You know that when you make your pharmacy the hub for information flowing among your healthcare partners and your patients, you are doing it right. Here we’ll take a look at the core communications tools at three pharmacies, and find out how they are deploying systems to address a range of needs.
Priyank Patel, Pharm.D., is the owner of Felicity Pharmacy, a community pharmacy in the Bronx, New York City. Patel has doubled the pharmacy’s prescription volume while also expanding clinical services. He has done this in part by building on communication and collaboration tools that automate processes. Patel highlights two crucial messaging automation features built into his PrimeRx pharmacy management software from Micro Merchant Systems. The first is a real-time benefit check done via Surescripts. “This benefit check means that our pharmacy team can view the costs for several different therapeutic alternatives for a patient,” Patel says, “and work with a prescriber to ensure that cost is not a barrier for starting a therapy and being adherent.”
For example, a doctor may prescribe a blood thinner that comes with a $150 copay for a patient, according to Patel. “The majority of the patients we serve are on Medicare and Medicaid,” says Patel, “and we know that it’s not going to be possible for them to afford a $150 copay.” Fortunately there are plenty of other blood thinners out there in this same class, and the Felicity Pharmacy staff can use the real-time benefit check right within the PrimeRx workflow to review the lower-cost alternatives. “Then we just click to submit an electronic change request via Surescripts to the doctor,” says Patel, “and we’ve avoided the stress and inconvenience for the patient that used to come with making a trip to the pharmacy, only to have to wait while we got on the phone with the plan and prescriber to try to lower the cost of the copay.” Patel’s staff gains a tremendous amount of efficiency with this tool and, even more importantly, they eliminate the risk of the patient going home in frustration without a critical medication.
Joe Moose, Pharm.D., is one of the owners of Moose Pharmacy along with his brother Whit. There are eight locations in North Carolina. The Mount Pleasant pharmacy has been at the same location since it opened in 1882. Moose Pharmacy has been a pioneer in care documentation and collaboration with the Pharmacists eCare Plan, and as part of the CPESN network. While the eCare plan is technically a standard rather than an application, and one that pharmacists may see as a way to be paid for services, Moose has found that it is central to Moose Pharmacy’s communications efficiency and both internal and external care collaboration.
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For example, Moose has found documentation critical for sharing what he calls clinical pearls with prescribers. “We use Parata automation to provide adherence packaging for our patients, which we call Moose Packs,” he explains. “We’ve been able to take a patient, for example, on eight medications from being 50% adherent to being over 99% adherent. We document our success in the eCare plan, and this is then the reference point when we reach out to prescribers or payers to say ‘Hey, you have a patient on three blood pressure medicines, but they were taking all three of them about half the time. We’ve been working to get them up to nearly 100% adherence. They may not need all three now.’ This creates an important connection for us with the prescriber community.”
Documenting Your Work
The eCare plan is also making a wide range of information easily accessible to the pharmacy team. Moose has a story that provides a good example of just what he means. “This happened very early on in our use of the eCare plan,” says Moose. “My office is in the back of the pharmacy, and I heard one of my pharmacists [on the phone] recommending epsom salts soak to a patient for her feet. An hour later, the patient comes in, the pharmacist she spoke to on the phone is on break, and no one else knows what their conversation was about. So employees in the pharmacy start asking each other, did you recommend something for Mrs. Smith on the phone? This is very disruptive to the entire staff. But the pharmacist had actually documented the call in the eCare plan. I thought to pull that up, and there it was: epsom salts. Every time I tell this story, every pharmacist in the room shakes their head because this has happened in their pharmacy too.” Once using a collaborative documentation portal like the eCare plan becomes the standard of practice for a pharmacy, as it has at Moose Pharmacy, it’s the team’s first stop when a question arises.
This has brought substantial operational efficiencies to the prescription-filling side, according to Moose. “While payment for services is definitely where I see the puck headed,” he says, “dispensing as efficiently as possible remains crucial, since that’s still where pharmacies earn the bulk of their revenue.” For example, Moose reports that documentation increases communications efficiency around opioid dispensing. “It’s as simple as having a record of the call or interaction when a patient may have asked to have their opioid prescription filled early,” says Moose. “It’s not uncommon, unfortunately, for patients to ask different staff about this over several days, and when we’ve been able to just look in the eCare plan documentation and let that patient know that we’ve already addressed the fact that we cannot fill this early, that’s really cut down on this behavior.” Moose also values this record of interactions because it demonstrates the care with which the pharmacy is managing such an issue. “Our dispensing workflow gives us a record of what we do,” notes Moose. “So we can look at that and say, yes we’ve refilled this prescription three times. But it doesn’t record the times we may have declined to refill it. The eCare plan does this, and I think it’s a good way of communicating to regulators what we are doing to be good stewards, in this case by addressing potential for opioid misuse.”
Messaging for Patient and Staff
Heather Ferrarese, Pharm.D., is a second-generation independent pharmacist and owner of Bartle’s Pharmacy in Oxford, N.Y. She still works alongside her father, Brian Bartle, R.Ph., who opened the pharmacy with her mother in 1963. Ferrarese reports relying on the secure text messaging feature in DrFirst’s Backline to communicate efficiently with patients in the pharmacy’s large med sync program. As any pharmacy knows, it’s not easy to get patients on the phone when you need them. And then when a patient calls back in reply to a generic voicemail from the pharmacy, which necessarily can’t include any PHI (protected health information), the staff can’t always easily figure out why. So instead of leaving voice messages, Bartle’s Pharmacy uses Backline to send out a text that’s carefully branded so that it is clear that the message is from Bartle’s Pharmacy. The patient clicks through to a HIPAA-secure message. “When that patient has a few minutes, or when they get home and they have a chance to look at their medication, they can get back to us,” says Ferrarese. “It could be three o’clock in the morning, but we’ll have the reply queued up in our system in the morning and can move forward with the med sync.” Ferrarese has found that this text-driven process is popular with both the pharmacy staff and patients, even older patients. “Everyone texts these days,” she says. And if the patient decides to call in to the pharmacy in reply to the text message, the staff have an easily accessible record of the communications out to them, making it simple to understand the reason for the call.
While Ferrarese highlights this use of Backline to streamline the med sync communications flow, she notes that it also offers a number of other useful communication and collaboration tools. “Staff can use Backline from a mobile device or desktop computer to communicate securely with each other, both one-to-one and as a group,” Ferrarese says. “We can also initiate a variety of interactions with prescribers that can include documents we upload, such as details for a prior authorization or a response we’ve received from a payer. Backline is just a really valuable tool for us.” This is, notes Ferrarese, just the kind of efficiency-oriented tool that Bartle’s Pharmacy has needed in order to be able to roll out critical services during the COVID-19 pandemic. “We’ve provided vaccinations to 20,000 people and partnered with the Department of Health and Human Services, eTrueNorth, and Health Mart to provide PCR [polymerase chain reaction] testing,” she says. “This has been a significant amount of additional work for pharmacy staff and very important in helping Oxford reopen in the face of limited testing capacity in our area. For example, Bartle’s Pharmacy has been able to provide twice-weekly testing for nursing home employees, without any expense to them. We continue to do this, and one reason we have been able to find the time to do so is how efficient we’ve become in other areas of our pharmacy work.”
The Benefits of Mass Messaging
Priyank Patel has found that text messaging integrated into his pharmacy management software is central to his efforts to connect with Felicity Pharmacy’s patients, especially when he can easily send out mass text messages as a step in the process of informing and educating patients. “Micro Merchant has done an excellent job of integrating text messaging into PrimeRx,” he says. “There are so many things we can do with texting, right from within our dispensing workflow, from general messages that our staff can type in for a patient, to updates on refill status and pickup reminder sequences. The biggest thing right now during COVID, though, is that we’re trying to communicate to everyone to get tested and get vaccinated.” For example, Patel reports creating a mass text message within the PrimeRx SMS (short message service) tool with a link back to a form that patients can fill out to schedule a vaccine or testing appointment. “As we’ve used this, we’ve actually had a lot of patients respond back that they didn’t know they could get the vaccine or a test with us,” he says. Patel is also relying on this ability to broadcast the pharmacy’s services via text to get the word out about an A1C testing pilot program. “It’s so easy for us to text our patients, and we find that we are sparking conversations this way,” continues Patel, “whether that’s about the safety and efficacy of a vaccine or why A1C testing is important.”
Patel is also using the texting functionality in PrimeRx to provide patients with dose reminders. “We provide blister adherence packaging,” he explains, “and then we ask if the patient would like us to send text reminders during the day to take their medications.” This is all easy to set up within the pharmacy software, and provides a HIPAA-compliant message that’s still easy for patients to understand. “A number of our patients really appreciate these reminders,” says Patel, “and we also get a good response from prescribers when they find out that this is something we can do to promote adherence.”
Priyank Patel and Heather Ferrarese both mentioned how important their pharmacies are for providing vaccinations and testing for their communities. This is something Moose Pharmacy has been doing as well, and it’s an area of increasing importance for community pharmacy in general. This leads to a real need for efficient appointment scheduling, which Joe Moose says is a make-or-break area for Moose Pharmacy right now. He’s found a solution in a scheduling app from Acuity that lets patients book and pay for services if necessary, and even cancel an appointment. “As recently as two years ago, we used a Google calendar shared with pharmacy staff as a sort of day planner,” says Moose. “This was useful but lacked the patient-facing capabilities that Acuity has. Now we’ve got a full-featured, self-service scheduling interface for patients on our website, and we know internally what’s on tap for the day and for the week. How many COVID or other vaccines and how many COVID or other point-of-care tests do we have booked for each location? How many consultations with the pharmacist? We can see it all in one place across all our pharmacies.” This leads to more accurate staffing. “We can work to make sure we have the right amount of staff at the pharmacies with the heaviest workloads,” says Moose. “It’s making us more efficient as an enterprise.”
Unfortunately, Acuity is not a pharmacy-focused app and so it does not integrate with the pharmacy management system, notes Moose. That means that there’s real room for greater efficiency. “I think what all pharmacies want,” says Moose, “is to have robust self-service scheduling features like this integrated with the pharmacy system, and I know pharmacy vendors are working on this.”
Making It All Click
Hopefully the different examples offered by these three pharmacies make it clear why you will want to make sure that you have the right communications and collaboration tools at your disposal. It should also be clear that your staff, your patients, and the other healthcare providers you work with are ready to engage. “If you think that your older patients don’t use technology,” says Priyank Patel, “let me tell you that they do. We find that many of our Medicare patients are very comfortable texting with us. Even if the text is just an easy way to prompt them to call us, it’s still very useful. And we’re the ones, the independent pharmacies, who really know our local communities. When we’re able to reach out to patients efficiently, the relationships we have and the role we play in the community mean that we’re going to be able to help them understand their care, to give them their options, and to let them know why a vaccine, test, or therapy is safe and effective for them.”
Your staff is ready too, says Heather Ferrarese. “Our staff at Bartle’s Pharmacy are all very agile with their smartphones and comfortable in the world of messaging platforms,” she says. “So it’s natural for them to come into the pharmacy and use the same kind of tools to connect with patients and to interact with each other in a way that lets them post messages any time, see when others have read and responded to them, and easily track the message flow.”
In fact, you can look at these tools as bringing the same kinds of accountability and transparency to your communications and collaborations as the workflow module in your software brings to prescription filling. “When the phone rings or we talk with a patient or prescriber now,” says Joe Moose, “we have workflow steps to document what we’re doing. We are opening up the eCare plan and we’re creating a record that’s available to all our staff. Just like with dispensing workflow steps, the pharmacist on the next shift or the pharmacist working the next week knows exactly who did what and when.”
There’s room for these tools to grow in importance, too. For one thing, secure messaging is in its infancy, relatively speaking. (For more on this, listen to our podcast with Integra’s Louie Foster.) But you can also listen to Joe Moose who, as usual, is thinking a few steps ahead. Moose offers this suggestion to all the software vendors out there that are developing documentation and collaboration tools: “Make it so that the notes are structured. Right now we are typing a bunch of free text, and that’s not standardized or easily searchable. For example, give us tools to help pick the right SNOMED codes to populate the eCare plan with as few clicks as possible. I’ll tell you, there’s a real sense of urgency to have this type of structured input within collaboration technology.” The goal for pharmacy, in Moose’s opinion, is to keep pushing vendors to build ever more intelligent systems that build on the pharmacy’s position as the hub of care in the community. Intuitive interfaces for all users can make the connection between patients, staff, and providers as easy as a click. CT