These systems are the technological heart of a pharmacy’s operations, and, like a heart, in the best possible circumstances they work day after day with only basic care and maintenance. But if this is no longer the case, it will be time to go shopping. Whether you are opening a new store or have run into issues with your old system that have made you realize that it’s time to move on, this is a big decision that requires careful thought.

The Change Decision Process

Naturally, there’s going to be variety in the motivations behind this decision to move to a new pharmacy management system. It may be that the old system works well enough, but doesn’t truly meet your current needs. This is the case at Falls Pharmacy, a small independent in the East Falls section of Philadelphia, where co-owners and pharmacists Gen Levans and Beth Dewan have found out that, after seven years in business and with the complexity of their daily activities increasing, they are ready to switch systems. For example, like most pharmacists Levans and Dewan face new regulatory requirements and business opportunities that they are looking to technology to help them with. After Levans and Dewan considered what they need and calculated the price to add each feature to their current system, they realized that they would do well to think about buying a new system instead. “We’ve been talking to our fellow pharmacists, as well as looking at the system endorsed by our wholesaler,” Levans says. “Beth and I are looking for a new system that integrates all the features we want, rather than making us add them piece by piece.”

Another possibility is that your system isn’t working as advertised. For example, Astrup Drug’s migration to HCC’s Synercom system began when Tim Gallagher, VP of pharmacy operations, saw that his existing pharmacy system wasn’t getting the job done. Astrup, a small family-owned chain based in Austin, Minn., was filling 200 prescriptions a day, seven days a week, at each of 10 retail pharmacies (eight Sterling Drug Stores and two Clancy stores), as well as running a central-fill operation and a closed-door LTC pharmacy. Volume was growing and problems were accumulating, particularly in the retail setting. For example, claims were disappearing and there were pricing problems. Patients were waiting an inordinately long time for their prescriptions. Gallagher was under pressure to make things work so the stores wouldn’t lose business. He knew it was time for a change.

And sometimes it comes down to the simple fact that your pharmacy management system is hardly working at all anymore, as was the case for pharmacist Scott Guisinger, president of Medicine Place of Rome in Rome, N.Y. He and his partners run a clinical pharmacy focused on helping patients manage disease states, and average 2,600 prescriptions per week. With six pharmacists supported by 11 staff members, Guisinger estimates that patients talk with a pharmacist at least once every other visit. “Our patient-centric focus requires plenty of time to counsel patients,” he says. When Medicine Place of Rome’s six-year-old pharmacy management software started freezing up regularly, the result was a significant decline in efficiency and service levels. “We got to a point where we were having to reboot workstations two or three times a day,” says Guisinger. “At first we thought it was a hardware issue, so we upgraded. But the problems persisted.” When efforts by the former system vendor to isolate the cause of the freezing didn’t prove successful, Guisinger and his partners knew that they were looking at installing a new system. Of course, this could have meant buying an upgrade from their old vendor. Instead, Guisinger and his partners recognized this as a prime opportunity to shop around. “We liked the old system, but it was clear that we needed to move on and modernize our software,” he says.

Healthwise Pharmacy ran into a similar situation, according to VP Jeff Boltinhouse and pharmacy manager Marcie Parker. This Greenville, N.C., independent has developed a broad range of businesses since opening in 1998, with 40% of its business coming from HME and with compounding and home infusion therapy mixed into the prescription side. As the pharmacy grew, Boltinhouse and Parker say, its old pharmacy management system wasn’t able to keep pace. “The old software would only allow us to submit a claim for one prescription per patient at a time,” says Boltinhouse. “We’d have to keep any other prescriptions on hold until the current claim was adjudicated. And the system took an extraordinary amount of time to get claims approved.” This caused serious backlogs, and each new prescription added to the filling queue caused the system to slow down. This was a critical issue, of course, but it wasn’t the only one. The old system lacked the ability to handle nursing home medication administration records. It didn’t permit for frequent, automatic updates of acquisition costs, making it hard for Boltinhouse and Parker to know what their current gross margins were. It required system updates from CDs, which took hours and had to be done when the pharmacy was closed. And it couldn’t handle Healthwise’s HME business. Ultimately, according to Boltinhouse, they took a look at the state of their software and hardware and decided to make a move to QS/1’s NRx system.

Integrating Features and Systems

Once you’ve decided to get out and look at new systems –– whatever the reason –– the next set of difficult decisions will likely center around the question: What features do I need? Falls Pharmacy’s Levans says that, of all her priorities, there are two things she must have integrated into any new system — prescription scanning at intake and electronic signature capture. Ranking right behind these two are pill imaging for verification, the option for an integrated IVR, a reliable off-site backup service, built-in accounts-receivable management, batching of insurance claims, and an integrated third-party online preedit service. And that’s not all. Automatic price updates are on her list as well. “Every penny counts in this business,” Levans says. “We want to be assured of being fairly reimbursed when we’re not present to physically check every price.” Falls Pharmacy also serves assisted-living facilities and offers vaccinations, activities that would be supported by Levans and Dewan’s ideal system. “We want one computer to be able to track these services so that we don’t have to bounce between the pharmacy system and a laptop,” Levans says. This is quite a list, but it nicely shows the demands that a typical pharmacy is making on technology today. Fortunately, Levans and Dewan should have some luck finding a system with these features as part of a package.

For instance, the integration they’re looking for is no pipe dream. Scott Guisinger, who was on a very similar mission to consolidate and integrate Medicine Place of Rome’s technology, certainly found what he wanted. He and his partners tried out 10 different systems, either in person or through a remote demo with phone support. They decided to make the switch to Micro Merchant Systems based on the range of integrated features that its PrimeRx platform offers. “We were running separate workflow and house-charge A/R software alongside our old pharmacy management system,” he says. Now, Guisinger has both these functions integrated with the pharmacy management software, which allows his staff to work with one system all the way from data entry to final verification and drug pickup. “Going from three systems down to one means that we don’t have to worry about interfaces,” notes Guisinger. They’ve even extended their technology integration by installing Micro Merchant’s point-of-sale (POS) system with delivery tracking. The best thing of all, in Guisinger’s opinion, is that there’s no longer any question of whom to call if there’s a problem. One vendor handles it all.

Astrup Drug’s Tim Gallagher has also seen benefits from the one-stop shopping that an integrated offering provides. His decision to go with HCC means that Astrup Drug now runs the Synercom pharmacy management software with RX-1 workflow and centralized data access, as well as claims switching, DME and long-term care software, and an in-store security system. There will also be a front-store POS system before the end of the year. The prospect of having access to a full range of products from one vendor appealed to Gallagher. But it turns out that he was not originally inclined to take the whole package. Specifically, he did not see the need to move to the vendor’s Freedom Data Services (FDS) claims-switching service. But Gallagher maintained an open mind and listened to the arguments in favor of this change. “HCC showed me that, if we tied everything together, there’s value,” he says. Now he sees that it was a good decision. “It’s a partnership,” he says. “And we decided to do everything with them.” He was also impressed with the company’s willingness to hammer out a solution to the unusual structure of Astrup’s central-fill operations –– six ScriptPro robots in one location that fill not only their own prescriptions, but also serve as the engine for Astrup’s Smart Fill central-fill program used by a few hundred other independent pharmacies. Overall, the results at Astrup Drug have been very positive. The workflow module offers some particularly attractive features, according to Gallagher, such as a hard stop in the filling process if the NDC number is incorrect; visual checks during the prescription-filling process, including pill images and a prescription image; and a searchable electronic log of who did data entry for a specific prescription and when it was filled. And while the upgrade to the new workflow concept caused some resistance among Astrup Drug staff, everyone is now supportive of it. “There is a lot more accountability,” Gallagher says. “We’ve virtually eliminated errors, and our billing is much more accurate.”

Joseph Afolabi, who fills an average of 120 to 150 prescriptions a day at his West Grove Pharmacy in Orlando, Fla., can speak to two other items on Levans and Dewan’s list: prescription scanning and batch claims submission. The convenience of integrated prescription scanning is one big reason why Afolabi chose to go with a new system, DAA’s Visual Superscript, when he opens a pharmacy in Tampa this fall. About the ability to batch claims, another reason he chose to expand with a new system, Afolabi says, “I can tag three or four prescriptions and send them all at the same time. This saves on time and cost.” Afolabi mentions two other reasons for the change. First, he has the ability to set the computer to default to a specific generic NDC in stock. This way, in cases where a substitute pharmacist would otherwise have to choose from a list, the DAA system will make clear which NDC Afolabi prefers to dispense in order to get the best profit margin. “Not only does it increase accuracy,” says Afolabi, “it also saves time and helps fill-in staff select the appropriate drug.” Second is a nice feature that Afolabi wasn’t expecting, but that he will look to make good use of. This is an ability to use the information in patient profiles to send out a special greeting, perhaps for a patient’s birthday; promote store specials to a certain category of patient; automatically identify refills due; or even offer counseling for a specific disease state. “This lets me do marketing,” he says. “I can develop a program that will bring these patients into the store.”

Specialty Features

When it comes to deciding on what features are going to be most important to you in a new system, you shouldn’t forget to consider any niche businesses that you’re in –– or that you plan to be in. For example, Levans and Dewan are excited about offering MTM services. As a result, they’re going to want the ability to record detailed notes about counseling and disease state management in patient records.

For another example, Jim Greene’s Skrip Shoppe in Greer, S.C., has a specialty in compounding, which turned out to be the driving force in his decision to switch to Speed Script. After using his old system for seven years, he was looking for new pharmacy management software that would tie in better with his compounding software. This need ended up making his choice easy. “I really only looked at one system,” Greene says of the process. “I liked Speed Script, and when I learned that they had the interface with PK Software [for compounding], that was all I needed to hear them say.” This interface allows the Speed Script system to track all lot numbers and expiration dates for compounded prescriptions, which is ex-

tremely important, according to Greene. For example, Greene’s pharmacy management system will alert him if an ingredient in a compounded drug that he’s filling is out of date –– before he begins compounding the prescription. “It’s a great safety feature and makes the workflow so much better,” he says. “Also, I print the lot number and expiration date on the label. The interface means that all the information I need is there.”

At Healthwise Pharmacy, HME was the business that Jeff Boltinhouse and Marcie Parker wanted their new QS/1 pharmacy management system to handle. “NRx allows us to have both our HME and prescription-processing software on the same server,” explains Boltinhouse. This single-server approach has been a valuable improvement that allows the staffs that handle these two different business lines to share data.

Jahan Shams is pharmacy manager at soon-to-open Riverside County, Calif., Rubidoux Pharmacy, which has also had to focus on needs specific to its special mission. “We are opening to serve county employees and act as a 340B site for a nearby clinic,” explains Shams. A county-convened selection committee finally settled on Cerner Etreby after looking for a vendor that offered strong interfaces to unit-dose packaging systems and automated counting. There also had to be appropriate 340B features that would support a separate physical inventory for the clinic, as well as the cost, price, and reporting demands of this federally sponsored discount-drug program. Finally, the county, which runs a network of similar pharmacies, needed the new system to interface with its centralized server.

Multisite Needs

So far, we’ve heard mostly about features that affect what goes on within a given pharmacy. But Riverside County Rubidoux Pharm- acy’s need for a central-server-ready system raises an important point. Whether you already have multiple stores or you are planning to expand, you’re going to need to think about how a new system will handle the complexity that comes with multiple locations and how it can keep your pharmacies connected to each other.

In fact, planning for growth is part of the decision that Falls Pharmacy’s Levans and Dewan are making. They want to be prepared when they add a second location. So their next system will need to be able to offer multistore capabilities. Multiple-location-friendly features are out there, something that Gail and Roger Helling, owners of Family Pharmacy Management, can speak to.

Since buying a Medicine Shoppe in Washington, Mo., they’ve developed a specialty in buying and managing pharmacies in rural or small communities in Missouri and Illinois. They are up to five stores now, with a goal of owning six to eight. And while they still have one store under contract with another pharmacy system vendor, they’ve made a conscious decision to convert all their stores to McKesson’s Pharmaserv platform. This includes their most recent acquisition, in Chester, Ill., which went live on Pharmaserv at the end of September. The nature of the Helling’s business model gives them an excellent perspective on the reasons for converting to a new system at the stores they acquire. “In the stores running Pharmaserv, we have uniform reports, uniform training, and one vendor contact,” explains Gail Helling. “We intend to have all our stores on the same platform eventually.” And while the Hellings are still looking to put in a chain-host system as they continue to grow, Astrup Drug’s Tim Gallagher knows just how valuable it is to get a group of pharmacies connected. The central-management feature in Astrup Drug’s HCC system was a definite upgrade from the old system, which offered the feature but didn’t live up to expectations. Now, Gallagher has the power, flexibility, and peace of mind that a central server should offer. “With the centrally managed database, there’s redundancy,” he says. “And our stores can access the information on the server independently of each other. So, if we have a power outage at one store, it doesn’t affect the rest.”

OK, But How Much?

Clearly, there are many great features to be had, no matter whether you’re looking to run the most cutting-edge retail system or have niche needs. But a very important question is: How much? Pharmacists demand a lot of value from their systems, and rightfully so, considering the pay environment. West Grove Pharmacy’s Joe Afolabi, for example, wanted to keep his technology costs down as he builds volume at his new Tampa location. “With reimbursement so low, you have to look for a system that is cost-effective and doesn’t erode your bottom line,” he says. The good news is that Afolabi isn’t the only pharmacist who has found the right combination of features at the right price. Scott Guisinger and his partners at Medicine Place of Rome had cost right at the top of their list as well. “The economics were a big part of our decision,” Guisinger says. “We saw other systems that had similar packages, but PrimeRx integrated everything and did it so economically.” Rubidoux Pharmacy’s county mandate means that the features of its Cerner Etreby system had to come at the right price, too. In Jahan Sham’s opinion, keeping a system economical really comes down to understanding your circumstances. “At Rubidoux Pharmacy, we needed a system with strong features for a retail setting,” Shams says. “If we were looking for software for a county hospital pharmacy, we’d need different, more clinical features, such as interfaces to patient and lab data. But we didn’t want to pay for more complex capabilities that weren’t necessary.”

Making the Transition: Conversion

The process of moving to a new system doesn’t end with the selection of a new vendor, of course. You’re also going to have to convert the data from your old system. Family Pharmacy Management’s Gail Helling offers some very sound advice on this topic. “Your success depends on the integrity of the data you are converting from,” she says. As an example, Helling mentions a conversion from a system that was really old. “It was one of those that had been through all kinds of people’s support,” she explains. “We eventually had to give up. We had to pull each customer over individually to get the new system populated with data, which was hard work.” Not to worry, though: Helling’s story is a worst-case scenario. Overall, she characterizes the conversions she’s managed to Pharmaserv –– generally handled by Two Point Conversions –– as pretty straightforward. “You’ll want to hang on to your old server for about a year to make sure that you haven’t lost any information,” she advises. And while Helling has never found the first week of a changeover to be fun, the main task, in her mind, is to keep your perspective and maintain a good attitude.

Two Point Conversions also handled Medicine Place of Rome’s conversion, a process that Scott Guisinger characterizes as generally smooth. “From the day we selected our new vendor, to going live, it was about five weeks,” he says. His biggest concern was that patients’ insurance profiles move over correctly. He was able to check on the success of the conversion by using a private connection that Micro Merchant Systems set up to its servers, which allowed Guisinger to review his data and make sure everything looked right. He identified two issues. “BINs didn’t come over cleanly,” he says. This was solved readily enough. Guisinger printed a list from his old system and Micro Merchant staff entered the data by hand. There was also a problem with getting allergy information and snap/lock-cap flags transferred. “We had to ask people about these again,” says Guisinger. This was a minor inconvenience, in the grand scheme of things.

Making the Transition: Training

While you’re getting a handle on your data, you’re also going to want to turn your attention to the people who will actually put the new system into action: your staff. You can’t underestimate the importance of proper training. Thankfully, the modern networked environment lets vendors provide convenient, remote training in many cases. For instance, Scott Guisinger and his staff got their first look at their new PrimeRx system through a remote preview arranged by Micro Merchant Systems. They were even able to look at the store’s actual data. Similarly, Gail Helling has used online tutorials to train staff on Pharmaserv.

There’s a role for personal, on-site training as well. Helling’s commitment to using a single pharmacy management platform in as many stores as possible lets her draw on her experienced staff for training purposes. “Before we make the switch, we send staff from the pharmacy we’re converting to work at a store already on Pharmserv,” she explains. “Then, when we do go live, we’ll bring experienced technicians in to consult at the converting store.” In Guisinger’s case, the personal touch in training meant having two Micro Merchant employees on hand to handle any glitches for the first two days live with the new software. “They were able to adjust how labels printed and walk staff through the more intricate tasks, such as billing Workmen’s Comp,” Guisinger says. “The software’s design and the Windows operating system made the transition smoother than others I’ve been through. And while we did have to do some learning as we went at first, now we’re breezing through volume that was tough before.” Part of Guisinger’s comment raises an interesting point about both selecting a system and training staff on it. While it may seem to be a matter of preference, the operating system your new software runs on can make a difference both in your transition and in how happy you end up being with your new technology.

The OS Debate

Like Guisinger, Helling is a Windows fan, all other things being equal. “New employees are more likely to be familiar with it,” she says. “If you have any turnover, this will come in handy.” Guisinger and his partners also see some distinct advantages to a Windows-based system, beyond initial and new staff training. First, there were some Windows-based programs that they wanted to be able to run on the same workstations as their pharmacy management software. Second, web access is easier, in Guisinger’s opinion, both to give his staff access to Internet-based resources such as Facts & Comparisons Online and to allow Guisinger himself to interact with students for whom he acts as a preceptor. On the other hand, Tim Gallagher originally subscribed to the view that Windows would make life easier, since that’s what most incoming pharmacists and technicians are familiar with already. But he’s had no regrets about switching to HCC’s Unix-based software. “We’ve found the stability of Unix valuable,” says Gallagher. “And our staff has found the interface very user-friendly.” Count Skrip Shoppe’s Jim Greene in the Unix camp as well. “Our Speed Script system is extremely user-friendly and unbelievably fast,” he says.

Some Final Words

In the end, nothing about moving to a new pharmacy management system is simple, and pharmacies are different enough that there are no strict rules to follow. As Falls Pharmacy’s Levans puts it: “There is a big ‘what if’ factor to getting a new system.” Still, careful planning and research can help minimize any unpleasant surprises. “The best thing you can do is to sit down and think about what you aren’t getting from your current system, and what you want from a new one,” Scott Guisinger says. “When you take the time to prepare to shop for a new system, you’ll know when you are seeing the features you need and you won’t be swayed by things you don’t need.” Make a list, he recommends, and mark off which vendors can answer your questions and offer what you want. This way, you’ll be comparing all the systems you look at based on the same criteria. Gail Helling also recommends paying some attention to the people at a new vendor. “You’ve got to go with a system where you feel you can work with the people who will provide you with support,” she says, “because there will be issues.” And Marcie Parker from Healthwise Pharmacy suggests finding a pharmacist in your area who is using the system you’re considering. “See the system work and talk to the pharmacist,” she says. While you’re creating a plan and making the connections you need to minimize the uncertainty surrounding a new system, don’t lose sight of the many positives. These will come in many different, often incremental, ways. “If you can do a little more with the staff you have, that’s good,” says Helling. But for both Helling and Guisinger, the real return is from the sum of all the improvements that adding a new pharmacy management system can make –– giving better service. This is something any pharmacy will be happy with. CT

Will Lockwood and Maggie Lockwood are on the editorial staff at ComputerTalk.
They can be reached at will@computertalk.com and maggie@computertalk.com.