Creating a Clinical Environment for Pharmacy Practice

Cheri Schmit, pharmacist and director of clinical pharmacy for GRX Holdings, LLC, in West Des Moines, Iowa, has a passion for clinical care, and coordinates and supports the clinical efforts of all pharmacists working in 22 Medicap pharmacies in central Iowa. A practicing pharmacist in a community setting since she graduated from pharmacy school, Schmit’s passion has been clinical services and helping improve patient care outcomes. She received the Medicine Shoppe International Clinical Innovation award at Cardinal Health’s annual Retail Business Conference for her support of the clinical work of GRX Holdings’ 50-plus pharmacists.

ComputerTalk: Congratulations on the award. Tell us a little about your role at GRX.

Cheri Schmit:  Thank you! My job is to help develop, implement, and assure quality clinical services at the 22 different pharmacy locations in and around the central Iowa area. The goal is to compete in the value-based healthcare world. Based on reports that show patient adherence and other clinical metrics, I offer the pharmacists guidance on how to be more efficient with their time and recommend clinical tools to use when they meet with patients.

CT: Do you find most pharmacists embrace the clinical role?

Schmit: Most of our pharmacies are Medicap pharmacies, and most of our pharmacists are working there because they like getting to know their patients. Most embrace the clinical role; overall, I work to help all the pharmacists understand how pharmacy is changing, how healthcare in general is changing, and that some offerings or services we’ve utilized in the past will be required to survive in the future. Much of that has been workflow changes and efficiencies, and shifting roles with our technicians to ensure everyone is practicing at the top of their license. We also look to technology platforms that give pharmacists more time to spend with their patients.

CT: What is the technology landscape like?

“I think we’re at a point
in time when we need documentation tools that are integrated into the workflow process.
Pharmacy is not just
about dispensing a
medication; it’s about
documenting the care the pharmacist provided during the dispensing.”

Schmit: All the pharmacies use Computer-Rx. It’s helpful for me to pull reports for the stores, and helpful for the pharmacists because they don’t have different systems when they move between pharmacies. We also use PrescribeWellness for pharmacy communications and campaigns. We’ve gradually increased our use for sync fill campaigns and medication therapy management (MTM) through OutcomesMTM, a Cardinal Health company, and we plan to start using the eCare plan more efficiently. With the technology tools, I can go in and proactively identify patients who might be good candidates for sync fills. The pharmacists can also schedule time in person with the patient for an MTM meeting to see what is happening with other areas of the patient’s healthcare. I’ll review the cases that are in Mirixa and OutcomesMTM, and let the pharmacists know what cases are outstanding.

“I think we’re at a point in time when we need documentation tools that are integrated into the workflow process. Pharmacy is not just about dispensing a medication; it’s about
documenting the care the pharmacist provided during the dispensing.”

CT: Adherence and clinical programs are clearly a priority.

Schmit: I think we’re at a point in time when we need documentation tools that are integrated into the workflow process. Pharmacy is not just about dispensing a medication; it’s about documenting the care the pharmacist provided during the dispensing. We’re hoping to start using the PrescribeCare module for some of our documentation purposes, in addition to the MTM feature in Computer-Rx, which we’ve been using for information that’s important in value-based care.

CT: What are some examples?

Schmit: There is value in documenting a patient’s A1C, blood pressures, lab values, or problems to follow up on. It was pretty much a paper process prior to electronically documenting what we had done and what follow-up was needed. We’re excited to have a new way to document within our existing workflow. The next step is to share that record with other healthcare providers. Ultimately, this could help pharmacists earn provider status to be paid for work they’re doing, especially around chronic care management, medication recommendations and transition-of-care opportunities.

CT: How does the pharmacy management system help with the clinical services?

Schmit: One goal is for our pharmacies to be an immunization center for patients. It is a priority for our pharmacists to screen patients at every opportunity that’s available to see what vaccines may be needed. We screen for ACIP (Advisory Committee on Immunization Practices)-recommended vaccines and educate patients about them. We can put a queue in our system to follow up with patients if they don’t want a vaccine that day. I think vaccines and immunizations are a big part of clinical services and are a gateway to offering other clinical services. I can run an immunization report out of Computer-Rx to see the patients who meet certain criteria and haven’t had an immunization, and are therefore good candidates for our pharmacists to contact.

We record clinical measures we’ve selected, like A1C and blood pressure in the Computer-Rx MTM module section of the patient’s profile. We also want to make it easier for the patients to share their lab and other health data. We are looking to roll out an app from OneTouch where patients can download a smartphone app, and the OneTouch Verio machine works with Bluetooth to communicate with the app. In the app, patients can put in a clinical code for our pharmacy and share their lab data and glucose values with our system via the cloud. This will load metrics into our system that we now update manually. I can run a report that shows patients who are struggling with their levels and flag those as good candidates for more education, and the pharmacist can follow up.

CT: How do you work with your technology partners?

Schmit: Technology companies are listening right now and they’re trying to find the solutions that pharmacists are looking for. When we identify a need,  we look to the vendors we currently have a relationship with to see if they can tailor their software to help meet our needs. We might love how one feature works, but call out that it would be ideal if it could do this, or we run into problems when this happens. They really like hearing from us. With our feedback, they can have a vision of how the software will be used as they are writing it.

CT: You spoke about pharmacy moving away from dispensing to providing clinical care. How are you supporting that effort at GRX?

Schmit: I serve as a luminary for the CPESN-Iowa [Community Pharmacy Enhanced Services Network]. We evaluate how the pharmacies are doing around core services, so when a payer comes who will cover those services, we have the metrics. We’ve worked with TELLIGEN, Iowa’s CMS QIN/QIO (Centers for Medicare & Medicaid Services Quality Innovation Network-Quality Improvement Organization), as well as both colleges of pharmacy to get reports and data to show metrics and performance. There is also a commercial payer in Iowa doing a project with select pharmacies on how pharmacists’ clinical care can affect the total cost of care and improve patient outcomes. They focus primarily on four disease states: diabetes, depression, hyperlipidemia, and asthma. They also consider how to reduce preventable emergency room visits and hospital readmissions, looking at total cost of care for all patients. I monitor the stores’ performance in these categories to provide actionable reports and performance measures. We look for the services that have an impact to evaluate and prioritize the services we provide. Much of this is also focused on communication and collaboration with other healthcare providers to close the gaps and improve continuity of care.

We’re always looking to develop new services. In the past few years we’ve started administering long-acting antipsychotic injections as a service in our pharmacies. We’re starting to see more patients being referred for that service. To be successful, we assess what we’re doing and ensure we’re doing it consistently well and meeting our goals. However, we’re also looking to see what else may be a need in the community that we could help with.

CT: What other ways are the GRX pharmacies involved with new practice models?

Schmit: Two of our locations are involved in a new model that is a waiver of Iowa Board of Pharmacy rules to allow for the practice of technician product verification. The pharmacist still checks the hard-copy prescription, conducts drug utilization review, looks at adherence and performs all the clinical tasks of dispensing a prescription. Certified and specially trained technicians are checking product using barcode technology. A study following the results of the program found that the pharmacist time on patient care nearly doubled, and their time in dispensing activities decreased — and patient safety has not changed. So the error rate has not increased and, in some cases, the error rate has gone down. This proves technicians can verify product just as safely with barcode technology and, as a result, give the pharmacist more time to provide clinical services to patients.

CT: Who nominated you for the award?

Schmit: Bob Kloeppel, senior business consultant at Cardinal Health, nominated me for the award. I had no idea. I was completely surprised and very grateful. I really feel like I’m not deserving, because it’s the pharmacists in our stores who do all the hard work. I just try to be a resource for the services they need to do the work. I really think it’s their award, and it speaks to what they’ve been able to accomplish with clinical services for our patients in their locations. CT

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