ScriptChek was founded a little over eight years ago when CEO Stacy Kaufman saw an opportunity to improve how well patients understand their prescription medications. First came the company's extended tab label, which provides more real estate for printing information. The most recent development is a 2-D printable image library that can be printed on vial labels and patient information leaflets. In this interview ComputerTalk senior editor Will Lockwood finds out about Kaufman's thoughts on patient safety and best medication information practices.

CT: Stacy, what's driving the need for more space on labels and for this pill image library that you're developing?

Kaufman: It's very interesting to me as we talk to the software providers and the national chains about labels and making sure patients understand their medications. Bring this up, and everyone starts talking about California and Oregon. These states and are trying to help the consumer, and states keep coming up with new requirements for labels and patient information to further this goal. Another example that's very current is the effort underway to provide better information about prescription medications containing acetaminophen. Acetaminophen overdose, often through the combination of prescription and OTC products, is a very serious safety issue, and one stated goal has been to spell out the ingredient name so patients are better informed.  This will take more label space.

So, in general, for the pharmacy, it gets harder and harder to comply with all of them, and they all place a premium on the space on the label. Then there are the pill images, you might end up putting these on the patient information leaflet. But patients don't always look at or even keep this. If you can put it on the label, then in many cases you are both addressing regulations and helping the consumer. But again you run into a label real estate problem. In my opinion, once you have the ability to print pill images, the pill vial is where people will want them. Then it's a question of finding room, which the extended tab label provides.

CT: What kind of information goes on the extended tab currently?

Kaufman: This really depends on the pharmacy. Most really use it in two ways: either printing whatever variable data you might want for that customer, or using all or part of the room for a preprinted message. It allows you to do some marketing or some very basic MTM and medication regimen compliance messaging. In the latter case, pharmacists can use the extra label room to provide more and better instructions on how to take a medication. This may also be in a patient information sheet. Realistically speaking, though, the label is a much more effective place for key information, and your standard label just doesn't have room.  These are just a couple of examples.  The sky's the limit, really. We are just providing the real estate and it's up to the pharmacy to put it to the best use.

CT: Stacy, the pill image library you've developed is a relatively new product, right? Where do you see them being used most effectively.

Kaufman: First, let me note that we're in the process of rolling this printable 2-D pill image library out to the broad market. Our images are based on the graphics from both First DataBank and MediSpan. We have customers using our extended tab labels who are ready to go live with the 2-D pill images, and we've partnered with one of the larger software companies to incorporate the pill images in to the system.

When it comes to where they can have an impact, just take a look at older patients and others who are taking multiple medications. It's such a confusing proposition.  If we really want to do the best job we can educating people about what they're taking, I don't know of a better place to do it than at the point of dispensing.  And then if we can put readily understood information about a medication, such as a standardized pill image, right on the viable label, I believe this is going to be a big help to patients.

Take the simple example of someone who's on multiple medications who accidentally spills some of them. How does this person or a caregiver go about figuring out what those pills are? If you've got pill images, that makes a huge difference.

CT: Pill images have become a significant driver of safety within the pharmacy dispensing workflow. Where do these 2-D printable images come in?

Kaufman: Well, there's an important difference.  The visual verification images used in the pharmacy workflow were never intended to be printed. So they aren't going to turn out very well if you try to put them on a vial label or patient information sheet. The pill images we've developed are modified line drawings that show you the shape of the medicine. They are strictly black and white, so they print easily. These images are also sized uniformly so that can be easily scaled up or down depending on how it needs to be printed. We have 64 shaded images, which represent over 28,000 drugs by shape only, excluding the imprint information, which can be printed beneath the pill shape. Let's say that's our first step. These representations cover not only oral solids, but many other delivery mechanisms as well: powders, eye drops, creams, and inhalers, for example. Based on these images, we have over 1,000 specific detailed drug images, and plan to grow that to 2,500, which we feel is a good target right now to cover 90% of medications dispensed.

Examples of the 2-D Pill Images

CT: So what's important here is creating visual representations of medications that are geared toward patients.

Kaufman: Yes, that's right. Our goal was to create images that are consistently represented in a standard way and that are easily comprehended, which is critical for the patient.

CT: To wrap up, what are the resources you go to when you want to move the case forward for giving patients better information about their medications?

Kaufman: One organization we've worked with from the start is NCPIE [National Council on Patient Information and Education], because it takes a stand on a lot of the core issues.  We're also working with NCPDP and FDA, where I've already spoken twice about patient safety and prescription drug labeling.