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."

Comments

This is bad

[dangermouse]

Human pharmacists have always served as information resources for their customers, and even as a check on poorly-chosen prescriptions from doctors.

I can understand automating away the cashier or the janitor, but automating away a job where human judgment is so crucial is a terrible idea.

Re:This is bad

[Daniel Dvorkin]

I've never understand the point of pharmacists. Really. To reply to dangermouse, shouldn't the doctor be an information resource? Also, the doctor should be picking the right prescriptions in the first place. I don't want to upset the pharmacists here, but it's just something I've never understood. I say, bring on the robots!!

To put it very simply: it's the doctor's job to decide what medications you should take, it's the pharmacist's job to tell you how to take it, and just as importantly, how not to take it.

This is an oversimplification, of course. A good physician needs to be able to give a patient advice on using medications. But doctors are busy; very, very often the doc needs to shoo the patient out of the exam room to get to the next patient, and the (often very confused) patient goes down to the pharmacy to get everything straightened out. This is particularly important for older people who may be a bit confused anyway, and on a whole shitload of different medications.

The problem of patients on multiple meds brings up another valuable function of pharmacists, which is catching drug interactions. Ideally, every time you went to the doctor -- any doctor, in any specialty, at any hospital or clinic, for every problem -- that doctor would a) know everything about your medical history (pharmaceutical and otherwise) and b) know every possible drug interaction and contraindication. The real world, of course, doesn't live up to this ideal. The fact is that people are more consistent in their pharmacist than in their doctor; old people with multiple conditions very often go to see several different specialists, but get all their meds from the same place. When a patient has a list of meds that fills both sides of a sheet of paper (and believe me, I've seen it) it's nice to have that extra sanity check.

Finally, good clinics and hospitals are increasingly finding it useful to have at least one or two PharmD's on staff to advise the physicians before the prescription is issued. "Hey, I've got this guy who's on Alizadol and Corvabarin, but his liver enzymes are running kind of high; what do you think of giving him Zelarin instead of the Alizadol?" (Drug names are made up, of course -- hey, it's New Year's, and my own biochemistry is a little altered right now; you want me to think of real ones right off the bat? ;) MD's know a great deal about the human body, but they very often find it impossible to keep up with the dizzying variety of chemicals designed to be put into the body.

When it's your body they're screwing with, it's good to have several sources of human judgement. Doctors can and do make mistakes, either because of a lack of specialized knowledge or (very often, especially in the case of interns) because of exahustion. Pharmacists very often keep those mistakes from killing people.

Re:This is bad

[CrystalFalcon]

The point of pharmacists should be obvious. You NEED to study for four years to understand the kind of handwriting they have to read to get you the right bottle.

Slick Technology

[edlong]

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.

Re:Robots and mistakes

[Jennifer E. Elaan]

Barcode reading errors are extremely rare with a proper lase reader. The only way the robot would mismatch barcodes is if the bottles were labelled incorrectly, and that would be a human error. They still put cameras to catch such glitches though, so the pharmacist should still notice.

As for the question of resources, if these machines cost a half million dollars each, I'm willing to bet that they are nearly as good as what the drug manufacturers use.

I would expect, although I'm not sure, that a half-million dollar piece of medical equipment would be jam packed with batteries in case of a power failure. In the unlikely occurance of a jam, or a natural disaster taking down most of the electronics (this sounds rather like a straw-man argument to me), there has been a relatively good track record with extra staff. The recent network packet storm in a major hospital comes to mind, everyone was busy but service was not particularly degraded, even with the network completely out of commission.

Besides this, for a regular pharmacy, delays of a day or two to get a prescription filled are not unusual in some cases. Only in emergency cases is this a mission-critical system, and emergency drugs are usually available in places other than the main dispensory.

From the trenches�

[(H)elix1]

This seems like a great idea, until I read the line - "Doctors type prescriptions into a pharmacy computer system and the orders send the robot into action." This implies a physician (or health care provider if you prefer a more derogatory term the insurance world uses) will actually use technology.... Not just a computer, but a handheld, tablet PC, something with a browser... the chances are slim to none with most of the baby boomers out there.

My first real world experience with CORBA was connecting a Cobol program on a mainframe to a Java application. The Java app would then shoot drug interaction and formulary data to be used by the Physician's winCE handheld. As a former biochemist that spent a serious amount of time working with MD/PhD's in a hospital, the app seemed like a killer idea - response time was fast, the data was secure, and the information was personalized. Then they tried to get them to use the thing. I understand 'you can lead a horse to water' on a whole new level.

Anyhow, there is the human factor as well. It is hard to beat a well designed smart system, but I like the idea of requiring two humans - one to order the drug, another to confirm. The physician spends a surprisingly little amount of time in the real sciences compared to a pharmacist. Different skill set (filtered on what I consider real science). As a side note, pharmacists were pretty good with technology - since they were using Power Builder thick clients and later web interfaces to deal with co-pays, adjudication, interaction warnings, etc.

Counting pills is not hard. Knowing that pill x with pill y scores you a role on the potion miscibility chart is priceless. A real easy fix to "has to read doctor's handwriting" problem? Get them to type the bloody prescription. Wait that would require them to use some funky software ranging from a typewriter to a computer thing...
nah... too hard.

Had this been a toolkit for a pharmacist, it would really take off.

My friend owns one of these robots

[jht]

I have a good friend who owns a large independent pharmacy in New England (I won't be more specific, because I'm not sure if he'd want it mentioned here - though his store and system have been profiled in both trade and general newspapers). He loves it - it handles his top 200 medications, and in his own paraphrased words:

"It lets the pharmacists (of which he is one) spend more time with the patients, and less time counting pills."

He is able to keep a couple fewer pharmacy techs on hand then he used to need for his volume, but it gives the pharmacists a nice assist. He worries less about mistakes - the sanity checks these machines have are a lot more reliable than a human's would be. He's told me he sleeps better at night, knowing the likelihood of a potentially fatal mistake is far lower because of the robot. He sees the role of a pharmacist as being to advise and dispense - with a strong emphasis on the first job.

Here's a true anecdotal story supporting robot usage: I take a Priloec every day. One time I went to my local CVS to get a refill - when I got home and opened the bottle I found Prozac instead (the prescription label was correct - they just filled it with the wrong drug). They took care of the problem immediately, but imagine if I wasn't bright enough to realize that those pills weren't mine (I joke that I'd still have had stomach trouble, but I'd have been happy about it). Fortunately, taking a Prozac per day wouldn't have killed me, but what if it had been something that could have?

That's where I can see robots helping the typical pharmacist. It'll prevent those sort of mistakes from happening, and ensure that the drug ordered is the drug given.

The point of this shouldn't be to. . .

[kfg]

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

Handwriting?

[nautical9]

Does this mean hand-writing-recognition has reached a huge milestone to actually understand what the doctor writes?

You're misreading the article

[srmalloy]

Human pharmacists have always served as information resources for their customers, and even as a check on poorly-chosen prescriptions from doctors.

I can understand automating away the cashier or the janitor, but automating away a job where human judgment is so crucial is a terrible idea.

The problem is that pharmacies and patients don't use the same terms. When your doctor writes you a prescription, you take it to a pharmacy to get it filled. When the pharmacist takes your prescription script, they fill it and then dispense it to you.

When a pharmacy fills a prescription, what they are doing is to take the ordered quantity of the medication out of their stock and package it; when they dispense a prescription, they present it to the patient along with information about how and when to take it. Filling machines as described in the article don't take the place of a pharmacist -- they're taking the place of the pharmacy techs back inside the pharmacy who type up prescription labels, count out pills, and put them in prescription bottles. This means that the people working in the pharmacy don't have to take as much time preparing the prescription, and can spend more time with the patient.

Fill robots don't replace the pharmacist; what they do is eliminate the place where many medication mistakes occur -- selecting and measuring out the drug that the patient will receive. Drug manufacturers deliberately make pills and capsules with different shapes, colors, sizes and markings in order to help both the patients and the pharmacy staff tell them apart, but a pharmacy tech can still make a mistake and pick the wrong canister off the shelf when pulling a medication, and not notice that they've got the wrong little white pill, particularly when they've got lots of prescriptions to fill. A fill robot doesn't make that mistake; as long as the correct drug is in the correct hopper (and it's easier to make sure you've got the right drug when you're only touching the supply to put another 10,000 pills in the hopper, rather than for each of the 60-pill prescriptions that would be filled from that supply), the fill robot will always pick the correct drug.

And the situation is not as generally clear-cut as the article portrays. Where I work -- a major military hospital -- I am the manager for the pharmacy module of the medical information system at the hospital. The pharmacy has a large fill robot that processes refills; patients can either bring in a prescription for refill or use the phone- or web-based refill system to order their refills. Prescriptions entered for refill are processed by the main medical information system (checking to make sure that there are still refills available on that Rx, that the patient isn't trying to refill the Rx too soon, etc.), and then are sent to the fill robot, which fills and labels the refills, which are then distributed to the satellite pharmacies that the patients have selected to pick up their refills. The prescriptions don't need counselling or instructions, because the patient got those when they got the prescription initially.