Eric Balmir Says Pediatric-Ready Drugs Are on the Horizon

Eric Balmir, MS, PharmD, serves as vice president and chief pharmacy officer at Children’s National Hospital in Washington, D.C.

MedPage Today met with Balmir, who earned his doctorate from the University of Florida in Gainesville, in a conference room inside the D.C. hospital for an hour one afternoon in late July. Joining Balmir was a medical student working with him this summer and a Children’s National Hospital public relations official.

Balmir spoke about his career, what changes are afoot in pharmacy, and about the Children’s Hospital Coalition — a group whose aim is to address drug shortages. Children’s National joined the Phlow Corporation-led coalition earlier this year, along with other top children’s hospitals in the U.S.

Following are excerpts from our conversation:

Tell me a little bit about your career background.

Balmir: I have been in pharmacy close to 35 years … I had the opportunity of having almost 30 years of my career in one place, at NewYork-Presbyterian in Brooklyn — my previous role. I was the informatics manager, I was quality assurance and data manager, I was regulatory at one point, and then I moved up to chief in Brooklyn as well.

I transferred here. The calling was great and it was time to move. My old hospital was going through a merger, so everyone at the top gets to say bye-bye. So here I am in D.C. for the past 4 years, where I spent the first 3 years as chief.

What made you want to go into pharmacy as a career?

Balmir: I didn’t have a choice. [My parents] said you’re either 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 in chemistry, I was great in math, and I hated it. Then that one class in my fifth year, it all came together. It was the therapeutics class.

How do you balance everything as you have moved your way up throughout your career?

Balmir: When you’re able to disconnect, really truly disconnect, you need to recharge, you come back stronger. You may find whatever it is you were focused on, [the time away] may give you more ideas and better ideas for when you come back to the work.

What is it about Children’s National that makes it unique?

Balmir: They really do a great job 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 life, Brooklyn, New York, we were a throughput machine; we didn’t have the time to enjoy, talk to family, talk to parents. Here there’s continuity of care. [In addition] because we are in the nation’s capital, we are viewed as leaders [among children’s hospitals].

Tell me about the way Children’s National is structured.

Balmir: Our CEO here is a medical doctor [Kurt Newman, MD, a pediatric surgeon]. He’s hands on, he is extremely personable, I find him extremely open to ideas. That was a great step up for me. It does feel different and better than my previous experience. This CEO has touched medicine. He’s able to relate to my world because he’s lived it.

Give us a sense of what your job is like on a daily basis or weekly basis.

Balmir: We are well over 6,000 doses [of medications] a day, we can’t miss a beat. We are starting off with staffing crises, drug shortage crises …We have 65,000 opportunities to make a mistake a day here. That’s what keeps me up at night: How do we make sure we minimize … mistakes will be made, but how do we make sure we are minimizing harm?

Did anything during the pandemic change your workflow? Do you foresee any lasting changes?

Balmir: Whatever support we could give [employees] via Zoom [was provided]. That was very different and I think something’s that’s going to last in our profession.

Did you enjoy doing telework? Is that something you would want to be a part of going forward?

Balmir: As a leader you can’t read the room, I’d rather, being old-school, have more in-person meetings. I think I’m going to stick to still running more in-person meetings.

Regarding telehealth for patients, to what extent do you foresee that being a part of your healthcare delivery in the future?

Balmir: Oh, absolutely, this has definitely shown us that people are more informed. It’s one-stop shopping with telehealth. If it’s wellness or well care, I think there’s room for that.

What is the Children’s Hospital Coalition? Who is involved? How did it come together?

Balmir: The original focus was more on those orphan diseases and orphan drugs. [Phlow] was able to develop a manufacturing process that was very novel and very cheap. Now our focus has truly been manufacturing drugs that are in short supply, but in a way that the entire nation can benefit.

The coalition was formed on top 10 hospitals coming together and saying we need to agree on a list of drugs that no matter what we can’t be without. The drugs need to be approved and, once that’s happened, Phlow is going to take that modality of various drugs and is going to go to companies and say, “Hey we have this new way of making drugs, would you be able to make these drugs for us?” They’ll be able to continually and consistently supply us.

How long has this drug shortage been going on?

Balmir: About 10 years. We would have a shortage every day and now we have it every week. But at any given moment, we could have a sourcing problem for a drug.

Looking long term, are there other items or other problems that the coalition might look to address other than drug shortages?

Balmir: Manufacturers don’t make drugs for us; the population is adults. When we get a drug, 99% of the time we have to dilute it into a concentrated form. What we are proposing is manufacturing drugs that already come in concentrations for us; that would be a game-changer, it would reduce compounding. We are actively discussing it … I don’t know exact dates. Lists have been finalized, concentrations have been agreed to.

How much has the field of pharmacy changed, and how has that affected your job as a pharmacy director?

Balmir: Predictive analytics, it’s sexy. It’s like chess playing with a computer, but with meds. What I like most about artificial intelligence and predictive analytics — you can run a model through a system and it’s going to say, “the likelihood of this becoming an error is higher if you take this path.” You have children that are less than a pound here and if you have a computer that says, “this is not working so great here,” you may consider lowering the dose. You can really predict the outcome of a child in need. That’s a home run.

We are utilizing artificial intelligence now. It’s allowing us to help reduce waste.

How do you try to stay on top of changes to the field? How have you been able to adjust throughout your career?

Balmir: [Students] do come with new ideas. The benefit of keeping the youth close was probably one of my secrets, making sure I’m in tune with what’s happening.

Any other technologies you could see having an impact on pharmacy or pediatrics?

Balmir: There’s artificial, then there’s automation; the hospital’s investing in that. We are in construction to make some room for automation, we are looking at delivery robots.

Are you doing anything in particular to prepare for the fall?

Balmir: We’re always ready. For mid-July to be full is just a hard indication that our fall is going to be busy as well. We will be in full business.

Anything else you want to add?

Balmir: This has been a year-and-a-half, almost 2 years of constant go-go-go; you learn to really appreciate where you’re at in this process.