At the National Association of Chain Drug Stores Pharmacy and Technology Conference this past August, Pharmacy Times brought industry leaders together for a roundtable discussion on pharmacy automation. Panelists discussed the impact automation has already had on pharmacy and how an increased dependence on automation will affect the practice of pharmacy in the future.

Panelists felt that automation is no longer a luxury—it is a necessity in a demanding marketplace in which pharmacists struggle to keep pace with the rising volume of prescriptions. "If you look at the industry in general," said one panelist, "you have pressures to lower costs and at the same time pressures to add more services."

Although panelists loved the idea of what automated systems can do for their business, they said that choosing the right system for a particular pharmacy's needs is not simple. Panelists agreed that, when it comes to choosing an automated system, one size just does not fit all.

Vendors, panelists said, do a good job of providing the industry with choices and suitable ways of integrating different pieces of automation into the workflow. Yet panelists advised pharmacists to have a clear idea of how a system will be used and to choose a vendor with a strategic partnership in mind.

Automated pharmacy systems, panelists said, free pharmacists from mundane tasks and allow them to spend more time with patients. Panelists credited automation with introducing more standardization, process control, and checks and balances as well. Although automation also is credited with improving safety, panelists felt that pressure will increase on the industry to introduce standards to prevent potential cross-contamination.

The Panel

• Fred M. Eckel, RPh, MS, Moderator, Professor and Director, Office of Practice Development and Education, School of Pharmacy, University of North Carolina at Chapel Hill, and Editor-in-Chief of Pharmacy Times
• Michael E. Coughlin, President and Chief Executive Officer, ScriptPro
• Mark Gregory, Vice President, Pharmacy and Government Affairs, Kerr Drug Inc
• Vanessa A. Jacobsen, PharmD, Manager, Medication Use Evaluation, Walgreens Health Initiatives
• Pete Klein, Vice President, Industry Relations, Parata Systems
• Stephen Mitchell, MS, RPh, Vice President, Marketing, AutoMed Technologies Inc.
• Samuel L. Nebiolo, Director, Product Management, McKesson Automated Prescription Systems
• Jeff Newell, RPh, Chief Operating Officer, Rhode Island Quality Partners
• Dan Villa, RPh, Vice President, Corporate Development, Kinney Drug
• Bruce Wiswell, Director, Pharmacy Operations/Technology, Rite Aid

An Excerpt from the Discussion

Fred Eckel (FE): Why has so much attention been paid to automation of the dispensing operation in pharmacy?

Michael Coughlin (MC): Pharmacy is under a lot of economic pressure and is economically vulnerable today. Changing business models are pretty much a given in this industry, yet many of the challenges the industry faces are out of its control. Technology is one area the industry can control. And technology can do some pretty powerful things for pharmacy.

FE: As the number of prescriptions has grown, the number of pharmacists dispensing hasn't kept pace. Is that another reason why automation is coming into play?

Dan Villa (DV): It's also a quality-oflife issue for the pharmacist. The volumes were getting so high in the stores that pharmacists just couldn't keep up, even when a technician was added. Automation can take the pressure off and give them more time to spend with the patients, and that's what we're trying to do.

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

FE: What impact does automation have in the safety arena?

Jeff Newell (JN): Automated systems compound the ability to be safe each and every time a prescription is being dispensed.

Stephen Mitchell (SM): I think automation gives pharmacists the opportunity to introduce more standardization, more process control, more checks and balances, without extending the time it takes to introduce those new activities.

FE: Is providing a safer practice something pharmacists see as enhancing their practice?

SM: There are many facets to what you describe as safety. It could start right on the front end in transcription of the prescription. And again, if you can let the pharmacist have more time to interact and become a clinical expert, you can eliminate a lot of problems downstream.

JN: I think the need to avoid potential cross-contamination in robotic systems is absolutely a standard that ought to be established going forward, and I think there's going to be pressure to establish that.

FE: How much penetration has already occurred with dispensing automation?

SM: All of the other pharmacy practice settings had very specific and clearly obvious operational needs imposed on them (hospitals with unit-dose dispensing, long-term care with punch cards, mail order with just the sheer volume of transactions). Without automation, they would have been unable to move forward. The retail market is just beginning to appreciate the impact of automation and pharmacy efficiency on reimbursement and labor challenges as well as accuracy and profitability.

FE: So there's still real opportunity for growth.

MC: There is real pressure on pharmacy to get dispensing costs down to a level that's competitive in the industry. Pharmacy has to use technology to push back by being more efficient. Having integrated systems allows community pharmacists to work at a higher level. It also gives them a way to differentiate themselves in the marketplace.

FE: How do we justify newer automated dispensing devices in community pharmacy? Is it still about people replacement, or are there other ways that we're justifying this investment?

BW: I don't view it as saving labor. We're just trying to catch up. By the time you're getting that automated device in the store, the pharmacists are already in great need of that help. So we're only trying to gain the time back, for the pharmacists to get back to doing what they were really supposed to do.

SM: From a pure labor perspective, shifting the work from the expensive pharmacist to the more inexpensive technician is a big opportunity and something that drives a lot of the ROI [return on investment].

Samuel Nebiolo (SN): At the end of the day, you're not looking to replace people with automation. You're looking to make them more effective, so they give better services to the end user. You know, less wait times, better clinical reviews, and things like that. At the same time, you're lowering the cost of your prescriptions.

BW: Sometimes pharmacists become the limiting step. Pharmacists need to accept the technician and help the technician do the job. Then the pharmacists can get on with the business of doing the job they should be doing.

DV: In the last store I worked in, 12 years ago, I was pounding away on the keyboard, and this young technician said, "Would you please move down the counter?"When I asked why, she said, "I can type with all my fingers, and I'm very accurate, so if you move down to the end of the counter and check the prescriptions, we won't have people waiting here."So I moved. From that day forward, I really understood the value of technicians. They really drive the business.

FE: How do pharmacies begin evaluating automation systems?

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

MC: We found that pharmacists have been very willing to share their experiences and invite someone to come in and mentor them through the process. Vendors can also provide peer comparisons.

Pete Klein: One of the most important things is to have a vision of where you're going to be after automation is in place. You have to understand exactly what parts of your everyday life it's going to impact. And when that impact is realized, what are you going to do with that time? What's going to change, and do you have a plan in place?

FE: How are board regulations today impacting either positively or negatively in the whole automation dispensing process?

DV: The New York board looks at automation as an integral part of the profession of pharmacy. Boards know that automation really does 2 things: it gives the pharmacist time with the patient, and it provides quality control. So I think the boards are supportive.

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

DV: Graduating pharmacists have such a high knowledge level that the ability for them to really make a difference in the patients'lives is going to be great. And I think that if we can let automation and technicians do the filling and let the pharmacists manage the disease states, it's a great time to be a pharmacist.

JN: Pharmacists are going to have new tools, automation tools, physician order entry. That's going to provide more data, so they have to become almost organizational experts in the way to manage their environment. Down the road, I would hope that a high-level paraprofessional technician manages that whole mechanical function, and pharmacists almost run a business around pharmaceutical care. It's not just about the product any more.

SM: The vision of pharmacy has to be in cognitive services. It has to evolve into being viewed as an integral part of the health care team. The role of automation is to enhance techniques, provide better safety, provide flexibilities, provide better utilization of the resources pharmacists have to improve their cost containment. But I think automation also has to be very flexible, very integrated. It has to be adaptable to a variety of situations. It isn't one pharmacy and one solution that fits all. And that's a challenge for us.

SN: Market forces are present, and technology is coming into play more and more. We all need to view this not as a customer-vendor issue to resolve, but a partnership, in order to address these issues. It's a necessity for the vendors and us to get together and form that partnership to look at business solutions. We should not look at selling products and pieces, but look at solutions to provide these better healthcare services to the consumer market.

MC: Retail pharmacy is a business, it's a retail business. It's under a lot of stress right now, and that's likely to continue, because it's an important part of the health care system, and the health care system everywhere is under pressure. We have to equip retail pharmacies to operate with integrated business systems. Those systems need to transform community pharmacy into more of a profit-margin-producing engine. There are opportunities to produce not just volume, because volume without profit margin is no good. We've seen too much of that.

BW: The vendors are doing a great job of providing us with choices, suitable ways to integrate different pieces of automation into our workflows. I think it's up to us to learn to use them and to really take advantage of them and to take advantage of them at the appropriate times. And I think that's probably where retail might be most behind, in the appropriate timing of using what's available.

JN: When pharmacists want to automate, they need to make sure they're looking at their selection with a strategic partner in mind: where are they going, what do they want out of that relationship?

DV: Automation in the future is going to do a number of things for us. It's improving the quality of the product, and it's giving us time to spend with our customers. Customers know a lot about their medications, but they still come to us to ask for more information. If the pharmacist has more time to spend with the patients out in the OTC aisles, it brings in extra sales. So I think it's a great time for pharmacy.

Ms. Sax is a freelance writer based in Ridgewood, NJ.