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When Kelly Selby graduated from Southwestern
Oklahoma State University's pharmacy program in 1981, 75% of his time was
spent on basic operational chores. Like most of his colleagues, he used a
typewriter to create labels and consulted massive reference books to check for
possible adverse interactions and dosage errors. He counted tablets and
capsules on a counting tray, poured them into bottles, pasted on the labels,
and filed the written prescriptions manually onto patients' paper charts.
After double-checking everything, he rang up the sale and started the process
all over again with the next prescription.
Selby, the owner of Community Pharmacy in Denton,
Texas, would have preferred spending more time with patients. But the
logistics of running a pharmacy made that impossible. "Still, that was pretty
much the expectation we had at that time of what our duties would be," Selby
said.
But times have changed. Today Selby employs four
pharmacists and fills 250 prescriptions per day--20% more than the national
average of 191--and is supported by an extensive portfolio of systems from
various vendors that have dramatically altered his daily workload. A PC-based
pharmacy management and point-of-sale system manages workflow, flagging
potential negative drug interactions and dosage errors. An interactive
voice-response (IVR) system allows patients to refill prescriptions by phone
and automatically routes calls to the right pharmacy employee. A Web-based
e-prescription service allows physicians to send prescriptions electronically
directly to the pharmacy management system, and a robotic dispensing system
automatically counts pills and fills bottles.
As a result, Selby spends quality time consulting
with patients, using his extensive clinical knowledge to help them understand
the expected outcomes, side effects, and possible lifestyle implications of
the medications they have been prescribed.
"Technology has allowed me to cut the time nearly
in half that I spend on manual procedures," says Selby. "I also get out into
the community and meet with physicians, take them to lunch, get to know them
personally, and generally develop relationships that help me grow my business."
Emerging from Isolation
Technology is helping
pharmacists, physicians, and other health care professionals emerge from the
functional "silos" that make it difficult for them to communicate with each
other, according to Michele Vilaret, Director of Telecommunications Standards
for the National Association of Chain Drug Stores.
"Because miscommunications are dramatically
reduced, the point of sale at retail pharmacies becomes a counseling rather
than a sales event where pharmacists do what they do best: use their clinical
knowledge to explain the particulars of the medication to the patient," said
Karla Anderson, a Managing Director for BearingPoint Life Sciences, one of the
world's largest management and technology consulting firms.
Pushing for True Partnerships
The goal is to integrate the many
different types of systems available to pharmacists, physicians, HMOs,
hospitals, and pharmaceutical companies. This includes what many believe is
the holy grail of health care technology: electronic health records. When
integration occurs, all health care providers will have secure and transparent
access to all the information they need to better serve patients. This is
likely to have an enormous impact on pharmacists.
"Although all the pieces won't be in place for
some time, with the help of technology, pharmacists are finally becoming
full-fledged members of the clinical patient support team," said Barry P.
Chaiken, Associate Chief Medical Officer for BearingPoint, which provides
design and implementation of next-generation systems for health care
organizations.
"[Pharmacists] possess extraordinary amounts of
clinical knowledge," remarked Chaiken. "They are bright, intelligent, and
highly motivated and should be having a tremendous impact on the practice of
health care. By embracing technology--as many of them are doing--their ability
to become partners with other clinicians should easily be achievable."
Pharmacists couldn't agree more. "I didn't go to
pharmacy school to count to 100," said Richard Ost, pharmacist and owner of
the Philadelphia Pharmacy. He employs three pharmacists and fills 750
prescriptions a day, an astounding 292% over the national average, for 3,800
customers each month. Since he has a small staff, he relies on an automated
pharmacy workflow system that makes it possible for him to handle his heavy
volume. "The more that technology can take over basic operations and
facilitate communications with other health care professionals, the better job
I can do serving patients," noted Ost.
The Evolving Physician–Pharmacist Relationship
It's not just pharmacists' own
automation efforts that are enabling professional transformation. The
increasingly sophisticated point-of-care (POC) systems being installed in
physicians' offices are also having a dramatic effect on pharmacists' lives.
Such systems typically include comprehensive drug
and even insurance formulary data, in addition to electronic patient records,
diagnostic aids, and treatment guidelines. By consulting these systems before
writing prescriptions, physicians eliminate the "ping-pong" phone calls that
were previously needed to clarify, modify, and correct prescriptions.
Initially, many pharmacists felt threatened by
these systems, perceiving them as usurping their professional
responsibilities, but now they welcome the technology. "The pharmacist is
still the expert in medication therapy and is invaluable in aiding the doctor
to pick the best pharmacological regimen for that patient," commented Mitch
Rothholz, Vice President of Professional Practice and Member Services at the
American Pharmacists Association. "It is fast becoming a two-way conversation,
thanks to better technological support."
Dr. Salwan AbiEzzi agrees. An internist at the
Palo Alto Medical Foundation in Palo Alto, California, AbiEzzi has access to a
sophisticated POC system that puts in-depth drug data at his fingertips. Yet,
he is more involved with pharmacists than he ever was in the past. "I now know
pharmacists on a first-name basis, something that never happened before,"
AbiEzzi said. "It's much more of a collaborative relationship. If I have a
question about a certain medication or a specific adverse reaction, I fire off
an email message to a pharmacist, and they respond immediately."
"We're actually visible now," said Stephanie
Svoboda, Pharmacy Director of the Ridgeview Medical Center, an independent,
129-bed acute care hospital in Waconia, Minnesota. "We're out on the floors,
side by side with the physicians as they are writing orders. We can catch any
problems at the time, rather than reacting to them later. Before, the attitude
was ‘Oh, that's just a pharmacist,' but now we get a lot more calls and pages
asking for clinical help," noted Svoboda, whose facility is in the process of
implementing an ambitious automation project, including automated dispensing
cabinets, fax imaging modules, e-prescription capabilities, and bar code
packing. Additionally, a pharmacy information system available to both
physicians and pharmacists will perform screening for allergies, dosages, and
interactions. Svoboda said the technology installed thus far has already freed
up 40% to 50% of her time.
Installing the latest technology is also turning
out to be a valuable marketing tool for many other pharmacists. "Increasingly,
doctors are asking us the type of technologies we use and whether we are
signed up for e-prescribing and other automation services," said Gary Melnick,
Director of Pharmacy Operations at Duane Reade, a 230-store retail pharmacy
chain serving the metropolitan New York area, which realized $161 billion in
sales in 2005. The company has installed computer-assisted ordering, kiosks at
80 different locations, e-prescribing and e-fax capabilities, IVR, automated
refill reminders, bar code readers, and a central database that allows
patients to access their medical records from any Duane Reade retail store. In
addition, Duane Reade is beginning to install robotic dispensing machines.
"Physicians are as conscious as we are about the efficiency and increased
patient safety that automation offers," Melnick said.
Alice LaPlante is a freelance writer
specializing in technology issues. She is based in Palo Alto, California.
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