Technology: How Ohio wrangles its pharm stockpiles

Public concern over anthrax may have waned since the rash of threats in 2001, but that hasn't prevented some public health officials from preparing supply chains to respond more quickly in the event of another anthrax or other bioterror attack.

The Ohio Department of Health is believed to be the first state agency to implement an automated warehouse-management system to avert widespread disorder through the orderly distribution of critical medication and medical equipment in emergency conditions. The system might also come in handy for non-terror events, such as an influenza pandemic or weather-related disasters.

After Sept. 11, 2001, the federal government charged states with putting plans in place for responding to terror events in their own regions. Part of that mandate required regional organizations to be able to distribute vaccines and medication from the Centers for Disease Control and Prevention Strategic National Stockpile.

The sns is supposed to have large enough quantities of medicine and medical supplies (antibiotics, chemical antidotes, life-support medication, and miscellaneous medical and surgical supplies) to protect the American public in the event of a public health emergency, such as terrorist attack, flu outbreak or earthquake severe enough to deplete local supplies.

Once federal and local authorities agree that the sns is needed, medicines are to be delivered to any state in the nation within 12 hours. Each state is expected to have plans to receive and distribute sns medicines and supplies to local communities as quickly as possible.

Medication mobility
While some state jurisdictions are implementing manual tracking procedures for sns supplies, Ohio recognized that the federal edict could best be served by an automated system. Since no one can predict where or when an event will occur or whether conventional communication channels will be open, Ohio officials wanted a system that could be quickly deployable from just about anywhere, without requiring an in-place infrastructure.

What they got was a computerized warehouse-management scheme that can be fully operational in less than 10 minutes.

"ODH created a system that enables us to quickly identify affected populations, determine dispensing sites that need to be activated, import medical product data from the strategic national stockpile, and collect activity data from the dispensing sites at a state level," says project manager Kent Ware, ODH's chief of immunization registry and vaccine distribution.

The system, called IRMS (Information Resource Management System), from Downers Grove, Ill.–based Integrated Warehousing Solutions <www.IRMSwms.com>, is being deployed by Ohio at a 40,000-square-foot central distribution facility, as well as at seven smaller regional warehouses. During an emergency, the mobile system could be used by potentially hundreds of stationary and portable satellite dispensing sites. ODH purchased the system in August 2004, and implementation began last November.

IRMS is meant to be an entirely mobile warehouse-management operation, complete with pre-packaged "Go Kits."

"Each Go Kit is a warehouse-in-a-box, containing the essential elements to effectively establish a remote field warehouse," says iws president Carl Brewer. IRMS can be up and running in about five minutes, from the time the kit is opened to the time the first vaccination is processed, he says.

Now, whenever cdc dispatches stockpile supplies during an emergency to the regional center in Ohio, state warehouse employees can use handheld devices to verify and validate each transaction, while healthcare professionals such as immunologists in the field will use similar devices to track where, what and to whom medications are administered.

A system that's paper thin
In a bioterror emergency, not only is it important to know how much medicine and supplies to dispatch to an area, but if resources are low it's even more crucial to know how much may already have been dispensed and how much more may be needed, says Ware. "Paper systems are inefficient" at such tasks, he says.

IRMS was designed to be a completely self-contained, mobile warehouse-management operation that controls the distribution of vaccines and other critical medicines, while at the same time automating record-keeping to insure regulatory compliance, including lot number and expiration date tracking, what has been distributed, and where it has been sent. The system can be run completely on laptop computers.

"The logistics system uses scanners, computers and radio-frequency devices to enable us to quickly identify how much product is needed in a certain location, track all items received through the strategic stockpile at multiple warehouses around the state, route products to dispensing sites, and also track what dosage of which medication each patient receives," says Ware. 

IRMS uses "wizard" software to walk users through a step-by-step process, so that virtually anyone can open a Go Kit and operate the system efficiently. Ware says users collect data and feed it into the wizard. The system then immediately identifies how much product to pull, place on a pallet and send to a specific truck.

In a prescient move in light of a possible avian flu pandemic, ODH recently tested portions of the system in an influenza vaccine clinic exercise, where a number of health departments met in a university field house for trial inoculations. During just one 30-minute period, more than 200 patients were entered into the system from just two handheld computers.

Supply chain reaction
"The closed-loop supply chain management solution provides Ohio with Web-based order processing and has secure wireless inventory visibility for mass distribution and management of pharmaceuticals and vaccines, as well as bioterrorism response products," Brewer says.    

IRMS interfaces with a new graphical information system that uses simple bar charts and graphs to illustrate order thresholds and quantities of products remaining within regions affected by bioterrorism. This is achieved through a decision support system, which is designed to digest complex data, merge it with the requirements of predefined scenarios, then present the information in a relatively simple way so critical decisions can be made rapidly without relying on lengthy analysis.

As an example, to plan an effective response to a bioterror event, ODH must consider such factors as the area affected, population density, and wind patterns and their potential influence on the spread of a suspected bioagent. The job of the dss is to sift all available variables, then present the results so ODH can react quickly and appropriately.

Armed with that information, ODH is then theoretically better able to determine exposure rates, symptoms, geographic distribution and other factors that guide what will be sent to temporary vaccination centers.

Another feature that makes IRMS unique is that it provides dual functionality, that is, the new system is not restricted to emergency use only. While IRMS, which is no small investment, is waiting to provide warehouse management in the event of a bioterror emergency, ODH is also adapting it to manage everyday state public health warehouse operations.

This not only streamlines day-to-day warehousing activity, it also ensures that healthcare professionals will be proficient at using the system long before it's needed in a real emergency.

"IRMS delivers value every day, facilitating day-to-day communication between ODH and more than 1,500 medical practitioners," Ware says. Because paper-based ordering and manual data entry have been eliminated, healthcare providers across Ohio can now access the system over the Internet to report medical  transactions they've performed and to order supplies.

ODH typically stores and manages between 3,000 and 5,000 different vaccine and medical equipment products at any one time, depending on the needs of Ohio's 11 million residents.

"Hoping that the bioterrorism components will never have to be deployed, having this everyday usage provides Ohio a way to leverage the technology on a daily basis," Brewer says.