Looking to the Future: Key Technologies Taking Chain Pharmacy to the Next Level

new technologies

Here is an interesting piece published earlier this year by Computer Talk. They surveyed U.S. chains on their pharmacy technology priorities and this article reports on the findings. Interesting they say “while compliance packaging automation for retail is not a major focus” even though “compliance packaging for LTC is very significant for their operations”. We’ve seen this for at least 2-decades: While Canadian pharmacists embraced compliance packaging automation the States tended to discount its value.

There’s quite a bit of information about the chains’ outlook for telepharmacy. A very interesting subject I lectured about at last year’s PharmacyU events (view article).

And of course there’s some discussion of how a pharmacist first approach (where the pharmacist[s] greet the patients and do counseling “up front” while technicians fill) can help improve adherence. This is an approach that impacts the design and workflow in the pharmacy to a great degree. Caverly Pharmacy Solutions are working with a few clients right now on new pharmacies that will use this approach and we look forward to sharing those designs with you in 2016. Wayne Caverly.

Here is the article:

Looking to the Future: Key Technologies Taking Chain Pharmacy to the Next Level

It’s time once again for our annual survey of chain pharmacy technology priorities, and a clear theme seems to emerge this year from the responses.
What this year’s findings suggest is that, while chains have invested a lot of resources in filling prescriptions as quickly and efficiently as possible — and are not yet finished looking for ways to improve this process — excellence in this area is no longer sufficient. So whether the chains were providing perspectives on pharmacy systems, point-of-sale systems, communications tools, dispensing automation, or other technologies, it became clear that current strategy focuses heavily on how to create better connections with patients to drive the clinical role in pharmacy. This in turn appears to be the result of two trends: First, pharmacy is being asked to take on greater responsibility for patient care and outcomes and, second, within an increasingly competitive market for pharmacy services, engaged patients are return patients. Let’s see where chains stand with their technology and how this trend emerges from their priorities.

The Status at the Core

Each year we find a consistent level of interest in keeping pharmacy management systems current, either through upgrades with an existing vendor or by moving to a new vendor.

Chains continue to take an ongoing and careful look at how their systems support their strategy. Several cited reasons for looking for a change, which included viewing other pharmacy software in the market as more current and innovative; dealing with software that has broken or poorly designed functions and modules; a lack of good specialty pharmacy features; no integration with electronic health records (EHRs) and medication therapy management (MTM) platforms; poor reporting capabilities; and limited features for clinical documentation ability for tracking interactions with patients over time.

Among those looking to make a change, a little over half will upgrade with their current vendor in order to get the newest features, improve error prevention, keep up with regulatory changes, run better adherence and cycle fill programs, and get MTM integrated within traditional workflow.

One respondent from among those moving to a new vendor is part of a medical clinic and mentioned moving to a pharmacy system from the same vendor providing the clinic’s software in order to be able to document interactions directly into the patient’s EHR.

Dispensing Efficiency a Must

Chain pharmacy continues to hone its efficiency at fulfilling prescriptions, with dispensing automation playing a significant role with 95% of this year’s respondents. Eighty percent call automation either very important or important to their operations, and we continue to see a focus on either end of the automation spectrum, with the tabletop counters most commonly in use and robotics the other main technology. While compliance packaging automation for retail is not a major focus, half of the pharmacies feel compliance packaging for long-term care (LTC) is very significant for their operations. Two thirds feel automation-powered central fill is very important.
While only a few have it operational currently, 25% of the remainder have it in development. Central fill may well be seen as a practical and useful solution for a wide range of pharmacy operations now that there’s a real focus on workload-smoothing sync programs that create predictability in the filling queue and bring patients in on a regular schedule for all their medications. And, of course, the more efficiently prescription volume is filled, the more time there is for taking on new roles in patient care and disease management.

Taking On Specialty

The drivers for greater efficiency in dispensing over the years have been primarily financial: Drive down your cost to dispense to become more competitive and combat margin erosion. But there’s been a new motivation working its way in recently: the need to have time to spend on patients and new clinical opportunities. Specialty dispensing is one such opportunity that’s clearly very important for chain pharmacy, with 75% reporting this year that they are dispensing these medications. However, it’s still a challenge for chains to get the functionality they need to support this area of practice: Only a third report that their pharmacy systems have the features needed, and two thirds are using a separate system to support and manage specialty operations and give these chains the tools to demonstrate their ability to meet the specific requirements for participating in specialty networks.

There was a lot of input on needs here, with two main groups. The first centered around improvements to integration and workflow. For example, one respondent would like to see the chain’s pharmacy management system connected with the separate specialty solution it uses; another is looking for an integrated patient management system; and a third wants seamless point-of-sale system integration with a shipping company. Within the pharmacy system itself, one chain wants dashboarding for visually managing the specialty workflow; another would like to see specialty-specific clinical management tools, appointment scheduling, and eligibility verification assistance; a third is looking for queuing capabilities for specialty workflow; and a fourth wants document management, reminders, and an integrated printable address book.

The second group focused on tools needed for meeting specialty-specific billing and reporting requirements. As one chain put it, in order to get a contract with certain manufacturers you have to be able to meet reporting requirements that aren’t necessarily addressed by the pharmacy software. This means a need for a robust ability to choose variable fields to report for each drug and manufacturer, reports that can show clinical documentation of disease state status and monitoring, and then the ability to provide visibility into this reporting documentation to manufacturers, providers, and others. There was also a need cited for enhanced logic to manage specialty billing.
And specialty is certainly one major area where, if a pharmacy chain wants to play, it’s going to need a strong rapport with patients in order to track the course of treatment and generate the feedback required by payers and manufacturers. But it’s certainly not the only area.

Reaching Out to Patients

In general, this year’s survey found that the chains are working hard to use a variety of communication channels to connect with patients. Counseling, including discussion of interactions, ranked at the top in 70% of replies. Immediately following were pickup reminders, refill reminders, and communications for med sync programs. Less popular, but still common, was pharmacy education messaging. Not yet in prime time were reminders to take medication and prescription fill status.
These last two require an ability to push out timely messaging for which mobile apps are ideal, though these apps are still gaining features and acceptance, and are only the third most popular communication channel. Interactive voice response (IVR) is still considered the most important method for communicating with patients, with 95% of respondents giving it a first or second rank. Texting is also significant, but with a smaller percentage calling it very important for communicating. Email is fairly widely used, but only considered very important by just over 10%. This may be due to the fact that people aren’t as likely to read an email in a timely fashion, and it may face a higher risk of being sent to a junk folder or getting lost in an inbox.

We also asked about two communications methods that aren’t yet considered important by even half of the respondents, but which bear watching: call centers and telepharmacy. Pharmacies looking at these face challenges of finding the right model to suit their scale, as well as varying regulatory environments. But it’s also clear that there’s great promise for maintaining or even increasing the personal interactions that are so critical for community pharmacy, while allowing for more structured interaction protocols and more effective triaging of interactions.

Adherence: Getting Results

Adherence has been a major recent trend in community pharmacy, with a lot of focus being placed on getting patients to pick up and take their medications as scheduled. There are various strategies being put into play here that can fall under the broader category of adherence programs, and this year’s survey confirms the trend, with 60% of chains reporting having adherence initiatives now and 35% having them in development.

And while the personal interactions between patient and pharmacist, at which community pharmacy excels, play a major role, we also wanted to find out which technologies are making the biggest impact on adherence right now. Tools that make for more efficient communication topped the list of responses, including automated outbound calls and text messaging, with medication sync programs also at the top. These are all tools that help the pharmacy and the patient maintain a regular and well-organized schedule around a medication regimen. Another interesting adherence driver cited a little less frequently was dashboard adherence metrics in the pharmacy system, a set of features that allow for rapid and informed decision-making about interventions that clinical staff may want to take. This is something that should become more common as the important adherence metrics become standardized and chains cycle through upgrades to the most current pharmacy systems. Adherence packaging, predictive modeling, and telepharmacy were all grouped together in a third tier, though more likely because these are technologies that vendors and chains are still building up to play a significant role in adherence, rather than because they lack utility.

In fact, when we asked about key adherence technologies for the future, one chain picked out telepharmacy specifically, noting that there’s a real need to be able to provide services to patients who can’t necessarily come into the pharmacy.

Another big theme for the future of adherence centers around ways to close the information loop. As one respondent put it: Pharmacies can do their best to make sure patients understand their medications, pick them up on schedule, and have them organized for ease of use, but after all that, how does the pharmacy know that the patients really take the medications? For some disease states there are lagging indicators, such as various lab values, but the chains are also envisioning routes for more timely feedback to the pharmacy through electronic monitoring of patient medication usage.

One respondent sees a benefit if pharmacy can gain access to the data streams coming from new consumer-oriented health technologies such as Fitbit and Apple Watch. This will make it easy for patients to collect data that, if it can be pulled into the pharmacy system, will make pharmacist interactions more meaningful.

Finally, several respondents are looking for improvements in medication sync programs, including better integration of these programs within the workflow and more robust logic that, for example, generates alerts when refills are late and is smart enough to reduce alert fatigue by excluding PRN medications.

What’s Next

When we asked about technologies the chains need for the next five years, answers were almost all focused on patient engagement, communications, and management. Some are what’s in play now, others are emerging, and all are clearly part of the trend of pharmacists being even more available to patients and playing a bigger role in their care. One response summed things up neatly, noting that what’s needed is the ability to engage with patients through multiple channels, giving access to pharmacists for near-real-time clinical questions and interactions.

Frequently mentioned among the technologies that will support this were better IVR, texting, and mobile apps. Call centers and telepharmacy each got mentions, which is interesting in light of their relatively sparing use currently.

One chain noted that increased communications and a rise in two-way platforms, such as telepharmacy or video calls, will require a real focus on security and encryption. Another chain listed a need for technology, such as a patient portal, that allows for patient self-monitoring.

And it isn’t just patients whom the chains recognize a real need to connect with more effectively. Also on the list of what’s needed soon were improved communication with prescribers via EHRs and the hospital information system (HIS), as well as better MTM platforms and immunization data entry and collection.

The Foundation of Messaging

IVR is clearly playing a central role in chain pharmacies, with outbound calling most frequently mentioned as the recent development offering the most benefit for pharmacy. And what more would pharmacies like to see their IVR do? The responses here centered around better linking of the IVR and the pharmacy management system database, and more precise rules for queuing prescriptions from the IVR. The logic driven by closer integration can be critical for creating the most efficient workflows. For example, one chain is looking for a real-time interface between the IVR and the pharmacy system in order to determine and communicate a prescription’s fill status when a patient calls in or when an outbound call is initiated. Another would like to see the ability to customize the communication programs for patients, something that would rely on strong filtering and grouping functions to select for the patients who will benefit most from a given message.

Another respondent spelled out a detailed example of integration between mobile apps and the pharmacy system that creates a rule-based flow of information between patient and pharmacy that’s consistently tracked. In this scenario, a mobile app would integrate with the processing system so the patient can see his or her medication profile, the refills remaining, and when they are due, as well as find drug and disease state information easily. The patient would also have the ability to respond electronically via the app to approve refills. Finally, the system would keep an audit of acknowledgements and requests for refills so pharmacies are protected from insurance audits requiring the patient to request the fill.

One other respondent raised an important point that offers a reasonable caution amid the enthusiasm for messaging patients: There’s a real need for better integration between different vendors to minimize the number of reminders and notices being sent to patients and to avoid message fatigue. Too much communication, it is easy to imagine, is likely just as bad as too little.

The Clinical Role

Chain pharmacies remain committed to positioning the profession for a bigger clinical role, with all respondents reporting that their companies have increased commitment to providing clinical care over the past year. Similarly, all respondents reported that their pharmacies are dedicated to demonstrating the impact of care on star ratings. The broader healthcare community still has some way to go in accepting pharmacy’s clinical role, with 75% of chains saying this role is accepted to some degree, and only 25% saying it is very much accepted. Still, one respondent who is part of a multilocation clinic setting provided an optimistic comment, noting that for the first time the group is finally seeing the providers in the clinics realizing how much pharmacists can really do and trying to maximize their full potential.

POS as a Valuable Data Center

We also asked for the current status of point-of-sale (POS) systems at the chains. What comes through in the responses is that chains aren’t just looking at POS as a front-of-store management tool, but as an important element of the technology ecosystem for collecting and collating data that can create a unified view of the patient.

Certainly, POS still plays a critical operational and regulatory management role, with the most important features breaking down as follows: Price updates and pseudoephedrine sales logging and reporting are in the top tier of current importance; perpetual inventory, moving inventory between locations, customer loyalty programs, and multiple-vendor electronic data interchange (EDI) for ordering come next; and inventory pricing based on sales ranking reports, mobile POS hardware, and delivery management follow in the third tier.

And while loyalty programs fall into the middle tier of importance, they were the area where pharmacies expressed the most need for more and better tools, including more robust customization options for the pharmacy and a broader range of digital promotional capabilities. In fact, these programs are really another aspect of customer/patient engagement, even if they are focused on the front end rather than prescriptions. A strong loyalty program helps build that connection and the regularity of interaction that will have a positive impact on pharmacy financials, create revenue that helps companies focus the pharmacy model on the clinical, and collect data on over the counters (OTCs) that, with the right system integrations, can support superior clinical decision-making.

Managing Operational and Regulatory Concerns

Technology is playing an important role in supporting a range of operational and regulatory tasks within the pharmacy workflow as well. In the top tier of importance here were prescription monitoring program (PMP) access for pharmacists to check on a person of interest. A second tier included electronic prior authorizations and providing patient access to medication records.

Notably, despite 100% of respondents putting PMP access in the top two categories of either very important or somewhat important, over 70% indicated that they are not aware that the American Society for Automation in Pharmacy (ASAP) has developed a real-time PMP query/response standard that can be integrated into the workflow of the pharmacy.

In fact, controlled substances, in general, feature prominently as an area of concern among the chains. They are looking for ways to better manage wholesaler-imposed ordering limits of prescribed medications, which leads one chain to cite a need for automated pharmacy system reporting to help it justify increasing controlled-substance inventory thresholds. PMP program requirements are also posing challenges, including in one case issues that arise when the name of the person who picked up a controlled prescription must also be included in the data sent to the PMP. There’s no way to do this except for manual data entry.

Three other areas of concern came up as well, the first being the Drug Supply Chain Security Act (DSCSA), also known as track and trace. Here chains are still working to understand how the requirements will ultimately impact operations. Second and third were state-specific requirements for vial labeling and states limiting central processing or shared workflow, both of which are indicative of the challenging regulatory environment pharmacies with locations in multiple states face.
What’s Next on the Agenda?

So, with everything going on at the chains, what are they prioritizing for the next year? Some, of course, have managing systems upgrades and migrations top of their list. One reports focusing on integration of clinical activities such as MTM within workflow and improving the way orders are prioritized. Moving forward with medication sync programs will be a priority in a number of cases, along with building up outbound communications that support sync and other initiatives. Several also mention working on rolling out central fill and workload balancing. There’s a clear need for chains, much as for pharmacy in general, to strike a careful balance between the ongoing need to maintain dispensing efficiency, and keeping an eye on the big-picture strategy, where engaging patients to drive clinical outcomes leads pharmacy forward into new roles.

Originally published in ComputerTalk for the pharmacist. July/August 2015.