Pharmacy and Technology: Industry Leaders Meet in Automation Roundtable

At the National Association ofChain Drug Stores Pharmacyand Technology Conferencethis past August, Pharmacy Timesbrought industry leaders together for aroundtable discussion on pharmacyautomation. Panelists discussed theimpact automation has already had onpharmacy and how an increaseddependence on automation will affectthe practice of pharmacy in the future.

Panelists felt that automation is nolonger a luxury—it is a necessity in ademanding marketplace in whichpharmacists struggle to keep pace withthe rising volume of prescriptions. "Ifyou look at the industry in general,"said one panelist, "you have pressuresto lower costs and at the same timepressures to add more services."

Although panelists loved the idea ofwhat automated systems can do fortheir business, they said that choosingthe right system for a particular pharmacy'sneeds is not simple. Panelistsagreed that, when it comes to choosingan automated system, one size justdoes not fit all.

Vendors, panelists said, do a good jobof providing the industry with choicesand suitable ways of integrating differentpieces of automation into the workflow.Yet panelists advised pharmaciststo have a clear idea of how a system willbe used and to choose a vendor with astrategic partnership in mind.

Automated pharmacy systems, panelistssaid, free pharmacists from mundanetasks and allow them to spendmore time with patients. Panelistscredited automation with introducingmore standardization, process control,and checks and balances as well.Although automation also is creditedwith improving safety, panelists feltthat pressure will increase on theindustry to introduce standards to preventpotential cross-contamination.

The Panel

• Fred M. Eckel, RPh, MS, Moderator,Professor and Director, Office of PracticeDevelopment and Education,School of Pharmacy, University ofNorth Carolina at Chapel Hill, andEditor-in-Chief of Pharmacy Times
• Michael E. Coughlin, President andChief Executive Officer, ScriptPro
• Mark Gregory, Vice President,Pharmacy and GovernmentAffairs, Kerr Drug Inc
• Vanessa A. Jacobsen, PharmD,Manager, Medication Use Evaluation,Walgreens Health Initiatives
• Pete Klein, Vice President, IndustryRelations, Parata Systems
• Stephen Mitchell, MS, RPh, VicePresident, Marketing, AutoMedTechnologies Inc.
• Samuel L. Nebiolo, Director, ProductManagement, McKesson AutomatedPrescription Systems
• Jeff Newell, RPh, Chief OperatingOfficer, Rhode Island Quality Partners
• Dan Villa, RPh, Vice President, CorporateDevelopment, Kinney Drug
• Bruce Wiswell, Director, PharmacyOperations/Technology, Rite Aid

An Excerpt from the Discussion

Fred Eckel (FE): Why has so muchattention been paid to automation of thedispensing operation in pharmacy?

Michael Coughlin (MC): Pharmacy isunder a lot of economic pressure and iseconomically vulnerable today. Changingbusiness models are pretty much agiven in this industry, yet many of thechallenges the industry faces are out ofits control. Technology is one area theindustry can control. And technologycan do some pretty powerful things forpharmacy.

FE: As the number of prescriptions hasgrown, the number of pharmacists dispensinghasn't kept pace. Is that anotherreason why automation is coming intoplay?

Dan Villa (DV): It's also a quality-oflifeissue for the pharmacist. The volumeswere getting so high in the storesthat pharmacists just couldn't keep up,even when a technician was added.Automation can take the pressure offand give them more time to spendwith the patients, and that's whatwe're trying to do.

Bruce Wiswell (BW): I really believethat we're trying to give pharmacists anopportunity to differentiate themselves.As we're all facing managed care issues,it really doesn't matter where patientsgo for a prescription. They're going toget covered by insurance somewhere,and we believe that if you're going todifferentiate yourself from mail order,you have to do something different.That's what automation for us is reallyabout—giving a pharmacist time.

FE: What impact does automationhave in the safety arena?

Jeff Newell (JN): Automated systemscompound the ability to be safe eachand every time a prescription is beingdispensed.

Stephen Mitchell (SM): I thinkautomation gives pharmacists theopportunity to introduce more standardization,more process control,more checks and balances, withoutextending the time it takes to introducethose new activities.

FE: Is providing a safer practice somethingpharmacists see as enhancing theirpractice?

SM: There are many facets to whatyou describe as safety. It could startright on the front end in transcriptionof the prescription. And again, if youcan let the pharmacist have more timeto interact and become a clinicalexpert, you can eliminate a lot of problemsdownstream.

JN: I think the need to avoid potentialcross-contamination in robotic systemsis absolutely a standard thatought to be established going forward,and I think there's going to be pressureto establish that.

FE: How much penetration has alreadyoccurred with dispensing automation?

SM: All of the other pharmacy practicesettings had very specific and clearlyobvious operational needs imposedon them (hospitals with unit-dose dispensing,long-term care with punchcards, mail order with just the sheer volumeof transactions). Without automation,they would have been unable tomove forward. The retail market is justbeginning to appreciate the impact ofautomation and pharmacy efficiencyon reimbursement and labor challengesas well as accuracy and profitability.

FE: So there's still real opportunity forgrowth.

MC: There is real pressure on pharmacyto get dispensing costs down to alevel that's competitive in the industry.Pharmacy has to use technology topush back by being more efficient.Having integrated systems allows communitypharmacists to work at a higherlevel. It also gives them a way to differentiatethemselves in themarketplace.

FE: How do we justify newer automateddispensing devices in community pharmacy?Is it still about people replacement, orare there other ways that we're justifyingthis investment?

BW: I don't view it as saving labor.We're just trying to catch up. By thetime you're getting that automateddevice in the store, the pharmacists arealready in great need of that help. Sowe're only trying to gain the time back,for the pharmacists to get back to doingwhat they were really supposed to do.

SM: From a pure labor perspective,shifting the work from the expensivepharmacist to the more inexpensivetechnician is a big opportunity andsomething that drives a lot of the ROI[return on investment].

Samuel Nebiolo (SN): At the end ofthe day, you're not looking to replacepeople with automation. You're lookingto make them more effective, sothey give better services to the enduser. You know, less wait times, betterclinical reviews, and things like that.At the same time, you're lowering thecost of your prescriptions.

BW: Sometimes pharmacists becomethe limiting step. Pharmacists need toaccept the technician and help thetechnician do the job. Then the pharmacistscan get on with the business ofdoing the job they should be doing.

DV: In the last store I worked in, 12years ago, I was pounding away on thekeyboard, and this young techniciansaid, "Would you please move downthe counter?"When I asked why, shesaid, "I can type with all my fingers,and I'm very accurate, so if you movedown to the end of the counter andcheck the prescriptions, we won't havepeople waiting here."So I moved.From that day forward, I really understoodthe value of technicians. Theyreally drive the business.

FE: How do pharmacies begin evaluatingautomation systems?

SM: There isn't one magic bullet inevery single situation. I think you haveto spend the time talking to the experts.

MC: We found that pharmacistshave been very willing to share theirexperiences and invite someone tocome in and mentor them through theprocess. Vendors can also provide peercomparisons.

Pete Klein: One of the most importantthings is to have a vision of whereyou're going to be after automation is inplace. You have to understand exactlywhat parts of your everyday life it'sgoing to impact. And when that impactis realized, what are you going to dowith that time? What's going to change,and do you have a plan in place?

FE: How are board regulations todayimpacting either positively or negatively inthe whole automation dispensing process?

DV: The New York board looks atautomation as an integral part of theprofession of pharmacy. Boards knowthat automation really does 2 things: itgives the pharmacist time with thepatient, and it provides quality control.So I think the boards are supportive.

FE: What will the future hold for pharmacistsas a result of automation?

DV: Graduating pharmacists have sucha high knowledge level that the ability forthem to really make a difference in thepatients'lives is going to be great. And Ithink that if we can let automation andtechnicians do the filling and let thepharmacists manage the disease states, it'sa great time to be a pharmacist.

JN: Pharmacists are going to havenew tools, automation tools, physicianorder entry. That's going to providemore data, so they have to becomealmost organizational experts in theway to manage their environment.Down the road, I would hope that ahigh-level paraprofessional technicianmanages that whole mechanical function,and pharmacists almost run a businessaround pharmaceutical care. It'snot just about the product any more.

SM: The vision of pharmacy has to bein cognitive services. It has to evolve intobeing viewed as an integral part of thehealth care team. The role of automationis to enhance techniques, provide bettersafety, provide flexibilities, provide betterutilization of the resources pharmacistshave to improve their cost containment.But I think automation also has to bevery flexible, very integrated. It has to beadaptable to a variety of situations. Itisn't one pharmacy and one solutionthat fits all. And that's a challenge for us.

SN: Market forces are present, andtechnology is coming into play moreand more. We all need to view this notas a customer-vendor issue to resolve,but a partnership, in order to addressthese issues. It's a necessity for the vendorsand us to get together and formthat partnership to look at businesssolutions. We should not look at sellingproducts and pieces, but look at solutionsto provide these better healthcareservices to the consumer market.

MC: Retail pharmacy is a business,it's a retail business. It's under a lot ofstress right now, and that's likely tocontinue, because it's an importantpart of the health care system, and thehealth care system everywhere is underpressure. We have to equip retail pharmaciesto operate with integrated businesssystems. Those systems need totransform community pharmacy intomore of a profit-margin-producingengine. There are opportunities to producenot just volume, because volumewithout profit margin is no good.We've seen too much of that.

BW: The vendors are doing a greatjob of providing us with choices, suitableways to integrate different piecesof automation into our workflows. Ithink it's up to us to learn to use themand to really take advantage of themand to take advantage of them at theappropriate times. And I think that'sprobably where retail might be mostbehind, in the appropriate timing ofusing what's available.

JN: When pharmacists want to automate,they need to make sure they'relooking at their selection with a strategicpartner in mind: where are theygoing, what do they want out of thatrelationship?

DV: Automation in the future is goingto do a number of things for us. It'simproving the quality of the product,and it's giving us time to spend with ourcustomers. Customers know a lot abouttheir medications, but they still come tous to ask for more information. If thepharmacist has more time to spend withthe patients out in the OTC aisles, itbrings in extra sales. So I think it's a greattime for pharmacy.

Ms. Sax is a freelance writer based inRidgewood, NJ.