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Volume 30 Number 6 • November/December 2010

For The Pharmacist

www.computertalk.com

Looking Ahead: What’s Coming in 2011 An exclusive industry survey that looks at... • New products and enhancements planned for 2011 • Factors driving pharmacists to change or upgrade their systems • Hot topics — SaaS, MTM, and D.0 • The growth segments for 2011 • What’s in store for central fill and central processing • And more... story begins on page 18

Plus... Plus... n A Look at the New Privacy Reducing and SecurityWaste Rules in LTC n What Healthcare Reform n Issues with E-Prescribing Means to Pharmacy nn How Secure is How One Pharmacist Your System? Deployed Technology n

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Parata Salutes:

Mark Aurit, R.Ph.

2 0 1 0 N E X T- G E N E R AT I O N P H A R M AC I S T

As an automated pharmacy looking to the future, I see script volumes continuing to rise. Pharmacies large or small will need automation to free up time to converse with customers, to provide cognitive services, disease-state management, medication therapy management and more.

Parata congratulates Mark Aurit and the other winners of the 2010 Next-Generation Pharmacist Awards, a program created to recognize professionals who are defining the future of pharmacy by their innovative practices. Call for entries for 2011 opens Jan. 15, 2011. Learn more at nextgenerationpharmacist.org.

Mark Aurit, R.Ph. Gateway Health Mart Pharmacy Bismarck, ND

November/December 2010

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In This Issue:

ComputerTalk

®

for the Pharmacist

November/December 2010 Vol. 30/No. 6

Looking Ahead: What’s Coming in 2011

This year’s edition of our annual vendor survey received responses from 29 companies and once again offers valuable insights into what pharmacists can expect on the technology front in the new year. Read about what’s coming in new and enhanced products and services; the state of the vendor response to D.0; the response to the new HIPAA privacy and security requirements under HITECH; where we are with SaaS; central fill and central processing; MTM; and more. Story begins on page 18.

Features: 10 Privacy and Security Rules Update:

The Impact on Pharmacies and Pharmacy Vendors by Mary Jo Carden, R.Ph., J.D.

The HITECH Act has led to a new proposed rule that strengthens the healthcare privacy and security provisions already in place under HIPAA. When HITECH is fully implemented, covered entities, which will include both pharmacies and business associates, will be required to comply with new administrative and recordkeeping requirements for handling patientspecific protected health information (PHI). The final rule is due out soon, making now the time to be sure you understand these new requirements.

14 My Experiences Deploying

Pharmacy Technology by Tim Davis, Pharm.D.

Here’s one pharmacist’s approach to putting new technology to work in both a high-volume, established location and a start-up. Find out what was considered critical at each stage of growth, the requirements for each new technology, and the thought process behind selecting vendors. 2

ComputerTalk

Departments: 4 Publisher’s Window Game-Changers 6

Industry Watch

34 George’s Corner From Premature Factulation to Organizing Your Shelves 37 Technology Corner New Technology Resource 39 Catalyst Corner Competition Means Moving Fast, But Buyer Beware 41 Viewpoints E-Prescribing: Expectations and Limitations 44 Conference Circuit The National Community Pharmacists Association (NCPA) 2010 Annual Convention and Trade Exposition The 2010 Speed Script Users Conference & Trade Show 47 PeopleTalk 47 Index of Advertisers 48 Web Sites to Visit


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Whether you fill 1,000 or 60,000 prescriptions per day - McKesson High Volume Solutions, the industry leader in closed-door pharmacy systems, has a pharmacy automation solution for you. Are You: - Running out of capacity to efficiently handle your volume? - Trying to reduce cost-to-fill and labor cost-per-script? - Eager to tap new revenue sources such as 340B, MTM and/or specialty programs? - Concerned about patient medication safety? - Interested in increasing operational efficiencies to drive greater profits and revenues?

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Let McKesson High Volume Solutions Help You Grow. · Central fill · Mail order · Hospital outpatient · 340B · Specialty Not Just Products, But a Partnership. We approach your business to achieve your goals. We sit down with you to understand your business and your needs. We will introduce pharmacy automation solutions and opportunities that fit your vision, your current volumes and your plans for growth.

Trust our team to provide the industry leading pharmacy automation solutions you need that allow you to spend more time with your patients, while lowering your operating costs. Call Us Today and Let Us Help You Grow Forward. Let us share a demo of our revolutionary new pharmacy automation technology. Plus, as a thank you, we will also send out our white paper: The Role of Automation in Pharmacy. 888-HVS-RXRX (888-487-7979) www.mckesson.com/hvs

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for the Pharmacist www.computertalk.com Volume 30, No. 6 November/December 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

4

ComputerTalk

publisher’s window Game-Changers

T

he cover story in the October 25 issue of Barron’s was on cloud computing and the trend toward offering software as a service (SaaS) through the cloud. This is more than a concept. It is the new IT model that can reduce computing costs for businesses of all stripes, including pharmacy. You have likely read about companies like Amazon and Google, with their vast computer capacity to allow companies to outsource their applications. Cloud computing can be the next game-changer. When the PC became a legitimate business computer it was a game-changer for companies such as Digital Equipment Corporation and Wang, to name two, who held sway with minicomputers. Do companies like HP and Dell now face a similar challenge? The way I size it up, pharmacies will be seeing more software-as-a-service applications run through a cloud. Software patches and new features will be immediately available. Dealing with file backups will be a thing of the past. This will be done for you. But make sure your data files are encrypted in order to avoid a HIPAA privacy breach violation. What’s interesting is that we have been here before. When computer applications were first offered to pharmacies in the mid-1970s, these were called online systems. Connection was made through a dial-up modem. The pharmacy’s data resided on the minicomputer hosting the service. Then there was a market shift to stand-alone systems that were minicomputer-based, prior to the personal computer taking the market by storm. Now we seem to be circling back to where we started. Another game changer is mobile technology. With the various apps available for this technology, pharmacists are finding ways to use these to improve customer service and manage the pharmacy remotely. This was very evident at the recent NCPA technology seminar during the 112th annual convention in Philadelphia, where a panel of pharmacists talked about how these devices are becoming an important part of their technology regimen. These pharmacists are able to gain access to their in-store systems from almost anywhere by using their phones and tablets and cellular or Wi-Fi connectivity. A few examples: One pharmacist described how he can remotely reset his stores’ servers if a problem develops; another pharmacist monitors inexpensive GPS devices in his delivery vehicles via the Web — showing him routes, speeds, and more; and a third was taking advantage of numerous apps to connect with his peers, as well as with his patients. Outside of the panel, I spoke with a pharmacy owner who described using her device to help her pharmacy on the other side of the country fill 600 prescriptions while she was at the NCPA convention for the weekend. The opportunities seem to be limitless. And another important aspect of cloud computing, mobile devices, and the apps that take advantage of them is their low cost. It’s now increasingly easy for innovative pharmacists to try out new technologies with the comfort of knowing that they can easily move on if they don’t see the benefits they hoped for. This is true too of some of the SaaS pharmacy applications out there, which run on existing hardware for a monthly fee. As these advances in technology reduce the fear of being stuck with a white elephant, there’s no telling what you can accomplish. CT Bill Lockwood, Chairman/Publisher, can be reached at wal@computertalk.com.


What makes a pharmacy her favorite? Her pharmacist.

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1.800.231.7776 www.qs1.com © 2010, J M SMITH CORPORATION. QS/1 and NRx are registered trademarks and InstantFill is a trademark of the J M Smith Corporation.


Industry

Watch

PDX Targets Inventory Management Through an agreement with R x Net Services, located in

Syracuse, N.Y., users of both the PDX pharmacy system and the new Enterprise Pharmacy System will have access to an integrated Rx Net platform for managing drug inventory. The integration will automate inventory management functions provided through Rx Net’s Targeted Inventory Management System (TIMS). TIMS is designed to address a subset of every pharmacy’s prescription drug inventory. By tracking drug expiration data, providing a chain-wide view of specific inventories in all store locations, and creating an electronic intra-chain transfer of slow-moving prescription drugs to locations where they will sell, TIMS can lower inventory levels, increase turns, reduce drug return volumes, and unlock substantial cost savings. According to PDX, integration of the Rx Net program will be available in the first quarter of 2011. Jeff Farris, CEO and president of PDX, sees this partnership with Rx Net as a way to “better manage a very costly portion of prescription drug inventories.” Dana Carder, president of Rx Net, says that “this analysis and automated inventory transfer represents our newest innovation, which complements and enhances other functional components of the TIMS software suite.”

Short-Cycle Solution from TCGRx TCGR x has launched ShortCycleRx to provide long-term 6

ComputerTalk

care pharmacies with a series of comprehensive dispensing options to meet the demands of the potential CMS regulations to reduce medication waste.

CEO of Wholesale Alliance LLC/ Pharmacy First. The company has partnered with PageMinder, located in Nevada, Mo., to provide the service.

CMS has its eye on reducing medication waste by dispensing medications in cycles of seven days or less. TCGRx is providing either a central pharmacy production model, which is a hybrid solution for central filling and facility medication access, or a complete remote medication access solution, which includes a real-time packaging product for the facility.

NABP Developing System to Link PrescriptionMonitoring Programs

The central pharmacy solution includes a tablet packager that automates unit-dose or multi-dose pouches, replacing more expensive 30-day packaging formats. The hybrid model allows for central pharmacy filling while leveraging remote dispensing from a secure medication cabinet for first doses, STATs, PRNs, and LOA medications.

Pharmacy First Introduces Refill Reminder Program

Pharmacy First will now allow a pharmacy’s patients to

receive communications specific to a patient’s treatment regimen. With the new FirstReminder program, patients will have the ability to set up their own refill and dosage reminders and have them directed to their choice of email or text. Pharmacy First network pharmacies can communicate these reminders, along with using the service to remind patients of upcoming sales and promotions. Because the patient opts into the program, all federal and state privacy concerns are covered, according to Brian Huckle,

Responding to the need for a way to facilitate information sharing among prescriptionmonitoring programs (PMPs), the National Association of Boards of Pharmacy (NABP) will be developing a communications hub for state PMPs.

Once the system is in place, authorized clients will log in to their PMP and request information from other participating PMPs through the interconnect hub. The hub will facilitate the completion of the information request so that clients can quickly obtain what they need to identify possible prescription drug abuse and diversion. The hub will enforce each program’s access rules to ensure that there is only authorized access to the information.

Surescripts Expands Network

Surescripts is expanding its nationwide e-prescribing net-

work to accelerate the digital transformation of the nation’s healthcare system by enabling electronic exchange of clinical information. Moving beyond e-prescribing, Surescripts will be building on its established network by giving participants and electronic health record partners new secure messagcontinued on page 8


Now Online at www.computertalk.com Exclusive Web content this month at ComputerTalk’s Web site The State of Automation An Interview with Parata’s New CEO Tom Rhoads

More from Our Looking Ahead Survey New Products and Enhancements Planned New Interfaces Revenue-Boosting Offerings Features Current and Prospective Users Want Pharmacy and Social Media

The Importance of Adherence An Interview with Med Time Technology President Ian Shendale Plus... The Latest on the New IIAS Rules for OTCs

Industry

Watch

continued from page 6

ing tools through an investment in Kryptig. This company facilitates an open collaborative network that connects physicians with each other and their patients. More than 40,000 physicians used Kryptig solutions. This move by Surescripts is supported by two years’ worth of technology pilot work with 500 CVS Caremark MinuteClinic sites in 26 states, where nurse practitioners are using the Surescripts network to share patient summaries with physicians.

NIH Chooses ScriptPro for Pharmacy Automation ScriptPro’s robotic dispensing, pharmacy management,

and drug information systems will be implemented at the National Institutes of Health (NIH) to assist in the internal control and identification of drugs and improve the safety and efficiency of medication dispensing and use by patients. The system is specifically directed at take-home medication orders provided to hospital and clinic patients. ScriptPro will provide a closed-loop system for filling and dispensing medications that will allow all the pharmacies to monitor workload and control operating costs. In addition to NIH, ScriptPro provides systems to the VA, the FDA, all branches of the DoD, U.S. public health services such as the Indian Health Service, and federal prisons.

PEER Portal for Reporting E-Rx Experiences The Alliance for Patient Medi-

8

ComputerTalk

cation Safety (APMS), a federally

listed patient safety organization, has launched a Web portal to allow pharmacists to document their experiences with electronic prescriptions. The purpose is to improve the e-prescribing process. “E-prescribing is on the rise, as more providers are tapping into this technology to improve the safety, quality, and efficiency of the prescribing process to take advantage of government incentives,” says Tara Modisett, executive director of APMS. “We are committed to using the reported data to identify and quantify the recurring issues so that we can advocate measures to improve the safety and quality of e-prescribing.” The Pharmacy and Provider ePrescribing Experience Reporting (PEER) Portal uses a Web-based questionnaire to collect the data. APMS and state pharmacy associations have teamed up to encourage pharmacists to use the portal. APMS was established by the National Alliance of State Pharmacy Associations. For more information, go to www.medicationsafety.org.

Sav-On Drugs Completes Rollout of ECRS POS

Sav-On Drugs has announced the completion of the implementa-

tion in its 22 stores of the ECRS CATAPULT enterprise retail automation system. The main components of this enterprise-wide system include point of sale, centralized multistore price-book management, centralized multistore reporting, and self-checkout. Along with the point-of-sale (POS) system, ECRS provides Sav-On with


headquarters data and reporting synchronization for all locations, centralized pricing and promotions, IIAS compliance, bidirectional pharmacy system integration, OTC inventory management, and e-signature capture. In response to customer feedback, Sav-On implemented the ECRS QUICKcheck self-checkout in a test store.

Innovation Gains DoD Security Accreditation Innovation, makers of Pharm ASSIST pharmacy automation solutions, has announced that its product line has been granted the authority to operate (ATO) and authority to connect (ATC) to the Air Force Global Information Grid under the Department of Defense (DoD) Information Assurance Certification and Accreditation Process (DIACAP).

Innovation’s PharmASSIST products are deployed in over 130 U.S. Air Force, Army, and Joint Forces pharmacies around the world. All DoD information systems must be certified and accredited. The process is complex and lengthy, and is completed in five phases. It can take months or even years, depending on the size of the system and the availability of the personnel responsible for completing different aspects of the process.

Kirby Lester Documents Efficiency Improvements In June the University Village Pharmacy, located on the

University of Illinois Chicago campus, installed a Kirby Lester KL60 robotic dispenser as part of a pilot program. To evaluate the effect the system had on operations, pharmacy staff completed a pre- and postinstallation survey.

Pharmacy e-Health HIT Collaborative Formed A number of pharmacy associations got together to form the

Pharmacy e-Health Information Technology Collaborative to address the technology needs of the pharmacy profession and ensure integration into the electronic health record (EHR) that will be the cornerstone of the U.S. health information technology infrastructure.

In commenting on the formation of the collaborative, Tom Menighan, CEO and executive vice president of the American Pharmacists Association and chair of the collaborative, points out that “in order for patients to receive optimal care, pharmacists need to have the ability to access and contribute to relevant, patient-specific information from the EHR.” This is the goal of the collaborative, he explains. In addition to the American Pharmacists Association, members include the Academy of Managed Care Pharmacy, Accreditation Council for Pharmacy Education, American Association of Colleges of Pharmacy, American College of Clinical Pharmacy, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, National Alliance of State Pharmacy Associations, and the National Community Pharmacists Association. Shelly Spiro has been retained to serve as director of the collaborative. Spiro is president of Spiro Consulting, Inc., a consulting firm specializing in long-term and post-acute care pharmacy services. For additional information on the collaborative, contact Jim Owen at jowen@aphanet.org. The survey found that prior to installation only half the staff thought that the technology was essential to a well-run pharmacy. However, after using the robotic dispenser for only three months, the staff was universal in its agreement that the technology was essential. There was total agreement that the KL60 speeded up dispensing, saved time, and improved workflow. “The KL60 proved to be a valuable addition to our pharmacy,” says Katherine Lee Mosio, assistant director of the pharmacy and clinical assistant professor at the college of pharmacy. “When verifying prescriptions, it is reassuring to know that they were accurately labeled and counted by the technology.” The KL60’s 46-inch depth allowed the pharmacy to install the unit without any remodeling. This was also viewed as a positive.

Rx-Net Tweaks Pricing Service In order to make its pricing service more pharmacy specific, Rx-Net has refined its use of ZIP codes in identifying market price data, according to Chuck Cannata, president of the company, located in Shawnee, Kan. In addition, it has built in more pricing specificity for generic drugs in order to give the pharmacy the ability to price based on drug popularity. And pharmacy owners can now set their pricing markups based on the classification of drugs. Cannata says that this feature provides a way for independent pharmacies to price competitively with the large chains. Cannata also reports that the company has redesigned its Web site to include new vendor links and other features to make for a more productive user experience. CT November/December 2010

9


Privacy and Security Rules Update: The Impact on Pharmacies and Pharmacy Vendors by Mary Jo Carden, R.Ph., J.D.

O

n July 14, 2010, the Department of Health and Human Services Office for Civil Rights (HHSOCR) issued a proposed rule, Modifications to the HIPAA Privacy, Security, and Enforcement Rules Under the Health Information Technology for Economic and Clinical Education Act [HITECH] that strengthens existing healthcare privacy and security provisions. When fully implemented, covered entities (CEs), including pharmacies and business associates (BAs), such as pharmacy vendor companies, will be required to comply with new administrative and recordkeeping requirements for handling of patient-specific protected health information (PHI). See key provisions included at right. HHS-OCR must review comments and then issue a final rule before implementation. HHS-OCR will allow 180 days after the release of the rule to comply with most provisions. Certain BA agreements will be delayed even longer. Table 1 shows the projected timeline for implementation, based on an assumed publication date of the final rule in either December 2010 or January 2011. Changes in the proposed rule will also be coupled with additional rules and guidance. Increased enforcement penalties are already in effect for covered entities and will become effective for BAs upon implementation of the final rule. CEs and BAs must report breaches according to requirements of an interim final rule, and a new, more stringent final rule is expected in the coming months. 10

ComputerTalk

Key Provisions ■ Increased

enforcement and recordkeeping requirements for BAs, and the need to revise BA agreements.

■ Changes

in marketing and sales provisions, including the need for CEs to update notice of privacy practices (NPPs) and receive authorization when using PHI. The rule preserves the ability of pharmacies to provide refill reminders to patients for current medication regimens.

■ Patients’

ability to restrict disclosures of PHI.

■ Patients’

ability to receive an accounting of disclosures.

Further guidance is also expected for minimum-necessary and limited data sets that will require BAs and CEs to evaluate practices and safeguards to limit unnecessary or inappropriate disclosures of PHI.

BA Agreements and Requirements for Technical, Operational, and Administrative Safeguards HHS-OCR will require full compliance with new and continued on page 12


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11


feature Privacy and Security Update continued from page 10

updated BA requirements, including provisions of the security rule and requirements to maintain PHI — within 180 days of publication of the final rule. Written BA agreements renewed prior to the publication of the final rule but not changed or modified between the effective date and the compliance date do not have to be renewed immediately if they meet existing HIPAA requirements. CEs and BAs will be given one year after the compliance date of the final rule to include all new privacy provisions in BA agreements. Based on current projections for publication of the final rule, full compliance will be required in the second quarter of 2012. Pharmacies and pharmacy vendors should begin reviewing existing BA agreements and consider renewing current contracts to ensure compliance with the privacy and security requirements. BAs will have to ensure compliance with the provisions of the security rule and ensure that appropriate technical, operational, and administrative safeguards are in place consistent with the rule. BAs should begin the process of compliance immediately. In July 2010, HHS-OCR finalized guidance on conducting a risk analysis that serves as a helpful starting point for BAs and CEs to evaluate existing practices. Given the new emphasis on enforcement for both CEs and BAs, evaluating and updating security measures is a necessity for most entities. A final risk analysis

guidance issued by HHS-OCR may be used for BAs to determine whether current gaps exist. A link to the current security rule and risk analysis is included in the box on the next page.

Marketing and Sales of PHI, NPP Changes, and Authorization Requirements CEs and BAs may make certain marketing communications to patients using PHI. Pharmacies are permitted to provide refill reminders to patients without specific authorization if the communication concerns medications currently prescribed to an individual and third-party financial remuneration is reasonable to cover the cost of making the communication. If a CE receives financial remuneration from a third party offering products or services necessary for the treatment of a patient, then this information must be disclosed to patients in the NPP (notice of privacy practices) and the communication itself, with an opportunity for the individual to opt out of such communications. Communications made for treatment alternatives or products offered on a population basis for financial remuneration would require specific authorization prior to making the communication. The proposed changes to NPPs represent a material change requiring CEs to revise and redistribute NPPs to all individuals on a date that will be specified in the final rule. NPP updates must include information related to the types of disclosures that will be made for marketing purposes and healthcare operations for remuneration. A

Action

Actual or Projected Timeline

Enhanced enforcement penalties for CEs

Effective for violations of the privacy and security rules on or after Sept. 23, 2009

Comments on proposed rule

Due Sept. 13, 2010

Publication of final rule*

Projected for December 2010 or January 2011

Compliance date for most provisions, including NPP updates and enforcement for BAs*

Projected for mid-2011

Final compliance date for all provisions, including final date for BA agreements*

Mid-2012

Table 1. Projected timeline for implementation of new privacy and security provisions* *Projections included in this timeline are subject to change depending upon the publication date of the final rule or other changes implemented by HHSOCR or by law. This timeline is intended to provide an estimate for planning purposes and should not be considered final. 12

ComputerTalk


feature Privacy and Security Update For more information: Current HIPAA Privacy and Security Rules http://www.hhs.gov/ocr/privacy/hipaa/administrative/index.html Proposed Changes to HIPAA Privacy and Security Rules http://edocket.access.gpo.gov/2010/pdf/2010-16718.pdf HHS-OCR Final Guidance on Risk Analysis http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/ rafinalguidance.html

statement and description of disclosures that may only be made pursuant to specific authorization must also be provided. Opt-out procedures may not present an undue burden to patients and may be made available through email, a Web site, or a tollfree number. Sales involving PHI must be made pursuant to a specific authorization by a CE or BA each time a sale occurs. The HIPAA privacy rule and proposed rule provides some exemptions to this requirement, including if a CE sells, transfers, or merges business or records; the sale is for public health purposes; or the sale involves a limited data set.

Patient Restrictions on Disclosures Patients may restrict disclosures of PHI to other providers or BAs if a service is fully paid out of pocket and the disclosure is not otherwise required by law. These restrictions could present issues for pharmacies that automatically adjudicate claims sent by prescribers electronically or by phone to pharmacies if nondisclosure information is not communicated by the prescriber. Pharmacies that receive electronic or telephonic prescriptions for existing patients covered by a third-party plan would generally adjudicate claims. The proposed rule recognizes the potential problems in this situation, but does not impose the responsibility on any single provider or entity to communicate information

to other providers or BAs. HHS-OCR sought comments on this provision and will likely provide further guidance in the final rule.

Accounting for Disclosures The HITECH Act required that providers who maintain electronic health records (EHRs) provide a complete accounting for disclosures, including treatment, payment, and operations, upon request. Pharmacy databases do not meet the current definition of EHRs and therefore could have been exempt from the accounting for disclosures, but in the proposed rule, HHS-OCR applies this requirement to all information stored or maintained in electronic databases. The proposed rule does not provide specific guidance on accounting for disclosures because this will be the subject of a future rulemaking.

Prepare Now The proposed changes to the privacy and security rules are important for pharmacies and pharmacy vendors to understand and review. In the short term, BA agreements should be reviewed and renewed, and affected entities should continue to monitor for further developments. CT Mary Jo Carden, R.Ph., J.D., is president of Carden & Associates, located in Arlington, Va. The author can be reached at mcarden@ cardenassociates.net. November/December 2010

13


My Experiences Deploying Pharmacy Technology by Tim Davis, Pharm.D.

A

s a 36-year-old second-generation pharmacist and pharmacy owner, I have had the experience of selecting and deploying technology for both a start-up pharmacy, which I opened in 1997, and for the pharmacy my father, Harry Davis, began in 1989, and where I still work day-to-day. My hope is that sharing my experiences and the decision-making process will be useful to my colleagues. Let’s begin with the start-up.

The Start-Up Beaver Health Mart Pharmacy was designed to be owned and managed remotely. It is located in Beaver, Pa., the town neighboring my father’s Brighton Health Mart Pharmacy, and although it was my first start-up, my intent was to create many more modeled after it. Replication of the physical pharmacy was important, but being able to maintain control over the customer experience within was critical as well. Thus, the technology I used on day one enabled me to project my intended business style into a pharmacy in which I was physically not present. My chief pharmacist was a new graduate and needed support to make good business decisions for running a successful pharmacy operation.

Choosing the PMS One way I looked to make life easier was by choosing a pharmacy management system (PMS) based on ease of user interface combined with functionality and support. At the time, the Windows GUI (graphical user interface) was still being rolled out by various vendors, so we were choosing between GUI- and DOS-based interfaces. The GUIs proved to be faster for people to learn and more comprehensive in the learning process. We expected (and 14

ComputerTalk

verified) many fewer business function mistakes (billing, reimbursement, coverage) as a result of adopting a GUI interface. Beyond the interface we looked at the system’s ability to handle multiple payer layers (primary, secondary, tertiary), finding that some systems were better than others with the requirements of our payers, in the robustness of the reporting module, for handling perpetual inventory, in the interface with our wholesaler, in the ability to expand the system, and in the proposed product development pipeline. We wanted to make a move to a PMS that was not only a great fit immediately, but was also poised to remain great in the future. Customer support was imperative, too. We spoke to many current users of different systems and asked for anecdotes about their support experience. We needed fine-tuned support to be available during business hours, an immediate response, and a vendor who understood the pressures placed on us during downtimes. We knew that it wasn’t a question of if the technology would fail, but when, and we wanted to prepare for that day.

POS and IVR We installed IVR. Although we did not use it during working hours, it made my pharmacy available to customers after-hours, when they might want to order refills. From opening day, we also had a point-of-sale (POS) system and electronic signature capture. The POS system allowed us to run perpetual inventory on our retail products and prepared us for regulatory requirements; pseudoephedrine tracking was one issue on our minds when we chose to install POS. Since then we’ve


Feature Technology Business Plan been able to use POS to meet new regulatory requirements that weren’t even on our radar then, such as the Red Flags rule and PCI compliance. Since we knew that our operations were subject to legislative and regulatory impact, we knew we needed a POS vendor that we could really trust to be responsive as issues arose. In fact, we explored the customer experience and the responsiveness of these vendors more than the product itself when evaluating them. A vendor who doesn’t listen, doesn’t care. I don’t want that vendor in my corner when the government wants a quick change to our business practices. With POS, my staff had to work less to keep the pharmacy stocked and priced. The time saved has been spent talking to patients about products rather than organizing them. The perpetual inventory experience carried over into the pharmacy prescription inventory as well. When this was paired with use of the DEA’s controlled-substance ordering system, we were able to concentrate on patients and always have their prescription products in stock. Data available from our POS has also allowed us to tailor our inventory to handle cash flow changes and account for growth on a patient-by-patient basis. For example, we can know what products are selling well and can expand these offerings, while reducing our inventory exposure within a product category that doesn’t sell at all. We are able to watch for evidence of internal and external shrinkage. We can respond with security actions based on sales data. One example is our handling of the abuse of cold medicine by local teenagers. We noticed in our reports that a higher-than-usual amount of a non-PSE product was being sold in the hours after school. With a little research, we learned that it had become fashionable to abuse the cough suppressant dextromethorphan. We moved the products in question to a secure area and limited their purchase to adults. In this way, we used our POS to detect and respond to a public-health issue and help curb illicit medication use.

From Year Two to Now Toward the end of year one, we adopted a stand-alone workflow solution that integrated with our pharmacy management system. This enabled us to use new procedures in the pharmacy to manage documents paperlessly and improve the customer experience. We could now track where a prescription was in the store, and patients never left with either the wrong prescription or missing prescriptions. The end of year one was also the advent of e-prescribing in our region. We saw this expedite our processes and enhance our safety profile. As we began to become profitable, we adopted smart

The author believes in the business advantage of a full array of technology. Top, the start-up. At right, the pharmacy where the author works with his father, Harry, pictured at left with a piece of automation from Parata.

phones to share information and communicate between pharmacies. In the past six months we have purchased iPads and a Wi-Fi scale for pediatric weight calculations. At present we are changing our PMS to adopt the newest technology for remote management and further enhance growth of the pharmacy enterprise as a whole through the correct networking of locations and sharing of information. The correct choice of PMS can make or break a start-up’s multiple-location venture.

Modernizing a Pharmacy Brighton Health Mart pharmacy, in New Brighton, Pa., turned 20 years old in 2009. When I graduated from pharmacy school in 2000, the only technology employed by Brighton was a pharmacy management system and a fax machine. We put a plan into motion to modernize the pharmacy, create the potential for growth, and ensure reevaluation of our technology footprint regularly. We updated our pharmacy management system and installed a POS system. We didn’t employ perpetual inventory management with either technology, however. At Brighton, there was concern that it wouldn’t work and would waste time. The next year we purchased automated counting cabinets and a stand-alone workflow solution. Our organization increased, and so did our prescription volume. This was also the point where we adopted electronic signature capture. We needed to ensure that as our continued on next page November/December 2010

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Feature Technology Business Plan continued from previous page

increased, our ability to respond to audits and comply with HIPAA scaled up as well. This has worked as planned. E-signature capture has helped our highvolume pharmacy avoid tens of thousands of dollars in PBM chargebacks. I also realized that our niche in long-term care was growing, so we made the investment in a long-term care module for our pharmacy management system. This gave us the ability to offer services and compete in a totally different market. The changes we made prepared us for comfortable growth. We never felt overwhelmed, and safety was never compromised for volume. We rested on our laurels for two short years. Then we removed the automated cabinets and replaced them with a fully automated robotic solution. It was after the robot was put in place that we recognized our workflow solution needed more robust capabilities to help us continue on a path of niche exploration and customer service enhancement. Based on the experience at my start-up, we replaced our stand-alone workflow solution with a new-generation system. Now the same

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capabilities of prescription tracking and prescription imaging were available at our high-volume location.

Better Signature and Document Management At the same time, we upgraded our e-signature capture and began paperless document management procedures. We upgraded signature capture to enhance our reporting capabilities. We wanted to be able to print reports showing the pickup dates and signatures for individual as well as groups of prescriptions. We wanted to be able to capture multiple signatures per prescription — for partial fills or owed meds, for example — in addition to being able to capture signatures for HIPAA, safety caps, and marketing opportunities. We initially used paperless document management in our retail area. Then we began to build document libraries for patients concerning anything that pertained to them. Naturally, prescriptions were scanned, but we also were able to store documents such as prior authorization letters, directions for delivery, HIPAA information, and immunizations digitally. We then began to do the same for our LTC services, and expanded the functionality to include physician standing orders, admission information, and discharge data. The upside was that we were scrambling less to find data and spending more time using that data. By filing documents in a digital format, we are able to retrieve or share these documents with little effort. As a result, our services are allowing us to pull away from the competition because we are handling the most labor-intensive components of our business with ease and beginning to close the loop on the patient care continuum.

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ComputerTalk

LTC Upgrades Last year we purchased a long-term care packaging robot and began to explore electronic MARs, although we are not necessarily seeing demand for eMARs from facilities at the moment. Still, we realize though that this is a technology that will strengthen the facility-pharmacy working relationship exponentially. If we can infuse preferred technology into our ancillary businesses, then we essentially extend our influence into the minute-to-minute activities in the facility. The reason to change the pharmacy providing LTC services would have to be very compelling once a solution was installed and learned by a facility. We believe that the results will be decreased volatility in our LTC business and longer relationships with facilities. This will allow more investment into


Feature Technology Business Plan LTC-specific systems and solutions. The second reason for exploring eMARs is that we are a high-service LTC model and spend an appreciable amount of time working on the monthly reports for each facility. An eMAR will mean that our workload would be shared, double entry eliminated, and communication errors eliminated.

New Robotics

patients access to their records in our PMS and allow them to give providers permission to access as well. The PMS we’ve chosen to move to also has the out-of-the-box functionality to send and receive HL7 messaging, giving us a bidirectional interface with our local healthcare system. We firmly believe that now is the time for us to begin building relationships as we adopt newer, better, and integrated solutions. CT

Our most recent change has been to upgrade our robot Tim Davis, Pharm.D., is a second-generation to the next-generation technology offered by our existing owner/pharmacist at Beaver and Brighton Health vendor, which allowed us to reduce noise, increase efficacy, Mart pharmacies. He was recently honored as the and decrease maintenance. I will say that I have concerns Next-Generation Pharmacist Technology Innovanot with the new technology, but with the process of tor of the Year. Tim is also the chairman of the transition. The vendors don’t have good solutions for NCPA Committee for Innovation and Technology. transferring data between solutions or even transferring You can contact him at pharmacytim@me.com. medications from one robotic solution to another. I had a real safety concern because we had no way to PrimeRx Pharmacy Management System use barcode scanning when moving prescription medications from the old PrimeESC robot to the new robot. Essentially, we PrimeWEB Electronic Signature Capture Customized Web Sites/Portals had to empty the contents of our old for Pharmacies robot into vials — because obviously nobody keeps empty stock bottles — line these up on the counter, and then PrimeDMS Document Management fill the new robot from the handwritPrimeCENTRAL System Central Data Reports for ten vials. This is not a good process Multiple Store Owners and creates a wide margin for error. Vendors who want pharmacies to transition from one robotic solution PrimeDELivERy In-house and Wireless PrimePOS to another should have a clear upgrade Delivery Module Point of Sale process established for each situation, one that ensures patient safety, as well ...because it’s not just filling prescriptions any more... as controlled-substance inventory Increase Revenue The focus of a pharmacist has always been to security along the way. and Profitability help people. You need tools that ensure

Integration the Goal As we look to our next steps, we are heading toward as much integration as possible and are getting this message to as many vendors as possible as well. Stand-alone systems and the resulting need to maintain many databases are too common in our field. We need to start working toward the concept of electronic health records and personal health records. We also are headed toward giving patients more responsibility and capability to manage their own health. The solution we have found is a Web portal that will give

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November/December 2010

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cover story

Looking Ahead: What’s Coming in 2011 by Will Lockwood

A

s we come to the close of the year, it’s again time for ComputerTalk’s annual survey of pharmacy technology vendors. This year we had 29 companies respond, representing the full range of technology offered. Working with the results, we’ll take a look at how vendors are meeting current challenges and what their plans are for 2011, with a focus on the new products and features pharmacists can look for. We’ll also find out what segments of pharmacy are the growth areas and how vendors will deploy their resources to support their users’ continued success.

New Products, New Features New products, new features, and new interfaces form the foundation of the efforts vendors are making to help pharmacists succeed in 2011. And while the majority of respondents have new products planned, the real drive is coming in enhancements to existing offerings and through the development of new interfaces. The tremendous amount of activity displayed by the release of new features demonstrates vendors’ commitment to build out their technology, providing valuable tools that pharmacists can look to when meeting day-to-day challenges. Expanded interfaces reflect a similar motivation to provide extra value and functionality and also recognize pharmacy’s need for interconnected systems that allow for the ready movement of data to the most critical points of the dispensing and patient care processes. 18

ComputerTalk

The survey results Are new products also show a strong, continued focus on planned? supporting revenues, Yes – 70% pharmacies’ finanWill existing cial lifeblood, and products/services be minimizing costs. In enhanced? fact, almost 80% of Yes – 95% vendors report plans for offerings aimed at these two business goals. What’s interesting is that many of these new tools seek to improve the pharmacist-patient relationship and encourage patient medication adherence, recognizing that having healthy and engaged patients is the true goal and the real foundation of a pharmacy’s success. As Pharmacy First CEO Brian Huckle puts it: “We truly believe that keeping in contact with patients between their visits will allow pharmacies to tap into increased revenues.”

Mobilizing Solutions Another area of innovation seeing broad activity among vendors is the deployment of products that take advantage of mobile devices to support pharmacy activities and connect with patients. About 85% reported action in this area, including leveraging mobile devices for drive-thru signature capture, inventory management, and delivery. For example, Integra CEO Kevin Welch notes that the comcontinued on page 20


What makes a pharmacy their first pick?

Time.

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1.800.231.7776 www.qs1.com © 2010, J M SMITH CORPORATION. QS/1 and NRx are registered trademarks and InstantFill is a trademark of the J M Smith Corporation.


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What’s Coming in 2011 continued from page 18

pany’s DeliveryTrack offering manages the entire delivery process from when a product leaves the pharmacy until it is delivered, as well as returns and refusals. Welch further notes that this mobile technology provides powerful management and efficiency tools, such as barcode scanning, GPS, route optimization, and real-time sychronization. Yogesh Desai, president of Best Computer Systems, is also looking to mobile devices as a low-cost way to manage delivery tasks. Desai reports developing a hand-held computer that will interface with the company’s pharmacy system via USB cable. “Users want to be able to capture signatures at delivery and then download them into the pharmacy computer for review in reports,” he says. Another interesting twist comes in from Greg Phillips, CEO of Emporos, who reports that the company is rolling out a mobile delivery app that will run on the iPod and

capture both delivery details and information at drive-thru windows. Additionally, several vendors are incorporating tools in their software that allow the pharmacy to reach out to patients on their mobile devices with messaging that their prescriptions are ready for pickup, for example. Mobile devices are also serving as another platform for refill orders. Speed Script’s Director of Business Development, Heath Reynolds, offers one more example, which combines mobile technology with the company’s new software-as-a-service (SaaS) LTC product. “Prescribers can view patient profiles and medication history, and prescribe from our Web-based LTC application on their mobile phones,” says Reynolds.

Hosted Services We can also report developments in several areas that have been gaining attention and that offer new ways for pharmacies to think about serving pa-

Want to read more about vendors’ plans for 2011? Visit computertalk.com’s exclusive online content for:  New products and enhancements planned  New interfaces  Revenue-boosting offerings  Features current and prospective users want  Pharmacy and social media tients and fulfilling their business obligations, while keeping an eye on costs. At the top of this list is technology offered through the SaaS model, something that’s quickly moved from being on the horizon to being a viable choice for an array of needs. The survey response shows a strong pace of innovation in this area for 2011. Almost 70% of vendors stated that continued on page 22

THE POWER OF AUTOMATION. MADE SIMPLE. 7-day • 14-day • 30-day On-Demand • Prepack • Calendar • Daily • Cycle DOSIS® L60 by Manchac Technologies, LLC is the first viable totally hands-free robotic solution for pharmacies. The L60 offers you the flexibility to choose your fulfillment solution for any number of pills from 1-31 days. All this in a single medication blister card for your long term care, institutional and correctional facility patients. The L60 offers maximum value to you by minimizing the space required to achieve significant prescription throughput rates for your highest-moving medications.

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Pharmacy benefit changes and manufacturer pricing increases can be costly.

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Prepare for the season of coverage, pricing changes Save time and deliver enhanced customer service by determining pharmacy benefit eligibility in real time with industry-leading Emdeon CardFinder.™ Easily obtain commercial and Medicare Part D coverage information at the point-of-sale. Regain lost revenue by easily identifying, reversing and resubmitting claims that have been paid based upon outdated average wholesale pricing. Emdeon Payer Compliance™automatically tracks NDCs with price changes and highlights opportunities for enhanced payment. Discover how these Emdeon solutions can help your pharmacy increase efficiency and profitability. Contact an Emdeon representative at 877.707.0024 or visit www.emdeon.com.

You don’t need one more partner. You need one partner that does more.

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November/December 2010

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What’s Coming in 2011 continued from page 20

they see interest in SaaS increasing in 2011, and close to 60% have plans for new SaaS products or services. This was a question that also generated quite an interesting set of comments, showing that there’s some real thought being put into just what this model can mean to pharmacy. Notably, and something that pharmacists will want to keep an eye on, several POS vendors see a future in SaaS. Thomas Greenhaw, founder of Cashier Live, feels that new low-cost SaaS services are generating interest. And Brad Jones, CEO of Retail Management Solutions, also points to economies of scale as a factor that continues to drive SaaS interest. “Improvements in telecommunications infrastructure and speed will make it the standard in the years to come,” he says. The model’s potential to create cost advantages is an important con-

sideration for vendors as well, according to Greg Phillips. He sees growing interest among vendors due to the lower cost of delivering and servicing applications. When it comes to the pharmacy management system, Brenton Burns, senior VP of McKesson Pharmacy Systems, continues the theme by citing not only a greater focus by pharmacies on the bottom line, but also a desire to ensure that staff can be attentive to growth opportunities instead of devoting so much energy to managing the pharmacy system. Burns also points out that SaaS has had success in other industries. PDX CEO Jeff Ferris sees real advantages in the SaaS model for the company’s most technically capable customers. “They will be able to consume our/ their content to build services that their business and customers require,” he says. “This is in line with our

pharmacy data platform strategy that we are building on the enterprise service bus and exposing Web services to serve up this software as a service.” Several respondents offered a look at SaaS’s limitations, as they see them. Innovation’s Executive VP Doyle Jensen, for example, points to several limiting factors. “Pharmacies generally prefer to have tight control over their software infrastructure, keeping a single version of software and upgrading only in a structured, planned fashion,” he says. “SaaS doesn’t really lend itself to that level of control. The nature of pharmacy data and protected health information also complicates the use of SaaS.” Integra’s Kevin Welch agrees that pharmacies want to eliminate or reduce the costs associated with running their own systems, but he cautions that in his experience the continued on page 24

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ComputerTalk

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November/December 2010

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What’s Coming in 2011 continued from page 22

SaaS model has difficulties when numerous highly connected interfaces are required. Larry Stephenson, HCC VP of sales, has not found that pharmacies are interested, for the most part, in moving all of their data and processing to a SaaS platform. “The real interest we have seen,” he says, “is for additional modules and interfaces that take advantage of centrally hosted controls and additional services.”

Centralized Solutions Two more hot topics these days are central fill and central processing, which around 60% of respondents feel will see more interest in the coming year. Again, the range and thoughtfulness of comments prove interesting, with something of a split between responses focused on central

fill and central processing. Automation vendors weighed in on the topic, of course, but brought several perspectives to the conversation. Michelle Leibow, marketing director for McKesson High Volume Solutions, is one voice on the side that sees real promise in central fill and central processing. “Central fill is a platform for growth for pharmacies,” she says. Leibow notes that there’s a growing premium on space, as pharmacists begin to see retail clinics and counseling expanding and offering new sources of revenue. “As a result,” she says, “pharmacies are investing in a centralized, off-site model as a platform to support growth, ensure patient safety, and reduce the cost to fill.” Innovation’s Doyle Jensen sees interest in central fill/central processing on the rise. “Currently, about 90% of the retail chains either have central fill/central processing, are

in the process of implementing it, or are actively pursuing it,” he says. The main factors driving this model, in Jensen’s opinion, are the need to reduce labor, prescription processing, and inventory-carrying costs. Jensen also reports seeing a rise in interest among hospitals and healthcare centers as many of them move toward providing their employees with outpatient pharmacy services, which has increased prescription volumes. ScriptPro CEO Mike Coughlin offered a balanced view of the possibilities available from central fill and central processing, noting that use should increase in some circumstances. However, Coughlin believes that most pharmacy operations would like to provide immediate service to customers, something that isn’t part of the central-fill model, in particular. Parata CEO Tom Rhoads draws a distinction between central fill and central processing, with the latter presenting the real opportunity, in his mind. “Inherent limitations in central fill are defining the opportunity as smaller than hoped,” Rhoads says. As examples, he notes limited addressable prescription volume, limited store targets based on geographic density requirements, and the impact on customer experience that arises from not aligning with demands for convenience. However, the prospects for central fill are different on the LTC side, according to Rhoads. “In this marketplace,” he says, “central fill refers to prescription preparation happening at a single pharmacy location to service beds at multiple facilities. This approach offers what we think will be a very effective strategic response to the expected changes associated with short-cycle dispensing.” When it comes to central processing, Rhoads says, applications such as continued on page 26

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ComputerTalk


What do these leading community pharmacies know that you should know?

Corley Drugs – LaGrange, GA

Walker Drug – Grand Junction, CO

Lifechek Drug, Rosenberg, TX

Kopp Drug – Altoona, PA

Ritzman Pharmacies – Wadsworth, OH

Northwest Hills Pharmacy, Austin TX

All of these successful pharmacies have embraced specialized retail technologies to optimize their retail business and create happier, more loyal customers. All of these respected pharmacies run their retail operations with Activant Eagle®. It’s the integrated business management solution that streamlines and automates their most time consuming functions, and provides the power and flexibility to manage thousands of SKUs, order smarter, and market more effectively. Cook’s Pharmacy – Eminence, KY

With our proven point-of-sale, loyalty and gift card programs, and seamless integration with their PMS, Activant helps them elevate their entire business.

Whether you’re a single store or multi-store business, find out how Activant Eagle will help take your pharmacy to the next level. Visit www.activant.com/pharmacyretail. Or call 888.463.4700 today.

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Retail. Elevated. November/December 2010

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What’s Coming in 2011 continued from page 24

ing, and to gain additional efficiencies in the filling process, according to HBS CEO Steven Hess. Phil Beck, sales leader at Cerner Eterby, sees central fill and central processing as two good ways for multistore operations to manage payroll and inventory while margins continue to shrink. McKesson’s Burns sees two benefits. First, central fill should offer the opportunity to reduce labor and inventory-carrying costs, especially for high-dollar drugs. Second, central processing should allow the pharmacy staff to focus more on patient relationships, safety, and developing and expanding consultative services such as MTM.

enterprise workload balancing offer a great example of an opportunity to balance appropriate activities across stores to improve efficiency without impacting customer experience. “Centralizing administrative processes is an ideal complement to in-store automation,” he says. “This frees pharmacy staff from the two biggest obstacles between them and their desire to help people with their medications: administrative and dispensing activities.” Pharmacy system vendors are seeing some demand for centralized solutions, particularly in multistore operations, according to Steve Wubker, president of Transaction Data Systems, among others. This The D.0 Outlook demand is driven by a desire, once again, to increase economies of scale, There’s broad confidence among to take advantage of work-load balanc- vendors that they’ll successfully meet

the challenge posed by the move from NCPDP 5.1 to D.0. In fact, 100% of software vendors report being on track to release the tested version of D.0 in 2011, and fully 80% feel the transition will go smoothly for pharmacists. “The transition is well planned across the industry,” says Rex Bloom, applications director for Kalos. “Everyone should be on board, and we are all starting from the same baseline in 5.1.” This is not to say that there isn’t a looming increase in the complexity of billing, something almost 65% of vendors cite as a concern about D.0. “While the implementation of D.0 software releases and features should be smooth, the pharmacy’s real challenge will be collecting information on certain claims that was not required before,” explains HCC’s Larry Stephenson. “This will mean additional claim rejections as technicians become accustomed to these requirements.” There will be real efforts made to overcome this complexity issue. For example, Emdeon’s Senior VP of Pharmacy Services Mark Lyle reports that the company has completed a thorough gap analysis for both 5.1/D.0 and X12 4010/5010 in an effort to better guide clients through the transition. “Any complexities the pharmacies experience,” says Lyle, “we are here to help simplify the billing cycle and have numerous downloads available for our customers at www. hipaasimplified.com.” There is a silver lining, though. According to Brenton Burns, while complexity is increasing overall along with the range and diversity of benefits, D.0 streamlines compound claims, eliminates many unnecessary elements/fields, and clarifies many claims scenarios. “On balance, this is ultimately very positive for pharmacy,” says Burns. continued on page 28

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ComputerTalk


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November/December 2010

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What’s Coming in 2011 continued from page 26

New HIPAA Requirements In reaction to the newly proposed HIPAA privacy requirements, 75% of respondents report that, as business associates, they’ll tighten security policies and procedures internally in 2011. A little less than 50%, however, reported adding any new security mechanisms to systems to control access to PHI in the pharmacies. Those vendors that are improving the security deployed at the pharmacy cite increased use of biometrics, additional layers of challenges to prevent unauthorized access, and improved data encryption.

Thoughts on MTM We took this survey as another opportunity to gauge the climate around medication therapy management (MTM) services, and 90% of respondents see pharmacist interest in MTM services increasing in 2011. Several vendors reported already having either billing or case management MTM functionalities in place. Cerner Etreby’s Phil Beck points to the company’s ApotheCare solution, for which enhancements are planned in 2011. Steven Hess notes that MTM functionality is built into HBS’s system with no interfacing required. “We continue to see a slow increase in the interest in MTM, but feel this will be the future of pharmacy,” says Hess. Speed Script’s Heath Reynolds also reports built-in MTM. Larry Stephenson says that HCC is transitioning its Alpha-Care product to a Web service, so that it is available for customers on all the company’s systems. Others are working on MTM interface opportunities, including QS/1, according to QS/1 Market Analyst Manager Michael Ziegler. And at SoftWriters, CEO Tim Hutchison 28

ComputerTalk

What factors are driving pharmacists to change or upgrade their systems? “Advanced retail management systems that allow pharmacists to improve their frontof-store management and offset shrinking prescription margins with higher-margin front-of-store revenue.” – Matt Mullen, director of market development, Activant “For POS, new regulations ranging from IIAS changes to PSE regulations. POS system with a two-way interface connecting the front and back ends of the store are more important as regulations increase.” – Kerry Rook, general manager, Freedom Data Systems “Two things: functionality and customer service. Many more owners are also looking for a software vendor that provides its own IVR and POS systems, as this generally reduces some of the typical support issues associated with interfaces and offers a higher level of satisfaction.” – Steven Hess, CEO, HBS “Many pharmacies are still using legacy products. Many of these do not receive regular software enhancements. Instead they receive only maintenance-related releases. Some legacy systems do not offer the interfaces to newer technologies, such as workflow and prescription imaging.” – Larry Stephenson, VP of sales, HCC “Efficiency and cost control still seem to be the major drivers.” – Kevin Welch, CEO, Integra “Many pharmacies still operate old pharmacy management systems or hang onto outdated dispensing machines. To truly compete, to maximize staff time, and to operate as error free as possible, a pharmacy really needs the latest technology.” – Christopher Thomsen, VP of business development, Kirby Lester “Regulations on short-cycle dispensing, once decided on, could force pharmacists to change/upgrade their systems to support whatever is decided by CMS.” – Randall Murphy, VP, Manchac Technologies “From the standpoint of retail prescription automation, a shift in the market’s focus from safety, which is a given, to productivity. Also, lower maintenance, high output with low staff intervention, and reduced labor in upkeep.” – Tom Rhoads, CEO, Parata

says, “We have been looking to create an interface with Outcomes for quite some time.” Integration is critical, in the view of McKesson’s Brenton Burns. “Pharmacy systems must be able to provide full integration with commercially accepted MTM programs before these programs will be successful across the industry,” he says. He cites access to data, including the full patient profile and more integration with other providers, such as doctors, as key. Transaction Data’s Steve Wubker injects a note of

caution, though. “I am still not seeing sky-rocketing ‘real life’ demand for this functionality,” he says, “but we are keeping an eye out for activities that could change the landscape from ‘it would be nice’ to ‘have to have this.’”

Improving  the MTM Climate What needs to change for MTM to flourish? Payment is number one on continued on page 30


Counts

top-selling drugs, making hand-counting a thing of the past. The RxMedic ACS™ counting system makes pinpoint accuracy affordable for any pharmacy. The ACS simultaneously counts and pre-counts pills. It’s available in four standard configurations or can be customized to fit your individual needs. The ACS includes the added safety of digitally imaging vial contents for more complete records. For higher-volume needs, experience fully-automated dispensing with the RxMedic ADS™ robotic system. Ready to count less and do more for your patients? Visit www.rxmedic.com or call 800-882-3819.

© RxMedic ACS and RxMedic ADS are trademarks of RxMedic Systems Inc.

Buyers Guide 2010

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cover story

What’s Coming in 2011 The average 2,000-bed pharmacy has $12 million in gross revenue per year. Wubker’s list, followed by personnel This new revenue stream currently is and workflow changes to support the not large enough to get their attenmodel. Tim Hutchison sheds some tion, especially when you consider light on the payment issue with a few the expense involved, including calculations: “Currently, approximatepharmacist salary, IT, workflow interly 5% of Part D recipients are eligible ruption, etc.” for MTM,” he says. “On average, an eligible recipient means $85 per year Finally, Speed Scripts’ Heath to the pharmacy or $8,500 per year Reynolds has clearly given the topic for a pharmacy servicing 2,000 beds. some serious thought, providing a continued from page 28

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ten-point checklist to consider when thinking about MTM. Among the items on his list are definition of services and the current state of care; a market needs assessment; the development of a marketing plan; a review of technology available for documentation and billing; an organizational structure review; an understanding of the legal and regulatory issues; and defined goals and the development of evaluation criteria to judge service and financial outcomes.

2011 Looking Up? In such a dynamic market, how do the vendors expect 2011 to turn out? About 65% see 2011 shaping up to be a better year than 2010, with buying triggers including a desire for greater efficiency, the pending rule on short-cycle dispensing and other regulatory changes, the continuing trend of automating tasks to lower costs, the drive to reduce inventory overhead, the never-ending quest to improve customer service, the desire to achieve better integration among systems, and greater economic certainty. Kirby Lester VP of Business Development Christopher Thomsen is one who definitely sees 2011 looking up. “So many great technologies are being offered to pharmacists, and costs have come down dramatically,” he says. “Pharmacies are still investing in technology to improve dispensing safety, to limit the need for additional staff, and to improve overall efficiency. As technology providers, we need to make it easy for our customers by offering affordable options.”

Some Final Thoughts In sum, 2011 will be another year in which pharmacists can look to the technology vendors to build new solutions, improve existing tools, continued on page 32

30 DAA 708.indd 1

ComputerTalk 7/23/08 3:51:49 PM


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November/December 2010

31


cover story

What’s Coming in 2011 continued from page 30

and generally act as partners to help them keep their balance on the competitive playing field. QS/1’s Ziegler emphasizes the need to stay on top of things. “During 2011, pharmacies need to stay up-to-date with legal requirements and new regulations,” he says. Kirby Lester’s Thomsen agrees. “Rules, regulations, and timehonored traditions have all changed. Generics squeeze everything. Technology changes fast,” he says. In another sign that vendors are planning for strong demand in 2011, 70% report that they will add staff. Key areas mentioned were product development and testing, customer support, and sales. One big variable for 2011 will be

32

ComputerTalk

The top three markets cited as offering strong growth prospects for pharmacies in 2011:   

Long-term care and assisted living Retail front end Compounding

clarity on the direction of healthcare reform, according to Parata’s Rhoads. “Clarity on the direction of healthcare reform will have a positive effect,” he says “and alleviate uncertainty in the marketplace.” Whatever happens, Rhoads sees something positive in the process alone, which he believes has underscored the valuable role pharmacists have to play in the future of healthcare. “We are

bullish on the future of pharmacy,” he continues. “We see new obstacles on the horizon, but for a decade now we’ve seen this industry respond with tenacity and creativity to a challenging marketplace. Pharmacists’ commitment to serve as healthcare providers who help people with their medication needs is changing the face of pharmacy, and creating a strong opportunity for technology solutions that drive productivity and move pharmacists closer to their customers.” CT Will Lockwood is ComputerTalk’s senior editor. He can be reached at will@ computertalk.com.


November/December 2010

33


george’s

corner

From Premature Factulation to Organizing Your Shelves

R

egular readers know that every now and then I read a book that I like and think you will enjoy as well. I just read one. Its title is Premature Factulation. The author is Philip Hansten. Yes, the same Phil Hansten who wrote the definitive book on drug interactions. Phil is internationally famous for his expertise in drug interactions. I think that he should be equally famous for clearly explaining some philosophical concepts that are worthy of our contemplation. Fifty years ago when I graduated from pharmacy school, I realized that my education did not include much in the liberal arts area. We did not have time to include art, philosophy, and music in the pharmacy curriculum. So as a graduation present to myself I bought a big set of books. I still have it — I believe it is called Great Books of the Western World. It has Aristotle, Plato, Kant, Tolstoy, Darwin, and a bunch of others. Needless to say, they have collected more dust than anything else.

George Pennebaker, Pharm.D.

The third part is about how we can deal with the “truths” that are actually premature factulations. If you have stuck with me this far you may be saying, “What in the heck is he talking about?” That’s what I like about Phil’s book. It is much easier to understand and think about than what I just wrote. Give it a go. The brain needs to be exercised. Some readers of the book may take exception to the examples of recent historical events that have occurred due to premature factulation. So be it. Nobody ever said philosophy is not controversial. I happen to believe it is worthwhile to contemplate the controversial instead of letting others do it for me.

Speaking of Exercise I decided a few months ago to exercise my body as well as my mind. It is the first time in my life that I have ever lifted a weight or stretched a muscle without being forced to do it in order to accomplish some task at hand. I was getting a bit of a paunch and sometimes feeling prematurely tired. The paunch is gone. I feel lots better. And I have some visible muscles that were invisible before.

When I heard that Phil had written this book, I decided to try again to delve into some more deep thoughts. I have been rewarded. His writing is excellent. His examples from everyday life and from his professional experiences make it all real. He does quote the famous philosophers. (The subtitle of the book is The Ignorance of Certainty and the Ghost Many of the machines at the exercise place have a place that of Montaigne.) But the quotes are short and the explanations holds a book for you to read and occupy your mind while your body is getting stretched as you work up a sweat. that follow them are clear as well as concise. The book is divided into three parts. The first part explores how we arrive at premature factulations. It is so easy to do. Until one stops and thinks about how we decide what is truth, one may be living in a made-up world.

So, get the book — Premature Factulation — sign up at the local exercise place, and exercise your brain and your body at the same time.

Organizing Your Shelves I have had the pleasure The second part discusses how certainties dependent on of working in a bunch of different pharmacies lately. I get ignorance are used to manipulate people. There are some a call and someone says, “Can you work next Tuesday?” I fascinating examples, ranging from drug interaction certain- say yes, show up, get the keys and the alarm code, and go ties to high-level political certainties. continued on page 36

34

ComputerTalk


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george’s

corner

continued from page 34

to work. There are lots of stories to tell. Some sad, some happy, some crazy, and some sane.

someone wants to know if the generic is in stock, look at the brand-name label — the generic name is right below the brand name. Go look there.

One of the crazies, to my mind, is the way that shelves are organized in many pharmacies. I can understand the separation of the ointments and creams from the tablets and capsules. Maybe even the birth controls from the other tablets and capsules.

Yes, I know that some pharmacies go to the other extreme and only shelve things according to their generic name, even though the product may be labeled as a branded drug. Let’s just let them suffer with the reverse problem — trying to remember the generic name when all you have is the brand name.

What I cannot understand is why most of the generics are shelved according to the brand name of the original product. It is especially strange when the brand-name product no longer exists and often has not existed for many years.

I have talked with some pharmacists who have reorganized their stock so that it is all alphabetical. While the first week was difficult (things were not where they used to be), after that it turned out to be much better.

In just about all cases, before the bottle is retrieved from the shelf you know what name is going to be on that bottle. If it is a DAW 1, the brand name will be printed on the documents used when pulling the drug. If it is not a DAW 1, the generic name will be there. If the drug is shelved alphabetically based on the biggest name on the label, it will be where the documents tell you to go.

I would like to hear from readers about this simple issue. Should all drugs be shelved according to their original brand names only, or should the generics be shelved according to their generic name? Why? (“Because we have always done it that way” is a bad reason.)

Hansten, Philip D. Premature Factulation: The Ignorance of Certainty and the Ghost of Montaigne, Port Ludlow, WashMore importantly, technicians and clerks can shelve incom- ington: Philoponus Press 2009. CT ing stock in the right place every time, and when they are George Pennebaker, Pharm.D., is a consultant and past president retrieving stock from the shelves they will be looking in of the California Pharmacists Association. He can be reached at the right place. If the Rx is written for a brand name and george.pennebaker@sbcglobal.net.

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ComputerTalk


technology

corner

New Technology Resource

D

uring the 2010 annual meeting of the NCPA in Philadelphia recently, a new resource was unveiled for pharmacists. The resource, which is currently live in demonstration mode, is intended to be utilized for the selection and evaluation of pharmacy technology. Phase 1 of the project, developed by the NCPA Innovation and Technology Committee, includes a technology self-assessment instrument, suggested questions that pharmacists should ask vendors in each of six detailed categories, and numerous other technology resources. Thus far, responses from pharmacists about the instrument have been very positive. The resource, called the Rx Technology Resource Center, was developed using the input of NCPA’s membership, the vendor community, and the committee. We are excited to write that the project is about to be pushed out to the entire pharmacy technology marketplace.

A portion of the Pharmacy Technology Self-Assessment Checklist, found at www.RxTechnologyResource.com

Bill G. Felkey, M.S.

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

The URL for the resource is http:// rxtechnologyresource.com, and at the time of this writing several of the site components are being actively linked to the homepage. By clicking on the Evaluation Tool tab, the site visitor accesses an interactive self-assessment tool (shown at left). This tool asks for demographic information that includes the number of years the pharmacy practice has been in place, prescription volume, and the brand (and operating system) of the installed pharmacy management system. Once someone completes the assessment tool, if/then logic is used to develop and present targeted recommendations for additional technology to be considered for adoption in the practice. The logic was developed by the NCPA committee to assist pharmacists in determining what core technology should be in place from the beginning and throughout the maturity of the practice. At the end of the assessment, pharmacists are also supplied with a list of vendors, and their contact information, for each of the suggested technologies generated by the tool. Additionally, users of the tool are presented links to ComputerTalk resources, such as continued on next page November/December 2010

37


technology

corner and America’s Pharmacist are supplied in a Tech Articles archive section of the new resource.

continued from previous page

the annual buyers guide edition of the publication. Because the potential categories of pharmacy technology were so extensive, the committee decided to choose an initial set of seven categories for development in phase one of the project. The categories are pharmacy management systems, workflow technology, POS tools, IVR applications, automation and robotics, long-term care and assisted living, and a miscellaneous “catch all” category. An extensive set of questions that pharmacists can use as due diligence during the product selection process was generated and published for each of the first six categories. The questions are designed to help pharmacists determine product functionality for areas or features that they may not have normally considered. For example, suggested questions to ask include the ability of a POS system to handle lottery tickets, employee discounts, and other special circumstances. The series of articles we have generated for ComputerTalk

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Implementation Guidance Committee mem-

bers have generated narrative case studies for visitors to the site. These case studies are intended to help visitors understand the rationale that tech-savvy pharmacists used for sequencing the adoption of their practice technology. Suggestions range from initial purchases, special services application integration, and multistore hosting interfaces. These narratives complement a comparative feature of the site where pharmacists learn how their adoption of technology compares with other pharmacists from similar settings through graphical reports. In this way, visitors learn not only what technology to consider but why a particular technology should be made a purchase priority.

Vendor Involvement Pharmacists are also

encouraged to engage potential vendors in their decisionmaking process. Involvement with the vendor community can begin by having each vendor self-report the coverage of their product line within the technology assessment categories. Vendors should also be expected to provide a listing of features and benefits offered by their individual products. In addition to the categories already mentioned, vendors who are supplying resources that focus on patient safety, specialty service areas, data security systems, pharmacy security and surveillance, Web site services, delivery technology, decision support, patient education, and telecommunication technologies are all welcome to participate. Future work of the committee will address these and other areas. This resource has already drawn attention from pharmacists who want a Spanish version of the tool created and from vendors who are eager to tell the advantages offered by their applications. We believe that your use of the site, and the feedback you subsequently provide, will only help improve its value to the profession. We recommend that you consider visiting the resource immediately to get a flavor for what is there and what is to come. Philip Quinlan of NCPA (philip.quinlan@ ncpanet.org) can work directly with vendor questions and participation. As always, we welcome your comments, questions, and suggestions. CT

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

ComputerTalk

TMT_CT_111610_v2.indd 2

11/17/10 3:17 PM


catalyst

corner

Competition Means Moving Fast, But Buyer Beware

O

ne trip to the Mall of America (MOA) is all it takes to appreciate the competitive frenzy that surrounds the technology sector.

Two weeks ago I made the trek over to what used to be my hometown’s national baseball stadium but is now the largest, fully enclosed bastion of consumer capitalism, to help my visiting cousin buy a power cord for her MacBook. She had forgotten the cord at home and thought having an additional one just for travel would be a good idea. The area’s closest Apple store was at the MOA. Upon our arrival, we found a mall floor map to efficiently guide us through the 570 shops and restaurants to the Apple store, trying to avoid a full half-mile trip around one of the mall’s three levels (mall walking takes on new meaning at the MOA during the Minnesota winter!). I wasn’t prepared for what I found on three fronts. First, the Apple store was packed to the hilt on this early weekday afternoon with people of all ages sitting at tables, using their iPhones, iPads, iTouches, iPods, and whatever other i or Apple devices they owned — all with no coffee or food being served. The neighborhood Caribou Coffee this wasn’t. They were there to learn the latest about their devices and new applications and share them with one another. Secondly, the employees at the store were all of the younger, mobile-enabled, text generation with extensive knowledge about anything we needed. They were polite, helpful, and enthusiastic to share their world. After my cousin selected the right power cord, my next surprise was the checkout process. No cash registers or POS systems here. All checkout is done by an iPhone with a special, retail-enabled cover that allows the clerk to swipe your credit card after he or she has scanned the item using a custom Apple app with all the store’s SKUs. The receipt printed off in paper (how old-fashioned!) at one of two workstations in the store. I’m sure we could have just had it emailed, but we didn’t think of it then. We were too wide-eyed from the whole experience.

Paying the Mobile Way While it was a fast, great experience, it hasn’t

converted me yet into an Apple fanatic. And there are some big commercial interests who want to ensure that others aren’t converted either. Who? Enter the brand-new, just-opened Microsoft store right across the aisle from the Apple store at the MOA. Yep, I was curious enough to make it a point to stop in yesterday when the store opened to see the buzz. Microsoft was doing the best

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

it could to draw in a crowd, with alluring deals, Wii-type devices for MS computers, and other bells and whistles. My only surprise was that no celebrity was in attendance — at least not yet. This MOA south-aisle microcosm is a good reflection of the continually rising competitive pace, to me becoming frenetic, in the technology world. What I experienced upon checkout at the Apple store was the feature in the Sunday Minneapolis Star Tribune’s business section the same week. In an article entitled, “A New Way to Pay,” reporter Chris Serres outlined the “high-stakes” race between the largest U.S. banks and mobile technology companies to launch and own the biggest share of new mobile payment networks. Why? Because the banking system stands to loose nearly $50 billion in transaction fees as consumers move from debit and credit cards to using their mobile devices at retail scanners. Serres describes the microchip technology the banks would need to provide their customers to enable their mobile devices to be used for paying, and how it will be more difficult for banks (compared to mobiledevice makers) to convert their users continued on next page November/December 2010

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catalyst

corner

The banks are not waiting until the situation eases. Beyond the transaction fees, they see the new technology as a way and capture this market. That is because the mobile-device to gain the loyalty of a young generation of customers and firms have the ability to reach their users quickly, since they launch a host of new services from the platform. Serres cites know their phone numbers and already have their banking electronic couponing — which happens while the person information. walks through a store aisle — as an example. Serres describes ways that retailers have already created apps The competition may not be as frenzied in the pharmacy and installed scanning devices in their stores that enable world, but it is heating up. Technology firms with telecomconsumers to make mobile payments. In some cases, it is munications, Internet, and mobile technology know-how through prepaid cards connected to a mobile-device app. may see opportunities for new applications and solutions One analyst quoted in the article said he thinks the top 50 for use in the pharmacy marketplace — for example, smart retailers will have developed apps to allow mobile payments phone apps that help pharmacies reach customers, improve by year’s end. For retailers, the attraction is speed at the patient compliance, order prescription refills, and perform point of sale. other functions. However, to be truly useful these emerging Serres also describes the chicken-and-egg phenomenon, apps have to integrate safely in a HIPAA environment to where mobile-phone makers are hesitant to install mipharmacy and/or POS systems without adding extra burcrochips in their devices because most retailers have not dens for the pharmacy staff to reenter or reprogram data. implemented the “contactless card” scanning technology Companies that are not pharmacy focused, or that do not to use them. Exceptions cited are CVS, McDonald’s, and have the relationships or interfaces to make their products Office Depot. or services integrated, are poor choices as solution providers for pharmacy customers. Worse, many new firms may try to sell these new “solutions” for a seemingly great price point. But money and time are wasted if the functionality means more work, no integration, and no future platform to build upon. continued from previous page

“Buyer beware” may be a good message to communicate to customers as a result. Established pharmacy technology vendors might consider cautioning customers to be extra careful about purchasing products and services from firms that are not well grounded in the pharmacy industry and warning them about potential drawbacks that may result. Making solutions successful requires relationships, interfaces, and connectedness. 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. 40

ComputerTalk


view

points

E-Prescribing: Expectations and Limitations

O

n Oct. 26, 2010, the entertainment industry celebrated the 25th anniversary of the movie “Back to the Future II.” This celebration sparked a lot of buzz, including a list entitled “14 Things from Back to the Future II That Actually Came True, and 5 That Haven’t... Yet” posted on the site tv.gawker.com by Kristina Lucarelli. The movie’s creator, Robert Zemeckis, accurately predicted a variety of technological advancements that have already come true, such as video conferencing and wall-mounted wide-screen televisions. However, he was overly optimistic about a few things, such as hoverboards and flying cars. The same could be said about early proponents of electronic prescribing (e-prescribing), a technological advancement that also had its beginnings in the 1980s. See quotes from some of these then-sanguine proponents in the box on this page. The aspirations of e-prescribing described in these quotes haven’t exactly come true yet, and it’s clear that we need to reexamine our expectations for e-prescribing, particularly now that the number of e-prescriptions and e-prescribers is increasing rapidly. We recently spoke with David Yakimischak, chief operating officer of Surescripts, about some of the challenges with e-prescribing. According to Surescripts, over the last five years the number of e-prescribing physicians has grown from 2,500 to 200,000 (nearly one in three office-based physicians). Surescripts is one company that is leading the charge to increase both the quantity and quality of e-prescriptions. Surescripts was created so that pharmacists could take a leading role in the eprescribing process. It is achieving two important goals: to transition away from handwritten prescriptions, and to support a manageable system that can influence changes by providing a view of what happens in the prescribing process. Yakimischak sees one of Surescripts’ roles as an “air traffic control system, which can help both prescribers and pharmacies continually improve.”

Melissa Sherer Krause, Pharm.D.

Fred Hamlin

“A computer is used to produce all prescriptions for patients…. This method of prescribing improves safety, saves time, decreases prescribing costs, and provides an instant audit of all important prescribing parameters…. I am sure that this method of producing prescriptions will be adopted increasingly in the future” – John B. Donald, writing in the British Medical Journal, 1986 “Physicians should never again write a prescription. Given the explosion of scientific information and advances in computer technology, prescribing medications on a blank piece of paper will soon seem as antiquated as ordering tinctures of botanicals in Latin.” – Gordon Schiff, M.D., and T. Donald Rucker, Ph.D., writing in JAMA, 1998 “Health information technology and the use of electronic prescribing is the one issue that everyone in healthcare can agree upon.” – Newt Gingrich, speaker of the U.S. House of Representatives at the time, in a white paper for the Center for Health Transformation, 2008

Yakimischak emphasizes that while many people expected e-prescribing to eradicate medication errors, perfection is not achievable. Yakimischak’s presentation at the Academy of Managed Care Pharmacy 2010 Educational Conference brought Package size/quantity to dispense to light some examples of the challenges associated with e-prescribing. Many of (metric quantity); Full instructions for the errors or miscommunications that occur in e-prescriptions stem from the use (aka Sig). fact that physicians are not giving all of the details of the prescription that will continued on next page be dispensed, including: Complete product name, strength, and/or dosage form; November/December 2010

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points

continued from previous page

Sig field and those in the pharmacy notes.

Let’s take a hypothetical situation where the physician may enter the Sig as “2qid.” If the e-prescribing system’s default Sig for that code is “Take 2 four times daily,” these instructions could be confusing for a prescription for an albuterol inhaler. Some physicians have attempted to clarify the instructions for use by adding a pharmacy note to the e-prescription that further specifies the instructions for use, such as “2 puffs.” If an e-prescription arrives at the pharmacy with this combination of instructions, the pharmacist would have to clarify the instructions for use. If the pharmacist did not recognize the inconsistency between the Sig and What’s in a Name? Pharmacists have correctly inter- the pharmacy note and simply filled the prescription with preted prescriptions handwritten with the generic/chemical the instructions listed in the Sig field, this could lead to a name “albuterol #1” to the corresponding brand of albuterol medication error. inhaler. When e-prescribing, physicians are forced to be Call to Action E-prescribing stakeholders, including more specific than just “albuterol” for a product name. prescribers, pharmacies, PBMs, and system vendors, all want The challenge with e-prescriptions is the assumption that the to address the issues described here. Surescripts’ establishprescription comes into the pharmacy system as the product ment of quality management system scorecards is a promisto be dispensed, with correct product name, strength, and ing step in the right direction. Pharmacists can play an active dosage form. But the reality is this is not happening. role and continue to be vigilant about reporting issues or Need the Details E-prescriptions may arrive at the errors with e-prescriptions to three of these stakeholders: pharmacy with a correct product name, but not the correct 1. The pharmacy’s system provider — to ensure that it is not an issue on their end. David Yakimischak shared strength and/or correct dosage form. This type of issue is one example where a pharmacy reported an issue, and typically not a simple truncation of the product name; more upon further inspection, Surescripts found that the often this is due to e-prescribers who use different productsame issue caused by the pharmacy system vendor had naming fields (i.e., drug name, drug strength, strength been impacting many pharmacies that never reported qualifier, and dosage form) from various drug compendia the issue. providers. Pharmacists have also translated the handwrit2. The prescribing physician — to clarify the prescription, ten quantity of “#1” to the corresponding metric decimal to alert them to the error, and to ask them to contact quantity of the specific brand being dispensed, such as 6.7 their e-prescribing software vendor to help prevent grams, 8.5 grams, or 18 grams. When e-prescribing, physisimilar errors in the future. cians need to be more specific than just “1” for a quantity. Surescripts is working with e-prescribing vendors and drug 3. Surescripts. If an e-prescribing issue is identified and compendia providers to address these issues. reported, and is not resolved by the technology provider, Surescripts requests that pharmacies report the issue Similar issues can arise for nearly any product that is not a directly to them. standard tablet or capsule dosage form, including liquids, Perhaps engineers continue to work to make flying cars and injectables, and topical products. hoverboards a reality; we too can help advance the technolInstructions for Use The abbreviations that preogy that we use to propel our patients and ourselves into the scribers often use on handwritten prescriptions may get future. CT lost in translation if they are entered into an e-prescribing Melissa Sherer Krause, Pharm.D., is a consultant, and Fred system. Some physicians have attempted to clarify the Hamlin is director of business development at Pharmacy Healthcare instructions for use by adding a pharmacy note to the eSolutions, Inc., (PHSI), in Pittsburgh, Pa., which provides consulting prescription that further specifies the instructions for use. that improves the profitability of its healthcare clients. They consult This may help in some instances, but anecdotal evidence with pharmaceutical manufacturers, PBMs, retail pharmacy chains, suggests that this can sometimes lead to further confusion and software companies on strategic business and marketing issues. The authors can be reached at mkrause@phsirx.com and if there are discrepancies between the instructions in the Prior to e-prescribing physicians issued the prescription, specified a quantity, and included a Sig. There are, however, instances where more specific information is needed. With paper-generated prescriptions, pharmacists handled these details almost exclusively, inserting the correct metric decimal quantity, for example. With e-prescribing, one classic example of a challenge that can arise is with prescriptions of albuterol. We have seen prescribing errors occur in at least three types of situations, all of which can occur with albuterol inhalers.

fhamlin@phsirx.com.

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ComputerTalk


AmericAn Society for AutomAtion in PhArmAcy

ASAP

2011 Annual Industry & Technology Issues Conference January 20-22 The Ritz-Carlton • Amelia Island, Florida

MEETING HIGHLIGHTS: • The

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Challenges and Opportunities

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and Data Security

• The

Impact of REMS on Pharmacy

• Attitudes

on e-Prescribing in Sweden

• Why Innovative Change is a Necessity • FDA, Brookings Institution, CMI, & MedGuides • What

You Should Know About the New Privacy and Security Rules

• The

Latest Studies Supporting Pharmacists’ Clinical Services

• The

National Pharmacist Workforce Survey

• Healthcare

IT and Open-Source Software

• The

Latest on the Patient Protection and Affordable Care Act

• Why

Patient Compliance and Adherence Is Good Business

• AMP • An

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Online conference registration available by visiting www.asapnet.org/registration.html.

Register today and participate in the most relevant conference on pharmacy technology.

ASAP

American Society for Automation in Pharmacy

492 Norristown Road, Suite 160 • Blue Bell, PA 19422 610/825-7783 • Fax: 610/825-7641 • www.asapnet.org Buyers Guide 2010 41 November/December 2010

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conference

circuit

The National Community Pharmacists Association (NCPA) brought its 2010 Annual Convention and Trade Exposition to Philadelphia. Highlights included a full day of technology panels and presentations attended by more than 400 pharmacists, plus a busy exhibit hall where attendees were on the lookout for the right technology to help take their operations into 2011 and beyond. KeyCentrix’s Jeff Dennet, right, talks with Keith Vance of Lewisville Drug Company in Lewisville, N.C. Dave Feeney, center, of Oxnard Pharmacy in Warwick, R.I., with voiceTech’s Larry Stratton and Joan Bobowiec.

Peter Hess, center, from Hometown & Mission Pharmacy in Kittanning, Pa., at the ReadyForREMS .com exhibit with Paula Williams and Jerry Kester from Cephalon. Don Porter, center, from MSN/Pharmstaff in Laramie, Wyo., with RxMedic’s Bart Mitchell, left, and Michael Dennis. QS/1’s Kelly Smith, left, with Bill and Lesley Koonce from Spindale Drug Company in Spindale, N.C. Kirby Lester’s Cindy Zlabis demos the KL16 for Eric Winegardner of Eric’s Pharmacy in Shawnee, Okla. Discussing Pharmacy First services with an NCPA attendee are, center, Nancy Benson and Dawn Suman. 44

ComputerTalk

HCC’s Larry Stephenson, left, and Ryan De La Garza with an attendee.

From left, Manchac’s Phillip Clark, Mathew Clark, and Randall Murphy, with Jon Post from MedExpress Pharmacy in Salisbury, N.C.

In the blue shirts from left, Speed Script’s Marcus Wilson, Rich Turpin, Heath Reynolds, and Chuck Welch, with, from center left, Emmanuel Takusi and Dorine Fobi-Takusi from Zonetak Pharmacy in Owings Mills, Md., and Anne Barr from Countryside Pharmacy in Savannah, Mo.

Two Point Conversions’ Sue Leiterman, left, and Sophia Chidichimo.

Net-Rx’s Laura Wasielewski and Paul Butler.

ScriptPro’s Rob Anderson, right, talks with Tripp Logan from L&S Pharmacy in Charleston, Mo.

Scott Meadows, center, shows ComputerRx’s system to Farzan Isfahani of AFI Pharmacy in Huntsville, Ala., while Lauren Warkentine looks on. FDS’s Charles Brinkley, right, with Edward Morreale of Dongan Hills Pharmacy on Staten Island, N.Y. Heather Martin from Parata with Greg Adams from Salisbury Pharmacy in Clinton, Okla.

From left, Lee Schlitt from Cape Girardeau, Mo., with Micro Merchant Systems’ Barb Rostine, Salim Lakhani, and Samir Haleem. Retail Management Solutions’ Mike Gross with Chanel Epstein, center, and Adrienne Defrancesco from Skippack & Sellersville Pharmacy in Skippack, Pa. McKesson Pharmacy Systems’ Billy Nitz, left, with Diane and Scott Mace from Rock Hill Pharmacy in Rock Hill, N.Y.


McKesson’s Bob Graul, left, with Dan Hussar from the University of the Sciences, Philadelphia College of Pharmacy.

Next-Generation Pharmacist Awards

Parata and Pharmacy Times presented the first annual Next-Generation Pharmacist awards during a ceremony in Philadelphia. Pharmacist Mark Aurit, owner of Gateway Health Mart Pharmacy in Bismarck, N.D., was the recipient of the top honor, selected from a field of 30 pharmacists and technicians recognized in 10 different categories. More information on 2010’s winners and how to nominate someone for 2011 is available at www.nextgenerationpharmacist.org. Top honoree and NextGeneration Pharmacist winner Mark Aurit with his wife, Susan, following the award ceremony.

Kmart’s Deborah Boland was named technician of the year. She’s seen here with Kmart’s Chip Maynard, right, and her husband, Bill.

Finalist Jonathan Marquess and his wife, Pam, from The Institute for Wellness & Education, in Woodstock, Ga. Finalist Kenny Akins, right, and Howard Lipham from Bowden Pharmacy in Bowden, Ga.

Finalist Danny Johnson, right, from Marble City Pharmacy in Sylacauga, Ala., with his wife, Marcia, and son Jared. Finalist Gretchen Kreckel from the West Virginia University School of Pharmacy.

Finalist Carl Hudson, center, of Hudson Drug Shop in Paxton, Ill., with his son and fellow pharmacist Andy Hudson and his wife, Janet.

NCPA 2010 Annual Convention and Trade Exposition

Representing RelayHealth were, from left, Preston Presnell, Brittany Bowers, Marissa Frasso, and Mark Wilson.

Ken Giaquinto, center, from Rye Beach Pharmacy in Rye, N.Y., with TeleManager Technologies David Hensen, left, and Harvey Glasser.

A group of attendees at the Rx30 exhibit, gather around company President Steve Wubker, center.

PDX’s Jason Adama, left, and Paul Dyas, right, with Lexmark’s Jeff Beard.

Samford University McWhorter School of Pharmacy students Daniel Johnson, right, and Ben Moultrie, with Cerner Etreby’s Matt Saladino, left, and Birgit Heidel.

Liberty Computer Service’s Thomas Greenhaw, left, and Tom Greenhaw represented Jeremy Manchester, left, Nova Libra and Cashier James Knotts from MWV and Greg Lybrand. Live. Pharmacy in Richmond, Va., with TCGRx’s Mike McCabe, at left. Integra’s Tony Chambrovich goes through the company’s offerings with a group.

Discussing the Innovation display are Larry and Mary Christopher of McCracken Pharmacy, right, with David McNeal, left, and Bill Bell, center.

From left, OpusISM’s Jonathan Jacobs, Scott Rizzitano, Donna Mirocco, Sheila Dawalt, and Doug Robertson.

November/December 2010

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The 2010 Speed Script Users Conference & Trade Show, themed “Invent. Develop. Implement. Grow.” and held Sept. 24–26 in Kansas City, Mo., attracted more than 110 Speed Script users and 20 business partners. The conference focused on new Speed Script software offerings and system interfaces supporting efforts to improve pharmacy business operations and patient care. 1. Speed Script’s Heath Reynolds, left, discusses Web site development and online refills with customer Bruce Wood, pharmacist, Dicks Pharmacy. 2. Randy Bass, pharmacist, Missouri State University Pharmacy, listens to Speed Script’s national sales manager, Rich Turpin, explain new features.

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3. From left, Emdeon’s David Dixon, Speed Script’s Ron Davis, and PPOk’s Josh Cline share a laugh. 4. Speed Script’s executive VP and COO, Chuck Welch, explains some of the latest pharmacy software and services. 5. Emdeon’s David Dixon, left, and Mary Kay Leuker, middle, discuss claims management services with Thuy McGarrah, Hermann Pharmacy. 6. Speed Script customers Jim Montgomery and Tony Hutchison discuss new products with Speed Script’s Gina Talley.

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7. Pharmacy First’s Nancy Benson, middle, and Dawn Suman, right, discuss rebate programs with Deborah Schulte, St. Mary’s Plaza Pharmacy. 8. Speed Script’s Marcus Wilson, left, was there to show software optimizing inventory turns.

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McKesson Names Mott as President of MPS McKesson has appointed Nathan Mott as the new president of McKesson Pharmacy Systems, replacing Stanton McComb, who has become the president of McKesson Automation, located in Pittsburgh. Mott, who has been with McKesson for 16 years, has held numerous leadership roles with the company. Most recently, he was responsible for the deployment of the Six Sigma program throughout the company. Prior to this he led strategic planning for McKesson Automation. According to Paul Julian, executive VP and group president of McKesson Distribution Solutions, Mott has

Index of Advertisers Activant Solutions ASAP

...25

...43, 48 Ateb ...16 Cerner Etreby ...31, 48 Computer-Rx ...13 DAA Enterprises ...30 Emdeon ...21 FDS ...36 Health Business Systems ...27 HCC ...23 Integra ...32 Kirby Lester ...22 Manchac Technologies ...20 McKesson High Volume Solutions ...3 McKesson Pharmacy Systems ...35, 48 Micro Merchant Systems ...17 Parata Systems ...Inside Front Cover PDX ...33 QS/1 ...5, 19, 48 Retail Management Solutions ...26, 48 RxMedic ...29 RxScan ...Back Cover ScriptPro ...7 SoftWriters ...1 Speed Script ...40

received many of McKesson’s highest distinctions, including the President’s Award, the Pinnacle Team Process Award, and the Achieving Excellence Award. Mott holds an M.B.A. degree from the University of Richmond.

NCPA Announces New CEO At the National Community Pharmacists Association (NCPA), Kathleen Jaeger has been named executive VP and CEO, replacing Bruce Roberts, who resigned earlier this year. Prior to joining NCPA, Jaeger served as president and CEO of the Generic Pharmaceutical Association. She holds a J.D. degree from the Catholic University of America and a B.S. in pharmacy from the University of Rhode Island. TeleManager Technologies ...38 Transaction Data Systems – Rx30 ...48, and Inside Back Cover Two Point Conversions ...11 voiceTech ...24 January/February 2011 ComputerTalk for the Pharmacist

On the Move:

How Mobile Technology Impacts Pharmacy Management Get a look at the way mobile technology touches every sector of community pharmacy. From pickup reminders to the LTC setting, today’s pharmacists have options to fit mobile devices into all their pharmacy operations.

Deadline to reserve space in the issue is Dec. 20. For more information, email: Will Lockwood (will@computertalk.com) Maggie Lockwood (maggie@computertalk.com)

To sign up to receive emails when new content is posted to the ComputerTalk Web site and to read issues online, visit www.subscribe.computertalk.com. November/December 2010

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web sites to visit 48

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

Exclusive Online Content

www.rx30.com

www.computertalk.com

ComputerTalk


Rx30 is a phenomenal pharmacy system. The intuitive filling process, reports, and menus, combined with a competitive price, made it the clear choice for our new pharmacy. Plus, the updates continually add little nuances and improvements that keep us loving this system! Dusty Lewis, “We both used another software for 10 years but when we decided to open our own pharmacy – we chose Rx30! We are really happy with Rx30! We made a great choice….it’s fast and that’s what we wanted!” Jonathan Canterbury and Matt Kennedy, J&M Drugs – Warner Robins, Georgia

“I have worked with many different software systems, at various community pharmacies. Rx30’s system is user friendly and far superior to the others, especially when it comes to support, reporting, and maintaining inventory.” Cherese Jones, Jones Total Health Pharmacy The data conversion was smooth, the training was excellent, and the service has been outstanding. Prescription scanning, built-in Fact & Comparisons, great interfaces with IVR, robotics, and POS in a very friendly operating system has increased our output giving us more time to spend with patients. This has been our best technology investment yet!

Clinton Memorial Regional Health System

Baker’s Pharmacy

“When I was looking to upgrade our pharmacy’s system, I needed a state of the art solution that was cost effective, along with a company that was quick to respond to our ever changing needs. Rx30 has met and surpassed our expectations!” Kevin Blessing Rph Sauk City Pharmacy

As the main point of contact for our conversion over to Rx30, I was in contact with at least a dozen Rx30 representatives, ranging from conversion support, operations, training, ongoing technical support and accounting. In each and every instance, our encounters have been outstanding, representing the best companywide professional and customer service support I have ever experienced. We are simply thrilled with our transition over to Rx30! Gary A. Stewart, Asst. Dir. of Pharmacy, Univ. Maryland Medical Center

A. Boyd Ennis, Jr., PharmD, RPh, Payless Drugs - Morris, Alabama

...ENOUGH SAID. Call today 800-289-7930



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