Embracing change: Box Labs, Ontario

JANUARY 2023 – Michael Demian comes from a family of pharmacists, but pharmacy was not his first career choice. He started out studying electrical and computer engineering, but had serious second thoughts when he realized the sector was rightsizing and jobs were scarce. Then the light-bulb idea hit: become a pharmacist and bring both passions together.

“I knew there was a lot of opportunity in pharmacy, and I was hoping I could put my computer electrical engineering background to good use in pharmacy. Today that’s coming to fruition,” says Demian, who earned his pharmacy degree in 2008.

Today, Demian is the Toronto-based owner of four independent pharmacies in Ontario and one in B.C. and he is a co-founder of Box Labs, a cloud-based pharmacy management platform. He shares his journey with the Canadian Foundation for Pharmacy.

How did you begin to marry your computer skills with pharmacy?

Before starting anything, I worked as a pharmacist and pharmacy owner for 10 years. I knew I had to immerse myself in pharmacy before I could effectively address the challenges. I started Box Labs about two years ago.

What did you learn as a frontline pharmacist and pharmacy owner?

I got my degree in Ohio so I worked in U.S. community pharmacies for almost two years before returning to Canada. That was good experience because U.S. pharmacies are far ahead in a lot of their technologies and are much more efficient as a result. Their healthcare system requires that they pump out high volumes of prescriptions to be profitable. Whereas here in Canada, a pharmacy could do 100 to 200 scripts a day and still turn a profit. Many pharmacy owners were happy enough just to be paying their own salary.

But efficiency in the pharmacy is just half of the equation. The patient’s experience is just as important. In the U.S., technologies made the process for patients very seamless, whether they’re picking up prescriptions or using clinical services. Canadian pharmacies have a long way to go on that front—which translates into a huge opportunity for pharmacies here to differentiate themselves.

Tell us about Box Labs.

I co-founded it in 2020 with Paul Wang and David Yuan, who are computer engineers. Using my pharmacies as test sites, we created Canada’s first cloud-based platform for dispensing and clinical interventions. In addition to creating efficiency and a seamless experience for patients, an overarching goal is to enable pharmacists to be able to work remotely. That was a major goal even before the pandemic.

We replace the outdated technology of cash registers with a point-of-sale (POS) system that is integrated with all pharmacy terminals. It’s essentially used to leverage more clinical services. Not only does it flag when a patient is eligible for a service, but it also facilitates billing for the service.

For example, one pharmacy went from capturing 19% of billable assessments for PCR tests for COVID-19 to 89%. Revenue for that one service grew by more than $200,000. Before Box Labs, the pharmacists were flooded with phone calls and did assessments over the phone, but they couldn’t capture those interactions for billing. It was awkward and time-consuming to get the patient’s personal information and health card number before starting the conversation. The solution was to start assessments online, which removed a huge barrier for both pharmacists and patients. The platform also kept up with changes in assessment criteria. Patients are queued for the pharmacist, who reaches out by text or email to complete the assessment by phone or in person.

What else is part of the platform?

It includes online booking and a mobile app for patients. Non-prescription sales can be attached to patients. There are modules for COVID-19 testing and vaccinating, medication reviews, smoking cessation and more. One is underway for minor ailments. The platform is compatible with existing pharmacy management systems, like Kroll, and can be integrated with other tools, like MAPflow for minor ailments.

Perhaps our biggest differentiator is Box Labs can bill directly to the Ontario drug benefit (ODB) plan as well as many private plans. This removes the pain point of having to use several systems. It took more than a year to complete conformance testing with the Ontario Ministry of Health, but we knew it had to be done.

How is it going so far?

Great! Our first investor came on board during the summer of 2021 and we continue to attract other investors, which is very exciting. I’ve been able to work full-time on Box Labs for the past year. We’re slowing rolling it out to other pharmacies, with excellent results. We’re focussed on Ontario for now, but definitely looking to be nationwide.

What words of advice do you have for pharmacists who may be hesitant to use new technologies, or are struggling with burnout?

Don’t be afraid to embrace change, knowing you won’t have all the answers right away. That’s okay. Governments and regulators are trying to figure everything out as well. Pharmacists tend to want to stay in their own lane, but that’s holding you back. It’s holding the profession back. When it comes to new technologies, innovation has to outpace regulation. Eventually, regulation catches up. So expect the hiccups and stay positive because you will be amazed by the benefits for both you and patients.