The technology includes inventory management, Sanders said, “So you know that you actually have the drug there. If the drug is short, the pharmacy will automatically get an alert that we’re low on this inventory and signal to reorder the medication and to restock the cart, so that we don’t get to the point where the nurse looks at the drawer and there’s nothing in there. … You’re not having delays in therapy because the medication is not available.”
Pharmacy automation improves workflow and efficiency, Sanders said, because “back in the day, pharmacists and technicians did the counting and pouring, which took up considerable time. Preparing these orders with automation, now our pharmacists have more time to spend in patient care, especially our clinical pharmacists. We’re fortunate in VA that we have clinical pharmacy specialists who can act as providers, prescribing medication and managing patients’ care. By having these technologies, we can free up pharmacists’ time so they can perform more of these clinical care capabilities that are so important, especially to our veterans.”
Because VA pharmacy automation utilizes industry standards, communication compatibility exists with the Department of Defense and other non-VA health care systems. VA is currently working on technology to incorporate additional standards and data-sharing and interoperability systems to improve these communications.
Additionally, the VA has developed tools to share data with states’ prescription drug monitoring programs, an important aspect in addressing potential opioid or other drug overdoses. With those technologies, Sanders said, “we can share data about patients’ medication use regarding controlled substances with participating states and give the prescribers and the clinicians in the state, as well as the VA, more information on how to better manage the patient and reduce the potential for misuse as a result.”
Sanders identified several project areas they’re working on to advance VA pharmacy automation capabilities and meet veterans’ needs.
Projects include enhancing the barcode medication administration system and improving the inpatient automated dispensing equipment interface to better utilize commercial technologies. The VA has a number of other key VistA software development projects that will improve the ability to use automated technologies. For example, Park a Prescription, OneVA Pharmacy, and InBound ePrescribing will expand the ability to dispense medications to better meet the needs of veterans.
Also, said Sanders, “We’re particularly looking at some specialty areas for pharmacy medication management in the area of women’s health and teratogenic drugs to reduce the risk to female patients of exposure to certain medications.” Other efforts are directed toward hepatitis, diabetes, and anticoagulation treatment, “areas where in the VA population, in particular, we have a significant need to address and be able to provide them additional services,” said Sanders.
A distinct quality of CMOP that is a major departure from commercial mail-order pharmacies is that it’s an integrated part of the whole VA pharmacy automation system, and in fact, extends those features into the mail-order process, improving continuity of care and providing additional safety and convenience for veterans.
Additional endeavors include: increasing rural access to medications with telehealth solutions; allowing the VA system to process veterans’ prescriptions from non-VA providers; and developing a mobile app for prescription refills.
“When veterans come into the VA system after their military career, they typically stay in our system for decades,” Sanders summarized. “It’s a very unique situation that you don’t see in the private sector, and often our pharmacists have very long-term relationships with our veterans. We know they have unique needs … and we’re constantly working on thinking of ways to better meet those specific needs.”
Another way in which VA pharmacy automation benefits veterans is through its mail-order pharmacy service.
“The VA is a unique environment where we can invest in automation throughout the health care scheme that relates to pharmacy, and it’s all under one umbrella,” said Ken Siehr, RPh, national director of the VA’s Consolidated Mail Outpatient Pharmacy (CMOP). That umbrella includes CMOP, a centrally managed, automated outpatient mail-order pharmacy system for veterans who choose to receive their prescriptions by mail.