keBack when I was a pharmacy student, there were still some pharmacies that kept prescription histories for their patients on paper and typed prescription labels on an electric typewriter. The Bates Number Machine was still a staple of many practices. Today, with the advances in computers and electronics, modern pharmacies in the United States use computerized Pharmacy Management Systems (PMSs otherwise known as dispensing systems) almost exclusively.
Today’s modern pharmacy software has helped improve workflow, and ensures accuracy in the dispensing pharmacy. New features are being added to these systems regularly. Today, the point of sale (register) is usually integrated, as is the telephone system (by use of an Interactive Voice Response or IVR system). Some vendors have created iPad based delivery apps and even added limited integration with clinical services like Outcomes and Mirixa. Overall efficiency in pharmacies today is very high, in large part due to these software packages.
But today’s pharmacy systems are really still one-trick ponies. Despite all of the “new” features, these systems still are centered around the dispensing function. Most pharmacists and pharmacy owners becoming aware that dispensing revenue is significantly down (despite increased prescription volume and sales) in pharmacies today.
Right now, the profession of pharmacy is in a transition period; moving from product based reimbursement to service based reimbursement. Traditionally, the services provided by pharmacists and pharmacies have been (unfortunately) given away along side the paid drug product. The payment received for the drug product historically provided enough profit to cover the professional time the pharmacist spent with the patient. Current payment for product, however, is drying up at an alarming rate, and the transition from product based reimbursement to service based reimbursement is still only in its infancy.
The discussion of pharmacy management systems, and the transition of pharmacy as a profession, are intrinsically related. In order to move the transition of pharmacy forward (and ultimately achieve “provider” status with both the State and federally, with Medicare), pharmacists need to prove that what they do outside traditional dispensing is intrinsically valuable.
Almost every newly minted pharmacist since the early 2000’s received a clinically oriented degree, a doctorate in pharmacy (Pharm.D). Many older pharmacists have even gone back and added this degree. The application of the clinical skills vested in these pharmacists, however, is not encourage by many employers. Many pharmacies continue to emphasize dispensing and prescription volume. And why wouldn’t they, because that is (still) what gets them paid.
Despite the lack of clinical emphasis in their workplace, many pharmacists continue to employ their clinical skills. The next obstacle for clinically motivated pharmacists, is their dispensing oriented pharmacy management system, because it is not designed to document the care these pharmacists are implementing. This is a significant problem facing the profession. If we cannot readily document the value we provide, how can we move forward, and transition toward an actual professional fee, or obtain provider status?
This is a real problem for today’s proactive pharmacists, and the problem is going to grow exponentially as the expectation that pharmacists demonstrate their value to the health care system grows. Pharmacies need a way to seamlessly document their actions, recommendations, and overall value to patients and the system, and dispensing focused software is woefully inadequate.
In our practice, the answer was to create our own documentation system to accumulate the interventions our pharmacists effect every day. Over the course of almost a decade, we massaged and integrated the software to the point where every one of our pharmacists record important information and face to face encounters with patients, documenting what was done, what needs to be done, and any communication with other health care providers. Thru tight integration with our dispensing system, the software has become an extension of our business model. Today the product is known as PharmClin. The core concepts of PharmClin are fundamentally simple, but put taken as a whole, and in the context of a clinically oriented practice, the package is so powerful and innovative that it is patented.
Many pharmacists have seen PharmClin in use (by visiting our pharmacies) or have seen images of the product in slides at national meetings. When pharmacists see what we are doing and how we are using PharmClin, most immediately “get it” and want to be able to do the same things themselves. What needs to happen next, is to bring this concept to the rest of the profession. This type of activity and documentation will be a game-changer for our profession. It emphasizes how every pharmacist can make encounters with their patients count.
