HIGH TECH, HIGH TOUCH

LIZ PARKS

With supermarket pharmacy at a crossroads, industry sources say the way to greater customer and pharmacist satisfaction is paved with technology.

The days when a pharmacist's role was chiefly counting pills and filling vials are ending, retailers and other experts told SN. With the demands of the new Medicare Part D program and a general desire by supermarkets to make greater use of the druggist as the in-store wellness expert, anything that frees up more of this professional's time is considered a welcome and productive addition to the pharmacy program.

Increasingly, this means pharmacy management systems, workflow software, interactive voice response systems, centralized filling, automated prescription filling equipment, refill dispensing kiosks and electronic prescribing.

"Pharmacists have the most underutilized education in all of health care," said Verne Mounts, director of pharmacy, Buehler Food Markets, Wooster, Ohio. "For whatever reasons, the model has been that pharmacists spend their time counting pills, licking labels and filling vials. Technology is letting us change that. It is letting us advance the profession and utilize our educations to benefit the public."

Supermarket retailers are being forced to decide. They can either "continue to treat prescriptions as a commodity category where all they do is dispense pills or they can use pharmacy and health care to create a point of difference for themselves, using technology to liberate their pharmacists so they can spend more time counseling patients," said Christopher Thomsen, president and founder of the ThomsenGroup, Kansas City, Mo., a pharmacy consulting company.

The grocery industry is "no longer content to provide a pharmacy as a convenience," said John Brady, executive vice president and co-founder, PrairieStone Pharmacies, Plymouth, Minn. "Today, supermarkets see pharmacy as a launching pad to being fully in the health care business. [It is] a place where people can not only pick up their daily medications but also get counseling on their disease states, their dietary habits, and technology is making that possible because it automates the lower-level manual tasks." PrairieStone operates 28 leased supermarket pharmacies.

Bashas', Chandler, Ariz., is "very interested in pursuing medication therapy management and using technology to track and bill insurers for the services we provide to help patients manage their diseases and become healthier," said Dan Milovich, director of pharmacy operations.

A supermarket pharmacy is "a way to provide more total health care, especially from the nutrition side," said Pam Heath, director of pharmacy for Sweetbay Supermarkets, Tampa, Fla., a division of Brussels-based Delhaize Group. "Two things that are really required as we age are the right food and medication, and those all can be bought in one place."

Through pharmacy technology, she added, many "tactile things" are now being done manually in supermarket pharmacies that can be handled by automation.

BASIC PLATFORM

However, to fully automate manual processes and to standardize processes more efficiently, most regional supermarket chains are finding that they need to upgrade their most basic technology platform, the pharmacy management system.

That's sparked a growing trend to examine all the various new types of PMS systems on the market, and for retailers to ask the vendors they consider best in class to actively bid for their business.

Bashas', which has four pharmacies opening this year and more on the drawing board for next year, is looking for a PMS system that can centralize everything from the patient's records to drug files, physician files, etc. "We want everything under a global host system," Milovich said. "Today, all our pharmacies are on a stand-alone platform and it's very difficult to manage 56 different entities. It's very time-consuming."

Bashas' hopes to have a centralized PMS in place, with workflow software either integrated or interfaced into it, by the end of this year or early next year, Milovich said. The speed of the rollout will depend on how long a training curve is needed to manage the transition, he said.

Buehler's is installing a new PMS that will allow the retailer to centralize prescription data, giving each store access to all patient profiles and making it possible to manage the information in each of its pharmacies from one location.

Eventually - perhaps by early next year, Mounts said - Buehler's will also "turn on" a central fulfillment module within its new PMS system.

A centralized fill process will allow Buehler's to automate the filling of some prescriptions for chronic conditions in a remote central pharmacy, balancing the workload for other stores, freeing pharmacists to spend more time counseling patients, he said.

Another efficiency in Buehler's new PMS is its connection to an interactive voice response system that can call patients.

"That will let me establish a courtesy refill program," Mounts said, "and the reason that is so important is because it will let our pharmacists take control of maybe 40% of their business. It will allow us to sign patients up for a refill program, enhancing medication compliance, and it will let us process refill prescriptions a day or before patients are to pick them up."

Ahold USA, Braintree, Mass., which has 650-plus pharmacies, is preparing to upgrade its pharmacy management system and install workflow software, along with testing robotic medication dispensers, said John Fegan, senior vice president of pharmacy.

"We need to take the pressure off our pharmacy teams so they can be more efficient and use their time more effectively."

An upgraded PMS interfaced with workflow software "will make us more effective in delivering prescriptions to our patients. It will also help store-level pharmacists manage their inventories much more efficiently," he said.

"With Medicare Part D and more people getting 90-day supplies of medication, how much inventory should we have? We don't know anymore. An automated system will help us as we move into the future."

In addition to testing automated counters, Sweetbay is evaluating two different pharmacy management systems, hoping to make a decision on one by the end of this year.

"We are looking at workflow so we can always identify where the prescription is in the filling process," Heath said. "The two systems we are looking at are both very different and much more upgraded than the system we currently have."

To explore new opportunities, Bashas' has opened three health clinics, with more on the drawing board, Milovich said. They are set up so the nurses can send electronic prescriptions directly into Bashas' PMS system.

As Sweetbay assimilates Kash N' Karry stores, it is testing a central patient profile database in 20% of the stores. "Pharmacists in those stores can access any of their patient profiles, which gives their patients the convenience of going to any store they choose to pick up or drop off prescriptions. There needs to be a central database. That's the wave of the future," Heath said.

AUTOMATION AND MTM

"We're looking at some automated dispensing devices. We just put automated counters in some of our stores. That's important because Florida is [starting to look] at programs that compensate pharmacists for medication therapy management programs. Automation helps free our pharmacists so they have more time to invest in MTM services," she said.

Sweetbay's sister company, Hannaford Bros., Scarborough, Maine, recently installed two robotic dispensers in higher-volume stores, Heath said. "We'll be looking at those to see how much they increase efficiency and free up the pharmacists."

PrairieStone Pharmacy uses technology to add value and create a point of difference for supermarkets. The company has a patent-pending process for automating the sorting of monthly prescriptions, over-the-counter medications and vitamins into sealed, single-dose packets that are arranged by the date and time they should be taken.

PrairieStone charges $15 a month for the service, called DailyMed, which Brady said the company plans to license to other pharmacies.

Up Next: E-Prescriptions

One of the fastest-growing new technological innovations is electronic prescribing, software that can transmit new prescriptions and renewal authorizations written by physicians directly into the pharmacy of the patient's choice.

In its 2006 pharmacy report, the Food Marketing Institute, Washington, reported that 37.8% of supermarkets with pharmacies said they were set up to receive electronic prescriptions and another 35.6% said they would be ready by the end of this year.

Tim Hammonds, chief executive officer of FMI, said one recent study found that e-prescribing delivers an average labor cost saving of 97 cents for each new prescription and 37 cents for each refill renewal processed electronically.

"Receiving prescriptions electronically improves accuracy, frees up pharmacists and technicians to spend more time with customers and do more productive work, and it has helped a great deal with flagging drug interactions, which is part of the work of a pharmacist counseling patients taking multiple prescriptions," Hammonds said.

"In fact, pharmacy technology in general, in the back room or on interactive kiosks on the sales floor, frees up pharmacist's time. That is something that we, in the supermarket industry, particularly like. To the extent that pharmacists are available to answer questions, we also see a lift in over-the-counter sales," he said.

The FMI report also noted that as of the end of 2005, three-quarters of all supermarket pharmacies had an interactive voice response system, and 13% had a central fill facility. Among them is Kroger Co., Cincinnati, according to industry sources.

Meanwhile, workflow software is one of the most valuable innovations in recent years, said consultant Christopher Thomsen, president and founder of the ThomsenGroup, Kansas City, Mo. It enhances productivity even more dramatically than robotic dispensers because it standardizes the workflow process, eliminating redundancies in task management and reducing wait time for customers, he said.