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Chris Fitzmaurice, Pharm.D., ScriptPro’s director of industry data resources, explains the importance of putting in the up-front work to define a clinical workflow and how ScriptPro’s patient case management platform, Advanced Pharmacy Clinical Services (APCS), supports a patient-centric model. 

ComputerTalk: Your focus is clinical services. Tell us ScriptPro’s approach to this area.

Chris Fitzmaurice
Chris Fitzmaurice

Fitzmaurice: ScriptPro Therapy Management Solutions Advanced Pharmacy Clinical Services (APCS) is ScriptPro’s patient case management platform for complex clinical care.

Everybody has his or her own opinion about the specific process from a day-to-day perspective. We try to let them know how they think that should apply to the pharmacy as a whole.

Most pharmacy operation workflow is very specifically driven by the pharmacy software that’s used. So whether that’s homegrown software that a company’s built or if it’s a third-party vendor that’s provided the software, the prompts in that pharmacy software indicate when techs or pharmacists should do something and then they’ll take that action and there’s the next step that’s always logical.

The key feature of APCS is the integration that it has with its pharmacy management system. Messages prompted on the pharmacy management system side will indicate that there is a patient who is eligible for a clinical program.

Read More: Workflow Integration

ComputerTalk: Let’s hear more about how clinical workflow is different than dispensing-focused workflow.

Fitzmaurice: Clinical workflow is much more nebulous in the sense that some people prefer to do it in a straightforward manner, but there is no one single thing that absolutely has to be performed for every single patient. Clinical workflows are patient-specific, whether it’s disease-related or drug-specific.

With clinical pharmacy workflow, you have to define what the end goal is for any particular patient.

There is some level of grayness, especially if it’s being left up to individual clinicians for what they should be doing throughout that process and how they should be managing a patient. If it’s not 100% clear exactly what you need, what outcome you’re looking to try to achieve for a particular patient or a particular set of patients, then it’s more difficult to wrap your head around exactly how you should build your workflow; how it should start and finish.

One of the things that I think is becoming more apparent as I’ve talked to more and more pharmacies, and those who are using ScriptPro’s APCS pharmacy software, is that if there isn’t visibility between what’s being done operationally to fill prescriptions and dispense them in a timely fashion, which is needed to survive from a business perspective, and you can’t see what’s going on in the clinical side of things, then you’re going to have a lot of redundancy in your workflow. You’re potentially going to have a lot of activities that just get left open.

One of the key features that I think any clinical workflow really needs is a systematic way to document things that are being done by the pharmacists or by other staff in a pharmacy — and at the same time some visibility into what’s going on operationally.

The way we’ve done it with APCS is a clinical case management that has scheduling built into it, task management built into it. It also has clinical assessments and other aspects of just the clinical workload built-in. But it’s also integrated with our pharmacy management system. When you have a person come into the pharmacy with a prescription, if there’s a program that that person should be enrolled in to manage their clinical care, our pharmacy management system will prompt the pharmacy staff to enroll that individual, but it doesn’t stop them right in the middle of the process and force them to carry out some action that is unrelated to filling the prescription.

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Pharmacies live and die on efficiency. If you can maximize the amount of time that you have to fill prescriptions, then you can shrink the amount of time that you get from point A to point B, and you minimize disruptions like insurance issues or not being able to counsel the patient. If you can do that, then typically you can be very successful.

One thing that I’ve noticed with clinical pharmacy workflow is that it can be highly disruptive if you don’t have an organized method of contacting patients. Pharmacists need to assign out specific tasks that technical staff can perform, as compared to your clinicians. If you’re working in an independent pharmacy and you know that you’re the only pharmacist on staff, so you’re the only person who can counsel patients or provide immunizations or do some of those clinical tasks, you have to try to maximize the rest of your staff’s workload.

I think good clinical pharmacy software helps pinpoint specific tasks and allows you to designate who is doing what, so that you don’t have some crossed wires about whether a technician can or can’t do something or should or should not be spending his or her time doing something so that you can free up the clinician to do exactly what he or she needs to be doing.

ComputerTalk: How does APCS address this?

Fitzmaurice: In APCS, we have a task management style for assignments. A pharmacy can customize whatever their tasks are. We usually encourage our customers to think through all of the operational and clinical tasks. Operationally, are we notifying the patient that we’re either shipping a medication or that a refill is ready to be picked up? And then on the clinical side, are we contacting a patient to perform some level of patient education?

Once they’ve customized those tasks on the screen, the pharmacist can assign those to specific individuals or to a group of individuals. So if there are four technicians, you can assign specific tasks for each tech, or a group of technicians. Then they work from a task list that’s autogenerated and kept up real-time. Once they see that a task comes into their queue, they can take that task, do whatever they need to, and then move on to the next one. And then the pharmacists can work from whatever their task list is as well. Everyone can verify they are not overlapping on any task, and this eliminates any redundant work.

The nature of the clinical pharmacy workflow is that there is the possibility that you may actually need to talk with the patient first for some reason. And you need to do that before you do all the other tasks, so you don’t waste time doing something that you ultimately end up not needing to do because you decided you need to change something on a prescription, or you perform DUR [drug utilization review] and it’s not relevant anymore.

We’ve had pharmacies that have reversed their operational workflow to say, let’s allow the clinical aspect of our job and the pharmacy software that we are using dictate when we can actually trigger events to fill the prescription or refill a prescription, and contact that patient first so that we know exactly what work needs to be done and what the timeline is. Because otherwise, again, if you complete something and have it filled and ready and then you go and you contact the patient and it takes you two weeks to get hold of them, you’ve just got something sitting on your shelf that you might end up returning to stock.

Since I’ve been a pharmacist, one of the very first things you learn in pharmacy school is there is going to be a lot of rework. I think in the earlier days, that was prompted because insurance companies were just going to reject a claim and then you had to rerun it and potentially refill it multiple times before you could get paid.

Whereas with the clinical work if you’re doing redundant work it may actually be something that you’re not generating revenue from. Unlike, say, if you do redundant work for filling a prescription, because eventually, you will generate revenue.

With something that is needed from a clinical standpoint and caring for your patients, but that also may strengthen your third-party insurance contracts or get you into networks for limited distribution drugs, you might see the immediate revenue. If you’re spending a lot of time duplicating those tasks or calling the same patient repeatedly so they stop answering the phone, that can hurt you both immediately and down the road.

ComputerTalk: What advice can you offer?

Fitzmaurice: Being organized through a pharmacy workflow that you’ve taken the time to set up is very important. I think that part of it too is the pharmacists taking that initial time to set it up, putting the work in on the front end so that down the road it pays off.

When a pharmacy gets started with APCS, we spend a lot of upfront time with them specifically building out what their clinical case management programs actually are going to look like. Our pharmacy software offers a lot of flexibility, and I think that’s really valuable. But at the same time, it can be a little frightening.

Say you’re a smaller pharmacy or a smaller chain and you want to get into the specialty pharmacy, for example. There are a lot of unknowns, and we help walk the pharmacy and the administrative team through both to make sure that they’ve got the right program set up that fits their pharmacy and their patient’s needs.

CT: What else would you like to add?

Fitzmaurice: We also really try to walk through in detail with them how to go about managing their tasks and allocating work to their staff so that when they go live with the pharmacy software, they know immediately where to go and what each step is in their workflow.

We’ve installed a large specialty pharmacy with 60-plus users, and we spent quite a bit of time with them. But we also have smaller pharmacies that want to get into specialty and we were able to do this with a few calls. It does depend on the knowledge of the pharmacy staff and how much we feel we need to help get them set up. We also provide consultation in terms of how they can be successful, both with the pharmacy software that they’re using and in whatever their particular operation is.

ACSP is not just for specialty pharmacy, though. It could be a chronic care management program. It could be a diabetes program. Obviously there’s a huge push right now with COVID-19 and the high likelihood that pharmacists are going to become a pretty big part of both the testing and the immunizations, and we’ve got a COVID-19 management program to help assist with that. With anything that potentially impacts the community’s health that could be run through pharmacy, our software is flexible enough that you can set up a specific program that you want to manage.

The COVID-19 program is meant to manage patients in the community who are suspected of having COVID-19 or do have it. We include CDC recommendations for self-quarantine and follow up. We can talk about relevant over-the-counter therapies used to treat the symptoms. And we are also giving the ability to track those folks.

Hopefully, as we start to get back to normal life, then the ways that we do that are through testing and contact tracing. With our program, we’ve got a way for the pharmacy to document those patients that have been exposed or suspected of having it or have had positive tests. Then we have some data exports that let the pharmacists do retroactive reporting to see how that has impacted the patient population. CT