Automation and Disease Management Make El Rio Stronger and Better Prepared

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There’s little doubt that pharmacy robots are elevating safety and efficiency in dispensing medicine to heights previously thought impossible, but can they also lead the way in making healthcare more patient-centered and compassionate?

That is exactly what is happening at El Rio Community Health Center, based in Tucson, AZ. El Rio began with one location in 1970 and provided healthcare to Tucson’s underserved and uninsured population. Many of the patients are Hispanic and American Indian, and three out of four patients who utilize services at El Rio fall at or below the federal poverty line.

The Center now serves approximately one in nine Tucsonans, over 80,000 people, a year and is one of the largest non-profit community health centers in the United States. With multiple locations throughout greater Tucson and southern Arizona, El Rio offers access and convenience that few health systems can match.

Services offered now include primary care, preventative health services, and specialized care in chronic disease treatment, as well as dental, radiology, lab and pharmacy services. El Rio has been recognized nationally as a model for community-based action in healthcare as well as for the quality of its programs and medical staff. This is in large part due to El Rio’s evolution and growth over the last 44 years.

Leading the Way in Disease Management And Wellness

El Rio seeks to treat the whole person with a focus on patient-centered care in all aspects of diagnosis and treatment, including prescription fulfillment and management. There are seven pharmacy locations in the system, and together they fill close to 600,000 prescriptions yearly. El Rio is also a 340B pharmacy, which ensures that all patients are able to afford their medications. The pharmacy is also home to El Rio’s Pharmacy-Based Diabetes Clinic, an award-winning approach to diabetes management.

The Pharmacy-Based Diabetes Management Program began in 2001. Patients are referred to the pharmacist by their primary care physician when they have uncontrolled or newly diagnosed diabetes. Pharmacists have collaborative practice agreements with doctors that allow them to manage patients’ medications, including making recommendations and changes in therapy regimens. Education, patient compliance and monitoring for adverse drug reactions are all part of the pharmacist’s role.

By integrating pharmacists into the healthcare team, El Rio has experienced improved patient outcomes, including an enhanced quality of life, greater medication adherence and fewer medication-related complications. Buoyed by this success, clinical pharmacists now have collaborative practice agreements with physicians in the treatment of hypertension and cholesterol management.

The clinical pharmacists also participate in annual wellness visits where they provide in-depth education that gives each patient the know-how to be proactive in managing and maintaining good health.

Automation Equals Teamwork

Just as the addition of pharmacists to the healthcare team has improved patient outcomes, the addition of pharmacy robots to the pharmacy team has improved patient care at El Rio. For starters, it gives the pharmacist a greater opportunity to connect with each patient.
This kind of connection is exactly what El Rio Associate Pharmacy Director Joshua Carzoli, Pharm.D., aims to provide more of, without sacrificing the efficiency or accuracy of prescription fulfillment. El Rio is achieving those lofty goals with the help of pharmacy automation. The health center purchased three RM64® pharmacy robots in early 2014. RM64s were designed by RxMedic® Systems, Inc. in Wake Forest, NC, and are known as the fastest pharmacy robots on the market – filling as many as five prescriptions per minute. With El Rio’s high and ever increasing demand, it helps meet their need for prescription filling immediately – without sacrificing patient care.

“Safety is paramount, as is efficiency,” Carzoli said. “With pharmacy automation, we are able to fill prescriptions quickly and safely so that our patients may have an excellent experience.”
The RM64 is leading-edge robotics technology. It can count up to five prescriptions simultaneously, dispensing each directly into one of three different vial sizes so there are no cross-contamination risks and no air-quality issues. Locating, selecting, verifying and checking out a prescription takes just three key strokes.

“Our managers are reporting decreased waiting times,” Carzoli said. “We are able to provide high-quality service without sacrificing safety.”

The safety features of the RM64 include a barcode system that ensures the right drug is dispensed to the right patient. The unique photo verification system provides a digital image of each prescription and stores it for future reference. Visual verification improves safety and accuracy in the filling process. Having an automation system also allows pharmacists more time to carefully review treatment plans for each patient.

“Our pharmacists now have time to review patient medical records, meet with patients and identify drug-related problems, such as duplicate therapy or gaps in therapy,” Carzoli said. “With a software system that is able to track refills and generate reports that identify patients who are struggling with adherence, we create a model that allows our pharmacists to reach out to those patients and their prescribers, to identify the reasons why.”

El Rio has plans underway to add a fourth pharmacy robot early next year. “We would like to expand automation across all our sites for the sake of safety and efficiency,” Carzoli said.

In addition to safety, the RM64 ensures the care each patient receives is the best it can be by improving collaboration between the pharmacist and the clinical teams.

“Our goal with pharmacy automation is to restructure our workflow to enable our pharmacists to expand our collaboration with our clinical teams and have a larger role in direct patient care. Our pharmacists are continually offering suggestions to prescribers about our patients and the types of medications they receive,” Carzoli said. “Automation creates the opportunity for our pharmacists to have more time to directly interact with our patients. These extended one-on-one visits have greatly improved healthcare outcomes.”

Preparing for tomorrow’s Challenges

At El Rio, it all comes back to the patients. “Our mission at El Rio is to improve the health of our community through comprehensive, accessible, affordable, quality and compassionate care,” Carzoli said. “We believe that having a pharmacist directly involved in patient care will improve the quality of care a patient receives.”

Recently, El Rio was selected to receive one of the 2014 American Pharmacists Association (APhA) Foundation Pinnacle Awards. This award was established in 1998 to celebrate significant contributions to the medication use process. The APhA Foundation stated in its news release, “The expanded services at El Rio Health Center have been pivotal in showing a pharmacist’s value in primary prevention, in addition to showing a reimbursable model for pharmacy services.”

When asked about the challenges of the future, Carzoli is hopeful that automation, such as the RM64, will help El Rio continue to thrive and grow. “Shrinking reimbursement, pharmacy benefit manager (PBM) contracting, provider status and appropriate staffing are the biggest challenges we face at El Rio,” he said. “We are hopeful that automation will help with our shrinking reimbursement and that PBM contracting will help us cut costs, increase safety and allow more time for staff to have meaningful patient interventions and interactions.”

In an era when the Affordable Care Act impacts all aspects of healthcare in the United States, El Rio Community Health Pharmacy is using technology to improve patient-centered care for underserved populations. El Rio is proof that striving for excellence in all aspects of patient care includes the pharmacist and the pharmacy.

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