The Problem: Surge in Medication Delivery Demand during COVID-19

Prior to COVID-19, the National Healthcare Group Pharmacy (NHGPh) made about 200-300 deliveries of medications to patients every month. This dramatically changed during the circuit breaker, where people were urged to stay home. Suddenly, the NHGPh was inundated with requests for medication deliveries.

In April 2020 alone, over 17,000 medication deliveries were made – an extraordinary increase of over 60 times the usual average. Packing medication for home deliveries typically takes more time than an over-the-counter sale, as staff have to incorporate the delivery address and also coordinate with the courier services.

Around the world, global supply chains were also disrupted by COVID-19. This meant that staff had to put in many extra hours of work to source for alternate places to procure medication, as well as arrange for multiple deliveries of smaller doses over a few months as medications were harder to come by. A combination of the above saw an estimated 3-fold increase in workload, which the pharmacies were not designed to handle.

The Solution: A Central Fill Pharmacy (CFP) that Manages Orders from Multiple Polyclinics

To alleviate the problem of individual pharmacies trying to cope with the extra work, a solution to centralise some of the processes was developed. Known as the Central Fill Pharmacy (CFP), it centralises the fulfilment of medication off-site, relieving the workload at the pharmacies and allowing them to focus on caring for patients.

How the Central Fill Pharmacy (CFP) Works:

• Pharmacy registers patient for home delivery during their visit

• Pharmacist confirms patients’ details

• Orders placed in the system will be scheduled for packing and labelling closer to delivery date

• Medications are verified, packed and dispensed at the centralised Pharmacy Services Centre, and added into a packing list

• Pharmacy verifies packing list and collates for courier delivery

A Central Fill Pharmacy (CFP) seamlessly and automatically manages the orders from multiple polyclinics, as opposed to individual pharmacies manually tracking the schedules for the next refill. It provides an integrated solution that enables information flow from source system, helping to eliminate manual transcription as the system generates the prescription details, delivery address, time and generation of subsequent delivery dates automatically. With CFP, NHG Pharmacies were able to:

• Automatically initiate a medication supply refill to ensure patient’s medication deliveries are fulfilled

• Provides an overview of the patient’s medication supply status, delivery schedules as well as track and manage medication packages with courier partners

• Streamlines operational workflow with just-in-time picking and packing of medications

• Manages complex and logistical challenges centrally for NHGPh

Prior to the Central Fill Pharmacy (CFP), all of these were either not possible or only possible to a certain extent. The CFP centralised supply model improved the operational efficiencies, productivity and resiliency for individual pharmacies.

Medication Delivery Module (MDM): HealthTech System Speeds up Central Fill Pharmacy’s Delivery Process

The key to the Central Fill Pharmacy (CFP) is the Medication Delivery Module (MDM) embedded inside. It manages the medication fulfilment across different processing steps, such as centralising the scheduling, packing, delivery and tracking of orders. This eliminates the manual workarounds and excel spreadsheets to maintain courier lists and generate consignment labels. It also has a delivery scheduler feature to assist pharmacy staff in managing 100% timely supply of home delivery orders.

Compared to the traditional manual packing and overseeing of schedules, MDM has an estimated time savings of about 8 hours per 1,000 prescriptions, and has the potential to eventually save 14 hours – or two full time equivalents. Statistics from the first few months have been very encouraging, as users have gave feedback that there was a 100% reduction in packing errors for medication delivery orders due to missing items. This has led to significant resources saved and productivity gained.

Between June and Aug 2020, more than 13,000 deliveries were made for three of NHGPh’s polyclinics, translating into more than 100 hours saved. As CFP continues to scale up its capabilities, the system is expected to further facilitate the coordination of up to 1,500 home delivery orders per day across all NHG polyclinics next year.

Staff at NHG Pharmacy said that they are grateful that CFP has gone through many rounds of customisation and enhancements to align the functions with their operational needs. For example, it allows them to validate the right number of items and packages before handing it over to the courier, thereby ensuring a higher level of accuracy for medication delivery orders.

CFP was also developed with patients in mind. For example, it has plans to automatically send SMS reminders to patients regarding the medication delivery status. This would give them ease of mind that their orders are being processed, and also help them to remember when the delivery days are.

Overcoming Challenges to Deliver the Central Fill Pharmacy at NHG

As with many of the projects developed during COVID-19, one of the biggest challenges was the tight timeline, as staff had to develop the solution as soon as possible.

Given that the public healthcare systems are so interconnected, a lot of coordination was necessary between various departments such as the project, infrastructure and cybersecurity teams to get the necessary pieces in place. For example, during the testing phase, daily user acceptance test debriefs were conducted between the business users and IHiS so that critical issues or roadblocks were quickly removed.

The team saved time by adapting an existing basic localised home delivery module, redesigning some of the key features and coming up with a centralised supply model all within six weeks. After the first release, IHiS continued to work closely with NHGPh staff to find out what the issues were and to resolve them quickly.

The IHiS team would like to thank everyone involved, in particular the NHGPh staff for making the smooth delivery of the project possible.