“The State of Healthcare Logistics”

Earlier this year The Association for Healthcare Resource & Materials Management (AHRMM) and the Center for Innovation in Healthcare Logistics (CIHL) at the University of Arkansas published the results of a survey they conducted in 2008 titled “The State of Healthcare Logistics”. The survey polled 1381 healthcare supply chain professionals regarding their “perceptions of cost and quality efficiencies and improvement opportunities within their organization”. I’m always a little skeptical (alright, I’m a lot skeptical) of “perception surveys”, but since this one was focused on the specific supply chain that I’m a member of, I took some interest. This survey included a series of questions about the respondent’s perception of Data Standards, which really caught my eye.

In fact, I’ve been doing a little investigating myself into the competing standards that are related to supply chain master data. My career experience in this area has almost solely dealt with GS1 standards, but that may be because the healthcare part of my career has centered on the pharmaceutical distribution corner of the full healthcare supply chain. If it had been centered on the distribution of medical devices, I would have been much more familiar with HIBCC (Healthcare Industry Business Communications Council) supply chain data standards. I’ve been trying to figure out if the industry needs multiple competing data standards and, if not, which one is a better set: GS1 or HIBCC? And should I consider some other set of standards that I just don’t know about? Are there good reasons to continue the use of either or both sets of standards in our supply chain?

In this light, I turned my attention to the AHRMM/CIHL survey results, hoping to gain some valuable insight. I quickly got stuck on their very first survey question in the Data Standards section (on page 15 of their report):

A. Is your organization moving towards the adoption of a data standards system (such as GS1) in the next five years?

Now this is an amazingly bad survey question that wouldn’t even pass a “survey questions 101” class. It is a classic example of a leading question. One where the desired answer is provided directly in the question itself. But look at the choice of answers!

  1. Yes – GS1
  2. Yes – Other
  3. No
  4. Don’t Know

Wow. Clearly this survey is trying to lead the respondents to indicate support for only GS1 data standards, and it worked. Over 50% of the respondents chose answer “1”, over 30% chose answer “4”, and about 20% chose answer “3”. What about answer “2”, indicating support for “other” data standards systems? Only about 3%.

But the authors go further. Here is part of the analysis provided in the report for this survey question:

“The majority of those that indicate that they are moving towards a data standards system other than GS1 do not know which system their organization is moving towards.”

Maybe that’s because they didn’t tell the respondent which “other” systems are out there. I’m assuming that the authors were just a little sloppy and failed to include in the report the additional question(s) that provided them with this extra information.

I wonder what they would have found if they had asked the question this way:

B. Is your organization moving towards the adoption of a data standards system (such as HIBCC) in the next five years?

  1. Yes – HIBCC
  2. Yes – Other
  3. No
  4. Don’t Know

My bet is that the results would be nearly the same.

In general, perception surveys don’t deserve much weight. This one provides a perfect example of why, and this one question destroys any remaining credibility this survey could have had. For this reason, this survey contributed absolutely nothing to my own investigation into systems of standards and it answered none of my questions. That’s sad, because I’m sure there are many other people in the supply chain who are having the same thoughts right now, and we could use some solid, unbiased information about the pros and cons of each choice.

This report has inspired me to construct my own perception survey:

C. Which standards organization (such as GS1) is most likely to have directly or indirectly funded the survey that generated Question A.?

  1. GS1
  2. Other
  3. No
  4. Don’t Know

D. Which public university (such as the University of Arkansas) should be most embarrassed by the construction of Question A. and the conclusions drawn from it?

  1. The University of Arkansas
  2. Other
  3. No
  4. Don’t Know

For more of my essays related to HIBCC, click here.

7 thoughts on ““The State of Healthcare Logistics””

  1. Which blog (such as RxTrace) is finding its groove?

    1. RxTrace
    2. Other
    3. Don't Know

    I pick answer (1).

    Great post, Dirk!

  2. This is an excellent post Dirk…These kind of "surveys" involving GS1 have been going on for as long as I can remember. It was very refreshing to realise that there are people out there like yourself that can still apply some basic critical thinking.

  3. I've designed a few surveys in my time and it is easy to develop one that gets the answer you want, but hard to get the ground truth.

    There are a number of competing standards that are related to supply chain master data including identification and data exchange among others. The good news is there is not always a best answer, "one size fits all" so ISO has established a number of standards that seek to standardize data elements and not the data tags among the standards. They recognize HIBCC, GS1, ATA, ANSI MH10 and others. So all you really need to know is what data is required and ensure clear standard definition of the data, represented by the data tags and you can ensure interoperability.

    The turf war you describe needs to be about capability to meet the business need. That can be broad or sector specific applications and not settled by who has the biggest budget for advertising/propoganda. Bottom line each "Enterprise" needs to make a choice of what best fits their business processes and ensure they follow the common standard elements and definitions for data exchange to work.

  4. Not surprising…I will not take the ahrmm surveys any more because of this "slanting". By the way if you figure out half way through the survey that there is slanting the survey monkey won't let you out either and it sends the half baked survey.

  5. I too am tired of the slanted marketing propaganda. One of the things that often gets overlooked in supply chain standards is what is needed for unit dose medications and patient medication safety. Manufacturers and wholesalers think in the terms of the pallets and case lots they sell and often do not package and label medications at the unit dose level. Therefore no unit dose "id" is issued. Recent HIBCC standards (ANSI\HIBC 3.0) have strived to combine the patient med safety / BPOC needs and also service supply chain needs. You can build a bar code or RFID tag that encodes just an ID or a virtual electronic label. Many providers are stuck using whatever their purchased systems support and more interoperability work need to be done here.
    Another thing to look at when evaluating standards is the cost. Some standards organizations charge users a fee based on sales for a unique id they manage, some acharge nominal or one time fees and some are free. Standards tha only allow numeric identifier fields can contain a hidden cost for information systems conversion whennumber ranges are exhausted. Alphnumeric identifiers have larger ranges and greater flexibility.

    Harry Manolopoulos

  6. Please consider these additional thoughts and clarifications regarding your blog post on the AHRMM-CIHL survey. Every question of this survey to identify cost and quality efficiencies and improvement opportunities within the healthcare supply chain was designed with the help of the University of Arkansas Survey Research Center, which has designed numerous research surveys. You make the claim that AHRMM/CIHL are trying to “lead the respondents to indicate support for only GS1 data standards”. We are not leading anyone. We are asking if they are moving toward data standards, and specifically if they are moving towards GS1, which AHRMM along with a majority of healthcare supply chain institutions have now endorsed. Neither the Research Center nor the expert cross-industry panel which reviewed the questions found the data standards question to which you refer to be a leading question. The question was purposely written. When the researchers framed the question, they were framing it to see who was moving toward GS1 and how close they were to achieving their sunrise goals (i.e. the reason for the additional questions to those that respond yes-GS1). The researchers added the additional Yes – Other response to accommodate those that were not moving to GS1.

    I don’t think you give enough credit to our survey’s respondents. Two out of three respondents have more than ten years of healthcare supply chain experience, and forty-five percent have more than twenty years of experience working in the healthcare supply chain. Experienced professionals are capable of deciding between these multiple choice options. Respondents were asked to specify the “Other system.” The exact question wording is below.

    • Is your organization moving towards the adoption of a data standards system (such as GS1) in the next five years?
    o Yes – GS1
    o Yes – Other (Please specify) ____________________________
    o No
    o Don’t Know

    The expert interviews conducted when vetting questions for the survey clearly indicated that there was confusion in the industry about what a data standards system was. The responses to the open ended (Yes – Other) question are below. You can see that some confusion does exist.

    Response Count %
    Do Not Know 44 61%
    UNSPSC (United Nations Standard Products and Services Code) 9 13%
    GS1 6 8%
    Government 3 4%
    Lawson 2 3%
    GHX 2 3%
    SAP 1 1%
    KPI’s 1 1%
    HIBCC (Health Industry Business Communications Council) 1 1%
    GIP 1 1%
    E-Clinical 1 1%
    DMLSS (Defense Medical Logistics Standard Support) 1 1%
    Also, please note that your summary of the results (quoted below) is incorrect.
    “Over 50% of the respondents chose answer “1”, over 30% chose answer “4”, and about 20% chose answer “3”. What about answer “2”, indicating support for “other” data standards systems? Only about 3%.”
    The most common response is Don’t Know (47%). 31% of respondents chose “Yes-GS1,” 17% chose “No,” and 5% chose “Yes – Other.”

    This survey did not set out to determine if the industry needs multiple competing data standards or to review the merits of different data standards systems. AHRMM conducted due diligence on this issue many years ago and publicly supported GS1. AHRMM has consistently and unambiguously declared its support of GS1 standards since 2006. It has been leading GS1 data standards adoption and implementation efforts alongside many other companies and healthcare institutions representing all sectors of the healthcare supply chain as I am sure you are aware.

    Another important note: AHRMM/CIHL did not receive financial support from GS1 to conduct this survey. AHRMM has never received any financial support from GS1 or its affiliates, and Heather Nachtmann and Ed Pohl of University of Arkansas/CIHL are independent academic researchers who do not have a stake in the success of GS1 or any other data standards system.

    Sarah Oaks
    Associate Executive Director

  7. I agree with you, Dirk, this survey failed to pass survey methods 101. It was just an opinion pool.

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