REP OCT 21

vol.29 no.10 • October 2021

repertoiremag.com

Made in America Can increased U.S. manufacturing help us avoid future product shortages?

Virtualize Thyself.

The pandemic has presented us with unprecedented challenges requiring distributor and manufacturer reps to pivot from traditional selling techniques to virtual interactions.

Our experienced sales and service teams are committed to continue as your trusted virtual selling partner and help ensure your success by providing the diagnostic products still critical to you and your customers.

Until we can work together in the field again, SEKISUI Diagnostics will be here for you in any other way possible. Because we understand, every result matters.

POINT-OF-CARE READER

RAPID DIAGNOSTICS

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SEKISUI DIAGNOSTICS IS YOUR PARTNER IN HEALTHCARE 800-332-1042 / sekisuidiagnostics.com © 2021 Sekisui Diagnostics, LLC. All rights reserved. Acucy® and OSOM® are registered trademarks of Sekisui Diagnostics, LLC. Because every result matters™ is a trademark of Sekisui Diagnostics, LLC. FastPack® is a registered trademark of Qualigen Inc.

OCTOBER 2021 • VOLUME 29 • ISSUE 10

PUBLISHER’S LETTER No Normal Life.................................... 2

PHYSICIAN OFFICE LAB Molecular Update How molecular testing is used, changing, shaping new markets and impacting diagnosis and treatment............................ 4

EXECUTIVE INTERVIEW The Digitization of Healthcare Five questions with Cardinal Health’s Dan Baker..................... 8

IDN OPPORTUNITIES Supply Chain Leader Spotlight Carlos Aguilar, vice president, Buy to Pay, Sourcing, Kaiser Permanente..................14

Made in America Can increased U.S. manufacturing help us avoid future product shortages?

18

NEWS

Carlos Aguilar

Putting a Relationship-Driven Industry to the Test

TRENDS A Matter of Trust AMA President: Patients trust their local doc when it comes to vaccines........30

How Secure is Your Device?

Connected devices and equipment can be an entranceway for hackers...........36

Home is Where the Heart is Home-based BP monitoring is on the rise...........................................44

Recent NDC Podcast examines how the pandemic is challenging the healthcare supply chain’s traditional interactions.......58

HIDA The U.S. Must Adopt a Policy to Diversify Manufacturing and Sourcing of Critical Medical Supplies............................. 60

QUICK BYTES Technology news............................66

MARKETING MINUTE How Qualified Web Traffic Improves Sales in Healthcare....................... 52

INDUSTRY NEWS

Rep Corner

Game Day Bonitatibus family feuds for the camera

Industry news....................................72

68

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October 2021

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PUBLISHER’S LETTER

No Normal Life This past month several events took place that made me pause. First, in a two-day

period, three people I know and love in the industry lost their lives: Jon Trujillo, formerly with PSS and Owens & Minor; Dee Chapman, formerly with Alere and Abbott (Dee was also a Repertoire Manufacturer Rep of the Year); and Linda Kitzmiller, wife of Don Kitzmiller, formerly with Midmark.

The second event, while small, in the big scheme of things hit me right between the eyes. My oldest son Scottie who works for MTMC in Nashville texted a picture on our family thread of a new grill he bought. The photo came with the following message: “I put together my first grill and had my first cookout with friends – this is a proud moment for me.” Most of you know I’m a grilling fanatic, so this was a proud moment for me as well.

So, what do these two completely different stories have in common? They are both lives filled with big events and small milestones. In the movie Tombstone, Wyatt Earp asked Doc Holiday why he could never have a normal life, to which Doc replied, “Wyatt, there is no normal life. There’s just life.” If these past 20 months have shown us anything, Doc couldn’t have been more correct. There is no normal life. There’s just life.

Our lives are a mere vapor. My hope is that none of us take any part of them for granted from the smallest things like your first grill to a tragic event of losing a loved one. Cherish every day, and every one, in your life.

Scott Adams

Have a wonderful fall and good selling out there!

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.com; www.sharemovingmedia.com

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sales executive

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Keith Boivin: IMCO Home Care

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PHYSICIAN OFFICE LAB

Molecular Update How molecular testing is used, changing, shaping new markets and impacting diagnosis and treatment.

By Jim Poggi

In times of need, major leaps in technology adoption can revolutionize a market, and our lives as well. Think of

the automobile, the internet, antibiotics and air travel. In 1900, none of these technologies existed. Today, they are all essential to our daily lives and, as important as they are, they are constantly changing and improving, becoming faster, more accessible, less expensive and more user friendly.

Molecular tests are widely applicable for diagnosis and treatment monitoring for many diseases including cancer, genetic diseases, influenza and others. The COVID-19 pandemic has caused the emerging technology of molecular testing to achieve a speed of adoption that is unheard of due to the critical need for faster, more sensitive and specific diagnostic technology. At the same time, molecular technology has evolved from large, relatively complex systems more well suited for use in sophisticated tertiary care hospital and reference laboratories to products used every day in physician office labs, even in waived testing settings. This column will examine how molecular testing is used, changing, shaping new markets and impacting diagnosis and treatment.

History of molecular testing The rationale for development and deployment of molecular tests is pretty straightforward for infectious disease diagnosis. Conventional microbiology plated media testing has several well-known drawbacks: it takes up to two days to identify the organism, it is highly technique 4

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dependent, nearly impossible to automate and does not lend itself to automated reporting of results. Even in the early going, molecular testing had advantages in terms of speed, specificity, sensitivity, automation and convenient LIS/HIS data management. In short, the market was ripe for an innovative solution. Over time, the larger more forward-thinking tertiary care hospitals began employing PCR and other molecular testing methods selectively for infectious disease testing. For inherited disease predisposition, the availability of whole genome sequencing was a fundamental step forward in understanding heritable conditions that might pass down based on parental genotype.

Fast forward to 2019 and the beginning of the COVID-19 pandemic, and the rate of change accelerated quickly. Emergency Use Authorization, rather than the more rigorous 510(k) clearance process led to a torrent of new molecular assays. How many you ask? As of August 2021, there are 255 molecular tests available under EUA for COVID-19 alone. While there was already a waived molecular influenza test in point of care, nothing could have prepared us for what the COVID-19 pandemic unleashed.

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PHYSICIAN OFFICE LAB Changing how we test There are at least five separate molecular technologies including RT-qPCR, LAMP (loop mediated isothermal amplification), RT-HDA (helicase dependent amplification), qSTAR (selective temperature amplification reaction) and others. The range of testing choices continues to grow as competition intensifies resulting in better performance, lower cost and the ability for tests to be done in a wider range of settings. Both conventional thermocycling methods like RT-qPCR and a range of isothermal methods have been developed.

Emergency Use Authorization, rather than the more rigorous 510(k) clearance process led to a torrent of new molecular assays.

How many you ask? As of August 2021, there are 255 molecular tests available under EUA for COVID-19 alone. While there was already a waived molecular influenza test in point of care, nothing could have prepared us for what the COVID-19 pandemic unleashed.

In the early going, isothermal methods were faster, but strides in microfluidics and other techniques are reducing RT-qPCR test times. RT-qPCR tests that used to take several hours can now be completed in under 1.5 hours, with some systems claiming 30 minutes. Isothermal systems are now claiming less than 15 minutes in some cases. Many molecular systems have “multiplexing” (multiple tests at the same time) capabilities. Several infectious disease tests can be run simultaneously creating a far broader range of diagnostic information. Many companies are offering combined COVID-19 and influenza assays and some offer even a broader range of tests that can be run simultaneously or separately. Many systems are automating the pre-analytical nucleic acid purification step simplifying sample handling and processing and smoothing workflow.

Newer technologies in development claim to be able to eliminate nucleic acid amplification altogether. This trend will continue. Data handling and analysis tools are being introduced to enable faster, more meaningful 6

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reporting of molecular tests, from thermocycle counts to data analytics attempting to predict treatment outcomes based on tumor genotype. Great strides are being made here, and more are on the way.

Changing where we test and who does the test There are a multitude of antigen tests for home use, either by prescription or self-directed (no prescription), but they are not molecular. Some are available over the counter.

On the molecular front there are at least 11 home sample collection kits cleared for use. And there are even three molecular kits cleared to be used at home. These home tests and home collection products are driving a sharp increase in “virtual visits”, which is a trend unlikely to slow down any time soon. While neither influenza nor strep tests are available without prescription or for home sample collection due to the potential for false negative results and, in the case of strep, potentially serious outcomes possible in the case of a false negative result. However, I can envision technology making these tests more likely to be cleared for home use in the future. Recent market data indicates quite strong consumer acceptance for home testing for a variety of infectious diseases. Urinalysis, pregnancy and ovulation tests are already accepted for home use.

Changing why we test Infectious disease testing represents the “low hanging fruit” in the molecular testing portfolio since it has improved every element of testing so dramatically. Testing for cancer diagnosis and therapy is ramping up quickly, and greater adoption for tests for genetic disease disposition or diagnosis are growing in number and adoption by the healthcare system. Companion drug/assay combinations are fueling this adoption also. The FDA has cleared over 40 companion drug/assay combinations already and more are in the pipeline. Along with the growth of liquid biopsy testing, the future of molecular testing is bright and will offer significant improvements in patient care, with reductions in morbidity and mortality and more effective treatments, particularly for cancer.

We are just beginning to see the level of impact molecular testing can have. It has expanded the number of tests available, increased the potential number of testing sites, made access to home testing or sample collection a reality and as the CLIA complexity of novel tests continues to drop, access to molecular testing in both waived and home testing locations increases. The world of molecular testing is changing. Are you keeping up with the changes?

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When it comes to preparing for this year’s respiratory season, one thing is certain – this year will be different than last. “There aren’t any assumptions being made based off last year, because of the anomaly of COVID being

so prevalent and fewer cases of other respiratory illnesses,” said James Taylor, distribution relations, Quidel.

The Quidel team is expecting changes to SARS, its different variants, and all the variables that go along with combatting COVID – vaccination rates, people going back to the office (or kids to school), social distancing policies and mandates.

“We’re talking with our distributor partners about being prepared for those changes,” Taylor said.

Indeed, the pandemic has taught us that healthcare providers will need to be in a constant state of readiness.

Physician offices must think beyond COVID. With handwashing less of a top-of-mind practice for consumers,

and social distancing policies relaxed, flu will be back. What if both flu and COVID cases mount, then what does the office need? If it’s just flu and COVID cases are minimal, then what testing protocols need to be in place? What about strep?

And what about RSV? Reports from the late summer were that the U.S. was experiencing a rise in RSV cases ahead of respiratory season, especially in kids. The CDC has already sent out a recommendation for symptomatic patients that are negative for COVID to consider testing for RSV as well.

For distributor reps, the first step in preparation will be to understand their customers’ needs, and how they manage their workflows. Are physician offices set up to flex from low volume to high volume very suddenly should there be strong flu, or an increase in COVID, or both?

Do customers prefer single tests?

Combo tests? Do they have product on hand from last season for flu, and need to keep their eye out for RSV and strep cases?

Then, distributor reps can work with their manufacturer partners to identify which products are the best fit for that particular customer.

This season, having options in terms of different respiratory assays will be more important than ever.

Rapid tests, molecular diagnostics – depending on the month and number of cases, physician offices may need something different.

Fortunately, Quidel is committed to delivering a continuum of diagnostic solutions from advanced lateral-flow and direct fluorescent antibody to molecular diagnostic tests that further improve the quality of healthcare. “Quidel is unique in that we have a very broad option of assays and a very broad array of different technologies,” said Taylor.

“Regardless of what happens, we are going to have an option for you and your customers.” www.repertoiremag.com

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October 2021

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EXECUTIVE INTERVIEW

The Digitization of Healthcare Five questions with Cardinal Health’s Dan Baker

Dan Baker recently joined Cardinal Health WaveMark™ Supply Management and Workflow Solutions as vice

president of Global Commercialization and Sales. In this role, Baker will provide leadership, talent management and culture-building initiatives across the WaveMark™ business. He has responsibility for defining WaveMark’s™ vision and commercial strategy and will lead the creation of new commercial growth initiatives to expand the business’ presence on a global scale.

In the following interview, Baker offered his insights on how digital health has evolved, industry challenges, lessons learned amid the pandemic, and more.

Repertoire: In your 20 years of experience, what have been some of the biggest benefits of the digitization of healthcare?

Dan Baker: Digital health has certainly evolved the last 20 years – and this evolution has presented incredible, worldchanging benefits. Looking back 20 years ago to a world where most clinical documentation was done on paper and stored in manilla folders, it’s incredible to reflect on the progress that’s been made. The aughts were still the early days of electronic health records, bookended by rapid adoption through “meaningful use” stimulus credits afforded by the Health Information Technology for Economic and Clinical Health Act. Widespread electronic health record (EHR) adoption really laid the groundwork for the digital health ecosystem we know today.

Record digital health investment is resulting in literally thousands of new software companies, all fighting for provider mindshare.

As core clinical data began to be captured at scale, population health and data analytics became the next best opportunity to impact care, allowing provider groups to practice more proactive and preventative versus pure traditional diagnostic care. I was driving adoption on the front lines, realizing the power of these growing data sets.

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Dan Baker

Like any meaningful change, it was hard work, but we saw tangible clinical and operational improvements.

The opportunity to unlock additional value for health systems from their EHRs, as well as from other clinical and ancillary systems, remains massive. As a personal example: I led a team that helped scale a precision medicine

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EXECUTIVE INTERVIEW software company called Syapse. We did some pioneering things with structuring and normalizing genomic and clinical data to help health systems make better treatment decisions for their cancer patients. We signed partnerships with many of the largest health systems in the world, and we eventually evolved to become the first-of-its-kind network connecting pharma and health systems to identify clinical trial sites, pre-screen trial cohorts and understand the clinical efficacy of targeted oncology drugs using realworld data and evidence.

I believe that technology that can enable greater trust, transparency, and collaboration between healthcare’s largest stakeholders presents the biggest opportunity in digital health today.

Success on any commercial team starts with a positive attitude, an inquisitive nature and a competitive team spirit.

Empathy is another key attribute I look for in future leaders. Being able to see a situation from a customer or team member’s perspective produces win-win outcomes.

Repertoire: What about the most pressing challenges related to the digitization of healthcare in today’s market?

Baker: One of the most pressing challenges in digital health today is physician and nurse burnout, an issue that has been making headlines over the last couple of years and especially this past year. As the U.S. healthcare system continues to realize the power and potential behind clinical data, it has shifted much of the data capture burden onto physicians and their care teams. Layer on a global pandemic and it’s no surprise that we’re seeing one of the biggest clinical labor shortages of our generation, with forecasts predicting the gap between clinician supply and demand only continuing to widen.

Record digital health investment is resulting in literally thousands of new software companies, all fighting for provider mindshare. The solutions that relieve the documentation and administrative burden from care teams, while ensuring comprehensive data capture for appropriate reimbursement, will win the mindshare over the next five years.

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Repertoire: As a leader, how do you approach talent management and building a successful culture?

Baker: Success on any commercial team starts with a positive attitude, an inquisitive nature and a competitive team spirit. Empathy is another key attribute I look for in future leaders. Being able to see a situation from a customer or team member’s perspective produces win-win outcomes.

Selling Enterprise SaaS solutions to large health systems is incredibly complex. Culturally, we need to remind ourselves of our responsibility to the provider and their patients. We could work in any industry, but there is nothing more rewarding than delivering solutions that directly impact the quality of patient care. The best healthcare commercial teams have this in mind every day.

Repertoire: Biggest lesson you’ve learned amid the pandemic?

Baker: The pandemic put a spotlight on the healthcare supply chain and how paramount it is to public health.

Giving clinicians the tools and supplies they need to safely provide the best possible care is the cornerstone of Cardinal Health’s business. WaveMark’s work with leading health systems to drive efficiency, transparency and clinical quality by enabling a truly clinically integrated, digitally automated supply chain is a very clear opportunity.

Things changed so fast and tough decisions had to be made without perfect data. It reinforced for me that speed beats perfection every time. We could all take a page from Voltaire and not let perfection be the enemy of good.

Repertoire: Why was this position at Cardinal a fit for you?

Baker: I’m passionate about solving really big problems in healthcare. Sixty percent of healthcare is still managing their supply chain manually – and most commercially available solutions are piecemeal, disparate technologies that do not roll up to provide clinical and supply chain leadership with enterprise-level insights or benchmarking. Cardinal Health WaveMark™ has a world-class team, innovative and best-in-class solutions and the largest footprint in clinically integrated supply chain technology.

Most importantly, I joined the WaveMark family because of the proven results it has achieved for some of the country’s leading health systems. The best products in healthcare come from on-the-ground work with forward-thinking health systems. Seeing the results that our health system partners have achieved toward their goals of patient safety, clinical quality and cost reduction is truly inspiring.

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1. Nathan DM, Griffin A, Perez FM, et al. Accuracy of a Point-of-Care Hemoglobin A1c Assay. J Diabetes Sci Technol. 2019;13(6):1149-1153. https://journals.sagepub.com/doi/abs/10.1177/1932296819836101.

2. Arnold WD, Kupfer K, Little RR, et al. Accuracy and Precision of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 10, 2019. https://journals.sagepub.com/doi/pdf/10.1177/1932296819831292.

3. Arnold WD, Kupfer K, Swensen MH, et al. Fingerstick Precision and Total Error of a Point-of-Care HbA1c Test. J Diabetes Sci Technol. March 6, 2019. https://journals.sagepub.com/doi/ pdf/10.1177/1932296819831273.

4. Lenters-Westra E, English E. Evaluation of Four HbA1c Point-of-Care Devices Using International Quality Targets: Are They Fit for the Purpose? J Diabetes Sci Technol. 2018;12(4):762-770. https://journals.sagepub.com/doi/pdf/10.1177/1932296818785612.

5. Sobolesky PM, Smith BE, Saenger AK, et al. Multicenter assessment of a hemoglobin A1c point-of-care device for diagnosis of diabetes mellitus. Clin Biochem. 2018;61(4):18-22. https://www.sciencedirect.com/journal/clinical-biochemistry/vol/61/suppl/C. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only.

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IDN OPPORTUNITIES

Supply Chain Leader Spotlight Carlos Aguilar, vice president, Buy to Pay, Sourcing, Kaiser Permanente Editor’s note: Carlos Aguilar, vice president, Buy to Pay, Sourcing, Kaiser Permanente, was one of this year’s Ten People to Watch in Healthcare Contracting. The Journal of Healthcare Contracting, a sister publication of Repertoire, interviewed him for the August 2021 issue.

The Journal of Healthcare Contracting: What’s the most challenging or rewarding project you have worked on in the last 12 to 18 months?

Carlos Aguilar: I would have to say the most challenging for us has been reconfiguring our supply chain and identifying new sources to meet our PPE needs. Everything from gowns, masks, and gloves to needles, syringes, and sanitary wipes were in shortage. It has been quite a range of categories and products that we had to identify new sources for, making sure that products and suppliers were verified and vetted. That was a big challenge, largely because there was a global shortage of all these products. But we also ran into more disruptions. Right when we solved one category, another arose.

For example, once we had a handle on the PPE supplies, then it was a shortage of the ultra-low temperature freezers for the vaccines, needles and syringes.

I would say the most rewarding project was when we had the supply chain stabilized and got to the point where we were setting up mass vaccination sites. This is really where the rubber meets the road. We set up large venues where we can help high volumes of our members get vaccinated, as well as the community

Carlos Aguilar

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IDN OPPORTUNITIES at large. That is when it finally felt like there was light at the end of the tunnel, not just for our organization and our members but for all of us.

Seeing all that come to fruition, that made it feel like we were not just treading water, but we were making the major progress we needed to overcome the pandemic.

much more broadly than just PPE. What categories? What inventory?

What risk mitigation plans do we need to put in place?

I’d say the second one that certainly was an eye opener for us is, as we worked with our manufacturers and distributors, it became pretty clear to us that suppliers and distributors

We’re looking at our end-to-end digital supply chain and transforming it. That was one of our major priorities before COVID hit. Obviously, when COVID hit, we needed to shift our priorities. But we’re at that point where we’re stable enough and mobilized, and we just launched that blueprint phase for the digital transformation.

JHC: What changes brought on by the pandemic are here to stay regarding the supply chain?

Aguilar: The biggest challenge that we all recognize throughout the industry is there has been a lot of leaning out of our traditional supply chains in health care due to inventory issues and limited availability.

When something like the pandemic hit, there just wasn’t enough buffer in the inventory. As a nation, we’ve been looking at some of those regulatory changes that have been passed at the local and national levels. But I think making sure that we are considering inventory and redundancy of supply, geographic diversity (domestic and global sources), and supply assurance is going to stay with us.

And we’re asking the question more broadly than just PPE. We’ve always looked at that in other categories, like pharmaceuticals and elsewhere, but now with the pandemic, I think we’re revisiting and looking at that 16

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didn’t always have complete control of the supply chain down to raw material and the factory level. That’s another area I think we’re taking away as an insight and one where we’re putting in more controls, more rigor, more due diligence around really understanding all aspects. What factories? What are they doing to assure supply assurance at the factory level?

How are they going about verifying the quality of those products? It’s really taking that extra level view into the first, second and third tier in the supply chain.

JHC: In order to maintain supply chain continuity, have you added or changed anything as far as storage, warehousing, or self-distribution?

Aguilar: We’ve done a combination of things. Prior to COVID, we had implemented a hybrid pharmaceutical distribution strategy through partnerships with a national phar-

maceutical national wholesaler and third-party logistics leader (3PL).

The 3PL direct channel stored, inventoried and distributed pharmaceuticals that showed a benefit to KP of a cost savings or supply assurance for care critical items.

As the pandemic hit, we had to expand these areas. We worked closely with our supply chain 3PL partner, who manages those warehouses and we’ve had to expand our relationship with them to cover some of the PPE categories as well.

But I think as we look ahead, it’s probably going to be part of our ongoing strategy. We just need to figure out how to optimize it. It really comes down to understanding the potential risk for which categories and what inventory levels might be affected. We want to make sure that we’re not just solving for this pandemic but anticipating any future disruptions too.

JHC: What project or initiative are you most looking forward to?

Aguilar: We’re looking at our endto-end digital supply chain and transforming it. That was one of our major priorities before COVID hit.

Obviously, when COVID hit, we needed to shift our priorities. But we’re at that point where we’re stable enough and mobilized, and we just launched that blueprint phase for the digital transformation.

That is probably the most exciting because after a year plus being in triage mode, it’s nice to be back into a project where you’re transforming and improving your operation. It covers the entire span of our organization from sourcing, ordering distribution, supply chain all the way through payables. We’re very excited about getting that moving again.

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Made in America Can increased U.S. manufacturing help us avoid future product shortages?

Last year PPE and ventilators were in short supply. This year, it’s been just

about everything else, including consumer products. Equipment shortages, capacity limits and logistical chokepoints throughout the supply chain created a backlog of container vessels and marine terminals at West Coast ports.

In the face of these challenges, “Made in America” looks like an attractive strategy to healthcare providers as well as consumers. But how realistic is it?

Do we have the capacity? The raw materials? Will vendors jump onboard? Are buyers committed to American-made products, even if they cost a bit more?

Repertoire posed these questions to a group of healthcare supply chain experts:

Mark Henderson, executive vice president, sales and marketing, Concordance Healthcare Solutions.

Linda Rouse O’Neill, vice president of government affairs, Health Industry Distributors Association.

Elizabeth Hilla, senior vice president, Health Industry Distributors Association.

Laura Reline, vice president, supplier management, NDC Inc.

Soumi Saha, vice president, advocacy, Premier

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Made in America

Repertoire: How would you gauge the demand for ‘Made in America’ among healthcare providers today?

Laura Reline: I believe everyone agrees that having more healthcare products produced in the United States boosts our domestic economy and creates more job opportunities, reduces transportation expenses and lead times, and provides less dependency on foreign nations. The complexity of this situation is: Will product prices be as competitive, given higher wages, more stringent regulations and potential lack of raw materials?

Let’s assume for a moment U.S.-made goods are more expensive. How much of a premium are customers willing to pay? NDC distributors are not unique in that they face increased pressure to provide quality products at competitive prices, especially given e-commerce price transparency. So where is the balance?

‘It’s one thing to bring manufacturing back to the U.S., but if no one is buying domestic products because of price, you won’t survive.’

NDC works with many suppliers who manufacture products in the United States and several that purchased machinery during COVID to produce key products domestically, such as PPE. We support this shift in production and have helped them communicate their American-made offerings and advantages to our distributors.

As with consumer goods, I believe in the future there will continue to be buyers that are more priceconscious, for whom country-of-origin isn’t necessarily their top priority. But others will seek out goods that are produced domestically, knowing the product price may come at a premium.

Mark Henderson: We are seeing an increased demand for ‘Made in America’ products, especially PPE. For most customers, it is a desire to diversify sourcing and have an 20

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established domestic supply that can flex in situations when the globally sourced product becomes constrained.

The additional cost of domestic products still seems to be a limitation to moving full categories, but the desire to build additional resiliency with domestic supply has increased significantly.

Repertoire: As a result of product shortages during the public health emergency, some PPE production has been shifted to the U.S. But what about other med/surg products, devices and equipment?

Laura Reline: For obvious reasons, there was a spotlight on PPE during the pandemic, and it is great that some production of masks and other PPE has shifted to the U.S. Having onshore or even near-shore production of other med/surg products would be welcomed, especially given current port and freight challenges. One of the continued concerns will be raw material availability. Even if the final product is made or assembled in the U.S, relying on imported raw materials does not help solve what is trying to be accomplished, that is, to gain better control of the supply chain in order to minimize potential future shortages.

Soumi Saha: Premier has been ringing the alarm bell on foreign manufacturing for years. We have spent more than a decade diversifying our portfolio. For more than a decade we have been talking about the critical nature of this issue for both pharmaceuticals and medical supplies, like PPE. However, a lot depends on the regulatory process.

PPE involves a relatively low degree of regulation, so moving production is easier. But medical devices involve more regulatory requirements. And pharmaceuticals are even more challenging. There’s also the time factor. Building a sterile facility to make infusion pumps, for example, is a three-to-five-year process. And you can’t build a pharmaceutical manufacturing facility overnight.

We also need to talk about committed purchasing. It’s one thing to bring manufacturing back to the U.S., but if no one is buying domestic products because of price, you won’t survive. At Premier, we have created committed purchasing programs in which hospitals commit to devoting a portion of their inventory to U.S.-made products for a certain number of years. Our partners include Prestige Ameritech, DeRoyal and Honeywell.

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Made in America

Premier has also been advocating for a 30% tax credit for companies that invest in domestic manufacturing.

That could help them get their facilities up and running, meet EPA requirements, etc.

Repertoire: Is “Made in America” realistic? What are the limits to how much production of healthcare supplies, devices and equipment can be brought back to the United States?

Laura Reline: It depends on a couple of factors. How cost-conscious are customers? Is buying American-made products a top priority for the office, health system or facility? The current administration has taken steps to support American manufacturing. In January, President Biden signed an executive order to launch a governmentwide initiative to increase the use of federal procurement to support American manufacturing.

‘Leveraging the strengths of each manufacturing location – U.S., regional and global – will result in the highest level of supply chain resilience at the lowest overall cost.’

At the end of July, the White House announced a proposed rule that aims to strengthen domestic supply chains for critical goods and increase the threshold for products to qualify as American-made, as part of the commitment to bolstering the number of products made in the U.S. Currently, 55% of the value of a product’s component parts must be manufactured in the U.S. to qualify. The proposed rule would raise that threshold to 60%, and then to 65% by 2024 and 75% by 2029. The rule would also extend enhanced price preferences to some critical products to support their development and expansion of domestic supply chains. The enhanced price preferences aim to provide a source of 22

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stable demand for domestically produced critical products, according to The Hill.

If the U.S. government continues to support these initiatives, then it will certainly assist efforts to bring manufacturing back to the United States.

Soumi Saha: Part of the challenge is that many of the raw materials used in medical products originate outside the United States. Prescription opioids, for example, are made from poppies, which are grown primarily in Afghanistan and Australia. Many computer chips are made in Asia. The same is true for many of the raw materials found in PPE. This is where our concept of developing near-shore partners comes into play. Our “All of the Americas” approach means we look to North, Central and South America for sources of supplies and products. Premier’s CEO Mike Alkire talks about what is needed to build a healthy supply chain – a combination of domestic, offshore and near-shore capabilities. What can we move on roads and railways, so we don’t need to rely on ocean vessels?

Linda Rouse O’Neill: HIDA supports expansion of domestic and near-shored manufacturing of critical products to augment global sources. Leveraging the strengths of each manufacturing location – U.S., regional and global – will result in the highest level of supply chain resilience at the lowest overall cost.

We recommend that the government use multiyear contracts and meaningful incentives to promote domestic manufacturing. Payment and trade policies can also be used to provide a consistent demand signal to the commercial market for long-term viability. Additionally, HIDA believes: ʯ The U.S. should have an idle manufacturing strategy to ensure that additional production lines can go live quickly during a crisis. ʯ Experienced companies should have priority to receive government support for on-shore production. ʯ A diversified global sourcing strategy is critical to reducing U.S. dependency on certain geographies and regions for key categories of medical supplies.

Mark Henderson: Manufacturing capabilities, cost of labor and access to raw materials could certainly limit the near-term movement of PPE to large-scale domestic

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Made in America

manufacturing. That’s especially true in product categories like exam gloves, isolation gowns, etc. But if the demand is strong enough and there is a willingness to pay a premium, our manufacturing capabilities can rise to the challenge.

For some non-PPE products, we are seeing an increased demand for domestic products. However, we have not heard the same level of concern about domestic production of med device products, such as implantables or equipment, as we have with PPE and other medical supplies.

“I want to help,” we often didn’t know who needed that help the most.

But in addition to keeping track of on-hand quantities, we are also thinking in terms of “time in inventory.”

It’s more of a “How do you ramp up for war?” scenario, or a virtual stockpile. In this case, you have a primary and second manufacturer contracted and ready to go when you say “go.” And you test the system periodically, as the federal government does.

Repertoire: What other methods – beside domestic manufacturing – should be employed to prevent future shortages of healthcare products?

Linda Rouse O’Neill: It’s critical to build a bigger cushion of medical supplies to fulfill providers’ initial demand during a crisis, giving critical time to ramp up manufacturing. Providers’ first call for product is to their distributors, so product reserves should be dispersed at distribution warehouses across the country. We recommend that the federal government contract with or fund distributors to increase inventory levels for PPE and other critical supplies at their approximately 500 locations around the country. Distributors should be funded to carry up to 90 to 120 days’ supply of an agreed-upon critical supplies list. Distributors have the expertise and infrastructure to keep inventory current by monitoring expiration dates, rotating, and replenishing these buffer reserves as needed.

‘The desire to build additional resiliency with domestic supply has increased significantly.’

Laura Reline: A better Strategic National Stockpile (SNS) would certainly assist in preventing future shortages of critical healthcare products. Two major healthcare distributors have already been awarded contracts for PPE and COVID-related supplies to support the SNS. The SNS has also collaborated with HIDA to coordinate manufacturer and distributor efforts. This commitment and cooperation among all parties will enhance the availability of stockpiled product for future pandemics and disasters.

Soumi Saha: When it comes to stockpiling, a lot of the discussion is about on-hand quantities, and rightly so.

Never during the pandemic did we have a firm grip on how much of a particular product category was on U.S. soil at any time, or where it was, specifically. We could have used that information to move product where it was most needed. As it was, when a manufacturer said, 24

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Mark Henderson: I believe there will be a continued partnership between the government and private sector to build greater resiliency into the healthcare supply chain. This could include agreed-to stockpile programs for critical supplies. I see it as an active RFP/bid process or a fee-for-service program, as opposed to funding of all distributors to carry additional stockpiles. Creating stockpiles mitigates supply disruptions for a period of time, but it also creates risk and additional cost. Any efforts to help mitigate that risk will help support more action. Better visibility and communication among manufacturers, distributors and providers will also be key in reducing the need for stockpiles.

Repertoire: During HIDA’s Supply Chain Visibility Conference this summer, it was noted that some distributors are providing warehouse space and inventory management services to providers that want to expand their reserves. How widespread is this?

Mark Henderson: Concordance has been very active in working with providers to establish 3PL programs to allow them to purchase additional stockpiles of products and store them in Concordance facilities. These programs have played a critical role in ensuring the availability of much-needed supplies for providers that do not have the space and/or resources to accommodate them.

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Made in America

Elizabeth Hilla: Many distributors are providing warehousing and inventory management services for providers that want to increase their reserves. These programs – sequestered inventories, pandemic reserves, etc. – aren’t new, but they are in much greater demand as organizations look to stockpile critical products without making enormous investments in infrastructure and expertise.

Repertoire: Recently, President Biden directed the Federal Maritime Commission and Surface Transportation Board to address consolidation and aggressive pricing practices among ocean shippers and railroads. From your perspective, does our country have some problems to work on related to ocean shippers, railroads and trucking firms?

Mark Henderson: Yes, the pandemic has exposed critical infrastructure issues related to the logistics of moving product from manufacturers to distributors.

These challenges include cost increases for containers, delays at the ports, reliability and quality of carriers, access to labor, etc. We have seen a significant increase in delivery delays and damaged products to our distribution centers over the course of the pandemic. These problems can only be solved with strong collaboration, higher accountability and identification of the underlying breakdowns across all stakeholders.

‘The complexity of this situation is: Will product prices be as competitive, given higher wages, more stringent regulations and potential lack of raw materials?’

Linda Rouse O’Neill: Challenges with shipping, port congestion, railroads and trucking are dramatically impacting the healthcare supply chain. Delays, rising costs and inconsistent delivery times can threaten suppliers’ ability to serve their healthcare customers.

HIDA supports the development of programs and policies to prioritize transportation of critical medical supplies through the supply chain. In a pandemic, essential products like PPE should have priority access to port, rail, and truck transport. Creating a “fast pass” system to align ports, rails, trucking, and distribution centers so PPE in the U.S. is expedited in front of less critical cargo would help to ensure that healthcare providers have the products they need, even during an emergency.

Laura Reline: We have definitely seen these offerings from NDC distributors. Typically regionally focused and acute-care-based, they enhance the traditional purchaseand-ship transaction. This is a huge benefit for health systems, as space for excess supplies is limited and expertise in inventory management is often lacking. Sometimes the inventory is consigned, meaning it is available but not paid for until needed. This helps the health system manage cash flow.

We also have had examples of distributors offering these services to healthcare facilities in remote areas.

Large physician group practices, whose facilities are spread across the U.S., have also made use of it to consolidate inventory in one central location.

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Laura Reline: Inbound shipments from overseas have tripled in cost and many suppliers are experiencing double-digit increases from domestic freight carriers.

Unfortunately, manufacturers and distributors cannot absorb these rising expenses and are often forced to raise product prices to offset the cost of transportation.

In addition, there has been a shortage of truck drivers for many years, which can delay shipments and increase damage claims due to less experienced personnel. Our transportation and operations team works on a daily basis to mitigate these challenges.

SPONSORED

GOJO

GOJO Supports the Healthcare Sector with a Focus on Sustainable Value

By Dylan Beach, Sustainability Manager, GOJO Industries

Sustainability is a business imperative. The question that should be at the top of an organization’s mind is, how do we transition to an equitable, low carbon, circular economy? This is arguably the biggest business opportunity in history and refers to the three biggest trends in sustainability today. The companies that enable this transition and provide products and services that deliver a real social good will survive.

National Council (WBENC) as a Women’s Business Enterprise (WBE).

Our WBENC certification is significant because GOJO can now help health systems achieve their supplier diversity goals and, in turn, formally demonstrate their commitment to fostering diversity and equity.

The healthcare sector can help transition to a low carbon future

The healthcare sector can drive diversity, equity, and inclusion The Diversity, Equity, and Inclusion movement in the U.S. continues to accelerate for many companies, including GOJO. We understand that sustainability is not just environmental, but also has interconnected social and economic elements. That’s why a low carbon, circular economy also needs to promote opportunities for people to bring their full and authentic selves to the work that they do.

According to the Bureau of Labor Statistics survey from 2020, the healthcare sector accounted for 12% of total U.S. employment1 and admitted 36,241,815 patients in 2019.2 In 2013, the average patient admission required $4,470 of supply expenses in U.S. hospitals.3 This sector can have a significant impact on promoting diversity, equity, and inclusion and suppliers to the sector can help in this effort.

In 2020, GOJO became certified by the Women’s Business Enterprise

The best science tells us that the world needs to reduce climate emissions by 50% by 2030 and become carbon neutral by 2050.4 The U.S. healthcare system has a role to play. It contributes an estimated 10% of the nation’s carbon emissions and 9% of harmful non-greenhouse air pollutants.5 Many health systems are adopting strong climate goals, such as the UK National Health System, Kaiser Permanente, and NYU Langone Health System. To seriously tackle carbon emissions, health systems will increasingly look at how to reduce select Scope 3 emissions (emissions from sources it does not directly own or control). A health system may ask its group purchasing organization to source low carbon products from www.repertoiremag.com

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SPONSORED

GOJO

suppliers that can show evidence of carbon reduction.

Between 2010 and 2015, GOJO reduced its carbon intensity by 46% per product use, and from 2015 to 2020, we reduced carbon intensity by an additional 49% per product use.

Furthering this goal, our Cradle to Cradle Certified® Gold PURELL® hand sanitizers and soaps are manufactured with 50% renewable energy.

Circular design can help hospitals ease reliance on disposable plastic Plastic use has grown exponentially since 1950. Approximately 40% of plastics are used to produce packaging, which is often single-use, meaning it is not designed to be refilled and has a life of less than 6 months.6 In hospitals, medical waste and singleuse plastics was already high, but the COVID-19 pandemic caused a surge in consumption.7 As we emerge from this pandemic, there is an opportunity to examine how health systems can reduce their reliance on disposable plastics, while of course addressing public health concerns regarding the spread of pathogens.

Circular design principles have been integrated into upcoming innovations in our pipeline, which will help our health system and distributor partners meet waste reduction and packaging sustainability goals. In the meantime,

our breakthrough Energy-on-the-Refill Technology on the PURELL® ES8 dispensing system represents a 68% reduction in battery waste and a 15% reduction in greenhouse gas emissions8 when compared to leading touch-free systems on the market.9

Safe, then Circular GOJO was founded in 1946 on a safer way to clean hands, and we carry that design ethos forward with us today. From 2015 to 2020, we have been advancing a sustainable chemistry strategy underpinned by two goals. First, to reduce chemicals of concern in our portfolio by 50% per product use and second, to double the percent of global sales from third-party certified products.

The NGO-led Chemical Footprint Project (CFP) began in 2014 with the mission to transform global chemical use by measuring and disclosing data on business progress to safer chemicals. Many healthcare organizations are signatories of the initiative, including Kaiser Permanente and Vizient. GOJO was a founding participant of CFP and the first company to declare a public, quantitative target to reduce chemicals of concern. Through CFP, we have publicly disclosed our progress since 2014, and at the end of 2020 we had reduced chemicals of concern in our portfolio by 64% per product use.

Third-party certifications make it easier to evaluate the health, safety, and environmental performance of products and help organizations buy green products with confidence. Significantly, certifications meet environmentally preferable purchasing guidelines of government contracts and green building standards such as LEED and WELL. Some significant third-party certifiers in the infection control space are the Cradle to Cradle Certified™ Products Program, Ecologo and Green Seal. GOJO was the first company in our industry to certify a hand soap to a third-party standard in 2006 and a hand sanitizer in 2010. In 2020, many PURELL® products achieved Cradle to Cradle Certified™ Gold with a Platinum level Material Health rating, the highest material health rating possible. The Cradle to Cradle Certified™ Products Program is the world’s most advanced standard for safe, circular and responsible materials and products.

GOJO uses the Chemical Footprint Chemicals of High Concern list and third-party certification standards as minimum benchmarks for product development. We know that providing products that are increasingly safe, effective and good for you and the planet helps deliver on our GOJO Purpose of Saving Lives and Making Life Better through Well-being Solutions, while helping to meet the needs of our customers.

Bureau of Labor Statistics, State Occupational Employment Statistics Survey, May 2020.

Fast Facts on U.S. Hospitals, 2021. AHA Hospital Statistics.

3 Abdulsalam, Y. and E.S. Schneller. Hospital supply expenses: An important ingredient in health services research. Medical Care Research and Review. 2017. 1–13. http://journals.sagepub.com/doi/10.1177/1077558717719928 4 IPCC, 2019: Summary for Policymakers. In: Climate Change and Land: an IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems.

5 Eckelman, M.J., and Sherman, J.D. Estimated Global Disease Burden From US Health Care Sector Greenhouse Gas Emissions. American Journal of Public Health. 2018. 108: S120-S122. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922190/ 6 Geyer, R. et al. Production, use, and fate of all plastics ever made. Science Advances. 2017. 3, 7. DOI: 10.1126/sciadv.1700782.

7 Silva, A. L., P., et. al. Increased plastic pollution due to COVID-19 pandemic: Challenges and recommendations. Chemical engineering journal.

2021. 405. https://doi.org/10.1016/j.cej.2020.126683.

8 Based on a 1200mL refill with an assumed usage rate of 2.35 refills per dispenser per year and a 6-year dispenser lifetime.

9 2017 Healthcare Sanitizer Market Sales provided by Definitive Healthcare, LLC. 1 2

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Solutions for a Better World GOJO Is Proud to Be a Leader in Sustainability From our ingredient safety evaluation process to our supply chain strategy, we’ve put great effort into embedding sustainability into everything we do to manage the social and environmental impacts we have on the global community.

We’re proud to offer well-being solutions that are paving the way to a better world. And, our commitment to health – for people and the environment – helps support your sustainability initiatives as we work together to enhance the lives of those we touch.

SUSTAINABILITY

Optimizing Packaging Reducing Materials Used Designing for Recyclability

DIVERSITY

Women-Owned Business WBENC-Certified Meet Tier 2 Supplier Diversity Goals

CERTIFICATIONS *

350+ Cradle to Cradle® Gold Products Design for the Environment EPA Safer Choice Partner USDA Certified Biobased Product ECOLOGO®

CHEMISTRY

Plant-Derived Products Biodegradable Ingredients Mild, Hypoallergenic Formulations Ph-Balanced Hand Hygiene

To learn more, visit GOJO.com/Rep5 or scan here *Certifications do not apply to all GOJO products. Please check individual products for applicable certifications. ©2021 GOJO Industries, Inc. All rights reserved. | 32361 (8/2021)

TRENDS

A Matter of Trust AMA President: Patients trust their local doc when it comes to vaccines

When it comes to the public gaining more confidence in the safety and efficacy of

COVID-19 vaccines, local doctors have an important role to play in mitigating hesitancy, according to Dr. Gerald E. Harmon, President of the American Medical Association.

That was one of several takeways from Dr. Harmon in a recent #scheinchats YouTube video, where the AMA president spoke with Stan Bergman, Chairman and CEO of Henry Schein, about how the pandemic will continue to shape health care for years to come.

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CHOLESTEROL M A N AG E M E N T I N T H E AG E O F COV I D -19 Protect Heart Health Preventative care and chronic disease management for diseases such as cardiovascular disease (CVD) are more important now than ever. High-quality point-of-care cholesterol and glucose testing enables practitioners to diagnose and manage cholesterol conditions at the time of consultations, providing comprehensive, immediate results that can improve patient care.

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Patients with preexisting comorbidities such as CVD and diabetes need to ensure diseases are managed to minimize the risks associated with COVID-19.6-8 Check out the inside cover of this issue to learn more and visit us at abbott.com/poct. *FDA approval since 1991.

1. Cholestech LDX™ Package Insert.

2. Frost & Sullivan. Global Point-of-Care Testing (POCT) Market. April 2013:71.

3. Jain A, Nair DR, et al. Evaluation of the point of care Afinion AS100 analyser in a community setting. Ann Clin Biochem. 2017;54(3):331-341.

4. Whitehead SJ, Ford C, Gama R. A combined laboratory and field evaluation of the Cholestech LDX and CardioChek PA point-of-care testing lipid and glucose analysers.

Ann Clin Biochem. Published online July 23, 2013. http://journals.sagepub.com/doi/pdf/10.1177/0004563213482890.

5. Jain A, et al. Point of care testing is appropriate for National Health Service health check. Ann Clin Biochem. 2011;48:159-165.

6. WHO. Clinical management of COVID-19. Interim guidance May 27, 2020. WHO/2019-nCoV/clinical/2020.5.

7. Holman N, Knighton P, Kar P, et al. Type 1 and Type 2 diabetes and COVID-19 related mortality in England: a cohort study in people with diabetes. NHS England.

Published May 19, 2020. Accessed June 8, 2020. https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf.

8. Bornstein S, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol. 2020;8:546-50. © 2020 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners. Any photos displayed are for illustrative purposes only. 10005909-01 08/20

TRENDS “Historically, we’ve had nothing to match this pandemic,” Dr. Harmon said. “And so we didn’t have the urgency to develop the vaccines and use that as an offensive weapon against this devastating virus. Now that we have them, the vaccines are absolutely effective.

They’re incredibly safe. They’ve been rapidly developed with good technology, shelf technology that was already there, but we’ve never had a pandemic that allowed us to move through the bureaucratic and regulatory barriers that existed in previous vaccines over the years.”

“The data from this survey ties in with what we’ve found, which is that an individual’s strong relationship with their primary care physician is essential for getting the right medical information and taking action to protect their health.”

However, Dr. Harmon said there’s a lot of misinformation out there regarding the vaccines. That’s where local doctors come in. “What people do, and we have studies that show this, they trust their local doctors, their family doctors, their frontline physicians to give them sound advice, to provide them good healthcare, and in the case of the vaccine, to give them the right defense against this virus.”

Patients surveyed The Henry Schein Cares Foundation commissioned a survey to find how much the average American values the opinion of their primary care physician and how that opinion informs their decision to get the COVID vaccine or not. “The results clearly indicate that most Americans who are hesitant to get vaccinated say they’d be willing to change their minds about getting the COVID-19 vaccine if their doctor reached out to them, or if there were incentives involved,” according to the research.

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Vaccine incentives are less likely to convince Americans to get the COVID-19 vaccine than a visit to their primary care physician, new research suggests.

Conducted by OnePoll and commissioned by the Henry Schein Cares Foundation, the survey revealed that: ʯ 88% who went to a primary care physician before getting the vaccine (1,202 respondents) said their doctor’s advice was an instrumental factor in their decision. ʯ 88% also said they trust their primary care physician’s advice either completely or most of the time. ʯ It takes the average patient two years and nine months to establish a meaningful level of trust with their primary care physician. ʯ 94% of parents trust the advice of their child’s physician either completely or most of the time. ʯ 92% trust the advice of their child’s primary care dentist. ʯ Besides doctors, respondents cited the CDC (49%) as their primary source of COVID-19 information, followed by state health agencies/officials (47%) and their own family members (33%).

“The simplest way to convince people to get the vaccine is by getting a trusted medical professional involved,” said Dr. Louis W. Sullivan, former head of the U.S. Department of Health and Human Services and current Co-Chair of the Henry Schein Cares Foundation’s board of directors.

“The data from this survey ties in with what we’ve found, which is that an individual’s strong relationship with their primary care physician is essential for getting the right medical information and taking action to protect their health.”

Front and center In the #scheinchats interview with Bergman, Dr. Harmon said local physicians need to be put front and center so that they can speak to their patients and simply administer the vaccine as they do with so many other vaccines.

Whereas the nation had to rely on mass vaccine sites in the initial ramp-up of vaccine distribution, the logistics have significantly improved for more physicians or practically any physician that would like access to these vaccines in their practices, Dr. Harmon said.

“It’s truly a remarkable achievement, a remarkable public-private partnership that we in this country obtained this vaccine, got this vaccine through the regulatory process in record speed. And these vaccines are effective.

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Pediatrics

TRENDS

How Secure is Your Device?

Connected devices and equipment can be an entranceway for hackers

By Mark Thill

The revelation was like something

out of a spy novel. In October 2013, former Vice President Dick Cheney and his cardiologist, Dr. Jonathan Reiner, told “60 Minutes” that when Cheney got a heart defibrillator in 2007, Reiner ordered the manufacturer to disable the wireless feature, to prevent would-be hackers from interfering with the device and shocking Cheney into cardiac arrest.

Since then, ransomware attacks on healthcare providers have become common, and medical devices are now being scrutinized not only because of the possibility of hackers interfering with them to hurt or kill people, but because devices can be used to “open the floodgates” for hackers to gain access to electronic medical records, personal patient information, even providers’ financial systems.

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MADE IN THE USA

TRENDS That’s the dark side of the Internet of Things, or IoT. And given the frequency of healthcare-related cyber attacks, Repertoire readers selling devices and equipment should expect this question from their customers: “How secure is it?” Sales reps aren’t information technology experts, but they should consider learning about cybersecurity and the steps that distributors and manufacturers are taking to shield their customers from malfeasance.

WannaCry In the first half of 2020 alone, the Department of Health and Human Services saw a nearly 50% increase in the number of healthcare-related cybersecurity breaches, writes cybersecurity expert Seth Carmody in a recent article in HIT Consultant. Carmody is vice president of regulatory strategy for MedCrypt, a healthcare security provider, and former cybersecurity program manager in the U.S. Food and Drug Administration’s Center for Devices and Radiological Health (CDRH). The healthcare industry’s cyber risk exposure is weak, he says.

Medical device evaluation firm ECRI pointed to cybersecurity challenges as one of its Top 10 Health Technology Hazards for 2021. Third-party software components that are incorporated into medical devices pose unique cybersecurity challenges, and reducing vulnerabilities can be hindered by: ʯ Difficulty identifying which medical devices include the affected software. ʯ Delays in receiving guidance while the medical device vendor audits its product lines, validates third-party patches, and develops recommendations for remediating the problem ʯ Practical challenges associated with applying the patch in a clinical environment where equipment is in continuous patient use.

The WannaCry ransomware attack in 2017 demonstrated how the exploitation of a vulnerability in thirdparty software could have devastating effects, according to ECRI. In the United Kingdom, WannaCry infected 1,200 diagnostic devices, caused many others to be temporarily taken out of service to prevent the malware from spreading, and forced five UK hospital emergency departments to close and divert patients, writes John Riggi, senior advisor for cybersecurity and risk for the American Hospital Association, in a recent post on the 38

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AHA website. “The FBI considers WannaCry the first ransomware attack to widely target vulnerabilities commonly found in medical devices.”

Cause for concern A 2016 article in HealthManagement.org by ECRI makes the case for medical devices and equipment as cause for concern.

“Medical devices are no longer just machines attached to or used by the patient. They are often connected to the HER – either hardwired or wirelessly. A typical patient in a critical care unit could easily be connected to 10 or more networked devices. While the information on the medical device may not be useful to a hacker, the medical device can be used as a conduit for accessing patient information in the EHR, like home address and social security number, which can be used to perpetrate identity theft or real theft in the patient’s home while the patient is hospitalized.”

If you try to make healthcare professionals security experts, you’ll get worse healthcare and inadequate security.

Biomedical engineering presents its own set of dangers, according to ECRI. “In-house biomedical engineering technicians and vendor field-service engineers typically have administrative rights to access performance records and to apply service diagnostics. These are typically not a managed credential and at many hospitals are the same for everyone with this level of access to the device. What happens if a technician or field service engineer leaves the hospital or the vendor? The password leaves with the person, with no hospital policy or procedure to update the access codes.”

Who’s responsible?

It’s not a question of negligence on the part of healthcare providers, medical device manufacturers or the FDA. But the fact is, someone has to address the growing problem. Who’s it going to be? Carmody points out the dilemma.

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TRENDS “Healthcare is optimized for healthcare, not security,” he says. “Expecting [healthcare] professionals to deliver world-class medical care and defend against cyberattacks is like requiring a world-class athlete in one sport to also be world-class in another sport – it can be done, but it’s rare and more than a little unfair. Do we really want companies that are working around the clock to care for those affected by a pandemic to also have to battle cyberattacks up and down the supply chain? If you try to make healthcare professionals security experts, you’ll get worse healthcare and inadequate security.”

Meanwhile, medical device manufacturers find themselves in a dilemma of their own, he says. “[Investing in] the level of commitment for security features that aren’t fully incentivized by the market is a tough sell for business leaders that are competing on clinical features.”

Medical devices are no longer just machines attached to or used by the patient.

Even the feds have their hands full.

“While it makes sense for the FDA to be arbiters of security, now the FDA also has to assess the security adequacy of each device given its clinical risk context,” says Carmody. “And because they are also part of the healthcare supply chain, their job, and first priority, is healthcare, not security. When push comes to shove, clinical wins.”

That said, the federal government has tried to address medical device cybersecurity for years. Most recently, the FDA appointed Kevin Fu, a University of Michigan associate professor and security advocate, to a newly created leadership position to oversee medical device security. In an interview with MedTech Dive, Fu said the FDA seeks to require that: ʯ Devices have the capability to be updated and patched in a timely manner. ʯ Premarket submissions to FDA include evidence demonstrating the capability from a design and architecture perspective for device updating and patching. ʯ Manufacturers phase in a Cybersecurity Bill of Materials [also referred to as a Software Bill of Materials, or SBOM], that is, a list that includes 40

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commercial, open source, and off-the-shelf software and hardware components that are or could become susceptible to vulnerabilities. ʯ Device firms publicly disclose when they learn of a cybersecurity vulnerability.

‘It takes a village’ “It is important to remember that in the cybersecurity world, ‘it takes a village,’” Peter Wyner, chief information officer for CME Corp., told Repertoire in an email.

“It is essential that manufacturers provide capabilities for any connected medical device to be updated as the threat landscape evolves, but it is equally important that they perform regular penetration testing on their devices, provide timely patches when required, and communicate in a clear, concise, and expeditious manner with their customer and distributor communities when such patches are required.

“Distributors have a role to play propagating information regarding vulnerabilities to their customers when they are notified by manufacturers,” he continues. “CME sees our role as that of trusted partner with many of the country’s largest healthcare providers. We strive to provide information to our customers as it is communicated to us from our vendor partners, and to broker communications between end user and manufacturer when needed.

“End users have probably the most vital role of all – maintaining accurate inventory management and patch management programs to ensure that EVERY device can be located and patched when required. CME can help customers large and small with both periodic and realtime inventory management solutions.”

“Security of a medical device is a joint venture between manufacturers and providers,” Chad Waters, senior cybersecurity engineer, Device Evaluation Group at ECRI, told Repertoire in an email. “Manufacturers should provide the information to assist in the minimizing of risk. This would include security questionnaires and security implementation guidance. Manufacturers should also be moving away from the notion of a medical device as a black box and have transparency about what is being connected to a provider’s environment.

“Some larger providers are already requiring SBOMs during the procurement process. As tools are developed to assist providers in analyzing SBOMs the requests will become more common throughout the sector. Manufacturers should incorporate SBOM generation into their product development processes going forward. Going back afterwards may require more resources.”

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Medtronic brings business continuity preparedness and supply chain resiliency to ASCs

Business continuity plans and supply chain resiliency have taken on even more importance in healthcare settings after the COVID-19 pandemic swept over the world. Ambulatory surgical centers (ASCs) are no exception.

As healthcare spending shifts to outpatient care in the U.S. and ASCs steadily grow, it’s essential for these sites to have a comprehensive business continuity approach and plan elements. A partnership with a medtech company like Medtronic, a global leader in medical technology, services and solutions, can help ASCs respond to business interruptions and supply chain disruptions.

The smaller size of ASCs and just-in-time inventory models leave them particularly vulnerable to supply constraints, and their lower overhead doesn’t allow for investment in risk management, leaving them blind to what could impact them. That’s where Medtronic’s end-to-end value streams can provide benefits to ASCs.

“We have invested heavily in building our own supply chain resilience to best support our customers and the delivery of products to the patients that need them, when they need them,” said Joe Robinson, Medtronic Senior Director, Enterprise Risk & Continuity.

“We prioritize patient procedures when products are on allocation, ensuring

appropriate patient outcomes over larger volume customers.”

Medtronic can provide inventory management services to ASCs, allowing for closer integration of its supply chain with them and extending the scale and experience of its supply chain planners and its distributor partners to ASCs. www.repertoiremag.com

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“Supply chain resilience is about having options and Medtronic-managed inventory has far more options than an individual ASC can create on its own,” Robinson added.

Medtronic has an enterprisewide commitment, including a Business Continuity Management (BCM) program, that increases operational resilience. The company prioritizes business continuity planning for key internal and supplier locations that support major product families.

They prosper when they have key partners like us.”

Medtronic has established response priorities, escalation periods, communication plans and alignment with regulatory agencies designed to minimize employee and business impact. Its site and corporate crisis management teams are trained to mobilize quickly to ensure health and safety, protect assets, limit environmental impact and effectively coordinate a crisis response.

“ We are all aware of global events disrupting supply chains, and at Medtronic we are investing in our own resilience to deliver on our Mission and ensure our customers’ future success.”

– Joe Robinson, Medtronic Senior Director, Enterprise Risk & Continuity

This includes on-site BCM managers and supply risk management teams that lead business continuity risk assessment and evaluation, identify inventory positions, and help implement other riskmitigation solutions on an ongoing basis. Additionally, dual manufacturing for a select number of key products in separate facilities in different geographies with similar capabilities, and strengthening existing critical, hurricane-prone facilities and upgraded infrastructure to reduce vulnerabilities.

“We are all aware of global events disrupting supply chains, and at Medtronic we are investing in our own resilience to deliver on our Mission and ensure our customers’ future success,” Robinson said. “ASCs are significantly increasing patient access and driving down costs, but they can’t meet all patient expectations alone.

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Optimizing patient outcomes through medical staff education and training But ultimately, it’s about optimizing patient outcomes. Medtronic provides education and training opportunities for medical staff at ASCs to meet those needs. It identifies critical products and services and locations that support them.

“That often leads to discussion around effective outcomes at various sites of service,” said Adam King, Medtronic Senior Director, Enterprise Accounts Specialty Channels. “Most of our physician key opinion leaders know of, or already perform, procedures in the ASC space and can provide insights for their peers. We are also sharing insights so that the physicians can make the most informed decision about the ‘right patient at the right place and time.’”

Medtronic has established specific approaches to ASCs through its Key Opinion Leader (KOL) advisory panels. They bring together both Medtronic product users and nonusers for a complete understanding of the market.

“We use these panels to gain insights into trends and identify new opportunities,” King said. “For example, these panels have provided input that spurred the creation of the Customer Choice Directed Rebate program that helps facilitate capital equipment acquisitions essential for ASCs.” Advisory panels have also provided Medtronic with insight to critical needs that vary from the acute care space to the ASC, such as financial payment flexibility and having one centralized resource center that spans the Medtronic portfolio.

“With our unrivaled portfolio breath, we launched a comprehensive digital solution for physicians and administrators to make it easier to find what they need from us with just a few clicks,” King concluded.

Medtronic also has Therapy Awareness Programs (TAP) that help physicians understand their overall market for patient referrals through digital assets and educational videos.

The company also provides reimbursement support for various procedures like coding basics for billing and support on prior authorization.

Medtronic’s training and education courses are designed to help individuals at all experience levels learn more about emerging technologies and innovative solutions.

Its workshops are focused on raising therapy awareness and building skills of healthcare professionals to improve patient outcomes.

To learn more, go to: Medtronic.com/asc.

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Home is Where the Heart is Home-based BP monitoring is on the rise You may have seen alarming headlines last September about a decline in blood pressure control in recent years.

Authors of a study in the Journal of the American Medical Association reported that the proportion of the population with controlled blood pressure dropped to 43.7% in 2017-2018. It had increased from 31.8% in 1999-2000 to 48.5% in 2007-2008, and remained stable through 2013-2014 (53.8%). And the decline preceded the pandemic, when in-office visits (and in-person BP checks) dropped precipitously.

Some experts argue with the study’s methodology, but hypertension is of concern to all. Educating people about the risks of hypertension and how to avoid or monitor it remains Public Health Step No. 1. Making sure that health professionals in doctors’ offices take blood pressure readings correctly is Step No. 2.

But increasingly, home BP monitoring is becoming Step No. 3. Ambulatory blood pressure monitoring continues to be the gold standard, but at-home units, including wearables, are playing a bigger role in BP monitoring today.

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Home monitoring Even as far back as 2008, there existed widespread agreement on the efficacy of home blood pressure monitoring.

“It is recommended that [home blood pressure monitoring] should become a routine component of BP measurement in the majority of patients with known or suspected hypertension,” read a Joint Scientific Statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association.

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TRENDS In 2017 and 2018, guidelines by the American College of Cardiology/American Heart Association and European Society of Cardiology/European Society of Hypertension recommended the use of out-of-office blood pressure measurements to confirm the diagnosis of hypertension and avoid white coat hypertension (said to occur when blood pressure readings at the doctor’s office are higher than they are in other settings, including the home).

Self-monitored BP could prevent false-positive diagnoses of about 420 patients in a population of 1,000, and avert unnecessary treatment of some 221 people per 1,000, reported the authors of a study published this summer in PLOS One. “When scaled to the U.S. population, adoption of SMBP would prevent nearly 16.5 million FP [false-positive] diagnoses, and 8.2 million unnecessary treatments,” the authors wrote.

“Self-monitoring should be the primary mode of measuring blood pressure,” says Issam Moussa, M.D., MBA, professor and head of the Department of Clinical Sciences at the Carle Illinois College of Medicine at the University of Illinois. White coat hypertension is one reason, says Moussa, who is co-chair of the American College of Cardiology’s Digital Health and Devices Work Group. The second reason is that BP is most accurately gauged over the course of multiple measures, not just one office reading. “Self-monitoring is essential,” he says.

Tom Schwieterman, M.D., vice president of clinical affairs and chief medical officer for Midmark, says that studies have demonstrated that at-home BP – despite a relative lack of control over the way the blood pressure measurement is taken (which is a key consideration) – is a valid measurement that helps identify key aspects of BP control, including identifying individuals with falsenegative or false-positive BP elevation at the clinical point of care.

“For false negatives, some patients may have ‘masked hypertension,’ where the BP measurement is artifactually normal at their provider’s office, but high at home,” Schwieterman told Repertoire in an email. “For false-positives, patients may have had their BP taken incorrectly or have ‘white-coat hypertension,’ where the healthcare environment induces short-term elevations that are absent when BP is taken in the comfort of the home.

“It is also useful to employ home readings to monitor patients during the third or fourth decade of life to see if they are trending toward unhealthy BP elevations between visits, which can be spaced years apart if there are no pre46

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existing issues,” he adds. “Wearables, home monitors and even pharmacy devices can be very useful in determining where a ‘patient lives’ with respect to their real-life BP. This can make a big difference in what pharmaceuticals are used, what doses are needed, and even when those medications should be taken.”

Ambulatory BP monitoring devices remain the gold standard in determining the true pattern and level of elevation for patients with BP issues (high or low), Schwieterman says. “With very little human intervention and the unique opportunity to achieve BP measurements while the patient is asleep or even driving, an ABPM unit captures rich serial data that is useful to correctly map the true physiology.”

Even so, he sees wearables as becoming a normal part of a patient’s home-care routine and a data contribution to every doctor visit. “It is that valuable.”

All in the wrists Thirteen years ago, the most commonly used homebased monitors were those placed on the upper arm and self-inflating. But the use of wrist monitors was already growing, used by 22% of patients who owned monitors at the time, according to the 2008 Joint Statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association.

If we could demonstrate that wearables are as reliable as traditional cuff devices, they would be preferred. But studies need to demonstrate their reliability.

Today, consumers can find wearables and fitness trackers on Amazon, though these are not certified medical devices. One significant example of the technology stepping up comes from a recent update to the Samsung Health Monitor app, reports TechRadar.

The update allows the user to use the PPG (photoplethysmography) sensor already in the Samsung Galaxy Watch 3 or Galaxy Watch Active to take a blood pressure reading.

Medical professional organizations such as the American College of Cardiology are embracing home-based wearables for blood pressure control. In June 2020,

TRENDS ACC and Heartbeat Health, a New York City-based virtual care company, announced a smartphone program in which key metrics – e.g., BP changes or volume status in heart failure – are transmitted in real-time to cloudbased artificial intelligence engines, which flag potential health risks for clinicians.

‘Wearables, home monitors and even pharmacy devices can be very useful in determining where a ‘patient lives’ with respect to their real-life BP.’ “To truly transform cardiovascular care and improve heart health, we must incorporate data, remote patient monitoring and outcome tracking in an easy-to-use format both the patient and the physician can use to inform shared decision-making,” John Rumsfeld, MD, PhD, FACC, ACC chief science and quality officer and chief innovation officer, was quoted as saying. “Wearable

health monitoring devices have evolved rapidly over the last five to 10 years and are now widely available; COVID-19 is a catalyst to push remote patient monitoring into the virtual care workflow.”

In June 2021, ACC and cliexa, a Denver-based start-up focused on remote patient monitoring, collaborated to launch a home health monitoring program called cliexa-Pulse, which allows clinicians to track symptoms, medications and daily activity for the management of hypertension, atrial fibrillation, heart failure and other cardiovascular conditions.

The limits Wearables may be improving every day, but some believe more study is necessary. The American Heart Association currently recommends that blood pressure readings be taken only from the upper arm. Other places, like the wrist or finger, might not be as accurate, according to the AHA. In a recent TechRadar article, Ghalib Janjua, a lecturer in electronic and electrical engineering at Robert Gordon University, Scotland, warned that cuffless monitors are limited in accuracy and require calibration against the sphygmomanometer devices.

The JAMA study in perspective In September 2020, authors of a study in the Journal of the American Medical Association reported that the proportion of the population with controlled blood pressure dropped to 43.7% in 2017-2018. It had increased from 31.8% in 1999-2000 to 48.5% in 2007-2008, and remained stable through 2013-2014 (53.8%). Experts believe the study must be put in its proper context.

The reported decrease in BP control was anticipated, says Tom Schwieterman, M.D., vice president of clinical affairs and chief medical officer for Midmark. In December

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2013, the eighth Joint National Committee (JNC 8) recommended higher BP goals for some adults compared with the previous guidelines, he told Repertoire in an email. “Five authors of the new guideline predicted the reported decrease, noting that the higher BP goal would result in reduced intensity of antihypertensive medication use. Under the later guideline, certain populations were determined to need more strict BP goals to achieve optimal clinical outcomes. In many respects, this shift incurred a higher percentage of individuals deemed not in control by the new standard.

www.repertoiremag.com

“Despite it having been expected, I do think that having less than 50% control, no matter the guideline used, is cause for alarm.”

Issam Moussa, M.D., MBA, professor and head of the Department of Clinical Sciences at the Carle Illinois College of Medicine at the University of Illinois, warns that studies done retrospectively, as the one reported in JAMA, are always subject to limitations. In this case, patients were seen only one time.

“One of the main premises [of blood pressure measurement] is, there needs to be multiple

visits,” said Moussa, who is co-chair of the American College of Cardiology’s Digital Health and Devices Work Group. “I don’t believe the results of this study are definitive enough to build an unequivocal conclusion.”

Other factors were at play as well, including the fact that the definition of what constitutes hypertension changed during the study period.

“Having said that, we know that blood pressure control varies among different populations, regions, health insurance plans, compliance, patient profiles, and treating institutions.”

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Armstrong 4.

Armstrong DG, DG, Nguyen Nguyen HC, Lavery LA, B, LA, van van Schie Schie CH,KA. CH, Boulton Boulton AJ, foot Harkless AJ, Harkless LB. Off-loading LB. Off-loading the the diabetic diabetic foot foot wound: wound: a randomized a randomized clinical clinical trial. trial.

Diabetes Diabetes Care.

Care.

2001;24(6):1019-1022.

2001;24(6):1019-1022.

Fife 3.

Fife CE, CE, Carter Carter MJ, MJ, Walker Walker D,HC, Thomson D,Lavery Thomson Eckert B, Eckert KA. Diabetic Diabetic foot ulcer ulcer off-loading: off-loading: TheThe gap gap between between evidence evidence andand practice: practice: DataData from from the the U.S. U.S. Wound Wound Registry.

Registry.

Advances Advances in Skin in Skin andand Wound Wound Care.

Care.

2014;27(7):310-316.

2014;27(7):310-316.

Armstrong 4.

Armstrong DG,DG, Nguyen Nguyen HC,HC, Lavery Lavery LA, LA, van van Schie Schie CH,CH, Boulton Boulton AJ, Harkless AJ, Harkless LB. Off-loading LB. Off-loading the the diabetic diabetic footfoot wound: wound: a randomized a randomized clinical clinical trial.trial.

Diabetes Diabetes Care.

Care.

2001;24(6):1019-1022.

2001;24(6):1019-1022.

ForFor more more information information or or toto place place anan order, order, please please contact: contact: ForFor more more information information or or toto place place anan order, order, please please contact: contact: USA USA 800-654-2873 800-654-2873 888-980-7742 888-980-7742 faxfax USA USA 800-654-2873 800-654-2873 888-980-7742 888-980-7742 faxfax integralife.com integralife.com integralife.com integralife.com n

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MediHoney, MediHoney, TCC-EZ, TCC-EZ, Integra, Integra, andand thethe Integra Integra logo logo are are registered registered trademarks trademarks of Integra of Integra LifeSciences LifeSciences Corporation Corporation or its or subsidiaries its subsidiaries in the in the United United States States and/or and/or other other countries. countries. ©2020 ©2020 Integra Integra LifeSciences LifeSciences Corporation.

Corporation.

All rights All rights reserved. reserved.

1499264-2-EN 1499264-2-EN MediHoney, MediHoney, TCC-EZ, TCC-EZ, Integra, Integra, and and thethe Integra Integra logo logo are are registered registered trademarks trademarks of Integra of Integra LifeSciences LifeSciences Corporation Corporation or its or subsidiaries its subsidiaries in the in the United United States States and/or and/or other other countries. countries. ©2020 ©2020 Integra Integra LifeSciences LifeSciences Corporation.

Corporation.

All rights All rights reserved. reserved.

1499264-2-EN 1499264-2-EN

TRENDS Says Moussa, “If we could demonstrate that wearables are as reliable as traditional cuff devices, they would be preferred, because the patient could get blood pressure any time, including during exercise. But studies need to demonstrate their reliability.”

And, as with so many IoT devices, there’s the challenge of integrating the influx of patient-generated data into the physician practice’s workflow, so the information is actionable.

COVID-19 is a catalyst to push remote patient monitoring into the virtual care workflow.

“This is a critical concern, as physicians have no shortage of data available to make decisions,” says Schwieterman. “Today’s workflow in a typical office does not provide adequate time nor methods of data review for chronic patients to allow this important clinical activity.

“With the rise of value-based care reimbursement, where financial success for the clinical team is tied to

success in disease care, and because of its centrality to both clinical and financial success, I do anticipate future workflow priorities changing to create time in the day for these activities. As of today, however, this shift has not occurred, and most clinicians are doing the best they can to review self-reported data, often while the patient is in the exam room for a checkup or during a telehealth visit.”

Clinicians are still the key Million Hearts® 2022 is a national initiative co-led by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services whose goal is to prevent 1 million heart attacks and strokes within five years. The program holds that self-monitoring of blood pressure + clinical support = lower hypertension rates, and it recognizes physician practice “Champions” that have used the program to improve their patients’ health.

According to the initiative’s leaders, public education campaigns can encourage patients to monitor their blood pressure at home, but clinician support is critical for empowering patients, training them on proper measurement techniques, monitoring home readings, and providing timely advice on medication titrations and lifestyle changes.

Seven steps for self BP measurement The American Medical Association recommends that physicians implement seven steps to improving self blood pressure measurement (SMBP) among their patients: 1. I dentify patients suited for SMBP (e.g., those with an existing diagnosis of hypertension, or those suspected of having it).

3. Educate patients on proper preparation and positioning before taking measurements, as well the need to rest one minute between measurements.

2. Make sure patients have automated, validated devices with appropriately sized upper arm cuffs. (Use the US Blood Pressure Validated Device Listing and self-measured blood pressure cuff selection.)

4. Instruct the patient to conduct SMBP monitoring whenever BP assessment is desired. Provide instructions on the frequency and duration of monitoring and the number of measurements to take each day. Determine when and how patients will share results back to care team.

5. Compute and document average SMBP measures received from patients for monitoring period.

6. Interpret results, then initiate, intensify or continue treatment.

7. Document treatment and follow-up plans and communicate to patients.

Confirm their agreement and understanding.

Source: American Medical Association, www.ama-assn.org/system/files/2020-06/7-step-smbp-quick-guide.pdf

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brewercompany.com

We Help Healers Heal Patient dignity. Provider comfort & well-being. We proudly build products designed to advance both.

4 reasons you should always include a quote from Brewer LOADS OF VALUE

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far more in value, at a price point that is at or below other brands. Your customer will love the lower cost of ownership, while you enjoy better margins.

Exam rooms continue to get smaller.

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Safety grab bars, pass-through work surfaces, seamless upholstery and additional storage can add hundreds or even thousands of dollars to the price of each exam table. Our Access Power Exam Table includes them for free.

Repairs can be costly. Your customer wants peace of mind. Brewer power exam tables come with a 3 year warranty, that’s up to three times longer than competitive tables.

The next time you have a great opportunity, let us give your customer a live demonstration.

Contact your Brewer representative or call (888) 273-9371.

MARKETING MINUTE

How Qualified Web Traffic Improves Sales in Healthcare

By Scott Adams

Content marketing is creating online content that

Gain Qualified Web Traffic

leads to sales. However, it’s pointless without a return on investment (ROI). That means you want to be making more money from sales than you are putting into marketing. Here is the basic strategy of content marketing, known as the sales funnel: ʯ Attract web traffic ʯ Turn the traffic into leads ʯ Convert the leads into sales

Here are three ways to customize your content and gain qualified web traffic that double your sales.

However, qualified web traffic, or visitors who are likely to turn a sale, takes out the middle step – giving you a straight line from your web traffic to sales. This means less work for you and more sales for your team.

The Benefit of Website Traffic for Medical Suppliers Your website traffic is the people visiting your site.

Your goal is to make a sale from that traffic. You can generate this traffic by creating content that ranks well in searches, shows up through paid ads, or shares on social media.

The problem is, not everyone who visits your site ends with a sale. You could spend thousands of dollars to gain traffic, but if none of that traffic includes healthcare companies, the traffic is pointless. It would be equal to owning a pet store, but only non-pet owners visit your store.

Web traffic isn’t enough for generating sales. But, by customizing your content and marketing techniques, you can rank higher for people who may make a purchase instead of ranking highly in general searches. These potential leads are called qualified web traffic.

No. 1: Create Lead-Specific Content. Your content is at the top of your marketing funnel. It’s what attracts leads to your website. If you want only to attract qualified traffic versus all traffic, gear your content towards your audience.

You can target your content by addressing a specific audience (like this article addresses medical suppliers), using relevant market research, and covering healthcare trends. This strategy appeals to the interests of your target audience and positions you as an expert in their field.

No. 2: Optimize Your Content for Healthcare Professionals. When you optimize your web content, you can target a specific audience. For example, if you want healthcare professionals to find your website in their searches, create headlines and content using standard healthcare search terms. Regular SEO research tells you common searches.

You may gain a large amount of traffic by using standard search terms. But, by taking the extra time to know what healthcare professionals specifically want and need, you can narrow your search focus to qualified leads.

No. 3: Link to Relevant Articles. Whenever you create web content, use links to gain exposure both in searches and within other sites. For example, healthcare providers will learn to associate your brand with healthcare supplies by linking to other relevant medical websites. Nearly 74% of websites will receive a reciprocal link. So with that in mind, when you link to those popular websites, you are leading qualified traffic back to your site through those reciprocal links.

To read the full article (which includes more ways to gain web traffic), visit https:// sharemovingmedia.com/how-qualified-web-traffic-improves-sales-in-healthcare.

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4-Stage ULPA Filtration

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Delivering the highest quality of care, together Supporting you and your non-acute customers at each step BD and MTMC have joined forces to serve you better. Presenting a comprehensive portfolio of medication delivery solutions—BD PosiFlush™ Pre-filled Saline Syringes, BD™ Port Access Kits and Huber Needle Sets, BD PureHub™ Disinfecting Cap, BD PhaSeal™ Optima System and BD ChloraPrep™ Patient Preoperative Skin Preparation with Sterile Solution. Backed by robust sales support and hands-on clinical experience. So you have everything you need to expand quality healthcare access to non-acute care settings, and empower your customers to improve outcomes and efficiency.

Discover the difference we can make together Contact your local MTMC partner or reach BD directly at Customer_Support@BD.com or 888.237.2762 BD, the BD Logo, ChloraPrep, PhaSeal, PosiFlush, PureHub and SafeStep are trademarks of Becton, Dickinson and Company or its affiliates. MTMC is a trademark of MedTech/ MedCare, LLC. © 2021 BD. All rights reserved. BD-40993 (08/21)

Promote consistency of care AllPoints™ Port Access System

BD™ Port Access Kits

• Components are presented in a step-by-step, sequential layout that may promote consistency of care • Masks, gloves, hand sanitizer and an absorbent towel are included to assist clinicians in maintaining sterile technique • Sterile field accommodates a variety of workspace environments

• The market leader in an all-inclusive port access kit that includes an infusion needle • Designed to follow industry guidelines for accessing a patient’s implanted port • Allows for consistency of care while engaging in best practices and meeting compliance needs with every procedure

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BD, the BD Logo and AllPoints are trademarks of Becton, Dickinson and Company or its affiliates. © 2021 BD. All rights reserved. BD-36833 (06/21)

SPONSORED

DALE

Clinical Guidelines Support the Use of Dale® Hold-n-Place® Catheter Securement Keeping catheters secure is critical to nurses and their patients.

Proper catheter securement reduces the risk of infection, protects healthcare workers from the risk of accidental needlestick, and increases patient comfort and satisfaction.

Clinical guidelines support the use of sutureless catheter securement devices like Dale Hold-n-Place Catheter Securement to help keep catheters in place.

A report from the U.S. Centers for Disease Control and Prevention says: “Catheter stabilization is recognized as an intervention to decrease the risk for phlebitis, catheter migration and dislodgement, and may be advantageous in preventing CRBSIs (catheter-related bloodstream infections).” 1 The report also notes that using a sutureless securement device mitigates the risk of sharps injury to the healthcare provider.

The Occupational Safety and Health Administration (OSHA) suggests that sutureless securement devices can be a safe alternative to sutures or tape. Its fact sheet on securing medical catheters states: “Appropriate products and effective work practices are essential to provide increased catheter stability. Such products and work practices may reduce catheter dislodgment and the

necessity of reinsertion with its associated needlestick risk.” 2 Dale Hold-n-Place Catheter Securement is designed specifically to keep the catheter positioned at the optimal insertion angle and to accommodate each patient. It provides superior securement for both horizontal and vertical line pulls.

In addition to its health and safety benefits, Dale Hold-n-Place can significantly improve patient comfort and satisfaction. It offers a soft, flexible design with no hard plastic parts. Hypoallergenic, breathable material is gentle on the skin and contains no latex, reducing the risk of allergic reactions and skin irritation. In addition, it allows visibility to the insertion site.

The issues associated with improperly secured catheters can increase nursing time and disrupt the caregiving process. Dale Hold-n-Place can help to improve the patient experience while enabling nurses to focus their attention on optimal patient care.

Dale Hold-n-Place can help: ʯ Reduce infection risk ʯ Protect against accidental needlestick ʯ Increase patient comfort and satisfaction ʯ Meets the Infusion Nurses Society guidelines for an Adhesive Securement Device (ASD) ʯ CDC and OSHA guidelines support the use of sutureless catheter securement devices like Dale Hold-n-Place

www.dalemed.com

’Grady, N., Alexander, M., Burns L., et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Centers for Disease Control O and Prevention, U.S. Department of Health and Human Services: 2011.

2 U.S. Occupational Safety and Health Administration (OSHA): OSHA Fact Sheet: Securing Medical Catheters. 2004.

1

Dale and Hold-n-Place are registered trademarks of Dale Medical Products, Inc. ©2020 Dale Medical Products, Inc. All rights reserved.

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Product Education

At Dale, we’re always focused on making things better. Always better performance. Always better value. Quality that’s always better for patients. Personal service that’s always better for practitioners.

From our founding in 1961, Dale has worked to make products that help make health care better, with lower infection rates, more efficient use of time, increased patient satisfaction and greater cost accountability.

Never accept less than the best.

Choose Dale.

Visit the Virtual Dale Medical Center to see our products by specialty

dalemed.com/virtual-tour/index.htm

Always Reach for Something Better Visit dalemed.com for more information Dale is a registered trademarks of Dale Medical Products, Inc. ©2021 Dale Medical Products, Inc. All rights reserved. AD-104 Rev A

NEWS

Putting a RelationshipDriven Industry to the Test Recent NDC Podcast examines how the pandemic is challenging the healthcare supply chain’s traditional interactions The healthcare supply chain is built on the relationships of distributors and sales representatives. The COVID-19

pandemic has created a series of unique challenges for an industry that relies so heavily on networking, relationshipbuilding, and other general face-to-face interactions. Your organization’s ability to be flexible and pivot during times of uncertainty is instrumental to staying relevant in an evolving market. Recently on a Parcels of Info podcast, Steve Martin, senior vice president of Supplier Management at NDC, and Jack Moran, managing partner at MTMC, discussed the challenges and opportunities of working in a relationship-driven industry during a pandemic.

Testing relationships in a pandemic Because the healthcare supply chain is built on a foundation of business relationships, the COVID-19 pandemic created challenges in cultivating and maintaining those relationships. Martin said he was used to having manufacturing and supplier partners visiting his NDC team on a regular basis. “There were a litany of reasons why getting together has made sense in the past,” Martin said. “This past year, all of those have gone away, along with the opportunity to develop a relationship outside of business.”

Fortunately, if you had already built relationships in the healthcare supply chain, the pandemic forced you to rely on them to avoid any business disruptions. Martin said, “One of the few positive aspects has been seeing how all those great relationships have been so beneficial in pivoting change in the way that we have operated in the pandemic. We leveraged these relationships to more quickly respond and change the way we do business.”

Moran discovered an efficiency in those relationships that allowed his team at MTMC to respond quickly to the pandemic. “For any newer relationships that didn’t run as deep, there were more inefficiencies and a lot of lost time. It was harder to develop new relationships with other companies because you didn’t have that foundation of time and trust.”

Post pandemic in the healthcare supply chain The pandemic helped to reveal that technology allows employees in a lot of industries to work remotely, giving them greater flexibility and better work-life balance.

The healthcare supply chain is going to continue to rely 58

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on those technologies and tools to avoid any further disruptions. But what’s next for building relationships in the post-pandemic world?

Moran said he believes that we will continue to leverage these virtual tools for remote work and meetings. “I think we anticipate that the old way we conducted business with customers will go back to some degree. Maybe not at the same pace or level. Everybody has gotten better with technology, making virtual work more possible. I don’t think that’s going away.”

The importance of relationships moving forward Even with all the changes that the pandemic enforced on the healthcare supply chain, it’s important to remember that the need for those relationships is not going anywhere. If anything, building solid relationships is more important now than ever before. “I would never have gotten to where I am today without the key relationships that I was lucky enough to build along the way that have led me to 25 years in this industry,” Martin said.

Those relationships are crucial to the success and stability of your supply chain. Without that process in place, your organization could lose its competitive edge. Moran said, “Over the years, I have met or worked with people who have come from outside the industry. They’re either working for a supplier or they are new to the industry.

And they either get it or they don’t. Some of them will take a very short term and transactional view of the relationships they are building. Typically, they don’t last very long. Others embrace it, and thrive in this industry.”

Let’smake makeaapositive positive Let’s Let’s make a positive impact together. impact together.

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DUKAL DUKAL can can be be aa strong stronglong longterm termpartner partnerfor foryou you DUKAL can be a strong long term partner for you in in the the personal personal protection protectionequipment equipmentcategory. category.

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We are continuously investing in our capabilities and capacity to bring high quality personal protection We are continuously investing in our capabilities and capacity to bring high quality personal protection equipment topersonal front-line workers.

Our PPE products meet or exceed all FDA requirements, holding multiple We are continuously investing in our and capacity to bring personal protection in the protection equipment category. equipment to front-line workers.

Ourcapabilities PPE products meet or exceed allhigh FDAquality requirements, holding multiple 510k’s for surgical masksworkers. and N-95 respirators.

DUKAL also AAMI levelrequirements, rated isolation gowns.multiple equipment to front-line Our PPE products meet oroffers exceed all FDA holding 510k’s for surgical masks and N-95 respirators.

DUKAL also offers AAMI level rated isolation gowns.

We arefor continuously investing in ourrespirators. capabilitiesDUKAL and capacity to bring personalgowns. protection 510k’s surgical masks and N-95 also offers AAMI high levelquality rated isolation Let’s make atopositive impact together.

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As a leader in the development and manufacturing a leader in the development andhealthcare manufacturing ofAs medical products we partner with As a leader in the development and manufacturing of medical products partner with healthcare professionals to launchwe innovative solutions to unmet of medical products we partner with healthcare professionals clinical needs. to launch innovative solutions to unmet professionals to launch innovative solutions to unmet needs.

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HIDA GOVERNMENT AFFAIRS

The U.S. Must Adopt a Policy to Diversify Manufacturing and Sourcing of Critical Medical Supplies

By Linda Rouse O’Neill, HIDA VP of Government Affairs

The COVID-19 pandemic has driven unprecedented

worldwide need for virus-fighting medical supplies. This surge in demand has pushed the U.S. to reconsider its heavy reliance on global sources to produce necessary healthcare equipment such as PPE. In the beginning of the pandemic, factories in China and Malaysia shut down due to worker illness caused by the virus. Concurrently, many employees were on holiday celebrating Lunar New Year. Overseas 60

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factories were slow to restart, but even as they began to ramp up again by manufacturing gloves, gowns, and masks, many U.S. healthcare providers and their trusted distributor partners had challenges in securing quality product. Countries around the globe clamored for the same supplies and raw materials while opportunistic brokers – both domestic and foreign – injected themselves into the supply chain, oftentimes pushing fraudulent goods.

CLINICAL SCALES

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DETECTO has been in the manufacturing business for 120 years supporting our distribution reps with high-quality medical products and first-class customer support. With a storied history and active R&D department, tradition meets technology every day at DETECTO. As we turn the corner on this pandemic, here’s to the next 120 years of working together!

Interested in Learning More?

Contact MedPro, DETECTO’s New Nationwide Manufacturer Representation

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HIDA GOVERNMENT AFFAIRS Fast forward to summer 2021. COVID vaccines are available and overseas factories are buzzing with production. But the highly contagious Delta variant is spreading quickly and shipping challenges have clogged the world’s ports, including the busiest in the U.S. The trucking and rail industries are also challenged with worker shortages and container backlogs. These logistical challenges have led to higher costs and longer wait times for medical supplies. The bottom line is that U.S. reliance on global sources has impacted supply chain resilience. The pandemic highlighted the need for diversity in sources for pandemic medical supplies, including building domestic manufacturing capability in the U.S.

HIDA supports domestic and nearshored manufacturing to augment global sources HIDA supports expansion of domestic and nearshored manufacturing capacity for critical products to augment global sources. Leveraging the strength of U.S., regional, and global manufacturing locations will lead to the highest level of supply chain resilience at the lowest overall cost.

These policies should apply to all products important for pandemic response including personal protective

equipment, testing supplies, needles and syringes, and infection prevention products.

Domestic production is often more expensive than global sources and can’t always be supported through normal market commerce. The U.S. government will need to support and fund a diversified sourcing strategy in partnership with the private sector.

HIDA recommends the following solutions: 1. Prioritize companies with experience in healthcare – Manufacturing medical grade products requires specialized expertise and capability. Companies selected to receive government support to onshore production must have an extensive track record of meeting FDA-quality standards for medical grade products.

2. Leverage the established public/private partnerships – The private sector is already actively ramping up investments in U.S. manufacturing. Government incentives and commercial market investments should complement and reinforce each other in a comprehensive plan that includes assessment of onshoring viability and meaningful incentives.

3. Establish a national sourcing strategy – Increasing U.S. manufacturing of critical medical supplies will help establish capacity to quickly ramp up medical supply production. A national strategy should enable U.S. surge manufacturing capabilities and prioritize transportation of PPE and other pandemic supplies across the nation.

Supplies must be easily and readily accessible to the nation’s 500,000 provider sites.

4. Support the long-term commercial viability of domestic manufacturing – Payment and trade policies can be used to provide a consistent demand signal to the commercial market for long-term viability. Policies should include direct procurement, trade agreements, reimbursement, subsidies, an idle manufacturing strategy, and thoughtful federal government purchases that don’t disrupt the supply chain.

Fostering diversified sourcing is a key component of HIDA’s comprehensive framework for building a more robust pandemic response infrastructure.

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SALES & MARKETING SUMMIT

100% Virtual Education Conference

November 16-17, 2021

If you’re a healthcare salesperson, or you lead a sales team, plan now to attend HIDA’s first-ever Sales & Marketing Summit.

It’s your opportunity to hone your knowledge and skills for succeeding in today’s quickly-evolving healthcare market.

Who Should Attend

How You’ll Benefit

The HIDA Sales & Marketing Summit will benefit sales and marketing professionals from healthcare distributors, manufacturers, group purchasing organizations, and technology companies, including:

• Gain insights on market trends and opportunities in a post-COVID world

• Sales reps • Sales managers • National accounts executives

• Advance your sales skills and strategy • Understand changing customer needs • More effectively engage and persuade executive-level decision-makers • For team leaders: better prepare your team for today’s customer challenges, and hone your own management skills

• Customer service professionals • Marketing leaders

Gain Expert Insights This interactive event will cover hot topics including: • Seeing Is Believing: Using Video To Supercharge Sales • Understanding Providers’ Post-Pandemic Priorities • 5 Ways To Make Your E-Commerce Website More User Friendly • Navigating GPO Relationships To Grow Sales • Optimize Commercial Targeting and Engagement With Product-Level Sales Data • Getting The Most From Your PIM Platform • Using Your Reimbursement Knowledge to Advance Customer Decisions • Talking to Customers About Self-Distribution • And more!

Register Now! For more information visit HIDA.org/sales-marketing-summit

SPONSORED

BD

BD’s new combined COVID-19 & Flu Assay Preparing for the upcoming respiratory season BD is prepared for whatever respiratory season may lay ahead. With the addition of the company’s newest combined

COVID-19 & Flu assay, BD is building a robust inbound pipeline for all five of the BD VeritorTM Plus assays so customers can meet the needs of their communities.

While COVID-19 testing should remain a priority for healthcare providers during the 2021-2022 flu season, the CDC has predicted that “reduced population immunity due to lack of flu virus activity since March 2020 could result in an early and possibly severe 2021-2022 flu season.” Additionally, the CDC has warned providers that it has observed concerning levels of RSV developing in the U.S. South.

The symptoms of influenza and COVID-19 are nearly identical, which can be a challenge to diagnose based solely on clinical presentation.

Launched in August, BD’s combined SARS-CoV-2 & Flu A+B assay provides three results from a single sample on one assay, all in just 15 minutes. The assay, available for the BD VeritorTM Plus Analyzer, can help clinicians to quickly and clearly differentiate between COVID and influenza as we enter the new respiratory season.

The newly expanded testing menu for the BD VeritorTM Plus System allows caregivers to easily bring in additional tests without a tremendous learning curve because the workflows are all so similar. Best of all, the Analyzer provides clear, unambiguous digital results, eliminating interpretation and enabling accurate diagnosis and treatment.

BD has recently partnered with ImageMover, a result management 64

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companion app that allows caregivers to input and manage patient records, notify patients of their results, and automatically report SARS-CoV-2 results to state health authorities. BD is providing complimentary access to all BD VeritorTM users.

The great thing about BD VeritorTM is its simplicity and versatility. From the ER to a school nurse’s office, and everywhere in between, the system provides reliable, rapid results onsite. In these non-acute spaces, ImageMover really shines as a seamless result record and reporting solution.

your customers can rest easy without having to worry about possible shortages at inopportune times.

By working closely with its distribution partners, BD is able to maintain constant inbound supply to meet current needs.

On top of that, BD continues to invest in its robust global supply chain. In order to support the unique needs of their customers BD is continuing to manufacture additional inventory for all five assays offered on the BD VeritorTM Plus System and pushing millions of tests into the marketplace weekly.

Product Assurance The upcoming respiratory season may be unpredictable, but BD is firing on all cylinders to make sure that

For more information reach out to your BD rep, or visit http://bdveritor.com.

BD Products Available for the 2021-22 Respiratory Season: The five assays offered on the BD Veritor Plus System currently are: 1. SARS-CoV-2/Flu (COVID & Flu Combo Assay) 2. SARS-CoV-2 (COVID Only Assay) 3. Flu A+B (Influenza Only Assay) 4. Group A Strep (GAS) 5. Respiratory Syncytial Virus (RSV) The company is also running a variety of seasonal promotions that provide customers added savings such as free instruments or test kits when purchasing kits. These kits require a CLIA Certificate of Waiver.

Is it COVID-19 or the Flu? Quickly detect and differentiate between Influenza and COVID-19* with a single test this flu season, with clear, trusted, digital results in 15 minutes.

See what’s new at BDVeritor.com/COVID-Flu *Emergency Use Authorization Information for the SARS-CoV-2 and SARS-CoV-2 & Flu A+B assays: • These products have not been FDA cleared or approved; but have been authorized by FDA under EUA for use by authorized laboratories • The BD Veritor™ System for Rapid Detection of SARS-CoV-2 has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; the BD Veritor™ System for Rapid Detection of SARS-CoV-2 & Flu A+B has been authorized only for the detection of proteins from SARS-CoV-2, influenza A and influenza B, not for any other viruses or pathogens; and, • These products are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Federal Food, Drug and Cosmetic Act, 21 U.S.C. § 360bbb-3(b)(1), unless the declaration is terminated or authorization is revoked sooner.

BD Life Sciences, 7 Loveton Circle, Sparks, MD 21152-0999 USA 800-638-8663 BD, the BD Logo and Veritor are trademarks of Becton, Dickinson and Company or its affiliates. © 2021 BD. All rights reserved.

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

The Future of Work and Digital Transformation More than one year after the global remote work revolution, the shift to work from home (WFH) and work from anywhere (WFA) is already resulting in profound effects on businesses’ digital transformation as well as data security concerns, according to Lenovo, which released the results of its Future of Work and Digital Transformation study in the spring.

According to the study, a vast majority of businesses (83%) expect to work remote at least half the time, whereas 60% of employees not only agree but are happy to do so. These new findings are part of a global survey of more than 8,000 employees and IT decisionmakers (ITDMs) across 14 markets from companies of all sizes on the impact of remote work, including job 66

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satisfaction, technology challenges and solutions conducted in early 2021.

Among the key insights is that workers have hit their stride navigating their new WFH lives. Most employees (83%) want a hybrid work model post-COVID, which businesses say are more than happy to accommodate because they know it’s a way to drive employee engagement and attract new talent. Enabling remote work has meant a change in digital adoption, with an increased usage of personal devices for work; wider adoption of collaboration cloud and software; and a heightened focus on data security among IT functions across businesses of all sizes. The study also shows that trusted technology providers will need to play a key role in developing future digital strategies, while Device-as-a-Service

(DaaS) is gaining traction among larger businesses to make it easier to provide employees with up-to-date technology devices and as a way to free up precious resources for more strategic priorities.

“With businesses and their employees both optimistic about a future in hybrid work and remote collaboration, today’s IT departments are faced with the rising resource costs of data security and compliance,” said Gianfranco Lanci, president and COO, Lenovo. “More than ever, businesses need reliable technology partners to fully manage their hardware, software and services to maximize value and boost security.”

Other findings of the study: ʯ Contrary to initial concerns that remote work would lead to a rise in employee burnout within the first year of the pandemic, the Lenovo study showed that most workers have adapted remarkably well to WFH and WFA – 70% say that the flexibility leaves them more satisfied with their job overall.

About 60% of surveyed employees now prefer remote work at least half the time, while over onethird want to WFH/WFA most or all of the time.

ʯ With 90% of workers surveyed still wanting the option to go into the office to connect with colleagues and 56% saying they are more productive at home, it’s clear that the role of the office will be changing. “The office is no longer the place where work gets done; it’s evolving into a place where one can connect and collaborate while leaving deep work for focused time at home.”

ʯ Remote work has also led to a new suite of digital hardware, software and services solutions. One’s collection of devices and technology for work has become increasingly personal and collaborative. “Employees are increasingly leaning into the use of their personal devices such as laptops, smartphones and tablets for work, with 79% of employee respondents saying they’re now using their smartphones for work-related tasks such as voice and video calls, email and work chat.”

Dell reports record second quarter Dell Technologies recorded its best second quarter in the company’s history. Strong demand in the personal computer market was one of the reasons Dell saw record second quarter revenue of $26.1 billion, up 15%. Its Client

Solutions Group revenue for the second quarter was up 27% to a record $14.3 billion. Operating income was a second quarter record $995 million, up 39%, and 7% of Client Solutions Group revenue, as the company innovates across the ecosystem to deliver an enhanced experience for customers looking to work and play effectively from anywhere.

“ Employees are increasingly leaning into the use of their personal devices such as laptops, smartphones and tablets for work, with 79% of employee respondents saying they’re now using their smartphones for work-related tasks such as voice and video calls, email and work chat.”

Best bets for Chromebooks If all you’re really looking for in a personal computer is to surf the web and don’t need heavy lifting software, Chromebooks may be your best bet. Fortunately, there are plenty of options of affordable Chromebooks that can get the job done. CNET recently highlighted their top picks in several categories, including: ʯ Best small Chromebook under $300: Lenovo Chromebook Duet. “A great pick if you’re looking for an affordable Chromebook for pure mobility or as a secondary device that can be used in tablet mode.”

ʯ Best Chromebook under $500: HP Chromebook x360 14c. “The Core i3 processor and 8GB of memory keep this HP Chromebook running smoothly even with a couple dozen tabs open and streaming video in the background.”

ʯ Best Chromebook 2-in-1 for multitaskers: Acer Chromebook Spin 713. “It gives you more vertical room to work in, but it still has the width of a typical 13.3-inch laptop with a 16:9 ratio.”

To read the full list, visit www.cnet.com/tech/ computing/best-chromebook. www.repertoiremag.com

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REP CORNER

Game Day Bonitatibus family feuds for the camera They’re loud. They’re competitive.

They’re close. Each one has a giant personality, and no one is afraid to show it.

They are the Bonitatibus family (pronounced bunny-totty-bus) of New York, and at press time, they were awaiting airing of the Family Feud TV show that they taped in May. Two of the Bonitatibus brothers who appeared on the show – Rocky and Nick – are account managers for CME Corp.

The patriarch of the family is Rocco, who, with his brother, Jerry,

started Fradeli’s Restaurant in Yonkers, New York, more than 37 years ago. The matriarch is Lori. Originally from Philadelphia, she met Rocco in Wildwood, New Jersey. Today she works for a reinsurance company.

“She is where our competitiveness comes from,” says Rocky, who covers northern New Jersey, Westchester County/Bronx New York, and a small part of Connecticut for CME. “Our mom is the most outgoing of all of us,” adds Nick, who covers New Hampshire and parts of Massachusetts for CME. “She has the

most energy. My dad can get there, but he needs to settle in a little bit first, see what’s going on. He’s feeling the waters, but once he sees we’re all into it, he’s there.”

Growing up in a household in Yorktown, New York, with four brothers provided excellent training for the TV competition. (The other two brothers are Joey, who appeared on the TV show, and Michael, who had to miss it due to another engagement.) Like their father before them, all four boys played lacrosse growing up, and three went on to play lacrosse in college.

“Just growing up with four boys, we were always competing, sometimes to the point of tears,” recalls Rocky. Turkey Bowl football games on Thanksgiving are a tradition. “’Competitive’ basically sums it up,” says Nick. The three older boys are about a year apart in age, with Nick following about four years after Joey, the next youngest. As the youngest, “you get picked on,” he says. “So you gotta get good at whatever is going on.”

Family Feud For years the Bonitatibus family has enjoyed watching Family Feud on TV. The show, which is emceed

by TV personality Steve Harvey, features two families competing to name the most popular answers to survey questions.

Two years ago, Lori learned that auditions were being held for the show in Stamford, Connecticut. Unbeknownst to the others, she signed up the family. In September, 68

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they auditioned along with hundreds of other families.

“It’s all about being as loud as possible, cheering your family on, and being over the top enthusiastic and excited,” says Nick. “But you also have to be good at the game! We are an extremely competitive family. We do not like to lose, and we wanted to make sure we did everything it takes to get on the show. We were able to stand out among the thousands of families who auditioned.”

Says Rocky, “We made it past the first stage of auditions and were told to go to a separate room where we were individually interviewed.

We did everything we could in that interview to get them to love our family and put us on the show. I also feel like the fact that we had all boys and my mom being the only girl made for a great dynamic.

taping in August of that year, Rocco Sr. got COVID. “He was hospitalized for three weeks,” says Rocky. “Thankfully he made a full recovery, but we thought our FF dream was over. A few months later my mom got an email saying that they loved our family so much, they still wanted us to come on the show.

They rescheduled us for May 2021.”

“We stood out by just being ourselves. We were very loud and obnoxious. We made fun of each other during interviews and cracked jokes, which made the producers laugh a ton.”

Two months after the audition, the Bonitatibuses got word that they would appear on the show. But because of COVID-19, the producers postponed filming in the spring of 2020. Then, shortly before the family was scheduled to do the

episodes during that time span. What also surprised me was how down to earth Steve Harvey is. When sitting in the audience waiting your turn to go, it almost feels like you are at a comedy show. It was about 80% Steve Harvey comedy show, 20% Family Feud. At times you would forget you were filming a show.

“It is nerve racking when the bright lights are on you and the camera starts recording,” he says. “Luckily, we

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Bright lights The best way to practice is to watch the show, says Nick. “I used to watch an episode almost every day leading up to our taping. We also got a board game and would play as a family when we were all together.

“What surprised me was how many moving parts and how much goes into the taping process,” he continues. “We were at the studio from 8 am to 8 pm, and they only filmed four

got to see other families play prior to us, and there’s a practice round without Steve Harvey when you arrive at the studio to get the jitters out and show you how it feels to be on the stage with all the cameras. That being said, once it was our turn to film, I was ready to rock and not even the slightest bit nervous.

“The most fun was interacting with Steve Harvey and creating a memory that will last forever with my family.”

Says Rocky, “I was most surprised with how much different the game is when you are under the lights. Anyone can play sitting on their couch, but can you perform when the camera is on, and Steve is standing right in front of you?

“The first couple of questions are hard, just because you need to get your nerves in check. But once we settled in, it was a breeze. Once you start playing the game, everything starts to click. It was like we were at home playing as a family.

“I just loved being around my family for an extended period. We also had a great time hearing some of the crazy answers we each came up with. Some of them will be standing jokes at family dinner for a long time.

“I learned that my family has a bond like no other, and that when we put our minds to something, we can do anything. We are resilient and will do anything it takes to win, whether that be a sport, an illness or a game show. I am super proud of my family and our performance on Family Feud, and I wouldn’t change this experience for anything in the world.”

Adds Nick, “I learned that I have an AWESOME, fun and outgoing family. I also learned we are pretty damn good at the game! All in all it was a great experience, and I wouldn’t have traded it for the world!”

NEWS

Industry News Sri Trang USA hires Sean Landers as director of Distributor Relations Sri Trang USA, a provider of infection prevention products including the Ventyv® brand, announced it has hired Sean Landers as its director of Distributor Relations. Landers will be responsible for working with Sri Trang’s national distributor to extend the value of the company’s infection prevention products to customers across the primary care segment. Landers previously worked with a manufacturer servicing the post-acute market. He obtained and managed business across the

segment in the southern region of the country. He has experience with multiple national distributors as he partnered with them to service the end customer. “We are lucky to have Sean on the team. His skillset and past successful experience with distributors while working with a manufacturer will be a big benefit for us. We will definitely lean on Sean to develop and strengthen relationships in the primary care marketplace,” said Billy Harris, CEO of Sri Trang USA.

Medline opens new distribution center Medline announced that its newest distribution facility in Katy, Texas opened for business this summer and is fully operational. The cutting-edge facility serves hospitals, physician offices, assisted living facilities, ambulatory surgery centers and all other healthcare providers throughout Texas and Louisiana.

The following are four things to know about the state-of-the-art facility.

High-tech The new facility utilizes the latest technology, including: ʯ An advanced robotic picking system ʯ Hands-free voice picking systems ʯ Full redundancy backup for power, communications, etc.

Innovative partnerships New jobs With the local expansion, Medline says it will add 100 new jobs to its existing 375-member team to support healthcare in the Houston region.

1.2 million square feet of space The $100 million medical-grade distribution center is a 1.2 million square-foot facility from which tens of thousands of individual products and devices will be shipped to healthcare providers across the continuum of care.

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In a news release, Medline says the Katy Distribution Center is spurring innovative partnerships with customers. For example, Houston Methodist is utilizing space to handle central receiving, case picking and inventory processing to increase efficiency, save money and enhance patient experience.

Medline says the Katy Distribution Center is part of a $500 million investment in 2021 and follows on the heels of Medline’s $1.5 billion Healthcare Resilience Initiative campaign the past three years.

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