The provision of medications in the outpatient setting is a process that faces unique scrutiny and logistical challenges related to the quality of service provided. When patients have options as to where they can fill medication prescriptions, the success of an outpatient pharmacy will depend largely on the patients’ overall experience, including expedited prescription fulfillment and efficient medication counseling. The effort to fulfill these expectations involves both human and technological solutions.  

The University of Virginia (UVA) Health System comprises a 700-bed medical center and approximately 70 associated practice sites that offer ambulatory care services. Serving many of these facilities is the Barringer Outpatient Pharmacy—the largest UVA Health System-affiliated pharmacy—which processes approximately 18,000 prescriptions per month originating from clinic, emergency room, and hospital discharge patients, as well as refills, at a central location on the UVA campus in Charlottesville, Virginia. To maintain superior ambulatory patient services, the Barringer pharmacy team tracks a number of criteria that measure the quality of patient service, including factors that impact the patient experience (eg, waiting times) and prescription fulfillment (eg, technology failures). 

Managing Prescription Will Call
For most of the 2000s, Barringer employed a four-carousel will call automation system that was discontinued by the manufacturer in 2009. Unfortunately, the product platform ran on a unique, esoteric operating system that few knew how to maintain successfully. As the system continued to age, we were no longer able to perform system updates or even basic maintenance, making the system vulnerable to failure. By 2010, Barringer was down to just two fully working carousels. Facing the problematic scenario of having to revert to housing outpatient medications on static shelves, we began to research options for a new, all-in-one will call medication storage and retrieval system. As the function of a will call system is fairly straightforward, we sought a technology that would be simple to learn and operate, and operationally consistent and accurate.

New Technology Integration
These factors led UVA outpatient pharmacy management to invest in upgrading its technology to meet the patient care and operational objectives of secure and traceable storage, seamless integration, and improved medication retrieval times. Due to the experience we had with our legacy system, ongoing software and hardware support also was deemed essential.

Ultimately, UVA chose the SencorpWhite WillCall Rx system, a HIPAA-compliant system that combines storage and retrieval hardware with simple software that enables wireless tracking, robust security, and real-time monitoring of inventory stored within the system. Although the technology appeared to address our needs, we realized that a specific, detailed implementation plan would need to be thoroughly vetted and approved before attempting to swap in the new system. The outpatient pharmacy model is highly dependent on a seamless customer experience, so we did not want to have any downtime during implementation. 

Accordingly, our project coordinator developed an implementation schedule, which included lead-up actions such as proper placement of Ethernet cables and electrical outlets, six months in advance, and we met weekly leading up to go-live to make sure the transition plan was clear to all relevant parties. This careful preplanning proved essential and we timed the project so that SencorpWhite delivered the new carousel on a Friday afternoon, we closed our pharmacy at the normal time, tore out the old system and installed the new one, and on Monday morning we opened on time. We spent the intervening days removing inventory from the old system and segregating medications into plastic totes, and on Sunday we scanned them all into the new system.

Process Improvement
Steps in the WillCall Rx fulfillment process:

1. When an item is placed into the WillCall Rx system, it is assigned a unique bar code and a secure storage location
2. When a patient comes to the outpatient pharmacy pick-up window, a technician or pharmacist simply looks up the patient record in the PIS, which then sends a message to WillCall Rx to retrieve the patient order by bar code identifier
3. Pharmacy staff are directed to the proper bin in the system via a touchscreen interface and the system rotates to deliver the correct prescription to the staff member, who removes and scans it
4. WillCall Rx is notified by the scan that the bin location is empty and can be used to store another prescription 

Our staff is quite pleased with the new workflow enabled by WillCall Rx. The system provides a secure, self-contained enclosure with put/pick receptacles located at the point-of-use, adjacent to the patient service counter. This set up allows pharmacy technicians to securely access medications quickly, as once they enter the patient information into the system, the carousel locates the product(s) and delivers it to the pick-up window. Our staff no longer has to search through unsecured bins or hanger systems, which helps mitigate picking errors while saving time and energy. We are now able to run full inventory reports and closely monitor turnover, while gauging the efficiency of serving patients with multiple prescriptions. Coupled with support from SencorpWhite’s engineering and software representatives, the WillCall Rx has improved our patients’ customer experience, accelerated prescription fulfillment, and increased productivity. 

Steven R. Miller, RPh, is director of pharmacy business services in the UVA Health System and is an assistant professor with the Virginia Commonwealth University School of Pharmacy at UVA. He previously served as director of ambulatory pharmacy services following his role as supervisor of the UVA outpatient pharmacy.