Slow progress in pharmacy automation and stale technology creates ho-hum interest

Recently I’ve been in bit of a blogging slump. The world of technology suddenly appears a little less exciting. In fact, I find myself thinking of current technology as boring. I read lots of blog posts and articles that refer to new technologies as “revolutionary”, but I haven’t seen much revolutionary technology lately. In fact, most of the new technology is simply an iteration of the same theme; or worse, recycling of an old theme.

Consumer technology is clearly ahead of healthcare with the exception of scanning devices like MRIs, which are pretty cool when you stop to think about what they do. However, some of the most recently vaunted consumer technologies are devices aimed at information consumption like the iPad or devices designed to access data and social media while on the go, i.e. the new crop of smartphones. It’s not really new technology per se, but rather a new application of already available technology.

The iPad experiment was cool, but is basically over for me. Android phones are cool, but I’m waiting to see what will happen over the next six months. Smartphones are improving at breakneck speed, but the improvements are tied to the user experience at this point. The iPhone 4 is cool, but it’s just a shiny representation of already available technology. The original iPhone was truly revolutionary as it changed the smartphone platform forever, but the newer devices are a rehash of the same idea. The simple fact that people can compare the new line of Android devices to the iPhone 4 is proof enough that it is not revolutionary. Of course the Apple zealots will call me a complete idiot for saying that, but it’s true. One can now make a conscious choice of smartphone platform and carrier without feeling like they’re missing out. If you want to go with Google and enjoy the freedom of the cloud and choice to do things a little different, then feel free to use the Android platform. If you like the ease of use and solid integration that Apple offers with their desktop and iTunes, then by all means feel free to do so. The choice is yours, and neither is wrong.

The introduction of Android tablets is a little exciting, but their appearance on the consumer market is late. I can’t wait to get my hands on one, but most people I talk to have little interest. To them the iPad is the perfect consumer device, and at the moment it’s impossible to argue otherwise. Microsoft has the power to compete, but they appear to be in complete disarray regarding the consumer tablet market. Microsoft has a desktop presence rivaled by none, and they are still king of the desktop and tablet platform for now. They continue to react slowly to market changes and have let the tablet PC platform become stale, which is a shame because the potential is great. Microsoft is also increasing their cloud presence, and while their offerings are cool, they feel disjointed. They’re teetering on greatness, but only time will tell which direction they’ll fall. This is in complete contrast to Google who has a great cloud presence, but offers nothing on the desktop to compliment it. The perfect union might be between Microsoft and Google, but I doubt that will ever happen because they approach things from completely different directions.

HP opened some eyes with their acquisition of Palm, and I think the WebOS has the potential to be the greatest slate OS on the market, but only time will tell. HP needs to get something in the hands of the consumer quickly if they have any hope of becoming more than water cooler conversation.

With that said, technology in the consumer market is light years ahead of technology in healthcare, especially when it comes to pharmacy. I’ve only been an informatics pharmacist for about three years and have seen little change in pharmacy automation and technology in that time. Sure there has been plenty of conversation, but little action. Groups have been formed, articles written and chests pounded, but no one has bothered to get down and dirty and make something happen. Where is pharmacy automation and technology headed? No one can say. ASHP appears to be leading the pharmacy informatics charge, but their efforts are in their infancy. It will be several years before pharmacists see the results of the work being done now. We’re five to ten years behind the technology curve, and we need young aggressive pharmacists to get involved now if we hope to change the future. Where are the pharmacy schools in all this? Where are all the academics and researchers? The line between UX professionals, biomedical engineers, software engineers and clinical informatics is blurry. There’s opportunity there for those schools willing to jump in to the fray.

Some of the technologies that I’ve had the pleasure of working on over the past three years:

1. Alaris smartpumps – This was one of the first projects I was involved with when I came to work for Kaweah Delta. I love the concept and think the technology is great. However, nothing has changed since implementing the pumps in early 2008. At the time of implementation integration with bar-coding systems was “close”. Well, here we are more than two years later and we still don’t have our smartpumps integrated with our BPOC system. I know that it is possible as I’ve attended two presentations on the subject; one at ASHP Midyear 2009 and the other at the unSUMMIT earlier this year. However, there is no official word from Care Fusion.
2. Siemens Pharmacy Information System (PhIS) – One of the things I wanted to do when I got to Kaweah was get the pharmacy system up to date. We were a few versions behind. With great effort we pushed out two significant upgrades, including a platform change, and several minor patches. Now we’re using the latest version of Siemens PhIS. My honest opinion is that the upgrade had significant changes in the user interface, but did little to advance the functionality. The clinical decision support needs some work as does the ability to log interventions. Siemens could take a lesion from Pharmacy OneSource when it comes to clinical surveillance. Throw in Siemens process for requesting changes and their ho-hum customer support and you can quickly see why I’m pessimistic about the future. Here’s the best part, Siemens is considered one of the better PhIS platforms in the industry. What does that say about the rest of the systems?
3. Talyst automation – This was my first really big project at Kaweah Delta. We implemented several pieces of Talyst automation throughout February, March and April of 2008. The equipment is solid and unlike most of the software in healthcare, our AutoPharm software has the look and feel of something designed in this decade. The functionality is better than most of the products we use. They’ve been a pleasure to work with and their customer support is the best I’ve seen to date. Period. With that said, there have been no real advancements since our implementation in early 2008. Minor upgrades here and there, but nothing earth shattering. Our facility has been fortunate to be involved with beta testing new Talyst products, but they’re simply minor changes to an existing model. We don’t even use two of their more advanced pieces of technology: AutoCool and InSiteRx. The former didn’t fit our immediate needs and the latter is designed for long term care.
4. Pyxis – The world of automated dispensing cabinets is interesting. These devices have become a standard of practice in most hospitals across America. And while the concept is solid, the technology has become stale. Omnicell appears to be advancing faster than Pyxis at the moment, but even that hasn’t changed the way we practice. Remember, the current practice model in pharmacy is a couple of decades old. Nothing should go that long without a major overhaul. I would like to see changes to the dispensing cabinets that allow less open access and greater flexibility in dispensing. I mentioned this in June 2009 when I spoke about using a modified unit-dose packager on nursing units in lieu of an open drawer configuration. Think of it as using an ATM machine to get money instead of a cash register. JVM offers a product called the JV-60C30 that might fit the bill with some modification. Just a thought.
5. BPOC system, a.k.a. MAK – The bedside scanning system from Siemens isn’t half bad. The software is a little clunky, i.e. it looks just like our pharmacy system, but it works. I’m a true believer in bar-coding and think Siemens is on the right track. There is certainly room for improvement, but it does the job for now. I would like to see better integration between the Siemens clinical nursing system, their PhIS and MAK. I’m really not a fan of the jigsaw puzzle method for building a HIT system in a hospital. It gets messy. I’ve had several opportunities to speak with Siemens representatives from programmers to consultants, and when pressed on the issue of creating a better integrated system they have no answers.
6. Clinical Decision Support (CDS) – This is one of the most underutilized technologies on the market today. A well designed CDS system can offer so much yet we rarely speak of it. Implementation of CDS has been on my “IT” budget for two years running, and two year straight it got axed in the first round. It has received no serious consideration in our healthcare system.
7. Mobile technology – The use of mobile technology in healthcare is more prominent with nurses and physicians than it is with pharmacists. I have no explanation for this, but it’s immediately obvious when walking around the hospital. Our pharmacists have been using tablet PCs on the floor for a couple of years, but interest in their use remains minimal. Interest increased with the introduction of the iPad, but as I initially suspected opinions for their use in clinical work has been lukewarm. Our facility has become thick with iPads, mostly carried by executives to meetings. Whether they increase productivity or not I cannot say. I see most individuals using them to check email and their calendars; not for notes or file access. Some secretaries have brought their “department iPads” to meetings for note taking only to pull out a stand and keyboard. Not sure if that offers any advantage over a laptop or not. The perfect device for clinical pharmacists has yet to be invented. The device will be a hybrid of the desktop and the current tablet offerings. Regardless, we’ve done a poor job of investigating this technology as it offers pharmacists freedom from the desktop to practice at the bedside.

This isn’t the first time I’ve pondered the future of technology in pharmacy, and it certainly won’t be the last. I don’t think pharmacy technology will be driven by hospitals because most hospital pharmacists are more interested in advancing clinical practice than advancing technology, which is unfortunate because doing one leads to the other. The bigger issue is the lack of both financial and labor resources to do the job right (another blog post all on its own).

Pharmacy schools needs to form relationships with vendors and begin researching new technologies that will unchain the pharmacists from the physical pharmacy and drive true clinical practice. RFID, improved robotics, remote monitoring, advanced CDS, automated order verification, voice recognition, expanded system interoperability, improved allergy reporting and identification systems, alternate operating systems to drive system integration, i.e. Mac OS, Android OS, etc, better use of the cloud, and so on ad infinitum. The possibilities are endless.

I’m looking for the next revolutionary technology and certainly hope to see it soon. I’m just sayin’.