Tech firms answer chain pharmacy's call for productivity

Dan Scheraga

With prescription volumes still on the rise and no end to the pharmacist shortage in sight, drug store chains are under more pressure than ever to raise productivity at the pharmacy. More frequently, technology is seen as the natural solution to that challenge. Manufacturers and developers of pharmacy automation and management solutions have responded to the call with a new wave of high-tech offerings.

The scope of the pharmacist shortage is illustrated in research from the National Association of Chain Drug Stores. NACDS projects that over the next five years, the volume of dispensed prescriptions will balloon 46 percent. The projected rise in the number of available pharmacists over that same time period: only 5.4 percent.

The pharmacist shortage continues to weigh heavily on the minds of chain drug store executives and the solutions providers that serve them. "One of the major trends we've seen is that prescription volumes are growing at one rate, and the number of new pharmacists is growing at about 10 times less," said Sam Nebiolo, senior product manager of Pittsburgh-based McKesson Automated Prescription Systems. "The big question is, how do we support these pharmacists who are already overworked but are still faced with an increasing workload?

"The answer is to give them the technology to make them productive enough to handle the load," he concluded.

Retail chain pharmacies are beginning to feel the squeeze already. Chains big and small are turning to technology to address the gap between the growth in pharmacy and the number of new pharmacists available to fill all those extra prescriptions.

At CVS, for instance, improving productivity and service at the pharmacy counter remains a major focus for the chain. Its new Pharmacy Service Initiative, or PSI, is ah outgrowth of CVS' Excellence in Pharmacy Service Innovation and Care program, which used technology and physical improvements to re-engineer work flow behind the counter. PSI, now in some 2,600 stores, improves CVS' pharmacy systems to enable CVS pharmacy staff to ajudicate third party prescription within three minutes or less. In stores where it has been implemented the longest, we have experienced quite substantial improvements in service levels. We are moving from good service to great service," CVS chief financial officer David Rickard told analysts in a recent conference call to discuss the chain's third quarter results. Rickard said the chain expects to complete the rollout of PSI by year's end.

The pharmacist shortage is a very real issue, and let's face it, it doesn't appear to be going away," said John Frandson, who is in charge of pharmacy tech support at Minneapolis-based Nash Finch Co. "It presents a challenge to us in particular because our company continues to expand. We're adding more and more stores, so naturally we re concerned about the availability of pharmacists to staff them."

So far, Nash Finch has been dealing with the labor crunch with the CRx pharmacy management solution from QS/1 Data Systems, based in Spartanburg, S.C. The system, which has been in place at Nash Finch for the past eight years, handles prescription pricing, processing, third party billing and other day-to-day functions.

"It raises the productivity of the pharmacists we have, so we don't have to keep adding people," Frandson said.

Pharmacy management

QS/1 recently built upon its existing pharmacy management product line with the release of its new NRx application. The pharmacy management solution was introduced at the NACDS Pharmacy and Technology Conference, held in Philadelphia last summer.

NRx represents an improvement over QS/1's previous pharmacy management systems, CRx and Rx Care Plus, in that it is the vendor's first product with a graphical user interface. Whereas QS/1's previous solutions relied upon text menus and prompts to guide the user, NRx uses an intuitive point-and-click interface with-pull-down and popup menus.

"It added an extra dimension of flexibility," said Tyler Thompson, QS/1's,national chain sales manager. Previous solutions could be controlled with the keyboard only. NRx allows the mouse to be used in conjunction with the keyboard, giving the pharmacist an added level of comfort." He added that NRx's intuitive interface is easy to learn, which cuts down on training time.

NRx also features enhanced security functions and onscreen pill imaging. In addition, it allows pharmacists to scan written prescriptions into a patient's file.

QS/1 also is aiming to improve the value proposition of its applications with the introduction of centralized architecture. New capabilities added to QS/l's line of pharmacy management solutions enable the applications to serve all locations from a single server at the retailer's data center. QS/1 also recently introduced an Application Service Provider option, under which the application is hosted at QS/1's own data centers.

Operating an application in a hosted environment rather than on in-store servers dramatically reduces the complexity of system maintenance. In a hosted environment, patches, updates and reconfigurations need only be applied once, at a single central point. When solutions run on in-store servers, every change must be applied multiple times: once at each affected store.

"When you have to apply patches and upgrades at the store level, that can be very time- and labor-consuming, and it opens the door for inconsistencies to crop up from store to store," Thompson said. "That's why centralized hosting is hot today. Our customers are beginning to see the wisdom of it, and they're asking for it."

Thompson added that in a hosted or ASP environment, solutions can be configured to serve all pharmacies identically, or the locations can be broken down into blocks to be configured separately. The flexibility is tremendous," he said.

Automated dispensing

Solutions providers also have made advances in drug-dispensing technologies, too. Demand for automated pharmacy solutions seems to be riding high. "We're seeing a lot of interest in our drug-dispensing robots from retail chain pharmacies in the U.S. and Canada," said Mary Reno of Innovation Associates. She added that the U.S. Air Force recently agreed to deploy Innovation Associates' Robotic Dispensing System II worldwide, starting with a rollout in Colorado Springs, Colo.

At the NACDS pharmacy show, Vernon Hills, Ill.-based AutoMed offered up its new R800 device. The robot is designed for pharmacies that fill between 200 and 800 prescriptions in a typical day. With the ability to count, fill and label up to 170 vials per hour, the robot is the fastest of its kind, according to vice president of marketing Russ Marable.

The device is built for speed in more ways than one, Marable said. It is designed to be rolled into a pharmacy setting and begin operating within an hour or two. Because the robot is designed to take the place of a standard piece of shelving, no remodeling of the pharmacy space is necessary. The R800, is integrated with AutoMed's flagship Efficiency Workpath System pharmacy management solution.

The R800 is priced for small- to-mid-sized retail pharmacies. "We wanted to create something that was cost-effective and within reach of smaller players," Marable said. "Not every store needs an $800,000 robot."

Much of the R800's benefit comes from improved prescription-fill accuracy, especially when it is combined with the Efficiency Workpath System, Marable added. The Efficiency Workpath System uses bar-coding and imaging every step of the way. It dramatically improves accuracy."

Marable cited recent research that finds that the average pharmacy makes four errors out of every 250 prescriptions. "Obviously, there's a heavy liability figure associated with that," he said.

Other advances in automated drug-dispensing technology were debuted at the NACDS pharmacy show, as well. ScriptPro unveiled its Collating Control Center. Designed to be used with ScriptPro's SP-100 or SP-200 drug-dispensing robots, the Collating Control Center sorts and organizes the robot's output based on the pharmacy's needs. Most commonly, the device sorts multiple prescriptions by patient name, presenting all of the patient's prescriptions in a. single package. The Collating Control Center can also be configured to bundle multiple prescriptions together for deliveries.

Also introducing a new drug-dispensing robot at the NACDS show was a new entrant to the market, Durham, N.C.-based Parata Systems. Its Robotic Dispensing System holds 252 drugs in a 12-square-foot footprint and can fill, cap and label vials at a rate of one per 18 to 25 seconds. More than 90 of the units are already in testing at several national and regional drug store chains, and Parata expects to begin shipping the units commercially next year.

More improvements in dispensing technology are on the way. In the first quarter of 2004, Pittsburgh-based McKesson Automation Systems expects to go forward with a new addition to its family of prescription-filling robots. The new unit, AccuScript, begins beta testing with a major East Coast pharmacy this month and is expected to start testing with another nationwide drug store chain soon.

AccuScript has the capacity to dispense 100 drugs, but can be upgraded to hold 100 more drugs with the addition of an optional attachment. The device can verify, count, fill and label up to 120 prescriptions an hour and occupies less than 12 square feet.

McKesson vice president of marketing and product management Gail Wunderlein-Beigh noted that the unit was designed with ease of maintenance in mind. Drugs and vials can be replenished without interrupting the prescription-filling process. Also, the canisters are self-calibrating and are cleaned as drugs are counted from them. Instead of cleaning out 200 canisters, pharmacy personnel need only clean a single filter every week or two.

"Our customers asked us for a robot with a smaller footprint and with reduced maintenance requirements. AccuScript is our response," Wunderlein-Beigh said.

Central fill

For pharmacies with volumes too great for on-site dispensing robots to keep up with, McKesson offers central filling services through its SI/Baker unit. The unit, formerly a joint venture between McKesson and Paragon Technologies, was fully bought out by McKesson this fall.

McKesson's Nebiolo said the move is consistent with the company's strategy of offering comprehensive filling solutions. "One of our goals this year is to bring our entire cadre of products and services together for the marketplace.

"Central filling plays an important role in that," he added. "We've found that especially in the large chain market, executives are looking for vendors to partner with, not piecemeal solutions. So it's important that we have a full range of answers so we can be that partner."

Centralized filling makes good business sense, too. According to Fort Worth, Texas-based PDX, pharmacies using central filling can reduce their labor costs by 30 percent to 36 percent and can reduce capital costs by 16 percent.

PDX is ramping up its own centralized filling presence with a new 200,000-square-foot centralized pharmacy to be opened this coming summer. instruction of the facility began last summer. When it is complete, the centralized pharmacy is expected to have capacity to fill 250,000 prescriptions per day, all delivered to individual stores by Federal Express on a next-day basis.

Telepharmacy

One of the more intriguing stories in emerging pharmacy technologies comes in the form of telepharmacy, which aims to reduce human resource demands in the pharmacy by hosting some functions--including pharmacist consultation--remotely.

ScriptPro is among the first solutions providers to explore this area. "In the past, there have been some vending machine-like telepharmacy solutions tried, but none met with great success because the necessary level of integration and infrastructure hadn't existed yet. But that's changing rapidly today, said ScriptPro president and chief executive officer Mike Coughlin.

ScriptPro is expected to make its telepharmacy solution commercially available soon. So far, it has been in testing in a clinical setting at some Veterans Administration pharmacies and, Coughlin told Drug Store News, the results to date have been overwhelmingly positive.

ScriptPro's telepharmacy solution consists of its SP Automation Center drug-dispensing system and teleconferencing gear, including cameras and monitors. With this equipment, a pharmacist at a central location can manage several pharmacies at once, down to patient counseling,, prescription fulfillment--even replenishing the robot. Coughlin said the solution is ideal for locations with frequent lulls in customer traffic. When the store is quiet, customers can consult with a pharmacist remotely, allowing the chain the luxury of not staffing that store during those hours.

But don't customers miss the face-to-face contact with their neighborhood pharmacist? Actually, quite often they prefer the remote conferencing," Coughlin said. "Sometimes they are embarrassed about their health condition, and the fact that the pharmacist is removed from them allows them to feel more at ease and speak more openly about their condition." He added that pharmacists connected through ScriptPro s telepharmacy solution have the option of counseling patients with a number of counseling videos. Patients can interrupt the videos at any time if they have questions.

The one thing pharmacists can't do with the telepharmacy solution is give the patient the medication. An on-hand technician still must be present for that.

Emerging technologies

Solutions providers also are working in a host of other emerging areas designed to reduce labor demands in the retail pharmacy setting.

Electronic kiosks are beginning to come into their own as viable pharmacy solutions. QS/1 has one in the works. The company is about to begin an in-the-field beta test of the yet-to-be-named product. QS/1's Thompson said the kiosk is designed to bring customer-facing Web-enabled services into the store. Most notable among QS/1's kiosk functions is its prescription reordering capability "The kiosk can be placed near the pharmacy counter and essentially act as a secondary prescription dropoff point," Thompson said.

Patients can key in their refill numbers at the kiosk, and the refill order is dropped automatically into the store's integrated pharmacy management system. Patients also can scan their bar-coded prescriptions into the kiosk with an optional scanner attachment. Once they have input their refill numbers and their order is accepted, the kiosk tells the patient when his or her order will be ready. If the patient is out of refills, the kiosk will offer to contact her physician for her. The kiosk also can serve as a source of health information. QS/1 loads the kiosk with a volume of Web-based health content based on the retail customer's needs and budget. The kiosk is comprised of only a pedestal and a touchscreen. Its tiny 1-square-foot footprint ensures that the kiosk won t get in the way of daily operations.

Mobility is beginning to take on increased importance in the pharmacy space. To address that need, McKesson plans to debut handheld devices for pharmacy usage early next year. The devices will interface with McKesson's AutoLink pharmacy management solutions.

Why would in-store pharmacists need handheld units? "It's largely a matter of mobility and counter space," Wunrlein-Beigh said. "Pharmacists want to be able to fill prescriptions and access information from wherever they are behind the counter. If you have only one terminal and multiple pharmacists, that can lead to crowding and awkward delays for the patient. Handhelds give the pharmacist instant access from wherever they are."

Also attempting to make its solutions more portable is ScriptPro. The company is testing a mobile version of its Checkpoint prescription verification and management device. Coughlin said the device is designed to be carried by delivery drivers for signature collection. Just as important, he said, the device provides the driver with a host of information on his cargo: Namely the prescriptions on his truck, their delivery addresses and the names of the people authorized to receive them.

Another promising technology is RFID, a scanning technology that works like barcode scanning except that RFID tags are read through radio waves instead of optics. No line of sight between scanner and tag is necessary.

GSL Laboratories, based in Vancouver, Wash., is exploring the possibilities of RFID. Chief executive officer Shelton Louie was secretive about GSL's plans, but said the company is thinking about RFID-enabling its IntelligiCab automated will-call system.

"We expect it will take a lot of the time and effort out of tracking prescriptions through the pharmacy," Louie said.

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