Understanding Patient-Centric Workflow

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Randy Burnett, QS/1 senior product manager, PrimeCare and NRx and Zach Princell, Pharm.D., QS/1 assistant product manager on customizing workflow, talk about getting the most from your pharmacy technology, especially in patient-centric models.

ComputerTalk: Zach, let’s start with you. How is QS/1 increasing the efficiency of the pharmacy?

Princell: NRx and PrimeCare are just so customizable and can be tailored to fit the need of any pharmacy. We have different queues. You can start with intake; that’s more of a clerical queue.

The queues are a good way for the pharmacist to customize the workflow. You can really do your clinical checks or whatever applicable step you want to perform. So if you want to run quality assurance or order entry or whatever, these can be specified in certain sections. If a technician is working in a certain queue, you can choose to get your med guides and monographs and things like that printed out at different steps of the process. It comes back to the customization for each pharmacy’s specific needs.

That’s my favorite thing about this pharmacy technology system — that it can be tailored to suit the needs of just about any type of pharmacy, low-volume or high-volume. You go into the store-level options and the store control and you see the plethora of settings that are available and you really get a feel of, “Wow, I can really tailor this to what I want it to do.” And I think the best time to get that done is when you first get the pharmacy management system and work with the people who come out there from QS/1 to get you set up.

My recommendation is: always, take a chance on a feature and see how it works for you. Many times the pharmacist comes back and says, “I don’t know how I lived without it.” You know, all it takes is a simple phone call or getting somebody to come out to visit your pharmacy from QS/1 and show you what this pharmacy technology can really do and then try it out for a week. Maybe you hate it or maybe you love it. I think it is really, really important just to explore all that our pharmacy management system has to offer.

My work has revolved around patient chart functionality and medication synchronization. We’re working on a nice revamp for that to make it more efficient, a lot more intuitive, and a lot more flexible. Of course, we have med sync built into the system and it works, but we feel it can always work better. Medication synchronization is such a big component of community pharmacy today. We know there are pharmacies who still use paper to organize their med sync, and we’d like to see if we can replace paper for them.

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Med sync would have its own queue showing what needs to be done today, tomorrow, or next week. Ideally, it’s a place where you don’t have to continuously go from trying to manage medication synchronization back to the patient profile. To be efficient, we want to give the pharmacist everything in one place.

Another big area is eCare plans. We have a lot coming down the pipeline with eCare plans. With Service Pack 32 we added functionality to directly submit lab values and vital signs and active and additional medications.

We are discussing a design change to improve the workflow a little there. We are looking into options for a universal platform. It’s a hot topic, and everybody here recognizes that.

We are very dedicated to supporting our CPESN customers. With Flip the Pharmacy, we are making sure our customers have all the pharmacy resources they need to succeed in this initiative —  whether it is updating SNOMED codes or making sure they have all the reporting functionalities they need. It’s a huge commitment on our end, and we are dedicating a lot of time and personnel to continuing the development of eCare.

Clinical pharmacy is going to change the pharmacy management workflow. This is patient-centric versus dispensing centric.

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ComputerTalk: Any other features you would like to tell us about?

Burnett: We have a feature called Health Minder that gives pharmacists the flexibility from a scheduling and staffing standpoint to customize their workflow around when they want prescriptions ready, depending on payers and how early refills are approved. We manage all that in the pharmacy software.

If we’re talking about chronic conditions and multiple medications, then our CycleRx medication synchronization program would be a huge benefit.

With CycleRx, the idea is to group patients with similar conditions in a group to fill those at the same time. You can look at it from the patient perspective, or you can look at it from the adherence and outcome perspective. If it’s the patient perspective, they have the convenience of getting all their prescriptions with one trip to the pharmacy. From the adherence perspective, I know my patients are getting their prescriptions at the same time and I control my gap days that I potentially was having with this customer. And now I reduce even my DIR fees from the PBM [pharmacy benefit manager] for not being adherent.

Within the pharmacy software we provide, you’re able to create a base date and look at the number of days’ supply for each one of those medications. It will take into account the various days’ supply and short-fill prescriptions; when the pharmacy fills it for the first time, and when they bill the first time, it’ll have the short-day supply cost to the customer and set it up for the approval process with the procedure codes to let the PBMs know that these are cycled medications so that they pass through the process of adjudication.

We’re making enhancements to the product. The whole synchronization process is about how efficient we can make the dispensing process. Even if the pharmacy gets a new prescription that comes in for that patient during order entry, the system identifies the patient as a med sync patient and shows the next sync date so the new prescription can fall in line. If it’s going to be a short fill for this fill so it syncs with rest, that’s part of the prescription processing flow as well.

Often there are medications within that patient’s profile that are filled on an as-needed basis, such as an inhaler. A patient might not need that every 30 days. With paper now, the pharmacy staff has to check everything on the patient, even an outlier, and will have to call to verify what is needed. When I take this from the paper-based system to an electronic-based system where you are organizing a queue for staff to follow up with the patient and let them know they are running low on something like an inhaler, and then add it to the sync, just for that cycle.

That to me is the evolution of pharmacies. Pharmacies still using a paper-based pharmacy management systems are incentivized to move away from paper and toward an electronic version of that worksheet to manage their patients.

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ComputerTalk: What else would you like to tell us?

Princell: We’ve dedicated the med sync queue its own space, separating this from the distractions of typical dispensing so the pharmacy staff can concentrate on the manual process that’s required with med sync. Med sync requires constant surveillance and constant updates. You’ve got to call these patients to check on them. With the appointment-based medicine model, you’re calling every 30 days, or however long your duration is, and the worksheet that we provide on-screen would ideally show you your already-synced medications, and all your other medications, as well as a separate section for the medications that need to be checked each month, whether it’s an OTC [over the counter] or supplements or insulin or inhalers, things that don’t typically fall into the pattern of maintenance meds. CycleRx will highlight those for you, and you don’t have to write it down or remember to check on those every time you check on the patient.

ComputerTalk: Anything new coming?

Princell: One of the things that we’re looking into developing within the pharmacy management system is what I’m calling a clinical trigger. If a pharmacist administers a vaccine, it gets processed like any other prescription, but the system would intuitively know to recognize that this is an excellent opportunity to document a care plan. When we get to the point where you can send care plans in for reimbursements, the system is essentially saying you want to get paid additionally for doing this. So providing that to our customers I think would be a huge competitive advantage. CT