I can tell you from personal experience that the economic downturn is creating a negative impact on the implementation of pharmacy technology and automation. Several projects I’ve been working on didn’t make it past the chopping block for the next fiscal year. They include:

All the projects above were part of an overall plan to increase patient safety through the use of automation and technology. Unfortunately automation and technology is expensive and decisions must be made where to best use limited financial resources, no matter how painful. Luckily for me I still have plenty of work to do.

Northwestern Memorial Hospital provides a total of 873 beds in the Feinberg Pavilion, Prentice Women’s Hospital and the Stone Institute of Psychiatry. Northwestern has a very busy inpatient pharmacy that has worked through several obstacles to create a very efficient system of drug distribution. I spent about 90 minutes talking with their pharmacy automation manager, Dennis.

Pharmacy System – Cerner Pharmacy:  Northwestern uses Computerized Provider Order Entry (CPOE) with their Cerner Pharmacy System and are very happy with the combination. CPOE has given the pharmacists additional freedom to move out of the pharmacy to the bedside where they should be. Cerner offers a unique function called “automated pharmacist review”. When the physician utilizes a pre-programmed medication entry that meets a host of rules in the pharmacy system, the order is automatically marked as reviewed and doesn’t require additional pharmacist verification. An example of this might be acetaminophen 650mg orally every 4 hours as needed for mild pain. The order is checked against allergies, maximum acetaminophen per 24 hours, the most recent liver enzymes, etc. If the order passes all the rules, it’s automatically marked as reviewed and placed on the patient’s profile as an active medication. Northwestern is in the process of implementing this feature now.

Automated Storage / Packaging – AutoCarousel, AutoCool (soon), AutoPack (500 canister model – utilizing just about a quarter of the packager’s capacity): Northwestern utilizes their AutoCarousel and AutoPack in much the same fashion as Kaweah Delta does with one major exception. They choose to store both unit-dosed items packaged by AutoPack and bulk bottles of the same medication in their carousels. Kaweah Delta chooses to package on demand and store unit-dosed medication from AutoPack in the carousel only when absolutely necessary. I can see pros and cons to both methods. Like Kaweah Delta, Northwestern has difficulty controlling inventory and dispensing refrigerated medications. There is no way to force users to go through the AutoPharm software for dispensing items stored outside the carousel. AutoCool offers a nice solution. I’ll be calling Dennis in a few months to get his take on the new hardware.

Automated Dispensing Cabinet (ADC) – Omnicell: I felt that Omnicell was an interesting choice for Northwestern’s automated dispensing cabinets (ADC) as Pyxis appears to be the de facto ADC among hospitals at the moment. However, it appears that several features offered by Omnicell may prove more advanced than Pyxis, including single, vending machine style dispensing of controlled substances. Dennis described Pyxis architecture as “antiquated” and had several examples to back it up. My lack of knowledge regarding Omnicell left me at a disadvantage. It will be interesting to see whether or not Omnicell will overtake Pyxis in the near future as the ADC of choice for hospitals.

Overall, Northwestern has designed a very efficient drug distribution model that takes full advantage of their automation.

AutoCool is an automated refrigerated storage system. The AutoCool unit looks similar to a “normal” refrigerator on the outside – the refrigeration unit is on top, it has a glass door that opens on hinges and has the same basic footprint – but that’s pretty much where the similarities end. Inside, AutoCool is a series of “Lazy Susan like” trays stacked one on top of the other. Each tray is divided into several pie shaped sections that present themselves via a small sprint loaded metal door.

This was the first opportunity I’ve had to see AutoCool in person, and I must say it was impressive. The units are small, but can be daisy chained together to increase storage space. An onsite Talyst representative told me that a maximum of 7 units could be connected in series. That’s a lot of refrigerated storage space.

Refrigerated storage is one area that we’ve struggled with this past year. The items are available in our AutoPharm software for scanning and inventory control, but their location away from the main carousels makes it too easy to bypass the system. Placing these items in a small refrigerated carousel turned on its end (i.e. AutoCool), would make bypassing the system much more difficult. While it’s clear from the size of the unit that not all our refrigerated items would fit in AutoCool, many of our high cost, high risk medications could.  That’s pretty slick.

AutoSplit is software designed to automate the 340B ordering process through you pharmacy’s wholesaler. The 340B Drug Pricing Program resulted from enactment of the Veterans Health Care Act of 1992. 340B limits the cost of covered outpatient drugs to certain federal grantees, federally-qualified health center look-alikes and qualified disproportionate share hospitals. You can save a lot of money if you are able to take advantage of 340B pricing. Our hospital currently utilizes the 340B program, but uses a manual system to track and order qualifying medications. AutoSplit automates the process, making the ordering process much easier. This type of thing doesn’t usually grab my attention, but with the current economic debacle and lower state reimbursement for hospital services, it makes sense to use technology to take full advantage of cost saving opportunities.

The rest of my morning was centered around a visit to Northwestern Memorial Hospital to take a look at their pharmacy technology. I’ll post more on that later.