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With pharmacies being busier than ever these days, we polled system vendors and users to find out which software feature or application used increases operating efficiency. Here’s what we found.
Simplifying Prescription Pickup
With Sack-It, Brantley explains, when the prescriptions come through the quality control screen, the pharmacist verifies them and opens a sack. As the pharmacist verifies each prescription, it is dropped into the sack. And when that’s done, the pharmacist hits a button called Closed Sack. And at that point the system generates one receipt that goes on the outside of the bag that lists the number of prescriptions for each patient. Optionally, the system may be configured to restrict one patient per sack. If the patient is flagged for texting, a text is sent to the patient letting him or her know the order is ready. The patient doesn’t want to get six messages, for example, for all the prescriptions in the sack.
The receipt indicates which prescription is for each patient and the total amount due. And it shows the location where the prescriptions are in will-call — or if in the refrigerator or a locked drawer because there’s a controlled substance.
Learn More: A Modern Workflow System
When the patient comes in, the system tells the techs exactly the location of that sack so they can go straight to it. According to Brantley, this not only speeds up the checkout process, but also ensures that one scan is all it takes to collect the amount due.
Chrissy Barr, Pharm.D., owner of The Medicine Shoppe in North Little Rock, Ark., and an RxMaster user, reinforces Brantley’s opinion on Sack-It. Barr says, “I enjoy the Sack-It feature. One, it makes it easier when patients pick up their prescriptions because you only have one thing to scan. Two, when the Sack-It receipt prints out it shows you how many prescriptions are in the sack for each patient (husband, wife, etc.). Three, it makes it easier when patients call and want a total. You don‘t have to stop and add receipts up. Finally, we also use it in our delivery system. We keep the Sack-It receipt until the payment comes back so we can use it to ring it up. The Sack-It feature also sends the patient a text letting them know their prescription is ready — another wonderful feature.”
But she also points to the RxQue, where she can see everything everyone has used their app for — website as well as eScripts. It’s all in one place.
Calming Down the Rx Filling Process
“The RxSafe 1800 has really calmed down the whole filling process,” notes Romph. He’s storing and filling about 80% of his prescription volume using the towers, and all this can be run by just one technician. “We used to have four or five technicians pulling stock bottles, counting, and labeling at multiple counters. If the wrong medication was pulled it took time to correct that. We no longer have these issues since most prescriptions are filled at the RxSafe station, and one other technician can easily pull any that are not in the RxSafe.”
The improvement to workflow efficiency starts when receiving new wholesaler orders. A technician scans each bottle into the RxSafe database and puts them in a tote for loading into the RxSafe 1800 as time allows. At filling, a technician processes incoming prescriptions in the PioneerRx pharmacy system and places labels in a basket for the pharmacist to check. That basket then goes to the RxSafe filling station. There the technician scans the labels, establishing the sequence in which they’ll be filled. RxSafe 1800 pulls the stock bottles automatically, choosing those closest to expiration first, and collects them at the outport, which opens to present each stock bottle only when a prescription is again scanned. “You know you are getting the right medication because this is all driven by the NDC number in the bar code,” notes Romph.
“RxSafe actually has scales that weigh each bottle,” says Romph. “It knows how much each tablet weighs and it alerts us if the bottle is too light going back in. We find this is particularly important for keeping careful track of controlled substances.” The staff can make a note in the system to explain a discrepancy, such as from removing a foil seal, cotton, or desiccants. The accounting is highly accurate. ”We dispense from 1,000-count bottles of Norco,” notes Romph, “and when we come to the end of a bottle, the count by weight is ordinarily within one or two tablets.”
This entire process happens in an ultra-compact footprint. “We’re storing about 2,600 stock bottles in the towers instead of in four bays of standard shelving.” says Romph. “We’ve condensed about 112 square feet of storage into 36 square feet for a filling station where the technician stays put and the stock bottles come to them.”
The RapidPakRx system fills from cartridges and checks each tablet or capsule against the known size of the product before pushing it into the pouch only if it‘s a match. The pouches are automatically sized according to the number of medications packaged in them, and Romph says that the system will allow up to 20 medications in one pouch. He can set RapidPakRx to fill as many pouches as necessary for a patient’s medication regimen, though he generally sticks to four per day. “If a patient wants a medication separated out, for example, one that has to be taken once a week before any other medications, that’s easy. It’s totally customizable, and it’s both very user-friendly for our technicians and customer friendly,” he says. Romph reports that RapidPakRx has been critical for keeping some patients. “We have had some people who were going over to Amazon’s PillPack, and we’re able to say, ‘Hey we can do that same packaging for you.’”
The combination of RxSafe and RapidPakRx has allowed Paw Paw Village Pharmacy to be competitive by reducing labor hours. ”We‘re open 55 hours a week and fill about 3,000 prescriptions,“ explains Romph. ”We used to run 96 hours of pharmacist time a week. Now we‘re running 55, and continuing to expand our services.”
Barcode-Driven Will-Call
Finney makes it a point to keep a sharp eye on pain points in his pharmacy’s workflow. That’s what led him to bring in scripClip will-call automation from PerceptiMed.
“We run a pretty robust medication synchronization service,” says Finney, “and so we have a lot of patients who will come in once a month to pick up anywhere from five to 15 or 20 medications at one time.” If the staff has trouble locating prescriptions in will-call, and if they end up missing one, then that’s contrary to the whole point of med sync.
With this in mind Finney is using scripClip to make will-call as efficient as possible. “Our customer service team scans prescriptions into scripClip using the barcode our PioneerRx system prints and then has the goal of loading all of a patient’s prescriptions into just one scripClip bag,” explains Finney. “Right there we generally eliminate the frustration of having multiple bags or trays for the same patient.”
scripClip then speeds up retrieving bags when patients arrive. “We enter some basic patient identifiers at the will-call workflow station, and the right bag lights up,” Finney says. “We are able to go and retrieve that bag very, very quickly.” From there it’s a simple matter of running the transaction through the PioneerRx point-of-sale system, which records the sale and communicates back to the pharmacy management system that the prescriptions have been completed.
“The scripClip system is simple,” says Finney. “There are really just those two points at which we interact with it, checking the prescriptions in by scanning the barcodes and then retrieving the bag when the patient arrives, and we are getting a massive boost to our workflow efficiency that makes a great impression on our patients.”
Customizing the Workflow
Another method, he says, is the pharmacy-at-a-glance dashboard that allows the staff to see where all the prescriptions are. This can be used to see what has to be processed and how many electronic prescriptions have come in. It’s another visual way to organize the work to maximize moving people around to tackle different areas that need attention when they back up. Within that module, thresholds can be set. You can see if there are four e-prescriptions that are in the queue, and then somebody needs to pay attention to those. The colors can be changed from red, yellow, or green for visual recognition on the screen.
“If we really get into efficiencies” says Burnett, “then I think there are several things that can happen. I would say a big one is the ability to autofill refill. This is another component within workflow that can be turned on. When a prescription comes in via a mobile request or the IVR, the system processes that through the prescription dispensing process, performs the adjudication, and prints the label for the vial. This eliminates several steps by having the system do these things. Part of the automation is also the clinical aspect. If there was a new medication added since the last time the patient got a refill, for example, and there are any issues with the prescription, it’s dumped to an error queue and will wait to be reworked. Another example is if there is a problem with the third-party process. Again, the pharmacist can quickly identify the issue and take care of it.
“If we dig a little deeper into automation, we have our automated health minder. Customers can sign up to automatically refill their prescriptions. Now we take out having to call to start the refill process. And you can take it a step further from an automation standpoint with work dropping into queues based on when the next refill is due.”
While inbound prescriptions by IVR have been around for a while, the idea that these are dropped into a specific queue seems to be a place where there can be real efficiency.
More from QS/1: The Move to a Patient-Centric Workflow
Flipping the Model
Evergreen Pharmacy has built its operations using a technology suite from Integra, including PrimeCare for managing prescription filling and DocuTrack for document and communications management. As it turns out, both have tools to manage workflow. Cichy notes that Evergreen pharmacy has been relying primarily on DocuTrack for workflow management, largely because of the high degree of customization it offers. But as the pharmacy grew from five to 20 to 25 employees, Cichy realized that he needed to flip the model and run workflow from PrimeCare.
“Manufacturers and payers are looking for how efficiently you‘re doing things,“ says Cichy. “They are looking for data that shows strict adherence to process and a quick turnaround for a prescription order, for example, to give us access to limited distribution medications.”
This led to a choice: end up pulling data from both systems to create workflow reporting and aggregate it using spreadsheets, which is not efficient, or move over to letting PrimeCare exclusively manage workflow. “Because we are committing to using PrimeCare for workflow,” explains Cichy, “we’re avoiding the need to build our reporting to payers and manufacturers from several workflow data sets with details that may not be labeled a hundred percent the same way. That’s a lot of time saved from not having to figure out, okay, what goes where to send these reports.”
Flipping the model means that workflow remains efficient. “PrimeCare’s workflow blocks give us the most efficient and easily reported way to create a precise record of the steps our staff takes,” says Cichy. PrimeCare’s workflow blocks also ensure that the staff can’t skip workflow steps, he notes.
“I think you can reach a point, as we have here,” says Cichy, “where you take a look at your pharmacy technology and how you can best use it to create an efficient workflow that meets your business needs, and what the other players in the market are asking for. We’re very pleased that we have a suite of software from Integra that’s allowed us to grow using one set of workflow tools in DocuTrack, and now successfully meet the evolving demands of the market by pivoting to using PrimeCare’s workflow blocks. This is a big reason why we’re glad we’re using products from one technology provider.”
Enhancing the Level of Care
Nichols explains that Greenwood Pharmacy is using MedWise as part of an enhanced medication therapy management program. “We have a group of patients from one of the Medicare drug plans enrolled in a pilot program with us,” says Nichols. “The workflow goes like this: We have a pharmacist resident and a clinical pharmacist who attach what we call a workflow note within our Computer-Rx pharmacy system to the patients in this program. This note travels with a patient’s prescriptions all the way through the dispensing process, right up to the point of sale.”
At this point the note is a prompt for the support personnel to ensure that the patient talks to a pharmacist. The pharmacist, as Nichols explains it, has been able to use Medwise to do a really quick, but comprehensive, medication reconciliation that includes the time of day when people are taking certain medications.
“Doing this med rec within MedWise allows us to capture information, that really opens up a whole new story of the true risk of drug interactions and side effects,” says Nichols. “We are also able to capture any nonprescription medications and evaluate the whole regimen in key areas, whether it be cytochrome P450 drug interactions, anticholinergic burden, sedative burden, side effect risks, or long QT syndrome risk. We can see at a glance where the highest risk is within a patient’s medication regimen, and whether it is a drug interaction risk or if it’s something like anticholinergic burden risk.” This, he also finds, increases efficiency.
MedWise is critical for being able to bring a complete and highly detailed picture of medication safety risk into the pharmacy’s workflow, and then PrescribeWellness, another Tabula Rasa HealthCare solution, makes the step of communicating recommendations to prescribers or patients highly efficient as well. The pharmacist documents in the eCare plan within PrescribeWellness the recommendations derived from MedWise, and the eCare plan is readily and easily shared with prescribers. Nichols reports great success in getting recommendations accepted because these tools within the pharmacy’s workflow permit the clinical pharmacist to develop them rapidly and communicate them effectively and at just the right time to prescribers.
Addressing an Evolving Payment Workflow
As it became clear that he’d have to implement measures to protect his staff and his customers during the COVID-19 pandemic, he quickly realized that he needed new tools to keep workflow moving efficiently yet maintain his connection with his patients. One area Shah found particularly challenging was payment processing.
“We started by asking patients to give us the card number over the phone,” explains Shah. “Then we’d take them their prescriptions and other items as they waited outside. Some patients were a little hesitant. They were concerned that giving us the number on the phone was not safe. So we tried going out to get the credit cards, but then we had to wash our hands so often or change gloves.” Both methods were certainly disrupting the pharmacy’s workflow, notes Shah.
Then Shah recalled the tools he’d seen during his work at other major retailers that offered the option for patients to pay and sign on their phones. “I said to myself, why can’t we bring that to our pharmacy?” Shah says. ”And I reached out to our pharmacy system vendor BestRx about this, and they were immediately interested in developing this.”
BestRx rolled out the new feature by the end of March. “It’s one of the best improvements we have in our software,” says Shah. Here’s how it works. When pharmacy staff scan prescriptions and OTC (over-the-counter) items at the point-of-sale (POS) system, they now see an option to request an online payment by text or email. Patients see the message within seconds and simply click on a link to be taken to a payment page, which also includes their transaction details.
They can make notes on the payment, select pickup or delivery, and also, importantly, sign the payment. “The signature is very important,” says Shah, “because that’s proof that the medication is sold.”
Once payment is made, the transaction is quickly updated in the BestRx POS system and the receipt is printed. “We’d been using the new online payment for a couple of days,” says Shah, “when I took another idea to BestRx for improving this new workflow step.” What Shah asked for was to have the patient’s name printed at the bottom of the receipt, to aid in matching receipts with orders. “Within a couple of hours they updated that in their system,” he says. “Now we can see the name as well as any notes at the bottom of the receipt.”
Shah has been very pleased with this new payment feature. It’s been critical for maintaining efficiency during the pandemic, and Shah sees it being a plus down the road too. “We have many 55-plus communities in our neighborhood,” he says, “and they have actually been ordering their basic supplies from me now, like toilet paper and laundry detergent.” This new payment option makes this so much easier.
Efficiency Through Integration
The integration also gives the status of where a patient‘s prescriptions are in the process. If the staff is performing a clinical task then, says Fitzmaurice, they can easily access information to know that the patient’s prescription is at verification and just waiting for a pharmacist to verify or the prescription is ready to go and it’s being stored in the refrigerator because it‘s a cold-ship item. This level of integration avoids jumping back and forth between multiple systems or using a system that’s been set up with a series of spreadsheets that requires reentering all that information.
More from ScriptPro: Defining Clinical Workflow Goals
“I think the thing that I’m most proud of, beyond the integration, is the fact that we’ve really honed it specifically for pharmacies and pharmacists,” says Fitzmaurice. “I lead a team of clinical pharmacists that designs and builds out our clinical assessments. We try to include disease or drug information that might be relevant to educate patients when counseling them. We have really done as much as we can to focus on what’s relevant to a pharmacist and the patient.”
Prepacking for Efficiency
Remedi SeniorCare has the goal of having 75% of medications prepacked in counts of 30, 28, or 14. “These medications are ready on a shelf when prescriptions come in,” explains Swepston, “and all we have to do is take one off the shelf and apply a prescription label to it, rather than take the time to package as it’s dispensed.” Prepacking is then a huge time saver and really an absolutely necessary workflow step for efficiency in a long-term care pharmacy. And while Remedi SeniorCare of Charlotte does have a large prepacking machine in the main pharmacy dispensing area, this was not a viable solution when it comes to controlled substances.
“I’d worked with a suction-based prepacker in my previous pharmacy,” notes Swepston, “and found it was a good tool to have.” So when she saw Pillvac, a small unit that uses suction rather than gravity to fill prepacks, she knew it was a good option to meet the needs of her pharmacy. Pillvac resembles a vacuum cleaner and has a piece of plexiglass with 30 suction points attached to the end of a hose. There are several of these attachments, with different-sized suction points. So if you need more suction to lift larger pills, you could switch attachments. Swepston has found that staff can really just use a suction point of one size for all the pharmacy’s needs.
“Before getting Pillvac we were hand-filling narcotics prepacks,” Swepston explains, “and that’s slow and time-consuming. I didn’t want to bring medications out from the control’s room and onto the floor to use our large prepack machine. That machine can also break pills. Pillvac does not do this. Broken pills are something we really need to avoid, since we’re trying to keep an exact count on narcotics.” But perhaps the most important feature, according to Swepston, is that the Pillvac unit is very small. “It’s portable and does not need a permanent footprint in the pharmacy,” she says.
Pillvac has become a critical piece of the workflow for ensuring that the pharmacy is meeting its prepacking goals. It’s very simple, as Swepston sees it: “The more prescriptions that we can have available in prepack, the more efficiently the pharmacy runs.”
Looking for Positive Impact
Some important questions to ask may include the following:
- Are the features scalable for growth?
- How will the pharmacy have to adapt its day-to-day operations with the changes being implemented?
- Once the workflow is implemented, are all the features required 100% of the time? For example, do the same workflow steps have to be performed on a slow day or when you are short staffed?
- Will software enhancements in the pharmacy management system affect the workflow?
- What role does the point-of-sale system play in workflow? For example, are multiple pickup signatures required?
- What about bin management options?
- Can the workflow options be unique to each store in a multiple-location setting?
What sets TDS apart, says Miguel, is its ability to leverage a large feature set with leading industry partners to give the pharmacy the ability to adapt as needed to their own changing environment and save costs in the process.
“The Clinical 360 portal from TDS is also a huge benefit in powering efficient dispensing and clinical workflows,” says Miguel. “It’s extremely valuable to deliver these clinical opportunities to increase patient outcomes right into the pharmacy management software, where the prescriptions are being filled, refilled, edited, and verified. The single sign-on capability helps to make the completion of these opportunities as seamless as possible.”
New Features for New Workflows
Bradshaw has also used her pandemic response as a motivation to finalize setting up the PioneerRx delivery app, which runs on a mobile device. “In our case we’re using an iPad mini, and we didn’t quite have it all set up, but the pandemic was a push to finish that,” she says. This has been very important for the pharmacy’s efficiency with demand for delivery increasing. “Our delivery driver can drop the prescriptions, watch the patient come get them, put COVID-19 down for the signature, and he’s good to go. He doesn’t have to have any physical contact with the patient,” she says.
The flow for accepting payments has changed as well; Bradshaw has been pleased by the ability to assure her patients that she can securely store their credit-card details. “We are having to take credit cards over the phone for payment now,” she says. “I’ve been able to confidently tell patients that we can’t see the card number after we enter it the first time, but that it will still be available for us to charge without having to take it down again.” CT
