Dave Burke R.Ph, M.B.A., pictured at left in blue, owner of Dave’s Pharmacy in Marysville, Ohio, took some time out at the recent Cardinal RBC to talk with ComputerTalk's Will Lockwood about his decision to a install a workflow management system and the benefits he has seen. Dave’s Pharmacy fills an average of 400 prescriptions per day, with peaks on some days of approximately 525 prescriptions. Dave’s also offers compounding for both human and veterinary prescriptions, and carries orthopedic and home health care items. Burke holds a seat on Cardinal Health’s National Retail Advisory Board.

CT: First, give us a little background. When did you first install workflow?

Burke: I put Innovation's PharmASSIST Symphony+ system in about two years ago, shortly after installing one of their 50-dispenser SmartCabinets. I was so impressed with the SmartCabinet results that I called three months later and said, "Send me the workflow."

CT: What's changed about how your store operates since then?

Burke: When you ask about changes two words come to mind: speed and accuracy. Prior to workflow, prescriptions would make loops around the pharmacy. Now every prescription goes in one direction, from intake all the way down to the cash register and will-call bin. At no point in time should a prescription go backwards. We also use a colored basket system to indicate a prescription's urgency. So if a customer is in the store waiting, a prescription can leap frog through the workflow.

CT: How does the workflow system's role differ from your pharmacy management system's?

Burke: Workflow is our control center for two critical activity areas. First is on the counter itself when the technicians pull and scan the product into the Symphony station or scan the label on the vial to initiate a count from the SmartCabinet. This step helps ensure the accuracy of the prescription before it ever reaches the pharmacist check station. This allows me, as the pharmacist, to focus primarily on checking the important therapeutic aspects of a prescription at the check station. I can spend more time with the patient as well. Of course, when I scan the vial at the check station, pill and prescription images comes up so that I can quickly double check that the fill is correct.

CT: And the second control center?

Burke: This is at will call. We have a dedicated cashier and will-call technician, Brittany, whose Symphony station provides her with the complete status trail for each prescription. All she has to do is enter a customer's basic information to pull up the details on any prescription we have for that person or their household, whether it is a phoned-in refill, a new prescription from the doctor's office, or even if it was brought in by a family member. We've made Brittany the trusted source for information on prescription status. Pharmacists aren't involved and she doesn't have to ask six people before she finally tracks something down. She can tell you about your prescription, your family's, and your pet's in one stop. Filling every prescription correctly is a critical part of running a successful pharmacy, but then you have to make sure that each one of these reaches the right person promptly.

CT: Can you give us some examples of how this works?

Burke: Sure. We often have a situation when we need to know that a customer not only has a prescription in standard will-call, but that he's got insulin waiting in the refrigerator as well. Or, there are the times when a family member has picked up a prescription already. Brittany has all the information and she can say: "Your wife picked that up at 11:42 this morning." In a case where the prescription isn't ready, she knows the status without having to ask around - for example she knows if we've faxed a refill request to a doctor, the exact time this fax went out, and what the refill status is. All this information has been tracked and made available to her automatically. Another great example is when someone has asked for a delivery, but then a family member who's unaware of this comes in to pick up prescriptions. Without workflow, we would not know where the prescription is and we would spend a lot of time looking. In general, you don't have issues when things are simple, you have them when things get complicated. Using Symphony workflow means that we can handle every customer efficiently and effectively because we have a status trail for each prescription.

CT: So you and your customers see some major improvements in efficiency from workflow.

Burke: Right. Our clientele has ongoing prescription needs. Many of them come in once or twice a month. They don't want to have an extended wait. They need prompt service. If I can't get their prescriptions to them quickly and accurately, then they may go elsewhere. This efficiency also means that we have more time to talk with them about other items they might need to support their health, HME/DME for example. Think about it, when you are filling 400 a day, you will have hundreds and maybe a 1,000 plus prescriptions in will-call at any given time. We have to have a process to manage this. Which brings up another piece of technology that I'm excited to implement. We're going to start using the call-back feature in our Voice-Tech IVR soon. If you don't come in to pick up your prescription on the day that our cashier has scanned it into will-call, IVR will call out with a generic reminder message that evening. This will be an opt-in program and it is going to do a lot to reduce the effort it takes to manage will-call, to improve service, and to increase sales.

CT: This sounds like a good example of the importance of having your systems integrated. Tell us more about how you tie all your systems together.

Burke: Innovation builds the Symphony workflow with what's called an open architecture. All this means is that the system plays well with others. You'd have to hunt for someone they don't or can't integrate well with. They run on a true Windows system that is up-to-date, which makes integration almost automatic. In our pharmacy, all the data flows from the Voice-Tech IVR into our QS/1 system and then on into the Symphony and back again seamlessly. Symphony knows when QS/1 has produced a paid claim, which has likely been routed into it by IVR. If you are still writing down numbers from phoned in prescriptions and typing them into your pharmacy management system, you are wasting time and money. I thought I did it better than a machine, I was wrong. We can not service hundreds of calls and hundreds of live people on current reimbursement levels without the use of technology.

CT: So how do you assess the overall value of the workflow system to your pharmacy?

Burke: You are gaining control over your work. I arrive in the morning and feel that I am in control of how the day is going to go. I love this and my staff loves it. My customers were happy to begin with, but they are happier now. You must impress the customer every visit. Any independent pharmacy has to in order to stay in business. But, we all have to realize that we aren't the best at everything all the time. We need technology to backstop us.

CT: What's your advice to your colleagues looking at adding workflow?

Burke: I kicked around the idea of doing this for about a year. I thought about it for a long time because it is a major capital investment. You need to go to a trade show and look at the product. Spend an hour or two playing with it and ask all the questions. Go home, think about it and wait. Determine whether you need it. It was a long road for me to make the decision. I'm happy to be busy enough and in a position to make such a major investment. But with profitability declining, you have to be more and more efficient when filling prescriptions to remain viable. You need to have a network running in your store, you need the high speed Internet. Another thing is that you have to make sure your staff is going to be happy with the decision. But keep in mind that your people don't have to be computer experts to use new technology. Our technician who does replenishment for the SmartCabinet doesn't even have a home computer. Also, no one should worry about losing a job. Workflow is about making your process seamless. Ultimately it has been one of the best investments I've made in my store. I've walked in the shoes where I read about someone with a new piece of technology and said, "That sounds great, but that guy must be loaded." We all have to make hard decisions about how to invest in our stores. Take your time making the decision, but don't be afraid to make the investment.