Lisa Schwartz, Pharm.D., is senior director of professional affairs at the National Community Pharmacists Association
Lisa Schwartz, Pharm.D., Senior Director of Professional Affairs, National Community Pharmacists Association

One of my favorite things to bring up when talking about independent pharmacy is that the entire pharmacy profession and all retail pharmacy benefit from creative owners trying to both address patients’ needs and reach their own goal of operating a profitable pharmacy practice. Of course, that’s after I refute that these owners are part of a dying breed. Technology solutions often get high marks for automating tasks that help patients and make pharmacy operations more efficient. I wouldn’t dream of opening a pharmacy today that didn’t have computerized dispensing records. The last time I met an owner who used only paper records was in 2003 — and that was hard to believe 20 years ago. Contrast this to medicine and other health professions that were much slower to adopt electronic health records until incentive and penalty programs came about in the last 10 years. Computerized records mean it’s possible to adjudicate prescription claims in real-time, quickly screen for drug interactions, receive and send e-prescription messages, report to immunization registries or prescription drug monitoring programs, and produce a variety of reports for regulatory compliance and business insight. A computerized point-of-sale system is another must-have for processing HSA/FSA (health saving account/flexible spending account) debit cards, customer loyalty programs, and reports to manage front-end inventory and marketing campaigns. The last thing to mention here is a security alarm, but there’s more to that than deterring burglars with motion detectors and video cameras.

Applying for a Loan

If I were to take everything I’ve learned from my work at the National Community Pharmacists Association (NCPA) and from meeting countless owners, I would be sure that any loan application I made would have the above pharmacy technology basics covered, plus a bunch of upgrades and extras. There are certainly business plans that leave these out until the break-even point on the loan or some cash flow milestone. But my plan for business success would anticipate operating at a volume that would leave pharmacy staff scrambling without these technologies. The dispensing system must be able to save a prescription image, enable refill synchronization, manage prescription inventory and wholesaler orders, allow remote access, and use safety checkpoints in the dispensing workflow. At a minimum, any loan request needs to include a countertop pill counting machine.

Devices with barcode scanning, image verification, and image capture are upgrades worth serious consideration. An interactive voice response system requires multiple phone lines but meets patient expectations of never hearing a busy signal and makes operations more efficient when refills ordered after hours are waiting to be processed when the store opens. Access to or a contract with a language service is pretty close to something that belongs in the previous paragraph, but in most cases, it can very quickly be added when it’s needed. Several states, however, require label translations. A security alarm connected to a robust phone system can have a line dedicated to calling for emergency service when the smoke detector goes off or the pharmacy triggers a silent alarm. Geotags can be useful for tracking valuable or diversion-prone inventory, as well as delivery driver safety, with the driver’s consent. Speaking of deliveries, mobile payments and signature capture go hand in hand with offering hand delivery.

What I Hear

In my work at the NCPA, I get to spend time with the NCPA Technology Steering Committee. This group makes it obvious that a savvy owner is using the newer e-prescription transactions (RxChange and CancelRx), using business intelligence applications to evaluate payer contracts, capturing pediatric height and weight from e-prescriptions, relying on robotics, scheduling appointments, collecting secure forms, and using secure messaging with prescribers or patients. These owners also see exciting solutions on the horizon to create a seamless experience for patients and operations.

High-quality pharmacy care requires access to complete medication history and relevant lab results. Pharmacy applications need to be poised for interoperability. Secure messaging or health information exchange is worth repeating. Using 2D barcodes will be unavoidable after November 2023, when the last compliance date for the Drug Supply Chain Security Act (DSCSA) arrives, but using the serialized product ID can improve response to recalls today. Two more e-prescription transactions, NewRx Request and RxTransfer, are overdue for widespread adoption. Pharmacies that may have been skeptical of the transfer transaction quickly came to see the value with pharmacy staff shortages and intermittent closures reported during the pandemic. Owners want workflow insight at a glance on the home screen to identify bottlenecks at any step and reassign staff to keep things moving — basically, tracking that everything requested gets billed and every paid claim gets filled. Remote access to the dispensing system could have allowed well-but-quarantining pharmacists to ease the strain of not being able to physically staff the pharmacy.

The last thing to mention (that these owners know they want) is a complete patient record: dispensing records, vaccine records, lab data (sent by or to the pharmacy), patient encounters and care plans, and pharmacist office visit billing. Technology solutions on the horizon that don’t often come up in conversation but need to be on everyone’s radar include prescribing (certain states give pharmacists the authority to prescribe), “dispensing” digital therapeutics, referral transactions, and telehealth, which could encompass remote dispensing site supervision, remote patient monitoring, and virtual visits for medication management or for evaluating patients who could start a medication prescribed by the pharmacist. Most, if not all of these technology solutions exist.

The challenge for most pharmacy owners is evaluating applications and vendors with the goal of creating a seamless experience for patients and pharmacy operations. It may not be realistic to find a dispensing system that can optimize delivery driver routes, bill a telehealth visit for starting hormone contraception, and send that prescription electronically to a different pharmacy in town. But reasonable efforts to develop interfaces to transfer data and work between applications will appeal to pharmacists. CT Lisa Schwartz, Pharm.D., is the senior director of professional affairs at the National Community Pharmacists Association. She can be reached at lschwartz@ncpa.org.

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