Tech Trends
Automation can help community pharmacies improve workflow and efficiency-and enhance their bottom line.

America’s Pharmacist, January 2005

Technology is not actually progressing at the speed of light. It may just seem that way sometimes. Some 40 years ago, as the space race kicked into high gear, state of the art technology was defined by a room full of machines called "computers" that eventually helped guide rockets toward the moon. Now that same technology is available in the palm of your hand.

Twenty years ago, fax machines became the rage as they replaced the cumbersome and slow telecopier. And in the early 1990s, the Internet and e-mail became the latest high-tech wonders.

Today, the opportunities in technology seem endless. And for business, it becomes a never-ending cycle: technology drives new business opportunities, which in turn drives even more new technology development and so it goes.

Independent community pharmacy is also embracing technology to enhance business. Workflow processes, e-prescribing and e-connectivity, integrated voice response (IVR), automated dispensing systems, pre- and post-editing systems, and point of sale (POS) systems may have sounded like futuristic terms a few years ago, but they are common tools today.

At NCPA's Annual Convention in Boston, pharmacists were given an opportunity to learn more about emerging technologies and how they can positively impact their bottom line. NCPA offered a Technology Seminar, an investment (ROI) through technology.

"The tech seminar was extremely popular at last year's convention (in Seattle)," said Todd Dankmyer, NCPA's Senior vice president of corporate and strategic initiatives. "It gives pharmacists a chance to learn new technologies from their peers."

In this article, we've provided a glimpse of some of the technology trends and where they may be taking independent community pharmacy.

Workflow and Technology

Sam Kalmanowitz, R.Ph., retired founder of Kaye's Pharmacy in Meriden, Connecticut, offered the following definition of a pharmacy workflow. He described it as "a structured procedure of prescription processing the maximizes technology through a series of edits and interventions that ensures the delivery of prescribed drug to correct patient within reasonable time frame that commands a multi-disciplinary, segmented team work approach."

Kalmanowitz, a veteran of more than 42 years in the profession, started embracing technology in the late 1970s. At that time, electric typewriters and manual entry prescription receipt systems were the norm. When inflation started pushing drug prices upward, he began looking into some computer programs to help improve workflow efficiency.

Kalmanowitz listed what he considers the five key components of the workflow process: intake, data entry, process development, quality assurance, verification, and final packaging.

"Pharmacy is changing," said Kalmanowitz. He noted that prescription volume is rapidly growing; there is a dramatic pharmacist shortage in some areas; there is increased growth in the elderly population and in demand for prescription services; and that mail order and large chain pharmacies are expanding.

In this environment, improved productivity is crucial. In his experience, Kalmanowitz said, there are a number of factors that can hinder productivity.

"Pharmacists are spending too much time on non-pharmacist issues," he said, pointing out that less than a third or their time is actually spent filling prescriptions, counseling patients and other "pharmacist" issues. Kalmanowitz also said current pharmacy management systems may not be able to react to current needs, potentially comprising customer service and creating high inventory costs.

To assist workflow, Kalmanowitz said there are a number of technology procedures that pharmacists should consider. These include:

• IVR
• Robotic systems
• Full scanning workflow systems
• Counting systems
• POS register systems
• Electronic prescribing
• Electronic signature capture

In particular, Kalmanowitz extolled the virtues of robotic systems. He points out that the robotics can perform complete functions unattended, help free up staff, help free up operations, and decreases dispensing errors.

Barcode Scanning

Ask Max J. Peoples, R.Ph., president of Uptown Pharmacy Ltd., in Westerville, Ohio, where barcode scanning fits in today's pharmacy, and his response is "everywhere. From the prescription preparation to the cash register."

Peoples said that barcode scanning is a "quick and affordable jump start into improving the efficiency, accuracy, and profitably of our pharmacies." He said he added barcode scanning in his pharmacy to help offset reimbursement reductions and increased transaction charges by the likes of PBMs.

Barcode scanning does not have to be a prohibitive expense, Peoples stressed. "The system we are discussing does not have to require a $150,000 or $200,000 automated counting and work flow system," he said, adding that is doesn't require the use of carpenters or days of learning new pharmacy software systems. They are simply added into the pharmacy system and workflow already in place.

Peoples said his Uptown Pharmacy uses barcode scanning for the following functions:

• POS
• Prescription refilling and lookup
• New prescription entry
• Prescription counting
• Prescription labeling
• Prescription final checking
• Medication ordering
• Separating and returning outdated drugs

Peoples stressed POS as an important piece of the workflow system.

"We have had POS since 1996," he said. "The key is to invest in a POS system if you don't have one. It improves speed and pricing accuracy for ringing up both OTC and prescriptions, and it improves the accuracy and timeliness of reordering OTCs."

Peoples listed a number of reasons to use bar code scanning for prescriptions:

• Prescription lookup—you can simply scan the prescription number barcode.
• You can do an instant entry into the pharmacy computer of the product currently on your shelf that you want to dispense to a patient.
• You can pull a bottle off your shelf and scan it, instead of looking up a drug name when they are often made by many manufactures, in many strengths and in many container sizes.
• It secures billing the latest average wholesale prices with current NDC numbers.
• It avoids Medicaid and Medicare billing fraud charges caused by not using the complete 11-digit NDC of the product you dispensed.
• Your staff will become hooked on scanners and thank you many times for getting them.

Peoples noted that there are several characteristics of different barcode readers. CCD's (Charge Coupled Device) are the cheapest available. They use a safe red light, with a broad beam. Some have five-year warranties.

Lasers have a thin light, and users must guard against eye exposures. They are more prone to breakage, and have warranties between one and three years. They are more expensive than the CCD.

Optical scanners work like a digital camera, reading all types of barcodes. They are the most expensive, but prices are coming down, and they can be updated to read future barcode symbologies.

NDC Smart scanners can translate manufacturer barcodes into 11-digit NDC numbers.

Overall, Peoples gave barcode scanning a strong endorsement saying "Unless you like being less profitable and less accurate, you need to add barcode scanning ASAP. If we can afford it, you can afford it."

Electronic Prescribing Technology

Kevin Hutchinson, president and chief executive officer of SureScripts, said electronic prescribing technology continues to make gains.

SureScripts was formed to improve the prescribing process in ways that serve the collective interest of parents, physicians, and pharmacists. The organizations was incorporated in August of 2001 by NCPA and the National Association of Chain Drugstores (NACDS), representing more than 55,000 pharmacies it the United States. To date, more than 75 percent of U.S. pharmacies have completed the certification process required to connect to SureScripts Messenger™ Services.

SureScripts was organized to support a strategic industry alliance to do the following:

• Improve the overall prescribing process
• Improve safety
• Improve efficiency
• Improve quality care
• Enable true electronic connectivity between physicians and pharmacies

Hutchinson pointed out that SureScripts does not develop, sell or endorse electronic prescribing software, but works with existing technology vendors to certify and connect their solutions to the network. It provided the behind-the-scenes network that makes the two-way electronic exchange of new prescription and renewal information between physicians and pharmacists possible.

According to Hutchinson, pharmacists have been activated in more than 40 states on the SureScripts network, and at present they are actively exchanging electronic prescriptions in more than 30 states. He said electronic prescribing may be able to provide solutions to four major questions:

1. What opportunities exist for collaboration between physicians and pharmacists to improve the prescription process?

One possible avenue is to explore new areas for communications and services. Another is to use technology to help move pharmacy closer to the clinical process.

2. How should advanced prescribing functions be implemented to improve the prescription process?

Factors such as patient compliance, medication history, and formulary management should be considered. Another idea is to work with physicians, community pharmacy, technology vendors, and other stakeholders.

3. How does electronic prescribing impact efficiency, safety, and care quality?

It quantifies return on investment and quality impacts for basic and advanced functions. It also focuses on pharmacies and physician practice (health plans and health systems opportunistically).

4. How can automating the prescription process best be integrated with the electronic health record (EHR) and other clinical technologies?

It can identify the implementation roadmap and customer migration strategies, from basic prescribing to EHR. It can also identify EHR features that can improve the prescription process.

From a doctor's perspective, there are five primary physician goals for e-prescribing according to Thomas E. Sullivan, M.D., 2003-2004 president of the Massachusetts Medical Society. They are practice efficiency, patient safety, care quality, physician/staff satisfaction, and patient satisfaction. He is optimistic about pharmacist/physician collaboration in technology.

"We have special relationships with independent community pharmacists," he said. "We trust you as professional partners in the care of our patients."

Sullivan also had a call to action. "Let's get connected and lets figure out how to make the prescription process safer and more effective for us both."

Look for more articles on technology and the role it will play for community pharmacists throughout 2005. For more information about NCPA's technology initiatives, contact the association at 703-683-8200, or 800-544-7447. The e-mail address is info@ncpanet.org.

NCPA Thanks Supporters of 2004 Technology Seminar

NCPA would like to express its gratitude to the following sponsors whose generous support helped make the 2004 Technology Seminar a success.

• AutoMed
• Innovation Associates
• Medicine-on-Time
• NDCHealth
• Parata Systems
• ScriptPro