Inventory Systems Keep Track of Injectables

Physicians can keep tabs, identify usage trends, assist with billing accuracy, and more.

STEVE LENIER

The practice of the retina specialist has changed tremendously over the last several years, as injections have more and more become the standard of practice for different diseases. The drugs given in those injections are now a very prominent part of the armamentarium of a retina specialist.

Given the high cost of these injectables, and the large number of vials of medication a practice uses, a need has arisen for practices to have an efficient way to keep track of this process. This need is being addressed by the creation of automatic inventory systems.

These systems are designed to allow physicians and office staff (who can be given various levels of accessibility) to view the inventory of pharmaceuticals at any time for any location in their practice, and keep track of what is coming in and what is being used.

They can be used to identify usage trends, assist in keeping billing accurate, and send alerts as warranted. They can also help with accountability, keeping track of who did what with each vial.

Robert Wendel, MD, of Retinal Consultants in Sacramento, said, ‘It’s not just Lucentis anymore, it’s Lucentis and Eylea and Ozurdex and Triescence, and each has more indications, which means you need more of them. I can’t imagine how anybody is keeping track of all this without an inventory system.”

Barbara Osmun works as Pharmaceutical Department Coordinator with Dr. Wendel. She said with the system they use (PODIS), “We can track everything. I can look in the system and see exactly what I have and I can see the expiration dates. I can run reports, for instance there’s a report that shows us if a vial has not been billed correctly or not been billed at all, or if there’s some kind of discrepancy with our billing system. There is even an alert that you can put in the system not to use a certain drug in a certain patient.”

Michael Colucciello, MD, who is a retina specialist and partner at South Jersey Eye Physicians in Moorestown, NJ, and who uses PODIS, commented on the usefulness of the expiration date notification, saying, “It allows us to evaluate which ones are expiring, so which lot number we should use first, versus which ones we should use later, and it gives us an alert to tell us when something is going to expire so we can preferentially use one lot over another.”

Different systems are being developed to address this need. Three inventory systems currently being used in retina practices are similar in some ways but have different approaches.

BAR CODE VS RFID

One difference is the method by which the system identifies the product being put into, or taken out of, the practice’s inventory. The Physician Office Drug Inventory System (PODIS) mentioned above uses bar codes.

Each vial has a bar code attached to its packaging, and this code matches up with the information in PODIS, so that every vial has a unique identifier and can be tracked. Both the CubixxMD system and the system from USRetina use Radiofrequency Identification (RFID) tags as the unique identifier on each vial.

For a bar code system, when a vial is used, or when it’s replaced, someone scans the vial with the code reader to transfer that code to the system. For the RFID systems, this is done automatically. Both of these RFID systems come with a refrigerated cabinet, and an ambient (non-refrigerated) cabinet.

As a vial is placed into, or taken out of, one of these cabinets, the cabinet is aware the door has opened and therefore a transaction has taken place. When the door closes, the cabinet then automatically scans the current contents and updates the system. For the PODIS system, any appropriate refrigerator and cabinet can be used.

Matt Balka, head of product development for the USRetina system, said, “In the past a practice would order inventory from their wholesale partner, receive that inventory, open it and manually check it in, place it in the freezer, and then track it all the way through use in a patient. We designed our system to automate that process.”

ORDERING MADE EASIER

In addition to storing and tracking injectables, inventory systems are increasingly adding ordering to the services they offer. All three of these systems include this feature, working with pharmaceutical distributors and pharmacies.

The CubixxMD system was developed by pharmaceutical distributor Besse Medical, so for anyone using that system, the ability to order through Besse Medical is included.

PODIS has a relationship with McKesson Distributors, and with Lucentis Direct, so their customers are able to order many of their medications through the system.

USRetina has developed a method where a practice’s wholesaler can automatically ship what is needed. In this system a practice sets up an order with their wholesale partner, indicating par values (the amount they want to keep on hand). The wholesaler has access to the information from the practice’s inventory system, so as soon as a practice falls below their par value, the wholesaler automatically sends out what is needed.

CubixxMD has developed a relationship with Avella Specialty Pharmacy and Pine Pharmaceuticals, so customers ordering from those places identify themselves as a CubixxMD customer, and their orders arrive pre-labeled with RFID tag and lot tracked.

For any pharmaceuticals arriving with the unique identifier already in place, CubixxMD and USRetina users access the refrigerated or ambient cabinet and place the order inside. The cabinet will re-scan and update. For PODIS, the user just informs the system that the medication has arrived, and the system prints the labels. Medications ordered from places that don’t pre-label with an identifier, or anything else a practice may want to keep track of within their system, can have an identifier attached.

PODIS comes with a bar code printer as the other piece (in addition to the scanner), and for the CubixxMD system, customers have the opportunity to purchase separate RFID tags for pharmaceuticals not purchased from Besse Medical. USRetina doesn’t have this feature available yet, but will be addressing it in the future.

INSTALLATION AND IMPLEMENTATION

All three of these systems are easy to install, train on, and use. For the CubixxMD and USRetina systems, you set up the two cabinets, learn the user interface, and you’re ready to go. For PODIS, users connect the USB-compatible scanning wand and bar code printer to a computer, and have a user interface portal accessible from any computer with an Internet connection.

Dr. Steve Madreperla said about PODIS, “It’s simple for people to learn how to use, and yet it’s sophisticated in the background and displays things in a way that makes everybody in the practice sort of breathe a sigh of relief once everything is in place.”

The CubixxMD system has a control pad on the front of each cabinet, where users punch in a PIN to gain access. There is a cellular connection already in place when the unit is delivered.

Eric Besse, Vice President of Business Information Solutions at Besse Medical said, “It’s really a matter of taking it out of the box and setting it up.” He said about the system, “It’s thorough but it’s easy to use, and I think that’s one of the things customers like about our system. The interface is very intuitive. We offer training as part of our service but it takes very little. We’ve had a couple customers go live on the system without any training at all.”

For the USRetina system, appropriate staff members are each given a secure RFID badge that they swipe to open the cabinets. To access the inventory information, reports, etc., the interface is through an iPad, using an app called Retina 365, which utilizes easy-to-use dashboards.

Sunil Gupta, MD, co-founder and CMO of USRetina, said that rather than having the data attached to the cabinet, “We decided to disconnect the two, so you truly have mobility of the data.”

Dr. Gupta explained that as the most recent arrival on the scene, his team was able to look at other systems and evaluate how to best approach building their system from the ground up. The developers of this system are retina specialists, who were looking at the daily operations of a retina practice as they decided how to proceed.

The iPad app includes additional features, such as allowing a picture of the patient to be included as part of the record, which helps with accuracy and compliance, and allowing patients to view a video of the procedure and to verify and witness the surgical site, and even includes a consent form they can sign.

BAR CODE VS RFID

Another important piece is how the inventory system interacts with EHR or practice management software. All three companies have developed interfaces to work with many of the main software packages being used.

Jeff Brockette, CEO of Texas Retina, said that the CubixxMD system works well with their EHR. He said, “The code used to open the refrigerator is employee specific and integrates with the EHR. We get down to a “who took it out of the closet” level, and then it integrates directly, so when they walk up to the refrigerator and they punch in their code, that tells us it’s employee X.

“On the screen of the refrigerator it shows the patients that are in the clinic for that physician, and they actually pick the patient and it’s allocated to that patient right there. They punch in their code, they pick the patient, they pick the product and it’s balanced.”

Vera Watkins, administrator for Retina Specialty Institute, Pensacola, FL, which has recently started using the USRetina system, said, “The system shows the accountability of everyone that touches it. You know who takes it out, and you know which patient it is assigned to, the whole loop is closed.”

EFFICACY AND BOTTOM LINE

As elegant, easy to use and non-disruptive as these systems may be, do they really save time and money for a practice?

Lisa Giffen, a medical assistant at Eye Medical Center of Fresno, Fresno, CA, said PODIS saves them money by ensuring drugs get billed correctly, and also by improving efficiency. “PODIS finds everything,” she said. “PODIS notifies me through a report that a drug hasn’t been billed. It shows up on my PODIS report but not on my financial report. It’s probably saving us a couple thousand dollars a month. But the time it saves is amazing. With just a few clicks I can compare my PODIS report to my practice management financial report, and they’re all in there. It saves me hours.”

Dr. Colucciello said of PODIS, “It dovetails nicely with our billing department, so the billing department can make certain we’ve billed for everything that we’ve injected.”

Marc Champa, Administrative Director at Vitreo-Retinal Associates, Worcester, MA, said, “With the amount of manual labor required to keep up with spreadsheets, and the reduction in human error, CubixxMD has greatly improved efficiency within the practice. Not only does it save the practice money by the reduction of staffing requirements, but in addition to that, if there are purchases that were made and we have not seen reimbursement for that, that could potentially be a loss in revenue. And the CubixxMD picks up on that. I’m able to do a report, which I do weekly or more, where I can take a look at what medications were removed from the CubixxMD, in what timely manner they were billed out, and the time frame that we are reimbursed for those. We had some noticeable inventory control issues prior to installing the system, and they have been eliminated.”

Matt Balka said, “We polled some practices, and some of them use up to 3 full-time employees to manage and track inventory. Certainly there are things these practices can do with these people that are a lot more efficient than counting boxes of drug.”

Vera Watkins said that in addition to the added efficiency, “The automatic reconciliation also eliminates human error to a great extent.”

THE USER EXPERIENCE

An important element of any tool is being sure the people using it are taken care of, that they like using it, and that they have the support they need to make it fit their circumstances and evolving needs.

Lisa Giffen said of PODIS, “It’s an excellent product, but they’re always trying to make it better. You can tell they’re very proud of their product and they perform due diligence to maintain that excellence.”

Dr. Colucciello said, “I endorse PODIS, we’ve always had good service from the company. Overall we’ve had a very good experience.”

Marc Champa said, “I think CubixxMD is a great advancement in inventory control as high priced medications become more and more commonplace. It’s well worth the investment, and Besse Medical has been nothing short of stellar in their support.”

Ms. Watkins said something that is valuable to her is the ability to keep track of the inventory in all of their 20-plus satellite locations, in one place. She said the USRetina system “shows you exactly where that drug is, and the point it was used. Where it was received, where it was used, and what happened after that.”

As for ease, she said, “There’s really nothing to it. You put the drug in, you swipe your badge and take it out. It’s very simple.”

CONCLUSION

With growing availability and ongoing improvements in services and features, there is no doubt more retina practices will begin using this type of inventory system. As Jeff Brockette put it, “We need to all go through this because as more and more pharmaceuticals come out we’re going to need a more and more sophisticated method of keeping track.”

Logan Brooks, MD, of Southern Vitreoretinal Associates in Tallahassee, FL, recently installed the USRetina system and anticipates great things. He said, “It’s going to be a game changer.” RP