Points of Difference Define Pharmacy Technology Today

Category: Pharmacy Advances Written by Dr. Charles Shively / August 29, 2017

How Is It We Are?

Which comes first? Technology and automation or sustainability and profitability? In today’s independent pharmacy environment many of the needs for sustainability and profitability has caused an influx of new automated technologies that emphasize labor reduction, improved workflow efficiencies and error avoidance. Automated technology designers and equipment manufacturers have been brought to the independent pharmacy marketplace by these needs.

Many marketing research organizations who assess pharmacy automation and technology growth believe pharmacy has already begun the ascent to meeting the future which involves sustainability and delivers profitability. In 2011 the global pharmacy automation and technology sales were $4.7 billion with the pharmacy automation market estimated to hit $ 7.8 billion by 2018 and $ 8.99 billion by 2020. North America… not surprisingly with independent pharmacy… is the leader in these investments with pharmacy automation followed worldwide by Europe. Automated pharmacy dispensing represents nearly 50% of total sales with pharmacy retail representing over 50% of the total automated pharmacy dispensing category.

In general, this growth toward the future is about dispensing the right medication and dosage, reviewing the inventory to increase the workflow efficiencies, correct delivery to the patient/customer and ensuring profitability because of these automation/technology advancements. Today this market arena is less about new technologies being introduced and more about collaboration between primary market technology leaders. This awareness has been reinforced through conversations with software and equipment providers and their primary stakeholder…the independent pharmacy owners…during the Healthcare Advocate and America’s Pharmacy Tours from 2014-2017 completed and posted on www.AskDrS.org.

Workflow Technology and Pharmacy Automation: Magnets for Profitability

Although pharmacy operational software was first offered to independent pharmacies by J M Smith Corporation (QS1), today many additional system offerings are now available (RX30, Pioneer, Computer Rx, Liberty, PrimeRx and others). At last tabulation there are now at least 25 independent pharmacy operational systems available across the fifty states in the US….and many of these systems alert pharmacists to an extensive list of the necessary daily workflow activities now preferred by the independent pharmacy owners, their patient/customers and pharmacy benefit managers and insurers. The latest pharmacy operation systems offer an almost amazing array of functions:

  • Prescription processing
  • Adherence reporting/tracking/trending
  • Medication synchronization
  • Medication therapy management (MTM) and outcomes integration
  • Web-based reporting analytics
  • Secure texting app for patient/doctor/coordinator of care
  • Patient assistance “free” drug program database
  • Telemedicine availability
  • Cost versus reimbursement smart dispensing
  • Blood pressure/MTM integration
  • QR code with educational video content
  • Web-Based performance reporting
  • Built-in Facts and Comparison
  • iPad delivery
  • Smartphone refills linkage
  • Internet refills linkage
  • Hard-copy prescription scanning
  • National DEA/NPI doctor database
  • Electronic 835 remittance processing
  • Outbound calling/emailing/texting for compliance
  • Surescripts and Emdeon e-Rx and EPCS enabled
  • Remote backup services (cloud based)
  • Automated Medicare and commercial plan lookups
  • Data conversions (in-house)
  • Electronic signature capture (wired and wireless)
  • Profitability monitoring
  • Central site services
  • Nursing home module
  • Compounding module
  • IV module
  • Auto claims tracking
  • Integrated point of sale
  • Integrated will-call medication delivery
  • Accounts receivable

Sustainability and profitability in the independent pharmacy today is intertwined with these advanced pharmacy management operational software capabilities and the linkage to different automated systems through collaboration.

Within Pharmacy Workflow Integration Demands Collaboration

Integration of pharmacy management operating systems with automated dispensing technology (automated filling equipment) for vials started as early as 2007 with many manufacturers now in place (RxMedic, Parata, ScriptPro, Kirby Lester, OmniCell and others). Points of difference have evolved with improvements in speed of filling, video capture of product in the filled vial, continual perpetual inventory, remote service with accessible on-unit hand held cameras (video sharing) and immediate real- time calibration (marriage) of bottle NDC to a specific robotic automated dispensing cell with automatic inventory updating. This can now be done with hand held scanners eliminating the need to purchase different dispensing cells from the system manufacturer (with the expense and wait time for arrival of correct cells). All of these advances have supported improved efficiencies in workflow and profitability.

Many independent pharmacies without automated filling equipment have enlisted tabletop counters of ifferent design to improve workflow speed and efficiency. Early tabletop counters (Kirby Lester and others) using weight and size to effect counting now have other counting companions which use camera technology (EyeCon, RxMedic) which count the number of dosage forms on the unit tabletop from below the counting table while allowing product addition or elimination while counting. When the desired quantity of unit dosage forms is completed, these systems capture and data store the visual completed counts with a photo capture of the event. These automated technologies also add an element of control to the filling process as the medication being counted is tied to the specific drug NDC and prescription being filled. For pharmacies that desire this accurate camera-based technology for a quick “electronic counting tray” approach, a lesser expensive and minimal countertop space unit (RxMedic) has recently been introduced.

Enter the Era of Compliant Packaging

Independent pharmacy has been the recipient of many technologies available in the hospital sector for several years. As pharmacists and pharmacy owners have initiated use of “compliant packaging” during the trend for medication synchronization and customer compliance (including performance ratings for customer satisfaction and PBM/insurer awareness), many of different approaches have been adopted at the independent pharmacy retail level (Medicine-on-Time). This started with the strip packaging of individual dosage used in long term care and hospitals (Rx Systems Inc., TCGRx and others) used in the cart delivery needed by nurses. It was subsequently extended to various pouches, blister trays or cards for weekly, even monthly (for as many as seven different meds) by Synmed, DOSIS-Manchac and Robotix Technology among others) through precise automated dispensing and placement into dosage regimens of the various medications prescribed. Points of difference in these systems is often related to the number of different medications that are stored in the filling and processing cabinet for access by the automated robotic arms and the printing of medication name on the back side of the blister card (behind the actual dosage form contained in the specific blister pocket). As might be expected these systems are remarkable engineering examples of pharmacy technology today.

For the independent pharmacy owner a unique automated (not manual dosage form placement) tabletop all-in-one compliance packaging for various forms should soon be available…based upon age of the patient/customer! The newest automation technology forthcoming to independent pharmacies is a marriage of two newer technologies from two different countries…Spain and the United States…for tabletop use with a small footprint on the workflow counter. The simple and correct tabletop electronic counting tray by RxMedic with the tabletop (multi-dosage form) automated one-week dispensing compliant (blister card) packaging system from Fagor Healthcare is under development. This combination-collaborative technology will offer very significant time-savings to the prescription filling with compliant packaging supporting both sustainability and profitability. The ascent toward the future or being in future would appear near for convenient and inexpensive, no longer labor-intensive, compliant packaging for multiple dosage forms.

Automated Technologies for Patient Medication Delivery

Electronic will-call or automated retrieval systems are a most recent entrant into select independent pharmacy workflow environments and offer assurance for correct medication to correct patient delivery of filled prescriptions. A few companies now offer automated will-call systems (GSL Solutions, RxMedic, TCGRx, RxSafe and Suncrest among others) based on radio frequency, infrared or wireless bluetooth technology. Current points of difference in these systems is based on the use of Bluetooth technology and complete integration into the pharmacy management operating system that allows work flow continuity without the need to exit the prescription filling process and eliminates the use of a separate stand-alone software to establish a location for completed prescription and customer pickup through point of sale. The best system available today, at time of point of sale, is the pharmacy operating system which identifies the correct “bagged” prescriptions for the specific patient with their blinking lights. No other bagged prescriptions will illuminate. This automated medication retrieval system, using traditional independent pharmacy bagging systems placement (no need for new expansive footprint or wall space) operation system also is valuable for return to stock activities as the integrated software, when asked, will identify all prescriptions which have remained in the will call area past a specified time frame (7, 10, 14 days, etc.). These bags can be pulled from will-call area and by scanning the prescription label barcode and bag barcode in sequence, the prescription adjudication is reversed and the medication quantity added back into store inventory for subsequent filling for another patient.

During the Healthcare Advocate and America’s Pharmacy Tours by this author, the RxMedic ARS received superior reviews for its accurate and timely performance in reducing the search for additional bags for the same patient filled at different times and quickness in locating the filled prescription for delivery. It improves HIPAA compliance and not surprisingly, supports customer loyalty.

Can the Patient/Customer Home Be An Extended Pharmacy?

It has already happened. Patient/customers, with novel software, communication apps and dispensing equipment are connected…even bonded…to medication compliance and medication synchronization through their independent pharmacies. These technologies are available today from two different organizations ( Robotix Technologies, Tabsafe and Liviathome). The efficiencies in dispensing, consulting, compliance and synchronization would appear an excellent addition to supporting sustainability and profitability once placement into the patient home is accepted. A new frontier?

The Pathway to Sustainability and Profitability

Imagine…just imagine… the complexity of decision making today regarding prescription processing, inventory control and secure medication delivery through point of sale for any new pharmacy graduate who desires to build and start their own new independent pharmacy operation with currently available technology. This of course is past the pharmacy layout with prescription inventory planning and front store planogram shelving, prescription delivery and counseling and as is known, the location, location and location of the new pharmacy.

What are the key decisions to be made? Perhaps only three: The most current operating pharmacy system with extensive features, the operating system company that collaborates with the leading automated pharmacy technology organizations and of course in the end, anticipated sustainability and profitability. It is actually not about the cost of the technology. Leading software and automation providers offer varied involvement costs. They must be explored before involvement.

Where Are We?

Automation technology manufacturers for independent pharmacy today would have appeared to answer the industry request from independent pharmacy owners through meeting the current seven commandments for independent pharmacy sustainability and profitability:

  1. Increase pharmacy workflow efficiency
  2. Ensure safety and correct medication delivery
  3. Avoid HIPAA violations and Audit Issues
  4. Help avoid Legal Challenges for Incorrect Medication Delivery
  5. Eliminate Lost Inventory Issues.
  6. Support and Increase Customer Loyalty.
  7. Show Me the Money!

Has independent pharmacy begun a rapid ascent to sustainability and profitability through pharmacy automation and technology? Yes, we are now here!

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