U.S. patent application number 11/959430 was filed with the patent office on 2009-02-12 for comprehensive medication management system.
This patent application is currently assigned to WALGREEN CO.. Invention is credited to Steve S. Dorfman, Gyula J. Nadas, Hee K. Oh, Laura J. Tebbe, Guirong Z. Webb.
Application Number | 20090043610 11/959430 |
Document ID | / |
Family ID | 40347363 |
Filed Date | 2009-02-12 |
United States Patent
Application |
20090043610 |
Kind Code |
A1 |
Nadas; Gyula J. ; et
al. |
February 12, 2009 |
COMPREHENSIVE MEDICATION MANAGEMENT SYSTEM
Abstract
A comprehensive medication management system is disclosed. The
comprehensive medication management system offers a number of
compliance related services that may be offered to patients in to
improve medication therapy compliance. The system identifies
compliance barriers facing individual patents and recommends
services designed to overcome those barriers. The system further
provides feedback to patients to document their progress. The
system proactively identifies patients who may benefit from
compliance services and blocks their transactions until the
services are explained. The point of sale block may be expanded to
other classes of patients so that the transactions of other classes
of patients blocked and other messages delivered or some other
customized interactions carried out. The medication management
system may serve as a central repository of information about a
patient's medication treatment program and the medication
management system may provide quick and easy access to a patient's
entire medication history to facilitate consultations between a
pharmacist and the patient. The medication management system may
generate lists of tasks for pharmacists to perform in order to
deliver the compliance related services to individual patients.
Inventors: |
Nadas; Gyula J.; (Wauconda,
IL) ; Oh; Hee K.; (Wilmette, IL) ; Tebbe;
Laura J.; (Lindenhurst, IL) ; Webb; Guirong Z.;
(Vernon Hills, IL) ; Dorfman; Steve S.; (Chicago,
IL) |
Correspondence
Address: |
FRANCIS C. KOWALIK;WALGREEN CO. LAW DEPARTMENT
104 WILMOT ROAD, M.S. #1425
DEERFIELD
IL
60015
US
|
Assignee: |
WALGREEN CO.
Deerfield
IL
|
Family ID: |
40347363 |
Appl. No.: |
11/959430 |
Filed: |
December 18, 2007 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60963871 |
Aug 7, 2007 |
|
|
|
Current U.S.
Class: |
705/3 ;
707/999.104; 707/999.107; 707/E17.009 |
Current CPC
Class: |
G06Q 10/06315 20130101;
G06Q 10/1097 20130101; G16H 20/10 20180101; G16H 10/20 20180101;
G06Q 50/00 20130101; G06Q 30/0201 20130101; G06Q 10/06311 20130101;
G06Q 30/0205 20130101; G06Q 10/063114 20130101; G16H 10/60
20180101; G16H 15/00 20180101 |
Class at
Publication: |
705/3 ;
707/104.1; 707/E17.009 |
International
Class: |
G06Q 50/00 20060101
G06Q050/00; G06F 17/30 20060101 G06F017/30 |
Claims
1. A comprehensive medication management system comprising: a
pharmacy workstation including a display, the pharmacy workstation
executing a web browser application configured to receive
medication management interface pages over a network and display
the received medication management interface pages on the display;
one or more databases storing patient medication management data;
and one or more back-end processors, the one or more back-end
processors executing a consultation manager application configured
to generate the medication management interface pages, the
medication management interface pages configured to guide a
pharmacist through a medication management consultation with a
patient, the one or more back-end processors further executing a
patient identification application configured to identify the
patient and populate the medication management interface pages with
patient-specific medication management data pulled from the one or
more databases, and a web server application configured to send the
medication management interface pages to the pharmacy workstation
over the network.
2. The comprehensive medication management system of claim 1
wherein the medication management interface pages comprise
suggested text for guiding a pharmacist through a consultation
session with a patient.
3. The comprehensive medication management system of claim 1
wherein the medication management interface pages provide
compliance service selection assistance services.
4. The comprehensive medication management system of claim 3
further comprising a rules engine executed by the one or more
back-end processors and configured to select compliance assistance
services to be recommended to a patient based on patient responses
to questions included on the medication management interface
pages.
5. The comprehensive medication management system of claim 1
wherein the medication management interface pages provide
medication therapy compliance feedback.
6. The comprehensive medication management system of claim 1
further comprising a personal medication record generator executed
by the one or more back-end processors, the personal medication
record generator configured to periodically generate a personal
medication record for a patient.
7. The comprehensive medication management system of claim 1
wherein the medication management interface pages comprise targeted
communications directed toward patients having one or more defined
characteristics.
8. The comprehensive medication management system of claim 7
further comprising an intervention engine executed by the one or
more back-end processors, the intervention engine configured to
identify patients having the one or more defined
characteristics.
9. The comprehensive medication management system of claim 1
wherein the medication management interface pages comprise a
consolidated patient data portal that displays patient data in
support of medication consultations with patients.
10. A comprehensive medication management system comprising:
Back-end systems including at least one processor and at least one
database, the back-end systems providing a plurality of medication
management services including at least one of: guided consultations
with a pharmacist; compliance-assistance services; selection
assistance services for choosing appropriate compliance assistance
services; compliance feedback reports; targeted patient
communications; a consolidated patient medication data portal; or
personal medication record services; and front-end systems
communicating with the back-end systems to provide an interface
with the medication management system.
11. The comprehensive medication management system of claim 10
wherein the front-end systems include a display configured to
display interface pages including suggested text for guiding a
pharmacist through a consultation session with a patient to
identify compliance barriers facing the patient and select
appropriate medication therapy compliance assistance services for
addressing the patient's compliance barriers.
12. The comprehensive medication management system of claim 11
further comprising a rules engine configured to identify medication
therapy compliance services to be recommended to the patient based
on patient responses to questions on a questionnaire included on
the interface pages.
13. The comprehensive medication management system of claim 10
wherein the front-end systems include a display configured to
display medication therapy compliance feedback.
14. The comprehensive medication management system of claim 13
wherein the medication therapy compliance feedback comprises a
printable document that may be given to a patient, the printed
document including a measure of the patient's compliance with the
medication therapy.
15. The comprehensive management system of claim 10 further
comprising a personal medical record generator executed by the
back-end systems, the personal medical record generator configured
to periodically generate a report detailing the patient's
medication history and current health status.
16. The comprehensive medication management system of claim 14
wherein the patient's personal medication record comprises a
printable document that may be given to the patient.
17. The comprehensive medication management system of claim 10
wherein the front-end systems comprise a display configured to
display targeted communications to select patients sharing a
specified characteristic.
18. The comprehensive medication management system of claim 17
wherein the one or more back-end processors is programmed to
execute an intervention engine to review patient characteristics
and identify patients having the specified characteristic.
19. The comprehensive medication management system of claim 10
wherein the front-end systems include a display to display
interface pages that comprise a consolidated patient medication
data portal whereby a pharmacist may access patient data to support
a patient consultation.
20. A system for providing comprehensive medication management
services, including medication consultation services,
compliance-assistance services, compliance-assistance service
selection services, compliance feedback services, personal
medication record services, and targeted patient communication
services, the system comprising: a database storing patient profile
and medication management data; one or more processors executing
medication management applications including a patient
identification module, a rules engine, an intervention engine, a
personal medication record generator, a pharmacy task list
generator, a consultation manager and a web server; and an
interface device configured to display interface pages and other
documents associated with the medication management services
received from the web server, the interface pages including patient
profile and medication data pulled from the database according to
the medication management applications executed by the one or more
processors.
Description
FIELD OF THE INVENTION
[0001] The present invention relates to a system for delivering
comprehensive medication management services to patients. An
embodiment a medication management system includes hardware,
software, and pharmacy workflows for identifying patients who may
benefit from medication management services, identifying the
medication management services most appropriate for individual
patients, providing medication therapy compliance feedback to
patients, and implementing reimbursable services on behalf of
stakeholders in the form of campaigns providing customized
interactions with targeted patients and documenting the
results.
BACKGROUND
[0002] Effective management of a patient's medication therapy is an
important factor in achieving successful treatment results. The
closer a patient adheres to his or her prescribed medication
treatment program, the more likely that the treatment will be
effective. Unfortunately, in many instances patients do not
adequately comply with their medication therapy programs. Poor
compliance with treatment programs can result in negative health
impacts for the patient as well as negative impacts on those who
have an interest in maintaining the patient's health.
[0003] In a typical medication therapy setting there is a number of
parties or stakeholders who have an in interest in achieving a
successful result. FIG. 1 is a diagram illustrating a number of the
stakeholders who may have an interest in a patient's successful
medication treatment outcome. At the center is the patient 10. No
stakeholder has a greater interest in an effective medication
treatment program than the patient 10. Many patients, such as
children or the elderly, may have a caregiver 12 who is responsible
for caring for them. A caregiver 12 may be responsible for
scheduling doctor appointments, transporting the patient to their
appointments, getting prescriptions filled, administering
medications, and so forth. The doctor 14 treating the patient 10
has a professional interest in the patient's health. The pharmacist
17 who fills the patient's prescriptions also has a professional
interest in serving the patient similar to that of the patient's
doctor 14. The pharmacy 16 that sells the patient his or her
prescribed medications has a business interest in continuing to
serve the patient. If the patient is covered by insurance or if the
patient is a member of a managed-care organization which pays for
some or all of the patient's medications, the insurance company or
managed-care organization 18 will have an interest in managing the
patient's medications and keeping costs down. At a further remove,
the pharmaceutical company 20 that manufactures the patient's
medications has an interest in continuing to sell medications to
the patient 10. Even more generally, pharmacy trade groups 22, such
as the American Pharmacists' Association, The American College of
Clinical Pharmacy and others, may have an interest in learning
about effective medication therapy management techniques, as well
as trends in the industry, successful drug treatments and the like.
Similarly, doctors, nurses, hospitals and other members of the
broader medical community 214 will have an interest in learning
about effective medication therapies, methods of keeping costs down
and improved treatment outcomes, as will public health
organizations 26 and government agencies 28 tasked with providing
health-related services.
[0004] Of the stakeholders identified in FIG. 1, only the caregiver
12, the doctor 14, the pharmacy 16 and perhaps the insurance
company or managed-care organization 18 are likely to have direct
contact with the patient 10. Nonetheless, other stakeholders may
wish to obtain data regarding the patient and the patient's
medication therapy program. Various stakeholders may also wish to
communicate important messages to individual patients regarding
their medication treatment programs. What is more, even though the
caregiver 12, the doctor 14, the pharmacy 16 and the even insurance
company/managed-care organization 18 may have somewhat regular
contact with the patient 10, the nature of the relationship with
the patient and the frequency of contact with the patient may vary
significantly for each entity. For example, the patient is unlikely
to discuss specifics of his or her treatment with the insurance
company 18. The doctor 14 prescribes the patient's medication but
may not have accurate information about the patient's compliance
with the prescribed medication therapy, and so forth. Thus, while
each stakeholder may be in a position to obtain a limited amount of
information about the patient 10 and the patient's medication
treatment program, the limited nature of the information results in
each party receiving only a partial view of what is actually taking
place with regard to the patient's medication therapy.
[0005] In many cases, data collected by or known by one stakeholder
may be highly valuable to one or more other stakeholders. For
example, once a patient's doctor 14 prescribes a specific
medication treatment, the doctor has no way of knowing how closely
the patient is adhering to the prescribed treatment regimen. The
pharmacy, on the other hand, is in a position to review the
patient's prescription fill history to determine whether the
patient has had enough medication on hand to comply with the
prescribed treatment program. Since a patient's failure to comply
with his or her doctor's prescribed treatment program could lead to
an unsuccessful result, which in turn could lead to a more serious
illness and more expensive treatments, many of the stakeholders
identified in FIG. 1 will have an interest in knowing whether the
patient 10 is complying with his or her prescribed medication
therapy.
[0006] Although there are many stakeholders who may have an
interest in a patient's medication therapy, a successful medication
management program must focus on the individual patient. Each
individual patient will have unique circumstances that define the
medication management issues facing that patient. For example, some
patients may have a very complicated medication regimen that is
difficult to keep track of and which is nearly impossible to follow
without fault. Other patients may have a nonchalant attitude toward
their medication which may cause them to frequently miss doses.
Still other patients may not have the financial resources to cover
the costs of their medications. Some treatments may require
frequent tests to ensure the efficacy of the treatment or to detect
the presence of adverse side effects. A medication management
system must be capable of dealing with all of these factors and
more in order to deliver all of the services necessary to help
patients manage their medications.
[0007] A medication management system is desired that will take
into account all of the unique circumstances facing individual
patients and provide services uniquely tailored to meet each
patient's needs. Such a medication management program must be
scalable to meet the individualized needs of hundreds of thousands
or even millions of individual patients. Further it is desired that
a medication management system may serve as a central repository
for information regarding patients and their medication treatment
programs. This information may be collected and presented in ways
that will help improve patient compliance with their medication
treatment programs and facilitate the delivery of compliance
related services. It also desired that a medication management
system provide a mechanism for identifying patients who may benefit
from compliance related services and communicating the availability
of such services to such patients. It is also desirable to identify
other classes of patients in order to deliver special messages or
have other customized interactions with the members of such classes
of patients on behalf of various stakeholders having an interest in
the various patients' treatment outcomes.
SUMMARY
[0008] The present invention provides a comprehensive medication
management system. The comprehensive medication management system
offers a number of different compliance related services that may
be offered to patients in order to improve compliance with their
individual medication therapy programs. The medication therapy
system helps to identify the personal compliance barriers facing
individual patients, and recommends compliance services that are
best suited for overcoming a patient's personal compliance
barriers. The medication management system further provides
feedback to patients to document how their compliance has improved
(or not) as a result of the compliance services they are receiving.
According to an embodiment, a medication management system may be
expanded to provide reimbursable cognitive services to third party
stakeholders. Reimbursable cognitive services may include
medication therapy management (MTM); insurance benefits
communication services; quality assurance programs; medication
safety, efficiency and appropriate usage programs; and medication
adherence and persistence programs; among others. An embodiment of
a medication management system actively identifies patients who may
benefit from compliance services and blocks transactions with such
patients at the point of sale until a consultation takes place
between a pharmacist and the patient in which the benefits of the
compliance related services are explained to the patient. The point
of sale block may be expanded so that other classes of patients may
be identified and their transactions blocked at the point of sale
until some other message is delivered or some other customized
interaction with the patient takes place. The expanded point of
sale blocking feature may be used to implement reimbursable
campaigns on behalf of third party stakeholders to reach targeted
patients. For example, a third party stakeholder may be willing to
pay for a particular message to be delivered to all of a pharmacy's
patients taking a certain medication, or to gather information from
patients about side effects or some other subject related to their
medication therapy.
[0009] A medication management system may serve as a central
repository of information about a patient's medication treatment
program. The medication management system may provide quick and
easy access to a patient's entire medication history to facilitate
a consultation between a pharmacist and the patient. Additionally,
the medication management system may generate lists of tasks for
pharmacists to perform in order to deliver the compliance related
services that have been offered to individual patients.
[0010] Other systems, methods, features and advantages of the
invention will be, or will become, apparent to those skilled in the
art upon examination of the following figures and detailed
description. It is intended that all such additional systems,
methods, features and advantages included within this description
be within the scope of the invention.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] FIG. 1 is a diagram illustrating the various stakeholders
having an interest in a patient's medication therapy outcome.
[0012] FIG. 2 is a diagram illustrating the communication paths
established between the various stakeholders having an interest in
a patient's medication therapy outcome and the patient according to
an embodiment of a medication management system.
[0013] FIG. 3 is a block diagram of an embodiment of a medication
management system.
[0014] FIG. 4 is a flow chart showing the process flow of a patient
consultation with a pharmacist for purposes of identifying
appropriate compliance services recommendations for the
patient.
[0015] FIG. 5 is a screen shot of a patient look-up user interface
page.
[0016] FIG. 6 is a screen shot of a patient contact information
user interface page.
[0017] FIG. 7 is a screen shot of a patient questionnaire user
interface page.
[0018] FIG. 8 is a screen shot of a first service maintenance user
interface page.
[0019] FIG. 9 is a screen shot of a second service maintenance user
interface page.
[0020] FIG. 10 is a sample medication management printed solutions
guide.
[0021] FIG. 11 is a is a sample patient compliance report card.
[0022] FIG. 12 is a sample medication manager chart.
[0023] FIG. 13 is a sample personal medication record (PMR).
[0024] FIG. 14 is a flow chart showing the process flow for
defining a targeted campaign for identifying and interacting with
patients.
[0025] FIG. 15 is a screen shot of a campaign editing user
interface page.
[0026] FIG. 16 is a screen shot of a campaign specification user
interface page
[0027] FIG. 17 is a is a screen shot of a campaign component
transition definition user interface page.
[0028] FIG. 18 is a is a screen shot of a campaign information
page.
[0029] FIG. 19 is a screen shot of a campaign question set
page.
[0030] FIG. 20 is a screen shot of a campaign thank you page.
[0031] FIG. 21 is a screen shot of a user interface page including
a consolidated patient profile view.
[0032] FIG. 22 is a screen shot of a full screen patient profile
user interface page showing a list of patient interactions.
[0033] FIG. 23 is a screen shot of a full screen patient profile
user interface page showing a list of drugs that have been
prescribed to a patient.
[0034] FIG. 24 is a screen shot of a full screen patient profile
user interface page showing a list of a patient's current allergies
and health conditions.
[0035] FIG. 25 is a screen shot of a full screen patient profile
user interface page showing a list of services a patient is
currently receiving.
[0036] FIG. 26 is a screen shot of a pharmacist task list interface
page.
DETAILED DESCRIPTION
[0037] The pharmacy is a significant point of contact between
patients and the health-care industry. The present medication
management system leverages this relationship to provide additional
services to patients for helping the patients manage their
medication treatment programs. The pharmacy helps monitor the
patient's compliance with his or her medication therapy and
provides services for helping patients improve compliance. The
medication management system opens lines of communication that run
through the pharmacy allowing various stakeholders to interact with
patients in a manner previously unavailable.
[0038] For purposes of the present disclosure, the pharmacy may be
any of the outlets through which the entity implementing the
present medication management system sells prescription medications
to patients. For example, the pharmacy may comprise a single
independent drug store or any one of a number of branch stores in a
large drugstore chain. The pharmacy may also be or include a
mail-order or on-line pharmacy, and one or more specialty
pharmacies dealing in rare expensive medications or drugs that
require special administering procedures. Typically, the pharmacy
will have a direct relationship with a very large number of
patients. Because of the direct relationship between the pharmacy
and such a vast pool of individual patients, the pharmacy is
ideally placed to provide a number of medication therapy management
services of significant value to both the patients and various
stakeholders in the medical services delivery community.
[0039] FIG. 2 illustrates the relationships between the various
stakeholders and the patient according to an embodiment of a
comprehensive medication management system. The medication
management system is patient-centric. The medication management
system builds on the direct relationship between the pharmacy 16
and individual patients 10 who purchase their medications from the
pharmacy 16. Communications between the various stakeholders,
including the doctor 14, the insurance/managed-care provider 18;
drug manufacturers 20; pharmacy trade groups 22; the larger medical
community 24; public health organizations 26; government agencies
28, and the patients 10 are all routed through the pharmacy 16. In
cases where a caregiver 12 is present, communications with the
patient may be routed through the caregiver 12. Of course, various
stakeholders may have additional communications with patients
outside the present system (for example, it is assumed that
patients will continue to visit their doctors and that important
information about the patient's health will be exchanged at those
visits), however, within the context of managing the patient's
medication therapy through the present medication management system
the primary point of contact with the patient 10 is through the
pharmacy 16. The various stakeholders may communicate messages to
individual patients through the pharmacy 16 and the pharmacy 16 may
forward appropriate medication management data back to the various
stakeholders. (Appropriate medication management data that may be
communicated back to the various stakeholders may include, for
example, non-patient specific information, information that an
individual patient has agreed may be sent to a specific
stakeholder, and so forth. In no circumstances should confidential
patient information be sent from the pharmacy 16 to an outside
party without the patient's authorization.) Routing communications
between the various stakeholders and the patients through the
pharmacy 16 allows the pharmacy to control what and how information
is passed on to the patient. The pharmacy 16 may create a
standardized and systematic approach toward patient communication
that ensures that a consistent unified message is delivered to the
patient.
[0040] FIG. 3 shows a block diagram of the architecture of an
embodiment of a medication management system 100. The systems and
processes implemented by the medication management system 100
facilitate the development of individualized medication management
programs specially designed to meet the needs of individual
patients. Nonetheless, the medication management system 100 may be
implemented on a scale that allows any number of individual
patients to be enrolled in the medication management system 100.
The high-level architecture includes both hardware and software
applications, as well as various data communications channels for
communicating data between the various hardware and software
components. The medication management system 100 may be roughly
divided into front-end components 102 and back-end components 104.
The front-end components 102 comprise the hardware and software
components associated with a pharmacy's sales outlets. For example,
a pharmacy may include a number of retail branch stores 144, an
on-line pharmacy 146, a mail order pharmacy 148 and a specialty
pharmacy 149. The front end components 102 may comprise the
hardware and software applications found in each of the pharmacy's
retail outlets.
[0041] The retail branch stores 144 may include one or more
pharmacy workstations 132. The pharmacy workstations 132 may
include software applications for managing pharmacy operations,
including filling patient prescriptions, and the like. The pharmacy
workstations 132 may also include software applications for
implementing the present medication management systems. Each store
may also include one or more point of sale (POS) terminals 138 for
performing cash register functions and certain medication
management functions associated with the medication management
system 100, as will be described. The POS terminal 138 may include
an LCD 140 or other display device for displaying messages to the
pharmacist or other pharmacy personnel. (For the remainder of the
present disclosure all pharmacy personnel will be referred to as
"the pharmacist" even though various tasks within the pharmacy may
be performed by personnel who are not registered pharmacists but
who operate under a pharmacist's supervision.) The POS terminal may
also include a bar code reader 142 for reading bar codes on product
packaging and the like. The individual pharmacy workstations 132
and the POS terminals 138 at a particular store may be connected to
an in-store local area network 134. The local area 134 network may
include an application server 136 which communicates with the
backend systems 104 over a wide area network 130. A similar
arrangement may be found in the pharmacy's other divisions such as
an on-line pharmacy 146, a mail order pharmacy 148, a specialty
pharmacy 149, or the like. The wide area network 130 may be a
proprietary network, a secure public internet, a virtual private
network or some other type of secure network.
[0042] The backend components 104 include medication management
central processing systems 106 and legacy systems and services 150.
The legacy systems and services 150 may include a pharmacy's
existing hardware and software systems associated with the delivery
of pharmacy services to patients. For example, the legacy systems
150 may execute software applications supporting pharmacy
operations, including filling patient prescriptions, keeping track
of patients' fill histories, and the like. The legacy systems 150
may also provide ad hoc medication management services that may be
integrated into the comprehensive medication management system 100.
The legacy systems 150 may include legacy data stores 152 for
storing patient information such as the patient's name, address,
phone number, insurance carrier, prescription history, and the
like, for all patients who have purchased prescription medications
from the pharmacy 16.
[0043] The medication management central processing systems 106 may
include one or more computer processors adapted and configured to
execute a number of software applications and other components of
the medication management system 100. The central processing
systems 106 also include a medication management transactional
database 108. The medication management transactional database 108
is adapted to store patient data related to the operation of the
medication management system 100. The various applications executed
by the central processing systems 106 may retrieve data from and
write data to the transactional database 108 and the legacy data
stored 152. The applications executed by the central processing
systems 106 include a central processing web server 112 and a
consultation manager 110. The consultation manager 110 is a
web-based tool that assists pharmacists in conducting compliance
consultations with patients. The consultation manager 110 interacts
with other software components of the medication management system
executed by the central processing systems 106 and generates web
based interface pages that are distributed to pharmacy workstations
132 by the web server 112 in response to specific URL requests from
the pharmacy workstations 132. The central processing systems
further include a patient identification module 114; a rules engine
116; an intervention engine 120; a patient medical record generator
122; and a task list generator 124.
[0044] Each pharmacy workstation 132 includes a web browser
application. The web pages served by the web server 112 are
displayed by the web browser applications on the pharmacy
workstations 132, providing a graphical user interface by which
pharmacists may interact with the medication management system 100.
The various web pages forming the user interface may include data
pulled from both the medication management transactional database
108 and the legacy data stores 152. The various software
applications executed by the central processing systems 106 are
responsible for gathering the appropriate data and generating the
content included in the user interface pages sent from the web
server 112 to the various pharmacy workstations 132. The software
applications may be executed on the same computer processor as the
web server application 112 or on different computer processors.
Furthermore, the medication management system 100 may also rely on
software applications executed by legacy systems 150 when legacy
software applications provide services and other functionality that
are incorporated into a comprehensive medication management
program.
[0045] As mentioned, the consultation manager 110 is a web based
tool for assisting pharmacists in conducting consultations with
patients for determining which compliance services should be
recommended to individual patients. The patient identification
module 114 performs a look-up function for identifying patients who
contact the pharmacy and accessing their records and personal data.
The rules engine 116 is an application designed to identify the
most appropriate services to be recommended to patients based on
the patient's answers to questions posed by the pharmacist during a
consultation session. The personal medical record (PMR) generator
122 pulls together patient data from multiple different data
sources in order to generate a comprehensive view of a patient's
medical profile. The data collected by the generator 122 may be
used to support a PMR service in which a patient is provided with a
printed version of their PMR each time they have a prescription
filled.
[0046] The intervention engine 120 defines rules for identifying
patients to be blocked at the point of sale when they have their
prescriptions filled. Patients may be blocked at the point of sale
so that some action relating to their medication therapy may be
taken before the transaction is complete. The action to be taken
may compromise delivering a message to the patient, scheduling a
consultation or some other type of appointment, asking questions
and getting feedback from the patient, or the like. When a patient
is blocked at the point of sale, the transaction may not be
completed until the particular task is completed. Finally, the task
list generator 124 is responsible for generating lists of tasks to
be performed by pharmacists at various facilities operated by the
pharmacy 16. Tasks may include contacting individual patients who
have signed up for personal refill reminders, preparing
automatically refilled prescriptions, scheduling patient
consultations, and the like.
[0047] The medication management system back-end systems 104 may
further include one or more administrator workstations 160. An
administrator workstation 160 allows an authorized user (an
administrator) to access the various applications running on the
central processing systems 106 to alter or adjust the operation of
the medication management system 100. For example, one or more
stakeholders 162 may wish to institute an educational campaign in
which they deliver an educational message to a certain class of
patients. The stakeholders 162 may contact the administrator and
describe the various characteristics of the patients the
stakeholder would like to reach. The administrator may then access
the central processing systems 106 via the administrator
workstation 140 and alter the rules implemented by the intervention
engine 120 for identifying patients who are to be blocked at the
point of sale when their next prescription is filled.
Alternatively, various processes may be automated such that the
stakeholders 162 may define their own set of intervention rules or
provide their own list of patients who are to be contacted during a
campaign.
[0048] A patient profile may be created for every patient
participating in a medication management program. A patient profile
is an assemblage of all of the data related to managing the
patient's medication therapy. Patient profiles may be created by
the pharmacy's legacy systems 150 and stored in the legacy data
stores 152, with associated medication management data stored in
the medication management transactional database 108.
Alternatively, the patient profiles may be created as needed in the
central processing systems 106 from data pulled from both the
legacy systems data stores 152 the central processing systems'
transactional database 108. For example, the central processing
systems 106 may pull basic patient information, such as the patient
name, address, phone number, insurance group number, prescription
fill history, and the like from the legacy systems data stores 152.
Additional data relating specifically to the patient's medication
management program such as the services the patient is currently
receiving, the patient's consultation history, messages to be
conveyed to the patient, status and alert flags, and other data may
be pulled from the medication management transactional database
108.
[0049] An important component of an effective medication management
program is compliance. The overarching goal of any medication
management program is to ensure that patients are consistently
taking their medications as prescribed by their doctors. When a
patient is not complying with his or her medication therapy the
reasons for the patient's non-compliance must be determined so that
corrective steps may be taken. There are many different factors
that may impact an individual patient's compliance with his or her
medication therapy. Sorting out a complex medication regimen and
adhering to it can be a significant barrier. Patients taking
several different maintenance medications may have difficulty
keeping track of which medications they have already taken, when
different medications are supposed to be taken and so forth.
Another compliance barrier may be cost. If a patient is uninsured
or is having difficulty meeting his or her co-payment requirements,
compliance may suffer. Indifference may also be a factor. A patient
may not believe that strict adherence to his or her prescribed
treatment plan is important and may inadvertently miss doses out of
sheer apathy. These are but a few examples of the many different
factors that may impact an individual's compliance with his or her
medication therapy.
[0050] A pharmacy may implement services designed to help
individual patients improve compliance with their medication
therapies. Such services may be introduced on an ad hoc basis or as
part of a comprehensive medication management program. A
comprehensive medication management program may include
implementation of a medication management system such as the
medication management system 100 shown in FIG. 3. A comprehensive
medication management program may incorporate a pharmacy's existing
compliance related services as well as those made available only
through the medication management system 100. Compliance related
services may include automatic prescription refills for maintenance
medications (Auto-Refill); regularly scheduled patient
consultations with a registered pharmacist; preparing customized
dose charts indicating when each dose of a patient's medications is
to be taken; express payment services for automatically charging
prescription charges to a patient's credit card or other account
(Express Pay); pill-box services for helping patients organize
their medications, including electronic "smart pill boxes"; special
compliance packaging where all of a patients medications are
packaged in combined multi-dose packets; pill box counseling;
special re-fill reminders printed on medication labels; a
prescription ready and refill reminder alert service for informing
patients when their prescriptions are ready and when their
prescriptions are due to be refilled (prescription refill reminder
and prescription ready messages may include text messages, email
messages, personal calls from a registered pharmacist, automated
calls, or calls from a central call center); a redirect service to
redirect reminder messages to a designated caregiver; a discount
program in which qualified patients can sign up for prescription
discounts; a frequent prescriber program; a script alignment
service for patients taking multiple medications so that all of
their prescriptions may be filled at the same time to avoid
multiple trips to the pharmacy; a health information card, and so
forth.
[0051] Auto refill is a service provided for patients whose
maintenance medications must be refilled on a periodic basis. The
pharmacy's legacy systems 150 keep track of each patient's
prescriptions and when they are due to be refilled. The legacy
systems 150 may perform a batch process on a periodic basis to
review the prescription records of all of the pharmacy's patients
who have signed up for the auto-refill service to determine which
prescriptions must be refilled during an upcoming period. For
example, a batch process may be performed every weekend to
determine which prescriptions are due to be refilled during the
upcoming week. The prescriptions that must be filled during the
upcoming period are assigned to various pharmacists who are tasked
with preparing the various prescriptions. When the refill
prescriptions are ready the patients may be contacted over one or
more preselected communication channels to notify them that their
prescriptions are ready to be picked up. For example, patients may
be notified by e-mail message, SMS text message, automated phone
message, a telephone message from a live agent at a central call
center, or a telephone message from a pharmacist at the nearest
branch store where the patient can pick up his or her refilled
prescription. Alternatively, the refilled prescription may be
delivered directly to the patient.
[0052] A similar refill reminder service may be available for
patients who opt not to participate in the auto-refill service, or
whose insurance plan does not allow automatic refills, or who live
in states where automatic refill services are prohibited. Like the
auto-refill service, a batch process may be performed on a regular
basis to identify patients who have prescriptions that are due to
be refilled during an upcoming period. Reminder messages may be
sent to the identified patients over designated communications
channels. Again, refill reminder messages may be sent via e-mail or
SMS text message, an automated telephone message, a telephone call
from a live agent at a central call center, or a live message from
a pharmacist at the branch store in the patient's neighborhood.
Refill reminder messages may be provided on a number of different
occasions. For example, reminder messages may be sent proactively
or retroactively. A proactive refill reminder may be sent to the
patient several days (e.g., 3 days) before a prescription is due to
be refilled. A retroactive reminder message may be sent if a
prescription refill is several days overdue (e.g., 7 days). Another
reminder message could be sent mid-way through a patient's
medication therapy, reminding the patient to complete the entire
course of treatment to ensure the best treatment results.
[0053] Compliance packaging is a service that can help patients
follow a complex medication regimen. Multiple medications that must
be taken together at the same time of day may be packed together in
individual packets. For example consider a patient taking three
separate medications. The instructions for taking the first
medication are to take one pill three times daily. The instructions
for taking the second medication are to take one pill twice daily.
The instructions for taking the third medication are to take one
pill once a day. The patient's medication may be packaged in
morning, afternoon, and evening packets. A morning packet may
include one pill each of the first and second medications. The noon
packet may contain one pill each of the first and third
medications. The evening packet may again contain one pill each of
the first and second medications. Individualized compliance
packaging can be implemented to conform specifically to an
individual patient's medication regimen.
[0054] A medication manager service may provide a patient with a
weekly or monthly dose chart. Each day represented on the chart may
include a check box for each dose of the patient's medication that
the patient must take during the course of the day. The patient may
keep track of his or her medication by checking off the appropriate
check box each time he or she takes a dose of his or her
medication.
[0055] A pill box training service may be offered to patients to
provide counseling for setting up their own pill box system. Such
counseling may be provided face-to-face by a registered pharmacist
and may be customized specifically to the patient's particular
medication regimen. Alternatively, special face-to-face counseling
sessions may be mandated for all first time fills on maintenance
medications and on the first refill.
[0056] A prescription alignment service may be provided so that all
of a patients prescriptions are arranged so that they will all come
due for a re-fill at substantially the same time. Upon implementing
the script alignment service, a patient may receive a reduced fill
on some medications so that all of his or her medications will
become due on the same date. Once this "alignment" date has been
reached, all of the patient's prescriptions may be filled on the
same day with the same number of days' supply of each medication so
that each prescription will again come due for a refill on the same
date thereafter. The alignment date may be determined by the date
that is the earliest that all medications may be aligned, or a date
may be chosen that would incur the least co-payment liability based
on the patient's insurance plan. Alternatively, some custom
alignment plan may be devised.
[0057] A frequent prescriber plan may be instituted to help defray
the cost of prescription medications. Under such a program each
prescription refill may be recorded. After a certain number of
refills (e.g., 10 or 11) the next refill may be subsidized by the
pharmacy, or the pharmacy may cover the cost up the patient's
insurance co-payment, or some other cost savings measure may be
implemented.
[0058] According to other compliance enhancement services, special
refill reminders may be printed on the labels of maintenance
medications. A redirection of reminder service may redirect
automated or personal reminders from the patient to a designated
caregiver, either temporarily or permanently. Electronic pill
counters or electronic pill boxes may be issued to patients to
further assist them in keeping track of their medications.
[0059] These are but a sampling of the types of compliance related
services that may be offered by a pharmacy as part of a
comprehensive medication management program. Other compliance
services may be included in addition to or instead of those
mentioned above in order to provide a comprehensive medication
management program that meets the needs of the pharmacy's
patients.
[0060] Since each patient faces different compliance barriers, the
appropriate services for improving a patient's compliance will
differ from one patient to another. Therefore, a first step in
creating an individualized medication management program is to
determine exactly what are the most significant compliance barriers
facing the patient. Only after a patient's compliance barriers are
known may the appropriate services be suggested for overcoming
those barriers.
[0061] According to an embodiment of a medication management
system, a patient's participation in a medication management
program begins with a consultation between the patient and a
registered pharmacist. The purpose of the consultation is to
identify the patient's personal compliance barriers and to select
those pharmacy services most likely to help the patient surmount
those barriers. According to the medication management system 100,
the consultation manager 110 provides a web based tool to assist
the pharmacist in conducting the initial compliance consultation.
The consultation manager records the results of the consultation
and recommends appropriate services for improving the patient's
overall compliance. The consultation manager may also take steps to
implement the various compliance services that have been agreed
upon between the pharmacist and the patient during the
consultation.
[0062] FIG. 4 is a flowchart showing the process flows for
selecting pharmacy services for a patient enrolling in a medication
management program. The process begins at 200 when the patient
learns of the program and visits or otherwise contacts the
pharmacy. The patient may learn of the program through advertising,
on the recommendation of their doctor, through word of mouth, and
the like. Alternatively, the pharmacy may make the determination
that the patient would benefit from compliance services and may
recommend the medication management program to the patient when the
patient visits the pharmacy to have his or her prescription filled.
In any case, when the patient expresses an interest in enrolling in
the medication management program, the pharmacist accesses the
medication management system at 202 using a pharmacy workstation
132. When first accessing the medication management system the
pharmacist is presented with a login screen at 204. The pharmacist
enters an appropriate login name and password, or performs some
other identity authentication process. If the pharmacist's login
attempt is determined to be unsuccessful at 206 process flow
returns to 204 where the login screen is again displayed by the
pharmacy workstation's web browser and the pharmacist can continue
to enter a login name and password until the pharmacist's login is
successful. Once the pharmacist successfully logs onto the system
the process flow moves on to 208.
[0063] At 208 the medication management web server 112 sends a
patient inquiry page to the pharmacy workstation 132. A sample
patient inquiry page 250 is shown in FIG. 5. The patient inquiry
page 250 includes a number of search fields such as phone number
252, birth date 254, first name 256, middle initial 258, and last
name 260 that can be used to search for the patient's profile. The
patient inquiry page 250 further contains a button 264 for
registering a new patient and a button 266 for printing a generic
patient questionnaire. If at any time during the consultation
process the patient does not want to continue the consultation, the
pharmacist may select the Print Blank Questionnaire button 266 to
print a paper version of a patient questionnaire as indicated at
244 in FIG. 4. The questionnaire may be given to the patient who
may fill out the questionnaire and return it to the pharmacy at a
later time rather than continuing the face-to-face consultation
with the pharmacist. Otherwise, the pharmacist may perform a
patient lookup at 210 by entering the appropriate data into one or
more of the patient search fields of the patient look up page 250.
The data entered in various search fields are sent back to the
central processing systems 106 where the patient identification
module 114 searches the legacy data stores 152 for patient profiles
that match the entered search criteria. Patient's whose profile
data meet the search criteria are sent back to the pharmacy
workstation 132. Search results 268 are shown in the bottom half of
the patient inquiry page 250.
[0064] If, upon an initial search, the patient's profile does not
appear in the search results 268, the pharmacist may alter the
search criteria at 214 in a continued effort to locate the
patient's profile. If the patient's profile still cannot be found,
it is likely that the patient is a new patient who has never been
registered with the medication management system 100 or with the
pharmacy's legacy systems 150. In this case the pharmacist may
select the Register New Patient button 264 to initiate the process
of registering the new patient. Selecting the register new patient
button 264 causes the medication management web server 112 to send
a new patient registration page to the pharmacy workstation 132 to
be displayed for the pharmacist. A sample new patient registration
page 280 is shown in FIG. 6. The new patient registration page 280
includes a plurality of blank data fields for entering new patient
data. For example, the new patient registration page 280 includes
fields for entering the new patient's name (first 282, middle
initial 284, last 286, and suffix 288); the patient's sex 290;
phone number 292; birthdate 294; email address 296, and mailing
address (street address 298, zip code 300, city 302 and state 304).
The pharmacist enters the patient's data and selects the continue
button 306. The new data is sent back to the central processing
systems 106 where a new patient profile is created and stored in
the legacy data stores 152. Once the new patient has been
registered at 212, the process moves on to 222 where the pharmacist
begins the patient consultation.
[0065] Returning to 210, if the patient profile is found in the
search results list 268 on the patient inquiry page 250, the
process moves on to 216 where the pharmacist verifies the profile
information with the customer and selects the appropriate patient
profile from the search results list 268. The patient's profile
data are displayed on the pharmacy workstation 132. At 218 a
determination is made whether the information in the patient
profile is up to date. If the customer information is up to date at
218, the process moves on to 222. If the customer information is
not up to date, the pharmacist updates the patient information at
220 before the process moves on to 222.
[0066] The patient consultation begins in earnest at 222. The
consultation comprises a series of guided questions that the
pharmacist asks the patient in order to learn what are the most
significant compliance barriers facing the patient. The patient may
answer the questions according to a sliding scale such as the 7
point readiness ruler commonly used in the pharmacy industry. Using
the 7 point readiness ruler, a patient answers each question with a
number from 1 to 7. A lower number represents a less significant
compliance barrier and a higher number represents a more
significant compliance barrier. Other scales such as a 1-5 point
scale or a 1-10 point scale may be employed if more or less
resolution in the patient's answers is desired. The set of
questions posed to the patient may be dynamic in nature, in that
the questions asked during the course of the consultation may
depend on answers the patient has given to earlier questions. The
questions that the pharmacist asks during the consultation are
generated by the consultation manager 110 and are sent to the
pharmacy workstation 132 by the medication management web server
112 where they are displayed for the pharmacist by the pharmacy
workstation's web browser. FIG. 7 shows a sample user interface
page 320 including a portion of the question set that the
pharmacist asks the patient during the course of a patient
consultation. The user interface page 320 includes a short
introductory paragraph 322 that the pharmacist may read to the
patient explaining how the consultation will proceed. A first group
of eight questions 324 is shown in the sample interface page 320.
Each question has a corresponding response scale 326. The
pharmacist reads each question to the patient and asks the patient
to respond with a number from 1-7. The pharmacist records the
patient's responses by selecting the appropriate radio button in
the corresponding response scale 326. The user interface page 320
further includes a Continue button 328 a Print Blank Questionnaire
button 330, a Back button 332 and a Cancel button 334. When the
pharmacist selects the Continue button 328, the patient's responses
to the questions 324 listed on the user interface page 320 are sent
by the pharmacy workstation 132 back to the web server 112 over the
network 130. The consultation manager 110 records the patient's
answers in the transactional database 108 and they become part of
the patient's profile. Selecting the Print Blank Questionnaire
button 330 again causes the pharmacy workstation 132 to print a
blank version of the initial consultation questionnaire which the
patient may take home and complete and return to the pharmacist at
a later time. Upon receiving the completed questionnaire, the
pharmacist may enter the patient's answers into the user interface
pages associated with the initial consultation in order to record
the patient's responses. The Back button 332 returns the interface
to a previously displayed page without recording the patients
responses to the questions 324. Finally, the Cancel button 334 is
provided for ending a consultation if the patient decides not to
continue. Selecting the cancel button 334 may return the pharmacist
to the patient look up page 250 (FIG. 5) or some other interface
page.
[0067] Returning to FIG. 4, if at any time during the consultation
222 the patient does not want to continue, the pharmacist may print
a blank questionnaire to be given to the patient at 244.
Alternatively, if the patient does not want a copy of the
questionnaire, the pharmacist may simply cancel the consultation
without printing the questionnaire. However, if the patient and
pharmacist complete the questionnaire, the patient's responses are
recorded at 226 and the rules engine 116 proceeds to determine the
compliance services best suited for improving the patient's
compliance.
[0068] The rules engine 116 maps the questions from the patient
questionnaire to various compliance services offered by the
pharmacy. The rules engine 116 takes into account the patient's
answers to each question (1-7 on the readiness scale) as well as
the clinical significance of the services to which each question is
mapped. For example, assume that a first question maps to a first
service, and a second question maps to a second service. If the
patient answers the first question with a higher number on the
readiness scale than the second question, the first service to
which the first question is mapped will take precedence. However,
if the patient answers both questions with the same number, the
clinical significance of each service is considered. If the second
service has a higher clinical significance, the second service
prevails. Alternatively, each question may be weighted. In this
case, the patient's numeric response to a question and the
question's weight may be considered in determining the significance
of the service to which a question is mapped. For example, if a
first question has a weight of 2 and a second question has a weight
of 3 and the patient responds to each question with a 5, the
weighted response to the first question is 10 and the weighted
response to the second question is 15, then the service to which
the second question is mapped will be given greater
significance.
[0069] The rules engine 116 may include an exclusion filter 118
which identifies services that are not available for certain
patients. A particular insurance plan may not support one or more
services offered by the pharmacy. Some states may not allow certain
services (such as Auto-Refill for example). Only certain drugs may
be eligible for some services. Services should not be offered to
patients living in states in which the services are prohibited, or
to patients whose insurance plans will not allow the services, or
if the patient's medication is not on the list of eligible drugs
for a particular service. Once the services have been ranked
according to the patient's responses to the questions on the
questionnaire and their clinical significance, they are run against
the exclusion filter. The exclusion filter will block services from
being recommended to the patient if the patient belongs to an
insurance plan that disallows the service, or if the branch store
is located in a state that prohibits the service, or if the
patient's profile indicates that the patient lives in a state that
prohibits the service, or if the patient's medication is not on the
list of drugs eligible for the service. Those services that are not
excluded may be recommended to the patient. Preferably only a
limited number of services will be recommended to the patient. For
example, perhaps only the 2 or 3 highest ranking services not
blocked by the exclusion filter may be recommended to the patient
by the rules engine 116.
[0070] Once the rules engine 116 has determined which compliance
services are most appropriate for the patient, the consultation
manager 110 generates a service maintenance page. The web server
112 forwards the service maintenance page to the pharmacy
workstation 132 where it is displayed by the pharmacy workstation's
web browser. FIG. 8 shows an example of a first service maintenance
page 340. The service maintenance page 340 includes a list 342 of
the compliance services recommended for the patient and a list 344
of services that the patient is already actively receiving. The
service maintenance page 340 further includes an Activate Now
button 346 by which the pharmacist may activate the recommended
services on behalf of the patient. A Save For Later button 348
saves the patient recommendations but does not activate the
recommended services. When the pharmacist selects the Save For
Later button 348, a pharmacist may retrieve the patient
recommendations and activate the services, or change the
recommendations at a later time. A Make Change button 350 accesses
a second service maintenance page in which the pharmacist may make
changes to the services that will be activated on the patient's
behalf. Finally, a Reprint Guide button 352 allows the pharmacist
to reprint the patient's medication management solutions guide once
the final set of compliance services has been selected and the
services activated for the patient.
[0071] FIG. 9 shows an example of a second service maintenance page
360 for changing a patient's compliance services selections. The
second service maintenance page 360 includes a list of active
services 362 and a list of the other compliance services 364
offered by the pharmacy. Check boxes are provided adjacent each
listed service for selecting or de-selecting the corresponding
service. Currently active services and the services recommended by
the Rules Engine 116 appear with their corresponding check boxes
already selected. The pharmacist may make changes, selecting
additional services or de-selecting services that have already been
selected, by simply mouse-clicking the appropriate check box 366.
Selecting the Submit Changes and Print Guide button 368 saves any
changes made to the patient's service selections, activates or
deactivates any services as required, and causes a new solutions
guide to be printed reflecting any changes made to the patient's
active services. The Back button 370 causes the interface to return
to a previously displayed page and the Cancel button 380 ends the
consultation without any changes being made to the patient's active
services.
[0072] Returning to FIG. 4, in addition to the service maintenance
pages 340, 360, the web server 112 may also forward the compliance
services recommendations to the pharmacy workstation 132 in a
printable format at 230. The pharmacist may print the printable
version of the recommendations for the patient's review and use the
printed version to guide the discussion as the pharmacist explains
the different compliance services to the patient and explains the
reasons why particular services were recommended. At 234 the
pharmacist determines whether the patient agrees with the service
recommendations and whether the patient wants to sign up to receive
the recommended services. If so, the pharmacist saves the
recommendations at 238 and the central processing systems 106 take
the necessary steps to implement the recommended services on the
patient's behalf. Otherwise, if the patient does not agree with the
recommended service selections at 234, the pharmacist may make
adjustments to the selected services described above. Once the
appropriate services have been selected, saved, and implemented,
the pharmacist may print the patient's personal compliance solution
guide at 240. The personal compliance solution guide identifies and
describes the various compliance services that have been activated
for the patient. A confirmation page is displayed by the pharmacy
workstation's web browser and the pharmacist confirms the patient's
compliance service selections at 342. After confirming the
patient's selections, the process returns to 208 where the patient
inquiry screen is displayed on the pharmacy workstation 132,
allowing the pharmacist to perform a patient lookup for the next
patient.
[0073] FIG. 10 shows an example of a personalized solution guide
400. The solution guide 400 may be printed in a columnar format on
two sides of a single sheet of paper so that the solution guide may
be folded in half to form a convenient four page brochure style
document. The personal solution guide includes a cover page 402.
The cover page 402 includes the patient's name 404 and a title 406
identifying the document as the patient's Personalized Medication
Management Solution Guide. The title page may also include the name
of the pharmacy 408 offering the compliance services outlined in
the solution guide 400. The second page of the solution guide 400
is a summary page 410. The summary page 410 includes summaries of
the compliance services that have been selected and implemented on
the patient's behalf. As can be seen in FIG. 10, the patient Jane
Q. Public 404 is enrolled in the Auto Fill service 412 and Text
Message Refill Reminder Service 414. The third page of the solution
guide 400 is a compliance suggestion page 420. The compliance
suggestion page 420 includes basic tips 422 for staying in
compliance with one's medication therapy. A short paragraph 424 at
the bottom of the compliance suggestion page 420 indicates that
additional service offerings are listed on the final page of the
solution guide 400. The compliance suggestion page 420 further
includes a block 426 where the pharmacist who conducted the
consultation with the patient can add his or her personal contact
information. As indicated, the final page of the solution guide 400
includes a comprehensive list 430 of the compliance services
offered by the pharmacy. The solution guide may be printed with
check marks next to the services that have already been selected
for the patient. The list of compliance services found on the final
page of the solution guide is substantially the same as the list of
services 342 displayed on the second service maintenance page 360
of FIG. 9. However, the list displayed for the pharmacist on the
service maintenance page may be more comprehensive, including
services that may be hidden from the patient's view.
[0074] Once a patient completes a consultation with the pharmacist
and the recommended compliance services have been implemented, it
is desirable to track the patient's compliance in order to
determine whether the selected programs have had an effect on
improving the patient's compliance, or whether additional or
different services should be recommended to the patient to further
improve the patient's compliance.
[0075] Patient feedback is itself a powerful tool for improving
compliance. The medication management system 100 may be adapted to
periodically generate a "compliance report card" for the patients
participating in a medication management program. Returning briefly
to FIG. 3, in order to prepare a compliance report card for a
particular patient the central processing systems 106 may pull data
such as a patient's prescription fill history from the pharmacy's
legacy data stores 152 and medication management data from the
medication management transactional database 108. These data may be
used to create a report that evaluates the patient's compliance
with his or her medication therapy program over a specific period
of time. For example, a first compliance report card may be
generated 90 days after a patient has had an initial compliance
consultation with a pharmacist and subsequent report cards may be
generated every six months thereafter. The first report card may
cover a six month period beginning three months before the initial
consultation and ending three months after the consultation in
order to show whether the consultation with the pharmacist and the
compliance services implemented as a result of the consultation
have had a positive effect. A patient's compliance report card may
be generated by the central processing systems 106 and forwarded to
a pharmacy workstation by the medication management web server 112.
The report card may be printed by the pharmacist when the patient
contacts the pharmacy on a date following the date on which the
report card is scheduled to be issued. Alternatively, the report
card may be generated automatically on the scheduled date and
emailed to the patient, faxed, sent by regular mail, posted on a
secure website which may only be accessed by the patient, the
patient's caregiver, the patient's physician, or some other
authorized party, or otherwise distributed to the patient.
[0076] Although a patient's compliance report card may be scheduled
to be generated on a specific date, the report card need not
actually be generated until it can be delivered to the patient. For
example, the report card may not actually be generated until the
patient contacts the pharmacy to get his or her prescriptions
refilled after the date on which the report card is to be issued.
On the date the report card is to be issued, a flag may be set in
the patient's profile indicating that the compliance report card is
due. The next time the patient contacts the pharmacy and the
pharmacist performs a patient look up on the patient as described
above, the central processing systems 106 will see that the
generate report card flag is set and will take the necessary steps
to pull the appropriate data and assemble the patient's compliance
report card. Once assembled, the web server 112 sends the final
document to the pharmacy workstation 132 where the pharmacist may
print the report card and discuss its contents with the patient. Of
course in other situations, such as when patients use online or
mail order pharmacy services, it may be necessary to generate the
patient's compliance report card on a date certain and forward it
to the patient automatically over an appropriate communication
channel, such as via email, a secure website, or the like.
[0077] FIG. 11 shows a sample compliance report card 500. A cover
page 502 identifies the report card and identifies the patient 516
for whom it is prepared. The cover page 500 may also identify the
pharmacy 524 that prepared the report card. The second page 504 of
the compliance report card 500 includes a set of instructions 526
for using the report card. The third page of the report card 506
includes the patient's personal information 530 including the
patient's name, address, date of birth, sex and home phone number.
A brief introductory paragraph 532 is followed by a summary of the
patient's medical profile 534. The medical profile includes the
patient's current medications 536; current allergies 538; and
current health conditions 540. In the example shown, Jane Q. Public
of 200 Wilmot Road, Deerfield, Ill. 12345, born Jan. 1, 1964,
female, having the phone number (262) 867-5309 is actively taking
Lipitor 10 mg tablets, ASA 81 mg tablets and Singulair 5 mg
tablets. Ms. Public is allergic to Penicillin, Biaxin and Sulfa
drugs. She currently suffers from elevated cholesterol and allergy
induced asthma.
[0078] Medication possession ratio (MPR) is a measure of a
patient's compliance with his or her medication therapy. A
patient's medication possession ratio is defined as the number of
days supply of medication that the patient has in his or her
possession over a specified number of days divided by the specified
number of days. The fourth page of the report card 508 includes a
chart 550 illustrating the patient's medication possession over the
period of time covered by the report card. The patient Jane Q.
Public had a service intervention comprising a consultation with a
pharmacist on March 1, 558. The chart 550 extends from December 1,
three months before the service intervention 558, to June 1, three
months after the service intervention 558. The chart 550 shows the
patient's medication possession 552, 554, 556 for each of her
maintenance medications. As can be seen, a narrow gap 560 appears
in her Lipitor possession graph 552 and a somewhat wider gap 562
appears in her Singulair possession graph 554. No gaps appear in
her ASA possession graph 556. The gaps 560, 562 indicate periods
during which the patient was not in possession of her maintenance
medications. Overall, the patient's MPR was 70% for Lipitor and 68%
for Singulair. The patient was in possession of her ASA medication
at all times, resulting in a 100% MPR for her ASA prescription.
Both of the gaps 552, 554 in the patient's possession of Lipitor
and Singulair appear in the period of time before the service
intervention 558. It appears, based on a review of the patient's
MPR, that the patient's compliance improved after the service
consultation 558.
[0079] The next page of the patient's compliance report card 500 is
a questionnaire summary and update page 510. The questionnaire
summary and update page 510 includes questions from the initial
consultation questionnaire that the patient completed during her
initial consultation with the pharmacist. The questions included on
the questionnaire summary and update page 510 are selected based on
the patient's answers during the initial consultation. Only the
questions that were the most significant in terms of identifying
the patient's compliance barriers are included in the compliance
report card. The original questions 580, 582, 584 are restated,
along with the patient's previous responses 586, 588, 590. The
patient is then asked how they would answer now? what has changed
since the last consultation? what has made compliance better? what
has made things worse? for each of the selected questions 580, 582,
584.
[0080] The next page 512 of the patient's compliance report card
500 includes a list of possible goals 600 the patient may work
towards before the next consultation with the pharmacist. The list
of goals 600 may include a number of pre-selected goals or the
pharmacist may simply check off those goals that he or she believes
would be most beneficial for the patient to work to achieve in the
weeks ahead.
[0081] Next, a health tips page 514 may include general health tips
610 or other ideas for the patient to keep in mind while managing
her medications. This page may also include a section 612 for the
patient to write notes or jot down questions that she may have for
the pharmacist at their next meeting.
[0082] A final page 516 of the compliance report card 500 may
provide a list 614 of the compliance related services offered by
the pharmacy. This may provide the patient another opportunity to
review the compliance services offered by the pharmacy and select
additional services if desired. The list of services 614 on the
compliance report card 500 may be substantially identical to the
list of services included in the medication management Solutions
Guide 400 given to the patient at the end of her initial
consultation with the pharmacist.
[0083] If a patient selects the medication manager service, the
medication management system prepares a customized medication
management chart for helping the patient keep track of his or her
medications. The medication management chart may be given to the
patient when he or she picks up her medications, or in conjunction
with a consultation with the pharmacist. Alternatively, medication
management charts may be mailed to the patient, e-mailed, posted to
a secure web cite, or otherwise delivered to the patient. A sample
medication management chart 700 is show in FIG. 12. The medication
management chart 700 includes the patient's name and personal
information 702. The chart is organized as a series of rows 704,
706 708, etc. Each of the patient's medications is listed on a
separate row. In the example shown the patient is taking three
different medications. Aciphex 20 mg tablets are listed in the
first row 704. Glipizide 10 mg tablets are listed in the second row
706. An Intal Inhaler is listed on the third row 708. The blank
rows 712, 814 may be used by the patient to record the use of other
medications, such as over the counter drugs, vitamins, aspirin, and
the like, or to record daily measurements such as blood pressure,
glucose levels, and so forth. Each row that lists a medication 704,
706, 708 includes the name of the drug 716, the form in which the
drug is provided 718, and a brief description of the medication's
appearance or how it is packaged 720. The instructions 722 for
taking each medication are also included on each corresponding
row.
[0084] Horizontally the chart 700 is divided into seven columns
representing the seven days of the week. The headings of the
columns 730, 732, 234, 736, 738, 740, 742 may be left blank so that
the patient may begin the program on any day of the week that he or
she sees fit. When the patient begins the program he or she can
pencil in the days of the week beginning with the day on which he
or she starts the program. Each column includes a number of check
boxes 750 in each row. The check boxes in each column correspond to
the individual doses of the medication listed on the corresponding
row that the patient must take that day. Thus, if a particular
medication is to be taken four times per day, four check boxes will
appear in each column of the row listing the particular
medication.
[0085] It is assumed that the patient will take each corresponding
dose at or about the same time on each subsequent day. The first
column 730 includes blank spaces 752 next to each check box 750 to
allow the patient to write in the times he or she takes each dose,
in order to customize his or her medication routine according to
his or her own schedule. The patient may place a check mark in each
box when he or she takes the corresponding dose each day. In this
way, the patient may keep track of each dose of his or her
medication to ensure that doses are not missed or that doses are
accidentally taken twice. The chart 730 may further include spaces
for the patient to write down notes for his or her doctor 760, for
the pharmacist 762, and to list any side effects he or she is
experiencing, or any other comments 764.
[0086] If a patient selects a personalized medication record (PMR)
service the medication management system may periodically prepare a
personalized medication report. A PMR is a document that includes
important information about the patient, the patient's health, and
the patient's medication history. The patient may carry the PMR
with them in case of emergency. Emergency personnel may refer to
the PMR to learn about the patient's health status and so forth.
The patient may show the PMR to his or her doctor to provide an
overview of his or her health status, medication record, and so
forth. A new PMR may be prepared for the patient each time the
patient has a new prescription filled, or each time a prescription
changes, and so forth. The patient may be provided with a
protective sleeve or cover so that the patient may insert a copy of
his or her PMR into the sleeve or cover each time the patient
receives and updated version.
[0087] FIG. 13. shows a sample PMR 800. A cover page 802 identifies
the document as a personalized medication record 804 and identifies
the patient 806 for whom it is prepared. The cover page 802 may
also identify the pharmacy 808 that prepared the PMR. The second
page 810 includes a set of instructions 812 on how to use the PMR
800. The next page 814 lists the patient's name and personal
information 816. This page may also include various medical and
emergency information. For example the page 814 may include the
patient's doctor's name and contact information 818, the patient's
pharmacy information 820, emergency contact information 822,
current allergies 824, and current health conditions 826. A next
page 830 may include a list of current medications 832. Finally, a
last page 840 may include a list of services 842 offered by the
pharmacy with checkmarks indicating which services the patient
currently receives.
[0088] Patients taking one or more maintenance medications for an
extended period of time are the patients who would benefit most
from a medication management program. A pharmacy implementing a
medication management system may rely on advertising and other
efforts to get the word out to patients about the medication
management services offered by the pharmacy. However, this requires
patients to self identify themselves as candidates for medication
management services, and requires patients to take the first step
in seeking out such services. A more proactive approach is for the
pharmacy to identify those of its patients who would benefit from a
medication management program and take the active steps of
contacting those patients and offering them medication management
services. Therefore, an embodiment of a medication management
system includes a point of sale (POS) blocking feature. According
to this embodiment patients who may benefit from medication
management services are identified and are blocked at the point of
sale when having their prescriptions filled. Blocking the
transaction allows a pharmacist to explain the pharmacy's
medication management program to the patient and determine whether
the patient may want to participate.
[0089] Returning again to FIG. 3, the pharmacy front end systems
102 include one or more pharmacy workstations 132 and one or more
POS terminals 138 located at retail branch stores 144. The POS
terminal 138 performs typical cash register functions and
accounting functions related to the sale of prescription drugs.
Both the pharmacy workstations 132 and the POS terminals 138 are
connected to the in-store data network 134. The in-store network
134 may be connected to an in-store application server 134 which
connects to the pharmacy back-end systems 104 via an external
network 130 as has already been described. The POS terminal 138
includes a small LCD screen or other type of display 140 for
displaying messages to the pharmacist operating the POS terminal
138. The POS terminal 138 further includes a bar code reader 140
for reading the bar codes on product packaging, including the bar
codes on the packaging of prescription drugs prepared by the
pharmacist to fill patient prescriptions.
[0090] When a patient comes to the pharmacy to have a prescription
filled, the pharmacist pulls up the patient's profile on the
workstation 132 as has been described. The pharmacist enters the
prescription using the pharmacy legacy systems 150 and prepares the
medications to fill the prescription. When the pharmacist enters
the prescription, the patient profile is analyzed by the
intervention engine 120 executed by the central processing systems
106. The intervention engine 120 includes a number of rules for
identifying patients who should be stopped at the point of sale
when they attempt to pay for their medications. For example, a rule
may be established to block all patients taking maintenance
medications who are not participating in a medication management
program. When the pharmacist enters the patient's prescription the
intervention engine 120 analyzes the patient's profile, including
the patient's prescription fill history, to determine whether the
patient is taking maintenance medications and if so whether or not
the patient is already participating in a medication management
program. If the patient meets the conditions of the rule, the
intervention engine 120 may issue a POS block by setting a flag in
the patient's profile. The flag set in the patient profile
indicates that the patient's transaction is to be blocked when the
patient returns to pick up and pay for his or her medication.
[0091] Back at the pharmacy, the pharmacist prepares the patient's
medication. The medication packaging includes a bar code
identifying the prescription to which the medication relates. When
the patient returns to pick up the medication the pharmacist scans
the bar code on the medication packaging using the bar code reader
142. The POS terminal 138 uses the information from the bar code to
access the prescription data entered by the pharmacist and stored
in the legacy system data stores 152, and the corresponding patient
profile. The patient profile includes the POS block flag that was
set by the rules engine 118 when the prescription was entered by
the pharmacist. The POS terminal 138 is barred from completing the
transaction while the POS block flag is set. A message is displayed
on the POS terminal's LCD display 140 indicating that the
transaction has been blocked. The pharmacist returns to the
pharmacy workstation 132 to learn the reason why the transaction
was blocked. The pharmacist accesses the patient's profile and a
message is displayed indicating that the transaction was blocked
because the patient is a candidate for participating in a
medication management program. The pharmacist may then consult with
the patient, explaining the medication management program to the
patient, and asking whether the patient would like to participate
in the program. If so, the pharmacist enrolls the patient in the
medication management program as has already been described. If
not, the pharmacist records that a consultation has taken place but
that patient declined to enroll in the medication management
program. In either case, the desired message has been delivered to
the patient and the POS block flag may be cleared in the patient's
profile, and the patient's transaction for the purchase of his or
her medications may proceed unhindered. If the patient declines to
participate in the medication management program he or she may be
blocked again on subsequent visits to the pharmacy unless and until
the patient decides to enroll in the medication management
program.
[0092] According to an embodiment of a medication management
system, the POS blocking feature may be expanded to block patients
at the point of sale for reasons other than making them aware of
the pharmacy's medication management program. According to this
embodiment patients sharing one or more common characteristics may
be blocked at the point of sale until some specified action is
taken. For example, campaigns may be implemented for contacting
certain classes of patients in order to deliver messages directed
toward the members of the various classes. Campaigns may provide
customized interactions with the pharmacy's patients on behalf of
the pharmacy itself or on behalf of third-party stakeholders.
[0093] Once enrolled in a campaign, a patient may be blocked during
future visits to the pharmacy in order to deliver additional
messages related to the campaign or to ensure that additional
actions related to the campaign are carried out.
[0094] The pharmacy may implement campaigns as a paid service to
third-party stakeholders. Stakeholders may be willing to pay the
pharmacy for delivering messages to various groups of patients,
gathering information from such patients or performing some other
customized interaction with such patients. A customized interaction
may include, for example, asking patients a series of questions
related to their medication therapy and recording their responses.
The medication management system data may provide the captured data
to the third party who requested the campaign on a reimbursable
basis. The captured data may be returned to the stakeholder in
substantially any format desired. For example, the medication
management system may generate customized reports on a periodic
basis incorporating the cumulative responses of many patients, or
the medication management system may forward patient responses to
the third party stakeholder as soon as they are recorded. The
reporting mechanism may be established on a case by case basis with
the third party stakeholder who is requesting the campaign. The
third party may be charged a flat fee for implementing a campaign,
or may be charged individually for each patient interaction, or
some other billing structure may be implemented.
[0095] According to an embodiment of a medication management
system, a web-based campaign management tool is provided for
creating and managing campaigns for identifying patients and taking
actions directed toward identified patients. According to this
embodiment campaigns include attributes and components. Table 1
describes the various campaign attributes according to an
embodiment of a campaign management tool. Table 1 includes the
attribute name, a description of the attribute and valid values
that the attribute may take on.
TABLE-US-00001 TABLE 1 Campaign Attributes Attribute Description
Valid Values 1) Campaign ID Unique; System Generated; This should
always be unique Generated for every new campaign This is created
upon saving the campaign. 2) Campaign Name Name of the campaign No
data validation A campaign created from copy create will have as
default file name "Copy of <Campaign Name>" but this can be
edited The campaign name will include some attribute values 3)
Campaign Description A brief description on what the No data
validation campaign is about, target audience This should be a
maximum of 500 characters 4) Campaign Start Date Can only be
changed if the When creating or activating a campaign has not been
activated, campaign it should be at least Once active it can't be
changed equal to the current date + 1 day and not later than the
end date. Illustration: Creation Date is 1 Feb 2007 Start Date
should be equal or greater than 2 Feb 2007 5) Campaign End Date Can
only be changed if the When creating or activating a campaign has
not been activated, campaign it should not be earlier Once active
it can't be changed than the start date. 6) Campaign Priority The
priority will decide which This can be numeric, descriptive
campaign will be "offered" to the (e.g., high, low), or whatever
(yet patient. This is reference point in to be defined) case
patient was hit by multiple campaigns 7) Campaign Coordinator This
could be the name, No data validation department, an organization
8) Campaign Coordinator This could be the phone number, No data
validation Contact Details email address just in case there would
be some concerns on the campaign 9) Cost Mandatory field This
should be in dollar 10) Expected Result Mandatory text field No
data validation 11) Campaign Status Inactive, active, terminated,
suspended, completed 12) Sponsor Name of group, organization
Optional text field sponsoring the campaign No validation 13) Payor
Name of the company, Optional text field organization funding the
campaign No validation 14) Fee Structure Optional text field No
validation 15) Fee Optional text field No validation 16) Billing
Optional text field No validation 17) Collect Billing Information
Optional text field No validation 18) Impact This is just a text
box. Optional text field. This is the probable number of No
validation patients that may be hit by the campaign 19)
Implementation Procedure This can be a 1,000-character text
Optional text field description of how the campaign No validation
will be implemented
[0096] Table 2 describes the various components of a campaign
according to an embodiment of a campaign management tool. Table 2
includes the component name and a brief description of the
component.
TABLE-US-00002 TABLE 2 Campaign Components Component Name
Description 1) Questions Asking the patient a set of questions. The
answer to the questions may or may not lead to service
recommendation Not all campaigns will have this component The
answers to the questions may not be limited to a range of ratings
(1 to 7), but it can be "Yes" or "No," and other that's not
numeric. 2) Services The service may not necessarily be triggered
by the questions. Illustration: Generate a report card for the
patients on ABC medications. Not all campaigns will have this
component. The service can be selected from the existing services
defined in a Service table. 3) Rules for These are the rules that
identify the type of patients for Identification the campaign. A
patient can be identified by anything on his profile including the
campaign he/she participated in. This is a mandatory campaign
component. 4) Reporting Provides the ability to generate statistics
related to the campaign 5) List This could be materials to educate
the patient sent via Generation mail. This could also be a list to
call. Not all campaigns will have this component. 6) POS Block The
patient is blocked at the store upon dropping a script. Not all
campaigns will have this component. 7) Termination This is a
constant component for all campaigns. This defines the process of
terminating a campaign. 8) Information Provides a text box where
customized messages up to Page 4000 characters long may be
defined.
[0097] Additional components may be defined as needed to meet the
requirements of various third party stakeholders who wish to
contact patients via the pharmacy's POS Block feature. In fact, a
direct user interface feed may be provided to receive text messages
or other customized interactions directly from the stakeholders to
be included in a campaign.
[0098] Finally, components themselves may have attributes. Table 3
describes the various attributes that campaign components may
include.
TABLE-US-00003 TABLE 3 Attributes of the Components Attribute
Description 9) Frequency/Schedule This will define how often the
component will happen in a campaign and when (start to end)
Example: Send mailer every month to the patient for the next 6
months. Generate the report card every 2 months from the time the
patient answered Question Set ABC. If the component is
service-related and that service is `not yet existing, the service
has to be created in the Service Maintenance application first. 10)
Campaign Scripting (Messaging) This is the UI messaging. If it's a
POS block scripting, this script will have to go to the campaign
landing page in RCA. This attribute can be changed on the condition
that the component for which this scripting is for has not started
yet (start date is not yet reached). 11) Dependencies This defines
what triggers a component to happen; i.e., answers to the
questions, report card printing, etc.
[0099] Once a campaign has been defined it may assume one of many
different statuses.
[0100] Table 4 describes the various statuses a campaign may
acquire. Table 4 lists each status, a description of each status
and the business rules that follow from a campaign having a
corresponding status.
TABLE-US-00004 TABLE 4 Campaign Status Status Definition Business
Rules on the Status Inactive The campaign has not been activated
Default campaign status Modifications allowed This can be deleted
Active The campaign has been activated even Modifications not
allowed after if the start date is still on a later time.
activation If the campaign is activated on a later date than the
start date, require new start date. Cannot be deleted Can be
suspended, terminated, completed Suspended The campaign is
temporarily stopped Modifications not allowed with the intention of
resuming If the end date was reached and campaign is still
suspended the campaign will automatically be terminated Cannot be
deleted Can be reactivated. Once reactivated it will be active
again Terminated The campaign is permanently stopped Modifications
now allowed before the end date Cannot be deleted Cannot be
reactivated Completed The campaign has reached the end date
Modifications not allowed and the status of the campaign is active
The campaign will take on the or suspended completed status a day
after the end date Cannot be deleted Cannot be "reactivated"
[0101] FIG. 14 is a flow chart 850 showing the campaign management
definition process flow according to an embodiment of a campaign
management tool. The campaign management definition begins at 852.
A campaign may be defined from scratch or may be created by
modifying an existing campaign. At 854 a determination is made
whether the campaign will be a new campaign or based on an existing
campaign. If the campaign is to be based on an existing campaign a
search for the existing campaign may be performed at 856 and the
attributes and components of the existing campaign may be edited to
meet the requirements of the new campaign. Otherwise if the
campaign is a new campaign, the attributes of the new campaign are
defined at 858. The components of the new campaign are defined at
860, and the transitions between the various components are defined
at 862. A determination is made at 864 whether or not to activate
the campaign. If the campaign is not to be activated the campaign's
status is set to inactive at 866. Otherwise, the campaign is
activated at 868. A determination is made at 870 whether to create
another campaign. If yes, the process returns to 858 where
attributes of the next campaign are defined and so forth. If not,
the application is closed and the process flow ends at 872.
[0102] FIG. 15 shows a campaign attributes interface page 900 for
defining or editing the attributes of a campaign. The interface
page 900 is part of the campaign management tool, and may be sent
to an administrator workstation 140 by the medication management
web server 112 (FIG. 3). The interface page 900 includes a number
of attribute fields where a user defining a new campaign or editing
an existing campaign may enter or change attribute values.
Attribute fields are included for entering the campaign name 902; a
description of the campaign 904; the campaign priority 906; the
name of a campaign coordinator 908; a campaign sponsor 910; a fee
structure 912, a billing structure 914; the cost of the campaign
916; the campaign status 918; the campaign start date 920; the
campaign end date 922; an expected result 924; the campaign
coordinator's contact information 926; the party paying for the
campaign 928; the fee 930; and billing 932.
[0103] FIG. 16 shows a campaign components interface page 950 for
defining the components of a campaign. The upper portion 952 of the
interface page 952 includes a summary of the campaign attributes
entered in the attributes interface page 900 of FIG. 15. The bottom
portion 954 of the campaign components interface page 950 includes
a number of data fields for entering campaign components and
related data. A campaign must include at least two components.
Generally, these will include a patient identification rule, and
some other step. For example, the second step may be delivering a
specified message, asking one or more questions of the patient, or
some other customized interaction. The campaign components
interface page 950 includes data fields for defining the component
type 956, the component ID 958, the component start date 960 and
the component end date 962. The component type data fields 956 may
include drop-down menus 964 from which a user may select the
component type for a particular component. The component types
listed in the drop-down menu may correspond to the components
listed in Table 2. The component ID fields 958 may also include
drop-down menus 966 for selecting specific components to be
included in the campaign. The component IDs included in the
component ID drop-down menu may depend on the type of component
selected in the corresponding component type field 956. The
campaign start date and campaign end date fields 960, 962 allow the
user to enter the dates during which the corresponding component
will be active.
[0104] Finally, FIG. 17 shows a campaign component transition
interface page 970. The campaign component transition interface
page 970 allows the user to define the transitions between the
campaign components selected in the campaign component interface
page 950 of FIG. 16. On the campaign component transition interface
page 970 the user may select a source component 972 and a
destination component 974, and a rule 976 for governing the
transition from the source component 972 to the destination
component 974. Three conditional transitions 978, 980, 982 are
shown in the sample campaign component transition interface page
970. The first two transitions 978, 980, 982 define transitions
from the same source component 972, namely, LIPITOR, MALE, 45 AND
ABOVE, to different destination components 974 depending on
different conditions defined by the corresponding rules 976 defined
in each transition 978, 980. In the first transition 978, the
campaign will transition from the LIPITOR, MALE, 45 AND ABOVE
source component 985 to the disease state block component 986. The
transition may be based, for example, on the cumulative score of
the patient's responses to a set of questions that form the
customized interaction implemented by the campaign. The first
transition occurs if the result is greater than seventy 992. In the
second transition, from the LIPITOR, MALE, 45 AND ABOVE source
component 987 to the report card question set component 988 occurs
if the result is less than seventy 994. Finally, in the third
transition 982, the campaign will transition from the report card
question set source component 989 to the refill reminder-phone
component 990 if the result is equal to seventy 996.
[0105] Once a campaign has been defined, the campaign management
tool interacts with the intervention engine 120 to load the rules
for identifying the patients who are the targets of the campaign.
Once a campaign has been implemented, the POS block feature works
as described above. When a patient contacts the pharmacy to have a
prescription filled, the pharmacist accesses the patient's profile
and enters the prescription using the pharmacy's legacy systems.
The patient's profile is run against the intervention engine 120 to
determine whether the patient has the characteristics of the
patients targeted by the campaign. If so, an intervention flag is
set in the patient's profile. When the patient picks up his or her
prescription at the pharmacy, the transaction is blocked at the
point of sale by the POS terminal. The POS terminal may display a
message indicating that the transaction has been blocked and
directing the pharmacist to the pharmacy workstation 132 to learn
why the patient was blocked. Upon accessing the patient profile,
the pharmacy workstation receives an interface page from the web
server 112 that includes a message describing the reason why the
patient was blocked as well as the actions that must be taken
regarding the patient in furtherance of the campaign. Once the
appropriate actions have taken place the intervention flag may be
reset in the patients profile, and the transaction allowed to
proceed.
[0106] As an example, a campaign may be established for providing
patients with detailed information about a new medication the first
time they have a prescription for the new medication filled. When a
patient drops off a prescription for the new medication at the
pharmacy the patient's profile is run against the intervention
engine 120. The intervention engine may include a rule associated
with the campaign for blocking patients the first time they have a
prescription for the new medication filled. In this case, if it is
the first time the patient is filling a prescription for the new
drug, the patient's profile will meet the condition defined by the
rule, and the intervention flag will be set in the patient's
profile. When the patient picks up his or her prescription, the
pharmacist scans the barcode on the prescription packaging, and the
POS terminal accesses the patient's profile data. Since the
intervention flag is set, the POS terminal will block the
transaction and direct the pharmacist to the pharmacy workstation
132. At the pharmacy workstation 132 the pharmacist accesses the
patient's profile. An interface page is sent from the medication
management web server 112 indicating the reason why the patient was
blocked. The pharmacist may then conduct a scripted interaction
with the patient based on the particular campaign for which the
patient was blocked.
[0107] The scripted interaction with the patients may be guided by
campaign interface pages sent from the medication management web
server 112 to the pharmacy workstation 132. The interface pages
associated with a campaign comprise three basic components, an
Information page, a Question Set page and a Thank You page. FIGS.
18, 19 and 20 show an Information page 1000, a Question Set page
1020, and a Thank You page 1040, respectively. The Information page
1000 identifies the patient 1002, includes basic patient
information 1004 (address, phone number, etc.) and includes a
scripted message 1006 for determining whether the patient is in
fact a patient having the characteristics of patients targeted by
the campaign and whether the patient would be willing to discuss
his or her medication therapy. The question set page 1020 includes
scripted questions 1022, 1024 associated with the campaign. The
pharmacist asks the patient the questions and records the patient's
answers by selecting the appropriate radio buttons 1026, 1028,
1030, 1902. In this case, the first question 1022 is merely to
confirm that the present prescription fill is the first time the
patient has had a prescription for the new medication. The second
question is whether the patient would like to receive additional
information about the prescribed medication. If the patient answers
"yes" to both of these questions, additional information about the
medication may be provided to the patient. In either case, once the
questions have been asked, and the patient's answers recorded, the
required patient level tasks associated with the campaign have been
completed with regard to the patient and the intervention flag in
the patient's profile may be reset. Once the intervention flag has
been reset the POS block is removed and the patient's transaction
may be completed. When the pharmacist has entered the patient's
answers to the questions the Thank You page 1040 is displayed. The
Thank You page may be merely a scripted message 1042 that the
pharmacist reads to the patient thanking the patient for
participating in the campaign.
[0108] Another example of a campaign that may lead to a POS block
may relate to periodic tests required of patients taking certain
medications. For example, a certain side effect may be associated
with a particular drug. Patients taking the drug may be required to
take a blood test after a certain period of time to ensure that the
negative side effects are not present. A campaign may be
established for blocking patients after the defined time period to
check whether they have had the required blood test. In this case,
a patient taking the medication may be blocked at the point of sale
until the patient produces evidence that the requisite blood test
has been performed and the results were consistent with continuing
to take medication in question.
[0109] In yet another embodiment the pharmacy may receive a data
feed directly from third party stakeholders identifying patients to
be blocked at the point of sale as part of a customized interaction
campaign. For example, an insurance company may want to contact all
of its patients taking a particular drug to inform them of a
cheaper generic equivalent. The insurance company may already know
the identity of all the patients in question. The insurance company
may feed the list of names to the pharmacy, and a POS block may be
established for every name on the list for which the pharmacy has a
customer profile. Individual patients on the list may be identified
and blocked at the point of sale as has already been discussed, and
the appropriate message delivered to the patient at the pharmacy by
the pharmacist.
[0110] An advantage of a comprehensive medication management system
is that a great deal of information about a patient and a patient's
medication therapy may be made easily accessible to a pharmacist or
other health-care professional. According to an embodiment of a
medication management system, a patient's medication data are
organized and displayed on an interface in a manner that provides a
pharmacist with quick and easy access to all or most of the patient
information that the pharmacist needs to perform an informed
consultation with a patient. According to this embodiment, the
consultation manager 110 may display a consolidated patient profile
interface on each page of a web-based consultation interface. FIG.
21, for example, shows a minimized patient chart 1100 displayed
along with a service maintenance page 1102. FIG. 22 shows an
expanded full-screen view 1110 of the consolidated patient profile.
If desired, a pharmacist may expand the minimized patient chart
1100 into the full-screen view 1110 from any consultation interface
page (e.g., from a medication management report card consultation
page, a script alignment interface page, and the like) provided by
the consultation manager 110.
[0111] The consolidated patient profile interface, either the
minimized version 1100 (FIG. 21) or the full-screen view 1110 (FIG.
22), includes a number of user selectable tabs 1114, 1116, 1118,
1120 for selecting the type of patient data displayed on the
consolidated patient profile interface 1100, 1110. The Interactions
Tab 1114 causes a list 1122 of all of the interactions that have
taken place between the patient and the pharmacy to be displayed.
The list 1122 displays the date on which the interaction occurred
1124, the type of interaction 1126, the subject of the interaction
1128, the location (i.e., branch store) at which the interaction
occurred 1130 and an overview 1132 of what transpired during the
interaction. A detail link 1134 is provided for each interaction. A
detail link 1134 links to an interface page that includes
additional details about the corresponding interaction.
[0112] FIG. 23 shows a full-screen view of a consolidated patient
profile 1140 with the Drugs Tab 1116 selected. The Drugs Tab 1116
causes a list 1142 of all of the patient's medications to be
displayed. When applicable, the list includes the prescription
number 1144 associated with each drug purchase, the name of the
drug 1146, the last date 1148 the drug was sold to the patient, and
the store 1150 at which the drug was sold.
[0113] FIG. 24 shows a full-screen view of a consolidated patient
profile 1160 with the Allergies and Health Conditions Tab 1118
selected. The Allergies and Health Conditions Tab 1118 causes a
list of the patient's current allergies 1162 and a list of the
patient's current health conditions 1164 to be displayed.
[0114] Finally, FIG. 25 shows a full-screen view of a consolidated
patient profile 1170 with the Services Tab 1120 selected. The
Services Tab 1120 causes a list 1172 of the pharmacy services that
are currently active in the patient's profile to be displayed.
Thus, the web-based consolidated patient profile interface pages
shown in FIGS. 21-25 provide the pharmacist with ready access to a
wealth of patient information that may be relied on by the
pharmacist when the pharmacist is consulting with a patient.
[0115] The interface pages displaying the consolidated patient
profile may be provided with additional or different display tabs
to display additional patient data or patient data that is
organized in a different manner, as necessary to provide
pharmacists with all of the patient data needed to perform thorough
and complete consultations with their patients. Furthermore,
patient data from a consolidated patient profile may be made
accessible to the patient, the patient's caregiver, the patient's
physician or some other authorized party, by posting the
consolidated patient profile to a secure website, or otherwise
making the data available on a protected basis to the patient and
other authorized parties.
[0116] Many of the services offered to patients as part of a
comprehensive medication management program will require individual
pharmacists to perform certain tasks. For example, an auto-refill
service will require a pharmacist to prepare the prescriptions that
are automatically being refilled. Preferably the prescriptions will
be prepared by a pharmacist at the local branch store where the
patient typically has his or her prescriptions filled. Similarly,
for patients who have signed up to receive personal calls when
their prescription refills are due, or past due, or when their
prescriptions are ready, a pharmacist must be tasked with placing
the call. Again, it is preferable that the pharmacist who places
the call is a pharmacist at a branch store where the patient
typically has his or her prescriptions filled.
[0117] According to an embodiment of a medication management system
100 (see FIG. 3) the task list generator 124 periodically performs
batch processes to identify patients who are receiving services
that require some action to be taken over a specified period of
time. The task list generator identifies the tasks that must be
performed (e.g., re-filling specific prescriptions, placing re-fill
reminder telephone calls, and so forth) and identifies the various
branch stores or other locations where it is most appropriate for
the various tasks to be performed. The task list generator then
prepares lists of tasks to be performed at the various branch
stores or other locations. Individualized task list interface pages
may be sent from the medication management web server 112 to the
pharmacy workstations 132 at the various branch stores and other
locations where the tasks are to be performed. The pharmacists at
the various branch stores and other locations may review the
individualized task list for his or her location, and perform the
various tasks described on the individualized task list interface
page as part of his or her daily responsibilities.
[0118] FIG. 26 shows an example of a pharmacist task list interface
page 1200. The task list interface page 1200 may be divided between
a pharmacist schedule 1202 and a pharmacist task list 1204. On the
pharmacist schedule 1202 portion of the pharmacist task list
interface page 1200 individual tasks 1206, 1208 are scheduled for
specific times of the day they are to be performed. Thus, the
pharmacist reviewing the pharmacist task list interface page 1200
will know that at 10:00 on May 1, he or she must place a refill
reminder call 1206 to patient Marie L. Johnson. At 10:30 that day,
the pharmacist is scheduled to have a diabetes follow-up
consultation 1208 with patient Steven R. Smith. Each scheduled
task, 1206, 1208 includes the time 1209 for which the task is
scheduled, a description of the task 1210, the name of the patient
associated with the task 1212, the patient's primary phone number
1214, and the status of the task.
[0119] The lower portion 1204 of the pharmacist task list interface
page 1200 merely shows a list of unscheduled tasks that must be
performed. The pharmacist may perform each task on an ad hoc basis
as time allows throughout the day without regard to a specified
time. Each task listed in the list 1204 includes the type of
interaction 1218, a description of the task 1220, a task due date
1222, the source or service that generated the task 1224, the
priority assigned to the task 1226, and the status of the task
1228. The pharmacist task list interface page 1230 further includes
a create new task button 1230 that allows the pharmacist to add new
tasks to the list.
[0120] By implementing a medication management system as described
herein, a pharmacy may better serve its patients by providing
services that will help patients improve their compliance with
their individual mediation therapies. The pharmacy may also provide
valuable services to the broader medical services delivery
community by providing access to patients heretofore unavailable to
third party stakeholders. Such services may be provided in a
setting that will improve the pharmacy's relations with its
customers while opening new potentially lucrative revenue streams
based on providing reimbursable cognitive services to the third
party stakeholders.
[0121] While the preceding paragraphs describe several exemplary
embodiments of a prescription alignment system, the various
embodiments described are not intended to limit the invention to
the individual embodiments. Various aspects of the alternate
embodiments may be combined in varying ways to create the system
and method that best suits the pharmacy implementing the system and
method, the pharmacy's customers, and the regulatory environment in
which the pharmacy operates
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