Eliminating bottlenecks

While robotic dispensing remains behind the counter and invisible to patients, other technologies are focusing on speeding patients through the pharmacy more efficiently or improving medication delivery and adherence. In most cases the solutions aim at relieving pharmacists of low-impact duties, such as answering the phone or dispensing refills.

To be sure patients have been using automatic teller machines at banks for decades. The move to self-service ATM-like machines has only slowly begun to cross regulatory hurdles. According to executives at Asteres and Parata who both offer self-service solutions, the machines are gaining acceptance in grocery stores and other types of locations in which the pharmacy is not always open. Such automation makes sense "wherever you have lots of people creating bottlenecks," explained Linda Pinney, chief business officer at Asteres.

For APhA's Burns, these types of automation may play a critical role as more pressure is put into measuring healthcare outcomes and implementing a value-driven healthcare system.

"Through the Pharmacy Quality Alliance, we are starting to focus on quality measures for pharmacists," Burns explained. Already there are report cards for physicians and hospitals, and pharmacy will be a part of that picture, she told Drug Topics. "We need to make sure that we can answer questions about the value that the pharmacist brings, measuring things like whether duplications or inappropriate therapies are caught. There will be measures for the dispensing process as well as pharmacy clinical services."

The future is now

Matt Johnson, R.Ph., owner of Chet Johnson & Sons Drug Store in Amery, Wis., wasn't exactly worried about how he might be measured when he recently tested the Parata Max at his store. With a large elderly population, the pharmacy has seen an explosion in the number of prescriptions filled. Despite its rural setting northeast of Minneapolis, the pharmacy is filling more than 400 prescriptions and attracting new patients from its pharmacy inside the Amery Regional Medical Center. Johnson's primary concern was freeing up time and ensuring safety. "Safety and accuracy have to remain the top priorities," he said. "If we do something wrong or give someone the wrong medication, it could be catastrophic for the patient and for me."

Automation allowed the third-generation pharmacist to re-orient his priorities, focusing on time with patients and new business opportunities. "We're certainly consulting with every patient now," Johnson explained. "I'm hoping to spend even more time, investigating MTM programs that we did not have time for."

Johnson expects that he will spend more time on ensuring accurate Medicare billing and timely payments. "It was money we were not seeing," he said. He also marvels that "at the end of day, the prescriptions are caught up. We can get the prescriptions run through without staying late or coming in early in the morning, and those sorts of things will only get better."

Time was also an essential consideration for Nick Karalis, R.Ph., of Elwyn Pharmacy in Media, Pa. Karalis recently opened a new 10,000-square-foot facility to handle the pharmacy's burgeoning specialty and long-term care business. The once-sleepy mom and pop operation now handles more than 1,700 scripts a day and has 12 full-time pharmacists between its two facilities. The specialty care business is growing by 30% to 35% a year.

That growth was accidental, Karalis admitted, but he added that the pharmacy maximized its opportunity. The original location was surrounded by a number of nursing homes and "stumbled into" long-term care. Afterwards the pharmacy expanded into personal care and skilled nursing homes and then slowly began to add specialty medications. "We saw that need develop and we got into more and more specialty medication and special disease states," he explained.

Now Karalis is an evangelist for independent pharmacies and sees unlimited potential in specialty pharmacy. He is the founder of the Community Specialty Pharmacy Network, a network of more than 100 independent pharmacies involved in specialty pharmacy services.

"We have automation to do multi-dose packaging, bar-code scanning, script imaging, and six to seven different types of compliance packaging," Karalis explained. "I started with technology five years ago, but it has never replaced an employee or cut down costs. I invest in technology for the ability to grow and for accuracy." In addition to a ScriptPro dispensing robot, the facility includes a data entry center for recording compliance and other critical data and a call center.

Karalis is keeping an eye on the future. His pharmacy developed a Web-based data collection system and is partnering with manufacturers to collect outcome information on disease states. "This is going to be a turning point for pharmacy," Karalis maintained.

Indeed, Karalis does have his eyes on the next step. "The future is going to be around outcomes for patients that are therapy specific," he concluded. "Focusing on that is what is going to differentiate successful independent pharmacies. We can't consider ourselves as a commodity; we are not just pushing pills, we are selling health care."