WellSpan Health is a community-based, not-for-profit, integrated health system in southeastern Pennsylvania. Including York Hospital and Gettysburg Hospital—a total of 614 beds—WellSpan Health services include neonatology, behavioral health, trauma, cardiology, orthopedics, neurosciences, and oncology. With a total of eight pharmacies, WellSpan delivers over 400,000 prescriptions each year. In August 2008, York hospital became the first hospital in the country to implement the Asteres ScriptCenter Express Prescription Pickup kiosk.

In the prior year, WellSpan began looking for solutions to provide prescription access to employees in the Gettysburg Hospital, which did not have an outpatient pharmacy, short of building one. We discovered the ScriptCenter system at that time, and thought it would be a good solution. However, the Pennsylvania State Board indicated that while we could use this new technology in theory, in order to comply with regulations, the ScriptCenter kiosk had to be adjacent to an actual pharmacy, and the existing inpatient pharmacy at Gettysburg was too small to accommodate such a build-out. We were intrigued by the ScriptCenter concept, but had to table the proposal at that time. As the year went on, we realized that at the York Hospital there was a need to relocate the existing outpatient pharmacy due to changing trends in patient flow. We needed to move to a place where it would be more conducive for discharged patients to be able to easily obtain medications upon departing the hospital.

The space allotted for a new outpatient pharmacy was small and awkwardly oriented. We realized early on that we would be scantly able to provide a waiting room area. We needed a solution to help us handle traffic to the pharmacy. Our goal was to permit our discharge patients to easily pick up their prescriptions and exit quickly; simultaneously, a significant population of employees would be using the pharmacy, and we did not want them waiting in line, creating a slowdown in the process for the discharges, and delaying their return to work. ScriptCenter came to mind as a possible solution to this workflow problem.

We quickly realized that a lot of our employees were picking up maintenance medications, month after month, and they did not have the same needs as our discharge patients, who needed more one-on-one education when picking up medications. There was also the idea that ScriptCenter would allow our employees (or any patient of WellSpan) to pick up prescriptions 24/7, a particular boon to off-peak and third-shift employees. We decided to pursue this solution for our York pharmacy.

Regulatory Requirements
Implementation of the ScriptCenter system had to be approved through the Pennsylvania State Board of Pharmacy, and while different states have different regulations, in Pennsylvania, ScriptCenter can only be used for refills. New prescriptions still need to be processed at the counter, allowing the patient to have an opportunity for medication counseling. After that, any customer of the pharmacy can use ScriptCenter for remaining refills. Meeting the requirements of both the Pennsylvania State Board of Pharmacy and the Department of Health was easily accomplished.

Stocking the Kiosk
ScriptCenter has received a positive response from users for a number of reasons. A clear benefit to both pharmacy and customer is decreased wait times, as the average turn around time for a ScriptCenter pickup is less than one minute. Just as is the case with ordering refills from a regular pharmacy, the patient calls in the refill, and the pharmacy processes the script as normal. After the medication has been put in a bottle, the bottle and paperwork are sealed inside a special, clear plastic bag that works with ScriptCenter’s robotic retrieval mechanism. The prescription and the bag—which have corresponding bar codes—are scanned using our bar-coding system. Scanning the bottle and bag only after the bagging process ensures that there are no mistakes placing a bottle into the wrong bag. Pharmacy staff then places the bagged prescriptions into the back of ScriptCenter, in any of the available holding slots, for the customers to pick up at their convenience. For prescriptions of different sizes, ScriptCenter has both small and large trays, which are configurable and can accommodate orders of any size. Using only the small trays, the ScriptCenter kiosk can hold up to 560 prescriptions at once.

Medication Retrieval
Convenience is key with ScriptCenter. Thus, a patient is able to enroll for ScriptCenter either online or at the kiosk. After the one-time enrollment, the patient has an option of logging in with an ID number and PIN number or fingerprint and PIN number. Once logged in, the patient sees all medications associated with that patient that are available for retrieval. The patient can pick and choose which medications to take or leave for a later retrieval. Given today’s economic reality, a patient may decide to pick up one medication today, and then wait until payday to pick up another. Patients can also add others to their account, making prescription pickup practical and efficient. As added safety precautions, pharmacy staff must use their fingerprint to access the back of the machine, and a photo and signature of the patient (or patient designee) are captured for each prescription delivered.

When the patient comes to retrieve the medication, the machine will find the proper medication, regardless of where it has been placed within the unit, using the bar code on the bag. If a customer is unable to come and pick up their medication within a specified amount of time, the bag is removed, and the patient would need to re-order the medication. As we already had BCMA in place,
we only had to make a few minor software tweaks to accommodate ScriptCenter’s automation.

Because some patients may not be able to pick up medications on their own, the system enables patients to indicate others, such as a family member, friend, or caregiver, who can input the proper identification information into the system and retrieve the medication.

Lean Pharmacy
As part of a general movement in pharmacy toward lean technology, when designing new programs and initiatives, we are always looking for the most effective approach. With the ScriptCenter, our efficiency has increased and we are able to provide better customer service to our patients, our employees, and our community. Wait time has decreased, while access has improved with 24/7 availability. As staff has been freed up from servicing long lines at the cash register, they are now available to provide additional services, such as patient counseling and administration of immunizations.

From a financial standpoint, ScriptCenter has also allowed us to capture more of our employee prescriptions within the organization, and by working with larger-scale medication acquisition, we have realized institutional cost savings. We are currently considering implementation of a second kiosk at our Gettysburg campus. This would allow us to take further advantage of economies of scale. At the end of the day, better service, faster turnover, the reallocation of specialized staff, and cost savings in medication delivery all lead to better care for the people in our community, which is, of course, our number one priority.

 
Melissa A. Mook is currently the practice manager for WellSpan Orthopedics and the director for WellSpan Pharmacy, Inc and the Healthy Community Pharmacy. Prior to her current positions, she served as the manager of WellSpan Infusion Service and was manager of WellSpan Pharmacy. She has been with WellSpan since 1997. Before joining WellSpan, Melissa held various pharmacy positions with Thrift Drug, PACE Program, and EPCO pharmacies. Melissa has a BS in pharmacy from Temple University and is an MBA candidate at York College of Pennsylvania.      

*Approval does not necessarily mean the state has the ability to deliver prescriptions after hours.