Matthew Catanzaro, R.Ph. Director of Correctional Services, Diamond Pharmacy
Matthew Catanzaro, R.Ph.

IT IS NO SECRET THAT PHARMACY margins are shrinking and pharmacists are expected to do more and more to try to keep up profits. In the past few decades, the practice of pharmacy has changed with the times, but one companion has been ever present: the computer. As practitioners, we often accept the computer system as is in our setting, and frequently only look to other aspects of the business for cost savings and profitability boosts. But the computer and computer systems are one aspect that can have huge ramifications on your output and overhead expenses, and it’s worth it to take a close look at just where your systems may be helping or hindering you.

There are many ways to look at computerization and how it can be improved in your practice setting. Traditionally, the hardware is one of the easier items to get upgraded, and new hardware can absolutely make an impact on your technology’s performance. But don’t underestimate the impact of software, workflow, or even data entry shortcuts to increase work efficiency. Let’s look at ways in which both hardware upgrades and attention to your software and workflow can help make a difference.

Some basic details of the comparison study:

Pool of pharmacists: 43
Time frame: One year
Duties:
• Compare in an electronic fashion the data entered to the prescription image/order for accuracy.
• Validate that the technician entered information versus the prescription.
• Clinically screen the order for interaction and appropriate dosage.
• Indicate the prescription is acceptable to move onto fulfillment, or reject with direction on how to correct.

In an age where computers become obsolete in a few short years, has your practice setting kept up with and replaced your computers in keeping with that trend? Hardware, such as the computer or server doing the heavy lifting, can be expensive, but how expensive is it to keep obsolete computers? In our practice in 2012, we took a control group of 24 technicians on computers that were five years of age or greater. These computers were communicating with a central server to push and pull data from the core database, but a reasonable amount of processing was done at the terminal level as well. After replacing the terminals with new models, we saw a little more than 10% increase in output. The replacement models were not top of the line. In fact, they were bare-bones processors, but because technology had improved in that time frame, the most basic of models was a substantial improvement over what was being used. In our practice, this improvement saved salary dollars, since that 10% increase in output was like getting an additional technician’s worth of production for every 10 technicians we employed. Our return on investment on the project was a little under three months. The intangible values of this enhancement were that staff felt appreciated in being given new computers, and their increased production served to help their quality of life, as business
demands were more easily met. Overall, we saw improved morale, making for a better work environment. It was unquestionably a win for management, ownership, and employees.

Beyond hardware, consider your software. It is difficult to know if slowness and delays experienced are related to hardware, software, or some other factor such as internet connectivity. Choosing the right software is a very personal and business-specific decision. While pharmacists are not expected to be information technology specialists, it serves anyone purchasing software to dig in for a better understanding of the company supplying the software, the platforms it runs on, and the underpinning architecture, to make certain it is keeping up with the 21st century. A number of software companies have been in business since the 1980s, but that doesn’t mean you want 1980s’ programming and structure. That can degrade performance and make it difficult to improve your productivity. The last thing anyone wants to do is take the time and effort to review, buy, install, and train on software only to find out in six to 18 months that the company is defunct or that the software is being abandoned in favor of an upgraded structure.

Next, let’s consider concepts around workflow, which may depend upon the layout of your environment. Sometimes it is impractical to have a consistent flow to the work, but don’t ignore evaluating this. Many of the larger retail pharmacies have developed a workflow plan and have expectations of how staff should function. Organized workflow helps to reduce errors and increase efficiency. This may be very evident to anyone working in a busy store, but what can be overlooked is how the software is designed in conjunction with the flow. As a rule, people dislike change, and this is important to keep in mind when you bring in a new software system, since you are likely bringing in a new workflow with it. That’s because trying to shoehorn existing processes into a new system is a recipe for disaster at best and complete failure at worst. It is best to learn how the software company envisions its product being used. The vendor will have extensive experience with how its customers use the system and, if asked, can most likely help you understand the best ways to function using the software. If possible, ask to visit existing software users to see how they function, and get their feedback and experiences with the software. While this is an expense in time and research, it will pay off if you find that customer support is lacking or that the billing component of the software is rife with errors. Don’t ignore the workflow within the software itself, either, as this is just as important as how the software is envisioned to function within the pharmacy. For example, some software places the provider at the top of the screen, while others place it at the bottom. Make sure that the logical flow of order entry works for your staff and how they are trained.

Good software should have shortcuts and best-practice guidance. Shortcuts are ways to get from one screen to the next or to trigger an event. Shortcuts should be clearly indicated within the help menus of the software or as a “hover over” tip that can act as a reminder to staff. Using a mouse should be minimized as much as possible during data entry, which means it should be relatively easy and logical to navigate the screen via a series of tabs, reverse tabs, and enter/return keys for completion of a given field. The ultimate goal is to allow the typist to move through the fields without being inhibited. Shortcuts are not just confined to special keys on the keyboard, but also include concepts such as searching the database. When looking for patients, searching by phone number or insurance ID is always going to be more reliable than searching by name, especially if the name is common. This same concept holds true for drug searches. Learn how the software searches for items and use as many tricks as are offered so that the drugs brought back on the search are minimized. If the software allows search criteria to include dosage forms or strengths, get staff members in the habit of using these fields when they are able. The closer you get in a query to the drug you desire, the less chance of a mistake getting selected.

All of that stated, why be bothered upgrading at all? If it works, then that is truly all one needs, correct? To exemplify how drastic a difference a computer system can make, consider the following assessment we performed. In a practice setting with the same pool of pharmacists, all of whom were expected to do the same duties and at the same level of scrutiny but using two different software systems, we found one system led to a performance metric average of 41.75 prescriptions per hour, while another rated at 96.5 per hour.

The evaluation indicated that a good pharmacy system can equate to 1.3 full-time equivalent (FTE) of pharmacist time savings. These values can most certainly be offset by system costs, but it is evident that a computer system really can allow you to do more with less help. The concept of saving one-third of your pharmacist’s time is a huge advantage in settings where there are limited resources available. Unfortunately, the above study did not afford a comparison for the technician staff, as their duties were substantially different.

Taking a good look at your current or prospective pharmacy software, keeping hardware up to date, and understanding the best ways to implement and use them for your pharmacy’s workflow should be embraced by anyone wishing to be more profitable. Cutting-edge technology should always be acquired with due diligence, but once proven, that technology could be the salvation for tight margins. Pharmacy should never be afraid to explore new options. CT

Matthew Catanzaro, R.Ph., is director of correctional services at Diamond Pharmacy in Indiana, Pa. He can be reached at mcatanzaro@diamondpharmacy.com.

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