A cautionary tale for healthcare. A lesson for pharmacy.

A couple of days ago I read an interesting piece by John Halamka over at healthsystemCIO.com. In it, Halamka shares two stories about purchasing parts for some projects. One part required a lot of legwork and took a month to secure. The other required a quick Amazon search and less that 24 hours to obtain.

“It’s clear [the people running the company have] been asleep since 1985. When it comes time to replace the windows in my buildings, I would never consider Marvin Windows products, since it’s clear they care more about preserving an ancient business model and less about their customers’ modern expectations and experiences”. I feel that this accurately describes today’s pharmacy model.

The pharmacy practice I returned to after nearly a 10-year absence appears to have been frozen in time. Yes, things have changed here and there, like the introduction of EHRs, but the distribution model feels the same as the one I left around 2006. It’s a model that relies heavily on humans to perform manual tasks, which isn’t terrible per se. Unlike others, Amazon, for example, there has been a failure in pharmacy to introduce and integrate automation and technology into the distribution process. While pharmacy continues to rely heavily on people and very little technology, Amazon has designed a system that uses people plus strategically chosen technology to improve efficiency and accuracy.

In today’s pharmacy model, medication orders are manually pulled, stocked and counted. Manual “double” and “triple” checks are used in place of simple technologies like barcode scanning and robotics; often leading to slips and lapses. Medications are frequently lost due to the inability to accurately track them once they leave the pharmacy. This in turn results in medications being re-dispensed and often given late. Stickers identifying medications as high-risk, high-alert, STAT, sound-alike-look-alike, “note dose”, “rectal use only”, “neuromuscular blocker”, and a slew of others, decorate the shelves turning them into a Jackson Pollock painting.  Buyers still walk the shelves and manually evaluate stock levels. Paper logs are filled with information that is often redundant and available elsewhere in digital form. Legacy software sits on desktop computers while the cloud begs to be used. “Mobile pharmacy” means the pharmacist is walking around. If you didn’t know better, you’d think I was joking. I’m not.

In the article, Halamka states that “The lesson learned is that in the near future, healthcare organizations that offer an Amazon approach will displace this [sic] which do not.” I wonder if this applies to the pharmacy as well as healthcare organizations. I think not. Time has shown that pharmacy is an often forgotten part of the healthcare system. Pharmacists get promoted to move up and out of the pharmacy. No one ever moves “down” into the pharmacy. As the saying goes, it’s a good place to be from.

Halamka describes the progressive nature of Beth Israel Deaconess Medical Center (BIDMC). It’s impressive, to be sure. But even so, I’ve never heard of the BIDMC pharmacy. I’m sure it’s a fine pharmacy, but it’s never come up in any conversation or discussion of “the best” or the “most progressive”. I hear about BIDMC and Halamka all the time. Why not the pharmacy? Is the department as forward thinking as the rest of BIDMC? I don’t know. Perhaps someday I’ll find out.

Companies that provide technology to pharmacies are partly to blame. Their products often lack proper functionality and are woefully inadequate for the tasks at hand. With that said, it’s unfair to hold them responsible for our lack of progress. After all, pharmacy administrators are cheapskates, unless of course, they can make a lot of money – 340B, specialty pharmacy, etc – and then they’re all over it. But for the average, desperately needed technology, those in charge are unwilling to invest even when the technology has demonstrated improved patient safety and workflow.

It’s difficult for me to take a Pharmacy Director seriously when they say “we don’t have the money” only to take a stroll through the pharmacy and see inefficiency compounded with bloated drug budgets and out-of-control overtime numbers. Fixing even one of those would free up enough money to implement any number of additional technologies.

More often than not, I find that I’m speaking to myself when attempting to engage others in this conversation. Most want to discuss “clinical pharmacy” and “patient safety”(1) initiatives, all the while missing the bigger picture in favor of the minutia. It’s this clear lack of strong leadership and forward thinking(2) that will continue to plague pharmacy for the foreseeable future.

In the best interest of healthcare systems everywhere, I think it’s time to turn all pharmacy operations over to Amazon. I jest, but only a little.

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• Strange that many pharmacists don’t see the connection between using automation and technology and patient safety. True story.
• There’s a whole nother blog post in there.