Tech talk: Pharmacy riding the technology wave

If you are looking for a template for pharmacy IT innovation, you’d be hard pushed to find somewhere better than Will Chemists in Aberdeenshire...

Pharmacist Galen Will is a tech pioneer and his passion for technology permeates every aspect of his business. In his office at Will Chemists there is a high-performance scanner, which scans invoices at an astounding speed. This alone has saved us around 50 archive boxes in storage space, he says.

All the invoices can be quickly and easily located on a laptop – something that has already come in very handy. “We have had two VAT inspections since this was installed, and the process was a breeze,” he says.

Technology can also be used for more interesting purposes. Galen has installed BD Rowa automated dispensing robots in each of his two pharmacies. “There are many benefits, such as accuracy, safety, dispensing efficiency and date rotation,” he says.

This set-up also allows stock levels to be controlled remotely which, he says, saves both time and money by reducing waste. He also thinks the technology has marketing appeal. “It is a great way of showing off to customers and improving rapport – customers love to ask and chat about it, especially when they see the robot in action on the display screen at the counter.” But, of course, the use of technology doesn’t end there.

Yet more tech...

Dispensed items waiting to be collected are scanned in to a shelving system – at which point the patient is sent a text to let them know their prescription is ready. Galen points out that, while other systems do something similar, they send the text at the point of labelling the script, which can bring its own problems.

“This scanning system allows staff to quickly locate dispensed prescriptions without having to rely on manual alphabetical filing – which often causes problems due to filing errors.” Patient deliveries are also scanned into the system. The delivery driver has a handheld device and each script is then scanned out to a patient at their house – a signature is taken from the patient to confirm receipt.

The pharmacy can also remotely track the delivery driver, see which deliveries he has made and which are still in the van. “This is great when patients call asking if their script will be with them soon. This system will soon be able to send a text to the patient letting them know the expected time of delivery,” he says.

Other technological solutions at Will Chemists include an electronic CD register that Galen has had for nearly 10 years “I can’t believe there isn’t one in all pharmacies. It saves huge amounts of time, improves accuracy and is especially useful when searching reports or checking for discrepancies.”

Another piece of kit making life easier is an electronic fridge temperature logger, which sends a text message notification if the fridge temperature is outside the normal range.

“On Boxing Day, one member of staff did not close the fridge door properly when leaving the shop. An hour later I got a text message saying the fridge had entered high alarm mode. I was able to contact the nearest key holder, who accessed the shop and found the fridge door partly ajar. We would have lost thousands of pounds if this had not been corrected or I had not been notified.”

Other IT solutions in his pharmacies include electronic filing of customer complaints, dispensing incidents and pharmacist interventions, an electronic private prescription book, and a responsible pharmacist log.

Key facts

  • Maximising the use of technology in pharmacy is a challenge but also a huge opportunity to improve business efficiency
  • 98 per cent of community pharmacies in England can now view patients’ summary care records
  • A pilot for prescribing schedule 2 and 3 controlled drugs through the EPS is planned for later this year

Get behind new health technologies

While Galen Will has a passion for technology, most pharmacists are merely scratching the surface when it comes to utilising new advances, says Professor Darrin Baines, an expert in economics and health technology.

“Pharmacists are technologists by nature. As a profession, they have helped develop and adopt some of the world’s most impactful health technologies,” he says. “The time has come to rejuvenate pharmacy by reassessing the profession’s role in assessing and promoting new health technologies.” 

Professor Baines believes community pharmacies should be transformed into “technology hubs” to allow patients to connect with their pharmacy, local doctors, the wider healthcare system, pharmaceutical companies, charities, as well as other patients.

Galen Will agrees that pharmacists could do much more with technology. “I just wish the NHS would be more supportive – rather than supplying money to pharmacy to spend on technology, supplying the actual technology directly would be more useful.”

Sandra Ball, head of marketing at Cegedim Rx, agrees there are hurdles to surmount but it is important to take a longer view. “Maximising the use of IT in pharmacy is a big challenge. The upfront cost can often pose a barrier, but this is short-sighted and the real cost is in not adopting the solutions available.”

There are many technological advancements “lurking on the horizon”, she says. These would help pharmacy to “further advance patient care, improve outcomes and reduce the cost of care”, creating new opportunities for pharmacy professionals to “use their skills and innovate ways to further evolve a value-based patient-centric care system”. However, she warns that, “what we need now is adoption and for community pharmacy to start embracing the solutions available to it”.

Shanel Raichura, general manager at EMIS Health Community Pharmacy, agrees. Pharmacists aren’t making the most of the IT functionality they already have at their fingertips, he says. The reasons for this could be lack of time, they might be unsure how to use it, or they just don’t need it.

NHS: digital update

It has been a busy year for NHS Digital. By January this year:

Some 98 per cent of community pharmacies in England could view patients’ summary care records (SCR). “We are now working with pharmacy system suppliers to make SCR access quicker and simpler by integrating it within pharmacies’ existing systems,” Vishen Ramkisson, senior clinical lead for digital medicines told Pharmacy Magazine. “We are also looking at how pharmacy professionals working across different care settings may be able to support the uptake of SCR additional information.”

NHSmail is now available in 95 per cent of community pharmacies but further developments are also planned, says Vishen. “We are now exploring if additional features, such as instant messaging and video calling, could add value to pharmacy professionals.”

NHS Digital is also working with the Professional Records Standards Bureau to establish a standard data set for recording flu vaccination data so it can be sent digitally from pharmacies to GP surgeries. It is hoped that a digital solution will be ready in time for the 2018-19 flu season.

A survey on the electronic prescription service (EPS) last year provided NHS Digital with feedback about what changes users most wanted to see. As a result, a pilot for prescribing schedule 2 and 3 controlled drugs through EPS is planned for later this year. This is in addition to the pilot for using EPS in integrated urgent care settings, such as NHS 111 and out-of-hours GPs, which was launched in December last year.

Clinical applications

While one of the core purposes of pharmacy technology remains the same (i.e. aiding the dispensing process), pharmacy IT has evolved “quite significantly” in the past 10 years, “delivering new tools that support the rapid growth in prescription numbers, and electronic solutions that automate and streamline workflows,” says Sandra Ball.

This includes (in England) tools to support the electronic prescription service, health checks, MURs and the NMS. “Our goal at Cegedim is to create new products and solutions that precisely match our customers’ needs, improve healthcare provision and expedite improvements in care and outcomes,” she says.

Pharmacy should adjust to a more services-based contract, Shanel Raichura believes, and there should be more “proactive support” for patients. However, it is up to companies like EMIS to provide the IT to support these developments.

Possibilities include a patient key performance indicator (KPI) dashboard, which would provide useful patient information in a concise and easy-to-read format. This could include compliance or polypharmacy details, useful information to help provide clinical support or even a system to support remote medication reviews from a pharmacy to people in their own homes.

Cegedim’s online clinical services delivery platform, Healthi Services (healthi.co.uk), enables pharmacies to efficiently provide services such as the NMS, MURs, NHS and private flu vaccines, while benefiting from a centralised patient view.

The company is planning to expand its service portfolio this year to enable pharmacies to use Healthi Services as a central platform to deliver all their clinical services to patients.

Automation opportunities

Gary Paragpuri, chief executive of Hub and Spoke Innovations, and his business partner, Ryszard Cygan, who both graduated together from Chelsea School of Pharmacy in the late 1980s, have another automated solution for pharmacies.

Pharmaself24 is a secure, automated 24-hour collection point that lets patients collect their dispensed medicines whenever is convenient for them.

“There is hardly an area of modern life that hasn’t been touched by robotics in some form or another – healthcare is no different. Technology is being used across the system to deliver efficiency, safety and patient convenience,” says Gary.

So what does it involve? A prescription is dispensed as normal and bagged up with a label containing the patient’s name and address. An additional label with a barcode identifies that particular bag and the patient’s name and phone number.

This additional barcode is scanned at the Pharmaself24, then placed in the robot. The Pharmaself24 automates the rest of the process. It sends out a text message letting the patient know their medicines are ready for collection and includes a unique six-digit PIN.

On collection, the patient enters the PIN into the touchscreen, pays any prescription charges and collects the medicines, which the Pharmaself24 picks automatically from its internal storage. Each transaction is recorded, providing an audit trail of every collection.

Technology helping TB care

New software is enabling a community pharmacist and a GP to improve care for patients with TB. EMIS Web for Pharmacy is a clinical system that enables pharmacists to read and write to a shared patient record with GPs.

The system is being piloted by pharmacist Jignesh Patel and GP Farzana Hussein in Newham, East London, where the incidence of TB is seven times the national average. It enables them to identify and treat the dormant form of the disease (the presence of which significantly increases the lifetime chances of a patient developing full-blown TB).

Jignesh is able to check the patient’s history, X-rays, possible drug contraindications and liver function test results. He can also book follow-up GP appointments for the patient if necessary and send referrals to other healthcare providers.

“Before, I would hope and pray that the prescription actually got to the pharmacist and that the patient understood what they were taking,” says Farzana. “Now, I’m confident that my pharmacy colleagues can check test results and dispense appropriately, and also have a consultation with the patient.”

“For the first time, the technology is available to support pharmacy in its goal of providing new and enhanced clinical services beyond dispensing,” says Shanel Raichura of EMIS Health.

Improved efficiency

Automation is key to dealing with the ever-increasing prescription volume, says Gary Paragpuri. “If we split the dispensing process into its constituent parts, we see that every pharmacy already automates the processing of prescriptions with PMR systems and, increasingly, high volume pharmacies are turning to assembly robots.

“But what about the handing out of dispensed prescriptions? What about the shelves full of dispensed, bagged, regular repeat medicines, simply waiting for collection or costly delivery?“

The Pharmaself24 prescription collection robot solves this problem by removing customer queues for routine collections, freeing up staff to focus on those patients who need advice from pharmacists and their teams, or who choose to seek help for an urgent health need,” he says.

“All this allows pharmacists to deliver more convenient and valued services while retaining control of supply, and creates space for the important personal interactions that robots will never be able to provide.”

For a community pharmacy doing 10,000 items a month, around 6,000 items may be suitable to go in the Pharmaself24, says Gary. “At a stroke you have automated 60 per cent of the workload associated with the handing-out process, cut near misses and errors, created a calmer working environment, freed up storage space, and replaced the pharmacy’s delivery service to boot.

“When combined with EPS, the Pharmaself24 offers unparalleled convenience and flexibility in collecting medicines.”

Wearable technology

Digital developments are increasingly giving patients more choice on how and where they access health products, services and care. Technology has the potential to improve safety and efficiency in pharmacy, allowing pharmacists and their teams to spend less time on the mechanics of dispensing and more time on providing clinical services for patients.

The possibility of interconnectivity between pharmacy PMR systems and wearable healthcare technology may provide pharmacy with a unique opportunity to become more involved in helping patients manage their long-term conditions.

 

Technology update: useful apps

  • BNF – This is an easy-to-navigate, comprehensive app that is a ‘must have’ for every pharmacist. Indications, doses, contraindications, adverse effects and interactions are covered for all medicines as in the paper version. There is also a handy “Other drugs in class” section.
  • LactMed –  A US-based app, this provides detailed information on the use of medicines in breastfeeding women. Much more detailed than the Summary of Product Characteristics for drugs and the BNF, it provides a better understanding of risk.
  • Rx Guidelines – This enable you to search for local guidelines on a whole range of specialities, download them onto the app and keep them in one handy place for reference.
  • MDCalc – As the name suggests, this offers a variety of useful calculators to use in practice, including creatinine clearance, Framingham risk score, Centor Score and CHA2DS2-VASc risk score.
  • Safeguarding app – This app helps support healthcare professionals to safeguard adults and children. It provides lots of information on different types of abuse, statutory responsibilities, when to suspect abuse and what to do, useful contact details and other reference material.
  • Univadis – This has many useful features, but you will need to register to use all of them. The app includes a drug database from the electronic Medicines Compendium, a drug interaction checker, a disease guide, useful calculators and information on laboratory tests.

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