title: Understanding the dispensary workflow at the Birmingham Free Clinic: a proposed framework for an informatics intervention.
abstract: BACKGROUND
  The Birmingham Free Clinic (BFC) in Pittsburgh, Pennsylvania, USA is a free, walk-in clinic that serves medically uninsured populations through the use of volunteer health care providers and an on-site medication dispensary. The introduction of an electronic medical record (EMR) has improved several aspects of clinic workflow. However, pharmacists' tasks involving medication management and dispensing have become more challenging since EMR implementation due to its inability to support workflows between the medical and pharmaceutical services. To inform the design of a systematic intervention, we conducted a needs assessment study to identify workflow challenges and process inefficiencies in the dispensary.
  
  
  METHODS
  We used contextual inquiry to document the dispensary workflow and facilitate identification of critical aspects of intervention design specific to the user. Pharmacists were observed according to contextual inquiry guidelines. Graphical models were produced to aid data and process visualization. We created a list of themes describing workflow challenges and asked the pharmacists to rank them in order of significance to narrow the scope of intervention design.
  
  
  RESULTS
  Three pharmacists were observed at the BFC. Observer notes were documented and analyzed to produce 13 themes outlining the primary challenges pharmacists encounter during dispensation at the BFC. The dispensary workflow is labor intensive, redundant, and inefficient when integrated with the clinical service. Observations identified inefficiencies that may benefit from the introduction of informatics interventions including: medication labeling, insufficient process notification, triple documentation, and inventory control.
  
  
  CONCLUSIONS
  We propose a system for Prescription Management and General Inventory Control (RxMAGIC). RxMAGIC is a framework designed to mitigate workflow challenges and improve the processes of medication management and inventory control. While RxMAGIC is described in the context of the BFC dispensary, we believe it will be generalizable to pharmacies in other low-resource settings, both domestically and internationally.
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. arf56@pitt.edu.
authors.forename: Arielle M
authors.initials: AM
authors.lastname: Fisher
authors.affiliation: Program for Health Care to Underserved Populations/Birmingham Free Clinic, Pittsburgh, PA, USA.
authors.forename: Mary I
authors.initials: MI
authors.lastname: Herbert
authors.affiliation: Center for Health Informatics for the Underserved, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Gerald P
authors.initials: GP
authors.lastname: Douglas
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003157:Community Pharmacy Services / Q000458:organization & administration*; D004282:Documentation; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D057286:Electronic Health Records; D006801:Humans; D008490:Medical Informatics; D017057:Medically Uninsured; D010414:Pennsylvania; D010595:Pharmacists / Q000458:organization & administration*; D011364:Professional Practice / Q000458:organization & administration; D035862:Vulnerable Populations; D057188:Workflow