Pharmacies leverage tech, automation to deliver on safety

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.

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. 

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. 

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.”

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. 

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.

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.”

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.”