Pharmacy

6 June, 2012

Introduction

• Why Pharmacy

• What’s the problem

• What should we do about it

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Why Pharmacy

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Population Illness Episode Intermediate Products

Resources Operating Costs

Why Pharmacy

Lee and Jones Model

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Population Illness Episode Intermediate Products

Resources Operating Costs

Reduce the rate at which

the population becomes ill

Select “best” treatment model and

location

Implement best practice

treatment protocols

Engineer the delivery of

intermediate products

Alloc’t “Make” resources,

Supplemental, Contract buy

Why Pharmacy

Lee and Jones Model

What’s the problem

• Critical Resource: Pharmacist

• Manual• Variance• Low volume/Geo isolation

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Prescribe Fill Compliance

What should we do about it

• Leverage technology• Automation (robots)• Tele-Pharmacy

• Maximize Pharmacist Value-added activity

• Provider prescribing• Patient compliance

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Appendix

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Patient compliance

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Patients have been shown to abandon their treatment. Pharmacists actively communicate with patients regarding refills and prescription issues to increase patient adherence

Patient compliance

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Reduction in total patient costs can be achieved with proactive pharmacists monitoring

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Current Pharmacy Operations Cost

Retail Prescriptions* Retail Cost*

Current State Statistics•Navy follows same general trend as DoD

•Retail Rx volumes increasing w/ Direct Care decreasing

•Retail drug costs Increasing

• Avg. ~$40 extra cost/Rx in Retail vs. Direct

Additional Costs

• Capital Investment: Automation replacement

• Inventory: $82 M with 60-day stock

• Rx replacement, Loss to Retail

• Patient Abandonment

*M2/PDTS Data: DoD Pharmacy Operations Center (Note: Mail Order Total Cost misleading due to dispensing fee being dropped and some ingredient cost issues after TPharm activated on 4 Nov 2009)

+27%

-2%

+33%

-5%

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Bank Teller Pharmacy Queuing Models•Bank Teller: Patient waits until called to window and then served (left)

•In-and-out: Patient submits Rx, sits down, and waits to be called again for Rx dispense and consult (below)

Pharmacy Standardization

•NO patient queuing standardization

•NO prescription fill process standardization

•Limited centrally driven decision making

In-and-out

Patient Arrives

Prescription Filled

Prescription Dispensed

Patient Arrives

Prescription Dispensed

Prescription Filled

Patient Queuing and Prescription Processing

Models

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Wait Time and Abandonment

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Pharmacy Automation Guiding Principles

• Single Piece Flow

• High Level of Automation

• Minimal Interruptions/Distractions

• Division of Labor

• Standardization

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New System ObjectivesQuality

Errors: Fill errors are reduced by 2/3

Value-added Pharmacist time:10% more time is dedicated to high

valued-added tasksAccess

Overall processing time:30 minute processing time From 1000 to 1400 for the 90th

percentile patientTicket abandonment:

Ticket abandonment is reduced by 1/3Cost

Staffing:10% reduction in tech staffing 10% increase in Pharmacist value-

added time

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• In/ Out process patient queuing

• Automated labeling and capping

• Single piece flow tote system

• Conveyor transport

• Re-engineered workstations

• Medication storage optimization

Automation System Elements Layout

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• Top 250-275 high demand items within arms reach of technician

• Computer, pill counter, barcode scanner, and labeler

• Dimensions: 10 ft length, 7 ft height, 2 ft depth

Automation system elements

Fast mover workstation

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• Fast movers in front / Slow movers behind

• ~ 760 additional items per work station

•~ 1,520 items total in two stations

•This is bulk storage for all items with < 4 fills per week

Automation system elements

Fast and slow mover workstation

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• Two automation robots for oral tablets

• 150 - 200 cells in each robot

• Highest mover items in both machines

• Automation controls tote movement along conveyor systems

• Perpetual inventory

Automation system elements

Robot automation

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• Designed to minimize disruptions

• Reinforces single piece flow

• C2s and refrigerated items in close proximity

• Dispensing windows in close proximity

Automation system elementsPharmacist verification

workstations

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Dashboards

ExamplesToday

Past 14 days

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Conveyor Concept In Use Around the Navy

• Scott Center• Naval Hospital San Diego

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Patient Experience Fast Mover Work Stations

Patient Experience

• Maximum wait decreased from 2 hrs to 45 min

• Improved flexibility (not “holding” patients in the waiting room)

• Error rates decreased by a factor of 50 (0.5% to 0.01% error rate)

Pharmacist Verification

Conveyor Concept in Military Environment

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