The Sync Workflow
Medication synchronization is a popular service offered by more and more pharmacies. The premise is two fold. One: create a convenience for your patients such that they only have to stop by the pharmacy once to get all of them medications. Two: allow the pharmacy to optimize its own workflow, as refills are now able to be scheduled like an appointment. This makes upcoming work load more predictable. The theory behind this would seem simple enough. In practice, however, synchronization is a little more challenging. Synchronization is more than just an auto-refill feature (offered by some pharmacy management systems). It involves actively validating all medications and quantities each sync period. This means a call to the patient and quick calculations of what the patient will need for the next sync cycle.
Medication synchronization at the very basic level is just a paperwork exercise. Simplify My Meds and other programs offer a paper based workflow to plan and execute synchronization. In our practice, after starting with a simple paper based system, it quickly became obvious that the operation could be very time intensive to the pharmacy staff. We realized that the process needed to be automated if we were going to move from a few dozen patients to a few hundred or even thousands of patients. There are a variety of vendors that now offer software services for synchronization. These allow the pharmacy staff to schedule and update each sync cycle. These software packages, however, are no better than the data that they extract from the pharmacy management system, and we have seen many problems arise with inaccurate or incomplete data being pulled by the vendor. This has resulted in our staff spending extra time verifying the data before synchronization can progress. The automated systems have the potential to save time, but until the data can be presumed accurate, we are still not optimizing our staff.
The workflow of synchronization ends on the prescription counter. On a given week, we are able to schedule the filling of sync patients during less busy times of the day because we know what prescriptions need to be filled several days in advance. Even with a reasonable barometer of pending workflow, we still end up congested on our prescription counter. The process could benefit from optimization. To do this, we need to speed our fill and check cycle, and robotics are an effective vehicle to accomplish both goals.
Rosie the Robot
Awhile back I wrote about our SuperSync program which leverages our Parata Pass robotic “unit dose” packaging robot. Our Pass-208 was named Phyllis (a play on the verb fill) was originally purchased to handle nursing home business. We have more and more patients that are electing to receive their retail medications using this method, and this has helped with our congestion issues. But as fast as the SuperSync patient base is growing, our sync program overall is growing faster. We had to make a decision: Phyllis is going to be a big sister. In the coming weeks, Max (a Parata Max) will be joining the family.
The symbiotic relationship between a robotic prescription filling robot and a med synchronization program is natural. The combination is so natural that currently Parata is offering a free year of the PrescribeWellness medication synchronization software when one purchases the machine. Using Max, our pharmacy can be actively filling med sync patients overnight, and the pharmacy tech or pharmacist can check the medications and get them to the shelf for pickup first thing in the morning.
Workflow Modifications
One of the more interesting discussions we had with respect to our workflow (working toward the upcoming installation of the robot) centered around our pharmacist’s CMM (Continuous Medication Management) program. Our normal workflow is:
[Intake] -> Data Entry -> Filling -> Final Verification* -> CMM -> Will Call
*In our practice, we are using a New Practice Model, which allows the Final Verification step for routine refills to be completed by a certified technician who has received extra training.
The CMM component for all prescriptions (regardless of the person doing final verification) must be done by the pharmacist.
In our discussions, our Medication Sync program starts with the pharmacist doing a reconciliation of the patient medications each sync period. Our workflow, therefore, could be modified to move the CMM to the beginning of the model along with the reconciliation done by the pharmacist:
CMM -> Data Entry -> Filling (overnight by robot) -> Final Verification* ->Will Call
This further decreases congestion on our counter as a significant number of prescriptions can be filled overnight and checked by a technician and moved directly to will call. The only issues are
- how to segregate new prescriptions from refills at the robot level and
- How to segregate Sync refills from non-sync refills
Both of these issues can probably be solved by minor modification to our clinical software system (PharmClin), which is used at the point of final verification.
Closing
While the OnePass packaging option (the Parata Pass 208) is gaining in popularity, we are also growing our regular sync customer base by leaps and bounds. Our goal is to have 30% of or customers on a sync program within the next 12 months. We have enrolled 150 new patients in the last couple of months and currently are at more than 250 sync participants. This change in our workload has lead to some issues with congestion on our prescription counter. Leveraging robotics in our workflow is one way we hope to enhance our workflow. The main goal, as always, is to be sure our pharmacists are free on the counter to perform CMM on every patient picking up prescriptions, making every encounter with the patient count.
