Pharmacy Captain Ryan Brock performs a step in the medication filling process at the Ambulatory Pharmacy at Madigan Army Medical Center on Joint Base Lewis-McChord, Wash., August 20, 2020.
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MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Washington. – The way Madigan Army Medical Center outpatient pharmacy operates is changing. For years, patients have come to the first floor of the Medical Mall, picked up a number, waited to be called, talked to a pharmacy technician, sat down and waited to be called back to collect their medications. The system was never perfect, but seemed to work well. The wait time was not too bad. In 2017, the Ministry of Defense Military Health System introduced its new electronic health record, MHS GENESIS, and that all changed.
While the new EHR is in many ways a godsend as it brings all other systems together and standardizes functions, it has resulted in painful complications and adjustments in terms of processing a prescription, affecting wait times in the pharmacy.
MHS GENESIS connects to a patient’s TRICARE coverage to determine approval before allowing prescription to be filled. This, and the fact that MHS GENESIS is a more complex system that poses more questions to the technician and pharmacist than the previous one, explains the longer wait times patients have seen since implementing MHS GENESIS.
An explanation for something that took a few minutes to accomplish and now takes hours is cold comfort to the patient who just wants to get on with their day. That’s why Madigan Outpatient Pharmacy has worked hard to find ways to reduce that wait time.
“It’s the best way to manage the amount of work we have with the software we have,” said Major Jason Parsons, deputy head of the pharmacy department, referring to the fact that neither MHS GENESIS nor TRICARE allows a prescription to be filled as soon as it is presented 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 services, not to keep patients as a captive audience, Parsons said. This is the industry standard and should speed up service for active duty soldiers who must return to work and those who are ill or injured and must return home to recover.
Parsons explained that other benefits of this process include reducing the number of people crammed into the pharmacy lobby or sitting in the medical center, waiting for their prescriptions to be filled. Executives approving this process change also hope it will reduce frustration with wait times as it no longer keeps patients in close proximity, waiting for their number to be called. With this system, they can activate their prescriptions and continue their day until the drugs are ready to be picked up. They can go to the commissary to do their shopping or go to the gym.
Finally, this process should also make better use of the pharmacy staff.
“Everything here is a volume,” Parsons said, explaining why the patient is in line instead of taking a number.
People in a queue pay attention to when they are next. However, when a number is called, a person must recognize that it is their number, get up from their seat, and walk to the window before their interaction with the technician can even begin. Then they are called back and the whole process takes place again. It may seem like a small thing – maybe a minute added each time. But, consider that the pharmacy has about 400 of each of these encounters each day.
Parsons calculated: “For these two functions alone, this represents a saving of about 15 hours per day; these are two full-time employees that we are putting back into our work pool by switching to this system.
This change is expected to result in shorter wait times, reduced stress for staff and an overall improvement in customer service.
What a patient should know about this new process
“The main thing people will notice right away when they walk in is that the layout of the lobby will change; they’ll see three routes they can take, ”Parsons added. “There is ample signage to direct them.
Patients who are on-duty ward members, patients who have been discharged after surgery or the emergency department, or who are going to get an antibiotic for themselves will pull a number from the kiosk and have a seat on the right for triage and expedited service.
Patients who are there to pick up a prescription they called for refill on the refill line will go to the collection line at windows 7 and 8 right in front of them.
Everyone else will go to the line on the left for drop-off at windows 1 through 6. There they will speak with a technician or pharmacist who will confirm the details of the prescription, activate it for dispensing, and give the patient the prescription. time to come back to Recover. They will come back at that time and enter the line for windows 7 and 8 for pickup.
“We’re starting with a rollback to the three hour pickup time, and we’re looking to reach a point where we can modulate that time throughout the day depending on how much volume we have and what resources are available. Parsons detailed. “The patient doesn’t have to be back here at exactly three o’clock, he can come back any time up to seven days after and pick up his medication. “
How providers can help you
“We have a common goal,” said Parsons of the Pharmacy and the rest of the Madigan clinical staff. “It’s about providing the best possible patient care; communication is crucial to achieve this goal.
When talking to their patients, providers and healthcare teams can make sure to ask them where they want to pick up their medications, Parsons noted. This can eliminate the simple mistake of a patient thinking their medication is running at Madigan’s outpatient pharmacy when their primary care manager sent it to a network pharmacy, because that’s where his last prescription has been sent.
Providers can also help patients recognize the difference between a refill prescription and a refill prescription.
“A renewal is actually a new prescription,” Parsons said. “We have to go over and make sure everything is correct on it, especially since they’re going to be there for maybe a year depending on the treatment plan. We need to make sure patient safety is our primary concern. “
A refill, being in effect a new prescription, takes longer to fill than a refill.
A prescription should be periodically reviewed by the PCM to ensure that it is still providing the patient with the appropriate therapeutic benefit. Some medications require lab tests to determine if a patient is within the healthy range of what this medication is prescribed to affect.
Alternatives to a pharmacy visit
Madigan patients have options when it comes to their medication. For the most part, they can receive their prescriptions using the ExpressScripts home delivery service.
“In some cases it is very beneficial to use ExpressScripts,” Parsons said. He noted that a patient can “use the search tool in the TRICARE formulary to identify co-pay for their specific medications using the home delivery option.” “
The Form Finder is available at: https://www.express-scripts.com/frontend/open-enrollment/tricare/fst/#/
Parsons also wanted to make sure patients were aware of the ScriptCenter vending machine in the Medical Mall, just around the corner from the information desk.
It’s a good way to get medicine from Madigan right away. It cannot dispense drugs that are controlled substances or that require refrigeration. But, it is available every hour when the Medical Mall is open, from 6 a.m. to 9 p.m., Monday to Friday, as well as on Saturdays, from 7 a.m. to 3 p.m.
“If a patient calls a refill and assigns it to the ScriptCenter, there’s no line, there’s no wait,” Parsons said.
The ScriptCenter is a pickup option when a patient calls for medication from the refill line. As with the other options, processing takes three business days. A patient should also be aware that they will need to register for the machine the first time they use it and that they will need the prescription number of one of their called refills to do so.
Madigan Outpatient Pharmacy has been looking for ways to reduce wait times and improve service. The change in this delivery model should free up patients for other activities of their day.
As Parsons said, “We don’t want to hold you hostage for drug delivery.”
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