Eric Balmir says pediatric-ready drugs are on the horizon
Eric Balmir, MS, PharmD, is vice president and director of pharmacy at Children’s National Hospital in Washington, DC
MedPage today met Balmir, who received his doctorate from the University of Florida at Gainesville, in a conference room inside DC Hospital for an hour one afternoon in late July. A medical student who worked with him this summer and a public relations manager from the National Children’s Hospital joined Balmir.
Balmir spoke about his career, the changes underway in pharmacy and the Children’s Hospital Coalition – a group whose aim is to remedy drug shortages. The Children’s National has joined the Led by Phlow Corporation coalition earlier this year, along with other top children’s hospitals in the United States
Here are excerpts from our conversation:
Tell me a bit about your professional background.
Balmir: I have been in pharmacy for almost 35 years … I had the opportunity to have almost 30 years of my career in one place, at NewYork-Presbyterian in Brooklyn – my previous role. I was an IT manager, I was responsible for quality assurance and data, I was responsible for regulation at one point, and then I moved to the position of chief in Brooklyn as well.
I was transferred here. The call was great and it was time to move out. My old hospital was merging, so everyone at the top can say goodbye. So here I am in DC for 4 years, where I spent the first 3 years as a chef.
What made you want to pursue a career in pharmacy?
Balmir: I had no choice. [My parents] I said you were going to be a nurse or a pharmacist, and I said, being the boy, I said I didn’t want to be the nurse. The first 4 years [of school] I was great at chemistry, I was great at math, and I hated it. Then this course of my fifth year, everything fell into place. It was the therapeutic class.
How do you balance everything as you have progressed throughout your career?
Balmir: When you are able to disconnect, really really disconnect, you need to re-energize yourself, you come back stronger. You can find whatever you focused on, [the time away] can give you more ideas and better ideas for your return to work.
What makes the Children’s National unique?
Balmir: They really do a great job of making sure people have what they need to do their jobs and that was a great, it was a change for me. In the fast-paced Brooklyn, New York, we were a debit machine; we didn’t have time to enjoy, to talk to the family, to talk to the parents. Here, there is continuity of care. [In addition] because we are in the nation’s capital, we are considered leaders [among children’s hospitals].
Tell me about how Children’s National is structured.
Balmir: Our CEO here is a doctor [Kurt Newman, MD, a pediatric surgeon]. He is involved, he is extremely sympathetic, I find him extremely open to ideas. It was a big step forward for me. It’s different and better than my previous experience. This CEO has touched on medicine. He is able to relate to my world because he has lived it.
Give us an idea of your daily or weekly work.
Balmir: We are well over 6000 doses [of medications] a day we can’t miss a beat. We start with staff crises, drug shortages … We have 65,000 opportunities to make mistakes a day here. This is what keeps me awake at night: how do I make sure I minimize … mistakes will be made, but how do I make sure that the damage is minimized?
Did anything during the pandemic change your workflow? Do you foresee lasting changes?
Balmir: Whatever support we might give [employees] via Zoom [was provided]. It was very different and I think something will last in our profession.
Did you enjoy telecommuting? Is this something that you would like to be a part of in the future?
Balmir: As a leader you can’t read the room, I’d rather, being old school, have more face-to-face meetings. I think I will continue to host more face-to-face meetings.
With regard to telehealth for patients, to what extent do you anticipate this will be part of your health care delivery in the future?
Balmir: Oh, absolutely, it definitely showed us that people are more informed. It is a one-stop-shop with telehealth. If it is wellness or care, I think there is room for it.
What is the Children’s Hospital Coalition? Who is involved? How did it come together?
Balmir: Initially, the focus was more on orphan diseases and orphan drugs. [Phlow] was able to develop a very new and very inexpensive manufacturing process. Now our goal is really to make drugs that are scarce, but in a way that the whole nation can benefit from.
The coalition was formed out of the top 10 hospitals that came together and said we need to agree on a list of drugs that we can’t live without no matter what. The drugs have to be approved, and once that is done, Phlow will take this modality of various drugs and go to the companies and say, “Hey, we have this new way of making drugs, would you be able to do them? to manufacture? drugs for us? ”They will be able to supply us on a continuous and constant basis.
How long has this drug shortage lasted?
Balmir: About 10 years. We would have a shortage every day and now we have it every week. But at any time, we could have a supply problem for a drug.
In the long term, are there other things or other issues that the coalition might seek to address other than drug shortages?
Balmir: The manufacturers don’t make drugs for us; the population is adult. When we receive a medicine 99% of the time we have to dilute it in a concentrated form. What we are proposing is to manufacture drugs that are already concentrated for us; it would change the situation, it would reduce the composition. We’re actively discussing it …. I don’t know the exact dates. The lists have been finalized, the mergers have been agreed.
How has the field of pharmacy changed and how has this affected your job as a pharmacy manager?
Balmir: Predictive analytics is sexy. It’s like playing chess with a computer, but with drugs. What I like most about artificial intelligence and predictive analytics: you can run a model in a system and it will say, “the likelihood of it becoming an error is higher if you take this route”. You have kids who weigh less than a pound here and if you have a computer that says “it doesn’t work so well here” you may consider lowering the dose. You can really predict the outcome of a child in need. It’s a home run.
We are now using artificial intelligence. This allows us to help reduce waste.
How do you try to stay abreast of changes on the pitch? How have you been able to adapt throughout your career?
Balmir: [Students] come up with new ideas. The benefit of keeping young people close was probably one of my secrets, making sure I was in tune with what was going on.
Could other technologies have an impact on pharmacy or pediatrics?
Balmir: There is the artificial, then there is the automation; the hospital is investing in it. We are under construction to make room for automation, we are considering delivery robots.
Are you doing anything in particular to prepare for fall?
Balmir: We are always ready. That mid-July is full is just a clear indication that our fall will be busy as well. We will be in full swing.
Anything you want to add?
Balmir: It’s been a year and a half, almost 2 years of constant go-go-go; you get to really appreciate where you are at in this process.