MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – The way Madigan Army Medical Center’s Outpatient Pharmacy operates is changing. For years, patients have come to the first floor of the Medical Mall, taken a number, waited to be called, talked to a pharmacy tech, sat back down and waited to be called again to retrieve their medications. The system was never perfect, but seemed to work alright. The wait time wasn’t too bad. In 2017, the Department of Defense Military Health System introduced its new electronic health record, MHS GENESIS, and everything changed.
Though the new EHR is in many ways a boon as it brings all other systems together and standardizes functions, it has brought complications and painful adjustment in terms of how a prescription is processed, thereby affecting wait times in the Pharmacy.
MHS GENESIS connects with a patient’s TRICARE coverage to determine approval prior to allowing filling of the prescription. This, and the fact that MHS GENESIS is a more complex system that asks more questions of the tech and pharmacist than the previous one, explains the longer wait times patients have seen since the implementation of MHS GENESIS.
An explanation for something that used to take minutes to accomplish now taking hours is cold comfort to the patient who simply wants to get on with their day. That is why Madigan’s Outpatient Pharmacy has been working hard to find ways to cut that wait time back down.
“This is the best way to manage the amount of work that we have along with the software that we have,” said Maj. Jason Parsons, the deputy chief of the Department of Pharmacy, referring to the fact that neither MHS GENESIS nor TRICARE allows a prescription to be filled upon its submission by a provider, but must also be activated by the patient at the Pharmacy.
Why the Pharmacy made this change
A patient should know that this is designed to be the best way to deliver service, and not keep patients as a captive audience, said Parsons. This is the industry standard and it should expedite service for active duty Soldiers who need to get back to work, and those who are ill or injured and need to get home to recuperate.
Parsons explained the further benefits of this process include reducing the number of people crowded into the lobby of the Pharmacy or sitting in the Medical Mall, waiting for their prescriptions to be filled. Leaders approving this process change also hope this will reduce frustration over wait times as it no longer keeps patients in the immediate vicinity, waiting for their number to be called. With this system, they can activate their prescription fills and go about their day until the medications are ready for pick-up. They can go to the commissary and get their grocery shopping done, or visit the gym.
Finally, this process is expected also make better use of Pharmacy staff.
“Everything here is volume,” said Parsons in explaining why having patient stand in line instead of taking a number.
People in a line pay attention to when they are up next. When a number is called, however, a person must recognize that is their number, get up from their seat and get to the window before their interaction with the technician can even begin. Then, they are called back up and the whole process unfolds again. This might seem like a small thing- maybe a minute added each time. But, consider that the Pharmacy has in the neighborhood of 400 of each of these encounters every day.
Parsons calculated, “In those two functions alone, that’s saving about 15 hours a day; that’s two full-time employees that we’re putting back into our work pool by moving over to this system.”
This change is expected to result in shorter wait times, reduced stress on staff and improved overall customer service.
What a patient needs to know about this new process
“The main thing that people are going to notice right off the bat when they walk in is the layout of the lobby will be changed; they'll see three routes that they can go,” Parsons added. “There's ample signage to direct them.”
Patients who are Service Members on duty, patients who have been discharged following surgery or from the Emergency Department, or are picking up an antibiotic for themselves will draw a number form the kiosk and have a seat to the right for triage and expedited service.
Patients who are there to pick up a prescription they called in for refill on the refill line will proceed to the pick-up line at windows 7 and 8 straight ahead of them.
Everyone else will proceed to the line to the left for drop-up at windows 1 through 6. There they will speak with a technician or pharmacist who will confirm details of the prescription, activate it for dispensing and give the patient a time to return for pick-up. They will return at that time and enter the line for windows 7 and 8 for pick-up.
“We're starting off with a return to pick-up time of three hours, and we're looking to get to a point where we can flex that time throughout the day depending on the volume that we've got and the resources available,” Parsons detailed. “The patient doesn't have to be back here exactly at the three hours, they can come back anytime up to seven days after, and pick their medication up.”
How providers can help
“We have a common goal,” said Parsons of the Pharmacy and the rest of Madigan’s clinical staff. “It is to provide the highest patient care possible; communication is crucial to achieve that goal.”
When talking to their patients, providers and care teams can make sure to ask them where they want to pick up their medication, Parsons noted. That can eliminate the simple error of a patient thinking their medication is being filled at the Madigan Outpatient Pharmacy when their primary care manager sent it to a network pharmacy because that is where their last prescription was sent.
Providers can also help patients recognize the difference between a renewal prescription and a refill one.
“A renewal is in fact a new prescription,” Parsons said. “We have to go through and make sure that everything is correct on it, especially since they're going to be on it for possibly a year depending on the treatment plan. We have to make sure that we have patient safety as our utmost concern.”
A renewal, being effectively a new prescription, takes longer to fill than a refill does.
A prescription should be reviewed by the PCM periodically to ensure it is still giving the patient the appropriate therapeutic benefit. Some medications require lab tests to determine if a patient is in the healthy range of what that medication is prescribed to affect.
Alternatives to a Pharmacy visit
Madigan patients have options when it comes to their medications. For most, they can receive their prescriptions using the ExpressScripts home delivery service.
“In some cases, it’s very beneficial to use ExpressScripts,” said Parsons. He noted that a patient can, “Use the TRICARE formulary search tool to identify the copay for their specific medications using the home delivery option.”
The formulary search tool can be found at: https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/#/
Parsons also wanted to make sure patients are aware of the ScriptCenter vending machine in the Medical Mall, just around the corner from the information desk.
It is a good way to pick up medications at Madigan without the wait. It cannot dispense medications that are controlled substances or that require refrigeration. But, it is available all hours the Medical Mall is open, which is 6 a.m. to 9 p.m., Monday through Friday, as well as Saturdays, 7 a.m. to 3 p.m.
“If a patient calls in a refill and assigns it to the ScriptCenter, there is no line, there is no wait,” said Parsons.
The ScriptCenter is an option for pick-up when a patient calls a medication into the refill line. As with other options, it requires three business days to process. A patient should also be aware that they will need to enroll at the machine the first time they use it and they will need a prescription number of one of their called in refills to do so.
Madigan’s Outpatient Pharmacy has been looking for ways to cut wait times and improve service. The change to this delivery model is expected to free up patients for other activities in their day.
As Parsons put it, “We don't want to hold you hostage for medication delivery.”
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