Q&A: QS/1’s Crystal Ratliff on how tech enables pharmacists to do their best work
Given the frequency with which pharmacists are required to act as an intermediary between patients and physicians, a recent focus of pharmacy technology companies — among them QS/1 — have been making it easier for pharmacists to integrate into a patient’s care team. At the same time, they are enabling pharmacists to better monitor patient adherence and needs. Drug Store News spoke with QS/1 interface market analyst Crystal Ratliff about how pharmacists can leverage the company's offerings to better provide care to their patients.
DSN: As pharmacists work to achieve provider status and continue to play a greater role in healthcare delivery, how is your company enabling community pharmacists to practice at the top of their license?
Crystal Ratliff: Not only is it pharmacists’ passion to provide the best patient care, community pharmacies must be prepared to keep patients compliant and adherent because their Five-Star Ratings depend on it…
Since 1977, QS/1 has been at the forefront of pharmacy technology, providing pharmacy management solutions that enable pharmacists to deliver enhanced patient care while keeping pace with the evolving healthcare industry.
As the pharmacy’s role in the patient care team expands, technology is becoming a greater factor in removing barriers between the pharmacy and the patient’s other healthcare providers. This expanded team provides a more collaborative, efficient process to improve patient outcomes.
Pharmacists’ ability to substantiate their value in improving patient outcomes is crucial to them receiving recognition as healthcare providers. Pharmacists are already providing services beyond filling prescriptions, but this work must be documented and shared with the healthcare community for pharmacists’ value to be realized.
QS/1’s role is to provide pharmacies with the tools necessary to adapt to a rapidly changing market and to give them a substantial competitive advantage. We provide the technology to speed workflow and track compliance and reimbursement, thereby increasing the time available for important patient counseling opportunities…
Technology, integration and interfaces are the way of the future. For 40 years, QS/1 has delivered top-notch pharmacy management solutions that enable pharmacists and their staff to provide advanced patient care. We will continue to develop tools and partner with vendors to give pharmacists the technology they need as their roles evolve in the healthcare continuum.
DSN: Medication adherence remains one of the most cost-effective ways to lower total healthcare costs and deliver improved outcomes. How is your company helping community pharmacy solve for this big opportunity to improve health care?
CR: We’re helping create positive outcomes with prescription synchronization tools to increase both adherence and the level of service to patients. In addition, QS/1 provides tools for home delivery, immunizations, medication therapy management (MTM), comprehensive medication reviews and mobile refills. These options allow pharmacies to provide more services to patients while keeping them engaged in their healthcare.
QS/1 DeliveryRx is a free iPad app that gives pharmacies a simple process to provide prescription delivery, making it easier to deliver medications to patients in remote areas without Wi-Fi or dependable cellular service. And with our mobileRx smartphone app, patients can view their prescription profiles, order refills easily and set up medication reminder alerts.
Our latest innovation, the SharpRx Pharmacy Management System, contains adherence tools such as prescription synchronization, refill reminders and our Interactive Voice Response (IVR) interface. QS/1’s IVR not only provides patients the ability to order refills whenever it’s convenient, but can make outbound reminder and compliance calls. SharpRx also includes e-Prescribing, price and clinical updates, images and imprints, prior authorization, patient monographs and Prescription Drug Monitoring Program (PDMP) reporting. Labels and forms can be easily customized for patients, including enlarging the font for patients with impaired vision.
DSN: As pharmacy continues to focus more broadly on outcomes and implementing more clinical services, how is your company helping pharmacy retailers better manage the vast amounts of data they need to deal with on a daily basis that comes as a part of that?
CR: Data share and technology make it easier than ever for pharmacists and community pharmacies to provide better care to their patients. Collecting patient information and discussing health concerns was historically done via face-to-face conversations. Now, patients can discuss health-related issues and concerns with their physicians and pharmacists through other avenues, such as secure portals and direct messaging.
Pharmacists and community pharmacies are under more pressure than ever to help patients achieve better health outcomes, but getting paid to provide these services can still be a challenge. Features like interfaces with MTM programs and automatic reporting of immunizations to state registries can free up pharmacists’ valuable time to spend with their patients; time they would otherwise be spending on paperwork and other administrative tasks.
There are several examples where technology has improved community pharmacies’ ability to improve patient health. Key are simple things like having an IVR system or website handle all the refills for the pharmacy, or even synching patients’ medications and dispensing them in compliance strip packs to make it easier for patients to take medications at the right time. Pharmacists and community pharmacies must be prepared to keep patients compliant and adherent.
Another way technology has been used to improve patient health is by using Electronic Prescriptions for Controlled Substances (EPCS) to combat the opioid epidemic in the US. States like New York have adopted legislation that requires prescribers’ Electronic Health Record/Electronic Medical Record system be certified to send digitally signed electronic prescriptions for controlled substances, and their pharmacy software be certified to receive EPCS prescriptions.
Another tool pharmacies can use to combat substance use disorder is NarxCare. NarxCare provides pharmacists with insight into a patient’s controlled substance prescription history, even at other pharmacies. The NarxCare tool analyzes real-time data from the states' Prescription Monitoring Program (PMP) and makes this data available to participating prescribers and dispensers.
CVS Health eyes faster pace of health innovation
Helena Foulkes, CVS Health EVP/CVS Pharmacy president
CVS Health is poised to boost its health innovation efforts in response to a rapid-fire series of marketplace changes. That was the message at a Drug Store News forum from top CVS Health executives, who demonstrated their desire to push the envelope further — and faster — and challenged suppliers to join the effort.
Much of the focus will center on embracing emerging health trends — from connected health technology to DNA testing. Efforts will address empowered health and the consumer’s journey from sick care to self care. The company will take a deeper dive into understanding how digital innovation can solve pain points for consumers. “We are committed to bringing innovative products and solutions to our customers and we are focused on finding ways to make it happen even faster,” said Jon Roberts, EVP and COO.
New market realities make it imperative to find different routes, he added. “The pace of change over the next five years will be greater than what we’ve seen over the past 30.”
The Health Innovation Summit, held over the summer in Providence, R.I., was hosted by CVS Health, in partnership with DSN and Mack Elevation. Presenters included a range of thought leaders both from within and outside of the industry, who addressed how emerging trends are reshaping the healthcare industry.
Roberts said CVS Health is aiming to address some of the biggest challenges across its expansive footprint, such as how to navigate omnichannel. “We are well positioned to bringing unique solutions to customers with our expansive retail footprint and our commitment and leadership within digital. We have an opportunity to leverage our bricks and mortar in an omnichannel way to redefine convenience beyond how it’s defined today in the consumer’s mind,” he said.
He pointed to opportunities for rapid home delivery of pharmacy and front-store products via an enhanced Maintenance Choice offering.
Amplifying Roberts’ comments, Helena Foulkes, EVP of CVS Health and president of CVS Pharmacy, talked about what it means for an organization to have an “innovation mindset,” and shared some of the ways in which the company is working to advance its digital offerings by “getting into the shoes of the consumer to solve for pain points.” These efforts gained momentum through the launch of the company’s digital innovation laboratory in Boston in 2014, which was created to spearhead new initiatives.
It included the development of CVS Pay, not just for mobile payments, but also as a tool to reduce the amount of information consumers need to provide at each pharmacy visit. It also included CVS Curbside to enable mobile or desktop ordering and pickup for busy consumers.
Foulkes said that even basic technologies can turn into “game changers” for solving consumer pain points. For example, the adoption of a technology as seemingly simple as two-way texting is helping CVS solve for interruptions that come when patients change insurance plans; now its patients can simply send a photo of their new insurance cards rather than wait until they arrive at the store to find that their prescription has not been filled because of an insurance issue.
“These are the kinds of innovations that really make a difference and ultimately drive the outcomes we’re all looking for,” she said.
Shifting to how the pace of innovation is impacting its stores, George Coleman, VP merchandising and consumer health care, talked about the company’s efforts to re-imagine the customer experience around health and wellness — from healthy food to healthy skin care. A range of new efforts target the omnichannel experience, new brands and products, as well as new services such as optometry and audiology, he shared. The enhanced services will leverage a range of clinicians at the company, including pharmacists, techs and nurse practitioners.
“We’re looking at telemedicine,” he said. “We’re looking at bringing health services into our stores. We’ve done pilots in optometry and audiology, and we’re scaling them further.”
The front store is being transformed into a “new health and beauty destination,” he explained. These advances come against the backdrop of a shifting consumer healthcare environment and changes in the insurance landscape. Consumers “put a premium on prevention, because it’s more costly to get sick,” he said. This reality supports the journey from sick care to self care, which makes it imperative that CVS adapts for the new climate, he explained.
Coleman highlighted some of the most important emerging trends the company is tracking in consumer health care:
- Self-knowledge: The emergence of DNA test kits will evolve into even more targeted forms of analysis, such as what kind of skin care may be most effective for a particular consumer. It’s “individualized literally to your DNA. This stuff is coming. It’s getting better,” he said;
- Connected devices: New devices, including wearables with data that’s integrated on apps, will continue to become more important for monitoring everything from blood pressure to temperature. “There will be more ways to integrate the apps and data, and we want to be one of those integrators,” he said;
- Nutrition and supplementation: How to best integrate healthy foods with pills, supplements and OTC’s is a big topic of focus. Consumers give top priority to eating healthy foods, but “90% of Americans don’t get enough of the recommended daily allowance of minerals and vitamins in food alone;”
- Sleep: Consumers are increasingly recognizing that adequate sleep is required for good health, and they are seeking a wider range of solutions to help facilitate this. This includes traditional OTC-type products, and also more natural remedies, including “solutions outside the bottle,” extending even into general merchandise and
- Immunity: “Immunity is becoming a big deal” to stave off sickness, and consumers are looking for natural solutions in addition to traditional supplements. “We’ve had a lot of success with smaller brands who are basing themselves in their ingredients stories,” he said.
The comments from the CVS Health executives set the tone for the presentations and discussions that followed throughout the day. In this special report, DSN recaps the major highlights and key themes from the event.
Pharmacies turn to automation as workloads, data needs rise
Retail pharmacy is being squeezed.
Even as an aging population and expanded insurance coverage under Obamacare propel rising dispensing rates and add to pharmacists’ workloads, they’re being called on to practice “at the top of their license” by filling an ever-expanding role as front-line patient-care specialists and fully engaged members of collaborative care provider networks.
With “the healthcare landscape … undergoing its most rapid transformation in a century,” to quote the National Association of Chain Drug Stores Foundation, chain and independent pharmacies are facing an existential challenge. How do pharmacists — no matter how highly trained and motivated they are — juggle rising prescription counts with expanding clinical and such preventive-care services as medication therapy management, diagnostic screenings, immunizations, medication adherence programs, appointment-based patient counseling sessions, and chronic disease monitoring and management? And how do they link those efforts to a broader, more holistic model of patient care in collaboration with doctors and health systems?
Technology firms say their solutions will enable community pharmacy to keep pace with the explosive changes occurring in health care. In an era of collaborative and accountable care, outcomes-based reimbursement models, rising prescription volumes, a shrinking pool of primary care physicians and urgent cost-cutting imperatives, pharmacy retailers and their technology vendors are more closely linked than ever. And automation is more critical than ever — both as a labor-saving tool and as a means of capturing, sharing and applying prescription data on behalf of healthier patients and lower health costs.
Some pharmacists might argue that those labor-saving tools aren’t being applied fast enough to keep up with the added burdens of clinical care. But massive investments in robotic dispensing systems and other tools are clearly shifting some of the dispensing workload away from pharmacists and onto more highly trained technicians — and into high-volume, highly automated central-fill facilities.
At the same time, systems to mine, measure and analyze patient data are advancing rapidly, giving pharmacists more powerful decision-making tools to support patient interventions and connect more seamlessly with the broader health network.
“We’ve seen this amazing transition taking place in community pharmacy with it becoming more clinical in nature,” said Brian Glaves, director of sales for ScriptPro. “Today’s incoming pharmacists are chomping at the bit to be a healthcare provider to their customers —developing those personalized relationships and helping set up prescribed medication therapies.”
For its part, “ScriptPro is keeping abreast — developing new technologies that enable pharmacists and their teams to stay connected across their network and with their patients and prescribers,” Glaves said.
Glaves called robotic dispensing systems “a game changer” that “go a long way to streamlining workflow, saving time and improving accuracy.”
“Now you can seamlessly integrate all these new technologies that keep patients and their pharmacies connected,” he added, citing ScriptPro’s own RefillPro and PharmacyPro mobile point of sale systems. Within “our industry’s growing collaborative care mindset, the retail setting is facing a huge need for organized case management and treatment plans for patients undergoing chronic disease, pain management and specialty drug therapies,” Glaves told DSN.
It’s about applying technology and patients’ electronic health records “to integrate pharmacy care from the payer to the provider to the patient,” CVS Health president and CEO Larry Merlo noted earlier this year. The company’s “truly integrated assets,” he added, give CVS “a full view of each patient and a single patient record for prescriptions and care regardless of the CVS Health channel used.” And it allows the broad-based retail pharmacy and pharmacy benefit management giant “to offer innovative services and to deliver additional value to [other healthcare] stakeholders.”
Supporting health provider status
The American Pharmacists Association calls health IT “an effective vehicle for exchanging information between practitioners, patients and pharmacists.” To that end, “Pharmacists need access to pertinent clinical information about their patients, and in turn should contribute information to the health care team in order to improve patient outcomes,” APhA noted.
“Information technology plays a major role in monitoring any adherence program. That’s especially true when it comes to tracking outcomes,” said Sandy Canally, founder and CEO of the Compliance Team, the first certified, woman-owned healthcare accreditation organization to hold “deeming authority” from the Center for Medicare and Medicaid Services.
“In this day and age, nearly every pharmacy uses some type of software program that enables them to submit data to payers and referral sources,” Canally added. “The best use of IT is utilized in the patient monitoring follow-up. Careful documentation is key to providing proof of a positive patient outcome.”
For that and other reasons, she told DSN, “Obtaining a complete medication history is critical in assessing the appropriateness of the prescribed medication therapy, and to create a reconciled medication list and care plan for the patient. Equally important is the coordination of care by the pharmacy with a patient’s prescribers.”
Automation experts agreed. “Technology, integration and interfaces are the way of the future,” said Crystal Ratliff, market analyst for technology provider QS/1. “As pharmacy’s role in the patient care team expands, technology is becoming a greater factor in removing barriers between the pharmacy and a patient’s other healthcare providers. This expanded team provides a more collaborative, efficient process to improve patient outcomes.
“Pharmacists’ ability to substantiate their value in improving patient outcomes will be crucial to their recognition as healthcare providers,” Ratliff pointed out. “Pharmacists are already providing services beyond filling prescriptions, but this work must be documented and shared with the healthcare community for the pharmacist's value to be realized.”
As for QS/1, she said, its role “is to provide pharmacies with the tools necessary to adapt to this rapidly changing market and to give them a substantial competitive advantage. We provide the technology to speed workflow and track compliance and reimbursement, thereby increasing the time available for important counseling opportunities.”
Another critical benefit community pharmacies can bring to the new health paradigm is their proven ability to improve patients’ adherence to medication therapies — a key core competency that can lead to reduced hospital readmissions and healthier patients long-term. The installation of unit-dose or multi-dose packaging systems within the pharmacy can be a powerful tool for improving adherence rates, said Mark Rinker, senior director of sales for Synergy Medical.
“We continue to strongly … advocate the use of packaging to improve patient outcomes,” Rinker told DSN. “The FAME (Federal Study of Adherence to Medications in the Elderly) study and others clearly indicate a patient is better off with their medication organized by the pharmacy by day and time of administration in a blister card, opposed to patients self-medicating with multiple vials.”
“Adherent patients drive plan Star ratings, and in turn this improves their reimbursement and plan inclusions,” Rinker noted. “Blister packaging as part of a broader medication adherence strategy is a means for community pharmacy to survive and thrive.”
‘Balancing expense and investment’
Meanwhile, the quest by pharmacy leaders for the right tools to free their pharmacists from most of the basic mechanics of dispensing and tracking scripts goes on. They’ve made — and continue to make — huge investments in both behind-the-counter robotics and other automation, and in offsite central fill facilities that can churn out and track hundreds of scripts an hour with multiple robots and other fast-track technology to ease in-store dispensing pressures.
“Pharmacy providers are constantly balancing expense versus investment,” said Doyle Jensen, executive VP of global business development for Innovation. “In these times of shrinking margins, money invested in pharmacy operations must provide the best possible return. That’s why more and more providers are turning to central fill; it’s the best way to leverage their technology spend.”
“Dispensing technology deployed at retail is severely underutilized, while centrally deployed technology supports hundreds of stores — and the volume of the stores can best leverage each dollar spent,” Jensen told DSN. “With up to 60% or more of the prescription production handled at central fill, retail pharmacists have much more time to deliver patient-facing care and other patient-related services.”
Other technology solutions providers also are focused hard on that quest for higher levels of productivity behind the counter and more time for pharmacists to practice at a higher level of care. Bobbie Riley, pharmacy director for LexisNexis – Health Care, said, “Our focus is on getting pharmacists the technology they need to be compliant and to be able to work as efficiently as possible.”
“As provider status progresses and prescriptive authority expands, these types of validations and insights become even more important,” Riley said. “And as reimbursement continues to shift from fee-for-service to value-based payment, treating the patient more holistically is key.”
“In addition, we are seeing more and more how social, economic and environmental factors are impacting the health of patients. Providing insights to help better understand behaviors [that] could influence medication adherence is becoming critical. The LexisNexis Socioeconomic Health Attributes and Scores is a solution that can help offer greater visibility into these key factors,” Riley told DSN.
Technology firms have developed a range of increasingly specialized tools to solve different aspects of pharmacy automation and pharmaceutical processing. PerceptiMed, for instance, was founded in 2013 to reduce pharmacy-based medication errors through its VeriFill automation processes.
PerceptiMed’s IdentRx proprietary technology “enables pharmacies to place the pharmacist at the top of their license by utilizing a remote-verification platform that rebalances verification workload across its footprint,” said Frank Maione, chief business officer. “Other benefits include labor savings from the time devoted to the Schedule 2 double-count and tracking process through a one-pour, triple-count, image-capture and record-retention [process], all in under 15 seconds.”
For its part, Morris Plains, N.J.-based Temptime has focused since 1987 on developing solutions to the safe storage, handling and transportation of medical products and pharmaceuticals. According to Chris Caulfield, VP of global customer development, “Temptime offers an entire range of temperature-monitoring solutions from low-cost, chemically based products to sophisticated, data-driven devices equipped with low-energy Bluetooth capabilities and cloud-based data storage.”
“Temptime understands that pharmacists are taking on an ever-growing responsibility of assuring that highly valued, temperature-sensitive medications are received by the patient per the temperature requirements of the manufacturer and … the state board of pharmacy,” Caulfield added.