Digital future and the human touch
23 May 2019
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We are in a golden age of technological and digital innovation that promises to revolutionise pharmacy working practices. The NPA believes that pharmacies must be progressive and modern, while at the same time being true to the historic values of pharmacy as a personal, caring profession.
The NPA’s Digital Programme Director, Harpreet Chana, says the association is working hard to ensure community pharmacy can develop successfully within a digital landscape.
“The NHS is moving towards a much more digital future,” she says. “There is emphasis on inter-operability across primary care and we want to make sure that community pharmacy is at the forefront and digitally enabled.”
“Our membership is incredibly varied and many members run small businesses, so it can be quite difficult for them to invest in technology in the same way that a bigger multiple could do. In part, our role is to ensure that all pharmacies can compete on a level footing.”
She continues: “It became apparent in feedback from NPA members that there are a lot of digital products and services available in the market and pharmacies are unclear about what or whom to invest in to help drive efficiency and operational performance. That’s why we have technology partners within our business partner programme who go through a vetting process before we will accept them as business partners.
“Then, what we can offer in terms of additional digital products, services and income streams in the future, those are the kinds of things that we are looking at now.”
Pharmacist Gary Warner launched PharmOutcomes – a national IT platform “to support the efficient recording, reporting and invoicing of a range of community pharmacy services” – in 2013.
“The exciting innovation for me is the integration of pharmacy digital systems, both with the NHS and other pharmacy systems,” Gary says.
“For example, PharmOutcomes and Sonar now both have links to Personal Demographics Service, which allows pharmacists to align their records with the rest of the NHS and find the NHS number without a prescription. Access to SCR 1-Click from within PharmOutcomes and Sonar, gives pharmacists access to Summary Care Records as understood by the NHS.
“The next innovation is NHS 111 integration. The first service to benefit from that is the NHS Urgent Message Supply and Advice Service (NUMSAS), which means the doctor is notified as necessary so the pharmacy can focus on the patient and the patient’s needs without worrying about all the associated paperwork. Another aspect is the Digital Minor Illness Referral Service (DMIRS), which is now being piloted in areas across England with directions from NHS 111, helping to alleviate pressure on urgent care.
“In terms of reading local records there’s something called LHCR – Local Health Care Records – and we’re working hard on integrating that into the PharmOutcomes pharmacy record. That is a much richer source of information than the SCR – it adds things like U&E, appointments, all sorts of things that pharmacists want.”
GPS AND PHARMACIES
For some pharmacies, that idea of bringing together care providers has taken a more tangible form than integrated patient records. MedicSpot is a remote consultation and examination service offered via terminal in a pharmacy’s consultation room that puts patient in touch with a GP for a fee of £39.
“Technology has given us a way to allow even more clinical services to be accessed through pharmacies,” MedicSpot founder and former GP Zubair Ahmed explains.
“Using connected cameras and sensors, MedicSpot’s GPs can do a full consultation through video link with examination as well. Our doctors can listen to the patient’s heart and lungs, look into the ear or throat, take blood pressure and temperature, etc. Then the doctor can make a diagnosis and the prescription can be sent directly by electronic prescription to the pharmacy and collected.”
One pharmacy that has featured MedicSpot almost since its inception is Stickland Pharmacy in South Kensington. Initially choosing the system as a perfect answer for foreign patients – such as the multitude of tourists that visit London – Stickland owner Amish Patel noticed MedicSpot quickly attracted another type of user.
“As the service grew, we saw a lot more NHS patients using it because they were willing to pay the consultation fee rather than wait hours in A&E, or wait two weeks to see a GP. With MedicSpot you get to see a GP within minutes – I think that’s where the real benefits are. And the unique thing about MedicSpot is that, rather than phone or Skype consultations, with its attached diagnostic equipment, the MedicSpot GP can actually see clinical readings for the patients. That is only going to improve with the potential for almost instant blood tests in the future.
RISE OF THE ROBOTS
The Topol Review on preparing the health care workforce for a digital future notes: “Robots in healthcare have been designed to address specific procedural technical challenges, for example, surgical robotics… Robots can also automate high-volume repetitive tasks, for example, dispensing in pharmacy.”
Certainly, for the vast majority of European pharmacies, dispensing robots are now a fact of life. Here in the UK, though – where pharmacies operate quite differently to those found on the continent – automation is nowhere near as widespread.
“In Germany and Nordic countries it would be a question of what automation do you have, rather than do you have automation,” says Chris Shelford, Marketing Manager of pharmacy automation market leaders BD Rowa technologies. “In Germany something like 90% of pharmacies will have a dispensing robot, whereas in the UK that number is almost reversed.”
Robots can improve efficiencies in dispensary and pharmacy workflow by saving time, making stock management more efficient and reducing wastage. With incredibly intelligent control systems, they can also provide other significant benefits. “
The artificial intelligence in our robots will learn over time which are the fastest moving items and store them closer to the outputs, so it’ll make dispensing them quicker,” Chris says. “It’ll dispense the stock with the shortest expiry date first and it’ll make sure you dispense the correct stock because it is scanned directly from a prescription on the PMR system. Really it just frees up time and space to make the business more profitable.”
Installing a robot isn’t a move to instant efficiency – preparation, training and programming is vital. Weldricks Pharmacy installed its first robot 14 years ago and has been at the cutting edge of automation ever since. It now operates eight dispensing robots (ADUs) and two Omnicell VBM systems for central hub and spoke distribution of medication provided in MDS trays. Weldricks’s David Vanns knows better than most what automation requires, and it starts with PMR.
“Robot technology requires good, solid interfaces with the PMR, so the PMR suppliers need to be supportive, too. Introducing a robot might also mean changing to a PMR supplier that accepts their responsibilities fully to allow integration into their PMR,” David says.
Then there has to be a recognition within the pharmacy that a robot changes the way a dispensary and staff must work. Visually checking every single detail of every single pack is no longer the critical factor, which frees up pharmacists’ time but introduces other issues.
“Managing and re-organising staff to work to new routines and new values is key to success with a robot. The patient experience should also improve – because they now walk into to a much calmer and more managed environment – but that also depends on how well pharmacists and staff restructure the process of prescriptions received and the dispensed items handed out,” David says.
“Improvements can include reducing staffing costs, managing high volumes dispensed more safely, reduced shrinkage through out-of-dates, and freeing pharmacists time to use their clinical skills and provide additional services to patients.”
BENEFITS FOR ALL
One of the common fears of automation is the potential for people to lose their jobs. In the case of Cadham Pharmacy in Glenrothes – which operates a pill pouch robot, pill counter, deblistering machine and a dispensing robot – automation has actually helped staff retention. Until the robots arrived, one of Cadham’s younger members of staff, pharmacist Maree Ferguson, was becoming disillusioned by community pharmacy.
“Automation has allowed me to do my clinical diploma and independent prescribing course,” Maree says. “Now that my day isn’t spent checking packages, I can do a lot of consultations for minor illness and use my independent prescribing qualification every day to check people who might otherwise be presenting themselves at a GP surgery.”
And it can go a stage further for patients. The combination of automation – in the form of two Hub and Spoke Innovations 24-hour collection robots found outside Cadham’s premises – with digitalisation – in the form of NHS Scotland’s Chronic Medication Service (CMS) – is helping transform patient experience, especially for those on long-term medication.
“We have about 500 patients on a pilot scheme that we’re running in liaison with doctors’ surgeries and CMS,” Cadham pharmacist and owner Bernadette Brown says. “For people who are on 10 medicines, for example, our mission is to make sure they only have to pick up their 10 medicines once every eight weeks.
“When people register with my pharmacy for that service, we have a medicines review to check they still need all their medicines, then we then put them in an electronic queue. Once we have that queue in place, we get five days’ notice that the patient is due their next eight-week supply. We then upload it from the NHS central store and dispense it and put it in our 24-hour robots. The robot then sends a code to the patient’s smart phone and they have three days to come and pick up their medication, any time of day, any day of the year.”
The Community Pharmacy IT Group – a body comprising representatives of NPA, AIM, CCA, PSNC and the Royal Pharmaceutical Society, and which works closely with NHS bodies and technology providers – is at forefront of pharmacy innovation. It recognises that services such as Bernadette’s CMS provision, represent important developments that aren’t about just new devices or equipment. “We’re moving to a stage where the NHS wants patients to take control of their own health,” Chair of the CP ITG, Richard Dean says. “If they want to book their own doctors’ appointments, organise their own repeat prescriptions, or look at their own test results, they should be able to do that. But it’s got to be in a format that is easily accessible and uses language that they understand.”
Digital technology should also herald a new age for better integrated care where GPs, hospitals and pharmacies can all understand every patient’s unique requirements. At the core of this is a pharmacy’s IT resources.
“For some people, pharmacy IT is just the computer in the dispensary. Of course, that is a huge part of what pharmacies do and we need a very effective way of managing that. But there are many people who also understand that IT is central to how pharmacies develop. If we can’t maintain our patient database and patient records, and make use of them to benefit patients and the profession then we’re not going to move forward,” Richard says.
“I think the horizon for NHS IT is greater inter-operability and patient records should be at the centre of that. There should be seamless interoperability between every part of the NHS so that the dentist in say, Scunthorpe – who you have to see in an emergency when you knock your teeth out – should know about the medicines you take in Margate.
“It’s crazy that we have to rely on patients to recite their medicines. NHS IT has been developed in silos: the GP silo, the foundation trust silo, the pharmacy silo. If we look into the near future, though, a patient record that is accessible to all will be the way forward. Secretary of State Matt Hancock is very IT aware and recognises that things have to change, but they won’t change overnight.”
THE HUMAN TOUCH
Harpreet says: “The NPA passionately believes that the ‘human touch’ is a vital element of health care and that technology should complement rather than replace face-to-face care. We will deliver our digital programme against the backdrop of a sector that could change massively. While we don’t know exactly what the future holds, we do know it will be important to deliver digital products and services that help pharmacies take the pressure off general practice and other frontline NHS care. We want to help our members operate efficiently, integrate more fully with other health services and give patients the best possible experience of pharmacy services.”