We collected 17 responses to our 2017 survey of chain pharmacy technology priorities, representing almost 5,700 pharmacy locations and with a strong response from midsized chains. What follows are highlights from the survey and a conversation about key areas between two chain pharmacy executives, Meghann Chilcott of Fred’s and Sam Haddadin of Associated Food Stores. The conversation ranged across topics such as the major push for technology to support clinical interactions; the best way to stay connected with patients; the key efficiency drivers saving pharmacists’ time; what makes for better retailing; and the current top regulatory and administrative needs.
ComputerTalk: Let’s start off talking about the big picture. What are the areas of greatest interest, the biggest trends that you’re seeing in the chain pharmacy market overall right now?
Meghann Chilcott: Clinical opportunities are really important in pharmacy now, ranging from managing adherence and managing medication therapy programs, to reducing our DIR [direct and indirect remuneration] fees. We use clinical programs, such as adherence programs, to help keep patients on therapy to reduce DIR impact. We‘ve been putting together programs that build around our implementation of a clinical software suite that will lay on top of our dispensing platform that’s in our pharmacies today.
CT: Interesting. That means bringing in separate software to address the clinical programs?
Chilcott: Yes. We are integrating a separate clinical platform with our dispensing platform
CT: Sam, what are you seeing as needs for pharmacy management functionality?
Sam Haddadin: We recently changed pharmacy systems, and one reason was that we needed a better foundation for managing things like transition of care, DIR fees, and adherence. We were doing things manually, and really, the most important tool in the pharmacy except for the pharmacist and the team is absolutely your pharmacy system. We wanted to make sure that we had a tool that would develop with the professional pharmacy so that our teams could really focus on taking care of patients.
CT: What are features in pharmacy systems that you see as needed to drive the clinical interaction?
Haddadin: I think a huge part of clinical programs in pharmacy is documentation. Frankly, a lot of pharmacy systems out there, their focus is filling prescriptions, versus a more clinically oriented application. This means that a lot of chains are actually going out and purchasing clinical management add-ons that overlay their pharmacy system, or are developing their own documentation system. That, to me, is one of the biggest challenges with our pharmacy teams: ensuring that they’re able to document clinical interactions and interventions. We’re working with our new vendor right now to implement a clinical program solution.
CT: Meghann, do you think the ideal situation is to have a single integrated platform for prescription dispensing management and clinical care management?
Chilcott: I believe that the best way to solve for that is to use two systems and bring them together through integration. The reason is that the purpose of these systems is different. The dispensing platform’s goal is to bill for a medication and get it out the door as quickly as possible. In some situations, that is the main task at hand — for example, when you have acute meds that you need to get out the door and there’s little follow-up needed. But for some more complex therapies and medications, like specialty medications, we do need to have a clinical platform that allows us to follow up with the patients. At Fred’s we do have both specialty and retail pharmacies, and obviously we want to have one view of our patient. So we’re integrating those environments together, but we are working on different platforms that we feel are best suited for the different purposes. It does not, to me, make sense to combine them together into one.
CT: Does this reflect the fact that there are different pharmacists in these roles?
Chilcott: Yes. We have two different types of pharmacist, one of which is focused on clinical care. We have a specialty-at-retail model where we actually bring that follow-up for those high-touch medications out of our retail pharmacies and into our specialty pharmacy, where the staff is dedicated to caring for those patients. The regular dispensing activities, however, are overseen by the pharmacists in our local stores.
Haddadin: For us, the pharmacists at the store locations are providing our patients with clinical services. I agree with Meghann 100% on the fact that your pharmacy management system in the store really needs to focus on filling prescriptions. I think the biggest challenge is getting the teams to have a seamless workflow when it comes to clinical interventions. This can be as simple as some sort of pop-up, just an alert to say that there’s an Outcomes or a Mirixa intervention available for this patient, or that this patient potentially has adherence issues, or this patient’s on an insurance plan that levies DIRs. At the same time, I think it’s important that the pharmacy team at the store has the ability to see the clinical as well as the filling workflow.
CT: In a way, this furthers Meghann’s rationale for having two separate systems, since every patient needs to be in that dispensing system, but not every patient necessarily needs to be in that clinical care management system. You might solve this by documenting within your pharmacy system, if that meets your needs, or by bringing on a clinical care management system.
Chilcott: Right. In the end, the most important thing is integrating clinical care into the workflow process. We have to make sure that the pharmacist isn’t having to spend extra time identifying or documenting a clinical opportunity for a patient. At Fred’s, we’ve spent a lot of time and effort ensuring that we chose a platform that will allow us to have a full integration. We’ve built it so that there’s messaging that’s part of the workflow, so that it’s not something that a pharmacist or technician or anyone has to think about while they’re actually trying to do their dispensing activities. When they’re in the process of completing a dispensing activity, we can alert them and tell them that they can click here, go into the other platform seamlessly, and finish that clinical activity if necessary.
CT: If you can combine the right kind of data integration with the right kind of processes within the pharmacy, then you don’t necessarily have to have one big platform that does all of these things.
Haddadin: Absolutely. Part of the challenge is, a lot of these pharmacy systems have been built over a long period of time with the foundation of filling prescriptions and not really documenting clinical services. Going back and trying to actually change the pharmacy systems is much more difficult. Considering what you can do with integration and outside applications now, it just makes more sense to have a bolt-on than it does to totally rewrite your code for your pharmacy system.
CT: Okay, let’s move onto another topic. We’re talking a lot about caring for patients. What are you seeing as the best ways to communicate with patients? I noticed the words app and mobile came up a lot in our survey.
Haddadin: I don’t know Meghann’s experience, but our experience has been that you want to offer an app, but that when we look at utilization it’s been relatively low. I think we have a pretty tech-savvy area in Salt Lake City. It’s interesting to see that everyone talks about mobile apps and web apps, but adoption by the patient is just not as dramatic as we would expect from as big of a deal as people make out of it.
From the Survey: If you could add one thing to your pharmacy technology suite, what would it be?
|• Drug net cost look-up to enable manual override for low income patients.
• Highlighting opportunities for clinical services.
• Clinical management services and billing.
• Quick views of month-to-date/year-to-date inventory usage.
• DSCSA [Drug Supply Chain Security Act] functionality.
• Med sync tools.
• Better will-call process.
|• Adherence functionality.
• Allow pharmacy application to run on mobile device (e.g., for use with flu clinics).
• EMR/EHR [electronic medical record/electronic health record] interface capabilities.
• Better multisite management and reporting tools.
• POS [point-of-sale] biometrics for Rx pickup.
• DIR [direct and indirect remuneration] fee management tools.
CT: Meghann, is that what you’re finding as well?
Chilcott: I have seen more adoption when it comes to text messaging for patients. Over the last few years, I’ve seen a huge uptick in the number of patients who have actually transitioned from preferring a telephone call to wanting to get text messages. But our app has seen much lower adoption from our patient population.
Haddadin: I agree 100%, Meghann. We’ve seen a huge adoption of texting versus the mobile app and the web applications. And we’ve seen the number of outbound telephone calls dramatically reduced in our pharmacies. Texts are just such an easy way for patients to get notifications.
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CT: A text is such a lightweight, asynchronous way to communicate. You send it out, they get it, they deal with it when they’re ready. And while the survey shows that pharmacies really value IVR (interactive voice response), it sounds as if what patients really value is text messaging.
Haddadin: Right. It’s a really simple process that has a big impact on important areas for the pharmacy and the patient. First, there’s patient convenience. There was a point where pharmacies were buying those paging systems so that they could page the customer in the store, but now our pharmacies just text them when the prescription is ready. If the patient’s in the store, they come into the pharmacy and pick up their prescription. If they’re not, they know their prescription is done.
And that convenience helps us meet our goal of reducing the amount of return to stock that we have in the pharmacy, which in turn means better care, since patients are only getting the benefit of their medications if they are actually picking them up. So, if text messaging seems to be the way that people want to go, that’s a communication method we’re going to focus on. I think a mobile app is important still. I think it’s nice to have a very clean interface mobile application, but we just don’t see the utilization as much as we do with a text.
CT: What are you seeing when it comes to centralization of tasks — and this could be centralization of filling, it could be workflow centralization or call centers. Is that something that either of your pharmacies are looking at or using?
Haddadin: For us at Associated Foods, we are looking at centralized services. I think the idea for us is to really take as much work as we can out of the stores, in order to help the stores loosen up their time so the pharmacist can really focus on clinical services and patient care. Our goal is to have our pharmacists practicing at the top of their license versus answering telephone calls. We’re also looking at central processing, and with our new pharmacy system we’re able to do that workflow balancing that allows a central site to help process prescriptions for the pharmacies.
From the Survey: Pharmacy Management System Satisfaction
|Half of respondents would recommend their current pharmacy management system to another pharmacy.
Just under half of respondents are planning to upgrade their pharmacy system or move to a new vendor.
Some of the reasons?
Chilcott: We have implemented technology that allows us to centralize tasks and distribute work among our stores, where it is allowed, using our pharmacy dispensing system. We are using data analytics and business intelligence to monitor this task distribution in near-real time.
CT: Okay. I do want to talk more about analytics and what you can learn from your pharmacy data. But first let’s back up and talk a little more about the focus on trying to give pharmacists the time to operate at the top of their license. Centralizing activities can drive that, it seems. What other technologies should pharmacies look to for saving the pharmacist’s time?
Haddadin: I think dispensing automation can be important here, but I also think the right workflow is extremely important. Auto refill and medication synchronization are two great tools to help the team work more efficiently. These are very good ways to ensure that the pharmacy isn’t scrambling every day and that patients aren’t waiting at the counter. Med sync allows us to work five, six days in advance and get the filling done in good time so that our pharmacists can then either focus on taking care of those patients who come in with an urgent need or provide clinical services to patients we’ve identified for that. The right workflow means that we are managing our time much better.
CT: You’re being proactive rather than reactive.
Haddadin: Right, absolutely. But while we’ve found that med sync and auto refill are actually tremendously effective for making our teams efficient, it’s important to realize that there are two separate populations, right? There’s your more urgent patient who’s got a prescription for an acute med, and having some dispensing automation in place — something as simple as a tabletop counter — is how you can take care of those patients in a more timely manner. But for your patients with chronic conditions that you know you need to see regularly, just working your workflow more efficiently is really what we found to be more successful for us.
From the Survey: Top Point-of-Sale System Features
|The Front End
Technology That Makes for Better Retailing
CT: I think that notion of having separate populations and knowing what needs to happen for each leads back into that topic of analytics and business intelligence. Meghann, can you tell us a little bit about what’s going on in this area at Fred’s?
Chilcott: For us it’s all about timely data. Historically, we’ve seen information the next day and we aggregate reports and we end up reacting to data. Now we’re changing our focus and building our platform so that we’re getting more timely information in real time during the day. We are able to make decisions because we know what is happening in our stores right now. We’re also focused on forecasting and predictive analytics. Machine learning and artificial intelligence are the next technologies that I am looking to use in our environment.
CT: We’ve identified a few important methods for driving a smoother workflow and addressing the needs of different patient populations. Let’s change gears a little and talk about addressing people’s needs as customers. What’s driving better retailing at chains now?
Chilcott: We’ve approached this using our mobile platform, which, for example, allows for digital coupons. Business intelligence comes into play here as well. We can see visitors that are in the front end of our stores, as well as those coming to see our pharmacists. We’re going to use that information to help drive the right opportunities for our customers, as well as for our patients.
Haddadin: From the pharmacy’s perspective, a lot of what we try to do is work to make our customers our patients, right? To that end we’re also utilizing a mobile application to offer rewards to our customers. Something else we’re doing is integrating our clinical services with our front-end grocery. For example, we’ll offer a diabetes walk in a store, where we have a dietician and a pharmacist walk around the store and work with a group of customers.
CT: So there’s a real opportunity in using some of that time that technology can free up for pharmacy staff to reach out to customers and patients. But it’s also interesting that this seems to be where the mobile app really shows value.
Chilcott: That’s right. We have historically looked at our mobile app as a pharmacy tool, something we offer patients for prescriptions refills and profile viewing. We’ve now repositioned our mobile app so that it’s an all-encompassing toolbox. It includes the front-end store — your coupons and rewards — and it still has the pharmacy functionality as well.
Haddadin: We actually are not really offering a pharmacy mobile app right now. Our pharmacy website is responsive and turns into a mobile platform when people access it on a mobile device.
CT: Okay. Let’s talk about regulatory challenges. There’s always something brewing there. What regulatory issues are top of mind?
Chilcott: From my perspective, data reporting has become a big challenge. It is getting more intense. We’ve got our controlled substance reporting, immunization reporting, and we’re even seeing states that are requiring that we submit to their centralized patient databases. As we’ve evolved with our technology, we’re seeing a much bigger push for us to provide information from our dispensing platforms. This has happened with data agreements with specialty, as well on the retail side with the data aggregators. It’s amazing how much that burden has been put on pharmacy chains or pharmacies in general.
Haddadin: Absolutely. We all know we’re in a regulated profession and we have pressures from federal and state agencies, but Meghann’s right — data is king nowadays. State and federal organizations are looking to the pharmacies to provide that data. So it’s critical to have the ability to do it. We’ve gone through several changes with our controlled substance database reporting, and having a good partner in a pharmacy management system is vital — not only because you want that pharmacy management system to be ahead of the game and not waiting for you to say, “Hey, we need to start doing this,” but also because you need a vendor that can actually adapt to what’s being required from the state PMPs [prescription monitoring programs]. It is quite dramatic compared to 10 years ago, for instance, when I think we would send them a disc. Now we have to FTP [file transfer protocol] to the PMP and to the state databases.
Chilcott: And in some cases, virtually in real time. Within five minutes.
Haddadin: Without a doubt I think it’s the right thing to do. And as technology advances, we should advance with it, and we shouldn’t become stagnant in technology and data reporting. But getting that data to where it needs to go from out of our dispensing system has definitely been a challenge for us.
There’s a similar demand for data from payers, too. They are increasingly looking for documentation, and that means it’s critical for our systems to ensure that our teams have a spot to document interventions, to collect the right data for Medicare Part B test strips, and so on. Really, responding to a lot of the third parties has almost been more difficult than working with the regulatory agencies on their requirements.
CT: Let’s talk about the big picture now to wrap up. How does all this boil down when it comes to strategy?
Haddadin: I think that our goals at Associated Food Stores are to be a good partner to our patients, a good partner to our communities, to do the right thing for the business, and to do the right things for the teams. In order to be a good healthcare provider, you need to exchange data, you need to move data back and forth. If I could pick one thing that would really drive all of those goals, it might well be a centralized patient record that all pharmacies get access to. That would reduce the amount of reporting that we would have to do, because then the states could just pull what they need from that centralized patient record. And we’d be able to better address a problem like transition of care, which is a big deal and where we see some real gaps. Having a centralized patient record that the pharmacies can work with in order to successfully transition a patient from a hospital to home, or the hospital to hospice or assisted living, would be gold.
But even still today, with the technology that we have, it’s interesting that we’re still working with data islands. A lot of systems just don’t want to talk to each other.
Chilcott: I think from a technology perspective, it all comes down to getting these integrations in place so that pharmacists and healthcare providers are not worrying about the technology, they’re not worrying about going into different systems for different tasks, and they’re focusing on the time that they have with their patients and improving the outcomes of those patients. CT