Central fill workflow management gets smart

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Central fill workflow management gets smart

By David Salazar - 03/13/2018
Pharmacy is no longer solely a volume-based business. As healthcare expenditures rise and controlling costs become an imperative, payers are increasingly tying their reimbursements to patient outcomes, which has allowing pharmacists to flex their clinical muscles. But increased clinical opportunities for pharmacists have had to come alongside a sustained — and ideally increased — volume of prescription fills.

As a result, retail chains are turning to a central fill model, with one location servicing dozens if not hundreds of stores. Pittsburgh-based supermarket chain Giant Eagle is no stranger to central fill, using it in one form or another for roughly 18 years, according to Matt Niskach, the chain’s senior director of pharmacy central services. Niskach said that Giant Eagle has taken a revamped approach to its central fill facility — which services 200 of its locations across Pennsylvania and Ohio — in the past three years, installing six central fill robots, PharmASSIST RDSx systems, from provider Innovation.

Because automation can only do so much on its own, Niskach said Giant Eagle also has implemented Innovation’s PharmASSIST Symphony workflow management platform. According to Innovation officials, Symphony is designed to be the adaptive brain of a high-volume central fill site that can adapt to the numerous changes in workflow that are caused by changes in demand.

“What we’ve found is that the dynamics of prescription fulfillment demand is extremely variable,” Innovation director of software systems engineering Alecia Lashier said.

As a result of constantly changing demand and workflow needs, Lashier said Innovation realized that a rudimentary first-in, first-out workflow management approach is not as easily scalable as one that can use workload balancing to determine the priorities within a central fill site.

“In a lot of ways, it’s using the early stages of machine learning to understand the current state of the system at any given time, and rework the balance of each substation — and the system as a whole — to make sure the entire system is optimized,” Lashier said, adding that Symphony can prioritize medication replenishments based on demand and need within the workflow so that the most necessary replenishments are made first.

Alongside workload balancing, Innovation has built into Symphony learnings for dynamic prioritization that were partially acquired through its research conducted in partnership with Binghamton University’s Watson Institute for Systems Excellence. Dynamic prioritization can improve a central fill site’s fill-time window, which is crucial to meeting fulfillment goals, Lashier said.

“The shorter the fill-time window, the larger your volume output for that day is, and vice versa,” she said. “Symphony’s algorithm works to keep the various elements of an order in sync in real time.”

At Giant Eagle, Symphony helps the chain prioritize certain stores over others based on when the shipment has to depart the facility to satisfy next-day delivery patients.

Niskach said that since implementing Innovation’s solutions, Giant Eagle has managed to double its central fill output. Some customers, Lashier said, have seen their automation utilization increase to roughly 98% from 20% by using Symphony with already existing automation.

Giant Eagle’s improvements have left pharmacists in-store with the ability to better offer their clinical capabilities to patients.

“This allows that patient more face-to-face time with the pharmacists,” Niskach said. “What we really went to school for and should be doing is not counting pills and doing product verifications, but making a difference for the customer, doing MTM, doing immunizations or recommending an OTC product.”

And that’s Innovation’s mission, as well. “Our overriding goal is to help our customers reposition their pharmacists as care providers and to work at the high end of their credentials,” said Innovation COO Tom Boyer. “Our various high-volume technologies and pharmacy intelligence do just that, enabling them to focus on delivering patient-facing care.”

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