Automation key to pharmacy’s reinvention
For decades, chain and independent retail pharmacy has been defined by its unyielding pursuit of professional recognition, fair reimbursement and full status as a member of the healthcare provider team. The industry has made huge strides toward that goal, thanks to massive investments in pharmacy technology and automation, which have enabled a shift in workflow, giving pharmacists the data and decision-making tools to support patient interventions and connect more seamlessly with the broader health network.
“Automation has led to the ability for us to reinvent ourselves as a profession, and we need to take the challenge,” said Marilyn Stebbins, a pharmacy professor and vice chair of clinical innovation at the University of California, San Francisco.
Managing and sharing data is a HIT
Health information technology and connectivity have been critical to pharmacy’s transformation. The industry’s quest to achieve full healthcare provider status for pharmacists hinges on pharmacy’s ability to capture, manage and share up-to-date patient health records in real-time with other members of the healthcare provider team.
This ability to manage and share data has been critical for CVS Health, said company president and CEO Larry Merlo. “… What really sets [us] apart is our ability, largely through technology, to integrate pharmacy care, from the payer to the provider to the patient. With our truly integrated assets, we have a full view of each patient and a single patient record for prescriptions and care regardless of the CVS Health channel used.”
According to Jocelyn Konrad, EVP pharmacy at Rite Aid, it’s critical that the profession and the industry it serves make every interaction between patient and pharmacist “meaningful, and customize those interventions based on the needs of the patient.” “The challenge is to get tools in the hands of the healthcare provider in real-time, to get the information at their fingertips to really personalize the experience,” said Brandon Worth, senior director of health-and-wellness innovations and systems for Walmart.
Relying on robots and central fill
Pharmacy retailers are investing big sums on the hardware and software needed to reduce pharmacy workloads and dispensing costs. Shifting more of the workload to robots and large-scale, automated central-fill pharmacies will lower average dispensing costs and allow pharmacists to engage with patients “at the top of their license.”
“The biggest concern we hear from retailers is the ever-shrinking margin on third-party prescriptions,” said Doyle Jensen, EVP of global business development for Innovation. “It’s getting to the point where … they’re going to have to stop taking certain plans because they’re just not economically viable. That’s why centralization has made so much sense; they can literally save $2 to $7 off the production cost of every single script they process centrally.”
To that end, said Rite Aid chairman and CEO John Standley, “we developed central-fill technology to facilitate the automated picking, packaging and labeling of prescriptions in a central-filling location. We also have developed workload-sharing technology within our stores, whereby stores within a close proximity can shift filling volume to stores with excess capacity. The efficiency of these processes allows our pharmacists to spend more time consulting with and answering our customers’ questions and concerns ….” (For a more in-depth look at recent product developments from Innovation, QS/1, VoicePort, ScriptPro and RxSafe, click here.)
Digital tools for personal service
In line with consumers’ heavy reliance on mobile devices, retailers also are spending heavily to extend their mobile reach. “We’ve made significant investments in the customer experience over the last two years …,” said Shane Sampson, chief marketing and merchandising officer for Albertsons. “E-commerce, digital and social media channels hold unlimited potential for delivering the kind of personalized service our customers want.”
Telehealth and telepharmacy also are getting increased attention as stakeholders begin to embrace the concept. “These technologies have the potential to increase consumer satisfaction, improve medication adherence and help consumers track and monitor their health,” Deloitte noted in its 2016 Survey of U.S. Health Care Consumers.
“I believe telepharmacy will become the system that conveys this information in an affordable and safe way. It will become a platform that enables pharmacies to make the transformation from a product industry to a knowledge industry,” said ScriptPro president and CEO Mike Coughlin.
For pharmacy operators to survive in the new world of interconnected health care and empowered consumers, investing in technological upgrades is a necessity, not an option, pharmacy leaders said.
Looking beyond influenza immunizations
In the roughly 20 years since pharmacists began providing vaccinations in some states, pharmacy is growing as a preferred site for patients to receive their immunizations. In PrescribeWellness’ 2017 Vaccination and Preventive Care Study, 55% of survey respondents said they prefer their pharmacy to their physician’s office as the place to get vaccinated.
Pharmacy is responding. Roughly 68% of community pharmacies offer immunization services, according to the 2016 National Community Pharmacy Association Digest. And approximately 300,000 pharmacists nationwide currently are trained to give immunizations, according to the American Pharmacists Association.
Pharmacy immunizations have played a large role in patients getting immunized against the flu. The Centers for Disease Control and Prevention numbers from November 2016 show that 24.3% of all flu vaccines were given in a retail pharmacy setting. Pharmacists can administer the flu vaccine to patients in all states, though some states require patients to have a prescription, typically depending on age.
But vaccinations in the pharmacy are more than just the flu vaccine. For example, pharmacy can provide an important place for patients to be vaccinated against shingles — something that the PrescribeWellness survey found is on the top of patients’ minds. The CDC noted that 1-in-3 people are expected to develop shingles. As a result, 89% of those surveyed thought that it was important to take shingles immunization seriously, with 40% saying they had been directly affected by shingles in some way.
In every state, pharmacists are authorized to administer the herpes zoster vaccine, according to the National Association of Chain Drug Stores. The Food and Drug Administration has approved the vaccine for patients ages 50 years and older, and CDC guidelines recommend the vaccine for patients ages 60 years and older. While in 39 states patients of the appropriate age don’t require a prescription, seven states always require a prescription. In addition in North Carolina, pharmacists must consult with a patient’s primary care physician first; in Wyoming, only high-risk patients’ physicians have to be consulted; and in Maine, patients without an established primary care physician can be vaccinated without a prescription. Missouri requires prescriptions for patients ages 50 years to 59 years old, with no prescription required for patients older than 60 years of age.
While many Americans are concerned about shingles, another vaccine commonly administered by pharmacists — the pneumococcal vaccine — is open to more patients beyond seniors, presenting another large opportunity for pharmacies. “It’s wonderful that Americans are taking the shingles immunization seriously, as the vaccine significantly reduces a person’s risk of developing herpes zoster,” said Farah Madhat, a licensed pharmacist and director of clinical services at PrescribeWellness.
“But there are other vaccines they should also make a priority. The pneumococcal and flu vaccines are also effective, inexpensive and readily available at local pharmacies, without a prescription in most states. Pneumococcal disease can cause severe infections of the lungs (pneumonia), bloodstream and lining of the brain and spinal cord, more commonly known as meningitis. Each year in the United States, pneumococcal disease kills thousands of adults and hospitalizes thousands more,” Madhat added.
Expanding tech offerings
From large-scale, high-volume processors linked with data management software and video-enabled prescription verification systems to “cobots’’ that require a minimal amount of countertop space, a new generation of dispensing tools is allowing pharmacies to shift more of the workload to technicians and central-fill sites so pharmacists can focus on patient interventions and clinical services. Also gaining in popularity are automated unit-dose or multi-dose packaging systems that can improve medication adherence by customizing prescription fills to a patient’s daily drug regimen. The following is a quick look at recent product developments.
Innovation has enhanced its PharmASSIST Symphony for high volume applications. The system now gives pharmacists “real-time digital images of canister replenishment,” including a more streamlined process for tailoring specific orders to specific pharmacies and a “customer-specific dashboard” that provides pharmacies with “full transparency into all system, user and fulfillment activity,” according to Innovation. This fall, Innovation also is partnering with Binghamton University to provide advanced pharmacy practice experience to students.
QS/1’s NRx Pharmacy Management System supports pharmacies’ efforts to shift patients to a once-monthly medication synchronization program, and its InstantFill feature “automatically queues eligible Interactive Voice Response and web refills, prints labels and sends them to an automated-dispensing system for filling,” according to QS/1. Other applications support pharmacists’ medication therapy management initiatives, and medication adherence through an application called Health-Minder.
VoicePort’s Claro Pharmacy Solutions division has teamed up with PDX to offer an interactive voice response service with outbound patient notification through PDX’s EPS and Classic pharmacy systems. VoicePort’s platform “offers a high degree of flexibility and configurability designed to optimize our customer’s specific technology, workflow and financial requirements, as opposed to a one-size-fits-all approach,” said Adam Vargulick, director of product development.
ScriptPro expanded its line of robotic dispensers to a total of six robots under two brand offerings — the larger-scale line of SP robots and the newer CRS, or compact robotic system line of automated systems. All six robots “interface with the pharmacy computer system to fill, label and collate up to 150 prescriptions per hour,” according to the company.
RxSafe expanded its automated dispensing line with the RxSafe 1800 robotic storage and retrieval system. “RxSafe technology automatically and accurately tracks all drugs in the pharmacy down to the pill or package,” the company reported. The RxSafe 900 and RxVault systems are for smaller available applications, along with the RxAWC, a fully automated, robotic will-call storage and retrieval station that the company said eliminates the possibility of theft, diversion or tampering.