Jerry Fahrni

Tag: Pharmacy Automation

  • Who should drive the selection of pharmacy automation and technology?

    Who should be the driving force behind the selection of new automation and technology in a hospital pharmacy? It’s a simple question really, and in my mind there’s only one clear answer: pharmacy should drive the selection of their own automation and technology. That makes sense, right? Well it certainly does to me.

    However, lately I’ve seen a disturbing trend when talking with hospital pharmacies about their selection process. It appears that the IT department – you know, those guys that configure computers and keep your network and hospital servers humming along – has been given a lot of authority in the selection process. Call me crazy, but that seems a little strange to me.

    I’ve always thought of IT as a service department, someone to help you accomplish your goal when it involves technology. As an IT pharmacist it was my job to look at pharmacy automation and technology, evaluate it, weigh the pros and cons, and make a decision based on what was best for the goals of the pharmacy. Once that was done I would get IT involved in the process to make sure we had everything we needed from not only the vendor, but our own hospital IT department as well. If there were gaps we would work together to flesh them out.

    What happens if the IT department is given the leeway to make a decision for the pharmacy on which automation and/or technology they should use? They might make the “right decision”, but if they did it would be the result of sheer dumb luck. The selection process should be one that looks to find the best fit for the pharmacy, one that fits into the pharmacy’s distribution model, one that lines up with existing technology, one that takes future pharmacy plans into consideration, one that will help drive pharmacists out of the pharmacy toward more clinical activities,  one that acknowledges the strengths and weaknesses of the vendor in terms of functionality, usability and support,  and so on. The decision should not be based on who uses the best security protocol, or who prefers Dell Servers over HP Severs, or whether or not the vendor needs network access for support or not, and so on and so forth.

    I truly feel sorry for healthcare systems that ignore their pharmacy personnel when thinking about purchasing new automation and technology for pharmacy operations. In my opinion it’s a recipe for disaster. I certainly wouldn’t want to work in a pharmacy where the tools I used were selected by someone who didn’t even know what I was working on. The next time you have the oil changed in your car, ask the mechanic if he would let the person that installed their computers pick out his tools. I bet you’ll get a similar response to mine, although the language may be a bit more colorful. Better yet, ask a software engineer if he’d let a pharmacist pick out the hardware and software necessary to do his job. It’s a safe bet that he’d look at you like you’d lost your mind.

  • Saturday morning coffee [November 24 2012]

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug to the right is from Denver, Colorado. I have been in Denver twice now, once in the summertime and once in the late fall/early winter. It’s a nice place, but not what you’d expect. Well, at least it’s not what I expected. With a nickname like “Mile High” I expected to be going up and down mountainous roads all the time. Not the case. It is much more flat than I expected. The downtown area has a small town feel to it, and the the 16th Street outdoor mall area was very nice. I found a lot of cool things to do down there in the evening. I also found the Mellow Mushroom pizza joint. Dude, that was some seriously good pizza. One thing is for sure, the views were spectacular. I ended up on the 9th floor of one of the hotels I was in. Outside my window was a picturesque view of show capped mountains and green trees. Overall it’s a nice place to visit. Word of caution though about the airport, it’s a mess at times. I’ve only been through there a dozen or so times and have gotten burned on a few occasions. Consider yourself warned.
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  • Cool Pharmacy Technology – RxMedic ADS

    The RxMedic ADS robot is kind of cool. I’m not a big fan of robotics because I think they’re basically slow and I don’t believe the technology is mature enough yet; in healthcare that is.

    The thing that makes this interesting to me is the checkout process, which can be found at about 1:30 into the video. The process includes photo verification. Lends itself to remote checking and tech-check-tech, don’t you think?

    As technology like this becomes available it is becoming increasingly clear that the traditional role of a pharmacist is obsolete. Not sure if the new role is a completely “clinical” one, but it certainly isn’t what it is now.

    From the RxMedic website:

    The only retail robotic dispensing system with photo verification. The RxMedic ADS packs high speed processing into a very small footprint. Its 256 cells enable you to fill as much as 80 percent of your daily processing, complete with verification, labeling and capping.

    • Interfaces with any pharmacy management system
    • Save 50% – 80% of time spent preparing orders
    • Can pay for itself in pharmacies with as few as 150 prescriptions per day
    • Fill up to 80% of your daily prescription volume
    • Special HEPA filtration combined with vacuum technology helps reduce dust and cross-contamination
    • Nationwide on-site service

  • Cool Pharmacy Technology – ZiuZ Inspector

    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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  • Technology in the IV room – its time has come

    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.

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  • Cool Technology for Pharmacy – PharmASSIST OPTIx

    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).

  • Where will automation and technology make the biggest impact in pharmacy?

    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.

  • Cool pharmacy technology – UCSF Robotics

    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.

  • Cool pharmacy technology – StoreRx

    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.

  • Hey, don’t forget about the technology in the central pharmacy

    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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