Do smaller hospitals get the shaft when it comes to automation and technology?

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.

Many hospitals with fewer than 200 beds have pharmacy automation budgets under $200,000.¹ While this is a lot of money for the average working man, it’s not a lot of money when it comes to purchasing cutting edge healthcare technology. I can’t quote exact dollars, but some of the technologies mentioned above could easily eat up a majority of those budgets with a single installation. And when you consider that more than 60% of the hospitals in the US are fewer than 200 beds you start to see the problem.²

It seems to me that the ideal place to install cutting edge pharmacy automation and technology would be in smaller facilities. I think they offer the advantage of being less hectic and easier to control. This may not always be the case, but I’ve found that it’s often true. A less hectic environment provides a space to work out bugs while keeping damage to a minimum. Think of it as experimenting on a small scale before going big. Unfortunately these facilities are the ones cutting the checks and don’t have the luxury of being a guinea pig for some all-encompassing healthcare initiative.

The lack of automation and technology in smaller healthcare systems has the unfortunate side effect of missed opportunities for patient safety. Some would argue that automation and technology isn’t the only intervention to improve patient safety, and I would have to agree. With that said, there are lots of ways to make the medication dispensing and administration process safer, but the addition of automation and technology like CPOE, smartpumps and BCMA can certainly add value to other patient safety measures. It’s true; don’t try to argue differently because you’ll only sound like a fool. Sometimes things really are as simple as they sound.

1. State of Pharmacy Automation. Pharm Purch Prod. 2010;8 http://is.gd/jaBiO 
2. American Hospital Association