MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – The way the Madigan Army Medical Center ambulatory pharmacy works is changing. For years, patients came to the first floor of the Medical Mall, took a number, waited to be called, spoke to a pharmacy technician, sat down again, and waited to be called again to pick up their medications. The system was never perfect, but seemed to work well. The waiting time was okay. In 2017, the Ministry of Defense military health system introduced its new electronic health record, MHS GENESIS, and everything changed.
While the new EHR is a boon in many ways as it brings all other systems together and standardizes functions, it has involved complications and painful adjustments in the way a prescription is processed, impacting pharmacy wait times.
MHS GENESIS connects to a patient’s TRICARE coverage to determine approval before the prescription can be filled. This, and the fact that MHS GENESIS is a more complex system that poses more questions to 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 is now cold comfort to the patient who just wants to get on with their day. That’s why Madigan’s outpatient clinic has been working hard to find ways to reduce that waiting time.
“This is the best way to manage the amount of work we have along with the software we have,” said Major Jason Parsons, the deputy head of the Pharmacy Department, referring to the fact that neither MHS GENESIS nor TRICARE allow a prescription that must be filled in by a healthcare provider upon submission, but also activated by the patient at the pharmacy.
Why did the pharmacy make this change?
A patient should know that this is the best way to provide service, not to keep patients as a captive audience, Parsons said. This is the industry standard and should expedite service for active duty soldiers returning to work, and those who are sick or injured and need to go home to recuperate.
Parsons explained that the further benefits of this process are that there are fewer people in the pharmacy lobby or sitting in the Medical Mall waiting for their prescriptions to be filled. Leaders adopting this process change also hope it will reduce frustration with waiting times as patients no longer have to wait in the immediate area for their number to be called. This system allows them to activate their prescription refills and go about their day until the drugs are ready for collection. They can go to the commissary to do their shopping, or go to the gym.
Finally, this process is also expected to make better use of Pharmacy staff.
“Everything here is volume,” Parsons said when explaining why the patient queues instead of taking a number.
People in a line pay attention to when it is their turn. However, when a number is called, a person must recognize that it is their number, get up from their seat and go to the window before their interaction with the technician can even begin. Then they are summoned again and the whole process unfolds again. This may seem like a trifle – maybe adding a minute each time. But remember that the pharmacy has about 400 of each of these encounters every day.
Parsons calculated: ‘With those two functions alone, that saves about 15 hours a day; these are two full-time employees that we will place back in our work pool by switching to this system.”
This change is expected to lead to shorter wait times, less stress for staff and better overall customer service.
What a patient should know about this new process
“The main thing that people will immediately notice when they walk in is the change in the lobby layout; they will see three routes they can go,” Parsons added. “There’s plenty of signage to point them out.”
Patients who are on-duty Service Members, patients who have been discharged from surgery or from the Emergency Department, or who are collecting an antibiotic for themselves, draw a number from the kiosk and have a seat on the right for triage and expedited service.
Patients who come to the refill line to collect a prescription that they have had refilled go to the collection line at counter 7 and 8 directly in front of them.
Everyone else will go to the line on the left for drop-up at windows 1 to 6. There they will speak to a technician or pharmacist who will confirm the details of the prescription, activate it for dispensing and give the patient a time to come back for pick up. They come back at that time and queue up for windows 7 and 8 for takeout.
“We’re starting with a return to the three-hour pick-up time, and we want to get to a point where we can adjust that time throughout the day, depending on the volume we have and the resources available,” Parsons told me. not be back exactly at three o’clock, they can come back up to seven days later to pick up their medication.”
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 possible patient care; communication is crucial to achieve that goal.”
When talking to their patients, caregivers and care teams can make sure to ask them where to pick up their medication, Parsons noted. That could eliminate the simple mistake of a patient thinking his medication is being filled at the Madigan Outpatient Clinic, when his primary care manager has sent it to a network pharmacy because that’s where his last prescription was sent.
Providers can also help patients recognize the difference between an extension prescription and a refill prescription.
“An extension is basically a new prescription,” Parsons said. “We have to go through it and make sure everything is right, especially since they may be on it for a year depending on the treatment plan. We need to make sure patient safety is our number one concern.”
An extension, basically a new prescription, takes longer to fill than a refill.
A prescription should be periodically reviewed by the PCM to ensure it continues to provide the patient with the appropriate therapeutic benefit. Some medications require lab testing 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 recipes using the ExpressScripts home delivery service.
“In some cases, it’s very useful to use ExpressScripts,” says Parsons. He noted that a patient “can use the TRICARE formulary search to identify the copay for their specific drugs using the home delivery option.”
The formula search function 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 medicine from Madigan without waiting. It cannot provide drugs that are controlled substances or that require refrigeration. But it is available at all hours that the Medical Mall is open, from 6am to 9pm, Monday to Friday, as well as Saturdays from 7am to 3pm
“If a patient calls a refill and assigns it to the ScriptCenter, there’s no line, there’s no waiting time,” Parsons said.
The ScriptCenter is an option to retrieve when a patient calls a drug into the refill line. As with other options, it takes three business days to process. A patient should also be aware that he must register with the machine the first time he uses it and that he will need a prescription number from one of the refills he has requested.
Madigan’s Outpatient Pharmacy is looking for ways to reduce wait times and improve service. The change in this delivery model is expected to free patients for other activities in their day.
As Parsons put it, “We don’t want to hold you hostage for drug administration.”
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