Pharmacies leverage tech, automation to deliver on safety

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Pharmacies leverage tech, automation to deliver on safety

By Sandra Levy - 08/27/2020

It is not easy keeping patients safe. Indeed, despite its importance, it is just one of a host of duties pharmacists are responsible for on a daily basis — a list that has only grown as the COVID-19 pandemic has worn on. 

On any given day, pharmacists are filling an increasing volume of 90-day prescriptions, supervising or conducting COVID-19 tests, providing masks, making hand sanitizer, counseling patients, and helping patients return to their regular vaccination schedules. Pharmacists also will have a significant role in the deployment of a COVID-19 vaccine when it becomes available. All of this is done while making sure they accurately fill prescriptions and adhere to federal regulations.

In order to juggle these responsibilities while continuing to ensure patient safety and improve patients’ health, many retailers turn to technology and automation companies, many of which have been responding with a sense of urgency amid the unprecedented challenges of the pandemic. They have been churning out innovative technologies and solutions, as well as enhanced functionalities that make pharmacists’ workflow more efficient and free them up to focus on patient safety and positive health outcomes. They also have been helping pharmacies deal with changes in regulations amid the pandemic. 

Following the Law
Verifying prescriptions that come into the pharmacy is a critical first step in the process of filling a script, which the COVID-19 pandemic has complicated. Craig Ford, senior vice president of the pharmacy market at LexisNexis Risk Solutions, said that a recent Drug Enforcement Administration change that allows providers to prescribe all classes of controlled substances without an in-person medical exam during the COVID-19 pandemic means that the safety responsibilities of pharmacies have expanded. “This includes ensuring that only authorized practitioners prescribe specific medications to ensure patient safety, particularly as the state prescribing rules continue to evolve,” Ford said.  

To meet these changes, LexisNexis Risk Solutions’ VerifyRx Prescriptive Authority Edit feature accurately checks state-specific prescriber credentials so that a provider’s prescriptive authority can be narrowed down to the drug level. 

“With its ability to allow pharmacies to create corporate policy specific rules, VerifyRx helps determine the necessary credentials required to prescribe any given drug,” Ford said. “Pharmacies can enable and manage all their prescriptive authority configurations in one place, while ensuring patient safety.” 

Changes to prescribing rules during the pandemic join other ongoing regulations governing pharmacy, including the Drug Supply Chain Security Act, which addresses the chain of custody of medications from the manufacturer to the patient to ensure patient safety. DSCSA’s deadline for compliance by wholesalers is this year, while retailer compliance is set for 2023.

For the past seven years, Kennesaw, Ga.-based KNAPP has been engaged in helping wholesalers comply with DSCSA. “Counterfeit medications are a large concern and a significant patient risk,” said Brian Sullivan, the company’s senior systems sales manager of healthcare solutions USA and Canada. “Most of KNAPP’s efforts have been focused on the first stage of distribution, from the manufacturer to the wholesalers, both of whom are KNAPP’s customers.” 

In order for wholesalers to meet DSCSA deadline compliance, he said they would have had to add a significant number of employees to manually scan individual medications to confirm serialization.

We worked with our customers to automate this process at the wholesaler level. In addition to facing similar staffing concerns as wholesalers, retailers have the added pressure of compressed margins. We are using what we have learned to accelerate the process for retailers to address compliance with the regulation, and assure that patients are indeed receiving the correct medications.
Brian Sullivan

KNAPP’s Vision Item Check, a semiautomated verification system for medications used downstream of automatic picking systems, is yet another system that fosters patient safety. “The system’s powerful cameras read and process the data contained in 1-D and 2-D codes, which include security features on packaging, lot information, date mark (date of minimum durability), and quality features of the articles,” he said.

Additionally, KNAPP’s Vision Central Belt automatically reads 2-D and QR Codes of medications on KNAPP’s central belt systems to verify that the correct medication is being supplied for the pharmacy and patient.

Safety is not only for patients, though. KNAPP ATD-L1P Automated Tablet Dispenser, with a modular dust and particle collection system, helps pharmacies meet <USP 800> requirements that are intended to assure the safest environment for pharmacy employees, who work with the National Institute for Occupational Safety & Health and 1, 2 and 3 hazardous medications. 

“Pharmacies are incorporating this modular solution to minimize medication dust and particles when replenishing and dispensing medications,” Sullivan said. “By incorporating this technology into their systems, more medications are able to stay in automated systems, and pharmacy staff at both centralized and retail pharmacies have less exposure to NIOSH 1, 2 and 3 medicines.”

Pharmacy technology companies also are concerned with helping pharmacists increase patients’ adherence with their medication regimens. 

Automating Adherence and Safety
When it comes to filling prescriptions accurately — and doing so in a way that can help improve patient health and, ideally, outcomes downstream — robotics and pharmacy management platforms are popular choices for retailers. 

Mission, Kan.-based ScriptPro CEO Mike Coughlin said that as healthcare systems and pharmacies are being called upon to provide critical services to their communities amid COVID-19, ScriptPro’s robotic prescription dispensing systems utilize numerous tech features, such as barcode scanning, to ensure accuracy and safety.

“Pharmacies experiencing staff shortages and the need for social distancing also can use robots,” Coughlin said. “We can deploy these quickly and efficiently into any pharmacy environment, along with training and 24/7 support.” 

ScriptPro’s workflow and pharmacy management systems also can leverage built-in communications capabilities to send text messages to patients, explaining procedures for accessing pharmacy services. “We will deploy this messaging service at no charge to customers using our communications module,” he said.

Additionally, ScriptPro’s software platforms can implement PharmacyPro, a mobile application to support curbside or delivery mobile dispensing and point of sale functions. “We can stand up or expand remote access solutions to allow staff to operate our workflow and pharmacy management platforms from home or other remote locations,” Coughlin said. 

Finally, ScriptPro’s web-based Advanced Pharmacy Clinical Services extension to its pharmacy management platforms pivoted quickly to launch clinical programs and protocols for outpatient COVID-19 patient case management, Coughlin said. “We will update these regularly as new data is released, including new information from clinical trials impacting outpatient treatment,” he said. “We also are ensuring that our drug information database includes the latest drug variations to facilitate dispensing.”

Automation also is taking on even greater importance in helping pharmacies to foster patient safety.

Synergy Medical, a Canada-based company, is a case in point. The company makes SynMed, an automation system for multidose and single-dose blister packs.

Mark Rinker, Synergy Medical vice president of sales for North America, said that patient safety starts with taking medication as prescribed, and that the prescription delivery method can greatly enhance, or impair, a patient’s ability to accurately self-administer.

Rinker cited the 2006 Federal Study of Adherence to Medications in the Elderly, which compared a patient’s adherence to vials (61%) versus multidose blisters (97%).  “The group self-administering their medication with multidose blisters had a statistical improvement in their underlying condition. Multidose blisters, therefore, are a cornerstone to a comprehensive medication strategy to enhance patient adherence and safety,” he said.

Rinker said he believes that manual production bottlenecks and accuracy levels are an impediment to scale the multidose service, and that this is where automation can play a critical role to allow independent pharmacies and pharmacy chains to safely and accurately scale this patient safety service.

Amid the COVID-19 pandemic, Rinker noted several trends, including how pharmacies are expanding their multidose blister service to meet the demand of patients wanting their medication organized by the pharmacy in an easy to follow format and delivered to their home. 

“In long-term care, we see pharmacies reviewing their medication delivery protocols to reduce touches during preparation and reduce bedside administration time,” he said. “In order to facilitate patient safety, the trend is away from single-dose blister cards and toward a multidose blister solution. Finally, COVID-19 has exposed pharmacies that rely on manual prescription preparation like no other time, and the resulting move to more pharmacy automation will help ensure the timely and uninterrupted supply of patient prescriptions.”

Adherence is the focus of Apple Creek, Ohio-based Euclid Medical Products, which recently introduced Vantage Vision MDM 1 and MDM 2, a line of verification machines that automatically check multidose medication pouches quickly and accurately.

Vantage Vision MDM 1 is designed for retail and smaller closed-door pharmacies that want to verify medication pouches to reduce the time-consuming process of manual verification. The conveniently sized vision system has fully integrated software, which will confirm the size, shape and color of each pill in the pouch package.

The MDM 1 Series records images of each pouch and will flag suspect pouches for further verification. Verifying up to 45 pouches per minute, the MDM 1 Series is meant for pharmacies looking to streamline the verification process. Vantage Vision MDM 2, a larger scale model designed for pharmacies running multiple packaging machines’ speeds, can verify up to 75 pouches per minute.

“When it comes to automation, manual verification can be a very time-consuming process,” said Kevin Copsey, business unit director at Euclid Medical Products. “Introducing Vantage Vision MDM 1 and MDM 2 into our product lineup was a natural product line expansion to complement our new line of next generation Axial multidose adherence pouch packaging machines.”

To reduce false positives in the pouch verification process, both machines in the Vantage Vision line are equipped with an agitator, a mechanism for ensuring that pills are sitting flat in the pouch. This agitator technology, along with highly sophisticated software algorithms, greatly reduces the likelihood of receiving false positives.

Smart functions in the software allow for a user-friendly interface and process flow. Reports can be printed or exported, and any repaired pouches can be registered by capturing a new image at the Repair Station. Through various processes, the software enables pharmacists to link data to a specific bar code, even after the medication pouches have left the pharmacy. 

Managing Volume
Johnson City, N.Y.-based Innovation is making headway in working with its customers to understand their needs and improve patient safety at high volume and central-fill sites through its suite of pharmacy automation solutions led by its Symphony software.

“Our team of pharmacists and software professionals work with our customers to navigate the ever-evolving compliance landscape,” said Marvin Richardson, CEO of Innovation. “As compliance becomes more tied to reimbursement, working with our customers to take advantage of the Symphony Platform’s broad range of tools helps our customers to improve management of their compliance initiatives.”

Richardson pointed out that given Innovation’s footprint across U.S. military pharmacy, which includes application of the Healthcare Failure Mode and Effect Analysis developed by the Department of Veterans Affairs’ health system, the company can help identify risks in an organization, analyze the ways in which processes can fail and take corrective action before failures have occurred. “This means our customers can be assured that patient safety is paramount at Innovation, and that they will realize improved patient safety outcomes,” he said.

The COVID-19 pandemic has been a defining moment for Innovation to work with its customers to transform pharmacy and take advantage of the power of pharmacy automation solutions to allow pharmacists the opportunity to increase their collective focus on patient care, Richardson said.  

“The question we’re working with our customers to answer is, ‘How can we work together to unleash the full potential of pharmacy?’” he said. “Innovation is working with its customers to shift scheduled dispensing work to central fill so that pharmacists can continue to play a critical role in health care, and step into new roles and responsibilities amid the pandemic. We are committed to working with pharmacists to focus on their singular and collective motivation, which is the patient.

Supporting Expanded Services
Pharmacy technology companies also are stepping up to the plate to help pharmacies operate more efficiently so that pharmacists have more time to provide such clinical services as COVID-19 testing and immunizations.

Mountain View, Calif.-based Omnicell is focused on providing pharmacies with digital solutions to support pharmacy safety, as well as free up pharmacists to handle additional responsibilities. These goals have taken on added urgency amid the COVID-19 pandemic, said Danny Sanchez, vice president and general manager of Omnicell’s population health solutions division. 

We know that pharmacists are going to be asked to do more. Pharmacies have already been given the go-ahead by new federal and state regulations to conduct COVID testing, and immunizations are coming. We know that the only delivery method for millions of those interactions will be at the retail pharmacy. Pharmacists are already doing a lot, and patient safety is their No. 1 concern. We are diving into our digital engagement and clinical solutions, and orchestrating them to free up pharmacists’ time so they may have more efficient interactions with patients.
Danny Sanchez

Sanchez cited his division’s medication synchronization solution as an offering, which ensures that patients haven’t had a change in their medication therapy. Med sync also consolidates all of a patient’s prescriptions so that the pharmacist can fill them at the same time.

“Our system sets up when it is time to refill a prescription,” he said. “We send a message asking a patient if there is any change in their medication therapy. If you say ‘yes,’ the system alerts the pharmacist to call to have a discussion. If they see that there are no changes, the pharmacist is confident that they are filling the right drugs for the patient. That ensures that the pharmacist is taking proper accountability and looking at the full profile. With med sync, we paint a full picture for pharmacists, and that increases safety and improves health outcomes.”

Patients also can receive reminders when their prescription will be ready, and they are asked if there are any changes. “These reminders also improve pharmacy workflow and return to stock, which is a big issue,” Sanchez said. 

Omnicell’s med sync offering also enables pharmacists to consolidate all of a patient’s medications so that they may be picked up on a single day. “This reduces the work for the pharmacy and reduces the number of patient visits to the pharmacy, thereby reducing exposure to COVID-19 or any disease, even the common cold,” Sanchez said.

Yet another offering from Omnicell’s Population Health Solutions unit, which aids in patient safety, is the recently launched CareScheduler, an automated solution that digitizes the existing manual and inefficient processes of scheduling, managing and reporting vaccinations, as well as point-of-care testing. 

CareScheduler utilizes such familiar communication tools as mobile messaging and convenient chatbots to streamline and simplify the entire process of notifying patients about available therapies and tests, and then manages every step in the process of administering them, including follow-up.

“We knew that retail pharmacies are looking for solutions now to manage the wave of immunizations that will come, as well as the continuing need for COVID testing,” Sanchez said. “The CDC is recommending that everyone get a flu vaccine this year. You’ll have an influx of patients who will get the flu immunization and people will need the COVID immunization, which will hopefully be available. The CareScheduler app streamlines and simplifies these essential pharmacy processes.”

With an automated care scheduling solution like CareScheduler, pharmacists can deliver appointment-based vaccinations, while reducing the number of pharmacy walk-ins. 

“The result is better health outcomes for patients, and better business results for pharmacies. We’re enabling our technology to work so the system can help people plan everything. They show up and get their immunization, and can walk away. Everything is done with consumer-friendly chatbots and text messages,” Sanchez said. “You get a text message from the pharmacy, answer questions and register for an onsite test. We’ve always done immunizations, but gearing up to do it in mass is what our pharmacy and health plan partners are asking for.”

Keeping Things Running
As critical as automating scheduling for patients to get therapies, tests and immunizations is, ensuring that safety checks are in place in pharmacy workflows to dispense the correct drug and correct dosage for patients is just as important.  

RxBenefits, based in Birmingham, Ala., is a technology-enabled pharmacy benefits optimizer that has more than 500 pharmacy pricing, data and clinical experts delivering prescription drug program savings to employee benefit consultants and their self-insured employer clients through improved pharmacy benefit contracts and clinical management. 

Kelly Chillingworth, RxBenefits’ director of business development, said that RxBenefits’ data, technology and professional service solutions help boost economic and clinical value by ensuring members get the right dose of the right medication for the right condition at the right time. 

Our responsibility is advocating inside the complex pharmacy ecosystem to serve the best financial interest of the plan sponsor and the best health interest of the members.
Kelly Chillingworth

When a pharmacist or pharmacy technician enters a prescription for a medication into a pharmacy system, RxBenefits ensures a series of checks are performed to ensure the medication is both cost-effective and being prescribed in accordance with Food and Drug Administration guidelines. 

In addition to the standard edits its back-end PBM partners put in place — things like quantity limits and step therapies — RxBenefits’ clinical team maintains a low clinical value drug formulary to eliminate wasteful spending, so valuable healthcare dollars can be redirected to more effective prevention and treatment strategies. “We add extra eyes and helping hands to support both busy prescribers and pharmacists in their efforts to create better healthcare outcomes,” Chillingworth said.

To improve member safety, while helping to manage plan spend, RxBenefits’ in house clinical pharmacists perform prior authorizations on certain high cost brand and generic prescriptions that are frequently prescribed off-label, intended for very limited use or that may have dosing errors. 

“In-house prior authorization review is an excellent way to ensure the right patient gets the right medication at the right time, and for facilitating communication with the prescriber,” Chillingworth said. 

Prior authorization also promotes lower cost options in a clinical category, which is a driver of patient adherence. “We can help keep the costs down for patients and save money for the plan sponsor,” Chillingworth said. “When co-pays are too high, people don’t take their medication. By offering a lower cost option through prior authorization, we can help improve adherence if people can afford their medication over time.”

Finally, as pharmacists increasingly are interacting with customers at the drive-thru, especially amid the COVID-19 pandemic, it is even more essential that there is clear communication between patients and pharmacists to ensure safety.

Cincinnati-based Bavis Drive-Thru has engineered an intelligent audio system known as B.E.A.M., which integrates into the pharmacy’s audio system, reducing environmental noise by as much as 90%. 

At all times, and especially currently, the ability of patients to converse with pharmacists is of the utmost importance. Thankfully, patients and their authorized caregivers can conduct essential transactions at their local pharmacy’s drive-thru. Not only does this save time, but it also offers the convenience and safety of being able to attend to health needs, while maintaining an adequate distance.
William Sieber, Bavis Drive-Thru president.

“However, pharmacy drive-thru is exposed to many oft unpredictable environmental stressors, including the constant clutter of noise and violent weather patterns. Conversations can prove to be quite difficult, and simply being heard is only part of the battle.”

Being understood with clarity when communicating such vital information as dosages of prescribed pharmaceuticals is not only important, but potentially can be a life-and-death affair, he said.

“With this system installed, pharmacists and patients can feel confident that their conversations come through with utmost clarity, thereby aiding in communications that may help save lives,” Sieber said. 

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