201004_CT_July_Aug_2010_Vol30_Num4

For The Pharmacist

Volume 30 Number 4 • July/August 2010

www.computertalk.com

The 2010 Chain MarkeT reporT:

y g o l o n h c Te

A Look AT WHeRe CHAinS STAnd on

WoRkFLoW SYSTeMS - i V R - BARCode SCAnning C e n T R A L P R o C e S S i n g - CenTRAL FiLL - P o S e-SignATuRe C A P T u R e - d o C u M e n T i M A g i n g R o B o T i C S - e-PReSCRiBing - MTM And MoRe story begins on page 27

Plus...

Reducing Waste in LTC n What Healthcare Reform Means to Pharmacy n How Secure is Your System? n

July/August 2010

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In This Issue:

ComputerTalk

®

July/August 2010 Vol. 30/No. 4 for the Pharmacist

The 2010 Chain Market Report:

y g o l o n h c e T

A Look at Where Chains Stand on

Features:

10 Reducing Medication Waste in LTC

by Jim Moncrief and Mary Ann Miller

Recent legislation means that long-term care pharmacy providers are going to need to provide facilities with short-cycle filling, with the goal of reducing waste. There are several different ways to do this and some real benefits from using automation.

13 IT Security and Architecture:

How Did We Get into This Mess?

by Steve G. Belovich, Ph.D.

IT security threats are often in the news. Find out what may make your systems vulnerable, how the forces of the desktop and Internet revolutions shaped today’s status quo, and what you can do to prioritize security.

17 Technology Helping Pharmacies Grow

on The Great American Frontier

by Bruce Kneeland

This is the first of two installments chronicling a road trip through the American West, where the author found innovative pharmacists putting technology to use in order to offer their patients the best in pharmacy practice. See a map of the author’s destinations for this installment by visiting http://tiny.cc/xg6ff.

23 Identifying Workarounds

by Wes Wilkerson, Pharm.D., M.S.

Finding the workarounds in your pharmacy is an important part of assessing how well your processes perform in practice. Read about different tools that you can use to find and assess workarounds.

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ComputerTalk

Departments: 4 Publisher’s Window New Rules Coming 6 Industry Watch 42 George’s Corner 50 Years 45 Technology Corner Survey Reports Huge Demand for MTM Messaging Standard 47 Catalyst Corner The Power of Partnerships 49 Viewpoints Healthcare Reform: The Pharmacy Perspective 52 Conference Circuit American Society for Automation in Pharmacy Midyear Conference QS/1 2010 Customer Conference 55 PeopleTalk 56 Web Sites To Visit 55 Index of Advertisers Exclusive Online Content at computertalk.com

Point-of-Sale Systems from the SaaS Perspective In this interview, ComputerTalk senior editor Will Lockwood talks with Tom Greenhaw, CEO of Cashier Live, a new Web-based, or software-as-a-service (SaaS), POS provider. Greenhaw offers his views on where pharmacy stands with FSA/HRA cards and what POS offers for pharmacists looking to improve their operations.

Let us handle IT

“If we had a Unix system or other platform, we would not be able to save the serious money that we do with a proven Windows system like Cerner Etreby’s.”

Keith Bibelhausen President, Hartig Drug Stores, Dubuque, Iowa

Your pharmacy information technology system should help solve your problems—not create new ones.

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Our reliable, user-friendly work environment offers easy device integration. Routine software upgrades keep you ahead of industry requirements.

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for the Pharmacist www.computertalk.com Volume 30, No. 4 July/August 2010 Staff William A. Lockwood, Jr. Chairman/Publisher

Maggie Lockwood

Vice President/Director of Production

Will Lockwood

Vice President/Senior Editor

Toni Molinaro

Administrative Assistant

Mary R. Gilman

Editorial Consultant

Mel Spigelmyer Cover Design

ComputerTalk (ISSN 07363893) is published bimonthly by ComputerTalk Associates, Inc. Please address all correspondence to ComputerTalk Associates, Inc., 492 Norristown Road, Suite 160, Blue Bell, PA 19422-2339.

Phone: 610/825-7686.

Fax: 610/825-7641.

Copyright© 2010 ComputerTalk Associates, Inc. All rights reserved.

Re­pro­duc­tion in whole or in part without written permission from the publisher is prohibited. ­Annu­al subscription in U.S. and terri­tories, $50; in Canada, $75; overseas, $85. Buyers Guide issue only: $25. Printed by Vanguard Printing.

General Disclaimer Opinions expressed in bylined articles do not necessarily reflect the opinion of the publisher or ComputerTalk. The mention of product or service trade names in editorial material or advertise­ments is not intended as an en­dorsement of those products or services by the publisher or ComputerTalk. In no manner should any such data be deemed complete or otherwise represent an entire compilation of available data.

Member

ASAP 2010

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ComputerTalk

publisher’s window New Rules Coming

Bill Lockwood, Chairman/Publisher

I just finished looking at the proposed rules from HHS that will update the HIPAA privacy, security, and enforcement final rules. The reason for this is to synch up the HIPAA rules with the HITECH Act. This act expanded many of the provisions dealing with privacy, security, and enforcement under HIPAA. First, with the HITECH Act business associates are now faced with the same requirements as covered entities. Because of the much stiffer penalties in the HITECH Act, covered entities and business associates alike must be mindful of not being caught for “willful neglect” if a person’s protected health information is compromised. A good way to avoid willful neglect is to be in compliance with the HIPAA security requirements. Specifically, you will want to have your security policies and procedures well documented and updated on a regular basis. The security rule tells you what you must do. I would not give this short shrift.

Something that caught my attention in reading the proposed changes was the notice of privacy practices (NPP) that covered entities are required to distribute to patients. HHS is asking for comments on several changes it is proposing for information to be included in the NPP. Chances are pharmacies will be issuing a revised NPP to patients when the final rule is published. Even though this is a one-time distribution, it’s another cost pharmacies must absorb.

As for a patient requesting nondisclosure of prescriptions to a health plan, there are a few scenarios HHS gave in order to illustrate the complexity of compliance. One scenario was for a prescription sent electronically to the pharmacy, where it gets adjudicated prior to the patient’s arrival to pick it up.

The patient, however, did not want this prescription billed to the health plan.

This is a good example of the devil being in the details. If patients remember to tell physicians they do not want a prescription disclosed, physicians could revert to a paper prescription. But this flies in the face of trying to get physicians to abandon paper prescriptions in favor of electronic prescriptions. HHS is asking for comments to help address the problem areas identified with nondisclosure.

There is a lot to absorb with the modifications HHS is proposing. Large chains with internal legal departments have an advantage over independent pharmacies. My advice for the independent is to retain the services of a lawyer to read the HITECH Act as well as the HIPAA final rule dealing with security, and advise on the steps that should be taken. You may want to download a copy of the proposed modifications to HIPAA and give it a read. Go to http:// edocket.access.gpo.gov/2010/pdf/2010-16718.pdf.

There will be enforcement of the HITECH Act, there will be audits, and there will be fines. The fines will provide the funding for the audits. As I mentioned earlier the number one priority is to avoid being caught for willful neglect in the event of a security breach. CT

Keep customers

coming back.

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1-800-231-7776 www.qs1.com © 2010, J M SMITH CORPORATION. QS/1 is a registered trademark and MSM is a trademark of the J M Smith Corporation.

Industry

Watch

Mobile Phone Apps Link Patients to Pharmacies TeleManager Technologies has introduced an app for the

Apple iPhone and iPad called iRefill.

This app will allow smart-phone users to order refills as well as get information about the pharmacy.

Paul Kobylevsky, cofounder and COO of TeleManager, says this is the first pharmacy IVR company to have been approved by Apple to provide this app and have it released by the Apple app store. He explains that iRefill is an extension of the company’s patented technologies like ASP/SaaS IVR and its Internet refill application.

The company has plans to offer similar versions for the Blackberry, Android, and other phones.

More Search Engines Support VIPPS Accreditation Microsoft and Yahoo have decided to follow Google’s lead by implementing a new policy that requires online pharmacies to be accredited by the National Association of Boards of Pharmacy’s (NABP) VIPPS program in order for online pharmacies to advertise on Bing.com and come up on Yahoo’s U.S. Sponsored Search results.

VIPPS, which stands for Verified Internet Pharmacy Practice Sites, was launched by the NABP to give consumers the confidence that they are ordering prescriptions from legitimate pharmacies. mobile applications,” says Jeff Farris, CEO and president of PDX.

Robotics Improves Health Center’s Efficiency Northeast Valley Health Corporation in San Fernando,

PDX is another company that has announced mobile phone functionality. PDX has partnered with mscripts, a leader in mobile phone technology, for the integration of this service with its PDX pharmacy system.

Calif., a nonprofit community health center serving uninsured and underserved residents of San Fernando and Santa Clarita valleys, is now using Innovation’s PharmASSIST ROBOTx robotic dispensing system in its 12 health centers, including a state-of-the-art mobile van.

Because of the integration, PDX users can make the service available to their patients for two-way, interactive messaging that supports a wide range of phones, including the iPhone, BlackBerry, Android, Windows Mobile, and Palm.

The robotic systems allow the health centers to keep up with the daily prescription workload, where the number of prescriptions filled can reach 1,200 a day. The robot is filling about 50% of these prescriptions.

“By partnering with mscripts, we are able to expand our offerings and provide our customers with an increasingly widespread means of transacting business with their patients and providing them with greater accessibility to their prescription information through text messaging and

In addition to boosting productivity, the dispensing system is facilitating plans to open another center without having to hire additional staff. According to Rosie Jadidian, director of pharmacy, “This is the first time we’ve been able to move forward with our current staff, so

6

ComputerTalk

we’re also looking forward to realizing a true labor savings because of the technology.”

New Drug Management System TCGR x (TCG), based in Powers Lake, Wis., has introduced

its Beacon system in the United States and Canada. This is a drug management system that replaces the traditional method of alphabetized medication organization with a computerized system based on utilization. Low-energy LED lights direct the pharmacist or technician to the medication stock location, which is then verified with a barcode scanner.

Organizing medication usage by activity makes the Beacon system’s high-density shelving space efficient.

A Beacon system with 100% of the formulary can be as small as 400 square feet. This smaller footprint allows pharmacies to increase profits by increasing the size of retail or counseling space, while reducing unnecessary and wasted staff movement. continued on page 8

July/August 2010

7

Industry

Watch

continued from page 6

The inventory control and reporting functionality track on-hand inventory levels, usage, returnable inventory, expired inventory, and will-call expiration.

One user of the system, Wayne Macardy, president of Phillips Healthcare Pharmacy, says that the system “allowed us to stay in the same building that we have been in for nearly 100 years and still be able to add a drivethru window and a closed-door pharmacy within our existing retail space.”

Adherence Program Increases Pharmacy Loyalty McKesson Patient Relationship Solutions, a

division of McKesson Corporation, has announced that last year its medication adherence program reached more than six million patients. It has also found that an increasing number of patients are enrolling in the company’s

LoyaltyScript program, and as a result are adhering more closely to prescribed therapies.

The program provides manufacturers with a way to strengthen patient relationships. The Web-based portal supporting the company’s offerings, including LoyaltyScript, gives manufacturers secure access to enrollment, program benefit data, and adherence measures that are updated daily.

Recently, McKesson was named a laureate in the Computerworld Honors Program for the innovative technology behind its medication adherence solutions.

Survey Provides Insights into LTC QS/1 and the A merican Society of Consultant Pharmacists (ASCP) have teamed up to conduct the

first survey taking a detailed look at the business operation of long-term care (LTC) pharmacy providers. The findings were presented at the opening of the ASCP midyear conference this year in Phoenix, Ariz.   that will be extremely help “This survey provides data  ful to pharmacists, pharmacy owners, and managers as  they evaluate their productivity, financial statistics, and     contracting terms,” says John Feather, ASCP CEO.   

                               

   8

ComputerTalk

 done  The survey was last year and focused on areas  such as gross profit margins of long-term care/closeddoor pharmacies, pharmacist salaries, Medicare Part A   contracting terms, and implementation of technology solutions.  











 “This report can help long-term care pharmacies see an  overall view of how business is being conducted across the   nation and adjust their terms and prices accordingly,” says Tammy Devine, QS/1 executive VP. 

Plans are underway between the two organizations for the  2010 survey. 

ASCP members can download a copy of the report at no   to www.ascp.com/business. For noncharge by going  is      members there a modest charge.     

Pharmacists Given Reconciliation Service Option 

Freedom  Data Services (FDS) has announced

that pharmacy owners now have the option of off-loading

the management of third-party claims reconciliation to the FDS reconciliation team. According to Clarence Lea, VP of marketing and industry relations, many owners want to free themselves of this task in order to have pharmacy staff available for additional patient-focused services.

With the reconciliation service, new features include reconciliation of claims from all payers, an online ability to review the status of claims from the past 15 weeks, a search tool that makes it easier to access and enter claim details, and a new centralized collections process for outstanding payments.

The FDS eConcile reconciliation program is a Web-based service that lets pharmacy owners do their own third-party claims management.

With the new eConcile Complete, FDS will manage this for the pharmacy to ensure timely and accurate payment from third-party payers.

Emdeon Shares Experience with DEA

Whether done by the pharmacy or the FDS staff, the reconciliation service can handle both a manual payment advice and the 835 electronic remittance advice.

Helping Independents Gain an Edge At its annual trade show for independent pharmacies in July, Cardinal Health introduced new services to improve reimbursement on third-party claims and marketing tools in order to do a better job of promoting the pharmacy and improving the customer experience.

According to Steve Lawrence, senior VP of independent sales for Cardinal, the new suite of marketing tools can be customized with the pharmacy’s name in order to build its own brand within the community.

These include new Web site design templates that are easy to personalize, a new in-store radio system to control what music the pharmacy’s customers hear, new and easier ways to order customizable in-store signage, custom TV and radio commercials tailored to the store’s products and services, and outbound calling services to increase prescription refills and market special promotions and services.

Through its eR x Network, Emdeon is participating in a

research project with the Massachusetts Department of Public Health for e-prescribing of controlled substances. The project began in 2007, and the company believes the lessons learned can assist in developing implementation guidelines for the DEA’s final rule for e-prescribing of controlled substances.

In commenting on the DEA’s interim final rule, the company noted that it believes the industry will take a significant amount of time to implement formal standards that address all parts of the final rule and suggested that the DEA consider interim guidelines to support adoption variances to achieve quicker adoption.

“Security and data integrity are the most important factors driving the future success of e-prescribing of controlled substances,” says Rick Sage, Emdeon’s VP of clinical services and manager of the company’s participation in the Massachusetts project. He notes that while the DEA’s interim final rule requires some specific requirements that differ from the Massachusetts project, there are enough similarities to enable Emdeon to readily assist its partners in implementing and complying with the final rule, when published by the DEA. CT

July/August 2010

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Reducing Medication Waste in LTC

by Jim Moncrief and Mary Ann Miller

A

mong the inclusions of the recently passed healthcare reform legislation is the requirement to, by Jan. 1, 2012, “reduce wasteful dispensing of outpatient prescription drugs in long-term care facilities under prescription drug plans and MA-PD plans.” The legislation specifically describes weekly, daily, or automated dose dispensing to patients in long-term care (LTC) facilities in order to reduce waste associated with 30-day fills.

The Centers for Medicare & Medicaid Services (CMS) plans to direct pharmacies serving long-term care facilities to deliver a 7-day or less supply of medications. Medication waste in long-term care has been a concern within CMS prior to the healthcare reform bill.

To understand why this was addressed in the legislation, let’s examine some of the history of medication dispensing in long-term care facilities.

From Soufflé Cups In the early days nurses spent hours in the medication room preparing for each med pass by removing pills from pharmacy bottles and vials and then “pouring” each resident’s pills into a paper soufflé cup. When blister cards came along it was considered a major step forward. These cards eliminated pour time and increased accountability.

Blister cards would be placed within the medication carts at the facility, typically in room order, to increase pass efficiency. Other systems were developed, including 7-, 14-, and 30-day unit-dose packages, but frequently met with nurses’ complaints of difficulty in opening this packaging.

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Today, shorter-stay residents are becoming the norm, with frequent changes in drug regimen following surgery, illness, or accident.

Shorter Stays Historically, long-term care facilities were passing “maintenance” type medications taken by long-stay patients, allowing some certainty that the medication regimen would be stable and resulting in the entire 30-day amount being used. Pharmacies refilled medications at various intervals prior to the last dose. Orders that were not faxed from the nursing facility in time to make the next delivery frequently resulted in missed doses.

Today, shorter-stay residents are becoming the norm, with frequent changes in drug regimen following surgery, illness, or accident. If a drug order changed, unused medications in longer cycle systems such as 30 days are wasted, and the payer is billed regardless of the amount used.

A Technology Leap Forward Remote automated pharmacy dispensing uses medication packaging and dispensing machines for oral solid medications designed to provide the highest level of packaging accuracy. In addition, these systems incorporate a unique combination of barcode and microchip technology in a cartridge/container building block or cell that serves as the foundation for the packaging process. There are several

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Reducing Medication Waste machines on the market with this capability.

These automated dispensing machines are placed within the nursing facility and are controlled by a central-processing system in the pharmacy. Medication orders are only released for packaging after the pharmacist’s final review of the order.

These machines can hold bulk quantities of more than 250 frequently prescribed medications for first dose, stat usage, and daily medication administration. Oral solid medications are automatically packaged in multidose form for each med pass. The medication is placed within a med-pass-specific, multidose envelope/package, then imprinted with the patient’s name and room number; the date, time, and quantity; and the name and strength of all medications. This type of packaging has clear view windows for maximum accuracy and an easy-to-open, tamper-evident crimp seal for safety.

An independently conducted study in 36 skilled-nursing facilities using remote automated dispensing for Medicare Part D transactions showed that this platform has the highest potential for reducing drug costs by reducing waste through just-in-time packaging for each medication.

Cost to the Pharmacy

Above, nursing staff who are responsible for each unit enter their user ID and PIN number and retrieve their PassPort Med Tote for that unit for that time pass. At left, the envelopes are automatically placed in room number order in a separate time-specific PassPort Med Tote for each nursing wing or unit. The AP PassPort remote automated dispensing system shown here is a product of Advanced Pharmacy.

creased labor and packaging expense. And there may also be costs involved if billing systems have to be changed, but waste can be decreased over a 30-day system.

Remote, patient-specific medication packaging just prior to the med pass offers the greatest decrease in medication waste of the drug distribution systems on the market today, and creates the added advantage of increased nursing efficiency and accuracy, but it, too, is not without

Even reducing the number of days’ medication supply to 7 days does not completely eliminate waste. In addition, changing to a centralized (in the pharmacy) short-cycle strip pack fill, such as 7 day, 4-3, or 2-2-3, requires a significant technology investment for the pharmacy, plus inFigure 1. Savings realized from remote automated dispensing compared

continued on next page

Month

with other types of dispensing.

Remote Automated Dispensing Expense

4-3 Cycle

Savings

Expense

1

$511,838.18 -25.56%

$515,977.19

2

$491,996.99 -25.12%

3

Number of Patients Served

Total Rx’s

Expense

-24.96%

$567,212.91 -17.51%

$687,634.45

1,869

11,822

$502,359.08

-23.54%

$538,267.45 -18.08%

$657,086.00

1,849

11,485

$490,660.17 -26.58%

$498,523.77

-25.41%

$549,324.14 -17.81%

$668,364.32

1,854

11,584

4

$514,897.32 -25.30%

$527,421.70

-23.48%

$563,514.48 -18.25%

$689,331.96

1,903

12,335

5

$522,239.12 -25.39%

$532,339.04

-23.95%

$585,211.23 -16.40%

$700,041.18

1,918

12,136

6

$527,546.30 -23.95%

$539,049.01

-22.29%

$588,113.22 -15.22%

$693,746.07

1,922

12,162

7

$506,005.76 -29.32%

$420,073.86

-27.35%

$562,394.08 -21.44%

$715,944.12

1,996

12,738

% -25.89% AVG Savings

Expense

30-Day Fill

Savings

AVG % Savings

Savings

7-Day Fill

% -24.43% AVG Savings

-17.82%

AVG 1,902 AVG 12,037 July/August 2010

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Reducing Medication Waste continued from previous page

additional expense to a pharmacy currently providing a long days’ supply of medication. However, there are some savings in labor and delivery expense with automated remote dispensing

Study Methodology Figure 1 (on previous page) shows calculations made to predict what the medication expense and savings would have been with remote automated

dispensing systems and other medication systems such as a 4-3 and 7 day against a 30-day fill cycle. Given that the price for a prescription is made up of ingredient cost and dispensing fee, it was presumed that the fee would remain the same regardless of the days’ supply dispensed. Removing the fee from the allocation and recalculating the remaining portion of the selling price (based on an increase in days’ supply) should lead to a reasonable approximation of the cost had a longer

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The study included actual dispensing activity for a pharmacy using remote automated dispensing technology located within the nursing facility. The findings reflect only those 170 routinely filled medications that were in the remote dispensing system. There were 1,902 patients represented.

The results showed a 25.89% savings using remote automated dispensing, compared with the use of 30-day blister cards. These savings resulted from prescriptions that were not entirely administered PrimeESC Electronic Signature Capture during a month because the patient was discharged or died, or the medication was discontinued.

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cycle been used by the pharmacy.

It is clear from the study that remote automated dispensing technology can reduce waste and, consequently, the cost to the payers of these prescriptions. The use of this type of technology is most likely what the market is going to demand as we move forward.

Pharmacies stand to benefit from increasing the service levels to the homes. CT Jim Moncrief is chairman of Advanced Pharmacy, located in Columbia, Md., and Mary Ann Miller is senior VP for the company.

The authors can be reached at jmoncrief@advanced pharmacy.com and mmiller@advanced pharmacy.com.

IT Security and Architecture: How Did

We Get into This Mess?

by Steve G. Belovich, Ph.D.

T

he past year has witnessed an amazing number of articles, reports, seminars, and news stories about successful hacking attempts and the lack of data and/or network security. The GAO reported in May 2009 that: Despite indications that agencies have improved their compliance with parts of the Federal Information Security Management Act (FISMA), many major agencies still consider their information security controls a significant deficiency or material weakness. (Source: fcw.com/articles/2009/05/19/web-fisma-informationsecurity.aspx)

Even mighty Google is not immune and is a target, as this excerpt from an April 19, 2010, article in The New York Times shows: Ever since Google disclosed in January [2010] that Internet intruders had stolen information from its computers, the exact nature and extent of the theft has been a closely guarded company secret. But a person with direct knowledge of the investigation now says that the losses included one of Google’s crown jewels, a password system that controls access by millions of users worldwide to almost all of the company’s Web services, including email and business applications. (Source: www.nytimes.com/2010/04/20/technology/20google. html) A common thread that runs through these articles is the network, and the focus is always on intrusion detection and how the network is configured. After all, hack-

What’s the Real Problem?

“IT security problem” (ITSP) is a generic term for the problems that arise when trying to achieve a set of operation-related goals. There are six members of the set: IT systems should do exactly what they are intended to do.

IT systems should operate when intended.

IT systems should work on behalf of duly authorized personnel.

IT systems should never do what is not intended.

IT systems should never operate when not intended.

IT systems should never work on behalf of nonauthorized personnel.

ers gained access to Google’s code base through a Web browser, which, in retrospect, seems a huge oversight.

What is totally ignored in analyzing IT security issues is the fundamental engineering and architecture of the IT systems that were penetrated and what can — or should — be done about that.

Requirements for a Secure System A lot of research was done in the 1960s that ultimately discovered that security had to be designed into an operating system (and into an IT system) from the ground up. Note that this security had two main operational components: multiuser protection and preventing continued on next page July/August 2010

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IT Security continued from previous page

unauthorized accesses. The results of this research revealed the necessary components of a secure, trustworthy system, summarized below: Policy Security Policy – System must enforce a well-defined security policy.

Marking – System must associate all objects with access control labels (sensitivity and access modes).

Accountability Identification – System must identify individuals and their various authorizations in a secure manner.

Audit Trail – System must keep and protect an audit trail so actions may be traced to the responsible party.

Assurance Evaluation – System must have hardware/software mechanisms that can be independently evaluated to assure that policy and accountability are enforced.

Continuous Protection – System must continuously protect trusted mechanisms that enforce policy and accountability and prevent tampering.

The Reference Monitor As part of these requirements for a secure system, the “reference monitor” concept was introduced. This was a logical structure built into the lowest level of the operating system (OS) that adjudicated the access of any subject to any object. The reference monitor (RM) is shown in the diagram in figure 1.

The RM mediates all accesses of objects by subjects. With properly defined subjects and objects, the RM, combined with the principles of a secure system architecture,

provides a trusted and verifiable security policy enforcement mechanism.

Where the RM Is (or Is Not) Used Some operating systems incorporated this concept at the lowest layer, right above the FLIH (first level interrupt handler). Most did not. The reason was that the installed base of existing systems prevented radical modifications to the underlying software structures. Adding the reference monitor would have been a very radical modification, which would have included creating a new file system.

Simply put, the size and inertia of the installed base prevented the fundamental reengineering and redeployment required for a truly secure OS.

The Desktop Revolution The lack of an RM is a result of the fact that consumer market economics limit design choices. Cost has always dominated the retail market. The cheapest, simplest design is the one that wins. Security, performance, etc., are all secondary to cost. The PC OS was made simple and dumb, with bare minimum support for a file structure.

The initial protection mechanism was physical: Lock it up. Multiuser support, multiuser protection, and system security were deliberately eliminated from the design because early PCs were intended for the home market, where there would be one user at a time and security was not a concern. Price and convenience drove the design, and they still do today.

The Invention of the Internet In parallel with this was the development of the Internet, which was really born out of Dr. Leonard Kleinrock’s work at MIT in the early 1960s, along with DARPA (Defense Advanced Research Projects Agency). The main networking goal in the early days was simply getting it to work! Early protocols were simple, with some complexity added later on to prevent errors such as lockups and other early “denial of service” situations that had a variety of causes, including a lack of reassembly buffers for lengthy messages.

Figure 1. The reference monitor is one part of the security structure requirement.

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Because getting the entire network to operate correctly was the goal, early network protocols ignored security. Additionally, the technologies used were intended to make hooking up to the network quick and easy.

Security was not required for early networks because access was physically controlled.

Also, the built-in access control mechanisms of the mainframe or central machine were

feature

IT Security well established and well understood.

The network simply presented the access request to the mainframe, which had the responsibility of granting or preventing access.

PC OS: No Secure Foundation

do that. It now mattered who could access what specific resource of which machine and when. Privileges (what you’re allowed to do) and quotas (how much of something you’re allowed to use) now became important.

So, the personal computer now needed a secure foundation, and it While networking was improving, just was not there. Usernames, passthe initial OS designs for PCs discard- words, and some limited-permission ed or ignored the “mainframe/mini” concepts of shared resources, multiuser access, memory protection, multilayer operation modes (e.g., kernel, executive, supervisor, user), user isolation, file-level access protection, ACLs (access control lists), privileges, quotas, etc.

management were the best that could be done. However, such access control mechanisms were crude and easily defeated. There was no underlying security mechanism for the PC operating system, and no easy way to add it, either. The size of the installed base and the economics of the consumer market prevented the much-needed continued on next page

SIMPLY THE BEST VALUE IN PHARMACY SOFTWARE

These engineering concepts were essential for a secure system in a multiuser environment because they allowed many users to share the computing resources (CPUs, RAM, disks, etc.) without interference. One user’s mistakes did not percolate over to another user. The operating system handled all the housekeeping and ensured that the entire computing system operated correctly, even if an individual user did something stupid.

These critical engineering concepts were not included in the architecture of the home computer because they had no economic purpose, and there was simply no demand for such features.

The problem is that such features really need to be engineered in from the beginning in order to work properly.

Adding them afterward is nearly impossible — and it has not occurred yet in the PC market. We are now living with the consequences of that.

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7/23/08 3:51:49 PM

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IT Security continued from previous page

reengineering of the desktop OS. Why bother to create it if you cannot sell it?

As an example, just adding proper “object marking” (a key requirement for a secure system) would require a brandnew file system, which would force the replacement of the entire installed base of PCs and software. By way of a benchmark, that installed base is about a trillion dollars.

Replacing all that just ain’t gonna happen.

The Fatal Flaw Although the weaknesses of the desktop operating system were well known early on, IT managers found the technology to be very attractive, convenient, easier to understand, and cheaper. After all, if it worked at home, it should be fine for the enterprise, right? Scaling up just seemed easy.

So, PCs migrated from the price-driven consumer market to the performance-driven enterprise. All in all, it looked like a smart move for business. The problem with that move was that the requirements of a business are far different from those of an individual user. The desktop was engineered to meet the needs of the consumer market, which wants the machine for entertainment purposes, Web surfing, and social networking, rather than for traditional computing.

Saleswise, consumer PC sales outnumber business PC sales by nearly a thousand to one, so that part of the market controls everything else. Clearly, business requires more secure systems, but the marketplace is not providing it because it’s listening to the consumer side. As we’ve seen, truly effective security is just not possible without fundamentally changing the desktop. That can’t happen due to the size of the installed base and the corresponding economics that prevent change. So here we sit!

What to Do? There are no quick fixes to this problem. One thing, however, is almost certain. The growing body of lawsuits on software security, safety, and reliability issues will lead to federal and/or state regulation. While no one welcomes this prospect, it is due to the inability and unwillingness of the software industry to police itself. The identical thing occurred with the automobile industry in the early 1900s.

Now we have the National Transportation Safety Board, among other organizations, to ensure travel safety.

In the meantime here are some helpful suggestions, which, if carefully followed, will reduce your risk. ❒ Recognize that desktop technology is not secure and was never intended nor designed to be secure. So do not 16

ComputerTalk

deploy critical applications on such systems. Just don’t do it. The desktop is best suited to serve as an interface to a centrally managed, secure application using a very thin-client architecture. ❒ If something is available via a Web browser, it can be

hacked. All Web browsers on desktop operating systems are vulnerable. So do not allow browser-based access to anything critically important. Use a thin client like Xlib for desktops to support a centrally managed graphical user interface (GUI) rather than a browser.

❒ Understand that your network will always be polluted to

some extent. The TCP/IP protocol is flawed because it permits challenge/response without authentication. So it will always be possible to do remote footprinting, scanning, and enumeration — which are the three essential steps in the hacking process. Proper firewall configuration — and the use of only stateful firewalls — will help a lot but cannot completely prevent unauthorized traffic.

❒ Deploy critical applications only on secure OS plat-

forms. If the OS itself is not secure, the application deployed on top of it cannot be secure.

❒ Spend the bucks to design systems right the first time.

It is never cheaper to redo. Also, the opportunity cost of not having the system deployed properly can be huge.

❒ Plan for rolling upgrades with system segmentation. Use

multivendor standards for GUI, database access, and network communication. That way, you can upgrade portions of your system without disturbing the rest of it.

Multivendor standards ensure that you have alternative sources for critical pieces of software. If you cannot get access to your data unless it’s through a single vendor’s proprietary interface, shy away from the situation.

❒ Keep the architecture flexible so it can adapt as your

business needs change. You want your IT systems to enable your organization, not limit your growth.

❒ Finally, choose stuff because it works and it’s reliable —

not because it’s cheap or convenient. The money that you save from preventing security issues will far outweigh the little extra in up-front cost. CT

Steve Belovich is CEO of IQware, an enterprise software company that makes and sells master data management (MDM) software to regulated industries, including government, healthcare, and pharmaceutical. Steve has a B.S. in electrical engineering and applied physics from Case Western Reserve University and an M.S. and a Ph.D. in electrical and computer engineering from Cleveland State University.

The author can be reached at steve.belovich@IQware.us.

by Bruce Kneeland

T

Graphic by Google Maps

Technology Helps Pharmacies Grow on The Great American Frontier Part I of 2

he trail of the Lewis and Clark expedition, Mount Rushmore, the site of Custer’s last stand, and Old Faithful are all icons of the upper Midwest. And they bring thousands of tourists each year to North Dakota, South Dakota, Montana, and Wyoming. Consider this: These four states, while physically one and a half times larger than Texas, have a population that is only one-tenth of the Lone Star state’s. For a pharmacy to thrive in this part of the country, it needs to be innovative and resourceful, and it needs to do a little something extra. Frequently, this is done by taking advantage of the latest in pharmacy technology.

Over two weeks in May 2010, I traveled 3,400 miles to visit 13 pharmacies in the upper Midwest. During the trip I discovered things that may help you operate your own pharmacy more effectively and better serve your patients.

So buckle up and come along, in this first of a two-part series, as I share some of the things I saw in what is still considered the great American frontier.

Roger’s Family Pharmacy Yankton, South Dakota

Roger Renner opened his pharmacy in 1987 in downtown Yankton, S.D. In 2003 he moved around the corner to a newer, slightly larger location, but kept his original apothecary-type front end using the extra space behind the counter to support a growing nursing home and assisted-living business.

The town of Yankton gets its The Itinerary name from the Yankton Sioux Roger’s Family Pharmacy who lived in the Yankton, South Dakota area at the time of the Lewis and Medical Center Pharmacy Clark expedition; Aberdeen, South Dakota it’s actually one of the places the Forman Drug famous explorers Forman, North Dakota stopped on their 1803–1806 trip. Dakota Drug

Bismarck, North Dakota

On the subject of technology, The Medicine Shoppe Renner says that Dickinson, North Dakota since his pharmacy has always had Pharmacy 1 a small front end, Billings, Montana he never paid much attention to POS. But when he moved into his new location, he had some extra money so he decided to invest in one “as a luxury.” Now he says “I can’t live without it.” For example, he says it is not unusual for a family member to pick up a prescription for a patient, and then for the patient to come in a few days later asking for the medication, insistcontinued on next page July/August 2010

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Road Trip continued from previous page

ing he or she never got it. With the POS and signature capture, Renner can instantly pull up a signed copy of the receipt. He maintains this has prevented a number of uncomfortable situations.

He also finds his POS system invaluable when he has to split bills between various payers — one for cash, another for a third party, another on an FSA card, and even another to a family member Roger Renner, R.Ph., shows his responsible for a nursing diabetes shoe display. He believes home patient. His POS sys- that aggressively promoting items of this type in his community tem automatically tracks all builds his professional reputation these issues. He says it ensures and helps bring in new customers. that his staff does not make costly financial mistakes or get unnecessarily involved with uncomfortable customer service issues.

his retail locations — a true benefit, as two of his medicalarts locations are not open on weekends.

Medical Center Pharmacy also provides delivery and mail order. Taffe says the combination of all three ways that patients can deal with his pharmacies — pickup, delivery, or mail — enables his pharmacies do a lot more refilling than is customary in a medical-arts pharmacy.

Like most independents Taffe says his true competitive advantage is personal service. He cites things like knowing a patient’s name, asking about family members, and providing detailed information and enhanced counseling to each patient as examples. And to make sure his staff has the time to devote to patients, Taffe has a Parata robot in the busiest retail location and a PacMed unit on order for his closed-door facility.

Renner has cracked the code when it comes to working with nursing homes, assisted-living facilities, and even psychiatric patients. One key to doing this has been the adoption of an Opus unit-dose system. He says his QS/1 pharmacy management system (PMS) has the capability to make filling the weekly dose system practical and that he Dave Taffe, R.Ph., owns three medical-arts and one closed-door pharmacy in Aberdeen, is ahead of the curve as new CMS regulations are expected S.D. One is located right at the main entrance to force pharmacies to adopt a weekly fill cycle in the near to a clinic, which provides the pharmacy with future. As for the psychiatric patients, he has 30 of them excellent visibility. on Clozapine, and his PMS helps make sure he does not dispense prescriptions without getting the lab reports this Housed in the back of one of the three retail locations is a compounding lab that is used to make a variety of powerful medication requires. transdermal, suppository, lollipop, and other customized medications. He even has two unguators — sophisticated Medical Center Pharmacy devices that mix creams and ointments in ready-toAberdeen, South Dakota dispense jars. Taffe says the compounding lab is a genuine Dave Taffe operates three pharmacies in three different profit builder in its own right. But, he adds, an important medical office complexes. He also has a closed-door phar- benefit is the extra business he gets, as his pharmacists macy in an upstairs location in one of the buildings. All are often contacted by doctors for dosing recommendafour of the pharmacies are so close that they can be visited tions on complex medications and even for advice on by parking your car in the same spot. what medications to prescribe. Taffe says he feels this is a To help stay on top of the inventory needs of all four loca- direct response to the contact he and his pharmacists have tions, Taffe installed a QS/1pharmacy management system made in calling on doctors to promote their compounding services. with a host-remote server that shares drug files, patient records, and prescriber information with all four units.

Forman Drug This unique setup means he can easily transfer inventory Forman, North Dakota from one location to another and manage his A/R to supIf you could look up “rural pharmacy” in the dictionary, port his in-house charge accounts from the main office. you’d likely see a picture of Nathan Schlecht, owner of this Patients can easily transfer prescriptions between any of 18

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Road Trip manager keeps them in a secure location, and that ensures patients sit and talk with the pharmacist on the telepharmacy link and sign a log book before receiving their medication.

Schlecht says he fills about 10% of his prescription in this manner.

About a year ago he upgraded to QS/1’s Windows-based Forman Drug occupies a prominent corner location on the main system. He says the street of the small town that shares its name. Nathan Schlecht, driving force beR.Ph., above left, with his virtual private network’s video link hind this was that he that puts him in touch with a patient at his remote telepharmacy. At right, Schlecht with his mobile barcode scanner. wanted a system that “was so easy to use that 2,000-square-foot traditional frontany relief pharmacist could use it.” end-oriented pharmacy in Forman, N.D. — population 551. Forman Drug was the first pharmacy in North vv Dakota to be licensed to practice telepharmacy. Using a secure Internet connection and a Polycom video camera, Schlecht provides remote pharmacy services to a satellite location in a general merchandise store he also owns 11 miles away.

Schlecht says telepharmacy regulations require him to provide counseling for every prescription he fills for the telepharmacy, both new and refill. Because the telepharmacy setup requires patients to sit down to talk with him over the video link, he thinks people actually pay more attention than they do when he talks with them face-to-face in his pharmacy.

In reality his telepharmacy location is not a pharmacy, but a remote pickup location. The manager of the general merchandise store can accept prescriptions and fax them in. Schlecht then fills them and packages them for delivery to the satellite location. The

He couples his system to a barcode scanner and a mobile signature capture device and says the workflow is so easy to learn that he can now take a day off and turn the pharmacy over to “just about anyone without any worries.”

One other thing Schlecht is using is the new Tri-Maxx triangular-shaped prescription vials. He says the triangular shape provides three almost flat and much easier to read surfaces. One side is for the pharmacy label and another for auxiliary labels; the third side is open for printing information that helps him promote his practice.

One such announcement that he says worked well was providing information on his immunization services. continued on next page

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Road Trip continued from previous page

Dakota Drug

Bismarck, North Dakota One of the things I have long believed is that for pharmacists to grow their practices they should realize they are in the healthcare business, not just the prescription business.

After visiting Dakota Drug and seeing how Kevin “Otis” Oberlander operates, I have a whole new appreciation for what being in the healthcare business means.

Dakota Drug is located near Bismarck’s downtown hospital district. Dakota Drug owns and is housed in a strip shopping center building, with an entrance for the pharmacy and a separate entrance for a health center that has a chiropractor, a massage facility, a physician’s assistant, and an immunizing nurse on site. Once coming in from either location, customers can move freely from one side to the other; there are no interior walls separating the pharmacy from the health center.

In explaining this unusual arrangement Oberlander says, “I’m all about helping people live healthier lives — and that isn’t limited to pharmaceuticals.” Dakota Drug offers a large selection of nutraceuticals and homeopathic medications. Oberlander does a lot of office-based oneon-one counseling, and part of that includes explaining drug nutrient depletion and the positive effects of proper nutritional support.

Laren Meadows’s Medicine Shoppe Pharmacy has been open on the main drag of Dickinson, N.D., for more than 27 years. At right, Laren Meadows, R.Ph., takes an extra minute to prepare a special patient information/compliance leaflet provided by the LDM Group.

that installed he agreed to be a beta site for the company’s soon-to-be-released POS system. He also invested in a Parata robot, even though the number of prescriptions he fills doesn’t meet the traditional cost justification threshold. But he says it frees up staff time to do other things, like counseling patients and recommending the store’s alternative and complementary products.

Like Forman Drug, Dakota Drug is a licensed telepharmacy, but in Oberlander’s case the satellite location is a true pharmacy, stocked with a complete inventory of prescription medications and staffed by a certified pharmacy technician. Perhaps the most unusual thing Dakota Drug has is a specially designed hard-walled patient counseling cubicle that provides an extra measure of privacy. It also houses a workstation, allowing the pharmacist to pull up a patient’s entire profile so more complete counseling can be provided.

The Medicine Shoppe Dickinson, North Dakota The pharmacy counter at Dakota Drug is low and uncluttered, making it easy for pharmacy personnel to talk with patients, and includes a private space for counseling (at the far right of the counter). At right, Kevin “Otis” Oberlander, R.Ph., owner of Dakota Drug.

On the technology front Oberlander is pretty aggressive.

He says that when he bought the store from his long-time partner, he knew he wanted to make some major technology upgrades. About two years ago he purchased a new Rx30 pharmacy management system. Shortly after getting 20

ComputerTalk

Laren Meadows has owned his Medicine Shoppe at the same location on the “main drag” of Dickinson for 27 years. He is included in this report not because he has so many technological devices, but because of how well he uses a few pretty standard tools.

This apothecary pharmacy does not have a POS or IVR, a robot, or even a pill counter. Meadows does have a QS/1 PMS, and each month he pulls product movement reports to identify medications that have been on the shelf for three months or more but not used. If these are unopened continued on page 22

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Road Trip Jarrod Williams, R.Ph., shows off his PacMed unit, which is helping him win business from nursing homes and assisted-living facilities, At left, Pharmacy 1 has found the ScripTalk unit helps it appeal

continued from page 20

and returnable, he sends them back to his wholesaler. By doing this, he says, he finds “a couple thousand dollars worth of product each month” to free up his cash. He does not have an automatic refill reminder system, but he looks at his patient profiles carefully when his patients are in the store and works with them personally on all medications on file that are eligible for refill. While not “sexy,” this process serves his patients and his business well, he says.

Meadows is doing MTM through Mirixa. He says he likes the Web-based system, and feedback from both patients and doctors in the area has been positive. He says he knows the reimbursement for doing this is not adequate but that it is “good enough,” and that this is as good a way to get started with providing enhanced care as any he has seen. Meadows says that about 5% of the prescriptions he gets are coming in as e-prescriptions, and he is a fan of the system. But he says that while this system works “okay,” he still needs to call or fax physicians to clarify details or to make corrections.

to patients with limited vision.

special “talking labels” cost about 50 cents each and the base unit costs only a few hundred dollars. He only had the unit for a few months when I visited him, but in that time, he says, he has picked up two patients and fills 30 prescriptions a month between them.

Williams aggressively goes after business at long-term care and assisted-living facilities. He provides prescriptions in bingo cards and has installed a PacMed “pouching” unit to ensure that he can meet the emerging needs of the facilities he serves. He claims bringing in the PacMed has taken Like nearly all pharmacists I have met, Meadows prides himself on paying attention to details and looking for and what used to be an eight-to-12-hour weekly filling process preventing therapeutic problems. He monitors DUR alerts down to three to four hours. He devotes his extra time to better, faster service in the retail pharmacy. and takes pride in his reputation for contacting doctors when something important or unusual pops up. He says Since Pharmacy 1 is on the main floor of a 50-doctor he has been in practice for nearly 30 years, and doctors medical complex, Williams gets a lot of first-time cusseem to appreciate being contacted with alerts and sugtomers. Williams also has a Parata robot, and he says one gestions on the prescriptions they have written. He also of the oft-heard comments from new customers whose watches his third-party billing and uses the reports and prescriptions he fills with it is, “I can’t believe how fast that alerts provided by Emdeon, his switching service, to enwas.” Which he says is exactly what he is striving for: to sure he is paid properly. Finally, Meadows says he has been find a way to impress both prescribers and patients with pleasantly surprised by the number of Internet-based refill his service. The bottom line for Williams is his goal to find requests through his Medicine Shoppe Web site provided ways to take care of patients by solving problems the big

by Cardinal Health. chains won’t. This brings us back to my opening comment: At Pharmacy 1 they will find a way.

Pharmacy 1

Billings, Montana

If I had to sum up what I learned from Jarrod Williams, owner of Pharmacy 1 in Billings, Mont., it would be “you can always find a way.” Williams is a highly motivated and personable pharmacist with a clear management philosophy. Several times during my visit he said something like, “We look for people with special needs and then try to find a way to help them.”

This attitude caused him to purchase and implement the ScripTalk device. This unit, which interfaces with his QS/1 RxCare and PrimeCare systems, allows him to fill prescriptions in vials with chips embedded in the label that enable the ScripTalk device to read the label out loud for patients with vision impairment. Williams says the 22

ComputerTalk

Well, we are about halfway through the list of pharmacies I visited. I hope a few things these impressive pharmacy owners are doing will inspire you to improve your service in some new and different ways. In the next issue I will take you inside a few more pharmacies, including a visit to Wall Drug, a truly remarkable pharmacy in Wall, S.D. CT Bruce Kneeland is an industry consultant based in Royersford, Pa., with a speciality in helping community pharmacies be more innovative and operate more profitably. He can be reached at brucekneeland@comcast.net. The author’s trip was made possible by a grant from QS/1.

Identifying Workarounds

by Wes Wilkerson, Pharm.D., M.S.

W

hether you think that workflow process workarounds are acceptable or not, you are going to want to know if they exist. Ideally, you’d like to study workarounds in sufficient detail to determine their risks and benefits. Included in this detail could be possible modifications to the workaround and the subsequent effects of these changes on the process outcome.

The identification of workarounds can be straightforward.

In my experience it’s often not that easy, however. Still, I would like to discuss some of the more straightforward approaches to discovering workarounds in your practice’s workflow. There will be several assumptions that need to be made in some of these examples, and I am addressing the subject from my point of view in health-system pharmacy. I acknowledge that not everyone may be in a position to use some of these tools, but the basic concepts should work for anyone.

Watching Your Workflow As you are watching your practice workflow, imagine the data-capturing points as a product or service passes through each workflow step from beginning to end.

For example, in a health-system setting, we order meds electronically, scan barcodes to receive them, sometimes rebarcode or repackage them, input orders that link to those meds, and scan meds and patient barcodes at administration. Even in this abbreviated example there is a wealth of information you could analyze about each step, and it doesn’t even take into consideration all of the patient’s demographic, lab, and procedural data that could also be reported on from the clinical system's databases.

These databases — and all clinical information systems house data in one or more databases — are critical for identifying workarounds. This data is the result of input

Identifying Workarounds: Tips Remember, no matter what tool or tools you choose, it’s about process improvement.

Study your Data Look for digital evidence using database analysis tools.

Talk with Users You can find out a lot, as long as you don’t seem like you are out to get them.

Observe the Workflow But remember that users may adhere to the official process because someone is watching.

Use a Survey Advantage of anonymity, but time consuming and a risk of low response rates. at the various stages of a workflow process. Some vendors are very easy to work with in gathering and/or analyzing data from their clinical information systems. Some are not, and may charge a fee even for basic data extraction, let alone analysis. However, getting direct access to your data will yield many more rewards above and beyond this topic, so I highly encourage the endeavor.

Studying Your Data The most abstract of the workaround discovery tools, then, is the use of database reporting. What are you looking for? If there are gaps of data (process omissions) or illogical mismatches of data, these could be signals continued on next page July/August 2010

23

feature Workarounds continued from previous page

that a workflow process has broken down. For a real-life example, in one case a few nurses at a facility developed a workaround that created a mismatch between how the patient was coded in the admission system and the patient’s actual location in the hospital. Specifically, they were updating a field called “patient type,” which pushed the patient into a certain unit but also caused the system to change the patient’s billing status to “outpatient observation.” Had the nurses gone through the process as intended, which involved a few more screens, the patient would have remained an inpatient for billing, while still moving to the intended location in the clinical system. The workaround appeared to them to increase efficiency, since it reduced the number of screens they had to click through to transfer a patient. It was not a process anticipated by the developers of the admission system.

What the particular nursing staff members who used this workaround did not realize was that, while it worked well for their immediate purposes of transferring patients and didn't change clinical results, they had in fact created a data entry error that caused trouble well after discharge.

That’s when this unanticipated and simple change in workflow created a huge billing mess of rejected insurance claims that took the finance department several hours to correct for each patient on whom the workaround was used.

This is a detailed example, and one specific to healthsystem pharmacy, but the point is that we have here a workaround creating an illogical mismatch of information and resulting ultimately in erroneous data. This is a situation that can occur in any area of pharmacy and, when recognized, should act as a trigger for a process investigation. Of course, you will need the right tools to perform the kind of retrospective analysis of a workflow’s digital fingerprints that will identify such a situation as I just described.

To do this, you will first need access to the information and, second, you will need a way to report on that information (e.g., using Access, Excel, Crystal Reports, Business Objects, SAS, SPSS, etc). Contact your IT department’s database administrator, if you have one, and your system vendor about getting access to the information.

Unfortunately, after that you are on your own. Which software will best suit you really depends on the data available to you and the reports you want. Keep in mind that some information systems are designed to work with specific database reporting products. You’ll want to ask some questions of your vendor to make sure you head in the right direction.

Talking About Processes Fortunately, however, the most valuable tool for discovering workarounds is communication with the users of the systems. Some users are quite proud of their discoveries and want to tell others about them because they believe that they are helpful. I will generally try to work in a question about “aggravating” or “irritating” processes whenever I am around experienced users. They usually have a couple they can think of immediately. And if they don’t already have continued on page 26 24

ComputerTalk

“Emdeon’s Medicare and Medicaid DME solutions have turned cumbersome processes into regular parts of our workflow.

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feature Workarounds continued from page 24

suggestions about how to improve the process, I ask for them directly. Many times this simple dialogue contains a side story of “We actually do it this way because of that” which is the workaround verbiage I am eager to hear. As long as you don’t seem like you are out to get the user or the department in trouble, they will typically tell you all sorts of unapproved processes that they use during the course of patient care.

Observing Processes Observation is another tool that I have used to identify workarounds. This is harder than it sounds and, in my opinion, is not as useful as the one-on-one user communication. It seems to have an authoritarian feel to it, and I often find myself wondering if the users are adhering to the official processes because someone is watching them.

But with all that said, observation has a place in your tool bag because it allows you to identify workarounds that users may think are actual official processes and that do not leave obvious digital fingerprints. This could result from a “train the trainer” environment in which a workaround

ends up being taught as the process instead of the true process being taught.

Surveys Lastly, and I must admit my least favorite, is the use of a survey to identify workarounds. Workaround surveys have their own issues — from potentially high cost and low response rates to the question of their response validity due to the technical nature of the topic. But again, they too can have a place in your workaround identification tool bag. One positive is that the anonymity of a survey may elicit user responses that otherwise would have never come out. However, after you have done one for the sake of completeness, it may be a while before you want to do another. This is because the workload created by a survey can be very demanding if you conduct it yourself, which makes return on investment low. And if you outsource it, it makes the ROI even lower.

Focus on Improvement

Remember, no matter what tool or tools you choose, it’s about process improvement. Be careful not to let your efforts to identify workarounds appear to be a witch hunt for disobedient users. For one thing, it’s not impossible that you’ll find that a workaround in use is in fact a process improvement. And even when it’s not, you Easy solutions for everyday pharmacy challenges. need to take an approach that allows you to educate your staff about the importance of the official process without offending them or making them defensive. That’s the way you’ll ensure the safety and effectiveness of your workflow. CT

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ComputerTalk

Wes Wilkerson, Pharm.D., M.S., is the pharmacy informatics coordinator for St. Francis Hospital in Columbus, Ga., where he is responsible for all technology systems that are involved in the medication use process. He also provides independent consultant services to help organizations build, clean up, and optimize their pharmacy information systems. The author can be reached at wes.wilkerson@ gmail.com.

The 2010 Chain Market Report:

y g o l o n h c e T A Look at Where Chains Stand on

by Will Lockwood

E

very year it has been our tradition to survey the chain market to gauge the state of technology and find out what the priorities are for the near future. This year’s edition drew responses from 27 chains representing 11,011 pharmacies. We continue to see a steady approach to upgrading systems. The findings also show the solidification of several pieces of technology as standards of practice and a few growing trends to keep an eye on. We also hear what the respondents think about what’s coming with electronic prescribing for controlled substances, medication therapy management, and the impact of the HITECH Act. What’s clear is that the chains responding to the survey are not standing still, but are engaged in a process of continuous technology deployment designed to help them keep pace with the current and coming demands on their operations. continued on next page July/August 2010

27

cover story

chain market report continued from previous page

Core Technologies Beginning with the core of pharmacy operations, the pharmacy management system (PMS), this year’s survey found that chains continue to move to new technology. Specifically, 50% of the respondents installed a new system. Four chains replaced all systems, which represented close to 60% the of total pharmacies in the survey.

Six more chains installed from one to 13 new systems, and among those, several will continue the implementations in more locations over the coming year. And among the chains that have not installed new systems in

THAT WAS THEN

the past year, one-third plan to do so in the next 12 months, demonstrating that keeping the latest in pharmacy management software deployed will continue to be a priority.

Breaking this down further, 45% moved to a new vendor, while 55% upgraded to a new system from their current vendor. An interesting note is that one chain engaged in an experiment, installing a PMS from a new vendor at one location while upgrading with its current vendor at two other locations. The rationale? “We wanted to test a store with the new vendor.” And the results? “We are not satisfied with the experience so far.”

There were a number of reasons cited for moving to a new vendor.

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Among these were the old PMS being phased out; a need for a more current Windows version; an old system that had limitations in dealing with more than a certain number of locations; a need for a more open framework with better access to data; a need for better support; and, finally, a need for a workflow solution.

And while the variety of reasons indicates that the decision to upgrade the PMS depends on each chain’s particular circumstances, the need for workflow does end up standing out as a major motivator. In fact, 80% of the respondents moving to a new system are doing so for workflow, giving a strong indication that this is perceived as a critical component of the dispensing process.

What accounts for the importance of workflow? There’s the safety component, of course, and 70% of the respondents also believe that good workflow saves time in a busy pharmacy. However, we received some interesting comments from the minority that don’t see a time savings — for example, “More steps, more time to move prescriptions through the system,” and “The workflow system we use cuts down on errors but increases the time to fill a prescription because it requires too much barcode scanning.”

Vendor Satisfaction When we asked how satisfied the chains are with their current vendor, the results were mixed, with only 30% answering “very,” while 70% answered “somewhat,” and none answered “not at all.” However, 70% of respondents felt that their vendors are responsive to changes they suggest, which likely means that there are continued on page 30

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July/August 2010

Š2010 McKesson Pharmacy Systems. All rights reserved.

29

TCGRx Retail Solutions

cover story

chain market report continued from page 28

other factors influencing the satisfac™ tion level.

POS

Two more technologies that are deployed in around 90% of the chains responding and can be said to represent the standard of practice are IVR and e-signature capture. IVR is in use in every store in 80% of the chains responding, and roughly half of the chains not currently using IVR are planning to add this technology soon. It is worth noting the reasons for not using IVR mentioned by the few chains that don’t use it and don’t intend to. One says, “We believe

Another key technology is a frontstore point-of-sale (POS) system. This year we asked again whether POS systems are integrated with the PMS. Barcode The responses broke down roughly Will Call Rx Scanning for 50-50. It turns out that integration Unmatched isn’t necessarily possible for some Accuracy chains. One, for example, has its & Inventory locations within grocery stores, Management Ninety percent of the while several mentioned having POS and PMS systems from differ- chains report using ent vendors. In those cases, a few barcode scanning in every Stocking are working on getting the systems pharmacy. In those integrated. On the other hand, Beacon, chains where rollout is among the chains that do have an Organized by integrated POS-PMS setup, the va- less than 100%, there are Activity In a Compact riety and number of benefits cited plans to increase use.

Footprint are impressive. These ranged from better sales tracking and ease of checkout to better inventory mancustomers prefer talking to a person,” agement and more accurate pricing.

Filling AVF-70, which has been a common rationale Cost Effective, for avoiding IVR over the years. AnStandards of Compact, other indicated that it does not foresee Automatic Practice a reasonable ROI given its volume.

Vial Filling There are a few technologies that have Notwithstanding these comments, IVR has clearly become standard for become so widely adopted among chains. chains that they can be viewed as standards of practice. One of these is The responses about IVR also showed AVS-100, Shredding barcode scanning, which 90% of the a developing trend when it comes to Reduces Waste chains report using in every pharusing the technology for outbound Volume, Labor macy. In those chains where rollout calls for prescriptions waiting to be & HIPAA is less than 100%, there are plans to picked up in will-call. While only four compliant increase use. Only two chains are not out of 10 chains using IVR are using using barcode scanning and have no it for these outbound calls, 80% have plans to do so. To give an idea of how plans to put their IVR to work for barcode scanning has been solidified this purpose. That indicates a trend as a standard in chain practice, note that will be worth keeping an eye on. that last year we found that 80% were Another interesting note from among scanning, with 60% having scanners the chains using IVR: For those that in every store. That result showed a 262.279.5307 report offering refill ordering through strong presence for this technology both their Web sites and IVR, we Sign Up For TCGRx and, considering this year’s results, found once again that the vast maUpdates At: scanning can now be called standard www.tcgrx.com continued on page 32 without doubt.

Do More With Less

30

ComputerTalk

Keep prescriptions

moving.

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July/August 2010

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chain market report continued from page 30

jority see patients preferring IVR to place their order.

When it comes to e-signature capture, all but two chains have deployed this technology, and both chains not yet using it said they have plans to install it. This pending complete adoption among the respondents to our survey indicates just how important this technology is for streamlining such tasks as documenting patients’ receipt of notice of privacy policies per HIPAA and maintaining a prescription pickup log for third-party audits that makes it easy to retrieve records.

Web access for pharmacy staff is another standard in chain pharmacy, according to our results, with all but one chain responding that their pharmacists have this available to them in the pharmacy. Of course, there’s due care applied to what can be accessed

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What accounts for the importance of workflow?

70% of the respondents believe that good workflow saves time in a busy pharmacy. via the Web, with 90% replying that they exercise control over the sites pharmacists can visit.

Finally, one more technology that has been widely adopted in the chain environment is real-time preedit services for third-party claims. In this case, 95% of the chains are using preedits, with the vast majority indicating that these services improve reimbursement levels.

MTM Status Our survey uncovered two more aspects of pharmacy operations that respondents indicate are widely ad-

opted, but which probably can’t be called standards of practice yet, for very specific reasons. The first of these is medication therapy management (MTM) programs. While, encouragingly, all but one chain responding participate in MTM programs, this field is likely far too new and in too formative a state to really be considered a standard, despite such widespread support. This is in part because the tools for being alerted to, managing, and billing for MTM opportunities are developing.

For example, we found that in the current state of MTM delivery, most are using a Web portal to document encounters. And while the majority is satisfied with the information on file for the patients involved in these encounters, a few thought it would be beneficial to have more detail available, including lab results, a station in the pharmacy where blood pressure could be taken and entered into the patient’s record, and the ability to

cover story

chain market report

Is MTM the Future?

While there’s still clearly work to be done on the nuts and bolts of providing MTM services, 90% of the chains believe that MTM represents the future of pharmacy. This enthusiasm is tempered by the fact that slightly more than half believe that the reimbursement received for MTM is not commensurate with the effort involved, which is an element of MTM that may come into line as the value of the concept is proven by its widespread use. We received a number of comments on just why MTM represents the future of the profession, and it is worthwhile to share a sample, since they are the opinions of the people working every day to provide these services to patients.

“Declining reimbursements for prescription dispensing have come to the point where there is almost no margin. Immunizations and MTM provide an opportunity to gain some income, but reimbursement needs to be more realistic for the MTM process.”

“Patient care and improving outcomes will continue to grow as a revenue source and position pharmacy as an integral part of overall healthcare.” “[MTM is the] first major step to reimbursement for cognitive services.”

“It is the precursor to outcomes-derived patient care services. This documents what we’ve already done.”

To be fair, not every respondent was completely convinced that MTM is the future, as sample comments show: “It will be an increasing part, but not the future.”

“Not sure it is the ‘future.’ It will become a bigger part of pharmacy.”

“Pharmacy still will remain a product delivery business primarily.” incorporate adherence data.

One aspect of MTM that chains would like to see improved, in particular, is the manner in which they are alerted about MTM opportunities. An overwhelming 95% want these alerts transmitted directly into their pharmacy or host system, complete with information to identify the patients, as opposed to being notified via email, fax, or through a Web portal. The idea is to streamline the delivery of these alerts and create efficiency by eliminating the need to move away from the patient care flow already established while filling prescriptions. One item of interest:

The American Society for Automation in Pharmacy (ASAP) has recently completed work on a standard to facilitate information exchange between MTM companies and the pharmacies in their networks via the pharmacy management system.

Expanding the Patient Record The ability to include OTCs in the patient file is one step toward addressing the desire expressed through this survey to improve the information continued on next page July/August 2010

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chain market report continued from previous page

available to pharmacists for MTM cases. It will be an important part of providing pharmacists engaging in MTM with complete information about their patients, ensuring that they have all the details they need to provide the best counseling. And while our survey found that more than 90% can add OTC products

and dietary supplements to patient profiles and are currently doing so, their descriptions of just how this is done suggests that there’s room for improving the process. In fact, it looks in general as if this is possible mainly when the OTC is a prescription from the doctor. Overall, however, it seems as if in most cases the current methods are going to limit the amount of OTC information

available in the typical patient profile, and therefore limit the ability to do a full MTM workup without gathering this information from the patient during counseling.

Automation The use of automation in the chains appears to be stable, with the findings pretty much in line with 2009.

Countertop counting devices are again the most common. These are in use for 66% of respondents and in 25% of the total pharmacies represented by the survey. Five chains are using countertop counters in every pharmacy. Four chains have plans to add more.

Robotic dispensing is the next most common, with close to 60% of respondents using this technology in approximately 15% of pharmacies.

Four out of 10 have plans to add more robotics in the coming year, making this the automation technology with the most positive trend and suggesting that chains perceive a quick return on investment for robotics in busy pharmacies.

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Finally, while 50% of the chains replying report using automated counting, this technology is only in operation in 6% of pharmacies represented, suggesting that it is not the go-to automation technology. However, four chains have plans to add more automated counting, and one chain not currently using automated counting reports plans to install three units this year.

Trend Toward Centralization There’s another application for dispensing automation, though, and continued on page 36

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ComputerTalk

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July/August 2010

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chain market report continued from page 34

E-Prescribing Our survey found that e-prescribing continues to grow, with all but one chain responding that they have seen an increase this year. The percentage of new prescriptions — other than for controlled substances — reported as now coming in from physicians electronically averaged 12% in this year’s survey, up from 8.5% in 2009. There is definitely some variation in e-prescribing reported, ranging from a low of 1% to a high of 30%. And while the trend in uptake is positive, we did find that the e-prescribing process is not perfect. Chains report experiencing a variety of problems with both new and refill prescriptions, including: “Lots and lots of data entry errors by prescribers — primarily incorrect or multiple sets of directions.”

“Inaccurate translation of sigs and lost prescriptions.”

“Refills coming back with the wrong drug, sig not correct, and duplicates.”

“Incomplete sigs and incorrect days’ supply being entered by physicians.”

“Physician systems not programmed to accept refill requests.”

“Bad quantity calculations and wrong patient chosen.”

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When you look at both central fill and central processing, it is clear that chains are embracing a model that off-loads tasks that consume resources in the pharmacy and allows for assigning specific tasks to staff who specialize in them. we last asked about central fill and suggests that there’s a real trend to keep an eye on here. Robotic systems appear to be the technology behind this trend, considering every chain that is using central fill also reports using robotic dispensing systems at these locations.

We make it

36

that’s central fill. This is something we have not asked about in recent surveys, but brought back into the 2010 edition with some interesting results.

Use of central fill is not widespread yet, with only 20% of respondents answering that they have a central-fill location. However, 25% of those not using central fill report that they have plans to do so. Taking into account the chains already using central fill and those planning to implement it, the total represents an impressive 40% of those responding to our survey. This is a significant change since

There appears to be another strong trend toward central processing, used to move responsibility for such things as gaining prior authorizations, resolving third-party rejects, and addressing drug interactions that require doctor continued on page 38

July/August 2010

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chain market report continued from page 36

contact out of the retail pharmacy environment. Again, 20% of respondents reported using central processing now, but close to 30% reported plans to begin using it. This is a sea change as well. When you look at both central fill and central processing, it is clear that chains are embracing a model that off-loads tasks that consume resources in the pharmacy and allows for assigning specific tasks to staff who specialize in them.

Other Technologies There are a few technologies that are in use in a significant minority of the responding chains, though there’s no evidence that they’re part of a strong trend.

Priorities in 2010 “POS-PMS interface and central fill.”

“Piloting of additional robotics; begin some level of central processing; simplify the script-filling process by streamlining all steps in the filling process associated with system interaction; making more Web sites available. Enhancing the replenishment system. POS integration.”

“Increase the use of e-prescribing.”

“New POS system.”

“Upgrade IVR to a central system and prepare for D.0.”

“Improved DUR documentation during the prescription-filling process.

Point-of-sale integration. Improved central system.”

“Deploy new PMS application.”

“Completing the rollout of our pharmacy system, outbound calling/ notification (text, mobile communication), POS integration — device sharing, electronic PSE monitoring (regulations coming fast and furious), and inbound fax.”

“D.0.”

“Upgrading central host server.”

Will-call bin management systems are deployed in only four out of 10 “Imaging.” cases, for example. Whether a chain has technology designed specifically to “Roll out system conversions for remaining eight locations.” manage will-call may depend on how “New system rollout.” its other technologies can be deployed “Investigate and begin implementation of new pharmacy software.” to the same end. For example, in one case, a chain with integrated PMS and “Improving Web offerings, automated refills, workload sharing.”

POS can see at the POS register how “New PMS.” many prescriptions someone should have, which is one element of will“Centralizing IVR.” call bin management. Another chain reported using an aged-prescription reporting feature in its PMS, which out of 10 cases. Items mentioned as commonly scanned helps limit how long a prescription will sit in will-call include new prescription hard copies, insurance cards, before some action is taken. Among those not using willdriver’s licenses, and immunization records. The genercall bin management systems, the reasons include a lack ous amounts of disk storage available at low cost these of perceived value and lack of feature availability in the current PMS. But where will-call bin management is used, days make scanning and storing documents very feasible, though of course it’s also important to have a PMS two advantages cited are ease of finding prescriptions, particularly in a high-volume pharmacy, and fewer returns that can incorporate these electronic documents into its databases and link them to patient records. In such cases, to stock. Finding prescriptions quickly also improves the much like e-signature capture, document imaging can professional image of the pharmacy staff. As one responthen improve efficiency within the pharmacy and help dent put it, everyone looks better when there’s “no more better manage audits.

‘Where’s Waldo?’” when a patient arrives to pick up a prescription.

Consumer Web portals are something many chains offer, Document imaging at intake is also in use in only four 38

ComputerTalk

continued on page 40

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July/August 2010

39

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chain market report continued from page 38

and are of increasing interest in general to pharmacists who want to make sure they are providing the broadest range of methods for their patients to order refills, access their prescription histories, and see information about a pharmacy location, including hours and details of services offered, such as whether there’s a drive-thru window.

E-Prescribing Controlled Substances Electronic prescriptions for controlled substances are only now possible after the DEA recently issued its interim final rule (IFR) on e-prescribing of controlled substances (CS). All but three respondents see the DEA requirements as a catalyst to prescribing CS drugs electronically. Those not as positive pointed to a lack of state regulations allowing it, and the fact that, as yet, there are no systems certified to transmit CS prescriptions according to the DEA’s requirements.

One statistic that bodes well for CS e-prescribing adoption is that 60% of respondents do not see problems with the DEA’s requirement that pharmacy management systems be audited or certified for compliance before being able to receive CS e-prescriptions.

This optimism is probably based on the fact that the audit and certification will be the vendor’s responsibility and not the chain’s, at least in those cases where the systems are not internally managed. Those seeing the potential for problems in this requirement cite the inconvenience and the likely cost of the audit/certification process. One respondent stated, “This will delay the use of the functionality.” Others thought the process “too complex to implement in a timely manner for prescribers,” and that “It is going to be difficult and maybe not worth it.”

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What’s Providing the Greatest Positive Impact?

Every year we ask which technologies offer the best ROI. In 2010 IVR came out on top once again. Notably, central fill also came up a few times, and it’s clear that robotics is important, particularly since it goes hand-in-hand with central fill.

One comment in particular was interesting and describes a specific instance when countertop counting can prove its ROI — in this case when it is applied to inventory management: “Last year we purchased an automated [countertop] counter. This one unit moves around our chain to do twice-per-year physical inventory counts. The machine counts over 1,000 tablets in 90 seconds, hands free. Great investment.

We use it 20 times annually.”

HITECH Act Another challenge pharmacy is facing are the new security and privacy provisions in the HITECH Act. When we asked if these new provisions will create the need to change procedures in the pharmacy, we found an almost even split, with 45% answering “yes” and 55% “no.”

The overall feeling among the chains surveyed is that the security now in place adequately addresses patient privacy, though two chains noted that they plan upgrades — using biometrics, in one case, and increased password strength, in the other.

The Priorities This brings us to the summation, a look at what’s going to be at the top of the chains’ technology agenda for the year ahead. Many of the items reflect the responses covered earlier, with PMS upgrades and new installations featuring prominently. POS installation and integration are also top priorities. Central fill was mentioned twice and central processing once, helping to confirm that there’s definitely a trend in this area as a way to distribute and balance the workload pharmacy locations experience.

Two chains indicate they are moving to centralized IVR, and D.0 is still on the agenda of a few chains. But let’s allow the respondents to speak for themselves. See the box on page 38 for a sampling of what we were told.

What’s clear from this year’s survey is that the chains responding are keeping technology a central priority, with continual investment in what’s working, along with efforts to branch out using new tools. We saw evidence that several trends of recent years have solidified into standards of practice, and we see what appear to be the early stages of new trends. Next year around this time, we’ll get another chance to see the how some of these developments have progressed. It’s sure to be interesting. CT As a condition of participation, the identities of those responding and their respective chains are not disclosed.

Will Lockwood is ComputerTalk’s senior editor. He can be reached at will@computertalk. com.

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george’s

corner

50 Years Fifty years ago I became a pharmacist. In some ways, 50 years is a long time. In other ways it is short. It is short in the history of the profession, but long when one thinks about the changes that have occurred.

50 years ago: The drug name was not on the label of a prescription.

Expiration dates were not on the label.

If anybody asked what a drug was for, he or she was told to ask the doctor.

Manual typewriters were common. The first electric ones were just starting to appear.

Many pharmacists were very fast two-fingered typists.

There were no computers.

The only prescription files we had were in numerical order.

Patients wanting a refill had to know the prescription number.

We pharmacists would find the original prescription and put the refill date and our initials on the back.

Refills were often handled by actually refilling the empty vial that the patient brought in.

There were no patient profiles.

Drug interactions were just beginning to be thought about.

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George Pennebaker, Pharm.D.

There were a lot of $1.95 prescriptions.

The only third-party payments came from county-level welfare programs.

Any other coverage was handled by the patient submitting receipts to the insurance program.

If a patient asked for the price on a prescription, the pharmacist would put the price (using the Pharmocist code, such as PSM=$1.95) on the Rx before giving it back to the patient.

Independents ruled the world. There were a few chains, but they had little impact.

Only pharmacists were members of boards of pharmacy.

There were no specialty pharmacies.

All hospital pharmacies were in the basement.

Most drugs in hospitals were “floor stock,” meaning that the pharmacies sent bottles of drugs to the nursing station and the nurses picked out the drugs and put them in a little cup for each patient. All of the IVs were mixed at the nursing station.

We punched out capsules and made lots of ointments, creams, and ophthalmic drops.

Birth control pills became available. Enovid was the first.

Condoms were kept in a drawer near the cash register. continued on page 44

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July/August 2010

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continued from page 42

The customer had to ask for them. We opened the drawer, lifted the requested product a bit for the customer to confirm the choice, and put the package in a bag that was also in the same drawer.

A pharmacy’s drug inventory was around $10,000 to $20,000.

It was very common for pharmacies to purchase direct from manufacturers. The drug salesman (they were all men) pitched his latest deal (which often involved a couple of bottles from the trunk of his car).

Hypodermic tablets (HTs) were still used for narcotic injections. Dissolve the tablet in a little water, draw it up into a syringe, and inject it into the patient.

Pharmacies were listed in the yellow pages under “Drug Stores.”

The economics were simple. Look at the bank account every now and then. If it was going down, maybe raise the prices a bit, except for refills for old customers.

Pharmacists’ education ranged from “work in a pharmacy a few years and take a test” to the new “Doctor of Pharmacy” after six years of college. (We Pharm.D.s still had to take a test.)

Huge changes have happened.

Every item in the above lists is either gone or has changed radically.

There are drugs to treat so many things that we had no drugs for 50 years ago.

Computers are everywhere and doing so much.

Mail-order prescriptions are a huge portion of the prescriptions dispensed.

Direct-to-consumer advertising has radically changed the drug decision process.

Emergency contraception is now readily available.

Marijuana and other drugs have become more readily available and more readily used.

Huge conglomerates of drug manufacturers have changed the economics and ethics of the drug industry.

More could be listed. Send me your additions.

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Some things have not changed: The handwriting of both prescribers and pharmacists is still hard to read.

Prescribers still talk too fast on the phone.

Price competition was and is still there.

Patients still complain about how long it takes to have a prescription filled and how expensive the drugs are.

We still have trouble getting patients to take their drugs correctly. They still take too little of some and too much of others.

What about the future?

The only thing we can be certain of is that the rate of change is going to increase. There will be more changes in the next five years than there were in the last five years.

Crystal balls are fuzzy, but I am sure we will see: More changes in the delivery system — how we get drugs to patients.

Big changes in who does what in medical care.

Greater use of computers to keep track of everything and to move information to those who need it.

More sophisticated gadgets for diagnosing and treating.

Better methods for administering drugs.

Of course, more new drugs. I hope some of them will be real breakthroughs.

DNA, nanotechnology, micro this and that.

More patient involvement and understanding.

The biggest changes will be in healthcare’s economic structures and the quality of care. The United States cannot continue to be the most expensive place to get healthcare — twice that of the next highest nation. We also cannot continue to rank tenth in the quality of the care we deliver.

As for me, I have had a great first 50 years and am looking forward to seeing what happens in the next 50. (I guess I am also counting on someone developing an anti-aging drug in the not-too-distant future.) CT George Pennebaker, Pharm.D., is a consultant and past president of the California Pharmacists Association. He can be reached at george.pennebaker@sbcglobal.net.

technology

corner

Survey Reports Huge Demand for MTM Messaging Standard The results are in and have been tabulated. NCPA’s Steering Committee for Technology and Innovation conducted a focused survey of NCPA members that asked the question, “Would you like to have an integrated feature in your pharmacy management system to identify patients qualifying for an MTM [medication therapy management] encounter?” Two hundred and seventy pharmacists responded to the survey. Ninety-four percent of respondents indicated that they would like to have an alert appear in their pharmacy management system indicating an opportunity for them to intervene with an MTM-eligible patient. Currently, pharmacists are required to look for MTM encounters via a Web site, email message, or fax from companies such as Outcomes and Mirixa.

The American Society for Automation in Pharmacy (ASAP) developed a standard to facilitate information exchange between MTM companies and the pharmacies in their networks via computer-to-computer notification of MTM opportunities. This new standard can also support bidirectional information exchange to allow pharmacies to populate the MTM companies’ patient files with medications that were not submitted to the patient’s insurance plan and OTCs that may be on file in the pharmacy. Patient consent and engagement in the process should be sought by the pharmacy. The MTM standard is currently undergoing testing; when this is successfully completed, it is hoped that the new standard will undergo rapid implementation by the vendor community. The messaging standard will be available on the ASAP Web site at http://www.asapnet.org/bookstore.html.

The survey sought additional insight by asking a second question, “Would this integrated functionality make it more likely that you would participate in these MTM programs?” Of the pharmacists who desired the new feature, 95% indicated that having it would assist them to provide MTM services.

At this point, the survey asked for open-ended comments from pharmacists who had no interest in this functionality and/or had other ideas to improve

Bill G. Felkey, M.S.

Brent I. Fox, Pharm.D., Ph.D.

the functionality of MTM messaging.

The comments included criticisms of pharmacy management systems that offered no support for the provision of MTM, difficulty of one-person pharmacies to break away from traditional dispensing transactions to offer MTM, and satisfaction with current email messaging. Other pharmacists who practice in a clinic setting (where 60-minute encounters were the rule) described a set of needs that differed from traditional community pharmacy operations. One comment addressed the advantages for continuity of care that would be achieved if messages were directed to a pharmacist rather than to the pharmacy.

Other suggestions included the need to concurrently use email channels, in addition to the proposed MTM standard, so that pharmacists could elect to engage patients with MTM encounters at times when they were not practicing in the pharmacy setting. Other suggestions asked for help with the timeliness of the pharmacist’s response so that due dates were not missed for eligible continued on next page July/August 2010

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continued from previous page

patients; fortunately, this timeliness issue is covered in the standard. NCPA will distribute a press release to alert other vendors to the high interest level of their members who request the adoption of this messaging standard.

The survey ended with a request for pharmacists to indicate other areas of improvement needed in their pharmacy information management systems. These responses will be used in formulating additional surveys that will gather more evidence that can help interested vendors improve their product offering for their users (you). It has already been determined that a second survey will focus on incorporating the billing process for reimbursing pharmacists after they have provided MTM services.

Historically, it’s been found that integrating this process into practice management systems will greatly increase the amount of service provided by the profession. When

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46

ComputerTalk

The October annual meeting of NCPA in Philadelphia will include a technology track that will further educate pharmacists regarding their technology choices. a state-sponsored program for Medicaid required pharmacists to spend as much time filling out a reimbursement form as they did providing the actual service, only 32 claims were made in an eight-month period. When a pharmacy management system integrated the state-specific requirements for the claims process by extracting the necessary data fields for reimbursement as a byproduct of rendering the care, and then submitting the claim for processing with as little as four keystrokes on a terminal, service levels expanded exponentially.

Our take on this and the other surveys NCPA’s committee is planning is that, finally, vendors will get some help on setting their enhancement and development priorities. We know how frustrating it can be for thousands of programming hours to go into the offering of a feature only to discover that end users choose not to employ the new offering. Hopefully, better communication between the vendor community and the pharmacy profession can improve this situation.

The October annual meeting of NCPA in Philadelphia will include a technology track that will further educate pharmacists regarding their technology choices. Sessions will provide pharmacists with a comprehensive listing of technology available, self-assessment tools for determining which new technology to adopt to improve the efficiency and effectiveness of their operations, and tools to determine which vendor offering best matches their practice needs. We would encourage the vendor community to exhibit their products and be ready for a more educated consumer to ask questions about how they can partner their way into a future with many significant changes in how healthcare is practiced in the United States.

We welcome your comments and questions. CT Bill G. Felkey, M.S., is professor emeritus, and Brent I. Fox, Pharm.D., Ph.D., is an assistant professor, Department of Pharmacy Care Systems, Harrison School of Pharmacy, Auburn University. They can be reached at felkebg@auburn.edu and foxbren@auburn.edu.

catalyst

corner

The Power of Partnerships Never before has the need for partnerships between pharmacies and their suppliers and system vendors been greater. I was reminded of that this week while participating in a wholesaler’s strategic business solutions meeting with its independent pharmacy customers. Continued emphasis on health information technology to reduce costs, improve quality, and create efficiencies was a theme echoed by former HHS Secretary Michael Levitt. During many of the meeting’s continuing-education sessions, technology was front and center, whether for building the pharmacy’s front-end or back-end programs. Further, as I scan my email-delivered news reports, technology-related stories abound. Yet, in spite of this need, many of the independent pharmacy customers still hesitate to make a commitment to fully implement the technology solutions that are available to them.

Let Me Provide Some Examples I was asked to give an update

on the IRS’s inventory information approval system (IIAS) for people with flexible spending accounts (FSAs) or health reimbursement accounts (HRAs).

While this issue has been percolating for nearly three years, the reason most pharmacists came to the session was to learn how to handle rejections of their pharmacies by third-party administrators (TPAs) and insurers. The majority of attendees decided to file an exception from the IIAS because of the 90% rule. About 20% of the participants had implemented POS systems. Many were surprised that the Special Interest Group for IIAS Standards (SIGIS) had clearly stated on its Web site and materials relating to the 90% rule that TPAs, insurers, and employers could decide to require their employees to use pharmacies that could process the FSA debit cards. Participants shared tips with one another on how they have tackled the issue. The March 2010 healthcare reform bill created a new requirement for FSA/HRA accounts whereby most OTC products will no longer be eligible for coverage under these accounts. As a result, SIGIS is updating its database of 43,000 items, of which about onethird will still be covered. Sources report that extensions to the rule’s effective date of Dec. 31, 2010, are being sought. That said, the rule has major implications for SIGIS’s future, according to the organization.

Marsha K. Millonig, R.Ph., M.B.A.

Further, many were surprised that while SIGIS recommends that TPAs and insurers download a list of pharmacies that have met the 90% exception, many do not do so. SIGIS updates the listing weekly, but it can take 15 to 45 days for a pharmacy that has followed the 90% rule process to appear on the list. A number of more detailed technical questions were raised by pharmacy owners with and without POS systems. After walking through the issue’s history and latest evolution, a few more pharmacists became convinced they may be better off seeking a POS solution. I provided a number of examples of business-building ideas linking POS systems to pharmacy management systems that I have learned at American Society for Automation in Pharmacy industry conferences. That resonated well with participants, and many left the session and headed to the exhibit hall to meet with vendors.

Planning for Disasters The second program I was asked to present was on disaster planning and preparedness. Participants in this session continued on next page July/August 2010

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learned about both personal and business-related planning and about a number of new tools to assist them in providing patient care in the event of a disaster. These include RxResponse.org and In-Case of Emergency (ICERx.org).

Both efforts are partnerships between numerous organizations to provide information and resources to both health providers and patients in disaster situations. The goal of Rx Response is to support the continued provision of critical medicines to patients whose health is threatened by a severe public health emergency. Resources on the site detail what constitutes an emergency, how the pharmaceutical supply chain functions, and how consumers can prepare for a severe public health emergency.

ICERx.org’s goal is to allow continuity of care by providing an online service for healthcare professionals assisting disaster-affected individuals. Authorized pharmacists and doctors obtain records of medications that evacuees were using prior to the disaster, including the specific dosages.

This allows for renewed prescriptions for evacuees and avoids harmful prescription errors. Pharmacists must register to use the systems. Both services illustrate to me the power of partnerships to address needed solutions, yet both were unknown to my audience.

As we moved into disaster preparedness, it became apparent to me from the stories that were shared by participants that many learned the hard way how to protect, back up, and restore their computer systems after a disaster struck.

Some just had plain bad luck, like the pharmacist who was changing insurance companies and did not have a signed contract yet when unexpected heavy rains flooded the pharmacy. Many pharmacists were not aware of how their technology partners could help them, or the possible limitations of their partners. I was able to point them to the ComputerTalk buyers guide issue (March/April 2010) for more information.

The buyers guide also featured prominently in tech-guru Bill Felkey’s presentation on technology solutions and strategies for evaluating them. It was a sold-out session, and, again, showed me how much opportunity exists to bring independent pharmacists up to speed in this area.

More MTM New opportunities for providing expanded clinical services also showcased the importance of technology, as when a wholesaler has created medication therapy management (MTM) service opportunities 48

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for its independent pharmacy network but a pharmacy must connect to the wholesaler’s system in order to take advantage of them. These service opportunities promise to expand. As I write this column, Senator Kay Hagan (D-N.C.) and Senator Al Franken (D-Minn.) have just introduced a bill in the Senate that will improve the MTM benefit in Medicare Part D by making more seniors eligible, ensuring they can receive MTM services from a pharmacy of their choice and creating a payment structure that assures pharmacies are appropriately paid for this care. NACDS notes in its press release on the bill’s introduction that fewer than 13% of seniors have access to MTM services, due to the highly restrictive eligibility criteria in the Part D program.

A related meeting session on MTM services for patients with diabetes showcased new glucose pump and meter technology and computer interfaces to support patient care and Medicare reimbursement. This meeting was well attended, and pharmacists were keen on implementing what they learned. Again, it reinforced that for pharmacists to provide MTM services, partnerships with providers are necessary and technology solutions required.

Spotlight on Security But security remains an important issue to be tackled. News of a big health and credit-card security breach hit the streets the same day as the new bill’s introduction. So did word of the White House’s new strategy designed to make the concept of trusted identities and authentication more of a reality in the digital world. Entitled “National Strategy for Trusted Identities in Cyberspace” (NSTIC), the 39-page document promotes an identity ecosystem, an interoperable environment where individuals, organizations, and devices can “trust each other because authoritative sources establish and authenticate their digital identities.” I encourage you to review the document at the following Web site to see how it may affect your systems: http://www.dhs.gov/ xlibrary/assets/ns_tic.pdf.

And keep up the hard work researching and innovating new technology solutions and partnerships that will help your pharmacy customers succeed. CT Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises, LLC, located in Eagan, Minn. The firm provides consulting, research, and writing services to help industry players provide services more efficiently and implement new services for future growth. The author can be reached at mmillonig@ catalystenterprises.net.

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Healthcare Reform: The Pharmacy Perspective Since the passage of healthcare reform legislation in March, we have all read or heard how it will impact us as employers, employees, and individuals. We would like to review the impact healthcare reform will have on practicing pharmacists.

Outlook for Prescriptions One positive impact will likely be an increase in prescription volume. The legislation is expected to reduce the number of uninsured by 32 million by 2019. The increase in coverage will come from several areas.

Expanded Medicaid

Previously, Medicaid coverage was based on a combination of population criteria (pregnant women, children, parents, disabled) and different levels of income criteria. The new Medicaid criteria will now cover all individuals with income up to 133% of the federal poverty limit.

Individual Mandate

Uninsured individuals will be required to purchase health insurance on state health insurance exchanges.

Employer Requirements

While the legislation did not mandate employer coverage, incentives and penalties have been created to increase coverage.

Insurance Regulation Reform

Regulations will require coverage of dependents until they are 26 years old, improve coverage for individuals with preexisting conditions, and eliminate lifetime limits.

The National Association of Chain Drug Stores estimates that prescription volume will increase by 91 million to 116 million prescriptions per year.

Using 100 million prescriptions and 60,000 retail pharmacies, this translates to 1,667 additional prescriptions per year, or 32 per week in many pharmacies. This will be the largest increase in prescription volume since the introduction of Medicare Part D.

Michael Bunn, Pharm.D., M.S.

Don Dietz, R.Ph., M.S.

Bigger Donut, Smaller Hole Medicare Part D patients will

be asking pharmacists about the highly publicized changes to the so-called donut hole. This year patients who hit the donut hole will receive a $250 rebate check from the government.

Tell patients who hit the coverage gap to be on the lookout for this check from the Social Security Administration about 45 days after they hit the donut hole. The check should be automatically sent to the address that Social Security has on file. Patients should call 1-800-Medicare if they do not get their check, and they can call the Social Security Administration to change their address.

Starting in 2011, Part D patients will benefit from a 50% rebate paid by pharmaceutical manufacturers for brand-name drugs dispensed in the donut hole. The 50% brand rebate will jump-start the eventual elimination of the donut hole for brand and generic drugs between 2011 and 2020. By 2020, the patient’s co-insurance in the donut hole will be reduced to 25%, which is equal to the 25% co-insurance that applies to the initial continued on next page July/August 2010

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coverage period. Figure 1 is a chart showing how the discount will be phased in for brands.

Figure 2 shows the phase-in for generic products.

Remember, this is the standard cost-sharing design, and a plan can vary from this design as long as it is actuarially equivalent.

The good news for pharmacy is that the manufacturer rebate does not need to be calculated or processed by the pharmacy. The standard patient co-insurance will be defined by the plan and calculated in the adjudication process. Pharmacies will collect the co-pay, and the Part D plan will pay the remaining amount due under the existing prompt-pay rules of 14 days for electronic claims and 30 days for all others. The rebate calculation and payment will be reconciled among CMS, a third-party contractor, and the manufacturers.

Cost Sharing for Brand-name Drugs in the Medicare Part D Coverage Gap, 2010-2020

Figure 1. Phase-in of the discount for Medicare Part D patient co-pay for brand-name prescription drugs.

Cost Sharing for Generic Drugs in the Medicare Part D Coverage Gap, 2010-2020

Coverage Changes Healthcare reform mandated several coverage changes that will affect your patients.

FSA OTCs

Beginning in 2011, OTC products will no longer be eligible items for tax-sheltered medical savings accounts. OTCs are eligible if they are dispensed pursuant to a prescription. OTC insulin is an exception and will remain an eligible product. Other previously eligible items, such as eye glasses, contact lenses and solutions, diabetic supplies, and other DME items, will continue to be covered.

Figure 2. Phase-in of the discount for Medicare Part D patient co-pay for generic prescription drugs.

Source Kaiser Family Foundation analysis of the standard Medicare drug benefit under the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010.

Medicaid Smoking Cessation

Medicaid is required to cover prescription and OTC smoking cessation treatments for pregnant women starting Oct. 1, 2010. By 2014, Medicaid will need to cover smoking cessation medications for all beneficiaries.

Medicare Coverage

The reform act clarifies that smoking cessation medications, barbiturates, and benzodiazepines are eligible for coverage under Medicare.

MTM Grants CMS is looking to expand the role of the pharmacist in providing medication therapy manage50

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ment (MTM) with a new grant program. The legislation allows pharmacists to apply for a grant to develop appropriate MTM services targeting high-risk patients. These programs should collaborate with other health professions, improve the quality of care, and reduce the overall cost of treatment for a chronic disease. Pharmacists will be able to submit a detailed grant application that includes their plan for implementation and long-term financial support of these services. While the start date for the grant program has passed, further details have been delayed as Congress determines a source of funding to meet the budget-neutral requirements of the legislation.

DME Accreditation Pharmacies had to complete

DME accreditation in the fall of 2009 to bill for such items as diabetic supplies, incontinence garments, and nutritionals. At that time, most pharmacies received accreditation, but some chose to “step down,” allowing them to only bill for Part B drugs such as biologic, inhalation, and transplant drugs.

The recent healthcare reform pushed the accreditation requirement back to January 2011 and made most pharmacies exempt from the requirement.

Pharmacies are exempt if they meet all of the following criteria: ❒ Less than 5% of total pharmacy sales averaged over 3 years are for Medicare DME. ❒ Medicare provider number active for at least five years. ❒ No adverse action in last 5 years. ❒ Pharmacy not competing in competitive bidding.

Medicare numbers are not transferable, so new stores or new pharmacy owners will not meet the exemption

criteria of having an active number for 5 years. In this case, they must be accredited to bill for DME. If they do not become accredited by Jan. 1, 2011, they will need to wait five years.

Pharmacy organizations are arguing for an exemption for these pharmacies or a shorter waiting period, but nothing has been finalized.

Healthcare reform also requires pharmacists to include NPI numbers and legal names of providers as listed in the Provider, Enrollment, Chain, and Ownership System (PECOS) for both the pharmacy and the Medicare provider on all Part B and DME pharmacy claims. The claims will be rejected without this information. This requirement was implemented July 6, 2010. Pharmacy organizations are concerned that pharmacists currently do not have access to this information and have asked CMS to delay full implementation until January 2011.

They have requested that CMS create a “smart” message back to pharmacy with the reason for rejection, release a

national database of provider information, and develop a process to allow for claims generated by interns and residents.

More Opportunities Many of the health reform changes will be phased in over time. Some start this year or next year, while others begin later in this decade. Pharmacists will have increasing opportunity to engage in MTM and work with prescribers as part of a healthcare team. These changes support the evaluation of technology to automate dispensing activities, as well as implementation of systems for tracking and billing of professional services. CT Michael Bunn, Pharm.D., M.S., is a consultant, and Don Dietz, R.Ph., M.A., is vice president at Pharmacy Healthcare Solutions, Inc., (PHSI), in Pittsburgh, Pa., which provides consulting that improves the profitability of its healthcare clients. They consult with pharmaceutical manufacturers, PBMs, retail pharmacy chains, and software companies on strategic business and marketing issues. The authors can be reached mbunn@ phsirx.com and ddietz@phsirx.com.

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July/August 2010

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The American Society for Automation in Pharmacy (ASAP) held its Midyear Industry & Technology Issues Conference in Louisville, Ky. The agenda included topics of immediate significance, such as an update on WAC pricing and the new HITECH requirements, and topics of broader interest, such as pharmacogenomics and entrepreneurial leadership. The conference also offered continuing education credits for pharmacists. All the presentations can be downloaded from http:// www.asapnet.org/pres.html.

Speaker Mary Jo Carden from Carden & Associates, left, is seen here taking a few minutes after her presentation to talk with Carla McSpadden from the American Society of Consultant Pharmacists. Carden’s presentation covered the new HITECH provisions, including steps to take to ensure compliance with the new privacy requirements for covered entities and business associates and the new requirements for breach notification.

Tammy Devine and Michael Ziegler, both from QS/1, with Bryan Amick, right, from Magellan Health Services.

Jerry Christenson from Mayo Clinic, left, talks with speaker Chuck Lee, M.D., right, from Polyglot Systems, and Retail Management Solutions’ Brad Jones. Dr. Lee’s presentation covered how technology can be used to overcome language barriers at pharmacies with multilingual customers.

Odile Harbaugh and Chad Sanders attended from Cardinal Health. Harbaugh gave a presentation on the power of combining POS sales data and wholesaler purchase information to improve front-end performance.

Richard Brook from Emdeon, left, is seen here with Rex Bloom from Kalos.

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Robert Cowan gave a talk on current NABP initiatives in support of the boards of pharmacy and protecting the public health.

Indiana University Kelley School of Business professor Don Kuratko called entrepreneurial leadership the cornerstone of the enterprise in the 21st century.

Cal Knowlton from Revolution Care provided an overview of pharmacogenomics, how it works in practice, and where the move toward using this precision deci-

Speaker Dave Hopkins, left, with the Kentucky KASPER PMP and Tomson George from Walgreens. sion tool is heading.

Hopkins’s topic was prescriptionThe topic for Michael monitoring programs, including a Carr from RxCrossroads look at the Prescription Monitoring was the needs of Information Exchange (PMIX) that specialty pharmacy, is designed to enhance interstate outlining the key data sharing. information required to exercise control over this segment of pharmacy.

Speaker Don Dietz, left, from Pharmacy Healthcare Solutions, Inc., during a break with Lew Burton from McKesson Pharmacy Systems. Dietz talked about where pharmacy is headed with reimbursement metrics.

Brad Mitchell, left, and Bob Loeper from Fresenius Medical Care Rx.

Surescripts’ Ken Whittemore brought everyone up to date on e-prescribing, including an overview of key provisions in the DEA’s interim final rule on e-prescribing of controlled substances.

On hand from SoftWriters were, from left, Chris Delposen, Tim Hutchison, and Chris Anderson.

Wolters Kluwer Health’s Paul Johnson, left, catches up with Ron McKillip from Millennium Pharmacy Systems during a break in the program.

ASAP Midyear Industry & Technology Issues Conference Shown here are Paul Hooper, left, from Emdeon, Baeteena Black from the National Alliance of State Pharmacy Associations, and industry consultant Bruce Kneeland.

From left, Steven Judy of Judy’s Drug Store in Petersburg, W.Va., Steve Roberts from Ateb, and Charles Brinkley from FDS.

Paul Dyas, left, from pc1-PDX-Freedom Data Systems, talking with Ron Hatfield from Appriss.

Tom Bizzaro from First DataBank is pictured here with his wife, Ann.

QS/1 2010 Customer Conference More than 400 customers and their guests attended the QS/1 2010 Customer Conference in Greenville, S.C. In addition to the speaker program, which covered industry issues and recent enhancements to QS/1 technology, there was a busy technology fair where customers could get hands-on time with QS/1 systems and chat with QS/1 staff as well as technology business partners. The highlight of this year’s conference: a tour of QS/1 headquarters in Spartanburg, S.C., followed by dinner and music.

Behind the scenes at QS/1 (clockwise from left): Vickie Patterson gives data center stats to a group of customers. The data center handles more than 1 million claims a day; during the tour customers heard about the different departments, such as phone support, which handles the 700–1,100 calls that come in a day; QS/1’s John Frady, standing at right, chats with customers at dinner in Indigo Hall, next to QS/1’s headquarters in Spartanburg.

VP Revonda Spratt, right, with longtime QS/1 customer Jim Mullaney, of Mullaney’s Rx Pharmacy, during a break.

QS/1’s Nancy Jones with Lazelle Marks, of Medical Center Pharmacy, during a break in the technology fair.

There was a buzz in the technology fair throughout the conference. At left, QS/1’s Lana Fowler reviews SystemOne features with QS/1’s Kristy Wood and TLC Medical Center’s Kara Cook and Jackie Younce.

continued on next page July/August 2010

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QS/1 2010 Customer Conference

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Getting questions answered: From left, are Kerri Lundy of Womble Drug Co., with Tiffany Hicks; customers watch an RxMedic ACS demonstration with Bart Mitchell; and Rita Proctor, Lincoln Community Health, gets details on enhanced printing from Mandi Biershenk.

Jason Janét, Ph.D., right, CTO of RxMedic, talks about the company’s ADS, a new level of automation offered to QS/1 customers.

Rx-Net-Inc.’s Chuck Cannata, left, discusses the company’s pricing service with Napolean Onyechi from Samuel Simmons Hospital.

Phillip Clark, center, gives details on DOSIS, by Manchac Technologies, to Juan Guerra, Lifemed Pharmacy.

DOSIS is an automated dispensing device that fills and seals 30- and 31-day blister cards.

QS/1’s Mike Ianitello with Tiffany Hicks and Shannon Owens, also from QS/1.

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Customers talk shop about QS/1’s workflow with QS/1’s Mark Comer (center). From Lahey Clinic are Scott McEachern, left, and Patrick Lam right, and from Nems Pharmacy is Eland Yu, seated.

Pharmacy First’s Brian Huckle, R.Ph., chats with Bob Moser, left, and Ron Kaiman, of Winston-Salem Healthcare during a break in the technology fair.

Charles Garner reviews the newest IVR, automation systems, and Web services, including the mobileRx functionality for CornerDrugstore.

Louie Foster talks about Integra’s DeliveryTrack and DocuTrack with Michael Nadeau and Steven Boyer, both of Bedford Medical.

David Valencia, left, explains PickPoint’s will-call system to Paul Mayer of Pauls Pharmacy.

POS remains a popular area that kept QS/1 staff busy showing updates such as gift receipt printing, multiple tender types, GS1 Databar, and patient verification. John Max is shown with Neil McPhail, center, of McPhail’s Pharmacy, and Ron Holland, Akers Pharmacy.

Net-Rx’s Paul Butler, left, and Laura Wasielewski field questions about interfaces available for prescription pricing and claims processing.

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➤ William T. Winsley, M.S., R.Ph., has begun his term as president of the National Association of Boards of Pharmacy (NABP). Winsley was sworn in as the 106th NABP president at the association’s 106th annual meeting in Anaheim, Calif., in May. He serves as the executive director of the Ohio State Board of Pharmacy, a position he has held since 1998.

Winsley is also a member of the State Alliance for e-Health’s Health Care Practice Task Force for the National Governor’s Association. He is a graduate of Ohio State University, where he earned his pharmacy degree and a master’s degree in hospital pharmacy administration. In 1999 Winsley was honored with the Distinguished Alumni Award.

Also at this year’s annual meeting, Malcolm J. Broussard, R.Ph., was elected NABP president-elect. He serves as executive director of the Louisiana Board of Pharmacy, where he is responsible for the board’s compliance with federal and state legislative and regulatory mandates. Prior to joining the board of pharmacy in 1999, he was a staff pharmacist in

both the hospital and retail settings.

Broussard received his pharmacy degree from Xavier University of Louisiana. ➤ Eatonform has announced the promotion of Craig Wells to group VP of the company‘s HealthCare Products Group. Prior to this he was general manager of healthcare products. ➤ Recipient of this year’s Ken Wurster Community Leadership award given by Cardinal Health was Jim Vallee, owner of C&C Drugs in Mandeville, La. In addition to managing two pharmacies, Vallee also participates in numerous community service organizations, including those providing shelter to the homeless, helping children in developing countries, serving those affected by natural disasters, and providing medication counseling and assistance to senior citizens.

This award, given annually, was created in honor of Tampa, Fla.,

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independent pharmacist Ken Wurster, who passed away in 2008. ➤ Centice has announced that Gale Massiah and Ryan Cole have joined the company as sales directors for the company’s PASS Rx, a system that verifies the chemical composition of the contents of medications being dispensed.

Massiah’s background includes sales with McKesson, Ortho Clinical Diagnostics, Summit Instruments, and Roche Biomedical.

Her focus will be the hospital market.

She holds a B.S. degree from Rutgers University.

Cole’s prior experience was with Myriad Genetic Laboratories, Parata Systems, Biovail Pharmaceuticals, and Eli Lilly. He is a graduate of Ball State University with a B.S. degree and will be responsible for the independent and small chain markets. CT

McKesson High Volume Solutions ...Back Cover McKesson Pharmacy Systems ...29, 56 Micro Merchant Systems, Inc. ...12 Parata Systems ...Inside Front Cover QS/1 ...5, 31, 56 Retail Management Solutions ...56 Rx-Net-Inc. ...8 ScriptPro ...7 SoftWriters, Inc. ...1 Speed Script ...24 TCGRx ...30 TeleManager Technologies ...36 Transaction Data Systems – Rx30 ...56, Inside Back Cover Two Point Conversions, Inc. ...51 voiceTech ...26 July/August 2010

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American Society for Automation in Pharmacy

Cerner Etreby

www.asapnet.org

www.etreby.com

ComputerTalk for the Pharmacist

McKesson Pharmacy Systems

www.computertalk.com

http://ct.aboutmps.info

QS/1

Retail Management Solutions

www.qs1.com

www.rm-solutions.com

Transaction Data — Rx30

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www.rx30.com

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ComputerTalk

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