TIME MACHINES

With the Medicare Part D prescription drug program nearing its January 2006 start date, pharmacies are using technology to buy more time with patients.Demand for more one-on-one time with pharmacists is expected to increase as beneficiaries seek assistance in enrolling in the program. The promise of compensation for pharmacists taking an active part in patient therapy will play a role as well.Part

With the Medicare Part D prescription drug program nearing its January 2006 start date, pharmacies are using technology to buy more time with patients.

Demand for more one-on-one time with pharmacists is expected to increase as beneficiaries seek assistance in enrolling in the program. The promise of compensation for pharmacists taking an active part in patient therapy will play a role as well.

Part of the new law allows for Medication Therapy Management programs in which pharmacists can be reimbursed for their efforts to counsel patients about their drugs. Many supermarket pharmacies plan to take advantage of this, although in some cases it will require changes in facilities, and in all situations, more of the pharmacists' time.

"The pharmacy industry is talking about getting out from behind the counter and truly involved in patient health care, because that is what pharmacists are trained to do," said Christopher Thomsen, president of the ThomsenGroup, a pharmacy and medical technology automation research and consultation company based in Kansas City, Mo. "The Medicare Part D switch gets turned on in 2006 and will support educating patients as well as engaging in Medication Therapy Management, with the possibility of reimbursement to pharmacies that can prove they are performing services that put patients at less risk."

Medicare is eventually going to provide prescription coverage to 40 million people who don't have coverage today and some who have never had any coverage, said John Fegan, senior vice president of pharmacy, Ahold USA, Braintree, Mass.

"We are being given the chance to ask pharmacists to be a part of the solution in the health care equation, to impart consultation, explain new programs and give the guidance allowed by law to patients that need education on medical conditions," Fegan said. "But we can't hang our hat on any one technology. We as a profession need to look at every possible technological alternative in order to take the pressure off our people."

Technology is the key to adding prescription volume while simultaneously freeing up pharmacists. "Because of the amount of traffic and dollars that already go through a supermarket, there are possibilities for increased customer convenience in the long run, such as educational kiosks to aid in Medication Therapy Management, more space for clinics and the possibility of integrated customer loyalty cards," said Jim Wisner, president, Wisner Marketing Group, Libertyville, Ill.

Accessing up-to-date patient health information quickly is at the top of pharmacies' list. One way to do this is through workflow software, a computer program that tracks and manages every step of the prescription-filling process and saves all of the information to a database.

"Workflow software applications that have the ability to not only tell pharmacists where a prescription is at any time in the process, but also to provide access to a database of patient health information for both the pharmacists and the patient, will be at the top of the list this year," said Pam Heath, director of pharmacy for Kash n' Karry Food Stores, Tampa, Fla. Being able to have conversations with patients about their health is where pharmacists really make a difference in patient safety, Heath said.

Patient safety was the main driver for the Penn Traffic Co., Syracuse, N.Y. The food retailer began converting its current pharmacy management systems -- databases for the storage, retrieval and management of patient information -- in all of its 42 stores to a newer system called NDC Pharmacy Rx.

The new system by NDCHealth in Atlanta is network-based, giving Penn Traffic the ability to connect to other computer systems, such as those belonging to physicians. The rollout is scheduled to be completed in October and will enable the pharmacies to perform e-prescribing, receiving prescription information electronically from patients' and physicians' computers.

"Network connectivity allows us to integrate e-prescribing, electronic signature capture and prescription scanning functionality to support our in-store pharmacists in filling prescriptions more efficiently and with improved accuracy," said Mario Pisano, corporate director of pharmacy, Penn Traffic. "We wanted to improve the proficiency inside our pharmacy departments to better manage patients, and in doing so improve their safety.

"The system also provides us with administrative control over multiple sites. This is a corporate-level capability that will enable us to manage and update pricing in real time in all of our stores from a central location."

Standardizing many pharmacy locations onto one computerized workflow system allows for aggressive pricing, according to John Brady, co-founder, PrairieStone Pharmacies, Minneapolis. The company, which operates leased-space pharmacies in stores of Lund Food Holdings, Edina, Minn., and D&W Food Centers, Grand Rapids, Mich., uses technology from prescription fulfillment provider AutoMed, Valley Forge, Pa.

Automation and workflow technology together help PrairieStone pharmacies fill between 400 and 600 prescriptions per day. "You've got two choices when it comes to redesigning your pharmacy to meet the needs for increased speed, efficiency and customer service: Up your labor and costs significantly, or free up your pharmacists with automation," Brady said. "The key is integrating automation technology with workflow software, investing in automation for the entire pharmacy, rather than bits and pieces."

"The best workflow software systems developed are provided by automation vendors," Thomsen said. He noted that workflow software can be connected to automatic or robotic counting and filling machines. "These systems track and manage every step of filling prescriptions, giving clear roles to pharmacy staff, a solid electronic chain of command integrated with robotics and automated filling, and a pharmacists' check or verification step."

Thomsen has been working with Hy-Vee, West Des Moines, Iowa, on completing a workflow study scheduled to end in April. "Hy-Vee feels that it is important to have one standard type of software that will provide a uniform approach throughout all of their stores," Thomsen said. "This will allow them to move staff throughout stores and not have to retrain or incur a loss in efficiency."

Bob Egeland, assistant vice president, pharmacy, Hy-Vee, reported that testing is being conducted on systems from at least three technology providers, including McKesson Corp., San Francisco, in a Lamars, Iowa, store; AutoMed, Vernon Hills, Ill., in a West Des Moines, Iowa, store; and Innovation Associates, Johnson City, N.Y., in a Waterloo, Iowa, store.

"We have the three systems in place, and they will stay in place in each store," Egeland explained. Feedback from employees at each of the three test sites will determine which system to standardize the rest of the stores on. This may be a tough choice, as "each of the stores that has an automated workflow system loves the one they are working with," Egeland said.

With the same system in all of its locations, Hy-Vee can create standard pharmacy procedures and raise the quality of life for pharmacists, technicians and patients, Egeland said. "However, even though automated workflow is an extremely efficient product, in some pharmacies it may not be necessary, and may even add steps," Egeland cautioned. Retailers should be sure to evaluate what is best for each store.

In stores where automated workflow may only prove to be a disruption, "IVR [interactive voice response] has been the technology we put in place years ago that has improved our productivity enormously," Egeland said. The telephony technology in which someone uses a touch-tone telephone to interact with a database to acquire information from or enter data into the database is often used to process prescription refill requests. "For the future, e-prescribing will probably be the next tremendously beneficial development," Egeland added.

For new PrairieStone pharmacies, "although we invest heavily in automation, in a complete paradigm shift, we do not use IVR," Brady said. It is a matter of "high tech vs. high touch." PrairieStone finds that having people answer the phone helps keep things "high touch."

The most obvious difference in pharmacies to come may be layout. "As we move forward, we need to look at the design and layout of in-store pharmacies to better accommodate the hardware and software and make better use of counter space," Egeland said.

ATM-like prescription refill delivery systems "have been approved in California and will be watched closely during pilots at Ahold in Virginia," Thomsen said. In California, Pleasanton-based Safeway has received a waiver from the California State Board of Pharmacy to test and install the devices.

The machines, made by Del Mar, Calif.-based Asteres and Distributed Delivery Networks Corp. of San Marcos, Calif., hold prescriptions that have been previously filled until a customer is able to pick them up.

Keeping convenience top of mind, PrairieStone Pharmacy's model "is focused on store within a store," Brady said. Where many in-store pharmacies average about 1,000 square feet, PrairieStone's model is slightly more than 400 square feet.

"Customers are starving for more interaction, more medications and more over-the-counter drug consultation," Brady said. "With automation, we can offer that alongside a very small footprint."

Customers will also be walking away from PrairieStone pharmacies with innovative drug packaging. "We are the first pharmacy to be licensed to package one patient's medication in a presorted box, arranged with that person's daily prescription regime plus any over-the-counter medicines they are taking," Brady said. The system, called Med-Pak, was rolled out in August with an initial 100 test patients at a Byerly's store.

A trend toward easy-to-understand prescription packaging can also be seen at Target Corp., Minneapolis. An entirely new packaging program called ClearRx has been developed to help patients recognize their medicines more easily. The packaging features transparent red bottles with color-coded rubber rings to help family members identify their own medicines. Patient information and directions are displayed prominently, and often-needed information is kept in a pocket attached to the label.

Putting safety front and center is one way for in-store pharmacies to stand out, even if it means working with the space and technology already available. While Target proved this through its drug-packaging initiative, more innovative store designs like PrairieStone's still serve as valuable illustrations.