TECHNO BREAKTHROUGH

MATTHEW W. EVANS

SAN DIEGO -- Technology is on the verge of transforming retail pharmacies, including supermarkets, from drug dispensers to community health resource centers.

"We are setting the agenda for a new century of providing innovative pharmacy services," said Alan Levin, president and chief executive officer of Newark, Del.-based Happy Harry's Discount Drug Stores. Levin, who is chairman of the National Association of Chain Drug Stores, Alexandria, Va., made these remarks during the opening session of the NACDS' Pharmacy Managed Care and Technology Conference and Bricks 2 Clicks Forum, held here Aug. 26 to 30.

"A decade from now we will marvel at the changes that will have occurred, both in expanding patient care to new levels of disease management, and in our continuing evolution into community health resource centers," he told a gathering of 2,600 attendees. It was the first NACDS pharmacy conference that combined electronic commerce and communication of health care services with business to business activities.

Technology is seen by many of those who attended the conference as complementary to their pharmacy operations. Many viewed technology as allowing pharmacists to re-apportion their time and duties. In other words, said one retailer, if medicine shelves behind the pharmacy counter are replaced by machines that fill and label prescription vials, a pharmacist -- not having to worry about those tasks -- is freed up to consult a diabetic patient on diet.

One case study presented during conference made this scenario a possibility.

Over the last two and a half years, Eckerd Corp., Largo, Fla. and Auburn University School of Pharmacy, Auburn, Ala., have conducted tests using automated equipment at two Atlanta-area stores. The stores contained new workstations, state-of-the art prescription filling and hosting systems, consultation areas and a self-education room for customers.

It was found that this store layout saved 22% of the pharmacist's time. Among some of that time saved, the following was re-directed into other valued tasks such as 6.9% of the time was successfully re-devoted to error reduction practices. More time, 3.7%, was spent on managerial tasks, 3% of that saved time was used for clinical services, and 2.5% was re-allocated for patient counseling and communication.

Among the pluses pharmacists cited in the store layout that made their life easier was a robotic filling system (ScriptPro) and prescription verification system. Electronic professional references were deemed valuable due to their quick-access and, therefore, time-saving capabilities (as opposed to reference books, which were abolished). The state-of-the art blood pressure equipment (DynaPulse) was also voted a favorite device.

However, not all elements implemented in the store layout proved successful. For example, pharmacists-patient consultations conducted on video cameras via the drive through window did not work out well because customers were either too rushed or felt uncomfortable. It was found that patients also did not make use of self-education media provided in the private consultation room.

One problem identified was the training period required to learn the use of the new technologies. It was recommended that training take precedent over disease state management programs. In other words, learn the technology first, then concentrate on patient care. Other challenges included under-utilization of the robotic fill system and the man hours it takes to replenish the cells in the robotic unit.

After the completion of the 30-month test stores, some of the more successful practices were adopted in other Eckerd units, said pharmacy director Deborah Simmons, without expounding or providing further details.

Manpower was a big issue explored at the conference. "We're looking at the technology to find ways to free up man hours," said Mark Tow, director of pharmacy, Bruno's Supermarkets, Birmingham, Ala.

Driving this point home is the fact that there are currently 7,000 vacancies across the country in chain pharmacies, Levin proclaimed. He suggested that management in the chain pharmacy setting address this shortage, making it a top priority in order to solve the problem.

In the face of manpower shortages, prescription volume continues to grow. From 1900 to 1990, prescription volume in the industry grew to 2 billion prescriptions dispensed annually, according to NACDS. In the last 10 years, annual prescriptions reached 3 billion a year. In half that time, by 2004, a level of 4 billion annually is expected.

At the same time, there is more pressure on the pharmacist to become involved in patient care and position the pharmacy as a "community health resource center." Questions arose the pharmacist's role and responsibility of today's retail setting. For example, should pharmacists warn patients about potential drug interactions, side effects, or give other medication guidance? Courts that have dealt with cases involving fatal drug interactions and pharmacists being sued, according to the National Association of Boards of Pharmacy, Park Ridge, Ill., say it isn't their responsibility.

"Pharmacists have no affirmative duty toward warning patients about side effects, contraindications, or a mistake in a prescription from a doctor," said Carmen Catizone, NABP secretary, when he addressed a conference work session on regulating pharmacy by outcomes. "To do so would be unwise," he said, citing court precedent.

If this seems to fly in the face of the current movement toward community pharmacy and pharmacist-patient interaction, it's because it does, according to many in attendance. In light of this movement, many on a reactionary panel - made up of chain pharmacy executives - were at odds with the precedent Catizone spoke of. Some considered it laughable.

Nevertheless, Catizone acknowledged that "the pharmacist's role has changed in the past few years from dispenser to trusted professional and learned intermediary."

Above all else -- new offerings from drug manufacturers, suppliers, and their services -- pharmacy operators' central focus at this year's event was how does labor-saving technology best suit my operation?