David Brzozowski Sr., CEO and President, Medacist Solutions Group
Despite persistent efforts to keep a tight rein on the glaring misuse of prescription drugs, opioid addiction continues to make headlines. What’s more unsettling is that as the grip of the opioid epidemic on the society becomes stronger, one thing has become crystal clear: no demographic is immune to its high-risk repercussions. Let’s consider the appalling case of drug diversion that came to light last year wherein a rogue nurse tampered with hydromorphone syringes to remove some of the drug for personal use while diluting the injectable opioid with tap water. The gruesome outcomes called for immediate attention. Not only did the nurse jeopardize her health due to opioid addiction, but also compromised the wellbeing of patients undergoing cancer treatments who were subjected to a rare infection as a result of the contaminated medication. Investigation reports later revealed that she had been stealing vials of hydromorphone by accessing the hospital’s automated medication-dispensing system for months; even on her days off and in hospital wings where she was not assigned patients.
Instances such as these reveal the grim reality of drug diversion within hospitals and care facilities, and the harsh truth is, the numbers are constantly on the rise. Statistics from both the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Nurses Association (ANA) suggest that about 10 percent of health care workers are abusing drugs. Proper monitoring of controlled substance diversion can be tricky, involving almost every part of the organization in some way or another, and if it fails, it can put employees and patients alike at significant risk. Most of the diversion detection solutions on the market, be it automated dispensing cabinet (ADC) or employee drug screenings, may provide a quick fix to the problem, but in reality, they just serve as the first layer of defense, as they can be easily be circumvented by knowledgeable diverters. To fortify drug diversion detection in healthcare systems, Connecticut-based, Medacist Solutions Group, is empowering clients with unmatched actionable information focused on the medication use process to drive better patient safety outcomes. As the lead innovator in drug diversion analytics, which has been granted the only U.S. patent for drug diversion, Medacist brings in the RxAuditor analytics suite—comprising comprehensive drug diversion services—to ensure regulatory compliance, reduce liability, and enhance patient safety.
The Ongoing War against Drug Diversion
“We were the first player in the market to discover the need for analytics around drug diversion way back in 1997. Upon witnessing a pressing need in the market for mitigating the misuse of prescription medicines by healthcare professionals, which posed a significant risk to patients, we developed our algorithm and implemented it,” begins David Brzozowski Sr., the CEO and President at Medacist. Not just that; having realized the gap that existed in the market, both from a clinical and sociological perspective early on, the Medacist team was quick to discern the necessity to fill it. To this end, with its unparalleled algorithm, as evidenced by over 2000 hospitals and healthcare facilities served, Medacist effectively sealed the void. The benefits of such a solution to drug diversion cannot be understated. In addition, to drive better analytics and enrich data, the company identified the need to integrate its solutions with other data sources, such as electronic health record systems (EHR), time and attendance systems and drug inventory systems. As pioneers in the drug diversion analytics field, Medacist is among the first to load all patient data from the different systems into a central data warehouse and perform analytics against it. “In the world of data science, data is the oil which fuels machine learning and Medacist is Saudi Arabia of pharmacy automated dispensing. With two decades worth of automated dispensing data at our disposal, we are leading the charge in building analytics around behavioral aspects deploying machine learning. We have confirmed cases of drug diversion compiled over the years, which our system learns from, and builds inferences on different user behaviors related to diversion,” says Brzozowski.
Before delving into the core of the solutions, it’s imperative to throw light on how it all began for Brzozowski to truly understand and appreciate what his company brings to the table. An erudite in the field of analytics and computer science since 1981, Brzozowski leveraged his extensive experience as a mainframe programmer during his stint at Yale-New Haven Health to pilot the program. Brzozowski partnered with Pyxis Corporation and competed directly against Omnicell, the two largest automated dispensing cabinet vendors only to realize that his software was more powerful than theirs. It was only a matter of time before he transformed from a partner of Pyxis to their competitor. As it was hard to compete with such a powerful software, over time Pyxis technologies (owned by CareFusion) became resellers of RxAuditor, and Omnicell became a licensee of Brzozowski’s software. “Our company has been operating as a SaaS model even before it was termed ASP or SaaS. From the very outset, we have been gleaning information from data and delivering it to acute care and long term care facilities in this form. Our industry exclusive knowledge base built on diversion events from thousands of facilities spanning over two decades has led to our latest innovation—Genesis,” he adds.
Genesis is the engine that powers Medacist’s machine learning algorithms developed to identify diversion patterns, learned and confirmed by actual diversion events. In light of the fact that clinicians and administrative personnel at hospitals and long-term care facilities often do not have the time required to sift through the analytics reports that they receive, Medacist focuses on equipping them with information delivered in actionable format. This, in turn, enables them to drill down the data to discern the specifics. Besides, Medacist also empowers clients with the ability to pull data on their own, allowing them to identify diverters, flag them, dig deeper into the history of a person to build an auditing case.
We were the first player in the market to discover the need for analytics around drug diversion way back in 1997
The RxAuditor Army
To reinforce patient safety, Medacist has introduced the RxAuditor analytics suite as a SaaS delivery model to the acute and long-term healthcare industry. One of the services of the analytics suite, Medacist’s RxAuditor 360 provides unparalleled patented dispense-to-administration medication reconciliation analytics, comparing the dispensing of drugs in acute care hospitals and long-term care settings with the electronic medical record of the patients. This, in turn, improves patient safety by providing analytics necessary to close the loop in the medication dispensing-to-administration process.
Another service from the RxAuditor family, RxAuditor CPA (Central Pharmacy Automation) delivers analytics associated with packaging and distribution of medications from the central pharmacy to the automated dispensing systems. Brzozowski explains, “RxAuditor CPA captures information related to drugs right from the loading dock to the central pharmacy, all the way to the automated dispensing cabinets. And, then we track these within the cabinets.” Added to that, Medacist assists clients with seamless tracking of drugs from the dispensing machine to a nurse’s hand and even further to a patient’s bedside with RxAuditor 360, as they scan or chart those, to discern the discrepancies and irregularities between the two pieces of data.
Medacist’s relentless effort to combat the nation’s opioid crisis does not end with RxAuditor. In addition to its unique analytics suite, Medacist developed an analytics platform focused on provider prescription practice of controlled substances—ScripTrac Analytics. While RxAuditor focuses on the dispensing activity of doctors and nurses in hospitals and long-term care centers, ScripTrac Analytics empowers clients to analyze and monitor the prescription practice/patterns of controlled substances, associated with prescribers or doctors. “We take the electronic health record information, source that against global medication data and provider prescription data, and then determine what the practices of different providers are in relation to prescription writing, specific to each facility or health system,” Brzozowski adds. This, in turn, helps in the comparison of different providers within an organization across distinct practices, identifying doctors that are prescribing more than others in a facility and also the patients that are being prescribed the most to evaluate if they have an aptitude for potential addiction. The ScripTrac Analytics platform synergistically melds EMR data, big data analytics, and artificial intelligence to form a web-based application for consumption by both healthcare administration, clinicians and providers.
Medacist’s uniqueness stems from its ability to abstract and enrich data by aggregating and categorizing it in terms of practice area and grouping of drugs. “If someone is looking to divert opioid, they wouldn’t consider if it’s Percocet or OxyContin or Oxycodone. They look at it as an opioid. Similarly we compare nurses performing the same activities against their peers rather than across different practices,” clarifies Brzozowski. He continues to emphasize the fact that there are numerous ways to potentially divert, and Medacist has discovered every possibility. As such, “Our algorithm learns the behavior patterns from all the various confirmed cases of diversion and then builds on them as it learns more.”
In addition to the statistics and algorithms, Medacist’s group of analysts also conducts a manual audit for clients to help them determine the best practices for further qualifying outliers as part of customer training.
This auditing expertise has been developed into a machine learning algorithm, by determining inferences and reinforcing heavier assurance or weighted auditing metrics and factoring a risk score for subject outliers. Following the evaluation of the different analytic reports and combining all the outcomes, the team enables clients to zero in on the people who are at higher risk while reducing false positives in the process. “Modeled after the audits performed by our analysts who possess an extensive experience of 20 plus years, we have introduced RxAuditor Investigate—a web-based drug auditing portal for all members of an enterprise wide diversion risk team.”
The robust auditing solution provides the team with an outlier list curated by Medacist’s proprietary risk assurance scoring methodology as well as with a means to conduct a diversion auditing workflow and collaboration within a secure portal. RxAuditor Investigate’s main objective is to target risk and decrease false positives across the medication use process. Evaluating risk from health system level to patient care area, the diversion auditing portal helps target individual outliers by risk score across an enterprise using diversion auditing intelligence while allowing administrators to holistically view their risks via a single Diversion Risk Dashboard visualization.
A Consistent Streak of Success
With its roots firmly embedded in the drug diversion analytics arena, Medacist prides on its sky-high success rates and a whopping 97 percent retention rate, catering to both large healthcare organizations as well as small rural hospitals. In one occasion, Brigham and Women’s Hospital (BWH), an acute-care teaching facility in Boston, which utilizes Omnicell automated dispensing equipment and profile technology in over 80 inpatient and ambulatory care areas, was challenged to develop systems that ensured drug control and identified potential drug diversion. In addition, the hospital’s pharmacy was looking for reporting tools to optimize the automated dispensing system throughout the hospital. After an evaluation of multiple vendors and their reporting tools, a multidisciplinary team consisting of nursing and pharmacy leadership chose Medacist’s RxAuditor. RxAuditor’s patented diversion algorithm delivered unparalleled results while its reporting tools identified drug diversion in automated dispensing systems. On a daily basis, hospital-wide medication dispensing information was passed electronically to Medacist, which were then returned in layers of drug utilization reports to the hospital. The reports were user-friendly, and provided the drilldown details that made it easy for BWH to follow-up on potential drug diversion. Medacist provided an initial 90-day retrospective transactional usage analysis that identified multiple individuals with Omnicell transaction patterns that exceeded those of their peers. Once those individuals are identified, RxAuditor provided a user-specific drug audit report from which pharmacy and nursing can conduct a detailed audit. Through the RxAuditor reports, BWH significantly optimized individual Omnicell cabinet supplies, improved inventory turnover, and maximized their investment in automation.
"Upon witnessing a pressing need in the market for mitigating the misuse of prescription medicines by healthcare professionals, which posed a significant risk to patients, we developed our algorithm and implemented it"
Medacist also monitors and manages clinical, economical, and operational automation metrics in today’s ever-changing healthcare industry. Besides leading the charge in the drug diversion analytics, Medacist also focuses on medication error analysis, risk analysis associated with advanced drug reactions, and the optimization of automated dispensing cabinets to ensure that right drug is in the right machine for the right patient population based on their utilization over time. This, in turn, reduces operational inefficiencies such as stockout of medicines, keeps a check on drug discrepancies, streamlines efficiency by helping technicians load and refill the machines with correct medication and inventory levels, and also from an economic perspective, eliminates wastage caused by outdated medicines that never get dispensed.
Moving ahead in full steam, Medacist is all set to launch (October 1, 2019) its powerful RxAuditor Investigate, the initial offering powered by its industry exclusive big-data analytics engine—Genesis. RxAuditor Investigate is currently in the beta phase and aims to efficiently target risk and decrease false positives across the medication use process. On top of that, the company is also looking at rolling out RxAuditor Reconcile to enhance reconciliation with different data sources and resolve potential diversion issues in real time. “In essence, it is an alert system designed to notify nurse managers in case someone over dispenses certain drugs or do not document the drug withdrawn from the cabinet,” explains Brzozowski.