Cover Story│ Gaining Traction
Jason Briscoe is director of pharmacy operations at Discount Drug Mart,
Inc., which operates 73 community retail pharmacies, a specialty
pharmacy, and a professional medical equipment division.
Karen Merrill is vice president of operations for GRX Holdings, an
operating company that has 20 pharmacies, all located in Iowa, and
mostly under the Medicap franchise. Included a compounding pharmacy and
one closed-door, long-term care/specialty pharmacy.
Jeff Pitts is director of IT for Fruth Pharmacy, which has 29 retail
locations and a central-fill site in western West Virginia, southern
Ohio, and Kentucky. Fruth is also currently developing a model of
opening smaller, pharmacy-only sites inside locations of a grocery store
The results are in for our annual look at the state of the chain
technology market. We’ll highlight key findings from our 2016 survey,
and this year we’ve also added something new: a roundtable discussion
among three chain pharmacy executives in which they highlight the most interesting topics and bring their perspective on technology needs and priorities.
Priority One: Technology to Help Pharmacy Evolve
CT: I’d like to get started by asking you what’s at the top of your priorities list right now.
Jason Briscoe: A big area of focus for us is prioritization within workflow, whether that’s leveraging our pharmacy management system, our IVR, or solutions programmed in-house. Everyone can agree that pharmacists are called upon to do more and more, and we must find ways to present them with the right opportunities at the right time within workflow by leveraging technology.
CT: Your comment is certainly supported by the survey results, which made a clear case for the need for pharmacy workflows that support the clinical role for pharmacists.
Briscoe: Right. We have pharmacists with all the best intentions in the world, who are eager to get after it from a patient care and clinical service perspective. The question becomes, do we want them to stand at a computer terminal scouring a patient’s profile to find these opportunities, or do we want to use technology and data to put the right opportunities in front of them at the right time in the workflow?
Karen Merrill: We’ve got some exciting things going on in Iowa right now. We just finished a test program where we had access to the Iowa Health Information Network, which typically pharmacies have been excluded from. That pilot project just ended, but it was good information to have. It really demonstrated to us that while we’re asking our pharmacists to do more and to be more clinical and use their license in a better manner, we don’t have all the tools and data. It also helped show how pharmacists can help other healthcare professionals when they have access to patient charts and data.
CT: What data did the pilot show was important?
Merrill: We confirmed that access to information like test results and diagnosis codes benefits our patients and other healthcare providers. And we confirmed that we need all of our platforms integrated so that you’re not going out to different websites for the immunization registry, for checking the prescription monitoring program [PMP] database, and for medication therapy management. Another thing we need is a documentation system so we can record in one place what we’ve done across all these areas. This is an immediate need. We have a community-enhanced services network proposal right now with a major payer, and they’re asking us how we’re going to document what we’re doing. Paper documentation just is not efficient.
The Need for Connecting Providers
Jeff Pitts: This ties into one of my arguments, which has always been that the community pharmacies will have the greatest impact on outcomes by being tied in closely with other healthcare organizations and data exchanges, like the ACO [accountable care organization] and HIE [health information exchange] models.
CT: We’re seeing a real clamor among chain pharmacies to participate in these models, right?
Pitts: Yes. If we’re not part of the continuum of care, then how are we going to impact patients’ lives? Fruth has done a pilot project with a hospital here, where we received discharge paperwork and our pharmacists were able to contact the patient within a day and begin to set up their continuation of care. It did help. I think that should be more common than it is.
What’s most important for repositioning community pharmacy for a more clinical role?
Merrill: Oh, absolutely. Transition of care is a huge problem. We’re finding that patients are being discharged and the hospital pharmacists are doing a great job on discharge counseling, but when they come to the retail store to pick up their prescriptions, we may not even know they have been hospitalized. Even if we know about the discharge, we may have to switch the medication due to insurance requirements. Now the patient can get confused because they have what we dispensed, and they have what they got from the hospital at discharge. They can end up with duplicate therapy. It is an issue with transitional care.
Engaging and Supporting Patients
CT: We’ve been talking about the need for pharmacy to be in constant communication with other healthcare providers. What about trends in connecting with and communicating with patients?
Pitts: This has been a major focus for us: How do we engage the customer? There’s a lot that we should be doing with analytics and being able to answer questions like: What information do we need to know about a patient? What do they need to know? What do they want to know? What can help their lives, based on the medications they’re on? And there are others. I think the more we can reach out to the customer and engage the customer with relevant information, the more useful we are to them and the more we’re able to impact their lives. If all we’re doing is putting pills in a bottle, they can get that anywhere.
Merrill: You have to target the message to your audience. If you’ve got an 86-year-old with a cellphone, that may not be a smartphone or a text-ready phone. So just because we have a mobile phone number, we shouldn’t automatically send text messages to them. That’s still a landline call, most likely. And then the younger generation, they want a self-service portal. They want a website where they can log in and they can run their own reports and check for coupons and request their own refills, gather information, and ask the pharmacist a question. We’ve got multiple different demographics and technology- savvy patients.
CT: What are the trends for patient-facing portals?
Briscoe: Patients seem to be on the lookout for access to educational information. A patient-focused portal makes a lot of sense in providing continual access to content. Whether it’s direct access to our pharmacists, printed patient education, or the availability of pushed or pulled online content in a portal, the key is having the flexibility to connect with patients in the way they want to be met.
Merrill: That’s right. The best portal is going to be one that we can customize to the patient’s needs and say, “There’s really good information specific to your healthcare at this site. Once you get home, go into the portal and I’ll have some things there waiting for you.” That way we’re not tying them up unexpectedly when they visit the pharmacy, when they’re at the drive-thru and the kids are screaming in the back of the car. They can get home at 11 o’clock at night and when they have three minutes, they can pop into the portal and take a look at what we sent them.
Top Tools for Engaging Patients
There’s also a real opportunity here to make a portal the basis for two-way communication and for us to learn more about our patients. For instance, I would like to see a portal where our diabetes patients can log in and tell us what their recent A1C is. Or they can log in and send us a message saying, “Hey, you mentioned nutrition when I was in the pharmacy. Can you send me some information on that?”
CT: That care interaction with patients is clearly so valuable for getting good outcomes. What’s helping pharmacy demonstrate that value?
Merrill: The first and most important thing is that we have to change our model so that we’re not reimbursed only on product costs. We have to be paid for our education. We’re getting there. We’re moving in the right direction.
Pitts: We are moving, but it’s not easy. One of my areas of interest that I read a lot about is innovation. I’m always thinking about it, but unfortunately, we’re in an industry that is heavily regulated. Each state has a board of pharmacy, for example, and the rules are not the same. It’s a struggle for me at times to see where we can try to grab some disruptive innovation to try to change the nature of pharmacy. For just a simple example, we have a 4:1 tech-to-pharmacist ratio in one state we operate in. This can make it hard to implement something new when the best way to do it would be to add a tech. If we’re already at max in a store, we can’t do some of these things.
CT: We’re talking about the value of pharmacy services, but there are some trends out there that are potentially limiting patient choice and access to care. Is there technology out there counteracting those trends? What about telepharmacy?
Merrill: Telepharmacy’s a great idea, and I’m sure there’s a place for it, but there’s also a need for additional clinical services. For example, you can’t provide immunizations remotely. You can’t provide blood pressure checks, things like that. When a pharmacist assesses a patient in full view, they’re going to catch things. They’re going to see leg edema. They’re going to see potential red flags that you might miss in telepharmacy.
Most Important to Workflow Efficiency
✓Central fill also scored highly, for those pharmacies using it.
Briscoe: I think we always talk about accessibility of community pharmacists, and for good reason. Where else in healthcare can a patient walk in and say, “I’m here. Please take care of me.”? Now we’re trying to leverage that as the advantage it is, but we’re also trying to manage workflow in a way that meets the demands that accessibility creates, all the while improving the level of care our patients receive.
CT: What’s helping you serve that drop-in patient?
Briscoe: Continued enrollment and proper execution within our sync-your-meds service and ensuring our pharmacists and technicians truly manage workflow properly. Prioritization becomes clearer and less reactionary with focus in this area. We are always striving at store level to “get above water.”
CT: It goes back to that central need for the time to actually practice pharmacy, right?
Briscoe: Now if we’ve done our job in creating that free time, what are we going to do with it? The good news is that opportunities exist for immunizations, medication therapy management, and other services. We could go on and on and on, but freeing up pharmacists’ time is simply more important than it’s ever been before.
Freeing Up Time
CT: So what technology has the biggest impact when it comes to freeing up time?
Processes for Which Technology Is Most Important
Merrill: We switched to more robust countertop counting technology a few years ago, which takes images of the count and has barcode scanning and inventory capabilities. That’s in all of our stores now, and there are clear efficiency and safety gains from these devices. That’s important, because I think we have to figure out a way to accomplish dispensing and medication education in a very short time. Most people aren’t able to sit down and wait 15 to 20 minutes. They want to be in and out. They want to be at our drive-thrus. We also need to change patients’ expectations regarding the types of services and interactions they should be expecting at the pharmacy.
CT: What about central fill? Is that freeing up time? It seems like we may be seeing more of it when you consider the move to the appointment-based model (ABM) and the predictability of prescription fill schedules and the patient visits that creates.
Pitts: We’re just finalizing the implementation of our central fill, and we’ve noticed that if the pharmacists are behind it, they know how to sell it to the patients, and then it really works. The patient behavior can get changed so that they are looking a little more ahead. That has really helped in some of the stores, to be able to push prescriptions out to central fill.
Merrill: Well, we haven’t found that central fill works for us. But appointment-based med sync has been helpful for us. We use our technology to send outbound text messages or calls to remind people of their appointment or remind them that our technician is going to be contacting them to discuss their medications prior to their fill this month. Again, that type of technology is really important. But it’s important to note also that not every appointment is a long one. It can be as simple and quick as the patient just picking up their prescriptions.
Briscoe: I would say that whether central fill is a good option for an organization or not, ABM makes the business case a little easier to obtain. Patients become used to the idea of picking their prescriptions up at a prearranged time, therefore providing that window of time to drive prescriptions to a central-fill site. If you’re executing well with your sync program, I think there is a business case based on that critical mass of patients you potentially can move to that facility. Whether it’s a good fit for your organization or not, that’s to be determined. I think it does make the business case a little clearer.
Top Tools for Adherence Programs
Pitts: I just want to go back to sync programs and ABM for a minute. We’ve had a harder time implementing that. We try to get the customer to come in, but they don’t keep the appointment, and so what we’re working on now is a patient care center with interns who do a lot of the prework for a patient’s prescriptions. Then, the next time the customer comes into the pharmacy, we’re ready for them, and the store staff have the opportunity to interact with the customer while they’re standing right there rather than trying to organize and schedule an appointment. In our world, it’s worked better.
What’s Top of Mind?
CT: OK. Let’s wrap up by touching on any final topics that are top of mind for you.
Merrill: Something interesting for us is that we just recently switched from a seven-day manual pillbox to a multidose blister pack. We have several hundred retail patients using this packaging now.
CT: So that’s compliance packaging at retail as an adherence driver. Very interesting, because adherence programs are certainly getting to be the standard of practice at this point, with 90% of responding pharmacies offering them and the rest developing a program. But our survey also shows that these programs mainly leverage med sync, while compliance packaging for retail isn’t really mainstream yet. Why is it working for you?
Merrill: Well, we’re promoting this for the folks that probably should be in assisted care but really don’t want to be yet. We’re talking with their children and saying, hey, this is a way to help your mom and dad stay at home, and we’ll package a month’s worth of meds or a week’s worth at a time and deliver them. I really think it’s a much better tool than bottles that can get mixed up and shuffled around. Every bubble is perforated so that they can be torn apart and sent with the mom to work or to daycare or wherever they go, and the bubbles are appropriately labeled. So that’s good for the patients and their families.
For the pharmacies, it’s knowing how many med packs we have to put together in a particular day that helps us control inventory, manage workflow, and manage our labor force. And we’re able to charge for the service at retail.
CT: Jeff, Jason, what topics do you want to wrap up with?
Pitts: We’re getting ready to roll out a PMP check process within the workflow in our pharmacy system. Our pharmacists are really chomping at the bit for this. It’s going to be really nice for them to be able to pull up all the PMP reporting they need. They’re loving that idea, and they want that.
Briscoe: That’s something we’re eager to roll out as well, and we’re taking steps. It’s not only about access to the reporting, though. I would like to see some type of automatic documentation as well, so that it paints a picture with a timestamp of who accessed the PMP data and when, without much manual manipulation by the user. The goal is being efficient while still satisfying requirements and creating a system with accountability and a clear record of what’s been done. If we can embed all this within workflow in an automated fashion, that’s a win. It’s a big win. CT
Will Lockwood is VP and a senior editor at ComputerTalk. He can be reached at firstname.lastname@example.org.