The Digitalization of medicine supply chain: How to re-aim the shots in the dark?

ABSTRACT Healthcare expenses have been on the rise for decades. One of the key areas contributing to this ever-expanding growth is medicine expenses. Medicines are required to maintain a sustainable health system in a world of aging populations and pandemics. Novel medicines combat diseases previously considered incurable, and medicines help people with chronic conditions to live normal lives. Furthermore, in emerging economies, pharmacies are often the first and only interface to healthcare services, whereby other medical services are scarce or expensive. However, medicines are associated with costs. To maintain a sustainable health system, the growing expenses have to be managed. There are different ways of controlling medicine expenses. In this age of digitalization, when multiple sectors have been disrupted by digital technologies, it can be argued that digital technologies have a role to play in the medicine supply field. This intersection of medicine supply and information systems has been, however, sparsely studied. This thesis seeks to fill this research gap by exploring the medicine supply chain and discovering obstacles and bottlenecks across the chain. The study also intends to identify how information systems and digital technologies can be utilized to remediate the problems and facilitate an efficient medicine supply chain. The research approaches the medicine supply chain arena through the medicine supply chain concept. The supply chain is a highly complex world involving the pharmaceutical industry and the distribution, prescription and dispensing of medicines. This research examines this arena through cases from across the supply chain covered in four separate studies and related articles. The supply chain concept and the scene are set in one of the studies, followed by studies on the digitalization of pharmacies, medicine waste management in hospitals and the digitalization of the plasma derivatives supply chain. The results of this research illustrate that the main role of digital technology in the management of the medicine supply chain relates to managing several information asymmetries across the chain. The key is to increase transparency between various stakeholders in the chain through novel digital solutions. Currently, the supply chain processes are largely based on rules of thumb rather than facts and evidence, and this should be addressed to maintain a sustainable chain and, subsequently, a sustainable health system. TIIVISTELMÄ Terveydenhuollon kulut ovat nousseet vuosikymmenien ajan. Lääkekulut muodostavat merkittävän osan terveysmenoista. Lääkkeitä tarvitaan kestävän terveydenhuoltojärjestelmän ylläpitämiseksi: lääkkeillä voidaan hoitaa aiemmin parantumattomia sairauksia sekä tukea ikääntyvää väestöä. Kehittyvissä talouksissa apteekit ovat usein myös ensimmäinen ja ainoa yhteys terveyspalveluihin. Lääkkeillä ja niiden kehittämisellä on kuitenkin kulunsa ja kestävän terveydenhuollon järjestelmän ylläpitämiseksi onkin kyettävä ymmärtämään ja hallitsemaan lääkekuluja. Lääkekuluja voidaan hallita eri tavoin. Digitalisaatiolla voidaan ajatella olevan tässä myös roolinsa – useat toimialathan ovat muuttuneet merkittävästi digitaalisten ratkaisujen myötä. Digitalisaation ja tietojärjestelmien merkitystä lääkejakelussa ei olla kuitenkaan tutkittu laajasti. Tämän väitöskirjan tarkoituksena on täyttää tätä tutkimusaukkoa perehtyen lääkejakelun prosesseihin, niihin liittyviin esteisiin ja pullonkauloihin sekä digitaalisiin ratkaisuihin, joilla lääkejakelua voidaan tukea ja tehostaa. Tutkimus lähestyy aluetta mallintaen lääkejakeluketjua. Lääkejakeluketju on monimutkainen globaali systeemi, joka kattaa toimijoita mm. lääketeollisuudesta, jakelusta ja logistiikasta, terveydenhuollosta ja vähittäismyynnistä. Tässä tutkimuksessa jakeluketjua tarkastellaan neljän tutkimuksen kautta, jotka liittyvät lääkejakeluketjun eri osiin. Aluksi esitellään lääkejakeluketjukonsepti, jota seuraavat tutkimukset apteekkien digitalisoinnista, sairaalan lääkehuollosta ja veriplasmatuotteiden toimitusketjun digitalisoinnista. Tämän tutkimuksen tulokset havainnollistavat, että digitaalisten ratkaisujen päärooli lääkejakeluketjun hallinnassa liittyy varsinkin informaatiosymmetrioiden hallintaan sekä tiedon avoimuuden ja läpinäkyvyyden lisäämiseen ketjun eri sidosryhmien välillä. Nykyisin lääkejakeluketjun prosesseja leimaa epävarmuus ja faktoihin perustuva päätöksenteko on vaikeaa, mikä heikentää tehokkaan lääkejakelun ylläpitämistä

Content diffusion in ALERT clinical applications

Estágio realizado na ALERT e orientado pelo Eng.º Tiago SilvaTese de mestrado integrado. Engenharia Informática e Computação. Faculdade de Engenharia. Universidade do Porto. 200

Strategies for Preventing and Mitigating Counterfeit Medication From Entering the U.S. Supply Chain

Some pharmaceutical brand protection managers lack strategies to mitigate financial losses from counterfeit prescription drugs. A multilayered approach involving guiding principles, supply chain security, investigations, enforcement, advocacy, and awareness can help mitigate potential financial losses and keep patients safe. Guided by the Six Sigma define, measure, analyze, improve, and control (DMAIC) model and the fraud triangle conceptual framework, the purpose of this multiple case study was to explore strategies brand protection managers use to mitigate financial losses from counterfeit prescription drugs. Data collection included three semi-structured interviews using Zoom. Analyzing data entailed transcribing and coding themes within data and relating findings to the composite conceptual framework and peer-reviewed literature. Four key themes emerged: (a) guiding principles, (b) securing the supply chain, (c) investigations and enforcement, and (d) advocacy and awareness. The primary recommendation for pharmaceutical brand managers is to build a risk profile for each product based on knowledge of how counterfeiters behave and implement a multilayered approach for improved supply chain security while educating consumers on risks associated with purchasing medications outside the legitimate supply chain. The implications for positive social change include the possibility to inform more consumers on potential risks, which could save lives

Drug Control: State Approaches Taken to Control Access to Key Methamphetamine Ingredient Show Varied Impact on Domestic Drug Labs

A letter report issued by the Government Accountability Office with an abstract that begins "Methamphetamine (meth) lab incidents--seizures of labs, dumpsites, chemicals, and glassware--declined following state and federal sales restrictions on pseudoephedrine (PSE), an ingredient commonly found in over-the-counter cold and allergy medications, but they rose again after changes to methods in acquiring PSE and in the methods to produce meth. According to Drug Enforcement Administration (DEA) data, the number of lab incidents nationwide declined through 2007 after the implementation of state and federal regulations on PSE product sales, which started in 2004. The number of meth lab incidents reported nationally increased after 2007, a trend primarily attributed to (1) the emergence of a new technique for smaller-scale production and (2) a new method called smurfing--a technique used to obtain large quantities of PSE by recruiting groups of individuals to purchase the legally allowable amount of PSE products at multiple stores that are then aggregated for meth production.

Cost-Containment Strategies Used by Hospital Business Leaders for Pharmaceutical Inventory

Ineffective strategies to contain the costs of medical supply inventory can result in financial loss and are a significant challenge for hospital leaders. Grounded in complex adaptive systems theory, the purpose of this qualitative single case study was to explore the cost-containment strategies that private hospital business leaders use to reduce the expense of pharmaceutical inventory. The participants comprised six private hospital business leaders in one healthcare organization in Myanmar. Data were collected from semistructured interviews, internal company documents, and publicly available annual reports. Four themes emerged from Yin’s five-step data analysis method: (a) management controls, (b) specialist engagement and compliance, (c) supplier management, and (d) centralized systems. A key recommendation is for hospital business leaders to use the themes to develop a framework and identify what strategies they already have in place and what strategies they may not have yet defined. Once developed, the framework may facilitate system change and support monitoring processes. The implication for positive social change includes the potential for hospital business leaders to support the affordability of pharmaceuticals by passing savings onto their patients so that they are more likely to purchase the medications they require to remain healthy

Electronic recording and reporting for tuberculosis care and control

"This guide on electronic recording and reporting is the result of a major collaborative effort involving 9 agencies and institutions and 21 individuals. This document was funded by the United States Agency for International Development under the USAID Tuberculosis CARE I, Cooperative Agreement No. AID-OAA-A-10-000020. Development of the guide was led by the World Health Organization (WHO) in close cooperation with the KNCV Tuberculosis Foundation (KNCV) and Management Sciences for Health (MSH). Hazim Timimi in the WHO Stop TB Department\ue2\u20ac\u2122s TB monitoring and evaluation team coordinated the production of the document, under the guidance of Katherine Floyd and Philippe Glaziou." --p. v"Adopting electronic recording and reporting is not simply about choosing a piece of software: it is also about changing how people work. This is not a simple undertaking. This document introduces the key questions to be considered and illustrates what the questions, options and recommendations mean in practice by drawing on examples of recent experience from a variety of countries. It is an essential resource for all those planning to introduce electronic recording and reporting systems for TB care and control, or to enhance existing systems."--p. [4] of cover.1. Identifying general requirements -- 2. Identifying detailed requirements -- 3. Selecting a solution -- 4. Implementing an electronic recording and reporting system -- Annex 1. Development of this document.Also available online.Includes bibliographical references

Community management and policy on diabetes patients in coastal developed areas of China: an in-depth analysis of Shanghai model

Diabetes Mellitus is a chronicle disease with a projected growth and social, human and economic consequences that cannot be overlooked in a growing economy and progressively urbanized structure such as China. It is very much a matter of urgency and systemic policymaking. Its insidious nature and everlasting outcomes highlight the importance of preventive measures, focusing on all the contributive factors, such as nutrition, life style, monitoring, diagnosing, and prescription. Aware of this issue, the Chinese Government put forward a reform of the community health service targeting chronic diseases, such as diabetes, at an early stage. However, not all modes of managing the health infrastructure, namely the third tier healthcare system, have been articulated in the same manner and the nature of Chinese economy and society does not allow the direct importation of models in use abroad. Likewise, the primacy of prevention over treatment puts emphasis on the role community-based healthcare play and it should be targeted for a special focus in order to optimize its effectiveness, considering all the complex issues on healthcare of chronic non-infectious diseases. Therefore, with the aim of establishing the theoretic basis to analyze diabetes healthcare management systems this study mobilizes state of art literature from home and abroad, conducts several field studies with multiple stakeholders of the system. This is therefore a macro level study intended to structure knowledge so to depict, explore, understand and offer recommendations to the improvement of the overall community-based diabetes management system in a large coastal urban area in China. To understand the dynamics and possibilities for optimization of the community-based diabetes management the study focused on Shanghai and conducted a comparative empirical study to explore the benefit it brings for the overall purpose of upgrading the system. Likewise, the study endeavored to identify constrains and offer recommendations. Via a mixed methods approach, involving both qualitative techniques and data collection through interviewing key stakeholders (overall 51 interviews conducted) as well as a quantitative approach via a survey with 60 doctors, 60 nurses and 22 patients, and a collection of archival data from 400 patients the study does a comparative analysis to identify to which extent the Shanghai model is superior to the standard one. As an outcome, the study structures a system to improve the effectiveness of community-based diabetes management in China and generates a body of knowledge for future reference and consideration when studying macro-level healthcare systems with a focus on preventable chronic diseases.A Diabetes Mellitus é uma doença crónica com um crescimento estimado e consequências económicas, sociais e humanas que não podem ser negligenciadas numa economia crescente e estrutura progressivamente urbanizada como a China. Trata-se de um assunto com carácter de urgência e de formulação de políticas sistémicas. A sua natureza assintomática a par das consequências duradouras sublinham a importância das medidas preventivas focadas sobre todos os fatores tributários tais como a nutrição, o estilo de vida, a monitorização, diagnóstico e prescrição. Consciente deste problema, o Governo Chinês instituiu uma reforma dos serviços de saúde comunitários centrada nas doenças crónicas em fase inicial, tais como a diabetes. Contudo, nem todos os modos de gestão da infraestrutura de saúde, sobretudo o sistema de três níveis na saúde, tem sido articulado da mesma forma e a natureza da economia e da sociedade chinesas não permite a importação direta dos modelos utilizado internacionalmente. Do mesmo modo a primazia da prevenção sobre o tratamento enfatiza o papel que o sistema de saúde de base comunitária pode desempenhar e, por isso, deve ser alvo de estudo com um foco especial para otimizar a sua eficácia, considerando todos os problemas complexos que as doenças crónicas não infeciosas importam. Assim, com o objetivo de estabelecer as bases teóricas para analisar os sistemas de gestão de saúde, este estudo mobiliza o estado da arte da literatura chinesa e internacional, realiza vários estudos de campo junto de vários stakeholders do sistema. Trata-se de um estudo de nível macro que pretende estruturar o conhecimento de forma a descrever, explorar, compreender e oferecer recomendações conducentes à melhoria global do sistema de saúde comunitário numa grande área urbana costeira na China. Para compreender as dinâmicas e possibilidades de otimização do sistema de gestão de saúde de base comunitária, o estudo centra-se em Shangai e realiza uma análise empírica comparada para explorar as mais-valias que traz para o propósito geral de melhorar o sistema. Do mesmo modo, o estudo procura identificar constrangimentos e oferecer recomendações. Por via de uma abordagem metodológica híbrida, envolvendo quer a recolha de dados e técnicas qualitativas através de entrevistas junto de stakeholders-chave (um total de 51 entrevistas realizadas) bem como uma abordagem quantitativa por via de um inquérito por questionário junto de 60 médicos, 60 enfermeiros, e 22 pacientes, bem como a recolha de dados de arquivo relativos a 400 pacientes, o estudo procede a uma análise comparada para perceber em que medida o modelo de Shangai é superior ao padrão. Como resultado, o estudo estrutura um sistema destinado a melhorar a eficácia dos serviços de saúde de base comunitária na China, com um enfoque na diabetes, e produz um corpo de conhecimentos para referência futura para efeitos de estudos centrados no nível macro dos sistemas de saúde com um foco nas doenças crónicas evitáveis

Pharmacies and medication information system in Jeddah City, Saudi Arabia

It is acknowledged that the introduction of Health Information Systems (HIS) have contributed to the reorganization of the methods used in health services for Health Information Management. Managers in the health services benefit from Health Information Systems provision both strategically and operationally, for example in the planning of new services and more routinely in assisting health professionals in making informed medical decisions. Health services in developed countries already have Health Information Systems (HIS) in place but their adoption in developing countries has been less widespread. In Jeddah, KSA there is a lack of a unified HIS. Health service provision in Jeddah is spread between a wide range of governmental and private health services. The lack of unification of these services and a bespoke HIS has led to problems for both patients and healthcare professionals. This research focuses on the methods of prescribing medication, provision of supplies and the dispensing of medication within pharmacies. [Continues.

Pharmacogenomics

This Special Issue focuses on the current state of pharmacogenomics (PGx) and the extensive translational process, including the identification of functionally important PGx variation; the characterization of PGx haplotypes and metabolizer statuses, their clinical interpretation, clinical decision support, and the incorporation of PGx into clinical care

Creative space - creating space - digital technology in a women's prison : a case study

Prison education has the potential to transforms offenders. It forms part of prison regimes for female offenders. At the beginning of the 21st century prison education and basic skills development are at the centre of rehabilitation debates. Computer technology has transformed human communication and interactions rendering digital literacy a basic skill in the 21st century and part of the rehabilitation agenda. However, prison education is not just entangled within rehabilitation debates. It is also an economic and prison security debate. Computer technology is already in use to manage offenders in local institutions and within wider prison and probation networks. Its application in prison education has been slow due to security imperatives of prisons. However, it has great potential to, on one hand, enhance learning opportunities for prisoners and, on the other, create inclusive prison classrooms that account for the diversity of its learners. The focus of this thesis is the application of computer technology in prison education for women. It, however, extends its view outside of ICT prison classrooms to account for the actors involved in shaping local classroom contexts. The thesis is not concerned with teaching techniques nor does it attempt to provide teaching guidelines. Using an actor-network approach, it, however, analysis how groups such as the female offender are stabilised to inform local procedures. It understands prison induction as start points of (in)dividual prison learner journeys. It examines closely the technologies and procedures that create educational data fragments - ‘virtual’ educational risk and needs potentialities - used to allocate learner in classes, but, more importantly, to create tightly managed, pre-formatted learning spaces. It, further, analyses how tutors and women appropriate those pre-designed spaces and provides detailed recommendations for the implementation of computer technology in prison classrooms for women