Centralizing pharmacy services is a popular topic, as health systems explore avenues that can bring value to the organization. The first step to centralizing services is determining what functions can be performed from a central location and the value of each. This will be specific to each health system as regulatory requirements are different in each state, as are the services offered by health systems, the prescription volume/mix, and the geography. Services that a central pharmacy can provide include mail order/specialty pharmacy, call center, prior-authorization, patient assistance, self-distribution/warehousing, repackaging, kit/tray management, training, order verification, and medication reconciliation.
Once a decision is made on the services, the next step is defining how each of the functions will be performed. Traveling around to the multitude of Central Pharmacies throughout the country you will see varying levels of automation versus manual processes. It is important to know about staffing limitations and address those through automation during this design phase. Automation vendors are expensive, long-term partners so this is a key decision point. Due diligence is needed, so leverage relationships with other health systems, GPOs, wholesalers, and potentially consultants, depending on the aptitude of your internal team. It is worthwhile to look outside of typical pharmacy vendors for technology solutions, as many of the activities performed from a central pharmacy are warehouse activities.
Another long-term decision is the floorplan of the central pharmacy. Even after the recent shift to move employees to work-from-home, most central pharmacies wish they had more space. There will be attempts to reduce square footage in favor of budget. If a compromise needs to be made on square footage, look to what employees could move to remote/hybrid, but be steadfast in your requirements for the operations and storage areas within the facility. Remember to define the footprint based off current opportunities AND potential future growth. It is much less expensive to plan for a potential 2nd floor upfront, rather than rip up concrete and replace support beams in the future.
Once the general floorplan is defined there will be a decision to buy existing property, build from scratch, or join existing property, which typically means co-locating with Supply Chain and/or Lab. If you are joining an existing centralized Supply Chain many of the vendor decisions may already be made (Warehouse Management Software, courier vendor, shipping software, etc.). If it’s a new build there will be a lot more decisions, but more freedom in design. Your ROI will be impacted by the location, and ability to tap into existing services.
Data is crucial in defining the revenue, costs, and savings available to the health system to support the business plan, as those will be the metrics that determine the viability of the facility. The goal is an autonomous pharmacy with 0 medication errors, 0 medication waste, and no manual intervention until medication is delivered to the patient. An autonomous pharmacy allows 100% of the pharmacists’ time spent on clinical activities, with 100% visibility into inventory levels system-wide, and 100% regulatory compliance. Lean on the wealth of data available through your EHR, dispensing software, automation software, and financial software to communicate the ROI of your proposed services. Be bold in your request of vendors, as much of the industry is inefficient today and is ripe for automation.
At this point, if your business plan supports a central pharmacy, be prepared for the multitude and magnitude of decisions that need to be made. Details matter, and there will be a lot of details. If you’ve built a custom home, you can appreciate the minutiae of building something from scratch. Defining every data/power drop, whether employees get a laptop or desktop, the number of monitors for an employee, furniture, signage, and all the way down to the location of each trash can. Do not underestimate the resource commitment from Pharmacy for the sheer volume of decisions that need to be made, the new technologies and software integration development needed, and the hiring required to open a new facility. Building out a new facility and team will demand significant resources, while the day-to-day functions of pharmacy will still need to be tended to.
Staffing a new facility is a challenge given the pharmacist and pharmacy technician shortage. Pharmacy will staff positions outside of the pharmacy department as well (Security, IT, Environmental Services, etc.). Lean on the leaders of those departments within your health system. Much of your time will be spent on interviewing and onboarding, which will all need to be timed out with a go-live date that is a moving target. Plan a calendar block for the interviews and create interview teams to tackle hiring as your team grows. This is another key focal point, because culture matters and as an organization scales you want to ensure your environment is a desirable workplace that can attract the top talent in a competitive market.
Go-live is likely a phased implementation, as it is typically too much to take on day one. Plan out your phases as many of the resources may overlap, or some of the functions may be required to go-live at the same time. With the knowledge you’ve gained with your implementation, share with other health systems. We are all in this together to provide first-class care for patients and to support the viability of the health systems in our community.
