Recently, while attending a long-term care (LTC) software vendor’s customer conference, one pharmacist lamented that everything out there seemed to be trying to keep her from running a successful business — DIR (direct and indirect remuneration) fees, low margins, regulations. The executive at the software company looked at her and said, “We’re working on tools to help you with all of that.”
Long-term care provides unique opportunities for all types of pharmacies. We spoke to three vendors for their perspective on the technology that gives you the powerful tools to dive into the business.
Vendors have done this for years, responding to the trends in the industry as well as the customer requests for features necessary to build a successful long-term care pharmacy business. According to a 2018 report by Morning Star, it’s estimated that by 2020 more than 12 million people will be in long-term care. Another important statistic is from the CDC (Centers for Disease Control and Prevention): The number of patients in home-based care was 4.5 million as of 2015. The workflows and services that retail pharmacies are offering (MTM [medication therapy management], clinical reviews, adherence packaging, and medication synchronization) easily translate into a homecare-based setting. As one vendor pointed out: many independents already have the tools at hand to start a long-term care business, especially if they’re looking to start small, with group homes or home-based caregivers
From automating manual tasks, to developing reports that provide business intelligence tools, the vendors we spoke to have decades of experience, and can really see what it was like then, what’s happening now, and where long-term pharmacy is headed into the future.
The Evolution of Automation
Tim Tannert, president of SoftWriters, remembers back to when began his career as a pharmacist in long-term care pharmacy two decades ago, and while the pharmacy system processed prescriptions, conducted DUR checks, and printed labels, every other aspect of the pharmacy was manual. “We sent and received faxes, and the paper was on spools. When you set it on the counter, it would curl up,” he recounts. “Filling prescriptions was done manually. The most sophisticated automation we had was a pre-pack robot, which allowed us to pack cards with medications with the same NDC [National Drug Code], but they weren’t patient specific. From a workflow perspective, I actually had to manually sign each and every prescription as proof that I had done the final pharmacist review before the cards went out the door.”
Workflows were built around these manual processes. Louie Foster, executive director at Integra, describes a similar situation around faxing and document management. If an order came in via fax, it was entered into the pharmacy system, and depending on the system, may or may not have synced with the toting automation and workflows. Once handed off to a driver, the delivery might have been entered into a third-party system that didn’t loop back with the pharmacy system to track it.
“Pharmacy management software has really evolved from something that initially just saved you time printing labels, so you didn’t have to use white-out,” says Foster, “to the operating system for a pharmacy, much like Windows is for a personal computer.”
Another change in the industry is the technology awareness of not only facility staff, but of patients as well. Foster notes that when he started, facilities were so averse to technology that training videos started with how to use a mouse. Today, you’ll be hard-pressed to find a caregiver who doesn’t have a smartphone. “The changes are twofold — not only for the staff, but also how technology is being adopted by the elderly,” he says. “A recent Pew research poll found that close to 70% of elderly citizens, 65 and older, have a smartphone, and they expect that to jump into the 80%-to-85% range in just the next couple of years.”
While in the past pharmacy services existed around the act of dispensing, Tannert sees the industry transitioning to a point where the primary growth driver for pharmacies will revolve around their ability to provide superior clinical services. “With the focus on transition of care, facilities are looking at pharmacies differently than they have in the past,” he says. “It’s much more than the time of the deliveries and the types of packaging that pharmacy would provide. They really need to have the pharmacies as clinical partners to help them manage these patients to ensure the best outcomes.”
The buzz around outcomes means pharmacists reinforce the concept they are the focal point of patient care and are partnering with facilities in this way. A customized workflow in your pharmacy system is an advantage pharmacists have today. At PioneerRx, Paul Carrig, VP for information technology, has seen that in the 10-plus years he’s worked on the system, the profession has moved toward medication adherence and reconciliation, as well as improving communications between patients, the pharmacy, and the facility. Customization of the pharmacy system results in pharmacists adapting to what their facilities want. This all adds up to ensuring the continuity of care is there, and pharmacists can put themselves in the role of patient care manager, thanks to improved communication and customized workflows. “The big areas where the profession is going as a whole include medication reconciliation, adherence, and communication,” says Carrig. “How do you make sure that the continuity of care is there for that patient when they’re transitioning into a facility? How does the pharmacy become that focal point? In the independent retail pharmacy space, the pharmacist is often the focal point of care and the contact between many different groups, and this really is no different.”
Breaking down silos is what Tannert sees as the future, especially surrounding the clinical consulting opportunities in the transition of care. SoftWriters’ new medication regimen review (MRR) software, RxPertise, connects the consultant pharmacist to the pharmacy in near real-time, thanks to an advanced integration with FrameworkLTC. When the pharmacy has the data from the admissions process, the pharmacist is able to review the medications and work with nurses and doctors to ensure patients are on the right medications. “The pharmacy system has become the central nervous system of the pharmacy. It drives everything that the long-term care pharmacy does,” says Tannert. “And the reality is, the pharmacy system is what allows the technology to work as well as it does. With an automated process, you have to make sure the communication to various systems are seamless, that it’s bidirectional, and that it has the functionality that’s needed to make the pharmacy successful.”
Modern pharmacy technology is unbelievably sophisticated, Tannert points out. The new technologies drive efficiencies with barcode scanning, document management, and robotics. Electronic medication administration record (eMAR) interfaces have streamlined communication collaboration between facility and pharmacy, resulting in a big jump in eMAR interfaces. “It’s just not enough to have these new technologies — it’s imperative to have a pharmacy system that’s going to allow these technologies to work together seamlessly,” he says.
Tannert has seen a growth in the area of interfaces with eMARs. “It’s mandatory for these pharmacies to connect to each of their facilities’ systems, and all the customers have different eMARs, he explains. Tannert advises asking questions about how patient demographics are sent and if the systems are certified to send controlled substances. Also, how does the information flow into the pharmacy system? “There’s real power and efficiencies for these pharmacies to be able to have these orders come through, enter workflow directly, and be presented to the pharmacist for initial review with very little touch,” he says.
The trend toward deeper integration between the facility’s management system and the pharmacy is something Carrig has seen as well. Carrig says there is a bigger uptick in the number of people who don’t want to do paper anymore. “They want to go electronic and just touch that data one time — and have it be shared,” he says.
Sharing that data, which is notoriously difficult in the healthcare environment, is not just associated with documentation. The pharmacists’ need to communicate about patient care with the facilities and providers is what prompted direct secure messaging, says Foster, who has seen this evolve through ONC (Office of the National Coordinator for Health Information Technology) and CMS (Centers for Medicare & Medicaid Services) regulations. Before secure messaging, the patient record would be faxed or stapled to the bottom of the gurney, says Foster. Now imagine if you have new technology on the facility side and the tools coming to fruition allow you to accept this patient with a few clicks, rather than having to type everything in. With secure messaging, clinical and prescription data moves with the patient, or even before, giving pharmacy a niche space to help manage transition of care. It also means pharmacies can get orders ready and out before it’s an overtime issue. “It’s not uncommon for these prescriptions to come in 30 minutes before closing, and the pharmacy is looking at overtime,” says Foster. “Pharmacies are looking for every avenue to save money, because the margins aren’t there to cover all these services. If they can get a copy of that admission prior to the patient even being transported, if they can reduce that overtime spend, it’s going to pay back in spades.”
Learn More: The Best Packaging for Medication Management
The Central Nervous System
The pharmacy system is what keeps everything together in a way that fits the pharmacy’s business goals. Tannert sees this as the way an LTC pharmacy can differentiate itself in the market. Every one of the nursing facilities, assisted-living facilities, and group homes wants different things from the pharmacy. When pharmacies are small, they can handle the individual personalities. Tannert points out that with growth comes complexity, and that’s handled by the software. The software now enables pharmacies to set up specific workflows to meet specific customer requests. “It allows them to provide the service that’s going to differentiate them in the market, the accuracy that is a given in this profession, and the efficiencies to run their business in a profitable way,” says Tannert. Here again is where automation of manual tasks is the biggest driver for success in long-term care, he says. It’s not just the efficiencies, but accuracy, too. “With the right technology, by automating the manual tasks, it allows the pharmacies to be both accurate and efficient,” he says. “And that’s what allows them to meet the needs of their customers.”
One example he gives surrounds the game-changing role automation plays in streamlining the dispensing and documentation of controlled substances. This means having the automation to identify, on a daily basis, which of these prescriptions will need refills for which patients, and to automatically send a notice to the director of nursing or to the physician to get those documents signed, as well as track whether or not, through barcode scanning, those signed documents were received back or not. And if they weren’t, to be able to follow up, all without human intervention. This is a game changer, says Tannert.
Managing care goals in the PioneerRx system is a recent feature that Carrig sees as one that applies to long-term care. A customized workflow gives the pharmacy a lot of power, because the system allows the pharmacy to set rules and formularies around what drugs the patients should be receiving from a facility, through to all kinds of care actions associated with that patient. “What’s really exciting, is the emergence of eCare plan standards that allow information exchange with other healthcare systems in a common format,” says Carrig. Ultimately, it will help with communication, but what it also does today is allow the pharmacy to focus on workflow with patient care that can be triggered automatically in the system. “The key is to integrate these tools into common practice in pharmacy, You don’t need a separate task, operations manual, or specialized team member who knows what your pharmacy does for each facility. Instead the system guides you through these processes,” says Carrig.
Connect and Collaborate
Going through the various pieces of what comes together in the long-term care pharmacy landscape, it’s clear the software vendors want to give pharmacists the ability to connect and to collaborate.
Foster says that’s where secure messaging came from. “And that’s not just direct secure messaging, which kind of replaces faxing — it’s easier to think of direct as direct, secure email,” he says. “ We now have the growth of healthcare-focused instant messaging. You may have heard of Mediprocity, TigerConnect, or Qliq, just to name a few off the top of my head, where the clinicians can now communicate. This is working to solve the communication triangle breakdown.” Now the healthcare providers and the pharmacy all communicate via one medium. “They can’t do things like send new orders, but everything else. Believe it or not, clinicians talk about more than just prescriptions,” he says.
All of this points to the same direction: that pharmacists must move beyond dispensing and own the role of the patient manager. This is where medication therapy management fits into the long-term care space, illustrating potential gaps in a patient’s medication history that could lead to hospital readmissions. Carrig says this is the kind of documentation and reporting that retail pharmacists have available to them now, and can serve as a bridge into building long-term care or home-based care adherence programs. “There are many opportunities for pharmacists to get started with the system they have,” points out Carrig. “The way PioneerRx manages reporting and adherence packaging for retail also transitions to the long-term care arena. Without immediately investing in expensive large-scale automation you could market yourself to your local area and get some of those group homes that are more in line with the services you already do on a daily basis, and then see where it goes from there.”
The power of the technology in your pharmacy is that it gives you options, and the vendors you work with are always listening to what you might need. Carrig says pharmacists may get impatient when a request isn’t implemented immediately, but the goal is to see how a specific request could result into a new feature that benefits other pharmacies as well. “Like with care plans, or handling adherence packaging, we try to solve problems for our customer base as a whole,” he says.
Interfaces that connect the consultant pharmacist to the pharmacy workflow represent a trend that Integra’s Foster is excited about. These applications are all cloud based, which means data from the consultant pharmacist is synced back to the pharmacy system in real time. Tannert says that SoftWriters sees opportunities to drive patient outcomes. “It’s an opportunity for the pharmacy to differentiate itself and to monetize the services,” he notes.
This data, clinical and financial, along with care plans, all stream back into the pharmacy system. To truly be successful, the system must tie all these various threads together. There may be a provider sending a secure message, using the IVR (Interactive Voice Response) to ask about a drug price. All these, kept separate, make it hard to prioritize the workload in the pharmacy. It’s easy to miss something. “As technology moves forward, the pharmacy will benefit from having all those tasks collectively placed in a central repository so that everyone in the pharmacy is working from the same list,” says Foster.
Is this all pie in the sky? These vendors don’t think so. They are designing systems that help pharmacies to make this routine. At PioneerRx, Carrig says the software can trigger specific workflow for follow-up or intervention so the people can focus on their specific tasks. At Integra, Foster says they have delivery modules that were designed specifically for long-term care, but now help the community pharmacy that’s adding delivery. They also provide analytics that give pharmacists a holistic look at the pharmacy business, from patient management to financial. The power to interface, connect, and collaborate, across the healthcare ecosystem, says Tannert, is what SoftWriters is focused on: “This will allow the pharmacies to reach and exceed their organizational and business goals to be able to compete effectively, maximize their margins, and grow efficiently.” CT