Automation in Pharmacy: Strategies for Health System Success

Health-system pharmacies face mounting pressures from drug shortages, workforce constraints, regulatory demands, and growing patient volumes. At the same time, a new generation of pharmacy technologies—from robotic dispensing systems to artificial intelligence (AI)-assisted clinical decision support (CDS)—offers concrete pathways to safer and more efficient care. For pharmacy leaders, the challenge is no longer whether to adopt these tools but how to implement them strategically and sustainably.

This article outlines practical, actionable strategies that pharmacy directors, clinical pharmacists, and health-system administrators can use to evaluate, implement, and optimize automation technologies across inpatient and outpatient settings.

Conduct a Workflow-Centered Needs Assessment

Before selecting any technology platform, pharmacy leaders should conduct a systematic workflow assessment. This means mapping the full medication use process—from prescribing and verification through dispensing, administration, and reconciliation—and identifying where errors, delays, or redundancies are most prevalent.

Key questions to address during the assessment include:

• Where do verification bottlenecks most commonly occur, and at what time of day?
• What percentage of dispensing errors are attributed to manual processes versus system failures?
• Which pharmacy staff roles spend disproportionate time on non-clinical tasks?
• Are there medication classes (eg, high-alert medications, controlled substances) that carry elevated risk under current workflows?

Engaging frontline pharmacists and pharmacy technicians in this process is essential. These staff members have firsthand knowledge of daily friction points and are more likely to champion technology adoption when they have been part of the selection decision.

Prioritize High-Impact Automation Investments

Not all automation investments deliver equal returns. Pharmacy leaders should prioritize technologies with demonstrated evidence of reducing harm, improving throughput, or generating measurable cost savings. Several categories of automation have shown particular promise in health-system settings.

Automated Dispensing Cabinets

Automated dispensing cabinets (ADCs) have become standard in many health systems, but their full potential is often unrealized. Optimizing ADC formularies, integrating real-time inventory management, and aligning cabinet profiles with unit-specific clinical needs can reduce overrides, minimize diversion risk, and improve charge capture accuracy.

Regular audits of ADC override patterns are an underutilized strategy for identifying both safety gaps and optimization opportunities. Published data indicate that unresolved high override rates correlate with increased rates of controlled substance diversion in inpatient units.

Pharmacy Robotics and Intravenous Workflow Management

Centralized robotic dispensing and intravenous compounding systems can substantially reduce technician time on repetitive tasks while improving sterile compounding accuracy. Facilities deploying IV workflow management software—which uses gravimetric analysis and barcode verification during compounding—have reported meaningful reductions in compounding errors and improved compliance with United States Pharmacopeia (USP) General Chapter <797> standards.¹ For health systems that compound large volumes of hazardous drugs or parenteral nutrition, these tools represent both a patient safety and a regulatory compliance investment.

Clinical Decision Support Integrated with the Electronic Health Record

Modern CDS tools embedded within the electronic health record (EHR) enable pharmacists to intercept high-risk orders before they reach the dispensing queue; however, alert fatigue remains a significant barrier to CDS effectiveness. A practical strategy is to conduct an annual CDS alert review to retire low-yield alerts, recalibrate thresholds for drug–drug interactions, and implement tiered severity levels that reserve mandatory overrides for truly critical situations.²

Build an Infrastructure for Interoperability

Technology investments in isolation rarely achieve their full potential. The most impactful pharmacy automation programs are those in which systems communicate seamlessly with each other and with the broader health-system information technology environment. Pharmacy leaders should advocate for bidirectional integration between ADCs, robotic systems, the EHR, and pharmacy information systems.

When evaluating vendors, request detailed documentation of existing integration capabilities and reference contacts at comparable health systems. Pay particular attention to how each platform handles data exchange during EHR upgrades, which is a common source of integration failures that can disrupt operations for days or weeks.

Health systems participating in health information exchange networks have an additional opportunity. By integrating medication history data from external sources into admission reconciliation workflows, pharmacist time spent on manual history-taking can be reduced and accuracy for high-risk patient populations—such as those with complex polypharmacy—can be improved.

Invest in Training and Change Management

Even the most sophisticated automation platform will underperform without adequate training and a structured change management approach. Staff resistance to new technology is most often rooted not in reluctance to improve but in fear of workflow disruption, lack of confidence with the system, or insufficient involvement in the implementation process.

Recommended implementation practices include:

• Designate pharmacy technology champions among both pharmacists and technicians who receive advanced training and serve as peer resources during go-live.
• Develop role-specific training modules rather than a single 1-size-fits-all approach; verification workflows differ substantially between clinical pharmacists and technicians.
• Conduct simulation training using representative patient scenarios before going live in clinical environments.
• Establish a formal postimplementation review at 30, 60, and 90 days to identify unintended consequences and optimization opportunities.

Leadership visibility during implementation matters. Pharmacy directors and health-system chief medical officers who participate in training sessions and walk-arounds during go-live signal organizational commitment and provide staff with real-time channels to escalate concerns.

Measure What Matters: Defining Metrics for Success

Sustaining executive and board-level support for pharmacy automation requires demonstrating measurable value. Health-system pharmacy leaders should define outcome metrics before implementation and track them systematically after go-live. Metrics that resonate across clinical, operational, and financial stakeholders include:

• medication error rates (dispensing, compounding, and administration errors per 1000 orders);
• pharmacist time devoted to direct patient care versus dispensing activities
• ADC override rate and controlled substance diversion events;
• time from order verification to dispensing for urgent medications;
• compounding error rate and USP General Chapter <797> compliance audit results;
• and staff satisfaction scores related to workload and technology usability.

Presenting these metrics through a pharmacy quality dashboard—updated monthly and shared with hospital leadership—positions pharmacy as an accountable, data-driven service line rather than a cost center.

Conclusion

Technology and automation are not substitutes for clinical pharmacy expertise—they are amplifiers of it. When implemented thoughtfully, these tools free pharmacists from routine dispensing tasks and redirect their time toward high-value patient care activities: medication reconciliation, therapeutic monitoring, and collaborative practice with physicians and nurses.

Health-system pharmacy leaders who approach automation through the lens of workflow improvement, interoperability, team engagement, and outcome measurement will be best positioned to realize the clinical and operational benefits these technologies can deliver—and to build the internal case for continued investment.

REFERENCES

1. United States Pharmacopeia. USP General Chapter <797> Pharmaceutical Compounding—Sterile Preparations. Rockville, MD: USP; 2023.

2. Pedersen CA, Schneider PJ, Ganio MC, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: dispensing and administration—2020. Am J Health Syst Pharm. 2021;78(12):1074-1093. doi:10.1093/ajhp/zxab120