McKesson Series: Using Technology to Simplify Vaccination Programs

Drug Topics®: Hello, and welcome back to Over the Counter, the podcast from Drug Topics®. I'm Gabrielle Ientile.

And thanks for tuning in to our newest podcast series in partnership with McKesson.

McKesson Pharmacy System’s clinically driven EnterpriseRx pharmacy workflow software is uniquely designed to help drive pharmacy efficiency and profitability while helping pharmacists provide clinical services that empower them to be more actively involved in patient care.

In this episode, I'm speaking with Heather Cusick, director of product management for clinical services at McKesson about vaccine workflow efficiencies within pharmacy.

If you're listening to this in November 2020, the flu season is inbound and compounded by the second wave of coronavirus disease 2019 (COVID-19). Amid these challenges, Heather discusses how pharmacies can streamline vaccination programs and prepare for surges of patients, as well as other important considerations amid the current pandemic.

Drug Topics®: Can we start off with a little bit of your background and your work with McKesson?

Cusick: Sure, my name is Heather Cusick and I'm currently the director of product management for our clinical solutions over our retail pharmacy systems. And so I am a pharmacist by trade. I got out of school and I actually worked at the Cleveland Clinic for several years as a staff pharmacist and then moved to Charleston, South Carolina, where I worked at a smaller community hospital there and that's actually where I got introduced more into the technology side, helping them with the configurations and their pharmacy systems.

And then I had an opportunity about 14 or so years ago to come to McKesson, helped as a product manager there from an inpatient perspective, working with the inpatient pharmacy, med reconciliation, some electronic prescription entry from the physician side. And as the retail pharmacy continues to expand community pharmacy and their opportunities, we have become more clinical in nature, had an opportunity to come over and really help to develop those solutions so our pharmacies can continue to offer additional services.

Drug Topics®: With the 2020-2021 influenza (flu) season in full swing, what can pharmacies do to streamline their process while also ensuring they're able to deliver as many vaccines as possible to their patients?

Cusick: Yeah, great question. Coming from technology, that's where my mind goes first. And really, I think leveraging your technology in your pharmacy is key. A lot of times, people kind of become complacent or pharmacies become complacent with their technology and maybe aren't taking the most recent updates, things of that nature. So really knowing your system, ensuring that you're staying up to date with whomever you're using.

I know that as vaccines continue to grow, that's really a huge opportunity for pharmacy services. Technology solutions are focusing on that and growing their capabilities. Here at McKesson and our EnterpriseRx solution, we have recently enhanced many of our workflows specifically around the vaccine process, trying to really streamline it as much as possible, worked really in-depth with our pharmacies to eliminate any non-essential steps and dramatically cut some of that data entry time.

So ensuring that you're keeping up with that and using that technology will help to make sure the process is as clean as possible, and you're serving as many of your patients as possible.

I'd also say that we, in our solution suite, have streamlined our reporting to agencies. So after vaccination you have to report to your state agency - we've worked on that type of integration. We're also serving back opportunities, so when somebody rolls up their sleeve for their flu, you're prompted proactively within our solution if there are additional opportunities for that patient. So that's a conversation you can have. So really trying to leverage any of those points of interaction are key.

I would also say that, to deliver as many vaccines as possible and to efficiently use your staff, leveraging any of your technology as it relates to kind of a more appointment-based or a synchronization of medication dispensing, because then you have that opportunity. If the patient's only coming in, in general, once a month, and you're having a conversation with them about all of their different medication use, it’s a great time for them to schedule ahead.

When your patient is coming in for that flu vaccine, you can staff accordingly. And then it's also an opportunity to talk to that patient about any other opportunities they might have. So that's kind of the focus from that technology perspective.

I would say, as you're just looking at the pharmacy in general, making sure to leverage your personnel effectively is key. So recently, with COVID, a lot of different orders have come down. And 1 of them actually has given authority for technicians to be able to administer injections in the pharmacy. And some folks are looking at getting some of their techs certified, and it's definitely a process to do that. There's definitely education and training that has to be done. But that is an opportunity to get more of your staff access to giving those vaccinations.

Also leveraging all your staff. If you are looking at registries or logging into registries to see other opportunities or vaccine history, ensuring that now, some states do allow technicians as well to have that opportunity, so you can really home in on what you want your pharmacists to do.

A lot of times pharmacies have more technicians than pharmacists on staff, so that might be an opportunity. I would also say to really look at workflow. With the current dynamic with COVID, having to be really careful about how many patients are in your pharmacy at 1 time, ensuring that there's adequate spacing between them, are there other ways that you want to take care of giving the vaccinations, looking at curbside options, or looking at your lobby and different counseling areas and really just understand your pharmacy and your patients that come in and looking through, how it is best to serve them.

I would say trying to keep things as paperless as possible, and this kind of goes back to technology. Within our solution, we offer the ability for our pharmacies to build out patient portals. And so sometimes some of that information that they're going to capture up front could be done electronically versus on paper. So really just leveraging any solutions like that that are possible.

And lastly, getting out there and getting that message to your patients. How are you marketing your services and making patients aware of what's available? And again, having the ability to maybe to schedule some times to come in or to do some off-site locations.

So overall, I think there's a lot that can be looked at to help with all the efficiencies around the flu vaccine.

Drug Topics®: Then outside of the flu vaccine, what are some of the things that pharmacists should consider when starting new vaccine programs or adding new options to what they currently offer?

Cusick: Yeah, and so again, leverage your technology. I'll go back to that probably repeatedly. I think that there are tools that help identify opportunities for your patients.

In our application, we have the ability to kind of give you some proactive notices about opportunities, that maybe you want to just see if that patient meets the criteria or they have an age range where a pneumococcal vaccine (Pneumovax) is important or a Shingrix vaccine.

So really trying to optimize that. And if you have the idea of synchronizing their medications, and having patients kind of comment on once a month for that, that's also that opportunity to do that comprehensive review.

If you're going to start a new program, you really want to look at your patient population. Is your location high travel? Maybe there's opportunity for travel vaccines. What does your elderly population look like? What are some of the common insurances - there are opportunities for employers in your area to go target your employers and ask them if you can serve them and their employees by doing their vaccinations for them.

Within that though, if you identify, okay, this is my target that I'd like to give some vaccines for, then you want to look at what those requirements are. There's collaborative practice because, like for pharmacy, often you have a collaborative practice agreement with a provider to be able to administer it, so what do those requirements look like? What is your state reporting for those type of vaccinations? Are you capable of doing that? Billing, of course, you want to make sure your services are billed and what type of resources. Some things are paid by a pharmacy claim and others are medically billed. All of that needs to be taken into consideration because you want to make sure you're getting a return on your investment.

And often some of these vaccines have interesting storage requirements. Do you have the right freezer? Do you have the right calibration tools that are required for the thermometer that has to be certified? I mean, there's little details, I think it's not just as easy as saying, well, I want to do it, so let's do it. But you really got to have to have a comprehensive look up what it would take to manage that. And once you do, I think it could be really successful.

Again, too, going back to the staff perspective, making sure your staff is on point and trained. What are the contraindications they need to look for? What is the prework they'd have to do? What are some of the questions that they might get? With COVID underway, and it's probably a common theme on everyone's mind, but if I come in for a flu vaccine, and everyone's hearing on the news, there might be a COVID vaccine, those are questions patients are going to ask. Trying to get ahead of it, get your pharmacy staff as up to date and educated as possible, so they can articulate clearly what the future looks like and what are some opportunities they might be able to bring them is important.

And then lastly, I think also as it relates right now, is making sure that you have the right personal protective equipment (PPE) for your pharmacy staff. Some of that stuff is in short supply, so ensuring that they have the right gowns or facemask gloves. Those are opportunities for you to ensure that your staff is well taken care of. And then again, just looking at that workflow, and how are you going to manage it, similar to what I talked about before, just in general, with any vaccine, that's going to be important.

We're doing flu vaccines; we also do these other vaccines - those are conversations you want to have with your patients proactively. So anytime you can advertise out, but then also when they come into the pharmacy, ensuring that your pharmacy is taking that time to have that conversation.

Drug Topics®: Absolutely. And then what do you see as the benefits of offering a robust vaccination program?

Cusick: So many advantages in my mind, and most of all, I like the idea that you're serving our patients. Most vaccines are there to really help minimize worst outcomes for the patient.

Keeping them safe and healthy. A lot of patients don't even realize that, hey, I didn't even know I could get shingles, and I have a much higher chance of getting them when I'm over 50. And so that's something maybe you want to proactively - shingles can be very painful. Recently my mother had it, and honestly, it's been almost a year and she still has residual effects. So things like that, it's huge to get in front of them, just make sure that the patients are aware, and keeping them safe.

It's also an opportunity for the pharmacy. We're trying to expand our profession. And I feel like pharmacy, especially in the community setting, has often been underutilized and we know our value and our patients know our value, but really being able to offer additional services continues to grow our profession.

I know many of us wanted to get a provider status over time, I think this is a great opportunity for us to really be diving in and showing our value for our patients and, let's be real, it's harder for a patient often to get to a provider's office than it is to get to the pharmacy. It's really a great opportunity for us to be offering them.

I'd also say that, from the pharmacy perspective, when you offer these additional services, this is a gateway into offering other services to your patients. Also going to other employers in your area, or payers, and being able to partner with them and bring more services into the pharmacy, more patients into your pharmacy. And then just overall healthcare spend. The nature of healthcare is very complex and very expensive. And if we can keep patients out of the emergency room, out of the hospital, the better we're serving our entire community.

Drug Topics®: And so, a lot of these vaccines/drugs are currently in short supply. How can pharmacists better manage the backlog of drug shortages?

Cusick: Yeah, that's a great point. Unfortunately, just because you have patients who want it or you want to be able to administer it, it doesn't always mean it's there.

Going back to technology, I would say trying to manage your patients through an electronic system tends to work best. That's at least how we feel here at McKesson. Our pharmacy management systems, we allow you to use these electronic lists – again, you have a list of all your patients that might have an opportunity for this medication, or maybe they had the first of a series of medications – and so you want to ensure that they're going to come back.

And you're following up with them, you're not just hoping that they remember in 2 months that they need to come back, or 60 days or whatever the timeframe is between, sometimes it's up to a year in a series of vaccinations, so being able to set that as a reminder, so that way, as it comes up, you have and you proactively reach them.

Also being able to identify – when you have a backlog, we have to prioritize. Your higher risk patients might be the patients that would go up in priority. So just even being able to identify who are those higher risk patients? Where are they in their series, if it is a series medication? Is it better to get 1 and then none, so get multiple patients at least 1 vaccine versus some patients getting the full series, those are all fine lines that have to be negotiated. But having the ability to kind of analyze your patients in that manner is really key to being able to manage that.

I would also say in general, order early and ahead of the season. If you know even now that we're in full swing, and because people are uber sensitive this year I think to any of the needs for any vaccines – we’ve heard from our pharmacies that flu vaccine has been out of the park, right? They've been giving more than they ever had in the past. Ensuring that, as things are coming up, or if you're going to then also do other vaccines like for pneumonia and COVID once that becomes available, you want to make sure that you've ordered it early enough because you might not be able to get that stock later.

Of course, look at all your wholesalers. Most pharmacies have a primary wholesaler, but there might be secondary backup ones, you just want to make sure that you're getting the medications that you need, and you know where to go. And then again, when it does come that you don't have the supply, which is likely to happen, how are you going to prioritize your patients? Leverage your technology, if it's an option where you can help prioritize them, you can help keep them in a list and keep yourself straight, really, for your pharmacy sake and for your patients.

Drug Topics®: Circling back to COVID-19, of course, the hope is, and according to Operation Warp Speed (OWS), that a COVID-19 vaccine will be available soon. How can pharmacies prepare for the potential of engaging in a large volume of patients or even off-site programs as well?

Cusick: Yeah, well, we all do hope it's right around the corner, and it seems like that's actually going to be the case. And I really kind of would say refer back to all the different things that I've talked about throughout this interview.

Accommodating high volume means do you have the space for it? What is it going to take? What does that workflow look like? Do you have enough staff to accommodate it? Again, looking at the use of your technicians. And are there opportunities to get them additional training and different additional certification? Does your state allow it on? Those are things to really look into. Leveraging technology, again, understanding what are the requirements?

What we're hearing coming down the line is that COVID is going to possibly require some unique characteristics about the reporting. So I need to capture information that not all other vaccines necessarily required pharmacists to capture. Does your technology provide you that ability? I know us at McKesson are learning the requirements as we speak and building that out to be able to serve our patients and our customers, so they can capture that information that's going to be required, and then report it out. Any billing that might be related to that? And are you able to process that? And getting ready to manage any backlog or shortages. I think we all anticipate that would be the case and just prioritizing your patients accordingly.

And lastly, the messaging and the education to your staff for your patients. So going back to what I said earlier on, I think everyone's very curious, I think there might be a lot of people who be suspect of something that comes out very quickly. You want to really make sure that there's knowns like, hey, what are the side effects I might be looking for? What are my contraindications and things of that nature?

The more educated all of us are, the better we can pass that on to our patients and serve them better. So hope that vaccine is available, we hope that we're all ready to serve it and definitely need to look at all our different resources, and as a community, together and really come up with good solutions. At McKesson, we’re really wanting to make sure they're ready for everything. So from that technical side, we're working hard on that and I know many others are as well to be able to serve our patients.

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