Time to accept pharmacy robotics as our friend and ally

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.

Medicine
Anyone that’s worked in healthcare for more than a day has surely heard of the de Vinci Robot. The de Vinci robotic surgery system has become quite a buzz word over the past few years. Places like UC Davis Medical Center even use it as a form of competitive advantage and advertise it as “leading-edge technology” in surgery. Hospitals like the one that previously employed me were leveraging such technology to get funding from the hospital board and gain support from the surrounding community and local media.

Back in October 2010 McGill University in Canada made headlines by performing the first all-robotic surgery with the da Vinci robo-surgeon and a robotic anesthesiologist named McSleepy. There’s no question that the surgical world understands the potential advantages of robotics; kind of like the automotive industry.

How about the use of small robots for spinal surgery that appear to reduce pain and complication risk for patients? An article in the December issue of Spine talks about the success of using SpineAssist surgical robot from Mazor Robotics to place robotically-guided spinal implants. Overall the data looks promising. The SpineAssist robot is currently in use in the United States, Germany, and Israel.

OctoMag micro robot is a nanorobot controlled by magnets. It’s designed to swim through the blood vessels of the eye, where it can perform various procedures. I can’t tell you how amazing this technology is, and it’s only going to get better.

It’s not just mega-million dollar companies that can advance robotics. Recently a group of engineering students from UW hacked a Kinetc for Xbox 360 from Microsoft with the idea of performing robotic surgery. Yeah, a gaming system appears to be the new frontier for advances in medical technology. Like I’ve said before, healthcare is way behind the consumer market when it comes to technology. Awesome.

Pharmacy
Not to be outdone by the surgery gurus, the pharmacy world has been quietly, and I do mean quietly, making robotic advances of their own.

To date the most well know piece of pharmacy robotic technology for use in acute care pharmacies is probably ROBOT-Rx from McKesson. This robotic dispensing system has been around for a long time. When you hear about a pharmacy using a “robot”, they’re generally referring to ROBOT-Rx. I’ve practiced in an acute care setting that used one and have formed my own opinions, but let’s just say that you need the right practice environment for ROBOT-Rx to be effective. Ask around and you’ll get similar responses.  

I don’t know of another inpatient dispensing robot similar to ROBOT-Rx. There are several outpatient systems like ScriptPro and Parata, but not in the acute care setting that I am aware of.

Companies like Swisslog make several robotic pharmacy solutions, including PillPick automated unit dose packaging, storage and dispensing system, as well as BoxPicker, an automated pharmacy warehouse system for storing and dispensing medications. In my opinion Swisslog stands out smong acute care pharmacy automation and technology, as they have some of the most advanced systems available at this time. Their concept of a futuristic pharmacy seems reasonable to me, and could go a long way in advancing a new pharmacy practice model.

There’s an interesting article about the use of PillPicker and BoxPicker from Memorial Medical Center in Springfield, Illinois. The article is an over simplified view of the entire process, but it gives you a general idea of where things fit and where such a system may benefit both the pharmacy and the patient.

My favorite area of pharmacy robotics, however has to be the use of robots for preparation of intravenous medications in the clean room. This area is a hot topic of discussion and appears to be advancing faster than most other areas in pharmacy automation and technology at the moment. 

Health Robotics has been quite prominent in the area of IV room automation with i.v.STATION for non-hazardous compounding and CytoCare for hazardous compounding.

I’ve seen i.v.STATION in action and think it’s a great start to the system I’ve imagined. Of the automated IV solutions I’ve seen I think i.v.STATION has the most to offer.

RIVA by Intelligent Hospital Systems is another fully contained automated IV preparation system. Secondary to i.v.STATION, RIVA is probably the most often cited IV room robot.

IntelliFill I.V by ForHealth Technologies, Inc is another automated IV solution that’s slightly different than i.v.STATION and RIVA as it specializes in preparation of small-volume IV medications. It’s hard to tell where IntelliFill I.V. fits because I rarely hear the system mentioned when talking about IV room automation.

It’s clear that IV room robotics is slowly becoming the next popular area of interest for many acute care pharmacies, but it’s certainly not the only area. Robotic delivery of medications also appears to be on the radar of many. When combined with RFID technology, small delivery bots can have a positive impact on patient care while improving pharmacy workflow with real-time drug tracking throughout the hospital. Aethon offers such a system. I had the opportunity to watch their little TUG robot in action at ASHP Midyear. I thought it was pretty slick.

1. “RRG/Learn More/History.” Robotics Research Group : The University of Texas At Austin. N.p., n.d. Web. 30 Jan. 2011.
2. Devito, MD, Dennis, Leon Kaplan, MD, Rupert Dietl, MD, et al. “Clinical Acceptance and Accuracy Assessment of Spinal Implants Guided With SpineAssist Surgical Robot: Retrospective Study.” Spine 35.24 (2010): 2109-2115. Print.