201005_CT_Sept_Oct_2010_Vol30_Num5 by ComputerTalk Associates, Inc.

Volume 30 Number 5 • September/October 2010

For The Pharmacist

www.computertalk.com

Long-Term Care: Technology That’s Driving the Market A look at what pharmacists are doing to make management and service improvements in their long-term care practices. story begins on page 25

Plus... n n n

How to Benchmark Your Pharmacy’s Performance A New Way to Improve Inventory Management Documenting and Billing MTM Services: What Pharmacists 57 Say September/OctoberHave 2010 to

PRSRT STD U.S. POSTAGE PAID Permit #162 ITHACA, NY

brate Come Cele acy at the rm of Pha the Future

5, 2010 October 2 ia. Philadelph Institute in n li k n ra F t The

For tickets:

ist.org

npharmac

eneratio www.nextg

It is a privilege to work with my father. It's a better atmosphere for our customers when we're here together. Jacob Johnson, R.Ph.

We really like working together. And our customers enjoy our banter. We work everyone into the conversation.

Danny Johnson, R.Ph. Marble City Pharmacy Sylacauga, AL

Parata salutes the fathers who started pharmacies to help people. Itâ&#x20AC;&#x2122;s a legacy honored by their sons and daughters, and enabled by our next-generation automation. Whatâ&#x20AC;&#x2122;s your story? Let us help you make it a great one.

SoftWriters, Inc.

Long Term Care pharmacy management technology.

“If you are looking for pharmacy software, look no further...SoftWriters is the standard” - J.S., RPh, New York

FrameworkLTC® — Powerful. Flexible. Scalable. FrameworkLTC, from SoftWriters, Inc., is the leading pharmacy management solution designed speciﬁcally for pharmacies servicing long-term care and institutional facilities. One Solution...Unlimited Growth FrameworkLTC provides the unmatched ability to manage your current pharmacy business, connect with more equipment and technology partners and allow for years of continued growth of your pharmacy operations.

Contact SoftWriters today for a live product demonstration. Call: 877.238.4516 Email: info@softwriters.com Visit: www.frameworkltc.com

SoftWriters, Inc. softwriters inc.

Pharmacy Management Technology

FrameworkLTC also provides robust reporting and business analytics that can help propel your pharmacy to even higher levels of efﬁciency and proﬁtability. Technology Leadership Leveraging the most current technologies and open data architecture, FrameworkLTC leads the industry with a solution designed for easy integration with third-party consulting software, document management systems, eMARs and automated dispensing equipment.

FrameworkLTC® is “Certiﬁed for Windows”, assuring you that the application is easy to use and will perform reliably on your existing Microsoft® Windows network.

Microsoft and Windows are registered trademarks or trademarks of Microsoft Corporation. Medi-Span is a registered trademark of Wolters Kluwer Health. Sage Software and the Sage software product are registered trademarks or trademarks of Sage Software, Inc. or its afﬁliated entities.

Â Full-Featured Order Entry

Â Short-Cycle Filling

Â Precise Inventory Control

Â Customizable Workﬂow

Â Robust Reporting

In This Issue:

ComputerTalk

for the Pharmacist

September/October 2010 Vol. 30/No. 5

Long-Term Care: Technology That’s Driving the Market

The long-term care market makes special demands on pharmacies. Achieving success, whether you are running a closed-door operation or have a retail segment as well, requires the intelligent and forward-thinking use of technology to support facilities’ needs and ensure that patients are receiving timely and accurate care. The tools are varied, and the key is finding the right set to move your LTC efforts out front and position your operations to grow with confidence. story begins on page 25

Features:

13 Shining a Beacon of Light

Through the Chaos by John Becker

How a clinic pharmacy in the upper Midwest has put in place an innovative, integrated system that reorganized its physical layout and inventory management method to improve workflow and increase inventory turnover.

17 Technology Helps Pharmacies

Grow on The Great American Frontier: Part Two by Bruce Kneeland

The second installment chronicling a road trip through the American West, where the author found innovative pharmacists putting technology to use in order to offer their patients the best in pharmacy practice. See an interactive map of the author’s destinations for this installment by visiting http://tiny.cc/xg6ff. 2

ComputerTalk

Departments: 4 Publisher’s Window Invalid Prescriber IDs 6

Industry Watch

43 George’s Corner The Future 45 Technology Corner Survey Reveals Desire for Integrated MTM Reimbursement Processing 47 Catalyst Corner The Stars Are Aligning 49 Viewpoints Want to Improve Operating Results? Try Benchmarking 52 Conference Circuit National Association of Chain Drug Stores 2010 Pharmacy & Technology Conference SoftWriters 2010 FrameworkLTC User Conference 55 PeopleTalk 55 Index of Advertisers 56 Web Sites to Visit

Want greater freedom to manage your LTC Pharmacy?

ďŁż

Authorized Reseller

Now there are APPs for that. Brought to you by RNA, the leader in LTC pharmacy management; and APPLEÂŽ, the genius behind intuitive technology and mobility. Designed for iPhones and iPads, this breakthrough, real-time technology will free you and your staff from being tied to a workstation. For more information or to schedule a free demonstration, please visit www.RNAhealth.com or call 800.762.9378.

publisher’s window

for the Pharmacist www.computertalk.com Volume 30, No. 5 September/October 2010 Staff William A. Lockwood, Jr. Chairman/Publisher

Maggie Lockwood

Vice President/Director of Production

Will Lockwood

Vice President/Senior Editor

Toni Molinaro

Administrative Assistant

Mary R. Gilman

Editorial Consultant

Mel Spigelmyer Cover Design

ComputerTalk (ISSN 07363893) is published bimonthly by ComputerTalk Associates, Inc. Please address all correspondence to ComputerTalk Associates, Inc., 492 Norristown Road, Suite 160, Blue Bell, PA 19422-2339. Phone: 610/825-7686. Fax: 610/825-7641. Copyright© 2010 ComputerTalk Associates, Inc. All rights reserved. Reproduction in whole or in part without written permission from the publisher is prohibited. Annual subscription in U.S. and territories, $50; in Canada, $75; overseas, $85. Buyers Guide issue only: $25. Printed by Vanguard Printing. General Disclaimer Opinions expressed in bylined articles do not necessarily reflect the opinion of the publisher or ComputerTalk. The mention of product or service trade names in editorial material or advertisements is not intended as an endorsement of those products or services by the publisher or ComputerTalk. In no manner should any such data be deemed complete or otherwise represent an entire compilation of available data. Member

ASAP 2010

ComputerTalk

Invalid Prescriber IDs

Bill Lockwood Chairman/Publisher

recently read the report published in June by the Office of Inspector General (OIG) on the use of invalid prescriber identifiers on Part D drug claims. OIG looked at claims data from 2007. Can you believe that $1.2 billion in Part D claims during that period contained invalid identifiers? The identifiers submitted in 17% of the claims using DEA numbers did not conform to length or format specifications, yet the claims were still paid. The report concluded that CMS and Part D plans did not have adequate procedures in place to detect invalid prescriber identifiers. There was no check to see if the prescriber IDs were enumerated in the DEA number, NPI, or UPIN registries. What’s startling is that of the more than half-million different identifiers used, there were 10 identifiers with the same length and format as a valid DEA number that accounted for 17% of the identifiers — and nine of these were not valid numbers when checked with the DEA. These are known as dummy numbers and are used to expedite getting a claim processed and paid when a prescriber’s DEA number is not on file in the pharmacy system. The remaining number had been retired in 2005. One OIG recommendation was for CMS to periodically review the validity of identifiers used in the prescription drug event records submitted to CMS by the Part D plans. Another was to require Part D plans to implement procedures to identify invalid identifiers and to flag for review the drug claims that contain an invalid identifier. CMS’s response was that invalid identifiers would decrease as the use of NPIs increases. In any case, I think you are going to see more claim resubmissions as CMS tightens up in this area. The problem is not just with Part D claims. I know that invalid DEA numbers are a common trigger for resubmissions to prescription-monitoring programs. The message I get from all of this is that getting the prescription filled with the least disruption is the priority. I have heard of cases where another prescriber’s ID will be used if the prescribing physician’s DEA number isn’t on file for just that purpose. There is just no way a pharmacy management system can be programmed to prevent such an occurrence. If workarounds are being taken here, where else are workarounds being used to get a prescription out the door? These workarounds can play havoc with the quality of the patient files sitting in the systems. This doesn’t project well for the profession. One goal of the recently formed Pharmacy e-Health Information Technology Collaborative is to make pharmacy a mainstream player in feeding into an electronic health record. However, more care will be needed to ensure the integrity of the patient files for this to happen. It could start with a concerted effort to clean up the prescriber files and stop the workarounds. CT Bill Lockwood, Chairman/Publisher, can be reached at wal@computertalk.com.

What makes a pharmacy her first choice? On-the-go access.

Customers are busy. QS/1®’s IVR helps you provide on-demand service. Provide anytime phone refill ordering and helpful services like timely refill reminders so they know their health is your first priority. Our end-to-end pharmacy system and services work together to free more of your time. To provide exceptional service. To improve lives. To be her pharmacist. Every day.

Industry

Watch

TeleManager Adds Smartphone Apps Earlier this year TeleManager introduced an

iRefill app for the Apple iPhone and Microsoft operating systems. It has now followed with an app for BlackBerry phones and Android from Google. An early user of the iPhone app was Craig McAlister, owner of Conrad Marr Drug in Yukon, Okla. According to McAlister the iRefill service is a hit with many of his customers. “Not only are they using it to request refills, but they are showing the app to their friends,” he says. Paul Kobylevsky, COO and cofounder of TeleManager, says that the iRefill app is a logical extension of the company’s patented technologies for ASP/SaaS IVR and other advanced Internet refill solutions.

Two Point Celebrates 20 Years It was 20 years ago that Two Point Conversions established it-

self as the first pharmacy system data conversion company. “Twenty years ago when I wrote the first conversion programs, sitting at my kitchen table, I never imagined I was creating an industry,” says Phil Lisitza, president and founder of the company. “Whether you’re a Bob Mandel, Sue Leiterman, Sophia Chidichimo, chain or an indepenand Phil Lisitza. dent pharmacy from anywhere in the nation, we ensure that all data transfers to a new system are secure, economical, efficient, and accurate.”

Satisfied customers include Joe Courtright, president and CEO of USA Drug, and Raymond McCall, VP of pharmacy operations at Albertsons. Courtright says, “Our company has a goal of 100% accuracy when conducting data conversion, and we have found the exact same commitment from Two Point.” McCall points to quality and efficiency as his reasons for always choosing them for Albertsons’ data conversions. Read an interview with Phil Lisitza at www.computertalk.com.

SaaS to Benefit LTC Facilities Speed Script has launched a new SaaS (software as a service)

product, Speed Script LTC, to improve communication between long-term care (LTC) facilities and the servicing pharmacies. This Web-based software allows immediate electronic updating of resident records stored in the servicing pharmacy’s system to eliminate phone, fax, and email communication with the pharmacies. The service synchronizes the patient information in the pharmacy management system to a centralized server hosted at Speed Script’s offices. This allows the pharmacy’s information to remain in the pharmacy, while also being shared on a secure Web application. 6

ComputerTalk

The entire cast of Two Point poses for a 20th anniversary photo.

Chuck Welch, executive VP and COO of the company, was recently awarded a patent for this configurable, distributed information-sharing system.

QS/1 Announces Smartphone Service With smartphones gaining

in popularity, QS/1 now offers

mobileRx for pharmacies to provide another way for consumers to order refills. “You can go anywhere now and find someone using a smartphone to check email, Web sites, and even view videos, so why not use that same technology to help continued on page 8

Now Online at www.computertalk.com Exclusive Web content this month at ComputerTalk’s Web site Data Conversion 20 Years of Data Conversion: An Interview with Two Point Conversions’ Phil Lisitza. Pharmacy Management Solving the PMS Dilemma: Comments from ScriptPro.

Industry

Watch

continued from page 6

manage your prescription refills?” says Charles Garner, QS/1 market analyst. The new service interfaces with the QS/1 pharmacy management systems through the phone’s Web browser. The customer enters the pharmacy’s Web site, or goes to a generic site and enters the pharmacy’s phone number to connect. In addition to ordering refills, the customer can authorize the pharmacy to contact the doctor for additional refills. QS/1 introduced mobileRx at its annual customer conference in Greenville, S.C., in mid-July. For a demonstration, go to www.mobilerx.net.

Highlights from McKesson’s Trade Show Parata Recognized Making and Managing Parata Systems has won the Change: Methods for Greater Durham Chamber of ComPharmacy – An interview with Parata’s Keith Overfield. merce 2010 Business Excellence What’s Happening with Management Tools and Technology – Interviews with McKesson’s Matt Lowe and Brent Burns.

The Driving Factors in Central Fill Innovation’s Executive VP Doyle Jensen talks about the role automation plays in the renewed push to implement central fill.

ComputerTalk

“A client can now automate up to 98% of all countable prescriptions with 99.99% count accuracy with the Parata Express,” says Joe Tammaro, VP of sales and customer service for McKesson HVS. McKesson HVS’s automated solutions are designed to adjust to multiple workflow configurations. The systems can accommodate anywhere from 1,000 to more than 70,000 prescriptions a day.

Innovation Selected as Preferred Vendor Pharmacy Providers of Oklahoma (PPOK) has selected

Innovation as the preferred pharmacy automation vendor for workflow software, counting technology, and robotic dispensing. This agreement gives PPOK’s 500 member pharmacies access to a variety of financial incentive programs and significant purchase discounts on Innovation’s complete product line.

Award in the large business category. This award recognizes the accomplishment of businesses and individuals in Durham, N.C. The awards New Product from event was attended by more than 200 business and community leaders, in- TCGRx Introduced cluding Jess Eberdt, Doug Townsend, The NACDS Pharmacy & and Tom Rhoads, senior executives Technology Conference in from Parata. August was the launch point for the new compact AVR-Series Automatic McKesson Expands Vial Filler from TCGRx.

Line of Automation Technology

McK esson High Volume Solutions (HVS) has partnered

with Parata to expand its product offerings for pharmacy automation solutions. The new Parata Express offered through McKesson HVS lowers the pharmacy’s capital expense and comes with a reduced footprint and other benefits.

AVR is a high-speed dispensing system that can group up to 12 canisters in order to accommodate highvolume or large-sized medications. The canisters can be calibrated at the pharmacy when medications are substituted or an NDC is changed to reduce canister turnaround time. The system supports 64, 70, 76, or 82 of the pharmacy’s fastest-moving medications.

ASAP Announces Two New Standards The A merican Society for Automation in Pharmacy (ASAP) has announced two new standards that complement its prescriptionmonitoring program (PMP) standard. One standard addresses the error reports that pharmacies receive when there is invalid or missing information for prescription records transmitted to a PMP. This error report standard uses a data structure and a minimum data set to allow pharmacies to quickly identify the prescription records and the specific data elements within that need to be corrected. Standardizing this process should improve compliance in correcting and resending the information. The other is a zero report standard to inform a PMP electronically that no reportable controlled substances were dispensed during the reporting period. Both standards are available at asapnet.org. According to Duane Chudy, CEO of the company, the AVR can be placed almost anywhere in a pharmacy, due to its compact footprint, and even on an existing countertop or a cart. “This allows the option to place the AVF in an existing space instead of having to remove fixtures,” says Chudy.

inventory costs. “The Eagle purchasing and receiving system will help us streamline our reordering process and simplify the job of keeping our inventory updated,” says Bruce Gingrich, CEO of Lifechek. He also sees the system’s inventory controls helping in price updates and loss prevention.

Lifechek Selects Activant as POS Vendor

New Lite POS Version from Freedom

Lifechek Drug, an independent pharmacy chain with 23

locations throughout Texas, will be using the Activant Eagle point-ofsale system (POS) for its front-store automation. To date the chain has focused on prescription sales, with only four of its locations having retail front-store space. Lifechek management decided earlier this year to expand its retail offerings in all 23 stores. Because retail had not previously been a point of emphasis, the company had been using the POS system that came with its pharmacy management system, but determined that it would not be sufficient to manage its expanding multistore retail requirements. With the addition of retail space and inventory, the company realized that it will dramatically increase its

Freedom Data Systems now offers a point-of-sale system for smaller pharmacies. Called PRO/POS Lite, this is a condensed version of its regular POS system that includes just the functionality these pharmacies need at a fraction of the cost.

One advantage is that pharmacies would be able to accept FSA cards, track pseudoephedrine (PSE) sales, and capture signatures, as well as receive updates to comply with any new government regulations, without having to upgrade the system. However, the system is expandable to the full-blown POS system offered by Freedom.

RxLogPlus Adds PSE Signature Capture R eliable Computer Solutions continued on next page September/October 2010

Industry

Watch

continued from previous page

has added an electronic signature capture fea-

ture for documenting pseudoephrine (PSE) sales in its RxLogPlus standalone program. Pharmacists are alerted when a personâ&#x20AC;&#x2122;s limit has been reached. The module also provides reports for law enforcement on the sale of PSE products.

NCPA Web Site to Connect Buyers and Sellers The National Community Pharmacists A ssociation (NCPA) has launched a Web

site, www.pharmacymatching.com, to bring together independent pharmacy owners preparing to sell their pharmacies with owners of pharmacies wanting to add locations and entrepreneurs looking for the right opportunity to become a pharmacy owner. continued on page 12

ComputerTalk

Surescripts Connects with HealthVault Consumers will now be able to use Microsoftâ&#x20AC;&#x2122;s

HealthVault to receive records of their dispensed medications from community pharmacies using a secure electronic connection to HealthVault through Surescripts. Users can log into their HealthVault account from the Web sites of participating pharmacies and request a download of their medication history into their HealthVault account. Once established, the medication history can be automatically updated whenever a new prescription is dispensed from the pharmacy. Surescripts also announced that Massachusetts is the leading state in e-prescribing. Rounding out the top 10 states are Michigan, Rhode Island, Delaware, North Carolina, Connecticut, Pennsylvania, Indiana, Hawaii, and Florida. According to the company there are 200,000 office-based prescribers e-prescribing nationwide. That equates to one out of every three physicians, nurse practitioners, and physician assistants in the United States.

It’s our anniversary!

We’re 20 years old for a reason... You! We’d like to say thank you to all of our loyal customers for 20 great years! And we’d also like to invite pharmacies of any size to call us today to ﬁnd out how we can help you get the most out of your data.

Two Point Conversions, Inc. 1800 W. Larchmont #2W Chicago IL 60613 800-276-4689 September/October 2010

Industry

Watch

continued from page 10

RelayHealth e-Prescribing Platform Accredited The Electonic Healthcare Network Accredi-

Commission (EHNAC) has given RelayHealth full accreditation with the e-Prescribing Accreditation Program. EHNAC’s ePAP accreditation demonstrates the operational integrity of companies that use e-prescribing, by ensuring compliance with HIPAA regulations and industry standards.

tation

RelayHealth’s electronic prescribing and fax-based prescribing transactions were able to meet the standards for confidentiality enforcement, security infrastructure, and other metrics.

SXC Ready for D.0

NCPDP D.0 standard. This is the version of the standard that becomes the new HIPAA requirement in 2012. “There are many features in D.0 that support advanced functionality in the pharmacy benefit management process, including more complete information on claims for compounds, more information to support consumer-directed health initiatives, better handling of claims involved in coordination of benefits, and the ability to handle claims for pharmaceutical services outside of the dispensing process,” says John Romza, CTO for SXC.

Iowa Begins New MTM Program The Iowa Department of A dministrative Services has selected Outcomes Pharmaceutical Health Care to administer a medication therapy management (MTM) program for the state’s employee health plan.

One service is an annual comprehensive medication review, which allows patients to meet with a specially completion of testing of its software to support the trained pharmacist or another qualified healthcare provider in their area. The company anticipates that  64,000 people will be enrolled throughout the state. services include prescriber consultations, patient  Other education and monitoring, and patient compliance consultations. 

SXC Health Solutions has announced the

                

              

     12

ComputerTalk

Outcomes recently announced over $100 million in estimated cost avoidance through its MTM program. In the company’s program the pharmacist assigns each MTM intervention a severity rating. Claims are then subject to quality assurance review before cost avoidance is calculated and assigned. Outcomes has used this model as a benchmark for program performance and ROI projections since 1999.

NABP Grants First Approved e-Advertiser Status Pharmahelper.com, QC Supply, and K err

Drug are the first online pharmacy services to be approved through the National Association of Boards of Pharmacy’s (NABP) new e-Advertiser Approval Program. This approval is required by Google, Microsoft, and Yahoo to show that companies offer reliable and trustworthy resources for consumers purchasing medications online. CT

Shining a Beacon of Light Through the Chaos by John Becker

airview Pharmacy, in Bloomington, Minn., is part of an eight-hospital health system. When management began searching for ways to decrease inventory cost, increase prescription-filling capacity without adding staff, and reduce the pharmacy’s footprint in order to maximize their OTC area, they knew they’d have plenty of vendors to consider. Site manager Laurie Deegan says after seeing one company’s innovative solution at a trade show, and then making a visit to the system’s initial installation site, management was pretty sure they’d found what they were looking for. A little more than a year later, Deegan thinks they made the right choice for her pharmacy.

The Solution Fairview chose the Beacon Inventory Management System from TCGRx. The Beacon system is a combination of physical fixtures and automation that provides tight control over the prescription-filling and inventory management processes. Beacon’s hardware and software dovetail with the pharmacy management system (PMS) to create a structured, consistent workflow. The system features unique “pick and put to light” technology that uses color-coded LEDs to ensure staff always identify the right product, whether they’re retrieving something for a fill or putting something away after filling or receiving an order. Organized by activity, directed by light, and verified by barcode is the Beacon mantra. “The system has improved accuracy, increased efficiency,

and enhanced our ability to effectively manage our inventory,” reports Deegan. As site manager at the 250-script-perday clinic-based retail pharmacy, Deegan’s responsible for all pharmacy operations, including budget, inventory, staff scheduling, and supervision. She Laurie Deegan consults with a patient. The also spends plenty of time in front of Beacon System lets Deegan and her staff identify the slowest-moving inventory and customers as the remove it from stock. store’s only full-time pharmacist. There are also two part-time pharmacists, a weekend pharmacist, two full-time technicians, three half-time techs, and one full-time clerk/cashier.

Building on a Strength Deegan says she and her staff have always been inventorycontrol focused, so when she heard they were considering a system like Beacon, she saw it as an opportunity to enhance what they were already doing well. “We were excited about the chance to implement a system that tracks inventory down to the pill level,” continued on next page September/October 2010

feature

Inventory Control continued from previous page

Deegan says, “and the system has met our requirements in this area since we installed it.” Before implementing Beacon, Deegan says, they had little technology in the pharmacy other than a legacy PMS that was in place before she arrived five years ago. They’ve since decided to move to McKesson’s EnterpriseRx — a hosted, software-as-a-service PMS, which they plan to implement system-wide beginning this fall. TCGRx developed a Beacon interface to Fairview’s current PMS, and they’re on track to deliver an EnterpriseRx interface by the time they migrate to that system.

Installing Beacon Deegan says when they installed the Beacon system, they “pretty much gutted” the pharmacy. The pharmacy front counter was left intact, but almost everything behind it — shelves, bays, even the pharmacist’s work island — was removed. Those fixtures were replaced by a tall carousel for medications in unit-of-use packaging; a corner unit workstation that stores faster-moving product; two large sets of high-density drawers that contain slower-moving inventory; shelving for items that don’t fit easily elsewhere; and racks for the will-call area. The pharmacist work area was also redesigned. In addition to the new fixtures, five Beacon workstations were installed. Each workstation includes a touch-screen display with keyboard and a cordless scanner. Most workstations have been set up to toggle between Beacon and the PMS. Scanners are color coded to identify the staff member using them. Colors are used extensively throughout the Beacon system to tie tasks to the staff member performing them. For example, if two technicians have simultaneous prescriptions to count, the location LED lights up in each technician’s assigned color, making it easy for each technician to know where to pull product from. The amazing part is that all the removal and installation was done during a single weekend in August 2009. The Beacon fixtures are small and modular, Deegan says, so they were easily brought in through the back door and installed by TCGRx technicians, who also set up the computer hardware and software. “The entire process took about 18 hours,” Deegan says. Although the physical transformation of the pharmacy was rapid, it did take a little time for staff from both companies to put all the inventory into the storage system following the system’s logic that locates product based on how often it’s needed — information contained in 14

ComputerTalk

Above, pharmacist Amy Hagbom searches for a product in the Beacon storage system; at left, Hagbom scans a prescription during customer pickup.

product movement reports Fairview provided to TCGRx in advance. During this transition period, pharmacy staff filled prescriptions from stock bottles that were in totes or on temporary shelving. Because they chose to leave their front counter in place, Fairview didn’t realize the reduction in pharmacy size they had hoped for. However, Deegan says that the staff has much more room now to do its job, and that’s greatly improved efficiency and staff morale. “We’re not tripping over ourselves to get our jobs done anymore,” Deegan says. “And while we didn’t experience the footprint reduction we envisioned, the process has showed us that for future pharmacies we can achieve the same volume in less space.”

The Workflow Process Even after installing Beacon, Deegan says, Fairview Pharmacy’s filling process begins as it always has: with a technician entering a prescription order into the PMS. Data is passed to the Beacon system when a label is printed for an active prescription. The labels are put into bags that will eventually contain filled prescriptions. Bags are handed off to a technician who scans a barcoded prescription number on the receipt. That prescription then appears in the Beacon system with a “ready to dispense” status. The system display tells the technician the location of the product to be dispensed, and an LED adjacent to that product’s physical location activates. Numeric displays

feature

Inventory Control manages the patient pickup process.

on pharmacy shelving guide the technician to the correct row and slot location within the Beacon storage system. The technician must scan the barcoded NDC number on the correct product to continue. If the wrong product is scanned, the LED flashes and the filling process comes to a halt. Deegan says this feature has improved filling accuracy.

“The clerk can do partial entry of first or last names, and that makes identifying customers easy when they come in to pick up their prescriptions,” she says. When the correct prescriptions are selected, the Beacon system displays the bag location for the clerk and an LED lights next to that location — or locations if there are multiple bags — making it easy for the clerk to find the right bag and virtually impossible to select the wrong one.

“The system basically won’t let you pick and count the wrong product,” she says. “Most of the errors we catch now are data entry errors.” After counting, the product is returned to the shelf and the technician scans a barcode at the location to indicate the fill is complete. A color-coded LED again verifies that the product has been returned to the correct location. A pharmacist then takes the bag and scans the barcode on the receipt to begin verification. Along with other essential information, an image of the product is displayed, which Deegan says greatly simplifies the quality assurance process. “You don’t have all those stock bottles traveling with you down the line, which can easily get misplaced,” she says.

“We really like how the system makes sure customers leave the pharmacy with all the prescriptions that are ready for them,” Deegan says. “It even helps us make sure we give patients the few pills we may owe them if we ran short on a previous fill.” Fairview also uses Beacon’s optional vial shredder and is working with a vial manufacturer to recycle what they collect. Deegan points out that not only is vial shredding environmentally friendly, it’s a great way to protect their patients’ confidential information. She plans to work with continued on next page

At Fairview Pharmacy, pharmacist verification still includes a review of the prescription hard copy, even though Beacon can provide a digital image of the script as part of its QA process. Deegan says this is because they plan to use that feature in the new EnterpriseRx system when it’s installed. When verification is complete, the pharmacist scans the barcode on the bag, indicating the prescription is ready for customer pickup. Multiple prescriptions for the same patient can be assigned to the same bag. The clerk then scans the barcode on the bag, selects an open location in the will-call area, scans the barcode associated with that location, and places the bag on the appropriate hook. Deegan says the system has the ability to suggest a location and activate an LED identifying that location for the clerk, but she says they don’t use that feature.

REDUCE RETURN TO STOCKS Do you want to reduce your return to stock rate each month and increase efficiencies?

PROVIDE AUTOMATED NOTIFICATIONS Do you want to place automated pick up notifications to your patients, but don’t have an IVR?

If so contact Ateb to have this implemented at your pharmacy

“It’s easier for us to select the location from what’s available than to wait for the system to tell us where to put the bag,” she says. The system then confirms that the bag was successfully placed and the location is recorded.

Prescription Pickup Deegan says she also likes how the Beacon system

Pharmacy Line™ (IVR) ▫ Automated Outbound Notifications SignatureLine™ (Electronic Signature Capture) NDC Check (Validation) ▫ Internet Prescription Refill ▫ Bin Management ▫ Prescriber Fax sales@ateb.com or 877.776.2832

September/October 2010

feature

Inventory Control continued from previous page

Fairview’s marketing department to promote the value of this service to customers.

Key Benefits Laurie Deegan sums up the top features of the Beacon system:

“If more customers knew we did this, I think it would really increase repeat business,” she says.

• The system runs smoothly and allows staff to operate with efficiency.

Seeing Results

• A much more manageable workflow process and less stressful environment is created.

Despite the focus Deegan’s staff has always placed on inventory control, she’s pleased with the positive impact the system’s had in this area. Before Beacon, Deegan’s pharmacy was turning its inventory 10 to 12 times per year. They’re turning it 16 to 17 times per year now, while most other Fairview sites average 6 to 8 turns per year.

• The pharmacist verification process is fast and easy, allowing staff to increase time spent counseling patients.

Deegan couldn’t provide exact figures, but she says she’s sure her overall inventory cost has decreased as well, since installing the system. In fact, Deegan and her staff have eliminated enough slow-movers from their stock so that one entire set of high-density drawers is now empty. This reflects how effectively Beacon helps them manage their inventory, Deegan says. “All I have to do is look at the empty shelving in the highdensity drawers to know we’re carrying much less product than we were,” she says. Deegan says the system’s done such a good job helping reduce inventory that they’re thinking about removing the bay of empty shelving and replacing it with TCGRx’s automatic vial filler. This device would enable automated simultaneous counting of the pharmacy’s 70 top-moving oral solids. “We’re still working through the cost justification,” Deegan says, “but from what I’ve seen so far I believe the productivity increase would more than offset the cost.” And while the accuracy hasn’t been measured statistically, Deegan says there’s no doubt they have fewer wrong drug picks than before. “The technicians appreciate that the system won’t let them pick the wrong drug, so they’re more confident in what they’re doing,” she says. Deegan also believes prescriptions move more quickly through the filling process than they did before. The defined workflow process allows each staff member to stick to the tasks they’re supposed to perform, and the smarter layout means there’s less running around in the pharmacy. Were there any unexpected results? “Because of the emphasis placed on expiration date tracking,” Deegan 16

ComputerTalk

• Any pharmacy staffer can easily determine the status of a prescription and see how long it will take for the order to be ready. • Complete transactional history for each prescription is recorded, including who counted it, who verified it, and who hung it in will-call.

explains, “it takes us longer now to put product away when we receive orders. For every item we receive, we scan not only the product barcode but the expiration date as well. It’s more time-consuming up front, but it’s worth it knowing we have a completely automated, up-to-date expiration date tracking system in place.” “We know much earlier in the process if we have product that’s getting ready to expire,” Deegan says, “which allows us to contact our other pharmacy sites to see if they have a need for that product before we otherwise dispose of it.” The system must be working. Deegan’s pharmacy has the lowest outdated-return cost of any site in the Fairview system.

Plans for the Future Deegan says Fairview plans to install Beacon at its smaller Andover location in December and will most likely install it at other pharmacies in the future. “The system’s very modular,” Deegan explains, “so at some locations we may install the entire solution and at others only parts, like only the will-call system, which can easily stand by itself.” CT After spending over 20 years as a sales and marketing professional in the pharmacy automation industry, John Becker is now an Atlanta-based freelance writer. His work appears in the Atlanta Journal-Constitution and other publications. He can be reached at jnbecker@me.com.

Graphic by Google Maps

Technology Helps Pharmacies Grow on The Great American Frontier by Bruce Kneeland

Part 2 of 2

n May 2010 I was able to take a two-week road trip and visit pharmacies in what is still the great American frontier, the nation’s four least populated states: North Dakota, South Dakota, Montana, and Wyoming. Each of these pharmacies was selected based on its location and its successful deployment of various pharmacy technologies, some of which, such as telepharmacy, I had never seen.

Another benefit she cites is having the IVR automatically fax a refill request to the patient’s physician.

This is the second of a two-part series on the trip. The first part was published in the July/August 2010 issue of ComputerTalk.

Highland Park Warm Springs, Montana Pharmacy is fully integrated Hospital Pharmacy West with both the hospital’s and the Sheridan, Wyoming clinic’s electronic Emissary Pharmacy medical records Casper, Wyoming systems, which excites the superCasper College visor of outpatient pharmacy Casper, Wyoming services, Alan Medicap Pharmacy West Brayton. “The big thing about Rapid City, South Dakota working at our Wall Drug pharmacy is the amount of clini- Wall, South Dakota cal information we have access to via the electronic medical record software,” he says. “This information enables us to serve our patients and healthcare professionals much more effectively.”

Highland Park Pharmacy Bozeman, Montana

Highland Park Pharmacy is housed in the Bozeman Deaconess Hospital complex and provides a great example of what the pharmacy of the future could look like. The outpatient pharmacy is busy and is equipped with POS and IVR, along with QS/1 workflow and nursing home systems, all interfacing with McKesson ConnectRx auto replenishment features. Clinical pharmacist Jean Sternhagen says each day 30 to 40 prescriptions come in via the pharmacy’s IVR system, which means the phone rings less frequently and that people on the other end are getting taken care of more effectively. Another key IVR benefit is the information patients receive about their prescriptions. “Having people come in expecting to get a prescription and then learning at the counter that it could not be filled is a major problem we avoid, because our IVR is integrated with our pharmacy system and lets them know during their call of the problem,” Sternhagen says.

The Itinerary Highland Park Pharmacy Bozeman, Montana

CPS Management

continued on next page September/October 2010

feature

Road Trip continued from previous page

For example, the pharmacy manages an anticoagulation clinic — which is in the same building as the pharmacy but separated by several floors, and is operated on a contract-for-services basis. Each day clinical pharmacists tap into patients’ electronic medical records to review diagnostic codes, lab results, and other medical information. They meet with patients on anticoagulation therapy, and under a carefully developed protocol administer finger stick tests, chart the results, and then order changes in dosages and work on lifestyle changes to ensure that patients are achieving optimum results. In addition to filling outpatient prescriptions, Highland Park Pharmacy supports three assisted-living centers and one LTC facility with unit-dose packaging. They also operate another pharClinical pharmacist Jean Sternhagen says IVR improves customer service by providing important macy at the information to patients when they call in for Big Sky Resort. refills as well as keeping the pharmacy much quieter. Below Sternhagen's pharmacy technician shows To round out how the clear hanging bag will-call bin system the pharmacy’s keeps filled prescription neat and orderly. offerings, the front end features wound care; breast pumps; specially compounded lotions, ointments, and soaps; a full assortment of braces; and a private consulting area.

CPS Management

Warm Springs, Montana Warm Springs is the home of the Montana State Hospital. It is in a very remote area about 30 miles northwest of the mining town of Butte. Larry Caddell is the clinical director and general manager for Comprehensive Pharmacy Services (CPS), a contracted pharmacy services company operating 250 pharmacies. The Warm Springs facility services the needs of 425 patients in either the state hospital or in one of five other state-supported facilities for psychiatric, developmentally disabled, and other chroniccare patients. Due to the diversity of the patients, CPS provides medica18

ComputerTalk

tions in a number of formats: regular vials, blister packs, unit dose, and, soon, pouches. The pharmacy owns a Parata PacMed unit and is in the final stages of getting the unit operational. Caddell says it will soon be interfaced with the pharmacy’s QS/1 PrimeCare and McKesson’s Connect-Rx. Above, Glenda Crum, pharmacy team member with a Parata pacMed, which lets CPS provide prescriptions in a variety of formats. At the left two staff members confer on treatment care options using QS/1's PrimeCare software.

When that happens he will be able to take advantage of the system’s unique ability to provide patient medication in individually labeled pouches that will make administration and tracking of patient compliance much more effective. And, he adds, the new CMS requirement slated to take effect in 2012 for short-cycle dosing will be much easier to handle using the pouch system. Caddell is a true pioneer, as his staff not only fills prescriptions but also manages a metabolic syndrome program, has access to patients’ medical records, participates in medical rounds, does chart reviews, sits on various committees, and provides input into each patient’s treatment plan. “Pharmacists have a huge role to play in psychiatric care,” Caddell says. “And while technology makes it possible to fill prescriptions faster and more accurately, it also provides us with access to information that helps us improve outcomes.” Caddell says his goal for everything he does is to make sure patients get the medication and care they need, and then to help them return to the community. As you prepare to leave the pharmacy you can’t help but notice the sign he has taped to the wall that proclaims “We Need an Integrated System: Nursing, Pharmacy, Physicians.”

Hospital Pharmacy West Sheridan, Wyoming

Hospital Pharmacy West is located in the medical office complex adjacent to Sheridan’s major hospital. It shares its front-end space with a small deli and coffee bar that is

feature

Road Trip frequented by hospital and clinic employees and visiting patients. Matt Meyer manages this location and co-owns it with his brother, along with a traditional community pharmacy located on a busy downtown street corner. Meyer is another one of those guys who knows how to make lemonade out of lemons. He’s capitalizing on his lower-than-average prescription volume by implementing a number of programs many pharmacists are too busy for — all with a positive effect on his profitability.

He encourages patients to use the Leader Drug Internet refill service available from his wholesaler-supported Web page. And to help improve accuracy and provide better workflow, Meyer purchased an Innovation Eyecon pill counter about a year ago. He interfaces his POS system with his pharmacy management system (PMS), both from QS/1. His PMS is set up to allow both pharmacies to share files so patients can easily fill their first prescription at the clinic pharmacy and then get their refills at the downtown location, a convenience he says has paid off well for both locations.

Emissary Pharmacy Casper, Wyoming

Hospital Pharmacy (downtown) boasts an impressive store front on Sheridan's main street. Left, Matt Meyer, R.Ph. and Mandeolyn Bandela, pharmacy tech, say their Eyecon counter helps them fill faster and more accurately allowing them time to provide enhanced services.

For example, he has effectively worked with a couple of dozen patients on the Mirixa and Outcomes MTM programs. He is also using the Rx Sync program, which is promoted by the National Alliance of State Pharmacy Associations and supports patients on multiple medications by organizing their prescriptions so that they all come due on the same day. The program supports compliance, provides enhanced counseling, simplifies workflow, and allows for tighter inventory control and better cash flow. Meyer says he has 12 patients on the program, and the feedback from patients, caregivers, and physicians has been positive. He plans to roll the program out to a number of additional patients in the near future. Continuing on the theme of spending a bit more time with each patient, Meyer works proactively to ferret out the various pharmaceutical company e-voucher programs that help patients reduce their out-of-pocket costs. And he is an avid supporter of the McKesson Patient Relationship Solutions program that pays him to provide counseling for medications such as Chantix and Spiriva.

Tim Renz is a registered nurse who, up until 1998, worked for the major hospital in Casper. As part of his duties he was assigned to work with the hospital’s DME and IV departments. While doing that he became well acquainted with two of the hospital’s pharmacists. In 1998 the hospital decided it would be better off getting out of these businesses, so Renz, along with his two pharmacist friends, made an offer and ended up owning what they now call Emissary Pharmacy. With a base of business, good connections, a proven skill set, and a lot of hard work, the business has grown until today it consists of three parts: an LTC unit, a compounding pharmacy, and a retail Tim Renz, left, has turned to technology to improve business for both the retail and nursing home sides of Emissary. As part of his vision, he helped develop an eMar.

pharmacy that specializes in 90-day prescriptions delivered to work sites and that helps keep large employers from contracting with an out-of-state PBM. The LTC unit serves 20 facilities with a total of more than 2,500 patients, using unit-dose, bingo card, cassette, and continued on next page September/October 2010

feature

Road Trip continued from previous page

Sherri Roumell, CPT (left) runs the Casper College Pharmacy Technicians program. Here she lectures students on clinical aspects of drug absorption.

other packaging. It also consults, does chart reviews, and provides other nursing home services. As their base of business grew, Renz says, they needed to find some technology to make things work better both for the pharmacy and for their nursing homes. In close collaboration with the homes they service, they determined that the most valuable thing they could do was to adopt a totally seamless electronic medication administration record (eMAR). They didn’t encounter the right system when they shopped around, so they decided to build their own. In concert with two professors from the University of Wyoming and a volunteer team of nurses from the homes they service, they created the MedRight eMAR. According to Renz, the software interfaces with his QS/1 system, as well as with SoftWriters and RNA systems. It allows for data to be entered on laptops at the nursing station and then transferred over a VPN to the host system. The architecture of the system calls for data to be shared on both the host systems and on laptops, ensuring that the home can provide care if there is a power outage or other disruption of service. And most importantly, the homes enjoy the benefit of a totally paperless system.

Casper College Casper, Wyoming

Sherri Roumell, program director for the Casper College Pharmacy Technology Program, has a passion for improving the practice of pharmacy by making sure pharmacy technicians are certified and well trained, and understand the important role they play in the healthcare system. Students are trained in a classroom and a lab that resembles the layout of a normal pharmacy. They benefit from being trained on one of 12 QS/1 pharmacy systems the college owns as a result of meeting with the company at the Pharmacy Technician Educators Council convention two years ago. The school’s curriculum ensures that each student understands pharmaceutical calculations and compounding technique, terminology, pharmacy law and ethics, and prescription product packaging, as well as third-party billing processes. The program is supported by 24 clinical rotation sites. Graduates are prepared to go into retail, health-system, LTC, and other pharmacy practice fields. Each year the college program trains about 40 students and is one of more than 300 similar programs certified by the American Society of Health-System Pharmacists. 20

ComputerTalk

As part of the program each student takes the pharmacy technician certification exam, and Roumell says the program enjoys a 100% exam pass rate as well as a 100% placement rate. Roumell says the Wyoming State Board of Pharmacy is supportive of the program and the positive effect it has on pharmacy by bringing career-minded individuals into the profession. One former student I met told me that when she graduated, she was hired by the local hospital and started out with credit for one year of service, resulting in a meaningful increase in her starting pay. In talking about the benefits of her program, Roumell says that one director of hospital pharmacy claims that hiring a graduate of the program saved him $8,000 the first year. The cost savings come in two forms: one, the graduates become productive much sooner; and two, because they have a more professional attitude, his turnover is greatly reduced. Roumell adds, “Our graduates do a better job because they completely understand how important it is that they do things right.”

Medicap Pharmacy West Rapid City, South Dakota

Rapid City is the home of two Medicap Pharmacies, both owned by Jo Prang. I was able to visit with her at the West facility, which was on my itinerary because of a unique medication compliance service she provides. The CompuMed device she uses is about the size of a shoebox and has a number of compartments that can be filled with different medications. It dispenses them into a removable tray at the appropriate time and notifies the patient to take them. The device is locked, and only the medications scheduled to be taken can be accessed. Prang and her staff work with family caregivers and healthcare professionals to enroll patients in the service. They refill, program the dispensing times, and deliver the CompuMed unit to patients on a weekly basis. Prang did not discuss the economics of the service, but it is apparent from the way she markets it that it has a positive impact on her bottom line. continued on page 22

Leave IT to us

“We often call in substitutes to relieve our pharmacist. The substitute pharmacists have all said that Etreby is the easiest program to learn and use.” Freddy Fournet General Manager, Fournet’s Pharmacy & Professional Home Medical, Franklin, La.

Since 1982, Etreby has been committed to building safe, cost-efficient, user-friendly technology. Today, this commitment is backed by the entrepreneurial ability and strength of Cerner, one of the world’s largest healthcare information technology (IT) companies. At Cerner Etreby, we can quickly develop solutions that meet your specific needs. Leave your pharmacy information technology system to the experts. Leave IT to us. Call us today at 800.292.5590 for more information and an obligation-free live demonstration or visit us at www.cerner.com/etreby.

Etreby Cerner Etreby

7861 Garden Grove Blvd., Garden Grove, CA 92841

800.292.5590

www.cerner.com/etreby

September/October 2010

Leave IT to us

Etreby Cerner Etreby

7861 Garden Grove Blvd., Garden Grove, CA 92841

800.292.5590

www.cerner.com/etreby

September/October 2010

Leave IT to us

Etreby Cerner Etreby

7861 Garden Grove Blvd., Garden Grove, CA 92841

800.292.5590

www.cerner.com/etreby

September/October 2010

In a World of no These days your pharmacy depends on front-of-store retail to attract customers, build loyalty and stay profitable. That means optimizing all parts of the retail equation. And a comprehensive best-of-breed retail solution. One that integrates seamlessly with your existing PMS and gives you powerful new tools to provide better customer service, build loyalty, improve inventory management, control margins, and market more effectively. One that’s backed by a nationwide network of business consulting, training and ongoing support. At Activant, we’ve dedicated 35 years to helping independent businesses do retail better. Today, our fully integrated Eagle® business management solutions give pharmacies and thousands of retailers across North America the power they need to thrive and grow. To discover how easily and affordably Activant can make your pharmacy the preferred destination for today’s consumers, call 888.463.4700 and speak to an Activant solutions specialist who can say “yes” to your business needs. Or visit us at www.activant.com/pharmretail.

! s e Y activant Says

A c t i vA n t S o l u t i o n S i n c | 7683 Southfront Road, Livermore CA 94551

retail. Elevated.

September/October 2010

feature

Road Trip continued from page 20

A partial list of other technologies I witnessed when visiting Prang includes a programmable digital exterior sign, which she installed a year ago when the pharmacy moved across the street; a drive-up window; a PMS from PDX that interfaces with a POS system and signature capture pad; and voiceTech IVR that Prang says has become a must, mentioning how having 20 or Jo Prang, above, provides medication complimore prescriptions ance with the help of the CompuMed system, already in the refill pictured below. queue when she opens in the morning is a real workflow benefit.

nothing Ted and Dorothy Hustead had done was producing the results they needed. Then one day, standing at the front of the store, Dorothy a western frontier theme and occupying an Hustead noticed Featuring entire city block Wall Drug became famous by offering all the “tin lizzies” free ice water to people driving by their store in rural that drove by and South Dakota. wondered how to get people out of their hot dusty cars and inside to visit the pharmacy’s soda fountain. Then the idea hit her: Offer everyone who stopped a glass of free ice water.

She shared her idea with her husband, and a plan was formed. They realized they had a product people wanted One way she has differenti- (ice water) at an attractive price (free) and they had the ated herself from the chain ability to deliver the product (a soda fountain). Now, all competition is by promotthey needed was a way to let people know about it. Ted ing a free Medicare Part D Hustead made a handful of simple signs and set out early consulting service. This service is provided by appointone morning to put them up. Each sign invited thirsty ment and gives her a chance to review all the medications travelers to stop at Wall Drug and get free ice water. a participant takes while she carefully researches the cover- Before he got back to the store later that morning dozens age various plans provide. Prang says this type of close of people had already stopped in and taken advantage of personal contact gives her a chance to tell people about the the offer. While the margin on free ice water is not large, it immunization services she provides, discuss the pharmacy’s did get people to come in, and they frequently purchased diabetes support programs, and describe how her Web other things they needed for their trip. site explains her compounding practice, free delivery, and Today, more than a million people a year visit this roadside many other benefits of her pharmacy. attraction, which still offers free ice water, five-cent coffee, and free donuts to veterans. And Wall Drug still has a fully Wall Drug functional pharmacy that serves the needs of the comWall, South Dakota munity, with a pharmacist who is on duty five days a week It is impossible to talk about pharmacy in this part of the and provides free advice to road-weary travelers. country and not mention this famous pharmacy with its literally hundreds of roadside signs offering free ice water The End of the Road to travelers passing by. Purchased in 1933 by Ted and Well, there you have it: 12 pharmacies plus a tech training Dorothy Hustead, this store has used a novel advertisprogram, all finding ways to meet the needs of people in ing campaign that has caused it to be known all over the their communities. Two things bring them together. They world. all operate in one of the most rural regions of the country and, by carefully managing their operation and making Ted Hustead, grandson of the founders and president of effective use of technology, are doing quite well. I hope an Wall Drug Corporation, says that while being a pharmacy is central to its operation, his core business is being idea, tool, or technique they have so willingly shared will a roadside attraction. The pharmacy does not boast a lot help you find new and better ways to grow. CT of technology, nor does it fill a lot of prescriptions, but Bruce Kneeland is an industry consultant based in there is still a lesson to be learned: Effective execution of Royersford, Pa., with a specialty in helping commua marketing plan can help a business succeed in virtually nity pharmacies be more innovative and operate more any environment. profitably. He can be reached at brucekneeland@ Here’s the history. Five years after purchasing the store,

ComputerTalk

comcast.net. The author’s trip was made possible by a grant from QS/1.

Leave IT to us

Since 1982, Etreby has been committed to building safe, cost-efficient, user-friendly technology. Now, this commitment is backed by the entrepreneurial ability and strength of Cerner, one of the world’s largest healthcare information technology (IT) companies. At Cerner Etreby, we can quickly develop solutions that meet your specific needs. Leave your pharmacy information technology system to the experts. Leave IT to us. Call us today at 800.292.5590 for more information and an obligation-free live demonstration or visit us at www.cerner.com/etreby.

Etreby Cerner Etreby

7861 Garden Grove Blvd., Garden Grove, CA 92841

800.292.5590

www.cerner.com/etreby

September/October 2010

AmericAn Society for AutomAtion in PhArmAcy

ASAP

THE

LEADING FORUM ON

TECHNOLOGY

FOR THE

PHARMACY MARKET

When you join ASAP you stay in the mainstream of IT pharmacy developments. How the HITECH Act Impacts You What Pharmacy Must Do to Comply with the New DEA Requirements for E-Prescriptions The New Direction with Prescription-Monitoring Programs How Technology Can be Used to Address Language Barriers A New Initiative with POS Data How Pharmacogenomics Will Change Pharmacy Practice Data Needs in Specialty Pharmacy Challenges with WAC Implementation

2011 Annual Industry & Technology Issues Conference January 20–22 • The Ritz-Carlton • Amelia Island, Florida

Learn more about

ASAP

ASAP has gained a reputation for presenting great meetings on industry issues touching technology.

American Society for Automation in Pharmacy

492 Norristown Road • Suite 160 • Blue Bell, PA 19422 610.825.7783 • Fax 610.825.7641 www.asapnet.org

Long-Term Care: Technology Thatâ&#x20AC;&#x2122;s Driving the Market A look at what pharmacists are doing to make management and service improvements in their long-term care practices. by Will Lockwood

erving patients in long-term care settings makes special demands on a pharmacy. Whether you are running a closeddoor operation focused exclusively on LTC or have a retail segment as well, achieving success requires the intelligent and forward-thinking use of technology to support facilitiesâ&#x20AC;&#x2122; needs and ensure that patients are receiving timely and accurate care. The tools are varied, and the key is finding the right set to move your LTC efforts out front and help you grow with confidence. continued on next page

September/October 2010

cover story

Technology Driving Long-Term Care continued from previous page

Getting Organized Managing the tremendous amount of information generated by the day-today operations in LTC pharmacy is a critical task. The need for technology to organize LTC operations becomes even more critical when you are dealing with more than one pharmacy location. Take ModernHealth Pharmacy as an example. It has a main LTC location in Monrovia, Calif., but serves a large number of skilled-care residents in the San Diego area, two to three hours south, not accounting for the notorious southern California traffic. According to executive VP and COO Sherri Cherman, the answer to the demands this places on making timely delivery was to open a satellite location in San Diego. The second LTC pharmacy is an intentionally lean operation that fills time-sensitive prescriptions, such as those for residents entering a facility and for new or changed prescriptions. This arrangement creates another set of demands for organizing the flow of information and prescriptions. ModernHealth has two main solutions in place in the form of a hostremote implementation of QS/1’s PrimeCare and DocuTrack document management from Integra. “Our data center is in Monrovia and is replicated in San Diego in case of disaster,” says director of technology Bryan Samuels. Data entry is done in Monrovia after orders are received via DocuTrack. Anything that needs to be filled in San Diego is then transferred there. Both locations run QS/1’s workflow, which means that each step in the dispensing process is tracked, whichever location it occurs in. These features provide ModernHealth with accountability and control, according to Samuels, while taking advantage of economies 26

ComputerTalk

ModernHealth Pharmacy Monrovia, Calif.

Sherri Cherman, Pharm.D. Executive VP, COO

Bryan Samuels Director of Technology

LTC division serves 6,500 skilled nursing beds and 2,500 assisted-living beds across southern California and extending into parts of central California. Annex LTC pharmacy in San Diego handles initial and new orders for the area.

of scale offered by running one main site supported by a leaner satellite. Once an order for the San Diego area has been fulfilled by the satellite pharmacy, a process that Samuels has set up seamlessly transfers the prescriptions back to Monrovia, which then dispenses and delivers refills or cycle fills. DocuTrack, mentioned earlier, is an important piece of keeping the two locations operating smoothly in unison, says Samuels. The Monrovia location is again the nerve center, receiving orders and other communications from facilities paperlessly. The technology allows for source-based routing of incoming information, according to Samuels, using the sender’s phone number or barcodes that the pharmacy can apply to outgoing documents and that automatically route returning documents to the proper folder or queue. The centralized, paperless nature of the process also allows for workload balancing. “Anyone authorized at either location can log in, find a document, and help out,” explains Samuels. “I think this is one of the key technol-

ogies we use,” says Cherman. “The ability to track when orders reach us and to track them through our system with records of who touched them and who dispositioned them is critical for our success.” Cherman even has her eye on using the data collected in DocuTrack to create reports that she can use to analyze and improve how ModernHealth organizes its processes. While this is currently just a wish list item for her, she sees big opportunities. “We’d like to look at the time orders are hitting the queue and then how long they take to process, for example,” she says. “With reporting of information like this, we could understand how efficient we are in our triaging of prescriptions and moving them through the DocuTrack workflow.” Samuels notes that ModernHealth will soon pilot another Integra product, DeliveryTrack, which he anticipates will complete the loop and provide more real-time information collected at the point of delivery. “This will really improve the visibility of our productivity and patient care,” he says. “And it will eliminate the delivery sheets we are printing, sending out with drivers, and then scanning back in.”

Know Your Facilities There’s also a good opportunity to use technology to keep pharmacy staff informed about a facility’s preferences and needs, key points in providing the best services possible, according to Joe Marasco. He and the staff at Express Meds Pharmacy take great pride in the service this independent, family-owned pharmacy provides. “On a daily basis we do what we have to do to take care of our clients,” he says, “but we have to do this with an eye on cost.” In order to do this, Marasco’s staff takes a very specific continued on page 28

What keeps customers coming back to one pharmacy? Triple points Tuesdays.

Customers can shop anywhere. QS/1®’s integrated Point-of-Sale and pharmacy management system can help you reward your store’s most valuable customers. Provide fast, accurate checkout and programs and promotions that say we appreciate your business. Our end-to-end pharmacy system and services work together to give you more time. To provide great service. To improve lives. To be their pharmacist. Every day.

September/October 2010

cover story

Technology Driving Long-Term Care continued from page 26

Organized by activity. Directed by light. Verified by barcode.

approach to setting up new LTC accounts in the pharmacy’s HBS pharmacy management software. Here’s how he explains the process: “Initially, we have a marketing representative go out and gather facility-specific information about patient demographics; packaging requirements, such as for controlled substances and maintenance medications; delivery services; and other details of day-to-day operations.” Armed with these details, his staff creates a facility account maintenance file within HBS.

Express Meds Pharmacy Monaca, Pa.

SCAN

Joe Marasco, R.Ph. VP and COO

HANG

Serves 65 facilities with a little over 100 locations, representing approximately 2,500 beds within a two-hour radius of the pharmacy in western Pennsylvania.

RETRIEVE

DELIVER

Call us or visit our website today to learn more! 262.279.5307 www.tcgrx.com

ComputerTalk

Serves predominately skilled facilities, including assisted-living, mental health, and group homes.

These details are then available on demand for Express Meds’ staff, whom Marasco expects to have a detailed knowledge of the accounts the pharmacy serves. The result is a consistently high level of cost-effectively delivered service.

The Short-Cycle World The need for operations carefully organized around the details of LTC pharmacy were also top of mind for Rick Rondinelli when he formed In Touch Pharmaceuticals about six years ago. “I realized that the amount of meds being administered makes med errors a real concern,” he says.

In Touch Pharmaceuticals Valparaiso, Ind.

Rick Mitch Gaffigan Rondinelli, R.Ph. CTO President and CEO

Serves 56 facilities, representing 7,000 beds.

Rondinelli decided to look at residentspecific, short-cycle unit-dose dispensing as a way to make things easier for nurses and to really reduce the opportunity for med errors. Rondinelli has executed this plan by installing dispensing automation from TCGRx and using key features in his FrameworkLTC pharmacy management system from SoftWriters to manage the important details that drive shortcycle dispensing. In Touch CTO Mitch Gaffigan explains how this works. In Touch predefines sig codes across a number of criteria by facility and by nursing station within the facility, including the time of administration, how the sig appears in the medical record, the number of pills given per dose, the number of times per day given, and where it shows up on the medication administration record (MAR), among other details. Sigs on incoming orders are automatically expanded in In Touch’s pharmacy management software based on these definitions, which ensures that each facility receives correct packaging and labeling without the need to rely on the pharmacy staff’s memory. Also critical is making sure that facilities are communicating exactly what time and what day they want to administer meds. “With short-cycle fill, we need to know not continued on page 30

No Bull!

Pharmacy software without the frustration! No one opens a pharmacy because they love computers. As a pharmacy owner, you need to be focused on providing excellent care to your customers, but you spend too much time dealing with your pharmacy system—time you would rather spend on your business and with your customers.

A N S X C C O M PA N Y (800) 444-1427 l www.HBSRx.com

Fortunately, HBS designed its pharmacy management system to be efficient and easy to use, and our dedicated group of hardware and software support teams are just a phone call away. Not to mention, HBS offers products and features that enable you to run your pharmacy operation with “udder” ease. Introduce yourself to HBS. Visit us at www.HBSRx.com or call us for additional info. Because helping you make your pharmacy successful is what we do!

THE SMART CHOICE IN PHARMACY SOFTWARE Independent

Chain

Institutional/Nursing Home

Mail Order/Central Fill

September/October 2010

cover story

Technology Driving Long-Term Care continued from page 28

only the sig, but also exactly which day to start in order for the cycle fill to be accurate,” Rondinelli says. Details such as these are collected by In Touch’s proprietary document management system, created and built by Gaffigan and called DMSrx. “DMSrx is a cloud-based application that will take faxes, emails, digital images, and other electronic forms of communication and aggregate them to a single manageable point,” says Gaffigan. The next and hardest step, according to Rondinelli, is moving the information from the pharmacy management system over to the packaging device. “The question is then what sort of software does the packaging automation have to process short-cycle, or even 30-day and multidose orders?” he asks. “Short cycle is a very unforgiving system. If you don’t package a dose or a day, the facility doesn’t have

Remedi SeniorCare Baltimore, Md. Alan Bronfein Senior Vice President

Seventh-largest LTC pharmacy in the country. Four locations in Maryland, Ohio, Virginia, and Michigan serve eight states.

extra meds to fill the gap.” Remedi SeniorCare is also bringing an innovative approach to the short-cycle fill challenge. The pharmacy has spent the last several years working on a totally new technology, Paxit, which Alan Bronfein thinks will completely change the way facilities administer medications. “Our proprietary new dispensing system fully automates the packaging of 100% of our oral solids, including partial tablets, which is over

1,200 drugs,” says Bronfein. This is a central-fill model, so the packaging happens at the pharmacy and is delivered in a 24-hour, time- and patient-specific compliance package to facilities. Bronfein reports that Remedi SeniorCare can fit all of a patient’s oral solid medications for a med pass into one Paxit bag 98% of the time. “We’ve designed the system to minimize waste, while affording significant efficiencies in the med pass that result in a 4% to 11% cost savings to the facility and payer, and a 15- to 30minute reduction in time per med pass,” says Bronfein. “We are also finding that its ease of use increases nurse satisfaction, which ultimately results in lower staff turnover.” This last point is important, according to Bronfein, because the med pass is one of the greatest points of dissatisfaction in LTC nursing and one of the main continued on page 32

THE POWER OF AUTOMATION. MADE SIMPLE. 7-day • 14-day • 30-day On-Demand • Prepack • Calendar • Daily • Cycle DOSIS® L60 by Manchac Technologies, LLC is the ﬁrst viable totally hands-free robotic solution for pharmacies. The L60 offers you the flexibility to choose your fulfillment solution for any number of pills from 1-31 days. All this in a single medication blister card for your long term care, institutional and correctional facility patients. The L60 offers maximum value to you by minimizing the space required to achieve significant prescription throughput rates for your highest-moving medications.

DOSIS® is safer and more accurate, allowing you to better serve your customers.

Visit www.dosis.com; send us an email at sales@manchac.com; or call us at 877.626.2422 for more information.

ComputerTalk

Provide outstanding patient care, everytime.

Discover why EnterpriseRx is the fastest growing software solution. EnterpriseRxâ&#x201E;˘, an innovative, next generation pharmacy management system built from the ground up, was designed by pharmacists with real world experience to positively transform the prescription fulfillment process. EnterpriseRx leverages a modern SaaS (Software as a Service) architecture to support industry changes. This allows our clients to consistently adapt and respond to the changing marketplace all the while delivering great pharmacy care. Additionally, the integrated EnterpriseRx workflow is designed to focus activities based on the roles of Pharmacist and Technicians and can adjust with the changing needs of your business. Our clients indicate the EnterpriseRx has dramatically improved the accuracy and safety of their pharmacy operations. ÂŠ2010 McKesson Pharmacy Systems. All rights reserved.

As a centrally hosted SaaS application, EnterpriseRx also enables users to access the system from virtually anywhere at any time via the Internet. Centralized databases, reporting, administration, and real-time communication are all possible with this platform. Regardless of your size, business model, or your plans for growth, EnterpriseRx, a product developed with the latest technologies, is designed to meet your needs today and tomorrow.

McKesson Pharmacy Systems Call: 1.866.682.8942 Write: mps.info@mckesson.com Visit: www.EnterpriseRx.com

September/October 2010

cover story

Technology Driving Long-Term Care continued from page 30

reasons nurses leave facilities. “Turnover runs 50% in nursing staff at many facilities, and that’s expensive,” he says, “so anything you can do to increase nurse satisfaction and reduce turnover is a big financial win for the facilities.”

Leveraging Safety Technology — dispensing automation and workflow in particular — can play a big role in helping pharmacies stay focused on safely and accurately filling prescriptions, while still allowing the time necessary to manage an LTC operation. “There’s so much that goes into LTC as far as paperwork,” says Keith Doehring. “We didn’t realize how much there was when we started.” In

addition to this, Doehring and his father, Tony, kept finding facilities ready to change pharmacies because of mistakes made by the previous provider. Keith Doehring believes that the assurances of quality he has been able to give to potential customers based on the confidence instilled by the pharmacy’s ScriptPro SP200 robotics have been critical to winning and keeping accounts. “We explain to facilities that the robotics helps us with extra ways to double-check ourselves and prevent mistakes,” says Keith Doehring. “This is a huge selling point and a major reason why we have convinced nursing homes to choose us as their pharmacy.” According to Doehring, the pharmacy can fill 50% to 60% of prescriptions with the robot, LTC included. This decreases the amount of time technicians have to spend filling and

Doehring’s Pharmacy Nashville, Ill. Keith Doehring, R.Ph.

Has both retail and LTC operations. Serves several nursing homes in the area.

gives them more time to keep up with the paperwork and provide services to facilities — such as maintaining convenience boxes or filling emergency orders. “There’s always something else to do with LTC,” says Doehring, “and the robot has definitely helped us have more time for these other activities, while being sure that prescriptions are being counted and dispensed safely.” The robot provides an organizational element as well. According to Doehring, it can be set to automatically prioritize retail prescriptions and collate these separately from LTC prescriptions. “We have two out the six collating slots on the SP200 reserved for LTC prescriptions,” says Doehring. Staff members simply take the filled vials from these designated LTC slots and transfer the vials to the back of the pharmacy for loading into blister cards. “There’s so much peace of mind having the robot ensure that the count is accurate and that the right medication is getting packaged because of the barcode-driven replenishment,” says Doehring. He is optimistic that the SP200 will further prove its worth for LTC with short-cycle fill, since that will mean his staff is filling prescriptions more frequently. Doehring anticipates being able to absorb this extra work without adding staff and with little added cost. continued on page 34

ComputerTalk

Pays for itself at

scripts per week, but you’ll love it long before that. The RxMedic ADS™ robotic dispensing system makes automation affordable for any pharmacy. The ADS fullyautomates dispensing for up to 256 different oral solid medications. It automatically dispenses, prints and applies labels, captures vial content images, and caps vials in seconds. The large, segmented collating area holds hundreds of scripts for longer hands-free use. For automated counting needs, the RxMedic ACS™ offers pinpoint accuracy in an affordable, modular design. Ready to count less and do more for your patients? Visit www.rxmedic.com or call 800-882-3819.

Visit us at NCPA booth 439 September/October 2010

cover story

Technology Driving Long-Term Care continued from page 32

Using workflow’s barcode scanning and detailed tracking record in concert with robotics can play a vital role in maintaining a pharmacy’s dispensing accuracy and safety. So says Paul Fritsch of Corner Drug Store. “If you are doing everything manually, you are giving up the accuracy and speed of robotics and a detailed record of who filled a prescription, who checked it, and when,” he explains. The combination has supported Fritsch’s efforts to increase his LTC business and helped him respond to changing patient needs. Fritsch cites using Innovation’s Robotx as improving his capacity to fill the blister packaging that Corner Drug offers by letting his staff focus on the packs themselves rather than pulling bottles and counting pills. As a result, he’s been able to increase the number of

Corner Drug Store Baraboo, Wisc. Paul Fritsch, R.Ph.

Has both LTC and retail operations. Serves 300 beds with three full-time pharmacists and the equivalent of eight technicians.

blister packs filled each month, which in turn has given him the capacity to serve a growing population of home care patients in his area. “The robot takes the process that much further,” he says. “The increase in business is handled without an increase in staffing, and it’s extremely important to the workflow; the robot does both things. It saves time and allows us to be more productive without compromising safety, which is key.”

Next Generation: Phone and IVR Solutions With our innovative, patented technologies and years of pharmacy industry experience, we make it easy to meet the current and future needs of any retail or institutional pharmacy. Contact us today to learn more or schedule a demo.

We make it

easy.

Call 800.600.0435 or visit www.telemanager.com. 34

When it comes to workflow specifically, Fritsch says that if you aren’t using it you’re trusting that everything is going to go through just fine, which he calls the old-fashioned way of doing pharmacy. “You need something much more reliable to double-check everything,” he says. “If there is an issue we can go back through Innovation’s Symphony software to verify the prescription.”

Marketing Your Services We’ve seen how technology can have a powerful impact on a pharmacy’s ability to win new business by assuring a highly accurate and efficient dispensing process. Life Tree Pharmacy’s Mark Taglianetti has had similar success marketing his investment in technology based on the style of packaging it allows him to offer. In his case, he has looked to Parata's PacMed to offer a new option to facilities. Taglianetti says that he took an active approach to this technology investment, evaluating the extent to which there was demand for the multidose onePac pouch packaging that PacMed provides, considering the challenges that might arise in modifying Life Tree’s workflow, and calculating what the cost/benefit balance was. Taglianetti then marketed to potential facilities that he and his staff thought would benefit from this packaging system, highlighting its flexibility and ability to reduce administration time, as well as its ease of use and portability. Life Tree staff also developed relationships with homecare agencies to show how the prepackaged medications would make it easier for homecare aides to pass medications to patients. Taglianetti’s whole approach was forward looking. “We developed new marketing materials to highlight these

ComputerTalk

TMT_CT_9-10.indd 1

9/6/10 9:39 PM

continued on page 36

September/October 2010

cover story

Technology Driving Long-Term Care continued from page 34

Life Tree Pharmacy Collegeville, Pa.

benefits as part of the PacMed purchase, not because of it,” he explains. Mark Taglianetti, R.Ph. He also ran color ads in the local President newspaper and created flyers for the Serves geriatric, area’s over-55 communities, both highmental health, lighting the independence afforded and special-needs by the PacMed technology. “We facilities in the emphasize how useful this packaging Philadelphia area. is for patients who may be going on Has a growing retail, home vacation or who attend day programs,” care, specialty, and LTC pharexplains Taglianetti. “We saw it as an macy business. option for current clients and were motivated by some new clients who And, in keeping with his forwardwanted this type of packaging. We looking approach, Taglianetti also likes wanted to be able to say yes to them.” the fact that PacMed will position him

PrimeRx

Pharmacy Management System

PrimeWEB Customized Web Sites/Portals

PrimeESC Electronic Signature Capture

PrimeCENTRAL

PrimeDMS Document Management

for Pharmacies

Central Data Reports for Multiple Store Owners

PrimePOS Point of Sale

System

PrimeDELivERy In-house and Wireless Delivery Module

...because it’s not just filling prescriptions any more... Increase Revenue and Profitability

Decrease Dispensing Errors

Increase Your Pharmacy’s Efficiency

The focus of a pharmacist has always been to help people. You need tools that ensure dispensing errors are caught before the medication is delivered to the patient and at the same time make sure that the workflow in the pharmacy contributes to the pharmacy’s efficiency and productivity to ultimately do what you had wanted to do in the first place… HELP your PATIENTS. For over 20 years, Micro Merchant Systems has provided solutions to independent pharmacies. Call today, and see how our Prime line of products can assist you in achieving your goal.

We help the pharmacies of today … become the pharmacies of tomorrow 866 495 3999 • 516 408 3999 w w w.micromerchantsystems.com 36

ComputerTalk

to handle the pending federal shortcycle fill requirements.

Offering the Right Options

Catherine Cary understands the importance of providing Bremo LTC Pharmacy’s patients with the packaging they need. For the unskilled group and assisted-living homes that the pharmacy serves, the preferred system is calendar cards. “We’d looked at automation before, but our homes were very accustomed to the calendar card look,” says Cary. “We wanted to be able to take advantage of the benefits of automation, without expecting our homes to change systems or lose some of the customization they are accustomed to.” There are good reasons for this. For example, Cary notes that group home patients may be out during the day — which means that they need two cards for any medications given during the middle of the day: one for the day program and one to keep at the home facility for weekend doses. While out learning about other technology options, Cary discovered DOSIS from Manchac Technologies, dispensing automation specifically designed to fill the calendar cards so important to her operations. The results have been impressive, according to Keith Kittinger. “We’re filling around 40% of our orders with DOSIS,” he says, “which is better than promised.” Moving this workload to automation has been critical, in his view, to maintaining the high level of customer service Bremo LTC Pharmacy offers, even in the face of declining reimbursement. “You have to use technology to be able to give that service and be able to grow at the same time,” he says. A strong interface between the QS/1 PrimeCare pharmacy management system and DOSIS means that Cary continued on page 38

Biggest impact.

Smallest footprint.

PharmASSIST SmartCabinet delivers the highest throughput, lowest cost per fill, and the best ROI.

The Results

The Facts Offers the smallest footprint and best dispenser/space ratio in the industry with 50 dispensers per every 3 square feet. Counts Rxs simultaneously providing throughput of over 200 Rxs an hour. Collects actionable data to maximize automated filling.

Provides on-site, softwarecontrolled drug changeovers to save valuable time and ensure accuracy. Enables you to “right-size” automation for specific Rx volumes and easily scale up when necessary.

Lowers the cost of Rx processing. Ensures superior patient safety. Increases throughput to address increasing Rx volumes.

Get the impact you’ve been looking for with

SmartCabinet

call 336.462.6765 or email sales@innovat.com

www.innovat.com September/October 2010

cover story

Technology Driving Long-Term Care continued from page 36

and Kittinger have been able to create rules that assess a prescription’s sig in order to determine whether the

Bremo LTC Pharmacy Richmond, Va.

Catherine Cary, PharmD. Owner and President

Keith Kittinger, R.Ph. Owner and Pharmacy Manager

Three pharmacies, one of which serves LTC, with a focus on assisted living, group homes, and unskilled facilities in the greater Richmond area. Serves over 200 facilities, many of which are very small.

robot can fill the order or if it needs to be bypassed to the printer for manual fill. Some prescriptions with unusual directions have multiple sigs attached to the order. For example, a patient might take one tablet in the morning and two tablets at bedtime. “PrimeCare allows us to print split instructions for these prescriptions on our MARs,” explains Kittinger. These split instructions also instruct DOSIS to correctly fill the calendar cards with two sets of specific directions for each time of administration. Heartland Homecare is another pharmacy that understands the importance of offering the packaging that its patients need. According to the pharmacist in charge, Melissa LeBar, Heartland has been using MedicineOn-Time’s calendar card system for 12 years. “Facilities and patients like a lot of things about it,” says LeBar.

Efficiency. Time Management. Customer Service. Easy solutions for everyday pharmacy challenges.

Heartland Homecare Services Lawrence, Kan. Melissa LeBar, Pharm.D. Pharmacist in Charge

LTC pharmacy that serves people in group living, assisted-living, skilled, and hospice settings. Serves 57 facilities with approximately 2,300 patients.

“It’s really great for people who want to be more independent or want to extend their self-care a little bit longer before entering a more skilled setting.” As she describes the system, it groups medications by time into foilbacked cups that fit multiple pills, which LeBar says helps patients and their caregivers follow complicated medication regimens. Heartland has gone one step further and developed a proprietary method that lets patients view and print information about their medications in the MedicineOn-Time packaging. “This packaging is a very important service for group home and assisted-living patients,” says LeBar.

Automating Facilities

fusion technology provides user friendly solutions for pharmacies, allowing you to run your business more efficiently so you can focus on your customers. Compliance refill reminders • Automatic will-call notification • Long term care refill reordering • Doctor authorization process • Self-service refill ordering MobileLink-Rx coming this fall to a cell phone near you!

Recognizing that every pharmacy is different, fusion technology solutions are available individually or in combination.

For the right solutions call today at 800.325.2017

www.voicetechinc.com

“Providing solutions that positively impact a pharmacy’s work environment and increase customer satisfaction.” 38

ComputerTalk

Automation isn’t just being put to work in the LTC pharmacies themselves. It is also finding its way into the facilities, where it can play a big role in improving care and lowering costs, according to Vantage Healthcare Networks’ Robin GarnerSmith. This is a new venture for Vantage, and Garner-Smith offers this background: “We were using the traditional 30-day punch card and seven-day multidrug pouch packaging. But we were looking for a way to better meet the increasing regulations concerning timeliness of delivery and pain management in the long-term continued on page 40

September/October 2010

cover story

Technology Driving Long-Term Care continued from page 38

care setting. There has also been a shift to a higher acute-care patient load in nursing homes, so we started looking for a way to address all of these issues, in conjunction with the looming short-cycle fill requirement.” The answer in this case was facilitybased dispensing automation from Talyst, called InSiteRx. According to Garner-Smith, this technology allows Vantage Healthcare to move inventory securely out to facilities and provide them with immediate onsite access to medications — whether for a new or existing order. This also drastically reduces medication waste, reports GarnerSmith. “We’re not sending 30 days

Vantage Healthcare Network Meadville, Pa. Robin Garner-Smith, Pharm.D. Senior Vice President of Long-Term Care

LTC division serves nursing home patients, assisted-living and correctional facilities, and group homes across Pennsylvania. Currently serves 3,200 patients in 45 different facilities.

of medication and then having to destroy 28 days of product if an order changes within a few days,” she says. The technology uses multidose packaging — complete with patient name, time due, and medication description, and all sorted to suit the nursing home by time of administration, patient, wing, or other criteria. The fact that it fills and dispenses on a 24-hour cycle means that it avoids a significant issue Garner-Smith experienced with seven-day pouch packaging: the need for facilities to cut out medications when orders change. The timeliness of dispensing is also important for PRN medications. 40

ComputerTalk

“We never really know how much of these a patient is going to use,” says Garner-Smith. “Now we stock PRN meds in the InSiteRx automation, and nurses simply draw the pills as they are needed.” This not only again reduces waste, she says, but it also provides for faster turns of PRN inventory. Vantage Healthcare is seeing savings on delivery, as well as increased efficiencies within the dispensing process, according to Garner-Smith. And her conservative estimate is that facilities can save 7% to 14% off the facility portion of the bill per month. “There are all these savings for the pharmacy, for the facility, for government-funded insurance, for other plans, and ultimately for the patients,” she says. “But what it really helps us do is to provide a higher level of patient care, as the medications they need are immediately available. For new patients, new and changed orders, for acute medical changes, or if the patient is at the end of life, the patient can get medications right away.” Another benefit, reports Garner-Smith, is that nurses are experiencing time savings during medication passes, resulting in more direct patient care time. It’s these elements that mean residents are receiving better healthcare that Garner-Smith really sees as the positive outcome of the improved dispensing and packaging Vantage Healthcare is experiencing with Talyst’s solution.

Supporting Communications There are other tools that are supporting improved patient care and helping pharmacies do more with the resources they have. For example, there are new options for communicating with facilities, some of which build on the traditional methods of phone and fax and some of which use

the Web to streamline interactions. In all cases, pharmacies are providing access to critical information that improves care, and doing it efficiently. Carvajal Pharmacy offers an example of building on existing IVR technology. Perhaps the key element of DirectLinkRx from voiceTech, in clinical pharmacist Omar Gonzalez’s opinion, is that it takes the standard IVR task of efficiently accepting refill

Carvajal Pharmacy San Antonio, Texas Omar Gonzalez, Pharm.D. Clinical Pharmacist

Serves the south side of San Antonio, including hospice, LTC, nursing homes, and nonprofit organizations.

orders and adds a faxed-back confirmation, which also provides the facility with a record of its requests. “We use these confirmation faxes when we’re working with a facility on a problem order,” notes Gonzalez. “Having these records is important because LTC facilities will enter literally pages of refill orders.” Equally important is that this technology provides an improved way to meet the need LTC facilities have for getting refill orders completed in a timely fashion, while reducing the burden on pharmacy staff. “This is a technology that limits the volume of phone calls we take, while making it even more convenient to order refills,” says Gonzalez. “Calls that are emergencies don’t get placed on hold. People can get their questions answered.”

Data on the Move Heartland Homecare, on the other hand, has recently began using a software-as-a-service (SaaS) application continued on page 42

“Emdeon Edit’s Market U&C reports have increased our

gross margin

by more than 2%.”

Add to your bottom line with easier business analysis Dennis Holley opened Fireside Pharmacy more than 25 years ago with little more than a cash register and the help of one technician. Since then, the industry has changed quite a bit, sending independent pharmacies like his in search of innovative ways to increase efficiency and bottom lines. As a result, the Pensacola, Florida, pharmacy, aided by the latest technology and Emdeon’s pre/post editing service, has been able to reduce third-party claim submission errors and increase its gross margin percentage. Emdeon Edit not only offers convenient online access to near real-time tools and reports that allow for easier business analysis, but it also provides valuable information for retail pricing evaluation via a userfriendly Market U&C feature. Plus, Emdeon Edit is the gateway to our AWP claim resubmission service, Emdeon Payer Compliance, which can help your pharmacy regain “lost” revenue at no additional cost. Discover how other Emdeon pharmacy solutions are helping Fireside Pharmacy increase efficiency and profitability. Contact an Emdeon representative at 877.707.0024 or visit www.emdeon.com.

You don’t need one more partner. You need one partner that does more.

September/October 2010

cover story

Technology Driving Long-Term Care continued from 40

called Speed Script LTC (SSLTC) and offered by its pharmacy management system provider, Speed Script. This application offers a broad set of functions designed to connect the facility to information at the pharmacy in real time. At the moment, however, Heartland’s Melissa LeBar says that they are using it primarily to receive new and refill prescriptions electronically. “We’ve just started one of our larger facilities with a number of inhouse prescribers on it,” she says. Even with this limited rollout, LeBar still reports seeing big benefits from SSLTC’s synchronized real-time messaging. “When we receive an order via SSLTC, we get a message on the screen of our Speed Script dispensing software,” explains LeBar. “We review it and can message the prescriber back right away if there are any issues or questions.” More importantly, in LeBar’s view, orders placed in SSLTC provide prescribers with up-to-the-minute data from Heartland’s pharmacy management system databases. Among the critical information passed along, prescribers can see other medications the patient is on, whether the order raises a drug interaction flag, and whether the medication is held in inventory at Heartland. “There’s a lot of detail that is provided directly to the prescriber at the time they enter the order,” says LeBar. “This allows them to place an informed order, and it eliminates a lot of the normal back and forth discussing prescriptions.” According to Alan Bronfein, Remedi SeniorCare also subscribes to the idea of making the data contained in its pharmacy systems available to facilities immediately and in ways that support their day-to-day activities. In this case, Remedi brings the resources of the seventh-largest LTC pharmacy 42

ComputerTalk

in the country to bear. “We take a lot of data out of FrameworkLTC and present it via a proprietary, secure Web portal called MyRemedi, where we have a variety of useful tools for our customers,” explains Bronfein. “Our goal is to leverage technology to provide better real-time information so our customers can make better decisions.” For example, says Bronfein, facilities can set up alerts in MyRemedi that are triggered if a medication’s cost exceeds a certain dollar amount or, from a clinical perspective, alert staff to an order for certain medications so that the nurse can take effective action in real time. “The nurse, physician, or nursing home administrator accesses information from our database instantaneously through our userfriendly Web portal,” he says. “This means that our facilities aren’t relying on retrospective reports to make decisions that control utilization, lower costs, and provide better therapeutic outcomes.” Bronfein reports that Remedi SeniorCare is also working to deliver pertinent data to facilities designed to help them meet the challenges of the new Minimum Data Set (MDS) 3.0. This federally mandated process, done first at admission and then periodically during a resident’s stay, assesses and records a patient’s psychological and physical state in detail. Bronfein describes it as essentially an algorithm, the outcome of which determines what resource utilization group (RUG) score the resident receives, and in turn what payment the facility is eligible for under Medicare Part A and most Medicaid plans. “This whole assessment is changing,” says Bronfein, “and this is a material change in process and possibly reimbursement for nursing facilities.” Remedi SeniorCare already has pertinent information facilities will need

to accurately complete the MDS. For just one example, Bronfein notes that there’s a section in the MDS that requires the nurse to identify the therapeutic class of certain medications prescribed for a resident. “Matching drugs to specific therapeutic classes is not something that nurses have had to do in the past,” says Bronfein, “so they aren’t necessarily well prepared to fill out this section.” Remedi SeniorCare provides a matrix of specific medications by therapeutic class to assist in accurate completion of the MDS 3.0. “It has never been more critical to be able to provide meaningful data to our customers in an efficient way,” concludes Bronfein.

Care, Safety, Communication, Growth Express Meds’ Joe Marasco offers a few thoughts that may well sum up the role technology is playing in LTC pharmacy. “Adopting technology allows us to grow a little bit faster than we would otherwise,” he says, “and with a much higher level of confidence in the quality of your process.” As Life Tree’s Mark Taglianetti sees it, “We are living in a time when medication plays a large role in sustaining and improving the quality of life for many patients. Fitting an individual with an optimal medication regimen is one part of the equation. Ensuring that they take their medication correctly is another part. As a pharmacist, I make solving both parts of this equation my responsibility. I believe surrounding myself with the right people and the correct technology will allow me to do so.” CT Will Lockwood is ComputerTalk’s senior editor. He can be reached at will@computertalk.com.

george’s

corner

The Future

n my last column I talked about how things used to be. One of our readers asked what I thought about the future. He asked the following questions: 1. “Is it possible that we will be untied from the product sometime in the future?” 2. “Will we ever get to the point of real clinical pharmacy in a community setting?” 3. “Will insurance companies pay us to do this for our non-Medicare patients?” 4. “If we counsel them appropriately now, won’t they be healthier seniors?” 5. “Are you doing this in California?” 6. “Do you miss those old days?”

Those questions made me stop and think. They are pertinent, especially in these times of rapid change. When I stop and think, I like to write because it clarifies my thoughts. I wrote a rather long email reply. Here is an expanded collection of my thoughts on his questions.

George Pennebaker, Pharm.D.

Too many expensive people are spending too much time “staying open” long, nonproductive hours. Patients do not know what to do with their drugs — or even when they do, they don’t do it. Mail-order pharmacies do a good job distributing prescriptions. Yes, there are problems and we hear about them, but considering the volume of transactions, the problem percentage is very low. Mail-order pharmacies are also efficient. However, they do not see the patient. Somebody needs to see the patient. They also are wrong for immediate needs such as antibiotics. I personally am bothered by the fact that they seem to have only one-size vial (large) that they can put drugs into. I am also bothered by the fact that so many mail-order pharmacies are closely associated with drug insurance programs. Too close for good independent patient care. I do see one good reason to stay tied to the product. It is the “You can’t have it until I say so” principle that enables us to insist on talking to the patient and/or doing whatever else needs to happen before the patient gets the drug. Yes, we will get untied from the product. But it will only

Is it possible that we will be untied be as a part of some total revision of other processes, procedures, and responsibilities. from the product sometime in the future? We will get untied from the product as soon as A note about technology. The technology folks will create

someone figures out a better way to distribute drugs, along with better ways to increase pharmacists’ involvement in the care of patients. It’s not easy. We are getting closer. Current facts: Too many expensive people are spending too much time counting by fives.

the tools and gadgets, and they will get better and better. The challenge is to make sure they make the right things in the right way to get the tasks of the future accomplished in the best manner possible. continued on page 44 September/October 2010

george’s

corner

continued from page 43

Will we ever get to the point of real clinical pharmacy in a community setting? Real clinical pharmacy in a community setting

The technology folks will create the tools and gadgets, and they will get better and better. The challenge is to make sure they make the right things in the right way to get the tasks of the future accomplished in the best manner possible.

is starting to happen. However, how it is paid for is important. It is important because it drives what is done. If payment is patient-encounter oriented, what is done is going to be different from what occurs if payment is for filling prescriptions. Right now the most important number is ever, there are still too many pharmacists who are afraid how many prescriptions we filled today. to say any more to patients than reading the label back to There are pharmacists who work with patients in a variety them: Take this after meals. Those pharmacists need confidence building. We need CE courses whose only goals are of nonpharmacy settings. A friend of mine has the legal authority to write Rx’s for schedule II drugs and routinely to build confidence. Those who take the courses should be awarded double hours for their time. does so as a part of his practice in a pain clinic. I know others who do similar things in other settings. I believe With a 50% increase in Medicaid patients and a huge most of them are salaried, although some of the income increase in elderly heavy users, it’s going to take more may come from fees paid to the practice by third parties. than physician assistants to take the increased patient load Pharmacists also take care of patients without getting paid directly for that service. Everyone who works in a community pharmacy does that every day — for free. However, some folks (not me) argue that the payment is included in the money they pay for prescriptions and OTC drugs. One can also define “real clinical pharmacy” as working on more complicated or critical clinical issues that, so far, have been the domain of physicians. Very little of this is happening in community pharmacies. More is happening in specialized (such as IV and compounding) pharmacies, and even more in medical clinics and hospital settings. In most of these settings the pharmacists are functioning as employees rather than owners of the practice setting. And it is the practice setting that gets paid.

Will insurance companies pay us to do this for our non-Medicare patients? The

insurance companies are paying for these clinical services. However, they are seldom paying pharmacists for them separately and directly. Very few pharmacists are in a business setting where this type of payment is possible. I do know of some who have created that setting. They counsel patients and bill insurance programs for the service. Often, but not always, the insurance company will pay. However, the volume is so low and the setting so rare that it is not yet common.

If we counsel them appropriately now, won’t they be healthier seniors? Yes. How44

ComputerTalk

off the MDs. Pharmacy may be ahead of the game on this one. We are training a lot of new clinical pharmacists. Too many for the needs of today’s systems. If pharmacists help fill that gap, they will not be working in pharmacies. That also means no product to count and pour. (See question 1.)

Are you doing this in California? A lot of

pharmacists are providing clinical services in California and in most other states. Most of them are being paid salaries for their services. You don’t hear about it much, but physicians are ahead of us on this. A very large portion of physicians are salaried — not fee for service — and they like it. Not many of these physicians are members of AMA, so you don’t hear about it.

Do you miss those old days? Yes and no. I

miss the old days because there is so much to understand in order to move forward. The future is coming whether we like it or not. We need to consider the past and its impact as we create the future. That is one reason I cannot seem to retire and walk away from the profession. I am just too interested in and excited about what our future will bring. Those are my thoughts. Let me know yours. CT

George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. He can be reached at george.pennebaker@sbcglobal.net.

technology

corner

Survey Reveals Desire for Integrated MTM Reimbursement Processing

ur profession is constantly evolving. From the early days as apothecaries who compounded medications, to the 1950s when the APhA Code of Ethics stated that pharmacists do not discuss therapeutic effects of medications with patients, to now, where we find ourselves in the midst of pharmaceutical care and medication therapy management services. Pharmaceutical care requires that we take responsibility for patient outcomes related to medications. According to Gregory Higby’s 2002 article in the Journal of the American Pharmacists Association, while many expected the 1990s would be the era of pharmaceutical care, in reality, business forces dominated pharmacy during the decade, and the focus was on cost control and efficiency in dispensing. Pharmacy has fought for many years to move itself beyond the role of “medication distribution” and instead be recognized as a healthcare provider. While we still have a way to go, important strides have been made. Consider medication therapy management (MTM) services as defined in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA 2003). Specific language in the act states that an MTM program “may be furnished by a pharmacist and…is designed to assure…that covered Part D drugs…are appropriately used to optimize therapeutic outcomes…” (the full document can be found at http://bit.ly/cO6Deu, page 21 of 415). After the posting of MMA 2003, our profession quickly reached a consensus definition of MTM, published by Benjamin Bluml in the Journal of the American Pharmacists Association in 2005, stating that it is “a distinct service or group of services that optimize therapeutic outcomes for individual patients. MTM services are independent of, but can occur in conjunction with, the provision of a medication product.” The definition of MTM is probably not new to you, nor are the implications of pharmacists being specifically mentioned in the act.

Brent I. Fox, Pharm.D., Ph.D.

Bill G. Felkey, M.S.

that you want in your pharmacy management system (PMS). The needs list is intended to help technology vendors prioritize product development and enhancements (see ComputerTalk, March/ April 2010). In the July/August 2010 issue of ComputerTalk, we addressed NCPA survey results that found a desire among pharmacists for an MTM messaging standard. In this issue we look at results of NCPA’s phase-two survey.

Phase two addressed specific aspects of MTM documentation and billing and includes interesting additional comments and responses. Readers should be aware that approximately 170 individuals completed the survey, representing a 2% response rate. In the research realm of scholars, a response rate this low does not allow us to make broad generalizations about the target population. We are, however, presenting the responses of the pharmacists who chose to participate in the survey because we would like to hear from ComputerTalk readers to know if the responses do in fact accurately represent the views of We have recently written about the NCPA Steering Committee for Innovation the profession. and Technology’s efforts to identify specific technology needs in pharmacy. A primary goal of these efforts is to develop a “needs list” of features/functions continued on next page September/October 2010

technology

corner

continued from previous page

When asked about their preferred method to document MTM encounters (PMS, Web portal, or both), respondents sent a strong message, with 50% indicating that they wanted to document through their PMS. The Web portal was preferred by 15% of respondents, with 34% preferring both methods. Clearly, and not surprisingly, pharmacists continue to focus their activities within the PMS. The strong support for both methods may suggest that pharmacists recognize the potential benefits offered through the anywhere, anytime access to documentation that is offered by the Web. Respondents were asked to indicate their preferred method to process billing of MTM encounters. They were not limited to selecting a single option when selecting among real time, batch, or CMS 1500 form. Real time was the most frequently selected choice, with 76% indicating this option. In total, 18% selected batch and 13% indicated CMS 1500. We all know that our profession was an early adopter of computing technology, primarily to bill for prescription reimbursement. Computers are even more important in today’s world of shrinking margins to efficiently and cost-effectively perform this critical business function. Is the survey’s strong support of realtime billing for MTM encounters a natural extension of our experiences with our current billing method? Or do these results suggest that pharmacists strongly associate MTM service provision with the dispensing of medications, desiring to bill for the encounter when they bill for the medication? Recall the consensus definition we used above, which indicates that MTM services do not have to occur in conjunction with the provision of a medication. Or is there another explanation?

Need for Training Continuing our look at the

theme of billing for MTM encounters, respondents were asked to indicate yes, no, or not sure to the question, “Does your pharmacy management system have the functionality to bill for services using the following transactions?” Transaction options were NCPDP 5.1 and X12 837. For NCPDP 5.1, 70% indicated yes, 2% no, and 28% not sure. For X12 837, 5% indicated yes, 5% no, and 80% not sure. (A small number of respondents did not answer this question, or partially completed it.) As background, the NCPDP 5.1 transaction standard has separate productbilling and service-billing data sets. Do the survey 46

ComputerTalk

responses indicate confusion regarding the appropriate method to bill for MTM encounters? Do the responses suggest that pharmacists believe their PMS is set up for service-billing using NCPDP 5.1? Several pharmacists commented on the need for billing training, suggesting that the responses above are not necessarily surprising. When we cover this distinction in our management courses at Auburn, we often see many sets of student eyes rolling backward. We believe this occurs because it is difficult for a second-year student to intuitively draw the linkage between these specific standards and their future practice. We hope that practicing pharmacists do recognize the importance of these standards, even though the survey may be reporting a misinterpretation of the question. A small number of respondents provided comments to the survey’s open-ended question that asked, “Is there anything not covered here that you would desire to assist you in documenting and billing for MTM services by you or for your pharmacy practice? If yes, please explain.” Again, several of the comments can be categorized as suggesting that the respondents were asking for help with how to bill for MTM encounters. These comments are consistent with the findings described in the paragraph above. When we finished reviewing the survey results, we end up asking ourselves, is the “everyday” community pharmacist familiar with how to bill for MTM services? We present the results of this survey to seek your input to determine if they are, in your opinion, an accurate representation. The pharmacy associations and academia have pushed forward their interpretation of MTM. Does their definition match that of those who actually do the work? Is more education needed on the MTM billing process? We absolutely recognize the significance of pharmacists being specifically named as providers capable of providing MTM services in MMA 2003, but we also see that other disciplines may elect to do this service if mainstream pharmacists do not engage in them. Where are you and your colleagues on the issue of providing and billing for MTM services? Please email us and let us know. CT Brent I. Fox, Pharm.D., Ph.D., is an assistant professor, and Bill G. Felkey, M.S., is professor emeritus, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University. They can be reached at foxbren@auburn.edu and felkebg@auburn.edu.

catalyst

corner

The Stars Are Aligning

Marsha K. Millonig, R.Ph., M.B.A.

abor Day weekend is the traditional marker of summer’s end, in spite of the actual autumn equinox. That is especially true here in Minnesota, where the rich but short summer season begins to turn to fall. Leaves are already starting to turn toward bright red, orange, and yellow as the nights become cooler and the days work hard to reach 70 degrees. Skies are crisp and clear blue, above our abundance of lakes. I was fortunate to spend the holiday weekend at one of our state’s premier lakes, enjoying the outdoors, with bald eagles soaring overhead. At night, the skies were filled with stars and galaxies were easily seen. Conversations with neighbors were diverse and interesting over bonfires each evening. Eventually, it seems, given my background and theirs, the talk turned to healthcare.

Connecting Online

One senior neighbor, who suffers from asthma, has met the Medicare Part D “donut hole” and was seeking advice on how to economically access two brand-name products he uses regularly to control his condition. Another neighbor’s daughter was seeking advice as a new graduate from dental hygiene school on career opportunities. So was another neighbor, who is a recent nursing school graduate — a midcareer change for her. She is currently working in home healthcare, and her former business experience gives her a keen eye on how care is organized, delivered, and documented. I learned much from each conversation about how care could be better coordinated and what barriers other professions and people face in trying to do so. In each case, I think, each neighbor began to see how working with a pharmacist could help address some of the issues they were facing and were interested in learning about.

May 2010 edition of Health Affairs, “Why Pharmacists Belong in the Medical Home”: http:// content.healthaffairs.org/cgi/ content/abstract/29/5/906

Being able to help others see our profession and its value continues to be an important daily effort, whether through interactions with friends and neighbors like those I experienced during the Labor Day weekend, or on a broader scale through organizational advocacy. Many such efforts are being undertaken, but three recent ones provide wonderful examples.

publication press release of a project looking at the health outcomes impact when pharmacists are included as members of healthcare teams. Marie A. Chisholm-Burns, Pharm.D., M.P.H., FASHP, led a research team

Pharmacists Prove Value The American Society of Health-System Pharmacists (ASHP) and the ASHP Research Foundation have issued a pre-

Links to Web pages referenced in this article: October 2010 edition of Medical Care: http://journals.lww.com/ lww-medicalcare/Abstract/ publishahead/US_Pharmacists__ Effect_as_Team_Members_on_ Patient.99710.aspx

New York Times feature story on August 13, 2010, entitled, “Pharmacists Take Larger Role on Health Team”: http:// www.nytimes.com/2010/08/14/ health/14pharmacist.html

continued on next page September/October 2010

catalyst

corner

continued from previous page

that conducted a comprehensive, systematic review of the healthcare literature to examine the effect of pharmacistprovided direct patient care on therapeutic, safety, and humanistic outcomes. The results will be published in the October 2010 edition of Medical Care (http://journals .lww.com/lww-medicalcare/Abstract/publishahead/ US_Pharmacists_Effect_as_Team_Members_on_ Patient.99710.aspx). Briefly, the researchers found favorable effects from including pharmacists in direct patient care activities. These included reducing adverse drug events and improving outcomes for patients with chronic diseases. Patients were 47% less likely to experience an adverse drug event when a pharmacist was involved in their care. Pharmacist interventions through disease management for patients with diabetes, hypertension, and high cholesterol also significantly improved outcomes. Nearly 90% of studies related to pharmacists’ impact on managing hemoglobin A1c showed favorable results. Eighty-four percent of the studies focused on managing blood pressure and 82% of studies looking at managing high cholesterol showed favorable results. Medication adherence, patient knowledge, and quality of life/general health meta-analyses were also significant, favoring pharmacists’ involvement in direct patient care. Nearly 300 published articles were reviewed in this meta-analysis. In the press release, ASHP CEO Henri R. Manasse, Jr., is quoted as saying, “This important study clearly demonstrates the valuable role pharmacists play in patient care. The findings are particularly relevant as policymakers begin to implement innovative care models included in the new healthcare reform law, like the medical home model, where patients can benefit from the medication expertise of pharmacists.” Study authors concluded that “involving pharmacists as healthcare team members in direct patient care is a viable solution to help improve U.S. healthcare.” In my view, one of the best aspects of the advocacy effort was finding the press release used in the American Health Insurance Plan’s medical home newsletter. The other recent advocacy effort is an excellent article by pharmacist Marie Smith and colleagues from the medical and public health communities that appeared in the May 2010 issue of the journal Health Affairs. Entitled “Why Pharmacists Belong in the Medical Home,” the article outlines how pharmacists may positively contribute to primary care through providing medication therapy management. (See http://content.healthaffairs.org/cgi/content/ abstract/29/5/906.) This idea was featured prominently as 48

ComputerTalk

well in a New York Times front-page story on August 13, entitled, “Pharmacists Take Larger Role on Health Team,” describing one patient’s use of her pharmacist as a “healthcare coach” to help her manage her diabetes (http://www .nytimes.com/2010/08/14/health/14pharmacist.html). These examples, combined with my experiences over Labor Day weekend, made me think the stars are aligned to really move pharmacists forward in providing the care we know they are capable of providing, and being reimbursed through new collaborative care entities. But good systems and support are an essential part of their full achievement of that role. While healthcare reform may bring “medical homes” and “accountable care organizations,” the reality is that the healthcare stimulus spending for health information technology is moving things forward now. Spending by state and local governments on HIT is expected to reach $10 billion by 2015. Pharmacy technology vendors have a great opportunity to help position their customers to fulfill these roles and provide the needed systems to support their MTM provision and other patient care services. Continued attention to using technology for increasing dispensing efficiency will also be critical. This opportunity was evident at the recent NACDS Pharmacy & Technology Conference held the end of August in San Diego, Calif. ComputerTalk’s Will Lockwood captured vendors in action on the exhibit floor and during educational sessions on maximizing technology for dispensing, DEA reporting, medication error reduction, and quality reporting. Efforts may be aided by the new pharmacy e-health information technology collaborative that has been launched by a number of pharmacy organizations to position pharmacy care processes and systems within the new world order of electronic health records. The collaborative’s executive committee consists of the ASHP, APhA, AMCP, and NCPA, with membership by several other organizations. James Owen of APhA presented information about the collaborative at the ASAP Annual Industry and Technology Conference in January 2010, and future meetings will provide updates. Perhaps members of the collaborative will also take APhA’s lead in offering their employees MTM services as part of their health benefit. Touché. CT Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises, LLC, located in Eagan, Minn. The firm provides consulting, research, and writing services to help industry players provide services more efficiently and implement new services for future growth. The author can be reached at mmillonig@ catalystenterprises.net.

view

points

Want to Improve Operating Results? Try Benchmarking defines benchmarking as “the process of comparing one’s Wikipedia business processes and performance metrics to industry bests and/

or best practices from other industries. Dimensions typically measured are quality, time, and cost.” Benchmarking could be an episodic activity, but is more often a continuous process in which organizations seek to improve their performance. In this issue, we are going to explore strategies that use benchmarking to improve the operating performance of your pharmacy. The benefits of benchmarking will enable you to compare the results at your pharmacy with industry statistics to determine areas where you are performing above industry averages and, more importantly, identify areas where management focus is needed to improve results. The selection of the attributes to benchmark is a critical component of a successful program. Attributes that are selected for benchmarking must drive specific operating results to improve sales, reduce expenses, or improve employee productivity. A partial list of attributes to benchmark (examples at right) is only as long as your imagination. These metrics can be measured in dollars, time, or percentages and help you decide on the direction that improves your results. For example, inventory turns should be maximized in order to free up dollars invested in inventory, while proper inventory management can minimize outof-stock situations. Another example is technician and pharmacist productivity, which would be an internal benchmark. You will not find these benchmarks in industry publications, so you will need to create your own. For example, if your pharmacy management system employs a workflow process, what is the productivity for each workflow queue? How many prescriptions can your best technician enter in order entry? How many prescriptions can your pharmacist verify in the final quality control check? Once you start measuring these items, you will see a spectrum of productivity, based on the talents of your staff, and create your own benchmark to increase productivity, i.e., the best practices that improve performance. continued on next page

Tim Kosty, R.Ph.

Don Dietz, R.Ph., M.S.

Attributes to Benchmark There are many attributes that can be benchmarked, including: ■ Sales per employee ■ Total sales per square foot of selling space ■ Prescription sales per square foot of pharmacy space ■ Average wait time per prescription ■ Percent of out-of-stock prescription items that must be ordered ■ Cost of goods sold as a percentage of sales ■ Gross profit margin ■ Net profit margin ■ Fixed expense as a percentage of sales ■ Variable expense as a percentage of sales ■ Labor costs per prescription ■ Technology costs per prescription ■ Technician productivity ■ Pharmacist productivity ■ Prescription inventory turnover ■ Current ratio = current assets/ current liabilities September/October 2010

view

points

continued from previous page

The next step is to decide which measurements are critical to your operational success. This evaluation requires a thoughtful approach to determine what metrics are measurable, actionable, and, most importantly, drive operating performance. We recommend selecting three to four key metrics to focus your attention on — areas where you believe there is room for improvement. Once you have decided on the metrics to measure, the question becomes, How do I stack up against my peers?

Sources of Comparative Information There are a num-

ber of industry sources where you can find comparative performance

information. Listed below are a few suggested sources: ■ If you own multiple pharmacies, stores within your organization. ■ NCPA Digest, which provides industry averages and identifies the top-performing 25% of the pharmacies metrics separately. ■ NACDS Chain Pharmacy Industry Profile.

to understand how the metrics are calculated so you are making appropriate apples-to-apples comparison. For example, what specific expenses are included/excluded from operating expenses? Once the metrics have been determined to be comparable, the hard work begins.

Improving Operational Performance You will most

likely find areas of your operating performance that will meet or beat industry benchmarks, and others that ■ Wholesaler franchise programs. are in need of improvement. The fol■ American Society for Automation lowing methodology can be effective in Pharmacy. in generating ideas and positive moWe suggest reviewing the results from mentum in creating actionable tactics to improve performance: multiple sources to identify the average range of performance. Make sure 1) Rate your pharmacy’s performance on the metric of a scale of 1 to 10 when compared to industry benchmarks. This is a subjective ranking, so be sure to evaluate yourself honestly. For example, if your prescription inventory turns is 8 per year and (we didn’t think so) the industry benchmark is 12 per year, this performance doesn’t The only data deserve a 9 rating. conversion solution ■ Independent buying groups.

Is this how you would preserve HISTORY?

with military-grade data security protocols

Data Services, Inc

SECURE Data Transport SECURE Data Retention SECURE Beyond Compliance ...make sure your data stays (702)914-9910 YOURS

FirSt 50

ComputerTalk

infowerks@infowerks.com

Pharmacy Data Security & retention

2) If you rated the performance a 7, what 10 things could be done to improve the performance level to an 8? Think about actionable items that could be implemented right now to incrementally improve your results. For example, to improve inventory turns, calculate what the average inventory on hand would need to be to reach your goal. If the goal is to increase inventory turns per year from 8 to 9, you will have to determine the dollar amount of inventory reduction needed to increase the turns, assuming sales and cost of goods sold remain

the same. Remember that annual inventory turns = annual cost of goods sold/average inventory (beginning inventory + ending inventory/2). If you have an average inventory of $225,000, then 8 turns per year indicates a cost of goods sold of $1,800,000. To increase the turns to 9, the average inventory would have to be reduced to $200,000. The calculation is $1,800,000 cost of goods sold/$200,000 average inventory = 9 turns. Therefore, an inventory reduction of $25,000 ($225,000 – $200,000) is needed. The question is, What actions can be taken to reduce the inventory on hand by $25,000?

most important step is to plan a course of action to implement your ideas. Begin by implementing the easiest, and be sure to involve the pharmacy staff. Track your benchmark attributes monthly, and adjust your strategies to continue to move the process forward. Benchmarking benefits are best realized through a continuous process. This has the added benefit of focusing your efforts on solutions, not problems. You may need to add or subtract a metric

3) Write down a list of 10 items that you or your staff could be doing or stop doing to improve results. Don’t evaluate the ideas as you write them down, just get to 10 ideas as quickly as possible. 4) Now evaluate the 10 ideas and select the top three ideas from your list. 5) Write down three action items that can be taken immediately to improve performance. 6) Prioritize and begin implementing these. This process should take five to 10 minutes, and you will be amazed at the number of actionable ideas you will find. Consider involving your pharmacy staff at this stage to help generate ideas to improve results. Involving your staff will help gain their buy-in and provides multiple perspectives. Repeat this process for each metric you have decided to benchmark. These ideas will focus your activities to improve operating performance. This process also works in any other area where improvement is sought.

that can move your pharmacy closer to your benchmarking goals. Good luck! CT Tim Kosty, R.Ph., is president, and Don Dietz, R.Ph., M.S., is vice president at Pharmacy Healthcare Solutions, Inc., (PHSI), in Pittsburgh, Pa., which provides consulting that improves the profitability of its healthcare clients. They consult with pharmaceutical manufacturers, PBMs, retail pharmacy chains, and software companies on strategic business and marketing issues. The authors can be reached tkosty@phsirx. com and ddietz@phsirx.com.

SIMPLY THE BEST VALUE IN PHARMACY SOFTWARE ®

FIND OUT WHY LONG- ▲ Data conversion available for most systems TIME USERS DESCRIBE ▲ True Windows environment VISUAL SUPERSCRIPT ▲ Comprehensive third-party billing to primary, AS “A CADILLAC AT A secondary & tertiary payers VW PRICE.” ▲ Unique drug file optimized for speed & accuracy ▲ Drug imprints & images ▲ Barcode & Rx scanning ▲ Inventory updates using wholesaler EDI ▲ Electronic prescriptions ▲ Fax refill requests from computer ▲ Plan 340B processing & reports ▲ Signature capture ▲ Workflow management ▲ Automated transparent updates ▲ Automated HIPAA compliant backups ▲ Many other exclusive features! PHONE AND INTERNET-BASED CUSTOMER SUPPORT provides you with instant access to our expert support staff CALL 800-359-5580 TO ORDER A FREE DEMO www.daaenterprises.com 800-359-5580 sales@daaenterprises.com

Track Your Progress The DAA 708.indd 1

September/October 2010

7/23/08 3:51:49 PM

conference

circuit

The National Association of Chain Drug Stores (NACDS) held its 2010 Pharmacy & Technology Conference in San Diego, Calif. Attendees availed themselves of educational programming, including presentations on making pharmacy technology work for you, best practices for quality assurance improvements, and improving adherence. The exhibit hall is always a big feature of this conference and was busy again this year.

QS/1’s Gary Throckmorton, left, and Tom McLeod.

Two Point Conversions celebrated its 20th anniversary in style. Seen here are Sophia Chidichimo and Bob Mandel.

The team from voiceTech included, from left, Marina Valencia, Tim Garofalo, Duane Smith, Celesta Sexton, and Paul Sutton.

Centice’s Gail Massiah and Scott Albert show Pass Rx to Brian Huebner from AmerisourceBergen, center. Joe Moore, left, and Val Gurovich from TeleManager Technologies. Among the group from McKesson Pharmacy Systems were, from left, Brandon Burns, Holly Lewis, Brent Burns, Kris Hunt, Steve Petrozzi, Joe Montler, and Ian Fallon. Attendees at the TCGRx exhibit looking at inventory, workflow, and automation solutions.

Sav-Mor Drug Stores’ Yvonne Gallagher, with Activant’s Bruce Kneeland, center, and Matt Mullen.

ComputerTalk

Scott McClusky was on hand to show HBS’s pharmacy software solutions. This group, shown at RelayHealth’s exhibit, includes Laura Cranston, front left, Jackie Green, front right, and David Nau, back left, from the Pharmacy Quality Alliance; Marc Cohen, front center, and Jim Rowe, back right, from RelayHealth; and Tom Bizzaro from First DataBank.

George Owens, right, and Andrew McKernon, second from right, show PDX’s software to a group of pharmacists.

From left, Mark Wilgus, Derrick White, and Julianne King were firsttime exhibitors with Supplylogix.

Jeremy Hume gives a demonstration of the offerings from KeyCentrix.

ScriptPro’s integrated suite of technologies kept a crowd at its exhibit.

Cerner Etreby’s Sameer Brahmavar, center left, and Mike Etreby, center right, speak with a group from Brookshire Brothers. Charles Brinkley, left, and Clarence Lea were available to talk about services from FDS.

Ateb’s Debbie Sheppard in discussion with two attendees.

Kirby Lester’s Christopher Thomsen answers questions about the company’s newest automation.

Dean Jolly and Shelly Hammer are seen here with RxMedic’s automation. John Heller, left, and Matt Reichert from Health Market Science.

Two attendees from Day Pharma check in with First DataBank’s Kevin Roth.

From left, Parata’s Heather Martin, Tom Rhoads, Andrea Overfield, and De Lelly in front of the company’s mobile unit containing its latest automation.

Steve Patton shows Integra’s DeliveryTrack product.

Rosanne Thurman from Cook Children’s Health Care System is seen here with Glenn Newman, left, and Larry Stephenson from HCC.

From left, Lathe Bigler, Jeremy King, and Rick Sage represented Emdeon.

Tim Limer, center, walks a few attendees through Innovation’s dispensing automation.

Andy Voso represented POS vendor ECRS.

Conference Circuit continued on next page September/October 2010

conference

circuit

SoftWriters convened its 2010 FrameworkLTC User Conference outside of Pittsburgh. The company hosted over 180 users for three days’ worth of educational sessions led by SoftWriters staff. Attendees received updates on FrameWorkLTC and e-prescribing, including for controlled substances; D.0 readiness; delivery management tools; FacilityLink; AWP; MTM; and analyzing profit margins; as well as a special talk by Dr. Richard Warnock of Golden Clinical Services who gave the facility’s perspective on the services and technologies desired from LTC pharmacies. A number of SoftWriters technology partners were also on hand. A group of partners — AccuFlo, ALMSA, Parata, PointClickCare, QuickMAR, and Carasolva — led breakout sessions on integrating eMARs into LTC operations. Additionally, Integra and Security MicroImaging led sessions on document management, and Veridikal Healthcare offered a session on LTC-specific preedits and postedits. Manchac was also on hand to talk about its Dosis automated dispensing technology. Senior editor Will Lockwood was also able to check in with five attendees and find out what’s on their minds right now: Eric Folino, R.Ph., executive VP of operations, PDC Pharmacy: “Our next strategic initiative is to purchase a document management system to provide for a paperless pharmacy environment that streamlines operations and ensures compliance with applicable pharmacy regulations. FrameworkLTC has provided us the opportunity to achieve this goal with mininal interuption to our pharmacy offering.” Paula Carlock, R.Ph., executive director, RxPartners: “The changes occurring in long-term care pharmacy are having a significant impact on the operations of the business. With an increasing demand for automation, changes in the day-to-day processes that must occur due to changes in client base or the upcoming decision on short-cycle dispensing require that everyone in our industry must work together to achieve success.”

Charlie Goodall, R.Ph., executive VP for pharmacy, DailyMed Pharmacy: “I think the LTC pharmacy space is like any business today. We are trying to increase our sales volume, decrease our operating expenses, and look for innovative ways to take better care of our patients."

Above, Greg Hutchison, SoftWriters, gives a presentation on short-cycle dispensing. Jim Moncrief, chairman, Advanced Pharmacy: “LTC is facing more challenges now than it has in the past 30 years, and it is great to know that the team at SoftWriters wants our input to continue to improve the FrameworkLTC software. The fact that they do almost 12 updates a year shows that they listen to our needs.”

ComputerTalk

Ryan Beddingfield, R.Ph., senior VP of pharmacy and medical surgical services, United Pharmacy Services: "We have heard over the years that pharmacy is in a paradigm shift. While this has been slow to occur, there are many indicators today that suggest it is happening. Healthcare reform, short-cycle dispensing, and a significant influx of technology into the long-term care sector are a few of the major challenges and opportunities that will reshape our profession."

people

talk

➤ At Pharmacy First, Richard A. Salazar has joined the organization’s Rx$hare program in the position of director of manufacturer contracting. Prior to joining Pharmacy First he served as national director of Rx and business development for AmerisourceBergen. ➤ Phil Beck, R.Ph., has been appointed as the new national sales leader at Cerner Etreby. Beck has been with Cerner for more than five years in a variety of roles, including pharmacy sales consultant and pharmacy executive. Prior to Cerner he practiced as a pharmacist and manager for several retail chains, as well as longterm care and hospital pharmacies. Beck will have sales responsibilities for all of Cerner Etreby solutions. CT

Parata Names New CEO Parata Systems has announced the promotions of Tom Rhoads, pictured at right, to CEO and D. J. Dougherty to chief financial officer. Rhoads has 20 years of experience in the healthcare field, joining Parata in 2004, where he served as EVP for marketing. Dougherty joined the company in 2003, and most recently served as EVP for finance and operations. Rhoads is a graduate of Duke University and holds an M.B.A. degree from The Citadel. He is a member of the North Carolina Technology Association and the Chief Marketing Officer Council, and an Iron Duke alumnus of Duke. Dougherty is a graduate of North Carolina State University. He is a founding member of the North Carolina Association of Certified Public Accountants.

Index of Advertisers Activant Solutions ASAP Ateb, Inc. Cerner Etreby DAA Enterprises, Inc. Emdeon FDS Health Business Systems, Inc. HCC Infowerks Data Services, Inc. Innovation Integra Manchac McKesson Pharmacy Systems Medicine-On-Time Micro Merchant Systems, Inc.

...21 ...24, 56 ...15 ...23, 56 ...51 ...41 ...10 ...29 ...35 ...50 ...37 ...9 ...30 ...31, 56 ...39 ...36

Parata Systems ...Inside Front Cover QS/1 ...5, 27, 56 Retail Management Solutions ...56 RNA Pharmacy Solutions ...3 RxMedic ...33 Rx-Net-Inc. ...12 ScriptPro ...7 SoftWriters, Inc. ...1 Speed Script ...32 Talyst ...Back Cover TCGRx ...28 TeleManager Technologies ...34 Transaction Data Systems – Rx30 ...56, Inside Back Cover Two Point Conversions, Inc. ...11 voiceTech ...38

September/October 2010

web sites to visit 56

American Society for Automation in Pharmacy

Cerner Etreby

www.asapnet.org

www.etreby.com

ComputerTalk for the Pharmacist

McKesson Pharmacy Systems

www.computertalk.com

http://ct.aboutmps.info

QS/1

Retail Management Solutions

www.qs1.com

www.rm-solutions.com

Transaction Data â&#x20AC;&#x201D; Rx30

Exclusive Online Content

www.rx30.com

www.computertalk.com

ComputerTalk

A few of Rx30’s newest users would like you to know… “The conversion, the product, the support, the price –

It’s no wonder Rx30 is talked about so often! We couldn’t be more pleased with our move to Rx30.”

“Our Pharmacy has actually reduced staff requirements because of our move away from our old Windows based system over to Rx30. My staff and I are thoroughly pleased with the move to Rx30!!” John Hoeschen St. Paul Corner Drug, St. Paul, MN

Hank Alexander, Savon Drugs, East Bernard, TX. “We looked at several dispensing systems before deciding on Rx30 for our new pharmacy. We like it so much that we have now converted two existing stores and soon will change two more.” Scott Benson, Goodrich Pharmacies, Minnesota

“I’ve used at least 6 different computer systems and been exposed to many others. Rx30 is far superior both in performance and customer care than any other system. I can

“Rx30 just seems to be extremely rresponsive and on top of the latest technology echnology offe offerings. In our short time with Rx30, we’re amazed at all of the enhancements continually being introduc introduced!” Darrell Miller, Thrifty Drugs, Pensacola, FL “After 3 years with Windows, I decided life was too short! I converted to Rx30 and after 3 months I was lling the same number of scripts with 1/3 fewer pharmacy technicians, and the software works like they promised – I’m amazed!” John Marshall, T&T Drug, Henderson, KY

now work through stressful and busy days with ZERO mental fatigue thanks to Rx30 and its efficient staff.” Stan Malkemus, Five Points Pharmacy, Alabama

“...Rx30 is by far the most

comprehensive, user friendly, support friendly, reliable system

Your peers’ reality ...advertising you can trust!

800-289-7930 or visit rx30.com

that meets today’s needs that I have utilized.” Jerry VanPevenage, Davenport Pharmacy, Davenport, WA

“InSiteRx is Your Solution to Short-Cycle Dispensing”

The InSiteRx™ Remote Dispensing System provides pharmacies a superior short-cylcle dispensing solution. InSiteRx is the preferred on-demand medication management system designed specifically for long-term care pharmacies. It allows pharmacies to place secure, automated medication dispensing units directly at the long-term care facilities they service; giving facilites access to medications 24/7. The secure, free-standing InSiteRx Remote Dispensing System: •

Dispenses patient-specific multi-dose medication packages right before each med pass, or on-demand to facilitate new patients, First Doses, and PRNs

•

Dramatically reduces pharmacy fill times

•

Streamlines pharmacy operations and improves efficiency

•

Provides down-to-the-dose accountability reducing waste and diversion while improving compliance

For more information, visit Talyst.com/LTC, or talk to a representative at 877.4.TALYST.

ComputerTalk

Talyst.com | 877.4.TALYST