Slashdot Mirror
Robot Pharmacists
Makarand writes "The next time you visit a pharmacy your prescription may be filled by a robot according to a
TechTV article. Hospitals and drugstores are now increasingly relying on automated technology to count, bottle, and label prescription drugs in a faster and more accurate way. The technology uses a bar-code system similar to those used to read prices in grocery stores. Doctors enter prescription details directly into the pharmacy computer. The robot springs into action when an order is recieved. Riding on a conveyor belt, the robot picks up an empty vial, identifies the bar code of the chosen drug, and automatically fills the drug bottle."
This company, http://www.innovat.com (skip flash intro), innovation associates, has some cool technology that does this. For example, if the doctor mistakenly chooses pill A, instead of pill B, the machine will not dispense. Also, you can't fill the Tylenol Aspirin tray with anything but that. It uses some fancy recognition software; it can tell the difference between a skittle and and M&M, plus it won't dispense if pills are deformed (chiped etc.) cool stuff.
Because doctors can perscribe any whole number of pills to any given individual. (In fact, they can perscribe half pills at times too.) The law requires that the pharmacist give exactly the number of pills perscribed, no more and no less.
Having them in pre-packaged units works for some medications, but for the vast majority you'd still find the phamacist having to rip the blister packs in half in order to get the exact number of doses the doctor requested.
I spent over two years working at NorTel's Bramalea site, which had robotic slide-lines for manufacturing surface-mount component boards. The equipment used tape hoppers of parts, which had individual components mounted on tape similar to a belt-fed machine gun. Once programmed, the robots themselves were flawless, doing exactly what they had been instructed.
The errors that typically cropped up after an assembly program was put in production were caused by good old fashioned human error: loading the wrong parts tape in a hopper (e.g. resistors with the wrong ohm value.)
I cannot see a robotic prescription-filler avoiding this problem. If someone fills the Atenolol (high blood pressure medication) hopper with Viagra, the robot is going to happily count out the correct number of the wrong pills, label them as Atenolol, and leave it up to humans to notice the error.
Cashiers/assistants (sometimes part-time high school or university students) usually hand the packages to customers, not the pharmacist. Even if the bottles aren't pre-bagged, the assistants are very unlikely to notice the pills are the wrong color, size, or shape -- they don't know what the pills are supposed to look like.
While I can see the benefit of a manually fed pill-counter device, all I can forsee from full automation are inevitable mis-filled prescriptions resulting in injury or death of the patients. This is one of the best examples of over-automation I've seen to date.
Some jobs just shouldn't be fully automated, even if we have the technology to do so.
I do not fail; I succeed at finding out what does not work.
Then you obviously don't know what a pharmacist really does. The 8 or so that I know don't count pills, that's what pharmacy techs do. The real pharmacist looks at the prescription and makes sure the doctor wasn't on crack when he wrote it.
A doctor has to know how the body works and know all the warning signs for about half a million diseases, and the tests for the signs. Are they supposed to know all about 3/4 of a million drugs, their side effects, their dangerous interactions with the other drugs the patient is taking, and the proper dosage?
I don't know how many times I've talked to the pharms' that I know that said some doctor prescribed something that was way too much/little for the patient's body or would've given them side effects that were worse than the origional problem.
Hell, if the town my Grandma's hospital was in had a decent pharm. maybe she'd still be alive, rather than the drugs (to treat the side effects of the drugs (to treat the side effects of the drugs)) causing her kidneys to rot out of her body.
----- - The beatings will continue until morale improves
They missed the boat on this one. I work for a mail order pharmacedical company that has been using robotics to do the same thing for many years (atleast the 7 that i've been there).
The most common misconception is that it replaces a pharamcist but by law (atleast here in the Pittsburgh PA area) the pharmacist still looks over the pills in the vial. But a pharmacists time is at a premium and machines are much more capable of doing the job of counting with less errors and faster than a human phar tech.
Overall our "defect" rate is on par with your mom and pop store but our RXs per hour count is much higher.
Dedicated Cthulhu Cultist since 4523 BC.
"And yes, even with automation and 7 checks by machinery including an automated image comparison the pharmacist STILL catches errors."
that's pretty surprising. if you assume these checks are relatively unreliable - say they're 98% accurate.
at 7 checks, you have an overall accuracy of 99.999999999872%. in other words, with these 7 checks, you're likely to miss an error once in 781,250,000,000 checks. if you assume that 1 in 10 prescriptions have en error in them, you'll fill about 7,8 trillion prescriptions before making an error. so if you're pumping out 60,000 prescriptions a day, you'll have an error once every 35,673 years.
in other words, with 7 automated checks, you shouldn't really have any errors. what can we conclude? the automation sucks a lot.
replace the pharmacist, for all the reasons you've stated and more. The point is to automate one of the routine jobs of the pharmacist where mechanical means is less prone to error and removes an act of pure labor from the job.
The pharmacist should, as a matter of course, double check on the work of the robot, because even robots can make mistakes.
This isn't like replacing the pharmacist. It's like giving a ditch digger a backhoe to replace his shovel, or automating a daily incremental system backup so the admin can spend his time and attention somewhere more profitable.
KFG
- It would be much easier to have them prepackaged at the manufacturer, so the pharmacist simply reaches in the shelf and grabs the prepackaged box of whatever the doctor prescribed.
Yes and no. First, note that my company, Dispensing Solutions, Inc., is a repackaging company specializing in point-of-care dispensing (meaning the physician or other prescribing healthcare provider hands the patient a bottle of the medication s/he prescribes instead of a prescription). I am not a pharmacist nor a healthcare professional; I'm the CTO and developer of the Internet-based point-of-care dispensing application (basically a real-time inventory control system with a procedurally controlled dispensing component), which is used in physician practices and community health clinics.The problem with the mfg making pre-packed bottles of drugs for instant dispensing is that doctors (more properly called "providers" since not only MD's can dispense drugs legally) don't prescribe the same number of pills and of the same strength for the same diagnosis. For example, Amoxicillin may come in 250 MG caplets or 500 MG caplets. A provider may prescribe 30 caps of Amoxicillin 250 MG,with one cap to be taken 4 times a day. Another may prescribe 28 caps. If the Rx says "28 caps" you can't dispense 30 caps just because that's the only bottle size you have on hand. Each provider has his/her own way, so mfg cannot pre-determine the dosing without practicing medication themselves.
This then is where repackaging companies such as the one I work for come in. We work directly with the providers to determine the top 20% of prescriptions and work to standardize their prescribing habits, according to their direction. This way we can provide high-quality prepacked drugs for point-of-care dispensing.
What's the benefit? One is quality control. With ever-increasing workloads and shrinking numbers of pharmacists the number of Rx fills per day is increasing, as is the number of errors and related injuries and deaths. In the same line, we are regulated by the FDA and licensed as a drug manufacturer. A pharmacist is regulated in each state by the Board of Pharmacy. The rules on cross-contamination are much more severe on us than on your local pharmacist. For example, penicillin is processed in the same area as all other drugs in a pharmacy, but we are forced to use a negative-air flow clean room for filling penicillin-type products and are not allowed to have any cross-contamination. It is unfortunately not uncommon for people allergic to penicillin to suffer anaphylactic shock from a cross-contaminated non-penicillin drug filled at a pharmacy.
Another benefit is financial to the provider. Providers, by law, cannot receive money from prescriptions written to be filled by a pharmacist. But, as long as the service is provided to the provider's own patients in their own practice/clinic, they can make money dispensing drugs they would otherwise send out to be filled. Some providers make an extra one or two hundred thousand dollars a year just dispensing their most commonly prescribed drugs.
There is a benefit to the insurer, or, more accurately, the pharmaceutical benefit manager (PBM). Each plan has a preferred formulary (say chosing Allegra over Clarinex for allergies). By having the preferred drug available in house the PBM could "give away" the preferred drug and save money over paying for the higher drug even with a higher co-pay.
Another therapeutical benefit is in therapy compliance. Usually, a provider has no way of knowing if a prescription written has been filled. However, if the provider hands the patient the drug directly it has been shown that there is a higher probability of that patient completing the therapy prescribed.
Lastly ('cause this is too long), there is a benefit for pharmacists, too. Precisely because the best use of a pharmacist's time is counselling not filling, we work with pharmacists to pre-pack common movers in their pharmacies. Thus the pharmacist needs only grab the right bottle matching the drug, strength, and count for the prescription. No counting (but they still collect the "fill fee"). This way the pharmacists can fill more prescriptions--safely.
The filling machines are neat. We have several in our facility, including one that has the capacity to fill 200,000 bottles a day. While these machines are slick, they're expense is hard to swallow, especially when companies like DSI are able to fill the need. Neat article. Good to see it on Slashdot.
-- @rjamestaylor on Ello
I lived in Europe for a few years (about 10 years ago) and prescription drugs were primarily obtained in packaged bubble packs (20, 30, etc. pills), much like you get many OTC drugs in the US. The advantage, I believe, is better quality control at the delivery end: not having to rely on an overworked pharmacist to dump and count the correct pills. Without a PDR (Physicians Desk Reference) you just can't verify that the pills you get are the ones that should have been prescribed. The US way just seems very backward and labor intensive.
Plus when you get a factory sealed box of pills, you get the package insert and all the information about the drug compound and side effects etc. In the US you always have to ask for that - it should be mandatory!
Interesting fact: In Switzerland, pharmacists are licensed to identify toxic and edible mushrooms and verify them for you. So after your deep woods mushroom collecting, you stop by the pharmacy with your bag of shrooms and get rid of the bad ones before dinner. Don't remember what they say about psychoactive fungi.