Eric Balmir, MS, PharmD, serves as vice president and chief pharmacy officer at Children’s National Hospital in Washington, D.C.
MedPage Today met Balmir, who received his PhD from the University of Florida at Gainesville, in a conference room at the DC hospital for an hour one afternoon in late July. To Balmir came a medical student who worked with him this summer and a public relations officer from the Children’s National Hospital.
Balmir spoke about his career, the changes underway in pharmacy and the Children’s Hospital Coalition – a group that aims to tackle drug shortages. Children’s National joined the Phlow Corporation-led coalition earlier this year, along with other top hospitals for children in the US
Following are excerpts from our conversation:
Tell me about your career background.
balmier: I’ve been in pharmacy for almost 35 years…I had the opportunity to have nearly 30 years of my career in one place, at NewYork-Presbyterian in Brooklyn – my previous position. I was the computer manager, I was quality assurance and data manager, I was regulatory at one point and then I went to the chief in Brooklyn as well.
I moved here. The calling was great and it was time to move. My old hospital went through a merger, so everyone at the top can say goodbye. So here I am for the past 4 years in DC where I spent the first 3 years as a chef.
Why did you want to enter pharmacy as a profession?
balmier: I had no choice. [My parents] said you’re going to be either a nurse or a pharmacist, and I said, as a boy, I said I didn’t want to be a nurse. The first 4 years [of school] I was great at chemistry, I was great at math and I hated it. When that one class in my fifth year, it all came together. It was the therapy class.
How do you balance everything as you progress through your career?
balmier: When you are able to disconnect, really really disconnect, you have to recharge, you come back stronger. You may find what you were focused on [the time away] can give you more ideas and better ideas for when you go back to work.
What makes Children’s National unique?
balmier: They do a really great job of making sure people have what they need to do their job and that was a very, that was a change for me. In the fast-paced life, Brooklyn, New York, we were a transit machine; we didn’t have time to enjoy ourselves, talk to family, talk to parents. Here is continuity of care. [In addition] because we are in the capital of the country, we are seen as leaders [among children’s hospitals].
Tell me about the way Children’s National is structured.
balmier: Our CEO here is a doctor [Kurt Newman, MD, a pediatric surgeon]. He’s hands-on, he’s extremely personable, I think he’s extremely open to ideas. That was a big step for me. It feels different and better than my previous experience. This CEO has touched medicine. He can relate to my world because he has experienced it.
Give us an idea of what your work looks like on a daily or weekly basis.
balmier: We are well over 6000 doses [of medications] one day, we can’t miss anything. We start with personnel crises, drug shortage crises… We have 65,000 chances to make a mistake here. That’s what keeps me up at night: how do we make sure we… minimize mistakes, but how do we make sure we minimize damage?
Has your workflow changed during the pandemic? Do you foresee lasting changes?
balmier: Whatever support we can give [employees] via Zoom [was provided]. That was very different and I think there’s something that persists in our craft.
Did you enjoy telecommuting? Is that something you would like to be a part of in the future?
balmier: As a leader, you can’t read the room, I prefer, because I’m old-fashioned, more face-to-face meetings. I think I’ll stick with having more face-to-face meetings.
As for telehealth for patients, to what extent do you expect it to be part of your healthcare delivery in the future?
balmier: Oh, absolutely, this has definitely shown us that people are more informed. It’s one-stop shopping with telecare. Whether it concerns wellness or well-being, I think there is room for that.
What is the Coalition of the Children’s Hospital? Who is involved? How is it put together?
balmier: The original focus was more on those orphan diseases and orphan drugs. [Phlow] was able to develop a manufacturing process that was very new and very cheap. Now our focus is really on manufacturing drugs that are scarce, but in a way that the whole country can benefit from.
The coalition was made up of top 10 hospitals who came together and said we should agree on a list of drugs we can’t live without. The drugs have to be approved and once that’s done, Phlow is going to take that modality of different drugs and go to companies and say, “Hey, we have this new way of making drugs, could you make these drugs for us?” They will be able to supply us continuously and consistently.
How long has this drug shortage lasted?
balmier: About 10 years. We would be short every day and now we have it every week. But at any time, we can have a purchasing problem for a drug.
Looking at the long term, are there other issues or other issues that the coalition could address, other than drug shortages?
balmier: Manufacturers don’t make drugs for us; the population is adults. When we get a drug, we have to dilute it to a concentrated form 99% of the time. What we are proposing is manufacturing drugs that already come in concentrations for us; that would be a game-changer, it would reduce the composition. We are actively discussing it… I don’t know the exact dates. Lists are final, concentrations have been agreed.
How much has the pharmacy field changed and how has that affected your job as a pharmacy director?
balmier: Predictive analytics, it’s 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 through a system and it says, “there’s a higher chance of this turning into an error if you go down this path.” You have kids here who weigh less than a pound, and if you have a computer that says, “This isn’t working very well here,” you might consider lowering the dose. You can really predict the outcome of a child in need. That’s a home run.
We now use artificial intelligence. It allows us to help reduce waste.
How do you try to keep abreast of changes in the field? How have you been able to adapt throughout your career?
balmier: [Students] come up with new ideas. The benefit of keeping youth close to me was probably one of my secrets, making sure I’m aware of what’s happening.
Are there any other technologies you could see impacting pharmacy or pediatrics?
balmier: There is artificial, then there is automation; the hospital invests in that. We are under construction to make some room for automation, we are looking at delivery robots.
Are you doing anything special to prepare for fall?
balmier: We are always ready. The fact that mid-July is full is just a hard indication that our fall is also going to be busy. We will be busy.
Do you want to add something?
balmier: This has been a year and a half, almost 2 years of constant go-go-go; you really learn to appreciate where you are in this process.
Ryan Basen reports for the MedPage enterprise and research team. He has worked as a journalist for over ten years and has earned national and state awards for his investigative work. He often writes on issues related to the practice and business of medicine. To follow