Jerry Fahrni

Tag: Pharmacy Technology

  • Center for the study of pharmacy automation and technology [idea]

    MadScientistEarlier this week I put up a post about a Prezi created by Dr. Robert Hoyt called Evidence Based Health Informatics: Replacing Hype with Science. It was a great presentation about a lot of the technology that healthcare has adopted over the years without any real evidence to back it up. I wish you could all see it, but it appears that someone has pulled it down. The link I have for the Prezi is dead. Bummer

    Anyway, the Prezi got me thinking about how we have many technologies in pharmacy that have precious little, or no data to support their use. We use carousels, high-speed packagers, tabletop packagers, robotic medication distribution, robotic IV preparation along with other IV room technologies, smart IV pumps, automated storage cabinets, and so on. The data we do have for these items is typically provided by the manufacturer’s themselves, which makes it biased in the best of situations and completely worthless in the worst cases.

    Pharmacy is in desperate need of an academic center for the study of pharmacy automation and technology. The center would study the use of pharmacy technology in different use cases, collect data, and provide the pharmacy community with the information. Look at robotics versus carousels for distribution. Analyze cross contamination in high-speed packagers versus tabletop models. Perform time-motion studies on cart fill vs. automated dispensing cabinets for medication distribution, and compare the safety of one over the other. Analyze pharmacy inventory costs of one technology over the other. And so on, ad infinitum.  Conclusions wouldn’t be necessary as simply presenting the information in an easy to understand format would suffice. Let the end users draw their own conclusions. Every practice setting is slightly different, and what may work for one may not work for another. But understanding how a piece of technology or automation fits into a particular practice model might be a significant benefit to many.

    The center would tear the automation and technology apart, both figuratively and literally to unveil all there is to know about each and every piece.

    Such a place would have to exist at a well respected academic research center as it is the only way to ensure some semblance of impartiality.

    How would it be funded? Ah, there’s the rub. Getting funding for such an endeavor would be difficult at best. A lot of this equipment is expensive. Of course the best place to troll for money would be the pharmacy technology vendors themselves. After all, they have all the equipment that would be needed to perform the research. Unfortunately this is unlikely to happen as most companies will not be willing to drop resources into a project that they have no control over. What if the outcome of such research reflected poorly on their products? That would not only be embarrassing, but could potentially hit them in the pocketbook. No, they couldn’t risk it. How about the federal government? Perhaps, but that might be like getting blood out of a turnip these days.

    Getting the equipment and funds would definitely be the hardest part. There’d be no shortage of pharmacists interested in doing that type of work. What pharmacist could resist playing with giant toys all day long?

    Time to get out my crayons and start drafting a proposal….

  • #1 thing to consider when buying pharmacy automation and/or technology…

    There are a ton of things to consider when you’re thinking about putting new technology in the pharmacy. You have to consider the cost, the impact on your operations, the reputation of the company that you’re buying from, what type of technology you’re going to buy, and so on and so forth ad infinitum.

    However, the number one thing you must consider before taking the plunge is whether or not the technology fits your dispensing model. Do you still do a cart fill? Are you completely decentralized? Are you using a just-in-time dispensing model? Will the technology that I’m looking at fit what I hope to accomplish? You need to think about that long and hard before making a decision.

    It’s like buying a new vehicle. You certainly don’t buy a Toyota Prius if you need to pull a 24 foot Centurion Enzo SV244 – a really nice boat – to the lake on weekends. No, instead you buy a new Ford Super Duty truck. I know that makes perfect sense to you, yet I hear people frequently say “it doesn’t fit the way we work” when talking about pharmacy automation and technology. When they say that, the first thing that pops into my mind is “then why did you buy it?”. It’s a question that needs serious consideration because some of this stuff is expensive.

    I experienced this firsthand in my previous role as an IT pharmacist. We installed new technology that didn’t really fit our distribution model all that well. We tried to cram the technology into an manual process. Didn’t work. I fought it for a few months until the light bulb finally went off. Once we got out act together we redesigned the process around the technology. We took advantage of the automation and filled in the gaps where necessary. It fundamentally changed the way we did things, and in the process improved the overall distribution process.

    So before you go and buy a robot, or a carousel, or a high-speed packager, or a compounding machine, make sure you ask yourself how you’re going to use it.  This stuff isn’t top secret. Do a quick Google search. Watch some videos. Talk with hospitals that do the same things as you.

    In a nutshell do your homework before taking the plunge because once you take the plunge and decide you’ve made a mistake you can only do one of two things: 1) change automation, or 2) change the way you work.

  • MedFolio, more medication compliance technology

    Seems like everyone has some piece of technology designed to help patients with medication adherence and/or compliance.

    What’s interesting to me is the number of different approaches there are out there to solve the problem. MedFolio looks similar to the old style medication organizers. It’s probably the most labor intensive solution I’ve seen, but then again it may be the most useful. Hard to say. From the videos I found on YouTube it looks like it’s been around for a while.
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  • Automating the oral pediatric syringe filling process [idea]

    oral syringeThe distribution process in pediatric acute care can be quite a bit different than its adult counterpart. The basics are the same on the surface: 1) receive medication orders, 2) fill medication orders, 3) dispense medications. The big difference however is how those medication orders are filled. Pediatric patients require a lot medications in liquid form pulled into oral syringes with patient specific dosages. The bummer is that a vast majority of these syringes are not manufactured in unit of use syringes. In other words you have to do most of the work yourself. It’s a bit of a hassle, but it has to be done. The process of pulling liquid doses into oral syringes has more in common with work done in the IV room than it does with traditional oral solid distribution.

    Recently I was visited a pediatric hospital and watched this process in action. Based on what I witnessed I started to wonder if it was possible to automate the process. And if you could automate it, would it offer any benefit? I suppose it could increase the safety of the process as well as potentially eliminate the need for a pharmacist, freeing them to do something else. Maybe. Maybe not. Regardless, it was worth more thought.

    I started breaking down the process and realizes that it’s more complex than it appears on the surface; it always is. Automating the process would be difficult. Several pieces of the puzzle are already available today, but as completely disparate systems.

    Just thinking out loud, or in writing as the case may be, the process would look a little like this:
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  • 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.

  • Pharmacy tabletop unit-dose packager comparison [table]

    Tabletop unit-dose packagers don’t get much respect, but have you ever been in a hospital pharmacy servicing more than 100 beds that doesn’t have one? I haven’t. Not to say that every pharmacy out there has one, but they’re certainly prevalent.

    The Cadet by Euclid is pretty much synonymous for “tabletop unit-dose packager” in the pharmacy world. It’s akin to how people use the term Xerox to refer to any copy machine, or iPod for any mp3 player. So don’t be surprised if someone refers to your tabletop unit as a “Euclid” regardless of which one you have.

    Anyway, I was doing a little research on the subject and thought I’d share my findings with you (table below). The one piece of data I don’t have is price; companies aren’t exactly transparent with that type of thing.
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  • RFID-enabled carousel [Video]

    A link to the video below was left in the comment section of my recent ASHP Midyear 2012 post. The video features a SencorpWhite RFID MiniVert Carousel. Pretty cool use of RFID technology. Where would something like this fit in a pharmacy? Not really sure, but I can think of a few use cases that would make sense.

    From the SencorpWhite site:

    In the pharmacy setting, the integrated RFID provides two distinct operations –real-time put-and-pick verification and cycle counting –and so, the MicroVert allows stock transactions to be securely and accurately monitored without operator intervention. In addition, inventory can be audited on-demand in as little as 30 seconds.

  • Upon further review – thoughts on ASHP Midyear 2012

    I’ve just returned from a week in Las Vegas, NV at ASHP Midyear 2012. The ASHP Midyear conference is the pinnacle of clinical meetings each year for most acute care pharmacists. For me it’s not that interesting anymore as I don’t attend as a pharmacist. It just more work days for me; long work days. I didn’t attend a single “session”, but did manage to find some time to walk through the exhibit hall once and catch up with some old friends.

    Enough of that, on with the thoughts:
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  • Cool Pharmacy Technology – Kirby Lester KL1Plus

    The Kirby Lester KL1Plus is a piece of technology designed to count medications in a retail/outpatient pharmacy setting. The device was introduced at the recent National Community Pharmacists Association (NCPA) and Department of Defense Joint Forces Pharmacy Services annual conventions in San Diego, CA.

    The KL1Plus is based on Kirby Lester’s KL1 tablet counter combined with new verification software. It’s small enough to fit in your hand and uses barcode technology to provide medication verification during the counting and filling process.

    The is pharmacy technician scans the barcode on the patient label, then scans the corresponding stock bottle or package when counting.

    What I really like about this technology is that it’s simple, it’s small, it fills a niche, it uses barcode scanning for verification, and uses touch screen technology. It’s a smartly designed product. I like it.
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  • 4 technologies every hospital pharmacy should be using right now

    There are lots of useful technologies out there for pharmacies, but I see precious few being put to good use. Why? Oh, who the heck knows. It’s a mystery to me. People whine all the time about how bad pharmacy operations are, but they never do anything to fix it. Human nature I suppose. If I were a DOP or CPO I’d be using anything and everything I could get my hands on to improve operations and make life easier for my pharmacists, and in turn easier for “pharmacy” and nursing, which in theory leads to better patient care. It’s the great circle of life. Sort of.

    Here are four things I think every hospital pharmacy should be using, in no particular order:
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