The ZiuZ Inspector – or is it the Foresee Inspector – is an interesting system designed to inspect the contents of unit dose packages produced by high-speed unit dose packagers. I don’t think there’s much need for this in most acute care pharmacy operations here in the U.S. because we don’t unit dose enough tablets and/or capsules to make it worth while, but I do think it may have potential in some long-term care pharmacies using a central dispensing model. Who knows, that’s not really my area of expertise.
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The cleanroom environment, a.k.a. the IV room, is one of my favorite areas inside an acute care pharmacy. It is often alive with activity, and can often be the busiest area of the pharmacy. It is also a unique place since the use of intravenous (IV) medications is vital to the successful outcomes of patients, but at the same time can result in some of the most egregious errors in healthcare. While the IV compounding process is under tight control as demanded by USP guidelines, the method of preparation and distribution is decidedly more conventional, i.e. IV rooms often rely heavily on humans. It’s an interesting dichotomy found nowhere else in the pharmacy. It is for these reasons that I find it interesting that pharmacy IV rooms have lagged behind other areas of pharmacy operations in automation and technology. However, that’s beginning to change.
ThomasNet News: “PharmASSIST OPTIx enables remote prescription verification by taking a high-resolution image of each prescription’s vial contents and vial label, and automatically displaying them on a designated pharmacist’s workstation. The pharmacist compares these images to the appropriate drug image from a standardized drug database, along with specific prescription details to complete the verification. The verifying pharmacist can be stationed anywhere – in the front of the pharmacy counseling patients or offsite at another pharmacy, a central processing center, or working from a home office. PharmASSIST OPTIx stores each prescription’s images as part of the patient history record, enabling pharmacies to quickly retrieve them for pharmacy benefit manager (PBM) audits and to confirm the quantity dispensed.
Pharmacies can use PharmASSIST OPTIx in stand-alone mode or integrated with Innovation’s PharmASSIST Symphony® workflow systems, which enables end-to-end prescription tracking, problem management, and reporting. In addition to processing a pharmacy’s countable medications, PharmASSIST OPTIx handles all non-countable products (e.g., ointments/creams, liquids, syringes, inhalers, etc.) for prescription filling and remote verification. The system can also assist pharmacies with physical inventory control.”
It reminds me of a non-cleanroom version of DoseEdge.
Additional automation is needed for it to be a real game changer, but it’s still pretty cool technology. It would be slick if the person filling the prescription never had to touch the product and the end result could be remotely verified.
Product website here.
OPTIx brochure (PDF).
I was planning on writing a rant this morning about lack of motivation, leadership and dumbasses – hey, I was in a fould mood when I got up – but then I opened an email from a friend. He asked me “How can retail pharmacists get involved in this [pharmacy informatics] industry?”. My first thought was to say that retail pharmacy would be the death of our profession and that they have no business getting involved in pharmacy informatics. Harsh I know, but I told you I was in a foul mood.
Then I did something I rarely do, I thought about the question a bit more before answering. After some time I came to the conclusion that retail, or more generally outpatient, pharmacy is exactly where more automation and technology is needed. I follow a few retail pharmacists on Twitter and one generalization I can make from reading their Tweets is that they all pretty much hate their jobs. Why? Because they spend precious little time working as pharmacists, instead spending most of their time physically filling prescriptions, chasing insurance claims, etc.
What retail pharmacy needs is a super-sized dose of pharmacy automation, technology and greater pharmacy technician involvement. Nowhere in pharmacy is there a greater need for automation and technology than outpatient services. Much of what’s done in the outpatient pharmacy setting does not require a pharmacist. This echoes the words by Chad Hardy last week on the RxInformatics website. Chad states “The longer we rely on pharmacists to run the entire supply chain, the higher our risk of obsolescence.” He’s absolutely right, although the article he references insinuates that pharmacists will become obsolete secondary to technology. Nay, I say. Technology in the outpatient arena can offer pharmacists the opportunity to break away from the mundane and do a little more hands on patient care. In addition, the drive to implement automation and technology in the retail setting creates the perfect job opportunity for pharmacists interested in informatics.
Of course we’ll have to prove to the retail boys upstairs that they can save money by using pharmacists in a more clinical role, but that’s what business cases are for. Unfortunately I couldn’t write a business case to save my life. In fact, a colleague of mine told me that pharmacists are terrible at creating business cases. I suppose that’s true as most of us didn’t become pharmacists to practice business. Instead we became pharmacists to provide patient care. Go figure.
UCSF: “Although it won’t be obvious to UCSF Medical Center patients, behind the scenes a family of giant robots now counts and processes their medications. With a new automated hospital pharmacy, believed to be the nation’s most comprehensive, UCSF is using robotic technology and electronics to prepare and track medications with the goal of improving patient safety.
Not a single error has occurred in the 350,000 doses of medication prepared during the system’s recent phase in.”
Robotics is nothing new, but it seems like everyone is taking notice of the new robotics in the pharmacy at UCSF. I suppose all the people pointing it out to me has something to do with the fact that UCSF School of Pharmacy is my alma mater, but you never know. Anyway, I’m pleasantly surprised to see UCSF taking such an active role in advancing pharmacy practice. When I spoke with some colleagues sill working for UCSF a little over a year ago they were still practicing pharmacy invented in the dark ages. Not any more.
Now I’m trying to get a hold of someone at UCSF that will let me stop by for a tour, and all of a sudden no one knows me. Poetic justice I suppose.
It’s not often that I take note of pharmacy technology designed for the outpatient setting, but I had to make an exception when I came across the StoreRx robotic prescription storage system by ARX.
What little outpatient pharmacy I remember, keeping track of patient prescriptions once filled was always a headache. I’ve seen several systems designed to make use of hanging bags like the WillCallRx system by TGCRx (PDF), but I never like the bag system; not sure why. However the StoreRx robot uses a different system altogether.
Unfortunately for you and me, I couldn’t find a video of the StoreRx system in action anywhere on the internet. That’s a real bummer as I’d like to see it doing its thing.
According to the ARX website:
StoreRX is the most space efficient way of storing your customer’s prescriptions inside a robot. It enables accurate tracking of completed prescriptions, which is ideal for prescriptions with several bags and also for monitoring those which have not been collected.
The white and brown medium grade e-flute cardboard boxes come in 2 different sizes, large and small. Both are easily recognised and efficiently stored by the robot. The StoreRX boxes are fully recyclable and bio degradable, but of course, these robust boxes can be re-used again and again.
Prescriptions can be stored and located using the patient name, as opposed to looking up the required packs, making the prescriptions easier to locate during busier periods.
Other outpatient pharmacy will-call systems can be found here.
The February 1, 2011 issue of the American Journal of Health-System Pharmacy (AJHP) has an interesting article on page 202 in a section called Management Consultation. The article is titled “Redesigning the workflow of central pharmacy operations”1. I’d like to have everyone read this article, but unfortunately access requires a ASHP membership or an AHJP subscription.
The article discusses the process involved in redesigning the workflow within an acute care central pharmacy, but fails to mention the use of technology.
So let’s break it down a bit, shall we?
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I’ve worked in several acute care hospitals during my career, from the small one horse operation that did little more than care for minor inconveniences, to larger, multi-pharmacy facilities that handled everything from pneumonia to severe trauma. As I’ve mentioned elsewhere on this blog each one of those pharmacies offered a slightly different way of doing things. Granted, some were variations on a similar approach, but they were all different.
However, one trend I’ve discovered across the range of facilities is that the smaller the hospital, the less automation and technology the pharmacy has. Why? It’s quite simple. Automation and technology is expensive. It’s also time consuming to plan for, implement and maintain. Of course another argument is that smaller hospitals - and therefore smaller pharmacies – need fewer technological advances. That doesn’t make much sense to me. I agree that a small 50 bed hospital pharmacy may not need a giant robot to fill their med carts, but they can certainly benefit from clinical decision support, pharmacy surveillance software, bar code medication administration (BCMA), computerized provider order entry (CPOE), automated dispensing cabinets (ADCs), smartpumps, mobile devices, so on and so forth. The problem is that much of this technology is expensive and takes a sizable chunk out of smaller budgets.
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Jan 312011
As the word “robot” passes its 90th birthday1 – introduced by Karel Capek in his play R.U.R. (Tossums’s Universal Robots) in January 1921 – it’s become obvious that robotics has not only captured the imagination of geeks everywhere, but has become a point of interest in many industries including healthcare.
Late last year ASHP began pushing the idea of a new pharmacy practice model, PPMI. The movement was a hot topic for a while, but seems to have lost a lot of steam recently – “Hence the name: movement. It moves a certain distance, then it stops, you see? A revolution gets its name by always coming back around in your face” (Tommy Lee Jones in Under Siege 1992) – Anyway, when the PPMI movement was still going strong many important people in the pharmacy world struggled with the best way to approach a new pharmacy practice model. Many believe, and rightly so, that the best way for pharmacists to reinvent themselves is to become the cornerstone of a more robust patient care model. After careful consideration I believe the best hope for developing such as model will be to rely heavily on pharmacy robotics to handle much of the repetitive dispensing duties now handled by pharmacist on a day to day bases. You know, free up the pharmacists. It’s not a new concept, but one that seems to escape us.
Obviously it will take some time to develop robotics to the point where it will be effective in such a system, and it certainly won’t be cheap, and pharmacists will have to fight with state boards of pharmacy to accept it, and pharmacy administrators will have to work closely with their hospitals to develop such a systems, and someone’s going to have to be brave enough to step up to the plate and get stated, and so on and so forth. In other words it’s going to be hard and it won’t happen overnight.
Who’s up for a little project? For now let’s just take a quick look at some of the things that lead me to believe robotics is worth another look as a potential solution.
Some items in a pharmacy are simply difficult to bar-code. Perhaps they’re too small, have an awkward shape or their surface won’t accommodate ink or an adhesive. The problem creates some interesting workarounds, and not always for the better.
One solution is to individually package each item and place the drug information and a bar-code on the outside of the packaging material; overwrapping, if you will. I’ve never been a big fan of overwrapping items because it can be time consuming and cumbersome. Today I ran across a machine that I think offers a genuine option for medications that are difficult to bar-code.
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