Insights

This week we began by better understanding the Seymour Johnson AFB Pharmacy’s general workflow and solidified our understanding of the issue at hand. We also began to present our MVP concept to our beneficiaries better align our solution concepts to needs of the consumers.

 

We quickly realized that our MVP from last week could better account for our beneficiaries’ wants and needs. First and foremost, we realized that a web-based, or even an app-based MVP, would pose too high of a barrier for patient beneficiaries to access. The technological literacy and hardware requirements were too high for the large proportion of patients who were retirees in their 60’s and 70’s. In addition, we also learned that the long wait times cause issues among waiting patients and requires significant amounts of manpower be used in addressing them. Taking this information into account, we modified our MVP: lowering our technological barrier to access and increasing the amount of communication and transparency between the pharmacy staff and patients. This updated MVP addresses the problem as we currently know it while also accounting for the traits and habits of our beneficiaries.

 

Beneficiaries:

[USAF]

Major Villalonga

– Issues worsened with move to new location with new computer systems and equipment.

– Issues include understaffing, the GSL system (is slow and difficult to teach volunteers to use), 7 different isolated computer systems, and small lobby (vs separate pharmacies for refills, AD/dependents, and others)

– GSL system helps to reduce medication errors by volunteers dispensing incorrect medications

 

Pharmacy Tech: SSGT Wray

– Rotate roles every 2 hours, alternating job types without repeating blocks; used to have a scanner, but retirees required guidance

– Challenges: understaffed (finally fully staffed in the last 3 months); IT problems (e.g. CHCS crashing, which prolongs delays, and each program requiring 2-3 monitors; inputting data is very slow); volunteers; new systems (CHCS and GSL are new since the move vs only Pharmassist before); officers are pulled to other duties/meetings elsewhere; some enlisted/NCOs do not show up for duty; GSL’s texting feature was not purchased

– Ideas: chatbot/automated texts

 

[Patients]

SSgt Ashley Torres (active duty)

– SJ has the longest wait time she has experienced; shortest 1h, longest 2h; bases overseas did not have veterans and had automated systems for patients to scan their tags

– Ideas: drive-through pharmacy for veterans and (Android) app to notify when med ready for pickup (vs the wait time)

 

David Gurley (retiree)

– Challenges: parking at the new location is worse than before and a much longer walk; e-prescriptions from on-base prescribers do not always make it to the pharmacy.

– Aware that meds can be mailed, but fills on-base because of habit, socialization, and it gives him an excuse to be on base again. The cost is also a barrier to some.

– Ideas: auto-SMS prescription status; explicitly/graphically depict the front-end pharmacy flow for patients so they know where to go and in what order; drive-through window like retail pharmacies; make information about busy/lull times available

 

TSgt Myron McElroy (active duty)

– Challenges: medications are often not ordered and Helicare (prescriber) system is unstable, so there is a mix of e-Rx and paper Rx, though the latter has been refused for filling at least once; check-in kiosk not reliable; even when the kiosk works, patients still have to check in at the window

– Ideas: notification when Rx is received and when med(s) is ready; [Android or iPad] app share information about (average) wait time

 

Joseph Wooten (Retiree)
– Experience: Fills meds 2-4pm, usually waits ~30 minutes; is understanding of active duty patients getting priority; would not get meds mailed because it requires using a computer, but would be ok with the cost for meds for which he already pays a copay
– To improve: informing patients of changes in estimated pickup dates when the pharmacy runs out of medications BEFORE patients show up at the pharmacy and wait in line to pick them up
– Ideas: automated phone call or mail

 

[Multiple roles]

Donna Martin (Patient and Volunteer)

– The check-in kiosk not working, window scanners not working, difficulty using (non-GSL) computer systems, and line extending to the clinic contribute to the wait time; patients also sometimes cut in line

– She has difficulty with the computer systems and with some people being notified that their meds are ready for pickup when they are actually not

– Many volunteers are new since the location move, as experienced ones quit

– Ideas: kiosk allowing selection of refill vs new fill (like at other bases); separate pharmacies for retirees and AD/families; scan ID into kiosk and verify ID on screen; automated text/call when prescription ready for pickup

 

[External]

Duke Outpatient Pharmacy Tech – Georgette

– Usual wait time for new Rx is 15-20 minutes

– Pharmacy well-manned with experienced staff who rotate duties daily and take the initiative to help smooth bottlenecks in flow.

– Pts can call in for refills – default 24h turnaround time; prescriptions are 90% electronic (rarely need to be fixed/edited), 8% hard copy (entered manually), and 2% faxed (entered manually).

– A limited number of people are assigned to fill controlled substances; counted twice; dispenses are additionally logged manually for accountability.

– New Rx: tech enters/verifies Pt info in system -> drug picked and scanned in to verify the NDC -> pills counted -> expiration date checked -> to pharmacist for verification of Pt info and sig

– Refills: tech prints a label, counts pills, and verifies the NDC; refills do not require any pharmacist intervention

 

Ashley Smith (Civ Pharmacy Technician) and Shannon Brewer (Civ Pharmacist)

– Adopted retail practice of patients lining up to only turn in prescriptions – takes ~5 minutes; active duty get priority (red bins); on-base prescriptions (white bins) filled before those received from off-base (usually handwritten Rx; yellow bins); different queue for Rx to be picked up the next day; separate lines for active duty and patients with disabilities; they have a drive-through open until 7pm; used to use QFlow, but now calculate wait times by hand

– Challenges: staffing levels have remained constant, though the base’s population has grown

– Patients prefer to drop Rx off and return later – no difference in their wait time

– Initiatives: trying to implement secure messaging so that people can queue through email instead of phone

 

Rachel Fefer (Mentor)

– She has TriCare, notes that army bases in DC do not have this issue, wonders why Seymour Johnson AFB does.

– She has many contacts who are experts in the military-healthcare field, including one at CRS who is an expert on military healthcare/TriCare

– Once we clarify what we aim to do, reconnect with her