have to be a nurse, they should demonstrate some expertise or training in microbiology or epidemiology.

A solid infection control and prevention system in place includes having a process to prevent, identify, report, analyze, and control infections and communicable diseases for all residents, staff, visitors, and volunteers, says Stewart. Having a sound system should be improved with the requirement of the infection preventionist. “This person’s role would include all of the above-mentioned items along with oversight of the antibiotic stewardship program,” she says. “Facility leaders should be preparing now to get this person properly trained and up-to-speed on their role. This would include reviewing all current policies and practices used by the facility.” The infection preventionist must be at least a parttime employee, and though they don’t necessarily have to be a nurse, they should demonstrate some expertise or training in microbiology or epidemiology. “We are awaiting further clarification [on the role] from CMS, says Stewart. But it’s safe to assume that the infection preventionist will be a key decision-influencer or decision-maker

regarding infection-prevention-related supplies, devices and equipment. “Now is a great time [for LTC facilities] to look at what is working and what isn’t working, and make the changes to the program,” she says. “For example, if facilities struggle to track and analyze staff infections, now is a great time to review the policy for reporting them and look for ways to improve the process. This may include a new method of tracking and trending these infections. “As with any policy change, staff need to be informed and understand why and how the policy change impacts them.”

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POST ACUTE CARE

C.A.U.T.I. intervention Catheter-associated urinary tract infections are costly and potentially life-threatening for long-term-care residents, and were identified as one of five priority areas in Phase Three of the United States Department of Health and Human Services (HHS) National Action Plan to Prevent Health Care-Associated Infections. An estimated 7 percent to 10 percent of all longterm-care residents have urinary catheters, including 12 percent of all new admissions at the time of transfer from acute care facilities to LTC facilities.

is essential, with hand hygiene before and after every resident contact and barrier precautions during intimate (e.g., toileting, bathing) assistance with activities of daily living. •U se catheters only if indicated. Routine assessments of catheter need (daily for short-term residents, monthly for longterm residents) should be conducted, and alternatives should be considered (such as intermittent catheterization, use of bladder scanner protocols to decrease

Training and mentorship of staff and family regarding catheter care are important, emphasizing the following points: Keep the drainage bag below the bladder, no violations of “closed” drainage system, and learn the appropriate use of leg bags. The Agency for Healthcare Research and Quality’s “Safety Program for LTC: HAIs/CAUTI” promotes the use of bundles or combinations of interventions to reduce CAUTIs, prevent infections, and improve the safety culture in long-term-care facilities. Here is AHRQ’s recommended intervention, using the letters of “CAUTI” as a memory device: • Catheters in newly admitted (and readmitted) residents should be removed to assess if still needed; every resident deserves a chance to be “catheter free.” •A septic insertion of indwelling catheters

need for catheterization, and other noncatheter solutions for incontinence). •T raining and mentorship of staff and family regarding catheter care are important, emphasizing the following points: Keep the drainage bag below the bladder, no violations of “closed” drainage system, and learn the appropriate use of leg bags. • Incontinence care planning to address individual resident challenges and solutions is important, including behavioral interventions such as timed and prompted voiding and appropriate medical management.

Source: AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs, Agency for Healthcare Research and Quality, May 2017, https://www.ahrq.gov/sites/default/files/wysiwyg/ professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/final-report.pdf

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Infection prevention takes a team Relationships among team members are key to successful infection prevention in the longterm-care setting, according to the Agency for Healthcare Research and Quality. Strong staff relationships lead to more excitement and support among the staff participating in the program, while weak or nonexistent relationships mean that staff will not participate in the same way or will only dedicate the minimum time and energy toward completing the program goals. All staff who participate in resident care – including certified nursing assistants (CNAs), nurses, physicians, environmental services, physical therapists, laundry, etc. – need to be educated on best practices for infection prevention, suggests AHRQ.

AHRQ created the “T.E.A.M.S. Intervention,” which focuses on the importance of having a good safety culture, and which uses TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training on teamwork and communication: • Team formation. Form a diverse team that will plan, champion, and implement the program. • Excellent communication. Encourage and educate the team on communication strategies. • Assess what’s working. Evaluate current culture, data, and practices; learn and implement; and continually reevaluate. • Meet monthly. Meet with the team regularly to discuss successes and barriers and to review data trends. • Sustain efforts. Plan for program sustainability early, and integrate program elements into daily workflow.

Source: “AHRQ Safety Program for Long-Term Care Preventing CAUTI and Other HAIs,” https://www.ahrq. gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/ modules/final-report.pdf

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POST ACUTE CARE

Water works Everyone knows that good hand hygiene – including hand washing and donning gloves – is important in preventing infections in healthcare settings. So is the infrastructure that supports it – sinks, faucets and soap and alcohol rub dispensers. Here are some things you might not know about water and related topics, as they pertain to healthcare-acquired infections. • The location of sinks is more influential than the number of sinks. One study found that each additional meter between the patient’s immediate surroundings and the nearest sink decreased the likelihood of handwashing by 10 percent. • Pathogens can be spread by water splashed from sinks, so water pressure should be optimized and flow should be offset from the drain. • Sinks designated for handwashing, and not for patient use, can improve hygiene, some studies show. • I t’s true that valves in faucets that automatically turn on and off by themselves can reduce transmission of pathogens by negating the need for users to touch the handle. But they also have low flow, tepid temperature and internal components (valves) that may harbor biofilm, which can contribute to microbial amplification. •P aper towels are preferable to warmair blowers for drying hands, because the towels can be used to turn off the faucet after use and the blowers may spread pathogens. But be careful: Pathogens can be spread by contaminated towel dispensers.

• Alcohol-based hand rub dispensers have been shown to improve hand hygiene compliance. The optimal location appears to be just outside the doorways to patient rooms. In that location, the dispenser is highly visible and is on the route of the caregiver; the action of entering the room is a trigger for the caregiver to perform hand hygiene. •D ispensers immediately near or on patient beds also help compliance. • The design of dispensers is important: A bright color and a design that differentiates the hand rub dispenser from soap dispensers improve usage. •P lumbing in a healthcare facility can house pathogens. In fact, completely eliminating those pathogens is unlikely. A multidisciplinary water management team should be appointed with the authority to implement water decisions. These include mapping the water system; analyzing hazards; developing mitigation strategies; establishing metrics; enacting policies that identify hazards; conducting surveillance for disease caused by waterborne pathogens (e.g., pneumonia, bloodstream infections, surgical site infections, meningitis, gastroenteritis and urinary tract infections); and developing a strategy for replacement of current higherrisk premise plumbing problem areas. • One more thing about water: Those beautiful, soothing, in-hospital water features – water walls, reflecting pools, fountains? Pretty to look at, but avoid them. They represent unacceptable risk in hospitals serving immunocompromised patients, even with standard maintenance and sanitizing methods.

Source: “Using the Health Care Physical Environment to Prevent and Control Infection,” a joint project prepared for the Centers for Disease Control and Prevention by the American Society for Health Care Engineering and several other organizations. (http://www.ashe.org/resources/pdfs/ cdc/CDCfullbookDIGITAL.pdf )

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TRENDS

Protecting the Channel The Grey market: Financial issue. Patient safety issue. By April 2018, BD was so concerned about the potential

patient-safety impact from product diversion and the grey market that the company put into place a full-time Channel Protection Team to identify and address grey market activity. The effort has paid off, as the amount of diverted BD product has declined. “The Channel Team has taken an aggressive approach to seeking out and shutting down diverters, proactively identifying fraudulent accounts and unauthorized resellers, as well as pursuing legal action against grey market participants,” says Jim Berdela, channel development and marketing vice president. And with good reason: Products sold on the grey market are vulnerable to a multitude of patient safety issues. Grey market commerce denies companies the ability to track an item’s end user or distributor – a significant liability in the event of a recall, Berdela points out. Additionally, without a proper chain of custody, the quality and sterility of a product can no longer be assured. “From a business perspective, companies face data distortion around purchasing trends, and loss of line-of-sight into who the ‘real’ customers are, and financial damage.”

What is the grey market? Diverted products can enter the grey market from both inside and outside the U.S. “For example, a U.S. manufacturer sells its product to a supplier outside the U.S. for the

sole purpose of servicing a different country or region (e.g. Latin America),” says Berdela. “The product is sold to this supplier, but after the sale, all or much of it is fraudulently diverted from the region, unbeknownst to the manufacturer, and re-sold back into the U.S.” Richard Bergner, chief operating officer, Integritet Global Consulting & Investigations in Miami, Florida, points out that domestic diversion in the U.S. can occur when products are sold at special pricing for home healthcare, Medicare, group pricing volume or other incentives. “These products can also be diverted, which usually involves falsified sales tracings and in some cases, fraud,” says Bergner, who since 2004 has been investigating healthcare diversion. “In other cases, we have seen cargo thefts where trucks are stolen. In yet other cases, we have seen multimillion-dollar thefts occurring at hospitals, distributors, wholesalers, manufacturers and others. These are not huge single hit ‘heists,’ but instead are daily thefts, which lead to losses in the millions of dollars over short periods of time – with the products making their way right back into the supply chain.” The desire for the lowest-price option on the part of purchasers fuels the secondary market, adds Bergner. Manufacturers inadvertently fuel the problem with varying global cost structures to penetrate emerging markets and improve healthcare for patients globally. “Savvy traders

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TRENDS exploit these opportunities, which means products intended for a particular market never make it to those patients.” Given that the grey market is “a shadow supply chain,” assigning a dollar value to it is difficult. Bergner estimates it is a “multi-billion-dollar problem for manufacturers, [which] results in lost sales, strained customer relationships, poor forecasting and in some cases, markets desperately in need of supplies underserved. “Worst of all, it creates an illicit supply chain which fuels cargo theft, counterfeiting, and other criminal activity. This channel can lead to improperly handled, misbranded, or counterfeit products being sold to healthcare providers, putting patients at risk.”

Online commerce The growth of online commerce may be exacerbating the problem. “Heavily trafficked e-commerce sites that specialize in marketplace sales provide easy access to outlets selling grey market product,” says Berdela. “Many online resellers using these retail sites’ third-party marketplaces are not authorized medical distributors, and it is difficult to know how they source the products they sell.” Says Bergner, “Third party market sellers can set up a storefront with little or no inventory, so there is no barrier to entry. Illicit products can be shipped to the online marketplace, get comingled with other inventories and fulfilled by that marketplace, so a reputable distributor could have their orders fulfilled with grey goods or worse.” Online auction sites are another concern. “Hospitals, clinics, surgery centers and even doctors are buying these products online to cut costs, improve margins, and sometimes to keep a struggling practice from failing,” says Bergner.

Meeting the challenge Although it is not illegal to buy product from the grey market, buyers should be aware of possible illegal or criminal activity going on behind the scenes, says Bergner. “Purchasing product from the grey market only encourages more such behind-the-scenes illegal activity.” In March 2019, the FDA Office of Criminal Investigations arrested four individuals accused of fraudulently diverting infant baby formula into the U.S. market that was contractually meant for sale into South America, Bergner points out. The indictment by the FDA included a requested judgment in excess of $120 million and jail

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time for the indicted individuals. The FDA got involved with this case due to the combination of fraudulent diversion and the potential public safety risk, he says. While the case focused on baby formula, the group was also trading in medical devices. BD’s Channel Protection Team “has made significant progress in implementing proactive and preventative measures to identify diversion, including educating and training our sales teams to recognize a fraudulent account or unauthorized reseller, data mining, using red-flag reports based on parameters and algorithms, and limiting access to U.S. products outside the country,” says Berdela. “BD also takes legal action against diverters by holding grey market suppliers accountable for impairing legitimate businesses, raising questions about brand authenticity and most important, compromising patient safety.” In 2018, the company discovered a U.S.-based distributor submitting fraudulent rebates, that is, rebates submitted on sales that never took place, and diverting product purchased from BD into the grey market, he continues. BD initiated litigation and was awarded a multi-million-dollar judgment. Such action was taken to help ensure a safe and secure supply chain for its customers and their patients, says Berdela. Attacking grey market product sales is a win for the entire healthcare supply chain, from manufacturer to patient, adds Bergner. “You can prevent risk to patients and improve the bottom line at the same time,” he says. Basic approaches include: • Conducting proper due diligence on new or even existing customers or companies of interest. • Evaluating shipments versus consumption for markets or geographies where diversion is possible. • Requiring proof of performance beyond simple assurances that the products went where they were supposed to go. • Conducting formal or informal market surveys or reviews. These can be done by company personnel or third parties. • Developing and maintaining a program to address and confront grey market activity and build it into day-to-day business. • Educating internal and external partners on the risks of the grey market and this illicit supply chain. • Partnering with customers and listening to what they are seeing out there, and then reacting to it.

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TRENDS

Primary Care Meets the Opioid Challenge Needed: A shared understanding among staff of how patients on chronic opioid therapy are managed. Primary care clinics are feeling the weight of the opi-

oid addiction crisis. And while newly developed medical devices will help them address the problem, a more important step will be improving the way practices manage chronic opioid therapy. “The sheer numbers of patients taking a prescription opioid medication for long-term chronic pain has placed an enormous burden on primary care, where the majority of opioid prescriptions are written,” according to researchers at the University of Washington in Seattle. “This burden may contribute to burnout and stress in primary care settings, where both prescribers and clinic support staff struggle daily to balance risks and the potential for abuse and diversion with empathy for the suffering of chronic pain patients,” write the researchers in an article in the Journal of the American Board of Family Medicine. Since 1999, nearly 400,000 people in the United States have fatally overdosed on opioid-containing drugs, with 47,600 deaths in 2017 alone, reports the National Institutes of Health. Many people with opioid use disorder,

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who initially were prescribed oral drugs to treat pain, now inject prescribed or illegal opioids. High-risk injection practices such as needle-sharing are causing a surge in infectious diseases. Additionally, risky sexual behaviors associated with injection drug use have contributed to the spread of sexually transmitted infections. In 2016, 66% of the 63,632 drug overdose deaths in the United States involved an opioid, according to the Centers for Disease Control and Prevention. In 2017, among 70,237 drug overdose deaths, 47,600 (67.8%) involved opioids. From 2016 to 2017, synthetic opioidinvolved overdose death rates increased 45.2%.

Medical device options The U.S. Food and Drug Administration believes that newly developed medical devices can help providers prevent and treat opioid use disorder. In 2018, the FDA’s Center for Devices and Radiological Health (CDRH) launched an “Innovation Challenge” to spur the development of medical devices – including digital health technologies and diagnostic tests – that could provide

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new solutions to detecting, treating and preventing addiction, addressing diversion and treating pain. Eight submissions were selected: •B rainsway, Ltd (Brainsway Deep Transcranial Magnetic Stimulation (DTMS) Device). •A vanos (pain therapy device). • iPill Dispenser (iPill dispenser). • Masimo Corporation (overdose detection device). • ThermoTek, Inc. (NanoTherm™ and VascuTherm™ Systems) (thermal compression therapy devices). • Milliman (opioid prediction service). • Algomet Rx, Inc. (rapid drug screen). •C ognifiSense, Inc. (virtual reality neuropsychological therapy). Although these products will not automatically receive marketing authorization from the FDA, device developers will receive increased interaction with CDRH experts, guidance for clinical trial development plans, and expedited review. “We believe the greatest opportunities for medical devices to help prevent opioid use disorder are devices that could help identify people likely to become addicted, devices that manage pain as an alternative to opioids or

reduce the need for opioid medications,” writes Jonathan Jarow, M.D., a chief medical officer, Office of Device Evaluation, Center for Devices and Radiological Health, in a December 2018 statement. “For example, the development of a diagnostic device, whether it be an in vitro diagnostic test, software or a mobile medical app, could be highly impactful in identifying those patients for whom extra caution should be exercised when prescribing opioids for acute or chronic pain.”

Building blocks to better management Even more important than therapeutic and diagnostic devices, however, is better management of chronic opioid therapy by primary care providers, according to experts. A good start is following “best practice” pain prescription guidelines, such as those released by the CDC, according to the University of Washington researchers. And that already seems to be happening. A study published in March from Harvard Medical School showed a dramatic drop – 54 percent – in the rate of monthly opioid prescriptions to patients who have never used these drugs or had been off them for at least six months. (First-time prescriptions are deemed an important gateway to long-term opioid use and misuse, and are a target for risk reduction, the researchers said.)

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TRENDS Primary care providers should also address clinic systems and workflows across the entire clinic – not just practices by individual prescribers. To that end, the Harvard researchers offer the following “Six Building Blocks.” Block One: Leadership and consensus. Leadership plays an important role by both prioritizing the work and creating opportunities for conversations among providers and staff to reach a shared understanding of how patients on chronic opioid therapy are managed. They help set goals for clinic-wide performance targets and help providers and staff understand their roles and responsibilities with patients on long-term opioid therapy. Block Two: Policies, patient agreements and workflows. Clinic policies about opioid prescribing for chronic pain create a shared understanding and agreedupon standards about how patients on long-term opioid therapy are to be managed. Defining standards for patient agreements, urine drug tests, and 28-day refill cycles can give providers the support they need when encountering resistance from patients. Block Three: Tracking and monitoring patient care. Implement proactive population management before, during, and between clinic visits of all patients on longterm opioid therapy. This is an “at-risk” population, and identifying them provides an opportunity to risk-stratify them and prevent them from “falling between the cracks” of a busy primary care clinic, according to the researchers. A population tracking system can help the practice identify care gaps between scheduled visits and conduct follow-up with those patients.

Block Four: Planned, patient-centered visits. Prepare and plan for the clinic visits of all patients on longterm opioid therapy. Care gaps can be identified by “scrubbing charts” the day before or during the morning huddle, and delegating tasks to different team members to close the gaps. Who will review the new patient agreement form with the patient and get their signature? Who will be responsible for checking the state prescription monitoring program database before the visit? Clinicians and staff can also briefly rehearse potentially difficult conversations with patients who have demonstrated aberrant behaviors, such as early prescription refill requests or an abnormal urine drug test. Block Five: Caring for complex patients. Some patients require more support because their chronic pain is complicated by other conditions, such as mental/behavioral health challenges. Others have developed opioid use disorder or an addiction. Identifying additional resources for these patients and creating systems to connect patients to these resources is essential for an effective chronic pain management plan. Some of these resources might be developed or brought in-house within the primary care clinic setting, while others will need to be identified in the local community and linkages established to them. Block Six: Measuring success. Teams need to see that the changes they are asked to implement are having the desired effect. Selecting a set of one or more measures to track over time, and providing that information to the entire clinic team at the local level, is crucial to improving and sustaining the work.

Additional resources: Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care, https://depts. washington.edu/fammed/improvingopioidcare/6-building-blocks/https://depts.washington.edu/fammed/ improvingopioidcare/6-building-blocks/ Primary Care Clinic Re-Design for Prescription Opioid Management, Journal of the American Board of Family Medicine, Jan-Feb 2017, Vol 30 No. 1, https://depts.washington.edu/fammed/improvingopioidcare/wp-content/ uploads/sites/12/2018/02/JABFM-article_2017.pdf CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016, Recommendations and Reports, March 18, 2016, https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm?CDC_AA_refVal=https%3A%2F%2Fwww. cdc.gov%2Fmmwr%2Fvolumes%2F65%2Frr%2Frr6501e1er.htm

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Each year, up to 40 percent of CMS-certified

nursing homes receive deficiency citations for inadequate infection control practices.1 Don’t let your customers be part of that crowd. Every healthcare setting is a place of healing. Ironically, it

is also a gathering spot for infectious agents, which can threaten the well-being of residents. That’s particularly true in the longterm care setting. In the United States, more than 15,700 long-term care facilities serve more than 1 million residents.2 The residents and staff in these facilities have an increased risk of infection due to the unique challenges in the care setting and the

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SPONSORED: CLOROX HEALTHCARE /ARKRAY USA resident population. The estimated prevalence of infections among nursing home residents ranges anywhere from 1.4 to 5.2 per 1,000 resident care days, which translates to 765,000 to 2.8 million infections annually.3,4 Healthcare-associated infections account for as many as 380,000 deaths annually.5 Infectious agents may be found on the instruments of healing themselves – reusable medical devices, such as the blood glucose meter. Somewhere between 25 percent and 34 percent of long-term-care residents are estimated to have diabetes, according to the American Diabetes Association. Each one of them needs regular testing with a glucometer, such as the ARKRAY Assure® Platinum blood glucose monitoring system. Here’s the challenge: Blood glucose meters can become contaminated with bloodborne pathogens, such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV); as well as the bacteria Clostridium difficile, or C. diff. Transmission of these pathogens from resident to resident has been documented due to contaminated blood glucose devices. Cleaning and disinfecting of meters with Clorox Health® care Bleach Germicidal Wipes or Dispatch® Hospital Cleaner Disinfectant Towels with Bleach after each use for individual resident care can prevent the transmission of these pathogens. Even if your customer uses one meter per resident, staff still should clean and disinfect it every time it is used. Failure to do so could result in a citation for failure to comply with CMS F-Tag 880, a guideline for infection control programs in long-term care facilities. Worse, it can put residents in harm’s way.

The good news is, there’s not much guesswork involved in cleaning and disinfecting medical instruments. Simply follow instructions, that is, the Directions for Use listed on the disinfectant manufacturer’s label as well as the IFU that comes with each medical device. “It is crucial that the glucometer manufacturer’s instructions for cleaning are followed,” says Doe Kley, RN, CIC, MPH candidate, senior infection preventionist for disinfectant manufacturer Clorox Healthcare.

Cleaning and disinfecting of meters with Clorox Healthcare® Bleach Germicidal Wipes or Dispatch® Hospital Cleaner Disinfectant Towels with Bleach after each use for individual resident care can prevent the transmission of these pathogens. Even if your customer uses one meter per resident, staff still should clean and disinfect it every time it is used. “It is equally important to adhere to the directions for use of the selected disinfectant, in particular, the contact time. “Typically, the glucometer manufacturers have tested and approved certain disinfectants, proven to be compatible with their devices, and these disinfectants are listed in their cleaning instructions. Adherence to manufacturer instructions can also protect product warranties.” Help your customers look out for infection among their residents with diabetes. Recommend Clorox Healthcare bleach-based products for their glucometers.

1. Herzig CT, Stone PW, Castle N, Pogorzelska-Maziarz M, Larson EL, Dick AW. Infection prevention and control programs in US nursing homes: results of a national survey. J Am Med Dir Assoc. 2016;17(1):85-88. [PubMed] 2. Harris-Kojetin L, Sengupta M, Park-Lee E, Valverde R. Long-term care services in the United States: 2013 overview. Vital Health Stat 3. 2013(37):1-107. [PubMed] 3. Tsan L, Davis C, Langberg R, et al. Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units. Am J Infect Control. 2008;36(3):173-179. [PubMed] 4. Tsan L, Davis C, Langberg R, et al. Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units. Am J Infect Control. 2008;36(3):173-179. [PubMed] 5. U.S. Department of Health and Human Services. National Action Plan To Prevent Healthcare-Associated Infections: Road Map to Elimination. Chapter 8, Long-Term Care Facilities. April 2013.

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TRENDS

Innovation in Healthcare Amazon’s Alexa launches 6 HIPAA-compliant services Amazon announced HIPAA-compliant software for its

Alexa voice assistant that allows healthcare organizations to transmit and receive patients’ protected health information. Six new Alexa healthcare skills from industry-leading healthcare providers, payors, pharmacy benefit managers, and digital health coaching companies are now operating in the HIPAA-eligible environment. In the future, Amazon expects to enable additional developers to take advantage of this capability. The new skills are designed to help customers manage a variety of healthcare needs at home, including booking a medical appointment, accessing hospital post-discharge instructions, checking on the status of a prescription delivery, and more. The new healthcare skills are: •E xpress Scripts (a leading Pharmacy Services Organization): Members can check the status of a home delivery prescription and can request Alexa notifications when their prescription orders are shipped. •C igna Health Today (by Cigna, the global health service company): Eligible employees with one of Cigna’s large national accounts can now manage their health improvement goals and increase opportunities for earning personalized wellness incentives. • My Children’s Enhanced Recovery After Surgery (ERAS) (by Boston Children’s Hospital, a leading children’s hospital): Parents and caregivers of children in the ERAS program at Boston

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Children’s Hospital can provide their care teams updates on recovery progress and receive information regarding their post-op appointments. •S wedish Health Connect (by Providence St. Joseph Health, a healthcare system with 51 hospitals across 7 states and 829 clinics): Customers can find an urgent care center near them and schedule a same-day appointment. •A trium Health (a healthcare system with more than 40 hospitals and 900 care locations throughout North and South Carolina and Georgia): Customers in North and South Carolina can find an urgent care location near them and schedule a same-day appointment. • Livongo (a leading consumer digital health company that creates new and different experiences for people with chronic conditions): Members can query their last blood sugar reading, blood sugar measurement trends, and receive insights and Health Nudges that are personalized to them. “Developers of the new healthcare skills are excited to enable their customers to access their healthcare services in the comfort of their own homes simply by asking Alexa,” according to an Amazon blog. “With our new Express Scripts skill, we are trying to make it easier for people to make better informed health care decisions,” said Mark Bini, Vice President of Innovation and Member Experience, Express Scripts. “In particular, we believe voice technology, like Alexa, can make it easy for people

to stay on the right path by tracking the status of their mail order prescription, helping us further solve the costly and unhealthy problem of medication non-adherence.” For more information, visit https://developer.amazon.com/blogs/alexa/post/ff33dbc7-6cf5-4db8-b20399144a251a21/introducing-new-alexa-healthcare-skills

Report examines challenges in evaluating, adopting innovative medical devices Over the last six years, the U.S. Food and Drug Administration has approved a number of highly innovative medical devices that have revolutionized cardiovascular care. These novel devices have provided advanced treatment options, improved quality of life and extended longevity for patients. Unfortunately, reimbursement has often failed to keep up with many of increasingly expensive treatment options. In the report, “The cost of medical device innovation: can we keep pace?” released, Vizient looks at how hospitals must develop a systematic process that enables the evaluation and adoption of emerging technology in a way that benefits patients and providers in a financially sustainable way. “A critical question facing providers is when they should implement an innovative technology. Physicians often want to be early adopters and have access to the latest technology because their goal is to always provide the best care for patients. But many potentially innovative technologies are never widely adopted for various reasons,” said Joe Cummings, technology program director for Vizient and a contributor to the white paper. “To use a value-based evaluation paradigm, the hospital’s technology adoption committee must engage in a systematic review of the clinical literature to determine pertinent clinical outcomes and also conduct financial analyses to estimate the total cost of care.” Key findings from the report include: •A n average 273.3 percent increase in price over the predicate medical device was found in a review of Vizient data for several recent innovative cardiovascular medical device introductions. •A review of select cardiovascular medical devices revealed considerable variability in the ratio of device cost to reimbursement. In fact, for some of the recent innovations, the device cost alone consumed a very high proportion of the overall reimbursement for the procedure, leaving minimal coverage for other expenses such as supplies, room costs and other miscellaneous resources required for the procedure.

• Hospitals, working collaboratively through multidisciplinary committees, must use a systematic, open and objective process focused on innovation assessments to determine which technologies provide better (optimal) patient care with improved value. • Suppliers initially, then technology advocates, must provide better clinical data during the launch and early-adopter phases of a medical device introduction. The data must clearly demonstrate better outcomes to support informed decision-making by physicians and hospitals. • Partnerships between providers and suppliers that allow for shared risk can help push both sides to improve quality and outcomes. The report was compiled by Vizient, the largest member-driven healthcare performance improvement company in the country. The full report can be accessed here: https://newsroom.vizientinc.com/sites/vha.newshq.businesswire.com/files/doc_library/file/The_cost_of_medical_device_innovation.pdf

MUSC receives $3.6M to launch national telehealth research network The National Center for the Advancement of Translational Sciences awarded a $3.6 million grant to the Medical University of South Carolina in Charleston (MUSC) in support of pediatric telehealth research. The five-year grant builds on work already underway as part of the Supporting Pediatric Research on Outcomes and Utilization of Telehealth, a network of institutions and pediatric providers within the American Academy of Pediatrics. The grant will establish a support structure for telehealth research that will provide tools, resources, education, and advocacy materials, among other resources. “This is a huge step forward in the development of safe and impactful telehealth programs across the country,” said primary investigator for the grant S. David McSwain, M.D., MUSC Children’s Health physician and MUSC associate professor of pediatric critical care and chief medical information officer. “Academic research into the real impact of telehealth services is a critical component of developing and growing programs with the greatest potential to improve our health care system. Many physicians and other health care providers are hesitant about incorporating telehealth into their practices because it’s difficult to separate the theoretical benefits from the real value.”

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WINDSHIELD TIME Chances are you spend a lot of time in your car. Here’s something that might help you appreciate your home-away-from-home a little more.

Automotive-related news Vehicle cybersecurity The 5StarS consortium has released a consultation paper to seek feedback on a new assurance framework to assess the cybersecurity of vehicles. Feedback is sought from automotive manufacturers, government and insurers to ensure this revolutionary framework is readily adopted when finalized this summer by the Innovate UK funded consortium. With the rise of new technology becoming a common component of new vehicles – from in-car entertainment, to connectivity that will boot up our homes as we drive there – manufacturers must have proven, built-

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in safeguards and resilience against the emerging threat of cyber attacks. Furthermore, the arrival of Connected Autonomous Vehicles (CAVs) and Advanced Driver Assistance Systems (ADAS) is also accelerating the debate around technology’s role, and impact on, road safety.

Backseat driver Volvo Cars says it believes intoxication and distraction should be addressed by installing in-car cameras and other sensors that monitor the driver and allow the car to intervene if a clearly intoxicated or distracted driver does

not respond to warning signals and is risking an accident. That intervention could involve limiting the car’s speed, alerting the Volvo on Call assistance service and, as a final course of action, actively slowing down and safely parking the car. Alerts would be triggered by a complete lack of steering input for extended periods of time, drivers who are detected to have their eyes closed or off the road for extended periods of time, as well as extreme weaving across lanes or excessively slow reaction times. Introduction of cameras on all Volvo models will start on the next generation of Volvo’s scalable SPA2 vehicle platform in the early 2020s.

Volvo Cars says it believes intoxication and distraction should be addressed by installing in-car cameras and other sensors that monitor the driver and allow the car to intervene if a clearly intoxicated or distracted driver does not respond to warning signals and is risking an accident. Meanwhile, Volvo Cars introduced the Care Key, which allows drivers to set limitations on their car’s top speed, before lending their car to other family members or to younger and inexperienced drivers. The Care Key will come as standard on all Volvo cars from model year 2021.

The streets were never free Congestion pricing has the potential to significantly change how traffic flows through Manhattan streets, how commuters get around the city, how companies like Uber and Lyft operate, writes Emily Badger in a recent article in The New York Times. But if the policy spreads, it could challenge a deeply embedded cultural idea, requiring people to pay for something Americans have long demanded – and largely believe they’ve gotten – free of charge. The idea of the open road evokes these intertwined meanings: The freedom to use it should be free. Residential street parking should be free. Traffic lanes should be free. Stretches of public curb dedicated to private driveways? Those should be free, too. Congestion pricing could finally put a price to what we’ve taken for granted.

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QUICK BYTES Editor’s note: Technology is playing an increasing role in the day-to-day business of sales reps. In this department, Repertoire will profile the latest developments in software and gadgets that reps can use for work and play.

Technology news Do you know what your IoT devices are doing? You may have a number of smart Internet-connected devices in your home, but do you have any idea who they’re talking to or what they’re sending? For instance, let’s say you have a Roku TV and that you are live-streaming the Bloomberg Channel. Do you know that the Bloomberg Channel could be communicating with 13 different advertising and tracking servers in the background? Or that your smart Geeni light bulb could be communicating with a Chinese company every 30 seconds even while you are not using the bulb? To learn more about your own IoT devices, you could set up a wireless hotspot and run Wireshark, but Princeton University says it has a better solution. Princeton IoT Inspector is an open-source tool that lets you inspect

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IoT traffic in your home network from the browser. With a one-click install process, you can watch how your IoT devices watch you. Download at https://iot-inspector.princeton.edu/blog/post/getting-started/

Apple Music vs Spotify Apple Music now has more paid U.S. subscribers than Spotify – specifically, more than 28 million versus Spotify’s 26 million, as of February 2019, reports Ars Technica. Sources claim that Apple Music is expanding more rapidly in the U.S., at a rate of about 2.6% to 3%. Spotify’s growth rate is reportedly 1.5% to 2%. It’s unlikely that Apple will claim this as a victory, because it, like Spotify, doesn’t publicly break out regional subscriber counts.

Space spinoffs No, Tang, Teflon and Velcro are not spinoffs of the U.S. space program, though their popularity was heightened by it. However, material meant to bring back samples from Mars, originally developed for NASA’s Jet Propulsion Laboratory, is now used in suture during heart surgery. What’s more, a lightweight, high-pressure tank NASA invented to hold rocket fuel now stores oxygen to keep pilots, firefighters and intensive care patients breathing. The latest edition of NASA’s Spinoff publication features nearly 50 commercial technologies that were developed or improved by the agency’s space program, and provides a look at some future ones too. Spinoff is part of the agency’s Technology Transfer program within the Space Technology Mission Directorate.

Don’t tell Facebook! Want to hide your browsing from Facebook? Here’s a Tip of the Week from The New York Times: On your computer: Install the Firefox web browser and download the Facebook Container, which is an add-on that isolates your browsing activity from Facebook. On your phone: Delete the Facebook mobile app and use only Facebook.com via the mobile browser. Install a tracker blocker, such as Disconnect.me, and activate the blocking. Alternatively, install a private web-browsing app like Firefox Focus, which blocks trackers by default, and only use this browser when loading Facebook.com

No more Google Glass Huawei is expected to launch a line of smart glasses this summer. The glasses let you listen to music in stereo and take calls. They also charge wirelessly. Writes a critic from CNET: “What’s impressive … is that there’s absolutely no discernible sign of any technology at all, no buttons and no bulges, and to the naked eye it would be impossible to distinguish them as smart glasses at all. We’ve come a long way since the days of Google Glass.”

Internet around the world OneWeb, a space startup that recently launched its first “constellation” of micro-satellites to deliver broadband access across the globe, has raised $1.25 billion to begin mass-producing its satellites and capitalize on what it calls “first mover advantage,” reports Venture Beat. Founded in London in 2012, OneWeb is one of a number of startups planning to bring affordable, high-speed Internet access to more people around the world by deploying hundreds of low-orbit satellites. The infrastructure is intended to not only help mobile operators and internet

service providers extend their coverage to hitherto hardto-reach areas, it will also ensure always-on coverage during natural disasters.

In-depth news from Alexa One of the top use cases for Amazon Alexa is its ability to quickly summarize the day’s headlines via its customizable “Flash Briefing” skill, reports TechCrunch. Now, Amazon is rolling out a new feature that will allow Alexa device owners to get more in-depth news from their preferred news provider – the launch of “long-form news.” Currently, the new feature works with news from Bloomberg, CNBC, CNN, Fox News, Newsy and NPR, Amazon says. Getting the news is already a top voice activity among smart-speaker owners. Amazon says that voice commands, such as “Alexa, tell me the news,” followed by the source’s name, will launch in-depth news sessions featuring stories curated by the news provider.

Wi-Fi 6 routers from Netgear Netgear is said to be introducing a family of four new routers that makes the migration to Wi-Fi 6 networking easy, reports Venture Beat. The San Jose, California-based maker of networking hardware has created four routers that support the latest Wi-Fi networking standard, 802.11ax. These devices are intended to help households that are dealing with an increasing number of connected devices and an increasing demand for greater bandwidth from streaming video, audio and online gaming. Netgear’s Wi-Fi 6 routers are said to deliver up to four times better performance than Wi-Fi 5, or 802.11ac.

Bottom-of-the-ocean dominance Google makes billions from its cloud platform. Now it’s using those billions to buy up the Internet itself – or at least the submarine cables that make up its backbone, reports Venture Beat. In February, the company announced its intention to move forward with the development of the Curie cable, a new undersea line stretching from California to Chile. It will be the first private intercontinental cable ever built by a major non-telecom company. Google has fully financed a number of intracontinental cables already; it was one of the first companies to build a fully private submarine line. And Google isn’t alone. The year 2016 saw the start of a massive submarine cable boom, and this time, the buyers are content providers. Corporations like Facebook, Microsoft and Amazon all seem to share Google’s aspirations for bottom-of-the-ocean dominance.

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June 2019

IDN OPPORTUNITIES

Nothing But the Truth Health system believes science – and data – can beat marketing Health systems operate in a competitive environment.

They want to provide the best patient care with the most advanced technologies, but they want to do so cost-effectively. That means they want to use technologies with proven effectiveness, that is, with real-world evidence behind them. But it can be a tangled web that binds medical technologies with outcomes. Mercy, working with a few collaborators, is working to untangle it. Mercy includes more than 40 acute care, managed and specialty hospitals, and more than 900 physician practices and outpatient facilities, in Arkansas, Kansas, Missouri and Oklahoma. In October 2017, Mercy signed a deal with Medtronic in which Mercy would capture de-identified data from approximately 80,000 patients with heart failure to explore real-world factors that determine a patient’s response to cardiac resynchronization therapy (CRT). Then, in July 2018, Mercy signed a data-sharing agreement with Johnson & Johnson Medical Devices Companies to establish a data platform that uses real-world clinical data to evaluate medical device performance. Most recently, in January 2019, Mercy Technology Services – Mercy’s IT backbone – announced a research

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collaboration with BD that will enable BD to use Mercy’s clinical data platform to help evaluate and improve the effectiveness of medical devices and procedures, beginning with integrated vascular therapy and vascular access management. “I believe that traditionally, marketing has beaten science,” says Vance Moore, president of business integration for Mercy. “Now we’re trying to make science beat marketing.” And the only way to do that is with data, or real-world evidence.

A natural relationship Approximately 12 years ago, Mercy extended the Epic electronic medical record system throughout its ministry. Consequently, Mercy has long, contiguous patient records. “We have taken that information, standardized it and used it productively inside Mercy,” says Moore, who helped found ROi, Mercy’s supply chain operation, in 2002. Vendors (or “collaborators,” the term that Moore prefers) recognize the value as well. “They have said to us, ‘We’re trying to make the very best products, but we can’t make our case without data,’”

IDN OPPORTUNITIES says Moore. “So it’s a natural relationship. The more data manufacturers get, the better they can make their case, and that is in best interest of all consumers of healthcare.” Of course, sometimes the truth can hurt. In other words, the data might show that the collaborator’s technology doesn’t yield the outcomes as marketed. “But they do want to know that, because over time, the truth does reveal itself,” he says. “If something doesn’t play out, it will ultimately surface. “The companies we’re working with want to get ahead of that. They’d much rather find out themselves if something isn’t working than find it in the news headlines.

“It’s true that some marketing teams don’t want to learn that their product isn’t working as it had promised customers it would. But Mercy – and most collaborators – believe this is the right thing to do. The future of healthcare will be defined by the effective use of information and technology, and by great caregivers who can use that information effectively.”

It’s about the data When asked about the challenges involved in gathering real-world evidence, Moore responds, “It’s about the data. It always is.” The three big issues are data definition, data cleanliness and data completeness. •D ata definition. Over the years, the meaning of data points can drift or “morph,” making it very

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difficult to gather and analyze information. For example, when the Mercy team reviewed generations of its medical record system, they found eight different definitions of “OR start time.” • Data cleanliness. Medical information isn’t always recorded uniformly in the medical record, Moore points out. Instead of a field in the electronic database, important information might show up on a piece of paper. All those scraps of information have to be gathered and organized. • Data completeness. One facility in a health system might be diligent about filling out every field in the electronic medical record, while another might say, “I’m not so sure it’s essential,” says Moore. “So you get partial data.” “We have spent a lot of time building our system, curating the data, and extracting it,” he says. Perhaps Mercy’s biggest advantage – and what makes it a desirable partner for collaborators – are its data scientists, that is, the people in IT, many of whom have had experience in healthcare. Because of that experience, they understand the context of the manufacturer’s request for information, and can supply it readily. Ultimately, the entire industry – collaborators, providers and patients – will benefit as more data is shared among all parties, says Moore. Even Mercy – as large as it is – can benefit by gaining a broader perspective on product usage. “That’s democratization of data in a consistent fashion,” he says. “That is crucial to being able to get the broadest picture possible. “Our hope is that products will improve, and that we will gain an understanding of what works better, when, where and how. With that information, we can build better care paths. That will differentiate us in our marketplace. We will compete with others on the basis of who provides great care. “None of us has all the answers. That’s why it’s important we share information in such a way that it leads to improved health outcomes.”

SMART SELLING HIDA

It Takes More Than One Great Relationship To Ensure Customer Loyalty By Elizabeth Hilla, Senior Vice President, Health Industry Distributors Association One of the great things about selling is the personal re-

lationships you form. However, I’ve found that over-reliance on those terrific personal relationships can give me blind spots. I think to myself “I don’t need to contact XYZ company today – I just talked to Joe last month and he loves the work we’re doing.” The risk is assuming that I can count on a long-term business partnership because my relationship with one key decision-maker is rock solid. And what happens? My big fan leaves or moves to a different role, and suddenly, a longstanding account is at risk. We can help to inoculate ourselves against this risk by carefully building relationships with multiple decision-makers within the account. I try to use this thinking in my work at HIDA. Maybe I know the VP of Sales who made the decision to join, and that person loves our resources. But do the experts in our research department know the member company’s market research team? Is their contract administration director engaged in our pricing accuracy work? If the answer to these and similar questions is yes, chances are the company’s membership doesn’t depend on my one key contact staying employed there. The same applies in your world. If your customer is a nursing home, for instance, perhaps the Director of Nursing is your key contact and a huge fan of you and your company. But it’s no secret that DON turnover is high in postacute care. So the smart rep, you’re working hard to get to know the administrator, the purchasing director, and other leaders of the team. By doing so, you ensure that if your biggest fan leaves the facility, you still have strong supporters who understand the value of your company’s services. Here are a few ideas for increasing engagement at multiple levels: •T hink about the people surrounding your key contact. Get to know your contact’s boss, direct reports,

and peers. For example, say your big supporter in an important IDN account is the Director of Sourcing. Do you know the VP she reports to? How about the Director of Supply Chain Operations and the Director of Value Analysis? And don’t overlook the managers who support the sourcing director – they might be the next employee in that role! • Ask for introductions to other departments. For example, hospital materials managers sometimes aren’t responsible for certain areas such as lab or environmental services. If you offer products for those departments, ask your key contact to connect you with their peers in those areas. • Honestly evaluate how you spend your time. It’s easy to convince yourself that spending extra time with your key contact in an account is worth it, and it often is. But because it’s so much nicer to hang out with friends, it’s possible to devote too much time to the fans who already love you rather than doing the harder work of connecting with new contacts. • Don’t assume that everyone in the account is a fan. Maybe the primary partner in a group practice would never considering buying medical supplies from anyone but you – but what does the new physician think? Have you built ties with other influencers, and are they aware of the value your company brings? The work of engaging at multiple levels within an account doesn’t have to fall on your shoulders alone. For your “A” customers especially, work to build connections at many levels – so that your billing person knows their payables supervisor, your operations leader works closely with theirs, and so on. Building a network of connections between your organization and your customer’s helps ensure that even if your biggest fan heads for the exit, the corporate relationship remains solid.

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corner

Family Legacy His parents’ sacrifice years ago continues to present opportunities for Gino Liongson, his wife and their children If you think selling to physicians, materials managers

or nursing directors is tough, try selling paints and stains to residential repaint contractors. It might mean sitting in a Lowe’s parking lot and jotting down phone numbers from contractors’ vans, or explaining a $5 difference between two cans of paint. Gino Liongson knows. Prior to becoming a district sales manager for MedPro Associates, he managed a Sherwin-Williams paint store for a year, and for two years served as a residential repaint sales rep. “I have always said that Sherwin-Williams was an integral component in the rep I am today, says Liongson, who calls on customers in Indiana and Michigan. “The consultative sales training on developing a solution and adding

Gino Liongson and his family

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value in a competitive landscape was the framework and foundation that I had as an early rep. If it weren’t for that platform, I never would be in the position I am today.”

Immigration Liongson was born in the Philippines, but his family moved to California when he was just one year old. It was an act of courage, selflessness and faith that drove his parents – Joe and Claudette Liongson – to make the move with Gino and three sisters: Jodette, 16 years old at the time; Kristine, 12 years old; and Jamaica, 5 years old. “My parents were very established in the Philippines, as my dad was a pharmaceutical sales rep and my mom was an English professor,” he says. “When my parents were petitioned, it took 12 years until they received the approval, and when they did, we had three months to decide if we were willing to leave everything behind to make the move.” They decided to go to the U.S. Each family member was allowed to bring just two boxes with them. “I remember having the conversation vividly with my parents about the entire process and the motivation behind giving up everything they had,” he recalls. “Their response was so moving and continues to resonate deep within my values. They told me the No. 1 reason for the move was for my three sisters and myself. The possibility for their kids to have more opportunities to be successful and be more independent in the U.S. was the motivating factor that gave them the courage to change our family legacy. It is 31 years later, and they have never regretted their decision.”

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corner When Gino was five, the family moved again, this time to Indiana, where Gino’s aunt lived. There, his father was able to get a job as a medical technologist, and his mother ultimately became head ombudsman for workers compensation in the state of Indiana. Liongson attended Indiana University in Bloomington and graduated with a marketing degree. He had an internship with drug company Eli Lilly and aspired to become a pharmaceutical sales rep. But when the opportunity with Sherwin-Williams presented itself, he took it.

Medical sales However, he always knew he wanted to be in the medical industry. “I’ve always heard the different success stories of my friends’ parents, and I wanted to strive for that as well,” he says. “I remember having conversations with several of them about the medical sales arena, and all signs pointed to this direction.”

More growth ahead Liongson believes he has grown from many perspectives – that of a sales rep, as a person, as a spouse and as a father. And he sees plenty more opportunities for growth ahead. As a medical sales rep, he has learned how to be more strategic, leveraging resources and relationships to provide the best solution for his customers. He has learned that success can be achieved through open lines of communication, visibility and teamwork. As a family man, he and his wife, Bobbie Liongson, have found financial stability and growth by following the direction of Dave Ramsey, founder of Financial Peace University. After three years, they paid off their mortgage and hope to leave a legacy for future generations. On a personal level, just about every day, Liongson goes to the gym, focusing on weight training. “I look forward to this time, as it gives me time to reflect and get in the right mindset,” he says. “I feel like it helps me stay motivated, driven, competitive, and it keeps my self-discipline at a high level. “I want to continue to focus on a healthy lifestyle as my kids get older and more involved in sports or any other activities.” (The Liongsons have two boys, Landry and Braven.) “I’d love to coach and be out there building memories with my family, and I want to be able to do that for a long time.” Liongson grew up fishing in neighborhood ponds, and in the past couple of years has fulfilled his dream to go deep-sea fishing, with fishing trips to Alaska (a MedPro award) and Florida. “Sleeping on a boat through different coves in Alaska is definitely not what I’m used to,” he says. “Moving forward, I definitely plan on taking my family on these trips. I don’t necessarily think we’ll sleep on the boat. But we’ll fish for sure!” In the end, it’s all about family, he says. “My better half, Bobbie, is the most beautiful, caring and selfless person I know, and I’m lucky to ‘do life’ with her.” Their three-and-a-half-year-old son Landry is an Avengers fan, while Braven, a year and a half old, prefers Mickey Mouse. “My family is my heart, my world, my motivation…. my everything,” he says. “As long as I have them in my corner, I know I can achieve anything.”

“T he possibility for their kids to have more opportunities to be successful and be more independent in the U.S. was the motivating factor that gave them the courage to change our family legacy.” It so happened that his next-door neighbors – whom Liongson considers his second family – were the Bartels. His friend, Scott Bartel, ultimately became a district sales manager with MedPro. When the opportunity with MedPro in Michigan and Indiana presented itself, Bartel recommended Liongson for the job. “I’m lucky to be a part of this organization,” he says. “Not a lot of people can say that they love their company, their company’s leadership, their company’s culture, and their company’s values. But … family means everything to me, and Bill Sparks, Manny Losada and everyone who is a part of this organization has built this culture [with] a true family feeling – a very competitive one at that! We continue to be a force with some of the leading manufacturers in this space, and I’m looking forward to many more successful years for our organization.”

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™ The New GAMMEX® PI Glove-in-Glove™ System PRE-DONNED GLOVE-IN-GLOVE, READY FOR DOUBLE GLOVING Experience double gloving convenience like never before. Ansell’s new, patent-pending GAMMEX® PI Glove-in-Glove™ System delivers a world first: pre-donned outer and inner synthetic surgical gloves ready for double gloving in just one don. Don in half the time. Don once and you’re done! It‘s that simple and it takes just seconds from un-wrapping to donning. Reduces environmental impact. By combining the glove-in-glove pairs in one poly-pouch and one inner-wrap, there is 50% less waste with inner packaging, so you further increase your contribution to the environment. For samples or more information, please visit ansell.com/jhcgig or contact Customer Service at 1-800-952-9916. Ansell, ® and ™ are trademarks owned by Ansell Limited or one of its affiliates. US Patented and US and non-US Patents Pending: www.ansell.com/patentmarking © 2019 Ansell Limited. All Rights Reserved

Industry News Owens & Minor names Jeffrey Jochims as EVP, Strategy & Solutions

Sri Trang USA retains MedPro to represent Ventyv Brands

Owens & Minor Inc appointed Jeffrey Jochims as EVP, Strategy & Solutions, effective April 8, 2019. In his new role, Jochims will serve as chief strategy officer and lead the Solutions portfolio including Provider Solutions, Manufacturer Services, Movianto, and the Fusion5 relationship. Jochims was formerly a longtenured executive at Thermo Fisher Scientific. Additionally, Stuart Morris-Hipkins has departed from the company to pursue other opportunities. O&M U.S. Distribution, including U.S. Sales Operations, U.S. Distribution Operations, and Strategic Supplier Management, will now report to Edward A. Pesicka, president & CEO of Owens & Minor.

Sri Trang USA has engaged MedPro to represent the Ventyv brands in the acute and primary care market segments effective April 1, 2019. MedPro will be responsible for creating opportunities with National and Regional distributor accounts for Sri Trang USA to extend the value of its infection prevention products to customers across the mentioned market segments.

Janice Carter Larson announces retirement Janice Carter Larson, CLLM, Vice President of Clinical Resources and Consulting for Encompass Group LLC, has announced her retirement from the company effective May 1, 2019. Janice is a 40-year veteran of the healthcare industry and is a pioneer Janice Carter Larson in hospital-based linen cost management consulting. For over half of her career, Janice has led a team of RN-based consultants at Encompass helping hospitals and healthcare laundries focus on linen use and utilization, saving customers well over $100 million in the process. Over the past several years, Janice and her team have expanded their impact to several clinical product areas outside of linen operations.

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HSCA names Khatereh Calleja as president & CEO The Healthcare Supply Chain Association (HSCA) (Washington, DC) named Khatereh Calleja as president and CEO of the Healthcare Supply Chain Association, effective April 29, 2019. Calleja joins HSCA from AdvaMed, the world’s largest association representing manufacturers of medical devices, diagnostic products, and medical information systems, where she was SVP of Technology and Regulatory Affairs. She succeeds outgoing HSCA President and CEO Todd Ebert, RPh, who is retiring and moving back to St. Louis after a distinguished career in healthcare spanning more than four decades.

Cardinal Health survey: Supply chain tasks causing stress for clinicians, impacting patient care Clinicians report spending more than twice the amount of time they would like to on supply chain-related tasks, and as a result have less time with patients and increased stress levels, according to the fourth annual Cardinal Health Hospital Supply Chain Survey. Additionally, 25% of those managing supply chains – along with 20% of clinicians – say that supply chain tasks “stress them out.”

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