Chains, both national and regional, are aggressive users of technology in order to improve workflow and help the bottom line. In this year’s survey you will see where technology is being put to use to this end, and what the wish list is moving forward.
IT IS NO SECRET THAT HEALTHCARE is becoming more expensive in this country. According to a McKinsey report last year, titled “Trends disrupting pharmacy value pools and potential implications for the value chain,” consumer out-of-pocket payments for prescriptions are on the rise. Pharmacies are no longer enjoying the rich margins on generics, and pharma isn’t raising the prices on brand drugs, which has been common practice. Moreover, there has been a lack of blockbuster drugs brought to market. This is putting unprecedented pressure on pharmacy profit margins across the board. DIR (direct and indirect remuneration) fees are compounding the problem with the after-the-fact clawbacks of prescription insurance reimbursements. And with Amazon’s foot in the door, with its acquisition of online pharmacy PillPack, we have a scenario that doesn’t bode well for brick-and-mortar pharmacy.
So how does all this play out for the technology that pharmacies have become so dependent on to increase workflow efficiency, better manage inventory, and add clinical services to remain profitable?
We took a look with our annual survey of the chain segment. What we found is that chains continue to install new technology. Approximately eight out of 10 chains fell into this category. The range of what was added included compliance-packaging technology, enhancing central-fill automation, the installation of a new interactive voice response (IVR) system, and upgrading to a cloud-based IVR system. Also mentioned were installing new computers and going to a perpetual inventory control system.
The above dovetails nicely with our finding that two-thirds of the chains stated that they plan to upgrade their existing systems and two chains reported plans to change vendors. One gave the reason for the change as “the current system is very slow and not user- friendly. Takes too long to fill prescriptions.” Speed in processing prescriptions is to this day still a top-of-the-list priority.
If one enhancement could be added to the pharmacy management system, what would this be? Here we received a wide range of features. These ranged from biometric patient recognition, the ability to track controlled substances purchased versus dispensed for a given time period, and a way to quickly detect diversion. Also thrown into the mix was better electronic prescription processing, indicating that this isn’t a seamless process for many. Adding functionality that addresses electronic care plans also made the list. This indicates an interest in having software that will support collaborative practice agreements.
TECHNOLOGY THAT MAKES A DIFFERENCE
IVR, as in past surveys, came out the winner again as having the greatest positive impact on pharmacy productivity. Not being interrupted by phone calls is what IVR addresses, and a byproduct of this is that with fewer distractions from phone calls, one can infer that this can lead to fewer prescription-filling errors.
Running a close second are prescriptions arriving at the pharmacy electronically, commonly referred to as e-prescribing. Having these prescriptions appear in the to-be-filled queue has also had a positive impact on productivity and improving workflow. Also in the e-prescribing category are electronic prescriptions for controlled substances, mentioned as contributing to better productivity. Robotic dispensing also made the list, as did electronic prior authorizations.
Central fill is being used to smooth out the workflow in pharmacies, but this approach to filling prescriptions for the pharmacy locations at a central site is justified in the larger chains, those with 100 or more locations. This was the finding in this year’s survey, which paralleled findings in recent years where central fill was finally embraced as a productivity tool. Robotic systems are used here as well to handle the prescription volume at the central-fill location.
WHAT COUNTS IN SELECTING NEW TECHNOLOGY?
When deciding to implement new technology or to add an interface to the existing system, a range of approaches is used.
With implementing new technology, the lead reason to justify it is the expected return on investment (ROI). Along with ROI, one person cited “the impact on productivity and on employees’ work experience.” Another stated, in addition to ROI, “the lasting partnership opportunity, with the vendor, in advancing future growth.” Still another reason given was how well it integrates with existing systems and what the improved outcomes will be.
Adding interfaces had a slightly different set of criteria. Here we heard “ease of interface with most other applications,” and “the ability to integrate with other applications for a comprehensive experience.”
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Synchronizing the refills for a patient to all come due on the same date is a way to improve patient compliance with the medication regimen. So what has been the uptake on med sync by the chains?
We found that close to 80% offer a med sync program, and in all but one case this has led to an increase in the number of prescriptions filled by the pharmacies.
The yield here is a double whammy. Med sync is a way to address compliance, while it also brings in prescription refills that otherwise would not have materialized.
There is extra work on the part of pharmacy staff to set up such a program and then manage it. But the payoff is apparently worth it.
The results showed that the chains in the survey were fairly evenly divided in responding that they were engaged in specialty pharmacy to manage these high-dollar, specialized drugs. And where this is the case, most reported that they have installed a different computer system/software for use in this area of the pharmacy
WHAT IS STILL NEEDED?
Questions about the software application needed to improve operating efficiency and patient safety produced a variety of replies. These provide insight into how chain management views the enhancement potential in which pharmacy can improve its position as a healthcare provider. For example, one chain would like to see pharmacist video consultations for mail and delivery patients. Further in this direction was the “continued advancement of our clinical management platform with more integration into workflow, allowing pharmacists and technicians to practice to their highest levels of patient engagement that will enhance patient outcomes and safety.”
More along these lines was the comment of “scanning the prescription at the final pharmacist verification station that shows all interactions before the prescription is sent to will-call.”
Another respondent felt that adding software for an eCare plan would go a long way toward addressing the patient safety issue.
A national chain in the survey reported that Appriss Health’s NarxCare program was recently implemented, “ to help our internal red-flag process to identify high-risk patients to drive better patient/pharmacist interactions.” NarxCare assigns risk scores to patients for their opioid use based on data reported to prescription drug monitoring programs.
THE END RESULT
It is apparent that technology continues to be the backbone of pharmacy operations. But there is room for improvement that will help pharmacy step up its game in patient care management. This is apparent from what chains feel is still needed for the technology to better serve the pharmacy. What is clear is that chains are willing to invest in system upgrades, and when the current vendor isn’t living up to expectations, moving on to a new vendor. CT