PRESCRIPTION FOR INTEGRATION

Liza Casabona

SAN DIEGO -- "Integration" is the watchword for pharmacy technology.

The industry has seen continued acceptance of workflow management software, automated pharmacy functions, electronic prescribing and in-store kiosks connected to the pharmacy and other developments in recent years. All are oriented toward increasing the efficiency and accuracy of pharmacy operations, retailers, technology providers and other industry experts told SN as they geared up for the Pharmacy & Technology Conference of the National Association of Chain Drug Stores, Alexandria, Va., here this week.

The hoped-for result will be more time for pharmacists to spend with customers, rather than wrestling with paperwork, information systems or phone calls with doctors, not to mention faster access to information about the new Medicare drug benefit program.

"A lot of chain managers are looking at systems that not only interface with IVR [interactive voice response], but also handle e-prescribing, electronic signature, mail order, central fill, inventory management, workload sharing [and] workflow. A lot is going on," said Joe Friedman, director of pharmacy, Topco Associates, Skokie, Ill. "There is going to be a lot of spend over the next few years to get up to speed with what the needs are in the industry."

The biggest trends in pharmacy technology involve tools that enhance workflow efficiency, said Deborah Faucette, director of pharmacy operations, NACDS. Those tools encompass everything from enhanced software to managed workflow to automated pill counting or robotic systems, she said.

"It's not just installing this machine that is going to make you more efficient. It's actually the integration of the entire process, from the software through the new technology addition that makes the workflow more efficient.

"The trend this year is toward more integration of the system," said Mike Coughlin, president and chief executive officer, ScriptPro, Mission, Kan. "The major advances have been out there and have been proven. Now you start saying, 'How can I knit my whole operation together in a tighter way?"'

Integration offers a whole new level of value that stores can attain through their technology implementations, Coughlin added. ScriptPro administers a variety of workflow and robotic solutions for a list of retailers that includes Schnucks, St. Louis; Hy-Vee, West Des Moines, Iowa; Price Chopper, Schenectady, N.Y.; and some Kroger divisions.

"I don't see any kind of new whiz-bang idea. It's been more a refinement of ideas that have evolved over the last several years," said Curtis Hartin, director of professional services, Schnuck Markets, St. Louis.

The next big change for Schnucks will be implementation of electronic prescribing within the next year, Hartin said. The chain has been upgrading its software to take advantage of the technology required to accept electronic prescriptions from doctors to save time and labor costs in the pharmacy. Schnucks' most significant technology installation was the recent addition of an integrated voice response system to help decrease the pharmacy workload and allow pharmacists to focus on customers in the store, Hartin said.

Electronic prescribing is gaining in importance for retailers. According to the "2004 Supermarket Pharmacy Survey" by the Food Marketing Institute, Washington, 20% of survey respondents said they can receive e-prescriptions from physicians. Additionally, 44% said they would have the ability to receive e-prescriptions by the end of 2004.

The trend toward e-prescribing could pick up even more speed this year as the Centers for Medicare & Medicaid Services, Baltimore, Md., and President Bush have come out in favor of it, industry sources said. Medicare's support of hastening the acceptance of e-prescribing came in conjunction with the new Medicare drug discount card programs.

"Medicare is the 800-pound gorilla," said Hartin. The marketplace responds to the opinions of CMS, and Medicare as a part of that, regardless of legislation because of the number of people it represents, he added.

"The Medicare prescription card benefit really encourages the use of e-prescribing," said Faucette. It's a trend that is on everyone's agenda, she said.

E-prescribing was the big news for pharmacy technology last year, it continues to be this year, and will remain so into 2005, said John Fegan, senior vice president of pharmacy, Ahold USA, Quincy, Mass. E-prescribing is just one of the ways that retailers can use technology as they start to look at increasing efficiency and taking pressure off the pharmacists in their day-to-day work activities, he said. E-prescribing is being rolled out in many retail locations by SureScripts, Alexandria, Va., a collaborative effort founded by NACDS and National Community Pharmacists Association, also based in Alexandria. SureScripts provides a network that allows physicians and pharmacists to communicate in an electronic format, eliminating the need for handwritten prescriptions and cutting down on phone time. Most of the major drug store chains including CVS, Brooks Pharmacy and Walgreens have tested or installed the system. Many supermarket retailers are starting to follow.

"If you look at it from the pharmacist's perspective -- the robotics, the e-prescribing, etc. -- we're trying to take as many of the clerical things away from the pharmacist while we're trying to increase the business. It's a give-and-take or ebb-and-flow kind of approach: Increase your business, but make it easier for the pharmacist to handle that business," Fegan said.

Ahold is testing different technology advances in each of its divisions. Currently, the chain is looking at integrating its Stop & Shop, Quincy, Mass., Shopping Buddy into the pharmacy. Shopping Buddy, a wireless device attached to shopping carts, communicates with the store's point-of-sale and loyalty database via a local area network to target offers and services to consumers as they shop. The device is already equipped to submit deli orders and notify customers when their order is ready, as well as allowing customers to self-scan items as they shop.

After customers swipe their loyalty card through Shopping Buddy to alert the system to their presence in the store, the device could prompt them if they need a prescription refill, allow them to order a prescription, and tell them when a prescription was ready for pickup, explained Fegan. Those developments are out in "2010 land," he said.

Coming up sooner for Ahold's retail outlets -- in 2005 vs. 2010 -- is the growth and perfection of in-store kiosk programs, Fegan said. The company is testing a system from HealthSmart Rx, Chicago, in Stop & Shop locations and is in discussions to expand the program. HealthSmart Rx includes an information kiosk, plasma screen television for advertisements, and an area of health information. Among its offerings are books, videos and related products from Newmark Media, Addison, Ill. Giant Carlisle is testing the Healthnotes Internet information system in its Pennsylvania market. That test will be expanded to include Giant of Landover, Md., and Stop & Shop, Fegan said.

It's too early to tell which system will prevail, Fegan said. It could be a combination of both.

Smaller chains sometimes have to meet a different set of needs. Coborn's, St. Cloud, Minn., has started to automate the process of filling prescriptions in its pharmacies by installing two different levels of automated equipment manufactured by McKesson, San Francisco, in some locations, said Robert Passavanti, director of pharmacy operations for the chain. Coborn's installed McKesson's Pharmacy 1000 and Pharmacy 2000 systems in pharmacies that process 900 and 1,500 prescriptions on a daily basis, respectively. McKesson's systems automate pill counting and, at the higher level, manage pharmacy workflow.

About 10 units were installed in Coborn's 23 retail pharmacy locations. (The chain also operates three clinic pharmacies and one long-term care pharmacy.) The decision to install the McKesson systems was precipitated by the increasing volume of prescriptions Coborn's pharmacies see, Passavanti said.

"The number of prescriptions we fill just continues to rise. You need to do something because, on top of the pharmacist shortage, that created the need to streamline," he said. Streamlining the process allowed the pharmacist to have more face time with patients.

Coborn's has also added an IVR system and a central host computer that took pricing functions and third-party reconciliations out of the stores over the last few years to help lighten the pharmacy load, Passavanti said. E-prescribing is also "coming down the pike," he said.

As margin pressures, increased mail-order competition, drug re-importation and other issues continue to crunch pharmacies, efficiency and automation will become more important, sources agreed.

"With technology, you aren't replacing people. You're repositioning them to do what they need to do -- interact with the patient," said Faucette.

"It's important for pharmacies to stay attuned to what technology is available out there. Technology is going to be a way for us to stay as efficient as we possibly can to compete with the low margins that were offered through the managed care organizations, as well as the volume pressures we are seeing from mail order," said Schnucks' Hartin.

Vending in Future for Scripts

The leading edge of pharmacy technology -- a self-service prescription-dispensing machine -- may push efficiency to new heights by eliminating the need for the pharmacist to interact with patients picking up medication, and opening up further options for areas where the cost of a full-service pharmacy would be prohibitive, said industry sources.

Prescription will-call solutions or prescription-dispensing machines utilize ATM technology that lets patients who are in a hurry pick up prescriptions for which they have no questions or are already familiar with, thus allowing them to bypass pharmacy lines. "[Dispensing machines] could be an advantage in a rural area where you don't want to go through the expense of putting in a full pharmacy," said Joe Friedman, director of pharmacy, Topco, Skokie, Ill.

Prescription-dispensing machines could be helpful when a pharmacist is offsite or could feature the most-prescribed medications, Friedman stated.

Deborah Faucette, director of pharmacy operations, National Association of Chain Drug Stores, Alexandria, Va., agreed this self-vending prescription machine could work well for rural stores, and elaborated that it could be used to advantage in a 24-hour store to eliminate the need for a third shift.

"This is something that would really enhance the efficiency in the pharmacy, especially for someone who is coming in to pick up a prescription, has no questions, and really needs to get in and out quickly," said Faucette. For example, she pointed out, if a patient has been on a diuretic for years, there is only so much information a pharmacist can tell them after a certain point.

Faucette mentioned ScriptCenter, manufactured by Asteres, Del Mar, Calif., a finished-prescription storage and self-checkout machine, as one such solution for retail pharmacies. Pharmacists fill a prescription and load it into the ScriptCenter unit, where consumers can pick up their prescription and pay for it without going to the pharmacy counter. The machines thus far have been piloted in Long's Drugstores, Columbia, S.C., Faucette said.