U.S. patent application number 14/014796 was filed with the patent office on 2013-12-26 for system and software of enhanced pharmaceutical operations in long-term care facilities and related methods.
This patent application is currently assigned to Tech Pharmacy Services, Inc.. The applicant listed for this patent is Tech Pharmacy Services, Inc.. Invention is credited to James J. Martin, James W. Moncrief.
Application Number | 20130340395 14/014796 |
Document ID | / |
Family ID | 34556191 |
Filed Date | 2013-12-26 |
United States Patent
Application |
20130340395 |
Kind Code |
A1 |
Moncrief; James W. ; et
al. |
December 26, 2013 |
SYSTEM AND SOFTWARE OF ENHANCED PHARMACEUTICAL OPERATIONS IN
LONG-TERM CARE FACILITIES AND RELATED METHODS
Abstract
A system, software and related methods of enhanced
pharmaceutical operations in long term care facilities are
provided. An embodiment of a system includes a long-term care
facility pharmacy group management server, long-term care facility
pharmacy management software associated with the long-term care
facility pharmacy group management server to manage pharmacological
operations in a plurality of long-term care facilities, a plurality
of pharmaceutical storage and electronic dispensing carts each
positioned in a long-term care facility remote from the long-term
care facility pharmacy group management server and in communication
therewith, a remote pharmacy group server in communication with the
long-term care facility pharmacy group management server, and a
plurality of pharmaceutical prescription document processors each
positioned in a long-term care facility and in communication with
the remote pharmacy group server or the long-term care facility
pharmacy group management server.
Inventors: |
Moncrief; James W.; (Plano,
TX) ; Martin; James J.; (Spring, TX) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Tech Pharmacy Services, Inc. |
Dallas |
TX |
US |
|
|
Assignee: |
Tech Pharmacy Services,
Inc.
Dallas
TX
|
Family ID: |
34556191 |
Appl. No.: |
14/014796 |
Filed: |
August 30, 2013 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13725432 |
Dec 21, 2012 |
8554574 |
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14014796 |
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13454624 |
Apr 24, 2012 |
8489425 |
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13725432 |
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11818416 |
Jun 14, 2007 |
8260632 |
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13454624 |
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10944993 |
Sep 20, 2004 |
7698019 |
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11818416 |
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60516678 |
Nov 3, 2003 |
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Current U.S.
Class: |
53/473 ;
53/77 |
Current CPC
Class: |
G06Q 10/08 20130101;
G06Q 40/08 20130101; G16H 40/67 20180101; B65B 1/30 20130101; G16H
20/13 20180101; G16H 40/20 20180101; G16H 10/60 20180101 |
Class at
Publication: |
53/473 ;
53/77 |
International
Class: |
G06F 19/00 20060101
G06F019/00 |
Claims
1. A method of using one or more pharmaceutical storage and
electronic dispensing machines in a long-term care facility when in
communication with a communication network and one or more remote
long-term care facility pharmacy management server, the method
comprising: installing one or more pharmaceutical storage and
electronic dispensing machines at each of a plurality of long-term
care facilities operable by one or more long-term care facility
staff members, each of the at least one pharmaceutical storage and
electronic dispensing machines being positioned remote from, and
adapted to be in communication with, one or more long-term care
facility pharmacy management server associated with a long-term
care facility remote pharmacy via a communications network, the one
or more long-term care facility pharmacy management server
including non-transitory, tangible memory medium to store long-term
care facility management computer programs including a patient
prescription receiver to receive a digital image of a patient
medication prescription order and a medication dispensing apparatus
administrator to selectively remote control one or more
pharmaceutical storage and electronic dispensing machine functions;
verifying, at the long-term care facility remote pharmacy, one or
more digital images of one or more patient medication prescription
orders received from one or more pharmaceutical prescription
document processors adapted to be in communication with one of the
at least one pharmaceutical storage and electronic dispensing
machines to thereby enhance reduction of medication order errors
and reduce miscommunication between one or more long-term care
facility staff members and the long-term care remote pharmacy;
adding, via the long-term care facility management computer
programs, the one or more digital images of one or more patient
medication prescription orders received from the one or more
pharmaceutical prescription document processors via the
communications network to memory of the long-term care facility
pharmacy management server for verification by one or more
long-term care facility remote pharmacy personnel; verifying the
one or more patient medication prescription orders in the memory of
the one or more long-term care facility pharmacy management server
by comparing, via the long-term care facility management computer
programs, the one or more digital images of the one or more patient
medication prescription orders with one or more of a patient
medication profile, a patient diagnosis profile, a patient
insurance profile, and a drug interaction profile, to thereby
enhance reduction of drug conflicts; analyzing, via the long-term
care facility management computer programs, the one or more patient
medication prescription orders in the memory of the long-term care
facility server to determine whether drug conflicts exist; and
transmitting dispensing instructions to the one or more
pharmaceutical storage and electronic dispensing machines by the
long-term care facility management computer programs via the
communications network when no drug conflicts exist to thereby
initiate dispensing of the one or more disposable individual
patient dosing package at the one or more pharmaceutical storage
and electronic dispensing carts; and packaging, by the one or more
pharmaceutical storage and electronic dispensing carts, one or more
medications into one or more disposable individual patient dosing
packages.
2. A method as defined in claim 1, wherein the method further
includes the step of providing remote training to the one or more
long-term care facility staff members from the long-term care
facility remote pharmacy by selectively remotely controlling one or
more functions, available to the one or more long-term care
facility staff members from a terminal of one of the at least one
pharmaceutical storage and electronic dispensing carts, by the
long-term care facility management computer programs via the
communications network responsive to input received from the one or
more long-term care facility remote pharmacy personnel.
3. A method as defined in claim 1, wherein the one or more
pharmaceutical storage and electronic dispensing machines is
further adapted to be in communication with one or more video input
devices, wherein the method further includes the step of
displaying, at the long-term care facility remote pharmacy, one or
more video images of at least one visually accessible functional
component of one of the one or more pharmaceutical storage and
electronic dispensing carts via the long-term care facility
management computer programs over the communications network
responsive to video signals received from the one or more video
input devices and providing remote troubleshooting of the one or
more pharmaceutical storage and electronic dispensing carts by the
one or more long-term care facility remote pharmacy personnel
responsive to the video image of the at least one visually
accessible functional component of the one or more pharmaceutical
storage and electronic dispensing machines.
4. A system to facilitate enhanced use of one or more
pharmaceutical storage and electronic dispensing machines in a
long-term care facility when in communication with a communication
network and one or more remote long-term care facility pharmacy
management server, the system comprising: one or more
pharmaceutical storage and electronic dispensing machines
positioned at each of a plurality of long-term care facilities
operable by one or more long-term care facility staff members, each
of the at least one pharmaceutical storage and electronic
dispensing machines being positioned remote from, and adapted to be
in communication with, one or more long-term care facility pharmacy
management server associated with a long-term care facility remote
pharmacy via a communications network, the one or more long-term
care facility pharmacy management server including non-transitory,
tangible memory medium to store long-term care facility management
computer programs, the long-term care facility management computer
programs including: a patient prescription receiver to receive a
digital image of a patient medication prescription order, and a
medication dispensing apparatus administrator to selectively remote
control one or more pharmaceutical storage and electronic
dispensing machine functions; the computer programs also being
configured and operable to: verify, at the long-term care facility
remote pharmacy, one or more digital images of one or more patient
medication prescription orders received from one or more
pharmaceutical prescription document processors adapted to be in
communication with one of the at least one pharmaceutical storage
and electronic dispensing machines to thereby enhance reduction of
medication order errors and reduce miscommunication between one or
more long-term care facility staff members and the long-term care
remote pharmacy; verify the one or more patient medication
prescription orders by comparing the one or more digital images of
the one or more patient medication prescription orders with one or
more of a patient medication profile, a patient diagnosis profile,
a patient insurance profile, and a drug interaction profile, to
thereby enhance reduction of drug conflicts; determine, responsive
to the one or more patient medication prescription orders, whether
drug conflicts exist; and transmit dispensing instructions to the
one or more pharmaceutical storage and electronic dispensing
machines via the communications network when no drug conflicts
exist to thereby initiate dispensing of the one or more disposable
individual patient dosing package at the one or more pharmaceutical
storage and electronic dispensing carts.
5. A system as defined in claim 4, wherein the computer programs
further include instructions to initiate packaging, by the one or
more pharmaceutical storage and electronic dispensing carts, one or
more medications into one or more disposable individual patient
dosing packages
6. A system as defined in claim 4, wherein the computer programs
further include instructions to provide remote training to the one
or more long-term care facility staff members from the long-term
care facility remote pharmacy by selectively remotely controlling
one or more functions, available to the one or more long-term care
facility staff members from a terminal of one of the at least one
pharmaceutical storage and electronic dispensing carts, by the
long-term care facility management computer programs via the
communications network responsive to input received from the one or
more long-term care facility remote pharmacy personnel.
7. A system as defined in claim 4, wherein the one or more
pharmaceutical storage and electronic dispensing machines is
further adapted to be in communication with one or more video input
devices, wherein the computer programs further include instructions
to display, at the long-term care facility remote pharmacy, one or
more video images of at least one visually accessible functional
component of one of the one or more pharmaceutical storage and
electronic dispensing carts via the long-term care facility
management computer programs over the communications network
responsive to video signals received from the one or more video
input devices and to provide remote troubleshooting of the one or
more pharmaceutical storage and electronic dispensing carts by the
one or more long-term care facility remote pharmacy personnel
responsive to the video image of the at least one visually
accessible functional component of the one or more pharmaceutical
storage and electronic dispensing machines.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 13/725,432, filed Dec. 21, 2012, titled
"System And Software Of Enhanced Pharmaceutical Operations In
Long-Term Care Facilities And Related Methods" which is a
divisional of U.S. patent application Ser. No. 13/454,624, filed
Apr. 24, 2012, now U.S. Pat. No. 8,489,425, issued Jul. 16, 2013,
titled "System and Software of Enhanced Pharmaceutical Operations
in Long-Term Care Facilities and Related Methods," which is a
continuation of U.S. patent application Ser. No. 11/818,416, filed
Jun. 14, 2007, now U.S. Pat. No. 8,260,632, issued Sep. 4, 2012,
titled "System and Software of Enhanced Pharmaceutical Operations
in Long-Term Care Facilities and Related Methods," which is a
divisional of U.S. patent application Ser. No. 10/944,993, filed
Sep. 20, 2004, now U.S. Pat. No. 7,698,019, issued Apr. 13, 2010,
titled "System and Software of Enhanced Pharmaceutical Operations
in Long-Term Care Facilities and Related Methods," which claims
priority of U.S. Provisional Application Ser. No. 60/516,678, filed
Nov. 3, 2003, titled "System and Software of Enhanced
Pharmaceutical Operations in Long-Term Care Facilities and Related
Methods," each incorporated herein by reference in its
entirety.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] This invention relates to the nursing home, retirement home,
assisted living facility, and other long-term care industries in
general and, more particularly, to pharmaceutical operations within
nursing homes, retirement homes, assisted living facilities, and
other long-term care facilities.
[0004] 2. Description of Related Art
[0005] Over the years, pharmacies have been a backbone in providing
prescription drugs and other medications to people and have been a
convenience as retail pharmacies have expanded to locating close to
most residential areas in our country. Recently, pharmacies also
have been placed inside of facilities such as hospitals, physician
offices, malls, nursing homes, retirement homes, assisted living
facilities, and other locations to make it easier for people to get
access to medications and to facilitate interaction with medical
personnel. Because of the numerous types of medications stored and
dispensed by pharmacies, automation within the pharmacy industry
has been desirable. Accordingly, numerous developments have been
made to automate the pharmacy ordering, dispensing, and storage
capabilities. For example, machines have been developed to store
and dispense medication responsive to security codes or other
identification from medical personnel or users. Also, electronic
storage and dispensing carts have been developed which are often
stored on each floor of a hospital to allow the carts to
electronically receive dispensing instructions from a hospital
pharmacy computer. Additionally, machines have been developed to
store several hundred different types of medications and to
dispense the medications to medical personnel for distribution to
patients.
[0006] Nevertheless, little has been done to enhance storage and
distribution of medications in nursing homes, retirement homes,
Alzheimer's living facilities, senior communities, assisted living
facilities, and other types of long term care facilities
(hereinafter collectively "long-term care facilities") which are
significantly different in operation, personnel structure, and
physical structure than hospitals, physician offices, and home
care. This is increasingly important as the baby boom generation
ages and more and more people enter these long-term care
facilities. Also, because more and more people are and will be
entering these long-term care facilities and because medication
costs have been rising over the years, attempting to help make
pharmacies, providing services to these long term facilities,
profitable can often be important in successfully operating a
long-term care facility. Further, error can arise when dispensing
medication, and a need still exists to reduce the risk of error in
dispensing medication, especially in long-term care facilities.
SUMMARY OF THE INVENTION
[0007] In view of the foregoing, embodiments of the present
invention advantageously provide a system, software and methods for
enhancing pharmaceutical operations in nursing homes, assisted
living facilities, retirement homes, and other long-term care
facilities. Embodiments of the present invention also
advantageously provide a system, software, and methods for enhanced
pharmaceutical operations in long-term care facilities that
substantially reduces medication shortages, reduces medication
preparation time, reduces medication passing or dispensing time,
reduces medication waste, enhances documentation, and enhances
regulatory acceptance. Embodiments of the present invention
additionally provide a system, software, and methods for enhanced
pharmaceutical operations in long-term care facilities, which
substantially reduce the risk of error associated with dispensing
medications to patients in the homes or facilities. Embodiments of
the present invention further provide a system, software, and
methods for enhanced pharmaceutical operations in long-term care
facilities, which enhance profitability of pharmacy business
associated with the homes or facilities. Embodiments of the present
invention still further provide a system, software, and methods for
enhanced pharmaceutical operations, which streamline the medication
dispensing procedures for medical personnel working with the
long-term care facilities to help make the procedures more
efficient and easier.
[0008] More particularly, embodiments of the present invention
provide a system of enhanced pharmaceutical operation services for
long-term care facilities. For example, in an embodiment of the
present invention, a system includes a first data processing and
management computer including a first memory to store data therein
to thereby define a long-term care facility pharmacy group
management server. Long-term care facility pharmacy management
software stored in the first memory of the long-term care facility
pharmacy group management server manages pharmaceutical operations
in long-term care facilities. A plurality of pharmaceutical storage
and electronic dispensing carts are each positioned in a separate
long-term care facility remote from the long-term care facility
pharmacy group management server and are in communication with the
long-term care facility pharmacy group management server though a
communication network to store pharmaceuticals therein and to
dispense the pharmaceuticals to authorized healthcare personnel
located at the long-term care facility. A second remote pharmacy
group computer is positioned remote from and in communication with
the long-term care facility pharmacy group management server, and
is positioned remote from and in communication with the plurality
of pharmaceutical storage and electronic dispensing carts. The
second remote pharmacy group computer includes a second memory to
store data therein to define a remote pharmacy group server. A
plurality of pharmaceutical prescription document processors are
each positioned in the long-term care facility where at least one
of the plurality of pharmaceutical storage and electronic
dispensing carts is located and are in communication with the
remote pharmacy group server or the pharmacy group management
server to process a pharmaceutical prescription order from the
long-term care facility to be delivered to the long-term care
facility for storage and dispensing through the at least one of the
plurality of pharmaceutical storage and electronic dispensing
carts. The system can also include a plurality of video input
devices each separately positioned adjacent a respective one of the
plurality of pharmaceutical storage and electronic dispensing carts
remote from and in communication with at least one of the long-term
care facility pharmacy group management server and the remote
pharmacy group server. Each video input device is positionable to
produce a video image of facility health care personnel and
preferably is positionable to view visually accessible functional
components of the adjacent pharmaceutical storage and electronic
dispensing cart. This allows for the provision of visual feedback
to pharmacy personnel to allow for enhanced training facility
health-care personnel and for troubleshooting the pharmaceutical
storage and electronic dispensing cart. The system also can include
a pharmaceutical storage facility associated with the remote
pharmacy group server and having a plurality of pharmaceuticals
stored therein. The pharmaceutical storage facility has at least
one vehicle to facilitate delivery of the pharmaceuticals at the
storage facility to each of the plurality of pharmaceutical storage
and electronic dispensing carts at the plurality of long-term care
facilities responsive to the pharmaceutical prescription order.
[0009] Also, for example, in an embodiment of the present
invention, a system can include a pharmacy group management
computer defining a long-term care facility pharmacy group
management server, and long-term care facility pharmacy management
software associated with the long-term care facility pharmacy group
management server to manage pharmaceutical operations in a
plurality of long-term care facilities. A plurality of
pharmaceutical storage and electronic dispensing carts are each
positioned in a long-term care facility separate and remote from
the long-term care facility pharmacy group management server to
store pharmaceuticals therein and to dispense the pharmaceuticals
to authorized health care personnel located at the long-term care
facility. The plurality of pharmaceutical storage and electronic
dispensing carts and a plurality of pharmaceutical prescription
document processors are each positioned in a long-term care
facility remote separate from and in communication with the
long-term care facility pharmacy group management server or a
remote pharmacy group computer or server to process a
pharmaceutical prescription order from the long-term care facility
and to be delivered to the long-term care facility.
[0010] Additionally, according to an embodiment of the present
invention, a system can include a first pharmacy group management
computer defining a long-term care facility pharmacy group
management server and long-term care facility pharmacy management
software associated with the long-term care facility pharmacy group
management server to manage pharmaceutical operations in a
plurality of long-term care facilities. A plurality of
pharmaceutical storage and electronic dispensing carts are each
positioned in one of the plurality of long-term care facilities
remote from the long-term care facility pharmacy group management
server and in communication with the long-term care facility
pharmacy group management server to store a plurality of different
pharmaceuticals, package a plurality of individual doses of
pharmaceuticals, and dispense the plurality of individual doses of
pharmaceuticals to authorized facility medical personnel located at
one of the plurality of long-term care facilities. A remote
pharmaceutical dispensing and storage facility is positioned remote
from the plurality of pharmaceutical storage and electronic
dispensing carts and is associated with a second remote pharmacy
group computer defining a remote pharmacy group server which is
also in communication with the long-term care facility pharmacy
group management server and each of the plurality of pharmaceutical
storage and electronic dispensing carts through the communication
network. The remote pharmaceutical dispensing storage facility has
a plurality of pharmaceuticals stored therein and has at least one
vehicle positioned to deliver selected pharmaceuticals at the
storage facility to each of the plurality of pharmaceutical storage
and electronic dispensing carts. Delivery, preferably along a
preplanned or preselected delivery route, is accomplished in
response to a combination of individual facility patient
pharmaceutical dispensing instructions and medication inventory for
each of the plurality of pharmaceutical storage and electronic
dispensing carts.
[0011] Embodiments of the present invention provide long-term care
facility pharmacy management software adapted to be stored on the
storage media. For example, in an embodiment of the present
invention, the software includes a patient prescription receiver
which receives a digital image of a patient medication prescription
order from a pharmaceutical prescription document processor
associated with a remote medication dispensing apparatus, such as
the above described pharmaceutical storage and dispensing device,
to store the digital image of the patient medication prescription
and to queue the digital image for prescription order processing. A
queue receives the digital image and holds the digital image for
prescription order requirements entry and release verification by a
remote pharmacy pharmacist. A drug conflict analyzer, responsive to
the prescription order requirements and data contained within the
patient record, can analyze the prescription order requirements
against a patient medication profile, a patient allergy profile, a
patient diagnosis profile, a patient insurance profile, and a drug
interaction profile, to determine if a conflict exists. If no
conflict is found, a dispensing initiator positioned to receive the
medication inventory for each of the pharmaceutical storage and
electronic dispensing carts and responsive to the release
verification performed by the remote pharmacy pharmacist, can
transmit individual facility patient pharmaceutical dispensing
instructions to the respective pharmaceutical storage and
electronic dispensing cart over the communication network to
thereby initiate patient medication dispensing.
[0012] Also, for example, in an embodiment of the present
invention, the software is adapted to be stored on a storage media
associated with a pharmacy group management computer to manage
pharmaceutical operations in a remote pharmaceutical dispensing and
storage facility and a plurality of remotely positioned long-term
care facilities each having a medication dispensing apparatus. The
software is further adapted to accept prescriptions from a
physician, patient identification information and pharmaceutical
inventory from the medication dispensing apparatus, and insurance
information from the patient's insurance company. This allows the
software to control dispensing medication from the medication
dispensing apparatus to an authorized health-care personnel in each
of the long-term care facilities, to control inventory in the
medication dispensing apparatus, to order delivery of
pharmaceuticals from the remote pharmaceutical dispensing and
storage facility to restock the medication dispensing apparatus or
for individually tailored prescription delivery for those
prescriptions not stocked in the medication dispensing apparatus,
and to electronically process medication claims with a
reimbursement provider.
[0013] Further, embodiments of the present invention also can
include a computer readable medium that is readable by a computer
to manage pharmaceutical operations in a remote pharmaceutical
dispensing and storage facility defining a remote pharmacy and in a
plurality of remotely positioned long-term care facilities each
having at least one remote pharmaceutical dispensing and storing
apparatus in communication with the computer and having a memory
and a plurality of medication dispensing cartridges associated
therewith. In the preferred embodiment of the present invention,
the computer readable medium includes a set of instructions that,
when executed by the computer, cause the computer to perform the
following operations: establishing remote communications between
each pharmaceutical storage and dispensing apparatus and the remote
pharmacy, registering at least one patient for each of the
plurality of long-term care facilities in a database of residents
for the long-term care facility associated with a pharmaceutical
storage and dispensing apparatus located at that long-term care
facility, storing in memory of each pharmaceutical storage and
dispensing apparatus at least one medication type, an amount of
medication to be dispensed, and a medication dispensing time,
dispensing medication responsive to patient prescription
requirements for each patient registered to the pharmaceutical
storage and dispensing apparatus located at each respective
long-term care facility, and maintaining a record of medication
dispensed and an inventory of medication remaining in each
cartridge of each pharmaceutical storage and dispensing
apparatus.
[0014] Embodiments of the present invention also include methods of
providing pharmaceutical services to long-term care facilities. A
method includes providing a pharmacy remote from a plurality of
long-term care facilities to define an long-term care facility
pharmacy, restructuring long-term care facility staff procedures
for communication between long-term care facility staff and the
long-term care facility pharmacy, restructuring medication
procurement and resident medication distribution procedures within
the plurality of long-term care facilities, installing a
pharmaceutical storage and electronic dispensing cart at each of
the plurality of the long-term care facilities to be used by the
long-term care facility staff, and visiting each of the plurality
of long-term care facilities on a preselected frequency by pharmacy
staff from the remote pharmacy to assess performance and enhance
communication.
[0015] By restructuring long-term care facility staff communication
procedures and medication procurement and patient distribution
procedures, embodiments of the present invention advantageously
enhance pharmaceutical operations by allowing an individual
long-term care facility to participate in a broader network of a
plurality of long-term care facilities to thereby participate in
costing and delivery benefits of the plurality or group of
long-term care facilities. Such group participation streamlines
operational procedures and communication and enhances profitability
of the individual long-term care facilities.
[0016] Embodiments of the present invention also include methods
for generating revenue from a plurality of long-term care
facilities each devoid of an on-location pharmacy. For example, in
an embodiment of the present invention, a method includes reducing
management overhead costs and reducing pharmaceutical delivery
costs. Management overhead costs can be reduced by assigning each
of the plurality of long-term care facilities at least one
automated pharmaceutical storage and dispensing cart to reduce
workload of facility staff members, assigning a plurality of the
long-term care facilities to each of at least one long-term care
facility remote pharmacy, and assigning the at least one long-term
care facility remote pharmacy to a single long-term care facility
pharmacy group manager, to thereby continuously monitor multiple
long-term care facilities. Pharmaceutical delivery costs can be
reduced by delivering pharmaceuticals by long-term care facility
remote pharmacy vehicle to replenish, in a single delivery
iteration, each of a plurality of the automated pharmaceutical
storage and dispensing carts and to provide those pharmaceuticals
according to the patient prescription requirements and not provided
by each respective pharmaceutical storage and electronic dispensing
cart.
[0017] Still further, in an embodiment of the present invention, a
method includes providing a pharmacy remote from a plurality of
long-term care facilities to define a long-term care facility
remote pharmacy, positioning at least one pharmaceutical storage
and dispensing apparatus having at least one removable medicine
cartridge in each of the plurality of long-term care facilities to
store and dispense pharmaceuticals to a patient living therein, and
establishing remote communications between each pharmaceutical
storage and dispensing apparatus and the remote pharmacy. This
results in a generation of revenue due to cost savings for both the
pharmacy and the long-term care facilities and secures a stable
level of sales. Patients for each of the plurality of long-term
care facilities are then registered in a database of residents for
the long-term care facility associated with a respective
pharmaceutical storage and dispensing apparatus located at that
long-term care facility, the database stored in memory of a data
processing and management computer. At least one medication type,
amount to be dispensed, and a medication dispensing time is then
remotely programmed into each pharmaceutical storage and dispensing
apparatus, and medication is dispensed according to patient
prescription requirements for each associated registered patient.
An inventory of medication dispensed and medication remaining can
be maintained in the pharmaceutical storage and dispensing
apparatus and transmitted directly or indirectly to the remote
pharmacy to allow for just-in-time type resupply of the
pharmaceutical storage and dispensing apparatus. Further, separate
billing records along with consolidated billing data can be
supplied for each plurality of registered patients at each of the
plurality of long-term care facilities. The methodology allows for
the consolidated billing data to be organized by patient, facility,
remote pharmacy, and reimbursement provider. This again reduces
overhead to the pharmacy and the facility and can allow for
batch-type processing by a reimbursement provider.
BRIEF DESCRIPTION OF THE DRAWINGS
[0018] So that the manner in which the features and benefits of the
invention, as well as others which will become apparent, may be
understood in more detail, a more particular description of the
invention briefly summarized above may be had by reference to the
embodiments thereof which are illustrated in the appended drawings,
which form a part of this specification. It is to be noted,
however, that the drawings illustrate only various embodiments of
the invention and are therefore not to be considered limiting of
the invention's scope as it may include other effective embodiments
as well.
[0019] FIG. 1A is a schematic block diagram of a plurality of
remote pharmacy group computers networked to a remote pharmacy
group management server of a system and software for enhanced
pharmaceutical operations in long-term care facilities according to
an embodiment of the present invention;
[0020] FIG. 1B is a schematic block diagram of a remote pharmacy
group computer networked to a plurality of long-term care
facilities of a system and software for enhanced pharmaceutical
operations in long-term care facilities according to an embodiment
of the present invention;
[0021] FIG. 2 is an environmental perspective view of a medication
storage and dispensing apparatus and a long-term care facility
operational diagram of a system, software, and method for enhanced
pharmaceutical operations in a long-term care facility according to
an embodiment of the present invention;
[0022] FIG. 3 is an environmental perspective view of medical
personnel using a medication storage and dispensing apparatus of a
system, software, and method of enhanced pharmaceutical operations
in long-term care facilities according to an embodiment of the
present invention;
[0023] FIG. 4A is a perspective view of a medication dispensing
tray/caddie of a medication storage and dispensing apparatus of a
system for enhanced pharmaceutical operations according to an
embodiment of the present invention;
[0024] FIG. 4B is a perspective view of one of the medication
dispensing envelopes in the medication dispensing tray/caddie of
FIG. 4A according to an embodiment of the present invention;
[0025] FIG. 5 is a top plan view of a long-term care facility of a
system and method of enhanced pharmaceutical operations in
long-term care facilities according to an embodiment of the present
invention;
[0026] FIG. 6 is a schematic flow diagram of a method of enhanced
pharmaceutical operations in a long-term care facility according to
an embodiment of the present invention;
[0027] FIG. 7 is a schematic block diagram of a system and software
for enhanced pharmaceutical operations of long-term care facilities
according to the present invention;
[0028] FIG. 8A is a partial schematic flow diagram of software and
methods for enhanced pharmaceutical operations in long-term care
facilities according to an embodiment of the present invention;
[0029] FIG. 8B is a partial schematic flow diagram of software and
methods for enhanced pharmaceutical operations in long-term care
facilities according to an embodiment of the present invention;
[0030] FIG. 8C is a schematic block diagram of database software of
a system for enhanced pharmaceutical operations in long-term care
facilities according to an embodiment of the present invention;
[0031] FIG. 9 is a schematic diagram of a system for enhanced
pharmaceutical operations in long-term care facilities according to
an alternative embodiment of the present invention;
[0032] FIG. 10 is a partial schematic diagram of software to
enhance pharmaceutical operations in long-term care facilities
according to an embodiment of the present invention;
[0033] FIG. 11 is a schematic flow diagram of a method of
generating revenue from a plurality of long-term care facilities
devoid of an on-location pharmacy according to an embodiment of the
present invention; and
[0034] FIGS. 12A-C are schematic flow diagrams of a method of
increasing sales to and generating revenue from a plurality of
long-term care facilities being devoid of an on-location pharmacy
according to an embodiment of the present invention.
DETAILED DESCRIPTION
[0035] The present invention now will be described more fully
hereinafter with reference to the accompanying drawings, which
illustrate embodiments of the invention. This invention may,
however, be embodied in many different forms and should not be
construed as limited to the illustrated embodiments set forth
herein. Rather, these embodiments are provided so that this
disclosure will be thorough and complete, and will fully convey the
scope of the invention to those skilled in the art. Like numbers
refer to like elements throughout. Prime notation, if used,
indicates similar elements in alternative embodiments.
[0036] FIGS. 1A-1B illustrate a system 10 of enhanced
pharmaceutical operation services for long-term care facilities 12
according to an embodiment of the present invention that includes a
data processing and management computer including a memory 21 to
store data therein thereby to define a long-term care facility
pharmacy group management server 15, long-term care facility
pharmacy management software 20 stored in the memory 21 of the
long-term care facility pharmacy group management server 15 to
manage pharmaceutical operations in long-term care facilities 12,
and a communications network 18 in communication with the long-term
care facility pharmacy group management server 15. An alternative
embodiment of such a system 10' is illustrated in FIG. 9 as
well.
[0037] As perhaps best shown in FIGS. 2-5, the system 10 also
includes a plurality of pharmaceutical storage and electronic
dispensing machines or carts 30 each positioned in a separate
long-term care facility 12 remote from the long-term care facility
pharmacy group management server 15 and in communication with the
long-term care facility pharmacy group management server 15 through
the communication network 18 to store pharmaceuticals therein and
to dispense the pharmaceuticals to authorized health care personnel
located at the long-term care facility 12. Each of the plurality of
pharmaceutical storage and electronic dispensing machines or carts
30 store a plurality of different pharmaceuticals, e.g., 176 oral
solid medications as well as additional bulk storage capabilities,
package a plurality of individual doses of pharmaceuticals,
dispense the plurality of individual doses of pharmaceuticals to
authorized healthcare personnel at the long-term care facilities,
and are well understood by those skilled in the art. An example of
such a pharmaceutical storage and electronic dispensing machine or
cart 30, as understood by those skilled in the art, is the
PyxisEnvoy.TM. by Pyxis Corporation of San Diego, Calif. The
PyxisEnvoy, for example, is a dispensing machine capable of
securely storing bulk medication for automated patient-specific
dispensing. The PyxisEnvoy is capable of packaging medications in
individual patient-specific envelopes, both on-demand or at a
predetermined time interval, and can organize the patient's
envelopes into medication carriers. The envelopes can be further
organized whereby "first dose" medications and PRN medications are
positioned into separate medication carriers. Further, each
envelope can be labeled by the machine with the patient's name,
room number, medication, and strength. The PyxisEnvoy can store
bulk medications in refill cartridges and containers providing an
on-site reserve supply of medications. The PyxisEnvoy, for example,
advantageously has the necessary hardware to be remotely
controllable from an off-site location and the ability to receive
or interface with additional software. As will be understood by
those skilled in the art, other types of dispensing carts can be
used as well according to the present invention.
[0038] Each of the pharmaceutical storage and electronic dispensing
machines or carts 30 has associated software which interfaces with
and communicates with the pharmacy group management software 20 so
that once preselected block times and other system parameters of
the embodiments of the present invention are implemented, data
entry can be performed by a pharmacy remote from the long-term care
facility 12. Also, once preselected block times are established,
the pharmaceutical storage and electronic dispensing machines or
carts 30 can automatically, i.e. responsive to predetermined
commands in memory, package all scheduled medications and perform a
regularly scheduled catch-up run to process new or changed
medication orders.
[0039] As understood by those skilled in the art, these machines or
carts 30 package medication in patient specific envelopes sorted in
a preselected order, e.g., an order specified by the long-term care
facility 12. Advantageously, there is no need to punch medications
out of a blister pack into a cup or to search an entire medication
cart for a vial of medication, e.g., that someone forgot to
reorder. Because these pharmaceutical storage and electronic
dispensing machines or carts 30 can store large amounts, e.g., 176,
of different medications and can dispense these medications,
long-term care facilities 12 do not have to constantly reorder
medications. The system 10 and methods maintain an inventory of the
number of medications dispensed and number available for
dispensing. Each container of the 176 working inventory containers
includes a memory chip (not shown), as understood by those skilled
in the art, for such inventory control and lot tracking of the
medication. Each machine or cart 30 can have a separate removable
medicine cartridge (not shown) for each medication type. The system
10 and methods fill these machines or carts 30 at preselected
intervals, e.g., once a week, or as needed based on current
inventory and usage rate.
[0040] As shown in FIGS. 1A and 1B, the system 10 additionally can
include a remote pharmacy group computer. The remote pharmacy group
computer is positioned remote from the long-term care facility
pharmacy group management server 15, in communication with the
long-term care facility pharmacy group management server 15 and the
plurality of pharmaceutical storage and electronic dispensing carts
30 through the communication network 18, and has a memory to store
data therein, to define a remote pharmacy group server 40. The
remote pharmacy group server 40 is preferably located in a remote
pharmaceutical dispensing and storage facility defining a remote
pharmacy 41.
[0041] The system 10 can also include a plurality of pharmaceutical
prescription document processors 14, e.g., facsimile machines,
scanners, or other document processing machines, computers, or
equipment as understood by those skilled in the art, each
positioned in a long-term care facility 12 remote from and in
communication with the remote pharmacy group server 40 to process a
pharmaceutical prescription order from the long-term care facility
12 to be delivered to the long-term care facility 12.
[0042] Each of a plurality of preferably non-stationary video input
devices 31 (FIG. 2), such as a digital, analog, or other type of
camera, charge coupled device, digital imaging source, or other
device to capture images, as understood by those skilled in the
art, can be positioned in one of the long-term care facilities 12
adjacent and preferably interfaced with a respective one of the
plurality of pharmaceutical storage and electronic dispensing carts
30 remote from and in communication with at least one of the
long-term care facility pharmacy group management server 15 and the
remote pharmacy group server 40. The video input devices 31 are
positionable to produce for display over the communications network
18 a video image of facility medical personnel and visually
accessible functional components of the pharmaceutical storage and
electronic dispensing cart 30, including e.g. the prescription
document processor 14. This functionality advantageously provides
visual feedback to pharmacy personnel to train the facility medical
personnel and for troubleshooting the pharmaceutical storage and
electronic dispensing cart 30.
[0043] The system 10 can also include a pharmaceutical storage
facility 16 associated with the remote pharmacy group server 40 and
having a plurality of pharmaceuticals stored therein and at least
one vehicle V to facilitate delivery of the pharmaceuticals at the
storage facility to each of the plurality of pharmaceutical storage
and electronic dispensing carts 30 at the plurality of long-term
care facilities 12, responsive to the pharmaceutical prescription
order.
[0044] As perhaps best shown in FIGS. 7, 8C, and 10, the long-term
care facility pharmacy management software 20 is particularly
adapted to accept prescriptions from a physician, patient
identification information from the long-term care facility,
facility information, insurance information from the patients
insurance company, claim information, drug utilization review, and
pharmaceutical inventory from the pharmaceutical storage and
dispensing machines or carts 30 (FIG. 2) to control inventory in
each of the plurality of pharmaceutical storage and electronic
dispensing machines or carts 30 and to order delivery of
pharmaceuticals to restock the dispensing carts 30 or for
individually tailored prescription delivery by the vehicles V (FIG.
1B) for those prescriptions not stocked in the dispensing carts 30.
The long-term care facility pharmacy management software 20, for
example, also can include automated inventory replenishment of the
dispensing carts 30, dispensing cart dispensing control, claim
processing, prescribed drug conflict analysis based on patient
medication profile, allergies, diagnosis, prescribed drug conflict
analysis based on prescribed drug interaction, and prescribed drug
analysis based on patient insurance coverage. Note, the software 20
can be in the form of microcode, programs, routines, and symbolic
languages that provide a specific set for sets of ordered
operations that control the functioning of the hardware and direct
its operation, as known and understood by those skilled in the
art.
[0045] As shown in FIGS. 1-12C, embodiments of the system 10
include pharmacy management software 20 and methods designed to
deliver pharmaceutical operation services to a plurality of
long-term care facilities 12, e.g., staff and residents, positioned
remotely from a pharmacy and utilizing a plurality of
pharmaceutical storage and dispensing carts 30 in the long-term
care facility 12, in a manner that significantly enhances the
synergistic relationships of healthcare providers involved in the
daily care of residents. The system 10 advantageously uses
hardware, software, and robotics to converge previously disparate
healthcare providers at the resident's side. The financial, social,
and medical impact of long-term care facility providers
communicating in real-time or near real time with near real-time
medication delivery provides significant cost reduction for
healthcare payors. It is thought that millions, or even billions,
of dollars of medication are wasted each year due to a combination
of poor communication between long-term care providers and prior
art medication delivery systems.
[0046] As shown in FIG. 10, much of the above identified software
20 can be implemented utilizing various components or modules.
Note, though shown positioned together, various parts of the
software 20, once loaded via a computer readable medium, can be
functionally distributed at various locations within the system
10.
[0047] In an embodiment of the present invention, the software 20
includes a patient prescription receiver 51 which receives a
digital image of a patient medication prescription order from a
pharmaceutical prescription document processor 14 associated with a
remote medication dispensing apparatus, such as pharmaceutical
storage and dispensing device 30, to store the digital image of the
patient medication prescription and to queue the digital image for
prescription order processing. A patient prescription order
transferor 53, preferably stored in memory of the pharmaceutical
storage and dispensing device 30 transmits over the communication
network 18 the digitized image of the patient medication
prescription order received from an associated pharmaceutical
prescription processor 14 to the pharmacy group management server
15 or remote pharmacy group server 40, in response to a release
initiated by either a pharmacy staff member or a facility staff
member. This provides the pharmacy group management server 15 or
remote pharmacy group server 40 with patient medication
requirements which can be stored in database 22. Correspondingly, a
patient record transferor 55 also preferably stored in the memory
of the pharmaceutical storage and dispensing device 30 can transmit
either a patient record or select portions thereof. The patient
record generally has fields which can include patient
identification, patient medication profile, patient allergy
profile, patient diagnosis profile, and patient insurance profile.
Upon receipt of either the entire patient record or select portions
thereof, the entire patient record or the select portions can be
stored in the memory 21 (database 22) of the pharmacy group
management server 15.
[0048] A queue 57 receives the digital image and holds the digital
image for prescription order requirements entry and release
verification by a remote pharmacy pharmacist. A drug conflict
analyzer 59, responsive to the prescription order requirements and
data contained within the patient record, can analyze the
prescription order requirements against the patient medication
profile, the patient allergy profile, the patient diagnosis
profile, and patient insurance profile, and a drug interaction
profile, to determine if a conflict exists. If no conflict is
found, a dispensing initiator 61 positioned to receive the
medication inventory for each of the pharmaceutical storage and
electronic dispensing carts 30 and responsive to the release
verification performed by the remote pharmacy pharmacist, can
transmit individual facility patient pharmaceutical dispensing
instructions to the respective pharmaceutical storage and
electronic dispensing cart 30 over the communication network 18 to
thereby initiate patient medication dispensing.
[0049] A patient billing tracker 63, responsive to patient
medication dispensing from the respective pharmaceutical storage
and electronic dispensing cart 30, can provide separate billing
records for each of a plurality of patients at the plurality of
long-term care facilities 12. A claims processor 65, responsive to
billing records from the patient billing tracker 63 and a date
reference signal, can submit medication claims for each patient to
either a reimbursement provider or a patient representative, or
both. The claims processor 65 can also consolidate billing data for
each long-term care patient, indexed by reimbursement provider, and
submit the medication claims to each respective reimbursement
provider.
[0050] An inventory tracker 67 can maintain the medication
inventory for each of the pharmaceutical storage and electronic
dispensing carts 30. An inventory replenisher 69 is positioned to
receive the medication inventory from the inventory tracker 67, and
responsive to the medication inventory decreasing below a minimum
threshold level, to notify pharmacy personnel associated with the
remote pharmaceutical dispensing and storage facility 40 of a
replenishment requirement for at least one of the pharmaceutical
storage and electronic dispensing carts 30.
[0051] A medication dispensing apparatus administrator 71,
responsive to an input from pharmacy personnel, can selectively
remotely control functions available to facility medical personnel
from the terminal of the pharmaceutical storage and electronic
dispensing cart 30, over the communications network, to thereby
remotely provide training to the facility medical personnel. A
medication dispensing apparatus imager 73, responsive to video
signals from the video input device 31, can display a video image
of facility medical personnel and functional components of the
pharmaceutical storage and electronic dispensing cart 30 over the
communications network 18, to also remotely provide training to the
facility medical personnel and for remote, real-time,
troubleshooting the pharmaceutical storage and electronic
dispensing cart 30.
[0052] It is important to note that although embodiments of the
present invention have been described in the context of a fully
functional system, those skilled in the art will appreciate that
the mechanism of the present invention and/or aspects thereof are
capable of being distributed in the form of a computer readable
medium of instructions in a variety of forms for execution on a
processor, processors, or the like, and that the present invention
applies equally regardless of the particular type of signal bearing
media used to actually carry out the distribution. Examples of
computer readable media include: nonvolatile, hard-coded type media
such as read only memories (ROMs) or erasable, electrically
programmable read only memories (EEPROMs), recordable type media
such as floppy disks, hard disk drives and CD-ROMs, and
transmission type media such as digital and analog communication
links.
[0053] For example, in an embodiment of the present invention, the
system 10 includes a computer readable medium comprising a set of
instructions that, when executed by a computer, such as, for
example, group management server 15, remote pharmacy group server
40, or a combination of the both, cause the computer to establish
remote communications between a remote pharmacy 16 and between each
of a plurality of pharmaceutical storage and dispensing apparatus
30 having a memory associated therewith and a plurality of
medication dispensing cartridges, to perform instructions to manage
pharmaceutical operations. The instructions can include those for
registering at least one patient for each of a plurality of
long-term care facilities 12 in a database of residents for the
long-term care facility 12 associated with a pharmaceutical storage
and dispensing apparatus 30 located at that long-term care facility
12. The instructions include those for receiving a digital image of
an actual pharmaceutical prescription order containing patient
prescription requirements, queuing the pharmaceutical prescription
order for examination by a remote pharmacy pharmacist associated
with the remote pharmacy 41, analyzing the patient prescription
requirements against parameters such as a patient medication
profile, a patient allergy profile, a patient diagnosis profile, a
patient insurance profile, and a drug interaction profile, to
determine if a conflict exists. The instructions can include those
for storing in memory of each pharmaceutical storage and dispensing
apparatus 30 at least one medication type, an amount to be
dispensed, and a medication dispensing time, and those for
maintaining a record of medication dispensed and an inventory of
medication remaining in each cartridge of each pharmaceutical
storage and dispensing apparatus 30. The instructions can also
include those for transmitting the patient prescription
requirements to the pharmaceutical storage and electronic
dispensing cart 30, and dispensing medication in response to the
patient prescription requirements for each patient registered to
the pharmaceutical storage and dispensing apparatus 30. The
instructions can further include those for submitting medication
claims to a reimbursement provider for each patient, providing
separate billing records for each registered patient at each of the
plurality of long-term care facilities 12, and consolidating
billing data for each registered patient at each of the plurality
of long-term care facilities 12, the billing data preferably
indexed by reimbursement provider.
[0054] FIG. 8C illustrates the typography of database software
according to an embodiment of the present invention. The system
user 351 is identified by a user ID related to the pharmacy group
353 by a pharmacy group ID. A facility 355 identified by a facility
ID is also related to the pharmacy group 353 by the pharmacy group
ID. A facility drug/medication dispensing cart 357 is related to
the facility 355 by the facility ID and to an individual drug cart
359 (identified by cart ID) by such cart ID. A drug cart inventory
361 identified by ndc (National Drug Counsel) and having
pharmaceuticals identified by medication ID is related to the drug
cart 359 by the cart ID. A facility formulary 363 is related to the
pharmacy group 353 through the preferred drug 365 by the group ID,
is related to the preferred drug 365 by a medication ID, and is
related to the facility 355 by the facility ID. A pharmacy 367
identified by nabp (National Association of Boards of Pharmacy
identification) is related to the pharmacy group 353 by the group
ID. A patient facility residency 369 identified by start date is
related to a patient 371 identified by patient ID by such patient
ID and is related to a facility room 373 (identified by room
number) by such room number. The patient 371 can be related to the
pharmacy group 353 by the group ID. The facility room 373 is
related to the facility 355 by the facility ID. A patient insurance
375 identified by coverage date is related to insurance 377
(identified by insurer ID) by such insurer ID, and is related to
the patient 371 by the patient ID. Patient allergy 379 identified
by allergy ID, patient diagnosis 381 identified by icd9 cd
(diagnosis profile), and patient medication profile 383 identified
by ndc are each related to patient 371 by the patient ID. A
prescription 385 identified by script ID is related to the pharmacy
367 by the nabp, is related to prescriber 389 (identified by
prescriber ID) by such prescriber ID, and can be related to the
patient 371 by the patient ID. Prescription detail 391 identified
by script fill number is related to the prescription 385 by the
script ID. Claim 393 identified by claim number is related to the
prescription detail 391 by the script fill number and to the
pharmacy group 353 by the group ID, is indirectly related to the
patient prescription 385 by the script ID and the pharmacy 367 by
the nabp, and can be related to the patient 371 by the patient ID.
A drug utilization review (DUR) 395 is related to the prescription
385 by the script ID, the patient 371 by the patient ID, and is
indirectly related to the pharmacy 367 by the nabp. DUR dose check
396, DUR drug allergy 397, DUR dup therapy 398, and DUR drug
interaction 399 are identified by drug index number and related
indirectly through the DUR 395 to the pharmacy 367 by the nabp,
prescription 385 by the script ID and patient 371 by the patient
ID. Database items (not shown) not having a primary relationship
include wholesale drug price identified by ndc, price code, icd9
cd, medication roa, medication dose form, and medication
frequency.
[0055] FIG. 9 illustrates a system 10' of enhanced pharmaceutical
operation services for a long-term care facility 12' according to
an embodiment of the present invention that includes an array of
incoming data servers, a database server, and automated dispensing
system servers each having a memory therein to store and process
data therein to thereby define a long-term care facility pharmacy
group management server 15'. The long-term care facility pharmacy
group management server 15' can manage pharmaceutical operations in
various managed care facilities and/or correctional facilities,
such as, for example, long-term care facility 12.' The long-term
care facility 12' includes at least one, but preferably a plurality
of automated dispensing systems or machines 30' to remotely
dispense medications, and a preferably centrally located image
capturing device or devices, such as, for example, fax machine 14'
and scanner 14'' connected to a workstation computer, to provide an
image of a patient prescription order. The system 10' additionally
can include at least one but preferably a plurality of remote
pharmacy group computers 40' positioned remote from the long-term
care facility 12.' The remote pharmacy group computers 40' are in
communication with the long-term care facility pharmacy group
management server 15' and the plurality of automated dispensing
systems or machines 30,' through a communication network, to
process the patient prescription orders and to provide dispensing
instructions to the automated dispensing systems or machines 30'.
The remote pharmacy group computers 40' are preferably located in a
remote pharmaceutical dispensing and storage facility at a location
remote from both the long-term care facility 12' and the pharmacy
group management server 15.' Long-term care facility pharmacy
management software 20 can be stored in the memory of the servers
defining the long-term care facility pharmacy group management
server 15' to manage pharmaceutical operations in long-term care
facility 12.' Further, at least portions of the software 20 can be
stored in the remote pharmacy group computers 40' and in the
automated dispensing systems or machines 30.'
[0056] As perhaps best shown in FIGS. 6, generally methods of
delivering pharmaceutical operation services have three main
components for implementation, namely restructuring communication
methods and intervals, automating medication procurement and
distribution, and evaluation of routine, e.g., weekly, visits to
assess system performance and maintenance. When a long-term care
facility 12 desires to implement an embodiment of a system 10
(FIGS. 1A-1B) to enhance pharmaceutical operations, a transition
team from the remote pharmacy staff, for example, or from a
combination of remote pharmacy staff and long-term care facility
staff, for example, can be used to assist in changing the existing
procedures of using pharmaceutical services and dispensing
medications for the long-term care facility 12 and in implementing
the new system 10, software 20, and methods of embodiments of the
present invention.
[0057] Restructuring communication methods and intervals, for
example, can include installing (block 101) facsimile, scanning, or
other document processing equipment 14 (FIG. 3) to scan physician
prescription orders and to transmit them to the remote pharmacy
group server 40 or the pharmacy group management server 15 via a
virtual private network ("VPN") 18 (see FIGS. 7). Medication errors
can be reduced when the pharmacy staff at the remote pharmacy view
exact images of orders (see also FIGS. 8A-8B). Voice communication
over telephone lines can be error prone due to language barriers
and transcription errors. Direct imaging allows the pharmacist to
interpret the medication orders in the same way as the facility
staff. Should an error be made, then one of the healthcare
professionals is more likely to discover the error if direct
imaging is in place. For example, allowing the pharmacist to read a
copy of the original document insures that at least two healthcare
professionals have reviewed the order, namely the nurse and the
pharmacist. These separate order reviews lead to separate
documentation by the nurse and the pharmacist. If these two
document sources do not match, then the nurse and pharmacist can
discuss the order and clarify with the prescriber, if
necessary.
[0058] The methods also supply long-term care facility staff with
the training and tools (block 103) to allow the remote pharmacy to
communicate with the facility 12 at the end of each medication
administration interval for administration of medication to the
residents of the long-term care facility 12. Because the
communication is built into or included with the medication
distribution procedures, the tools, for example, allow this
communication to occur frequently and without requiring additional
facility staff time. More frequent communications allow the system
10, software 20, and methods to reduce errors due to
miscommunication and misinterpretation of medication orders, and
tools such as medication pass lists (not shown) and new or changed
order reports (not shown), as understood by those skilled in the
art, result in better synchronization between the pharmacy and the
facility documentation. Medication pass lists are generally
utilized to document delivery of medication to a patient and
include the time, quantity, method of dispensing, and health
professional dispensing the medication. By supplying or
communicating such medication pass lists to the pharmacist, the
pharmacist is provided a unique methodology to determine if the
medication was dispensed according to instructions provided to the
pharmaceutical storage and dispensing apparatus 30 and if the
medication distribution procedures are being adhered too. New or
changed order reports are generally used to document changes in a
patient medication order and include changes in the time, quantity,
or method of dispensing medication. By supplying or communicating
such changed order report to the pharmacist, the pharmacist is
provided yet another methodology of determining if the medication
dispensing instructions provided to the pharmaceutical storage and
dispensing apparatus 30 coincide with that which the facility
medical personnel believe to be the instructions provided by the
patient prescription order. Any discrepancy can be discussed
between pharmacy member and facility medical personnel, enhancing
quality control. Advantageously, use of standardized medication
pass lists and new or changed order reports provided or approved by
the pharmacy allows enhanced communication between pharmacy and
facility medical personnel, not otherwise available if the pharmacy
had to review medication pass lists and new or changed order
reports having a different format for each long-term care facility
12.
[0059] Further, remote pharmacy personnel, through the long-term
care facility pharmacy group management server 15 or a remote
pharmacy group server 40, can dial-up or otherwise remotely access
the dispensing cart 30 through the communication network 18 and
perform virtual "face-to-face" training of facility medical
personnel along with other tasks such as, troubleshooting,
packaging medications, and all other functions that can be
performed by the dispensing cart 30, itself. In an embodiment of
the present invention having video input device 31 (FIG. 2), this
virtual "face-to-face" can further be in the form of a
videoconference, including audio communications, whereby pharmacy
personnel can monitor instantaneously the actions of the facility
medical personnel to provide real-time feedback and to verify
results of actions taken by the facility medical personnel or
functions performed by the dispensing cart 30. These features
provide the facility medical personnel real-time help in learning
and operating the dispenser cart 30 which advantageously provides
for an acceptance level not attainable where such real-time support
24/7 is not available. Note, the video input device 31 can be
mounted either to the dispensing cart 30 or adjacent the dispensing
cart 30 such that pharmacy personnel can readily view, and thus
help instruct, actions by facility medical personnel. In an
embodiment of the present invention, the video input device 31 can
include hardware such as, for example, servo motors, that will
allow the device 31 to be remotely controlled to change viewing
angle, to change focus, or to zoom in or out to better view the
facility medical personnel or components of the dispensing cart
30.
[0060] Likewise, within the remote pharmacy facility, the pharmacy
management software 20 can be networked to communicate with both
the long-term care facility document processor 14, e.g., fax
machine, scanner, or image capture device, and the pharmaceutical
storage and dispensing machines or cart 30, and the optional video
input device 31, at the long-term care facility 12 (block 105). The
software 20 and methods can be configured (block 107) to manage
information flow on the VPN 18 between the long-term care facility
document processor 14, long-term care facility pharmaceutical
storage and dispensing machines or cart 30, and one or more
pharmacy database 22 associated with the software 20. The software
20 and methods, thus, allow the remote pharmacy and the long-term
care facility 12 to communicate in real time or near real time and
provide near real time medication fulfillment for the long-term
care facility residents. The software 20 and methods also can
manage an unlimited number of long-term care facilities 12 (for
example, via a plurality of remote pharmacy groups (see FIG.
1A-1B)) within embodiments of the system 10 of the present
invention and can be assessed/managed by remote pharmacy staff by
use of the VPN.
[0061] For automating medication procurement and distribution, for
example, the transition team can aid in restructuring the
medication administration intervals (block 109) to accommodate more
of a just-in-time medication procurement system to significantly
reduce waste and risk of errors (see also FIG. 5). The medication
intervals can be combined into a preselected number of medication
pass time blocks (block 111), e.g., four pass times (breakfast
2400-0600, AM 0600-1030, Noon 1030-1430, and HS 1830-2400). Each
block of time has specific medication administration times within
the block (see also FIG. 5). Once time blocks are established,
these time blocks are programmed (blocks 113 and 115) into the
pharmaceutical storage and dispensing machines or carts 30 so that
pharmaceuticals or medications (FIG. 4B) are packaged by physical
location within the long-term care facility 12 and by time block
and loaded into caddies or trays 35 (FIG. 4A) associated with the
dispensing carts 30. This procurement method significantly reduces
long-term care facility staff time spent on medication procurement,
e.g., by up to 50%, and reduces medication errors. Long-term care
facility staff can be taught (block 117) how to produce medication
lists for each time block. The medication list is used as a road
map for the medication administration interval and can be
transmitted via the VPN 18 to the remote pharmacy. This method
enhances communication by requiring or insuring communication
between the remote pharmacy staff and the long-term care facility
staff at least four times per day with little added time commitment
by either party.
[0062] Additionally, the transition team can meet with facility
physicians to establish a type of automated therapeutic exchange
protocol (block 119). This protocol can be managed by the remote
pharmacy management software 20 and allows the long-term care
facility and remote pharmacy to manage formulary management
programs through the VPN 18 in a real time or near real time
manner. The therapeutic exchange protocol streamlines the inventory
of each of the plurality of pharmaceutical storage and electronic
dispensing carts 30, reduces wasted medication, and reduces costs
for payors.
[0063] Further, periodic or preselected visits (block 121) to each
long-term care facility within the system 10 to assess system
performance and maintenance can be conducted by the remote pharmacy
staff. This can enhance communication and enhance performance
assessments within the system 10. Dispensing carts 30, document
processors 14, software 20, medication inventory, and other
elements of the system 10 also can be maintained during these
visits as well. For example, medications that cannot be packaged by
a pharmaceutical storage and electronic dispensing cart 30 can be
reviewed and reordered, if needed.
[0064] As perhaps best shown in FIGS. 7-8B, in operation, to start
new medications nurses can have first dose privileges. If a
medication is for a new resident in the long-term care facility 12,
then the remote pharmacy or an on-call pharmacist can be notified
so the resident can be added to a database 22 of residents for the
particular long-term care facility 12 associated with the
pharmaceutical storage and dispensing cart 30 located at that
facility. A pharmacist at the remote pharmacy can enter
prescription information from a faxed or scanned physician's order
into the pharmacy group management software 20. More specifically,
the pharmacist receives the digital faxed/scanned image (block 131)
of the prescription for a patient. Based upon the information
provided with the prescription, the pharmacist then enters into the
software 20 the location of a remote pharmacy (block 133), the name
of or identification for the facility (block 135), the patient
information (block 137), and the preferred drug (block 139). The
pharmacist further enters (block 141) details of dosage, route of
administration, frequency and duration of the prescription. The
pharmacist further enters (block 143) the quantity to be dispensed
and prescribing physician information.
[0065] The software 20 can then perform (block 145) a drug
utilization review (see also FIG. 7). The above described
information is then sent to a checking queue (block 147) whereby
the pharmacist checks (block 149) the physical prescription for
correctness. The software 20 then can determine if the drug to be
dispensed is in stock in the pharmaceutical storage and dispensing
cart 30. If the software 20 determines that the medication is
stocked in the dispensing cart 30, then it can send the
prescription information to the dispensing cart 30 (block 151)
instead of printing a traditional prescription label. The cart 30
can then dispense the medication during the scheduled
administration time. If the medication is not stocked in the
dispensing cart 30, then a prescription label can be produced. The
prescription can then be filled and delivered in a traditional way
to the long-term care facility 12, e.g., by the vehicle V. The
traditional way, for example, can also be used for non-oral solid
medication such as liquids, creams, inhalers, and injectables as
well, e.g., daily deliveries, as the pharmaceutical storage and
electronic dispensing carts 30 often do not dispense these
items.
[0066] Advantageously, embodiments of the present invention also
include methods of increasing or generating revenue from a
plurality of long-term care facilities 12 being devoid of an
on-location pharmacy. For example, as perhaps best shown in FIG.
11, a method includes the steps of providing a pharmacy remote from
a plurality of long-term care facilities (block 161) to define a
long-term care facility remote pharmacy 41, positioning at least
one pharmaceutical storage and dispensing apparatus 30 in each of
the plurality of long-term care facilities 12 (block 163) to store
and dispense pharmaceuticals to a patient living therein, each
apparatus 30 preferably having at least one removable medicine
cartridge. Remote communications are established (block 165)
between each pharmaceutical storage and dispensing apparatus 30 and
the remote pharmacy 41. Patients can then be registered (block 167)
for each of the plurality of long-term care facilities 12 in a
database of residents of the long-term care facility 12 associated
with a respective pharmaceutical storage and dispensing apparatus
30, the database preferably stored in memory 21 of a data
processing and management computer, such as, for example group
management server 15. At least one medication type and amount to be
dispensed (block 169) and a medication dispensing time (block 171)
can be remotely programmed into each pharmaceutical storage and
dispensing apparatus 30. Medication is then dispensed (block 173)
according to patient prescription requirements for each associated
registered patient. An inventory is maintained (block 175) of the
medication dispensed and medication remaining in the pharmaceutical
storage and dispensing apparatus. Advantageously, the method can
include providing separate billing records (block 177) for each of
the patients at each of the plurality of long-term care facilities
12. Billing data can then be consolidated for each of the patients
(block 179) at each of the plurality of long-term care facilities.
Medication claims can then be submitted to a reimbursement provider
(block 181) organized by patient, grouped into categories, supplied
in a batch form for each registered patient.
[0067] Also for example, as perhaps best shown in FIGS. 12A-C, a
method of generating revenue from a plurality of long-term care
facilities each devoid of an on-location pharmacy generally
includes the steps of reducing management overhead costs (block
200), reducing pharmaceutical delivery costs (block 220), reducing
pharmaceutical error costs and liabilities due to miscommunication
and misinterpretation of a pharmaceutical prescription order (block
230), maintaining automated pharmaceutical storage and dispensing
cart operational status (block 240), streamlining long-term care
facility medication dispensing procedures (block 250), and
preventing prescription backlogs (block 260).
[0068] Management overhead costs can be reduced by assigning each
of the plurality of long-term care facilities 12 at least one
automated pharmaceutical storage and dispensing cart 30 (block
201), assigning a plurality of the long-term care facilities 12 to
each of at least one long-term care facility remote pharmacy 41
(block 203), and assigning the at least one long-term care facility
remote pharmacy 41 to a single long-term care facility pharmacy
group manager (block 205). This hierarchal management and supply
structure allows pharmacy group management to continuously monitor
multiple long-term care facilities 12 for a preselected region and
to provide real-time management of pharmaceutical distribution and
resupply. Further, costs can be reduced by remotely providing
training (block 207) by selectively remotely controlling functions
available to a facility staff member from a terminal of the
pharmaceutical storage and electronic dispensing cart 30 over a
communications network 18. This allows for the provision of a
virtual on-site face-to-face training session to help a facility
staff member having difficulties interfacing with the
pharmaceutical storage and dispensing cart 30, thus preventing the
need for an actual on-site visit and allowing provision of such
service 24 hours a day, 7 days a week, generally not otherwise
available. Training of facility staff members can be enhanced
(block 209) by providing pharmacy personnel with audio and with
visual feedback through a video input device 31 (FIG. 2) positioned
adjacent to and preferably interfaced with the pharmaceutical
storage and electronic dispensing cart 30 and positionable to
display over the network 18 a video image of the facility staff
member. Costs can further be reduced through the use of software 20
that can interface with the pharmaceutical storage and electronic
dispensing cart 30 to both providing separate billing records for a
plurality of patients at each of the plurality of long-term care
facilities (block 211), and generate reimbursements from a
reimbursement provider electronically (block 213). The
reimbursements can be generated by consolidating billing data for a
plurality of patients at each of the plurality of long-term care
facilities 12 (block 215) for submission to a respective same
reimbursement provider, followed by submitting medication claims
electronically (block 217) to each respective reimbursement
provider for each of the plurality of patients. This allows for
efficient batch-type processing of patient claims by each
reimbursement provider.
[0069] Pharmaceutical delivery costs can be reduced through the use
of a dedicated remote pharmacy vehicle V for delivering
pharmaceuticals to multiple long-term care facilities 12 to
resupply each facilities pharmaceutical storage and dispensing
carts 30 and to provide those pharmaceuticals according to the
patient prescription requirements and not provided by each
respective pharmaceutical storage and electronic dispensing cart
30, preferably all in a single delivery iteration. This allows for
establishing regular delivery routes resulting in efficient use of
the vehicular asset and pharmacy personnel.
[0070] Pharmaceutical error costs and liabilities due to
miscommunication and misinterpretation of a pharmaceutical
prescription order can be reduced through use of a procedure
whereby instead of having facility staff members review a
physician's prescription order and transmit extracted information,
facility staff members can transmit an exact image of each
physician's pharmaceutical prescription order (block 231) from a
pharmaceutical document processor 14 associated with a
pharmaceutical storage and electronic dispensing cart 30 over the
network 18 to a respective long-term care facility remote pharmacy
41. This procedure allows for establishment of a quality assurance
check (block 233) whereby both the facility staff member and the
remote pharmacist can both review the original or an exact image of
the original physician's pharmaceutical prescription order. This
redundancy reduces errors in interpretation of the physician's
prescription order. Patient prescription requirements can then be
analyzed (block 235) against a patient medication profile, a
patient allergy profile, a patient diagnosis profile, a patient
insurance profile, and a drug interaction profile, to determine if
a conflict exists. Further, a standardized Medication Pass List
(not shown) and a New or Changed Order Report (not shown) can be
provided (block 237) to synchronize pharmacy and long-term care
facility documentation. This synchronization prevents waste and
helps ensure accountability.
[0071] Maintaining operational status of an automated
pharmaceutical storage and dispensing cart 30 can be an extremely
significant issue in an automated pharmaceutical dispensing
operation. In the preferred embodiment of the present intention,
pharmacy staff members rather than facility staff members are
assigned a primary responsibility to monitor usage, restocking, and
maintenance of the pharmaceutical storage and dispensing cart 30
(block 241). Establishing accountability for the carts 30 with
pharmacy personnel has led to significant improvements in
operational status. Further, implementing a procedure whereby
pharmacy personnel can remotely troubleshoot over the communication
network 18 (block 243) a visually accessible functional component
of the pharmaceutical storage electronic dispensing cart 30 with
use of a video input device 31 (FIG. 2) positioned adjacent to and
preferably interfaced with the pharmaceutical storage and
electronic dispensing cart 30. In an embodiment of the present
invention, the video input device 31 can be connected to or
adjacent the pharmaceutical storage and electronic dispensing cart
30 via a flexible and/or snake mount or other suitable connection
known to those skilled in the art, such as, for example, a USB
cable, telephone cable, coaxial cable, optical cable, or wireless
transceiver. The video input device 31 can thus be positionable by
facility staff members or other personnel to display a real-time
video image of the visually accessible functional component of the
pharmaceutical storage and electronic dispensing cart 30, allowing
for real-time troubleshooting of the cart 30. Further, the video
input device 31, can be remotely controlled to change viewing
angle, to change focus, or to zoom in or out to better view the
component or components of interest and to monitor actions of the
facility medical personnel or other on-station pharmacy personnel
requested to move a panel or component or to perform the repair.
This allows pharmacy personnel to maintain supervision and thus
control, over any non-standard mechanical manipulation or repair of
the cart 30.
[0072] Streamlining long-term care facility medication dispensing
procedures can be accomplished by consolidating medication
intervals (block 251). In the preferred embodiment of the present
intention, medication intervals are consolidated into four
medication pass time blocks, each block having specific medication
administration times within the respective block. This has resulted
in improved medication dispensing efficiency, reduced facility
staff member workload and potentially significantly reduced costs
for the long-term care facility 12, and thus, an increase in
acceptance of the pharmaceutical storage and electronic dispensing
carts 30.
[0073] An inherent problem with having to receive electronic images
of the physician's prescription order is the potential for a
backlog due to prescription order entry difficulties. Due to the
reduced number of medication pass time blocks, receiving and
processing prescription orders can be time critical. In a
just-in-time type system, a prescription order entry difficulty
caused by as little as a single entry problem could potentially
cause a late arrival of the prescription order resulting in a late
delivery of patient medication. Institution of a maximum individual
order entry time protocol (block 261) prevents such prescription
backlogs due to prescription order entry difficulties. This
protocol allows the remote pharmacy 41 to accommodate massive
numbers of incoming prescription orders.
[0074] As illustrated in FIGS. 1-12C, and as described above,
embodiments of the present invention includes a method of providing
pharmaceutical services to long-term care facilities 12 including
providing a pharmacy remote from a plurality of long-term care
facilities 12 to define a long-term care facility remote pharmacy,
restructuring long-term care facility staff procedures for
communication between the long-term care facility staff and the
long-term care facility remote pharmacy, restructuring medication
procurement and resident medication distribution procedures within
a plurality of long-term care facilities, installing a
pharmaceutical storage and electronic dispensing machine or cart 30
at each of the plurality of long-term care facilities 12 to be used
by the long-term care facility staff, and visiting each of the
plurality of long-term care facilities 12 on a preselected
frequency, e.g., from the remote pharmacy, to assess performance
and enhance communication.
[0075] By implementing these methods, a system 10, and software 20
of embodiments of the present invention, shift-change medication
counts can be eliminated or significantly reduced, medication
preparation and pass times can be reduced, and drug/medication
destruction can be significantly reduced. Also, long-term care
facility staff can have more free time due to the planning and
implementation of a structure procedure of embodiments of the
present invention. In turn, care of the residents can be enhanced
by allowing staff to have more time for care of residents instead
of on medication preparation and passing time, documentation can be
improved, risk of liabilities can be reduced, risk of errors and
stolen medications can be reduced, and communication between
long-term care facility staff and pharmacy staff can be enhanced.
Additionally, embodiments of a system 10, software 20, and methods
allow a long-term care facility 12 to reduce operational costs and
staffing, if desired. In turn, residents and payors can save money,
and residents can have better care.
[0076] This application is a continuation of U.S. patent
application Ser. No. 13/725,432, filed Dec. 21, 2012, titled
"System And Software Of Enhanced Pharmaceutical Operations In
Long-Term Care Facilities And Related Methods" which is a
divisional of U.S. patent application Ser. No. 13/454,624, filed
Apr. 24, 2012, now U.S. Pat. No. 8,489,425, issued Jul. 16, 2013,
titled "System and Software of Enhanced Pharmaceutical Operations
in Long-Term Care Facilities and Related Methods," which is a
continuation of U.S. patent application Ser. No. 11/818,416, filed
Jun. 14, 2007, now U.S. Pat. No. 8,260,632, issued Sep. 4, 2012,
titled "System and Software of Enhanced Pharmaceutical Operations
in Long-Term Care Facilities and Related Methods," which is a
divisional of U.S. patent application Ser. No. 10/944,993, filed
Sep. 20, 2004, now U.S. Pat. No. 7,698,019, issued Apr. 13, 2010,
titled "System and Software of Enhanced Pharmaceutical Operations
in Long-Term Care Facilities and Related Methods," which claims
priority of U.S. Provisional Application Ser. No. 60/516,678, filed
Nov. 3, 2003, titled "System and Software of Enhanced
Pharmaceutical Operations in Long-Term Care Facilities and Related
Methods," each incorporated herein by reference in its
entirety.
[0077] Many modifications and other embodiments of the invention
will come to the mind of one skilled in the art having the benefit
of the teachings presented in the foregoing descriptions and the
associated drawings. Therefore, it is to be understood that the
invention is not to be limited to the illustrated embodiments
disclosed, and that modifications and other embodiments are
intended to be included within the scope of the appended
claims.
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