The following is a guest article by Kilee Yarosh, Senior Manager, Clinical Strategists at Omnicell
Everyone in healthcare has lived some version of the “surprise shortage” moment. It often looks like this: a clinician and pharmacist align on a medication plan, orders go in, and the care team moves on to the next urgent task. Then, someone discovers the medication is constrained, unavailable, or quietly on allocation. Now the plan that felt settled is back on the table and the full care team is under pressure to not just identify a substitution, but also ensure education materials and counseling requirements align to the new treatment plan. While all that is going on, the patient is waiting while the system reworks what should have been routine.
That moment is frustrating, operationally expensive, and clinically risky – especially when it becomes increasingly routine. With ongoing warnings from the USP that raw materials are becoming a bottleneck for medication supply chains, the organization has identified 100 clinically important medicines that are most at risk of disruption. In recent years, shortages have been widespread, expensive, and persistent enough that workaround mode can start to feel like the default operating model.
The good news is that while no single health system can solve the national shortage problem, organizations can leverage advanced technology that supports inventory transparency to reduce surprises, mitigate inconsistency, and respond faster.
The Surprise is Rarely the Shortage, It is When You Find Out
In many organizations, the hardest part is not that a drug is scarce. It is that the availability signal arrives too late, too inconsistently, or in the wrong place. A common scenario in multi-hospital systems may look like this:
- One campus has enough on-hand inventory to cover near-term demand
- Another campus is already below par levels and is burning through the remaining supply
- Clinics are still ordering as usual because nothing in their workflow indicates a constraint
- Pharmacy only learns the “real” status after orders are placed and verification or dispensing is underway
At that point, teams have to improvise in real time to:
- Locate the product across sites
- Decide whether a medication supply transfer is feasible and compliant with policy
- Re-route doses or adjust distribution plans
- Communicate changes to nursing and providers
- Update orders, substitutions, and documentation
- Monitor for downstream impacts, like missed doses or delays
The scramble that ensues often gets framed as a supply chain issue, but the day-to-day pain is felt across the full care team’s workflow. When the shortage signal is late, humans become the integration layer.
The Biggest Gap Health IT Can Influence: No Single Source of Truth
Most health systems already have a lot of inventory information. The problem is that it is fragmented across automated dispensing systems and cabinet counts at the unit level, central pharmacy systems and internal distribution workflows, and EHR ordering workflows that may not reflect real-time supply constraints.
Even when each component is working as designed, the combined picture can still be blurry. Counts might be delayed. Locations might not be normalized. On-hand inventory might not reconcile with on-order. Allocation changes may not surface where clinicians and pharmacists make decisions.
This is why shortage readiness, at its core, is an interoperability and data governance problem.
Shortage response depends on the ability to reconcile data across EHR-facing workflows, dispensing and storage systems, and purchasing and distribution feeds so the availability signal is consistent everywhere it appears. If “available” means one thing in procurement, another in the central pharmacy, and something else at the cabinet, care teams will keep getting surprised.
What “Good” Looks Like When Visibility, Workflow, and Analytics Work Together
Organizations reduce chaos during shortages when three capabilities work together: real-time, location-aware visibility, exception-based workflows, and practical analytics that predict where shortages will hit first. Teams need an enterprise view of what is on hand by location and care area, what is on order and when it will arrive, what is allocated or delayed, what inventory is near expiration or at risk, and where demand is rising or stable, since many “shortages” are really “right drug, wrong building” issues.
Readiness improves with standardized exception workflows that define shortage triggers, assign a clear owner (often pharmacy partnered with supply chain), document decisions and substitutions, give role-based tasks to each group, and use consistent communication to nursing and providers. These engagements and workflows must also be embedded in the tools staff already use to avoid side-channel coordination.
Analytics platforms can also help by estimating days of supply on hand by location, empowering pharmacy teams to identify units likely to run out first. These tools can also help project the impact if trends continue, forecast demand spikes for alternatives when substituting, and flag supplies that can be redistributed quickly. Strong governance pre-defines who decides and documents, who can authorize substitutions, what thresholds trigger escalation (days of supply, allocation changes, patient safety risk), and how decisions are communicated and recorded to enable faster action with fewer meetings.
A 90-Day Playbook to Operationalize Shortage Readiness
The 90-day playbook for shortage readiness emphasizes progress over perfection by building a steady work rhythm that links actual inventory, employee workflows, and forecasting.
In the first 30 days, teams should map the full inventory process, noting breakdowns like slow updates, unclear responsibilities, mismatches between stock and activity, ambiguous product locations, and information gaps at key workflow stages. This phase produces a simple truth map of systems, handoffs, and weaknesses across the organization.
From day 31 to 60, the focus shifts to establishing a consistent minimum dataset across sites, including on-hand and on-order quantities, expected arrival dates, par levels, recent usage rates, expiration risks, and standardized location IDs. At the same time, teams should formalize substitution escalation by assigning roles, defining clear pathways, using aligned communication templates, and deciding on central versus distributed inventory.
In the final 30 days, shortage information should be integrated into core workflows so it is visible during ordering, verification, dispensing, restocking, and inventory transfers. This ensures action is based on up-to-date signals. Finally, a manageable set of KPIs should be tracked weekly, starting with metrics like time to shortage identification, time to substitution decisions, and delay days avoided.
These steps help organizations respond quickly, maintain operational consistency, and translate readiness into actual patient impact.
A Modern Platform Approach Can Support This Shift
A cloud-based medication management platform approach can make it easier to operationalize standardized workflows across multiple sites, especially when paired with unified user management and guided task workflows for technicians.
In that model, analytics can synthesize internal signals, like dispensing trends and location-level burn rates, alongside external signals, like purchasing constraints and allocation changes. When those signals are combined into risk scoring and exception queues, teams can prioritize action earlier and reduce the volume of manual triage.
Titan XT is one example of how modern automated dispensing design is evolving toward more connected, enterprise-ready inventory governance at the dispensing layer. The specific product matters less than the capability pattern: standardize data capture, improve real-time visibility, and make exception workflows easier to execute consistently across facilities.
Shortages May Be Out of Your Control, Surprise and Inconsistency Are Not
Drug shortages are likely to remain part of healthcare operations – manufacturing disruptions, quality issues, and supply constraints will continue to ripple into hospitals and clinics. What health systems can control is whether shortages show up as last-minute surprises or as managed exceptions.
When organizations pair real-time inventory visibility with standardized shortage workflows, supported by automation and analytics across the dispensing layer and the broader medication management ecosystem, three things tend to improve quickly: teams get earlier, more credible signals, manual workarounds start to shrink instead of spread, and execution becomes more predictable for pharmacy, clinicians, and patients.
The goal is not to eliminate disruption. It is to make the response faster, safer, and far less chaotic, even when the shortage itself is not going away anytime soon.
What are some of your feelings and emotions as you step away from Epic?