Green Rx Pharmacy Project: End-to-End Workflow and System Architecture Training

Overview of Green Rx Pharmacy Project and Target Population

  • The Green Rx Pharmacy project focuses on the end-to-end pharmacy process, encompassing the journey of a prescription from initial provider entry to final delivery at the patient's residence.
  • The project is managed within an organization referred to as "pass" (likely PAS or PASLP).
  • The primary demographic served by Green Rx consists of senior citizens and aged individuals who face significant physical challenges.
  • These challenges include:
    • Mobility issues (individuals who cannot walk properly).
    • Visual impairments (vision-challenged individuals).
    • General disabilities that make it difficult for them to visit a physical pharmacy.
  • Due to these challenges, patients rely on Green Rx for consistent medication delivery, often managing multiple complex prescriptions simultaneously.

Phase 1: Customer Care and Order Intake

  • The process begins at the Provider level (hospitals or doctors' offices).
  • Providers share patient information and medication orders with Green Rx through various methods:
    • Facsimile (Fax).
    • Electronic Medical Record (EMR) systems.
    • Electronic Health Record (EHR) systems.
  • Initial Triage Process:
    • Upon receiving an order, Green Rx performs a first-level check on patient and medication details.
    • The system verifies if the patient is a new entry or an existing patient in the database.
    • The order is triaged based on urgency (e.g., distinguishing between a regular recurring medication and an emergency or new prescription).
    • The team checks for the completeness of information provided by the doctor or pharmacist.

Phase 2: Order Entry and Professional Keying

  • Once the order passes triage, it enters the "Order Entry" phase, which marks the internal start of the Green Rx processing workflow.
  • Personnel check the correctness of the medication, specifically focusing on:
    • Dosage requirements.
    • Frequency of administration.
    • Time limits for the prescription.
  • Escalation Protocol:
    • If any clarification is required regarding the prescription, the order is escalated back to the healthcare provider.
    • If the information is complete, the order is "keyed" (entered into the system) for further processing.
  • Specific checks during this phase include identifying high-cost medications, potential allergies, and non-clinical data gaps (such as missing patient demographic information).

Pharmacist Review 1 (PV1): Clinical Verification

  • The first formal review by a pharmacist (PV1) focuses on deep clinical verification.
  • The pharmacist reviews:
    • Drug-to-drug interactions: Ensuring multiple prescribed medications do not cause adverse reactions when taken together.
    • Emergency and allergy risks.
    • Duplicate entries: Checking if the order has already been filled or entered previously.
  • Authorization of Pharmacists:
    • As authorized clinicians, pharmacists can adjust dosages or therapies themselves without necessarily returning to the provider for every minor adjustment.
    • They have the authority to approve, modify, or reject an order.
    • If a major issue is found, they raise an EPR (Electronic Prescriber Nursing) notification to communicate back to the medical staff.

Specialized Services: MedInstruct and Medispan

  • MedInstruct Service:
    • This service facilitates language translation for patients who do not speak English as their primary language.
    • Target languages include Korean, Chinese, and Japanese, among others.
    • Labels are translated to ensure patients understand how to take their medication (e.g., instructions for taking meds before or after food).
    • The service incorporates images and icons to assist comprehension.
  • MediSpan Service:
    • MediSpan provides a comprehensive library of warning labels based on the specific medication prescribed.
    • Warning triggers include:
      • "Extra doses should not be taken."
      • "Must be kept away from children."
      • "Should not be kept in the refrigerator" vs. "Must be stored at room temperature."
      • Specific food-related warnings (e.g., "Do not take immediately after eating").

Adjudication and Billing Process

  • Claim Submission:
    • Claims are submitted for adjudication to determine if the insurance will cover the cost.
    • The system decides to either approve or reject the claim.
  • Billing Exceptions and Rejections:
    • If a claim is rejected, the billing team provides a clarification (e.g., "refill too soon," meaning the patient still has a supply from a previous order and is not yet eligible for more).
    • "Refill too soon" cases are sent back to the pharmacist (PV1) for review if there is a clinical reason to override.
    • Coverage issues or missing Pre-Authorization (PA) approvals are common road blocks.
    • Pre-authorization is specifically required for high-cost items like IV (intravenous) injections and medications for certain chronic conditions.
    • This communication happens between Green Rx and the Payer (Insurance Company).

Fulfillment: Packaging and Labeling

  • Once the billing is cleared, the order moves to fulfillment.
  • Packaging Details:
    • Labels are generated with indications of use and specific administration instructions.
    • Labeling includes images of the tablets to ensure the patient can identify the correct pill.
    • A single package might be a box with 66 different sides, containing up to 2020 different prescribed medications.
    • Vial Labeling: Used for smaller boxes or individual containers with just one or two medications.
  • Instruction details appearing on labels include specific times of day (morning, noon, evening).

Pharmacist Review 2 (PV2): Final Safety Check

  • The second pharmacist review (PV2) is the final safety gate before shipping.
  • The pharmacist verifies the physical accuracy of the final packaging against the order.
  • Critical check points include:
    • Accuracy of the "indication of use" instructions.
    • Verification of tablet images on the label.
    • Ensuring the labeling language matches the patient's requirement.
  • This step is described as a "life or death situation" because any error in instructions at this stage could be fatal for the end user.
  • If errors are found, the order is reverted to PV1 for correction.

Logistics, Shipping, and Confirmation

  • Following a positive PV2 review, the order is moved to logistics.
  • The shipment contains the filled medications and the full delivery address.
  • Meds Receivable Notification:
    • Once delivered, the system aims to receive a confirmation that the patient has received the medications.
  • Delivery Tracker Project:
    • Green Rx is currently developing a new delivery tracker because current systems do not accurately capture granular progress (e.g., first attempt, second attempt, acknowledgment of receipt).
    • Currently, they rely on reports from third-party vendors rather than having integrated tracking in the Green Rx system.

Digital Ecosystem and Current Enhancements

  • Several active projects are being developed as enhancements to the Green Rx system:
    • Language Labeling Project: Moving beyond MedInstruct to provide more exact, full-fledged translations rather than just partial instructions or simple images.
    • CCT (Clinician Consultant Toolkit): An application for pharmacists to manage recommendations, findings, and patient risk scores. It uses a back-end rules engine to flag emergency patients who need priority medication changes.
    • Ready, Set, Go Project: An operations-side project (currently on hold) led by Belinda and Cindy, focusing on customer priority requirements.

Team Roles and Organizational Background

  • Speaker Information:
    • The main presenter is a Lead Business Analyst and Product Owner who facilitates requirements and hands them off to the development team.
    • The speaker has 1212 total years of professional experience, with 1010 to 1111 years in healthcare and the last 22 years specializing in pharmacy.
  • Key Contacts:
    • Seth: Shared initial information about the onboarding.
    • Satya: The project Architect.
    • Rich: The owner of the Microsoft Teams channel where documentation is stored.
    • Odin: The new joiner being trained.
  • Geographic Context: Much of the team is based in India, leading to early morning meeting schedules for global collaborators.

Questions & Discussion

  • Question: Where is the team based?
    • Response: Most members are based in India, including the speaker and the architect (Satya).
  • Question/Concern: Audio issues during the call.
    • Response: Gaurav's voice was not audible because the Zoom microphone was muted, though system audio was functioning.
  • Question: What is the company name for the project?
    • Response: The company is referred to as "pass" (PAS or paslp.com).
  • Technical Issue: Citrix issues.
    • Response: One team member reported that Citrix was running slowly on their personal machine and they were waiting for their official work laptop to arrive via shipping.
  • Resource Access:
    • Access to the Green Rx Teams channel is restricted; it contains deep documentation on CCT, the language model, and workflow diagrams. Rich is the person who can grant access.