CASE STUDY
noritsu-rx.com
THE JOURNEY TOWARD AUTOMATION
When Emily Powers, Pharm. D. took the reins as president in 2018 – Medicine Express, a long-term
care pharmacy, was a relatively small operation servicing roughly 300 beds. Their vision, however,
was to increase that number to 1,000 beds. In fact, the owner had purchased an automated filling
machine just ahead of Powers’s arrival to help them move away from their traditional paper-based
processes.
Since then, Medicine Express has grown to service 2,700 beds at assisted living and memory care
facilities across 14 states and today process 27,000 prescriptions monthly out of its Bellville, Illinois,
location. The path, however, was not always a straightforward one, says Powers.
THE CHALLENGE – SCALING TECHNOLOGY TO MATCH GROWTH
With experience working at larger pharmacy operations using advanced technology and computer
systems, Powers was well-equipped to help Medicine Express staff adapt to the new automated
filling machine. The original automation worked well with their volume at the time, she reports.
However, once they reached their growth projections by adding 1,000 more beds in 2019 – they
began to experience challenges. “The system just couldn’t keep up with our growth,” says Powers.
Plus, as they added more beds, it became clear they would need an automated visual verification
process to reduce the need for pharmacy staff to validate each prescription manually.
“We were happy with our existing vendor, so we upgraded to one of their systems designed to
handle the volume,” Powers explains. The company also had a visual verification product slotted
for release in early 2020 that would give Medicine Express the improved efficiency and medication
accuracy they wanted. “That didn’t happen because the global pandemic shut down production and
development across various industries – including ours.”
Despite the pandemic, however, Medicine Express continued to grow — and by the end of 2020 had
added another 1,000 beds. “We knew we really needed an established visual verification process to
deliver the level of service our patients had come to rely on - so decided to make a change.”
THE SOLUTION — PARTNERING WITH NORITSU
While attending an industry conference, Powers met the Noritsu
Pharmacy Automation team. “What caught my attention was a case
study they had displayed featuring a pharmacy similar to ours – so
we started talking.” They continued to keep in touch as Powers
HOW TECHNOLOGY AND VISUAL
VERIFICATION HELPED TRANSFORM
MEDICINE EXPRESS’ LONG-TERM
CARE BUSINESS MODEL
Emily Powers, Pharm. D.
President
~ Medicine Express
CASE STUDY
noritsu-rx.com
explored other options. “Let’s just say all the research I did and references I spoke with kept pointing
to Noritsu being the right choice for us.” As a bonus, the company had St. Louis-based technicians
less than an hour away.
Ultimately, Medicine Express opted for two NX4000 strip pouch packagers for high-volume
dispensing and two Benjamin Tray stations for split-dose, one-off or less frequently used
medications. They also have an NV 3 verification system for visual verification, which checks the
contents of each pouch against a library of images uploaded by the pharmacy.
Once the system was installed, Noritsu sent a technician out to train pharmacy staff how to export
prescriptions to the machine and begin transitioning long-term communities. “He taught us how
to keep the system going, the types of service messages we might see and how to clean the
machine,” says Automation Lead Technician, Carly Thomas. According to Powers, the trickiest part
of their implementation was that they weren’t ready to transition every community until they were
completely comfortable. “I wanted to be sure we knew this one inside and out before we transitioned
fully.” Some facilities and patients were also not comfortable moving to Noritsu’s strip pouches at
first anyway because they’d gotten familiar with the traditional blister packs. So, in the beginning,
the pharmacy had six employees simultaneously operating the two systems – old and new – which
made scheduling difficult. “At the end of the day, however, because Noritsu’s technology was so
user-friendly, and the margins were telling us that it was a well-oiled machine, we were able to
transition fully about a month earlier than planned,” says Powers.
THE RESULT – ENHANCED EFFICIENCY AND ACCURACY
First and foremost, the NX strip packaging machines deliver an incredibly efficient process, Powers
says. Where previously it might have taken hours to run a single community – it now takes about
45 minutes with Noritsu’s system and strip pouches. It’s also easier for long-term care nurses to
make medication changes. “Most of our communities were on a standard 28- or 30-day cycle,” she
explains. “Noritsu’s technology allows us to run shorter cycles for them – and we’ve successfully
converted everyone to a 14-day cycle with no impact to our bottom line.” This reduces medication
waste when changes are needed, or a medication is discontinued. The strip pouches are also
extremely easy to use, which makes them ideal for assisted living or long-term care at home
patients who are independent with their medications.
According to Powers, it’s Noritsu’s NV verifier that’s been a game changer for Medicine Express’s
business model. During implementation, the pharmacy team took several images from various
angles of each pill they dispense to record the unique markings, size and color. They now repeat
this process with each new medication they offer. “When we run a patient or a community cycle,
we feed each strip pouch into the NV,” explains Powers. The NV takes a picture of every pouch
and can identify what should be inside from the barcode printed on it. The system then references
the images of the pills in the pouch with actual images in Medicine Express’s library. When that’s
complete, pharmacists can review computer images of all pouches – including those flagged in red
that the NV couldn’t verify. “Before Noritsu’s visual verification, we had to physically look at every
pill in every bubble for every patient to verify that it was correct,” says Powers. “Now we only have to
look at about 4%, our average pouch check rate.” And even with that rate, she says, the issues are
usually unrelated to an inaccuracy but have been flagged for things like a broken tablet or an oil-filled
pill like Vitamin D that doesn’t reflect the light correctly.
Not only is the NV faster and more accurate than relying on a pharmacist’s manual checks, but
images of pouches are stored so it’s easy to go back and review what was delivered if a nurse or
patient has a question. “The quality assurance we gain from the NV’s
visual verification is something I can’t imagine doing without now,”
Powers states.
“
“
The quality
assurance we gain
from the NV’s
visual verification
is something I can’t
imagine doing
without now.”
We've reduced
labor by 15% and
cut production
time for multidose
cycles by 66%.”
Emily Powers, Pharm. D.
President
~ Medicine Express
Emily Powers, Pharm. D.
President
~ Medicine Express
CASE STUDY
noritsu-rx.com
THE END RESULT – EFFICIENCY AND SCALABILITY
“We knew from our research that Noritsu was the most efficient and cost-effective solution, even
before we started working with them,” says Powers. Now that they’ve been using the system for a
year, she says it’s far exceeded our expectations. “We’ve reduced labor by 15% and cut production
time for multidose cycles by 66%.”
Noritsu’s automation is so simple to use that anyone can be trained to use it. “We can pull anyone
from the pharmacy if we’re shorthanded – like someone from my billing team – and teach them
how to use the system in a day.” The system also gives them a great deal of data for measuring their
progress, including how many pouches they’re filling each day and for how many patients, what the
pouch check rate is and what they spend on supplies.
Even with all the added efficiency and accuracy, Powers and Thomas agree that what sets Noritsu
apart for them is the customer support. “We just fill in a customer support ticket online along with
the issue’s priority,” Thomas describes. “We normally get a call within 10 minutes!” If a technician
visit is necessary, Noritsu gets someone onsite the next day. “What’s nice about this system, though,
is that it’s so user-friendly,” Thomas continues. “So most of the time, a technician can troubleshoot
to help us solve the problem over the phone or FaceTime.” As a result, she says they rarely see a
technician outside of regular preventative maintenance, and they seldom have downtime anymore.
“The people who work at Noritsu are awesome.”
LOOKING AHEAD FOR MEDICINE EXPRESS
In the midst of all this, Medicine Express upgraded their software as well. That means over the
course of less than five years – they implemented new automation, upgraded that automation
again, added a visual verification system, grew from 300 to 2,700 beds and installed a new software
platform. And they aren’t done yet, Powers says. While they no longer have a retail counter, retail
and long-term care at home clients with higher medication needs have been coming to them based
on recommendations from existing patients. They’ve also been exploring working with correctional
pharmacies. “Regardless of what’s next for us, I know that with Noritsu’s automation, visual
verification, and support in place, we’ll be able to scale and grow at any pace.” Added to that, Powers
says Medicine Express now has a strong automation team in place with Pharmacist Alex Dow and
Certified Pharmacy Technicians, Cody Boswell, Kathy Frazier, and Jody Munyon. Rounding out the
team is a family affair – with Powers’s sister, Thomas, cousin Mikey Crotty, and mother Liz Thomas,
who all joined the pharmacy to help during COVID-19 and have stayed on to contribute to its growth.
“
What’s nice about
this system, though,
is that it’s so user-
friendly. So most
of the time, a
technician can
troubleshoot to help
us solve the problem
over the phone or
FaceTime.”
Carly Thomas
Automation Lead Technician
~ Medicine Express