Scripps Health desperately needed a cost-effective way to free its 200 internal medicine and family medicine physicians from the daily deluge of prescription refill requests that robbed them of time better spent with patients.
System leaders had considered hiring more staff. But adding 30 nurses to handle the work was prohibitively expensive.
Monica LaJoie, prescription refill center nurse manager at Scripps Health, decided to look at the problem from a different angle. She and a project manager began researching software programs that promised to boost refill workflow efficiency.
One of the firms that came to their attention was Healthfinch. The startup visited Scripps to do an in-house demonstration of Swoop, a software application that automates and streamlines prescription refill workflow. Swoop easily interacted with the health system's Allscripts electronic health record software. It worked behind the scenes without an interface.
After a refill is generated, Swoop picks up the task and checks the patient's last qualifying visit and labs. If the request is routine and doesn't require a physician's eyes, the app automatically routes it to a nurse or pharmacy technician. Swoop enabled the system to hire pharmacy technicians paid $20,000 to $25,000 less than nurses.
“Swoop was basically what we were looking for to minimize the staff needed to handle refill requests and to put context within that workflow,” said LaJoie.
Scripps's Prescription Refill Center went live with the application in August of last year. Since then, Healthfinch has boosted workflow efficiency and gotten provider buy-in. The clinic handles 46,000 prescriptions per month. “The application has been amazing — we see how efficient it is, and how fast we're refilling now,” LaJoie said.
Swoop also enabled LaJoie and her colleagues to identify bottlenecks in their workflow. By tweaking the protocol within Swoop, they reduced the turnaround time for refilling prescriptions to less than 24 hours. Ideally, the aim is an 8-hour turnaround time so patients can get their medication on the same day.
It took Scripps physicians some time to trust the new application. They had reservations about letting nurses and pharmacy technicians take over a portion of their medication approvals.
“We've been over a year now on Swoop, but it was rough in the beginning before getting provider buy-in,” she said. “Those who are not as open-minded to change are obviously going to be a challenge.”
To assuage those concerns, LaJoie and her colleagues created an orientation packet for providers that contained the biographies of every nurse and pharmacy technician in the program. They outlined the refill protocols that the doctors themselves had approved, and explained the audit process adopted to ensure staff followed the rules.
UT Southwestern Medical Center in Dallas had a similar concern with clinicians overburdened with refilling prescriptions – but in their case it involved nurses getting buried under piles of administrative busywork. System officials contacted Healthfinch after learning a former employee worked there.
“When Healthfinch showed us a demo, I was like, 'Shazam, this is awesome,'” said Stacey Clark, assistant vice president of ambulatory clinical operations and training at UT Southwestern. “Nurses spend hours on the chart to try and renew medication — when is the last time I saw this patient, did they get their labs done, etc. — and Healthfinch automates that process.”
The health system went live with Swoop for prescription refills in October 2015, initially rolling it out in its primary care and OB/GYN clinics. It plans to roll it out next in its specialty clinics, which have more complex medication protocols.
Transplant specialists and oncologists, for instance, prescribe numerous drugs at varying doses, depending on the specific needs of each patient. But that complexity also opens the door to unnecessary variation in prescribing patterns, which can result in suboptimal care. Besides expediting refills, Healthfinch can help physicians in highly complex fields by bringing greater standardization to each of their many care patterns.
Although workflow changes had to be made, Clark says Swoop's implementation received little pushback from staff. Training was minimal, too. Physicians and nurses began asking for other protocols to be added to the system.
“The biggest part is getting consensus from the providers because we've elected to go with clinic-level protocols rather than individual provider ones,” she said. “It has standardized the practice.”
Today, nurses are spending less time buried in patient records and more time with patients. UT Southwestern's nurse-related patient satisfaction scores have gone up since implementation of the program.
“Swoop has allowed us to spend more time teaching and doing more education to the patient, and that's what we were missing before,” said Clark.
Meeri Kim is a freelance writer based in Los Angeles.
