At each hour, tech took scripts from that hour’s slot and entered all required data into pharmacy info system (so no one looked at script until 1 hour before pickup) Info logged in: Patient contact info Doctor contact info Third party payor info – insurance companies, employers Drug name Dosage Number of doses Number of refills System performed an automated Drug Utilization Review: Automated check of script against all other prescriptions in CVS database for patient; looking for harmful drug interactions and appropriateness of drug for patient given age, weight, gender, etc.
Hard Stop = fulfillment process cannot proceed until DUR reviewed by pharmacist if automated review reveals any potential problems Hard Stop Good for patient safety Hard Stop Bad for slowing down process, lowering efficiency Insurance check was done after DUR. Checking to make sure insurance still valid, script matches drugs on formulary, customer not trying to refill too soon, etc. In most cases, script would still be filled even if there was a problem with insurance – customer would simply be told to pay full amount at pickup.
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Potential Data Entry Problems: Tech couldn’t read handwriting on script, No refills allowed on script (6%), DUR hard stop (20%), Insurance problems (17%) Production Scripts were filled by pharmacy technicians Potential Production Problem: Insufficient inventory – patient wouldn’t find out until pick-up that drug wasn’t available Quality Assurance Pharmacist reviewed each script to make sure it was filled correctly. First priority is customer safety! Potential Quality Assurance Problem : None identified Pickup Bags stored in pickup area in alphabetical order until customer came for pickup.
Potential Pickup Problems: Many, including staff couldn’t find script, unauthorized refill, script not covered by insurance – customer asked to pay full price, script not ready (waiting for doctor or insurance call-back or queue backed-up). Worst between 5-7 p. m. – long lines of angry customers – hard to get staff to work that shift. 6. How can IT help with streamlining the process at CVS pharmacies? Get Teams to come up with a solution to problems in fulfillment process keeping 3 goals in mind: 1) Doesn’t degrade safety at all 2) Decreases waiting time 3) Improves customer satisfaction What CVS did to improve fulfillment process.
Drop off, data entry, insurance check – all done while customer is present. Data entry completed at drop-off while customer was still there – made it easier to verify customer insurance information. Insurance check is now done with customer present. Used to be they’d just make sure your name, address, and birth date were on prescription and let you go. At local CVS, there is a “new” drop-off window away from cash register where pick-ups are done. Clerks enter data into computer while you are still there. CVS was missing the opportunity to identify and resolve problems early in the process, when the customer is still present.
Under old system, no one would look at script until 1 hour before pick-up – not enough time to resolve any problems. Clerk asks for best number to reach customer in case of a problem, which is a change from the past. Staff can also inform customer about insufficient inventory at drop off instead of customer finding out when they come back for pick-up. Automated “instock” check. Also, box that held prescriptions was replaced by an online “virtual queue,” which can be displayed on all workstations in the pharmacy. Virtual queue tells techs and pharmacist what prescriptions to work on filling next. 2) Production – prescription is filled by tech.
No change here – techs have always been the ones to fill the prescriptions. 3) DUR and QA – done by pharmacist in single step. DUR process was folded into Quality Assurance step – DUR no longer part of Data Entry. Both DUR and QA are done after prescription is filled. DUR should not be done when customer is present; don’t want customer to get the impression that the drug could be harmful because they might be less likely to take it. Also, DUR is done at pharmacist’s station during QA – more efficient use of pharmacist’s time to check filled prescription for accuracy and deal with any problems revealed during automated DUR.
However, pharmacists could argue that it makes no sense, and is in fact dangerous to fill prescription before DUR is completed. PSI team had to “sell” the new process using communication efforts that were persuasive and effective. Also, changes were mandatory, not optional, so team used both hard sell and soft sell techniques to win pharmacists over. When there is a problem discovered with a script, an Action Note is filled out so that staff manning Pickup can adequately explain the problem to the customer, based on what the Action Note says. Case highlights IT’s principle capabilities: Design Standardization Monitoring Case also points out concerns that changes in process will be resisted by pharmacists, even though the new process changes no responsibilities or rights of pharmacists. This was a top-down change that was necessary to improve customer service. To drive compliance with change.