Our guests: Patrick Yoder, PharmD Co-Founder and CEO Logic Stream, Peter Ketchum Executive VP LogicStream, Darren Jones, Pharm D, BCPS Pharmacy Director – Regulatory, Quality and Diversion.
The team from LogicStream, along with one of their customers, gives us an overview of their product and tells us why a facility should consider LogicStream over the competition when it comes to diversion software. Darren from Carilion Clinic shares with us why he selected this particular product and how it has helped him streamline the monitoring for diversion and improved the effectiveness of his program.
Transcript:
Terri
Welcome everybody, to Diversion Insights. My guests today are the team from Logicstream. We have Patrick Yoder, the co founder and CEO, Pete Ketchum, the executive vice president, and we also have Darren Jones, the pharmacy director at Karelian Clinic, a Logicstream customer. Welcome to all of you. I want to start with Logicstream. Logicstream is a company which provides diversion software as a service, and other several things actually, one of which is diversion. So we’re going to talk about that today. Patrick, could you start us off with an overview of the company and some of the services that you offer?
Patrick
Absolutely, I’m happy to do that. So, first of all, Patrick Yoder, I’m a pharmacist by training. I’ve been in healthcare technology for quite some time, probably 15 years now. And our company focuses not only in the pharmacy space, but also in quality improvement. So we have a long history of data analytics and data acquisition cleansing, and then also how do you use data and workflows to understand how human beings, how care providers deliver care, and then also their behaviors as part of that. So that’s a high level overview of our company and what we do.
Terri
Yeah. Can you give us just a couple of practical applications for those of us that are less It savvy? Like, give us a couple of specific examples of what your product can help a facility or healthcare provider learn.
Patrick
Yeah, we have three software products for health systems, two of which are in the pharmacy space. One, we’re going to spend most of the time today talking about, which is our diversion software. We also have a drug shortage or drug supply software product that uses the same exact data platform and very similar data points, although a few more in that case for upstream in the supply chain even further. And that product is all about, as many people probably recognize drug shortages that are kind of plaguing the marketplace right now.
Terri
Horrible.
Patrick
Yeah, it’s quite heartbreaking at times. But the other software product that we offer is we call it Clinical Process Improvement Software. So essentially what it does, it allows you to look at any workflow in the electronic health record and understand the data surrounding that workflow at an individual level and at a population level so that you can improve it to drive better outcomes, better quality, lower costs, those type of things.
Terri
Okay, is your diversion software the last of the three that you have developed?
Patrick
Pete might have to help me with this. I think it’s the most recent.
Terri
Yes, most recent.
Peter
We launched the drug diversion product in 2019, so it’s the most recent of the products that Patrick mentioned, but a few years ago was our introduction to that.
Terri
Okay, and what was the impetus for releasing that and developing that portion of what you guys offer?
Patrick
Yeah, I mean, at a really high level, all of our products came from this type of work and hopefully, Darren describes this experience from the customer side. But we spend a lot of time with customers, and we spend a lot of time listening to what they’re saying and what they’re doing with our products. And what we found is that with our clinical process, product, customers, specifically pharmacists within our customer base were using it to help them understand drug diversion. And so we started digging into that, and then the product kind of developed from that work, and it’s gotten a lot more sophisticated over time, and it does a better and better job of helping solve that problem.
Terri
Sure, okay, that makes sense. Yeah, you saw them using it for something else, kind of piecemealing it together and thought, all right, let’s do this for and we definitely will hear from Darren on that, and we’ll talk about that, and so we’ll find out what he thinks. But I want to ask you, Patrick and Pete, from your perspective, what differentiates your product from other diversion software products? There’s a handful of them out there, so why should a customer select yours?
Patrick
Yeah, I mean, I’ll cover the very high level and Pete can cover the specifics. So fundamentally, the main reason that you would want to work with Logistream is that we’ve spent ten years worth both acquiring, cleaning, organizing, and understanding data and applying it to significant healthcare problems. And we basically bring all of that experience because of the way that our software is architected. We bring all that experience to bear on every solution that we build.
Peter
Right. Yeah, I guess in more detail. So for ten years now, we’ve been solving very complex problems that depend heavily on multiple data sources electronic health record systems, drug dispensing systems, patterns in wholesale purchases. We’ve had ten years to solve the problem of how do you collect this data in a very efficient way that doesn’t place a lot of demand on the health system, and especially the It department of the health system. How do you collect this data? How do you merge the data? How do you map information across those different sources of data? Users represented this way in a dispensing cabinet system. Same user is represented this different way in the EHR system. How do you map those concepts? How do you map drug concepts across those sources?
Peter
And how do you extract from an enormous data set insights that are useful and actionable? We’ve had ten years to do that, and that being able to do that effectively is really essential to solving the problem of drug diversion, identifying diversion risks. And so how does all that materialize in the diversion product? Well, in the fidelity, the signals that we use to identify diversion risk, those signals incorporate clinical rules and logic and data models that operate off of that really complete and clean set of underlying data. We also go to great lengths to understand how things are happening across the health system organization so that we can present information at any organization level, the entire health system, a hospital, a department. And one of the things that makes our diversion product unique is you can look at diversion risks at any of those levels.
Peter
For example, you can look at if you regard a person at your organization as a diversion risk, you can look at them from the top down, what are they doing across the health system, what are they doing at a specific hospital, what are they doing at a department?
Terri
Yeah, that’s really important to see all of those levels. Okay. And is it safe to assume if a customer has any of your three products that you offer, it’s easy to just integrate the others and make it a complete package, because you’re already getting a lot of that data is going to be the same, right. For no matter how they’re using it.
Peter
In fact, all three of those applications operate off of one contiguous software architecture, and they share all these underlying resources, like acquisition of data from those data sources and processing of the data.
Terri
Okay, all right. So they can get a deal with a bundle.
Peter
Sure.
Terri
All right. Okay. So, Darren, let’s hear from the customer when it comes to implementation and what it does for you. But before we hear that, give us a big picture of Karelian Clinic. What size are we talking about here? Do you have inpatient, outpatient, ambulatory care? What types of things do you have?
Darren
Yeah, so we’re the largest provider in southwestern Virginia. We’re based out of Roanoke, Virginia. We have a total of 126 beds scattered over six hospitals, six facilities inpatient, and then we are a healthcare system. So we have a lot of ambulatory sites specialties. We run the gamut of everything, pretty much.
Terri
Okay, and do you utilize Logicstream in all of those settings, or is it more just for the inpatient side?
Darren
So from a diversion perspective, it’s mostly from an inpatient side. You can look at a bigger picture with their other software in terms of opioid stewardship type things, like, how many morphine equivalents is this provider prescribing versus another on the outpatient side? But from diversion, it’s mostly just on the inpatient side.
Terri
Okay. All right. Did you review other products before purchasing Logic stream? And if so, why did you select that one over the others? What did it offer you?
Darren
I did you probably know better than I do, but there were five or six when I was looking, and now I think they’ve added two or three more. And so I’m not going to go into details about specific ones, but a lot of them, they had a lot of data that they were throwing at you, but they didn’t really integrate it into anything special. So in other words, you would get these 1000 page reports and you’re like, well, what do I do with all this data? That was the hang up on a few of them, again, they didn’t integrate the information well into a usable form. So instead of decreasing my FTEs that I’m using to monitor for diversion, I’m increasing them with a lot of these programs, and logic stream wasn’t that way.
Darren
In addition, I’ll throw out that they have been working with the electronic health record Epic, specifically for us, and they can pull data points that a lot of the other software companies cannot, such as, like, pain scales. So when I ask other companies, do you pull the pain scales? And they’re like, well, what flow sheet does that come out of? And it gets very complicated. So Logicstream does that pretty well, in my opinion.
Terri
Okay. Because they’ve been working on that for ten years. Right. That’s part of what you’ve been working on and how to get that data out of there. What did you do before you had logic stream?
Darren
Yeah. So I’m not sure how processes go between states, but Virginia says essentially you either have to audit a full day’s worth of transactions, which we had thousands of transactions for controlled substances, and what you do is you reconcile all of those between the dispense and the administration and the waste and all of that. So we either had to pick a day, and that would take us up to a week to audit, or what you could do is a more traditional sense is a lot of software will throw out standard deviations, and that’s what you hear a lot about diversion monitoring. And so what you could do is you could pick people greater than three standard deviations and audit those particular people.
Darren
The standard deviations are mostly based on overall controlled substance use, so it really doesn’t pull out individuals who prefer one type of substance that they’re diverting. So you can kind of get lost in there as well. But overall, the reconciliation process, it was just I don’t see how people do it effectively without some type of software.
Terri
Yeah, that’s interesting that your state requires it tells you specifically that full day’s worth of transactions. Is that monthly?
Darren
Yeah, once a month is what their standard has been. Yeah. So you can either audit a full days, which were mixed. Some facilities would do it that way, and others would just take the three standard deviations.
Terri
Yeah. Do you have pixis? Is that what you have?
Darren
Yes, Pixis. We’re converting to omnicell.
Terri
Okay.
Darren
Now?
Terri
Yeah. I haven’t seen Omnicell reports with standard deviations. I’m very familiar with Pixis using them and standard deviations. In fact, I’ll tell you, one day I went to audit somebody who had over three standard deviations and spent fair amount of time, a couple of hours, probably looking nothing looked squirrely. And of course, the very last transaction was what caused them to be over three standard deviations, because they put in the inventory number 20 for their dispense number, and I didn’t notice. Right. And it was the last transaction. It’s like, okay, never making that mistake again. I’m going to scan the whole thing and look for that error before I count that as a true three plus standard deviation. But waste of time.
Darren
Standard deviation can be a huge waste of time.
Terri
Yeah. Can be, definitely. I was also very successful with it in general, once you kind of get the hang of it, but you can certainly waste a lot of time, that’s for sure. And you don’t have a view into a lot. Right. I mean, that’s one of the benefits with the software, is that you really get a view of, well, everything, and then you decide what you want to do with it. All right. Does your software does it work in the or and the nursing units procedural areas, does it do it all?
Darren
Are you asking them or me?
Terri
Well, you.
Darren
We are just onboarding our anesthesia devices.
Terri
Okay.
Darren
We didn’t have them with Pixis, so we’re still working through that. So I can’t comment a whole lot on those.
Terri
Sure.
Darren
But it works very well with the other.
Terri
Okay. All right, perfect. What is on the roadmap? So I’m going to assume that since your hospital is the one that was kind of the you’ve got to get your anesthesia machines in there for the software to work. Safe to assume, Pete, that your software works in the or, right? Anesthesia, yes, it does. Okay. All right. Is there anything on the roadmap that’s coming that either Darren, you know about and you’re really excited, or the Logic Stream wants to share that they’re excited about improvements. Things are always changing.
Darren
Yeah. So I’ll throw this out there on top of everything else I’ve said, is that they have been great to work with. And so, like they mentioned, customer service is excellent. One of the big hang ups we had is different institutions will use different data points. Right. So for us, you have an hour to administer something after you pull it from a device, which is not standard. I’ll go there. So Logic Stream originally had it as 30 Minutes, which is pretty standard for most organizations, I think, but ours was 60, and so were pulling in a lot of these things that were not necessarily against our policy. So nursing was kind of pushing back and saying, hey, these aren’t incidents.
Darren
Why do you keep so Logic Stream was able to go in there and make it so that we could adjust that time limit in that space. And they did it in a very timely manner on top of so they are continuing to develop and work with you.
Terri
That’s great. Yeah. I’ve seen 30 and I’ve seen 60 Minutes. I’ve also seen some facilities that utilize a software program, and their policy is 30 Minutes, but they have it set for 60 Minutes, especially as they start ramping up and getting started, because as you know, I’m going to guess that you probably found a lot of practice issues as you were getting started. And so rather than overwhelm them with sticking to that 30 minutes, let’s start with 60, and then let’s work with that and then work our way backwards.
Darren
Yeah. Obviously, like you mentioned, a lot of this software, including other companies, it comes down to practice, right? So you’re going to make a ton of practice improvements, probably, no matter which software you get, but it’s nice to be able to adjust those on the fly, if you will.
Terri
Yeah, absolutely. Can you share with us a couple of just a high overview of maybe a couple of cases where the software was put to work and it helped you identify somebody that you never would have even been aware of in your old process?
Darren
So a couple of cases are still ongoing, I will tell you. And most of the software does this. If it doesn’t, I wouldn’t purchase it. But it’s the reconciliation piece between Waste and the Mar and the Pixis or Omnicell Dispense. And so that was a huge one, because in order to reconcile all these transactions, it took four or five people working almost full time. I think we had 10,000 just Oxycodone over a month. And so if you’re auditing and reconciling all of those, it’s a mess. But this software can get that. And what we saw was, and this is Blatant, I haven’t really seen this before, but a nurse was essentially just taking pills out based on an order of the dispensing machine and not charting them. And you think to yourself, well, how can that happen?
Darren
And if you don’t have a software looking for it, or you’re not auditing all of that every day, it can happen pretty easily. And that’s when the DA is going to care, too. What are your processes? How is this nurse just pulling stuff like it’s a candy store and taking it? So that was a big one that we caught really early. It could have been a lot worse. And then they’re starting to integrate, signal based on usage. And it’s nice because the usage breaks out each individual med. So most diverters have a specific med that they like, right? At least that’s what I’ve seen in my experience. And so it’s breaking those out and looking at standard deviations at meds and then comparing that to peers and throwing that out at you, too. So I have great hopes that’ll catch a lot of people.
Darren
Just browsing through that, though. I’ve identified four cases, I think, of diversion.
Terri
Okay. All right, so it’s definitely made a big difference for you. Oh, yeah, that’s great. And you’ve mentioned staffing. Have you been able to move your staffing around so that those people some I mean, we all know, or we should know, that just because we have a surveillance product doesn’t mean we don’t need any staffing. But has it freed you up to move them around to other tasks.
Darren
So were really light on diversion type stuff. And when I say that, I’m talking like were identifying one or two cases a year. And so we implemented this and we updated a little bit. So really we’ve only got three FTEs pushed towards diversion exclusively. And then the other pharmacists in charge at the other facilities are responsible for their facilities and auditing the software there. But the software, I want to say and this is just anecdotal it seems like we find at least one person a month now, and I attribute a lot of that to the software and just putting the information there so that you don’t have to dig for it.
Terri
Yes, putting it at your fingertips, which is really nice. Okay, that’s great. All right, so guys, I think you have a satisfied customer.
Peter
Always nice to see customer and a partner in our development. Darren talked about some of the things that we’re working, those a lot of our current development activities are, thanks in large part to Darren’s input. And, yeah, it’s been a good partnership from logic streams perspective.
Terri
Yeah, that’s important because he’s the hands on, so he knows what he’d like to see or maybe what’s not working well. And that’s what it’s all about, right? We’re learning from each other and then giving it to the guys that can make it happen and then making it better.
Peter
Absolutely.
Terri
Yeah. All right, do you guys have anything else that you want to add? Patrick pete? Anything?
Patrick
Go ahead, Pete.
Peter
Yeah, just thanks, Terri, for giving us the opportunity to get the word out, tell folks about Logicstream. Darren, thanks very much for taking some of your time to let folks know how you’ve been using.
Terri
Yeah, sure. Absolutely. Yeah, I think that the other products that you offer certainly make this the next logical step in offering the diversion surveillance because you know where to find the data. And that’s sometimes the most complicated piece I hear from implementation is that it’s hard to implement. We’re trying to get the data, where do we get the data? So if you’ve got that worked out, then that certainly helps.
Peter
Yes, we’ve put a lot of work over the years in streamlining how to make that happen, how to get through initial implementation, how to do the ongoing work of receiving new data from those sources. It’s complicated, but it’s possible to make it work in a way that is efficient and streamlined for health systems.
Terri
Great. Okay. All right, I want to thank all three of you for joining us today and thanks for sharing your product with everybody. I want everyone to know what the options are out there and kind of what the differences are and help them on their journey to their selection and looking for ways to make their diversion monitoring more efficient. And like Darren said, going know one or two a year to finding one a month, or at least on a regular basis. And then that goes a long way to keeping not only our patients safe, but our employees as well. And so that’s something that we should all be striving for. Yeah. All right. Thank you, gentlemen, for your time.
Patrick
Thank you.
Terri
Darren. Thanks.
