Technology impact to Pharmacy

Technology impact to Pharmacy - Evaluating the Impact of...

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Unformatted text preview: Evaluating the Impact of Technology in Pharmacy Practice Michael T. Rupp, Ph.D., R.Ph. Professor and Executive Director Center for the Advancement of Pharmacy Practice Midwestern University – Glendale, AZ and Managing Partner MENTORx 1 The Practice Ideal 2 The Practice Reality 3 What do pharmacists want? Technology that really works and fits seamlessly into a . . . Practice Model that really works which will support a . . . Business Model that really works. 4 Pharmacy Accounting 101 Sales – COGS = Gross Margin GM – Op. Expenses = Net Income To improve profitability, you can increase sales (price and/or volume) buy cheaper reduce operating expenses 5 Reducing Operating Costs Increase staff productivity (quantitative) Reduce the pharmacy’s average dispensing cost output (Rx’s) per unit input (time) 6 The Dispensing Process Inputs Rx Through Puts Outputs 7 Inputs: Receiving the Rx (12% of personnel time) Internet refills Integrated Voice Response (IVR) e­prescribing (CPOE) 8 Through­puts: Processing the Rx (45.5% of personnel time) Automated dispensing technology Unit­of­use packaging High speed Internet claims services Workflow systems 9 Outputs: Delivery & Counseling (16.3% of personnel time) Rx tracking from receipt of the Rx order through pick­up by patient Patient education and counseling aids POS systems (9% of personnel time is spent on inventory management) 10 What is “Cost of Dispensing?” The price of a retail prescription has four components: acquisition cost of the medication cost of acquiring, stocking, repackaging, labeling and dispensing the medication cost of providing standard professional services such as DUR and patient counseling (not MTM) a fair return on investment (net profit) 11 How is COD calculated? Direct Costs – would not be incurred if the activity were not performed Indirect Costs – would be incurred even if the activity were not performed Variable – fluctuate with volume (labels, vials) Fixed – do not fluctuate with volume (staff) each indirect cost in the operation must be allocated to the activity being costed using a reasonable criterion Area (sq. ft.) – utilities, maintenance, rent (usually) Sales – advertising, accounting/legal fees 12 Internet Portal Guided Interview Software Application Cost­of­Dispensing Analysis Financial Ratio Analysis Cost­of­Service Analysis Data Warehouse customized individual reports group reports for any level of data aggregation 13 Increasing Sales Improved staff productivity (qualitative) improved customer/patient service Increased customer satisfaction, loyalty and patronage 14 Other Technology Goals Enhanced quality of care Improved patient safety Improved quality of worklife Prove it! 15 The Effect of Patient Information on the Quality of Pharmacists’ Drug Use Review Decisions* Research Conducted by Terri Warholak­Juarez, M.S. Michael T. Rupp, Ph.D. Purdue University *Warholak­Juarez T, Rupp MT. “The Effect of Patient Information on the Quality of Pharmacists’ Drug Use Review Decisions.” J APhA 2000;40:500­8 16 Background The Omnibus Budget Reconciliation Act of 1990 (OBRA’90) made pharmacists legally responsible for performing comprehensive prospective drug utilization review (DUR) on every prescription they dispense. 17 OBRA ’90 Requirements for Prospective DUR by Pharmacists Over­utilization or underutilization Therapeutic duplication Drug­disease contraindications Drug­drug interactions Incorrect drug dosage or duration of treatment Drug­allergy interactions Clinical abuse or misuse 18 Research Questions What is the effect of enhanced patient information on the quality of pharmacists’ DUR decisions: Panel A ­ pharmacists who routinely have access to comprehensive patient­specific information (IHS). Panel B ­ pharmacists who do not routinely have access to comprehensive patient­specific information (community). 19 Methods Clinical cases were created that contained known DUR problems. Each case contained four levels of patient information: Information Level 1 Level 2 Level 3 Level 4 Legal Rx Info + + + + Med Profile + + + Diagnosis + + Encounter Form + 20 Methods Pharmacists worked through each level of information on each case looking for DUR problems. At each level, the pharmacist evaluated the prescribed drug therapy on the basis of the available information and indicated does a problem exist? would you dispense the prescription? 21 Agreement Between Pharmacists and Experts on Problems 0.6 0.5 0.4 Kappa 0.3 0.2 0.1 0 Level 1 Level 2 Level 3 Level 4 22 IHS Community Patient Information Agreement Between Pharmacists and Experts on Dispensing Decision 0.8 0.7 0.6 Kappa 0.5 0.4 0.3 0.2 0.1 0 Level 1 Level 2 Level 3 Level 4 23 IHS Community Patient Information Conclusions Pharmacists made significantly better clinical decisions when they had access to more and better patient information. Pharmacists who routinely practice in information­rich environments made better use of additional patient information than their colleagues who do not. 24 Recommendations Systems should be created to provide pharmacists with access to all patient information necessary to fulfill their legally mandated responsibilities. Pharmacy education should emphasize the systematic use of patient information to support clinical decision making. Where technology allows us to rebuild the communication links between physicians and 25 pharmacists, we should embrace it. The Effect of E­Prescribing on Staff Productivity and Dispensing Costs in Community Pharmacy Research Conducted by Michael T. Rupp, Ph.D. MENTORx Rupp MT “The Impact of E­Prescribing on Staff Productivity in Community Pharmacy – Part 2.” Computer Talk 2005;25(4):14­17 Rupp MT “The Impact of E­Prescribing on Staff Productivity in Community Pharmacy – 26 Part 1.” Computer Talk 2005;25(3):15­22. Sample 10 outlets of a chain pharmacy organization in New England. Stores concentrated in a geographic area where e­prescribing had been implemented by physicians. Study pharmacies had been processing e­prescriptions for three months prior to the study 27 Research Questions What changes in staff productivity result from implementing e­prescribing in a community pharmacy? What is the impact of e­prescribing on a community pharmacy’s dispensing costs? 28 Study Objectives Compare e­prescriptions to conventional prescriptions on the time required by pharmacy staff to complete five dispensing­ related activities: Receive the Rx Order Process the Rx Order Resolve 3rd Party Conflicts Resolve Clinical Conflicts Prepare the Prescription 29 Methods Observers recruitedfrom among senior technicians in the chain and trained in observation and documentation methods Data collected September ­ November, 2004. Observers recorded the time required by pharmacy staff to complete each of the five dispensing activities for 80 prescriptions ­ 10 from each of eight prescription classes. 30 Prescription Classes New e­prescription New walk­in New phone­in New fax­in Renewed e­prescription Renewed walk­in Renewed phone­in Renewed fax­in 31 E­prescriptions vs. All Others 80 70 60 seconds Rx Dispensing Time * * * 50 40 30 20 10 0 RPh E­Rx Other Rx *higher than E­Rx (p<.05) New Rx Tech RPh Renewed Rx Tech 32 Attitudes toward E­prescriptions “How do e­prescriptions compare with other methods of receiving and processing prescription orders in your pharmacy?” Processing Speed Workflow Disruptions DUR Problems General Satisfaction 0 1 2 3 4 5 5=Much Better, 4=Somewhat Better, 3=About Same, 2=Somewhat Worse, 1=Much Worse 33 Tech RPh Conclusion New e­Rxs required 26.6% less staff time for completion of the five dispensing activities, and renewed e­Rxs required 10.2% less staff time when compared to all other prescriptions. Pharmacy staff perceived e­Rxs to be much better in speed of processing/dispensing and overall general comparison, and slightly better in terms of causing disruptions in workflow and DUR issues. Improvements were due primarily to increased efficiencies in receiving and processing Rx orders. 34 E­prescribing and Dispensing Costs e­prescriptions reduced total labor costs by 15.8% for new prescriptions and 6.1% for renewed prescriptions. 35 How do we Redeem the Value of E­prescribing? Reduce staff or trim hours Increase volume, where available Redeploy staff to implement new specialized programs or services Absorb productivity gains to enhance quality of worklife and improve staff satisfaction and retention. 36 Future Projects Repeat staff productivity study in a panel of independent community pharmacies. Evaluate the impact of e­prescriptions on streamlining renewal requests & approvals. Perform in­depth analysis of best practice models among pharmacy organizations and computer system vendors. Evaluate the impact of e­prescribing on prescribing errors and dispensing errors. 37 Maximizing the effectiveness of eprescribing between physicians and community pharmacies Project Coordinator: Ken Whittemore Jr., RPh, MBA SureScripts 38 Pharmacy Analyses Midwestern University – Glendale Michael T. Rupp, Ph.D. Terri Jackson, Ph.D. University of Arizona 39 Measurement Aims Attitudes, beliefs and opinions of pharmacy personnel toward e­prescribing Effect of e­prescribing on the quality of physician prescribing behavior Effect of e­prescribing on pharmacy workflow, productivity and operating cost 40 Pharmacy Personnel e­ prescribing Survey Aim: Measure the subjective attitudes, opinions and beliefs of pharmacists and dispensing technicians toward e­prescribing when compared to conventional channels and methods of receiving, processing and dispensing prescriptions in the community practice setting. Rationale: As with physicians, the willingness of pharmacy to adopt and use e­prescribing technology will be influenced by the extent to which pharmacy personnel perceive that e­prescribing maintains benefits or advantages over conventional prescribing. 41 Pharmacy Personnel e­ prescribing Survey Methods: Self­administered survey collected data from pharmacists and technicians who practicein pharmacies that routinely receive, process and dispense e­ prescriptions. Attributes of interest included: • Safety of patient care • Effectiveness of patient care • Efficiency of patient care • Communications with the patient and physician • Effect on relations with the patient and physician • Overall satisfaction with e­prescribing • Perceived positive and negative features of e­prescribing 42 Medication Therapy Intervention (MTI) Aim: measure the incidence and nature of prescriber­ generated problems on e­prescriptions that required intervention by dispensing pharmacists to correct: What is the incidence of e­prescription problems that require contact with the prescribing physician to resolve? What are the types of e­prescription problems that require intervention by pharmacists? How much personnel time and related practice expense is required to resolve problems on e­prescriptions? 43 Medication Therapy Intervention (MTI) Rationale: Depending on the delivery channel through which they are sent, up to 11% of all new prescriptions have been found to contain at least one error that requires intervention by the pharmacist to clarify or resolve. However, the rate of prescribing errors on e­ prescriptions generated in the community setting remains virtually uninvestigated. 44 Medication Therapy Intervention (MTI) Methods: A Medication Therapy Intervention (MTI) documentation form was constructed to collect data on e­prescribing problems identified by pharmacists practicing in chain pharmacies that routinely receive, process and dispense e­prescriptions. MTI reporting could be done via hard copy or on­line. 45 Electronic prescription (e-Rx) Medication Therapy Intervention (MTI) Report Confidential PLEASE PRINT On the date shown I conducted the following interventions to correct or resolve medication-related problems that were identified from prescriptions that were sent electronically: Drug(s) Involved Drug(s) Involved Secondary or e-Rx Type Medication: Conflicting Rx Source (New, Refill, or (e-Rx) Name/NDC # Medication: Transfer) Name/NDC # PLEASE PRINT Zip code of pharmacy: ________________ Reporting Pharmacist (a four digit identifier known only to you) _______________________________________ Day (circle one): M T W TH F SAT SUN Date: _____________________________________ Total e-Rxs I Reviewed/approved on this date: New :______________________Refill:_____________________ Medication Therapy Intervention (MTI) How was the Reason(s) Pharmacist Time Spent Results pharmacist on for Actions (All that alerted to the Intervention (All that Intervention apply) apply) (minutes) problem? (All that apply) Comments e e e e How was the pharmacist alerted to the problem? [1] [2] [3] [4] [5] [6] PBM / Payer alert Physician notification Patient notification Pharmacist identified Pharmacy Computer system Other (specify above) Reason(s) for Intervention: Prescribing Problems A = Inappropriate Drug/Indication B = Incorrect Patient C = Excessive Dose D = Excessive Quantity/Duration E = Insufficient Dose F = Insufficient Quantity/ Duration G = Inappropriate Dosage Form H = Drug-Drug Interaction I = Drug Allergy or Sensitivity J = Drug-Disease Interaction K = Missing Information Reason(s), cont. L = Illegible M = Violates Legal Requirements N = Non-Formulary Drug O = Additional Drug Needed Drug Use Problems P = Side Effects or Toxicity Q = Over-Utilization R = Under-Utilization S = Patient Concern or Question T = Possible Fraud or Abuse U = Other (specify above) Pharmacist Actions: [1] Prescriber Consulted [2] Patient or Representative Consulted [3] Profile/Medication History Consulted [4] Literature Search/Review [5] Other (specify above) Results: A = Dispensed as Written B = Dispensed with Different Dose C = Dispensed with Different Directions D = Dispensed with Different Dosage Form E = Dispensed with Different Quantity F = Dispensed with Different Drug G = Rx Not Dispensed H = Drug Discontinued I = Patient Education /Counseling J = Other (specify above) 3/10/06 ©2005, National Alliance of State Pharmacy Associations, LLC Fax completed form to: Terri L. Jackson, Ph.D. 520. 626.7355 OR Enter data into the web portal at http://www.pqc.net/intervention Questions? Call 520.235.5529 46 47 Possible Future Analyses Analysis 1: Quantify and characterize electronic alerts generated through an automated DUR program in response to prescriptions issued by physicians before and after implementation of e­prescribing in their practices. Analysis 2: Evaluate the impact on medication reconciliation of providing hospital pharmacists with access to patients’ community pharmacy Medication Histories upon admission. 48 49 ...
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This note was uploaded on 01/14/2011 for the course MBA 581 taught by Professor David during the Spring '10 term at University of Phoenix.

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Technology impact to Pharmacy - Evaluating the Impact of...

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