Time and money impact pharmacy
Time is money. This is particularly true at retail pharmacies, where pharmacists and technicians are often stretched to the gills by manual tasks. At the same time, prescription profits continue to decline. This is prompting pharmacies to explore more pro table clinical services. But to accomplish this, pharmacists and technicians must be freed from some responsibilities.
To make this shift, pharmacies are implementing technologies in stores, warehouses and via customer interfacing apps to perform certain functions. Back-end tools include inventory optimization, financial management and central fill as well as robotics, billing and automated pricing. Other technologies include vaccine data management and automatic storage and retrieval products.
On the patient interfacing side, digital platforms are providing self-service along with information and reminders regarding prescriptions, vaccines and other services.
“The greatest issue we’re helping pharmacies overcome is saving time,” said Jason Briscoe, Pharm.D., R.Ph., VP, healthcare sector at STChealth, which offers vaccine reporting software. “There’s immediate ROI. We save them a bunch of unnecessary key strokes, helping them accomplish more in less time while increasing patient safety. This can help profitable growth, whether you have one location or 10,000. Pharmacies can’t afford wasted steps.”
Store closings by major drug chains are also driving technology adaptation as nearby competitors take on locations’ patients. Sometimes, competitors are small chains or independents. “We have customers outside of large chains taking on this business,” said Brian Sullivan, principal pharmacy solutions, North America at Knapp. “They’re bringing on volume they’re not equipped to address and are seriously looking at technologies to address it. Now, they have the ROI to do this.”
Retail wage growth is another impetus. “Technicians cost $25 to $30 hourly,” said Darin Gleason, national sales director, U.S. retail, ScriptPro. “With benefits, a technician can cost $70,000 to $80,000 annually. This has accelerated conversations with pharmacies on how we can help stem this tide and continue providing good service and prescription output levels.”
“We’re seeing most innovation on the clinical services side which, for the most part, wasn’t automated,” said David Pope, chief pharmacy officer, XiFin Pharmacy Solutions. “There’s been movement on state and federal legislative fronts allowing pharmacists to use their full extent of training. We’re opening up pharmacists to be the front door to primary care. This is the most rapidly growing pharmacy area. But automation must be true for that to occur. Otherwise, you’re asking too much of pharmacists.”
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Less pill counting
While automated pill counting solutions have existed for some time, the desire to implement more clinical services and improve ROI is driving adaptation and upgrading of central fill, robotics and other technologies addressing this task. “There’s been more change in the past three years than in the previous 20,” said Gleason. “The goal is to reduce dispensing errors and become more efficient. And many pharmacies are dealing with medication compliance and multi-dose packaging.” For years, ScriptPro’s vialling robots were one size. But increasing demand prompted it to offer six sizes. The smallest occupies just 4 feet “because pharmacies are different sizes and have different workflows,” said Gleason. “The interface works seamlessly with almost every pharmacy solution available. And they last for decades. You’re not allocating capital for new automation every five or six years.”
At Knapp, off-site central fill technology costs “a fraction” of in-store prescription filling, said Sullivan. “Ninety-five percent of prescriptions can go through various processes without anyone touching them. Central fill is significantly more accurate than prescriptions manually filled in stores. Human error is removed. It frees up pharmacists and technicians to perform other, more pro table clinical activities.”
In stores, Knapp’s A-3000 automated storage and retrieval product also eliminates human pill counting, also freeing up time. “There’s no money to be made in counting pills,” said Sullivan. The vertical, space-saving device can go as high as 12 feet, leaving square footage for clinical services.
Knapp also offers 24/7 automatic medication dispensing terminals, which have been deployed in Europe. In Canada, it is experimenting with a different version. In addition to freeing pharmacists’ time, kiosks let patients access medication when pharmacies are closed or when lines are long. When a customer scans a bar code, the prescription is dispensed. The technology directly interfaces with Knapp’s A-3000 system.
Scope of practice by state
State laws vary widely regarding scope of practice, a challenge for nationwide retailers. EnlivenHealth, an Omnicell subsidiary, offers a Scope of Practice and Reimbursement Snapshot tool, which is a resource for the industry. It identifies what duties pharmacists can legally perform by state and what is eligible for reimbursement.
It can be coupled with EnlivenHealth’s Amplicare Clinical Solution, a technologic innovation that streamlines the entire clinical workflow, including personalized communication campaigns and automated appointment scheduling. The EnlivenHealth tool also standardizes documentation and integrates medical billing, said Jason Ausili, Pharm.D., head of pharmacy transformation. “It helps overcome the hardest thing to implement, which is new clinical services,” he added. “Pharmacies are more dependent on technology and automation than ever. We must solve economic problems impacting profitability.”
Expanded scope of practice has allowed pharmacists and technicians in more states to administer vaccines. STChealth’s Vaccine Intelligence reports vaccines administered to immunization information systems (IIS) nationwide, as is often required by law. Briscoe said STChealth “does business” with about 70% of pharmacies that administer and report vaccines.
“We can make reporting very streamlined so pharmacists and technicians don’t have to think about that administrative step and can spend time with patients. It’s a requirement we remove,” said Briscoe. Through electronic data interchange, IIS also lets pharmacists know what vaccines patients have had and which ones they need. “That’s one less conversation a pharmacist must have with a patient.” The product works directly with STChealth’s or other pharmacy management systems. “It’s very flexible.”
Expanded scope of practice also has created a need for patient information, documentation and medical billing technologies designed for pharmacies. XiFin's’ software allows patients to schedule appointments and fill in health and insurance information online before visiting a pharmacy for clinical services. This predetermines clinical and financial eligibility. “It’s similar to what’s done in physicians’ practices,” said Pope. “It maximizes pharmacists’ time.”
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XiFin’s technology also creates an automatic, electronic health record of test results. Results can be automatically communicated to patients, eliminating the need for pharmacists to make phone calls. To initiate treatment, patients can go online and answer questions regarding drug allergies and other issues. On the back end, medical billing software bundles all patient medical information together for insurance companies. “Pharmacy traditionally hasn’t done this,” said Pope. “Now, it can bill patients for uncovered amounts.”
Challenges and obstacles
Pharmacy is rapidly changing. This presents challenges, be they related to legislation, insurance reimbursement or addition of new services and supportive technologies. “It’s a changing healthcare landscape,” said Ausili. “Implementing new services is difficult. Practice authority varies greatly, with no two states alike. And what will pharmacies get paid for?”
Doug Hart, vice president of marketing at ScriptPro, agreed. “The future will depend on how pharmacies are allowed to change and adapt,” he said. “During COVID, pharmacies proved they could handle complex situations and be part of the overall health care system, not just a place to get prescriptions. Over the next five to 10 years, you’ll see pharmacists becoming more entrenched in patient care. They’re really taking on the role of health care providers. If that continues and pharmacists are appropriately paid, they’ll gravitate to having more services. But automation will be necessary to balance the workload while they’re doing other things.”
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- CVS facilitates tasks for pharmacists & patients
Looking to lighten pharmacists’ load and streamline patient interactions, CVS Health is using a number of technologies across its retail pharmacy and customer ecosystem. Pharmacy solutions simplify workflow while digital apps and phone services let customers access information without involving pharmacists. The goal is to reduce administrative, non-clinical tasks so pharmacists can spend more time with patients.
“We’re focused on a mix of technologies to help meet patients’ needs and transform how pharmacy care is delivered through digital innovation,” said Andrew Bunton, VP, pharmacy and consumer wellness omnichannel customer experience. “We’re reinventing pharmacy. Ongoing improvements to support pharmacists’ workflow are helping pharmacists and technicians spend more time with patients.”
While technology implementation is ongoing, the size and scope of CVS’ pharmacy empire presents challenges. “With more than 9,000 pharmacies nationwide, it’s not necessarily technology that presents the biggest challenge but implementation in general,” added Bunton. “With a presence in 50 states and Washington, D.C., developing innovations and systems that are scalable and meet federal, state and local requirements is one of the biggest challenges.”
Patient interfacing technologies include:
- CVS’ Pharmacy App lets patients automatically refill prescriptions or check status. If a medication is out of stock, the app details when it will be available and lets customers know what nearby stores may stock it. Customers can then automatically transfer their prescription to a sister location. Questions like whether the pharmacy has received a prescription from a provider, whether a prescription is ready and medication prices can also be answered instantly through the app and via CVS.com.
- If a patient must speak with pharmacy personnel directly, he/she can leave a confidential message. The message is transcribed and, if applicable, patients may receive an immediate SMS message with self-service options and can opt out of a call back. Calls needing responses are prioritized for personnel to research before returning them.
Some pharmacy-specific tools are:
- Robotics and automation assist in prescription filling, which is particularly important in high volume stores. Dynamic workload sharing across pharmacies lets workflow be completed virtually by neighboring stores. This improves workflow and workload balance while creating efficiency and capacity so pharmacists can interact more with customers. It also lets CVS adapt to unplanned staffing fluctuations.
- A new tool, SmartDUR, streamlines support of pharmacists in the Drug Utilization Review process. It uses clinical data, smart rules, and algorithms to help identify potential problems--like drug interactions—and recommends next best options or therapeutic alternatives. SmartDUR also helps reduce repetitive alerts.
- Prescription verification process and system innovations equip pharmacists with advanced technology to support quality assurance checks on prescriptions. Virtual verification technology, used in most locations, lets pharmacists perform product verification based on a medication’s image captured while the script is being processed. This maintains quality and safety checks and frees up pharmacists for patient interactions.
