The Pharmacy of Tomorrow

Pharmacy automation is finding its way to more and more pharmacies every day?from the small independent pharmacies to the big chain pharmacies to mail-order pharmacies to hospital pharmacies. In order for pharmacies to keep up with the increasing population and prescription volume, they need solutions that will help carry them into the future. In the coming months, Pharmacy Times will explore the latest technology and what it means to pharmacy. This series will begin with a look at robotic dispensing systems. Future topics will include bar coding, e-prescribing, and pharmacy software.

If pharmacists are asked about their main concern for the pharmacy of tomorrow, 2 issues always come to the forefront?the shortage of graduating pharmacists and the aging of the American population, which will lead to greater prescription volume. To meet the increased demand for prescription medications with less staffing, automation?specifically the use of a robotic dispensing system?is an option many pharmacies are implementing to meet current pharmacy trends. Perhaps among the most important benefits of choosing robotics is time. Pharmacists have more time to spend counseling patients because it relieves them of the duties of counting pills. Bruce Roberts, RPh, owner of Leesburg Pharmacy in Leesburg, Va, was among the first pharmacists to use robotics. His pharmacy, which fills 450 prescriptions a day, uses ScriptPro?s SP 200. "We put the system in to make our process more efficient, and it has allowed the pharmacist to interact more with patients," said Roberts, who also is executive vice president and chief executive officer of the National Community Pharmacists Association.

"It?s very time-consuming [counting pills], especially when a machine can do that so well. The robot saves us time and allows our technicians to help out in areas they normally wouldn?t be able to if they were counting," said Cheri Garvin, manager of Leesburg Pharmacy. "It?s less chaotic, and we are better able to serve our customers and work at a safer pace with the robot." In addition, Garvin has found that she has more time to be out in the pharmacy among the customers because the SP 200 is helping to handle the increased workload. "I find that when I?m out in the pharmacy I?m more accessible, and I get a lot more questions about OTC products." The SP 200 and the SP 100 are part of the ScriptPro line of robotic prescription-dispensing technology. The SP 200 is a compact unit that interfaces with the pharmacy computer system. It delivers filled and labeled vials at a rate of 100 prescriptions per hour. This system contains 200 universal dispensing cells. The SP 100, on the other hand, is ideal for pharmacies with space restraints. That system holds a pharmacy?s 100 top-selling tablets and capsules.

"A general realization that implementing robotics into the pharmacy is beneficial is a clear trend," said Mike Coughlin, president and chief executive officer of ScriptPro.

"The robotic systems we produce are doing extremely well. It?s bringing a lot of stability and order to the pharmacy." ScriptPro is not the only company developing and manufacturing robotics. AutoMed, an AmerisourceBergen Company, and McKesson Automated Prescription Systems (APS) also offer robotic systems.

Russ Marable, vice president of marketing for AutoMed, has met with pharmacy clients who have told him, "My business is growing so fast, I don?t know what to do." AutoMed offers automation and efficiency in all types of pharmacy markets, including retail, hospital inpatient and outpatient, and assisted living. In retail pharmacy, automation has meant robotics, according to Marable. AutoMed has developed a retail series of robotic dispensing systems that can handle prescription volume for any size pharmacy. "We manage all the prescriptions, not just the Top 100. Pills is what drives automation, and we cover pills in every format," said AutoMed President Duane Chudy during the AmerisourceBergen Healthcare Conference & Exposition last month. For example, the R400 is ideal for pharmacies averaging between 100 and 400 prescriptions per 10-hour shift. This system automates up to 45% of the prescriptions and allows for a 15% to 25% increase in prescription volume with the pharmacy?s current staff, according to Marable. As for large retail pharmacy stores, Marable said, the R1000 will meet their needs. That system is designed for pharmacies handling 400 to 1000 prescriptions per 10-hour shift and can automate 80% of the prescriptions. "Our goal is to help them [the pharmacists] be accurate and efficient in filling all prescriptions, not just the top 100 to 200," Marable said.

McKesson APS prides itself on leading the way in innovation. The company has been building robotics since the late 1980s. Gail Wunderlin-Beigh, vice president of McKesson APS marketing and product management, believes that McKesson APS is "staying ahead of the market" with its products and services for pharmacy automation.

A robotic dispensing system that has seen a great deal of success in the marketplace is McKesson?s AutoScript III. "It was the first pharmacy robot introduced in chain and independent pharmacies and government institutions," said Wunderlin-Beigh. Designed for nonstop dispensing, AutoScript III offers 2 options: The A-Series holds 145 drugs and verifies, counts, fills, and labels 100 prescriptions per hour. The B-Series houses 240 drugs and verifies, counts, fills, and labels 120 prescriptions per hour.

In addition, McKesson will be unveiling its newest robot at the NACDS Pharmacy & Technology Conference in Philadelphia, Pa, this month. This robot is designed by pharmacists for pharmacists, according to Wunderlin-Beigh. She explained that during the robot?s development McKesson conducted market research surveys and held customer focus group and review meetings to get pharmacists? input about what they wanted. "It worked like a charm. By the time we got to the prototype, we were dead-on. It was almost 95% accurate," she said.

McKesson?s newest robot, which will be available in the marketplace in 2004, complements most pharmacy layouts and can hold 100 or 200 drugs. The client can easily upgrade the robot from a capacity of 100 drugs to 200 drugs. Because it can process 100 prescriptions per hour, the robot allows the pharmacy to handle higher prescription volume.

While robotic dispensing systems free up pharmacists? time, cost and safety features are just as pivotal. "When you look at the cost of personnel, this system [SP 200] allowed us to grow," said Leesburg Pharmacy?s Roberts. "If you look at the cost over a period of time, it?s not that expensive. You can have a working unit at about the cost of a technician, [approximately] $12 an hour, and it can do the work of 5 technicians," added Script Pro?s Coughlin.

In the past, only the bigger pharmacies (filling 400 or more prescriptions a day) had robotics because the smaller pharmacy owners did not think that they could afford it, according to AutoMed?s Marable. This is no longer the case, however. He said that AutoMed offers small, inexpensive systems that fit a pharmacy?s budget and space constraints. "We have systems to help that are under $10,000," he pointed out.

When it comes to cost, McKesson?s Wunderlin-Beigh has seen 2 mind-sets. She said that chain pharmacies are more "price driven," and smaller pharmacies are "looking not just at the cost, but at what [automation] can do to help the pharmacy." Therefore, she said that McKesson offers its clients a number of solutions instead of just 1 in order to position them for the future.

Safety is a critical issue concerning automation. All 3 companies have safety features built into their systems to deliver more accurate prescriptions and to lower the risk of medication error. For example, ScriptPro?s systems use bar-code scanning to ensure that the right drug in the correct strength is dispensed to the patient. Also, because the robotic arm fills the vials directly from the dispensing cells, no drug cross contamination is present. Once the prescription is filled, the pharmacist makes the final check for accuracy by comparing the pills in the vial with an on-screen image of the drug.

AutoMed?s dispensing systems use the company?s Efficiency WorkPath System to enhance safety. It decreases the likelihood of medication errors with image and bar-code verification and dispensing. The software integrates with a pharmacy?s information system and manages prescription orders, whether filled by automation or manually.

McKesson?s robots also use bar-code verification and digital imaging to ensure that the correct prescription is dispensed. The new robot also will have additional safety features, including unique dispensing chutes to eliminate the risk of harmful drug cross contamination. Furthermore, pharmacists can choose advanced security options such as password protection and manager-assigned permission levels.

As pharmacists look to the future, among their main focuses is patient counseling, along with other patient-related services. Automation is helping them achieve this goal. For instance, because of the SP 200, Leesburg Pharmacy has been able to add a 4000-sq-ft area for patient counseling stations and other patient-centered services. Aside from patient counseling, this pharmacy offers patient screenings and follow-up care. "We?re always looking for a better way and how we can be part of the health care industry and really dealing with the patients. It?s an exciting time to see these young [graduating] pharmacists geared toward interacting with patients," said Roberts. "Counseling is a very necessary piece of dispensing," added Garvin. "I don?t know if it?s possible, but I would love to counsel each and every person that walks out of here."