Centralized Refill Renewals in a Large Healthcare System

The centralized refill renewal center (CRC) was created as a collaboration between a primary care clinic and the outpatient pharmacy department to remove the work of handling refills from clinic staff and providers. This allows greater patient access since the work is done by the centralized refill team, allowing clinic MAs and RNs to focus on direct patient care and reducing after-hours charting for the providers. Today, the CRC services primary care and specialty clinics across the health system.

At the start, the CRC was staffed with three clinical team members, 2 RNs and 1 pharmacist. With growth, pharmacy technicians were added to the team. Currently, there are 19 pharmacy technicians, 10 RNs, and 5 pharmacists that handle refill renewal requests per protocol. Pharmacy technicians sort faxes and electronic messages from patients and providers and take phone calls. Clinical staff and pharmacy technicians can approve or deny refill request per protocol. When a medication cannot be approved by a pharmacy technician, they put the medication on a pending status, document relative information, and send clarification questions to providers and patients, allowing clinical staff to focus on work that requires clinical decision-making.
The CRC receives refill renewal requests electronically from pharmacies, telephone calls, electronic messaging through the EHR, and faxes. When questions arise, the CRC staff communicates with pharmacies, providers, and patients either electronically or by phone. To increase staff satisfaction, the CRC is piloting telecommuting, as this work does not need to be completed onsite and the staff require minimal supervision.
The CRC protocol encompasses approximately 800 medications, and of these, 460 are refillable by pharmacy technicians. The CRC refill renewal protocol is embedded in the EHR with automated identification of the last provider visit, relevant lab work, and vital signs for each medication. The protocol is vetted by a multidisciplinary steering committee made up of providers, RNs, clinic mangers, pharmacy technicians, and pharmacists.

The CRC has grown from servicing 26 clinics to over 80 clinics in the last two years without increasing FTE due to embedding the protocol in the EHR. The CRC processes over 50,000 refill renewal requests on a monthly basis. The CRC has a service agreement with all clinics to process routine refill renewal requests in two business days and urgent refill renewal requests in one business day. The average handle time per staff member is 2.8 minutes (SD 1.3 to 4.1 minutes) per refill renewal. The work completed by the CRC save 25,000 provider/clinic hours per month.

Centralizing services is an added value to a large healthcare system by standardizing workflows, meeting CMS compliance with an embedded EHR protocol, reducing provider burnout, and creating additional patient access. The CRC staff express high job satisfaction as compared to pharmacy technicians and pharmacist in a retail setting and RNs in direct patient care roles. The demand for the CRC services is high, and in the future, it is expected the CRC will service all 300 clinics in the health system.